scholarly journals Risk Factors and Outcomes of Non-albicans Candida Bloodstream Infection in Patients with Candidemia at Siriraj Hospital—Thailand’s Largest National Tertiary Referral Hospital

2021 ◽  
Vol 7 (4) ◽  
pp. 269
Author(s):  
Chaiyapong Ngamchokwathana ◽  
Piriyaporn Chongtrakool ◽  
Amiroh Waesamaae ◽  
Methee Chayakulkeeree
Keyword(s):  
Risk Factors ◽  
Hematologic Malignancies ◽  
Male Gender ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Fluconazole Resistance ◽  
Significant Difference ◽  
Siriraj Hospital ◽  
Independent Risk Factors ◽  
Candida Bloodstream Infection

This study aimed to investigate the risk factors for and the outcomes of patients with candidemia caused by non-albicans Candida. Candidemia patients treated at Siriraj Hospital (Bangkok, Thailand) during January 2016 to December 2017 were enrolled. A total of 156 patients (mean age: 65 years, 56.4% male) were included. The most prevalent underlying conditions were diabetes (32.1%), chronic cardiac disease (28.2%), chronic kidney disease (26.9%), and hematologic malignancies (21.2%). Candida species isolated from patient blood were C. tropicalis (49.4%), C. albicans (28.8%), C. glabrata (16.7%), and C. parapsilosis (5.1%). Fluconazole resistance was significantly increased in C. tropicalis (37.8%). No independent risk factors were associated with patients with non-albicans Candida candidemia compared to those with C. albicans candidemia. There was no significant difference in mortality between patients with non-albicans Candida candidemia and patients with C. albicans candidemia (OR: 1.35, 95% CI: 0.64–2.85). When compared with C. albicans candidemia, multivariate analysis revealed chronic liver disease (OR: 11.39, 95% CI: 1.38–94.02), neutropenia (OR: 4.31, 95% CI: 1.34–13.87), and male gender (OR: 2.34, 95% CI: 1.04–5.29) to be independent risk factors for C. tropicalis candidemia. The observed high resistance of C. tropicalis to fluconazole indicates that fluconazole should not be used for empirical antifungal treatment in these patients.

Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

2020 ◽  
Vol 66 (1) ◽  
pp. 19-22
Author(s):  
Melania Macarie ◽  
Simona Maria Bataga ◽  
Monica Pantea ◽  
Razvan Opaschi ◽  
Simona Mocan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Ratio ◽  
Hiatal Hernia ◽  
Statistical Significance ◽  
Erosive Esophagitis ◽  
Male Gender ◽  
Consecutive Series ◽  
Study Group ◽  
Entire Study ◽  
Significant Difference

AbstractObjective: This study aims to determine the correlation between risk factors and erosive esophagitis development.Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification.Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%).Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

scholarly journals Risk Factors for Mortality in Severely Ill Children Admitted to a Tertiary Referral Hospital in Malawi

2019 ◽  
Vol 101 (3) ◽  
pp. 670-675 ◽  
Author(s):  
Fatsani Ngwalangwa ◽  
Chikondi H. A. Phiri ◽  
Queen Dube ◽  
Josephine Langton ◽  
Helena Hildenwall ◽  
...  
Keyword(s):  
Risk Factors ◽  
Referral Hospital ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital

scholarly journals Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Han Zhang ◽  
Yingying Wu ◽  
Yuqing He ◽  
Xingyuan Liu ◽  
Mingqian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Population Based ◽  
Male Gender ◽  
Poor Correlation ◽  
Age Related ◽  
Related Risk ◽  
Independent Risk Factors

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057–1.065], p &lt; 0.001), male gender (OR = 1.726 [95% CI 1.582–1.885], p &lt; 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355–1.786], p &lt; 0.001), smoking (OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118–1.413], p &lt; 0.001), cancer (OR = 1.86 [95% CI 1.507–2.279], p &lt; 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427–2.12], p &lt; 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged &lt;40 years, only cancer (OR = 17.112 [95% CI 6.264–39.73], p &lt; 0.001) and ICH (OR = 31.538 [95% CI 5.213–158.787], p &lt; 0.001) were significantly associated with higher odds of death. For patients aged &gt;80 years, only age (OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301–1.933], p &lt; 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

Treatment of patients with locally advanced Merkel cell carcinoma: A multicenter study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21566-e21566
Author(s):  
Monika Dudzisz-Śledź ◽  
Pawel Sobczuk ◽  
Katarzyna Kozak ◽  
Tomasz Switaj ◽  
Hanna Kosela-Paterczyk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Poor Prognosis ◽  
Locally Advanced ◽  
Male Gender ◽  
Merkel Cell ◽  
Nodal Involvement ◽  
Free Survival ◽  
Independent Risk Factors ◽  
Clinical Metastases

e21566 Background: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high risk of recurrence and poor prognosis. The treatment of locally advanced disease includes surgery (SUR) and radiotherapy (RTH) to achieve high locoregional control rates. The sentinel lymph node biopsy (SLNB) is recommended procedure in cases without clinical nodal involvement. In selected cases, chemotherapy (CHT) may also be considered, but its role is not confirmed. This study aimed to analyze outcomes for locally advanced MCC pts treated in routine clinical practice. Methods: We conducted the retrospective analysis of data from 156 MCC pts treated with curative surgery in four oncological centers, diagnosed between 01/2010 and 12/2019, with data cut-off on 31/12/2020. The data collected included epidemiological and clinical information. Survival analyses were performed using the Kaplan-Meier method, log-rank test and multivariate Cox regression. Results: The median patient age at diagnosis was 72 years (30-94); 50.6% were male. The primary tumor (PT) locations were lower limbs (33.3%), upper limbs (30.1%), and head and neck (28.2%). MCC with no PT was diagnosed in 3.9%. In 62.0% the PT was located in the sun-exposed skin. The median tumor size was 25 mm (4-170). Lymph node (LN) involvement (clinical or positive SLNB or LND) at diagnosis was found in 26.9% (n = 42). The scar excision was done in 50.0% (positive in 16.6%), SLNB in 36.5% (positive in 10.5 %), 51.9% of pts received perioperative treatment, including RTH- 86.4%, CHT- 21%. The relapse rate was 38.3% (35.8% local-regional, 11.1% distant). With the median follow-up of 2.2-years, the median disease-free survival (DFS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were not reached. The 1-year DFS, LRFS and DMFS rates were 65%, 68%, and 90%. The negative independent risk factors for DFS were male gender (HR 1.42, 95%CI 1.06-3.01), metastases in LN at diagnosis (HR 5.41, 95%CI 2.39-12.26), no SLNB in pts with no clinical metastases in LN (HR 5.45, 95%CI 2.41-12.3), and no perioperative RTH (HR 2.19, 95%CI 1.29-3.76). The median overall survival (OS) was 6.9 years (95%CI 4.64-9.15). The negative independent risk factors for OS were male gender (HR 1.95, 95%CI 1.16-3.27), age above 70 (HR 2.0, 95%CI 1.15-3.48), metastases in LN at diagnosis (HR 3.15, 95%CI 1.49-6.68), and no SLNB in pts with no clinical metastases in LN (HR 2.30, 95%CI 1.10-4.82). PT location, UV-exposure, and perioperative CHT or RTH were not independent risk factors for OS. Conclusions: Our results confirm that the MCC treatment should be done in an experienced multidisciplinary team. Male gender, nodal involvement at diagnosis, and no SLNB in pts without clinical metastases in LN are associated with poor prognosis in DFS and OS. The perioperative RTH improves the treatment outcomes and reduces disease progression risk but does not impact OS. Perioperative CHT does not affect pts survival.

scholarly journals Helicobacter pylori Recurrence after Eradication Therapy in Jiangjin District, Chongqing, China

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Gang Zhou
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Recurrence Rate ◽  
Standard Therapy ◽  
Family Members ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Eating Out ◽  
H Pylori ◽  
Infection Recurrence

Purpose. To investigate the recurrence rate of Helicobacter pylori infection after eradication in Jiangjin District, Chongqing, China, and to analyze the related causes. Methods. Outpatients who were eradicated of H. pylori infection with standard therapy between August 2014 and August 2017 were included in this study. The recurrence rate was investigated 1 year later. Data regarding gender, smoking, alcohol intake, frequency of eating out, and treatment strategy were recorded, and their relationships with the recurrence rate were analyzed. Multivariate logistic regression analysis was performed to determine the independent risk factors for H. pylori infection recurrence. Results. In total, 400 patients (225 males and 175 females) were included in this study. Of them, the recurrence rate of H. pylori infection was 4.75% (19/400), with 5.33% (12/225) in males and 4.57% (7/175) in females, showing no gender difference. The recurrence rate was 7.03% (9/128) in smokers and 3.68% (10/272) in nonsmokers, while it was 6.45% (12/186) in those who drink alcohol and 3.27% (7/214) in those who do not drink alcohol, showing no significant differences. The higher the frequency of eating out, the higher the recurrence rate of H. pylori infection (P=0.001). There was a statistically significant difference in the recurrence rate between patients receiving treatment alone and patients whose family members also received treatment (6.08% vs. 0.96%, P=0.035). Drinking and dining out were independent risk factors for H. pylori infection recurrence (P=0.014 for drinkers and P=0.015 and P=0.003 for those who sometimes and often dine out, respectively). Conclusions. The overall recurrence rate after H. pylori eradication by standard therapy in Jiangjin District is 4.75%. Reducing the frequency of eating out and family members receiving treatment may reduce the recurrence of H. pylori infection.

scholarly journals Does the male gender govern conversion of laparoscopic cholecystectomy?

2019 ◽  
Vol 6 (1) ◽  
pp. 14-20
Author(s):  
Kishor Manandhar ◽  
Sujita Manandhar
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Male Gender ◽  
Female Group ◽  
Emergency Visit ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy ◽  
Upper Abdominal

Introductions: Laparoscopic cholecystectomy (LC) occasionally demands conversion to open cholecystectomy (OC) because of multiple risk factors. This study was conducted to find out whether male gender is a stand-alone risk factors for conversion of LC to OC. Methods: This was a comparative analysis of conversion of LC to OC in patients operated for symptomatic cholelithiasis during June 2017 to May 2018 at Bir hospital, National Academy of Medical Sciences, Kathmandu, Nepal. The patients were divided into two groups: male (group 1) and female (group 2). Study variables included gender, America Society of Anesthesiologist class, history of upper abdominal pain within six weeks prior to surgery, upper abdominal surgery, emergency department visit due to upper abdominal pain, adhesion of gallbladder to adjacent structure and body mass index. Binominal logistic regression analysis of risk factors for conversion was conducted. Odds ratio (95% CI) was calculated. The p value ≤ 0.05 was considered statistically significant. Results: Among 151 patients (male 39, female 112), 7 (4.6%, male 3 and female 4) had conversion from LC to OC. Male gender itself as an isolated risk factor had no significant association to conversion (p=0.303). There was no significant difference found for age, operating time and hospital stay. Previous emergency visit (p=0.020) and adhesion (p<0.030) were associated with conversion. Conclusions: Male gender had no significant association for conversion of LC to open. Previous emergency visit due to upper abdominal pain and adhesion of gallbladder were associated risk factors for conversion.

The Retrospective Analysis of Pediatric Acute Leukemia Cases between 1980–2003: Hacettepe Experience.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4542-4542
Author(s):  
Sule Unal ◽  
Gonul Hicsonmez ◽  
Sevgi Yetgin ◽  
Aytemiz Gurgey ◽  
Fatma Gumruk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Leukemia ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Hematologic Malignancies ◽  
Cns Involvement ◽  
Laboratory Findings ◽  
Cancer Data ◽  
Significant Difference

Abstract Leukemia constitutes 25–30% of all pediatric malignancy cases. The epidemiologic and demographic characteristics of this group of patients are important not only for determination of the prognostic factors, but also the risk factors. In this study, 683 patients under 16 years of age who were diagnosed with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) between January 1980-July 2003 in Hacettepe University, Pediatric Hematolgy Division are analyzed retrospectively. Besides the epidemiologic characteristics including age, sex, geographic distiribution; the type of disease, clinical presentation, physical examination and laboratory findings on admission and the survival and prognosis relationships are also evaluated in order to determine the disease properties of our country. ALL patients have recieved St. Jude Total XI until 1997, and after 1997 they are treated by St. Jude Total XIII protocol. AML patients have been treated by AML 1995 and AML 1998 protocols. The study group includes 548 (80.2%) ALL and 135 (19.8%) AML cases. Two thirds of the all acute leukemia cases are males in both ALL and AML cases. The median age at diagnosis is 62 months for ALL and 108 months for AML patients. ALL is more common among 1–5 year old group; AML is more common among adolescent age group. The incidence of hematologic malignancies increases suddenly in 1997 and 1998 and then showes a decline later. The hematologic malignancy cases who have been admitted to our clinic is most commonly living in the northern and southeastern parts of Turkey. 50% of ALL and AML patients presents with the complaints of fever and pallor. Bone pain is significantly more common in ALL patients. Median time between onset of syptoms and diagnosis is 30 days for both ALL and AML patients. Lymphadenopathy is present in almost half of ALL and AML patients at diagnosis. Hepatomegaly (72.4% vs 50.4%) and splenomegaly (53.8% vs 36.3%) are more commonly observed in ALL then AML patients (p<0.001). The central nervous system (CNS) involvement is present in 5.8% of ALL and 5.9% of AML patients. There is no statisticaly significant difference between ALL and AML patients in terms of bone, mediastinial and CNS involvements. The most common cytogenetical abnormality in ALL patients is hypodiploidy. 25.4% of ALL and 43.7% of AML patients have relapsed subsequently. The most common type of relaps is seen in bone marrow in both ALL and AML cases, however CNS relaps is seen more commonly among ALL patients (31% vs 4%). Fatality rates of ALL and AML are 20.1% and 56.3%, respectively. The fatality rate of AML is significantly higher than ALL. The CNS involvement at diagnosis and sex have no influnce on the fatality rates; on the other hand the presence of relaps for ALL and AML groups and L3 subtype, being less then 1 year old at diagnosis for ALL cases have a negative effect on fatality rates. Also the fatality rates of ALL patients who have been diagnosed before 1997 and recieved St. Jude Total XI protocol has higher fatality rates then who have been diagnosed after 1997 and recieved St. Jude Total XIII (23.3% vs 14.1%). The collection of the cancer data throughout the country is crucial for the determination of the distribution and risk factors of our country. The best way of cancer data collection is development of cancer recording systems and analyzing these data for the determination of distribution and risk factors of patients with hematologic malignancies.

scholarly journals Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

2020 ◽  
Author(s):  
Xiao-huan Ma ◽  
Fang Yin ◽  
Jie Zhang ◽  
Meng-yun Peng ◽  
Hong Guan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Laboratory Data ◽  
Male Gender ◽  
High Flow ◽  
Binary Logistic Regression Analysis ◽  
Hypoxemic Respiratory Failure ◽  
Factors Associated ◽  
Independent Risk Factors

Abstract Background Acute hypoxemic respiratory failure is prevalent in severe Coronavirus Disease 2019 (COVID-19). High-flow nasal canula (HFNC) is currently the most common ventilation strategy for COVID-19 patients with respiratory failure. This study is to analyze the risk factors associated with high-flow nasal canula (HFNC) oxygen therapy failure in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure was seen more commonly in patients aged ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure had the following characteristics: higher percentage of fatigue and anorexia as well as cardiovascular disease; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock, myocardial damage, and acute kidney injury; increased neutrophil counts and prothrombin time; and decreased arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male gender and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male gender and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure in severe COVID-19 patients.

scholarly journals Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

2021 ◽  
Author(s):  
Hui Wang ◽  
Tun Wang ◽  
Hao He ◽  
Xin Li ◽  
Yuan Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Aortic Pseudoaneurysm ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
The Mean

Abstract Backgrounds: The prognosis of thoracic aortic pseudoaneurysm (TAP) after thoracic endovascular aortic repair (TEVAR) remains unclear. This study investigates the early and midterm clinical outcome as well as relevant risk factors of TAP patients following TEVAR therapy.Methods: From July 2010 to July 2020, 37 eligible TAP patients who underwent TEVAR were selected into our research. We retrospectively explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. Risk factors of late survival were discerned using Cox regression analysis.Results: There were 29 men and 12 women, with the mean age as 59.5±13.0 years (range, 30-82). The mean follow-up time was 30.7±28.3 months (range, 1-89). For early result, early mortality (≦30days) happened in 3(8.1%) zone 3 TAP patients versus 0 in zone 4 (p= 0.028); acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm result, survival at 3 months, 1 year and 5 years was 88.8±5.3%, 75.9±7.5% and 68.3±9.9%, which showed significant difference between zone 2/3 versus zone 4 group (56.3±14.8% versus 72.9±13.2%, p= 0.013) and emergent versus elective TEVAR groups (0.0±0.0% versus 80.1±8.0%, p= 0.049). On multivariate Cox regression, lesions at zone 2/3 (HR 4.605, 95%CI 1.095-19.359), concomitant cardiac disease (HR 4.932, 95%CI 1.086-22.403) and emergent TEVAR (HR 4.196, 95%CI 1.042-16.891) were significant independent risk factors for worse late clinical outcome. Conclusions: TEVAR therapy is effective and safe with satisfactory early and midterm clinical outcome for TAP patients. Lesions at zone 2/3, concomitant cardiac disease and emergent TEVAR were independent risk factors for midterm survival outcome.

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