scholarly journals No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study

2020 ◽  
pp. 219256822090241 ◽  
Author(s):  
Dorine S. Klei ◽  
F. Cumhur Öner ◽  
Luke P. H. Leenen ◽  
Karlijn J. P. van Wessem
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Failure Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Spinal Fractures ◽  
Thoracic Wall ◽  
Upper Cervical Spine ◽  
Lower Lumbar Spine

Study Design: Retrospective cohort study. Objectives: Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing. Methods: A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded. Results: In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes. Conclusions: These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.

scholarly journals Predictors of increasing injury severity across suspected recurrent episodes of non-accidental trauma: a retrospective cohort study

2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Jonathan Thackeray ◽  
Peter C. Minneci ◽  
Jennifer N. Cooper ◽  
Jonathan I. Groner ◽  
Katherine J. Deans
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Accidental Trauma ◽  
Non Accidental Trauma

scholarly journals Time to develop severe acute malnutrition and its predictors among children living with HIV in the era of test and treat strategies at South Gondar hospitals, northwest, Ethiopia, 2021: a multicentre retrospective cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ermias Sisay Chanie ◽  
Getasew Legas ◽  
Shimeles Biru Zewude ◽  
Maru Mekie ◽  
Dagne Addisu Sewyew ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Living With Hiv ◽  
South Gondar

Abstract Background Although severe acute malnutrition is a major public issue among HIV infected children, there is no prior evidence in Ethiopia. Hence, this study aims to assess the time to develop severe acute malnutrition and its predictors among children living with human immunodeficiency virus in Ethiopia, 2012. Methods An institution based retrospective cohort study was conducted in South Gondar hospitals among 363 HIV infected children from February 10, 2014, to January 7, 2021. Epi-data version 3.1 was used to enter data, which was then exported to STATA version 14 for analysis. Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. A standardized data extraction tool was used to collect the data. The Kaplan Meier survival curve was used to estimate the median survival time. The Cox-proportional hazard model assumption was checked via the Schoenfeld residual ph test and a stph plot. Bivariable and multivariable Cox proportional hazard models were employed at 95% confidence intervals (CI). A variable having a p-value < 0.05 was considered a statistically significant predictor of severe acute malnutrition. Results A total of 363 children living with HIV, 97 (26.72%) developed severe acute malnutrition during the follow-up period. The overall incidence rate was 5.4 (95% CI: 4.7–5.9) person per year with a total of 21, 492 months or 1791 years of observation. Moreover, the median survival time was 126 months. Treatment failure [AHR =3.4 (95% CI: 2.05–5.75)], CD4 count below threshold [AHR =2.5 (95% CI: 1.64–3.95)], and WHO stage III & IV [AHR =2.9 (95% CI: 1.74–4.73)] were all significant predictors of severe acute malnutrition. Conclusion The time to develop severe acute malnutrition was found to be very low. Treatment failure, CD4 count below threshold, and WHO stage III were all significant predictors of severe acute malnutrition. Hence, emphasizing those predictor variables is essential for preventing and controlling the occurrence of severe acute malnutrition among HIV infected children.

scholarly journals Mycobacterium abscessus Complex Infections: A Retrospective Cohort Study

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Maroun Sfeir ◽  
Marissa Walsh ◽  
Rossana Rosa ◽  
Laura Aragon ◽  
Sze Yan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Renal Disease ◽  
Treatment Failure ◽  
Retrospective Cohort Study ◽  
Early Treatment ◽  
Retrospective Cohort ◽  
Positive Culture ◽  
Mycobacterium Abscessus ◽  
Early Treatment Failure

Abstract Background Infections caused by Mycobacterium abscessus group strains are usually resistant to multiple antimicrobials and challenging to treat worldwide. We describe the risk factors, treatment, and clinical outcomes of patients in 2 large academic medical centers in the United States. Methods A retrospective cohort study of hospitalized adults with a positive culture for M. abscessus in Miami, Florida (January 1, 2011, to December 31, 2014). Demographics, comorbidities, the source of infection, antimicrobial susceptibilities, and clinical outcomes were analyzed. Early treatment failure was defined as death and/or infection relapse characterized either by persistent positive culture for M. abscessus within 12 weeks of treatment initiation and/or lack of radiographic improvement. Results One hundred eight patients were analyzed. The mean age was 50.81 ± 21.03 years, 57 (52.8%) were females, and 41 (38%) Hispanics. Eleven (10.2%) had end-stage renal disease, 34 (31.5%) were on immunosuppressive therapy, and 40% had chronic lung disease. Fifty-nine organisms (54.6%) were isolated in respiratory sources, 21 (19.4%) in blood, 10 (9.2%) skin and soft tissue, and 9 (8.3%) intra-abdominal. Antimicrobial susceptibility reports were available for 64 (59.3%) of the patients. Most of the isolates were susceptible to clarithromycin, amikacin, and tigecycline (93.8%, 93.8%, and 89.1%, respectively). None of the isolates were susceptible to trimethoprim/sulfamethoxazole, and only 1 (1.6%) was susceptible to ciprofloxacin. Thirty-six (33.3%) patients early failed treatment; of those, 17 (15.7%) died while hospitalized. On multivariate analysis, risk factors significantly associated with early treatment failure were disseminated infection (odds ratio [OR], 11.79; 95% confidence interval [CI], 1.53–81.69; P = .04), acute kidney injury (OR, 6.55; 95% CI, 2.4–31.25; P = .018), organ transplantation (OR, 2.37; 95% CI, 2.7–23.1; P = .005), immunosuppressive therapy (OR, 2.81; 95% CI, 1.6–21.4; P = .002), intravenous amikacin treatment (OR, 4.1; 95% CI, 0.9–21; P = .04), clarithromycin resistance (OR,79.5; 95% CI, 6.2–3717.1, P &lt; .001), and presence of prosthetic device (OR, 5.43; 95% CI, 1.57–18.81; P = .008). Receiving macrolide treatment was found to be protective against early treatment failure (OR, 0.13; 95% CI, 0.002–1.8; P = .04). Conclusions Our cohort of 108 M. abscessus complex isolates in Miami, Florida, showed an in-hospital mortality of 15.7%. Most infections were respiratory. Clarithromycin and amikacin were the most likely agents to be susceptible in vitro. Resistance to fluoroquinolone and trimethoprim/sulfamethoxazole was highly common. Macrolide resistance, immunosuppression, and renal disease were significantly associated with early treatment failure.

scholarly journals Longitudinal Radiographic Outcomes of Vestibular Schwannoma in Single and Fractionated Stereotactic Radiosurgery: A Retrospective Cohort Study

2019 ◽  
Vol 81 (03) ◽  
pp. 308-316
Author(s):  
Mohamed H. Khattab ◽  
Neil B. Newman ◽  
David M. Wharton ◽  
Alexander D. Sherry ◽  
Guozhen Luo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Stereotactic Radiosurgery ◽  
Vestibular Schwannoma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Treatment Success ◽  
Three Dimensional ◽  
Target Volume ◽  
Surveillance Imaging

AbstractManagement of vestibular schwannoma (VS) includes stereotactic radiosurgery (SRS) in single or fractionated treatments. There is a paucity of literature on the three-dimensional (3D) volumetric kinetics and radiological changes following SRS and no consensus on appropriate post-SRS surveillance imaging timeline. This is a retrospective cohort study with institutional review board approval. A total of 55 patients met study criteria. We collected volumetric kinetic data in VS treated with SRS over time using a target volume contouring software. We also tracked radiographic phenomena such as pseudoprogression and necrosis. A secondary objective was to describe our overall treatment success rate and any failures. For all treatments groups, pseudoprogression most typically occurred within 12 months post-SRS, after which tumor volumes on average normalized and then decreased from pretreatment size at the last follow-up. Only two patients required salvage therapy post-SRS and were considered SRS treatment failures. Both patients were in the five-fraction cohort but with a lower biologically equivalent dose. Our study is first to collect 3D volumetric kinetics of VS following single and fractionated SRS in contrast to extrapolations from single and two-dimensional measurements. Our longitudinal data also show initial increases in volume in the first 12 months post-SRS followed by later declines, setting up interesting questions regarding the utility of early posttreatment surveillance imaging in the asymptomatic patient. Finally, we show low rates of treatment failure (3.6%) and show in our cohort that SRS dose de-escalation posed a risk of treatment failure.

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