Risk Factors With Intravenous Sedation for Patients With Disabilities

Abstract The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO2 <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003–7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO2 in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration.

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Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

10.21203/rs.3.rs-128508/v1 ◽

2020 ◽

Author(s):

Ruo-Yi Huang ◽

Szu-Jen Chen ◽

Yen-Chang Hsiao ◽

Ling-Wei Kuo ◽

Chien-Hung Liao ◽

...

Keyword(s):

Risk Factors ◽

Endotracheal Tube ◽

Odds Ratio ◽

Inhalation Injury ◽

Burn Patients ◽

Shortness Of Breath ◽

Airway Protection ◽

Increased Risk ◽

Independent Risk Factors ◽

Facial Burn

Abstract BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

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Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

Korean Journal of Anesthesiology ◽

10.4097/kja.20035 ◽

2020 ◽

Vol 73 (6) ◽

pp. 542-549

Author(s):

Taeha Ryu ◽

Baek Jin Kim ◽

Seong Jun Woo ◽

So Young Lee ◽

Jung A Lim ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Odds Ratio ◽

Arthroscopic Surgery ◽

Sitting Position ◽

Past Medical History ◽

Frequent Adverse Event ◽

Increased Risk ◽

Potential Risk Factors ◽

Independent Risk Factors

Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position. Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB. Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB. Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

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Bortezomib administration is a risk factor associated with the development of tumor lysis syndrome in male patients with multiple myeloma: A retrospective study

10.21203/rs.3.rs-22557/v4 ◽

2020 ◽

Author(s):

Masahiro Kondo ◽

Yuji Hotta ◽

Karen Yamauchi ◽

Akimasa Sanagawa ◽

Hirokazu Komatsu ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Odds Ratio ◽

Tumor Lysis Syndrome ◽

Low Risk ◽

Novel Therapies ◽

Tumor Lysis ◽

Factors Associated ◽

Increased Risk ◽

Male Patients

Abstract Background: Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Although multiple myeloma is a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. Previous studies, mostly case reports or case series, have reported bortezomib-induced TLS in patients with multiple myeloma. This study aimed to investigate risk factors associated with TLS development in multiple myeloma patients.Methods: We retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between TLS and several parameters previously reported to be associated with increased risk.Results: This study included 210 patients with multiple myeloma, of which ten (4.8%) had LTLS and seven (3.3%) had CTLS. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between patients with and without TLS. Multivariate analyses revealed that TLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of TLS (odds ratio = 8.51, P = 0.046).Conclusion: In the present study, we investigated the risk factors associated with TLS development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients’ backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, since a significant number of novel therapies can achieve high antitumor responses.

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Abstract WP164: Role of Risk Factors in the Paradoxical Effect of Smoking on Peri-procedural Stroke in SAMMPRIS

Stroke ◽

10.1161/str.44.suppl_1.awp164 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Christine A Holmstedt ◽

Tanya N Turan ◽

Michael J Lynn ◽

Bethany F Lane ◽

Jean Montgomery ◽

...

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Multivariate Analyses ◽

Smoking Status ◽

Active Form ◽

Intracranial Stenosis ◽

Contributory Factor ◽

Increased Risk ◽

Never Smokers

Background: A previous SAMMPRIS analysis of patients randomized to stenting showed that peri-procedural ischemic infarcts were significantly associated with diabetes, basilar stenosis, age, and smoking status with never smokers having a higher risk (odds ratio = 8.8, p< 0.001). We sought to determine if this finding could be due to a higher burden of other risk factors in never smokers. Method: Baseline features in 213 patients undergoing stenting in SAMMPRIS were compared between never smokers vs. former and current smokers in univariate and multivariate analyses. Logistic regression was used to determine the effect of smoking on peri-procedural ischemic infarcts after adjusting for factors related to smoking. Data: Univariate results are shown in Table 1. Never smokers were significantly (P<0.05) more likely to be female, diabetic, hypertensive, and have another intracranial stenosis, but in multivariate analyses only hypertension and another intracranial stenosis remained significantly (P<0.05) associated with smoking status. In a multivariate model that incorporated hypertension and another intracranial stenosis along with smoking status, diabetes, basilar stenosis, and age, smoking status remained significant with an increased risk among patients who never smoked (odds ratio = 5.3, p = 0.005). Conclusion: While never smokers had significantly higher rates of some risk factors compared to active or previous smokers, these risk factors do not explain all the increased risk of early stroke in never smokers after stenting in SAMMPRIS. Another contributory factor may be that smoking accelerates the conversion of clopidogrel to its active form.

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Psoriatic arthritis epidemiology, comorbid disease profiles and risk factors: results from a claims database analysis

Rheumatology Advances in Practice ◽

10.1093/rap/rkaa033 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Jürgen Rech ◽

Michael Sticherling ◽

Daniel Stoessel ◽

Mona H C Biermann ◽

Benjamin M Häberle ◽

...

Keyword(s):

Risk Factors ◽

Psoriatic Arthritis ◽

Odds Ratio ◽

Claims Data ◽

Health Claims ◽

Comorbid Disease ◽

Data Set ◽

Increased Risk ◽

Systemic Inflammatory Disease ◽

Health Claims Data

Abstract Objective Psoriasis is a systemic inflammatory disease often accompanied by comorbidities, including metabolic syndrome, cardiovascular diseases and depression. Up to 41% of psoriasis patients develop psoriatic arthritis (PsA), making it one of the most relevant manifestations. A large health claims data set was analysed to determine the rate of PsA development in psoriasis patients. Furthermore, comorbid disease profiles of psoriasis patients with or without PsA were compared, and potential risk factors for the development of PsA were identified. Methods This was a non-interventional, retrospective analysis of anonymized insurance health claims data using a subset of the Institute of Applied Health Research Berlin (InGef) database. The primary outcome was the prevalence and incidence of diagnosed PsA among psoriasis patients in Germany. Risk factors for the development of PsA in psoriasis patients were determined by conditional logistic regression analysis. Results The cumulative percentage of patients with existing psoriasis developing concomitant PsA over 4 years was 3.44%, with a mean time to diagnosis of PsA of 1.5 years. Psoriasis patients diagnosed with acute rheumatism (odds ratio: 2.93, 95% CI = 1.76, 4.86; P < 0.001) or pain in unspecific joints (odds ratio: 1.74, 95% CI = 1.01, 2.99; P = 0.047) showed an increased risk for development of PsA later on. Interestingly, fewer than half of the patients with concomitant PsA consulted a rheumatologist. Conclusions Unspecific arthritic symptoms are likely to precede PsA diagnoses and can develop soon after onset of psoriasis, with accumulating risk over time. There is a high unmet need for early rheumatological assessment of psoriasis patients.

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Anastrozole-Induced Carpal Tunnel Syndrome: Results From the International Breast Cancer Intervention Study II Prevention Trial

Journal of Clinical Oncology ◽

10.1200/jco.2015.63.4972 ◽

2016 ◽

Vol 34 (2) ◽

pp. 139-143 ◽

Cited By ~ 17

Author(s):

Francesco Spagnolo ◽

Ivana Sestak ◽

Anthony Howell ◽

John F. Forbes ◽

Jack Cuzick

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Odds Ratio ◽

Intervention Study ◽

Musculoskeletal Symptoms ◽

Increased Risk ◽

Tunnel Syndrome ◽

Cancer Intervention

Purpose Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist in the carpal tunnel. It has been suggested that hormonal risk factors may be involved in the pathogenesis of CTS, and a higher incidence of CTS has been reported in randomized clinical trials with aromatase inhibitors (AIs) compared with tamoxifen. Patients and Methods This was an exploratory analysis of the International Breast Cancer Intervention Study II, a double-blind randomized clinical trial in which women at increased risk of breast cancer were randomly assigned to receive anastrozole or placebo. This is the first report of risk factors for and characteristics of CTS in women taking an AI in a placebo-controlled trial. Results Overall, 96 participants with CTS were observed: 65 (3.4%) in the anastrozole arm and 31 (1.6%) in the placebo arm (odds ratio, 2.16 [1.40 to 3.33]; P < .001). Ten participants were reported as having severe CTS, of which eight were taking anastrozole (P = .08). Eighteen women (0.9%) in the anastrozole arm and six women (0.3%) in the placebo arm reported surgical intervention, which was significantly different (odds ratio, 3.06 [1.21 to 7.72], P = .018). Six women discontinued with the allocated treatment because of the onset of CTS. Apart from treatment allocation, a high body mass index and an a prior report of musculoskeletal symptoms after trial entry were the only other risk factors for CTS identified in these postmenopausal women. Conclusions The use of anastrozole was associated with a higher incidence of CTS but few participants required surgery. Further investigations are warranted into the risk factors and treatment of AI-induced CTS.

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Sex Differences in Cardiovascular Markers and BDNF between Cerebral Palsy and Mild Cognitive Impairment

Innovation in Aging ◽

10.1093/geroni/igab046.3731 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 1055-1055

Author(s):

Kheng Siang (Ted) Ng ◽

James Carollo ◽

Alex Tagawa ◽

Zhaoxing Pan ◽

Patricia Heyn

Keyword(s):

Risk Factors ◽

Sex Differences ◽

Cerebral Palsy ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Healthy Aging ◽

Accelerated Aging ◽

Intermediate Stage ◽

Cvd Risk ◽

Increased Risk

Abstract Adults with cerebral palsy (CP) have higher risk of developing geriatric syndromes. Mild cognitive impairment (MCI) is an intermediate stage between healthy aging and dementia, often co-morbid with cardiovascular disease (CVD). We recently showed an “accelerated aging model”, where CP shares similar CVD risk factors with MCI, potentially accounting for CP’s increased risk of dementia. In this study, we further examined sex differences between CP and MCI (aim 1) and within CP (aim 2). From an accredited clinical motion analysis laboratory at Children’s Hospital Colorado (CP) and a university in Singapore (MCI), we recruited 72 adults with CP [mean (SD) of age=20 (5.3), Sex: men=47.2% and women=52.8%] and MCI [mean (SD) of age=71.28 (6.03), Sex: men=29.2% and women=70.8%]. We analyzed blood Pressure (BP), Framingham Heart Study Score (FHSS), and brain-derived neurotrophic factor (BDNF). Compared to MCI, women with CP had lower BDNF (β=-3.550, 95% CI=-5.659 to -1.441, p=0.001), while men with CP had lower diastolic BP (β=-28.204, 95% CI=-52.148 to -4.260, p=0.022). Both women and men with CP also had lower FHSS, compared to MCI (β=-2.515, 95% CI=-3.721 to -1.309, p<0.001; β=-3.724, 95% CI=-5.561 to -1.888, p<0.001, respectively). Women in the CP cohort showed lower FHSS (β=-0.172, 95% CI=-0.310 to -0.033, p=0.016). We found sex-related differences in BDNF and CVD markers. Comparing across and within cohorts, although having lower BDNF levels, women with CP had better FHSS. These findings support our accelerated aging hypothesis, and further suggest sex differences in aging-related risk factors in CP, supporting sex-related precision medicine approach.

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COVID-19 in Children with Down Syndrome: Data from the Trisomy 21 Research Society Survey

Journal of Clinical Medicine ◽

10.3390/jcm10215125 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5125

Author(s):

David Emes ◽

Anke Hüls ◽

Nicole Baumer ◽

Mara Dierssen ◽

Shiela Puri ◽

...

Keyword(s):

Risk Factors ◽

Down Syndrome ◽

Significant Risk ◽

The United States ◽

Research Society ◽

Medical Complications ◽

Thyroid Disorder ◽

Increased Risk ◽

Using Data ◽

And Control

Adults with Down Syndrome (DS) are at higher risk for severe outcomes of coronavirus disease 2019 (COVID-19) than the general population, but evidence is required to understand the risks for children with DS, which is necessary to inform COVID-19 shielding advice and vaccination priorities. We aimed to determine the epidemiological and clinical characteristics of COVID-19 in children with DS. Using data from an international survey obtained from a range of countries and control data from the United States, we compared the prevalence of symptoms and medical complications and risk factors for severe outcomes between DS and non-DS paediatric populations with COVID-19. Hospitalised COVID-19 patients <18 years with DS had a higher incidence of respiratory symptoms, fever, and several medical complications from COVID-19 than control patients without DS <18 years. Older age, obesity, and epilepsy were significant risk factors for hospitalisation among paediatric COVID-19 patients with DS, and age and thyroid disorder were significant risk factors for acute respiratory distress syndrome. Mortality rates were low in all paediatric COVID-19 patients (with and without DS), contrasting with previous findings in adults with DS (who exhibit higher mortality than those without DS). Children with DS are at increased risk for more severe presentations of COVID-19. Efforts should be made to ensure the comprehensive and early detection of COVID-19 in this population and to identify children with DS who present comorbidities that pose a risk for a severe course of COVID-19. Our results emphasize the importance of vaccinating children with DS as soon as they become eligible.

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Bortezomib administration is a risk factor associated with the development of tumor lysis syndrome in male patients with multiple myeloma: A retrospective study

10.21203/rs.3.rs-22557/v1 ◽

2020 ◽

Author(s):

Masahiro Kondo ◽

Yuji Hotta ◽

Karen Yamauchi ◽

Akimasa Sanagawa ◽

Hirokazu Komatsu ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Odds Ratio ◽

Tumor Lysis Syndrome ◽

Low Risk ◽

Primary Therapy ◽

Novel Therapies ◽

Tumor Lysis ◽

Number Of Patients ◽

Increased Risk

Abstract Background Many novel medicines such as proteasome inhibitors have been developed during the last decade to treat multiple myeloma. Although multiple myeloma is defined as a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. In fact, there have been some prior reports of bortezomib-induced TLS in patients with multiple myeloma. However, almost all of them have been case reports or case series. Thus, we investigated the risk factors for TLS in multiple myeloma patients. Methods We retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between LTLS and several parameters previously reported to be associated with increased risk. Results This study included 210 patients, seventeen (8.1%) and seven (3.3%) patients with LTLS and CTLS, respectively. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between the patients with and without LTLS. Multivariate analyses revealed that LTLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of LTLS (odds ratio = 8.51, P = 0.046). Conclusion In the present study, we investigated the risk factors for developing TLS in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients’ backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male multiple myeloma patients. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, as an increasing number of novel therapies can achieve high antitumor responses.

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Bortezomib administration is a risk factor associated with the development of tumor lysis syndrome in male patients with multiple myeloma: a retrospective study

BMC Cancer ◽

10.1186/s12885-020-07592-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Masahiro Kondo ◽

Yuji Hotta ◽

Karen Yamauchi ◽

Akimasa Sanagawa ◽

Hirokazu Komatsu ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Odds Ratio ◽

Tumor Lysis Syndrome ◽

Low Risk ◽

Novel Therapies ◽

Tumor Lysis ◽

Factors Associated ◽

Increased Risk ◽

Male Patients

Abstract Background Novel agents such as proteasome inhibitors have been developed for several years to treat multiple myeloma. Although multiple myeloma is a low-risk disease for developing tumor lysis syndrome (TLS), treatment with these novel therapies might increase TLS risk. Previous studies, mostly case reports or case series, have reported bortezomib-induced TLS in patients with multiple myeloma. This study aimed to investigate risk factors associated with TLS development in multiple myeloma patients. Methods We retrospectively investigated incidences of laboratory and clinical TLS (LTLS and CTLS, respectively) in patients who received primary therapy for treatment-naive, symptomatic multiple myeloma between May 2007 and January 2018. We used multivariate logistic regression analyses to evaluate the associations between TLS and several parameters previously reported to be associated with increased risk. Results This study included 210 patients with multiple myeloma, of which ten (4.8%) had LTLS and seven (3.3%) had CTLS. The characteristics of the administered anticancer or prophylactic antihyperuricemic agents were similar between patients with and without TLS. Multivariate analyses revealed that TLS was most strongly associated with bortezomib-containing therapy (odds ratio = 3.40, P = 0.069), followed by male sex (odds ratio = 2.29, P = 0.153). In a subgroup analysis focused on men, treatment with bortezomib-containing therapy was significantly associated with increased risk of TLS (odds ratio = 8.51, P = 0.046). Conclusion In the present study, we investigated the risk factors associated with TLS development in 210 multiple myeloma patients, which, to the best of our knowledge, is the largest number of patients reported to date. Furthermore, this study is the first to evaluate TLS risk factors in MM by adjusting for the effects of potential confounding factors in patients’ backgrounds. Consequently, we found that bortezomib-containing therapy increases the risk of TLS in male patients with multiple myeloma. TLS risk should be evaluated further in low-risk diseases such as multiple myeloma, since a significant number of novel therapies can achieve high antitumor responses.

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