The Outcome of Patients with Sepsis at Tarakan Hospital Central Jakarta in 2018

2021 ◽  
Vol 2 (2) ◽  
pp. 49
Author(s):  
Ade Dharmawan ◽  
Mieke Joseba Istia ◽  
Henny Tannady Tan ◽  
Suparto Suparto ◽  
Monica Cherlady Anastasia ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Patient Outcomes ◽  
Sepsis Patient ◽  
District Hospital ◽  
Common Source ◽  
Inclusion Criteria ◽  
Common Life ◽  
Source Of Infection ◽  
Life Threatening ◽  
Male Patients

Background: Sepsis is a common, life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, estimated cases for sepsis reached 48.9 million worldwide, with 11 million deaths. Adequate antibiotic therapy is crucial for the treatment of sepsis. Purposes: The objective of this study is to find factors related to sepsis patient outcomes. Methods: We conducted a 1-year retrospective descriptive study with the inclusion criteria of all adult sepsis patients in Tarakan District Hospital in 2018. We compiled 39 samples that fit the inclusion criteria. Results: The distribution gender of this study were 51.2% female and 48.8% male patients; with most patients in the age of <65 years old (53.8%), <7 days in the length of stay (72%), and the most common source of infection was gastrointestinal (33.3%) followed by lungs (28.2%). Conclusion: We found a mortality rate of 59%, with the most common source of infection leading to death was the lungs (81.2%) and treated with single ceftriaxone antibiotic therapy (78.3%). Another factor associated with mortality is inadequate single antibiotic therapy.

scholarly journals Vascular Injury and Its Management: Experience at Universal College of Medical Sciences, Bhairahawa, Nepal

2018 ◽  
Vol 5 (1) ◽  
pp. 8-11
Author(s):  
Santosh Shah ◽  
Rajesh Poudel ◽  
Tika Ram Bhandari ◽  
Damber Bikram Shah ◽  
Ghanshyam Sigdel ◽  
...  
Keyword(s):  
Patient Survival ◽  
Vascular Reconstruction ◽  
Vascular Trauma ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Medical Sciences ◽  
Common Life ◽  
Life Threatening ◽  
Male Patients ◽  
Management Experience

INTRODUCTION: Vascular trauma is a common life-threatening injury leading to serious consequences if not timely and efficiently managed. Although they represent less than 3% of all injuries, they deserve special attention because of their severe complications. The aim of this study was to analyze the causes of injury, presentations, surgical (recent) approaches, outcomes, and complications of vascular trauma.  MATERIALS & METHODS: This was a retrospective analysis performed over 6 months. From December 2015 to May 2016, 12 patients were included in the study and were operated upon for peripheral vascular injuries. Diagnosis was made by physical examination as well as with hand Doppler alone or in combination with Doppler scan. Primary vascular repair was carried out whenever possible; however, if it was not possible, an interposition vein graft was placed.  RESULTS:  Of the total 12 patients who sustained major vascular injuries during this period, 9 sustained injuries to the upper limb vessels, 3 had injuries of the lower limb vessels. Trauma with sharp object was the cause in 4 cases, blunt trauma was the cause in 4 cases and rupture pesudoaneurysm was the cause in 2 cases and ruptured aneurysm was the cause in 2 cases. Of the 12 patients, 12 patients were successfully managed by vascular reconstruction without any residual disability. There were 8 male patients (66.67%) and 4 female patients (33.33%), and their ages ranged from 16–60 years (mean 35 years).  CONCLUSION:  Patients who suffer vascular injuries should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 8-11

scholarly journals Necrotizing fasciitis of head – neck

1970 ◽  
Vol 14 (1) ◽  
pp. 9-14
Author(s):  
Sudhangshu Shekhar Biswas ◽  
Zaheer Al-Amin
Keyword(s):  
Antibiotic Therapy ◽  
Necrotizing Fasciitis ◽  
Primary Source ◽  
Good Control ◽  
Surgical Debridement ◽  
Electrolyte Imbalance ◽  
Diabetic Patients ◽  
Source Of Infection ◽  
Life Threatening ◽  
Head Neck

Necrotizing Fasciitis of head -neck is not so uncommon in diabetic patients which is a progressive, destructive and potentially life threatening soft tissue infection primarily affecting superficial fascial planes. It is caused by group A streptococci or by a synergistic combination of aerobe and anaerobe micro organisms. This is a retrospective study which makes an attempt to analyze various parameters such as demography, aetiology, complications, and management methods determining the overall prognosis. Odontogenic infection was the primary source of infection. Diabetes, anaemia, chronic renal failure and electrolyte imbalance were the most commonly associated illness. Surgical debridement with combined antibiotic therapy was used in the management of necrotizing fasciitis along with good control of diabetes and correction of anaemia and electrolyte imbalances. Overall mortality was low. The late referral and associated complications had increased the hospital stay. With proper control of infection by early diagnosis, surgical debridement and combined antibiotic therapy, along with timely control of complications and associated illness - better results can be possible. Key words: necrotizing fasciitis, antibiotics, debridement  DOI: 10.3329/bjo.v14i1.3274 Bangladesh J of Otorhinolaryngology 2008; 14(1) : 9-14

Severe Sepsis Attributable to Community-Associated Methicillin-Resistant Staphylococcus aureus: An Emerging Fatal Problem

2007 ◽  
Vol 73 (7) ◽  
pp. 684-687 ◽  
Author(s):  
Eric T. Castaldo ◽  
Edmund Y. Yang
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Soft Tissues ◽  
Hospital Admissions ◽  
Primary Source ◽  
Necrotizing Pneumonia ◽  
Inclusion Criteria ◽  
Methicillin Resistant ◽  
Cardiorespiratory Failure ◽  
Source Of Infection

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.

scholarly journals 284. Evaluation of Oral Step-Down Therapy for Enterobacteriaceae Bloodstream Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Sara Utley ◽  
Dawn Bouknight ◽  
Radha Patel ◽  
Kent Stock
Keyword(s):  
Bloodstream Infection ◽  
Oral Therapy ◽  
Common Source ◽  
Oral Antibiotic ◽  
Beta Lactam ◽  
Hospital System ◽  
Source Of Infection ◽  
Complete Treatment ◽  
Antibiotic Duration ◽  
Alternate Source

Abstract Background Oral antibiotic stepdown therapy for Gram-negative (GN) bloodstream infection (BSI) appears to be a safe option, though high bioavailability drugs like fluoroquinolones (FQ) and trimethoprim-sulfamethoxazole are often recommended without clear evidence demonstrating superiority. Due to increasing concerns of FQ resistance and collateral damage with an increasing community C. difficile rate, our organization sought to reduce overall FQ use and a shift toward oral beta-lactams (BL) was observed. A review was conducted to assess the outcomes of this shift. Methods This retrospective cohort included all patients within our 3-hospital system who had a positive GN blood culture and were transitioned to oral therapy to complete treatment outpatient for bacteremia between Jan 2017-Sept 2019. The primary outcome was recurrent BSI within 30 days of completing initial treatment. Secondary outcomes included 30-day mortality, 30-day recurrence of organism at an alternate source, 30-day readmission, and 90-day BSI relapse. Results Of 191 GN BSIs, 77 patients were transitioned to oral therapy. The mean age was 68 years, 60% were female. The most common source of infection was described as urine (39/77), intra-abdominal (16/77), unknown (13/77). Mean total antibiotic duration (IV plus PO) was 14 days (range 7–33). Patients received an average of 5 days IV prior to transitioning to PO therapy. The most common PO class was a 1st gen cephalosporin (29/77), followed by BL/BL inhibitor (16/77), and a FQ (13/77). There were no 30-day relapse BSIs observed in this cohort. There was 1 patient discharged to inpatient hospice, and no other 30-day mortality observed. There were 4 recurrent UTIs observed within 30 days, none of which required readmission. Of the twelve 30-day readmissions, 1 was considered by the investigators to be related to the initial infection. Conclusion An opportunity for education regarding duration of therapy was identified. Oral beta lactam use in our limited population appears to be a reasonable option to facilitate discharge. Results should be confirmed in additional, larger studies. Disclosures All Authors: No reported disclosures

Quality and Reliability of YouTube for Patient Information on Neurotoxins

2020 ◽  
Vol 36 (06) ◽  
pp. 773-777
Author(s):  
Manish Patel ◽  
Mit M. Patel ◽  
Robert T. Cristel
Keyword(s):  
Personal Experience ◽  
Medical Information ◽  
Average Length ◽  
Final Analysis ◽  
Accurate Information ◽  
Common Source ◽  
Inclusion Criteria ◽  
Educational Value ◽  
Global Quality ◽  
Source Reliability

YouTube is a common source of medical information for patients. This is the first study to assess the reliability and educational value of YouTube videos on neurotoxin procedures. YouTube.com was searched on June 15, 2020 using the keyword “Botox” or “neurotoxin.” A total of 100 videos were reviewed. Sixty-one videos met the inclusion criteria and were included in the final analysis. Video characteristics were noted, and a score was assigned to each video using the Journal of the American Medical Association (JAMA) benchmark criteria and the Global Quality Score (GQS) to measure source reliability and educational value, respectively. A total of 61 videos that met the inclusion criteria had an average length of 589 seconds (9 minutes and 49 seconds), 210,673 views, 5,295 likes, 318 dislikes, and 478 comments. A total of 30 videos (49%) were posted with an intention to educate patients while 31 videos (51%) were posted with the intention to detail a personal experience with neurotoxin. Patient education videos were significantly more reliable (P JAMA< 0.001) and had more educational value (P GQS < 0.001) but were less popular than “personal experience videos.” Personal-experience videos posted by patients had higher popularity, more likes and comments, yet lower scores on reliability and education. Patients will continue to seek educational material online, and clinicians should utilize this information to help primarily educate patients with standardized and accurate information about their treatment. Key Points

scholarly journals The OSMR Gene Is Involved in Hirschsprung Associated Enterocolitis Susceptibility through an Altered Downstream Signaling

2021 ◽  
Vol 22 (8) ◽  
pp. 3831
Author(s):  
Tiziana Bachetti ◽  
Francesca Rosamilia ◽  
Martina Bartolucci ◽  
Giuseppe Santamaria ◽  
Manuela Mosconi ◽  
...  
Keyword(s):  
Immune Response ◽  
Oncostatin M ◽  
Common Life ◽  
Downstream Signaling ◽  
Whole Exome ◽  
Gut Homeostasis ◽  
Life Threatening ◽  
Infection And Inflammation ◽  
Susceptibility Variant ◽  
Oncostatin M Receptor

Hirschsprung (HSCR) Associated Enterocolitis (HAEC) is a common life-threatening complication in HSCR. HAEC is suggested to be due to a loss of gut homeostasis caused by impairment of immune system, barrier defense, and microbiome, likely related to genetic causes. No gene has been claimed to contribute to HAEC occurrence, yet. Genetic investigation of HAEC by Whole-Exome Sequencing (WES) on 24 HSCR patients affected (HAEC) or not affected (HSCR-only) by enterocolitis and replication of results on a larger panel of patients allowed the identification of the HAEC susceptibility variant p.H187Q in the Oncostatin-M receptor (OSMR) gene (14.6% in HAEC and 5.1% in HSCR-only, p = 0.0024). Proteomic analysis on the lymphoblastoid cell lines from one HAEC patient homozygote for this variant and one HAEC patient not carrying the variant revealed two well distinct clusters of proteins significantly up or downregulated upon OSM stimulation. A marked enrichment in immune response pathways (q < 0.0001) was shown in the HAEC H187 cell line, while proteins upregulated in the HAEC Q187 lymphoblasts sustained pathways likely involved in pathogen infection and inflammation. In conclusion, OSMR p.H187Q is an HAEC susceptibility variant and perturbates the downstream signaling cascade necessary for the gut immune response and homeostasis maintenance.

scholarly journals Metabolic disturbances of the vitamin A pathway in human diaphragmatic hernia

2015 ◽  
Vol 308 (2) ◽  
pp. L147-L157 ◽  
Author(s):  
Karen Coste ◽  
Leonardus W. J. E. Beurskens ◽  
Pierre Blanc ◽  
Denis Gallot ◽  
Amélie Delabaere ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Perinatal Death ◽  
Single Gene ◽  
Gene Mutations ◽  
Transcriptional Analysis ◽  
Metabolic Disturbances ◽  
Common Life ◽  
Retinoid Signaling ◽  
Life Threatening ◽  
Surgically Induced

Congenital diaphragmatic hernia (CDH) is a common life-threatening congenital anomaly resulting in high rates of perinatal death and neonatal respiratory distress. Some of the nonisolated forms are related to single-gene mutations or genomic rearrangements, but the genetics of the isolated forms (60% of cases) still remains a challenging issue. Retinoid signaling (RA) is critical for both diaphragm and lung development, and it has been hypothesized that subtle disruptions of this pathway could contribute to isolated CDH etiology. Here we used time series of normal and CDH lungs in humans, in nitrofen-exposed rats, and in surgically induced hernia in rabbits to perform a systematic transcriptional analysis of the RA pathway key components. The results point to CRPBP2, CY26B1, and ALDH1A2 as deregulated RA signaling genes in human CDH. Furthermore, the expression profile comparisons suggest that ALDH1A2 overexpression is not a primary event, but rather a consequence of the CDH-induced lung injury. Taken together, these data show that RA signaling disruption is part of CDH pathogenesis, and also that dysregulation of this pathway should be considered organ specifically.

Treatment of Occult Bacteremia

PEDIATRICS ◽  
1984 ◽  
Vol 74 (6) ◽  
pp. 1131-1132
Author(s):  
WILLIAM FELDMAN
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Characteristics ◽  
Large Percentage ◽  
Source Of Infection ◽  
Occult Bacteremia ◽  
Obvious Source

To the Editor.— I am concerned about the conclusions in the paper on treatment of occult bacteremia.1 Carroll at al recommend "expectant antibiotic therapy for children who have no obvious source of infection and who have the clinical characteristics associated with occult bacteremia." As a relatively large percentage of infants aged 6 to 24 months have high fevers at one time or another, the implications of this approach were it to be widely implemented would be great.

Severe invasive disease caused by hypervirulent Klebsiella pneumoniae: a case report

2021 ◽  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Patient Outcomes ◽  
Liver Abscess ◽  
Pathogenic Bacteria ◽  
Treatment Options ◽  
Invasive Disease ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Antimicrobial Drugs ◽  
Life Threatening

Klebsiella pneumoniae (K. pneumoniae) is a common pathogenic bacteria that causes numerous infectious diseases. Hypervirulent K. pneumoniae (hvKP) can lead to invasive K. pneumoniae liver abscess syndrome, which can induce life-threatening multiple organ dysfunction syndrome or septic shock. We report a case of invasive K. pneumoniae liver abscess syndrome caused by hvKP and discuss the treatment options of this syndrome. Appropriate antimicrobial drugs should be administered to improve prognosis and prevent complications, and laboratory testing is essential to guide clinical management and optimize patient outcomes.

EP.WE.1048Weight Regain After Sleeve Gastrectomy More Common in Male and Less Common in Super-Obese Patients - Results of an 18-Month Follow-up Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ahmed Salman Bodla ◽  
Jenny Abraham ◽  
Neha Shah ◽  
Vinod Menon
Keyword(s):  
Sleeve Gastrectomy ◽  
Revisional Surgery ◽  
Patient Specific ◽  
Obese Patients ◽  
Inclusion Criteria ◽  
Super Obese ◽  
Burn Out ◽  
Single Centre Study ◽  
Male Patients

Abstract Aims Long-term success of Sleeve Gastrectomy (SG) is undermined by weight regain (WR). Several procedure- and patient-specific factors have been proposed in previous studies. Here we look at 18-month follow-up post-SG to investigate WR and patient-specific variables influencing this. Methods A single-centre study involving retrospective analysis of a prospectively-maintained database. Inclusion criteria: Primary non-revisional SG patients with adequate follow-up data to assess WL/WR trends. Patients were divided into two subgroups based on their %EWL between 6-to-12 and 12-to-18 months: weight regainers (WR) and weight losers/maintainers (WL/M). Results Out of 338 SG cases between 2012-2017, 180 met inclusion criteria of which 18.3% were men and 45% were super-obese. All patients lost weight during first 6 months (mean %EWL 52.3%, P &lt; 0.0001). Between 6-to-12 months, 87.6% patients continued WL with a further mean %EWL of 10.35% (P &lt; 0.0001). Between 12-to-18 months, a drastic deceleration/reversal of WL progress was observed with an average of only 0.76% EWL (P = 0.84), with 42% of patients regaining weight in this period (mean EWG 6.8%). Male patients encountered significantly higher WR rate (OR 3.27, P = 0.003), whereas it was much less frequent in pre-operatively super-obese patients (OR 0.48, P = 0.036). Moreover, there was no difference in the 6-month %EWL between WR and WL/M subgroups (P = 0.62), thus negating the possibility of WL burn-out phenomenon. Conclusions Different rates of WR in men and super-obese patients may indicate underlying behavioural and biological differences. More research is needed to investigate them in detail, having implications for revisional surgery and follow-up support.

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