Risk Factors for Nephrolithiasis in Adults with Short Bowel Syndrome

2019 ◽  
Vol 75 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Jianbo Yang ◽  
Haifeng Sun ◽  
Songlin Wan ◽  
Gulsudum Mamtawla ◽  
Xuejin Gao ◽  
...  

Introduction: Patients with short bowel syndrome (SBS) commonly develop nephrolithiasis. However, the risk factors for nephrolithiasis in patients with SBS remain unclarified. The present study aimed to identify the risk factors for nephrolithiasis in adults with SBS. Methods: All eligible adults diagnosed with SBS and admitted to a tertiary referral center from December 2008 to 2018 were retrospectively identified from a prospectively maintained database. Patients’ demographic and clinical characteristics were analyzed using univariate and multivariate analyses to identify the risk factors for nephrolithiasis. Results: Of 231 adults with SBS, 42 (18.2%) developed nephrolithiasis. The mean age was 46.4 ± 17.8 years, the mean body mass index was 18.2 ± 3.8 kg/m2, and median duration of SBS was 11 months (range 2–324 months). Multivariate binary logistic regression analysis revealed that the independent risk factors for nephrolithiasis in adults with SBS were jejuno-ileal anastomosis and colon-in-continuity (OR 4.335; 95% CI 1.175–16.002; p = 0.028), prolonged duration of SBS (OR 1.008; 95% CI 1.002–1.014; p = 0.010), and increased serum creatinine concentration (OR 1.005; 95% CI 1.001–1.009; p = 0.012). Conclusions: Nephrolithiasis is common in adults with SBS. As nephrolithiasis can have adverse clinical consequences, patients with SBS should be closely monitored, and prophylactic interventions should be considered.

2021 ◽  
Vol 8 ◽  
Author(s):  
Xuejin Gao ◽  
Li Zhang ◽  
Siwen Wang ◽  
Yaqin Xiao ◽  
Deshuai Song ◽  
...  

Background: Patients with short bowel syndrome (SBS) are at a high risk of cholestasis or cholelithiasis. This study aimed to determine the incidence, risk factors, and clinical consequences of cholelithiasis in adults with SBS over an extended period.Methods: All eligible adults diagnosed with SBS and admitted to a tertiary hospital center between January 2010 and December 2019 were retrospectively identified from the hospital records database. Kaplan–Meier analysis was used to estimate the cumulative incidence of SBS during the 10-year period. For assessment the risk factors for cholelithiasis, we used multivariate Cox proportional hazards model with estimation of hazard ratio (HR) with 95% confidence intervals (95 %CI).Results: This study enrolled 345 eligible patients with SBS. Kaplan–Meier analysis revealed that 72 patients (20.9%) developed cholelithiasis during the 10-year observation period. In multivariate analyses using the Cox proportional hazard model revealed that the remnant jejunum (HR = 2.163; 95% confidence interval [CI]: 1.156–4.047, p = 0.016) and parenteral nutrition dependence (HR = 1.783; 95% CI: 1.077–2.952, p = 0.025) were independent risk factors for cholelithiasis in adults with SBS. Twenty-eight patients developed symptoms and/or complications in the cholelithiasis group. Proportions of acute cholecystitis or cholangitis and acute pancreatitis were significantly increased in the cholelithiasis group compared with the non-cholelithiasis group (31.9 vs. 7.7%, p < 0.01; and 6.9 vs. 1.1%, p = 0.003, respectively).Conclusion: Because of the adverse clinical consequences of cholelithiasis, adult patients with SBS should be closely monitored, and preventive interventions should be considered.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04867538.


2021 ◽  
Author(s):  
Fei Wang ◽  
Jingwen Yu ◽  
Fen Wang ◽  
Qun Ji ◽  
Lan Gao ◽  
...  

Abstract Background Falls of T2DM inpatients with multiple comorbidities not only lead to musculoskeletal injury but also prolonged duration of hospital stay due to delayed healing, original diseases aggravation and increased risk of nosocomial infection.Objective To determine the risk factors of falling in T2DM patients during hospitalization.Methods Clinical data are selected from the patients administered in the department of endocrinology in Hainan General Hospital from the year of 2015 to 2020 with 38 patients in the fall group and 38 patients in the non-fall group. Clinical features and diagnosis-treatment differences are analyzed between the two groups and the correlations of falls and variables are as well evaluated. Results Levels of FBG, LDL-C, ALP, Morse Fall Scale (MFS), treatment of insulin or secretagogue, frequency of hypoglycemic events, diabetic peripheral neuropathy (DN), diabetic retinopathy (DR), chronic kidney disease (CKD), coexistence of cerebral infarction (CI) and osteoporosis (OP) rates in fall group were higher than those in non-fall group (P<0.05), the serum albumin (ALB), HDL-C and ADL scores were lower in fall group than those in non-fall group; MFS score, frequency of hypoglycemic events, DN, DR, CKD, OP, CI, FBG, LDL-C and ALP levels were positively correlated with fall (P<0.05);on the other hand, 25 (OH) D, serum calcium, ALB, and HDL-C levels were negatively correlated with falls (P<0.05);Binary logistic regression analysis revealed that low level of HDL-C and cerebral infarction were the main risk factors of falls in T2DM inpatients, and the higher the HDL-C, the lower the risk of falls (OR=0.021,P=0.002).Besides, the risk of falling was higher in patients with concurrent cerebral infarction (OR=21.738,P=0.029).Conclusion Patients with chronic diabetic complications, cerebral infarction or osteoporosis, insulin or insulin secretagogue adminstration, high frequency of hypoglycemic events and low HDL-C level are at a higher risk of falling during hospitalization. Therefore, it is necessary to identify the occurrence of falling intensely, prescribe drugs with lower risk of hypoglycemia , and reinforce fall prevention education.


2021 ◽  
Vol 8 (12) ◽  
pp. 706-710
Author(s):  
Kemal Göçer ◽  
Ahmet Çağrı Aykan ◽  
Bayram Öztürk ◽  
Alihan Erdoğan

Objective: This study aimed to evaluate whether neutrophil/lymphocyte (N/L) ratio assists in the diagnosis of coronary artery disease (CAD) in patients with suspected diaphragmatic attenuation artifact (DAA) on myocardial perfusion SPECT (MP-SPECT). Material and Methods: A total of 255 patients undergoing coronary angiography between 2015-2020 due to unclear DAA of the inferior wall on MP-SPECT were included in this retrospective study. Patients were divided into two groups (CAD and non-CAD) according to angiographic images. Significant CAD was defined as ≥50% stenosis of coronary arteries feeding the inferior wall. White blood cell count, biochemical parameters, and risk factors for CAD were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of age (p = 0.055), gender (p = 0.482), and body mass index (p = 0.305). N/L ratio (OR = 1.397 p = 0.002 95% Cl = 1.128-1.732) and left ventricle ejection fraction (OR = 0.896 p = 0.023 95% Cl = 0.815-0.985) were independent risk factors for CAD in multivariate binary logistic regression analysis. Receiver Operating Characteristic (ROC) curve analysis showed that a cut-off value of ≥2 for N/L ratio predicted the presence of CAD (sensitivity=63.5%, specificity=60.7%, AUC=0.668, 95% CI=0.596 – 0.740, p<0.001). Conclusion: N/L ratio is a simple and accessible test and may increase the diagnostic accuracy of MP-SPECT for CAD in patients with suspicious diaphragmatic attenuation on MP-SPECT.


Author(s):  
Dimitrios Eleftheriadis ◽  
Christina Imalis ◽  
Guido Gerken ◽  
Heiner Wedemeyer ◽  
Jan Duerig

Abstract Background and aim Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. Patients and methods We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. Results PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 – 223.44), pedunculated: OR 56.67 (95 % CI 5.03 – 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 – 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 – 741.21)] as significant risk factors for PPB, too. Conclusions The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.


2017 ◽  
Vol 44 (11) ◽  
pp. 1674-1679 ◽  
Author(s):  
Ji-Won Kim ◽  
Yoon Young Kim ◽  
Hwajeong Lee ◽  
Sung-Hoon Park ◽  
Seong-Kyu Kim ◽  
...  

Objective.Several studies have reported risk factors for hydroxychloroquine (HCQ) retinal toxicity, but data are limited for patients of Asian ancestry. The aim of this study was to investigate the rate of and factors for HCQ retinal toxicity in the Korean population.Methods.There were 123 patients enrolled in this study who were using or had used HCQ. Retinal toxicity was detected using spectral domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, and automated visual field testing. Binary logistic regression analysis was performed to identify factors associated with HCQ retinal toxicity.Results.Mean duration of HCQ use and mean HCQ dose in study participants was 10.1 years and 6.4 mg/kg, respectively. We found 17 patients (13.8%) with HCQ retinal toxicity among 123 patients. Patients with retinal toxicity took HCQ ranging from 6.7–21.9 years and daily dosage ranging from 4.9–9.1 mg/kg. Only 1 patient had retinal toxicity among patients with daily dose < 5.0 mg/kg. These factors increased the risk of HCQ retinal toxicity: longer duration of HCQ use [adjusted OR (aOR) = 4.71, 95% CI 2.18–10.15 for duration of HCQ use in 5-yr increments], higher daily HCQ dose (aOR = 3.34, 95% CI 1.03–10.80 for daily HCQ dose in 100-mg increments), and the presence of kidney disease (aOR = 8.56, 95% CI 1.15–64.00).Conclusion.HCQ retinal toxicity is associated with duration of HCQ use, daily HCQ dose, and presence of kidney disease. Proper dosing of maximum 5 mg/kg and regular screening according to risk factors are important in HCQ use.


2019 ◽  
Author(s):  
Ling Lan ◽  
Li-jian Pei ◽  
Feifei Zhai ◽  
Yuelun Zhang ◽  
Jun Jing ◽  
...  

Abstract Background Hip fractures are typical fractures in geriatric patients and are associated with a high risk of postoperative complications and extended length of stay (LOS) compared with other osteoporotic fractures, particularly among patients over age 90. We aimed to identify the risk factors for extended LOS (more than 14 days) in patients older than 90 years. Methods A single-centre retrospective cohort study was performed in 50 patients (over age 90) who experienced hip fracture between June 1, 2013, and August 31, 2017. Their medical records were retrospectively reviewed from the hospital’s electronic database. The baseline characteristics of the patients, intraoperative data and postoperative complications were collected for the assessment of potential risk factors. Univariate analysis and multivariate binary logistic regression analysis were performed to determine potential risk factors for extended LOS. Results The age of the patients in the cohort ranged from 90 to 101 years, and the analysis demonstrated that 70% (n = 35) of the patients experienced a complicated course of treatment with an in-hospital mortality rate of 4% (n = 2). The most common complication was the occurrence of postoperative pneumonia (38%). The median duration of hospital stay was 18 (IQR 11, 21) days. Multivariate binary logistic regression analysis showed that a LOS of more than 14 days was significantly associated with a lower mean diastolic blood pressure during surgery [odds ratio (OR) =0.86, 95% confidence interval (CI)=0.76-0.98, P = 0.018] and the occurrence of postoperative pneumonia (OR=8.95, 95% CI=1.45-55.3, P = 0.018). The occurrence of postoperative pneumonia was significantly associated with the neutrophil-to-lymphocyte ratio (NLR) at admission (D0) [odds ratio (OR) =1.20, 95% confidence interval (CI)=1.02-1.41, P = 0.029]. Neither the LOS nor postoperative pneumonia was found to be associated with the anaesthesia technique. Conclusions A lower mean diastolic blood pressure during surgery and the occurrence of postoperative pneumonia may extend the LOS in patients aged 90 years and over who undergo hip fracture surgery. The use of regional anaesthesia was not associated with a shorter LOS.


2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ehsan Alimohammadi ◽  
Seyed Reza Bagheri ◽  
Paniz Ahadi ◽  
Sahar Cheshmehkaboodi ◽  
Homa Hadidi ◽  
...  

Abstract Background There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients. Methods We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management. Results There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78–2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61–2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management. Conclusions Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.


2019 ◽  
Vol 10 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Christopher G. Varlotta ◽  
David H. Ge ◽  
Nicholas Stekas ◽  
Nicholas J. Frangella ◽  
Jordan H. Manning ◽  
...  

Study Design: Retrospective cohort study. Objective: To investigate radiological differences in lumbar disc herniations (herniated nucleus pulposus [HNP]) between patients receiving microscopic lumbar discectomy (MLD) and nonoperative patients. Methods: Patients with primary treatment for an HNP at a single academic institution between November 2012 to March 2017 were divided into MLD and nonoperative treatment groups. Using magnetic resonance imaging (MRI), axial HNP area; axial canal area; HNP canal compromise; HNP cephalad/caudal migration and HNP MRI signal (black, gray, or mixed) were measured. T test and chi-square analyses compared differences in the groups, binary logistic regression analysis determined odds ratios (ORs), and decision tree analysis compared the cutoff values for risk factors. Results: A total of 285 patients (78 MLD, 207 nonoperative) were included. Risk factors for MLD treatment included larger axial HNP area ( P < .01, OR = 1.01), caudal migration, and migration magnitude ( P < .05, OR = 1.90; P < .01, OR = 1.14), and gray HNP MRI signal ( P < .01, OR = 5.42). Cutoff values for risks included axial HNP area (70.52 mm2, OR = 2.66, P < .01), HNP canal compromise (20.0%, OR = 3.29, P < .01), and cephalad/caudal migration (6.8 mm, OR = 2.43, P < .01). MLD risk for those with gray HNP MRI signal (67.6% alone) increased when combined with axial HNP area >70.52 mm2 (75.5%, P = .01) and HNP canal compromise >20.0% (71.1%, P = .05) cutoffs. MLD risk in patients with cephalad/caudal migration >6.8 mm (40.5% alone) increased when combined with axial HNP area and HNP canal compromise (52.4%, 50%; P < .01). Conclusion: Patients who underwent MLD treatment had significantly different axial HNP area, frequency of caudal migration, magnitude of cephalad/caudal migration, and disc herniation MRI signal compared to patients with nonoperative treatment.


Surgery Today ◽  
2011 ◽  
Vol 42 (5) ◽  
pp. 447-452 ◽  
Author(s):  
Motoi Uchino ◽  
Hiroki Ikeuchi ◽  
Toshihiro Bando ◽  
Hiroki Matsuoka ◽  
Yoshiko Takahashi ◽  
...  

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Dapeng Xu ◽  
Rong Qin ◽  
Wuyu Wang ◽  
Jun Shen ◽  
Aiguo Zhang ◽  
...  

Background: Fractures of the middle and distal diaphysis of the forearm are common in children. Conservative treatment is effective in this regard. Some studies have discussed the risk factors and predictive indicators of re-displacement; however, the objects of the study are all fixed with tubular plaster or double sugar splint. Objectives: This study was performed to determine the risk factors of re-displacement after closed reduction and double splint plaster fixation of unstable pediatric fractures of the middle and distal diaphysis of the forearm. Methods: This retrospective study was conducted on 57 patients undergoing closed reduction and plaster fixation after unstable diaphyseal fractures of the middle and distal forearm in Wuxi Children's Hospital of Nanjing Medical University within May 2014 to May 2020. A total of 35 male and 22 female subjects aged 6 - 9 years (average: 7.3 years) participated in this study. They were followed up for more than 6 weeks after fracture healing. According to whether experiencing a secondary displacement within 2 weeks after the fracture, the subjects were divided into two groups, namely displacement, and non-displacement. Gender, age, double fracture, reduction quality, and plaster fixation type were analyzed as relevant, effective factors. Results: All 57 patients were followed up, and all fractures reached clinical healing standards at the last follow-up. Moreover, 20 and 37 cases were in the shift and non-shift groups, respectively. No statistically significant difference was reported in gender (c2 = 0.168; P = 0.780), age (t = 1.003; P = 0.217), double fracture (c2 = 0.021; P = 1), and plaster fixation type (c2 = 0.416; P = 0.699) between the two groups. The reduction quality (c2 = 7.480; P = 0.025) showed a statistically significant difference. Binary logistic regression analysis showed that reduction quality was a risk factor for fracture relocation providing a predictive value. Conclusions: Good reduction quality can reduce the risk of fracture displacement.


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