Association Between Ultrasound Parameters and History of Ischemic or Hemorrhagic Stroke in Patients With Moyamoya Disease

Objective: To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD.Methods: We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness.Results: Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656–0.870) in the training dataset and 0.753 (95% CI, 0.550–0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful.Conclusions: Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.

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Development and Validation of a Score for Prediction of Postoperative Respiratory Complications

Anesthesiology ◽

10.1097/aln.0b013e318293065c ◽

2013 ◽

Vol 118 (6) ◽

pp. 1276-1285 ◽

Cited By ~ 112

Author(s):

Britta Brueckmann ◽

Jose L. Villa-Uribe ◽

Brian T. Bateman ◽

Martina Grosse-Sundrup ◽

Dean R. Hess ◽

...

Keyword(s):

Area Under The Curve ◽

Training Dataset ◽

Validation Dataset ◽

Multivariable Logistic Regression Analysis ◽

Respiratory Complications ◽

Billing Data ◽

Entire Cohort ◽

Postoperative Respiratory Complications ◽

History Of ◽

American Society

Abstract Background: Postoperative respiratory failure is associated with increased morbidity and mortality, as well as high costs of hospital care. Methods: Using electronic anesthesia records, billing data, and chart review, the authors developed and validated a score predicting reintubation in the hospital after primary extubation in the operating room, leading to unplanned mechanical ventilation within the first 3 postoperative days. Using multivariable logistic regression analysis, independent predictors were determined and a score postulated and validated. Results: In the entire cohort (n = 33,769 surgical cases within 29,924 patients), reintubation occurred in 137 cases (0.41%). Of those, 16%, (n = 22) died subsequently, whereas the mortality in patients who were not reintubated was 0.26% (P < 0.0001). Independent predictors for reintubation were: American Society of Anesthesiologist Score 3 or more, emergency surgery, high-risk surgical service, history of congestive heart failure, and chronic pulmonary disease. A point value of 3, 3, 2, 2, and 1 were assigned to these predictors, respectively, based on their β coefficient in the predictive model. The score yielded a calculated area under the curve of 0.81, whereas each point increment was associated with a 1.7-fold (odds ratio: 1.72 [95% CI, 1.55–1.91]) increase in the odds for reintubation in the training dataset. Using the validation dataset (n = 16,884), the score had an area under the curve of 0.80 and similar estimated probabilities for reintubation. Conclusion: The authors developed and validated a score for the prediction of postoperative respiratory complications, a simple, 11-point score that can be used preoperatively by anesthesiologists to predict severe postoperative respiratory complications.

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The associations between risk behaviour and reported history of sexually transmitted diseases, among young women: a population-based study

International Journal of STD & AIDS ◽

10.1258/0956462971920659 ◽

1997 ◽

Vol 8 (8) ◽

pp. 501-505 ◽

Cited By ~ 36

Author(s):

Monica Jonsson ◽

Roger Karlsson ◽

Ewa Rylander ◽

Ake Gustavsson ◽

Goran Wadell

Keyword(s):

Alcohol Consumption ◽

Sexually Transmitted Diseases ◽

Univariate Analysis ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Risk Behaviour ◽

Population Based ◽

Sexual Partners ◽

Sexually Transmitted ◽

History Of

The aim of this study was to determine the associations between risk behaviour and women's reported sexually transmitted diseases (STDs). All the women aged 19, 21, 23 and 25, residing in a specified housing area, were invited to answer a questionnaire regarding their sexual behaviour, smoking and alcohol consumption and previous history of STD. Of the 611 women participating, one out of 4 women had a history of at least one STD. In an univariate analysis, self-reported STD was found to be related to age, having more than 4 lifetime sexual partners, having practised intercourse at first date, inconsistent use of condoms, alcohol consumption of more than 3 bottles of wine per month and smoking. These factors were, however, not independent of each other and when subjected to a multivariate logistic regression analysis 2 factors, i.e. the lifetime number of sexual partners (more than 4 partners vs one; OR 7.94, (3.41-18.50)) and coitus on first date (practised more than once vs never, OR 2.99 (1.55-5.78)) emerged as independently associated with a previous STD.

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Predictors of healthcare worker burnout during the COVID-19 pandemic

10.1101/2020.08.26.20182378 ◽

2020 ◽

Author(s):

Amy V Ferry ◽

Ryan Wereski ◽

Fiona E Strachan ◽

Nicholas L Mills

Keyword(s):

Healthcare Worker ◽

Online Survey ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Primary Outcome Measure ◽

General Anxiety ◽

Patient Health ◽

History Of ◽

Anxiety Depression ◽

History Of Depression

Objective We aim to provide a snapshot of the levels of burnout, anxiety, depression and distress among healthcare workers during the COVID-19 pandemic. Design, setting, participants We distributed an online survey via social media in June 2020 that was open to any healthcare worker. The primary outcome measure was symptoms of burnout as measured using the Copenhagen Burnout Inventory (CBI). Secondary outcomes of depression, anxiety and distress as measured using the Patient Health Questionnaire-9, General Anxiety Scale-7, and Impact of Events Scale-Revised were recorded along with subjective measures of stress. Multivariate logistic regression analysis was performed to identify factors associated with burnout, depression, anxiety and distress. Results Of 539 persons responding to the survey, 90% were female, and 26% were aged 41-50 years, 53% were nurses. Participants with moderate-to-severe burnout were younger (49% [206/424] versus 33% [38/115] under 40 years, P=0.004), and more likely to have pre-existing comorbidities (21% versus 12%, P=0.031). They were twice as likely to have been redeployed from their usual role (22% versus 11%; adjusted odds ratio [OR] 2.2, 95% confidence interval [CI] 1.5-3.3, P=0.042), or to work in an area dedicated to COVID-19 patients (50% versus 32%, adjusted OR 1.6, 95% CI 1.4-1.8, P<0.001), and were almost 4-times more likely to have previous depression (24% versus 7%; adjusted OR 3.6, 95% CI 2.2-5.9, P=0.012). A supportive workplace team and male sex protected against burnout reducing the odds by 40% (adjusted OR 0.6, 95% CI 0.5-0.7, P<0.001) and 70% (adjusted OR 0.3, 95% CI 0.2-0.5, P=0.003), respectively. Conclusion Independent predictors of burnout were younger staff, redeployment to a new working area, working with patients with confirmed COVID-19 infection, and being female or having a previous history of depression. Evaluation of existing psychological support interventions is required with targeted approaches to ensure support is available to those most at risk.

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Magnitude and Determinants of Perinatal Mortality in Southwest Ethiopia

Journal of Pregnancy ◽

10.1155/2020/6859157 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Gurmesa Tura Debelew

Keyword(s):

Perinatal Mortality ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Mortality Data ◽

Skilled Attendant ◽

Southwest Ethiopia ◽

Danger Signs ◽

Pregnancy And Childbirth ◽

History Of ◽

Knowledge Of Danger Signs

Despite several efforts globally, the problem of perinatal mortality remained an unsolved agenda. As a result, it continued to be an essential part of the third sustainable development goals to end preventable child deaths by 2030. With a rate of 33 per 1000 births, Ethiopia has the highest level of perinatal mortality in the world. Thus, determining the magnitude and identifying the determinants are very crucial for evidence-based interventions. A community-based longitudinal study was conducted in Southwest Ethiopia among 3474 pregnant women to estimate the magnitude of perinatal mortality. Then, a case-control study among 120 cases and 360 controls was conducted to identify the determinants of perinatal mortality. Data were collected by using an interviewer-administered questionnaire and analyzed by using SPSS version 20. Multivariate logistic regression analysis was used to identify variables having a significant association with perinatal mortality at p<0.05. The perinatal mortality rate was 34.5 (95% CI: 28.9, 41.1) deaths per 1000 births. Attending ≥4 ANC visits (AOR=0.46; 95% CI: 0.23, 0.91), having good knowledge on key danger signs (AOR=0.27; 95% CI: 0.10, 0.75), and having a skilled attendant at birth (AOR=0.34; 95% CI: 0.19, 0.61) were significantly associated with a reduction of perinatal mortality. Being a primipara (AOR=3.38; 95% CI: 1.90, 6.00), twin births (AOR=5.29; 95% CI: 1.46, 19.21), previous history of perinatal mortality (AOR=3.33; 95% CI: 1.27, 8.72), and obstetric complication during labor (AOR=4.27; 95% CI: 2.40, 7.59) significantly increased perinatal mortality. In conclusion, the magnitude of perinatal mortality in the study area was high as compared to the national target for 2020. Care during pregnancy and childbirth and conditions of pregnancy and labor were identified as determinants of perinatal mortality. Hence, interventions need to focus on increasing knowledge of danger signs and utilization of skilled maternity care. Special emphasis needs to be given to mothers with a previous history of perinatal mortality, twin pregnancies, and having obstetric complications.

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Role of ethnicity in thrombotic and hemorrhagic complications of myeloproliferative neoplasms.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18555 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18555-e18555

Author(s):

Andrew Peseski ◽

Antoine Saliba ◽

Hamid Sayar

Keyword(s):

Myeloproliferative Neoplasms ◽

Philadelphia Chromosome ◽

Previous History ◽

Multivariate Logistic Regression Analysis ◽

Vascular Complications ◽

Bleeding Complications ◽

Vascular Events ◽

Hemorrhagic Complications ◽

History Of ◽

Caucasian Patients

e18555 Background: Philadelphia-chromosome negative myeloproliferative neoplasms (MPN) are a group of hematologic malignancies with known complications of hemorrhage and thrombosis. Age and a previous history of thrombosis are well-documented risk factors for future vascular events. Variations in the rates of these complications among ethnicities and sexes have not been extensively explored. Methods: Our retrospective analysis included 301 adult patients with a diagnosis of MPN without a history of thrombosis or hemorrhagic event seen at the Indiana University Simon Cancer Center between 1992 and 2019. Relationships between ethno-racial backgrounds and vascular complications and disease outcomes were evaluated using multivariate logistic regression analysis and Cox regression models. Results: Two hundred seventy-one patients (90.0%) were Caucasian and 30 patients (10.0%) were non-Caucasian. Non-Caucasian patients were comprised of African America, Asian, and Middle Eastern ethnicities. Median age at diagnosis was 56 years, and 43.9% were male. No association was found between the incidence of thrombotic complications and ethnicity using the log-rank test ( p 0.68). The incidence of hemorrhagic events was significantly increased in non-Caucasian patients (OR = 4.33; 95% CI [1.15 – 16.36], p 0.03). Patients with higher hemoglobin concentration at diagnosis were at a significantly lower risk of bleeding complications (OR = 0.79; 95% CI [0.65 – 0.95], p 0.01). Non-Caucasian patients were at 2.98 times (95% CI [1.19 – 7.44], p 0.02) higher risk when vascular complications were pooled together. Our models also showed that male sex (OR = 0.14; 95% CI [.02 – .98], p 0.048) and a higher platelet count at the time of diagnosis (OR = 0.99; 95% CI [.993 –.999], p 0.03) had a marginally significant association with decreased rate of progression to acute myeloid leukemia. Conclusions: This study suggests that in patients without a history of thrombosis or bleeding, non-Caucasian ethnicity was associated with an increased adjusted risk of hemorrhagic complications in patients with MPN. This observation may inform future studies to further characterize those disparities in outcomes at the genetic or socioeconomic level.

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The risk of ischemic stroke and hemorrhagic stroke in Chinese adults with low-density lipoprotein cholesterol concentrations < 70 mg/dL

BMC Medicine ◽

10.1186/s12916-021-02014-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Zhijun Wu ◽

Zhe Huang ◽

Alice H. Lichtenstein ◽

Yesong Liu ◽

Shuohua Chen ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Training Dataset ◽

Validation Dataset ◽

Low Density ◽

Low Density Lipoprotein Cholesterol

Abstract Background The risk of stroke in individuals with very low low-density lipoprotein cholesterol (LDL-C) concentrations remains high. We sought to prioritize predictive risk factors for stroke in Chinese participants with LDL-C concentrations < 70 mg/dL using a survival conditional inference tree, a machine learning method. Methods The training dataset included 9327 individuals with LDL-C concentrations < 70 mg/dL who were free of cardiovascular diseases and did not use lipid-modifying drugs from the Kailuan I study (N = 101,510). We examined the validity of this algorithm in a second Chinese cohort of 1753 participants with LDL-C concentrations < 70 mg/dL from the Kailuan II study (N = 35,856). Results During a mean 8.5–9.0-year follow-up period, we identified 388 ischemic stroke cases and 145 hemorrhagic stroke cases in the training dataset and 20 ischemic stroke cases and 8 hemorrhagic stroke cases in the validation dataset. Of 15 examined predictors, poorly controlled blood pressure and very low LDL-C concentrations (≤ 40 mg/dL) were the top hierarchical predictors of both ischemic stroke risk and hemorrhagic stroke risk. The groups, characterized by the presence of 2–3 of aforementioned risk factors, were associated with a higher risk of ischemic stroke (hazard ratio (HR) 7.03; 95% confidence interval (CI) 5.01–9.85 in the training dataset; HR 4.68, 95%CI 1.58–13.9 in the validation dataset) and hemorrhagic stroke (HR 3.94, 95%CI 2.54–6.11 in the training dataset; HR 4.73, 95%CI 0.81–27.6 in the validation dataset), relative to the lowest risk groups (presence of 0–1 of these factors). There was a linear association between cumulative average LDL-C concentrations and stroke risk. LDL-C concentrations ≤ 40 mg/dL was significantly associated with increased risk of ischemic stroke (HR 2.07, 95%CI 1.53, 2.80) and hemorrhagic stroke (HR 2.70, 95%CI 1.70, 4.30) compared to LDL-C concentrations of 55–70 mg/dL, after adjustment for age, hypertension status, and other covariates. Conclusion Individuals with extremely low LDL-C concentrations without previous lipid-modifying treatment could still be at high stroke risk. Trial registration Chinese Clinical Trial Register, ChiCTR-TNRC-11001489. Registered on 24-08-2011.

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Abstract 717: An Association between Frontal Non-hemorrhagic Stroke and Atrial Fibrillation.

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.717 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Daniel Sedhom ◽

Neil Yager ◽

Michael Ashamalla ◽

Ketan Ghate ◽

Justin Pieper ◽

...

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Logistic Regression ◽

Coronary Artery ◽

Hemorrhagic Stroke ◽

Normal Sinus Rhythm ◽

Multivariate Logistic Regression Analysis ◽

Study Cohort ◽

History Of ◽

Artery Disease

Background: Atrial fibrillation is a known risk factor for thromboembolic events. We sought to investigate an association between arrhythmia and stroke location in patients with non-hemorrhagic stroke. Materials and methods: The study cohort included 514 consecutive patients with non-hemorrhagic stroke treated at a single academic center. Stroke location was classified as frontal, occipital, lacunar, brainstem, left or right temporal, left or right parietal, cerebellar and insular. ANOVA, chi-square and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Frontal embolic stroke was noted more frequently in patients with atrial fibrillation (29% vs. 15% in normal sinus rhythm, NSR, p<0.0001). No other anatomic location of the stroke was associated with arrhythmia. Frontal strokes were more likely in patients with history of coronary artery disease (23% vs. 12%, p<0.005). However, there was no association between frontal stroke location and gender, age, history of hypertension, diabetes, dyslipidemia, peripheral vascular disease, or chronic renal insufficiency. In multivariate logistic regression analysis, atrial fibrillation (HR 2.3; 95% CI 1.2-4.5, p=0.018) and history of coronary artery disease (HR 2; 95%CI 1.2-3.4, p=0.012) remained important predictors of frontal strokes. Discussion: Non-hemorrhagic strokes are common in patients with atrial fibrillation. We found increased prevalence of frontal embolic strokes in atrial fibrillation, possible due to the dual blood supply the frontal cerebrum from both the middle and anterior cerebral arteries. This association is intriguing and requires further studies.

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Aneurysmal Subarachnoid Hemorrhage in a 68-Year-old Hyperglycemic Female Patient: Case Report and Literature Review

International Journal of Medical Students ◽

10.5195/ijms.2019.393 ◽

2019 ◽

Vol 7 (2) ◽

pp. 45-49

Author(s):

Paul Marcel Morgan

Keyword(s):

Subarachnoid Hemorrhage ◽

Hemorrhagic Stroke ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Previous History ◽

Channel Blockers ◽

Small Areas ◽

Glucose Levels ◽

History Of ◽

Western Regional ◽

Acute Hemorrhagic Stroke

Background: While hyperglycemia is intimately associated with uncontrolled diabetes mellitus (DM), recent clinical studies have demonstrated that hyperglycemia is also present in the early acute phase of stroke and is associated with poor prognosis and increased long-term mortality. About half of patients with acute hemorrhagic stroke also present with hyperglycemia upon admission. But more than 50% of patients with acute hemorrhagic stroke develop hyperglycemia even without a previous history of DM. This sheds new light on the relationship between DM, hyperglycemia, and hemorrhagic stroke, with a pathophysiology that is perhaps more profound than is conventionally understood. The Case: We report a case of a 68-year-old female, with a history of DM Type 2 and stage 3 hypertension who presents to the emergency room (ER) at the Western Regional Hospital in Belmopan City, Belize, with hemorrhagic stroke and hyperglycemia. Diffuse subarachnoid hemorrhage was found in the frontal, temporal, and parietal regions. Mild intraventricular hemorrhage was also observed in the frontal horns and basal cisterns. And small areas of intraparenchymal hemorrhage were present in the frontal lobes. The patient was stabilized and treated conservatively with calcium channel blockers, and diuretics. Conclusion: Despite a unifying consensus that is still pending, maintaining glucose levels between 110-120 mg/dl by using continuous insulin infusions after traumatic brain injury or aneurysmal subarachnoid hemorrhage may carry some clinical benefit with slightly improved outcome.

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Development and validation of a predictive model of drug-resistant genetic generalized epilepsy

Neurology ◽

10.1212/wnl.0000000000010597 ◽

2020 ◽

Vol 95 (15) ◽

pp. e2150-e2160 ◽

Cited By ~ 1

Author(s):

Hyunmi Choi ◽

Kamil Detyniecki ◽

Carl Bazil ◽

Suzanne Thornton ◽

Peter Crosta ◽

...

Keyword(s):

Characteristic Curve ◽

Training Dataset ◽

Validation Dataset ◽

Seizure Type ◽

Drug Resistant ◽

Psychiatric Condition ◽

Catamenial Epilepsy ◽

Increased Risk ◽

History Of ◽

Generalized Epilepsy

ObjectiveTo develop and validate a clinical prediction model for antiepileptic drug (AED)–resistant genetic generalized epilepsy (GGE).MethodWe performed a case-control study of patients with and without drug-resistant GGE, nested within ongoing longitudinal observational studies of AED response at 2 tertiary epilepsy centers. Using a validation dataset, we tested the predictive performance of 3 candidate models, developed from a training dataset. We then tested the candidate models' predictive ability on an external testing dataset.ResultsOf 5,189 patients in the ongoing longitudinal study, 121 met criteria for AED-resistant GGE and 468 met criteria for AED-responsive GGE. There were 66 patients with GGE in the external dataset, of whom 17 were cases. Catamenial epilepsy, history of a psychiatric condition, and seizure types were strongly related with drug-resistant GGE case status. Compared to women without catamenial epilepsy, women with catamenial epilepsy had about a fourfold increased risk for AED resistance. The calibration of 3 models, assessing the agreement between observed outcomes and predictions, was adequate. Discriminative ability, as measured with area under the receiver operating characteristic curve (AUC), ranged from 0.58 to 0.65.ConclusionCatamenial epilepsy, history of a psychiatric condition, and the seizure type combination of generalized tonic clonic, myoclonic, and absence seizures are negative prognostic factors of drug-resistant GGE. The AUC of 0.6 is not consistent with truly effective separation of the groups, suggesting other unmeasured variables may need to be considered in future studies to improve predictability.

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Simple-to-use nomogram for predicting the risk of syphilis among MSM in Guangdong Province: results from a serial cross-sectional study

BMC Infectious Diseases ◽

10.1186/s12879-021-06912-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Peizhen Zhao ◽

Ziying Yang ◽

Baohui Li ◽

Mingzhou Xiong ◽

Ye Zhang ◽

...

Keyword(s):

Predictive Accuracy ◽

Multivariate Logistic Regression Analysis ◽

Guangdong Province ◽

Assessment Model ◽

Training Dataset ◽

Validation Dataset ◽

Syphilis Infection ◽

Discriminative Ability ◽

Cross Sectional ◽

The Past

Abstract Background The purpose of this study was to develop and validate a simple-to-use nomogram for the prediction of syphilis infection among men who have sex with men (MSM) in Guangdong Province. Methods A serial cross-sectional data of 2184 MSM from 2017 to 2019 was used to develop and validate the nomogram risk assessment model. The eligible MSM were randomly assigned to the training and validation dataset. Factors included in the nomogram were determined by multivariate logistic regression analysis based on the training dataset. The receiver operating characteristic (ROC) curves was used to assess its predictive accuracy and discriminative ability. Results A total of 2184 MSM were recruited in this study. The prevalence of syphilis was 18.1% (396/2184). Multivariate logistic analysis found that age, the main venue used to find sexual partners, condom use in the past 6 months, commercial sex in the past 6 months, infection with sexually transmitted diseases (STD) in the past year were associated with syphilis infection using the training dataset. All these factors were included in the nomogram model that was well calibrated. The C-index was 0.80 (95% CI 0.76–0.84) in the training dataset, and 0.79 (95% CI 0.75–0.84) in the validation dataset. Conclusions A simple-to-use nomogram for predicting the risk of syphilis has been developed and validated among MSM in Guangdong Province. The proposed nomogram shows good assessment performance.

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