scholarly journals Symptomatic pelvic hematoma following hysterectomy: risk factors, bacterial pathogens and clinical outcome

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Henry H. Chill ◽  
Itshak Amsalem ◽  
Gilad Karavani ◽  
Sharon Amit ◽  
Abraham Benshushan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Bacterial Pathogens ◽  
Anaerobic Bacteria ◽  
Vaginal Surgery ◽  
Abdominal Hysterectomy ◽  
University Teaching ◽  
Common Finding ◽  
Pelvic Hematoma ◽  
Substantial Morbidity

Abstract Background Pelvic hematoma is a common finding following hysterectomy which at times may become infected causing substantial morbidity. The aim of this study was to describe the incidence, clinical manifestation and identify risk factors for infected pelvic hematoma. We also attempted to identify specific bacterial pathogens which may cause this phenomenon. Methods We conducted a retrospective cohort study at a tertiary university teaching hospital. Included were all women who underwent hysterectomy and were diagnosed with a pelvic hematoma following surgery from 2013 to 2018. In an attempt to assess possible risk factors for infected pelvic hematoma women with asymptomatic pelvic hematoma were compared to women with an infected pelvic hematoma. Results During the study period 648 women underwent hysterectomy at our medical center. Pelvic hematoma was diagnosed by imaging in 50 women (7.7%) including 41 women who underwent vaginal hysterectomy and 9 women who underwent abdominal hysterectomy. In 14 (2.2%) cases the hematoma became infected resulting in need for readmission and further treatment. Women who underwent vaginal surgery were more likely to return with infected pelvic hematoma compared to women who underwent open abdominal or laparoscopic surgery (4.5% vs. 1.1%, p < 0.05). In 8 women bacterial growth from hematoma culture was noted. Enterococcus faecalis, was the most abundant pathogen to be isolated in this sub-group. Conclusion Vaginal route of hysterectomy is a risk factor for infected pelvic hematoma following hysterectomy. Most of these infections were caused by anaerobic bacteria which may not be sufficiently covered by current antibiotic prophylactic regimens.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

Effect of Bismuth Subnitrate Teat Canal Sealant with Ampicillin-Cloxacillin Combination in Control of Bovine Mastitis in Selected Farms in Kenya

2020 ◽  
Keyword(s):  
Risk Factors ◽  
Bacterial Pathogens ◽  
Animal Health ◽  
Bovine Mastitis ◽  
Test Group ◽  
Control Group ◽  
Dry Period ◽  
Coagulase Negative Staphylococci ◽  
Bismuth Subnitrate ◽  
Teat Canal

This study presents the results of effect of a combination of bismuth subnitrate teat canal sealant (Boviseal® -Bimeda® Animal Health, Ireland) and the antibiotic Ampicillin & Cloxacillin (Bovaclox® DC-Norbrook Laboratories Ltd-UK) when used during the dry period on occurrence of mastitis 100 days post-calving. The objectives of this study were: to determine the effect of Boviseal® teat canal sealant in combination with Bovaclox® DC in control of dairy cow mastitis 100 days after calving; to determine bacterial pathogens causing mastitis in the selected farms and to determine risk factors for occurrence of dairy mastitis in the selected farms. This controlled field trial was carried out in two Kenyan dairy farms: Chemusian Farm in Nakuru County and Gicheha Farm in Kiambu County. 156 dairy cows were used in the study. Healthy cows with no history of mastitis in their current lactation were recruited. They were randomly placed into either of the two study groups: the control and the test group. The Control group received Bovaclox® DC while the Test group received the Bovaclox® DC followed by Boviseal®. The cows were followed during the entire dry period and 100 days post-calving monitoring for mastitis occurrence. Cows in the control group were more susceptible to mastitis 100 days post-calving compared to cows in the treatment group (P<0.001, RR=4.4, OR=17.7). Of the bacterial pathogens, coagulase negative Staphylococci (CNS) were the most common pathogens isolated from mastitic milk at 34.6 % followed by Micrococcus spp. (9.0%). Other bacteria isolated were Streptococcus agalactiae (3.8%), Staphylococcus aureus (1.9%); Escherichia coli (0.6%) and various bacterial mixtures. Results of logistic regressions at P≤0.05 showed that farm, position of the quarter, type of barn floor and type of treatment were significantly associated with occurrence of mastitis. Cows in Gicheha farm whose barn floor was earthen, those cows in the control group and hindquarters were risk factors for mastitis (RR=1.5, 4.4 and 1.18 respectively). The results of this study showed that Bovaclox® DC + Boviseal® teat canal sealant combination applied during the dry period is more effective in controlling bovine mastitis 100 days post-calving compared to the use of Bovaclox® DC alone. The study thus recommends the use of Bovaclox® DC + Boviseal® dry cow combination for control of bovine mastitis.

Characteristics and risk factors associated with stroke subtypes among adult patients admitted to stroke unit of JUMC

2019 ◽  
Vol 15 ◽  
Author(s):  
Bekalu Getachew Gebreegziabher ◽  
Tesema Etefa Birhanu ◽  
Diriba Dereje Olana ◽  
Behailu Terefe Tesfaye
Keyword(s):  
Risk Factors ◽  
Stroke Unit ◽  
Medical Center ◽  
Data Entry ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Factors Associated ◽  
Stroke Subtypes

Background: Stroke is a great public health problem in Ethiopia. According to reports, in-hospital stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, in this country researches done on factors associated with stroke sub-types were inadequate. Objective: To assess the Characteristics and risk factors associated with stroke sub-types among patients admitted to JUMC. Methods and materials: A retrospective cross sectional study was conducted from May 2017 to May 2018 in stroke unit of Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. Checklist comprising of relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Chi-square test was used to point-out association and difference among stroke sub-types. The data was presented using text, tables and figures. Result: From a total of 106 patients, 67(63.2%) were men. The mean ± SD of age was 52.67±12.46 years, and no significant association was found. Of all the patients, 59(55.6%) had ischemic strokes and 47(44.4%) had hemorrhagic strokes. The most common risk factor in the patients was alcohol use with a prevalence of 69.9%. Of all the risk factors, only sex, cigarettes smoking and dyslipidemia were significantly associated to sub-types of stroke. Conclusion: Ischemic stroke was the most common subtype of stroke. Sex of patient, cigarette smoking and dyslipidemia are significantly associated with the two stroke subtypes.

scholarly journals Analysis of Stress Factors for Female Professors at Online Universities

2020 ◽  
Vol 17 (8) ◽  
pp. 2958 ◽  
Author(s):  
Marialuz Arántzazu García-González ◽  
Fermín Torrano ◽  
Guillermo García-González
Keyword(s):  
Risk Factors ◽  
Time Pressure ◽  
Health And Safety ◽  
Stress Factors ◽  
University Teaching ◽  
Psychosocial Risks ◽  
Primary Stress ◽  
Information And Communication ◽  
The University ◽  
Mental Overload

The aim of this paper is to analyze the primary stress factors female professors at online universities are exposed to. The technique used for the prospective and exploratory analysis was the Delphi method. Two rounds of consultations were done with fourteen judges with broad experience in health and safety at work and university teaching who reached a consensus of opinion regarding a list of nine psychosocial risk factors. Among the most important risk factors, mental overload, time pressure, the lack of a schedule, and emotional exhaustion were highlighted. These risk factors are related to the usage and expansion of information and communication technology (ICT) and to the university system itself, which requires initiating more research in the future in order to develop the intervention programs needed to fortify the health of the affected teachers and protect them from stress and other psychosocial risks.

scholarly journals Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny S. Lou ◽  
Charles W. Goss ◽  
Bradley A. Evanoff ◽  
Jennifer G. Duncan ◽  
Thomas Kannampallil
Keyword(s):  
Risk Factors ◽  
Clinical Education ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Work ◽  
Educational Opportunities ◽  
Missed Opportunities ◽  
Physician Trainee ◽  
At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

Umbilical Fascial Defects are Common and Predict Trocar Site Hernias After Laparoscopic Appendectomy

2021 ◽  
pp. 000313482199506
Author(s):  
Steven M. Hernandez ◽  
Elizabeth A. Kiselak ◽  
Tania Zielonka ◽  
Scarlett Tucker ◽  
Melissa Blatt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Laparoscopic Appendectomy ◽  
Medical Center ◽  
Area Under The Curve ◽  
Demographic Information ◽  
Fascial Defect ◽  
Trocar Site ◽  
Trocar Site Hernia ◽  
Preoperative Ct ◽  
Tomography Scan

Introduction Investigations have demonstrated that trocar site hernia (TSH) is an under-appreciated complication of laparoscopic surgery, occurring in as many as 31%. We determined the incidence of fascial defects prior to laparoscopic appendectomy and its impact relative to other risk factors upon the development of TSH. Methods TSH was defined as a fascial separation of ≥ 1 cm in the abdominal wall umbilical region on abdominal computerized tomography scan (CT) following laparoscopic appendectomy. Patients admitted to our medical center who had both a preoperative CT and postoperative CT for any reason (greater than 30 days after surgery) were reviewed for the presence of TSH from May 2010 to December 2018. CT scans were measured for fascial defects, while investigators were blinded to film timing (preoperative or postoperative) and patient identity. Demographic information was collected. Results 241 patients undergoing laparoscopic appendectomy had both preoperative and late postoperative CT. TSH was identified in 49 (20.3%) patients. Mean preoperative fascial gap was 3.3 ± 4.3 mm in those not developing a postoperative hernia versus 14.8 ± 7.3 mm in those with a postoperative hernia ( P < .0001). Preoperative fascial defect on CT was predictive of TSH ( P < .001, OR = 1.44), with an Area Under the Curve (AUC) of .921 (95%CI: .88–.92). Other major risk factors for TSH were: age greater than 59 years ( P < .031, OR = 2.48); and obesity, BMI > 30 ( P < .012, OR = 2.14). Conclusions The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.

scholarly journals Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 598-604
Author(s):  
Valentina Opancina ◽  
Snezana Lukic ◽  
Slobodan Jankovic ◽  
Radisa Vojinovic ◽  
Milan Mijailovic
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Medical Center ◽  
White Blood Cells ◽  
Cerebral Aneurysms ◽  
International Normalized Ratio ◽  
Cross Sectional Study ◽  
Cross Sectional

AbstractIntroductionAneurysmal subarachnoid hemorrhage is a type of spontaneous hemorrhagic stroke, which is caused by a ruptured cerebral aneurysm. Cerebral vasospasm (CVS) is the most grievous complication of subarachnoid hemorrhage (SAH). The aim of this study was to examine the risk factors that influence the onset of CVS that develops after endovascular coil embolization of a ruptured aneurysm.Materials and methodsThe study was designed as a cross-sectional study. The patients included in the study were 18 or more years of age, admitted within a period of 24 h of symptom onset, diagnosed and treated at a university medical center in Serbia during a 5-year period.ResultsOur study showed that the maximum recorded international normalized ratio (INR) values in patients who were not receiving anticoagulant therapy and the maximum recorded white blood cells (WBCs) were strongly associated with cerebrovascular spasm, increasing its chances 4.4 and 8.4 times with an increase of each integer of the INR value and 1,000 WBCs, respectively.ConclusionsSAH after the rupture of cerebral aneurysms creates an endocranial inflammatory state whose intensity is probably directly related to the occurrence of vasospasm and its adverse consequences.

scholarly journals The Prevalence and Clinical Significance of Anaerobic Bacteria in Major Liver Resection

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 139
Author(s):  
Jens Strohäker ◽  
Sophia Bareiß ◽  
Silvio Nadalin ◽  
Alfred Königsrainer ◽  
Ruth Ladurner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anaerobic Bacteria ◽  
Positive Culture ◽  
Infectious Complications ◽  
University Hospital ◽  
Clinical Role ◽  
Liver Resections ◽  
Management Of Complications ◽  
Anaerobic Infections ◽  
Major Hepatectomies

(1) Background: Anaerobic infections in hepatobiliary surgery have rarely been addressed. Whereas infectious complications during the perioperative phase of liver resections are common, there are very limited data on the prevalence and clinical role of anaerobes in this context. Given the risk of contaminated bile in liver resections, the goal of our study was to investigate the prevalence and outcome of anaerobic infections in major hepatectomies. (2) Methods: We retrospectively analyzed the charts of 245 consecutive major hepatectomies that were performed at the department of General, Visceral, and Transplantation Surgery of the University Hospital of Tuebingen between July 2017 and August 2020. All microbiological cultures were screened for the prevalence of anaerobic bacteria and the patients’ clinical characteristics and outcomes were evaluated. (3) Results: Of the 245 patients, 13 patients suffered from anaerobic infections. Seven had positive cultures from the biliary tract during the primary procedure, while six had positive culture results from samples obtained during the management of complications. Risk factors for anaerobic infections were preoperative biliary stenting (p = 0.002) and bile leaks (p = 0.009). All of these infections had to be treated by intervention and adjunct antibiotic treatment with broad spectrum antibiotics. (4) Conclusions: Anaerobic infections are rare in liver resections. Certain risk factors trigger the antibiotic coverage of anaerobes.

scholarly journals THU0417 READMISSION RISK AND QUALITY OF CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH GOUT FLARES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 446.2-446
Author(s):  
L. Brunetti ◽  
J. Vekaria ◽  
P. Lipsky ◽  
N. Schlesinger
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Economic Burden ◽  
Hospital Admissions ◽  
Medical Center ◽  
Research Support ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Anti Inflammatory ◽  
Gout Flares

Background:Gout is the most common form of inflammatory arthritis and its economic burden is substantial, with estimates for the overall cost exceeding $20 billion (US) annually. Contributing to the economic burden are hospital admissions and iatrogenic events associated with pharmacotherapy. Identification of modifiable risk factors would be an important contribution to clinical practice.Objectives:The aim of this study was to identify opportunities for enhancing gout care in patients presenting to the Emergency Department (ED) with gout flares.Methods:This retrospective cohort study used data from electronic medical records (EMR) at a large community hospital. All consecutive patients visiting the medical center ED with a primary diagnosis of gout from 1/1/2016 to 7/1/2019 were included. Patients were then followed for 90 days to determine whether they were readmitted to the ED for any reason. A chart review identified whether they were on appropriate medications in terms of gout flare management. All data were summarized using descriptive statistics. A multiple logistic regression was constructed to identify risk factors for ED utilization within 90 days of the index visit.Results:A total of 214 patients were included in the analysis. Most patients were male (79%), mean age was 59.4 ± 15.6 years, and mean Charlson comorbidity index was 0.5 ± 1.14. The most common medications prescribed during the ED visit included NSAIDs (41.6%), opioids (28%), corticosteroids (26.6%), and colchicine (21%). Allopurinol and febuxostat were initiated in the ED in 4.7% and 0.9%, respectively. Discharge medications for the management of gout included NSAIDs (37%), corticosteroids (34.6%), opioids (23.8%), colchicine (14%), febuxostat (7%), and allopurinol (6.5%). Of the patients sent home with an opioid, 40% were newly prescribed. An anti-inflammatory medication was not prescribed in 29.6% of patients discharged from the ED. Readmission within 90 days was recorded in 16.8% of patients. Of these readmissions, 33.3% were gout-related and 11.1% were cardiac related.After adjusting for age and comorbidity index, patients receiving colchicine were 2.8 times more likely (OR, 2.81; 95% CI, 1.12 to 7.02; p=0.027) to return to the ED within 90 days. The most common cause of readmission in this subset was gout-related (54.5%).Conclusion:Nearly 30% of patients were discharged from the ED without an anti-inflammatory medication, whereas initiation of urate lowering therapy was rare. Opiates were used frequently, but the indication was uncertain. Only 5.6% of subjects revisited the ED for gout-related diagnoses in the subsequent 3 months. Colchicine prescription was associated with an increased risk of gout-related ED utilization within 90 days. Treatment of gout in the ED is sub-optimal and often does not follow established guidelines.Disclosure of Interests: :Luigi Brunetti Grant/research support from: Astellas Pharma, CSL Behring, Consultant of: Horizon Foundation of New Jersey, Janaki Vekaria: None declared, Peter Lipsky Consultant of: Horizon Therapeutics, Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon

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