scholarly journals Predictors of spontaneous resolution of umbilical hernia in children

2021 ◽  
Vol 4 (3) ◽  
pp. e000287
Author(s):  
Manvinder Kaur ◽  
Viviane Grandpierre ◽  
Irina Oltean ◽  
Arielle Weir ◽  
Ahmed Nasr
Keyword(s):  
Odds Ratio ◽  
Umbilical Hernia ◽  
Chart Review ◽  
Surgical Repair ◽  
Retrospective Chart Review ◽  
Binary Logistic Regression ◽  
Defect Size ◽  
Spontaneous Resolution ◽  
Premature Babies ◽  
Unit Increase

ObjectiveThe aims were to describe the management of umbilical hernias, to define postoperative complications, and to identify the characteristics of patients that were more likely to have spontaneous resolution of their hernia.MethodsAll patients referred for umbilical hernia at the Children’s Hospital of Eastern Ontario from January 1990 to April 2017 were examined via retrospective chart review. Spontaneous resolution of umbilical hernia was examined using binary logistic regression.ResultsWe included 2621 patients presenting with an umbilical hernia. A total of 1587 (60.5%) patients underwent surgical repair at a median age of 3.6 years (IQR 2.3–5.4). Surgical complications consisted of infection (n=3), bleeding (n=3), hematoma (n=3), and anesthesia-related complications (n=3). For every one-unit increase in defect size, the odds of a spontaneous resolution of the hernia were 5% lower while controlling for prematurity and the presence of comorbidities [adjusted odds ratio (aOR)=0.95; 95% confidence intervel (CI) 0.93 to 0.97]. Premature babies were 80% less likely to experience hernia resolution compared with non-premature babies (aOR=0.20; 95% CI 0.03 to 0.74).ConclusionThe odds of spontaneous resolution were lower for premature babies and were negatively correlated with defect size.

scholarly journals Intravitreal Melphalan for Retinoblastoma: The Impact of Toxicity on Recurrence and Ultimate Globe Salvage

2020 ◽  
Vol 6 (6) ◽  
pp. 388-394
Author(s):  
Jesse L. Berry ◽  
Mary E. Kim ◽  
Maria Pefkianaki ◽  
Mark Reid ◽  
Rachana Shah ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Tumor Formation ◽  
Intravenous Chemotherapy ◽  
Significant Toxicity ◽  
Efficacious Treatment ◽  
Unit Increase ◽  
The Impact ◽  
Vitreous Seeding

<b><i>Introduction:</i></b> Intravitreal melphalan (IVM) has emerged as an efficacious treatment for vitreous seeding in retinoblastoma. Although rarely severe, IVM-related toxicity may be treatment limiting. There is paucity of data on the impact of IVM toxicity on new tumor formation and ultimate globe salvage. <b><i>Objectives:</i></b> To investigate whether the grade of retinal toxicity post-IVM impacts retinal and seeding tumor recurrence, as well as the overall ability to salvage the eye. <b><i>Methods:</i></b> A single-institution retrospective chart review was performed on 47 eyes of 42 patients who received systemic intravenous chemotherapy followed by IVM as salvage treatment for persistent or recurrent vitreous seeding. Chorioretinal toxicity was graded from 0 to 5. <b><i>Results:</i></b> Toxicity grade was inversely associated with the risk of recurrence, where a one-unit increase in toxicity grade correlated with nearly a 54% reduction in the odds of tumor recurrence (OR 0.46 [0.25–0.84], <i>p</i> = 0.01). Similarly, toxicity grade was related to enucleation, where a one-unit increase in toxicity grade was associated with a 31% reduction in the odds of undergoing enucleation (OR 0.69 [0.40–1.18], <i>p</i> = 0.17). <b><i>Conclusions:</i></b> While retinoblastoma therapy aims to limit toxicity, especially visually significant toxicity, eyes with higher grades of post-IVM toxicity are less likely to have retinal and seeding tumor recurrence.

Complication Rates in Early Versus Late Cranioplasty—A Fourteen-Year Single-Center Case Series

2021 ◽  
Author(s):  
Muhibullah S Tora ◽  
James G Malcolm ◽  
Zayan Mahmooth ◽  
Amit Pujari ◽  
Rima S Rindler ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Chart Review ◽  
Preoperative Planning ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Optimal Timing ◽  
Complication Rates ◽  
Neurosurgical Procedure ◽  
Potential Benefits ◽  
The Impact

Abstract BACKGROUND Cranioplasty (CP) following decompressive craniectomy (DC) is a common neurosurgical procedure for cranial cosmesis and protection. There is uncertainty regarding the complication rates and potential benefits related to the timing of CP. OBJECTIVE To investigate the impact of the timing of CP on complication rates for different etiologies of DC. METHODS A retrospective chart review was performed of all CP cases between 2004 and 2018 for traumatic and nontraumatic indications of DC. Demographics, clinical characteristics, and complications were collected. Early and late CP were defined as replacement of the bone flap at ≤90 and &gt;90 d following DC, respectively. RESULTS A total of 278 patients were included, receiving 81 early and 197 late CPs. When analyzing all patients, early CP was associated with a statistically significant higher odds of any complication (odds ratio [OR]: 3.25, P &lt; .001), reoperation (OR: 2.57, P = .019), hydrocephalus (OR: 6.03, P = .003), and symptomatic extra-axial collections (OR: 9.22, P = .003). Subgroup analysis demonstrated statistically significant higher odds of these complications only for the CP trauma subgroup, but not the nontrauma subgroup. The odds of complications postCP demonstrated a statistically significant decrease of 4.4% for each week after DC (Unit Odds Ratio [U-OR]: 0.956, P = .0363). CONCLUSION In our retrospective series, early CP was associated with higher odds of postoperative complications compared to late CP in the trauma subgroup. Greater care should be taken in preoperative planning and increased vigilance postoperatively for complications with this potentially more vulnerable subpopulation. Future prospective controlled trials are needed to elucidate optimal timing for CP.

scholarly journals Fitting Assistive Technology for People with Hearing Loss: The Importance of Remote Microphone Systems′ Electroacoustic Verification

2021 ◽  
Vol 18 (24) ◽  
pp. 13251
Author(s):  
Regina Tangerino de Souza Jacob ◽  
Elaine Cristina Moreto Paccola ◽  
Érika Cristina Bucuvic ◽  
Manoel Henrique Salgado
Keyword(s):  
Hearing Loss ◽  
Assistive Technology ◽  
Odds Ratio ◽  
Chart Review ◽  
Hearing Aid ◽  
Retrospective Chart Review ◽  
Verification And Validation ◽  
Verification Process

The remote microphone system (RMS) must be appropriately working when fitting it in a person with hearing loss. For this verification process, the concept of transparency is adopted. If it is not transparent, the hearing aid (HA) may not capture the user’s voice and his peers appropriately, or the RMS may not have the advantage in gain needed to emphasize the speaker’s voice. This study investigates the influence of the receiver’s gain setting on the transparency of different brands and models of RMS and HAs. It is a retrospective chart review with 277 RMS from three distinct brands (RMA, RMB, and RMC) and HAs. There was an association of the receiver’s gain setting with the variables: brand of the transmitter/receiver (p = 0.005), neck loop’s receiver vs. universal and dedicated receivers (p = 0.022), and between brands of HA and transmitter/receiver (p < 0.001). RMS transmitter (odds ratio [OR = 7.9]) and the type of receiver (neckloop [OR = 3.4]; universal [OR = 0.78]) presented a higher risk of not achieving transparency in default gain, confirming and extolling the need to include electroacoustic verification in the protocol of fitting, verification, and validation of RMS and HA.

scholarly journals Obesity and Heart Failure as Predictors of Failure in Outpatient Skin and Soft Tissue Infections

2017 ◽  
Vol 61 (3) ◽  
Author(s):  
Erin L. Conway ◽  
John A. Sellick ◽  
Kari Kurtzhalts ◽  
Kari A. Mergenhagen
Keyword(s):  
Heart Failure ◽  
Chart Review ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Skin Infections ◽  
Unit Increase ◽  
Classification Of Diseases ◽  
International Statistical Classification

ABSTRACT The purpose of this study was to evaluate risk factors for failure of antibiotic treatment within 30 days for uncomplicated skin infections of outpatients treated in a Veterans Affairs hospital. A retrospective chart review of outpatients between January 2006 and July 2015 with an ICD-9 (International Statistical Classification of Diseases and Related Health Problems) code of cellulitis or abscess was included in the analysis. The primary outcome was success versus failure of the antibiotic, with failure defined as another antibiotic prescribed or hospitalization within 30 days for the original indication. A total of 293 patients were included in the final analysis, 24% of whom failed within 30 days. Obesity/overweight (body mass index [BMI] of >25 kg/m2) was identified in 83% of the overall population, with 16% of that population having a BMI greater than 40 kg/m2. An elevated mean BMI of 34.2 kg/m2 (P = 0.0098) was found in the subset of patients who failed oral antibiotics compared to a BMI of 31.32 kg/m2 in patients who were treated successfully. Additionally, the patients who failed had an increased prevalence of heart failure at 16% (P = 0.027). Using multivariate logistic regression, BMI and heart failure were determined to be significant predictors of antibiotic prescription failure. Each 10-kg/m2 unit increase in BMI was associated with a 1.62-fold-greater odds of failure. A diagnosis of heart failure increased the odds of failure by 2.6-fold (range, 1.1- to 5.8-fold). Outpatients with uncomplicated skin infections with an elevated BMI and heart failure were found to have increased odds of failure, defined as hospitalization or additional antibiotics within 30 days.

scholarly journals Factors Associated With Pre- and Postoperative Seizures in 1033 Patients Undergoing Supratentorial Meningioma Resection

Neurosurgery ◽  
2017 ◽  
Vol 81 (2) ◽  
pp. 297-306 ◽  
Author(s):  
William C. Chen ◽  
Stephen T. Magill ◽  
Dario J. Englot ◽  
Joe D. Baal ◽  
Sagar Wagle ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tumor Location ◽  
Seizure Freedom ◽  
Factors Associated ◽  
Anti Epileptic Drug ◽  
Unit Increase ◽  
Long Term Follow Up

Abstract BACKGROUND: Risk factors for pre- and postoperative seizures in supratentorial meningiomas are understudied compared to other brain tumors. OBJECTIVE: To report seizure frequency and identify factors associated with pre- and postoperative seizures in a large single-center population study of patients undergoing resection of supratentorial meningioma. METHODS: Retrospective chart review of 1033 subjects undergoing resection of supratentorial meningioma at the author's institution (1991-2014). Multivariate regression was used to identify variables significantly associated with pre- and postoperative seizures. RESULTS: Preoperative seizures occurred in 234 (22.7%) subjects. At 5 years postoperative, probability of seizure freedom was 89.9% among subjects without preoperative seizures and 62.2% with preoperative seizures. Multivariate analysis identified the following predictors of preoperative seizures: presence of  ≥1 cm peritumoral edema (odds ratio [OR]: 4.45, 2.55-8.50), nonskull base tumor location (OR: 2.13, 1.26-3.67), greater age (OR per unit increase: 1.03, 1.01-1.05), while presenting symptom of headache (OR: 0.50, 0.29-0.84) or cranial nerve deficit (OR: 0.36, 0.17-0.71) decreased odds of preoperative seizures. Postoperative seizures after discharge were associated with preoperative seizures (OR: 5.70, 2.57-13.13), in-hospital seizure (OR: 4.31, 1.28-13.67), and among patients without preoperative seizure, occurrence of medical or surgical complications (OR 3.39, 1.09-9.48). Perioperative anti-epileptic drug use was not associated with decreased incidence of postoperative seizures. CONCLUSIONS: Nonskull base supratentorial meningiomas with surrounding edema have the highest risk for preoperative seizure. Long-term follow-up showing persistent seizures in meningioma patients with preoperative seizures raises the possibility that these patients may benefit from electrocorticographic mapping of adjacent cortex and resection of noneloquent, epileptically active cortex.

scholarly journals Necessity of trauma referrals to the emergency department

2020 ◽  
Vol 29 (3) ◽  
pp. 163-166
Author(s):  
Chengjie Lee ◽  
Paul Yugendra ◽  
Choon Peng Jeremy Wee ◽  
Jen Heng Pek
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Odds Ratio ◽  
Chart Review ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Smoke Inhalation ◽  
Traumatic Injuries ◽  
The Mean ◽  
Care Costs

Background: Patients with traumatic injuries presenting to the emergency department (ED) may be referred to another hospital for further management. Unnecessary referrals can inflate health-care costs and workload, as well as reduce provider and patient satisfaction. Objectives: In this study, we determined the proportion of unnecessary trauma referrals and described the characteristics of this patient population. Methods: A retrospective chart review was carried out between 1 January and 31 December 2016. Data regarding demographics, diagnosis and clinical course at the ED were collected in standardised forms. A referral was defined as unnecessary if the patient was discharged from the ED without a therapeutic procedure performed. Results: There were 121 trauma referrals. The mean age was 39.0±18.3 years old, and 94 (77.7%) patients were male. Seventy-eight (64.5%) of the referrals were from EDs in the same health-care cluster. Overall, 15 (12.3%) referrals were unnecessary, and of these, nine patients had sustained burns or were suffering from smoke inhalation. The length of stay of these unnecessary referrals was 197.0±96.2 minutes. Referring ED outside the health-care cluster was significantly associated with unnecessary referrals (odds ratio=4.42, 95% confidence interval 1.40–13.97, p=0.007). Conclusion: More than 1 in 10 trauma referrals were unnecessary. Further collaborative prospective studies with other EDs are needed to elucidate the underlying reasons for such unnecessary referrals so that targeted solutions can be implemented to reduce them in the future.

Is there a relationship between gestational diabetes and postpartum depression?

2020 ◽  
Vol 16 ◽  
Author(s):  
Salman Khazaei ◽  
Erfan Ayubi ◽  
Saeid Bashirian ◽  
Ronak Hamzehei ◽  
Ensiyeh Jenabi
Keyword(s):  
Gestational Diabetes ◽  
Postpartum Depression ◽  
Odds Ratio ◽  
Depression Scale ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
University Education ◽  
P Value ◽  
Cross Sectional ◽  
The Relationship

Background: The relationship between gestational diabetes and postpartum depression (PPD) is poorly understood and seldom studied. Objective: In an effort to explore this issue, the present study investigated the relationship between gestational diabetes and PPD. Methods: The present cross-sectional study was performed with 342 women who were referred to four urban health centers of Hamadan city, west of Iran. We used convenience sampling as a method to recruit women in each health center. We used a researcher-made checklist for gathering data on socio-demographic characteristics and potential risk factors of PPD. The Persian validated version of the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Univariate and multivariable binary logistic regression was applied to estimate the odds ratio (OR) (95% confidence interval [CI]). Results: Gestational diabetes was identified as the most important risk factor for PPD with OR (95% CI) of 2.19 (1.11, 4.31); P-value=0.02 after adjusting for other variables. Moreover, the adjusted odds ratio showed that PPD among lesseducated women (primary school) was 3.5 times higher compared to women with a university education (OR=3.54, 95% CI: 1.27, 9.84; P-value=0.01). Conclusion: Our findings suggested that PPD is more likely among women with gestational diabetes and those who were less educated. Interventional and educational activities for reducing the risk of PPD can be targeted for use with this population.

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