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Clinical Severity Score Infection

Jacob Calvert, Nicholas Saber, Jana Hoffman, Ritankar Das
Sepsis, a dysregulated host response to infection, is a major health burden in terms of both mortality and cost. The difficulties clinicians face in diagnosing sepsis, alongside the insufficiencies of diagnostic biomarkers, motivate the present study. This work develops a machine-learning-based sepsis diagnostic for a high-risk patient group, using a geographically and institutionally diverse collection of nearly 500,000 patient health records. Using only a minimal set of clinical variables, our diagnostics outperform common severity scoring systems and sepsis biomarkers and benefit from being available immediately upon ordering...
February 13, 2019: Diagnostics
Sungwook Choi, Jong-Hwan Bae, Yong Suk Kwon, Hyunseong Kang
BACKGROUND: Reverse total shoulder arthroplasty (RTSA) is a treatment option for patients with severe osteoarthritis, rotator cuff arthropathy, or massive rotator cuff tear with pseudoparalysis. We are to deduce not only the early functional outcomes and complications of cementless RTSA during the learning curve period but also complication-based, and operation time-based learning curve of RTSA. METHODS: Between March 2010 and February 2014, we retrospectively evaluated 38 shoulders (6 male, 32 female)...
February 18, 2019: Journal of Orthopaedic Surgery and Research
Narendra S Choudhary, Sanjiv Saigal, Dheeraj Gautam, Neeraj Saraf, Amit Rastogi, Sanjay Goja, Prashant Bhangui, Srinivasan Thiagrajan, Sanjay K Yadav, Saurabh Mehrotra, Vipul Rastogi, Arvinder S Soin
INTRODUCTION: There are limited data on outcomes of living donor liver transplantation (LDLT) for patients with severe alcoholic hepatitis. METHODS: The study included LDLT recipients for severe alcoholic hepatitis (n = 39) who did not improve with medical treatment and compared their outcomes with patients who underwent LDLT for alcoholic liver disease (n = 461). The diagnosis of severe alcoholic hepatitis was based on both clinical and explants data. No patients had psychiatric contraindications for liver transplant and all had good family support...
July 24, 2018: Alcohol
M Del Papa, G D'Amata, F Manzi, P Carnì, G Florio, M Crovaro, L Musmeci, C Buonocore
Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. Several trials have investigated the role of self-adhesive mesh repair for inguinal hernia, with special attention to the incidence of chronic postoperative inguinal pain and recurrence. The purpose of our study was to retrospectively evaluate the early and long-term results using a self-gripping mesh (Parietex Progrip® , Covidien) in our institution. A total of 204 patients, mean age 50.3 standard deviation (SD) 15...
January 2019: Il Giornale di Chirurgia
Chanu Rhee, Zilu Zhang, Sameer S Kadri, David J Murphy, Greg S Martin, Elizabeth Overton, Christopher W Seymour, Derek C Angus, Raymund Dantes, Lauren Epstein, David Fram, Richard Schaaf, Rui Wang, Michael Klompas
OBJECTIVES: Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment score by greater than or equal to 2 points. However, some Sequential Organ Failure Assessment score components are not routinely recorded in all hospitals' electronic health record systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for electronic health records (eSOFA)...
March 2019: Critical Care Medicine
Talia M Nir, Neda Jahanshad, Christopher R K Ching, Ronald A Cohen, Jaroslaw Harezlak, Giovanni Schifitto, Hei Y Lam, Xue Hua, Jianhui Zhong, Tong Zhu, Michael J Taylor, Thomas B Campbell, Eric S Daar, Elyse J Singer, Jeffry R Alger, Paul M Thompson, Bradford A Navia
Growing evidence points to persistent neurological injury in chronic HIV infection. It remains unclear whether chronically HIV-infected individuals on combined antiretroviral therapy (cART) develop progressive brain injury and impaired neurocognitive function despite successful viral suppression and immunological restoration. In a longitudinal neuroimaging study for the HIV Neuroimaging Consortium (HIVNC), we used tensor-based morphometry to map the annual rate of change of regional brain volumes (mean time interval 1...
February 14, 2019: Journal of Neurovirology
Yun Zhou, Vatsalya Vatsalya, Leila Gobejishvili, Richard J Lamont, Craig J McClain, Wenke Feng
Bacterial infection is frequently observed in patients with alcoholic liver disease (ALD). We examined a possible role of Porphyromonas gingivalis in the development/progression and severity of disease in patients with acute alcoholic hepatitis (AAH). Plasma specimens from 47 patients with AAH (16 moderate, Model for End-Stage Liver Disease [MELD] score <20]; 31 severe, MELD score >20) and 22 healthy controls (HCs) were collected. Clinical, drinking history (lifetime drinking history [LTDH]), and demographic data were collected...
February 2019: Hepatology communications
Giovanni Guaraldi, Stefano Zona, Ana Rita Silva, Marianna Menozzi, Giovanni Dolci, Jovana Milic, Federica Carli, Cristina Mussini
OBJECTIVE: To investigate the association between current CD4+ T-cell count and CD4/CD8+ ratio with severity of frailty among people aging with HIV. METHODS: Cross-sectional observational study analysing data from all study visits in the ongoing prospective Modena HIV Metabolic Clinic Cohort between 2006 and 2015. Frailty severity was assessed using a frailty index (FI). We visualized the relationships between frailty index score and current CD4 cell count and CD4/CD8 ratio on two different curves adjusted for age, sex, and duration of HIV infection...
2019: PloS One
Mariëlle Rockland, Mike Marvin Ruth, Nicole Aalders, Lian Pennings, Wouter Hoefsloot, Melanie Wattenberg, Jakko van Ingen
Nontuberculous mycobacteria (NTM) cause severe opportunistic infections and have a rising incidence in most settings. Rising diagnostic need must be met by national reference laboratories, which rely on Clinical & Laboratory Standards Institute (CLSI) guideline approved manual readout of microtiter plates for antimicrobial susceptibility testing (AST) to determine antibiotic minimum inhibitory concentrations (MICs). Interpretation of these plates leads to different outcomes between laboratories. The SensiTitre™ Vizion™ Digital MIC Viewing System (Vizion) offers a more streamlined approach using semi-automated reading...
February 13, 2019: Journal of Clinical Microbiology
Fiona C C Chan, Phillip Chan, Iris Chan, Andrew Chan, Tommy H C Tang, Wilson Lam, W C Fong, M P Lee, Patrick Li, Germaine H F Chan
BACKGROUND: HIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy (cART). The prevalence of HAND in Hong Kong is not known. METHODS: Between 2013 and 2015, 98 treatment-naïve HIV-1-infected individuals were referred to and screened by the AIDS Clinical Service, Queen Elizabeth Hospital with (1) the International HIV Dementia Scale (IHDS), a screening tool that targets moderate to severe HAND, (2) the Montreal Cognitive Assessment (MoCA), a frequently used cognitive screening test and (3) the Patient Health Questionnare-9 (PHQ-9), a 9-item questionnaire that evaluates depression symptoms...
February 13, 2019: BMC Infectious Diseases
Federico De Meo, Giorgio Cacciola, Vittorio Bellotti, Antongiolio Bruschetta, Pietro Cavaliere
INTRODUCTION: Severe acetabular bone loss during revision hip arthroplasty can be restored with different surgical techniques. Best results have been observed using porous tantalum cementless cups. Trabecular Titanium (TT) cups were designed to reproduce the structure, mechanical and biological characteristics of trabecular bone. Few clinical studies have been published with these cups. The aim of this study is to evaluate the clinical and radiological outcome of patients with large acetabular defects (Paprosky IIb or higher) revised using TT cups...
November 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Edward V Loftus, Walter Reinisch, Remo Panaccione, Sofie Berg, Gabriela Alperovich, Mareike Bereswill, Jasmina Kalabic, Joel Petersson, Roopal Thakkar, Anne M Robinson, Geert D'Haens
Background: PYRAMID was an international multicenter, noninterventional, postmarketing registry assessing long-term safety and effectiveness of adalimumab (Humira), as used in routine clinical practice. Methods: Adult patients with moderately to severely active Crohn's disease with or without prior adalimumab experience were enrolled in the registry and followed for up to 6 years. Effectiveness measurements included the Physician's Global Assessment (PGA, a composite of Harvey Bradshaw Index [HBI] and rectal bleeding score), clinical remission (HBI < 5), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and Work Productivity and Activity Impairment (WPAI) questionnaire...
February 8, 2019: Inflammatory Bowel Diseases
Tanya Anand, Santa Ponce, Andrea Pakula, Cindy Norville, David Kallish, Maureen Martin, Ruby Skinner
Ventilator-associated pneumonia (VAP) is linked to increased morbidity and mortality and clinical protocols (VAP bundles) have evolved to minimize VAP. In 2009, a quality improvement project was implemented at our institution to decrease VAP rates in adult trauma patients. A VAP prevention committee was developed, and formal evidence-based education for the nursing and physician staff was introduced. During the study period (2009-2016), 2380 patients required ICU admission to our Level II trauma center. The mean Injury Severity Score was 33 + 12, and there were 17 per cent penetrating and 83 per cent blunt injuries...
October 1, 2018: American Surgeon
Maria Chiara Supino, Danilo Buonsenso, Simona Scateni, Barbara Scialanga, Maria Alessia Mesturino, Caterina Bock, Antonio Chiaretti, Emanuele Giglioni, Antonino Reale, Anna Maria Musolino
Bronchiolitis is the most common cause of hospitalization of children in the first year of life. The lung ultrasound is a new diagnostic tool which is inexpensive, non-invasive, rapid, and easily repeatable. Our prospective study was conducted in the emergency department and all patients underwent a routine clinical evaluation and lung ultrasound by the pediatricians who defined the clinical and the ultrasound score. We enrolled 76 infants (median age 90 days [IQR 62-183], 53.9% males). In nasopharyngeal aspirates, the respiratory syncytial virus was isolated in 33 patients...
February 12, 2019: European Journal of Pediatrics
John H Ahn, Jennifer L Waller, Stephanie L Baer, Rhonda E Colombo, Mufaddal F Kheda, N Stanley Nahman, Jake E Turrentine
Background: End-stage renal disease (ESRD) patients have increased risk of developing herpes zoster (zoster) compared with the general population, but mortality risk is unknown. We assessed the risk of mortality in hospitalized ESRD patients with a diagnosis of zoster from the inpatient hospital files (as opposed to outpatient records) of the United States Renal Data System. Methods: This study analyzed incident ESRD patients from 2006 to 2009. Based on an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of zoster infection, we determined 2-year mortality following an inpatient diagnosis...
February 2019: Clinical Kidney Journal
Thomas Puehler, Armin Zittermann, Mohamad Dia, Eric Emmel, Mustafa Gercek, Jochen Börgermann, Kavous Hakim-Meibodi, Jan Gummert
BACKGROUND:  Coronary artery bypass grafting is the first-line therapy for severe multivessel coronary artery disease. We aimed to investigate the clinical outcome in patients undergoing isolated off-pump surgery with the single or bilateral internal mammary artery (SIMA or BIMA) approach. METHODS:  We performed a propensity score-matched analysis in 1,852 consecutive patients, aged 50 to 70 years, who underwent myocardial revascularization at our institution between July 2009 and August 2016...
February 9, 2019: Thoracic and Cardiovascular Surgeon
Elizabeth Y Killien, Reid W D Farris, R Scott Watson, Leslie A Dervan, Jerry J Zimmerman
OBJECTIVES: Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis. DESIGN: Retrospective cohort study. SETTING: Seattle Children's Hospital. PATIENTS: Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available...
February 1, 2019: Pediatric Critical Care Medicine
Antje Giede-Jeppe, Jonathan Reichl, Maximilian I Sprügel, Hannes Lücking, Philip Hoelter, Ilker Y Eyüpoglu, Joji B Kuramatsu, Hagen B Huttner, Stefan T Gerner
OBJECTIVEStroke-associated immunosuppression and inflammation are increasingly recognized as factors triggering infections and thus potentially influencing outcome after stroke. Several studies have demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes for patients with ischemic stroke or intracerebral hemorrhage. Thus far, in patients with subarachnoid hemorrhage the association between NLR and outcome is insufficiently established. The authors sought to investigate the association between NLR on admission and functional outcome in aneurysmal subarachnoid hemorrhage (aSAH)...
February 1, 2019: Journal of Neurosurgery
Alessandro Aprato, Matteo Olivero, Luigi Branca Vergano, Alessandro Massè
BACKGROUND AND AIM OF THE WORK: To investigate the clinical, radiological and functional outcomes of acetabular revisions with acetabular reinforcement rings and cages. METHODS: A comprehensive literature study of international databases was performed. Inclusion criteria were cementless revisions, use of reinforcement rings, radiological and clinical follow-up, availability of full text in English, publication between January 1990 and July 2018. In a second further analysis, we selected only studies describing patients with more severe acetabular defects (AAOS 3, AAOS 4, Paprosky III)...
January 10, 2019: Acta Bio-medica: Atenei Parmensis
Grant V Bochicchio, Alvaro Garcia, Jarrod Kaufman, Qiao Zhang, Chris Horn, Kelly Bochicchio, Bryan Sato, Stacey Reese, Obeid Ilahi
BACKGROUND: To our knowledge, there is an absence of PRMCTs evaluating both the impact of technique and mesh type on outcome in CVHR. STUDY DESIGN: A PRMCT of 120 patients at 3 sites was conducted in which patients were randomized to either overlay (anterior component separation) vs. underlay mesh placement (posterior component separation) and mesh type (human acellular HADM vs porcine acellular PADM dermis). Key inclusion criteria included hernia size (>200 cm2 ), BMI <40 kg/m2 , HBA1C <7%, tobacco free >6 weeks and primary fascial closure...
January 29, 2019: Journal of the American College of Surgeons
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