Risk Factors for Gemcitabine-Induced Vascular Pain in Patients With Pancreatic Cancer

2020 ◽  
pp. 106002802096935
Author(s):  
Shigeru Ishida ◽  
Yoko Makihara ◽  
Hiroyuki Watanabe ◽  
Takafumi Nakashima ◽  
Kenichiro Nagata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Predictive Factors ◽  
Preventive Measures ◽  
Regression Analyses ◽  
Multivariable Analyses ◽  
Vascular Pain ◽  
Pain Symptoms ◽  
Gemcitabine Treatment ◽  
Hot Pack

Background: Peripheral intravenous injection of gemcitabine often causes vascular pain; however, preventive measures have not yet been established. Objectives: This study focused on identifying predictive factors for gemcitabine-induced vascular pain. Methods: We retrospectively analyzed risk factors for developing vascular pain in patients with pancreatic cancer receiving gemcitabine infusions at our institution. Infusions were divided into groups according to presence or absence of vascular pain symptoms, and variables were compared. Odds ratios for risk factors were calculated using logistic regression analyses. Results: Overall, 272 patients with pancreatic cancer were subjected to 725 gemcitabine infusions, and of these, 18.4% (n = 50) experienced vascular pain. There were significant differences in the gemcitabine dose ( P = 0.025), dose of gemcitabine/body surface area (BSA; P = 0.004), concentration of gemcitabine ( P = 0.025), and hot pack use ( P = 0.011) between the vascular pain and no vascular pain groups. Multivariable analyses indicated that gemcitabine dose/BSA and lack of hot pack use were risk factors for developing vascular pain. Moreover, on administration of a higher dosage (>930 mg/m2), the incidence of vascular pain in patients using a hot pack (6.7%) was significantly lower than that in patients not provided a hot pack (16.2%). Conclusions and Relevance: High gemcitabine dosages and lack of hot pack use were predictive factors for gemcitabine-induced vascular pain in patients with pancreatic cancer. Patients receiving gemcitabine treatment should apply a hot pack to the injection site. Scrupulous clinical attention is required for patients presenting with these risk factors to improve pain management.

Graft detachments in endothelial keratoplasty

2021 ◽  
pp. bjophthalmol-2020-318092
Author(s):  
Rashmi Deshmukh ◽  
Sridevi Nair ◽  
Darren Shu Jeng Ting ◽  
Tushar Agarwal ◽  
Jacqueline Beltz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preventive Measures ◽  
Endothelial Keratoplasty ◽  
Common Complication ◽  
Prevention Measures ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Secondary Interventions ◽  
Different Types ◽  
Incidence Risk ◽  
Donor Graft

Graft detachment is the most common complication of endothelial keratoplasty. With the ongoing advancements in the field of endothelial keratoplasty, our understanding of risk factors of graft detachments and its management has been evolving. Various prevention measures have been described in literature including presoaking the donor graft, anterior chamber tamponade, venting incisions, sutures to prevent dislocation of graft. Management of a detached graft involves secondary interventions such as rebubbling, suturing and regrafts. In this review, we discuss graft detachment in different types of endothelial keratoplasty techniques including Descemet stripping endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet’s membrane endothelial keratoplasty; with emphasis on incidence, risk factors, preventive measures and their management.

90 Socio-Demographic and Medical Factors in A Multi-Ethnic Cohort of COVID Deaths

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
M Patel ◽  
U Umasankar ◽  
B McCall
Keyword(s):  
Risk Factors ◽  
South Asian ◽  
Multivariable Analysis ◽  
Uneventful Recovery ◽  
Asian Ethnicity ◽  
Black African ◽  
Medical Factors ◽  
Multivariable Analyses ◽  
Independent Risk Factors ◽  
Medical Wards

Abstract Introduction Whilst most patients during the COVID pandemic made an uneventful recovery,there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to examine and evaluate risk factors for those patients who died of COVID and to identify any markers for improvement in the management of such patients during future COVID surges. Methods Medical records of all patients who died within a multi-ethnic, inner city acute district general hospital over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for these patients. Results Of 275 deaths,204 were related to COVID. Compared to non-COVID deaths(n = 71), there were no age differences. There were significantly more deaths in males (58%vs39%,P < 0.001)) and in Black African and South Asian groups. 18% of COVID deaths were those who were not frail (Frailty Rockwood Scale 1–3) whereas there were no non-COVID deaths in this group(P < 0.001). 69% of COVID deaths occurred in general medical wards whereas 19% in critical care units (90% and 7% for non-COVID deaths,p < 0.001). COVID patients died more quickly compared to non-COVID patients (length of stay mean, 11vs21,p < 0.001). Medical factors prevalent in >20% of COVID deaths included Diabetes, Hypertension, Chronic Heart Disease, Chronic Kidney Disease,and Dementia. Multivariable analyses showed males (OR 1.9), age > 70(OR 2.0), frailty (OR 2.3) were independent risk factors for COVID deaths. Discussion Compared to non-COVID deaths,COVID deaths were more common in previously well individuals,males,Black African and South Asian ethnicity, but multivariable analyses showed males, age > 70 and frailty were independent risk factors for COVID deaths. This survey indicates that greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths.

scholarly journals Epidemiology of Hepatitis E in 2017 in Bavaria, Germany

2021 ◽  
Author(s):  
K. Hriskova ◽  
D. Marosevic ◽  
A. Belting ◽  
J. J. Wenzel ◽  
A. Carl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis E ◽  
Food Samples ◽  
Healthy Population ◽  
Genotype 3 ◽  
Human Samples ◽  
Multivariable Analyses ◽  
Upper Abdominal ◽  
Undercooked Meat

AbstractIn the last decade, the number of reported hepatitis E virus (HEV) infections in Germany, including Bavaria, has continued to rise. In order to identify risk factors associated with HEV infection, we investigated notified hepatitis E cases from Bavaria during 2017. The project “Intensified Hepatitis E Surveillance in Bavaria” included interviews with questionnaires, collection and genotyping of stool, serum and food samples. In addition, certain risk factors were examined in a sample comparison with healthy population using univariable analysis and logistic regression. In total, 135 hepatitis E cases from Bavaria were included in the analysis. Mean age for women was 46 (range 20–74) years and 47.5 (range 20–85) for men. 56 of the cases (41.5%) were asymptomatic. Among the symptomatic cases, both men and women were equally affected with symptoms like fever (16.3%), jaundice (18.8%) and upper abdominal pain (28.2%). 145 human samples (serum, stool) and 6 food samples were collected. 15.9% of the human samples (n = 23) were positive for HEV RNA by reverse-transcription quantitative real-time PCR (RT-qPCR). Identified risk factors significantly associated with hepatitis E were sausage consumption with odds ratio 9.6 (CI 1.3–70.1), fish with OR 2.2 (CI 1.1–4.4) and cat ownership with OR 1.9 (CI 1.3–3.0) in multivariable analyses. Further investigation is needed to confirm the role of fish in HEV transmission. Autochthonous HEV genotype 3 is prevalent in Bavaria and there could be more transmission routes contributing to the spread of HEV than previously known. Undercooked meat, offal, sausages, fish, shellfish and contact with animals and pets are possible sources for infection.

scholarly journals Analysis of Risk Factors for African Swine Fever in Lombardy to Identify Pig Holdings and Areas Most at Risk of Introduction in Order to Plan Preventive Measures

Pathogens ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 1077
Author(s):  
Silvia Bellini ◽  
Alessandra Scaburri ◽  
Marco Tironi ◽  
Stefania Calò
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
European Union ◽  
Preventive Measures ◽  
Descriptive Analysis ◽  
African Swine Fever ◽  
The European Union ◽  
Z Score ◽  
Pork Products ◽  
Pig Farms

In 2019, the area of the European Union (EU) affected by African swine fever (ASF) expanded progressively in a southwestern direction from Baltic and eastern countries. The disease can severely affect and disrupt regional and international trade of pigs and pork products with serious socioeconomic damages to the pig industry. Lombardy is one of the most important European pig producers and the introduction of ASF into the pig population could adversely affect the entire sector. A study was carried out to identify the farms and territories in the region most at risk of ASF introduction to plan preventive measures. The pig holdings were identified through a descriptive analysis of pig movements and Social Network Analysis (SNA), while, for the identification of the most exposed municipalities, an assessment of risk factors was carried out using the ranking of summed scores attributed to the Z-score. From the analysis, it was found that 109 municipalities and 297 pig holdings of the region were potentially more at risk, and these holdings were selected for target surveillance. This information was provided to veterinary authority to target surveillance in pig farms, in order to early detect a possible incursion of ASF and prevent its spread.

scholarly journals Relation between body composition and severe diarrhea in patients treated with preoperative chemoradiation with capecitabine for rectal cancer: a single-centre cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. M. van Rees ◽  
W. Hartman ◽  
J. J. M. E. Nuyttens ◽  
E. Oomen-de Hoop ◽  
J. L. A. van Vugt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Body Composition ◽  
Logistic Regression ◽  
Cohort Study ◽  
Preoperative Chemoradiation ◽  
Regression Analyses ◽  
Single Centre ◽  
Severe Diarrhea ◽  
The Impact

Abstract Background Chemoradiation with capecitabine followed by surgery is standard care for locally advanced rectal cancer (LARC). Severe diarrhea is considered a dose-limiting toxicity of adding capecitabine to radiation therapy. The aim of this study was to describe the risk factors and the impact of body composition on severe diarrhea in patients with LARC during preoperative chemoradiation with capecitabine. Methods A single centre retrospective cohort study was conducted in a tertiary referral centre. All patients treated with preoperative chemoradiation with capecitabine for LARC from 2009 to 2015 were included. Patients with locally recurrent rectal cancer who received chemoradiation for the first time were included as well. Logistic regression analyses were performed to identify risk factors for severe diarrhea. Results A total of 746 patients were included. Median age was 64 years (interquartile range 57–71) and 477 patients (64%) were male. All patients received a radiation dosage of 25 × 2 Gy during a period of five weeks with either concomitant capecitabine administered on radiation days or continuously during radiotherapy. In this cohort 70 patients (9%) developed severe diarrhea. In multivariable logistic regression analyses female sex (OR: 4.42, 95% CI 2.54–7.91) and age ≥ 65 (OR: 3.25, 95% CI 1.85–5.87) were the only risk factors for severe diarrhea. Conclusions Female patients and patients aged sixty-five or older had an increased risk of developing severe diarrhea during preoperative chemoradiation therapy with capecitabine. No relation was found between body composition and severe diarrhea.

scholarly journals Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Flook ◽  
C. Jackson ◽  
E. Vasileiou ◽  
C. R. Simpson ◽  
M. D. Muckian ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Systematic Review ◽  
At Risk ◽  
Risk Factor ◽  
Disease Severity ◽  
Severe Disease ◽  
Public Health Response ◽  
Wide Range ◽  
Multivariable Analyses

Abstract Background Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics. Methods Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised. Results One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity. Conclusions The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected. Registration This review was registered on PROSPERO as CRD42020177714.

scholarly journals Predictive Factors for Pancreatic Cancer and Its Early Detection Using Special Pancreatic Ultrasonography in High-Risk Individuals

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 502
Author(s):  
Junko Fukuda ◽  
Kenji Ikezawa ◽  
Miho Nakao ◽  
Suetsumi Okagaki ◽  
Reiko Ashida ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Predictive Factors ◽  
Survival Duration ◽  
Pancreatic Cysts ◽  
Neoplastic Progression ◽  
Dismal Prognosis ◽  
Independent Risk Factors ◽  
Cyst Growth

Because pancreatic cancer has a dismal prognosis, a strategy for early diagnosis is required. This study aimed to identify predictive factors of neoplastic progression in patients at high risk for pancreatic cancer and examined the efficiency of surveillance using transabdominal special ultrasonography focusing on the pancreas (special pancreatic US). Patients with slight main pancreatic duct (MPD) dilatation (≥2.5 mm) and/or pancreatic cysts (≥5 mm) were enrolled in a prospective surveillance study with special pancreatic US in a Japanese cancer referral center. A total of 498 patients undergoing surveillance for ≥3 years were included. During the median follow-up of 5.9 years, neoplastic progression developed in 11 patients (2.2%), including 9 patients who underwent pancreatectomy. Eight patients (72.7%) were diagnosed with stage 0/I disease, with an overall survival duration of 8.8 years. Findings of both MPD dilatation and pancreatic cysts at initial surveillance, MPD growth (≥0.2 mm/year) and cyst growth (≥2 mm/year) during surveillance were identified as independent risk factors for neoplastic progression. In summary, surveillance with special pancreatic US for high-risk individuals contributed to earlier detection of neoplastic progression, leading to a favorable prognosis. During surveillance, attention should be paid to MPD growth as well as to cyst growth.

scholarly journals Pulmonary infection after cardiopulmonary bypass surgery in children: a risk estimation model in China

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chunnian Ren ◽  
Chun Wu ◽  
Zhengxia Pan ◽  
Quan Wang ◽  
Yonggang Li
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Prediction Model ◽  
Congenital Heart ◽  
Bypass Surgery ◽  
Pulmonary Infection ◽  
Regression Analyses ◽  
Cardiopulmonary Bypass Surgery ◽  
Independent Risk Factors ◽  
Individualized Prediction

Abstract Objectives The occurrence of pulmonary infection after congenital heart disease (CHD) surgery can lead to significant increases in intensive care in cardiac intensive care unit (CICU) retention time, medical expenses, and risk of death risk. We hypothesized that patients with a high risk of pulmonary infection could be screened out as early after surgery. Hence, we developed and validated the first risk prediction model to verify our hypothesis. Methods Patients who underwent CHD surgery from October 2012 to December 2017 in the Children’s Hospital of Chongqing Medical University were included in the development group, while patients who underwent CHD surgery from December 2017 to October 2018 were included in the validation group. The independent risk factors associated with pulmonary infection following CHD surgery were screened using univariable and multivariable logistic regression analyses. The corresponding nomogram prediction model was constructed according to the regression coefficients. Model discrimination was evaluated by the area under the receiver operating characteristic curve (ROC) (AUC), and model calibration was conducted with the Hosmer-Lemeshow test. Results The univariate and multivariate logistic regression analyses identified the following six independent risk factors of pulmonary infection after cardiac surgery: age, weight, preoperative hospital stay, risk-adjusted classification for congenital heart surgery (RACHS)-1 score, cardiopulmonary bypass time and intraoperative blood transfusion. We established an individualized prediction model of pulmonary infection following cardiopulmonary bypass surgery for CHD in children. The model displayed accuracy and reliability and was evaluated by discrimination and calibration analyses. The AUCs for the development and validation groups were 0.900 and 0.908, respectively, and the P-values of the calibration tests were 0.999 and 0.452 respectively. Therefore, the predicted probability of the model was consistent with the actual probability. Conclusions Identified the independent risk factors of pulmonary infection after cardiopulmonary bypass surgery. An individualized prediction model was developed to evaluate the pulmonary infection of patients after surgery. For high-risk patients, after surgery, targeted interventions can reduce the risk of pulmonary infection.

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