scholarly journals Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pathology (166)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0028
Author(s):  
Clarabelle DeVries ◽  
James Bomar ◽  
Andrew Pennock
Keyword(s):  
General Population ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patellofemoral Pain ◽  
High Grade ◽  
Sulcus Angle ◽  
Increased Risk ◽  
History Of ◽  
Total Knee ◽  
The Mean

Objectives: Patellar instability is a common condition of adolescents with an incidence of 29 to 43 per 100,000. Trochlear dysplasia has been found in up to 85% of those with recurrent patellar instability and has been found in association with ACL rupture. However, the prevalence of trochlear dysplasia in the general population has not yet been defined. The purpose was to define the prevalence of trochlear dysplasia as defined by ultrasound in a skeletally mature population and characterize associations of trochlear dysplasia with patellofemoral pathology. Methods: Skeletally mature adolescents and parents aged 50 and under presenting to orthopedics clinics were recruited from 2019 to 2020. Those with a history of intra-articular fracture, total knee arthroplasty, and syndromic ligamentous laxity or neuromuscular disease were excluded. Surveys were collected detailing any history of knee symptoms and surgery as well as an abbreviated Anterior Knee Pain Score (AKPS) with a score of 4 or greater being considered positive. Ultrasounds were obtained of bilateral knees and the osseous sulcus angle of the trochlea as well as the trochlear depth were measured (Figure 1). Basic descriptive statistics are reported. Results: One hundred and two patients (203 knees) were studied. The mean osseous sulcus angle was 144.1±6.8° and the mean trochlear depth was 5.5±1.4mm. The distribution of outcomes of interest can be found in Table 1. High grade trochlear dysplasia was defined as two standard deviations from the mean which was shown to be a sulcus angle ≥158˚ or a trochlear depth of ≤3mm. Prevalence of high grade trochlear dysplasia based on sulcus angle was 3.0% and 5.9% based on trochlear depth. In the presence of high grade trochlear dysplasia as defined by osseous sulcus angle, there was a 32 times increased risk of previous patellar instability (p=0.007) and 10 times increased risk of a positive AKPS (p=0.016). All those with high grade trochlear dysplasia as defined by osseous sulcus angle had a history of, or current, patellofemoral pain. Conclusions: The prevalence of trochlear dysplasia in the general population is approximately 6%. There are significant associations of trochlear dysplasia not only with patellar instability but also with patellofemoral pain. Use of ultrasound to diagnose trochlear dysplasia may prove to be a rapid and useful tool in guiding patient education and treatment decisions.

scholarly journals Trochlear dysplasia - congenital anomaly or biomechanical development

2018 ◽  
Vol 71 (3-4) ◽  
pp. 96-99
Author(s):  
Zlatko Temelkovski ◽  
Zoran Bozinovski ◽  
Alan Andonovski ◽  
Biljana Andonovska
Keyword(s):  
Knee Flexion ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Breech Presentation ◽  
Trochlear Groove ◽  
Mechanical Theory ◽  
Predisposing Factor ◽  
Sulcus Angle ◽  
Pathologic Findings ◽  
The Mean

Introduction. The aim of this study was to investigate the appearance of the trochlear groove in infants and to present the possible causes for the development of trochlear dysplasia as one of the most severe pathologic findings in patients with patellar instability. Material and Methods. Knee ultrasonography was performed in 200 infants, 3 to 6 months of age. The measurements were made at 30 and 60 degrees of knee flexion, in order to measure the trochlear bone and cartilaginous sulcus angle on the patellar surface of the femur and to determine the degree of trochlear dysplasia. A 7-megahertz probe was used for measurements, which was tangentially placed with the reference to the posterior femoral joint. Results. A completely flat trochlear bony sulcus angle was registered in all infants aged 3 to 6 months. The mean cartilaginous sulcus angle was between 149 ? 5.4? and 19 infants had a sulcus angle over 159?. Eleven infants with trochlear dysplasia were in breech presentation at birth. Conclusion. Our study showed that the cartilaginous part of the trochlear groove was already well developed at birth. Breech presentation of the fetus could be a predisposing factor for dysplasia of the cartilaginous part of the trochlear groove. The bony part of the trochlear groove is dysplastic in infants and it gradually gets deeper, later getting a shape of the overlying articular cartilage. The influence of the Delpech law, with lower pressure in the trochlear groove, could be the possible mechanical theory explaining the development of the trochlear dysplasia in the later stage of the childhood.

scholarly journals Trochleoplasty is a Viable Option for Patellar Instability in Patients with Severe Trochlear Dysplasia: a Minimum 1-year Follow-Up Prospective Study

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0030
Author(s):  
S. Evan Carstensen ◽  
Matthew Tyrrell Burrus ◽  
Scott Feeley ◽  
Jourdan M. Cancienne ◽  
David R. Diduch
Keyword(s):  
Outcome Measures ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
The United States ◽  
Radiographic Analysis ◽  
Sulcus Angle ◽  
The Mean ◽  
One Year ◽  
Patellotrochlear Index

Objectives: Patellar instability caused by trochlear dysplasia may be addressed by sulcus-deepening trochleoplasty. A paucity of data exists from the United States regarding this procedure and no long term follow up. The purpose of this study was to evaluate the outcome data of patients undergoing sulcus-deepening trochleoplasty for high-grade trochlear dysplasia at our institution. Methods: Sixty-four patients (71 knees) with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty using the Dejour method from 2011-2018. Thirty-six of 71 knees (50.6%) had prior surgery and failed prior surgical management for patellar instability. Concomitant procedures during trochleoplasty were performed at varying rates. Radiographic analysis, physical examination, and clinical follow-up were obtained for all patients. At enrollment, patients completed preoperative visual analog scores (VAS), international knee documentation committee (IKDC) and Kujala scores, which were repeated at their 6 month, 1 year, 2 year, 3 year, and 4 year follow-up visits. Preoperatively, the patellotrochlear index (PTI), trochlear spur height, and trochlear depth were all measured. The patient’s sulcus angle was measured preoperatively and postoperatively on sunrise (merchant) view xray. Of the entire cohort, 43 patients (49 knees) had at least one year complete follow-up including xrays, physical exam, and patient-reported outcome measures and were included in the study. Results: The majority of patients were female (81.6%) with a mean age of 19.6 (+/- 6.8y). Follow-up ranged from 12 months to 78.4 months (mean 27.7 +/- 15.4). At the time of enrollment, mean BMI was 27.1 kg/m2 (+/-6.3) with one current smoker and one diabetic patient. Mean duration of symptoms prior to surgery was 75.2 months (+/- 72.5; r: 4-370mos). All knees were either Dejour B (81.3%) or D (18.8%) with a mean Caton-Deschamps index (CDI) of 1.20 (+/-0.2). Mean spur height preoperatively was 7.41 mm (+/1.84 mm) with a mean trochlear depth -0.18 (+/-2.71). Mean patellotrochlear index (PTI) was 0.41 (+/0.41). There were zero episodes of recurrent instability. All patients reported clinically significant improvements compared with baseline preoperative outcome scores. The mean preoperative IKDC score was 49.99, which improved to 79.86 (p&lt0.001), and the mean preoperative Kujala score was 55.88, which improved to 85.80 (p&lt0.001). Patients reported high satisfaction rates (9.5 +/-1.6 out of 10). All but 1 patient (96.9%) returned to work while 88.2% of patients were able to return to sport. Ten knees (20.4%) developed arthrofibrosis and required manipulation under anesthesia while eight of which underwent simultaneous arthroscopic lysis of adhesions. At the latest follow-up, mean knee range of motion was 132.4 +/- 13.2 degrees. Preoperative VAS was 3.31 (right) and 4.16 (left) while postoperative was 1.31 (right) and 1.76 (left) (p=0.007 R, 0.002 L). Radiographic analysis of the sulcus angle demonstrated a significant decrease from 148.86 degrees (+/-11.42) preoperatively to 135.11 degrees (+/-8.85) postoperatively (p<0.001). Conclusion: In the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty can provide a reliable and successful surgical solution to recurrent patellar instability. At a minimum of one year follow-up, the majority of patients were satisfied with their outcome corroborated by their subjective, validated outcome measures.

Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Kim ◽  
H Jung ◽  
P.S Yang ◽  
H.T Yu ◽  
T.H Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Middle Age ◽  
Population Based ◽  
Entire Cohort ◽  
Incident Dementia ◽  
Increased Risk ◽  
Diagnosis Of Dementia ◽  
History Of ◽  
The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p&lt;0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p&lt;0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

scholarly journals RISK FACTORS FOR PATELLAR INSTABILITY USING A QUANTITATIVE ANALYSIS OF TROCHLEAR DYSPLASIA

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Jon Hedgecock ◽  
Christopher Cheng ◽  
Matthew Solomito ◽  
James Pace
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Roc Curve ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Roc Curves ◽  
Patellar Height ◽  
Sulcus Angle ◽  
Demographic Risk ◽  
Demographic Risk Factors

Objectives: Multiple studies have described several anatomic and demographic risk factors of patellar instability (PI). Trochlear dysplasia (TD) has been shown to be a dominant risk factor for patellar instability but most prediction models have used the qualitative Dejour system to evaluate the influence of TD on PI. The lateral trochlear inclincation (LTI) angle is a described quantitative method to evaluate TD and a recent measurement technique has near perfect inter and intra rater reliability. Our hypothesis is that, in combination with other known radiographic and demographic risk factors of PI, that using a quantitative and numeric evaluation for TD, a highly reliable prediction model for PI can be created. Methods: 98 patients in a pediatric and adolescent sports medicine practice were identified with documented PI that had magnetic resonance imaging (MRI) studies available for review. A matched cohort of 100 patients with no history of PI but with MRI’s were identified as a control group. Anatomic risk factors evaluated included the LTI, sulcus angle, lateral condyle index (LCI), lateral patellar inclination angle (LPI), proximal and distal tibial tubercle-trochlear groove distance (pTTTG and dTTTG), Caton-Deschamps ratio (CD ratio), and patellotrochlear index (PTI). Demographic data included age and sex. Receiver operator characteristic (ROC) curves were constructed for each variable to identify which variables were the best predictors of PI (ROC value >0.7). Using the ROC curves with a Youden’s J statistic and setting specificity at 0.9, cutoff values for each variable were created. Each radiographic and demographic variable was analyzed for significance and those that were found to be significant were analyzed. Area under the curve (AUC) was determined for each variable. Two predictive models were created. One was developed from the ROC curve results while the other evaluated all measured variables. The models were designed to produce the best possible fit while trying to limit the total number of predictors. These models were tested on a second cohort of 45 patients with PI and 42 control patients. Results: ROC curve data is in Table 1. Of the two models, the superior model was the model that evaluated all variables, regardless of ROC cutoff value. The model takes on the form of a general logistic regression (Eq 1, Eq 2). Model accuracy on the validation set showed 84% accuracy with 78% sensitivity and 88% specificity. These values are based on a probability of >90%. Patellar height measures had significant AUC’s but were not prime drivers of the final model. Age was not significant in the ROC analysis. Conclusion: This study establishes a highly reliable and predictive model for PI that is driven by various direct (LTI, sulcus angle, LCI) or indirect (dTT-TG, LPI) quantitative measurements of TD. Patellar height did correlate with PI but was not a prime driver of the model which suggests that patella alta is a less common risk factor for PI.

scholarly journals Prevalence of ADHD in Accident Victims: Results of the PRADA Study

2019 ◽  
Vol 8 (10) ◽  
pp. 1643 ◽  
Author(s):  
Kittel-Schneider ◽  
Wolff ◽  
Queiser ◽  
Wessendorf ◽  
Meier ◽  
...  
Keyword(s):  
General Population ◽  
Incidence Rate ◽  
Adult Adhd ◽  
Demographic Data ◽  
Trauma Surgery ◽  
Self Report ◽  
Stimulant Treatment ◽  
Surgery Patient ◽  
Increased Risk ◽  
History Of

Background: Recent research has shown an increased risk of accidents and injuries in ADHD patients, which could potentially be reduced by stimulant treatment. Therefore, the first aim of our study was to evaluate the prevalence of adult ADHD in a trauma surgery population. The second aim was to investigate accident mechanisms and circumstances which could be specific to ADHD patients, in comparison to the general population. Methods: We screened 905 accident victims for ADHD using the ASRS 18-item self-report questionnaire. The basic demographic data and circumstances of the accidents were also assessed. Results: Prevalence of adult ADHD was found to be 6.18% in our trauma surgery patient sample. ADHD accident victims reported significantly higher rates of distraction, stress and overconfidence in comparison to non-ADHD accident victims. Overconfidence and being in thoughts as causal mechanisms for the accidents remained significantly higher in ADHD patients after correction for multiple comparison. ADHD patients additionally reported a history of multiple accidents. Conclusion: The majority of ADHD patients in our sample had not previously been diagnosed and were therefore not receiving treatment. The results subsequently suggest that general ADHD screening in trauma surgery patients may be useful in preventing further accidents in ADHD patients. Furthermore, psychoeducation regarding specific causal accident mechanisms could be implemented in ADHD therapy to decrease accident incidence rate.

Management Of Pregnancy In Patients With Antithrombin Deficiency

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 216-216
Author(s):  
Mario von Depka ◽  
Stefanie Döpke ◽  
Anja Henkel-Klene ◽  
Cornelia Wermes ◽  
Mahnaz Ekhlasi-Hundrieser ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Loss ◽  
Conflicts Of Interest ◽  
Fetal Loss ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Increased Risk ◽  
History Of ◽  
At Deficiency ◽  
The Mean

Abstract Introduction During pregnancy women have a four- to five-fold increased risk of thromboembolism (TE) compared to women who are not pregnant. Among the most important risk factors for TE in pregnancy is the presence of thrombophilia. Multiple reports have described an association between antithrombin (AT) deficiency and an increased rate of thromboembolic events especially during pregnancy. As the placental development depends on well-balanced pro- and anticoagulant mechanisms, thrombophilia, e.g. AT deficiency may be associated with poor pregnancy outcome. Despite anticoagulation with low molecular weight heparin (LMH) during pregnancy and the postpartum period alone, women with AT deficiency are still at a high risk to develop TE, especially perinatal and during puerperium because of withheld anticoagulation to prevent bleeding complications. Therefore, several guidelines recommend the administration of antithrombin concentrates during high risk situations as pregnancy. Here, we present the results of our study on the usage of AT concentrates in pregnant women with AT deficiency who either suffered from fetal loss or thromboembolism prior inclusion. Methods In total, 22 pregnancies in 19 patients (age: 31.9±4.7; 22-41) with AT deficiency were included in this open-label, single-center study. Ten patients (53%) had a history of fetal loss, 9/19 (47%) patients hat a history of thromboembolism. During all pregnancies AT concentrate (AT-C) was administered, in 18/22 (81.8%) pregnancies LMH was given in addition. Prior pregnancy losses (21/30, 70%) occurred in all trimester (t1: n=11, t2: n=5, and in t3: n=5). Historical live birth rate (LBR) was 30%. Blood samples were collected in all trimesters and postpartum to analyze AT activity and antigen, endogenous thrombin potential (ETP), thrombin-antithrombin-complex (TAT), Fragment 1+2 (F1+2) and c-reactive protein test (CRP). A total of 114 uneventful pregnancies of 113 healthy women served as controls. Furthermore, the mean doses of AT concentrates/kg BW and the mean total number of infusions were calculated. Results In total, 21 pregnancies (95.5%) were successful. Mean total requirement of AT concentrate per pregnancy was 79.454 IU (range: 3.000-272.000 IU) during 27.8 treatment days per pregnancy (range: 1-88). Our data show an increase of F1+2 in the course of pregnancy. Mean levels of F1+2 at t1, t2 and t3 (t1= 255.9 ± 107.6, t2= 360.9 ± 117.4, t3= 545.3 ± 220.3 pmol/L) were significantly higher than in controls (t1= 82.2 ± 43, t2= 140 ± 100.2, t3= 183.5 ± 103.1, p<.001). Mean level of TAT was higher (3.1 ± 1.4 ng/mL) than in controls (1.7 ± 1.6 ng/mL, p=.001) in t1, whereas mean TAT in t2 and t3 was lower than in controls (3.8 ± 1.3 vs. 4.8 ± 1.9, p=.03; 5.0 ± 1.4 vs. 6.1 ± 3.0 ng/mL, n.s., resp.). No thromboembolic events occurred. In patients receiving AT-C, LBR increased from 30% to 95.5% (p<0.001) with a relative risk of 49.0 to develop pregnancy loss without anticoagulant treatment (5.7 – 421.8; 95% CI). Conclusion In patients with AT deficiency receiving AT concentrate and LMH we could demonstrate a significant increase of LBR from 30% to 95.5%. Furthermore, no thromboembolic events occurred, though almost half of the patients had a history of thromboembolism. There was no clear evidence of increased hypercoagulability. We conclude that combined AT concentrate and LMH are safe and efficacious for mother and child in preventing thromboembolism and pregnancy loss. Further studies to evaluate the exact mode of anticoagulation and benefit of combining AT concentrate and LMH are warranted. Disclosures: No relevant conflicts of interest to declare.

Analysis of Hemorrhagic Phenotype and Cardiovascular Risk of Severe Hemophilia a Carriers and Difference with Female Working Population Control Group

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5048-5048
Author(s):  
María Eva Mingot-Castellano ◽  
María Jose Ariza-Corbo ◽  
Álvaro Amo Vázquez de la Torre ◽  
María Inmaculada Alonso-Calderón ◽  
Pedro Valdivielso ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
General Population ◽  
Hemophilia A ◽  
Risk Scores ◽  
Control Group ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Risk Of Death ◽  
History Of ◽  
The Mean

Abstract INTRODUCTION: Recent studies in male subjects with haemophilia have described a prevalence of cardiovascular risk factors (CVRF) and cardiovascular events (CVE) similar to the general population. This finding has not been tested in severe haemophilia A carriers so far. We have little information about whether there is a particular bleeding profile in this group and if this tendency is able to modify cardiovascular risk in these women. OBJECTIVES: To evaluate bleeding profile from laboratory and clinical point of view in haemophilia A carriers and working population controls; to define and to calculate CVRF, CVE and cardiovascular risk scores in severe haemophilia A carriers and controls; to analyse if there is any difference in cardiovascular risk between symptomatic severe haemophilia A carriers and general population. PATIENTS AND METHODS: This is a descriptive, cross-sectional, non interventional, single center study. Ethics Committee evaluation and written informed consent are requested to be included for carriers and controls. The target population are severe haemophilia A carriers from our area aged between 18 and 70 years old. The control group are women from regular health laboral checkings. We evaluate bleeding, ischemic and thrombotic personal and familiar history, bleeding profile (ISTH/SSC bleeding assessment tool, ISTH BAT), factor VIII (FVIII) genetic study, complete blood count, basic biochemistry, haemostasis (aPTT, PT, fibrinogen, platelet function tests, FVIIIc, FvWAg and FvWRCo, FXIII, homocysteine, resistence to APC, antithrombin, protein C and S, 20210A prothrombin mutation), cardiovascular risk (Framingham score and Systematic Coronary Risk Evaluation Project, SCORE). The controls have been studied in the same way with the exception of laboratory studies of hemostasis. Only in controls with pathologic ISTH BAT (greater than 3), basic and primary hemostasis have been studied. To describe continuous variables we will use mean, median, standard deviation, maximum and minimum. For categorical variables will be used the percentage of every category. RESULTS: Out of a total of 81 carriers have been identified between August 2012 to December 2013. We have evaluated 69 carriers. To achieve a confidence level of 95% with 50% heterogeneity we have recruited 138 controls. The mean age of carriers and controls was 43.7+/-15 and 41.5 +/-11.7 years old (p 0.308). In the group of carriers, the mean and standard deviation (SD) of FVIII levels were 87.2+/-35.7%, FvW:RCo 75.6 +/-30% and vWF:Ag 75.6 +/-30, 1%. We found no relationship between levels of FVIII:c and haemophilia genetic defect (34.8% substitutions, 34.8% intron 22, 27.5% mutations). 20.3% of carriers and 2.2% of controls present a pathologic ISTH BAT score (p 0.001). The table describes CVRF and cardiovascular risk scores of carriers and controls. TableCARRIERSCONTROLSHigh Blood Pressure(HBP)17,4%5%0,001Smoking29%32,6%0,596Sedentariness55,1%37,7%0,025Diabetes8,7%2,9%0,069Metabolic Syndrome(ATPIII)14,5%8%0,143Dyslipemia14,5%12,8%0,474Overweight and Obesity50,7%34,8%0,027Framingham(median, IQR)2 (0,47-7,41)0,4 (0-3,75)0,001SCORE (median, IQR)1 (0,73-1,58)0 (0-0,71)0,001Family history ischemia66,7%28,3%0,001 No personal CVE in carriers group. We found two cases of thrombophilia. They are two women from the same family with high homocysteine levels and family history of heart attack and stroke in haemophiliacs men. Most of family history of ischemia in carriers group comes from haemophiliac male relatives. Among controls only one patient has experienced heart attack and other a deep vein thrombosis. They both were older controls with CVRF. We have analysed separately the 14 symptomatic carriers (pathological ISTH BAT). This particular group has a similar Framingham score to general population but remains in a higher risk of death from vascular event (SCORE) compared to general population. CONCLUSIONS: Low levels of FVIII do not prevent from developing vascular risk factors in syntomatic carriers of severe haemophilia A. In our media, we describe a higher prevalence of HBP, sedentariness, obesity and overweight in the group of carriers than in controls. The risk of suffering a cardiovascular event and the risk of death because of a cardiovascular events is higher in the group of severe hemophilia A carriers than in the working control population, even in symptomatic carriers. Disclosures No relevant conflicts of interest to declare.

scholarly journals Epidemiological Profile and Determinants of Tuberculosis in Urban Nepalese Population

2019 ◽  
Vol 2 (2) ◽  
pp. 250-254
Author(s):  
Subash Bhatta ◽  
Nayana Pant
Keyword(s):  
Extrapulmonary Tuberculosis ◽  
Female Ratio ◽  
Short Course ◽  
Increased Risk ◽  
The Family ◽  
Directly Observed Treatment ◽  
History Of ◽  
The Mean ◽  
Epidemiological Profile ◽  
Male To Female

Introduction: Tuberculosis has evolved through ages to remain a major cause of morbidity and mortality worldwide. Despite having a very successful Directly Observed Treatment, Short-course program, tuberculosis is still one of the most widespread infections in Nepal. This study was done to observe the epidemiological profile of tuberculosis patients in an urban Nepalese population.Materials and Methods: 585 newly diagnosed cases of pulmonary and extrapulmonary tuberculosis in two tertiary level hospitals in the country were enrolled in the study during a period of 18months. A standard questionnaire was formatted and the required information was acquired with the help of interview and investigation reports.Results: The mean age of presentation was 35.76 with a male to female ratio of 1.48:1.57% of the cases had less than primary education with 26 % being illiterates. The most commonly involved occupational group was farmers (22%) followed by students (20%) and laborers (14%). 22% of cases had a history of contact with tuberculosis in the family. 41 % were smokers and 18 % abused alcohol. Pulmonary tuberculosis comprised 68% of the total cases. The most common extrapulmonary presentation was lymph node TB (28%) followed by pleural effusion (21.5%) and tubercular meningitis (16%).Conclusions: Young people with lower literacy levels and with a family history of tuberculosis are at increased risk of acquiring tuberculosis and community approaches for tuberculosis control should target this group to reduce the burden of the disease

The study of tamoxifen and raloxifene (STAR): Initial findings from the NSABP P-2 breast cancer prevention study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. LBA5-LBA5 ◽  
Author(s):  
D. L. Wickerham ◽  
J. P. Costantino ◽  
V. Vogel ◽  
W. Cronin ◽  
R. Cecchini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Invasive Breast Cancer ◽  
Cardiac Events ◽  
Degree Relative ◽  
Treatment Groups ◽  
Increased Risk ◽  
History Of ◽  
The Mean

LBA5 Background: The STAR trial was designed to compare raloxifene to tamoxifen in terms of relative effect on invasive breast cancer risk and on other beneficial and detrimental outcomes associated with the use of tamoxifen. Methods: The trial opened on 7-1-1999, and accrual was completed November 4, 2004, with 19,747 women enrolled. To be eligible, a woman had to be postmenopausal with a 5-year predicted breast cancer risk of 1.66% as determined by the modified Gail model. Women were randomized and treated in a double-blinded fashion to receive 5 yr of therapy with either 20 mg per day of tamoxifen or 60 mg per day of raloxifene. The protocol-defined monitoring plan called for a final analysis and release of findings when 327 invasive breast cancer cases had been diagnosed in the total population. The mean age of the population at the time of entry into this trial was 58 yr, and the mean 5-yr risk of breast cancer was 4.04%. 93.5% of the women were white; 51.5% had a hysterectomy before entry into the study; 9.2% had a history of LCIS; 71.1% had at least one first-degree relative with a history of breast cancer. The average time on the study is 47 months. Results: There was no difference between the treatment groups in terms of effect on invasive breast cancer: 163 cases in women assigned to tamoxifen and 167 in women assigned to raloxifene (RR = 1.02, 95% CI = 0.82–1.27). The risk of invasive uterine malignancies was 40% less in the raloxifene group (36 in women assigned tamoxifen and 23 in women assigned raloxifene [RR = 0.62, 95% CI = 0.35–1.08]). The risk of non invasive breast cancer was less in the tamoxifen group (57 cases in those assigned to tamoxifen and 81 in those assigned to raloxifene [RR = 1.41, 95% CI = 1.00–2.02]). There were no significant differences between the treatment groups for any of the other invasive cancer sites or for cardiac events, osteoporotic fractures, or deaths. There were fewer thromboembolic events in women taking raloxifene than in those taking tamoxifen. Conclusions: Raloxifene is an effective alternative to tamoxifen for reducing the incidence of invasive breast cancer in postmenopausal women at increased risk of developing the disease and is associated with fewer endometrial cancers, deep vein thromboses, and pulmonary emboli. [Table: see text]

Abstract 14881: Shortened Telomere Length is Associated with Paroxysmal but Not Persistent/Permanent Atrial Fibrillation in Cardiovascular Patients Referred for Angiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John F Carlquist ◽  
Stacey Knight ◽  
Richard M Cawthon ◽  
Benjamin D Horne ◽  
Jeffrey S Rollo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Telomere Length ◽  
Detection System ◽  
Single Copy ◽  
Physiological Basis ◽  
Cardiovascular Patients ◽  
Increased Risk ◽  
Prognostic Utility ◽  
History Of ◽  
The Mean

BACKGROUND: Telomeres are hexanucleotide repeats at chromosome ends that prevent chromosome degradation. Short telomere length (TL) correlates with biological ageing and is associated with risk for age-associated diseases. Atrial fibrillation (AF) can occur as paroxysmal (Px), persistent (Ps) or permanent (Pm). Progression from Px to Ps/Pm AF is accompanied by increased risk for AF-associated adverse events. We t found that short TL is associated with a history of AF; for the present study we examined TL in relationship to the types of AF. METHODS: Peripheral blood DNA was obtained from sequential consenting patients (pts) (n=3576) at angiography. TL was measured in triplicate by monochrome (SYBR Green I) multiplex quantitative PCR (Bio-Rad CFX384 Detection System) and normalized to a quantitatively-measured, single-copy gene (albumin). AF history was extracted from Intermountain Healthcare’s electronic records and AF type determined by chart review for 246 of 325 (75.7%) AF patients. Non-parametric tests were used. RESULTS: For the 246 subtyped AF pts, 66.3% were male, 94.3% Caucasian, mean age was 70 yrs. The leading AF type was Px (43.5%), followed by Pm (32.9%), and Ps (23.6%). Mean TL for non-AF pts was 0.954 ±0.325 and the mean TL for AF pts was 0.912±0.30. The mean Px TL (Table) was significantly shorter than for Ps or Pm AF. Ps and Pm TL did not differ. Adjusting for age, gender, prior CVA, PCI, statin use, disease severity; TL (per unit of decrease) was associated with Px AF compared to Ps/Pm AF (OR=6.64; CI 2.17, 20.32; p=0.0009). CONCLUSIONS: The association of shorter TL with Px AF but not Ps/Pm AF suggests that decreased TLs is associated with an etiologic AF subtype. No association between shortened TL and Ps/Pm AF may further suggest that TL measurement for pts with Px AF may have prognostic utility with respect to AF progression. Further study into the physiological basis of these observations is warranted.

Sign in / Sign up

Export Citation Format

Share Document