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Sample records for life-threatening incidents factors

  1. Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease.

    Science.gov (United States)

    Lin, C Huie; Hegde, Sanjeet; Marshall, Audrey C; Porras, Diego; Gauvreau, Kimberlee; Balzer, David T; Beekman, Robert H; Torres, Alejandro; Vincent, Julie A; Moore, John W; Holzer, Ralf; Armsby, Laurie; Bergersen, Lisa

    2014-01-01

    Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.

  2. Life-threatening bleeding in a case of autoantibody-induced factor VII deficiency.

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    Okajima, K; Ishii, M

    1999-02-01

    A male patient presented with life-threatening bleeding induced by autoantibody-induced factor VII (F.VII) deficiency. This patient had macroscopic hematuria, skin ecchymosis, gastrointestinal bleeding, and a neck hematoma that was causing disturbed respiration. He developed acute renal failure and acute hepatic failure, probably due to obstruction of the ureters and the biliary tract, respectively. Although activated partial thromboplastin time was normal, prothrombin time (PT) was remarkably prolonged at 71.8 seconds compared to 14.0 seconds in a normal control. Both the immunoreactive level of F.VII antigen and the F.VII activity of the patient's plasma samples were VII activity. These findings suggested the presence of a plasma inhibitor for F.VII. After administration of large doses of methylprednisolone, PT was gradually shortened and plasma levels of F.VII increased over time. Bleeding, acute renal failure, and acute hepatic failure improved markedly following the steroid treatment. These observations suggest that life-threatening bleeding can be induced by autoantibody-induced F.VII deficiency and that immunosuppressive therapy using large doses of steroid can be successful in inhibiting the production of the autoantibody.

  3. The use of recombinant factor VIIa in a patient with Noonan syndrome and life-threatening bleeding.

    Science.gov (United States)

    Tofil, Nancy M; Winkler, Margaret K; Watts, Raymond G; Noonan, Jacqueline

    2005-05-01

    To present a case report of a patient with Noonan syndrome who developed life-threatening gastrointestinal bleeding shortly after cardiac surgery that was successfully treated with recombinant factor VIIa. Case report. Pediatric intensive care unit of a children's hospital. Ten-month-old with Noonan syndrome and massive gastrointestinal bleeding resulting in severe hypovolemic shock. Recombinant factor VIIa was used in this patient's severe bleeding associated with Noonan syndrome after no other supportive measures were successful. Recombinant Factor VIIa significantly decreased the patient's bleeding and allowed his hypovolemic shock to improve. Ultimately, the patient made a complete recovery. Noonan syndrome has a constellation of both cardiac and noncardiac malformations including an increased risk of bleeding, and recombinant factor VIIa is an important agent in the treatment of significant bleeding.

  4. Clinical risk factors for life-threatening lower respiratory tract infections in children: a retrospective study in an urban city in Malaysia.

    Science.gov (United States)

    Nathan, Anna Marie; Rani, Fairuz; Lee, Rachel Jiun Yi; Zaki, Rafdzah; Westerhout, Caroline; Sam, I-Ching; Lum, Lucy Chai See; de Bruyne, Jessie

    2014-01-01

    Lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia. This retrospective study included children aged less than 18 years admitted for LRTIs over 13 months in a tertiary referral centre in Kuala Lumpur, Malaysia. Neonates, children with asthma and those with either no or a normal chest radiograph were excluded. Life-threatening infection was defined as that needing non-invasive ventilation or admission to the paediatric intensive care unit. Routine blood investigations and nasopharyngeal secretion results (bacterial and viral) were obtained. Chest radiographs were reviewed by a designated radiologist. Environmental data (rainfall, particulate matter ≤ 10 µm [PM10] and air pollution index [API]) was obtained from the respective government departments. Three hundred and ninety-one episodes of LRTIs were included. Viruses were implicated in 48.5% of LRTIs, with respiratory syncytial virus (RSV) being detected in 44% of viral LRTIs. Forty-six (11.8%) children had life-threatening disease and the overall mortality rate was 1.3% (5 children). RSV was detected in 26% of children with life-threatening LRTIs. In multivariate logistic regression, chronic lung disease, presenting history of apnoea and signs of hypoxia, was associated with life threatening LRTIs. Increased LRTI admissions were associated with low rainfall but not PM10 nor API. Of those on follow-up, 39% had persistent respiratory symptoms. One in nine children admitted with LRTI had a life-threatening LRTI. The aetiology was viral in almost half of admitted children. RSV was detected in a quarter of children with life-threatening LRTIs. Children who present with LRTIs and either have chronic lung disease, presenting history of apnoea or signs of hypoxia, should be observed carefully as the risk of deterioration to life-threatening

  5. Esophageal multichannel intraluminal impedance and pH-testing in the study of apparent life threatening episode incidents in infants

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    Javier Blasco-Alonso

    2014-03-01

    Full Text Available Introduction: The conventional 24-hour pH monitoring is the gold standard for the diagnosis of gastro-esophageal reflux (GER, a possible cause of Apparent Life Threatening Episodes (ALTE. However, multichannel intraluminal impedance (MII may provide advantages. Objectives: Comparison of the results of MII and pH monitoring in patients undergoing MII-pH monitoring in the 3-year study period because of having suffered from ALTE. Material and methods: Prospective study of MII-pH monitoring performed in our unit to infants 5 min per patient and clearance of 1.20 (IQ: 0.70-2.20 min/reflux. With pH monitoring analysis, 14 children (35.9 % could have been diagnosed as GER (8 mild, 4 moderate and 2 severe based on the classical criteria. MII identified a total of 8,895 events; only 3,219 among them were refluxes, with a median of 75 (IQ: 54-111 per patient, 1.30 (IQ: 1.3-2.6 episodes/hour. With MII-pH monitoring combination there were 21.60 (SD 15.21 acid reflux episodes, 67.33 weekly acid (SD 32.09 and 3.34 (SD 7.23 non-acid, being finally diagnosed 33 patients as GER. Conclusions: The association of pH monitoring and MII provides additional information that improves GER diagnostic performance without posing any additional risk to the infant patient. The non-acid/weekly acid refluxes, not detected by pH monitoring, account for a high percentage of episodes, this may have diagnostic and therapeutic significance, especially in infants. Further studies are needed to assess the normality of MMI in pediatric patients.

  6. Impact of indoor air pollution from the use of solid fuels on the incidence of life threatening respiratory illnesses in children in India.

    Science.gov (United States)

    Upadhyay, Ashish Kumar; Singh, Abhishek; Kumar, Kaushalendra; Singh, Ashish

    2015-03-28

    India contributes 24% of the global annual child deaths due to acute respiratory infections (ARIs). According to WHO, nearly 50% of the deaths among children due to ARIs is because of indoor air pollution (IAP). There is insufficient evidence on the relationship between IAP from the use of solid fuels and incidence of life threatening respiratory illnesses (LTRI) in children in India. Panel data of children born during 2001-02, from the Young Lives Study (YLS) conducted in India during 2002 and 2006-07 was used to estimate the impact of household use of solid fuels for cooking on LTRI in children. Multivariable two-stage random effects logistic regression model was used to estimate the odds of suffering from LTRI among children from households using solid fuels relative to children from households using other fuels (Gas/Electricity/Kerosene). Bivariate results indicate that the probability of an episode of LTRI was considerably higher among children from households using solid fuels for cooking (18%) than among children from households using other fuels (10%). Moreover, children from households using solid fuels in both the rounds of YLS were more likely to suffer from one or more than one episode of LTRI compared to children from households using solid fuels in only one round. Two-stage random effects logistic regression result shows that children from households using solid fuels were 1.78 (95% CI: 1.05-2.99) times as likely to suffer from LTRI as those from households using other fuels. The findings of this paper provide conclusive evidence on the harmful effects of the use of solid fuels for cooking on LTRI in India. The Government of India must make people aware about the health risks associated with the use of solid fuels for cooking and strive to promote the use of cleaner fuels.

  7. Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

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    Pauline Lorena Kale

    Full Text Available Abstract: We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births and lack of prenatal care (80.8‰ live births. Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2, hemorrhage (OR = 2.2; 95%CI: 1.3-3.9, hypertension (OR = 3.0; 95%CI: 2.0-4.4, syphilis (OR = 3.3; 95%CI: 1.5-7.2, lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7, cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3, lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8 and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.

  8. Factors for poor prognosis of near-fatal asthma after recovery from a life-threatening asthma attack.

    Science.gov (United States)

    Kim, Myung Shin; Cho, Young Joo; Moon, Hee Bom; Cho, Sang Heon

    2008-12-01

    The aim of this study was to investigate poor prognostic factors associated with a near-fatal asthma attack following patient recovery. We enrolled 68 patients who suffered near-fatal asthma attacks and were admitted to the intensive care units of five university hospitals. The patients were divided into two groups. The first group was comprised of patients who discontinued oral corticosteroids within 6 months after being discharged from the hospital and who maintained a forced expiratory volume in 1 s (FEV(1)) >/=60% of the maximum or estimated values of the corresponding patients. The second group included patients who continued on oral corticosteroids for >/=6 months or who maintained a FEV(1) asthma, factors for a poor prognosis included older age [48.47+/-3.53 vs. 64.69+/-2.59 years, pasthma, high values for inflammation-related laboratory markers (ESR, 8.75+/-2.05 vs. 23.88+/-4.40 mm/h, p=0.004; CRP, 1.72+/-0.46 vs. 6.68+/-9.36 mg/dL, pasthma exacerbated by pneumonia (28.1 vs. 52.8%, pasthma or the need for continual oral corticosteroids after being discharged from the hospital. Patients with these factors should be treated appropriately, under close surveillance.

  9. Eventos com aparente risco de vida: incidência, etiologia e investigação clínica = Apparent life-threatening events: incidence, etiology and investigation

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    Anjos, Alessandra Marques dos

    2005-01-01

    Full Text Available Objetivo: Avaliar a incidência, fatores etiológicos e investigação clínica de pacientes com Evento com Aparente Risco de vida (Apparent life-threatening event – ALTE. Métodos: Revisão da literatura através de pesquisa no banco de dados Medline e LILACS entre 1986- 2006 e publicações da Associação Latinoamericana de Pediatria, selecionados a partir de autores com experiência reconhecida em ALTE. Foram revisados 13 artigos de autores renomados além de 3 consensos: americano sobre apnéia infantil e monitorização domiciliar, consenso latinoamericano sobre ALTE e consenso da sociedade européia para estudo e preven- ção de morte infantil. Resultados: A incidência de ALTE descrita foi de 0,6 a 2,27% nos casos revisados. Quanto a etiologia aproximadamente 50% dos casos de ALTE são sintomáticos, sendo mais freqüente doenças do trato gastrointestinal e neurológicas. A investigação deve ser realizada seguindo protocolo padrão e estar direcionada para o diagnóstico da doença de base que definirá o prognóstico do ALTE. Casos recorrentes sem etiologia definida na investigação inicial necessitam de exames complementares, devendo ser considerado o abuso infantil e Munchausen por procura- ção como diagnóstico diferencial. Conclusão: Como o episódio de ALTE pode ser a manifestação inicial de entidades nosológicas diversas recomenda-se sempre sua investigação diagnóstica direcionada para doença de base

  10. Tracheal intubation in the ICU: Life saving or life threatening?

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    Jigeeshu V Divatia

    2011-01-01

    Full Text Available Tracheal intubation (TI is a routine procedure in the intensive care unit (ICU, and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR, the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  11. Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

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    Mazen Zaarour

    2015-01-01

    Full Text Available In the last decade, the desire for safer oral anticoagulants (OACs led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH. Our case is the third one described and the first one to involve the cervicothoracic spine.

  12. Risk Factors Analysis and Death Prediction in Some Life-Threatening Ailments Using Chi-Square Case-Based Reasoning (χ2 CBR) Model.

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    Adeniyi, D A; Wei, Z; Yang, Y

    2018-01-30

    A wealth of data are available within the health care system, however, effective analysis tools for exploring the hidden patterns in these datasets are lacking. To alleviate this limitation, this paper proposes a simple but promising hybrid predictive model by suitably combining the Chi-square distance measurement with case-based reasoning technique. The study presents the realization of an automated risk calculator and death prediction in some life-threatening ailments using Chi-square case-based reasoning (χ 2 CBR) model. The proposed predictive engine is capable of reducing runtime and speeds up execution process through the use of critical χ 2 distribution value. This work also showcases the development of a novel feature selection method referred to as frequent item based rule (FIBR) method. This FIBR method is used for selecting the best feature for the proposed χ 2 CBR model at the preprocessing stage of the predictive procedures. The implementation of the proposed risk calculator is achieved through the use of an in-house developed PHP program experimented with XAMP/Apache HTTP server as hosting server. The process of data acquisition and case-based development is implemented using the MySQL application. Performance comparison between our system, the NBY, the ED-KNN, the ANN, the SVM, the Random Forest and the traditional CBR techniques shows that the quality of predictions produced by our system outperformed the baseline methods studied. The result of our experiment shows that the precision rate and predictive quality of our system in most cases are equal to or greater than 70%. Our result also shows that the proposed system executes faster than the baseline methods studied. Therefore, the proposed risk calculator is capable of providing useful, consistent, faster, accurate and efficient risk level prediction to both the patients and the physicians at any time, online and on a real-time basis.

  13. Ectopic pregnancy: a life-threatening gynecological emergency

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    Lawani OL

    2013-08-01

    Full Text Available Osaheni L Lawani, Okechukwu B Anozie, Paul O Ezeonu Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: The aim of this work was to determine and evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancies at Ebonyi State University Teaching Hospital (EBSUTH in Abakaliki. Methods: This was a retrospective, descriptive study of ectopic pregnancies managed in EBSUTH during the study period (June 1, 2002 to May 31, 2012. The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 4,610 gynecological admissions and 9,828 deliveries, with 215 cases of ectopic pregnancies. A total of 205 cases were suitable for analysis after excluding cases with incomplete records. The relevant data collected were analyzed with SPSS version 15.0 for Windows. Results: Ectopic pregnancy constituted 4.5% of all gynecological admissions, and its incidence was 2.1%. The mean age of the patients was 27 ± 2 years, 196 of 205 (95.6% had ruptured ectopic pregnancies, and the remaining nine (4.4% were unruptured. The commonest (166 of 205, 80.0% clinical presentation was abdominal pain, and the commonest (105 of 205, 51.2% identified risk factor was a previous history of induced abortion. Three deaths were recorded, giving a case-fatality rate of 1.4% (three of 205. Conclusion: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to Nigerian women, as well as a threat to efforts in achieving the UN's Millennium Development Goal 5 in sub-Saharan Africa

  14. Psychotherapeutic work with Families with Life-threatening Maternal Illness

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    Chinoy, Freni

    2016-01-01

    This exploratory research study describes a child and adolescent psychotherapeutic clinical service offered to children/adolescents and their families with mothers with a life-threatening illness. The clinical service itself was also exploratory in nature. The research objectives of the study were (i) to explore whether this form of clinical work could be beneficial for such families in relieving distress and supporting their development; (ii) to discover the factors at play within and betwee...

  15. Can femoral dialysis catheter insertion cause a life threatening complication?

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    Nurkay Katrancıoğlu

    2014-09-01

    Full Text Available Venous catheter (VC insertion may be necessary for the patients with renal failure facing vascular access problem. Femoral VCs are commonly used for their lower complication rates especially in emergency clinics. The incidence of bleeding associated with VC is reported 0.5-1.6%, however, life threatening hemorrhage and complications requiring surgical intervention are very rare. In this manuscript, we aimed to present a case with hemolytic uremic syndrome complicated with retroperitoneal hematoma after femoral VC insertion. J Clin Exp Invest 2014; 5 (3: 472-474

  16. Infantile Apparent Life-Threatening Events, an Educational Review

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    Hamed Aminiahidashti

    2015-01-01

    Full Text Available Many physicians have received a frantic call from anxious parents stating that their child had stopped breathing, become limp, or turned blue but then had recovered quickly. An apparent life-threatening event (ALTE is defined as “an episode that is frightening to the observer, and is characterized by some combination of apnea, color change, marked change in muscle tone, choking, gagging, or coughing”. The incidence of ALTE is reported to be 0.05% to 6%. The knowledge about the most common causes and factors associated with higher risk of ALTE could be resulted in a more purposeful approach, improving the decision making process, and benefiting both children and parents. The aim of this review article was to report the epidemiology, etiology, evaluation, management, and disposition of ALTE. Infants with an ALTE might present no signs of acute illness and are commonly managed in the emergency settings that often require significant medical attention; hence, the emergency medicine personnel should be aware of the its clinical importance. There is no specific treatment for ALTE; therefore, the clinical evaluations should be focused on the detection of the underlying causes, which will define the outcomes and prognosis. ALTE is a confusing entity, representing a constellation of descriptive symptoms and signs; in other words, it is not a diagnosis. There are multiple possible etiologies and difficulties in evaluating and managing infants with these events, which are challenges to primary care physicians, emergency medicine specialists, and subspecialty pediatricians. The evaluation of these events in infants includes a detailed history, appropriate physical examination, diagnostic tests guided by obtained clues from the history and physical examination, and observation in the emergency department.

  17. Potentialities of embolization of life threatening hemorrhages

    International Nuclear Information System (INIS)

    Moskvichev, V.G.

    1985-01-01

    The author analysed experience in the embolization of the abdominal vessels in 79 patients with diseases and lesions of the peritoneal cavity and retroperitoneal space accompanied by life threatening hemorrhage. In 51 cases embolization was used as an independent method of hemorrhage arrest and in 28 cases for patients' preoperative preparation. A hemostatic sponge combined with a superselective administration of 150-200 ml of aminocaproic acid was used as an emboilizing material. Complications attributed to embolization were noted in 5 patients: pancreatitis, subdiaphragmatic abscess, paranephritis, ischemia of the gluteal soft tissues, sciatic neuritis. An analysis has shown that urgent embolization of the abdominal vessels in diseases and lesions of the organs of the peritoneal cavity and retroperitoneal space accompanied by massive hemorrhage, can be used as an independent method for hemorrhage arrest

  18. Tension pneumothorax, is it a really life-threatening condition?

    Science.gov (United States)

    2013-01-01

    Background Tension pneumothorax is a life-threatening occurrence that is infrequently the consequence of spontaneous pneumothorax. The aim of this study was to identify the risk factors for the development of tension pneumothorax and its effect on clinical outcomes. Methods We reviewed patients who were admitted with spontaneous pneumothorax between August 1, 2003 and December 31, 2011. Electronic medical records and the radiological findings were reviewed with chest x-ray and high-resolution computed tomography scans that were retrieved from the Picture Archiving Communication System. Results Out of the 370 patients included in this study, tension pneumothorax developed in 60 (16.2%). The bullae were larger in patients with tension pneumothorax than in those without (23.8 ± 16.2 mm vs 16.1 ± 19.1 mm; P = 0.007). In addition, the incidence of tension pneumothorax increased with the lung bulla size. Fibrotic adhesion was more prevalent in the tension pneumothorax group than in that without (P = 0.000). The bullae were large in patients with fibrotic adhesion than in those without adhesion (35.0 ± 22.3 mm vs 10.4 ± 11.5 mm; P = 0.000). On multivariate analysis, the size of bullae (odds ratio (OR) = 1.03, P = 0.001) and fibrotic adhesion (OR = 10.76, P = 0.000) were risk factors of tension pneumothorax. Hospital mortality was 3.3% in the tension pneumothorax group and it was not significantly different from those patients without tension pneunothorax (P = 0.252). Conclusions Tension pneumothorax is not uncommon, but clinically fatal tension pneumothorax is extremely rare. The size of the lung bullae and fibrotic adhesion contributes to the development of tension pneumothorax. PMID:24128176

  19. Preparing School Personnel to Assist Students with Life-Threatening Food Allergies.

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    Hay, Genevieve H.; And Others

    1994-01-01

    Knowledge of and preparation for life-threatening food allergies will enable school personnel to better respond to students who have severe allergic reactions. Given the high incidence of food-related anaphylaxis in public places, teachers and school personnel should be aware of and prepared to handle severe food allergy reactions. (SM)

  20. Myasthenia gravis: descriptive analysis of life-threatening events in a recent nationwide registry.

    Science.gov (United States)

    Ramos-Fransi, A; Rojas-García, R; Segovia, S; Márquez-Infante, C; Pardo, J; Coll-Cantí, J; Jericó, I; Illa, I

    2015-07-01

    Myasthenia gravis (MG) may become life-threatening if patients have respiratory insufficiency or dysphagia. This study aimed to determine the incidence, demographic characteristics, risk factors, response to treatment and outcome of these life-threatening events (LTEs) in a recent, population-based sample of MG patients. A retrospective analysis of MG patients who presented with an LTE between 2000 and 2013 was performed. Participants were identified from a neuromuscular diseases registry in Spain that includes 648 patients with MG (NMD-ES). Sixty-two (9.56%) patients had an LTE. Thirty-two were classified as class V according to the MG Foundation of America, and 30 as class IVB. Fifty per cent were previously diagnosed with MG and median duration of the disease before the LTE was 24 months (3-406). The most common related factor was infection (n = 18). All patients received intravenous human immunoglobulin; 11 had a second infusion and six had plasma exchange. Median time to feeding tube removal was 13 days (1-434). Median time to weaning from ventilation was 12 days (3-176), and it was significantly shorter in late onset MG (≥50 years) (P = 0.019). LTEs improved <2 weeks in 55.8% but did not improve until after 1 month in 20% of patients. Four patients died. No other factors influenced mortality or duration of LTEs. The percentage of LTEs in MG patients was low, particularly amongst those previously diagnosed and treated for the disease. The significant percentage of treatment-resistant LTEs indicates that more effective treatment approaches are needed for this vulnerable sub-population. © 2015 EAN.

  1. Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern

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    Nour-Eldin, Nour-Eldin A.; Naguib, Nagy N.N.; Mack, Martin; Abskharon, John E.; Vogl, Thomas J. [Johann Wolfgang Goethe-University Hospital, Institute for Diagnostic and Interventional Radiology, Frankfurt am Main (Germany)

    2011-01-15

    To assess risk factors and the extent of pulmonary hemorrhage complicating radiofrequency ablation (RFA) of pulmonary neoplasms. This retrospective study involved 248 ablation sessions for lung tumors (20 primary lesions and 228 metastatic lesions) in 164 patients (mean age 59.7 years, SD: 10.2). Both unipolar and bipolar radiofrequency systems were used under CT fluoroscopic guidance. Extent and underlying factors associated with development of pulmonary hemorrhage were analyzed. Incidence of intra-parenchymal pulmonary hemorrhage, pleural effusion, and hemoptysis were 17.7% (44/248 sessions), 4% (8/248 sessions), and 16.1% (40/248 sessions), respectively. Death because of massive bleeding occurred in one session (0.4%). Significant risk factors associated with intra-parenchymal hemorrhage included: lesions of <1.5 cm diameter (P = 0.007); basal and middle lung zone lesions (P = 0.026); increased needle track distance traversing the lung parenchyma >2.5 cm (P = 0.0017); traversing pulmonary vessels in the track of ablation (P < 0.001); and the use of multi-tined electrodes (P = 0.004). Concomitant incidence of pulmonary hemorrhage and pneumothorax was 29.2% (14/48 sessions). While typically safe, RFA of pulmonary neoplasms can result in pulmonary hemorrhage ranging from mild to life-threatening. Management of this complication is mainly preventive through adequate patient selection for ablation therapy and exclusion of technically avoidable risk factors. (orig.)

  2. Life threatening spinal shock and complete neurological recovery ...

    African Journals Online (AJOL)

    Mild to moderate trauma to the spinal cord that is complicated by existing cervical canal stenosis or spondylosis can be a life threatening event. It is against this background that we present a 41 year old male with cervical spinal stenosis who developed marked quadriparesis and respiratory embarrassment following ...

  3. Life threatening arrhythmias: Knowledge and skills among nurses ...

    African Journals Online (AJOL)

    Conclusion: Although the majority of the participants scored highly in their level of knowledge regarding life threatening arrhythmias, they scored poorly in most of the observed skills when identifying and treating this patient group. It is important that hospital administration take into consideration the identified areas of ...

  4. Mobile phone use for contacting emergency services in life-threatening circumstances.

    Science.gov (United States)

    Wu, Olivia; Briggs, Andrew; Kemp, Tom; Gray, Alastair; MacIntyre, Kate; Rowley, Jack; Willett, Keith

    2012-03-01

    The potential health benefits of mobile phone use have not been widely studied, except for telemedicine-type applications. This study seeks to determine whether initial contact with emergency services via a mobile phone in life-threatening situations is associated with potential health benefits when compared to contact via a landline. A record-linkage study was carried out in which data from all emergency dispatches for immediately life-threatening events from a United Kingdom county ambulance service were linked to the Patient Admission System at two major local hospitals. Mortality (at the scene, at the emergency department [ED], and during hospitalization); transfer to the ED; admission (inpatient care, and intensive care unit); and length of stay were analyzed for calls classified as Code Red (immediately life-threatening) by initial exposure (mobile phone vs. landline), while controlling for potential confounding variables. Of 354,199 ambulances dispatched to attend emergency incidents, 66% transported patients to the hospital while 2% stood down due to death at the scene. Mobile phone compared to landline reporting of emergencies resulted in significant reductions in the risk of death at the scene (odds ratio [OR] 0.77), but not for death in the ED or during inpatient admission. The risk of being transferred to the ED and subsequent inpatient admission were significantly lower with reporting from mobile phones compared to landline (OR 0.93 and OR 0.82, respectively). In this study, evidence of statistical association was demonstrated between the use of mobile phones to alert ambulance services in life-threatening situations and improved outcomes for patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy

    International Nuclear Information System (INIS)

    Tabatabai, Abbas; Hashemi, Mozaffar; Mohajeri, Gholamreza; Ahmadinejad, Mojtaba; Khan, Ishfaq Abass; Haghdani, Saeid

    2009-01-01

    The objective of our study was to identify the incidence and risk factors of anastomotic leaks following transhiatal esophagectomy (THE). A prospective study was conducted on 61 patients treated for carcinoma of the esophagus between 2006 and 2007. We examined the following variables: age, gender, preoperative cardiovascular function, intraoperative complications such as hypotension, arrhythmia, mediastinal manipulation period, blood loss volume, blood transfusion, duration of surgery, postoperative complications such as anastomotic leak, anastomotic stricture, requiring reoperation, respiratory complications, and total morbidity and mortality. Variables were compared between the patients with and without anastomotic leak. T-test for quantitative variables and Chi-square test for qualitative variables were used to find out any relationship. P value less than 0.05 was considered significant. Out of 61 patients, anastomotic leaks occurred in 13 (21.3%). Weight loss, forced expiratory volume (FEV1) < 2 lit, preoperative albumin, intaoperative blood loss volume, and respiratory complication were associated with the anastomotic leak in patients undergoing THE. Anastomotic leaks were the leading cause of postoperative morbidity, anastomotic stricture, and reoperation. Anastomotic leakage is a life-threatening postoperative complication. Careful attention to the factors contributing to the development of a leak can reduce the incidence of anastomotic complications postoperatively. (author)

  6. Life-threatening motor vehicle crashes in bright sunlight

    OpenAIRE

    Redelmeier, Donald A.; Raza, Sheharyar

    2017-01-01

    Abstract Bright sunlight may create visual illusions that lead to driver error, including fallible distance judgment from aerial perspective. We tested whether the risk of a life-threatening motor vehicle crash was increased when driving in bright sunlight. This longitudinal, case-only, paired-comparison analysis evaluated patients hospitalized because of a motor vehicle crash between January 1, 1995 and December 31, 2014. The relative risk of a crash associated with bright sunlight was estim...

  7. Life-threatening hypokalemia following rapid correction of respiratory acidosis.

    Science.gov (United States)

    Hammond, Kendra; You, David; Collins, Eileen G; Leehey, David J; Laghi, Franco

    2013-01-01

    A 56-year-old woman with a history of paraplegia and chronic pain due to neuromyelitis optica (Devic's syndrome) was admitted to a spinal cord injury unit for management of a sacral decubitus ulcer. During the hospitalization, she required emergency transfer to the intensive care unit (ICU) because of progressive deterioration of respiratory muscle function, severe respiratory acidosis, obtundation and hypotension. Upon transfer to the ICU, arterial blood gas revealed severe acute-on-chronic respiratory acidosis (pH 7.00, PCO2 120 mm Hg, PO2 211 mm Hg). The patient was immediately intubated and mechanically ventilated. Intravenous fluid boluses of normal saline (10.5 L in about 24 h) and vasopressors were started with rapid correction of hypotension. In addition, she was given hydrocortisone. Within 40 min of initiation of mechanical ventilation, there was improvement in acute respiratory acidosis. Sixteen hours later, however, the patient developed life-threatening hypokalemia (K(+) of 2.1 mEq/L) and hypomagnesemia (Mg of 1.4 mg/dL). Despite aggressive potassium supplementation, hypokalemia continued to worsen over the next several hours (K(+) of 1.7 mEq/L). Urine studies revealed renal potassium wasting. We reason that the recalcitrant life-threatening hypokalemia was caused by several mechanisms including total body potassium depletion (chronic respiratory acidosis), a shift of potassium from the extracellular to intracellular space (rapid correction of respiratory acidosis with mechanical ventilation), increased sodium delivery to the distal nephron (normal saline resuscitation), hyperaldosteronism (secondary to hypotension plus administration of hydrocortisone) and hypomagnesemia. We conclude that rapid correction of respiratory acidosis, especially in the setting of hypotension, can lead to life-threatening hypokalemia. Serum potassium levels must be monitored closely in these patients, as failure to do so can lead to potentially lethal consequences

  8. Identifying and treating a life-threatening disease.

    Science.gov (United States)

    Cole, Beverley

    2014-02-01

    Meningococcal septicaemia is a life-threatening condition that all nurses working in emergency and urgent care settings are likely to come across during their careers. This article presents, and reflects on, a case study involving a woman with the disease whose signs and symptoms were atypical, and who was not therefore diagnosed with the condition immediately. The author aims to raise awareness among emergency nurses and nurse practitioners of the atypical signs and symptoms of the infection, and its consequences. The article also discusses how referring to patient scenarios can improve practice.

  9. Organising pneumonia presenting as acute life threatening pulmonary haemorrhage.

    Science.gov (United States)

    Narasimhaiah, Damodhara Honnavally; Chakravorty, Indranil; Swamy, Rajiv; Prakash, Doraiswamy

    2011-11-08

    Organising pneumonia, previously called bronchiolitis obliterans organising pneumonia is a clinicopathological entity of unknown aetiology, which has been reported with increasing frequency. Various modes of presentation have been described such as cough, fever, weight loss and alveolar opacities on chest radiograph. Haemoptysis as primary presenting symptom has only rarely been reported. The authors report a case in which massive life-threatening haemoptysis was the major presenting symptom. No aetiology was identified for the haemoptysis and the diagnosis was confirmed on postmortem histology. This case highlights the importance of considering organising pneumonia in the differential diagnosis of acute severe haemoptysis.

  10. Life-Threatening Atypical Case of Acute Generalized Exanthematous Pustulosis.

    Science.gov (United States)

    Tajmir-Riahi, Azadeh; Wörl, Petra; Harrer, Thomas; Schliep, Stefan; Schuler, Gerold; Simon, Miklos

    2017-01-01

    Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases. Herein, we report a case of AGEP in a young healthy male leading to systemic inflammatory response syndrome and to treatment in an intensive care unit after being treated with 5 different antibiotics. Initial symptoms were not indicative for AGEP and the patient's course of disease led promptly to critical cardiorespiratory symptoms and systemic inflammatory response syndrome. We assume that the administration of the 5 different antibiotics resulted in type IV allergy as well as secondary infection with Enterococcus faecium and Staphylococcus aureus, while the underlying periodontitis also contributed to the severity of this case. © 2017 S. Karger AG, Basel.

  11. Life-Threatening Obstructive Sleep Apnea Caused by Adenoid Hypertrophy in an Infant with Noonan Syndrome

    Directory of Open Access Journals (Sweden)

    Sonia Khirani

    2012-01-01

    Full Text Available Adenoidectomy is a commonly performed surgery in children, even though its effectiveness is still under investigation. However, in children with risk factors such as age under 3 years old, associated comorbidities, or severe obstructive sleep apneas, a high postoperative respiratory morbidity is possible. We report the case of a 15-month-old boy with Noonan syndrome and a complex clinical history, who presented with a life-threatening obstructive sleep apnea due to hypertrophy of the adenoids which resolved completely after adenoidectomy.

  12. Near-death experiences in non-life-threatening events and coma of different etiologies

    Directory of Open Access Journals (Sweden)

    Vanessa eCharland-Verville

    2014-05-01

    Full Text Available Background: Near death experiences (NDEs are increasingly being reported as a clearly identifiable physiological and psychological reality of clinical significance. However, the definition and causes of the phenomenon as well as the identification of NDE experiencers is still a matter of debate. To date, the most widely used standardized tool to identify and characterize NDEs in research is the Greyson NDE Scale. Using this scale, retrospective and prospective studies have been trying to estimate their incidence in various populations but few studies have tackled to associate the experiences’ intensity and content related to etiology. Methods: This retrospective investigation assessed the most frequently recounted features of self-reported NDEs after a non-life-threatening event (i.e., NDE-like experience or after a pathological coma (i.e., classical NDEs and according to the etiology of the acute brain insult. We also compared our retrospectively acquired data in anoxic coma with historical data from the published literature on prospective post-anoxic studies using the Greyson NDE Scale. Results: From our 190 reports who met the criteria for NDE (i.e., NDE scale total score Conclusions: It appears that real NDEs after coma of different etiologies are similar to NDE-like experiences occurring after non-life threatening events. Subjects reporting NDEs retrospectively tend to have experienced a different content compared to the prospective experiencers

  13. Life-Threatening Thrombocytopenia Following Intravenous Contrast Media Infusion.

    Science.gov (United States)

    Park, Mihwa; Kim, Minjeong; Park, Jisun; Cho, Jinhyun

    2018-01-01

    Radiocontrast media-induced acute severe thrombocytopenia is a very rare complication and potentially life-threatening. Here, we report the case of a 63-year-old male patient with severe acute thrombocytopenia following first exposure to intravenous non-ionic contrast media without immediate allergic reactions. His platelet count dropped from 107000/μL to 2000/μL after six hours of radiocontrast infusion. After administration of corticosteroid and transfusion of platelet concentrates, the platelet count returned gradually to normal within 5 days. To the best of our knowledge, non-ionic contrast media-induced isolated acute severe thrombocytopenia following no signs or symptoms of immediate allergic reaction has never been described. © Copyright: Yonsei University College of Medicine 2018.

  14. Seronegative neuromyelitis optica presenting with life-threatening respiratory failure.

    Science.gov (United States)

    Nardone, Raffaele; Zuccoli, Giulio; Brigo, Francesco; Trinka, Eugen; Fitzgerald, Ryan T

    2016-11-01

    Dyspnea has rarely been reported as a presenting symptom in patients with neuromyelitis optica (NMO). We report an unusual case of NMO relapse presenting with rapidly progressive respiratory failure and briefly discuss the possible pathophysiological mechanisms of this potential life-threatening complication of NMO. The 58-year-old woman with a history of bilateral optic neuritis presented to the emergency department with rapidly worsening dyspnea. Cervical spine magnetic resonance imaging showed extensive abnormal signal with involvement of the medulla oblongata. Since in our patient chest radiography failed to disclose a diaphragmatic palsy that is commonly observed in patients with phrenic nerve involvement, this acute manifestation of the disease may be attributed to brainstem involvement instead of cervical myelitis. Clinicians should be aware of this atypical presentation of NMO, which needs to be promptly recognized and aggressively treated.

  15. Parental spirituality in life-threatening pediatric cancer.

    Science.gov (United States)

    Nicholas, David B; Barrera, Maru; Granek, Leeat; D'Agostino, Norma Mammone; Shaheed, Jenny; Beaune, Laura; Bouffet, Eric; Antle, Beverley

    2017-01-01

    This study addressed parental spirituality in the context of pediatric cancer with a poor prognosis. Drawing upon previous research implementing a longitudinal grounded theory design examining parental hope, 35 parents were interviewed regarding their experiences with an emergent description of the role of spirituality in parents' daily lives. Spirituality included religious beliefs and practices, notions of a higher force or cosmos, relationship with a divine being, as well as elements emerging from meaning-making and relationships. Parental expectations of spirituality remained relatively constant across data collection time points (3-9 months postdiagnosis), although limited variation occurred relative to shifting circumstance (e.g., deterioration of the child's condition). Spirituality appeared to offer: greater acceptance of parents' inability to protect their child from harm related to her/his life-threatening illness, guidance and emotion decompression, and support from one's faith community. Recommendations for integrating spiritual assessment in clinical care practice are offered.

  16. Life-threatening asthma attack during prolonged fingolimod treatment: case report

    Directory of Open Access Journals (Sweden)

    Zecca C

    2014-07-01

    Full Text Available Chiara Zecca,1,* Matteo Caporro,1,* Sandor Györik,2 Claudio Gobbi11Neurocenter of Southern Switzerland, Department of Neurology, Ospedale Regionale di Lugano, Lugano, Switzerland; 2Department of Internal Medicine, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland*These authors contributed equally to this workBackground: Fingolimod (FTY mediates bronchoconstriction by interacting with sphingosine-1-phosphate receptors. The majority of the reported adverse respiratory events occur during the first weeks of treatment.Case presentation: A 49-year-old woman developed a life-threatening asthma attack after 6 months of continuous FTY treatment. The adverse event required prolonged hospitalization, and the patient recovered without sequelae after FTY interruption. A history of previous airway hyperreactivity and a concurrent viral respiratory infection possibly acted as predisposing factors.Conclusion: This first description of a severe, life-threatening asthma attack during prolonged FTY treatment suggests the need for long-term clinical surveillance, especially in patients with known predisposing factors.Keywords: multiple sclerosis, bronchial hyper-reactivity

  17. Pseudohypoaldosteronism in a Neonate Presenting as Life-Threatening Hyperkalemia

    Directory of Open Access Journals (Sweden)

    Najya A. Attia

    2016-01-01

    Full Text Available Context. Pseudohypoaldosteronism type 1 (PHA1 is a life-threatening disease that causes severe hyperkalemia and cardiac arrest if not treated appropriately or if diagnosis is missed. Objective. To report a case of a newborn with vomiting and lethargy, ultimately diagnosed with pseudohypoaldosteronism. Patient. This case presented to the ED at an age of 14 days in hypovolemic shock. There was a family history of sudden infant death, her sister who was diagnosed with CAH and passed away at 3 months of age despite regular hormone replacement. Our patient had cardiac arrest in ED, due to hyperkalemia; while receiving fluid boluses, cardiopulmonary resuscitation was initiated. After stabilization, diagnostic workup demonstrated persistently low sodium, acidosis, and high potassium, which required peritoneal dialysis. Based on these findings, the patient was diagnosed with CAH. It turned out later that the patient had PHA1. Two years later, the patient had a new sibling with the same disease diagnosed at birth and started immediately on treatment without any complication. Conclusions and Outcome. This case highlights the significant diagnostic and therapeutic challenges in treating children with PHA1. Adrenal crisis is not always CAH; delayed diagnosis can lead to complication and even death. The presence of high plasma renin activity, aldosterone, and cortisol, along with the presence of hyponatremia and hyperkalemia, established the diagnosis of PHA type 1 and ruled out CAH.

  18. Life-Threatening Hypokalemic Paralysis in a Young Bodybuilder

    Directory of Open Access Journals (Sweden)

    Kitty K. T. Cheung

    2014-01-01

    Full Text Available We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR 3.5–5.0 mmol/L. He was admitted to the intensive care unit (ICU and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology.

  19. Life-threatening hypokalemic paralysis in a young bodybuilder.

    Science.gov (United States)

    Cheung, Kitty K T; So, Wing-Yee; Kong, Alice P S; Ma, Ronald C W; Chow, Francis C C

    2014-01-01

    We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG) showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR) 3.5-5.0 mmol/L). He was admitted to the intensive care unit (ICU) and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology.

  20. Life-Threatening Hypokalemic Paralysis in a Young Bodybuilder

    Science.gov (United States)

    Cheung, Kitty K. T.; So, Wing-Yee; Kong, Alice P. S.; Ma, Ronald C. W.; Chow, Francis C. C.

    2014-01-01

    We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG) showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR) 3.5–5.0 mmol/L). He was admitted to the intensive care unit (ICU) and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology. PMID:24660073

  1. Relationship of external influence to parental distress in decision making regarding children with a life-threatening illness.

    Science.gov (United States)

    Miller, Victoria A; Luce, Mary Frances; Nelson, Robert M

    2011-01-01

    To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making.

  2. Biodegradable airway stents in infants - Potential life-threatening pitfalls.

    Science.gov (United States)

    Sztanó, B; Kiss, G; Márai, K; Rácz, G; Szegesdi, I; Rácz, K; Katona, G; Rovó, L

    2016-12-01

    The solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. Five SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). The breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing 'foreign body' from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. Polydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4-6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Life-threatening infectious diseases of childhood: single-gene inborn errors of immunity?

    Science.gov (United States)

    Alcaïs, Alexandre; Quintana-Murci, Lluis; Thaler, David S; Schurr, Erwin; Abel, Laurent; Casanova, Jean-Laurent

    2010-12-01

    The hypothesis that inborn errors of immunity underlie infectious diseases is gaining experimental support. However, the apparent modes of inheritance of predisposition or resistance differ considerably among diseases and among studies. A coherent genetic architecture of infectious diseases is lacking. We suggest here that life-threatening infectious diseases in childhood, occurring in the course of primary infection, result mostly from individually rare but collectively diverse single-gene variations of variable clinical penetrance, whereas the genetic component of predisposition to secondary or reactivation infections in adults is more complex. This model is consistent with (i) the high incidence of most infectious diseases in early childhood, followed by a steady decline; (ii) theoretical modeling of the impact of monogenic or polygenic predisposition on the incidence distribution of infectious diseases before reproductive age; (iii) available molecular evidence from both monogenic and complex genetics of infectious diseases in children and adults; (iv) current knowledge of immunity to primary and secondary or latent infections; (v) the state of the art in the clinical genetics of noninfectious pediatric and adult diseases; and (vi) evolutionary data for the genes underlying single-gene and complex disease risk. With the recent advent of new-generation deep resequencing, this model of single-gene variations underlying severe pediatric infectious diseases is experimentally testable. © 2010 New York Academy of Sciences.

  4. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    International Nuclear Information System (INIS)

    Sofue, Keitaro; Takeuchi, Yoshito; Arai, Yasuaki; Sugimura, Kazuro

    2013-01-01

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  5. Caring for children with life-limiting and life-threatening illnesses ...

    African Journals Online (AJOL)

    2011-07-03

    Jul 3, 2011 ... She currently works with funding support from the Red Cross War Memorial Children's Hospital and the ... Children with life-limiting illnesses may also develop life-threatening ... bodies in an age-appropriate manner a basic.

  6. Life-threatening ventricular tachyarrhythmias in the cardiology department: Implications for appropriate prescription of telemetry monitoring.

    Science.gov (United States)

    Zorzi, Alessandro; Peruzza, Francesco; Stella, Federica; Del Monte, Alvise; Migliore, Federico; Gasparetto, Nicola; Badano, Luigi; Iliceto, Sabino; Corrado, Domenico

    2016-04-01

    in-hospital life-threatening ventricular arrhythmias (LT-VA) may complicate the course of cardiovascular patients. We aimed to assess the incidence, circumstances, determinants, and outcome of in-hospital LT-VA in order to help clinicians in prescribing appropriate levels of monitoring. the study population consisted of all 10,741 consecutive patients (65 ± 15 years, 67.7% males) admitted to a cardiology department in 2009-2014. Terminally ill patients and those with primary arrhythmia diagnosis were excluded. The composite end-point included sudden arrhythmic death, ventricular fibrillation, unstable ventricular tachycardia and appropriate ICD shock unrelated to invasive interventions. the incidence of LT-VA was 0.6%, with no differences regarding age, gender and primary diagnosis of coronary artery disease between patients with and without LT-VA. The incidence of LT-VA was significantly higher (1.2% versus 0.1%, p<0.001) among urgent compared with elective admissions and among patients with left ventricular ejection fraction (LV-EF) <45% (1.7% versus 0.2%, p<0.001). At multivariable analysis, urgent admission and LV-EF <45%, but not primary diagnosis of coronary artery disease, remained independent predictors of LT-VA. At the time of the event, 97.1% fulfilled either class I or class II indications for telemetry monitoring according to the American Heart Association guidelines. Survival to discharge with good neurological status was 70.6%. acutely ill patients with heart failure and LV systolic dysfunction showed the highest rate of LT-VAs, regardless of the underlying cardiac disease (ischemic or non-ischemic). Current guidelines demonstrated high sensitivity in identifying patients at risk. These findings may favor proper utilization of telemetry monitoring resources. Copyright © 2016. Published by Elsevier Ireland Ltd.

  7. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Alzamora, M.G.; Klisch, J. [Section of Neuroradiology, Neurocenter, University of Freiburg (Germany); Rosahl, S.K.; Lehmberg, J. [Department of Neurosurgery, Neurocenter, University of Freiburg (Germany)

    2005-04-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel.

  8. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    International Nuclear Information System (INIS)

    Alzamora, M.G.; Klisch, J.; Rosahl, S.K.; Lehmberg, J.

    2005-01-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel

  9. Life-threatening rupture of a renal angiomyolipoma in a patient taking over-the-counter horse chestnut seed extract.

    LENUS (Irish Health Repository)

    Snow, Aisling

    2011-02-09

    BACKGROUND: Alternative medical therapies are increasingly being prescribed due to their good safety profile and perceived limited side effects. They are often unregulated and prescribed over the counter. One such medication is horse chestnut seed extract (HCSE), which is used for the treatment of chronic venous insufficiency and is known to affect blood coagulation. Angiomyolipoma (AML) is a benign fat-containing mesenchymal tumor of the kidney. It is often found incidentally and in most cases can be managed conservatively. Rupture of the kidney with hemorrhage is a well-known complication that may be serious and life-threatening. Known risk factors for hemorrhage include anticoagulation as well as pregnancy, increased size of the lesion, high lesion vascularity, and aneurysm formation within the tumor. OBJECTIVES: The aim is to raise awareness of potential HCSE-induced anticoagulation, including, as in the case presented, acute renal AML hemorrhage. CASE REPORT: The case of a patient taking HCSE for venous insufficiency is presented. The patient suffered a life-threatening rupture of the kidney in the presence of known renal AML. She underwent emergency embolization with a successful outcome. Because HCSE-containing products are thought to be generally safe in the treatment of chronic venous insufficiency, it is important to be mindful of their potential anticoagulant properties and, therefore, their relative contraindication both in patients taking other anticoagulants and those with known renal AML. CONCLUSION: We demonstrate a potentially life-threatening association between HSCE-containing products and renal AML, highlighting the risk associated with HSCE-induced anticoagulation.

  10. Citation classics in suicide and life threatening behavior: a research note.

    Science.gov (United States)

    Stack, Steven

    2012-12-01

    The number of citations a scholarly work receives is a common measure of its impact on the scientific literature; "citation classics" are the most highly cited works. The content of Suicide and Life-Threatening Behavior (SLTB) citation classics is described here. The impact of SLTB citation classics is compared to their counterparts in journals having published the most suicide papers. All data are from the ISI electronic venue on the Web of Science and refer to the number of citations the top 1% of works received in each of ten journals from 1975 through August 10, 2011. Among all ten journals, SLTB ranked first in the number of works on suicide. The principle theme of half of SLTB suicide classics was literature review. The median number of citations for SLTB citation classics (top 1%) was 121.5, with a range between 96 and 279 citations, but classics from generalized psychiatric journals received more citations as anticipated. Journal impact factors explained 73% of the variance in classic's citation counts across journals. On average, suicide classics received 30% more citations than all classics. Among a second group of five specialized suicide journals, however, SLTB ranked first in average 5-year impact. Although SLTB produced the highest number of suicide articles of any journal, SLTB's citation classics received fewer citations than suicide classics in high-impact/prestige, general journals. Future work is needed to assess what predicts which SLTB articles ultimately become citation classics. © 2012 The American Association of Suicidology.

  11. Pre-eclampsia: a Life-threatening Pregnancy Syndrom

    Czech Academy of Sciences Publication Activity Database

    Brázdová, A.; Keprová, Alena; Zídková, J.; Madar, J.

    2014-01-01

    Roč. 57, č. 5 (2014), s. 701-705 ISSN 1516-8913 Grant - others:GA AV ČR(CZ) IAA600110902 Program:IA Institutional support: RVO:61388963 Keywords : placenta * pre-eclampsia * pregnancy * oxidative stress Subject RIV: CE - Biochemistry Impact factor: 0.546, year: 2014

  12. Relationship of External Influence to Parental Distress in Decision Making Regarding Children with a Life-Threatening Illness

    Science.gov (United States)

    Luce, Mary Frances; Nelson, Robert M.

    2011-01-01

    Objective To examine the relationship of external influence to parental distress when making a decision about research or treatment for a child with a life-threatening illness and to test potential moderators of this relationship. Methods Parents (n = 219) who made a decision about research or treatment for a child completed measures of external influence, distress, decision-making preference, and coping. Results More external influence was associated with more hostility, uncertainty, and confusion. Decision-making preference and coping style moderated the relationship between external influence and distress: More external influence was associated with more distress when decision-making preference was low and task-focused coping was high. Conclusions External influence appears to be related to distress in parents making research and treatment decisions for children with life-threatening illnesses. However, it is important to consider parent characteristics, such as decision-making preference and coping style, when examining the effects of contextual factors on distress during decision making. PMID:21693541

  13. Endogenous nocardial endophthalmitis in an immunosuppressed patient: A serious warning of an underlying life threatening and blinding disorder

    Directory of Open Access Journals (Sweden)

    Hemant Trehan

    2017-01-01

    Conclusion: Ocular nocardiosis is a serious vision and life threatening disorder, particularly in patients on immunosuppressive therapy. A high index of suspicion is required for successful treatment.

  14. Role of Rhinovirus C in Apparently Life-Threatening Events in Infants, Spain

    Science.gov (United States)

    García, M. Luz; Pozo, Francisco; Reyes, Noelia; Pérez-Breña, Pilar; Casas, Inmaculada

    2009-01-01

    To assess whether infants hospitalized after an apparently life-threatening event had an associated respiratory virus infection, we analyzed nasopharyngeal aspirates from 16 patients. Nine of 11 infants with positive virus results were infected by rhinoviruses. We detected the new genogroup of rhinovirus C in 6 aspirates. PMID:19788827

  15. Life-threatening necrotizing fasciitis of the neck: an unusual consequence of a sore throat

    NARCIS (Netherlands)

    Persaud, R.; Krahé, D.; Georgalas, C.; Kaniyur, S.; Das, S.; Alusi, G.

    2004-01-01

    BACKGROUND: Necrotizing fasciitis is life-threatening bacterial infection which spreads with frightening speed along the fascial planes resulting in extensive tissue necrosis and often death. The infection is caused by either Group A streptococci or a combination of aerobic and anaerobic bacteria.

  16. Citation Classics in "Suicide and Life Threatening Behavior": A Research Note

    Science.gov (United States)

    Stack, Steven

    2012-01-01

    The number of citations a scholarly work receives is a common measure of its impact on the scientific literature; "citation classics" are the most highly cited works. The content of "Suicide and Life-Threatening Behavior" ("SLTB") citation classics is described here. The impact of "SLTB" citation classics is compared to their counterparts in…

  17. An extended family suddenly confronted with a life-threatening hereditary arrhythmia

    NARCIS (Netherlands)

    Hendriks, K. S. W. H.; van Langen, I. M.; van Tintelen, J. P.; Grosfeld, F. J. M.; Wilde, A. A. M.; ten Kroode, H. F. J.

    2005-01-01

    This exploratory study serves to illustrate the psychological impact on an extended family in the process of genetic counselling and testing for a potentially life-threatening arrhythmia, the long-QT syndrome (LQTS). All members of the third generation and their partners (n=11) were interviewed, the

  18. An extended family suddenly confronted with a life-threatening hereditary arrhythmia

    NARCIS (Netherlands)

    Hendriks, K.S.W.H.; Van Langen, I.M.; Van Tintelen, J.P.; Grosfeld, F.J.M.; Wilde, A.A.M.; Ten Kroode, H.F.J.

    2005-01-01

    Objective. This exploratory study serves to illustrate the psychological impact on an extended family in the process of genetic counselling and testing for a potentially life-threatening arrhythmia, the long-QT syndrome (LQTS). Method. All members of the third generation and their partners (n=11)

  19. Candida albicans-associated necrotizing vasculitis producing life-threatening gastrointestinal hemorrhage.

    LENUS (Irish Health Repository)

    Sargent, Jeremy

    2012-02-01

    Patients undergoing treatment of acute lymphoblastic leukemia are at risk for fungal infections including disseminated candidiasis. We describe a case of systemic Candida albicans infection associated with life-threatening gastrointestinal hemorrhage due to unusual necrotizing vasculitis involving the gastrointestinal tract. We explore the association between Candida and such vasculopathy.

  20. Life-threatening Pneumocystis jiroveci pneumonia following treatment of severe Cushing's syndrome

    NARCIS (Netherlands)

    Oosterhuis, J. K.; van den Berg, G.; Monteban-Kooistra, W. E.; Ligtenberg, J. J. M.; Tulleken, J. E.; Zijlstra, J. G.; Meertens, John

    We describe two patients with a severe Cushing's syndrome due to ectopic production of ACTH. Both patients developed a life-threatening Pneumocystis jiroveci pneumonia (PCP) shortly after treatment of the hypercortisolism was started by means of inhibition of production of glucocorticoids and

  1. Life-Threatening Adverse Events Following Therapeutic Opioid Administration in Adults: Is Pharmacogenetic Analysis Useful?

    Directory of Open Access Journals (Sweden)

    Parvaz Madadi

    2013-01-01

    Full Text Available BACKGROUND: Systemic approaches are needed to understand how variations in the genes associated with opioid pharmacokinetics and response can be used to predict patient outcome. The application of pharmacogenetic analysis to two cases of life-threatening opioid-induced respiratory depression is presented. The usefulness of genotyping in the context of these cases is discussed.

  2. A life-threatening case of disseminated nocardiosis due to Nocardia brasiliensis.

    Science.gov (United States)

    Paramythiotou, Elisabeth; Papadomichelakis, Evangelos; Vrioni, Georgia; Pappas, Georgios; Pantelaki, Maria; Kontos, Fanourios; Zerva, Loukia; Armaganidis, Apostolos

    2012-10-01

    Nocardiosis is a rare disease caused by infection with Nocardia species, aerobic actinomycetes with a worldwide distribution. A rare life-threatening disseminated Nocardia brasiliensis infection is described in an elderly, immunocompromised patient. Microorganism was recovered from bronchial secretions and dermal lesions, and was identified using molecular assays. Prompt, timely diagnosis and appropriate treatment ensured a favorable outcome.

  3. Optical illusions and life-threatening traffic crashes: A perspective on aerial perspective.

    Science.gov (United States)

    Redelmeier, Donald A; Raza, Sheharyar

    2018-05-01

    Aerial perspective illusion is a feature of visual perception where landscapes appear relatively close in clear light and distant in dim light. We hypothesized that bright sunlight might cause drivers to perceive distant terrain as relatively close and misinterpret the approach speed of surrounding landscape as unduly slow. This hypothesis would mean, in turn, that drivers in bright sunlight may underestimate their progress on the road, compensate by traveling at a faster baseline speed, and ultimately increase the prevailing risk of a life-threatening traffic crash. We conducted three pilot studies to illustrate how the illusion might contribute to a life- threatening traffic crash. The first illustration used a questionnaire to demonstrate that most respondents were mistaken when judging the distance between simple balls in different positions. The second illustration involved an experimental manipulation to assess whether aerial perspective influenced judgments about the relative positions of vehicles in traffic. The third illustration analyzed a segment of high-volume fast-speed traffic and found an increased frequency of speeding under bright sunlight. Together with past work based on the visual arts, these examples illustrate how an aerial perspective illusion can affect distance perception, may appear in realistic traffic situations, and could potentially contribute to the risk of a life-threatening traffic crash. An awareness of this hypothesis might lead to applications on how optical illusions could extend to everyday traffic and might potentially inform safety warnings to prevent life- threatening crashes. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Guidelines for Managing Life-Threatening Food Allergies in Massachusetts Schools

    Science.gov (United States)

    Sheetz, Anne H.; Goldman, Patricia G.; Millett, Kathleen; Franks, Jane C.; McIntyre, C. Lynne; Carroll, Constance R.; Gorak, Diane; Harrison, Christanne Smith; Carrick, Michele Abu

    2004-01-01

    During the past decade, prevalence of food allergies among children increased. Caring for children with life-threatening food allergies has become a major challenge for school personnel Prior to 2002, Massachusetts did not provide clear guidelines to assist schools in providing a safe environment for these children and preparing for an emergency…

  5. Sex Differences in Violent versus Non-Violent Life-Threatening Altruism

    Directory of Open Access Journals (Sweden)

    Carey J. Fitzgerald

    2009-07-01

    Full Text Available Many studies on Hamilton's (1964 inclusive fitness theory have used the burning house and kidney donation examples of life-threatening altruism. However, these examples may not be sufficiently exhibiting the risk involved with life-threatening altruism that would have occurred in hunter-gatherer societies, such as fighting off attackers and/or predators. The present study examined participants' estimated likelihood to perform altruistic acts for specific kin members/friends in two violent life-threatening situations (i.e., being mugged and being chased and two non-violent life-threatening situations (i.e., the burning house and kidney donation examples. Participants were 216 undergraduate students who completed a questionnaire on altruism toward an actual kin member/friend. Each questionnaire contained four life-or-death scenarios (two violent and two non-violent in which either the participant's sibling, cousin, or best friend was in danger and needed help. Results indicated that people were more likely to help siblings than cousins and friends in both the violent and non-violent hypothetical scenarios. Participants indicated a greater likelihood to help people in violent situations than in non-violent situations. Women indicated a greater estimated likelihood than men to help people in non-violent situations while men indicated a greater estimated likelihood than women to help people in violent situations. Both male and female participants indicated a greater estimated likelihood to help women than men in violent situations.

  6. Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma.

    Science.gov (United States)

    Clay, Fiona J; Newstead, Stuart V; Watson, Wendy L; Ozanne-Smith, Joan; McClure, Roderick J

    2010-01-05

    To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social

  7. Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    Blanchard Elizabeth

    2010-07-01

    Full Text Available Abstract Introduction Acquired factor VIII deficiency is a rare entity that can lead to severe and life-threatening bleeding. We describe a case of severe bleeding from the tongue secondary to acquired hemophilia and discuss treatment options, including aminocaproic acid and recombinant factor VIII, which have not been widely reported in the literature for the management of such patients. Case presentation A 94-year-old Caucasian man presented to our institution with diffuse bruising and extensive bleeding from the tongue secondary to mechanical trauma. He had no prior history of bleeding and his medical history was unremarkable except for dementia and hypertension. Coagulation studies revealed a prolonged activated partial thromboplastin time and a mixing study was consistent with the presence of an inhibitor. Quantitative assays revealed a reduced level of factor VIII activity (1% and the presence of a factor VIII inhibitor, measured at seven Bethesda units, in the serum. Oral prednisone therapy (60mg/day was given. He also received intravenous aminocaproic acid and human concentrate of factor VIII (Humate-P and topical anti-thrombolytic agents (100 units of topical thrombin cream. His hospital course was prolonged because of persistent bleeding and the development of profuse melena. He required eight units of packed red blood cells for transfusion. Hospitalization was also complicated by bradycardia of unclear etiology, which started after infusion of aminocaproic acid. His activated partial thromboplastin time gradually normalized. He was discharged to a rehabilitation facility three weeks later with improving symptoms, stable hematocrit and resolving bruises. Conclusions Clinicians should suspect a diagnosis of acquired hemophilia in older patients with unexplained persistent and profound bleeding from uncommon soft tissues, including the tongue. Use of factor VIII (Humate-P and aminocaproic acid can be useful in this coagulopathy but

  8. Lung cancer incidence and risk factors

    International Nuclear Information System (INIS)

    Bairakova, A.

    1993-01-01

    The possibility of developing lung cancer (lc) as a consequence of inhaling hot particles from the Chernobyl accident is discussed. The risk from various factors is reviewed in order to assess the rate of contribution for any of them to carcinogenic process. The conclusions are based on data reported by National Centre of Oncology, Sofia (BG). A total of 2873 new cases have been recorded in 1990. The data for the period 1970-1990 show a crude increase for males and tend to stabilization for females. The similar pattern is obtained in other countries and geographic areas with steady rise of lc cases with about 0.5% per year. The contribution of particular risk factor and its interaction with other factors is assessed on the basis of large number of epidemiologic and experimental studies. The risk of cigarette smoking, as the principal cause for lc, is discussed in various aspects - age, duration, possible dropping the habit. The assessment of another risk factor - exposure to relatively high doses of natural radon daughter products - is more complicated. As an occupational hazard in uranium mines radon and its progeny reveals an increase in excess lc incidence. Regarding radon and its daughters as an environmental risk factor in dwellings, no clear positive relationship between exposure and lc incidence has been observed. In this case the assessment for population living in areas with higher concentration of radon products have to rely on data from uranium mines. Non radiation factors as asbestos, ethers, chromates, metallic iron, nickel, beryllium and arsenic, are also considered. The combined effect of all these factors, as well as of pathological cell processes, viruses, malfunctions of immune system, is mentioned as well. The possibility of interpreting the findings from epidemiological studies within the framework of theoretical multistage models of carcinogenic process is pointed out. (author)

  9. Life-threatening hyperkalemia following zoledronic acid infusion for Paget's disease: a case report

    Directory of Open Access Journals (Sweden)

    Naysmith Morag

    2011-08-01

    Full Text Available Abstract Introduction Zoledronic acid is a highly effective treatment in Paget's disease for persistent bone pain and prevention of further progression of the disease. The commonest electrolyte abnormality is hypocalcemia. To the best of our knowledge this is the first case of hyperkalemia secondary to zoledronic acid to be published in the world literature. The commonest arrhythmia related to zoledronic acid is atrial fibrillation. Case presentation We describe the case of an 80-year-old Caucasian man, with a history of ischemic heart disease, who had an in-hospital cardiac arrest related to hyperkalemia. Increasing potassium levels were noted following his first zoledronic acid infusion for symptomatic control of bone pain secondary to Paget's disease. Our patient suffered a cardiac arrest 10 days following the zoledronic acid infusion. Our patient's biochemistry and electrocardiogram output were monitored until his death 26 days after his cardiac arrest. Our patient developed paroxysmal atrial fibrillation in the post-resuscitation period and there was persistent hyperkalemia that required prolonged treatment with calcium resonium. All other possible causes of hyperkalemia were excluded. Conclusion In our patient's case persistent hyperkalemia and life-threatening arrhythmias were associated with use of zoledronic acid. These side effects have not been reported before and the causative mechanism is far from clear as there are no obvious systemic effects of zoledronic acid. The combination of zoledronic acid with predisposing factors such as structural heart disease might account for the clinical picture we witnessed. As a result, electrolyte monitoring should be adopted early in zoledronic acid use. Further studies are required to elucidate the underlying mechanism of hyperkalemia and identify the target group of patients where zoledronic acid can be safely administered. Great caution is advised in patients with underlying heart conditions.

  10. Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting.

    Science.gov (United States)

    Muscara, F; McCarthy, M C; Woolf, C; Hearps, S J C; Burke, K; Anderson, V A

    2015-07-01

    Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child. WHAT DOES THIS STUDY ADD?: At four weeks following a child's diagnosis of a serious illness, 49-54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15-27% of parents were in the moderate/severe range for depression and anxiety, and 25-31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type. A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury. Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n=53), oncology (n=40) and pediatric intensive care units (n=52), for serious

  11. Incidence And Potential Risk Factors Of Low Birth Weight Among ...

    African Journals Online (AJOL)

    Incidence And Potential Risk Factors Of Low Birth Weight Among Full Term Deliveries. ... (LBW) is a reliable indicator in monitoring and evaluating the success of maternal and child ... Key words: Low birth weight- incidence- associated factors.

  12. The radiology perspective: needs and tools for management of life-threatening events

    International Nuclear Information System (INIS)

    Gaca, Ana Maria; Lerner, Catherine B.; Frush, Donald P.

    2008-01-01

    Studies have shown that life-threatening contrast agent reactions in adults are very rare, and even less common in children. The rarity of severe allergic reactions to contrast material challenges educators to achieve radiology resident competency in this setting. However, using a simulated anaphylactic contrast reaction paradigm, we have drawn two conclusions: (1) Residents are insufficiently prepared to recognize and manage these life-threatening events and (2) with an interactive, computer-based tool we can significantly improve resident performance in these situations. Simulation is a growing tool in medicine and allows standardized resident exposure to uncommon events in a setting that is conducive to resident education without fear of repercussions (see Ruddy and Patterson in this issue of Pediatric Radiology). More important, simulation provides a cornerstone in patient safety resident education without putting patients at risk. (orig.)

  13. Heparin-Induced Cardiac Tamponade and Life-Threatening Hyperkalemia in a Patient with Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    2005-03-01

    Full Text Available Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin-induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin-induced hyperkalemia, an unusual but well-described side effect, is frequently forgotten until life-threatening arrhythmia has occurred. We report a case involving a 40-year-old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life-threatening hyperkalemia were both noted in this patient.

  14. The radiology perspective: needs and tools for management of life-threatening events

    Energy Technology Data Exchange (ETDEWEB)

    Gaca, Ana Maria; Lerner, Catherine B.; Frush, Donald P. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2008-11-15

    Studies have shown that life-threatening contrast agent reactions in adults are very rare, and even less common in children. The rarity of severe allergic reactions to contrast material challenges educators to achieve radiology resident competency in this setting. However, using a simulated anaphylactic contrast reaction paradigm, we have drawn two conclusions: (1) Residents are insufficiently prepared to recognize and manage these life-threatening events and (2) with an interactive, computer-based tool we can significantly improve resident performance in these situations. Simulation is a growing tool in medicine and allows standardized resident exposure to uncommon events in a setting that is conducive to resident education without fear of repercussions (see Ruddy and Patterson in this issue of Pediatric Radiology). More important, simulation provides a cornerstone in patient safety resident education without putting patients at risk. (orig.)

  15. Life-threatening hereditary angio-oedema: Challenges of care in South Africa.

    Science.gov (United States)

    Potter, P; Peter, J

    2018-03-28

    The report and description by Coovadia et al.[1] in this issue of SAMJ of a large cohort of patients in the Western Cape Province of South Africa (SA) suffering from type 1 hereditary angio-oedema (HAE) not only documents for the first time a significant presence of this life-threatening condition on the African continent but highlights the challenges of diagnosis and management in the SA socioeconomic and healthcare context.

  16. Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage

    Directory of Open Access Journals (Sweden)

    Alexander Shaw

    2013-01-01

    Full Text Available Background. Duodenal gastrointestinal stromal tumours (GISTs are an uncommon malignancy of the gastrointestinal (GI tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.

  17. Cisplatin chemotherapy (without erythropoietin) and risk of life-threatening thromboembolic events in carcinoma of the uterine cervix: the tip of the iceberg? A review of the literature

    International Nuclear Information System (INIS)

    Anders, Jon C; Grigsby, Perry W; Singh, Anurag K

    2006-01-01

    The risk of severe cardiovascular toxicity, specifically thromboembolic events (TE), in patients with cervical cancer receiving concurrent irradiation and cisplatin chemotherapy is reported to be less than 1% in several large prospective trials. However, the anecdotal risk appears to be far higher. A review of several prospective trials demonstrates no treatment related grade 4 cardiovascular toxicities and only two grade 5 toxicities in 1424 (0.1%) collective patients. A recent publication and our own unpublished experience finds 6 of 128 (4.7%) patients developed grade 4 to 5 cardiovascular (thrombosis/embolism) toxicity. The differenc in incidence of severe or life threatening cardiovascular toxicity of 0.1 versus 4.7% is highly statistically significant (p < 0.00001.) This dramatic difference in incidence of cardiovascular toxicity raises the possibility that cardiovascular toxicities were inadequately reported on the listed prospective trials. For those patients enrolled in prospective trials, we suggest that thromboses should be diligently documented and reported. Only after the true incidence of thromboses is established can we implement appropriate levels of early screening and intervention that may prevent life threatening complications

  18. Corneal Graft Rejection: Incidence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Alireza Baradaran-Rafii

    2008-12-01

    Full Text Available

    PURPOSE: To determine the incidence and risk factors of late corneal graft rejection after penetrating keratoplasty (PKP. METHODS: Records of all patients who had undergone PKP from 2002 to 2004 without immunosuppressive therapy other than systemic steroids and with at least one year of follow up were reviewed. The role of possible risk factors such as demographic factors, other host factors, donor factors, indications for PKP as well as type of rejection were evaluated. RESULTS: During the study period, 295 PKPs were performed on 286 patients (176 male, 110 female. Mean age at the time of keratoplasty was 38±20 (range, 40 days to 90 years and mean follow up period was 20±10 (range 12-43 months. Graft rejection occurred in 94 eyes (31.8% at an average of 7.3±6 months (range, 20 days to 39 months after PKP. The most common type of rejection was endothelial (20.7%. Corneal vascularization, regrafting, anterior synechiae, irritating sutures, active inflammation, additional anterior segment procedures, history of trauma, uncontrolled glaucoma, prior graft rejection, recurrence of herpetic infection and eccentric grafting increased the rate of rejection. Patient age, donor size and bilateral transplantation had no significant influence on graft rejection. CONCLUSION: Significant risk factors for corneal graft rejection include

  19. Postinfusion Phlebitis: Incidence and Risk Factors

    Science.gov (United States)

    Webster, Joan; McGrail, Matthew; Marsh, Nicole; Wallis, Marianne C.; Ray-Barruel, Gillian; Rickard, Claire M.

    2015-01-01

    Objective. To document the incidence of postinfusion phlebitis and to investigate associated risk factors. Design. Analysis of existing data set from a large randomized controlled trial, the primary purpose of which was to compare routine peripheral intravascular catheter changes with changing catheters only on clinical indication. Participants and Setting. Patients admitted to a large, acute general hospital in Queensland, Australia, and who required a peripheral intravenous catheter. Results. 5,907 PIVCs from 3,283 patients were studied. Postinfusion phlebitis at 48 hours was diagnosed in 59 (1.8%) patients. Fifteen (25.4%) of these patients had phlebitis at removal and also at 48 hours after removal. When data were analyzed per catheter, the rate was lower, 62/5907 (1.1%). The only variable associated with postinfusion phlebitis was placement of the catheter in the emergency room (P = 0.03). Conclusion. Although not a common occurrence, postinfusion phlebitis may be problematic so it is important for health care staff to provide patients with information about what to look for after an intravascular device has been removed. This trial is registered with ACTRN12608000445370. PMID:26075092

  20. Postinfusion Phlebitis: Incidence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Joan Webster

    2015-01-01

    Full Text Available Objective. To document the incidence of postinfusion phlebitis and to investigate associated risk factors. Design. Analysis of existing data set from a large randomized controlled trial, the primary purpose of which was to compare routine peripheral intravascular catheter changes with changing catheters only on clinical indication. Participants and Setting. Patients admitted to a large, acute general hospital in Queensland, Australia, and who required a peripheral intravenous catheter. Results. 5,907 PIVCs from 3,283 patients were studied. Postinfusion phlebitis at 48 hours was diagnosed in 59 (1.8% patients. Fifteen (25.4% of these patients had phlebitis at removal and also at 48 hours after removal. When data were analyzed per catheter, the rate was lower, 62/5907 (1.1%. The only variable associated with postinfusion phlebitis was placement of the catheter in the emergency room (P=0.03. Conclusion. Although not a common occurrence, postinfusion phlebitis may be problematic so it is important for health care staff to provide patients with information about what to look for after an intravascular device has been removed. This trial is registered with ACTRN12608000445370.

  1. Ventricular arrhythmias and sudden cardiac arrest in Takotsubo cardiomyopathy: Incidence, predictive factors, and clinical implications.

    Science.gov (United States)

    Jesel, Laurence; Berthon, Charlotte; Messas, Nathan; Lim, Han S; Girardey, Mélanie; Marzak, Halim; Marchandot, Benjamin; Trinh, Annie; Ohlmann, Patrick; Morel, Olivier

    2018-04-06

    Takotsubo cardiomyopathy (TTC) is a stress-related transient cardiomyopathy. Life-threatening arrhythmias (LTA) can occur and worsen prognosis. The purpose of this study was to assess the incidence and outcome of LTA in TTC, as well as its predictive factors and clinical implications. We studied 214 consecutive cases of TTC over 8 years. The study cohort was divided into 2 groups: those with LTA (LTA group) and those without (non-LTA group). LTA was defined as ventricular tachycardia, ventricular fibrillation, or cardiac arrest. LTA occurred in 10.7% of patients mainly in the first 24 hours of hospitalization: ventricular tachycardia (n = 2), ventricular fibrillation (n = 11), cardiac arrest (n = 10: 5 asystole, 3 complete heart block, and 2 sinoatrial block). LTA were associated with lower left ventricular ejection fraction (LVEF) and a high rate of conduction disturbances. In-hospital (39.1% vs 8.9%; P 105 ms were independent predictors of LTA. In cases where a device was implanted, conduction disturbances persisted after the index event despite complete recovery of LVEF. There was no ventricular arrhythmia recurrence during follow-up. LTA occur early in patients presenting with TTC and is associated with significantly worse short- and long-term prognosis. Left ventricular impairment and QRS duration >105 ms are independent predictors of LTA. Ventricular arrhythmias occurred in the acute phase without further recurrence recorded in hospital survivors, whereas severe conduction disorders persisted during long-term follow-up. These findings may have implications on the choice of device therapy for this specific patient subgroup. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  2. [Pre-hospital management of adults with life-threatening emergencies].

    Science.gov (United States)

    Wattel, Francis; Dubois, François

    2012-01-01

    In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas

  3. Sevoflurane therapy for life-threatening acute severe asthma: a case report.

    Science.gov (United States)

    Ruszkai, Zoltán; Bokrétás, Gergely Péter; Bartha, Péter Töhötöm

    2014-10-01

    Acute severe asthma is a life-threatening form of bronchial constriction in which the progressively worsening airway obstruction is unresponsive to the usual appropriate bronchodilator therapy. Pathophysiological changes restrict airflow, which leads to premature closure of the airway on expiration, impaired gas exchange, and dynamic hyperinflation ("air-trapping"). Additionally, patients suffering from asthma for a prolonged period of time usually have serious comorbidities. These conditions constitute a challenge during the treatment of this disease. Therapeutic interventions are designed to reduce airway resistance and improve respiratory status. To achieve therapeutic goals, appropriate bronchodilator treatment is indispensable, and mechanical ventilation under adequate sedation may also be required. The volatile anesthetic agent, sevoflurane, meets both criteria; therefore, its use can be beneficial and should be considered. A 67-yr-old Caucasian male presented with acute life-threatening asthma provoked by an assumed upper airway infection and non-steroidal anti-inflammatory drug antipyretics, complicated by chronic atrial fibrillation and hemodynamic instability. Due to frequent premature ventricular contractions, conventional treatment was considered unsafe and discontinued, and sevoflurane inhalation was initiated via the AnaConDa (Anaesthetic Conserving Device). Symptoms of life-threatening bronchospasm resolved, and the patient's respiratory status improved within hours. Adequate sedation was also achieved without any hemodynamic adverse effects. The volatile anesthetic agent, sevoflurane, is used widely in anesthesia practice. Its utility for treatment of refractory bronchospasm has been appreciated for years; however, its administration was difficult within the environment of the intensive care unit due to the need for an anesthesia machine and a scavenging system. The introduction of the AnaConDa eliminates these obstacles and makes the use of

  4. A pediatric case of life-threatening airway obstruction caused by a cervicomediastinal thymic cyst

    Energy Technology Data Exchange (ETDEWEB)

    Komura, Makoto; Kanamori, Yutaka; Sugiyama, Masahiko; Iwanaka, Tadashi [University of Tokyo Hospital, Department of Pediatric Surgery, Tokyo (Japan); Fukushima, Noriyoshi [University of Tokyo Hospital, Department of Pathology, Tokyo (Japan)

    2010-09-15

    Most patients with thymic cysts complain of a slowly enlarging, asymptomatic cervical mass. Only 6-10% suffer dysphagia, dyspnoea, stridor, cervical pain or vocal paralysis. In some rare cases sudden onset of severe dyspnoea or asphyxia is the first symptom, especially in neonates and small infants. We report a unique case of a 20-month-old child, who required emergency tracheal intubation due to asphyxia. Cervicomediastinal thymic cyst might need to be included in causes of life-threatening airway obstruction in young children. (orig.)

  5. Successful reversal of life threatening cardiac effect following dosulepin overdose using intravenous lipid emulsion

    DEFF Research Database (Denmark)

    Boegevig, Soeren; Rothe, Anders; Tfelt-Hansen, Jacob

    2011-01-01

    CONTEXT. We report a successful acute reversal of potential life threatening QRS complex widening and prolonged QT interval following dosulepin overdose using intravenous lipid emulsion 20% in an unstable patient. CASE DETAILS. A 36-year-old female following the ingestion of 5.25 g of dosulepin...... became shorter. DISCUSSION. Cyclic antidepressants affect the cardiac conduction system and the myocardium. The exact mechanism of action from intravenous lipid emulsions may not be determined from the data presented, and the obtained effect does not rule out the supposed effects of alkalinisation...

  6. Resolution of a life-threatening complication after lung radiofrequency ablation.

    Science.gov (United States)

    Andreetti, Claudio; Maurizi, Giulio; Cassiano, Francesco; Rendina, Erino Angelo

    2014-10-01

    Lung radiofrequency ablation (RFA) is an option for the treatment of unresectable lung cancer. Clinical investigators have previously warned against severe complications associated with this procedure. We report a case of life-threatening complication after lung RFA for non-operable non-small-cell lung cancer consisting of pulmonary abscess evolving into a bronchopleural fistula, severe pneumothorax and septic pleuritis, which was successfully treated with a multimodal conservative approach. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. Life-Threatening Hypernatremia In A Case Of Diabetes Insipidus/Panhypopituitarism

    Directory of Open Access Journals (Sweden)

    Ekamol Tantisattamo

    2012-06-01

    Water balance is controlled by thyroid, glucocorticoid, and principally ADH working at the renal effector level while the RAAS principally controls sodium balance. Together these hormones tightly regulate serum sodium concentration. Managing hospitalized patients with DI/panhypopituitarism requires knowledge of the intricate interplay between ADH and thyroid/glucocorticoid tone to minimize the risk for dangerous sodium fluctuations. It is usually better to err on the side of mild hyponatremia than holding DDAVP in these complex patients which can lead to life threatening hypernatremia.

  8. Reported incidences and factors associated with percutaneous ...

    African Journals Online (AJOL)

    Microsoft Office User

    precautions, training and reduction of long working hours are necessary in order to reduce infections from .... -4-. Incidences of percutaneous injuries and mucocutaneous blood exposure ... than 40 hours per week (14.9 %) (p= 0.001).

  9. Acute or chronic life-threatening diseases associated with Epstein-Barr virus infection.

    Science.gov (United States)

    Okano, Motohiko; Gross, Thomas G

    2012-06-01

    Infectious mononucleosis (IM) is one of the representative, usually benign, acute diseases associated with primary Epstein-Barr virus (EBV) infection. IM is generally self-limiting and is characterized mostly by transient fever, lymphadenopathy and hepatosplenomegaly. However, very rarely primary EBV infection results in severe or fatal conditions such as hemophagocytic lymphohistiocytosis together with fulminant hepatitis designated as severe or fatal IM or EBV-associated hemophagocytic lymphohistiocytosis alone. In addition, chronic EBV-associated diseases include Burkitt's lymphoma, undifferentiated nasopharyngeal carcinoma, Hodgkin lymphoma, T-cell lymphoproliferative disorder (LPD)/lymphoma, natural killer-cell LPD including leukemia or lymphoma, gastric carcinoma, pyothorax-associated lymphoma and senile B-cell LPD as well as chronic active EBV infection and LPD/lymphoma in patients with immunodeficiency. The number of chronic life-threatening diseases linked to the EBV infection is increasingly reported and many of these diseases have a poor prognosis. This review will focus on the historical, pathogenetic, diagnostic, therapeutic and prophylactic issues of EBV-associated life-threatening diseases.

  10. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail: okabone@gmail.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Frank, Michael, E-mail: michael.frank@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Pellerin, Olivier, E-mail: olivier@pellerin.as; Primio, Massimiliano Di, E-mail: massimiliano.di.primio@gmail.com; Angelopoulos, Georgios, E-mail: giorginos78@msn.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Boughenou, Marie-Fazia, E-mail: marie-fazia.boughenou@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Anesthesia and Surgical Intensive Care Unit (France); Pagny, Jean-Yves, E-mail: jean-yves.pagny@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Messas, Emmanuel, E-mail: emmanuel.messas@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France)

    2013-05-09

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

  11. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    International Nuclear Information System (INIS)

    Okada, Takuya; Frank, Michael; Pellerin, Olivier; Primio, Massimiliano Di; Angelopoulos, Georgios; Boughenou, Marie-Fazia; Pagny, Jean-Yves; Messas, Emmanuel; Sapoval, Marc

    2014-01-01

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture

  12. A case report of life-threatening acute dysphagia in dermatomyositis: Challenges in diagnosis and treatment.

    Science.gov (United States)

    Kwon, Kyoung Min; Lee, Jung Soo; Kim, Yeo Hyung

    2018-04-01

    Although dysphagia is a known complication of dermatomyositis, sudden onset of dysphagia without the notable aggravation of other symptoms can make the diagnosis and treatment challenging. A 53-year-old male diagnosed as dermatomyositis 1 month ago came to our emergency department complaining of a sudden inability to swallow solid foods and liquids. The patient showed generalized edema, but the muscle power was not different compared with 1 month ago. Serum creatine kinase level was lower than that measured 2 weeks ago. Computed tomography scan of the larynx, chest, abdomen, and pelvis, an esophagogastroduodenoscopy, and brain magnetic resonance imaging were unremarkable. A videofluoroscopic swallowing study revealed inadequate pharyngeal contraction and slightly decreased upper esophageal sphincter opening with silent aspiration. Treatment with oral prednisolone, intravenous methylprednisolone, azathioprine, and intravenous immunoglobulins was applied. During the course of medical treatment for life-threatening dysphagia, he continued with rehabilitative therapy. He could swallow saliva at 2 months and showed normal swallowing function at 3 months from the onset of dysphagia. Dysphagia has not recurred for 3 years after recovery. A multidisciplinary approach is necessary to diagnose severe acute dysphagia due to exacerbation of underlying dermatomyositis rather than other structural or neurological causes. Appropriate supportive care is important because dysphagia can be life-threatening and last for a long time.

  13. Threatened fertility and gonadal function after a polytraumatic, life-threatening injury

    Directory of Open Access Journals (Sweden)

    Ward Michael

    2010-01-01

    Full Text Available Trauma literature regarding management of genitalia trauma affecting future fertility and gonadal function in the face of coexisting life-threatening injuries is underdeveloped. We present a unique case that necessitated integrative management of a 24-year-old male who became entangled within the blades of a manure spreader and presented with life-threatening trauma in addition to severe genital trauma, including penile degloving, bilateral testicular avulsion and bilateral spermatic cord laceration. During the initial stabilization and surgical management, urology and plastic surgery were consulted to assess the urogenital injuries. Together, the surgical team orchestrated potentially life-saving interventions while successfully performing both a testicular sperm extraction and a testicular revascularization. Viable sperm was collected on the day of surgery and initial follow-up showed preserved sexual function and adequate perfusion to the testicle. This report presents a case and provides a review discussing the management of traumatic genital injuries and the importance of early involvement of surgical specialties in genitalia trauma to optimize future fertility and gonadal function. The literature search was performed in August 2008 using Medline for articles only in English, including any of the following terms: polytrauma, trauma, penis, testicle, degloving, avulsion, spermatic cord, laceration, fertility, reproduction or revascularization.

  14. Detection of Life Threatening Ventricular Arrhythmia Using Digital Taylor Fourier Transform.

    Science.gov (United States)

    Tripathy, Rajesh K; Zamora-Mendez, Alejandro; de la O Serna, José A; Paternina, Mario R Arrieta; Arrieta, Juan G; Naik, Ganesh R

    2018-01-01

    Accurate detection and classification of life-threatening ventricular arrhythmia episodes such as ventricular fibrillation (VF) and rapid ventricular tachycardia (VT) from electrocardiogram (ECG) is a challenging problem for patient monitoring and defibrillation therapy. This paper introduces a novel method for detection and classification of life-threatening ventricular arrhythmia episodes. The ECG signal is decomposed into various oscillatory modes using digital Taylor-Fourier transform (DTFT). The magnitude feature and a novel phase feature namely the phase difference (PD) are evaluated from the mode Taylor-Fourier coefficients of ECG signal. The least square support vector machine (LS-SVM) classifier with linear and radial basis function (RBF) kernels is employed for detection and classification of VT vs. VF, non-shock vs. shock and VF vs. non-VF arrhythmia episodes. The accuracy, sensitivity, and specificity values obtained using the proposed method are 89.81, 86.38, and 93.97%, respectively for the classification of Non-VF and VF episodes. Comparison with the performance of the state-of-the-art features demonstrate the advantages of the proposition.

  15. Life-threatening event reduces subjective well-being through activating avoidance motivation: a longitudinal study.

    Science.gov (United States)

    Van Dijk, Dina; Seger-Guttmann, Tali; Heller, Daniel

    2013-04-01

    Drawing on the approach-avoidance theory, we have examined the role of avoidance motivation in explaining the negative effects of a life-threatening event on subjective well-being (SWB). Residents of the south of Israel were surveyed during heavy missile attacks in January 2009 (T1; n = 283), and again after 6 months (T2; n = 212) and 1 year (T3; n = 154). During the missile attacks, we also surveyed a group from the center of the country (T1; n = 102), not exposed to the attacks. The results indicate that avoidance motivation was activated by the life threat and further mediated its detrimental influence on SWB measures (positive/negative affects, anxiety, and subjective health). Moreover, within the southern sample, the drop in avoidance motivation over time mediated the parallel drop in SWB. In contrast to avoidance motivation, approach motivation remained stable over time and was related to positive emotions. The role of avoidance and approach motivations in life-threatening situations is further discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  16. Qualitative analysis of factors leading to clinical incidents.

    Science.gov (United States)

    Smith, Matthew D; Birch, Julian D; Renshaw, Mark; Ottewill, Melanie

    2013-01-01

    The purpose of this paper is to evaluate the common themes leading or contributing to clinical incidents in a UK teaching hospital. A root-cause analysis was conducted on patient safety incidents. Commonly occurring root causes and contributing factors were collected and correlated with incident timing and severity. In total, 65 root-cause analyses were reviewed, highlighting 202 factors implicated in the clinical incidents and 69 categories were identified. The 14 most commonly occurring causes (encountered in four incidents or more) were examined as a key-root or contributory cause. Incident timing was also analysed; common factors were encountered more frequently during out-hours--occurring as contributory rather than a key-root cause. In total, 14 commonly occurring factors were identified to direct interventions that could prevent many clinical incidents. From these, an "Organisational Safety Checklist" was developed to involve departmental level clinicians to monitor practice. This study demonstrates that comprehensively investigating incidents highlights common factors that can be addressed at a local level. Resilience against clinical incidents is low during out-of-hours periods, where factors such as lower staffing levels and poor service provision allows problems to escalate and become clinical incidents, which adds to the literature regarding out-of-hours care provision and should prove useful to those organising hospital services at departmental and management levels.

  17. Idiopathic factor VIII inhibitor autoantibody in a man presented after accident.

    NARCIS (Netherlands)

    Mansouritorghabeh, H.; Lak, M.; Heerde, W.L. van

    2009-01-01

    Acquired hemophilia A is a rare but severe autoimmune bleeding disorder caused by autoantibodies against factor VIII activity and is a potentially life-threatening hemorrhagic disorder. The incidence of acquired hemophilia A has been estimated as 1.48 cases per million per year. The overall rate of

  18. Human factors analysis of incident/accident report

    International Nuclear Information System (INIS)

    Kuroda, Isao

    1992-01-01

    Human factors analysis of accident/incident has different kinds of difficulties in not only technical, but also psychosocial background. This report introduces some experiments of 'Variation diagram method' which is able to extend to operational and managemental factors. (author)

  19. Factors influencing incident reporting in surgical care.

    Science.gov (United States)

    Kreckler, S; Catchpole, K; McCulloch, P; Handa, A

    2009-04-01

    To evaluate the process of incident reporting in a surgical setting. In particular: the influence of event outcome on reporting behaviour; staff perception of surgical complications as reportable events. Anonymous web-based questionnaire survey. General Surgical Department in a UK teaching hospital. Of 203 eligible staff, 55 (76.4%) doctors and 82 (62.6%) nurses participated. Knowledge and use of local reporting system; propensity to report incidents which vary by outcome (harm, no harm, harm prevented); propensity to report surgical complications; practical and psychological barriers to reporting. Nurses were significantly more likely to know of the local reporting system and to have recently completed a report than doctors. The level of harm (F(1.8,246) = 254.2, pvs 53%, z = 4.633, psystems.

  20. Panhypopituitarism presenting as life-threatening heart failure caused by an inherited microdeletion in 1q25 including LHX4.

    Science.gov (United States)

    Filges, Isabel; Bischof-Renner, Andrea; Röthlisberger, Benno; Potthoff, Christian; Glanzmann, René; Günthard, Joëlle; Schneider, Jacques; Huber, Andreas R; Zumsteg, Urs; Miny, Peter; Szinnai, Gabor

    2012-02-01

    Clinical presentation of hypopituitarism in the neonate may be variable, ranging from absent to severe nonspecific symptoms and may be life-threatening in patients with adrenocorticotropic hormone deficiency. The LIM homeobox gene 4 (LHX4) transcription factor regulates early embryonic development of the anterior pituitary gland. Autosomal dominant mutations in LHX4 cause congenital hypopituitarism with variable combined pituitary hormone deficiency (CPHD). We report on a neonate with unexplained heart failure and minor physical anomalies, suggesting a midline defect. She was diagnosed with complete CPHD. Cardiac function was rescued by replacement with hydrocortisone and thyroxine; hypoglycaemia stopped under growth hormone therapy. Magnetic resonance imaging revealed a dysgenetic pituitary gland suggesting an early developmental defect. Array comparative genomic hybridization showed a maternally inherited 1.5-megabase microdeletion in 1q25.2q25.3, including the LHX4 gene. Haploinsufficiency of LHX4 likely explains the predominant pituitary phenotype in the proposita and we suggest variable intrafamilial penetrance of the inherited microdeletion. To the best of our knowledge, we are the first to report on heart failure as a rare nonspecific symptom of treatable CPHD in the newborn. Variably penetrant pituitary insufficiency, including this severe and atypical presentation, can be correlated with LHX4 insufficiency and highlights the role of LHX4 for pituitary development.

  1. Life-threatening subdural hematoma after aortic valve replacement in a patient with Heyde syndrome: a case report.

    Science.gov (United States)

    Uchida, Tetsuro; Hamasaki, Azumi; Ohba, Eiichi; Yamashita, Atsushi; Hayashi, Jun; Sadahiro, Mitsuaki

    2017-08-08

    Heyde syndrome is known as a triad of calcific aortic stenosis, anemia due to gastrointestinal bleeding from angiodysplasia, and acquired type 2A von Willebrand disease. This acquired hemorrhagic disorder is characterized by the loss of the large von Willebrand factor multimers due to the shear stress across the diseased aortic valve. The most frequently observed type of bleeding in these patients is mucosal or skin bleeding, such as epistaxis, followed by gastrointestinal bleeding. On the other hand, intracranial hemorrhage complicating Heyde syndrome is extremely rare. A 77-year-old woman presented to our hospital with severe aortic stenosis and severe anemia due to gastrointestinal bleeding and was diagnosed with Heyde syndrome. Although aortic valve replacement was performed without recurrent gastrointestinal bleeding, postoperative life-threatening acute subdural hematoma occurred with a marked midline shift. Despite prompt surgical evacuation of the hematoma, she did not recover consciousness and she died 1 month after the operation. Postoperative subdural hematoma is rare, but it should be kept in mind as a devastating hemorrhagic complication, especially in patients with Heyde syndrome.

  2. Acid Gastroesophageal Reflux Disease and Apparent Life-Threatening Events: Simultaneous pH-metry and Cardiorespiratory Monitoring.

    Science.gov (United States)

    Macchini, Francesco; Morandi, Anna; Cognizzoli, Paola; Farris, Giorgio; Gentilino, Valerio; Zanini, Andrea; Leva, Ernesto

    2017-02-01

    To investigate the prevalence and the characteristics of gastroesophageal reflux disease (GERD) in infants with apparent life threatening events (ALTE). Infants with at least one episode of ALTE in absence of predisposing factors were included. All infants underwent a cardiorespiratory recording with simultaneous 24-hour pH-monitoring. Patients were divided into 3 groups according to the severity of GERD: A. Reflux Index (RI) 7%. Monthly evaluations were performed and the anti-reflux therapy was maintained till normalization of monitoring and clinic. 41 infants were enrolled. GERD was found in 80% of patients (moderate in 54%, severe in 27%). A normalization of the cardiorespiratory tracks was recorded on average after 1 month for group A, 7 months for the group B and 9.5 months for group C. A significant difference was registered between group A and both group B and C (P < 0.0001), as well as between the group B and C (P < 0.05). GERD influences significantly the time of normalization of the cardiorespiratory monitoring in infants with ALTE. GERD diagnosis and treatment are mandatory in these patients. Copyright © 2016. Published by Elsevier B.V.

  3. Docetaxel induced Lyell′s syndrome: A rare life threatening cause of dermatitis medicamentosas

    Directory of Open Access Journals (Sweden)

    Faheem Arshad

    2014-01-01

    Full Text Available Lyell′s syndrome or toxic epidermal necrolysis (TEN is a life threatening complication mostly caused by medications, characterized by desquamative lesions of the skin and mucous membranes with 30 percent or more epidermal involvement along with mucus membrane. We report a rare case of toxic epidermal necrolysis following administration of docetaxel, a semi-synthetic taxane. A female diagnosed as having metastatic breast carcinoma received chemotherapy in form of docetaxel after being exposed to adjuvant chemotherapy, developed severe involvement of skin and mucus membrane. Diagnosis of TEN was made and she was managed with steroids, antibiotics, intravenous fluids and antiseptic dressings. Common toxicities reported with this drug include myelosuppression, alopecia, nail damage, erythema multiforme major and neuropathy. We believe this is the first case report of Lyell′s syndrome following docetaxel. Main aim of this case is to make physicians aware of the severe skin reactions with docetaxel, measures to avoid them, early recognition and prompt treatment.

  4. Premenstrual Exacerbation of Life-Threatening Asthma: Effect of Gonadotrophin Releasing Hormone Analogue Therapy

    Directory of Open Access Journals (Sweden)

    Alun L Edwards

    1996-01-01

    Full Text Available Variability in the severity of asthma during various phases of the menstrual cycle has been frequently suspected. However, the hormonal changes that might affect mediators of bronchospasm have yet to be elucidated. The case of a 41-year-old woman suffering from longstanding asthma with life-threatening exacerbations is reported. The patient was treated with buserelin, a gonadotropin releasing hormone (GnRH analogue, which created a temporary chemical menopause and thus permitted diagnosis of a premenstrual exacerbation of asthma and offered insight into potential therapy. GnRH analogues may therefore be of value in assessing women with severe asthma suspected to vary with the menstrual cycle. The addition of estrogens and progestins at the same time as treatment with GnRH analogue may be of value in determining the role of these hormones in the pathogenesis of menstrually related exacerbations of asthma.

  5. Thyrotoxic periodic paralysis in a Saudi patient complicated by life-threatening arrhythmia

    International Nuclear Information System (INIS)

    Aldasouqi, Saleh; Bokhari, Samia A; Khan, Patan M; AlZahrani, Ali S

    2009-01-01

    Thyrotoxic periodic paralysis (TPP) is rare in non-Orientals, and sporadic case reports were reported world-wide. Eight cases were reported in Arabs, including 3 Saudis. We present an additional case of TPP in a 38-year-old Saudi man, and review the literature on TPP in Arabs. Our patient presented with complete flaccid quadriplegia, 5 weeks after he was diagnosed with Graves' disease that was treated with carbimazole and propranolol. He was hyperthyroid, and his potassium was extremely low (1.5 mmol/L). During initial evaluation in the emergency room, he developed transient asystole manifested by syncope. He was resuscitated and his hypokalemia was corrected, and he had a full recovery. This case emphasizes the notion that TPP can occur in patients of any ethnic background. The development of serious cardiac complications in our patient underscores the importance of early and correct diagnosis of this potentially life-threatening complication of hyperthyroidism. (author)

  6. Life-threatening intoxication with methylene bis(thiocyanate: clinical picture and pitfalls. A case report

    Directory of Open Access Journals (Sweden)

    Schnuelle Peter

    2006-04-01

    Full Text Available Abstract Background Methylene bis(thiocyanate (MBT is a microbiocidal agent mainly used in industrial water cooling systems and paper mills as an inhibitor of algae, fungi, and bacteria. Case presentation We describe the first case of severe intoxication following inhalation of powder in an industrial worker. Profound cyanosis and respiratory failure caused by severe methemoglobinemia developed within several minutes. Despite immediate admission to the intensive care unit, where mechanical ventilation and hemodialysis for toxin elimination were initiated, multi-organ failure involving liver, kidneys, and lungs developed. While liver failure was leading, the patient was successfully treated with the MARS (molecular adsorbent recirculating system procedure. Conclusion Intoxication with MBT is a potentially life-threatening intoxication causing severe methemoglobinemia and multi-organ failure. Extracorporeal liver albumin dialysis (MARS appears to be an effective treatment to allow recovery of hepatic function.

  7. Life-threatening macroglossia after posterior fossa surgery: a surgical positioning problem?

    Science.gov (United States)

    Vermeersch, G; Menovsky, T; De Ridder, D; De Bodt, M; Saldien, V; Van de Heyning, P

    2014-01-01

    A 55-year-old woman was operated in the lateral park bench position with significant neck flexion and oral packing. Macroglossia was noticed immediately postoperatively after endotracheal extubation. The patient was reintubated for 13 days and subsequently required a tracheostoma. After the placement of the tracheostoma and the removal of the endotracheal tube, the congestion of the tongue decreased markedly within 24 hours. Macroglossia is a rare complication following posterior fossa procedures with few cases reported so far. It can cause airway obstruction, which could be a life-threatening complication, and it therefore requires prompt treatment. The aetiology of postoperative macroglossia remains uncertain and has been attributed to arterial, venous and lymphatic compression, mechanical compression, or neurogenic causes. This article describes new insights into aetiology and also describes preventive measures and possible treatment.

  8. Headache associated with sexual activity: From the benign to the life threatening

    Directory of Open Access Journals (Sweden)

    Frank Aiwansoba Imarhiagbe

    2016-01-01

    Full Text Available Background: Neurologic syndromes like headache may on occasion complicate sexual activity. Though largely benign, the headache may seldom be a symptom of an underlying sinister and life threatening neurologic disorder such as aneurysmal subarachnoid heamorrhage. Method: Relevant published materials on the subject of headache associated with sexual intercourse and their cross references from Pubmed Medline, Cochrane Library, International Headache society, EMBASE and other relevant bibliographic repositories were ferreted since 1980 till date. Result: HAS is mainly a diagnosis of exclusion. The secondary or malignant form has a course that is dictated by its underlying cause. HAS in the primary or benign form is amenable to treatment with drugs including indomethacin, propranolol and calcium channel blockers (nimodipine, verapamil and diltiazem with excellent prognosis. Conclusion: Early evaluation for underlying cause of HAS and institution of appropriate treatment is recommended.

  9. The dorsolateral periaqueductal gray and its role in mediating fear learning to life threatening events.

    Directory of Open Access Journals (Sweden)

    Grasielle C Kincheski

    Full Text Available The dorsolateral column of the periaqueductal gray (dlPAG integrates aversive emotional experiences and represents an important site responding to life threatening situations, such as hypoxia, cardiac pain and predator threats. Previous studies have shown that the dorsal PAG also supports fear learning; and we have currently explored how the dlPAG influences associative learning. We have first shown that N-methyl-D-aspartate (NMDA 100 pmol injection in the dlPAG works as a valuable unconditioned stimulus (US for the acquisition of olfactory fear conditioning (OFC using amyl acetate odor as conditioned stimulus (CS. Next, we revisited the ascending projections of the dlPAG to the thalamus and hypothalamus to reveal potential paths that could mediate associative learning during OFC. Accordingly, the most important ascending target of the dlPAG is the hypothalamic defensive circuit, and we were able to show that pharmacological inactivation using β-adrenoceptor blockade of the dorsal premammillary nucleus, the main exit way for the hypothalamic defensive circuit to thalamo-cortical circuits involved in fear learning, impaired the acquisition of the OFC promoted by NMDA stimulation of the dlPAG. Moreover, our tracing study revealed multiple parallel paths from the dlPAG to several thalamic targets linked to cortical-hippocampal-amygdalar circuits involved in fear learning. Overall, the results point to a major role of the dlPAG in the mediation of aversive associative learning via ascending projections to the medial hypothalamic defensive circuit, and perhaps, to other thalamic targets, as well. These results provide interesting perspectives to understand how life threatening events impact on fear learning, and should be useful to understand pathological fear memory encoding in anxiety disorders.

  10. Situational and Age-Dependent Decision Making during Life Threatening Distress in Myotis macrodactylus.

    Directory of Open Access Journals (Sweden)

    Xiaobin Huang

    Full Text Available Echolocation and audiovocal communication have been studied extensively in bats. The manner in which these abilities are incorporated within escape behaviors during life-threatening distress is largely unknown. Here we tested the hypothesis that behavioral response profiles expressed during distress are relatively stereotypic given their evolutionary adaptations to avoid predators. We subjected juvenile and adult big-footed myotis (Myotis macrodactylus to a sequence of three types of life threatening distress: 1 trapping them in a mist-net (environmental threat, 2 approaching them when trapped (predator threat, and 3 partially restraining their freedom to move (arrest, and recorded their escape behavior in each of the three conditions. Response profiles differed across individuals and with the context in which they were expressed. During environmental and predator threat, bats displayed significantly more biting and wing-flapping behaviors and emitted more echolocation pulses than during arrest. Response profiles also varied with age. During arrest, juveniles were more likely than adults to emit distress calls and vice-versa for biting and wing flapping during environmental and predator threat. Overall, individualized response profiles were classified into ten clusters that were aligned along two divergent response trajectories when viewed within two-dimensional, multifactorial decision space. Juvenile behaviors tended to follow a predominantly "social-dependence" trajectory, whereas adult behaviors were mostly aligned along a "self-reliance" trajectory. We conclude that bats modify their vocal behavior and make age-appropriate and contextually adaptive decisions when distressed. This decision-making ability is consistent with observations in other social species, including humans.

  11. The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors.

    Science.gov (United States)

    Swinbourne, F; Jeffery, N; Tivers, M S; Artingstall, R; Bird, F; Charlesworth, T; Doran, I; Freeman, A; Hall, J; Hattersley, R; Henken, J; Hughes, J; de la Puerta, B; Rutherford, L; Ryan, T; Williams, H; Woods, S; Nicholson, I

    2017-09-01

    The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence. © 2017 British Small Animal Veterinary Association.

  12. An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS).

    Science.gov (United States)

    Sloan, Danetta Hendricks; BrintzenhofeSzoc, Karlynn; Kichline, Tiffany; Baker, Karen; Pinzon, Jean-Paul; Tafe, Christina; Li, Lingsheng; Cheng, M Jennifer; Berger, Ann

    2017-01-01

    Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS) assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho-social-spiritual homeostasis. Preliminary examination of responses to items on the HEALS and examination of the factor structure. The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument. Outcome testing of sample adequacy using Kaiser-Meyer-Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach's a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1) religion; 2) spirituality, demonstrated by a) interaction with a religious community and b) belief in higher power; 3) intrapersonal; and 4) interpersonal relationships expressed through psychological changes resulting in enhanced outlook and improvement in relationships with family and friends. This study involved the initial step to commence the process of scale validation, with promising outcomes identifying subscales as an effective way to assess the construct of

  13. Shoulder Dystocia: Incidence and Risk Factors.

    Science.gov (United States)

    Ouzounian, Joseph G

    2016-12-01

    Shoulder dystocia complicates ∼1% of vaginal births. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part its occurrence remains largely unpredictable and unpreventable.

  14. Social, institutional, and psychological factors affecting wildfire incident decision making

    Science.gov (United States)

    Matthew P. Thompson

    2014-01-01

    Managing wildland fire incidents can be fraught with complexity and uncertainty. Myriad human factors can exert significant influence on incident decision making, and can contribute additional uncertainty regarding programmatic evaluations of wildfire management and attainment of policy goals. This article develops a framework within which human sources of uncertainty...

  15. Incidence and risk factors for thrombocytopenia in the intensive care ...

    African Journals Online (AJOL)

    the incidence, risk factors and transfusion requirements of thrombocytopenia in tertiary care ICUs in northern India. Objective. To study the incidence and ... [1] Thrombocytopenia has been found to predispose patients to increased ... any intracranial bleed or any bleed associated with a fall in haemoglobin by at least 2 g/dL.

  16. Incidence of risk factors for hearing impairment in premature babies

    Directory of Open Access Journals (Sweden)

    Nikolić Mina

    2016-01-01

    Full Text Available According to the World Health Organization, the incidence of hearing impairment in newborn population is 1-3 per 1000 (WHO, 2012. Apart from that, many authors have found that the incidence of hearing impairment is twenty times higher, 2-4%, in neonatal intensive care unit (NICU. Thus, a congenital hearing loss is the most frequent sensory or motor deficit that could be diagnosed immediately upon birth. The objective of this study was to determine the incidence of risk factors for hearing impairment in the population of preterm babies. We were especially interested in the impact of gestational age at birth on the incidence of risk factors for hearing loss. A cohort of 150 preterm babies was enrolled in the study. They were hospitalized in the Institute for Neonatology in Belgrade during 2014 and 2015 and the data were obtained from their medical files. The results of this study indicate high incidence of risk factors for hearing impairment in this population of babies. Gestational age at birth had a strong, statistically significant, correlation with risk factor incidence in lower gestational age and vice versa. High incidence of risk factors and their interaction could account for twenty times higher occurrence of congenital and early acquired hearing loss in population of preterm babies compared to term neonates. These results imply the need for systematic audiological surveillance of prematurely born babies at least until 12 months of corrected age.

  17. Bandit strategies evaluated in the context of clinical trials in rare life-threatening diseases.

    Science.gov (United States)

    Villar, Sofía S

    2018-04-01

    In a rare life-threatening disease setting the number of patients in the trial is a high proportion of all patients with the condition (if not all of them). Further, this number is usually not enough to guarantee the required statistical power to detect a treatment effect of a meaningful size. In such a context, the idea of prioritizing patient benefit over hypothesis testing as the goal of the trial can lead to a trial design that produces useful information to guide treatment, even if it does not do so with the standard levels of statistical confidence. The idealised model to consider such an optimal design of a clinical trial is known as a classic multi-armed bandit problem with a finite patient horizon and a patient benefit objective function. Such a design maximises patient benefit by balancing the learning and earning goals as data accumulates and given the patient horizon. On the other hand, optimally solving such a model has a very high computational cost (many times prohibitive) and more importantly, a cumbersome implementation, even for populations as small as a hundred patients. Several computationally feasible heuristic rules to address this problem have been proposed over the last 40 years in the literature. In this article we study a novel heuristic approach to solve it based on the reformulation of the problem as a Restless bandit problem and the derivation of its corresponding Whittle index rule. Such rule was recently proposed in the context of a clinical trial in Villar et al (2015). We perform extensive computational studies to compare through both exact value calculations and simulated values the performance of this rule, other index rules and simpler heuristics previously proposed in the literature. Our results suggest that for the two and three-armed case and a patient horizon less or equal than a hundred patients, all index rules are a priori practically identical in terms of the expected proportion of success attained when all arms start

  18. Trends in a Life Threatening Condition: Morbid Obesity in Dutch, Turkish and Moroccan Children in The Netherlands

    NARCIS (Netherlands)

    Dommelen, P. van; Schönbeck, Y.; Buuren, S. van; Hirasing, R.

    2014-01-01

    Background: Morbid obesity can be a life threatening condition. The aim of our study is to assess the trend in morbid obesity in The Netherlands among children of Dutch origin since 1980, and among children of Turkish and Moroccan origin since 1997. Methods and Findings: Cross-sectional height and

  19. Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: a case report

    NARCIS (Netherlands)

    Engelen, Marc; Nederkoorn, Paul J.; Smits, Marion; van de Beek, Diederik

    2009-01-01

    Minor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral anticoagulation

  20. Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: A case report

    NARCIS (Netherlands)

    M. Engelen (Marc); P.J. Nederkoorn (Paul); M. Smits (Marion); D. van de Beek (Diederik)

    2009-01-01

    textabstractMinor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral

  1. Trends in a life threatening condition : Morbid obesity in Dutch, Turkish and Moroccan children in the Netherlands

    NARCIS (Netherlands)

    Van Dommelen, Paula; Schönbeck, Yvonne; Van Buuren, Stef; HiraSing, Remy A.

    2014-01-01

    Background: Morbid obesity can be a life threatening condition. The aim of our study is to assess the trend in morbid obesity in The Netherlands among children of Dutch origin since 1980, and among children of Turkish and Moroccan origin since 1997. Methods and Findings: Cross-sectional height and

  2. TECRL, a new life-threatening inherited arrhythmia gene associated with overlapping clinical features of both LQTS and CPVT

    NARCIS (Netherlands)

    Devalla, Harsha D.; Gélinas, Roselle; Aburawi, Elhadi H.; Beqqali, Abdelaziz; Goyette, Philippe; Freund, Christian; Chaix, Marie-A.; Tadros, Rafik; Jiang, Hui; Le Béchec, Antony; Monshouwer-Kloots, Jantine J.; Zwetsloot, Tom; Kosmidis, Georgios; Latour, Frédéric; Alikashani, Azadeh; Hoekstra, Maaike; Schlaepfer, Jurg; Mummery, Christine L.; Stevenson, Brian; Kutalik, Zoltan; de Vries, Antoine Af; Rivard, Léna; Wilde, Arthur Am; Talajic, Mario; Verkerk, Arie O.; Al-Gazali, Lihadh; Rioux, John D.; Bhuiyan, Zahurul A.; Passier, Robert

    2016-01-01

    Genetic causes of many familial arrhythmia syndromes remain elusive. In this study, whole-exome sequencing (WES) was carried out on patients from three different families that presented with life-threatening arrhythmias and high risk of sudden cardiac death (SCD). Two French Canadian probands

  3. Life-threatening angio-oedema after the first dose of an ACE inhibitor-not an anaphylactic reaction

    DEFF Research Database (Denmark)

    Krogh Nielsen, Troels; Bygum, Anette; Rye Rasmussen, Eva

    2016-01-01

    We present a case of a 60-year-old Caucasian woman, with no prior history of swellings, who was admitted to a hospital due to life-threatening angio-oedema. She had, the previous day, been prescribed an ACE inhibitor for her essential hypertension. She had taken one tablet at night-time, and awoke...

  4. Effectiveness of storytelling interventions on psychosocial outcomes in adult patients with a life-threatening illness: a systematic review protocol.

    Science.gov (United States)

    Schoenau, Mai Nanna; Jackson, Inger Marie

    2016-06-01

    The objective of this review is to identify the effectiveness of storytelling interventions on psychosocial outcomes. In this review, storytelling is where adult patients with a life-threatening illness tell their illness story, facilitated by a healthcare professional.Specifically the review questions are.

  5. Risk factors for first time incidence sciatica: a systematic review.

    Science.gov (United States)

    Cook, Chad E; Taylor, Jeffrey; Wright, Alexis; Milosavljevic, Steven; Goode, Adam; Whitford, Maureen

    2014-06-01

    Characteristically, sciatica involves radiating leg pain that follows a dermatomal pattern along the distribution of the sciatic nerve. To our knowledge, there are no studies that have investigated risk factors associated with first time incidence sciatica. The purpose of the systematic review was to identify the longitudinal risk factors associated with first time incidence sciatica and to report incidence rates for the condition. For the purposes of this review, first time incidence sciatica was defined as either of the following: 1) no prior history of sciatica or 2) transition from a pain-free state to sciatica. Studies included subjects of any age from longitudinal, observational, cohort designs. The study was a systematic review. Eight of the 239 articles identified by electronic search strategies met the inclusion criteria. Risk factors and their respective effect estimates were reported using descriptive analysis and the preferred reporting items for systematic reviews and meta-analyses guidelines. Modifiable risk factors included smoking, obesity, occupational factors and health status. Non-modifiable factors included age, gender and social class. Incidence rates varied among the included studies, in part reflecting the variability in the operationalized definition of sciatica but ranged from sciatica are modifiable, suggesting the potential benefits of primary prevention. In addition, those risk factors are also associated with unhealthy lifestyles, which may function concomitantly toward the development of sciatica. Sciatica as a diagnosis is inconsistently defined among studies. © 2013 John Wiley & Sons, Ltd.

  6. Life-threatening emphysematous liver abscess associated with poorly controlled diabetes mellitus: a case report.

    Science.gov (United States)

    Takano, Yuichi; Hayashi, Masafumi; Niiya, Fumitaka; Nakanishi, Toru; Hanamura, Shotaro; Asonuma, Kunio; Yamamura, Eiichi; Gomi, Kuniyo; Kuroki, Yuichiro; Maruoka, Naotaka; Inoue, Kazuaki; Nagahama, Masatsugu

    2017-03-06

    Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care. The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged. Emphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.

  7. Oropharyngeal Dysphagia Is Strongly Correlated With Apparent Life-Threatening Events.

    Science.gov (United States)

    Duncan, Daniel R; Amirault, Janine; Mitchell, Paul D; Larson, Kara; Rosen, Rachel L

    2017-08-01

    The aim of the present study was to investigate the prevalence of oropharyngeal dysfunction with resultant aspiration in patients admitted after apparent life-threatening events (ALTE) and to determine whether historical characteristics could predict this oropharyngeal dysphagia and aspiration risk. We retrospectively reviewed the records of all patients admitted to Boston Children's Hospital between 2012 and 2015 with a diagnosis of ALTE to determine the frequency of evaluation for oropharyngeal dysphagia using video fluoroscopic swallow studies (VFSS) and clinical feeding evaluations, to determine the prevalence of swallowing dysfunction in subjects admitted after ALTE and to compare presenting historical characteristics to swallow study results. A total of 188 children were admitted with a diagnosis of ALTE of which 29% (n = 55) had an assessment of swallowing by VFSS. Of those who had a VFSS, 73% (n = 40) had evidence of aspiration or penetration on VFSS. Of all of the diagnostic tests ordered on patients with ALTEs, the VFSS had the highest rate of abnormalities of any test ordered. None of the historical characteristics of ALTE predicted which patients were at risk for aspiration. In patients who had both clinical feeding evaluations and VFSS, observed clinical feedings incorrectly identified 26% of patients as having no oropharyngeal dysphagia when in fact aspiration was present on VFSS. Oropharyngeal dysphagia with aspiration is the most common diagnosis identified in infants presenting with ALTEs. The algorithm for ALTE should be revised to include an assessment of VFSS as clinical feeding evaluations are inadequate to assess for aspiration.

  8. Parental explicit heuristics in decision-making for children with life-threatening illnesses.

    Science.gov (United States)

    Renjilian, Chris B; Womer, James W; Carroll, Karen W; Kang, Tammy I; Feudtner, Chris

    2013-02-01

    To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.

  9. Life-Threatening Hypercalcemia During Prodrome of Pneumocystis jiroveci Pneumonia in an Immunocompetent Infant

    Directory of Open Access Journals (Sweden)

    Judith Sebestyen VanSickle MD

    2017-04-01

    Full Text Available Severe hypercalcemia in infants is usually attributed to genetic etiologies and less commonly to acquired ones. An 8-week-old girl presented with failure to thrive, mild respiratory distress, and life-threatening hypercalcemia (23.5 mg/dL. Serum 1,25(OH2-vitamin D (1,25(OH2-D level was elevated and parathyroid hormone undetectable. Evaluation for genetic mutations and malignant etiologies of hypercalcemia was negative. Treatment with intravenous hydration, loop diuretic, and calcitonin failed to correct the hypercalcemia, which was subsequently controlled with bisphosphonate therapy. Due to progressive respiratory deterioration, a bronchopulmonary lavage was done on day 17 of her hospitalization disclosing Pneumocystis jiroveci infection. The subsequent immunological investigation showed no abnormalities. She was treated with trimethoprim/sulfamethoxazole resulting in gradual clearing of her lungs and normalization of serum 1,25(OH2-D level. A year later, she remains healthy with normal biochemical parameters of mineral metabolism. We conclude that in a child with hypercalcemia with suppressed parathyroid hormone and elevated 1,25(OH2-D, once the genetic etiology for elevated 1,25(OH2-D and malignancy are ruled out, one should investigate closely for a chronic granulomatous disease. Among the latter Pneumocystis jiroveci pneumonia infection should be considered even in an immunocompetent child.

  10. Splenic Abscess: An Uncommon Entity with Potentially Life-Threatening Evolution

    Directory of Open Access Journals (Sweden)

    Mei-Chun Lee

    2018-01-01

    Full Text Available Background/Purpose. Splenic abscess is rare with potentially life-threatening evolution. The aim of this study is to review the clinical features, microbiological etiologies, treatment, and outcomes of patients with splenic abscess. Methods. We reviewed the admitted patients with suspected splenic abscess and made the diagnosis of splenic abscess. The clinical characteristics, underlying diseases, treatment course, organism spectra, abscess number and size, therapeutic methods, and clinical outcome at a tertiary medical center in Taiwan over a period of 5 years were analyzed. Results. Of 16 patients with splenic abscess, the male to female ratio was 1 : 1. Common presentations were fever (11 patients, 68.7%, diffuse abdominal pain (6 patients, 37.5%, left upper quadrant pain or tenderness (6 patients, 37.5%, and left-sided pleural effusions (8 patients, 50%. Antimicrobial therapy was administered in all patients. Fourteen (87.5% patients recovered under medical treatment. One (6.2% patient underwent splenectomy, four (25% patients performed percutaneous drainage of their splenic abscess, and 11 (68.7% patients received antimicrobial therapy alone. Conclusion. We noted that mortality may be more related to patients with underlying immunodeficiency. Patients with splenic abscesses receiving antimicrobial therapy alone were in a relatively high proportion and got a good prognosis especially in patients with small and multiple abscesses.

  11. Life-Threatening Retropharyngeal Hemorrhage Secondary to Rupture of the Inferior Thyroid Artery

    Directory of Open Access Journals (Sweden)

    Cristina G. Calogero

    2015-01-01

    Full Text Available Inferior thyroid artery (ITA rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm anteroposteriorly and extended from the level of the lower nasopharynx, down the neck into the retropharyngeal and danger space and into the mediastinum posterior to the esophagus, overall approximately 25 cm. The larynx was deviated anteriorly and there was esophageal compression. An emergent arteriogram and catheterization confirmed bleeding from branches of the ITA, and successful embolization was performed. It is important to recognize the ITA rupture as a potential etiology of an acute airway compromise. In emergent situations, while securing an airway is a priority, rapidly initiating diagnostic testing to confirm the diagnosis and arranging for arterial embolization can be life-saving.

  12. A rare life-threatening disease: unilateral kidney compressed by huge chronic spontaneous retroperitoneal hemorrhage

    Directory of Open Access Journals (Sweden)

    Lu HY

    2018-03-01

    Full Text Available Hao-Yuan Lu,1,* Wei Wei,2,* Qi-Wei Chen,1,* Qing-Gui Meng,1 Gao-Hua Hu,1 Xian-Lin Yi,1,3 Xian-Zhong Bai1 1Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China; 2Department of Radiology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021,China; 3Hubei Engineering Laboratory for Synthetic Microbiology, Wuhan Institute of Biotechnology, Wuhan 430075, China *These authors contributed equally to this work Objectives: To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage. Case descriptions: A 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared. Results: The first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma. Conclusion: Conservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition. Keywords: kidney, spontaneous, retroperitoneal, hemorrhage, surgery

  13. Incidence and risk factors of neonatal thrombocytopenia: a pr

    Directory of Open Access Journals (Sweden)

    Nila Kusumasari

    2010-03-01

    Conclusions The incidence of neonatal thrombocytopenia was 12.2%. Significant risk factor of mother that caused thrombocytopenia was pre-eclampsia, while risk factors of neonates were asphyxia, sepsis and necrotizing enterocolitis.[Paediatr Indones. 2010;50:31-7].

  14. Incidence and predicting factors of falls of older inpatients

    Directory of Open Access Journals (Sweden)

    Hellen Cristina de Almeida Abreu

    2015-01-01

    Full Text Available OBJECTIVE To estimate the incidence and predicting factors associated with falls among older inpatients. METHODS Prospective cohort study conducted in clinical units of three hospitals in Cuiaba, MT, Midwestern Brazil, from March to August 2013. In this study, 221 inpatients aged 60 or over were followed until hospital discharge, death, or fall. The method of incidence density was used to calculate incidence rates. Bivariate analysis was performed by Chi-square test, and multiple analysis was performed by Cox regression. RESULTS The incidence of falls was 12.6 per 1,000 patients/day. Predicting factors for falls during hospitalization were: low educational level (RR = 2.48; 95%CI 1.17;5.25, polypharmacy (RR = 4.42; 95%CI 1.77;11.05, visual impairment (RR = 2.06; 95%CI 1.01;4.23, gait and balance impairment (RR = 2.95; 95%CI 1.22;7.14, urinary incontinence (RR = 5.67; 95%CI 2.58;12.44 and use of laxatives (RR = 4.21; 95%CI 1.15;15.39 and antipsychotics (RR = 4.10; 95%CI 1.38;12.13. CONCLUSIONS The incidence of falls of older inpatients is high. Predicting factors found for falls were low education level, polypharmacy, visual impairment, gait and balance impairment, urinary incontinence and use of laxatives and antipsychotics. Measures to prevent falls in hospitals are needed to reduce the incidence of this event.

  15. An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS

    Directory of Open Access Journals (Sweden)

    Sloan DH

    2017-02-01

    Full Text Available Danetta Hendricks Sloan,1 Karlynn BrintzenhofeSzoc,2 Tiffany Kichline,1 Karen Baker,1 Jean-Paul Pinzon,1 Christina Tafe,1 Lingsheng Li,1 M Jennifer Cheng,1 Ann Berger1 1Pain and Palliative Care, National Institutes of Health, Clinical Center, Bethesda, MD, 2School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA Context: Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho–social–spiritual homeostasis.Objective: Preliminary examination of responses to items on the HEALS and examination of the factor structure.Method: The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument.Results: Outcome testing of sample adequacy using Kaiser–Meyer–Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach’s a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1 religion; 2 spirituality, demonstrated by a

  16. Psychological adaptation to life-threatening injury in dyads: the role of dysfunctional disclosure of trauma

    Directory of Open Access Journals (Sweden)

    Laura Pielmaier

    2011-12-01

    Full Text Available Certain modes of trauma disclosure have been found to be associated with more severe symptoms of posttraumatic stress (PTS in different trauma populations: the reluctance to disclose trauma-related thoughts and feelings, a strong urge to talk about it, and physical as well as emotional reactions during disclosure. Although social-contextual influences gain more and more interest in trauma research, no study has yet investigated these “dysfunctional disclosure tendencies” and their association with PTS from an interpersonal perspective.(1 To replicate previous findings on dysfunctional disclosure tendencies in patients with life-threatening injury and their significant others and (2 to study interpersonal associations between dysfunctional disclosure style and PTS at a dyadic level.PTS symptom severity and self-reports on dysfunctional disclosure tendencies were assessed in N=70 dyads comprising one individual with severe traumatic brain injury and a significant other (“proxy” 3 months after injury.Regression analyses predicting PTS symptom severity revealed dysfunctional disclosure tendencies to have incremental validity above and beyond sex, age, and trauma severity within the individual (both patient and proxy, with moderate effect sizes. The interaction between patient's and proxy's disclosure style explained additional portions of the variance in patients’ PTS symptom severity.Findings suggest that dysfunctional disclosure tendencies are related to poorer psychological adaptation to severe traumatic brain injury. This intrapersonal association may be exacerbated by dysfunctional disclosure tendencies on the part of a significant other. Although the results require replication in other trauma samples without brain injury to further generalize the findings beyond the observed population, the study contributes to the expanding literature on the crucial role of interpersonal relationships in trauma recovery.For the abstract or full

  17. Self-reported recognition of undiagnosed life threatening conditions in chiropractic practice: a random survey

    Directory of Open Access Journals (Sweden)

    Daniel Dwain M

    2012-07-01

    Full Text Available Abstract Background The purpose of this study was to identify the type and frequency of previously undiagnosed life threatening conditions (LTC, based on self-reports of chiropractic physicians, which were first recognized by the chiropractic physician. Additionally this information may have a preliminary role in determining whether chiropractic education provides the knowledge necessary to recognize these events. Methods The study design was a postal, cross-sectional, epidemiological self-administered survey. Two thousand Doctors of Chiropractic in the US were randomly selected from a list of 57878. The survey asked respondents to state the number of cases from the list where they were the first physician to recognize the condition over the course of their practice careers. Space was provided for unlisted conditions. Results The response rate was 29.9%. Respondents represented 11442 years in practice and included 3861 patients with a reported undiagnosed LTC. The most commonly presenting conditions were in rank order: carcinoma, abdominal aneurysm, deep vein thrombosis, stroke, myocardial infarction, subdural hematoma and a large group of other diagnoses. The occurrence of a previously undiagnosed LTC can be expected to present to the chiropractic physician every 2.5 years based on the responding doctors reports. Conclusion Based on this survey chiropractic physicians report encountering undiagnosed LTC’s in the normal course of practice. The findings of this study are of importance to the chiropractic profession and chiropractic education. Increased awareness and emphasis on recognition of LTC is a critical part of the education process and practice life.

  18. Diagnosis of Life-Threatening Alpha-Gal Food Allergy Appears to Be Patient Driven.

    Science.gov (United States)

    Flaherty, Mary Grace; Kaplan, Samantha Jan; Jerath, Maya R

    2017-10-01

    Patients exhibiting life-threatening symptoms associated with the alpha-gal food allergy (delayed urticaria or anaphylaxis due to mammalian meat) are frequently undiagnosed, causing unnecessary emergency department (ED) and health care visits, and extensive pain and suffering. This study aimed to determine the path to diagnosis experienced by alpha-gal patients. Semistructured interviews were conducted from March to June 2016 with a chronological systematic sample of approximately 10% of patients diagnosed with alpha-gal and treated by the University of North Carolina Allergy and Immunology Clinic (n = 28). Main outcome measures included average length of time between first symptoms' appearance and diagnosis, number and type of health care encounters en route to diagnosis, and typical symptom severity. Six interviewees (21%) were diagnosed within a year of experiencing symptoms, of the remaining 22, mean time to diagnosis was 7.1 years. In over 100 medical encounters (including 28 ED visits and 2 urgent care) the correct diagnosis or effective diagnosing referral occurred less than 10% of the time. Seventy-one percent (20/28) described their first symptoms as severe. More patients found the allergist specializing in this condition on their own (n = 12; 43%) than those who were formally diagnosed or received referrals (n = 10; 36%) through the health care system. The medical community is challenged to stay abreast of emerging and newly uncovered illnesses through traditional medical literature communication channels. Presently, patients more often discover a diagnosis of alpha-gal allergy by using information resources on their own than by presenting to the ED with anaphylaxis.

  19. Near-death-like experiences without life-threatening conditions or brain disorders: a hypothesis from a case report

    Directory of Open Access Journals (Sweden)

    Enrico eFacco

    2012-11-01

    Full Text Available Near-death experiences (NDEs are profound psychic experiences commonly occurring in life-threatening conditions. They include feeling a sense of peace, of seeing a bright light, encountering deceased relatives or religious figures, and of transcending space and time. To explain them, it has been suggested that they stem from brain disorders and/or psychological reactions to approaching death, a sort of wishful thinking in response to the perceived threat.This is a report on a case with most of the features typical of NDEs except that it occurred entirely without any life-threatening conditions. This evidence is theoretically incompatible with either of the above hypotheses, suggesting that a broader interpretation of the phenomenon is needed.

  20. POSITIVE LIVING STRATEGIES THAT CAN BE LEARNED FROM STUDIES ON NEAR-DEATH EXPERIENCES AND LIFE-THREATENING ILLNESSES

    Directory of Open Access Journals (Sweden)

    Kasiram, Madhu

    2015-09-01

    Full Text Available This article addresses the two related issues of near-death experience and life-threatening illness with a view to helping survivors and helping professionals appreciate how to make sense of the experience whilst considering future living and future service provision. The article is based on two related research studies, citing literature from different disciplines of nursing, women’s health, spirituality and near death. This research was undertaken in the light of these experiences affecting so many aspects of life and living. The need to “dialogue with death” (Easwaran, 2008: Foreword and life-threatening illness is the key message as opposed to shunning what is not readily understood and appreciated

  1. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    LENUS (Irish Health Repository)

    Cashman, Emma

    2012-02-01

    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  2. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    LENUS (Irish Health Repository)

    Cashman, Emma

    2011-02-01

    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  3. Understanding, Predicting, and Preventing Life Changing and Life Threatening Health Changes among Aging Veterans and Civilians with Spinal Cord Injury

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-16-1-0629 TITLE: Understanding, Predicting, and Preventing Life -Changing and Life -Threatening Health Changes among Aging...Annual 3. DATES COVERED 30 Sep 2016 - 29 Sep 2017 4. TITLE AND SUBTITLE Understanding, Predicting, and Preventing Life -Changing and Life ... hope of preventing them. Our purpose is to better understand the how and why of the development of negative health spirals and how they may best be

  4. Dyspnea in a case of shoulder dislocation – to beware of this rare life-threatening symptom

    Directory of Open Access Journals (Sweden)

    Joshi Satyen Praful

    2016-01-01

    Full Text Available Shoulder dislocation is a common injury in orthopedic practice. In an acute presentation, closed reduction of the shoulder joint leads to an uneventful recovery. However, in the developing world neglected shoulder dislocation and treatments from quacks are not uncommon. Improper treatment and neglect can rarely become life threatening. We present one such case, emphasizing the need to investigate the symptom of dyspnea in a patient with history of shoulder dislocation.

  5. Effects of meteorological factors on the incidence of meningococcal ...

    African Journals Online (AJOL)

    Background and Objectives: Substantial climate changes have led to the emergence and re-emergence of various infectious diseases worldwide, presenting an imperative need to explore the effects of meteorological factors on serious contagious disease incidences such as that of meningococcal meningitis (MCM).

  6. Incidence and risk factors of Parkinson's disease in The Netherlands.

    NARCIS (Netherlands)

    Hofman, A.; Collette, H.J.A.; Bartelds, A.I.M.

    1989-01-01

    The incidence and some risk factors of Parkinson's disease were investigated in a study performed in The Netherlands. The study was based on a disease register of the Sentinel Stations, which provide a complete ascertainment of new patients with Parkinson's disease in 60 general practices in The

  7. New-onset diabetes after transplant: Incidence, risk factors and ...

    African Journals Online (AJOL)

    To ascertain the incidence of and clinical and genetic risk factors that predispose to NODAT, and to examine its effect on the outcome of renal transplantation. Methods. We performed a retrospective cohort review of all renal transplants at Groote Schuur Hospital, Cape Town, South Africa, between 2004 and 2008. Patients ...

  8. Contextual factors and social consequences of incident disease

    DEFF Research Database (Denmark)

    Christensen, Ulla; Kriegbaum, Margit; Hougaard, Charlotte Ørsted

    2008-01-01

    practice modify the employment effect of disease. We have studied risk of labour market exclusion following incident hospitalization for ischaemic heart disease (IHD), and whether this risk may be modified by contextual factors on the municipal level. Methods: A cohort design on a 10% random sample...

  9. Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: Technical and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Baltacioglu, Feyyaz [Marmara University School of Medicine, Department of Radiology, Istanbul (Turkey)], E-mail: fbaltaci@yahoo.com; Cimsit, Nuri Cagatay [Marmara University School of Medicine, Department of Radiology, Istanbul (Turkey)], E-mail: cagataycimsit@gmail.com; Bostanci, Korkut [Marmara University School of Medicine, Department of Thoracic Surgery, Istanbul (Turkey)], E-mail: kbostanci@marmara.edu.tr; Yueksel, Mustafa [Marmara University School of Medicine, Department of Thoracic Surgery, Istanbul (Turkey)], E-mail: myuksel@marmara.edu.tr; Kodalli, Nihat [Marmara University School of Medicine, Department of Radiology, Istanbul (Turkey)], E-mail: nihatkodalli@yahoo.com

    2010-02-15

    Objectives: To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis. Materials and methods: Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure. Results: Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24 h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications. Conclusions: Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.

  10. [Prenatal intestinal volvulus: A life-threatening event with good long-term outcome].

    Science.gov (United States)

    Raherison, R; Grosos, C; Lemale, J; Blondiaux, E; Sabourdin, N; Dahan, S; Rosenblatt, J; Guilbert, J; Jouannic, J-M; Mitanchez, D; Audry, G; Auber, F

    2012-04-01

    . Median duration of parenteral nutrition was 29 days (range, 6-667 days). None of the patients had cystic fibrosis. Unlike postnatal volvulus, most prenatal volvulus occurs without malrotation. Although prenatal volvulus is a life-threatening condition, our results suggest that good long-term outcome can be achieved in most cases. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  11. Incidence and risk factors of occupational blood exposure

    DEFF Research Database (Denmark)

    Nelsing, S; Nielsen, T L; Brønnum-Hansen, Henrik

    1997-01-01

    Occupational blood exposures involves a risk of transmission of serious infections. We performed a nation-wide survey, to describe the incidence and risk factors of percutaneous (PCE) and mucocutaneous (MCE) blood exposures among hospital employed doctors in Denmark. Of 9,374 questionnaires, 6......). Only 35% adhered to the basic principles of universal precautions (UP) and non-compliance was associated with a considerably increased risk of both MCE and PCE, especially in non-surgical specialties. In conclusion, we found an unacceptably high incidence of occupational blood exposures among Danish...

  12. Which factors affect reported headache incidences after lumbar myelography?

    International Nuclear Information System (INIS)

    Sand, T.

    1989-01-01

    Nineteen publications were reviewed and subjected to a combined statistical analysis (meta-analysis) regarding the influence of study design factors upon reported headache and total symptom incidences after lumbar iohexol myelography. A significant association was found between reported side effects on one hand and needle diameter, follow-up time and the method of questioning respectively on the other. The combination of long follow-up time and specific questioning and the combination between larger diameter (20G) needles and long follow-up time, both seemed to be strong predictors for reporting high side effect incidences. Nine studies were similarly analyzed regarding the influence of early ambulation and contrast type upon reported headache incidences. Early ambulation significantly increased headache after iohexol or iopamidol lumbar myelography as opposed to metrizamide myelography. (orig.)

  13. Modifiable Lifestyle Risk Factors and Incident Diabetes in African Americans.

    Science.gov (United States)

    Joseph, Joshua J; Echouffo-Tcheugui, Justin B; Talegawkar, Sameera A; Effoe, Valery S; Okhomina, Victoria; Carnethon, Mercedes R; Hsueh, Willa A; Golden, Sherita H

    2017-11-01

    The associations of modifiable lifestyle risk factors with incident diabetes are not well investigated in African Americans (AAs). This study investigated the association of modifiable lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden) with incident diabetes among AAs. Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson Heart Study who were free of diabetes at baseline (2000-2004) using baseline questionnaires and combined into risk factor categories: poor (0-3 points), average (4-7 points), and optimal (8-11 points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI. Outcomes were collected 2005-2012 and data analyzed in 2016. Over 7.6 years, there were 560 incident diabetes cases (mean age=53.3 years, 64% female). An average or optimal compared to poor risk factor categorization was associated with a 21% (IRR=0.79, 95% CI=0.62, 0.99) and 31% (IRR=0.69, 95% CI=0.48, 1.01) lower risk of diabetes. Among participants with BMI <30, IRRs for average or optimal compared to poor categorization were 0.60 (95% CI=0.40, 0.91) and 0.53 (95% CI=0.29, 0.97) versus 0.90 (95% CI=0.67, 1.21) and 0.83 (95% CI=0.51, 1.34) among participants with BMI ≥30. A combination of modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, particularly among those without obesity. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Factors influencing recovery and restoration following a chemical incident.

    Science.gov (United States)

    Peña-Fernández, A; Wyke, S; Brooke, N; Duarte-Davidson, R

    2014-11-01

    Chemicals are an important part of our society. A wide range of chemicals are discharged into the environment every day from residential, commercial and industrial sources. Many of these discharges do not pose a threat to public health or the environment. However, global events have shown that chemical incidents or accidents can have severe consequences on human health, the environment and society. It is important that appropriate tools and technical guidance are available to ensure that a robust and efficient approach to developing a remediation strategy is adopted. The purpose of remediation is to protect human health from future exposure and to return the affected area back to normal as soon as possible. There are a range of recovery options (techniques or methods for remediation) that are applicable to a broad range of chemicals and incidents. Recovery options should be evaluated according to their appropriateness and efficacy for removing contaminants from the environment; however economic drivers and social and political considerations often influence decision makers on which remedial actions are implemented during the recovery phase of a chemical incident. To date, there is limited information in the literature on remediation strategies and recovery options that have been implemented following a chemical incident, or how successful they have been. Additional factors that can affect the approach taken for recovery are not well assessed or understood by decision makers involved in the remediation and restoration of the environment following a chemical incident. The identification of this gap has led to the development of the UK Recovery Handbook for Chemical Incidents to provide a framework for choosing an effective recovery strategy. A compendium of practical evidence-based recovery options (techniques or methods for remediation) for inhabited areas, food production systems and water environments has also been developed and is included in the chemical

  15. Persistent perineal sinus. Incidence, pathogenesis, risk factors, and management

    International Nuclear Information System (INIS)

    Lohsiriwat, V.

    2009-01-01

    This review discusses the incidence, pathogenesis, risk factors, diagnosis, and therapeutic options for persistent perineal sinus (PPS), defined as a perineal wound that remains unhealed more than 6 months after surgery. The incidence of PPS after surgery for inflammatory bowel disease (IBD) ranges from 3% to 70% and after abdominoperineal resection (APR) for Low rectal cancer, it can be up to 30%. These unhealed wounds are frequently related to perioperative pelvic or perineal sepsis. Crohn's disease (CD) and neoadjuvant radiation therapy are also important risk factors. The management of PPS is based on an understanding of pathogenesis and clinical grounds. The advantages and disadvantages of the current therapeutic approaches, including the topical administration of various drugs, vacuum-assisted closure, and perineal reconstruction with a muscle flap or a myocutaneous flap are also discussed. (author)

  16. Phlebitis in amiodarone administration: incidence, contributing factors, and clinical implications.

    Science.gov (United States)

    Norton, Linda; Ottoboni, Linda K; Varady, Ann; Yang-Lu, Chia-Yu; Becker, Nancy; Cotter, Theresa; Pummer, Eileen; Haynes, Annette; Forsey, Lynn; Matsuda, Kelly; Wang, Paul

    2013-11-01

    Intravenous amiodarone is an important treatment for arrhythmias, but peripheral infusion is associated with direct irritation of vessel walls and phlebitis rates of 8% to 55%. Objectives To determine the incidence and factors contributing to the development of amiodarone-induced phlebitis in the coronary care unit in an academic medical center and to refine the current practice protocol. Medical records from all adult patients during an 18-month period who received intravenous amiodarone while in the critical care unit were reviewed retrospectively. Route of administration, location, concentration, and duration of amiodarone therapy and factors associated with occurrence of phlebitis were examined. Descriptive statistics and regression methods were used to identify incidence and phlebitis factors. In the final sample of 105 patients, incidence of phlebitis was 40%, with a 50% recurrence rate. All cases of phlebitis occurred in patients given a total dose of 3 g via a peripheral catheter, and one-quarter of these cases (n = 10) developed at dosages less than 1 g. Pain, redness, and warmth were the most common indications of phlebitis. Total dosage given via a peripheral catheter, duration of infusion, and number of catheters were significantly associated with phlebitis. Amiodarone-induced phlebitis occurred in 40% of this sample at higher drug dosages. A new practice protocol resulted from this study. An outcome study is in progress.

  17. Endodontic flare up: incidence and association of possible risk factors.

    Science.gov (United States)

    Gbadebo, S O; Sulaiman, A O; Anifowose, O O

    2016-06-01

    Endodontic emergency during root canal treatment (flare up) is a common occurrence in multivisit root canal treatment (RCT) and it may be associated with many factors. The occurrence however can affect the prognosis of the tooth and the patient -clinician relationship. To determine the incidence and risk factors associated with occurrence of flare up in a multi visit RCT. Patients planned for multi-visit (RCT) were recruited for the research. Standard protocol was followed in all cases. After the first visit, the patients were followed up for possible development of flare up. Patients' demographics, presence or absence of preoperative pain, status of the pulp and occurrence of flare up were among the data collected. Data was analyzed using SPSS version 20 with level of significance set at P flare up was 8.5%. Prior to treatment, 47% of the cases had pain, 61.3% had apical radioluscency and 83% had pulpal necrosis. Majority (7, 77.8%) of the flare up occurred after the first visit (p=0.000). Only pre- treatment pain had a statistical significant ielationship with occurrence of flare up (p=0.009). Incidence of flare up was 8.5% and the major risk factor was preoperative pain. First visit in a multi visit RCT is an important stage which if well handled, can reduce the incidence of flare up.

  18. Incidence and risk factors for exacerbations of asthma during pregnancy

    Directory of Open Access Journals (Sweden)

    Ali Z

    2013-05-01

    Full Text Available Zarqa Ali, Charlotte Suppli UlrikDepartment of Pulmonary Medicine, Hvidovre Hospital and University of Copenhagen, Copenhagen, DenmarkBackground: Asthma is one of the most common chronic diseases among pregnant women. Acute exacerbations of asthma during pregnancy have an unfavorable impact on pregnancy outcome. This review provides an overview of current knowledge of incidence, mechanisms, and risk factors for acute exacerbations of asthma during pregnancy.Methods: A narrative literature review was carried out using the PubMed database.Results: During pregnancy, up to 6% of women with asthma are hospitalized for an acute exacerbation. The maternal immune system is characterized by a very high T-helper-2:T-helper-1 cytokine ratio during pregnancy and thereby provides an environment essential for fetal survival but one that may aggravate asthma. Cells of the innate immune system such as monocytes and neutrophils are also increased during pregnancy, and this too can exacerbate maternal asthma. Severe or difficult-to-control asthma appears to be the major risk factor for exacerbations during pregnancy, but studies also suggest that nonadherence with controller medication and viral infections are important triggers of exacerbations during pregnancy. So far, inconsistent findings have been reported regarding the effect of fetal sex on exacerbations during pregnancy. Other risk factors for exacerbation during pregnancy include obesity, ethnicity, and reflux, whereas atopy does not appear to be a risk factor.Discussion: The incidence of asthma exacerbations during pregnancy is disturbingly high. Severe asthma – better described as difficult-to-control asthma – nonadherence with controller therapy, viral infections, obesity, and ethnicity are likely to be important risk factors for exacerbations of asthma during pregnancy, whereas inconsistent findings have been reported with regard to the importance of sex of the fetus.Keywords: acute exacerbations

  19. Postoperative mortality after inpatient surgery: Incidence and risk factors

    Directory of Open Access Journals (Sweden)

    Karamarie Fecho

    2008-09-01

    Full Text Available Karamarie Fecho1, Anne T Lunney1, Philip G Boysen1, Peter Rock2, Edward A Norfleet11Department of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; 2Department of Anesthesiology, University of Maryland, Baltimore, MD, USAPurpose: This study determined the incidence of and identified risk factors for 48 hour (h and 30 day (d postoperative mortality after inpatient operations.Methods: A retrospective cohort study was conducted using Anesthesiology’s Quality Indicator database as the main data source. The database was queried for data related to the surgical procedure, anesthetic care, perioperative adverse events, and birth/death/operation dates. The 48 h and 30 d cumulative incidence of postoperative mortality was calculated and data were analyzed using Chi-square or Fisher’s exact test and generalized estimating equations.Results: The 48 h and 30 d incidence of postoperative mortality was 0.57% and 2.1%, respectively. Higher American Society of Anesthesiologists physical status scores, extremes of age, emergencies, perioperative adverse events and postoperative Intensive Care Unit admission were identified as risk factors. The use of monitored anesthesia care or general anesthesia versus regional or combined anesthesia was a risk factor for 30 d postoperative mortality only. Time under anesthesia care, perioperative hypothermia, trauma, deliberate hypotension and invasive monitoring via arterial, pulmonary artery or cardiovascular catheters were not identified as risk factors.Conclusions: Our findings can be used to track postoperative mortality rates and to test preventative interventions at our institution and elsewhere.Keywords: postoperative mortality, risk factors, operations, anesthesia, inpatient surgery

  20. Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

    Directory of Open Access Journals (Sweden)

    Margrethe Aase Schaufel

    2011-03-01

    Full Text Available Coping with existential challenges is important when struck by serious disease, but apart from cancer and palliative care little is known about how patients deal with such issues and maintain hope. To explore how patients with life-threatening heart disease experience hope when coping with mortality and other existential challenges, we conducted a qualitative study with semi-structured interviews. We made a purposive sample of 11 participants (26–88 years who had experienced life-threatening disease: eight participants with serious heart disease, two with cancer, and one with severe chronic obstructive pulmonary disease. Analysis was by systematic text condensation. The findings showed that hope could enhance coping and diminish existential distress when patients were confronted with mortality and other existential challenges. Hope was observed as three types of dynamic work: to shift perception of mortality from overwhelming horror toward suppression or peaceful acceptance, to foster reconciliation instead of uncertainty when adapting to the new phase of life, and to establish go-ahead spirit instead of resignation as their identity. Meaning of life could, hence, be sustained in spite of serious threats to the persons’ future, everyday life, and self-conception. The work of hoping could be supported or disturbed by relationships with family, friends, and health care professionals. Hope can be regarded as an active, dynamic state of existential coping among patients with life-threatening disease. Physicians may support this coping and thereby provide personal growth and alleviation of existential distress by skillfully identifying, acknowledging, and participating in the work of hoping performed by the patient.

  1. Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

    Science.gov (United States)

    Schaufel, Margrethe Aase; Nordrehaug, Jan Erik; Malterud, Kirsti

    2011-01-01

    Coping with existential challenges is important when struck by serious disease, but apart from cancer and palliative care little is known about how patients deal with such issues and maintain hope. To explore how patients with life-threatening heart disease experience hope when coping with mortality and other existential challenges, we conducted a qualitative study with semi-structured interviews. We made a purposive sample of 11 participants (26–88 years) who had experienced life-threatening disease: eight participants with serious heart disease, two with cancer, and one with severe chronic obstructive pulmonary disease. Analysis was by systematic text condensation. The findings showed that hope could enhance coping and diminish existential distress when patients were confronted with mortality and other existential challenges. Hope was observed as three types of dynamic work: to shift perception of mortality from overwhelming horror toward suppression or peaceful acceptance, to foster reconciliation instead of uncertainty when adapting to the new phase of life, and to establish go-ahead spirit instead of resignation as their identity. Meaning of life could, hence, be sustained in spite of serious threats to the persons' future, everyday life, and self-conception. The work of hoping could be supported or disturbed by relationships with family, friends, and health care professionals. Hope can be regarded as an active, dynamic state of existential coping among patients with life-threatening disease. Physicians may support this coping and thereby provide personal growth and alleviation of existential distress by skillfully identifying, acknowledging, and participating in the work of hoping performed by the patient. PMID:21423599

  2. Hope in action-facing cardiac death: A qualitative study of patients with life-threatening disease.

    Science.gov (United States)

    Schaufel, Margrethe Aase; Nordrehaug, Jan Erik; Malterud, Kirsti

    2011-03-18

    Coping with existential challenges is important when struck by serious disease, but apart from cancer and palliative care little is known about how patients deal with such issues and maintain hope. To explore how patients with life-threatening heart disease experience hope when coping with mortality and other existential challenges, we conducted a qualitative study with semi-structured interviews. We made a purposive sample of 11 participants (26-88 years) who had experienced life-threatening disease: eight participants with serious heart disease, two with cancer, and one with severe chronic obstructive pulmonary disease. Analysis was by systematic text condensation. The findings showed that hope could enhance coping and diminish existential distress when patients were confronted with mortality and other existential challenges. Hope was observed as three types of dynamic work: to shift perception of mortality from overwhelming horror toward suppression or peaceful acceptance, to foster reconciliation instead of uncertainty when adapting to the new phase of life, and to establish go-ahead spirit instead of resignation as their identity. Meaning of life could, hence, be sustained in spite of serious threats to the persons' future, everyday life, and self-conception. The work of hoping could be supported or disturbed by relationships with family, friends, and health care professionals. Hope can be regarded as an active, dynamic state of existential coping among patients with life-threatening disease. Physicians may support this coping and thereby provide personal growth and alleviation of existential distress by skillfully identifying, acknowledging, and participating in the work of hoping performed by the patient.

  3. Factors Associated with Incidence of Induced Abortion in Hamedan, Iran.

    Science.gov (United States)

    Hosseini, Hatam; Erfani, Amir; Nojomi, Marzieh

    2017-05-01

    There is limited reliable information on abortion in Iran, where abortion is illegal and many women of reproductive age seek clandestine abortion to end their unintended pregnancy. This study aims to examine the determinants of induced abortion in the city of Hamedan, Iran. The study utilizes recent data from the 2015 Hamedan Survey of Fertility, conducted in a representative sample of 3,000 married women aged 15-49 years in the city of Hamedan, Iran. Binary logistic regression models are used to examine factors associated with the incidence of abortion. Overall, 3.8% of respondents reported having had an induced abortion in their life. Multivariate results showed that the incidence of abortion was strongly associated with women's education, type of contraceptive and family income level, after controlling for confounding factors. Women using long-acting contraceptive methods, those educated under high school diploma or postsecondary education, and those with high level of income were more likely to report having an induced abortion. The high incidence of abortion among less or more educated women and those with high income level signifies unmet family planning needs among these women, which must be addressed by focused reproductive health and family planning programs.

  4. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis

    Directory of Open Access Journals (Sweden)

    Anura Michelle Manuel

    2017-03-01

    Full Text Available Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.

  5. Life-Threatening Contraceptive-Related Pulmonary Embolism in a 14-Year-Old Girl with Hereditary Thrombophilia

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Grove, Erik Lerkevang

    2015-01-01

    . Based on a case of life-threatening COC-associated pulmonary embolism in a girl heterozygous for the prothrombin G20210A mutation and with a family history of thrombotic disease, we discuss the importance of assessing not just the genotype but also the phenotype when considering initiation of COCs...... in patients with thrombophilia. CASE REPORT: A 14-year-old girl presented with acute onset of chest pain and dyspnea followed by syncope. She was hypoxic and hemodynamically compromised at admission. Computed tomography pulmonary angiography revealed a large central "saddle" pulmonary embolism causing nearly...

  6. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis.

    Science.gov (United States)

    Manuel, Anura Michelle; Kalimuthu, Santhi; Pathmanathan, Sitra Siri; Narayanan, Prepageran; Zainal Abidin, Zurina; Azmi, Khairul; Khalil, Alizan

    2017-04-01

    Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management. Copyright © 2017. Published by Elsevier Taiwan.

  7. Recurrent life-threatening reactions to platelet transfusion in an aplastic anaemia patient with a paroxysmal nocturnal haemoglobinuria clone.

    Science.gov (United States)

    Mohamed, M; Bates, G; Richardson, D; Burrows, L

    2014-09-01

    A 60-year-old woman was diagnosed with non-severe aplastic anaemia when she presented with anaemia and thrombocytopenia. She developed recurrent life-threatening hypotensive reactions during transfusion of leukodepleted platelet concentrates, and washed platelet concentrates prevented the development of such reactions subsequently. A paroxysmal nocturnal haemoglobinuria clone was detected on investigating for aplastic anaemia, which has been speculated to play a role in the recurrent hypotensive reactions. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  8. Subclinical Mastitis in Dairy Animals: Incidence, Economics, and Predisposing Factors

    Directory of Open Access Journals (Sweden)

    Mukesh Kr. Sinha

    2014-01-01

    Full Text Available A study was conducted to assess the incidence and economics of subclinical form of bovine mastitis in Central Region of India. Daily milk records of 187 animals during three seasons were collected and subjected to analysis. The economic loss due to reduction in yield, clinical expenses, and additional resources used were quantified and aggregated. The losses due to mastitis in monetary terms were estimated to be INR1390 per lactation, among which around 49% was owing to loss of value from milk and 37% on account of veterinary expenses. Higher losses were observed in crossbred cows due to their high production potential that was affected during mastitis period. The cost of treating an animal was estimated to be INR509 which includes cost of medicine (31.10% and services (5.47%. Inadequate sanitation, hygiene, and veterinary services were the main predisposing factors for incidence and spread of mastitis as perceived by the respondents.

  9. Risk factors associated with incidence and persistence of frequent headaches.

    Science.gov (United States)

    Marklund, Susanna; Häggman-Henrikson, Birgitta; Wänman, Anders

    2014-11-01

    Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches. The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses. The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3-5.4), self-reported bruxism (OR = 2.3; CI = 1.2-4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4-7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6-22.6). The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated.

  10. Prospective effect of community distress and subcultural orientation on mortality following life-threatening diseases in later life.

    Science.gov (United States)

    Wen, Ming; Christakis, Nicholas A

    2006-07-01

    We conducted a prospective and contextual study to examine the effects of community social-economic-physical distress and subcultural orientation on mortality following onset of 13 life-threatening diseases in later life. We also examined the inter-relationship between the effects of community social, economic and physical distress (i.e. poverty, physical disorder and low collective efficacy) and subcultural orientation (i.e. anomie and tolerance of risk behaviour) on the survival chances of seriously ill older patients. Three data sources were combined to construct the working sample: 1990 Census data, the 1994-95 PHDCN-CS, and the COSI data. Fifty-one ZIP code areas in Chicago and 12,672 elderly patients were studied. Community distress (HR = 1.04; 95% CI = (1.01, 1.07)) and anomie (HR = 1.26; 95% CI = (1.02, 1.54)) are found to be significantly and positively associated with a higher hazard of death. Moreover, community anomie contributes to the effect of community distress on post-hospitalisation mortality. The social, economic, physical and cultural environment in which people live appears to exert a significant impact on whether older people facing life-threatening illness live or die.

  11. Lactose intolerance in prostate cancer patients: incidence and associated factors.

    Science.gov (United States)

    Agarwal, Mayank Mohan; Rana, Satyavati V; Mandal, Arup Kumar; Malhotra, Sunita; Khandelwal, Niranjan; Kumar, Santosh; Acharya, Naveen Chandra; Singh, Shrawan Kumar

    2008-03-01

    Osteoporosis is common in prostate cancer (CaP) patients both before and after institution of androgen deprivation therapy and is associated with significant morbidity. Lactose intolerance (LI) can affect bone mass but has not been studied in this group of patients. The objective of this study was to compare the incidence of LI in CaP patients with that in the general population and to identify factors affecting lactose intolerance in CaP patients. Fifty-five men with CaP planned for bilateral orchidectomy were enrolled in the study and their baseline characteristics including age, weight, height, body mass index (BMI), prostate-specific antigen, serum calcium profile, lactose tolerance status, physical activity, alcohol intake and smoking, bone mineral density and calcium intake were registered. The data on lactose tolerance in these patients were compared with those of 81 age-matched controls (data taken from the available database). The incidence of LI in CaP patients was significantly less than that in the control group (36.2% and 58.3%, respectively, p = 0.027). A significantly greater number of CaP patients in the lactose-tolerant group had a calcium intake of >1500 mg/day (p = 0.03) and that of milk >500 ml/day (p = 0.05) than those in the intolerant group. Age >70 years, BMI 163 cm, lower physical activity and co-abuse of alcohol and smoking significantly correlated with the presence of LI (p 25 kg/m2 and weight >65 kg. The incidence of LI in CaP patients is less than that in the general population despite a higher incidence of osteoporosis, indicating a complex etiology of CaP-related osteoporosis. Certain physical characteristics and personal habits are important in determining lactose-tolerant status.

  12. Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report

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    Semih Hot, M.D.

    2016-01-01

    Conclusions: The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.

  13. Incidence and predisposing factors of phlebitis in a surgery department.

    Science.gov (United States)

    Rego Furtado, Luís Carlos do

    This paper reports on a study conducted to determine the incidence of phlebitis related to peripheral cannulae, and its predisposing factors in a general surgery department. Phlebitis is a serious health problem that affects a large proportion of hospitalized patients receiving intravenous therapy. A data collection tool was developed based on the previous literature and was completed between 15 October and 30 November 2010 in a general surgery department. All patients with peripheral cannulae who fulfilled the inclusion criteria, and who agreed to participate in the study where monitored. This was a quantitative study, which used descriptive, inferential, and correlational analysis. A total of 171 patients and 286 peripheral cannulae were monitored. The average incidence of phlebitis was 61.5%, and factors such as diabetes and tobacco consumption were identified as relevant to the development of phlebitis. Other elements identified as predisposing to the development of phlebitis include administration of potassium chloride, the dwell time of the peripheral cannula, and the anatomical location of the cannula. Phlebitis associated with peripheral cannulae is still a current problem requiring knowledgeable staff who can prevent, recognize and act appropriately in a timely manner to minimize its severity.

  14. Risk Factors Correlated with Incidence of Low Birth Weight Cases

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    Anjas Dwi Purwanto

    2017-01-01

    Full Text Available The infant with Low Birth Weight (LBW was one of the risk factors that contributed to the high infant mortality, especially in the neonatal period. About 17% from 25 millions birth each year in the world are infant with LBW. LBW could be caused by multifactor that were maternal factors (maternal age, birth interval, parity, anemia, social-economic and behaviour, fetus factor, placental factor, and environmental factor. The research aims was to analyze the risk factors correlated with incidence of LBW. This research was an observational  research with case-control design. The number of samples in this research were 120 mothers who delivered in working area of RSIA Kendangsari in 2014. The subjects were selected used systematic random method. The independent variabels in this research were maternal age, education level, employment status, birth interval, parity, age pregnancy, multiple pregnancy, hypertension, and anemia, while the dependent variable in this research was LBW. Based on correlation analysis used Chi-square test showed there were not significant correlation (p>0,05 between birth interval and parity with LBW cases and there were significant correlations (p<0,05 between age pregnancy, hypertension during pregnancy and anemia with LBW cases. Odds Ratio (OR were 13,571 on age pregnancy, 2,224 on multiple pregnancy,2,753 on hypertension and 4,030 on anemia. The conlusion showed that the risk factors of LBW cases were age pregnancy, multiple pregnancy, hypertension and anemia. While maternal age, education level, employment status, birth intervaland parity were not had any correlation with LBW cases. Keywords: LBW, risk factors, babies, maternal, pregnancy

  15. Mesenteric vascular occlusion: Comparison of ancillary CT findings between arterial and venous occlusions and independent CT findings suggesting life-threatening events

    International Nuclear Information System (INIS)

    Wong, Yon Cheong; Wu, Cheng Hsien; Wang, Li Jen; Chen, Huan Wu; Lin, Being Chuan; Huang, Chen Chih

    2013-01-01

    To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

  16. Medical Simulation as a Vital Adjunct to Identifying Clinical Life-Threatening Gaps in Austere Environments.

    Science.gov (United States)

    Chima, Adaora M; Koka, Rahul; Lee, Benjamin; Tran, Tina; Ogbuagu, Onyebuchi U; Nelson-Williams, Howard; Rosen, Michael; Koroma, Michael; Sampson, John B

    2018-04-01

    Maternal mortality and morbidity are major causes of death in low-resource countries, especially those in Sub-Saharan Africa. Healthcare workforce scarcities present in these locations result in poor perioperative care access and quality. These scarcities also limit the capacity for progressive development and enhancement of workforce training, and skills through continuing medical education. Newly available low-cost, in-situ simulation systems make it possible for a small cadre of trainers to use simulation to identify areas needing improvement and to rehearse best practice approaches, relevant to the context of target environments. Nurse anesthetists were recruited throughout Sierra Leone to participate in simulation-based obstetric anesthesia scenarios at the country's national referral maternity hospital. All subjects participated in a detailed computer assisted training program to familiarize themselves with the Universal Anesthesia Machine (UAM). An expert panel rated the morbidity/mortality risk of pre-identified critical incidents within the scenario via the Delphi process. Participant responses to critical incidents were observed during these scenarios. Participants had an obstetric anesthesia pretest and post-test as well as debrief sessions focused on reviewing the significance of critical incident responses observed during the scenario. 21 nurse anesthetists, (20% of anesthesia providers nationally) participated. Median age was 41 years and median experience practicing anesthesia was 3.5 years. Most participants (57.1%) were female, two-thirds (66.7%) performed obstetrics anesthesia daily but 57.1% had no experience using the UAM. During the simulation, participants were observed and assessed on critical incident responses for case preparation with a median score of 7 out of 13 points, anesthesia management with a median score of 10 out of 20 points and rapid sequence intubation with a median score of 3 out of 10 points. This study identified

  17. Constipation in intensive care unit: incidence and risk factors.

    Science.gov (United States)

    Nassar, Antonio Paulo; da Silva, Fernanda Maria Queiroz; de Cleva, Roberto

    2009-12-01

    Although gastrointestinal motility disorders are common in critically ill patients, constipation and its implications have received very little attention. We aimed to determine the incidence of constipation to find risk factors and its implications in critically ill patients During a 6-month period, we enrolled all patients admitted to an intensive care unit from an universitary hospital who stayed 3 or more days. Patients submitted to bowel surgery were excluded. Constipation occurred in 69.9% of the patients. There was no difference between constipated and not constipated in terms of sex, age, Acute Physiology and Chronic Health Evaluation II, type of admission (surgical, clinical, or trauma), opiate use, antibiotic therapy, and mechanical ventilation. Early (constipation, a finding that persisted at multivariable analysis (P Constipation was not associated with greater intensive care unit or mortality, length of stay, or days free from mechanical ventilation. Constipation is very common among critically ill patients. Early enteral nutrition is associated with earlier return of bowel function.

  18. Incidence and risk factors for chronic uveitis following cataract surgery.

    Science.gov (United States)

    Patel, Chirag; Kim, Stephen Jae; Chomsky, Amy; Saboori, Mazeyar

    2013-04-01

    To determine the incidence of and associated risk factors for uveitis after cataract surgery. A total of 17,757 eyes were identified and records of 42 eyes that developed uveitis and 2320 eyes that did not were reviewed. Postsurgical uveitis was defined as persistent inflammation for ≥ 6 months after surgery. Forty-two eyes of 35 patients developed uveitis (0.24%). Eleven patients underwent consecutive cataract surgery but developed unilateral uveitis, and intraoperative complications occurred in 55% of uveitic eyes compared to 0% in fellow eyes (p < 0.05). Median duration of inflammation was 8 and 11.5 months in eyes with and without vitrectomy (p < 0.05). Intraocular complications occurred in 44 and 8.3% of eyes that did and did not develop uveitis, respectively (p = 0.01). Postsurgical uveitis developed after approximately 1 in 400 cataract surgeries and occurred more frequently in eyes experiencing intraoperative complications.

  19. Bacteremia and Peritonitis in a Patient With Cirrhosis: A Life-Threatening Case From a Prick of a Cactus

    Directory of Open Access Journals (Sweden)

    Jodi-Anne Wallace MD

    2017-08-01

    Full Text Available A 58-year-old male with nonalcoholic steatohepatitis cirrhosis presents with right lower extremity cellulitis, abdominal tenderness, and severe sepsis after sustaining puncture injury from a cactus on a property with feral cats. Blood cultures and diagnostic paracentesis were consistent with spontaneous bacterial peritonitis due to Pasteurella multocida , a gram-negative coccobacillus found in the respiratory tract of domestic animals. The patient received timely antibiotic coverage with resolution of spontaneous bacterial peritonitis and sepsis after 14-day treatment. This case emphasizes the life-threatening nature of systemic Pasteurella multocida infection as well as an indirect way of acquiring a zoonotic infection in a patient with end-stage liver disease.

  20. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

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    Mondel, Prabath Kumar, E-mail: prabathmondel@gmail.com; Anand, Sunanda, E-mail: sunandaanand@gmail.com; Limaye, Uday S., E-mail: uslkem@gmail.com [Lilavati Hospital and Research Centre, Department of Interventional Neuroradiology (India)

    2015-08-15

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described.

  1. Mind's response to the body's betrayal: Gestalt/Existential therapy for clients with chronic or life-threatening illnesses.

    Science.gov (United States)

    Imes, Suzanne A; Clance, Pauline Rose; Gailis, Andra T; Atkeson, Ellen

    2002-11-01

    In the literature on chronic or life-threatening illness, there is an overriding emphasis on clients' psychological coping styles and how they relate to psychological functioning. By contrast, in our approach, we look at the subjective mind/body experiences that clients have of their illness and how their lives are impacted by their illness. As psychotherapists, we address their existential distress, pain, body experience, thoughts, and feelings, as well as their efforts to cope or find meaning in their illness. We summarize Gestalt/Existential therapy for chronic illness, illustrate the approach with three case-vignettes, and stress the importance of attending to each client's unique responses to illness. Copyright 2002 Wiley Periodicals, Inc.

  2. Evaluation of Therapeutics for Advanced-Stage Heart Failure and Other Severely-Debilitating or Life-Threatening Diseases.

    Science.gov (United States)

    Prescott, J S; Andrews, P A; Baker, R W; Bogdanffy, M S; Fields, F O; Keller, D A; Lapadula, D M; Mahoney, N M; Paul, D E; Platz, S J; Reese, D M; Stoch, S A; DeGeorge, J J

    2017-08-01

    Severely-debilitating or life-threatening (SDLT) diseases include conditions in which life expectancy is short or quality of life is greatly diminished despite available therapies. As such, the medical context for SDLT diseases is comparable to advanced cancer and the benefit vs. risk assessment and development of SDLT disease therapeutics should be similar to that of advanced cancer therapeutics. A streamlined development approach would allow patients with SDLT conditions earlier access to therapeutics and increase the speed of progression through development. In addition, this will likely increase the SDLT disease therapeutic pipeline, directly benefiting patients and reducing the economic and societal burden of SDLT conditions. Using advanced-stage heart failure (HF) as an example that illustrates the concepts applicable to other SDLT indications, this article proposes a streamlined development paradigm for SDLT disease therapeutics and recommends development of aligned global regulatory guidance. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  3. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

    International Nuclear Information System (INIS)

    Mondel, Prabath Kumar; Anand, Sunanda; Limaye, Uday S.

    2015-01-01

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described

  4. Ceftriaxone-induced immune hemolytic anemia as a life-threatening complication of antibiotic treatment of 'chronic Lyme disease'.

    Science.gov (United States)

    De Wilde, Maarten; Speeckaert, Marijn; Callens, Rutger; Van Biesen, Wim

    2017-04-01

    'Chronic Lyme disease' is a controversial condition. As any hard evidence is lacking that unresolved systemic symptoms, following an appropriately diagnosed and treated Lyme disease, are related to a chronic infection with the tick-borne spirochaetes of the Borrelia genus, the term 'chronic Lyme disease' should be avoided and replaced by the term 'post-treatment Lyme disease syndrome.' The improper prescription of prolonged antibiotic treatments for these patients can have an impact on the community antimicrobial resistance and on the consumption of health care resources. Moreover, these treatments can be accompanied by severe complications. In this case report, we describe a life-threatening ceftriaxone-induced immune hemolytic anemia with an acute kidney injury (RIFLE-stadium F) due to a pigment-induced nephropathy in a 76-year-old woman, who was diagnosed with a so-called 'chronic Lyme disease.'

  5. Endogenous Nocardial Endophthalmitis in an Immunosuppressed Patient: A Serious Warning of an Underlying Life Threatening and Blinding Disorder.

    Science.gov (United States)

    Trehan, Hemant; Kaushik, Jaya; Jain, Vaibhav Kumar; Parihar, Jitendra Kumar Singh; Avasthi, Abhijit

    2017-01-01

    To report a case of bilateral endogenous nocardial endophthalmitis with central nervous system involvement in an immunocompromised individual with an extremely poor outcome. A 35-year-old man with a history of long-term, prescribed oral steroid use for membranoproliferative glomerulonephritis presented with profound bilateral vision loss. Patient's diagnosis of bilateral endogenous nocardial endophthalmitis was delayed. Nocardia was finally isolated from a brain biopsy after a repeat magnetic resonance imaging revealed a brain abscess. With anti-nocardia therapy, patient improved systemically, but the visual outcome was poor, with no light perception in both eyes. Ocular nocardiosis is a serious vision and life threatening disorder, particularly in patients on immunosuppressive therapy. A high index of suspicion is required for successful treatment.

  6. Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report

    Directory of Open Access Journals (Sweden)

    Al-Sebaei MO

    2015-03-01

    Full Text Available Maisa O Al-Sebaei,1 Omar A Halabi,2 Ibrahim E El-Hakim3 1Department of Oral and Maxillofacial Surgery, King Abdulaziz University – Faculty of Dentistry, Jeddah, Kingdom of Saudi Arabia; 2Saudi Board of Oral and Maxillofacial Surgery, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia; 3Department of Oral and Maxillofacial Surgery, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia Aim: This case report describes a serious and life-threatening complication of the use of sodium hypochlorite as an irrigation solution in root canal therapy. Summary: This case report describes a hypochlorite accident that occurred in a healthy 42-year-old female who was undergoing routine root canal therapy for the lower right central incisor (tooth #41. After approximately 1 hour of irrigation with 3% sodium hypochlorite (for a total of 12 cc, the patient complained of severe pain and burning in the lip. The swelling progressed over the next 8 hours to involve the sublingual and submental fascial spaces with elevation of the tongue and resultant upper airway obstruction. The patient was intubated and remained on mechanical ventilation for 3 days. She recovered without any skin necrosis or nerve deficits. Key learning points: This case report highlights the importance of carefully performing root canal irrigation with sodium hypochlorite to avoid complications. Careful injection without pressure, the use of proper rubber dam isolation, and the use of the endodontic needle are necessary to avoid this type of complication. Although it is a safe root canal irrigation solution, its use may lead to life-threatening complications. Early recognition and management of the untoward effects of sodium hypochlorite are vital for the patient's safety. Keywords: complications of root canal, facial edema, root canal irrigation, root canal therapy, sodium hypochlorite, upper airway obstruction

  7. [Reduced number of fatal and life-threatening reactions to food. Reporting by the medical profession has resulted in effective measures].

    Science.gov (United States)

    Foucard, Tony; Yman, Ingrid Malmheden; Nordvall, Lennart

    The results from the Swedish system for reporting severe and fatal reactions caused by food for the period 1993-96 were published in Lakartidningen in 1997. We now report the results for the period 1997-2003. The number of fatal cases has decreased from 1.75 to 0.86 per year and the number of life-threatening cases from 3 to I per year. The most gratifying result was the large decrease in severe reactions caused by soy, from 3 deaths and 6 life-threatening cases during the first 4-year period to just one life-threatening case during the following 7-year period. This reduction is probably largely due to an increased awareness of identified risk persons, but also to a reduced use of soy protein. The ongoing study illustrates the usefulness of a national system for reporting severe and fatal reactions caused by food.

  8. Papilledema in children with hydrocephalus: incidence and associated factors.

    Science.gov (United States)

    Lee, Haeng Jin; Phi, Ji Hoon; Kim, Seung-Ki; Wang, Kyu-Chang; Kim, Seong-Joon

    2017-06-01

    OBJECTIVE The aim of this study was to report the incidence of and the factors associated with papilledema in children with hydrocephalus. METHODS Patients younger than 15 years of age who had been diagnosed with hydrocephalus and treated by extra-ventricular drainage or ventriculoperitoneal shunt surgery between 2005 and 2015 were retrospectively reviewed. Factors including patient age and sex, etiology of hydrocephalus, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. RESULTS Forty-six patients, whose mean age was 6.3 ± 4.7 years, were included in the study. The 19 patients without papilledema had a mean age of 2.7 ± 2.7 years, and the 27 patients with papilledema had a mean age of 8.8 ± 4.2 years (p hydrocephalus were tumor (59%), congenital anomaly (19%), hemorrhage (13%), and infection (9%). CONCLUSIONS Papilledema was more common in patients who were older, who had higher ICP, and whose hydrocephalus had been induced by brain tumor. However, since papilledema was absent in 41% of the children with hydrocephalus, papilledema's absence does not ensure the absence of hydrocephalus, especially in younger patients.

  9. Evento com aparente risco de morte: uma revisão Evento con aparente riesgo de muerte (alte: una revisión Apparent life-threatening event: a review

    Directory of Open Access Journals (Sweden)

    Mariana Tresoldi das N. Romaneli

    2012-12-01

    Full Text Available OBJETIVO: Realizar uma revisão crítica reunindo informações disponíveis a respeito dos eventos com aparente risco de morte. FONTES DE DADOS: Revisão bibliográfica dos artigos (em português, inglês e espanhol obtidos dos bancos de dados eletrônicos Medline, Lilacs e SciELO, utilizando as palavras-chave: eventos com aparente risco de morte, evento com aparente risco de vida infantil, lactente, apneia, monitorização e cianose. SÍNTESE DOS DADOS: Os eventos com aparente risco de mortesão súbitos e caracterizados por uma combinação de apneia, alteração na coloração da pele e tônus muscular, com inúmeras causas subjacentes. Sua incidência verdadeira é desconhecida e a faixa etária mais acometida é de 11 a 12 semanas. Não há correlação entre o evento com aparente risco de morte e a síndrome da morte súbita do lactente, embora já tenham sido consideradas manifestações da mesma doença. Muitas vezes, o lactente tem aparência saudável ao ser avaliado pelo pediatra após apresentar eventos com aparente risco de morte, porém, isso não afasta a possibilidade de existir uma doença grave associada ao evento, que deve ser investigada e tratada. Quando não são encontradas as causas, o evento é idiopático, geralmente com boa evolução. CONCLUSÕES: É necessário investigar os lactentes levados ao pronto-socorro após apresentarem eventos com aparente risco de morte, devido ao risco de sequelas e mortalidade. Não há uma padronização das condutas a serem realizadas diante de um lactente com aparência saudável que tenha evento com aparente risco de morte, mas recomenda-se que o paciente seja internado e a causa do evento, investigada. A observação e o monitoramento em ambiente hospitalar devem ocorrer no mínimo 24 horas após o evento.OBJETIVO: Realizar una revisión crítica, reuniendo las informaciones disponibles respecto a los Eventos con Aparente Riesgo de Muerte (ALTE - Apparent life-threatening event

  10. Life-threatening hemorrhage from acquired hemophilia A as a presenting manifestation of prostate cancer

    Directory of Open Access Journals (Sweden)

    Chirag Sheth

    2016-09-01

    Full Text Available Acquired factor VIII deficiency (acquired hemophilia A is a rare condition characterized by the acquisition of autoantibodies that affect the clotting activity of factor VIII (fVIII. The most common manifestation in affected patients is a hemorrhagic diathesis. This disorder is associated with autoimmune diseases, pregnancy, postpartum period, drugs, and malignancy. Management of this condition begins with attempts to arrest an acute bleed based on the site and severity of bleeding and inhibitor titer. The next priority is eradication of the fVIII antibodies using immunosuppressive therapies. We report the case of a 66-year-old male who presented with spontaneous right thigh hematoma with prolonged activated partial prothrombin time and normal prothrombin time. Mixing studies confirmed the presence of an inhibitor. Further investigation for the underlying etiology of acquired hemophilia A leads to diagnosis of prostate cancer. Treatment consisted of bypassing agents including activated factor VII and activated prothrombin plasma concentrate to arrest the bleeding. Steroids and cyclophosphamide were added to suppress the fVIII inhibitors. Concomitant treatment of locally advanced prostate cancer with chemotherapy confirmed the eradication of the inhibitors. To our knowledge, this is the first reported case of prostate cancer diagnosed and treated simultaneously with acquired hemophilia A resulting in favorable patient outcome.

  11. Occurrence of clinical mastitis and environmental factors favoring its incidence

    Directory of Open Access Journals (Sweden)

    Elisa Junqueira Oliveira

    2013-02-01

    Full Text Available The objective of this study was to evaluate the frequency of clinical mastitis (CM, in high production Holstein cows, as well as the environmental factors that favoring its incidence. The average milk production of 305 days, according to the class of mastitis was estimated by the method of least squares. The frequencies of clinical mastitis (CM events were analyzed according to the calving sequences (1-6, year of calving, season and stage of lactation, and infected quarter (right anterior, left anterior, right posterior, left posterior. The frequency of CM ranged from 11.39% in the first calving to 21.18% in the third. 58.56% of mastitis cases occurred in the wet season, and 41.44% occurred in the dry season. The final lactation stage (200 to 300 days was the period with the highest occurrence of CM (45.33%. The quarter posterior had a higher frequency CM (54.25%. Animals with higher levels of milk production of 305 days showed highest occurrence of CM. We must find a balance between milk production and mastitis in order to increase profitability. The study of the periods of greatest frequency clinical mastitis events is essential for dairy farming, to direct a program to control this disease.

  12. Groin hematoma after electrophysiological procedures-incidence and predisposing factors.

    Science.gov (United States)

    Dalsgaard, Anja Borgen; Jakobsen, Christina Spåbæk; Riahi, Sam; Hjortshøj, Søren

    2014-10-01

    We evaluated the incidence and predisposing factors of groin hematomas after electrophysiological (EP) procedures. Prospective, observational study, enrolling consecutive patients after EP procedures (Atrial fibrillation: n = 151; Supraventricular tachycardia/Diagnostic EP: n = 82; Ventricular tachycardia: n = 18). Patients underwent manual compression for 10 min and 3 h post procedural bed rest. AF ablations were performed with INR 2-3, ACT > 300, and no protamine sulfate. Adhesive pressure dressings (APDs) were used if sheath size ≥ 10F; procedural time > 120 min; and BMI > 30. Patient-reported hematomas were recorded by a telephone follow-up after 2 weeks. Hematoma developed immediately in 26 patients (10%) and after 14 days significant hematoma was reported in 68 patients (27%). Regression analysis on sex, age, BMI 25, ACT 300, use of APD, sheath size and number, and complicated venous access was not associated with hematoma, either immediately after the procedure or after 14 days. Any hematoma presenting immediately after procedures was associated with patient-reported hematomas after 14 days, odds ratio 18.7 (CI 95%: 5.00-69.8; P hematoma immediately after EP procedures was the sole predictor of patient-reported hematoma after 2 weeks. Initiatives to prevent groin hematoma should focus on the procedure itself as well as post-procedural care.

  13. Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report.

    Science.gov (United States)

    Næss, Pål Aksel; Engeseth, Kristian; Grøtta, Ole; Andersen, Geir Øystein; Gaarder, Christine

    2016-05-29

    Life-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery. A 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient's blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient's arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was

  14. Acute and potentially life-threatening tropical diseases in western travelers--a GeoSentinel multicenter study, 1996-2011

    NARCIS (Netherlands)

    Jensenius, Mogens; Han, Pauline V.; Schlagenhauf, Patricia; Schwartz, Eli; Parola, Philippe; Castelli, Francesco; von Sonnenburg, Frank; Loutan, Louis; Leder, Karin; Freedman, David O.; Simon, Fabrice; Delmont, Jean; Carosi, Giampiero; Chappuis, François; Caumes, Eric; Pérignon, Alice; Burchard, Gerd-Dieter; Torresi, Joseph; Brown, Graham; Kain, Kevin; Boggild, Andrea; Keystone, Jay S.; Pandey, Prativa; Pradhan, Rashila; Murphy, Holly; Coyle, Christina M.; Wittner, Murray; de Vries, Peter; Grobusch, Martin C.; Gadroen, Kartini; Rapp, Christophe; Aoun, Olivier; Kanagawa, Shuzo; Kato, Yasuyuki; Mizunno, Yasutaka; Gkrania-Klotsas, Effrossyni; McCarthy, Anne; Weber, Rainer; Steffen, Robert; Hagmann, Stefan; Henry, Michael; Miller, Andy O.; Hale, Devon C.; Anand, Rahul; Gelman, Stephanie S.; Kozarsky, Phyllis E.; Fairley, Jessica; Franco-Paredes, Carlos; Barnett, Elizabeth D.; Libman, Michael D.

    2013-01-01

    We performed a descriptive analysis of acute and potentially life-threatening tropical diseases among 82,825 ill western travelers reported to GeoSentinel from June of 1996 to August of 2011. We identified 3,655 patients (4.4%) with a total of 3,666 diagnoses representing 13 diseases, including

  15. The Importance of Awareness and Communication for the Inclusion of Young People with Life-Limiting and Life-Threatening Conditions in Mainstream Schools and Colleges

    Science.gov (United States)

    Asprey, Anthea; Nash, Tricia

    2006-01-01

    Anthea Asprey and Tricia Nash both belong to the Children's Hospice South West Research Group, based at the University of Exeter. In this article, they report one aspect of a research project designed to determine the adequacy of support for young people with life-limiting and life-threatening conditions in the education system. They describe here…

  16. Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study.

    Science.gov (United States)

    MacLennan, Calman A; Msefula, Chisomo L; Gondwe, Esther N; Gilchrist, James J; Pensulo, Paul; Mandala, Wilson L; Mwimaniwa, Grace; Banda, Meraby; Kenny, Julia; Wilson, Lorna K; Phiri, Amos; MacLennan, Jenny M; Molyneux, Elizabeth M; Molyneux, Malcolm E; Graham, Stephen M

    2017-12-01

    Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years) and 52/256 children (20%; 95%CI 15-25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%), 123/240 (51%; 95%CI 45-58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49%) had an overlapping clinical syndrome. Presentation at Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children.

  17. Scrub Typhus Incidence Modeling with Meteorological Factors in South Korea.

    Science.gov (United States)

    Kwak, Jaewon; Kim, Soojun; Kim, Gilho; Singh, Vijay P; Hong, Seungjin; Kim, Hung Soo

    2015-06-29

    Since its recurrence in 1986, scrub typhus has been occurring annually and it is considered as one of the most prevalent diseases in Korea. Scrub typhus is a 3rd grade nationally notifiable disease that has greatly increased in Korea since 2000. The objective of this study is to construct a disease incidence model for prediction and quantification of the incidences of scrub typhus. Using data from 2001 to 2010, the incidence Artificial Neural Network (ANN) model, which considers the time-lag between scrub typhus and minimum temperature, precipitation and average wind speed based on the Granger causality and spectral analysis, is constructed and tested for 2011 to 2012. Results show reliable simulation of scrub typhus incidences with selected predictors, and indicate that the seasonality in meteorological data should be considered.

  18. Scrub Typhus Incidence Modeling with Meteorological Factors in South Korea

    Directory of Open Access Journals (Sweden)

    Jaewon Kwak

    2015-06-01

    Full Text Available Since its recurrence in 1986, scrub typhus has been occurring annually and it is considered as one of the most prevalent diseases in Korea. Scrub typhus is a 3rd grade nationally notifiable disease that has greatly increased in Korea since 2000. The objective of this study is to construct a disease incidence model for prediction and quantification of the incidences of scrub typhus. Using data from 2001 to 2010, the incidence Artificial Neural Network (ANN model, which considers the time-lag between scrub typhus and minimum temperature, precipitation and average wind speed based on the Granger causality and spectral analysis, is constructed and tested for 2011 to 2012. Results show reliable simulation of scrub typhus incidences with selected predictors, and indicate that the seasonality in meteorological data should be considered.

  19. Blood oozing: A cause of life-threatening bleeding without overt source after transcatheter aortic valve replacement.

    Science.gov (United States)

    Tarantini, Giuseppe; Mojoli, Marco; Barioli, Alberto; Battistel, Michele; Généreux, Philippe

    2016-12-01

    Post-procedure non-access site-related bleedings have a significant impact on mortality in patients treated by transcatheter aortic valve replacement (TAVR). Notwithstanding, the source of these bleedings is frequently indeterminate, with potentially serious clinical implications related to lack of diagnosis and treatment. Out of 513 TAVR performed between June 2007 and January 2016 in the Interventional Cardiology Laboratory of the Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, we identified few proven cases of concealed bleeding after TAVR due to blood oozing. We report three cases of angiographically confirmed post-TAVR non-access bleedings related to spontaneous blood oozing, a life-threatening condition consisting of diffuse capillary hemorrhage developing from vessels not directly involved by the procedure. We hypothesize that spontaneous post-procedural blood oozing may account for a substantial proportion of non-overt, non-access site-related bleeding after TAVR. The possibility of post-TAVR blood oozing is largely neglected in the literature, and comprehensive categorization of non-access site bleedings in current standardized endpoints of TAVR studies is missing. Early assessment with arterial and venous contrast phase angio-MDCT scans in case of post-TAVR unexplained and persistent anemia may allow diagnosis and treatment of this subtle condition. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. A study of family carers of people with a life-threatening illness. 2: Implications of the needs assessment.

    Science.gov (United States)

    Scott, G

    2001-07-01

    This is the second of two articles that consider the findings of a Carers' Assessment of Difficulties Index (CADI) (Nolan et al, 1998) delivered in a palliative care context. It analyses the implications of these findings for practitioners concerned with the delivery of palliative care to such carers and their families. The development of support strategies and services addressing their needs are also presented against a backdrop of transactional stress theory. For people new to caring, recommendations for the local service include early intervention through informational support and validation of their emotional responses to caring; for longer-term carers they include assistance with cognitive reappraisal of the stressfulness of caring and regular 'respite' and socializing opportunities. These are taking place in a political climate that finally recognizes the contribution and value of carers (Department of Health, 1999). The research behind these carer identity and recognition initiatives aims to apply the spirit of public recognition and practical wisdom of palliative care expertise by responding sensitively to the specific needs of carers of people with a life-threatening illness.

  1. Rituximab administration within 6 months of T cell-depleted allogeneic SCT is associated with prolonged life-threatening cytopenias.

    Science.gov (United States)

    McIver, Zachariah; Stephens, Nicole; Grim, Andrew; Barrett, A John

    2010-11-01

    The monoclonal anti-CD20 antibody Rituximab (RTX) is increasingly used in allogeneic stem cell transplantation (SCT) to treat lymphoproliferative disorders and chronic graft-versus-host disease (GVHD). RTX administration can be complicated by delayed and prolonged neutropenia, but the mechanism is unclear. We report the occurrence of profound cytopenias following RTX given in the conditioning regimen or early after T cell-deplete SCT to treat B cell lymphoproliferative disorders or chronic GVHD (cGVHD). Between 2006 and 2009, 102 patients (median age: 43 years, range: 13-68 years), received a myeloablative matched-sibling T cell-deplete SCT for lymphoid or myeloid hematologic disorders. Neutropenia occurring within 4 weeks of treatment developed in 16 of 17 patients given RTX within the first 190 days after SCT. Fourteen patients developed severe neutropenia (count SCT compared to patients with cGVHD not treated with early RTX (P SCT experienced only moderate neutropenia 3 to 5 months after treatment lasting 10 to 20 days while maintaining absolute neutrophil count (ANC) >1.0 × 10⁹/L. Although RTX rapidly controlled cGVHD, we conclude that its administration early after T cell-deplete SCT is associated with prolonged profound and life-threatening cytopenias, and should be avoided. Published by Elsevier Inc.

  2. Conveying hope in consultations with patients with life-threatening diseases: the balance between supporting and challenging the patient.

    Science.gov (United States)

    Werner, Anne; Steihaug, Sissel

    2017-06-01

    There is limited knowledge about the communication of hope and denial in consultations with patients with life-threatening diseases on a practical level. In this study, we explored a real-life medical consultation between a doctor and a patient with incurable cancer, focusing on conveying hope. We found one consultation especially suited for illustrating how a physician can convey and reinforce hope without attaching it to curative treatment. The consultation was analysed using a method for discourse analysis, where we took as a point of departure that discourse means language in use. The doctor communicated in a recognising manner, expressing respect for the patient as a subject and an authority of his own experiences. The doctor and patient succeeded in creating a good working alliance characterised by warmth and trust. Within this context, there was room for the doctor to challenge the patient's views and communicate disagreement. The doctor succeeds in conveying and maintaining hope. Within a good working alliance with the patient the doctor can convey hope by balancing between supporting and challenging him. Exploring and grasping the patient's real concerns is essential for being able to relieve and comfort him and convey hope.

  3. Supporting children when a parent has a life-threatening illness: the role of the community practitioner.

    Science.gov (United States)

    Fearnley, Rachel

    2012-12-01

    The last two decades have seen an academic and practice based shift in the acknowledgment that children require support following the death of a significant person. However, the needs of children who are living amidst parental life threatening illness are not, as yet, so clearly recognised or acknowledged. These children are often forgotten and their needs are frequently peripheral, if not absent, within the clinical setting. The current study adopted qualitative methodology to explore children's experiences when living with a parent who is dying. A total of 36 people were interviewed, including children, their parents and professionals. The findings highlighted the importance of age appropriate information sharing with the children and the significant role professionals have in facilitating conversations either directly or through supporting the parents to hold these 'difficult' discussions. This paper offers an overview of the vital role community practitioners have in supporting the children of patients. It argues that they often have a more in-depth knowledge of the family and its functioning and that consequently they can add a different dimension to the care provided.

  4. Efficacy of selective arterial embolisation for the treatment of life-threatening post-partum haemorrhage in a large population.

    Directory of Open Access Journals (Sweden)

    Cyril Touboul

    Full Text Available BACKGROUND: The objective of this study was to assess efficacy and determine the optimal indication of selective arterial embolisation (SAE in patients with life-threatening post-partum haemorrhage (PPH. METHODOLOGY/PRINCIPAL FINDINGS: One hundred and two patients with PPH underwent SAE and were included from January 1998 to January 2002 in our university care center. Embolisation was considered effective when no other surgical procedure was required. Univariate and multivariate statistical analysis were performed. SAE was effective for 73 patients (71.5%, while 29 required surgical procedures. SAE was effective in 88.6% of women with uterine atony that was associated with positive outcome (OR 4.13, 1.35-12.60, whereas caesarean deliveries (OR 0.16, 0.04-0.5 and haemodynamic shock (OR 0.21, 0.07-0.60 were associated with high failure rates, 47.6% and 39.1%, respectively. CONCLUSIONS/SIGNIFICANCE: Success rate for SAE observed in a large population is lower than previously reported. It is most likely to succeed for uterine atony but not recommended in case of haemodynamic shock or after caesarean section.

  5. Life-threatening bleeding and radiologic intervention after aesthetic surgeries with minimal invasive approaches: report of two cases.

    Science.gov (United States)

    Kim, Youn-Hwan; Kim, Jong-Do; Visconti, Giuseppe; Kim, Jeong-Tae

    2010-10-01

    In this article, the authors report two cases of life-threatening bleeding after cosmetic surgeries that have been successfully treated with radiologic intervention. A 25-year-old female and a 35-year-old female presented at their institutions because of postoperative bleeding after intraoral mandibular angle ostectomy and endoscopic-guided trans-axillary breast augmentation, respectively. A ruptured traumatic pseudo-aneurysm of the right superficial temporal artery was diagnosed in the first case and a haematoma posterior to the right pectoralis major, due to active bleeding from a perforator of internal mammary artery, in the second case. Attempts were made to stop the haemorrhage using standard methods, but failed. Therefore, superselective microcatheter angioembolisation has been successfully performed in both the cases. At 22-month follow-up for the first case and at 12-month follow-up for the second case, the patients are asymptomatic and the cosmetic outcomes are being preserved. With radiologic intervention, the authors gained satisfactory results in the above-mentioned situations. Using this, with only local anaesthesia and the absence of incisions, a precise approach with immediate treatment to the haemorrhaging site is possible. This can be an excellent solution for arterial bleeding that is difficult to access anatomically after aesthetic surgeries, and in selected cases. Furthermore, this procedure is less disfiguring and preserves the aesthetic surgery outcomes. Copyright 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Antipsychotics, glycemic disorders, and life-threatening diabetic events: a Bayesian data-mining analysis of the FDA adverse event reporting system (1968-2004).

    Science.gov (United States)

    DuMouchel, William; Fram, David; Yang, Xionghu; Mahmoud, Ramy A; Grogg, Amy L; Engelhart, Luella; Ramaswamy, Krishnan

    2008-01-01

    disproportionality reporting ratios relating to glycemic effects, especially life-threatening events, in the AERS database. The relative associational rankings of drugs are similar in reports from younger and older patients. These results agree with several other reports in the literature, do not support a "class effect" hypothesis, and provide a strong rationale for further studies to clarify the issue.

  7. Baseline risk factors for incidence of blindness in a South Indian population: the chennai eye disease incidence study.

    Science.gov (United States)

    Vijaya, Lingam; Asokan, Rashima; Panday, Manish; Choudhari, Nikhil S; Ramesh, Sathyamangalam Ve; Velumuri, Lokapavani; Boddupalli, Sachi Devi; Sunil, Govindan T; George, Ronnie

    2014-08-07

    To report the baseline risk factors and causes for incident blindness. Six years after the baseline study, 4419 subjects from the cohort underwent a detailed examination at the base hospital. Incident blindness was defined by World Health Organization criteria as visual acuity of less than 6/120 (3/60) and/or a visual field of less than 10° in the better-seeing eye at the 6-year follow-up, provided that the eye had a visual acuity of better than or equal to 6/120 (3/60) and visual field greater than 10° at baseline. For incident monocular blindness, both eyes should have visual acuity of more than 6/120 (3/60) at baseline and developed visual acuity of less than 6/120 (3/60) in one eye at 6-year follow-up. For incident blindness, 21 participants (0.48%, 95% confidence interval [CI], 0.3-0.7) became blind; significant baseline risk factors were increasing age (P = 0.001), smokeless tobacco use (P blindness was found in 132 participants (3.8%, 95% CI, 3.7-3.8); it was significantly more (P blindness and monocular blindness. No history of cataract surgery was a risk factor for blindness and a protective factor for monocular blindness. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  8. Incidence and Major Metabolic Risk Factors of Metabolic Syndrome ...

    African Journals Online (AJOL)

    The study involved 300 (92 males and 208 females) type 2 diabetic patients and was conducted at the Tamale Teaching/Regional Hospital from June 2006 to May 2007. Metabolic syndrome was diagnosed using the National Cholesterol Education Programme, Adult Treatment Panel III (2001) criteria. The incidence of the ...

  9. Risk factors for diarrheal disease incidence in early childhood

    DEFF Research Database (Denmark)

    Mølbak, K; Jensen, H; Ingholt, L

    1997-01-01

    , comprehensive data on explanatory variables were recorded. Of 57 variables, seven were independently associated with an increased incidence of diarrhea. These were a recent (in the past 14 days) diarrheal episode, male sex, being weaned from breast milk, not being looked after by the mother, head...... of the household being sex, and not being looked after by the mother. Among weaned children, six variables...

  10. Middle mesial canals in mandibular molars: incidence and related factors.

    Science.gov (United States)

    Nosrat, Ali; Deschenes, Raney J; Tordik, Patricia A; Hicks, M Lamar; Fouad, Ashraf F

    2015-01-01

    Although the internal anatomy of mandibular molars has been extensively studied, information about middle mesial (MM) canals is limited. The primary aim of this retrospective study was to evaluate the incidence of MM canals in mandibular first and second molars. The secondary aim was to correlate the incidence of MM canals with variables of molar type, sex, age, ethnicity, and presence of a second distal canal. All mature permanent first and second mandibular molars treated from August 2012 to May 2014 were included in the analysis. After completion of root canal instrumentation in all main canals, the clinician inspected the isthmus area of the mesial root using the dental operating microscope. If there was a catch point in this area with a file or explorer, the operator spent more time attempting to negotiate an MM canal. Seventy-five mandibular first and second molars were treated during the specified period. Fifteen (20%) teeth had negotiable MM canals. The incidence of MM canals was 32.1% in patients ≤ 20 years old, 23.8% in patients 21-40 years old, and 3.8% in patients > 40 years. Analysis of data revealed a significant difference in the distribution of MM canals among different age groups (P molar type, and presence of a second distal canal were not significant. The incidence of negotiable MM canals overall and their frequency of identification in younger patients were higher than in previous reports. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. Placenta Praevia: Incidence, Risk Factors, Maternal and Fetal ...

    African Journals Online (AJOL)

    Maternal complications included post-partum anaemia, postpartum haemorrhage & operative site infection. There were two maternal deaths (1.48%) and the perinatal mortality rate was 18.7%. Conclusion: The incidence of Placenta praevia was relatively high and associated with high maternal and perinatal complications.

  12. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark.

    Science.gov (United States)

    Jabbari, Reza; Engstrøm, Thomas; Glinge, Charlotte; Risgaard, Bjarke; Jabbari, Javad; Winkel, Bo Gregers; Terkelsen, Christian Juhl; Tilsted, Hans-Henrik; Jensen, Lisette Okkels; Hougaard, Mikkel; Chiuve, Stephanie E; Pedersen, Frants; Svendsen, Jesper Hastrup; Haunsø, Stig; Albert, Christine M; Tfelt-Hansen, Jacob

    2015-01-05

    We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  13. Validation of the "Quality of Life in Life-Threatening Illness--Family Carer Version" (QOLLTI-F) in German-speaking carers of advanced cancer patients.

    Science.gov (United States)

    Schur, Sophie; Ebert-Vogel, Alexandra; Amering, Michaela; Masel, Eva Katharina; Neubauer, Marie; Schrott, Andrea; Sibitz, Ingrid; Watzke, Herbert; Schrank, Beate

    2014-10-01

    Palliative care is a multidisciplinary approach that focuses on the improvement of quality of life (QOL) of patients as well as their families. QOL research in palliative care has so far primarily focused on patients, but interest in the QOL of their relatives is increasing. For instruments measuring QOL in relatives, data on psychometric properties are often limited, and so far, none has been available in German. This study translates and validates the "Quality of Life in Life-Threatening Illness-Family Carer Version" (QOLLTI-F) in German-speaking carers of advanced cancer patients. The QOLLTI-F was translated from English into German according to the World Health Organisation's recommendations and validated in informal caregivers of terminally ill cancer patients of three Viennese hospitals. Hope was measured to assess concurrent validity; traumatic stress, anxiety, depression and subjective burden were measured to assess discriminant validity. Internal consistency, test-retest reliability and discriminative power were established. The scale's factor structure was explored using a set of factor analyses. Of the 308 caregivers participating in the study, 42 completed the QOLLTI-F retest after a mean of 5 days. The internal consistency was α = 0.85 for the overall scale, Pearson correlation between test and retest lay at r = 0.92. As expected, a significant positive correlation was found with hope (r = 0.40) and significant negative correlations with traumatic stress (r = -0.41), depression (r = -0.51), anxiety (r = -0.52) and overall subjective burden (r = -0.55). The original seven-factor structure was not reproduced, but the scale showed a stable four-factor structure with factors capturing (1) feelings about carers' own life, (2) professional care, (3) interaction with the patient and others and (3) carers' outlook on life. This study provides a sound translation and validation of the first QOL assessment tool for caregivers of

  14. Life-threatening false alarm rejection in ICU: using the rule-based and multi-channel information fusion method.

    Science.gov (United States)

    Liu, Chengyu; Zhao, Lina; Tang, Hong; Li, Qiao; Wei, Shoushui; Li, Jianqing

    2016-08-01

    False alarm (FA) rates as high as 86% have been reported in intensive care unit monitors. High FA rates decrease quality of care by slowing staff response times while increasing patient burdens and stresses. In this study, we proposed a rule-based and multi-channel information fusion method for accurately classifying the true or false alarms for five life-threatening arrhythmias: asystole (ASY), extreme bradycardia (EBR), extreme tachycardia (ETC), ventricular tachycardia (VTA) and ventricular flutter/fibrillation (VFB). The proposed method consisted of five steps: (1) signal pre-processing, (2) feature detection and validation, (3) true/false alarm determination for each channel, (4) 'real-time' true/false alarm determination and (5) 'retrospective' true/false alarm determination (if needed). Up to four signal channels, that is, two electrocardiogram signals, one arterial blood pressure and/or one photoplethysmogram signal were included in the analysis. Two events were set for the method validation: event 1 for 'real-time' and event 2 for 'retrospective' alarm classification. The results showed that 100% true positive ratio (i.e. sensitivity) on the training set were obtained for ASY, EBR, ETC and VFB types, and 94% for VTA type, accompanied by the corresponding true negative ratio (i.e. specificity) results of 93%, 81%, 78%, 85% and 50% respectively, resulting in the score values of 96.50, 90.70, 88.89, 92.31 and 64.90, as well as with a final score of 80.57 for event 1 and 79.12 for event 2. For the test set, the proposed method obtained the score of 88.73 for ASY, 77.78 for EBR, 89.92 for ETC, 67.74 for VFB and 61.04 for VTA types, with the final score of 71.68 for event 1 and 75.91 for event 2.

  15. Life-threatening and disabling injuries in car-to-car side impacts--implications for development of protective systems.

    Science.gov (United States)

    Håland, Y; Lövsund, P; Nygren, A

    1993-04-01

    Improvements to the passive safety of cars in lateral collisions are of great importance. This study of injuries in car side collisions in Sweden by the use of two evaluation methods has been performed to establish the basis for future development of protective systems for this type of accident. The Folksam car accident data file has been used. Injuries were found to be twice as common for near-side than for far-side* occupants in car to car impacts. Serious to fatal (AIS 3-6) injuries to belted front seat occupants in near side impacts (10% of all injuries) were compared with the estimated number of injuries to different parts of the body with risk of serious consequences (RSC)--either deaths or permanent disabilities (4.5% of all injuries). The two injury evaluation methods resulted in different ranking orders. AIS 3-6 injuries were received by the chest (37%), abdomen/pelvis (25%), and the head (15%). The RSC method gave a ranking order of head (25%), neck (21%), leg (15%), chest (14%), and abdomen/pelvis (11%). The method of evaluating AIS 3-6 injuries emphasizes only the threat to life. The RSC method also takes into account the risk of disabilities. Injuries to the neck and the leg were found to be most disabling, whilst the injuries to the head, chest, and abdomen/pelvis were the most life threatening. The study also shows that elderly people receive significantly more chest injuries (relative to the number of head injuries), on average four times more than young people.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes.

    Science.gov (United States)

    Zorzi, Alessandro; Perazzolo Marra, Martina; Rigato, Ilaria; De Lazzari, Manuel; Susana, Angela; Niero, Alice; Pilichou, Kalliopi; Migliore, Federico; Rizzo, Stefania; Giorgi, Benedetta; De Conti, Giorgio; Sarto, Patrizio; Serratosa, Luis; Patrizi, Giampiero; De Maria, Elia; Pelliccia, Antonio; Basso, Cristina; Schiavon, Maurizio; Bauce, Barbara; Iliceto, Sabino; Thiene, Gaetano; Corrado, Domenico

    2016-07-01

    The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. We compared 35 athletes (80% men, age: 14-48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography. © 2016 The Authors.

  17. Parenting under pressure: a grounded theory of parenting young children with life-threatening congenital heart disease.

    Science.gov (United States)

    Rempel, Gwen R; Ravindran, Vinitha; Rogers, Laura G; Magill-Evans, Joyce

    2013-03-01

    To report a grounded theory study to describe the process of parenting young children who have survived hypoplastic left heart syndrome to inform parent-focused interventions. Technological advances in paediatric cardiology worldwide have improved the survival rates for young children with hypoplastic left heart syndrome who undergo staged surgical palliation. These children, however, are at risk for life-threatening complications and parents are charged with the responsibility to monitor their children at home with minimal support and guidance from healthcare professionals once home. A constructivist grounded theory study. The study was conducted in 2006-2008. Participants were 25 parents (15 mothers, 10 fathers) and 28 grandparents (17 grandmothers, 11 grandfathers) of 15 young children (6 months-4·5 years) who had undergone the Sano surgical approach for hypoplastic left heart syndrome. The 53 interviews were digitally recorded, transcribed and analysed using open and focused coding, constant comparative analysis and memoing. A process of Parenting under Pressure emerged that was characterized by four overlapping and re-emerging phases: (1) realizing and adjusting to the inconceivable; (2) growing increasingly attached; (3) watching for and accommodating the unexpected; and (4) encountering new challenges. In-depth understanding of the phases of Parenting under Pressure provides direction for nurses to support parents of children who survive hypoplastic left heart syndrome. Interventions that help carers of children with complex health conditions move through the phases of our Parenting under Pressure process may help them safeguard the survival of their children, and their own survival as parents as they manage multiple demands. © 2012 Blackwell Publishing Ltd.

  18. Neonatal severe hyperparathyroidism caused by homozygous mutation in CASR: A rare cause of life-threatening hypercalcemia.

    Science.gov (United States)

    Murphy, Heidi; Patrick, Jessica; Báez-Irizarry, Eileen; Lacassie, Yves; Gómez, Ricardo; Vargas, Alfonso; Barkemeyer, Brian; Kanotra, Sohit; Zambrano, Regina M

    2016-04-01

    Neonatal severe hyperparathyroidism (NSHPT) is a rare, life-threatening condition that presents with severe hypercalcemia, hyperparathyroidism, and osteopenia in the newborn period. Treatment of NSHPT traditionally includes hydration and bisphosphonates; however newer calcimimetic agents, such as cinacalcet, are now being utilized to prevent or delay parathyroidectomy which is technically difficult in the newborn. Medical treatment success is related to calcium sensing receptor (CaSR) genotype. We report a 4-day-old infant who presented with hyperbilirubinemia, poor feeding, weight loss, severe hypotonia and was ultimately diagnosed with NSHPT. The patient's total serum calcium level of 36.8 mg/dL (reference range: 8.5-10.4 mg/dL) is, to our knowledge, the highest ever documented in this setting. Exome data previously obtained on the infant's parents was re-analyzed demonstrating bi-parental heterozygosity for a mutation of the CASR gene: c.206G > A, and Sanger sequencing data confirmed the patient was a homozygote for the same mutation. Though a patient with the same CaSR gene mutation described here has responded to cinacalcet, our patient did not respond and required parathyroidectomy. Though this case has previously been published as a surgical case report, a full report of the medical management and underlying genetic etiology is warranted; this case underscores the importance of disclosing bi-parental heterozygosity for a gene causing severe neonatal disease particularly when treatment is available and illustrates the need for further in vitro studies of this CaSR mutation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Factors influencing the incidence of pre-term birth in Calabar, Nigeria

    African Journals Online (AJOL)

    Women who had pre-term birth in the University of Calabar Teaching Hospital, Calabar, over a 2 ½ year period were studied. The aim was to establish the factors influencing the incidence of pre-term birth in Calabar. Factors which significantly increase the incidence of pre-term delivery included: previous induced abortion ...

  20. Analysis of contributing factors associated to related patients safety incidents in Intensive Care Medicine.

    Science.gov (United States)

    Martín Delgado, M C; Merino de Cos, P; Sirgo Rodríguez, G; Álvarez Rodríguez, J; Gutiérrez Cía, I; Obón Azuara, B; Alonso Ovies, Á

    2015-01-01

    To explore contributing factors (CF) associated to related critical patients safety incidents. SYREC study pos hoc analysis. A total of 79 Intensive Care Departments were involved. The study sample consisted of 1.017 patients; 591 were affected by one or more incidents. The CF were categorized according to a proposed model by the National Patient Safety Agency from United Kingdom that was modified. Type, class and severity of the incidents was analyzed. A total 2,965 CF were reported (1,729 were associated to near miss and 1,236 to adverse events). The CF group more frequently reported were related patients factors. Individual factors were reported more frequently in near miss and task related CF in adverse events. CF were reported in all classes of incidents. The majority of CF were reported in the incidents classified such as less serious, even thought CF patients factors were associated to serious incidents. Individual factors were considered like avoidable and patients factors as unavoidable. The CF group more frequently reported were patient factors and was associated to more severe and unavoidable incidents. By contrast, individual factors were associated to less severe and avoidable incidents. In general, CF most frequently reported were associated to near miss. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  1. The incidence of depression and its risk factors in Dutch nursing homes and residential care homes

    NARCIS (Netherlands)

    Boorsma, M.; Joling, K.J.; Dussel, M.; Ribbe, M.W.; Frijters, D.H.M.; van Marwijk, H.W.J.; Nijpels, G.; van Hout, H.P.J.

    2012-01-01

    Objective: Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for

  2. Life-threatening urethral hemorrhage after placement of a Foley catheter in a patient with uroseptic disseminated intravascular coagulation due to chronic urinary retention induced by untreated benign prostatic hyperplasia.

    Science.gov (United States)

    Ikegami, Yukihiro; Yoshida, Keisuke; Imaizumi, Tsuyoshi; Isosu, Tsuyoshi; Kurosawa, Shin; Murakawa, Masahiro

    2016-10-01

    A 77-year-old man with severe septic disseminated intravascular coagulation following urinary infection was transported to our hospital. He had developed urinary retention induced by untreated prostatic hyperplasia. Immediate drainage with a Foley catheter was successfully carried out, but the hematuria progressed to life-threatening hemorrhage. Complete hemostasis was impossible by surgical treatment because the tissue around the prostatic urethra was very fragile and hemorrhagic. Organized treatments (continuous hemodiafiltration combined with polymyxin-B immobilized fiber column hemoperfusion and systemic treatment with antibiotics and coagulation factors) were commenced soon after the operation. The patient eventually recovered from the septic disseminated intravascular coagulation. This case report illustrates the risk of placement of Foley catheters in patients with severe septic disseminated intravascular coagulation.

  3. Incidence and predictive factors of isolated neonatal penile glanular torsion.

    Science.gov (United States)

    Sarkis, Pierrot E; Sadasivam, Muthurajan

    2007-12-01

    To determine the incidence of isolated neonatal penile glanular torsion, describe the basic characteristics, and explore the relationship between foreskin and glans torsion. A prospective survey was conducted of all male newborns admitted to nursery after delivery, or neonates less than 3 months presenting for circumcision. Cases with associated genital malformations were excluded. The incidence of isolated neonatal penile torsion was 27% (95% CI: 22.2%-31.84%), to the left in 99% of cases. In 3.5% of cases, the penis had an angle 20 degrees. Using Spearman's correlational coefficient, deviation of penile raphe from the midline at the foreskin tip had a better correlation with glans torsion than deviation of raphe at the coronal sulcus (0.727 vs 0.570; both significant at pscope of the study.

  4. [Pressure ulcers in surgery patients: incidence and associated factors].

    Science.gov (United States)

    Scarlatti, Kelly Cristina; Michel, Jeanne Liliane Marlene; Gamba, Mônica Antar; de Gutiérrez, Maria Gaby Rivero

    2011-12-01

    Pressure ulcers are an important perioperatory care quality indicator This is a longitudinal case series study, performed with the following objectives: to estimate the incidence of pressure ulcers in patients submitted to medium and large surgeries; rate them according to the stage and location; verify the association with the variables: gender, age, body mass index (BMI), co-morbidities, surgical position, duration of surgery, anesthesia type and use of positioning devices, with presence or absence of pressure ulcers. Data collection took place in 2007 in São Paulo, with 199 patients, 20.6% of which presented pressure ulcers, and most (98.6%) in stages I and II, and the main location was the trunk (35.1%). The variables: position, surgery time, general anesthesia, and device use had a statistically significant association. In conclusion, there is a high incidence of pressure ulcers among surgical patients, requiring actions aimed at reducing this type of injury.

  5. Subclinical Mastitis in Dairy Animals: Incidence, Economics, and Predisposing Factors

    OpenAIRE

    Sinha, Mukesh Kr.; Thombare, N. N.; Mondal, Biswajit

    2014-01-01

    A study was conducted to assess the incidence and economics of subclinical form of bovine mastitis in Central Region of India. Daily milk records of 187 animals during three seasons were collected and subjected to analysis. The economic loss due to reduction in yield, clinical expenses, and additional resources used were quantified and aggregated. The losses due to mastitis in monetary terms were estimated to be INR1390 per lactation, among which around 49% was owing to loss of value from mil...

  6. Incidents at nuclear power plants caused by the human factor

    International Nuclear Information System (INIS)

    Mashin, V. A.

    2012-01-01

    Psychological analysis of the causes of incorrect actions by personnel is discussed as presented in the report “Methodological guidelines for analyzing the causes of incidents in the operation of nuclear power plants.” The types of incorrect actions and classification of the root causes of errors by personnel are analyzed. Recommendations are made for improvements in the psychological analysis of causes of incorrect actions by personnel.

  7. Key Planning Factors for Recovery from a Radiological Terrorism Incident

    Science.gov (United States)

    2012-09-01

    measurements are made, these are collected electronically4 and automatically exported to local operation centers and incident command posts where the...economic, natural and built environments and a move to self-sufficiency, sustainability and resilience.” As can be seen in Figure 3-11, some long-term...Transportation and access routes Bridges Streets and thoroughfares Sidewalks and walkways Release of property from radiologically controlled areas

  8. Broncho-esophageal fistula leading to lung abscess: a life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus

    International Nuclear Information System (INIS)

    Puranik, Ameya D.; Purandare, Nilendu C.; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh

    2013-01-01

    Sinister undesirable pathologies often accompany malignancies. Though the entire emphasis is on cancer management, these benign conditions are more life-threatening than the primary malignancy itself. We report an interesting imaging finding of broncho-esophageal fistula leading to lung abscess on 18 F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) in large middle esophageal cancer, which due to early detection, was promptly managed. (author)

  9. Broncho-esophageal fistula leading to lung abscess: A life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus.

    Science.gov (United States)

    Puranik, Ameya D; Purandare, Nilendu C; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh

    2013-07-01

    Sinister undesirable pathologies often accompany malignancies. Though the entire emphasis is on cancer management, these benign conditions are more life-threatening than the primary malignancy itself. We report an interesting imaging finding of broncho-esophageal fistula leading to lung abscess on (18)F- fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) in large middle esophageal cancer, which due to early detection, was promptly managed.

  10. Infantile colic incidence and associated risk factors: a cohort study

    OpenAIRE

    Saavedra, Maria A.L.; Costa, Juvenal S. Dias da; Garcias, Gilberto; Horta, Bernardo L.; Tomasi, Elaine; Mendonça, Rodrigo

    2003-01-01

    OBJETIVOS: estabelecer a incidência de cólica no lactente e seus determinantes. MÉTODOS: entre maio e julho de 1999, a equipe de pesquisa visitou, diariamente, as três principais maternidades da cidade de Pelotas, RS, e todas as mulheres, após o parto, foram entrevistadas, e seus filhos acompanhados aos três meses. Definiu-se a criança com cólica conforme proposto por Wessel. Os possíveis fatores de risco avaliados foram: classe social, escolaridade materna, idade dos pais, tipo e tempo de re...

  11. Does decisional conflict differ across race and ethnicity groups? A study of parents whose children have a life-threatening illness.

    Science.gov (United States)

    Knapp, Caprice; Sberna-Hinojosa, Melanie; Baron-Lee, Jacqueline; Curtis, Charlotte; Huang, I-Chan

    2014-05-01

    Children with life-threatening illnesses and their families may face a myriad of medical decisions in their lifetimes. Oftentimes these complicated medical decisions cause disagreements among patients, families, and providers about what is the best course of action. Although no evidence exists, it is possible that conflict may affect subgroups of the population differently. This study aims to investigate how decisional conflict varies among racial and ethnic subgroups. Two hundred sixty-six surveys were completed with parents whose children have a life-threatening illness. All children lived in Florida and were enrolled in the Medicaid program. The Decisional Conflict Scale, overall and broken down into its five distinct subscales, was used to assess parental decision-making. Descriptive, bivariate, and multivariate analyses were conducted. Subgroup analyses were conducted on Latino respondents. Our bivariate results suggest that minority parents report less Effective Decision Making (pracial and ethnic differences in decisional conflict of parents of children with life-threatening illnesses. Significant differences exist by race, ethnicity, language spoken, and diagnosis time across several subdomains of decisional conflict. These differences are important to address when creating clinical care plans, engaging in shared decision-making, and creating interventions to alleviate decisional conflict.

  12. Dry Socket: Incidence, Clinical Features, and Predisposing Factors

    Directory of Open Access Journals (Sweden)

    Babatunde O. Akinbami

    2014-01-01

    Full Text Available Background. Dry socket is a global phenomenon. The purpose of the study was to investigate the incidence of dry socket in recent times in a Nigerian Tertiary Hospital. Methods. Patients who were referred for dental extractions were included in the study. The case files of patients were obtained and information retrieved included biodata, indication for extraction, number and type of teeth extracted, oral hygiene status, compliance to oral hygiene instructions, and development of dry socket. Results. One thousand, one hundred and eighty two patients with total of 1362 teeth extracted during the 4-year period of the study were analyzed, out of which 1.4% teeth developed dry socket. The mean age (SD was 35.2 (16.0 years. Most of the patients who presented with dry socket were in the fourth decade of life. Mandibular teeth were affected more than maxillary teeth. Molars were more affected. Retained roots and third molars were conspicuous in the cases with dry socket. Conclusion. The incidence of dry socket in our centre was lower than previous reports. Oral hygiene status, lower teeth, and female gender were significantly associated with development of dry socket. Treatment with normal saline irrigation and ZnO eugenol dressings allowed relief of the symptoms.

  13. Risk factors for radiotherapy incidents and impact of an online electronic reporting system

    International Nuclear Information System (INIS)

    Chang, David W.; Cheetham, Lynn; Marvelde, Luc te; Bressel, Mathias; Kron, Tomas; Gill, Suki; Tai, Keen Hun; Ball, David; Rose, William; Silva, Linas; Foroudi, Farshad

    2014-01-01

    Background and purpose: To ascertain the rate, type, significance, trends and the potential risk factors associated with radiotherapy incidents in a large academic department. Materials and methods: Data for all radiotherapy activities from July 2001 to January 2011 were reviewed from radiotherapy incident reporting forms. Patient and treatment data were obtained from the radiotherapy record and verification database (MOSAIQ) and the patient database (HOSPRO). Logistic regression analyses were performed to determine variables associated with radiotherapy incidents. Results: In that time, 65,376 courses of radiotherapy were delivered with a reported incident rate of 2.64 per 100 courses. The rate of incidents per course increased (1.96 per 100 courses to 3.52 per 100 courses, p < 0.001) whereas the proportion of reported incidents resulting in >5% deviation in dose (10.50 to 2.75%, p < 0.001) had decreased after the introduction of an online electronic reporting system. The following variables were associated with an increased rate of incidents: afternoon treatment time, paediatric patients, males, inpatients, palliative plans, head-and-neck, skin, sarcoma and haematological malignancies. In general, complex plans were associated with higher incidence rates. Conclusion: Radiotherapy incidents were infrequent and most did not result in significant dose deviation. A number of risk factors were identified and these could be used to highlight high-risk cases in the future. Introduction of an online electronic reporting system resulted in a significant increase in the number of incidents being reported

  14. Pilot Critical Incident Reports as a Means to Identify Human Factors of Remotely Piloted Aircraft

    Science.gov (United States)

    Hobbs, Alan; Cardoza, Colleen; Null, Cynthia

    2016-01-01

    It has been estimated that aviation accidents are typically preceded by numerous minor incidents arising from the same causal factors that ultimately produced the accident. Accident databases provide in-depth information on a relatively small number of occurrences, however incident databases have the potential to provide insights into the human factors of Remotely Piloted Aircraft System (RPAS) operations based on a larger volume of less-detailed reports. Currently, there is a lack of incident data dealing with the human factors of unmanned aircraft systems. An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. During each focus group session, a note taker produced a de-identified written record of the incident narratives. At the end of the session, participants reviewed each written incident report, and made edits and corrections as necessary. The incidents were later analyzed to identify contributing factors, with a focus on design issues that either hindered or assisted the pilot during the events. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies. Pilots participated willingly and enthusiastically in the study

  15. Neonatal clavicle fracture in cesarean delivery: incidence and risk factors.

    Science.gov (United States)

    Choi, Hyun Ah; Lee, Yeon Kyung; Ko, Sun Young; Shin, Son Moon

    2017-07-01

    Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied. We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance. Among a total 89 367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥ 4000  g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture. Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.

  16. Incidence and risk factors for pin tract infection in external fixation of ...

    African Journals Online (AJOL)

    Incidence and risk factors for pin tract infection in external fixation of fractures ... for pin tract infection, there were 93 pins scored grade 1, 32 pins grade 2, 15 ... The incidence increased from 20.5% in closed fractures to 75.9% in open fractures.

  17. Incidences and Risk Factors of Organ Manifestations in the Early Course of Systemic Sclerosis

    DEFF Research Database (Denmark)

    Jaeger, Veronika K; Wirz, Elina G; Allanore, Yannick

    2016-01-01

    risk factors associated with incident renal crisis. CONCLUSION: In SSc patients presenting early after RP onset, approximately half of all incident organ manifestations occur within 2 years and have a simultaneous rather than a sequential onset. These findings have implications for the design of new...

  18. Increased sexually transmitted infection incidence in a low risk population: identifying the risk factors.

    LENUS (Irish Health Repository)

    Shiely, Frances

    2010-04-01

    Between 1994 and 2006, the incidence of sexually transmitted infections (STIs) in Ireland has increased by over 300%. Recent literature would suggest that this figure is an underestimation of the true scale of infection. Our objective was to determine the risk factors associated with STI diagnosis in a population with a rapidly increasing STI incidence.

  19. Relationship between mechanical factors and incidence of low back pain.

    Science.gov (United States)

    Nourbakhsh, Mohammad Reza; Arab, Amir Massoud

    2002-09-01

    A multifactorial cross-sectional nonexperimental design. To collectively investigate the association among 17 mechanical factors and occurrence of low back pain (LBP). Several physical characteristics, based on assumptions, clinical findings, and scientific experiments, have been associated with the development of LBP Controversy exists regarding the degree of association between some of these physical characteristics and LBP. Information regarding the degree of association of each factor to LBP is needed for effective prevention and appropriate treatment strategies. A total of 600 subjects participated in this study. Subjects were categorized into 4 groups: asymptomatic men (n = 150, age [mean +/- SD] = 43 +/- 15 years), asymptomatic women (n = 150, age [mean +/- SD] = 43 +/- 13 years), men with LBP (n = 150, age [mean +/- SD] = 43 +/- 14 years), and women with LBP (n = 150, age [mean +/- SD] = 43 +/- 13 years). Seventeen physical characteristics were measured in each group and the relative association of each characteristic with LBP was assessed. Among all the factors tested, endurance of the back extensor muscles had the highest association with LBP Other factors such as the length of the back extensor muscles, and the strength of the hip flexor, hip adductor, and abdominal muscles also had a significant association with LBP. It appears that muscle endurance and weakness are associated with LBP and that structural factors such as the size of the lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and iliopsoas muscles are not associated with the occurrence of LBP.

  20. Incidence and risk factors of periparturient conditions in smallholder ...

    African Journals Online (AJOL)

    Department of Clinical Studies, University of Nairobi, P.O. Box 29053-00625, ... fever and retained placenta among others) in smallholder dairy cattle herds and ... study it can be concluded that downer cow syndrome, dystocia, mastitis, metritis, ..... eliminate the factors that were not significant at P<0.05 in the overall model.

  1. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors

    NARCIS (Netherlands)

    Ree, Isabelle M. C.; Fustolo-Gunnink, Suzanne F.; Bekker, Vincent; Fijnvandraat, Karin J.; Steggerda, Sylke J.; Lopriore, Enrico

    2017-01-01

    Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predictive, independent risk factors for sepsis-associated mortality. This study aims to clarify the occurrence, severity and duration of thrombocytopenia in neonatal sepsis. A cohort study was carried out among all

  2. Factors Determining the Incidence of Suicide within Families

    Science.gov (United States)

    Farber, Maurice L.

    1977-01-01

    This paper addresses itself to the reasons why suicide tends to repeat in some families. Factors include entire family exposure to stresses, grief, and guilt induced by suicide, the provision of a model by the original suicide, suicidogenic interpersonal styles in families, suicidogenic child-rearing practice, and innate predispositions to…

  3. Analysis of human factors in incidents reported by Swiss nuclear power plants to the inspectorate

    International Nuclear Information System (INIS)

    Alder, H.P.; Hausmann, W.

    1997-01-01

    197 reported incidents in Swiss Nuclear Power Plants were analyzed by a team of the Swiss Federal Nuclear Safety Inspectorate (HSK) using the OECD/NEA Incident Reporting System. The following conclusions could be drawn from this exercise. While the observed cause reported by the plant was ''technical failure'' in about 90% of the incidents, the HSK-Team identified for more than 60% of the incidents ''human factors'' as the root cause. When analyzing this root cause further it was shown that only a smaller contribution came from the side of the operators and the more important shares were caused by plant maintenance, vendors/constructors and plant management with procedural and organizational deficiencies. These findings demonstrate that root cause analysis of incidents by the IRS-Code is a most useful tool to analyze incidents and to find weak points in plant performance. (author). 5 tabs

  4. Incidence, risk factors, and morphology in operating microscope light retinopathy

    International Nuclear Information System (INIS)

    Khwarg, S.G.; Linstone, F.A.; Daniels, S.A.; Isenberg, S.J.; Hanscom, T.A.; Geoghegan, M.; Straatsma, B.R.

    1987-01-01

    A review of 135 consecutive cataract operations identified ten cases (7.4%) of operating microscope light retinopathy. Ophthalmoscopically, these light retinopathy lesions appeared as a focal pigment epithelial change with varying degrees of pigment clumping in the center. Fluorescein angiography accentuated the lesion by demonstrating a sharply demarcated transmission defect, occasionally with multiple satellite lesions. The shape of the lesion matched the shape of the illuminating source of the particular operating microscope used during the surgery. The most significant risk factor associated with the production of these light retinopathy lesions was prolonged operating time. Mean total operating time for the ten patients with light retinopathy was 51 minutes longer than for those without (P less than .0001). Other significant associated factors were the presence of diabetes mellitus (P less than .03), younger age (P less than .05), and the use of hydrochlorothiazide (P less than .04)

  5. Evaluation of Effective Factors in Incidence of Colorectal Cancer

    Directory of Open Access Journals (Sweden)

    Farhad Pourfarzi

    2012-11-01

    Full Text Available Background & Objectives: Colorectal cancer is considered as the third prevalent malignancy worldwide. Investigation of information on cancers in Iran during 1985-1996 showed an increase in the incidence and prevalence of colorectal cancer. Its rank in Iran has increased from 9 to 5th during 10 years. It was reported as high prevalent cancer in Iranian people aged less than 40 years among Asian countries.   Methods: In this cases-control study patients with a pathologic report of colorectal cancer were recruited among those cases registered in Ardabil Cancer Registry. Control group were selected from neighbors, frequency matched for age and gender. Subjects were interviewed using a questionnaire consisting information on age, gender, smoking, drugs and alcohol consuming, diet, family history of cancer and serum IgM and IgG level for H. pylori. Data were analyzed using SPSS v16.   Results: In the current study, 43 persons (53.8% were male and 37 (46.2% were female. In the case group, 10 persons (12.5% were under 40, 34 cases (42.5% in age group of 41- 60 and 36 persons (45% were more than 61 years. In the control group 12 persons (15% were under 40, 36 persons (45.5% in age group of 41-60 and 40 persons (68% were more than 61 years. In the control group 3 cases had BMI less than 19, 36 cases (45% between 19-24.9, 31 cases (38.8% between 25-29.9 and 10 cases (12.5% were more than 30, whereas this variable was 2.5, 32.5, 46.2 and 18.8% respectively in the case group.   Positive history of smoking found to increase the risk of cancer around 1.8 times (OR= 1.78 CI: 0.91- 5.85. However, significant difference was not observed between two groups regarding alcoholic beverage consumption (p=0.385 . There were significant differences between two groups in terms of vegetables and carbohydrates intake. Difference was also significant between two groups regarding positive level of IgG. Among studied persons, 19 and 13 patients in case and control group had

  6. In-depth analysis of the causal factors of incidents reported in the Greek petrochemical industry

    International Nuclear Information System (INIS)

    Konstandinidou, Myrto; Nivolianitou, Zoe; Kefalogianni, Eirini; Caroni, Chrys

    2011-01-01

    This paper presents a statistical analysis of all reported incidents in the Greek petrochemical industry from 1997 to 2003. A comprehensive database has been developed to include industrial accidents (fires, explosions and substance releases), occupational accidents, incidents without significant consequences and near misses. The study concentrates on identifying and analyzing the causal factors related to different consequences of incidents, in particular, injury, absence from work and material damage. Methods of analysis include logistic regression with one of these consequences as dependent variable. The causal factors that are considered cover four major categories related to organizational issues, equipment malfunctions, human errors (of commission or omission) and external causes. Further analyses aim to confirm the value of recording near misses by comparing their causal factors with those of more serious incidents. The statistical analysis highlights the connection between the human factor and the underlying causes of accidents or incidents. - Highlights: → The research work is original, based on field data collected directly from the petrochemical industry. → It deals with the in-depth statistical analysis of accident data on human-organizational causes. → It researches underlying causes of accidents and the parameters affecting them. → The causal factors that are considered cover four big taxonomies. → Near misses are worth recording for comparing their causal factors with more serious incidents.

  7. In-depth analysis of the causal factors of incidents reported in the Greek petrochemical industry

    Energy Technology Data Exchange (ETDEWEB)

    Konstandinidou, Myrto [Institute of Nuclear Technology-Radiation Protection, National Center for Scientific Research ' Demokritos' , Aghia Paraskevi 15310 (Greece); Nivolianitou, Zoe, E-mail: zoe@ipta.demokritos.gr [Institute of Nuclear Technology-Radiation Protection, National Center for Scientific Research ' Demokritos' , Aghia Paraskevi 15310 (Greece); Kefalogianni, Eirini; Caroni, Chrys [School of Applied Mathematical and Physical Sciences, National Technical University of Athens, 9 Iroon Polytexneiou Str., Zografou Campus, 157 80 Athens (Greece)

    2011-11-15

    This paper presents a statistical analysis of all reported incidents in the Greek petrochemical industry from 1997 to 2003. A comprehensive database has been developed to include industrial accidents (fires, explosions and substance releases), occupational accidents, incidents without significant consequences and near misses. The study concentrates on identifying and analyzing the causal factors related to different consequences of incidents, in particular, injury, absence from work and material damage. Methods of analysis include logistic regression with one of these consequences as dependent variable. The causal factors that are considered cover four major categories related to organizational issues, equipment malfunctions, human errors (of commission or omission) and external causes. Further analyses aim to confirm the value of recording near misses by comparing their causal factors with those of more serious incidents. The statistical analysis highlights the connection between the human factor and the underlying causes of accidents or incidents. - Highlights: > The research work is original, based on field data collected directly from the petrochemical industry. > It deals with the in-depth statistical analysis of accident data on human-organizational causes. > It researches underlying causes of accidents and the parameters affecting them. > The causal factors that are considered cover four big taxonomies. > Near misses are worth recording for comparing their causal factors with more serious incidents.

  8. Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis.

    Science.gov (United States)

    Strömberg, A; Broström, A; Dahlström, U; Fridlund, B

    1999-01-01

    The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure. A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic. Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals. By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance.

  9. Complications of thoracentesis: incidence, risk factors, and strategies for prevention.

    Science.gov (United States)

    Cantey, Eric P; Walter, James M; Corbridge, Thomas; Barsuk, Jeffrey H

    2016-07-01

    Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema. Recent data support the importance of operator expertise and the use of ultrasound in reducing the risk of iatrogenic pneumothorax. Although coagulopathy or thrombocytopenia and the use of anticoagulant or antiplatelet medications have traditionally been viewed as contraindications to thoracentesis, new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk. Re-expansion pulmonary edema, a rare complication of thoracentesis, is felt to result in part from the generation of excessively negative pleural pressure. When and how to monitor changes in pleural pressure during thoracentesis remains a focus of ongoing study. Major complications of thoracentesis are uncommon. Clinician awareness of risk factors for procedural complications and familiarity with strategies that improve outcomes are essential components for safely performing thoracentesis.

  10. Incidence and Risk Factors of Persistent Hyperparathyroidism After Kidney Transplantation.

    Science.gov (United States)

    Nakai, K; Fujii, H; Ishimura, T; Fujisawa, M; Nishi, S

    Persistent hyperparathyroidism after kidney transplantation is related to graft function, but pre-transplantation risk factors of persistent hyperparathyroidism have not been evaluated in detail. We enrolled 86 patients who had undergone kidney transplantation between 2008 and 2014. Nine patients showed persistent hyperparathyroidism characterized by the following: 1) serum parathyroid hormone levels >65 pg/mL and serum calcium levels >10.5 mg/dL at 1 year after kidney transplantation; 2) parathyroidectomy after kidney transplantation; and 3) reintroduction of cinacalcet after kidney transplantation. Compared with other patients, these 9 patients had significantly longer duration of dialysis therapy (186 ± 74 mo vs 57 ± 78 mo) and more frequent treatment with cinacalcet during dialysis (89% vs 12%). Multivariate analysis showed that dialysis vintage, calcium phosphate products, and cinacalcet use before kidney transplantation were independent risk factors of persistent hyperparathyroidism after kidney transplantation. A receiver operating characteristic curve showed 72 months as the cutoff value of dialysis vintage and 55 as the cutoff value of calcium phosphate products. In conclusion, dialysis vintage >6 years, calcium phosphate products >55 (mg/dL) 2 , and cinacalcet use before kidney transplantation are strong predictors of persistent hyperparathyroidism. High-risk patients should be evaluated for parathyroid enlargement, and parathyroidectomy must be considered before kidney transplantation. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. The effects of life review on psycho-spiritual well-being among patients with life-threatening illness: a systematic review and meta-analysis.

    Science.gov (United States)

    Chen, Ying; Xiao, Huimin; Yang, Yanqing; Lan, Xiuyan

    2017-07-01

    The aim of this study was to examine the strength of evidence regarding the effects of life review on psycho-spiritual well-being among patients with life-threatening illness. Life-threatening illness not only causes physical symptoms but also psycho-spiritual burdens. Life review has been widely implemented to assist people coping with these burdens. However, the effectiveness of life review is not clear. To date, no systematic review or meta-analysis has been published on this topic. A systematic review with meta- analysis consistent with the recommendations of the Cochrane Collaboration was conducted. Database searches included MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, CNKI and VIP et al. up to April 2015. We also searched the grey literature, reviewed reference lists from relevant articles and book chapters and contacted experts. Nine randomized controlled trials (RCTs) and two controlled clinical trials (CCTs) were eligible for this systematic review and meta-analysis. The risk of bias for those studies were rated as moderate (n = 11). The meta-analyses demonstrated significant standardized mean differences or mean differences in favour of life review compared with the control for depression, quality of life and self-esteem. The findings indicate that life review can decrease depressive symptoms, improve quality of life and enhance self-esteem among patients with life-threatening illnesses. Multi-centre studies with adequate sample size and rigorous designs are needed in future research. © 2016 John Wiley & Sons Ltd.

  12. A Case of Apparent Life-Threatening Event: Comorbid Gastric Volvulus Associated Gastroesophageal Reflux Disease and Epilepsy in a 4-Month-Old Boy

    Directory of Open Access Journals (Sweden)

    Yoshihiko Takano

    2016-01-01

    Full Text Available Most isolated episodes of apparent life-threatening events (ALTEs do not lead to the diagnosis of serious conditions, and their prognoses are generally benign. However, recurrent ALTEs are often associated with a risk of future serious adverse events and should be evaluated for appropriate management. Here we present ALTE case in which gastric volvulus associated gastroesophageal reflux disease was detected as an etiology initially, followed by the detection of epilepsy as another etiology. Clinicians should consider possibility of two or more etiologies in a single recurrent ALTE case.

  13. Patterns, incidence and predictive factors for pain after interventional radiology

    International Nuclear Information System (INIS)

    England, A.; Tam, C.L.; Thacker, D.E.; Walker, A.L.; Parkinson, A.S.; DeMello, W.; Bradley, A.J.; Tuck, J.S.; Laasch, H.-U.; Butterfield, J.S.; Ashleigh, R.J.; England, R.E.; Martin, D.F.

    2005-01-01

    AIM: To evaluate prospectively the pattern, severity and predictive factors of pain after interventional radiological procedures. MATERIALS AND METHODS: All patients undergoing non-arterial radiological interventional procedures were assessed using a visual-analogue scale (VAS) for pain before and at regular intervals for 24 h after their procedure. RESULTS: One hundred and fifty patients (87 men, mean age 62 years, range 18-92 years) were entered into the study. Significant increases in VAS score occurred 8 h after percutaneous biliary procedures (+47.7 mm, SD 14.9 mm; p=0.001), 6 h after central venous access and gastrostomy insertion (+23.7 mm, SD 19.5 mm; p=0.001 and +28.4 mm, SD 9.7 mm; p=0.007, respectively) and 4 h after oesophageal stenting (+27.8 mm, SD 20.2 mm, p=0.001). Non-significant increases in VAS pain score were observed after duodenal and colonic stenting (duodenal: +5.13 mm, SD 7.47 mm; p=0.055, colonic: +23.3 mm, SD 13.10 mm, p=0.250) at a mean of 5 h (range 4-6 h). Patients reported a significant reduction in pain score for nephrostomy insertion (-28.4 mm, SD 7.11 mm, p=0.001). Post-procedural analgesia was required in 99 patients (69.2%), 40 (28.0%) requiring opiates. Maximum post-procedural VAS pain score was significantly higher in patients who had no pre-procedural analgesia (p=0.003). CONCLUSION: Post-procedural pain is common and the pattern and severity of pain between procedures is variable. Pain control after interventional procedures is often inadequate, and improvements in pain management are required

  14. Nationwide analysis on the impact of socioeconomic land use factors and incidence of urothelial carcinoma.

    Science.gov (United States)

    Brandt, Maximilian P; Gust, Kilian M; Mani, Jens; Vallo, Stefan; Höfner, Thomas; Borgmann, Hendrik; Tsaur, Igor; Thomas, Christian; Haferkamp, Axel; Herrmann, Eva; Bartsch, Georg

    2018-02-01

    Incidence rates for urothelial carcinoma (UC) have been reported to differ between countries within the European Union (EU). Besides occupational exposure to chemicals, other substances such as tobacco and nitrite in groundwater have been identified as risk factors for UC. We investigated if regional differences in UC incidence rates are associated with agricultural, industrial and residential land use. Newly diagnosed cases of UC between 2003 and 2010 were included. Information within 364 administrative districts of Germany from 2004 for land use factors were obtained and calculated as a proportion of the total area of the respective administrative district and as a smoothed proportion. Furthermore, information on smoking habits was included in our analysis. Kulldorff spatial clustering was used to detect different clusters. A negative binomial model was used to test the spatial association between UC incidence as a ratio of observed versus expected incidence rates, land use and smoking habits. We identified 437,847,834 person years with 171,086 cases of UC. Cluster analysis revealed areas with higher incidence of UC than others (p=0.0002). Multivariate analysis including significant pairwise interactions showed that the environmental factors were independently associated with UC (psocioeconomic factors based on agricultural, industrial and residential land use may be associated with UC incidence rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Elnahal, Shereef M., E-mail: selnaha1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Blackford, Amanda [Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2016-04-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  16. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    International Nuclear Information System (INIS)

    Elnahal, Shereef M.; Blackford, Amanda; Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A.

    2016-01-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  17. Effects of weather factors on dengue fever incidence and implications for interventions in Cambodia

    Directory of Open Access Journals (Sweden)

    Youngjo Choi

    2016-03-01

    Full Text Available Abstract Background Dengue viruses and their mosquito vectors are sensitive to their environment. Temperature, rainfall and humidity have well-defined roles in the transmission cycle. Therefore changes in these conditions may contribute to increasing incidence. The aim of this study was to examine the relationship between weather factors and dengue incidence in three provinces in Cambodia, in order to strengthen the evidence basis of dengue control strategies in this high-burden country. Methods We developed negative binomial models using monthly average maximum, minimum, mean temperatures and monthly cumulative rainfall over the period from January 1998 to December 2012. We adopted piecewise linear functions to estimate the incidence rate ratio (IRR between dengue incidence and weather factors for simplicity in interpreting the coefficients. We estimated the values of parameters below cut-points defined in terms of the results of sensitivity tests over a 0-3 month lagged period. Results Mean temperature was significantly associated with dengue incidence in all three provinces, but incidence did not correlate well with maximum temperature in Banteay Meanchey, nor with minimum temperature in Kampong Thom at a lag of three months in the negative binomial model. The monthly cumulative rainfall influence on the dengue incidence was significant in all three provinces, but not consistently over a 0-3 month lagged period. Rainfall significantly affected the dengue incidence at a lag of 0 to 3 months in Siem Reap, but it did not have an impact at a lag of 2 to 3 months in Banteay Meanchey, nor at a lag of 2 months in Kampong Thom. Conclusions The association between dengue incidence and weather factors also apparently varies by locality, suggesting that a prospective dengue early warning system would likely be best implemented at a local or regional scale, rather than nation-wide in Cambodia. Such spatial down-scaling would also enable dengue control

  18. Risk Factors for Incident Carotid Artery Revascularization among Older Adults: The Cardiovascular Health Study

    Directory of Open Access Journals (Sweden)

    Parveen K. Garg

    2016-11-01

    Full Text Available Background: Population-based risk factors for carotid artery revascularization are not known. We investigated the association between demographic and clinical characteristics and incident carotid artery revascularization in a cohort of older adults. Methods: Among Cardiovascular Health Study participants, a population-based cohort of 5,888 adults aged 65 years or older enrolled in two waves (1989-1990 and 1992-1993, 5,107 participants without a prior history of carotid endarterectomy (CEA or cerebrovascular disease had a carotid ultrasound at baseline and were included in these analyses. Cox proportional hazards multivariable analysis was used to determine independent risk factors for incident carotid artery revascularization. Results: Over a mean follow-up of 13.5 years, 141 participants underwent carotid artery revascularization, 97% were CEA. Baseline degree of stenosis and incident ischemic cerebral events occurring during follow-up were the strongest predictors of incident revascularization. After adjustment for these, factors independently associated with an increased risk of incident revascularization were: hypertension (HR 1.53; 95% CI: 1.05-2.23, peripheral arterial disease (HR 2.57; 95% CI: 1.34-4.93, and low-density lipoprotein cholesterol (HR 1.23 per standard deviation [SD] increment [35.4 mg/dL]; 95% CI: 1.04-1.46. Factors independently associated with a lower risk of incident revascularization were: female gender (HR 0.51; 95% CI: 0.34-0.77 and older age (HR 0.69 per SD increment [5.5 years]; 95% CI: 0.56-0.86. Conclusions: Even after accounting for carotid stenosis and incident cerebral ischemic events, carotid revascularization is related to age, gender, and cardiovascular risk factors. Further study of these demographic disparities and the role of risk factor control is warranted.

  19. Development and test of a classification scheme for human factors in incident reports

    International Nuclear Information System (INIS)

    Miller, R.; Freitag, M.; Wilpert, B.

    1997-01-01

    The Research Center System Safety of the Berlin University of Technology conducted a research project on the analysis of Human Factors (HF) aspects in incident reported by German Nuclear Power Plants. Based on psychological theories and empirical studies a classification scheme was developed which permits the identification of human involvement in incidents. The classification scheme was applied in an epidemiological study to a selection of more than 600 HF - relevant incidents. The results allow insights into HF related problem areas. An additional study proved that the application of the classification scheme produces results which are reliable and independent from raters. (author). 13 refs, 1 fig

  20. Incidence and associated factors to adverse reactions of the initial antiretroviral treatment in patients with HIV

    OpenAIRE

    Astuvilca, Juan; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Sociedad Científica de San Fernando. Lima, Perú. Estudiantes de medicina.; Arce-Villavicencio, Yanet; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Sociedad Científica de San Fernando. Lima, Perú. Estudiantes de medicina.; Sotelo, Raúl; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Sociedad Científica de San Fernando. Lima, Perú. Estudiantes de medicina.; Quispe, José; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Sociedad Científica de San Fernando. Lima, Perú. Estudiantes de medicina.; Guillén, Regina; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Estudiantes de medicina.; Peralta, Lillian; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Estudiantes de medicina.; Huaringa, Jorge; Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima, Perú. Estudiantes de medicina.; Gutiérrez, César; Departamento Académico de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Lima-Perú. Médico epidemiólogo.

    2007-01-01

    The high incidence of adverse reactions to the high activity antiretroviral treatment (HAART) in patients with HIV/AIDS, can affect their quality of life and adherence to the treatment. Objectives: To determinate the incidence of adverse reactions to the initial HAART and to identify the factors associated to the occurrence of adverse reactions when receiving this therapy. Material and methods: Historic cohort study. The population was conformed by all the HIV-infected adult patients (≥18...

  1. Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome.

    Science.gov (United States)

    Vlug, Roos D; Lopriore, Enrico; Janssen, Marleen; Middeldorp, Johanna M; Rath, Mirjam E A; Smits-Wintjens, Vivianne E H J

    2015-02-01

    Polycythemia occurs in 1 to 5% of neonates and is associated with complications, including an increased risk of thrombocytopenia. To evaluate incidence, risk factors, management and outcome of thrombocytopenia in neonates with polycythemia. All neonates with polycythemia admitted to our neonatal intensive care unit between 2006 and 2013 were included in this retrospective study. We evaluated the incidence of thrombocytopenia (platelet count polycythemia and is independently associated with growth restriction. Increased hematocrit is associated with decreased platelet count.

  2. Work-related risk factors for incidence of lateral epicondylitis in a large working population.

    Science.gov (United States)

    Herquelot, Eleonore; Guéguen, Alice; Roquelaure, Yves; Bodin, Julie; Sérazin, Celine; Ha, Catherine; Leclerc, Annette; Goldberg, Marcel; Zins, Marie; Descatha, Alexis

    2013-11-01

    This study aims to estimate the association between repeated measures of occupational risk factors and the incidence of lateral epicondylitis in a large working population. A total of 3710 workers in a French region were included in 2002-2005, and among them 1046 had a complete follow-up in 2007-2010. At both stages, occupational health physicians assessed the presence of lateral epicondylitis and workers self-reported their occupational exposures. Poisson models were performed to assess the incidence rate ratios (IRR) separately by sex using multiple imputed data. The annual incidence rate of lateral epicondylitis was estimated as 1.0 [95% confidence interval (95% CI) 0.7-1.3] per 100 workers among men and 0.9 (95% CI 0.6-1.3) among women. Workers aged >45 years had higher incidence than those aged 2 hours/day) was a risk factor, with an age-adjusted IRR of 3.2 (95% CI 1.5-6.4) for workers exposed at both questionnaires [3.3 (95% CI 1.4-7.6) among women]. This study highlights the importance of temporal dimensions for occupational risk factors on the incidence of lateral epicondylitis. Further research should evaluate the risk associated with the duration and repetition of occupational exposure on the incidence of lateral epicondylitis.

  3. Incidence and risk factors associated with the development of pressure ulcers in an intensive care unit.

    Science.gov (United States)

    González-Méndez, María Isabel; Lima-Serrano, Marta; Martín-Castaño, Catalina; Alonso-Araujo, Inmaculada; Lima-Rodríguez, Joaquín Salvador

    2018-03-01

    To determinate the incidence, incidence rate and risk factors of pressure ulcers in critical care patients. Pressure ulcers represent one of the most frequent health problems in clinical practice. Specifically, critical patients who are hospitalised in intensive care units have a higher risk of developing a pressure ulcer, with an incidence that fluctuates between 3.3-39.3% according to previous studies. Prospective cohort study. Three hundred and thirty-five adult patients (over 18 years old) who were hospitalised in intensive care units for at least 24 hr were monitored for a maximum of 32 days. They were excluded if they had a pressure ulcers at admission. The survival rate for pressure ulcers, from stages I-IV, was calculated using the Kaplan-Meier method. A multivariate Cox regression model was adjusted to identify the main risk factors for pressure ulcers: demographic, clinical, prognostic and therapeutic variables. The incidence of pressure ulcers in critical patients was 8.1%, and the incidence rate was 11.72 pressure ulcers for 1,000 days of intensive care units stay; 40.6% of pressure ulcers were of stage I and 59.4% of stage II, mainly in the sacrum. According to the Cox model, the main risk factors for pressure ulcers were in-hospital complications, prognostic scoring system (SAPS III) and length of immobilisation. The incidence of pressure ulcers is lower than that shown in recent studies. Complications on the unit and the prognosis score were risk factors associated with pressure ulcers but, surprisingly, length of immobilisation was a protective factor. Survival analysis of pressure ulcer allows for identification of risk factors associated with this health problem in the intensive care units. Identifying these factors can help nurses establish interventions to prevent pressure ulcers in this healthcare scenario, given that pressure ulcers prevention is an indicator of nursing quality. © 2017 John Wiley & Sons Ltd.

  4. Incidence of work injuries amongst Danish adolescents and their association with work environment factors

    DEFF Research Database (Denmark)

    Rasmussen, Kurt; Hansen, Claus D; Nielsen, Kent Jacob

    2011-01-01

    psychological demands and low social support increased the risk of experiencing work injuries after adjustment for a number of factors. CONCLUSIONS: The incidence of work injuries among adolescents appears to be higher than the incidence among their older colleagues. Lack of social support from management......BACKGROUND: The objective was to examine the incidence of work accidents that required medical attention among Danish adolescents and to identify possible work environment factors associated with such accidents. METHODS: We collected information in two questionnaire rounds (2004 and 2007) from...... a birth cohort comprising all adolescents born in 1989 (n = 3,687) living in Ringkjobing County, Denmark. The questionnaire contained items on self-reported number of accidents and number of working hours in both rounds and on work environment factors in the second round. RESULTS: Approximately 5...

  5. Factors predictive for incidence and remission of internet addiction in young adolescents: a prospective study.

    Science.gov (United States)

    Ko, Chih-Hung; Yen, Ju-Yu; Yen, Cheng-Fang; Lin, Huang-Chi; Yang, Ming-Jen

    2007-08-01

    The aim of the study is to determine the incidence and remission rates for Internet addiction and the associated predictive factors in young adolescents over a 1-year follow-up. This was a prospective, population-based investigation. Five hundred seventeen students (267 male and 250 female) were recruited from three junior high schools in southern Taiwan. The factors examined included gender, personality, mental health, self-esteem, family function, life satisfaction, and Internet activities. The result revealed that the 1-year incidence and remission rates for Internet addiction were 7.5% and 49.5% respectively. High exploratory excitability, low reward dependence, low self-esteem, low family function, and online game playing predicted the emergency of the Internet addiction. Further, low hostility and low interpersonal sensitivity predicted remission of Internet addiction. The factors predictive incidence and remission of Internet addiction identified in this study could be provided for prevention and promoting remission of Internet addiction in adolescents.

  6. Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases.

    Science.gov (United States)

    Suárez-García, Inés; Jarrín, Inmaculada; Iribarren, José Antonio; López-Cortés, Luis Fernando; Lacruz-Rodrigo, José; Masiá, Mar; Gómez-Sirvent, Juan Luis; Hernández-Quero, José; Vidal, Francesc; Alejos-Ferreras, Belén; Moreno, Santiago; Del Amo, Julia

    2013-05-01

    The aim of this study was to investigate the incidence and risk factors for the development of AIDS-defining cancers (ADCs); and to investigate the effect of making different assumptions on the definition of incident cases. A multicentre cohort study was designed. Poisson regression was used to assess incidence and risk factors. To account for misclassification, incident cases were defined using lag-times of 0, 14 and 30 days after enrolment. A total of 6393 HIV-positive subjects were included in the study. The incidences of ADCs changed as the lag periods were varied from 0 to 30 days. Different risk factors emerged as the definition of incident cases was changed. For a lag time of 0, the risk of Kaposi sarcoma [KS] and non-Hodgkin lymphoma [NHL] increased at CD4 counts sex with men had a higher risk of KS. KS and NHL were not associated with viral load, gender, or hepatitis B or C. The results were similar for a lag-time of 14 and 30 days; however, hepatitis C was significantly associated with NHL. This analysis shows the importance of the definition of incident cases in cohort studies. Alternative definitions gave different incidence estimates, and may have implications for the analysis of risk factors. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. Influence Of Demographic Factors And History Of Malaria With The Incidence Malaria In MORU PHC

    Directory of Open Access Journals (Sweden)

    Sudirman Manumpa

    2017-01-01

    Full Text Available Malaria morbidity in Moru health center, with parameter Annual Parasite Incident (API, amounted to 16.9% in 2014. This figure was still high when compared to the target of eliminating malaria in Indonesia about <1% in 2030. Incidence of malaria is more common in children aged 5 months - <12 years. This high rates of malaria leads to poverty, low level of learning achievement of children and in pregnant women causing low birth weight in babies and death. The purpose of this study was to analyze the factors that influence the incidence of tertian and Tropikana malaria or combined Tropikana and tertian (mix in Moru PHC in sub-district Alor Southwestern, Alor Regency.This study used a cross-sectional design, the population of study were all patients undergoing peripheral blood examination in Moru PHC’s laboratory from June to October 2015. The number of samples in this study was 173 respondents. The sampling technique was Simple Random Sampling. Instruments of data collection were a questionnaire and observation sheet.Results of the study by Chi-Square test showed that the factors influencing the incidence of malaria were socioeconomic status (sig 0,000, education level (sig 0.001. By using multivariate analysis with logistic regression test, results were obtained the age of 5 months - <12 value (sig 0.025 and socioeconomic status (sig 0,000 influencing the incidence of malaria.Variables that affect the incidence of malaria were demographic factors such as age, education level, socioeconomic status. It is advisable to harness swamp thus improving the economic status of society and build permanent house. Keywords: incidence malaria, demographic factors, history of malaria

  8. [Relationship between 'ideal' cardiovascular behaviors and factors and the incidence of hypertension].

    Science.gov (United States)

    Zhang, Caifeng; Shi, Jihong; Huang, Zhe; Li, Huiying; Wei, Xiaoming; Lin, Liming; Xing, Aijun; Chen, Shuohua; Wu, Shouling

    2014-05-01

    To explore the relationship between 'ideal' cardiovascular behaviors and factors and the incidence of hypertension. A prospective cohort study including 52 133 workers who had participated in the 2006-2007 Kailuan health examination without history of cerebral infraction, myocardial infarction or hypertension but with complete data, was carried out. All workers were followed on their occurrence of hypertension. According to the AHA definition of 'ideal' cardiovascular health behaviors and factors, the cumulative incidence rates of hypertension in different groups were calculated under the life table method, and compared by Log-rank test, Cox proportional hazards regression was used to calculate the hazard rations and 95% confidence intervals for baseline behaviors and factors. The cumulative incidence rates of hypertension according 0-1, 2, 3, 4, 5-7 ideal cardiovascular health behaviors and factors were 65.72%, 59.14%, 54.59%, 50.24% and 34.22%, respectively in the 0-1, 2, 3, 4, 5-7 groups. Data from the Cox proportional hazards model showed that after adjusting for age, education level and family history of hypertension, the ones who had 2, 3, 4, 5-7 ideal cardiovascular behaviors/factors were 0.75, 0.69, 0.63, 0.36 times more than those who had 0-1 ideal behaviors. The incidence of hypertension and risk reduced along with the increase of ideal cardiovascular health behaviors and factors.

  9. Incidence, Mortality, and Predictive Factors of Hepatocellular Carcinoma in Primary Biliary Cirrhosis

    Directory of Open Access Journals (Sweden)

    Kenichi Hosonuma

    2013-01-01

    Full Text Available Background. The study aims to analyze in detail the incidence, mortality using the standardized incidence ratio (SIR, and standardized mortality ratio (SMR of hepatocellular carcinoma (HCC in primary biliary cirrhosis (PBC, because no large case studies have focused on the detailed statistical analysis of them in Asia. Methods. The study cohorts were consecutively diagnosed at Gunma University and its affiliated hospitals. Age- or sex-specific annual cancer incidence and deaths were obtained from Japanese Cancer Registry and Death Registry as a reference for the comparison of SIR or SMR of HCC. Moreover, univariate analyses and multivariate analyses were performed to clarify predictive factors for the incidence of HCC. Results. The overall 179 patients were followed up for a median of 97 months. HCC had developed in 13 cases. SIR for HCC was 11.6 (95% confidence interval (CI, 6.2–19.8 and SMR for HCC was 11.2 (95% CI, 5.4–20.6 in overall patients. The serum albumin levels were a predictive factor for the incidence of HCC in overall patients. Conclusions. The incidence and mortality of HCC in PBC patients were significantly higher than those in Japanese general population. PBC patients with low serum albumin levels were populations at high risk for HCC.

  10. Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs.

    Science.gov (United States)

    Glickman, L T; Glickman, N W; Schellenberg, D B; Raghavan, M; Lee, T L

    2000-01-01

    To compare incidence of and breed-related risk factors for gastric dilatation-volvulus (GDV) among 11 dog breeds (Akita, Bloodhound, Collie, Great Dane, Irish Setter, Irish Wolfhound, Newfoundland, Rottweiler, Saint Bernard, Standard Poodle, and Weimaraner). Prospective cohort study. 1,914 dogs. Owners of dogs that did not have a history of GDV were recruited at dog shows, and the dog's length and height and depth and width of the thorax and abdomen were measured. Information concerning the dogs' medical history, genetic background, personality, and diet was obtained from owners, and owners were contacted by mail and telephone at approximately 1-year intervals to determine whether dogs had developed GDV or died. Incidence of GDV based on the number of dog-years at risk was calculated for each breed, and breed-related risk factors were identified. Incidence of GDV for the 7 large (23 to 45 kg [50 to 99 lb]) and 4 giant (> 45 kg [> 99 lb]) breeds was 23 and 26 cases/1,000 dog-years at risk, respectively. Of the 105 dogs that developed GDV, 30 (28.6%) died. Incidence of GDV increased with increasing age. Cumulative incidence of GDV was 5.7% for all breeds. The only breed-specific characteristic significantly associated with a decreased incidence of GDV was an owner-perceived personality trait of happiness.

  11. Incidence and Risk Factors for Parastomal Bulging in Patients with Ileostomy or Colostomy

    DEFF Research Database (Denmark)

    Andersen, Rune M; Klausen, Tobias W; Danielsen, Anne K

    2018-01-01

    AIM: To investigate incidence and risk factors for parastomal bulging, a clinically important complication, in patients with an ileostomy or colostomy. METHOD: The Danish Stoma Database Capital Region prospectively collects data on patients with a stoma up to a year after surgery. Stoma care nurses...... an exploratory approach. RESULTS: In a study population of 5019, the cumulative incidence (with competing risks) of parastomal bulging was 36.2% at 400 days after surgery. Age, colostomy, male gender, alcohol consumption, and laparoscopy were associated with an increased risk of parastomal bulging. Compared...... for age and colostomy as being risk factors for parastomal bulging. This article is protected by copyright. All rights reserved....

  12. Incidence, risk factors and mortality of tuberculosis in Danish HIV patients 1995-2007

    DEFF Research Database (Denmark)

    Taarnhøj, Gry A.; Engsig, Frederik N; Ravn, Pernille

    2011-01-01

    Human Immunodeficiency Virus (HIV) infection predisposes to tuberculosis (TB). We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996), early (1997-1999), and late Highly Active Antiretroviral Therapy (HAART) (2000-2007) periods.......Human Immunodeficiency Virus (HIV) infection predisposes to tuberculosis (TB). We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996), early (1997-1999), and late Highly Active Antiretroviral Therapy (HAART) (2000-2007) periods....

  13. Manual handling incident claims in the healthcare sector: Factors and outcomes.

    Science.gov (United States)

    Dockrell, Sara; Johnson, Muriel; Ganly, Joe; Bennett, Kathleen

    2011-01-01

    Manual handling (MH) incidents may result in injury, absenteeism and/or compensation claim. This study investigated the factors associated with MH incidents among healthcare workers who had made a claim, and the management and outcome of those workers. A national sample of healthcare sector MH incident claim files (n=247) were accessed and 35~files met the inclusion criteria. Data were collected and presented graphically or descriptively using percentages (and 95% Confidence intervals, CI). Chi-square (χ2) tests were used for comparing proportions between groups. SPSS (v14.0) was used for analysis. Significance at p 52 weeks. Only 58% (49%, 65%) returned to work. Claimants who had been in communication with employers were significantly more likely to return to work than those who did not (χ2 test, p=0.017). Improved management of MH incidents and injured workers are recommended.

  14. Epidemiology of stroke in the elderly in the Nordic countries. Incidence, survival, prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Torgeir Engstad

    2012-11-01

    Full Text Available Objective: To review what is known at present with respect to incidence, survival, risk factors and prevalence among the elderly stroke patients in the Nordic countries.Method: This article is based mainly on literature identified through search engines (Mc Master Plus, Cochrane Library, Medline and PubMed, restricted to first-ever stroke in Nordic population-based studies and having applied to the standard WHO definition, a prospective study design and no upper age limit.Results: Data from the Nordic countries show an incidence rate of 1250 to 1796/100 000 in the age group 75-84, and 1628 to 2234 in those above 85 years. The incidence rates are higher among men, but women are expected to contribute more to incident cases due to their higher life expectancy. If the age-specific incidence of stroke remains stable, the proportion of stroke patients aged 80 years and older may reach 50% in a few decades. The elderly stroke patients have a higher 30-days case fatality, and a higher risk of dependency. Better treatment of stroke patients has improved the survival over the last two decades. The prevalence is expected to increase due to the decrease in lethality, a slower fall in incidence and a higher proportion of elderly. Cardiovascular risk factors increase with age. Hypertension is a major risk factor for stroke mortality in the elderly. Cardioembolic stroke due to atrial fibrillation is the most common stroke subtype in the elderly. Lifestyle risk factors are less prevalent in the older stroke patients.Conclusion: The growing proportion of elderly stroke patients is a major challenge for future stroke care. The elderly stroke patients have a different risk factor profile compared to younger stroke patients. Treatment should focus on regaining independency. The age-specific epidemiology of stroke needs to be studied further in large studies in order to plan for future health care.

  15. Incidence and Risk Factors of Parenteral Nutrition-Associated Cholestasis in Omani Neonates; Single centre experience

    Directory of Open Access Journals (Sweden)

    Sharef W. Sharef

    2015-05-01

    Full Text Available Objectives: Parenteral nutrition-associated cholestasis (PNAC is one of the most challenging complications of prolonged parenteral nutrition (PN in neonates. There is a lack of research investigating its incidence in newborn infants in Oman and the Arab region. Therefore, this study aimed to assess the incidence of PNAC and its risk factors in Omani neonates. Methods: This retrospective study took place between January and April 2014. All neonates who received PN for ≥14 days during a four-year period (June 2009 to May 2013 at the neonatal intensive care unit (NICU in Sultan Qaboos University Hospital, Muscat, Oman, were enrolled. Results: A total of 1,857 neonates were admitted to the NICU over the study period and 135 neonates (7.3% received PN for ≥14 days. Determining the incidence of PNAC was only possible in 97 neonates; of these, 38 (39% had PNAC. The main risk factors associated with PNAC were duration of PN, duration of enteral starvation, gastrointestinal surgeries, blood transfusions and sepsis. Neonates with PNAC had a slightly higher incidence of necrotising enterocolitis in comparison to those without PNAC. Conclusion: This study found a PNAC incidence of 39% in Omani neonates. There were several significant risk factors for PNAC in Omani neonates; however, after logistic regression analysis, only total PN duration remained statistically significant. Preventive strategies should be implemented in NICUs so as to avoid future chronic liver disease in this population.

  16. Combined influence of multiple climatic factors on the incidence of bacterial foodborne diseases.

    Science.gov (United States)

    Park, Myoung Su; Park, Ki Hwan; Bahk, Gyung Jin

    2018-01-01

    Information regarding the relationship between the incidence of foodborne diseases (FBD) and climatic factors is useful in designing preventive strategies for FBD based on anticipated future climate change. To better predict the effect of climate change on foodborne pathogens, the present study investigated the combined influence of multiple climatic factors on bacterial FBD incidence in South Korea. During 2011-2015, the relationships between 8 climatic factors and the incidences of 13 bacterial FBD, were determined based on inpatient stays, on a monthly basis using the Pearson correlation analyses, multicollinearity tests, principal component analysis (PCA), and the seasonal autoregressive integrated moving average (SARIMA) modeling. Of the 8 climatic variables, the combination of temperature, relative humidity, precipitation, insolation, and cloudiness was significantly associated with salmonellosis (Pclimatic factors. These findings indicate that the relationships between multiple climatic factors and bacterial FBD incidence can be valuable for the development of prediction models for future patterns of diseases in response to changes in climate. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Incidence and related factors for intraoperative failed spinal anaesthesia for lower limb arthroplasty

    DEFF Research Database (Denmark)

    Aasvang, E K; Laursen, M B; Madsen, J

    2018-01-01

    include the risk for intraoperative failed spinal anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed spinal incidence and related factors during THA....../TKA, hindering evidence-based information and potential anaesthesia stratification. METHODS: In a sub-analysis, data from a prospective study on spinal anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general anaesthesia. Potential perioperative factors (age, gender, American...... Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from spinal administration until end of surgery) were analysed with logistic regression for relation to failed spinal anaesthesia. RESULTS: In all, 1451 patients were included for analysis...

  18. Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study.

    Science.gov (United States)

    Hernan, Andrea L; Giles, Sally J; Fuller, Jeffrey; Johnson, Julie K; Walker, Christine; Dunbar, James A

    2015-09-01

    Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap. Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework. Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment. Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not

  19. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

    NARCIS (Netherlands)

    Belderok, S.M.; van den Hoek, A.; Kint, J.A.; van der Loeff, M.F.S.; Sonder, G.J.B.

    2011-01-01

    Background: Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among

  20. Neutropenia and agranulocytosis in England and Wales: incidence and risk factors

    NARCIS (Netherlands)

    van Staa, T. P.; Boulton, F.; Cooper, C.; Hagenbeek, A.; Inskip, H.; Leufkens, H. G. M.

    2003-01-01

    The objectives of this study were to estimate the incidence of idiosyncratic neutropenia and agranulocytosis in England and Wales and to evaluate their risk factors and outcomes. The study was conducted using data from the General Practice Research Database. All cases of idiosyncratic neutropenia or

  1. Risk factors for incident asthma and COPD in a cohort of young adults

    DEFF Research Database (Denmark)

    Traulsen, Lisbet Krogh; Baelum, Jesper; Halling, Anders

    2018-01-01

    Introduction: The aim of the study was to describe potential shared risk factors for incident asthma and COPD in a population-based, 9-year follow-up study. Methods: From a cohort of 1191 individuals, aged 20-44, who participated in baseline survey including spirometry, bronchial challenge, and s...

  2. Venous thromboembolism in ovarian cancer: incidence, risk factors and impact on survival.

    LENUS (Irish Health Repository)

    Abu Saadeh, Feras

    2013-09-01

    Ovarian cancer has a higher incidence of venous thromboembolism (VTE) than other cancers. Clear cell cancers carry the highest risk at 11-27%. The aim of this study was to identify the predisposing factors for VTE in a population of ovarian cancer patients and to determine the influence of VTE on overall survival.

  3. Incidence and risk factors of milk fever among cross-bred dairy cows ...

    African Journals Online (AJOL)

    The study was conducted on 206 cross-bred dairy cows in different dairy herds in Khartoum State, Sudan, during the period from March 2003 to June 2004 to determine the prevalence and incidence rate of milk fever (MF) based on clinical and laboratory diagnosis, and to recognize the risk factors associated with the ...

  4. Adverse radiation effect after stereotactic radiosurgery for brain metastases : incidence, time course, and risk factors

    NARCIS (Netherlands)

    Sneed, Penny K.; Mendez, Joe; Vemer-van den Hoek, Johanna; Seymour, Zachary A.; Ma, Lijun; Molinaro, Annette M.; Fogh, Shannon E.; Nakamura, Jean L.; McDermott, Michael W.

    OBJECT The authors sought to determine the incidence, time course, and risk factors for overall adverse radiation effect (ARE) and symptomatic ARE after stereotactic radiosurgery (SRS) for brain metastases. METHODS All cases of brain metastases treated from 1998 through 2009 with Gamma Knife SRS at

  5. Occupational accidents in the Netherlands: incidence, mental harm, and their relationship with psychosocial factors at work

    NARCIS (Netherlands)

    Klauw, M. van der; Oude Hengel, K.; Bakhuys Roozeboom, M.M.C.; Koppes, L.; Venema, A.

    2016-01-01

    This study investigated the incidence of mental harm due to occupational accidents and the relation between psychosocial factors at work and the occurrence of occupational accidents in the Netherlands for the construction industry and health and welfare sector. Analyses revealed that occupational

  6. Incidence of shoulder pain after neck dissection : A clinical explorative study for risk factors

    NARCIS (Netherlands)

    Dijkstra, PU; van Wilgen, PC; Brendeke, W; de Goede, CJT; Kerst, A; Koolstra, M; Marinus, J; Schoppink, EM; Stuiver, MM; van de Velde, CF; Roodenburg, JLN

    2001-01-01

    Background. It is the purpose of this study to determine the incidence of shoulder pain and restricted range of motion of the shoulder after neck dissection, and to identify risk factors for the development of shoulder pain and restricted range of motion. Methods. Clinical patients who underwent a

  7. Lifestyle Factors and Incident Mobility Limitation in Obese and Non-obese Older Adults.

    NARCIS (Netherlands)

    Koster, A.; Penninx, B.W.J.H.; Newman, A.B.; Visser, M.; van Gool, C.H.; Harris, T.B.; van Eijk, J.T.; Kempen, G.I.; Brach, J.S.; Simonsick, E.M.; Houston, D.K.; Tylavsky, F.A.; Rubin, S.M.; Kritchevsky, S.B.

    2007-01-01

    Objective: This study examines the association between incident mobility limitation and 4 lifestyle factors: smoking, alcohol intake, physical activity, and diet in well-functioning obese (n = 667) and non-obese (n = 2027) older adults. Research Methods and Procedures: Data were from men and women,

  8. Occupational diseases in the Netherlands: incidence, type, consequences and risk factors: abstract and presentation

    NARCIS (Netherlands)

    Venema, A.; Steenbeek, R.; Dam, L. van; Vroome, E. de

    2017-01-01

    Objectives: Occupational diseases are common and result in a substantial disease burden and high sickness absence. Reliable data on the incidence and a better understanding of the risk factors will help to develop preventive measures. Methods: Several sources of measuring occupational diseases were

  9. Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Wyss, Natascha; Zwahlen, Marcel; Bohlius, Julia

    2016-01-01

    BACKGROUND:  Kaposi sarcoma (KS) remains a frequent cancer in human immunodeficiency virus (HIV)-positive patients starting combination antiretroviral therapy (cART). We examined incidence rates and risk factors for developing KS in different periods after starting cART in patients from European...

  10. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery : a prospective cohort study

    NARCIS (Netherlands)

    Koorevaar, Rinco C. T.; van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K.

    Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder

  11. Incidence of and risk factors for skin cancer after heart transplant

    NARCIS (Netherlands)

    Brewer, Jerry D.; Colegio, Oscar R.; Phillips, P. Kim; Roenigk, Randall K.; Jacobs, M. Amanda; van de Beek, Diederik; Dierkhising, Ross A.; Kremers, Walter K.; McGregor, Christopher G. A.; Otley, Clark C.

    2009-01-01

    OBJECTIVE: To examine the incidence, tumor burden, and risk factors for nonmelanoma and other skin cancer types in this heart transplant cohort. DESIGN: Retrospective review of patient medical records. SETTING: Tertiary care center. Patients All heart transplant recipients at Mayo Clinic from 1988

  12. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

    NARCIS (Netherlands)

    Belderok, Sanne-Meike; van den Hoek, Anneke; Kint, Joan A.; Schim van der Loeff, Maarten F.; Sonder, Gerard Jb

    2011-01-01

    Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent

  13. Udder diseases in dairy cows — field observations on incidence, somatic and environmental factors, and control

    Directory of Open Access Journals (Sweden)

    Hannu Saloniemi

    1980-03-01

    Full Text Available The incidence of udder diseases and the predisposing factors were examined in 32 herds, in a total of 500 cows. During a 3-year-period 0.32 cases of clinical mastitis occurred per cow per annum. Subclinical mastitis was detected in 61.2 % of the cows during one year. The average incidence based on a single sampling was 36.5 %. In order to obtain reliable information on the udder health of a herd the occurrence of both clinical and subclinical mastitis must be followed. Clinical cases, both those treated by a veterinarian on a farm visit and those treated by the owner according to phone prescription must be filed statistically. In this study the incidence of mastitis as reported by owner was only half of that actually detected. The incidence of teat injuries requiring veterinary treatment was 0.03 cases per cow per annum. The diagnosis »presence of bacteria» obtained from a milk sample examination using Nordic methods means according to this study in most cases the probable occurrence of infection and mastitis. Scoring of observations made from udder health, and indexes based on these scores prove to be good tools when studying relationships between udder diseases and predisposing factors. Of the somatic factors the age of the cow, stage of lactation, the distance of the rear teats from the stall floor and the position of the teats influence the incidence of mastitis. Therefore, these factors must be taken into consideration in preventive work, especially in the culling of cows. Neither teat shape nor milkability had any connection with the incidence of udder diseases. With regard to the factors in the production environment the incidence of clinical mastitis was influenced especially by the function of the milking machine. Diurnal changes in temperature, when exceeding5 degrees centigrade, increased the occurrence of mastitis. The use of a thermohygrograph is proposed in preventive work. Because of the small number of the herds only in few

  14. Prospective study of rape perpetration by young South African men: incidence & risk factors.

    Science.gov (United States)

    Jewkes, Rachel; Nduna, Mzikazi; Jama Shai, Nwabisa; Dunkle, Kristin

    2012-01-01

    There has been very little prospective research on rape perpetration among men. This paper describes the incidence and risk factors for new rape and attempted rape events among young South African men in an HIV prevention trial. We followed 1,147 men aged 15-26 years who enrolled into a cluster randomised controlled trial to evaluate the HIV prevention behavioural intervention Stepping Stones. Incidence rate ratios for factors associated with incident rape were derived from Poisson models. The young men reported 217 incident rapes (completed or attempted) of a girl or woman over 1,914 person years of follow up, yielding a rape incidence of 11.2 per 100 person years. Overall 24.9% of men had previously raped at baseline, and 18.9% did so during the follow up. Among the latter, 61.3% raped for the first time, and 38.7% re-offended. Multivariable Poisson modelling showed a higher incidence of rape perpetration among men who had ever used drugs (IRR 1.86 95%CI 1.39, 2.49), had eight or more lifetime partners (IRR 1.48 95% CI 1.09, 2.01), had been physically violent toward a female partner (IRR 1.50 95%CI 1.11, 2.03) and had disclosed rape perpetration at baseline (IRR 1.45 95%CI 1.07, 1.97). A lower incidence was found among those with greater resistance to peer pressure (IRR 0.85 95%CI 0.74, 0.97). The findings highlight the importance of male gender socialisation and addressing delinquent youth sub-cultures in rape prevention. Prevention requires change in hegemonic masculinity, with its emphasis on gender hierarchy, exaggerated performance of heterosexuality and control of women. Interventions are needed to address male socialisation with delinquent peers, by reducing exposure to childhood trauma and strengthening opportunities for gainful employment (in work or recreation).

  15. Incidence of Endodontic Flare-ups and Its Related Factors: A Retrospective Study.

    Science.gov (United States)

    Nair, Manuja; Rahul, J; Devadathan, A; Mathew, Josey

    2017-01-01

    The aim and objective of the study were to determine the incidence of flare-ups during endodontic treatment and to identify the risk factors associated with flare-ups. A total of 1725 patients who were treated during the time period of 2009-2014 by the same endodontist were reviewed. Incidence of flare-up, patients' age, gender, status of pulp, tooth position, number of roots, and treatment provided were taken from their dental records. Relationship between these factors and flare-ups was examined. Statistical analysis was done using Pearson Chi-square test and Fisher's exact test. A total of 2% incidence of endodontic flare-ups was seen out of 1725 cases. Patient's age, gender, and diagnosis had a significant effect on the development of flare-ups ( P flare-up incidence. Diagnosis plays an important role in predicting the incidence of flare-ups. Patients in the age group of 40-60 years had a higher risk of developing flare-ups. Women compared to men are more prone to flare-ups.

  16. Incidence rates of asthma, rhinitis and eczema symptoms and influential factors in young children in Sweden

    DEFF Research Database (Denmark)

    Larsson, M.; Hagerhed-Engman, L.; Sigsgaard, T.

    2008-01-01

    questionnaire based on an ISAAC protocol to all children in the age of 1-6 years. Five years later a follow-up questionnaire was sent to the children that were 1-3 years at baseline. In total, 4779 children (response rate = 73%) participated in both surveys and constitute the study population in this cohort...... study. Results: The 5-year incidence of doctor-diagnosed asthma was 4.9% (95% CI 4.3-5.3), rhinitis was 5.7% (5.0-6.4) and eczema was 13.4% (12.3-14.5). However, incidence rates strongly depend on the health status of the baseline population. Risk factors for incident asthma were male gender and short...... period of breast-feeding. Allergic symptoms in parents were also a strong risk factor for incident asthma, as well as for rhinitis and eczema. Conclusion: When comparing incident rates of asthma between different studies it is important to realize that different definitions of the healthy baseline...

  17. Impact of maternal risk factors on the incidence of low birth weight neonates in southern India

    Directory of Open Access Journals (Sweden)

    : U.N.Reddy, VamshiPriya, SwathiChacham, SanaSalimKhan, J Narsing Rao, Mohd Nasir mohiuddin

    2014-11-01

    Full Text Available Introduction: Birth weight is recommended as one of the twelve global indicators for monitoring the health of the community and is an important determinant of adverse perinatal and neonatal events. LBW infant carries five times higher risk of dying in the neonatal period and three times more in infancy. Aims and Objectives: To estimate the incidence of LBW and impact of various maternal and biosocial factors on the incidence of LBW neonates in the study population. Material and methods: This prospective observational study was carried out in Princess Esra hospital, a tertiary care hospital in south India, over a period of six months. All consecutive LBW (single ton neonates admitted to the neonatal intensive care unit were enrolled, while those born of multiple gestation and those with major congenital malformations were excluded. Results: A total of 300 neonates were included in the present study out of which 150 were LBW and 150 weighed ≥2500 gm. Higher maternal weight (>60kgs had low incidence of LBW neonates (p value-0.03. Illiterate women had a remarkably higher incidence of LBW babies (p value-0.001. In primigravida incidence of LBW was 61.2%. Higher incidence of LBW was seen in mothers with oligo hydramnio’s. Conclusions: This study showed that maternal age, weight, literacy level and parity have a significant influence on the incidence of LBW. Incidence of LBW neonate in the study was 50%. Risk of having LBW neonates was higher in primigravida. There was a significant association between LBW with oligo hydramnio’s and female gender.

  18. Quantitative and qualitative factors that leads to slip and fall incidents

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    Syahrom, Ardiyansyah; Tap, Masine Md; Rohani, Jafri Mohd

    2017-01-01

    This book investigates the factors that lead to slip and fall incidents and establishes a relationship between the coefficient of friction (COF), floor slipperiness and floor roughness. It also examines human perception of slipperiness through measured coefficient of friction (COF). On the basis of questionnaire surveys among manufacturing workers, it identifies potential risk factors and assesses human perceptions of slipperiness. It also uses a tribology approach to relate the interaction between contaminants, floor and footwear materials.

  19. Sudden Onset of Life-Threatening Methaemoglobinaemia After Intake of Inappropriately Stored Vegetable (Collard Greens Meal in a 2.5-Year-Old Child

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    Ozlem Cakmak Yilmaz

    2015-06-01

    Full Text Available Acquired methaemoglobinaemia most commonly occurs due to intake of or contact to certain drugs, such as local anesthetics. However, intake of certain vegetables which are essential for a healthy diet may also cause methaemoglobinaemia due to their high nitrate or nitrite content, and prolonged and inappropriate storage after preparation of vegetable meals increases the risk. We present a 2.5-year-old girl with Down's syndrome who presented with central cyanosis due to severe methaemoglobinemiae with a methaemoglobin level of 62% after intake of collard greens (Brassica oleracea var. acephala soup. Although development of methaemoglobinaemia after food intake has been reported rarely before, recognition of this potentially life-threatening condition early in its course may be life-saving. [Cukurova Med J 2015; 40(2.000: 353-357

  20. Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge

    LENUS (Irish Health Repository)

    2017-05-01

    Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17\\/25 (68%) were trained and 13\\/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2\\/13 (15%) of children. Non-medical grade monitors were in use by 10\\/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge

  1. Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge.

    Science.gov (United States)

    Macken, W L; Clarke, N; Nadeem, M; Coghlan, D

    2017-05-10

    Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge.

  2. Acute poisoning following ingestion of medicines: initial management. How to treat life-threatening complications and to evaluate the risk of delayed effects and psychological distress.

    Science.gov (United States)

    2010-12-01

    Acute poisoning following ingestion of medications, both intentional and unintentional, is frequent and more or less severe. It is often unclear whether a toxic dose has been ingested. This review examines the initial management of patients with suspected acute poisoning, based on a review of the literature using the standard Prescrire methodology. We examined clinical practice guidelines, which are mostly based on observational, pharmacological and toxicological data, as well as empirical data. Few comparative trials are available. In life-threatening situations, the first priority is to call an emergency response mobile unit and to implement life-support techniques, i.e., resuscitation for cardiorespiratory arrest; respiratory support if necessary; and the left lateral head-down position and glucose injection if the patient is unconscious. Prompt, initial measures may also include: anticonvulsant injection for status epilepticus (diazepam, for example); a sedative for extreme agitation (diazepam or clorazepate if there is no risk of respiratory depression; otherwise haloperidol); atropine for severe bradycardia; elevating the legs for hypotension; and naloxone in case of respiratory depression due to opioids. Drug poisoning can be life-threatening.The extent of the risk should be assessed by questioning the patient and close contacts, examining the immediate environment, and carrying out a clinical examination to identify a major toxic condition. The severity of poisoning is assessed by gathering all information about the patient, the drug(s) ingested, the circumstances of ingestion, and any other substances ingested at the same time. A poison control centre may be called to assist with diagnosis, to predict the clinical consequences, and to guide patient management. Activated charcoal can reduce the gastrointestinal absorption of some drugs. It should be given as soon as possible, preferably within 2 hours after ingestion of a drug known to be adsorbed by

  3. Exercise-Induced Anaphylaxis: A Case Report and Review of the Diagnosis and Treatment of a Rare but Potentially Life-Threatening Syndrome

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    Nathan T. Jaqua

    2013-01-01

    Full Text Available A 24-year-old male Marine with an uncomplicated medical history and a long history of strenuous, daily exercise presented to the emergency department after experiencing anaphylactic shock while running. Symptoms resolved following administration of intramuscular diphenhydramine, ranitidine, intravenous methylprednisolone, and intravenous fluids. On followup in the allergy clinic, a meticulous clinical history was obtained which elucidated a picture consistent with exercise-induced anaphylaxis. He had experienced diffuse pruritus and urticaria while exercising on multiple occasions over the last three years. His symptoms would usually increase as exercise continued. Prior to the first episode, he regularly exercised without symptoms. Exercise-induced anaphylaxis is a rare but potentially life-threatening syndrome that requires a careful clinical history and is a diagnosis of exclusion. Treatment is primarily exercise avoidance. Prophylactic mediations are inconsistently effective but are empirically used. Successful treatment with omalizumab was recently reported in a case of refractory exercise-induced anaphylaxis.

  4. Prevalence of epilepsy and seizure disorders as causes of apparent life- threatening event (ALTE) in children admitted to a tertiary hospital.

    Science.gov (United States)

    Anjos, Alessandra Marques dos; Nunes, Magda Lahorgue

    2009-09-01

    To determine the prevalence and describe clinical characteristics of seizure disorders and epilepsy as causes of apparent life- threatening event (ALTE) in children admitted at the emergency and followed in a tertiary hospital. Cross-sectional study with prospective data collection using specific guidelines to determine the etiology of ALTE. During the study, 30 (4.2%) children admitted to the hospital had a diagnosis of ALTE. There was a predominance of males (73%) and term infants (70%). Neonatal neurological disorders and neuropsychomotor development delay were found respectively in 13.4% and 10% of the cases. Etiological investigation revealed that 50% of the cases were idiopathic, and 13.4% were caused by epilepsy or seizure disorders. Although all patients had recurrent ALTE events, epilepsy had not been previously suspected. Epilepsy should be included in the differential diagnosis of ALTE, particularly when events are recurrent.

  5. Incidence and risk factors for post-ERCP pancreatitis in chronic pancreatitis.

    Science.gov (United States)

    Zhao, Zhen-Hua; Hu, Liang-Hao; Ren, Hong-Bo; Zhao, An-Jing; Qian, Yang-Yang; Sun, Xiao-Tian; Su, Song; Zhu, Shu-Guang; Yu, Jin; Zou, Wen-Bin; Guo, Xiao-Rong; Wang, Lei; Li, Zhao-Shen; Liao, Zhuan

    2017-09-01

    Almost all studies on post-ERCP pancreatitis (PEP) have mainly involved patients with biliary diseases rather than chronic pancreatitis (CP), and the concept that CP seems to be a protective factor associated with PEP has not been studied in detail. The aim of this study was to determine the incidence of PEP in patients with CP at different clinical stages and to identify the predictive and protective factors of PEP in a large cohort. In this observational cohort study, medical records of patients with CP (CP group) and biliary diseases (BD group) in a tertiary hospital from January 2011 to May 2015 were examined. The difference in the incidence of PEP between CP group and BD group and the risk of PEP at different clinical stages of CP were calculated by the χ 2 test or the Fisher exact test. The predictive and protective factors for PEP were investigated by univariate and multivariate analysis. In total, 2028 ERCP procedures were performed in 1301 patients with CP and 2000 procedures in 1655 patients with BD. The overall incidence of PEP in CP group (4.5%) was similar to that in the BD group (4.8%; P = .747). However, CP patients had significantly lower rates of moderate and severe attacks (0% vs 1.3%, P pancreatitis, and prior PEP were independent risk factors of PEP, whereas extracorporeal shock wave lithotripsy was a protective factor. Compared with BD patients, CP patients had similar incidence of PEP overall but lower grades of severity. The incidence of PEP in CP patients decreased significantly with disease progression. (Clinical trial registration number: NCT02781987.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  6. Role of Risk Factors in the Incidence of Multidrug-Resistant Tuberculosis

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    Alya Putri Khairani

    2017-09-01

    Full Text Available Objective: To determine the risk factors that played roles in the incidence of multidrug-resistant tuberculosis (MDR-TB in such patients. Multidrug-Resistant Tuberculosis is a form of tuberculosis caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampicin. Methods: This was a case control study to compare MDR-TB to non-MDR-TB pulmonary tuberculosis outpatients in Dr. Hasan Sadikin General Hospital, Bandung on August–September 2014. Fifty MDR-TB outpatients were included as the cases and 50 non-MDR-TB outpatients as controls. Data was collected by questionnaires and patient’s registration forms. Bivariate and multivariate analyses were performed using chi-square test and multiple logistic regression test, with p<0.05 considered significant. Results: From bivariate analysis, number of previous tuberculosis treatments, regularity of previous treatment, and burden of cost were significant risk factors for developing MDR-TB (p<0.05; while from multivariate analysis, number of previous TB treatments was the only risk factor that played a significant role in the incidence of MDR-TB (OR 24.128 95% CI 6.771-85,976. Conclusions: Patients and medication factors are risk factors that play roles in the incidence of MDR-TB. The significant risk factor is the number of previous TB treatment.

  7. Risk Factors Associated with Incident Syphilis in a Cohort of High-Risk Men in Peru

    Science.gov (United States)

    Konda, Kelika A.; Roberts, Chelsea P.; Maguiña, Jorge L.; Leon, Segundo R.; Clark, Jesse L.; Coates, Thomas J.; Caceres, Carlos F.; Klausner, Jeffrey D.

    2016-01-01

    Background Syphilis is concentrated among high-risk groups, but the epidemiology of syphilis reinfection is poorly understood. We characterized factors associated with syphilis incidence, including reinfection, in a high-risk cohort in Peru. Methods Participants in the NIMH CPOL trial were assessed at baseline and 2 annual visits with HIV/STI testing and behavioral surveys. Participants diagnosed with syphilis also attended 4- and 9-month visits. All participants underwent syphilis testing with RPR screening and TPPA confirmation. Antibiotic treatment was provided according to CDC guidelines. Reinfection was defined as a 4-fold titer increase or recurrence of seroreactivity after successful treatment with subsequent negative RPR titers. The longitudinal analysis used a Possion generalized estimating equations model with backward selection of variables in the final model (criteria P <0.02). Results Of 2,709 participants, 191 (7.05%) were RPR-reactive (median 1:8, range 1:1–1:1024) with TPPA confirmation. There were 119 total cases of incident syphilis, which included both reinfection and first-time incident cases. In the bivariate analysis, the oldest 2 quartiles of age (incidence ratio (IR) 3.84; P <0.001 and IR 8.15; P <0.001) and being MSM/TW (IR 6.48; P <0.001) were associated with higher risk of incident syphilis infection. Of the sexual risk behaviors, older age of sexual debut (IR 12.53; P <0.001), not being in a stable partnership (IR 1.56, P = 0.035), higher number of sex partners (IR 3.01; P <0.001), unprotected sex in the past 3 months (IR 0.56; P = 0.003), HIV infection at baseline (IR 3.98; P <0.001) and incident HIV infection during the study period (IR 6.26; P = 0.003) were all associated with incident syphilis. In the multivariable analysis, older age group (adjusted incidence ratio (aIR) 6.18; P <0.001), men reporting having sex with a man (aIR 4.63; P <0.001), and incident HIV infection (aIR 4.48; P = 0.008) were significantly associated

  8. Incidence Patterns and Occupational Risk Factors of Human Brucellosis in Greece, 2004-2015.

    Science.gov (United States)

    Lytras, T; Danis, K; Dounias, G

    2016-10-01

    Brucellosis is the most common bacterial zoonosis worldwide. Greece has the highest reported incidence among EU countries. However, occupational risk factors have not been well described. To determine the incidence patterns and exposure risk factors of brucellosis in Greece. We used national-level surveillance and occupational denominator data to estimate the incidence patterns and exposure risk factors of brucellosis in Greece, with particular emphasis on occupation. Between November 2003 and December 2015 a total of 2159 human brucellosis cases was reported. The mean incidence rate was 1.62 per 100 000 population per year. A large majority of cases (77.1%) reported consumption of unpasteurized milk or contact with livestock animals. Most cases occured in farmers and livestock breeders (1079 [87.7%] of 1231 cases reporting their occupation), corresponding to an annual incidence of 7.1 per 100 000. However, there were other occupations with a similar or higher risk: butchers and abattoir workers (12.7 per 100 000), laboratory personnel (3.1 per 100 000), while the highest risk was for veterinarians (53.2 per 100 000). Brucellosis incidence in specific occupational groups was much higher than in the general population. These results underline the importance of collecting information on occupation, both during the diagnostic process and in the surveillance system. Besides efforts to control brucellosis in animals, organized prevention efforts are needed within an occupational health framework, especially for the most vulnerable workers.

  9. Incidence Patterns and Occupational Risk Factors of Human Brucellosis in Greece, 2004–2015

    Directory of Open Access Journals (Sweden)

    T Lytras

    2016-10-01

    Full Text Available Background: Brucellosis is the most common bacterial zoonosis worldwide. Greece has the highest reported incidence among EU countries. However, occupational risk factors have not been well described. Objective: To determine the incidence patterns and exposure risk factors of brucellosis in Greece. Methods: We used national-level surveillance and occupational denominator data to estimate the incidence patterns and exposure risk factors of brucellosis in Greece, with particular emphasis on occupation. Results: Between November 2003 and December 2015 a total of 2159 human brucellosis cases was reported. The mean incidence rate was 1.62 per 100 000 population per year. A large majority of cases (77.1% reported consumption of unpasteurized milk or contact with livestock animals. Most cases occured in farmers and livestock breeders (1079 [87.7%] of 1231 cases reporting their occupation, corresponding to an annual incidence of 7.1 per 100 000. However, there were other occupations with a similar or higher risk: butchers and abattoir workers (12.7 per 100 000, laboratory personnel (3.1 per 100 000, while the highest risk was for veterinarians (53.2 per 100 000. Conclusion: Brucellosis incidence in specific occupational groups was much higher than in the general population. These results underline the importance of collecting information on occupation, both during the diagnostic process and in the surveillance system. Besides efforts to control brucellosis in animals, organized prevention efforts are needed within an occupational health framework, especially for the most vulnerable workers.

  10. Incidence and risk factors for neonatal tetanus in admissions to Kilifi County Hospital, Kenya.

    Directory of Open Access Journals (Sweden)

    Fredrick Ibinda

    Full Text Available Neonatal Tetanus (NT is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya.We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999-2013 and identified cases of NT (standard clinical case definition admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61 and neonates (n = 47 were tested for anti-tetanus antibodies.There were 191 NT admissions, of whom 187 (98% were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81-0.89, P<0.001 but the case fatality (62% did not change over the study period (P = 0.536. Younger infant age at admission (P = 0.001 was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82% had undetectable levels of antitetanus antibodies, and most (8/9, 89% mothers with detectable antibodies had a neonate without protective levels.Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to

  11. Incidence of work injuries amongst Danish adolescents and their association with work environment factors.

    Science.gov (United States)

    Rasmussen, Kurt; Hansen, Claus D; Nielsen, Kent J; Andersen, Johan H

    2011-02-01

    The objective was to examine the incidence of work accidents that required medical attention among Danish adolescents and to identify possible work environment factors associated with such accidents. We collected information in two questionnaire rounds (2004 and 2007) from a birth cohort comprising all adolescents born in 1989 (n = 3,687) living in Ringkjøbing County, Denmark. The questionnaire contained items on self-reported number of accidents and number of working hours in both rounds and on work environment factors in the second round. Approximately 5% of the adolescents who held a job, experienced a work injury at the age of 17. This equals an incidence of 65 accidents per million working hours. Most adolescents had decent working conditions, although nearly half reported that their work was heavy, monotonous or psychologically demanding. Heavy work, high psychological demands and low social support increased the risk of experiencing work injuries after adjustment for a number of factors. The incidence of work injuries among adolescents appears to be higher than the incidence among their older colleagues. Lack of social support from management significantly raised adolescents' risk of experiencing a work injury. This suggests that more direct supervision may be a good way of preventing accidents in this age group. Copyright © 2010 Wiley-Liss, Inc.

  12. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors.

    Science.gov (United States)

    Touré, Abdoulaye; Vanhems, Philippe; Lombard-Bohas, Catherine; Cassier, Philippe; Péré-Vergé, Denis; Souquet, Jean-Christophe; Ecochard, René; Chambrier, Cécile

    2012-12-01

    Central venous access port-related bloodstream infection (CVAP-BSI) is associated with morbidity and mortality in patients with cancer. This study examined the incidence rates and risk factors for CVAP-BSI in adult patients with digestive cancer. This prospective observational cohort study was performed from 2007 to 2011 in 2 oncology units of a university hospital. Incidence rate was expressed as number of CVAP-BSI per 1,000 catheter-days. A Cox regression model was used to identify risk factors for CVAP-BSI. A total of 315 patients were included. CVAP-BSI occurred in 41 patients (13.0%). The overall incidence rate was 0.76/1,000 catheter-days. The rate was higher in patients with esophageal cancer (1.28. P = .05) and pancreatic cancer (1.24; P = .007). Risk factors independently associated with CVAP-BSI were World Health Organization performance status between 2 and 4, catheter utilization-days in the previous month, pancreatic cancer, and parenteral nutrition. Coagulase-negative Staphylococci and enterobacteria were the main microorganisms isolated. In adult patients with digestive cancer, pancreatic cancer, cumulative catheter utilization-days, World Health Organization performance status, and parenteral nutrition were identified as independent risk factors for CVAP-BSI. Patients with any of these risk factors could be candidates for preventive strategies. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  13. Factors associated with the incidence of pressure ulcer during hospital stay.

    Science.gov (United States)

    Matozinhos, Fernanda Penido; Velasquez-Melendez, Gustavo; Tiensoli, Sabrina Daros; Moreira, Alexandra Dias; Gomes, Flávia Sampaio Latini

    2017-05-25

    Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers. Estimar a taxa de incidência de úlcera por pressão e verificar fatores associados a essa ocorrência em uma coorte de pacientes hospitalizados. Trata-se de estudo de coorte no qual o desfecho foi a ocorrência da úlcera por pressão. A estimativa do efeito das variáveis para a proporção de incidência acumulada do desfecho foi realizada utilizando o modelo de riscos proporcionais de Cox. A seleção das variáveis ocorreu por meio do teste de hipóteses Logrank. A amostra foi composta de 442 adultos, com 25 casos incidentes de úlcera por pressão. Pacientes com altos escores na escala de Braden apresentaram maior risco de incidência de úlcera por pressão quando comparados com aqueles classificados na categoria de baixo escore. Os resultados reforçam a importância do uso da Escala de Braden para auxiliar na identificação dos pacientes com maior probabilidade de desenvolver úlcera por pressão.

  14. Trends in Incidence and Factors Affecting Survival of Patients With Cholangiocarcinoma in the United States.

    Science.gov (United States)

    Mukkamalla, Shiva Kumar R; Naseri, Hussain M; Kim, Byung M; Katz, Steven C; Armenio, Vincent A

    2018-04-01

    Background: Cholangiocarcinoma (CCA) includes cancers arising from the intrahepatic and extrahepatic bile ducts. The etiology and pathogenesis of CCA remain poorly understood. This is the first study investigating both incidence patterns of CCA from 1973 through 2012 and demographic, clinical, and treatment variables affecting survival of patients with CCA. Patients and Methods: Using the SEER database, age-adjusted incidence rates were evaluated from 1973-2012 using SEER*Stat software. A retrospective cohort of 26,994 patients diagnosed with CCA from 1973-2008 was identified for survival analysis. Cox proportional hazards models were used to perform multivariate survival analysis. Results: Overall incidence of CCA increased by 65% from 1973-2012. Extrahepatic CCA (ECC) remained more common than intrahepatic CCA (ICC), whereas the incidence rates for ICC increased by 350% compared with a 20% increase seen with ECC. Men belonging to non-African American and non-Caucasian ethnicities had the highest incidence rates of CCA. This trend persisted throughout the study period, although African Americans and Caucasians saw 50% and 59% increases in incidence rates, respectively, compared with a 9% increase among other races. Median overall survival (OS) was 8 months in patients with ECC compared with 4 months in those with ICC. Our survival analysis found Hispanic women to have the best 5-year survival outcome ( P better survival outcomes compared with ICC ( P better survival outcomes compared with others ( P <.0001). Conclusions: This is the most up-to-date study of CCA from the SEER registry that shows temporal patterns of increasing incidence of CCA across different races, sexes, and ethnicities. We identified age, sex, race, marital status, income, smoking status, anatomic location of CCA, tumor grade, tumor stage, radiation, and surgery as independent prognostic factors for OS in patients with CCA. Copyright © 2018 by the National Comprehensive Cancer Network.

  15. Amniotic fluid embolism incidence, risk factors and outcomes: a review and recommendations

    Directory of Open Access Journals (Sweden)

    Knight Marian

    2012-02-01

    Full Text Available Abstract Background Amniotic fluid embolism (AFE is a rare but severe complication of pregnancy. A recent systematic review highlighted apparent differences in the incidence, with studies estimating the incidence of AFE to be more than three times higher in North America than Europe. The aim of this study was to examine population-based regional or national data from five high-resource countries in order to investigate incidence, risk factors and outcomes of AFE and to investigate whether any variation identified could be ascribed to methodological differences between the studies. Methods We reviewed available data sources on the incidence of AFE in Australia, Canada, the Netherlands, the United Kingdom and the USA. Where information was available, the risk factors and outcomes of AFE were examined. Results The reported incidence of AFE ranged from 1.9 cases per 100 000 maternities (UK to 6.1 per 100 000 maternities (Australia. There was a clear distinction between rates estimated using different methodologies. The lowest estimated incidence rates were obtained through validated case identification (range 1.9-2.5 cases per 100 000 maternities; rates obtained from retrospective analysis of population discharge databases were significantly higher (range 5.5-6.1 per 100 000 admissions with delivery diagnosis. Older maternal age and induction of labour were consistently associated with AFE. Conclusions Recommendation 1: Comparisons of AFE incidence estimates should be restricted to studies using similar methodology. The recommended approaches would be either population-based database studies using additional criteria to exclude false positive cases, or tailored data collection using existing specific population-based systems. Recommendation 2: Comparisons of AFE incidence between and within countries would be facilitated by development of an agreed case definition and an agreed set of criteria to minimise inclusion of false positive cases for

  16. [Incidence and risk factors associated with nosocomial infection in pediatric heart surgery].

    Science.gov (United States)

    Duarte-Raya, Fidencia; Baeza-Zarco, Fabiola Janet

    2016-01-01

    Nosocomial infections are responsible for a high rate of morbidity and mortality in pediatric patients undergoing heart surgery. Our objective was to determine the incidence and associated risk factors to nosocomial infections in this group of patients. A descriptive, prospective, clinical study was conducted in a tertiary hospital for a year. We calculated the rate of incidence, accumulated incidence and devices used. Was Applied the EPIDAT 2004 version 3.1 program OPS for obtaining of Chi-square with Yates correction for p with a confidence of 95 %, alpha of 0.05 with a degree of freedom, we calculated odds ratio, besides of the identification of microorganisms, their sensitivity and resistance to antibiotics. We calculated rates of: 45 % the incidence, 80.6 % cumulative incidence, 7.4 % of mortality, 13.3 % of case-fatality rate of infected and 2.7 % non-infected. The 44.4 % with pneumonia, 74 % associated with mechanical ventilation, 100 % nasogastric tube. The most frequently isolated microorganisms are: Acinetobacter baumanni, Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa with high resistance to antibiotics. Pediatric patients undergoing heart surgery have high risk of infection heart disease, cyanogen's have 5 times more risk. We observed a statistically significant association with infection using nasogastric probe and endotracheal tube, the risk increases to increased hospital stay. Infected patients have 4 times the risk of death.

  17. Causal Factors and Adverse Events of Aviation Accidents and Incidents Related to Integrated Vehicle Health Management

    Science.gov (United States)

    Reveley, Mary S.; Briggs, Jeffrey L.; Evans, Joni K.; Jones, Sharon M.; Kurtoglu, Tolga; Leone, Karen M.; Sandifer, Carl E.

    2011-01-01

    Causal factors in aviation accidents and incidents related to system/component failure/malfunction (SCFM) were examined for Federal Aviation Regulation Parts 121 and 135 operations to establish future requirements for the NASA Aviation Safety Program s Integrated Vehicle Health Management (IVHM) Project. Data analyzed includes National Transportation Safety Board (NSTB) accident data (1988 to 2003), Federal Aviation Administration (FAA) incident data (1988 to 2003), and Aviation Safety Reporting System (ASRS) incident data (1993 to 2008). Failure modes and effects analyses were examined to identify possible modes of SCFM. A table of potential adverse conditions was developed to help evaluate IVHM research technologies. Tables present details of specific SCFM for the incidents and accidents. Of the 370 NTSB accidents affected by SCFM, 48 percent involved the engine or fuel system, and 31 percent involved landing gear or hydraulic failure and malfunctions. A total of 35 percent of all SCFM accidents were caused by improper maintenance. Of the 7732 FAA database incidents affected by SCFM, 33 percent involved landing gear or hydraulics, and 33 percent involved the engine and fuel system. The most frequent SCFM found in ASRS were turbine engine, pressurization system, hydraulic main system, flight management system/flight management computer, and engine. Because the IVHM Project does not address maintenance issues, and landing gear and hydraulic systems accidents are usually not fatal, the focus of research should be those SCFMs that occur in the engine/fuel and flight control/structures systems as well as power systems.

  18. Recognizing Life-threatening Features of Dengue in Children and Health Seeking Behavior in Dengue Emergency Amongst Parents and Carers: A Cross-sectional study in Gombak District, Malaysia.

    Science.gov (United States)

    Ariffin, F; Ramli, A S; Naim, N; Selamat, M I; Syed-Jamal, S J

    2014-10-01

    Dengue is life-threatening and the paediatric population is highly susceptible to complications. Deterioration can occur rapidly and ability to recognise early warning signs is crucial. This study aims to determine the knowledge and awareness of parents and carers and to predict their ability in recognising life-threatening symptoms and signs of dengue in children and to assess their health-seeking behaviour in dengue emergency. Methods This is a crosssectional study involving parents and carers of children ≤ 12 years old in schools and kindergartens in the Gombak district. Demographic details, knowledge on life-threatening symptoms and signs of dengue and health-seeking behaviour were collected using a self-administered questionnaire and knowledge scoring was done. The questionnaire was pilot tested with a Cronbach alpha of 0.82. The results were analysed using SPSS version 20.0. Results Total respondents were 866 with 44.8% men and 55.2% women. The mean age was 40.3 years (SD ± 5.7). Knowledge score of dengue life threatening features among respondents were good (30.0%) to average (56.8%). Respondents were able to recognise fever (98.5%), petechial rash (97.1%) and bleeding (65.2%) but were less able to recognise abdominal pain (22.3%) and passing less urine (28.2%) as life threatening dengue features. However, the ability to recognise fever is a poor predictor in recognising life threatening dengue in children compared to all other symptoms which were good predictors. A respondent that recognise stomach pain or neck stiffness were five times more likely to recognise life-threatening dengue. Respondents preferred to bring their children to the clinic (50.8%) or hospital (37.8%) themselves Instead of calling for ambulance. Worryingly, some would give antipyretics (3.6%) or wait for improvements (7.8%). Conclusion Concerted efforts by the schools, healthcare professionals and health authorities are required to educate parents and carers to identify life-threatening

  19. Environmental and state-level regulatory factors affect the incidence of autism and intellectual disability.

    Directory of Open Access Journals (Sweden)

    Andrey Rzhetsky

    2014-03-01

    Full Text Available Many factors affect the risks for neurodevelopmental maladies such as autism spectrum disorders (ASD and intellectual disability (ID. To compare environmental, phenotypic, socioeconomic and state-policy factors in a unified geospatial framework, we analyzed the spatial incidence patterns of ASD and ID using an insurance claims dataset covering nearly one third of the US population. Following epidemiologic evidence, we used the rate of congenital malformations of the reproductive system as a surrogate for environmental exposure of parents to unmeasured developmental risk factors, including toxins. Adjusted for gender, ethnic, socioeconomic, and geopolitical factors, the ASD incidence rates were strongly linked to population-normalized rates of congenital malformations of the reproductive system in males (an increase in ASD incidence by 283% for every percent increase in incidence of malformations, 95% CI: [91%, 576%], p<6×10(-5. Such congenital malformations were barely significant for ID (94% increase, 95% CI: [1%, 250%], p = 0.0384. Other congenital malformations in males (excluding those affecting the reproductive system appeared to significantly affect both phenotypes: 31.8% ASD rate increase (CI: [12%, 52%], p<6×10(-5, and 43% ID rate increase (CI: [23%, 67%], p<6×10(-5. Furthermore, the state-mandated rigor of diagnosis of ASD by a pediatrician or clinician for consideration in the special education system was predictive of a considerable decrease in ASD and ID incidence rates (98.6%, CI: [28%, 99.99%], p = 0.02475 and 99% CI: [68%, 99.99%], p = 0.00637 respectively. Thus, the observed spatial variability of both ID and ASD rates is associated with environmental and state-level regulatory factors; the magnitude of influence of compound environmental predictors was approximately three times greater than that of state-level incentives. The estimated county-level random effects exhibited marked spatial clustering, strongly

  20. The Incidence and the Contributing factors of premenstrual syndrome in health working women

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    Bülent Demir

    2006-12-01

    Full Text Available AIM: To report the incidence of premenstrual syndrome in working women and the association of premenstrual syndrome with social and demographical factors, menstrual cycle, and nutritional status. The second aim of this study is to investigate the influence\tof premenstrual syndrome on working performance. Finally, to contribute to decrease the waste of labor time and unnecessary drugs usage caused by premenstrual syndrome.\tMATERIAL-METHODS: Totally 254 women aged between 19-49 years old who work in Dicle University Faculty of Medicine Hospital were enrolled for this prospective study. Data were obtained by face to face interview questionnaires.\tRESULTS: The incidence of premenstrual syndrome was 20.1%. The 91.7% of women had experienced mild or moderate symptoms in premenstrual period. The most common complains were pelvic pain, tension or restlessness, irritability or agitation, abdominal bloating and breast tenderness. Furthermore, in the presence of following factors; women with young ages ( CONCLUSION: The incidence of premenstrual syndrome is higher in working women and this condition may affect the whole population. In order to decrease the incidence of premenstrual syndrome and to increase the life quality of women; more attention\tshould be paid to this condition and proper precautions should be taken.

  1. Incidence and risk factors of emergence agitation in pediatric patients after general anesthesia.

    Science.gov (United States)

    Saringcarinkul, Ananchanok; Manchupong, Sithapan; Punjasawadwong, Yodying

    2008-08-01

    To study the incidence and evaluate factors associated with emergence agitation (EA) in pediatrics after general anesthesia. A prospective observational study was conducted in 250 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in Maharaj Nakorn Chiang Mai Hospital between October 2006 and September 2007. The incidence of EA was assessed Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. One hundred and eight children (43.2%) had EA, with an average duration of 9.6 +/- 6.8 minutes. EA associated with adverse events occurred in 32 agitated children (29.6%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2-5 years), and general anesthesia with sevoflurane. However; difficult parental-separation behavior; and preschool age were the only factors significantly associated with EA in the multiple logistic regression analysis with OR = 3.021 (95% CI = 1.680, 5.431, p anesthesia personnel responsible for pediatric anesthesia should have essential skills and knowledge to effectively care for children before, during, and after an operation, including implementing the methods that minimize incidence of EA.

  2. Incidence and risk factors for suicide attempts in a general population of young people

    DEFF Research Database (Denmark)

    Christiansen, Erik; Juul Larsen, Kim; Agerbo, Esben

    2013-01-01

    OBJECTIVE: To estimate the Danish epidemiological long-term incidence rates for suicide attempts in the general population of children and adolescents, and to analyze the impact from single and multiple risk factors on the risk of suicide attempts. METHOD: We used longitudinal register data from ...... on the increase in the period studied. Individuals exposed to multiple risk factors are at the highest risk for suicide attempts, and when spotted or in contact with authorities they should be given proper care and treatment to prevent suicide attempts and death.......OBJECTIVE: To estimate the Danish epidemiological long-term incidence rates for suicide attempts in the general population of children and adolescents, and to analyze the impact from single and multiple risk factors on the risk of suicide attempts. METHOD: We used longitudinal register data from...... a total cohort of all individuals born between 1983 and 1989 and living in Denmark to calculate incidence rates. From the cohort, we identified all who have attempted suicide, and matched 50 controls to each case. A nested case-control design was used to estimate the impact from risk factors on the risk...

  3. Risk Factors Associated with Injury and Mortality from Paediatric Low Speed Vehicle Incidents: A Systematic Review

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    Anne Paul Anthikkat

    2013-01-01

    Full Text Available Objective. This study reviews modifiable risk factors associated with fatal and nonfatal injury from low-speed vehicle runover (LSVRO incidents involving children aged 0–15 years. Data Sources. Electronic searches for child pedestrian and driveway injuries from the peer-reviewed literature and transport-related websites from 1955 to 2012. Study Selection. 41 studies met the study inclusion criteria. Data Extraction. A systematic narrative summary was conducted that included study design, methodology, risk factors, and other study variables. Results. The most commonly reported risk factors for LSVRO incidents included age under 5 years, male gender, and reversing vehicles. The majority of reported incidents involved residential driveways, but several studies identified other traffic and nontraffic locations. Low socioeconomic status and rental accommodation were also associated with LSVRO injury. Vehicles were most commonly driven by a family member, predominantly a parent. Conclusion. There are a number of modifiable vehicular, environmental, and behavioural factors associated with LSVRO injuries in young children that have been identified in the literature to date. Strategies relating to vehicle design (devices for increased rearward visibility and crash avoidance systems, housing design (physical separation of driveway and play areas, and behaviour (driver behaviour, supervision of young children are discussed.

  4. Early and Late Recurrent Epistaxis Admissions: Patterns of Incidence and Risk Factors.

    Science.gov (United States)

    Cohen, Oded; Shoffel-Havakuk, Hagit; Warman, Meir; Tzelnick, Sharon; Haimovich, Yaara; Kohlberg, Gavriel D; Halperin, Doron; Lahav, Yonatan

    2017-09-01

    Objective Epistaxis is a common complaint, yet few studies have focused on the incidence and risk factors of recurrent epistaxis. Our objective was to determine the patterns of incidence and risk factors for recurrent epistaxis admission (REA). Study Design Case series with chart review. Settings Single academic center. Subjects and Methods The medical records of patients admitted for epistaxis between 1999 and 2015 were reviewed. The follow-up period was defined as 3 years following initial admission. REAs were categorized as early (30 days) and late (31 days to 3 years) following initial admission. Logistic regression was used to identify potential predictors of REAs. Results A total of 653 patients were included. Eighty-six patients (14%) had REAs: 48 (7.5%) early and 38 (6.5%) late. Nonlinear incidence curve was demonstrated for both early and late REAs. Based on logistic regression, prior nasal surgery and anemia were independent risk factors for early REAs. According to multivariate analysis, thrombocytopenia was significantly associated with late REAs. Conclusion Early and late REAs demonstrate different risk predictors. Knowledge of such risk factors may help in risk stratification for this selected group of patients. All patients at risk should be advised on possible preventive measures. Patients at risk for early REA may benefit from a more proactive approach.

  5. Endodontic interappointment flare-ups: a prospective study of incidence and related factors.

    Science.gov (United States)

    Walton, R; Fouad, A

    1992-04-01

    Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.

  6. Contributory factors in surgical incidents as delineated by a confidential reporting system.

    Science.gov (United States)

    Mushtaq, F; O'Driscoll, C; Smith, Fct; Wilkins, D; Kapur, N; Lawton, R

    2018-05-01

    Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework. Results The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) - with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures - those closest in time and space to the adverse event - pointed to frequent coupling with latent, systems-related contributory factors. Conclusions Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements.

  7. Incidence and Risk Factors for Incident Syphilis among HIV-1-Infected Men Who Have Sex with Men in a Large Urban HIV Clinic in Tokyo, 2008−2015

    Science.gov (United States)

    Nishijima, Takeshi; Teruya, Katsuji; Shibata, Satoshi; Yanagawa, Yasuaki; Kobayashi, Taiichiro; Mizushima, Daisuke; Aoki, Takahiro; Kinai, Ei; Yazaki, Hirohisa; Tsukada, Kunihisa; Genka, Ikumi; Kikuchi, Yoshimi; Oka, Shinichi; Gatanaga, Hiroyuki

    2016-01-01

    Background The epidemiology of incident syphilis infection among HIV-1-infected men who have sex with men (MSM) largely remains unknown. Methods The incidence and risk factors for incident syphilis (positive TPHA and RPR> = 1:8) among HIV-1-infected MSM who visited a large HIV clinic in Tokyo for the first time between 2008 and 2013 were determined, using clinical data and stored blood samples taken every three months for screening and determination of the date of incident syphilis. Poisson regression compared the incidence of syphilis at different observation periods. Results Of 885 HIV-1-infected MSM with baseline data, 34% either presented with active syphilis at baseline (21%) or became infected with syphilis during follow-up (13%). After excluding 214 patients (MSM with syphilis at baseline (n = 190) and no follow-up syphilis test (n = 24)), of 671 men, 112 (17%) developed incident syphilis with an incidence of 43.7/1,000 person-years [95% CI, 36.5–52.3]. The incidence decreased slightly during observation period although the trend was not significant (2008–2009: 48.2/1,000 person-years, 2010–2011: 51.1/1,000 person-years, 2012–2013: 42.6/1,000 person-years, 2014 to 2015: 37.9/1,000 person-years, p = 0.315). Multivariable analysis identified young age (40, HR 4.0, 95%CI 2.22–7.18, psyphilis at baseline (HR 3.0, 95%CI 2.03–4.47, psyphilis. Incidence of syphilis was particularly high among young patients (age syphilis were asymptomatic. Conclusions Although incidence of syphilis did not increase during the observation period, it was high among HIV-1-infected MSM, especially among young HIV-1-infected MSM and those with history of syphilis, in Tokyo. Regular screening for syphilis needs to be strictly applied to this population. PMID:27992604

  8. Incidence and risk factors of urinary incontinence in women visiting Family Health Centers

    OpenAIRE

    K?l??, Meral

    2016-01-01

    Background The objective of this study is to determine the incidence and the risk factors of the urinary incontinence in women visiting the Health Family Center. Methods 430 women, who visited three Family Health Centers in the city center of Erzurum for any reason between 25 November and 20 January 2016, were included in this study without any sampling. The data were collected by using the face-to-face interview method. Percentage distribution, Chi square test, and logistic regression analys...

  9. 59. Urinary tract infection in children after cardiac surgery: Incidence, risk factors and outcome

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    Rehana Shafi

    2015-10-01

    Conclusions: Foley catheter duration, presence of syndrome and prolonged PCICU and hospital stay were the main risk factors for CAUTI in postoperative pediatric cardiac patients. Resistant Gram-negative were the main cause for BSI with one third of CAUTI cases caused by MDRO or ESBL organisms. The cases with CAUTI were generally sicker and with more morbidity. The study will establish a baseline clinical indicator for monitoring quality improvement and the future measures to minimize CAUTI incidence, and its co-morbidity.

  10. Incidence and related factors of traffic accidents among the older population in a rapidly aging society.

    Science.gov (United States)

    Hong, Kimyong; Lee, Kyoung-Mu; Jang, Soong-nang

    2015-01-01

    To estimate the incidence of traffic accidents and find related factors among the older population. We used the cross-sectional data from the Korean Community Health Survey (KCHS), which was conducted between 2008 and 2010 and completed by 680,202 adults aged 19 years or more. And we used individuals aged 60 years or above (n=210,914). The incidence of traffic accidents was estimated as number of traffic accidents experienced per thousand per year by a number of factors including age, sex, residential area, education, employment status, and diagnosis with chronic diseases. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each potential risk factor adjusted for the others. Incidence of traffic accidents was estimated as 11.74/1,000 per year for men, and 7.65/1,000 per year for women. It tended to decline as age increased among women; compared to the youngest old age group (60-64), the older old groups (70-74 and 80+) were at lower risk for traffic accidents. Depressive symptom was the strongest predictor for both men (OR=1.83, 95% CI=1.28-2.61) and women (1.70, 1.23-2.35). Risk of traffic accident was greater in employed men (1.76, 1.40-2.22) and women diagnosis with arthritis (1.36, 1.06-1.75). Given that the incidence of and factors associated with traffic accidents differ between men and women, preventive strategies, such as driver education and traffic safety counseling for older adults, should be modified in accordance with these differences. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors

    OpenAIRE

    Teofili, Luciana; Bianchi, Maria; Zanfini, Bruno A.; Catarci, Stefano; Sicuranza, Rossella; Spartano, Serena; Zini, Gina; Draisci, Gaetano

    2014-01-01

    Background. We retrospectively investigated the incidence and risk factors for transfusion-related acute lung injury (TRALI) among patients transfused for post-partum hemorrhage (PPH).  Methods. We identified a series of 71 consecutive patients with PPH requiring the urgent transfusion of three or more red blood cell (RBC) units, with or without fresh frozen plasma (FFP) and platelet (PLT) transfusion. Clinical records were then retrieved and examined for respiratory distress events. Accor...

  12. Falls in ambulatory individuals with spinal cord injury : incidence, risk factors and perceptions of falls

    OpenAIRE

    Jørgensen, Vivien

    2016-01-01

    Background: Falls in ambulatory individuals with chronic spinal cord injury (SCI) are common and may have adverse consequences. Little and inconclusive research has been done in this population, and there is a need for more knowledge in order to develop prevention strategies appropriate for this population. Aim: The overall aim of this thesis was to study the incidence of and identify the risk factors for recurrent (>2) and injurious falls in ambulatory individuals with SCI...

  13. Codeine Shopping Behavior in a Retrospective Cohort of Chronic Noncancer Pain Patients: Incidence and Risk Factors.

    Science.gov (United States)

    Chenaf, Chouki; Kabore, Jean-Luc; Delorme, Jessica; Pereira, Bruno; Mulliez, Aurélien; Roche, Lucie; Eschalier, Alain; Delage, Noémie; Authier, Nicolas

    2016-12-01

    Codeine is a widely used opioid analgesic but studies on its misuse in chronic noncancer pain (CNCP) are still lacking. The aim of this study was to assess the incidence of codeine shopping behavior in CNCP patients and to identify the associated risk factors. This was a population-based retrospective cohort study from the French health insurance claims database from 2004 to 2014. The main outcome was the one-year incidence of codeine shopping behavior defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies. A total of 1,958 CNCP patients treated with codeine were included, with a mean age of 62.7 ± 16.1 years, 36.8% men. The 1-year incidence rate of codeine shopping behavior was 4.03% (95% confidence interval [CI], 3.07-5.28). In multivariate analysis, risk factors associated with shopping behavior were younger age (≤40 years) (hazard ratio [HR] = 7.29; 95% CI, 4.28-12.42), mental health disorders (HR = 2.25; 95% CI, 1.08-4.67), concurrent use of anxiolytic benzodiazepines (HR = 3.12; 95% CI, 1.55-6.26), and previous use of strong opioids (HR = 2.94; 95% CI, 1.24-6.98). The incidence of codeine shopping behavior in CNCP patients was 4% and risk factors identified were shared with those of opioid abuse. Shopping behavior for codeine was not infrequent in CNCP patients. The risk factors identified in this study are similar to those identified for opioid abuse in other studies. Appropriate use of codeine from the perspectives of patients and healthcare providers should be encouraged. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  14. Assessment of ergonomics risk factors influencing incidence of musculoskeletal disorders among office workers

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    S. I. Samaei

    2015-12-01

      Conclution: According to results, ROSA assessment method is an efficient tool in the classification and identification of factors affecting the incidence of MSDs among office workers. Performing corrective measures in the dangerous work stations (the second level identified by ROSA technique, reducing the duration of computer use per day, and doing regular sport activities can be noted in order to decrease the prevalence of MSDs in the study group (office workers.

  15. Incidence and risk factors of phlebitis associated to peripheral intravenous catheters.

    Science.gov (United States)

    Arias-Fernández, Loreto; Suérez-Mier, Belén; Martínez-Ortega, María Del Carmen; Lana, Alberto

    To determine the incidence and risk factors of phlebitis associated to the care of peripheral vascular catheters (PVC). Prospective cohort study at the Central University Hospital of Asturias (Spain). A total of 178PVC were observed daily until their extraction. The incidence of phlebitis was measured using the Visual Infusion Phlebitis Scale, that distinguishes between gradei (possible phlebitis) andii (phlebitis). The independent diagnoses of phlebitis made by staff nurses were also collected. Finally, data about the insertion and the care of the PVC was also obtained. The incidence of phlebitis and the validity of the diagnoses made by staff nurses were calculated and the risk factors of phlebitis were determined by means of logistic regression. 5.6% of the PVC presented phlebitis, 21.3% possible phlebitis and 11.2% had phlebitis according to nurses' criteria. The staff nurses had a sensitivity of 100%, a specificity of 94% and a positive predictive value of 50% in the diagnosis of phlebitis. After adjusting for potential confounders, the use of an extension tube as an accessory of the PVC was an independent predictor of phlebitis (odds ratio: 4.8; P=.04), but a PVC size of 22/24 gauges was associated with lower phlebitis incidence (odds ratio: 0.2; P=.02). Clinical phlebitis assessment is difficult because the agreement for phlebitis diagnosis is low. To minimize the incidence of phlebitis would be recommended to choose the smallest PVC size possible and to avoid using an extension tube as an accessory of the PVC. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  16. A Systematic Review againts Risk Factors on The Low-weight Birth Incidence in Indonesia

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    Estri Kusumawati

    2017-04-01

    Full Text Available The number of maternal and infant mortality in Indonesia is still high. Most of Indonesian neonatal mortality occurs in the first week of life with low-weight birth (LwB / premature as the main cause. Birth weight is an important and reliable indicator for the survival of neonates and infants, both in terms of physical growth and development of the mental status. LwB caused by many complicated factors that related each others as if maternal factors that also affect the baby's weight at their birth. The purpose of this study was to identified the determinant factors that affect the incidence of LwB based on the related research topic. The data source obtained from the scientific journals with LwB studies during the years of 2009 untill 2016 with the total of 14 studies consisting of scientific papers and thesis. In this study, researchers divided into five risk factors associated with LwB. From those factors then it divided again into 20 aspects. The result show that the maternal nutritional aspec and anemia status have become significant risk factors againts the low-weight birth incidence.

  17. Urinary tract infection in renal transplant recipients: incidence, risk factors, and impact on graft function.

    Science.gov (United States)

    Camargo, L F; Esteves, A B A; Ulisses, L R S; Rivelli, G G; Mazzali, M

    2014-01-01

    Urinary tract infection (UTI) is the most common infection posttransplant. However, the risk factors for and the impact of UTIs remain controversial. The aim of this study was to identify the incidence of posttransplant UTIs in a series of renal transplant recipients from deceased donors. Secondary objectives were to identify: (1) the most frequent infectious agents; (2) risk factors related to donor; (3) risk factors related to recipients; and (4) impact of UTI on graft function. This was a retrospective analysis of medical records from renal transplant patients from January to December 2010. Local ethics committee approved the protocol. The incidence of UTI in this series was 34.2%. Risk factors for UTI were older age, (independent of gender), biopsy-proven acute rejection episodes, and kidneys from deceased donors (United Network for Organ Sharing criteria). For female patients, the number of pretransplant pregnancies was an additional risk factor. Recurrent UTI was observed in 44% of patients from the UTI group. The most common infectious agents were Escherichia coli and Klebsiella pneumoniae, for both isolated and recurrent UTI. No difference in renal graft function or immunosuppressive therapy was observed between groups after the 1-year follow-up. In this series, older age, previous pregnancy, kidneys from expanded criteria donors, and biopsy-proven acute rejection episodes were risk factors for posttransplant UTI. Recurrence of UTI was observed in 44%, with no negative impact on graft function or survival. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study.

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    Chen Chen

    Full Text Available BACKGROUND: Meningitis after neurosurgery can result in severe morbidity and high mortality. Incidence varies among regions and limited data are focused on meningitis after major craniotomy. AIM: This retrospective cohort study aimed to determine the incidence, risk factors and microbiological spectrum of postcraniotomy meningitis in a large clinical center of Neurosurgery in China. METHODS: Patients who underwent neurosurgeries at the Department of Neurosurgery in Huashan Hospital, the largest neurosurgery center in Asia and the Pacific, between 1st January and 31st December, 2008 were selected. Individuals with only shunts, burr holes, stereotactic surgery, transsphenoidal or spinal surgery were excluded. The complete medical records of each case were reviewed, and data on risk factors were extracted and evaluated for meningitis. RESULTS: A total of 65 meningitides were identified among 755 cases in the study, with an incidence of 8.60%. The risk of meningitis was increased by the presence of diabetes mellitus (odds ratio [OR], 6.27; P = 0.009, the use of external ventricular drainage (OR, 4.30; P = 0.003 and the use of lumbar drainage (OR, 17.23; P<0.001. The isolated microorganisms included Acinetobacter baumannii, Enterococcus sp, Streptococcus intermedius and Klebsiella pneumonia. CONCLUSIONS: Meningitis remains an important source of morbidity and mortality after major craniotomy. Diabetic patients or those with cerebral spinal fluid shunts carry significant high risk of infection. Thus, identification of the risk factors as soon as possible will help physicians to improve patient care.

  19. The incidence and risk factors of meningitis after major craniotomy in China: a retrospective cohort study.

    Science.gov (United States)

    Chen, Chen; Zhang, Bingyan; Yu, Shenglei; Sun, Feng; Ruan, Qiaoling; Zhang, Wenhong; Shao, Lingyun; Chen, Shu

    2014-01-01

    Meningitis after neurosurgery can result in severe morbidity and high mortality. Incidence varies among regions and limited data are focused on meningitis after major craniotomy. This retrospective cohort study aimed to determine the incidence, risk factors and microbiological spectrum of postcraniotomy meningitis in a large clinical center of Neurosurgery in China. Patients who underwent neurosurgeries at the Department of Neurosurgery in Huashan Hospital, the largest neurosurgery center in Asia and the Pacific, between 1st January and 31st December, 2008 were selected. Individuals with only shunts, burr holes, stereotactic surgery, transsphenoidal or spinal surgery were excluded. The complete medical records of each case were reviewed, and data on risk factors were extracted and evaluated for meningitis. A total of 65 meningitides were identified among 755 cases in the study, with an incidence of 8.60%. The risk of meningitis was increased by the presence of diabetes mellitus (odds ratio [OR], 6.27; P = 0.009), the use of external ventricular drainage (OR, 4.30; P = 0.003) and the use of lumbar drainage (OR, 17.23; PMeningitis remains an important source of morbidity and mortality after major craniotomy. Diabetic patients or those with cerebral spinal fluid shunts carry significant high risk of infection. Thus, identification of the risk factors as soon as possible will help physicians to improve patient care.

  20. Incidence and risk factors for backpack palsy in young Korean soldiers.

    Science.gov (United States)

    Kim, Kyoung-Eun; Kim, E-J

    2016-02-01

    Backpack palsy (BPP) is a common aetiology of brachial plexopathy in military hospitals. We aimed to determine the incidence and risk factors of BPP in young Korean soldiers. We identified enlisted patients who were diagnosed with BPP from a review of the medical records of all the Korean military hospitals in 2011 and 2012 and investigated their clinical findings and medical study results. To identify risk factors of BPP, we also surveyed, by questionnaire, healthy recruits of a company in a training centre who had just finished night marches. We divided them according to whether they had paresthaesia and/or weakness in their arm(s) during marching and compared their characteristics. The incidence of BPP in Korean soldiers was 29.7 per 100,000 person-years (95% CI 17.2 to 24.3). Body mass index (BMI) was significantly lower in patients with BPP than it was in healthy recruits. Among healthy recruits, those who had experienced paresthaesia and/or weakness during marching had a significantly lower BMI than did those who had not. We report the incidence of BPP in young Korean soldiers. A low BMI was a risk factor for BPP. These results may be helpful in establishing a strategy for the prevention of BPP in the setting of military training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Hospital Clostridium difficile infection (CDI) incidence as a risk factor for hospital-associated CDI.

    Science.gov (United States)

    Miller, Aaron C; Polgreen, Linnea A; Cavanaugh, Joseph E; Polgreen, Philip M

    2016-07-01

    Environmental risk factors for Clostridium difficile infections (CDIs) have been described at the room or unit level but not the hospital level. To understand the environmental risk factors for CDI, we investigated the association between institutional- and individual-level CDI. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project state inpatient databases for California (2005-2011). For each patient's hospital stay, we calculated the hospital CDI incidence rate corresponding to the patient's quarter of discharge, while excluding each patient's own CDI status. Adjusting for patient and hospital characteristics, we ran a pooled logistic regression to determine individual CDI risk attributable to the hospital's CDI rate. There were 10,329,988 patients (26,086 cases and 10,303,902 noncases) who were analyzed. We found that a percentage point increase in the CDI incidence rate a patient encountered increased the odds of CDI by a factor of 1.182. As a point of comparison, a 1-percentage point increase in the CDI incidence rate that the patient encountered had roughly the same impact on their odds of acquiring CDI as a 55.8-day increase in their length of stay or a 60-year increase in age. Patients treated in hospitals with a higher CDI rate are more likely to acquire CDI. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  2. Retinopathy of prematurity: Revisiting incidence and risk factors from Oman compared to other countries.

    Science.gov (United States)

    Reyes, Zenaida Soriano; Al-Mulaabed, Sharef Waadallah; Bataclan, Flordeliz; Montemayor, Cheryl; Ganesh, Anuradha; Al-Zuhaibi, Sanaa; Al-Waili, Huda; Al-Wahibi, Fatma

    2017-01-01

    The purpose of this study is to determine the incidence of retinopathy of prematurity (ROP) and the maternal/neonatal risk factors at a tertiary care hospital in Oman, compared to other countries. A retrospective analysis of premature neonates born with gestational age (GA) 24-32 weeks at Sultan Qaboos University Hospital, Oman, from January 2007 to December 2010. Maternal and neonatal in-hospital course was retrieved. The incidence of ROP was reported. Risk factors analyses were performed using univariate and multivariate statistics. A total of 171 neonates (57% males, 43% females) were included for analysis. The incidence of ROP (any stage) was 69/171 (40.4%). Infants with ROP had significantly lower GA (27.7±2 weeks) compared to non-ROP group (30.2±1.7 weeks), P < 0.001),P < 0.001) and significantly lower birth weight (BW) (948 ± 242 g in ROP group vs. 1348 ± 283 g in non-ROP group;P < 0.001). Other significant risk factors associated with ROP were: small for GA, respiratory distress syndrome, requirement for ventilation, duration of ventilation or oxygen therapy, bronchopulmonary dysplasia, hyperglycemia, late onset sepsis (clinical or proven), necrotizing enterocolitis, patent ductus arteriosus, seizures, and number of blood transfusions. There was no significant difference in maternal characteristics between the ROP and non-ROP groups except that mothers of infants with ROP were found to be significantly younger. Logistic regression analysis revealed early GA, low BW, duration of Oxygen therapy, and late-onset clinical or proven sepsis as independent risk factors. ROP is still commonly encountered in neonatal practice in Oman and other countries. Early GA, low BW, and prolonged oxygen therapy continue to be the main risk factors associated with the occurrence of ROP in our setting. In addition, an important preventable risk factor identified in our cohort includes clinical or proven late-onset sepsis.

  3. Prospective study of rape perpetration by young South African men: incidence & risk factors.

    Directory of Open Access Journals (Sweden)

    Rachel Jewkes

    Full Text Available There has been very little prospective research on rape perpetration among men. This paper describes the incidence and risk factors for new rape and attempted rape events among young South African men in an HIV prevention trial.We followed 1,147 men aged 15-26 years who enrolled into a cluster randomised controlled trial to evaluate the HIV prevention behavioural intervention Stepping Stones. Incidence rate ratios for factors associated with incident rape were derived from Poisson models.The young men reported 217 incident rapes (completed or attempted of a girl or woman over 1,914 person years of follow up, yielding a rape incidence of 11.2 per 100 person years. Overall 24.9% of men had previously raped at baseline, and 18.9% did so during the follow up. Among the latter, 61.3% raped for the first time, and 38.7% re-offended. Multivariable Poisson modelling showed a higher incidence of rape perpetration among men who had ever used drugs (IRR 1.86 95%CI 1.39, 2.49, had eight or more lifetime partners (IRR 1.48 95% CI 1.09, 2.01, had been physically violent toward a female partner (IRR 1.50 95%CI 1.11, 2.03 and had disclosed rape perpetration at baseline (IRR 1.45 95%CI 1.07, 1.97. A lower incidence was found among those with greater resistance to peer pressure (IRR 0.85 95%CI 0.74, 0.97.The findings highlight the importance of male gender socialisation and addressing delinquent youth sub-cultures in rape prevention. Prevention requires change in hegemonic masculinity, with its emphasis on gender hierarchy, exaggerated performance of heterosexuality and control of women. Interventions are needed to address male socialisation with delinquent peers, by reducing exposure to childhood trauma and strengthening opportunities for gainful employment (in work or recreation.

  4. Prospective Study of Rape Perpetration by Young South African Men: Incidence & Risk Factors

    Science.gov (United States)

    Jewkes, Rachel; Nduna, Mzikazi; Jama Shai, Nwabisa; Dunkle, Kristin

    2012-01-01

    Background There has been very little prospective research on rape perpetration among men. This paper describes the incidence and risk factors for new rape and attempted rape events among young South African men in an HIV prevention trial. Methods We followed 1,147 men aged 15–26 years who enrolled into a cluster randomised controlled trial to evaluate the HIV prevention behavioural intervention Stepping Stones. Incidence rate ratios for factors associated with incident rape were derived from Poisson models. Results The young men reported 217 incident rapes (completed or attempted) of a girl or woman over 1,914 person years of follow up, yielding a rape incidence of 11.2 per 100 person years. Overall 24.9% of men had previously raped at baseline, and 18.9% did so during the follow up. Among the latter, 61.3% raped for the first time, and 38.7% re-offended. Multivariable Poisson modelling showed a higher incidence of rape perpetration among men who had ever used drugs (IRR 1.86 95%CI 1.39, 2.49), had eight or more lifetime partners (IRR 1.48 95% CI 1.09, 2.01), had been physically violent toward a female partner (IRR 1.50 95%CI 1.11, 2.03) and had disclosed rape perpetration at baseline (IRR 1.45 95%CI 1.07, 1.97). A lower incidence was found among those with greater resistance to peer pressure (IRR 0.85 95%CI 0.74, 0.97). Conclusions The findings highlight the importance of male gender socialisation and addressing delinquent youth sub-cultures in rape prevention. Prevention requires change in hegemonic masculinity, with its emphasis on gender hierarchy, exaggerated performance of heterosexuality and control of women. Interventions are needed to address male socialisation with delinquent peers, by reducing exposure to childhood trauma and strengthening opportunities for gainful employment (in work or recreation). PMID:22675449

  5. Incident factors in facility location: An application in the Colombian biofuel sector

    Directory of Open Access Journals (Sweden)

    Alexandra Eugenia Duarte

    2013-09-01

    Full Text Available Facility location concerns high impact strategic decision-making in supply chain design. One of the most important issues regarding such decision is a suitable selection of incident factors due to their effects on costs and customer service level. This paper was thus aimed at presenting a methodology for defining and hierarchising a group of factors which affect decision-making concerning facility location. The methodology was based on expert methods, incorporating a goal programming application extended to support weighting. Colombian biofuels sector results are presented.

  6. Incidence and factors associated with infective endocarditis in patients undergoing left-sided heart valve replacement

    DEFF Research Database (Denmark)

    Østergaard, Lauge; Valeur, Nana; Ihlemann, Nikolaj

    2018-01-01

    Aims: Patients with left-sided heart valve replacement are considered at high-risk of infective endocarditis (IE). However, data on the incidence and risk factors associated with IE are sparse. Methods and results: Through Danish administrative registries, we identified patients who underwent left.......35-2.15), and cardiac implantable electronic device (CIED) (HR = 1.57, 95% CI 1.19-2.06) were among factors associated with an increased risk of IE. Conclusion: Infective endocarditis after left-sided heart valve replacement is not uncommon and occurs in about 1/20 over 10 years. Male, bioprosthetic valve, and heart...

  7. Vitamin K deficiency bleeding presenting as nodular purpura in infancy: A rare and life-threatening entity

    Directory of Open Access Journals (Sweden)

    Pratik Gahalaut

    2013-01-01

    Full Text Available Vitamin K deficiency bleeding (VKDB disorder is an uncommon entity, which occurs due to inadequate activity of vitamin K-dependant coagulation factors. An 8-months-old exclusively breast-fed male infant presented with multiple, purpuric and nodular non-collapsible swellings on trunk of 4 days duration. Investigations revealed raised activated partial thromboplastin time and prothrombintime. Fibrinogen level and platelet counts were normal. Late VKDB usually presents as intra-cranial or mucosal hemorrhages. [1] Though skin and mucosal bleeding may occur in 1/3 rd of infants with VKDB, ′nodular purpura′ is not the common presenting feature. Earlier recognition of VKDB and immediate investigation/treatment helps prevent the potentially fatal outcome of the disease. Very little is mentioned about this entity in dermatology literature.

  8. Incidence and risk factors of infections complications related to implantable venous-access ports

    International Nuclear Information System (INIS)

    Shim, Ji Sue; Seo, Tae Seok; Song, Myung Gyu; Cha, In Ho; Kim, Jun Suk; Choi, Chul Won; Seo, Jae Hong; Oh, Sang Cheul

    2014-01-01

    The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs.) From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

  9. Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review.

    Science.gov (United States)

    Gane, E M; Michaleff, Z A; Cottrell, M A; McPhail, S M; Hatton, A L; Panizza, B J; O'Leary, S P

    2017-07-01

    Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications. Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form - Quantitative Studies. Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10-100%) compared with MRND (range, 0-100%) and SND (range, 9-25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5-20%). The prevalence of reduced neck active range of motion after neck dissection was 1-13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life. The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  10. Incidence and risk factors of infections complications related to implantable venous-access ports

    Energy Technology Data Exchange (ETDEWEB)

    Shim, Ji Sue; Seo, Tae Seok; Song, Myung Gyu; Cha, In Ho; Kim, Jun Suk; Choi, Chul Won; Seo, Jae Hong; Oh, Sang Cheul [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2014-08-15

    The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs.) From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

  11. Incidence and risk factors for retinopathy of prematurity in a Brazilian reference service.

    Science.gov (United States)

    Gonçalves, Eduardo; Násser, Luciano Sólia; Martelli, Daniella Reis; Alkmim, Isadora Ramos; Mourão, Thalita Veloso; Caldeira, Antônio Prates; Martelli, Hercílio

    2014-01-01

    Retinopathy of prematurity (ROP) is a known cause of blindness in which diagnosis and timely treatment can prevent serious harm to the child. This study aimed to evaluate the incidence of ROP and its association with known risk factors. Longitudinal incidence study in the neonatal intensive care unit (NICU) of Universidade Estadual de Montes Claros. Newborns admitted to the NICU with gestational age less than 32 weeks and/or birth weight less than 1,500 grams, were followed up over a two-year period. The assessment and diagnosis of ROP were defined in accordance with a national protocol. The chi-square test or Fisher's exact test were used to determine associations between independent variables and ROP. Analysis on the independent effect of the variables on the results was performed using multiple logistic regression. The incidence of ROP was 44.5% (95% confidence interval, CI = 35.6-46.1) in the study population. The risk factors associated with the risk of developing the disease were: birth weight less than 1,000 grams (odds ratio, OR = 4.14; 95% CI = 1.34-12.77); gestational age less than 30 weeks (OR = 6.69; 95% CI = 2.10-21.31); use of blood derivatives (OR = 4.14; 95% CI = 2.99-8.99); and presence of sepsis (OR = 1.99; 95% CI = 1.45-2.40). The incidence of ROP was higher than that found in the literature. The main risk factors were related to extreme prematurity.

  12. Bowel Angioedema Associated With Iodinated Contrast Media: Incidence and Predisposing Factors.

    Science.gov (United States)

    Seo, Nieun; Chung, Yong Eun; Lim, Joon Seok; Song, Mi Kyung; Kim, Myeong-Jin; Kim, Ki Whang

    2017-09-01

    Bowel angioedema is an acute adverse reaction to iodinated contrast media (CM) that involves the gastrointestinal tract. We aimed to investigate the incidence and predisposing factors of iodinated CM-associated bowel angioedema during computed tomography (CT) examinations. This study was approved by our institutional review board, and informed consent was waived due to its retrospective design. From July 2013 to July 2015, adult patients with a history of adverse reactions to iodinated CM during CT (group A, n = 427) and patients without adverse reactions matched for age and sex with the propensity-score matching method (group B, n = 427) were studied. Contrast media-associated bowel angioedema was determined when bowel wall thickness increased after contrast enhancement compared with the precontrast scan. Potential predisposing factors including patient demographics, symptoms and time of adverse reactions, and CM-related factors were compared between patients with and without angioedema in group A. In addition, the incidence of bowel angioedema was compared between groups A and B. The incidence of CM-associated bowel angioedema in group A was 3.3% (14/427) in the per-patient analysis and 2.6% (15/578) in the per-examination analysis. The CM-associated bowel angioedema involved the distal duodenum and/or proximal jejunum and showed long-segmental circumferential bowel wall thickening on CT. None of the studied predisposing factors was different between patients with and without bowel angioedema (P > 0.05). The incidence of CM-associated bowel angioedema in group B was 1.9% (8/427) and 1.7% (8/458) for per-patient and per-examination analyses, respectively, and these rates were not significantly different between groups A and B (P = 0.346 and P = 0.370, respectively). The incidence of CM-associated bowel angioedema during CT was 1.7% to 3.3%, and none of the studied predisposing factors was associated with bowel angioedema.

  13. Incidence and risk factors of ventilator associated pneumonia in a tertiary care hospital.

    Science.gov (United States)

    Charles, Mv Pravin; Easow, Joshy M; Joseph, Noyal M; Ravishankar, M; Kumar, Shailesh; Umadevi, Sivaraman

    2013-01-01

    Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia associated with increased morbidity and mortality. Knowledge about the incidence and risk factors is necessary to implement preventive measures to reduce mortality in these patients. A prospective study was conducted at a tertiary care teaching hospital for a period of 20 months from November 2009 to July 2011. Patients who were on mechanical ventilation (MV) for more than 48 hours were monitored at frequent intervals for development of VAP using clinical and microbiological criteria until discharge or death. Of the 76 patients, 18 (23.7%) developed VAP during their ICU stay. The incidence of VAP was 53.25 per 1,000 ventilator days. About 94% of VAP cases occurred within the first week of MV. Early-onset and late-onset VAP was observed in 72.2% and 27.8%, respectively. Univariate analysis showed chronic lung failure, H2 blockers usage, and supine head position were significant risk factors for VAP. Logistic regression revealed supine head position as an independent risk factor for VAP. VAP occurred in a sizeable number of patients on MV. Chronic lung failure, H2 blockers usage, and supine head position were the risk factors associated with VAP. Awareness about these risk factors can be used to inform simple and effective preventive measures.

  14. Radiation factors and smoking interaction at lung cancer incidence for workers at a nuclear enterprise

    International Nuclear Information System (INIS)

    Tokarskaya, Z.B.; Khokhryakov, V.T.; Okladnikova, N.D.; Belyaeva, Z.D.; Zhuntova, G.V.; Fleck, C.M.; Schollnberger, H.; Drozhko, E.G.

    1998-01-01

    A study is reported which is a continuation of a previous investigation of lung cancer incidence in workers at a nuclear enterprise and its relation to three basic etiological factors: the body burden due to 239 Pu, chronic external gamma irradiation, and smoking. Whereas previously each of the factors was assessed separately, in the present study the attempt was made to assess the interaction of the factors. A statistical analysis of the data revealed that for the following pairs of factors a superposition effect could be seen: external gamma irradiation and 239 Pu body burden; external gamma irradiation and a medium level of smoking; and 239 Pu body burden and a medium level of smoking. (A.K.)

  15. Prevalence, incidence and risk factors of carpal tunnel syndrome in a large footwear factory.

    Science.gov (United States)

    Roquelaure, Y; Mariel, J; Dano, C; Fanello, S; Penneau-Fontbonne, D

    2001-01-01

    The study was conducted to assess the prevalence and incidence of carpal tunnel syndrome (CTS) in a large modern footwear factory and to identify factors predictive of CTS. To this end, 199 workers were examined in 1996, and 162 of them were re-examined in 1997. Ergonomic and psychosocial risk factors of CTS were assessed by workpost analysis and self-administered questionnaire. The prevalence of CTS at baseline in 1996 and in 1997 was 16.6% (95%CI: 11.4-21.7) and 11.7% (95%CI: 6.7-16.8), respectively. The incidence rate of CTS in 1997 was 11.7% (95%CI: 6.7-7.8). No specific type of job performance was associated with CTS. Obesity (OR = 4.4; 95%CI: 1.1-17.1) and psychological distress at baseline (OR = 4.3; 95%CI: 1.0-18.6) were strongly predictive of CTS. Rapid trigger movements of the fingers were also predictive of CTS (OR = 3.8; 95%CI: 1.0-17.2). A strict control of thework by superiors was negatively associatedwith CTS (OR = 0.5; 95%CI: 0.2-1.3). The prevalence and incidence of CTS in this workforce were largely higher than in the general population and numerous industries. The study highlights the role of psychological distress in workers exposed to a high level of physical exposure and psychological demand.

  16. The incidence of and risk factors for emergence delirium in U.S. military combat veterans.

    Science.gov (United States)

    McGuire, Jason M

    2012-08-01

    The purpose of this research was to identify the incidence and potential risk factors for emergence delirium (ED) in a U.S. military combat veteran surgical population at Naval Hospital Camp Pendleton. ED is a postanesthetic phenomenon that occurs immediately after emergence from general anesthesia and is characterized by agitation, confusion, and violent behavior. Clinical evidence suggests that ED is increasingly seen among military personnel returning from the wars in Iraq and Afghanistan, and that the incidence of anxiety, depression, and post-traumatic stress disorder (PTSD) are higher in this population than in noncombat troops or nonmilitary populations. The incidence of ED in this sample of 130 postoperative military personnel with combat exposure was 20% (n=26). Those previously diagnosed with a psychological disorder had a higher rate of ED (50%) than those who did not (17.5%), χ(2)=5.53, PPTSD symptoms, and depression [state anxiety: r(128)=0.40, PPTSD: r(128)=0.35, PPTSD, and depression as risk factors. Regression modeling suggested that state-anxiety served as the best predictor. These findings increase clinicians' understanding of ED among combat veterans and give direction to future studies that should focus on preventive treatment. Published by Elsevier Inc.

  17. Late Toxicities after Conventional Radiotherapy for Nasopharyngeal Carcinoma: Incidence and Risk Factors

    International Nuclear Information System (INIS)

    Siala, W.; Mnejja, W.; Elloumi, F.; Daoud, J.; Ghorbel, A.; Mnif, J.; Frikha, M.

    2014-01-01

    Background. To determine the incidence and analyze the factors affecting late toxicity for nasopharyngeal carcinoma patients treated with conventional radiotherapy. Patients and Methods. Retrospective analysis was performed on 239 NPC patients treated between 1993 and 2004 in our institution. One hundred and fifty-seven patients were treated with conventional fractionation (2 Gy per fraction, 5 fractions per week) and eighty-two patients with hyperfractionated radiotherapy (1.6 Gy per fraction twice a day, 5 days per week). One hundred fifty nine patients underwent neoadjuvant cisplatin based chemotherapy. Late toxicity was evaluated according to the RTOG/EORTC score. Results. Xerostomia was the most common related complication (98.7%). Neoadjuvant chemotherapy and hyperfractionated radiotherapy did not increase late toxicities. Multivariate analyses showed that radiation dose was a significant factor for hearing impairment, younger age for trismus, initial node status for neck fibrosis, and initial dental hygiene for dental complications. Female gender was associated with significantly higher incidence of trismus and hearing impairment. Conclusion. Conventional radiotherapy was associated with a high rate of late toxicities which affect patients’ quality of life. With the development of three-dimensional conformal radiotherapy and intensity modulated radiotherapy, a reduced incidence of radiation related complications could be expected.

  18. Incidence and risk factors for delirium development in ICU patients - a prospective observational study.

    Science.gov (United States)

    Kanova, Marcela; Sklienka, Peter; Roman, Kula; Burda, Michal; Janoutova, Jana

    2017-06-01

    Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

  19. Perceived job insecurity as a risk factor for incident coronary heart disease

    DEFF Research Database (Denmark)

    Virtanen, Marianna; Nyberg, Solja T; Batty, George David

    2013-01-01

    OBJECTIVE: To determine the association between self reported job insecurity and incident coronary heart disease. DESIGN: A meta-analysis combining individual level data from a collaborative consortium and published studies identified by a systematic review. DATA SOURCES: We obtained individual....... REVIEW METHODS: Prospective cohort studies that reported risk estimates for clinically verified incident coronary heart disease by the level of self reported job insecurity. Two independent reviewers extracted published data. Summary estimates of association were obtained using random effects models...... versus low job insecurity was 1.32 (95% confidence interval 1.09 to 1.59). The relative risk of job insecurity adjusted for sociodemographic and risk factors was 1.19 (1.00 to 1.42). There was no evidence of significant differences in this association by sex, age (

  20. Influence of radiation and non-radiation factors on pancreatic cancer incidence among Mayak PA workers

    Energy Technology Data Exchange (ETDEWEB)

    Zhuntova, G.V.; Tokarskaya, Z.B.; Belyaeva, Z.D. [Southern Ural Biophysics Institute (SUBI), Ozyorsk (Russian Federation); Syrchikov, V.A.; Grigoryeva, E.S. [Mayak Production Association (Mayak PA), Ozyorsk (Russian Federation)

    2006-07-01

    The finding of this nested case-control study suggests that high levels of 239 Pu incorporation (239 Pu body burden > 3.7), alcohol abuse and smoking were associated with increasing the risk of pancreatic cancer among Mayak PA workers chronically exposed to ionizing radiation. The contribution of non radiation factors (alcohol abuse and smoking) to pancreatic tumor incidence is greater (AR=51%) than 239 Pu incorporation kBq; AR = 7%). No significant effect of external gamma rays ({<=} 6.8 Gy), prior exposure to chemical agents, or chronic digestive diseases was found on the incidence of pancreatic tumor. Evaluation of the absorbed alpha-radiation pancreatic dose will permit to make more exact the 239 Pu risk estimation in the further extended study.

  1. Incidence and risk factors for hypogammaglobulinemia in pediatric patients following allo-SCT.

    Science.gov (United States)

    Frangoul, H; Min, E; Wang, W; Chandrasekhar, R; Calder, C; Evans, M; Manes, B; Bruce, K; Brown, V; Ho, R; Domm, J

    2013-11-01

    We evaluated the incidence and risk factors for hypogammaglobulinemia after allogeneic hematopoietic SCT (HSCT) in pediatric patients. Ig levels were measured pre-transplant, every 2 weeks until day 100 and then monthly post SCT in 185 patients undergoing myeloablative HSCT. Median age was 9 years; 142 (77%) had malignant disease and 114 (62%) received stem cells from an unrelated source. Hypogammaglobulinemia (IgG SCT. The cumulative incidence of hypogammaglobulinemia at 1 year was higher among patients who developed acute GVHD (97% vs 54%, PSCT (P<0.001) and development of acute GVHD (P<0.001) were all significantly associated with higher risk of hypogammaglobulinemia post HSCT. We conclude that hypogammaglobulinemia is common, following allogeneic HSCT in pediatric patients, especially in those with malignant diseases, those who receive an unrelated transplant or patients who develop GVHD.

  2. Influence of radiation and non-radiation factors on pancreatic cancer incidence among Mayak PA workers

    International Nuclear Information System (INIS)

    Zhuntova, G.V.; Tokarskaya, Z.B.; Belyaeva, Z.D.; Syrchikov, V.A.; Grigoryeva, E.S.

    2006-01-01

    The finding of this nested case-control study suggests that high levels of 239 Pu incorporation (239 Pu body burden > 3.7), alcohol abuse and smoking were associated with increasing the risk of pancreatic cancer among Mayak PA workers chronically exposed to ionizing radiation. The contribution of non radiation factors (alcohol abuse and smoking) to pancreatic tumor incidence is greater (AR=51%) than 239 Pu incorporation kBq; AR = 7%). No significant effect of external gamma rays (≤ 6.8 Gy), prior exposure to chemical agents, or chronic digestive diseases was found on the incidence of pancreatic tumor. Evaluation of the absorbed alpha-radiation pancreatic dose will permit to make more exact the 239 Pu risk estimation in the further extended study

  3. Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database.

    Science.gov (United States)

    Sammy, Ian Ayenga; Chatha, Hridesh; Lecky, Fiona; Bouamra, Omar; Fragoso-Iñiguez, Marisol; Sattout, Abdo; Hickey, Michael; Edwards, John E

    2017-04-01

    First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted. Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research Network. The prevalence of life-threatening injuries was compared in patients with first rib fractures and those with other rib fractures. Multivariate logistic regression was performed to determine the association between first rib fractures, injury severity, polytrauma and mortality. There were 1683 patients with first rib fractures and 8369 with fractures of other ribs. Life-threatening intrathoracic and extrathoracic injuries were more likely in patients with first rib fractures. The presence of first rib fractures was a significant predictor of injury severity (Injury Severity Score >15) and polytrauma, independent of mechanism of injury, age and gender with an adjusted OR of 2.64 (95% CI 2.33 to 3.00) and 2.01 (95% CI 1.80 to 2.25), respectively. Risk-adjusted mortality was the same in patients with first rib fractures and those with other rib fractures (adjusted OR 0.97, 95% CI 0.79 to 1.19). First rib fractures are a marker of life-threatening injuries in major trauma, though they do not independently increase mortality. Management of patients with first rib fractures should focus on identification and treatment of associated life-threatening injuries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) [year]. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Incidence and Risk Factors for Prolonged Hospitalization and Readmission after Transsphenoidal Pituitary Surgery.

    Science.gov (United States)

    Bur, Andrés M; Brant, Jason A; Newman, Jason G; Hatten, Kyle M; Cannady, Steven B; Fischer, John P; Lee, John Y K; Adappa, Nithin D

    2016-10-01

    To evaluate the incidence and factors associated with 30-day readmission and to analyze risk factors for prolonged hospital length of stay following transsphenoidal pituitary surgery. Retrospective longitudinal claims analysis. American College of Surgeons National Surgical Quality Improvement Program. The database of the American College of Surgeons National Surgical Quality Improvement Program was queried for patients who underwent transsphenoidal pituitary surgery (Current Procedural Terminology code 61548 or 62165) between 2005 and 2014. Patient demographic information, indications for surgery, and incidence of hospital readmission and length of stay were reviewed. Risk factors for readmission and prolonged length of stay, defined as >75th percentile for the cohort, were identified through logistic regression modeling. A total of 1006 patients were included for analysis. Mean hospital length of stay after surgery was 4.1 ± 0.2 days. Predictors of prolonged length of stay were operative time (P surgery between 2012 and 2014, 7.2% (n = 38) required hospital readmission. History of congestive heart failure (CHF) was a predictor of hospital readmission (P = 0.03, OR = 12.7, 95% CI = 1.1-144.0). This review of a large validated surgical database demonstrates that CHF is an independent predictor of hospital readmission after transsphenoidal surgery. Although CHF is a known risk factor for postoperative complications, it poses unique challenges to patients with potential postoperative pituitary dysfunction. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  5. Factors affecting incidence of dry socket: a prospective community-based study.

    Science.gov (United States)

    Parthasarathi, Krishnan; Smith, Andrew; Chandu, Arun

    2011-07-01

    Dry socket, or alveolar osteitis, can occur because of the removal of teeth. No clear etiology has been acknowledged; however, numerous risk factors have been proposed and tested. We report on the results of a prospective, multicenter study of the incidence and factors affecting the occurrence of alveolar osteitis at the Royal Dental Hospital of Melbourne and Community Dental Clinics in Melbourne, Australia. Ethics approval was gained from the University of Melbourne and Dental Health Services Victoria. The data were analyzed in a descriptive fashion, and the factors affecting alveolar osteitis were assessed using logistic regression analysis. The incidence of alveolar osteitis was 2.3% of all teeth extracted, with 4.2% of all patients experiencing alveolar osteitis in a public dental setting. Multivariate analysis revealed operator experience, perioperative crown and root fractures, periodontal disease, posterior teeth, and, interestingly, the use of mental health medications to be significant independent risk factors for the development of alveolar osteitis. No alveolar osteitis was reported in patients taking antibiotics, the oral contraceptive pill, bisphosphonates, or oral steroid drugs. Smoking and extraction technique (either operative or nonoperative) were also not found to significantly affect the development of alveolar osteitis. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Investigation of incidence and risk factors for surgical glove perforation in small animal surgery.

    Science.gov (United States)

    Hayes, Galina M; Reynolds, Deborah; Moens, Noel M M; Singh, Ameet; Oblak, Michelle; Gibson, Thomas W G; Brisson, Brigitte A; Nazarali, Alim; Dewey, Cate

    2014-05-01

    To identify incidence and risk factors for surgical glove perforation in small animal surgery. Observational cohort study. Surgical gloves (n = 2132) worn in 363 surgical procedures. All gloves worn by operative personnel were assessed for perforation at end-procedure using a water leak test. Putative risk factors were recorded by a surgical team member. Associations between risk factors and perforation were assessed using multivariable multi-level random-effects logistic regression models to control for hierarchical data structure. At least 1 glove perforation occurred in 26.2% of procedures. Identified risk factors for glove perforation included increased surgical duration (surgery >1 hour OR = 1.79, 95% CI = 1.12-2.86), performing orthopedic procedures (OR = 1.88; 95% CI = 1.23-2.88), any procedure using powered instruments (OR = 1.93; 95% CI = 1.21-3.09) or surgical wire (OR = 3.02; 95% CI = 1.50-6.05), use of polyisoprene as a glove material (OR = 1.59, 95% CI = 1.05-2.39), and operative role as primary surgeon (OR = 2.01; 95% CI = 1.35-2.98). The ability of the wearer to detect perforations intraoperatively was poor, with a sensitivity of 30.8%. There is a high incidence of unrecognized glove perforations in small animal surgery. © Copyright 2014 by The American College of Veterinary Surgeons.

  7. Incidence of dental caries in primary dentition and risk factors: a longitudinal study.

    Science.gov (United States)

    Corrêa-Faria, Patrícia; Paixão-Gonçalves, Suzane; Paiva, Saul Martins; Pordeus, Isabela Almeida

    2016-05-20

    The objectives of this prospective, longitudinal, population-based study were to estimate the incidence of dental caries in the primary dentition, identify risk factors and determine the proportion of children receiving dental treatment, through a two-year follow up. The first dental exam was conducted with 381 children aged one to five years, at health centers during immunization campaigns; 184 of them had dental caries and 197 had no caries experience. The second exam was carried out two years later at a nursery or at home with the same individuals who participated in the first exam. The diagnosis of dental caries was performed using the dmft criteria. Parents were interviewed regarding socioeconomic indicators. Descriptive, bivariate and adjusted Poisson regression analyses were performed. Among the 381 children, 234 were reexamined after two years (non-exposed: 139; exposed: 95). The overall incidence of dental caries was 46.6%. The greatest incidence of dental caries was found in the group of children with previous caries experience (61.1%). Among the children without dental caries in the first exam, 36.7% exhibited caries in the second exam. The majority of children (72.6%) received no treatment for carious lesions in the two-year interval between examinations. Children with previous dental caries (RR: 1.52, 95%CI: 1.12-2.05) had a greater risk of developing new lesions, compared with the children without previous dental caries. The incidence of dental caries was high and most of children's caries were untreated. Previous caries experience is a risk factor for developing new carious lesions in children.

  8. Cholestasis in neonates with red cell alloimmune hemolytic disease: incidence, risk factors and outcome.

    Science.gov (United States)

    Smits-Wintjens, Vivianne E H J; Rath, Mirjam E A; Lindenburg, Irene T M; Oepkes, Dick; van Zwet, Erik W; Walther, Frans J; Lopriore, Enrico

    2012-01-01

    Etiology of cholestatic liver disease in neonates with hemolytic disease of the newborn (HDN) has been associated with iron overload due to intrauterine red cell transfusions (IUTs). Data on the incidence and severity of cholestasis in neonates with HDN are scarce, and little is known about pathogenesis, risk factors, neonatal management and outcome. To evaluate incidence, risk factors, management and outcome of cholestasis in neonates with red cell alloimmune hemolytic disease. All (near-) term neonates with HDN due to red cell alloimmunization admitted to our center between January 2000 and July 2010 were included in this observational study. Liver function tests (including conjugated bilirubin) were routinely performed in the neonatal period. We recorded the presence of cholestasis, investigated several potential risk factors and evaluated the management and outcome in affected neonates. A total of 313 infants with red cell alloimmune hemolytic disease treated with or without IUTs were included. The incidence of cholestasis was 13% (41/313). Two risk factors were independently associated with cholestasis: treatment with at least one IUT (OR 5.81, 95% CI 1.70-19.80, p = 0.005) and rhesus D type of alloimmunization (OR 4.66, 95% CI 1.05-20.57, p = 0.042). Additional diagnostic tests to investigate possible causes of cholestasis were all negative. In 5 infants (12%), supportive medical and nutritional therapy was started, and one neonate required iron chelation therapy. Cholestasis occurs in 13% of neonates with HDN due to red cell alloimmunization, and it is independently associated with IUT treatment and rhesus D type of alloimmunization. Copyright © 2012 S. Karger AG, Basel.

  9. Risk factors for incident HIV infection among antenatal mothers in rural Eastern Cape, South Africa

    Directory of Open Access Journals (Sweden)

    Charles Bitamazire Businge

    2016-01-01

    Full Text Available Background: The prevalence of HIV among antenatal clients in South Africa has remained at a very high rate of about 29% despite substantial decline in several sub-Saharan countries. There is a paucity of data on risk factors for incident HIV infection among antenatal mothers and women within the reproductive age bracket in local settings in the Eastern Cape, South Africa. Objective: To establish the risk factors for incident HIV infection among antenatal clients aged 18–49 years attending public antenatal clinics in rural Eastern Cape, South Africa. Design: This was an unmatched case–control study carried out in public health antenatal clinics of King Sabata District Municipality between January and March 2014. The cases comprised 100 clients with recent HIV infection; the controls were 200 HIV-negative antenatal clients. Socio-demographic, sexual, and behavioral data were collected using interviewer-administered questionnaires adapted from the standard DHS5 women's questionnaire. Multivariate logistic regression models were used to identify the independent risk factors for HIV infection. A p<0.05 was considered statistically significant. Results: The independent risk factors for incident HIV infection were economic dependence on the partner, having older male partners especially among women aged ≤20 years, and sex under the influence of alcohol. Conclusions: Therefore, effective prevention of HIV among antenatal mothers in KSDM must target the improvement of the economic status of women, thereby reducing economic dependence on their sexual partners; address the prevalent phenomenon of cross-generation sex among women aged <20 years; and regulate the brewing, marketing, and consumption of alcohol.

  10. Incidence, risk factors and mortality of tuberculosis in Danish HIV patients 1995-2007

    Directory of Open Access Journals (Sweden)

    Andersen Aase B

    2011-05-01

    Full Text Available Abstract Background Human Immunodeficiency Virus (HIV infection predisposes to tuberculosis (TB. We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996, early (1997-1999, and late Highly Active Antiretroviral Therapy (HAART (2000-2007 periods. Methods We included patients from a population-based, multicenter, nationwide cohort. We calculated incidence rates (IRs and mortality rates (MRs. Cox's regression analysis was used to estimate risk factors for TB infection with HAART initiation included as time updated variable. Kaplan-Meier was used to estimate mortality after TB. Results Among 2,668 patients identified, 120 patients developed TB during the follow-up period. The overall IR was 8.2 cases of TB/1,000 person-years of follow-up (PYR. IRs decreased during the pre-, early and late-HAART periods (37.1/1000 PYR, 12.9/1000 PYR and 6.5/1000 PYR respectively. African and Asian origin, low CD4 cell count and heterosexual and injection drug user route of HIV transmission were risk factors for TB and start of HAART reduced the risk substantially. The overall MR in TB patients was 34.4 deaths per 1,000 PYR (95% Confidence Interval: 22.0-54.0 and was highest in the first two years after the diagnosis of TB. Conclusions Incidence of TB still associated with conventional risk factors as country of birth, low CD4 count and route of HIV infection while HAART reduces the risk substantially. The mortality in this patient population is high in the first two years after TB diagnosis.

  11. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study.

    Science.gov (United States)

    Koorevaar, Rinco C T; Van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K

    2017-03-01

    Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder after shoulder surgery are not known. The purpose of this explorative study was to determine the incidence of postoperative frozen shoulder after various operative shoulder procedures. A second aim was to identify prognostic factors for postoperative frozen shoulder after shoulder surgery. 505 consecutive patients undergoing elective shoulder surgery were included in this prospective cohort study. Follow-up was 6 months after surgery. A prediction model was developed to identify prognostic factors for postoperative frozen shoulder after shoulder surgery using the TRIPOD guidelines. We nominated five potential predictors: gender, diabetes mellitus, type of physiotherapy, arthroscopic surgery and DASH score. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%). Frozen shoulder was encountered after all types of operative procedures. A prediction model based on four variables (diabetes mellitus, specialized shoulder physiotherapy, arthroscopic surgery and DASH score) discriminated reasonably well with an AUC of 0.712. Postoperative frozen shoulder is a serious complication after shoulder surgery, with an incidence of 11%. Four prognostic factors were identified for postoperative frozen shoulder: diabetes mellitus, arthroscopic surgery, specialized shoulder physiotherapy and DASH score. The combination of these four variables provided a prediction rule for postoperative frozen shoulder with reasonable fit. Level II, prospective cohort study.

  12. Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Paul, Matthias; Acil, Tayfun; Breithardt, Guenter; Wichter, Thomas [Hospital of the University of Muenster, Department of Cardiology and Angiology, Muenster (Germany); Schaefers, Michael; Kies, Peter; Schaefers, Klaus; Schober, Otmar [Hospital of the University of Muenster, Department of Nuclear Medicine, Muenster (Germany)

    2006-08-15

    Idiopathic ventricular fibrillation (IVF) is defined as VF in the absence of any identifiable structural or functional cardiac disease. The underlying pathophysiological mechanisms are unknown. This study was performed to investigate the potential impact of sympathetic dysfunction, assessed by {sup 123}I-meta-iodo-benzylguanidine scintigraphy ({sup 123}I-MIBG SPECT), on the long-term prognosis of patients with IVF. {sup 123}I-MIBG SPECT was performed in 20 patients (mean age 37{+-}13 years) with IVF. Mean follow-up of patients after study entry was 7.2{+-}1.5 years (range 4.9-10.5 years). Ten patients (five men, five women; mean age 43{+-}12 years; p=NS versus study group) with medullary carcinoma of the thyroid gland served as an age-matched control group. Abnormal {sup 123}I-MIBG uptake was observed in 13 patients (65%). During follow-up, 18 episodes of VF/fast polymorphic ventricular tachycardias occurred in four IVF patients with abnormal {sup 123}I-MIBG uptake whereas only two episodes of monomorphic ventricular tachycardia (and no VF) occurred in a single IVF patient with normal {sup 123}I-MIBG uptake. Impairment of sympathetic innervation may indicate a higher risk of future recurrent episodes of life-threatening ventricular tachyarrhythmias in patients with IVF. Studies in larger cohorts are required to validate the significance of {sup 123}I-MIBG SPECT during the long-term follow-up of these patients. (orig.)

  13. Thoracic hyperextension injury with complete “bony disruption” of the thoracic cage: Case report of a potentially life-threatening injury

    Directory of Open Access Journals (Sweden)

    Bailey James

    2012-05-01

    Full Text Available Abstract Background Severe chest wall injuries are potentially life-threatening injuries which require a standardized multidisciplinary management strategy for prevention of posttraumatic complications and adverse outcome. Case presentation We report the successful management of a 55-year old man who sustained a complete “bony disruption” of the thoracic cage secondary to an “all-terrain vehicle” roll-over accident. The injury pattern consisted of a bilateral “flail chest” with serial segmental rib fractures, bilateral hemo-pneumothoraces and pulmonary contusions, bilateral midshaft clavicle fractures, a displaced transverse sternum fracture with significant diastasis, and an unstable T9 hyperextension injury. After initial life-saving procedures, the chest wall injuries were sequentially stabilized by surgical fixation of bilateral clavicle fractures, locked plating of the displaced sternal fracture, and a two-level anterior spine fixation of the T9 hyperextension injury. The patient had an excellent radiological and physiological outcome at 6 months post injury. Conclusion Severe chest wall trauma with a complete “bony disruption” of the thoracic cage represents a rare, but detrimental injury pattern. Multidisciplinary management with a staged timing for addressing each of the critical injuries, represents the ideal approach for an excellent long-term outcome.

  14. Neonatal screening for life-threatening conditions persistent – pulmonary hypertension in newborns and critical congenital heart disease – by the method of pulse oximetry

    Directory of Open Access Journals (Sweden)

    D. I. Sadykova

    2017-01-01

    Full Text Available Research objective: to assess the diagnostic significance of the pulse oximetry performed by the newborn for the 3rd hour of life to identify critical conditions and to justify the expediency of further introduction of this technology in the work of obstetric institutions.Results. In 5 maternity hospitals of the Republic of Tatarstan, from April 2016 to February 2017, 8358 88.4% of newborns were pulsometrically screened. Positive results were obtained in 95 (1.14% patients. Because of screening, 13 newborns were diagnosed with congenital heart defects, not diagnosed in utero, in the first hours of life, five of them were critical. All newborns with critical congenital heart defects were successfully operated. Besides, 20 patients had persistent pulmonary hypertension, 30 had intrauterine pneumonia.Conclusions. The measurement of saturation at the 3rd hour of life of a newborn allows avoiding life-threatening complications in children with critical congenital heart defects and persistent pulmonary hypertension and in a stable state to transfer them to a further treatment stage.

  15. Impact, meaning and need for help and support: The experience of parents caring for children with disabilities, life-limiting/life-threatening illness or technology dependence.

    Science.gov (United States)

    Whiting, Mark

    2013-03-01

    Parenting a child with complex needs or disabilities is a challenging proposition. This study, which drew upon of the experiences of the parents of 34 children (in 33 families), set out to explore the themes of impact, need for help and support and meaning/sense-making as they were related by parents. Data were collected using semi-structured interviews, and an emerging theoretical framework was validated through the use of a series of mind-maps(®) which were presented to individual parents as the basis for a second round (verificational) interview. Parents were nominated into the study by health care professions who were asked to identify the subject children to one of three separate sub-groups: children with a disability; children with a life-limiting/life-threatening illness or children with a technology dependence. Comparisons were made between the three study sub-groups in order to identify areas of consistency and of inconsistency. A fourth study theme - 'battleground' emerged from entirely within the data set. Sense-making occupied a central position within the overall theoretical framework for the study and parental perception of 'battleground' presented as significant element of parental sense-making, particularly in the context of their relationships with professional staff. © The Author(s) 2012.

  16. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.

    Science.gov (United States)

    Griffiths, Roland R; Johnson, Matthew W; Carducci, Michael A; Umbricht, Annie; Richards, William A; Richards, Brian D; Cosimano, Mary P; Klinedinst, Margaret A

    2016-12-01

    Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes. ClinicalTrials.gov identifier: NCT00465595. © The Author(s) 2016.

  17. Limitations of Routine Verification of Nasogastric Tube Insertion Using X-Ray and Auscultation: Two Case Reports of Life-Threatening Complications.

    Science.gov (United States)

    Nejo, Takahide; Oya, Soichi; Tsukasa, Tsuchiya; Yamaguchi, Naomi; Matsui, Toru

    2016-12-01

    Several bedside approaches used in combination with thoracoabdominal X-ray are widely used to avoid severe complications that have been reported during nasogastric tube management. Although confirmation by X-ray is considered the gold standard, it is not yet perfect. We present 2 cases of rare complications in which the routine verification methods could not detect all the complications related to the nasogastric tube placement. Case 1 was a 17-year-old male who presented with a brain tumor and repeatedly required nasogastric tube placement. Despite normal auscultatory and X-ray findings, the patient's condition deteriorated rapidly after resuming the enteral nutrition (EN). Computed tomography images showed the presence of hepatic portal venous gas (HPVG). Urgent upper gastrointestinal endoscopy showed esophagogastric submucosal tunneling of the tube that required an emergency open total gastrectomy. Case 2 was a 76-year-old man with long-term EN after stroke. While the last auscultatory verification was normal, he suddenly developed extensive HPVG due to gastric mucosal injury following EN, which resulted in progressive intestinal necrosis, general peritonitis, and death. These 2 cases indicated that routine verification methods consisting of auscultation and X-ray may not be completely reliable, and the awareness of the limitations of these methods should be reaffirmed because expeditious examinations and necessary interventions are critical in preventing life-threatening complications.

  18. Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study.

    Science.gov (United States)

    Tomlinson, Emily Jane; Phillips, Nicole M; Mohebbi, Mohammadreza; Hutchinson, Alison M

    2017-03-01

    To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. Retrospective case-control study with two controls per case. An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation. Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission. Multiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation. Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and

  19. Analysis of human factor aspects in connection with available incident reports obligatorily reported by German nuclear power plants

    International Nuclear Information System (INIS)

    Wilpert, B.; Freitag, M.; Miller, R.

    1993-01-01

    Goal of the present study is the analysis of human factor aspects in connection with available incident reports obligatorily reported by German nuclear power plants. Based on psychological theories and empirical studies this study develops a classification scheme which permits the identification of foci of erroneous human actions. This classification scheme is applied to a selection of human factor relevant incidents by calculating frequencies of the occurrence of human error categories. The results allow insights into human factor related problem areas. (orig.) [de

  20. Incidence of environmental and genetic factors causing congenital cataract in Children of Lahore.

    Science.gov (United States)

    Naz, Shagufta; Sharif, Saima; Badar, Hafsa; Rashid, Farzana; Kaleem, Afshan; Iqtedar, Mehwish

    2016-07-01

    To check the incidence of environmental and genetic factors causing congenital cataract in infants. The descriptive study was conducted at Layton Rahmatullah Benevolent Trust, Lahore, Pakistan, from October 2013 to April 2014, and comprised children under 15 years of age who had rubella syndrome, herpes simplex, birth trauma, trisomy 21, Nance-Horan syndrome or Lowe's syndrome. Of the 38,000 cases examined, 120(0.3%) patients were diagnosed with congenital cataract. Of them, 52(43.33%)were aged between 2 and 5 years,22(18.33%) <11 years and 10(8.33%) ?15 years. Bilateral congenital cataract was observed in 91(75.83%) patients and unilateral congenital cataract in 29(24.17%). Environmental factors caused 72(62.07%) cases and genetic factors caused 44(37.93%).. Congenital cataract predominated in boys compared to girls. Early diagnosis and adequate therapy requires specific technology, as well as long-term and permanent care..

  1. Occupational accidents in the Netherlands: incidence, mental harm, and their relationship with psychosocial factors at work.

    Science.gov (United States)

    van der Klauw, Marloes; Hengel, Karen Oude; Roozeboom, Maartje Bakhuys; Koppes, Lando L; Venema, Anita

    2016-01-01

    This study investigated the incidence of mental harm due to occupational accidents and the relation between psychosocial factors at work and the occurrence of occupational accidents in the Netherlands for the construction industry and health and welfare sector. Analyses revealed that occupational accidents in the construction industry more often involved physical harm, whereas accidents in the health and welfare sector relatively more often resulted in mental harm, in comparison to other sectors. Results showed that psychosocial factors were associated with occupational accidents in both sectors. For the construction industry, high time pressure and exposure to violence and harassment by colleagues or supervisors were associated with occupational accidents. For the health and welfare sector, low autonomy and exposure to violence and harassment by colleagues or supervisors or by people outside the organization were associated with occupational accidents. The present paper stresses the importance of also taking psychological consequences and psychosocial factors at work into account in assessing the occurrence of occupational accidents.

  2. Adverse drug reactions to CT contrast media in south Korea: Incidence and risk factors

    International Nuclear Information System (INIS)

    Bae, Kyung Soo; Jeon, Kyung Nyeo; Moon, Jin Il; Choi, Bo Hwa; Baek, Hye Jin; Cho, Soo Buem; Lee, Sang Min; Ha, Ji Young; Choi, Dae Seob; Cho, Jae Min; Na, Jae Beom

    2016-01-01

    To evaluate the incidence, severity, and risk factors of adverse drug reactions (ADR) to intravenous administration of nonionic iodinated contrast media in computed tomography (CT), and to determine the recurrence rate after premedication in patients with a previous history of ADR. We prospectively recorded all ADR to intravenous CT contrast media in 32313 consecutive outpatients (54572 cases) who underwent contrast enhanced CT examinations. Clinical report forms and electronic medical records were reviewed to search for the incidence of ADR, treatment, and clinical outcome of patients. The risk factors of ADR to CT contrast media (age, sex, history of previous ADR, season) were evaluated using statistical analysis. Of the 54572 cases, a total of 191 (0.35%) had adverse reactions. Of the 191 cases, 157 (82%) were categorized as mild reactions, 29 (15%) were moderate, and 5 (3%) were severe. A total of 165 (86.4%) cases had acute adverse reactions (which occurred within 1 hour after administration), while 26 (13.6%) had delayed adverse reactions (occurred 1 hour after the administration). The rate of ADR was significantly higher in females [relative risk (RR) = 2.05, 95% confidence interval (CI) 1.53-2.75], patients under the age of 60 years (RR = 1.45, 95% CI 1.07-1.98), patients with a history of previous ADR (RR = 6.51, 95% CI 3.13-13.57), and in the spring season (RR = 1.44, 95% CI 1.07-1.95). The recurrence rate after premedication in patients with previous ADR to CT contrast media was 3.2% (8/247). No deaths occurred that were attributed to the contrast media. The incidence of ADR to nonionic CT contrast media was 0.35%; most of which were mild reactions. Risk factors for ADR included female gender, an age of under 60 years, a history of previous ADR, and spring season

  3. Adverse drug reactions to CT contrast media in south Korea: Incidence and risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Kyung Soo; Jeon, Kyung Nyeo; Moon, Jin Il; Choi, Bo Hwa; Baek, Hye Jin; Cho, Soo Buem [Dept. of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon (Korea, Republic of); Lee, Sang Min; Ha, Ji Young; Choi, Dae Seob; Cho, Jae Min; Na, Jae Beom [Dept. of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju (Korea, Republic of)

    2016-07-15

    To evaluate the incidence, severity, and risk factors of adverse drug reactions (ADR) to intravenous administration of nonionic iodinated contrast media in computed tomography (CT), and to determine the recurrence rate after premedication in patients with a previous history of ADR. We prospectively recorded all ADR to intravenous CT contrast media in 32313 consecutive outpatients (54572 cases) who underwent contrast enhanced CT examinations. Clinical report forms and electronic medical records were reviewed to search for the incidence of ADR, treatment, and clinical outcome of patients. The risk factors of ADR to CT contrast media (age, sex, history of previous ADR, season) were evaluated using statistical analysis. Of the 54572 cases, a total of 191 (0.35%) had adverse reactions. Of the 191 cases, 157 (82%) were categorized as mild reactions, 29 (15%) were moderate, and 5 (3%) were severe. A total of 165 (86.4%) cases had acute adverse reactions (which occurred within 1 hour after administration), while 26 (13.6%) had delayed adverse reactions (occurred 1 hour after the administration). The rate of ADR was significantly higher in females [relative risk (RR) = 2.05, 95% confidence interval (CI) 1.53-2.75], patients under the age of 60 years (RR = 1.45, 95% CI 1.07-1.98), patients with a history of previous ADR (RR = 6.51, 95% CI 3.13-13.57), and in the spring season (RR = 1.44, 95% CI 1.07-1.95). The recurrence rate after premedication in patients with previous ADR to CT contrast media was 3.2% (8/247). No deaths occurred that were attributed to the contrast media. The incidence of ADR to nonionic CT contrast media was 0.35%; most of which were mild reactions. Risk factors for ADR included female gender, an age of under 60 years, a history of previous ADR, and spring season.

  4. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics.

    Science.gov (United States)

    Belderok, Sanne-Meike; van den Hoek, Anneke; Kint, Joan A; Schim van der Loeff, Maarten F; Sonder, Gerard Jb

    2011-10-29

    Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent travellers. Persons who attended the travel clinic of the Public Health Service Amsterdam in 2006-2007 before short-term travel to tropical and subtropical countries were invited to answer a questionnaire regarding sociodemographics and travel purpose; they were also asked to keep a daily structured travel diary, recording their itinerary, symptoms, and self-medication or consultation with a doctor. Diarrhoea episodes containing blood or mucous were considered severe. Of 1202 travellers, the median age was 38 years, and the median travel duration 3 weeks. Of all episodes, 96% were mild. The median duration of TD was 2 days and significantly shorter in subsequent episodes compared to first episodes (p sex, a Western country of birth, and tourism as the purpose of travel. The lowest risk was in travellers to South America. An independent risk factor for subsequent episodes was female sex. In total, 5% of travellers used antibiotics; of those, 92% had mild diarrhoea, and 53% received antibiotics over the counter. TD is common among travellers, but the overall course is mild, not requiring treatment. The incidence rates for first and second episodes are comparable. Female sex is a risk factor for the first episode, as well as subsequent ones. Prescription antibiotics are not needed in short-term healthy travellers.

  5. Incidence of local complications and risk factors associated with peripheral intravenous catheter in neonates

    Directory of Open Access Journals (Sweden)

    Mitzy Tannia Reichembach Danski

    2016-02-01

    Full Text Available Abstract OBJECTIVE To evaluate the incidence of complications related to the use of peripheral intravenous catheter in neonates and identify the associated risk factors. METHOD Prospective cohort study conducted in a Neonatal Intensive Care Unit. Participants were the hospitalized neonates undergoing peripheral intravenous puncture in the period from February to June 2013. RESULTS The incidence of complications was 63.15%, being infiltration/extravasation (69.89%, phlebitis (17.84% and obstruction (12.27%. The risk factors were the presence of infection (p = 0.0192 and weight at the puncture day (p = 0.0093, type of intermittent infusion associated with continuous infusion (p <0.0001, endotracheal intubation (p = 0.0008, infusion of basic plan (p = 0.0027, total parenteral nutrition (P = 0.0002, blood transfusion associated with other infusions (p = 0.0003 and other drugs (p = 0.0004. Higher risk of developing complications in the first 48 hours after puncture. CONCLUSION A high rate of complications related to the use of peripheral intravenous catheter, and risk factors associated with infection, weight, drugs and infused solutions, and type of infusion.

  6. Delirium in Hospitalized Children with Cancer: Incidence and Associated Risk Factors.

    Science.gov (United States)

    Traube, Chani; Ariagno, Sydney; Thau, Francesca; Rosenberg, Lynne; Mauer, Elizabeth A; Gerber, Linda M; Pritchard, David; Kearney, Julia; Greenwald, Bruce M; Silver, Gabrielle

    2017-12-01

    To assess the incidence of delirium and its risk factors in hospitalized children with cancer. In this cohort study, all consecutive admissions to a pediatric cancer service over a 3-month period were prospectively screened for delirium twice daily throughout their hospitalization. Demographic and treatment-related data were collected from the medical record after discharge. A total of 319 consecutive admissions, including 186 patients and 2731 hospital days, were included. Delirium was diagnosed in 35 patients, for an incidence of 18.8%. Risk factors independently associated with the development of delirium included age Delirium was associated with increased hospital length of stay, with median length of stay for delirious patients of 10 days compared with 5 days for patients who were not delirious during their hospitalization (P delirium was a frequent complication during admissions for childhood cancer, and was associated with increased hospital length of stay. Multi-institutional prospective studies are warranted to further characterize delirium in this high-risk population and identify modifiable risk factors to improve the care provided to hospitalized children with cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Factors influencing upon the incidence of seed migration in I-125 seed transperineal prostate implantation

    International Nuclear Information System (INIS)

    Itami, Jun; Onishi, Kayoko; Kanemura, Mikio

    2005-01-01

    Transperineal I-125 seed brachytherapy for prostate cancer is rapidly expanding in Japan. Seed migrations to lung and abdomen are well known complication in the seed brachytherapy. The rate of incidence and the predisposing factors were studied. From April 2004 through January 2005, 36 patients underwent transperineal I-125 seed brachytherapy for prostate cancer. In all patients loose I-125 seeds were inserted with Mick applicator according to modified peripheral loading pattern. One day, 1 week, and 1 month after the procedure, posteroanterior and lateral chest X-rays and abdominal X-ray were performed. Abdominal and chest seed migrations were seen in 11 (30.6%) and 14 (38.9%) patients, respectively. In total, 20 patients (55.6%) showed seed migrations. Forty-two I-125 seeds migrated out of 2,508 implanted seeds. Most of the migrations were seen until 1 month after the procedure. The preplanned number of the extraprostatic seeds had a statistically significant influence upon the incidence of seed migration. Seed migration is not a rare phenomenon in transperineal I-125 seed brachytherapy for prostate cancer. To confirm seed migration, X-ray examinations 1 month after the procedure are suited. At the preplanning, the number of extraprostatic seeds should be limited to minimal to decrease the incidence of seed migration. In future, the introduction of linked I-125 seeds is preferred. (author)

  8. The Incidence And Risk Factors Nosocomial Pneumonia In A Neuromedical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Devragudi TS

    2001-01-01

    Full Text Available This retrospective study examined the incidence and factors influencing the occurrence of nonsocomial pneumonia (NP in a neuromedical intensive care unit (NICU. Of the 57 patients admitted to the NICU over one year, 26% developed nosocomial pneumonia. It was observed that the infected patients were significantly older than the noninfected (43+15 vs 22+18 years; p<0.001, had a longer NICU stay (33+31 vs 18+18 days: p=0.05 and needed longer duration of mechanical ventilation (20+25 vs 9 + 12 days: P<0.05. Patients with neuromuscular diseases had a trend towards higher incidence of NP than those with encephalopathy and therapeutic interventions such as plasmapheresis, blood transfusion and inotropic therapy did not influence the incidence of nosocomial pneumonia. The NICU mortality was not significantly influenced by nosocomial pneumonia. Pseudomonas aerugenosa was the predominant organism responsible for pneumonia. Nine percent of the tracheobronchial isolates were resistant to the routinely-tested antibiotics. In conclusion, nosocornial pneumonia is a common complication in a NICU and while it increases the duration of NICU stay, mortality appears to be uninfluenced.

  9. INCIDENCE AND RISK FACTORS FOR CHRONIC PELVIC PAIN AFTER HYSTEROSCOPIC STERILIZATION

    Science.gov (United States)

    YUNKER, Amanda C.; RITCH, Jessica M. B.; ROBINSON, Erica F.; GOLISH, Cara T.

    2014-01-01

    Objective To investigate the incidence and pre-operative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure™ micro-inserts Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University Medical Center Patients A total of 458 patients who underwent hysteroscopic sterilization with Essure™ between January 1, 2005 and June 30, 2012. Results The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and the incidence of persistent pain after 3 months post-procedure was 4.2%. The range of presentation with pain was 1 to 469 days, with a mean time of 56 days. Of the patients that developed chronic pelvic pain after the procedure, 75% presented within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (OR 6.81, 95% CI 2.95,15.73) and chronic pain (OR 6.15, 95% CI 2.10,18.10) after hysteroscopic sterilization. Conclusions Pelvic pain may develop after hysteroscopic sterilization. Patients with preexisting chronic pain diagnoses may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure™ placement will resolve by 3 months. PMID:24952343

  10. The incidence of depression and its risk factors in Dutch nursing homes and residential care homes.

    Science.gov (United States)

    Boorsma, Marijke; Joling, Karlijn; Dussel, Martine; Ribbe, Miel; Frijters, Dinnus; van Marwijk, Harm W J; Nijpels, Giel; van Hout, Hein

    2012-11-01

    Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for depression in Dutch nursing homes and residential care homes. Data on depression were extracted from the Vrije Universiteit naturalistic cohort on routine care monitoring with the Minimum Data Set of the Resident Assessment Instrument. A total of 1,324 residents in six nursing homes and 1,723 residents in 23 residential care homes with an average follow-up of 1.2 years. Depression was defined as a clinical diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and the use of antidepressants. Residents with prevalent depression at baseline were excluded. The incidence rate was 13.6 per 100 person years in the nursing homes and 10.2 per 100 person years in the residential care homes. The independent risk factors for in-home depression for residents in nursing homes included dementia (OR: 1.7; 95% CI: 1.02-2.95) and a score of 3 or more on the Depression Rating Scale (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.23-3.70). A protective effect was seen on the use of a hearing aid (OR: 0.3; 95% CI: 0.12-0.80). In the residential care homes, being male (OR: 2.1; 95% CI: 1.27-3.30), having cancer (OR: 2.9; 95% CI: 1.64-4.95), and a score of 2 or higher on the Cognitive Performance Scale (OR: 1.5; 95% CI: 1.05-2.22) increased the risk to develop depression. Age greater than 85 years (OR: 0.5; 95% CI: 0.31-0.67) and hearing impairment (OR: 0.8; 95% CI: 0.60-1.00) appeared to be protective. The incidence rate for depression in residents of Dutch nursing homes and residential care homes was high and the associated risk factors found may have important implications for staff. 2012 American Association for Geriatric Psychiatry

  11. Life-threatening mycobacteria infection

    NARCIS (Netherlands)

    Faber, William R.

    2005-01-01

    Most mycobacteria cause localized and often harmless infections of the skin, Leprosy. which dates back to approximately 60 BC in India,(1) was supposed to be eliminated as a Public health problem by the year 2000.(2) With a new case detection rate between 600,000 and 700,000 yearly, however.(3)

  12. Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study.

    Science.gov (United States)

    French, Amanda N; Morgan, Ian G; Mitchell, Paul; Rose, Kathryn A

    2013-10-01

    To examine the risk factors for incident myopia in Australian schoolchildren. Population-based, longitudinal cohort study. The Sydney Adolescent Vascular and Eye Study (SAVES) was a 5- to 6-year follow-up of the Sydney Myopia Study (SMS). At follow-up, 2103 children were reexamined: 892 (50.5%) from the younger cohort and 1211 (51.5%) from the older cohort. Of these, 863 in the younger cohort and 1196 in the older cohort had complete refraction data. Cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1; Canon, Tokyo, Japan) was measured at baseline and follow-up. Myopia was defined as a spherical equivalent refraction of ≤-0.50 diopters (D). Children were classified as having incident myopia if they were nonmyopic at baseline and myopic in either eye at follow-up. A comprehensive questionnaire determined the amount of time children spent outdoors and doing near work per week at baseline, as well as ethnicity, parental myopia, and socioeconomic status. Incident myopia. Children who became myopic spent less time outdoors compared with children who remained nonmyopic (younger cohort, 16.3 vs. 21.0 hours, respectively, Phours, respectively, P=0.001). Children who became myopic performed significantly more near work (19.4 vs. 17.6 hours; P=0.02) in the younger cohort, but not in the older cohort (P=0.06). Children with 1 or 2 parents who were myopic had greater odds of incident myopia (1 parent: odds ratio [OR], 3.2, 95% confidence interval [CI], 1.9-5.2; both parents: OR, 3.3, 95% CI, 1.6-6.8) in the younger but not the older cohort. Children of East Asian ethnicity had a higher incidence of myopia compared with children of European Caucasian ethnicity (both Pwork, parental myopia, and ethnicity to the model significantly improved the predictive power (Pwork and parental myopia were additional significant risk factors for myopia only in the younger cohort. The author(s) have no proprietary or commercial interest in any materials discussed in this article

  13. Incidence of pregnancy following antiretroviral therapy initiation and associated factors in eight West African countries

    Science.gov (United States)

    Burgos-Soto, Juan; Balestre, Eric; Minga, Albert; Ajayi, Samuel; Sawadogo, Adrien; Zannou, Marcel D.; Leroy, Valériane; Ekouevi, Didier K.; Dabis, François; Becquet, Renaud

    2014-01-01

    Introduction This study aimed at estimating the incidence of pregnancy after antiretroviral therapy (ART) initiation in eight West African countries over a 10-year period. Methods A retrospective analysis was conducted within the international database of the IeDEA West Africa Collaboration. All HIV-infected women aged Pregnancy after ART initiation was the main outcome and was based on clinical reporting. Poisson regression analysis accounting for country heterogeneity was computed to estimate first pregnancy incidence post-ART and to identify its associated factors. Pregnancy incidence rate ratios were adjusted on country, baseline CD4 count and clinical stage, haemoglobin, age, first ART regimen and calendar year. Results Overall 29,425 HIV-infected women aged 33 years in median [Inter Quartile Range: 28–38] contributed for 84,870 women-years of follow-up to this analysis. The crude incidence of first pregnancy (2,304 events) was 2.9 per 100 women-years [95% confidence interval [CI]: 2.7–3.0], the highest rate being reported among women aged 25–29 years: 4.7 per 100 women-years; 95% CI: 4.3–5.1. The overall Kaplan-Meier probability of pregnancy occurrence by the fourth year on ART was 10.9% (95% CI: 10.4–11.4) and as high as 28.4% (95% CI: 26.3–30.6) among women aged 20–29 years at ART initiation. Conclusion The rate of pregnancy occurrence after ART initiation among HIV-infected women living in the West Africa region was high. Family planning services tailored to procreation needs should be provided to all HIV-infected women initiating ART and health consequences carefully monitored in this part of the world. PMID:25216079

  14. The NLstart2run study: Incidence and risk factors of running-related injuries in novice runners

    NARCIS (Netherlands)

    Kluitenberg, B.; van Middelkoop, M.; Smits, D.W.; Verhagen, E.A.L.M.; Hartgens, F.; Diercks, R.; van der Worp, H.

    2015-01-01

    Running is a popular form of physical activity, despite of the high incidence of running-related injuries (RRIs). Because of methodological issues, the etiology of RRIs remains unclear. Therefore, the purposes of the study were to assess the incidence of RRIs and to identify risk factors for RRIs in

  15. The NLstart2run study : Incidence and risk factors of running-related injuries in novice runners

    NARCIS (Netherlands)

    Kluitenberg, B; van Middelkoop, M; Smits, D W; Verhagen, E; Hartgens, F; Diercks, R; van der Worp, H

    2015-01-01

    Running is a popular form of physical activity, despite of the high incidence of running-related injuries (RRIs). Because of methodological issues, the etiology of RRIs remains unclear. Therefore, the purposes of the study were to assess the incidence of RRIs and to identify risk factors for RRIs in

  16. Incidence and factors related to delirium in an intensive care unit.

    Science.gov (United States)

    Mori, Satomi; Takeda, Juliana Rumy Tsuchihashi; Carrara, Fernanda Souza Angotti; Cohrs, Cibelli Rizzo; Zanei, Suely Sueko Viski; Whitaker, Iveth Yamaguchi

    2016-01-01

    To identify the incidence of delirium, compare the demographic and clinical characteristics of patients with and without delirium, and verify factors related to delirium in critical care patients. Prospective cohort with a sample made up of patients hospitalized in the Intensive Care Unit (ICU) of a university hospital. Demographic, clinical variables and evaluation with the Confusion Assessment Method for Intensive Care Unit to identify delirium were processed to the univariate analysis and logistic regression to identify factors related to the occurrence of delirium. Of the total 149 patients in the sample, 69 (46.3%) presented delirium during ICU stay, whose mean age, severity of illness and length of ICU stay were statistically higher. The factors related to delirium were: age, midazolam, morphine and propofol. Results showed high incidence of ICU delirium associated with older age, use of sedatives and analgesics, emphasizing the need for relevant nursing care to prevent and identify early, patients presenting these characteristics. Identificar a incidência de delirium, comparar as características demográficas e clínicas dos pacientes com e sem delirium e verificar os fatores relacionados ao delirium em pacientes internados em Unidade de Terapia Intensiva (UTI). Coorte prospectiva, cuja amostra foi constituída de pacientes internados em UTI de um hospital universitário. Variáveis demográficas, clínicas e da avaliação com o Confusion Assessment Method for Intensive Care Unit para identificação de delirium foram processadas para análise univariada, e regressão logística para identificar fatores relacionados à ocorrência do delirium. Do total de 149 pacientes da amostra, 69 (46,3%) apresentaram delirium durante a internação na UTI, observando-se que a média da idade, o índice de gravidade e o tempo de permanência nas UTI foram estatisticamente maiores. Os fatores relacionados ao delirium foram: idade, midazolam, morfina e propofol. Os

  17. Incidence and risk factors of hypomagnesemia in head and neck cancer patients treated with cetuximab

    Directory of Open Access Journals (Sweden)

    Tomohiro Enokida

    2016-09-01

    Full Text Available Background Hypomagnesemia is a common adverse event during cetuximab (Cmab treatment. However, few reports have investigated the incidence and risk factors of hypomagnesemia in head and neck cancer patients treated with Cmab. Methods We retrospectively reviewed 131 head and neck cancer patients who received Cmab-containing therapy. Main eligibility criteria were ≥3 Cmab administrations, no prior EGFR-directed therapy, and no prophylactic Mg supplementation.Results Median baseline serum Mg level and number of Cmab administrations were 2.2 mg/dl and eight, respectively. Overall incidence of hypomagnesemia was 50.4% (grade 1, 46.6%; grade 2, 3.1%; grade 3, 0%; grade 4, 0.8% and differed between patients treated with palliative chemotherapy and bioradiation (Cmab and radiation (63% vs. 24%; p<0.01. Independent risk factors were low baseline serum Mg [Odds ratio (OR 161.988, 95% confidence interval (CI 9.436-2780.895], ≥7 Cmab administrations (OR 3.56, 95% CI 1.16-13.98, and concurrent administration of platinum (cisplatin; OR 23.695, 95% CI 5.219-107.574, carboplatin; OR 5.487, 95% CI 1.831-16.439. Respective incidence of hypomagnesemia in patients in high- (concurrent platinum and ≥7 Cmab administrations and low-risk (no concurrent platinum and <7 Cmab administrations groups was 66.0% and 6.6% (P<0.001, OR 28.0. Conclusion Cmab is associated with a significant risk of hypomagnesemia in patients with head and neck cancer with longer term administration and concurrent platinum therapy. High-risk patients should be treated with particular care.

  18. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

    Directory of Open Access Journals (Sweden)

    Belderok Sanne-Meike

    2011-10-01

    Full Text Available Abstract Background Travellers' diarrhoea (TD is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent travellers. Methods Persons who attended the travel clinic of the Public Health Service Amsterdam in 2006-2007 before short-term travel to tropical and subtropical countries were invited to answer a questionnaire regarding sociodemographics and travel purpose; they were also asked to keep a daily structured travel diary, recording their itinerary, symptoms, and self-medication or consultation with a doctor. Diarrhoea episodes containing blood or mucous were considered severe. Results Of 1202 travellers, the median age was 38 years, and the median travel duration 3 weeks. Of all episodes, 96% were mild. The median duration of TD was 2 days and significantly shorter in subsequent episodes compared to first episodes (p Conclusions TD is common among travellers, but the overall course is mild, not requiring treatment. The incidence rates for first and second episodes are comparable. Female sex is a risk factor for the first episode, as well as subsequent ones. Prescription antibiotics are not needed in short-term healthy travellers.

  19. The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study

    Directory of Open Access Journals (Sweden)

    Turkay Mehtap

    2006-05-01

    Full Text Available Abstract Background Medical education requires detailed investigation because it is a period during which the attitudes and behaviors of physicians develop. The purpose of this study was to calculate the yearly smoking prevalence and incidence rates of medical faculty students and to identify the risk factors for adopting smoking behaviour. Methods This is a cohort study in which every student was asked about their smoking habits at the time of first registration to the medical faculty, and was monitored every year. Smoking prevalence, yearly incidence of initiation of smoking and average years of smoking were calculated in analysis. Results At the time of registration, 21.8% of the students smoked. At the end of six years, males had smoked for an average of 2.6 ± 3.0 years and females for 1.0 ± 1.8 years (p Conclusion The first 3 years of medical education are the most risky period for initiation of smoking. We found that factors such as being male, having a smoking friend in the same environment and having a high trait anxiety score were related to the initiation of smoking. Targeted smoking training should be mandatory for students in the Medical Faculty.

  20. Chronic dry eye in PRK and LASIK: manifestations, incidence and predictive factors

    Science.gov (United States)

    Bower, Kraig S.; Sia, Rose K.; Ryan, Denise S.; Mines, Michael J.; Dartt, Darlene A.

    2017-01-01

    Purpose To evaluate dry eye manifestations following photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and determine the incidence and predictive factors of chronic dry eye using a set of dry eye criteria. Setting Walter Reed Army Medical Center, Washington, DC, USA Methods This is a prospective non-randomized clinical study of 143 active duty U.S. Army personnel aged 29.9±5.2 years with myopia or myopic astigmatism (manifest spherical equivalent −3.83±1.96 diopters) undergoing either PRK or LASIK. Dry eye evaluation was performed pre- and postoperatively. Main outcome measures included dry eye manifestations, incidence, and predictive factors of chronic dry eye. Results Schirmer scores, corneal sensitivity, ocular surface staining, surface regularity index (SRI), and responses to dry eye questionnaire significantly changed over time after PRK. After LASIK, significant changes were observed in tear breakup time, corneal sensitivity, ocular surface staining, and responses to questionnaire. At twelve months postoperatively, 5.0% of PRK and 0.8% of LASIK participants developed chronic dry eye. Regression analysis showed preoperatively lower Schirmer score will significantly influence development of chronic dry eye after PRK whereas preoperatively lower Schirmer score or higher ocular surface staining score will significantly influence the occurrence of chronic dry eye after LASIK. Conclusions Chronic dry eye is uncommon after PRK and LASIK. Ocular surface and tear film characteristics during preoperative examination may help predict chronic dry eye development in PRK and LASIK. PMID:26796443

  1. Intimate partner violence among Egyptian pregnant women: incidence, risk factors, and adverse maternal and fetal outcomes.

    Science.gov (United States)

    Ibrahim, Z M; Sayed Ahmed, W A; El-Hamid, S A; Hagras, A M

    2015-01-01

    To assess incidence and risk factors of intimate partner violence (IPV) during pregnancy among a sample of women from Egypt and to evaluate its impact on maternal and fetal adverse health outcomes. After obtaining ethical approval, a total of 1,857 women aged 18 - 43 years completed the study and were investigated using an interview questionnaire. The questionnaire contains five main items: demographic characteristics of women, intimate partner characteristics, assessment of IPV during current pregnancy, and assessment of maternal as well as fetal/neonatal adverse outcomes. Women were also examined to detect signs of violence and identify injuries. Exposure to IPV during pregnancy was reported among 44.1% of the studied women. Emotional violence was the most common form. Women exposed to violence were of younger age, higher parity, and lower educational level. Their partners were older, less educated, and more likely to be addicted to drugs and alcohol. Women were also found to have significantly higher incidence of adverse pregnancy outcomes (miscarriage, preterm labor, and premature rupture of membrane), and fetal/neonatal adverse outcomes (fetal distress, fetal death, and low birth weight). A total of 297 cases had been exposed to physical violence (15.9%) vs 32.6% and 10% exposed to emotional and sexual violence, respectively. The most common form of physical violence was kicking. Violence during pregnancy is prevalent among Egyptian women. Exposure to violence was a significant risk factor for multiple adverse maternal and fetal health outcomes.

  2. Female genital tract graft-versus-host disease: incidence, risk factors and recommendations for management.

    Science.gov (United States)

    Zantomio, D; Grigg, A P; MacGregor, L; Panek-Hudson, Y; Szer, J; Ayton, R

    2006-10-01

    Female genital tract graft-versus-host disease (GVHD) is an under-recognized complication of allogeneic stem cell transplantation impacting on quality of life. We describe a prospective surveillance programme for female genital GVHD to better characterize incidence, risk factors and clinical features and the impact of a structured intervention policy. A retrospective audit was conducted on the medical records of all female transplant recipients surviving at least 6 months at a single centre over a 5-year period. Patients commenced topical vaginal oestrogen early post transplant with hormone replacement as appropriate for age, prior menopausal status and co-morbidities. A genital tract management programme included regular gynaecological review and self-maintenance of vaginal capacity by dilator or intercourse. The incidence of genital GVHD was 35% (95% confidence interval (CI) (25, 50%)) at 1 year and 49% (95% CI (36, 63%)) at 2 years. Topical therapy was effective in most cases; no patient required surgical intervention to divide vaginal adhesions. The main risk factor was stem cell source with peripheral blood progenitor cells posing a higher risk than marrow (hazard ratio=3.07 (1.22, 7.73), P=0.017). Extensive GVHD in other organs was a common association. We conclude that female genital GVHD is common, and early detection and commencement of topical immunosuppression with dilator use appears to be highly effective at preventing progression.

  3. The Incidence and Risk Factors of In-Stent Restenosis for Vertebrobasilar Artery Stenting.

    Science.gov (United States)

    Zheng, Dai; Mingyue, Zhu; Wei, Shi; Min, Li; Wanhong, Chen; Qiliang, Dai; Yongjun, Jiang; Xinfeng, Liu

    2018-02-01

    In-stent restenosis (ISR) remains a challenge for vertebrobasilar artery stenting (VBAS). We aimed to investigate the incidence and risk factors of ISR. This was a retrospective study. From July 28, 2005, to July 30, 2015, patients who received VBAS with an angiographic follow-up time of 6 to 12 months after surgery were enrolled. The clinical and angiographic issues were recorded and analyzed. In total, 283 patients with 335 stents were incorporated into the study. Vertebral ostial lesions accounted for 73.4% (246/335) of the lesions. During the follow-up period, 58 patients with 60 stents experienced ISR (>50%). Stepwise logistic regression analysis showed that the degree of residual stenosis, stent diameter, and alcohol consumption were independent predictors of ISR. Our study demonstrated the incidence and risk factors of ISR after VBAS. This retrospective study with the largest cohort to date provided insight into the occurrence of ISR after VBAS. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Incidence and risk factors for central venous access port-related infection in Chinese cancer patients.

    Science.gov (United States)

    Wang, Ting-Yao; Lee, Kuan-Der; Chen, Ping-Tsung; Chen, Min-Chi; Chen, Yi-Yang; Huang, Cih-En; Kuan, Feng-Che; Chen, Chih-Cheng; Lu, Chang Hsien

    2015-11-01

    Cytotoxic chemotherapy via central venous access ports is an important part of the standard treatment for most cancers, but it is accompanied with the risk of infections. This study aimed to analyze the incidence and risk factors for central venous access port-related infection (CPI) among Chinese patients receiving cytotoxic chemotherapy. Between January 1, 2002 and December 31, 2005 a total of 1391 cancer patients with 1449 totally implantable central venous access ports were evaluated. The log-rank test and Cox proportional hazards model were used for the analyses of risk factors. The overall CPI incidence rate was 0.21 per 1000 catheter-days. Hematological malignancies and head and neck cancer were associated with an increased risk of CPI (hazard ratio 4.00 and 4.11, respectively, both p risk of infection than for patients in a nonadjuvant setting (p ports. Implementation of an insertion bundle for the prevention of central line-associated bloodstream infections is warranted, especially for those patients with hematological and head and neck cancers, as well as for patients receiving chemotherapy in the metastatic settings. Copyright © 2015. Published by Elsevier B.V.

  5. Burnout Among Chinese Adult Reconstructive Surgeons: Incidence, Risk Factors, and Relationship With Intraoperative Irritability.

    Science.gov (United States)

    Zheng, Hanlong; Shao, Hongyi; Zhou, Yixin

    2018-04-01

    Burnout is a major concern in human service occupations, mainly characterizing in emotional exhaustion and depersonalization. There is very limited research dealing with burnout in orthopedic surgeons. Exploring burnout prevalence, risk factors, and intraoperative irritability-related incidences is necessary to improve the quality of life for surgeons. The study population consisted of 202 registered adult reconstructive doctors in China. Burnout was measured using a normalized translated version of the Maslach Burnout Inventory-Human Service Survey. Demographics, professional characteristics, and intraoperative irritability-related questions were also collected by electronic questionnaires. Statistical analysis was performed using SPSS 22.0. The overall rate of burnout was 85.1%. Variables significantly associated with high emotional exhaustion scores included poor sleeping time per day (P = .008), more nights on call per week (P = .048), and absence of research (P = .014). For depersonalization, absence of marriage (P burnout, especially in emotional exhaustion. Residents were the population having the least opportunities to lose temper in operation. Burnout is highly prevalent in Chinese adult reconstructive surgeons, and it had some correlations with irritability. Further research is needed to determine more risk factors and reduce intraoperative irritability-related incidences. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. European Clearinghouse. Incidents related to reactivity management. Contributing factors, failure modes and corrective actions

    International Nuclear Information System (INIS)

    Bruynooghe, Christiane; Noel, Marc

    2009-01-01

    This work is part of the European Clearinghouse on Nuclear Power Plant Operational Experience Feedback (NPP-OEF) activity carried out at the Joint Research Centre/Institute for Energy (JRC/IE) with the participation of nine EU Regulatory Authorities. It investigates the 1999 Shika-1 criticality event together with other shortcomings in reactivity management reported to the IAE4 Incident Reporting System in the period 1981-2008. The aim of the work was to identify reactivity control failure modes, reactor status and corrective actions. Initiating factors and associated root causes were also analysed. Five of the 7 factors identified for all events were present in the 1999 Shika-1 event where criticality has been unexpectedly reached and maintained during 15 minutes. Most of the events resulted in changes in procedures, material or staff and management training. The analysis carried out put in evidence that in several instances appropriate communication based on operational experience feedback would have prevented incident to occur. This paper also summarises the action taken at power plants and by the regulatory bodies in different countries to avoid repetition of similar events. It identifies insights that might be useful to reduce the likelihood of operational events caused by shortcomings in reactivity management. (orig.)

  7. Progression of diffuse esophageal spasm to achalasia: incidence and predictive factors.

    Science.gov (United States)

    Fontes, L H S; Herbella, F A M; Rodriguez, T N; Trivino, T; Farah, J F M

    2013-07-01

    The progression of certain primary esophageal motor disorders to achalasia has been documented; however, the true incidence of this decay is still elusive. This study aims to evaluate: (i) the incidence of the progression of diffuse esophageal spasm to achalasia, and (ii) predictive factors to this progression. Thirty-five patients (mean age 53 years, 80% females) with a manometric picture of diffuse esophageal spasm were followed for at least 1 year. Patients with gastroesophageal reflux disease confirmed by pH monitoring or systemic diseases that may affect esophageal motility were excluded. Esophageal manometry was repeated in all patients. Five (14%) of the patients progressed to achalasia at a mean follow-up of 2.1 (range 1-4) years. Demographic characteristics were not predictive of transition to achalasia, while dysphagia (P= 0.005) as the main symptom and the wave amplitude of simultaneous waves less than 50 mmHg (P= 0.003) were statistically significant. In conclusion, the transition of diffuse esophageal spasm to achalasia is not frequent at a 2-year follow-up. Dysphagia and simultaneous waves with low amplitude are predictive factors for this degeneration. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  8. NASA-ONERA Collaboration on Human Factors in Aviation Accidents and Incidents

    Science.gov (United States)

    Srivastava, Ashok N.; Fabiani, Patrick

    2012-01-01

    This is the first annual report jointly prepared by NASA and ONERA on the work performed under the agreement to collaborate on a study of the human factors entailed in aviation accidents and incidents, particularly focused on the consequences of decreases in human performance associated with fatigue. The objective of this agreement is to generate reliable, automated procedures that improve understanding of the levels and characteristics of flight-crew fatigue factors whose confluence will likely result in unacceptable crew performance. This study entails the analyses of numerical and textual data collected during operational flights. NASA and ONERA are collaborating on the development and assessment of automated capabilities for extracting operationally significant information from very large, diverse (textual and numerical) databases; much larger than can be handled practically by human experts.

  9. Equestrian injuries: incidence, injury patterns, and risk factors for 10 years of major traumatic injuries.

    Science.gov (United States)

    Ball, Chad G; Ball, Jill E; Kirkpatrick, Andrew W; Mulloy, Robert H

    2007-05-01

    Horseback riding is more dangerous than motorcycle riding, skiing, football, and rugby. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with severe equestrian trauma. All patients with major equestrian injuries (injury severity score > or = 12) admitted between 1995 and 2005 were reviewed. A 46-question survey outlining potential rider, animal, and environmental risk factors was administered. Among 7941 trauma patients, 151 (2%) were injured on horseback (mean injury severity score, 20; mortality rate, 7%). Injuries included the chest (54%), head (48%), abdomen (22%), and extremities (17%). Forty-five percent required surgery. Survey results (55%) indicated that riders and horses were well trained, with a 47% recidivism rate. Only 9% of patients wore helmets, however, 64% believed the accident was preventable. Chest trauma previously has been underappreciated. This injury pattern may be a result of significant rider experience. Helmet and vest use will be targeted in future injury prevention strategies.

  10. Incidence and risk factors of refeeding syndrome in head and neck cancer patients

    DEFF Research Database (Denmark)

    Rasmussen, Stine Ostenfeldt; Kristensen, Marianne Boll; Wessel, Irene

    2016-01-01

    This study aimed to determine the incidence rates of refeeding phenomena (defined as a decline in p-phosphate) and refeeding syndrome (RFS; defined as development of clinical symptoms in addition to a decline in p-phosphate) in head and neck cancer patients, and to identify risk factors. Fifty......-four head and neck cancer patients referred for surgery were included. Forty-six potential risk factors were registered at the baseline, and p-phosphate was measured at Days 2, 4, and 7. Eleven patients (20%) developed RFS, and twenty-eight (52%) developed refeeding phenomena. At baseline, these patients...... presented a higher prevalence of head and neck pain, eating difficulties, higher p-phosphate levels, lower p-transferrin levels, and, in men, lower b-hemoglobin levels. Patients who developed symptoms had a decline in p-phosphate ≥0.22 mmol/l. At baseline, these patients had higher p-phosphate levels...

  11. Human Papillomavirus Cervical Infection and Associated Risk Factors in a Region of Argentina With a High Incidence of Cervical Carcinoma

    Directory of Open Access Journals (Sweden)

    S. A. Tonon

    1999-01-01

    Full Text Available Objective: To assess the prevalence and potential risk factors associated with human papillomavirus (HPV cervical infection among women residing in a region of northeastern Argentina with a high incidence of cervical cancer.

  12. Incidence and Risk Factors for Neonatal Jaundice among Newborns in Southern Nepal

    Science.gov (United States)

    Scrafford, Carolyn G.; Mullany, Luke C.; Katz, Joanne; Khatry, Subarna K.; LeClerq, Steven C.; Darmstadt, Gary L.; Tielsch, James M.

    2016-01-01

    Objective To quantify the incidence of and risk factors for neonatal jaundice among infants referred for care from a rural, low-resource, population-based cohort in southern Nepal. Methods Study participants were 18,985 newborn infants born in Sarlahi District in Southern Nepal from May 2003 through January 2006 who participated in a cluster-randomized, placebo-controlled, community-based trial to evaluate the effect of newborn chlorhexidine cleansing on neonatal mortality and morbidity. Jaundice was assessed based on visual assessment of the infant by a study worker and referral for care. Adjusted relative risks (RR) were estimated to identify risk factors for referral for neonatal jaundice using Poisson regression. Results The incidence of referral for neonatal jaundice was 29.3 per 1,000 live births (95% Confidence Interval: 26.9, 31.7). Male sex, high birth weight, breastfeeding patterns, warm air temperature, primiparity, skilled birth attendance, place of delivery, prolonged labor, oil massage, paternal education, and ethnicity were significant risk factors (p-valuesjaundice, whereas exclusive breastfeeding was protective among infants with no report of difficulty feeding. Conclusions Several known risk factors for neonatal jaundice in a low-resource setting were confirmed in this study. Unique observed associations of jaundice with ambient air temperature and oil massage may be explained by the opportunity for phototherapy based on the cultural practices of this study population. Future research should investigate the role of an infant’s difficulty in feeding as a potential modifier in the association between exclusive breastfeeding and jaundice. PMID:24112359

  13. Risk factors for breast cancer in a population with high incidence rates

    International Nuclear Information System (INIS)

    Wrensch, Margaret; Peskin-Mentzer, Roni; Quesenberry, Charles P Jr; Souders-Mason, Virginia; Spence, Linda; Suzuki, Marisa; Gould, Mary; Chew, Terri; Farren, Georgianna; Barlow, Janice; Belli, Flavia; Clarke, Christina; Erdmann, Christine A; Lee, Marion; Moghadassi, Michelle

    2003-01-01

    This report examines generally recognized breast cancer risk factors and years of residence in Marin County, California, an area with high breast cancer incidence and mortality rates. Eligible women who were residents of Marin County diagnosed with breast cancer in 1997–99 and women without breast cancer obtained through random digit dialing, frequency-matched by cases' age at diagnosis and ethnicity, participated in either full in-person or abbreviated telephone interviews. In multivariate analyses, 285 cases were statistically significantly more likely than 286 controls to report being premenopausal, never to have used birth control pills, a lower highest lifetime body mass index, four or more mammograms in 1990–94, beginning drinking after the age of 21, on average drinking two or more drinks per day, the highest quartile of pack-years of cigarette smoking and having been raised in an organized religion. Cases and controls did not significantly differ with regard to having a first-degree relative with breast cancer, a history of benign breast biopsy, previous radiation treatment, age at menarche, parity, use of hormone replacement therapy, age of first living in Marin County, or total years lived in Marin County. Results for several factors differed for women aged under 50 years or 50 years and over. Despite similar distributions of several known breast cancer risk factors, case-control differences in alcohol consumption suggest that risk in this high-risk population might be modifiable. Intensive study of this or other areas of similarly high incidence might reveal other important risk factors proximate to diagnosis

  14. Incidence, predictive factors, and clinical outcomes of acute kidney injury after gastric surgery for gastric cancer.

    Directory of Open Access Journals (Sweden)

    Chang Seong Kim

    Full Text Available BACKGROUND: Postoperative acute kidney injury (AKI, a serious surgical complication, is common after cardiac surgery; however, reports on AKI after noncardiac surgery are limited. We sought to determine the incidence and predictive factors of AKI after gastric surgery for gastric cancer and its effects on the clinical outcomes. METHODS: We conducted a retrospective study of 4718 patients with normal renal function who underwent partial or total gastrectomy for gastric cancer between June 2002 and December 2011. Postoperative AKI was defined by serum creatinine change, as per the Kidney Disease Improving Global Outcomes guideline. RESULTS: Of the 4718 patients, 679 (14.4% developed AKI. Length of hospital stay, intensive care unit admission rates, and in-hospital mortality rate (3.5% versus 0.2% were significantly higher in patients with AKI than in those without. AKI was also associated with requirement of renal replacement therapy. Multivariate analysis revealed that male gender; hypertension; chronic obstructive pulmonary disease; hypoalbuminemia (<4 g/dl; use of diuretics, vasopressors, and contrast agents; and packed red blood cell transfusion were independent predictors for AKI after gastric surgery. Postoperative AKI and vasopressor use entailed a high risk of 3-month mortality after multiple adjustments. CONCLUSIONS: AKI was common after gastric surgery for gastric cancer and associated with adverse outcomes. We identified several factors associated with postoperative AKI; recognition of these predictive factors may help reduce the incidence of AKI after gastric surgery. Furthermore, postoperative AKI in patients with gastric cancer is an important risk factor for short-term mortality.

  15. Epidemiology of glaucoma in sub-saharan Africa: prevalence, incidence and risk factors.

    Science.gov (United States)

    Kyari, Fatima; Abdull, Mohammed M; Bastawrous, Andrew; Gilbert, Clare E; Faal, Hannah

    2013-01-01

    The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa. Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition. Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma.

  16. Epidemiology of Glaucoma in Sub-Saharan Africa: Prevalence, Incidence and Risk Factors

    Science.gov (United States)

    Kyari, Fatima; Abdull, Mohammed M.; Bastawrous, Andrew; Gilbert, Clare E.; Faal, Hannah

    2013-01-01

    Purpose: The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. Methods: Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa. Results: Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition. Conclusion: Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma. PMID:23741130

  17. Gallbladder perforation during elective laparoscopic cholecystectomy: Incidence, risk factors, and outcomes

    Science.gov (United States)

    Altuntas, Yunus Emre; Oncel, Mustafa; Haksal, Mustafa; Kement, Metin; Gundogdu, Ersin; Aksakal, Nihat; Gezen, Fazli Cem

    2018-01-01

    OBJECTIVE: This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy. METHODS: Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed. RESULTS: In total, 664 patients [524 (78.9%) females, 49.7±13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4±17.5 vs 41.4±18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group. CONCLUSION: The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without. PMID:29607432

  18. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study.

    Science.gov (United States)

    Woolfall, Kerry; Frith, Lucy; Gamble, Carrol; Gilbert, Ruth; Mok, Quen; Young, Bridget

    2015-09-18

    Alternatives to prospective informed consent to enable children with life-threatening conditions to be entered into trials of emergency treatments are needed. Across Europe, a process called deferred consent has been developed as an alternative. Little is known about the views and experiences of those with first-hand experience of this controversial consent process. To inform how consent is sought for future paediatric critical care trials, we explored the views and experiences of parents and practitioners involved in the CATheter infections in CHildren (CATCH) trial, which allowed for deferred consent in certain circumstances. Mixed method survey, interview and focus group study. 275 parents completed a questionnaire; 20 families participated in an interview (18 mothers, 5 fathers). 17 CATCH practitioners participated in one of four focus groups (10 nurses, 3 doctors and 4 clinical trial unit staff). 12 UK children's hospitals. Some parents were momentarily shocked or angered to discover that their child had or could have been entered into CATCH without their prior consent. Although these feelings resolved after the reasons why consent needed to be deferred were explained and that the CATCH interventions were already used in clinical care. Prior to seeking deferred consent for the first few times, CATCH practitioners were apprehensive, although their feelings abated with experience of talking to parents about CATCH. Parents reported that their decisions about their child's participation in the trial had been voluntary. However, mistiming the deferred consent discussion had caused distress for some. Practitioners and parents supported the use of deferred consent in CATCH and in future trials of interventions already used in clinical care. Our study provides evidence to support the use of deferred consent in paediatric emergency medicine; it also indicates the crucial importance of practitioner communication and appropriate timing of deferred consent discussions

  19. Bowel perforation due to break and distal passage of the safety ring of an adjustable intra-gastric balloon: A potentially life threatening situation.

    Science.gov (United States)

    Al-Zubaidi, Ali M; Alghamdi, Hassan U; Alzobydi, Abdu H; Dhiloon, Irshad A; Qureshi, Laeeque A

    2015-04-16

    A 45-year-old man of Middle Eastern origin, morbid obese, with a body mass index of 39 had an intra-gastric balloon, filled with 500 mL of saline/methylene blue and intended as definite therapy, inserted some 8 wk previously. He was admitted to the emergency department with abdominal cramps. An ultrasound of the abdomen was performed in ER which confirmed the balloon to be in place without any abnormality. He was discharged home on symptomatic medication. Patient remains symptomatic therefore he reported back to ER 2 d later. Computed tomography scan was performed this time for further evaluation which revealed a metallic ring present in the small bowel while the intra-gastric balloon was in its proper position. There was no clinical or radiological sign of intestinal obstruction. Patient was hospitalized for observation and conservative management. The following night, patient experienced sudden and severe abdominal pain, therefore an X-ray of the abdomen in erect position was done, which showed free air under the right dome of diaphragm. Patient was transferred to O.R for emergency laparotomy. There were two small perforations identified at the site of the metallic ring entrapment. The ring was removed and the perforations were repaired. Due to increasing prevalence of obesity and advances in modalities for its management, physicians should be aware of treatment options, their benefits, complications and clinical presentation of the known complications. Physicians need to be updated to approach these complications within time, to avoid life-threatening situations caused by these appliances.

  20. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study

    Science.gov (United States)

    Woolfall, Kerry; Frith, Lucy; Gamble, Carrol; Gilbert, Ruth; Mok, Quen; Young, Bridget

    2015-01-01

    Objective Alternatives to prospective informed consent to enable children with life-threatening conditions to be entered into trials of emergency treatments are needed. Across Europe, a process called deferred consent has been developed as an alternative. Little is known about the views and experiences of those with first-hand experience of this controversial consent process. To inform how consent is sought for future paediatric critical care trials, we explored the views and experiences of parents and practitioners involved in the CATheter infections in CHildren (CATCH) trial, which allowed for deferred consent in certain circumstances. Design Mixed method survey, interview and focus group study. Participants 275 parents completed a questionnaire; 20 families participated in an interview (18 mothers, 5 fathers). 17 CATCH practitioners participated in one of four focus groups (10 nurses, 3 doctors and 4 clinical trial unit staff). Setting 12 UK children's hospitals. Results Some parents were momentarily shocked or angered to discover that their child had or could have been entered into CATCH without their prior consent. Although these feelings resolved after the reasons why consent needed to be deferred were explained and that the CATCH interventions were already used in clinical care. Prior to seeking deferred consent for the first few times, CATCH practitioners were apprehensive, although their feelings abated with experience of talking to parents about CATCH. Parents reported that their decisions about their child's participation in the trial had been voluntary. However, mistiming the deferred consent discussion had caused distress for some. Practitioners and parents supported the use of deferred consent in CATCH and in future trials of interventions already used in clinical care. Conclusions Our study provides evidence to support the use of deferred consent in paediatric emergency medicine; it also indicates the crucial importance of practitioner communication

  1. Enhancing pediatric safety: assessing and improving resident competency in life-threatening events with a computer-based interactive resuscitation tool

    International Nuclear Information System (INIS)

    Lerner, Catherine; Gaca, Ana M.; Frush, Donald P.; Ancarana, Anjanette; Hohenhaus, Sue; Seelinger, Terry A.; Frush, Karen

    2009-01-01

    Though rare, allergic reactions occur as a result of administration of low osmolality nonionic iodinated contrast material to pediatric patients. Currently available resuscitation aids are inadequate in guiding radiologists' initial management of such reactions. To compare radiology resident competency with and without a computer-based interactive resuscitation tool in the management of life-threatening events in pediatric patients. The study was approved by the IRB. Radiology residents (n=19; 14 male, 5 female; 19 certified in basic life support/advanced cardiac life support; 1 certified in pediatric advanced life support) were videotaped during two simulated 5-min anaphylaxis scenarios involving 18-month-old and 8-year-old mannequins (order randomized). No advance warning was given. In half of the scenarios, a computer-based interactive resuscitation tool with a response-driven decision tree was available to residents (order randomized). Competency measures included: calling a code, administering oxygen and epinephrine, and correctly dosing epinephrine. Residents performed significantly more essential interventions with the computer-based resuscitation tool than without (72/76 vs. 49/76, P<0.001). Significantly more residents appropriately dosed epinephrine with the tool than without (17/19 vs. 1/19; P<0.001). More residents called a code with the tool than without (17/19 vs. 14/19; P = 0.08). A learning effect was present: average times to call a code, request oxygen, and administer epinephrine were shorter in the second scenario (129 vs. 93 s, P=0.24; 52 vs. 30 s, P<0.001; 152 vs. 82 s, P=0.025, respectively). All the trainees found the resuscitation tool helpful and potentially useful in a true pediatric emergency. A computer-based interactive resuscitation tool significantly improved resident performance in managing pediatric emergencies in the radiology department. (orig.)

  2. At-admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients.

    Science.gov (United States)

    Zorzi, Alessandro; Turri, Riccardo; Zilio, Filippo; Spadotto, Veronica; Baritussio, Anna; Peruzza, Francesco; Gasparetto, Nicola; Marra, Martina Perazzolo; Cacciavillani, Luisa; Marzari, Armando; Tarantini, Giuseppe; Iliceto, Sabino; Corrado, Domenico

    2014-12-01

    Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients. We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)140 (OR=14.6; 95% CI 3.4-62) and LV-EF 140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%. Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality. © The European Society of Cardiology 2014.

  3. [The role of complementary examinations and home monitoring in patient at risk from apparent life threatening event, apneas and sudden infant death syndrome].

    Science.gov (United States)

    Martínez Monseny, A; Bobillo Pérez, S; Martínez Planas, A; García García, J J

    2015-08-01

    Home apnea monitors detect abnormalities in cardiac and respiratory frequency, but their use in the diagnosis of respiratory -related sleep disturbances in children has not been demonstrated, as was originally thought. To describe the type of patients being monitored, for how long and their outcome. A retrospective descriptive study was conducted on patients with controlled home cardiorespiratory monitoring from October 2008 to September 2012 in the Outpatient department of a Maternity tertiary hospital. During the study period 88 patients were included, 58% of them were male, with a median age of 15.5 days, and followed up for a period of 4.7 months. The reason for monitoring was in a 20.5% due to a history of sudden death without finding underlying pathology in 20.5%, 25% due to apnea of prematurity, 20.5% due to apparent life-threatening event, and 14.8% due to choking. Other causes accounted for 19.3% (apnea/hypopnea, desaturation and periodic breathing). Of these last three groups, pathological events were observed in 50% of them: reflux disease (9), apnea of prematurity (2), neurological causes (3), and apnea of unknown cause (10). Suspected infant apnea is a cause for consultation that creates a great deal of concern to the family and the pediatrician. Home monitoring is useful in detecting changes in cardiac and respiratory frequency, but is necessary to limit its indications and ensure proper monitoring of these patients, avoiding the abuse of other tests or treatments. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  4. Worldwide incidence of hepatocellular carcinoma cases attributable to major risk factors.

    Science.gov (United States)

    Baecker, Aileen; Liu, Xing; La Vecchia, Carlo; Zhang, Zuo-Feng

    2018-05-01

    To facilitate regionally specific liver cancer prevention and control, this study estimates the fraction of hepatocellular carcinoma (HCC) cases attributable to five major liver cancer risk factors by geographic region. Prevalence estimates of major HCC risk factors, including chronic infection with hepatitis B and hepatitis C, alcohol drinking, tobacco smoking, obesity, and diabetes, were extracted for each country from the literature, along with recent incidence and risk estimate data, to calculate regionally specific population attributable fractions. Overall, 44% of HCC cases worldwide were attributable to chronic hepatitis B infection, with the majority of cases occurring in Asia. Hepatitis C was responsible for 21% of cases. Lifestyle risk factors such as alcohol drinking and obesity were responsible for a larger percentage of cases in North America and Western, Central, and Eastern Europe. In addition, strong sex disparities were observed when looking at lifestyle risk factors, particularly tobacco smoking, in Asia and Africa. Prominent risk factors for HCC vary depending on the region. Our findings provide useful data for developing regionally specific guidelines for liver cancer prevention and control worldwide.

  5. Incidence and Risk Factor Analysis of Symptomatic Venous Thromboembolism After Knee Arthroscopy.

    Science.gov (United States)

    Krych, Aaron J; Sousa, Paul L; Morgan, Joseph A; Levy, Bruce A; Stuart, Michael J; Dahm, Diane L

    2015-11-01

    To (1) determine the incidence of symptomatic venous thromboembolic events (VTEs) after knee arthroscopy and arthroscopy-assisted procedures at a single institution and (2) determine associated risk factors for VTEs in these patients. The records of patients who underwent knee arthroscopy at a single institution between 1988 and 2008 were reviewed. Chemoprophylaxis was not routinely used. Confirmed VTEs occurring within 4 weeks after the index arthroscopy procedure were included. A 2:1 matched control group was generated to include patients in whom knee arthroscopy was performed by the same surgeon either on the same day or immediately before each case resulting in a VTE. Preoperative and perioperative data were collected with respect to demographic data, medical history, medications, and surgical and anesthesia data. Univariate and multivariate analyses were performed. During the study period, 12,595 patients underwent knee arthroscopy. Among these patients, 43 cases of VTEs (35 deep venous thromboses [DVTs], 5 pulmonary embolisms [PEs], and 3 DVTs that progressed to PEs) occurred, resulting in an incidence of 0.30% (95% confidence interval [CI], 0.22% to 0.41%) for DVT, 0.06% (95% CI, 0.03% to 0.12%) for PE, and 0.34% (95% CI, 0.25% to 0.46%) for VTEs overall. Factors associated with an elevated risk of symptomatic postoperative VTEs included a history of malignancy (P = .01; odds ratio [OR], 6.3), a history of VTEs (P = .02; OR, 5.2), or the presence of more than 2 classic risk factors for VTEs (P = .01; OR, 13.6). In this study, symptomatic VTEs were rare and occurred infrequently, with an incidence of 0.34% (95% CI, 0.25% to 0.46%), after knee arthroscopy and arthroscopy-assisted cases in the absence of routine chemoprophylaxis. Patients with a history of VTEs, a history of malignancy, or 2 or more classic risk factors are at increased risk of VTEs after knee arthroscopy, and chemoprophylaxis should be considered in these select patients. Level III, case

  6. Subacute haematotoxicity after PRRT with {sup 177}Lu-DOTA-octreotate: prognostic factors, incidence and course

    Energy Technology Data Exchange (ETDEWEB)

    Bergsma, Hendrik; Konijnenberg, Mark W.; Kam, Boen L.R.; Teunissen, Jaap J.M.; Kooij, Peter P.; Krenning, Eric P.; Kwekkeboom, Dik J. [Erasmus University Medical Center, Department of Nuclear Medicine, Rotterdam (Netherlands); Herder, Wouter W. de [Erasmus Medical Center, Department of Internal Medicine, Rotterdam (Netherlands); Franssen, Gaston J.H.; Eijck, Casper H.J. van [Erasmus Medical Center, Department of Surgery, Rotterdam (Netherlands)

    2016-03-15

    In peptide receptor radionuclide therapy (PRRT), the bone marrow (BM) is one of the dose-limiting organs. The accepted dose limit for BM is 2 Gy, adopted from {sup 131}I treatment. We investigated the incidence and duration of haematological toxicity and its risk factors in patients treated with PRRT with {sup 177}Lu-DOTA{sup 0}-Tyr{sup 3}-octreotate ({sup 177}Lu-DOTATATE). Also, absorbed BM dose estimates were evaluated and compared with the accepted 2 Gy dose limit. The incidence and duration of grade 3 or 4 haematological toxicity (according to CTCAE v3.0) and risk factors were analysed. Mean BM dose per unit (gigabecquerels) of administered radioactivity was calculated and the correlations between doses to the BM and haematological risk factors were determined. Haematological toxicity (grade 3/4) occurred in 34 (11 %) of 320 patients. In 15 of the 34 patients, this lasted more than 6 months or blood transfusions were required. Risk factors significantly associated with haematological toxicity were: poor renal function, white blood cell (WBC) count <4.0 x 10{sup 9}/l, age over 70 years, extensive tumour mass and high tumour uptake on the OctreoScan. Previous chemotherapy was not associated. The mean BM dose per administered activity in 23 evaluable patients was 67 ± 7 mGy/GBq, resulting in a mean BM dose of 2 Gy in patients who received four cycles of 7.4 GBq {sup 177}Lu-DOTATATE. Significant correlations between (cumulative) BM dose and platelet and WBC counts were found in a selected group of patients. The incidence of subacute haematological toxicity after PRRT with {sup 177}Lu-DOTATATE is acceptable (11 %). Patients with impaired renal function, low WBC count, extensive tumour mass, high tumour uptake on the OctreoScan and/or advanced age are more likely to develop grade 3/4 haematological toxicity. The BM dose limit of 2 Gy, adopted from {sup 131}I, seems not to be valid for PRRT with {sup 177}Lu-DOTATATE. (orig.)

  7. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis.

    Science.gov (United States)

    Cui, Mei Lan; Kim, Kook Hyun; Kim, Ho Gak; Han, Jimin; Kim, Hyunsoo; Cho, Kwang Bum; Jung, Min Kyu; Cho, Chang Min; Kim, Tae Nyeun

    2014-05-01

    Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems. Acute fluid collections and pseudocyst formation are the most frequent complications of acute pancreatitis. The aims of this study were to evaluate the incidence, risk factors, and clinical course of pancreatic fluid collections and pseudocyst formation following acute pancreatitis. A prospective multicenter study was conducted in five participating centers with 302 patients diagnosed with acute pancreatitis from January 2011 to July 2012. The incidence of pancreatic fluid collections and pseudocyst was 42.7 and 6.3 %, respectively. Patients with fluid collections were significantly younger, compared to those without fluid collections (51.5 ± 15.9 vs. 60.4 ± 16.5 years, P = 0.000). The proportion of alcoholic etiology (54.3 %) in patients with fluid collections was significantly higher compared to other etiologies (P = 0.000). C-reactive protein (CRP) (48 h) was significantly higher in patients with fluid collections, compared to patients without fluid collections (39.2 ± 77.4 vs. 15.1 ± 36.2 mg/dL, P = 0.016). LDH (48 h) was significantly higher in patients with pseudocyst formation, compared to patients with complete resolution (1,317.6 ± 706.4 vs. 478.7 ± 190.5 IU/L, P = 0.000). Pancreatic fluid collections showed spontaneous resolution in 69.8 % (90/129) and 84.2 % of the pseudocysts disappeared or decreased in size during follow up. Age, CRP (48 h), and alcohol etiology are risk factors for pancreatic fluid collections. LDH (48 h) appears to be a risk factor for pseudocyst formation. Most pseudocysts showed a decrease in size or spontaneous resolution with conservative management.

  8. Acute lung injury complicating blood transfusion in post-partum hemorrhage: incidence and risk factors.

    Science.gov (United States)

    Teofili, Luciana; Bianchi, Maria; Zanfini, Bruno A; Catarci, Stefano; Sicuranza, Rossella; Spartano, Serena; Zini, Gina; Draisci, Gaetano

    2014-01-01

    We retrospectively investigated the incidence and risk factors for transfusion-related acute lung injury (TRALI) among patients transfused for post-partum hemorrhage (PPH). We identified a series of 71 consecutive patients with PPH requiring the urgent transfusion of three or more red blood cell (RBC) units, with or without transfusion of fresh frozen plasma (FFP) and/or platelets (PLT). Clinical records were then retrieved and examined for respiratory distress events. According to the 2004 consensus definition, cases of new-onset hypoxemia, within 6 hours after transfusion, with bilateral pulmonary changes, in the absence of cardiogenic pulmonary edema were identified as TRALI. If an alternative risk factor for acute lung injury was present, possible TRALI was diagnosed. Thirteen cases of TRALI and 1 case of possible TRALI were identified (overall incidence 19.7%). At univariate analysis, patients with TRALI received higher number of RBC, PLT and FFP units and had a longer postpartum hospitalization. Among the diseases occurring in pregnancy- and various pre-existing comorbidities, only gestational hypertension and pre-eclampsia, significantly increased the risk to develop TRALI (p = 0.006). At multivariate analysis including both transfusion- and patient-related risk factors, pregnancy-related, hypertensive disorders were confirmed to be the only predictors for TRALI, with an odds ratio of 27.7 ( 95% CI 1.27-604.3, p=0.034). Patients suffering from PPH represent a high-risk population for TRALI. The patients with gestational hypertension and pre-eclampsia, not receiving anti-hypertensive therapy, have the highest risk. Therefore, a careful monitoring of these patients after transfusions is recommended.

  9. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China.

    Science.gov (United States)

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China.

  10. Incidence of and risk factors for surgical site infections in women undergoing hysterectomy for endometrial carcinoma.

    Science.gov (United States)

    Tuomi, Taru; Pasanen, Annukka; Leminen, Arto; Bützow, Ralf; Loukovaara, Mikko

    2016-04-01

    The purpose of this study was to determine the incidence of, and risk factors for, surgical site infections in a contemporary cohort of women with endometrial carcinoma. We retrospectively studied 1164 women treated for endometrial carcinoma by hysterectomy at a single institution in 2007-2013. In all, 912 women (78.4%) had minimally invasive hysterectomy. Data on surgical site infections were collected from medical records. Univariate and multivariate analyses were used to identify risk factors for incisional and organ/space infections. Ninety-four women (8.1%) were diagnosed with a surgical site infection. Twenty women (1.7%) had an incisional infection and 74 (6.4%) had an organ/space infection. The associations of 17 clinico-pathologic and surgical variables were tested by univariate analyses. Those variables that were identified as potential risk factors in univariate analyses (p infections as dependent variables. Obesity (body mass index ≥ 30 kg/m(2)), diabetes, and long operative time (>80th centile) were independently associated with a higher risk of incisional infection, whereas minimally invasive surgery was associated with a smaller risk. Smoking, conversion to laparotomy, and lymphadenectomy were associated with a higher risk of organ/space infection. Organ/space infections comprised the majority of surgical site infections. Risk factors for incisional and organ/space infections differed. Minimally invasive hysterectomy was associated with a smaller risk of incisional infections but not of organ/space infections. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the netherlands, january 2008 to december 2012

    NARCIS (Netherlands)

    Gadroen, Kartini; Kemmeren, Jeanet M.; Bruijning-Verhagen, P. C.; Straus, Sabine M J M; Weibel, Daniel; de Melker, Hester E.; Sturkenboom, M. C.

    2017-01-01

    Intussusception is a rare, potentially life-threatening condition in early childhood. It gained attention due to an unexpected association with the first rotavirus vaccine, RotaShield, which was subsequently withdrawn from the market. Across Europe, broad variations in intussusception incidence

  12. Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012.

    NARCIS (Netherlands)

    Gadroen, Kartini; Kemmeren, Jeanet M; Bruijning-Verhagen, Patricia Cj; Straus, Sabine Mjm; Weibel, Daniel; de Melker, Hester E; Sturkenboom, Miriam Cjm

    2017-01-01

    Intussusception is a rare, potentially life-threatening condition in early childhood. It gained attention due to an unexpected association with the first rotavirus vaccine, RotaShield, which was subsequently withdrawn from the market. Across Europe, broad variations in intussusception incidence

  13. Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

    International Nuclear Information System (INIS)

    Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo

    2009-01-01

    To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 ± 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition

  14. Risk Factors for Incident and Redetected Chlamydia trachomatis Infection in Women

    DEFF Research Database (Denmark)

    Harder, Elise; Thomsen, Louise T; Frederiksen, Kirsten

    2016-01-01

    .69; 95% CI, 1.11-2.56; for basic education vs. high school or higher), and high-risk HPV positivity at baseline (OR, 1.66; 95% CI, 1.06-2.58) were risk factors for incident infection, whereas older age (OR, 0.86 per year increase; 95% CI, 0.80-0.93) and condom use (OR, 0.60; 95% CI, 0.38-0.94) were...... associated with reduced risk. Among CT DNA positive women at baseline (n = 469), 108 (23.0%) tested positive at follow-up (redetected infection). We found no statistically significant associations between age, educational level, sexual behavior, smoking, or high-risk HPV status and the risk for redetected CT....... CONCLUSION: Young age, low educational level, high number of sexual partners, failure to use condoms, and high-risk HPV positivity are associated with increased risk for incident CT infection. These findings may guide the development of targeted CT prevention strategies, including screening and information...

  15. Terrorism in Australia: factors associated with perceived threat and incident-critical behaviours

    Directory of Open Access Journals (Sweden)

    Raphael Beverley

    2009-03-01

    Full Text Available Abstract Background To help improve incident preparedness this study assessed socio-demographic and socio-economic predictors of perceived risk of terrorism within Australia and willingness to comply with public safety directives during such incidents. Methods The terrorism perception question module was incorporated into the New South Wales Population Health Survey and was completed by a representative sample of 2,081 respondents in early 2007. Responses were weighted against the New South Wales population. Results Multivariate analyses indicated that those with no formal educational qualifications were significantly more likely (OR = 2.10, 95%CI:1.32–3.35, p Conclusion Low education level is a risk factor for high terrorism risk perception and concerns regarding potential impacts. The pattern of concern and response among those of migrant background may reflect secondary social impacts associated with heightened community threat, rather than the direct threat of terrorism itself. These findings highlight the need for terrorism risk communication and related strategies to address the specific concerns of these sub-groups as a critical underpinning of population-level preparedness.

  16. Identification and prioritization of effective factors in fire incidents preparation programs

    Directory of Open Access Journals (Sweden)

    M. Arvan

    2016-04-01

    Full Text Available One of the major challenges in mega cities is the degree of the preparedness of organizations, institutions and people in facing with critical conditions and their immediate reaction according to pre-defined instructions. Identification of priorities and acting accordingly is an undeniable factor in urban crisis management. The purpose of this research was to identify the priorities of preparedness and readiness to immediate responses in case of large fire incident occurrence in the urban areas. District 9 of Tehran municipality was selected as a case study. Considering the Specific regional conditions of this area such as high population, old unstable housing constructions, presence of Mehr-abad air port at the heart of the district, and the gas transmission pipeline mark this district as a vulnerable area to fire incidents. According to the crisis management readiness index, 2 types of questionnaires were distributed among members of the crisis department and fire rescue forces of the district 9. The results reviled that the most important priorities were basic training to residents, equipping the gas valves with automatic cut off switches in an emergency situation, training the responsible personnel to act efficiently in the early hours of accident and performing maneuvers. SPSS software was used for statistical analysis and Cranach’s alpha coefficient was used to test the reliability of the questionnaire and to test the hypotheses single-sample T -test was used.

  17. Epidemiology of systemic sclerosis: incidence, prevalence, survival, risk factors, malignancy, and environmental triggers.

    Science.gov (United States)

    Barnes, Jammie; Mayes, Maureen D

    2012-03-01

    To identify the recent data regarding prevalence, incidence, survival, and risk factors for systemic sclerosis (SSc) and to compare these data to previously published findings. SSc disease occurrence data are now available for Argentina, Taiwan, and India and continue to show wide variation across geographic regions. The survival rate is negatively impacted by older age of onset, male sex, scleroderma renal crisis, pulmonary fibrosis, pulmonary arterial hypertension, cancer, and antitopoisomerase and anti-U1 antibodies. It appears that silica exposure confers an increased risk for developing scleroderma, but this exposure accounts for a very small proportion of male patients. Smoking is not associated with increased SSc susceptibility. Malignancies are reported in scleroderma at an increased rate, but the magnitude of this risk and the type of cancer vary among reports. Prevalence and incidence of SSc appears to be greater in populations of European ancestry and lower in Asian groups. Exposure to silica dust appears to be an environmental trigger, but this only accounts for a small proportion of male cases. Evidence for increased risk of neoplasia is suggestive, but the magnitude of the risk and the types of malignancies vary among reports.

  18. Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment.

    Science.gov (United States)

    Guimaraes-Pereira, Luis; Valdoleiros, Ines; Reis, Pedro; Abelha, Fernando

    2016-04-01

    Persistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months' duration. Identify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients. We conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D). One hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%. This study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment.

  19. Incidence and mechanism of central pontine myelinolysis based on analysis of MRI images and risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Kondo, Masato [Akita Univ. (Japan). School of Medicine

    2000-02-01

    In this study, the incidence of central pontine myelinolysis (CPM)-like lesions on MRI images was studied in 1917 subjects, 1,500 of which were psychiatric patients and 417 were patients attending a brain health examination. The CPM-like lesions were first classified into four groups based on the characteristics of their MRI images: group 1 showed symmetrical lesions on both T1 low and T2 high images and were considered to be typical CPM; group 2 showed symmetrical high intensity lesions only on T2 images; group 3 had asymmetrical lesions only on T2 images; and group 4 had asymmetrical lesions on both T1 low and T2 high images. Furthermore, the relationships of each group with particular risk factors, such as alcoholism, hypertension, hyperlipidemia were statistically analysed. The cause of CPM-like features in the MRI images were discussed. Among our subjects, the incidence of CPM-like lesions was 3.8%, and that of group 1 was 1.2%. Significant correlations between group 1 and alcoholism, and group 3 and 4 with brain ischemic lesions were observed. A previous hypothesis that group 2 may be a premature state of CPM is not supported by our results. (author)

  20. Causal Factors and Adverse Conditions of Aviation Accidents and Incidents Related to Integrated Resilient Aircraft Control

    Science.gov (United States)

    Reveley, Mary S.; Briggs, Jeffrey L.; Evans, Joni K.; Sandifer, Carl E.; Jones, Sharon Monica

    2010-01-01

    The causal factors of accidents from the National Transportation Safety Board (NTSB) database and incidents from the Federal Aviation Administration (FAA) database associated with loss of control (LOC) were examined for four types of operations (i.e., Federal Aviation Regulation Part 121, Part 135 Scheduled, Part 135 Nonscheduled, and Part 91) for the years 1988 to 2004. In-flight LOC is a serious aviation problem. Well over half of the LOC accidents included at least one fatality (80 percent in Part 121), and roughly half of all aviation fatalities in the studied time period occurred in conjunction with LOC. An adverse events table was updated to provide focus to the technology validation strategy of the Integrated Resilient Aircraft Control (IRAC) Project. The table contains three types of adverse conditions: failure, damage, and upset. Thirteen different adverse condition subtypes were gleaned from the Aviation Safety Reporting System (ASRS), the FAA Accident and Incident database, and the NTSB database. The severity and frequency of the damage conditions, initial test conditions, and milestones references are also provided.

  1. Incidence and factors associated with sensorineural and conductive hearing loss among survivors of congenital diaphragmatic hernia.

    Science.gov (United States)

    Partridge, Emily A; Bridge, Christina; Donaher, Joseph G; Herkert, Lisa M; Grill, Elena; Danzer, Enrico; Gerdes, Marsha; Hoffman, Casey H; D'Agostino, Jo Ann; Bernbaum, Judy C; Rintoul, Natalie E; Peranteau, William H; Flake, Alan W; Adzick, N Scott; Hedrick, Holly L

    2014-06-01

    The reported incidence of sensorineural hearing loss (SNHL) in long-term survivors of congenital diaphragmatic hernia varies widely in the literature. Conductive hearing loss (CHL) is also known to occur in CDH patients, but has been less widely studied. We sought to characterize the incidence and risk factors associated with SNHL and CHL in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution. We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2004 through December 2012. Categorical variables were analyzed by Fisher's exact test and continuous variables by Mann-Whitney t-test (p≤0.05). A total of 112 patients met study inclusion criteria, with 3 (2.7%) patients diagnosed with SNHL and 38 (34.0%) diagnosed with CHL. SNHL was significantly associated with requirement for ECMO (p=0.0130), prolonged course of hospitalization (p=0.0011), duration of mechanical ventilation (p=0.0046), requirement for tracheostomy (p=0.0013), and duration of loop diuretic (p=0.0005) and aminoglycoside therapy (p=0.0003). We have identified hearing anomalies in over 30% of long-term CDH survivors. These findings illustrate the need for routine serial audiologic evaluations throughout childhood for all survivors of CDH and stress the importance of targeted interventions to optimize long-term developmental outcomes pertaining to speech and language. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Epidemiology and Risk Factors of Incident Hepatitis E Virus Infections in Rural Bangladesh

    Science.gov (United States)

    Labrique, Alain B.; Zaman, K.; Hossain, Zahid; Saha, Parimalendu; Yunus, Mohammad; Hossain, Anowar; Ticehurst, John R.; Nelson, Kenrad E.

    2010-01-01

    Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. Most of South Asia is HEV endemic, with frequent seasonal epidemics of hepatitis E and continuous sporadic cases. This author group's epidemiologic work and clinical reports suggest that Bangladesh is HEV endemic, but there have been few population-based studies of this country's HEV burden. The authors calculated HEV infection rates, over an 18-month interval between 2003 and 2005, by following a randomly selected cohort of 1,134 subjects between the ages of 1 and 88 years, representative of rural communities in southern Bangladesh. Baseline prevalence of antibody to hepatitis E virus (anti-HEV) was 22.5%. Seroincidence was 60.3 per 1,000 person-years during the first 12 months and 72.4 per 1,000 person-years from >12 to 18 months (during the monsoon season), peaking by age 50 years and with low rates during childhood. Few of the seroconverting subjects reported hepatitis-like illness. Overall incidence was calculated to be 64 per 1,000 person-years, with 1,172 person-years followed. No significant associations were found between anti-HEV incidence and demographic or socioeconomic factors for which data were available. This is the first study to document annual HEV infection rates among “healthy” and very young to elderly subjects in a rural Bangladeshi population. PMID:20801864

  3. Angiographically Negative Acute Arterial Upper and Lower Gastrointestinal Bleeding: Incidence, Predictive Factors, and Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hyoung; Shin, Ji Hoon; Yoon, Hyun Ki; Chae, Eun Young; Myung, Seung Jae; Ko, Gi Young; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, Seoul (Korea, Republic of)

    2009-08-15

    To evaluate the incidence, predictive factors, and clinical outcomes of angiographically negative acute arterial upper and lower gastrointestinal (GI) bleeding. From 2001 to 2008, 143 consecutive patients who underwent an angiography for acute arterial upper or lower GI bleeding were examined. The angiographies revealed a negative bleeding focus in 75 of 143 (52%) patients. The incidence of an angiographically negative outcome was significantly higher in patients with a stable hemodynamic status (p < 0.001), or in patients with lower GI bleeding (p = 0.032). A follow-up of the 75 patients (range: 0-72 months, mean: 8 {+-} 14 months) revealed that 60 of the 75 (80%) patients with a negative bleeding focus underwent conservative management only, and acute bleeding was controlled without rebleeding. Three of the 75 (4%) patients underwent exploratory surgery due to prolonged bleeding; however, no bleeding focus was detected. Rebleeding occurred in 12 of 75 (16%) patients. Of these, six patients experienced massive rebleeding and died of disseminated intravascular coagulation within four to nine hours after the rebleeding episode. Four of the 16 patients underwent a repeat angiography and the two remaining patients underwent a surgical intervention to control the bleeding. Angiographically negative results are relatively common in patients with acute GI bleeding, especially in patients with a stable hemodynamic status or lower GI bleeding. Most patients with a negative bleeding focus have experienced spontaneous resolution of their condition.

  4. Incidence and mechanism of central pontine myelinolysis based on analysis of MRI images and risk factors

    International Nuclear Information System (INIS)

    Kondo, Masato

    2000-01-01

    In this study, the incidence of central pontine myelinolysis (CPM)-like lesions on MRI images was studied in 1917 subjects, 1,500 of which were psychiatric patients and 417 were patients attending a brain health examination. The CPM-like lesions were first classified into four groups based on the characteristics of their MRI images: group 1 showed symmetrical lesions on both T1 low and T2 high images and were considered to be typical CPM; group 2 showed symmetrical high intensity lesions only on T2 images; group 3 had asymmetrical lesions only on T2 images; and group 4 had asymmetrical lesions on both T1 low and T2 high images. Furthermore, the relationships of each group with particular risk factors, such as alcoholism, hypertension, hyperlipidemia were statistically analysed. The cause of CPM-like features in the MRI images were discussed. Among our subjects, the incidence of CPM-like lesions was 3.8%, and that of group 1 was 1.2%. Significant correlations between group 1 and alcoholism, and group 3 and 4 with brain ischemic lesions were observed. A previous hypothesis that group 2 may be a premature state of CPM is not supported by our results. (author)

  5. Are first rib fractures a marker for other life-threatening injuries in patients with major trauma? A cohort study of patients on the UK Trauma Audit and Research Network database

    OpenAIRE

    Sammy, Ian Ayenga; Chatha, Hridesh; Lecky, Fiona; Bouamra, Omar; Fragoso-I?iguez, Marisol; Sattout, Abdo; Hickey, Michael; Edwards, John E

    2017-01-01

    Background: First rib fractures are considered indicators of increased morbidity and mortality in major trauma. However, this has not been definitively proven. With an increased use of CT and the potential increase in detection of first rib fractures, re-evaluation of these injuries as a marker for life-threatening injuries is warranted.\\ud \\ud Methods: Patients sustaining rib fractures between January 2012 and December 2013 were investigated using data from the UK Trauma Audit and Research N...

  6. Alpine ski and snowboarding traumatic injuries: incidence, injury patterns, and risk factors for 10 years.

    Science.gov (United States)

    McBeth, Paul B; Ball, Chad G; Mulloy, Robert H; Kirkpatrick, Andrew W

    2009-05-01

    Alpine skiing and snowboarding are popular winter sports in Canada. Every year participation in these activities results in traumatic injury. The purpose of this study was to identify the incidence and injury patterns, as well as risk factors associated with ski and snowboarding injuries. A comprehensive 10-year retrospective review of Alpine ski and snowboarding injuries from 1996 to 2006 was conducted. The Alberta Trauma Registry was used as the primary source of data. A total of 196 patients (56.6% skiers, 43.4% snowboarders) were identified as having major traumatic injuries (Injury Severity Score, >or=12). Forty-three patients required intensive care unit support. The majority of injuries were related to falls and collisions with natural objects. Head injuries were most common, followed by chest, spinal, and extremity trauma. Seventy-nine patients required emergency surgery. Skiing and snowboarding represent activities with high potential for traumatic injury. Safety initiatives should be developed to target this population.

  7. Psychosocial factors of modern work life and incident depression in Denmark 2000-06

    DEFF Research Database (Denmark)

    Nygaard, Else; Thielen, Karsten; Diderichsen, Finn

    2008-01-01

    . By logistic regression we calculated odds ratio (OR) and confidence intervals (CIs) for depression, controlling for age, sex, occupational social position, family status, alcohol consumption, seniority and MDI score at baseline. Results Preliminary results showed that work pace (OR 1.72, 95% CI 1......Depressions and depressive symptoms play a major explanatory role to sickness absence and early retirement at the Danish labour market, and represent a general public health issue. Modern work life is borderless, transient and lack sense of community. Aim of study was to analyse the effect...... of psychosocial factors of modern work life on the incidence of depression. Methods Baseline data 2000 were collected from a sample of 7588 Danish men and women aged 40 and 50 years. By October 2006, a follow-up survey was sent to all respondents. Persons, who at baseline were unemployed, with current or prior...

  8. The incidence and risk factors associated with developing symptoms of hypoglycemia after bariatric surgery.

    Science.gov (United States)

    Lee, Clare J; Brown, Todd T; Schweitzer, Michael; Magnuson, Thomas; Clark, Jeanne M

    2018-01-31

    Hypoglycemia after bariatric surgery is an increasingly recognized metabolic complication associated with exaggerated secretion of insulin and gut hormones. We sought to determine the incidence of hypoglycemic symptoms (hypo-sx) after bariatric surgery and characteristics of those affected compared with those unaffected. University hospital. We collected retrospective survey data from the patients who underwent bariatric surgery at a single center. Based on number and severity of postprandial hypo-sx in Edinburgh hypoglycemia questionnaire postoperatively, patients without preoperative hypo-sx were grouped into high versus low suspicion for hypoglycemia. We used multivariable logistic regression to examine potential baseline and operative risk factors for the development of hypo-sx after surgery. Among the 1119 patients who had undergone bariatric surgery who received the questionnaire, 464 (40.6%) responded. Among the 341 respondents without preexisting hypo-sx, 29% (n = 99) had new-onset hypo-sx, and most were severe cases (n = 92) with neuroglycopenic symptoms. Compared with the low suspicion group, the high suspicion group consisted of more female patients, younger patients, patients without diabetes, and those who underwent Roux-en-Y gastric bypass with a longer time since surgery and more weight loss. In multivariate analysis, factors independently associated with incidence of hypo-sx after bariatric surgery were female sex (P = .003), Roux-en-Y gastric bypass (P = .001), and absence of preexisting diabetes (P = .011). New onset postprandial hypoglycemic symptoms after bariatric surgery are common, affecting up to a third of those who underwent bariatric surgery. Many affected individuals reported neuroglycopenic symptoms and were more likely to be female and nondiabetic and to have undergone Roux-en-Y gastric bypass. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  9. Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: Manifestations, incidence, and predictive factors.

    Science.gov (United States)

    Bower, Kraig S; Sia, Rose K; Ryan, Denise S; Mines, Michael J; Dartt, Darlene A

    2015-12-01

    To evaluate dry-eye manifestations after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and determine the incidence and predictive factors of chronic dry eye using a set of dry-eye criteria. Walter Reed Army Medical Center, Washington, DC, USA. Prospective, non-randomized clinical study. Dry-eye evaluation was performed before and after surgery. Main outcome measures included dry-eye manifestations, incidence, and predictive factors of chronic dry eye. This study comprised 143 active-duty U.S. Army personnel, ages 29.9 ± 5.2 years, with myopia or myopic astigmatism (manifest spherical equivalent -3.83 ± 1.96 diopters) having PRK or LASIK. Schirmer scores, corneal sensitivity, ocular surface staining, surface regularity index, and responses to dry-eye questionnaire significantly changed over time after PRK. After LASIK, significant changes were observed in tear breakup time, corneal sensitivity, ocular surface staining, and responses to questionnaire. Twelve months postoperatively, 5.0% of PRK and 0.8% of LASIK participants developed chronic dry eye. Regression analysis showed that pre-operatively lower Schirmer score will significantly influence development of chronic dry eye after PRK, whereas preoperatively, lower Schirmer score or higher ocular surface staining score will significantly influence the occurrence of chronic dry eye after LASIK. Chronic dry eye was uncommon after PRK and LASIK. Ocular surface and tear-film characteristics during pre-operative examination might help to predict chronic dry-eye development in PRK and LASIK. The authors have no financial interest in any product, drug, instrument, or equipment discussed in this manuscript. Copyright © 2015 ASCRS and ESCRS. All rights reserved.

  10. Lobular breast cancer: incidence and genetic and non-genetic risk factors.

    Science.gov (United States)

    Dossus, Laure; Benusiglio, Patrick R

    2015-03-13

    While most invasive breast cancers consist of carcinomas of the ductal type, about 10% are invasive lobular carcinomas. Invasive lobular and ductal carcinomas differ with respect to risk factors. Invasive lobular carcinoma is more strongly associated with exposure to female hormones, and therefore its incidence is more subject to variation. This is illustrated by US figures during the 1987 to 2004 period: after 12 years of increases, breast cancer incidence declined steadily from 1999 to 2004, reflecting among other causes the decreasing use of menopausal hormone therapy, and these variations were stronger for invasive lobular than for invasive ductal carcinoma. Similarly, invasive lobular carcinoma is more strongly associated with early menarche, late menopause and late age at first birth. As for genetic risk factors, four high-penetrance genes are tested in clinical practice when genetic susceptibility to breast cancer is suspected, BRCA1, BRCA2, TP53 and CDH1. Germline mutations in BRCA1 and TP53 are predominantly associated with invasive ductal carcinoma, while BRCA2 mutations are associated with both ductal and lobular cancers. CDH1, the gene coding for the E-cadherin adhesion protein, is of special interest as mutations are associated with invasive lobular carcinoma, but never with ductal carcinoma. It was initially known as the main susceptibility gene for gastric cancer of the diffuse type, but the excess of breast cancers of the lobular type in CDH1 families led researchers to identify it also as a susceptibility gene for invasive lobular carcinoma. The risk of invasive lobular carcinoma is high in female mutation carriers, as about 50% are expected to develop the disease. Carriers must therefore undergo intensive breast cancer screening, with, for example, yearly magnetic resonance imaging and mammogram starting at age 30 years.

  11. Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators.

    Science.gov (United States)

    Webster, Joan; Lister, Carolyn; Corry, Jean; Holland, Michelle; Coleman, Kerrie; Marquart, Louise

    2015-01-01

    To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. We used a prospective cohort study to investigate the research question. The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion. Patients who provided informed consent for study participation were assessed for pressure ulcers, using the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Guidelines, before entering the operating room and again in the post-anesthetic care unit (PACU). Research nurses and all PACU nurses were trained in skin assessment and in pressure ulcer staging. Patients were not assessed again after their discharge from the PACU. Seven patients (1.3%) had existing pressure injuries (ulcers) and a further 6 (1.3%) developed a surgery-related pressure ulcer. Risk factors associated with surgery-related pressure injuries were similar to non-surgically related risks and included older age, skin condition, and being admitted from a location other than one's own home. Length of surgery was not associated with pressure ulcer development in this cohort. Perioperative nurses play an important role in identifying existing or new pressure injuries. However, many of these nurses are unfamiliar with pressure ulcer classification, so education in this area is essential. Although the incidence of surgically acquired pressure ulcers was low in this cohort, careful skin inspection before and after surgery provides an opportunity for early treatment and may prevent existing lesions progressing to higher stages.

  12. Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

    Directory of Open Access Journals (Sweden)

    Meena Pradhan

    2014-03-01

    Full Text Available Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage. Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61 due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333 during the same study period. Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i blood loss 1000-2000 ml, crude odd ratio (OR =18.48 (95% CI 5.1-65.7, adjusted odd ratio (AOR = 9.1 (95% CI 2.2-37.7; (ii blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4, AOR = 45.3 (95% CI 11.6-176.9; (iii previous caesarean section, OR = 5.5 (95% CI 2.9-9.7, AOR = 3.7(95% CI 1.4-9.9; (iv uterine atony, OR = 11.9 (95% CI 5.8-24.6, AOR = 7.5 (95% CI 1.8-30.2; (v placenta previa, OR = 2.04 (95% CI 1.1-3.5, AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy. Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

  13. Incidence, risk factors and ERCP outcome for biliary complications after cadaveric OLT.

    Science.gov (United States)

    Martins, Fernanda Prata; De Paulo, Gustavo Andrade; Conceição, Raquel Dilgerian; Zurstrassen, Maria Paula; Thomé, Tadeu; Ferraz-Neto, Ben-Hur; Ferrari, Angelo Paulo

    2011-01-01

    Biliary complications (BC) occur in up to 39.5% of patients after orthotopic liver transplantation (OLT), being an important source of post-transplant morbidity. The aim is to evaluate the incidence of BC after OLT, associated risk factors and outcome after endoscopic treatment. A retrospective case series between June 2005 and December 2008, including 195 patients that underwent 216 OLT from deceased donors. Thirty-one patients (14.3%) presented at least 1 BC, anastomotic stricture being the most frequent (83.8%). Non-anastomotic stricture was present in 1 (3.2%) and anastomotic fistula in 1. One patient presented anastomotic disconnection at ERCP. BC occurred 94.6 (7-487) days after OLT. Twenty-seven patients underwent endoscopic treatment, on average 2.6 ERCPs were performed per patient. Global endoscopic treatment success rate was 77.3%; being 73.7% for stenosis and 100% (3/3) for anastomotic fistula with stenosis. Recurrence of biliary stricture was observed in 3 patients, all referred to endoscopic re-treatment. ERCP complications: 2 (2.8%) stent migrations, 1 (1.4%) early stent occlusion, 1 (1.4%) respiratory distress and 1(1.4%) severe acute pancreatitis and death. There was no correlation between studied risk factors and BC's occurrence. ERCP was effective for the treatment of BC after OLT. Studied risk factors had no correlation with BC.

  14. The role of environmental and lifestyle factors in the incidence and prevalence of cancer

    Directory of Open Access Journals (Sweden)

    Fatemeh Amereh

    2016-12-01

    Full Text Available  Background and purpose: Cancer is a noteworthy cause of morbidity and mortality worldwide, especially in developing countries. It is more often caused by the environment of a person lives in, rather than his or her innate biology. The highly significant and rapid changes in cancer incidence in the last decades are generally attributed to equally dramatic changes in population exposure to environmental factors. Methods: The available evidence on the role of environmental factors and their relevant effects in cancer rates has been studied. Results: Major of cancer risk factors are include tobacco, overweight and obesity, physical activity, diet and body composition, food, air and water contamination, and viral chronic infections. Exposure assessment and research methodology has been the Achilles heel for studies on environmental contaminants and cancer. Thus, it should not be looked at cancer merely as a disease, since cancer is beyond a disease and must be considered through different aspects. Conclusion: The scientific community effort to increase public awareness, winning the support of policy makers as well as intersectoral coordination in order to lifestyle modifications, reducing high-risk behaviors and confronting food, air and water contamination have strategic importance in cancer prevention. Basic and clinical studies as well as interdisciplinary research thence are necessary for a better understanding of the pathophysiology and finding more effective and cheaper ways to prevent, early diagnosis and treatment of cancer. Accordingly, this requires the investment of governmental and non-governmental democrats. 

  15. Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors

    Science.gov (United States)

    Descatha, Alexis; Leclerc, Annette; Chastang, Jean-François; Roquelaure, Yves

    2003-01-01

    As medial epicondylitis has not been studied alone, we investigated its links between personal and occupational factors in repetitive work, and its course. 1757 workers were examined by an occupational health physician in 1993–94. 598 of them were re-examined three years later. Prevalence was between 4 and 5%, with annual incidence estimated at 1.5%. Forceful work was a risk factor for medial epicondylitis (OR 1.95 CI [1.15–3.32]), but not exposure to repetitive work (OR 1.11, CI [0.59–2.10]). Workers with medial epicondylitis had a significantly higher prevalence of other work-related upper-limb musculoskeletal disorders (WRMD). Risk factors differed for medial and lateral epicondylitis. The prognosis for medial epicondylitis in this population was good with a three-year recovery rate at 81%. Medial epicondylitis was clearly associated with forceful work and other upper-limb WRMD, and its prognosis was good. PMID:14506342

  16. First Annual Report: NASA-ONERA Collaboration on Human Factors in Aviation Accidents and Incidents

    Science.gov (United States)

    Srivastava, Ashok; Fabiani, Patrick

    2012-01-01

    This is the first annual report jointly prepared by NASA and ONERA on the work performed under the agreement to collaborate on a study of the human factors entailed in aviation accidents and incidents particularly focused on consequences of decreases in human performance associated with fatigue. The objective of this Agreement is to generate reliable, automated procedures that improve understanding of the levels and characteristics of flight-crew fatigue factors whose confluence will likely result in unacceptable crew performance. This study entails the analyses of numerical and textual data collected during operational flights. NASA and ONERA are collaborating on the development and assessment of automated capabilities for extracting operationally significant information from very large, diverse (textual and numerical) databases much larger than can be handled practically by human experts. This report presents the approach that is currently expected to be used in processing and analyzing the data for identifying decrements in aircraft performance and examining their relationships to decrements in crewmember performance due to fatigue. The decisions on the approach were based on samples of both the numerical and textual data that will be collected during the four studies planned under the Human Factors Monitoring Program (HFMP). Results of preliminary analyses of these sample data are presented in this report.

  17. Behavioral problems in people with intellectual disability: Basic facts, incidence and risk factors

    Directory of Open Access Journals (Sweden)

    Buha Nataša

    2013-01-01

    Full Text Available In people with intellectual disabilities, behavioral problems result from the interaction of multiple risk factors of different origin, which undoubtedly indicates the importance of knowing their individual characteristics and life circumstances. Incidence, specific forms and topography of behavioral problems depend on different factors, both socio-demographic and inherent ones. Behavioral problems significantly impede acquiring new adaptive skills and have a negative influence on the interaction with the environment. Emotional and behavioral problems are a significant source of stress in children with intellectual disability, as well as their parents and professional staff. These difficulties, especially aggression and disruptiveness, have a big influence on the selection of education model, i.e. on how much the child will be involved in the educational process and the decision whether or not a person will be institutionalized. Better understanding of behavioral problems in people with intellectual disability is the basis of eliminating or reducing risk factors, as well as creating a comprehensive treatment model.

  18. Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country.

    Science.gov (United States)

    Bernabé-Ortiz, Antonio; White, Peter J; Carcamo, Cesar P; Hughes, James P; Gonzales, Marco A; Garcia, Patricia J; Garnett, Geoff P; Holmes, King K

    2009-02-03

    Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially

  19. Perceived job insecurity as a risk factor for incident coronary heart disease

    DEFF Research Database (Denmark)

    Virtanen, Marianna; Nyberg, Solja T; Batty, George David

    2013-01-01

    To determine the association between self reported job insecurity and incident coronary heart disease.......To determine the association between self reported job insecurity and incident coronary heart disease....

  20. Risk factors and incidence of contrast induced nephropathy following coronary intervention

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2008-06-01

    Full Text Available Contrast induced nephropathy (CIN is one of important complication of contrast media administration. Its incidence and risk factors among Indonesian patients undergoing coronary intervention has not been reported yet. CIN was defined as increasing of serum creatinine by 0.5 mg/dl or more in the third day following contrast media exposure. Of 312 patients undergoing coronary intervention, 25% developed CIN. Patient-related risk factors comprised of hypertension, diabetes mellitus, NYHA class, proteinuria, serum creatinine > 1.5 mg/dl and ejection fraction ≤ 35%. Contrast-related risk factors comprised of contrast media volume > 300 ml, contrast media type. However, our final model demonstrated that only hypertension [Hazard ratio (HR = 2.89, 95% confidence intrval (CI = 1.78 to 4.71, P = 0.000], diabetes mellitus (HR = 3.09, 95% CI = 1.89 to 5.06, P = 0.000, ejection fraction (EF ≤ 35% (HR = 2.92; 95% CI = 1.72 to 4.96; P = 0.000, total contrast volume > 300 ml (HR = 7.73; 95% CI = 3.09 to 19.37; P = 0.000 and proteinuria (HR = 14.96; 95% CI = 3.45 to 64.86; P = 0.000 were independent risk factors of CIN. In conclusion, CIN developed in 25% of patients undergoing coronary intervention. The independent risk factors of CIN included hypertension, diabetes mellitus, EF ≤ 35%, contrast volume > 300 ml and proteinuria. (Med J Indones 2008; 17: 131-7Keywords: contrast induced nephropathy, coronary intervention

  1. [Thrombosis and obstruction associated with central venous lines. Incidence and risk factors].

    Science.gov (United States)

    Vivanco Allende, A; Rey Galán, C; Rodríguez de la Rúa, M V; Alvarez García, F; Medina Villanueva, A; Concha Torre, A; Mayordomo Colunga, J; Martínez Camblor, P

    2013-09-01

    To analyse the incidence of thrombosis and obstruction associated with central venous lines (CVL) inserted in critically ill children, and to determine their risk factors. Prospective observational study in a Pediatric Intensive Care Unit in a University Hospital. An analysis was made of 825 CVL placed in 546 patients. Age, gender, weight, type of catheter (lines, size, and brand), final location of the catheter, mechanical ventilation, type of sedation and analgesia used, initial failure by the doctor to perform CVL catheterization, number of attempts, CVL indication, admission diagnosis, emergency or scheduled procedure, and delayed mechanical complications (DMC). Risk factors for these complications were determined by a multiple regression analysis. A total of 52 cases of DMC, 42 cases of obstruction, and 10 of thrombosis were registered. Obstruction and thrombosis rates were 4.96 and 1.18 per 100 CVL, respectively. The only risk factor independently linked to obstruction was the duration of the CVL (OR 1.05; 95% CI; 1.00-1.10). The number of lines with thrombosis (OR 4.88; 95% CI; 1.26-18.0), as well as parenteral nutrition (OR 4.17; 95% CI; 1.06-16.31) was statistically significant according to bivariate analysis. However, no risk factors for thrombosis were found in the multivariate analysis. Obstruction and thrombosis of CVL inserted in a Pediatric Intensive Care Unit are relatively common complications. CVL duration is an independent risk factor for any line obstruction. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  2. Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors.

    Science.gov (United States)

    Sneed, Penny K; Mendez, Joe; Vemer-van den Hoek, Johanna G M; Seymour, Zachary A; Ma, Lijun; Molinaro, Annette M; Fogh, Shannon E; Nakamura, Jean L; McDermott, Michael W

    2015-08-01

    The authors sought to determine the incidence, time course, and risk factors for overall adverse radiation effect (ARE) and symptomatic ARE after stereotactic radiosurgery (SRS) for brain metastases. All cases of brain metastases treated from 1998 through 2009 with Gamma Knife SRS at UCSF were considered. Cases with less than 3 months of follow-up imaging, a gap of more than 8 months in imaging during the 1st year, or inadequate imaging availability were excluded. Brain scans and pathology reports were reviewed to ensure consistent scoring of dates of ARE, treatment failure, or both; in case of uncertainty, the cause of lesion worsening was scored as indeterminate. Cumulative incidence of ARE and failure were estimated with the Kaplan-Meier method with censoring at last imaging. Univariate and multivariate Cox proportional hazards analyses were performed. Among 435 patients and 2200 brain metastases evaluable, the median patient survival time was 17.4 months and the median lesion imaging follow-up was 9.9 months. Calculated on the basis of 2200 evaluable lesions, the rates of treatment failure, ARE, concurrent failure and ARE, and lesion worsening with indeterminate cause were 9.2%, 5.4%, 1.4%, and 4.1%, respectively. Among 118 cases of ARE, approximately 60% were symptomatic and 85% occurred 3-18 months after SRS (median 7.2 months). For 99 ARE cases managed without surgery or bevacizumab, the probabilities of improvement observed on imaging were 40%, 57%, and 76% at 6, 12, and 18 months after onset of ARE. The most important risk factors for ARE included prior SRS to the same lesion (with 20% 1-year risk of symptomatic ARE vs 3%, 4%, and 8% for no prior treatment, prior whole brain radiotherapy [WBRT], or concurrent WBRT) and any of these volume parameters: target, prescription isodose, 12-Gy, or 10-Gy volume. Excluding lesions treated with repeat SRS, the 1-year probabilities of ARE were 2.1 cm, target volume > 1.2 cm(3), prescription isodose volume > 1.8 cm(3

  3. Incidence and risk factors for radiographic lumbar spondylosis and lower back pain in Japanese men and women: the ROAD study.

    Science.gov (United States)

    Muraki, S; Akune, T; Oka, H; Ishimoto, Y; Nagata, K; Yoshida, M; Tokimura, F; Nakamura, K; Kawaguchi, H; Yoshimura, N

    2012-07-01

    To determine the incidence of radiographic lumbar spondylosis (LS)and lower back pain, and their risk factors in Japan using a large-scale population from the nationwide cohort Research on Osteoarthritis/osteoporosis Against Disability (ROAD) Study. Participants in the ROAD study who had been recruited between 2005 and 2007 were followed up with lumbar spine radiography for 3 years. A total of 2,282 paired radiographs (75% of the original sample) were scored using Kellgren and Lawrence (KL) grades, and the incidence and progression rate of radiographic LS was analyzed. The incidence of lower back pain was also examined. In addition, associations between risk factors and incident and progressive radiographic LS as well as incident lower back pain were tested. Given a 3.3-year follow-up, the incidence of KL≥2 radiographic LS was 50.0% and 34.4% (15.3% and 10.5% per year), while that of KL≥3 LS was 15.3% and 23.7% (4.6% and 7.2% per year) in men and women, respectively. The progression rate of LS was 20.5% and 27.4% (6.2% and 8.3% per year) in men and in women, respectively. In addition, the incidence of lower back pain was 28.3% and 31.2% (8.6% and 9.5% per year) in men and women. Lower back pain was not significantly associated with incident radiographic LS, while a more severe KL grade at baseline was associated with incident lower back pain. The present longitudinal study revealed a high incidence of radiographic LS in Japan. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  4. Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal

    Directory of Open Access Journals (Sweden)

    Sokhna Thiam

    2017-09-01

    Full Text Available We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011–2014. Climatic data (i.e., daily temperature, night temperature and rainfall for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health–climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming.

  5. Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal.

    Science.gov (United States)

    Thiam, Sokhna; Diène, Aminata N; Sy, Ibrahima; Winkler, Mirko S; Schindler, Christian; Ndione, Jacques A; Faye, Ousmane; Vounatsou, Penelope; Utzinger, Jürg; Cissé, Guéladio

    2017-09-12

    We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011-2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health-climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming.

  6. The factor analysis of the incidence of pneumothorax after CT-guided transthoracic needle aspiration biopsy

    International Nuclear Information System (INIS)

    Zhong Tao; Yu Hongguang; Wang Yong; Yang Sifu; Wang Xiaoxuan

    2007-01-01

    Objective: To analyze the impact of multiple factors on the incidence of pneumothorax associated with CT-guided transthoracic needle aspiration biopsy. Methods: The sign of pneumothorax after 162 cases (lesion diameter from 1 cm to 6 cm) CT-guided transthoracic needle aspiration biopsy was observed and its relationship with multivariate factors were analyzed by multivariate logistic regression model. Results: Thirty-two cases presented pneumothorax accounting for 19. 8%. Single variate analysis showed that the sign of pneumothorax related to intercurrent COPD, distance from lesion and chest wall, needle dwelling time and lesion diameter. 67 patients of intercurrent COPD with postoperative pneumothorax occurred in 22 cases (32.8%); With respect to those having lesions close to the chest wall (48 cases), and the cases with the distance between the chest wall and lesions less than 2 cm (55 cases) and greater than 2 cm (59 cases), the postoperative pneumothorax occurred in 0, 14 (25.5%), 18 (30.5%) cases respectively; For those patients with needle in the chest residence time of less than 10 minutes (82 cases), 10-20 minutes (51 cases), more than 20 minutes (28 cases) after the occurrence of pneumothorax were 8 (9.6%), 10(19.6%), 14 (50%) cases respectively; In contrast, those with lesion diameter less than 2 cm (65 cases), 2-4 cm(52 cases), more than 4cm(45 cases) were 19 (29.2%), 8 (15.4%) and 5 (11.1% ) respectively. The multivariate logistic regression analysis showed that the prior three factor's were risk factors of pneumothorax (OR=4.652, 4.030, 2.855 respectively). Conclusions: To avoid the pneumothorax, caution must be taken with respect to CT-guided transthoracic needle aspiration biopsy, patients with intercurrent COPD, long distance between lesion and chest wall, and smaller lesion diameter. For operation the needle dwell time within thorax should be minimized. (authors)

  7. Spontaneous regression of retinopathy of prematurity:incidence and predictive factors

    Directory of Open Access Journals (Sweden)

    Rui-Hong Ju

    2013-08-01

    Full Text Available AIM:To evaluate the incidence of spontaneous regression of changes in the retina and vitreous in active stage of retinopathy of prematurity(ROP and identify the possible relative factors during the regression.METHODS: This was a retrospective, hospital-based study. The study consisted of 39 premature infants with mild ROP showed spontaneous regression (Group A and 17 with severe ROP who had been treated before naturally involuting (Group B from August 2008 through May 2011. Data on gender, single or multiple pregnancy, gestational age, birth weight, weight gain from birth to the sixth week of life, use of oxygen in mechanical ventilation, total duration of oxygen inhalation, surfactant given or not, need for and times of blood transfusion, 1,5,10-min Apgar score, presence of bacterial or fungal or combined infection, hyaline membrane disease (HMD, patent ductus arteriosus (PDA, duration of stay in the neonatal intensive care unit (NICU and duration of ROP were recorded.RESULTS: The incidence of spontaneous regression of ROP with stage 1 was 86.7%, and with stage 2, stage 3 was 57.1%, 5.9%, respectively. With changes in zone Ⅲ regression was detected 100%, in zoneⅡ 46.2% and in zoneⅠ 0%. The mean duration of ROP in spontaneous regression group was 5.65±3.14 weeks, lower than that of the treated ROP group (7.34±4.33 weeks, but this difference was not statistically significant (P=0.201. GA, 1min Apgar score, 5min Apgar score, duration of NICU stay, postnatal age of initial screening and oxygen therapy longer than 10 days were significant predictive factors for the spontaneous regression of ROP (P<0.05. Retinal hemorrhage was the only independent predictive factor the spontaneous regression of ROP (OR 0.030, 95%CI 0.001-0.775, P=0.035.CONCLUSION:This study showed most stage 1 and 2 ROP and changes in zone Ⅲ can spontaneously regression in the end. Retinal hemorrhage is weakly inversely associated with the spontaneous regression.

  8. Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections

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    Gajović Olgica

    2011-01-01

    Full Text Available Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30% patients developed nosocomial pneumonia. The time to develop pneumonia was 10±6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%, Pseudomonas aeruginosa (24.1%, Acinetobacter spp. (16.6% and Staphylococcus aureus (25.9%. Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

  9. Gestational Diabetes in Korea: Incidence and Risk Factors of Diabetes in Women with Previous Gestational Diabetes

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    Hak Chul Jang

    2011-02-01

    Full Text Available Korean women with a history of gestational diabetes mellitus (GDM have a 3.5 times greater risk of developing postpartum diabetes than the general population. The incidence of type 2 diabetes mellitus in early postpartum is reported as 10-15% in Korean women. A prospective follow-up study on Korean women with GDM showed that approximately 40% of women with previous GDM were expected to develop diabetes within 5 years postpartum. Independent risk factors for the development of diabetes in Korean women with previous GDM are pre-pregnancy body weight, gestational age at diagnosis, antepartum hyperglycemia on oral glucose tolerance test, low insulin response to oral glucose load, and family history of diabetes. Women with postpartum diabetes have greater body mass indexes, body weight, and waist circumferences than women with normal glucose tolerance. Multiple logistic regression analysis has revealed that waist circumference is the strongest obesity index along with systolic blood pressure and that triglyceride levels are a major independent risk factor for developing diabetes. These results in Korean women with previous GDM underline the importance of postpartum testing in Korean women diagnosed with GDM, and demonstrate that impaired B-cell function, obesity, and especially visceral obesity, are associated with the development of diabetes.

  10. Intraoperative ventilation: incidence and risk factors for receiving large tidal volumes during general anesthesia

    Directory of Open Access Journals (Sweden)

    Fernandez-Bustamante Ana

    2011-11-01

    Full Text Available Abstract Background There is a growing concern of the potential injurious role of ventilatory over-distention in patients without lung injury. No formal guidelines exist for intraoperative ventilation settings, but the use of tidal volumes (VT under 10 mL/kg predicted body weight (PBW has been recommended in healthy patients. We explored the incidence and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW. Methods We performed a cross-sectional analysis of our prospectively collected perioperative electronic database for current intraoperative ventilation practices and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW. We included all adults undergoing prolonged (≥ 4 h elective abdominal surgery and collected demographic, preoperative (comorbidities, intraoperative (i.e. ventilatory settings, fluid administration and postoperative (outcomes information. We compared patients receiving exhaled tidal volumes > 10 mL/kg PBW with those that received 8-10 or Results Ventilatory settings were non-uniform in the 429 adults included in the analysis. 17.5% of all patients received VT > 10 mL/kg PBW. 34.0% of all obese patients (body mass index, BMI, ≥ 30, 51% of all patients with a height T > 10 mL/kg PBW. Conclusions Ventilation with VT > 10 mL/kg PBW is still common, although poor correlation with PBW suggests it may be unintentional. BMI ≥ 30, female gender and height

  11. Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors.

    Science.gov (United States)

    Plisky, Melody S; Rauh, Mitchell J; Heiderscheit, Bryan; Underwood, Frank B; Tank, Robert T

    2007-02-01

    Prospective cohort. To determine (1) the cumulative seasonal incidence and overall injury rate of medial tibial stress syndrome (MTSS) and (2) risk factors for MTSS with a primary focus on the relationship between navicular drop values and MTSS in high school cross-country runners. MTSS is a common injury among runners. However, few studies have reported the injury rate and risk factors for MTSS among adolescent runners. Data collected included measurement of bilateral navicular drop and foot length, and a baseline questionnaire regarding the runner's height, body mass, previous running injury, running experience, and orthotic or tape use. Runners were followed during the season to determine athletic exposures (AEs) and occurrence of MTSS. The overall injury rate for MTSS was 2.8/1000 AEs. Although not statistically different, girls had a higher rate (4.3/1000 AEs) than boys (1.7/1000 AEs) (P = .11). Logistic regression modeling indicated that only gender and body mass index (BMI) were significantly associated with the occurrence of MTSS. However, when controlled for orthotic use, only BMI was associated with risk of MTSS. No significant associations were found between MTSS and navicular drop or foot length. Our findings suggest that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross-country season; thus, additional studies are needed to identify appropriate preseason screening tools.

  12. Sphincter-Preserving Surgery for Low Rectal Cancers: Incidence and Risk Factors for Permanent Stoma.

    Science.gov (United States)

    Mak, Joanna Chung Kiu; Foo, Dominic Chi Chung; Wei, Rockson; Law, Wai Lun

    2017-11-01

    Advances in surgical techniques and paradigm changes in rectal cancer treatment have led to a drastic decline in the abdominoperineal resection rate, and sphincter-preserving operation is possible in distal rectal cancer. The aim of this study is to evaluate the long-term incidence of permanent stoma after sphincter-preserving surgery for low rectal cancer and its corresponding risk factors. From 2000 to 2014, patients who underwent sphincter-preserving low anterior resection for low rectal cancer (within 5 cm from the anal verge) were included. The occurrence of permanent stoma over time and its risk factors were investigated by using a Cox proportional hazards regression model. This study included 194 patients who underwent ultra-low anterior resection for distal rectal cancer, and the median follow-up period was 77 months for the surviving patients. Forty-six (23.7%) patients required a permanent stoma eventfully. Anastomotic-related complications and disease progression were the main reasons for permanent stoma. Clinical anastomotic leakage (HR 5.72; 95% CI 2.31-14.12; p consideration when contemplating sphincter-preserving surgery.

  13. [Risk factors for the oral use of antibiotics and animal treatment incidence of weaners in Switzerland].

    Science.gov (United States)

    Hirsiger, P; Malik, J; Kommerlen, D; Vidondo, B; Arnold, C; Harisberger, M; Spring, P; Sidler, X

    2015-12-01

    In the present study, risk factors for the use of oral antibiotics in weaned piglets were collected on 112 pig farms by a personal questionaire. The most common indication for an antibiotic group therapy was diarrhoea, and the most frequently used antibiotic was Colistin. On average, 27.33 daily doses in the control farms and 387.21 daily doses in the problem farms per 1000 weaners were administered on a given day. The significant risk factors in the multivariate model were poor hygiene in the water supply of suckling piglets, less than two doses ofprestarter feed daily, lack of an all-in-and-all-out production system in weaners, no herd book performance data analysis, and less than two of the legally prescribed veterinary visits per year. Furthermore, the treatment incidence of weaners for oral antibiotics was calculated on the basis of the drug inventory. This study provides evidence that the use of oral antibiotics in weaners can be reduced by interventions in hygiene and management.

  14. Incidence of and risk factors for developing pancreatic cancer in patients with chronic pancreatitis.

    Science.gov (United States)

    Kudo, Yujin; Kamisawa, Terumi; Anjiki, Hajime; Takuma, Kensuke; Egawa, Naoto

    2011-01-01

    Pancreatic cancer sometimes occurs during the course of chronic pancreatitis. This study aimed to identify risk factors for developing pancreatic cancer associated with chronic pancreatitis. The incidence of pancreatic cancer developing in 218 patients with chronic pancreatitis and clinical features of the chronic pancreatitis patients who developed pancreatic cancer were studied. Nine patients developed pancreatic cancer. Average period from the diagnosis of chronic pancreatitis to the diagnosis of pancreatic cancer was 9.6 years. All pancreatic cancers were diagnosed at an advanced stage. Only 2 patients had been followed-up periodically. There were no significant differences between chronic pancreatitis patients who developed pancreatic cancer and those who did not in male/female ratio (3.5 vs. 8), average age on diagnosis (65.0 vs. 56.5), alcoholic/non-alcoholic chronic pancreatitis (1.6 vs. 2.6), smoking habits (62.5% vs. 70.7%), diabetes mellitus (77.8% vs. 54.4%), and continued alcohol drinking (37.5% vs. 53.1%). Over the period examined, 4% of chronic pancreatitis patients developed pancreatic cancer. Sex ratio, onset age, etiology, smoking habits, diabetes mellitus, and continued alcohol drinking were not significant risk factors for developing pancreatic cancer in chronic pancreatitis patients. Periodic follow-up due to the possibility of pancreatic cancer is necessary in chronic pancreatitis patients.

  15. [Renal failure in patients with liver transplant: incidence and predisposing factors].

    Science.gov (United States)

    Gerona, S; Laudano, O; Macías, S; San Román, E; Galdame, O; Torres, O; Sorkin, E; Ciardullo, M; de Santibañes, E; Mastai, R

    1997-01-01

    Renal failure is a common finding in patients undergoing orthotopic liver transplantation. The aim of the present study was to evaluate the incidence, prognostic value of pre, intra and postoperative factors and severity of renal dysfunction in patients who undergo liver transplantation. Therefore, the records of 38 consecutive adult patients were reviewed. Renal failure was defined arbitrarily as an increase in creatinine (> 1.5 mg/dl) and/or blood urea (> 80 mg/dl). Three patients were excluded of the final analysis (1 acute liver failure and 2 with a survival lower than 72 hs.) Twenty one of the 35 patients has renal failure after orthotopic liver transplantation. Six of these episodes developed early, having occurred within the first 6 days. Late renal impairment occurred in 15 patients within the hospitalization (40 +/- 10 days) (Mean +/- SD). In he overall series, liver function, evaluated by Child-Pugh classification, a higher blood-related requirements and cyclosporine levels were observed more in those who experienced renal failure than those who did not (p renal failure was related with preoperative (liver function) and intraoperative (blood requirements) factors and several causes (nephrotoxic drugs and graft failure) other than cyclosporine were present in patients who developed late renal impairment. No mortality. No mortality was associated with renal failure. We conclude that renal failure a) is a common finding after liver transplantation, b) the pathogenesis of this complication is multifactorial and, c) in not related with a poor outcome.

  16. PTSD following childbirth: a prospective study of incidence and risk factors in Canadian women.

    Science.gov (United States)

    Verreault, Nancy; Da Costa, Deborah; Marchand, André; Ireland, Kierla; Banack, Hailey; Dritsa, Maria; Khalifé, Samir

    2012-10-01

    The goals of the present study were to estimate the incidence and course of full and partial Post-Traumatic Stress Disorder (PTSD) following childbirth and to prospectively identify factors associated with the development of PTSD symptoms at 1month following childbirth. The sample comprised 308 women, with assessments at four time points: 25-40weeks gestation, 4-6weeks postpartum, 3 and 6months postpartum. Current and prior PTSD were assessed by the Structured Clinical Interview for DSM-IV (SCID-I) and the Modified PTSD Symptom Scale Self-Report (MPSS-SR). Incidence rates of PTSD varied according to time of measurement and instrument used, with higher rates of full and partial PTSD using the MPSS-SR at 1month postpartum (7.6% and 16.6%, respectively). Multivariate logistic regression showed that higher anxiety sensitivity (OR=1.75; 95% CI=1.19‒2.57, p=.005), history of sexual trauma (OR=2.81; 95% CI=1.07‒7.37, p=.036), a more negative childbirth experience than expected (OR=0.96; 95% CI=0.94‒0.98, p=.001), and less available social support at 1month postpartum (OR=0.40; 95% CI=0.17‒0.96, p=.041) independently predicted full or partial PTSD at 1month following childbirth. Our results indicate that a history of sexual trauma and anxiety sensitivity can increase the probability of developing PTSD after childbirth. The findings highlight the importance of screening and providing more tailored services for women at high risk. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  17. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors.

    Science.gov (United States)

    Ottomeyer, Christina; Taylor, Benjamin C; Isaacson, Mark; Martinez, Lara; Ebaugh, Pierce; French, Bruce G

    2017-02-01

    Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern. We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. A review of human factors causations in commercial air transport accidents and incidents: From to 2000-2016

    Science.gov (United States)

    Kharoufah, Husam; Murray, John; Baxter, Glenn; Wild, Graham

    2018-05-01

    Human factors have been defined by the International Civil Aviation Organization (ICAO) as "about people in their living and working situations; about their relationship with machines, with procedures and with the environment about them; and about their relationships with other people (at work)". Human factors contribute to approximately 75% of aircraft accidents and incidents. As such, understanding their influence is essential to improve safety in the aviation industry. This study examined the different human factors causations in a random sample of over 200 commercial air transport accidents and incidents from 2000 to 2016. The main objective of this study was to identify the principal human factor contributions to aviation accidents and incidents. An exploratory research design was utilised. The qualitative data were recorded in a database, and were coded into categories about the flights (including date, manufacturer, carrier, state of occurrence, etc). These categories were then analysed using Chi-Squared tests to determine which were statistically significant in terms of having an influence on the accidents/incidents. The most significant human factor was found to be situational awareness followed by non-adherence to procedures. In addition, charter operations proved to have a significantly higher rate of human factor related occurrence as compared to other type of operations. A significant finding was that Africa has a high rate of accidents/incidents relative to the amount of traffic and aircraft movements. These findings reflect some of the more noteworthy incidents that have received significant media attention, including Air Asia 8501 on the 28th of December 2014, TransAsia Airways 235 on the 4th of February 2015, and Air France 447 on the 1st of June 2009; these accidents resulted in a significant loss of lives where situational awareness and non-adherence to procedures were significant contributing factors.

  19. Hydrology and human behavior: two key factors of diarrhea incidence in montane tropical humid areas

    Science.gov (United States)

    Boithias, Laurie; Choisy, Marc; Souliyaseng, Noy; Jourdren, Marine; Quet, Fabrice; Buisson, Yves; Thammahacksa, Chanthamousone; Silvera, Norbert; Latsachack, Keooudone; Sengtaheuanghoung, Oloth; Pierret, Alain; Rochelle-Newall, Emma; Becerra, Sylvia; Ribolzi, Olivier

    2017-04-01

    The global burden of diarrhea is a leading cause of morbidity and mortality worldwide. In montane areas of South-East Asia such as northern Laos, recent changes in land use have induced increased runoff, soil erosion and in-stream suspended sediment loads, and potential pathogen dissemination. In this study we hypothesized that climate factors combined with human behavior control diarrhea incidence, either because higher rainfall, leading to higher stream discharges, suspended sediment loads and Fecal Indicator Bacteria (FIB) counts, are associated with higher numbers of reported diarrhea cases during the rainy season, or because water shortage leads to the use of less safe water sources during the dry season. For this mixed methods approach, we conducted a retrospective time series analysis of meteorological variables (rainfall, air temperature), hydrological variables (discharge, suspended sediments, FIB counts, water temperature) at the outlet of 2 catchments in Northern Lao PDR, and the number of diarrheal disease cases reported in 6 health centers located in the Luang Prabang Province. We also examined the socio-behavioral factors potentially affecting vulnerability to the effect of the climate factors, such as drinking water sources and hygiene habits. We found the FIB Escherichia coli to be present all year long (100-1,000 MPN 100 mL-1) indicating that fecal contamination is ubiquitous and constant. We found that populations switch their water supply from wells to surface water during drought periods, the latter of which appear to be at higher risk of bacterial contamination than municipal water fountains. We thus found that water shortage in the Luang Prabang area triggers diarrhea peaks during the dry and hot season and that rainfall and aquifer refill ends the epidemic during the wet season. We thus found that anthropogenic drivers, such as hygiene practices, were at least as important as environmental drivers in determining the seasonal pattern of a

  20. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors.

    Science.gov (United States)

    Solans-Domènech, Maite; Sánchez, Emília; Espuña-Pons, Montserrat

    2010-03-01

    To estimate frequency and severity and to identify risk factors of urinary incontinence (UI) and anal incontinence during pregnancy and after delivery in previously continent nulliparous women. We designed a cohort study of healthy, continent, nulliparous pregnant women attending public health care services. The field work was conducted during the control visits of the three trimesters of pregnancy, at the time of delivery, and postpartum. A self-administered questionnaire was used to assess UI (validated and adapted) and anal incontinence. Frequency of UI and anal incontinence and their confidence intervals (95% CIs) were calculated. The correlations between the severity of UI and the degree of effect on daily life were also estimated. Multivariable Cox models were applied to estimate hazard ratios for both incontinences (urinary/anal) during pregnancy and postpartum. The cumulative incidence rate during pregnancy was 39.1% (95% CI 36.3-41.9) for UI and 10.3% (95% CI 8.3-12.3) for anal incontinence. The correlation between severity of UI and effect on daily life was moderate. Age, baseline body mass index, and family history of UI were significantly associated with the occurrence of UI during pregnancy, while age and excess weight gain during pregnancy were associated with the occurrence of anal incontinence during pregnancy. Postpartum, the identified risk factors for both incontinences were incontinence during pregnancy and vaginal delivery. The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence. Some risk factors for both incontinences during pregnancy and postpartum are related to lifestyles and obstetric practices.

  1. Incidence, Risk Factors, and Clinical Implications of Pneumonia Following Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Bohl, Daniel D; Saltzman, Bryan M; Sershon, Robert A; Darrith, Brian; Okroj, Kamil T; Della Valle, Craig J

    2017-06-01

    The purpose of this study is to determine the incidence, risk factors, and clinical implications of pneumonia following total joint arthroplasty (TJA). The American College of Surgeons National Surgical Quality Improvement Program was used to conduct a retrospective cohort study of patients undergoing TJA. Independent risk factors for the development of pneumonia within 30 days of TJA were identified using multivariate regression. Mortality and readmission rates were compared between patients who did and did not develop pneumonia. Multivariate regression was used to adjust for all demographic, comorbidity, and procedural characteristics. In total, 171,200 patients met inclusion criteria, of whom 66,493 (38.8%) underwent THA and 104,707 (61.2%) underwent TKA. Of the 171,200 patients, 590 developed pneumonia, yielding a rate of 0.34% (95% confidence interval = 0.32%-0.37%). Independent risk factors for pneumonia were chronic obstructive pulmonary disease, diabetes mellitus, greater age (most notably ≥80 years), dyspnea on exertion, dependent functional status, lower body mass index, hypertension, current smoker status, and male sex. The subset of patients who developed pneumonia following discharge had a higher readmission rate (82.1% vs 3.4%, adjusted relative risk [RR] = 16.6, P pneumonia. Pneumonia is a serious complication following TJA that occurs in approximately 1 in 300 patients. Approximately 4 in 5 patients who develop pneumonia are subsequently readmitted, and approximately 1 in 25 die. Given the serious implications of this complication, evidence-based pneumonia prevention programs including oral hygiene with chlorhexidine, sitting upright for meals, elevation of the head of the bed to at least 30°, aggressive incentive spirometry, and early ambulation should be considered for patients at greatest risk. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: Incidence, contributing factors and outcomes.

    Science.gov (United States)

    Shahbazian, Hajieh; Nouhjah, Sedigheh; Shahbazian, Nahid; Jahanfar, Shayesteh; Latifi, Seyed Mahmoud; Aleali, Armaghan; Shahbazian, Nasrin; Saadati, Najmieh

    Different approaches for screening and diagnosis of gestational diabetes mellitus(GDM) have great impact on all process of management of gestational diabetes and its future complications. The aims of this study were to evaluate rate, risk factors and outcomes of GDM based on International Association of Diabetes and Pregnancy Study Groups diagnostic criteria. In a prospective study pregnant women attended 5 clinics in Ahvaz, screened for gestational diabetes mellitus using IADPSG criteria and followed up delivery from August 2014 to February 2015. At the first prenatal visit women underwent the fasting blood sugar test. A 75-g oral glucose tolerance test (OGTT) was performed for 750 mothers between 24 and 32 weeks of gestation. Logistic regression test for calculating the odds ratios and 95% confidence intervals was used. The mean age of participants was 28.43±5.52years. The overall rate of GDM in our study was 29.9% (224/750). Incidence of gestational diabetes was associated with age group≥35years [OR=1.92(95% CI, 1.19-3.09)], family history of diabetes [OR=2.47(95% CI, 1.33-4.59)], previous GDM [OR=3.12(1.35-7.19)], BMI≥25 [OR=1, 71(1.10-2.67)] Using logistic regression. The most common maternal complication in studied women was cesarean section followed by hypertension and preeclampsia. About one third of studied women diagnosed as GDM according to the IADPSG criteria. Risk factors of GDM were maternal age, family history of diabetes, Previous GDM, overweight and obesity before pregnancy, the same reported factors with 2 steps approach. Higher rate of GDM using this criterion may increase concern about healthcare costs and workloads. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  3. Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients.

    Science.gov (United States)

    Kaoutzanis, Christodoulos; Winocour, Julian; Gupta, Varun; Ganesh Kumar, Nishant; Sarosiek, Konrad; Wormer, Blair; Tokin, Christopher; Grotting, James C; Higdon, K Kye

    2017-10-16

    Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences. To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database. A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81). Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas. 2. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  4. Incidence of diabetic macular edema and associated risk factors in a cohort of patients with type 1 diabetes in Denmark

    DEFF Research Database (Denmark)

    Rasmussen, Malin Lundberg

    Incidence of diabetic macular edema and associated risk factors in a cohort of patients with type 1 diabetes in Denmark. Rasmussen M.L.1, Pedersen R.B. 1, Sjølie A.K. 1, Grauslund J1 1University of Southern Denmark, Department of ophthalmology, Odense University Hospital, Denmark Purpose: To eval......Incidence of diabetic macular edema and associated risk factors in a cohort of patients with type 1 diabetes in Denmark. Rasmussen M.L.1, Pedersen R.B. 1, Sjølie A.K. 1, Grauslund J1 1University of Southern Denmark, Department of ophthalmology, Odense University Hospital, Denmark Purpose......: To evaluate the 16-year incidence of diabetic macular edema (DME) in a cohort of type 1 diabetic patients and to investigate possible risk factors of developing DME. Methods: This was a prospective cohort study of Danish type 1 diabetic patients. A total of 131 patients were examined at baseline in 1995...

  5. Dietary factors and incident atrial fibrillation: the Framingham Heart Study123

    Science.gov (United States)

    Shen, Jian; Johnson, Victor M; Sullivan, Lisa M; Jacques, Paul F; Magnani, Jared W; Lubitz, Steven A; Pandey, Shivda; Levy, Daniel; Vasan, Ramachandran S; Quatromoni, Paula A; Junyent, Mireia; Ordovas, Jose M; Benjamin, Emelia J

    2011-01-01

    Background: There have been conflicting reported associations between dietary factors and incident atrial fibrillation (AF). Objective: We evaluated associations between consumption of alcohol, caffeine, fiber, and polyunsaturated fatty acids (PUFAs) and incident AF in the Framingham Heart Study. Design: Participants without AF (n = 4526; 9640 examinations; mean age: 62 y; 56% women) from the original and offspring cohorts completed food-frequency questionnaires and were followed prospectively for 4 y. We examined the associations between dietary exposures and AF with Cox proportional hazards regression. Results: A total of 296 individuals developed AF (177 men, 119 women). In multivariable analyses, there were no significant associations between examined dietary exposures and AF risk. Hazard ratios (HRs) for increasing quartiles of dietary factors were as follows: for alcohol, 0.73 (95% CI: 0.5, 1.05), 0.85 (95% CI: 0.61, 1.18), and 1.12 (95% CI: 0.83, 1.51) (P for trend = 0.48); for caffeine, 0.84 (95% CI: 0.62, 1.15), 0.87 (95% CI: 0.64, 1.2), and 0.98 (95% CI: 0.7, 1.39) (P for trend = 0.84); for total fiber, 0.86 (95% CI: 0.61, 1.2), 0.64 (95% CI: 0.44, 0.92), and 0.81 (95% CI: 0.54, 1.2) (P for trend = 0.16); and for n−3 (omega-3) PUFAs, 1.11 (95% CI: 0.81, 1.54), 0.92 (95% CI: 0.65, 1.29), and 1.18 (95% CI: 0.85, 1.64) (P for trend = 0.57; quartile 1 was the reference group). In exploratory analyses, consumption of >4 servings of dark fish/wk (5 cases and 21 individuals at risk) was significantly associated with AF risk compared with the consumption of <1 serving of dark fish/wk (HR: 6.53; 95% CI: 2.65, 16.06; P < 0.0001). Conclusions: Consumption of alcohol, caffeine, fiber, and fish-derived PUFAs was not significantly associated with AF risk. The observed adverse association between the consumption of dark fish and AF merits further investigation. Our findings suggest that the dietary exposures examined convey limited attributable risk of AF in the

  6. Spatio-temporal factors associated with meningococcal meningitis annual incidence at the health centre level in Niger, 2004-2010.

    Directory of Open Access Journals (Sweden)

    Juliette Paireau

    2014-05-01

    Full Text Available BACKGROUND: Epidemics of meningococcal meningitis (MM recurrently strike the African Meningitis Belt. This study aimed at investigating factors, still poorly understood, that influence annual incidence of MM serogroup A, the main etiologic agent over 2004-2010, at a fine spatial scale in Niger. METHODOLOGY/PRINCIPAL FINDINGS: To take into account data dependencies over space and time and control for unobserved confounding factors, we developed an explanatory Bayesian hierarchical model over 2004-2010 at the health centre catchment area (HCCA level. The multivariate model revealed that both climatic and non-climatic factors were important for explaining spatio-temporal variations in incidence: mean relative humidity during November-June over the study region (posterior mean Incidence Rate Ratio (IRR = 0.656, 95% Credible Interval (CI 0.405-0.949 and occurrence of early rains in March in a HCCA (IRR = 0.353, 95% CI 0.239-0.502 were protective factors; a higher risk was associated with the percentage of neighbouring HCCAs having at least one MM A case during the same year (IRR = 2.365, 95% CI 2.078-2.695, the presence of a road crossing the HCCA (IRR = 1.743, 95% CI 1.173-2.474 and the occurrence of cases before 31 December in a HCCA (IRR = 6.801, 95% CI 4.004-10.910. At the study region level, higher annual incidence correlated with greater geographic spread and, to a lesser extent, with higher intensity of localized outbreaks. CONCLUSIONS: Based on these findings, we hypothesize that spatio-temporal variability of MM A incidence between years and HCCAs result from variations in the intensity or duration of the dry season climatic effects on disease risk, and is further impacted by factors of spatial contacts, representing facilitated pathogen transmission. Additional unexplained factors may contribute to the observed incidence patterns and should be further investigated.

  7. Spatio-temporal factors associated with meningococcal meningitis annual incidence at the health centre level in Niger, 2004-2010.

    Science.gov (United States)

    Paireau, Juliette; Maïnassara, Halima B; Jusot, Jean-François; Collard, Jean-Marc; Idi, Issa; Moulia-Pelat, Jean-Paul; Mueller, Judith E; Fontanet, Arnaud

    2014-05-01

    Epidemics of meningococcal meningitis (MM) recurrently strike the African Meningitis Belt. This study aimed at investigating factors, still poorly understood, that influence annual incidence of MM serogroup A, the main etiologic agent over 2004-2010, at a fine spatial scale in Niger. To take into account data dependencies over space and time and control for unobserved confounding factors, we developed an explanatory Bayesian hierarchical model over 2004-2010 at the health centre catchment area (HCCA) level. The multivariate model revealed that both climatic and non-climatic factors were important for explaining spatio-temporal variations in incidence: mean relative humidity during November-June over the