scholarly journals Predictors of a Successful Bipolar Radiofrequency Endometrial Ablation

2019 ◽  
Vol 79 (03) ◽  
pp. 286-292
Author(s):  
Lilly Eisele ◽  
Lea Köchli ◽  
Patricia Städele ◽  
JoEllen Welter ◽  
Maja Fehr-Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Multivariate Analyses ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Endometrial Ablation ◽  
Bipolar Radiofrequency ◽  
Increased Risk ◽  
Intramural Fibroids

Abstract Introduction The studyʼs objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method. Materials and Methods 195 women who were treated with bipolar radiofrequency endometrial ablation between 01/2009 and 06/2016 were included in this prospective cohort study. Postoperative data from 187 women were collected at a median of 17.5 months (IQR 4.5–34.9; 1–82). Multivariate analyses of risk factors were performed. Success was defined as amenorrhoea or spotting. Results Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity 2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median BMI 23.5 kg/m2 (IQR 21–27). 30 patients (19.5%) had intramural masses that could be measured with ultrasound. Postoperative success rate was 86.1%. 10 patients (5%) had a hysterectomy postoperatively – 6 for heavy bleeding, 3 due to prolapse, and 1 due to dysmenorrhoea. Multivariate analyses showed the presence of intramural masses in women < 45 years was a significant risk factor for therapeutic failure (p = 0.033; 95% CI 1.08–12.57), with an increased risk of hysterectomy (OR 7.9, 95% CI 1.2–52.7, p = 0.033). Conclusion Bipolar radio frequency endometrial ablation was highly successful in the absence of an intramural mass (88%). Even smaller intramural fibroids (DD: adenomyomas of a median of 15 mm) reduce the success rate (76%), which is why preoperative ultrasound is recommended. In the presence of intramural masses, the risk of a hysterectomy for women < 45 years increases eightfold.

scholarly journals Prevalence of pulmonary tuberculosis in Karachi juvenile jail, Pakistan

2003 ◽  
Vol 9 (4) ◽  
pp. 667-674
Author(s):  
S. A. Shah ◽  
S. A. Mujeeb ◽  
A. Mirza ◽  
K. G. Nabi ◽  
Q. Siddiqui
Keyword(s):  
Risk Factors ◽  
Positive Family History ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Treatment Programme ◽  
Tb Treatment ◽  
Increased Risk ◽  
History Of ◽  
Poor Ventilation ◽  
General Community

Jailinmates may be at increased risk of contracting tuberculosis [TB]. We studied 386 detainees [mean age 17.7 years] in Karachi juvenile jail to determine the prevalence of TB and possible risk factors for contracting TB. We found a 3.9% prevalence of TB among the inmates, significantly higher than the estimated 1.1% prevalence in the general population of Pakistan. Positive family history of TB was a significant risk factor for TB. Poor adherence of previously diagnosed patients to anti-TB treatment was found. Our study highlights the vulnerability of inmates to TB owing to the presence of highly infectious cases, along with environmental conditions such as overcrowding and poor ventilation. This study strongly indicates the need for an effective treatment programme in the jails as well in the general community

scholarly journals Parvovirus Enteritis and Other Risk Factors Associated With Persistent Gastrointestinal Signs in Dogs Later in Life: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Kanae Takada ◽  
Anne M. Flemming ◽  
Maarten J. Voordouw ◽  
Anthony P. Carr
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Health Problems ◽  
Organ Systems ◽  
Increased Risk

Abstract Background: Parvoviral enteritis is a viral gastrointestinal (GI) infection of dogs. Recovery from PE has been associated with persistent GI signs. The objectives of this study were: (i) To determine whether dogs that have recovered from PE (post-parvo dogs) had an increased risk of persistent GI signs compared to uninfected controls. (ii) To investigate the lifestyle and clinicopathologic factors that are associated with persistent GI signs in post-parvo dogs. Methods: Eighty-six post-parvo dogs and 52 age-matched control dogs were enrolled in this retrospective cohort study. The owners were interviewed about the health and habits of their dogs using a questionnaire. We used logistic regression to test whether parvovirus enteritis and other risk factors are associated with general health problems in all dogs and with persistent GI signs in post-parvo dogs.Results: The prevalence of persistent GI signs was significantly higher in post-parvo dogs compared to control dogs (57% vs 25%, P < 0.001). Markers of disease severity such as neutropenia, low body temperature, and treatment with an antiemetic medication (metoclopramide) were significant risk factors for persistent GI signs in post-parvo dogs. Persistent GI signs in post-parvo dogs was a risk factor for health problems in other organ systems.Conclusions: Parvovirus enteritis is a significant risk factor for persistent GI signs in dogs highlighting the importance of prevention. The risk factors identified in the present study may guide future investigations on the mechanisms that link parvovirus enteritis to chronic health problems in dogs.

Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery

2021 ◽  
pp. 193864002110291
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Corey Spenser ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Ankle Fracture ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Low Back ◽  
Opioid Use ◽  
Increased Risk ◽  
Fracture Surgery

Background The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. Methods The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. Results In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). Conclusion Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. Levels of Evidence Prognostic, Level III

Prevention of Recurrent Thrombotic Events in Children with Central Venous Catheter-Associated Venous Thrombosis

Blood ◽  
2021 ◽  
Author(s):  
Helen Havens Clark ◽  
Lance Ballester ◽  
Hilary B Whitworth ◽  
Leslie Raffini ◽  
Char Witmer
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Venous Catheter ◽  
Significant Risk Factor ◽  
Bleeding Risk ◽  
Secondary Prophylaxis ◽  
Central Venous ◽  
Full Dose ◽  
Increased Risk ◽  
Recurrent Vte

Central venous catheters (CVC) are the most significant risk factor for pediatric venous thromboembolism (VTE). After an index CVC-associated VTE (CVC-VTE), the role of secondary prophylaxis for subsequent CVC placement is uncertain. Aims of this single center retrospective study were to evaluate the efficacy of secondary prophylaxis for patients with a prior CVC-VTE and identify risk factors associated with recurrent VTE in patients less than 19 years with an index CVC-VTE between 2003 and 2013. Data collection included clinical and demographic factors, subsequent CVC placement, secondary prophylaxis strategy, recurrent VTE, and bleeding. Risk factors for recurrence and effectiveness of secondary prophylaxis were evaluated using survival and binomial models. Among 373 patients with an index CVC-VTE, 239 (64.1%) had subsequent CVC placement. 17.4% (65/373) of patients had recurrent VTE, 90.8% (59/65) were CVC-associated. On multivariable survival analysis, each additional CVC (HR 12.00; 95% CI 2.78 - 51.91), congenital heart disease (HR 3.70; 95% CI 1.97 - 6.95), and total parenteral nutrition dependence (HR 4.02; 95% CI 2.23 - 7.28) were associated with an increased hazard of recurrence. Full dose anticoagulation for secondary prophylaxis was associated with decreased odds of recurrent CVC-VTE (OR 0.35; 95% CI 0.19 - 0.65) but not prophylactic dosing (OR 0.61; 95% CI 0.28 - 1.30). Only 1.3% of CVCs experienced major bleeding with prophylactic or full dose anticoagulation. In summary, children with CVC-VTE are at increased risk for recurrent VTE. Secondary prophylaxis with full dose anticoagulation was associated with a 65% reduction in odds of thrombotic events.

scholarly journals 2430. Comorbidity and Severity of Illness Risk Adjustment for Hospital-Onset Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S840-S840
Author(s):  
Stephanie Cabral ◽  
Gita Nadimpalli ◽  
Kerri Thom ◽  
Surbhi Leekha ◽  
Lisa Harris ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Eligible Patient ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Significant Risk Factor ◽  
Patient Admissions ◽  
Increased Risk ◽  
Binomial Regression

Abstract Background Hospital-onset C. difficile infection (HO-CDI) rates are publicly reported. However, patient-level risk factors are not included in the current risk adjustment methodology, and the knowledge as to which risk factors to include is incomplete. This study aimed to determine whether electronically-available comorbidities and laboratory indicators of severity of illness are risk factors for HO-CDI. Methods We performed a retrospective cohort study of all adult patients admitted to three hospitals (one academic, two community) in Baltimore, Maryland between January 1, 2016 and January 1, 2018. Information extracted from electronic medical records included demographics, ICD-10 codes, laboratory results within 24 hours of admission (i.e., hematocrit, hemoglobin, platelet count, leukocytes, BUN, CO2, creatinine, glucose, sodium, and potassium), medication administration (i.e., antibiotic and antacid use), and C. difficile test result. Comorbid conditions were assessed by the Elixhauser Comorbidity Index components. HO-CDI was defined by positive laboratory test > 3 days after admission. Potential risk factors for HO-CDI were assessed using bivariate log binomial regression. Multivariable log binomial regression was conducted using significant (P < 0.1) covariates. Results At hospital 1 (academic), 314 of the 48,057 (0.65%) eligible patient admissions had HO- CDI; 41 of the 8,791 (0.47%) and 75 of the 29,211 (0.26%) of patient admissions at community hospitals 2 and 3, respectively, had HO-CDI. In multivariable analysis, Elixhauser Score was a significant risk factor for HO-CDI at all hospitals when controlling for antibiotic and antacid use; for every one-point increase in Elixhauser Score, there was an increased risk of HO-CDI of 1.27 (95% CI: 1.21, 1.32) at hospital 1, 1.38 (95% CI: 1.24, 1.54) at hospital 2, and 1.28 (95% CI: 1.10, 1.31) at hospital 3. Table 1 shows significant risk factors for HO-CDI for each hospital. When individual comorbidities were assessed in the regression analysis, fluid and electrolyte disorders were a significant risk factor for HO-CDI for all hospitals. Conclusion Laboratory values upon admission and electronically available patient comorbidities are important risk factors for HO-CDI and should be considered for future risk adjustment. Disclosures All authors: No reported disclosures.

scholarly journals Risk factors for Clostridium difficile infection in pediatric inpatients: A meta-analysis and systematic review

2019 ◽  
Vol 40 (4) ◽  
pp. 420-426 ◽  
Author(s):  
Scott Anjewierden ◽  
Zheyi Han ◽  
Charles B. Foster ◽  
Chaitanya Pant ◽  
Abhishek Deshpande
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Factor ◽  
Meta Analysis ◽  
Significant Risk ◽  
Female Gender ◽  
Significant Risk Factor ◽  
Antibiotic Exposure ◽  
H2 Receptor Antagonist ◽  
Increased Risk

AbstractObjective:To summarize risk factors for Clostridioides (formerly Clostridium) difficile infection (CDI) in hospitalized pediatric patients as determined by previous observational studies.Design:Meta-analysis and systematic review.Patients:Studies evaluating risk factors for CDI in pediatric inpatients were eligible for inclusion.Method:We systematically searched MEDLINE, Web of Science, Scopus, and EMBASE for subject headings and text words related to CDI and pediatrics from 1975 to 2017. Two of the investigators independently screened studies, extracted and compiled data, assessed study quality, and performed the meta-analysis.Results:Of the 2,033 articles screened, 14 studies reporting 10,531,669 children met the inclusion criteria. Prior antibiotic exposure (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31–3.52) and proton pump inhibitor (PPI) use (OR, 1.33; 95% CI, 1.07–1.64) were associated with an increased risk of CDI in children. Subgroup analyses using studies reporting only adjusted results suggested that prior antibiotic exposure is not a significant risk factor for CDI. H2 receptor antagonist (H2RA) use (OR, 1.36; 95% CI, 0.31–5.98) and that female gender (OR, 0.87; 95% CI, 0.74–1.03) did not play a significant role as a risk factor for developing CDI.Conclusion:Prior antibiotic exposure appears to be an important risk factor for CDI based on the combined analysis but not significant using adjusted studies. PPI use was associated with an increased risk of CDI. Judicious and appropriate use of antibiotics and PPIs may help reduce the risk of CDI in this vulnerable population.

scholarly journals Incidence and perioperative risk factors for surgical site infections in neurosurgery: prospective observational study

2022 ◽  
Vol 37 (1) ◽  
Author(s):  
Assem Mouneir Abdel-Latif ◽  
Amira A. Moharram ◽  
Ahmed Higazy ◽  
Nehal I. Ghoneim ◽  
Omnia Shafei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Prophylaxis ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Csf Leak ◽  
Neurosurgical Procedures ◽  
Trauma Patients ◽  
Contributing Factors

Abstract Background Surgical site infections (SSI) represent a burden on the health care system especially in developing countries with significant morbidity and mortality. In Egypt, especially in our institution, there is no registry for the SSI rate or the contributing factors with no clear guidelines regarding the regimen of perioperative antibiotic prophylaxis. Our study was conducted to assess the local practice and to calculate the rate and risk factors of SSI. Patients and methods A prospective registry was established at the Neurosurgery Department, Demerdash teaching hospital Ain Shams University, Cairo, Egypt. All patients who underwent elective neurosurgical procedures were included in this study. Trauma patients were excluded. Patients were followed-up for incident SSI for 1 month postoperatively. SSIs were identified based on CDC criteria and a standardized data collection form predictor variables including patient characteristics, preoperative, intraoperative, and postoperative factors along with the pattern of antimicrobial prophylaxis. Results The study included 248 patients with 1-month postoperative follow-up. An SSI rate of 19% was recorded being mainly in patients below 10 years of age. Postoperative CSF leak was noticed to be the most significant risk factor of SSI in our study (p value < 0.01). Sixty five percent of culture results showed infection with gram-negative bacilli with the predominance of Acinetobacter. Conclusion Prolonged use of perioperative antibiotics does not seem to have an added benefit in SSI prevention. Tailoring of the used antibiotic regimen is highly recommended according to the latest antimicrobial prophylaxis guidelines and the local culture and sensitivity results.

Factors Associated with Revision Adenoidectomy

2012 ◽  
Vol 146 (6) ◽  
pp. 984-990 ◽  
Author(s):  
Amy C. Dearking ◽  
Brian D. Lahr ◽  
Admire Kuchena ◽  
Laura J. Orvidas
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Gastroesophageal Reflux Disease ◽  
Surgical Technique ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Historical Cohort ◽  
Increased Risk

Objective. To determine whether patient factors (eg, indication for initial surgery, medical comorbidity, or age) are associated with adenoid regrowth and subsequent need for revision adenoidectomy and whether surgical factors (eg, surgical technique or level of surgeon’s training) are associated with adenoid regrowth and subsequent need for revision adenoidectomy. Study Design. Historical cohort study. Setting. Tertiary care academic medical center. Subjects and Methods. Children (≤18 years) who underwent adenoidectomy or adenotonsillectomy between 1980 and May 2009 were identified. Medical and surgical records were reviewed for sex, age at surgery, indication for surgery, training level of surgeon, surgical technique, and history of allergies, asthma, or gastroesophageal reflux disease. Results. Of 8245 surgical cases (53.8% male), 163 were revision adenoidectomies. Age at initial adenoidectomy was a significant factor for revision adenoidectomy, with younger ages associated with higher increased risk. Indication for adenoidectomy was also a significant risk factor; adjusted for age, patients with ear rather than infectious indications were about 10 times more likely to require revision. A diagnosis of gastroesophageal reflux disease was a significant risk factor (hazard ratio, 2.23; P = .002). Conclusion. Several risk factors are associated with revision adenoidectomy: young age at initial procedure, indication for adenoidectomy, and diagnosis of gastroesophageal reflux disease. Surgical technique, level of experience of the initial surgeon, and diagnosis of asthma or allergies were not significant risk factors for revision adenoidectomy.

Demographics and Risk Factors for Non-Accidental Orthopedic Trauma

2019 ◽  
Vol 58 (6) ◽  
pp. 618-626
Author(s):  
Lakshmanan Sivasundaram ◽  
Nikunj N. Trivedi ◽  
Julian Gatta ◽  
Anne Y. Ning ◽  
Chang-Yeon Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analyses ◽  
Significant Risk ◽  
Spine Fractures ◽  
Orthopedic Trauma ◽  
Injury Patterns ◽  
Increased Risk ◽  
Non Accidental Trauma ◽  
Inpatient Database ◽  
Current Risk

Childhood non-accidental trauma (NAT) is the second most common cause of death in children. Despite its prevalence, NAT is frequently unreported due to provider misdiagnosis or unawareness. The purpose of this study was to determine current risk factors and injury patterns associated with NAT. A retrospective review of the Kids’ Inpatient Database was performed for the years 2009 and 2012. Univariate and multivariate analyses were used to determine the statistically significant risk factors for NAT. In 2009 and 2012, 174 442 children were hospitalized for fractures. Of these, 2.07% (3614) were due to NAT. Lower extremity (femur, tibia/fibula, foot), hand/carpus, clavicle, pelvis, and spine fractures were more likely to result from NAT; tibia/fibula fractures were most predictive of NAT. Children with anxiety, attention-deficit, conduct, developmental, and mood disorders were more likely to experience NAT. Those with cerebral palsy and autism were not at an increased risk for NAT.

Dupuytren’s Disease Risk Factors

2004 ◽  
Vol 29 (5) ◽  
pp. 423-426 ◽  
Author(s):  
J.M. GEOGHEGAN ◽  
J. FORBES ◽  
D.I. CLARK ◽  
C. SMITH ◽  
R. HUBBARD
Keyword(s):  
Risk Factors ◽  
Disease Risk ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Increased Risk ◽  
Antiepileptic Medications ◽  
Control Study ◽  
Large Case

Dupuytren’s is a common problem, but little is known about its a etiology. We have undertaken a large case-control study to assess and quantify the relative contributions of diabetes and epilepsy as risk factors for Dupuytren’s in the community. Cases were patients with a diagnosis of Dupuytren’s disease and, for each, two controls were individually matched by age, sex, and general practice. Our dataset included 821 cases and 1,642 controls. Five hundred and eighty-eight (72%) of the cases were men. The mean age at diagnosis was 62 (range 24–97) years. Diabetes was a significant risk factor for Dupuytren’s disease (OR = 1.75) and there was an increased risk for medicinally treated diabetes (metformin – R = 3.56; sulphonylureas – OR = 1.75) and particularly insulin controlled (OR = 4.39) rather than diet-controlled diabetes. Epilepsy (OR = 1.12) and antiepileptic medications were not associated with Dupuytren’s disease. Ascertainment bias in previous studies may explain the reported association with epilepsy.

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