scholarly journals Establishing a sentinel surveillance system for the novel COVID-19 in a resource-limited country: methods, system attributes and early findings

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055169
Author(s):  
Pritimoy Das ◽  
Zubair Akhtar ◽  
Syeda Mah-E-Muneer ◽  
Md Ariful Islam ◽  
Mohammed Ziaur Rahman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Outcome Measures ◽  
Smoking History ◽  
Categorical Variables ◽  
Common Symptom ◽  
The Novel ◽  
Resource Limited ◽  
Patients With Diabetes ◽  
Admission Status ◽  
Potential Risk Factors

ObjectivesTo establish a hospital-based platform to explore the epidemiological and clinical characteristics of patients screened for COVID-19.DesignHospital-based surveillance.SettingThis study was conducted in four selected hospitals in Bangladesh during 10 June–31 August 2020.ParticipantsIn total, 2345 patients of all age (68% male) attending the outpatient and inpatient departments of surveillance hospitals with any one or more of the following symptoms within last 7 days: fever, cough, sore throat and respiratory distress.Outcome measuresThe outcome measures were COVID-19 positivity and mortality rate among enrolled patients. Pearson’s χ2 test was used to compare the categorical variables (sign/symptoms, comorbidities, admission status and COVID-19 test results). Regression analysis was performed to determine the association between potential risk factors and death.ResultsCOVID-19 was detected among 922 (39%) enrolled patients. It was more common in outpatients with a peak positivity in second week of July (112, 54%). The median age of the confirmed COVID-19 cases was 38 years (IQR: 30–50), 654 (71%) were male and 83 (9%) were healthcare workers. Cough (615, 67%) was the most common symptom, followed by fever (493, 53%). Patients with diabetes were more likely to get COVID-19 than patients without diabetes (48% vs 38%; OR: 1.5; 95% CI: 1.2 to 1.9). The death rate among COVID-19 positive was 2.3%, n=21. Death was associated with age ≥60 years (adjusted OR (AOR): 13.9; 95% CI: 5.5 to 34), shortness of breath (AOR: 9.7; 95% CI: 3.0 to 30), comorbidity (AOR: 4.8; 95% CI: 1.1 to 21.7), smoking history (AOR: 2.2, 95% CI: 0.7 to 7.1), attending the hospital in <2 days of symptom onset due to critical illness (AOR: 4.7; 95% CI: 1.2 to 17.8) and hospital admission (AOR: 3.4; 95% CI: 1.2 to 9.8).ConclusionsCOVID-19 positivity was observed in more than one-third of patients with suspected COVID-19 attending selected hospitals. While managing such patients, the risk factors identified for higher death rates should be considered.

scholarly journals The Characteristics, Dynamics, and the Risk of Death in COVID-19 Positive Dialysis Patients in London, UK

Kidney360 ◽  
2020 ◽  
Vol 1 (11) ◽  
pp. 1226-1243
Author(s):  
Dalvir Kular ◽  
Irina Chis Ster ◽  
Alexander Sarnowski ◽  
Eirini Lioudaki ◽  
Dandisonba C.B. Braide-Azikiwe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Age Groups ◽  
Case Fatality ◽  
Smoking History ◽  
Case Fatality Ratio ◽  
Risk Of Death ◽  
Dialysis Vintage ◽  
Patients With Diabetes ◽  
Potential Risk Factors

BackgroundPatients on dialysis with frequent comorbidities, advanced age, and frailty, who visit treatment facilities frequently, are perhaps more prone to SARS-CoV-2 infection and related death—the risk factors and dynamics of which are unknown. The aim of this study was to investigate the hospital outcomes in patients on dialysis infected with SARS-CoV-2.MethodsData on 224 patients on hemodialysis between February 29, 2020 and May 15, 2020 with confirmed SARS-CoV-2 were analyzed for outcomes and potential risk factors for death, using a competing risk-regression model assessed by subdistribution hazards ratio (SHR).ResultsCrude data analyses suggest an overall case-fatality ratio of 23% (95% CI, 17% to 28%) overall, but that varies across age groups from 11% (95% CI, 0.9% to 9.2%) in patients ≤50 years old and 32% (95% CI, 17% to 48%) in patients >80 years; with 60% of deaths occurring in the first 15 days and 80% within 21 days, indicating a rapid deterioration toward death after admission. Almost 90% of surviving patients were discharged within 28 days. Death was more likely than hospital discharge in patients who were more frail (WHO performance status, 3–4; SHR, 2.16 [95% CI, 1.25 to 3.74]; P=0.006), had ischemic heart disease (SHR, 2.28 [95% CI, 1.32 to 3.94]; P=0.003), cerebrovascular disease (SHR, 2.11 [95% CI, 1.20 to 3.72]; P=0.01), smoking history (SHR, 2.69 [95% CI, 1.33 to 5.45]; P=0.006), patients who were hospitalized (SHR, 10.26 [95% CI, 3.10 to 33.94]; P<0.001), and patients with high CRP (SHR, 1.35 [95% CI, 1.10 to 1.67]) and a high neutrophil:lymphocyte ratio (SHR, 1.03 [95% CI, 1.01 to 1.04], P<0.001). Our data did not support differences in the risk of death associated with sex, ethnicity, dialysis vintage, or other comorbidities. However, comparison with the entire dialysis population attending these hospitals, in which 13% were affected, revealed that patients who were non-White (62% versus 52% in all patients, P=0.001) and those with diabetes (54% versus 22%, P<0.001) were disproportionately affected.ConclusionsThis report discusses the outcomes of a large cohort of patients on dialysis. We found SARS-CoV-2 infection affected more patients with diabetes and those who were non-White, with a high case-fatality ratio, which increased significantly with age, frailty, smoking, increasing CRP, and neutrophil:lymphocyte ratio at presentation.

Risk factors for sporadic pancreatic neuroendocrine tumors (PNETs): Updated results from a single-center case control study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14594-e14594
Author(s):  
Thorvardur Ragnar Halfdanarson ◽  
William R Bamlet ◽  
Robert R. McWilliams ◽  
Timothy J. Hobday ◽  
Patrick A. Burch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Use ◽  
Smoking History ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Region Of Residence ◽  
Potential Risk Factors ◽  
Chi Square Test ◽  
History Of

e14594 Background: PNETs are uncommon malignancies and little is known about risk their factors and association with other cancers. Our aim was to evaluate smoking, alcohol use, personal history of diabetes and a family history of PNET and other cancers as potential risk factors. Methods: PNET cases seen at Mayo Clinic Rochester from 2000 to 2011 were evaluated. Insulinoma and high-grade PNETs were excluded. Primary care patients served as controls and were matched (2:1 ratio) to cases on age, sex and region of residence. Cases and controls completed questionnaires at the time of evaluation. Categorical variables were compared with the chi-square test; continuous variables were compared using a two-sample t test. Results: 355 cases were evaluated, mean age was 56.6 years, 52% were males and 96% were White. Personal smoking history was not associated with PNETs (cases 51%, controls 47%, p=0.24). Ever-alcohol use was less common among cases (54% vs. 67%, p=0.001). 19% of cases reported a history of diabetes compared with 11% of controls (p<0.001). Cases were more likely than controls to report a family member with sarcoma (p=0.02), PNET (p=0.024), gall bladder cancer (p=0.024), ovarian cancer (p=0.04) and stomach cancer (p=0.01). Conclusions: Cases with PNETs were more likely than controls to report a history of diabetes and less likely to report alcohol use. There was no association with smoking. Several types of cancer were more commonly reported in family members of cases than controls.

scholarly journals Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004–2019

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044349
Author(s):  
Ning-ning Tao ◽  
Yi-fan Li ◽  
Wan-mei Song ◽  
Jin-yue Liu ◽  
Qian-yun Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Resistance ◽  
Retrospective Study ◽  
Pulmonary Tuberculosis ◽  
Logistic Models ◽  
Smoking History ◽  
Categorical Variables ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

ObjectiveThis study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB).DesignA retrospective study was conducted among all the 36 monitoring sites in Shandong, China, over a 16-year period. Baseline characteristics were collected from the TB Surveillance System. Categorical variables were compared by Fisher’s exact or Pearson’s χ2 test. The risk factors for drug resistance were identified using univariable analysis and multivariable logistic models. The influence of comorbidity on different types of drug resistance was evaluated by performing multivariable logistic models with the covariates adjusted by age, sex, body mass index, drinking/smoking history and cavity.ResultsA total of 10 975 patients with PTB were recorded during 2004–2019, and of these 1924 retreated PTB were finally included. Among retreated PTB, 26.2% were DR-TB and 12.5% had comorbidity. Smoking (adjusted OR (aOR): 1.69, 95% CI 1.19 to 2.39), cavity (aOR: 1.55, 95% CI 1.22 to 1.97) and comorbidity (aOR: 1.44, 95% CI 1.02 to 2.02) were risk factors for DR-TB. Of 504 DR-TB, 9.5% had diabetes mellitus, followed by hypertension (2.0%) and chronic obstructive pulmonary disease (1.8%). Patients with retreated PTB with comorbidity were more likely to be older, have more bad habits (smoking, alcohol abuse) and have clinical symptoms (expectoration, haemoptysis, weight loss). Comorbidity was significantly associated with DR-TB (aOR: 1.44, 95% CI 1.02 to 2.02), overall rifampin resistance (aOR: 2.17, 95% CI 1.41 to 3.36), overall streptomycin resistance (aOR: 1.51, 95% CI 1.00 to 2.27) and multidrug resistance (aOR: 1.96, 95% CI 1.17 to 3.27) compared with pan-susceptible patients (p<0.05).ConclusionSmoking, cavity and comorbidity lead to an increased risk of drug resistance among retreated PTB. Strategies to improve the host’s health, including smoking cessation, screening and treatment of comorbidity, might contribute to the control of tuberculosis, especially DR-TB, in China.

Auricular Complications in Parotid, Temporal Bone, Infratemporal Fossa, and Lateral Skull Base Surgery

2017 ◽  
Vol 96 (2) ◽  
pp. E27-E31
Author(s):  
Patrick S. Carpenter ◽  
Ryan C. Burgette ◽  
John P. Leonetti ◽  
Sam J. Marzo
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Temporal Bone ◽  
Blood Supply ◽  
Potential Risk ◽  
Infratemporal Fossa ◽  
Smoking History ◽  
Reconstructive Procedures ◽  
Lateral Skull Base ◽  
Potential Risk Factors

Neoplasms located in the parotid region, temporal bone, infra-temporal fossa, and lateral skull base represent a challenge due to their difficult anatomic location and surrounding neurovascular structures. A variety of surgical approaches are appropriate to access this area, although several of them can place the auricular blood supply in danger. If the auricular blood supply is compromised, ischemia and, eventually, avascular necrosis of the auricle can occur. Auricular necrosis often can cause patients a delay in adjuvant radiation therapy and result in the need for additional reconstructive procedures. There-fore, it is imperative to identify risk factors associated with the development of this disabling complication. We conducted a retrospective review of 32 individuals undergoing treatment of benign and malignant lesions in the parotid gland, infratemporal fossa, and lateral skull base. To identify potential risk factors for auricular necrosis, the patients were analyzed based on the type of neoplasm (malignant or benign), risk factors affecting blood flow (diabetes mellitus, smoking history, prior radiation, prior surgery), body mass index, and the length of surgery. In our population examined, 3 instances of auricular necrosis occurred. None of the potential risk factors proved to be statistically significant (although malignant pathology approached significance at p = 0.07). Two of the patients required an auriculectomy with reconstruction. The third had multiple postoperative clinic visits for surgical debridement. Although no potential risk factors were statistically significant, surgeons should remain cognizant of the auricular blood supply while performing surgery via preauricular and postauricular approaches to this area.

scholarly journals Delusions in Patients with Dementia with Lewy Bodies and the Associated Factors

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ray-Chang Tzeng ◽  
Ching-Fang Tsai ◽  
Ching-Tsu Wang ◽  
Tzu-Yuan Wang ◽  
Pai-Yi Chiu
Keyword(s):  
Risk Factors ◽  
Cognitive Performance ◽  
Caregiver Burden ◽  
Associated Factors ◽  
Dementia With Lewy Bodies ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Common Symptom ◽  
Vascular Risk ◽  
Patients With Diabetes

Objective. Delusions are common neuropsychiatric symptoms in patients with dementia with Lewy bodies (DLB). The aim of this study was to investigate the associated factors of delusions in patients with DLB. Method. A retrospective study of outpatients with DLB registered in a regional hospital’s database was performed. The associated factors including cognitive performance, clinical features, vascular risk factors, and neuropsychiatric symptoms between delusional and nondelusional patients with DLB were compared. Results. Among 207 patients with DLB, 106 (51.2%) were delusional and 101 (48.8%) were not. Delusion of other persons are stealing was the most common symptom (35.3%). The delusional group had a significantly higher diagnostic rate of probable than possible DLB, higher disease severity, poorer cognitive performance, more severe neuropsychiatric symptoms, and higher caregiver burden (all p<0.05). In addition, the delusional group had a significantly lower frequency of diabetes compared to the nondelusional group (odds ratio=0.28, p<0.001). Conclusion. Delusion of other persons are stealing was the most common delusional symptom. The patients with DLB who presented with delusions had poorer cognitive function and more severe neuropsychiatric symptoms. A novel finding is that the DLB patients with diabetes had a lower frequency of delusions.

scholarly journals Psychosexual morbidity in women with ovarian cancer

2020 ◽  
Vol 30 (12) ◽  
pp. 1983-1989
Author(s):  
Chloe Alice Logue ◽  
Julia Pugh ◽  
Gordon Jayson
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Body Image ◽  
Epithelial Ovarian Cancer ◽  
Outcome Measures ◽  
Potential Risk ◽  
Primary Outcome ◽  
Sexual Problems ◽  
Vaginal Dryness ◽  
Potential Risk Factors

Increasing numbers of women are surviving for longer with epithelial ovarian cancer. Consequently, there is increased focus on long-term quality of life in national guidance. Psychosexual morbidity including vaginal dryness, pain during intercourse (dyspareunia), reduced libido, and negative perceived body image exacerbate stress and anxiety and impact intimate relationships. Although a priority for women with epithelial ovarian cancer, clinicians seldom discuss sexual problems. Therefore, psychosexual morbidity and the associated distress remain unaddressed. We synthesize evidence from primary qualitative and quantitative research studies exploring psychosexual morbidity in women with epithelial ovarian cancer to identify potential risk factors and common symptoms, to facilitate the identification and management of sexual problems in clinic. Literature (2008–19) from 10 databases identified 29 suitable publications (4116 patients). The papers were assessed to answer the question: “What are the key potential risk factors and presentations of psychosexual morbidity in women with epithelial ovarian cancer?” Current literature lacks consensus in defining clinically significant psychosexual morbidity in women with epithelial ovarian cancer. Discrepancies in measurement tools, questionnaires, and primary outcome measures confound result interpretation, limiting wider application. Key potential risk factors identified included: younger age (<53 years); pre-menopausal status at diagnosis; aim of treatment; extent of surgery; more courses of chemotherapy; cardiovascular co-morbidities; and anxiety and depression. Up to 75% of women with epithelial ovarian cancer reported adverse changes in their sex lives following diagnosis and, of the sexually active, vaginal dryness affected 81–87% and pain 77%. Other prevalent symptoms included: reduced sexual desire and activity, impaired orgasm, diminished perceived body image, and reduced partner intimacy. Psychosexual morbidity represents a significant unmet need for women with epithelial ovarian cancer. Effective treatment necessitates a multimodal approach encompassing medical, psychoeducational, and physiotherapy-based strategies. Future studies need agreement in their questionnaires, definitions, thresholds, and primary outcome measures for meaningful interstudy comparisons to be drawn.

scholarly journals Rates of Nonunion for Different Joints after Foot And Ankle Surgery: A Review of 2301 Fusions

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0045
Author(s):  
Alastair S.E. Younger ◽  
Andrea Veljkovic ◽  
Kevin Wing ◽  
Murray J. Penner ◽  
Hong Qian ◽  
...  
Keyword(s):  
Risk Factors ◽  
P Value ◽  
Foot And Ankle ◽  
Repeat Surgery ◽  
Logistic Regression Models ◽  
Primary Surgery ◽  
Union Status ◽  
Patients With Diabetes ◽  
Potential Risk Factors ◽  
The Impact

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Nonunion after fusion results in ongoing pain and a request for repeat surgery in many patients. Nonunion is therefore a failure of the primary surgery. Patients undergoing fusion surgery need to understand the risk for nonunion and the risk for repeat surgery. This is a review of fusions performed at a single institution by 4 foot and ankle surgeons to outline the nonunion rate after foot and ankle fusion for different joints. Methods: Data on fusions performed between January 1, 2010 to July 31, 2006 were retrospectively extracted from database. The records were reviewed to determine the union status of each fusion. Demographic and clinic risk factors of nonunion were recorded. The nonunion rate for each joint (ankle, subtalar, talonavicular, calcaneocuboid, navicular cuneiform, tarsometatarsal and metatssophalengeal joints) was estimated. Due to multiple surgeries performed on individual patient and fusions in the same surgery, random effects logistic regression models were conducted to assess the impact of risk factor on nonunion. The study include 2301 fusions preformed on 1320 patients. The minimum follow up was two years. The majority of patients were female (70%), with mean age of 57 years old and mean body mass index (BMI) of 28. There were 9% of patients with diabetes, 11% being smokers, 18% having lung disease, 8% with renal disease, and 29% with high blood pressure. Results: The risk of nonunion by joint is outlined in figure 1. The ankle showed the highest nonunion rate at 8%, and the calcaneocuboid joint had the lowest rate at 2%. Comparing to ankle, the nonunion rate was significantly lower at Talocalcaneal (Subtalar) joint (Odd ratio [OR]=0.05, p-value= 0.02) and Tarsometatarsal (OR=0.03, p-value=0.01). Across all joints the nonunion rate was higher in males, smokers, having a higher BMI and diabetes Age had a minimal effect. Conclusion: Union rate varied among fusion sites. Patient’s demographic and clinic characteristics might be potential risk factors for nonunion. This paper assists surgeons in determining the risk factors for nonunion after foot and ankle fusions. The ankle joint is at highest risk for nonunion, and the tarsometatarsal joint and the subtalar joints the lowest risk.

scholarly journals Incidence and Trends of Leishmaniasis and Its Risk Factors in Humera, Western Tigray

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Dawit Gebremichael Tedla ◽  
Fsahatsion Hailemariam Bariagabr ◽  
Hagos Hadgu Abreha
Keyword(s):  
Risk Factors ◽  
Visceral Leishmaniasis ◽  
Potential Risk ◽  
Mortality Rates ◽  
Health Concern ◽  
Categorical Variables ◽  
Infection Rates ◽  
Labor Migrants ◽  
Potential Risk Factors ◽  
The Impact

Introduction. Leishmaniasis is a neglected vector borne disease, which constitutes a major public health concern in several tropical and subtropical countries. An estimated 4500 to 4000 new cases of visceral leishmaniasis (VL) occur per year and over 3.2 million people are at risk of infection in the country. In Humera, VL epidemics are associated with migration of workers from nonendemic highlands into the visceral leishmaniasis endemic extensive farmlands. Therefore, the objective of this study is to estimate the incidence and the risk factors of leishmaniasis in Humera, Western Tigray. Methods. A retrospective study was conducted using the hospital admission database on all patients admitted who have been suspected of having leishmaniasis infection and tested for rK39-based immune chromatographic test (ICT) at Kahsay Abera Hospital in Humera town from January 2012 to December 2017. Potential risk factors for leishmaniasis infection in human were collected from the hospital, which included categorical variables: age, sex, origin of place, clinical forms of leishmaniasis, mortality rates, and the occurrence of infections according to format of hospital. Results. A total of 26511 hospital discharged patients with diagnosis of leishmaniasis were identified, out of which 2232 (8.42%) human leishmaniasis cases were registered and of them 71 were dead from January 2012 to December 2017. Mortality rates of leishmaniasis were 18 (3.3%) in 2012, 16 (3.1%) in 2013, 15 (2.4%) in 2014, 8 (3.3%) in 2015, 9 (4.1%) in 2016, and 5 (5.4%) in 2017. Univariate analysis of the infection rate of leishmaniasis was based on the potential risk factors and found higher male infection rates than female (P <0.05) in all the study years. Origin of place was also significantly associated (P< 0.05) where labor migrants from highland to agricultural fields had higher infection rates than those who permanently lived in and around Humera. Trends in season of occurrence revealed that weeding and harvesting time (July–December) had higher incidence of leishmaniasis than dry time (January–June). Conclusion. Male labor migrants from the highlands older than 15 years of age were at the highest risks of leishmaniasis during weeding and harvest season. Therefore, awareness creation on the risks of sleeping outdoors and the impact of using of bed nets is imperative especially for labor migrants during weeding and harvesting season.

scholarly journals Pediatric Anti-Phospholipid Syndrome: Thromboses Outcomes, Mayo Clinic Children's Center Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4258-4258 ◽  
Author(s):  
Kendra Elwood ◽  
Amulya Nageswara ◽  
Deepti M. Warad ◽  
Shakila Khan ◽  
Vilmarie Rodriguez
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Potential Risk ◽  
Arterial Thrombosis ◽  
Statistical Tests ◽  
Thrombotic Event ◽  
Primary Site ◽  
Categorical Variables ◽  
Potential Risk Factors ◽  
Anti Phospholipid Syndrome

Abstract Background: Pediatric Anti-Phospholipid Syndrome (APS) is the most commonly acquired state of hypercoagulability in children, and is defined by venous and/or arterial thrombosis in the presence of circulating anti-phospholipid antibodies (aPLs) (most commonly lupus anticoagulant (LA), anticardiolipin antibody (aCL) and anti-β2-glycoprotein antibody (aβ2GP)). Catastrophic APS (CAPS) is a rare manifestation of APS, with thrombosis of multiple vessels that can lead to multi-system organ failure. Purpose: To determine the thromboses outcomes and factors predisposing to the risk of thrombotic recurrence in pediatric patients with a diagnosis of APS. Methods: Retrospective review of patients between the ages of 0-21 years diagnosed and treated with APS from 1997-2013 at our institution. Clinical data and long-term outcomes of these patients were reviewed. Exclusion criteria included neonatal APS and thrombosis with fetal loss. Statistical tests were performed using JMP software (© 2014 SAS Institute Inc., North Carolina, US). Associations between categorical variables were tested using chi-square test or Fisher’s exact test when required. Differences were considered statistically significant if p<0.05. Results: The study identified 23 patients (12 female; 11 male). Three patients with CAPS were identified and excluded from the analysis (3 female). Gender distribution for primary and secondary APS was similar (5 female/6 male primary APS; 4 female/5 male secondary APS). The median follow up period was 3.2 years (range; 0.01 – 16.87 years ). Median age at diagnosis of first episode of thrombosis was 16.16 years (range; 6.05 – 20.6 years). Nine patients (45%) with secondary APS had underlying autoimmune disease or malignancy (7 systemic lupus erythematosus, 1 ulcerative colitis, 1 Non-Hodgkin Lymphoma) and the remaining 11 patients were diagnosed as primary APS. Arterial and venous thrombosis occurred as the first thrombotic event in 7 (35%) and 13 (65%) patients, respectively. Lower extremity deep vein thrombosis (DVT) was the most frequent thrombotic event 11/20 (55%), followed by pulmonary embolism 7/20 (35%), ischemic stroke 4/20 (20%), lower extremity arterial thrombosis 3/20 (15%), upper extremity DVT 2/20 (10%), and IVC thrombosis 2/20 (10%). Recurrent or progressive thrombotic events occurred in 12/20 patients (60%). Of those, 7 were venous (58%), 5 were arterial (42%). At the time of recurrence, 3 patients were fully anticoagulated, (INR 2.5-3.5) versus 9 who were subtherapeutic (INR<2.0). Recurrent/progression thrombotic events occurred at the original site of thrombosis in 8 patients (3 arterial, 5 venous) while the remaining 4 recurrent thrombotic events occurred at other sites than the primary site. Overall venous and arterial thrombotic events were no different among primary or secondary APS (p=0.88). Thrombosis recurrence/progression risk at the original site or distant site was no different among primary or secondary APS (p=0.22 and p=0.30 respectively). Risk of recurrence/progression was not associated with subtherapeutic levels of anticoagulation (p=0.08), or presence of residual thrombosis at primary site at the time of recurrence (p=0.48). Conclusion: Recurrence and/or progression of thrombosis in APS occurred in 60% of the patients in our cohort, with 25% of the thrombosis recurrences occurring despite documented therapeutic anticoagulation in these patients. In contrast to other studies, our APS cohort demonstrated a higher rate of recurrence with other groups reporting thrombosis rates of recurrence such as 19-25%. Our cohort demonstrated similar rates of primary and secondary APS among female patients, in contrast to other studies suggesting higher rates of secondary APS in females. Potential risk factors such as primary versus secondary APS, subtherapeutic anticoagulation, and residual thrombosis from primary thrombotic event were not found as significant risk factors for thrombosis recurrence. Larger pediatric APS studies are needed in order to address other potential risk factors for thrombosis (ie obesity, inherited thrombophilia, intensity of anticoagulation, immune suppression approach for secondary APS), in order to establish treatment strategies for the prevention of recurrent thrombosis. Disclosures No relevant conflicts of interest to declare.

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