scholarly journals Factors Associated with Treatment Failure in Patients with Acute Exacerbation of COPD Admitted to the Emergency Department Observation Unit

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wasuntaraporn Pethyabarn ◽  
Sareeman Chewae ◽  
Ar-aishah Dadeh
Keyword(s):  
Treatment Failure ◽  
Beta Agonist ◽  
Diabetic Mellitus ◽  
Observation Unit ◽  
X Ray ◽  
Factors Associated ◽  
Chest X Ray ◽  
Exacerbation Of Copd ◽  
Long Term Oxygen Therapy

Objective. We aimed to identify factors associated with treatment failure in patients with acute exacerbation of COPD (AECOPD) admitted to the emergency department observation unit (EDOU). Methods. A retrospective cohort study was conducted between January 1, 2013, and October 31, 2019. The electronic medical records were reviewed of patients with AECOPD admitted to the EDOU. The patients were divided into treatment failure and treatment success groups. Treatment failure was defined as prolonged stay at the EDOU (>48 h) or COPD-related ED revisit (within 72 h) or readmission within 1 month. The two groups were compared and analyzed using univariable and multivariable analyses by logistic regression. Results. Of the 220 patients enrolled, 82 (37.3%) developed treatment failure. Factors associated with treatment failure included arrhythmias (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.04–13.9), diabetic mellitus (OR 2.32, 95% CI 1.09–4.95), long-term oxygen therapy (OR 2.89, 95% CI 1.08–7.72), short-acting beta-agonist use (OR 6.06, 95% CI 1.98–18.62), pneumonia findings on chest X-ray (OR 3.24, 95% CI 1.06–9.95), and ED length of stay less than 4 h (OR 2, 95% CI 1.08–3.73). Conclusion. Arrhythmias, diabetic mellitus, long-term oxygen therapy, short-acting beta-agonist use, pneumonia findings on chest X-ray, and ED length of stay <4 h were the significant factors associated with treatment failure of AECOPD to which physicians at the ED should pay special attention before the admission of patients to the EDOU.

Anterior diaphragmatic hernias in children: long-term surgical outcomes

2021 ◽  
Vol 16 (3) ◽  
pp. 7-15
Author(s):  
D.A. Morozov ◽  
◽  
D.V. Khaspekov ◽  
E.A. Okulov ◽  
V.G. Masevkin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diaphragmatic Hernia ◽  
Complex Analysis ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
X Ray ◽  
Hernial Sac ◽  
Chest X Ray ◽  
Diaphragmatic Hernias

Anterior diaphragmatic hernia (ADH) is a rare congenital pathology that occurs in children with a frequency of 1:4800 (1–6% of all congenital diaphragmatic hernias). There are many controversial aspects in the surgical treatment of patients with ADH: the choice of surgical approach, the method of diaphragmatic repair and the feasibility of excision of the hernial sac. Objective. To conduct a comparative analysis of the surgical treatment of patients with ADH in different clinics, assessing longterm outcomes. Patients and methods. The medical records of 7 children with ADH who underwent surgical repair in different clinics (in time period from 2009 to 2019) were retrospecively reviewed. Evaluating the long-term results of ADH repair was made by telephone and online surveys of the parents of patients and by outpatient examination of children (chest x-ray in two projections). Results. In a ten-year period, 7 patients (4 boys and 3 girls) were operated on with a diagnosis of “anterior diaphragmatic hernia” at the age of 3 months to 12 years. In most children, a hernia was discovered accidentally by chest x-ray. Laparoscopic correction was performed in 5 (71%) cases, thoracoscopic correction – in 2 cases (29%). The main difference in surgical tactics in ADH patients was the manipulation with the hernial sac – the hernial sac was excised in 4 (57%) patients, but it was left in three cases (43%). The defect closure was performed by “full-thickness” separated sutures that fix the diaphragm to the anterior abdominal wall during laparoscopy (5) and to the chest tissue during thoracoscopy (2); in some cases, additional fixation to the rib (4) was performed. Sutures were tied extracorporeally and buried in the subcutaneous layer in 6 (86%) patients. Average follow-up was 7 years. While evaluating long-term outcomes no ADH recurrence were found. Conclusions. There are still many controversial aspects in the surgical treatment of ADH patients. In our opinion, multicenter studies with complex analysis of long-term results are required to standardize the surgical treatment of such patients. Key words: anterior diaphragmatic hernia, Larrey hernia, long-term outcomes, Morgani hernia

scholarly journals Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Michael Paplawski ◽  
Swapna Munnangi ◽  
Jody C. Digiacomo ◽  
Edwin Gonzalez ◽  
Ashley Modica ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Tube ◽  
Rib Fractures ◽  
Tube Placement ◽  
Chest Tubes ◽  
Chest Tube Placement ◽  
X Ray ◽  
Factors Associated ◽  
Occult Pneumothorax ◽  
Chest X Ray

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

scholarly journals Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1950
Author(s):  
Giulia Scioscia ◽  
Rosanel Amaro ◽  
Victoria Alcaraz-Serrano ◽  
Albert Gabarrús ◽  
Patricia Oscanoa ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Factors ◽  
Treatment Results ◽  
Factors Associated ◽  
Long Term Oxygen Therapy

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

scholarly journals Compliance of St Joseph’s Hospital Roma, Lesotho with the National Tuberculosis Programme of Lesotho, 2007 and 2008

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Oladoyinbo O. Samuel ◽  
Pierre J.T. De Villiers
Keyword(s):  
Treatment Failure ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Sputum Smear Microscopy ◽  
X Ray ◽  
National Tuberculosis Programme ◽  
National Tuberculosis ◽  
Tuberculosis Programme ◽  
Chest X Ray ◽  
Smear Negative

Background: In 2009 Lesotho had an estimated TB prevalence of 696 cases/100 000 population − the 4th highest in the world. This epidemic was characterised by high rates of death, treatment failure and unknown treatment outcomes. These adverse outcomes were attributable to a high rate of TB and/or HIV co-infection and weaknesses in the implementation of Lesotho’s National Tuberculosis Programme (NTP). This study was conducted in St Joseph’s Hospital, Roma (SJHR) to assess the implementation of the NTP.Method: Records of 993 patients entered into the SJHR TB register between 2007 and 2008 were reviewed. Patients’ treatment details were extracted from the register, validated and analysed by STATA 10.0.Results: Of 993 patients registered: 88% were new patients, 37% were diagnosed on sputum smear microscopy alone, 35% were diagnosed on sputum smear microscopy with chest X-ray, whilst 25% were diagnosed on chest X-ray alone. In addition: 33% were sputum smear positive, 45% were sputum smear negative, and 22% had extra-pulmonary TB. As to treatment outcome: 26% were cured, 51% completed treatment, and 51% converted from sputum smear positive to sputum smear negative over six months, whilst 16% died. Regarding HIV, 77% of patients were tested for HIV and 59% had TB and/or HIV co-infection. Of ten NTP targets only the defaulter and treatment failure rate targets were met.Conclusion: Whilst only two out of ten NTP targets were met at SJHR in 2007–2008, improvements in TB case management were noted in 2008 which were probably due to the positive effects of audit on staff performance.

scholarly journals Factors Associated with Participation in Pulmonary Tuberculosis Screening Using Chest X-Ray among Diabetes Mellitus Type II Patients in Denpasar, Bali, Indonesia

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
I Gusti Ngurah Edi Putra ◽  
Putu Ayu Swandewi Astuti ◽  
I Ketut Suarjana ◽  
Ketut Hari Mulyawan ◽  
I Made Kerta Duana ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Insurance ◽  
Pulmonary Tuberculosis ◽  
Health Provider ◽  
Type Ii ◽  
Cross Sectional ◽  
Pulmonary Tb ◽  
X Ray ◽  
Factors Associated ◽  
Chest X Ray

Diabetes mellitus (DM) increases the risk of developing pulmonary tuberculosis (TB) disease. Therefore, pulmonary TB screening among DM patients is essential. This study aimed to identify factors associated with participation of DM type II patients in pulmonary TB screening using chest X-ray. This was a cross-sectional analytic study and was part of TB-DM screening study in Denpasar, Bali, Indonesia. The sample consisted of 365 DM type II patients selected by quota sampling among DM type II patients joining the screening program from January until March 2016 in 11 public health centres in Denpasar. Data were collected via structured interviews. The contributing factors were determined by modified Poisson regression test for cross-sectional data. From the findings, less than half (45.48%) of DM type II patients participated in chest X-ray examination for TB. Factors associated with participation in pulmonary TB screening were having a higher educational level [APR = 1.34, 95% CI (1.07–1.67)], having family member who developed pulmonary TB disease [APR = 1.47, 95% CI (1.12–1.93)], the travel time to referral hospital for screening being ≤ 15 minutes [APR = 1.6, 95% CI (1.26–2.03)], having health insurance [APR = 2.69, 95% CI (1.10–6.56)], and receiving good support from health provider [APR = 1.35, 95% CI (1.06–1.70)]. Therefore, training for health provider on providing counselling, involvement of family members in screening process, and improving the health insurance coverage and referral system are worth considering.

Extrapleural Apical Fluid Collection: An Important Sign on Plain X-ray Suggesting a Pre-ganglionic Brachial Plexus Injury

2008 ◽  
Vol 33 (4) ◽  
pp. 501-506 ◽  
Author(s):  
J. MCCAUL ◽  
H. SHARMA ◽  
T. E. HEMS
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Fluid Collection ◽  
X Rays ◽  
X Ray ◽  
First Rib ◽  
Chest X Ray ◽  
Important Sign ◽  
The Difference

Forty of 136 consecutive patients referred for management of brachial plexus injuries had closed supraclavicular injuries. The results of the initial chest X-rays were available for 29 patients. Nine had avulsion of the C8 and T1 nerve roots from the spinal cord. Eight cases had MR confirmation of lower root avulsion, six of these cases were confirmed surgically and none had any long-term clinical recovery. Twenty had partial brachial plexus injuries without avulsion of these roots. Seven of nine patients with avulsion of C8 and T1 had an extrapleural apical fluid collection. One of these had a fractured first rib. Two of 20 without avulsion had an extrapleural apical fluid collection. Both had fractured the first rib. The difference in incidence of extrapleural apical fluid collection between the two groups, excluding those cases with first rib fractures, was statistically significant. Without a first rib fracture, an ipsilateral extrapleural apical haematoma on a plain chest X-ray of patients with brachial plexus injury strongly suggests pre-ganglionic injury to the lower roots.

HYPERSENSITIVITY PNEUMONITIS FOLLOWING ALEMTUZUMAB TREATMENT FOR MULTIPLE SCLEROSIS

2015 ◽  
Vol 86 (11) ◽  
pp. e4.31-e4
Author(s):  
Mark Willis ◽  
Mark Cossburn ◽  
Gillian Ingram ◽  
Trevor Pickersgill ◽  
Simon Barry ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Computed Tomography ◽  
Autoimmune Disease ◽  
Hypersensitivity Pneumonitis ◽  
Oral Prednisolone ◽  
X Ray ◽  
Humoral Immune ◽  
Chest X Ray ◽  
Relapsing Multiple Sclerosis

Alemtuzumab has recently been licensed in several countries for relapsing multiple sclerosis. Despite its marked clinical efficacy it is associated with acquired autoimmune disease with a particular predilection for the thyroid gland. Despite the recognition and surveillance mechanisms that exist to monitor patients treated with alemtuzumab, vigilance must be maintained to monitor for less common immune-related disorders. We present two patients diagnosed with hypersensitivity pneumonitis following alemtuzumab therapy for multiple sclerosis. Both patients presented with a sub-acute pulmonary illness characterized by cough and breathlessness with interstitial pulmonary infiltrates subsequently demonstrated on chest x-ray and computed tomography of the thorax. Both patients responded well to oral prednisolone and in the case of one patient for whom serum avian precipitins had been strongly positive, removal of a pet parrot. There has been no recurrence of respiratory disease following treatment. Autoimmune disease post-alemtuzumab treatment tends to be due to an aberrant humoral immune response such as that seen in Grave's disease. However, these cases highlight that cell-mediated autoimmunity disorders may also occur and underline the importance of long term surveillance for immune complications in patients treated with this drug.

scholarly journals 365 Patients with Pectus Excavatum Undergoing Video-Assisted Thoracoscopic Surgery for the Nuss Procedure: A 5-Year Single-Institution Experience

2020 ◽  
Author(s):  
Nguyen The May ◽  
Uoc ◽  
Lu ◽  
Son ◽  
Tu ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Wound Infection ◽  
Body Weight Gain ◽  
Surgical Wound Infection ◽  
Surgical Wound ◽  
Fluid Accumulation ◽  
X Ray ◽  
Haller Index ◽  
Chest X Ray

Abstract Objective: We conducted this study to review our large single-center experience in Vietnam in the use of the VATS-NUSS for 365 consecutive patients with PE within the five years and to evaluate mid-term to long-term outcome in these patients. Methods: In this retrospective study, we consecutively selected the patients with the diagnosis of PE who underwent VATS-NUSS from January 2015 to September 2019. A total of 365 patients who were surgically treated for PE at the Department of Cardiovascular and Thoracic Surgery, Viet Duc University Hospital (Hanoi, Vietnam) was included in final analysis. Results: The length of postoperative hospitalization ranged from 1 to 13 days (Mean: 5.1). Early postoperative complications were recorded up to 30 days during hospital stay, consisting of pneumothorax (n = 5, 1.37%), pleural bleeding / pleural fluid (n = 2, 0.55%), pleural hematoma (n = 1, 0.27%), pneumonia (n = 1, 0.27%), surgical wound infection (n = 1, 0.27%), incision fluid accumulation (n = 3, 0.82%), metal bar infection (n = 1, 0.27%), atelectasis (n = 3, 0.82%), and fever (n = 8, 2.19%). In the late postoperative complications, surgical wound infection (n = 2, 0.55%), metal bar deviation (n = 5, 1.37%), metal bar allergy (n = 10, 2.74%), recurrent PE (n = 2, 0.55%), and persistent PE (n = 5, 1.37%) were observed. No deaths occurred. The outcomes related to the bar removal that was carried out in 175 patients (47.95%). The time the bar was in situ ranged from 2 to 49 months (mean: 28.89±7.48 years). The mean operative time at bar removal was 34.09 ± 10.61 minutes, and the length of hospitalization following bar removal was 2.4 ± 1.34 days. Of 175 patients performed bar removal, the most frequent complication was pneumothorax, which was diagnosed in 19 (10.85%) patients; surgical wound infection in 1 patient and incision fluid accumulation in 1 patient were observed following bar removal. Towards mid-term results at 6 – 30 months postoperatively, there were 124 out of 365 patients (33.97%). Of 124 patients, most patients were unremoved the bar (n = 121, 97.58%), and only 3 patients were removed the bar (2.42%). Most patients had body weight gain (n = 97, 78.23%), and increased physical activity and improved health (n = 115, 92.74%). The Haller index on chest X-ray was 2.44 ± 0.15. 220 out of 365 patients (60.27%) were postoperatively evaluated long-term results at over 30 months. Of those, 172 received bar removal (78.18%) and 48 have not yet received bar removal (21.82%). 217 patients (98.64%) had both body weight gain, and increased physical activity and improved health. The Haller index on chest X-ray was 2.45±0.21. Conclusions: The VATS-NUSS for PE was safe and effective approach with minimizing the occurrence of serious intra- and postoperative complications. From our initial one-institution experience in a resource-scare country, good mid-term to long-term postoperative outcomes in PE patients were obtained with VATS-NUSS. Current rare evidence drawn from this cohort enables to give a real picture in the application, modification and development of VATS-NUSS not only for Vietnam but also the countries having similar resource-scare conditions.

scholarly journals MO664DYNAMIC ASSESSMENT OF INTERLEUKIN-6 DURING HEMODIALYSIS AND MORTALITY IN COVID 19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Patricia Muñoz Ramos ◽  
Martin Giorgi ◽  
Yohana Gil Giraldo ◽  
Antonio De Santos ◽  
Almudena Núñez ◽  
...  
Keyword(s):  
Interleukin 6 ◽  
Hemodialysis Patients ◽  
Dialysis Session ◽  
Serum Samples ◽  
X Ray ◽  
Factors Associated ◽  
Positive Balance ◽  
Dialysis Vintage ◽  
Chest X Ray ◽  
The Impact

Abstract Background and Aims The impact of the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease-19 (COVID-19) in hemodialysis patients remains poorly characterized. Some hemodialysis techniques reduce systemic inflammation but their impact on COVID-19 has not been addressed. The aim of this prospective study was to evaluate factors associated to mortality in COVID-19 hemodialysis patients, including the impact of reducing interleukin-6 using a cytokine adsorbent filter. Method This is a prospective single-center study including 16 hemodialysis patients with COVID-19. All were dialyzed using a polymethyl methacrylate (PMMA) filter. Interleukin-6 levels were obtained before and after the first admission hemodialysis session and at one week. Also we collected serum samples from 8 patients of our unit as controls: 4 in online hemodiafiltration (OLHDF) and 4 in high-flux hemodialysis Baseline comorbidities, laboratory values, chest X-ray and treatments were recorded and compared between survivors and non-survivors. Results Sixteen patients were included (13 males, mean age 72±15 years). Four patients (25%) died. Factors associated to mortality were dialysis vintage (p=0.01), the presence of infiltrates in chest X-ray (p=0.032), serum C-reactive protein (p=0.05) and lactate dehydrogenase (p=0.02) at one week, the requirement of oxygen therapy (p=0.02) and the use of anticoagulation (p&lt;0.01). At admission, post-dialysis interleukin-6 levels were higher (p&lt;0.01) in non-survivors and these patients differed from survivors in the reduction of interleukin-6 levels during the dialysis session despite using a PMMA filter (survivors vs non survivors (25 [17-53]% vs -3 [-109-12] %, p=0.04). Conclusion In hemodialysis COVID-19 patients, a positive balance of interleukin-6 during the session was associated to higher mortality.

Sign in / Sign up

Export Citation Format

Share Document