scholarly journals Recovery time, risk factors, and volumetric analysis in acute mTBI

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S17.2-S17
Author(s):  
Teena Shetty ◽  
Joseph Nguyen ◽  
Taylor Cogsil ◽  
Apostolos John Tsiouris ◽  
Sumit Niogi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Recovery Time ◽  
Age Groups ◽  
Volumetric Analysis ◽  
Initial Symptom ◽  
Psychiatric History ◽  
History Learning ◽  
Symptom Severity Score ◽  
History Of ◽  
The Right

ObjectiveThis study investigated the influence of demographic factors, the course of recovery, and the utility of investigational MR sequences (specifically volumetry) in mild traumatic brain injury (mTBI) patients.BackgroundMost literature suggests that the majority of mTBI patients achieve recovery within 1 month of injury, or sooner. This may be affected by younger age, female sex, concussion history, learning disability, psychiatric history, or migraines. The role of volumetric analysis in mTBI requires further investigation.MethodsOne hundred eleven patients (15–50 years old) enrolled in the study within 10 days of head injury. Patients completed a maximum of 4 encounters over 3 months, undergoing volumetric structural imaging at each visit. Patients were contacted to determine recovery date.ResultsRecovery date was obtained in 73 patients at HSS. The median days to recovery was 44 days (IQR: 23–88 days). 33% of this population was recovered in 30 days, 63% in 60 days, and >75% in 90 days. Of the subjects who were not recovered by 90 days, the right thalamus volume trended towards a negative correlation with SSS at that time point. Initial symptom severity score (SSS) was significantly correlated with increased days to recovery (p = 0.382, p = 0.001). Average days to recover was longer in patients with diagnosed depression, anxiety, or other psychiatric disorder (121 vs 70 days, p = 0.037). No significant differences in days to recovery were found between age groups, sex, learning disorder, previous concussions, or history of migraines.ConclusionAverage time to recover from mTBI may be longer than previously reported. Acute SSS may be a useful indicator in determining recovery time. Of previously reported risk factors, personal psychiatric history may have the greatest effect on recovery time. Despite being interesting, the volumetric correlations did not survive multiple comparison corrections and may not be the most sensitive variable for mTBI imaging.

scholarly journals Predicting COVID-19 mortality with electronic medical records

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hossein Estiri ◽  
Zachary H. Strasser ◽  
Jeffy G. Klann ◽  
Pourandokht Naseri ◽  
Kavishwar B. Wagholikar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Information ◽  
Age Groups ◽  
Prognostic Models ◽  
Smoking History ◽  
Risk Scores ◽  
Gradient Boosting ◽  
Chronic Obstructive ◽  
Clinical Expertise ◽  
History Of

AbstractThis study aims to predict death after COVID-19 using only the past medical information routinely collected in electronic health records (EHRs) and to understand the differences in risk factors across age groups. Combining computational methods and clinical expertise, we curated clusters that represent 46 clinical conditions as potential risk factors for death after a COVID-19 infection. We trained age-stratified generalized linear models (GLMs) with component-wise gradient boosting to predict the probability of death based on what we know from the patients before they contracted the virus. Despite only relying on previously documented demographics and comorbidities, our models demonstrated similar performance to other prognostic models that require an assortment of symptoms, laboratory values, and images at the time of diagnosis or during the course of the illness. In general, we found age as the most important predictor of mortality in COVID-19 patients. A history of pneumonia, which is rarely asked in typical epidemiology studies, was one of the most important risk factors for predicting COVID-19 mortality. A history of diabetes with complications and cancer (breast and prostate) were notable risk factors for patients between the ages of 45 and 65 years. In patients aged 65–85 years, diseases that affect the pulmonary system, including interstitial lung disease, chronic obstructive pulmonary disease, lung cancer, and a smoking history, were important for predicting mortality. The ability to compute precise individual-level risk scores exclusively based on the EHR is crucial for effectively allocating and distributing resources, such as prioritizing vaccination among the general population.

scholarly journals Factors Associated With Early-Onset Esophageal Cancer in Tanzania: A Case-Control Study

2018 ◽  
Vol 4 (Supplement 1) ◽  
pp. 29s-29s
Author(s):  
Geoffrey Buckle ◽  
Elia J. Mmbaga ◽  
Alan Paciorek ◽  
Larry Akoko ◽  
Katrina Deardorff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Household Income ◽  
Early Onset ◽  
Case Control Study ◽  
Age Groups ◽  
Young Patients ◽  
Second Hand Smoke ◽  
Factors Associated ◽  
History Of ◽  
Control Study

Abstract 89 Purpose Previous studies have characterized geographic clusters of esophageal cancer (EC) in East Africa. Many of the epidemiologic features of EC in this context are shared globally with other clusters, including high rates, male predominance, and squamous cell histology. A unique feature in East Africa is the high proportion of young patients, with a recent case series reporting up to 24% of patients age < 45 years. The aim of the current study was to assess factors that are associated with early-onset EC in Tanzania (TZ). Methods We performed a secondary analysis of a previous case-control study. Patients with newly diagnosed EC were recruited at Muhimbili National Hospital and Ocean Road Cancer Institute in 2014 to 2016. Hospital controls were identified from patients with nonmalignant conditions and matched 1:1 for gender and age ± 10 years. Risk factors were assessed through interviews. Logistic regression was used to estimate age-specific odds ratios (ORs) of EC for exposures across age groups (30 to 44 years, 45 to 59 years, and ≥ 60 years) and for interactions with age. Results A total of 473 cases and 473 controls were enrolled. Median ages were 59 years (range, 30 to 91 years) for cases and 55 years (range, 31 to 88 years) for controls. Among cases, 102 patients (22%) were age 30 to 44 years, 144 patients (30%) were age 45 to 59 years, and 227 patients (48%) were age ≥ 60 years. High household income was protective for those age 30 to 44 years (OR, 0.08; 95% CI, 0.01 to 0.69) and 45 to 59 years (OR, 0.13; 95% CI, 0.04 to 0.45), but not for those age ≥ 60 years (effect modification P = .047). Family history of EC was associated with a higher risk of EC among those age 45 to 59 years (OR, 3.8; 95% CI, 1.02 to 14.47) and age ≥ 60 years (OR, 6.63; 95% CI, 1.50 to 29.37), with no effect among those age 30 to 44 years (effect modification P = .019). Second-hand smoke and infrequent teeth cleaning were also associated with early-onset EC, but did not differ significantly across age groups. Additional factors associated with EC risk across all ages were firewood use (cooking), kerosene use (lighting), work on a maize farm, and in-home grain and nut storage. Protective factors were the regular use of medication, surrogates of high socioeconomic status (TV, radio, refrigerator, indoor toilet, and electricity), and charcoal or gas cooking. Conclusion Multiple exposures were identified as risk factors for early-onset EC in TZ. In age-stratified analyses, household income, second-hand smoke, and poor dental hygiene emerged as possible risk factors, whereas family history of EC had strong associations among the older but not the young age group. Our results suggest that environmental factors may underlie the high incidence of young patients with EC in TZ. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

scholarly journals Medical and social factors of the possibility of spreading coronavirus infection among fertile aged women

2021 ◽  
pp. 8-14
Author(s):  
V.V. Podolskyi ◽  
Y.H. Antypkin ◽  
Vl.V. Podolskyi ◽  
T.R. Umanets ◽  
T.M. Kaminska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Factors ◽  
Odds Ratio ◽  
Age Groups ◽  
Upper Respiratory Tract ◽  
Female Population ◽  
Younger Women ◽  
History Of ◽  
Risk Of Disease ◽  
Coronavirus Infection

Research objective: to determine the risk factors for the spread of coronavirus infection among women of fertile age.Materials and methods. Authors analyzed the medical records (case histories and questionnaires) of 60 women of fertile age who were treated for coronavirus disease. After analysis of medical and social factors women were divided into age groups. Analysis of risk factors for coronavirus disease was determined by calculating the odds ratio according to Wald at p < 0.05.Results. Evaluation of the odds ratio of the COVID-19 chances depending on the nature of work of women of different ages showed that with intense work the risk of disease increases 2.5 times in the age group up to 30 years, which also confirms the analysis of previous indicators, that younger women with moderate workloads have more opportunities to attend mass events and crowds. In the structure of extragenital diseases in women with coronavirus disease, the chances of disease increased 2.6 times in those women who had a history of chronic tonsillitis. Among the history of infectious diseases, the chance ratio of coronavirus disease was increased in women over 30 years of age who had pertussis. Such data may indicate a similar mechanism of development of these diseases, because the causative agent of pertussis also penetrates the upper respiratory tract and may be accompanied by neurological symptoms – the appearance of seizures and bronchospasm.Conclusions. The data obtained in this way allow us to separate a narrower cohort of women of fertile age who may develop coronavirus disease. This will further allow developing proposals for a more efficient distribution of vaccines among the female population of Ukraine and reduce the prevalence of coronavirus infection.

scholarly journals Ajmaline‐Induced Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging

2022 ◽  
Author(s):  
Luigi Pannone ◽  
Cinzia Monaco ◽  
Antonio Sorgente ◽  
Pasquale Vergara ◽  
Paul‐Adrian Calburean ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Recovery Time ◽  
Area Under The Curve ◽  
Electrocardiographic Imaging ◽  
Mapping System ◽  
Before And After ◽  
History Of ◽  
Noninvasive Mapping ◽  
The Difference ◽  
The Right

Background The rate of sudden cardiac death (SCD) in Brugada syndrome (BrS) is ≈1%/y. Noninvasive electrocardiographic imaging is a noninvasive mapping system that has a role in assessing BrS depolarization and repolarization abnormalities. This study aimed to analyze electrocardiographic imaging parameters during ajmaline test (AJT). Methods and Results All consecutive epicardial maps of the right ventricle outflow tract (RVOT‐EPI) in BrS with CardioInsight were retrospectively analyzed. (1) RVOT‐EPI activation time (RVOT‐AT); (2) RVOT‐EPI recovery time, and (3) RVOT‐EPI activation‐recovery interval (RVOT‐ARI) were calculated. ∆RVOT‐AT, ∆RVOT‐EPI recovery time, and ∆RVOT‐ARI were defined as the difference in parameters before and after AJT. SCD‐BrS patients were defined as individuals presenting a history of aborted SCD. Thirty‐nine patients with BrS were retrospectively analyzed and 12 patients (30.8%) were SCD‐BrS. After AJT, an increase in both RVOT‐AT [105.9 milliseconds versus 65.8 milliseconds, P <0.001] and RVOT‐EPI recovery time [403.4 milliseconds versus 365.7 milliseconds, P <0.001] was observed. No changes occurred in RVOT‐ARI [297.5 milliseconds versus 299.9 milliseconds, P =0.7]. Before AJT no differences were observed between SCD‐BrS and non SCD‐BrS in RVOT‐AT, RVOT‐EPI recovery time, and RVOT‐ARI ( P =0.9, P =0.91, P =0.86, respectively). Following AJT, SCD‐BrS patients showed higher RVOT‐AT, higher ∆RVOT‐AT, lower RVOT‐ARI, and lower ∆RVOT‐ARI ( P <0.001, P <0.001, P =0.007, P =0.002, respectively). At the univariate logistic regression, predictors of SCD‐BrS were the following: RVOT‐AT after AJT (specificity: 0.74, sensitivity 1.00, area under the curve 0.92); ∆RVOT‐AT (specificity: 0.74, sensitivity 0.92, area under the curve 0.86); RVOT‐ARI after AJT (specificity 0.96, sensitivity 0.58, area under the curve 0.79), and ∆RVOT‐ARI (specificity 0.85, sensitivity 0.67, area under the curve 0.76). Conclusions Noninvasive electrocardiographic imaging can be useful in evaluating the results of AJT in BrS.

scholarly journals SPINDLE CELL CARCINOMA OF LARYNX- A DISTINCT CLINICOPATHOLOGICAL AND HISTOLOGICAL ENTITY

2017 ◽  
Vol 3 (3) ◽  
Author(s):  
Muhammad Faisal ◽  
Arif Jamshed ◽  
Raza Hussain
Keyword(s):  
Risk Factors ◽  
Cell Carcinoma ◽  
Vocal Cord ◽  
Distant Metastasis ◽  
Spindle Cell ◽  
Spindle Cell Carcinoma ◽  
Treatment Result ◽  
Left Vocal Cord ◽  
History Of ◽  
The Right

Spindle cell carcinoma (SpCC) is a variant of squamous cell carcinoma with biphasic components and more aggressive behaviour. Its rarity and histopathological pattern pose a diagnostic challenge. Early diagnosis and treatment result in a decrease in local and distant metastasis. Case 1 is a 71-year-old female presented with hoarseness of voice and dyspnoea for 2 years without any risk factors. Fibre-optic laryngoscopy (FOL) revealed smooth polyp hanging from anterior two-third of the left vocal cord. Microlaryngoscopic excision revealed SpCC followed by post-operative radiotherapy and is currentlyalive. Case 2 is a 72-year-old male presented with worsening stridor for 2 years post-excision of laryngeal nodule and history of smoking and hookah use for >20 years. He developed dysphonia after a few months with fixed hard level 3 nodes at the right side. FOL showed a polypoid mass extending from the left vocal cord into the supraglottis. Fine-needle aspiration cytology of the neck swelling confirmed the diagnosis of SpCC. Computerised tomography (CT) chest/abdomen showed distant metastasis. Palliative radiotherapy was given, but the patient died after 3 months due to locoregional failure. Case 3 is a 35-year-old male presented with a history of hoarseness for 3 years with no risk factors. FOL showed a 1.2-cm polypoid growth on the right vocal cord. Total laryngectomy was performed and histopathology showed SpCC. Radiotherapy was given and the patient is alive without disease with regular follow-ups. Smoking and alcohol are thought to be the contributing factors causing this disease. Biphasic nature of the tumour requires pathological sampling for diagnostic confirmation. Surgery combined with radiotherapy has a better survival outcome. SpCC is a rare tumour with a tendency for locoregionalrecurrence. Surgery should remain the mainstay of treatment followed by post-operative radiotherapy for a better control.Key words: Larynx, radiotherapy, spindle cell carcinoma

scholarly journals Internal Carotid Dissection as the Cause of Stroke in Childhood

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Giulia Cinelli ◽  
Vitaliana Loizzo ◽  
Lisa Montanari ◽  
Ilaria Filareto ◽  
Elisa Caramaschi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Magnetic Resonance ◽  
Internal Carotid ◽  
Clinical Signs ◽  
Cervical Pain ◽  
Resonance Imaging ◽  
Cervical Trauma ◽  
History Of ◽  
Associated Risk Factors ◽  
The Right

Internal carotid artery (ICA) dissection is a cause of stroke, but it is often underdiagnosed in children. ICAs’ risk factors and pathogenic mechanisms are poorly understood, and the treatment is still empirical. We report the case of a previously healthy 9-year-old girl who presented with involuntary hypertonic closure of the right hand associated with transient difficulty for both fine movements of the right arm and speech. She had a history of minor cervical trauma occurring 20 days prior to our observation without other associated risk factors. Magnetic resonance imaging and magnetic resonance angiography showed ischemic lesions due to the left ICA dissection. Treatment with both acetylsalicylic acid and levetiracetam allowed recanalization of the ICA associated with the resolution of clinical signs. Our clinical case suggests that the ICA dissection must be suspected early whenever a child manifests mild neurologic deficits after a cervical trauma, especially if they are associated with headache and/or cervical pain. Moreover, the management of ICA dissection must be improved.

scholarly journals A case of recurring Amaurosis Fugax

2019 ◽  
pp. 85-87
Author(s):  
Y. Suthahar ◽  
J. Blackwell ◽  
G. Zachariah ◽  
V. Umachandran
Keyword(s):  
Risk Factors ◽  
Visual Loss ◽  
Sudden Onset ◽  
Vascular Risk ◽  
Amaurosis Fugax ◽  
Anti Platelet Therapy ◽  
History Of ◽  
Ct Head ◽  
The Right ◽  
Hospital Manager

WW a 43 year old Caucasian Hospital Manager, first presented in July 08 complaining of transient mono-ocular visual loss in the right eye.  She described sudden onset loss of vision – ‘like a curtain coming across the vision’.  She then proceeded to have similar symptoms in the left eye.  There was no history of a subsequent headache. The episode would between 30 seconds and 10 minutes and could occur up to 10 times a day. At times, the attack was also associated with some left arm numbness.  She was initially reviewed by Dr Vu [ Stroke Consultant] who diagnosed Amaurosis Fugax and started her on standard anti-platelet therapy  [combination of Aspirin and Dypyridamole].  She had very little in terms of vascular risk factors [nil hypertensive, minimal alcohol and a life-long non-smoker with a fasting cholesterol 3.12]. Her PMH history consisted of Gilberts’ Syndrome and endometriosis. She also suffered a DVT following a hysterectomy. Her initial investigations of a CT head and carotid duplex were normal.

scholarly journals COGNITIVE APPRAISAL AND KNOWLEDGE AS RISK FACTORS FOR HIGH FEAR OF FALLING IN OLDER AND MIDDLE-AGED ADULTS IN SINGAPORE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S473-S473
Author(s):  
Pey June Tan ◽  
Reuben Ng ◽  
Angelique Chan ◽  
Jagadish U Mallya ◽  
Noor Hafizah Ismail ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Fall Risk ◽  
Cognitive Appraisal ◽  
Fear Of Falling ◽  
Age Groups ◽  
Fall Risk Factors ◽  
History Of ◽  
Middle Aged Adults ◽  
Balance Problems

Abstract Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF amongst community-dwelling older adults (OA) and middle-aged adults (MA) in Singapore. This was a cross-sectional survey of a nationally-representative sample of OA (≥60 years) and MA (40-59 years) identified by stratified random sampling. Primary outcome was high FOF measured by a single-item (4-point scale). Independent variables were history-of-falls, quality-of-life, fall-related cognitive appraisal (balance problems, importance to restrict activities to prevent falls) and knowledge indicators (knowledge of other OA who fell, ability to identify out of 13 fall risk factors). MA were also asked if they’re caregivers. Multiple logistic regressions identified risk factors for high FOF separately by age-groups, adjusting for socio-demographics and comorbidities. The final analysis included 549 OA (70.6±6.88 years) and 309 MA (49.7±5.89 years). No differences in high FOF was found among OA and MA (37% vs. 38%, p=0.305), but there were more falls among OA (19% vs 12%, p=0.010). Higher knowledge of fall risk factors and self-reported balance problems were significant risk factors for high FOF among OA only, while a history-of-falls and being a caregiver were significant among MA only. Perceived importance to restrict activities was associated with high FOF in both age-groups. Although findings suggest differences in the mechanism of high FOF between OA and MA, both age-groups have maladaptive appraisal tendencies related to restrict activities to prevent falls.

scholarly journals A Case of Unilateral Coccidioidal Chorioretinitis in a Patient with HIV-Associated Meningoencephalitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher B. Toomey ◽  
Andrew Gross ◽  
Jeffrey Lee ◽  
Doran B. Spencer
Keyword(s):  
Risk Factors ◽  
Vision Loss ◽  
Complement Fixation ◽  
Rare Condition ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Blurry Vision ◽  
Systemic Symptoms ◽  
The Right

Intraocular coccidioidomycosis is a rare condition, with the most commonly reported presentation being an idiopathic iritis in patients who live in or have traveled thorough endemic areas. A paucity of reports exists describing the chorioretinal manifestations of coccidioidomycosis. Here we report a case of unilateral coccidioidal chorioretinitis and meningoencephalitis in an AIDS patient that led to near complete unilateral loss of vision. A 48-year-old Hispanic female with poorly controlled HIV/AIDS in southern California presented with a three-week history of headache, nausea, vomiting, right eye blurry vision, and a one-day history of subjective fever. Examination of the right eye revealed vitritis and several large chorioretinal lesions scattered throughout the periphery and macula with optic disc pallor. Serum coccidioidomycoses complement fixation (CF) was positive (titers of 1 : 256). Neuroimaging revealed a new area of enhancement in the left anterior frontal lobe consistent with meningoencephalitis. The patient was treated with intravenous fluconazole and intravitreal voriconazole with resolution of systemic symptoms and vitritis but persistence of unilateral, severe chorioretinal scarring and vision loss. In conclusion, in spite of the rarity of intraocular coccidioidomycosis, one must carry a degree of suspicion for this vision- and life-threatening condition as a potential etiology of chorioretinitis in individuals with pertinent risk factors.

INFLUENCE OF RISK FACTORS FOR CARDIOVASCULAR DISEASES, HISTORY OF CARDIOVASCULAR DISEASES, AND STRUCTURAL AND FUNCTIONAL STATE OF THE HEART ON 3-YEAR SURVIVAL IN PERSONS 95 YEARS AND OLDER

2021 ◽  
pp. 727-733
Author(s):  
К.А. Ерусланова ◽  
А.В. Лузина ◽  
Ю.С. Онучина ◽  
В.С. Остапенко ◽  
Н.В. Шарашкина ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
History Of ◽  
The Right

В последние годы появляется все больше работ, посвященных снижению воздействия классических факторов риска, негативно сказывающихся на выживаемости с возрастом. Целью исследования была оценка влияния сердечно-сосудистых заболеваний, их факторов риска и структурно-функциональных характеристик сердца на трехлетнюю выживаемость лиц 95 лет и старше. В исследовании участвовали 69 пациентов 95 лет и старше (98±1,9 года), из них 61 (88,4 %) женщина и 8 (11,6 %) мужчин. Через 3 года были получены данные о статусе жизни участников: 25 (36,2 %) были живы и 44 (63,8 %) умерли. По результатам проведенного однофакторного регрессионного анализа было определено, что факторы риска и анамнез сердечно-сосудистых заболеваний не ассоциированы с трехлетней выживаемостью. Однако в трехлетнем периоде риск смерти увеличивался в 3 раза при снижении ДАД <75 мм рт. ст., в 7,8 раза - при снижении ФВ ЛЖ <62 % и в 4,9 раза - при увеличении конечного диастолического размера правого желудочка >2,9 см. In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4 %) were women. After 36 months, data were obtained on the participants’ status of life: 25 (36,2 %) were alive, and 44 (63,8 %) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62 %, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.

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