Risk factors for construct/implant related complications following primary posterior hemivertebra resection: Study on 116 cases with more than 2 years’ follow-up in one medical center

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

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Prevention of Infections Associated With Permanent Cardiac Antiarrhythmic Devices by Implementation of a Comprehensive Infection Control Program

Infection Control and Hospital Epidemiology ◽

10.1086/502428 ◽

2004 ◽

Vol 25 (6) ◽

pp. 492-497 ◽

Cited By ~ 20

Author(s):

Abraham Borer ◽

Jacob Gilad ◽

Eytan Hyam ◽

Francisc Schlaeffer ◽

Pnina Schlaeffer ◽

...

Keyword(s):

Risk Factors ◽

Infection Control ◽

Medical Center ◽

Tertiary Care ◽

Pacemaker Implantation ◽

Relative Weight ◽

Control Program ◽

Cardiac Device ◽

Infection Control Program

AbstractObjective:To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).Design:Prospective before-after trial with 2 years of follow-up.Setting:A tertiary-care, university-affiliated medical center.Patients:A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.Intervention:An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.Results:Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).Conclusions:We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.

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Risk factors for Lassa fever infection among survivors at the Federal Medical Center, Owo, Ondo State, Nigeria

International Journal of One Health ◽

10.14202/ijoh.2021.128-134 ◽

2021 ◽

Vol 7 (1) ◽

pp. 128-134

Author(s):

Olayinka Stephen Ilesanmi ◽

Oluwatosin Temitope Owoeye-Lawal ◽

Adewale Johnson Aro ◽

Aanuoluwapo Adeyimika Afolabi ◽

Adesola Olawumi Kareem ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Medical Center ◽

Public Information ◽

Lassa Fever ◽

Sources Of Information ◽

Cross Sectional ◽

Preventive Practices ◽

Ondo State

Background and Aim: There is insufficient information about the successfully managed Lassa fever (LF) patients in Nigeria. This study aimed to utilize the One Health approach to identify the risk factors for LF infection among LF patients who were managed and on follow-up at the Federal Medical Center, Owo, Ondo State, Nigeria. Materials and Methods: A cross-sectional study was done on 101 LF survivors who were managed and on follow-up at the Federal Medical Center. The data were collected using a semi-structured interviewer-administered questionnaire. The respondents were assessed for symptoms and factors that might have predisposed them to LF, and the data were analyzed with SPSS version 23 (IBM Corp., NY, USA). Those who had more than 3 identifiable risks were categorized as high risk. Descriptive statistics were done, and the association between sociodemographic characteristics and high risk was explored using Chi-square test. Results: The median age of the respondents was 33 years (8-85 years); 62 (61.4%) were male, and 93 (92.1%) have heard of LF before diagnosis. The perceived cause of LF infection among the respondents included the consumption of food contaminated by rats' feces among 57 (56.4%) persons, while 16 (15.8) attributed their infection to contact with LF-infected persons. Among the respondents with primary education and below, 5 (29.4%) were at higher risk for LF infection compared to 7 (8.3%) with secondary education and above (p=0.014). Conclusion: The mass media and other sources of information should be well-harnessed in the communication of risks and preventive practices for LF. Public information campaigns should be organized to discourage bush burning in affected communities.

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Behavioural outcome in twin–twin transfusion syndrome survivors treated with laser surgery

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-317080 ◽

2019 ◽

Vol 105 (3) ◽

pp. 304-309 ◽

Cited By ~ 1

Author(s):

Fieke L Brandsma ◽

Marjolijn S Spruijt ◽

Monique Rijken ◽

Ratna N G B Tan ◽

Dick Oepkes ◽

...

Keyword(s):

Risk Factors ◽

Child Behavior ◽

Child Behavior Checklist ◽

Medical Center ◽

Behavioural Problem ◽

Behavioural Problems ◽

Laser Coagulation ◽

Medical Database ◽

Neurodevelopmental Impairment

ObjectiveEvaluate the incidence of and risk factors for behavioural problems in twin–twin transfusion syndrome (TTTS) survivors treated with fetoscopic laser coagulation.DesignObservational cohort study.SettingNational referral center for fetal therapy, Leiden University Medical Center, The Netherlands.PatientsBehavioural outcome was assessed in 417 TTTS survivors, at the age of 2 years.InterventionsParents completed the Child Behavior Checklist for their twins. Antenatal, neonatal and follow-up data including Bayley III and a neurological exam were recorded from the medical database.Main outcome measuresThe incidence of and risk factors for behavioural problems.Results332 twin pregnancies (664 fetuses) were treated with fetoscopic laser for TTTS between 2008 and 2015. For 517 children eligible for follow-up, 417 (81%) Child Behavior Checklist questionnaires were completed. The study group was born at a mean gestational age of 32.8 weeks±3.2. Total behavioural problems within the borderline to clinical range were reported in 8% (95% CI 5.9 to 11.2) of survivors, compared with 10% in the general Dutch population (p=0.12). No difference between donors and recipients was detected (p=0.84). Internalising and externalising problems were reported in 9.4% (95% CI 6.9 to 12.6) and 11.5% (95% CI 8.8 to 15.0), respectively. Severe neurodevelopmental impairment was more frequent in the children with behavioural problems. High maternal educational level was associated with lower behavioural problem scores.ConclusionParents of twins treated with fetoscopic laser therapy for TTTS do not report more behavioural problems compared with general population norms. More behavioural problems are reported in children with severe neurodevelopmental impairment.

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Methicillin-ResistantStaphylococcus AureusCarriage Among Patients After Hospital Discharge

Infection Control and Hospital Epidemiology ◽

10.1086/502592 ◽

2005 ◽

Vol 26 (7) ◽

pp. 629-633 ◽

Cited By ~ 31

Author(s):

Menno R. Vriens ◽

Hetty E. M. Blok ◽

Ada C. M. Gigengack-Baars ◽

Ellen M. Mascini ◽

Chris van der Werken ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Hospital Discharge ◽

Medical Center ◽

Eradication Therapy ◽

Infect Control Hosp ◽

The University ◽

Mrsa Colonization

AbstractBackground and Objective:At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.Design:All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage ofStaphylococcus aureus, and eradication treatment.Results:A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.Conclusions:Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)

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Unruptured intracranial aneurysm growth trajectory: occurrence and rate of enlargement in 520 longitudinally followed cases

Journal of Neurosurgery ◽

10.3171/2018.11.jns181814 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1077-1087 ◽

Cited By ~ 3

Author(s):

Aichi Chien ◽

Rashida A. Callender ◽

Hajime Yokota ◽

Noriko Salamon ◽

Geoffrey P. Colby ◽

...

Keyword(s):

Risk Factors ◽

Growth Rate ◽

Medical Center ◽

Growth Trajectory ◽

Patient Specific ◽

Limited Information ◽

Initial Size ◽

Unruptured Intracranial Aneurysms ◽

Aneurysm Growth

OBJECTIVEAs imaging technology has improved, more unruptured intracranial aneurysms (UIAs) are detected incidentally. However, there is limited information regarding how UIAs change over time to provide stratified, patient-specific UIA follow-up management. The authors sought to enrich understanding of the natural history of UIAs and identify basic UIA growth trajectories, that is, the speed at which various UIAs increase in size.METHODSFrom January 2005 to December 2015, 382 patients diagnosed with UIAs (n = 520) were followed up at UCLA Medical Center through serial imaging. UIA characteristics and patient-specific variables were studied to identify risk factors associated with aneurysm growth and create a predicted aneurysm trajectory (PAT) model to differentiate aneurysm growth behavior.RESULTSThe PAT model indicated that smoking and hypothyroidism had a large effect on the growth rate of large UIAs (≥ 7 mm), while UIAs < 7 mm were less influenced by smoking and hypothyroidism. Analysis of risk factors related to growth showed that initial size and multiplicity were significant factors related to aneurysm growth and were consistent across different definitions of growth. A 1.09-fold increase in risk of growth was found for every 1-mm increase in initial size (95% CI 1.04–1.15; p = 0.001). Aneurysms in patients with multiple aneurysms were 2.43-fold more likely to grow than those in patients with single aneurysms (95% CI 1.36–4.35; p = 0.003). The growth rate (speed) for large UIAs (≥ 7 mm; 0.085 mm/month) was significantly faster than that for UIAs < 3 mm (0.030 mm/month) and for males than for females (0.089 and 0.045 mm/month, respectively; p = 0.048).CONCLUSIONSAnalyzing longitudinal UIA data as continuous data points can be useful to study the risk of growth and predict the aneurysm growth trajectory. Individual patient characteristics (demographics, behavior, medical history) may have a significant effect on the speed of UIA growth, and predictive models such as PAT may help optimize follow-up frequency for UIA management.

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Cohort protocol: Guangzhou High-Risk Infant Cohort study

BMJ Open ◽

10.1136/bmjopen-2020-037829 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037829

Author(s):

Pian Hu ◽

Azhu Han ◽

Yan Hu ◽

Yuqi Wen ◽

Jingjing Liang ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

High Risk ◽

Medical Center ◽

High Risk Infant ◽

Factors Affecting ◽

Registration Number ◽

Complex Relationships ◽

High Risk Infants

IntroductionDespite the increase in the survival rate of high-risk infants (HRIs) worldwide, the prevalence of motor and neurodevelopmental sequelae in such newborns has not shown concomitant improvement. Meanwhile, there are few cohorts that explore factors related to the development of HRIs in China. Therefore, the Guangzhou High-Risk Infant Cohort (GHRIC) has been designed to examine the complex relationships among a myriad of factors influencing growth and development in such children.Methods and analysisThe GHRIC study is a prospective cohort study that by the year 2023 will enrol an estimated total of 3000 HRIs from Guangzhou Women and Children’s Medical Center (GWCMC) in Guangzhou, China. This study is designed to assess the growth and cognitive characteristics of HRIs and the risk factors affecting their development and prognoses. Data on risk factors, neurodevelopmental and cognitive-function evaluations, laboratory results, and specimens will be collected and analysed. Information on perinatal and clinical interventions for these infants will also be recorded during regular follow-up visits until age 6.Ethics and disseminationThe protocol for this study has been approved by the Research Ethics Committee of GWCMC, which accepted responsibility for supervising all of the aspects of the study (No. 2017102712). Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the Internet and social media.Trial registration numberChiCTR-EOC-17013236

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Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma

Journal of Neurosurgery ◽

10.3171/2016.8.jns16867 ◽

2017 ◽

Vol 127 (5) ◽

pp. 1117-1125 ◽

Cited By ~ 16

Author(s):

Myung-Hoon Han ◽

Je il Ryu ◽

Choong Hyun Kim ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Subdural Hematoma ◽

Repeated Measures ◽

Proportional Hazards ◽

Medical Center ◽

Chronic Subdural Hematoma ◽

Cox Proportional Hazards ◽

Risk Factors For Recurrence

OBJECTIVEChronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals.METHODSKaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up.RESULTSThis study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03–2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m2), and a bilateral operation.CONCLUSIONSThis study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.

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Clinical Analysis of 382 Sinonasal Inverted Papilloma Cases Treated at A Single Tertiary Medical Center

Journal of Rhinology ◽

10.18787/jr.2020.00309 ◽

2020 ◽

Vol 27 (2) ◽

pp. 102-107

Author(s):

Soo Kyoung Park ◽

Geonho Lee ◽

Min Su Kim ◽

Yong Min Kim ◽

Ki-Sang Rha

Keyword(s):

Risk Factors ◽

Recurrence Rate ◽

Surgical Approach ◽

Medical Center ◽

Demographic Data ◽

Inverted Papilloma ◽

Sinonasal Inverted Papilloma ◽

Associated Malignancy ◽

Risk Factors For Recurrence

Background and Objectives: Sinonasal inverted papilloma (IP) is a benign tumor with a locally aggressive nature and a propensity to recur. Many risk factors for recurrence have been reported, but they are still controversial. The aim of this study was to comprehensively assess the demographic data, clinical features, and potential risk factors for recurrence of IP.Subjects and Method: This work is a retrospective review of 382 patients diagnosed with and treated for sinonasal inverted papilloma between 1986 and 2017 at a single tertiary medical center. Demographic data, presence of associated malignancy, information about previous surgeries, tumor location, Krouse stage, surgical approach, follow-up duration, and data on recurrence were obtained.Results: In our study, 31 of 382 cases (8.1%) were associated with malignancy. Mean age was significantly higher in patients with associated malignancy compared to the benign IP group. Of the 351 benign cases, 263 (74.9%) were primary, and 88 (25.1%) were revision cases (residual or recurrent disease). Although the proportion of patients with high Krouse stage or multifocal involvement was high in the revision cases, there was no significant difference in recurrence rate. The 226 patients with a minimum follow-up of 1 year were included for recurrence analysis. Recurrence rate was significantly higher in the conventional surgery group (17.4%) compared to that of the endoscopic and combined surgery groups (8.1% and 3.6%, respectively). Also, the recurrence group showed significantly larger proportion of patients with high Krouse stage and multifocal involvement.Conclusion: Risk factors for recurrence of IP found in this study are comparable to those previously published. Generally, the factors associated with recurrence of IP were prior surgery, clinical stage, involved site, and surgical approach. Therefore, surgeons should always consider these risk factors to reduce the chance of recurrence.

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Peripartum cardiomyopathy – risk factors, characteristics and long-term follow-up

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0086 ◽

2014 ◽

Vol 0 (0) ◽

Cited By ~ 2

Author(s):

Hagit Shani ◽

Rafael Kuperstein ◽

Alla Berlin ◽

Michael Arad ◽

Ilan Goldenberg ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Dysfunction ◽

Retrospective Cohort ◽

Medical Center ◽

Peripartum Cardiomyopathy ◽

Assisted Reproduction Techniques ◽

Maternal Morbidity And Mortality ◽

Long Term Follow Up

AbstractPeripartum cardiomyopathy (PPCM) is an infrequent form of cardiomyopathy causing significant maternal morbidity and mortality. We aimed to evaluate the risk factors, characteristics and prognosis of PPCM during the index and subsequent pregnancies.: A retrospective cohort of 36 women with PPCM in a tertiary medical center was analyzed and compared with 10,370 women who gave birth during a single calendar year at the same institution.Women diagnosed with PPCM were older (mean 33.5 years) than controls. A significantly higher proportion were primiparous (63.9%), carried multifetal pregnancies (33.3%) and had hypertensive pregnancy complications (38.9%). Thirty-six percent of PPCM patients conceived with: Risk factors for peripartum cardiomyopathy include primiparity, hypertension and multifetal pregnancies. Assisted reproduction techniques are not independently associated with PPCM but rather through other risk factors for PPCM. The degree of cardiac dysfunction at diagnosis and time to recovery are important prognostic factors.

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