scholarly journals Predicting negative ureteroscopy for stone disease – Minimizing risk and cost

2021 ◽  
Vol 93 (3) ◽  
pp. 323-325
Author(s):  
Miguel Eliseu ◽  
Roberto Jarimba ◽  
Pedro Moreira ◽  
Pedro Simões ◽  
Paulo Temido ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Financial Burden ◽  
Univariate Analysis ◽  
Stone Disease ◽  
High Rate ◽  
Stone Size ◽  
Female Population ◽  
Female Patients ◽  
Complication Risk ◽  
Unnecessary Procedures

Introduction: Urolithiasis is common worldwide, with ureteric stones being a particular burden. Ureteroscopy (URS) is one of the most useful procedures in treating ureteric stones not passed spontaneously; this procedure has a complication risk of 4%. Negative URS, with described rates up to 15%, represents an avoidable patient risk and use of medical resources. Objectives: To describe rates and identify predictive factors for negative URS and to define strategies which would minimize patient and financial burden from these unnecessary procedures. Materials and methods: A retrospective cohort study analyzed patients who underwent URS in our Center to treat ureteric stones over a period of 2 years. Patient age, gender, and comorbidities, as well as laboratory and imaging findings, were analyzed. Results: 262 patients underwent URS for ureteric stones. The female population was 50.8% with a mean age of 56.89 years. A total of 78 (29.8%) URS procedures were negative. Univariate analysis showed a higher prevalence of negative URS in female patients, as well as in primary, smaller, and radiolucent stones. At multivariate analysis, a logistic regression model correctly classified 76% of patients, with smaller stone size and radiolucency being significant predictors of negative URS. Discussion and conclusions: Our Center showed a high rate of negative URS, higher than commonly described in the literature. Female patients tend to have an even higher rate, possibly due to unnoticed passage of stones. Patients with small, radiolucent stones showed the highest rates of negative URS.

scholarly journals 387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
Kok Hoe Chan ◽  
Bhavik Patel ◽  
Iyad Farouji ◽  
Addi Suleiman ◽  
Jihad Slim
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prognostic Markers ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Significant Difference ◽  
New Onset

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

Abstract 16884: Evaluating the Effectiveness of Atrial Fibrillation Ablation Guided by Spatiotemporal Electrogram Dispersion

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian Liu ◽  
Arismendy Nunez-Garcia ◽  
Cao Tran ◽  
Michael Wu
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
External Validation ◽  
Posterior Wall ◽  
High Rate ◽  
Single Center Experience ◽  
The Mean

Introduction: Catheter ablation of atrial fibrillation (AF) guided by spatiotemporal dispersion (SD) of electrograms has been proposed as an ablation strategy to treat patients with persistent AF. However, external validation of this technique is lacking. Here we report a single center experience using ablation by SD. Hypothesis: Targeting regions with SD is associated with a high rate of termination and favorable freedom from AF among patients with persistent AF. Methods: Patients with persistent AF who underwent SD from November 2018 to January 2020 were included in this study. All patients underwent pulmonary vein isolation (PVI) in addition to targeting areas of SD. Lesions on areas of electrogram dispersion were anchored to the PVI or to mitral or posterior wall lines where appropriate. EKG, Holter, event monitors or device interrogations were obtained at 3 and 6 months to assess for arrhythmia recurrence. Results: 44 patients met the inclusion criteria and were included in the study. The patients had a mean age of 69±8 years and were 68 % male. The prevalence of comorbidities was as follows: hypertension (89%), diabetes (21%), OSA (37%) and CAD (26%). Average CHADSVASC score was 2.9±1.4, LVEF was 53±11% and left atrium (LA) diameter was 5.2±1 cm. The recurrence rate of AF at 6 months was 14% whereas the recurrence of atrial tachycardia was 20%. Acute AF termination was observed in 73% of the patients. Termination to sinus occurred in 38% of the patients and the remaining terminated to atrial tachycardia which was subsequently ablated to sinus. The mean procedure duration was 240±90 minutes. Univariate analysis showed recurrence was associated with LA diameter (r=.52; p<.001). No recurrences were observed among patients with a LA diameter < 5 cm. Termination rates were higher among patients with LA diameter < 5 cm when compared to LA diameter ≥ 5 cm. However, it did not reach statistical significance (80% vs. 60%; p=.21). Conclusions: The target of electrograms with SD during AF ablation added to PVI was associated with a high termination rate and a good freedom from AF recurrence at 6 months. The ideal candidate for this procedure may be those with LA diameter < 5 cm among persistent AF. The long-term efficacy of this technique merits further studies in larger populations.

scholarly journals Prediction of Outcome for Transabdominal Cerclage in Women with Cervical Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ji Eun Song ◽  
Keun Young Lee ◽  
Ga Hyun Son
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Cervical Length ◽  
Cervical Insufficiency ◽  
Prediction Of Outcome

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre- and postoperative cervical length (CL), and CL at 20–24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%,P<0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20–24 weeks and adenomyosis were associated with delivery at <34 weeks’ gestation following TAC (P=0.015andP=0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20–24 weeks was a significant predictor (P=0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20–24 weeks may predict the delivery at <34 weeks’ gestation following TAC.

scholarly journals Seroprevalence of toxoplasmosis in Vojvodina

2010 ◽  
Vol 138 (5-6) ◽  
pp. 333-336 ◽  
Author(s):  
Snezana Brkic ◽  
Gorana Gajski ◽  
Mirjana Bogavac ◽  
Daniela Maric ◽  
Vesna Turkulov ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
General Population ◽  
Pregnant Women ◽  
Acute Infection ◽  
Clinical Manifestations ◽  
Congenital Toxoplasmosis ◽  
Reproductive Age ◽  
Female Population ◽  
Effective Measure ◽  
Female Patients

Introduction Toxoplasmosis is an acute infectious anthropozoonotic disease with mild asymptomatic clinical manifestations in immunocompetent persons and more severe in immunocompromised patients. Acute infection in pregnancy can result in severe congenital toxoplasmosis with severe sequels. Objective Aims of study were to detect Toxoplasma gondii seroprevalence in general population of Vojvodina, Serbia, differences between genders and determination of seroprevalence in women of reproductive age and pregnant women. Methods Our retrospective study was conducted from 2006 to 2008 including 625 immunocompetent patients, hospitalized or observed as outpatients at the Clinical Centre of Vojvodina, Novi Sad. We performed commercial ELISA kits SERION - ELISA classic test by VIRION for the presence of specific IgG and IgM antibodies. According to seroepidemiological aim of the study, our results were presented only in qualitative values. Results We observed 173 male and 452 female patients. Seroprevalence in general population of Vojvodina was 38.1%. In male population seroprevalence was 45.7%, and in female population it was 35.2%, the difference which was statistically significant (p<0.05). Seroprevalence increased with age and seroconversion was detected to occur in persons aged about 20 years. In all female patients, 353 (78.1%) were in reproductive age with seroprevalence of 30%. In 161 pregnant women seroprevalence was 31.7%. Conclusion In this study we screened actual seroepidemiological situation to Toxoplasma gondii in Vojvodina, thus giving a contribution to the continuous epidemiological screening done in this region and in the country. According to our results, almost 70% of women in reproductive age were sensitive to primary acute infection during further pregnancies, which is highly important for the prevention of congenital toxoplasmosis. Although not routinely conducted in many countries, routine serological testing to Toxoplasma gondii in pregnant women and their education about preventive measures against this infection could be an effective measure in the future.

scholarly journals A study on health related risk factors and health seeking behavior among elderly population in rural Bangladesh

Mediscope ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. 75-81
Author(s):  
Farhana Ferdaus ◽  
Refat Zahan ◽  
Md Abdur Rahman ◽  
Shahin Chowdhury
Keyword(s):  
Risk Factors ◽  
Elderly People ◽  
Elderly Population ◽  
Common Disease ◽  
World Population ◽  
Health Seeking ◽  
Female Population ◽  
Female Patients ◽  
The World ◽  
Health Related

Globally, 10% of the world population is elderly people and it is expected to increase to 21% in the year 2051. In the year 2002, the number of elderly people in the world was estimated to be 605 million, which is expected to rise to more than 1.2 billion by the year 2025. This crosssectional study was conducted to and out the health-related quality of life and risk factors among elderly population in the selected rural population of Shyamnagar Upazila of Satkhira District. Data was collected from both the male and female population, aged 60 years and above, during February to June 2018. Purposive sampling technique was used to collect data from 50 respondents by face to face interview with semi-structured questionnaire. In the study, the mean age of elderly was male 63 (±2.95) years, and female 61.8 (±2.04) years. Other socio-demographic factors among elderly were as follows: 20 (40%) of elderly were illiterate, 15 (30%) of elderly were doing business, 21 (42%) were doing farming. 40 (80%) of elderly were married. The study also reported the five most common disease co-morbidities for elderly which included: 71.43% male and 28.57% female had hypertension while 72.22% of male and 27.78% of female patients were already treated, 68.75% male and 31.25% female had diabetes mellitus and 100% of them were treated, 50% of male elderly and 50% of female elderly were suffering bone and joint pain/arthritis and 60% of them were received treatment, hearing impairment found among 100% of male while two-third of patients received treatment, one-third of female and two-third of male elderly suffered from poor vision; however, only one-third of female patients were treated. On the basis of these findings, it can be recommended that there is a need to develop geriatric health-care services. Mediscope Vol. 7, No. 2: July 2020, Page 75-81

scholarly journals Discoid lupus erythematosus skin lesion distribution and characteristics in Black patients: a retrospective cohort study

2021 ◽  
Vol 8 (1) ◽  
pp. e000514
Author(s):  
Adrienne K Joseph ◽  
Brandon Windsor ◽  
Linda S Hynan ◽  
Benjamin F Chong
Keyword(s):  
Cohort Study ◽  
Lupus Erythematosus ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Univariate Analysis ◽  
Cutaneous Lupus Erythematosus ◽  
Discoid Lupus Erythematosus ◽  
Anatomical Location ◽  
Scarring Alopecia ◽  
Black Patients

ObjectiveEpidemiological studies have shown that discoid lupus erythematosus (DLE) has a higher incidence and prevalence in racial/ethnic minority groups, particularly Black individuals. The objective of this retrospective cohort study was to identify the differences in DLE lesion distribution and characteristics in Black individuals compared with non-Black individuals.Methods183 patients with DLE (112 Black patients and 71 non-Black patients) with a reported race/ethnicity and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores were included in this retrospective cohort study. Univariate analysis was performed to determine significant differences in demographic data, clinical characteristics, DLE lesion distribution and DLE lesion characteristics in Black and non-Black patients with DLE. Multivariable logistic regression was preformed to determine significant predictors of DLE lesion location and characteristics.ResultsBlack patients with DLE had worse baseline CLASI damage scores compared with non-Black patients with DLE (median (IQR): 10.0 (6.0–14.5) vs 6.0 (3.0–10.0), p<0.001) and had 48.9 greater odds of dyspigmentation in any anatomical location (p<0.001). Black patients had 2.54 greater odds of having scalp involvement (p=0.015) and 1.97 greater odds of having ear involvement (p=0.032) compared with non-Black patients. Black patients also had greater odds of scalp dyspigmentation (OR=5.85, p<0.001), ear dyspigmentation (OR=2.89, p=0.001) and scarring alopecia (OR=3.00, p=0.001) compared with non-Black patients.ConclusionsSigns of disease damage, particularly ear dyspigmentation, scalp dyspigmentation and scarring alopecia, can more frequently affect Black patients with DLE. Recognising differences in clinical presentation of DLE among Black patients can assist future efforts with understanding biological, cultural, psychosocial and systemic factors that influence DLE presentation and outcomes in Black patients and may guide clinicians when counselling Black patients.

scholarly journals LUNG CANCER - STATISTICAL ANALYSIS DATA IN A 5 YEAR PERIOD IN BITOLA, REPUBLIC OF NORTH MACEDONIA

2020 ◽  
Vol 8 (2) ◽  
pp. 108-117
Author(s):  
Jihe Zhu ◽  
Blagica Arsovska ◽  
Kristina Kozovska
Keyword(s):  
Public Health ◽  
Lung Cancer ◽  
Analysis Data ◽  
Malignant Cells ◽  
Female Population ◽  
Female Patients ◽  
The World ◽  
Pulmonary Parenchyma ◽  
Male Patients ◽  
The Republic

Lung cancer is one of the most common and deadly malignancies in the world, which is characterized by uncontrolled division and growth of malignant cells in the pulmonary parenchyma. For the purposes of this paper was used data from the clinical hospital “Dr. Trifun Panovski'' in the Municipality of Bitola, Republic of North Macedonia  in the period of 2015-2019. The results show that the most of the cases are male with the leading age of about 55-64 years. However, the disease is becoming more common in the female population at a later age. Regarding the number of male patients treated in the Municipality of Bitola, it can be noted that the highest number of male patients was in 2018, and the lowest in 2017. Most female patients were treated in 2016 and the least in 2018. From the analysis of the Institute of Public Health, the highest number of male deaths in Bitola occurred in 2014 and the lowest in 2015 and 2018, among female patients, the highest number of deaths was in 2014, but the lowest in 2018. Death outcomes in Bitola represent about 6-7% of total number of deaths in the Republic of North Macedonia.

scholarly journals The identification of pregnant women with renal colic who may need surgical intervention

2021 ◽  
Author(s):  
He Maomao ◽  
Ming Lei ◽  
Lin Xiaoting ◽  
Xiaolan Xu ◽  
Zhihui He
Keyword(s):  
Pregnant Women ◽  
Renal Colic ◽  
Surgical Intervention ◽  
Clinical Laboratory ◽  
Ureteral Stone ◽  
Univariate Analysis ◽  
White Blood Cells ◽  
Stone Size ◽  
Related Factors ◽  
In Pregnancy

Abstract Objectives: To analyze clinical data and stone-related factors to identify predictive factors for surgical intervention in pregnant women with renal colic. Methods: We conducted a retrospective review of 212 pregnant women presenting with renal colic between 1st January 2009 and 31st December 2019. Patients were grouped according to surgical intervention and a range of demographic, clinical, laboratory, and ultrasound data were obtained. Univariate and multivariate analyses identified a range of predictive variables for surgical intervention. In addition, we used receiver operating characteristic (ROC) curve analysis to evaluate the predictive power of our model and created a nomogram for clinical application. Results: Of the 212 patients presenting with acute renal colic in pregnancy, 100 patients (47.2%) underwent surgical intervention and 112 patients (52.8%) were treated conservatively. Univariate analysis identified significant differences between the two groups with regards to fever, the duration of pain, white blood cells (WBCs), C-reactive protein (CRP), ureteral stone size, hydronephrosis, and stone location. Multivariate analysis further identified a number of independent predictors for surgical intervention, including fever, a duration of pain ≥4 days, a ureteral stone size ≥ 8 mm, and moderate or severe hydronephrosis.Conclusions: We identified several independent predictors for surgical intervention for renal colic in pregnancy. Fever, a duration of pain ≥4 days, a ureteral stone size ≥8 mm, and moderate/severe hydronephrosis, play significant roles in predicting surgical intervention. Our nomogram can help to calculate the probability of surgical intervention in a simple and efficient manner. Prospective studies are now required to validate our model.

scholarly journals A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

2015 ◽  
Vol 156 (21) ◽  
pp. 862-868 ◽  
Author(s):  
Mihály Makara ◽  
Béla Hunyady
Keyword(s):  
Hepatitis C ◽  
Financial Burden ◽  
National Level ◽  
Work Productivity ◽  
High Rate ◽  
Moral Obligations ◽  
Hepatitis C Infection ◽  
Financial Benefit ◽  
Screening Programs ◽  
Life Years

The worldwide prevalence of hepatitis C infection is 2–3%. In addition to its individual consequences, it generates huge financial impact on national level. In particular, lack of recognition or late diagnosis of the disease is associated with high rate of liver cirrhosis related complications (hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma) and/or demands liver transplantation. Loss of quality assisted life years and/or those spent in employment, reduced work productivity, as well as costs of antiviral therapy also contribute to the financial burden. The costs of new interferon-free therapies may exceed the prices of previous pegylated interferon based therapies with or without protease inhibitors; however, shorter treatment durations and extremely low rates of severe side-effects with much less related expenses can reduce total costs of these treatments. In addition to the moral obligations, published cost-effectiveness analyses conclude that early diagnosis and treatment of this primarily iatrogenic infection through organized screening programs and wide access to effective therapies may lead to long term financial benefit. Orv. Hetil., 2015, 156(21), 862–868.

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