scholarly journals Clinical Features and Therapeutic Management of Postoperative Eso-Gastro-Duodenal Fistulas – A 6-Year Retrospective Study

2020 ◽  
Vol 25 (1) ◽  
pp. 36-40
Author(s):  
Vlad Andrei Porojan ◽  
Oana Ilona David ◽  
Ionut Simion Coman ◽  
Violeta Elena Coman ◽  
Costin Florea ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Malignant Disease ◽  
Clinical Manifestations ◽  
Favourable Outcome ◽  
Benign Lesions ◽  
Duodenal Stump ◽  
The Mean ◽  
Digestive Fistula ◽  
Surgery Department

AbstractThe postoperative digestive fistula is the most feared complication of gastrointestinal surgeries. We performed a retrospective study over a period of 6 years, in which we included 28 patients who developed postoperative esophageal, gastric or duodenal fistulae in the General Surgery Department of “Bagdasar–Arseni” Emergency Hospital. We assessed the risk factors for this complication, its management and its results. Most patients were males and the mean age was 61.1 years. For 15 patients, the surgeries were required for benign lesions while the rest of 13 patients had malignant disease. Regarding the type of the fistula, 14 were duodenal stump fistulas, 13 were anastomotic leakages and one was a dehiscence of a sutured duodenal ulcer. Six cases required emergency relaparotomy for sepsis and peritonitis. Sixteen patients had a favourable outcome while death occurred in 12 cases. The mortality was higher for patients with sepsis and peritonitis as the first clinical manifestations of fistula and with the need for an emergency reoperation.

scholarly journals AB0533 ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) IN GENERAL POPULATION WITHOUT ANCA ASSOCIATED VASCULITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1563.3-1563
Author(s):  
H. Tamaki ◽  
S. Fukui ◽  
T. Nakai ◽  
G. Kidoguchi ◽  
S. Kawaai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Autoimmune Disease ◽  
General Population ◽  
Granulomatosis With Polyangiitis ◽  
Dietary Habits ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Anca Associated Vasculitis ◽  
The Mean

Background:Currently it is hypothesized that many systemic autoimmune diseases occur due to environmental risk factors in addition to genetic risk factors. Anti-Neutrophil Cytoplasmic Antibody (ANCA) is mainly associated with three systemic autoimmune disease including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA). It is known that ANCA can be positive before clinical symptoms in patients with known diagnosis of GPA and ANCA titers rise before clinical manifestations appear. However, prevalence of ANCA among general population is not well known. It has not been described as well how many of people with positive ANCA eventually develop clinical manifestations of ANCA associated Vasculitis.Objectives:This study aims to estimate prevalence of ANCA in general population without ANCA associated Vasculitis. It also describes natural disease course of people with positive ANCA without ANCA associated Vasculitis. Risk factors for positive ANCA are also analyzed.Methods:This is a single center retrospective study at Center for Preventive Medicine of St. Luke’s International Hospital in Tokyo. ANCA was checked among the patients who wished to between 2018 and 2019. St. Luke’s Health Check-up Database (SLHCD) was utilized to collect the data. The patients whose serum was measured for ANCA were identified. The data for basic demographics, social habits, dietary habits and laboratory data were extracted. The charts of the patients with positive ANCA were reviewed.Results:Sera of total 1204 people were checked for ANCA. Of these 1204 people, 587 (48.8%) are male and the mean age was 55.8 years (32.6 to 79). There were total 11 patients with positive ANCA. Myeloperoxidase ANCA (MPO-ANCA) was positive for 3 patients and proteinase 3 ANCA (PR3-ANCA) was positive for 8 patients. Of these 11 patients, 5 were male (45.5%) and the mean age was 54.6 years. Two patients had history of autoimmune disease (primary biliary cirrhosis and ulcerative colitis). Five patients were evaluated by rheumatologists with the median follow-up period of 274 days. None of them developed clinical signs and symptoms of ANCA associated Vasculitis. Four out of five patients had ANCA checked later, two of which turned negative. The prevalence of ANCA in this cohort was 0.9% (95% confidence interval [95% CI]: 0.5% to 1.6%). Univariate analysis was performed to identify risk factors of positive ANCA. The variables analyzed include age, gender, body mass index (BMI), smoking habits, alcohol intake, dietary habits (fruits, fish, red meat), hypertension, dyslipidemia, and laboratory data. None of these variables demonstrated statistically significant differences except for positive rheumatoid factor (ANCA positive group: 33 % vs ANCA negative group: 9.1%, p value = 0.044).Conclusion:The prevalence of ANCA in this cohort was 0.9% (95% CI: 0.5% to 1.6%). None of them who had a follow-up developed ANCA associated Vasculitis during the follow-up period. Longer follow-up and more patients are necessary to determine natural course of people with positive ANCA.Disclosure of Interests:None declared

scholarly journals Corneal Higher-Order Aberrations after Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade: Preliminary Early 3-Month Results

2021 ◽  
Vol 10 (18) ◽  
pp. 4115
Author(s):  
Hiromitsu Onoe ◽  
Kazuyuki Hirooka ◽  
Hideaki Okumichi ◽  
Yumiko Murakami ◽  
Yoshiaki Kiuchi
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Retrospective Study ◽  
Cataract Surgery ◽  
Higher Order ◽  
Higher Order Aberrations ◽  
Postoperative Changes ◽  
The Mean ◽  
Kahook Dual Blade ◽  
Ab Interno

We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent μLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that underwent cataract surgery alone used as controls. Visual acuity and corneal HOAs, coma-like aberrations, and spherical-like aberrations were analyzed before and at 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence HOAs were evaluated. No significant postoperative changes were noted for corneal HOAs, coma-like aberrations, and spherical-like aberrations after cataract surgery alone. The mean corneal HOAs, coma-like aberrations, and spherical-like aberrations were 0.222 ± 0.115 μm, 0.203 ± 0.113 μm, and 0.084 ± 0.043 μm at baseline and 0.326 ± 0.195 μm (p < 0.001), 0.302 ± 0.289 μm (p = 0.03), and 0.150 ± 0.115 μm (p < 0.001) at 3 months after LOT-Phaco, respectively. Results of the analysis for risk factors suggested that a longer incision in Schlemm’s canal could influence corneal HOAs, coma-like aberrations, and spherical-like aberrations after LOT-Phaco. Although no significant postoperative changes were observed in corneal HOAs and coma-like or spherical-like aberrations after cataract surgery alone, a significant increase in corneal HOAs and coma-like or spherical-like aberrations remained after the LOT-Phaco procedure.

scholarly journals Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Han Zhang ◽  
Yingying Wu ◽  
Yuqing He ◽  
Xingyuan Liu ◽  
Mingqian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Population Based ◽  
Male Gender ◽  
Poor Correlation ◽  
Age Related ◽  
Related Risk ◽  
Independent Risk Factors

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057–1.065], p &lt; 0.001), male gender (OR = 1.726 [95% CI 1.582–1.885], p &lt; 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355–1.786], p &lt; 0.001), smoking (OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118–1.413], p &lt; 0.001), cancer (OR = 1.86 [95% CI 1.507–2.279], p &lt; 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427–2.12], p &lt; 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged &lt;40 years, only cancer (OR = 17.112 [95% CI 6.264–39.73], p &lt; 0.001) and ICH (OR = 31.538 [95% CI 5.213–158.787], p &lt; 0.001) were significantly associated with higher odds of death. For patients aged &gt;80 years, only age (OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301–1.933], p &lt; 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

scholarly journals Risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces: A retrospective observational study of 238 cases

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Hsiao-Han Wang ◽  
Yu-Chen Huang
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Poor Control ◽  
Reasonable Expectation ◽  
Nail Changes ◽  
Treatment Plans ◽  
Suitable Treatment ◽  
The Mean ◽  
Ingrown Toenails

Background: Nail braces are reportedly effective for treating both acute inflamed and chronic dystrophic type ingrown toenails. Aims: In this study, risk factors for poorly controlled and recurrence-prone ingrown toenails treated with nail braces were identified. Methods: We performed a retrospective study on patients with ingrown toenails between June 1, 2015, and May 31, 2018. The last follow-up date was January 31, 2019. Multivariate logistic regression was performed to evaluate the possible factors associated with poorly controlled status (ongoing paronychia during treatment) and recurrence. Results: There were 120 (244 sides) and 118 patients (167 sides) with chronic dystrophic and acute inflamed type ingrown toenails, respectively. The mean treatment duration and follow-up period were 161.2 ± 98.3 days and 432.7 ± 320.9 days, respectively. Poor control and recurrence were seen in 7.3% (17/232) and 12.2% (27/221) of the patients, respectively. In the multivariate analysis, acute inflamed ingrown toenails, previous nail avulsion, proximal nail fold hypertrophy and more than one affected side remained significantly associated with poorly controlled ingrown toenails. Foot bone deformity was significantly associated with recurrence. Limitations: This study was a retrospective study so that confounding factors such as comorbidities, body mass index, accompanying nail changes and lifestyle could not be evaluated. Conclusion: Several risk factors related to poor control and recurrence were identified. Patients could therefore benefit from more suitable treatment plans with reasonable expectation.

scholarly journals Risk factors of postoperative low back pain for low-grade isthmic spondylolisthesis: a retrospective study

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051989079
Author(s):  
Fulin Guan ◽  
Hongna Yin ◽  
Lin Zhu ◽  
Zhizhuang Zhang ◽  
Qichang Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Retrospective Study ◽  
Pain Score ◽  
Disc Height ◽  
Low Grade ◽  
Low Back ◽  
Isthmic Spondylolisthesis ◽  
The Mean

Objective To investigate the risk factors of postoperative low back pain (LBP) following posterior lumbar interbody fusion (PLIF) surgery for low-grade isthmic spondylolisthesis (IS). Methods This retrospective study enrolled patients with IS that underwent PLIF between January 2011 and January 2016. Demographic, clinical, surgical and radiological characteristics were analysed to determine associations between these characteristics and LBP as measured using a visual analogue scale (VAS) pain score. Results A total of 192 patients were enrolled in the study. The mean VAS pain score of LBP decreased significantly after surgery. The mean preoperative VAS pain score was significantly greater in patients with symptoms of ≤3 years duration compared with those with symptoms lasting >3 years. The postoperative VAS pain score was significantly lower in patients with grade 1 slippage compared with those with grade 2 slippage. There was a significant correlation between preoperative to postoperative change of VAS pain score and postoperative disc height ( r = 0.99). Conclusion PLIF significantly improved LBP in patients with low-grade IS, although patients still reported some postoperative LBP. The grade of slippage was a risk factor for postoperative LBP. Restoring the disc height appeared to improve LBP.

Deep venous thrombosis and cancer (about 68 cases)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19672-19672
Author(s):  
A. Tahri ◽  
M. El Hattaoui ◽  
N. Charei ◽  
M. El Belghiti ◽  
L. Mahmal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cost Effective ◽  
Spiral Ct ◽  
Physical Exam ◽  
Basic Work ◽  
The Mean ◽  
Work Up

19672 Background: The association between cancer and deep venous thrombosis (DVT) has been known for a century. The goal of this retrospective study is to evaluate the risk factors and the characteristics of patients presenting with a DVT to determine the interest of a malignancy work up. Methods: This is a monocentric retrospective study of 405 DVT’s ± pulmonary embolism reported between January 2003 and July 2006, confirmed by sonogram and spiral CT. The risk factors for the embolic events as well as the diagnosis work up done to determine the origin of the embolism were analyzed. Results: In our population the mean age was 50 years, 300 patients (74 %) presented with at least one risk factor for thrombosis event, 68 cases were found to have a malignancy (16.8%) from which 9 were occult malignancies (found among 109 cases of idiopathic DVT’s).The mean age of the patients diagnosed with cancer was significantly higher with a female predominance. These malignancies were distributed as follow: 50% gynecologic origin, 25% gastrointestinal, 10% pulmonary, 9 % urologic and 6% of hematologic origin. The risk factors identified were: Surgery (OR = 4) and Chemotherapy (OR=6). The occult malignancies were mentioned during the encounter with 6 patients. The physical exam, abdomino-pelvic sonograms were sufficient for the etiologic diagnosis in 8 cases. Other exams like (tumor markers, gastrointestinal endoscopies) were non contributive, a part of the clinical orientation they provided. Conclusions: DVT’s do occur more frequently in operated cancer patients or those who received chemotherapy. The malignancies are more frequently of gynecologic or gastrointestinal origin. It appears that an extensive diagnosis work up is not cost effective, a basic work up including: a thorough history, a complete physical exam, simple blood tests (inflammatory markers and CBC) as well as a abdomino-pelvic sonogram are sufficient for the screening of a malignancy, extensive work up should be done as a second option. No significant financial relationships to disclose.

Catheter-related venous thrombosis in NICU: A case-control retrospective study

2020 ◽  
pp. 112972982098320
Author(s):  
Karolina Chojnacka ◽  
Zbigniew Krasiński ◽  
Katarzyna Wróblewska-Seniuk ◽  
Jan Mazela
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Venous Thrombosis ◽  
Neonatal Intensive Care ◽  
Neonatal Period ◽  
Clinical Manifestations ◽  
Significant Risk ◽  
Case Control ◽  
Control Group ◽  
Vein Thrombosis

Introduction: Newborns treated in a neonatal intensive care unit (NICU) are susceptible to several complications one of them being vein thrombosis. Aim: The study aims to evaluate risk factors of catheter-related venous thrombosis, clinical manifestations, treatment, and the outcomes of thrombotic events (TE) during the neonatal period. Methods: This work is a case-control retrospective study performed on patients in the tertiary NICU between January 2013 and June 2016. The analysis includes data from infants with CVC diagnosed with thrombosis and infants with CVC, not being diagnosed with thrombosis (control group). Statistica 10 software was used for statistical analysis. Results: Vein thrombosis was diagnosed in 19 NICU infants including 16 cases of catheter-related vein thrombosis (84% of complicated cases). Other statistically significant risk factors were asphyxia, infection, and the duration of CVC use. The incidence of thrombosis in our population increased during the study which may result from a statistically significant increase in the number of inserted CVC (294 vs 435), and more frequent diagnosis of incidental thrombosis (1 vs 9). Conclusion: Vein catheterization, asphyxia, infection, and prolonged CVC use are critical risk factors for thrombosis in the neonatal period. Given the hereinbefore mentioned increased number of central line catheterizations in the NICU, it would be useful to conduct a prospective study with a scheduled routine ultrasound protocol applied not only as a tool to diagnose thrombosis but also to prevent it by determining a proper catheter for a particular vein.

STUDY OF CARDIOVASCULAR RISK FACTORS DURING GESTATIONAL DIABETES IN SENEGAL

2021 ◽  
pp. 98-102
Author(s):  
Soumah I.Y ◽  
Thiam S ◽  
Toure Y ◽  
Ndiaye A ◽  
Samba A ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Gestational Diabetes ◽  
Analytical Study ◽  
Delayed Diagnosis ◽  
Favourable Outcome ◽  
Apo B ◽  
History Of ◽  
The Mean ◽  
Lipid Parameters

The evolution of gestational diabetes is most often marked by preventable maternal-foetal complications. The objective of this study was to identify factors inuencing the development of pregnancy in women with gestational diabetes. This was a retrospective and analytical study including women with gestational diabetes and treated in gynaecological services in Dakar and its suburbs between 2018 and 2019. A total of 24 women with gestational diabetes were recruited. The mean age of the patients was 29.9 ± 6.45 years (18-45) with a predominance of women over 30 years old. Dyslipidaemias were frequent (91.2%) with a predominance of hypercholesterolemia (n = 13, 54.2%) followed by hyperLDLemia (n = 10, 41.7%). The atherogenic risk was high with the TG / HDL (12.5%) and Apo B / A (20.83%) ratios. A positive correlation was noted between homocysteine and total cholesterol (r = 0.457, p = 0.025), LDL (r = 0.449, p = 0.028), triglycerides (r = 0.540, p = 0.006), apolipoproteins A (r = 0.463, p = 0.023) and B (r = 0.480, p = 0.018), urea (r = 0.0671, p <0.0001) and creatinine (r = 0.0673, p <0, 0001). The development of the pregnancy was marked by caesarean deliveries (54.2%) and macrosomia (8.3%). The factors which were identied in relation to the caesarean section were delayed diagnosis of GD, history of personal abortion (RR (CI) = 2.04 (0.4 - 10.6)), multiparity (RR (CI)) = 2.3 (0.4 - 12.7)) and the advanced age of the woman (RR (CI) = 2.1 (0.5 - 14.4)). The biological monitoring of women with gestational diabetes must consider the dosage of lipid parameters extended to apolipoproteins and homocysteine for a favourable outcome of the pregnancy

Osteonecrosis of the Jaw in Multiple Myeloma Patients: Incidence and Characteristics in Korean Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4956-4956 ◽  
Author(s):  
Hyo Jung Kim ◽  
Hyeok Shim ◽  
Eunkyung Park ◽  
Min Kyoung Kim ◽  
Seok Jin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Retrospective Study ◽  
Conflicts Of Interest ◽  
Previous History ◽  
Clinical Manifestations ◽  
Osteonecrosis Of The Jaw ◽  
Korean Patients ◽  
Dental Procedures ◽  
Exposed Bone

Abstract Abstract 4956 Introduction Osteonecrosis of the Jaw (ONJ) is a potentially serious complication of bisphosphonate (BP) therapy in multiple myeloma (MM). Despite of current update about bisphosphonate related ONJ (BRONJ), only a few Asian BRONJ cases were reported and incidence of BRONJ in Asian MM patients has not yet been definitively estimated. The purpose of this study was to determine incidence and characteristics of BRONJ in Korean MM patients who were receiving BP therapy. Patients and Methods We invited 9 hospitals of Korean Multiple Myeloma Working Group (KMMWP) to participate in a retrospective multicenter study on BRONJ in MM patients. To defined BRONJ incidence, we reviewed the data from 130 MM patients treated with BP in one hospital. We also reviewed the medical records of MM patients with BRONJ treated in 9 hospitals to know the patterns of disease. We analyzed patient and disease characteristics, type and number of BP infusions, previous history of dental procedures, locations of osteonecrosis, clinical symptoms, treatment and outcome. ONJ was defined as clinical evidence of exposed bone in the jaw, which has been present for more than 8 weeks. Results Nine of 130 MM patients (6.9%) treated with BP developed BRONJ in the hospital. Twenty-two patients with MM developed BRONJ after a median number of 17 BP infusions (range 6 - 50) in all 9 hospitals. None of the patients had been irradiated to the jaw. There were 14 male and 8 female patients. The median age was 62 years (range 46 – 75). Median time from MM diagnosis to BRONJ was 2.8 years (range 0.6 – 15.6). The MM isotype was IgG in 9, IgA in 8, IgM in 1, light chain in 3 and non-secretory myeloma in 1 patient. BP therapy included zoledronate (n = 2) or pamidronate (n = 4) and both drugs as sequential treatment (n = 16). Fifteen patients had recent problems in oral cavity (72.7%) and 14 had prior dental procedures (63.6%). The mandible was involved in 14 patients (63.6%), the maxilla in 7 (31.8%), and both the maxilla and mandible in 1 (4.5%). Patients usually presented with pain and soft tissue swelling. ONJ staging (Khan et al. Canadian consensus practice guidelines of Bisphosphonate associated ONJ. J Rheumatol 2008;35:1391-7) was used to define the severity, there were 5 patients in stage I, 14 in stage II and 1 in stage III. Because of the limitation of retrospective study, the stage of 2 patients could not be confirmed. Management of these established cases were discontinuation of BP and medical treatment including antibiotics and pain killer. Surgical debridement of necrotic bone was performed in 12 patients. From onset of exposed bone in jaw, patients were followed for median 11 months (range 4.2 - 42). Wounds of 10 patients were healed at median 175 days (range 60 – 404) after bone exposure. In 8 patients, lesions had persisted over 154 days (range 66 – 425). Evaluation was impossible for 4 patients due to loss of follow up. Four patients were dead because of disease progression (n = 3) or concomitant infection. BRONJ was healed in 2 of them. Conclusions To the best of our knowledge, this is the largest retrospective study ever reported about BRONJ in Asian MM patients. The incidence of BRONJ in Korean MM patients was 6.9% and this is similar with data in western countries. Clinical manifestations and outcome of BRONJ in Korean patients were not different from previously reported data, but no risk factors could be definitively identified with our retrospective analysis. In the name of KMMWP, prospective trials are ongoing to define incidence and risk factors of BRONJ in Korean MM patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Clinical manifestations, associated risk factors and treatment outcomes of Chronic Pulmonary Aspergillosis (CPA): Experiences from a tertiary care hospital in Lahore, Pakistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259766
Author(s):  
Waqas Akram ◽  
Muhammad Bilal Ejaz ◽  
Tauqeer Hussain Mallhi ◽  
Syed Azhar bin Syed Sulaiman ◽  
Amer Hayat Khan
Keyword(s):  
Risk Factors ◽  
Treatment Response ◽  
Hematological Malignancies ◽  
Clinical Manifestations ◽  
Response Rates ◽  
Pulmonary Aspergillosis ◽  
Factors Associated ◽  
Icu Admission ◽  
Chronic Pulmonary Aspergillosis ◽  
The Mean

Background Chronic pulmonary aspergillosis (CPA) has a wide spectrum of illnesses depending on the progression of the disease and comorbid conditions. However, there is an inadequacy of investigations regarding clinical, laboratory, risk factor and prognostic data on CPA. The current study is aimed to consider the clinical manifestations, risk factors and outcomes of CPA. Methodology Retrospective records of all patients with a confirmed diagnosis of CPA who sought treatment at Gulab Devi Chest Hospital Lahore, Pakistan from January 2017 to December 2019 were evaluated. Data regarding demographics, clinical manifestations, comorbidities, radiographic and microbiological findings, length of hospital stay (LOS) and intensive care unit (ICU) admission was collected and analyzed to identify the factors associated with mortality. The independent factors associated with mortality were also identified by appropriate analyses. Results A total of 218 CPA patients were included in this study. The mean age was 45.75 ± 6.26 years. Of these, 160 (73.4%) were male, and 65 (29.8%) had diabetes. The mean LOS was 18.5 ± 10.9 days. The most common type of CPA was simple aspergilloma (56%) followed by chronic cavitary pulmonary aspergillosis (CCPA) (31.2%). About one half of the patients had a history of pulmonary tuberculosis (TB) and treatment response rates were low in patients with active TB. The overall mortality rate was 27.1%. ICU admission was required for 78 (35.8%) patients. Diabetes mellitus (DM), hematological malignancies and chronic kidney disease (CKD) were the common underlying conditions predicting a poor outcome. Mean LOS, hematological malignancies, consolidation and ICU admission were identified as the independent factors leading to mortality. Conclusions CPA had a significant association with TB in the majority of cases. Treatment response rates in cases with active TB were comparatively low. Cases with high mean LOS, hematological malignancies, consolidation, ICU admission, CKD and DM experienced poor outcomes. High mean LOS, hematological malignancies, consolidation and ICU stay were identified as independent risk factors for mortality. Future large prospective studies, involving aspergillus specific immunoglobulin G (IgG) antibody testing, are required for a better understanding of CPA in Pakistan.

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