General Health Status Of Patients Research Articles

The Influence of Comorbidities, General Health Status, and Self-Care Self-Efficacy on COVID-19 Symptoms During the Omicron Wave.

Background The emergence of the less virulent COVID-19 strains such as Omicron and its subvariants shifted the paradigm of COVID-19 treatment from inpatient treatment to regular outpatient care. The individual health determinants affecting COVID-19 disease severity among vulnerable adults treated in outpatient settings are an under-researched area. Methods This study conducted in an outpatient COVID-19 antibody infusion center employed a cross-sectional survey design to explore the impact of comorbidities, general health status, and self-care self-efficacy on COVID-19 symptom severity. We recruited 120 COVID-19-positive participants over 40 years of age, of which 117 completed the study with 87 providing complete data. After the screening and consenting process, the participants completed the following surveys in a secure REDCap survey software (Vanderbilt University, Nashville, USA)on an iPad (Apple Inc., Cupertino, USA): 1) sociodemographic questionnaire, 2) Charlson Comorbidity Index (CCI) to capture comorbidities, 3)Medical Outcomes Study Short-Form (SF-12) to assess general health including physical (PCS) and mental (MCS) health subscales, 4) Self-Care Self-Efficacy Scale (SCSES) to measure self-care self-efficacy, and 5) the COVID-19 Symptom rating scale (COVID-19 SRS). Statistical analysis used were Chi-square and Pearson correlations. Results As evidenced by CCI, the top five comorbidities were hypertension (42%), diabetes mellitus (31%), pulmonary disease (19%), depression (14%), and solid tumors (11%). Age was statistically significantly correlated to comorbidity burden(p<0.0001). Severe COVID-19 symptoms reported were fatigue, myalgia, cough, runny nose, and sore throat. The general health status measure (SF-12) subscales showed that the patient's mental component summary (MCS) was more statistically significant to COVID-19 symptom severity than the physical component summary (PCS). The MCS demonstrated a statistically significant correlation with fatigue and myalgia (p<0.0001), headache and breathing difficulties (p<0.001), nausea/vomiting (p<0.01), and abdominal pain/diarrhea (p<0.05). The PCS showed a lesser statistically significant correlation with fatigue, myalgia, headaches (p<0.01), fever/chills, cough, congestion/runny nose, night sweats, breathing difficulties, nausea/vomiting, and abdominal pain/diarrhea (p<0.05). Interestingly, the 'loss of smell' which is the hallmark symptom of COVID-19 was the only symptom that showed a statically significant correlation with the Charlson Comorbidity Index (p<0.05), and it did not show any association with either mental (SF-12 MCS) or physical (SF-12 PCS) health status. The SF-12 MCS also showed a statistically significant correlation with a diagnosis of depression (p< 0.01), validating it as a true measure of mental health among vulnerable adults. The SCSES was not correlated with any of the COVID-19 symptoms. Conclusions The patient's general health status, especially mental health was more statistically significant to COVID-19 symptoms. The COVID-19 hallmark symptom of 'loss of smell' was the only symptom that showed statistical significance with comorbidities. Within the limitations of a cross-sectional survey design and convenient sampling methods, this study calls to tailor general health status, especially mental health, and cumulative comorbidity burden to risk assessment/risk stratification of COVID-19 care.

A Patient with Decubitus Ulcer in the Scapular Region: Case Report

Decubitus ulcers are a widespread healthcare problem, especially among hospitalized patients who receive long-term time treatment. A multidisciplinary approach is required to provide appropriate treatment. The patient's general health status and cooperation define the treatment methods. Decubitus ulcers of the scapular region are not a common entity. This paper aimed to present a case with the successful treatment of decubitus ulcer stage IV with diagnosed Staphylococcus aureus deep wound infection in a patient who followed up by home health care service. Our multidisciplinary approach includes cleaning, debridement and dressing of the wound, optimized dressings, anti-biotherapy, the role of reconstructive surgery, and improvement of nutritional conditions and chronic health problems. Keywords: decubitus ulcer, pressure ulcer, geographic locations

Surgical and non­surgical methods of penis enlargement

Abstract. In this scientific study we reviewed the literature on non-invasive and invasive methods of male genital enhancement. A non-systematic review of current scientific evidence was conducted to obtain reliable data on surgical and non-surgical penile procedures, which may form the basis of possible indications and recommendations for the future. To achieve this goal, we conducted a systematic search for scientific medical information in English-language databases such as MEDLINE, Embase, AMED (Allied and Complementary Medicine) and HMIC (Health Management Information Consortium). We analyzed all articles that met the specified search parameters. In addition, a manual search for relevant references in the found texts was conducted. The study conducted in this paper examined and recorded the main results related to changes in penis size in men who used both non-surgical and surgical methods of penis enlargement. One of the key goals of this study was to examine in detail the impact of different methods on the length and girth of the penis, as well as to analyze possible complications after these procedures. The principles of choosing treatment methods for patients who express a desire to increase the size of the penis are based on the individual characteristics of the patient, his medical indicators and personal preferences. Doctors should take into account the patient's general health status, possible risks of complications, and his realistic expectations of the procedure. Based on the results of the literature analysis, a strategy for working with patients before penis enlargement procedures was generalized. This strategy includes detailed counseling of the patient about possible methods, their benefits and risks, as well as taking into account his personal wishes. An important step is to prepare the patient for the procedure, including all the necessary examinations and tests to determine his suitability for the intervention.

Local Factors for Development of Denture Stomatitis and Strategies for Their Management

One of the most frequent diseases of oral cavity in elderly people that use removable dentures is denture stomatitis. Large set of local factors predispose towards the occurrence of denture stomatitis – quantity and Ph of saliva, violations of oral mucosa integrity, surface characteristics of the denture base materials, the maintenance of dentures and oral cavity hygiene, the period of using one and the same dentures, etc. Development of denture stomatitis can deteriorate not only the oral health but general health status of patients, hence their quality of life. This predefines problem’s great social significance. The purpose of this review was to analyse the local factors that make impact on development of denture stomatitis in complete dentures wearers, the contemporary prevention strategies and the role of the patients in their realization. Successful prevention of the disease could be achieved with the application of complex approach that includes evaluation of all the general and local factors and implementation of multi-component strategy for the management of their influence. The active collaboration with patient is essential for successful prevention of the denture stomatitis. Keywords: denture stomatitis; local factors; strategies for prevention

Multicenter Longitudinal Observational Study Pharmaceuticals Alflutop in Russia (message 2)

Osteoarthritis (OA) is one of the most important medical and social problems due to the steady increase in morbidity and disability. Prevention, management of risk factors, and early treatment of OA are critical.Objective of the ISKRA study was to evaluate the efficacy of Alflutop in patients with OA of different locations and/or low back pain (LBP) with or without concomitant diseases.Material and methods. We selected 11,136 patients with OA of specific localizations aged 50 to 72 years. The duration of the study ranged from 20 to 31 days, and the number of visits was 2 (B1 and B2). Alflutop was prescribed 1 ml intramuscularly (IM) daily No. 20 or 2 ml IM every other day No. 10.The efficacy of therapy was determined by the time of onset of clinical effect (pain reduction, as assessed by the patient), the dynamics of pain intensity in the studied joint during movement and/or LBP according to the visual analogue scale (VAS), the assessment of quality of life according to the EQ-5D questionnaire and the patient's general health status (PGH) according to VAS. We assessed treatment adherence, need for nonsteroidal anti-inflammatory drugs (NSAIDs), satisfaction with treatment (based on VAS). The presence of comorbidities was also considered.Results and discussion. In hand OA (n=2776), a positive effect of therapy was observed in 98.6% of cases, according to patients' assessment. During the course of therapy, there was a significant decrease in pain on movement in the hands (according to VAS), improvement in PGH and quality of life (according to EQ-5D). Rapid development of the analgesic effect was seen on average at day 9.In hip OA (n=6666), a decrease in pain was noted in 83.3% of cases (&lt;40 mm), improvement in PGH and quality of life in most patients, and a decrease in the need for NSAIDs in 64.9%.In the generalized form of OA (n=1694), significant clinical improvement was achieved in 97.1% of patients. A pain reduction ≥50% from baseline was noted in nearly 65% of cases.Elderly age, more severe radiographic manifestations of OA, low quality of life and compliance, and concomitant diseases were associated with a lower effect of therapy in hand and hip OA. In hand OA, high pain scores and worse PGH VAS scores also played a role. In hip OA, lower success was observed more often in women, and in hand OA — in men.In the generalized form of OA, lower satisfaction with pain management was associated with age, female sex, high body mass index, long history of OA, advanced radiographic stages, poorer quality of life and compliance, and comorbidity.Conclusion. The results of the use of Alflutop in hand and hip OA and generalized form of OA suggest the usefulness of its wide application in real clinical practice. Consideration and correction of the factors associated with less pronounced analgesic effect of the drug will improve the effectiveness of OA therapy.

Emotional Distress, Anxiety, and General Health Status in Patients With Newly Identified Small Pulmonary Nodules: Results From the Watch the Spot Trial

Anxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules. How common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes? This study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vsless intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8weeks following nodule identification. Mixed-effects models were used to compare outcomes between study arms following adjustment for potential confounders and clustering within enrollment site, while also examining a limited number of prespecified explanatory factors, including nodule size, mode of detection, type of ordering clinician, and lack of timely notification prior to contact by the study team. The trial enrolled 34,699 patients; 2,049 individuals completed the baseline survey (5.9%). Respondents and nonrespondents had similar demographic and nodule characteristics, although more respondents were non-Hispanic and White. Impact of Event Scale-Revised scores indicated mild, moderate, or severe distress in 32.2%, 9.4%, and 7.2%of respondents, respectively, with no difference in scores between study arms. Following adjustment, greater emotional distress was associated with larger nodule size and lack of timely notification by a clinician; distress was also associated with younger age, female sex, ever smoking, Black race, and Hispanic ethnicity. Anxiety was associated with lack of timely notification, ever smoking, and female sex. Almost one-half of respondents experienced emotional distress 6 to 8weeks following pulmonary nodule identification. Strategies are needed to mitigate the burden of distress, especially in younger, female, ever smoking, and minoritized patients, and those with larger nodules. ClinicalTrials.gov; No.: NCT02623712; URL: www. gov.

Network meta-analysis of the prognosis of curative treatment strategies for recurrent hepatocellular carcinoma after hepatectomy.

Recurrent hepatocellular carcinoma (rHCC) is a common outcome after curative treatment. Retreatment for rHCC is recommended, but no guidelines exist. To compare curative treatments such as repeated hepatectomy (RH), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and liver transplantation (LT) for patients with rHCC after primary hepatectomy by conducting a network meta-analysis (NMA). From 2011 to 2021, 30 articles involving patients with rHCC after primary liver resection were retrieved for this NMA. The Q test was used to assess heterogeneity among studies, and Egger's test was used to assess publication bias. The efficacy of rHCC treatment was assessed using disease-free survival (DFS) and overall survival (OS). From 30 articles, a total of 17, 11, 8, and 12 arms of RH, RFA, TACE, and LT subgroups were collected for analysis. Forest plot analysis revealed that the LT subgroup had a better cumulative DFS and 1-year OS than the RH subgroup, with an odds ratio (OR) of 0.96 (95%CI: 0.31-2.96). However, the RH subgroup had a better 3-year and 5-year OS compared to the LT, RFA, and TACE subgroups. Hierarchic step diagram of different subgroups measured by the Wald test yielded the same results as the forest plot analysis. LT had a better 1-year OS (OR: 1.04, 95%CI: 0.34-03.20), and LT was inferior to RH in 3-year OS (OR: 10.61, 95%CI: 0.21-1.73) and 5-year OS (OR: 0.95, 95%CI: 0.39-2.34). According to the predictive P score evaluation, the LT subgroup had a better DFS, and RH had the best OS. However, meta-regression analysis revealed that LT had a better DFS (P < 0.001) as well as 3-year OS (P = 0.881) and 5-year OS (P = 0.188). The differences in superiority between DFS and OS were due to the different testing methods used. According to this NMA, RH and LT had better DFS and OS for rHCC than RFA and TACE. However, treatment strategies should be determined by the recurrent tumor characteristics, the patient's general health status, and the care program at each institution.

INFLUENCE OF SUBJECTIVE FACTORS OVER HYGIENE HABITS OF COMPLETE DENTURE WEARERS

Background: Hygiene of the complete dentures is closely related to the oral and general health status of patients. Different factors can impact hygiene habits of complete denture wearers.There not agreement of opinion about the most significant subjective factor. The aim of this research was to study the hygiene habits of the complete denture wearers and the influence of some factors as age, sex and education over patients behaviour. Material and Method: Subjects of observation in the study were 110 (48 men and 62 women) complete dentures wearers, aged 52 to 84. Questionnaire and information leaflet were created. The questionnaire contained 16 questions concerning the manners for hygiene maintenance of dentures and oral cavity, the sources of the information about the hygiene care and the score of the leaflet by the patient. Results: Washing dentures with water, soap and toothbrush was reported as preferred method for cleaning (32.73%).42.73% of participants were not provided with information about hygiene care for dentures. Significant correlation was established between patients education and: method for hygiene maintenance of the dentures (r = 0.5754) hygiene care of the oral cavity (r = 0.6395) use of additional means for disinfection of dentures (r = 0.6489). Conclusion: Within the range of this study we could conclude that the education is the more significant factor that impacts patients hygiene habits. The age is not determinative factor, whereas the sex of patients can impact their choice of methods and the frequency of hygiene procedures.

Relationship between prognostic nutritional index and mortality in cancer patients treated with immunotherapy

Immunotherapy, in addition to surgery, chemotherapy, radiotherapy, and targeted therapies in cancer treatment, has emerged over the last decade as a significant contributor to improving patient survival. The prognostic nutritional index (PNI), which is a simple and useful tool that provides information about the general health status of patients and helps the treatment process, is used for many different types of cancer. This study aimed to evaluate the prognostic importance of PNI on mortality in cancer patients treated with immunotherapy. A total of 100 patients who were treated with immune checkpoint blockade in the oncology outpatient clinic were included retrospectively. According to our findings, only 23% of patients responded to immunotherapy, while 72% progressed. When PNI values were compared according to mortality status, it was determined that PNI values at baseline, first, third, sixth, and twelfth months were statistically significantly lower in patients who died during their follow-up. We also determined 44 as the cut-off value for the PNI in our study. The mortality rate was 76.7% in patients with PNI&gt;44 and 43.5% in patients with PNI≤44. PNI appears to be a simple and useful tool for predicting mortality in cancer patients treated with immunotherapy.

Anamu, moringa, spirulina i hlorela - doprinos kvalitetu života onkoloških pacijenata - rezultati postmarketinške prospektivne studije u Srbiji, 2021 - 2022. godine

Introduction: The quality of life is one of the priority goals in the treatment of oncology patients. In addition to conventional therapies, symptomatic and supportive treatments are valuable for the final treatment outcome. Many such patients resort to alternative methods, such as herbal therapy. Study aim: This prospective study aimed to assess the effect of the plants: anamu, moringa, spirulina, and chlorella, which are routinely used in Cuba, on the quality of life of oncology patients. Materials and methods: Forty-six patients with various stage four malignant tumors were examined. Of the 46 patients, 26 were on chemotherapy, while 18 were on symptomatic and supportive therapy. The patients used extracts of the aforementioned plants orally, for three months. With prior consent and authorization, the standard EORTC QLQ-C30 questionnaire, written in the patients' native language, was used to assess quality of life, before and after three months of use. Results: According to patient ratings, overall assessment of patient general health status and quality of life showed significant improvement after three months of use of the extracts, as compared to the beginning of application. According to the questionnaire, all five parameters improved on the functional scale, (p &lt; 0.001), and the scores on the symptoms scale also improved (fatigue, p = 0.015; pain, p = 0 ,044). Women achieved better physical functionality and significant loss of fatigue and pain, while cognitive functionality improved in men. Emotional functionality improved in the subgroup of patients who were receiving chemotherapy, while in those who had previously received chemotherapy, there were significant differences in the symptoms scale score regarding loss of appetite and constipation - symptoms that resolved after three months of product use, thus equating the subgroups in terms of the reduction of these symptoms. In other functional parameters, statistically significant differences were also obtained for all patients. Conclusion: The improvement in the quality of life and functionality of patients, as well as the reduction in symptoms, whether the patients received chemotherapy or not, was statistically significant.

Investigation of the effects of preoperative nutritional status scores on renal injury after cardiac surgery in elderly patients.

Acute kidney injury (AKI) is a common complication after cardiac operations accompanied by cardiopulmonary bypass (CPB). Nutritional status is an important parameter that reflects the general health status of patients, and its prognostic importance has been shown in numerous diseases. For this reason, various scoring systems are used to show nutritional status, the most known of which are the controlling nutritional status (CONUT) score and the geriatric nutritional risk index (GNRI). In this current study, we aimed to investigate the prognostic values of the CONUT score and GNRI in predicting AKI after cardiac surgery. Patients over sixty-five years of age who underwent cardiac surgery with CPB in our clinic between March 2019 and January 2021, were consecutively included in the study. The patients who did not develop AKI in the postoperative period were recorded as Group 1, whereas the patients who did develop were defined as Group 2. Postoperative AKI occurred in 126 (28.7%) patients (Group 2). The median age of the 313 patients included in Group 1 and 126 patients in Group 2 was 69 (67 to 81) and 71 (66 to 85) years, respectively (p = 0.033). The two groups were similar in terms of gender, body mass index, hypertension, smoking, and left ventricular ejection fraction rates. In Group 2, albumin and GNRI values were significantly lower (p = 0.019 and p < 0.001, respectively), whereas the CONUT score was significantly higher (p < 0.001). We showed the CONUT score and GNRI values calculated in the preoperative period in patients over 65 years of age as independent predictors of the development of AKI, after cardiac surgery.

Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide.

Diabetic foot disease is a serious complication of diabetes mellitus. Patients with diabetes mellitus have a 25% lifetime risk for developing a foot ulcer, and between 14% and 24% of patients require a major or minor lower limb amputation due to severe gangrene. However, decisions concerning whether to amputate or whether to perform a major or minor lower limb amputation, and how best to determine the amputation plane remain unclear. To consolidate the current literature with expert opinion to make recommendations that will guide surgical amputation for patients with diabetic foot ulcers. A total of 23 experts experienced in surgical treatment of patients with diabetic foot ulcers formed an expert consensus panel, and presented the relevant evidence, discussed clinical experiences, and derived consensus statements on surgical amputation for patients with diabetic foot ulcers. Each statement was discussed and revised until a unanimous consensus was achieved. A total of 16 recommendations for surgical amputation for patients with diabetic foot ulcers were formulated. The experts believe that determination of the amputation plane should be comprehensively evaluated according to a patient's general health status, the degree of injury, and the severity of lower limb vasculopathy. The Wagner grading system and the severity of diabetic lower extremity artery disease are important criteria when determining the degree of amputation. The severity of both diabetic foot infection and systemic underlying diseases are important factors when considering appropriate treatment. Moreover, consideration should also be given to a patient's socioeconomic status. Given the complexities of treating the diabetic foot, relevant issues in which consensus could not be reached will be discussed and revised in future. This expert consensus could be used to guide doctors in clinical practice, and help patients with diabetic foot ulcers gain access to appropriate amputation treatment.

Abnormal preoperative platelet count may predict postoperative complications following shoulder arthroplasty.

The purpose of this study is to investigate the association between preoperative platelet counts and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019. The study population was then divided into 5 groups based on their preoperative platelet count: <100k (moderate-to-severe thrombocytopenia), 100-150k (mild thrombocytopenia), 150-200k (low-normal preoperative platelet count), 200-450k (normal, reference cohort), and >450k (thrombocytosis). Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to investigate the relationship between preoperative platelet counts and postoperative complications. A total of 19,721 patients undergoing TSA between 2015 and 2019 were included in this study. One hundred fifty-five patients (0.8%) had moderate-to-severe thrombocytopenia, 982 (5.0%) had mild thrombocytopenia, 3945 (20.0%) had a low-normal preoperative platelet count, 14,386 (72.9%) had a normal preoperative platelet count, and 253 (1.3%) had thrombocytosis. An increasing rate of overall complications was observed as the severity of thrombocytopenia progressed from low-normal (6.4%) to mild thrombocytopenia (10.2%) and to moderate-to-severe thrombocytopenia (18.7%). The overall complication rate of the thrombocytosis cohort was 14.6%. In comparison to normal platelet count, low-normal thrombocytopenia, mild thrombocytopenia, moderate-to-severe thrombocytopenia, and thrombocytosis were identified by multivariate analysis as significant predictors of overall complications (odds ratios [ORs] of 1.12, 2.15, 2.43, 2.71, respectively), postoperative anemia requiring transfusion (ORs of 1.63, 3.45, 5.97, 4.21, respectively), and minor complications (ORs of 1.39, 2.64, 3.40, 3.34, respectively). Minor complications include progressive renal insufficiency, urinary tract infection, transfusions within 72 hours after surgery, pneumonia, and superficial incisional surgical site infection. Increasing severity of thrombocytopenia correlated with higher overall postoperative complication rates following TSA. Interestingly, patients with thrombocytosis had the highest overall postoperative complication rates among all cohorts included in this study. Platelet counts are often the reflection of other comorbidities and a good indicator of patient's general health status. Long-term optimization of abnormal platelet counts may potentially reduce surgical complications.

197 Non-Traumatic Spontaneous Ileal Perforation: Experience With 125 Cases

Abstract Background Non-traumatic ileal perforation is a common cause of obscure peritonitis in developing and underdeveloped world. The perforation of the ileum is one of the causes of peritonitis that is difficult to diagnose preoperatively. The objective of the study was to determine the increasing frequency of cases of non-traumatic ileal perforations and their subsequent management Method This descriptive case-series included 125 cases presenting in surgical emergency of Lahore General Hospital from 1st January 2014 to 1st December 2014. All patients were resuscitated and underwent emergency exploratory laparotomy. Results The causes for perforation were enteric fever in 82 cases (65.6%), tuberculosis in 38 cases (30.4%), adhesions and other causes in 5 cases (4%). The main presenting symptom in all patients were severe abdominal pain associated with fever and abdominal distension. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. In total out of 125 cases, primary repair was done in 9 cases, resection, and end to end anastomosis in 19 cases and in 13 patients’ resection and ileotransverse anastomosis was done. In the case of 78 patients loop ileostomy was done and in 6 patients double barrelled ileostomy was performed. Conclusions The incidence of terminal ileal perforations due to typhoid and the tuberculosis is high and carries high mortality and morbidity rates in delayed presentations. Therefore, it is high time now that general public health awareness should be created regarding food handling, sanitation, and personal hygiene.

Antimicrobial use and mortality among intensive care unit patients with bloodstream infections: implications for stewardship programs.

BackgroundBloodstream infections (BSIs) are one of the most critical illnesses requiring intensive care unit (ICU) admission. Antimicrobial therapy (AMT) is one of the vital management strategies for the treatment of BSIs; it should be chosen appropriately to reduce mortality.ObjectivesThis is the first study to investigate the types of antimicrobial agents administered in the ICU setting and the predictor variables associated with mortality.MethodsThis retrospective study was conducted at King Abdullah University Hospital (KAUH). All hospitalized patients admitted to the ICU and received at least one antimicrobial agent over 3 years period (January 1, 2017, to December 31, 2019) were included in the study. Electronic patients' medical records were used to collect patients' demographic and clinical characteristics, patient general health status, events that occurred during hospitalization, and events after obtaining the blood culture. Descriptive analysis was done to identify the types of antimicrobials used and the distribution of the microorganisms among the study participants. The susceptibility test of the bloodstream culture was checked for each patient. Moreover, crude mortality and its associated factors were investigated.ResultsA total of 1051 patients were enrolled in the study, where 650 patients (61.84%) were treated with three or more antimicrobial agents. The most frequent antimicrobials used were piperacillin/tazobactam followed by teicoplanin, meropenem, and levofloxacin. About half of the patients died within 30-days of BSI, which was associated with several factors including advanced age, presence of co-morbidities, nosocomial infections or healthcare-associated infections, length of ICU stay, respiratory tract infections, receiving vasopressor during the hospital stay, concurrent positive culture other than blood with BSI, receiving combination antimicrobial therapy, those who were complicated with septic shock or renal failure, receiving total parenteral protein (TPN) nutrition, and inappropriate empiric antimicrobial therapy.ConclusionIn conclusion, the administration of the antimicrobials among ICU patients was highly based on a combination of three or more agents covering a broad spectrum of microorganisms. The mortality rate was high among patients which were associated with inappropriate empirical therapy. Therefore, the antimicrobial stewardship (ASP) protocol has to be evaluated in the hospital for ICU patients. Moreover, we suggest recommending that hospital policies should apply the ASP protocol, infection control, implement the antimicrobial de-escalation protocol, and do best controlling on the co-morbid conditions, especially for ages 65 years or more to reduce the mortality rate in the ICU.

Identification and treatment of potentially destabilizing Vancouver B-lesser trochanter periprosthetic fracture (“New B2”): A 33-case series

IntroductionA new type of periprosthetic fracture, between Vancouver-SoFCOT types A and B, was recently described and labeled “new B2”. It occurs intraoperatively or in the early postoperative period, on cementless implants, and features a posteromedial cortical fragment around the lesser trochanter. The main aim of the present study was to report clinical and radiological results in a series of 33 cases of what is better called Vancouver B-lesser trochanter (VB-LT) fracture. The secondary objective was to identify risk factors. The study hypothesis was that VB-LT fracture might occur in the late postoperative course. Material and methodA2 single-center retrospective study included all patients with postoperative periprosthetic VB-LT fracture diagnosed on standard X-ray. Treatment was operative or non-operative depending on femoral implant subsidence and the patient's general health status. ResultsThere were 33 VB-LT fractures out of 445 periprosthetic femoral fractures (7.5%), in 27 women and 6 men; all were postoperative, at a mean 47 months (range, 1 day to 20 years). Mean subsidence of the femoral stem was 8.8mm, in 73% of cases (24 out of 33 implants). The 9 VB-LT1 fractures (without subsidence) were treated non-operatively, without secondary displacement. Thirteen of the 24 VB-LT2 fractures (with subsidence) were managed by stem exchange and cerclage; 3 other patients had isolated stem exchange, 2 had isolated internal fixation by cerclage, and 6 in poor health were managed non-operatively. At a mean 28 months’ follow-up (range, 6–48 months), mean PMA score was 15.5 (range, 10–18), Harris Hip score 72.4 (range, 43–100) and Parker score 7.2 (range, 4–9). All cases showed osseointegration and implant stability; there was 1 case of non-union, without impact on stability. ConclusionPostoperative Vancouver B-lesser trochanter fracture seemed specific to cementless implants and did not occur exclusively in the early postoperative period. Non-operative treatment gave good results when there was no implant subsidence (type VB-LT1). Level of evidenceIV, retrospective.

Reconstruction and Outcome of Foot Defects Following Oncological Resection-Experience from a Cancer Centre in North-East India.

Solid tumours around the foot are rare and include soft tissue sarcomas, skin and bone malignancies. Extended soft tissue defects due to oncological resection result in the loss of shock-absorbing and friction resistant tissue, which leads to altered walking patterns and pain. Replacement of plantar tissue requires soft tissue resistant to weight, pressure and shear stress. The other important desired goal of foot reconstruction is short wound healing time in order to allow adjuvant therapy at stipulated time. This is a retrospective study from March 2016 to October 2019. A total of twenty-one (n = 21) patients were operated for foot malignancies during this period in our institute and the resulting defects were reconstructed using various methods. Different reconstructive surgeries were performed depending on tumour size, location and general health status of patients. The length of hospitalization and the presence of local postoperative complications were assessed. Functional outcomes were measured in terms of MSTS score. Average age of the series is 53.1years. Sixty-six percent of the patients (n = 14) presented with tumour at the weight bearing areas and 33% patients (n = 7) at the non-weight bearing areas of the foot. Fifty-seven percent of patients (n = 12) presented with malignant melanoma of foot, squamous cell carcinoma was seen in 33% (n = 7) patients and 4% patients (n = 1 each) presented as osteosarcoma and malignant peripheral nerve sheath tumour respectively. The mean MSTS score in patients with weight bearing areas (location) is statistically significant (p = 0.031). There is a significant correlation between the surgical complications and follow up MSTS score (p = 0.046) which signifies that flap related complications result in lower MSTS score. The mean MSTS score was 22.71/30. Complications were observed in three cases which included partial flap necrosis, graft loss and foot stiffness. Simple skin grafts to local flaps maybe a viable option in a limited resource setting based on the location of defect. Free tissue transfer is the ideal choice in case of weight bearing areas to achieve acceptable outcomes.

PHYSIOTHERAPY REHABILITATION IN ELDERLY PATIENTS WITH POSTOPERATIVE FEMORAL NECK FRACTURE

of The femoral neck fracture in older people is a significant public health problem. Femoral neck fracture is a common type of hip fracture, which has a high morbidity and mortality. Surgical treatments is the first choice. Femoral neck fractures are common injuries in every trauma center's patient population and have a high prevalence in the overall population. The most severe outcomes of hip fractures are known to be falls or osteoporosis, which is typically confirmed in patients with trauma. Ninety-seven femoral neck fracture patients aged 70 years or older were included, and history characteristics, falls, fractures, and other postoperative complications were examined and reported during hospitalization. Therefore, this study focus on the protocols for the treatment of physical therapy following surgically treated proximal femoral fractures in elderly patients. In the postoperative treatment of patients with proximal femoral fracture, physical therapy helps to increase muscle strength and enhance walking safety and performance, understanding the condition of the patient, thereby helping the elderly to become more independent. It is incredibly necessary for the doctor to have knowledge about the form of fracture, along with the material used for surgical fixation, secure a healthy beginning for physical therapy. In order to avoid respiratory issues and other complications resulting in immobility, it is of critical importance for this patient to remain orthostatic and to walk as soon as possible, irrespective of the nature of fracture and the material used for fixation, although this is frequently not possible because of the patient's general health status.

Is It Feasible to Conduct Post-Tuberculosis Assessments at the End of Tuberculosis Treatment under Routine Programmatic Conditions in China?

There is growing evidence that a substantial proportion of people who complete anti-tuberculosis treatment experience significant morbidity and mortality which can negatively affect their quality of life. It is suggested that national tuberculosis programs conduct end-of-treatment assessments, but whether this is feasible is currently not known. We therefore assessed whether tuberculosis program staff could assess functional and general health status of patients at the end of treatment in five TB clinics in four provinces in China. There were 115 patients, aged 14–82 years, who completed anti-tuberculosis treatment and a post-TB assessment. There were 54 (47%) patients who continued to have symptoms, the commonest being cough, dyspnea and fatigue. Symptom continuation was significantly more common in the 22 patients with diabetes (p = 0.027) and the 12 patients previously treated for TB (p = 0.008). There were 12 (10%) current smokers, an abnormal chest X-ray was found in 106 (92%) patients and distance walked in the 6-min walking test (6MWT) ranged from 30–750 m (mean 452 ± 120); 24 (21%) patients walked less than 400 m. Time taken to perform the post-TB assessment, including the 6MWT, ranged from 8–45 min (mean 21 ± 8 min). In 98% of the completed questionnaires, health workers stated that conducting post-TB assessments was feasible and useful. This study shows that post-TB assessments can be conducted under routine programmatic conditions and that there is significant morbidity that needs to be addressed.

The Assessment of General Health Status in Patients with Odonto-Periodontal Pathology and Diabetes Mellitus

Abstract The present research attempts to assess the general health status of the studied group of patients by applying the questionnaire method. The research group has been composed of 210 subjects, from both urban and rural areas, having periodontal pathologies and disorders of the glucidic metabolism. In order to obtain information about the general health condition as well as the orodental hygiene, we have applied the questionnaire method, this being well individualized and adapted to be relevant to the present study. It was highlighted that patients with odonto-periodontal pathology and diabetes gave a more affected general health compared to those without diabetes.