Sociodemographic, Epidemiological, and Clinical Risk Factors for Childhood Pulmonary Tuberculosis in Severely Malnourished Children Presenting With Pneumonia

We aimed to evaluate sociodemographic, epidemiological, and clinical risk factors for pulmonary tuberculosis (PTB) in children presenting with severe acute malnutrition (SAM) and pneumonia. Children aged 0 to 59 months with SAM and radiologic pneumonia from April 2011 to July 2012 were studied in Bangladesh. Children with confirmed PTB (by culture and/or X-pert MTB/RIF) (cases = 27) and without PTB (controls = 81; randomly selected from 378 children) were compared. The cases more often had the history of contact with active PTB patient ( P < .01) and exposure to cigarette smoke ( P = .04) compared with the controls. In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with working mother ( P = .05) and positive tuberculin skin test (TST; P = .02). Thus, pneumonia in SAM children is a common presentation of PTB and further highlights the importance of the use of simple TST and/or history of contact with active TB patients in diagnosing PTB in such children, especially in resource-limited settings.

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Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

PLoS ONE ◽

10.1371/journal.pone.0073728 ◽

2013 ◽

Vol 8 (9) ◽

pp. e73728 ◽

Cited By ~ 22

Author(s):

Mohammod Jobayer Chisti ◽

Mohammed Abdus Salam ◽

Hasan Ashraf ◽

Abu S. G. Faruque ◽

Pradip Kumar Bardhan ◽

...

Keyword(s):

Risk Factors ◽

Critical Care ◽

Severe Acute Malnutrition ◽

Clinical Risk Factors ◽

Acute Malnutrition ◽

Clinical Risk ◽

Care Ward

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Pulmonary tuberculosis: An analysis of isolation practices and clinical risk factors in a tertiary hospital

Indian Journal of Tuberculosis ◽

10.1016/j.ijtb.2018.04.013 ◽

2019 ◽

Vol 66 (4) ◽

pp. 437-442

Author(s):

Srivathsan Thiruvengadam ◽

Lauren Giudicatti ◽

Siaavash Maghami ◽

Hussein Farah ◽

Justin Waring ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Tuberculosis ◽

Tertiary Hospital ◽

Clinical Risk Factors ◽

Clinical Risk

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Risk Factors and Outcomes of Hospital Acquired Pneumonia in Young Bangladeshi Children

Life ◽

10.3390/life11101030 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1030

Author(s):

Abu Sadat Mohammad Sayeem Bin Shahid ◽

Tahmina Alam ◽

Lubaba Shahrin ◽

K. M. Shahunja ◽

Md. Tanveer Faruk ◽

...

Keyword(s):

Risk Factors ◽

Severe Acute Malnutrition ◽

Multivariate Logistic Regression Analysis ◽

Acute Malnutrition ◽

Persistent Diarrhea ◽

Multivariate Logistic Regression ◽

Resource Limited ◽

Hospital Acquired Pneumonia ◽

Independent Risk Factors ◽

Hospital Acquired

Hospital acquired pneumonia (HAP) is common and often associated with high mortality in children aged five or less. We sought to evaluate the risk factors and outcome of HAP in such children. We compared demographic, clinical, and laboratory characteristics in children <5 years using a case control design during the period of August 2013 and December 2017, where children with HAP were constituted as cases (n = 281) and twice as many randomly selected children without HAP were constituted as controls (n = 562). HAP was defined as a child developing a new episode of pneumonia both clinically and radiologically after at least 48 h of hospitalization. A total of 4101 children were treated during the study period. The mortality was significantly higher among the cases than the controls (8% vs. 4%, p = 0.014). In multivariate logistic regression analysis, after adjusting for potential confounders, it was found that persistent diarrhea (95% CI = 1.32–5.79; p = 0.007), severe acute malnutrition (95% CI = 1.46–3.27; p < 0.001), bacteremia (95% CI = 1.16–3.49; p = 0.013), and prolonged hospitalization of >5 days (95% CI = 3.01–8.02; p < 0.001) were identified as independent risk factors for HAP. Early identification of these risk factors and their prompt management may help to reduce HAP-related fatal consequences, especially in resource limited settings.

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Major clinical risk factors for seizures in febrile children aged 6 to 60 months.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.05.3397 ◽

2020 ◽

Vol 27 (05) ◽

pp. 891-894

Author(s):

Shahid Ishaq ◽

Ejaz Mazari ◽

Fazal ur Rehman

Keyword(s):

Risk Factors ◽

Family History ◽

Febrile Seizures ◽

Study Groups ◽

Clinical Risk Factors ◽

P Value ◽

Chi Square ◽

Clinical Risk ◽

Significant Difference ◽

History Of

Objectives: Febrile seizures (FS) are the most common type of seizures and typically transpire in children with ages from 6 to 60 months. This study was planned to find out major clinical risk factors for seizures in febrile children who were aged 6 to 60 months. A total of 100 febrile children aged 6 to 60. Study Design: Analytical Study. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health, Multan. Period: From 1st April 2018 to 31st December 2018. Material & Methods: Group A had 40 children with febrile seizures while group B had 60 febrile children but without seizures. Demographic features along with family history of (H/O) epilepsy as well as family history of febrile seizure, types of seizure and infection diseases were noted and analyzed using SPSS version 20. Odds ratio was calculated for various risk factors. Chi square test was applied and P value < 0.05 was considered as significant. Results: Out of a total of 100 children, there were 54 (54.0%) male and 46 (46.0%) female. There was no statistical difference in terms of gender between the two groups (p value = 0.566). Overall, mean age of the children was 26.02 months with standard deviation of 13.4 months. There were 28 (70.0%) children who reported with simple seizures while complex seizures were found in 12 (30.0%) cases. Statistically significant difference (p value = 0.001) was seen in terms of types of infections between the two study groups. When risk of seizures for various risk factors was calculated, family H/O FS, family H/O epilepsy, and upper RTI were as 14, 7 and 3 times respectively and turned out to be the major risk factors for seizures in febrile children. Conclusions: Family H/O FS, family H/O epilepsy and upper RTIs are the major risk factors related with seizures in febrile children. Measures to prevent these risk factors can decrease the burden of FS in our population.

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Examining the Relationship between Biopsychosocial History and Clinical Profiles Following Concussion

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz026.35 ◽

2019 ◽

Vol 34 (5) ◽

pp. 765-765

Author(s):

K Emami ◽

A M Sufrinko ◽

M W Collins ◽

A P Kontos ◽

E A Rossi

Keyword(s):

Risk Factors ◽

Motion Sickness ◽

Clinical Profile ◽

Clinical Risk Factors ◽

Post Injury ◽

Chi Square ◽

Clinical Risk ◽

History Of ◽

Concussion History ◽

Clinical Profiles

Abstract Purpose To determine if clinical risk factors (e.g., migraine history, motion sickness, concussion history) place an individual at risk for specific clinical profiles (e.g., posttraumatic migraine, vestibular) designated by a clinician following concussion. Methods Fifty (22M; 28F) symptomatic, concussed patients (17.02±3.14 years old) were evaluated within 21days post-injury. Demographics and medical history were obtained, including history of migraine, motion sickness, ADHD, learning disability (LD), oculomotor disorder, psychiatric diagnoses, and prior concussion. The presence of each clinical profile was determined by a clinician, based on synthesis of evaluation findings, including neurocognitive testing, symptom report, and vestibular/oculomotor screening results. Chi-square analyses were used to explore associations between risk factors and clinical profile post-injury. Results Chi-square analyses found that female sex was associated with increased odds (OR=5.25,95% CI[1.55, 17.77]) of vestibular clinical profile, X2(1, n=50)=7.55, p=.006. History of concussion was associated with increased odds (OR=7.10,95%CI[1.39,35.87]) of the PTM profile (X2[1, n=50]=6.56, p=.01) and increased odds (OR=9.85,95%CI[1.00,96.67]) of anxiety/mood profile (X2 1, n=50]=5.24, p=.022. Further, history of motion sickness was associated with increased odds OR=10.2,95%CI[1.2,86.69] of the PTM profile (X2[1, n=50]=6.11, p=.013). No other relationships were found. Conclusion Some clinical risk factors were associated with post-injury clinical profiles consistent with prior literature, while others were not. For example, females were more likely to have a vestibular profile. While motion sickness was associated with PTM, history of migraine was not. Concussion history, which has inconsistent findings for re-injury outcomes, was associated with increased likelihood of PTM and anxiety/mood profiles. Findings add to the literature supporting relationships among risk factors and clinical outcomes.

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Biological versus Clinical Risk Factors in Acute Myeloid Leukemia: Is There a Winner?

Case Reports in Hematology ◽

10.1155/2019/3914828 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

M. Malagola ◽

N. Polverelli ◽

V. Cancelli ◽

E. Morello ◽

A. Turra ◽

...

Keyword(s):

Risk Factors ◽

Acute Myeloid Leukemia ◽

Myelodysplastic Syndrome ◽

Myeloid Leukemia ◽

Clinical Risk Factors ◽

Decision Algorithm ◽

Platelet Recovery ◽

Clinical Risk ◽

History Of ◽

Acute Myeloid

We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.

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Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease

Circulation Genomic and Precision Medicine ◽

10.1161/circgen.120.003006 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Nicholas A. Marston ◽

Giorgio E.M. Melloni ◽

Yared Gurmu ◽

Marc P. Bonaca ◽

Frederick K. Kamanu ◽

...

Keyword(s):

Risk Factors ◽

Risk Score ◽

Genetic Risk ◽

Genetic Risk Score ◽

Risk Groups ◽

Clinical Risk Factors ◽

Cardiometabolic Disease ◽

Polygenic Risk Score ◽

Clinical Risk ◽

History Of

Background: Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality and has a known genetic contribution. We tested the performance of a genetic risk score for its ability to predict VTE in 3 cohorts of patients with cardiometabolic disease. Methods: We included patients from the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk), PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin), and SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus) trials (history of a major atherosclerotic cardiovascular event, myocardial infarction, and diabetes, respectively) who consented for genetic testing and were not on baseline anticoagulation. We calculated a VTE genetic risk score based on 297 single nucleotide polymorphisms with established genome-wide significance. Patients were divided into tertiles of genetic risk. Cox proportional hazards models were used to calculate hazard ratios for VTE across genetic risk groups. The polygenic risk score was compared with available clinical risk factors (age, obesity, smoking, history of heart failure, and diabetes) and common monogenic mutations. Results: A total of 29 663 patients were included in the analysis with a median follow-up of 2.4 years, of whom 174 had a VTE event. There was a significantly increased gradient of risk across VTE genetic risk tertiles ( P -trend <0.0001). After adjustment for clinical risk factors, patients in the intermediate and high genetic risk groups had a 1.88-fold (95% CI, 1.23–2.89; P =0.004) and 2.70-fold (95% CI, 1.81–4.06; P <0.0001) higher risk of VTE compared with patients with low genetic risk. In a continuous model adjusted for clinical risk factors, each standard deviation increase in the genetic risk score was associated with a 47% (95% CI, 29–68) increased risk of VTE ( P <0.0001). Conclusions: In a broad spectrum of patients with cardiometabolic disease, a polygenic risk score is a strong, independent predictor of VTE after accounting for available clinical risk factors, identifying 1/3 of patients who have a risk of VTE comparable to that seen with established monogenic thrombophilia.

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P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features

European Heart Journal ◽

10.1093/eurheartj/ehz746.0768 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S E Lee ◽

G Pontone ◽

I Gottlieb ◽

M Hadamitzky ◽

J A Leipsic ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Obstructive Coronary Artery Disease ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Obstructive Lesion ◽

History Of ◽

Artery Disease

Abstract Background It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP. Purpose We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP. Methods Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05). Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use. Conclusion The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline. Acknowledgement/Funding This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).

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Abstract P251: The Impact of Clinical Risk Factors on Risk of Peripheral Arterial Disease in Men

Circulation ◽

10.1161/circ.125.suppl_10.ap251 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Michel M Joosten ◽

Jennifer K Pai ◽

Eric B Rimm ◽

Donna Spiegelman ◽

Murray A Mittleman ◽

...

Keyword(s):

Risk Factors ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Clinical Risk Factors ◽

Individual Risk ◽

Clinical Risk ◽

Hazard Ratios ◽

History Of ◽

Peripheral Arterial

Background: Previous studies have examined individual risk factors in relation to peripheral arterial disease (PAD) but the combined effects of these factors are largely unknown. We investigated the degree to which clinical risk factors may explain the risk of PAD among men. Methods: We prospectively followed 45,596 men from the Health Professional Follow-up Study without a history of cardiovascular disease at baseline during a 22-year period (1986–2008). We defined four clinical risk factors - smoking, history of type 2 diabetes, hypertension, and hypercholesterolemia - that were updated biennially during follow-up. Cox proportional hazard models were used to compare PAD risk across individual and joint risk factors. Results: During 874,769 person-years of follow-up, 497 confirmed PAD cases occurred. All four clinical risk factors were significantly and independently associated with a higher risk of PAD after multivariate adjustment (Figure). Risk of PAD more than doubled (hazard ratio: 2.14; 95% confidence interval [95% CI]: 1.95–2.35) for each additional risk factor compared with the group free of risk factors. Men without any of the four risk factors had a relative risk of PAD of 0.19 compared with all other men (95% CI: 0.11–0.31). In 96.8% (95% CI: 95.2–98.3%) of the PAD cases, at least one of the four risk factors was present. Overall, 8 out of 10 cases of PAD appeared to be attributable to these four conventional risk factors. Conclusion: The great majority of PAD can be explained by four conventional risk factors. Figure legend: Hazard ratios for incident peripheral arterial disease (PAD) according to individual and joint risk factors. Hazard ratios are adjusted for age, height, aspirin use, family history of myocardial infarction before age 60 y, geographical region, body mass index, physical activity, alcohol consumption (and each of the other three binary clinical risk factors in the individual risk factor analyses).

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Racial Differences In Pediatric Venous Thromboembolism

Blood ◽

10.1182/blood.v116.21.3176.3176 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3176-3176

Author(s):

Madhvi Rajpurkar ◽

Cynthia Sabo ◽

Ayesha Zia ◽

Michael U Callaghan ◽

Bulent Ozgonenel ◽

...

Keyword(s):

Risk Factors ◽

African American ◽

Racial Differences ◽

Positive Family History ◽

Clinical Risk Factors ◽

Major Surgery ◽

Clinical Risk ◽

History Of ◽

Caucasian Patients ◽

Prothrombin Gene

Abstract Abstract 3176 Background: Racial differences in the prevalence, risk factors, outcomes and recurrence rates of venous thromboembolism (VTE) have been reported in adults with the highest prevalence in African American (AA) males. Individuals of AA origin also have higher incidence of pulmonary embolism and increased mortality as compared to Caucasians. Such data are unknown in childhood VTE. Aim: Our aim was to evaluate the racial differences in risk factors, treatment response, outcomes and risks for recurrence in childhood VTE at a single center. Materials and Methods: All patients presenting to the pediatric hematology oncology service at this large urban Children's Hospital were followed prospectively from 2000–2010 and analyzed in a systematic manner. Data were analyzed using the SPSS v.17 software after approval from the institutional review board. Results: Preliminary analysis revealed that two hundred and eighteen patients with VTE were followed. There were 105 (48.2%) AA, 100 (45.9%) Caucasian (C), 4 (1.8 %) Middle Eastern (ME), 4(1.8%) Hispanic (H) and 5 Asian/Pacific islander (API) patients. Differences between AA and C were analyzed. Of the AA patients, there were 52 females (F), 53 males (M); Sites of presentation were upper extremity (UE) 12, lower extremity (LE) 24, pulmonary embolism (PE) 25, cortical sinus thrombosis (CST) 5, jugular (J) 13, vena caval (VC) 10, hepatic (H) 2 and cardiac atrial (CA) 8. Thirty six patients had more than one site at presentation. Of the Caucasian patients, there 51 F and 49 M; Sites of presentation were UE 12, LE 25, PE 17, CST 16, H 3, CA 8, VC 9, jugular 7, renal 3. Twenty four patients had more than one site of presentation. In AA patients, risk factors were persistently elevated D-Dimer and FVIII levels in 34 (32.4%) and 14 (13.3%) patients respectively; Elevated Lipoprotein (a){Lp(a)} in 24 (22.9%), positive cardiolipin antibodies (ACLA) in 11 (10.5%), ANA 18 (17.1%), and Lupus anticoagulant in 15 (14.3%) of patients. There were no patients with the Factor V Leiden (FVL) or the Prothrombin gene mutation. Clinical risk factors included the presence of central venous lines (CVL) in 58.1%, obesity in 26.7% and major surgery and immobilization in 36.2% and 30.5% respectively. Thirty percent of AA patients had positive family history of thrombosis in immediate family members. In Caucasian patients, risk factors were persistently elevated D- Dimer and FVIII levels in 19 (19%) and 13 (13%); antithrombin III deficiency in 3 (3%), heterozygous FVL in 10 (10%) and the Prothrombin gene variant in 3 (3%); Positive ACLA in 8(8 %), ANA in 11 (11%) and LA in 4 (4%), Elevated Lp(a) in 11 (11%). Clinical risk factors included presence of central venous lines (CVL) in 44.1%, obesity in 22% and major surgery and immobilization in 31% each. Interestingly, 30% of Caucasian patients had a positive family history of thrombosis in immediate family members In AA patients, 61.4% had complete (CR) or partial resolution (PR); in C patients 68.4% had CR or PR. Eleven (10%) AA and 7 (7%) C patients had recurrent events. There were no statistically significant differences in gender, laboratory and clinical risk factors and outcomes between African American and Caucasian patients analyzed. As anticipated, the FVL and Prothrombin gene variants were not seen in AA patients. Conclusions: In contrast to adults, there were no racial differences in presentation, risk factors and outcomes between Caucasian and African American patients with VTE followed at this single Children's Hospital thrombosis center. We believe this is the first report on racial differences in pediatric VTE. Larger population based studies are needed to confirm these findings. Disclosures: No relevant conflicts of interest to declare.

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