scholarly journals Management of Septic Arthritis in Emergency Department

2021 ◽  
pp. 235-241
Author(s):  
Mohammed H. Abushal ◽  
Yazeed Ali S. Albalawi ◽  
Muflih Abdullah S. Albalawi ◽  
AlTurki Abdulrahman Mohammed ◽  
Amal Sulaiman A. Albalawi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Arthritis ◽  
Joint Destruction ◽  
Beta Lactams ◽  
Bacterial Arthritis ◽  
Irreversible Damage ◽  
Laboratory Findings ◽  
Restricted Mobility ◽  
Careful Assessment ◽  
Infectious Etiology

Bacterial arthritis is an inflammation of the joints caused by an infectious etiology, usually bacterial, but there are also fungi, mycobacteria, viruses, or other rare pathogens. Both healthy and predisposed people can be infected. Nongonococcal infectious arthritis, usually a monoarticular disease,  affects multiple joints in about 10% of patients and  is a new form of septic arthritis. Without treatment, it can progress rapidly and cause irreversible damage to the joints. The overall incidence of bacterial arthritis  is  2 to 6  per 100,000, depending on the presence of risk factors. Bacterial arthritis is more common in children than in adults. The incidence of septic arthritis peaks between the ages of 2 and 3  and is predominantly male (2: 1). Most septic joints develop as a result of hematogenous dissemination of the vascular synovium due to bacterial episodes. Osteoarthritis, rheumatoid arthritis, and corticosteroid therapy are the most common predisposing conditions. Typical symptoms of acute  septic arthritis without gonorrhea include recent  fever, malaise, and local findings of pain, warmth, swelling, and restricted mobility of the affected joint. Accurate history and assessment of risk factors can provide important clues for diagnosis. Careful assessment of risk factors can significantly change the likelihood of a provider developing septic arthritis prior to testing. Laboratory findings, diagnostic imaging, and synovial fluid assessment are all useful for diagnosis. Management components include early detection and treatment with joint aspiration, antibiotics, and orthopedic advice for possible surgical management. Widespread antibiotics are often needed due to the potential for rapid joint destruction. A combination of cefepime or anti-Pseudomonas aeruginosa beta-lactams and vancomycin is recommended to cover both Gram-negative and MRSA bacteria.

scholarly journals Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?

2021 ◽  
Vol 9 (7) ◽  
pp. 1505
Author(s):  
Claire Roger ◽  
Benjamin Louart
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Convulsive Status Epilepticus ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Drug Induced ◽  
Icu Patients

Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10–15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.

scholarly journals Comparison of Risk Factors in Patients with Normal Arteries and Coronary Disease After Infarction

1977 ◽  
Author(s):  
S. K. Durairaj ◽  
A. H. Khan ◽  
L. J. Haywood
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
At Risk ◽  
Coronary Artery ◽  
Mexican American ◽  
Acute Attack ◽  
Similar Distribution ◽  
Laboratory Findings ◽  
High Prevalence ◽  
Artery Disease

Risk factors were compared in 42 patients (pts) with coronary artery disease (CAD) and 18 with radiographically patent arteries (RPA) on angiography performed three weeks to six months after documented myocardial infarction (Ml). All pts had typical clinical and laboratory findings during the acute attack. All pts were below age 50 and both groups had a similar distribution of racial background (Caucasian, black and Mexican-American). Psychiatric problems were not more frequent in either group. The data demonstrated a high prevalence of standard risk factors in the CAD group for hypertension (28 of 42 = 67%), hypercholesterolemia (25 of 42 = 60%) and smoking (17 of 42 = 64%), and similarly high prevalence of smoking (16 of 18 = 89%), heavy labor (12 of 18 = 61%) and obesity (9 of 18 = 50%) in the RPA group. Factors significantly more common in the CAD group as compared to the RPA group by the Chi Square test were:Hypertension (P < 0.001), hypercholesterolemia (P < 0.001), diabetes (P < 0.001), and family history (P < 0.05). Factors more common in the RPA group were heavy alcohol consumption (P < 0.001), smoking (P < 0.05), heavy laborer occupation (P < 0.001) and obesity (P < 0.001). The data suggest that risk factor screening would identify individuals at risk from coronary artery disease but would be unreliable in identifying individuals at risk for MI with RPA. Further study is indicated to determine what factors operate to produce ischemia and infarction in the RPA group of pts.

Educating medical professionals about suicide prevention among military veterans

2013 ◽  
Vol 25 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Debora Ganz ◽  
Leo Sher
Keyword(s):  
Risk Factors ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Medical Professionals ◽  
Major Depressive ◽  
Physical Injuries ◽  
Assessment Techniques ◽  
Psychosocial Difficulties ◽  
Military Veteran ◽  
Careful Assessment

Abstract The aim of this paper was to discuss the results of a review of literature related to suicide in military veteran populations. Suicide in veteran populations has been increasing in recent years, and continues to be a medical and social problem across the globe. For medical health professionals, knowledge of the risk factors for suicide, careful assessment, and appropriate interventions are key to suicide prevention. The main aim of this review is to better understand the risk factors present in veteran suicide and find ways by which to educate medical professionals in suicide prevention. Key suicide risk factors found in veteran populations include posttraumatic stress disorder, major depressive disorder, physical injuries, substance use disorders, traumatic brain injury, combat-related guilt, access to firearms, and insufficient social support. Some psychosocial difficulties are unique to veteran populations, and medical professionals should be culturally sensitive to these factors. Psychosocial changes upon discharge from active duty, as well as stigma against mental health disorders and treatment, should also be considered and assessed. Given that general practitioners may be the first line of defense for these veterans, they should be educated in risk factors for veteran suicide and proper assessment techniques. Any suicide risk in a veteran population should be taken very seriously, and responded to appropriately.

scholarly journals Comparison of clinical features of pulmonary cryptococcosis with and without central nervous system involvement in China

2021 ◽  
Vol 49 (2) ◽  
pp. ???
Author(s):  
Xinying Xue ◽  
Xuelei Zang ◽  
Lifeng Wang ◽  
Dongliang Lin ◽  
Tianjiao Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Features ◽  
Central Nervous System Involvement ◽  
Pulmonary Cryptococcosis ◽  
Cns Involvement ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Presenting Symptoms

Objective This study aimed to compare the clinical features of pulmonary cryptococcosis (PC) in patients with and without central nervous system (CNS) involvement. Methods We retrospectively reviewed demographics, presenting symptoms, radiographic features, and laboratory findings of patients diagnosed with PC in 28 hospitals from 2010 to 2019. Risk factors for CNS involvement were analyzed using logistic regression models. Result A total of 440 patients were included, and 36 (8.2%) had CNS involvement. Significant differences in fever, headache, and chills occurred between the two groups (overall and with/without CNS involvement) for fever (17.8% [78/440]; 52.8% vs. 14.6% of patients, respectively), headache (4.5% [20/440]; 55.6% vs. 0% of patients, respectively), and chills (4.3% [19/440]; 13.9% vs. 3.5% of patients, respectively). The common imaging manifestation was nodules (66.4%). Multivariate analysis showed that cavitation (adjusted odds ratio [AOR] = 3.552), fever (AOR = 4.182), and headache were risk factors for CNS involvement. Routine blood tests showed no differences between the groups, whereas in cerebrospinal fluid the white blood cell count increased significantly and glucose decreased significantly. Conclusion In patients with PC, the risk of CNS involvement increases in patients with headache, fever, and cavitation; these unique clinical features may be helpful in the diagnosis.

scholarly journals Influence of sexually transmitted infections in a horse breeding

2015 ◽  
Vol 69 (5-6) ◽  
pp. 443-452
Author(s):  
Marjan Kosec ◽  
Natasa Sterbenc ◽  
Janko Mrkun ◽  
Igor Klobucar ◽  
Primoz Klinc
Keyword(s):  
Risk Factors ◽  
Sexually Transmitted Diseases ◽  
Artificial Insemination ◽  
Clinical Picture ◽  
Preventive Measures ◽  
Sexually Transmitted ◽  
Direct Damage ◽  
Horse Breeding ◽  
Common Causes ◽  
Infectious Etiology

The most frequent problems in horses reproduction are generally divided into those of infectious and non infectious etiology. Common causes of infectious diseases are usual?ly viruses and bacteria, and less frequently protozoa, mykoplasma and fungi. In this work there are presented the most important fact about sexually transmitted diseases, their clinical picture, risk factors, preventive measures as well as measures to prevent and eradicate the diseases. The biggest risk factor for sexually transmitted diseases in horses are breeding stallions, both in natural mating and in artificial insemination. Therefore, in order to prevent genital infections in horses, it is essential that the stallions used for breeding are healthy (non-infected). That can be determined with certainty only if the stallions are examined (tested) just before the breeding season on most frequent sexually transmitted diseases (CEM,EAV). It is well known that in most cases the clinical picture of sexually transmitted diseses is not manifested on genitals. As well, variations in clinical picture can be expected also in mares, depending on the stage of the disease and its etiology. Harms arising from sexually transmitted diseases can be divided into direct and indirect. Direct damage occurs in the form of endometritis, miscarriage, stillbirths and births of weak foals, and indirect in restricting the traffic of infected and suspicios animals, isolation of the infected ones as well as medical treatment and interrupting mating.

scholarly journals Preoperative risk factors of malnutrition for cardiac surgery patients

2016 ◽  
Vol 23 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Donata Ringaitienė ◽  
Dalia Gineitytė ◽  
Vaidas Vicka ◽  
Tadas Žvirblis ◽  
Jūratė Šipylaitė ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Preoperative Risk ◽  
Related Factors ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Preoperative Risk Factors ◽  
Valve Pathology

Background. Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients. Materials and methods. The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models. Results. A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416–6.668, p = 0.007), valve pathology (OR: 1.825, CI95%: 1.182–2.819, p = 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995–8.389, p 

scholarly journals 64-year-old male with septic arthritis of the pubic symphysis

2011 ◽  
Vol 1 (3) ◽  
pp. 76 ◽  
Author(s):  
Ewa Konik ◽  
Brent Bauer ◽  
Mark Lee
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Septic Arthritis ◽  
Groin Pain ◽  
Pubic Symphysis ◽  
Pelvic Malignancy ◽  
Incontinence Surgery ◽  
Streptococcus Anginosus ◽  
Hip Motion

Septic arthritis of the pubic symphysis is a rare disease. Typical clinical features include fever, pubic or groin pain, pain with hip motion, and painful or waddling gait. Identified predisposing factors to develop an infection in pubic joint include female incontinence surgery or postpartum period; sports, especially soccer; pelvic malignancy; and intravenous drug abuse. The most often identified microorganisms were Staphylococcus aureus and Pseudomonas aeruginosa. Osteomyelitis complicates the majority of cases, and about half of the patients require surgical debridement along with a prolonged antibiotic treatment. We report a case of Streptococcus anginosus septic arthritis of the pubic symphysis. The patient did not have any of the above risk factors.

scholarly journals The Incidence, Risk Factors, Predictors, and Prognoses of Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

2021 ◽  
Author(s):  
Zhihui Zhang ◽  
Xuesong Liu ◽  
Ling Sang ◽  
Sibei Chen ◽  
Zhan Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Area Under The Curve ◽  
University Hospital ◽  
Laboratory Findings ◽  
Cytomegalovirus Reactivation ◽  
Cmv Reactivation ◽  
Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation can seriously affect the clinical prognoses of critically ill patients. However, the epidemiology and predictors of CMV in immunocompetent patients with mechanical ventilation are not very clear. Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with mechanical ventilation at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week until 28 days (Day1, 7, 14, 21, 28) and serology, laboratory findings, and clinical data were obtained at admission.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within ICU 28-day admission. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body weight, body mass index (BMI), sepsis, NT-proBNP, BUN, and Hb levels (P< 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were associated with CMV reactivation patients (P< 0.05). Moreover, the area under the curve (AUC) of BMI, Hb and BMI combined Hb was 0.69, 0.70, 0.76, respectively. The rate of complications, duration of mechanical ventilation, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P< 0.05).Conclusions: Among immunocompetent patients with mechanical ventilation, the incidence of CMV reactivation was high. CMV reactivation can lead to various adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

Clinical and Epidemiological Features of Acute Zika Virus Infections in León, Nicaragua

2021 ◽  
Author(s):  
Natalie M. Bowman ◽  
Filemón Bucardo ◽  
Matthew H. Collins ◽  
Yaoska Reyes ◽  
Edwing Centeno Cuadra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sore Throat ◽  
Zika Virus ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Maculopapular Rash ◽  
Laboratory Diagnosis ◽  
Zikv Infection ◽  
Serological Tests ◽  
Laboratory Findings

The American Zika virus (ZIKV) epidemic has highlighted the need to gain a better understanding of this emerging virus. The goal of this study was to describe the clinical symptoms, laboratory findings, and risk factors for symptomatic ZIKV infection in an area with ongoing transmission of other arboviral infections. We recruited patients at least 2 years of age seeking care at public health centers in León, Nicaragua, between January 2016 and August 2017, for fever, maculopapular rash, and/or nonsuppurative conjunctivitis with a duration of less than 1 week. A laboratory diagnosis of ZIKV was established using a combination of molecular and serological tests. Clinical and laboratory findings and potential risk factors were compared between participants with and without acute ZIKV infection. Fifty-eight (26%) of the 225 participants included in the analysis were found to have acute ZIKV infection. Pregnancy and reports of previous arboviral infection were associated with a higher risk of ZIKV infection. Rash, conjunctivitis, sore throat, and lower absolute neutrophil counts were associated with acute ZIKV infection. The clinical characteristics and risk factors identified were consistent with those identified by previous studies; however, we found sore throat to be a feature of ZIKV infection. We also found that neutrophil counts were lower in ZIKV-infected subjects. These clinical symptoms and laboratory data may help clinicians suspect ZIKV infection during future outbreaks.

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