The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study

Ohta, Ryuichi; Ryu, Yoshinori; Sano, Chiaki

doi:10.3390/healthcare9121611

Cited by 5 publications

(6 citation statements)

References 40 publications

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“…The patient's immunocompromised state could have affected the pathophysiology [12]. In addition to a history of liver cirrhosis and renal failure, the patient had white nails, which is a predictor of mortality in admitted patients [17,18]. Therefore, the patient's immunocompromised state might have facilitated the dissemination of Candida into the prostate [19].…”

Section: Discussionmentioning

confidence: 99%

Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an Immunocompromised Patient

Ohta¹,

Hattori²,

Inoue³

et al. 2022

Cureus

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Prostate abscesses often occur in immunocompromised individuals. Contrast-enhanced imaging tests can aid diagnosis; however, they can be difficult to perform in older patients with renal insufficiency. Various organisms can cause prostate abscesses, and poor antibiotic penetration into the prostate can hinder treatment. Here, we report a case of prostate abscess manifesting as fever of unknown origin. The patient, a 78-year-old man with a history of heart failure, renal failure, and liver cirrhosis, presented with dyspnea and fever. He was initially diagnosed with aspiration pneumonia. However, the fever persisted, and urinary tract infection was diagnosed and treated with antibiotics and antifungal drugs. Further investigation with contrast-enhanced computed tomography revealed a prostate abscess. This case demonstrates the importance of aggressive investigation of fever of unknown origin in older patients with renal insufficiency. Furthermore, the problem of tissue penetration of antimicrobial agents should be thoroughly considered when treating prostate abscesses.

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Section: Discussionmentioning

confidence: 99%

Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an Immunocompromised Patient

Ohta¹,

Hattori²,

Inoue³

et al. 2022

Cureus

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“…Decreased pain sensation and poor cognition can make the symptoms of diseases vague and difficult to diagnose. Previous studies in rural areas have shown that low serum albumin levels are associated with high mortality and morbidity [ 20 , 21 , 27 ]. High mortality and morbidity rates might also be caused by misdiagnosis and mistreatment of patients [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Delayed Diagnosis of Acute Cholecystitis among Rural Older Patients: A Retrospective Cohort Study

Ikeda

Ohta²,

Sano

2022

Medicina

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Background and objectives: Acute cholecystitis causes acute abdominal pain and may necessitate emergency surgery or intensive antibiotic therapy and percutaneous drainage, depending on the patient’s condition. The symptoms of acute cholecystitis in older patients may be atypical and difficult to diagnose, causing delayed treatment. Clarifying the risk factors for delayed diagnosis among older patients could lead to early diagnosis and treatment of acute cholecystitis. This study aimed to explore the risk factors for delayed diagnosis of acute cholecystitis among rural older patients. Material and Methods: This retrospective cohort study included patients aged over 65 years diagnosed with acute cholecystitis at a rural community hospital. The primary outcome was the time from symptom onset to acute cholecystitis diagnosis. We reviewed the electronic medical records of patients with acute cholecystitis and investigated whether they were diagnosed and treated for the condition at the time of symptom onset. Results: The average ages of the control and exposure groups were 77.71 years (standard deviation [SD] = 14.62) and 80.13 years (SD = 13.95), respectively. Additionally, 41.7% and 64.1% of the participants in the control and exposure groups, respectively, were men. The logistic regression model revealed that the serum albumin level was significantly related to a time to diagnosis > 3 days (odds ratio = 0.51; 95% confidence interval, 0.28–0.94). Conclusion: Low serum albumin levels are related to delayed diagnosis of cholecystitis and male sex. The presence of abdominal pain and a high body mass index (BMI) may be related to early cholecystitis diagnosis. Clinicians should be concerned about the delay in cholecystitis diagnosis in older female patients with poor nutritional conditions, including low serum albumin levels, a low BMI, vague symptoms, and no abdominal pain.

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“…The findings of white nails were characterized by a white appearance of the proximal nails with the absence of a lunula. Color changes in the distal region of nails were excluded from the assessment [5,6]. The nail lunula is eventually diminished in all fingers; however, the lunula of the first finger is often persistent, even in older individuals.…”

Section: Assessment Of White Nailsmentioning

confidence: 99%

“…The nail evaluators were unaware of the endpoints of the patients. To improve the diagnosis of white nails, the family physicians who performed the nail examinations in this study were trained using clinical pictures of white nails from a previous study (Figure 1) [5,6].…”

Section: Assessment Of White Nailsmentioning

confidence: 99%

“…It can be used to assess the previous conditions of patients with acute symptoms because nail plates and bed conditions may not change as static physical findings [5]. A previous study showed that clinicians could predict the risk of death in older admitted patients with white nails [6]. In addition, the presence of white nails can indicate comorbidities and nutritional conditions that may influence morbidity and mortality [7].…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between the Presence of White Nails and Readmission Among Rural Older Admitted Patients: A Prospective Cohort Study

Ohta¹,

Ryu²,

Sano³

2022

Cureus

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BackgroundNail changes can indicate systemic changes within the body. According to previous studies, white nails, characterized by the whitening of the proximal nails with the absence of a lunula, were related to in-hospital mortality in rural community hospitals. Hence, this study aimed to investigate the relationship between the presence of white nails and readmissions among rural older patients who had previously been discharged from rural community hospitals. MethodologyThe relationship between white nails and readmissions among admitted older patients discharged from community hospitals was investigated. This was a single-center prospective study. All patients >65 years admitted from April 2020 to March 2021 and readmitted between April 2020 and June 2021 were included in the study. Upon admission, all patients' nails were evaluated by trained evaluators for whitening. The presence of white nails was correlated with readmission using a multivariate logistic regression model. ResultsApproximately 28.7% of all participants were readmitted to the hospital during the study period; 41.1% had white nails, and 24.6% did not. Cox hazard model was used to analyze the relationship between readmission and white nails. Of all 637 participants, 24.8% had white nails. Significant variables for readmission were cancer (hazard ratio, HR = 1.52, p = 0.033), dementia (HR = 1.52, p = 0.037), heart failure (HR = 1.53, p = 0.033), home discharge (HR = 0.32, p ≤ 0.001), duration of previous hospitalization (HR = 0.99, p = 0.0026), and white nails (HR = 2.07, p ≤ 0.001). ConclusionsWhite nails may be associated with readmission among previously admitted older patients. Identifying white nails in older admitted patients may enhance awareness of readmission risk; however, this needs further research.

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The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study

Cited by 5 publications

References 40 publications

Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an Immunocompromised Patient

Difficulty in Diagnosing and Treating a Prostate Abscess With Bacterial and Fungal Coinfection in an Immunocompromised Patient

Risk Factors for Delayed Diagnosis of Acute Cholecystitis among Rural Older Patients: A Retrospective Cohort Study

The Relationship Between the Presence of White Nails and Readmission Among Rural Older Admitted Patients: A Prospective Cohort Study

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