scholarly journals Diagnostic utility of inflammatory markers in septic arthritis in pediatric patients in atertiary care hospital in Bangalore

2019 ◽  
Vol 5 (6) ◽  
pp. 343-348
Author(s):  
Dr. Manasa S ◽  
◽  
Dr. Mahantesh S ◽  
Keyword(s):  
Septic Arthritis ◽  
Inflammatory Markers ◽  
Pediatric Patients ◽  
Diagnostic Utility ◽  
Care Hospital

scholarly journals Can High Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios at Presentation Predict Sustained Elevation of CRP Levels in Pediatric Patients with Septic Arthritis?

2021 ◽  
Author(s):  
Ömer Naci Ergin ◽  
Başak Koç ◽  
Emre Özmen
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Inflammatory Markers ◽  
Pediatric Patients ◽  
Threshold Level ◽  
Curve Analysis ◽  
Significant Morbidity ◽  
Roc Curve Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Left And Right

INTRODUCTION: Septic arthritis is a surgical emergency that can result in significant morbidity if not treated promptly and appropriately. With appropriate surgical and antibiotic therapy, inflammatory markers are expected to rapidly normalize in the patients with septic arthritis. Lack of or slow normalization may signify treatment failure. Our aim was to investigate if high neutrophil-lymphocyte and platelet-lymphocyte values can be used to predict sustained elevation of CRP levels. METHODS: Fifty-seven pediatric patients operated in our clinic with the diagnosis of septis athritis between 2003 and 2016 were included in the study. Neutrophil, lymphocyte and platelet counts as well as CRP and ESR values at presentation, 1 and 2 weeks were scanned Neutrophil-lymphocyte and platelet-lymphocyte values were calculated. RESULTS: Average age of the patients were 7 years (1 month-16 years).Of the 57 patients 41 were male (71.9%) and 16 were female (28.1%).The knee was the affected joint in 38 cases (66.7%) and hip in 19 cases (33.3%). Left and right sides were affected in 29 (50.9%) cases and in 28 cases (49.1%), respectively.Average neutrophil count at presentation was (1,1-34,9), platelet 425,7 (31-830) and lymphocyte 3.1 (0,1-9,8).CRP at 14 days was on average 38 (3-164) mg/dL. ROC curve analysis showed that a threshold level of neutrophil-lymphocyte>4,3 at presentation is 71% sensitive and 70%spesific for CRP levels >20 mg/L at 2 weeks. DISCUSSION AND CONCLUSION: A threshold of neutrophil-lymphocyte ratio of >4.3 at presentation is fairly sensitive and specific for prediction of CRP levels above >20 mg/L at 2 weeks. Possibility of slow normalization and even persistence of higher levels of CRP, in this patient group should be kept in mind.

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

Pediatric Drug-Related Problems in an Indian Tertiary Care Hospital

2021 ◽  
Vol 08 ◽  
Author(s):  
Qaiser Jahan ◽  
K. Pallavi ◽  
R. Hamshika ◽  
Varun Talla ◽  
Jupally Venkateshwar Rao ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Drug Related Problems ◽  
Cross Sectional ◽  
Pediatric Department ◽  
Root Cause ◽  
Patient Morbidity ◽  
Tertiary Care Hospitals

Background: Improper drug usages expose patients to drug-related problems (DRPs) and can be the cause of patient morbidity and even mortality, especially frequent in hospitalized patients and pediatric groups. Objective: The objective of the present study was to identify and assess the drug-related problems in the pediatric department of tertiary care hospitals. Methods: The cross-sectional, observational study was carried out for six months included pediatric in-patients of age ≤15 years of either gender in pediatric units of tertiary care hospitals of India. The enrolled pediatric patients were observed for any drug-related problem that were further recorded and classified using the DRP registration format taken from Cipolle et al. The assessment of therapy was done by using positional statements from standard organizations and guidelines. Main outcome measure: Incidences of drug-related problems and their assessment and root cause analysis. Results: A total of 970 DRPs were identified in 296 patients, with an overall incidence of 49.3%. The incidence of DRPs was maximum in the age group of 2-12 years of children (51.2%). Patients who took six or more drugs were around eight (OR:8.41 , 95% CI: 5.22 to 13.55) times more likely to have DRPs compared to those patients who took less than six drugs. The incidences of DRPs were more in patients who were hospitalized for ≥ 7 days. Conclusion: The present study revealed significantly higher incidences of DRPs in hospitalized pediatric patients necessitating the involvement of clinical pharmacists in the pediatric department of tertiary care hospitals.

EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nadia Gulnaz ◽  
Sadia Tasleem ◽  
Farooq Abdullah
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Inflammatory Markers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Clinical Accuracy ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates. 

scholarly journals Impact of antibiotic pretreatment on cultures in children with osteomyelitis and septic arthritis: a retrospective review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amanda Lansell ◽  
Yasasvi Vasili ◽  
Parminder S. Suchdev ◽  
Janet Figueroa ◽  
Anjali Kirpalani
Keyword(s):  
Septic Arthritis ◽  
Pediatric Patients ◽  
Small Sample Size ◽  
Positive Culture ◽  
Small Sample ◽  
Blood Cultures ◽  
Pathogen Identification ◽  
Culture Positivity ◽  
Antibiotic Duration ◽  
Bone Cultures

Abstract Background In the management of pediatric osteomyelitis or septic arthritis, delay in treatment may affect outcome, while receipt of antibiotics prior to culture may affect culture results. We aimed to determine if pathogen identification decreased in cultures that were pretreated with antibiotics. Methods We conducted a retrospective cohort study of 584 hospitalized children between 30 days and 18 years of age admitted to two tertiary children’s hospitals. Logistic regression assessed the effect of antibiotic duration on blood, bone, joint aspirate, and “other” culture positivity. Results Overall, 42% of blood cultures, 70% of bone cultures, 39% of joint cultures, and 70% of “other” cultures were positive. Compared with children who did not receive antibiotics prior to culture, there were no significant differences in odds of a positive culture in children whose cultures were pretreated with antibiotics for any of the culture types [OR (95% CI) 0.90 (0.56–1.44) for blood cultures, 0.77 (0.25–2.34) for bone cultures, 0.71 (0.39–1.28) for joint cultures, 1.18 (0.58–2.41) “for other” cultures; all p > 0.05]. Furthermore, the duration (hours) of antibiotics in the pretreated cultures was also not a significant predictor of culture positivity (OR ranged from 0.99–1.00 for all cultures, p > 0.05). Conclusions Culture positivity was not associated with antibiotic pretreatment in any of the samples, even for longer duration of antibiotics prior to culture, though the small sample size of subgroups is an important limitation. In pediatric patients hospitalized with osteomyelitis and/or septic arthritis, early initiation of antibiotics may not affect culture positivity.

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