Risk of Surgery and Anesthesia for Ischemic Stroke

Background The goal of this study was to determine if the combination of surgery and anesthesia is an independent risk factor for the development of incident (first-time) ischemic stroke. Methods All residents of Rochester, MN, with incident ischemic stroke from 1960 through 1984 (1,455 cases and 1,455 age- and gender-matched controls) were used to identify risk factors associated with ischemic stroke. Cases and controls undergoing surgery involving general anesthesia or central neuroaxis blockade before their stroke/index date of diagnosis were identified. A conditional logistic regression model was used to estimate the odds ratio of surgery and anesthesia for ischemic stroke while adjusting for other known risk factors. Results There were 59 cases and 17 controls having surgery within 30 days before their stroke/index date. After adjusting for previously identified risk factors, surgery within 30 days before the stroke/index date (perioperative period) was found to be an independent risk factor for stroke (P<0.001; odds ratio, 3.9; 95% confidence interval, 2.1-7.4). In an analysis that excluded matched pairs where the case and/or control underwent surgery considered "high risk" for stroke (cardiac, neurologic, or vascular procedures), "non-high-risk surgery" was also found to be an independent risk factor for perioperative stroke (P = 0.002; odds ratio, 2.9; 95% confidence interval, 1.5-5.7). Conclusion Our results suggest that there is an increased risk of ischemic stroke in the 30 days after surgery and anesthesia. This risk remains elevated even after excluding surgeries (cardiac, neurologic, and vascular surgeries) considered to be high risk for ischemic stroke.

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Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury

The American Surgeon ◽

10.1177/000313482008600106 ◽

2020 ◽

Vol 86 (1) ◽

pp. 8-14

Author(s):

Sahil Gambhir ◽

Areg Grigorian ◽

Divya Ramakrishnan ◽

Catherine M. Kuza ◽

Brian Sheehan ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Risk Factor ◽

Brain Injury ◽

Confidence Interval ◽

Odds Ratio ◽

Independent Risk Factor ◽

Factors Associated ◽

Severe Tbi ◽

Life Sustaining Treatment

Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients with severe TBI of the head. Patients were compared by age (age < 65 and age ≥ 65 years) and survival after WLST (survivors versus non-survivors) at hospitalization discharge. A multivariable logistic regression model was used for analysis. From 1,403,466 trauma admissions, 328,588 (23.4%) patients had severe TBI. Age ≥ 65 years was associated with increased WLST (odds ratio: 1.76, confidence interval: 1.59–1.94, P < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55–0.65, P < 0.001). Compared with non-survivors of WLST, survivors were older (74 vs 61 years, P < 0.001) and more likely to have comorbidities such as hypertension (57% vs 38.5%, P < 0.001). Age ≥ 65 years was an independent risk factor for WLST, and nonwhite race was associated with decreased WLST. Patients surviving until discharge after WLST decision were older (≥74 years) and had multiple comorbidities.

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Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort

Diseases of the Esophagus ◽

10.1093/dote/doz061 ◽

2019 ◽

Cited By ~ 2

Author(s):

K Y Song ◽

A J Henn ◽

A A Gravely ◽

H Mesa ◽

S Sultan ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Independent Risk Factor ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Increased Risk ◽

Low Grade Dysplasia

SUMMARY Patients with Barrett's esophagus (BE) and low-grade dysplasia (LGD) are at increased risk of esophageal adenocarcinoma (EAC), although many regress to nondysplastic BE. This has significant clinical importance for patients being considered for endoscopic eradication therapy. Our aim is to determine the risk for progression in patients with confirmed persistent LGD. We performed a single-center retrospective cohort study of patients with BE and confirmed LGD between 2006 and 2016. Confirmed LGD was defined as LGD diagnosed by consensus conference with an expert GI pathologist or review by an expert GI pathologist and persistence as LGD present on subsequent endoscopic biopsy. The primary outcome was the incidence rate of HGD (high-grade dysplasia)/EAC. Secondary outcomes included risk factors for dysplastic progression. Risk factors for progression were assessed using univariate and multivariate analysis with logistic regression. Of 69 patients (mean age 65.2 years) with confirmed LGD were included. In total, 16 of 69 patients (23.2%) with LGD developed HGD/EAC during a median follow-up of 3.74 years (IQR, 1.24–5.45). For persistent confirmed LGD, the rate was 6.44 (95% confidence interval (CI), 2.61–13.40) compared to 2.61 cases per 100 patient-years (95% CI, 0.83–6.30) for nonpersistent LGD. Persistent LGD was found in only 29% of patients. Persistent LGD was an independent risk factor for the development of HGD/EAC (OR 4.18; [95% CI, 1.03–17.1]). Persistent confirmed LGD, present in only 1/3 of patients, was an independent risk factor for the development of HGD/EAC. Persistence LGD may be useful in decision making regarding the management of BE.

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Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery

Anesthesia Progress ◽

10.2344/anpr-64-02-11 ◽

2017 ◽

Vol 64 (2) ◽

pp. 104-105 ◽

Cited By ~ 4

Author(s):

Masanori Tsukamoto ◽

Miwa Kobayashi ◽

Takeshi Yokoyama

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Confidence Interval ◽

Odds Ratio ◽

Pressure Ulcers ◽

Oral Surgery ◽

Male Gender ◽

Quality Review ◽

Nasal Tube

A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years. We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio = 9.1411; 95% confidence interval = 1.680–170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval = 1.0034–1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.

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Psoríase e Doença Cardiovascular

Acta Médica Portuguesa ◽

10.20344/amp.4061 ◽

2013 ◽

Vol 26 (5) ◽

pp. 601

Author(s):

Tiago Torres ◽

Rita Sales ◽

Carlos Vasconcelos ◽

Manuela Selores

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Risk Factor ◽

Independent Risk Factor ◽

Cardiovascular Comorbidities ◽

Increased Risk ◽

Systemic Inflammatory Disease ◽

Obesity Hypertension

Psoriasis is a common, chronic and systemic inflammatory disease associated with several comorbidities, such as obesity, hypertension, diabetes, dyslipidaemia and metabolic syndrome, but also with an increased risk of cardiovascular disease, like myocardial infarction or stroke. The chronic inflammatory nature of psoriasis has been suggested to be a contributing and potentially independent risk factor for the development of cardiovascular comorbidities and precocious atherosclerosis. Aiming at alerting clinicians to the need of screening and monitoring cardiovascular diseases and its risk factors in psoriatic patients, this review will focus on the range of cardiometabolic comorbidities and increased risk of cardiovascular disease associated with psoriasis.

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The Effect of Ethnicity on Preterm Birth and its Influence on the Risk Factors for Prematurity

Current Opinion in Gynecology and Obstetrics ◽

10.18314/cogo.v2i1.1456 ◽

2019 ◽

pp. 180-192

Author(s):

P Bachkangi ◽

AH Taylor ◽

JC Konje

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Preterm Birth ◽

High Risk ◽

Risk Groups ◽

Individual Risk ◽

Individual Risk Factor ◽

Increased Risk ◽

Gestational Age At Delivery ◽

Very High

Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.

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Incidence, Risk Factors, and Outcomes for Atrial Arrhythmias in Trauma Patients

The American Surgeon ◽

10.1177/000313481107700526 ◽

2011 ◽

Vol 77 (5) ◽

pp. 634-639 ◽

Cited By ~ 16

Author(s):

Pantelis Hadjizacharia ◽

Terence O'Keeffe ◽

Carlos V.R. Brown ◽

Kenji Inaba ◽

Ali Salim ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Odds Ratio ◽

Independent Risk Factor ◽

Beta Blockers ◽

Head Injuries ◽

Paroxysmal Supraventricular Tachycardia ◽

Trauma Patients ◽

Academic Level ◽

Incidence Risk

The purpose of this study is to determine the incidence, risk factors, and outcomes after the development of an atrial arrhythmia (AA) in trauma patients admitted to the Intensive Care Unit (ICU). We performed a retrospective study of more than 7 years of trauma patients admitted to the ICU at an urban, academic Level I trauma center. Patients with AA, defined as atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia, were compared with patients without AA. Groups were compared by univariate and multivariate analysis. Three thousand, four hundred and ninety-nine trauma patients were admitted to the ICU during the study period and 210 (6%) developed an AA. AA patients were more likely to sustain blunt trauma, were older, more often female, more severely injured, and sustained more head injuries. The only independent risk factor for developing an AA was age > 55 years (odds ratio = 4.6, P < 0.01). Mortality was higher in the AA group (33% vs 14%, P < 0.01) and AA was an independent risk factor for mortality (odds ratio = 1.7, P = 0.01). Twenty-eight per cent (n = 59) of AA patients received beta-blockers in the postinjury period, and these patients had lower mortality (22% vs 37%, P = 0.04). AA occurs in 6 per cent of trauma patients admitted to the ICU. Developing an AA is an independent risk factor for mortality after trauma. Beta-blocker therapy was associated with decreased mortality in trauma patients with AA.

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Abstract WMP51: Patients’ Social Networks Influence Timing of Hospital Arrival After Acute Ischemic Stroke: a Mixed Methods Study

Stroke ◽

10.1161/str.47.suppl_1.wmp51 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Amar Dhand ◽

Douglas Luke ◽

Michael Tsiaklides ◽

Catherine Lang ◽

Jin-Moo Lee

Keyword(s):

Risk Factors ◽

Social Networks ◽

Risk Factor ◽

Ischemic Stroke ◽

Social Network ◽

Network Structure ◽

Independent Risk Factor ◽

Hospital Arrival ◽

Prehospital Delay ◽

Social Network Structure

Introduction: Delay in hospital arrival is a major reason for stroke patients’ exclusion from acute therapy. Risk factors for delay include older age, minor symptoms, and living alone. Personal social networks, consisting of the structure and content of relationships around a patient, are important and modifiable factors to health behavior. This study examined the role and mechanisms of patients’ social networks in prehospital delay. Hypothesis: Social network structure is an independent risk factor of prehospital delay through social influence mechanisms. Methods: Seventy consecutive patients with mild acute ischemic stroke were interviewed in the hospital. An established social network analysis instrument was used to assess personal network structure and composition. This was followed by semi-structured interviews in 14 patients focused on the arrival process. Fast arrival was defined as before 6 hours, and slow was after 6 hours. Results: There were 32 slow and 38 fast arrivers. The mean age (63) and NIHSS (3) did not differ between groups. Subcortical stroke location (53% versus 26%) and being unmarried (75% versus 44%) were more common in slow compared to fast arrivers (p<0.05). After controlling for known risk factors, social network structure was significantly associated with arrival time. As shown in figure 1, patients (A) who had networks with high constraint (e.g., strong ties among all network members) were slower to arrive than patients (B) with low constraint (e.g., weak or no ties among network members). Constraint had an adjusted OR=1.08 (95% CI 1.03-1.13, p<0.005) for slow arrival. Mechanisms revealed from qualitative analysis were social capital benefits in fast arrivers, and family members’ perceptual bias to minimize symptoms in slow arrivers. Conclusions: Patients’ social network structure is an independent risk factor for prehospital delay. These results may be used to develop network-tailored stroke education.

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Atrial fibrillation and migraine with aura in young adults with ischemic stroke

Cephalalgia ◽

10.1177/0333102420970880 ◽

2020 ◽

pp. 033310242097088

Author(s):

Cédric Gollion ◽

Julie Gazagnes ◽

Vincent Fabry ◽

Marianne Barbieux-Guillot ◽

Fleur Lerebours ◽

...

Keyword(s):

Atrial Fibrillation ◽

Young Adults ◽

Ischemic Stroke ◽

Confidence Interval ◽

Migraine With Aura ◽

Odds Ratio ◽

Migraine Without Aura ◽

University Hospital ◽

Common Cause ◽

Increased Risk

Background Migraine is associated with an increased risk of ischemic stroke. The associations are stronger in migraine with aura than in migraine without aura, in women than in men, and in younger subjects. However, the mechanisms by which migraine might increase the risk of ischemic stroke are debated. Methods We analysed the associations between migraine without aura and migraine with aura and the causes of ischemic stroke in patients aged 18–54 years treated consecutively in a university hospital stroke center. Results A total of 339 patients (mean/SD age 43.8/8.8 years, 62.83% male) were included. Migraine with aura was diagnosed in 58 patients, and migraine without aura in 54 patients. Patients with migraine with aura were younger and had fewer traditional cardiovascular risk factors than patients with no migraine. Migraine with aura was strongly associated with atrial fibrillation (odds ratio, 5.08; 95% confidence interval, 1.24–21.92; p = 0.011) and negatively associated with atherosclerosis (odds ratio, 0.29; 95% confidence interval, 0.05–0.97; p = 0.033) and small vessel disease (odds ratio, 0.13; 95% confidence interval, 0.00–0.87; p = 0.022). No other cause of stroke was significantly associated with migraine. The most common cause of stroke was atherosclerosis in no-migraine patients, dissection in migraine without aura patients and patent foramen ovale in migraine with aura patients. Atrial fibrillation was, together with dissection, the second leading cause of stroke in migraine with aura patients, accounting for 10.34% of cases in this subgroup. Conclusion We showed that atrial fibrillation was a common cause of ischemic stroke in young adults with migraine with aura.

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Antibody profiles for the diagnosis of antiphospholipid syndrome

Thrombosis and Haemostasis ◽

10.1160/th04-12-0839 ◽

2005 ◽

Vol 93 (06) ◽

pp. 1147-1152 ◽

Cited By ~ 172

Author(s):

Alessandra Biasiolo ◽

Cinzia Pegoraro ◽

Umberto Cucchini ◽

Franco Noventa ◽

Sabino Iliceto ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Confidence Interval ◽

Antiphospholipid Syndrome ◽

Odds Ratio ◽

Obstetric Complications ◽

Antibody Detection ◽

Enzyme Linked Immunosorbent Assay ◽

Antiphospholipid Antibody ◽

Arterial Thromboembolism

SummaryAmong the so called‘antiphospholipid antibodies’, the presence of Lupus Anticoagulant (LA) is associated with thrombosis-related events and defines the antiphospholipid syndrome. The role of anti-cardiolipin (aCL) antibodies and anti-human β2-glycoprotein I (aβ2GPI) antibodies is less striking. Since the problem of standardization for these tests is far from resolved, we evaluated whether the combination of results (antiphospholipid laboratory profiles) could help to better classify these patients. Over a 6-year period, 618 consecutive subjects (55% of whom had previous documented thrombosis-related events) were referred to our clinic for Antiphospholipid antibody detection. LA was detected according to internationally accepted recommendations. ACL and aβ2GPI antibodies were detected by Enzyme-Linked-Immunosorbent Assay (ELISA). Patients’ records were reviewed for the presence of previous thromboembolic events or obstetric complications according to Sapporo’s clinical criteria for the diagnosis of antiphospholipid syndrome (APS) and each patient underwent a physical examination. When individual tests were considered in a multivariate analysis which took into account age, gender, the presence of SLE or other autoimmune diseases and established risk factors for venous and arterial thromboembolism, LA (Odds Ratio 4.4, Confidence Interval 1.5–13.3) and aβ2GPI antibodies (Odds Ratio 2.9, Confidence Interval 1.1–7.5) but not aCL antibodies (Odds Ratio 1.2, Confidence Interval 0.5–2.7) were found to be independent risk factors for thrombosis-related events. When antiphospholipid antibody profiles instead of individual test positivity were analyzed in the above mentioned model, triple positivity resulted a strong independent risk factor (Odds Ratio 33.3, Confidence Interval 7.0–157.6), retaining its significance when the association with venous or arterial thromboembolism was considered. Double positivity with negative LA was close to significance for thrombosis-related events (Odds Ratio 2.2, Confidence Interval1.0–5.2, p=0.056) and highly significant risk factor for obstetric complications (Odds Ratio 10.8, Confidence Interval 2.9–40.8). Other combinations did not reach statistical significance. The mean level of IgG aβ2GPI antibodies was statistically higher in triple positive profile and might account for positive LA. As compared to a single test, the analysis of a complete antiphospholipid antibody profile can better determine patients at risk.

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Risk factors for recurrent wheezing after bronchiolitis in infants: 2-year follow up in China

BMC Infectious Diseases ◽

10.1186/s12879-021-05937-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sainan Chen ◽

Wenjing Gu ◽

Min Wu ◽

Chuangli Hao ◽

Canhong Zhu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Severe Disease ◽

Recurrent Wheezing ◽

Increased Risk ◽

Tnf Α ◽

History Of ◽

Outpatient Appointments

Abstract Background Infants with bronchiolitis have an increased risk of developing recurrent wheezing and asthma. However, the risk factors for the development of recurrent wheezing after bronchiolitis remains controversial. Our study was to investigate risk factors of post-bronchiolitis recurrent wheezing. Methods Infants with bronchiolitis were enrolled from November 2016 through March 2017. Nasopharyngeal aspirates were obtained for detection of respiratory viruses which were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and direct immunofluorescent assay. Serum cytokines including TSLP, IL2, IL13, TIMP-1, MMP-9, IL33, IL5, IL4, IL25, TNF- α and MIP-1α were measured by flow cytometry. Patients were followed up every 3 months for a duration of 2 years by telephone or at outpatient appointments. Results We enrolled 89 infants, of which 81 patients were successfully followed up. In total, 22.2% of patients experienced recurrent wheezing episodes. The proportion of patients with history of eczema, systemic glucocorticoid use and patients with moderate-to-severe disease were significantly higher in the recurrent wheezing group than the non-recurrent wheezing group (83.3% vs 52.4%; 66.7% vs 36.5%; 61.1% vs 33.3%, respectively, all P < 0.05); There were no significant differences between patients with and without recurrent wheezing episodes in the levels of TSLP, IL2, IL13, TIMP-1, MMP-9, IL33, IL5, IL4, IL25, TNF- α and MIP-1α (P > 0.05). Logistic regression analysis showed that history of eczema was an independent risk factor for post-bronchiolitis recurrent wheezing (odds ratio [OR] = 5.622; 95% confidence interval [CI], 1.3–24.9; P = 0.023). Conclusion The incidence of recurrent wheezing among infants after contracting bronchiolitis was 22.2% during a 2-year follow-up. History of eczema was the only independent risk factor identified and no correlation was found between the specific virus and disease severity in children with post-bronchiolitis recurrent wheezing.

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