Outcomes after endovascular embolization for the treatment of nasal and oropharyngeal hemorrhage: safety, efficacy, and rebleeding

Background Intractable nasal and oropharyngeal hemorrhage may be treated with endovascular embolization, but limited data are available. We sought to evaluate the efficacy, safety, and factors associated with rebleeding. Methods A retrospective analysis of consecutive embolizations for nasal and oropharyngeal hemorrhage over a 10-year period at a single institution was performed. Outcomes included procedural success (defined as cessation of hemorrhage in the immediate postoperative period), rebleeding requiring an additional intervention, and procedural complications. Results A total of 47 embolizations on 39 patients were included. The mean age was 60 years (standard deviation 16.1), 23.1% of patients were women, and 21 (53.8%) patients had a previously diagnosed head/neck malignancy. Bleeding sites were the nose in 20 patients and oropharynx in 21 (two patients presented with both nasal and oral bleeding). Immediate procedural success was achieved in 45 (95.7%) embolizations. Rebleeding requiring an additional intervention occurred after 11 (23.4%) embolizations at a median of one day after the procedure. In the multivariate analysis, preoperative hypotension (odds ratio 4.78, 95% confidence interval 1.04–24.61) and the use of coils (odds ratio 6.09, 95% confidence interval 1.24–46.69) were associated with rebleeding requiring repeat intervention. Complications included two watershed strokes that were anticipated due to occlusion of the internal carotid artery. Conclusions In our experience endovascular embolization was a safe and effective treatment option for stopping oral and nasal hemorrhage. However, rebleeding was present after 23.4% of treatments and was associated with preoperative hypotension and the use of coils. Further study in a large multi-institutional cohort is warranted.

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Prevalence and risk factors of Neospora caninum infection in ovine flocks of central-western Mexico

Acta Veterinaria Hungarica ◽

10.1556/004.2019.006 ◽

2019 ◽

Vol 67 (1) ◽

pp. 51-59 ◽

Cited By ~ 1

Author(s):

Jesús Manuel Romo-Gallegos ◽

Carlos Cruz-Vázquez ◽

Leticia Medina-Esparza ◽

Miguel Ramos-Parra ◽

Dora Romero-Salas

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Odds Ratio ◽

Animal Species ◽

Neospora Caninum ◽

Domestic Animal ◽

Caninum Infection ◽

Blood Samples ◽

Western Mexico ◽

The Mean

This study, carried out in 13 sheep flocks of central-western Mexico, aimed to identify the prevalence of anti-N. caninum antibodies, to develop a risk analysis of the infection and to estimate the prevalence of parasite DNA in blood. A total of 368 serum and blood samples were subjected to ELISA and PCR tests, respectively, and the association between the prevalence of antibodies and some management factors was estimated. The overall prevalence of anti-N. caninum antibodies was 13.5% [50/368; 95% confidence interval (CI) 10–17], ranging from 2.7 to 90% per flock, and 92% of the farms had seropositive animals. In ewes the prevalence was 14% (48/348, 95% CI 10–17) and in rams 10% (2/20; 95% CI 1– 33). The mean prevalence of Neospora DNA in blood was 27% (99/368, 95% CI 22–31), implying a range between 16 and 82%. In rams, the prevalence was 5% (1/20 95% CI 2–26), while in ewes it was 28% (98/348, 95% CI 23–33). The agreement between the tests was k = 0.19. The presence of other domestic animal species in the farms [odds ratio (OR) 4.4] and the consumption of placental debris, fetuses and stillborn lambs by dogs living in the farms (OR 5.8) were demonstrated to be risk factors.

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Status of dental caries and associated factors in Tibetan adults: findings from the fourth China National Oral Health Survey

BMC Oral Health ◽

10.1186/s12903-020-01225-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lingxia Guan ◽

Jing Guo ◽

Jinghao Ban ◽

Gang Li ◽

Juan Tong ◽

...

Keyword(s):

Oral Health ◽

Dental Caries ◽

Confidence Interval ◽

Health Survey ◽

Odds Ratio ◽

Associated Factors ◽

Tooth Brushing ◽

Root Caries ◽

The Status ◽

The Mean

Abstract Background Tibet, a region where average elevation is above 3500 m and socio-economic development is relatively lower, was not included in National Oral Health Survey over decades. The cross-sectional study aimed to investigate the status of dental caries and associated factors in Tibetan adults. Methods Participants aged 35–44, 55–64 and 65–74 years were selected. Decayed, missing, and filled tooth (DMFT), decayed and filled root (DF-Root) and root canal index (RCI) were used to evaluate dental caries. Questionnaire survey on demographic information, socioeconomic status, dietary habits, and oral health knowledge and behavior was conducted. Mann-Whitney U test, logistic regression were used for the statistical analyses. Results A total of 446 participants were enrolled in the survey. Of these: 222 (49.8%) were females, 224 (50.2%) were males; 149 (33.4%), 151 (33.9%), 146 (32.7%) were aged 35–44, 55–64 and 65–74 years respectively. The mean DMFT (SD) was 7.62 (4.84), 12.46 (8.16), and 21.38 (8.93). The filling rate was very low in all age groups (1.77%, 0.98%, 0.45%). The mean DF-Root (SD) was 0.50 (1.04), 1.04 (2.02), 1.32 (2.14), respectively. Root caries index was 42.27, 44.78 and 57.60%. Older age (65–74 age group) was positively associated with crown caries (odds ratio = 31.20, 95% confidence interval: 10.70–90.96). College degree and above and brushing teeth at least once a day were negatively associated with crown caries (odds ratio = 0.28, 95% confidence interval: 0.09–0.89; odds ratio = 0.39, 95% confidence interval: 0.21–0.72, respectively). Rural area, high income level and brushing teeth at least once a day were negatively and tooth with attachment loss was positively associated with root caries. Conclusions The status of dental caries in the adults in Tibet is severe and the treatment rate is very low. The study suggests a correlation between crown caries and the variables age, level of education and frequency of tooth brushing; correlation between root caries and residence, income level, frequency of tooth brushing and exposed root surfaces. These findings could be as reference to develop community based interventions to reduce the prevalence of caries in Tibet.

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Incidence and Risk Factors for Vancomycin Nephrotoxicity in Acutely Ill Pediatric Patients

Journal of Pharmacy Technology ◽

10.1177/8755122517747088 ◽

2017 ◽

Vol 34 (1) ◽

pp. 9-16 ◽

Cited By ~ 4

Author(s):

Henock Woldu ◽

B. Joseph Guglielmo

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Serum Creatinine ◽

Odds Ratio ◽

Kidney Injury ◽

Severe Toxicity ◽

Vancomycin Trough ◽

Trough Concentrations ◽

The Mean ◽

Mean Time

Background: Particularly with the current increased vancomycin dosing trends, the true risk of the agent’s nephrotoxicity is not well characterized and remains of concern. Objective: To determine the incidence of vancomycin nephrotoxicity in acutely ill hospitalized children and to secondarily characterize the risk factors for this complication. Methods: A single-center retrospective cohort study conducted at UCSF Benioff Children’s Hospital from June 2012 to June 2015. Inpatients 3 months to <19 years who received intravenous vancomycin for ≥48 hours were included. The primary outcome was incidence of nephrotoxicity, defined as an increase in serum creatinine by ≥50% from baseline. Univariate and multivariate analyses were conducted to identify risk factors for vancomycin nephrotoxicity. Results: A total of 291 patients (272 nonnephrotoxic and 19 nephrotoxic) were included in the analysis. Of the 19 patients, 12 (4.1%) were found to have moderate to severe toxicity. The median duration of therapy was 3 (3-5) and 4 (3-6) days for the group with “no nephrotoxicity” and “nephrotoxicity,” respectively. The mean time for the serum creatinine to return to normal in patients with nephrotoxicity was 5.1 days. In the multivariate analysis, only final trough concentration ≥15mg/dL (odds ratio = 3.49, 95% confidence interval = 1.2-10.1; P = .021) and receipt of piperacillin/tazobactam (odds ratio = 3.14, 95% confidence interval = 1.02-9.6; P = .046) were significantly associated with nephrotoxicity. Conclusion: The rate of moderate to severe vancomycin-associated nephrotoxicity in acutely ill children is relatively uncommon and reversible. Kidney injury is associated with increased vancomycin trough concentrations and concomitant receipt of nephrotoxins, particularly piperacillin/tazobactam.

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Blood Pressure Association with Sodium Intake from Snacks Among Undergraduates of Afe Babalola University, Nigeria

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_003 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 152-152

Author(s):

Kayode Ajayi ◽

Ibidayo Alebiosu

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Body Mass ◽

Odds Ratio ◽

Sodium Intake ◽

Metabolic Equivalent ◽

The Mean

Abstract Objectives The aim of the study was to assess the association between blood pressure (BP) values and sodium intake from snacks. Methods The mean weekly consumption of snacks was evaluated in 1500 randomly selected undergraduate aged 16–24 years by a food frequency questionnaire. Participants were divided into quartiles of systolic blood pressure and diastolic blood pressure. The mean weekly exercise level was calculated as the product of duration and frequency of each activity (in hours/week), weighted by an estimate of the metabolic equivalent of the activity (MET) and summed for the activities performed. The whole cohort was divided into tertiles of exercise and the individuals were classified as; sedentary, moderately active and active. The cut of points in the whole cohort were respectively; ≤10, 11–29, ≥30 MET h/week. Exercise levels were therefore expressed as MET h/week. Results The mean age, metabolic equivalent of activity (METs), body mass index (BMI) and mean sodium intake from snacks per day were; 20.10 ± 1.44 years, 25.51 ± 10.03 METs h/week, 24.86 ± 4.80 kg/m2 and 1.5 g/day respectively. Systolic blood pressure (SBP) ranges between 104.43 ± 4.89 mmHg and 137.27 ± 16.71 mmHg while the diastolic blood pressure (DBP) ranges from 71.24 ± 7.83–83.11 ± 12.03 mmHg. The SBP and DBP significantly increased from the lower to the higher tertile of sodium from snacks and with increasing frequency of salty snacks consumption (P < 0.001). In the multiple logistic regression model, being in the highest SBP quartile (≥115 mmHg) was significantly associated with consumption of sodium from snacks (odds ratio (OR) = 1.46; 95% confidence interval (CI) 1.13–1.82; P = 0.001), age, gender and body mass index. Also, being in the highest DBP quartile (≥70 mmHg) was significantly associated with consumption of sodium from snacks (odds ratio (OR) = 2.84; 95% confidence interval (CI) 1.41–5.69; P = 0.003), age, body mass index, but not with gender. Conclusions The study has shown that a strong association exists between sodium intake from snack, daily frequency of consumption of salty snacks and blood pressure. Public education and social marketing are needed to motivate the undergraduate to choose healthier snacks with lower sodium content. Funding Sources The study did not receive any funding from any source.

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Abstract WP220: The Effect of Self-Reported Optimism on the Incidence of Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp220 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ahmed Malik ◽

Haseeb Rahman ◽

Adnan Qureshi ◽

Martha A Wojtowycz

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Standard Deviation ◽

Confidence Interval ◽

Stroke Prevention ◽

Odds Ratio ◽

Categorical Variables ◽

The Mean ◽

Baseline Characteristics

Purpose: The purpose of this study is to determine whether having an optimistic outlook on life decreases the risk of developing incident stroke. Methods: Participants who developed incident stroke in Americans’ Changing Lives study, and participants who did not develop incident stroke (dependent variable) in were compared for demographics, baseline characteristics, comorbidities, and optimistic outlook on life. Numbers and proportions of respondents in both groups were reported for all categorical variables, while mean and standard deviation were reported for age. All statistically significant variables from the above analyses were entered into a logistic regression analysis to ascertain the association between optimistic outlook on life and stroke. Results: Of the 98,577,928 participants, 73,040,055 did not have stroke at baseline. There were 599,190 who developed incident stroke and 1,104,751 who did not develop incident stroke. The mean age (standard deviation) was lower in those who developed incident stroke compared to those who did not [45.9 (13.8) vs. 46.4 (9.9) p<.0001], and participants with an optimistic outlook on life, were 0.20 times less likely to develop stroke as those who did not have an optimistic outlook on life [OR (Odds ratio) 0.20 95% CI (95% confidence interval) 0.20,0.21], after adjusting for confounders. Conclusions: People who have an optimistic outlook on life are less likely to develop incident stroke. The protective value of optimism lends credence to the value of targeting unconventional risk factors in stroke prevention.

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Factors Affecting Resolution of Subretinal Fluid After Selective Retina Therapy for Central Serous Chorioretinopathy

10.21203/rs.3.rs-253890/v1 ◽

2021 ◽

Author(s):

Manabu Yamamoto ◽

Akika Kyo ◽

Kumiko Hirayama ◽

Takeya Kohno ◽

Dirk Theisen-Kunde ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Central Serous Chorioretinopathy ◽

Subretinal Fluid ◽

Rate Of Change ◽

Factors Affecting ◽

Selective Retina Therapy ◽

Significant Difference ◽

The Mean

Abstract The purpose of this study was to investigate the factors of clinical outcome of selective retina therapy (SRT) for central serous chorioretinopathy (CSC). This retrospective study included 77 eyes of 77 patients, who were treated with SRT for CSC and observed at least 6 months after the treatment. SRT laser (527 nm, 1.7 µs, 100 Hz) was used for treatment. The mean best-corrected visual acuity (BCVA) (logMAR), central macular thickness (CMT) and central choroidal thickness were changed from baseline to at 6-months follow-up with significant difference. The multivariate analyses found that the rate of change (reduction) in CMT was associated with focal leakage type on fluorescein angiography (FA) (p = 0.03, coefficient 15.26, 95% confidence interval 1.72 – 28.79) and larger baseline CMT (p < 0.01, coefficient -0.13, 95% confidence interval -0.13 – -0.05). Complete resolution of subretinal fluid was associated with nonsmoking history (p = 0.03, odds ratio 0.276, 95% confidence interval 0.086 – 0.887) and focal leakage type on FA (p < 0.01, odds ratio 0.136, 95% confidence interval 0.042 – 0.437). This result may be useful for predicting the therapeutic effectiveness of SRT.

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Preoperative scar perception study comparing ‘scarless’ in the neck endoscopic thyroidectomy with open thyroidectomy: a cross-sectional study

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0174 ◽

2020 ◽

Vol 102 (9) ◽

pp. 737-743

Author(s):

TY Qiu ◽

JWL Lau ◽

O Wong ◽

HB Oh ◽

TW Boon ◽

...

Keyword(s):

Body Image ◽

Confidence Interval ◽

Surgical Approach ◽

Thyroid Surgery ◽

Odds Ratio ◽

Endoscopic Thyroidectomy ◽

Open Thyroidectomy ◽

Body Image Scale ◽

The Mean ◽

Perception Score

Introduction Open thyroidectomy is the most common approach to thyroid surgery. However, ‘scarless’ (in the neck) endoscopic thyroidectomy, consisting of endoscopic and robotic surgery, is progressively being adopted for its perceived cosmetic benefits. This study aims to determine the patient’s preferred surgical approach and to identify the factors that influence their decision. Materials and methods A pilot study consisting of 100 patients with a surgical thyroid disorder were prospectively recruited from a single tertiary centre. An interviewer-administered survey was conducted. Demographic, socioeconomic status, scar perception and an adapted body image scale were evaluated to identify factors that shaped the patient’s perception of the surgical approach. Results The mean age of participants was 54.5 ± 13.0 years; 72% were women and 87% Chinese. Of the 100 patients, 75 patients considered scarless endoscopic thyroidectomy as their preferred surgical approach while 25 patients opted for open thyroid surgery. Improvement in scar perception score between scarless endoscopic thyroidectomy and open thyroid surgery is associated with an increased willingness to choose scarless endoscopic thyroidectomy. The mean body image scale score was 6.9 ± 2.8, indicating no statistical difference between the surgical approaches. On multivariate analysis, improvement in scar perception score (odds ratio 3.38, 95% confidence interval 1.11–10.29) and having surgeon recommendation (odds ratio 6.38, 95% confidence interval 1.80–22.63) were independently associated with interest in scarless endoscopic thyroidectomy. Conclusion Patients interest in undergoing scarless endoscopic thyroidectomy is driven by improved scar perception and surgeon’s recommendation compared with open thyroid surgery.

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Meta-analysis of the efficacy of sexual intercourse for distal ureteric stones

Journal of International Medical Research ◽

10.1177/0300060518814116 ◽

2019 ◽

Vol 47 (2) ◽

pp. 497-504 ◽

Cited By ~ 1

Author(s):

Bin Xu ◽

Huilei Yan ◽

Xuebao Zhang ◽

Yuanshan Cui

Keyword(s):

Confidence Interval ◽

Sexual Intercourse ◽

Odds Ratio ◽

Meta Analysis ◽

Ureteral Stones ◽

Controlled Trials ◽

Expulsion Rate ◽

Randomized Controlled ◽

The Mean ◽

Distal Ureteric Stones

Objective This meta-analysis was performed to evaluate the efficacy of sexual intercourse for treatment of distal ureteral stones. Methods Randomized controlled trials (RCTs) of sexual intercourse for treatment of distal ureteral stones were searched using PubMed, EMBASE, and the Cochrane Controlled Trials Register. Results Three RCTs comprising 240 patients were included in the meta-analysis, which showed that sexual intercourse was effective in treating distal ureteral stones. The expulsion rate of distal ureteral stones at the second week (odds ratio [OR] = 6.61, 95% confidence interval [CI]: 3.66 to 11.94), expulsion rate of distal ureteral stones at the fourth week (OR = 4.00, 95% CI: 2.09 to 7.64), and number of analgesic injections (mean difference [MD] = −0.79, 95% CI: −1.51 to −0.08) indicated that sexual intercourse was more effective than placebo. However, the mean expulsion time of distal ureteral stones (MD = −3.98, 95% CI: −8.77 to 0.81) showed no difference between sexual intercourse and placebo. Conclusions Compared with placebo, sexual intercourse exhibited greater efficacy for the treatment of distal ureteral stones, whilst potentially alleviating pain.

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Brain oxygen tension and outcome in patients with aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2008.109.12.1075 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1075-1082 ◽

Cited By ~ 47

Author(s):

Rohan Ramakrishna ◽

Michael Stiefel ◽

Joshua Udoteuk ◽

Alejandro Spiotta ◽

Joshua M. Levine ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Pressure ◽

Confidence Interval ◽

Oxygen Tension ◽

Odds Ratio ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Hypoxia ◽

Brain Oxygen ◽

The Mean ◽

The Relationship

Object Poor outcome is common after aneurysmal subarachnoid hemorrhage (SAH). Clinical studies suggest that cerebral hypoxia after traumatic brain injury is associated with poor outcome. In this study we examined the relationship between brain oxygen tension (PbtO2) and death after aneurysmal SAH. Methods Forty-six patients, including 34 women and 12 men (Glasgow Coma Scale Score ≤ 8 and median age 58.5 years) who underwent PbtO2 monitoring were studied prospectively during a 2-year period in a neurosurgical intensive care unit at a University Level I Trauma Center. Brain oxygen tension, intracranial pressure (ICP), mean arterial pressure, cerebral perfusion pressure (CPP), and brain temperature were continuously monitored, and treatment was directed toward ICP, CPP, and PbtO2 targets. The relationship between PbtO2 and 1-month survival was examined. Results Data were available from 5424 hours of PbtO2 monitoring. For the entire cohort the mean ICP, CPP, and PbtO2 were 13.85 ± 2.40, 84.05 ± 3.41, and 30.79 ± 1.91 mm Hg, respectively. Twenty-five patients died (54%). The mean daily PbtO2 was higher in survivors than nonsurvivors (33.94 ± 2.74 vs 28.14 ± 2.59 mm Hg; p = 0.05). In addition, survivors had significantly shorter episodes of compromised PbtO2 (defined as 15–25 mm Hg) than nonsurvivors (125.85 ± 15.44 vs 271.14 ± 55.23 minutes; p < 0.01). Intracranial pressure was similar in survivors and nonsurvivors. In contrast, the average CPP was significantly lower in nonsurvivors than survivors (76.96 ± 5.50 vs 92.49 ± 2.75 mm Hg; p = 0.01). When PbtO2 was stratified according to CPP level, survivors had higher PbtO2 levels. Following logistic regression, the number of episodes of compromised PbtO2 (odds ratio 1.1, 95% confidence interval 1.003–1.2) and number of episodes of cerebral hypoxia (< 15 mm Hg; odds ratio 1.3, 95% confidence interval 1.0–1.7) were more frequent in those who died. Conclusions Patient deaths after SAH may be associated with a lower mean PbtO2 and longer periods of compromised cerebral oxygenation than in survivors. This knowledge may be used to help direct therapy.

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Psychosocial determinants of nurses’ intention to practise euthanasia in palliative care

Nursing Ethics ◽

10.1177/0969733014557117 ◽

2014 ◽

Vol 23 (1) ◽

pp. 48-60 ◽

Cited By ~ 12

Author(s):

Mireille Lavoie ◽

Gaston Godin ◽

Lydi-Anne Vézina-Im ◽

Danielle Blondeau ◽

Isabelle Martineau ◽

...

Keyword(s):

Palliative Care ◽

Confidence Interval ◽

Odds Ratio ◽

Cross Sectional Study ◽

Moral Norm ◽

Ethical Considerations ◽

Cross Sectional ◽

Psychosocial Determinants ◽

Centre Hospitalier Universitaire ◽

The Mean

Background: Most studies on euthanasia fail to explain the intentions of health professionals when faced with performing euthanasia and are atheoretical. Research objective: The purpose of this study was to identify the psychosocial determinants of nurses’ intention to practise euthanasia in palliative care if it were legalised. Research design: A cross-sectional study using a validated anonymous questionnaire based on an extended version of the Theory of Planned Behaviour. Participants and research context: A random sample of 445 nurses from the province of Quebec, Canada, was selected for participation in the study. Ethical considerations: The study was reviewed and approved by the Ethics Committee of the Centre hospitalier universitaire de Québec. Findings: The response rate was 44.2% and the mean score for intention was 4.61 ± 1.90 (range: 1–7). The determinants of intention were the subjective (odds ratio = 3.08; 95% confidence interval: 1.50–6.35) and moral (odds ratio = 2.95; 95% confidence interval: 1.58–5.49) norms. Specific beliefs which could discriminate nurses according to their level of intention were identified. Discussion: Overall, nurses have a slightly positive intention to practise euthanasia. Their family approval seems particularly important and also the approval of their medical colleagues. Nurses’ moral norm was related to beneficence, an ethical principle. Conclusion: To our knowledge, this is the first study to identify nurses’ motivations to practise euthanasia in palliative care using a validated psychosocial theory. It also has the distinction of identifying the ethical principles underlying nurses’ moral norm and intention.

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