ObjectiveTo evaluate the frequency of intra-abdominal hypertension in major burn
patients and its association with the occurrence of acute kidney injury.MethodsThis was a prospective cohort study of a population of burn patients
hospitalized in a specialized intensive care unit. A convenience sample was
taken of adult patients hospitalized in the period from 1 August 2015 to 31
October 2016. Clinical and burn data were collected, and serial
intra-abdominal pressure measurements taken. The significance level used was
5%.ResultsA total of 46 patients were analyzed. Of these, 38 patients developed
intra-abdominal hypertension (82.6%). The median increase in intra-abdominal
pressure was 15.0mmHg (interquartile range: 12.0 to 19.0). Thirty-two
patients (69.9%) developed acute kidney injury. The median time to
development of acute kidney injury was 3 days (interquartile range: 1 - 7).
The individual analysis of risk factors for acute kidney injury indicated an
association with intra-abdominal hypertension (p = 0.041), use of
glycopeptides (p = 0.001), use of vasopressors (p = 0.001) and use of
mechanical ventilation (p = 0.006). Acute kidney injury was demonstrated to
have an association with increased 30-day mortality (log-rank, p =
0.009).ConclusionIntra-abdominal hypertension occurred in most patients, predominantly in
grades I and II. The identified risk factors for the occurrence of acute
kidney injury were intra-abdominal hypertension and use of glycopeptides,
vasopressors and mechanical ventilation. Acute kidney injury was associated
with increased 30-day mortality.
Purpose
The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL).
Materials and Methods
A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589.
Results
Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 – 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 – 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 – 0.663, p = 0.001) than the control group.
Conclusion
one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.
implanting toxoplasmosis notification afforded epidemiological, clinical and diagnostic data on the disease that contributed to the assessment of the clinical evolution of children exposed to Toxoplasma gondii.
Here we describe the case of a patient who was referred to our institution with an immense abdominal volume of unknown origin. The patient was unable to stand up and therefore was bedridden. A giant hydronephrotic kidney was diagnosed and total volume of urine removed was 80L. Nephrectomy was uneventful and, despite his acquired thoracic and abdominal deformities, he was able to recover completely. This is the largest reported hydroneprosis in the literature.
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