scholarly journals Parotid Space, a Different Space from Other Deep Neck Infection Spaces

2021 ◽  
Vol 9 (11) ◽  
pp. 2361
Author(s):  
Shih-Lung Chen ◽  
Chi-Kuang Young ◽  
Chun-Ta Liao ◽  
Tsung-You Tsai ◽  
Chung-Jan Kang ◽  
...  
Keyword(s):  
Medical Center ◽  
Patient Characteristics ◽  
Population Based ◽  
Deep Neck Infection ◽  
Duration Of Symptoms ◽  
Neck Infection ◽  
Streptococcus Anginosus ◽  
Reactive Protein ◽  
Medical Emergencies ◽  
Deep Neck Space Infections

Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to confirm this in the present retrospective population-based cohort study. Between August 2016 and January 2020, 412 patients with DNIs seen at a tertiary medical center were enrolled in this study. Infections of the parotid space were compared with those of other deep neck spaces, according to patient characteristics. All patients were divided into parotid space (PS; n = 91, 22.08%) and non-parotid space (NPS; n = 321, 77.92%) subgroups. We further divided the patients into single parotid space (PS-single; n = 50, 12.13%), single non-parotid space (NPS-single; n = 149, 36.16%), multiple parotid space (PS-multiple; n = 41, 9.95%), and multiple non-parotid space (NPS-multiple; n = 172, 41.76%) DNI subgroups. In the PS-single and PS-multiple subgroups, a longer duration of symptoms (p = 0.001), lower white blood cell count (p = 0.001), lower C-reactive protein level (p = 0.010), higher rate of ultrasonography-guided drainage (p < 0.001), and lower rates of surgical incision and drainage (p < 0.001) were observed compared with the NPS-single and NPS-multiple subgroups. The PS group had a higher positive Klebsiella pneumoniae culture rate (p < 0.001), and lower positive Streptococcus constellatus (p = 0.002), and Streptococcus anginosus (p = 0.025) culture rates than the NPS group. In a multivariate analysis, K. pneumoniae was independently associated with parotoid space involvement in comparisons of the PS and NPS groups, PS-single and NPS-single subgroups, and PS-multiple and NPS-multiple subgroups. The clinical presentation of a parotid space infection differs from that of other deep neck space infections.

scholarly journals Management of Descending Necrotizing Mediastinitis, a Severe Complication of Deep Neck Infection, Based on Multidisciplinary Approaches and Departmental Co-Ordination

2022 ◽  
pp. 014556132110685
Author(s):  
Chia-Ying Ho ◽  
Shy-Chyi Chin ◽  
Shih-Lung Chen
Keyword(s):  
Mortality Rate ◽  
Treatment Protocol ◽  
Tertiary Hospital ◽  
Deep Neck Infection ◽  
Descending Necrotizing Mediastinitis ◽  
Neck Infection ◽  
Streptococcus Anginosus ◽  
Reactive Protein ◽  
Unit Management ◽  
Aggressive Interventions

Objectives Descending necrotizing mediastinitis (DNM) developing after deep neck infection (DNI) is a potentially lethal disease of the mediastinum with a mortality rate as high as 40% prior to the 1990s. No standard treatment protocol is available. Here, we present the outcomes of our multidisciplinary approaches for treating DNM originating from a DNI. Methods Between June 2016 and July 2021, there were 390 patients with DNIs admitting to our tertiary hospital. A total 21 patients with DNIs complicated with DNM were enrolled. The multidisciplinary approaches included establishment of airway security, appropriate surgery and antibiotics, extracorporeal membrane oxygenation, and intensive care unit management. The clinical variables were analyzed. Results Two patients died and 19 survived (mortality 9.5%). The patients who died had a higher mean C-reactive protein (CRP) level than did those who survived (420.0 ± 110.3 vs 221.8 ± 100.6 mg/L) (P = .038). The most common pathogens were Streptococcus constellatus and Streptococcus anginosus. From 2001 to 2021, the average mortality rate of studies enrolling more than 10 patients was 16.1%. Conclusion Multidisciplinary approaches, early comprehensive medical treatment, and co-ordination among departments significantly reduce mortality. Patients with severe inflammation and high CRP levels require intensive and aggressive interventions.

Deep neck cellulitis: a challenging diagnosis

2020 ◽  
Vol 13 (12) ◽  
pp. e236415
Author(s):  
Ana Isabel Gonçalves ◽  
Ditza Vilhena ◽  
Delfim Duarte ◽  
Nuno Trigueiros
Keyword(s):  
Soft Tissues ◽  
Deep Neck Infection ◽  
Central Nervous System Infections ◽  
C Reactive Protein ◽  
Intense Pain ◽  
Neck Infection ◽  
Reactive Protein ◽  
Deep Neck Infections ◽  
T2 Hyperintensity ◽  
High Degree

A 38-year-old woman with Crohn’s disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.

scholarly journals FRI0643-HPR CARDIOVASCULAR DISEASE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS COMPARED WITH THOSE WITH OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 925.3-926
Author(s):  
F. Wang ◽  
B. Mukerji ◽  
R. Markert ◽  
V. Mukerji
Keyword(s):  
Rheumatoid Arthritis ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Cardiac Arrhythmias ◽  
European Heart Journal ◽  
Smoking Status ◽  
Medical Center ◽  
Systemic Disease ◽  
Patient Characteristics ◽  
Population Based

Background:Rheumatoid arthritis (RA) is a chronic immune mediated systemic disease known to affect multiple organs. It is known that cardiovascular disease accounts for nearly half the mortality among RA patients1,2,3. Osteoarthritis (OA), on the other hand, is not an inflammatory arthritis. No prior study has compared the prevalence of cardiovascular disease (CVD) among these two groups of patients.Objectives:The purpose of this study was to compare the prevalence of CVD among U.S. veterans with RA versus those with OA.Methods:The study was conducted in a metropolitan Veterans Affairs Medical Center in the U.S. Information was collected from 125 consecutive patients with RA and 125 consecutive patients with OA as they presented to the clinic. Patient characteristics were noted as well as the presence of CVD and certain subgroups: Cardiac arrhythmias4, coronary artery disease (CAD), congestive heart failure (CHF), cerebrovascular accident (CVA), abdominal aortic aneurysm (AAA), peripheral vascular disease (PVD), deep vein thrombosis (DVT), pulmonary embolism (PE), or any other form of embolism. The chi square test and the mann-whitney test were used for statistical analyses.Results:Patient characteristics did not differ between the two groups for age, race, smoking status, or for the presence of hypertension or diabetes. There were more women in the RA group. The OA group had a higher BMI and a higher prevalence of hyperlipidemia. RA patients compared to OA patients had a higher incidence of CVD as a whole (60% vs. 42%, p < 0.004) and of cardiac arrhythmias (33.6% vs. 13.6%, p = 0.001). There was no difference between the 2 groups for the incidence of CAD, CHF, CVA, AAA, PVD or DVT/PE. RA seropositive and seronegative patients did not differ in the prevalence of CVD. RA duration was not related to the increased prevalence of CVD. Among the cardiac arrhythmias, patients with RA had a higher prevalence of atrial fibrillation (19.2% vs. 8.8%, p < 0.03), and arrhythmias requiring pacemaker or defibrillator implant (12.8% vs. 4.0%, p < 0.02).Conclusion:The findings of this study demonstrate that our patients with RA have a statistically higher prevalence of CVD compared to OA patients. Among the subgroups, RA patients had a higher prevalence of cardiac arrhythmias, specifically atrial fibrillation and arrhythmias requiring pacemaker or defibrillator implant.References:[1] England BR, et al. Cause-specific mortality in male US veterans with rheumatoid arthritis. Arthritis Care Res (Hobboken); 68: 36-45 2016[2] Avina-Zubiets JA, et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a met-analysis of observational studies. Ann Rheum Dis 2012; 71: 1524-1529.[3] Maradit-Kremers,H et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: A population-based cohort study. Arthritis Rheum. 2005; 52: 402-411[4] Lazzerini PE, Capechi L et al. Systemic Inflammation and arrhythmic risk: lessons from rheumatoid arthritis. European Heart Journal; 2017, 38: 1717-1727Disclosure of Interests:None declared

scholarly journals Pre-test symptom duration and cycle threshold values for SARS-CoV-2 reverse transcription-PCR (RT-PCR) predict COVID-19 mortality

2021 ◽  
Author(s):  
Emily Happy Miller ◽  
Jason Zucker ◽  
Delivette Castor ◽  
Medini K Annavajhala ◽  
Jorge L Sepulveda ◽  
...  
Keyword(s):  
Viral Load ◽  
Symptom Onset ◽  
Medical Center ◽  
Strong Predictor ◽  
Academic Medical Center ◽  
Patient Characteristics ◽  
Symptom Duration ◽  
Rt Pcr ◽  
Duration Of Symptoms ◽  
The Impact

Abstract Background The relationship between SARS-CoV-2 viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with COVID-19. Methods We conducted an observational study between March 10–May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N=16,384), there were 5,467 patients with positive tests, of which 4,254 had available Ct values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms prior to testing, patient characteristics and mortality. The primary outcome is defined as death or discharge to hospice. Results Lower Ct values at diagnosis (i.e. higher viral load) were associated with significantly higher mortality among both in- and out-patients. Interestingly, patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than three days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality. Conclusions SARS-CoV-2 RT-PCR Ct value and duration of symptoms are strongly associated with mortality. These two factors add useful information for clinicians to risk stratify patients presenting with COVID-19.

No relation between biomarkers at age 47–49 and aortic diameter after 14–19 years of follow-up – a population-based study

VASA ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 291-295 ◽  
Author(s):  
Soumia Taimour ◽  
Moncef Zarrouk ◽  
Jan Holst ◽  
Olle Melander ◽  
Gunar Engström ◽  
...  
Keyword(s):  
Population Based ◽  
Aortic Diameter ◽  
Aortic Dilatation ◽  
Population Based Study ◽  
Reactive Protein ◽  
Abdominal Aortic ◽  
Long Term Follow Up ◽  
Old Men

Abstract. Background: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA. Probands and methods: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47–49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14–19 years of follow-up. Results: Biomarker levels at baseline did not correlate with aortic diameter after 14–19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = –.156], Lp-PLA2 [r = .024], Cyst C [r = –.015], MR-proANP [r = 0.014], MR-proADM [r = –.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations. Conclusions: Tested biomarker levels at age 47–49 were not associated with aortic diameter at ultrasound examination after 14–19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.

A dangerous cause of airway obstruction: deep neck infection

2020 ◽  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Deep Neck Infection ◽  
Jugular Vein Thrombosis ◽  
Neck Infection ◽  
Vein Thrombosis ◽  
Lethal Complications ◽  
Life Threatening ◽  
Fascial Spaces ◽  
Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

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