Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience

Purpose A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs. Materials and methods Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6). Results Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches. Conclusion Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.

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Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

10.31234/osf.io/je3ch ◽

2021 ◽

Author(s):

Ekaterina Mosolova ◽

Dmitry Sosin ◽

Sergey Mosolov

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Female Gender ◽

Assessment Tools ◽

Care Workers ◽

Younger Age ◽

Wide Range ◽

Associated Risk Factors ◽

Anxiety Depression ◽

The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

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Low-pressure CSF shunt malfunction without preceding lumbar puncture treated by epidural blood patch: report of 2 cases

Child s Nervous System ◽

10.1007/s00381-020-04996-7 ◽

2021 ◽

Vol 37 (3) ◽

pp. 973-976

Author(s):

Adeline Kim ◽

Doyle Lim ◽

Joseph Piatt

Keyword(s):

Lumbar Puncture ◽

Epidural Blood Patch ◽

Low Pressure ◽

Shunt Malfunction ◽

Csf Shunt ◽

Blood Patch

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Pattern of Congenital Heart Diseases and Associated Risk Factors among Children at a Tertiary Care Hospital

10.53350/pjmhs211592451 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2451-2453

Author(s):

Shahid Iqbal ◽

Muhammad Fareed Khan ◽

Raja Imtiaz Ahmed ◽

Shahab Saidullah ◽

Nisar Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Folic Acid ◽

Congenital Heart ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Febrile Illness ◽

Care Hospital ◽

Younger Age ◽

History Of ◽

Associated Risk Factors

Objective: To find out the pattern of CHD and associated risk factors among children presenting at a tertiary care hospital. Study Design: A case-control study. Place and Duration of the Study: The Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to June 2021. Material and Methods: A total of 207 children of both genders, screened by ECG along with chest x-ray and further confirmed with the diagnosis of CHD through echocardiography were enrolled as cases. Same number of healthy controls (n=207) were recruited from immunization center of the study institution. Among cases, types of CHD were noted. For cases and controls, demographic, antenatal and maternal risk factors including maternal age, gender of the child, history of consanguinity, history of febrile illness in pregnancy, use or multi-vitamin or folic acid in pregnancy, bad obstetrical history and maternal diabetes mellitus were noted. Results: In a total of 414 children (207 cases and 207 controls), there were 219 (53.8%) male. In terms of CHD types among cases, VSD was the most noted in 62 (30.0%), ASD 35 (16.9%), TOF 33 (15.9%) and PDA in 30 (14.5%). Cases were found to have significant association with younger age (78.3% cases below 1 year of age vs. 64.7% in controls, p=0.0085), bad obstetrical history (p=0.0002), history of febrile illness in 1st trimester of pregnancy (p=0.0229) and lack of multivitamins and folic acid in the 1st trimester of pregnancy (p=0.0147). Conclusion: Majority of the children with CHDs were male and aged below 1 year. VSD, ASD, TOF and PDA were the most frequent types of CHD. Younger age, bad obstetrical history, history of febrile illness in 1st trimester of pregnancy and lack of multivitamins and folic acid in the 1st trimester of pregnancy were found to have significant association with CHDs among children. Keywords: Congenital heart disease, echocardiography, ventricular septal defect.

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Study of Risk Factors for Conegnital Heart Defect in a Tertiary Level Hospital

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i1.38946 ◽

2018 ◽

Vol 27 (1) ◽

pp. 51-56

Author(s):

Ferdousi Hossain Poly ◽

Syeda Afroza ◽

Hasanur Rahman ◽

Md Imran Hassan

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Maternal Age ◽

Congenital Heart ◽

Heart Defects ◽

Medical College ◽

History Of ◽

The Difference

A congenital heart defect is a heart problem which is present at birth, caused by improper development of the heart during fetal development. In majority of cases there is no known reason for the heart to develop improperly. Some type of congenital heart defects are related to chromosomal abnormality(5-6%), some are to single gene defect(3-5%) or environmental factors(2%). In 85-90% of cases there is no identifiable cause and are generally considered to be caused by multifactorial inheritance. There are some maternal factors which have some role in cardiovascular malformations. These include high maternal age(above 30 years), maternal obesity, consanguinity among the parents, fever during pregnancy, gestational diabetes mellitus, smoking, alcohol consumption, ingestion of any teratogenic drug including homeopathy and herbal medicine. Objective of the study: To evaluate the risk factors associated with congenital heart disease. Methodology: A case control study was conducted at paediatric department of Sir Salimullah Medical College & Mitford Hospital following approval of the protocol from 1st January 2013 to 30th June 2014. Children fulfilling the inclusion criteria-(0-5 year old children of both sexes admitted in paediatric units of Mitford Hospital with any type of congenital heart disease confirmed by echocardiography) were considered as cases. A similar number of age and sex matched children admitted in Mitford Hospital without any cardiac defect were considered as controls. Data were collected by questionnaire. Results: The results show that majority of the cases are male. Maternal age (27.09 ± 4.63) and BMI (24.10 ± 2.28) both are significantly higher in cases than those of controls. Among the cases 31.8% mothers had consanguineous marriage (p=0.001) and 27.1% mothers had history of fever during pregnancy whereas it was present in 9.3% mothers of controls, the difference is significant statistically (p=0.001). Among the cases 34.6% mothers had history of gestational diabetes mellitus and only 18.9% controls had so and the difference is significant statistically (p=0.014). Conclusion: Relatively old age and more weight during pregnancy, consanguinity between parents, fever during pregnancy, history of gestational diabetes mellitus are the main risk factors of congenital heart defects in children J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 51-56

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ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ФАКТОРІВ РИЗИКУ

Medical Informatics and Engineering ◽

10.11603/mie.1996-1960.2012.1.173 ◽

2012 ◽

Author(s):

І. К. Чурпій

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Pulmonary Embolism ◽

High Risk ◽

Significant Risk ◽

Female Gender ◽

Electrolyte Composition ◽

Terminal Phase ◽

Phase Flow ◽

History Of

<p>To optimize the therapeutic tactics and improve the treatment of peritonitis on the basis of retrospective analysis there are determined the significant risk factors: female gender, age 60 – 90 years, time to hospitalization for more than 48 hours, a history of myocardial infarction, stroke, cardiac arrhythmia, biliary, fecal and fibrinous purulent exudate, the terminal phase flow, operations with resection of the intestine and postoperative complications such as pulmonary embolism, myocardial infarction, pleurisy, early intestinal obstruction. Changes in the electrolyte composition of blood and lower albumin <35 % of high risk prognostic course of peritonitis that requires immediate correction in the pre-and postoperative periods. The combination of three or more risk factors for various systems, creating a negative outlook for further treatment and the patient's life.</p>

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Adult Victimization over Time

In the Fullness of Time ◽

10.1093/med-psych/9780195370607.003.0016 ◽

2018 ◽

pp. 171-174

Author(s):

Mary C. Zanarini

Keyword(s):

Risk Factors ◽

Sexually Abused ◽

Female Gender ◽

Physical Assault ◽

Clinical Implications ◽

Axis Ii ◽

Borderline Patients ◽

History Of ◽

Over Time

At baseline, borderline patients reported higher rates of adult rape and physical assault by a partner than Axis II comparison subjects. Four risk factors were found to significantly predict whether borderline patients had an adult history of being a victim of physical and/or sexual violence before their index admission: female gender, a substance use disorder that began before the age of 18, childhood sexual abuse, and emotional withdrawal by a caretaker (a form of neglect). At six-year and 10-year follow-up, borderline patients reported higher rates of being verbally, emotionally, physically, and sexually abused or assaulted than did Axis II comparison subjects. However, each of these forms of abuse declined significantly over time. The clinical implications of these prevalence and predictive findings are discussed.

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Gender differences in acute coronary events

American Journal of Critical Care ◽

10.4037/ajcc2000.9.3.207 ◽

2000 ◽

Vol 9 (3) ◽

pp. 207-209 ◽

Cited By ~ 7

Author(s):

KB Keller ◽

L Lemberg

Keyword(s):

Risk Factors ◽

Gender Differences ◽

Early Detection ◽

Early Death ◽

Female Gender ◽

The United States ◽

Vascular Events ◽

Aggressive Therapy ◽

The Difference ◽

Coronary Events

The most frequent cause of death among women in the United States is coronary heart disease, which claims 200,000 lives a year. The prognosis with either medical or surgical therapy is worse in females than in males. The following significant gender differences have been observed and reported: (1) the rate of early death following acute myocardial infarction is greater in women, (2) the difference between sexes remains whether or not thrombolytic therapy is used, and (3) the hospital mortality rate following coronary angioplasty, atherectomy, or bypass surgery is greater in females. The reasons for these gender differences are not clearly understood. Nevertheless, awareness of the higher morbidity and mortality in women dictates the need for early detection and more aggressive therapy of the risk factors. However, diabetes mellitus and essential hypertension are 2 well-established major risk factors for coronary disease and stroke that are more prevalent in the female gender. These 2 risk factors are cumulative and require more intensive and aggressive therapy to prevent acute vascular events, and therefore early detection is mandatory.

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Relapse predictors and serologically unstable condition of IgG4-related disease: a large Chinese cohort

Rheumatology ◽

10.1093/rheumatology/kez669 ◽

2020 ◽

Vol 59 (8) ◽

pp. 2115-2123 ◽

Cited By ~ 1

Author(s):

Yanying Liu ◽

Qiaozhu Zeng ◽

Lijuan Zhu ◽

Jingyuan Gao ◽

Ziqiao Wang ◽

...

Keyword(s):

Risk Factors ◽

Relapse Rate ◽

Unstable Condition ◽

Serum Igg4 Level ◽

Related Disease ◽

Igg4 Related Disease ◽

Younger Age ◽

Serum Igg4 ◽

History Of ◽

Igg4 Level

Abstract Objectives Patients with IgG4-related disease (IgG4-RD) typically respond well to initial glucocorticoid therapy, but always relapse with tapered or maintenance dosage of steroid. We aimed to identify the risk factors for relapse of IgG4-RD and explore the impact of active intervention on the serologically unstable condition. Methods We performed a retrospective study of 277 IgG4-RD patients at Peking University People’s Hospital from February 2012 through February 2019. They were all followed for >4 months. The primary outcome was patient relapse. Data on recurrence of IgG4-RD symptoms, laboratory and image findings were recorded, along with information on treatment in the serologically unstable condition. Results The cumulative relapse rate was 12.86%, 27.84% and 36.1% at 12, 24 and 36 months, respectively. Younger age at onset, younger age at diagnosis, longer time from diagnosis to treatment and history of allergy were associated with relapse. Identified independent risk factors were longer time from diagnosis to treatment and history of allergy. When serum IgG4 level was 20%, 50% or 100% higher than that of the remission period, similar percentages of patients finally relapsed, regardless of whether they were in the immunosuppression intensified or non-intensified group. Median duration from serum IgG4 level instability to relapse in the intensified and non-intensified group was not statistically different. Conclusion The risk factors of relapse were longer time from diagnosis to treatment and history of allergy. Intervention in the serologically unstable condition was not helpful for reducing relapse rate.

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Risk factors of vitamin K antagonist overcoagulation

Thrombosis and Haemostasis ◽

10.1160/th08-04-0265 ◽

2008 ◽

Vol 100 (10) ◽

pp. 685-692 ◽

Cited By ~ 11

Author(s):

Gwenaëlle Cadiou ◽

Rémi Varin ◽

Hervé Levesque ◽

Vanessa Grassi ◽

Jacques Benichou ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Medical History ◽

Vitamin K ◽

Female Gender ◽

Vitamin K Antagonist ◽

High Morbidity ◽

Duration Of Hospitalization ◽

History Of ◽

Previous Medical History

SummaryThe aims of this case-control study were to identify in vitamin K antagonist (VKA)-treated unselected patients, factors associated with international normalised ratio (INR) values: (i) greater than 6.0.;and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. During a two-month period, 4,188 consecutive and unselected patients were referred to our Emergency Department. At admission, the medical records of each patient and two age- and sex-matched controls were reviewed for: both duration and indication of VKA therapy, previous medical history of VKA-related haemorrhage, underlying co-morbidities, concomitant medications other than VKA, duration of hospitalization and deaths’ causes. Of these 4,188 subjects,50 case-patients (1.19%) were identified; both case-patients and controls did not differ as regards indications and patterns of VKA therapy. Interestingly, two-thirds of case-patients were women, suggesting that female gender may be a risk factor of VKA over-coagulation onset. We identified the following risk factors of VKA over-coagulation: previous medical history of INR levels over therapeutic range, therapy with antibiotics, amiodarone and proton pump inhibitors, as well as fever. A total of 88% of case-patients were hospitalized; mean duration of patients’ hospitalization was seven days [range:1–56 days];no patient died from major bleeding. Our study underscores that it is of utmost importance to consider the strength of indication before starting VKA therapy, as this therapy has been responsible for as high as 1.19% of admissions in unselected subjects referred to an Emergency Department. Our data therefore suggest that internists should be aware of VKA-related high morbidity, particularly in situations at risk of VKA over-coagulation.

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