scholarly journals A Prospective Cohort Study of Catheter Drainage versus Percutaneous Needle Aspiration in Treatment of Liver Abscess

2021 ◽  
Author(s):  
RK Vineeth Kumar ◽  
Ashish Pratap Singh ◽  
Ashish Singh ◽  
Priyank Sharma
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Liver Abscess ◽  
Prospective Cohort ◽  
Needle Aspiration ◽  
P Value ◽  
Cavity Size ◽  
Success Rates ◽  
Catheter Drainage ◽  
Duration Of Hospital Stay

Introduction: India has second highest incidence of liver abscess worldwide. Image guided drainage methods are increasingly used to treat liver abscesses with fairly high success rates and with low cost and patient preference. But to choose a preferred one among these two methods of Percutaneous Catheter Drainage (PCD) and Percutaneous Needle Aspiration (PNA) still is a dilemma. Aim: To compare the effectiveness and outcome of PCD and PNA in treatment of liver abscess. Materials and Methods: A prospective cohort study was conducted on 150 liver abscess patients in Shyam Shah Medical College in Vindhya region Rewa, Madhya Pradesh, India, from June 2019 to May 2020. They were divided into two groups PNA (n=75) and PCD (n=75) by simple randomisation. Patient outcome was on the basis of duration to attain clinical relief (assessed subjectively), duration of hospital stay and days required for reduction in cavity size below 50%, death, and success rates were assessed in terms of number of attempts for adequate pus drainage. Chi-square test, non-paired Student’s t-test and ANOVA tests were used. Results: In this study mean age was 40.57 years with 92.67% males. Most common lobe to involved was right lobe (87.3%). E.coli was the most common organism. All patients in PCD group were successfully treated in a single attempt. PNA group had a success rate of 84%. Mean number of days of clinical improvement were less for PCD (mean was 5.27 days) than PNA group (mean was 7.49 days) p-value=0.002. Mean days required for reduction in cavity size to less than 50% was lower in PCD (mean was 7.20 days) than PNA group (mean was 8.75 days) p-value=0.01. Total duration of hospital stay was higher in PNA (mean was 11.59 days) than in PCD group (mean was 9.28 days) p-value=0.03. All multiloculated cavities in PNA group were failures. Conclusion: PCD method was found to be more efficacious than needle aspiration method in this study.

scholarly journals A comparative study of liver abscess: therapeutic aspiration verses continuous catheter drainage

2019 ◽  
Vol 6 (3) ◽  
pp. 922
Author(s):  
Unmed Chandak ◽  
Prenoy Araujo ◽  
Arti Mitra
Keyword(s):  
Liver Abscess ◽  
Interventional Procedures ◽  
Imaging Techniques ◽  
Hepatic Abscess ◽  
Needle Aspiration ◽  
Left Lobe ◽  
P Value ◽  
Catheter Drainage ◽  
Group B ◽  
Amoebic Abscess

Background: Previously liver abscesses were treated primarily by surgery but with advances in imaging techniques the trend is changing towards use of potent antimicrobials and minimally invasive ultrasound guided interventional procedures and surgery is being done only in selected cases. We conducted this study to find out the feasibility, limitations, effectiveness, outcome and complications of therapeutic needle aspiration and continuous catheter drainage of liver abscess.Methods: This was a hospital based randomized control prospective study in which patients with liver abscess were included. 100 patients of liver abscess selected by simple randomization to 2 groups namely Group A (needle aspiration) or Group B (continuous catheter drainage) undergo the above two interventional procedures. For statistical purposes P value less that 0.05 was taken as statistically significant.Results: This study consisted of 100 patients out of whom there were 78 (78%) males and 22 (22%) females with a M:F ratio of 1:0.28. Single hepatic abscess (75%) was more common than multiple abscesses (25%) and pyogenic abscess (67%) was more common than amoebic abscess (33%). Right lobe of liver was most commonly involved (61%) followed by left lobe (22%). All patients in both the groups were treated successfully and there was no treatment failure in any of the groups.Conclusions: Therapeutic needle aspiration as well as continuous catheter drainage both are equally effective in management of liver abscess but needle aspiration had the advantage of being less expensive, easily available and requiring less hospital stay.

COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS NEEDLE ASPIRATION VERSUS PIGTAIL CATHETER DRAINAGE FOR SOLITARY LIVER ABSCESS.

2021 ◽  
pp. 76-77
Author(s):  
Samir Kumar ◽  
Manish Manish
Keyword(s):  
Hospital Stay ◽  
Clinical Improvement ◽  
Liver Abscess ◽  
Needle Aspiration ◽  
Abscess Cavity ◽  
Pigtail Catheter ◽  
Catheter Drainage ◽  
Group A ◽  
Solitary Liver ◽  
Group B

Objective: The aim of this study was to compare the outcomes of ultrasound guided percutaneous needle aspiration and percutaneous pigtail catheter drainage in the treatment of solitary liver abscess with respect to successful drainage, clinical improvement, reduction in size of abscess cavity, duration of hospital stay and procedure related complications. Methods: Prospective randomized study on 108 patients treated over a period of 30 months. Using standard randomization they were divided equally into two groups A and B. Group A patients underwent usg guided percutaneous needle aspiration for a maximum of three attempts, and Group B patients were treated by pigtail catheter drainage. All the patients received a uniform protocol based supportive care and antimicrobial treatment. Outcomes were compared with respect to successful drainage, resolution of symptom, fty percent reduction in size of abscess cavity, hospital stay duration and procedure related complications. Results: A successful drainage was noted in 52(96%) patients in group B treated with PCD and 46 (84%) patients in group A treated with PNA. 8(11%) patients in group A did not respond to three attempts due to very thick pus and they were offered pigtail catheter drainage. The duration required for initial clinical improvement and fty percent reduction of size of abscess cavity was signicantly lesser in group B. Though the duration of hospital stay was lesser in group B the difference was not statistically signicant. Complication was noted only in group B where one patient developed perihepatic and subdiaphragmatic collection and the other had peritonitis. Both were cured after surgical intervention. Conclusion: Both percutaneous needle aspiration and pigtail catheter drainage are almost equally effective in the treatment of solitary liver abscess. Though pigtail catheter drainage helped in earlier clinical improvement and reduction in cavity size but the difference in duration required for full recovery and complete resolution of abscess cavity was not statistically signicant. Hence the selection of the procedure needs to be individualized and should take into account various factors like patient's general condition, laboratory parameters, and nature of abscess cavity.

scholarly journals A COMPARATIVE STUDY OF PERCUTANEOUS NEEDLE ASPIRATION AND CATHETER DRAINAGE IN MANAGEMENT OF LIVER ABCESS

2021 ◽  
pp. 1-2
Author(s):  
Haresh G. Memariya ◽  
Rajnish R. Patel ◽  
Hitendra K. Desai ◽  
Rajesh K. Patel ◽  
Deep N. Patel ◽  
...  
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Percutaneous Drainage ◽  
Treatment Effectiveness ◽  
Needle Aspiration ◽  
Percutaneous Catheter Drainage ◽  
Common Disease ◽  
Catheter Drainage ◽  
Duration Of Hospital Stay ◽  
Percutaneous Catheter

Modern management of liver abcess include a combination of percutaneous Needle aspiration or percutaneous Catherter drainage along with intravenous antibiotic .Liver abcess is common disease in india, if not treated properly can lead to hazardous complication. MATERIAL AND METHOD; This was comparative study of 30 patient from august 2018 to August2020 in civil hospital ahmedabad. Randomization was done and dived into two groups of 25 each and assigned two group as percutaneous Catherter drainage and needle aspiration. Both groups were given intravenous antibiotics for 7 days .Both modalities were performed under guidance of ultrasound imaging. Needle aspiration was repeated for three times and if size of abcess cavity not reduced to half consider as failure of treatment. Effectiveness of treatment measured in term of days to achieve clinical improvement, total/near total resolution of abcess cavity and duration of hospital stay. RESULT; Needle aspiration was successful in 13 out of 15,whereas percutaneous drainage was successful in 14 out of 15.Duration of hospital stay were significantly lower in percutaneous drainage.one patient with needle aspiration developed subcapsular hematoma. CONCLUSION; We can conclude that percutaneous drainage is better modality is better modality as compared to needle aspiration in medium to large size liver abcess. The duration of hospital stay is comparatively lower in percutaneous drainage and days of clinical relief were earlier in percutaneous drainage. This study also verify that both were adequately effective in the treatment of liver abcess. *AIM OF THE STUDY To compare the effectiveness of percutaneous catheter drainage and percutaneous needle aspiration in management of liver abcess.

scholarly journals The healthcare costs of antimicrobial resistance in Lebanon: a multi-centre prospective cohort study from the payer perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katia Iskandar ◽  
Christine Roques ◽  
Souheil Hallit ◽  
Rola Husni-Samaha ◽  
Natalia Dirani ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antimicrobial Resistance ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Prospective Cohort ◽  
Healthcare Costs ◽  
Hospital Charges ◽  
Resistant Bacteria ◽  
Matched Cohort ◽  
Payer Perspective

Abstract Background Our aim was to examine whether the length of stay, hospital charges and in-hospital mortality attributable to healthcare- and community-associated infections due to antimicrobial-resistant bacteria were higher compared with those due to susceptible bacteria in the Lebanese healthcare settings using different methodology of analysis from the payer perspective . Methods We performed a multi-centre prospective cohort study in ten hospitals across Lebanon. The sample size consisted of 1289 patients with documented healthcare-associated infection (HAI) or community-associated infection (CAI). We conducted three separate analysis to adjust for confounders and time-dependent bias: (1) Post-HAIs in which we included the excess LOS and hospital charges incurred after infection and (2) Matched cohort, in which we matched the patients based on propensity score estimates (3) The conventional method, in which we considered the entire hospital stay and allocated charges attributable to CAI. The linear regression models accounted for multiple confounders. Results HAIs and CAIs with resistant versus susceptible bacteria were associated with a significant excess length of hospital stay (2.69 days [95% CI,1.5–3.9]; p < 0.001) and (2.2 days [95% CI,1.2–3.3]; p < 0.001) and resulted in additional hospital charges ($1807 [95% CI, 1046–2569]; p < 0.001) and ($889 [95% CI, 378–1400]; p = 0.001) respectively. Compared with the post-HAIs analysis, the matched cohort method showed a reduction by 26 and 13% in hospital charges and LOS estimates respectively. Infections with resistant bacteria did not decrease the time to in-hospital mortality, for both healthcare- or community-associated infections. Resistant cases in the post-HAIs analysis showed a significantly higher risk of in-hospital mortality (odds ratio, 0.517 [95% CI, 0.327–0.820]; p = 0.05). Conclusion This is the first nationwide study that quantifies the healthcare costs of antimicrobial resistance in Lebanon. For cases with HAIs, matched cohort analysis showed more conservative estimates compared with post-HAIs method. The differences in estimates highlight the need for a unified methodology to estimate the burden of antimicrobial resistance in order to accurately advise health policy makers and prioritize resources expenditure.

scholarly journals Clinical outcomes of colistin in combination with either 6-g sulbactam or carbapenems for the treatment of extensively drug-resistant Acinetobacter baumannii pneumonia with high MIC to sulbactam, a prospective cohort study

2019 ◽  
Author(s):  
Chutchawan Ungthammakhun ◽  
Vasin Vasikasin ◽  
Dhitiwat Changpradub
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Mortality Rates ◽  
P Value ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Abstract Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) is an important cause of nosocomial pneumonia with limited therapeutic options. Colistin based regimen is recommended treatment. Which drugs should be combined with colistin remains uncertain. The aim of this study was to investigate the clinical outcomes of patients with XDRAB pneumonia who were treated with colistin, combined with either 6-g sulbactam or carbapenems, in the setting of high MIC to sulbactam. Methods: In this prospective cohort study, hospitalized patients diagnosed with XDRAB pneumonia in Phramongkutklao Hospital were enrolled. The primary outcome was the 28-day mortality. Secondary outcomes were 7 and 14-day mortality, length of stay, ventilator days and factors associated with mortality. Results: From 1 July 2016 to 30 September 2017, 192 patients were included; 92 received colistin plus sulbactam and 90 received colistin plus carbapenems. Most of the patients were male diagnosed with ventilator associated pneumonia in medical intensive care unit. Overall mortality rates at 7, 14, 28 days were 24.2%, 37.4%, 53.3%, respectively. Mortality rates did not differ between sulbactam group and carbapenems groups at 7 days (19.6% vs. 28.9%, p-value 0.424, adjusted HR 1.277; 95% CI = 0.702-2.322), 14 days (34.8% vs. 40%, p = 0.658, adjusted HR 1.109; 95% CI = 0.703-1.749) and 28 days (51.1% vs. 55.6%, p = 0.857, adjusted HR 1.038; 95% CI = 0.690-1.562). Length of stay, ICU days and ventilator days did not differ. Complications of treatment including acute kidney injury were not statistically different. Conclusions: In XDRAB pneumonia with high MIC to sulbactam, mortality rates were not statistically significant between colistin plus 6-g sulbactam and colistin plus carbapenems. Keywords: XDR A. baumannii pneumonia, mortality rate, colistin based, sulbactam, carbapenems

Preventable hospitalizations among older patients with cognitive impairments and dementia

2018 ◽  
Vol 31 (3) ◽  
pp. 383-391 ◽  
Author(s):  
Dominik Wolf ◽  
Carolin Rhein ◽  
Katharina Geschke ◽  
Andreas Fellgiebel
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Ambulatory Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Older Patients ◽  
Hospital Admissions ◽  
Cognitive Impairments ◽  
Length Of Hospital Stay ◽  
Complication Rates

ABSTRACTObjectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

Gestational metabolic syndrome and neonatal anthropometric indices: a prospective cohort study

2021 ◽  
Vol 29 (7) ◽  
pp. 386-391
Author(s):  
Zeinab Hatamian ◽  
Lida Moghaddam-Banaem ◽  
Samira Mokhlesi ◽  
Marzieh Saei Ghare Naz
Keyword(s):  
Metabolic Syndrome ◽  
Cohort Study ◽  
Birth Weight ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Linear Regression Analysis ◽  
First Trimester ◽  
P Value ◽  
Anthropometric Parameters ◽  
First Trimester Of Pregnancy

Background and aim There is limited knowledge about the effect of maternal metabolic syndrome (MetS) on the anthropometric parameters of newborns. Therefore, the authors aimed to evaluate the association between MetS in the first trimester of pregnancy with weight and height of the newborn. Methods This prospective cohort study was conducted on 455 pregnant women in Tehran during their first trimester of pregnancy. MetS was defined as the coexistence of three or more of the following criteria: fasting blood sugar (FBS) level ≥92 mg/dl, blood pressure ≥130.85 mm/hg, triglyceride ≥150 mg/dl, high density lipoprotein ≤50 mg/dl, and body mass index (BMI) ≥30 kg/m2. All participants were followed up to childbirth. After birth, the baby's weight and height data were collected from the birth certificate. Results Linear regression analysis showed FBS (ß: 0.100, p-value: 0.038), BMI (ß: 0.139, p-value: 0.004), and MetS (ß: -0.122, p-value: 0.015) were significantly associated with birth weight but no statistically significant results were found for birth height. Conclusion MetS and some of its components in pregnancy can affect birth weight of neonates.

scholarly journals Prevalence and clinical predictors for early post-operative urinary retention in patients undergoing pelvic reconstructive surgeries: a prospective cohort study

2018 ◽  
Vol 7 (4) ◽  
pp. 1452
Author(s):  
Annie P. Vijjeswarapu ◽  
Vaibhav Londhe ◽  
Mahasampath Gowri ◽  
Aruna Kekre ◽  
Nitin Kekre
Keyword(s):  
Cohort Study ◽  
Pelvic Organ Prolapse ◽  
Urinary Retention ◽  
Prospective Cohort Study ◽  
Reconstructive Surgery ◽  
Prospective Cohort ◽  
Pelvic Organ ◽  
P Value ◽  
Pelvic Reconstructive Surgery ◽  
Clinical Predictors

Background: Pelvic organ prolapse (POP) has a significant impact on quality of life. Post-operative voiding dysfunction is seen in 2.5 to 24% of patients following pelvic reconstructive surgery. Risk factors like age of the patient, size of the genital hiatus and stage of prolapse are known to be associated with early post-operative voiding disorders.Methods: This is a prospective cohort study done in Christian Medical College, Vellore over one year. Patients with stage II to IV pelvic organ prolapse who underwent pelvic reconstructive surgery were observed post operatively for covert and overt urinary retention. Inability to void accompanied by pain and discomfort is defined as overt retention. Early post-operative urinary retention (POUR) is retention of urine in the first 72 hours postoperatively. Covert retention is defined as a non-painful bladder with chronic high post void residue. Chi- square test or Fisher’s exact test was used to assess the association between the clinical predictors and early post-operative urinary retention in univariate analysis.Results: In this study, 75 patients were recruited. Nine patients had POUR. Among the patients who had post-operative urinary retention, 77.78% had stage III pelvic organ prolapse (n=7). P value was 0.042. The prevalence of early POUR after pelvic reconstructive surgery was 12.85 % (n=9). A 55.55% had covert retention (n=5) and 44.44% patients had overt retention (n=4).Conclusions: The prevalence of early POUR after pelvic reconstructive surgery was 12.85%. Stage of the prolapse was an independent predictor for early postoperative urinary retention.

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