Observational study of ifosfamide (Ifos) neurotoxicity (N): The prospective use of a nursing assessment tool.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19580-e19580
Author(s):  
Jeanne Held-Warmkessel ◽  
Monica Davey ◽  
Samuel Litwin ◽  
John Lee ◽  
Mitchell Reed Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Assessment Tool ◽  
Signs And Symptoms ◽  
Well Being ◽  
Prior History ◽  
Low Grade ◽  
Nursing Assessment ◽  
History Of ◽  
Hand Writing ◽  
Writing Sample

e19580 Background: Ifos chemotherapy is known to cause central nervous system toxicity. Risk factors have not been well identified in the literature, with limited information on the onset, duration, and severity of this toxicity. No clinical tools are available to assess and document N. Methods: We developed a clinical nursing assessment tool based upon review of the literature. Patients initiating inpatient Ifos chemotherapy, after informed consent was obtained under an IRB approved protocol, were prospectively monitored for signs and symptoms of N during 1 cycle of therapy. A full neurologic nursing assessment of 24 signs and symptoms including a hand writing sample was done at baseline and a basic assessment evaluating alertness, orientation, sense of well being and a hand writing sample was repeated every 12 hours. In the event N was identified, a full assessment was repeated; observed N was graded using the NCI CTC, version 3. Other variables collected were demographic traits, dose per day, hydration, and potential risk factors for N: renal function, albumin, largest pelvic tumor dimension, prior Ifos or cisplatin, use of other medications with potential for N, and alcohol use history. Individual factors were analyzed using Fisher’s exact test or the Wilcoxon two-sample test. Results: Eighty patients were accrued from 5/09-1/12. Median age was 54.5 (range: 21-85), 51% were males, PS 0 in 26.3%, 1 in 65%, 2 in 6.3% and 3 or 4 in 1.3% each. Diagnosis was sarcoma in 73.75%, lymphoma 22.5%, or germ cell tumor 3.75%. N was observed in 47.5% of patients. Toxicities in >15% of patients were sleepiness (25%), lethargy and restlessness (16.25% for each), and dizziness (15%). The majority were grade 1-2 (89.6%). Factors associated with N included generic versus brand formulation of Ifos (p=0.041) and prior history of a drug related neurotoxicity (p=0.047). BSA, performance status, gender, age, dose per m2, total planned dose, pretreatment Cr, and pretreatment albumin were not associated. Conclusions: The incidence of Ifos N is common using this nursing assessment tool, although usually low grade. We identified the formulation of Ifos and a prior history of drug related N as statistically correlated with developing N.

scholarly journals Clozapine-induced stuttering in the absence of known risk factors: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Florence Jaguga
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Side Effect ◽  
Case Reports ◽  
Extrapyramidal Symptoms ◽  
Prior History ◽  
Case Presentation ◽  
Rare Side Effect ◽  
History Of ◽  
Electrophysiological Findings

Abstract Background Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors. Case presentation A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms. Conclusion Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

Abstract 27: Statin use and risk of hemorrhagic stroke in a community-based cohort of aging women: The Women’s Health Initiative

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Elena Salmoirago-Blotcher ◽  
Kathleen M Hovey ◽  
Judith K Ockene ◽  
Chris A Andrews ◽  
Jennifer Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Women's Health ◽  
Hemorrhagic Stroke ◽  
Extension Study ◽  
Prior History ◽  
Health Initiative ◽  
Increased Risk ◽  
History Of ◽  
Statin Use ◽  
The Women’S Health Initiative

Background: Statin therapy is recommended for treatment of hypercholesterolemia and prevention of cardiovascular events. Concerns have been raised about a potentially higher risk of hemorrhagic stroke in statin users; however, there is limited information in women and in older populations. We evaluated whether statin treatment was associated with increased risk of hemorrhagic stroke among women enrolled in the Women’s Health Initiative (WHI). Methods: This secondary data analysis was conducted among 68,132 women enrolled in the WHI Clinical Trials (CTs). Participants were 50 to 79 yrs old; postmenopausal; and were followed through 2005 (parent study) and for an additional 5 yrs (through September 30, 2010) in the WHI extension study. Statin use was assessed at baseline and at follow-up (FU) visits at 1, 3, 6, and 9 years. Women brought all medications in original containers for inventory. Strokes were self-reported annually and adjudicated by medical record review. Risk of hemorrhagic stroke by statin use (modeled as a time-varying covariate, with the “no use” category as the referent) was estimated from Cox proportional hazard regression models adjusted for age (model 1); risk factors for hemorrhagic stroke (model 2); and possible confounders by indication (model 3). All models adjusted for enrollment in the different CTs and in the extension study. Participants were censored at the date of last contact or loss to FU. Pre-specified subgroup analyses were conducted according to use or non-use of antiplatelet medications (including aspirin) or anticoagulants, and prior history of stroke. Results: Final models included 67,882 women (mean age at baseline 63 ± 7 yrs). Over a mean FU of 12 yrs, incidence rates of hemorrhagic stroke were 6.4/10,000 person-years among women on statins and 5.0/10,000 person-years among women not taking statins. The unadjusted risk of hemorrhagic stroke in statin users vs. non-users was 1.21 (CI: 0.96, 1.53). The HR was attenuated to 0.98 (CI: 0.76, 1.26) after adjusting for age, hypertension, and other risk factors for hemorrhagic stroke. Planned subgroups analyses showed that women taking both statins and antiplatelet agents had a higher risk of hemorrhagic stroke than women taking antiplatelet medications without statins (HR: 1.59; CI: 1.02, 2.46), whereas women not taking antiplatelet medications had no risk elevation with statins (HR=0.79; CI: 0.58-1.08); P for interaction = .01. No significant interactions were found for anticoagulant use or prior history of stroke, but the statistical power for these analyses was low. Conclusion: Statin use was not associated with an overall increased risk of hemorrhagic stroke among older community-dwelling women. However, women taking statins in conjunction with antiplatelet medications had elevated risk; a finding that warrants further study and potential incorporation into clinical decision making.

scholarly journals Risk Factors for Community Acquired Extended-Spectrum Β-lactamase (ESBL) Producing Enterobacteriaceae Urinary Tract Infections (UTIs)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S345-S345
Author(s):  
Dheeraj Goyal ◽  
Kristin Dascomb ◽  
Peter S Jones ◽  
Bert K Lopansri
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Urinary Catheter ◽  
Univariate Analysis ◽  
Prior History ◽  
Factors Associated ◽  
Extended Spectrum ◽  
History Of ◽  
Enterobacteriaceae Infections ◽  
Tract Infections

Abstract Background Community-acquired extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae infections pose unique treatment challenges. Identifying risk factors associated with ESBL Enterobacteriaceae infections outside of prior colonization is important for empiric management in an era of antimicrobial stewardship. Methods We randomly selected 251 adult inpatients admitted to an Intermountain healthcare facility in Utah with an ESBL Enterobacteriaceae urinary tract infection (UTI) between January 1, 2001 and January 1, 2016. 1:1 matched controls had UTI at admission with Enterobacteriaceae but did not produce ESBL. UTI at admission was defined as urine culture positive for > 100,000 colony forming units per milliliter (cfu/mL) of Enterobacteriaceae and positive symptoms within 7 days prior or 2 days after admission. Repeated UTI was defined as more than 3 episodes of UTI within 12 months preceding index hospitalization. Cases with prior history of ESBL Enterobacteriaceae UTIs or another hospitalization three months preceding the index admission were excluded. Univariate and multiple logistic regression techniques were used to identify the risk factors associated with first episode of ESBL Enterobacteriaceae UTI at the time of hospitalization. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, presence of a urinary catheter at time of admission, and prior exposure to outpatient antibiotics within past one month were found to be significantly associated with ESBL Enterobacteriaceae UTIs. When controlling for age differences, severity of illness and co-morbid conditions, history of repeated UTIs (adjusted odds ratio (AOR) 6.76, 95% confidence interval (CI) 3.60–13.41), presence of a urinary catheter at admission (AOR 2.75, 95% CI 1.25 – 6.24) and prior antibiotic exposure (AOR: 8.50, 95% CI: 3.09 – 30.13) remained significantly associated with development of new ESBL Enterobacteriaceae UTIs. Conclusion Patients in the community with urinary catheters, history of recurrent UTIs, or recent antimicrobial use can develop de novo ESBL Enterobacteriaceae UTIs. Disclosures All authors: No reported disclosures.

scholarly journals Hepatitis C in pregnancy: an observational study highlighting its association with maternal parameters

2019 ◽  
Vol 8 (1) ◽  
pp. 344
Author(s):  
Bushra . ◽  
Ambreen Ghori ◽  
Azra Ahmed ◽  
Najma Dalwani ◽  
Mushtaque Ali Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Previous History ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Prior History ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
History Of

Background: Pregnancy is a very crucial time in a woman’s life. In this period of time, not only multiple physiological alterations effect the usual health status but also makes women more vulnerable to contract infection and face negative sequalae. Hepatitis C, a blood borne viral infection serve the similar fate when encountered by pregnant ladies. This study is based on exploring the prevalence of the Hepatitis C virus seropositivity among pregnant population. Moreover, we also evaluated the major risk factors leading to the infection in these mothers. Besides this, infected mothers were studied for their pregnancy outcomes.Methods: In this study 114 pregnant females were observed for this cross-sectional study. It was conducted in Gynecology Unit- 1, Liaquat University Hospital Hyderabad, for the period of January 2017 to July 2017. Chi square test was applied for statistical analysis on SPSS version 16. The criteria for enrollment in the study was set to be a pregnant lady belonging to age group 20-35 years; having singleton pregnancy; was a booked case at the hospital with compliant to antenatal follow ups; admitted to the labor room for delivery. All the non-pregnant ladies, whom had co morbid conditions such as hypertension or diabetes or had infected with hepatitis B or D were excluded from the study. Furthermore, pregnant ladies with multiple gestion or those who were either diagnosed of hepatitis C prior to conceive or had a previous history of hepatitis C were also excluded.Results: Present study revealed that out of 114, 10(8.8%) pregnant ladies were found seropositive for Hepatitis C virus. Prior history for transfusion of blood was the Foremost risk factor discovered, with 60.5% women reported this. History of surgery was the 2nd commonest factor and 43.9% had this in their medical records. On the other hand, only 8.8% women gave the history for previous evacuation. While observing pregnancy outcomes, we found 48.2% neonates had low birth weight, 41.2% were born preterm and 21.1% had low APGAR score.Conclusions: In a nutshell hepatitis c is prevalent in the pregnant population of this region and showing its effects in the form of compromised pregnancies. History of blood transfusion and previous surgery were found to be chief risk factors in the study.

scholarly journals P154 DOES A PENO-SCROTAL APPROACH FOR PENILE PROSTHESIS IMPLANTATION INCREASE THE INCIDENCE OF INGUINAL HERNIAS POSTOPERATIVELY?

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Shadi Al-Bahri ◽  
Hazem Taifour
Keyword(s):  
Risk Factors ◽  
Inguinal Hernia ◽  
Case Series ◽  
Penile Prosthesis ◽  
Signs And Symptoms ◽  
General Surgeon ◽  
Direct Inguinal Hernia ◽  
Prosthesis Implantation ◽  
Radiologic Imaging ◽  
History Of

Abstract Aim The incidence of direct inguinal hernia and reservoir migration post-penile prosthesis implantation is extremely rare. We present a case series of patients presenting with direct inguinal hernia following three-piece penile prosthesis implantation. Material and Methods Three patients presented with direct inguinal hernia shortly following penile prosthesis implantation for treatment of refractory erectile dysfunction due to venous leak that was confirmed on ultrasound imaging. All patients underwent standard open Lichtenstein tension free repair. Results All patients underwent penile prosthesis Implantation through a peno-scrotal approach in which the reservoir was placed in the space of Retzius. The first patient had reservoir displacement one day post-operatively presenting as an inguinal bulge and discomfort, and repaired the same day. The other two patients presented with symptoms of inguinal swelling and pain at 40 days and 8 months respectively. None of our patients had signs and symptoms of intestinal obstruction. Identifiable risk factors included high BMI and a history of smoking, however dissection and placement of the reservoir may play a role in weakening the floor of the inguinal canal. Conclusions Despite the rare incidence of inguinal hernia post-penile prosthesis implantation, identification of patients with risk factors for inguinal hernia development should be done preoperatively. This may be evaluated through preoperative radiologic imaging with an abdominal wall ultrasound or clinical examination by a general surgeon.

A single-institution survey of de novo secondary malignancies in patients occurring after orthotropic liver transplantation.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 297-297
Author(s):  
Quentin Gillebert ◽  
Mohamed Bouattour ◽  
Francois Durand ◽  
Claire Francoz ◽  
Valerie Paradis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
De Novo ◽  
Secondary Malignancy ◽  
Prior History ◽  
Lung Cancers ◽  
History Of ◽  
Independent Risk Factors ◽  
De Novo Cancer ◽  
Tumor Types

297 Background: We aim to evaluate in our institution the incidence of de novo malignancies following orthotopic liver transplantation (OLT) and their impact the prognosis of patients (pts). Methods: Pts treated with OLT from August 1991 To March 2009 were considered in this analysis. All pts data had been prospectively recorded in the database of French “Bio-medecine Agence”. Pts were considered for this analysis only if they survived at least 3-months after. Occurrence of de novo malignancies we analyzed and additional data (including immunosuppressive profile, type of cancer, potential independent risk factors of cancers, prognosis and the influence of immunosuppression protocols or risk factors on occurrence of cancers) were collected in patients who developed secondary cancers. Results: A total of 833 patients who underwent OLT were considered for this analysis. With a median follow-up of 7.9 years, 72 pts developed 92 de novo malignancies. The overall incidence of cancers in our population was 10.4% occurring with a median time of 6.1 years following OLT. Sixteen pts developed 2 different types of cancer and 2 pts had more than 3 tumor types. Before 12/1998, immunosuppression was primarily based on cyclosporine, steroids and/or azathiopirine, and since 01/1999 was switched to tacrolimus. Incidence of cancers regarding these two periods is summarized in the table. Before 1998, only 3 pts (17.6%) with secondary cancer had prior history of alcoholism and/or smoking compared to 27 pts (50%) after 1999. Thirty one deaths were observed and the median overall survival (OS) after the time of diagnosis of secondary malignancy was 5.62 years. Conclusions: The risk of de novo cancer after OLT is similar to reported series. History of smoking and alcohol use, increase the incidence of de novo malignancies especially head and neck and lung cancers however, immunosuppression type may not interfere with this risk. [Table: see text]

scholarly journals Risk Factors and Quality of Life of Lung Cancer Survivors in Lahore, Pakistan

2021 ◽  
pp. 68-71
Author(s):  
Rehan Ahmad Khan Sherwani ◽  
Sajjad Ali Gill ◽  
Saba Younus ◽  
Sana Saeed ◽  
Nadia Saeed ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Lung Cancer ◽  
Family History ◽  
Cancer Patients ◽  
Environmental History ◽  
Well Being ◽  
Lung Cancer Patients ◽  
History Of

Introduction: The objectives of this study is to determine the risk factors of lung cancer were patients and investigate the quality of life of lung cancer survivors. The occupational, smoking, personal, environmental and family history of the survivors are investigated. The well-being of the survivors with physical and social norms not were also studied. Methods: Risk factors and quality of life from a sample of 50 lung cancer patients investigated through a self-administered questionnaire after getting consent from the hospital management and the patients. All the analysis has been done in SPSS 21. Results: Most of the lung cancer patients were male smokers with a strong history of smoking, and more than half of the respondents inhaled while smoking cigarettes. The significant risk factors among non-smokers are occupational history, personal history, environmental history, and family history. The impact of environmental history with smoking history is observed in lung cancer patients. The physical well-being of the patients is considerably affected by the disease and the pain in their daily activities. Conclusion: Smoking remained the leading risk factor of lung cancer patients followed by radon. However, family history is found statistically significant in the prevalence of lung cancer. Authorities should draw and implement some guiding rules to control smoking, radon, and air pollution, particularly in residential areas.

scholarly journals Factors Associated with Depression and Anxiety in the Adult Population of Qatar in the First Year of the COVID-19 pandemic: Results from an Online Survey

2021 ◽  
Author(s):  
Salma M. Khaled ◽  
Iman Amro ◽  
Lina Bader ◽  
Peter Woodruff ◽  
Majid A Alabdulla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Online Survey ◽  
Adult Population ◽  
Prior History ◽  
First Year ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
Factors Associated ◽  
Potential Risk Factors ◽  
History Of

Abstract Background: There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, COVID-19 infection and mortality rates.Aim: To identify factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic.Method: We conducted a cross-sectional online survey in Qatar between July and December 2020 after the first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the PHQ-ADS scale. Results: Of 1138 participants, 71.05% were female, 69.0% Arabs, and 70.0% Non-Qataris. 77% were < 40 years (the median age in Qatar is 32 years). In a fully-adjusted model, six variables were significantly associated with PHQ-ADS; Arab ethnicity (OR=1.67, p=0.026), never married (OR=2.04, p < 0.001 (versus married), prior history of psychiatric disorder (versus no history) (OR=1.76, p=0.039), increased worries due to social media use for COVID-related news/updates (OR=1.72, p=0.003), those with a history of COVID-19 (OR=1.76, p=0.039), loneliness (OR=1.91, p < 0.001), and lower levels of religiosity (OR=0.96, p=0.039). These associations also pertained in the reduced model, with exception of religiosity which was only marginally statistically significant (OR=0.97, p=0.055).Conclusions: The potential risk factors identified may assist with anxiety and depression prevention in future COVID-19 waves, and similar crises, and assist with early intervention to treat sufferers.

scholarly journals ASSESSING RISK FOR ENDOMETRIAL CANCER AMONG HISPANIC FEMALES AGE 50 YEARS AND OLDER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S460-S460
Author(s):  
Ana Rodriguez ◽  
Yong-Fang Kuo ◽  
Enshuo Hsu
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Endometrial Cancer ◽  
Health Care Utilization ◽  
Gynecological Cancer ◽  
Signs And Symptoms ◽  
Care Utilization ◽  
Common Symptom ◽  
Hispanic Females ◽  
History Of

Abstract Endometrial cancer is the most common gynecological cancer in the US, with most women diagnosed between 55 and 64 years old. Seventy-five percent of women with endometrial cancer are postmenopausal, and the most common symptom is postmenopausal bleeding. Only a few studies have addressed the lack of knowledge and awareness of risk factors and/or health care utilization for early signs and symptoms of endometrial cancer. The objective of this study was to evaluate health care utilization among Hispanic women aged ≥50 years who are at risk for endometrial cancer. This retrospective cohort study used a combination of diagnosis and procedure codes from UTMB’s electronic health records to identify Texas Hispanic females who had a health encounter at ≥50 years of age between 2012 and 2016. Risk factors included conditions/treatments affecting hormone levels, age, body mass index, diabetes, gravidity, parity, family history of endometrial or colorectal cancer, previous diagnosis of breast or ovarian cancer or endometrial hyperplasia, smoking or alcohol use, and treatment with radiation therapy in the pelvis area. Multivariate logistic regression models evaluated for predictors of endometrial cancer. The study included 11,563 Hispanic females aged ≥50 years (median age=57). Most women were overweight. Currently, we identified 705 Hispanic females (6.1%) with possible endometrial cancer with validation underway. Females who have a history of vaginal spotting/bleeding, pelvic bleeding, and pelvic pain are at higher risk for endometrial cancer. It is important for physicians to educate patients on recognizing the signs and symptoms of endometrial cancer.

scholarly journals The risk and prevention of venous thromboembolism in the pregnant traveller

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
Divya J Karsanji ◽  
Shannon M Bates ◽  
Leslie Skeith
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Absolute Risk ◽  
Careful Consideration ◽  
Prior History ◽  
Average Risk ◽  
Limited Data ◽  
Compression Stockings ◽  
History Of ◽  
The Absolute

Abstract Background The average risk of venous thromboembolism (VTE) in long haul travellers is approximately 2.8 per 1000 travellers, which is increased in the presence of other VTE risk factors. In pregnant long-haul travellers, little is known in terms of the absolute risk of VTE in these women and, therefore, there is limited consensus on appropriate thromboprophylaxis in this setting. Objective This review will provide guidance to allow practitioners to safely minimize the risk of travel-related VTE in pregnant women. The suggestions provided are based on limited data, extrapolated risk estimates of VTE in pregnant travellers and recommendations from published guidelines. Results We found that the absolute VTE risk per flight appears to be &lt;1% for the average pregnant or postpartum traveller. In pregnant travellers with a prior history of VTE, a potent thrombophilia or strong antepartum risk factors (e.g. combination of obesity and immobility), the risk of VTE with travel appears to be &gt;1%. Postpartum, the risk of VTE with travel may be &gt;1% for women with thrombophilias (particularly in those with a family history) and other transient risk factors and in women with a prior VTE. Conclusions Based on our findings, we recommend simple measures be taken by all pregnant travellers, such as frequent ambulation, hydration and calf exercises. In those at an intermediate risk, we suggest a consideration of 20–30 mmHg compression stockings. In the highest risk group, we suggest careful consideration for low-molecular-weight heparin thromboprophylaxis. If there are specific concerns, we advise consultation with a thrombosis expert at the nearest local centre.

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