Risk Factors of Diabetic Retinopathy

To the Editor.— In their article on risk factors for diabetic retinopathy in youth, Malone et al1 make note of the recent report of Goldstein and associates2 of a direct association between antecedent long-term glycemic control and the development of diabetic retinopathy in a population with age and duration of diabetes similar to those in the study population of Malone et al. However, Malone et al do not mention a significant difference between their study group and that of Goldstein et al: the group of Malone et al had no well-controlled diabetics whereas the group of Goldstein et al had many.

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Pattern and Risk Factors of Diabetic Retinopathy among Type 2 Diabetic Patients: Experience in a Tertiary Care Hospital

Journal of Medicine ◽

10.3329/jom.v17i1.30053 ◽

2016 ◽

Vol 17 (1) ◽

pp. 17-20

Author(s):

Md Mostarshid Billah ◽

Muhammad Abdur Rahim ◽

Md Anisur Rahman ◽

Palash Mitra ◽

Tufayel Ahmed Chowdhury ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Glycemic Control ◽

Proliferative Diabetic Retinopathy ◽

Poor Glycemic Control ◽

Diabetic Patients ◽

Care Hospital ◽

Duration Of Diabetes ◽

Type 2 Diabetic

Background: Diabetic retinopathy is the commonest cause of blindness in the working age group of both developed and developing countries. It is the indicator of all micro-vascular complications of diabetes mellitus. This study was aimed to find out the frequency and pattern of diabetic retinopathy among hospitalized adult type 2 diabetic patients.Methodology: This cross-sectional study was carried out in the Department of Medicine and Endocrinology of BIRDEM General Hospital, Dhaka over a period of six months. Retinopathy was determined by fundoscopic examination in dilated pupil. Data were collected in preformed questionnaire including demographic characteristics, fundoscopic findings, and laboratory investigation reports with prior informed consent of the patients.Results: Total patients were 94, male were 52 and female were 42. Mean age of the patients was 52.2 ± 11.12 years. Hypertension was the most common (42.8%) co-morbid condition followed by dyslipidemia (33%), nephropathy (34%), neuropathy (21.3%), ischemic heart disease (9.6%) and stroke (5.3%). Study showed 37.23% Patient had good glycemic control (HbA1C <7%) and 62.77% had poor glycemic control. The frequency of retinopathy of any form was present in 36.2% patients. Among them, non-proliferative diabetic retinopathy (NPDR) was present in 78.79%, proliferative diabetic retinopathy (PDR) 6.06%, maculopathy 6.06%, both maculopathy and PDR in 9.09% diabetic patients. Among NPDR, 46.15 % was mild, 26.92% was moderate and 26.92% was severe NPDR. This study also revealed retinopathy was more with increase in duration of diabetes (66.6% vs. 17.3% p=0.01), in poorly controlled diabetic than good control (52.54% vs. 8.5%, p=0.01), those with hypertension (55% vs. 22%, p=0.02), and those having diabetic nephropathy (78.12% vs. 14.51%, p=0.01).Conclusion: This study showed frequency of diabetic retinopathy was 36.2% and among retinopathy NPDR was predominate. Poor glycemic control, increase duration of diabetes, presence of other microvascular complication i.e. nephropathy found to be significant risk factors for developing retinopathy.J MEDICINE January 2016; 17 (1) : 17-20

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Persistent postoperative limitation of range of motion after total knee arthroplasty - Are there predictors?

10.21203/rs.3.rs-299870/v1 ◽

2021 ◽

Author(s):

Stella Oberberg ◽

Jessica Dammers ◽

Jan Nottenkämper ◽

Jan Krapp ◽

Roland Ernst Willburger

Keyword(s):

Risk Factors ◽

Range Of Motion ◽

Postoperative Outcome ◽

Study Group ◽

Related Risk ◽

Duration Of Surgery ◽

Study Population ◽

Total Knee

Abstract BackgroundImplantation of total knee arthroplasty (TKA) is one of the most common operations in orthopedics. However, about 20% of all patients are not satisfied with the result after TKA. Thus, persistent postoperative limitation of range of motion, for instance in the context of arthrofibrosis is with approximately 10% one of the most frequent complications after TKA and, thus, one of the most reasons for an operative revision or a worse postoperative outcome. Some potential therapeutic strategies are described in recent literature including patient-related risk factors and models for the pathogenesis of arthrofibrosis. The weighting of individual risk factors is currently not fully understood. MethodsIn the present study, a retrospective analysis of patient data was performed using a literature-based questionnaire in 72 patients following mobilization under anesthesia due to persistent limitation of range of motion (ROM) after TKA. An existing internal data set of 72 patients without restriction of ROM after TKA was used as a control-population. The study-group was invited to a follow-up examination to assess long-term outcome by several scores “Knee osteoarthritis outcome score” (KOOS) and “Knee society score” (KSS). In addition, patient expectation and satisfaction were evaluated according to the New KSS. ResultsIn total, 144 patients were included in the retrospective analysis. Person-related risk factors described in the literature, such as gender or secondary diseases (diabetes mellitus, rheumatoid arthritis, or psychiatric diseases) could not be confirmed as risk factors in our population. There was a statistically significant difference in pre- and postoperative range of motion. The study-group showed a essentially higher preoperative flexion deficit and developed a lower postoperative range of motion in both extension and flexion deficits. Significant differences were found with respect to previous surgeries and duration of surgery. The study-population showed an increased number of previous operations, especially arthroscopic surgeries of the knee joint, as well as a prolonged operation time exceeding 90 minutes. Preoperative patient expectations were not fulfilled on average, despite this, patient satisfaction was still high in the long term examination. ConclusionsWe determined risk factors for our population. For example, the preoperative range of motion, previous operations, and the duration of surgery were relevant factors that were closely related to the postoperative outcome of our study-population. However, due to the retrospective study design, these results are limited. In order to perform an exact evaluation of the risk factors mentioned above, we would recommend to supplement a prospective investigation with regard to these aspects. In the follow-up examination, we furthermore could confirm the significant impact of patient expectation on outcome after TKA as described in the literature.

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Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

Acta Marisiensis - Seria Medica ◽

10.2478/amma-2020-0002 ◽

2020 ◽

Vol 66 (1) ◽

pp. 19-22

Author(s):

Melania Macarie ◽

Simona Maria Bataga ◽

Monica Pantea ◽

Razvan Opaschi ◽

Simona Mocan ◽

...

Keyword(s):

Risk Factors ◽

Sex Ratio ◽

Hiatal Hernia ◽

Statistical Significance ◽

Erosive Esophagitis ◽

Male Gender ◽

Consecutive Series ◽

Study Group ◽

Entire Study ◽

Significant Difference

AbstractObjective: This study aims to determine the correlation between risk factors and erosive esophagitis development.Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification.Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%).Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

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Patient Demographics, Characteristics, and Intrahospital Mortality of Different Ischemic Stroke Subtypes in a Tertiary Hospital during Five-Year Period

Medical Sciences Forum ◽

10.3390/iecmd2021-10315 ◽

2021 ◽

Vol 6 (1) ◽

pp. 6

Author(s):

Sintija Strautmane ◽

Kristaps Jurjāns ◽

Estere Zeltiņa ◽

Evija Miglāne ◽

Andrejs Millers

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Reperfusion Therapy ◽

Cardioembolic Stroke ◽

Study Group ◽

Large Artery ◽

Patient Demographics ◽

Stroke Subtypes ◽

Female Predominance ◽

Study Population

Background and Objectives. Ischemic stroke (IS) is one of the leading causes of disability, morbidity, and mortality worldwide. The goal of the study was to evaluate patient demographics, characteristics, and intrahospital mortality among different ischemic stroke subtypes. Materials and Methods. A retrospective observational non-randomized study was conducted, including only ischemic stroke patients, admitted to Pauls Stradins Clinical university hospital, Riga, Latvia, from January of 2016 until December 2020. Ischemic stroke subtypes were determined according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria as a stroke due to (1) large-artery atherosclerosis (atherothrombotic stroke (AS)), (2) cardioembolism (cardioembolic stroke (CS)), (3) small-vessel occlusion (lacunar stroke (LS)), (4) stroke of other determined etiology (other specified stroke (OSS)), and (5) stroke of undetermined etiology (undetermined stroke (US)). The data between different stroke subtypes were compared. Results. There was a slight female predominance among our study population, as 2673 (56.2%) patients were females. In our study group, the most common IS subtypes were cardioembolic stroke (CS), 2252 (47.4%), and atherothrombotic stroke (AS), 1304 (27.4%). CS patients were significantly more severely disabled on admission, 1828 (81.4%), and on discharge, 378 (16.8%), p < 0.05. Moreover, patients with CS demonstrated the highest rate of comorbidities and risk factors. This was also statistically significant, p < 0.05. Differences between the total patient count with no atrial fibrillation (AF), paroxysmal AF, permanent AF, and different IS subtypes among our study population demonstrated not only statistical significance but also a strong association, Cramer’s V = 0.53. The majority of patients in our study group were treated conservatively, 3389 (71.3%). Reperfusion therapy was significantly more often performed among CS patients, 770 (34.2%), p < 0.05. The overall intrahospital mortality among our study population was 570 (12.0%), with the highest intrahospital mortality rate noted among CS patients, 378 (66.3%), p < 0.05. No statistically significant difference was observed between acute myocardial infarction and adiposity, p > 0.05. Conclusions. In our study, CS and AS were the most common IS subtypes. CS patients were significantly older with slight female predominance. CS patients demonstrated the greatest disability, risk factors, comorbidities, reperfusion therapy, and intrahospital mortality.

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Clinical profile of fungal sepsis in new born: a tertiary centre experience from Bangladesh

Journal of Pediatrics & Neonatal Care ◽

10.15406/jpnc.2020.10.00432 ◽

2020 ◽

Vol 10 (6) ◽

pp. 170-173

Author(s):

Farhana Tasneem ◽

Mohammad Monir Hossain ◽

Salahuddin Mahmud ◽

Syed Shafi Ahmed

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Study Group ◽

Ventilator Support ◽

Study Population ◽

Feed Intolerance ◽

Neonatal Candidiasis

Background: Candida infections are frequent and major causes of septicemia in neonatal intensive care units and are associated with high morbidity and mortality. Low birth weight preterm infants are especially vulnerable to these devastating infections. Material and methods: A prospective observational study was done from May 2013 to June 2014 in SCABU (Special Care Baby Unit) & ICU (Intensive Care Unit) of Dhaka Shishu (Children) Hospital, Dhaka. All neonates admitted with suspected clinical sepsis were analyzed in the study. Among which 30 culture positive candida cases were identified and included in this study. Outcome measures assessed was the incidence of candidemia in our NICU with clinical profiles and associated risk factors. Results: Out of 30 newborns 18 (60%) were preterms, 20% of study population were having a birth weight of <1 kg, 23.3% with a birth weight of 1-1.5 kg and 23.3% with a birth weight of 1.5-2.5 kg. 73.4% of the study population were hospitalized for >1 week. In the study group 56.7% had feed intolerance, 53.3% needed ventilator support, 56.7% had temperature instability, 73.3% had thrombocytopenia 63.3% had apnea and 73.3% had jaundice. The overall survival was 63.3%. Conclusions Low birth weight, prematurity, use of broad spectrum antibiotics, mechanical ventilation and prolonged hospital stay were important risk factors associated with neonatal candidiasis in this study. Thrombocytopenia, feed intolerance, increased requirement for ventilator support, temperature instability, jaundice and apnea were significant clinical parameters noted in babies with culture proven neonatal candidiasis. The overall survival was 63.3% in the study group.

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30-Year Cardiovascular Disease in Type 1 Diabetes: Risk and Risk Factors Differ by Long-Term Patterns of Glycemic Control

10.2337/figshare.16775965 ◽

2021 ◽

Author(s):

Rachel G. Miller ◽

Trevor J. Orchard ◽

Tina Costacou

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Latent Class ◽

Diabetes Duration ◽

Cvd Risk ◽

High Hba1c

Objective: We hypothesized that there is heterogeneity in long-term patterns of glycemic control with respect to cardiovascular disease (CVD) development in type 1 diabetes and that risk factors for CVD differ by glycemic control pattern. Thus, we estimated associations between data-derived latent HbA1c trajectories and 30-year CVD risk in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset (<17 years old) type 1 diabetes. Research Design and Methods: Participants (n=536 with ≥2 HbA1c measurements [median 6] and CVD-free at baseline; mean age 27 and diabetes duration 18 years) were followed from 1986-88 to 2016-18 to ascertain CVD incidence (CVD death, myocardial infarction, stroke, coronary revascularization or blockage ≥50%, ischemic ECG, or angina). Latent HbA1c trajectories and their association with time-to-CVD incidence were simultaneously assessed using Joint Latent Class Mixed Models. Results: Two HbA1c trajectories with respect to differential CVD risk were identified: Low (HbA1c ~8% [64 mmol/mol] and improving over follow-up, 76% of cohort) and High (HbA1c ~10% [86 mmol/mol] and stable, 24%). Overall, 30-year CVD incidence was 47.4% (n=253); MACE incidence 31.0% (n=176). High HbA1c was associated with 3-fold increased CVD risk versus Low HbA1c. Both groups had similar age and diabetes duration. Non-HDLc and estimated glomerular filtration rate were associated with CVD risk only in Low HbA1c; albumin excretion rate was associated with CVD risk only in High HbA1c. Conclusions: These risk factor differences suggest that pathways to CVD may differ by glycemic control, potentially resulting in important implications for prognosis in type 1 diabetes.

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Risk factors for fecal carriage of IMP-6-producing Enterobacteriaceae at a long-term care hospital in Japan: A follow-up report from the northern Osaka multicentre study group

Journal of Infection and Chemotherapy ◽

10.1016/j.jiac.2018.03.009 ◽

2018 ◽

Vol 24 (9) ◽

pp. 769-772 ◽

Cited By ~ 7

Author(s):

Hideharu Hagiya ◽

Norihisa Yamamoto ◽

Ryuji Kawahara ◽

Yukihiro Akeda ◽

Rathina Kumar Shanmugakani ◽

...

Keyword(s):

Risk Factors ◽

Multicentre Study ◽

Long Term Care ◽

Study Group ◽

Care Hospital ◽

Term Care ◽

Fecal Carriage

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Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

Medicina ◽

10.3390/medicina56040177 ◽

2020 ◽

Vol 56 (4) ◽

pp. 177

Author(s):

Wojciech Matuszewski ◽

Magdalena M. Stefanowicz-Rutkowska ◽

Magdalena Szychlińska ◽

Elżbieta Bandurska-Stankiewicz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Study Group

Background and Objective: Nowadays, diabetes is one of the main causes of blindness in the world. Identification and differentiation of risk factors for diabetic retinopathy depending on the type of diabetes gives us the opportunity to fight and prevent this complication. Aim of the research: To assess differences in the risk factors for diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in Warmia and Mazury Region, Poland. Materials and Methods: Risk factors for diabetic retinopathy (DR) were assessed on the basis of an original questionnaire, which included: personal data, clinical history of diabetes and eye disease. Elements of clinical examination: blood pressure, BMI, waist circumference. Indicators of diabetes metabolic control: mean glycemia, glycated hemoglobin (HbA1c), total cholesterol and triglycerides, creatinine, glomerular filtration rate (GFR), albumin–creatinine ratio in urine. Results: The study group included 315 (26%) patients with DM1 and 894 (74%) patients with DM2. Risk factors were estimated on the basis of logistic regression and verified with Student’s t-test. Statistically significant dependencies were found in both groups between the occurrence of diabetic retinopathy and diabetes duration, HbA1c, triglyceride concentrations, indicators of kidney function and cigarette smoking status. In the DM2 group, the development of DR was significantly influenced by the implemented models of diabetic treatment. Conclusions: In the whole study group, the risk of DR was associated with the duration of diabetes, HbA1c, triglyceride concentrations and smoking. In DM1 patients, the risk of DR was associated with diabetic kidney disease in the G1A1/A2 stage of chronic kidney disease, and in DM2 patients with the G2 stage of chronic kidney disease. An important risk factor for DR in DM2 patients was associated with late introduction of insulin therapy.

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Evaluation of HbA1c Level and Other Risk Factors in Diabetic Retinopathy: A Study of Type 2 Diabetic Patients Attending in a Tertiary Level Hospital

KYAMC Journal ◽

10.3329/kyamcj.v6i2.33738 ◽

2017 ◽

Vol 6 (2) ◽

pp. 614-619 ◽

Cited By ~ 1

Author(s):

Sayama Hoque ◽

MA Muttalib ◽

Md Imtiajul Islam ◽

Parvin Akter Khanam ◽

Subhagata Choudhury

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Diabetic Retinopathy ◽

Blood Glucose ◽

Advanced Age ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Duration Of Diabetes ◽

Type 2 Diabetic

Background: Retinopathy is the leading cause of blindness in persons with diabetes. Strict monitoring and maintenance of normal blood glucose specially HbA1c and prevention of different risk factors can prevent and delay the diabetic retinopathy. The purpose of the study was to explore the factors influencing or related to the development of the diabetic retinopathy with spcial concern to the HbA1c levels.Materials and Methods: We studied 400 type 2 diabetic patients in this cross-sectional study which was conducted in the out-patient department of BIRDEM hospital, Bangladesh. The randomly selected patients were evaluated for the presence of retinopathy through the review of their registered diabetic guide book. We included sociodemographic information, blood pressure, anthropometry (height, weight, BMI) and lipid profile of the patients. Glycaemic status was assessed by HbA1c (HbA1c was categorized into 3 groups) and plasma glucose levels. We used Student's t-test, Chi-square test and logistic regression analysis to determine and quantify the association of diabetic retinopathy with various risk factors specially HbA1c.Results: 400 type 2 diabetic patients (male 166 and female 234) were studied. The prevalence of retinopathy was 12.3%; male 12.7%, female 12.0%. Increasing HbA1c categories above 7.0% were significantly associated with increased prevalence of retinopathy (4.2 vs 12.3 vs 18.1%;c2 = 12.529, p < .01). Logistic regression models of univariate analysis showed that the risk of retinopathy at HbA1c categories >7.0% was (OR = 3.22; 95% CI: 1.12-9.25) and the risk was strongly increased at the HbA1c categories 8% (OR = 5.07; 95% CI: 1.90-13.50). Advanced age (OR = 2.92; 95% CI: 1.44-5.91), longer duration of diabetes (OR = 3.08; 95% CI: 1.49-6.37), presence of hypertension (OR = 2.42; 95% CI: 1.14-5.16), FBG (OR = 1.139; 95% CI: 1.036-1.251), blood glucose 2 hours ABF (OR = 1.124; 95% CI: 1.046-1.207) and SBP (OR = 1.033; 95% CI: 1.011-1.056) had significant association with retinopathy.Conclusions: HbA1c categories >7.0% is an important risk factor for the development of retinopathy. Poor glycaemic control, advanced age, longer duration of diabetes, hypertension are other significant risk factors of diabetic retinopathy.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 614-619

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Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis, and literature review

Journal of Neurosurgery ◽

10.3171/2019.7.jns19885 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1450-1459

Author(s):

Yu Chen ◽

Li Ma ◽

Junlin Lu ◽

Xiaolin Chen ◽

Xun Ye ◽

...

Keyword(s):

Risk Factors ◽

Acute Phase ◽

Moyamoya Disease ◽

Disease Risk ◽

Propensity Score Analysis ◽

Postoperative Hemorrhage ◽

Posterior Circulation ◽

Short Term ◽

Significant Difference

OBJECTIVEPostoperative hemorrhage during the acute phase is rarely observed after revascularization surgery for moyamoya disease (MMD) but can have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage.METHODSThe authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases (518 procedures) that had undergone direct or combined bypass surgery at their institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage (ICH) or ICH plus intraventricular hemorrhage (IVH) during the acute phase were screened, and then the incidence, location, and risk factors of hemorrhage in these patients were analyzed. Short-term and long-term outcomes (modified Rankin Scale scores) for these patients were also collected. Outcomes were compared between patients with and those without postoperative ICH using propensity score analysis to reduce the between-group differences in baseline characteristics.RESULTSPostoperative hemorrhage occurred in 11 (2.1%; ICH = 9, IVH = 2) of 518 procedures (mean patient age 39.82 ± 8.8 years). Hemorrhage occurred in the first 24 hours after the operation in 8 cases (72.7%). In the ICH group, most of the hemorrhage sites (77.8%) were located beneath the anastomosed area, and the mean hematoma volume was 16.98 ± 22.45 ml (range 3–57 ml). One case from the ICH group required hematoma evacuation. Among the adult patients (463 procedures [89.4%]), preoperative hypertension (p = 0.008), CT perfusion (CTP) stage > III (p = 0.013), and posterior circulation involvement (p = 0.022) were significantly associated with postoperative ICH. No significant differences between the postoperative ICH group and the no-hemorrhage group were detected in terms of postoperative neurofunctional status at discharge (p = 0.569) or at the last follow-up (p = 1.000). Neither was there a significant difference in future stroke risk (p = 0.538) between these two groups.CONCLUSIONSPreoperative hypertension, CTP stage > III, and posterior circulation involvement are independent risk factors for postoperative ICH after direct or combined revascularization for MMD. After appropriate perioperative management, postoperative ICH has no significant correlations with the postoperative short-term and long-term neurofunctional status.

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