Evaluations for abuse in young children with subdural hemorrhages: findings based on symptom severity and benign enlargement of the subarachnoid spaces

OBJECTIVEChildren who have subdural hematomas (SDHs) with no or minimal neurological symptoms (SDH-mild symptoms) often present a forensic challenge. Nonabusive causes of SDH, including birth-related SDH, benign enlargement of the subarachnoid spaces (BESS), and other proposed causes have been offered as etiologies. These alternative causes do not provide explanations for concomitant suspicious injuries (CSIs). If SDH with mild symptoms in young children are frequently caused by these alternative causes, children with SDH-mild symptoms should be more likely to have no other CSIs than those who have SDH with severe symptoms (SDH-severe symptoms). Additionally, if SDH with mild symptoms is caused by something other than abuse, the location and distribution of the SDH may be different than an SDH caused by abuse. The objectives of this study were to determine the prevalence of other CSIs in patients who present with SDH-mild symptoms and to compare that prevalence to patients with SDH-severe symptoms. Additionally, this study sought to compare the locations and distributions of SDH between the two groups. Finally, given the data supporting BESS as a potential cause of SDH in young children, the authors sought to evaluate the associations of BESS with SDH-mild symptoms and with other CSIs.METHODSThe authors performed a 5-year retrospective case-control study of patients younger than 2 years of age with SDH evaluated by a Child Abuse Pediatrics program. Patients were classified as having SDH-mild symptoms (cases) or SDH-severe symptoms (controls). The two groups were compared for the prevalence of other CSIs. Additionally, the locations and distribution of SDH were compared between the two groups. The presence of BESS was evaluated for associations with symptoms and other CSIs.RESULTSOf 149 patients, 43 presented with SDH-mild symptoms and 106 with SDH-severe symptoms. Patients with SDH-mild symptoms were less likely to have other CSIs (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.08–0.5) and less likely to have severe retinal hemorrhages (OR 0.08, 95% CI 0.03–0.3). However, 60.5% of patients with SDH-mild symptoms had other CSIs. There was no difference between the groups regarding the location and distribution of SDH. Of the entire study cohort, 34 (22.8%) had BESS, and BESS was present in 17 (39.5%) of the SDH-mild symptoms group and 17 (16%) of the SDH-severe symptoms group (OR 3.4, 95% CI 1.5–7.6). The presence of BESS was significantly associated with a lower chance of other CSIs (OR 0.1, 95% CI 0.05–0.3). However, 17 patients had BESS and other CSIs. Of these 17, 6 had BESS and SDH-mild symptoms.CONCLUSIONSThe high occurrence of other CSIs in patients with SDH-mild symptoms and a similar high occurrence in patients with BESS (including those with SDH-mild symptoms) indicate that such children benefit from a full evaluation for abuse.

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Feasibility of Screening for Lynch Syndrome Among Patients With Colorectal Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2008.17.5950 ◽

2008 ◽

Vol 26 (35) ◽

pp. 5783-5788 ◽

Cited By ~ 512

Author(s):

Heather Hampel ◽

Wendy L. Frankel ◽

Edward Martin ◽

Mark Arnold ◽

Karamjit Khanduja ◽

...

Keyword(s):

Colorectal Cancer ◽

Lynch Syndrome ◽

Mismatch Repair ◽

Cancer Surveillance ◽

Study Cohort ◽

Entire Study ◽

Gene Testing ◽

Revised Bethesda Guidelines ◽

Repair Genes ◽

Entire Study Cohort

Purpose Identifying individuals with Lynch syndrome (LS) is highly beneficial. However, it is unclear whether microsatellite instability (MSI) or immunohistochemistry (IHC) should be used as the screening test and whether screening should target all patients with colorectal cancer (CRC) or those in high-risk subgroups. Patients and Methods MSI testing and IHC for the four mismatch repair proteins was performed on 500 tumors from unselected patients with CRC. If either MSI or IHC was abnormal, complete mutation analysis for the mismatch repair genes was performed. Results Among the 500 patients, 18 patients (3.6%) had LS. All 18 patients detected with LS (100%) had MSI-high tumors; 17 (94%) of 18 patients with LS were correctly predicted by IHC. Of the 18 probands, only eight patients (44%) were diagnosed at age younger than 50 years, and only 13 patients (72%) met the revised Bethesda guidelines. When these results were added to data on 1,066 previously studied patients, the entire study cohort (N = 1,566) showed an overall prevalence of 44 of 1,566 patients (2.8%; 95% CI, 2.1% to 3.8%) for LS. For each proband, on average, three additional family members carried MMR mutations. Conclusion One of every 35 patients with CRC has LS, and each has at least three relatives with LS; all of whom can benefit from increased cancer surveillance. For screening, IHC is almost equally sensitive as MSI, but IHC is more readily available and helps to direct gene testing. Limiting tumor analysis to patients who fulfill Bethesda criteria would fail to identify 28% (or one in four) cases of LS.

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Abstract 11159: Prolonged QRS Duration Predicts Outcomes in Heart Failure With Preserved Ejection Fraction

Circulation ◽

10.1161/circ.132.suppl_3.11159 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jacob Joseph ◽

Brian L Claggett ◽

Inder S Anand ◽

Jerome L Fleg ◽

Thao Huynh ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Primary Outcome ◽

Statistical Significance ◽

Study Cohort ◽

Preserved Ejection Fraction ◽

Entire Study ◽

Increased Risk ◽

Qrs Duration ◽

Entire Study Cohort

Introduction: QRS widening on the surface electrocardiogram (ECG) is a marker of disease progression in heart failure (HF) with reduced ejection fraction. We hypothesized that prolonged QRS duration would similarly identify patients with HF with preserved ejection fraction (HFPEF) at high risk for cardiovascular (CV) events. Methods: We examined the relationship of baseline QRS duration to primary outcome [composite of CV death, aborted cardiac arrest, or HF hospitalization (HFH)] and HFH alone in TOPCAT, a multicenter, randomized, placebo-controlled trial of spironolactone in HFPEF. QRS duration was analyzed as a dichotomous variable (≥ 120 ms or < 120 ms). Multivariable analyses were conducted including variables that were significantly associated with QRS duration ≥ 120 ms (Table 1). Analyses were conducted in the entire study cohort as well as in separate analyses for only subjects enrolled from the Americas or from Russia/Georgia independently. Results: QRS duration was known in 3426 of 3445 TOPCAT patients. Compared to those with QRS duration < 120ms, 613 (17.9%) subjects had a QRS duration ≥ 120 ms and were older (72.9 years vs. 67.8 years; p < 0.0001) and more likely to be men (62% vs. 45%; p<0.0001). A QRS duration ≥ 120 ms was independently associated with an increased risk of primary outcome and HFH in the entire study cohort and in the subset of patients enrolled in the Americas but was of borderline statistical significance in Russia/Georgia (Table 1). No statistical interaction was observed between treatment with spironolactone and QRS duration (p value for interaction= 0.33). Conclusions: QRS duration identifies HFPEF subjects at a higher risk of adverse clinical outcomes; spironolactone had a similar effect on outcomes independent of QRS duration. This easily obtainable marker may be an important component of risk stratification in this syndrome.

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Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.307 ◽

2016 ◽

Vol 38 (3) ◽

pp. 340-347 ◽

Cited By ~ 7

Author(s):

Thomas L. Walsh ◽

Ashley M. Querry ◽

Sheila McCool ◽

Alison L. Galdys ◽

Kathleen A. Shutt ◽

...

Keyword(s):

Risk Factors ◽

Spinal Fusion ◽

Protective Factor ◽

Case Control Study ◽

Care Center ◽

Surgical Site Infections ◽

Case Control ◽

Study Cohort ◽

Retrospective Case ◽

Control Study

OBJECTIVETo determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion.DESIGNRetrospective case-control study.SETTINGLarge, academic, quaternary care center.PATIENTSThe study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI.METHODSTo achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls.RESULTSDuring the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78).CONCLUSIONSIn additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion.Infect Control Hosp Epidemiol 2017;38:348–352

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Sleep apnoea is a risk factor for severe COVID-19

10.1101/2020.09.26.20202051 ◽

2020 ◽

Author(s):

Satu Strausz ◽

Tuomo Kiiskinen ◽

Martin Broberg ◽

Sanni E. Ruotsalainen ◽

Jukka Koskela ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Sleep Apnoea ◽

Chronic Obstructive ◽

Study Cohort ◽

Retrospective Case ◽

Obstructive Pulmonary Disease ◽

Obstructive Sleep ◽

Control Study ◽

Independent Cohort

AbstractObjectiveTo investigate if obstructive sleep apnoea (OSA) is an independent risk factor for severe COVID-19. To examine whether the risk for contracting COVID-19 is elevated among OSA patients.Design and settingRegistry based retrospective case-control study using Finnish nationwide health registries and the FinnGen Study cohort.ParticipantsInformation regarding OSA diagnosis and COVID-19 infection was extracted from the FinnGen study (N=260,405) with a total of 305 patients who had a recorded PCR- validated COVID-19 infection including 26 (8.5%) individuals who were also OSA patients. Severe COVID-19 (N=83; 27.2%) was defined as an infection requiring hospitalization. Among the hospitalized individuals there were 16 (19.3%) with OSA diagnosis. In addition, we also included in our analysis previously reported risk factors for both severe COVID-19 or risk factors and comorbidities for OSA from FinnGen.Main outcome measuresOSA diagnosis, information concerning COVID-19 infection such as hospitalization, were derived from Finnish National Hospital Discharge Registry, Causes of Death Registry and the National Infectious Diseases Registry.ResultsWe show that OSA is a risk factor for COVID-19 hospitalization independent from age, sex, body mass index (BMI), hypertension, diabetes, coronary heart disease (CHD), asthma and chronic obstructive pulmonary disease (COPD), (p-unadjusted=1.04×10−4, OR- adjusted=5.14 [95%CI 1.31 to 22.91], p-adjusted=0.023). OSA was not associated with the risk of contracting COVID-19 (p=0.49).ConclusionWhile an OSA patient’s risk of contracting COVID-19 is the same as non-OSA individuals, the OSA patients have a five-fold risk to be hospitalized when affected by COVID-19 than non-OSA individuals. Our findings suggest OSA as one of the risk factors for severe COVID-19. While these associations are statistically significant, they would benefit from replication in an independent cohort.

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Epidemiology of Vancomycin-Resistant Enterococcus faecalis: a Case-Case-Control Study

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01271-12 ◽

2012 ◽

Vol 57 (1) ◽

pp. 49-55 ◽

Cited By ~ 21

Author(s):

Kayoko Hayakawa ◽

Dror Marchaim ◽

Mohan Palla ◽

Uma Mahesh Gudur ◽

Harish Pulluru ◽

...

Keyword(s):

Enterococcus Faecalis ◽

Case Control Study ◽

Medical Center ◽

Case Control ◽

Study Cohort ◽

Retrospective Case ◽

Content Type ◽

Skin Ulcers ◽

Vancomycin Resistant ◽

Control Study

ABSTRACTAlthough much is known about vancomycin-resistant (VR)Enterococcus faecium, little is known about the epidemiology of VREnterococcus faecalis. The predilection of VRE. faecalisto transfer the vancomycin resistance determinant toStaphylococcus aureusis much greater than that of VRE. faecium. The epidemiology of VRE. faecalishas important implications regarding the emergence of vancomycin-resistantS. aureus(VRSA); 8 of 13 reported VRSA cases have been from Michigan. A retrospective case-case-control study was conducted at the Detroit Medical Center, located in southeastern Michigan. Unique patients with VRE. faecalisinfection were matched to patients with strains of vancomycin-susceptible (VS)E. faecalisand to uninfected controls at a 1:1:1 ratio. Five hundred thirty-two VRE. faecaliscases were identified and were matched to 532 VSE. faecaliscases and 532 uninfected controls. The overall mean age of the study cohort (n= 1,596) was 63.0 ± 17.4 years, and 747 (46.8%) individuals were male. Independent predictors for the isolation of VRE. faecalis(but not VSE. faecalis) compared to uninfected controls were an age of ≥65 years, nonhome residence, diabetes mellitus, peripheral vascular disease, exposure to cephalosporins and fluoroquinolones in the prior 3 months, and immunosuppressive status. Invasive procedures and/or surgery, chronic skin ulcers, and indwelling devices were risk factors for both VRE. faecalisand VSE. faecalisisolation. Cephalosporin and fluoroquinolone exposures were unique, independent predictors for isolation of VRE. faecalis. A majority of case patients had VRE. faecalispresent at the time of admission. Control of VRE. faecalis, and ultimately VRSA, will likely require regional efforts focusing on infection prevention and antimicrobial stewardship.

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Equipment-independent reference values for dopamine transporter imaging with 123I-FP-CIT

Nuklearmedizin ◽

10.1160/nukmed-0037 ◽

2007 ◽

Vol 46 (03) ◽

pp. 107-111 ◽

Cited By ~ 6

Author(s):

J. Hornung ◽

C. Hamann ◽

G. Pöpperl ◽

K. Tatsch ◽

W. Koch

Keyword(s):

Essential Tremor ◽

Dopamine Transporter ◽

Reference Values ◽

Reference Range ◽

Normal Values ◽

Specific Binding ◽

Study Cohort ◽

Entire Study ◽

Dopamine Transporter Imaging ◽

Entire Study Cohort

Summary Aim: Reliable reference values are helpful to interpret and compare the results of dopamine transporter imaging with SPECT. Since semi-quantitative reference values cannot be easily transferred between imaging equipments, this study aimed to establish equipment independent normal values for the true striatal binding of 123I-FP-CIT. Patients, methods: Specific striatal FP-CIT binding of 6 healthy volunteers and 26 patients with essential tremor were used to generate a reference range by applying an equipment specific resolution dependent factor to compensate for recovery effects. This factor has been determined previously by a series of standardized phantom measurements of an anthropomorphic basal ganglia phantom. Herewith, the resulting DAT binding values represent the expected true specific binding in the striatum. Results: On average, true specific striatal binding was 5.83 ± 0.96 in healthy controls, 5.25 ± 0.67 in patients with essential tremor and 5.36 ± 0.75 in the entire study cohort. Conclusion: These preliminary results may serve as a basis for the generation of a generally accepted equipment independent reference range for dopamine transporter imaging with 123I-FP-CIT. By a simple phantom measurement that can be accomplished within one day factors related to specific imaging equipment and processing can be corrected for, resulting in specific binding values which may enable a more standardized interpretation of dopamine transporter scans.

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