回顾性分析颅内肿瘤患者术后感染危险因素

目的:了解神经外科颅内肿瘤切除患者术后相关感染（HAI）的发生情况及其危险因素,为制定干预措施提供理论依据。方法:收集 2017 年1月至2018年12月1 049例颅脑手术患者的临床资料,根据术后是否发生颅内感染将患者分为感染组 91例和非感染组958例。对两组患者进行临床资料的单因素和多因素logistic回归分析。结果:颅内肿瘤患者术后医院感染率为8.67%。两组在年龄、性别、职业、文化程度、民族、药物过敏、切口等级等方面比较差异无统计学意义（P＞0.05）,麻醉方式、手术等级、转科情况、住院天数和住院费用两方面比较差异有统计学意义（P＜0.05）;经过logistic多因素回归分析显示麻醉方式、住院天数是颅内肿瘤手术患者术后医院感染的独立危险因素,其OR及95％CI分别为5.173（2.738～9.774）、1.132（1.079～1.189）。结论:颅脑手术患者中HAI发生率较高,应根据危险因素采取有效预防和控制措施,以降低HAI的发生率。     

Community-Based Assessment of Knowledge,Attitude, Practices and Risk Factors Regarding COVID-19 Among Pakistanis Residents During a Recent Outbreak: A Cross-Sectional Survey

Exceptional precautionary measures have been adopted to stop the transmission and control of COVID-19 through the world and Pakistan is facing lockdown in this scenario. Public loyalty to precautionary measures is affected by their knowledge, attitude, risk factors and practices (KAP) towards COVID-19. The present study was conducted among the Pakistani residents to observe the knowledge, attitude, practices and risk factors towards COVID-19 outbreak in Pakistan. A questionnaire was designed, and a cross-sectional survey was conducted among participants of the study area. Participants were asked the questions regarding knowledge, attitude, practices and risk factors towards COVID-19. Data were analyzed by SPSS and t/F test and correlation was applied among the knowledge, attitude, risk factors and practices. A total of 1060 questionnaires were received. 1004 were included while 56 were excluded. The highest representation was from Punjab province (65.6%), female (63%) and age group of 21–30 years (62.1%). Most participants were single (85%), Muslim (99.4%), Urdu speaking (45.6%) and were graduates (51.5%). Most of the participants were students (52.9%) and were from economically middle-class families (40.8%). The knowledge was positively correlated with attitude and practices whereas negatively correlated with risk factors (P?<?0.05). The attitude was negatively correlated with risk factor and positively correlated with practices. The risk factors and practices were positively correlated with each other. Health education program to improve the COVID-19 knowledge, attitude, practices and risk factors should be initiated to combat current health challenge.

     

Cytomegalovirus associated oral ulcerations in HIV-infected patients

Oral ulcerations associated with disseminated cytomegalovirus (CMV) infection were observed in four patients with AIDS manifestations showing low CD4 counts. Virus cultures of urine and saliva samples were positive for CMV in all cases. The lesions were characterized by a punched-out appearance, non-indurated borders, low bleeding tendency and lack of inflammatory wall. Light microscopy revealed granulation tissue containing "owl's eye" like cells in all specimens. Presence of CMV was confirmed by immunohistochemistry and in situ hybridization. The ulcerations were infiltrated with T-lymphocytes of the helper, suppressor and cytotoxic subset, most were positive for HLA DR. Despite the local invasion with immunocytes and high serum titers of serum antibodies the patients experienced progressive CMV disease.     

Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control

Background

Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care.

Objective

To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control.

Design

Retrospective difference-in-difference analysis.

Participants

Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis).

Intervention

From July 1, 2014–December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation.

Main Measures

Meeting guideline concordant LDL and BP goals.

Key Results

At baseline, there were racial/ethnic disparities in meeting LDL (p?=?0.007) and BP (p?=?0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09–1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80–1.65) and Hispanic (OR 1.29 95% CI 0.66–2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05–1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94–1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59–1.36) patients did not. Interaction testing confirmed that disparities did not decrease (p?=?0.73 for LDL and p?=?0.69 for BP).

Conclusions

The population health management intervention did not decrease disparities. Further efforts should explicitly target improving both healthcare equity and quality.Clinical Trials #: NCT02812303 (ClinicalTrials.gov).

     

Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan

This prospective study aimed to determine the surgical site infection (SSI) rate and associated risk factors was carried in a general surgical ward at Liaquat University Hospital Jamshoro. A total of 460 patients requiring elective general surgery from July 2005 to June 2006 were included in this study. All four surgical wound categories were included. Primary closure was employed in all cases. Patients were followed up to 30th day postoperatively. All cases were evaluated for postoperative fever, redness, swelling of wound margins and collection of pus. Cultures were taken from all the cases with any of the above finding. Mean +/- SD age of the patients was 38.8 +/- 17.4 years with male to female ratio of 1.5:1. The overall rate of surgical site infection was 13.0%. The rate of wound infection was 5.3% in clean operations, 12.4% in clean-contaminated, 36.3% in contaminated and 40% in dirt-infected cases. Age, use of surgical drain, duration of operation and wound class were significant risk factors for increased surgical site infection (P < 0.05). Postoperative hospital stay was double in cases who had surgical site infection. Sex, haemoglobin level and diabetes were not statistically significant risk factors (P > 0.05). In conclusion, surgical site infection causes considerable morbidity and economic burden. The routine reporting of SSI rates stratified by potential risk factors associated with increased risk of infection is highly recommended.     

Clinical features of culture-proven Mycoplasma pneumoniae infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Objective  

This retrospective chart review describes the epidemiology and clinical features of 40 patients with culture-proven Mycoplasma pneumoniae infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.     

‘Putting our heads together’: insights into genomic conservation between human and canine intracranial tumors

Numerous attributes render the domestic dog a highly pertinent model for cancer-associated gene discovery. We performed microarray-based comparative genomic hybridization analysis of 60 spontaneous canine intracranial tumors to examine the degree to which dog and human patients exhibit aberrations of ancestrally related chromosome regions, consistent with a shared pathogenesis. Canine gliomas and meningiomas both demonstrated chromosome copy number aberrations (CNAs) that share evolutionarily conserved synteny with those previously reported in their human counterpart. Interestingly, however, genomic imbalances orthologous to some of the hallmark aberrations of human intracranial tumors, including chromosome 22/NF2 deletions in meningiomas and chromosome 1p/19q deletions in oligodendrogliomas, were not major events in the dog. Furthermore, and perhaps most significantly, we identified highly recurrent CNAs in canine intracranial tumors for which the human orthologue has been reported previously at low frequency but which have not, thus far, been associated intimately with the pathogenesis of the tumor. The presence of orthologous CNAs in canine and human intracranial cancers is strongly suggestive of their biological significance in tumor development and/or progression. Moreover, the limited genetic heterogenity within purebred dog populations, coupled with the contrasting organization of the dog and human karyotypes, offers tremendous opportunities for refining evolutionarily conserved regions of tumor-associated genomic imbalance that may harbor novel candidate genes involved in their pathogenesis. A comparative approach to the study of canine and human intracranial tumors may therefore provide new insights into their genetic etiology, towards development of more sophisticated molecular subclassification and tailored therapies in both species.     

Near infrared spectroscopy in paediatric cardiac surgery – a review of local experience and national survey

Introduction: Many centres have adopted Near infrared spectroscopy (NIRS) as a standard of care for adult cardiac surgery, despite limited evidence [1]. A search of the literature on the use of NIRS in paediatric cardiac surgery reveals mostly case reports and no randomised controlled trials. NIRS has been used for selected cases at Bristol Children's Hospital (BCH) for 2 years. We sought to establish firstly, whether there was evidence that NIRS had guided perioperative management at BCH by auditing current practice and, secondly, whether NIRS was used routinely in the other UK paediatric cardiac centres. Methods: For the first phase of the project, downloaded NIRS data, anaesthetic and bypass records covering a 10‐week period at BCH were collated retrospectively. Periods of significant cerebral desaturation were mapped to contemporaneous notes and recordings to determine whether they related to specific perioperative events. In the second phase, a 10‐question survey was e‐mailed to a paediatric cardiac anaesthetist at all UK paediatric cardiac centres. A reminder email was sent 10 days later, if required and a second anaesthetist was contacted after a further week if there was still no response. Anaesthetists were asked questions concerning their peri‐ and‐postoperative use of NIRS, how reliant they were on it, what indicators they used to signify cerebral hypoxia and whether they have used NIRS to guide therapy. Results: NIRS at Bristol Children's Hospital Twenty eight sets of records were analysed and, of these, two provided clear evidence of NIRS guiding perioperative management. In the first, concerning a 19‐month‐old, a Glenn shunt was performed on bypass, following a non‐bypass attempt, aborted due to poor cerebral oxygen saturations. The second concerned low cerebral tissue saturation due to temporary obstruction of the superior vena cava by the cannula after commencing bypass in a 3‐year‐old. National Survey: We received 11 completed surveys from 13 centres. NIRS is used in 6/11 (55%) centres and, of these, three use it for all cases. Of the four that don't use NIRS, two plan to in the near future. All of those using NIRS routinely stated they would now be uncomfortable undertaking a case without it. Concerning those with experience of NIRS (7), cerebral hypoxia is determined by either a percentage drop (3), absolute values (1) or a combination (3). The cerebral saturation % for concern given ranged from 30% to 55%. All centres with NIRS also used it postoperatively (although half did so only occasionally) and 6/7 of those with experience of NIRS were aware of situations where NIRS had significantly altered patient management. Discussion: There is a large disparity in the use of NIRS in paediatric cardiac surgery in the UK with around half of the centres surveyed using it. Furthermore, of those that do use NIRS, there is a lack of consensus between centres on the most accurate mechanisms and thresholds used to identify cerebral hypoxia. This is probably related to the lack of clarity in the literature of the benefits of NIRS in this patient group. Our local review illustrated two instances, over 10 weeks, where NIRS was valuable in directing patient management. Furthermore, the vast majority of those surveyed with experience of NIRS had also used it to guide management at some point. There are some limitations to this study. Our local note review was retrospective and relied on accurate reporting by the anaesthetist at the time. If anything, however, this would result in the under‐reporting of events. We acknowledge that we only surveyed one anaesthetist in each centre and their answers may not reflect those of all of their colleagues. There were also two centres that we were unable to get a reply from. Conclusion: We have found two local examples of perioperative management guided by NIRS. We have further identified, through the survey, evidence of the inconsistency and deficiency of standard in the use of NIRS in the UK. Conflict of interest: The authors declare no conflict of interest in this study.