Independent Risk Factor For Pneumonia Research Articles

A nomogram predicting pneumonia after cardiac surgery: a retrospective modeling study

BackgroundPostoperative pneumonia (POP) is the most prevalent of all nosocomial infections in patients who underwent cardiac surgery. The aim of this study was to identify independent risk factors for pneumonia after cardiac surgery, from which we constructed a nomogram for prediction.MethodsThe clinical data of patients admitted to the Department of Cardiothoracic Surgery of Nanjing Drum Tower Hospital from October 2020 to September 2021 who underwent cardiac surgery were retrospectively analyzed, and the patients were divided into two groups according to whether they had POP: POP group (n=105) and non-POP group (n=1083). Preoperative, intraoperative, and postoperative indicators were collected and analyzed. Logistic regression was used to identify independent risk factors for POP in patients who underwent cardiac surgery. We constructed a nomogram based on these independent risk factors. Model discrimination was assessed via area under the receiver operating characteristic curve (AUC), and calibration was assessed via calibration plot.ResultsA total of 105 events occurred in the 1188 cases. Age (>55 years) (OR: 1.83, P=0.0225), preoperative malnutrition (OR: 3.71, P<0.0001), diabetes mellitus(OR: 2.33, P=0.0036), CPB time (Cardiopulmonary Bypass Time) > 135 min (OR: 2.80, P<0.0001), moderate to severe ARDS (Acute Respiratory Distress Syndrome )(OR: 1.79, P=0.0148), use of ECMO or IABP or CRRT (ECMO: Extra Corporeal Membrane Oxygenation; IABP: Intra-Aortic Balloon Pump; CRRT: Continuous Renal Replacement Therapy )(OR: 2.60, P=0.0057) and MV( Mechanical Ventilation )> 20 hours (OR: 3.11, P<0.0001) were independent risk factors for POP. Based on those independent risk factors, we constructed a simple nomogram with an AUC of 0.82. Calibration plots showed good agreement between predicted probabilities and actual probabilities.ConclusionWe constructed a facile nomogram for predicting pneumonia after cardiac surgery with good discrimination and calibration. The model has excellent clinical applicability and can be used to identify and adjust modifiable risk factors to reduce the incidence of POP as well as patient mortality.

Risk factors for pneumonia among children with coinfection of influenza A virus and Mycoplasma pneumoniae.

To investigate the clinical characteristics and risk factors for pneumonia in children co-infected with influenza A virus (IAV) and Mycoplasma pneumoniae (MP). Children who were diagnosed with IAV and MP infection between January and December, 2023 were enrolled and divided into a non-pneumonia group and a pneumonia group. Univariate analysis and logistic regression analysis were used to evaluate each index, and the risk factors for pneumonia caused by coinfection in the two groups were explored. A total of 209 patients were enrolled, of which 107 and 102 patients were in the pneumonia and non-pneumonia groups, respectively. The patients in the pneumonia group were older and had a longer duration of fever (P < 0.05). Univariate analysis revealed that the median age, duration of fever, and CD3+, CD4+, CD8+ and IL-10 levels were significantly correlated with pneumonia (P < 0.05). Multivariate logistic regression analysis revealed that the median age, duration of fever, and CD4+, CD8+ and IL-10 levels were independent risk factors for pneumonia. Area under the curve of the five combined indicators in the ROC (receiver operator characteristic) analysis was 0.883, was higher than single factor. Children with IAV and MP infection whose age older than 6.08years, had a fever longer than 4days, had a CD4+ count < 22.12%, had a CD8+ count < 35.21%, had an IL-10 concentration > 22.08 ng/ml were more likely to develop pneumonia.

The Trends of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Systemic Immunoinflammatory Index in Patients with Intracerebral Hemorrhage and Clinical Value in Predicting Pneumonia 30 Days After Surgery

BackgroundInflammatory response is closely associated with secondary brain injury and pneumonia in intracerebral hemorrhage (ICH). In this study, we aimed to investigate the value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII) in the development of pneumonia in ICH patients 30 days after surgery. MethodsWe retrospectively collected clinical data on patients with ICH who underwent surgical treatment at our institution from January 2016 to December 2022, mainly including NLR, PLR and SII at different time points. Receiver operating characteristic (ROC) curves were used to compare the value of different inflammatory indicators in predicting the development of postoperative pneumonia 30 days after surgery in ICH patients, and multivariate logistic regression analyses were used to identify independent risk factors for pneumonia 30 days after surgery. ResultsAmong 112 patients with intracerebral hemorrhage undergoing surgical treatment, 31 (27.7%) developed pneumonia postoperatively. The results of the univariate analysis demonstrated that patients in the pneumonia group experienced significantly higher blood glucose, NLR3, PLR3, and SII3 than those in the non- pneumonia group, and significantly lower admission Glasgow Coma Scale (GCS) scores than those in the Non- pneumonia group (all P<0.05). NLR, PLR, and SII showed an increasing and then decreasing in the disease process of intracerebral hemorrhage, and peaked at 48 hours postoperatively. Multivariable logistic regression analysis revealed that SII3 was an independent risk factor for postoperative pneumonia 30 days after surgery in ICH patients (OR=1.001, 95%CI: 1.000-1.002, P=0.008). The area under the curve (AUC) of the developed nomogram model was 0.895 (95%CI = 0.823 - 0.967), with a sensitivity and specificity of 0.903 and 0.815, respectively, providing good predictive power. ConclusionsIn the course of intracerebral hemorrhage, NLR, PLR, and SII increased and then decreased, and peaked at 48 hours postoperatively. The SII3 was the best predictor of the occurrence of pneumonia postoperatively in ICH patients.

Development and validation of a nomogram for pneumonia risk in burn patients with inhalation injury: a multicenter retrospective cohort study.

Burn patients with inhalation injury are at higher risk of developing pneumonia, and yet there is no reliable tool for the assessment of the risk for such patients at admission. This study aims to establish a predictive model for pneumonia risk for burn patients with inhalation injury based on clinical findings and laboratory tests. This retrospective study enrolled 546 burn patients with inhalation injury. They were grouped into a training cohort and a validation cohort. The least absolute shrinkage and selection operator (LASSO) regression analysis and binary logistic regression analysis were utilized to identify risk factors for pneumonia. Based on the factors, a nomogram for predicting pneumonia in burn patients with inhalation injury was constructed. Areas under the receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis (DCA) were used to evaluate the efficiency of the nomogram in both the training and validation cohorts. The training cohort included 432 patients, and the validation cohort included 114 patients, with a total of 225 (41.2%) patients experiencing pneumonia. Inhalation injury, tracheal intubation/tracheostomy, low serum albumin, and high blood glucose were independent risk factors for pneumonia in burn patients with inhalation injury and they were further used to build the nomogram. The AUC of the nomogram in the training and validation cohorts were 0.938 (95% CI: 0.917-0.960) and 0.966 (95% CI: 0.931-1), respectively. The calibration curve for probability of pneumonia showed optimal agreement between the prediction by nomogram and the actual observation, and the DCA indicated that the constructed nomogram conferred high clinical net benefit. This nomogram can accurately predict the risk of developing pneumonia for burn patients with inhalation injury, and help professionals to identify high-risk patients at an early stage as well as to make informed clinical decisions.

Serum Interleukin-6 and Serum Ferritin Levels Are the Independent Risk Factors for Pneumonia in Elderly Patients.

Pneumonia is a common infection in elderly patients. We explored the correlations of serum interleukin-6 (IL-6) and serum ferritin (SF) levels with immune function/disease severity in elderly pneumonia patients. Subjects were allocated into the mild pneumonia (MP), severe pneumonia (SP), and normal groups, with their age/sex/body mass index/ disease course and severity/blood pressure/comorbidities/medications/prealbumin (PA)/albumin (ALB)/C-reactive protein (CRP)/procalcitonin (PCT)/smoking status documented. The disease severity was evaluated by pneumonia severity index (PSI). T helper 17 (Th17)/regulatory T (Treg) cell ratios and IL-6/SF/immunoglobulin G (IgG)/Th17 cytokine (IL-21)/Treg cytokine (IL-10)/PA/ALB levels were assessed. The correlations between these indexes/independent risk factors in elderly patients with severe pneumonia were evaluated. There were differences in smoking and CRP/PCT/ALB/PA levels among the three groups, but only CRP/ALB were different between the MP/SP groups. Pneumonia patients exhibited up-regulated Th17 cell ratio and serum IL-6/SF/IL-21/IL-10/IgG levels, down-regulated Treg cell ratio, and greater differences were noted in severe cases. Serum IL-6/SF levels were positively correlated with disease severity, immune function, and IL-21/IL-10/IgG levels. Collectively, serum IL-6 and SF levels in elderly pneumonia patients were conspicuously positively correlated with disease severity and IL-21/IL-10/IgG levels. CRP, ALB, IL-6 and SF levels were independent risk factors for severe pneumonia in elderly patients.

Predictors of dysphagia screening and pneumonia among patients with intracerebral haemorrhage in China: a cross-sectional hospital-based retrospective study

ObjectivesThis study aimed to investigate factors associated with undergoing dysphagia screening (DS) and developing pneumonia, as well as the relationship between DS and pneumonia in patients with intracerebral haemorrhage (ICH).DesignOur...

Perioperative Infection After Aneurysmal Subarachnoid Hemorrhage: Risk Factors, Causative Pathogens, and Long-Term Outcomes.

Nosocomial infections are the most common complication among critically ill patients and contribute to poor long-term outcomes. Patients with aneurysmal subarachnoid hemorrhage (aSAH) are highly susceptible to perioperative infections, yet it is unclear what factors influence infection onset and functional recovery. The objective was to investigate risk factors for perioperative infections after aSAH and relate causative pathogens to patient outcomes. Clinical records were obtained for 194 adult patients with aSAH treated at our institution from 2016 to 2020. Demographics, clinical course, complications, microbiological reports, and outcomes were collected. χ 2 , univariate, and multivariate logistic regression analyses were used to analyze risk factors. Nearly half of the patients developed nosocomial infections, most frequently pneumonia and urinary tract infection. Patients with infections had longer hospital stays, higher rates of delayed cerebral ischemia, and worse functional recovery up to 6 months after initial hemorrhage. Independent risk factors for pneumonia included male sex, comatose status at admission, mechanical ventilatory use, and longer admission, while those for urinary tract infection included older age and longer admission. Staphylococcus , Klebsiella , and Enterococcus spp. were associated with poor long-term outcome. Certain pathogenic organisms were associated with delayed cerebral ischemia. Perioperative infections are highly prevalent among patients with aSAH and are related to adverse outcomes. The risk profiles for nosocomial infections are distinct to each infection type and causative organism. Although strong infection control measures should be universally applied, patient management must be individualized in the context of specific infections.

Diabetes mellitus as a risk factor for postoperative complications following arthroscopic rotator cuff repair

Patients with diabetes mellitus who undergo arthroscopic rotator cuff repair (aRCR) have an increased risk of postoperative complications when compared to nondiabetics. To further investigate these complications, we used a large national database to determine the 30-day postoperative complications associated with insulin-dependent and non-insulin-dependent diabetics following aRCR. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all patients who underwent aRCR between 2015 and 2020. The study population was categorized into cohorts based on diabetes mellitus status: non-insulin-dependent diabetes mellitus (NIDDM), insulin-dependent diabetes mellitus (IDDM), and no diabetes. Multivariate analysis, adjusted for confounding demographics and comorbidities, was used to determine independently associated complications. There were 39,877 cases of aRCR in NQSIP included in this study. Diabetics comprised 6575 (16.7%) of these cases, with 4758 being NIDDM (11.9%) and 1817 being IDDM (4.6%). Bivariate logistic regression found both NIDDM and IDDM cohorts to be significantly associated with higher body mass index, ASA class ≥3, hypertension, chronic obstructive pulmonary disease, bleeding disorders, and preoperative wounds or infection (P<.001). NIDDM was an independently associated risk factor for sepsis (odds ratio [OR], 2.77; 95% confidence interval [CI]: 1.01-7.58; P=.047). IDDM was an independently associated risk factor for pneumonia (OR, 2.49; 95% CI: 1.13-5.48; P=.023), readmission (OR, 1.617; 95% CI: 1.19-2.33; P=.003), myocardial infarction (OR, 0.50; 95% CI: 0.12-1.00; P=.048), and on a ventilator >48 hours (OR, 5.63; 95% CI: 1.40-22.62; P=.015). NIDDM is an independent risk factor for sepsis, while IDDM is an independent risk factor for pneumonia, readmission, myocardial infarction, and remaining on a ventilator for greater than 48 hours following aRCR.

Febrile Children with Pneumonia Have Higher Nasopharyngeal Bacterial Load Than Other Children with Fever.

Febrile episodes are common in children and the most frequent reason for attending emergency services. Although most infections have a benign and self-limiting course, severe and sometimes life-threatening infections occur. This prospective study describes a cohort of children presenting to a single-centre pediatric emergency department (ED) with suspected invasive bacterial infection, and explores the relationships between nasopharyngeal microbes and outcomes. All children attending the ED who had a blood culture taken were offered to participate over a two-year period. In addition to conventional medical care, a nasopharyngeal swab was obtained., which was analysed for respiratory viruses and three bacterial species using a quantitative PCR. Fisher's exact test, Wilcoxon rank sum, and multivariable models were used for statistical analyses of the 196 children (75% younger than four years) who were enrolled and had sufficient data for analysis; 92 had severe infections according to the study protocol, while five had bloodstream infections. Radiologically confirmed pneumonia was the most common severe infection found in 44/92 patients. The presence of respiratory viruses and the carriage of Streptococcus pneumoniae and Haemophilus influenzae were associated with a higher risk of pneumonia. Higher density colonisation with these bacteria were independent risk factors for pneumonia, whereas Moraxella catarrhalis carriage was associated with lower risk. Our data support the hypothesis that higher nasopharyngeal density of pneumococci and H. influenzae could play a role in the development of bacterial pneumonia in children. A preceding viral infection of the respiratory tract may be a trigger and play a role in the progression to severe lower respiratory tract infection.

Pulmonary toxicity of craniospinal irradiation using helical tomotherapy

Craniospinal irradiation using helical tomotherapy (HT-CSI) has advantages in aspects of homogeneous dose distribution. Physicians, however, still have concerns of pulmonary toxicity due to HT-CSI’s relatively large, low-dose irradiated volume from continuous and 360° rotation delivery. In this study, we investigated the pulmonary toxicity of HT-CSI. We retrospectively reviewed 105 patients who received HT-CSI between January 2014 and December 2019. Grade 2 + pulmonary toxicities were evaluated. Intensive systemic treatment was defined as systemic treatment administration before, during, and after HT-CSI. VX Gy was defined as % volume receiving ≥ X Gy. Thirteen patients (12.4%) presented with grade 2 + pulmonary toxicities after HT-CSI. Of these patients, only one experienced grade 2 radiation pneumonitis combined with pembrolizumab-induced pneumonitis. Conversely, pneumonia was observed in 12 patients. Intensive systemic treatment (p = 0.004), immunosuppressive drugs (p = 0.031), and bilateral lung V5 Gy ≥ 65% (p = 0.031) were identified as independent risk factors for pneumonia. The risk factor for pneumonia in pediatric patients were immunosuppressive drugs (p = 0.035) and bilateral lung V5 Gy ≥ 65% (p = 0.047). HT-CSI can be a safe treatment modality with tolerable pulmonary toxicities. Intensive systemic treatment, immunosuppressive drugs, and bilateral lung V5 Gy ≥ 65% were significantly associated with pneumonia. In these patients, close follow-up should be considered for proper management of pneumonia.

Risk Due to ABO Incompatibility and Donor-Recipient Weight Mismatch in Living Donor Kidney Transplantation: A National Cohort Study.

The effect of donor-recipient weight mismatch is not well established in ABO-incompatible living donor kidney transplantation (LDKT). A total of 2584 LDKT patients in the Korean Organ Transplantation Registry were classified into four groups according to the presence or absence of ABO incompatibility and donor-recipient weight mismatch (donor-to-recipient weight ratio (DRWR) < 0.8). In a multivariable Cox analysis, the combination of ABO incompatibility and DRWR incompatibility (n = 124) was an independent risk factor for graft survival (HR = 2.73, 95% CI = 1.11–6.70) and patient survival (HR = 3.55, 95% CI = 1.39–9.04), whereas neither factor alone was a significant risk factor for either outcome. The combination of ABO incompatibility and DRWR incompatibility was not an independent risk factor for biopsy-proven graft rejection (HR = 1.27, 95% CI = 0.88–1.82); however, it was an independent risk factor for pneumonia (HR = 2.94, 95% CI = 1.64–5.57). The mortality rate due to infection was higher among patients with both ABO incompatibility and DRWR incompatibility than among patients with neither factor or with either factor alone. The combination of ABO incompatibility and DRWR incompatibility was an independent risk factor for graft and patient survival after LDKT, whereas neither factor alone significantly affected graft or patient survival. Thus, donor-recipient weight matching should be cautiously considered in LDKT with ABO incompatibility.

Risk Factors for the Development of Pneumonia and Severe Pneumonia in Children

To identify the risk factors for pneumonia and severe pneumonia in children. Prospective cohort study. Five tertiary-care teaching hospitals in India. Children 2 to 59 months of age suffering from acute respiratory infection (ARI). Risk factors for the development of WHO defined pneumonia and severe pneumonia. A total of 18159 children screened, and 7026 (39%) children with ARI were enrolled. According to the WHO criteria, 938 (13.4%) and 6088 (86.6%) of the enrolled children had pneumonia and no pneumonia, respectively. Out of 938 children with pneumonia, 347 (36.9%) had severe pneumonia. On univariate analysis, younger age, male gender and low weight for height, were significant risk factors for pneumonia. On multivariate analysis, one-unit increase in age in months (OR = 0.97; 95% CI: 0.97-0.98) and weight for height z-score (OR = 0.76; 95% CI: 0.72-0.79) had a protective effect. Young age and undernutrition (low weight for height/length) in children are significant independent risk factors for pneumonia.

Preoperative Hyponatremia Is an Independent Risk Factor for Prolonged Hospital Stay After Anterior Cervical Discectomy and Fusion

To determine the association of preoperative hyponatremia with short-term postoperative complications and health care utilization (length of stay, readmissions) after anterior cervical fusion and discectomy (ACDF). Patients who underwent ACDF were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients who had revision surgery, trauma, vertebral malignancy, or infection were excluded. Eunatremia was defined as sodium (Na) level between 135 and 145 mEq/L, whereas hyponatremia was defined as Na < 135 mEq/L. Preoperatively, patients with hyponatremia were matched 1:1 with patients with eunatremia using propensity score matching based on age, sex, American Society of Anesthesiologists score, and baseline comorbidities. Minor adverse events included superficial infection, dehiscence, urinary tract infection, pneumonia, and renal insufficiency or failure. Serious adverse events included deep wound infection, reintubation, pulmonary embolism, cerebrovascular accident, cardiac arrest, deep vein thrombosis, sepsis, return to operating room, and death within 30 days. Complications were analyzed using bivariate and logistic analysis with significance set at P < 0.05. Of the 9094 patients undergoing ACDF, 3.64% (n= 331) were preoperatively hyponatremic. Preoperative hyponatremia was an independent risk factor for postoperative pneumonia after ACDF (odds ratio [OR], 4.47; P= 0.020) and extended length of hospital stay >1 SD above the mean (OR, 1.71; P= 0.042). Preoperative hyponatremia was an independent risk factor for having a serious adverse event (OR, 2.40; P= 0.005) and any adverse event (OR, 2.44; P= 0.009). Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay after ACDF.

Pneumonia in Patients with Chronic Kidney Disease Admitted to Nephrology Department of a Tertiary Care Center: A Descriptive Cross-sectional Study.

Chronic Kidney Disease is an independent risk factor for pneumonia. The risk of hospitalization, Intensive Care Unit and ventilator requirement, in-hospital death is high in pneumonia patients with chronic kidney disease. This study aims to find the prevalence of pneumonia in patients with chronic kidney disease admitted to nephrology department of a tertiary care center. A descriptive cross-sectional study was conducted among all the hospital records of pneumonia patients with Chronic Kidney Disease admitted to the Nephrology department between April 2019 and April 2021. Ethical clearance was obtained from the Institutional Review Committee of same institute (Reference number: 0505202106). Statistical Package for the Social Sciences version 20 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Of the total 407 patients with Chronic Kidney Disease, 78 (19.1%) (95% Confidence Interval= 15.28-22.92) had pneumonia. Among the 78 pneumonia patients, 17 (21.8%) were Stage 3, 13 (16.7%) Stage 4 and 48 (61.5%) Stage 5 of chronic kidney disease. Forty Seven (60.3%) required Intensive Care Unit (ICU), 19 (24.4%) required ventilator and 22 (28.2%) of the patient expired in hospital. The most commonly isolated organisms were Severe Acute Respiratory Syndrome Coronavirus 2 which was 13 (16.6%) followed by Strepotococcus pneumoniae which was 8 (10.2%). The prevalence of pneumonia in Chronic Kidney Disease was observed higher in our study compared to other studies.

HLA-B54 is an independent risk factor for pneumonia in Japanese patients with interstitial lung disease: A multicenter retrospective cohort study

PurposePneumonia is a major cause of respiratory-related hospitalization and an important prognostic factor in patients with chronic interstitial lung disease (ILD). However, the relationship between the incidence of pneumonia and human leukocyte antigen (HLA) serotype has not been fully elucidated. Therefore, this study aimed to determine if there is a relationship between HLA serotype and the incidence of pneumonia in Japanese patients with ILD. MethodsThe medical records of patients with ILD treated at any of three centers in Japan were reviewed to determine their HLA-A and HLA-B serotypes. The characteristics of patients with and without pneumonia were compared. Cox regression analysis was performed to identify risk factors for pneumonia and death in these patients. ResultsOne hundred and forty-four patients with ILD (pneumonia group, n = 27; non-pneumonia group, n = 117) and complete HLA serology data available were included. HLA-B54 positivity was significantly more common in the pneumonia group than in the non-pneumonia group (37.0% vs. 15.4%, p = 0.010). HLA-B54 positivity was also a significant risk factor for pneumonia (hazard ratio [HR] 4.166, 95% confidence interval [CI] 1.862–9.320, p = 0.001) and death (HR 4.050, 95% CI 1.581–10.374, p = 0.004) in patients with ILD. Furthermore, HLA-B54 positivity was a significant risk factor for pneumonia (HR 3.964, 95% CI 1.392–11.090, p = 0.010) and death (HR 8.131, 95% CI 1.763–37.494, p = 0.007) in patients with idiopathic pulmonary fibrosis. ConclusionHLA-B54 positivity was a significant risk factor for pneumonia and death in patients with ILD, including those with idiopathic pulmonary fibrosis.

Predictors of surgical site infection and pneumonia following oral cavity tumor surgery.

To identify risk factors for surgical site infection (SSI) and pneumonia following oral cavity tumor surgery. Retrospective chart review of a consecutive series of patients undergoing oral cavity resection. Several clinicopathologic variables were tested for their association with SSI and pneumonia. Three hundred and forty-four cases in 330 patients were included. Incidence of SSI and pneumonia was 67 (19.5%) and 38 (11%), respectively. On multivariate analysis, marginal mandibulectomy and segmental mandibulectomy were independent risk factors for SSI, whereas time under anesthesia (TUA) was an independent risk factor for pneumonia. Receiver operating characteristic curve identified 390 min as the cutoff above which pneumonia was predicted with a high degree of accuracy. In oral cavity resections, mandibulectomy predisposes to SSI. Further, prolonged TUA (>390 min) is a powerful predictor for pneumonia. As it is a modifiable risk factor, reduction in TUA might correspondingly lower the incidence of postoperative pneumonia.

Prolonged Prehospital Time Is a Risk Factor for Pneumonia in Trauma (the PRE-TRIP Study): A Retrospective Analysis of the United States National Trauma Data Bank

Although multiple risk factors for development of pneumonia in patients with trauma sustained in a motor vehicle accident have been studied, the effect of prehospital time on pneumonia incidence post-trauma is unknown. Is prolonged prehospital time an independent risk factor for pneumonia? We retrospectively analyzed prospectively collected clinical data from 806,012 motor vehicle accident trauma incidents from the roughly 750 trauma hospitals contributing data to the National Trauma Data Bank between 2010 and2016. Prehospital time was independently associated with development of pneumonia post-motor vehicle trauma (P< .001). This association was primarily driven by patients with low Glasgow Coma Scale scores. Post-trauma pneumonia was uncommon (1.5%incidence) but was associated with a significant increase in mortality (P< .001, 4.3%mortality without pneumonia vs12.1%mortality with pneumonia). Other pneumonia risk factors included age, sex, race, primary payor, trauma center teaching status, bed size, geographic region, intoxication, comorbid lung disease, steroid use, lower Glasgow Coma Scale score, higher Injury Severity Scale score, blood product transfusion, chest trauma, and respiratory burns. Increased prehospital time is an independent risk factor for development of pneumonia and increased mortality in patients with trauma caused by a motor vehicle accident. Although prehospital time is often not modifiable, its recognition as a pneumonia risk factor is important, because prolonged prehospital time may need to be considered in subsequent decision-making.

A Study on Risk Factors Associated with Stroke

Introduction: The majority (about 75%) of cases of stroke occur in people over the age of 65 years and about one-third of patients die of stroke within a year of onset. Over half of survivors remain dependent on others for everyday activities, often with significant adverse effects on caregivers. Medical complications after acute stroke may adversely impact outcome and in some cases may be preventable. Limited data exist regarding the frequency of such complications occurring in the first days after the ictus and the relationship of these complications to outcome. Methodology: All selected patients were studied for post stroke pulmonary complications mainly pneumonia, mechanical ventilation, respiratory depression, it sincidence, age, gender distribution and its association with the site of lesion (i.e Anterior vs Posterior),type of lesion(infarct vs bleed), Severity of the stroke if measured by NIHSS scoring system. Results: Among smokers 9 out of 29 patients have developed pneumonia that is 47%. But this finding did not show statistical significance. Among 24 Alcholics 13 patients developed pneumonia with 54% association. but no statistical significance. Diabetic and hypertensives, did not show any significant association with pneumonia and statistical significance. Conclusion: With other risk factors, there was more incidence of developing pneumonia. but there was no statistical significance and so these are no independent risk factors for pneumonia.

Age, ageing, ageism and \u201cage-itation\u201d in the Age of COVID-19: rights and obligations relating to older persons in Israel as observed through the lens of medical ethics

COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions. Although the virus can cause disease in anyone, it is particularly dangerous for those with various “co-morbidities” such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on), even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from the virus. It is therefore essential to find ways to protect all at-risk persons (old or young) from the virus but at the same time not harming, more than absolutely necessary their essential freedoms as well as taking into account their social/psychological needs. Compared with other OECD countries, Israel’s population is still relatively young, with only 11.5% being over 65+ with a smaller proportion of older persons in long-term institutions than that found in most other comparable jurisdictions. These factors might explain a part of the country’s (so far) relatively low rates of serious disease and mortality compared to those seen in other developed countries. However there are still over a million older citizens at risk and the numbers of infected, hospitalized and seriously ill persons are rising once again. This is no time for complacency.An analysis of the effect of age on the disease as seen through the principles of medical ethics is followed by a proposal as to how best to balance these sometimes conflicting goals. This paper relates mainly to older persons in the community since the Ministry of Health early on in the pandemic initiated an effective program (Magen Avot) meant to protect those older persons in long-term care institutions. Recommendations include the Ministry of Health publishing clear guidelines as to risk factors and offering sensible advice on how to practice physical (not “social”) distancing without exacerbating an older person’s sense of social isolation. In order to reduce the incidence of influenza (which can clinically be confused with COVID-19) and the potentially disastrous consequences of a “double pandemic” this coming winter, a robust flu vaccination program needs immediate implementation. Persons at all ages (but especially those 60+) should be encouraged and assisted to sign advance directives, especially those who do not wish to undergo invasive therapy. An individual older person’s wish to “make way” for younger people should be respected as an expression of his/her autonomy. As we enter the second wave, triage mechanisms and protocols need to be circulated in readiness for and well before a situation in which an acute imbalance develops between the availability for acute resources and the population’s need for them. The Ministry of Health, in cooperation with other relevant ministries and NGOs, should take the lead in developing plans, ensuring that they are carried out in an orderly, timely and transparent manner. The blanket is indeed not large enough but we must place it as judiciously as possible in order as much as possible to protect, cover and keep warm the body politic.

Impacts of Preoperative Psoas Muscle Mass and Visceral Fat Area on Postoperative Short- and Long-Term Outcomes in Patients with Gastric Cancer.

Sarcopenia and obesity are associated with outcomes after surgery. However, few studies have investigated which more accurately predicts postoperative complications or prognosis in patients with gastric cancer. A total of 567 consecutive patients with gastric cancer who underwent gastrectomy between 2010 and 2015 were retrospectively reviewed. Psoas muscle mass index (PMI) and visceral fat area (VFA) were measured by CT scan. Patients were divided into two groups based on PMI (PMI-H group: male ≥ 6.36 cm2/m2, female ≥ 3.92 cm2/m2; and PMI-L group: male < 6.36 cm2/m2, female < 3.92 cm2/m2) and two groups based on VFA (VFA-H group: ≥ 100 cm2; VFA-L group: < 100 cm2). The incidence of postoperative complications and the recurrence-free survival (RFS) were compared between the two groups. The incidence of postoperative complications was significantly higher in the VFA-H group than in the VFA-L group (35.1% vs. 20.3%; P < 0.001), whereas there was no significant difference between the PMI-H and PMI-L groups. Multivariate analysis showed that PMI-L and VFA-H were independent risk factors for pneumonia (odds ratio, 4.49; P = 0.018) and intra-abdominal abscess (odds ratio, 5.19; P = 0.004), respectively. While there was no significant difference in RFS between the VFA-H and VFA-L groups, the PMI-L group showed significantly worse RFS than the PMI-H group (P < 0.001). PMI and VFA were useful predictive factors for postoperative pneumonia and intra-abdominal abscess, respectively. PMI might be a useful prognostic factor in patients with gastric cancer, but VFA is not.