Epidemiology of Pediatric Tracheostomy and Risk Factors for Poor Outcomes: An 11-Year Single-Center Experience

2019 ◽  
Vol 162 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Aletheia Z. H. Chia ◽  
Zhi Min Ng ◽  
Yu Xian Pang ◽  
Annette H. C. Ang ◽  
Cristelle C. T. Chow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Unit Length ◽  
Case Series ◽  
Failure To Thrive ◽  
Tertiary Hospital ◽  
Supplemental Oxygen ◽  
Interquartile Range ◽  
Factors Associated ◽  
Single Center Experience

Objective Children with long-term tracheostomies are at higher risk of complications. This study aims to describe the epidemiology, outcomes, and factors associated with successful decannulation in children undergoing tracheostomy. Study Design Case series with chart review. Setting Tertiary hospital. Subjects and Methods A retrospective analysis was conducted on pediatric tracheostomies performed from 2006 to 2016. Demographics, preexisting comorbidities, indications for tracheostomy, and pretracheostomy ventilatory requirements were collected. A multivariate regression model with covariates of age, failure to thrive (FTT), and comorbidities was used to identify factors associated with successful decannulation. Secondary outcomes were ventilation and oxygen requirements at hospital discharge, hospital and intensive care unit length of stay, and complications. Results In total, 105 patients received a tracheostomy at a median age of 8.0 months (interquartile range, 2.0-45.0). The most common indication was anatomic airway obstruction (55 of 105, 52.5%). Forty-four (41.9%) patients had preexisting FTT. In-hospital mortality was 14 of 105 (13.3%). None were directly related to tracheostomy. At discharge, 40 of 91 (44.0%) and 12 of 91 (13.2%) required home mechanical ventilation and supplemental oxygen, respectively. Forty-one (39%) patients underwent successful decannulation at a median 408 days (interquartile range, 170-1153) posttracheostomy. On adjusted analysis, unsuccessful decannulation was more common in patients with FTT and neurologic comorbidities. Postoperative complications were more common in younger patients and those with a longer time to decannulation. Conclusion Neurologic comorbidities and FTT were risk factors for unsuccessful decannulation after pediatric tracheostomy. Nutritional interventions may have a role in improving long-term outcomes following pediatric tracheostomies and should be investigated in future studies.

scholarly journals OP0133 THE PREVALENCE AND RISK FACTORS OF RETINAL TOXICITY ASSOCIATED WITH LONG-TERM HYDROXYCHLOROQUINE USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 77-78
Author(s):  
S. Do ◽  
J. H. Du ◽  
J. X. An ◽  
J. Wang ◽  
A. Lin
Keyword(s):  
Risk Factors ◽  
Cumulative Dose ◽  
Daily Intake ◽  
Retinal Toxicity ◽  
Factors Associated ◽  
Duration Of Therapy ◽  
Increased Risk ◽  
Hydroxychloroquine Retinopathy ◽  
Risk Of Retinopathy

Background:Hydroxychloroquine (HCQ) is commonly used for the treatment of various autoimmune diseases. The medication is generally well-tolerated. However, long-term use after 5 years may increase the risk of retinopathy. One study in 2014 has demonstrated the risk can be as high as 7.5%. Optical Coherence Tomography (OCT) has become a major modality in screening retinopathy.Objectives:To evaluate the prevalence of retinal toxicity among patients using hydroxychloroquine and to determine various risk factors associated with hydroxychloroquine-associated retinal toxicity.Methods:We performed a retrospective chart review on a cohort of adult patients with long-term use (≥ 5 years cumulative) of HCQ between January 1st, 2011 to December 31st, 2018 from the Kaiser Permanente San Bernardino County and Riverside medical center areas in Southern California, USA. Patients were excluded if they had previously been diagnosed with retinopathy prior to hydroxychloroquine use, were deceased, or had incomplete OCT exam. Our primary endpoint was the prevalence of patients who developed retinal toxicity detected by OCT, and later confirmed by retinal specialist. Potential risk factors (age, duration of therapy, daily consumption per actual body weight, cumulative dose, confounding diseases and medication) for developing retinopathy were also evaluated. Univariable and multivariable logistic regression analyses were used to determine risk factors associated with retinal toxicity.Results:Among 676 patients exposed to more than 5 years of HCQ, the overall prevalence of retinal toxicity was 6.8%, and ranged from 2.5% to 22.2% depending on the age, weight-based dosing, duration of use and cumulative dose. Duration of therapy for 10 years or more increased risk of retinopathy by approximately 5 to 19 folds. Similarly, weight-based dose of 7 mg/kg/day or greater was assciated with increased risk of retinopathy by approximately 5 times. Patients with cumulative dose of 2000 grams or more had greater than 15 times higher risk of developing retinopathy. Duration of use for10 years or more (odd ratio 4.32, 95% CI 1.99 – 12.49), age (odd ratio 1.04; 95% CI 1.01 - 1.08), cumulative dose of more than 1500 g (odd ratio 7.4; 95% CI 1.40 – 39.04) and atherosclerosis of the aorta (odd ratio 2.59; 95% CI, 1.24 – 5.41) correlated with higher risk of retinal toxicity.Conclusion:The overall prevalence of retinopathy was 6.8%. Regular OCT screening, especially in patients with hydroxychloroquine use for more than 10 years, daily intake > 7 mg/kg, or cumulative dose > 1500 grams is important in detecting hydroxychloroquine-associated retinal toxicityReferences:[1]Hobbs HE. Sorsby A, & Freedman A. Retinopathy Following Chloroquine Therapy. The Lancet. 1959; 2(7101): 478-480.[2]Levy, G. D., Munz, S. J., Paschal, J., Cohen, H. B., Pince, K. J., & Peterson, T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis & Rheumatism: 1997; 40(8): 1482-1486.[3]Ding, H. J., Denniston, A. K., Rao, V. K., & Gordon, C. Hydroxychloroquine-related retinal toxicity. Rheumatology. 2016; 55(6): 957-967.[4]Stelton, C. R., Connors, D. B., Walia, S. S., & Walia, H. S. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clinical rheumatology. 2013; 32(6): 895-898.[5]Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016; 123(6): 1386-1394.[6]Melles, R. B., & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA ophthalmology. 2014; 132(12): 1453-1460.Disclosure of Interests:None declared

Infections Acquired by Adults Who Receive Extracorporeal Membrane Oxygenation Risk Factors and Outcome

2013 ◽  
Vol 34 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Cecile Aubron ◽  
Allen C. Cheng ◽  
David Pilcher ◽  
Tim Leong ◽  
Geoff Magrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Extracorporeal Membrane Oxygenation ◽  
Unit Length ◽  
Severity Of Illness ◽  
Infectious Complications ◽  
Hospital Length ◽  
Interquartile Range ◽  
Hospital Length Of Stay ◽  
Membrane Oxygenation

Objectives.To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.Design.Retrospective observational survey from 2005 through 2011.Participants and Setting.Patients who required ECMO in an Australian referral center.Methods.Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.Results.A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.Conclusion.The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.

Long‐term Surgical Outcomes after Resection of Presacral Tumours and Risk Factors Associated with Recurrence

2021 ◽  
Author(s):  
Di Zhang ◽  
Yizhou Sun ◽  
Lei Lian ◽  
Bang Hu ◽  
Heng Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Factors Associated

Abstract W P21: Should We Perform Thrombectomy In Patients With Wake-up Strokes? A Case Series Using Ct Perfusion For Patient Selection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gabriel Vidal ◽  
James Milburn ◽  
Garrett Bennett ◽  
Vivek Sabharwal ◽  
Mustafa Al Hasan
Keyword(s):  
Risk Factors ◽  
Ct Perfusion ◽  
Medical Center ◽  
Case Series ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Single Center Experience ◽  
Aspiration Technique ◽  
Group 2

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

scholarly journals Analysis of Risk Factors Associated with Outcomes in Road Traffic Injury Patients with Acute Lung Injury

2009 ◽  
Vol 37 (3) ◽  
pp. 835-840
Author(s):  
L Sheng ◽  
J-S Wu ◽  
M Zhang ◽  
S-W Xu ◽  
J-X Gan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Road Traffic ◽  
Road Traffic Injury ◽  
Apache Ii Score ◽  
Factors Associated ◽  
Traffic Injury ◽  
Short And Long Term

Over 50% of road traffic injury (RTI) patients experience post-traumatic acute lung injury (ALI) and it is, therefore, extremely important to identify the risk factors related to the poor outcomes associated with ALI in RTI populations. This study evaluated 19 potential risk factors associated with the outcomes of ALI in 366 RTI patients. They were divided into two groups: a ‘favourable outcomes group’ and an ‘unfavourable outcomes group’. The results indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the presence of gastrointestinal haemorrhage may help predict the outcomes of ALI in the early post-trauma phase of treatment. The duration of trauma and sepsis were shown to impact strongly on both the short- and long-term outcomes of ALI. Age (≥ 65 years) and disseminated intravascular coagulation in the early RTI phase were also independent risk factors for a poorer short- and long-term outcome in ALI.

scholarly journals Examination of main lymph node (No.253) metastasis in left colorectal cancer: A retrospective analysis of a single-institution cohort

2021 ◽  
Author(s):  
Takefumi Yoshida ◽  
Fumihiko Fujita ◽  
Dai Shida ◽  
Kenichi Koushi ◽  
Kenji Fujiyoshi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Poor Prognosis ◽  
Advanced Colorectal Cancer ◽  
D3 Lymphadenectomy ◽  
Positive Group ◽  
Factors Associated

Abstract Background. The extent of lymph node dissection in advanced colorectal cancer varies according to regional guidelines. D3 lymphadenectomy is routinely performed in Japan but is associated with several risk factors. Metastases of the main lymph nodes (No.253 lymph nodes), which are located at the root of the inferior mesenteric artery, are rare in left-sided colorectal cancer. Tumor depth (T4) is an identifier of No.253 lymph node metastasis (LNM) risk, but other risk factors associated with No.253 LNM are unclear. This study was undertaken to investigate the frequency of No.253 LNM and to identify other clinicopathological risk factors associated with No.253 LNM in left-sided colorectal cancer. In this study, we aimed to evaluate the clinical benefit of routine D3 lymphadenectomy in surgically treated advanced colorectal cancer. Methods. A retrospective database of patients with colorectal cancer who underwent D3 dissection and R0 resection at Kurume University Hospital from 1978 to 2017 was constructed and used to search for the frequency and risk factors of No.253 LNM to investigate long-term prognosis. Clinicopathological factors associated with No.253 LNM, including age, sex, tumor location, T stage, tumor diameter, carcinoembryonic antigen levels, and various dissected lymph nodes, were analyzed. Results. Among 1,614 consecutive patients, No.253 LNM was observed in 23 cases (1.4%). The presence of three or more regional LNMs was an independent risk factor for No.253 LNM (odds ratio: 26.8). The 5-year overall survival rate was 49.1% in the No.253 LNM-positive group and 78.4% in the No.253 LNM-negative group (p=0.002). Conclusion. In left-sided colorectal cancer, No.253 LNM was a poor prognosis factor, and three or more regional LNMs were a risk factor for No.253 LNM. The No.253 LNM-positive group had a poor prognosis, but there are cases of long-term survival, with a 5-year survival rate of 49%. D3 lymphadenectomy is suitable when three or more metastatic LNs are identified prior to surgery.

scholarly journals Outcome of pinning in patients with slipped capital femoral epiphysis: risk factors associated with avascular necrosis, chondrolysis, and femoral impingement

2017 ◽  
Vol 46 (6) ◽  
pp. 2120-2127 ◽  
Author(s):  
Alexandru Ulici ◽  
Madalina Carp ◽  
Iulia Tevanov ◽  
Catalin Alexandru Nahoi ◽  
Alin Gabriel Sterian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Avascular Necrosis ◽  
Slipped Capital Femoral Epiphysis ◽  
Normal Weight ◽  
Single Centre ◽  
Factors Associated ◽  
Hip Impingement ◽  
Α Angle

Objective This study aimed to assess the principal risk factors that could lead to the most common long-term complications of slipped capital femoral epiphysis, such as avascular necrosis, chondrolysis, and hip impingement. Methods We conducted a single-centre, retrospective study and evaluated patients (70 patients, 81 hips) who were treated for slipped capital femoral epiphysis from 2010 to 2015 and who underwent pinning. We measured the severity of displacement radiologically using the Southwick angle. Postoperative radiographs were evaluated for the most frequent long-term complications of avascular necrosis (AVN), chondrolysis, and femoral acetabular impingement (FAI). Results We found seven cases of AVN, 14 cases of chondrolysis, and 31 hips had an α angle of 60°. Sex, ambulation, and symptoms did not affect development of these complications. Patients with a normal weight were almost two times more likely to develop FAI. Patients with moderate and severe slips had a similar percentage of AVN. In severe slips, 85.7% of patients had an α angle higher than 60°. Conclusions This study shows that severe slips have a higher risk of developing AVN and hip impingement. Every patient who suffers from SCFE (even the mildest forms) should be regularly checked for FAI.

MO291RITUXIMAB IS EFFECTIVE AND SAFE IN ADULTS WITH STEROID-DEPENDENT NEPHROTIC SYNDROME: A LONG-TERM, SINGLE-CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Gemma Patella ◽  
Alessandro Comi ◽  
Giuseppe Coppolino ◽  
Nicolino Comi ◽  
Giorgio Fuiano ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Case Series ◽  
Adult Patients ◽  
Single Center ◽  
Single Center Experience ◽  
Steroid Dependent ◽  
The Mean ◽  
Steroid Dependent Nephrotic Syndrome

Abstract Background and Aims Steroid-dependent nephrotic syndrome (SDNS) may require a prolonged multi-drug therapy with risk of drug toxicity and renal failure. Rituximab (RTX) treatment has been found to be helpful in reducing the steroid dosage and the need for immunosuppressants (ISs), but little data are currently available regarding very long-term outcomes in adults. We herein describe a long-term, single-center experience of RTX use in a large series of adults with SDNS. Method We studied 23 adult patients with SDNS (mean age 54.2±17.1 y; 65% male; BMI 28.5±4.7), mostly consequent to membranous (47.8%) or focal glomerulonephritis (30.2 %) who were eligible to start a RTX regimen. Before entering the RTX protocol, proteinuria and eGFR were 7.06±3.87 g/24h and 65.9±28.2 ml/min/1.73 m2, respectively; albumin and CD19/CD20 ratio were 2.9±0.9 g/L and 0.99±0.01 respectively; the mean number of ISs was 2.39±0.89 and the mean annual rate of relapses was 2.2±0.9. Results Patients were followed over a mean follow-up of 64 months (range: 12-144). After RTX (mean dose: 1202.1±372.4 mg) the rate of relapses was virtually nullified (p&lt;0.001). eGFR remained roughly stable (62.1±19.8 ml/min/1.73 m2, p=NS), while proteinuria, albumin, CD19/CD20 and BMI all significantly improved (p ranging from 0.01 to 0.001). The mean number of additional ISs was also reduced (0.44±0.12; p&lt;0.001) and RTX enabled discontinuation of steroids in 13/23 (56.5%) patients. No major adverse events related to therapy were recorded. Conclusion Findings from this large case-series with a remarkable very long follow-up reinforce the role of RTX as an efficient and safe weapon to improve outcomes in adult patients suffering from SDNS.

scholarly journals Risk factors for delayed negative conversion of SARS-CoV-2 in patients with COVID-19 pneumonia: a retrospective cohort study

2020 ◽  
Vol 148 ◽  
Author(s):  
Pingzheng Mo ◽  
Liping Deng ◽  
Xiaoping Liu ◽  
Shicheng Gao ◽  
Ke Liang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Short Term ◽  
Factors Associated ◽  
Single Centre Study ◽  
Chief Complaints ◽  
Area Under Roc Curve ◽  
Conversion Time ◽  
To Receive ◽  
Negative Conversion

Abstract The epidemic of coronavirus disease 2019 (COVID-19) began in China and had spread rapidly to many other countries. This study aimed to identify risk factors associated with delayed negative conversion of SARS-CoV-2 in COVID-19 patients. In this retrospective single-centre study, we included 169 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from 15th January to 2nd March. The cases were divided into two groups according to the median time of SARS-CoV-2 negative conversion. The differences between groups were compared. In total, 169 patients had a median virus negative conversion time of 18 days (interquartile range: 11–25) from symptom onset. Compared with the patients with short-term negative conversion, those with long-term conversion had an older age, higher incidence of comorbidities, chief complaints of cough and chest distress/breath shortness and severer illness on admission, higher level of leucocytes, neutrophils, aspartate aminotransferase, creatine kinase and erythrocyte sedimentation rate (ESR), lower level of CD3+CD4+ lymphocytes and albumin and more likely to receive mechanical ventilation. In multivariate analysis, cough, leucocytes, neutrophils and ESR were positively correlated with delayed virus negative conversion, and CD3+CD4+ lymphocytes were negatively correlated. The integrated indicator of leucocytes, neutrophils and CD3+CD4+ lymphocytes showed a good performance in predicting the negative conversion within 2 weeks (area under ROC curve (AUC) = 0.815), 3 weeks (AUC = 0.804), 4 weeks (AUC = 0.812) and 5 weeks (AUC = 0.786). In conclusion, longer quarantine periods might be more justified for COVID-19 patients with cough, higher levels of leucocytes, neutrophils and ESR and lower levels of CD3+CD4+ lymphocytes.

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