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[PMID]:28455457
[Au] Autor:Mansour AM; Kheir-Jurdi W; Hadi UE; Awar G
[Ad] Endereço:Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
[Ti] Título:Odontogenic abscess mimicking acute dacryocystitis.
[So] Source:BMJ Case Rep;2017, 2017 Apr 28.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A middle-aged poorly controlled diabetic man developed left-sided orbital and facial swelling several days after extraction of a left upper wisdom tooth. The clinical impression was that of acute dacryocystitis. Opening the skin above the lacrimal sac failed to reveal an inflamed sac establishing the diagnosis of deep facial cellulitis. Complete resolution occurred few weeks after systemic antibiotics and repeated dental drainage of the tooth abscess.
[Mh] Termos MeSH primário: Abscesso/complicações
Celulite (Flegmão)/tratamento farmacológico
Dacriocistite/diagnóstico por imagem
[Mh] Termos MeSH secundário: Abscesso/cirurgia
Administração Intravenosa
Antibacterianos/administração & dosagem
Antibacterianos/uso terapêutico
Dacriocistite/complicações
Diagnóstico Diferencial
Drenagem
Face/patologia
Seres Humanos
Masculino
Meia-Idade
Dente Serotino/microbiologia
Dente Serotino/patologia
Dente Serotino/cirurgia
Ducto Nasolacrimal/patologia
Doenças Orbitárias/tratamento farmacológico
Doenças Orbitárias/etiologia
Doenças Orbitárias/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29228410
[Au] Autor:Ozawa H; Kuwano K; Manabe S; Ishihara T; Komatsu M; Kobayashi T; Yanagi H; Oki M; Takagi A
[Ad] Endereço:Department of General Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, kanagawa 259-1193, Japan. hide1012@is.icc.u-toka.ac.jp.
[Ti] Título:Clinical Course of Eosinophilic Cellulitis.
[So] Source:Tokai J Exp Clin Med;42(4):143-146, 2017 Dec 20.
[Is] ISSN:2185-2243
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:The patient was a previously healthy 23-year-old woman who made an outpatient visit to our hospital's Department of General Internal Medicine after developing pain and edema of the lower legs a week earlier. The patient was diagnosed with eosinophilic cellulitis (EC) based on an increased eosinophil count of 5,418/mm and the results of a skin biopsy of the lower leg that showed eosinophilic infiltration of the dermal tissue. Her condition improved after oral prednisone therapy. EC presents clinically as edema and eosinophilia. Therefore, in many cases, patients make an outpatient visit to the internal medicine department. In the present study, the clinical course of nine patients diagnosed with EC as outpatients at our Department of General Internal Medicine over the past 10 years was examined.
[Mh] Termos MeSH primário: Celulite (Flegmão)/diagnóstico
Celulite (Flegmão)/patologia
Eosinofilia/diagnóstico
Eosinofilia/patologia
[Mh] Termos MeSH secundário: Adulto
Celulite (Flegmão)/tratamento farmacológico
Celulite (Flegmão)/imunologia
Eosinofilia/tratamento farmacológico
Eosinofilia/imunologia
Eosinófilos/imunologia
Eosinófilos/patologia
Feminino
Seres Humanos
Perna (Membro)
Contagem de Leucócitos
Imagem por Ressonância Magnética
Prednisona/administração & dosagem
Pele/patologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
VB0R961HZT (Prednisone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE


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[PMID]:27770490
[Au] Autor:Subramaniam S; Bober J; Chao J; Zehtabchi S
[Ad] Endereço:Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY.
[Ti] Título:Point-of-care Ultrasound for Diagnosis of Abscess in Skin and Soft Tissue Infections.
[So] Source:Acad Emerg Med;23(11):1298-1306, 2016 Nov.
[Is] ISSN:1553-2712
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). Management of an abscess requires incision and drainage, whereas cellulitis generally requires a course of antibiotics. Misdiagnosis often results in unnecessary invasive procedures, sedations (for incision and drainage in pediatric patients), or a return ED visit for failed antibiotic therapy. OBJECTIVE: The objective was to describe the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in ED patients with SSTI. METHODS: We systematically searched Medline, Web of Science, EMBASE, CINAHL, and Cochrane Library databases from inception until May 2015. Trials comparing POCUS with clinical examination to identify abscesses when evaluating SSTI in the ED were included. Trials that included intraoral abscesses or abscess drainage in the operating room were excluded. The presence of an abscess was defined by drainage of pus. The absence of an abscess was defined as no pus drainage upon incision and drainage or resolution of SSTI without pus drainage at follow-up. Quality of trials was assessed using the QUADAS-2 tool. Operating characteristics were reported as sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-), with their respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic (HSROC) model. RESULTS: Of 3,203 references identified, six observational studies (four pediatric trials and two adult trials) with a total of 800 patients were included. Two trials compared clinical examination with clinical examination plus POCUS. The other four trials directly compared clinical examination to POCUS. The POCUS HSROC revealed a sensitivity of 97% (95% CI = 94% to 98%), specificity of 83% (95% CI = 75% to 88%), LR+ of 5.5 (95% CI = 3.7 to 8.2), and LR- of 0.04 (95% CI = 0.02 to 0.08). CONCLUSION: Existing evidence indicates that POCUS is useful in identifying abscess in ED patients with SSTI. In cases where physical examination is equivocal, POCUS can assist physicians to distinguish abscess from cellulitis.
[Mh] Termos MeSH primário: Abscesso/diagnóstico por imagem
Celulite (Flegmão)/diagnóstico por imagem
Sistemas Automatizados de Assistência Junto ao Leito
Infecções dos Tecidos Moles/diagnóstico por imagem
Ultrassonografia/métodos
[Mh] Termos MeSH secundário: Abscesso/terapia
Adulto
Antibacterianos/uso terapêutico
Feminino
Seres Humanos
Masculino
Estudos Observacionais como Assunto
Exame Físico
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171201
[Lr] Data última revisão:
171201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161102
[St] Status:MEDLINE
[do] DOI:10.1111/acem.13049


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[PMID]:29069019
[Au] Autor:Muradbegovic M; St-Amour P; Martin D; Petermann D; Benabidallah S; Di Mare L
[Ad] Endereço:aDepartment of General and Visceral Surgery, EHC Hospital, Morges b Department of Visceral Surgery, University Hospital CHUV, Lausanne cUnilabs, Department of Pathology, Lausanne, Switzerland.
[Ti] Título:End-colostomy diverticulitis with parastomal phlegmon: A case report.
[So] Source:Medicine (Baltimore);96(43):e8358, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Acute colonic diverticulitis is a well-known surgical emergency, which occurs in about 10 percent of patients known for diverticulosis. PATIENT CONCERNS: The case of a 77-year-old woman is reported, with past history of abdominoperineal resection with end-colostomy for low rectal adenocarcinoma, and who developed an acute colonic diverticulitis in a subcutaneous portion of colostomy with parastomal phlegmon. DIAGNOSES: Initial computed tomography imaging demonstrated a significant submucosal parietal edema with local fat tissues infiltration in regard of 3 diverticula. INTERVENTIONS: A two-step treatment was decided: first a nonoperative treatment was initiated with 2 weeks antibiotics administration, followed by, 6 weeks after, a segmental resection of the terminal portion of the colon with redo of a new colostomy by direct open approach. OUTCOMES: Patient was discharged on the second postoperative day without complications. Follow-up at 2 weeks revealed centimetric dehiscence of the stoma, which was managed conservatively until sixth postoperative week by stomatherapists. LESSONS SUBSECTIONS: Treatment of acute diverticulitis with parastomal phlegmon in a patient with end-colostomy could primary be nonoperative. Delayed surgical treatment with segmental colonic resection was proposed to avoid recurrence and potential associated complications.
[Mh] Termos MeSH primário: Celulite (Flegmão)/etiologia
Colostomia/efeitos adversos
Doença Diverticular do Colo/etiologia
Complicações Pós-Operatórias/etiologia
Estomas Cirúrgicos/efeitos adversos
[Mh] Termos MeSH secundário: Neoplasias Abdominais/cirurgia
Idoso
Neoplasias do Ânus/cirurgia
Feminino
Seres Humanos
Períneo/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171123
[Lr] Data última revisão:
171123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008358


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[PMID]:28904688
[Au] Autor:Mzabi A; Marrakchi W; Alaya Z; Fredj FB; Rezgui A; Bouajina E; Kechrid CL
[Ad] Endereço:Department of Internal Medicine, Sahloul Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia.
[Ti] Título:Cellulitis in aged persons: a neglected infection in the literature.
[So] Source:Pan Afr Med J;27:160, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Celulite (Flegmão)/epidemiologia
Fasciite Necrosante/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Antibioticoprofilaxia/métodos
Braço
Celulite (Flegmão)/terapia
Face
Feminino
Hospitalização
Seres Humanos
Perna (Membro)
Masculino
Estudos Retrospectivos
Índice de Gravidade de Doença
Distribuição por Sexo
Tunísia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.160.12007


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[PMID]:28697851
[Au] Autor:Marcelin JR; Challener DW; Tan EM; Lahr BD; Baddour LM
[Ad] Endereço:Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN. Electronic address: marcelin.jasmine@mayo.edu.
[Ti] Título:Incidence and Effects of Seasonality on Nonpurulent Lower Extremity Cellulitis After the Emergence of Community-Acquired Methicillin-Resistant Staphylococcus aureus.
[So] Source:Mayo Clin Proc;92(8):1227-1233, 2017 Aug.
[Is] ISSN:1942-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Nonpurulent lower extremity cellulitis (NLEC) is a common clinical diagnosis, with ß-hemolytic streptococci and Staphylococcus aureus considered to be the most frequent causes. In 1999, the US Public Health Service alerted clinicians to the presence of community-acquired methicillin-resistant S aureus (CA-MRSA) infections in 4 children in the upper Midwest. Since then, it has become a well-recognized cause of skin and soft-tissue infections, in particular, skin abscess. A previous population-based study of NLEC in Olmsted County, Minnesota, reported an unadjusted incidence rate of 199 per 100,000 person-years in 1999, but it is unknown whether CA-MRSA subsequently has affected NLEC incidence. We, therefore, sought to determine the population-based incidence of NLEC since the emergence of CA-MRSA. Age- and sex-adjusted incidence (per 100,000 persons) of NLEC was 176.6 (95% CI, 151.5-201.7). Incidence differed significantly between sexes with age-adjusted sex-specific rates of 133.3 (95% CI, 104.1-162.5) and 225.8 (95% CI, 183.5-268.0) in females and males, respectively. Seasonal incidence differed, with rates of 224.6 (95% CI, 180.9-268.4) in warmer months (May-September) compared with 142.3 (95% CI, 112.8-171.9) in colder months (January-April and October-December). Despite emergence and nationwide spread of CA-MRSA since 1999 in the United States, the incidence of NLEC in Olmsted County was lower in 2013 than in 1999, particularly in females. This suggests that CA-MRSA is not a significant cause of NLEC and that NLEC cases are seasonally distributed. These findings may be important in formulation of empirical therapy for NLEC and in patient education because many patients with NLEC are prone to recurrent bouts of this infection.
[Mh] Termos MeSH primário: Celulite (Flegmão)/epidemiologia
Infecções Comunitárias Adquiridas/epidemiologia
Extremidade Inferior
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Infecções dos Tecidos Moles/epidemiologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Minnesota
Estudos Retrospectivos
Fatores de Risco
Infecções Estafilocócicas/tratamento farmacológico
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE


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[PMID]:28631307
[Au] Autor:Dalal A; Eskin-Schwartz M; Mimouni D; Ray S; Days W; Hodak E; Leibovici L; Paul M
[Ad] Endereço:Department of Dermatology, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, Israel, 49100.
[Ti] Título:Interventions for the prevention of recurrent erysipelas and cellulitis.
[So] Source:Cochrane Database Syst Rev;6:CD009758, 2017 06 20.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Erysipelas and cellulitis (hereafter referred to as 'cellulitis') are common bacterial skin infections usually affecting the lower extremities. Despite their burden of morbidity, the evidence for different prevention strategies is unclear. OBJECTIVES: To assess the beneficial and adverse effects of antibiotic prophylaxis or other prophylactic interventions for the prevention of recurrent episodes of cellulitis in adults aged over 16. SEARCH METHODS: We searched the following databases up to June 2016: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS. We also searched five trials registry databases, and checked reference lists of included studies and reviews for further references to relevant randomised controlled trials (RCTs). We searched two sets of dermatology conference proceedings, and BIOSIS Previews. SELECTION CRITERIA: Randomised controlled trials evaluating any therapy for the prevention of recurrent cellulitis. DATA COLLECTION AND ANALYSIS: Two authors independently carried out study selection, data extraction, assessment of risks of bias, and analyses. Our primary prespecified outcome was recurrence of cellulitis when on treatment and after treatment. Our secondary outcomes included incidence rate, time to next episode, hospitalisation, quality of life, development of resistance to antibiotics, adverse reactions and mortality. MAIN RESULTS: We included six trials, with a total of 573 evaluable participants, who were aged on average between 50 and 70. There were few previous episodes of cellulitis in those recruited to the trials, ranging between one and four episodes per study.Five of the six included trials assessed prevention with antibiotics in participants with cellulitis of the legs, and one assessed selenium in participants with cellulitis of the arms. Among the studies assessing antibiotics, one study evaluated oral erythromycin (n = 32) and four studies assessed penicillin (n = 481). Treatment duration varied from six to 18 months, and two studies continued to follow up participants after discontinuation of prophylaxis, with a follow-up period of up to one and a half to two years. Four studies were single-centre, and two were multicentre; they were conducted in five countries: the UK, Sweden, Tunisia, Israel, and Austria.Based on five trials, antibiotic prophylaxis (at the end of the treatment phase ('on prophylaxis')) decreased the risk of cellulitis recurrence by 69%, compared to no treatment or placebo (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.13 to 0.72; n = 513; P = 0.007), number needed to treat for an additional beneficial outcome (NNTB) six, (95% CI 5 to 15), and we rated the certainty of evidence for this outcome as moderate.Under prophylactic treatment and compared to no treatment or placebo, antibiotic prophylaxis reduced the incidence rate of cellulitis by 56% (RR 0.44, 95% CI 0.22 to 0.89; four studies; n = 473; P value = 0.02; moderate-certainty evidence) and significantly decreased the rate until the next episode of cellulitis (hazard ratio (HR) 0.51, 95% CI 0.34 to 0.78; three studies; n = 437; P = 0.002; moderate-certainty evidence).The protective effects of antibiotic did not last after prophylaxis had been stopped ('post-prophylaxis') for risk of cellulitis recurrence (RR 0.88, 95% CI 0.59 to 1.31; two studies; n = 287; P = 0.52), incidence rate of cellulitis (RR 0.94, 95% CI 0.65 to 1.36; two studies; n = 287; P = 0.74), and rate until next episode of cellulitis (HR 0.78, 95% CI 0.39 to 1.56; two studies; n = 287). Evidence was of low certainty.Effects are relevant mainly for people after at least two episodes of leg cellulitis occurring within a period up to three years.We found no significant differences in adverse effects or hospitalisation between antibiotic and no treatment or placebo; for adverse effects: RR 0.87, 95% CI 0.58 to 1.30; four studies; n = 469; P = 0.48; for hospitalisation: RR 0.77, 95% CI 0.37 to 1.57; three studies; n = 429; P = 0.47, with certainty of evidence rated low for these outcomes. The existing data did not allow us to fully explore its impact on length of hospital stay.The common adverse reactions were gastrointestinal symptoms, mainly nausea and diarrhoea; rash (severe cutaneous adverse reactions were not reported); and thrush. Three studies reported adverse effects that led to discontinuation of the assigned therapy. In one study (erythromycin), three participants reported abdominal pain and nausea, so their treatment was changed to penicillin. In another study, two participants treated with penicillin withdrew from treatment due to diarrhoea or nausea. In one study, around 10% of participants stopped treatment due to pain at the injection site (the active treatment group was given intramuscular injections of benzathine penicillin).None of the included studies assessed the development of antimicrobial resistance or quality-of-life measures.With regard to the risks of bias, two included studies were at low risk of bias and we judged three others as being at high risk of bias, mainly due to lack of blinding. AUTHORS' CONCLUSIONS: In terms of recurrence, incidence, and time to next episode, antibiotic is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in those under prophylactic treatment, compared with placebo or no treatment (moderate-certainty evidence). However, these preventive effects of antibiotics appear to diminish after they are discontinued (low-certainty evidence). Treatment with antibiotic does not trigger any serious adverse events, and those associated are minor, such as nausea and rash (low-certainty evidence). The evidence is limited to people with at least two past episodes of leg cellulitis within a time frame of up to three years, and none of the studies investigated other common interventions such as lymphoedema reduction methods or proper skin care. Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Antibioticoprofilaxia
Celulite (Flegmão)/prevenção & controle
Erisipela/prevenção & controle
Prevenção Secundária/métodos
Selênio/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Antibacterianos/efeitos adversos
Antibioticoprofilaxia/efeitos adversos
Braço
Eritromicina/efeitos adversos
Eritromicina/uso terapêutico
Hospitalização/estatística & dados numéricos
Seres Humanos
Dermatoses da Perna/prevenção & controle
Meia-Idade
Penicilina G Benzatina/efeitos adversos
Penicilina G Benzatina/uso terapêutico
Penicilina V/efeitos adversos
Penicilina V/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 63937KV33D (Erythromycin); H6241UJ22B (Selenium); RIT82F58GK (Penicillin G Benzathine); Z61I075U2W (Penicillin V)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170621
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009758.pub2


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[PMID]:28606058
[Au] Autor:Njim T; Aminde LN; Agbor VN; Toukam LD; Kashaf SS; Ohuma EO
[Ad] Endereço:Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Old Road Campus, University of Oxford, Oxford, OX3 7BN, UK. tsinjim@gmail.com.
[Ti] Título:Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study.
[So] Source:BMC Infect Dis;17(1):418, 2017 Jun 12.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying the risk factors and burden of lower limb cellulitis to inform preventive strategies in Cameroon. METHODS: This was a hospital-based case-control study carried out in the Bamenda Regional Hospital (BRH) between September 2015 and August 2016. Cases were defined as consenting adults admitted to the surgical unit who presented with a localised area of lower limb erythema, warmth, oedema and pain, associated with fever (temperature ≥ 38 °C) and/or chills of sudden onset. Controls were adults hospitalised for diseases other than cellulitis, necrotising fasciitis, myositis, abscess or other variants of dermo-hypodermitis. Cases and controls were matched (1:2) for age and sex. RESULTS: Of the 183 participants (61 cases of cellulitis and 122 controls) included in the study, the median age was 52 years [Interquartile range (IQR): 32.5-74.5]. After controlling for potential confounders, obesity [adjusted odds ratio (AOR) = 4.7, 95% CI (1.5-14.7); p = 0.009], history of skin disruption [AOR = 12.4 (3.9-39.1); p < 0.001], and presence of toe-web intertrigo [AOR = 51.4 (11.7-225.6); p < 0.001] were significantly associated with cellulitis. Median hospital stay was longer (14 days [IQR: 6-28]) in cases compared to the controls (3 days [IQR: 2-7]). Among the cases, Streptococci species were the most frequent (n = 50, 82%) isolated germ followed by staphylococci species (n = 9, 15%). Patients with cellulitis were more likely to undergo necrosectomy (OR: 21.2; 95% CI: 7.6-59.2). Toe-web intertrigo had the highest (48.9%) population attributable risk for cellulitis, followed by history of disruption of skin barrier (37.8%) and obesity (20.6%). CONCLUSION: This study showed a high disease burden among patients with cellulitis. While risk factors identified are similar to prior literature, this study provides a contextual evidence-base for clinicians in this region to be more aggressive in management of these risk factors to prevent disease progression and development of cellulitis.
[Mh] Termos MeSH primário: Celulite (Flegmão)/epidemiologia
Celulite (Flegmão)/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Camarões/epidemiologia
Estudos de Casos e Controles
Edema/etiologia
Feminino
Febre/etiologia
Seres Humanos
Tempo de Internação
Extremidade Inferior
Masculino
Meia-Idade
Razão de Chances
Fatores de Risco
Infecções Estreptocócicas/epidemiologia
Infecções Estreptocócicas/etiologia
Streptococcus/isolamento & purificação
Streptococcus/patogenicidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2519-1


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[PMID]:28601567
[Au] Autor:Temming LA; Raghuraman N; Carter EB; Stout MJ; Rampersad RM; Macones GA; Cahill AG; Tuuli MG
[Ad] Endereço:Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO. Electronic address: temmingl@wudosis.wustl.edu.
[Ti] Título:Impact of evidence-based interventions on wound complications after cesarean delivery.
[So] Source:Am J Obstet Gynecol;217(4):449.e1-449.e9, 2017 Oct.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A number of evidence-based interventions have been proposed to reduce post-cesarean delivery wound complications. Examples of such interventions include appropriate timing of preoperative antibiotics, appropriate choice of skin antisepsis, closure of the subcutaneous layer if subcutaneous depth is ≥2 cm, and subcuticular skin closure with suture rather than staples. However, the collective impact of these measures is unclear. OBJECTIVE: We sought to estimate the impact of a group of evidence-based surgical measures (prophylactic antibiotics administered before skin incision, chlorhexidine-alcohol for skin antisepsis, closure of subcutaneous layer, and subcuticular skin closure with suture) on wound complications after cesarean delivery and to estimate residual risk factors for wound complications. STUDY DESIGN: We conducted a secondary analysis of data from a randomized controlled trial of chlorhexidine-alcohol vs iodine-alcohol for skin antisepsis at cesarean delivery from 2011-2015. The primary outcome for this analysis was a composite of wound complications that included surgical site infection, cellulitis, seroma, hematoma, and separation within 30 days. Risk of wound complications in women who received all 4 evidence-based measures (prophylactic antibiotics within 60 minutes of cesarean delivery and before skin incision, chlorhexidine-alcohol for skin antisepsis with 3 minutes of drying time before incision, closure of subcutaneous layer if ≥2 cm of depth, and subcuticular skin closure with suture) were compared with those women who did not. We performed logistic regression analysis limited to patients who received all the evidence-based measures to estimate residual risk factors for wound complications and surgical site infection. RESULTS: Of 1082 patients with follow-up data, 349 (32.3%) received all the evidence-based measures, and 733 (67.7%) did not. The risk of wound complications was significantly lower in patients who received all the evidence-based measures compared with those who did not (20.3% vs 28.1%; adjusted relative risk, 0.75; 95% confidence interval, 0.58-0.95). The impact appeared to be driven largely by a reduction in surgical site infections. Among patients who received all the evidence-based measures, unscheduled cesarean delivery was the only significant risk factor for wound complications (27.5% vs 16.1%; adjusted relative risk, 1.71; 95% confidence interval, 1.12-2.47) and surgical site infection (6.9% vs 1.6%; relative risk, 3.74; 95% confidence interval, 1.18-11.92). Other risk factors, which include obesity, smoking, diabetes mellitus, chorioamnionitis, surgical experience, and skin incision type, were not significant among patients who received all of the 4 evidence-based measures. CONCLUSION: Implementation of evidence-based measures significantly reduces wound complications, but the residual risk remains high, which suggests the need for additional interventions, especially in patients who undergo unscheduled cesarean deliveries, who are at risk for wound complications even after receiving current evidence-based measures.
[Mh] Termos MeSH primário: Cesárea
Prática Clínica Baseada em Evidências
[Mh] Termos MeSH secundário: Adulto
Anti-Infecciosos Locais/administração & dosagem
Antibioticoprofilaxia
Celulite (Flegmão)/prevenção & controle
Clorexidina/administração & dosagem
Corioamnionite/epidemiologia
Diabetes Mellitus/epidemiologia
Emergências
Feminino
Hematoma/prevenção & controle
Seres Humanos
Missouri/epidemiologia
Obesidade/epidemiologia
Gravidez
Fatores de Risco
Seroma/prevenção & controle
Fumar/epidemiologia
Deiscência da Ferida Operatória/prevenção & controle
Infecção da Ferida Cirúrgica/prevenção & controle
Técnicas de Sutura
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Infective Agents, Local); R4KO0DY52L (Chlorhexidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170612
[St] Status:MEDLINE


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[PMID]:28594848
[Au] Autor:Ko HH; Chien WC; Lin YH; Chung CH; Cheng SJ
[Ad] Endereço:Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.
[Ti] Título:Examining the correlation between diabetes and odontogenic infection: A nationwide, retrospective, matched-cohort study in Taiwan.
[So] Source:PLoS One;12(6):e0178941, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:More than 90% of head and neck infections are caused by pathological changes originating in the teeth. When odontogenic infections are not properly treated, infections may spread to distant spaces and cause more serious infections in fascial spaces, ultimately leading to deep neck infections. Clinical experience has indicated that patients with diabetes mellitus (DM) may be more susceptible to facial cellulitis and deep neck infections caused by odontogenic infections. This study used the Taiwan National Health Insurance Database (NHIRD) to analyze and examine the correlation between DM and odontogenic infections in patients. To this end, this study analyzed 1 million NHIRD individual datasets from 2005, of which 964,182 individuals had medical treatment records. The insurance database also recorded related factors such as age, sex, duration of hospital stays, season, and whether patients were low income. We also analyzed the correlation between urbanization and the studied diseases. The results indicated that the correlation between facial cellulitis and DM patients was confirmed; facial cellulitis was most likely to occur 2 years after the initial DM diagnosis, with a risk occurrence 1.409 times greater than that of the control group. Facial cellulitis is more likely to occur in patients originating from poorer socioeconomic backgrounds, and female DM patients are more likely to experience this condition. These conclusions may facilitate the establishment of clinical guidelines for preventative education and treatment. Oral prevention and health education for high-risk patients, as well as early-stage surgical intervention and antibiotic usage in early-stage odontogenic infections, can prevent disease progression, improve patient recovery rates, and reduce the use and waste of medical resources.
[Mh] Termos MeSH primário: Celulite (Flegmão)/fisiopatologia
Diabetes Mellitus/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Algoritmos
Celulite (Flegmão)/mortalidade
Diabetes Mellitus/mortalidade
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Taiwan
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170609
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178941



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