scholarly journals Specific Bile Microorganisms Caused by Intra-Abdominal Abscess on Pancreaticoduodenectomy Patients: A Retrospective Cohort Study

2021 ◽  
Vol 29 (1) ◽  
pp. 111-121
Author(s):  
Young-Jen Lin ◽  
Te-Wei Ho ◽  
Chien-Hui Wu ◽  
Ting-Chun Kuo ◽  
Ching-Yao Yang ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Abdominal Cavity ◽  
Fluid Collection ◽  
Enterococcus Species ◽  
Ct Guided ◽  
Factors Associated ◽  
Streptococcus Species ◽  
Bile Culture ◽  
Bile Spillage ◽  
Significant Factors

We retrospectively collected PD patients with a performance of bile culture between 2007 and 2019 in our institute. As to bile culture, we used a swab to do intraoperative bile cultures after transection of the CBD. IAA was defined as the documental bacteriological culture from either a turbid discharge from the intraoperatively placed drain in patients with a clinical picture consistent with infection or a postoperative fluid collection managed by CT-guided placement of drains. A total of 1244 PD patients were identified, and 539 (43.3%) subjects with bile sampling were included for analysis. Among these study patients, 433 (80.3%) developed bile contamination (positive bile culture). Bile contamination showed a significantly higher rate of IAA compared to non-bile contamination (17.1% vs. 0.9%, p < 0.001). The rate of co-shared microorganisms in both bile and abscess was 64.1%. On the multivariate analysis, age and specific bile microorganisms (Enterococcus species, Escherichia Coli, Streptococcus species, Citrobacter species, and Candida) are significantly associated with development of IAA. Specific bile microorganisms are the highly significant factors associated with development of IAA. The strategy to prevent bile spillage during PD should be considered to minimize afterward contamination of the abdominal cavity and prevent IAA.

scholarly journals Comparative Analysis of Cage Subsidence in Anterior Cervical Decompression and Fusion: Zero Profile Anchored Spacer (ROI-C) vs. Conventional Cage and Plate Construct

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhe-yu Jin ◽  
Yun Teng ◽  
Hua-zheng Wang ◽  
Hui-lin Yang ◽  
Ying-jie Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Factors Associated ◽  
Subsidence Rate ◽  
Cage Subsidence ◽  
Conventional Plate ◽  
Male Sex ◽  
Significant Factors

Background: Anterior cervical discectomy and fusion (ACDF) has been widely performed to treat cervical generative diseases. Cage subsidence is a complication after ACDF. Although it is known that segmental kyphosis, acceleration of adjacent segmental disease, and restenosis may occur due to cages subsidence; however detailed research comparing zero-profile cages (ROI-C) and conventional plate and cage construct (CPC) on cage subsidence has been lacking.Objective: The objectives of this study was to compare the rate of postoperative cage subsidence between zero profile anchored spacer (ROI-C) and conventional cage and plate construct (CPC) and investigate the risk factors associated with cage subsidence following ACDF.Methods: Seventy-four patients with ACDF who received either ROI-C or CPC treatment from October 2013 to August 2018 were included in this retrospective cohort study. Clinical and radiological outcomes and the incidence of cage subsidence at final follow up-were compared between groups. All patients were further categorized into the cage subsidence (CS) and non-cage subsidence (NCS) groups for subgroup analysis.Results: The overall subsidence rate was higher in the ROI-C group than in the CPC group (66.67 vs. 38.46%, P = 0.006). The incidence of cage subsidence was significantly different between groups for multiple-segment surgeries (75 vs. 34.6%, P = 0.003), but not for single-segment surgeries (54.55 vs. 42.30%, P = 0.563). Male sex, operation in multiple segments, using an ROI-C, and over-distraction increased the risk of subsidence. Clinical outcomes and fusion rates were not affected by cage subsidence.Conclusion: ROI-C use resulted in a higher subsidence rate than CPC use in multi-segment ACDF procedures. The male sex, the use of ROI-C, operation in multiple segments, and over-distraction were the most significant factors associated with an increase in the risk of cage subsidence.

scholarly journals 664 Factors and Outcomes Associated with Delays in Carotid Endarterectomy in Symptomatic Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Hussain
Keyword(s):  
Carotid Endarterectomy ◽  
Surgical Outcomes ◽  
Retrospective Cohort ◽  
Stroke Risk ◽  
Adverse Outcome ◽  
Carotid Artery Disease ◽  
Index Event ◽  
Factors Associated ◽  
Artery Disease ◽  
Significant Factors

Abstract Introduction Carotid artery disease (CAD) contributes to 20% of ischaemic stroke. Carotid endarterectomy (CEA) reduces stroke risk significantly if performed within 14 days of the index event in symptomatic patients. Studies report delayed CEA is common in practice, however underlying reasons are poorly understood. The aim is to assess factors associated with delayed CEA, and to compare outcomes between timely and delayed CEA. Method This retrospective cohort study included 24 symptomatic CAD patients planned for CEA between October 2018 and December 2019 in a tertiary vascular unit. Time from index event to CEA was measured in “timely” (≤14 days) and “delayed” (&gt;14 days) cohorts and causes for delay were explored. Univariate logistic regression was performed to assess factors associated with delay. Surgical outcomes at 30-days and 1-year were compared between cohorts. Results Overall, 58.3% (n = 14/24) patients underwent delayed CEA. Median time from index event to CEA was 10.5 (IQR 7.5-12) and 22 (IQR 16-32) days in timely and delayed cohorts respectively (P &lt; 0.0001). The main cause of delay was deterioration in patient condition (50%, n = 7/14). In 35.7% (n = 5/14) reasons were unclear. No statistically significant factors were associated with a delay. All surgical outcomes, including 30-day mortality (0%, n = 0/10 vs 7.1%, n = 1/14;P&gt;0.9999) and all-stroke (0%, n = 0/10 vs 14.3%, n = 2/14;P=0.4928), were not statistically significant between timely and delayed cohorts respectively. Conclusions A substantial proportion of patients undergo delayed CEA, with inconclusive associated factors. Those undergoing a delayed CEA did not comparatively have an adverse outcome, but numbers in our study were limited. A larger scale study with increased power is required.

scholarly journals Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049089
Author(s):  
Marcia C Castro ◽  
Susie Gurzenda ◽  
Eduardo Marques Macário ◽  
Giovanny Vinícius A França
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Factors Associated ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

scholarly journals Prevalence of suicidal ideation and associated factors among HIV positive perinatal women on follow-up at Gondar town health institutions, Northwest Ethiopia: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leul Belachew Zewdu ◽  
Mebratu Mitiku Reta ◽  
Niguse Yigzaw ◽  
Koku Sisay Tamirat
Keyword(s):  
Suicidal Ideation ◽  
Unplanned Pregnancy ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Hiv Status ◽  
Cross Sectional ◽  
Factors Associated ◽  
Gondar Town ◽  
Perinatal Women ◽  
Significant Factors

Abstract Background Suicidal behaviors cover a range or continuum of acts from suicidal ideations to a series of actions, commonly known as suicidal attempts or deliberate self-harms. Though different mental disorders related studies were conducted among HIV/AIDS patients, there is a scarcity of information about the magnitude and determinants of suicidal thoughts among perinatal women. Therefore, this study aimed to determine the prevalence of suicidal ideation and associated factors among HIV positive perinatal women in the study setting. Methods An institution-based cross-sectional study was conducted among perinatal women on treatment to the prevention of mother to child transmission of HIV/AIDS at Gondar town health facilities. A total of 422 HIV-positive perinatal women were selected systematically and the data collected through medical record review and interview using a Composite International Diagnostic Interview (CIDI) toolkit. A binary and multivariable logistic regression model was employed to identify factors associated with suicidal ideation. An Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was computed to see the strength of association between outcome and independent variables. Characteristics having less than 0.05 p-value had been taken as significant factors associated with the outcome of interest. Result The prevalence of suicidal ideation was found to be 8.2% (95% CI; 5.7 to 11.3) and with a standard error of 0.013. Perinatal depression (AOR=4.40, 95%CI: 1.63 11.85), not disclosed HIV status (AOR=3.73, 95%CI: 1.44 9.65), and unplanned pregnancy (AOR=2.75, 95%CI: 1.21 6.21) were significant factors associated with suicidal ideation. Conclusion The magnitude of suicidal ideation among HIV positive perinatal women was found to be low. Perinatal depression, non-disclosed HIV status, and unplanned pregnancy were factors significantly associated with suicidal ideation. This finding suggests the integration of mental health services with maternal and HIV support programs.

scholarly journals Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
K. Goel ◽  
S. Sharma ◽  
D. D. Baral ◽  
S. K. Agrawal
Keyword(s):  
Tobacco Use ◽  
Smokeless Tobacco ◽  
Periodontal Diseases ◽  
Adult Population ◽  
Multivariate Logistic Regression Analysis ◽  
Case Definition ◽  
Current Status ◽  
Cross Sectional ◽  
Factors Associated ◽  
Significant Factors

Abstract Background Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal. Methods A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis. Results The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45–65 years (AOR = 7.58, 95% CI 3.93–14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00–1.02), smoking (AOR = 3.14, 95% CI 1.36–7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12–4.61) and teeth loss (AOR = 2.02, 95% CI 1.21–3.38) as the significant factors associated with periodontitis. Conclusion The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.

scholarly journals Factors associated with initiation of bone-health medication among older adults in primary care in Ireland

2021 ◽  
Author(s):  
Mary E Walsh ◽  
Mari Nerdrum ◽  
Tom Fahey ◽  
Frank Moriarty
Keyword(s):  
Primary Care ◽  
Fracture Risk ◽  
Bone Health ◽  
Retrospective Cohort ◽  
Hormone Replacement ◽  
Inverse Association ◽  
High Fracture ◽  
Factors Associated ◽  
General Practices ◽  
Multimorbid Patients

Abstract Background Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common. Objective This study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care. Design This was a retrospective cohort study. Setting The study used data from forty-four general practices in Ireland from 2011–2017. Subjects The study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months. Methods Overall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution. Results Of 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17–1.50), P &lt; 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17–1.44), P &lt; 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association. Conclusions Bone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those &gt;80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.

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