scholarly journals Occurrence of Hyperbilirubinemia in Neonates Given a Short-term Course of Ceftriaxone versus Cefotaxime for Sepsis

2021 ◽  
Vol 26 (1) ◽  
pp. 99-103
Author(s):  
Garrett B. Hile ◽  
Kaitlin L. Musick ◽  
Adam J. Dugan ◽  
Abby M. Bailey ◽  
Gavin T. Howington
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Median Number ◽  
Antibiotic Administration ◽  
Neonatal Infections ◽  
Short Term ◽  
Significant Difference ◽  
Abnormal Level ◽  
Antimicrobial Administration

OBJECTIVE Ceftriaxone and cefotaxime are appealing options for the treatment of neonatal infections. Guidelines recommend cefotaxime as the cephalosporin of choice in neonates because of ceftriaxone's potential to cause hyperbilirubinemia. Unfortunately, due to cefotaxime discontinuation, providers must choose between alternative antibiotics. Clinicians at our institution adopted a protocol allowing for the utilization of cefepime and ceftriaxone for the management of neonatal sepsis. The objective of this study was to compare the incidence of hyperbilirubinemia between ceftriaxone and cefotaxime in the treatment of neonatal infections beyond the first 14 days of life. METHODS This was a retrospective chart review of patients receiving ceftriaxone or cefotaxime for the treatment of neonatal infections. Patients were 15 to 30 days old at the time of antimicrobial administration and received at least 1 dose of ceftriaxone or cefotaxime during hospital admission. Patient characteristics and bilirubin levels were compared between ceftriaxone and cefotaxime. RESULTS The analysis included 88 patients. There was no statistically significant difference between groups in age, gestational age, weight, and baseline total calcium and bilirubin levels. Normal baseline bilirubin levels increased to an abnormal level after antibiotic administration in 2 patients in the cefotaxime group and 1 patient in the ceftriaxone group. The median number of doses of cefotaxime and ceftriaxone were 3 and 2, respectively. CONCLUSION Patients who received a short-term course of ceftriaxone did not have a higher likelihood of developing hyperbilirubinemia compared with those who received a short-term course of cefotaxime during their hospital stay.

Do Postoperative Antibiotics Prevent Abscess Formation in Complicated Appendicitis?

2014 ◽  
Vol 80 (9) ◽  
pp. 878-883 ◽  
Author(s):  
Ashlee R. Kimbrell ◽  
Timothy J. Novosel ◽  
Jay N. Collins ◽  
Leonard J. Weireter ◽  
Hillman W. T. Terzian ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Infectious Complications ◽  
Complicated Appendicitis ◽  
Abscess Formation ◽  
Antibiotic Administration ◽  
Abdominal Abscesses ◽  
Significant Difference ◽  
Periappendiceal Abscess ◽  
Larger Sample

Recent studies have shown that postoperative antibiotics in nonperforated appendicitis do not reduce infectious complications; however, there is no consensus on patients with complicated appendicitis. The aim of this study is to determine whether postoperative antibiotic administration in complicated appendicitis prevents intra-abdominal abscess formation. We conducted a retrospective chart review of all patients undergoing appendectomy from 2007 to 2012 at our institution. Patients with complicated appendicitis (perforated, gangrenous, or periappendiceal abscess) were identified and data collected including details of postoperative antibiotic administration and rates of postoperative abscess development. Of 444 charts reviewed, 52 patients were included. Forty-four patients received greater than 24 hours and eight patients received 24 hours or less of postoperative antibiotics. In those receiving greater than 24 hours of antibiotics, nine of 44 (20.5%) developed a postoperative abscess, and in those receiving 24 hours or less of antibiotics, two of eight (25.0%) developed a postoperative abscess ( P = 1.0000). There is no significant difference in postoperative abscess development among those with complicated appendicitis who received greater than 24 hours of postoperative antibiotics compared with those who did not. Postoperative antibiotics may not provide an appreciable clinical benefit for preventing intra-abdominal abscesses; however, larger sample sizes and prospective studies are needed to confirm these findings.

scholarly journals Percutaneous Biliary Drain Complications in Transplanted versus Native Liver: A Comparative Retrospective Study

2021 ◽  
Author(s):  
Lauren Marissa Stumbras ◽  
Keith Quencer ◽  
Claire Kaufman
Keyword(s):  
Liver Function ◽  
Chart Review ◽  
Bile Leak ◽  
Retrospective Chart Review ◽  
Median Number ◽  
Liver Transplants ◽  
Secondary Complications ◽  
Significant Difference ◽  
Chi Squared ◽  
Subsequent Intervention

Abstract Purpose The aim of this study was to assess the rate of complications of percutaneous transhepatic biliary drain in transplanted versus native livers. Materials and Methods A retrospective chart review was performed of all percutaneous transhepatic biliary drains completed at our institution from 2009 to 2018. Chart review of complications and interventions was recorded. Chi-squared and Fisher’s exact tests were used to compare percutaneous transhepatic biliary drains performed in patients with liver transplants (n = 62) to those with native livers (n = 285). Results There was a statistically significant difference in the frequency of complications of percutaneous transhepatic biliary drains in patients with liver transplants (61%) compared with those with native livers (13%), χ2(1) = 9.59, p<0.01. There was a statistically significant increased frequency of worsening liver function, sepsis, bile leak, arterial and portal venous bleeds, and secondary complications in those with liver transplants. The median number of days until the complication occurred for those with liver transplants was nearly three times longer than those with native livers. The most common subsequent intervention for patients with liver transplants was placement of a new drain (53%), whereas those with native livers was drain upsize (70%). Conclusion Complications including vascular injury, sepsis, bile leak, and worsening liver function after percutaneous transhepatic biliary drains occurred more commonly in patients with liver transplants versus native livers.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

An Evaluation of the Effects of Elevated Body Mass Index on Skeletal Age

2021 ◽  
Author(s):  
Michael H. French ◽  
Michael S. Kung ◽  
W. Nathan Holmes ◽  
Hossein Aziz ◽  
Evelyn S. Thomas ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Skeletal Age ◽  
Chronological Age ◽  
Age Group ◽  
Obese Children ◽  
Significant Difference ◽  
Hand Radiographs

Abstract BackgroundMany treatment decisions in children’s Orthopaedics are based on age. This study determined whether a discrepancy between chronological age (CA) and skeletal age (SA) is dependent on BMI and if overweight or obese children would have an advanced SA.Materials and Methods120 children between ages 8-17 with an adequate hand radiograph and a correlating BMI were enrolled by retrospective chart review. Stratification based on age, sex, ethnicity, and BMI percentile was performed. For each age group, 6 males and 6 females were selected with 50% of each group having an elevated BMI. Two blinded physicians independently evaluated hand radiographs and recorded the SA. Statistical analyses evaluated inter-rater reliability and any discrepancy between groups.ResultsThe final statistical analysis included 96 children. The Intraclass Correlation Coefficient for SA determined by the two reviewers was excellent at 0.95. A difference of 13 months was found between CA and SA in the elevated BMI cohort versus the non-elevated BMI cohort, (p<0.001). No significant difference was seen between CA and SA for the non-elevated cohort (p=0.72), while matching for age and sex. ConclusionChronological age and skeletal age are not always equivalent especially in pediatric patients who are overweight or obese.

589 Methadone in Procedural Care for Burn Injuries of 20–30% Total Burn Surface Area: A Retrospective Chart Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S146-S146
Author(s):  
Loryn Taylor ◽  
Kimberly Maynell ◽  
Thanh Tran ◽  
David J Smith
Keyword(s):  
Physical Therapy ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Surface Area ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Opioid Consumption ◽  
Burn Injuries ◽  
Methadone Group ◽  
Significant Difference

Abstract Introduction Prolonged opioid usage remains a concern in pain management in procedural care. Recent evidence also suggests that a considerable number of patients who were prescribed opioids struggle with transitioning to non-opioid pain medications. As a continuous effort to reduce opioid consumption following burn surgical procedures, our institution recently evaluated methadone administration for burn procedural care in patients with 20–30% total burn surface area (TBSA) requiring excision and grafting. Methods After IRB approval, we performed a retrospective chart review of patients who underwent excision and grafting procedure for 20–30% TBSA burn injuries between January 1, 2019 and June 30, 2020. The following data was evaluated: postoperative opioid consumption, postoperative pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), time to physical therapy and time to hospital discharge. Data was analyzed using chi square/Fisher exact test for categorical variables and t-test/Wilcoxon rank sum test for continuous variables. Results Our preliminary data included 12 patients who met inclusion criteria, of which two patients received methadone administration. Our patient sample consisted of average age of 43 years, 75% male, and 24% TBSA (92% were flame burns). Patients in both methadone and non-methadone groups had no significant differences in medical histories and TBSA (23% TBSA in methadone, 25% TBSA in non-methadone). There was no significant difference in reported preoperative pain intensity between the two groups, rating moderate to severe. Postoperative pain intensity remained the same, rating moderate to severe and controlled with fentanyl, oxycodone, morphine and non-opioid analgesics. While there was no difference in postoperative fentanyl, opioid and non-opioid analgesic consumptions between the two groups, morphine consumption was significantly lower in the methadone group compared to non-methadone group (2±2 mg vs 51±54 mg, respectively, p=0.02). There was no significant difference between average time from surgery to first physical therapy session and time to hospital discharge (about 21 days after surgery) between the two groups. Conclusions This evaluation shows a potential trend in reduction of inpatient postoperative opioid consumption with the conjunctive administration of methadone, although a bigger sample size is needed for further assessment.

scholarly journals The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Amyna Husain ◽  
M. Douglas Baker ◽  
Mark C. Bisanzo ◽  
Martha W. Stevens
Keyword(s):  
Emergency Department ◽  
Tooth Extraction ◽  
Chart Review ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cultural Practice ◽  
Fluid Bolus ◽  
Significant Difference ◽  
To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

Safety and efficacy of electroconvulsive therapy for depression following cerebrovascular accident

2012 ◽  
Vol 24 (4) ◽  
pp. 226-229 ◽  
Author(s):  
Magdalena Romanowicz ◽  
Bruce Sutor ◽  
Christopher Sola
Keyword(s):  
Electroconvulsive Therapy ◽  
Cerebrovascular Accident ◽  
Chart Review ◽  
Short Term Memory ◽  
Retrospective Chart Review ◽  
Neurological Deficits ◽  
Response To Treatment ◽  
Short Term ◽  
Memory Problems ◽  
Depressive Syndromes

Introduction: Depressive syndromes are common following cerebrovascular accident (CVA) and many patients do not respond to pharmacotherapy. Electroconvulsive therapy (ECT) is a safe and effective treatment for mood disorders arising with many comorbid medical conditions. In this paper, we describe the successful treatment of post-CVA depression with ECT.Methods: Retrospective chart review of 24 patients hospitalised for depression on an in-patient Medical Psychiatry unit between 2000 and 2010. Medical, neurologic and psychiatric histories, physical examination findings, results of laboratory, imaging and neurophysiologic investigations and treatment response with medications and ECT were recorded.Results: Twenty patients (83%) showed a positive response to treatment with ECT. None had worsening of depression after the ECT or experienced exacerbation of post-stroke neurological deficits. Three patients suffered from minor complications of ECT (prolonged confusion or short-term memory problems).Conclusions: This review supports the use of ECT after a stroke with appropriate clinical observation. The treatment was well tolerated and the majority obtained clinical benefit.

Patient characteristics and outcomes of an interdisciplinary menopause clinic: a retrospective chart review

Maturitas ◽  
2015 ◽  
Vol 81 (1) ◽  
pp. 178-179
Author(s):  
Beate C. Sydora ◽  
Nicole Veltri ◽  
Christoph P. Sydora ◽  
Justin Marillier ◽  
Lori Battochio ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics

Change in pelvic incidence between the supine and standing positions in patients with bilateral sacroiliac joint vacuum signs

2021 ◽  
pp. 1-6
Author(s):  
Anthony L. Mikula ◽  
Jeremy L. Fogelson ◽  
Soliman Oushy ◽  
Zachariah W. Pinter ◽  
Pierce A. Peters ◽  
...  
Keyword(s):  
Chart Review ◽  
Pelvic Incidence ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Significant Difference ◽  
Spinopelvic Parameter ◽  
Fixed Parameter ◽  
Si Joint ◽  
Post Hoc ◽  
Supine Radiograph

OBJECTIVEPelvic incidence (PI) is a commonly utilized spinopelvic parameter in the evaluation and treatment of patients with spinal deformity and is believed to be a fixed parameter. However, a fixed PI assumes that there is no motion across the sacroiliac (SI) joint, which has been disputed in recent literature. The objective of this study was to determine if patients with SI joint vacuum sign have a change in PI between the supine and standing positions.METHODSA retrospective chart review identified patients with a standing radiograph, supine radiograph, and CT scan encompassing the SI joints within a 6-month period. Patients were grouped according to their SI joints having either no vacuum sign, unilateral vacuum sign, or bilateral vacuum sign. PI was measured by two independent reviewers.RESULTSSeventy-three patients were identified with an average age of 66 years and a BMI of 30 kg/m2. Patients with bilateral SI joint vacuum sign (n = 27) had an average absolute change in PI of 7.2° (p < 0.0001) between the standing and supine positions compared to patients with unilateral SI joint vacuum sign (n = 20) who had a change of 5.2° (p = 0.0008), and patients without an SI joint vacuum sign (n = 26) who experienced a change of 4.1° (p = 0.74). ANOVA with post hoc Tukey test showed a statistically significant difference in the change in PI between patients with the bilateral SI joint vacuum sign and those without an SI joint vacuum sign (p = 0.023). The intraclass correlation coefficient between the two reviewers was 0.97 for standing PI and 0.96 for supine PI (p < 0.0001).CONCLUSIONSPatients with bilateral SI joint vacuum signs had a change in PI between the standing and supine positions, suggesting there may be increasing motion across the SI joint with significant joint degeneration.

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