Non-Intensive Continuous Treatment with a Tyrosine Kinase Inhibitor (TKI) Followed By Allo-HSCT Is an Effective Therapeutic Strategy for Adult Ph-Positive Acute Lymphoblastic Leukemia: Outcomes of the Russian Prospective Multicenter RALL Study

Abstract Introduction. As Ph-positive (Ph+) ALL in adults remains less favorable in prognosis than other ALL, and by expert opinion needs non-intensive chemotherapy protocols and new generation TKI with the majority of pts undergoing allo-HSCT, the results of treatment based on the different approach: de-escalated but continuous treatment with the change of TKI according to the molecular response and allo-HSCT may be of interest and provide new insights to the treatment of Ph+ ALL. Aim. To evaluate survival and outcomes in different risk groups in pts with Ph+ ALL in the RALL-study (Ph+ALL-2009, Ph+ALL-2012 and Ph+ALL-2012m protocols). Patients and methods. Between January 2010 and June 2021, 74 new Ph+ ALL cases were diagnosed in 6 centers of the RALL-group and 63 of them were evaluable for analysis (median age 37 years (17-73), m/f 32(43%)/42(57%), CNS disease in 13(21%) pts, WBC>30*10 9/l in 27(43%) pts, bcr/abl transcript p190/p210/p190+210 in 31(60%)/12(23%)/9(17%) cases). Standard cytogenetic was performed in all 63 pts, 1 had no mitosis, 6(10%) monosomy 7 and 2 (3%) complex karyotypes were detected. All pts were treated according to RALL protocols with continuous Imatinib. Ph+ALL-2009 protocol included 600 mg Imatinib with prednisone, VNCR, L-asp, Dauno, Cph, followed by 6-MP and MTX. Imatinib had to be changed to Dasatinib (140 mg) after non-achievement of molecular complete response (MolCR) on day 70. MolCR was defined as bcr/abl chimeric transcript <0,01% by PCR with 10 -4 sensitivity. In protocols Ph+ALL-2012 and Ph+ALLm, we de-intensified chemotherapy: reduced Dauno, Cph and L-asp doses, accordingly. All pts were considered as candidates for allogeneic HSCT in CR1 if HLA-identical donor was available. 36 (57%) pts underwent HSCT in the first-line therapy: 2(6%) autologous, 9 (25%) matched related, 20 (56%) matched unrelated and 5 (13%) haplo-HSCT. Results. Hematological complete remission (CR) was achieved in 60 (95%) of 63 pts (1 early death and 2 refractory cases occurred). On day 70, MolCR was achieved in 21(38%) of 56 pts. Death on therapy in CR (within 5 months of induction/consolidation) was registered in 4 (6%) cases. The major causes of the non-relapsed mortality in unrelated allo-HSCT (n=9) were aGVHD and severe infections, at a median +4 months after HSCT. The 5-year overall survival (OS) and disease-free survival (DFS) for all 63 pts were 58% and 45%, respectively. The long-term outcome on different protocols (Ph+ALL-2009, Ph+ALL-2012 and Ph+ALL-2012m) were similar: 3-year OS - 55% vs 51% vs 75% (p=0,27), 3-year DFS - 56% vs 44% vs 50% (p=0,54), respectively. The 5-year OS was 65% vs 61% (p=0,84), and DFS was 57% vs 31% (p=0,24) in transplanted vs non-transplanted patients by landmark analysis with a median 5,3 month of CR. Landmark analysis of 5-year OS for transplanted and non-transplanted pts depending on age showed no significant difference for both groups: >45y 40% vs 80%; and ≤45y 70% vs 49%, respectively (p=0,1625), although data for 5-year OS was still not mature at the time of analysis. DFS was significantly different in transplanted vs. non-transplanted pts: >45y 40% vs 71%; ≤45y 61% vs 0%; respectively (p=0,0439). In a multivariate analysis for Ph+ ALL among common risk factors (age > 45y, WBC>30, LDH>2N, immunophenotype, late MolCR >70d, CNS leukemia) WBC>30, HSCT were significant risk factors for OS and DFS. Conclusions. Our data demonstrate that de-intensification of chemotherapy does not affect the efficacy of Ph+ ALL therapy in the era of TKIs. We confirmed that patients older than 45y old could be treated by chemotherapy with TKI (new generation TKI if needed) only, but all pts younger than 45y should be considered for HSCT. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Socioeconomic, Psychiatric and Materiality Determinants and Risk of Postpartum Depression in Border City of Ilam, Western Iran

Depression Research and Treatment ◽

10.1155/2013/653471 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Pegah Taherifard ◽

Ali Delpisheh ◽

Ramin Shirali ◽

Abdorrahim Afkhamzadeh ◽

Yousef Veisani

Keyword(s):

Risk Factors ◽

Postpartum Depression ◽

Low Socioeconomic Status ◽

Data Gathering ◽

Significant Risk ◽

Cross Sectional Study ◽

Cross Sectional ◽

Western Iran ◽

Border City ◽

Significant Difference

Background. Postpartum depression (PPD) is considered as one of the mood disturbances occurring during 2-3 months after delivery. The present study aimed to determine the prevalence of PPD and its associated risk factors in border city of Ilam, western Iran.Methods. Through a descriptive cross-sectional study in 2011, overall, 197 women who attended Obstetrics & Gynecology clinics postpartumly in the border city of Ilam, western Iran, were randomly recruited. A standard questionnaire that was completed by a trained midwife through face to face interviews was used for data gathering.Results. Mean age ± standard deviations was 27.9 ± 5.2 years. Prevalence of PPD was estimated to be 34.8% (95% CI: 27.7–41.7). A significant difference was observed among depression scores before and after delivery (P≤0.001). Type of delivery (P=0.044), low socioeconomic status (P=0.011), and women having low educational level (P=0.009) were the most important significant risk factors associated with PPD. The regression analysis showed that employed mothers compared to housekeepers were more at risk for PPD (adjusted OR = 2.01, 95% CI: 1.22–2.28,P=0.003).Conclusions. Prevalence of PPD in western Iran was slightly higher than the corresponding rate from either national or international reports.

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Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1494-1 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Petri Bellova ◽

Hinnerk Baecker ◽

Sebastian Lotzien ◽

Marvin Brandt ◽

Thomas A. Schildhauer ◽

...

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Periprosthetic Fractures ◽

Matched Pair ◽

Categorical Variables ◽

Bipolar Hemiarthroplasty ◽

Exact Test ◽

Displaced Femoral Neck Fractures ◽

Significant Difference ◽

Postoperative Mobility

Abstract Background Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Methods We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients’ demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon’s experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher’s exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. Results Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872–6.079), stovepipe femur (OR 1.749, 95% CI .823–3.713), junior surgeon (OR 1.204, 95% CI .596–2.432), and on-call-duty surgery (OR 1.471, 95% CI .711–3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). Conclusions IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.

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Induction of Effector and Memory Cellular Immunity in a Patient with Long-Term Complete Molecular Response to Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

Case Reports in Oncology ◽

10.1159/000508997 ◽

2020 ◽

Vol 13 (2) ◽

pp. 990-996

Author(s):

Tatsuro Jo ◽

Haruna Shioya ◽

Hiroo Tominaga ◽

Takahiro Sakai ◽

Shizuka Hayashi ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Quantitative Polymerase Chain Reaction ◽

Philadelphia Chromosome ◽

Molecular Response ◽

Gene Repertoire ◽

Monosomy 7 ◽

Long Time ◽

Lineage Markers ◽

Complete Molecular Response

This case report is about a patient who suffered from Philadelphia chromosome (Ph1)-positive acute lymphoblastic leukemia. The blasts were positive for myeloid-lineage markers including CD13 and CD33, as well as B-cell-lineage markers. Minor bcr-abl1 mRNA was detected by real-time quantitative polymerase chain reaction. Chromosomal abnormality monosomy 7 was also observed, in addition to Ph1. Despite treatment difficulties that were anticipated based on these findings, the patient had long-time complete molecular response (CMR) for approximately 5 years using chemotherapy and two tyrosine kinase inhibitors, imatinib and dasatinib. Lymphocytes were elevated after the patient switched from imatinib to dasatinib, and a T-cell receptor (TCR) V beta gene repertoire analysis revealed oligoclonal expansion of effector and memory cytotoxic T lymphocytes (CTLs), including Wilms tumor 1-specific CTLs. More specifically, the two memory CTLs expressing TCR V beta 3 and V beta 7.1 gradually increased after dasatinib administration. The activation and maintenance of anti-leukemia immunity may have allowed the patient to obtain long-time CMR. These results highlight that obtaining memory CTLs for leukemia cells may lead to safe withdrawal from dasatinib in the patient.

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Long Term Follow-Up of Pediatric Sickle Cell Disease Patients with Conditional Velocities on Transcranial Doppler (TCD).

Blood ◽

10.1182/blood.v106.11.2338.2338 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2338-2338

Author(s):

Lena Coïc ◽

Suzanne Verlhac ◽

Emmanuelle Lesprit ◽

Emmanuelle Fleurence ◽

Francoise Bernaudin

Keyword(s):

Risk Factors ◽

Color Doppler ◽

Significant Risk ◽

Biological Data ◽

Treatment Intensification ◽

Significant Difference ◽

History Of ◽

The Mean

Abstract Abnormal TCD defined as high mean maximum velocities > 200 cm/sec are highly predictive of stroke risk and justify long term transfusion program. Outcome and risk factors of conditional TCD defined as velocities 170–200 cm/sec remains to be described. Patients and methods Since 1992, 371 pediatric SCD patients (303 SS, 44 SC, 18 Sß+, 6 Sß0) were systematically explored once a year by TCD. The newborn screened cohort (n=174) had the first TCD exploration between 12 and 18 months of age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. Biological data were assessed at baseline, after the age of 1.5 years and remotely of transfusion or VOC. We report the characteristics and the outcome in patients (n=43) with an history of conditional TCD defined by mean maximum velocities ranging between 170 and 200 cm/s in the ACM, the ACA or the ICA. Results: The mean follow-up of TCD monitoring was 5,5 years (0 – 11,8 y). All patients with an history of conditional doppler were SS/Sb0 (n=43). Mean (SD) age of patients at the time of their first conditional TCD was 4.3 years (2.2) whereas in our series the mean age at abnormal TCD (> 200 cm/sec) occurrence was 6.6 years (3.2). Comparison of basal parameters showed highly significant differences between patients with conditional TCD and those with normal TCD: Hb 7g4 vs 8g5 (p<0.001), MCV 82.8 vs 79 (p=0.047). We also had found such differences between patients with normal and those with abnormal TCD (Hb and MCV p< 0.001). Two patients were lost of follow-up. Two patients died during a trip to Africa. Conditional TCD became abnormal in 11/43 patients and justified transfusion program. Mean (SD) conversion delay was 1.8 (2.0) years (range 0.5–7y). No stroke occurred. 16 patients required a treatment intensification for other indications (frequent VOC/ACS, splenic sequestrations): 6 were transplanted and 10 received HU or TP. Significant risk factors (Pearson) of conversion to abnormal were the age at time of conditional TCD occurrence < 3 y (p<0.001), baseline Hb < 7g/dl (p=0.02) and MCV > 80 (p=0.04). MRI/MRA was performed in 31/43 patients and showed ischemic lesions in 5 of them at the mean (SD) age of 7.1 y (1.8) (range 4.5–8.9): no significant difference was observed in the occurrence of lesions between the 2 groups. Conclusions This study confirms the importance of age as predictive factor of conditional to abnormal TCD conversion with a risk of 64% when first conditional TCD occured before the age of 3 years. TCD has to be frequently controled during the 5 first years of life.

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The Retrospective Analysis of Pediatric Acute Leukemia Cases between 1980–2003: Hacettepe Experience.

Blood ◽

10.1182/blood.v106.11.4542.4542 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4542-4542

Author(s):

Sule Unal ◽

Gonul Hicsonmez ◽

Sevgi Yetgin ◽

Aytemiz Gurgey ◽

Fatma Gumruk ◽

...

Keyword(s):

Risk Factors ◽

Acute Leukemia ◽

Hematologic Malignancy ◽

Lymphoblastic Leukemia ◽

Hematologic Malignancies ◽

Cns Involvement ◽

Laboratory Findings ◽

Cancer Data ◽

Significant Difference

Abstract Leukemia constitutes 25–30% of all pediatric malignancy cases. The epidemiologic and demographic characteristics of this group of patients are important not only for determination of the prognostic factors, but also the risk factors. In this study, 683 patients under 16 years of age who were diagnosed with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) between January 1980-July 2003 in Hacettepe University, Pediatric Hematolgy Division are analyzed retrospectively. Besides the epidemiologic characteristics including age, sex, geographic distiribution; the type of disease, clinical presentation, physical examination and laboratory findings on admission and the survival and prognosis relationships are also evaluated in order to determine the disease properties of our country. ALL patients have recieved St. Jude Total XI until 1997, and after 1997 they are treated by St. Jude Total XIII protocol. AML patients have been treated by AML 1995 and AML 1998 protocols. The study group includes 548 (80.2%) ALL and 135 (19.8%) AML cases. Two thirds of the all acute leukemia cases are males in both ALL and AML cases. The median age at diagnosis is 62 months for ALL and 108 months for AML patients. ALL is more common among 1–5 year old group; AML is more common among adolescent age group. The incidence of hematologic malignancies increases suddenly in 1997 and 1998 and then showes a decline later. The hematologic malignancy cases who have been admitted to our clinic is most commonly living in the northern and southeastern parts of Turkey. 50% of ALL and AML patients presents with the complaints of fever and pallor. Bone pain is significantly more common in ALL patients. Median time between onset of syptoms and diagnosis is 30 days for both ALL and AML patients. Lymphadenopathy is present in almost half of ALL and AML patients at diagnosis. Hepatomegaly (72.4% vs 50.4%) and splenomegaly (53.8% vs 36.3%) are more commonly observed in ALL then AML patients (p<0.001). The central nervous system (CNS) involvement is present in 5.8% of ALL and 5.9% of AML patients. There is no statisticaly significant difference between ALL and AML patients in terms of bone, mediastinial and CNS involvements. The most common cytogenetical abnormality in ALL patients is hypodiploidy. 25.4% of ALL and 43.7% of AML patients have relapsed subsequently. The most common type of relaps is seen in bone marrow in both ALL and AML cases, however CNS relaps is seen more commonly among ALL patients (31% vs 4%). Fatality rates of ALL and AML are 20.1% and 56.3%, respectively. The fatality rate of AML is significantly higher than ALL. The CNS involvement at diagnosis and sex have no influnce on the fatality rates; on the other hand the presence of relaps for ALL and AML groups and L3 subtype, being less then 1 year old at diagnosis for ALL cases have a negative effect on fatality rates. Also the fatality rates of ALL patients who have been diagnosed before 1997 and recieved St. Jude Total XI protocol has higher fatality rates then who have been diagnosed after 1997 and recieved St. Jude Total XIII (23.3% vs 14.1%). The collection of the cancer data throughout the country is crucial for the determination of the distribution and risk factors of our country. The best way of cancer data collection is development of cancer recording systems and analyzing these data for the determination of distribution and risk factors of patients with hematologic malignancies.

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Bleeding and thrombosis outcomes in patients with acute leukemia.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19501 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19501-e19501 ◽

Cited By ~ 1

Author(s):

Amar Harry Kelkar ◽

Asha R. Dhanarajan ◽

Mona Arti Kelkar ◽

John R. Wingard

Keyword(s):

Risk Factors ◽

Acute Leukemia ◽

Major Bleeding ◽

Significant Risk ◽

Bleeding Events ◽

Logrank Test ◽

Hospital System ◽

Vte Prophylaxis ◽

Vein Thrombosis ◽

Significant Difference

e19501 Background: Management of acute leukemia is often complicated by acute venous thromboembolism (VTE) and bleeding. However, it is unknown which risk factors contribute to these VTE and bleeding events, how they impact survival, or whether they warrant VTE prophylaxis. Methods: A retrospective study was conducted at the University of Florida Health Shands Hospital System. The study included patients aged 18 or older with acute leukemia who received induction chemotherapy between January 2000 and December 2011. Bleeding was defined as clinically significant non-major bleeding and major bleeding per the International Society on Thrombosis and Haemostasis guidelines. VTE was defined as pulmonary embolism, deep vein thrombosis of the upper or lower extremities, or visceral vein thrombosis. Results: Of the 250 patients with acute leukemia, 65 had VTE, 60 had bleeding, and 152 had no significant VTE or bleeding. There were 27 patients with both VTE and bleeding. There were no significant differences in demographics or disease types between these three groups. There was a total of 77 VTE events and 72 bleeding events. We performed a logistic regression analysis in a mixed model to identify risk factors for VTE and bleeding, considering leukemia type, presence of infection, chemotherapy, number of comorbidities, VTE prophylaxis, and transplant as covariates. Presence of infection and number of comorbidities were significantly associated with VTE (p = 0.0094 and 0.0009, respectively). We did not find any significant risk factor associated with bleeding. Kaplan-Meier survival analysis showed a non-significant difference in survival between the non-VTE, non-bleed group and the VTE group (Logrank test, p = 0.52). In contrast, survival in the non-VTE, non-bleed group was significantly higher than the bleed group (Logrank test, p = 0.0006). The table demonstrates higher two-year survival in the non-VTE, non-bleed group (68.7%) compared to the VTE and bleed groups (54.4% and 30.3%, respectively). Conclusions: Acute leukemia patients without VTE or bleeding had significantly higher duration of survival than patients with bleeding. Patients with acute leukemia and presence of infection or multiple comorbidities may warrant greater consideration of VTE prophylaxis. [Table: see text]

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Risk factors for bladder calculus in patients with benign prostatic hyperplasia: a retrospective single-center study

10.21203/rs.2.24560/v1 ◽

2020 ◽

Author(s):

Xin Sun ◽

Dexin Yu ◽

Zhangjun Cao ◽

Dongdong Xie ◽

Liangkuan Bi

Keyword(s):

Risk Factors ◽

Benign Prostatic Hyperplasia ◽

Multivariate Analyses ◽

Specific Antigen ◽

Significant Risk ◽

Prostatic Hyperplasia ◽

Bladder Calculus ◽

Total Prostate Specific Antigen ◽

Significant Difference ◽

Group 2

Abstract Background: To explore the risk factors that lead to the formation of bladder calculus in patients with benign prostatic hyperplasia (BPH). Methods: Retrospective study was performed between June 2017 and October 2019, 103 patients with BPH who underwent transurethral resection of the prostate (TURP) were included. Patients with BPH were divided into two groups: 32 patients with bladder calculus in group1 and 71 patients without bladder calculus in group2. Characteristics of both groups were compared and univariate and multivariate analyses were performed to investigate the association between BPH with or without bladder calculus. Results: There was no significant difference between the two groups regarding age, duration of BPH, body mass index (BMI), total prostate volume (TPV), total prostate-specific antigen (TPSA), International prostate symptom score (IPSS), serum albumin, hemoglobin, uric acid, urinary tract infection, diabetes, and hypertension. The patients' serum creatinine and acute urinary retention (AUR) were significantly lower, while intravesical prostatic protrusion (IPP) was significantly higher in group 1 than group 2. Multivariate analyses revealed that IPP and AUR were significant risk factors for the formation of bladder calculus in patients with BPH. For IPP, the receiver operating characteristic (ROC) curve showed that the cut-off value of the highest risk of the formation of bladder calculus was 11.5 mm. Conclusions: Our study indicated that IPP and AUR were independent risk factors that were closely linked with the incidence of bladder calculus in BPH patients.

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Parental factors associated with intrauterine growth restriction

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1512701h ◽

2015 ◽

Vol 143 (11-12) ◽

pp. 701-706 ◽

Cited By ~ 3

Author(s):

Monica Hăşmăşanu ◽

Sorana Bolboacă ◽

Tudor Drugan ◽

Melinda Matyas ◽

Gabriela Zaharie

Keyword(s):

Risk Factors ◽

Intrauterine Growth Restriction ◽

Newborn Infants ◽

Significant Risk ◽

Growth Restriction ◽

University Hospital ◽

Control Group ◽

Parental Factors ◽

Intrauterine Growth ◽

Significant Difference

Introduction. Linear growth failure is caused by multiple factors including parental factors. Objective. The aim of this study was to evaluate parental risk factors for intrauterine growth restriction (IUGR) on a population of Romanian newborn infants in a tertiary level maternity facility for a period of 2.5 years. Methods. A retrospective matched case-control study was conducted in the Emergency County Hospital of Cluj-Napoca, a university hospital in North-Western Romania. The sample was selected from 4,790 infants admitted to the Neonatal Ward at 1st Gynecology Clinic between January 2012 and June 2014. Results. The age of mothers was significantly lower in the IUGR group compared to controls (p=0.041). A significantly higher percentage of mothers had hypertension in the IUGR group compared to those in the control group (p<0.05). No other significant differences were identified with regard to the investigated characteristics of mothers between IUGR infants compared to controls (p>0.13). The age of fathers of infants with IUGR proved significantly lower compared to controls (p=0.0278). The analysis of infants? comorbidities revealed no significant difference between groups for respiratory distress, hyperbilirubinemia, hypocalcaemia, and heart failure (p>0.27). Intracranial hemorrhage, necrotizing enterocolitis and hypoglycemia were significantly higher in the IUGR group compared to controls. The logistic regression identified hypertension as a significant risk factor for IUGR (OR=2.4, 95% CI [1.3-4.5]). Conclusion. Although the age of the mothers and fathers proved significantly lower in the IUGR group compared to controls, only hypertension in the mothers proved significant risk factors for IUGR.

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A study to determine risk factors for renal scarring as detected by dimercaptosuccinic acid scan in children with urinary tract infection

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20212764 ◽

2021 ◽

Author(s):

Nisha Jacob Arackal Jacob ◽

Seshagiri Koripadu ◽

Harishchandra Venkata Yanamandala

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Renal Scarring ◽

Significant Risk ◽

Significant Risk Factor ◽

Positive Group ◽

Recurrent Uti ◽

Significant Difference ◽

Dimercaptosuccinic Acid Scan ◽

Dmsa Scan

Background: The aim of the study was to determine the risk factors for renal scarring detected by DMSA (dimercaptosuccinic acid) scan in children with culture-proven urinary tract infection (UTI).Methods: A hospital based observational case-control study was conducted from 2018 June to 2020 June in children aged between 1 month to 5 years who underwent a DMSA scan following culture-proven UTI (N=72). Of the children fulfilling the criteria, 43 had renal scarring in the DMSA scan as a case group and the remaining 29 children who had no renal scarring were taken as a control group.Results: Of the total 72 cases with culture-positive UTI, 59% of patients had renal scarring and the rest and 40% were scar negative. There was no significant difference in the renal scarring observed with respect to age in the two groups. There was significant (p<0.05) the association noted between renal scarring and VUR (vesicoureteric reflux). A significant difference was observed in the renal scarring between the two groups regarding the presence of recurrent UTI (p=0.000). Although most cases (97.7%) had a fever in the DMSA positive group, this was not a significant risk factor for scarring (p>0.05). In DMSA positive group, circumcision was not a significant risk factor for scarring.Conclusions: VUR and recurrent UTI were significant risk factors for renal scarring in children with culture-proven UTI as detected by DMSA scan. The other risk factors like age, sex, fever, leucocytosis and circumcision were not found to be significant.

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Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

10.21203/rs.3.rs-1008430/v1 ◽

2021 ◽

Author(s):

Xining Zhao ◽

Jie Liu ◽

Ying Wang ◽

Yuying Yang ◽

Yan Pan ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Postoperative Complications ◽

Geriatric Patients ◽

Cox Regression ◽

Significant Risk ◽

Related Factors ◽

Factors Associated ◽

Delayed Discharge ◽

Significant Difference

Abstract Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

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