scholarly journals Transition to oral antibiotic therapy for pyelonephritis in children under 60 days of age: An observational retrospective cohort study

2020 ◽  
Author(s):  
David-Alexandre Lessard ◽  
Thelma Huard-Girard ◽  
Arnaud Tremblay ◽  
Jean-Francois Turcotte
Keyword(s):  
Cohort Study ◽  
Antibiotic Therapy ◽  
Tertiary Care ◽  
P Value ◽  
Oral Antibiotic ◽  
Tertiary Care Centre ◽  
Oral Antibiotic Therapy ◽  
Observational Cohort ◽  
Systemic Symptoms ◽  
Retrospective Observational Cohort Study

Abstract Objectives To describe the use of antibiotics and assess if an early transition from intravenous to oral antibiotic therapy is generally safe in infants less than 60 days of age with a diagnosis of pyelonephritis. Methods This retrospective observational cohort study included hospitalized infants less than 60 days with a diagnosis of pyelonephritis based on fever or systemic symptoms and a positive urine culture between January 1, 2015 and July 30, 2017 at a Canadian paediatric tertiary care centre. Results A total of 108 infants were included. Forty-eight of them were under 1 month of age. The median intravenous (IV) antibiotic therapy duration was 3.5 days, with a longer duration of 4 days in infants less than 1 month of age. The total antibiotic therapy was almost equally divided between a shorter (10 days) and longer (14 days) duration. The recurrence of pyelonephritis within the 2 months following the initial urinary infection was 9 % in the group with IV antibiotic therapy duration of <4 days, compared to 11% in the group treated ≥4 days IV (P-value 0.75). There was a recurrence of pyelonephritis of 10.2% in the group treated for 10 days, compared to 11.5% of recurrence in the group treated for 14 days (P-value 1.0). Conclusions Our study provides limited retrospective data regarding the management of pyelonephritis in infants less than 60 days of age. Prospective research is needed to confirm those findings.

scholarly journals SAFE TRANSITION TO ORAL ANTIBIOTIC THERAPY FOR PYELONEPHRITIS IN CHILDREN UNDER 2 MONTHS OF AGE: A RETROSPECTIVE STUDY

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e40-e40
Author(s):  
David-Alexandre Lessard ◽  
Arnaud Tremblay ◽  
Thelma Huard-Girard ◽  
Jean-Francois Turcotte
Keyword(s):  
Antibiotic Therapy ◽  
Urine Culture ◽  
Tertiary Care ◽  
Future Research ◽  
Renal Ultrasound ◽  
Oral Antibiotic ◽  
Tertiary Care Centre ◽  
Oral Antibiotic Therapy ◽  
Renal Complication ◽  
Multiple Variables

Abstract BACKGROUND Febrile urinary tract infection (UTI) is a common cause of acute illness in paediatric medicine. Whereas oral antibiotic therapy (OAT) has become common practice in older children, the evidence supporting OAT in infants less than 2 months of age is still limited. The need for future research in the management strategies of UTIs in infants < 2 months of age has been acknowledged by the Canadian Paediatric Society. OBJECTIVES Describe the use of antibiotics in children < 2 months of age with a diagnosis of pyelonephritis at a Canadian tertiary care paediatric hospital and assess the safety of an early OAT switch in this population. DESIGN/METHODS A retrospective observational cohort study of infants < 2 months of age with a diagnosis of pyelonephritis based on 1) fever or systemic symptoms (lethargy, vomiting) and 2) a positive urine culture obtained from urinary catheterization. All children were seen between January 1st 2015 and July 30th 2017 at a single tertiary care centre. Infants were either hospitalized or followed in an outpatient day clinic. Chart review was performed and multiple variables were included in the analysis. RESULTS 105 patients were included. Among those, 81 (77%) were boys. Most patients (87%) had Escherichia coli infection. Patients presented at a mean age of 33 ± 15 days and were admitted for 3.7 ± 2.7 days. Intravenous antibiotic therapy (IAT) – ampicillin and tobramycin or ampicillin and cefotaxime – were initially used in most patients (96%) with transition to OAT after a mean IAT duration of 3.9 days ± 2.4 days. A renal ultrasound was performed in all patients. In a subgroup of patients aged less than 30 days without bacteremia (44 patients), mean age at presentation was 19 ± 6 days. They were treated with IAT for 3.7 days ± 1.9 days before transition to OAT based on urine culture and resolution of fever. No patient was readmitted for a renal complication following discharge. CONCLUSION Early use of OAT following an initial IAT in infants < 2 months of age with a diagnosis of pyelonephritis appears to be a safe option. In infants < 30 days of age without bacteremia, our data suggests that early transition to OAT is not associated with worse outcomes.

scholarly journals Serum potassium disorders predict subsequent kidney injury: a retrospective observational cohort study of hospitalized patients

2022 ◽  
Author(s):  
Gianmarco Lombardi ◽  
Giovanni Gambaro ◽  
Pietro Manuel Ferraro
Keyword(s):  
Cohort Study ◽  
Serum Potassium ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Observational Cohort Study ◽  
Hospitalized Patients ◽  
P Value ◽  
Significant Difference ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Introduction Electrolytes disorders are common findings in kidney diseases and might represent a useful biomarker preceding kidney injury. Serum potassium [K+] imbalance is still poorly investigated for association with acute kidney injury (AKI) and most evidence come from intensive care units (ICU). The aim of our study was to comprehensively investigate this association in a large, unselected cohort of hospitalized patients. Methods: We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 1, 2010 and December 31, 2014 with inclusion of adult patients with at least 2 [K+] and 3 serum creatinine (sCr) measurements who did not develop AKI during an initial 10-day window. The outcome of interest was in-hospital AKI. The exposures of interest were [K+] fluctuations and hypo (HoK) and hyperkalemia (HerK). [K+] variability was evaluated using the coefficient of variation (CV). Cox proportional hazards regression models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between the exposures of interest and development of AKI. Results: 21,830 hospital admissions from 18,836 patients were included in our study. During a median follow-up of 5 (interquartile range [IQR] 7) days, AKI was observed in 555 hospital admissions (2.9%); median time for AKI development was 5 (IQR 7) days. Higher [K+] variability was independently associated with increased risk of AKI with a statistically significant linear trend across groups (p-value = 0.012). A significantly higher incidence of AKI was documented in patients with HerK compared with normokalemia. No statistically significant difference was observed between HoK and HerK (p-value = 0.92). Conclusion: [K+] abnormalities including fluctuations even within the normal range are associated with development of AKI.

scholarly journals Study of Trauma Profile and its Outcomes at a Tertiary Care Centre: A Cohort Study of 1000 Cases

2021 ◽  
Author(s):  
Bhupinder Singh Walia ◽  
Pankaj Dugg ◽  
Kanwaldeep Singh Aulakh ◽  
Sanjeev Sharma ◽  
Venita Kapur
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Emergency Surgery ◽  
Road Traffic ◽  
Tertiary Care ◽  
P Value ◽  
Age Group ◽  
Tertiary Care Centre ◽  
Male Population ◽  
Male Predominance

Introduction: Trauma has been the leading cause of mortality and morbidity. However, there are changes in pattern of trauma and their outcomes with time. Aim: To study the mode and nature of injury and mortality associated with trauma of head, chest and abdomen. Materials and Methods: A prospective cohort study was conducted on 1000 individuals that presented to emergency surgery ward from 2014 to 2019. Patients presented to emergency surgery of Government Medical College, Amritsar, Punjab, India were observed for various characteristics i.e., age group, mode of injury, site of injury, outcomes and management. Results: The mean age of patients was 33.91±16.29 years with significant male predominance (n=794, 79.4%) (p-value 0.00001). Road Traffic Injuries (RTIs) were the most common mode of trauma affecting 490 patients (49%). Head injury was the most common of all injuries (n=834). Overall mortality was 3.6% (n=36). Mortality was higher in males (p-value 0.00933) and mortality rate of 25% was seen in age group of 61-70 years. Conclusion: RTIs followed by assaults are the most common cause of trauma and it significantly affects young male population. However, mortality rate increases with increase in age group with higher rates in older age groups.

scholarly journals Effect of Phacoemulsification on Intraocular Pressure in Cataract Patients Attending a Tertiary Care Centre in Kerala- A Retrospective Cohort Study

2021 ◽  
Author(s):  
Manoj Prathapan ◽  
Namrata Pambavasan ◽  
Smrithi Sony Thampi ◽  
Smriti Nair ◽  
Leyanna Susan George ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intraocular Pressure ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tertiary Care ◽  
Anterior Chamber Depth ◽  
P Value ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Post Surgery

Introduction: Cataract is the leading cause of preventable blindness worldwide. It is caused by the degeneration and opacification of the lens fibres. Phacoemulsification is the current treatment modality available for cataract. However, there is a possibility of an increase in the anterior chamber depth after phacoemulsification. This occurs as a result of the removal of the bulky lens matter and implantation of a thin intraocular lens, thereby reducing the intraocular pressure. Aim: To compare the preoperative and postoperative Intraocular Pressure (IOP) changes and the factors associated with intraocular pressure changes among patients who underwent phacoemulsification in a Tertiary Care Centre in Kerala. Materials and Methods: A retrospective cohort study was carried out among 610 patients, who underwent phacoemulsification surgery from January 1st, 2017 to December 31st, 2017. Using a checklist, the following data such as age, sex, Date of Surgery, Last recorded preoperative intraocular pressure of both eyes, First recorded Postoperative intraocular pressure of both eyes any time after 3 months, Axial length, Grade of cataract and comorbidities like diabetes, hypertension, dyslipidaemia, glaucoma and Coronary Artery Disease (CAD) was obtained from the hospital Information System. Data collected was entered into an MS Excel and was analysed using SPSS version 20. Frequency and percentages were calculated and association assessed using Chi-square test. Paired t-test was applied to find the mean changes in the IOP levels and p-value was ≤0.05, thus significant. Results: It was observed that there was a mean reduction of 7.907 mmHg in ocular hypertensives when compared to ocular normotensives following phacoemulsification. This finding was found to be statistically significant (p-value <0.001). There was association between grade of cataract and change in IOP which was significant with a p-value of 0.031. Conclusion: Phacoemulsification is the treatment of choice in patients with cataract. In the study, it was found that ocular hypertensives who underwent phacoemulsification had a significant drop in intraocular pressure post-surgery. Phacoemulsification can be employed in patients who have both ocular hypertension and cataract. This procedure can improve vision and in addition to having a positive effect on IOP reduction.

scholarly journals Disorders of placental villous maturation in fetal death

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sunil Jaiman ◽  
Roberto Romero ◽  
Percy Pacora ◽  
Eunjung Jung ◽  
Gaurav Bhatti ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fetal Death ◽  
Prevalence Ratio ◽  
Normal Pregnancy ◽  
Observational Cohort Study ◽  
Maturation Arrest ◽  
Inflammatory Lesions ◽  
Multiple Gestations ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women’s Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks’ gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37–42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of womem with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.

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