Analysis of glycosylated hemoglobin (HbA1c) level on maxillofacial fascial space infection in diabetic patients

Oral infections - a retrospective study of patients treated in the Oral and Maxillofacial Surgery clinic of the Emergency County Clinical Hospital in Sibiu

Background and aims

The present study was carried out in the Department of Oral and Maxillo-Facial Surgery of the Sibiu County Emergency Clinical Hospital and aimed to evaluate the oral health status of patients who refer to this medical unit, identifying the presence and frequency of dental infections among these patients. The study also aimed to identify and characterize the comorbidities present in patients with these oral conditions. Finally, the study aims to highlight the degree of concern regarding the oral health status of patients and provide relevant information for dental health services and for the development of appropriate prevention and intervention strategies.

Methods

The study was conducted retrospectively and descriptively, using the hospital's electronic medical records. The total sample consisted of 1246 people, the inclusion criteria were: (a) patients admitted to the OMF Surgery Department; (b) outpatients who required hospitalization; (c) patients hospitalized under continuous hospitalization regime; (d) patients over 16 years of age; (e) patients diagnosed with infectious pathologies.After data registration, information on sex, background, distribution of diagnoses, associated pathologies of the patients and the existence of combined pathologies of the patients included in the study were taken into account. The duration of hospitalization of patients, the need and duration of antibiotic therapy, the frequency of use of combinations of antibiotics, and the number of antibiotics used in correlation with the duration of hospitalization were also analyzed.The data are presented as frequency and percentages. The combination of the most frequent associated pathologies was analyzed using an algorithm based on association rules and chord diagram was used for their visual representation. Statistical analyses were performed using IBM SPSS® (Statistical Package for the Social Science) version 20 and R software.

Results

The total sample consisted of a total of 1246 people. From the preliminary analysis, the majority of people in the sample, 68.5%, did not suffer from infectious conditions, while 31.5% were affected. Most of the patients came from the urban environment (61.73%) and were male (54.34%). Frequent comorbidities included cardiac pathologies (11.99%) and diabetes (4.08%).These data indicate the poor state of oral health among patients who call on the OMF Surgery services. It is not an isolated case, but it reflects a pattern observed globally. Based on the results of the study, the hypothesis is validated that there is a poor state of oral health among the population, manifested by the increased incidence of dental infections. International studies confirm that dental infections are often complicated by the presence of comorbidities.

Conclusion

The study concludes that patients hospitalized in the department of Oral and Maxillofacial Surgery face a poor oral health state, characterized by a high prevalence of dental infections. The presence of comorbidities and seasonal factors contribute to the aggravation of these infections. These results emphasize the need for preventive and educational interventions to improve the oral health of the population in this region, as well as the development of personalized treatment strategies.

Diabetes Health Supervision and Treatment Strategy Based on Data Management and Analysis on eKTANG Platform

BACKGROUND

The management of diabetes-related risk factors could effectively reduce the occurrence of its complications, improve the quality of life of patients, and reduce the mortality of patients. Data analysis based on the eKTANG platform could greatly improve the efficiency of communication between patients and doctors, and strengthen the treatment and management of diabetes.

AIM

We created eKTANG to monitor patient health effectively. The eKTANG health management system aims to extensively intervene in blood glucose monitoring, nutrition, exercise, medicine, and health education to enable diabetes patients to achieve optimal treatment results.

METHODS

Diabetes patients diagnosed by Henan University Medical School included through the eKTANG platform were randomly divided into three groups: member service package group, discharge/ outpatient follow-up group, and out-of-hospital care group. We conducted intensive out-ofhospital interventions for three groups of patients for three months to help patients formulate precise blood glucose control plans and conduct training. The traditional group was compared with the eKTANG platform group, and the physiological indicators and patient compliance of the four groups were observed 6 months later.

RESULTS

In the eKTANG platform management group, the average blood glucose compliance rate increased significantly, and the percentage of average blood glucose in the range of 3.9-10.0 showed an upward trend. Fasting blood glucose and postprandial blood glucose showed a downward trend. At the same time, the number of patients per capita blood glucose monitoring showed a significant increase compared with the control group.

CONCLUSION

The establishment of the eKTANG platform can improve the efficiency of patient's medical treatment, improve their lifestyles, reduce the incidence of patient complications, and build a virtuous circle gradually. This research has strengthened the health management and autonomy of diabetic patients and improved the efficiency of treatment. It is worthy of promotion.

Admission C-reactive protein, WBC count, glucose, and body temperature in severe odontogenic infections: a retrospective study using severity scores

OBJECTIVE

The purpose of this study was to determine whether various serum marker levels (C-reactive protein [CRP], white blood cell [WBC] count, glucose) or body temperature at admission are associated with severity of odontogenic infections.

STUDY DESIGN

This retrospective chart review of patients admitted to the hospital for treatment of severe odontogenic infections (SOIs) over a 5-year period (2016-2020) assigned patients with a severity score (SS) ≥5 to group A and those with an SS <5 to group B. Serum marker levels and temperature at admission were collected, and comparisons between group A and group B were conducted for serum marker levels and body temperature at admission using 2-sample t tests.

RESULTS

The mean serum CRP and temperature at admission between the 2 groups was not statistically significant (P > .05). The mean WBC count and serum glucose at admission between the 2 groups was statistically significant (P = .001 and P = .036, respectively).

CONCLUSIONS

This study demonstrates that serum glucose and WBC at admission are significantly higher in patients with more SOIs. In addition, serum CRP and body temperature at admission are not adequate prognostic indicators of odontogenic infection severity.

Evaluation of the safety and healing potential of a fibroin-aloe gel film for the treatment of diabetic foot ulcers

OBJECTIVE

This study aimed to develop a wound dressing prepared from the blending of silkworm fibroin and aloe gel extract for use in the treatment of diabetic foot ulcers (DFUs).

METHODS

Fibroin extracted from silkworm cocoons and aloe gel extract were dissolved in deionised water. pH levels were then adjusted with lactic acid solution. A simple casting technique was used to obtain the fibroin-aloe gel film. The surface morphology, hardness, flexibility and infrared spectrum of the sterilised film were tested. Swelling ratio was measured from changes in weight. The cytocompatibility of the film to human dermal fibroblast was determined using XTT assay. Hard-to-heal DFUs (grade I Wagner score) were treated with the film for four weeks. The application site was assessed for allergic reactions and/or sensitisation. Wound size was measured using standardised digital photography.

RESULTS

A total of five hard-to-heal DFUs were treated. The obtained film sterilised with ozonation showed a non-porous structure. The elongation at break and tensile strength of the wet film were 9.00±0.95% and 6.89±1.21N, respectively. Fourier-transform infrared spectroscopy data indicated the presence of amides I, II and III, of peptide linkage, which are the chemical characteristics of the fibroin. Functional groups relating to healing activity of the aloe gel extract were also found. The swelling ratio of the film immersed in water for 24 hours was 0.8±0.01. In three DFUs (40-50mm² in size), a wound area reduction of 0.4-0.8mm²/day was observed and were healed in 2-3 weeks. The remaining two SFUs (500mm² in size) showed a wound area reduction of 4mm²/day and were almost closed at four weeks. No allergic reaction or infection was observed in any of the wounds.

CONCLUSION

The obtained film showed a non-porous structure, and its strength and flexibility were adequate for storage and handling. The film tended to increase the proliferation of fibroblasts. The wound dressing showed potential for accelerating the healing rate of DFUs.

Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center

Objectives

The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea.

Materials and Methods

A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses.

Results

Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis.

Conclusion

For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

Diabetes and acute bacterial skin and skin structure infections

Acute bacterial skin and skin structures infections (ABSSSIs) are associated with high morbidity, costs and mortality in patients with diabetes mellitus. Their appropriate management should include several figures and a well-organized approach. This review aims to highlight the interplay between diabetes and ABSSSIs and bring out the unmet clinical needs in this area. Pathogenetic mechanisms underlying the increased risk of ABSSSIs in diabetes mellitus are multifactorial: high glucose levels play a crucial pathogenetic role in the tissue damage and delayed clinical cure. Moreover, the presence of diabetes complications (neuropathy, vasculopathy) further complicates the management of ABSSSIs in patients with diabetes. Multidrug resistance organisms should be considered in this population based on patient risk factors and local epidemiology and etiological diagnosis should be obtained whenever possible. Moreover, drug-drug interactions and drug-related adverse events (such as nephrotoxicity) should be considered in the choice of antibiotic therapy. Reducing unnecessary hospitalizations and prolonged length of hospital stay is of primary importance now, more than ever. To achieve these objectives, a better knowledge of the interplay between acute and chronic hyperglycemia, multidrug resistant etiology, and short and long-term outcome is needed. Of importance, a multidisciplinary approach is crucial to achieve full recovery of these patients.

A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward

Background

The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay.

Methods

A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression.

Results

A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age.

Conclusions

The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.

Helicobacter pylori eradication in patients with type 2 diabetes mellitus: Multicenter prospective observational study

OBJECTIVE

To compare Helicobacter pylori (H. pylori) eradication rate of type 2 diabetic patients with non-diabetic subjects.

METHODS

In this multicenter prospective observational study, H. pylori-infected subjects were enrolled from three university-affiliated hospitals. Eradication regimen was triple therapy with standard dose of proton pump inhibitors (b.i.d), amoxicillin (1.0 g b.i.d), and clarithromycin (500 mg b.i.d) for 7 days. Urea breath test was performed 4 weeks after treatment. Various clinical and laboratory data were collected for identification of factors associated with successful eradication.

RESULTS

Totally, 144 subjects were enrolled and 119 (85 non-diabetic and 34 diabetic patients) were finally analyzed. Eradication rate was 75.6% and there was no difference between diabetic patients and non-diabetic subjects (73.5% vs 76.5%, p value: 0.814). Adverse drug reactions were reported in 44.5% of patients. In multivariate analysis for predicting H. pylori eradication in diabetic patients, HbA1c (⩾7.5%) was a significant factor affecting eradication rate (adjusted odds ratio: 0.100, 95% confidence interval: 0.011-0.909, p value: 0.041).

CONCLUSION

Diabetes itself is not a major factor affecting H. pylori eradication. However, poor glucose control may harmfully affect H. pylori eradication.

Infrahyoid involvement may be a high-risk factor in the management of non-odontogenic deep neck infection: Retrospective study

OBJECTIVES

This study sought to investigate the impact of involvement of the infrahyoid neck space on the management of non-odontogenic DNI.

METHOD

Eighty-one patients treated for non-odontogenic DNI over 5 years were retrospectively recruited into this study. Demographics, etiology, radiology results, treatments, duration/cost of hospital stay, and complications were recorded. Differences between DNIs with and without infrahyoid involvement, as defined based on an anatomical chart, were analyzed.

RESULTS

Sixty-two male and 19 female patients with a median age of 46.22 years were included. Fifteen patients had cellulitis, and 66 patients had abscesses. Streptococcus was the most commonly observed bacterium. Compared with DNIs only in suprahyoid spaces (n = 60, 74.07%), DNIs with infrahyoid space involvement (n = 21, 25.93%) were associated with higher incidences of the involvement of ≥3 spaces (85.71%, P = 0.000), mediastinitis (38.10%, P = 0.000), tracheostomy (28.57%, P = 0.008), surgery using a transcervical approach (66.67%, P = 0.000), and intensive care unit therapy (19.05%, P = 0.004), as well as longer hospital stays (16 days, P = 0.000) and higher costs ($2872, P = 0.000).

CONCLUSION

Infrahyoid involvement should be regarded as a high-risk factor in the management of deep neck infection (DNI). A relatively aggressive plan that includes transcervical surgery and tracheostomy should be considered at earlier stages for DNI with infrahyoid involvement.