scholarly journals The impact of establishing a regional infective endocarditis (IE) network on pre-operative IE-related complications and on post-operative outcome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Diab ◽  
M Franz ◽  
S Hagel ◽  
A Guenther ◽  
A Struve ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Chi Square ◽  
Exact Test ◽  
Logistic Regression Models ◽  
European Guidelines ◽  
Management Recommendations ◽  
The Impact

Abstract Background Infective endocarditis (IE) requires a high degree of suspicion and advanced level of multidisciplinary management. In 2015, the European guidelines recommended the formation of an endocarditis-team (ET) for optimal treatment of IE. In 2011, we already established an ET within the hospital that was only consulted on demand for certain patients. Since 2015, ET has been increasingly involved in the management of almost all patients with IE. In addition, we established in 2015 a statewide endocarditis- (E) network for the referring hospitals. Purpose We investigated the effect of E-network on reducing referral latency and pre-operative IE-related complications. We also investigated the adherence to the ET management recommendations in our hospital and its impact on post-operative stroke and mortality. Methods We retrospectively analyzed data from patients operated for IE in our center between 01/2007 and 03/2018. We conducted univariate analysis using Chi-square or Fisher's exact test, Multivariate logistic regression models for in-hospital mortality and post-operative stroke, and Kaplan-Meier estimate of 5-years survival. Results Among 630 patients operated for IE in our center, 409 (65%) underwent surgery in the 1st era before 12/2014. S. aureus IE was more frequent in the second era (34% vs 25%, p<0.001). The median time from the onset of symptoms to referral in the 2nd era was halved compared to the first one [7 days (IQR 2–19) vs 15 days (IQR 6–35)]. Patients in the 2nd era were admitted with less IE-related complications, i.e. less preoperative stroke (14% vs 27%, p<0.001), less heart failure (45% vs 69%, p<0.001) less cardiac abscesses (24% vs 34%, p=0.018), less acute renal insufficiency requiring hemodialysis (8% vs 14%, p=0.026). The lack of ET management recommendations was an independent predictor for in-hospital mortality (adjusted OR: 2.13, 95% CI: 1.27–3.53, p=0.004) and post-operative stroke (adjusted OR: 2.23, 95% CI: 1.12–4.39, p=0.02), and was associated with worse 5-years survival (59% compared to 40%, log rank<0.001). Conclusion Endocarditis-network led to earlier referral of patients, which resulted in less IE-related complications on admission. Lack of ET management recommendations was an independent predictor for post-operative stroke, in-hospital mortality and was associated with worse 5-years survival. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Ecoepidemiological approach in an urban community: environmental factors associated with injuries in humans caused by bats

2019 ◽  
Vol 13 (11) ◽  
pp. 1045-1051
Author(s):  
Norlan Jesus Santos ◽  
Ianei Carneiro ◽  
Aroldo Borges ◽  
Elen Paz ◽  
Ricardo Lustosa ◽  
...  
Keyword(s):  
Urban Community ◽  
Univariate Analysis ◽  
Chi Square ◽  
Final Model ◽  
Exact Test ◽  
Logistic Regression Models ◽  
Historic Center ◽  
Historical Series ◽  
Forested Areas ◽  
Official Records

Introduction: The intense urbanization process has resulted in the reduction of forested areas, which poses an additional risk to public health. The aim of this study was to identify environmental variables in an urban community associated with the chances of injuries (bites/scratches) in humans caused by bats. Methodology: The study community was the Historic Center District of Salvador, Bahia, Brazil. The cases were the official records of households that reported injuries in humans caused by bats along the historical series from 2012 to 2015. Controls were selected from households near the cases without records of injuries involving bats. Univariate analysis was performed for the data using the chi-square and Fisher's exact test. Significant variables (p < 0.05) were included in the logistic regression models. Results: The variable for bats having access to households via defective/broken windows showed an association with the cases in the final model (OR = 45.14, CI = 6.08-335.10). The variables presence of domiciled dogs (OR = 6.04, CI = 1.44-25.92) and exposed fruit (OR = 4.41, CI 95% = 1.15-16.9) were significant factors. Conclusion: The results shows that access to the residence and supply of food that can be used by bats are factors that increase the chances of injuries in humans caused by these animals possibly increasing the risk of infectious diseases.

Abstract 3775: Average Blood Glucose and Mortality in Patients Hospitalized with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mikhail Kosiborod ◽  
Silvio Inzucchi ◽  
Harlan M Krumholz ◽  
Lan Xiao ◽  
Phillip G Jones ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Hospital Mortality ◽  
Regression Models ◽  
Independent Predictor ◽  
Laboratory Data ◽  
Logistic Regression Models ◽  
Average Blood Glucose ◽  
The Relationship ◽  
Multivariable Adjustment ◽  
Better Than

Background: Elevated blood glucose (BG) on admission is associated with higher mortality risk in patients (pts) hospitalized with AMI. However, the prognostic value of average BG, which reflects overall glycemic exposure much better than admission BG, is unknown. Furthermore, the nature of the relationship between average BG and mortality has not been determined. Methods: We evaluated a cohort of 16,871 AMI pts hospitalized from January 2000-December 2005, using Cerner Corporation’s Health Facts® database from 40 hospitals, which contains demographics, clinical and comprehensive laboratory data. Logistic regression models evaluated the nature of the relationship between mean BG during the entire AMI hospitalization and in-hospital mortality, after adjusting for multiple patient factors and confounders. Similar analyses were performed in subgroups of pts with and without diabetes (DM). Results: A J-shaped relationship was observed between mean BG and in-hospital mortality, which persisted after multivariable adjustment (Figure ). Mortality increased with each 10 mg/dL incremental rise in mean BG over >120 mg/dL, and with incremental decline in mean BG <80 mg/dL. The slope of these relationships was much steeper in pts without DM. Conclusions: Average BG during the entire AMI hospitalization is a powerful independent predictor of in-hospital mortality. Both persistent hyper- and hypoglycemia are associated with adverse prognosis. Whether strategies directed at optimizing BG control will improve survival remains to be established. Association Between Mean BG and In-Hospital Mortality After Multivariable Adjustment (Reference: Mean BG 100 to <110)

scholarly journals The Relationship of Waste Management With The Incidence Of Diarrhea In Argasunya Village Cirebon City

2018 ◽  
Vol 5 (1) ◽  
pp. 16-22
Author(s):  
Jaenudin ◽  
Sandi Aprianto ◽  
Citra Setyo Dwi Andini
Keyword(s):  
Waste Management ◽  
Univariate Analysis ◽  
P Value ◽  
Chi Square ◽  
The Status ◽  
Diarrhea Incidence ◽  
Chi Square Test ◽  
Relationship Of ◽  
The Impact ◽  
The Relationship

Background: Garbage is something material or solid objects that is no used by humans. The impact or risk of improper handling of garbage can cause to environmental damages that can cause health problems and disesase, one of them is diarrhea disease. According to the health profile of West Java Province (2012) showed that the 1.906.886 diarrhea incidence. Cirebon City is ranked ninth with 88,702 diarrhea incidence. Purpose: The purpose of this research is to know the relationship of waste management with the incidence of diarrhea In Argasunya Village Cirebon City. Method: This research used descriptive correlation with kohort retrospekif approach. The population in this study that is all the people who suffer from diarrhea in the Argasunya Village with 72 respondents. The sample in this study using total sampling with 72 respondents who suffer from diarrhea. The research instrument used the observation sheet of waste management and the result of the status of the patient according the medical record data in Sitopeng Public Health Center. The analysis used univariate and bivariate used Chi Square test. Result: The result of univariate analysis showed that most of the waste management did not fulfill the requirement of 59 respondents (81,9%) and most of the acute diarrhea was 62 respondents (86,1%). There was no significant relationship of waste management with the incidence of diarrhea In Argasunya Village Cirebon City, p-value = 0,677.

Abstract P122: The Impact of Center Certification Status on Acute Stroke Care Within a Multi-Hospital System in Western United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Radoslav I Raychev ◽  
CrystalAnn Moreno ◽  
Leslie Corless ◽  
Jason W Tarpley ◽  
John F Zurasky ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Outcome ◽  
Regression Models ◽  
Process Of Care ◽  
Chi Square ◽  
Hospital System ◽  
Logistic Regression Models ◽  
Stroke Center ◽  
The Impact ◽  
Iv Tpa

Introduction: We aimed to investigate the impact of certification status on process of care metrics and clinical outcome in a large multi-center hospital system. Methods: We analyzed data obtained from the Providence Stroke Registry between January 2016 and December 2019. Key process of care metrics and clinical outcome were compared among patients with a discharge diagnosis of stroke and stratified based on site certification: comprehensive stroke center (CSC), thrombectomy-capable stroke center (TSC), primary stroke center (PSC) and no certification (NC). Donner’s adjusted chi-square tests were used to compare proportions for each metric grouped by certification. Generalized linear mixed effects logistic regression models were used to adjust for mode of patient arrival, age, sex, admit NIHSS, and medical history. Results: Data included 45,278 patients. Results from the analyses are summarized in the table. Donner’s adjusted chi-square analyses showed significant differences for metrics across certification groups. Results from the logistic regression models indicated significant differences in IV TPA and EVT treatment, as well as IV TPA treatment times across certification groups. There were no significant differences between TSC and CSC. Conclusions: Patients presenting with acute ischemic stroke at NC and PSC were significantly less likely to receive IV TPA or EVT with significantly less efficient IV tPA treatment times as compared to CSC. However, CSC and TSC sites performed similarly.

P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Anguita ◽  
A Sambola Ayala ◽  
J Elola ◽  
J L Bernal ◽  
C Fernandez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
National Health System ◽  
Anterior Myocardial Infarction ◽  
Female Sex ◽  
Spanish National Health System ◽  
History Of ◽  
The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

scholarly journals Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Núria Fernández Hidalgo ◽  
Amal A Gharamti ◽  
María Luisa Aznar ◽  
Benito Almirante ◽  
Mohamad Yasmin ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Case Report Form ◽  
Predisposing Factor ◽  
Cardiac Device ◽  
Native Valve ◽  
Data Set ◽  
Standard Case ◽  
Cardiac Devices

Abstract Background Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P &lt; .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P &lt; .005). Clinically, they were more likely to present acutely (P &lt; .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P &lt; .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.

scholarly journals Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment

2019 ◽  
Vol 16 (6) ◽  
pp. 967 ◽  
Author(s):  
Liang Wee ◽  
Tammy Tsang ◽  
Huso Yi ◽  
Sue Toh ◽  
Geok Lee ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Public Housing ◽  
Low Socioeconomic Status ◽  
Physical Environment ◽  
Home Ownership ◽  
Univariate Analysis ◽  
Rental Housing ◽  
Neighbourhood Environment ◽  
Chi Square ◽  
The Impact

In Singapore, a densely urbanised Asian city state, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. We were interested in exploring social-environmental factors that are associated with loneliness among elderly residents of public rental housing in Singapore. We surveyed residents aged ≥60 in two Singapore public housing precincts in 2016. Loneliness was measured using a three-item scale. Sociodemographic information was obtained via standardised questionnaires. We used chi-square to identify associations between loneliness and sociodemographic characteristics, as well as neighbourhood perceptions (safety, convenience and the physical environment), on univariate analysis; and logistic regression for multivariate analysis. The response rate was 62.1% (528/800). On multivariate analysis, staying in a rental flat block was independently associated with loneliness (adjusted odds ratio, aOR = 2.10, 95% confidence interval (CI) = 1.32–3.36), as was staying in a poorer physical environment (aOR = 1.92, 95% CI = 1.15–3.22). Although needy Singapore residents share the same built environment as more well-to-do neighbours, differences in the impact of loneliness do exist.

scholarly journals Deep brain stimulation hardware–related infections: 10-year experience at a single institution

2019 ◽  
Vol 130 (2) ◽  
pp. 629-638 ◽  
Author(s):  
Kingsley O. Abode-Iyamah ◽  
Hsiu-Yin Chiang ◽  
Royce W. Woodroffe ◽  
Brian Park ◽  
Francis J. Jareczek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Single Institution ◽  
Chi Square ◽  
Related Factors ◽  
Exact Test ◽  
Vancomycin Powder ◽  
The Impact ◽  
Deep Brain

OBJECTIVEDeep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP).METHODSThe authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network’s definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher’s exact test, or logistic regression, as appropriate for the variables examined.RESULTSFour hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10–1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10–1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations.CONCLUSIONSWhile most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

scholarly journals 2145. Carbapenem-Resistant Enterobacteriaceae infections at the Maharaj Nakorn Chiang Mai Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S727-S727
Author(s):  
Romanee Chaiwarith ◽  
Wisarut Supparatpinyo
Keyword(s):  
Univariate Analysis ◽  
Tertiary Care ◽  
Control Measures ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Chiang Mai ◽  
Chi Square ◽  
Exact Test ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Nowadays, carbapenem-resistant enterobacteriaceae (CRE) infection has been spreading worldwide in a tertiary care hospital and causing globally health damage. In Thailand, the studies of the epidemiology of CRE are scarce. This study aimed to describe epidemiology, clinical characteristics and treatment outcome of CRE infection. Methods A retrospective cohort study was conducted among patients admitted to the Maharaj Nakorn Chiang Mai Hospital between January 2014 and December 2016 who had clinical diagnosis of CRE infection. Characteristics between groups were compared using Chi-square, Fisher exact test or Student t-test, Mann–Whitney U test. Factors associated with mortality in univariate analysis were analyzed in the logistic regression model. Results Among 241 patients who had clinical specimens grew CRE, 51 had infection. Twenty-five patients (49%) were previously hospitalized within 90 days and 42 patients (82.4%) had exposed to antibiotics before documented CRE infection. The most common sites of clinical isolates were urine (33.3%), sputum (29.4%), and blood (21.6%). The mortality rate was 47.1%, which 17 (33.3%) patients’ death was attributable to CRE infection. Factor associated with mortality was higher body temperature (OR 4.8, P = 0.005) and thrombocytopenia. Conclusion CRE infections cause high mortality. Strategies to prevent emergence through prudent uses of antibiotics and transmission through infection control measures should be implemented in order to reduce mortality. Disclosures All authors: No reported disclosures.

Incidence of adverse drug reactions induced by N-acetylcysteine in patients with acetaminophen overdose

2010 ◽  
Vol 29 (3) ◽  
pp. 153-160 ◽  
Author(s):  
Sa'ed H Zyoud ◽  
Rahmat Awang ◽  
Syed Azhar Syed Sulaiman ◽  
Waleed M Sweileh ◽  
Samah W Al-jabi
Keyword(s):  
Adverse Drug Reactions ◽  
Univariate Analysis ◽  
Drug Reactions ◽  
Chi Square ◽  
Exact Test ◽  
Acetaminophen Overdose ◽  
Significant Difference ◽  
Chi Square Test ◽  
Comparative Results ◽  
Student’S T

Background: Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay. Objective: the aim of this study was to investigate the type and incidence of ADR induced by IV-NAC in patients treated for acetaminophen overdose. Methods: This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 4 years (1 January 2005 to 31 December 2008). The primary outcome of interest in this study was the occurrence of ADR during NAC administration. Pearson chi-square test or Fisher’s exact test, student’s t test, and Mann-Whitney U test were used in univariate analysis. SPSS 15 was used for data analysis. Results: Two hundred and fifty five patients were studied. Different types of ADR were observed in 119 (46.7%) cases. Of those patients, 83 (69.7%) had been treated with IV-NAC versus 36 (30.3%) who had not (p < .001). The following ADR were significantly associated with IV-NAC administration: vomiting (p = .001), flushing (p < .001), rash (p < .001), pruritus (p < .001), chest pain (p = .001), bronchospasm (p = .03), coughing (p = .01), headache (p = .001), dizziness (p < .001), convulsion (p = .03), and hypotension (p = .001). ADR were mild in 54 (43.2%), moderate in 17 (13.6%), and severe in 12 (9.6%) patients. There were no ADR in 42 (33.6%) patients. Comparative results of the characteristics of patients who reacted to IV-NAC and nonreactors showed that patients with ADR had no significant difference in age, gender, ethnicity, amount ingested, latency time, and acetaminophen level than nonreactors. Conclusion: ADR to IV-NAC were common among patients with acetaminophen overdose, but mostly minor and all reported adverse reactions were easily managed.

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