Secondary tonsillar hemorrhage: a one year retrospective study in a District General Hospital

Tonsillectomy is one of the most commonly performed surgical procedures. Hemorrhage is its most significant complication. The literature indicates that most concern centres on reactionary rather than secondary hemorrhage. The aims of this study have been to determine the incidence of secondary tonsillar hemorrhage, the influence of patient age and operator experience and the predictive value of a history of infection, bleeding disorders and coagulation studies. A 4% incidence of secondary tonsillar hemorrhage was found, almost half of these having such severe bleeding as to warrant surgical intervention. The following findings also emerged: a) More adults than children suffered secondary hemorrhage. b) Incidence of secondary hemorrhage is independent of operator experience. c) There was a negative history of infection and bleeding disorders. d) Coagulation studies were normal in all cases. Despite improvements in standards and socio-economic and medical advances, secondary tonsillar haemorrhage continues to be a significant risk.

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Menorrhagia in Women with Severe Bleeding Disorders

Blood ◽

10.1182/blood.v120.21.4626.4626 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4626-4626

Author(s):

Susan Halimeh ◽

Joanna Davies ◽

Debra Pollard ◽

Rezan Abdul-Kadir

Keyword(s):

Tranexamic Acid ◽

Surgical Intervention ◽

Postoperative Bleeding ◽

Bleeding Complications ◽

Severe Bleeding ◽

Bleeding Disorders ◽

Line Treatment ◽

First Line ◽

First Line Treatment ◽

Factor Concentration

Abstract Abstract 4626 The management of menorrhagia presents a challenge in women with severe bleeding disorders. Conservative medical management is the first line treatment and most women with severe bleeding disorder require combination treatment. Surgical intervention may ultimately be offered to women in whom medical management has failed and whom no longer desire fertility. Women with low factor levels are at risk of perioperative bleeding complications and may require haemostatic support. A total of 50 women with severe factor deficiencies (less than 20iu/dL) were included in this study. 46 women were registered at the Haemophilia Centre at the Royal Free Hospital in London. Four cases were also included from the Rhine-Ruhr Haemophilia Centre in Duisburg, Germany. We reviewed the occurrence of menorrhagia and the management options that were offered. In those that required surgical intervention, the incidence of postoperative bleeding complications and the requirement for factor concentration was also reviewed. The bleeding disorders in these women were 34 (68%) with severe factor XI deficiency, 10 (20%) with severe type 1 and type 3 von Willebrand's disease, 4 (8%) with factor VII deficiency, 2 (4%) had factor V or X deficiencies and one (2%) had a combination of factor VI and VIII deficiency. The ISTH/SSC joint working group bleeding assessment tool was used to assess the severity and frequency of bleeding symptoms among this cohort of women. The bleeding scores ranged from −2 to 30 with a median score of 9.5. In total, 32 out of 50 (64%) women with severe factor deficiency required medical attention for menorrhagia. Medical treatment included hormonal preparations (combined oral contraceptive pill or levonorgestrel intrauterine device), which was used as a first line treatment in 15 out of 32 (46.8%) women. Haemostatic treatment included antifibrinolytic medication such as tranexamic acid, which was used in combination with hormonal therapy. One women required intranasal DDAVP, von Willebrand factor concentrate and tranexamic acid. Failure to control menstrual bleeding occurred in 14 (43.7%) women and surgical intervention was required. 7 out of 14 (50%) women required hysterectomy and the remaining 7 women underwent endometrial ablation. Prophylaxis with factor concentration to cover surgical intervention was given in 8 out of 14 women (64.2%). The remainder received tranexamic acid for 24–48 hours following surgery. Postoperative bleeding occurred in 7 women that had surgical intervention, despite two women receiving prophylaxis. This study highlights the complexity involved in the management of menorrhagia in women with severe bleeding disorders and the high risk of postoperative bleeding. Disclosures: No relevant conflicts of interest to declare.

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Mycoplasma pneumoniae and Recurrent Respiratory Tract Infection Within One Year After Treatment in Infants: Risk Factors and Prevalence

Iranian Journal of Pediatrics ◽

10.5812/ijp.112283 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Cheng-Yi Wang ◽

Chao-Min Song ◽

Guang-Hua Liu

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Respiratory Tract ◽

Mycoplasma Pneumoniae ◽

Significant Risk ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

History Of ◽

One Year ◽

Tract Infections

Background: Mycoplasma pneumoniae pneumonia (MPP) is common in pediatric patients. Many studies showed that recurrent respiratory tract infections (RRTIs) are common in the year following treatment of MPP in infants, but the factors associated with the occurrence of RRTIs are rarely reported. Therefore, the present study aimed to identify these factors. Methods: This retrospective observational study included infants (< one year) who were clinically treated for MPP from January 2015 to December 2018. Clinical features and relevant data were collected on admission. The cases of the occurrence of RRTIs and the presence of related factors after one year of follow-up were investigated by questionnaires. The questionnaires contained the number of upper respiratory infections, tracheobronchitis, and pneumonia, the titers and course of MP-IgG and positive IgM antibody, eczema, pet ownership, interior decoration, inhaled or ingested allergens, exposure to environmental tobacco smoke, and gastrointestinal function. Independent significant risk factors for RRTIs were identified using binary logistic regression. Results: A total of 300 MPP cases were included, among which RRTIs occurred in 134 (44.7%) cases in the year following MPP treatment. Binary logistic regression analysis showed that a history of prematurity (OR = 6.336, 95% CI: 2.337 - 17.116, P ≤ 0.001), a history of exposure to inhaled or ingested allergens (OR = 2.527, 95% CI: 1.289 - 4.956, P = 0.007), and co-infection involving Chlamydia pneumoniae (OR = 2.787, 95% CI: 1.145 - 6.784, P = 0.024) were significantly and positively associated with RRTIs after MPP, while age (OR = 0.894, 95% CI: 0.825 - 0.970, P = 0.007) showed a negative correlation with RRTIs. Conclusions: RRTIs in the year following clinical treatment of MPP in infants are relatively common and significantly associated with the patient’s age, history of prematurity, history of exposure to inhaled or ingested allergens, and C. pneumoniae co-infection. Thus, these factors should be carefully assessed in pediatric MPP cases to predict the risk of RRTIs and appropriately manage the patient.

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Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: Retrospective cohort study

10.21203/rs.3.rs-27382/v1 ◽

2020 ◽

Author(s):

Se Jin Lee ◽

Hyun Sun Ko ◽

Sunghun Na ◽

Jin Young Bae ◽

Won Joon Seong ◽

...

Keyword(s):

Cohort Study ◽

Uterine Rupture ◽

Placenta Previa ◽

Significant Risk ◽

Population Based ◽

Obstetric Outcomes ◽

History Of ◽

Adverse Pregnancy ◽

One Year ◽

Insurance Database

Abstract Background Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysisResults During the study period, 38,402 women with diagnosed myoma(s), 9,890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16, p = 0.042; and aOR 7.46, 95% CI 6.97-7.98, p < 0.001, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54, p = 0.042; and aOR 1.58, 95% CI 1.35-1.83, p < 0.001, respectively), compared to women without a diagnosed myoma. And the risks of uterine rupture, preterm birth, and low birth weight were significantly higher in women with previous myomectomy but not in women with diagnosed myoma(s), compared to women without a diagnosed myoma (aOR 12.78, 95% CI 6.5-25.13, p < 0.001; aOR 1.64, 95% CI 1.47-1.84, p < 0.001; and aOR 1.53, 95% CI 1.39-1.68, p < 0.001, respectively). The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.Conclusions When a woman who might become pregnant later on is diagnosed with uterine myoma, she should be counseled about the risk of myoma(s) and myomectomy on obstetric complications, especially including the significant risk of uterine rupture in pregnancies following myomectomy.

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Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽

10.1024/0301-1526/a000023 ◽

2010 ◽

Vol 39 (2) ◽

pp. 169-174 ◽

Cited By ~ 7

Author(s):

Reich-Schupke ◽

Weyer ◽

Altmeyer ◽

Stücker

Keyword(s):

Scientific Evidence ◽

Daily Practice ◽

Severe Adverse Effect ◽

Safe Procedure ◽

Efficacy And Safety ◽

Foam Sclerotherapy ◽

History Of ◽

One Year ◽

Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

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Thrombolysis in Arterial Occlusion

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615565 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 109-111 ◽

Cited By ~ 3

Author(s):

Raymond Verhaeghe

Keyword(s):

Clinical Practice ◽

Thrombolytic Therapy ◽

Hemorrhagic Stroke ◽

Surgical Intervention ◽

Bypass Graft ◽

Surgical Techniques ◽

Arterial Occlusion ◽

Second Step ◽

Severe Bleeding ◽

Initial Management

SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

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Evaluation of Individualized Physiotherapy in Pediatric Patients with Severe Bleeding Disorders

10.1055/s-0040-1721584 ◽

2020 ◽

Author(s):

Elisabeth Kahre ◽

Tina Adelhardt ◽

Claudia Nitze ◽

Ursula Range ◽

Sylvia von Mackensen ◽

...

Keyword(s):

Pediatric Patients ◽

Severe Bleeding ◽

Bleeding Disorders

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Newton and the Origin of Civilization

10.23943/princeton/9780691154787.001.0001 ◽

2012 ◽

Cited By ~ 1

Author(s):

Jed Z. Buchwald ◽

Mordechai Feingold

Keyword(s):

Good Reason ◽

History Of Mathematics ◽

Primary Sources ◽

Ancient History ◽

Isaac Newton ◽

History Of ◽

Ancient Civilizations ◽

And Mathematics ◽

One Year ◽

Radical Ideas

Isaac Newton’s Chronology of Ancient Kingdoms Amended, published in 1728, one year after the great man’s death, unleashed a storm of controversy. And for good reason. The book presents a drastically revised timeline for ancient civilizations, contracting Greek history by five hundred years and Egypt’s by a millennium. This book tells the story of how one of the most celebrated figures in the history of mathematics, optics, and mechanics came to apply his unique ways of thinking to problems of history, theology, and mythology, and of how his radical ideas produced an uproar that reverberated in Europe’s learned circles throughout the eighteenth century and beyond. The book reveals the manner in which Newton strove for nearly half a century to rectify universal history by reading ancient texts through the lens of astronomy, and to create a tight theoretical system for interpreting the evolution of civilization on the basis of population dynamics. It was during Newton’s earliest years at Cambridge that he developed the core of his singular method for generating and working with trustworthy knowledge, which he applied to his study of the past with the same rigor he brought to his work in physics and mathematics. Drawing extensively on Newton’s unpublished papers and a host of other primary sources, the book reconciles Isaac Newton the rational scientist with Newton the natural philosopher, alchemist, theologian, and chronologist of ancient history.

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200511 ◽

2020 ◽

pp. 1-6

Author(s):

P. Dubey ◽

J. Shrivastava ◽

B.P. Choubey ◽

A. Agrawal ◽

V. Thakur

Keyword(s):

Serum Bilirubin ◽

Tertiary Care ◽

Neurodevelopmental Outcome ◽

Significant Risk ◽

Central India ◽

Significant Risk Factor ◽

Motor Domain ◽

Medical Emergency ◽

One Year ◽

Group 1

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

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To Study the Clinical Profile and Management of Cellulitis of Lower Limb in Northern India

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620986679 ◽

2021 ◽

pp. 153473462098667

Author(s):

Tripta S. Bhagat ◽

Luv Kumar ◽

Prakhar Garg ◽

Apoorv Goel ◽

Amit Aggarwal ◽

...

Keyword(s):

Bacterial Infection ◽

Lower Limb ◽

Surgical Intervention ◽

Significant Risk ◽

Cross Sectional Study ◽

Common Complication ◽

Cross Sectional ◽

Medical College ◽

Northern India ◽

Working Age

Cellulitis is a bacterial infection of the dermis and subcutaneous tissues occupying a large proportion of hospital beds. This study was conducted for analysis of patients with cellulitis according to their demographics and clinical presentation and to examine their comorbidities, complications, and its management. This observational cross-sectional study was conducted in the Department of Surgery at Santosh Medical College and Hospitals involving a total of 60 cases having cellulitis and other soft tissue infections of lower limb. Analysis of their demographic profile, management, and complications was done. Cellulitis is seen commonly in males, 46 (76.6%). The mean age of patients affected by cellulitis in the study was 36.4 ± 1.23 years. The most common site affected is leg involving more people in field jobs. The most common risk factor was trauma in 46.6%, and other factors were diabetes mellitus and smoking, while abscess formation was the most common complication observed in 36.6% of cases. A total of 56.6% cases were managed conservatively, while 43.3% cases required surgical intervention. Mean hospital stay in this study was 5.02 ± 0.23 days. It was concluded that cellulitis is subcutaneous, spreading bacterial infection is more common in males, and its incidence is highest in working age group population. Lower limb is commonly involved. Trauma, smoking, and diabetes are significant risk factors for development of cellulitis. Abscess is the most common complication. About 50% patients with cellulitis can be managed conservatively and the rest require surgical intervention.

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