CI Of Odds Ratio Research Articles

Bridging and non‐bridging external fixation in the treatment of unstable fractures of the distal radius: A retrospective study of 588 patients

Background and purpose Bridging external fixation is used more frequently than non‐bridging fixation in the management of unstable distal radius fractures, despite evidence from randomized controlled trials of better outcome with the latter technique. This study was designed to investigate the generalizability of the technique of non‐bridging external fixation, and to define the indications for the use of each technique and their complications.Methods 641 patients with unstable displaced fractures of the distal radius were treated with bridging or non‐bridging external fixation. Non‐bridging external fixation was used where there was space for pins in the distal fragment. 52 patients were lost to follow‐up, leaving 588 patients available for study. Complete data from radiographic measurements after fracture healing were available for 546 patients. 59 % of fractures were treated with the non‐bridging technique.Results Fractures treated with bridging external fixation had a 6 times increased risk of dorsal malunion (p < 0.001) and a 2.5 times increased risk of radial shortening (p < 0.001) after adjusting for confounding factors (95% CI for odds ratio: 3–13 and 1.5–4, respectively) compared to non‐bridging techniques. Minor pin tract infections were more common in the non‐bridging group.Interpretation Non‐bridging external fixation of the distal radius is a generalizable technique, and reduces the risk of dorsal malunion compared with bridging external fixation. Major complication rates are low and the technique is applicable to most unstable fractures of the distal radius. We recommend that non‐bridging external fixation be used where there is space for the pins in the distal fragment.

A Retrospective Analysis of Risk and Protective Factors for Natural Death in Bipolar Disorder

Many of the prior mortality studies on bipolar disorder have emerged primarily from the larger health service groups, with a tendency to focus on suicide alone. This study examines personal and clinical characteristics of bipolar patients in Taiwan in order to identify the factors associated with early natural death. Bipolar patients admitted to a psychiatric hospital in Taiwan between 1987 and 2002 were retrospectively followed through record linkage for cause of death. One living bipolar individual was matched to each deceased patient as a control subject for age, gender, and date of index admission. Clinical data and the results of laboratory examinations during the last period of hospitalization were obtained through a review of medical records. In a total of 60 natural deaths, the principal cause was circulatory disease (33.3%). Conditional logistic regressions revealed that the variables most strongly associated with natural deaths were years of antipsychotic treatment prior to the last visit (95% CI for odds ratio [OR] = 0.77 to 0.98), serum alanine aminotransferase levels (95% CI for OR = 1.02 to 1.25), and leukocyte counts (95% CI for OR = 1.01 to 2.50). Years of lithium treatment (95% CI for OR = 0.74 to 0.97) may be substituted for antipsychotic treatment as a protective factor. Systemic inflammation and nonhepatic tissue damage during the acute phase of bipolar disorder may be risk factors for early natural death. Psychiatric treatment, including medication with antipsychotics or lithium, could be a factor in protecting against early natural death.

Diagnostic survey of bovine abortion with special reference to Neospora caninum infection: Importance, repeated abortion and concurrent infection in aborted fetuses in Southern Brazil

The protozoa Neospora caninum is an important cause of bovine abortion world-wide. The objective of this survey was to determine the distribution pattern of infectious abortion in Southern Brazil with special reference to N. caninum infection. A total of 161 bovine aborted fetuses from 149 farms were analysed during a 1.5 year period. The cause of abortion was identified in 51.5% of cases. Overall, 23% (37/161) of the fetuses were considered to be infected with N. caninum. Bacterial infection accounted for 17.4% (28/161) of cases, fungal infection for 3.1% (5/161) of cases and viral aetiology for 1.8% (3/161). Six fetuses had concurrent infection with N. caninum and Leptospira spp. Data from 111 fetuses and the respective aborted cows were analysed to investigate the association between previous abortion and current N. caninum infection. The prevalence of N. caninum-infected fetuses from cows with and without a history of previous abortion was 44% (11/25) and 24.4% (21/86), respectively. Cows aborting a N. caninum-infected fetuses were 2.4 times more likely to have aborted previously than cows aborting for other reasons (95% CI of odds ratio = 0.9–6.8, P = 0.06).

The Effect of Initial Shunt Outflow Position on Patency of Transjugular Intrahepatic Portosystemic Shunts

It has been suggested that initial stent position in transjugular intrahepatic portosystemic shunts (TIPS) with relation to hepatic venous outflow is an important determinant of shunt patency. It was hypothesized that TIPS with the stent-implanted segments terminating in the hepatic vein (HV) have shorter primary unassisted shunt patency durations than TIPS with the stent-implanted segments extending to the hepatocaval junction. A consecutive group of 107 patients who underwent TIPS creation for variceal bleeding were retrospectively identified, and the angiographic images during initial TIPS creation were reviewed independently by two observers who were blinded to outcome. Primary unassisted patency was estimated in group A (TIPS terminating in the HV; n = 47) and group B (TIPS terminating at the hepatocaval junction; n = 60) with the Kaplan-Meier method, and the two groups were compared with the log-rank test. Patients who had less than 30 days of follow-up were excluded from the analysis. Among all 107 patients, primary unassisted patency rates at 3, 6, and 12 months were 91% +/- 4%, 74% +/- 6%, and 49% +/- 6%. TIPS were classified into group A or group B with high interobserver agreement (Cohen kappa = 0.98). At 12 months, the primary unassisted patency rate among the patients in group A was 36% +/- 10%, compared with 58% +/- 8% among the patients in group B (P =.017, log-rank test). Patients in group A were twice as likely to lose patency than patients in group B (95% CI of odds ratio, 1.2-4.5). Thirty-day mortality was similar between groups (15% vs 12%; P =.13). Initial stent position within the hepatic venous outflow is predictive of shunt patency, with TIPS extending to the hepatocaval junction having a longer lifespan than shunts terminating in the HV.

Fall-related injuries in the elderly in Tehran

During 13 months of data gathering, all injury-related information concerning trauma patients was gathered according to International Classification of Diseases, 10th revision (ICD-10). The severity of the injury was calculated according to Abbreviated Injury Scale (AIS-90) in six major university hospitals in Tehran. Twelve percent of 8000 hospitalised trauma patients were elderly (65 years or older) and 70% of them (675 patients) had suffered from fall-related injuries. Falling on the ground and falling on stairs were the most common kinds of injury (with 462 (68%) and 122 (18%) cases, respectively). In the home and on the street were the most common sites of fall occurrence (with 520 cases (77%) and 91 cases (13.5%), respectively). After adjustment for the gender, kind of fall and Injury Severity Score, it was shown that the elderly were more prone to death than their younger counterparts (odds ratio=5.8, 95% CI for odds ratio: 2.3–7.2), but there was no significant difference in mortality rate between elderly men and women. Further studies are needed to evaluate personal and environmental risk factors for falls in our population. Furthermore, significantly higher mortality rate in our elderly trauma victims necessitates prudent attention to elderly trauma care in our teaching hospitals.

Down's syndrome and paternal age in Norway.

There is strong evidence for an effect of maternal age on the risk of Down's syndrome. An effect of paternal age has been suspected, but so far neither confirmed nor completely excluded. Large population-based data that allow detailed adjustment for maternal age are needed for a definitive analysis of the paternal age effect. We used data from the Medical Birth Registry of Norway recorded from 1967 to 1998. A total of 1738852 children were included in the analysis. A total of 10.3 per 10000 newborns had Down's syndrome. The data were fitted to logistic regression models with careful control for maternal age, birth calendar year and place of birth. When maternal age was adjusted for using categories of 5-year intervals, residual confounding still resulted in a strong effect of paternal age. However, when the shape of the effect of maternal age was well captured by the model, the estimated effect of paternal age was weak (1.11-fold increased risk per 10 years of paternal age, 95% CI of odds ratio 0.99, 1.22) and not statistically significant.

Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial

Background: Recurrent herpes simplex labialis (HSL) occurs in 20% to 40% of the US population. Although the disease is self-limiting in persons with a healthy immune response, patients seek treatment because of the discomfort and visibility of a recurrent lesion. Objective: Our purpose was to determine whether docosanol 10% cream (docosanol) is efficacious compared with placebo for the topical treatment of episodes of acute HSL. Methods: Two identical double-blind, placebo-controlled studies were conducted at a total of 21 sites. Otherwise healthy adults, with documented histories of HSL, were randomized to receive either docosanol or polyethylene glycol placebo and initiated therapy in the prodrome or erythema stage of an episode. Treatment was administered 5 times daily until healing occurred (ie, the crust fell off spontaneously or there was no longer evidence of an active lesion) with twice-daily visits. Results: The median time to healing in the 370 docosanol-treated patients was 4.1 days, 18 hours shorter than observed in the 367 placebo-treated patients (P = .008; 95% confidence interval [CI]: 2, 22). The docosanol group also exhibited reduced times from treatment initiation to (1) cessation of pain and all other symptoms (itching, burning, and/or tingling; P = .002; 95% CI: 3, 16.5); (2) complete healing of classic lesions (P = .023; 95% CI: 1, 24.5); and (3) cessation of the ulcer or soft crust stage of classic lesions (P < .001; 95% CI: 8, 25). Aborted episodes were experienced by 40% of the docosanol recipients versus 34% of placebo recipients (P = .109; 95% CI for odds ratio: 0.95, 1.73). Adverse experiences with docosanol were mild and similar to those with placebo. Conclusion: Docosanol applied 5 times daily is safe and effective in the treatment of recurrent HSL. Differences in healing time compared favorably with those reported for the only treatment of HSL that has been approved by the Food and Drug Administration. (J Am Acad Dermatol 2001;45:222-30.)

Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is associated with a 30% death rate. Tumour necrosis factor alpha (TNF-alpha) has been implicated in the pathogenesis of TEN. Thalidomide is a potent inhibitor of TNF-alpha action. We did a double-blind, randomised, placebo-controlled study of thalidomide in TEN. The patients received a 5-day course of thalidomide 400 mg daily or placebo. The main endpoint was the progression of skin detachment after day 7. Secondary endpoints were the severity of the disease, evaluated with the simplified acute physiology score (SAPS), and the mortality. TNF-alpha and interleukin 6 were measured. The study was stopped because there was excess mortality in the thalidomide group--ten of 12 patients died compared with three of ten in the placebo group (Fisher's exact test with Katz's approximation, relative risk=2.78, p=0.03). After adjustment for SAPS, mortality remained significantly higher in the thalidomide group than in the placebo group (exact logistic regression mid-p=0.007; 95% CI for odds ratio 2.7 to infinity). Plasma TNF-alpha concentration was higher in the thalidomide group than the placebo group on day 2, though the difference was not significant (Wilcoxon rank-sum test p=0.07). Even though few patients were included, our data suggest that thalidomide is detrimental in TEN, possibly because of a paradoxical enhancement of TNF-alpha production.