scholarly journals Fatores Clínico-Laboratoriais Associados ao Internamento Prolongado em Doentes com Celulite/Erisipela

2019 ◽  
Vol 32 (6) ◽  
pp. 448
Author(s):  
Ângela Roda ◽  
Ana Marcos Pinto ◽  
Ana Rita Filipe ◽  
Ana Rita Travassos ◽  
João Pedro Freitas ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Clinical Investigation ◽  
Positive Culture ◽  
Length Of Hospital Stay ◽  
Dermatology Department ◽  
Prolonged Stay ◽  
Reactive Protein ◽  
Prolonged Hospitalization ◽  
Positive Culture Result ◽  
Santa Maria

Introduction: Cellulitis and erysipelas represent the most frequent cause of hospitalization in the dermatology department of Santa Maria Hospital in Lisbon, Portugal. The aim of this study was to investigate whether patient demographics, comorbidities, previous episodes of cellulitis/erysipelas, the presence of complications, laboratory markers at admission, microbial isolation or previous use of antibiotics, are associated with prolonged stays.Material and Methods: Retrospective analysis, including patients admitted with cellulitis/erysipelas in the inpatient dermatology department of Santa Maria Hospital between July 1st 2012 and June 30th 2017.Results: There were 372 admissions, corresponding to 348 patients. The median length of stay was 11 days. Increased age (p = 0.002, OR 1.03, 95% CI 1.01 – 1.04), previous episode of cellulitis/erysipelas requiring hospitalization (p = 0.005, OR 4.81, 95% CI 1.63 – 14.23), the presence of cellulitis/erysipelas-associated complications (p = 0.001, OR 3.28, 95% CI 1.63 – 6.59), leukocytosis (p = 0.049, OR 1.81, 95% CI 1.00 – 3.30), high levels of C-reactive protein (p = 0.035, OR 1.03, 95% CI 1.00 – 1.06) and a positive culture result (p = 0.002, OR 2.59, 95% CI 1.41 – 4.79) were associated with prolonged hospitalization.Discussion: Prolonged hospitalization for cellulitis/erysipelas is associated with higher costs, additional clinical investigation, invasive treatments, prolonged courses of antibiotic therapy, risk of nosocomial infections, and delayed return to activities of daily living. Thus, the investigation of clinical-laboratory factors associated with prolonged hospitalization for cellulitis / erysipelas is essential and may beuseful for the construction of a severity score.Conclusion: The knowledge of the characteristics that are associated with prolonged stay among patients with cellulitis/erysipelas may be relevant to improve health care, by reducing the length of hospital stay and associated risks and costs.

The Pattern of Ventricular Remodeling Influences the Level of Oxidative Stress in Heart Failure Patients

2017 ◽  
Vol 68 (7) ◽  
pp. 1506-1511
Author(s):  
Cerasela Mihaela Goidescu ◽  
Anca Daniela Farcas ◽  
Florin Petru Anton ◽  
Luminita Animarie Vida Simiti
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Ventricular Remodeling ◽  
Clinical Laboratory ◽  
Left Ventricular ◽  
Control Group ◽  
Reactive Protein ◽  
Lv Mass ◽  
Few Data

Oxidative stress (OS) is increased in chronic diseases, including cardiovascular (CV), but there are few data on its effects on the heart and vessels. The isoprostanes (IsoP) are bioactive compounds, with 8-iso-PGF25a being the most representative in vivo marker of OS. They correlate with the severity of heart failure (HF), but because data regarding OS levels in different types of HF are scarce, our study was aimed to evaluate it by assessing the urinary levels of 8-iso-PGF2aand its correlations with various biomarkers and parameters. Our prospective study included 53 consecutive patients with HF secondary to ischemic heart disease or dilative cardiomyopathy, divided according to the type of HF (acute, chronic decompensated or chronic compensated HF). The control group included 13 hypertensive patients, effectively treated. They underwent clinical, laboratory - serum NT-proBNP, creatinine, uric acid, lipids, C reactive protein (CRP) and urinary 8-iso-PGF2a and echocardiographic assessment. HF patients, regardless the type of HF, had higher 8-iso-PGF2a than controls (267.32pg/�mol vs. 19.82pg/�mol, p[0.001). The IsoP level was directly correlated with ejection fraction (EF) (r=-0.31, p=0.01) and NT-proBNP level (r=0.29, p=0.019). The relative wall thickness (RWT) was negatively correlated with IsoP (r=-0.55, p[0.001). Also 8-iso-PGF25a was higher by 213.59pg/�mol in the eccentric left ventricular (LV) hypertrophy subgroup comparing with the concentric subgroup (p=0.014), and the subgroups with severe mitral regurgitation (MR) and moderate/severe pulmonary hypertension (PAH) had the highest 8-iso-PGF2a levels. Male sex, severe MR, moderate/severe PAH, high LV mass and low RWT values were predictive for high OS level in HF patients.Eccentric cardiac remodeling, MR severity and PAH severity are independent predictors of OS in HF patients.

scholarly journals C-reactive protein and procalcitonin - laboratory markers of degrees of severity and complications of an acute necrotic pancreatitis

2020 ◽  
Vol 87 (3-4) ◽  
pp. 14-17
Author(s):  
O. V. Rotar ◽  
I. V. Khomiak ◽  
V. I. Rotar ◽  
A. I. Khomiak ◽  
S. I. Railianu
Keyword(s):  
Septic Shock ◽  
Protein Concentration ◽  
Inflammatory Process ◽  
Clinical Laboratory ◽  
C Reactive Protein ◽  
Septic Complications ◽  
Reactive Protein ◽  
Laboratory Markers ◽  
Necrotic Pancreatitis ◽  
Degrees Of Severity

Objective. To conduct comparative estimation of efficacy of C-reactive protein and procalcitonin as laboratory markers for stratification of the patients severity state suffering an acute necrotic pancreatitis. Materials and methods. Prospective cohort investigation, including 151 patients with an acute necrotic pancreatitis, was conducted. Clinical, laboratory and bacteriological investigations were accomplished. The levels of C-reactive protein and procalcitonin were determined in the blood plasm. Results. The necrotic accumulations infectioning was diagnosed in 89 (58.9%) patients: local purulent complications - in 27, sepsis - in 33,septic shock - in 29. In 62 patients with sterile pancreonecrosis a C-reactive protein concentration have raised from (5.6 ± 0.89) to (206 ± 29) mg/l (p˂0.001). Development of purulent-septic complications was accompanied by significant and trustworthy (p<0.01) elevation of procalcitonin concentration: in the patients with sepsis - up to (5.05 ± 0.92) ng/ml, in the patients with septic shock - up to (7.25 ± 2.15) ng/ml. Conclusion. Simultaneous measurement of levels of C-reactive protein and procalcitonin in the blood plasm in patients, suffering acute necrotic pancreatitis, gives permission to determine the inflammatory process character and stratify the disease severity in its early terms.

scholarly journals Laboratory Characteristics and Presentation of Multi-Organ Affection among Hospitalized Patients with SARS-CoV-2 Infection in Public Hospital in Bitola.

2020 ◽  
Vol 1 (1) ◽  
pp. 01-06
Author(s):  
Biljana Ilkovska
Keyword(s):  
Public Hospital ◽  
Clinical Laboratory ◽  
Vascular Inflammation ◽  
World Health ◽  
The Public ◽  
Reactive Protein ◽  
Therapy Decision ◽  
Decision Making Processes ◽  
Health Organization ◽  
Glutamyl Transferase

Introduction: In December 2019, a highly infectious disease i.e. pneumonia caused by the coronavirus disease SARS-CoV-2, occurred in Wuhan, China, and the World Health Organization has declared its ongoing outbreak a pandemic. The clinical laboratory plays a key role in supporting the monitoring and management of SARS-CoV-2 disease. Material and methods: Our study describes the laboratory characteristics of 103, SARS-CoV-2 patients hospitalized in the public hospital Trifun Panovski in the period April - June 2020. Only two patients died as a result of the SARS-CoV-2. The most common laboratory abnormalities were: elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP). Results: Leukocytosis was found in 23.3%, and leucopenia in 3% of patients with SARS – CoV-2. SARS-CoV-2 infection can be associated with myocardial injury, heart failure, vascular inflammation, myocarditis, cardiac arrhythmias, and hypoxic encephalopathy. We found increased values of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ –glutamyl transferase (γ –GT) in 35 – 50% of patients. We detected affected renal function in 10% of our patients with SARS – CoV 2. Conclusion:We identified potential biomarkers of disease severity. Our results provide guidance in risk assessment, clinical monitoring and therapy decision-making processes

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p &lt; 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p &lt; 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

scholarly journals Clinical Characteristics and Outcomes of Diabetic COVID-19 patients in Kuwait

2020 ◽  
Author(s):  
Abdullah Alshukry ◽  
Mohammad Bu Abbas ◽  
Yaseen Ali ◽  
Barrak Alahmad ◽  
Abdullah A. Al-Shammari ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Laboratory ◽  
Fasting Blood Glucose ◽  
List Type ◽  
Laboratory Findings ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
Laboratory Investigations ◽  
Insight Into ◽  
Variable Clinical Presentation

AbstractBackgroundCOVID-19 has a highly variable clinical presentation, ranging from asymptomatic to severe respiratory symptoms and death. Diabetes seems to be one of the main comorbidities contributing to a worse COVID-19 outcome.ObjectiveIn here we analyze the clinical characteristics and outcomes of diabetic COVID-19 patients.MethodsIn this single-center, retrospective study of 417 consecutive COVID-19 patients, we analyze and compare disease severity, outcome, associated complications, and clinical laboratory findings between diabetic and non-diabetic COVID-19 patients.ResultsCOVID-19 patients with diabetes had more severe outcomes and higher mortality than non-diabetic COVID-19 patients. Diabetic COVID-19 patients had significantly higher prevalence of comorbidities, such as hypertension. Laboratory investigations also highlighted notably higher levels of C-reactive protein in diabetic COVID019 patients and lower estimated glomerular filtration rate. They also showed a higher incidence of complications.ConclusionDiabetes could be a major contributor to worsening outcomes in COVID-19 patients. Understanding the pathophysiology underlining these findings could provide insight into better management and improved outcome of such cases.Highlights of the StudyA significantly higher proportion of Diabetic COVID-19 patients required admission to the ICU.Higher fasting blood glucose was associated with higher risk of COVID-19 associated mortality.Diabetic COVID-19 patients had significantly higher incidence of complications including sepsis, ARDS, cardiac failure and renal failure.

scholarly journals Inflammatory Burden and Persistent CT Lung Abnormalities in COVID-19 Patients

2021 ◽  
Author(s):  
Giulia Besutti ◽  
Paolo Giorgi Rossi ◽  
Marta Ottone ◽  
Lucia Spaggiari ◽  
Simone Canovi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Lung Damage ◽  
Reactive Protein ◽  
Lung Abnormalities ◽  
The Relationship ◽  
Lung Ct ◽  
D Dimer ◽  
Inflammatory Burden

Abstract Inflammatory burden is associated with COVID-19 severity and outcomes. Residual computed tomography (CT) lung abnormalities have been reported after COVID-19. The aim was to evaluate the association between inflammatory burden during COVID-19 and residual lung CT abnormalities collected on follow-up CT scans performed 2–3 and 6–7 months after COVID-19, in severe COVID-19 pneumonia survivors. C-reactive protein (CRP) curves describing inflammatory burden during the clinical course were built, and CRP peaks, velocities of increase, and integrals were calculated. Other putative determinants were age, sex, mechanical ventilation, lowest PaO2/FiO2 ratio, D-dimer peak, and length of hospital stay (LOS). Of the 259 included patients (median age 65 years; 30.5% females), 202 (78%) and 100 (38.6%) had residual, predominantly non-fibrotic, abnormalities at 2-3 and 6-7 months, respectively. In age- and sex-adjusted models, best CRP predictors for residual abnormalities were CRP peak (odds ratio [OR] for one standard deviation [SD] increase=1.79; 95% confidence interval [CI]=1.23-2.62) at 2-3 months and CRP integral (OR for one SD increase=2.24; 95%CI=1.53-3.28) at 6-7 months. Hence, inflammation is associated with short- and medium-term lung damage in COVID-19. Other severity measures, including mechanical ventilation and LOS, but not D-dimer, were mediators of the relationship between CRP and residual abnormalities.

Determining the Effects of Patient Casemix on Length of Hospital Stay: A Proportional Hazards Frailty Model Approach

2001 ◽  
Vol 40 (04) ◽  
pp. 288-292 ◽  
Author(s):  
K. K. W. Yau ◽  
A. H. Lee
Keyword(s):  
Proportional Hazards ◽  
Diagnosis Related Groups ◽  
Insurance Coverage ◽  
Length Of Hospital Stay ◽  
Patient Discharge ◽  
Frailty Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Data ◽  
Prolonged Hospitalization

Summary Objectives: To identify factors associated with hospital length of stay (LOS) and to model variations in LOS within Diagnosis Related Groups (DRGs). Methods: A proportional hazards frailty modelling approach is proposed that accounts for patient transfers and the inherent correlation of patients clustered within hospitals. The investigation is based on patient discharge data extracted for a group of obstetrical DRGs. Results: Application of the frailty approach has highlighted several significant factors after adjustment for patient casemix and random hospital effects. In particular, patients admitted for childbirth with private medical insurance coverage have higher risk of prolonged hospitalization compared to public patients. Conclusions: The determination of pertinent factors provides important information to hospital management and clinicians in assessing the risk of prolonged hospitalization. The analysis also enables the comparison of inter-hospital variations across adjacent DRGs.

scholarly journals Atypical Bacterial Growth within Units of Platelets Challenges Transfusion Medicine Dogma

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Eric A. Gehrie
Keyword(s):  
Bacterial Contamination ◽  
Current Issue ◽  
Safety Concern ◽  
Positive Culture ◽  
Storage Period ◽  
Transfusion Medicine ◽  
Platelet Concentrates ◽  
Content Type ◽  
Platelet Storage ◽  
Positive Culture Result

ABSTRACT Although transfusion-transmitted bacterial infection is relatively rare, mitigation of bacterial contamination of platelet units is arguably the top current transfusion-related safety concern. Several different technologies have been employed to detect or neutralize bacteria in platelet concentrates. However, studies of the efficacy of these systems have been hampered by problematic definitions of what represents a “true-positive” versus a “false-positive” culture result. In the current issue of the Journal of Clinical Microbiology (M. Cloutier, M.-È. Nolin, H. Daoud, A. Jacques, M. J. de Grandmont, É Ducas, G. Delage, and L. Thibault, J Clin Microbiol 56:e01105-18, 2018, https://doi.org/10.1128/JCM.01105-18), it was demonstrated that the growth of Bordetella holmesii is inhibited by the platelet storage environment, which may explain why the results of initial positive platelet cultures are not always confirmed by subsequent cultures later during the storage period. This important finding is at odds with the generally held belief within the field of transfusion medicine that initially positive platelet cultures that are not confirmed on repeat testing are instrumentation-based false positives. The clinical risk profile of organisms demonstrating storage-related low viability is worthy of further study.

scholarly journals Comparison of Three Skin Sampling Methods and Two Media for Culturing Malassezia Yeast

2020 ◽  
Vol 6 (4) ◽  
pp. 350
Author(s):  
Abdourahim Abdillah ◽  
Saber Khelaifia ◽  
Didier Raoult ◽  
Fadi Bittar ◽  
Stéphane Ranque
Keyword(s):  
Human Skin ◽  
Sampling Methods ◽  
Clinical Laboratory ◽  
Culture Media ◽  
Positive Culture ◽  
Laboratory Procedure ◽  
Study Results ◽  
Malassezia Spp ◽  
Routine Clinical Laboratory ◽  
Sterile Gauze

Malassezia is a lipid-dependent commensal yeast of the human skin. The different culture media and skin sampling methods used to grow these fastidious yeasts are a source of heterogeneity in culture-based epidemiological study results. This study aimed to compare the performances of three methods of skin sampling, and two culture media for the detection of Malassezia yeasts by culture from the human skin. Three skin sampling methods, namely sterile gauze, dry swab, and TranswabTM with transport medium, were applied on 10 healthy volunteers at 5 distinct body sites. Each sample was further inoculated onto either the novel FastFung medium or the reference Dixon agar for the detection of Malassezia spp. by culture. At least one colony of Malassezia spp. grew on 93/300 (31%) of the cultures, corresponding to 150 samplings. The positive culture rate was 67%, 18%, and 15% (P < 10−3), for samples collected with sterile gauze, TranswabTM, and dry swab, respectively. The positive culture rate was 62% and 38% (P < 0.003) by using the FastFung and the Dixon media, respectively. Our results showed that sterile gauze rubbing skin sampling followed by inoculation on FastFung medium should be implemented in the routine clinical laboratory procedure for Malassezia spp. cultivation.

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