scholarly journals Factors associated with hospital outcomes of patients with penetrating craniocerebral injuries in armed conflict areas of the Democratic Republic of the Congo: a retrospective series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paterne Safari Mudekereza ◽  
Gauthier Bahizire Murhula ◽  
Charles Kachungunu ◽  
Amani Mudekereza ◽  
Fabrice Cikomola ◽  
...  

Abstract Introduction Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI. Methods This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients’ admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4. Results The prevalence of PCCI was 9.1% (91/858 cases) among admitted TBI patients. More than one-third (36.2%) of patients were admitted with GCS < 13, and 40.6% of them were unstable hemodynamic. Hemiplegia was found in 23.1% on admission. Eight patients had an intracerebral hemorrhage. Among the 69 operated patients, complications, mainly infectious, occurred in half (50.7%) of patients. Poor hospital outcomes were observed in 30.4% and associated with an admission GCS < 13, hemodynamic instability, intracerebral hemorrhage, and hemiplegia (p < 0.05). Conclusion The hospital poor outcomes are observed when patients present with hemodynamic instability, an admission GCS < 13, intracerebral hemorrhage, and hemiplegia. There is a need for optimizing the initial care of patients with PCCI in armed conflict regions.

2010 ◽  
Vol 86 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Sérgio Diniz Guerra ◽  
Luis Fernando Andrade Carvalho ◽  
Carolina Ara&uacute;jo Affonseca ◽  
Alexandre Rodrigues Ferreira ◽  
Heliane Brant Machado Freire

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
William Beaubien-Souligny ◽  
Yifan Yang ◽  
Karen E. A. Burns ◽  
Jan O. Friedrich ◽  
Alejandro Meraz-Muñoz ◽  
...  

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aaron S Lord ◽  
Mitchell S Elkind ◽  
Carl D Langefeld ◽  
Charles J Moomaw ◽  
Neeraj Badjatia ◽  
...  

Background: Risk factors for nosocomial infections and their impact on ICH outcomes are unclear. We hypothesized that factors present on admission are associated with developing infection, and patients who develop infections have worse outcomes. Methods: We determined prevalence of infections among patients in ERICH, a multicenter, triethnic case-control study of ICH. Exclusion criteria specific to this analysis were incomplete CT data and death/withdrawal of care <72 hours after admission. Patients with infection <two weeks before ICH were excluded from risk factor analyses, but included for outcomes assessments. We compared prevalence of risk factors for infections using chi-square and non-parametric tests, and performed multivariate logistic regression for risk of infection. Results: We enrolled 1397 individuals, 144 of whom died/had withdrawal of care within 72 hours and 210 with incomplete CT data, leaving 1043 patients. Nosocomial infections occurred in 300 patients (29%). Factors associated with presence of infections included ICH volume (13mL vs. 7mL, p <0.0001), GCS on admission (13 vs. 15, p <0.0001), WBC > 10 (42% vs. 32%), and higher CRP levels (4.9 vs. 1.8, p=0.01). Blacks had higher infection rates versus whites and Hispanics (33% vs. 27% and 24%, p=0.06). Procedural factors associated with infection included ventriculostomy, intrathecal-tPA, and intubation, while major neurosurgical procedures were associated with a 10-fold increase in CNS infection (all p <0.001). Infections were associated with bowel-bladder dysfunction, CHF/pulmonary edema, decubiti, DVT, dysphagia requiring PEG, and MI. Patients with infection were more likely to have DNR/DNI orders or to be dead at discharge (12.3% vs. 6.5%, p=0.0017). In a multivariate model for factors associated with infection, ICH volume, HIV history, intubation, CHF/pulmonary edema, and dysphagia requiring PEG were all associated with infection. Conclusion: There are identifiable risk factors associated with nosocomial infection after ICH, and infections are associated with mortality. Identification of patients at risk for infections may improve outcomes after ICH.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael L James ◽  
Julian P Yand ◽  
Maria Grau-Sepulveda ◽  
DaiWai M Olson ◽  
Deepak L Bhatt ◽  
...  

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.


2014 ◽  
Vol 53 (4) ◽  
pp. 283-293 ◽  
Author(s):  
Katarina Boričić ◽  
Snežana Simić ◽  
Nađa Vasiljević ◽  
Jelena Marinković

AbstractIntroduction. The pandemic of obesity in adolescents is one of the challenges of public health.Aim. The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents.Method. A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model.Results. The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p< 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index.Conclusion. These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.


2021 ◽  
Vol 121 (1) ◽  
pp. 65-69
Author(s):  
Svіtlana Diachenko ◽  
Roksolana Dіduk ◽  
Nailia Kashapova ◽  
Alina Pletenetska

The problem of studying the mechanisms of the occurrence of traumatic brain injury remains a very urgent issue for forensic medicine. The high incidence and high mortality rate of head injuries underlines its importance to experts. The article presents a case from the practice of a forensic medical examination of a traumatic brain injury. This case is indicative, since it clearly demonstrates the difficulties that forensic doctors face when examining craniocerebral injuries, when determining the mechanism of damage and the severity of bodily injuries. In this case, there is damage to the head and a concussion. The cited several conclusions of the experts of the bureau of forensic medical examination and the commission examination of the Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine regarding the forensic medical assessment in the case of traumatic brain injury with damage to the head. When conducting an investigative experiment, it was determined that the simultaneous occurrence of an abrasion and a concussion of the brain with one traumatic effect in the glabellar region is unlikely. After all, a concussion of the brain and abrasions in the glabellar area were formed by different mechanisms. The results of this assessment of the characteristics of traumatic brain injury can be useful for preventing difficulties in establishing the mechanism of damage in further expert practice.


Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Zhu Zhu ◽  
Sahar Osman ◽  
Mark Farag ◽  
Dana Stradling ◽  
Mohammad Shafie ◽  
...  

Author(s):  
Ntamulenga Innocent ◽  
Mulongo Mbarambara Philémon ◽  
Imani Prince ◽  
Yatoka Justine ◽  
Mukanire Ntakwinja ◽  
...  

Background: The primary objective of the present study is to determine the episiotomy rate and factors associated with practice of episiotomy at the maternities in Bukavu town, South-Kivu, DRC.Methods: A case-control study was carried out the women who underwent the episiotomy (case) and those which did not undergo episiotomy (control) over one 12 months period between January to December 2015. A total of 1878 women had a vaginal delivery at a rate of one case for one control (939 cases and 939 controls) were included. Their medical files were exploited. The factors associated with episiotomy were performed by logistic regression.Results: The rate of episiotomy was 20.4%. It was found that after the logistic regression, the Primiparity (OR = 4,5;95% CI:2,31-4,49), the existence of a foetal distress (OR = 4,2;IC to 95% CI :2,36-5,29), the antecedent of episiotomy (OR = 3,9;95% CI:2,83-7,07), private character of maternity (OR= 3,3; 95% CI :2,12-6,30) and the fact that the childbirth was directed by a doctor (OR = 2,3; 95% CI :1,85-5,08) were strongly associated with the practice of the episiotomy in our medium of study.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted.


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