scholarly journals Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Alyssa Denton ◽  
Lilian Thorpe ◽  
Alexandra Carter ◽  
Adriana Angarita-Fonseca ◽  
Karen Waterhouse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Drug Resistant ◽  
Age Group ◽  
Drug Resistant Epilepsy ◽  
New Diagnosis

Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

scholarly journals Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas ◽  
James P. Bradley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Revision Surgery ◽  
Significant Risk ◽  
Return To Sport ◽  
Significant Risk Factor ◽  
Return To Play ◽  
Bone Width ◽  
Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

scholarly journals Bedtime Salivary Cortisol and Depressive Symptoms in Older Adults Living With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 437-437
Author(s):  
Miranda McPhillips ◽  
Darina Petrovsky ◽  
Liming Huang ◽  
Adriana Adriana ◽  
Nancy Hodgson ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Salivary Cortisol ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Quadratic Term ◽  
Baseline Cortisol ◽  
Prospective Longitudinal

Abstract The dysregulation of cortisol has been associated with depressive symptoms in older adults. To date, no prospective longitudinal studies have examined whether salivary cortisol is a risk factor for depressive symptoms in persons living with dementia (PLWD). With a sample of 123 PLWD, baseline salivary cortisol was collected at awaking, 30 minutes after awaking, and bedtime. Depressive symptoms were assessed at baseline and the four-week follow-up. Cortisol indicator were centered. Baseline bedtime cortisol level was significantly associated with depressive symptoms in a curvature style while controlling age, gender, and baseline depressive symptoms (𝛽=3.76 for linear term and 𝛽=-1.57 for quadratic term, both ps&lt;0.04). No other baseline cortisol measures were significant prospective predictors. Our results suggest the bedtime cortisol was a significant risk factor for depressive symptoms in PLWD. These findings suggest that bedtime cortisol may play a role in the etiology of depressive symptoms in PLWD.

scholarly journals Risk Factors for Incident Myopia among Teenaged Students of the Experimental Class of the Air Force in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Lin-song Qi ◽  
Lu Yao ◽  
Xue-feng Wang ◽  
Jiu-mei Shi ◽  
Yong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Air Force ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Work Time ◽  
Related Risk ◽  
Refractive Change ◽  
Near Work

Background. In recent decades, the prevalence rate of myopia has markedly increased, especially among teenagers. Our purpose was to determine the incidence of myopia and identify the related risk factors among schoolchildren in the experimental classes of the Air Force in China. Methods. In May 2015, this 3-year prospective cohort study enrolled 522 boys (age, 14–16 years) attending grade 10 in 16 high schools in 15 cities in China. Cycloplegic refraction was examined using retinoscopy in both eyes at the baseline and follow-up (3 years). A detailed questionnaire was completed by the students at the 3-year follow-up and included questions on parental myopia and on the total time spent doing near work and outdoor activities each week. Results. The incidence of myopia at the 3-year follow-up was 27.01% (141/522, 95% confidence interval (CI): 23.38% to 30.98%). The refractive change was −0.46 D (95% CI: −0.49 to −0.42 D). More hyperopic or less myopic baseline refraction, outdoor activity time per week ≥14 h (odds ratio (OR) = 0.464, 95% CI: 0.227 to 0.950), and reading/writing distance ≥ 30 cm (OR = 0.505, 95% CI: 0.270 to 0.944) were significant protective factors against incident myopia. Near-work time ≥28 h per week was a significant risk factor (OR = 2.579, 95% CI: 1.314 to 5.061). Parental myopia, age at the start of primary school, continuous reading/writing for ≥1 h, sleep duration per week <49 h, and one or more dietary biases were not significant risk factors (P>0.05). Conclusion. A more hyperopic baseline refraction, more time spent outdoors, and longer writing/reading distance were protected against myopia onset, while more near-work time was a risk factor.

scholarly journals Treatment Trends in Dry Eye Disease and Factors Associated with Ophthalmic Follow-up Discontinuation in Japan

2019 ◽  
Vol 8 (8) ◽  
pp. 1120 ◽  
Author(s):  
Miki Uchino ◽  
Norihiko Yokoi ◽  
Motoko Kawashima ◽  
Yamanishi Ryutaro ◽  
Yuichi Uchino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Dry Eye ◽  
Past History ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
History Of

Despite the importance of dry eye disease (DED) treatment, the rate of DED treatment discontinuation, especially discontinuation of ophthalmic follow-up, remains unknown. This study aimed to assess the prevalence and risk factors of ophthalmic follow-up discontinuation for DED. A cross-sectional survey of 1030 participants was conducted using a self-administered web-survey instrument. We collected lifestyle information, history of DED diagnosis, types of treatment, frequency of eye-drop usage, symptoms, and the reasons for discontinuing treatment. Statistical analyses including logistic regression were used to evaluate the risk factors of discontinuing ophthalmic follow-up for DED. A past history of clinical DED diagnosis was reported by 155 (15.0%) subjects. Of those, 130 had persistent DED, and 88 (67.7%) of the subjects reported discontinuation of ophthalmic follow-up for DED. The most prevalent reasons for ophthalmic follow-up discontinuation were time restrictions, followed by dissatisfaction with the DED treatment. Duration after DED diagnosis was the only significant risk factor for discontinuing ophthalmic follow-up after adjusting for age and sex (odds ratio = 1.09, 95% confidence interval = 1.02–1.17, p = 0.009). In conclusion, longer DED duration after diagnosis was a significant risk factor for discontinuing ophthalmic follow-up for DED. This study showed that DED ophthalmic follow-up discontinuation involves both medical and non-medical reasons. Clinicians need to be aware of them, and preventative effort is needed to avoid discontinuation.

scholarly journals P.009 Characterizing drug-resistant epilepsy in an adult cohort with new-onset epilepsy

2019 ◽  
Vol 46 (s1) ◽  
pp. S16
Author(s):  
A Denton ◽  
L Hernandez-Ronquillo ◽  
J Tellez-Zenteno ◽  
K Waterhouse
Keyword(s):  
Risk Factors ◽  
Age Of Onset ◽  
Significant Risk ◽  
Bivariate Analysis ◽  
Drug Resistant ◽  
Seizure Onset ◽  
Cranial Trauma ◽  
Drug Resistant Epilepsy ◽  
New Onset

Background: There are few studies exploring rates of drug resistant epilepsy in populations with new-onset epilepsy (NOE). This prospective cohort study characterizes the development of drug-resistant epilepsy (DRE) and risk factors in an adult cohort with NOE or newly-diagnosed epilepsy (NDE). Methods: Patients are from the Single Seizure Clinic (SSC) in Saskatoon, SK between 2011 and 2018. The SSC sees patients who experience their first seizure; approximately 30% are diagnosed with epilepsy. Patients were followed prospectively. We identified the following variables in the cohort: epilepsy type, seizure onset, etiology, syndromes, and rates of DRE. Inclusion criteria included patients with NO and NDE, at least 18 years at diagnosis, and a minimum 1 year of follow-up. Results: Ninety-five patients were included, 46 females and 49 males. Median age of onset was 33 years. Of those, 28.4% developed DRE. Average time between onset and DRE diagnosis was 1.44 years. Bivariate analysis identified age, gender, and cranial trauma as significant risk factors for DRE. The multivariate model was not significant. Conclusions: Our study shows that patients with new-onset epilepsy have are less likely to develop DRE compared with patients from epilepsy clinics. This study contributes valuable information about NO epilepsy in adults and the development of DRE.

scholarly journals Cohort Study on the Prevalence and Risk Factors for Delayed Pulmonary Complications in Adults Following Minor Blunt Thoracic Trauma

CJEM ◽  
2014 ◽  
Vol 16 (02) ◽  
pp. 136-143 ◽  
Author(s):  
Miville Plourde ◽  
Marcel Émond ◽  
André Lavoie ◽  
Chantal Guimont ◽  
Natalie Le Sage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Thoracic Trauma ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Blunt Thoracic Trauma ◽  
X Ray ◽  
Delayed Complications ◽  
Delayed Pneumothorax

ABSTRACTObjectives:The objectives of this study are to determine the prevalence, risk factors, and time to onset of delayed hemothorax and pneumothorax in adults who experienced a minor blunt thoracic trauma.Method:A prospective cohort of 450 consecutive patients was recruited. Eligible patients had to be over 16 years of age, consulted within 72 hours for a trauma, and available for outpatient follow-up at 2, 7, and 14 days posttrauma. The clinical outcome investigated was the presence of delayed pneumothorax or hemothorax on the follow-up chest x-ray.Outcomes:Delayed hemothorax occurred in 11.8% (95% CI 8.8–14.8), and delayed pneumothorax occurred in 0.9% (95% CI 0.2–2.3) of participants. During the 14-day follow-up period, 87.0% of these delayed complications developed in the first week. In the multivariate analysis, the only statistically significant risk factor for delayed complications was the location of fractures on the x-ray of the hemithorax. The adjusted odds ratio was 1.52 (95% CI 0.62–3.73) for the lower ribs (tenth to twelfth rib), 3.11 (95% CI 1.60–6.08) for the midline ribs (sixth to ninth rib), and 5.05 (95% CI 1.80–14.19) for the upper ribs (third to fifth rib) versus patients with no fractures.Conclusion:The presence of at least one rib fracture between the third and ninth rib on the x-ray of the hemithorax is a significant risk factor for delayed hemothorax and pneumothorax.

scholarly journals A New Hemodynamic Index To Predict Late Right Failure In Patients Implanted With Last Generation Centrifugal Pump.

2021 ◽  
Author(s):  
Andrea Montalto ◽  
Cristiano Amarelli ◽  
Vito Piazza ◽  
Kali Hopkins ◽  
Marina Comisso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Diuretic Therapy ◽  
Interventricular Septum ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Inotropic Support ◽  
Pump Speed ◽  
Speed Optimization

Background. Right ventricular failure (RVF) is a severe event that increases perioperative mortality after Left Ventricle Assist Device (LVAD) implantation. RV function is particularly affected by the LVAD speed by changing RV preload and afterload as well as the position of the interventricular septum. However, there are no studies focusing on the relationship between pump speed optimization and risk factors for development of lateRVF. Methods. Between 2015 and 2019,50 consecutive patients received LVAD implantation at San Camillo Hospital in Rome. Of these, 38 who underwent pump speed optimization were included. Post optimization hemodynamic data were collected. We assessed: a new Hemodynamic Index (HI), calculated as follows HI=MAP x PCWP/CVP x RPM set/RPM max; risk factors for late RVF, which was defined as the requirement for 7 days or more of inotropic support. Results 10 patients had late RVF after LVAD implantation. 5 patients required diuretic therapy and speed optimization. In 3 patients inotropic support with adrenaline 0.05 g/kg/min was started. 2 patients required prolonged continuous veno-venous hemofiltration and high dosage inotropic support. Multivariate analysis revealed that a low HI (odds ratio 11.5, 95 % confidence interval,1.85-65.5,p[.003] was an independent risk factor for late RVF after LVAD implantation. Conclusion A low HI, according to our study, is a significant risk factor for the development of RVF after LVAD implantation. We suggest adopting this index during the follow-up to stratify the different hemodynamic profiles and modify the therapeutic strategies according to the different HI levels obtained for every single patient.

Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

2020 ◽  
pp. 1-7
Author(s):  
Stephanie M. Cabral ◽  
Katherine E. Goodman ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Larry S. Magder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Community Hospital ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bivariate Analysis ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

scholarly journals PREVALENCE OF SMOKING IN ADULT POPULATION OF IRKUTSK

2016 ◽  
Vol 1 (6) ◽  
pp. 153-156
Author(s):  
Максикова ◽  
Tatyana Maksikova ◽  
Бабанская ◽  
Evgeniya Babanskaya ◽  
Меньшикова ◽  
...  
Keyword(s):  
Risk Factor ◽  
Adult Population ◽  
Age Groups ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Noncommunicable Diseases ◽  
Age Difference ◽  
Age Group ◽  
Considerable Problem ◽  
The One

Smoking is a significant risk factor of chronic noncommunicable diseases. Smoking prevalence is variable in different populations. A study of the prevalence of this risk factor allows to estimate its contribution to the development of cardiovascular pathology, to plan the necessary amount of medical care for people using tobacco, and to determine the effectiveness of prevention activities in the region. As a result of the study, smoking frequency in population of the Irkutsk region older 18years of age or over was established as 29.5%. The number of smokers increased with age, reaching maximum value of 38.6% in the group 30–39 years. Male smokers made maximum in the age group 30–39 years, women – in the age group of 18–19 years. The average age of smokers was 34 years, the one of nonsmokers – 43 years. The age difference was 9 years, and it was lower in the group of men than in the group of women (5 and 11 years, respectively). The number of the smoking men were 3 times larger, than women: 50.2% and 13.5%, respectively. Among persons with arterial hypertension, 22.1% were smoking with the maximum frequency of smoking in age groups from 20 to 49 years. These figures point to a considerable problem of smoking in the region.

scholarly journals Risk factors for hypertensive crisis in children with acute glomerulonephritis

2016 ◽  
Vol 56 (2) ◽  
pp. 101
Author(s):  
Sherly Yuniarchan ◽  
Risky Vitria Prasetyo ◽  
Ninik Asmaningsih Soemyarso ◽  
Mohammad Sjaifullah Noer
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Pediatric Population ◽  
Hypertensive Crisis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
P Value ◽  
Acute Glomerulonephritis ◽  
Female Ratio

Background Hypertensive crisis occurs in 1-4% of the hypertensive pediatric population, mostly due to acute glomerulonephritis (AGN). Some factors have been suggested to affect blood pressure (BP) in children, such as age, sex, race/ethnicity, obesity, and socioeconomic status, but little is known for risk factors for hypertensive crisis in AGN.Objective To analyze the risk factors for hypertensive crisis in children with AGN.Methods Retrospectively, we studied possible risk factors for hypertensive crisis in children with AGN at Dr. Soetomo Hospital from 2007 to 2011. Hypertensive crisis was defined as systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg (for children ≥ 6 years of age); and systolic and/or diastolic BP >50% above the 95th percentile (for children aged <6 years). We evaluated the demographic and clinical characteristics as potential risk factors. Statistical analysis was done with Chi-square, Fisher’s exact, and logistic regression tests. Variables with P <0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value of < 0.05 was considered statistically significant.Results There were 101 children included (mean age 9.7 (SD 2.17) years), with a male-to-female ratio of 2.7:1. Hypertensive crisis occurred in 42 (41.6%) children, of whom 8 had hypertensive urgency and 34 had hypertensive emergency. Proteinuria was seen in 53 children with AGN (52.5%) and was the significant risk factor for hypertensive crisis in our subjects (OR=2.75; 95%CI 1.16 to 6.52; P=0.021). Gender, clinical profiles, ethnicity, nutritional status, blood urea nitrogen (BUN), and glomerular filtration rate (GFR) were not significant risk factors for hypertensive crisis.Conclusion Proteinuria is the significant risk factor for hypertensive crisis in children with AGN.

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