Invasive Candidiasis in Hospitalized Patients with Major Burns

Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions.

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Epidemiology of hypertension in selected towns of Wollega zones, Western Ethiopia, 2019: A community-based cross-sectional study

SAGE Open Medicine ◽

10.1177/20503121211024519 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110245

Author(s):

Getu Mosisa ◽

Bikila Regassa ◽

Bayise Biru

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Alcohol Consumption ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Community Based ◽

Cross Sectional

Introduction: Hypertension remains an emerging public health problem globally, particularly in developing countries. Age, income level, obesity, alcohol consumption, smoking, vegetables and fruit consumption, physical activity and chat chewing were some risk factors of hypertension. However, there are limited data on the epidemiology of hypertension in Ethiopia. This study aimed to assess Epidemiology of Hypertension among the community of selected towns of Wollega zones. Methods: A community-based cross-sectional study was conducted from 1 to 30 June 2019 in selected towns of Wollega zones. A multistage sampling technique was used to select 840 study participants. Data were collected using the WHO STEP wise approach. The data were coded and entered into EpiData 3, and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regression analyses were conducted. Statistical significance was declared at p-value < 0.05. Results: The study included a total of 838 respondents with a response rate of 99.7%. The prevalence of hypertension was found to be 189 (22.6%) (95% confidence interval = 19.9%–25.2%). Of this, 108 (12.9%) and 81 (9.7%) of female and male were hypertensive, respectively. Age groups of 30–44 years (adjusted odds ratio = 2.65 (1.43, 4.89)), 45–59 years (adjusted odds ratio = 3.55 (1.79, 7.04)), above 60 years (adjusted odds ratio = 2.97 (1.43, 6.18)), having history of alcohol consumption (adjusted odds ratio = 4.29 (2.4, 7.66)), involving in vigorous physical activity (adjusted odds ratio = 0.096 (0.028, 0.33)), not walking to and from the work (adjusted odds ratio = 13.12 (8.34, 20.67)), being overweight (adjusted odds ratio = 1.98 (1.21, 3.25)), inadequate fruits serving per day (adjusted odds ratio = 2.93 (1.75, 4.88)) were significantly associated with hypertension. Conclusion: The prevalence of hypertension was found to be high in the study area. Older age, alcohol consumption, not engaging in vigorous activity, physical inactivity, being overweight and inadequate intake of fruits were found to be risk factors for hypertension. Therefore, health care providers should provide extensive health education and promotion on recommended lifestyle modification to tackle the burden of hypertension.

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Outcomes of Hospitalized Patients with Glucocorticoid-Induced Hyperglycemia—A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9124079 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4079

Author(s):

Neele Delfs ◽

Tristan Struja ◽

Sandra Gafner ◽

Thaddaeus Muri ◽

Ciril Baechli ◽

...

Keyword(s):

Odds Ratio ◽

Cardiovascular Events ◽

Adjusted Odds Ratio ◽

Adverse Outcome ◽

Hospitalized Patients ◽

Secondary Outcome ◽

Treat To Target ◽

Inclusion Criteria ◽

Future Studies ◽

Target Treatment

Background: Glucocorticoid (GC)-induced hyperglycemia is a frequent side effect in hospitalized patients. Guidelines recommend treat-to-target treatment between 6–10 mmol/L (108–180 mg/dL) with insulin, but data on outcome is scarce. We investigated the 30-day outcome in hospitalized patients receiving GCs. Methods: All patient records of hospitalized patients between January 2014 and April 2018 were screened for GC administration and consecutive hyperglycemia. The primary combined endpoint consisted of death, cardiovascular events, and infections until 30 days after admission. Hypoglycemia was a secondary outcome. Results: Of the 2424 hospitalized patients (9.6% of all hospitalized patients) who received systemic GCs and met inclusion criteria, the overall incidence for GC-induced hyperglycemia was 812 (33.5%), and 89 (3.7%) had at least one documented hypoglycemia during their hospital stay. Compared to patients with normoglycemia, GC-induced hyperglycemia had an adjusted-odds ratio of 1.68 (95% CI 1.25–2.26) for the combined primary endpoint. Hypoglycemia even had an odds ratio of 1.95 (95% CI 1.2–3.17). Conclusions: Mortality, cardiovascular events, and rate of infections were markedly higher in patients with GC-induced hyperglycemia as compared to patients with normoglycemia. Importantly, hypoglycemia was associated with a doubled risk for adverse outcome. Future studies should evaluate whether optimized glucose control by minimizing the risk for hypoglycemia has a beneficial effect on clinical outcomes in patients with GC-induced hyperglycemia.

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Preoperative Risk and the Association between Hypotension and Postoperative Acute Kidney Injury

Anesthesiology ◽

10.1097/aln.0000000000003063 ◽

2020 ◽

Vol 132 (3) ◽

pp. 461-475 ◽

Cited By ~ 9

Author(s):

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Validation Cohort ◽

Kidney Injury ◽

Preoperative Risk ◽

Intraoperative Hypotension

Abstract Background Despite the significant healthcare impact of acute kidney injury, little is known regarding prevention. Single-center data have implicated hypotension in developing postoperative acute kidney injury. The generalizability of this finding and the interaction between hypotension and baseline patient disease burden remain unknown. The authors sought to determine whether the association between intraoperative hypotension and acute kidney injury varies by preoperative risk. Methods Major noncardiac surgical procedures performed on adult patients across eight hospitals between 2008 and 2015 were reviewed. Derivation and validation cohorts were used, and cases were stratified into preoperative risk quartiles based upon comorbidities and surgical procedure. After preoperative risk stratification, associations between intraoperative hypotension and acute kidney injury were analyzed. Hypotension was defined as the lowest mean arterial pressure range achieved for more than 10 min; ranges were defined as absolute (mmHg) or relative (percentage of decrease from baseline). Results Among 138,021 cases reviewed, 12,431 (9.0%) developed postoperative acute kidney injury. Major risk factors included anemia, estimated glomerular filtration rate, surgery type, American Society of Anesthesiologists Physical Status, and expected anesthesia duration. Using such factors and others for risk stratification, patients with low baseline risk demonstrated no associations between intraoperative hypotension and acute kidney injury. Patients with medium risk demonstrated associations between severe-range intraoperative hypotension (mean arterial pressure less than 50 mmHg) and acute kidney injury (adjusted odds ratio, 2.62; 95% CI, 1.65 to 4.16 in validation cohort). In patients with the highest risk, mild hypotension ranges (mean arterial pressure 55 to 59 mmHg) were associated with acute kidney injury (adjusted odds ratio, 1.34; 95% CI, 1.16 to 1.56). Compared with absolute hypotension, relative hypotension demonstrated weak associations with acute kidney injury not replicable in the validation cohort. Conclusions Adult patients undergoing noncardiac surgery demonstrate varying associations with distinct levels of hypotension when stratified by preoperative risk factors. Specific levels of absolute hypotension, but not relative hypotension, are an important independent risk factor for acute kidney injury. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Effect of oral olive oil on healing of 10–20% total body surface area burn wounds in hospitalized patients

Burns ◽

10.1016/j.burns.2014.08.010 ◽

2015 ◽

Vol 41 (3) ◽

pp. 493-496 ◽

Cited By ~ 13

Author(s):

Mahtab Najmi ◽

Zahra Vahdat Shariatpanahi ◽

Mohammad Tolouei ◽

Zohreh Amiri

Keyword(s):

Olive Oil ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Total Body Surface Area ◽

Hospitalized Patients ◽

Burn Wounds ◽

Total Body

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Risk Factors for Umbilical Cord Prolapse at the Time of Artificial Rupture of Membranes

American Journal of Perinatology Reports ◽

10.1055/s-0038-1649486 ◽

2018 ◽

Vol 08 (02) ◽

pp. e89-e94 ◽

Cited By ~ 1

Author(s):

Tetsuya Kawakita ◽

Chun-Chih Huang ◽

Helain Landy

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Adjusted Odds Ratio ◽

Cervical Dilation ◽

Cord Prolapse ◽

Umbilical Cord Prolapse ◽

Singleton Pregnancies

Objective The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates. Results Of 57,204 women who underwent AROM, cord prolapse occurred in 113 (0.2%). Compared with dilation 6 to 10 cm + station ≥ 0 at the time of AROM, <6 cm + any station and 6–10 cm + station ≤ −3 were associated with increased risks of cord prolapse (<6 cm + station ≤ −3 [aOR, 2.29; 95% CI, 1.02–5.40]; <6 cm + station −2.5 to −0.5 [aOR, 2.34; 95% CI, 1.23–4.97]; <6 cm + station ≥ 0 [aOR, 3.31; 95% CI, 1.39–8.09]; and 6–10 cm + station ≤ −3 [aOR, 5.47; 95% CI, 1.35–17.48]). Conclusion Cervical dilation < 6 cm with any station and 6 to 10 cm with station ≤ −3 were associated with a higher risk of cord prolapse.

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Predictors of Early Infarct Recurrence in Patients With Symptomatic Intracranial Atherosclerotic Disease

Stroke ◽

10.1161/strokeaha.120.032676 ◽

2021 ◽

Author(s):

Shyam Prabhakaran ◽

David S. Liebeskind ◽

George Cotsonis ◽

Azhar Nizam ◽

Edward Feldmann ◽

...

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Diffusion Weighted Imaging ◽

Adjusted Odds Ratio ◽

Recurrent Stroke ◽

Brain Mri ◽

Atherosclerotic Disease ◽

Intracranial Atherosclerotic Disease ◽

Diffusion Weighted ◽

Artery Embolism

Background and Purpose: While prior studies identified risk factors for recurrent stroke in patients with symptomatic intracranial atherosclerotic disease, few have assessed risk factors for early infarct recurrence. Methods: We performed a post hoc analysis of the MYRIAD study (Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease) of intracranial atherosclerotic disease patients with recent (<21 days) stroke/transient ischemic attack, 50% to 99% stenosis and who underwent 6- to 8-week magnetic resonance imaging (MRI) per protocol. Infarct recurrence was defined as new infarcts in the territory of the symptomatic artery on brain MRI at 6 to 8 weeks compared to index brain MRI. Qualifying events and clinical and imaging outcomes were centrally ascertained by 2 independent reviewers. We assessed the association between baseline clinical and imaging variables and recurrent infarct in bivariate models and multivariable logistic regression to identify independent predictors of infarct recurrence. Results: Of 105 enrolled patients in MYRIAD, 89 (84.8%) were included in this analysis (mean age, 64±12 years, 54 [60.7%] were male, and 53 [59.6%] were White). The median time from qualifying event to MRI was 51+16 days, on which 22 (24.7%) patients had new or recurrent infarcts. Younger age (57.7 versus 66.0 years; P <0.01), diabetes (32.6% versus 14.6%, P =0.05), index stroke (31.3% versus 4.6%, P =0.01), anterior circulation location of stenosis (29.7% versus 12.0%, P =0.08), number of diffusion-weighted imaging lesions (>1: 40.0%, 1: 26.9% versus 0: 4.4%, P <0.01), and borderzone infarct pattern (63.6% versus 25.0%, P =0.01) on baseline MRI were associated with new or recurrent infarcts. Age (adjusted odds ratio, 0.93 [95% CI, 0.89–0.98], P <0.01) and number of diffusion-weighted imaging lesions (adjusted odds ratio, 3.24 [95% CI, 1.36–7.71], P <0.01) were independently associated with recurrent infarct adjusting for hypertension, diabetes, and stenosis location (anterior versus posterior circulation). Conclusions: An index multi-infarct pattern is associated with early recurrent infarcts, a finding that might be explained by plaque instability and artery-to-artery embolism. Further investigation of plaque vulnerability in intracranial atherosclerotic disease is needed. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02121028.

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Risk factors for perineal and vaginal tears in primiparous women – a prospective cohort study

10.21203/rs.3.rs-28633/v1 ◽

2020 ◽

Author(s):

Markus Harry Jansson ◽

Karin Franzén ◽

Ayako Hiyoshi ◽

Gunilla Tegerstedt ◽

Hedda Dahlgren ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Prospective Cohort ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Vacuum Extraction ◽

Perineal Tears ◽

Independent Risk Factors ◽

Primiparous Women ◽

Second Degree

Abstract BackgroundThe aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries, and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.MethodsAll nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.ResultsA total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (adjusted odds ratio 2.26 (95% CI: 1.22, 4.19) and 3.28 (95% CI: 1.73, 6.21) respectively) and OASI (adjusted odds ratio 5.93 (95% CI: 2.29, 15.33) and 4.31 (95% CI: 1.49, 12.5) respectively), whereas age above 25 years only increased the risk of second-degree perineal tears (adjusted odds ratio 1.94 (95% CI: 1.10, 3.43)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (adjusted odds ratio 2.33 (95% CI: 1.09, 5.00), 3.64 (95% CI: 1.54, 8.59) and 2.86 (95% CI: 1.43, 5.75) respectively).ConclusionsThis prospective study showed that fetal weight exceeding 4000 g and vacuum extraction are independent risk factors for both second-degree perineal tears and OASI in primiparous women. Risk factors for high vaginal tears were heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, and fetal head circumference > 35 cm. These tears have been found to be common among primiparous women, and merit more attention.Brief summary: This prospective cohort study showed that fetal birthweight exceeding 4000 g and vacuum extraction increased the risk of second-degree tear and anal sphincter injury.

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Predictors of mortality and validation of burn mortality prognostic scores in a Malaysian burns intensive care unit

BMC Emergency Medicine ◽

10.1186/s12873-019-0284-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Henry Tan Chor Lip ◽

Mohamad Azim Md. Idris ◽

Farrah-Hani Imran ◽

Tuan Nur’ Azmah ◽

Tan Jih Huei ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Burn Injury ◽

Total Body Surface Area ◽

Primary Objective ◽

Prognostic Scores ◽

Secondary Objective ◽

Total Body

Abstract Background Majority burn mortality prognostic scores were developed and validated in western populations. The primary objective of this study was to evaluate and identify possible risk factors which may be used to predict burns mortality in a local Malaysian burns intensive care unit. The secondary objective was to validate the five well known burn prognostic scores (Baux score, Abbreviated Burn Severity Index (ABSI) score, Ryan score, Belgium Outcome Burn Injury (BOBI) score and revised Baux score) to predict burn mortality prediction. Methods Patients that were treated at the Hospital Sultan Ismail’s Burns Intensive Care (BICU) unit for acute burn injuries between 1 January 2010 to 31 December 2017 were included. Risk factors to predict in-patient burn mortality were gender, age, mechanism of injury, total body surface area burn (TBSA), inhalational injury, mechanical ventilation, presence of tracheotomy, time from of burn injury to BICU admission and initial centre of first emergency treatment was administered. These variables were analysed using univariate and multivariate analysis for the outcomes of death. All patients were scored retrospectively using the five-burn mortality prognostic scores. Predictive ability for burn mortality was analysed using the area under receiver operating curve (AUROC). Results A total of 525 patients (372 males and 153 females) with mean age of 34.5 ± 14.6 years were included. There were 463 survivors and 62 deaths (11.8% mortality rate). The outcome of the primary objective showed that amongst the burn mortality risk factors that remained after multivariate analysis were older age (p = 0.004), wider TBSA burn (p < 0.001) and presence of mechanical ventilation (p < 0.001). Outcome of secondary objective showed good AUROC value for the prediction of burn death for all five burn prediction scores (Baux score; AUROC:0.9, ABSI score; AUROC:0.92, Ryan score; AUROC:0.87, BOBI score; AUROC:0.91 and revised Baux score; AUROC:0.94). The revised Baux score had the best AUROC value of 0.94 to predict burns mortality. Conclusion Current study evaluated and identified older age, total body surface area burns, and mechanical ventilation as significant predictors of burn mortality. In addition, the revised Baux score was the most accurate burn mortality risk score to predict mortality in a Malaysian burn’s population.

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Risk factors associated with pain in patients with venous malformations of the extremities

Vascular Medicine ◽

10.1177/1358863x18802007 ◽

2018 ◽

Vol 24 (1) ◽

pp. 56-62 ◽

Cited By ~ 1

Author(s):

Li Hu ◽

Hui Chen ◽

Xi Yang ◽

Yongying Wang ◽

Hao Gu ◽

...

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Univariate Analysis ◽

Lesion Size ◽

Common Symptom ◽

Type Ii ◽

Venous Malformations ◽

Average Pain ◽

Independent Risk Factors

Pain is a common symptom and the major complaint in patients with venous malformations of the extremities, which may lead to joint dysfunction and even walking disabilities. Therefore, this study aimed to investigate determined independent risk factors for pain in these patients. We retrospectively collected data for 168 patients with venous malformations of the extremities from January 16, 2013 to August 13, 2015. They were categorized into painful and painless groups according to the symptom and pain scores. Associations between pain and candidate factors were determined using univariate and multivariate analyses. A total of 125 (74.4%) patients with an average pain score of 4.4 were included in the painful group. In univariate analysis, age, lesion size, tissue involvement, and phleboliths were associated with pain. In the multivariate analysis, only type-II tissue involvement (adjusted odds ratio 4.57; p = 0.001) and phleboliths (adjusted odds ratio 2.44; p = 0.039) were identified as the independent risk factors. In conclusion, this study revealed that prevalence of pain in patients with venous malformations of the extremities was high. Patients who presented with type-II tissue involvement and phleboliths are more likely to suffer from pain.

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The Use of a Simple Three-Level Bronchoscopic Assessment of Inhalation Injury to Predict in-Hospital Mortality and Duration of Mechanical Ventilation in Patients with Burns

Anaesthesia and Intensive Care ◽

10.1177/0310057x1804600110 ◽

2018 ◽

Vol 46 (1) ◽

pp. 67-73 ◽

Cited By ~ 12

Author(s):

M. T. Aung ◽

D. Garner ◽

M. Pacquola ◽

S. Rosenblum ◽

J. McClure ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Body Surface ◽

Odds Ratio ◽

Total Body Surface Area ◽

Severity Of Illness ◽

Inhalation Injury ◽

Inhalational Injury ◽

Total Body ◽

Duration Of Ventilation

Major burn centres in Australia use bronchoscopy to assess severity of inhalation injuries despite limited evidence as to how best to classify severity of inhalational injury or its relationship to patient outcomes. All patients with burns who were admitted to the intensive care unit (ICU) at The Alfred Hospital between February 2010 and July 2014 and underwent bronchoscopy to assess inhalational injury, were reviewed. Age, total body surface area burnt, severity of illness indices and mechanisms of injury were extracted from medical histories and local ICU and burns registries. Inhalational injury was classified based on the Abbreviated Injury Score and then grouped into three categories (none/mild, moderate, or severe injury). Univariable and multivariable analyses were undertaken to examine the relationship between inhalational injury and outcomes (in-hospital mortality and duration of mechanical ventilation). One hundred and twenty-eight patients were classified as having none/mild inhalational injury, 81 moderate, and 13 severe inhalation injury. Mortality in each group was 2.3% (3/128), 7.4% (6/81) and 30.7% (4/13) respectively. Median (interquartile range) duration of mechanical ventilation in each group was 26 (11–82) hours, 84 (32–232) hours and 94 (21–146) hours respectively. After adjusting for age, total body surface area burnt and severity of illness, only the severe inhalation injury group was independently associated with increased mortality (odds ratio 20.4 [95% confidence intervals {CI} 1.74 to 239.4], P=0.016). Moderate inhalation injury was independently associated with increased duration of ventilation (odds ratio 2.25 [95% CI 1.53 to 3.31], P <0.001), but not increased mortality. This study suggests that stratification of bronchoscopically-assessed inhalational injury into three categories can provide useful prognostic information about duration of ventilation and mortality. Larger multicentre prospective studies are required to validate these findings.

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