Relationship Between Subtherapeutic Warfarin Anticoagulation and the Development of Post Thrombotic Syndrome After a First Unprovoked Deep Vein Thrombosis: Results From the REVERSE Cohort Study

Abstract Abstract 712 Background & Objective: Risk factors for the post-thrombotic syndrome (PTS) remain poorly understood. In a prospective multinational multicenter cohort study of patients with a first episode of unprovoked deep venous thrombosis (DVT), we sought to evaluate whether subtherapeutic anticoagulation was associated with the development of PTS. Methods: The study population was derived from the REVERSE study, a prospective cohort study done to develop a clinical prediction rule to identify patients with unprovoked venous thromboembolism (VTE) at low risk of recurrent VTE. Patients with a first unprovoked VTE (index event) were treated with standard anticoagulant therapy with a target INR of 2–3 for a period of 5–7 months. Patients were then enrolled in the REVERSE study, anticoagulation was stopped, and patients were monitored for VTE recurrence. For the present study, patients with DVT as their index VTE event were assessed for PTS at enrollment into the REVERSE study, using the validated Villalta scale. PTS was defined by a score of > 4. Mild PTS was defined by a score of 5–9, moderate PTS by a score of 10–14 and severe PTS was defined by a score of ≥15 or presence of an ipsilateral leg ulcer. Using international normalized ratio (INR) data from the full period of warfarin anticoagulation, time in therapeutic range (TTR) was calculated by the Rosendaal method of linear interpolation. TTR data were analyzed to evaluate whether there was an association between sub-therapeutic INR values during various time windows since the index DVT and development of PTS. Based on published trials of warfarin anticoagulation for VTE, INR <2 for more than 20% of the time was considered to represent subtherapeutic anticoagulation. Univariate analysis was performed to determine the odds ratio (OR) for development of PTS if anticoagulation was considered subtherapeutic. Multivariate analysis was then performed to adjust for known confounding variables. Results: 646 patients were enrolled into the REVERSE study, of whom 410 had DVT as their index event. Of these, 61 were excluded for insufficient INR or PTS data. Hence, the study population comprised 349 patients. The average age was 54.2 years, and 55.6% of the patients were male. Patients were on oral anticoagulation for a mean (SD) of 199 (17) days. Ninety-seven patients (27.8%) developed PTS; of these, 77 (74.7%) had mild PTS, 16 (15.5%) had moderate PTS and 4 (3.9%) had severe PTS. For the study population, the overall mean (SD) TTR during oral anticoagulation was 64.3% (19.4%) and the overall mean (SD) percentage time spent with an INR under 2 was 23.7% (18.7%). For the time window ‘first 3 months of anticoagulation', patients who developed PTS had an INR of <2 for 30% of the time vs. 24% of the time in patients without PTS (p=0.023). For the time window ‘full period of anticoagulation', patients who developed PTS had INR <2 for 27% of the time vs. 23% of the time in patients without PTS (p=0.08). Using our predefined cut-off for subtherapeutic anticoagulation (i.e. INR <2 for more than 20% of the time), patients with PTS were more likely to have received subtherapeutic anticoagulation than those without PTS during the first 3 months of anticoagulation (62.9% vs. 48.8%; p=0.02) and during the full period of anticoagulation (62.9% vs. 48.0%; p=0.01). The incidence of PTS in patients with an INR below 2 for >20% of the full time period was 33.5% compared to 21.6% in those with an INR below 2 for ≥20% of the time (p=0.02). In univariate analysis, the OR for development of PTS if the INR was <2 for more than 20% of the time during the first 3 months of anticoagulation was 1.78 (95% CI 1.10–2.87). In multivariate analysis adjusting for age, sex, body mass index, concurrent PE, previous secondary VTE and use of graduated compression stockings, the association between subtherapeutic anticoagulation and PTS remained robust (1.84 95% CI 1.13–3.01). Corresponding ORs for the full period of anticoagulation were 1.83 (95% CI 1.14–3.00) [crude] and 1.88 (95% CI 1.15–3.07) [adjusted]. Conclusion: Subtherapeutic warfarin anticoagulation after a first unprovoked DVT may be a risk factor for the development of PTS. Careful attention to INR control may have value in preventing PTS. Further study of the risk of PTS associated with oral or parenteral anticoagulants that offer more predictable anticoagulation than warfarin may be of value. Disclosures: No relevant conflicts of interest to declare.

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Prediction of Outcome for Transabdominal Cerclage in Women with Cervical Insufficiency

BioMed Research International ◽

10.1155/2015/985764 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Ji Eun Song ◽

Keun Young Lee ◽

Ga Hyun Son

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Cohort Study ◽

Pregnancy Outcomes ◽

Retrospective Cohort ◽

Multivariate Analyses ◽

Univariate Analysis ◽

Cervical Length ◽

Cervical Insufficiency ◽

Prediction Of Outcome

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre- and postoperative cervical length (CL), and CL at 20–24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%,P<0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20–24 weeks and adenomyosis were associated with delivery at <34 weeks’ gestation following TAC (P=0.015andP=0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20–24 weeks was a significant predictor (P=0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20–24 weeks may predict the delivery at <34 weeks’ gestation following TAC.

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Neoadjuvant chemotherapy in operable breast cancer with docetaxel, doxorubicin, and cyclophosphamide (TAC) or TAC followed by vinorelbine and capecitabine (NX): Final results and analysis of markers predicting response to treatment

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.524 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 524-524

Author(s):

J. Huober ◽

G. von Minckwitz ◽

C. Denkert ◽

A. Kleine-Tebbe ◽

E. Weiss ◽

...

Keyword(s):

Multivariate Analysis ◽

Neoadjuvant Chemotherapy ◽

Clinical Response ◽

Remission Rate ◽

Univariate Analysis ◽

Early Response ◽

Response To Treatment ◽

Lymph Node Status ◽

Study Population ◽

Her 2

524 Background: The aim of this analysis was to determine the pathological complete remission rate (pCR) for the entire Gepartrio study population and to identify markers predicting response to NACT. Methods: The design of the Gepartrio study was described elsewhere (von Minckwitz et al.). Age at diagnosis, tumor size, lymph node status, estrogen (ER), progesterone (PgR), HER-2 status, histological type, and grade were assessed in uni- and multivariate analysis. Clinical response after 2 cycles TAC and pCR at surgery were used as efficacy endpoints. Results: 2072 pts were randomized depending on response after 2 cycles TAC. 1122 pts (54.2%) had a clinical response after 2 cycles and 385 (18.6 %) pCR. The highest pCR rate (60%) was observed in pts with triple neg tumors and < 40 years. In the HR pos/HER-2 pos pts the pCR rates were 17.6% vs. 9% for HR pos/HER-2 neg pts (p<0.001). In the HR neg subset absence of HER-2 overexpression (“triple neg tumors”) resulted in significantly improved pCR rates compared to the HR neg HER-2 pos subset (40.7% versus 31.6%, p=0.041). In univariate analysis predictors for both an early response and a pCR at surgery were age < 40 years, non T4 tumor, grade 3, neg hormone receptors (HR) and a triple neg status. Non lobular histology was only predictive for a pCR in univariate analysis. In multivariate analysis independent factors for early response were non T4 tu, tumors ≥ 40 mm, poor grading and neg HRs. Independent predictors for a pCR remained age < 40 years, poor grading, a non lobular subtype and triple neg tumors. Conclusions: The pCR rate for the whole study population of the Gepartrio trial was comparable to other neoadjuvant regimens. Markers identified as independent predictors may help in decision making for pts being considered for neoadjuvant chemotherapy. [Table: see text]

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Cognitive flexibility of smokers in the context of social anxiety

10.32592/ajnpp.2020.7.2.103 ◽

2020 ◽

pp. 93-99

Keyword(s):

Multivariate Analysis ◽

Social Anxiety ◽

Analysis Of Variance ◽

Cognitive Flexibility ◽

Univariate Analysis ◽

Multivariate Analysis Of Variance ◽

Nicotine Abuse ◽

Significant Difference ◽

Wilks Lambda ◽

Study Population

Background: The cognitiveCognitive dysfunction may be an important factor in smoking and nicotine abuse. However, there are very few studies that have examined the effects of psychiatric conditions on the cognitive flexibility of smokers. Objectives: This research was conducted with the aim of examination theto examine cognitive flexibility (perceive theperceived controllability and cognitive alternatives) ofamong smokers in the context of with social anxiety. MaterialMaterials and methods: The research was a study withpresent causal-comparative design. The populationstudy was allconducted on 60 smoker students ofstudying at Arak University, Arak, Iran, in 2018-2019 years. For selecting the research sample the. The study population was selected using the purposive sampling was usedtechnique. At first, the participants completed the Social Phobia Inventory (SPIN) and Cognitive Flexibility Inventory (CFI).. Then, based on the cutoff point scores of SPIN (19 to above),≤), the participants were divided into two smoker groups (n=30 in each group) were selected: smoker groupsof smokers with and without social anxiety. (n=30 in each group). Finally, these groups were compared in perceive the terms of perceived controllability and cognitive alternatives by Multivariate Analysis of Variance (MANOVA).using the multivariate analysis of variance. Results: The results indicated a significant difference in the linerlinear composition of the dependent variables ofin the two groups (wilks,Wilks’ lambda= 0/.799, F50,2= 6/.726, p= P=0/.004). UnivariateThe results of the univariate analysis of variance indicated that the smoker group with social anxiety had lower perceive theperceived controllability and cognitive alternatives, compared to the smoker group without social anxiety. Conclusion: In generalAs the findings indicated, the level of cognitive flexibility in the smokers with and without social anxiety iswas different. Therefore, it is necessary to consideringconsider the evaluation and treatment of cognitive deficits in smokers based on their level of social anxiety.

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Association between the Use of Backpack and Static Foot Posture in Schoolchildren with Static Pronated Foot Posture: A 36-Month Cohort Study

Children ◽

10.3390/children8090800 ◽

2021 ◽

Vol 8 (9) ◽

pp. 800

Author(s):

Pilar Alfageme-García ◽

Julián Fernando Calderón-García ◽

Alfonso Martínez-Nova ◽

Sonia Hidalgo-Ruiz ◽

Belinda Basilio-Fernández ◽

...

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Cohort Study ◽

Prospective Study ◽

Odds Ratio ◽

Univariate Analysis ◽

Foot Posture ◽

The Mean ◽

The Impact

Background: Schoolchildren often spend a lot of time carrying a backpack with school equipment, which can be very heavy. The impact a backpack may have on the pronated feet of schoolchildren is unknown. Aims: The objective of this study was to evaluate the association of the backpack use on static foot posture in schoolchildren with a pronated foot posture over 36 months of follow-up. Methods: This observational longitudinal prospective study was based on a cohort of consecutive healthy schoolchildren with pronated feet from fifteen different schools in Plasencia (Spain). The following parameters were collected and measured in all children included in the study: sex, age, height, weight, body mass index, metatarsal formula, foot shape, type of shoes, and type of schoolbag (non-backpack and backpack). Static foot posture was determined by the mean of the foot posture index (FPI). The FPI was assessed again after 36 months. Results: A total of 112 participants used a backpack when going to school. Over the 36-month follow-up period, 76 schoolchildren who had a static pronated foot posture evolve a neutral foot posture. Univariate analysis showed that the schoolchildren using backpacks were at a greater risk of not developing neutral foot (odds ratio [OR]: 2.09; 95% CI: 1.08–4.09). The multivariate analysis provided similar results, where the schoolchildren using a backpack (adjusted OR [aOR]: 1.94; 95% CI: 1.02–3.82) had a significantly greater risk of not developing a neutral foot posture. Conclusions: A weak relationship was found between backpack use and schoolchildren aged from five to eleven years with static pronated feet not developing a neutral foot posture over a follow-up period of 36 months.

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Predictive Factors for the Efficacy of Voice Therapy for Pediatric Vocal Fold Nodule

Journal of The Korean Society of Laryngology Phoniatrics and Logopedics ◽

10.22469/jkslp.2021.32.3.130 ◽

2021 ◽

Vol 32 (3) ◽

pp. 130-134

Author(s):

Chang Bin Yun ◽

Young-Mo Kim ◽

Jeong-Seok Choi ◽

Ji Won Kim

Keyword(s):

Multivariate Analysis ◽

Cohort Study ◽

Proton Pump Inhibitor ◽

Predictive Factors ◽

Gold Standard ◽

Retrospective Cohort ◽

Vocal Fold ◽

Univariate Analysis ◽

Voice Therapy ◽

The Voice

Background and Objectives Voice therapy (VT) is considered to be the gold standard of treatment of vocal fold nodule in children. This study was designed to analyze the success rate of pediatric VT and investigate the predictive factors for good response of periatic VT for vocal fold nodule.Materials and Method This was a retrospective cohort study of 23 patients under 18 years old who were diagnosed with vocal fold nodule and received pediatric VT. We divided the patients into responding and non-responding groups. We analyzed clinical and voice parameters related to the voice results.Results Twelve patients showed improved findings after VT. By univariate analysis, female patients (85.7%) and adolescence children (100%) showed a good response to VT. In multivariate analysis, female sex (p<0.05) and adolescence children (p<0.05) were significantly related to a successful voice response. Proton pump inhibitor or antihistamine, mucolytics treatment and pre-VT voice parameters did not significantly influence voice outcomes.Conclusion Pediatric VT is more effective in female and adolescence children.

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Frequency and Predictors of Post-Thrombotic Syndrome in Patients with a First, Unprovoked Deep Vein Thrombosis and No Prior Primary Venous Insufficiency: Results From the REVERSE Cohort Study,

Blood ◽

10.1182/blood.v118.21.3332.3332 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3332-3332

Author(s):

Jean-Philippe Galanaud ◽

Susan R Kahn ◽

Michael Kovacs ◽

Christina Holcroft ◽

Marisol Betancourt ◽

...

Keyword(s):

Cohort Study ◽

Deep Vein Thrombosis ◽

Anticoagulant Therapy ◽

Household Income ◽

Venous Insufficiency ◽

Univariate Analysis ◽

Compression Stockings ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Deep Vein

Abstract Abstract 3332 Background: Post thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT). Symptoms and signs assessed by the Villalta PTS scale are non-specific and may have causes other than PTS, especially primary venous insufficiency. This may lead to an overestimate of patients categorized as having PTS. To date, the frequency and predictors of PTS in patients with DVT who are free of primary venous insufficiency have not been evaluated. Methods: Using data from the REVERSE prospective multicentre cohort study, we analyzed the prevalence and risk factors for PTS in patients who had a first, unprovoked, unilateral proximal DVT 5–7 months previously and did not have clinically significant primary venous insufficiency (defined as the absence of moderate or severe venous ectasia in the contralateral leg). At the time of enrolment in the REVERSE study, PTS was evaluated in the DVT-affected leg using the Villalta scale and was considered to be present if Villalta score >4. Independent predictors of PTS were assessed using a multivariable logistic regression model adjusting for age, sex, and use of compression stockings and included all variables achieving a p value ≤ 0.10 in univariate analysis. Results: Between October 2001 and March 2006, 664 patients were enrolled in the REVERSE study after having received a 5–7 month course of anticoagulant therapy. Of these, 452 had DVT with or without concomitant pulmonary embolism (PE) as the index event. Of these, 131 patients were excluded from this sub-study for the following reasons: previous secondary DVT/PE (n=24), presence of moderate or severe venous insufficiency in the contralateral leg (n=54), no PTS assessment (n=53). Among the remaining 321 sub-study patients, 48% (n=155) reported using compression stockings. The overall prevalence of PTS 5–7 months after DVT was 27.4% (n=88). The distribution of PTS severity category was as follows: mild PTS (Villalta score, 5–9) in 80% (n=70) of cases, moderate PTS (Villalta score, 10–14) in 17% (n=15) of cases and severe PTS (Villalta score ≥15 or ipsilateral leg ulcer) in 3.4% (n=3) of cases. In univariate analysis, age, sex, concomitant PE at presentation, thrombophilia (mutation of factor II or V, elevated factor VIII or hyperhomocysteinemia, presence of a lupus anticoagulant) and levels of the inflammatory marker C reactive protein or elevated ddimer before stopping anticoagulant therapy did not influence the risk of developing a PTS at 5–7 months (all p>0.10). Obesity (OR=2.3 [1.3 – 4.0]), household income <$25,000 per annum (OR= 2.8 [1.2 – 6.8]), mild venous insufficiency (OR=2.3 [1.2 – 4.4]) and ultrasonographic evidence of ipsilateral vein wall thickening or residual venous obstruction at 5–7 months (OR=1.9 [1.0 – 3.4]) were found to be predictors of PTS in the multivariable model. Poor INR control tripled the risk of PTS but the result did not reach statistical significance (OR=3.5 [0.8 – 15.8]). When restricting our analysis to the 226 patients without any signs, even mild, of contralateral venous insufficiency, the prevalence of PTS decreased slightly to 24.8% (n=56). Only obesity remained an independent predictor of PTS (OR=2.3 [1.2 – 4.4]). Poor INR control, ultrasonographic features described above and household income <$25,000 per annum also increased the risk of PTS, but results were no or no longer statistically significant (OR=2.8 [0.5 – 17.1], OR= 1.7 [0.9 – 3.4] and (OR=1.7 [0.7 – 4.5]) respectively). Conclusions: In a population of patients with a first unprovoked proximal DVT and without significant primary venous insufficiency, obesity and ultrasonographic evidence of DVT sequelae at 5–7 months after DVT independently influenced the risk of PTS. Mild clinical expression of primary venous insufficiency was also found to be a predictor of PTS and could therefore play a role in PTS pathophysiology. Nevertheless, it had a limited impact on the assessment of the overall prevalence of ipsilateral PTS according to the Villalta scale. Disclosures: Crowther: Pfizer: Consultancy, Honoraria; Leo Pharma: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; BI: Honoraria; CSL Behring: Consultancy; Octaphram: Consultancy; Artisan: Consultancy.

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Prognostic factors for severe diarrhea in patients with locally advanced rectal carcinoma treated with neoadjuvant chemoradiation with capecitabine: A single-center cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15176 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15176-e15176

Author(s):

Wesley Hartman ◽

Esther Oomen De Hoop ◽

Cornelis Verhoef ◽

Joost Nuyttens ◽

Esther van Meerten

Keyword(s):

Multivariate Analysis ◽

Cohort Study ◽

Prognostic Factors ◽

Rectal Carcinoma ◽

Univariate Analysis ◽

Locally Advanced ◽

Female Gender ◽

Neoadjuvant Chemoradiation ◽

Tertiary Center ◽

Grade 3

e15176 Background: Chemoradiation with concomitant capecitabine (CRT) followed by total mesorectal excision is the standard of care for locally advanced rectal carcinoma (LARC). Grade ≥ 3 diarrhea is considered a dose-limiting toxicity of adding capecitabine to radiotherapy. The aim of this study is to describe the risk factors of grade ≥ 3 diarrhea in patients with LARC during CRT. Methods: A single centre retrospective cohort study was conducted in our tertiary center. All patients with LARC treated with CRT from 2009 to 2015 were included. Patients with local recurrence who received CRT for the first time were also included. Univariate logistic regression analyses were used, followed by a multivariate analysis of the significant factors with backward selection at p < 0.05. Results: A total of 738 patients were included: 67% male, median age 64 years (range 17-88), 95% primary presentation. DPYD-testing was not performed upfront. In this cohort 69 patients (9%) developed ≥3 grade diarrhea. In the univariate analysis, factors significantly associated with ≥3 grade diarrhea were; female gender, age ≥65 years, body weight and decreased renal function (defined as MDRD GFR < 60 ml/min/1,73 m2). The following factors remained significantly associated with ≥3 grade diarrhea in the multivariate analysis; female gender (odds ratio (OR) 2.77, 95% confidence interval (CI) 1.54-4.99, p 0.001), age ≥65 years (OR 2.85, 95% CI 1.63-4.98, p < 0.001) and a lower bodyweight (OR 0.98, 95% CI 0.96-1.00, p 0.015). Conclusions: Female gender and age ≥65 years significantly increase the risk of grade ≥ 3 diarrhea caused by neoadjuvant CRT for LARC. So, older female patient must be closely watched during this treatment to intervene on time. The difference in toxicity between females and males might be explained by the pelvic anatomical differences between men and women. The found prognostic factors will be validated in a second cohort of patients with LARC treated with CRT. Besides, sarcopenia will be tested as a prognostic factor as well.

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Effectiveness of cetuximab as preemptive postsurgical therapy for oral squamous cell carcinoma patients with major risk: a single‐center retrospective cohort study

Investigational New Drugs ◽

10.1007/s10637-021-01062-0 ◽

2021 ◽

Author(s):

Chonji Fukumoto ◽

Yuta Sawatani ◽

Ryo Shiraishi ◽

Manabu Zama ◽

Michiko Shimura ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Multivariate Analysis ◽

Cohort Study ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Univariate Analysis ◽

Maxillofacial Surgery

SummaryA retrospective cohort study was performed to investigate the effectiveness of preemptive postsurgical therapy with cetuximab for patients with a major risk of recurrence or metastasis after clinical complete resection of primary oral squamous cell carcinoma (OSCC). The study period was from 2007 to 2019 for patients treated at the Department of Oral and Maxillofacial Surgery, Dokkyo Medical University School of Medicine. OSCC patients with major risk (n = 88) in the follow-up period were divided into groups with no postsurgical treatment (NP group), with standard postsurgical treatment (SP group), and with postsurgical treatment including cetuximab (CP group), and prognosis were compared among those groups. The 5-year overall survival rate was significantly higher in patients who received postsurgical treatment with cetuximab (CP) compared to that in the other two groups ((CP vs. NP, p = 0.028; CP vs. SP, p = 0.042). Furthermore, we performed multivariate analysis to evaluate the effects of the main components of the treatment. Among CDDP, radiotherapy, and cetuximab, only cetuximab significantly contributed to improved survival by univariate analysis (crude HR:0.228, 95%CI:0.05–0.968, p = 0.045). cetuximab also showed the same tendency in multivariate analysis, although p value did not reach significant level (Adjusted HR: 0.233, 95%CI: 0.053–1.028, p = 0.054). The results suggest that the postsurgical treatment with cetuximab as a preemptive postsurgical therapy after complete surgical resection of a visible tumor is considerably effective for OSCC patients with major risk, in other words, invisible dormant metastasis.

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Campylobacteriosis outbreak associated with ingestion of mud during a mountain bike race

Epidemiology and Infection ◽

10.1017/s095026881000049x ◽

2010 ◽

Vol 138 (12) ◽

pp. 1695-1703 ◽

Cited By ~ 35

Author(s):

T. L. STUART ◽

J. SANDHU ◽

R. STIRLING ◽

J. CORDER ◽

A. ELLIS ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Cohort Study ◽

Water Consumption ◽

Environmental Samples ◽

Retrospective Cohort ◽

Public Awareness ◽

Univariate Analysis ◽

Significant Risk ◽

Mountain Bike

SUMMARYOne of the largest reported campylobacteriosis outbreaks in Canada occurred in June 2007 in British Columbia, associated with a mountain bike race that took place in muddy conditions. A retrospective cohort study was conducted and environmental samples were collected and tested. There were 537 racers included in the study and 225 racers (42%) reported diarrhoeal illness after the race.C. jejuniclinical isolates (n=14) were found to be identical by multi-locus sequence typing. Although univariate analysis suggested water consumption and mud exposure as significant risk factors, multivariate analysis revealed that on direct ingestion mud was significantly associated with illness (OR 4·08, 95% CI 2·03–8·21). Contaminated mud was thus the most likely source ofCampylobacterinfection. We identified other unpublished reports of outbreaks associated with bike races in rainy or muddy conditions; these underscore the importance of educating racers and raising public awareness of the risks of mud ingestion.

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A Retrospective Cohort Study of Glossopharyngeal Nerve Taste in Children with Recurrent Acute Tonsillitis

Otolaryngology ◽

10.1177/0194599816674662 ◽

2016 ◽

Vol 156 (1) ◽

pp. 189-193 ◽

Cited By ~ 1

Author(s):

Courtney A. Hill ◽

Suveera Dang ◽

Michael Beach ◽

Eunice Y. Chen

Keyword(s):

Multivariate Analysis ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Univariate Analysis ◽

Tertiary Care ◽

Healthy Children ◽

Acute Tonsillitis ◽

Insurance Type ◽

Significant Difference

Objective To compare glossopharyngeal taste between healthy children and those with recurrent acute tonsillitis. Study Design Retrospective cohort study. Setting Pediatric clinics in a tertiary care medical center and satellite location. Subjects and Methods Smell and taste testing was administered to 80 well children and 64 children with recurrent acute tonsillitis (age range, 6-17 years). Smell testing was performed with the NIH Toolbox Odor Identification Test, with scores based on national averages for age and sex. Validated Taste Strips were placed on the midline of the tongue at the circumvallate papillae in random tastant order and in increasing concentrations to test sweet, salty, sour, and bitter. Ordinal logistic regression was used for multivariate analysis. Results The healthy and tonsillitis groups were similar, with mean ages of 11.3 and 10.8 years ( P = .34), respectively. The tonsillitis group had fewer boys (n = 18 vs 43, P = .002), higher mean body mass index (BMI) percentile (n = 72.2 vs 59.8, P = .01), and more subjects with public or no insurance (n = 24 vs 13, P = .004). Univariate analysis revealed no statistically significant differences in rate of normal overall taste (67.2% vs 60%, P = .39) and in sweet (79.7% vs 82.5%, P = .67), salty (85.9% vs 82.8%, P = .82), sour (64.1% vs 70%, P = .48), and bitter (90.6% vs 86.3%, P = .45). In multivariate analysis, smell ability, sex, BMI percentile, parent BMI, and insurance type did not affect overall taste or sweet, salty, sour, or bitter alone. Conclusion Despite controlling for potential intrinsic (sex, smell, BMI) and extrinsic (parent BMI, insurance type) confounders, there was no statistically significant difference in taste among children with recurrent acute tonsillitis as compared with healthy children.

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