scholarly journals Routine screening for hepatitis C viral infection in patients undergoing elective cranial neurosurgery

2019 ◽  
Vol 131 (3) ◽  
pp. 941-948
Author(s):  
Eric S. Nussbaum ◽  
Kevin Kallmes ◽  
Jodi Lowary ◽  
Leslie A. Nussbaum
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Drug Abuse ◽  
Positive Result ◽  
Rapid Test ◽  
Cost Effective ◽  
Viral Loads ◽  
Iv Drug Abuse ◽  
History Of ◽  
The Cost

OBJECTIVEUndiagnosed hepatitis C virus (HCV) and HIV in patients present risks of transmission of bloodborne infections to surgeons intraoperatively. Presurgical screening has been suggested as a protocol to protect surgical staff from these pathogens. The authors sought to determine the incidence of HCV and HIV infection in elective craniotomy patients and analyze the cost-effectiveness of universal and risk factor–specific screening for protection of the surgical staff.METHODSAll patients undergoing elective craniotomy between July 2009 and July 2016 at the National Brain Aneurysm Center who did not refuse screening were included in this study. The authors utilized rapid HCV and HIV tests to screen patients prior to elective surgery, and for each patient who tested positive using the rapid HCV or HIV test, qualitative nucleic acid testing was used to confirm active viral load, and risk factor information was collected. Patients scheduled for nonurgent surgery who were found to be HCV positive were referred to a hepatologist for preoperative treatment. The authors compared risk factors between patients who tested positive on rapid tests, patients with active viral loads, and a random sample of patients who tested negative. The authors also tracked the clinical and material costs of HCV and HIV rapid test screening per patient for cost-effectiveness analysis and calculated the cost per positive result of screening all patients and of screening based on all patient risk factors that differed significantly between patients with and those without positive HCV test results.RESULTSThe study population of patients scheduled for elective craniotomy included 1461 patients, of whom 22 (1.5%) refused the screening. Of the 1439 patients screened, 15 (1.0%) tested positive for HCV using rapid HCV screening; 9 (60%) of these patients had active viral loads. No patient (0%) tested positive for HIV. Seven (77.8%) of the 9 patients with active viral loads underwent treatment with a hepatologist and were referred back for surgery 3–6 months after sustained virologic response to treatment, but the remaining 2 patients (22.2%) required urgent surgery. Of the 9 patients with active viral loads, 1 patient (11%) had a history of both intravenous drug abuse and tattoos. Two of the 9 patients (22%) had tattoos, and 3 (33%) were born within the age-screening bracket (born 1945–1965) recommended by the Centers for Disease Control and Prevention. Rates of smoking differed significantly (p < 0.001) between patients who had active viral loads of HCV and patients who were HCV negative, and rates of smoking (p < 0.001) and IV drug abuse (p < 0.01) differed significantly between patients who were HCV rapid-test positive and those who were HCV negative. Total screening costs (95% CI) per positive result were $3,877.33 ($2,348.05–$11,119.28) for all patients undergoing HCV rapid screening, $226.29 ($93.54–$312.68) for patients with a history of smoking, and $72.00 ($29.15–$619.39) for patients with a history of IV drug abuse.CONCLUSIONSThe rate of undiagnosed HCV infection in this patient population was commensurate with national levels. While the cost of universal screening was considerable, screening patients based on a history of smoking or IV drug abuse would likely reduce costs per positive result greatly and potentially provide cost-effective identification and treatment of HCV patients and surgical staff protection. HIV screening found no infected patients and was not cost-effective.

Demographic characteristics of IV drug abusers commencing treatment in opiate detoxification centers in Iran

2011 ◽  
Vol 26 (S2) ◽  
pp. 129-129
Author(s):  
S.M. Yassini Ardekani ◽  
S. Bozorgi ◽  
M. Taghavi
Keyword(s):  
Risk Factors ◽  
Drug Abuse ◽  
Family History ◽  
Positive Family History ◽  
Structured Interview ◽  
Demographic Characteristics ◽  
Psychiatric Disease ◽  
Drug Abusers ◽  
Iv Drug Abuse ◽  
History Of

IntroductionIV drug abuse is a medical and social problem in countries all over the world including IranObjectivesKnowing about the characteristics of drug abuser could help policy makers to have more precise plan of action for prevention and management of addictionAimsThis study was designed to investigate the demographic characteristics of IV drug abusers in Iran and determining the risk factors for shifting to IV drug abuse.Methods150 intravenous drug addicts (147 males and 3 females) aged 19–61 referred to opiate detoxification centers in Yazd city in autumn 2008 were randomly enrolled to this descriptive cross sectional study. Data collection was undertaken through a structured interview, a questionnaire for demographic data and written documents at detoxification centers. Analysis of data was done with SPSS software (version 13).ResultsThere was positive family history of addiction in 56.7%, known psychiatric illness in 43.3%, known physical disease in 32% and history of psychotropic medication abuse in 58% of participants. The mean age of onset in opium and its derivatives abusers was 19.12, heroin abusers 23.5 and IV bupropion abusers 27.2 years. The most common injecting drug at the time of study was heroin (65.2%).ConclusionFamily history of addiction, psychiatric disease, physical illness and low education could all be risk factors for exacerbating an addiction. Identification of these risk factors could lead to the development of interventions to reduce the burden of addiction. Further research about this subject is required to determine if this is true.

Abstract O.13: Kawasaki disease in the Maghreb community in Quebec

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Arbia A Gorrab ◽  
Asma Abed Bouaziz ◽  
Linda Spigelblatt ◽  
Anne Fournier ◽  
Nagib Dahdah
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Kawasaki Disease ◽  
University Hospitals ◽  
Specific Population ◽  
History Of ◽  
Statistics Canada ◽  
Artery Disease ◽  
Children Under 5

Background: The real incidence of Kawasaki disease (KD) in the Maghreb countries (Morocco, Algeria, and Tunisia) is unknown. It is estimated low according to the literature. However, the number of Maghrebi children living in Quebec (Qc) affected by KD seems important. We sought to determine the incidence of KD among Maghrebi children in Qc, Canada, and to study its epidemiological and clinical features and to clarify possible risk factors related or superimposed to their immigration. Methods: A retrospective study of KD in Maghrebi children living in Qc (n=24) (1996-2013), compared to reports from Fes, Morocco (n=23) a doctoral thesis published in 2010 (2001-2009) and from Tunisia (n=31) collected in five university hospitals with four from the Great Tunis and one from Nabeul city (1996-2013). There are no reports available from Algeria. The “country of origin” specific population in the Province of Qc was obtained from Statistics Canada. Results: The annualized incidence rate (AIR) of KD among Maghrebi children in Qc was 9.58/100,000 children under 5 years(Standard-Denominator (SD)).This is 6 times higher in Qc (5.57/SD and 19.02/SD among Tunisian and Moroccan descents) vs Tunisia (Nabeul Governorate) and Morocco (Fes) (0.95/SD and 3.15/SD). Personal and family history of allergy were significantly higher in Qc 42% (10/24) and 75% (18/24), respectively, whereas these features were reported near 0% in both reports from Morocco and Tunisia. The prevalence of incomplete KD criteria was relatively high in the 3 series 46% (11/24) in Qc vs 43% (10/23) and 35% (11/31); (p=NS). Diagnosis was late (gt day 10 of fever) in 1/24(4%) in Qc vs 7/23 (30%) in Morocco and 11/31 (35%) in Tunisia; (p 0.01). IVIG were administered in the acute phase to all patients in Qc, 5/23 in Morocco and 28/31 in Tunisia. However coronary complications were more common in Qc 42% (10/24) vs 22% (5/23) vs 19% (6/31) (p=0.02). Aneurysms were significantly associated with the incomplete form in the 3 groups (p=0.01). Conclusions: The observed AIR of KD in the Maghreb community in Qc is higher than the countries of origin where underdiagnosis is possible. Atopy may still be a risk factor in Qc. The coronary artery disease seems linked not only to therapeutic delay but also to the underlying terrain.

Abstract P676: Rates of Preventable Thrombectomy in Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rakhee Lalla ◽  
Ryan Dunlow ◽  
Karen L Yarbrough ◽  
Prachi Mehndiratta ◽  
Michael S Phipps ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Vascular Disease ◽  
Antiplatelet Agent ◽  
Left Ventricular ◽  
Vascular Risk Factors ◽  
Large Vessel ◽  
Favorable Outcome ◽  
Vascular Risk ◽  
History Of

Introduction: The AHA notes that more than 76% of strokes are the first occurrence. There are class 1 recommendations for the management of common risk factors such as atrial fibrillation (AF), hyperlipidemia (HLD), hypertension (HTN), diabetes (DM), and vascular disease. The purpose of this study is to investigate the percentage of large vessel strokes that are potentially preventable with adequate management of vascular risk factors. Methods: A retrospective chart review was conducted on all patients undergoing endovascular therapy (EVT) from 2012-2019. Data was collected on vascular risk factors present prior to admission including HTN, DM, HLD, AF, and smoking. Preventable stroke was defined as having at least one of the following: untreated AF, untreated HLD, poorly controlled HTN (presence of left ventricular hypertrophy on transthoracic echo), history of vascular disease not on an antiplatelet agent, poorly controlled DM (A1c>10), current smoking. Groups were compared based on age, sex and 90 day functional outcomes, with favorable outcome defined as mRS ≤ 2. Results: Our sample included 396 patients who underwent EVT (mean age 65, 50% female). 42% of patients with Afib were not on anticoagulation, 31% of patients with HLD were untreated, 39% of patients with HTN were poorly controlled, 27% of patients with a history of vascular disease were not on an antiplatelet, 14% of patients with DM were poorly controlled, and 46% of all patients were smokers. In total, 78% of patients had at least 1 poorly controlled risk factor and 37% had at least 2. There was no difference in rates of preventable stroke between males and females (48% vs 52%, p=0.30) and between age groups above and below 70 (40% vs 60%, p=0.68). 64% of patients with well controlled risk factors had a favorable outcome compared to 51% with at least one poorly controlled risk factor (p=0.03). Conclusions: Our data suggests that despite guidelines on management of vascular risk factors, a large number of these are poorly controlled prior to admission for large vessel stroke, leading to a potentially preventable procedure. Not only could improved primary prevention save the wide array of resources utilized in EVT, but it could also influence long term outcomes in this cohort of patients.

scholarly journals Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia

2016 ◽  
Author(s):  
Denny Khusen
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Gestational Age ◽  
Post Partum ◽  
Severe Preeclampsia ◽  
Maternal Complications ◽  
History Of ◽  
Post Partum Bleeding

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/μl, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia

scholarly journals Risk Factors for Maternal Chagas Disease and Vertical Transmission in a Bolivian Hospital

2020 ◽  
Author(s):  
Melissa D Klein ◽  
Freddy Tinajeros ◽  
María del Carmen Menduiña ◽  
Edith Málaga ◽  
Beth J Condori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Chagas Disease ◽  
Vertical Transmission ◽  
Quantitative Polymerase Chain Reaction ◽  
Diagnostic Testing ◽  
Rapid Test ◽  
Diagnostic Techniques ◽  
Lower Education Level ◽  
History Of

Abstract Background Vertical transmission of Trypanosoma cruzi infection accounts for a growing proportion of new cases of Chagas disease. Better risk stratification is needed to predict which women are more likely to transmit the infection. Methods This study enrolled women and their infants at the Percy Boland Women’s Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test and received confirmatory serology. Infants of seropositive mothers underwent diagnostic testing with quantitative polymerase chain reaction (qPCR). Results Among 5,828 enrolled women, 1,271 (21.8%) screened positive for Chagas disease. Older maternal age, family history of Chagas disease, home conditions, lower education level, and history of living in a rural area were significantly associated with higher adjusted odds of maternal infection. Of the 1,325 infants of seropositive mothers, 65 infants (4.9%) were diagnosed with congenital Chagas disease. Protective factors against transmission included Cesarean delivery (adjusted OR [aOR]: 0.60, 95% CI: 0.36-0.99) and family history of Chagas disease (aOR: 0.58, 95% CI: 0.34-0.99). Twins were significantly more likely to be congenitally infected than singleton births (OR: 3.32, 95% CI: 1.60-6.90). Among congenitally infected infants, 32.3% had low birth weight, and 30.8% required hospitalization after birth. Conclusions Although improved access to screening and qPCR increased the number of infants diagnosed with congenital Chagas disease, many infants remain undiagnosed. A better understanding of risk factors and improved access to highly sensitive and specific diagnostic techniques for congenital Chagas disease may help improve regional initiatives to reduce disease burden.

scholarly journals Risk factor of severe preeclampsia in Dr. Soetomo Hospital Surabaya in 2015

2018 ◽  
Vol 25 (1) ◽  
pp. 6 ◽  
Author(s):  
Amelia Rahmah Kartika ◽  
Muhammad Ilham Aldika Akbar ◽  
Pirlina Umiastuti
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pregnant Women ◽  
Medical Records ◽  
Maternal Obesity ◽  
Significant Risk ◽  
Severe Preeclampsia ◽  
History Of

Objectives: to determine which of the risk factors above associated with the occurrence of severe preeclampsia at dr. Soetomo Hospital, Surabaya during 2015.Materials and Methods: The type and design of the study were analytic and retrospective. This study was held in the dr. Soetomo Hospital from April until November 2016. The instrument of the study was the medical records then being coded and analysed. The samples were 134 pregnant women, consisting of 67 pregnant women with severe preeclampsia as cases and 67 pregnant women as controls.Results: Maternal obesity (OR= 5,786; 95% CI: 2,300–14,555), history of hypertension (OR= 6,693; 95% CI: 1,848–24,237) and secondary elderly primi (OR= 6,384; 95% CI: 1,357–30,031) are associated with the development of severe preeclampsia.Conclusion: In conclusion, the significant risk factors of severe preeclampsia in dr. Soetomo Hospital Surabaya during 2015 are obesity, history of hypertension and secondary elderly primi variables.

Abstract TP238: Encephalopathy Only Stroke Codes (EoSC) Do Not Result in rt-PA Treatments

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Patrick Chen ◽  
Dawn Meyer ◽  
Brett Meyer
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Acute Stroke ◽  
Retrospective Analysis ◽  
Thrombolytic Treatment ◽  
Knowing That ◽  
History Of ◽  
Demographic Risk ◽  
To Receive ◽  
Demographic Risk Factor

Background: Isolated mental status changes as presenting sign (EoSC+), are not uncommon stroke code triggers. As stroke alerts, they still require the same intensive resources be applied. We previously showed that EoSC+ strokes (EoSC+CVA+) account for 8-9% of EoSC+ codes but only 0.1-0.2% of all codes. Whether these result in thrombolytic treatment (rt-PA), and the characteristics/ risk factor profiles of EoSC+CVA+ patients, have not been reported. Methods: Retrospective analysis of stroke codes from an IRB approved registry, from 2004 to 2018, was performed. EoSC+ definition used was consistent with prior publications (NIHSS>0 for Q1a, 1b, or 1c with remaining elements scored 0). Other definitions were also assessed. Characteristics and risk factors were compared for EoSC+, EoSC+CVA+, and rt-PA (EoSC+ CVA+TPA+) patients. Results: EoSC+ occurred in 59/2982 (1.98%) of all stroke codes. EoSC+CVA+ occurred in 8/59 (13.56%) of EoSC+ codes and 8/2982 (0.27%) of all stroke codes. 6/8 (75%) of EoSC+CVA+ scored NIHSS=1. Hispanic ethnicity (p=0.009), HTN (p=0.02), and history of stroke/TIA (p=0.002) were less common in EoSC+. No demographic/ risk factor differences were noted for [EoSC+CVA+ vs. EoSC+CVA-]. No cases of rt-PA eligibility/ treatment were noted. In EoSC+CVA+ analysis, imaging positive stroke/intracranial hemorrhage was noted on only 3 cases (3/2982=0.10% of all stroke codes) and none were posterior stroke. Conclusions: EoSC+ is not an uncommon reason to activate stroke codes, but rarely results in stroke/TIA (0.27%) or stroke (0.10%), and in our analysis never (0%) resulted in rt-PA. Sub-analysis did not show missed rt-PA or posterior strokes. This adds information for application of limited acute stroke code resources. Though stroke codes must still to be activated, understanding characteristics, and knowing that EoSC+CVA+ patients are unlikely to receive rt-PA, may help triage stroke resources. Further investigation is warranted.

Abstract NS6: Family History of Stroke: Invisibility of a Key Stroke Risk Factor among High Risk African Americans

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Dawn M Aycock ◽  
Kenya D Kirkendoll ◽  
Kisha C Coleman ◽  
Karen C Albright ◽  
Anne W Alexandrov
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Family History ◽  
Perceived Control ◽  
Stroke Risk ◽  
Perceived Threat ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors ◽  
History Of ◽  
Physiologic Data

Background & Purpose: Young to middle aged African Americans (AA) are at greater risk for a first-ever stroke, severe neurologic disability, and stroke-related mortality, than Caucasians of similar age; however, it remains unclear what role a family history of stroke (FHS) plays in promoting adoption of healthier lifestyles in this cohort. The purpose of this study was to explore differences between rural Stroke Belt AA with a FHS (e.g. parent/grandparent/sibling) on modifiable stroke risk factors, knowledge, perceived threat and perceived control of stroke, and exercise behaviors to AA without a FHS. Methods: A cross-sectional study was conducted recruiting AA aged 19-54 from the Black Belt region of Alabama via a mobile health clinic. Participants’ perceptions, knowledge, exercise history/intent, physiologic data, and health history were recorded. Results: Participants (N=66) averaged 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). Common risk factors were insufficient exercise (76%), obesity (59%), hypertension (53%; blood pressure M=145+17.6/88.3+12.9), and cigarette smoking (38%). Participants with a FHS (n=33) did not differ on average number of risk factors compared to those without a FHS (FHS 2.8+1.4 vs. 2.2+1.5; t(64)= 1.73, p=.089), nor did they differ on physiologic data. However, participants with a FHS were more likely to report a history of hypertension (67%) compared to those without a FHS (33%; χ2 =4.93, p <.05). There were no significant differences between groups for knowledge of stroke risk factors, perceived threat and perceived control of stroke, or recent exercise performance, although participants with a FHS (3.4+1.2) had significantly lower future intentions to exercise compared to those without a FHS (3.9+0.8); t(64)=2.45, p<.05). Conclusions: Although FHS is a significant non-modifiable risk factor for stroke and was common in this young to middle-aged AA cohort, FHS did not drive perceived stroke risk, risk factor control, or current/future intentions to exercise. Identification of interventions designed to personalize FHS as a key stroke risk factor, while promoting lifestyle change and self-management, may play an important role in future primary stroke prevention.

A case history of a cost effective 3D seismic survey over the Perth Basin, Western Australia

1989 ◽  
Vol 20 (2) ◽  
pp. 229
Author(s):  
S.C. Stewart ◽  
B.J. Evans
Keyword(s):  
Western Australia ◽  
Three Dimensional ◽  
Cost Effective ◽  
Cost Comparison ◽  
Seismic Survey ◽  
3D Seismic ◽  
Seismic Surveying ◽  
History Of ◽  
The Cost ◽  
Funded Research Project

As part of an industry funded research project into the application of the technique of LOFOLD3D land seismic surveying, a four fold three dimensional seismic survey was performed in the Perth Basin at Moora, Western Australia in July 1987. The volume covered an area of four kilometres by just under two kilometres, producing a total of 23,000 common midpoint traces. The objective was to collect and process the data in such a manner that a three dimensional structural interpretation would result, which would be the same as that resulting from a conventional three dimensional survey. A cost comparison indicates that a commercial LOFOLD3D survey would reduce the cost of performing a land 3D survey to an estimated 20% of the full fold equivalent, and the technique therefore offers potential for substantial savings if it is adopted on a commercial basis.

Sign in / Sign up

Export Citation Format

Share Document