scholarly journals Measures of Risk for Sepsis and Mortality in Severe Burned Patients with Stress Induced Hyperglycemia.

2021 ◽  
Vol 5 (2) ◽  
pp. 830-833
Author(s):  
Albana Aleksi ◽  
Monika Belba
Keyword(s):  
Medical Condition ◽  
University Hospital ◽  
Burn Shock ◽  
Burn Treatment ◽  
Risk Of Mortality ◽  
Close Relationship ◽  
Life Threatening ◽  
Burn Disease ◽  
The University ◽  
The Impact

Background; Hyperglycemia as a medical condition due to diabetes or other underlying conditions like Stress-Induced Hyperglycemia and sepsis as a life-threatening medical condition are two of the challenges faced during burn treatment. The purpose of this study was to evaluate the risk for sepsis and mortality for the patients with critical hyperglycemic values during the disease. Material and Methods; This is an observational retrospective cohort study conducted in the Service of Burns of the University Hospital Centre “Mother Teresa” in Tirana (UHCT), Albania from 1st January 2010 to 31st December 2014. Patients were categorized as having euglycemia (mean BG values ranging from 80-120 mg/dl), moderate hyper Sepsis was defined according to the ABA Consensus Panel Publication for Infection and Sepsis glycemia (mean BG values <180 mg/dl) or critical hyperglycemia (mean BG values ≥180 mg/dl). to evaluate the impact of the presence of critical hyperglycemia during the disease in sepsis and mortality, we performed Relative risk, Odds ratio Results; Those who had overall hyperglycemia (Moderate and Critical) had 2.6 times the risk for sepsis compared to those who were in the euglycemia group. Analyzing the risk of mortality in patients with overall hyperglycemia during the disease, we observed that the chance of a bad outcome was 2.7 times more likely to occur if the patient had hyperglycemia (RR=2.7). Conclusions: Glucose values on admission, as one of the derangement features of burn shock, are prognostic factors in critical hyperglycemia during burn disease and have a close relationship with other outcomes (sepsis and mortality).

scholarly journals Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients

2021 ◽  
Vol 5 (2) ◽  
pp. 849-853
Author(s):  
Besnik Faskaj ◽  
Monika Belba
Keyword(s):  
Relative Risk ◽  
Statistical Significance ◽  
Burn Injuries ◽  
University Hospital ◽  
Burn Shock ◽  
Ringer Lactate ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Observational Prospective Cohort Study ◽  
The University

Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h. This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids.  Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours. Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL. Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.

scholarly journals Impact of the COVID-19 pandemic and its related psychological effect on orthopedic surgeries conducted in different types of hospitals in Taiwan

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199607 ◽  
Author(s):  
Chia-Lung Shih ◽  
Peng-Ju Huang ◽  
Hsuan-Ti Huang ◽  
Chung-Hwan Chen ◽  
Tien-Ching Lee ◽  
...  
Keyword(s):  
Community Hospital ◽  
University Hospital ◽  
Total Knee Arthroplasties ◽  
Peak Period ◽  
Number Of Patients ◽  
Total Knee ◽  
Investigation Period ◽  
Orthopedic Diseases ◽  
The University ◽  
The Impact

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.

scholarly journals Treatment of Anorexia Nervosa: The Importance of Disease Progression in the Prognosis

2017 ◽  
Vol 30 (7-8) ◽  
pp. 517
Author(s):  
Rodrigo Andrade ◽  
Manuel Gonçalves-Pinho ◽  
António Roma-Torres ◽  
Isabel Brandão
Keyword(s):  
Anorexia Nervosa ◽  
Dropout Rate ◽  
University Hospital ◽  
High Rate ◽  
Prognostic Features ◽  
Illness Duration ◽  
Intense Fear ◽  
Life Threatening ◽  
Fear Of Weight Gain ◽  
The Impact

Introduction: Anorexia nervosa is a severe, usually chronic, life-threatening disease of complex etiology characterized by food restriction, overestimation of the importance of body weight and image, intense fear of weight gain and distortion of body image. Anorexia nervosa is associated with high rates of mortality, suicide and decreased quality of life. Our aim is to present an anorexia nervosa treatment program offered in a major university hospital in Portugal, and to determine the impact of illness duration before admission on the outcome. Our hypothesis is that patients with greater disease longevity may have worse prognosis and poorer outcome.Material and Methods: The sample included data from case records of 169 patients seen consecutively and for the first time at Centro Hospitalar São João, between 2010 and 2015. We performed a retrospective observational study which included data collected at admission and from later follow-up years.Results: From the initially selected patients, 14.8% reached total remission, 16% accomplished partial remission and 14.2% ended up with exacerbation/stagnation of the disease. The dropout rate was of 55% throughout our study period. We found significant differences on outcome rates between distinct illness duration groups (p = 0.007).Discussion: There are several factors frequently associated with poor outcome for anorexia nervosa. The interpretation of outcome findings was limited by the high rate of dropout and lack of consistent definition criteria.Conclusion: Our results support the idea that illness duration has an important role on the outcome and prognostic features of these patients.

scholarly journals Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11534
Author(s):  
Stefano Sartini ◽  
Laura Massobrio ◽  
Ombretta Cutuli ◽  
Paola Campodonico ◽  
Cristina Bernini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Outcome ◽  
University Hospital ◽  
Rt Pcr ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

Fetal Profile Markers for the Detection of Robin Sequence in Fetuses with Retrognathia

2021 ◽  
Author(s):  
Cornelia Wiechers ◽  
Christian Poets ◽  
Markus Hoopmann ◽  
Karl Oliver Kagan
Keyword(s):  
Normal Population ◽  
False Positive Rate ◽  
University Hospital ◽  
Robin Sequence ◽  
Profile Line ◽  
Positive Rate ◽  
Life Threatening ◽  
Matched Case ◽  
The University ◽  
Control Study

Abstract Objective To determine whether the prefrontal space ratio (PSFR), inferior facial (IFA) and maxilla-nasion-mandible angle (MNM), and the fetal profile line (FPL) are helpful in identifying fetuses with Robin sequence (RS) in cases with isolated retrognathia, and thus better predict the likelihood of immediate need for postnatal respiratory support. Methods This was a retrospective matched case-control study of fetuses/infants with isolated retrognathia with or without RS receiving pre- and postnatal treatment at the University Hospital of Tübingen, Germany between 2008 and 2020. The PFSR, IFA, MNM, and FPL were measured in affected and normal fetuses according to standardized protocols. Cases were stratified into isolated retrognathia and RS. Results 21 (n=7 isolated retrognathia, n=14 RS) affected fetuses and 252 normal fetuses were included. Their median gestational age at ultrasound examination was 23.6 and 24.1 weeks, respectively. In fetuses with isolated retrognathia and RS, the PSFR, IFA, and FPL were significantly different from the normal population. At a false-positive rate of 5%, the detection rate was 76.2% for the PFSR, 85.7% for the IFA, and 90.5% for both parameters combined. However, all parameters failed to distinguish between isolated retrognathia and RS. Conclusion PSFR and IFA are simple markers for identifying retrognathia prenatally. However, they are not helpful for the detection of RS in fetuses with isolated retrognathia. Therefore, delivery should take place in a center experienced with RS and potentially life-threatening airway obstruction immediately after birth.

scholarly journals Impact of ERAS compliance on the delay between surgery and adjuvant chemotherapy in hepatobiliary and pancreatic malignancies

2020 ◽  
Vol 405 (7) ◽  
pp. 959-966
Author(s):  
Pénélope St-Amour ◽  
Pascal St-Amour ◽  
Gaëtan-Romain Joliat ◽  
Aude Eckert ◽  
Ismail Labgaa ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Enhanced Recovery ◽  
Young Patients ◽  
University Hospital ◽  
Colorectal Metastases ◽  
Liver Malignancies ◽  
Study Population ◽  
Eras Protocol ◽  
The University ◽  
The Impact

Abstract Background Multidisciplinary approach with adjuvant chemotherapy is the key element to provide optimal outcomes in pancreas and liver malignancies. However, post-operative complications may increase the interval between surgery and chemotherapy with negative oncologic effects. Hypothesis and study aim The aim of the study was to analyse whether compliance to Enhanced Recovery After Surgery (ERAS) pathway was associated with decreased interval to adjuvant chemotherapy. Methods Retrospective analysis of all consecutive ERAS patients with surgery for hepatobiliary or pancreatic malignancies at the University Hospital of Lausanne between 2012 and 2016. Multivariate analysis was performed to assess the impact of ERAS compliance on time to chemotherapy. Results A total of 133 patients with adjuvant chemotherapy were included (n = 44 liver and n = 89 pancreatic cancer). Median compliance to ERAS was 61% (IQR 55–67) for the study population, and median delay to chemotherapy was 49 days (IQR 39-61). Overall, compliance ≥ 67% to ERAS induced a significant reduction in the interval between surgery and chemotherapy for young patients (< 65 years old) with or without severe comorbidities (reduction of 22 and 10 days, respectively). High compliance in young ASA3 patients with liver colorectal metastases was associated with an increase of 481 days of DFS. Conclusions ERAS compliance ≥ 67% tends to be associated with a reduction in the delay to adjuvant chemotherapy for young patients with hepatobiliary and pancreatic malignancies. More prospective studies with strict adhesion to the ERAS protocol are needed to confirm these results.

Odontogenic phlegmon of the mouth floor: a case report

2016 ◽  
Vol 6 (2) ◽  
pp. 0-0
Author(s):  
P. Bortnik ◽  
P. Wieczorek ◽  
P. Załęski ◽  
P. Kosierkiewicz ◽  
A. Siemiątkowski ◽  
...  
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Plastic Surgery ◽  
Successful Treatment ◽  
Surgical Intervention ◽  
University Hospital ◽  
Local Complication ◽  
Life Threatening ◽  
Ludwig’S Angina ◽  
The University

Odontogenic phlegmon of the mouth floor—Ludwig's angina (phlegmonae fundi cavi oris seu angina Ludovici)—is a rare, life-threatening, local complication in most cases of odontogenic inflammation. This study presents the case of a patient treated in the Department of Maxillofacial and Plastic Surgery of the University Hospital in Białystok due to phlegmon of the mouth floor resulting from odontogenic inflammation with a dynamic course. Quick diagnostics, surgical intervention as well as antibiotic therapy contributed to its efficient and successful treatment.

Drugs that can cause respiratory depression with concomitant use of opioids

2017 ◽  
Vol 16 (1) ◽  
pp. 186-186
Author(s):  
B.D. Sigmarsdottir ◽  
Th.K. Gudmundsdottir ◽  
S. Zoäga ◽  
P.S. Gunnarsson
Keyword(s):  
Respiratory Depression ◽  
Medical Records ◽  
Medical Condition ◽  
University Hospital ◽  
Drug Classes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Using Data ◽  
Medical Records System ◽  
Sedative Drugs

Abstract Aims Respiratory depression is a serious life threatening condition and a known adverse event of opioids. Little is known about the use of the opioid antidote naloxon in Iceland, and the additive effects of other potentially respiratory depressive drugs administered with opioids. The aim of the study was to review the literature on drugs that may cause respiratory depression and to assess medication use in patients receiving parenteral naloxone in Landspítali University Hospital. Methods A review and analysis of drugs that can cause respiratory depression based on information from the scientific literature, medicine databases and clinical guidelines. A retrospective study was performed using data collected from the electronic medical records system of Landspítali University Hospital for all patients, 18 years and older that had parenteral naloxon administered in the years 2010–2014. Information about the type of opioid and other respiratory depressive drugs was collected and the data was further investigated in regards to age, gender, and type of service. Results The most potential drugs and drug classes that can cause respiratory depression when used concomitantly with opioids are benzodiazepines and other anxiolytics, hypnotics and sedatives, antipsychotics, antiepileptics, antihistamins and anesthetics. When use was examined (N=138) morphine was the most frequent opioid given (49%). Concomitant use of opioids and other respiratory depressive drugs was seen in 63% of cases, and benzodiazepines were the most frequent drugs given with opioids (33%). Conclusions The concomitant use of benzodiazepines and other sedative drugs with opioids is frequent, despite the known risk of additive respiratory depression as described in the literature. Other patient risk factors such as medical condition, general health and consciousness should be considered in context with drugs used.

scholarly journals Profile of cases suspected of attempted suicide by exogenous intoxication

2018 ◽  
Vol 9 (2) ◽  
pp. 123
Author(s):  
Fernanda Pamela Machado ◽  
Marcos Hirata Soares ◽  
Patricia Dias Francisquini ◽  
Layla Karina Ferrari Ramos
Keyword(s):  
Medical Records ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
University Hospital ◽  
Professional Service ◽  
Information Center ◽  
Life Threatening ◽  
Physical Consequences ◽  
The University ◽  
Present Life

Objective: To characterize the profile of patients suspected of attempting suicide, based on cases reported by the Toxicological Information Center of the University hospital of Southern Brazil.Methods: This is a retrospective aggregate study, based on the analysis of medical records and files between January 2009 and December 2012, aiming to collect information that would create the profile of patients suspected of attempting suicide, from the cases notified by the Toxicological Information Center.Results: Regarding the physical consequences and the danger of the suicide attempt, 97% of the suicide attempts did not present life threatening (n = 1,605); 85.4% were not referred to any professional service (n = 1,412). The year 2012 was the year with the highest number of suicide attempts that the other years.Conclusions: It is considered important to improve the notification form for poisoning injuries, to better detect information about suicide attempts.

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