scholarly journals Epidemiological Trends in Asthma

1996 ◽  
Vol 3 (4) ◽  
pp. 261-268 ◽  
Author(s):  
Malcolm R Sears
Keyword(s):  
Risk Factors ◽  
Hospital Admissions ◽  
Significant Risk ◽  
Morbidity And Mortality ◽  
Beta Agonist ◽  
Physician Education ◽  
Physician Visits ◽  
Asthma Morbidity ◽  
Beta Agonists ◽  
Epidemiological Trends

Many markers of asthma morbidity have shown substantial increases over the past two decades, including family physician visits, use of anti-asthma medications, emergency room visits and hospital admissions. The reported prevalence of diagnosed asthma and of wheezing has increased, especially in children, with accompanying evidence of increased atopy and increased airway responsiveness. Allergen exposure and parental smoking are significant risk factors for childhood wheezing, whereas the influence of outdoor air pollution is uncertain. Increasing use of beta-agonist treatment, which appears to increase the severity of asthma by increasing early and late responses to allergen, may contribute to increased morbidity and mortality, especially if potent beta-agonists are used. Risk factors for asthma mortality include age, smoking, allergy and airway lability, as well as over-reliance on beta-agonists and poor compliance with other aspects of treatment. Following withdrawal of the potent beta-agonist fenoterol in New Zealand, both hospital admissions and mortality from asthma fell abruptly. Continued patient and physician education, with emphasis on avoidance of risk factors and use of appropriate treatment, should reduce morbidity and mortality from asthma in Canada.

scholarly journals Cancer-Associated Thrombosis: An Overview

2014 ◽  
Vol 8 ◽  
pp. CMO.S18991 ◽  
Author(s):  
Ghaleb Elyamany ◽  
Ali Mattar Alzahrani ◽  
Eman Bukhary
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Arterial Occlusion ◽  
Predictive Biomarkers ◽  
Morbidity And Mortality ◽  
Antiangiogenic Agents ◽  
Cancer Associated Thrombosis

Venous thromboembolism (VTE) is a common complication in patients with malignant disease. Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. In addition to VTE, arterial occlusion with stroke and anginal symptoms is relatively common among cancer patients, and is possibly related to genetic predisposition. Several risk factors for developing venous thrombosis usually coexist in cancer patients including surgery, hospital admissions and immobilization, the presence of an indwelling central catheter, chemotherapy, use of erythropoiesis-stimulating agents (ESAs) and new molecular-targeted therapies such as antiangiogenic agents. Effective prophylaxis and treatment of VTE reduced morbidity and mortality, and improved quality of life. Low-molecular-weight heparin (LMWH) is preferred as an effective and safe means for prophylaxis and treatment of VTE. It has largely replaced unfractionated heparin (UFH) and vitamin K antagonists (VKAs). Recently, the development of novel oral anticoagulants (NOACs) that directly inhibit factor Xa or thrombin is a milestone achievement in the prevention and treatment of VTE. This review will focus on the epidemiology and pathophysiology of cancer-associated thrombosis, risk factors, and new predictive biomarkers for VTE as well as discuss novel prevention and management regimens of VTE in cancer according to published guidelines.

scholarly journals Proceedings of a Workshop on Near Fatal Asthma

1995 ◽  
Vol 2 (2) ◽  
pp. 113-126 ◽  
Author(s):  
J Mark FitzGerald ◽  
Peter T Macklem
Keyword(s):  
At Risk ◽  
Management Strategies ◽  
Beta Agonist ◽  
Ambulatory Care Setting ◽  
Asthma Morbidity ◽  
Beta Agonists ◽  
Asthma Patients ◽  
Fatal Asthma ◽  
Patients At Risk ◽  
Near Fatal Asthma

Concern has been expressed about rising asthma morbidity and mortality, although the latter appears to have declined recently. A reasonable surrogate for fatal asthma is an episode of near fatal asthma (NFA). The etiology of episodes of NFA appears to be multifactorial. Features that would characterize asthma patients at risk of NFA have been difficult to define but have included psychosocial barriers. environmental exposures, inadequate or inappropriate physician and/or patient responses to deteriorating asthma and, in particular, overreliance on symptomatic bronchodilator therapy. The association between fatal asthma and NFA with beta-agonist use has been controversial, with it being argued that high use of beta-agonists reflects severity of asthma as opposed to being causal. Studies in the laboratory and ambulatory care setting suggest that regular compared with as-required use of beta-agonists is associated with worsening in asthma control. Although a reduced perception of dyspnea has been identified in some asthma patients, it is not universally present in those with NFA. Retrospective data suggest that hyperinflation of the thorax, as judged by total lung capacity, may be a useful marker for subjects at risk of NFA. Future studies should better characterize these risk factors and develop management strategies (both therapeutic and educational) that might reduce the risk of subjects experiencing episodes of NFA and, by extension, reducing the continued unacceptable mortality associated with asthma.

scholarly journals Risk Factors for Multidrug-Resistant Invasive Pneumococcal Disease in South Africa, a Setting with High HIV Prevalence, in the Prevaccine Era from 2003 to 2008

2012 ◽  
Vol 56 (10) ◽  
pp. 5088-5095 ◽  
Author(s):  
Penny Crowther-Gibson ◽  
Cheryl Cohen ◽  
Keith P. Klugman ◽  
Linda de Gouveia ◽  
Anne von Gottberg
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Multidrug Resistance ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Hospital Admissions ◽  
Significant Risk ◽  
Pneumococcal Vaccination ◽  
Multidrug Resistant ◽  
Content Type

ABSTRACTThe emergence of multidrug-resistant (MDR)Streptococcus pneumoniaecomplicates disease management. We aimed to determine risk factors associated with MDR invasive pneumococcal disease (IPD) in South Africa and evaluate the potential for vaccination to reduce disease burden. IPD data collected by laboratory-based surveillance from 2003 through 2008 were analyzed. Multidrug resistance was defined as nonsusceptibility to any three or more different antibiotic classes. Risk factors for multidrug resistance were evaluated using multivariable logistic regression. Of 20,100 cases of IPD identified, 3,708 (18%) had MDR isolates, with the proportion increasing from 16% (461/2,891) to 20% (648/3,326) (P< 0.001) over the study period. Serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13) accounted for 94% of MDR strains. Significant risk factors for MDR IPD included PCV13 (1,486/6,407; odds ratio [OR] of 6.3; 95% confidence interval [CI] of 5.0 to 7.9) and pediatric (3,382/9,980; OR of 12.8; 95% CI of 10.6 to 15.4) serotypes, age of <5 (802/3,110; OR of 2.0; 95% CI of 1.8 to 2.3) or ≥65 (39/239; OR of 1.5; 95% CI of 1.0 to 2.2) years versus age of 15 to 64 years, HIV infection (975/4,636; OR of 1.5; 95% CI of 1.2 to 1.8), previous antibiotic use (242/803; OR of 1.7; 95% CI of 1.4 to 2.1), previous hospital admissions (579/2,450; OR of 1.2; 95% CI of 1.03 to 1.4), urban location (883/4,375; OR of 2.0; 95% CI of 1.1 to 3.5), and tuberculosis treatment (246/1,021; OR of 1.2; 95% CI of 1.03 to 1.5). MDR IPD prevalence increased over the study period. The effect of many of the MDR risk factors could be reduced by more judicious use of antibiotics. Because PCV13 serotypes account for most MDR infections, pneumococcal vaccination may reduce the prevalence of multidrug resistance.

scholarly journals What Is the Role of Beta-Agonist Bronchodilators in the Day-to-Day Treatment of Chronic Asthma?

1995 ◽  
Vol 2 (suppl a) ◽  
pp. 32A-34A
Author(s):  
Pierre Ernst
Keyword(s):  
Inhaled Corticosteroids ◽  
Day Treatment ◽  
Beta Agonist ◽  
Exact Role ◽  
Onset Of Action ◽  
Asthma Morbidity ◽  
Beta Agonists ◽  
Life Threatening ◽  
Slow Onset

The reported links of asthma morbidity and mortality to the use of in haled beta-agonist bronchodilators are reviewed. Reports from the Saskatchewan Asthma Epidemiology Project (SAEP) suggest that it is excessive use that is linked to life-threatening asthma and that patients at highest risk can be identified by their increasing use of these medications. This is the major justification for prescribing short acting beta-agonists on an as needed basis, though there is both clinical and experimental evidence suggesting regular use of these agents may not be beneficial. New longer acting inhaled beta-agonists designed for regular use are being introduced and their exact role remains to be defined. Provisionally, they appear to be useful in patients whose asthma is not well controlled with optimal doses of inhaled corticosteroids. The use of these newer agents for the relief of acute bronchospasm is contraindicated because of their slow onset of action.

scholarly journals Predicting respiratory hospital admissions in young people with cerebral palsy

2018 ◽  
Vol 103 (12) ◽  
pp. 1119-1124 ◽  
Author(s):  
Amanda Marie Blackmore ◽  
Natasha Bear ◽  
Eve Blair ◽  
Katherine Langdon ◽  
Lisa Moshovis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Young People ◽  
Hospital Admission ◽  
Respiratory Symptoms ◽  
Hospital Admissions ◽  
Oropharyngeal Dysphagia ◽  
Significant Risk ◽  
Respiratory Illness ◽  
International Statistical Classification

ObjectiveTo determine the early predictors of respiratory hospital admissions in young people with cerebral palsy (CP).DesignA 3-year prospective cohort study using linked data.PatientsChildren and young people with CP, aged 1 to 26 years.Main outcome measuresSelf-reported and carer-reported respiratory symptoms were linked to respiratory hospital admissions (as defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes) during the following 3 years.Results482 participants (including 289 males) were recruited. They were aged 1 to 26 years (mean 10 years, 10 months; SD 5 years, 11 months) at the commencement of the study, and represented all Gross Motor Function Classification Scale (GMFCS) levels. During the 3-year period, 55 (11.4%) participants had a total of 186 respiratory hospital admissions, and spent a total of 1475 days in hospital. Statistically significant risk factors for subsequent respiratory hospital admissions over 3 years in univariate analyses were GMFCS level V, at least one respiratory hospital admission in the year preceding the survey, oropharyngeal dysphagia, seizures, frequent respiratory symptoms, gastro-oesophageal reflux disease, at least two courses of antibiotics in the year preceding the survey, mealtime respiratory symptoms and nightly snoring.ConclusionsMost risk factors for respiratory hospital admissions are potentially modifiable. Early identification of oropharyngeal dysphagia and the management of seizures may help prevent serious respiratory illness. One respiratory hospital admission should trigger further evaluation and management to prevent subsequent respiratory illness.

Risk Factors for Asthma Morbidity and Mortality in a Large Metropolitan City

2001 ◽  
Vol 38 (8) ◽  
pp. 625-635 ◽  
Author(s):  
Mario Castro ◽  
Kenneth B. Schechtman ◽  
John Halstead ◽  
Gordon Bloomberg
Keyword(s):  
Risk Factors ◽  
Morbidity And Mortality ◽  
Asthma Morbidity ◽  
Metropolitan City

scholarly journals Clinical profile and outcome of acute kidney injury in neonatal sepsis in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 635
Author(s):  
Divya Durga ◽  
Sudha Rudrappa
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Incidence And Mortality

Background: Septicemia remains a leading cause of morbidity and mortality among neonates with AKI complicating as many as 3.4 to 24% of them. The actual incidence of renal failure in all sepsis cases is not documented. There are several studies in the literature on renal failure in neonates which were based on older definitions using blood urea and urine output as parameters. The major limitation of the older studies was that they did not use the current acute kidney injury network (AKIN) definition. In the present study, we have attempted to investigate AKI in neonatal sepsis using the AKIN definition based on serum creatinine (Table1). We also attempted to determine the predictors of AKI in neonatal sepsis.Methods: The present study was an explorative study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute in which a total of 50 neonates with clinical/ culture positive sepsis were enrolled during the period of June 2014 to June 2015.Results: These neonates were investigated for the presence of AKI based on serum creatinine values of three consecutive days and were divided into two groups. Group 1 consisted of septic neonates with AKI and group 2 consisted of septic neonates without AKI. Both the groups were followed up till discharge or death. The risk factors associated with sepsis were compared in both the groups and predictors of morbidity and mortality associated with AKI in sepsis were also determined.Conclusions: Incidence and mortality associated with AKI in sepsis was found to be 24% and 75% respectively. Factors like PROM, foul smelling liquor, > 3 unclean vaginal examinations during labour were significant risk factors for development of AKI in sepsis. Culture positivity, associated meningitis, DIC, shock and need for assisted ventilation were poor prognostic indicators and were significantly associated with mortality. 

scholarly journals Thromboembolic Complications in Patients with Sickle Cell Disease

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4913-4913
Author(s):  
Salam Alkindi ◽  
Anwaar Al-Ghadani ◽  
Samah Al-zeheimi ◽  
Anil Pathare
Keyword(s):  
Risk Factors ◽  
Sickle Cell Disease ◽  
Venous Thrombosis ◽  
Sickle Cell ◽  
Significant Risk ◽  
Central Venous Catheters ◽  
Morbidity And Mortality ◽  
Thromboembolic Complications ◽  
Cell Disease ◽  
Central Venous

Abstract Background and Purpose: Venous thromboembolism (VTE) is common in patients with sickle cell disease (SCD). Traditional risk factors such as central venous catheters, frequent hospitalization, orthopedic surgeries for avascular necrosis, and pregnancy often leads to an increased incidence of VTE in the SCD. In addition, SCD itself appears to be a hypercoagulable state with many SCD-specific factors such as genotype, splenectomy and thrombophilia modifying the risk of VTE. This study aims to assess the clinical and pathological characteristics of VTE amongst a cohort of patients with SCD at the Sultan Qaboos University Hospital and determine its relation to morbidity and mortality. Methodology: In this retrospective case control study, medical details of all patients with SCD who developed thromboembolic complications over the past decade were retrieved from the hospital information system. SCD patients matched for age and gender (2:1 ratio) who did not have thromboembolic complications but had a thrombophilia screen performed served as controls. The study was approved by the local Medical Research and Ethics Committee. Results & Discussion: A total of 53 SCD patients were enrolled [34 cases, 19 controls] in this study. Amongst the 34 cases (mean age-30 yrs.), 18 had pulmonary embolism, eight had deep venous thrombosis, whereas, three each had cerebral venous thrombosis and portal venous thrombosis and one each had cerebral arterial thrombosis and VTE. A higher incidence of autosplenectomy(69.7% v/s 52.6%) and central venous catheters(42.4% v/s 5.3%) were significantly associated with thrombosis (p<0.05, Chi Square test). High LDH levels, WBC and Platelet counts were significant risk factors(p<0.05) for VTE. 21 patients [63.6%] amongst the cases developed acute chest syndrome, where 3[9%] had cerebrovascular accident. Mortality was seen in seven cases [21%]. Conclusions: The study shows that thromboembolic complications in SCD has a high impact on the morbidity and mortality. It confirms PE as the leading cause for VTE in SCD with asplenia, central venous catheter, high LDH, WBC and Platelet counts being significant risk factors. Disclosures No relevant conflicts of interest to declare.

scholarly journals Study on clinical profile and risk factors associated with pneumonia

2019 ◽  
Vol 6 (5) ◽  
pp. 1926
Author(s):  
Gangina Sriram ◽  
Akula Satyanarayana
Keyword(s):  
Risk Factors ◽  
Economic Status ◽  
Significant Risk ◽  
Severe Pneumonia ◽  
Control Programme ◽  
Morbidity And Mortality ◽  
Prospective Clinical Study ◽  
Age Group ◽  
Factors Affecting ◽  
Medical College

Background: Modernization, industrialization and urbanization are now posed with the problem of increase in ARI morbidity and mortality. The epidemiological information regarding risk factors and management is scanty. A large gap exists in our knowledge about these factors, which needs to be fulfilled by systematic studies. The present study is designed to identify the risk factors of pneumonia in our area.Methods: This was a prospective clinical study of pneumonia conducted on 94 children who were admitted to Paediatric ward in GSL Medical College General Hospital, Rajahmundry in study duration. Epidemiological factors affecting the same were studied and bronchoscopy was done whenever it was needed. A detailed history of the relevant symptoms, such as fever, cough, rapid breathing, refusal of feeds, noisy breathing, bluish discolouration etc., was collected.Results: The most affected children belonged to the age group of 1 year to 3 years (64.9%). Bronchopneumonia (86.2%) was the most common clinical diagnosis made at admission. According to WHO ARI control programme, 28.7% had pneumonia, 54.3% had severe pneumonia and 17% very severe pneumonia. It was found that younger age group, malnutrition, kutcha house, crowding, poor sanitation facilities, cooking with fuel other than LPG (indoor pollution) and low socio economic status and high respiratory rate were significant risk factors for pneumonia in children.Conclusions: ARI, especially pneumonia is one of the major causes of morbidity and mortality in children. Bronchopneumonia is the predominant form of presentation in infants and preschool children.  

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