ABSTRACT
Abstract There are divergences among studies regarding features associated to increased risk of osteoradionecrosis (ORN). Our objective was to identify factors that predispose to the development of ORN of the jaw. This was a retrospective, hospital-based, case-control study involving patients with head and neck cancer who had been treated with ≥ 60 Gy external radiotherapy (RT) to the jaw. A total of 19 cases of ORN and 43 controls were included. The patients' demographic data, tumor type, staging, treatment and outcome information, and pre-treatment oral status were collected. Univariate analysis showed that the oral cavity/oropharynx sites were associated with 9.77-fold increased risk of ORN development compared to other sites (p = 0.005). Being an active smoker was associated with 3.95-fold increased risk of ORN development (p = 0.01). A tendency towards increased risk of ORN was observed particularly when tooth extraction occurred after RT (odds ratio (OR): 3.04; p = 0.08). Multivariable analysis showed that tumor site was the only significant risk factor (OR: 21.03, p = 0.01). The oral and oropharyngeal primary site is an important risk factor for ORN. Dental extraction, which did not occur in 28% of the sample, was not an essential event for ORN development.
ABSTRACT
OBJECTIVE: To assess the possible change of clinical response to empiric antibiotic therapy among children survivors hospitalized with community-acquired pneumonia at a teaching hospital during 1991-2001. METHODS: This was a retrospective observational study. The medical records of children (aged 29 days to 12 years) with diagnosis of presumed bacterial pneumonia at hospital discharge were reviewed and patients data were extracted, using standardized forms. The principal outcome was patients response to empiric antibiotic therapy. The secondary outcome was length of hospital stay. RESUltS: 893 patients were included for this study. Penicillin and derivatives were the most commonly used empiric antibiotics throughout the studied period. There was a slight but statistically significant increase in the mean rate of antibiotic failure from 1991-1998 to 1999-2001 (3.8% vs 11.4% P<0,001). The most common causes for antibiotic failure were inadequate coverage of initial antibiotics between 1991-1998 and presumed antibiotic resistance between 1999-2001. No significant difference was observed regarding the means of length of hospital stay during the whole studied period (P=0.08). CONCLUSION: Empiric antibiotic therapy was effective among children with community-acquired pneumonia treated at a teaching hospital between 1991-2001, inspite of a slight increase in the rate of presumed antibiotic resistance in later years.