Necrotizing Fasciitis: Risk Factors and Outcomes in the COVID-19 Era

Background: Necrotizing Fasciitis is a severe, rapidly spreading soft tissue infection with high morbidity and mortality. Diabetes mellitus, hypertension, and immune suppression are the some of the predisposing factors for the disease. The objective of this study was to study the risk factors and outcomes of necrotizing fasciitis in the COVID-19 era. Methods and Materials: a retrospective analysis of the data of forty-four patients admitted with the diagnosis of NF from April 2020 to April 2021was done at Dr Ram Manohar Lohia Hospital, New Delhi. Data was recorded in MS Excel spreadsheet program. SPSS v23 (IBM Corp.) was used for data analysis. Descriptive statistics were elaborated in the form of means/standard deviations and medians/IQRs for continuous variables, and frequencies and percentages for categorical variables. Chi-square test (X2) was used for group comparisons of categorical data. Results: Out of forty-four patients, 26 (59.10%) were male and 18 (40.9%) were female. The mean age was 54.2 years (+ 14.4 years). Extremities (68.2%) were the most commonly involved site followed by perineum (29.5%) and abdominal wall (2.2%). Diabetes mellitus (DM) was the most prevalent comorbidity. 10 patients had both DM and hypertension (HTN). Fourteen patients (32%) had a polymicrobial infection on tissue culture. Rest thirty patients had involvement of gram positive (44%) and gram negative (24%) organisms. Twenty-two patients (50%) had healthy granulation tissue as the final outcome. However, the rest 50% patients had a poor outcome in form of amputation (13.63%) and mortality (36.36%). Average duration from onset of symptoms to presentation at the hospital was 7.11 (+ 3.47) days. Patients who presented early to the hospital within 7 days of symptom onset had a good outcome in the form of healthy granulation tissue (X2= 7.62 and p <0.05). Conclusions: Early diagnosis and prompt surgical intervention in necrotizing fasciitis is the key to its management. Delayed presentation was because of restricted movement, government-imposed lockdowns, patients ignoring their symptoms, and resorting to self-medications. The delay in diagnosis leading to a delay in treatment is one of the major factors contributing to poor outcomes in the COVID-19 era. Keywords: necrotizing fasciitis, risk factors, COVID 19.

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Sex, Knowledge, and Attitude of Stroke Survivors Attending Bebe Herbal Center on Risk Factors before and after Stroke

Stroke Research and Treatment ◽

10.1155/2021/6695522 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Polycarp U. Nwoha ◽

Florence O. Okoro ◽

Emmanuel C. Nwoha ◽

Fidelia N. Chukwu ◽

Chidinma O. Nwoha ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Risk Factor ◽

Alcohol Intake ◽

Categorical Variables ◽

Stroke Survivors ◽

Continuous Variables ◽

Chi Square ◽

Before And After ◽

Chi Square Test

Objective. The objective of this study was to investigate the extent stroke survivors who attended an herbal center knew of stroke risk factors and whether significant sex differences existed. Study Design. This was a cross-sectional study conducted from January to June 2018 at Bebe Herbal Center, and it involved two well-trained assistants who interviewed 149 first-time stroke survivors after consent and ethical approval were obtained. The survivors self-reported their knowledge, attitude, and beliefs on risk factors before and after stroke. Statistical Analyses. Means of continuous variables were compared using Student’s unpaired t -test, while categorical variables between males and the females were analyzed using Pearson’s chi-square test. P < 0.05 was taken as significant. Results. Mean age of men ( 64.81 ± 1.24 yrs ) was significantly higher than that of women ( 61.39 ± 1.42 yrs ) ( F = 0.096 , t = 1.79 , df = 147 ; P < 0.05 ). More men than women were 60 years and above while more women than men were below 60 years. Pearson’s chi-square test showed significant association of sex with education ( χ 2 = 12.31 ; df = 3 , P < 0.006 ), occupation ( χ 2 = 23.65 ; df = 4 , P < 0.001 ), alcohol intake ( χ 2 = 24.23 ; df = 1 ; P < 0.001 ), and smoking ( χ 2 = 9.823 ; df = 1 ; P < 0.001 ). The commonest risk factor suffered was hypertension (73.1%), followed by alcohol intake (59.1%), smoking (31.5%), and diabetes mellitus (26.7%); these affected men more than women. Male survivors unaware of their hypertensive status were more likely to have stroke than females, and age had a significant effect on the likelihood of developing a stroke; the same was occupation. Conclusions. These survivors suffered mainly from hypertension, triggered by psychosocial problems and diabetes mellitus; their stroke seemed fueled by unrecognized hypertension, unrecognized diabetes mellitus, ignorance of hyperlipidemia, and wide-scale belief in witchcraft as risk factor. Awareness programs in the third world should take these observations into consideration.

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Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1216 ◽

2015 ◽

Vol 18 (1) ◽

pp. 006

Author(s):

Hasan Reyhanoglu ◽

Kaan Ozcan ◽

Murat Erturk ◽

Fatih İslamoglu ◽

İsa Durmaz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Failure ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Bypass Surgery ◽

Artery Bypass ◽

Significant Risk ◽

High Morbidity ◽

Factors Associated

Objective: We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery. Methods: One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group (C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated. Results: Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while 26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P < .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively. Conclusion: Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.

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HPV genotyping and risk factors for anal high-risk HPV infection in men who have sex with men from Toronto, Canada

Scientific Reports ◽

10.1038/s41598-021-84079-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoojin Choi ◽

Mona Loutfy ◽

Robert S. Remis ◽

Juan Liu ◽

Anuradha Rebbapragada ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Hpv Vaccine ◽

Hpv Infection ◽

Categorical Variables ◽

Genotype Distribution ◽

Continuous Variables ◽

Chi Square ◽

Hpv Genotypes ◽

Sex With Men

AbstractMen who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection. Currently, the nonavalent HPV vaccine provides coverage against nine HPV genotypes, including seven HR-HPV genotypes. Here, we characterize anal HR-HPV genotype distribution and associated risk factors in MSM from Toronto, Canada recruited between September 2010 and June 2012. Wilcoxon–Mann–Whitney test was used for continuous variables, Chi-square test was performed for categorical variables, and a multivariable model using logistic regression was created to assess for correlates of anal HR-HPV infection. A total of 442 MSM were recruited, with a median age of 45 (IQR 38–50) and an overall HPV prevalence of 82%. The prevalence of any HR-HPV infection was 65.3% and 50.7% in the HIV-positive and HIV-negative MSM, respectively. No participant tested positive for all genotypes covered by the nonavalent vaccine. HIV status (aOR 1.806; 95% CI 1.159–2.816), smoking (aOR 2.176; 95% CI 1.285–3.685) and the number of lifetime sexual partners (aOR 2.466; 95% CI 1.092–5.567) were independent risk factors for anal HR-HPV infection. Our findings will be useful to inform HPV vaccine rollout and HPV prevention strategies in Canadian MSM.

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Risk factors, microbiological findings and outcomes of necrotizing fasciitis at a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20184743 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3858

Author(s):

Divakara S. R. ◽

Thrishuli P. B. ◽

Bhavuray Teli

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Necrotizing Fasciitis ◽

Blood Sugar ◽

Serum Ferritin ◽

Morbidity And Mortality ◽

Type I ◽

Medical College ◽

Sugar Levels ◽

Low Serum

Background: Necrotizing fasciitis (NF) is a uncommon and serious infection involving the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier’s gangrene), and the abdominal wall with high morbidity and mortality. Early diagnosis and aggressive treatment can reduce the mortality rate of NF. The objectives of this study are to study the etiolopathological, microbiological factors determining the outcome of necrotizing fasciitis.Methods: It is prospective study and was conducted in JSS Medical College and Hospital in October 2008 to October 2010. Total 50 patients diagnosed with necrotizing fasciitis were admitted to JSS Medical College and Hospital. Demographic data, type of co morbidities, site of infection, clinical features with microbiology and laboratory results, and outcomes of patients were analyzed.Results: Out of 50 patients there were 42 males and 8 females. Highest number of cases was found in the age group of 65-74 years among males, 55-64 years among females. The commonest site in the present study is lower limbs (74%). Diabetes mellitus was the commonest (76%) co morbidity. Beta hemolytic streptococci 22 (44%) was the highest to be isolated. In type I and Coagulase positive staphylococci 18 (36%) was the commonest organism isolated in type II necrotizing fasciitis. The significant risk factors were gender, comorbidties, hospital length of stay, and albumin level, leucocytosis, anemia, hypoalbumenia, low serum ferritin levels increase blood sugar levels. The mortality was 12% (8 patients).Conclusions: Patients with advance age, co-morbid conditions like diabetes mellitus, hypertension, peripheral vascular disease, osteomyelitis had high unexplained susceptibility to the disease and with a higher incidence in males. Thus, early recognition with a high index of clinical suspicion would definitely reduce both morbidity and mortality. It has gross morbidity and mortality if not treated in its early stages. Leucocytosis, anemia, hypoalbumenia, low serum ferritin levels, increase blood sugar levels were consistent findings seen in majority of the patients which resulted in increased morbidity.

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P1553Differential association between vascular and chronological age with cardiovascular outcomes

European Heart Journal ◽

10.1093/eurheartj/ehz748.0313 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R M Bruno ◽

P Nilsson ◽

G Engstrom ◽

B Wadstrom ◽

J P Empana ◽

...

Keyword(s):

Risk Factors ◽

Reference Values ◽

Smoothing Splines ◽

Categorical Variables ◽

Study Cohort ◽

Continuous Variables ◽

Vascular Aging ◽

Cancer Study ◽

Vascular Age ◽

Diet And Cancer

Abstract Background/Introduction Increased pulse wave velocity (PWV), is a reliable marker of early vascular aging (EVA). However, the identification of individuals whose arteries are abnormally healthy in comparison to their age and cardiovascular (CV) risk profile might be of interest, to discover novel pathways of cardioprotection and provide preventive strategies for successful vascular aging. Purpose 1) to provide a novel calculation for vascular age and examine his determinants; 2) to test the hypothesis that individuals with the largest difference between chronological and vascular age (C-V age) show a lower rate of CV events than their counterparts, and may thus be defined as the supernormal vascular aging group (SUPERNOVA). Methods Vascular age was defined as predicted age based on classical CV risk factors and PWV. The best fitting model for vascular age was investigated in the multicenter, European, cross-sectional Reference Values for Arterial stiffness Collaboration Database (n=11406). Continuous variables were modelled as smoothing splines. Thereafter, the risk of fatal and non-fatal CV events associated with C-V age was examined in the longitudinal cohort of the Malmo Diet and Cancer Study (n=2663) using Cox proprotional hazard regression models. C-V age was examined as a continuous variable (natural splines) and as a 3 levels categorical variables based on the best grouping of the deciles of C-V age and corresponding to the EVA (<3.0 years), normal vascular aging (3.0 to 8.8 years) and SUPERNOVA (>8.8 years) respectively. Results In the Reference Values Cohort (age range 17–85 years, 52.4% men, 38.1% hypertensives, 3.9% diabetics, average PWV 7.8 m/s), the most significant predictor of vascular age (full model r2 0.598) was PWV. In the Malmo Diet and Cancer Study Cohort (age 61–89 years, 63.6% men, 64.0% hypertensives, 12.9% diabetics, PWV 11.5 m/s), during follow-up (6.6 years on average), 286 individuals developed a first cardiovascular event. In the Cox survival analysis, C-V age was significantly and inversely associated with CV events. Compare to normal vascular aging, participants with SUPERNOVA had lower risk for CV events [HR 0.51 (0.34–0.76)] whereas those with EVA had a higher risk [HR 2.71 (1.80–4.09)]. Instead, there was no significant association with all-cause mortality. Conclusions The use of PWV and CV risk factors may be useful to define early and supernormal vascular aging in particular, and to assess its clinical relevance towards the risk of cardiovascular disease and death.

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Cervical necrotizing fasciitis with facial nerve paralysis

The Journal of Laryngology & Otology ◽

10.1258/0022215041615119 ◽

2004 ◽

Vol 118 (7) ◽

pp. 573-575 ◽

Cited By ~ 5

Author(s):

Amed Al-Ammar ◽

Suhail Maqbool Mir

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Facial Nerve ◽

Necrotizing Fasciitis ◽

Mortality Risk ◽

Present Report ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

High Mortality Risk ◽

Aggressive Management

Necrotizing fasciitis (NF) is a very aggressive infection with associated high mortality. Risk factors of acquiring this infection may include diabetes mellitus, surgery, trauma, and infection. This infection necessitates prompt recognition and aggressive management in order to avoid its unfavourable outcomes. Associated nerve paralysis may indicate the involvement of deeper tissue.The present report highlights a case of cervical NF that was complicated by facial nerve paralysis, a feature that has rarely been reported.

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Necrotizing Fasciitis in a Patient with Type 2 Diabetes Mellitus

Journal of the American Podiatric Medical Association ◽

10.7547/0960067 ◽

2006 ◽

Vol 96 (1) ◽

pp. 67-72 ◽

Cited By ~ 4

Author(s):

David M. Kanuck ◽

Thomas Zgonis ◽

Gary Peter Jolly

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Necrotizing Fasciitis ◽

Subcutaneous Fat ◽

Disease Process ◽

Treatment Modalities ◽

Successful Outcome ◽

High Morbidity

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. We present a case of limb salvage in a 52-year-old patient with type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome. (J Am Podiatr Med Assoc 96(1): 67–72, 2006)

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Risk factors for poor outcome in diabetic keto acidosis at the initial presentation among children with type 1 diabetes mellitus

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182945 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1745

Author(s):

Merceline Alice PonJeba J. ◽

Poovazhagi Varadarajan

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Significant Risk ◽

Initial Presentation ◽

High Morbidity ◽

Onset Type ◽

New Onset

Background: Diabetic keto acidosis (DKA) is a serious metabolic disorder among children with new onset Type 1 Diabetes mellitus and is associated with high morbidity and mortality. Objective of the present study was to assess the risk factors associated with mortality in DKA at its initial presentation among children with new onset type 1 diabetes mellitus (T1DM).Methods: A case control study was designed and conducted in the Institute of child Health and Hospital for children, Madras Medical College, Chennai from February 2013 to February 2015. All children admitted with DKA as initial presentation of type 1 Diabetes mellitus were enrolled for this study.Results: Out of 72 new cases of T1DM, diagnosed during the study period 47 children had DKA and 25 children presented without DKA. Of the 47 children 6 children died. On comparing risk factors for mortality in DKA at the initial presentation, delayed treatment(p-0.002), altered sensorium at presentation(p-0.04), high urea(p-0.014) creatinine(p-0.042), lower bicarbonates (p-0.035), higher sodium(p-0.025) and lower pH(p-0.009) were found to be significantly associated with mortality. Overall mortality in DKA at its initial presentation is 12.8%.Conclusions: Delay in therapy for DKA and presence of features of severe disease at admission are significant risk factors for mortality.

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A study to evaluate scope of preventive strategies in modifiable risk factors of hypertension

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20184583 ◽

2018 ◽

Vol 5 (11) ◽

pp. 4849

Author(s):

Medha Mathur ◽

Navgeet Mathur

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Risk Factor ◽

Family History ◽

Positive Family History ◽

High Morbidity ◽

Modifiable Risk Factors ◽

Preventive Strategies ◽

Hypertensive Patients ◽

Lack Of Exercise

Background: Hypertension is a vascular disorder associated with high morbidity and mortality. Risk factor prevention plays key role in control of the non-communicable diseases. Current study was conducted to assess prevalence of risk factors related to hypertensive patients.Methods: This cross-sectional study was conducted for the period of six months (January to June 2018). Total 672 hypertensive patients were included in this study and subjected to evaluation of modifiable risk factors like obesity, lack of exercise, smoking, dyslipidemia and pre-existing diabetes mellitus along with non-modifiable risk factors like positive family history and age.Results: On risk factor evaluation of 672 hypertensive patients it was found that 601(89.4%) patients had lack of exercise, 210 (31.2%) patients had dyslipidemia, 190 (28.2%) patients were smokers, 164 (24.4%) patients had diabetes mellitus before emergence of hypertension, 132 (19.6%) patients were obese and 498 (74.1%) patient had age more than 60 years, 94 (13.9%) patients had family history of hypertension.Conclusions: High prevalence of risk factors for this non-communicable disease in Indian community is alarming. Dealing with modifiable risk factors by health education, promotion of exercise, favourable life style, dietary modifications, cessation of smoking, screening programmes for early detection of deranged blood pressure, blood sugar, lipid profile can be effective preventive strategies.

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High Anemia Prevalence in Korean Older Adults, an Advent Healthcare Problem: 2007-2016 KNHANES

10.21203/rs.3.rs-34749/v4 ◽

2020 ◽

Author(s):

Hee won Chueh ◽

Hye Lim Jung ◽

Ye Jee Shim ◽

Hyoung Soo Choi ◽

Jin Yeong Han

Keyword(s):

Rheumatoid Arthritis ◽

Older Adults ◽

Multivariate Analyses ◽

Categorical Variables ◽

High Morbidity ◽

Continuous Variables ◽

Older Individuals ◽

Female Sex ◽

Korean Adults ◽

Increased Risk

Abstract BACKGROUND: Anemia is associated with high morbidity and mortality in older people. However, the prevalence and characteristics of anemia in older individuals are not fully understood, and national data on these aspects in older Korean adults are lacking. This study aimed to evaluate the prevalence and characteristics of anemia in older adults using data from the Korea National Health and Nutrition Examination Survey (KNHANES), which is a nationwide cross-sectional epidemiological study conducted by the Korean Ministry of Health and Welfare.METHODS: Data from a total of 62,825 participants of the 2007-2016 KNHANES were compiled and analyzed to investigate differences in participant characteristics and potential risk factors for anemia. Differences in clinical characteristics of participants were compared across subgroups using the chi-square test for categorical variables and independent t-test for continuous variables. Univariate and multivariate analyses using logistic regression were performed to identify related clinical factors.RESULTS: The prevalence of anemia was higher in the population aged ≥ 65 years than in the younger population. Anemia was also more prevalent among females than among males, but this difference was not significant in people aged >85 years. Being underweight, receiving a social allowance, living alone, and having comorbidities such as hypertension, rheumatoid arthritis, diabetes mellitus (DM), cancer, and chronic renal failure (CRF) were more common among older adults with anemia than among the population without anemia. In univariate and multivariate analyses, older age, female sex, underweight, and presence of comorbidities including rheumatoid arthritis, DM, cancer, and CRF were associated with an increased risk of anemia. CONCLUSIONS: This study revealed that age, female sex, underweight, and the presence of comorbidities such as rheumatoid arthritis, DM, cancer, and CRF were associated with an increased risk of anemia in older Korean adults. Further study on causal relationships between anemia and other variables in the older population is necessary.

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