scholarly journals Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot (‘BA-TOF’ Score): Results of a Case–Control Study and Implications for Community Surveillance

2021 ◽  
Author(s):  
Vidyasagar Kanneganti ◽  
Sumit Thakar ◽  
Saritha Aryan ◽  
Prayaag Kini ◽  
Dilip Mohan ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Brain Abscess ◽  
Predictive Value ◽  
Case Control Study ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
Case Control ◽  
Retrospective Case ◽  
Neutrophil Lymphocyte Ratio ◽  
Control Study

Abstract Background Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF). Methods From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case–control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA. Statistical Analysis Variables demonstrating significant bivariate correlations with the presence of a CBA were further analyzed using multivariate logistic regression (LR) analysis. Various LR models were tested for their predictive value, and the best model was then validated on a hold-out dataset of 25 patients. Results Among the 26 variables tested for bivariate associations with the presence of a CBA, some of the clinical, echocardiographic, and laboratory variables demonstrated significant correlations (p < 0.05). LR analysis revealed elevated neutrophil–lymphocyte ratio and erythrocyte sedimentation rate values and a lower age-adjusted resting heart rate percentile to be the strongest independent biomarkers of a CBA. The LR model was statistically significant, (χ2 = 23.72, p = <0.001), and it fitted the data well. It explained 53% (Nagelkerke R 2) of the variance in occurrence of a CBA, and correctly classified 83.93% of cases. The model demonstrated a good predictive value (area under the curve: 0.80) on validation analysis. Conclusions This study has identified simple clinical and laboratory parameters that can serve as reliable pointers of a CBA in patients with TOF. A scoring model—the ‘BA-TOF’ score—that predicts the occurrence of a CBA has been proposed. Patients with higher scores on the proposed model should be referred urgently for a CT confirmation of the diagnosis. Usage of such a diagnostic aid in resource-limited settings can optimize the pickup rates of a CBA and potentially improve outcomes.

scholarly journals Diagnostic Utility of Procalcitonin and Neutrophil-Lymphocyte Ratio in Bacterial Septicaemia - A Retrospective Case Control Study from a Tertiary Care Institute

2020 ◽  
Vol 7 (48) ◽  
pp. 2856-2861
Author(s):  
Mamatha T. Shenoy ◽  
Hariharan Alexander ◽  
Jeyakumar Manavalan ◽  
Suganthy K ◽  
Pradipta Kumar Mohanty
Keyword(s):  
Blood Culture ◽  
Case Control Study ◽  
Tertiary Care ◽  
Cost Effective ◽  
Case Control ◽  
Retrospective Case ◽  
Gram Negative ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Control Study

BACKGROUND Sepsis is a frequently encountered critical care problem wherein great emphasis is laid on early and accurate diagnosis of the infective organism. Blood culture though precise, is time consuming. Empiric antibiotic therapy leads to development of antibiotic resistance amongst organisms. Thus, there is a need for a biomarker that is cost effective, simple and rapid to perform. Procalcitonin elevates in response to chemical mediators produced due to bacteraemia within 2 - 4 hours and serves as an early marker. Neutrophil-Lymphocyte Ratio is available universally and is highly cost-effective. We wanted to assess the utility of Procalcitonin (PCT) and Neutrophil-Lymphocyte Ratio (NLR) in detecting the bloodstream infections and determine their usefulness in establishing the nature of infective organisms. METHODS A retrospective case control study was undertaken from January 2018 to December 2018 in a tertiary care teaching hospital in Madurai, Tamil Nadu. Patients tested for serum PCT, complete blood count and blood culture simultaneously prior to antibiotic therapy were included in the study (n = 288). The study cohort was classified into two groups. Group I, controls (n = 155) and group II, cases (n = 133). Out of 133 patients, 73 % (98) were infected by Gramnegative bacteria and 27 % (35) by Gram-positive bacteria. Data was analysed using SPSS V.16 software (SPSS Inc., Chicago, IL, USA). Students unpaired t test and Mann-Whitney U test were used for intergroup comparisons of continuous variables. p < 0.05 was considered to be statistically significant. Cut off for detecting bacteriemia and gram negative bacteriemia was created using Receiver Operating Characteristic (ROC) curve. RESULTS The area under ROC of PCT to detect gram negative bacteraemia was 0.752 (95 % CI = 0.692 – 0.812). CONCLUSIONS Escherichia coli was the most frequent cause of sepsis. Higher levels of PCT and NLR were associated with gram negative organisms. PCT levels can help in determining the cause of infection. NLR and PCT are able to establish the presence of bacteraemia in a short span of time, thus alleviating the over dependence on blood culture reporting. Such earlier decision-making tools help in reducing empirical antibiotic usage and thereby lessen the burden of bacterial resistance to antibiotics. KEYWORDS Procalcitonin, PCT, Neutrophil Lymphocyte Ratio, NLR, Gram Negative Bacteria, Sepsis, Biomarker

scholarly journals Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Huseyin Bilgin ◽  
Murat Haliloglu ◽  
Ali Yaman ◽  
Pinar Ay ◽  
Beliz Bilgili ◽  
...  
Keyword(s):  
Predictive Value ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Pentraxin 3 ◽  
Surgical Intensive Care ◽  
Nested Case Control ◽  
Control Study

Purpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p<0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

scholarly journals High Prevalence of Hypocalcemia in Non-severe COVID-19 Patients: A Retrospective Case-Control Study

2021 ◽  
Vol 7 ◽  
Author(s):  
Rimesh Pal ◽  
Sant Ram ◽  
Deepy Zohmangaihi ◽  
Indranil Biswas ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Case Control Study ◽  
Healthy Adult ◽  
Tertiary Care ◽  
Case Control ◽  
Retrospective Case ◽  
Hydroxyvitamin D ◽  
Number Of Patients ◽  
25 Hydroxyvitamin D ◽  
Control Study

Purpose: To compare serum total calcium and phosphate levels in patients with non-severe COVID-19 with age, sex, and serum 25-hydroxyvitamin D level matched healthy adult cohort.Methods: In this retrospective case-control study, medical records of patients (≥18 years) diagnosed as non-severe COVID-19 admitted at and discharged from our tertiary care institution during the period from April 10, 2020 and June 20, 2020 were retrieved. Baseline investigations, notably, serum calcium, phosphate, albumin, magnesium, 25-hydroxyvitamin D, and C-reactive protein (CRP), were performed at admission before any form of calcium or vitamin D supplementation were considered. The biochemical parameters were compared with age, sex, and 25-hydroxyvitamin D matched healthy adult controls (1:1 ratio) derived from the Chandigarh Urban Bone Epidemiological Study (CUBES).Results: After exclusion, 72 patients with non-severe COVID-19 (63 mild and 9 moderate disease) and an equal number of healthy controls were included in the final analysis. Age, sex, serum 25-hydroxyvitamin D, and albumin levels were matched between the 2 groups. Hypovitaminosis D and hypocalcemia were seen in 97 and 67% of the patients, respectively. The patients had lower serum calcium (P value &lt;0.001) and phosphate (P = 0.007) compared with the controls. There was no statistically significant correlation between serum calcium and CRP.Conclusions: Hypocalcemia is highly prevalent even in COVID-19 patients with non-severe disease probably implying that hypocalcemia is intrinsic to the disease. Prospective studies with larger number of patients are required to prove this hypothesis and unravel the underlying pathophysiological mechanisms.

scholarly journals Epidemiology and Comorbidities of Excoriation Disorder: A Retrospective Case-Control Study

2020 ◽  
Vol 9 (9) ◽  
pp. 2703
Author(s):  
Christina Kwon ◽  
Nishadh Sutaria ◽  
Raveena Khanna ◽  
Erik Almazan ◽  
Kyle Williams ◽  
...  
Keyword(s):  
Case Control Study ◽  
Care Center ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Case Control ◽  
Post Traumatic Stress ◽  
Retrospective Case ◽  
Compulsive Disorder ◽  
Excoriation Disorder ◽  
Control Study

Excoriation disorder is a psychocutaneous disorder characterized by repetitive skin-picking and associated with significant morbidity. Currently, epidemiological data in patients with excoriation disorder are lacking so we sought to characterize common patient demographics and comorbidities. We conducted a retrospective case-control study comparing 250 patients with excoriation disorder with 250 age-, race- and sex-matched controls identified between 2007 and 2019 at a single tertiary care center. We found that the majority of excoriation disorder patients were female (76%), Caucasian (82%) and unmarried (62%), with a mean age of 49 years. Compared to the matched controls, patients with excoriation disorder had increased odds of several psychiatric illnesses, including obsessive compulsive disorder (odds ratio (OR) 28.48, 95% confidence interval (CI): 1.68, 481.75), substance use disorder (OR 24.33, 95% CI: 5.81, 101.77), post-traumatic stress disorder (OR 8.23, 95% CI: 2.24, 129.40), depression (OR 8.19, 95% CI: 4.86, 13.80), bipolar disorder (OR 7.55, 95% CI: 2.22, 25.65), attention-deficit/hyperactivity disorder (OR 5.63, 95% CI: 1.62, 19.57), and anxiety (OR 5.01, 95% CI: 2.92, 8.62). Only a minority (42%) of patients were given psychiatry referrals and of those referred, a majority (64%) did not follow-up with psychiatry. The outcomes were also generally unfavorable as only 21% of patients experienced a resolution or improvement in their symptoms. This highlights the need for a multidisciplinary approach to manage patients with excoriation disorder, involving both dermatologists and psychiatrists.

scholarly journals Optimal Time Intervals for Vaginal Breech Births: A Case-Control Study

2021 ◽  
Author(s):  
Emma Spillane ◽  
Shawn Walker ◽  
Christine McCourt
Keyword(s):  
Predictive Value ◽  
Case Control Study ◽  
Algorithm Design ◽  
Population Sample ◽  
Case Control ◽  
Optimal Time ◽  
Retrospective Case ◽  
Second Stage Of Labour ◽  
Breech Birth ◽  
Control Study

Objective: To test the predictive value of the Physiological Breech Birth Algorithm. Design: Retrospective case-control study Setting: Teaching Hospital, United Kingdom Population/sample: Cases were all vaginal breech births >37 weeks’ gestation where neonatal admission or death occurred between April 2012 and April 2020. Controls were the two term breech births without admission immediately prior to the cases. Methods: Data was collected from intrapartum care records and analysed using SPSS v26 statistical software. The chi-square test was used to determine association between exposure to the variables of interest and admission to the neonatal unit. Multiple logistic regression was used to test the predictive value of delays defined as non-adherence to the Algorithm. Main outcome measures: Intervals between the start of labour, the start of second stage of labour and various stages of emergence (presenting part, buttocks, pelvis, arms, head). Results: Logistic regressing modelling using the Algorithm time frames had an 84.2% accuracy, a sensitivity of 66.7% and a specificity of 92.3%. Delays between umbilicus and head >3 minutes (OR: 9.508 [95% CI: 1.390-65.046] p=0.022) and from buttocks on the perineum to head >7 minutes (OR: 6.682 [95% CI: 0.940-41.990] p=0.058) showed the most effect. Lengths of time until the first intervention were also longer among the cases, suggesting that at least some of this delay is modifiable. Conclusions: Improved recognition of delay and efficient assistance may help improve vaginal breech birth outcomes. Further research should determine whether training based on the Physiological Breech Birth Algorithm can reduce neonatal admissions.

scholarly journals A case–control study of human immunodeficiency virus-negative patients with cryptococcemia and cryptococcal meningitis in a Chinese tertiary care hospital during 10 years

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098465
Author(s):  
Liling Liang ◽  
Zhixin Liang ◽  
Danyang She ◽  
Liang’an Chen
Keyword(s):  
Human Immunodeficiency Virus ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Care Hospital ◽  
Retrospective Case ◽  
Immunodeficiency Virus ◽  
Control Study

Objective This study aimed to characterize patients with cryptococcemia and compare the clinical features of cryptococcemia and cryptococcal meningitis. Methods This was a retrospective, case–control study. We retrospectively identified blood cultures with Cryptococcus spp. growth. Controls were hospitalized patients who suffered from cryptococcal meningitis, but did not experience cryptococcemia. Controls and cases were matched by admission date, age, sex, and body weight. Clinical information was analyzed by two independent reviewers. Results Eight patients with cryptococcemia and eight patients with cryptococcal meningitis were included. They were all negative for human immunodeficiency virus. The most common underlying disease was primary nephrotic syndrome. All patients presented with fever. The incidence of headache, nausea/vomiting, seizures, and cough/expectoration was significantly lower in patients with cryptococcemia than in those with cryptococcal meningitis. All clinical strains of Cryptococcus, except for one, were sensitive to fluconazole, voriconazole, itraconazole, amphotericin B, and flucytosine in vitro. The rate of receiving an amphotericin B-containing regimen was significantly higher in patients with cryptococcal meningitis than in those with cryptococcemia. In-hospital mortality was significantly higher in cryptococcemia cases compared with cryptococcal meningitis cases. Conclusion Cryptococcemia is an unusual infection characterized by a high mortality. Cryptococcemia requires early identification and prompt antifungal therapy.

Sign in / Sign up

Export Citation Format

Share Document