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Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis
Matthias Klein, Uwe Koedel, Thomas Pfefferkorn, Grete Zeller, Bianca Woehrl, Hans-Walter Pfister
Critical Care , 2011, DOI: 10.1186/cc10565
Abstract: We retrospectively studied patients with acute bacterial meningitis who were treated in our university hospital from 2000 to 2009. Data were analyzed with the main focus on the incidence of an increase of CBFv on TCD, defined as peak systolic values above 150 cm/s, and the development of stroke.In total, 114 patients with acute bacterial meningitis were treated, 94 of them received routine TCD studies during their hospital stay. 41/94 patients had elevated CBFv values. This increase was associated with an increased risk of stroke (odds ratio (95% confidence intervall) = 9.15 (1.96-42.67); p < 0.001) and unfavorable outcome (Glasgow Outcome Score < 4; odds ratio (95% confidence intervall) = 2.93 (1.23-6.98); p = 0.018). 11/32 (34.4%) patients with an increase of CBFv who received nimodipine and 2/9 (22.2%) patients with an increase of CBFv who did not receive nimodipine developed stroke (p = 0.69).In summary, TCD was found to be a valuable bedside test to detect arterial alterations in patients with bacterial meningitis. These patients have an increased risk of stroke.The development of cerebrovascular alterations is an important intracranial complication in acute bacterial meningitis and is associated with poor outcome [1]. Arterial cerebrovascular complications are reported to occur in approximately one-fifth of patients [2]. Using digital subtraction angiography (DSA), arterial narrowing is the predominant finding in patients with arterial complications, involving all vessel sizes [1]. The underlying reason for narrowing of the cerebral arteries during bacterial meningitis is still a matter of debate. Autopsy and animal model studies indicate severe inflammation of the vessel walls (vasculitis) as a key etiology [3,4]. Furthermore, patients in whom histopathological correlates in terms of inflammation were not found at the sites of arterial narrowing have been reported [5,6]. This suggests vasospasm as a second important etiology. Also, ischemic stroke can occur a
Transcatheter Closure of Atrial Septal Defects in Children, Middle-Aged Adults, and Older Adults: Failure Rates, Early Complications; and Balloon Sizing Effects  [PDF]
Chodchanok Vijarnsorn,Kritvikrom Durongpisitkul,Prakul Chanthong,Paweena Chungsomprasong,Jarupim Soongswang,Duangmanee Loahaprasitiporn,Apichart Nana
Cardiology Research and Practice , 2012, DOI: 10.1155/2012/584236
Abstract: Objectives. To compare the failure ratio and inhospital complications across three age groups of patients and to investigate the effects of balloon sizing on the success and the device diameter. Methods. This retrospective review was of 665 patients who had been listed for transcatheter-based closure of ASD between 1999 and 2010. The patients were divided into three age groups: children (<18 years; ), adults (18–50 years; ), and older adults (>50 years; ). Procedural outcomes and early complications were reviewed. Use of balloon sizing was explored for its benefits. Results. Overall, failure of closure was 6.6% ( ). Use of balloon sizing tended to lead to a smaller device/defect ratio that was comparable to procedures without balloon sizing, though it did not predict the success rate (OR 1.4, 95% CI 0.7–2.3). Seven patients reported device embolization (1%). No mortalities were noted. In-hospital complications were 3.4%, with common complications, being vascular complications (1.4%) and cardiac arrhythmia (1.1%). No differences in failure rate or events were found among the three groups. Conclusion. Transcather closure of ASD is feasible and safe, regardless of the patient’s age. A low rate of early complications was noted. Balloon sizing does not aggravate an oversizing of the device, but does not predict success. 1. Introduction Atrial septal defect (ASD) is a common congenital heart malformation comprising 5.9–10% of all congenital heart diseases (CHD) [1]. The defect may lead to right ventricular volume overload, increased pulmonary pressure, atrial arrhythmia, and paradoxical emboli in later decades. Usually, symptoms worsen with increasing age and according to an ageeffect of the patients’ ventricular compliance [2, 3]. The ideal remedy has been to eliminate the left- to right-shunt before it develops its late attritions [3]. Surgical closure has been accepted as the standard option, having nearly 100% efficacy [4]. Nevertheless, transcatheter closure of secundum-type ASD has also been used, after its introduction by King and Mills in 1974 [5]. Currently, the technique has become the preferred option in many institutes, because of its effects on cardiac geometry and performance that are comparable to surgical ASD closure, especially for young adults [6, 7]. Transcatheter closure of ASD should be carefully considered for small children, based on the procedure’s failure rate and safety [8, 9], though in older adults, the procedure is considered to have contentious benefits, because of long-standing volume overload and ageing comorbidities [2, 10,
Survivorship and Severe Complications Are Worse for Octogenarians and Elderly Patients with Pelvis Fractures as Compared to Adults: Data from the National Trauma Data Bank  [PDF]
Amir Matityahu,Joshua Elson,Saam Morshed,Meir Marmor
Journal of Osteoporosis , 2012, DOI: 10.1155/2012/475739
Abstract: Purpose. This study examined whether octogenarians and elderly patients with pelvic fractures have a different risk of complication and mortality as compared to adults. Methods. Data was gathered from the National Trauma Data Bank from 2002 to 2006. There were 32,660 patients 18–65, 6,408 patients 65–79, and 5,647 patients ≥ 80 years old with pelvic fractures. Descriptive statistics and bivariate and multivariate analyses were performed with the adult population as a referent. Results. Multivariate analysis showed 4.7-fold higher odds of death and 4.57 odds of complications in the octogenarian group after a pelvic fracture compared to adults. The elderly had 1.81-fold higher odds of death and 2.18-fold higher odds of severe complications after sustaining a severe pelvic fracture relative to adults. An ISS ≥ 16 yielded 15.1-fold increased odds of mortality and 18.3-fold higher odds of severe complications. Hypovolemic shock had 7.65-fold increased odds of death and 6.31-fold higher odds of severe complications. Between the ages of 18 and 89 years, there is approximately a 1% decrease in survivorship every 10 years. Conclusions. This study illustrates that patients older than 80 years old with pelvis fractures have a higher mortality and complications rate than elderly or adult patients. 1. Introduction Pelvic fractures comprise less than 5% of all fractures in octogenarians. However, fractures of the pelvis constitute up to 23% of admissions to level I trauma centers [1]. Similar to adults, octogenarians have pelvic fractures that can be associated with high-energy trauma and injury to other physiological systems that may lead to an increased incidence of complications and mortality [1]. Multiple fractures and organ damage may occur with low velocity injury because of the osteoporotic nature of the octogenarian skeleton and the increased association with chronic comorbidities and sarcopenia [2, 3]. Thus, an elderly person presenting with a pelvic fracture should be evaluated early for having a multiorgan injury with an increased potential for harm, complications, and death. Previous studies on octogenarian pelvic fractures analyzed the elderly population as a whole, including both the elderly (65–79 years old) and the octogenarians (≥ 80 years old) [1, 4]. Low velocity injuries in the elderly have been the focus studies that evaluated patients with osteoporosis and pelvis fractures [5–7]. Patients older than 80 comprise a period of life that is fraught with multiple comorbidities that are managed by their primary care physician. Decline in the
Survivorship and Severe Complications Are Worse for Octogenarians and Elderly Patients with Pelvis Fractures as Compared to Adults: Data from the National Trauma Data Bank  [PDF]
Amir Matityahu,Joshua Elson,Saam Morshed,Meir Marmor
Journal of Osteoporosis , 2012, DOI: 10.1155/2012/475739
Abstract: Purpose. This study examined whether octogenarians and elderly patients with pelvic fractures have a different risk of complication and mortality as compared to adults. Methods. Data was gathered from the National Trauma Data Bank from 2002 to 2006. There were 32,660 patients 18–65, 6,408 patients 65–79, and 5,647 patients ≥ 80 years old with pelvic fractures. Descriptive statistics and bivariate and multivariate analyses were performed with the adult population as a referent. Results. Multivariate analysis showed 4.7-fold higher odds of death and 4.57 odds of complications in the octogenarian group after a pelvic fracture compared to adults. The elderly had 1.81-fold higher odds of death and 2.18-fold higher odds of severe complications after sustaining a severe pelvic fracture relative to adults. An ISS ≥ 16 yielded 15.1-fold increased odds of mortality and 18.3-fold higher odds of severe complications. Hypovolemic shock had 7.65-fold increased odds of death and 6.31-fold higher odds of severe complications. Between the ages of 18 and 89 years, there is approximately a 1% decrease in survivorship every 10 years. Conclusions. This study illustrates that patients older than 80 years old with pelvis fractures have a higher mortality and complications rate than elderly or adult patients.
Health risks and complications associated with the use of intraoral and perioral piercing: knowledge of young adults
Ger?nimo Schettert Fortes,Tommy Luiz Rasmussen,Constanza Marin,Elisabete Rabaldo Bottan
RSBO , 2012,
Abstract: Objective: The aim of this study was to identify the knowledge of young adults on health risks and complications associated with the use of intraoral and perioral piercing. Material and methods: A descriptive transversal study using primary data. The study group comprised individuals with 18 years of age or more who were found in collective spaces, in the urban perimeter of Balneário Camboriu (Santa Catarina). The probabilistic sample was calculated as infinite population, defining a margin of error of 5%. The survey data were collected through an in-person structured questionnaire. Results: 395 individuals (39.5% male; 60.5% female) participated in the research, with ages ranging from 18 to 26 years-old. Most of the individuals (74.2%) have medium level of education. Six percent (6%) were or had been using oral piercing. Sixty-seven percent (67%) did not have received any information about the possible implications for health, as a result of the use of oral piercing; however, 89.7% believed that the use of this accessory offered risks to health. The percentage of users of oral piercing in the group was 6%, among which 93% told that they had observed some type of alteration as a result of the use of oral piercing. Conclusion: Most of the participants of this research did not have suitable knowledge on the health risks, as a result of the use of an oral piercing. Therefore the accomplishment of information campaigns for general population is fundamental, in which the -dentist must play a significant role.
Immunreconstitution and Infectious Complications After Rituximab Treatment in Children and Adolescents: What Do We Know and What Can We Learn from Adults?  [PDF]
Jennifer Worch,Olga Makarova,Birgit Burkhardt
Cancers , 2015, DOI: 10.3390/cancers7010305
Abstract: Rituximab, an anti CD20 monoclonal antibody, is widely used in the treatment of B-cell malignancies in adults and increasingly in pediatric patients. By depleting B-cells, rituximab interferes with humoral immunity. This review provides a comprehensive overview of immune reconstitution and infectious complications after rituximab treatment in children and adolescents. Immune reconstitution starts usually after six months with recovery to normal between nine to twelve months. Extended rituximab treatment results in a prolonged recovery of B-cells without an increase of clinically relevant infections. The kinetic of B-cell recovery is influenced by the concomitant chemotherapy and the underlying disease. Intensive B-NHL treatment such as high-dose chemotherapy followed by rituximab bears a risk for prolonged hypogammaglobulinemia. Overall transient alteration of immune reconstitution and infections after rituximab treatment are acceptable for children and adolescent without significant differences compared to adults. However, age related disparities in the kinetic of immune reconstitution and the definitive role of rituximab in the treatment for children and adolescents with B-cell malignancies need to be evaluated in prospective controlled clinical trials.
Urinary Retention in Adults Male Patients: Causes and Complications among Patients Managed in a Teaching Hospital in North Western Nigeria  [PDF]
Muzzammil Abdullahi, Bashir Yunusa, Sharfuddeen Abbas Mashi, Sani Ali Aji, Sani Usman Alhassan
Open Journal of Urology (OJU) , 2016, DOI: 10.4236/oju.2016.67020
Abstract: Background: Urinary retention is one of the common urologic emergencies constituting a significant workload of urologists and non-urologists alike. Aims and Objectives: This study was undertaken to identify the causes and complications associated with urinary retention in adult male patients at AKTH, Kano. Patients and Methods: It was a prospective hospital-based study of 110 consecutive adult male patients who presented to Aminu Kano Teaching Hospital, Kano with urinary retention over 12 months. On presentation, a brief history was taken and rapid physical examination done; the urinary retention was relieved by urethral catheterization or suprapubic cystostomy. A detailed history and thorough physical examination findings were later obtained. Results: One hundred and ten patients were seen during the study period. There ages ranged from 17 to100 years with a mean of 56 ± 19.3 SD years. Patients within the age range 55 - 74 years accounted for the largest group, (25.5% + 23.6% = 49.1%). The most common cause of urinary retention in this study was benign prostatic hyperplasia (51.8% of the patients). This was followed by urethral stricture (20%), cancer of the prostate (7.3%), urethral injury (7.3%) and bladder tumour (6.4%). More than half of the patients (53.4%) presented with acute urinary retention, 30.5% presented with chronic urinary retention, and 16.1% were diagnosed to have acute-on-chronic urinary retention. The complications of urinary retention found were: urinary tract infection (in 24.5% of patients), renal impairment (14.5%), and anaemia (11.8%). Conclusion: Urinary retention is commoner among the middle aged and the elderly. Benign prostatic hyperplasia remains the leading cause of urinary retention. Acute urinary retention was the commonest type of urinary retention; however, complications due to the retention were associated with chronic and acute-on-chronic urinary retention.
Long-Term Nucleos(t)ide Analogues Therapy for Adults With Chronic Hepatitis B reduces the Risk of Long-Term Complications: a meta-analysis
Qin-Qin Zhang, Xuan An, Ying-Hong Liu, Shi-Ying Li, Qing Zhong, Jing Wang, Huai-Dong Hu, Da-Zhi Zhang, Hong Ren, Peng Hu
Virology Journal , 2011, DOI: 10.1186/1743-422x-8-72
Abstract: We searched MEDLINE, EMBASE, OVID, the Cochrane Central Register of Controlled Trials. Relative risks (RRs) of long-term complications with or without treatment were studied. Also subgroup analyses including the status of drug-resistance, HBeAg and pre-existing compensated cirrhosis were done using relative risks of long-term complications either with or without treatment or among nucleos(t)ide analogues treatment groups.Six eligible studies (3644 patients in all) were included. Data showed the incidence of long-term complications in treatment groups was induced by 74%(RR:0.26, 95% CI: 0.15-0.47) compared with no treatment. Whether drug-resistant happened or not during the long-term therapy, the incidence of long-term complications was still significantly induced respectively by 45%(RR: 0.55,95%CI:0.40-0.76) and 78% (RR:0.22, 95%CI: 0.13-0.36). For both different status of HBeAg and pre-existing compensated cirrhosis, there was significant lower incidence of long-term complications in treatment groups compared with no treatment, too. Moreover, among the NA treatment groups, patients with drug-resistance had 2.64 times (RR:2.64, 95%CI: 1.58-4.41) higher chance of developing to long-term complications, and patients with pre-existing compensated cirrhosis also had 3.07 times (RR:3.07, 95%CI: 1.04-9.11) higher chance of developing to long-term complications.Long-term nucleos(t)ide analogue therapy for adults with CHB prevents or delays the development of long-term complications including decompensated cirrhosis, CHB-related death or CHB-related HCC in patients with CHB. The patients who need take antiviral drugs should receive the antiviral therapy as soon as possible.HBV infection is a common global public health problem which affects over 400 million people worldwide [1]. It not only leads to a wide spectrum of liver disease ranging from acute hepatitis (including fulminant hepatic failure) to chronic hepatitis [2] but also the main reason of fatal complications inclu
Orbital complications of rhinosinusitis  [PDF]
Stojanovi? J.,Ili? N.,Beli? B.,?ivi? Lj.
Acta Chirurgica Iugoslavica , 2009, DOI: 10.2298/aci0903121s
Abstract: Introduction: Orbital complications were observed in 53 patients (1.35%, n=53/3912 of all treated patients; 11.04% , n= 53/480 of hospitalized patients). Complications in the orbit can occur in 3 - 5% of adults with the inflammatory condition of sinuses, while the percentage in children ranges from 0.5 - 8%. Objective: The objective of our work was to determine the frequency of the occurrence of orbital complications of the rhinosinal inflammatory origin in a group of adults and children. Method: The retrospective analysis of patients treated of rhinosinusitis in the period 1992 to 2007, in the Clinical Center in Kragujevac. Results: In the period of 15 years, a total number of 3912 patients were treated for inflammatory conditions of paranasal cavities. Orbital complications were found in 53 patients (1.35%, n=53/3912 of all treated patients). The number of children showing orbital complications caused by rhinosinusitis was 0.79%, while the number of adults was 1,88%. Acute rhinosinusitis in children was manifested as orbital complication in 14 patients (n=14/15, 93.33%), while 33 adults (n=33/38, 86.84%) had the exarcerbation of the chronic rhinosinusitis at the time of diagnosis of orbital complication. 80% of examined children had the maxillary and ethmoid sinus infected (n=12/15), while the adults most often had polysinusitis (n=22/38, 57.89%). In the juvenile age the most frequent complication was the cellulitis of the orbite (n=7/15 , 46.66%), while in the adults it was the subperiostal absces (n=14/38, 36.84%). The adults were mostly treated surgically (n=31/38, 81.58%), while the children were treated by using conservative treatment (n=13/15, 86.67%). There were no cases of mortality. Conclusion: The prevention of complications is based on the adequate and timely treatment of acute sinusitis in children, as well as the curative treatment of chronical processes in adults.
Genetic Polymorphisms and Posttraumatic Complications  [PDF]
Wei Gu,Jianxin Jiang
Comparative and Functional Genomics , 2010, DOI: 10.1155/2010/814086
Abstract: Major trauma is the leading cause of death in young adults. Despite advances in prehospital system and treatment in hospital, mortality rates have not improved significantly over the past decades. Victims of severe injuries who survive the initial hours have great risk for additional life-threatening complicaitons, including uncontrollable infection (sepsis) and multiple organ dysfunction syndrome (MODS). Single nucleotide polymorphisms (SNPs) have been shown to affect susceptibility to the course of numerous diseases. Accumulating evidence suggests that genetic backgrounds also play important roles in posttraumatic complications. Genetic polymorphisms may become powerful biomarkers for diagnosis and prognosis of trauma-induced complications. Recent advances in studies on associations between genetic polymorphisms and sepsis or MODS have led to better understanding of posttraumatic complications. Here we summarise recent findings on genetic variations in molecules of the innate immune system and other systems as well as their connection with susceptibility to posttraumatic complications.
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