Demographics and Risk Factors for Non-Accidental Orthopedic Trauma

2019 ◽  
Vol 58 (6) ◽  
pp. 618-626
Author(s):  
Lakshmanan Sivasundaram ◽  
Nikunj N. Trivedi ◽  
Julian Gatta ◽  
Anne Y. Ning ◽  
Chang-Yeon Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analyses ◽  
Significant Risk ◽  
Spine Fractures ◽  
Orthopedic Trauma ◽  
Injury Patterns ◽  
Increased Risk ◽  
Non Accidental Trauma ◽  
Inpatient Database ◽  
Current Risk

Childhood non-accidental trauma (NAT) is the second most common cause of death in children. Despite its prevalence, NAT is frequently unreported due to provider misdiagnosis or unawareness. The purpose of this study was to determine current risk factors and injury patterns associated with NAT. A retrospective review of the Kids’ Inpatient Database was performed for the years 2009 and 2012. Univariate and multivariate analyses were used to determine the statistically significant risk factors for NAT. In 2009 and 2012, 174 442 children were hospitalized for fractures. Of these, 2.07% (3614) were due to NAT. Lower extremity (femur, tibia/fibula, foot), hand/carpus, clavicle, pelvis, and spine fractures were more likely to result from NAT; tibia/fibula fractures were most predictive of NAT. Children with anxiety, attention-deficit, conduct, developmental, and mood disorders were more likely to experience NAT. Those with cerebral palsy and autism were not at an increased risk for NAT.

scholarly journals Predictors of a Successful Bipolar Radiofrequency Endometrial Ablation

2019 ◽  
Vol 79 (03) ◽  
pp. 286-292
Author(s):  
Lilly Eisele ◽  
Lea Köchli ◽  
Patricia Städele ◽  
JoEllen Welter ◽  
Maja Fehr-Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Multivariate Analyses ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Patient Characteristics ◽  
Endometrial Ablation ◽  
Bipolar Radiofrequency ◽  
Increased Risk ◽  
Intramural Fibroids

Abstract Introduction The studyʼs objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method. Materials and Methods 195 women who were treated with bipolar radiofrequency endometrial ablation between 01/2009 and 06/2016 were included in this prospective cohort study. Postoperative data from 187 women were collected at a median of 17.5 months (IQR 4.5–34.9; 1–82). Multivariate analyses of risk factors were performed. Success was defined as amenorrhoea or spotting. Results Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity 2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median BMI 23.5 kg/m2 (IQR 21–27). 30 patients (19.5%) had intramural masses that could be measured with ultrasound. Postoperative success rate was 86.1%. 10 patients (5%) had a hysterectomy postoperatively – 6 for heavy bleeding, 3 due to prolapse, and 1 due to dysmenorrhoea. Multivariate analyses showed the presence of intramural masses in women < 45 years was a significant risk factor for therapeutic failure (p = 0.033; 95% CI 1.08–12.57), with an increased risk of hysterectomy (OR 7.9, 95% CI 1.2–52.7, p = 0.033). Conclusion Bipolar radio frequency endometrial ablation was highly successful in the absence of an intramural mass (88%). Even smaller intramural fibroids (DD: adenomyomas of a median of 15 mm) reduce the success rate (76%), which is why preoperative ultrasound is recommended. In the presence of intramural masses, the risk of a hysterectomy for women < 45 years increases eightfold.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

scholarly journals Combining Carcinoembryonic Antigen and Platelet to Lymphocyte Ratio to Predict Brain Metastasis of Resected Lung Adenocarcinoma Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Wei Wang ◽  
Chao Bian ◽  
Di Xia ◽  
Jin-Xi He ◽  
Ping Hai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Metastasis ◽  
Lung Adenocarcinoma ◽  
Carcinoembryonic Antigen ◽  
Roc Curve ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Increased Risk

We aimed to evaluate the role of pretreatment carcinoembryonic antigen (CEA) and platelet to lymphocyte ratio (PLR) in predicting brain metastasis after radical surgery for lung adenocarcinoma patients. The records of 103 patients with completely resected lung adenocarcinoma between 2013 and 2014 were reviewed. Clinicopathologic characteristics of these patients were assessed in the Cox proportional hazards regression model. Brain metastasis occurred in 12 patients (11.6%). On univariate analysis, N2 stage (P = 0.013), stage III (P = 0.016), increased CEA level (P = 0.006), and higher PLR value (P = 0.020) before treatment were associated with an increased risk of developing brain metastasis. In multivariate model analysis, CEA above 5.2 ng/mL (P = 0.014) and PLR ≥ 120 (P = 0.036) remained as the risk factors for brain metastasis. The combination of CEA and PLR was superior to CEA or PLR alone in predicting brain metastasis according to the receiver operating characteristic (ROC) curve analysis (area under ROC curve, AUC 0.872 versus 0.784 versus 0.704). Pretreatment CEA and PLR are independent and significant risk factors for occurrence of brain metastasis in resected lung adenocarcinoma patients. Combining these two factors may improve the predictability of brain metastasis.

scholarly journals Relationship between childhood obesity and dietary behavior in selected school-going children from Dhaka city, Bangladesh

2020 ◽  
Vol 7 (7) ◽  
pp. 2469
Author(s):  
Mohammad Rahanur Alam ◽  
Mohammad Asadul Habib ◽  
A. K. Obidul Huq ◽  
Sumaiya Mamun ◽  
Sompa Reza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fast Food ◽  
Primary Schools ◽  
Significant Risk ◽  
Dietary Behavior ◽  
Communicable Diseases ◽  
Overweight And Obesity ◽  
Dhaka City ◽  
Non Communicable Diseases ◽  
Increased Risk

Background: The prevalence of non-communicable diseases is rising in Dhaka City, Bangladesh. Obesity is one of the significant risk factors for many non-communicable diseases. This research aimed to investigate the current prevalence of overweight and obesity among children in selected schools in Dhaka City through anthropometric evaluation, as well as to assess the correlation of various environmental determinants such as physical activity, dietary behavior, lifestyle habits, are associated with increased risk of obesity in children.Methods: This school-based cross-sectional study was conducted among 106 participants (50 male and 56 female participants) aged 6-14 years selected by convenience sampling from four randomly selected primary schools of different regions of Dhaka city. A pre-tested questionnaire was used to collect data.Results: The prevalence of overweight and obesity among school-going children 24.5%, 68% respectively. Factors associated with being obese included type of game (χ2=34.036; p=0.001), total playtime (χ2=17.788; p=0.000), TV and computer watch time (χ2=27.321; p=0.007), spend money to buy fast food (χ2=26.451; p=0.002), eating days fast food in a week (χ2=24.825; p=0.003), type of tiffin (χ2=19.757; p=0.072).Conclusions: Less playtime, longer watching TV and computer, and eating more fast food are major risk factors for overweight and obesity among school-going children in Dhaka city. Interventions are needed to increase awareness of child overweight weight and obesity risk factors to decrease the prevalence of overweight and obesity.

Primary Graft Dysfunction

2021 ◽  
Vol 42 (03) ◽  
pp. 368-379
Author(s):  
Jake G. Natalini ◽  
Joshua M. Diamond
Keyword(s):  
Risk Factors ◽  
Lung Transplantation ◽  
Ex Vivo ◽  
Significant Risk ◽  
Subsequent Development ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Increased Risk

AbstractPrimary graft dysfunction (PGD) is a form of acute lung injury after transplantation characterized by hypoxemia and the development of alveolar infiltrates on chest radiograph that occurs within 72 hours of reperfusion. PGD is among the most common early complications following lung transplantation and significantly contributes to increased short-term morbidity and mortality. In addition, severe PGD has been associated with higher 90-day and 1-year mortality rates compared with absent or less severe PGD and is a significant risk factor for the subsequent development of chronic lung allograft dysfunction. The International Society for Heart and Lung Transplantation released updated consensus guidelines in 2017, defining grade 3 PGD, the most severe form, by the presence of alveolar infiltrates and a ratio of PaO2:FiO2 less than 200. Multiple donor-related, recipient-related, and perioperative risk factors for PGD have been identified, many of which are potentially modifiable. Consistently identified risk factors include donor tobacco and alcohol use; increased recipient body mass index; recipient history of pulmonary hypertension, sarcoidosis, or pulmonary fibrosis; single lung transplantation; and use of cardiopulmonary bypass, among others. Several cellular pathways have been implicated in the pathogenesis of PGD, thus presenting several possible therapeutic targets for preventing and treating PGD. Notably, use of ex vivo lung perfusion (EVLP) has become more widespread and offers a potential platform to safely investigate novel PGD treatments while expanding the lung donor pool. Even in the presence of significantly prolonged ischemic times, EVLP has not been associated with an increased risk for PGD.

Abstract WP164: Role of Risk Factors in the Paradoxical Effect of Smoking on Peri-procedural Stroke in SAMMPRIS

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Christine A Holmstedt ◽  
Tanya N Turan ◽  
Michael J Lynn ◽  
Bethany F Lane ◽  
Jean Montgomery ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Multivariate Analyses ◽  
Smoking Status ◽  
Active Form ◽  
Intracranial Stenosis ◽  
Contributory Factor ◽  
Increased Risk ◽  
Never Smokers

Background: A previous SAMMPRIS analysis of patients randomized to stenting showed that peri-procedural ischemic infarcts were significantly associated with diabetes, basilar stenosis, age, and smoking status with never smokers having a higher risk (odds ratio = 8.8, p< 0.001). We sought to determine if this finding could be due to a higher burden of other risk factors in never smokers. Method: Baseline features in 213 patients undergoing stenting in SAMMPRIS were compared between never smokers vs. former and current smokers in univariate and multivariate analyses. Logistic regression was used to determine the effect of smoking on peri-procedural ischemic infarcts after adjusting for factors related to smoking. Data: Univariate results are shown in Table 1. Never smokers were significantly (P<0.05) more likely to be female, diabetic, hypertensive, and have another intracranial stenosis, but in multivariate analyses only hypertension and another intracranial stenosis remained significantly (P<0.05) associated with smoking status. In a multivariate model that incorporated hypertension and another intracranial stenosis along with smoking status, diabetes, basilar stenosis, and age, smoking status remained significant with an increased risk among patients who never smoked (odds ratio = 5.3, p = 0.005). Conclusion: While never smokers had significantly higher rates of some risk factors compared to active or previous smokers, these risk factors do not explain all the increased risk of early stroke in never smokers after stenting in SAMMPRIS. Another contributory factor may be that smoking accelerates the conversion of clopidogrel to its active form.

scholarly journals Epidemiology, risk factors and outcomes of Candida albicans vs. non-albicans candidaemia in adult patients in Northeast China

2019 ◽  
Vol 147 ◽  
Author(s):  
Wei Zhang ◽  
Xingpeng Song ◽  
Hao Wu ◽  
Rui Zheng
Keyword(s):  
Risk Factors ◽  
Antifungal Agents ◽  
Multivariate Analyses ◽  
Urinary Catheter ◽  
Bloodstream Infections ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Isolated Species

Abstract This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012–2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066–6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129–4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476–10.906)), renal failure (OR 3.24 (1.084–9.683)), thrombocytopaenia (OR 7.171 (2.152–23.892)) and C. albicans (OR 3.629 (1.352–9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550–274.918)). All these factors may provide useful information to select initial empirical antifungal agents.

Do Biologics Protect Patients With Psoriasis From Myocardial Infarction? A Retrospective Cohort

2016 ◽  
Vol 20 (6) ◽  
pp. 536-541 ◽  
Author(s):  
Wayne P. Gulliver ◽  
Shane Randell ◽  
Susanne Gulliver ◽  
Sean Connors ◽  
Hervé Bachelez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Retrospective Cohort ◽  
Biologic Therapy ◽  
Age Of Onset ◽  
Significant Risk ◽  
Severe Psoriasis ◽  
Inflammatory Disorder ◽  
Dermatology Clinic ◽  
Increased Risk

Background: Psoriasis is a chronic immune-mediated inflammatory disorder that affects approximately 2% to 3% of the population, which translates to 17 million in North America and Europe and approximately 170 million people worldwide. Although psoriasis can occur at any age, most cases develop before age 40 years. Some larger studies have noted bimodal age at onset with the first peak occurring at approximately age 30 years and the second peak at around 55 to 60 years, but most patients have a younger age of onset (15-30 years). Psoriasis is associated with multiple comorbidities, decreased quality of life, and decreased longevity of life. Two recent systematic reviews and a meta-analysis concluded that psoriasis patients are at increased risk of major adverse cardiovascular events. Multiple studies confirm that many of the comorbidities found in patients with psoriasis are also important risk factors for cardiovascular disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, obesity, and metabolic syndrome. Methods: We conducted a retrospective cohort study using charts from a dermatology clinic combined with an administrative database of patients with moderate to severe psoriasis in Newfoundland and Labrador, Canada. We examined the role of clinical predictors (age of onset of psoriasis, age, sex, biologic use) in predicting incident myocardial infarction (MI). Results: Logistic regression revealed that age of onset (odds ratio [OR], 8.85; P = .005), advancing age (OR, 1.07; P < .0001), and being male (OR, 3.64; P = .018) were significant risk factors for the development of MI. Neither biologic therapy nor duration of biologic therapy were statistically significant risk factors for the development of MI. Our study found that in patients with psoriasis treated with biologics, there was a nonsignificant trend in reduced MI by 78% (relative risk, 0.18; 95% confidence interval, 0.24-1.34; P = .056). Conclusion: Our study demonstrated a trend toward decreased MI in patients with moderate to severe psoriasis on biologics. Patients with an early age of onset of psoriasis (<25 years) were nearly 9 times more likely to have an MI. Clinicians should consider appropriate cardiovascular risk reduction strategies in patients with psoriasis.

scholarly journals Prevalence of Asthma and Risk Factors for Asthma-Like Symptoms in Aboriginal and Non-Aboriginal Children in the Northern Territories of Canada

2008 ◽  
Vol 15 (3) ◽  
pp. 139-145 ◽  
Author(s):  
Zhiwei Gao ◽  
Brian H Rowe ◽  
Carina Majaesic ◽  
Cindy O’Hara ◽  
A Senthilselvan
Keyword(s):  
Risk Factors ◽  
Urban Areas ◽  
Smoking Habit ◽  
Significant Risk ◽  
Daily Smoking ◽  
Asthma Prevalence ◽  
Infants And Toddlers ◽  
Increased Risk ◽  
Northern Territories ◽  
Aboriginal Children

BACKGROUND: Few studies have investigated the prevalence and risk factors of asthma in Canadian Aboriginal children.OBJECTIVE: To determine the prevalence of asthma and asthma-like symptoms, as well as the risk factors for asthma-like symptoms, in Aboriginal and non-Aboriginal children living in the northern territories of Canada.METHODS: Data on 2404 children, aged between 0 and 11 years, who participated in the North component of the National Longitudinal Survey of Children and Youth were used in the present study. A child was considered to have an asthma-like symptom if there was a report of ever having had asthma, asthma attacks or wheeze in the past 12 months.RESULTS: After excluding 59 children with missing information about race, 1399 children (59.7%) were of Aboriginal ancestry. The prevalence of asthma was significantly lower (P<0.05) in Aboriginal children (5.7%) than non-Aboriginal children (10.0%), while the prevalence of wheeze was similar between Aboriginal (15.0%) and non-Aboriginal (14.5%) children. In Aboriginal children, infants and toddlers had a significantly greater prevalence of asthma-like symptoms (30.0%) than preschool-aged children (21.5%) and school-aged children (11.5%). Childhood allergy and a mother’s daily smoking habit were significant risk factors for asthma-like symptoms in both Aboriginal and non-Aboriginal children. In addition, infants and toddlers were at increased risk of asthma-like symptoms in Aboriginal children. In analyses restricted to specific outcomes, a mother’s daily smoking habit was a significant risk factor for current wheeze in Aboriginal children and for ever having had asthma in non-Aboriginal children.CONCLUSIONS: Asthma prevalence appears to be lower in Aboriginal children than in non-Aboriginal children. The association between daily maternal smoking and asthma-like symptoms, which has been mainly reported for children living in urban areas, was observed in Aboriginal and non-Aboriginal children living in northern and remote communities in Canada.

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