Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

2014 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Kilian Friedrich ◽  
Sabine G. Scholl ◽  
Sebastian Beck ◽  
Daniel Gotthardt ◽  
Wolfgang Stremmel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Endoscopic Procedure ◽  
Shortness Of Breath ◽  
Respiratory Complications ◽  
Endoscopic Procedures ◽  
Increased Risk ◽  
High Incidence ◽  
Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

2020 ◽  
Vol 35 (10) ◽  
pp. 643-648
Author(s):  
Miral A. Al Momani ◽  
Basima Almomani ◽  
Salar Bani Hani ◽  
Andrew Lux
Keyword(s):  
University Hospital ◽  
Unprovoked Seizure ◽  
Recurrent Attack ◽  
Parental Consanguinity ◽  
Pediatric Clinic ◽  
Increased Risk ◽  
High Incidence ◽  
History Of

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

scholarly journals Reactive arthritis and other musculoskeletal symptoms associated with acquisition of diarrhoeagenic Escherichia coli (DEC)

2020 ◽  
Vol 79 (5) ◽  
pp. 605-611
Author(s):  
Riitta Tuompo ◽  
Tinja Lääveri ◽  
Timo Hannu ◽  
Sari H Pakkanen ◽  
Juha Kirveskari ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Multivariate Analysis ◽  
Antibiotic Treatment ◽  
Reactive Arthritis ◽  
Musculoskeletal Symptoms ◽  
E Coli ◽  
Increased Risk ◽  
Stool Samples ◽  
Study Participants

ObjectivesUsing a prospective research design, we evaluated the association between acquisition of diarrhoeagenic Escherichia coli (DEC) and development of reactive arthritis (ReA) and other reactive musculoskeletal (MSK) symptoms among international travellers.MethodsA total of 526 study participants were asked to provide pretravel and post-travel stool samples and fill in questionnaires (pretravel, post-travel and 3-week follow-up). A multiplex quantitative PCR assay was deployed to detect five DEC comprising enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli, enterohaemorrhagic E. coli and enteroinvasive E. coli and Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio cholerae. Multivariate analysis was employed to identify factors predisposing to MSK symptoms. New post-travel MSK symptoms reported by participants with DEC were assessed by phone interviews and, if needed, clinically confirmed.ResultsFrom among the total of 224 volunteers who returned all questionnaires and stool specimens, 38 (17.0%) reported MSK symptoms. Multivariate analysis revealed that acquisition of DEC was associated with MSK symptoms (OR 3.9; 95% CI 1.2 to 13.3). Of the 151 with only-DEC, four (2.6%) had ReA, two (1.3%) reactive tendinitis and three (2.0%) reactive arthralgia. ReA was mostly mild, and all patients with ReA were negative for human leucocyte antigen B27. Antibiotic treatment of travellers’ diarrhoea did not prevent development of MSK symptoms.ConclusionA total of 17% of volunteers reported post-travel MSK symptoms. DEC acquisition was associated with an increased risk of developing them, yet the ReA incidence remained low and the clinical picture mild. Antibiotic treatment did not protect against development of MSK symptoms.

scholarly journals Respiratory follow-up of patients with COVID-19 pneumonia

Thorax ◽  
2020 ◽  
Vol 75 (11) ◽  
pp. 1009-1016 ◽  
Author(s):  
Peter M George ◽  
Shaney L Barratt ◽  
Robin Condliffe ◽  
Sujal R Desai ◽  
Anand Devaraj ◽  
...  
Keyword(s):  
Clinical Care ◽  
Pulmonary Vascular Disease ◽  
Guidance Document ◽  
Respiratory Complications ◽  
Thoracic Imaging ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
General Wards

The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. COVID-19 is also associated with an increased risk of hypercoagulability and venous thromboembolism. The overwhelming majority of patients admitted to hospital have respiratory failure and while most are managed on general wards, a sizeable proportion require intensive care support. The long-term complications of COVID-19 pneumonia are starting to emerge but data from previous coronavirus outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that some patients will experience long-term respiratory complications of the infection. With the pattern of thoracic imaging abnormalities and growing clinical experience, it is envisaged that interstitial lung disease and pulmonary vascular disease are likely to be the most important respiratory complications. There is a need for a unified pathway for the respiratory follow-up of patients with COVID-19 balancing the delivery of high-quality clinical care with stretched National Health Service (NHS) resources. In this guidance document, we provide a suggested structure for the respiratory follow-up of patients with clinicoradiological confirmation of COVID-19 pneumonia. We define two separate algorithms integrating disease severity, likelihood of long-term respiratory complications and functional capacity on discharge. To mitigate NHS pressures, virtual solutions have been embedded within the pathway as has safety netting of patients whose clinical trajectory deviates from the pathway. For all patients, we suggest a holistic package of care to address breathlessness, anxiety, oxygen requirement, palliative care and rehabilitation.

scholarly journals Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

2018 ◽  
Vol 52 (1) ◽  
pp. 1800591 ◽  
Author(s):  
Claudia C. Dobler ◽  
Greg J. Fox ◽  
Paul Douglas ◽  
Kerri A. Viney ◽  
Faiz Ahmad Khan ◽  
...  
Keyword(s):  
Foreign Born ◽  
Screening Practices ◽  
Migrant Populations ◽  
Long Duration ◽  
Increased Risk ◽  
High Incidence ◽  
Latent Tb ◽  
Low Incidence ◽  
Latent Tb Infection

In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination countryviaapplication for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.

Abstract 17233: Implantable Loop Recorder Monitoring Detects a High Incidence of Bradycardia Leading to Pacemaker Implant in Hemodialysis Patients: Preliminary Results From the Monitoring in Dialysis (MiD) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bruce A Koplan ◽  
David M Charytan ◽  
Amber S Podoll ◽  
Vikranth Reddy ◽  
Prabir Roy-Chaudhury ◽  
...  
Keyword(s):  
Permanent Pacemaker ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Premature Ventricular Contractions ◽  
Increased Risk ◽  
High Incidence ◽  
Clinically Significant ◽  
Multi Center Study ◽  
Esrd Patients

Introduction: Hemodialysis (HD) pts have an increased incidence of syncope and sudden death. A greater understanding of the incidence of bradyarrhythmias as a potential risk factor for these events is needed. The MiD study enrolled maintenance HD pts to undergo implantable loop recorder (ILR) placement to determine the arrhythmia incidence in this population. Hypothesis: ILR monitoring will be useful in detecting bradyarrhythmias and guiding treatment in ESRD patients Methods: MiD is a prospective, multi-center study to characterize arrhythmias in HD pts during 12mo of ILR monitoring. All ILR-detected events with stored ECG are visually reviewed for confirmation during the initial 6mo. Clinically significant arrhythmias include bradycardia <=40bpm for 6sec, asystole >=3sec, or sustained VT >=130bpm for >=30sec. Results: Follow up is available for 45 pts [mean follow-up 6.4mo (0.6-12.0mo), mean age 56 (27-76yrs), 36% female]. Bradycardia events occurred in 16/45 pts (36%) with an incidence of 28.7 (95% CI 10.1-81.7) events per patient month in these 16 pts. Bradycardia was confirmed by visual review in 408 out of 456 ILR-detected brady events with stored ECG occurring during the first 6mo for a positive predictive value (PPV) of 89.5%. An additional 27 of these ILR-detected “brady events” were found to contain either premature ventricular contractions or atrial arrhythmias (PPV for any arrhythmia 95.5%). 4 of 45 subjects (8.9%) have undergone permanent pacemaker implant for bradyarrhythmias or symptomatic tachy-brady syndrome. In comparison, only one patient (2.2%) has been observed to have ventricular tachycardia (VT>=130bpm for >=30seconds). There was no association between timing of dialysis and bradyarrhythmias. Conclusions: ILR monitoring detects bradyarrhythmias with high PPV in > 1/3 of HD pts and is associated with a high incidence (9%) of permanent pacemaker implant. With improvement in ILR technology with respect to size and wireless capability, clinicians should have a low tolerance to evaluate HD patients for bradyarrhythmias. These findings may also have implications when considering ESRD patients at increased risk of sudden cardiac death for subcutaneous-only defibrillators that do not currently have permanent pacing capability.

Bony Morbidity in Children Treated for Acute Lymphoblastic Leukemia

2001 ◽  
Vol 19 (12) ◽  
pp. 3066-3072 ◽  
Author(s):  
Adam J. Strauss ◽  
Joyce T. Su ◽  
Virginia M. Kimball Dalton ◽  
Richard D. Gelber ◽  
Stephen E. Sallan ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Older Children ◽  
Event Free Survival ◽  
Free Survival ◽  
Increased Risk ◽  
High Incidence ◽  
Pediatric All ◽  
Male Sex

PURPOSE: Corticosteroids are widely used in the treatment of acute lymphoblastic leukemia (ALL). To determine the frequency of corticosteroid-associated bony morbidity in children with ALL, we retrospectively evaluated the incidence of fractures and osteonecrosis (ON) on two consecutive pediatric ALL protocols. PATIENTS AND METHODS: One hundred seventy-six consecutive children were treated for ALL between 1987 and 1995 at the Dana-Farber Cancer Institute and Children’s Hospital. Prednisone was used as the corticosteroid during postremission therapy from 1987 to 1991, and dexamethasone was used from 1991 to 1995. Medical records for all patients were reviewed to assess the occurrence of fractures and ON. RESULTS: With a median follow-up of 7.6 years, the 5-year cumulative incidence (CI) ± SE of any bony morbidity for the 176 patients was 30% ± 4%, with a 5-year CI of fractures of 28% ± 3% and of ON of 7% ± 2%. With multivariate analysis, independent predictors of bony morbidity included age 9 to 18 years at diagnosis (P < .01), male sex (P < .01), and treatment with dexamethasone (P = .01). Dexamethasone was associated with a higher risk of fractures (5-year CI, 36% ± 5% v 20% ± 4% with prednisone; P = .04), but not ON (P = .40). The 5-year event-free survival for the 176 patients was 79% ± 3%. CONCLUSION: Children treated for ALL had a high incidence of fractures and ON. Older children, boys, and patients receiving dexamethasone were at increased risk for the development of bony morbidity. Future studies should attempt to minimize corticosteroid-associated bony morbidity without compromising clinical efficacy.

scholarly journals Association between pregravid physical activity and family history of stroke and risk of stillbirth: population-based cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017034
Author(s):  
Grace M Egeland ◽  
Grethe S Tell ◽  
Øyvind Næss ◽  
Jannicke Igland ◽  
Kari Klungsøyr
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cohort Study ◽  
Family History ◽  
Vigorous Activity ◽  
Shortness Of Breath ◽  
Light Physical Activity ◽  
Increased Risk ◽  
History Of

ObjectivesTo evaluate whether family history of disease and pregravid lifestyle and cardiovascular risk factors are associated with subsequent stillbirth delivery.DesignPrepregnancy cohort study.SettingCohort Norway regional health surveys (1994–2003) linked to Medical Birth Registry of Norway for deliveries through 2012.Participants13 497 singleton births (>22 weeks gestation) in 8478 women.Main outcome measureRisk of stillbirth evaluated by Poisson regression.ResultsMean (SD) length of follow-up was 5.5 (3.5) years. In analyses adjusting for baseline age and length of follow-up, ≥3 hours of baseline past-year vigorous physical activity per week (resulting in shortness of breath/sweating) was associated with increased risk of stillbirth compared with <1 hour/week of vigorous activity (incidence rate ratio, IRR 2.46; 95% CI 1.23 to 4.90). In contrast, baseline past-year light physical activity of ≥3 hours per week associated with reduced risk of stillbirth compared with <3 hours of light physical activity per week (IRR 0.53; 95% CI 0.30 to 0.93). A family history of stroke associated with increased risk of stillbirth delivery (IRR 2.53; 95% CI 1.06 to 6.01). Because overweight/obese women may experience shortness of breath and sweating with less physical exertion than normal weight women, a sensitivity analysis was conducted limited to women with a normal BMI (>18.5 and <25 kg/m2). Vigorous activity of ≥3 hours per week (IRR of 4.50; 95% CI 1.72 to 11.79) and a family history of stroke (IRR of 3.81; 95% CI 1.31 to 11.07) were more strongly related to stillbirth risk among women with a normal BMI than that observed for all women combined. Established risk factors also associated with stillbirth risk.ConclusionsThe study identified physical activity and family history of stroke as potential new risk factors for stillbirth delivery.

scholarly journals Fatal course of undetected Ewing-like sarcoma in a 9-year-old boy with uncharacteristic clinical presentation

2021 ◽  
Author(s):  
Walther Gotsmy ◽  
Bettina Neumayer ◽  
Theo Kraus ◽  
Barbara Zellinger ◽  
Daniel Neureiter ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Post Mortem ◽  
Shortness Of Breath ◽  
Tumor Mass ◽  
Post Mortem Examination ◽  
Advanced Tumor ◽  
Fatal Course

AbstractA 9-year-old boy collapsed shortly after complaining of shortness of breath. Despite immediate resuscitation measures, the boy died. A few weeks earlier, he had received antibiotic treatment for respiratory infection. However, the post-mortem examination revealed an advanced tumor mass of the mediastinum with infiltration of vital structures, which was identified as a small blue round neoplasm with aspects of an extramedullary Ewing-like sarcoma by supplementary histological and immunohistochemical examinations.This dramatic clinical course of events shows that the possible presence of serious diseases should always be considered behind harmless symptoms, even in children.

Follow-up of Osteomyelitis of Infants with Systemic Serum Parameters and Bone Scintigraphy

1996 ◽  
Vol 35 (04) ◽  
pp. 116-121 ◽  
Author(s):  
G. E Fueger ◽  
M. Vejda ◽  
R. M. Aigner
Keyword(s):  
Bone Scintigraphy ◽  
Antibiotic Treatment ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Serum Parameters ◽  
Wbc Count ◽  
Differential White Blood Cell

Summary Aim: To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC). Methods: AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography. Results: CRP was the most effective serum parameter for follow- up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment. Conclusion: Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.

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