Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes

ORL ◽  
2021 ◽  
pp. 1-9
Author(s):  
José Luis Treviño-Gonzalez ◽  
Félix Maldonado-Chapa ◽  
Amalia González-Larios ◽  
Josefina Alejandra Morales-Del Angel ◽  
Germán Armando Soto-Galindo ◽  
...  
Keyword(s):  
Demographic Data ◽  
Tertiary Referral Hospital ◽  
Factors Associated ◽  
Icu Admission ◽  
Life Threatening ◽  
History Of ◽  
Deep Neck Infections ◽  
Poor Outcomes ◽  
Predicting Factor ◽  
Overall Mortality

<b><i>Introduction:</i></b> Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. <b><i>Methods:</i></b> Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. <b><i>Results:</i></b> Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). <i>Streptococcus</i> spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (<i>n</i> = 5). Mean hospital stay was 9.13 days (±7.2). DM (<i>p</i> = 0.016), age (<i>p</i> = 0.001), BMI classification 3, 4, and 6 (<i>p</i> = 0.041), and intensive care unit (ICU) admission (<i>p</i> = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (<i>p</i> = 0.001) and masticator (<i>p</i> = 0.002) space involvement and DM (<i>p</i> = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (<i>p</i> = 0.001), ICU admission (<i>p</i> &#x3c; 0.0001), <i>Streptococcus</i> spp. (<i>p</i> = 0.019), and low hemoglobin levels (<i>p</i> = 0.004) were associated with mortality. <b><i>Discussion/Conclusion:</i></b> DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.

Nosocomial Methicillin-ResistantStaphylococcus aureusBacteremia: Is It Any Worse Than Nosocomial Methicillin-SensitiveStaphylococcus aureusBacteremia?

2000 ◽  
Vol 21 (10) ◽  
pp. 645-648 ◽  
Author(s):  
Linda A. Selvey ◽  
Michael Whitby ◽  
Barbara Johnson
Keyword(s):  
Past History ◽  
Healthcare Setting ◽  
Underlying Disease ◽  
Tertiary Referral Hospital ◽  
Historical Cohort ◽  
General Consensus ◽  
Risk Of Death ◽  
History Of ◽  
Mrsa Strains ◽  
Overall Mortality

AbstractObjective:To determine the comparative virulence of methicillin-resistantStaphylococcus aureus(MRSA) and methicillin-sensitiveS aureus(MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting.Design:Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality.Setting:A 916-bed, university-affiliated, tertiary referral hospital.Results:Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68;P<.05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups.Conclusions:There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.

scholarly journals Nephrolithiasis in gout: prevalence and characteristics of Brazilian patients

2019 ◽  
Vol 60 (1) ◽  
Author(s):  
Leonardo Santos Hoff ◽  
Claudia Goldenstein-Schainberg ◽  
Ricardo Fuller
Keyword(s):  
Uric Acid ◽  
Clinical History ◽  
Potassium Citrate ◽  
Male Gender ◽  
Inverse Association ◽  
Tertiary Referral Hospital ◽  
Urine Ph ◽  
Factors Associated ◽  
Primary Gout ◽  
History Of

Abstract Background The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. Methods One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. Results One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p <  0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. Conclusions The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.

scholarly journals Risk Factors Predicting Candida glabrata Bloodstream Infection

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S75-S75
Author(s):  
Jane O’Halloran ◽  
Ryan Kronen ◽  
Charlotte Lin ◽  
Kevin Hsueh ◽  
William Powderly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Predictive Model ◽  
Candida Glabrata ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Blood Stream ◽  
Central Line ◽  
Parenteral Feeding ◽  
Tertiary Referral Hospital ◽  
History Of

Abstract Background Increased incidence of Candida glabrata (CG) infection is a growing concern in recent years due to the higher rates of fluconazole resistance associated with C. glabrata . This study aimed to create a risk predictive model for C. glabrata in patients with culture-positive candidemia. Methods Demographic data, risk factors, laboratory parameters, and outcomes were retrospectively collected on all cases of candidemia occurring at a large tertiary referral hospital between January 2002 and January 2015. Between-group differences were compared using 2 square tests. A risk predictive model was built using multivariate logistic regression. Results Of 1,913 subjects with candidemia, 398 (21%) had C. glabrata isolated. Those with C. glabrata were older (mean [SD] 61 [23] vs. 58 [23] years; P &lt; 0.001) and more often female (231 (58%) vs. 681 (45%); P &lt; 0.001). On univariate analysis, age (OR 1.01 [95% CI 1.01,1.02]), gender (0.6 [0.5, 0.7]), history of rectal cancer (2.00 [1.2, 3.5]), other GI malignancy (3.0 [1.5, 6.2]), breast cancer (1.8 [1.1, 3.0]), enteral and parenteral feeding (1.9 [1.2, 3.2]), bowel resection (3.0 [1.4, 6.2]), temperature (0.9 [0.8, 1.0], recent fluconazole use (2.0 [1.4, 2.9]), and The presence of urinary catheter (2.3 [1.4, 3.6]), central line (1.4 [1.1, 1.7) or ventilator (2.2 [1.3, 3.8]) were all associated with C. glabrata infection (P &lt; 0.05) and included in the multivariate modeling. Age, gender, history of rectal malignancy, other GI malignancies, use of enteral or parenteral feeding and recent fluconazole use remained significant (effect size 1.2 [95% CI 1.1, 1.3]; 1.8 [1.4, 2.3]; 2.0 [1.1, 3.6]; 3.0 [1.3, 6.9]; 1.9 [1.0, 3.3]; 2.0 [1.3, 3.0], respectively). The final model had a c-statistic of 0.66 [95% CI 0.63–0.69]). Ninety-day mortality in the C. glabrata group was not significantly different from the non-C. glabrata group (40% (158/398) vs. 42.5% (644/1515). Conclusion Underlying bowel pathology was more commonly associated with C. glabrata candidemia than with other candida species. Further exploration of the direct association between C. glabrata and GI malignancy and indirect effects of prior surgery or antifungal use on risk of C. glabrata candidemia are required. Interestingly, mortality did not differ between groups with glabrata and non-glabrata candida blood stream infections. This may reflect increasing empiric use of echinocandin therapy. Disclosures A. Spec, Astellas Pharma US, Inc.: Grant Investigator, Research grant

scholarly journals Clinical and thoracic radiography features determine patient outcome in young and middle age adults with COVID-19

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Alexander Sosa Frias ◽  
Aimara de la C Vergara Santos
Keyword(s):  
Multivariate Analysis ◽  
White Blood Count ◽  
Bivariate Analysis ◽  
P Value ◽  
Fisher Exact Test ◽  
Icu Admission ◽  
Poor Outcome ◽  
Severity Scores ◽  
History Of ◽  
Poor Outcomes

Background: The new coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019. Researchers described COVID-19 mortality risk factors as being elderly, male, having comorbidities, and in some ethnicities. Some authors validated the use of first chest x-ray (CXR) severity scores (CSE) as an independent indicator of poor outcomes with COVID-19. Our objective was to evaluate the clinical and CXR findings as predictors of poor outcomes (death, needing intubation, Intensive Care Unit (ICU) admission) in patients with COVID-19. Methods: We performed a retrospective study of case-controls using a sample size of 60 patients admitted with the diagnosis of COVID-19 during the period of July-August 2020 to the Cuban Hospital in Qatar, as determined with the free online OpenEpi software (https://www.openepi.com/SampleSize/SSCC.htm). We defined cases as patients with a complication like death, needing intubation, ICU admission, or organ failure, and controls as patients who did not demonstrate the described complications. The dependent variables used were patient evolution divided into poor outcome or good outcome. The independent variables used were age, history of diabetes mellitus type II, and high blood pressure (HBP), CSE, and white blood count (WBC). The bivariate analysis was performed using the Chi-Square test or Fisher exact test. Multivariate analysis was done using binary logistic regression (IBM SPSS software 25). The results are expressed in Odds Ratio with p-value < 0.05 defined as statistically significant. Results: The bivariate analysis showed being older, having a history of HBP, diabetes, abnormal WBC, and high CSE were linked to poor outcome (p < 0.05) . The multivariate analysis defined WBC and CSE with independent influence over the patient evolution . Conclusion: We demonstrated that the value of WBC and CSE are predictors of poor outcome in patients with COVID-19. WBC increases the possibility of the described complications in COVID-19 patients 68,634 times and CSE 12,201 times.

Unexpected ICU Admission is Associated with Pulmonary Complications but Not Increased Mortality; Rescue is Essential for Optimal Patient Outcome

2019 ◽  
Vol 85 (12) ◽  
pp. 1409-1413
Author(s):  
Marc O. Duverseau ◽  
Dominic Suma ◽  
Shelley L. Galvin ◽  
Anne M. Conquest ◽  
Michael J. Schurr
Keyword(s):  
Myocardial Infarction ◽  
Injury Severity ◽  
Pulmonary Complications ◽  
Trauma Patients ◽  
Severely Injured ◽  
Icu Admission ◽  
Chi Squared ◽  
Referral Hospitals ◽  
History Of ◽  
Overall Mortality

ICU beds are in demand in large regional referral hospitals; therefore, nonintubated polytrauma patients are often admitted to general care (GC) wards. We hypothesized that trauma patients with Injury Severity Score (ISS) greater than 15 and unexpected ICU admission (U-ICU) after initial admission to GC had increased morbidity and mortality. We also hypothesized that those requiring U-ICU could be predicted based on admission parameters. This was a retrospective review of patients aged at least 18 years, admitted to GC with blunt trauma and ISS greater than 15 from April 2015 to March 2017. Demographics were collected along with injury patterns and complications. Statistics included chi-squared, Fisher's exact, Mann-Whitney, and t tests. Of 986 patients, 502 (50.9%) were directly admitted to GC. Prevalence of U-ICU was 9.8 per cent (49/502 patients). The only admission predictor of U-ICU was a history of myocardial infarction (8/49, 16.3%, vs 21/453, 4.6%, P = 0.001). Those with U-ICU had increased incidence of pneumonia, acute respiratory distress syndrome, and endotracheal intubation compared with GC, but there was no difference in overall mortality (3/49, 6.1% vs 18/453, 4.0%, P = 0.45). Half of all severely injured, nonintubated patients can be managed on the GC ward; however, 9.8 per cent of patients will require U-ICU admission for pulmonary complications. Admission history of myocardial infarction predicts those at risk. Severely injured patients with U-ICU admission have significant cardiopulmonary complications, but can be rescued with no increase in overall mortality.

scholarly journals Risk Factors Associated With Health Care Utilization in Preschool Recurrent Wheezers in a Tropical Environment

2021 ◽  
Vol 2 ◽  
Author(s):  
César Muñoz ◽  
Lissette Guevara ◽  
María-Isabel Escamilla ◽  
Ronald Regino ◽  
Nathalie Acevedo ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Tap Water ◽  
Specific Ige ◽  
Care Utilization ◽  
Total Serum ◽  
Factors Associated ◽  
Icu Admission ◽  
History Of ◽  
Nocturnal Cough

Introduction: The severity of wheezing episodes is related with the need for health services, but the factors associated with health care utilization in preschool recurrent wheezers in underdeveloped regions are unclear.Objective: To evaluate the factors associated with health care utilization in preschool recurrent wheezers in Cartagena, Colombia.Methods: One hundred twenty-seven recurrent wheezers (age 2–6 years old) who were admitted to the emergency room (ER) due to wheezing in a Pediatric reference hospital in Cartagena were included. Children were evaluated by means of questionnaires and classified according to the number of ER visits, need for hospitalization and history of intensive care unit (ICU) admission due to wheezing within the last year. Total serum IgE and specific IgE to house dust mite allergens (HDM) were measured by ImmunoCAP® and allergen sensitization was evaluated by skin prick tests (SPT).Results: The maternal report of nocturnal cough without fever in their children increased the risk to have ≥5 ER visits in the last year due to wheezing. The use of montelukast was negatively associated with hospitalization, while a history of pneumonia and lack of tap water, increased the risk of hospitalization due to wheezing. A history of bronchiolitis, family history of asthma, cohabiting with two or more siblings, passive exposure to smoke and lack of sewage facilities increased the risk of ICU admission due to wheezing. The presence of atopy evaluated by SPT reactivity, total IgE levels or specific IgE to HDM were not associated with health care utilization. We also found that seroprevalence of positive IgE (≥0.35 kU/L) was 27% to B. tropicalis and 20.3% to D. pteronyssinus but the prevalence of positive IgE sensitization to these allergens was below 2% and 8% when evaluated by SPT, respectively.Conclusions: Poverty indicators are associated with ICU admission in a group of preschool recurrent wheezers and should be considered as aggravating factors for wheezing. These factors must be systematically assessed in the medical approach in underdeveloped regions in the tropics. Nocturnal cough without fever is a symptom associated with frequent ER visits while atopy was not associated with health care utilization in preschool recurrent wheezers.

scholarly journals Rates and Risk Factors for Suicide Ideas among Schizophrenia Patients in Indonesia

2019 ◽  
Vol 7 (16) ◽  
pp. 2579-2582
Author(s):  
Nurmiati Amir ◽  
Ronald Antoni ◽  
Asmarahadi Asmarahadi ◽  
Prianto Djatmiko ◽  
Siti Khalimah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Suicide Attempts ◽  
Clinical Symptoms ◽  
Demographic Data ◽  
Disease Onset ◽  
Multivariate Logistic Regression Analysis ◽  
High Rate ◽  
Factors Associated ◽  
History Of

BACKGROUND: Schizophrenia is associated with a high rate of suicide. AIM: Our study was aimed to identify the rates of suicide ideas in patients with schizophrenia as well as the risk factors associated with suicide ideas. METHODS: As many as 1130 subjects were evaluated using the Indonesian version of Diagnosis Interview for Psychosis (DIP) to establish the diagnosis of schizophrenia. Subjects aged 18-65 years. The risk factors were socio-demographic data, mental disorder history in the family, clinical symptoms and clinical course of schizophrenia. Risk factors that have the strongest correlation with suicide ideas were analysed using multivariate logistic regression analysis. RESULTS: About 6.1% of subjects reported suicide ideas in their life. The age of disease onset (p = 0.006), family history of schizophrenia (p = 0.013), poor concentration (p = 0.032), loss of enjoyment (p = 0.000), guilty feeling (p = 0.000), family history of mental illness (p = 0.000), nihilistic delusion (p = 0.001) and alcohol abuse (p = 0.000) were significantly associated with suicide ideas. CONCLUSION: Suicide idea is quite common in people with schizophrenia. Evaluation and management of risk factors associated with suicide ideas should be performed to prevent suicide attempts or death. Suicide ideas and risk factors can become clinical parameters in the instrument of suicide prevention.

Demographic Factors Associated with Congenital Malformations Among Young Infants in Fallujah Maternity and Children Hospital, Fallujah City, Iraq

2020 ◽  
pp. 1-5
Author(s):  
Samira T.Abdulghani ◽  
Samira T.Abdulghani
Keyword(s):  
Developing Countries ◽  
Congenital Anomalies ◽  
Prevalence Rate ◽  
Gestational Hypertension ◽  
Heart Defects ◽  
Demographic Factors ◽  
Cross Sectional ◽  
Factors Associated ◽  
Young Infants ◽  
History Of

Background: Congenital anomalies are a major cause of infant morbidity and mortality in developing countries including our country. Registries and data on these anomalies are still primitive and poorly collated. In this study we aimed to assess the important demographic factors associated with the development of congenital anomalies. Methods: This was a cross-sectional hospital-based study involving 880 infants in the 1st year of life registered in the birth defect unit in Fallujah Maternity and Children Hospital in the period between 1st of January 2017 to the 31st of December 2019. The prevalence rate, the pattern of anomalies and the factors associated with their occurrence were determined. Results: The prevalence rate of the group enrolled in this study was 31/1000 total births, congenital heart defects was the commonest followed by central nervous system anomalies, 58% of the infants were males, 65% had ≥ 2.5 kg birth weight & 95% were singletons. Family history of congenital anomalies was found in 31.25% of cases. The largest group of mothers (55.7%) were 21-30 years old & 92.5% of fathers were less than 45 years old. Parental consanguinity reported in 64.3% of the total cases. Only 4.5% of mothers reported history of fever during pregnancy, and none of them had history of exposure to x-ray or teratogenic drug use. Gestational hypertension was reported in 10% of the total (880) mothers, hypertension and diabetes mellitus in 0.3%, while hepatitis C, hepatitis B, toxoplasmosis and epilepsy, each was reported in only one mother (0.1% of the total). Regarding the outcome of pregnancy, 66.6% were live births, 24.2% were abortions and 9.2% were stillbirths. History of previous abortions was reported in 22% of cases. Urban residents accounted for 63% of the families of congenitally abnormal infants while 37% were rural. Conclusion: Congenital anomalies are still a major cause for concern and tension in Fallujah society, there is serious need to establish a surveillance and good statistical system for congenital anomalies and efforts should be made to raise awareness of their occurrence and the associated risk factors in Iraq and other developing countries.

Efficacy of Thiol disulfide Homeostasis and Ischemia Modified Albumin Values in Estimating the Degree of Difficulty for Laparoscopic Cholecystectomy

2020 ◽  
Vol 23 ◽  
Author(s):  
Gökhan Akkurt ◽  
Burcu Akkurt ◽  
Emel Alptekın ◽  
Birkan Birben ◽  
Mehmet Keşkek ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Demographic Data ◽  
Previous History ◽  
Significant Negative Correlation ◽  
White Blood Count ◽  
Ischemia Modified Albumin ◽  
Total Thiol ◽  
Duration Of Surgery ◽  
History Of

Aim: The aim of this study is to investigate the efficacy of thiol disulfide homeostasis and Ischemia Modified Albumin (IMA) values in predicting the technical difficulties that might be encountered during laparoscopic cholecystectomy. Materials and Methods: The study included 65 patients who underwent laparoscopic cholecystectomy due to cholelithiasis at the General Surgery Clinic of Ankara Numune Training and Research Hospital. All patients’ demographic data, previous history of cholecystitis, a history of chronic illness, preoperative white blood count (WBC), liver function tests (AST, ALT), amylase and lipase levels, intra-operative adhesion score, the ultrasonographic appearance of gallbladder, duration on hospital stay, duration of operation, thiol disulfide and IMA values were evaluated. Results: Native thiol and total thiol averages were higher in patients without a history of cholecystitis, on the other hand, disulfide, disulfide/native thiol rate, disulfide/total thiol rate, native thiol/total thiol rate and IMA averages were higher in patients with a history of cholecystitis. While there was a statistically significant negative correlation between native and total thiol values and age, duration of surgery and duration of hospital stay; IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol rates were higher in older patients with a longer duration of surgery and hospital stay. In addition, preoperative IMA, disulfide, disulfide/Total thiol, Native/Total thiol and disulfide/Native thiol were observed to increase as the degree of intraoperative pericholecystic adhesion increased. Conclusion: We believe that the evaluation of thiol disulfide homeostasis and IMA parameters prior to laparoscopic cholecystectomy can be used as an effective method for predicting intraoperative difficulties.

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