scholarly journals Recurrent tuberculosis disease in Singapore

2021 ◽  
Author(s):  
Suay Hong Gan ◽  
Kyi Win KhinMar ◽  
Li Wei Ang ◽  
Leo K Y Lim ◽  
Li Hwei Sng ◽  
...  
Keyword(s):  
Significant Risk ◽  
Control Unit ◽  
Significant Risk Factor ◽  
Molecular Fingerprinting ◽  
Retrospective Case ◽  
Patient Demographics ◽  
Treatment Information ◽  
Previously Treated ◽  
Culture Positive ◽  
Recurrent Tuberculosis

Abstract Background Previously treated ie. recurrent tuberculosis (TB) cases account for ~7-8% of incident TB globally and in Singapore. Molecular fingerprinting has enabled the differentiation of these patients into relapsed or re-infection cases. Methods Patient demographics, disease characteristics and treatment information were obtained from the national TB notification registry and TB Control Unit. We performed a retrospective, case-control study to evaluate factors associated with recurrent TB disease in Singapore citizens and Permanent Residents with culture-positive TB from 2006 to 2013 and who developed a second episode of culture-positive TB up to 2016 using multivariable logistic regression analyses. Results 91 cases with culture-positive first and recurrent TB disease episodes were identified. Recurrent TB was associated with age ≥60 years (adjusted odds ratio [aOR] 1.98, 95% confidence interval [CI] 1.09-3.61), male gender (aOR 2.29, 95% CI 1.22–4.51), having concomitant pulmonary and extrapulmonary TB (aOR 3.10, 95% CI 1.59–6.10) and extrapulmonary TB alone (aOR 3.82, 95% CI 1.12-13.31); and was less likely in non-Malays (aOR 0.52, 95% CI 0.27–0.99). DNA fingerprinting results for both episodes in 49 cases differentiated these into 28 relapsed and 21 re-infection cases. Relapse was associated with having concomitant pulmonary and extrapulmonary TB (aOR 9.24, 95% CI 2.50–42.42), and positive sputum acid fast bacilli smear (aOR 3.95, 95% CI 1.36–13.10). Conclusion Relapse and re-infection contributed to 57% and 43% respectively of recurrent TB in Singapore. Our study highlights the under-appreciated association of concomitant pulmonary and extrapulmonary TB as a significant risk factor for disease relapse.

Abstract 17276: Impact of Cardiovascular Comorbidities on COVID-19 Infection Risk

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David Tofovic ◽  
Minji Seok ◽  
Logan S Schwarzman ◽  
Sreenivas Konda ◽  
Noreen T Nazir
Keyword(s):  
Risk Factors ◽  
Cohort Analysis ◽  
Age Groups ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Age Group ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Patient Demographics ◽  
The Impact

Introduction: A disproportionate amount of COVID-19 infections has occurred in minority populations and in individuals with comorbid disease. We sought to evaluate the impact of patient demographics, cardiovascular disease (CVD), and known CVD risk factors on the incidence of COVID-19 infection. Methods: Between April 1st to May 1st, 2020, 844 adult patients (mean age 51.4±17.7 years, mean BMI 29.6±8.3, 50% male) admitted for any reason and tested for COVID-19 based on CDC criteria were studied in this large, metropolitan, single-center retrospective cohort analysis. Bivariate and multivariate analysis between patient demographics, CVD, and CVD risk factors with COVID-19 were evaluated. The nonlinear effects of age on COVID-19 test results were further analyzed. Results: Prevalence of COVID-19 was 21.7%. African Americans, Latinos, and Caucasian were 463(55%), 216(25%), 165(20%) respectively. Unadjusted, diabetes mellitus (DM) was significantly related with the COVID-19 positivity (OR 1.83, 95% CI 1.30-2.58, P=0.0005), but age adjusted DM was insignificant (OR 1.35, 95% CI 0.93-1.97, P=0.12). Similar results were found with other CVD risk factors (see Tables 1,2). Stratified analysis by age groups (18-40 years, ≥40 years), DM in the younger age group was the most significant risk factor for the COVID-19 positivity (OR 4.52, 95% CI 1.95-10.52, P=0.0002) but not in older inpatients (OR 1.23, 95% CI 0.85-1.81, P=0.2763). In the older age group, Latinos were significantly higher risk for COVID-19 compared to Caucasian (OR 2.27, 95% CI 1.26-4.07, P=0.005). Conclusions: Increased resources for testing in younger individuals with DM and the Hispanic population may be merited.

Prior gemtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation

Blood ◽  
2003 ◽  
Vol 102 (5) ◽  
pp. 1578-1582 ◽  
Author(s):  
Martha Wadleigh ◽  
Paul G. Richardson ◽  
David Zahrieh ◽  
Stephanie J. Lee ◽  
Corey Cutler ◽  
...  
Keyword(s):  
Stem Cell ◽  
Short Interval ◽  
Significant Risk ◽  
Disease Status ◽  
Significant Risk Factor ◽  
Gemtuzumab Ozogamicin ◽  
Myelogenous Leukemia ◽  
Increased Risk ◽  
Acute Myelogenous ◽  
Previously Treated

AbstractGemtuzumab ozogamicin (GO), a monoclonal antibody used in the treatment of acute myelogenous leukemia (AML) has been linked to the development of venoocclusive disease (VOD). We conducted a retrospective study of 62 patients with previously treated AML/MDS (myelodysplastic syndrome) who underwent allogeneic stem cell (SC) transplantation at our institution from December 2000 to October 2002 to determine whether GO exposure prior to allogeneic SC transplantation increases the risk of developing VOD. Fourteen patients received GO prior to SC transplantation. Of 62 patients, 13 (21%) developed VOD; 9 (64%) of 14 with prior GO exposure developed VOD compared with 4 (8%) of 48 without prior GO exposure (P < .0001). Logistic regression controlling for sex, disease status, donor type, and graft-versus-host disease prophylaxis identified prior treatment with GO as a significant risk factor for VOD (odds ratio [OR], 21.6; 95% confidence interval [CI], 4.2-112.2]. Nine of 10 patients who underwent SC transplantation 3.5 months or less following GO developed VOD compared with none of 4 patients who underwent SC transplantation more than 3.5 months from GO administration. Three of 14 patients who received GO prior to SC transplantation died of VOD. We conclude that patients undergoing SC transplantation within a short interval from GO administration are at increased risk of developing VOD.

A case-control study of post-operative endophthalmitis diagnosed at a Spanish hospital over a 13-year-period

2014 ◽  
Vol 143 (1) ◽  
pp. 178-183 ◽  
Author(s):  
M. A. ASENCIO ◽  
M. HUERTAS ◽  
R. CARRANZA ◽  
J. M. TENIAS ◽  
J. CELIS ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Incidence Rate ◽  
Case Control Study ◽  
Significant Risk ◽  
Cataract Extraction ◽  
Significant Risk Factor ◽  
Case Control ◽  
Retrospective Case ◽  
Spanish Hospital ◽  
Control Study

SUMMARYA retrospective case-control study of patients who had undergone cataract extraction at a Spanish hospital over a 13-year period was conducted to identify the risk factors for developing post-operative endophthalmitis (POE). During the study period, the type of antibiotic prophylaxis was changed from subconjunctival gentamicin to the addition of both vancomycin and gentamicin to the irrigating solution. The overall incidence of POE was 0·19% (35 cases/18 287 operations). For the period prior to the change in antibiotic prophylaxis, the incidence rate of POE was 3·4 cases/1000 operations while in the latter period the incidence rate decreased to 0·34 cases/1000 operations. All patients who presented a virulent microorganism had a final visual acuity worse than 20/200. The only significant risk factor identified was the type of prophylaxis used (odds ratio 1·97, 95% confidence interval 0·94–4·14, P = 0·07). There were no significant differences between cases and controls although choice of surgeon approached significance.

scholarly journals Pseudomonas aeruginosa as a Cause of Nosocomial Infections

2021 ◽  
Author(s):  
Silvia Labovská
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Nosocomial Infections ◽  
Significant Risk ◽  
Lung Ventilation ◽  
Significant Risk Factor ◽  
Hemodynamic Instability ◽  
Multidrug Resistant ◽  
Wound Infections ◽  
Patient Demographics ◽  
Sporadic Cases

Pseudomonas aeruginosa, as a gram-negative aerobic rod, is still one of the most resistant agents of nosocomial infections. It is used for the development of respiratory, urinary and wound infections. It causes bacteremia, especially in patients who are hospitalized for anesthesiology and resuscitation department or ICU, who often have respiratory insufficiency and hemodynamic instability and require artificial lung ventilation. Mechanical ventilation itself is a significant risk factor for the development of pseudomonad pneumonia. Pseudomonas aeruginosa has enzymes that are encoded on both chromosomes and plasmids, often in combination with other mechanisms of resistance, such as reducing the permeability of the outer or cytoplasmic membrane. Due to carbapenemases, Pseudomonas aeruginosa loses sensitivity to carbapenem and becomes resistant to this antibiotic. It also becomes resistant to aminoglycosides, cephalosporins and ureidopenicillins. It is also resistant to Quaternary disinfectants. The reservoir of pseudomonas nosocomial infection is hospital water, taps, shower roses, swimming pools, healing waters and others. The intervention of anti-epidemic measures in the case of infections caused by pseudomonad strains has not yet reached such sophistication as in the case of MRSA for time, personnel and economic reasons. In the absence of an epidemic, intervention in sporadic cases consists of informing nursing staff of the occurrence of a multidrug-resistant agent, including providing all patient demographics and relieving careful adherence to the barrier treatment, cleansing, disinfection and isolation regimen.

Extreme corneal flattening following collagen crosslinking for progressive keratoconus

2020 ◽  
pp. 112067212094766
Author(s):  
Prema Padmanabhan ◽  
Michael W Belin ◽  
Vasanthi Padmanaban ◽  
Rachapalle Reddi Sudhir
Keyword(s):  
Regression Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Multivariate Regression Analysis ◽  
Retrospective Case ◽  
Collagen Crosslinking ◽  
Cohort Group ◽  
Group A ◽  
Group B ◽  
Corneal Flattening

Purpose: To study the clinical, tomographic and densitometric features of eyes that showed >5 D of corneal flattening following collagen crosslinking (CXL) for progressive keratoconus and to identify preoperative predictive factors for such a response. Methods: This was a retrospective case control study of 548 eyes with progressive keratoconus which had undergone epithelium-off CXL (Dresden protocol) with a follow-up of 1 to 10 years. Eyes that showed ⩾5 D corneal flattening in maximum keratometry (Kmax) following CXL (group A) were compared with one eye of the remaining patients in the same cohort (group B). Changes in refraction and visual acuity, Kmax and thinnest pachymetry were compared between both groups. Univariate and multivariate regression analysis identified preoperative risk factors for unusual corneal flattening. Results: Forty three eyes in group A were compared with 502 eyes in group B. At the time of maximum flattening, group A showed more flattening (−7.6 ± 3.2 D) and thinning (−53.7 ± 45.2 µ) than group B (−1.69 ± 2.9 D and −26.6 ± 36.7 µ, respectively). Multivariate analysis based on parameters suggested by a univariate regression analysis identified pre-op Kmax to be the most significant predictor of intense corneal flattening. A subgroup analysis of K-matched eyes revealed that the duration of time following CXL was a significant risk factor for extreme corneal flattening following CXL Conclusion: An intense corneal flattening >5 D in Kmax was documented in 7.85% of a cohort of keratoconus patients who underwent CXL. High preoperative Kmax and the duration of time following CXL were significant predictors of this response which was accompanied by significant corneal thinning.

Physical Illness and Suicide Risk in Rural Residents of Contemporary China

Crisis ◽  
2014 ◽  
Vol 35 (5) ◽  
pp. 330-337 ◽  
Author(s):  
Cun-Xian Jia ◽  
Lin-Lin Wang ◽  
Ai-Qiang Xu ◽  
Ai-Ying Dai ◽  
Ping Qin
Keyword(s):  
Risk Factor ◽  
Family Income ◽  
Rural China ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Health Condition ◽  
Physical Illness ◽  
Rural Residents ◽  
Increased Risk ◽  
Study Population

Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.

scholarly journals Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junya Arai ◽  
Jun Kato ◽  
Nobuo Toda ◽  
Ken Kurokawa ◽  
Chikako Shibata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Poor Prognosis ◽  
Significant Risk ◽  
Care Facility ◽  
Significant Risk Factor ◽  
Advanced Age ◽  
Gastroduodenal Ulcers ◽  
Poor Outcomes

Abstract Background Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU. Methods In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis. Results Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7). Conclusion In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

Neurodevelopmental outcome of healthy term newborn with serum bilirubin >15 mg/dl at one year

2020 ◽  
pp. 1-6
Author(s):  
P. Dubey ◽  
J. Shrivastava ◽  
B.P. Choubey ◽  
A. Agrawal ◽  
V. Thakur
Keyword(s):  
Serum Bilirubin ◽  
Tertiary Care ◽  
Neurodevelopmental Outcome ◽  
Significant Risk ◽  
Central India ◽  
Significant Risk Factor ◽  
Motor Domain ◽  
Medical Emergency ◽  
One Year ◽  
Group 1

BACKGROUND: Neonatal hyperbilirubinemia is a common medical emergency in early neonatal period. Unconjugated bilirubin is neurotoxic and can lead to lifelong neurological sequelae in survivors. OBJECTIVE: To find out the association between serum bilirubin and neurodevelopmental outcome at 1 year of age using Development Assessment Scale for Indian Infants (DASII). METHODS: A prospective cohort study was conducted in the Department of Pediatrics of a tertiary care institution of Central India between January 2018 and August 2019. Total 108 term healthy neonates, with at least one serum bilirubin value of >15 mg/dl, were included. Subjects were divided into three groups based on the serum bilirubin; group 1: (15–20 mg/dl) –85(78.7%) cases, group 2: (20–25 mg/dl) –17(15.7%), and group 3: (>25 mg/dl) –6(5.5%). Developmental assessment was done using DASII at 3, 6, 9, 12 months of age. RESULTS: Out of 108 cases, 101(93.5%) received phototherapy, and 7(6.5%) received double volume exchange transfusion. Severe delay was observed in 5(4.6%) and mild delay in 2(1.9%) cases in the motor domain of DASII at one year. Severe delay in the motor domain was associated with mean TSB of 27.940±2.89 mg/dl and mild delay with mean TSB of 22.75±1.76 mg/dl (p = 0.001). On cluster analysis, delay was observed in locomotion 1 score in 11(13%) cases (p = 0.003) and manipulation score in 6(7.1%) cases in group 1. CONCLUSION: Increased serum bilirubin was a significant risk factor for the delayed neurodevelopment in babies with neonatal jaundice. Even a moderate level of bilirubin significantly affects the developmental outcome.

scholarly journals Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Chun Huang ◽  
Po-Tseng Lee ◽  
Mu-Shiang Huang ◽  
Pei-Fang Su ◽  
Ping-Yen Liu
Keyword(s):  
Risk Factor ◽  
Dose Response ◽  
Cox Model ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cardiovascular Death ◽  
Specific Model ◽  
Distribution Model ◽  
All Cause Mortality ◽  
Quartile Group

AbstractPremature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. We analyzed 15,893 patients in a medical referral center from July 1st, 2011, to December 31st, 2018. Multivariate regression driven by ln PAC (beats per 24 h plus 1) or quartiles of PAC burden were examined. Older group had higher PAC burden than younger group (p for trend < 0.001), and both genders shared similar PACs distribution. In Cox model, ln PAC remained an independent risk factor for all-cause mortality (hazard ratio (HR) = 1.09 per ln PAC increase, 95% CI = 1.06‒1.12, p < 0.001). PACs were a significant risk factor in cause-specific model (HR = 1.13, 95% CI = 1.05‒1.22, p = 0.001) or sub-distribution model (HR = 1.12, 95% CI = 1.04‒1.21, p = 0.004). In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p = 0.005), but no difference in cardiovascular death were found in competing risk analysis. In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups. In conclusion, PAC burden has a dose response effect on all-cause mortality and cardiovascular death.

scholarly journals The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

2021 ◽  
Vol 18 (2) ◽  
pp. 649
Author(s):  
Leah Shelef ◽  
Jessica M Rabbany ◽  
Peter M Gutierrez ◽  
Ron Kedem ◽  
Ariel Ben Yehuda ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
Suicidal Behavior ◽  
Military Service ◽  
Suicide Ideation ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Severity Rating ◽  
Significant Difference

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

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