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Tienpratarn W, Yuksen C, Pauly JD, Vu D, Benbourenane AN, Sangskul N. Factors and clinical prediction score for complication development after cellulitis diagnosis in adult patients. Int J Emerg Med 2024; 17:68. [PMID: 38778270 PMCID: PMC11110201 DOI: 10.1186/s12245-024-00646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Cellulitis is defined as a bacterial infection of the skin and subcutaneous tissue that can cause multiple complications, such as sepsis and necrotizing fasciitis. In extreme cases, it may lead to multiorgan failure and death. We sought to analyze the clinical factors that contribute to the development of complicated disease, including demographics, clinical presentation, initial vital signs, and laboratory studies. METHODS Our study is a retrospective cohort study carried out in a university-based tertiary care hospital in Bangkok, Thailand. Adult patients who presented with cellulitis from January 1, 2018, to December 31, 2022, were evaluated for eligibility and inclusion in this study. All related variables for both outcomes, bacteremia and necrotizing fasciitis, were gathered from electronic medical records and analyzed using multivariable logistic regression analysis. RESULTS Of the 1,560 visits to this hospital, 47 cases reported at least one complication, with bacteremia noted in 27 visits (1.73%) and necrotizing fasciitis in 20 visits (1.27%). From the multivariable logistic regression analysis, six variables emerge as predictors of cellulitis complications. These are: Age ≥ 65 years, Body Mass Index ≥ 30 kg/m2, diabetes mellitus, body temperature ≥ 38 °C, systolic blood pressure ≤ 100 mmHg, and involvement of lower extremities. The predictive score was developed from these factors and was named the Ramathibodi Necrotizing Fasciitis/Bacteremia (RAMA-NFB) Prediction Score. Our predictive score has an accuracy of 82.93% (95% CI, 0.77-0.89). Patients in the high-risk group (RAMA NFB score > 6) have a likelihood ratio of 8.75 (95% CI, 4.41-18.12; p < 0.001) times to develop complications of cellulitis. CONCLUSION In our study, the RAMA-NFB Prediction Score predicts complications of necrotizing fasciitis and bacteremia in adult patients who present with cellulitis. External validation of this predictive score is still needed for further practical application.
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Affiliation(s)
- Welawat Tienpratarn
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Joseph Daniel Pauly
- Yale School of Medicine, Yale New Haven Hospital Emergency Department, New Haven, CT, USA.
| | - Diana Vu
- George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Nuttamon Sangskul
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
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Simo LP, Agbor VN, Temgoua FZ, Fozeu LCF, Bonghaseh DT, Mbonda AGN, Yurika R, Dotse-Gborgbortsi W, Mbanya D. Prevalence and factors associated with overweight and obesity in selected health areas in a rural health district in Cameroon: a cross-sectional analysis. BMC Public Health 2021; 21:475. [PMID: 33691650 PMCID: PMC7944596 DOI: 10.1186/s12889-021-10403-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background Overweight and obesity are major public health problems worldwide, with projections suggesting a proportional increase in the number of affected individuals in developing countries by the year 2030. Evidence-based preventive strategies are needed to reduce the burden of overweight and obesity in developing countries. We assessed the prevalence of, and factors associated with overweight and obesity in selected health areas in West Cameroon. Methods Data were collected from a community-based cross-sectional study, involving the consecutive recruitment of participants aged 18 years or older. Overweight and obesity were defined according to the WHO classification. The statistical software R (version 3.5.1, The R Foundation for statistical computing, Vienna, Austria) was used for statistical analysis. Multivariable logistic regression analysis was used to assess independent factors associated with overweight and obesity, and obesity. Results Records of 485 participants were included for analysis. The age and sex-standardized prevalence of overweight, obesity, and overweight and obesity were 31.1% (95% CI, 27.0–35.2), 18.9% (95% CI, 14.9–22.9), and 50.1% (95% CI, 45.7–54.6), respectively. In multivariable analysis, being female (adjusted OR [aOR] = 2.79, 95% CI = 1.69–4.63), married (aOR = 3.90, 95% CI = 2.23–6.95), and having secondary or tertiary education (aOR = 3.27, 95% CI = 1.77–6.17) were associated with higher odds of overweight and obesity, while current smokers had lower odds of overweight and obesity (aOR = 0.37, 95% CI = 0.16–0.82) when compared to their respective counterpart. Compared to their respective reference categories, being female being (aOR = 3.74, 95% CI = 2.01–7.30), married (aOR = 2.58, 95% CI = 1.37–5.05) and having secondary or tertiary education (aOR = 2.03, 95% CI = 1.00–4.23) were associated with higher odds of obesity after adjustments for confounding. Conclusion We observed a high prevalence of overweight and obesity in this study. The odds of overweight and obesity was higher in females, married participants, and those with higher levels of education. Community-based interventions to control overweight and obesity should consider targeting these groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10403-w.
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Affiliation(s)
- Larissa Pone Simo
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Valirie Ndip Agbor
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Department of Clinical Research, Health Education and Research Organization (HERO), Douala, Cameroon.
| | | | | | | | | | - Raymond Yurika
- Technical Group for Tuberculosis Control, North West Regional Delegation of Public Health, Bamenda, Cameroon
| | - Winfred Dotse-Gborgbortsi
- School of Geography and Environmental Science, Highfield, University of Southampton, Southampton, SO17 1BJ, UK
| | - Dora Mbanya
- Faculty of Health Sciences, the University of Bamenda, Bamenda, Cameroon.,Yaoundé University Teaching Hospital (YUTH), Yaoundé, Cameroon
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Lee DU, Fan GH, Ahern RR, Karagozian R. The effect of malnutrition on the infectious outcomes of hospitalized patients with cirrhosis: analysis of the 2011-2017 hospital data. Eur J Gastroenterol Hepatol 2021; 32:269-278. [PMID: 33252419 DOI: 10.1097/meg.0000000000001991] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In patients with cirrhosis, there is a clinical concern that the development of protein-calorie malnutrition will affect the immune system and predispose these patients to increased infectious outcomes. AIMS In this study, we evaluate the effects of malnutrition on the infectious outcomes of patients admitted with cirrhosis. MATERIALS AND METHODS This study used the 2011-2017 National Inpatient Sample to identify patients with cirrhosis. These patients were stratified using malnutrition (protein-calorie malnutrition, cachexia, and sarcopenia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. The endpoints included mortality and infectious outcomes. RESULTS After matching, there were 96 842 malnutrition-present cohort and equal number of controls. In univariate analysis, the malnutrition cohort had higher hospital mortality [10.40 vs. 5.04% P < 0.01, odds ratio (OR) 2.18, 95% confidence interval (CI) 2.11-2.26]. In multivariate models, malnutrition was associated with increased mortality [P < 0.01, adjusted odds ratio (aOR) 1.32, 95% CI 1.27-1.37] and infectious outcomes, including sepsis (P < 0.01, aOR 1.94, 95% CI 1.89-2.00), pneumonia (P < 0.01, aOR 1.68, 95% CI 1.63-1.73), UTI (P < 0.01, aOR 1.39, 95% CI 1.35-1.43), cellulitis (P < 0.01, aOR 1.09, 95% CI 1.05-1.13), cholangitis (P < 0.01, aOR 1.39, 95% CI 1.26-1.55), and clostridium difficile (P < 0.01, aOR 2.11, 95% CI 1.92-2.31). CONCLUSION The results of this study indicate that malnutrition is an independent risk factor of hospital mortality and local/systemic infections in patients admitted with cirrhosis.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology, Liver Center, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, USA
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Gomes Siqueira GL, Alves de Olinda R, Barbosa de Siqueira CM, Barros de Vasconcelos Sá Torres A, de Carvalho Viana Corrêa L, de Assis Silva Lacerda F, Fernandes Guimarães PL. Non-necrotizing and necrotizing soft tissue infections in South America: A retrospective cohort study. Ann Med Surg (Lond) 2020; 59:24-30. [PMID: 32983444 PMCID: PMC7498730 DOI: 10.1016/j.amsu.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background This study analyzed and described factors related to necrotizing or non-necrotizing soft tissue infections (SSTIs) in a hospitalized patient population in Northeastern South America. Materials and methods This retrospective study included patients hospitalized with SSTIs between January 2011 and December 2016. The main factors related to necrotizing SSTIs (NSTIs) or non-necrotizing SSTIs were analyzed together or separately. Results Of 344 SSTI patients (161 [46.8%] non-necrotizing, 183 [53.2%] necrotizing), NSTI patients had a higher incidence of heart disease (P = 0.0081) and peripheral arterial disease (PAD; p < 0.001), more antibiotic use, and longer hospital stay (P < 0.001). NSTI was associated with a 9.58, 33.28, 2.34, and 2.27 times higher risk of PAD (confidence interval [CI] 3.69–24.87), amputation (7.97–139), complications (1.45–3.79), and death (1.2–4.26), respectively, than non-necrotizing SSTI. The risk factors associated with amputation were PAD (P < 0.001) and poor glycemic control during hospitalization (P = 0.0011). Factors associated with higher mortality were heart disease (P < 0.001), smoking (P = 0.0135), PAD (P = 0.001), chronic renal failure (P = 0.0039), poor glycemic control (P = 0.0005), and evolution to limb irreversibility (P < 0.001). Conclusion Patients with NSTI have greater illness severity, with a greater association with PAD and amputation. Patients with poor glycemic control more frequently underwent amputation and died. Patients with necrotizing infections and poor glycemic control have higher risks for amputation. Diabetes as a risk factor most associated with soft tissue infections. Peripheral arterial disease is the main risk factor for amputation and death. Soft tissue infections with necrosis evolve with more complications and risk of amputation and death.
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Ebob-Anya BA, Bassah N, Palle JN. Management of cellulitis and the role of the nurse: a 5-year retrospective multicentre study in Fako, Cameroon. BMC Res Notes 2019; 12:452. [PMID: 31337435 PMCID: PMC6651919 DOI: 10.1186/s13104-019-4497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
Objective This was a 5 year retrospective study of patients’ hospital records to find out how patients with cellulitis are managed and the care provided by nurses to these patients in some hospitals in Fako, Cameroon. Results Of the 236 cases of cellulitis identified from a study of hospital records, 202 were included in the study. Most of the participants (55%) were female and the mean (SD) age was 43 (1.1) years. Cellulitis accounted for 2.3% of admissions in this study. The predisposing factors identified were; the presence of trauma (60.5%), HIV infection (18.6%), alcohol consumption (8.4%) and tobacco use (4.8%). Commonly recorded complications were necrosis (32.2%), sepsis (23%), abscess formation (19.5%), and ulcer development (19.5%). Medical management was with antibiotic therapy, including mostly penicillin (26.5%), aminoglycoside (22.1%), nitroimidazole (20.2%) and cephalosporin (19.6%). Debridement (46.7%), and incision and drainage (44.4%) were the most implemented surgical interventions. Nursing care, as found in patients’ hospital records were predominantly on medication administration (98.0%), vital signs assessment (90.5%) and patient assessment (53%). Cellulitis therefore was found among a substantial number of patients and management was predominantly with combination antibiotics therapy and inadequate nursing care. Electronic supplementary material The online version of this article (10.1186/s13104-019-4497-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bachi-Ayukokang Ebob-Anya
- Department of Nursing, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, South-West Region, Cameroon
| | - Nahyeni Bassah
- Department of Nursing, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, South-West Region, Cameroon.
| | - John Ngunde Palle
- Department of Nursing, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, South-West Region, Cameroon.,Saint Luke's Medical Center Buea, Buea, Cameroon
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