Prevalence and risk factors of upper gastrointestinal cancers missed during endoscopy: a nationwide registry-based study

Endoscopy ◽  
2021 ◽  
Author(s):  
Wladyslaw Januszewicz ◽  
Klaudiusz Witczak ◽  
Paulina Wieszczy ◽  
Magda Socha ◽  
Maryla Helena Turkot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Proportion ◽  
Female Gender ◽  
Gastrointestinal Cancers ◽  
Nationwide Registry ◽  
Multivariable Regression Model ◽  
Primary Care Sector ◽  
Multivariable Regression ◽  
Comorbidity Index ◽  
Upper Gastrointestinal

Background and aims A significant proportion of upper gastrointestinal cancers (UGICs) remain undetected during esophagogastroduodenoscopy (EGD). We investigated the characteristics and risk factors of UGICs missed during endoscopy. Methods In this nationwide registry-based study, we analyzed two large Polish datasets: the National Health Fund and the National Cancer Registry, to identify individuals who underwent EGD and were subsequently diagnosed with UGICs. Cancers diagnosed <6 months after EGD were defined as “prevalent” and those within ≥6 and <36 months as “missed.” We compared the characteristics of missed and prevalent cancers and analyzed the risk factors for missed UGICs in a multivariable regression model. Results We included 4,105,399 patients (mean age 56.0 [±17.4] years; 57.5% female) who underwent 5,877,674 EGDs between 2012-2018. Within this cohort, 33,241 UGICs were diagnosed, of which 1,993 (6.0%) were missed. Within esophageal neoplasms, adenocarcinomas were more commonly missed than squamous-cell cancers (6.1% vs. 4.2%) with a relative risk of 1.4 (95% confidence interval [CI]:1.2–1.5, P=0.011). In the stomach, missed adenocarcinomas constituted 5.7%. Overall, missed UGICs presented more often at an advanced stage than prevalent cancers (42.2% vs. 36.2%, P<.001). Risk factors for missed UGICs included: initial EGD performed within primary (vs. secondary) care (odds ratio[OR] 1.3, 95%CI:1.2–1.5), female gender (OR 1.3; 95%CI:1.2–1.4), and higher comorbidity (Charlson comorbidity index ≥5 vs. 0; OR 6.0; 95%CI:4.7–7.5). Conclusions Esophageal adenocarcinomas are most commonly missed among UGICs. Overlooked cancers occur more frequently within the primary care sector and are found more often in women and individuals with multiple comorbidities.

scholarly journals 773 CLINICAL CHARACTERISTICS AND RISK FACTORS OF UPPER GASTROINTESTINAL CANCERS MISSED DURING ENDOSCOPY: A NATION-WIDE REGISTRY-BASED STUDY

2020 ◽  
Vol 91 (6) ◽  
pp. AB67
Author(s):  
Wladyslaw Januszewicz ◽  
Klaudiusz Witczak ◽  
Magda Lukaszewicz ◽  
Maryla H. Turkot ◽  
Urszula E. Wojciechowska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Gastrointestinal Cancers ◽  
Upper Gastrointestinal

scholarly journals Risk Factors for Postpartum Septic Pelvic Thrombophlebitis: A Multicenter Cohort

2017 ◽  
Vol 34 (11) ◽  
pp. 1148-1151 ◽  
Author(s):  
Marcela Smid ◽  
Matthew Grace ◽  
Jennifer Thompson ◽  
R. Heine ◽  
Tracy Manuck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Febrile Illness ◽  
Secondary Case ◽  
Multiple Gestation ◽  
Maternal Fetal Medicine ◽  
Black Race ◽  
Logistic Regression Models ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Control Study

Objective The objective of this study was to identify risk factors associated with the development of septic pelvic thrombophlebitis (SPT). Study Design This is a secondary case–control study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network Cesarean Registry. SPT was defined as suspected infectious thrombosis of the pelvic veins, often persistent febrile illness in the setting of antibiotic therapy for endometritis. Women with SPT were compared with those without SPT using descriptive statistics. Logistic regression models estimated the association between selected risk factors and SPT. Results Of 73,087 women in the cohort, 89 (0.1%) developed SPT. Women with SPT were more likely to be < 20 years old (33.7 vs. 10.6%, p < 0.001), black race (58.4 vs. 29.1%, p < 0.001), and nulliparous (51.1 vs. 23.3%, p < 0.001). Hypertensive disorders of pregnancy (32.6 vs. 11.8%, p < 0.001) and multiple gestation (12.5 vs. 7.4%, p = 0.03) were also more common in women with SPT. In the multivariable regression model, maternal age < 20, black race, multiple gestation, and preeclampsia were all significantly associated with increased odds of SPT (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.22, 3.14; aOR: 2.6, 95% CI: 1.68, 4.02; aOR: 2.10, 95% CI: 1.13, 3.88; aOR: 2.91, 95% CI: 1.86, 4.57). Conclusion SPT is a rare pregnancy complication. Our analysis confirmed known risk factors (e.g., infections, cesarean delivery), and identified novel ones, including black race, young age, preeclampsia, and multiple gestation.

scholarly journals Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

2018 ◽  
Vol 39 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Anthony D. Harris ◽  
Alyssa N. Sbarra ◽  
Surbhi Leekha ◽  
Sarah S. Jackson ◽  
J. Kristie Johnson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Gastric Acid ◽  
Antibiotic Use ◽  
Acid Suppression ◽  
Comorbid Conditions ◽  
Acid Suppression Therapy ◽  
Multivariable Regression ◽  
Comorbidity Index ◽  
Gastric Acid Suppression

OBJECTIVETo analyze whether electronically available comorbid conditions are risk factors for Centers for Disease Control and Prevention (CDC)-defined, hospital-onset Clostridium difficile infection (CDI) after controlling for antibiotic and gastric acid suppression therapy use.PATIENTSPatients aged ≥18 years admitted to the University of Maryland Medical Center between November 7, 2015, and May 31, 2017.METHODSComorbid conditions were assessed using the Elixhauser comorbidity index. The Elixhauser comorbidity index and the comorbid condition components were calculated using the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes extracted from electronic medical records. Bivariate associations between CDI and potential covariates for multivariable regression, including antibiotic use, gastric acid suppression therapy use, as well as comorbid conditions, were estimated using log binomial multivariable regression.RESULTSAfter controlling for antibiotic use, age, proton-pump inhibitor use, and histamine-blocker use, the Elixhauser comorbidity index was a significant risk factor for predicting CDI. There was an increased risk of 1.26 (95% CI, 1.19–1.32) of having CDI for each additional Elixhauser point added to the total Elixhauser score.CONCLUSIONSAn increase in Elixhauser score is associated with CDI. Our study and other studies have shown that comorbid conditions are important risk factors for CDI. Electronically available comorbid conditions and scores like the Elixhauser index should be considered for risk-adjustment of CDC CDI rates.Infect Control Hosp Epidemiol 2018;39:297–301

scholarly journals D-dimer/Fibrinogen ratio and recurrent exacerbations might have a potential impact to predict 90-day mortality in patients with COPD exacerbation

2021 ◽  
Vol 33 (4) ◽  
pp. 276-280
Author(s):  
Cihan Aydin ◽  
Birsen Pınar Yıldız ◽  
Didem Görgün Hattatoğlu
Keyword(s):  
Risk Factors ◽  
Regression Model ◽  
Acute Exacerbation ◽  
Mortality Risk ◽  
World Health ◽  
Multivariable Regression Model ◽  
The World ◽  
Multivariable Regression ◽  
Predictive Risk ◽  
D Dimer

BackgroundAccording to the World Health Organisation reports (WHO), COPD is the third leading cause of overall in the World by 2020. AimWe aimed to determine the prognostic predictors of 90-day mortality after an initial exacerbation in patients with acute exacerbation of COPD (AECOPD). Results Increased Charlson Comorbidity Score(CCS) (HR:1.47; p<0.05), readmission after initial exacerbation (HR:1.47; p<0.05) were predictive risk factors for 30-day mortality in multivariable regression model. The 90-day mortality rate was %11.8. Hypertension, increased median age, nutrition risk score (NRS), CCS, CAT score, and mMRC 4th level were possible risk factors for 90-day mortality. There was a significant difference in the mortality of patients with D-dimer/Fibrinogen ratios>0.11 and ≤0.11 (HR:2.47; p<0.05). Recurrent exacerbations after discharge were predictive risk factors for 90-day mortality in the multivariable regression model (HR:2.25; p<0.001) with the increased mortality risk 4.73 times (HR:4.73; p=0.002). Furthermore, a 1-unit increment of acute exacerbation increased the mortality risk 3.39 times (HR:3.39; p<0.001). ConclusionOur study showed that D-dimer/Fibrinogen ratio but not D-dimer and recurrent exacerbations after discharge might have a critical impact on 90-day mortality

Statin-induced adverse effects – facts and genes

2013 ◽  
Vol 154 (3) ◽  
pp. 83-92
Author(s):  
Mariann Harangi ◽  
Noémi Zsíros ◽  
Lilla Juhász ◽  
György Paragh
Keyword(s):  
Risk Factors ◽  
Single Nucleotide Polymorphisms ◽  
Adverse Effects ◽  
Adverse Events ◽  
Statin Therapy ◽  
Significant Proportion ◽  
Gene Mutations ◽  
Nucleotide Polymorphisms ◽  
Serious Adverse Events ◽  
Single Nucleotide

Statin therapy is considered to be safe and rarely associated with serious adverse events. However, a significant proportion of patients on statin therapy show some degree of intolerance which can lead to decreased adherence to statin therapy. The authors summarize the symptoms, signs and frequencies of the most common statin-induced adverse effects and their most important risk factors including some single nucleotide polymorphisms and gene mutations. Also, they review the available approaches to detect and manage the statin-intolerant patients. Orv. Hetil., 2013, 154, 83–92.

Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

2021 ◽  
Author(s):  
Ekaterina Mosolova ◽  
Dmitry Sosin ◽  
Sergey Mosolov
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Female Gender ◽  
Assessment Tools ◽  
Care Workers ◽  
Younger Age ◽  
Wide Range ◽  
Associated Risk Factors ◽  
Anxiety Depression ◽  
The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

Targeting c-MET/HGF Signaling Pathway in Upper Gastrointestinal Cancers: Rationale and Progress

2014 ◽  
Vol 15 (14) ◽  
pp. 1302-1311 ◽  
Author(s):  
Sharareh Gholamin ◽  
Hamid Fiuji ◽  
Mina Maftouh ◽  
Reza Mirhafez ◽  
Fatemeh Shandiz ◽  
...  
Keyword(s):  
Signaling Pathway ◽  
Gastrointestinal Cancers ◽  
Upper Gastrointestinal

Molecular Components of Wnt/β-catenin Pathway As Therapeutic Targets For Upper Gastrointestinal Cancers

2015 ◽  
Vol 2 (2) ◽  
pp. 72-79
Author(s):  
Nikki P. Lee ◽  
Zhi Xu ◽  
Sarwat Fatima ◽  
Timothy T. Yung ◽  
Raymond W. Y. Sun ◽  
...  
Keyword(s):  
Therapeutic Targets ◽  
Gastrointestinal Cancers ◽  
Molecular Components ◽  
Upper Gastrointestinal
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