scholarly journals Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

2021 ◽  
Author(s):  
XYJ Leow ◽  
JTC Tan ◽  
TH Yeo ◽  
KPL Wong ◽  
A Mahadev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Bone Health ◽  
Fragility Fractures ◽  
Neurological Condition ◽  
Factors Associated ◽  
Fractures In Children ◽  
Neurology Clinic

Introduction: The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically therefore we aim to evaluate the risk factors associated with fragilty fractures in children with LTNC. Methods: In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC who are under follow-up in the Paediatric Neurology clinic and of patients who presented with fracture to the Paediatric Orthopaedic clinic. Information on patient’s demographics, medical history, intervention, biochemical bone markers and fracture history were collected. Results: In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (GMFCS V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% had a vitamin D level measured and 33% had calcium measured. Conclusion: The local prevalence of fragility fractures in children with LTNC who are under follow-up at the Neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimize bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight, avoiding vitamin D deficiency and ensuring adequate calcium intake.

Bone loss and vitamin D deficiency post gastrectomy for gastro-esophageal malignancy.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 165-165 ◽  
Author(s):  
Kiran Virik ◽  
Robert Wilson
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Bone Disease ◽  
Bone Health ◽  
Nutritional Supplementation ◽  
Type I ◽  
Mineral Density ◽  
Post Surgery

165 Background: Metabolic bone disease is a known but incompletely understood consequence of gastrectomy. Post gastrectomy osteoporosis (OP) is multifactorial. Evidence suggests that patients who undergo this surgery require long term bone health assessment and nutritional support. Methods: 30 post gastrectomy patients (2000-2008) from a single centre in Australia were evaluated re bone health post surgery and post nutritional supplementation. Exploratory analysis included: age, gender, pathology, type of surgery, 25 OH-vitamin D, calcium, parathyroid hormone (PTH), bone mineral density (BMD), vertebral XRs, urinary calcium and N telopeptides of type I collagen. Other risk factors evaluated were: smoking, corticosteroid use, alcohol intake, hyperthyroidism, menopausal status, hyperparathyroidism (hPTH), pre-existing bone disease. Results: The median age of the cohort was 67.5 (range 53-83) of whom 22 (73%) were male. Histology showed 16 (53%) gastric adenocarcinoma, 6 (20%) esophageal adenocarcinoma, 2 (7%) GISTs, 5 (17%) gastric/duodenal lymphoma and 1 other category. Similar numbers of patients underwent total (12) and partial/distal gastrectomy (12), with 6 having a subtotal gastrectomy. 22 (73%) had a Roux-en-Y or BR II reconstruction and 8 had a BRI/other. Median time from surgery to first BMD was 54.5 months (range 12-360) with median correlative calcium level 2.24 (range 1.97-2.49), median vitamin D level 43 (range 11-82) and median PTH 6.4 (range 1.8-13.8). Osteoporosis was diagnosed in 14 (47%) of patients, osteopenia in 14 and 2 (7%) patients had a normal BMD. Low vitamin D was seen in 23 (77%) patients, low calcium levels in 5 (17%) and secondary hPTH in 12 (41%). Post nutritional supplementation preliminary results showed 2/23 (9%) had a low vitamin D level, 3/11 (27%) had secondary hPTH, 5/19 (26%) had osteoporosis, 12/19 (63%) had osteopenia and 2/19 had a normal BMD. Analysis of other risk factors is to follow. Conclusions: Poor bone health and vitamin D deficiency is a clinically significant problem post gastrectomy. Patients should undergo long term nutritional and bone health surveillance in addition to their oncological follow up post resection.

Prevalence and risk factors associated with hepatitis C among Brazilian male patients with haemophilia: A long‐term follow‐up

Haemophilia ◽  
2019 ◽  
Vol 25 (3) ◽  
pp. 447-455 ◽  
Author(s):  
Ricardo Andrade Carmo ◽  
Marina Lobato Martins ◽  
Daniel Gonçalves Chaves ◽  
Lorenza Nogueira Campos Dezanet
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Haemophilia A ◽  
Factors Associated ◽  
Long Term Follow Up ◽  
Male Patients

Factors associated with long-term haemoptysis recurrence after transarterial embolisation for haemoptysis

2020 ◽  
Vol 24 (6) ◽  
pp. 606-611
Author(s):  
Y. Li ◽  
Z. Jia ◽  
S. Li ◽  
Y. Huang ◽  
X. Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Multivariate Analyses ◽  
Fresh Blood ◽  
Factors Associated ◽  
Transarterial Embolisation ◽  
History Of ◽  
The Mean

OBJECTIVE: To assess factors associated with long-term haemoptysis recurrence after transarterial embolisation (TAE) for haemoptysis due to bronchiectasis.METHODS: Patients with haemoptysis due to bronchiectasis who underwent TAE between May 2010 and May 2019 were included in this retrospective study. Long-term haemoptysis recurrence was defined as the expectoration of >10 mL/day of fresh blood (for at least 1 day) 1 month after TAE. Univariate and multivariate analyses were performed to identify risk factors for long-term haemoptysis recurrence after TAE.RESULTS: A total of 197 patients (108 women; mean age, 61.0 ± 12.2 years) were included in the study. TAE was performed successfully in all patients. Side effects occurred in 43 (21.8%) patients, and all patients recovered uneventfully. During 37.6 ± 11.6 months of follow-up, long-term haemoptysis recurrence occurred in 41 (20.8%) patients; the mean interval between the TAE and haemoptysis recurrence was 21.4 ± 16.3 months. Long-term haemoptysis recurrence after TAE was associated with a history of haemoptysis (OR 3.483, 95% CI 1.373–8.836; P = 0.009).CONCLUSIONS: Approximately one fifth patients with bronchiectasis had long-term haemoptysis recurrence after TAE. Risk factor for long-term haemoptysis recurrence after TAE was a history of haemoptysis.

Su1345 Endoscopic Papillectomy: Risk Factors Associated With Incomplete Resection and Recurrence During Long Term Follow-up

2013 ◽  
Vol 77 (5) ◽  
pp. AB291-AB292
Author(s):  
Gregory A. Cote ◽  
Damien Tan ◽  
Wiriyaporn Ridtitid ◽  
James L. Watkins ◽  
Evan L. Fogel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incomplete Resection ◽  
Factors Associated ◽  
Endoscopic Papillectomy ◽  
Long Term Follow Up

Extension of anticoagulation after venous thromboembolism

2008 ◽  
Vol 28 (03) ◽  
pp. 110-119 ◽  
Author(s):  
S. Schulman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Secondary Prophylaxis ◽  
Factors Associated ◽  
Long Term Follow Up ◽  
Risk Factors For Recurrence ◽  
Individual Decisions ◽  
The Individual

SummaryWhereas every clinician agrees on the need for anticoagulation initially after the diagnosis of venous thromboembolism (VTE), the opinions regarding optimal duration of secondary prophylaxis differ. The decision is complicated by the large number of identified risk factors associated with the risk of recurrence. In addition consideration has to be taken to the risk factors for bleeding and individual patient preferences. Data from long-term follow-up studies up to a decade indicate that some risk factors for recurrence decline and others seem to gain importance with time. In this review data has been extracted from the most illustrative trials to highlight controversies but also where there is consensus in order to give the clinician some support for the individual decisions on extension of anticoagulation after VTE.

scholarly journals Long‐Term Fate of the Truncal Valve

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Laura Gellis ◽  
Geoffrey Binney ◽  
Laith Alshawabkeh ◽  
Minmin Lu ◽  
Michael J. Landzberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Truncus Arteriosus ◽  
Valve Regurgitation ◽  
Term Survival ◽  
Factors Associated ◽  
Patients At Risk ◽  
Independent Risk Factors

Background Long‐term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long‐term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow‐up time was 12.6 years (interquartile range, 5.0–22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow‐up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P <0.001) or stenosis (HR, 4.12; P <0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60; P <0.001). During follow‐up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root z ‐score before truncus arteriosus full repair and during follow‐up was associated with worsening truncal valve regurgitation. Conclusions Long‐term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z ‐score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.

scholarly journals The importance of maternal pregnancy vitamin D for offspring bone health: learnings from the MAVIDOS trial

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110069
Author(s):  
Rebecca J. Moon ◽  
Elizabeth M. Curtis ◽  
Stephen J. Woolford ◽  
Shanze Ashai ◽  
Cyrus Cooper ◽  
...  
Keyword(s):  
Vitamin D ◽  
Bone Development ◽  
Controlled Trial ◽  
Clinical Care ◽  
Later Life ◽  
Vitamin D Supplementation ◽  
Public Health Policies ◽  
Positive Effects

Optimisation of skeletal mineralisation in childhood is important to reduce childhood fracture and the long-term risk of osteoporosis and fracture in later life. One approach to achieving this is antenatal vitamin D supplementation. The Maternal Vitamin D Osteoporosis Study is a randomised placebo-controlled trial, the aim of which was to assess the effect of antenatal vitamin D supplementation (1000 IU/day cholecalciferol) on offspring bone mass at birth. The study has since extended the follow up into childhood and diversified to assess demographic, lifestyle and genetic factors that determine the biochemical response to antenatal vitamin D supplementation, and to understand the mechanisms underpinning the effects of vitamin D supplementation on offspring bone development, including epigenetics. The demonstration of positive effects of maternal pregnancy vitamin D supplementation on offspring bone development and the delineation of underlying biological mechanisms inform clinical care and future public-health policies.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110280
Author(s):  
Sukru Arslan ◽  
Ahmet Yildiz ◽  
Okay Abaci ◽  
Urfan Jafarov ◽  
Servet Batit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vessel Diameter ◽  
Side Branch ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

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