scholarly journals Clinical study of enterocutaneous fistula

2017 ◽  
Vol 4 (9) ◽  
pp. 2972
Author(s):  
Mahadeo Namdeo Garale ◽  
Yogesh Prabhakar Takalkar ◽  
Karthik Venkatramani
Keyword(s):  
Enterocutaneous Fistula ◽  
Statistical Significance ◽  
Intestinal Fistula ◽  
Anatomical Location ◽  
High Morbidity ◽  
Chi Square ◽  
Exact Test ◽  
Colonic Fistula ◽  
Key Aspects ◽  
High Output

Background: An enterocutaneous fistulae (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death.Methods: This descriptive study was conducted prospectively in the Department of Surgery between September 2004 and August 2010. Patients whom develop ECF after surgery were included in the study while patients with esophageal, biliary, pancreatic, and perianal fistulas were excluded. The description of fistula included cause, anatomical location, fistula output, complications, and outcome. Fistula output was quantified by direct measurement, in the presence of drain or by calculating number of dressing pads soaked per day. To examine the statistical significance of association between attributes, Chi-square test and Fisher's exact test were used. A probability value of less than 5% (P < 0.05) was considered significant.Results: A total of 42 patients were included in the study, of which 23 were males and 19 were females and the male:female ratio was 1.2:1. Most patients with ECF were aged 41-50 (mean age, 44.23±2.72). Of the 42 patients, 9 patients had colonic fistula and the remaining had small intestinal fistula; 16 ileal, 5 duodenal, and 12 jejunal. There were 22 patients with high-output fistula as compared to 20 patients with low output fistula. Mortality was significantly higher in patients with males, age >60 years, high-output fistula, mesenteric ischemia as underlying pathology, serum albumin <2.5g/dl and re-surgery.Conclusions: Early diagnosis and stabilization form key aspects of management of ECF as most patients are managed conservatively. Prompt nutritional supplementation alters the outcome of this disease. High output fistulae required mostly surgical management and had high morbidity and mortality.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

scholarly journals MRI of the Entire Spinal Cord—Worth the While or Waste of Time? A Retrospective Study of 74 Patients with Multiple Sclerosis

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1424
Author(s):  
Esben Nyborg Poulsen ◽  
Anna Olsson ◽  
Stefan Gustavsen ◽  
Annika Reynberg Langkilde ◽  
Annette Bang Oturai ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Cervical Spinal Cord ◽  
Brain Mri ◽  
Anatomical Location ◽  
Spinal Cord Lesions ◽  
Chi Square ◽  
Exact Test ◽  
Mcdonald Criteria ◽  
Chi Square Test

Spinal cord lesions are included in the diagnosis of multiple sclerosis (MS), yet spinal cord MRI is not mandatory for diagnosis according to the latest revisions of the McDonald Criteria. We investigated the distribution of spinal cord lesions in MS patients and examined how it influences the fulfillment of the 2017 McDonald Criteria. Seventy-four patients with relapsing-remitting MS were examined with brain and entire spinal cord MRI. Sixty-five patients received contrast. The number and anatomical location of MS lesions were assessed along with the Expanded Disability Status Scale (EDSS). A Chi-square test, Fischer’s exact test, and one-sided McNemar’s test were used to test distributions. MS lesions were distributed throughout the spinal cord. Diagnosis of dissemination in space (DIS) was increased from 58/74 (78.4%) to 67/74 (90.5%) when adding cervical spinal cord MRI to brain MRI alone (p = 0.004). Diagnosis of dissemination in time (DIT) was not significantly increased when adding entire spinal cord MRI to brain MRI alone (p = 0.04). There was no association between the number of spinal cord lesions and the EDSS score (p = 0.71). MS lesions are present throughout the spinal cord, and spinal cord MRI may play an important role in the diagnosis and follow-up of MS patients.

scholarly journals Presepsin as a Biomarker for Risk Stratification and Prognosis of Acute Cholangitis:A Single Center Prospective Cohort Study

2021 ◽  
Author(s):  
Hanyu Zhang ◽  
Zhaoqing Lu ◽  
Guoxing Wang ◽  
Di Wu ◽  
Xu Ge ◽  
...  
Keyword(s):  
Blood Culture ◽  
Risk Stratification ◽  
Bacterial Infection ◽  
Positive Blood Culture ◽  
Characteristic Curve ◽  
Acute Cholangitis ◽  
High Morbidity ◽  
Chi Square ◽  
Exact Test ◽  
Prognostic Assessment

Abstract Background: Presepsin is currently a promising biomarker for the early diagnosis and prognosis of acute bacterial infection. Acute cholangitis is caused by bacterial infection and has high morbidity and mortality. The study engaged to assess the grading and prognostic value of presepsin in patients with acute cholangitis. Methods: This study enrolled patients with acute cholangitis in the emergency department from May 1, 2019 to December 20, 2020. The patients were evaluated for severity by the 2018 Tokyo Guidelines for Acute Cholangitis. Patients’ baseline features and routine clinical data were collected. On admission, presepsin, procalcitonin (PCT) and systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores were determined; and blood cultures were performed. IBM SPSS software (version 22.0) was used. The comparation of values was performed by Pearson chi-square test or Fisher's exact test or Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC), multivariate logistic regression, and correlation analysis were used to analyze this importance of determining the presepsin levels on admission for acute cholangitis. Results: In total, 330 patients, including 109, 101, and 120 patients classified as having mild, moderate, and severe cholangitis, respectively, were examined. The AUCs of presepsin were 0.713 in predicting severe acute cholangitis, better than those of white blood cell (WBC 0.411), C-reactive protein (CRP 0.615), PCT 0.608, and total bilirubin (T-Bil 0.441) (P<0.05). The AUC of presepsin in predicting 28-day mortality was higher than that of WBC, CRP, PCT, and T-Bil. The presepsin level in the positive blood culture group was higher than that in the negative blood culture group (P=0.000). The P values for correlations of presepsin with SIRS and SOFA scores were 0.002 and 0.000, respectively. Conclusions: Presepsin levels on admission were correlated with SIRS and SOFA scores. Presepsin may predict positive blood culture and 28-day mortality in patients with acute cholangitis, and it is superior to WBC, CRP, PCT, and T-Bil in the risk stratification and prognostic assessment of severe cholangitis. Trial registration: Ethical code of this study is 2018-P2-063-01 and acquired on May, 22, 2018.

scholarly journals Outcome and management of postoperative enterocutaneous fistula

2020 ◽  
Vol 7 (12) ◽  
pp. 4112
Author(s):  
Dinesh Chandra Sharma ◽  
Gaurav Jalendra ◽  
Pugazhenthi M. ◽  
Amit Kumar
Keyword(s):  
Enterocutaneous Fistula ◽  
Electrolyte Imbalance ◽  
Electrolyte Balance ◽  
High Morbidity ◽  
First Line ◽  
Sepsis Management ◽  
Time Treatment ◽  
Fistula Healing ◽  
And Control ◽  
High Output

Background: Approximately 75% of enterocutaneous fistula (ECF) occur following surgery. Due to the high morbidity and mortality associated with ECF, prompt and effective treatment is important. This study was conducted to study the outcome and management of patients with enterocutaneous fistula.Methods: Total 40 patients developing the enterocutaneous fistula following surgery were included. All patients were treated either conservatively or operatively by various means and varying period of time. Treatment was focused on the correction of dehydration, controlling sepsis, management of electrolyte imbalance and nutritional support.Results: Overall 40 patients were included in this observational study, comprising 26 were males and 14 were females. About 97.5% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 42.5% of fistulas were high output and 57.5% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 37.5% of patients.Conclusions: Conservative management with emphasis on improvement of nutrition, control of sepsis, management of fluid and electrolyte balance and control of fistula output is first line of management. Operative intervention must be done in selectively after cases after aggressive and targeted measures for improvement of nutritional status and control of infection.

Vanishing congenital lung malformations: What is the incidence of true regression?

2021 ◽  
pp. 1-7
Author(s):  
C. Griggs ◽  
M. Schmaedick ◽  
C. Gerall ◽  
W. Fan ◽  
C. Orlas ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test ◽  
Congenital Lung Malformation ◽  
Nicu Admission

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.

Breast Arterial Calcifications on Mammography: A Survey of Practicing Radiologists

2021 ◽  
Author(s):  
Fernando Collado-Mesa ◽  
Monica M Yepes ◽  
Kristopher Arheart
Keyword(s):  
Breast Imaging ◽  
Statistical Significance ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Chi Square Test ◽  
Artery Disease ◽  
Α Level ◽  
Training Practice ◽  
Question Survey

Abstract Objective To explore current practice patterns of reporting and issuing recommendations based on the presence of breast arterial calcifications on mammography and existing knowledge of their prevalence and associated factors. Methods An online anonymous 19-question survey was distributed to 2583 practicing radiologists who were members of the Society of Breast Imaging. Questions covered demographics, breast imaging training, practice type, and knowledge regarding the epidemiology and potential clinical significance of breast arterial calcifications detected on mammograms. Differences between groups were calculated using the chi-square test or Fisher exact test. An α level of 0.05 was used to determine statistical significance. Results Response rate was 22% (364/1662). The median age of respondents was 51 years (range: 29–76) and most were female (248/323, 77%). The most prevalent characteristics among respondents were as follows: 69% (223/323) had completed a breast imaging fellowship, 55% (179/323) were in private practice, 49% (158/323) practiced dedicated breast imaging, and 38% (124/323) had been in practice for more than 20 years. The prevalence of breast arterial calcifications was correctly estimated to be 1%–30% by 39% (125/323) of respondents. Most respondents correctly recognized the growing evidence of an association between breast arterial calcifications and coronary artery disease (275/323, 85%). However, only 15% (48/323) always reported the presence of these calcifications, and of those who report them at any time, only 0.7% (2/274) always issued recommendations. Conclusion There are differences in both knowledge of the epidemiology of breast arterial calcifications and practices around their reporting amongst breast radiologists.

scholarly journals QTc Prolongation in Patients Acutely Admitted to Hospital for Psychosis and Treated with Second Generation Antipsychotics

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Erik Johnsen ◽  
Kristina Aanesen ◽  
Sanjeevan Sriskandarajah ◽  
Rune A. Kroken ◽  
Else-Marie Løberg ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Statistical Significance ◽  
Torsade De Pointes ◽  
Positive Association ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Chi Square ◽  
Exact Test ◽  
Second Generation Antipsychotics ◽  
Qtc Interval Prolongation

QTc interval prolongation is a side effect of several antipsychotic drugs, with associated risks of torsade de pointes arrhythmias and sudden cardiac death. There is an ongoing debate of whether or not electrocardiogram (ECG) assessments should be mandatory in patients starting antipsychotic drugs. To investigate QTc prolongation in a clinically relevant patient group 171 adult patients acutely admitted to an emergency ward for psychosis were consecutively recruited. ECGs were recorded at baseline and then at discharge or after 6 weeks at the latest (discharge/6 weeks), thus reflecting the acute phase treatment period. The mean QTc interval was 421.1 (30.4) ms at baseline and there was a positive association between the QTc interval and the agitation score whereas the QTc interval was inversely associated with the serum calcium level. A total of 11.6% had abnormally prolonged QTc intervals and another 14.3% had borderline prolongation. At discharge/6 weeks, the corresponding proportions were reduced to 4.2% and 5.3%, respectively. The reduction of the proportion with prolonged QTc intervals reached statistical significance (chi-square exact test:P=0.046). The finding of about one-quarter of the patients with borderline or prolonged QTc intervals could indicate mandatory ECG recordings in this population. This trial is registered with ClinicalTrials.gov ID:NCT00932529.

identification risk for falls diagnosis in the elderly serviced by the elderly care program

2011 ◽  
Vol 5 (10) ◽  
pp. 2507 ◽  
Author(s):  
Erika Cássia Lopes Chaves ◽  
Laís De Andrade Martins Cordeiro ◽  
Sueli Leiko Takamastu Goyatá ◽  
Mônica Lá-Salette da costa Godinho ◽  
Valéria Cruz Meirelles ◽  
...  
Keyword(s):  
Elderly Care ◽  
Statistical Significance ◽  
Care Program ◽  
The Elderly ◽  
Diagnostic Study ◽  
Chi Square ◽  
Significance Level ◽  
Exact Test ◽  
The North ◽  
Nursing Diagnosis

ABSTRACT Objective: identifying the frequency of nursing diagnosis Risk for falls in the elderly and assess their risk factors. Method: retrospective study based on data recorded in the medical records of elderly patients in the Elderly Care Program. Data collection was done between May-June 2009, by means of a questionnaire with information on the epidemiological and diagnostic study, classified according to the North American Nursing Diagnosis Association (NANDA-I), after approval by the Ethics Committee of the Federal University of Alfenas (protocol 23087.001613/2009-01). For tabulation and analysis of data the statistical program Statistical Package for Social Sciences (SPSS) was used.  Descriptive statistics allowed us to describe and summarize the data obtained which were compared using the chi-square (X2) and Fisher's exact test. The statistical significance level adopted was 5% (p

scholarly journals Comparison of a single-use, digital flexible ureteroscope with a reusable, fiberoptic ureteroscope for management of patients with urolithiasis

2021 ◽  
Vol 93 (3) ◽  
pp. 326-329
Author(s):  
Panagiotis Mourmouris ◽  
Lazaros Tzelves ◽  
Grigorios Raptidis ◽  
Marinos Berdempes ◽  
Titos Markopoulos ◽  
...  
Keyword(s):  
Chart Review ◽  
Statistical Significance ◽  
High Volume ◽  
Flexible Ureteroscopy ◽  
Chi Square ◽  
Exact Test ◽  
Flexible Ureteroscope ◽  
High Volume Hospital ◽  
Single Use ◽  
Baseline Characteristics

Objectives: Ureteroscopy is one of the commonest procedures performed to manage urolithiasis. Flexible ureteroscopy has been traditionally based on reusable, fiber-optic ureteroscopes. Technology advancements permitted the development of single-use scopes with digital image. The aim of this study is to compare efficacy and safety between a reusable, fiberoptic ureteroscope with a single-use, digital scope. Patients and methods: We collected data based on chart review from a prospectively collected database on a tertiary, high-volume hospital in Greece. Baseline, perioperative and postoperative data were gathered and analyzed. Chi-square and Fisher's exact test was used to compare qualitative data and unpaired t-test for continuous data, with a statistical significance set at a = 0.05. Results: 40 patients underwent flexible ureteroscopy with a single- use digital scope, while 37 with the reusable scope. The two groups were matched regarding baseline characteristics and stone-related parameters. After data analysis, a shorter operative time in favor of single-use flexible ureteroscope was detected (45 vs 65 min, p = 0.001), while safety was also in favor of this type of scope with a significantly higher immediate stonefree rate (70% vs 43%, p = 0.005). Overall complications did not differ between the two groups, although a lower sepsis rate was detected in patients treated with single-use scope. Conclusions: Our findings indicate that single-use, digital ureteroscopes are a viable alternative for flexible ureteroscopy and management of urolithiasis, especially in centers with deficient facilities for sterilization and ensured funds for more expensive reusable scopes.

scholarly journals Clinical and histopathological profile of female genital schistosomiasis

2021 ◽  
Vol 10 (7) ◽  
pp. e47410716652
Author(s):  
Dayvson Moraes Leandro ◽  
Francisco Prado Reis ◽  
José Rodrigo Santos Silva ◽  
Andrea Ferreira Soares ◽  
Ana Denise Santana de Oliveira ◽  
...  
Keyword(s):  
Morbidity Rate ◽  
Histopathological Analysis ◽  
Anatomical Location ◽  
High Morbidity ◽  
Chi Square ◽  
Uterine Tumors ◽  
High Morbidity Rate ◽  
Chi Square Test ◽  
Pathology Reports ◽  
Female Genital

Objective: The present research performed a clinical and histopathological analysis of female genital schistosomiasis (FGS) cases. This was a descriptive and retrospective study, with a quantitative approach based on secondary databases belonging to Memorial Nestor Piva from Universidade Tiradentes. Methodology: Medical records and biopsies from patients affected with genital schistosomiasis (1984-1994) 75 pathology reports were found, biopsies of feminine genitals, with the respective paraffin blocks and slides. In these three search blocks, to contain sufficient quantity of biological material underwent histological new. For pathological analysis, hematoxylin-eosin, picrosirius Red and Masson's trichrome staining were used. A distribution of cases per year was performed to obtain an average and a percentage distribution among the most affected organs. In addition, the chi-square test was used to establish an association between schistosomiasis and its anatomical location and with other pathologies. Results: An average of four cases per year was obtained and the infection was found in all genital system organs, with its highest concentration in the ovaries followed by the uterus. In addition, there was an association between the parasitosis and cervical metaplasia, uterine tumors and salpingitis. In the histopathological analysis, several granulomas containing Schistosoma mansoni eggs, in productive and curing phases, were observed. Conclusion: It was concluded that ovaries were the most affected anatomical sites and that the presence of genital schistosomiasis may favor the occurrence of associated pathologies, thus causing a high morbidity rate to women's health.

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