scholarly journals Risk factors of extended-spectrum beta-lactamaseproducing Enterobacteriaceae bacteremia in Thai emergency department: a retrospective case-control study

2011 ◽  
Vol 5 (1) ◽  
pp. 129-138 ◽  
Author(s):  
Khrongwong Musikatavorn ◽  
Chatgaew Chumpengpan ◽  
Chaita Sujinpram
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Enteric Bacteria ◽  
Control Group ◽  
Retrospective Case ◽  
Extended Spectrum ◽  
First Choice ◽  
Group 2 ◽  
Control Study ◽  
Group 1

Abstract Background: Infections caused by resistant extended-spectrum beta-lactamase (ESBL)-producing enteric bacteria and their risk factors are globally recognized. However, such risk factors have not been explored in emergency department (ED) where the first choice of empirical antimicrobials is crucial. Objective: Determine risk factors of ESBL bacteremia in ED, especially in our geographic area. Methods: A retrospective case-double-control study was conducted at King Chulalongkorn Memorial Hospital. All adult ED patients with ESBL-producing E. coli and K. pneumoniae in blood cultures between October 2007 and October 2008 were recruited for this study. The potential risk factors were analyzed and compared with non- ESBL-producing bacteremic patients (control group 1) and matched general ED patients (control group 2). Nonbeta- lactam susceptibility testing among the cohort was also evaluated. Results: Thirty ESBL (cases), 103 group 1 controls, and 100 group 2 controls were assessed. Based on the univariate analysis, age, chronic kidney diseases, malignancy, poor functional status, previous hospitalization within 90 days, and previous antimicrobial exposure especially to cephalosporins, quinolones, and carbapenems within 30 days were the risk factors for ESBL bacteremia compared with both types of control patients. Age > 60 and previous cephalosporin use were consistently identified as the risk factors by multivariate models using both control groups. The susceptibility to non-beta-lactam agents in the ESBL group was significantly lower than the non-ESBL. No carbapenem resistance was found. Conclusion: Elderly ED patients, especially those who had previous cephalosporin exposure within 30 days, were at higher risk of ESBL-producing bacteremic infections. ESBLs tended to have less susceptibility to the non-β-lactam agents.

scholarly journals Analisis Faktor Fetus dan Tali Pusat terhadap Risiko Asphyxia Perinatal di Surakarta

2020 ◽  
Vol 3 (1) ◽  
pp. 16
Author(s):  
Siti Lestari ◽  
Dyah Dwi Astuti ◽  
Fachriza Malika Ramadhani
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Perinatal Asphyxia ◽  
Case Control ◽  
Control Group ◽  
Case Group ◽  
Retrospective Case ◽  
Chi Square ◽  
Fetal Position ◽  
Control Study

Asfiksia perinatal merujuk pada kekurangan oksigen selama persalinan, sehingga berpotensi menyebabkan kematian dan kecacatan. WHO memperkirakan  4 juta anak terlahir dengan asfiksia setiap tahun, dimana 1 juta di antaranya meninggal dan 1 juta anak bertahan hidup dengan gejala sisa neurologis yang parah. Penelitian ini bertujuan untuk menganalisis faktor risiko fetal dan tali pusat pada asfiksia neonatal.Penelitian dilakukan di lakukan di RS Dr Moewardi Surakarta dengan pendekatan  quantitative retrospective case control study. Data diambil dari rekam medis antara  tahun 2013-2018. Penelitan ini melibatkan  264 neonatal yang terdiri dari 88 kelompok kasus dan 176  kelompok control. Kelompok kasus adalah bayi dengan diagnosa  asfiksia yang  dilakukan analisis terhadap faktor risiko fetal, sedangkan bayi yang tidak mengalami asfiksia dijadikan  kelompok kontrol. Hasil analisis statistik uji Chi-Square dan Fisher Exact ditemukan bahwa  kelahiran prematur (OR 2,07 CI 95% P 0,02), persalinan dengan tindakan (OR 3,61 CI 95% P 0,00), berat bayi (OR 2,85 CI 95% P 0,00), posisi janin (OR 2,37 CI 95% P 0,05), tali pusat ( QR 3,071 CI 95%  P 0,01)  berisiko terhadap insiden asfiksia perinatal. Air ketuban yang bercampur meconium (OR 1,51 CI 95% P 0,16) tidak memiliki risiko  dengan Asfiksia perinatal. Kesimpulan: Risiko terhadap insiden asfiksia perinatal  meliputi kelahiran prematur, persalinan dengan tindakan, berat bayi, posisi janin,  dan tali pusat.Perinatal asphyxia refers to a lack of oxygen during labor, which has the potential to cause death and disability. WHO estimates  4 million children born with asphyxia each year, in  which 1 million dies and 1 million survive with severe neurological sequelae. This study aims to analyze fetal and umbilical risk factors in neonatal asphyxia.This research is a quantitative retrospective case-control study, which was conducted at The Dr. Moewardi  hospital,  Surakarta. Data was taken from  medical records from 2013-2018. The case group was patients diagnosed  asphyxia, while those who did not experience asphyxia were treated as a control group.  A total of 264  samples, consisting of 88 case group respondents and 176 control group respondents. Statistical analysis Chi- Square and Fisher Exact found that preterm birth (OR 2.07 CI 95% P 0.02), labor with instrument or complication (OR 3.61 CI 95% P 0.00), infant weight (OR 2.85 CI 95% P 0, 00), fetal position (OR 2.37 CI 95% P 0.05), umbilical cord (QR 3.071 CI 95% P 0.01) are at risk for the incidence of perinatal Asphyxia. The amniotic fluid mixed with meconium (OR 1.51 CI 95% P 0.16) has no risk with perinatal asphyxia.The risk factors of incidences of perinatal asphyxia were  preterm birth, labor with instrument or complication, baby weight, fetal position and umbilical cord. 

scholarly journals Role of inflammation, autotaxin and lipoprotein (a) in degenerative aortic valve stenosis in patients with coronary artery disease

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
A. L. Burdeynaya ◽  
O. I. Afanasyeva ◽  
E. A. Klesareva ◽  
N. A. Tmoyan ◽  
O. A. Razova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Control Group ◽  
Lymphocyte Ratio ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Aim. To study the relationship between the concentration of lipoprotein (a) (Lp (a)) and autotaxin (ATX) in patients with and without degenerative aortic valve stenosis (AoS) in the presence of coronary artery disease (CAD).Material and methods. The study included 461 patients (mean age, 66±11 years, men, 323), 354 of whom had CAD with stenosis ≥50% in at least one coronary artery according to angiography. Degenerative AoS was diagnosed with ultrasound. The control group consisted of 107 patients without CAD and degenerative AoS. Concentrations of Lp (a), ATX, lipids and blood cells were measured for all patients.Results. CAD without degenerative AoS (group 1) was diagnosed in 307 patients, while 47 patients had CAD and degenerative AoS (group 2). Patients in both groups were older than patients in the control group (66±10, 74±8, and 61±13 years, respectively). The ATX level was lower in group 1 (median [25; 75%]: 495 [406; 583] ng/ml) than in the control group (545 [412; 654] ng/ml) or group 2 (545 [476; 605] ng/ml) (p<0,05 for all). Lp (a) was lower in the control group (14,5 [5,5; 36,0] mg/dl) than in group 1 (24,9 [9,7; 58,4] mg/dl) (p<0,005) and group 2 (23,8 [9,9; 75,7] mg/dL) (p<0,05). According to the logistic regression, an increased ATX level, regardless of age and other risk factors, was associated with degenerative AoS only in patients with CAD, while age and neutrophil to lymphocyte ratio were associated with the development of degenerative AoS both in patients with CAD and the general group.Conclusion. An elevated Lp (a) level is associated with CAD regardless of the aortic valve involvement, while an increased concentration of ATX and neutrophil to lymphocyte ratio in patients with CAD were associated with degenerative AoS regardless of age and other risk factors.

scholarly journals Predictors of Preeclampsia Based on a 10-Year Case-Control Study

2019 ◽  
Author(s):  
Arezoo Shayan ◽  
Hadis Sourinejad ◽  
Mansoureh Refaei ◽  
Seyedeh Zahra Masoumi ◽  
Leili Tapak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Group ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Case Group ◽  
Retrospective Case ◽  
Low Education ◽  
High Age ◽  
Control Study

Objective: To investigate the predictors of preeclampsia based on a 10-years case-control study. Materials and methods: The present retrospective, case-control study was carried out in a referral Hospital in Hamadan, Iran, during 2005-2015. Using a hospital information system (HIS), all the available information on hospitalized preeclamptic patients during 10-years period was collected and all preeclamptic women were qualified for the study as the case group (729 subjects) and the same number of non-preeclamptic women were assigned to the control group. The required data were collected using the researcher-made questionnaire and analyzed using descriptive statistics, chi-square test, independent t-test and logistic regression. Results: The results show that high age (OR = 1.04), low education (diploma compared to illiterate OR = 0.51 and middle school education compared to illiterate OR = 0.55), blood group O (AB: OR = 0.32; B: OR = 0.36; A: OR = 0.26) and fertilization during autumn (spring: OR = 0.41; summer: OR = 0.26; autumn: OR = 1.13) could raise the risk of preeclampsia. Conclusion: High age, low education, blood group O and fertilization in cold seasons could be the risk factors of preeclampsia.  Recognizing the risk factors of preeclampsia could help the determination of high risk cases and designing of effective interventions.

scholarly journals Risk factors of bronchopulmonary dysplasia in premature infants under 32 weeks of gestation: A retrospective case-control study

2020 ◽  
Author(s):  
Li Yue ◽  
Shu Dong Cui
Keyword(s):  
Risk Factors ◽  
Premature Infants ◽  
Gestational Age ◽  
Invasive Mechanical Ventilation ◽  
Calorie Intake ◽  
Control Group ◽  
Retrospective Case ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Control Study

Abstract Background: Bronchopulmonary dysplasia (BPD) in preterm infants is one of the most serious complications in neonatology, as it significantly affects the quality of life of preterm children. We retrospectively analyze the incidence and risk factors of BPD in premature infants under 32 weeks of gestation age.Methods: Clinical data of premature infants with gestational age ≤32 weeks admitted to the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from 2015 to 2017 were selected for this retrospective case-control study. The patients were classified into the BPD and control groups based on the clinical diagnosis. We compared the general condition, treatments, complications, and clinical outcome of premature infants in both groups. Student’s t-test, non-parametric test, and binary logistic regression were used to analyze the occurrence of BPD and its potential risk factors.Results: A total of 213 premature infants aged ≤32 gestational weeks were included in the study; of these, 81 (38%) were diagnosed with BPD. The gestational age (29.14±1.88 weeks vs. 30.82±0.98 weeks, P<0.001) and weight (1240±314.87 g vs. 1584.77±318.18 g, P<0.001) in the BPD group were lower than those in the control group. The liquid quantity, urine volume, and calorie intake of preterm infants in the BPD group within one week after birth were significantly lower than those of infants in the control group. Logistic regression analysis showed that invasive mechanical ventilation (OR=5.065, 95% CI: 1.680–15.266); use of erythrocyte suspension (OR=10.146, 95% CI: 1.860–55.336); and PCO2 in early postnatal arterial blood gas (OR=1.122, 95% CI: 1.024–1.229) were risk factors for BPD. On the other hand, gestational age (OR=0.657, 95% CI: 0.460–0.937); calorie intake (OR=0.917, 95% CI: 0.874–0.963); PO2 (OR=0.925, 95% CI: 0.870–0.985); and pH in early postnatal arterial blood gas (OR<0.001, 95% CI: 0.000–0.156) were protective factors for BPD.Conclusion: The incidence of BPD in very low and extremely low birth weight infants is high. Maintaining early internal environment stability, increasing early calorie intake, shortening invasive mechanical ventilation time, reducing blood transfusion, and closing patent ductus arteriosus could likely reduce the incidence of BPD.

Invasive aspergillosis in adult patients with rheumatic diseases

2020 ◽  
Vol 14 (4) ◽  
pp. 16-22
Author(s):  
V. I. Mazurov ◽  
A. M. Lila ◽  
O. V. Shadrivova ◽  
M. S. Tonkoshkur ◽  
M. S. Shostak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Invasive Aspergillosis ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Control Group ◽  
Group 2 ◽  
Group 1

Objective: to study risk factors for invasive aspergillosis (IA), its etiology, clinical manifestations, and treatment efficiency in patients with rheumatic diseases (RD).Patients and methods. The first study of proven and probable IA (EORT/MSGERC, 2019) was conducted in 18 patients with RD, who accounted for 3% of all adult IA patients (n=699) included in the 1998–2020 registry of the Department of Clinical Mycology, Allergology, and Immunology, I.I. Mechnikov North-Western State Medical University (Group 1). This group comprised 56% women; the median age was 59 [21; 75] years. Group 2 (a comparison group) included 610 adult hematology patients with IA (median age, 45 [18; 79] years; 42% women). A prospective case-control study was conducted to identify risk factors for IA in patients with RD: 36 rheumatic patients without IA (median age, 58 (18–79) years; 61% women) (a control group).Results and discussion. Patients with RD were found to often develop IA in the presence of anti-neutrophilic cytoplasmic antibody-associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis) and systemic lupus erythematosus (50 and 16%, respectively). It was shown for the first time that the likelihood of IA in patients with RD increases with prolonged (median 14 days) lymphocytopenia during RD treatment (odds ratio 13.0; 95% confidence interval, 3.3–50.3). The main causative agents of IA were A. fumigatus (50%) and A. niger (29%). IA was more severe in Group 1 than in Group 2: in the resuscitation and intensive care units, there were 44 and 18%, respectively (p=0.01). Group 1 versus Group 2 more frequently had respiratory failure (61 and 37%, respectively; p=0.03), hemoptysis (28 and 7%; p=0.0001), chest pain (17 and 7%; p=0.04), and cardiac involvement (11 and 1%; p=0.0001), and less frequently had fever (67 and 85%; p=0.01). The common site of IA was the lung (83%); the characteristic feature detected by computed tomography (CT) is pulmonary cavitation (44%). Antifungal therapy was used in 89% of Group 1 patients; the overall 12-week survival was 69%.Conclusion. In patients with RD, it is difficult to differentiate between the progression of the underlying disease, adverse drug reactions, infectious complications, or a combination of these disorders due to the similarity of their clinical manifestations. When RD patients with infectious syndrome and respiratory failure develop prolonged lymphocytopenia during combination therapy, AI should be suspected and lung CT, bronchoscopy, and mycological examination of the material obtained by bronchoalveolar lavage be done.

scholarly journals The Effect of Periarticular Injection of Methylprednisolone Acetate in Patients with Primary Osteoarthritis of the Proximal Interphalangeal Joints: A Case Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
George Habib ◽  
Fahed Sakas ◽  
Suheil Artul ◽  
Fadi Khazin
Keyword(s):  
Matched Control ◽  
Controlled Study ◽  
Control Group ◽  
Methylprednisolone Acetate ◽  
Periarticular Injection ◽  
Primary Osteoarthritis ◽  
Group 2 ◽  
Approach Group ◽  
Control Study ◽  
Group 1

Backgrounds. Primary osteoarthritis of the proximal interphalangeal joints (PIPJ) is a common entity. It could be associated with local pain that has no effective treatment. Local subcutaneous periarticular injection of methylprednisolone acetate (MPA) was evaluated in a prospective case-control study. Methods. Patients with painful osteoarthritis of the PIPJ for more than 1 month not responding to nonsteroidal meds were prospectively recruited. Radiographic, demographic, clinical, and lab parameters were documented. Visual analogue scale (VAS) was documented regarding the level of PIPJ pain prior to the injection. Patients had local subcutaneous periarticular injection at the medial and lateral sides of each painful PIPJ of one hand, of 8 mg (0.2 ml) of MPA mixed with 0.1 ml of lidocaine 1% (group 1) at each side. Age- and sex-matched control group were given 0.3 ml of normal saline using the same approach (group 2) at each side. VAS was evaluated 1, 4, and 10 weeks following the injection and compared to baseline levels using Wilcoxon’s ranks signed test. Results. Eighteen and sixteen patients were recruited in group 1 and group 2, respectively. There were 11 females in group 1 with mean age of 52.7 ± 9.2 years. Mean VAS in group 1 at baseline was 67 and at weeks 1, 4, and 10 was 23 (p=0.001), 29 (p=0.001), and 55 (p=0.043), respectively. Mean VAS in group 2 at baseline was 65 and at weeks 1, 4, and 10 was 43 (p=0.005), 64 (p=0.534), and 69 (0.698), respectively. Conclusions. Subcutaneous periarticular injection of MPA + lidocaine at the PIP joints resulted in a small but significant improvement that gradually diminished with time across the week 10, among patients with primary OA of hands.

scholarly journals Chronic Parenchymal Lung Changes after COVID-19 Infection

2021 ◽  
Author(s):  
Abdelfattah Touman ◽  
Mohammed Khayat ◽  
Adeeb Bulkhi ◽  
Mutaz Khairo ◽  
Wael Alyamani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Multivariate Analyses ◽  
Invasive Mechanical Ventilation ◽  
Nasopharyngeal Swab ◽  
Retrospective Case ◽  
Medical City ◽  
Group 2 ◽  
Parenchymal Lung ◽  
Group 1

Abstract Background: Persistent parenchymal lung changes are an important long-term sequela of COVID-19. There are limited data on the disease characteristics and trajectories. This study aims to evaluate persistent COVID-19-related parenchymal lung changes after 10 weeks of acute viral pneumonia and to identify its risk factors. Methods: This was a retrospective case-control observational study involving 38 COVID-19 confirmed cases using nasopharyngeal swab reverse-transcriptase-polymerase-chain-reaction (RT-PCR) at King Abdullah Medical City (KAMC) hospital, Makkah. Patients were recruited from the Post-COVID interstitial lung disease (ILD) clinic. Referral to this clinic was based on the pulmonology consultants’ assessment of hospitalized patients suspected of developing COVID-19-related ILD changes during hospitalization. Measurements and Main Results: Nineteen patients with persistent parenchymal lung changes after 10 weeks of the acute illness (group-1) were compared with 19 control patients referred for assessment of post-COVID-19 ILD and had accelerated clinical and/or radiological features (group-2). Group-1 was found to have more severe clinical and radiological disease, with higher peak value of inflammatory biomarkers. Two risk factors were identified, NLR >3.13 at admission increases the odds ratio (OR) of chronic parenchymal changes by 6.42 and 13.09 in the univariate and multivariate analyses, respectively. Invasive mechanical ventilation had a more profound effect with ORs of 5.92 and 44.5 in the univariate and multivariate analyses, respectively.Conclusion: Herein, persistent parenchymal lung changes were observed in several patients 10 weeks after acute COVID-19 infection. We found that only receiving invasive mechanical ventilation and NLR >3.13 at admission were strong risk factors for persistent parenchymal lung changes.

scholarly journals Lower genital tract infections in preterm premature rupture of membranes and preterm labor: a case-control study from Vietnam

2021 ◽  
Vol 15 (06) ◽  
pp. 805-811
Author(s):  
Quoc Huy Vu Nguyen ◽  
Hung Nam Le ◽  
Van Anh Ton Nu ◽  
Nguyen Dac Nguyen ◽  
Minh Tam Le
Keyword(s):  
Preterm Labor ◽  
Case Control Study ◽  
Aerobic Bacteria ◽  
Control Group ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Group 2 ◽  
Control Study ◽  
Group 1

Introduction: This study aimed to determine the incidence of lower genital infections and related factors in preterm premature rupture of membranes (PPROM) and preterm labor. Methodology: A case-control study was conducted on pregnant women who were admitted to the Hospital of Hue University of Medicine and Pharmacy, Vietnam between November 2017 and May 2019. Cases from 22 to 36 gestational weeks were included as group 1 (patients with preterm labor and intact membranes) or as group 2 (those with PPROM). The control group included women with singleton pregnancies who were matched on gestational age and recruited concurrently with the study cases. Gram stain was perfomed to identify Lactobacillus, Gardnerella, mobiluncus, Candida, and leucocytes. Trichomonas vaginalis was detected by wet mount. Cultures of vaginal secretions and aminotic fluid were performed to identify aerobic bacteria. Results: Bacterial vaginosis was higher in group 1 (28.9%) compared to control (11.4%). The incidence of isolated aerobic bacteria was 44.1% in group 2, 11.1% in group 1, and 12.7% in the control group (p < 0.001). Fungal infection was not shown to be a risk factor for preterm labor (p = 0.990), whereas, bacterial vaginosis was (OR = 3.16; 95%CI = 1.23-8.15; p = 0.016). Isolated aerobic bacteria were associated with premature rupture of membranes (OR = 5.45; 95%CI = 2.11-14.05; p < 0.001). Conclusions: Bacteria vaginosis increased the risk of preterm labor and preterm premature rupture of membranes. Isolated aerobic bacteria were related to PPROM, while fungal infection was not associated with preterm labor.

Comparing the outcome of Muller’s muscle conjunctival resection for mild/moderate versus severe involutional aponeurotic ptosis

2020 ◽  
pp. 112067212096345
Author(s):  
Senay Asik Nacaroglu ◽  
Gamze Ozturk Karabulut ◽  
Korhan Fazil ◽  
Kubra Serefoglu Cabuk ◽  
Nilay Kandemir Besek ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Success Rates ◽  
Retrospective Case ◽  
Upper Eyelid ◽  
Surgical Success ◽  
Resected Tissue ◽  
Group 2 ◽  
Control Study ◽  
Müller’S Muscle ◽  
Group 1

Aims: To compare predictability of the outcomes of Muller’s muscle conjunctiva resection (MMCR) in patients with severe versus mild/moderate involutional aponeurotic ptosis. Methods: This was a retrospective case-control study. All cases were recruited into the groups in terms of preoperative marginal reflex distance of upper eyelid (MRD-1). Group 1 consisted of patients with mild to moderate blepharoptosis was defined as an MRD-1 equal to 1.1 to 3 mm and Group 2 consisted of patients with severe blepharoptosis defined as MRD-1 ⩽ 1 mm. All patients underwent MMCR based on the response to phenylephrine and the amount of ptosis. MRD-1 obtained both manually and with ImageJ analysis program preoperatively and on the postoperative sixth month was compared. Successful surgical outcome criteria were defined as MRD-1 ⩾ 2.5 mm and inter-eyelid symmetry ⩽ 1 mm. Results: A total of 97 eyes of 83 participants met the inclusion criteria for this study (Group 1 n = 50, Group 2 n = 47). In terms of MRD-1 success rates were 88% in Group 1, and 70.2% in Group 2 ( p = 0.03). Preoperative MRD-1 which was measured by ImageJ, and the amount of resected tissue in mm were the predictive data of surgical outcome by the logistic regression analysis (OR 6.45, 95% CI 1.82–22.78, p = 0.004, OR 2.47, 95% CI 1.05–5.80, p = 0.037, respectively). Conclusion: The surgical success of MMCR can be predicted via tissue resection length and preoperative MRD-1. Higher surgical success rates were obtained in cases with mild-moderate ptosis and clinically acceptable success rates were obtained in cases with severe ptosis.

scholarly journals Risk factors associated with progressive myelomalacia in dogs with complete sensorimotor loss following intervertebral disc extrusion: a retrospective case-control study

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Aude Castel ◽  
Natasha J. Olby ◽  
Hongyu Ru ◽  
Christopher L. Mariani ◽  
Karen R. Muñana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intervertebral Disc ◽  
Pain Perception ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Retrospective Case ◽  
Increased Risk ◽  
Control Study ◽  
Disc Extrusion

Abstract Background Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression. Results One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3–7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1–10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3–16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3–7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3–5.3, p = 0.006). Conclusion Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.

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