International normalised ratio as an independent predictor of mortality in limb necrotising fasciitis with sepsis

Introduction Necrotising fasciitis with sepsis is a life threatening disease. The aim of this study was to analyse the association between international normalised ratio (INR) and mortality in sepsis patients with necrotising fasciitis. Methods A retrospective review was undertaken of 106 patients suffering from necrotising fasciitis with sepsis between November 2007 and December 2016. Data on comorbidities, clinical manifestations, laboratory findings, causative microbiological organisms, APACHE II (Acute Physiology and Chronic Health Evaluation II) score and outcomes were extracted. Logistic regression was carried out to examine the factors affecting mortality. Results Forty patients (37.7%) died. There was no significant difference in the white blood count (WBC) for the survivor and non-survivor groups. Non-survivors had a lower mean oxygenation index (OI) (288.7mmHg vs 329.4mmHg, p=0.032) and platelet count (PC) (139.5 vs 214.8 x 109/l, p=0.028), and a higher mean INR (1.9 vs 1.3, p=0.000), activated partial thromboplastin time (APTT) (54.6 vs 44.2 seconds, p=0.005) and serum creatinine (2.3mg/dl vs 1.4mg/dl, p=0.007). Mortality in patients with INR >1.5 was significantly higher than in those with INR <1.5 when all risk factors (WBC, PC, OI, INR, APTT, creatinine) were considered (odds ratio: 4.414, 95% confidence interval: 1.263–15.428, p=0.020). Even after adjusting for age, sex, bacteraemia, diabetes and hepatic disorders, the data still exhibited elevated mortality for patients with INR >1.5 (odds ratio: 5.600, 95% confidence interval: 1.415–22.166, p=0.014). Conclusions INR is a significant independent predictor of mortality in sepsis patients diagnosed with necrotising fasciitis.

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Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v4i1.88 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

M. Trajchevska ◽

A. Lleshi ◽

S. Gjoshev ◽

A. Trajchevski

Keyword(s):

Health Care ◽

Health Status ◽

Independent Predictor ◽

Demographic Data ◽

Parental Satisfaction ◽

Pediatric Care ◽

Simple Random Sample ◽

Significant Independent Predictor ◽

Cross Sectional ◽

Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

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Prevalence, risk factors, and impact of lung cancer on outcomes of idiopathic pulmonary fibrosis: a study from the Middle East

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2018.191 ◽

2018 ◽

Vol 13 ◽

Author(s):

Sherif Mohamed ◽

Hassan Bayoumi ◽

Nashwa Abd El-Aziz ◽

Ehab Mousa ◽

Yasser Gamal

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Odds Ratio ◽

Independent Predictor ◽

Significant Independent Predictor ◽

Upper Egypt ◽

The Impact

Background: No studies have addressed the impact of lung cancer (LC) on prognosis of patients with idiopathic pulmonary fibrosis (IPF) in Upper Egypt. We aimed to evaluate the prevalence and risk factors for LC among IPF patients and its impact on their outcomes and survival in Upper Egypt. Methods: A total of 246 patients with IPF who had complete clinical and follow up data were reviewed. They were categorized into 2 groups: 34 patients with biopsy-proven LC and IPF (LC-IPF) and 212 patients with IPF only (IPF). Survival and clinical characteristics of the two groups were compared. Results: Prevalence of LC was 13.8%. Pack/years was the most significant predictor for LC development in IPF (Odds ratio; 3.225, CI 1.257–1.669, p = 0.001). Survival in patients with LC-IPF was significantly worse than in patients with IPF without LC; median survival, 35 months vs 55 months; p = 0.000. LC accompanying IPF was one of the most significant independent predictors of survival in IPF patients (Hazard ratio 5.431, CI 2.186–13.492, p = 0.000). Mortality in LC-IPF patients was mainly due to LC progression in 36% and LC therapy-related complications in 22%. Conclusions: Prevalence of LC in IPF patients was 13.8%. Lung cancer has significant impacts on patients with IPF in Upper Egypt, in terms of clinical outcomes and survival. Smoking is the most significant independent predictor of LC development in IPF patients. A poorer survival was observed for patients with IPF developing LC, mainly due to LC progression, and to complications of its therapies. Further prospective, multicenter and larger studies are warranted.

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THYROID NODULE GROWTH AS A PREDICTOR OF MALIGNANCY

Endocrine Practice ◽

10.4158/ep-2019-0049 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1029-1034 ◽

Cited By ~ 2

Author(s):

Kathleen O'Connell ◽

Alexa Clark ◽

Wilma Hopman ◽

Joshua Lakoff

Keyword(s):

Confidence Interval ◽

Thyroid Nodule ◽

Odds Ratio ◽

Doubling Time ◽

Thyroid Nodules ◽

Volume Growth ◽

Needle Aspiration ◽

Health Science ◽

Significant Difference ◽

Nodule Growth

Objective: To assess which measure of thyroid nodule growth on serial neck ultrasound, if any, is associated with malignancy. Methods: Retrospective exploratory chart review of malignant thyroid nodules assessed at Kingston Health Sciences Centre (2006–2016) and benign thyroid nodules (2016), at least 1 cm in diameter and with 2 ultrasounds completed at least 30 days apart. Groups were compared using independent samples Student's t test, chi-square test, or Mann-Whitney U test as appropriate, as well as multivariable logistic and linear regression modelling to adjust for age and baseline volume. Results: One hundred and seventy-eight nodules were included in the study. When growth was defined as >20% increase in 2 dimensions (minimum 2 mm), malignant nodules (MNs) underwent significantly more growth than benign nodules (BNs) (16.8% BN versus 29.8% MN [ P = .026]; odds ratio = 2.49; 95% confidence interval = 1.12 to 5.56). There was no significant difference between the groups when growth was defined as >2 mm/year or ≥50% volume growth. Nodules shrank >2 mm/year in each group and the difference was not statistically significant (24.2% BN versus 20.7% MN [ P = .449]). The median doubling time for the nodules that grew was 1022.1 days in the BN group and 463.2 days in the MN group ( P = .036). The median doubling time for all nodules was 456.5 days in the BN group and 244.2 days in the MN group ( P = .015). Conclusion: Thyroid nodule growth defined as >20% increase in 2 dimensions (minimum 2 mm) is associated with risk of malignancy. Nodule shrinkage did not distinguish between BNs and MNs. Abbreviations: BN = benign nodule; CI = confidence interval; FNA = fine needle aspiration; KHSC = Kingston Health Science Centre; MN = malignant nodule; OR = odds ratio; ROC = receiver operating characteristic

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Carotid artery web and ischemic stroke

Neurology ◽

10.1212/wnl.0000000000003464 ◽

2016 ◽

Vol 88 (1) ◽

pp. 65-69 ◽

Cited By ~ 53

Author(s):

Jonathan M. Coutinho ◽

Sheldon Derkatch ◽

Alphonse R.J. Potvin ◽

George Tomlinson ◽

Leanne K. Casaubon ◽

...

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Confidence Interval ◽

Atherosclerotic Plaque ◽

Odds Ratio ◽

Conditional Logistic Regression ◽

Cerebral Aneurysms ◽

Anterior Circulation ◽

Stroke Treatment ◽

Significant Difference

Objective:To determine whether there is an association between carotid artery web and ischemic stroke.Methods:This was a single-center, age- and sex-matched, case-control study. Cases were consecutive patients with anterior circulation ischemic stroke of undetermined etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification). Controls were consecutive patients with cerebral aneurysms, arteriovenous malformations, or primary intracerebral hemorrhages. Additional inclusion criteria were age <60 years and CT angiography of the neck. Two neuroradiologists diagnosed webs according to previously published criteria. One neuroradiologist also assessed for nonstenotic atherosclerotic plaque (carotid wall thickness ≥3 mm or intramural calcification). We used conditional logistic regression to estimate the odds ratio between carotid web and ischemic stroke and its 95% confidence interval.Results:Fifty-three of 62 cases (85%) were matched by age (within 1 year) and by sex to 102 controls. There was a carotid web in 4 of 53 cases (9.4%) vs 1 of 102 controls (1.0%, odds ratio = 8.0, 95% confidence interval = 1.2–67, p = 0.032). There was no significant difference in the prevalence of nonstenotic carotid atherosclerotic plaque between the case and control groups. There was agreement on diagnosis of web for 163 of 164 patients (99%) and 7 of 8 webs (88%), and the Cohen κ for interobserver agreement was 0.93.Conclusions:There is an association between carotid artery web and ischemic stroke in patients who lack an alternative cause of stroke. Carotid web may be an underappreciated risk factor for stroke.

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Nontuberculous mycobacterial and Nocardia infections mimicking pulmonary tuberculosis: a retrospective study of a general hospital patient population in China

Journal of Medical Microbiology ◽

10.1099/jmm.0.000961 ◽

2020 ◽

Vol 69 (9) ◽

pp. 1145-1150

Author(s):

Guowei Dong ◽

Ping Chu ◽

Jie Guo ◽

Yuduan Xie ◽

Jie Lu

Keyword(s):

Mass Spectrometry ◽

Confidence Interval ◽

Immunosuppressive Therapy ◽

General Hospital ◽

Odds Ratio ◽

Clinical Manifestations ◽

Content Type ◽

Pulmonary Tb ◽

Link Type ◽

Positive Bacterial Culture

Purpose. In this study, we differentiated between tuberculosis (TB) and infections caused by nontuberculous mycobacteria (NTM) or Nocardia in a tertiary general hospital in China. Differences in clinical manifestations and factors between respiratory infections associated with these organisms were also investigated. Methodology. A retrospective analysis was conducted for suspected pulmonary TB patients with positive bacterial culture results under treatment at Wangjing Hospital, a tertiary general hospital, between January 2014 and June 2017. Sputum samples were submitted for liquid culture and species identification by mass spectrometry. Results. Between January 2014 and June 2017, a total of 3981 suspected TB cases were analysed, of which 151 (3.8 %) exhibited positive mycobacterial culture results. Using mass spectrometry, the 151 isolates were classified into three groups: Mycobacterium tuberculosis (MTB) (n=112; 74.2 %), NTM (n=21 13.9 %) and Nocardia (n=18; 11.9 %). The NTM and Nocardia prevalence rates were significantly higher amongst elderly patients [aged ≥65 years; odds ratio (95 % confidence interval): 3.89 (1.05–14.38) for NTM; odds ratio (95 % confidence interval): 5.10 (1.09–23.91) for Nocardia ]. In addition, treatment with immunosuppressive therapy [odds ratio (95 % confidence interval): 3.92 (1.16–13.27)] was identified as a risk factor for Nocardia infection in these patients. Conclusion. Our results demonstrated that a quarter of culture-positive ‘suspected TB patients’ harboured NTM or Nocardia infections. Notably, nearly all patients with non-TB infections presented with clinical syndromes mimicking pulmonary TB. Individuals receiving immunosuppressive therapy were at greater risk of acquiring Nocardia infections.

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Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618823349 ◽

2019 ◽

Vol 9 (6) ◽

pp. 599-607 ◽

Cited By ~ 1

Author(s):

Grímur Høgnason Mohr ◽

Kathrine B Søndergaard ◽

Jannik L Pallisgaard ◽

Sidsel Gamborg Møller ◽

Mads Wissenberg ◽

...

Keyword(s):

Cardiac Arrest ◽

Confidence Interval ◽

Odds Ratio ◽

Heart Rhythm ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Significant Difference ◽

Bystander Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest ◽

Diabetes Patients

Background: Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. Methods: Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001–2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. Results: In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66–0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48–0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). Conclusion: No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.

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Obesity increases the incidence of new-onset lupus nephritis and organ damage during follow-up in patients with systemic lupus erythematosus

Lupus ◽

10.1177/0961203320913616 ◽

2020 ◽

Vol 29 (6) ◽

pp. 578-586 ◽

Cited By ~ 1

Author(s):

Ji-Hyoun Kang ◽

Haimuzi Xu ◽

Sung-Eun Choi ◽

Dong-Jin Park ◽

Jung-Kil Lee ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Confidence Interval ◽

Lupus Erythematosus ◽

Odds Ratio ◽

Global Assessment ◽

Clinical Manifestations ◽

Organ Damage ◽

Physician Global Assessment ◽

Systemic Lupus

Objective This study explored the effects of obesity on clinical manifestations, disease activity and organ damage in Korean patients with systemic lupus erythematosus (SLE). Methods We assessed 393 SLE patients annually for three consecutive years based on demographic information, clinical manifestations, laboratory findings and Physician Global Assessment, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000 and Systemic Lupus International Collaborating Clinics (SLICC) damage index (SDI) scores. Patients were grouped by body mass index (BMI): normal weight, BMI <23 kg/m2; overweight, 23 kg/m2 ≤BMI <25 kg/m2; obese, BMI ≥25 kg/m2. The impact of obesity on clinical outcomes was assessed using univariate and multivariate analyses. Results Of the 393 patients, 59 (15.0%) were obese at enrollment. They had more comorbidities compared with non-obese patients, including diabetes, hypertension, hyperlipidemia and pulmonary hypertension. Nephritis at enrollment and newly developed nephritis during follow-up were more common ( p = 0.002 and p = 0.002, respectively) and Physician Global Assessment and SDI scores were higher in these patients for three consecutive years ( p = 0.017 and p = 0.039, respectively). Multivariate analysis revealed that obesity was significantly associated with development of nephritis during follow-up (odds ratio = 26.636; 95% confidence interval, 11.370–62.399; p < 0.001) and cumulative organ damage (odds ratio = 4.096; 95% confidence interval, 2.125–7.894, p < 0.001). Conclusions The incidences of newly developed nephritis and cumulative organ damage were higher in obese SLE patients than in non-obese SLE patients.

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Low SARS-CoV-2 seroprevalence but high perception of risk among healthcare workers at children’s hospital before second pandemic wave in Germany

World Journal of Pediatrics ◽

10.1007/s12519-021-00447-8 ◽

2021 ◽

Author(s):

Marietta Neumann ◽

Annette Aigner ◽

Eileen Rossow ◽

David Schwarz ◽

Maria Marschallek ◽

...

Keyword(s):

Confidence Interval ◽

Perceived Risk ◽

Odds Ratio ◽

Healthcare Workers ◽

Herd Immunity ◽

High Risk Group ◽

Children's Hospital ◽

Significant Difference ◽

Children’S Hospital ◽

Epidemic Wave

Abstract Background Healthcare workers are considered a particularly high-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Healthcare workers in paediatrics are a unique subgroup: they come into frequent contact with children, who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, therefore, may transmit the disease to unprotected staff. In Germany, no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions. Methods We tested the staff at a large children’s hospital in Germany for immunoglobulin (Ig) G antibodies against the nucleocapsid protein of SARS-CoV-2 in a period between the first and second epidemic wave in Germany. We used a questionnaire to assess each individual’s exposure risk and his/her own perception of having already been infected with SARS-CoV-2. Results We recruited 619 participants from all sectors, clinical and non-clinical, constituting 70% of the entire staff. The seroprevalence of SARS-CoV-2 antibodies was 0.325% (95% confidence interval 0.039–1.168). Self-perceived risk of a previous SARS-CoV-2 infection decreased with age (odds ratio, 0.81; 95% confidence interval, 0.70–0.93). Having experienced symptoms more than doubled the odds of a high self-perceived risk (odds ratio, 2.18; 95% confidence interval, 1.59–3.00). There was no significant difference in self-perceived risk between men and women. Conclusions Seroprevalence was low among healthcare workers at a large children’s hospital in Germany before the second epidemic wave, and it was far from a level that confers herd immunity. Self-perceived risk of infection is often overestimated.

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Early stroke after carotid endarterectomy: A case series during a 5-year period

Medicinski pregled ◽

10.2298/mpns1812389m ◽

2018 ◽

Vol 71 (11-12) ◽

pp. 389-393

Author(s):

Vladimir Manojlovic ◽

Djordje Milosevic ◽

Nebojsa Budakov ◽

Vladimir Markovic ◽

Dragan Nikolic

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Confidence Interval ◽

Carotid Endarterectomy ◽

Odds Ratio ◽

Carotid Artery Disease ◽

Case Series ◽

Carotid Occlusion ◽

Significant Difference ◽

Early Stroke

Introduction. Carotid endarterectomy is an efficient surgical procedure of primary and secondary prevention of ischemic stroke in asymptomatic and symptomatic patients with extracranial carotid artery disease. Material and Methods. In this paper we analyzed incidence, risk factors, potential causes and preventive measures for early stroke after carotid endarterectomy in patients (809) who underwent surgery for carotid artery stenosis at the Clinic of Vascular and Endovascular Surgery of the Clinical Center of Vojvodina in Novi Sad during a five year period (April 2013 - March 2018). Results and Discussion. Early operative stroke was registered in 12 patients with no significant difference between symptomatic (2.8%) and asymptomatic (1.1%) patients (odds ratio - 2,56, 95% confidence interval - 0.8063 to 8.1770 standard deviation 1,596; p = 0,11). Contralateral carotid occlusion (odds ratio - 3.1154, 95% confidence interval - 1.1620 to 8.3522, p = 0.0239) and no dual antiplatelet therapy (odds ratio - 3.1154, 95% confidence interval - 1.8537 to 526.4871; p = 0.0169) were pointed out as risk factors for operative stroke. Most of the perioperative and early postoperative strokes after carotid endarterectomy were due to arterial-arterial thromboembolism, intracerebral hemorrhage and acute carotid occlusion that developed rarely and were associated with severe neurological deficit. Conclusion. Even though our results are in agreement with the literature data, additional measures for surgical quality control would further decrease the incidence of operative stroke.

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Efficacy of Transparent vs. Pressure Dressing in Prevention of Post-Cardiac Catheterization Pain, Discomfort and Hematoma: A Systematic Review and Meta-analysis of RCTs

Journal of Caring Sciences ◽

10.34172/jcs.2021.019 ◽

2021 ◽

Vol 10 (2) ◽

pp. 103-110

Author(s):

Suresh K Sharma ◽

Kalpana Thakur ◽

Shiv K Mudgal ◽

Barun Kumar

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Cardiac Catheterization ◽

Odds Ratio ◽

English Language ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Difference ◽

Pressure Dressing

ABSTRACT Introduction: There is lack consensus on superiority of transparent vs. pressure dressing for prevention of post-cardiac catheterization pain, discomfort and hematoma. Therefore, we conducted this systematic review and meta-analysis of available RCTs on this subject. Methods: We performed a systematic search of RCTs published between in 2000-2019 in English language using databases including PubMed Medline, EMBASE, CINAHL, Cochrane Library, ERMED Journals, Clinical trials database, DELNET, Google Scholar and Discovery Search. Studies conducted on adult patients with femoral dressing after cardiac catheterization measuring pain, discomfort, hematoma as intended outcomes have been included. Data extraction, critical appraisal, assessment of risk bias was done and decisions on quality were made on mutual consensus. Mantel-Haenszel (MH) and odds ratio for dichotomous variables was calculated by Review Manager 5.3 software. Results: Out of all identified studies, only 5 studies comprising 664 patients fulfilled the inclusion criteria and met the quality assessment. Incidence of discomfort (25, 333) were significantly less in transparent dressing group as compared to pressure dressing group (149, 331); odds ratio 0.10, 95% confidence interval [CI] 0.06-0.15; I2 = 0%, P= 0.00. Four studies reported significantly lower number of pain cases in transparent dressing (17, 203) as compared to pressure dressing (57, 201); odds ratio 0.13, 95% confidence interval [CI] 0.03-0.59; I2 = 47%, P= 0.01). However, incidence of hematoma did not reveal any significant difference between two groups. Conclusion: Transparent dressing is a better option in patients with femoral/groin dressing after cardiac catheterization as it is more effective in prevention of pain and discomfort.

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