Hospital-Acquired Diarrhea in Adults: A Prospective Case-Controlled Study in Mexico

1991 ◽  
Vol 12 (6) ◽  
pp. 349-355 ◽  
Author(s):  
Mussaret Zaidi ◽  
Samuel Ponce de Leon ◽  
Rosa Maria Ortiz ◽  
Sergio Ponce de Leon ◽  
Juan J. Calva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diarrheal Disease ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Controlled Study ◽  
General Internal ◽  
Nosocomial Diarrhea ◽  
Nasogastric Tubes ◽  
Potential Pathogen ◽  
Immunodeficiency Syndrome

AbstractObjective:To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults.Design:Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus.Setting:Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems.Patients:Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls.Results:Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p<.01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/Hz-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea.Conclusions:Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality, The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

2021 ◽  
Author(s):  
Tahmina Parvin ◽  
Elizabeth D. Thomas ◽  
Md. Sazzadul Islam Bhuyian ◽  
Ismat Minhaj Uddin ◽  
Md. Tasdik Hasan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drinking Water ◽  
Young Children ◽  
Diarrheal Disease ◽  
Fecal Contamination ◽  
Significant Risk ◽  
Sociodemographic Factors ◽  
Individual Level ◽  
Colony Forming Units ◽  
Slum Areas

We investigated the environmental and individual-level risk factors for diarrheal disease among young children in slum areas of Dhaka, Bangladesh. A prospective cohort study was conducted among 884 children under 5 years of age. Caregiver reports were collected on sociodemographic factors and hygiene behaviors. Diarrhea surveillance data was collected monthly based on caregiver-reported diarrhea for children in the past 2 weeks during the 12-month study period. Unannounced spot checks of the household compound were performed at 1, 3, 6, 9, and 12 months after enrollment to check for the presence of feces (animal or human) and the presence of animals in the child’s sleeping space, to assess child and caregiver hands for the presence of dirt, and to collect samples of the household’s source and stored drinking water. Children with feces found on the household compound during spot checks had a significantly higher odds of diarrhea (odds ratio: 1.71; 95% confidence interval: 1.23–2.38). Children residing in households with > 100 colony forming units/100 mL Escherichia coli in source drinking water had a significantly higher odds of diarrhea (OR: 1.43; 95% CI: 1.06–1.92). The presence of feces on the household compound and source drinking water with > 100 colony forming units/100 mL E. coli were significant risk factors for diarrheal disease for children < 5 years of age in slum areas of Dhaka, Bangladesh. These findings demonstrate the urgent need for comprehensive interventions to reduce fecal contamination on the household compound to protect the health of susceptible pediatric populations.

scholarly journals Selection of the optimal type of the stapler cassette for distal pancreas resection

2021 ◽  
pp. 85-91
Author(s):  
E.S. Drozdov ◽  
◽  
A.I. Baranov ◽  
D.A. Shkatov ◽  
S.S. Klokov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Controlled Study ◽  
Pancreatic Stump ◽  
Stump Closure ◽  
Distal Pancreas ◽  
The Difference ◽  
Parenchymal Thickness ◽  
Resection Area ◽  
Selection Of

Aim of study. Investigation of risk factors in development of postoperative pancreatic fi stula (POPF) in patients aft er distal pancreatectomy (DP) involving application of a cutting stapler device (CS) as well as determination of the criteria for selection of the optimal cassette type for such devices making it possible to reduce the POPF development frequency. Material and methods. A two-centre retrospective/prospective controlled study was performed. A total of 46 patients (19 (41.3 %) male and 27 (58.7 %) female) were enrolled. All patients included in the study underwent DP surgery using CS for excision of the pancreas with closure of its stump. In all cases, measurement of the pancreas thickness in the resection area based on the data of preoperative computed tomography and calculation of the difference between the pancreatic parenchymal thickness in the resection area and the staple closure height (SCH). Th e patients were distributed between two groups: 1) without POPF of with biochemical leakage (BL); 2) with clinically relevant POPF (CR-POPF). Results. CR-POPF developed in 15 (32.6 %) cases (type-B POPF: 14 (93.3 %) cases, type-С: 1 (6.7 %) case). Statistically signifi cant diff erence in mean pancreatic parenchymal thickness in the resection area as well as mean SCH between the group without POPF or with BL and the group with CR-POPF (15.4±4.3mm versus 12.3±3.5mm, р=0.01 and 12.8±2.3mm versus 16.4±3.1mm, р<0.01, respectively). Th e frequency of CR-POPF development was reliably lower at the SCH varying from 8 to 14mm (9.5 %) as compared to cases with SCH below 8mm (55.6 %, p<0.01) and above 14mm (50.0 %, p<0.01). Conclusion. Upon analysis of risk factors in POPF development aft er DP, it has been established that a greater pancreatic parenchymal thickness in the resection area as well as SCH are statistically significant risk factors for this complication. Th e optimal SCH making it possible to achieve the minimal frequency of POPF aft er pancreatic stump closure using a CS is within the range of 8-14mm.

Prevalence of Human Immunodeficiency Virus Seropositivity in Pediatric Emergency Room Patients Undergoing Phlebotomy

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 660-665
Author(s):  
Paula J. Schweich ◽  
Patricia D. Fosarelli ◽  
Anne K. Duggan ◽  
Thomas C. Quinn ◽  
James L. Baker
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Health Care Workers ◽  
Significant Risk ◽  
Hiv Seropositivity ◽  
Blood Samples ◽  
Care Workers ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Information on the prevalence of human immunodeficiency virus (HIV) infection among children and adolescents requiring medical care is sparse. A small but significant risk of seroconversion occurs in health care workers who handle blood and body fluids of patients infected with HIV. The prevalence of HIV seropositivity in children who had phlebotomy as part of emergency care was measured. Of 749 blood samples, 21 (2.8%) tested positive for HIV antibody by enzyme-linked immunosorbent assay and Western Blot analysis: 14 samples from 6 patients with hemophilia, 6 from 3 patients with acquired immunodeficiency syndrome/acquired immunodeficiency syndrome-related complex, and 1 from a patient with asthma. Of these 21 blood samples, 10 were from 4 children previously known to be HIV positive, 4 were from patients with a known parental risk factor, and 16 were from patients with known history of blood transfusion. One sample was from a children with unknown HIV status and no documented risk factors. Procedures included 9 venipunctures, 17 intravenous line placements, 1 lumbar puncture, and 1 pelvic examination. Most patients with HIV seropositivity had been known to be HIV seropositive or at significant risk for HIV seropositivity. Although the potential risk to health care workers from children without known risk factors for HIV seropositivity was small in this population, the currently recommended infection-control precautions should always be observed.

scholarly journals 2430. Comorbidity and Severity of Illness Risk Adjustment for Hospital-Onset Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S840-S840
Author(s):  
Stephanie Cabral ◽  
Gita Nadimpalli ◽  
Kerri Thom ◽  
Surbhi Leekha ◽  
Lisa Harris ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Eligible Patient ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Significant Risk Factor ◽  
Patient Admissions ◽  
Increased Risk ◽  
Binomial Regression

Abstract Background Hospital-onset C. difficile infection (HO-CDI) rates are publicly reported. However, patient-level risk factors are not included in the current risk adjustment methodology, and the knowledge as to which risk factors to include is incomplete. This study aimed to determine whether electronically-available comorbidities and laboratory indicators of severity of illness are risk factors for HO-CDI. Methods We performed a retrospective cohort study of all adult patients admitted to three hospitals (one academic, two community) in Baltimore, Maryland between January 1, 2016 and January 1, 2018. Information extracted from electronic medical records included demographics, ICD-10 codes, laboratory results within 24 hours of admission (i.e., hematocrit, hemoglobin, platelet count, leukocytes, BUN, CO2, creatinine, glucose, sodium, and potassium), medication administration (i.e., antibiotic and antacid use), and C. difficile test result. Comorbid conditions were assessed by the Elixhauser Comorbidity Index components. HO-CDI was defined by positive laboratory test > 3 days after admission. Potential risk factors for HO-CDI were assessed using bivariate log binomial regression. Multivariable log binomial regression was conducted using significant (P < 0.1) covariates. Results At hospital 1 (academic), 314 of the 48,057 (0.65%) eligible patient admissions had HO- CDI; 41 of the 8,791 (0.47%) and 75 of the 29,211 (0.26%) of patient admissions at community hospitals 2 and 3, respectively, had HO-CDI. In multivariable analysis, Elixhauser Score was a significant risk factor for HO-CDI at all hospitals when controlling for antibiotic and antacid use; for every one-point increase in Elixhauser Score, there was an increased risk of HO-CDI of 1.27 (95% CI: 1.21, 1.32) at hospital 1, 1.38 (95% CI: 1.24, 1.54) at hospital 2, and 1.28 (95% CI: 1.10, 1.31) at hospital 3. Table 1 shows significant risk factors for HO-CDI for each hospital. When individual comorbidities were assessed in the regression analysis, fluid and electrolyte disorders were a significant risk factor for HO-CDI for all hospitals. Conclusion Laboratory values upon admission and electronically available patient comorbidities are important risk factors for HO-CDI and should be considered for future risk adjustment. Disclosures All authors: No reported disclosures.

scholarly journals Risk factors for delirium among hospitalized patients in Zambia

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249097
Author(s):  
Justin K. Banerdt ◽  
Kondwelani Mateyo ◽  
Yan Yan ◽  
Dandan Liu ◽  
Yi Zuo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Hospitalized Patients ◽  
University Teaching ◽  
Middle Income ◽  
History Of ◽  
The University

Objective To identify risk factors for delirium among hospitalized patients in Zambia. Methods We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. We report associations of exposures including sociodemographic and clinical factors with delirium over the first three days of hospital admission, assessed using a modified Brief Confusion Assessment Method (bCAM). Findings 749 patients were included for analysis (mean age, 42.9 years; 64.8% men; 47.3% with HIV). In individual regression analyses of potential delirium risk factors adjusted for age, sex and education, factors significantly associated with delirium included being divorced/widowed (OR 1.64, 95% CI 1.09–2.47), lowest tercile income (OR 1.58, 95% CI 1.04–2.40), informal employment (OR 1.97, 95% CI 1.25–3.15), untreated HIV infection (OR 2.18, 95% CI 1.21–4.06), unknown HIV status (OR 2.90, 95% CI 1.47–6.16), history of stroke (OR 2.70, 95% CI 1.15–7.19), depression/anxiety (OR 1.52, 95% CI 1.08–2.14), alcohol overuse (OR 1.96, 95% CI 1.39–2.79), sedatives ordered on admission (OR 3.77, 95% CI 1.70–9.54), severity of illness (OR 2.00, 95% CI 1.82–2.22), neurological (OR 7.66, 95% CI 4.90–12.24) and pulmonary-system admission diagnoses (OR 1.91, 95% CI 1.29–2.85), and sepsis (OR 2.44, 95% CI 1.51–4.08). After combining significant risk factors into a multivariable regression analysis, severity of illness, history of stroke, and being divorced/widowed remained predictive of delirium (p<0.05). Conclusion Among hospitalized adults at a national referral hospital in Zambia, severity of illness, history of stroke, and being divorced/widowed were independently predictive of delirium. Extension of this work will inform future efforts to prevent, detect, and manage delirium in low- and middle-income countries.

scholarly journals Determinants of Dehydration Status and Associated Risk Factors of Cholera Outbreak in Oromia, Ethiopia

2020 ◽  
Author(s):  
Endale Alemayehu Ali ◽  
Tsigereda Tilahun ◽  
Eshetu Mebrate
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Diarrheal Disease ◽  
Significant Risk ◽  
Case Fatality ◽  
Ordinal Logistic Regression ◽  
Annual Number ◽  
P Value ◽  
Cholera Outbreak ◽  
History Of

Abstract Introductions: Cholera is a diarrheal disease caused by infection of the intestine with the gram-negative bacteria Vibrio cholera. According to updated global burden of cholera estimate 2019 in Ethiopia 68,805,272 populations are at risk of cholera with incidence rate of 4 per 1000 population and case fatality of 3.8% estimated annual number of cases 275,221.Methods: The main objective of this study is to identify the significant risk factors of dehydration status of cholera outbreak in Oromia regional state of Ethiopia. Ordinal logistic regression was used to model the data by incorporating the assumption behind this novel model. Results: The results of the study indicated that of the total 965 cholera patients, most of them 560(58%) were severely dehydrated by cholera. The overall goodness of model (p-valu=0.07) shows that the model fits the data well. Besides, the proportional odds assumption also revealed that the slop coefficients in the model are the same across dehydration status (p-value=0.094). For those have history of travel, the odds of severely dehydrated versus the combined some dehydrated and no dehydrated was exp(1.133804)=3.11 times higher than those have no history of travel (p-value<0.01). All the other factors like history of contact with other patients, other sick patients in the family, Intravenous and Antibiotics drugs are statistically significant with 5% level of significance to determine the status of dehydration. Conclusions: The ordinal logistic regression was fitted the data well and most of the included factors were significant for the dehydration status of cholera outbreak.

Hypernatremic Dehydration Risk Factors in Newborns: Prospective Case-Controlled Study

2021 ◽  
Vol 233 (04) ◽  
pp. 194-199
Author(s):  
Kiymet Celik ◽  
Aylin Ozbek ◽  
Ozgur Olukman ◽  
Figen Isleten ◽  
Sebnem Calkavur
Keyword(s):  
Risk Factors ◽  
Breast Milk ◽  
Demographic Data ◽  
Significant Risk ◽  
Depression Scale ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Breastfeeding Support ◽  
Hypernatremic Dehydration

Abstract Background The prevalence of hypernatremic dehydration (HND) has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. This study aimed to investigate risk factors of HND. Methods In this study, 47 neonates whom were diagnosed to have HND were included in the study group and 96 healty neonates whom were included in the control group. While demographic data of the patients were recorded, mothers were asked to fill out the sociodemographic/ psychosocial data form, Edinburgh Postpartum Depression Scale(EPDS) and STAI I and II State and Trait Anxiety Scale. Breast milk sodium concentrations were studied from mothers of all infants. The relationship between the development of neonatal HND and risk factors affecting this condition were evaluated. Results Being the first-born baby of the family was found to be a significant risk factor for HND. Breast milk sodium concentration was 25.8±7.9 mmol/L in the HND group which was significantly higher than the control group. Median depression score was similar in both groups and there was no statistical difference in terms of groups. The anxiety score was higher in the control group compared to the study group. There was no difference in terms of other sociodemographic / psychosocial data of mothers. Conclusion Primiparity or insufficient breastfeeding may result in elevated breast milk sodium levels and related neonatal HND. Breastfeeding support should principally target primiparous women to improve breastfeeding outcomes like as especially HND.

scholarly journals Determinants of dehydration status and associated risk factors of cholera outbreak in Oromia, Ethiopia

2020 ◽  
Author(s):  
Endale Alemayehu Ali ◽  
Tsigereda Tilahun ◽  
Eshetu Mebrate
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Diarrheal Disease ◽  
Significant Risk ◽  
Case Fatality ◽  
Ordinal Logistic Regression ◽  
Annual Number ◽  
P Value ◽  
Cholera Outbreak ◽  
History Of

Abstract Introductions: Cholera is a diarrheal disease caused by infection of the intestine with the gram-negative bacteria Vibrio cholera. According to updated global burden of cholera estimate 2018 in Ethiopia 68,805,272 populations are at risk of cholera with incidence rate of 4 per 1000 population and case fatality of 3.8% estimated annual number of cases 275,221.Methods: The main objective of this study is to identify the significant risk factors of dehydration status of cholera outbreak in Oromia regional state of Ethiopia. Ordinal logistic regression was used to model the data by incorporating the assumption behind this novel model. Results: The results of the study indicated that of the total 965 cholera patients, most of them 560(58%) were severely dehydrated by cholera. The overall goodness of model (p-valu=0.07) shows that the model fits the data well. Besides, the proportional odds assumption also revealed that the slop coefficients in the model are the same across dehydration status (p-value=0.094). For those have history of travel, the odds of severely dehydrated versus the combined some dehydrated and no dehydrated was exp(1.133804)=3.11 times higher than those have no history of travel (p-value<0.01). All the other factors like history of contact with other patients, other sick patients in the family, Intravenous and Antibiotics drugs are statistically significant with 5% level of significance to determine the status of dehydration. Conclusions: The ordinal logistic regression was fitted the data well and most of the included factors were significant for the dehydration status of cholera outbreak.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

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