scholarly journals Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage

2021 ◽  
Vol 9 ◽  
Author(s):  
Luis Moral ◽  
Teresa Toral ◽  
Agustín Clavijo ◽  
María Caballero ◽  
Francisco Canals ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Strong Relationship ◽  
Population Based ◽  
Parapneumonic Effusion ◽  
Strongly Correlated ◽  
Pleural Drainage ◽  
Imaging Studies ◽  
Intravenous Treatment ◽  
Appropriate Treatment

Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD).Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018.Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) (p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721).Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.

scholarly journals Retrospective Analysis of Large-Dose Intrapleural Alteplase for Complicated Pediatric Parapneumonic Effusion and Empyema

2015 ◽  
Vol 20 (2) ◽  
pp. 128-137
Author(s):  
Jessica L. Taylor ◽  
Meixia Liu ◽  
David S. Hoff
Keyword(s):  
Large Dose ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Length Of Hospital Stay ◽  
Oxygen Desaturation ◽  
Parapneumonic Effusion ◽  
Pleural Drainage ◽  
Tube Output ◽  
Chest Tube Output ◽  
Complicated Parapneumonic Effusion

OBJECTIVES: Medical treatment of complicated parapneumonic effusion or empyema in pediatric patients includes antibiotics and pleural space drainage. Intrapleural fibrinolysis may facilitate pleural drainage; however, there is a lack of consensus regarding the optimal dosing regimen. The primary purpose of this study was to evaluate the efficacy and safety of a large-dose intrapleural alteplase regimen in pediatric patients. Secondarily, this investigation sought to differentiate the clinical characteristics of responders and non-responders to intrapleural alteplase therapy. METHODS: All patients with parapneumonic effusions treated with intrapleural alteplase between June 2003 and December 2011 were reviewed retrospectively. Efficacy was assessed by comparing chest tube output, in mL/hr and mL/kg/hr, for 24 hours before and after the first dose of alteplase. Additional efficacy outcomes included duration of in situ chest tubes, a need for surgical intervention for pleural effusion, and length of hospital stay. Safety was assessed by frequency and severity of adverse events. Non-responders and responders were compared based on demographic and disease characteristics. Responders were defined as patients who did not require surgical intervention after intrapleural alteplase therapy. RESULTS: Seventy-three patients, aged 0.5 to 22.5 years, received intrapleural alteplase to facilitate pleural drainage. Median alteplase dose was 7 mg (range, 3 to 10 mg; median 0.38 mg/kg). Chest tube output increased from 10.7 to 24.2 mL/hr (p = 0.006), and median length of hospital stay was 9 days. Eighty-four percent of patients were responders. The most common adverse events were pain (20.5%) and oxygen desaturation greater than 10% from baseline (16.4%). High-flow nasal cannula was the most common intervention for oxygen desaturation to 80% to 90%. Nine patients (12%) required a blood transfusion during the study. CONCLUSION: Large-dose intrapleural alteplase is effective in facilitating pleural drainage in pediatric patients with complicated parapneumonic effusion or empyema. Common adverse effects include pain and oxygen desaturation. The potential for bleeding warrants clinical monitoring.

scholarly journals Salivary Biomarkers of Stress, Anxiety and Depression

2021 ◽  
Vol 10 (3) ◽  
pp. 517
Author(s):  
Sylwia Chojnowska ◽  
Iwona Ptaszyńska-Sarosiek ◽  
Alina Kępka ◽  
Małgorzata Knaś ◽  
Napoleon Waszkiewicz
Keyword(s):  
Salivary Cortisol ◽  
Depressive Disorders ◽  
Immunoglobulin A ◽  
Strong Relationship ◽  
Fibroblast Growth Factor 2 ◽  
Stress Axis ◽  
Anxiety And Depression ◽  
Salivary Biomarkers ◽  
Appropriate Treatment ◽  
As Stress

Stress, anxiety and depressive disorders are often characterized by the activation of the stress axis, which results in similar symptoms at some point in these disorders. These disorders are closely related to each other—they occur simultaneously or follow one another. The diagnosis of stress, anxiety and depression is not a perfect procedure currently—it is based on patient observation and an interview with the patient and their family. There are no laboratory tests that would dispel the doubts of the doctor making the diagnosis and allow the appropriate treatment to be implemented as soon as possible. Therefore, this study will review the components of saliva that could be helpful in the quick diagnosis of stress, anxiety and/or depression. Such potential salivary biomarkers could also be useful in monitoring the effectiveness of pharmacological treatment prescribed by a psychiatrist. The following are promising salivary biomarkers of stress, anxiety or depression: cortisol, immunoglobulin A (sIgA), lysozyme, melatonin, α-amylase (sAA), chromogranin A (CgA) and fibroblast growth factor 2 (FGF-2). To the best valuable potential salivary markers of stress, we can include cortisol, lysozyme, sAA and CgA. To differentiate depression from stress, salivary cortisol and melatonin can be helpful. Fluctuations in the concentrations of the above-mentioned substances in saliva indicate a particularly strong relationship with typical human psychological problems, such as stress, depression or anxiety.

The neuropathogenesis of delirium

2002 ◽  
Vol 12 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Susan White
Keyword(s):  
Hospital Stay ◽  
Older Patients ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Predisposing Factors ◽  
Advanced Age ◽  
Major Surgery ◽  
Common Disorder ◽  
Disturbance Of Consciousness ◽  
Short Period

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

Biochemical parameters and relation to disease severity in COVID-19 patients

2021 ◽  
pp. 93-96
Keyword(s):  
Biochemical Parameters ◽  
Troponin I ◽  
Total Bilirubin ◽  
Early Stage ◽  
Length Of Hospital Stay ◽  
Rt Pcr ◽  
Sodium Potassium ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
Severity Of The Disease

Aim: In this study, we aimed to evaluated whether there is an association between the biochemistry parameters obtained from the first blood test after hospitalization of COVID 19 patients and the prognosis and severity of the disease. Thus, we planned to identify patients with a severe course at an early stage and to help physicians determine the appropriate treatment. Material and Method: The study included 106 COVID 19 patients confirmed by RT-PCR. Patients were categorized into two groups: those admitted to the hospital ward and discharged with recovery (mild cases) and those admitted directly or eventually to the intensive care unit (severe cases). Biochemical parameters of the groups were compared with the Mann Whitney-U Test, as none of the compared parameters fit the normal distribution. Results: There was no statistically significant difference between the male-female numbers and ages of the two groups. Statistically significant differences were observed in the length of hospital stay, procalcitonin, hs-troponin I, ferritin, glucose, urea, creatinine, calcium, direct bilirubin, AST, LDH and CRP values (p<0,05). However, no significant difference was found in sodium, potassium, chloride, total bilirubin and ALT tests. Conclusion: The results show that some biochemistry parameters may be used to predict the prognosis of the disease. In particular, procalcitonin, hs troponin I, LDH and CRP values seem to be moderate biomarkers of the prognosis of the disease.

238 SERUM ALBUMIN EARLY DECREASE IS AN INDEPENDENT PREDICTOR OF MAJOR COMPLICATIONS AFTER ONCOLOGICAL ESOPHAGECTOMY; RESULTS FROM A LARGE EUROPEAN SERIES

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Ismail Labgaa ◽  
Styliani Mantziari ◽  
Michael Winiker-Seeberger ◽  
Jerôme Pasquier ◽  
Marguerite Messier ◽  
...  
Keyword(s):  
Predictive Value ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Adverse Outcomes ◽  
Major Surgery ◽  
Roc Curve Analysis ◽  
Comprehensive Complication Index ◽  
Major Complications ◽  
Patients At Risk

Abstract   The predictive value of postoperative albuminemia decrease (ΔAlb) has been increasingly evidenced in different types of major surgery but data on esophagectomy remain scarce. This study aimed to assess the predictive value of ΔAlb for adverse short-term outcomes after oncological esophagectomy. Methods Retrospective analysis of an international multicentric cohort of patients undergoing oncological esophagectomy between 2006–2017. Patients with missing pre- and postoperative albumin values were excluded from the analysis. Primary endpoint was postoperative morbidity according to Clavien classification. Secondary endpoints were Comprehensive Complication Index (CCI) and length of hospital stay (LoS). Results A total of 1046 patients were analyzed. Major complications were reported in 363 (34.7%) patients. Albuminemia showed a rapid postoperative decrease on postoperative day 1 (POD1) (ΔAlb POD1) with a median value of 11 g/L. ROC curve analysis determined a cut-off of 11 g/L for the prediction of overall complications. Patients with ΔAlb POD1 ≥ 11 g/L showed increased overall complications (p = 0.004), major complications (p = 0.009) and CCI (p = 0.006) while LoS was comparable (p = 0.099). On multivariable analysis, ΔAlb POD1 ≥ 11 g/L was an independent predictor of overall (OR: 1.55; 95% CI 1.09–2.21; p = 0.015) and major complications (OR: 1.43; 95% CI 1.09–1.89; p = 0.009). Conclusion Oncological esophagectomy induced a rapid decrease of albuminemia. ΔAlb POD1 ≥ 11 g/L was independently associated with the occurrence of overall and major postoperative complications. ΔAlb appears as a promising biomarker to detect patients at risk of adverse outcomes after oncological esophagectomy.

No association between vulvovaginitis-bacterial vaginosis, related drug treatments of pregnant women, and congenital abnormalities in their offspring — A population-based case-control study

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 332-340 ◽  
Author(s):  
Nándor Ács ◽  
Ferenc Bánhidy ◽  
Erzsébet Puhó ◽  
Andrew Czeizel
Keyword(s):  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Congenital Abnormality ◽  
Congenital Abnormalities ◽  
Population Based ◽  
Case Control ◽  
Data Set ◽  
Appropriate Treatment ◽  
Drug Treatments ◽  
Related Drug

AbstractThe possible association between prospectively and medically recorded vulvovaginitis-bacterial vaginosis (VV-BV) and different congenital abnormalities (CA) has not been studied. The data set of the population-based Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996 were evaluated, i.e. 22,843 pregnant women who had newborns or fetuses with congenital abnormality (cases) and 38,151 pregnant women who delivered newborn babies without any congenital abnormality (controls). The main outcome measures were different congenital abnormalities. Of 22,843 cases with CA, 1,536 (6.7%) had mothers with VV-BV, while of 38,151 matched controls without CA, 2,698 (7.1%) had mothers with VV-BV in the second and/or third gestational month of pregnancy. Nearly all pregnant women with VV-BV were treated during pregnancy, but a higher risk for the total group of CAs (adjusted POR with 95% CI: 0.95, 0.89–1.02) or any CA group was not found. In addition, the risk for total CAs was significantly lower in cases born to mothers with VV-BV and appropriate treatment than born to mothers with VV-BV but without treatment. Thus maternal VV-BV needs treatment during pregnancy as well, because it helps reduce the rate of preterm birth without a risk for CAs.

Implementation of the national register of suicide attempts as a preliminary strategy for the prevention of suicides in Poland

2017 ◽  
Vol 41 (S1) ◽  
pp. s892-s893
Author(s):  
A. Gmitrowicz ◽  
R. Szmajda ◽  
A. Baran ◽  
I. Makowska ◽  
P. Kropiwnicki
Keyword(s):  
Suicide Attempts ◽  
Independent Predictor ◽  
Population Based ◽  
Death Certificates ◽  
Psychiatric Institutions ◽  
Central Register ◽  
Central Statistical ◽  
Central Statistical Office ◽  
Competing Interest ◽  
Reported Data

Studies show that suicide attempts are a major independent predictor of suicide. Only in some countries of the world, there are national registers of these behaviors. Poland is among the countries where suicide prevention is at the stage of implementation of these strategies. One is the initial diagnosis of the prevalence of suicidal behavior (SB) in selected populations. The aim of the study was to assess the prevalence of SB in Poland on the basis of available databases, including data such as age, sex and mental disorders and the analysis of differentiation of selected indicators of SB.Material and methodsWe analyzed available registers of completed suicides (CS) and suicide attempts (SA), carried out under reporting of the central statistical office (CSO, in the general population, based on death certificates), Police Headquarters (PH, the number of reported SB in the country) and the Institute of Psychiatry and Neurology in Warsaw (IPiN, the number of SB in all psychiatric institutions) and the department of adolescent psychiatry in Łódź (SB among hospitalized youth).Results and conclusionsReported data on dissemination of SB in Poland are incomplete, which may affect the reliability of the assessment of the effectiveness of implemented strategies for the prevention of suicides. The aim should be to create a central register of SB, which will not only gather a well-defined data but also monitor how it is obtained.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Kaleidoscope

2014 ◽  
Vol 205 (2) ◽  
pp. 166-167 ◽  
Author(s):  
Derek K. Tracy ◽  
Dan W. Joyce ◽  
Sukhwinder S. Shergill
Keyword(s):  
Violent Crime ◽  
Population Based ◽  
The Novel ◽  
Drug Induced ◽  
Persecutory Delusions ◽  
Appropriate Treatment ◽  
Cannabis Extract ◽  
Drug Induced Psychosis ◽  
The Uk

Drugs and violence are often observed as bedfellows; both have been associated with psychosis but the nature and timing of their relationships remains unclear. As part of the UK Prisoner Cohort Study, Keers et al prospectively followed up 967 prisoners convicted of sexual or violent offences (about a quarter of whom had a psychotic illness) in the community after release. Schizophrenia was associated with greater rates of violence, but the risk was mediated by untreated psychosis or when presenting with persecutory delusions – and no other definable psychopathology. Interestingly, drug-induced psychosis did not increase the risk of violence per se, once the substance misuse itself was accounted for. Does treatment have an impact on risk of violence in a population-based sample of patients with psychosis? Fazel et al demonstrated reductions in violent crime in patients during the time they were prescribed antipsychotics. Interestingly, the rates of violent crime were also reduced in patients with bipolar disorder who received mood stabilisers. Therefore, in addition to the effects of antipsychotics and mood stabilisers on relapse rates, their potential effects on violence and crime could be used to make decisions about management for these groups of patients. There is a clearer need for the appropriate treatment of prisoners with psychotic illnesses if their risk of violence is to be moderated. Cannabis is one of the most commonly used social drugs worldwide; it increases risk of psychosis, but there has been little to offer pharmacologically to those dependent upon this most prevalent illicit drug, and various trials of mood stabilisers, antidepressants and α2 adrenergic agonists have generally been disappointing. Allsop et al evaluated the novel cannabis extract nabiximols, containing cannabidiol – which has been shown to attenuate paranoia and euphoria – and tetrahydrocannabinol, delivered as a buccal spray. The active drug group showed statistically significant benefits in reduced withdrawal irritability, depression and cravings and remained longer in treatment. However, both placebo and drug groups showed reduced cannabis use at follow-up, with placebo being as effective as nabiximols in promoting longer-term cessation.

Abstract 412: Obesity is an Independent Predictor Of Arterial Stiffness

Hypertension ◽  
2013 ◽  
Vol 62 (suppl_1) ◽  
Author(s):  
Mohan Thanikachalam ◽  
Shasha Bai ◽  
Vijayakumar Harivanzan ◽  
Ragavendra R Baliga ◽  
William T Abraham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Arterial Stiffness ◽  
Multivariate Regression ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Multivariate Regression Analysis ◽  
Population Based ◽  
Cross Sectional Survey ◽  
Cross Sectional

Background Arterial stiffness assessed by carotid-femoral pulse wave velocity (PWV) is an independent predictor of cardiovascular morbidity and mortality. We aimed to investigate how various measures of obesity affect arterial stiffness. Methods We conducted a population-based cross-sectional survey in 8,042 South Indians above the age of 20 years. Following completion of a detailed medical history questionnaire, all participants underwent haemodynamic screening including brachial and central blood pressure, and PWV measurements using a high-fidelity applanation tonometry. The study included anthropometric measurements and fasting blood for total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and blood glucose (BG) levels. After the exclusion of people with previous history of diabetes, hypertension and dyslipidemia on drug therapy, 5,841 subjects (mean age 41.6 years; 58% women) constituted the study sample Results In an univariate analysis, PWV correlated positively with age, mean blood pressure (MAP), heart rate (HR), body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), body fat percent (BF%), TC, TG, LDL and BG levels (P <0.001) and negatively with HDL levels (P=0.005). In a multivariate regression analysis, majority of the PWV variability in the model was accounted for by MAP and age, (cumulative adjusted R2 change of 32.79% as compared to the total adjusted R2 change of 35.25%). However, BMI (β= 0.042; adjusted R2 change=2.83%; p<0.001) independently correlated with PWV and its contribution to the PWV variability was far more significant compared to LDL, BG and TG (cumulative adjusted R2 change=1.08%). Multivariate regression analysis using the WC, WHR, or BF% instead of the BMI continued to demonstrate a significant independent effect of obesity parameters on PWV. Conclusion: In a large a population-based cross-sectional survey the study demonstrates a positive, independent association between obesity parameters and increased arterial stiffness.

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