Trisomy 18 Pregnancies: Is there an Increased Maternal Risk?

2017 ◽  
Vol 34 (11) ◽  
pp. 1054-1057
Author(s):  
Kayli Senz ◽  
Whitney Humphrey ◽  
Vanessa Lee ◽  
Aaron Caughey ◽  
Sarah Dotters-Katz
Keyword(s):  
International Classification Of Diseases ◽  
Vital Statistics ◽  
Trisomy 18 ◽  
Trisomy 13 ◽  
Obstetric Outcomes ◽  
Maternal Risk ◽  
Increased Risk ◽  
Multiparous Women ◽  
Classification Of Diseases ◽  
The Impact

Objective Characterize the impact of a trisomy 18 (T18) fetus on maternal and obstetric outcomes in a cohort including T18-affected deliveries. Study Design Retrospective cohort study of singleton deliveries in California from 2005 to 2008 using linked vital statistics and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) data to compare deliveries affected by T18 to those without known aneuploidy. Outcomes of interest included gestational diabetes mellitus (GDM), preterm delivery (PTD), preeclampsia, cesarean delivery (CD), and intrauterine fetal demise (IUFD). The χ2 and paired t-tests were used to compare the outcomes. Multiple logistic regression was used to further characterize these risks and control potential confounders. Results Of 2,029,000 deliveries, 298 involved T18. Compared with unaffected deliveries, T18 was associated with GDM (10.7 vs. 6.5%, p = 0.003), PTD < 37 (40.6 vs. 9.9%, p < 0.001) and < 32 weeks (14.8 vs. 1.4%, p < 0.001), and cesarean section (56 vs. 30.2%, p < 0.001), but not preeclampsia. In adjusted analyses, T18 pregnancies were associated with an increased risk of PTD < 37 and < 32 weeks (adjusted odds ratio [AOR]: 5.48, 95% confidence interval [CI]: 4.29, 6.99; AOR: 10.4, 95% CI: 7.26, 14.8), and an increased odd of CD for primiparous and multiparous women (AOR: 2.41, 95% CI: 1.48, 3.91; AOR: 5.42, 95% CI: 3.90, 7.53). Risk of GDM did not persist. Conclusion Unlike trisomy 13 (T13), pregnancies complicated by fetal T18 did not appear to result in an increased risk of preeclampsia. However, there is an increased risk of a range of other obstetric complications.

scholarly journals Impact of Immune Thrombocytopenia in Patients Admitted with Coronary Artery Disease: Results from National Inpatient Sample 2009-2011

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5891-5891
Author(s):  
Madan Aryal ◽  
Sijan Basnet ◽  
Rashmi Dhital ◽  
Rohit Gosain ◽  
Anthony Donato
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
International Classification Of Diseases ◽  
National Inpatient Sample ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
Artery Disease ◽  
The Impact

Abstract Background Patients with immune thrombocytopenia (ITP) may be at increased risk of thromboembolism related to different causes, including the use of thrombopoietin receptor agonists and splenectomy. Patients with ITP who develop coronary artery disease (CAD) can be a further challenge given their risk of both thromboembolism and bleeding, which may significantly increase the risk of mortality and length of stay (LOS) compared to patients who do not have ITP. We aimed to study the impact of ITP in hospital outcomes of patients with CAD. Methods We utilized the National Inpatient Sample database from years 2009 - 2011. We selected non-pregnant inpatients over the age of 18 with history of CAD. We selected patients with CAD and ITP based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We used STATA version 13.0 (College Station, TX) for database analysis. Results A total of 4,777 cases of ITP with CAD were identified compared to 2,614,008 without ITP (Table 1). Logistic multivariable analyses found that patients with ITP had higher in-hospital mortality (95% CI: 1.21 to 1.55, p=0.0001) and LOS (95% CI: 1.32 to 1.72, p<0.0001) after adjustment for age, sex, race, smoking, obesity, dyslipidemia, diabetes, hypertension, chronic kidney disease, peripheral vascular disease, smoking, obesity, stroke, and Charlson comorbidity index (Table 2). Conclusion: Our study shows that in patients with coronary artery disease-associated ITP, adjusted LOS and mortality was significantly higher compared to patients without ITP. Disclosures No relevant conflicts of interest to declare.

Weekend Admission Does Not Confer an Increased Risk of Mortality in Septic Shock

2021 ◽  
pp. 088506662110385
Author(s):  
Saqib H. Baig ◽  
David A. Oxman ◽  
Erika J. Yoo
Keyword(s):  
Septic Shock ◽  
Interaction Analysis ◽  
Univariate Analysis ◽  
Severity Of Illness ◽  
International Classification Of Diseases ◽  
Diagnosis Codes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
The Impact

Purpose: To investigate the impact of weekend admission on mortality for patients with septic shock. Material and Methods: Retrospective cohort study of adults in the 2017 to 2018 National Inpatient Sample coded as R65.21 (severe sepsis with septic shock) within the first 3 diagnosis codes according to the 10th revision of the International Classification of Diseases. Measurements and Main Results: After exclusions, 100,584 records were analyzed (73,966 weekday and 26,618 weekend admissions). Severity-of-illness was estimated using the Charlson-Deyo comorbidity index. Using weighted logistic regression adjusted for factors identified on univariate analysis as potentially significant, we found no higher odds of death for weekday compared to weekend admissions (OR 1.00, 95% CI 0.99-1.02, P = .84). There was a temporal improvement in septic shock outcomes with 2018 admissions having lower odds of death (OR 0.97, 95% CI 0.96-0.98, P < .001). There was no evidence for interaction between weekend admission and individual years of admission ( P = .17 and P = .05 for 2017 and 2018, respectively). However, weekend mortality did seem to vary by region in our interaction analysis with higher odds of death seen in the West (OR 1.08, 95% CI 1.05-1.11, P < .001). Conclusion: We found no evidence for higher mortality among patients admitted on weekends with septic shock.

Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. S575-S576
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Trend Test ◽  
Classification Of Diseases ◽  
Competing Interest ◽  
Armitage Trend Test ◽  
The Impact

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prevalence and risk factors for chalazion in an older veteran population

2021 ◽  
pp. bjophthalmol-2020-318420
Author(s):  
Sneh Patel ◽  
Natalia Tohme ◽  
Emmanuel Gorrin ◽  
Naresh Kumar ◽  
Brian Goldhagen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tear Film ◽  
International Classification Of Diseases ◽  
Retrospective Case ◽  
Eyelid Margin ◽  
Factors Associated ◽  
Classification Of Diseases ◽  
Health Database ◽  
Irritable Bowel ◽  
The Impact

BackgroundChalazia are common inflammatory eyelid lesions, but their epidemiology remains understudied. This retrospective case–control study examined the prevalence, risk factors and geographic distribution of chalazia in a large veteran population.MethodsData on all individuals seen at a Veterans Affairs (VA) clinic between October 2010 and October 2015 were extracted from the VA health database. Subjects were grouped based on International Classification of Diseases, Ninth Revision (ICD-9) code for chalazion. Univariable logistic regression modelling was used to identify clinical and demographic factors associated with chalazion presence, followed by multivariable modelling to examine which factors predicted risk concomitantly. All cases were mapped across the continental US using geographic information systems modelling to examine how prevalence rates varied geographically.ResultsOverall, 208 720 of 3 453 944 (6.04%) subjects were diagnosed with chalazion during the study period. Prevalence was highest in coastal regions. The mean age of the population was 69.32±13.9 years and most patients were male (93.47%), white (77.13%) and non-Hispanic (93.72%). Factors associated with chalazion risk included smoking (OR=1.12, p<0.0005), conditions of the tear film (blepharitis (OR=4.84, p<0.0005), conjunctivitis (OR=2.78, p<0.0005), dry eye (OR=3.0, p<0.0005)), conditions affecting periocular skin (eyelid dermatitis (OR=2.95, p<0.0005), rosacea (OR=2.50, p<0.0005)), allergic conditions (history of allergies (OR=1.56, p<0.0005)) and systemic disorders (gastritis (OR=1.54, p<0.0005), irritable bowel syndrome (OR=1.45, p<0.0005), depression (OR=1.35, p<0.0005), anxiety (OR=1.31, p<0.0005)). These factors remained associated with chalazion risk when examined concomitantly.ConclusionPeriocular skin, eyelid margin and tear film abnormalities were most strongly associated with risk for chalazion. The impact of environmental conditions on risk for chalazion represents an area in need of further study.

Association of age with risk of major depression among patients with chronic kidney disease over midlife: a nationwide cohort study in Taiwan

2018 ◽  
Vol 31 (08) ◽  
pp. 1171-1179 ◽  
Author(s):  
Shih-Feng Chen ◽  
Yu-Huei Chien ◽  
Pau-Chung Chen ◽  
I-Jen Wang
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Major Depression ◽  
Kidney Disease ◽  
Comparison Group ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Classification Of Diseases ◽  
The Impact

ABSTRACTBackground:The impact of age on the development of depression among patients with chronic kidney disease (CKD) at stages before dialysis is not well known. We aimed to explore the incidence of major depression among predialysis CKD patients of successively older ages through midlife.Methods:We conducted a retrospective cohort study using the longitudinal health insurance database 2005 in Taiwan. This study investigated 17,889 predialysis CKD patients who were further categorized into study (i.e. middle and old-aged) groups and comparison group aged 18–44. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was applied for coding diseases.Results:The group aged 75 and over had the lowest (hazard ratio [HR] 0.47; 95% confidence interval [CI] 0.32–0.69) risk of developing major depression, followed by the group aged 65–74 (HR 0.67; 95% CI 0.49–0.92), using the comparison group as reference. The adjusted survival curves showed significant differences in cumulative major depression-free survival between different age groups. We observed that the risk of major depression development decreases with higher age. Females were at a higher risk of major depression than males among predialyasis CKD patients.Conclusions:The incidence of major depression declines with higher age in predialysis CKD patients over midlife. Among all age groups, patients aged 75 and over have the lowest risk of developing major depression. A female preponderance in major depression development is present. We suggest that depression prevention and therapy should be integrated into the standard care for predialysis CKD patients, especially for those young and female.

Readmission after Adult Uvulopalatopharyngoplasty: A Population-Based Inpatient Cohort Study in Taiwan

2018 ◽  
Vol 160 (3) ◽  
pp. 559-566 ◽  
Author(s):  
Ying-Shuo Hsu ◽  
Wei-Chung Hsu ◽  
Jenq-Yuh Ko ◽  
Te-Huei Yeh ◽  
Chia-Hsuan Lee ◽  
...  
Keyword(s):  
Odds Ratio ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Factors Associated ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
Insurance Database ◽  
Population Based Survey

Objective To investigate readmissions among adult inpatients who underwent uvulopalatopharyngoplasty (UPPP) in Taiwan. Design Population-based survey. Setting Retrospective study with the National Health Insurance Database. Methods All cases of inpatient adult UPPP (age >20 years) from 1997 to 2012 were identified through International Classification of Diseases, Ninth Revision, Clinical Modification. Factors associated with readmission within 30 days after surgery were analyzed. Results A total of 38,839 adults with UPPP were identified (mean age, 39.3 years; men, 73.7%). The incidence of UPPP was 14.6 per 100 000 adults, which increased from 1997 to 2012 (6.7 to 16.7 per 100,000, Ptrend < .001). The rates of readmission for any reason, readmission for bleeding, reoperation for bleeding, and 30-day mortality were 4.2%, 1.7%, 1.0%, and 0.14%, respectively. Young age increased the risk of reoperation for bleeding, and old age increased the risk of readmission for any reason and mortality. Men had an increased risk of readmission and reoperation. Hypertension was associated with an increased risk of readmission for any reason (odds ratio [OR], 1.29; 95% CI, 1.10-1.51), bleeding-related readmission (OR, 1.89; 95% CI, 1.52-2.36), and reoperation (OR, 2.47; 95% CI, 1.84-3.30). Concurrent hypopharyngeal surgery was associated with an increased risk of readmission for any reason (OR, 1.34; 95% CI, 1.07-1.66) and bleeding-related readmission (OR, 1.69; 95% CI, 1.25-2.27). Finally, the use of steroids was associated with an increased risk of bleeding-related readmission and reoperation. Conclusions The incidence of adult UPPP increased from 1997 to 2012 in Taiwan. Age, sex, comorbidity, concurrent hypopharyngeal surgery, and drug administration were associated with readmission after inpatient UPPP.

scholarly journals Prevalence of Nonopioid and Opioid Prescriptions Among Commercially Insured Patients with Chronic Pain

Pain Medicine ◽  
2018 ◽  
Vol 20 (10) ◽  
pp. 1948-1954 ◽  
Author(s):  
Gabrielle F Miller ◽  
Gery P Guy ◽  
Kun Zhang ◽  
Christina A Mikosz ◽  
Likang Xu
Keyword(s):  
Chronic Pain ◽  
International Classification Of Diseases ◽  
The United States ◽  
Design Data ◽  
Classification Of Diseases ◽  
Drastic Increase ◽  
Inflammatory Drugs ◽  
Insured Patients ◽  
Evidence Based Guidelines ◽  
The Impact

Abstract Objective The increased use of opioids to treat chronic pain in the past 20 years has led to a drastic increase in opioid prescribing in the United States. The Centers for Disease Control and Prevention’s (CDC’s) Guideline for Prescribing Opioids for Chronic Pain recommends the use of nonopioid therapy as the preferred treatment for chronic pain. This study analyzes the prevalence of nonopioid prescribing among commercially insured patients with chronic pain. Design Data from the 2014 IBM® MarketScan® databases representing claims for commercially insured patients were used. International Classification of Diseases, Ninth Revision, codes were used to identify patients with chronic pain. Nonopioid prescriptions included nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics/antipyretics (e.g., acetaminophen), anticonvulsants, and antidepressant medications. The prevalence of nonopioid and opioid prescriptions was calculated by age, sex, insurance plan type, presence of a depressive or seizure disorder, and region. Results In 2014, among patients with chronic pain, 16% filled only an opioid, 17% filled only a nonopioid prescription, and 28% filled both a nonopioid and an opioid. NSAIDs and antidepressants were the most commonly prescribed nonopioids among patients with chronic pain. Having prescriptions for only nonopioids was more common among patients aged 50–64 years and among female patients. Conclusions This study provides a baseline snapshot of nonopioid prescriptions before the release of the CDC Guideline and can be used to examine the impact of the CDC Guideline and other evidence-based guidelines on nonopioid use among commercially insured patients with chronic pain.

scholarly journals Association Between Diagnosis Code Expansion and Changes in 30‐Day Risk‐Adjusted Outcomes for Cardiovascular Diseases

2021 ◽  
Author(s):  
Lauren Gilstrap ◽  
Rishi K. Wadhera ◽  
Andrea M. Austin ◽  
Stephen Kearing ◽  
Karen E. Joynt Maddox ◽  
...  
Keyword(s):  
Logistic Regression ◽  
International Classification Of Diseases ◽  
Fee For Service ◽  
Readmission Rates ◽  
Difference In Differences ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Changes In Risk ◽  
The Impact

BACKGROUND In January 2011, Centers for Medicare and Medicaid Services expanded the number of inpatient diagnosis codes from 9 to 25, which may influence comorbidity counts and risk‐adjusted outcome rates for studies spanning January 2011. This study examines the association between (1) limiting versus not limiting diagnosis codes after 2011, (2) using inpatient‐only versus inpatient and outpatient data, and (3) using logistic regression versus the Centers for Medicare and Medicaid Services risk‐standardized methodology and changes in risk‐adjusted outcomes. METHODS AND RESULTS Using 100% Medicare inpatient and outpatient files between January 2009 and December 2013, we created 2 cohorts of fee‐for‐service beneficiaries aged ≥65 years. The acute myocardial infarction cohort and the heart failure cohort had 578 728 and 1 595 069 hospitalizations, respectively. We calculate comorbidities using (1) inpatient‐only limited diagnoses, (2) inpatient‐only unlimited diagnoses, (3) inpatient and outpatient limited diagnoses, and (4) inpatient and outpatient unlimited diagnoses. Across both cohorts, International Classification of Diseases, Ninth Revision ( ICD‐9 ) diagnoses and hierarchical condition categories increased after 2011. When outpatient data were included, there were no significant differences in risk‐adjusted readmission rates using logistic regression or the Centers for Medicare and Medicaid Services risk standardization. A difference‐in‐differences analysis of risk‐adjusted readmission trends before versus after 2011 found that no significant differences between limited and unlimited models for either cohort. CONCLUSIONS For studies that span 2011, researchers should consider limiting the number of inpatient diagnosis codes to 9 and/or including outpatient data to minimize the impact of the code expansion on comorbidity counts. However, the 2011 code expansion does not appear to significantly affect risk‐adjusted readmission rate estimates using either logistic or risk‐standardization models or when using or excluding outpatient data.

scholarly journals INCREASED NUCHAL TRANSLUCENCY IN A FETUS WITH A NORMAL KARYOTYPE: CASE REPORT

2019 ◽  
Vol 2 (1) ◽  
pp. 59-61
Author(s):  
Cristina Moisei ◽  
Anca Lesnica ◽  
Romina Marina Sima ◽  
Liana Pleș
Keyword(s):  
Chorionic Villus ◽  
Normal Karyotype ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Trisomy 18 ◽  
Trisomy 13 ◽  
Chorionic Villus Sampling ◽  
Increased Risk ◽  
First Trimester Ultrasound ◽  
Increased Nuchal Translucency

Nuchal translucency (NT) is the normal fluid filled subcutaneous space measured at the back of the fetal neck measured in the late first trimester and early second trimester. Nuchal translucency screening can detect approximately 80% of fetuses with Down syndrome and other major aneuploidies with a rate of 5% of false positive results, but the merger of the NT screening with β-hCG and PAPP-A testing increases the detection rate to 90%. We present the case of a fetus with a NT of 49 mm detected at the first trimester ultrasound morphologic exam. The Kryptor test revealed a 1:35 risk for Trisomy 13 and 1:721 for Trisomy 18. We report the case of an investigated pregnancy with a NT of 49 mm detected at the first trimester ultrasound exam, with a risk of 1:35 for Trisomy 13 and 1:721 for Trisomy 18 calculated at the Kryptor test. A chorionic villus sampling was recommended and performed with a result of 46XY normal karyotype. The particularity of this case is represented by the increased nuchal translucency as well as an increased risk for trisomy 13 and 18 in a normal karyotype fetus that had a normal development in the second and third trimester with no pregnancy complications arising.

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