Firesetting among 18-23 year old un-apprehended adults: a UK community study

Purpose This study aims to assess the prevalence of firesetting in a sample of young UK adults aged 18 to 23 years and to compare their characteristics with non-firesetting individuals. Design/methodology/approach Two-hundred and forty male (n = 119, 49.6%) and female (n = 121, 50.4%) participants were recruited through Prolific Academic. Comparisons were made between self-reported firesetting and non-firesetting participants on a range of demographic, fire-related and personality measures. Factors predictive of firesetting status were examined using hierarchical logistic regression. Findings Twenty-five percent of participants (n = 60) reported igniting a deliberate fire. Logistic regression was used to examine the ability of parental supervision and behavioural issues (e.g., witnessing domestic violence, experimenting with fire before age 10 and family history of firesetting), antisocial behaviours (e.g., having criminal friends, impulsivity, teenage access to fire paraphernalia, skipping class more than once per week, taken any illegal drugs and participation in criminal behaviour) and fire-related interests, attitudes and propensities in predicting firesetting status. Factors found to distinguish firesetting and non-firesetting participants included the following: experimented with fire before 10 years of age, family history of firesetting, impulsivity, teenage access to fire paraphernalia, participation in criminal behaviour and the Fire Setting Scale. Practical implications The results provide key information about potential risk factors relating to un-apprehended firesetting in the general population. Originality/value This research adds to the small body of literature examining firesetting in the general population. It refines previously used methodologies, presents the first research study to examine the prevalence of firesetting behaviour in emerging adults and enhances our understanding of un-apprehended firesetting.

Gastrointestinal Bleeding in Congenital Bleeding Disorders

Gastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.

Percutaneous iliosacral screw and trans-iliac trans-sacral screw with single C-arm fluoroscope intensifier is a safe treatment for pelvic ring injuries

To elucidate the accuracy, efficacy, and safety of percutaneous iliosacral screw (ISS) and trans-iliac trans-sacral screw (TITS) insertion using a single C-arm fluoroscopy intensifier. Additionally, the potential risk factors that might cause mal-positioned screws were identified. Patients with pelvic ring injuries who underwent percutaneous screw fixation in a single medical institute were divided into an ISS group (n = 59) and a TITS group (n = 62) and assessed. The angles deviated from ideal orientation (ADIO) of the implanted screw were measured, and potential risk factors for mal-positioned screws were analyzed. Overall, the reduction quality of the pelvic ring was good or excellent in 70 patients (82.4%) by Matta’s criteria and in 48 patients (56.5%) by Lefaivre’s criteria. ADIO measurements of the ISS and TITS groups via multi-planar computed tomography were 9.16° ± 6.97° and 3.09° ± 2.8° in the axial view, respectively, and 5.92° ± 3.65° and 2.10° ± 2.01° in the coronal view, respectively. Univariate statistical analysis revealed body mass index as the single potential risk factor of mal-positioned screws. With careful preoperative planning and intraoperative preparations, placing ISS and TITS under the guidance of single C-arm fluoroscopy intensifier is a reliable and safe technique. Caution should be exercised when performing this procedure in patients with a high body mass index.

Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults

Hemorrhoidal disease is a highly prevalent anorectal condition causing substantial discomfort, disability, and decreased quality of life. Evidence on preventable risk factors for hemorrhoidal disease is limited. We conducted a cross-sectional study of 194,620 healthy men and women who completed a health screening exam including colonoscopy in 2011–2017. We evaluated potential risk factors of hemorrhoidal disease, including lifestyle factors, medical history, birth history, gastrointestinal symptoms, and anthropometric measurements. The prevalence of hemorrhoidal disease was 16.6%, and it was higher in females than in males (17.2 vs. 16.3%; P < 0.001). Compared to men, the prevalence of hemorrhoidal disease was higher in parous women (adjusted odds ratio [OR] 1.06; 95% confidence interval [CI] 1.02–1.10), and lower in nulliparous women (adjusted OR 0.92; 95% CI 0.86–0.98). In the adjusted analyses, older age, female sex, smoking, overweight, and being hypertensive were independently associated with the presence of hemorrhoidal disease. The prevalence of hemorrhoidal disease was positively associated with body mass index and waist circumference in parous women. The prevalence of hemorrhoidal disease was higher in older age, females, ever-smokers, and hypertensive participants. The association of excess adiposity with the prevalence of hemorrhoidal disease differed by sex and parity.

Cardiac device implantation and device usage in Fabry and hypertrophic cardiomyopathy

Background Fabry disease (FD) is a treatable X-linked condition leading to progressive cardiac disease, arrhythmia and premature death. We aimed to increase awareness of the arrhythmogenicity of Fabry cardiomyopathy, by comparing device usage in patients with Fabry cardiomyopathy and sarcomeric HCM. All Fabry patients with an implantable cardioverter defibrillator (ICD) implanted in the UK over a 17 year period were included. A comparator group of HCM patients, with primary prevention ICD implantation, were captured from a regional registry database. Results Indications for ICD in FD varied with 72% implanted for primary prevention based on multiple potential risk factors. In FD and HCM primary prevention devices, arrhythmia occurred more frequently in FD over shorter follow-up (HR 4.2, p < 0.001). VT requiring therapy was more common in FD (HR 4.5, p = 0.002). Immediate shock therapy for sustained VT was also more common (HR 2.5, p < 0.001). There was a greater burden of AF needing anticoagulation and NSVT in FD (AF: HR 6.2, p = 0.004, NSVT: HR 3.1, p < 0.001). Conclusion This study demonstrates arrhythmia burden and ICD usage in FD is high, suggesting that Fabry cardiomyopathy may be more ‘arrhythmogenic’ than previously thought. Existing risk models cannot be mutually applicable and further research is needed to provide clarity in managing Fabry patients with cardiac involvement.

Predictors of preoperative cognitive dysfunction in adults with Moyamoya disease: a preliminary research

Objective To explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels. Methods The author reviewed adult MMD patients harboring no parenchymal infarction or hemorrhage underwent a standardized neuropsychological assessment test battery from December 2018 to May 2019. The authors defined patients with cognitive dysfunction as cognitive impairment shown on 3 or more neuropsychological tests. According to the presence of cerebral angiography, arterial stenosis, moyamoya vessels, and compensatory arteries were conducted. Univariate and multivariate analyses were performed to identify predictors for cognitive dysfunction before surgery. Subgroup analyses by onset type and Suzuki stage were carried out to identify specific predictors for preoperative cognitive dysfunction. Results In total, 29 of 92 (31.52%) patients had cognitive dysfunction. Multivariate analysis showed that moyamoya vessels generating from left hemisphere was recognized as independent predictor for cognitive dysfunction (P = 0.025, OR [95%CI], 0.085 [0.012–0.874]). For patients in left ICA-moyamoya subgroup, 19 of 45 (42.22%) cases with sparse moyamoya vessels had cognitive dysfunction (P = 0.031), while 22 (91.67%) of patients with dense moyamoya vessels had normal cognition (P = 0.004). Moyamoya vessels arising from ophthalmic artery had no significant association with cognitive dysfunction (P = 0.111). Multivariate analysis found that moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%CI], 0.394 [0.132–0.926]). Conclusions Moyamoya vessels arising from left hemisphere was a risk factor for the preoperative cognitive dysfunction in adult patients with MMD, with the denser moyamoya vessels, the less cognitive dysfunction. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

Sinonasal mycosis following transfrontal craniotomy in three dogs

CASE DESCRIPTION Three dogs were presented for investigation of chronic nasal discharge and epistaxis 141, 250, and 357 days after undergoing transfrontal craniotomy to treat an intracranial meningioma (2 dogs) or a meningoencephalocele (1 dog). CLINICAL FINDINGS CT findings were consistent with destructive rhinitis and frontal sinusitis in all 3 dogs, with results of histologic examination and fungal culture of samples obtained during frontal sinusotomy confirming mycotic infection. Frontal sinusotomy revealed fungal plaques covering a combination of bone and residual surgical tissue adhesive at the site of the previous craniotomy in all 3 dogs. Aspergillus spp were identified in all 3 dogs, and Chrysosporium sp was also identified in 1 dog. TREATMENT AND OUTCOME Surgical curettage was followed by antifungal treatment (topical clotrimazole in 2 dogs and oral itraconazole for 3 months in 1 dog). Nasal discharge improved in the short-term but recurred in all dogs 99, 118, and 110 days after frontal sinusotomy. One dog received no further treatment, 1 dog received an additional 8.5 months of oral itraconazole treatment, and 1 dog underwent 2 additional surgical debridement procedures. At last follow-up, 2 dogs were alive 311 and 481 days after frontal sinusotomy; the third dog was euthanized because of status epilepticus 223 days after frontal sinusotomy. CLINICAL RELEVANCE Sinonasal mycosis should be considered as a potential complication in dogs developing persistent mucopurulent nasal discharge, intermittent epistaxis, and intermittent sneezing following transfrontal craniotomy. The pathophysiology may be multifactorial, and potential risk factors, including use of surgical tissue adhesive in the frontal sinus, require further investigation.

Incidence and risk factors of acute kidney injury after femoral neck fracture in elderly patients: a retrospective case-control study

Background Hip fracture is highly associated with disability and consequently, mortality in the elderly population. Postoperative acute kidney injury (AKI) is not unusual and is associated with considerable morbidity and mortality. We aimed to determine the incidences and potential risk factors for postoperative AKI in elderly patients with femoral neck fracture. Methods We retrospectively evaluated patients over 65 years of age who had been subjected to surgery for femoral neck fracture at Peking University People's Hospital from January 2015 to December 2019. Demographic characteristics and potential risk factors were collected. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). Results A total of 308 elderly patients with femoral neck fracture were included in the study. The overall incidence of postoperative AKI was 12% (37 cases). Through binary logistic regression analysis, adjusted for age, intraoperative blood loss and BMI, we identified that early postoperative albumin levels, hemoglobin changes and intraoperative hypotension are independent risk factors for postoperative AKI. The model considering the three factors can improve accuracy of predicting the possibility of developing AKI. The patients with AKI had a significantly higher mortality of 40.5% than those without AKI (24.0%, p < 0.001) Conclusion The incidence of postoperative AKI in elderly patients with femoral neck fracture was 12%. Independent risk factors for postoperative AKI included hemoglobin changes, early postoperative hypoalbuminemia and intraoperative hypotension. At the same time, postoperative AKI significantly increased mortality in elderly patients with femoral neck fracture. Taking multiple possible factors into consideration can better predict the possibility of elderly patients developing AKI after surgery.

Survey of Opioid-Induced Respiratory Depression in Critically Ill Patients Without Mechanical Ventilation and Construction of a Risk Nomogram

Objectives To investigate the current status of opioid-induced respiratory depression (OIRD) and potential risk factors in critically ill patients without mechanical ventilation in the intensive care unit (ICU) and to construct a risk nomogram to predict OIRD. Methods A total of 103 patients without (or who were weaned from) mechanical ventilation who had stayed for more than 24 h in the ICU between June 1, 2021 and September 31, 2021, were included. Patient data, including respiratory depression events, were recorded. The least absolute shrinkage and selection operator regression model were used to select features that were then used to construct a prediction model by multivariate logistic regression analysis. A nomogram was established for the risk of respiratory depression events in patients without mechanical ventilation. The discriminatory performance and calibration of the nomogram were assessed with Harrell’s concordance index and a calibration plot, respectively, and a bootstrap procedure was used for internal validation. Results Respiratory depression was diagnosed in 49/103 (47.6%) patients. Factors included in the nomogram were cardiopulmonary disease (odds ratio [OR]=5.569, 95% confidence interval [CI]=0.751–118.083), respiratory disease (OR=32.833, 95% CI=4.189–725.164), sepsis (OR=6.898, 95% CI=1.756–33.000), duration of mechanical ventilation (OR=3.019, 95% CI=0.862–11.322), lack of mechanical ventilation (OR=20.757, 95% CI=2.409–502.222), and oxygenation index (OR=7.350, 95% CI=2.483–24.286). The nomogram showed good performance for predicting respiratory depression events in critically ill patients without mechanical ventilation. Conclusion The nomogram can be used to identify ICU patients without mechanical ventilation who are at risk of opioid-induced respiratory depression and may therefore benefit from early intervention.

The Value of Corrective Effect of Human Serum Albumin For The Mortality of Septic Patients With Hypoproteinemia

Timely and accurately evaluating the severity and prognosis of sepsis occupy an important position in septic management. The purpose of the article was to investigate the value of corrective effect of human serum albumin (HSA) in assessment on the mortality of septic patients with hypoproteinemia.A retrospective analysis was carried out. A logistic regression model was adopted to analyze the association between the mortality and related risk factors. Furthermore, the receiver operating characteristic curves (ROC) were utilized to analyze the abilities of potential risk factors in prediction of the mortality of septic patients with hypoproteinemia. The ratio of total dosage of HSA-to-the difference of serum albumin before and after albumin supplement (THSA/DALB) was significantly increased in non-survivors of septic patients with hypoproteinemia than that in survivors (P <0.001). THSA/DALB (P = 0.018) was an independent risk factor for the mortality of septic patients with hypoproteinemia. ROC analysis showed that area under curve (AUC) of THSA/DALB, SOFA score and APACHE II score were 0.800 , 0.802 and 0.766 , respectively. The data demonstrated that THSA/△ALB could be an independent risk factor in predicting the mortality of septic patients with hypoproteinemia.