Hormonal Contraception and Massive Pulmonary Embolism in a COVID-19 Ambulatory Patient: A Case Report

Coronavirus 19 disease (COVID-19) presents a highly variable clinical presentation and course, ranging from asymptomatic patients to rapidly progressive, fatal pneumonia. The known heterogeneous outcomes can affect both previously healthy patients and those with significant comorbidities, who develop clinical courses with possibly more multisystemic compromise. Likewise, the development of thrombotic phenomena during the acute course of the disease is associated with complications that worsen patient prognosis. We present a case report of a 45-year-old multiparous patient with a history of overweight and chronic use of oral hormonal contraception with low doses of levonorgestrel and estradiol as the only risk factors favoring the development of thrombotic events. During her outpatient COVID-19 clinical course, she developed massive pulmonary thromboembolism resulting in secondary obstructive shock, which required pharmacological thrombolysis. At discharge, hormonal contraception was considered contraindicated, and the patient was released from our institution with continued oral anticoagulant therapy. COVID-19 infection, contraceptive hormone therapy, and overweight are known risk factors for the development of thromboembolic events. The impact of their concomitance has not been studied to date. From our experience, we discuss the impact these risk factors have when present together and invite others to report similar cases.

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Stress, Cortisol and Suicide Risk

10.31234/osf.io/92b7z ◽

2019 ◽

Author(s):

Daryl Brian O'Connor

Keyword(s):

Risk Factors ◽

Suicidal Behavior ◽

Suicide Risk ◽

Stressful Events ◽

Additional Risk ◽

Global Health Issue ◽

History Of ◽

Hpa Axis Activity ◽

The Impact

Suicide is a global health issue accounting for at least 800,000 deaths per annum. Numerous models have been proposed that differ in their emphasis on the role of psychological, social, psychiatric and neurobiological factors in explaining suicide risk. Central to many models is a stress-diathesis component which states that suicidal behavior is the result of an interaction between acutely stressful events and a susceptibility to suicidal behavior (a diathesis). This article presents an overview of studies that demonstrate that stress and dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, are important additional risk factors for suicide. Evidence for other putative stress-related suicide risk factors including childhood trauma, impaired executive function, impulsivity and disrupted sleep are considered together with the impact of family history of suicide, perinatal and epigenetic influences on suicide risk.

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Risk factor for gestational diabetes mellitus and impact of gestational diabetes mellitus on maternal and fetal health during the antenatal period

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213169 ◽

2021 ◽

Author(s):

Uma Jain ◽

Kusumlata Singhal ◽

Shikha Jain ◽

Deepali Jain

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Congenital Malformation ◽

Fetal Health ◽

Antenatal Period ◽

Study Results ◽

History Of ◽

The Impact

Background: Gestational diabetes mellitus (GDM) is defined as any degree of dysglycaemia that occurs for the first time or is first detected during pregnancy. The adverse effects of GDM on pregnant women are pre-eclampsia, PIH, PPH, polyhydramanios, PROM, meanwhile, there would be an increase in dystocia, birth injury, and cesarean sectionMethods: This retrospective study was conducted in a Gynecology clinic in District Shivpuri to find out the various risk factors for GDM and to evaluate the impact of GDM on maternal and fetal health during the antenatal period. 84 patients who were diagnosed with GDM were included in the study. Results: Among risk factors; BMI >25 kg/m2 before pregnancy was found in 15.47% of the case, family history of diabetes mellitus 8.33%, Previous history of macrosomia 17.85%, Poor reproductive history 17.85%, baby with congenital malformation 8.33%, H/o unexplained IUFD 11.90%. H/o polyhydramnios 15.47%. History of PCOS 13.09% and preeclampsia was found in 17.85% of cases. In antenatal complications; miscarriages was found in 15.47%. polyhydramnios in 17.85%. Oligohydramnios in 8.33%, preterm labor in 11.90%, PROM in 9.52%, pre-eclampsia in 17.85%, sudden IUFD in 8.33% and congenital malformation was found in 4.76% of cases. On USG; IUGR was found in 7.14% of cases. Large for date fetus in 16.66% of cases and the normal growth was found in 76.19% of cases.Conclusions- In conclusion appropriate and timely diagnosis and treatment of GDM will result in decreased maternal and neonatal adverse outcomes comparable to general population rates, therefore, early diagnosis is important.

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575. Evaluation of Risk Factors and Clinical Outcomes of Patients with Vancomycin-Resistant Enterococcus Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.644 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S271-S271

Author(s):

Gauri Chauhan ◽

Nikunj M Vyas ◽

Todd P Levin ◽

Sungwook Kim

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Subgroup Analysis ◽

Term Care ◽

Treatment Groups ◽

Increased Risk ◽

History Of ◽

Vancomycin Resistant ◽

The Impact

Abstract Background Vancomycin-resistant Enterococci (VRE) occurs with enhanced frequency in hospitalized patients and are usually associated with poor clinical outcomes. The purpose of this study was to evaluate the risk factors and clinical outcomes of patients with VRE infections. Methods This study was an IRB-approved multi-center retrospective chart review conducted at a three-hospital health system between August 2016-November 2018. Inclusion criteria were patients ≥18 years and admitted for ≥24 hours with cultures positive for VRE. Patients pregnant or colonized with VRE were excluded. The primary endpoint was to analyze the association of potential risk factors with all-cause in-hospital mortality (ACM) and 30-day readmission. The subgroup analysis focused on the association of risk factors with VRE bacteremia. The secondary endpoint was to evaluate the impact of different treatment groups of high dose daptomycin (HDD) (≥10 mg/kg/day) vs. low dose daptomycin (LDD) (< 10 mg/kg/day) vs. linezolid (LZD) on ACM and 30-day readmission. Subgroup analysis focused on the difference of length of stay (LOS), length of therapy (LOT), duration of bacteremia (DOB) and clinical success (CS) between the treatment groups. Results There were 81 patients included for analysis; overall mortality was observed at 16%. Utilizing multivariate logistic regression analyses, patients presenting from long-term care facilities (LTCF) were found to have increased risk for mortality (OR 4.125, 95% CI 1.149–14.814). No specific risk factors were associated with 30-day readmission. Patients with previous exposure to fluoroquinolones (FQ) and cephalosporins (CPS), nosocomial exposure and history of heart failure (HF) showed association with VRE bacteremia. ACM was similar between HDD vs. LDD vs. LZD (16.7% vs. 15.4% vs. 0%, P = 0.52). No differences were seen between LOS, LOT, CS, and DOB between the groups. Conclusion Admission from LTCFs was a risk factor associated with in-hospital mortality in VRE patients. Individuals with history of FQ, CPS and nosocomial exposure as well as history of HF showed increased risk of acquiring VRE bacteremia. There was no difference in ACM, LOS, LOT, and DOB between HDD, LDD and LZD. Disclosures All authors: No reported disclosures.

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Pregnancy failure in patients with obstetric antiphospholipid syndrome with conventional treatment: the influence of a triple positive antibody profile

Lupus ◽

10.1177/0961203317692432 ◽

2017 ◽

Vol 26 (9) ◽

pp. 983-988 ◽

Cited By ~ 25

Author(s):

J O Latino ◽

S Udry ◽

F M Aranda ◽

S D A Perés Wingeyer ◽

D S Fernández Romero ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Antiphospholipid Syndrome ◽

Pregnancy Outcomes ◽

Conventional Treatment ◽

Poor Response ◽

Anticardiolipin Antibodies ◽

History Of ◽

Obstetric Antiphospholipid Syndrome ◽

The Impact

Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20–30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin. Pregnancy outcomes were evaluated according to the following associated risk factors: triple positivity profile, double positivity profile, single positivity profile, history of thrombosis, autoimmune disease, more than four pregnancy losses, and high titers of anticardiolipin antibodies and/or anti-βeta-2-glycoprotein-I (aβ2GPI) antibodies. To establish the association between pregnancy outcomes and risk factors, a single binary logistic regressions analysis was performed. Risk factors associated with pregnancy loss with conventional treatment were: the presence of triple positivity (OR = 5.0, CI = 1.4–16.9, p = 0.01), high titers of aβ2GPI (OR = 4.4, CI = 1.2–16.1, p = 0.023) and a history of more than four pregnancy losses (OR = 3.5, CI = 1.2–10.0, p = 0.018). The presence of triple positivity was an independent risk factor associated with gestational complications (OR = 4.1, CI = 1.2–13.9, p = 0.02). Our findings reinforce the idea that triple positivity is a categorical risk factor for poor response to conventional treatment.

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Case Report: Migrainous Infarct without Aura

Case Reports in Neurology ◽

10.1159/000481281 ◽

2017 ◽

Vol 9 (3) ◽

pp. 241-251

Author(s):

Kamesh Gupta ◽

Anurag Rohatgi ◽

Shivani Handa

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Case Report ◽

Rare Case ◽

Case Presentation ◽

The Past ◽

Need To Evaluate ◽

History Of ◽

Complicated Migraine ◽

Full Investigation

Background: Stroke in a migraine with aura has been documented in several cases, even deserving the merit of a classification as complicated migraine. Herein, we present a rare case of migrainous infarct without aura. The diagnosis was challenging due to lack of risk factors. The patient was unique in not having any other comorbidities. Case Presentation: The case is of a 21-year-old female presenting with right-sided hemiplegia and facial drooping. She had had an index presentation of throbbing headaches for the past 2 years, typical of a migraine but not preceded by any aura symptoms. However, in the current episode, the pain became excessively severe and accompanied by right-sided hemiplegia and facial drooping. A full investigation workup using MRI revealed evidence of infarct in the left temporoparietal and basal ganglion region. Conclusion: Our case highlights the need to evaluate silent ischemic stroke in case of prolonged headache with a history of migraine as well as the need for precaution to avoid the use of triptans or opioids in such a case. It also highlights the conditions that need to be excluded before labeling it as a migrainous infarct.

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Risk factors of bronchial asthma, chronic obstructive lung disease and «OVERLAP» syndrome asthma-COPD among adults in Ekaterinburg

Rossiiskii Allergologicheskii ZHurnal ◽

10.36691/rja133 ◽

2018 ◽

Vol 15 (4) ◽

pp. 26-29

Author(s):

V C Abdullaev ◽

E K Beltyukov ◽

V V Naumova

Keyword(s):

Risk Factors ◽

Bronchial Asthma ◽

Chronic Obstructive Lung Disease ◽

Overlap Syndrome ◽

Chronic Obstructive ◽

Actual Risk ◽

History Of ◽

Definition Of ◽

The Impact ◽

Over 40 Years

Topicality. Prevalence of bronchial asthma (BA) and COPD achieves in different countries 18 and 20% respectively. The prevalence of «OVERLAP» syndrome - ASTHMA/COPD in Russia is unknown. Objective. To determine the prevalence ofBA, COPD and «OVERLAP» syndrome - ASTHMA/COPD. Materials and methods. The study included a survey using a specially developed questionnaire to identify asthma-like symptoms (ALS), risk factors for BA, COPD, and the definition of FEV^ FEV^FVC in adults in Ekaterinburg. Results. The study has revealed that the risk factors for developing ALS are exposure to tobacco smoke and age over 40 years. The impact of allergens and family history of allergy are less significant. Decrease of spirometry indices is associated with smoking, age over 40 years and the presence of ALS. The diagnostic criteria for the «OVERLAP» syndrome - ASTHMA/COPD were developed based on the answers to the questionnaire on ALS, risk factors and the results of the screening spirometry. Conclusions. Preliminary prevalence ofBA, COPD, «OVERLAP» syndrome - ASTHMA/COPD and actual risk factors have been established in Ekaterinburg in 2018. Unfavorable situation with prevalence of smoking in Ekaterinburg has been showing.

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GAMBARAN PENGGUNAAN KONTRASEPSI HORMONAL PADA PASIEN STROKE ISKEMIK DI RSUD Dr. SOETOMO SURABAYA

Indonesian Midwifery and Health Sciences Journal ◽

10.20473/imhsj.v3i1.2019.37-50 ◽

2021 ◽

Vol 3 (1) ◽

pp. 37

Author(s):

Virna Safira Puspaningtyas ◽

Baksono Winardi ◽

Sulistiawati Sulistiawati

Keyword(s):

Ischemic Stroke ◽

Hormonal Contraception ◽

Hormonal Contraceptive ◽

Hereditary Disease ◽

Hereditary Diseases ◽

Coagulation System ◽

Age Group ◽

Consecutive Sampling ◽

History Of ◽

The Impact

AbstrakLatar Belakang : Kontrasepsi hormonal berfungsi untuk mencegah terjadinya kehamilan yang mengandung preparat estrogen dan progesteron. Esterogen diketahui dapat menginduksi perubahan signifikan dalam sistem koagulasi yang dapat menyebabkan terjadinya tromboembolik seperti stroke. Sementara pada beberapa penelitian, kontrasepsi progesterone-only, dampaknya pada penyakit kardiovaskular belum dapat dijelaskan secara pasti. Penelitian bertujuan untuk mengetahui gambaran pengguna kontrasepsi hormonal pada pasien stroke iskemik di RSUD Dr. Soetomo Surabaya. Metode : Penelitian deskriptif observasional. Teknik sampling secara consecutive sampling. Variabel penelitian meliputi usia, pekerjaan, riwayat penyakit, jenis dan lama penggunaan kontrasepsi hormonal, serta jarak berhenti penggunaan kontrasepsi hormonal sampai terjadinya stroke. Untuk mengetahui gambaran dan distribusi frekuensi variabel dilakukan analisis univariat atau deskriptif. Hasil :. Didapatkan kelompok usia tertinggi yakni 40% adalah masa lansia awal (46 – 55 tahun), sebanyak 42% responden berprofesi sebagai ibu rumah tangga. Didapati 40% responden pernah menderita hipertensi dan juga mayoritas 50% memiliki riwayat penyakit keturunan hipertensi. Sebesar 54% responden menggunakan alat kontrasepsi hormonal ≥5 tahun dengan jenis kontrasepsi hormonal terbanyak adalah suntik 3 bulan (progesterone-only) yaitu 42%. Sebanyak 68% responden menyatakan jangka waktu berhentinya menggunakan kontrasepsi hormonal sampai terjadinya stroke iskemik rata - rata <12 tahun. Kesimpulan : Usia responden pada penelitian ini mayoritas pada kelompok umur lansia awal (46 - 55 tahun) dengan jenis pekerjaan terbanyak ibu rumah tangga. Hipertensi merupakan riwayat penyakit terdahulu dan penyakit keturunan yang banyak diderita oleh responden. Sebagian kecil responden menggunakan kontrasepsi hormonal lamanya ≤5 tahun dengan jenis penggunaan terbanyak adalah suntik 3 bulan (progesterone-only). Rata-rata responden berhenti menggunakan kontrasepsi hormonal <12 tahun sebelum terjadinya stroke iskemik. AbstractBackground : Hormonal contraception serves to prevent pregnancy from it contains estrogen and progesterone preparations. Esterogens are known to induce significant changes in the coagulation system that can cause thromboembolic events such as stroke. While in some studies, progesterone-only contraception, the impact on cardiovascular disease has not been clearly explained. This study aims to determine the description of hormonal contraceptive users in ischemic stroke patients at Dr. Soetomo Surabaya. Method : Observational descriptive study. In addition, researcher applied consecutive sampling in this study. Research variables included age, occupation, disease history, type and duration of hormonal contraceptive use, as well as the distance to stop using hormonal contraception until the occurrence of stroke. Univariate or descriptive analysis is applied to perceive the representation and frequency distribution of variables. Result : The highest age group of 40% was obtained from the early elderly (46 - 55 years), as many as 42% of respondents worked as housewives. In the amount of 40% respondents had suffered from hypertension and also 50% had a history of hypertensive hereditary disease. 54% of respondents used hormonal contraception in ≥5 years with the most types of hormonal contraception were injections of progesterone-only, which is 42%. As many as 68% of respondents stated that the duration of cessation of using hormonal contraception until the occurrence of ischemic stroke was on average <12 years. Conclusion : The majority of the respondent were in the age group of the early elderly (46 - 55 years) with the most respondents worked as housewives. Hypertension is a history of previous illnesses and hereditary diseases that were mostly suffered by respondents. A small proportion of respondents used hormonal contraception for ≤5 years with the most type of use being injected progesterone-only. On average respondents stopped using hormonal contraception in <12 years before the occurrence of ischemic stroke.

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P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽

10.1093/europace/euaa162.058 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Pavlikova ◽

A Shevelyok ◽

N Vatutin

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Serum Sodium ◽

Sodium Level ◽

Cox Regression ◽

Serum Sodium Level ◽

History Of ◽

The Impact

Abstract Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018. In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level < 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps < 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion. In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

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The impact of family history of diabetes on risk factors for gestational diabetes

Clinical Endocrinology ◽

10.1111/j.1365-2265.2007.02958.x ◽

2007 ◽

Vol 67 (5) ◽

pp. 754-760 ◽

Cited By ~ 19

Author(s):

Ravi Retnakaran ◽

Philip W. Connelly ◽

Mathew Sermer ◽

Bernard Zinman ◽

Anthony J. G. Hanley

Keyword(s):

Risk Factors ◽

Family History ◽

Gestational Diabetes ◽

Family History Of Diabetes ◽

History Of ◽

The Impact

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The Risk Factors and the Impact of Hernia Development on Technique Survival in Peritoneal Dialysis Patients: A Population-Based Cohort Study

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00139 ◽

2015 ◽

Vol 35 (3) ◽

pp. 351-359 ◽

Cited By ~ 17

Author(s):

Shang-Feng Yang ◽

Chia-Jen Liu ◽

Wu-Chang Yang ◽

Chao-Fu Chang ◽

Chih-Yu Yang ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Protective Factor ◽

Female Gender ◽

Population Based ◽

Chronic Obstructive ◽

Research Database ◽

Hernia Formation ◽

History Of ◽

The Impact

ObjectivesThere is a lack of consensus on the risk factors for hernia formation, and the impact on peritoneal dialysis (PD) survival has seldom been studied.MethodsThis was a population-based study and all collected data were retrieved from the National Health Insurance Research Database of Taiwan. Patients who commenced PD between January 1998 and December 2006 were screened for inclusion. Multiple logistic regression and Cox proportional hazards models were applied to estimate the predictors for hernia formation and determine the predictors of PD withdrawal.ResultsA total of 6,928 PD patients were enrolled and followed until December 2009, with 631 hernia events and 391 hernioplasties being registered in 530 patients (7.7%). The incidence rate was 0.04 hernias/patient/year. Longer PD duration (per 1 month increase, hazard ratio (HR) 1.019) and history of mitral valve prolapse (MVP) (HR 1.584) were independent risk factors for hernia formation during PD, and female gender (HR 0.617) was a protective factor. On the other hand, there were 4,468 PD withdrawals, with cumulative incidence rates of 41% at 1 year, 66% at 3 years, and 82% at 5 years. Independent determinants for cumulative PD withdrawal included hernia formation during PD (HR 1.154), age (per 1 year increase, HR 1.014), larger dialysate volume (per 1 liter increase, HR 0.496), female gender (HR 0.763), heart failure (HR 1.092), hypertension (HR 1.207), myocardial infarction (HR 1.292), chronic obstructive pulmonary disease (COPD) (HR 1.227), cerebrovascular accident (CVA) (HR 1.364), and history of MVP (HR 0.712)ConclusionsProlonged PD duration was a risk factor for hernia formation, and female gender was protective. Hernia formation during PD therapy may increase the risk of PD withdrawal.

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