Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team

2017 ◽  
Vol 107 (5) ◽  
pp. 355-364 ◽  
Author(s):  
Laura E. Sansosti ◽  
Amanda Crowell ◽  
Eric T. Choi ◽  
Andrew J. Meyr
Keyword(s):  
Lower Limb ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Care Hospital ◽  
Factors Associated ◽  
Knee Amputation ◽  
History Of

Background: One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital. Methods: A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation. Results: The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral above-the-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] = 2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR = 3.62). Those who had a history of dementia (OR = 0.00), a history of peripheral arterial disease (OR = 0.35), and a preamputation history of ipsilateral limb revascularization (OR = 0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures. Conclusions: These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.

Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽  
2021 ◽  
pp. 026765912110506
Author(s):  
Natasha Habr ◽  
Jamal J Hoballah ◽  
Jamil Borgi ◽  
Caroline Hamadi ◽  
Pierre Sfeir ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Venous Cannulation ◽  
Knee Amputation ◽  
Venous Cannula ◽  
Arterial Insufficiency ◽  
Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

scholarly journals Risk factors associated with postpartum depression in two tertiary care hospitals of Peshawar: a comparative cross-sectional study

2020 ◽  
Vol 6 (3) ◽  
pp. 16-19
Author(s):  
Hira Bakhtiar ◽  
Maria Malik A. Khaliq ◽  
Asif Nawaz ◽  
Muhammad Asif ◽  
Siraj Jamil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postpartum Depression ◽  
Postpartum Period ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Factors Associated ◽  
History Of

Introduction: Postpartum depression has become a common complication in women in their postpartum period, affecting not only the mother but her child and her family. Due to lack of awareness regarding the subject it has been widely neglected, especially in Pakistan.Objective: To determine and compare the frequency and risk factors associated with postpartum depression in a public and a private tertiary care hospital in Peshawar.Materials & Methods: A comparative cross-sectional study was conducted in the Gynecology and Pediatrics OPD and Pediatrics ward of Rehman Medical Institute (RMI) and Gynecology and Pediatrics OPD as well as the vaccination center of Hayatabad Medical Complex (HMC) over a period of 6 months (January to June 2016). The women were interviewed after obtaining informed consent during 1-12 months of their postpartum period using the Edinburgh Postnatal Depression Scale (EPDS) as well as a pretested self-structured questionnaire. Chi Square test and binary logistic regression were used to determine the relative significance of various risk factors for PPD.Results: A total of 280 women were interviewed, 140 in each hospital, their ages ranging from 16 to 45 years. The frequency of PPD calculated at RMI was 62.7% and at HMC it was 37.3% (p=0.001). Risk factors that showed a close association with PPD included the level of education of women (p=0.008), family support (p=0.022), and history of previous trauma (p= 0.055).Conclusion: Postpartum depression is twice as likely to occur in a private tertiary care hospital compared to a public one, and appears related to educational status, family help, and history of trauma.Keywords: Depression, Postpartum; Postpartum Period, Mothers; Child; Breast Feeding; Childbirth

Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 2451-2453
Author(s):  
Shahid Iqbal ◽  
Muhammad Fareed Khan ◽  
Raja Imtiaz Ahmed ◽  
Shahab Saidullah ◽  
Nisar Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Congenital Heart ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Hospital ◽  
Younger Age ◽  
History Of ◽  
Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

ICD-10 Diagnostic Coding for Identifying Hospitalizations Related to a Diabetic Foot Ulcer

2021 ◽  
Vol 44 (4) ◽  
pp. E11-16
Author(s):  
Muzammil H. Syed ◽  
Mohammed Al-Omran ◽  
Jean Jacob-Brassard ◽  
Joel G. Ray ◽  
Mohamad A. Hussain ◽  
...  
Keyword(s):  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Hospital ◽  
Reference Standard ◽  
Diagnostic Coding ◽  
Icd 10

Purpose: To estimate the positive predictive value (PPV) of Canadian ICD-10 diagnostic coding for the identification of hospitalization related to a diabetic foot ulcer (DFU). Methods: Hospitalizations related to a neuropathic and/or ischemic DFU were identified from the Discharge Abstract Database (DAD) records of a single Canadian tertiary care hospital between April 1, 2002 and March 31, 2019. The first coding approach required a most responsible diagnosis (MRDx) code for diabetes-specific foot ulceration or gangrene (DSFUG group). Three alternative coding approaches were also considered: MRDx code for lower-limb osteomyelitis (osteomyelitis group); lower-limb ulceration (LLU group); or lower-limb atherosclerotic gangrene (atherosclerosis group)—each in conjunction with a non-MRDx DSFUG code on the same DAD record. From all eligible DAD records, random samples were drawn for each coding group. DAD records were independently compared by a masked reviewer who manually abstracted data from the entire hospital record (reference standard). The PPV and 95% CI were generated. Results: Out of 1,460 hospitalizations, a total of 300, 50, 33 and seven records were included from the DSFUG, osteomyelitis, LLU and atherosclerosis samples, respectively. Compared to the reference standard, the PPV for all 390 records was 88.5% (95% CI 84.9 to 91.5). The DSFUG group had the highest PPV (90.0%, 95% CI 86.0 to 93.2), followed by the atherosclerosis (85.7%, 95% CI 42.1 to 99.6), LLU (84.9%, 95% CI 68.1 to 94.9) and osteomyelitis (82.0%, 95% CI 68.6 to 91.4) groups. Conclusion: Based on data from a Canadian tertiary care hospital, the specified coding algorithms can be used to identify and study the management and outcomes of people hospitalized with a DFU in Ontario.

scholarly journals The clinical study of dermatophytosis in a tertiary care hospital of konkan region, Maharashtra

2021 ◽  
Vol 7 (4) ◽  
pp. 315-319
Author(s):  
U Ketan Raju ◽  
Hanamant G Bobade ◽  
Anil Mishra
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hair Shaft ◽  
Care Hospital ◽  
Common Site ◽  
Tinea Cruris ◽  
Nail Changes ◽  
Male Preponderance ◽  
History Of ◽  
Epidemiological Characteristics

Dermatophytes are aerobic fungi that produce proteases that digest keratin and allows colonization, invasion and infection of the stratum corneum of the skin, the hair shaft, and the nail. This study was an attempt on the part of the author to find out the incidence and various clinico-epidemiological characteristics of Dermatophytosis in skin OPD of Tertiary care Hospital, B.K.L.W.R.M.C., Dervan. The study was carried on 2444 patients of Dermatophytosis attending the OPD, out of which 49.79% of the cases were Tinea Cruris (TC). The age group of 11-20 years showed maximum prevalence of Dermatophytosis (22.17%). 58% of the patients had diffuse lesions. Body involvement was seen in 87% of cases. Itching was the most common condition associated with Dermatophytosis. 35% of the patients reported with family history of Tinea Cruris.Circumscribed variety of TC was found to be most common variant mostly observed in 2and 4 decade, with a male preponderance. Groin was the most common site with multiple lesions. Nail changes was most commonly associated with TC.

scholarly journals Prevalence and the risk factors for the carriage of beta-haemolytic streptococci among women visiting a tertiary care hospital in South India

2021 ◽  
Vol 8 (4) ◽  
pp. 308-312
Author(s):  
Pendru Raghunath ◽  
LN Rao Sadanand
Keyword(s):  
Risk Factors ◽  
Teaching Hospital ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Research Centre ◽  
Care Hospital ◽  
Microbiological Techniques ◽  
History Of ◽  
Group B

Streptococci are gram positive cocci arranged in chains and are part of normal flora of humans and animals. The present study is carried out to determine the prevalence and risk factors for the carriage of beta-haemolytic streptococci (BHS) among women visiting Dr. VRK Women’s Teaching Hospital & Research Centre, Hyderabad. Vaginal swabs were collected from 250 patients attending outpatient department (OPD) of Dr. VRK Women’s Teaching hospital. Swabs were inoculated onto 5% sheep blood agar plates and incubated for 24 h at 37°C in a candle jar. BHS isolates were phenotypically identified by standard microbiological techniques, all the isolates presumptively identified as BHS were tested for Bacitracin susceptibility. Sensitive isolates were presumptively identified as GAS and resistant isolates were identified as non-group A BHS (NGABHS). Presumptively identified GAS & NGABHS isolates were serogrouped by Lancefield grouping using a commercially available latex agglutination test. BHS were isolated from 12.4% of samples. As many as 12 BHS isolates were identified as GAS and 19 were identified as NGABHS. Ten of nineteen were identified as group B (GBS), 4 (12.9%) were identified as group C (GCS) and 5 (16.12%) were identified as group G (GGS). Among six clinical groups, the prevalence of GAS is highest i.e. 7.5% in female patients visiting Gynaecology OPD with history of white discharge. Prevalence of NGABHS was more among post insertion (18%) IUCD group compared to pre insertion (8%) IUCD group. GBS were isolated from 7% of samples from IUCD group and 4% of samples from prostitutes.This study reports the prevalence of BHS among women visiting a tertiary care hospital in Hyderabad. This study also identified certain risk factors such as IUCD usage and working as a FSW are associated with the increased prevalence of NGABHS especially GBS.

scholarly journals Assessment of Factors Associated with Dropout for Pentavalent Vaccine in Tertiary Care Hospital of Kathmandu, Nepal

2020 ◽  
Vol 22 (3) ◽  
pp. 106-110
Author(s):  
Supri Raj Shrestha ◽  
B Shakya ◽  
R Oli
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
College Teaching ◽  
Sampling Technique ◽  
Cost Effective ◽  
Dropout Rate ◽  
Care Hospital ◽  
Vaccine Preventable Diseases ◽  
Factors Associated ◽  
Pentavalent Vaccine

Immunization is one of the most cost-effective public health measures as it has helped in huge reduction of disease, disability and death from different infectious diseases in children by protecting them from vaccine preventable diseases. The current study aimed to study factors associated with dropout for pentavalent vaccine in tertiary care hospital of Kathmandu. A longitudinal observational study using purposive sampling technique was conducted among 196 infants. The information was obtained using self-constructed structured questionnaire from parents visiting Community Medicine OPD of Nepal Medical College Teaching Hospital. The information regarding socioeconomic characteristics of mother, gender of the infant, place of delivery of child, birth order and reasons for dropout of pentavalent third dose were taken. The dropout of third dose pentavalent vaccine was mainly seen in infant of parents living in rented house and according to gender wise, dropout was high among male infants. The different reasons for dropout of vaccine were busy parents, forgotten date, visit to other immunization centres and sick infants. Among these, the main reason for dropout of vaccine was due to infants getting sick during the time of immunization. The dropout rates between first and third dose of pentavalent vaccine were 26.3% and 30.4% respectively for two consecutive months and the overall dropout rate was 28.35%. Also, literacy level of the mother was directly associated with the immunization visit of the infant as, maximum number of infants of illiterate mother were absent for third dose of pentavalent vaccine as opposed to no absentee among master degree holding mothers. Thus, the present study provides valuable information regarding the factors associated with dropout for pentavalent vaccine.

scholarly journals Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population

2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Pui M Chung ◽  
Bolton KH Chau ◽  
Esther C-S Chow ◽  
Kwok H Lam ◽  
Nang MR Wong
Keyword(s):  
Mortality Rate ◽  
Lower Limb ◽  
Chinese Population ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Hong Kong Chinese ◽  
Limb Amputation ◽  
The Mean ◽  
One Year ◽  
The One

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.

Sign in / Sign up

Export Citation Format

Share Document