Risk factors for pre-operative functional deterioration in children with lipomyelomeningocele

BACKGROUND: More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. OBJECTIVE: To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. METHODS: A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. RESULTS: Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. CONCLUSIONS: Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.

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The intersection of Mineralocorticoid Receptor (MR) activation and the FGF23 – Klotho cascade. A Duopoly that promotes renal and cardiovascular injury

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab254 ◽

2021 ◽

Author(s):

Murray Epstein ◽

Michael Freundlich

Keyword(s):

Risk Factors ◽

Mineralocorticoid Receptor ◽

Mineral Metabolism ◽

Fibroblast Growth Factor 23 ◽

Adverse Outcomes ◽

Phosphate Metabolism ◽

Fibroblast Growth ◽

Fibrosis Progression ◽

Circulating Levels ◽

Functional Deterioration

Abstract The nexus of CKD and cardiovascular disease (CVD) amplifies the morbidity and mortality of CKD, emphasizing the need for defining and establishing therapeutic initiatives to modify and abrogate the progression of CKD and concomitant CV risks. In addition to the traditional CV risk factors, disturbances of mineral metabolism are specific risk factors that contribute to the excessive CV mortality in patients with CKD. These risk factors include dysregulations of circulating factors that modulate phosphate metabolism including fibroblast growth factor 23 (FGF23) and soluble Klotho. Reduced circulating levels and suppressed renal klotho expression may be associated with adverse outcomes in CKD patients. While elevated circulating concentrations or locally produced FGF23 in the strained heart exert pro-hypertrophic mechanisms on the myocardium, Klotho attenuates tissue fibrosis, progression of CKD, cardiomyopathy, endothelial dysfunction, vascular stiffness, and vascular calcification. Mineralocorticoid receptor (MR) activation in non-classical targets, mediated by aldosterone and other ligands, amplifies CVD in CKD. In concert, we detail how the interplay of elevated FGF23, activation of the MR, and concomitant reductions of circulating Klotho in CKD, may potentiate each other’s deleterious effects on kidney and the heart, thereby contributing to the initiation and progression of kidney and cardiac functional deterioration, acting through multipronged albeit complementary mechanistic pathways.

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Premacular membrane formation after scleral buckling for primary rhegmatogenous retinal detachment: prospective study and pathophysiological insights

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311787 ◽

2018 ◽

Vol 103 (4) ◽

pp. 481-487 ◽

Cited By ~ 1

Author(s):

Viviana Cacioppo ◽

Andrea Govetto ◽

Paolo Radice ◽

Gianni Virgili ◽

Antonio Scialdone

Keyword(s):

Risk Factors ◽

Retinal Detachment ◽

Rhegmatogenous Retinal Detachment ◽

Case Series ◽

Subretinal Fluid ◽

Scleral Buckling ◽

Key Factor ◽

Subretinal Fluid Drainage ◽

Functional Deterioration

PurposeTo investigate the incidence, clinical features and risk factors of premacular membrane (PMM) formation after primary rhegmatogenous retinal detachment (RRD) repair with scleral buckling (SB) alone.MethodsThis institutional, prospective and consecutive case series included phakic eyes with RRD, treated with SB alone within 7 days from the occurrence of symptoms, with a follow-up of 6 months. Spectral-domain optical coherence tomography images were reviewed. The association of PMM development and morphology with preoperative and intraoperative RRD features was analysed.ResultsNinety-two patients with a mean age of 56±13 years completed the 6 months follow-up period. Postoperatively, eyes with any PMM stage were 30 out of 92 (32.6%) at 1 month and 47 out of 92 (51,1%) at both 3 months and 6 months. Over the follow-up period, 17 out of 47 PMMs (36.2%) progressed to later stages. Progression of PMMs to later stages were observed only in RRDs involving the macular region (17 out of 35 eyes, 48.5%), while none of the PMMs in macula-sparing detachments progressed to later stages (p=0.020). The risk factors significantly associated with postoperative new onset of PMM were preoperative RRDs involving the macular region (p=0.001), cryopexy time (p=0.045), presence of horseshoe tears (p=0.003), worse preoperative visual acuity (p=0.004) and subretinal fluid drainage (p=0.047).ConclusionThe incidence of postoperative PMM formation after RRD repair with SB alone was high. In retinal detachments involving the macular region PMM were more severe, tending to anatomical progression and functional deterioration. Activation of foveal Müller cell in detachments involving the macula may be a key factor in PMM progression.

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Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-038720 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038720

Author(s):

Sandeep Sandhar ◽

Toby O Smith ◽

Kavanbir Toor ◽

Franklyn Howe ◽

Nidhi Sofat

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Narrative Analysis ◽

Data Extraction ◽

Meta Analysis ◽

Hip Osteoarthritis ◽

Chronic Widespread Pain ◽

Scoring Method ◽

Knee Oa ◽

Functional Deterioration

ObjectiveTo identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future ‘stratification tool’ for OA development or progression.DesignSystematic review and meta-analysis.MethodsAn electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990–February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach.Results82 studies (41 810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence≥2 (MD: 2.04, 95% CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95% CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ≥1 (OR: 1.35, 95% CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ≥1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43).ConclusionsOur study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A ‘stratification tool’ combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA.PROSPERO registration numberCRD42018117643.

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Elevated level of circulatory sTLT1 induces inflammation through SYK/MEK/ERK signalling in coronary artery disease

Clinical Science ◽

10.1042/cs20190999 ◽

2019 ◽

Vol 133 (22) ◽

pp. 2283-2299

Author(s):

Apabrita Ayan Das ◽

Devasmita Chakravarty ◽

Debmalya Bhunia ◽

Surajit Ghosh ◽

Prakash C. Mandal ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Chronic Inflammation ◽

Ex Vivo ◽

Human Subjects ◽

Critical Role ◽

Atherosclerotic Cardiovascular Disease ◽

Tnf Α ◽

Artery Disease

Abstract The role of inflammation in all phases of atherosclerotic process is well established and soluble TREM-like transcript 1 (sTLT1) is reported to be associated with chronic inflammation. Yet, no information is available about the involvement of sTLT1 in atherosclerotic cardiovascular disease. Present study was undertaken to determine the pathophysiological significance of sTLT1 in atherosclerosis by employing an observational study on human subjects (n=117) followed by experiments in human macrophages and atherosclerotic apolipoprotein E (apoE)−/− mice. Plasma level of sTLT1 was found to be significantly (P<0.05) higher in clinical (2342 ± 184 pg/ml) and subclinical cases (1773 ± 118 pg/ml) than healthy controls (461 ± 57 pg/ml). Moreover, statistical analyses further indicated that sTLT1 was not only associated with common risk factors for Coronary Artery Disease (CAD) in both clinical and subclinical groups but also strongly correlated with disease severity. Ex vivo studies on macrophages showed that sTLT1 interacts with Fcɣ receptor I (FcɣRI) to activate spleen tyrosine kinase (SYK)-mediated downstream MAP kinase signalling cascade to activate nuclear factor-κ B (NF-kB). Activation of NF-kB induces secretion of tumour necrosis factor-α (TNF-α) from macrophage cells that plays pivotal role in governing the persistence of chronic inflammation. Atherosclerotic apoE−/− mice also showed high levels of sTLT1 and TNF-α in nearly occluded aortic stage indicating the contribution of sTLT1 in inflammation. Our results clearly demonstrate that sTLT1 is clinically related to the risk factors of CAD. We also showed that binding of sTLT1 with macrophage membrane receptor, FcɣR1 initiates inflammatory signals in macrophages suggesting its critical role in thrombus development and atherosclerosis.

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Hearing Loss Risk Factors and Strategies in Rural Areas

Perspectives on Aural Rehabilitation and Its Instrumentation ◽

10.1044/arii12.1.17 ◽

2004 ◽

Vol 12 (1) ◽

pp. 17-20

Author(s):

Gregory A. Flamme

Keyword(s):

Risk Factors ◽

Hearing Loss ◽

Rural Areas

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The Preschool Stuttering Screen for Health Care Professionals

Perspectives on Fluency and Fluency Disorders ◽

10.1044/ffd21.2.59 ◽

2011 ◽

Vol 21 (2) ◽

pp. 59-62

Author(s):

Joseph Donaher ◽

Christina Deery ◽

Sarah Vogel

Keyword(s):

Risk Factors ◽

Health Care ◽

Differential Diagnosis ◽

Preschool Children ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Evidence Based ◽

Developmental Profile

Healthcare professionals require a thorough understanding of stuttering since they frequently play an important role in the identification and differential diagnosis of stuttering for preschool children. This paper introduces The Preschool Stuttering Screen for Healthcare Professionals (PSSHP) which highlights risk factors identified in the literature as being associated with persistent stuttering. By integrating the results of the checklist with a child’s developmental profile, healthcare professionals can make better-informed, evidence-based decisions for their patients.

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Clinical Response to Questions Regarding Outcomes and Therapy Efficacy

Perspectives on Fluency and Fluency Disorders ◽

10.1044/ffd20.3.76 ◽

2010 ◽

Vol 20 (3) ◽

pp. 76-83 ◽

Cited By ~ 1

Author(s):

Joseph Donaher ◽

Tom Gurrister ◽

Irving Wollman ◽

Tim Mackesey ◽

Michelle L. Burnett

Keyword(s):

Risk Factors ◽

Clinical Response ◽

Speech Language Pathologists ◽

Specific Therapy ◽

Therapy Efficacy ◽

Therapy Program ◽

Adults Who Stutter ◽

Cure Rates

Parents of children who stutter and adults who stutter frequently ask speech-language pathologists to predict whether or not therapy will work. Even though research has explored risk-factors related to persistent stuttering, there remains no way to determine how an individual will react to a specific therapy program. This paper presents various clinicians’answers to the question, “What do you tell parents or adults who stutter when they ask about cure rates, outcomes, and therapy efficacy?”

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