Epidemiology of drowning incidents among children at Sultan Qaboos University Hospital Muscat, Oman

Objectives: To study the epidemiology of drowning among children cases reported at Sultan Qaboos University Hospital in Oman. Methods: We conducted a retrospective study of the patients who were presented at emergency department with the history of drowning over a period of 10 years from January 2008 to December 2017. Patients with age 1 to 18 years were included in the study. The data including demographics, timing and location of drowning, season, adult supervision, swimming ability, medical risk factors, duration of submersion, on spot resuscitation, emergency medicine department assessment, hospital management and outcome were collected from electronic hospital information system using a preformed proforma. Outcome was categorized into either full recovery, severe neurological injury or brain death based on the pediatric cerebral performance category (PCPC). A good outcome represents to a score of 1-3 points and PCPC 2 of 4-6 points corresponds to poor outcome. We calculated correlation for all variables with the outcome by using chi square and fisher exact tests. P value of <0.05 is taken as significant value. Results: A total of 74 patients were included in the study. Of them, 54 (73%) were male, children of less than six years of age were 47 (63.5%). More than 50% of drownings happened in outside swimming pool, 21 (28.4%) of patients were unsupervised during incident and 39 (52.7%) required cardiopulmonary resuscitation. Out of all studied subjects, 3 (4%) were brain dead and 2 (2.7%) developed severe neurological injury. On univariate analysis, the following variables were statistically significant (p<0.05) predicting the poor outcome like lack of adult supervision, duration of submersion >10 minutes, asystole, Glasgow Coma Scale <8, temperature <35c, PH <7, anion gap >20, blood glucose >10 mmol/L, abnormal chest x-ary findings, rewarming, cardiopulmonary resuscitation, intubation, inotrope support and pediatric intensive care unit admission. Conclusion: This study suggests that children especially male below 6 years of age without swimming ability need strict supervision next to body of water. Furthermore; preventive measures might include raising community awareness about the risk factors of drowning, commencing public CPR lessons and strict pool safety regulation by related authorities.

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Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience

Journal of Clinical Medicine ◽

10.3390/jcm10020339 ◽

2021 ◽

Vol 10 (2) ◽

pp. 339

Author(s):

Vassili Panagides ◽

Henrik Vase ◽

Sachin P. Shah ◽

Mir B. Basir ◽

Julien Mancini ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Cardiopulmonary Resuscitation ◽

Univariate Analysis ◽

Cerebral Performance Category ◽

Neurological Impairment ◽

Left Ventricular ◽

Circulatory Support ◽

Factors Associated ◽

Analysis Survival

Background: Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. Methods: We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. Results: Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). Conclusions: In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.

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Impact of the cardiopulmonary resuscitation-related injuries on the prognosis after cardiac arrest

European Heart Journal ◽

10.1093/ehjci/ehaa946.1819 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Merino Argos ◽

I Marco Clement ◽

S.O Rosillo Rodriguez ◽

L Martin Polo ◽

E Arbas Redondo ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

University Hospital ◽

Temperature Management ◽

Performance Category ◽

Neurological Outcomes ◽

Cardiac Care Unit ◽

Sternal Fractures

Abstract Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p<0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p<0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

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832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1021 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S457-S457

Author(s):

Henry Pablo Lopes Campos e Reis ◽

Ana Beatriz Ferreira Rodrigues ◽

Julio César Castro Silva ◽

Lia Pinheiro de Lima ◽

Talita Lima Quinaher ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Univariate Analysis ◽

Multidrug Resistant ◽

University Hospital ◽

Gram Negative Bacteria ◽

Multiresistant Pathogens ◽

Gram Negative ◽

Contact Isolation ◽

Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

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Established the first clinical prediction model regarding the risk of hyperuricemia in IgA nephropathy

10.21203/rs.3.rs-888732/v1 ◽

2021 ◽

Author(s):

Yin-Hong Geng ◽

Zhe Zhang ◽

Jun-Jun Zhang ◽

Bo Huang ◽

Zui-Shuang Guo ◽

...

Keyword(s):

Risk Factors ◽

Iga Nephropathy ◽

Interstitial Fibrosis ◽

Characteristic Curve ◽

Univariate Analysis ◽

Curve Analysis ◽

University Hospital ◽

Prediction Ability ◽

Decision Curve Analysis ◽

Incidence Risk

Abstract Objective. To construct a novel nomogram model that predicts the risk of hyperuricemia incidence in IgA nephropathy (IgAN) . Methods. Demographic and clinicopathological characteristics of 1184 IgAN patients in the First Affiliated Hospital of Zhengzhou University Hospital were collected. Univariate analysis and multivariate logistic regression were used to screen out hyperuricemia risk factors. The risk factors were used to establish a predictive nomogram model. The performance of the nomogram model was evaluated using an area under the receiver operating characteristic curve (AUC), calibration plots, and a decision curve analysis. Results. Independent predictors for hyperuricemia incidence risk included sex, hypoalbuminemia, hypertriglyceridemia, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), 24-hour urinaryprotein (24h TP), Gross and tubular atrophy/interstitial fibrosis (T). The nomogram model exhibited moderate prediction ability with an AUC of 0.834 ((95% CI 0.804–0.864)). The AUC from validation reached 0.787 (95% CI 0.736-0.839). The decision curve analysis displayed that the hyperuricemia risk nomogram was clinically applicable.Conclusion. Our novel and simple nomogram containing 8 factors may be useful in predicting hyperuricemia incidence risk in IgAN.

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The Prevalence of Health Care-Associated Infections and Risk Factors in a University Hospital

Medicina ◽

10.3390/medicina48080059 ◽

2012 ◽

Vol 48 (8) ◽

pp. 59 ◽

Cited By ~ 1

Author(s):

Greta Gailienė ◽

Zita Gierasimovič ◽

Daiva Petruševičienė ◽

Aušra Macijauskienė

Keyword(s):

Risk Factors ◽

Health Care ◽

Acute Care ◽

Prevalence Rate ◽

Antimicrobial Agents ◽

Univariate Analysis ◽

University Hospital ◽

Stepwise Logistic Regression ◽

Antimicrobial Use ◽

Health Care Associated Infections

The aim of the study was to evaluate the prevalence of health care-associated infections, risk factors, and antimicrobial use. Material and Methods. The study was carried out as a point-prevalence study in acute care wards, i.e., intensive care, surgical, and medical wards, at Vilnius University Hospital Santariškių Klinikos in April 2010. The study variables included the patient’s general data, indwelling devices, surgery, infection and its microbiological investigation, and antimicrobial use. All the variables that were logically related or had a P value of <0.25 in the univariate analysis were included in the stepwise logistic regression in order to study the factors potentially associated with health careassociated infections. Results. A total of 731 patients were surveyed. The overall prevalence rate of health care-associated infections was 3.8%. The prevalence of health care-associated infections differed by hospital wards (range 0.0%–19.2%). The lower respiratory tract (32.2%), urinary tract (28.5%), and surgical site infections (32.1%) were the most common health care-associated infections. Moreover, 89.3% of the cases of health care-associated infections were microbiologically investigated. Staphylococcus aureus (28.6%) and Escherichia coli (19.1%) were the most frequently isolated microorganisms. The use of one or more invasive devices was recorded in 332 patients (45.4%). Of the surveyed patients, 20.2% received antimicrobial agents. The most commonly prescribed antimicrobial agents were fluoroquinolones (21.1%), broad-spectrum penicillins (19.1%), and first- or second-generation cephalosporins (18.6%). Conclusions. The prevalence of health care-associated infections was found to be similar to the reported overall prevalence rate of health care-associated infections in acute care hospitals in Lithuania.

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Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders

BMC Anesthesiology ◽

10.1186/s12871-019-0897-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Silvia Mongodi ◽

Gaia Ottonello ◽

Raffaelealdo Viggiano ◽

Paola Borrelli ◽

Simona Orcesi ◽

...

Keyword(s):

Risk Factors ◽

Clinical Judgment ◽

Statistical Significance ◽

Neuromuscular Disorders ◽

Univariate Analysis ◽

Neuromuscular Diseases ◽

Neuropsychiatric Disorders ◽

University Hospital ◽

Respiratory Complications ◽

Asa Score

Abstract Background Children require anesthesia for MRI to maintain immobility and reduce discomfort; clear indications about the best anesthesiologic management are lacking and each center developed its own protocol. Moreover, children with neuropsychiatric disorders more likely require sedation and are described in literature as more prone to general and respiratory complications. Aim of this study was to analyze the applicability of a sevoflurane-based approach, to describe general and respiratory complications and to identify risk factors in a pediatric neuropsychiatric population. Methods Retrospective cohort study, university Hospital (January 2007–December 2016). All the 1469 anesthesiologic records of children addressed from Neuropsychiatric Unit to undergo MRI under general anesthesia were analyzed; 12 patients equal or older than 18-year-old were excluded. We identified post-hoc nine macro-categories: static encephalopathies, metabolic/evolutive encephalopathies, epileptic encephalopathies, neuromuscular diseases, autistic spectrum disorders, migraine, psychiatric disorders, intellectual disabilities, others. A logistic regression model for events with low frequency (Firth’s penalized likelihood approach) was carried out to identify the mutually adjusted effect among endpoints (complications) and the independent variables chosen on the basis of statistical significance (univariate analysis, p ≤ 0.05) and clinical judgment. Results Of 1457 anesthesiologic records (age 4.0 (IQR 2.0 to 7.0) year-old, males 891 (61.2%), weight 17.0 (IQR 12.0 to 24.9) kg), 18 were cancelled for high anesthesiologic risk, 50 were cooperative, 1389 were anesthetized. A sevoflurane-based anesthesia was feasible in 92.3%; these patients required significantly less mechanical ventilation (8.6 vs. 16.2%; p = 0.012). Complications’ rate was low (6.2%; 3.1% respiratory). The risk for general complications increases with ASA score > 1 (OR 2.22, 95 CI% 1.30 to 3.77, p = 0.003), male sex (OR 1.73, 95% CI 1.07 to 2.81, p = 0.025), multi-drug anesthesia (OR 2.98, 95 CI% 1.26 to 7.06, p = 0.013). For respiratory complications, it increases with ASA score > 1 (OR 2.34, 95 CI% 1.19 to 4.73, p = 0.017), autumn-winter (OR 2.01, 95 CI% 1.06 to 3.78, p = 0.030), neuromuscular disorders (OR 3.18, 95 CI% 1.20 to 8.41, p = 0.020). We had no major complications compromising patients’ outcome or requiring admission to ICU. Conclusions Sevoflurane anesthesia is feasible and safe for children affected by neuropsychiatric disorders undergoing MRI. Specific risk factors for general and respiratory complications should be considered.

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Incidence and Risk Factors for Ventilator-Associated Pneumonia in Kathmandu University Hospital

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i1.6258 ◽

2012 ◽

Vol 9 (1) ◽

pp. 28-31 ◽

Cited By ~ 3

Author(s):

S Ranjit ◽

B Bhattarai

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Univariate Analysis ◽

University Hospital ◽

Ventilator Associated Pneumonia ◽

Chi Square ◽

H2 Blockers ◽

Observational Cohort ◽

Level Of Significance

Background Ventilator associated pneumonia is a major cause of morbidity in the intensive care unit. Difficulties in identification of the risk factors, in diagnosing and in prevention, have intensified the problem. Objectives To measure the incidence of ventilator associated pneumonia in intensive care unit and to identify the risk factors associated. Methods A prospective observational cohort study of 69 patients who were mechanically ventilated for more than 48 hours were evaluated to find out the development of nosocomial pneumonia and presence or absence of risk factors. Data were subjected to univariate analysis using chi-square and t-test. Level of significance was set at 0.05. Results Twenty two (31.88%) out of 69 patients developed ventilator associated pneumonia, majority of them between four days to 14 days. Reintubation, invasive lines, H2 blockers and low PaO2/FiO2 were identified as major risk factors in our study. Enteral feeding via nasogastric tube and use of steroids was not associated with development of ventilator associated pneumonia. The patients with ventilator associated pneumonia had significantly longer duration of mechanical ventilation (18.88±7.7 days vs 7.36±4.19 days) and stay (29±17.8 days vs 9.22±5.14 days). The morality was similar for both the groups with or without ventilator associated pneumonia. ConclusionThe incidence of ventilator pneumonia is high. Patients requiring prolonged ventilation, re-intubation, more invasive lines and H2 blockers, are at high risk and need special attention towards prevention.http://dx.doi.org/10.3126/kumj.v9i1.6258 Kathmandu Univ Med J 2011;9(1):28-31

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Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study

International Journal of Endocrinology ◽

10.1155/2018/7631659 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Leila Yazdanpanah ◽

Hajieh Shahbazian ◽

Iraj Nazari ◽

Hamid Reza Arti ◽

Fatemeh Ahmadi ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Univariate Analysis ◽

Previous History ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Population Based ◽

University Hospital ◽

Foot Deformity ◽

History Of

Aim/Introduction. This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods. In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89–8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13–43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37–14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33–7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40–8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10–8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. Conclusion. Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

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HBV and HCV serological markers in patients with the hepatosplenic form of mansonic schistosomiasis

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032011000200008 ◽

2011 ◽

Vol 48 (2) ◽

pp. 124-130 ◽

Cited By ~ 6

Author(s):

Jéfferson Luis de Almeida Silva ◽

Veridiana Sales Barbosa de Souza ◽

Tatiana Aguiar Santos Vilella ◽

Ana Lúcia C. Domingues ◽

Maria Rosângela Cunha Duarte Coêlho

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Cross Sectional Study ◽

University Hospital ◽

Northeastern Brazil ◽

Serological Markers ◽

Sectional Study ◽

Serum Samples ◽

Cross Sectional ◽

Factors Associated

CONTEXT: Blood transfusion is one of the major risk factors for the transmission of the hepatitis B (HBV) and C (HCV) viruses. However, there are no reports describing the endoscopic transmission of these viruses in patients with the hepatosplenic form of schistosomiasis. OBJECTIVE: To estimate the prevalence of serological markers of HBV and HCV in patients with the hepatosplenic form of schistosomiasis and evaluate the possible risk factors associated with these infections. METHODS: A cross-sectional study was conducted on 230 patients with hepatosplenic form of schistosomiasis who attended a university hospital in Recife, Northeastern Brazil, from February to August 2008. The patients answered a standardized questionnaire about risk factors. Serum samples were analyzed for anti-HBc total, anti-HBs, HBsAg, and anti-HCV using enzyme-linked immunosorbent assays. Univariate analysis and multiple logistic regression were performed. RESULTS: The prevalence was 30% for anti-HBc total and/or HBsAg and 7.4% for anti-HCV. There was a higher frequency of the serological markers in females and in patients aged .50 years. A significant association was detected between the presence of anti-HCV and the receipt of six or more blood transfusions. There was no association of history and number of digestive endoscopies with the serological markers analyzed. CONCLUSIONS: We observed a higher prevalence of serological markers for HBV and a lower prevalence of anti-HCV. Our results indicate that females and patients of an advanced age are the most affected categories and that patients that received multiple transfusions are at a higher probability of HCV infection.

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High detection rate of osteoporosis with screening of a general hospitalized population: a 6-year study in 6406 patients in a University Hospital setting.

10.21203/rs.2.17254/v2 ◽

2020 ◽

Author(s):

Olivier Malaise ◽

Marie Detroz ◽

Mathieu Leroy ◽

Lorenzo Leonori ◽

Laurence Seidel ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Ambulatory Care ◽

Univariate Analysis ◽

Hospital Setting ◽

University Hospital ◽

Additional Tool ◽

Fracture History ◽

Low Bmi ◽

Osteoporosis Risk

Abstract Background: Osteoporosis is a highly prevalent disease identified by Dual Energy X-ray Absorptiometry (DEXA) that can be performed in an ambulatory (out-patient) or hospitalized population. We evaluated the use of baseline in-hospital DEXA screening to identify osteoporosis in ambulatory care and hospitalized patients; we also assessed specific risk factors for osteoporosis among these populations. Methods: We included a baseline initial DEXA from 6406 consecutive patients at our tertiary referral University Hospital. Results: Osteoporosis was diagnosed in 22.3% of the study population. In univariate analysis, osteoporosis risk factors were age, fracture history and low BMI (for all 3 sites), but also corticotherapy (lumbar spine and femoral neck) and male (lumbar spine). In multivariate analysis, age, fracture history, low BMI, and male increased osteoporosis risk. In-hospital screening yielded a higher percentage of osteoporosis positive scans than ambulatory care screening (31.8% vs 18.5%, p<0.001).In-hospital screening targeted an older and more predominantly male population with a higher fracture history. Z-scores revealed that this difference was not only due to an older age of the population and mainly concerned cortical bone. Conclusions: In-hospital osteoporosis screening revealed more osteoporosis than screening in ambulatory practiceand could be an additional tool to improve the identification and management of osteoporosis. In addition to typical risk factors, we identified male as an osteoporosis risk factor in our cohort.

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