Hydrocephalic risk factors after spontaneous subarachnoidal haemorrhaging of aneurysmal aetiology

INTRODUCTION Hydrocephalus is one of the most significant complications of spontaneous subarachnoidal haemorrhaging that can be treated surgically. OBJECTIVE We analyzed risk factors that caused spontaneous subarachnoidal haemorrhaging. Patients were divided into two groups: shunt-dependent and shunt-independent. METHOD We retrospectively analyzed 174 patients (63 men and 111 women), surgically treated at the Institute of Neurosurgery of Clinical Center of Serbia in the period from January 2002 to January 2004. RESULTS The prevalence of hydrocephalus in patients with a shunt (shunt-dependent) was most significant in women (18%:9.5%), but not statistically significant (p>0.05). Concerning the significance of age (years), we found that hydrocephalus in patients with a shunt was most significant in older patients (p<0.025).The HiH and Fisher grading were not statistically significant in our study (p>0.05%). In patients with intraventricular haemorrhaging (29.3%:10.5%) and vasospasms (34.6%:6.5%), the prevalence of shunt-dependent hydrocephalus was statistically very significant (p<0.005; p<0.001). The frequency of ventriculomegania in the initial CT scan was greater for patients with a confirmed diagnosis, but of no statistical significance (p>0.05). The prevalence of shunt-dependent hydrocephalus with aneurysms in the a. basillaris basin was 47.4%, with multiple aneurysms 17.2%, and with aneurysms of the anterior segment 9.5%, which represents a statistically significant difference (p<0.001). CONCLUSION We discovered that hydrocephalus, as a complication of spontaneous subarachnoidal haemorrhaging, was most frequent in patients older than 50 years, manifesting in ventricular haemorrhaging, vasospasm, and aneurysms of the posterior segment.

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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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Sepsis associated new onset atrial fibrillation; risk factors and long term outcomes

European Heart Journal ◽

10.1093/ehjci/ehaa946.0363 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Moosavi ◽

M Paymard ◽

R Ebrahimi ◽

T Harvey ◽

N Parkes ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Major Bleeding ◽

Rate Control ◽

Statistical Significance ◽

Significant Difference ◽

All Cause Mortality ◽

New Onset

Abstract Background Atrial fibrillation (AF) is commonly encountered in the setting of systemic inflammation or infection. The optimal management of AF in this cohort and their long-term AF-related clinical outcome are unknown. Purpose The aims of our study were to evaluate the traditional and non-traditional AF risk factors and long-term AF-related clinical outcomes in patients who were diagnosed with new onset AF in the setting of sepsis. Methods In this retrospective cohort study, we used the medical records to identify patients who were diagnosed with the new onset AF during hospitalization for sepsis at our centre between 2013 and 2017. The primary clinical outcomes included 24-month risk of ischaemic stroke, major bleeding (gastrointestinal or intracranial bleeding), the recurrence of AF and the all-cause mortality. The patients with known AF or those who died during the index admission were excluded from the analysis. Results 5598 patients were admitted to our hospital between 2013 and 2017 with sepsis. Of this cohort, 126 patients (mean age 69.7 years, 62.7% male) developed new onset AF during the index hospital admission (72.2% required ICU admission). 38 patients (30.1%) died during the initial hospitalisation while 88 patients (69.9%) were discharged from hospital (32% anticoagulated). 14 patients (16%) died within 24 months. Hypertension (59%), CKD (30%), diabetes (21%), and CCF (17%) were the most common risk factors. Mean CHA2DS2VASC score was 2.56±1.4 and mean HAS BLED score was 2.5±1.3. Mean CRP and WCC were 228±119 and 12.3±9.1 respectively. Comparing risk factors, only HASBLED score showed statistical significance on 24 months mortality (p=0.036, 95% CI 0.43–1.52). The composite incidence of all-cause mortality and ischaemic stroke was three times lower in anticoagulated patients compared with those who did not receive anticoagulation even though this did not reach statistical significance (7.1% v 21.6% respectively, p=0.07; RR=0.32; 95% CI=0.79–1.36). There was no statistically significant difference between the two groups for major bleeding events (3.5% v 3.3% respectively, p=0.68; RR=1.07; 95% CI=0.10–11.3). Rhythm and rate control therapies showed no significant difference on the composite outcome of all-cause mortality, ischaemic stroke and recurrence of AF (28.0% v 28.9%, p=0.92; RR=0.96, 95% CI=0.49–1.88), however, there was a trend towards less recurrence of AF in patients who received rate or rhythm control therapies (12% vs 18% respectively p=0.44; RR=0.67; 95% CI=0.24–1.85). Conclusions Our study suggests that anticoagulation therapy in patients with sepsis associated new onset AF may decrease composite of all-cause mortality and ischaemic stroke without increasing major bleeding risk. Rhythm and rate control strategies did not decrease all-cause mortality, ischaemic stroke or risk of recurrence of AF. These findings can provide benchmarks for design of randomized control trials. Funding Acknowledgement Type of funding source: None

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Clinical features and tumor mutational profile of younger versus older patients with cholangiocarcinoma (CCA).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.240 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 240-240

Author(s):

Lipika Goyal ◽

Stephanie Reyes ◽

Apurva Jain ◽

Rachna T. Shroff ◽

Tri Minh Le ◽

...

Keyword(s):

Risk Factors ◽

Older Patients ◽

Tertiary Care ◽

Tumor Biology ◽

Young Patients ◽

Molecular Testing ◽

Extrahepatic Cholangiocarcinoma ◽

Younger Patients ◽

Molecular Features ◽

Significant Difference

240 Background: As seen in lung cancer, young patients with cancer can have different risk factors, presentation, and tumor genotype than older patients with the same disease. The clinical and molecular features of young patients with CCA have yet to be well characterized. Methods: Retrospective chart review was performed on patients with intrahepatic (ICC) or extrahepatic cholangiocarcinoma (ECC) across 5 institutions. Data on demographics, risk factors, treatments, pathology, and overall survival (OS) were collected. Tumor genotyping results from MGH SNaPShot and Foundation Medicine were analyzed. Log-rank tests and Kaplan-Meier survival curves were used for statistical analysis. Results: Of 567 patients analyzed, 134 (23.6%) were < 50 years old (yo) and 455 (80.2%) had ICC. When assessed for risk factors, younger patients ( < 50yo) were more likely to have primary sclerosing cholangitis (PSC) (p < 0.001) and less likely to have diabetes (p = 0.05), compared to older patients ( ≥ 50yo). Surgical resection rates were similar in younger vs older patients (41.9 vs 42.6%, p = 0.890), but younger patients had larger tumors (median size 7.1 vs 5.3cm p = 0.012). Younger patients were also more likely to receive palliative systemic chemotherapy (p < 0.001) and more lines of therapy (median, 2 vs 1 line, p < 0.001). Frequency of treatment with liver directed therapy did not differ between the two groups. Molecular testing was performed on 222/567 (39.1%) patients of which 84/134 (62.7%) were younger patients and 138/433 (31.9%) were older patients. FGFR aberrations were more common in younger patients versus older patients (17.6 vs. 5.7%, p = 0.002). Targeted therapy was given to 15/84 (17.9%) younger and 28/138 (20.3%) older patients based on results of mutational profiling. Finally, no significant difference was seen in OS between younger and older patients (22.9 vs 22.7 months, p = 0.89). Conclusions: Younger patients with CCA may have different risk factors, tumor biology, and tolerance of systemic therapy compared to older patients. Further study is needed as referral patterns to tertiary care centers and motivation of younger patients to seek tertiary care may impact these results.

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Bilateral Spontaneous Hyphemas in a Patient with Aplastic Anemia

Case Reports in Ophthalmology ◽

10.1159/000493784 ◽

2018 ◽

Vol 9 (3) ◽

pp. 444-448

Author(s):

Mohammad Z. Siddiqui ◽

Grant Gebhard ◽

Alice Behrens ◽

Ahmed Sallam ◽

Sami Uwaydat

Keyword(s):

Risk Factors ◽

Aplastic Anemia ◽

Anterior Segment ◽

Posterior Segment

Bilateral spontaneous hyphemas are a rare ophthalmic event. Aplastic anemia is a hematologic condition with well-documented manifestations in the posterior segment but not the anterior segment. We present a patient with aplastic anemia without obvious risk factors for hyphema who developed bilateral spontaneous hyphemas. To our knowledge, this is the first reported case of bilateral spontaneous hyphemas in a patient with aplastic anemia.

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A Retrospective Multisite Case-Control Series of Concomitant Use of Daptomycin and Statins and the Effect on Creatine Phosphokinase

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz444 ◽

2019 ◽

Vol 6 (11) ◽

Author(s):

Bethany Lehman ◽

Elizabeth A Neuner ◽

Victor Heh ◽

Carlos Isada

Keyword(s):

Risk Factors ◽

Creatine Phosphokinase ◽

Statistical Significance ◽

Case Control ◽

Retrospective Case ◽

Control Series ◽

Significant Difference ◽

Increase Risk ◽

Potential Risk Factors ◽

Control Study

Abstract Objective Daptomycin has been associated with increased creatine phosphokinase (CPK) due to muscle injury leading to myalgias and muscle weakness. Statins have been proven to cause the same effects and it is recommended to discontinue the use of statins while on daptomycin. Evidence regarding this drug interaction is mixed. This study evaluated the risk of CPK elevation in concomitant use of daptomycin and statins compared to daptomycin alone. Method This is a multisite retrospective case-control study of patients who received daptomycin therapy with monitoring of CPK. Rates of CPK elevations were compared in patients receiving daptomycin with a statin versus daptomycin alone. To estimate the association between CPK elevation and daptomycin therapy controlling for other risk factors, logistic regression was used to analyze data. Statistical significance was determined at ɑ of 0.05. Results A total of 3658 patients were included in the study, with 2787 on daptomycin therapy alone and 871 with concurrent statin use. The incidence of CPK elevation was 90 events (3.2%) in the daptomycin group and 26 events (3.0%) in the concurrent statin group. Patients who received daptomycin therapy in addition to statins had no statistically significant difference from patients on daptomycin alone (hazard ratio, 1.05; P = .85; 95% confidence interval, 0.61–1.84). After adjusting for potential risk factors, the hazards ratio remained almost the same. Conclusions Concomitant use of daptomycin and statin did not show an increase risk of CPK elevation. Clinicians may consider concomitant use of daptomycin and statin therapy with weekly CPK monitoring.

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Assessment of oxidative damage and enzymatic antioxidant system activity on the umbilical cord blood and saliva from preterm newborns with risk factors for early-onset neonatal sepsis

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.10.888 ◽

2018 ◽

Vol 64 (10) ◽

pp. 888-895 ◽

Cited By ~ 1

Author(s):

Fábio Gonçalves Coutinho ◽

Edna Maria de Albuquerque Diniz ◽

Ingrid Kandler ◽

Marco Antônio Cianciarullo ◽

Natália Rodrigues dos Santos

Keyword(s):

Risk Factors ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Neonatal Sepsis ◽

Early Onset ◽

Umbilical Vein ◽

Statistical Significance ◽

Cross Sectional ◽

Significant Difference

SUMMARY BACKGROUND: To determine the concentration of the Lipid Peroxidation Marker: Malondialdehyde (MDA), and Antioxidant Markers: Superoxide Dismutase (SOD), Glutathione Peroxidase (GPX), Catalase (CAL) in umbilical cord blood and in unstimulated saliva in the first 24 and 48 hours of life in the PTNB of mothers with and without risk factors for early-onset neonatal sepsis. METHODS: Cross-sectional study with the signing of informed consent by the pregnant women and application of a standard questionnaire classifying the PTNB in Group 1 or 2. RESULTS: Twenty-one PTNB were studied. Regarding gender, birth weight, need for oxygen, use of phototherapy, diagnosis of assumed sepsis, presence of fetal distress, number of pregnancies, type of delivery, use of corticosteroids, premature rupture of membranes, maternal fever, chorioamnionitis, APGAR at the 5th and 10th minute of life. Statistical analysis was performed with the Mann-Whitney test (p = 0.019) on the GPX variable of umbilical cord blood in the group of mothers with risk factors for early-onset neonatal sepsis. There was no statistical difference in the MDA, SOD, and CAT variables of the group with risk factors and in any variable of the group without risk factors. CONCLUSION: There was an increase of the GPX concentration in the blood from the umbilical vein in the group with risk factors for early-onset neonatal sepsis. There was no statistical significance in the comparison of saliva and umbilical cord blood. There was no statistically significant difference in MDA, SOD, CAT.

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The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity

PLoS ONE ◽

10.1371/journal.pone.0262340 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262340

Author(s):

Marte Sofie Wang-Hansen ◽

Hege Kersten ◽

Jūratė Šaltytė Benth ◽

Torgeir Bruun Wyller

Keyword(s):

Risk Factors ◽

Older Patients ◽

Readmission Rate ◽

Female Gender ◽

Community Dwelling ◽

Referral Letter ◽

Geriatric Ward ◽

Old Patients ◽

Significant Difference ◽

Medical Wards

Background Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions. Methods Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records. Results We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91–0.99) per year), female gender (2.17 (1.15–4.00)) and higher MMSE score (1.03 (1.00–1.06) per point) were significant risk factors for readmission. Conclusions Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.

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Characteristics and Outcomes of Younger Adults with Embolic Stroke of Undetermined Source (ESUS): A Retrospective Study

Stroke Research and Treatment ◽

10.1155/2019/4360787 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Ali M. Al Khathaami ◽

Bayan Al Bdah ◽

Abdulmjeed Alnosair ◽

Abdulkarim Alturki ◽

Rayan Alrebdi ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Retrospective Study ◽

Length Of Stay ◽

Older Patients ◽

Embolic Stroke ◽

Stroke Severity ◽

Median Length ◽

Younger Adults ◽

Significant Difference

Introduction. Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia. Patients and Methods. A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Results. Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; P=0.004), diabetes (35.9% vs. 57.4%; P=0.03), and dyslipidaemia (12.8% vs. 28.7%; P=0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay. Discussion. Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors. Conclusion. This study showed that 26.5% of patients with ESUS were aged ≤50 years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.

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High seroprevalence of Toxocara antibodies in pregnant women attending an antenatal clinic at a university hospital in Ile-Ife, Nigeria

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/trz116 ◽

2020 ◽

Vol 114 (4) ◽

pp. 301-307 ◽

Cited By ~ 1

Author(s):

Kemisola Ikotun ◽

Oluyomi Sowemimo ◽

Chia-Mei Chou ◽

Kayode Ajenifuja ◽

Ting-Wu Chuang ◽

...

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Statistical Significance ◽

Epidemiological Data ◽

Antenatal Clinic ◽

University Hospital ◽

Personal Hygiene ◽

Seroprevalence Rate ◽

High Seroprevalence ◽

Significant Difference

Abstract Background Human toxocariasis is a neglected zoonotic disease and its impact on human health is underestimated. Studies investigating the occurrence of toxocariasis in pregnancy are very scarce in Nigeria. This study investigated the seroprevalence of Toxocara spp. antibodies as well as the possible risk factors in pregnant women who routinely attended an antenatal clinic in a university hospital in Ile-Ife, Osun state. Methods Blood samples were collected from 413 participating pregnant women between October 2017 and February 2018. Epidemiological data were obtained through a structured questionnaire. The sera were screened for anti-Toxocara IgG antibodies by western blot technique based on Toxocara canis larval excretory-secretory antigens, targeting low molecular weight bands of 24-35 kDa, specifically for T. canis infection. Results The overall seroprevalence was 92.49% (382/413). There was no significant difference in the seroprevalence rate of Toxocara spp. infection between pregnant women aged ≤30 y and those aged >30 y (91.63 vs 93.33%; OR 1.28, 95% CI 0.61 to 2.67, p=0.511). The seroprevalence rate increased with the number of miscarriages but there was no statistical significance (p>0.05). Moreover, no significant associations were found between Toxocara spp. seropositivity and other studied risk factors (p>0.05). Conclusion The high seroprevalence of Toxocara spp. in pregnant Nigerian women needs comprehensive health education regarding personal hygiene and how to avoid exposure to this parasite infection.

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Acute Diverticulitis in the Young: The Same Disease in a Different Patient

Gastroenterology Research and Practice ◽

10.1155/2013/867961 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Adolfo Pisanu ◽

Valentina Vacca ◽

Isabella Reccia ◽

Mauro Podda ◽

Alessandro Uccheddu

Keyword(s):

Risk Factors ◽

Older Patients ◽

Acute Diverticulitis ◽

Young Patients ◽

Cross Sectional Study ◽

Prior History ◽

Cross Sectional ◽

High Fiber ◽

Recurrent Diverticulitis ◽

Significant Difference

Background. Natural history and risk factors for diverticulitis in young patients are still debatable. This study aimed to assess whether difference exists in patients aged 50 and younger when compared to older patients and to identify risk factors for acute diverticulitis in the young.Patients and Methods. From January 2006 to December 2011, 80 patients were admitted to our department for acute diverticulitis. We carried out a cross-sectional study in 23 patients (28.7%) aged 50 and younger and 57 older patients (71.3%).Results. Acute diverticulitis in the young was not more aggressive than in the older patient. Diverticulitis at patient’s admission was similar with respect to Hinchey’s stage and prior history of diverticulitis. No significant difference was found for both medical and surgical treatment. The rate of recurrent diverticulitis in nonoperated patients was similar. Male gender, body mass index ≥25, and assumption of alcohol were independent risk factors for the occurrence of an acute diverticulitis in the young.Conclusions. The same disease seems to be affecting young patients such as overweight or obese male individual. Current policies to prevent diverticular disease and its related complications must include obesity control together with high-fiber diet and regular exercise.

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