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Decubitus Ulcers [keywords]
- Pulmonary Edema Induced by Hyperbaric Oxygen Therapy. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):456A.
Miscellaneous Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Pulmonary edema is a rare complication of hyperbaric oxygen therapy (HBOT). Riddick et al suggested that patient who have low ejection fraction should not receive hyperbaric oxygen therapy because the risk of acute pulmonary edema. This was confirmed by observational case series by Lindell et al1. We herein describe a case of pulmonary edema associated with hyperbaric oxygen therapy in patient who has normal ejection fraction (EF) with mild diastolic dysfunction.CASE PRESENTATION: A 57-year-old male with history of obesity, sleep apnea and chronic leg ulcer, presented with acute onset difficulty breathing. During a session of HBOT, he developed acute shortness of breath associated with pink frothy sputum, tachypnea and diaphoresis. On examination, his HR 120, RR was 30 /min. He had bilateral lung crackle. His arterial blood gas sampling showed pH 7.14; PaCO2, 85; PaO2, 40. Patient was placed on BiPAP and admitted to ICU. Chest X-ray and CTA of the chest showed bilateral generalize alveolar infiltrates representing pulmonary edema. EKG showed sinus tachycardia rate 110. His EF was 60% with mild diastolic dysfunction, no wall motion abnormality. Patient was intubated for worsening hypoxia and alteration of mental status for 1 day. Patient received and responded to diuretics. Eventually, the patient was extubated and safely discharged home.DISCUSSION: Pulmonary edema associated with HBOT is rare. Contraindication for HBOT included untreated pneumothorax, obstructive lung disease, pulmonary bleb, sinus infection, seizure disorder2,3. Generally, heart failure is not considered a risk factor in HBOT. However, our case report supports the previous opinion that acute pulmonary edema may complicate HBOT. As opposed to the previously reported case of HBOT induced pulmonary edema, our case reports the development of HBOT induced acute pulmonary edema in a patient with mild diastolic dysfunction and normal EF. Possible mechanism for HBOT causing pulmonary edema include increasing LV afterload, increasing LV filling pressure, increasing oxidative myocardial stress, increasing pulmonary capillary permeability, or causing pulmonary oxygen toxicity. Caution is recommended in treating both, low cardiac EF or diastolic dysfunction patients with HBOT.CONCLUSIONS: Acute pulmonary edema is a rarely reported complication of HBOT. Pulmonary edema can occur in low EF heart failure patients as well as in patients with mild diastolic dysfunction and normal cardiac EF. We advise caution using HBOT not only in reduced cardiac EF but also in cardiac diastolic dysfunction patients. Reference #1: 1. Weaver LK, Churchill S. PUlmonary edema associated with hyperbaric oxygen therapy*. CHEST Journal 2001;120:1407-9.Reference #2: 2. Toklu AS, Korpinar S, Erelel M, Uzun G, Yildiz S. Are pulmonary bleb and bullae a contraindication for hyperbaric oxygen treatment? Respiratory Medicine 2008;102:1145-7.Reference #3: 3. Tibbles PM, Edelsberg JS. Hyperbaric-Oxygen Therapy. New England Journal of Medicine 1996;334:1642-8.DISCLOSURE: The following authors have nothing to disclose: Pornchai Leelasinjaroen, Nibal Saad, Wuttiporn Manatsathit, Equakhide Inegbenebor, William VentimigliaNo Product/Research Disclosure Information.
- An Unusual Presentation of Aortic Coarctation in a 33-Year-Old Navajo Sheep Herder. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):106A.
Cardiovascular Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Aortic coarctation (CoA) is the fifth most common congenital heart defect with an estimated incidence of 1 in 2500 births. CoA is typically diagnosed and corrected in early childhood. Unrepaired or undiagnosed CoA presenting during adult life is rare and the mean life expectancy of patients with CoA is 31 years.1 Most patients who survive into adulthood present with cardiovascular complications. We report a case of a 33 year old Navajo male presenting in severe sepsis from a lower extremity abscess who was subsequently diagnosed with CoA.A 33 year old male with a childhood diagnosis of bicuspid aortic valve (BAV) and untreated Diabetes Mellitus (A1C 11%) was admitted to an Indian Health Service hospital with an infected ulcer on his right lower extremity (RLE). He presented to the hospital with progressive erythema, swelling and pain of his RLE after 3 days on his feet herding sheep. He was febrile to 38.6C and had equal blood pressures in both arms (135/60 on the right, 138/65 on the Left). He had a 3cm fluctuant ulcer on the lateral aspect of his foot with blanching erythema and tenderness. Pedal pulses were not palpable nor audible with doppler. Subsequently a right thigh blood pressure was noted to be 115/55 and he had a significant radio-femoral pulse delay. He was admitted to the intensive care unit with severe sepsis and acute kidney injury. After undergoing an operative debridement, his sepsis resolved with intravenous fluid and broad spectrum antibiotics. MRA of his thorax revealed coarctation of the proximal descending thoracic aorta which resulted in focal stenosis of 70%. An echocardiogram confirmed a bicuspid aortic valve without stenosis or regurgitation. He was referred to a tertiary center for repair of his CoA.CoA is a congenital lesion usually diagnosed in childhood and often coexisting with concomitant congenital heart defects, most commonly BAV. Most infants born with CoA develop heart failure following closure of the ductus arteriosus and require intervention for survival. Survival past infancy without intervention is due to less severe narrowing or the development of collateral circulation that bypasses the coarctation. The natural history of unrepaired CoA is dismal with the mean age of death 31 years.1 Mortality is usually from hypertensive related cardiovascular disease including heart failure, cerebral hemorrhage or aortic rupture. Less commonly, patients present with claudication.2 We present a case of adult onset CoA with an unusual preceding diagnosis: sepsis from an infected lower extremity ulcer. It is likely that in addition to uncontrolled diabetes, impaired blood flow distal to the coarctation promoted the development of infection in this patient. Although the presentation of a diabetic foot infection would not typically warrant a CoA workup, this patient's exam findings and history of BAV increased the index of suspicion. Given that 25-75% of patients with a BAV have coexisting CoA,3 clinicians should maintain a high index of suspicion for CoA and consider routine screening with aortic imaging in patients with presumptive isolated BAV.Adult patients with uncorrected CoA typically present with cardiovascular disease complications, however atypical presentations such as an infected lower extremitiy ulcer can occur. Clinicians should maintain a high index of suspicion for CoA and consider routine screening with aortic imaging in patients with presumptive isolated BAV regardless of the patient's initial presentation. Reference #1: Kenny D and Hijazi Z. Coarctation of the aorta: From fetal life to adulthood. Cardiology Journal 2011, vol18, No 5, 487-495.Reference #2: Fitzpatrick CM, Clouse WD, Eliason JL, Gage K, Podberesky DJ, Bush DM. Infrarenal aortic coarctation in a 15-yr-old with claudication. J Vasc Surg 2006;44:1117. Reference #3: Tanous D, Benson LN and Horlick EM. Coarctation of the aorta: evaluation and management. Current Opinion in Cardiology 2009, 24: 509-515.The following authors have nothing to disclose: Drew Harris, Salerno AmyNo Product/Research Disclosure Information.
- Development of intelligent model for personalized guidance on wheelchair tilt and recline usage for people with spinal cord injury: Methodology and preliminary report. [JOURNAL ARTICLE]
- J Rehabil Res Dev 2014; 51(5):775-788.
Wheelchair tilt and recline functions are two of the most desirable features for relieving seating pressure to decrease the risk of pressure ulcers. The effective guidance on wheelchair tilt and recline usage is therefore critical to pressure ulcer prevention. The aim of this study was to demonstrate the feasibility of using machine learning techniques to construct an intelligent model to provide personalized guidance to individuals with spinal cord injury (SCI). The motivation stems from the clinical evidence that the requirements of individuals vary greatly and that no universal guidance on tilt and recline usage could possibly satisfy all individuals with SCI. We explored all aspects involved in constructing the intelligent model and proposed approaches tailored to suit the characteristics of this preliminary study, such as the way of modeling research participants, using machine learning techniques to construct the intelligent model, and evaluating the performance of the intelligent model. We further improved the intelligent model's prediction accuracy by developing a two-phase feature selection algorithm to identify important attributes. Experimental results demonstrated that our approaches held the promise: they could effectively construct the intelligent model, evaluate its performance, and refine the participant model so that the intelligent model's prediction accuracy was significantly improved.
- Nurse Assistant Communication Strategies About Pressure Ulcers in Nursing Homes. [JOURNAL ARTICLE]
- West J Nurs Res 2014 Oct 20.
There is growing recognition of benefits of sophisticated information technology (IT) in nursing homes (NHs). In this research, we explore strategies nursing assistants (NAs) use to communicate pressure ulcer prevention practices in NHs with variable IT sophistication measures. Primary qualitative data were collected during focus groups with NAs in 16 NHs located across Missouri. NAs (n = 213) participated in 31 focus groups. Three major themes referencing communication strategies for pressure ulcer prevention were identified, including Passing on Information, Keeping Track of Needs and Information Access. NAs use a variety of strategies to prioritize care, and strategies are different based on IT sophistication level. NA work is an important part of patient care. However, little information about their work is included in communication, leaving patient records incomplete. NAs' communication is becoming increasingly important in the care of the millions of chronically ill elders in NHs.
- [Current decubitus prevention and treatment algorhytm]. [English Abstract, Journal Article]
- Acta Med Croatica 2014 Oct.:109-16.
Decubitus ulcer treatment options, as well as the etiology, classification and prevention guidelines are presented. The importance of a multidisciplinary approach along with prevention and education is emphasized. The National Pressure Ulcer Advisory Panel guidelines ensure contemporary decubitus ulcer treatment all over the world, while adoption of the basic algorithm is a precondition of good medical practice and nursing care. Upgrading the patient quality of life and complete healing of decubitus ulcer is definitely achievable by strict application of these recommendations.
- An innovative solid oral nutritional supplement to fight weight loss and anorexia: opened, randomised controlled trial of efficacy in institutionalised, malnourished older adults. [JOURNAL ARTICLE]
- Age Ageing 2014 Oct 16.
to evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults >70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis(®), Solidages, France).an open, multicentre, randomised controlled trial.seven nursing homes.one hundred and seventy-five malnourished older adults, aged 86 ± 8 years.all participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6).five visits (w-4, w0, w6, w10 and w18). Main outcome: percentage of weight gain from w0 to w6 (body mass in kg). Secondary outcomes: appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea.average weight increased in Intervention group (n = 88) compared with Control group (n = 87) without cookies supplementation (+1.6 versus -0.7%, P = 0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P = 0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P = 0.003), with diarrhea reduction (P = 0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P = 0.024), appetite increase (P = 0.009) and pressure ulcers reduction (P = 0.031).the trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.
- [Orthopaedic footwear against foot ulcers in diabetes]. [English Abstract, Journal Article]
- Ned Tijdschr Geneeskd 2014; 158(0):A7497.
- In people with diabetes mellitus, foot ulcers are a major problem because they increase the risk of a foot infection and amputation and reduce quality of life.- After a foot ulcer has healed, the risk of recurrence is high. - Orthopaedic shoes and orthotics are often prescribed to high risk patients and aim to reduce the mechanical pressure on the plantar surface of the foot. - Orthopaedic footwear that is modified to reduce pressure is not much more effective in preventing foot ulcer recurrence than orthopaedic footwear that did not undergo such modification, unless the shoes are worn as recommended. In that case, the risk of ulcer recurrence is reduced by 46%. - In patients with a history of ulceration, compliance in wearing orthopaedic shoes at home is low, while these patients walk more inside the house than outside the house.- Foot pressure measurements should be part of the prescription and evaluation of orthopaedic footwear for patients at high risk for foot ulceration.
- Epidemiological and genome-wide association study of gastritis or gastric ulcer in korean populations. [Journal Article]
- Genomics Inform 2014 Sep; 12(3):127-33.
Gastritis is a major disease that has the potential to grow as gastric cancer. Gastric cancer is a very common cancer, and it is related to a very high mortality rate in Korea. This disease is known to have various reasons, including infection with Helicobacter pylori, dietary habits, tobacco, and alcohol. The incidence rate of gastritis has reported to differ between age, population, and gender. However, unlike other factors, there has been no analysis based on gender. So, we examined the high risk factors of gastritis in each gender in the Korean population by focusing on sex. We performed an analysis of 120 clinical characteristics and genome-wide association studies (GWAS) using 349,184 single-nucleotide polymorphisms from the results of Anseong and Ansan cohort study in the Korea Association Resource (KARE) project. As the result, we could not prove a strong relation with these factors and gastritis or gastric ulcer in the GWAS. However, we confirmed several already-known risk factors and also found some differences of clinical characteristics in each gender using logistic regression. As a result of the logistic regression, a relation with hyperlipidemia, coronary artery disease, myocardial infarction, hyperlipidemia therapy, hypotensive or antihypotensive drug, diastolic blood pressure, and gastritis was seen in males; the results of this study suggest that vascular disease has a potential association with gastritis in males.
- [Logistic regression analysis on risk factors of cerebral hemorrhage complicated with stress ulcer]. [English Abstract, Journal Article]
- Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2014 Oct; 26(10):730-3.
To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU).The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender, age, amount of bleeding, the bleeding site (basal ganglia, thalamus, brainstem, brain lobe, ventricle, subarachnoid, and cerebellum), disturbance of consciousness, acute physiology and chronic health evaluation II (APACHEII) score, systolic blood pressure (SBP), history of hypertension, and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve) was plotted to analyze the independent risk factors and evaluate their power of test.1 185 patients with cerebral hemorrhage were enrolled in the study, 293 cases occurred SU, accounting for 24.7%, and 892 cases without SU, which accounted for 75.3%. As shown by univariate analysis, risk factors for cerebral hemorrhage complicated with SU included age, amount of bleeding, the bleeding site, disturbance of consciousness, APACHEII score, SBP. As to the site of bleeding, brain, thalamus, brainstem hemorrhage complicated with SU were higher proportion, 45.3% (43/95), 39.1% (63/161), 36.9% (48/130), which were significantly higher than those of the lobes of the brain [26.2% (33/126)], cerebellum [18.8% (15/80)], basal ganglia [16.1% (78/485)], arachnoid the inferior vena cava [12.0% (13/108)]. Multivariate logistic regression analysis showed that amount of bleeding [odds ratio (OR)=3.305, P=0.001, 95% confidence interval (95%CI) 2.213-48.634], the bleeding site (OR=1.762, P=0.008, 95%CI 0.123-2.743), SBP (OR=1.223, P=0.034, 95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC) of amount of bleeding and SBP were 0.846 and 0.597, suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value.Cerebral hemorrhage patients with large amount of bleeding, the bleeding site in the ventricle, thalamus or brainstem, high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.
- A novel model of human skin pressure ulcers in mice. [Journal Article]
- PLoS One 2014; 9(10):e109003.
Pressure ulcers are a prevalent health problem in today's society. The shortage of suitable animal models limits our understanding and our ability to develop new therapies. This study aims to report on the development of a novel and reproducible human skin pressure ulcer model in mice.Male non-obese, diabetic, severe combined immunodeficiency mice (n = 22) were engrafted with human skin. A full-thickness skin graft was placed onto 4×3 cm wounds created on the dorsal skin of the mice. Two groups with permanent grafts were studied after 60 days. The control group (n = 6) was focused on the process of engraftment. Evaluations were conducted with photographic assessment, histological analysis and fluorescence in situ hybridization (FISH) techniques. The pressure ulcer group (n = 12) was created using a compression device. A pressure of 150 mmHg for 8 h, with a total of three cycles of compression-release was exerted. Evaluations were conducted with photographic assessment and histological analysis.Skin grafts in the control group took successfully, as shown by visual assessment, FISH techniques and histological analysis. Pressure ulcers in the second group showed full-thickness skin loss with damage and necrosis of all the epidermal and dermal layers (ulcer stage III) in all cases. Complete repair occurred after 40 days.An inexpensive, reproducible human skin pressure ulcer model has been developed. This novel model will facilitate the development of new clinically relevant therapeutic strategies that can be tested directly on human skin.