scholarly journals Perineal Outcome after Restrictive use of Episiotomy in Primi-gravidas

2009 ◽  
Vol 48 (176) ◽  
Author(s):  
A Joshi ◽  
R Acharya
Keyword(s):  
Risk Factors ◽  
Prospective Observational Study ◽  
Evidence Based ◽  
Perineal Tear ◽  
Factors Associated ◽  
Mission Hospital ◽  
The Mean ◽  
Clinically Significant ◽  
Based Medicine

Introduction: Episiotomy is a common obstetrical practice that is believed to prevent severe lacerations. Principles of evidence based medicine raises questions on the utility of routine episiotomy. Methods: A prospective observational study was conducted in primi gravidas coming to Tansen Mission Hospital for delivery who were not offered episiotomy sticking to the protocol of restrictive use of episiotomy and the subsequent perineal tear was evaluated in terms of its length, degree and complications. Risk factors associated with significant degrees of perineal tear was investigated. Results: The episiotomy rate during the time of study was only 22%. Among those included in the study, 16.2% of women had intact perineum and majority of women (43.2%) had first degree of tear. Only one (1.4%) had third degree tear without any long term complications. Having a baby weighing 2.5 kg increases the mean tear length significantly (P=0.019) and increases the risk of having second or third degree of tear by almost two times (Relative Risk=1.95). No clinically significant complications were observed in any of the women after the delivery. Conclusions: This study provides some evidence that the principle of restrictive use of episiotomy with a total episiotomy rate being around 20% can be carried out successfully even in an under¬resourced setting of our country.

Factors associated with long-term haemoptysis recurrence after transarterial embolisation for haemoptysis

2020 ◽  
Vol 24 (6) ◽  
pp. 606-611
Author(s):  
Y. Li ◽  
Z. Jia ◽  
S. Li ◽  
Y. Huang ◽  
X. Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Multivariate Analyses ◽  
Fresh Blood ◽  
Factors Associated ◽  
Transarterial Embolisation ◽  
History Of ◽  
The Mean

OBJECTIVE: To assess factors associated with long-term haemoptysis recurrence after transarterial embolisation (TAE) for haemoptysis due to bronchiectasis.METHODS: Patients with haemoptysis due to bronchiectasis who underwent TAE between May 2010 and May 2019 were included in this retrospective study. Long-term haemoptysis recurrence was defined as the expectoration of >10 mL/day of fresh blood (for at least 1 day) 1 month after TAE. Univariate and multivariate analyses were performed to identify risk factors for long-term haemoptysis recurrence after TAE.RESULTS: A total of 197 patients (108 women; mean age, 61.0 ± 12.2 years) were included in the study. TAE was performed successfully in all patients. Side effects occurred in 43 (21.8%) patients, and all patients recovered uneventfully. During 37.6 ± 11.6 months of follow-up, long-term haemoptysis recurrence occurred in 41 (20.8%) patients; the mean interval between the TAE and haemoptysis recurrence was 21.4 ± 16.3 months. Long-term haemoptysis recurrence after TAE was associated with a history of haemoptysis (OR 3.483, 95% CI 1.373–8.836; P = 0.009).CONCLUSIONS: Approximately one fifth patients with bronchiectasis had long-term haemoptysis recurrence after TAE. Risk factor for long-term haemoptysis recurrence after TAE was a history of haemoptysis.

scholarly journals Risk Factors Associated with Multiple End-Organ Damage in Idiopathic Thrombotic Thrombocytopenic Purpura (TTP) Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4928-4928
Author(s):  
Limin Gao ◽  
Grace Kao
Keyword(s):  
Risk Factors ◽  
Organ Damage ◽  
Organ Involvement ◽  
Platelet Response ◽  
Thrombocytopenic Purpura ◽  
Tissue Ischemia ◽  
Factors Associated ◽  
End Organ Damage ◽  
The Mean

Introduction: Idiopathic thrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder caused by deficiency of ADAMTS13 activity and subsequent development of vWF-platelets-rich microthrombi leading to tissue ischemia and organ dysfunction. Standard treatment consists of daily plasma exchange (PEX) to remove the autoantibodies and replenishes ADAMTS13 activity and immunosuppressive therapy for patients with autoimmune process. Recent publication showed that caplacizumab, an anti-vWF humanized nanobody which inhibits the interaction between vWF multimers and platelets, can be used together with PEX to reduce time to platelet normalization but not risk of relapse when compared to placebo. However, incorporate caplacizumab with PEX in high risk TTP patients maybe even more important to reduce long-term organ damage. Therefore, we performed a retrospective single center analysis of TTP patients to identify the incidence and risk factors associated with end-organ damage. Method: Sixteen adult patients with idiopathic TTP were identified from January 2005 through December 2015. Idiopathic TTP was defined as thrombotic microangiopathy with an ADAMTS13 ≤10%. Cardiac involvement was defined as an increased Troponin I (TnI) level >0.1µg L-1. Renal involvement was defined as serum creatinine >1.30mg/dL. Of note, all the 16 patients had normal baseline renal function. Neurological involvement was defined as documentation of confusion, headaches, seizure, aphasia and syncope. The time to a platelet response was defined as a platelet count that was ≥150,000/mm3 for at least 48 hours. All patients were treated with PEX, corticosteroids, ± rituximab. Results: The mean (range) age was 48 (23 to 78) and the female: male ratio was 12:4. All (16) patients had end-organ involvements: 16 (100%) neurological, 6 (37.5%) renal, and 4 (25%) cardiac. Seven patients (43.75%) had single organ involvement (Group one), 9 patients (56.25%) had two or three organ involvement (Group two). The mean age for Group one was 44 as compared to 51 for Group two. The mean LDH level on admission was 987 IU/L (range: 417-1,289 IU/L) for Group one as compared to 1,715 IU/L (range: 336-4,455 IU/L) for Group two (p value: 0.06). The mean platelet count on admission was 20 k/µL for Group one as compared to 18 k/µL for Group two. The mean hemoglobin level on admission was 7.5g/dL (range: 5.3-8.6g/dL) for Group one as compared to 8.78g/dL (range: 8.1-10.5g/dL) for Group two. The median time to a platelet response was 5 days in this study population. Conclusions: Our study showed that more than 50% of TTP patients presented with multi-organ involvement. Very high LDH at initial presentation prior to PEX was identified as a probable single risk factor associated with multi-organ involvement. Prompt arrest of vWF-mediated platelet aggregation with agents such as calpalacizumab in TTP patients could prevent or minimize early irreversible end-organ damage due to tissue ischemia. Identifying risk factors for severe end-organ involvement will be important to study the potential benefit of incorporating calpalacizumab into TTP treatment. Further study on the risk factors for end-organ involvements in TTP patients and their long-term outcome at a multi-center level and with a larger patient population is warranted. Disclosures No relevant conflicts of interest to declare.

Design and Development of a Web-based Delirium Preventive Application for Long-term Care Facilities: A Methodological Study (Preprint)

2020 ◽  
Author(s):  
Kyoung Ja Moon ◽  
Chang-Sik Son ◽  
Jong-Ha Lee ◽  
Mina Park
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Cloud System ◽  
Evidence Based ◽  
Methodological Study ◽  
Term Care ◽  
Web Based ◽  
Care Facilities ◽  
Delirium Prevention

BACKGROUND Long-term care facilities demonstrate low levels of knowledge and care for patients with delirium and are often not properly equipped with an electronic medical record system, thereby hindering systematic approaches to delirium monitoring. OBJECTIVE This study aims to develop a web-based delirium preventive application (app), with an integrated predictive model, for long-term care (LTC) facilities using artificial intelligence (AI). METHODS This methodological study was conducted to develop an app and link it with the Amazon cloud system. The app was developed based on an evidence-based literature review and the validity of the AI prediction model algorithm. Participants comprised 206 persons admitted to LTC facilities. The app was developed in 5 phases. First, through a review of evidence-based literature, risk factors for predicting delirium and non-pharmaceutical contents for preventive intervention were identified. Second, the app, consisting of several screens, was designed; this involved providing basic information, predicting the onset of delirium according to risk factors, assessing delirium, and intervening for prevention. Third, based on the existing data, predictive analysis was performed, and the algorithm developed through this was calculated at the site linked to the web through the Amazon cloud system and sent back to the app. Fourth, a pilot test using the developed app was conducted with 33 patients. Fifth, the app was finalized. RESULTS We developed the Web_DeliPREVENT_4LCF for patients of LTC facilities. This app provides information on delirium, inputs risk factors, predicts and informs the degree of delirium risk, and enables delirium measurement or delirium prevention interventions to be immediately implemented with a verified tool. CONCLUSIONS This web-based application is evidence-based and offers easy mobilization and care to patients with delirium in LTC facilities. Therefore, the use of this app improves the unrecognized of delirium and predicts the degree of delirium risk, thereby helping initiatives for delirium prevention and providing interventions. This would ultimately improve patient safety and quality of care. CLINICALTRIAL none

scholarly journals OP0133 THE PREVALENCE AND RISK FACTORS OF RETINAL TOXICITY ASSOCIATED WITH LONG-TERM HYDROXYCHLOROQUINE USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 77-78
Author(s):  
S. Do ◽  
J. H. Du ◽  
J. X. An ◽  
J. Wang ◽  
A. Lin
Keyword(s):  
Risk Factors ◽  
Cumulative Dose ◽  
Daily Intake ◽  
Retinal Toxicity ◽  
Factors Associated ◽  
Duration Of Therapy ◽  
Increased Risk ◽  
Hydroxychloroquine Retinopathy ◽  
Risk Of Retinopathy

Background:Hydroxychloroquine (HCQ) is commonly used for the treatment of various autoimmune diseases. The medication is generally well-tolerated. However, long-term use after 5 years may increase the risk of retinopathy. One study in 2014 has demonstrated the risk can be as high as 7.5%. Optical Coherence Tomography (OCT) has become a major modality in screening retinopathy.Objectives:To evaluate the prevalence of retinal toxicity among patients using hydroxychloroquine and to determine various risk factors associated with hydroxychloroquine-associated retinal toxicity.Methods:We performed a retrospective chart review on a cohort of adult patients with long-term use (≥ 5 years cumulative) of HCQ between January 1st, 2011 to December 31st, 2018 from the Kaiser Permanente San Bernardino County and Riverside medical center areas in Southern California, USA. Patients were excluded if they had previously been diagnosed with retinopathy prior to hydroxychloroquine use, were deceased, or had incomplete OCT exam. Our primary endpoint was the prevalence of patients who developed retinal toxicity detected by OCT, and later confirmed by retinal specialist. Potential risk factors (age, duration of therapy, daily consumption per actual body weight, cumulative dose, confounding diseases and medication) for developing retinopathy were also evaluated. Univariable and multivariable logistic regression analyses were used to determine risk factors associated with retinal toxicity.Results:Among 676 patients exposed to more than 5 years of HCQ, the overall prevalence of retinal toxicity was 6.8%, and ranged from 2.5% to 22.2% depending on the age, weight-based dosing, duration of use and cumulative dose. Duration of therapy for 10 years or more increased risk of retinopathy by approximately 5 to 19 folds. Similarly, weight-based dose of 7 mg/kg/day or greater was assciated with increased risk of retinopathy by approximately 5 times. Patients with cumulative dose of 2000 grams or more had greater than 15 times higher risk of developing retinopathy. Duration of use for10 years or more (odd ratio 4.32, 95% CI 1.99 – 12.49), age (odd ratio 1.04; 95% CI 1.01 - 1.08), cumulative dose of more than 1500 g (odd ratio 7.4; 95% CI 1.40 – 39.04) and atherosclerosis of the aorta (odd ratio 2.59; 95% CI, 1.24 – 5.41) correlated with higher risk of retinal toxicity.Conclusion:The overall prevalence of retinopathy was 6.8%. Regular OCT screening, especially in patients with hydroxychloroquine use for more than 10 years, daily intake > 7 mg/kg, or cumulative dose > 1500 grams is important in detecting hydroxychloroquine-associated retinal toxicityReferences:[1]Hobbs HE. Sorsby A, & Freedman A. Retinopathy Following Chloroquine Therapy. The Lancet. 1959; 2(7101): 478-480.[2]Levy, G. D., Munz, S. J., Paschal, J., Cohen, H. B., Pince, K. J., & Peterson, T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis & Rheumatism: 1997; 40(8): 1482-1486.[3]Ding, H. J., Denniston, A. K., Rao, V. K., & Gordon, C. Hydroxychloroquine-related retinal toxicity. Rheumatology. 2016; 55(6): 957-967.[4]Stelton, C. R., Connors, D. B., Walia, S. S., & Walia, H. S. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clinical rheumatology. 2013; 32(6): 895-898.[5]Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016; 123(6): 1386-1394.[6]Melles, R. B., & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA ophthalmology. 2014; 132(12): 1453-1460.Disclosure of Interests:None declared

Long‐term Surgical Outcomes after Resection of Presacral Tumours and Risk Factors Associated with Recurrence

2021 ◽  
Author(s):  
Di Zhang ◽  
Yizhou Sun ◽  
Lei Lian ◽  
Bang Hu ◽  
Heng Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Outcomes ◽  
Factors Associated

Risk of hemorrhage from de novo cerebral aneurysms

2013 ◽  
Vol 118 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William J. Kemp ◽  
Daniel H. Fulkerson ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Term Follow Up ◽  
De Novo Aneurysm ◽  
The Mean ◽  
Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

scholarly journals Analysis of Risk Factors Associated with Outcomes in Road Traffic Injury Patients with Acute Lung Injury

2009 ◽  
Vol 37 (3) ◽  
pp. 835-840
Author(s):  
L Sheng ◽  
J-S Wu ◽  
M Zhang ◽  
S-W Xu ◽  
J-X Gan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Road Traffic ◽  
Road Traffic Injury ◽  
Apache Ii Score ◽  
Factors Associated ◽  
Traffic Injury ◽  
Short And Long Term

Over 50% of road traffic injury (RTI) patients experience post-traumatic acute lung injury (ALI) and it is, therefore, extremely important to identify the risk factors related to the poor outcomes associated with ALI in RTI populations. This study evaluated 19 potential risk factors associated with the outcomes of ALI in 366 RTI patients. They were divided into two groups: a ‘favourable outcomes group’ and an ‘unfavourable outcomes group’. The results indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the presence of gastrointestinal haemorrhage may help predict the outcomes of ALI in the early post-trauma phase of treatment. The duration of trauma and sepsis were shown to impact strongly on both the short- and long-term outcomes of ALI. Age (≥ 65 years) and disseminated intravascular coagulation in the early RTI phase were also independent risk factors for a poorer short- and long-term outcome in ALI.

scholarly journals Comparison of the Contamination Rate and Risk Factor Profile of Blood Culture Done in Emergency Department and MHDU/MICUs

2021 ◽  
pp. 1-8
Author(s):  
Dr. Pankaj Kumar Singh
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Blood Culture ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Contamination Rate ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Factors Associated

Aims and objectives: To determine the risk factors of blood culture contamination done in ED and those done in the MHDU/MICU among patients admitted with medical illness. Material and Methods: This is a two months’ prospective observational study comparing blood culture contamination rate and risk factors associated with contamination between ED and MICU/MHDU. A total of 998 patients were included in the study who underwent blood culture in ED and MICU/MHDU. 570 in ED and 428 in MICU/MHDU were included after meeting exclusion and inclusion criteria. Results: Blood culture growths were higher in ED (19%). Most common growth was CoNS (4%). The overall contamination rate in this study was (4.8%) The contamination rate was lower in ED (4.4%) when compared to MICU/MHDU (5.4%).

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