scholarly journals Morbidity and mortality of serious gastrointestinal complications after lung transplantation

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Annette Zevallos-Villegas ◽  
Rodrigo Alonso-Moralejo ◽  
Félix Cambra ◽  
Ana Hermida-Anchuelo ◽  
Virginia Pérez-González ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Early Recognition ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Survival Function ◽  
Survival Rates ◽  
Late Complications ◽  
Morbidity And Mortality ◽  
Gastrointestinal Complications ◽  
Increased Risk

Abstract Background Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. Methods We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. Results There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). Conclusions SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.

scholarly journals Autoimmune Hepatitis in a North American Aboriginal/First Nations Population

2008 ◽  
Vol 22 (10) ◽  
pp. 829-834 ◽  
Author(s):  
GY Minuk ◽  
S Liu ◽  
K Kaita ◽  
S Wong ◽  
E Renner ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
First Nations ◽  
North American ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Immunoglobulin A ◽  
Tertiary Care Centre ◽  
Increased Risk ◽  
Aboriginal Populations ◽  
Elevated Bilirubin

North American Aboriginal populations are at increased risk for developing immune-mediated disorders, including autoimmune hepatitis. In the present study, the demographic, clinical, biochemical, serological, radiological and histological features of autoimmune hepatitis were compared in 33 First Nations (FN) and 150 predominantly Caucasian, non-FN patients referred to an urban tertiary care centre. FN patients were more often female (91% versus 71%; P=0.04), and more likely to have low serum albumin (69% versus 36%; P=0.0006) and elevated bilirubin (57% versus 35%; P=0.01) levels on presentation compared with non-FN patients. They also had lower hemoglobin, and complement levels, more cholestasis and higher serum immunoglobulin A levels than non-FN patients (P=0.05 respectively). Higher histological grades of inflammation and stages of fibrosis, and more clinical and radiological evidence of advanced liver disease were observed in FN patients, but the differences failed to reach statistical significance. The results of the present study suggest that in addition to being more common, autoimmune hepatitis may be more severe in FN populations, compared with predominantly Caucasian, non-FN populations.

scholarly journals Maternal and Fetal Outcome in Eclampsia: A Study From Tertiary Care Hospital

2017 ◽  
Vol 15 (2) ◽  
pp. 6-9
Author(s):  
Husneyara Haque ◽  
Kalpana Kumari Thapa
Keyword(s):  
Early Recognition ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Medical College ◽  
Life Threatening ◽  
Study Population

Introduction: Eclampsia is an acute and life-threatening complication of pregnancy associated with elevated maternal and fetal morbidity and mortality. This study was done with the aim to evaluate the maternal and fetal outcome in eclampsia patients and to observe various factors affecting its occurrence and outcome. Methods: A retrospective cross-sectional hospital based study carried out in Nepalgunj Medical College, Nepalgunj from January 2015 to December 2016. Details and data obtained from maternity register were analysed. All patients with eclampsia were included and fetomaternal outcomes measured in terms of complications. Simple descriptive statistical method was applied for analysis. Result: Out of 6056 pregnant women, 46 had eclampsia with the incidence of 7.59 per 1000 deliveries. 58.7% of study population belonged to age group of 21-30 years followed by 36.96% from age less than 20 years. 78.26% cases were unbooked. 73.91% eclamptic patients were primi gravida and 60.87% had gestational age less than 37 weeks. Half of pregnancies with eclampsia underwent ceasarian for delivery and 30.44% required ICU care. One third women developed eclampsia related complications and 2(4.35%) died. Common complications were atonic postpartum heamorrhage (15.21%), psychosis (8.71%) acute renal failure (4.35%). 60.86% newborn were preterm and 56.52% were low birth weight. In 50% newborn, Apgar score at 5 minutes was less than 7. Fetal death was 10.85%. Conclusion: Eclampsia continues to be one of the prime etiological factors for maternal and fetal morbidity and mortality. Therefore early recognition and proper management are vital to tackle this challenge.

Readmissions After Lung Transplantation

2020 ◽  
Vol 30 (4) ◽  
pp. 365-367
Author(s):  
Jane Simanovski ◽  
Jody Ralph
Keyword(s):  
Risk Factors ◽  
Lung Transplantation ◽  
Care Facility ◽  
Readmission Rates ◽  
Term Care ◽  
Gastrointestinal Complications ◽  
Long Term Care Facility ◽  
Body Of Knowledge ◽  
Increased Risk ◽  
End Stage

Lung transplantation has evolved to become an acceptable therapy for individuals with end-stage lung disease. Readmissions rates after lung transplantation remain high as compared to other medical surgical populations. The purpose of this review is to synthesize the current body of knowledge about patterns, risk factors, and outcomes of readmissions after lung transplantation. The literature revealed that the most common admission diagnoses linked to lung transplant readmissions are infections followed by tachyarrhythmias, airway complications, surgical complications, rejection, thromboembolic events, gastrointestinal complications, and renal dysfunction. Risk factors for these readmissions include male gender, longer intensive care unit stay, reintubation, prolonged chest tube air leak, frailty, and discharge to a long-term care facility. Outcomes of multiple readmissions after lung transplantation are associated with decreased survival and increased risk of mortality. Further research is needed to better understand which readmission diagnoses are preventable and whether multidisciplinary interventions can reduce readmission rates among patients after lung transplantation.

scholarly journals Maternal and fetal outcome in abruptio placentae at a tertiary care centre: a retrospective analysis

2021 ◽  
Vol 10 (10) ◽  
pp. 3860
Author(s):  
Jessica C. Fernandes ◽  
Nandini Gopalakrishna
Keyword(s):  
Risk Factors ◽  
Early Intervention ◽  
Placental Abruption ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Timely Diagnosis ◽  
Increased Risk ◽  
Abruptio Placenta

Background: Placental abruption is a major obstetric complication leading to increased risk of maternal and neonatal morbidity and mortality globally. Placental abruption is traditionally defined as premature separation of a normally implanted placenta after 20 weeks of gestation and before delivery of the fetus. Early recognition of the risk factors, timely diagnosis and early intervention can significantly reduce maternal and fetal morbidity and mortality. This study was aimed to identify the associated risk factors with abruptio placenta and to analyse the maternal and perinatal outcome in abruptio placenta.Methods: This was a retrospective observational study, from Jan 2016 to Dec 2019 at M.S. Ramaiah medical college and hospitals, Bangalore.Results: In our study, the incidence of abruptio placenta was 0.95%. Majority of our patients were between 20-24 years (41.5%). Primigravidae accounted for 46.15% of the cases. The unbooked cases were 92%. The commonest risk factor was hypertension complicating pregnancy which accounted for 26% .The live births were 64%. Postpartum haemorrhage was one of the major complications in our study. There was no maternal mortality, probably due to early intervention and availability of blood and blood products.Conclusions: Timely diagnosis and appropriate intervention preferably in tertiary care centre will significantly reduce mortality and morbidity in both mother and fetus.  

scholarly journals Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Akin Abayomi ◽  
Akin Osibogun ◽  
Oluchi Kanma-Okafor ◽  
Jide Idris ◽  
Abimbola Bowale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Illness ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Survival Rates ◽  
Outcome Data ◽  
Morbidity And Mortality ◽  
Hypertensive Patients ◽  
Increased Risk

Abstract Background The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described. Methods In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 62,020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher’s exact tests were used in determining associations between variables. Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant. Results A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P < 0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR = 2.41, P = 0.001, 95%CI = 1.4–4.0, death: HR = 2.30, P = 0.001, 95%CI = 1.2–4.6, for those with hypertension only} {severe/critical illness: HR = 3.76, P = 0.001, 95%CI = 2.1–6.4, death: crude HR = 6.63, P = 0.001, 95%CI = 3.4–1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities. Conclusion The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.

scholarly journals Morbidity and Mortality Outcomes of Covid-19 Patients With and Without Hypertension in Lagos, Nigeria: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Akin Osibogun ◽  
Akin Abayomi ◽  
Oluchi Kanma-Okafor ◽  
Jide Idris ◽  
Abimbola Bowale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Illness ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Survival Rates ◽  
Outcome Data ◽  
Morbidity And Mortality ◽  
Hypertensive Patients ◽  
Increased Risk

Abstract Background: The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients with COVID-19. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.Methods: In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 6 2020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying or being discharged by July 6, 2020. Variables were compared between hypertensive and non-hypertensives using univariable and multivariable logistic regression, cox regression and Kaplan Meier survival analysis methods to assess hypertension as a risk factor associated with worsened disease severity and death.Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension was 17.8% and it was the most common comorbidity followed by diabetes (7.2%) and asthma (2.0%). Overall mortality from COVID-19 was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of an additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P<0.001). After adjustment for confounders, severe COVID-19 disease and death were higher for hypertensives (severe/critical illness: HR=2.41, P=0.001, 95%CI=1.4–4.0, death: HR=2.30, P=0.001, 95%CI=1.2–4.6, for those with hypertension only). Hypertension posed an increased risk of severe morbidity and death from coronavirus disease in the presence of other comorbidities (severe/critical illness: HR=3.76, P=0.001, 95%CI=2.1–6.4, death: crude HR=6.63, P=0.001, 95%CI=3.4–1.6, for those with additional comorbidities).Conclusion: The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.

scholarly journals P481 Repeated surgery for recurrent ileocolonic Crohn’s disease: does the outcome keep worsening operation after operation? A comparative study of 1224 consecutive procedures

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S423-S424
Author(s):  
F Colombo ◽  
A Frontali ◽  
C Baldi ◽  
G M B Lamperti ◽  
G Maconi ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Postoperative Morbidity ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Anastomotic Site ◽  
Clinical Recurrence ◽  
Increased Risk ◽  
Repeated Surgery

Abstract Background Despite relevant improvement in the medical treatment of ileocolic Crohn’s disease (CD), still surgery is needed in 80% of patients and clinical recurrence occurs in more than 50% of cases after surgery. Aim of the study is to assess the outcome for patients undergoing repeated surgery for recurrent CD. Methods All patients undergoing surgery for ileal or colonic CD between 1993 and 2018 in our tertiary care centre were retrospectively reviewed. We considered all small bowel resections, colonic resections, conventional (SP) and not conventional strictureplasties (NCSP). Results In the study period, 1224 CD patients underwent a surgical operation. We performed 713 (58.2%) primary operations (1R), 325 (26.5%) re-operations (2R group) and 186 (15.3%) three or more interventions (≥3R group). A CD diagnosis and the time of first surgery at early age were a negative prognostic factor, favouring repeated surgery in the time (R1 vs. R2p &lt; 0.004 and R1 vs. ≥3R p &lt; 0.0001 comparing age at diagnosis; R1 vs. R2p &lt; 0.0001 and R1vs. ≥3R&lt; 0.0001 regarding the time to firstt surgery). The indication for surgery (stenosis, fistula/abscess and refractoriness to medical therapy) does no’t change significantly with the number of surgeries regarding the analysis of variance of the three groups (p = 0.3). In the repeated surgery (R2 and ≥3R group) the incidence of recurrence appears to be more frequent at the anastomotic site for the 2R group (197/325, 61% vs. 103/186, 55% p &lt; 0.05) and at SP site for the ≥3R group (19/325, 5% vs. 23/186, 12% p &lt; 0.01). The ≥3R group underwent to a higher number of strictureplasties in comparison to the 1R group (100/186, 53% vs. 305/713, 43% p &lt; 0.0001) and the 2R group (100/186, 53 vs. 127/325, 43% p &lt; 0.0004). The duration of the surgical procedure tends to be higher for the ≥3R group but without reaching a statistical significance (p = 0.2). Postoperative morbidity (Clavien Dindo I-V) was increased in the 2R and in the ≥3R group but not in a significant way: (1R group n = 187 (26%); 2R group n = 102 (31%); ≥3R group n = 64 (34%); 1R vs. 2R p = 0.1, 2R vs. ≥3R group p = 0.5). In particular there was no difference between the groups in the incidence of severe postoperative morbidity (Clavien-Dindo ≥3): 1R group n = 69 (9.6%); 2R group n = 37 (11%); ≥3R group n = 24 (12%); 1R vs. 2R p = 0.4, 2R vs. ≥3R group p = 0.7. Conclusion In this series, we treated more than 40% of the small bowel segments with SP and NCSP at first surgery. This percentage gradually increases to 49% in 2R group and to 53% in ≥3R group. Even if the overall morbidity rate was higher, repeated surgery for recurrent CD doesn’t appear to be related to an increased risk of severe postoperative morbidity in our experience.

scholarly journals Risk factors for ischemic stroke in Bulgaria

2021 ◽  
Vol 20 (1) ◽  
pp. 41-49
Author(s):  
Mihael Emilov Tsalta-Mladenov ◽  
◽  
Silva Peteva Andonova ◽  
◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Statistical Significance ◽  
Tertiary Care ◽  
P Value ◽  
Case Group ◽  
Inverse Association ◽  
Stroke Incidence ◽  
Increased Risk ◽  
Overall Risk

Background. Stroke is a multifactorial disease with various clinical presentations ruled out by modifiable and non-modifiable risk factors (RF). Multiple vascular and behavioural factors lead to an increased risk of ischemic stroke, as they can differ in various countries. Understanding those factors may result in the implementation of strategies for screening, prevention, and reducing the overall risk of stroke. There is a lack of contemporary information regarding the RF for ischemic stroke (IS) in Bulgaria. Objective. We aimed to determine the major potential RF for ischemic stroke in the Bulgarian population. Material and methods. A prospective hospital-based case-control study was conducted between July 1, 2019, and June 30, 2020, at a tertiary care referral center for neurological disorders. We included cases with first-ever and recurrent stroke and stroke-free controls. Association between RF and IS was expressed in odds ratio (OR) through a 95% confidence interval (CI). Statistical significance was defined as a p-value of 0.05 or less. Results. Overall 150 cases and 100 stroke-free participants were included. All risk factors were more prevalent in the case-group, except for dyslipidemia which had an inverse association with IS risk. The most significant RF for IS consisted of hypertension (OR, 28.78; 95% CI, 6.67 – 124.15) heart failure (OR, 15.25; 95% CI, 6.29-36.97), atrial fibrillation (OR, 11.29; 95% CI, 3.92-32.51), ischemic heart disease (OR, 5.83; 95% CI, 2.81-12.12), diabetes mellitus (OR, 2.65; 95% CI, 1.28-5.49), daily alcohol abuse with concentrate (OR, 9.39; 95% CI, 1.21-73.00) and current smoking (OR, 1.82; 95% CI, 1.00-3.32). Conclusions. The results of this study confirm the significant contribution of modifiable RF, both behavioral and related to medical conditions. Early detection and management of the major stroke RF may result in lower stroke incidence. Therefore, implementations of strategies for screening and prevention are needed to reduce the overall risk of stroke.

scholarly journals Early recognition of peripheral intravenous catheter failure using serial ultrasonographic assessments

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253243
Author(s):  
Amit Bahl ◽  
Steven Johnson ◽  
Nicholas Mielke ◽  
Patrick Karabon
Keyword(s):  
Early Recognition ◽  
Strong Predictor ◽  
Tertiary Care ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Intravenous Catheter ◽  
Clinical Exam ◽  
Subcutaneous Edema ◽  
Increased Risk ◽  
Peripheral Intravenous Catheter

Objective Peripheral intravenous catheter (PIVC) failure occurs frequently, but the underlying mechanisms of failure are poorly understood. We aim to identify ultrasonographic factors that predict impending PIVC failure prior to clinical exam. Methods We conducted a single site prospective observational investigation at an academic tertiary care center. Adult emergency department (ED) patients who underwent traditional PIVC placement in the ED and required admission with an anticipated hospital length of stay greater than 48 hours were included. Ongoing daily PIVC assessments included clinical and ultrasonographic evaluations. The primary objective was to identify ultrasonographic PIVC site findings associated with an increased risk of PIVC failure. The secondary outcome was to determine if ultrasonographic indicators of PIVC failure occurred earlier than clinical recognition of PIVC failure. Results In July and August of 2020, 62 PIVCs were enrolled. PIVC failure occurred in 24 (38.71%) participants. Multivariate logistic regression demonstrated that the presence of ultrasonographic subcutaneous edema [AOR 7.37 (1.91, 27.6) p = 0.0030] was associated with an increased likelihood of premature PIVC failure. Overall, 6 (9.67%) patients had subcutaneous edema present on clinical exam, while 35 (56.45%) had subcutaneous edema identified on ultrasound. Among patients with PIVC failure, average time to edema detectable on ultrasound was 46 hours and average time to clinical recognition of failure was 67 hours (P = < 0.0001). Conclusions Presence of subcutaneous edema on ultrasound is a strong predictor of PIVC failure. Subclinical subcutaneous edema occurs early and often in the course of the PIVC lifecycle with a predictive impact on PIVC failure that is inadequately captured on clinical examination of the PIVC site. The early timing of this ultrasonographic finding provides the clinician with key information to better anticipate the patient’s vascular access needs. Further research investigating interventions to enhance PIVC survival once sonographic subcutaneous edema is present is needed.

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