Screening for hemodialysis graft stenosis and short-term thrombosis risk: A comparison of the available tools

2019 ◽  
Vol 21 (2) ◽  
pp. 195-203 ◽  
Author(s):  
Nicola Tessitore ◽  
Giovanni Lipari ◽  
Alberto Contro ◽  
Francesca Moretti ◽  
Giancarlo Mansueto ◽  
...  
Keyword(s):  
Blood Flow ◽  
Relative Risk ◽  
Confidence Interval ◽  
Short Term ◽  
Ultrasound Dilution ◽  
Graft Stenosis ◽  
Thrombosis Risk ◽  
Increased Risk ◽  
Acute Hypotension ◽  
Hemodialysis Graft

Introduction: Guidelines recommend hemodialysis graft screening to identify and repair significant (>50%) stenosis at high risk of thrombosis, but there is insufficient evidence to prefer one or other screening tool due to the lack of studies comparing all available options. Methods: Seeking an optimal screening approach, we compared the performance of all currently used tools (duplex ultrasound to detect significant stenosis (StD) and measure access blood flow (QaD), ultrasound dilution access blood flow (QaU), static venous intra-access pressure ratio (VAPR), dynamic arterial and venous pressures measurement, and monitoring) for diagnosing significant angiography-proven stenosis (StA) and predicting incipient thrombosis (occurring within 4 months) in 62 grafts. All thrombotic and symptomatic acute hypotension episodes were recorded during follow-up. Results: VAPR > 0.70 and QaU < 1600 mL/min were the best indicators to angiography for those aiming to identify the majority of StA (91% sensitivity) and QaU < 1000 mL/min or StD for those aiming to avoid unnecessary angiograms (95%–93% positive predictive value). At Cox’s analysis, the only significant thrombosis predictors were acute hypotension episodes (relative risk = 4.4 (95% confidence interval = 2.2–8.8), p < 0.0001) and QaU or QaD (14% (95% confidence interval = 8–21) or 16% (95% confidence interval = 6–25) increased risk per 100 mL/min drop in Qa, p < 0.003). Thrombosis risk (adjusted for acute hypotension) became significantly higher at QaU = 1000–700 mL/min (relative risk = 3.6 (95% confidence interval = 1.6–8.2), p < 0.001) and QaD = 1300–1000 mL/min (relative risk = 3.1 (95% confidence interval = 1.1–12.8), p = 0.031). The proportion of thromboses attributable to acute hypotension was 40% (95% confidence interval = 24–57). Conclusions: Our comparative study showed that an effective screening for graft stenosis and short-term thrombosis risk can rely on Qa surveillance alone, and suggested that avoiding acute hypotension and correcting stenosis at QaU < 1000 mL/min or QaD < 1300 mL/min can contain thrombosis risk.

Association between Diabetes Mellitus and the Risk of Herpes Zoster: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Chun-Ta Huang ◽  
Chi-Yu Lee ◽  
Heng-You Sung ◽  
Shu-Jung Liu ◽  
Po-Chih Liang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Herpes Zoster ◽  
Relative Risk ◽  
General Population ◽  
Confidence Interval ◽  
Varicella Vaccination ◽  
Cochrane Central Register ◽  
Case Control Studies ◽  
Increased Risk

Abstract Context Individuals with diabetes mellitus (DM) are susceptible to various infections. Objective We estimated the risk of herpes zoster (HZ) among individuals with DM compared to individuals in the general population. Data Sources We searched the PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trails, Cumulative Index to Nursing and Allied Health Literature and PerioPath databases from their inception to January 30, 2021 for studies on the risk of HZ in individuals with DM. Study Selection Two authors independently screened all articles identified. Data Extraction The same two authors independently extracted the data. Four case-control studies and 12 cohort studies were included. Data Synthesis Meta-analyses were performed using fixed and mixed-effects models. In the pooled analysis, individuals with DM had a higher risk of developing HZ (pooled relative risk: 1.38, 95% confidence interval: 1.21–1.57) than individuals in the general population. The results were consistent in subgroup analyses stratified by type of diabetes, age, and study design. In individuals with DM, cardiovascular disease had an additive effect on increasing the risk of HZ (pooled relative risk: 1.19, 95% confidence interval: 1.11–1.28). There was a linear dose-response association between age and the risk of HZ in individuals with DM. Conclusion Individuals with DM have an increased risk of HZ compared to the general population. Varicella vaccination should be provided to individuals with DM regardless of their age, prioritizing older adults and those with cardiovascular disease. Varicella vaccination policies for individuals with DM should be updated based on the evidence.

Mental disorders and their impact on school performance and high school completion by gender in Australia: A matched population-based cohort study

2021 ◽  
pp. 000486742110616
Author(s):  
Rebecca J Mitchell ◽  
Anne McMaugh ◽  
Carolyn Schniering ◽  
Cate M Cameron ◽  
Reidar P Lystad ◽  
...  
Keyword(s):  
High School ◽  
Relative Risk ◽  
Young People ◽  
Confidence Interval ◽  
Mental Disorder ◽  
School Performance ◽  
Adjusted Relative Risk ◽  
Minimum Standard ◽  
Young Males ◽  
Increased Risk

Background: Young people with a mental disorder often perform poorly at school and can fail to complete high school. This study aims to compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder health condition by gender. Method: A population-based matched case-comparison cohort study of young people aged ⩽18 years hospitalised for a mental disorder during 2005–2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. Results: Young males with a mental disorder had over a 1.7 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.71; 95% confidence interval: [1.35, 2.15]) and reading (adjusted relative risk: 1.99; 95% confidence interval: [1.80, 2.20]) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.50; 95% confidence interval: [1.14, 1.96]) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a sixfold increased risk and young females with multiple disorders had up to an eightfold increased risk of not completing high school compared to peers. Conclusion: Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.

scholarly journals Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

1998 ◽  
Vol 42 (6) ◽  
pp. 1336-1339 ◽  
Author(s):  
Ronen Loebstein ◽  
Antonio Addis ◽  
Elaine Ho ◽  
Roseann Andreou ◽  
Suzanne Sage ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Pregnancy Outcome ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
In Utero ◽  
Controlled Study ◽  
Control Group ◽  
Increased Risk ◽  
Clinically Significant

ABSTRACT Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (±3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary to the misperception of a major risk related to quinolone use during pregnancy.

Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

2004 ◽  
Vol 34 (8) ◽  
pp. 1431-1441 ◽  
Author(s):  
ULRIKA KREICBERGS ◽  
UNNUR VALDIMARSDÓTTIR ◽  
ERIK ONELÖV ◽  
JAN-INGE HENTER ◽  
GUNNAR STEINECK
Keyword(s):  
Psychological Distress ◽  
Relative Risk ◽  
Confidence Interval ◽  
Stressful Life Event ◽  
Population Based ◽  
Anxiety And Depression ◽  
Control Group ◽  
Bereaved Parents ◽  
Increased Risk ◽  
Loss Of A Child

Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.

Increased Familial Cardiovascular Mortality in Obese Schoolchildren: The Muscatine Ponderosity Family Study

PEDIATRICS ◽  
1992 ◽  
Vol 89 (2) ◽  
pp. 262-268
Author(s):  
Trudy L. Burns ◽  
Patricia P. Moll ◽  
Ronald M. Lauer
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Relative Risk ◽  
Confidence Interval ◽  
Relative Weight ◽  
Death Certificates ◽  
Random Group ◽  
Blood Pressure Elevation ◽  
Increased Risk ◽  
Heavy Group

Total and cause-specific mortality was investigated in 387 first- and second-degree deceased adult relatives of three groups of children selected from those who participated in three biennial school surveys in Muscatine, Iowa: the lean group (students in the first quintile of relative weight on all three surveys); the random group (a random sample of all eligible students); and the heavy group (students in the fifth quintile of relative weight on all three surveys). A greater proportion of death certificates for heavy group relatives listed a cardiovascular cause of death (60%) compared with lean (48%) and random (43%) group relatives. The relative risk of dying of cardiovascular disease for heavy group vs random group relatives was 1.41 (95% confidence interval 1.01, 1.98). In a subset of heavy group families identified by children with elevated systolic blood pressure, the proportion of death certificates listing a cardiovascular cause was even higher (76%) and the estimate of relative risk vs random group relatives was 2.20 (95% confidence interval 1.43, 3.37). These results indicate that persistent obesity in children, particularly when accompanied by persistent blood pressure elevation, identifies families whose members are at increased risk of dying of cardiovascular disease.

scholarly journals Coffee Consumption and Risk of Dementia and Alzheimer’s Disease: A Dose-Response Meta-Analysis of Prospective Studies

Nutrients ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 1501 ◽  
Author(s):  
Susanna Larsson ◽  
Nicola Orsini
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Relative Risk ◽  
Confidence Interval ◽  
Dose Response ◽  
Prospective Studies ◽  
Linear Trend ◽  
Meta Analysis ◽  
Coffee Consumption ◽  
Increased Risk

Coffee consumption is associated with a reduced risk of several diseases but uncertainty remains about the influence of coffee consumption on the risk of dementia. We performed a dose-response meta-analysis to summarize the prospective data on coffee consumption and associated risk of dementia and Alzheimer’s disease. We identified studies by searching PubMed (from January 1966) and Web of Science (from January 1945) through 4 October 2018 and by scrutinizing the reference lists of pertinent publications. Two researchers independently reviewed the literature. Results were combined using a restricted cubic spline random-effects dose-response meta-analysis based on a one-stage approach. Eight relevant prospective studies were identified. These studies included 7486 dementia cases diagnosed among 328,885 individuals during an average follow-up of 4.9–25 years. Meta-analysis of all eight studies indicated no statistically significant association between coffee consumption and the risk of dementia and no deviations from a linear trend (p = 0.08). The relative risk of dementia per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval (CI) 0.98–1.05; p = 0.37). Meta-analysis of five studies that focused on Alzheimer’s disease revealed no association between coffee consumption and Alzheimer’s disease and no deviations from a linear trend (p = 0.79). The relative risk of Alzheimer’s disease per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval 0.95–1.07; p = 0.80). These results do not support an association between coffee consumption and an increased risk of overall dementia or Alzheimer’s disease specifically, but further research on the association of coffee consumption with dementia risk is needed.

scholarly journals Plasma Resistin Levels and Risk of Myocardial Infarction and Ischemic Stroke

2008 ◽  
Vol 93 (7) ◽  
pp. 2647-2653 ◽  
Author(s):  
Cornelia Weikert ◽  
Sabine Westphal ◽  
Klaus Berger ◽  
Jutta Dierkes ◽  
Matthias Möhlig ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Confidence Interval ◽  
High Plasma ◽  
Case Control Studies ◽  
Blood Draw ◽  
Increased Risk ◽  
Aged Subjects

Abstract Context: Resistin is a hormone that has been linked to insulin resistance, inflammatory processes, and coronary heart disease in case-control studies; however, prospective data on the association between plasma resistin levels and future risk of cardiovascular disease are lacking. Objective: The objective of the study was to investigate the association between plasma resistin levels and risk of future myocardial infarction (MI) and ischemic stroke (IS) in a large prospective cohort. Methods: We investigated the association between plasma resistin levels and risk of MI and IS in a case-cohort design among 26,490 middle-aged subjects from the European Investigation into Cancer and Nutrition-Potsdam Study without history of MI or stroke at time of blood draw. Plasma resistin levels were measured in baseline blood samples of 139 individuals who developed MI, 97 who developed IS, and 817 individuals who remained free of cardiovascular events during a mean follow-up of 6 yr. Results: After multivariable adjustment for established cardiovascular risk factors including C-reactive protein, individuals in the highest compared with the lowest quartile of plasma resistin levels had a significantly increased risk of MI (relative risk 2.09; 95% confidence interval 1.01–4.31; P for trend = 0.01). In contrast, plasma resistin levels were not significantly associated with risk of IS (relative risk 0.94; 95% confidence interval 0.51–1.73; P for trend = 0.88). Conclusion: Our data suggest that high plasma resistin levels are associated with an increased risk of MI but not with risk of IS. Further studies are needed to evaluate the predictive value of plasma resistin levels for cardiovascular disease.

Psychological Sequelae of Medical Complications During Pregnancy

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 566-571
Author(s):  
JoAnne Burger ◽  
Sarah McCue Horwitz ◽  
Brian W.C. Forsyth ◽  
John M. Leventhal ◽  
Philip J. Leaf
Keyword(s):  
Primary Care ◽  
Relative Risk ◽  
Postpartum Depression ◽  
Confidence Interval ◽  
Pregnancy Complications ◽  
Medical Complications ◽  
Community Based ◽  
Increased Risk ◽  
Interview Survey

To determine whether mothers with complicated pregnancies are at increased risk of postpartum depression and whether their children are at increased risk of being perceived as vulnerable, the investigators conducted an interview survey of mothers of 1095 children aged 4 to 8 in a community-based sample of primary care pediatric practices. The offspring were viewed as vulnerable by 17% of the women with severe pregnancy complications and 9% of the women without pregnancy complications (relative risk = 1.88; 95% confidence interval = 1.11, 2.63). Women with a severe complication of pregnancy were significantly more likely to report postpartum depression than those without a complication (27% vs 11%; relative risk = 2.45; 95% confidence interval = 1.55, 3.01). These relationships persisted after adjustment for prematurity, neonatal hospitalization, and demographic factors. It is concluded that pregnancy complications may place a woman at increased risk of postpartum depression and may have important effects on a mother's long-term perceptions of her child's vulnerability to illness.

Economy Class Syndrome: A “Pilot” Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4130-4130
Author(s):  
Sigurdur Y. Kristinsson ◽  
Brynjar Vidarsson ◽  
Thorvardur J. Love ◽  
Vilhjalmur Rafnsson ◽  
Jon Hrafnkelsson ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Personal Identification ◽  
University Hospital ◽  
P Value ◽  
Expected Number ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Medium Range ◽  
Primary Hospital

Abstract Introduction: Air travel associated venous thromboembolism (VTE) has been termed the economy class syndrome (ECS). Risk factors for ECS are divided into i) patient related; age, previous VTE, thrombophilia, malignancy and ii) cabin related; hypoxia, low humidity, dehydration and prolonged sitting. No study to date has looked at the incidence of VTE in healthy frequent flyers. The aim of this study was to see if professional pilots are at increased risk of VTE. Materials and methods: A retrospective cohort of 206 pilots working for a single airline operating on medium duration (3–7 hour) international routes from 1991–2000 was studied. Landspitali University Hospital is the only hospital serving Reykjavik, Iceland and its neighboring communities, and it is the sole primary hospital for approximately 130.000 people age 18 and over. Databases of clinical and radiographic diagnoses made at Landspitali University Hospital were searched for codes consistent with deep vein thrombosis (DVT) and pulmonary embolism (PE) occurring from 1991 to 2000. A computerized database of pilot personal identification numbers was then record linked to this VTE cohort from Landspitali University Hospital to see if any of the pilots had been diagnosed with VTE. For comparison purposes, a subgroup of the hospital database cohort and the underlying Reykjavik population was defined to match the gender and age characteristics of the pilot group. Expected number of cases with VTE among pilots was then calculated by extrapolating the observed prevalence of VTE among this subgroup to the pilot cohort. Finally, the relative risk of VTE for the pilots was calculated with p-value and 95% confidence interval. Results: Two hundred and six male pilots (median age 37 years, range 26–69) were included in the study. A total of 2263 patients were diagnosed with VTE at the Landspitali during the 10 year period, 931 with DVT and 1509 with PE, of whom 177 had both DVT and PE. There were 46,016 males aged 26 to 69 years living in the service area. Of these, 447 developed VTE. Extrapolating from the observed proportion of males age 26–69 diagnosed with VTE in the greater Reykjavik area, the expected number of VTE in the pilot cohort was found to be two. Of the 206 pilots, none was diagnosed with DVT or PE at Landspitali University Hospital during the study period. The relative risk of VTE in the pilot group was found to be 0, with no applicable lower limit to the 95% confidence interval, an upper limit of 1.83, and a p-value of 0.14. Conclusion: Professional airline pilots flying medium range distances do not have an increased risk of VTE and therefore they seem not to develop the ECS. This study does not point to an increased risk of VTE in healthy travelers in association with medium range flights.

Inter-leg systolic blood pressure difference predicts cardiovascular events and mortality in incident hemodialysis patients

2019 ◽  
Vol 43 (4) ◽  
pp. 217-224
Author(s):  
Sawako Kato ◽  
Bengt Lindholm ◽  
Abdul Rashid Qureshi ◽  
Hideyuki Mukai ◽  
Yukio Yuzawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Pressure Difference ◽  
Cardiovascular Events ◽  
Hemodialysis Patients ◽  
Cumulative Number ◽  
Blood Pressure Difference ◽  
Increased Risk

Background: High inter-arm blood pressure difference, a marker of vascular disease, may be difficult to assess in hemodialysis patients with arm arteriovenous fistulae. We investigated if high inter-leg systolic blood pressure difference associates with cardiovascular events and increased mortality in hemodialysis patients. Methods: Among 118 incident Japanese dialysis patients, bilateral leg blood pressure, arm blood pressure, brachial–ankle pulse wave velocity, and ankle–brachial index were measured, and the relative risk associated with inter-leg systolic blood pressure difference and other indices of vascular status was analyzed. Results: During follow-up (median, 46 months), 18 deaths and 75 cardiovascular events occurred in 38 patients. Kaplan–Meier curves showed that higher inter-leg systolic blood pressure difference was associated with overall (log-rank 9.35, p = 0.002) and cardiovascular (log-rank 5.81, p = 0.02) mortality. The period from the start of dialysis therapy to the first cardiovascular event was shorter as inter-leg systolic blood pressure difference increased (log-rank 23.7, p < 0.0001). In Cox hazard models, inter-leg systolic blood pressure difference greater than median independently predicted deaths (relative risk, 3.8; 95% confidence interval, 1.3–13.9) and cardiovascular events (relative risk, 3.9; 95% confidence interval, 1.9–9.21) after adjustments for age, sex, nutritional status, and diabetes, whereas other indices were not related to the risks. For well-nourished, moderately malnourished, and severely malnourished patients, the cumulative number of cardiovascular events in the high–inter-leg systolic blood pressure difference patients were 4.96, 31.44, and 55.18 events per 100 patient-years. Conclusions: Higher inter-leg systolic blood pressure difference associated with increased risk of mortality and cardiovascular events suggesting that wider application of inter-leg systolic blood pressure difference measurements may be warranted in hemodialysis patients.

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