The Factors Contributing to Efficiency in Surgical Management of Purulent Infections of Deep Neck Spaces

Deep neck infections (DNIs) are still emergency conditions in otorhinolaryngology. Due to rapid disease progression and life-threatening complications, the accurate surgical and medical treatment must be promptly applied. In the present study, we analyzed treatment protocols of 46 adults to assess efficacy of the treatment and search for prognostic factors of the outcomes. We performed retrospective analysis of medical data of 46 patients, who underwent surgical treatment in our department due to purulent DNI in the period from 2009 to 2017. Data investigated included age, sex, hospitalization time, duration of symptoms before drainage, comorbidities, selected laboratory tests results, location and the number of abscesses, results of microbiological cultures, and antibiotic treatment options. The study group consisted of 33 (71.7%) men and 13 (28.3%) women. Patients age ranged from 18 to 82 years. The mean duration of hospital stay was 13.2 ± 8.4 days. The most common site involved was submandibular space (43.5%), followed by parapharyngeal space (28.3%). The majority of patients had single abscess (81.2%), the multiple abscesses were revealed in 8 (18.8%) cases. The mean size of the abscesses was 42 mm. C-reactive protein level was increased in 96.7% patients (mean level 155.5 ± 146.7 mg/L), but the white blood cell count exceeded the normal in 60.9% cases (mean level 16.89 ± 5.59 × 109/L). Staphylococcus aureus (20.7%) and Peptostreptococcus (20.7%) were the most common species cultured from swabs. The antibiotic treatment included most commonly a combined ceftriaxone and metronidazole (n = 23). Two patients died due to complications. The correlation between different variables and the duration of hospitalization revealed only the hemoglobin level below 12.5 g/dL, a significant predictor of longer hospitalization (16.23 days vs 12.09 days, P = .017). Patients with purulent DNIs and decreased hemoglobin level are predisposed to prolonged recovery following the surgical drainage.

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Retinoblastoma: geographic distribution and presentation at a tertiary eye care centre in Kathmandu, Nepal

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i2.8708 ◽

2013 ◽

Vol 5 (2) ◽

pp. 169-176 ◽

Cited By ~ 4

Author(s):

Rohit Saiju ◽

G Moore ◽

U Shrestha ◽

MK Shrestha ◽

S Ruit

Keyword(s):

Geographic Distribution ◽

Clinical Presentation ◽

Treatment Options ◽

Histopathological Analysis ◽

Duration Of Symptoms ◽

Exact Test ◽

Bilateral Retinoblastoma ◽

Hilly Region ◽

Region Of Residence ◽

The Mean

Introduction: Several aspects of retinoblastoma in Nepal remain enigmatic. Objective: To assess the demographic and geographic distribution, clinical presentation, and treatment methods of retinoblastoma at a tertiary level ophthalmic institution in Kathmandu, Nepal. Materials and methods: A retrospective analysis of all the patients diagnosed with retinoblastoma at Tilganga Institute of Ophthalmology from July 2004 to June 2008 was performed. The main outcome measures included region of residence, treatment options and histopathological findings. The histopathological analysis was performed on enucleated and exenterated specimens. Statistics: The statistical analysis was performed with SPSS Version 11.5. Descriptive statistics are represented as mean ± standard deviation. All tests were two-sided and the P-values of less than 0.05 were considered statistically significant. Results: Thirty patients presented with retinoblastoma during the study period. The mean age at presentation was 2.5 ± 1.6 years (range five months to seven years). Ten of the 12 patients who presented with bilateral retinoblastoma (83 %) were from the Terai region of Nepal. The ratio of unilateral to bilateral cases in the Terai region was 1:2. This differed significantly with the ratio in the hilly region (Fisher’s Exact Test, p = 0.0012). The mean duration of symptoms before presentation was 2.5 3.2 months (range three days to 12 months). Twenty-four patients (80 %) presented with leukocoria. Eleven patients (36.6 %) presented with leukocoria as their only symptom. Ninety-seven percent of the patients underwent either enucleation (90 %) or exenteration (6.7 %) of at least one eye. Conclusion: Bilateral retinoblastoma is more prevalent in the Terai region of Nepal. The majority of the patients present with leucokoria and are treated with enucleation. Nepal J Ophthalmol 2013; 5(10): 169-176 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8708

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Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

Foot & Ankle International ◽

10.1177/1071100719833928 ◽

2019 ◽

Vol 40 (7) ◽

pp. 803-807 ◽

Cited By ~ 4

Author(s):

Abdel-Salam Abdel-Aleem Ahmed ◽

Mahmoud Ibrahim Kandil ◽

Eslam Abdelshafi Tabl

Keyword(s):

Treatment Options ◽

Case Series ◽

Deformity Correction ◽

Functional Results ◽

The Body ◽

Retrospective Case ◽

Level Of Evidence ◽

Duration Of Symptoms ◽

The Mean ◽

Calcaneal Lengthening

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series.

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Clinical profile of parkinsonian disorders in the tropics: Experience at Kano, northwestern Nigeria

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.102589 ◽

2012 ◽

Vol 03 (03) ◽

pp. 237-241 ◽

Cited By ~ 8

Author(s):

Owolabi Lukman Femi ◽

A Ibrahim ◽

S Aliyu

Keyword(s):

Treatment Options ◽

Age At Onset ◽

Clinical Profile ◽

Time Interval ◽

Delayed Presentation ◽

Drug Induced ◽

Duration Of Symptoms ◽

Male Preponderance ◽

Idiopathic Parkinsonism ◽

The Mean

ABSTRACT Background: No data exists on Parkinson’s disease (PD) and secondary Parkinsonism in Northwestern Nigeria. This study was designed to create a database, document the clinical profile of PD in Kano, northwestern Nigerian, and compare this to prior observations within and outside Nigeria. Materials and Methods: A database was documented on prospective patients presenting consecutively to the Neurology out-patients clinic of the two tertiary health facilities in Kano northwestern Nigeria over a period of 4 years. Demographic and clinical data at presentation were documented for all patients. Cases were classified as PD or secondary Parkinsonism. The severity at presentation and at last visit was classified using the H and Y scale. Results: Over a period of 4 years, out 1153 a total of 96 patients comprising 74 males and 22 females were enrolled. Eighty (83.3%) of them had clinically diagnosed PD while 16 (16.7%) had clinical features compatible with secondary Parkinsonism. The mean age at onset of symptoms in the PD patients (mean 58.2 ± 6.72 yrs ) was more than in secondary Parkinsonism (mean 51.4 ± 10.04 and P = 0.001). There was male preponderance in both idiopathic Parkinsonism (PD) (m:f = 3.2:1) and secondary Parkinsonism (m:f = 4.3:1). Out of the patients with secondary Parkinsonism, 10 (62.5%) and 5 (31.3%) had vascular Parkinsonism and drug-induced Parkinsonism, respectively. Duration of symptoms prior to presentation ranged between 3 months and 16 years. The mean (SD) time interval from the onset of motor symptoms to diagnosis of PD was 3.6 ± 3.4 yrs and time interval for men and women (male 3.8 ± 3.7; female 2.8 ± 2.1; P = 0.249). Conclusions: Clinical profile of patients with PD and secondary Parkinsonism in Kano is similar to that from other populations within Nigeria and other developing countries. However, delayed presentation, less frequent family history, lower frequency of Young-onset PD as well as treatment challenges occasioned by poverty, inadequacy of expert, and lack of newer drugs and treatment options contrasts the situation in western populations.

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Antibiotic Treatment According to Procalcitonin and C- Reactive Protein Levels

Acta Medica Transilvanica ◽

10.2478/amtsb-2021-0048 ◽

2021 ◽

Vol 26 (3) ◽

pp. 42-44

Author(s):

Adeline Larisa Horga ◽

Mihai Leonida Neamţu

Keyword(s):

Respiratory Tract ◽

Antibiotic Therapy ◽

Antibiotic Treatment ◽

Respiratory Tract Infections ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Duration Of Hospitalization ◽

Tract Infections ◽

Time Of Admission

Abstract Respiratory tract infections are the most common infections find at pediatric age. Children with lower respiratory tract infections can presents severe forms, which is why early diagnosis and treatment are essential. Choosing the therapy is made according to the etiology, but at the time of admission it is difficult to establish the etiology of the disease and for this reason, most often, it is decided to initiate the antibiotic therapy. Excessive antibiotic prescription, in cases that it is not justified, is really a problem because it contributes to the increase of antimicrobial resistance. A study was conducted in order to limit the hypothesis of prolonged antibiotic therapy, which also prolongs the duration of hospitalization. By anticipating C-reactive protein and procalcitonin levels we could guide or reconsider the antibiotic treatment.

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Coronavirus Disease 2019 in Kidney Transplant Recipients: Our Single Center Experiences

Grand Journal of Urology ◽

10.5222/gju.2021.75047 ◽

2021 ◽

Author(s):

Serdar Karadağ ◽

Ramazan Uğur ◽

Emre Sam ◽

Mithat Ekşi ◽

Yunus Çolakoğlu ◽

...

Keyword(s):

Kidney Transplantation ◽

Severe Pneumonia ◽

High Serum ◽

Kidney Transplant Recipients ◽

Treatment Protocols ◽

Reactive Protein ◽

Radiological Data ◽

Discharged Patients ◽

The Mean ◽

Almost All

Objective: To investigate whether tacrolimus (Tac), mycophenolate mofetil (MMF), mycophenolic acid (MPA), prednisolone (Pred) and methylprednisolone (MP) are affect the COVID-19 pathogenesis and on its progression in kidney transplantation recipients diagnosed with COVID-19 patients. Materials and Methods: Among patients hospitalized due to COVID-19, patients who had kidney transplantation were retrospectively detected on the online database of our center. Referral complaints, laboratory and radiological data at referral, applied treatment protocols, and ultimate conditions of the patients were documented. Results: Among the total of 11 patients, 73% (8) were male and 27% (3) were female. The mean age was 49.63 (27-71). Hypertension and diabetes mellitus were the most common comorbid diseases. The most common symptoms were coughing, fever and exhaustion-fatigue. High serum reactive protein and lymphopenia were detected in almost all patients. Acute renal failure was observed in seven patients (73%). While all patients were using Tac and Pred, nine patients (82%) were using MMF and two patients (18%) were using MPA. Hydroxychloroquine, favipiravir, and azithromycin were treatments for COVID-19. RT-PCR results of 11 patients were positive in 7 and negative in 4 patients. The mean hospital stay of the discharged patients was 8.8 days. Eight patients recovered and were discharged, treatment of two intubated patients continues in intensive care unit and one patient died. Conclusion: Clinical characteristics of COVID-19 in kidney transplanted patients are similar to the general population and it should be kept in mind that the disease occurs with moderate-severe pneumonia in this patient group. Disease progress can be stopped through early treatment.

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Establishing a Group Educational Session for Hyperacusis Patients

American Journal of Audiology ◽

10.1044/2019_aja-18-0148 ◽

2019 ◽

Vol 28 (2) ◽

pp. 245-250

Author(s):

Ann E. Perreau ◽

Richard S. Tyler ◽

Patricia C. Mancini ◽

Shelley Witt ◽

Mohamed Salah Elgandy

Keyword(s):

Therapeutic Process ◽

Treatment Options ◽

Clinical Group ◽

Education Session ◽

Group Approach ◽

Treatment Protocols ◽

Educational Session ◽

Evidence Based Treatment ◽

Relationship Of ◽

The Relationship

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197

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Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

Revista de Chimie ◽

10.37358/rc.18.2.6110 ◽

2018 ◽

Vol 69 (2) ◽

pp. 375-378

Author(s):

Catalin Pricop ◽

Ileana Adela Vacaroiu ◽

Daniela Radulescu ◽

Daniel Andone ◽

Dragos Puia

Keyword(s):

Renal Impairment ◽

Serum Creatinine ◽

Young Patients ◽

Kidney Injury ◽

Contralateral Kidney ◽

Reactive Protein ◽

Ureteral Lithiasis ◽

Unilateral Hydronephrosis ◽

Duration Of Hospitalization ◽

History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

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Incomplete Kawasaki disease - a diagnostic and therapeutic challenge

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v9i4.10234 ◽

2014 ◽

Vol 9 (4) ◽

pp. 30-35

Author(s):

S Datta ◽

S Maiti ◽

G Das ◽

A Chatterjee ◽

P Ghosh

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

Incomplete Kawasaki Disease ◽

Duration Of Symptoms ◽

Clinical Criteria ◽

Echocardiographic Finding ◽

2D Echocardiography ◽

Acquired Heart Disease ◽

The Mean ◽

One Year

Background The diagnosis of classical Kawasaki Disease was based on clinical criteria. The conventional criteria is particularly useful in preventing over diagnosis, but at the same time it may result in failure to recognize the incomplete form of Kawasaki Disease. Objective To suspect incomplete Kawasaki Disease, because early diagnosis and proper treatment may reduce substantial risk of developing coronary artery abnormality which is one of the leading causes of acquired heart disease in children. Method Nine cases of incomplete Kawasaki Disease were diagnosed over a period of one year. The diagnosis of incomplete Kawasaki Disease was based on fever for five days with less than four classical clinical features and cardiac abnormality detected by 2D- echocardiography. A repeat echocardiography was done after 6 weeks of onset of illness. The patients were treated with Intravenous Immunoglobulin and/or aspirin. Result The mean age of the patients was 3.83 years and the mean duration of symptoms before diagnosis was 12.1 days. Apart from other criteria all of our patients had edema and extreme irritability. All the patients had abnormal echocardiographic finding. Five patients received only aspirin due to nonaffordability of Intravenous Immunoglobulin and four patients received both aspirin and Intravenous Immunoglobulin, but the outcome was excellent in all the cases. Conclusion Incomplete Kawasaki Disease can be diagnosed with more awareness and aspirin alone may be used as a second line therapy in case of non affordability of Intravenous Immunoglobulin. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10234

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POS1281 HOW DOES OBESITY INFLUENCE THE FEATURES OF KNEE OSTEOARTHRITIS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3602 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 923.4-924

Author(s):

H. Hachfi ◽

D. Khalifa ◽

M. Brahem ◽

N. Ben Chekaya ◽

M. Younes

Keyword(s):

Knee Osteoarthritis ◽

Functional Impairment ◽

Statistical Significance ◽

Obese Group ◽

University Hospital ◽

Obese Patients ◽

Cross Sectional ◽

Duration Of Symptoms ◽

Lequesne Index ◽

The Mean

Background:Knee osteoarthritis and obesity are both major health problems. It is now admitted that the prevalence of knee osteoarthritis gets higher with obesity and that weight loss helps knee function and allows patients to avoid surgery.Objectives:The aim of this study was to study the influence of obesity on knee osteoarthritis features.Methods:A cross-sectional study was conducted in the university hospital Taher Sfar of Tunisia over a period of 6 months. Patients who had knee osteoarthritis confirmed by radiographs were included. Sociodemographic, clinical, radiological and therapeutic data were collected from medical records and visits. Obesity was defined by a body mass index (BMI) ≥30. Functional impairment was assessed by the Womac index and Lequesne index.Results:The study included 186 patients. There were 31 males and 155 femmes. The mean age was 60±10 years. The percentage of obese patients was 53,8%. The mean age was similar in both groups obese and non obese. There were more women in the obese group compared to the non obese group (p=0.0001), more patients who had diabetes mellitus and dyslipidemia (p=0.002). Non-obese patients had a shorter duration of symptoms with no statistical significance (p=0.151). Obese patients had more involvement of both knees (p<0.0001). Obesity did not have an impact on pain severity. Severity of radiological images (p=0,0001) were more frequent in obese patients. Functional impairment was similar in both groups. However, the percentage of patients having a very important functional impairment with Lequesne index was higher in obese patients (p<0.029). Obese patients also needed more physical therapy sessions (p=0.035).Conclusion:Knee osteoarthritis in obese patients is characterized with the femlae gender predominance, bilateral knee involvement, and a more severe images on radiographs. Thus the need for better control of weight and the importance of physical activity.References:[1]Coggon D, Reading I, Croft P, et al. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 2001; 25: 622–627.Disclosure of Interests:None declared

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Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis

Journal of Orthopaedic Surgery ◽

10.1177/2309499020968296 ◽

2020 ◽

Vol 29 (1) ◽

pp. 230949902096829

Author(s):

Christina van Gerven ◽

Kevin Eid ◽

Tobias Krüger ◽

Michael Fell ◽

Daniel Kendoff ◽

...

Keyword(s):

Antibiotic Treatment ◽

Serum Levels ◽

Blood Chemistry ◽

Nonoperative Treatment ◽

C Reactive Protein ◽

Disc Disease ◽

Reactive Protein ◽

Postoperative Serum ◽

Wbc Count ◽

And Control

Purpose: C-reactive protein (CRP) and white blood cell (WBC) count are routine blood chemistry parameters in monitoring infection. Little is known about the natural history of their serum levels in conservative and operative spondylodiscitis treatment. Methods: Pre- and postoperative serum levels of CRP and WBC count in 145 patients with spondylodiscitis were retrospectively assessed. One hundred and four patients were treated by debridement, spondylodesis, and an antibiotic regime, 41 only with a brace and antibiotics. The results of the surgical group were compared to 156 patients fused for degenerative disc disease (DDD). Results: Surgery had a significant effect on peak postoperative CRP levels. In surgically managed patients, CRP peaked at 2–3 days after surgery (spondylodiscitis: pre-OP: 90 mg/dl vs. post-OP days 2–3: 146 mg/dl; DDD: 9 mg/dl vs. 141 mg/dl; p < 0.001), followed by a sharp decline. Although values were higher for spondylodiscitis patients, dynamics of CRP values were similar in both groups. Nonoperative treatment showed a slower decline. Surgically managed spondylodiscitis showed a higher success rate in identifying bacteria. Specific antibiotic treatment led to a more predictable decline of CRP values. WBC did not show an interpretable profile. Conclusion: CRP is a predictable serum parameter in patients with spondylodiscitis. WBC count is unspecific. Initial CRP increase after surgery is of little value in monitoring infection. A preoperative CRP value, and control once during the first 3 days after surgery is sufficient. Closer monitoring should then be continued. Should a decline not be observed, therapy needs to be scrutinized, antibiotic treatment reassessed, and concomitant infection contemplated.

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