Fournier’s gangrene: 15-year retrospective study at a tertiary hospital
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PROVIDER: S-EPMC11020226 | biostudies-literature | 2024 Apr
REPOSITORIES: biostudies-literature
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Project description:IntroductionTreatment failure (TF) in HIV infected children is a major concern in resource-constrained settings in Sub-Saharan Africa (SSA). This study investigated the prevalence, incidence, and factors associated with first-line cART failure using the virologic (plasma viral load), immunologic and clinical criteria among HIV-infected children.MethodsA retrospective cohort study of children (<18 years of age on treatment for a period of > 6 months) enrolled in the pediatric HIV/AIDs treatment program at Orotta National Pediatric Referral Hospital from January 2005 to December 2020 was conducted. Data were summarized using percentages, medians (± interquartile range (IQR)), or mean ± standard deviation (SD). Where appropriate, Pearson Chi-Squire (χ2) tests or Fishers exacts test, Kaplan-Meier (KM) estimates, and unadjusted and adjusted Cox-proportional hazard regression models were employed.ResultsOut of 724 children with at least 24 weeks' follow-up 279 experienced therapy failure (TF) making prevalence of 38.5% (95% CI 35-42.2) over a median follow-up of 72 months (IQR, 49-112 months), with a crude incidence of failure of 6.5 events per 100- person-years (95% CI 5.8-7.3). In the adjusted Cox proportional hazards model, independent factors of TF were suboptimal adherence (Adjusted Hazard Ratio (aHR) = 2.9, 95% CI 2.2-3.9, p < 0.001), cART backbone other than Zidovudine and Lamivudine (aHR = 1.6, 95% CI 1.1-2.2, p = 0.01), severe immunosuppression (aHR = 1.5, 95% CI 1-2.4, p = 0.04), wasting or weight for height z-score < -2 (aHR = 1.5, 95% CI 1.1-2.1, p = 0.02), late cART initiation calendar years (aHR = 1.15, 95% CI 1.1-1.3, p < 0.001), and older age at cART initiation (aHR = 1.01, 95% CI 1-1.02, p < 0.001).ConclusionsSeven in one hundred children on first-line cART are likely to develop TF every year. To address this problem, access to viral load tests, adherence support, integration nutritional care into the clinic, and research on factors associated with suboptimal adherence should be prioritized.
| S-EPMC9997912 | biostudies-literature
Project description:BackgroundThe current Italian scenario of pediatric palliative care (PPC) services is characterized by inadequate coverage of the territory. Therefore, it is important to improve the referral of patients to the most appropriate setting (community care, general PPC, or specialized PPC) and to improve the delivery of PPC care.MethodsAiming at obtaining information about the referrals to the Padua Pediatric Hospice that could help estimate the investments needed to improve the provision of care, a retrospective analysis has been carried out. The rate of proper referral and discharge, the number of patients followed at the hospice, the mortality rate, and the length of follow-up were analyzed, and, when possible, data were stratified by oncological and non-oncological diseases.ResultsThe analysis showed that of the 870 patients referred to the Padua Pediatric Hospice between 2008 and 2022, 76% were affected by non-oncological conditions. 82% of patients referred were taken in charge and most of the remaining patients have been inappropriately referred. The analysis showed a growing number of total referrals, which increased by 195% from 2008 to 2022. An increase in proper referrals and referrals of non-oncological patients was observed alongside a decrease in oncological patient referrals and a trend toward a decrease in discharge rates. A decreased mortality was observed in patients with non-oncological conditions, with only 6% of deceased patients in 2022. Moreover, a longer survival with a median follow-up length of 43 months was observed among patients with non-oncological conditions who were followed up at the Padua Pediatric Hospice for more than 12 months. Conversely, the short survival rate observed for oncological patients suggests that those patients should have been referred to PPC earlier to benefit from palliative care for longer periods.ConclusionsConsidering these data, it is expected that the number of patients needing PPC services will steadily increase in the next years. Hence, there is a need to invest resources to provide the best care delivery model encompassing specific pathways for the transition into adulthood, the establishment of networks within all the Italian regions, and an efficient referral to the more suitable setting of care.
| S-EPMC11301942 | biostudies-literature
Project description:IntroductionAntimicrobial resistance is a significant global health concern, particularly in western Sub-Saharan Africa. This study describes causes of bloodstream infections and antimicrobial resistance at a tertiary hospital in The Gambia.MethodsThis retrospective analysis included all blood cultures performed at the Edward Francis Small Teaching Hospital, Banjul, The Gambia, from September 2022 to August 2023. Blood culture positivity-rates and pathogens were described. Antimicrobial susceptibility testing was performed using disk diffusion following the Clinical & Laboratory Standards Institute guidelines.ResultsA total of 645 patients had blood cultures drawn during the study period with 260 (40%) positive results. Contaminants were identified in 28 cases (4%). The majority were drawn from neonatal or paediatric patients (360/645, 56%) and overall primarily in intensive care units (406/645, 63%). The median age was 3 years (interquartile range 0-31 years) and 46% were female. The most common pathogens were Staphylococcus aureus 106/260 (41%), Klebsiella spp. 41/260 (16%), other bacteria within the Enterobacterales order 33/260 (13%), Pseudomonas spp. 22/260 (8%) and Acinetobacter spp. 19/260 (7%). Methicillin-resistant S. aureus (MRSA) was seen in 34/58 (59%) tested. Extended-spectrum beta-lactamases (ESBL) were seen in 36/40 (90%) of Klebsiella spp. and in 16/28 (57%) of other bacteria within the Enterobacterales order. Acquired antibiotic resistance, beyond wild-type, was reported in 17/20 (85%) of Pseudomonas spp. and 16/19 (84%) of Acinetobacter spp.ConclusionOverall, blood culture positivity rates were high, indicating restrictive testing suggesting that sample collection were restricted to mainly critically ill, neonatal or paediatric patients. Nonetheless, our data suggests a high proportion of bloodstream infections due to multi-drug resistant pathogens, including MRSA and ESBL-Enterobacterales. Importantly, generalisability of findings beyond this tertiary hospital setting remains restricted. However, our findings demonstrate a need for improved diagnostic stewardship and ongoing surveillance to provide robust evidence-based data to inform antimicrobial resistance interventions.
| S-EPMC11800432 | biostudies-literature
Project description:Extensive research has been carried out on the comparative effectiveness of antipsychotic medications. Most studies, however, have been performed in Western countries. The purpose of this study was to compare the effectiveness, indicated by time to any-cause discontinuation, of antipsychotic drugs in a large number of patients with schizophrenia in South Korea. We identified 1458 patients with schizophrenia or schizophreniform disorder who were treated with antipsychotic medications using a clinical data warehouse at the Seoul National University Hospital between March 2005 and February 2014. Kaplan-Meier survival analyses were used to estimate the time to discontinuation of antipsychotic drugs. We compared the survival curves of different antipsychotics using log-rank tests. Overall, the median time to discontinuation for any cause was 133 days (95% CI, 126-147). The longest time to discontinuation was observed for clozapine, followed by aripiprazole, paliperidone, olanzapine, amisulpride, risperidone, quetiapine, ziprasidone, and haloperidol. Specifically, clozapine was significantly different from all other antipsychotic drugs (all p < 0.001). Aripiprazole also had a significantly longer time to discontinuation than amisulpride (p = 0.001), risperidone (p < 0.001), quetiapine (p < 0.001), ziprasidone (p < 0.001), and haloperidol (p < 0.001). In Asian patients with schizophrenia, clozapine was the most effective antipsychotic in terms of time to discontinuation, followed by aripiprazole. This study extends the findings of previous effectiveness studies from Western populations and suggests the need to develop guidelines for the pharmacotherapy of schizophrenia tailored to Asian individuals.
| S-EPMC7677553 | biostudies-literature
Project description:ObjectiveTo describe the demographics and outcomes of sports-related ocular injuries in an Australian tertiary eye hospital setting.MethodsRetrospective descriptive study from the Royal Victorian Eye and Ear Hospital from 2015 to 2020. Patient demographics, diagnosis and injury causation were recorded from baseline and follow-up. Outcomes included visual acuity (VA), intraocular pressure (IOP), ocular injury diagnosis, investigations and management performed.ResultsA total of 1793 individuals (mean age 28.67 ± 15.65 years; 80.42% males and 19.58% females) presented with sports-related ocular trauma. The top three injury-causing sports were soccer (n = 327, 18.24%), Australian rules football (AFL) (n = 306, 17.07%) and basketball (n = 215, 11.99%). The top injury mechanisms were projectile (n = 976, 54.43%) and incidental body contact (n = 506, 28.22%). The most frequent diagnosis was traumatic hyphaema (n = 725). Best documented VA was ≥6/12 at baseline in 84.8% and at follow-up in 95.0% of cases. The greatest risk of globe rupture/penetration was associated with martial arts (odds ratio [OR] 16.22); orbital blow-out fracture with skiing (OR 14.42); and hyphaema with squash (OR 4.18): P < 0.05 for all. Topical steroids were the most common treatment (n = 693, 38.7%). Computed tomography orbits/facial bones were the most common investigation (n = 184, 10.3%). The mean IOP was 16.1 mmHg; 103 (5.7%) cases required topical anti-ocular hypertensives. Twenty-six individuals (1.45%) required surgery with AFL contributing the most surgical cases (n = 5, 19.23%).ConclusionThe top three ocular injury causing sports were soccer, AFL and basketball. The most frequent injury was traumatic hyphaema. Projectiles posed the greatest risk.
| S-EPMC9790689 | biostudies-literature
Project description:Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalisation. There was previously a dearth of studies exploring the incidence, risk factors and outcome of AP in the Caribbean region.All patients with a diagnosis of AP admitted to the University Hospital of the West Indies (UHWI) between 2006 and 2012 were reviewed. The epidemiological profile, risk factors, clinical presentation and outcomes of patients with AP were retrospectively studied.There were 70 females and 21 males with a median age of 44 years (range 2-86). The median age of males was significantly higher than that of females (p = 0.041). The incidence of AP was 74 per 100,000 admissions per year. Vomiting and abdominal tenderness were noted in the majority of patients. The most common aetiology was biliary disease (71.4%), idiopathic (12%), post-ERCP (6.6%) and alcohol (5.5%). Alcoholic pancreatitis was only seen in males whereas idiopathic and post-ERCP pancreatitis only occurred in females. The mean duration of hospitalisation was 9.51 ± 8.28 days. Disease severity was mild in 61.1%, moderately severe in 26.7%, and severe in 12.2% of patients. Factors associated with more severe disease included overweight/obesity, idiopathic aetiology and post-ERCP status. The case fatality rate was 2%.The incidence of AP was 74/100,000 hospital admissions annually. There was an unusual female preponderance, with biliary pancreatitis being the most common type occurring at an equal frequency among males and females. Only 12.2% of the total cases seen were severe. The case fatality rate was 2%. Local health policy should target timely interventions for biliary pancreatitis and should also address the local factors affecting disease severity.
| S-EPMC5537196 | biostudies-other
Project description:Background: Kikuchi-Fujimoto disease (KFD) is a rare, benign condition of unknown etiology, presenting as cervical lymphadenitis. Lymphadenopathy is usually tender and maybe associated with systemic symptoms. Despite the extensive literature on this disease, it continues to be misdiagnosed owing to its misleading clinical presentation.MethodsA retrospective hospital-based descriptive cross-sectional study was conducted in tertiary care hospitals from 2011 to 2019. All patients with confirmed KFD diagnosis were included and after ethics committee approval the clinical details and histopathological data was retrieved from the medical records department and analyzed.ResultsA total of 67 cases were included. The mean age was 26.9±11.3 years with a female: male ratio of 1.9:1. There were 50 patients with tender cervical lymphadenopathy which was the most common clinical presentation. The mean length and width of palpable lymph nodes were 2.3±1.0 cm and 2.2±0.7 cm respectively. Histology revealed proliferative stage in majority of patients ( n=40, 59.7%). Lymphadenopathy resolved in 83.6% within 2 months. There were 42 patients who had complete recovery with symptomatic treatment within a period of 9 months.ConclusionsKFD is prevalent in young, female patients of Asian descent and often presents as tender cervical lymphadenopathy. Early diagnosis with excisional lymph node biopsy is crucial to avoid unnecessary investigations and treatment. Treatment is symptomatic unless complicated, where steroid therapy is considered. KFD has an excellent prognosis with almost no risk of fatality.
| S-EPMC9226704 | biostudies-literature
Project description:To describe the epidemiology of sport-related open fractures from one centre's adult patient population over a 15-year period.A retrospective review of a prospectively-collected database was performed: The database contained information all sport-related open fractures, sustained from 1995 to 2009 in the Edinburgh, Mid and East Lothian Populations.Over the 15-year period, there were 85 fractures recorded in 84 patients. The annual incidence of open sport-related fractures was 0.01 per 1000 population. The mean age at injury was 29.2 years (range 15-67). There were 70 (83%) males and 14 females (17%). The 6 most common sports were soccer (n = 19, 22%), rugby (n = 9, 11%), cycling (n = 8, 9%), hockey (n = 8, 9%); horse riding (n = 6, 7%) and skiing (n = 6, 7%). The five most common anatomical locations were finger phalanges (n = 30, 35%); tibial diaphysis (n = 19, 23%); forearm (n = 12, 14%); ankle (n = 7, 8%) and metacarpals (n = 5, 6%). The mean injury severity score was 7.02. According to the Gustilo-Anderson classification system, 45 (53%) fractures were grade 1; 28 (33%) fractures were grade 2; 8 (9%) fractures were grade 3a; and 4 (5%) fractures were grade 3b. Out of the total number of fractures, 7 (8%) required plastic surgical intervention as part of management. The types of flaps used were split skin graft (n = 4), fasciocutaneous flaps (n = 2); and adipofascial flap (n = 1).We analysed the epidemiology of open fractures secondary to sport in one centre over a 15-year period. Soccer and rugby were the most common causative sports while fractures of the finger phalanx and of the tibial diaphysis were the most common sites. Open fractures are uncommon in sport; however, when they are sustained they usually occur on muddy sport fields or forest tracks and therefore must be treated appropriately. It is important that clinicians and sports therapists have knowledge of these injuries, in order to ensure they are managed optimally.
| S-EPMC5534403 | biostudies-other
Project description:IntroductionSelf-harm represents a complex and multifaceted public health issue of global significance, exerting profound effects on individuals and communities alike. It involves intentional self-poisoning or self-injury with or without the motivation to die. Although self-harm is highly prevalent, limited research has focused on the patterns and trends of self-harm among hospital populations in low- and middle-income countries, particularly within Africa. This study aims to explore the socio-demographic and clinical profile of patients presenting with self-harm and determine the common self-harm patterns at a tertiary facility in Kenya.MethodologyWe carried out a descriptive retrospective study and included patients from inpatient units and outpatient settings within the Secion of Psychiatry at the Aga Khan University Hospital, Nairobi from January 1st 2018 to December 31st 2022. A data abstraction tool was used to collect data from eligible files sourced from the medical records department for all patients who met the study criteria. Summary statistics were reported as frequencies and percentages for categorical data and as means and standard deviations for continuous data.ResultsA total of 507 files were reviewed in the given timeframe and 497 patients were included in the analysis. Of these patients, 28.1% (n = 144) presented with self-harm. The mean age of the self-harm patients was 26.5 years (SD = 10.5) and a majority (74.3%) were female. The first point-of-contact was at the emergency department in 72.9% of the cases. A majority of them, i.e. 89.6%, reported a past psychiatric diagnosis. Based on the psychiatric diagnosis evaluation of the patients- depression was the most common diagnosis at 88.2%, followed by anxiety disorder at 27.8% and bipolar mood disorder at 17.4%. The majority of reported self-harm cases involved overdose incidents (68.8%), with self-injury accounting for 56.3% of cases. Analgesics were the most frequently reported type of overdose, followed by tricyclic antidepressants. In context of self-injury, cutting emerged as the predominant form of self-harm. Family conflict was reported to be the most common reason for self-harm at 39.6%.ConclusionThis study shows a high rate of self-harm among patients with mental illness in this facility, necessitating the development of self-harm prevention and management protocols. A national registry of self-harm behavior would also help further elucidate the occurrence and mechanisms of self-harm in the population, improving the possibility for early interventions and prevention.
| S-EPMC11771914 | biostudies-literature
Project description:BackgroundThis study performed a follow-up investigation of parasitic infections and the evolution of the infection spectra in Shanghai and its surrounding areas in Eastern China. The current study was conducted in the Shanghai Ruijin Hospital, a tertiary hospital affiliated with Shanghai Jiao Tong University School of Medicine.MethodsThis retrospective investigation reviewed a total of 412 parasitic infections in patients admitted to the Department of Infectious Diseases, Ruijin Hospital from January 1, 2010 to July 31, 2022. Detailed information for these patients was retrieved from the Electronic Medical Record System. Analysis was performed using GraphPad Prism 5.0 and SPSS Statistics 26.ResultsOverall, 17 species of parasites were detected from the 412 admissions. Over the 13 years, the number of patients peaked in 2021 and food-born parasites (FBPs) were the primary species. During the most recent 5 years, Clonorchis sinensis, replacing Paragonimus westermani, has become the primary parasite detected among the patients, consistent with the observation that eating uncooked fish has turned into the most common route of transmission. Paragonimus westermani infections declined with age, but Cysticercus increased with age. The periods from the onset of symptoms to definite diagnosis for some patients infected with Sparganum mansoni, Paragonimus westermani, and Cysticercus were more than 6 months. Interestingly, eosinophilia was only detected in 51.83% of parasite-infected patients. In addition, superinfections of parasites were common in our study.ConclusionOur study demonstrates the transitional change in the prevalence of parasitic infection over the latest 13 years in a single center in Eastern China. The incidence of parasitic infections peaked in 2021, and the dominant parasitic species switched from a soil origin to foodborne. The direction for the diagnosis and prevention of parasitic infection among different age groups should alter according to age. It is difficult to diagnose parasitic infections and superinfections that occur in some patients. Thus, more sensitive and efficient detection methods should be developed. In addition, although eosinophilia and elevated IgE are still reliable indicators for initiating screening of parasitic infection, the development of novel parasitic diagnostic kits is still in urgent need for occult infection.
| S-EPMC9554607 | biostudies-literature