scholarly journals Factors associated with changes in creatine phosphokinase (CPK) in trauma patients submitted to the “Red Wave”, with evolution to rhabdomyolysis

2018 ◽  
Vol 45 (2) ◽  
Author(s):  
MARIO PASTORE NETO ◽  
RAFAEL VALÉRIO GONÇALVES ◽  
CARLA JORGE MACHADO ◽  
VIVIAN RESENDE
Keyword(s):  
Compartment Syndrome ◽  
Blunt Trauma ◽  
Renal Injury ◽  
Creatine Phosphokinase ◽  
Statistical Significance ◽  
Thoracic Injury ◽  
Acute Renal Injury ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Prospective Longitudinal

ABSTRACT Objective: to identify and analyze factors associated with plasma creatine phosphokinase (CPK) levels in trauma victims with progression to rhabdomyolysis. Methods: we conducted a prospective, longitudinal study, with 50 patients submitted to the “Red Wave” protocol, with evolution to rhabdomyolysis after hospital admission. We studied the variables age, gender, trauma scores, mechanism and outcome, CPK at admission and final, intervals of days between laboratory evaluations, surgery and complications. We stratified CPK values in <500U/L, ≥500 - <1000 U/L, and ≥1000U/L, with calculation of the difference between the initial and final values. Results: at admission, 83% of patients (n=39) had CPK≥1000U/L, with predominance of blunt trauma and thoracic injury (p<0.05), as well as orthopedic fracture, acute renal failure and gastrointestinal bleeding, CPK being lower in those without acute renal injury, with a trend towards statistical significance. There were no differences in final CPK stratification. Factors that were independently associated with the greater CPK variation were, positively, hospitalization time greater than one week and compartment syndrome, and negatively, acute renal injury. Conclusion: the CPK level of 1000U/L remains the lower limit, with importance for early intervention in worsening conditions such as digestive hemorrhage, acute renal injury and compartment syndrome, which implied greater absolute differences between initial and final CPK, in addition to blunt trauma, thoracic injury and orthopedic fracture.

scholarly journals Decreased mobility, lack of social support, haemosiderosis and use of antidepressant medications may predict recurrent venous leg ulcers within 12 months of healing: A prospective longitudinal study

2021 ◽  
pp. 026835552110639
Author(s):  
KJ Finlayson ◽  
CN Parker ◽  
C Miller ◽  
HE Edwards ◽  
J Campbell
Keyword(s):  
Social Support ◽  
Longitudinal Study ◽  
Statistical Significance ◽  
Ulcer Recurrence ◽  
Leg Ulcers ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Antidepressant Medications ◽  
Venous Leg Ulcers ◽  
Prospective Longitudinal

Aim To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. Methods A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. Design Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. Results A sample of 143 participants was recruited (51% male, M age = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks ( SE 1.63, 95% CI 33.7–40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications ( p = .035), presence of haemosiderosis ( p = .006), decreased mobility (longer sitting times) ( p = .007) and lower social support scale scores ( p = .002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance ( p = .06). Conclusion Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention.

scholarly journals Prognostic factors and clinical outcome in a rare form of spastic paraplegia (Spoan syndrome): a 10-year follow-up

2019 ◽  
Author(s):  
Cláudia R. C. Galvão ◽  
Priscilla M. A. Cavalcante ◽  
Ricardo Olinda ◽  
Zodja Graciani ◽  
Mayana Zatz ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Outcome ◽  
Statistical Significance ◽  
Hand Function ◽  
Age At Onset ◽  
Spastic Paraplegia ◽  
Prospective Longitudinal Study ◽  
The Mean ◽  
Prospective Longitudinal

Abstract Background: Spastic paraplegia, optic atrophy and neuropathy (Spoan syndrome) is an autosomal recessive disease with approximately 70 cases recorded in Brazil and Egypt. Methods: This is a prospective longitudinal study performed with 47 patients affected with Spoan syndrome of seven communities of Rio Grande do Norte (Brazil) to investigate prognostic factors and clinical outcome based on comparative data obtained from a 10-year follow-up. Results: The mean age of the participants was 47.21±12.42 years old, and the mean ages at loss of ambulation and hand function were 10.78±5.55 and 33.58±17.47 years old, respectively. Spearman’s correlation analysis between the score on the Modified Barthel Index and the investigated variables evidenced statistical significance for age (p<0.001) and right- and left-hand grip strength (p=0.042 and p=0.021, respectively). Statistical significance was not evidenced for the remainder of the variables, including age at onset of symptoms (p=0.634), age at loss of ambulation (p=0.664) and age at loss of hand function (p=0.118). Conclusions: Our analysis allows asserting that the participants exhibited slight dependence until age 35. The greatest losses occurred from ages 35 to 41, and starting at 50, practically all patients become completely dependent. In fact, age is the main prognostic factor of impaired motor function among Spoan syndrome patients.

scholarly journals Radiological Analysis of Frontal Cells and its Association with Frontal Sinus Mucosal Disease: A Tertiary Care Hospital Based Study

2019 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Bikash Lal Shrestha ◽  
Sameer Karmacharya
Keyword(s):  
Frontal Sinus ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Small Sample ◽  
Care Hospital ◽  
Prospective Longitudinal Study ◽  
Mucosal Disease ◽  
Complex Anatomy ◽  
Prospective Longitudinal

Introduction The frontal sinus and frontal recess both have complex anatomy causing difficulty during endoscopic sinus surgeries. The term frontal cells is currently used to describe a group of anterior ethmoidal cells classified by Kuhn et al into 4 types. Though there are precise descriptions, the frequency of frontal sinus cells (FSCs) varies widely in the literature. The presence of FSCs is responsible for a narrowing of the frontal sinus outflow tract which subsequently causes a partial obstruction of drainage and aeration of the frontal sinus. Our main aim is to the see the distribution of different frontal cells in Nepali population and relation with frontal sinus mucosal disease.   Materials and Methods This prospective, longitudinal study performed in 110 consecutive patients who underwent CT scan of nose and paranasal sinuses. The frontal cells and agger nasi cells were identified and association between the frontal cells and agger nasi cells with frontal sinus mucosal disease was analyzed with chi square test.   Results The agger nasi was present in 83.63% CT scans whereas frontal cells were distributed in 61.82% CT (computed tomogram) scans. There was not statistical significance and any association between the frontal cells and agger nasi cells with frontal sinus mucosal disease.   Conclusion The frontal cells and agger nasi cells distribution in Nepalese population, even though in small sample size, is similar with other studies in the literature. There is also non association of either frontal cells or agger nasi cells with frontal sinus mucosal disease.

Prospective analysis of expression of circulating levels of matrix metalloproteinase-9 (MMP-9) in the serum of patients with primary central nervous system lymphoma (PCNSL)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1532-1532
Author(s):  
A. F. Hottinger ◽  
B. Gu ◽  
M. Fleisher ◽  
L. E. Abrey ◽  
E. Holland ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Brain Mri ◽  
Central Nervous System Lymphoma ◽  
Disease Status ◽  
Disease Recurrence ◽  
Small Population ◽  
Significant Drop ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal ◽  
Circulating Levels

1532 Background: Matrix metalloproteinases have been associated with angiogenesis, tumor infiltration and metastases formation in systemic lymphoma. Disease status in PCNSL is determined by brain MRI; however it may be inconclusive and non-invasive tests to evaluate disease status would be useful. This study was designed to determine whether circulating levels of MMP-9 could be related to disease status in PCNSL. Methods: Circulating levels of MMP-9 were determined by ELISA and correlated with disease status assessed by MRI in a prospective longitudinal study. The disease status was classified as no evidence of disease (CR) versus active disease (AD). Results: We enrolled 18 PCNSL patients and obtained 93 blood samples (median 6 per patient, range 1–10) from August 2002 to December 2005. When in CR (12 patients, 59 samples), the mean MMP-9 level was 205.5 ± 19.1 ng/ml (median 162.3 ng/ml, range: 35.9–649.1 ng/ml). MMP-9 levels were significantly higher in AD (16 patients, 34 samples), with a mean MMP-9 of 638.2 ± 140.7 ng/ml (median 287.5 ng/ml, range 24.7–3340.6 ng/ml) (p = 0.0001). Paired samples obtained before and after therapy were obtained in 10 patients. Patients in AD had a mean of 1223.9 ± 336.5 ng/ml (median 770.1 ng/ml, range 284.1–3340.6 ng/ml) before treatment and levels fell to a mean of 143.5 ± 38.4 ng/ml (median 86.7 ng/ml, range 28.1–356.5 ng/ml) (p = 0.005) when CR was reached. During follow-up, 4 of the 18 patients developed recurrent disease (total 5 recurrences). MMP-9 levels increased from 154.22 ± 34.9 ng/ml (median 162.4 ng/ml, range 64.5–260.3 ng/ml) to 324.4 ± 98.5 ng/ml (median 251.5 ng/ml, range: 159.5–709.7 ng/ml) (p = 0.14) at relapse. Conclusions: PCNSL patients in CR have circulating MMP-9 levels that are significantly lower than in patients with AD. A significant drop in MMP-9 was seen after treatment compared to baseline. MMP-9 levels increased with disease recurrence but did not reach statistical significance in this small population. MMP-9 has the potential to complement neuroimaging to confirm remission or progression. No significant financial relationships to disclose.

scholarly journals Changes in liver stiffness after ART initiation in HIV-infected Nigerian adults with and without chronic HBV

2019 ◽  
Vol 74 (7) ◽  
pp. 2003-2008
Author(s):  
Jennifer L Grant ◽  
Patricia Agaba ◽  
Placid Ugoagwu ◽  
Auwal Muazu ◽  
Jonathan Okpokwu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Stiffness ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Hiv Care ◽  
Inverse Association ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Art Initiation ◽  
Prospective Longitudinal

Abstract Background There are limited data from sub-Saharan Africa on long-term liver fibrosis changes in HIV- and HIV/HBV-infected individuals. Objectives To assess the effects of ART on liver stiffness measurement (LSM) using transient elastography (TE) in HIV- and HIV/HBV-infected Nigerian adults and examine factors associated with fibrosis regression. Methods We included ART-naive HIV- and HIV/HBV-infected adults (≥18 years) enrolled in a prospective, longitudinal study of liver disease between July 2011 and February 2015 at Jos University Teaching Hospital HIV Care and Treatment Centre in Nigeria. Patients initiated ART and had TE at baseline and follow-up (year 3). LSM cut-offs for Metavir scores were 5.9, 7.6 and 9.4 kPa for moderate fibrosis, advanced fibrosis and cirrhosis, respectively. We used multivariable regression to identify factors associated with TE (≥1 Metavir) stage decline. Results A total of 106 HIV- and 71 HIV/HBV-infected patients [70.5% female and median age = 34 years (IQR = 29–42 years)] were studied. Baseline LSM and median LSM decline were significantly higher in HIV/HBV- versus HIV-infected patients; 41% of HIV/HBV-infected patients regressed ≥1 Metavir stage versus 17% of HIV-infected patients (P < 0.01); LSM scores at year 3 were not significantly different between HIV- and HIV/HBV-infected patients. In multivariable analyses, patients with baseline CD4+ T cells ≥200 (versus <200) cells/mm3 and lower BMIs were more likely to experience LSM stage decline. Conclusions HBV coinfection does not attenuate LSM declines in HIV-infected patients after ART initiation despite being a risk factor for more advanced liver disease prior to therapy. The inverse association between BMI and TE stage decline needs further investigation.

Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 36-45
Author(s):  
Katie Truss ◽  
Stephen J C Hearps ◽  
Franz E Babl ◽  
Michael Takagi ◽  
Gavin A Davis ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Multinomial Logistic Regression ◽  
Internalizing Behavior ◽  
Parental Distress ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Postconcussive Symptoms ◽  
Chi Squared ◽  
Symptom Recovery ◽  
Prospective Longitudinal

Abstract BACKGROUND Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. OBJECTIVE To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. METHODS This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. RESULTS We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. CONCLUSION This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.

scholarly journals PSV-1 A prospective longitudinal study of the incidence and risk factors associated with footrot in feedlot lambs in Southern Alberta

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 227-227
Author(s):  
Karen S Schwartzkopf-Genswein ◽  
Wiolene M Nordi ◽  
Désirée Gellatly ◽  
Daniela M Meléndez ◽  
Timothy D Schwinghamer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Prospective Longitudinal Study ◽  
Factors Associated ◽  
Southern Alberta ◽  
Unit Increase ◽  
Feedlot Lambs ◽  
Potential Strategy ◽  
Associated Risk Factors ◽  
Prospective Longitudinal

Abstract Lameness in sheep caused by footrot (FR) is a significant health, welfare, and economic concern worldwide. To date, no studies have documented the incidence of FR or associated risk factors in feedlot lambs in Alberta. The objectives of this study were to determine 1) FR incidence and 2) animal, managerial and environmental risk factors associated with FR in one Southern Alberta, lamb feedlot. Assessments were conducted biweekly (average of 10 pens per visit) by 2 experienced observers. A total of 73,150 lambs were assessed between October 2017 and March 2019. All lame lambs were scored according to a 3-point mobility scale (1 = mild, 2 = moderate, and 3 = severe lameness) and physically examined to diagnose the cause of lameness. Risk factors associated with FR were documented and included gender, days on feed (DOF), diet composition, and season. Multivariable regression models (SAS PROC GLIMMIX) were used to determine significant risk factors. A total of 473 lambs were identified as lame, 107 of which were diagnosed with FR (incidence of 22.6%). Footrot affected lambs had greater mobility scores (≥ 2; P &lt; 0.0001) than all other lame diagnoses. Footrot was 4.40 and 0.10 times more likely (P &lt; 0.0001) in female and wether than ram lambs, and 0.60 and 0.23 times more likely (P &lt; 0.0001) in fall and summer than winter and spring seasons. The odds of being diagnosed with FR increased for each additional DOF and each unit increase of barley in the diet (P = 0.0268), while the odds decreased (P = 0.0016) for each additional unit of supplement in the diet. Based on our findings, footrot is an issue to lambs in Alberta, and further studies are still necessary to understand the risk factors associated with potential strategy for mitigating FR in feedlot lambs.

scholarly journals Assessment of image-derived risk factors for natural course of unruptured cerebral aneurysms

2016 ◽  
Vol 124 (2) ◽  
pp. 288-295 ◽  
Author(s):  
Manasi Ramachandran ◽  
Rohini Retarekar ◽  
Madhavan L. Raghavan ◽  
Benjamin Berkowitz ◽  
Benjamin Dickerhoff ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Cerebral Aneurysms ◽  
Expectant Management ◽  
Wall Tension ◽  
Prospective Longitudinal Study ◽  
Longitudinal Outcome ◽  
Imaging Surveillance ◽  
Unruptured Cerebral Aneurysms ◽  
Prospective Longitudinal

OBJECT The goal of this prospective longitudinal study was to test whether image-derived metrics can differentiate unruptured aneurysms that will become unstable (grow and/or rupture) from those that will remain stable. METHODS One hundred seventy-eight patients harboring 198 unruptured cerebral aneurysms for whom clinical observation and follow-up with imaging surveillance was recommended at 4 clinical centers were prospectively recruited into this study. Imaging data (predominantly CT angiography) at initial presentation was recorded. Computational geometry was used to estimate numerous metrics of aneurysm morphology that described the size and shape of the aneurysm. The nonlinear, finite element method was used to estimate uniform pressure-induced peak wall tension. Computational fluid dynamics was used to estimate blood flow metrics. The median follow-up period was 645 days. Longitudinal outcome data on these aneurysm patients—whether their aneurysms grew or ruptured (the unstable group) or remained unchanged (the stable group)—was documented based on follow-up at 4 years after the beginning of recruitment. RESULTS Twenty aneurysms (10.1%) grew, but none ruptured. One hundred forty-nine aneurysms (75.3%) remained stable and 29 (14.6%) were lost to follow-up. None of the metrics—including aneurysm size, nonsphericity index, peak wall tension, and low shear stress area—differentiated the stable from unstable groups with statistical significance. CONCLUSIONS The findings in this highly selected group do not support the hypothesis that image-derived metrics can predict aneurysm growth in patients who have been selected for observation and imaging surveillance. If aneurysm shape is a significant determinant of invasive versus expectant management, selection bias is a key limitation of this study.

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