scholarly journals Clinical Factors Associated with Cavitary Tuberculosis and Its Treatment Outcomes

2021 ◽  
Vol 11 (11) ◽  
pp. 1081
Author(s):  
Sun-Hyung Kim ◽  
Yoon Mi Shin ◽  
Jin Young Yoo ◽  
Jun Yeun Cho ◽  
Hyeran Kang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Treatment Outcomes ◽  
Treatment Duration ◽  
Previous History ◽  
Current Smoker ◽  
Clinical Factors ◽  
Pulmonary Tb ◽  
Factors Associated ◽  
History Of ◽  
Positive Results

Cavitary pulmonary tuberculosis (TB) is associated with poor outcomes, treatment recurrence, higher transmission rates, and the development of drug resistance. However, reports on its clinical characteristics, associated factors, and treatment outcomes are lacking. Hence, this study sought to evaluate the clinical factors associated with cavitary pulmonary TB and its treatment outcomes. We retrospectively evaluated 410 patients with drug-susceptible pulmonary TB in a university hospital in Korea between 2014 and 2019. To evaluate the factors associated with cavitary TB, multivariable logistic regression was performed with adjustments for potential confounders. We also compared the treatment outcomes between patients with cavitary TB and those without cavitary TB. Of the 410 patients, 244 (59.5%) had non-cavitary TB and 166 (40.5%) had cavitary TB. Multivariable logistic analysis with forward selection method showed that body mass index (BMI) (adjusted OR = 0.88, 95% CI: 0.81–0.97), previous history of TB (adjusted OR = 3.45, 95% CI: 1.24–9.59), ex- or current smoker (adjusted OR = 1.77, 95% CI: 1.01–3.13), diabetes mellitus (adjusted OR = 2.72, 95% CI: 1.36–5.44), and positive results on the initial sputum acid-fast bacilli (AFB) smear (adjusted OR = 2.24, 95% CI: 1.26–3.98) were significantly associated with cavitary TB. Although treatment duration was significantly longer in patients with cavitary TB than in those with non-cavitary TB (248 (102–370 days) vs. 202 (98–336 days), p < 0.001), the recurrence rate after successful treatment was significantly higher in the patients with cavitary TB than in those with non-cavitary TB (0.4% vs. 3.0% p = 0.042). In conclusion, ex- or current smoker, lower BMI, previous history of TB, diabetes mellitus, and positivity of the initial AFB smear were associated with cavitary TB. The patients with cavitary TB had more AFB culture-positive results at 2 months, longer treatment duration, and higher recurrence rates than those with non-cavitary TB.

scholarly journals Effect of Gestational Diabetes Mellitus History on Future Pregnancy Behaviors: The Mutaba’ah Study

2020 ◽  
Vol 18 (1) ◽  
pp. 58
Author(s):  
Nasloon Ali ◽  
Aysha S. Aldhaheri ◽  
Hessa H. Alneyadi ◽  
Maha H. Alazeezi ◽  
Sara S. Al Dhaheri ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Previous History ◽  
Previous Pregnancy ◽  
Prenatal Health ◽  
Supplement Use ◽  
History Of ◽  
Future Pregnancy

Gestational diabetes mellitus (GDM) increases the risk of adverse pregnancy outcomes in any pregnancy and recurrence rates are high in future pregnancies. This study aims to investigate the effect of self-reported history of previous GDM on behaviors in a future pregnancy. This is an interim cross-sectional analysis of the pregnant women who participated in the Mutaba’ah Study between May 2017 and March 2020 in the United Arab Emirates. Participants completed a baseline self-administered questionnaire on sociodemographic and pregnancy-related information about the current pregnancy and previous pregnancies. Regression models assessed the relationships between self-reported history of GDM and pre-pregnancy and pregnancy behaviors in the current pregnancy. Out of 5738 pregnant parous women included in this analysis, nearly 30% (n = 1684) reported a history of GDM in a previous pregnancy. Women with a history of previous GDM were less likely to plan their current pregnancies (adjusted odds ratio (aOR): 0.84, 95% confidence interval (CI) 0.74–0.96) and more likely to be worried about childbirth (aOR: 1.18, 95% CI 1.03–1.36). They had shorter interpregnancy intervals between their previous child and current pregnancy (aOR: 0.88, 95% CI 0.82–0.94, per SD increase). There were no significant differences between women with and without a history of GDM in supplement use, sedentary behavior, or physical activity before and during this current pregnancy. Nearly a third of parous pregnant women in this population had a history of GDM in a previous pregnancy. Pregnant women with a previous history of GDM were similar to their counterparts with no history of GDM in the adopted pre-pregnancy and prenatal health behaviors. More intensive and long-term lifestyle counseling, possibly supported by e-health and social media materials, might be required to empower pregnant women with a history of GDM. This may assist in adopting and maintaining healthy prenatal behaviors early during the pregnancy or the preconception phase to minimize the risk of GDM recurrence and the consequential adverse maternal and infant health outcomes.

Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Chase A Rathfoot ◽  
Camron Edressi ◽  
Carolyn B Sanders ◽  
Krista Knisely ◽  
Nicolas Poupore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Medical History ◽  
Clinical Decision Making ◽  
Past Medical History ◽  
Clinical Factors ◽  
Stroke Patients ◽  
Factors Associated ◽  
History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: A multicenter study

2018 ◽  
Vol 33 (4) ◽  
pp. 863-868 ◽  
Author(s):  
Eiji Yamada ◽  
Yulia Namiki ◽  
Yuya Takano ◽  
Hikaru Takamine ◽  
Koji Inazumi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Multicenter Study ◽  
Clinical Factors ◽  
Factors Associated ◽  
Patients With Diabetes

scholarly journals Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryota Inokuchi ◽  
Xueying Jin ◽  
Masao Iwagami ◽  
Toshikazu Abe ◽  
Masatoshi Ishikawa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cerebral Infarction ◽  
Clinic Visit ◽  
Telephone Triage ◽  
Hospital Visit ◽  
Over The Counter ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
History Of ◽  
House Call

Abstract Background Prehospital telephone triage stratifies patients into five categories, “need immediate hospital visit by ambulance,” “need to visit a hospital within 1 hour,” “need to visit a hospital within 6 hours,” “need to visit a hospital within 24 hours,” and “do not need a hospital visit” in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged. Methods We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively. Results We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16–64, 65–74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71–3.36], 8.57 [95% CI 4.83–15.2], and 14.9 [95% CI 9.65–23.0], respectively; reference patients aged < 15 years); those with diabetes mellitus (2.31 [95% CI 1.25–4.26]); those with dementia (2.32 [95% CI 1.05–5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01–3.87]) as more likely to be undertriaged. Conclusions We found that older adults and patients with diabetes mellitus, dementia, or a history of cerebral infarction were at risk of undertriage in patients triaged as need to visit a hospital within 1 h and 6 h, but further studies are needed to validate these findings.

COVID-19 WITH RHINO-ORBITO-CEREBRAL MUCORMYCOSIS : A SUDDEN SURGE

2021 ◽  
pp. 130-133
Author(s):  
Seema Patel ◽  
A. Z. Nitnaware ◽  
R. T. Pawar ◽  
Ashish Keche ◽  
Tanvi Rekhade
Keyword(s):  
Diabetes Mellitus ◽  
Early Diagnosis ◽  
Prospective Study ◽  
Previous History ◽  
Diagnosis And Treatment ◽  
Temporal Association ◽  
Concomitant Infection ◽  
History Of ◽  
A Prospective Study

Recently an increase in the incidence of mucormycosis is noticed in COVID-19 cases. The main aim of this study is to present our experience of rhino-orbito-cerebral mucormycosis in COVID-19 patients and thereby aid its early diagnosis and treatment. This is a prospective study of 12 cases diagnosed as Rhino-orbito-cerebral mucormycosis . Presentation of mucormycosis in COVID-19, their temporal association and outcome of treatment was studied. Pre-existing comorbidities were seen in 91.67% patients, Diabetes Mellitus (83.33%). Previous history of COVID-19 infection and treatment for the same in 41.67% cases, concomitant infection in 16.67% and asymptomatic undiagnosed covid (antibodies positive) was detected in 41.67%. All patients showed improvement in general and nasal condition (100%). Early diagnosis is must.

scholarly journals Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Barnabas Kahiira Natamba ◽  
Arthur Araali Namara ◽  
Moffat Joha Nyirenda
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Meta Analysis ◽  
Previous History ◽  
Sub Saharan Africa ◽  
African Women ◽  
History Of ◽  
Sub Saharan

Abstract Background The burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region. Methods PubMed was searched from inception to January 31st 2019. Studies were included if carried out in any of the sub-Saharan Africa countries and were available as abstracts or full texts. Interventional studies and those only including qualitative data were excluded. We employed random effects modelling to estimate the pooled GDM prevalence and risk ratios (RRs) for risk factors and outcomes of GDM and their 95%CI. Results 283 papers were identified in the initial search, 33 of which met the inclusion criteria. Data on GDM burden suggest a pooled prevalence of 9% (95%CI, 7–12%). Family history of type 2 diabetes and previous history of GDM, macrosomia, stillbirth and abortion were important risk factors of GDM. In addition, being overweight or obese, over 25 years of age or hypertensive increased the risk of GDM. In terms of complications, GDM more than doubles the risk macrosomia (RR; 95%CI: 2.2; 1.1–4.4). Conclusions There is a high burden of gestational diabetes mellitus in sub-Saharan Africa, but more studies are needed to document locally important risk factors as well as maternal and offspring outcomes. Interventions to reduce obesity among older African women might lead to reduced risk of GDM in sub-Saharan Africa.

Secondary Acute Myeloid Leukemia (AML), Including Therapy-Related AML, Associates with Worse Treatment Outcomes, Than De Novo AML Even After Hematopoietic Stem Cell Transplantation, and Its Unfavorable Behavior Does Not Associated with Functional Activity of p-Glycoprotein, MDR1

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2157-2157
Author(s):  
Boram Han ◽  
Ha Yeon Lee ◽  
Jun Ho Yi ◽  
Jun Ho Jang ◽  
Kihyun Kim ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Functional Activity ◽  
De Novo ◽  
Risk Group ◽  
Previous History ◽  
Risk Groups ◽  
Hematopoietic Stem ◽  
P Glycoprotein ◽  
History Of ◽  
De Novo Aml

Abstract Abstract 2157 Background: Secondary acute myeloid leukmia (AML; sAML) is a distinct disease entity among AMLs. It usually includes AMLs with previous history of myelodysplastic syndrome (MDS) or myeloproliferative neoplasm (MPN), and therapy-related AMLs (tAMLs) developed after exposure to leukemogenic chemotherapy or radiation therapy. It has been known that its prognosis is very poor with median survival of less than 1 year, and that allogeniec hematopoietic stem cell transplantation (HSCT) is the only curative treatment modality with improving clinical outcomes. The current study evaluated clinical characteristics, treatment outcomes in patients with sAML, the impact of cytogenetic risk group or functional activity of p-glycoprotein, related to multidrug resistance 1 (MDR1), on the treatment outcomes in sAML compared to those in de novo AML (dAML). Methods: A total of 441 consecutive AML patients diagnosed at the Samsung Medical Center, Seoul, Korea between Jan 2002 and Jun 2010 were included in this retrospective study. Out of them, 76 patients (17.2%) were sAML, among whom 39 patients (8.8%) had previous history of MDS or MPN and 37 patients (8.4%) were tAML. The overall survival (OS) and event free survival (EFS) were evaluated according to the cytogenetic risk group and the performance of HSCT, in addition to other clinical risk factors. Furthermore, P-glycoprotein assay for multidrug resistance 1 (MDR1) functional activity was performed. MDR1 functional activity was calculated by verapamil-inhibited rhodamine-123 efflux activity minus uninhibited rhodamine-123 efflux activity, and positivity was determined as equal to or over 5% MDR activity. Results: In sAML, a trend of higher frequency of unfavorable cytogenetic group was noted (23.7% in sAML vs 13.7% in dAML). The OS and EFS were significantly shorter in sAML than in dAML. Median OS duration was 12.8 months in sAML, but not reached in dAML (p<0.001), while that of EFS was 8.5 months in sAML, vs. 28.1 months in dAML (p<0.001). Confined to intermediate cytogenetic risk group, sAML group showed shorter OS than dAML group (8.0 months vs 55.1 months; p<0.001). However, no difference of OS was noted between sAML vs dAML in favorable (not reached vs not reached; p=0.4) or unfavorable cytogenetic risk groups (16.5 months vs 11.2 months; p=0.7), respectively. With respect to EFS, when confined to intermediate cytogenetic risk group, sAML group showed shorter EFS than dAML group (5.7 months vs 19.9 months; p<0.001). No difference of EFS was noted between sAML vs dAML in unfavorable cytogenetic risk groups (12.6 months vs 7.9 months; p=0.9). Of interest, in favorable cytogenetic risk group, adverse impact of sAML over dAML on EFS was suggested (15.4 months vs not reached, p=0.1). The patients receiving HSCT for sAML showed better survival compared to those not receiving HSCT for sAML (p<0.001). Among patients receiving HSCTs, OS of sAML patients was still shorter than that of dAML patients (28.3 months vs not reached, p=0.01). Even more, among patients without receiving HSCT, OS of sAML patients was significantly shorter than that of dAML patients (4.4 month vs 28.3month, p<0.001), thus still requiring further improvement of HSCT outcomes in sAML. In terms of MDR1 activity, no difference of MDR1 positivity was noted between sAML (60.6% [n=20/33]) and dAML (61.9% [n=117/189]; p=0.8). Also, mean MDR1 activity was indifferent between in sAML and dAML groups (12.5±2.9% in sAML, 13.4±1.8% in dAML, p=0.8). This finding suggested that MDR1 may not be resopnsbile for drug resistance in patients with sAML, thus other mechanism needs to be investigated for unfavorable characteristics of sAML. Conclusion: The current study suggested that 1) the patients with sAML showed a poorer outcome especially in intermediate cytogenetic risk group; 2) HSCT could improve treatment outcomes of sAML patients, but transplant outcome in sAML patients is still inferior to that in dAML patients receiving HSCT; 3) MDR1, one of important resistance mechanism of AML, may not be the case for resistance in sAML. Disclosures: No relevant conflicts of interest to declare.

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