Define Risk Factors Research Articles

Factors affecting pretransplant muscle strength in allogeneic stem cell transplant candidates prior transplantation

PurposePhysical performance is crucial for prognosis after allogeneic hematopoietic stem cell transplantation (allo-HCT). Cardiorespiratory fitness has already been shown to have prognostic value, and there is increasing evidence that muscle strength and associated parameters (e.g., sarcopenia) are also of clinical relevance. Therefore, there is a need for the quantification of muscle strength and defining risk factors for reduced performance values.MethodsMaximal voluntary isokinetic (MVIC) and isometric (MIPT) muscle strength was assessed 2.4 ± 7.1 days prior admission for allo-HCT with a stationary isokinetic testing machine (IsoMed2000). We calculated percentiles for knee extension and hip flexion using healthy reference values. Regression models were used to identify predictors for reduced muscle strength including gender, age, body mass index (BMI), number of previous cardiotoxic therapies, number of previous transplantations, comorbidity index (HCT-CI), hemoglobin level, and physical activity.ResultsData of 212 patients (male n = 143, female n = 69), with a mean age of 54.49 ± 11.4, revealed considerably deviations from healthy reference values. Patients were located in the following percentiles: MVICKnee 37.5 ± 30.3, MVICHip 39.5 ± 31.3 and MIPTKnee 22.9 ± 26.5; MIPTHip 22.6 ± 27.4. Sub-group analyses showed that patients with younger age and male gender possess the highest deviations. Muscle strength values were significantly (p < 0.05) influenced by age, female gender, lower BMI, and higher HCT-CI.ConclusionMuscle strength is considerably reduced immediately prior to allo-HCT. Identified patient characteristics for reduced muscle strength point to the population that should be primarily targeted with exercise respectively resistance training interventions prior to allo-HCT to contribute to a well prepared transplant candidate.Trial registrationNCT01374399.

Outcomes Associated With Blastomycosis in Solid Organ and Hematopoietic Cell Transplant Recipients.

With reports of expanding epidemiology of blastomycosis across the United States, the purpose of this study was to evaluate the incidence and outcomes associated with blastomycosis in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients. We conducted a retrospective case series of adult SOT and HCT recipients at a tertiary care medical center between January 1, 2005 and September 30, 2023. Cases were defined as culture-proven blastomycosis. We performed descriptive statistical analysis to evaluate diagnosis, management, and outcomes (mortality) of blastomycosis in SOT. The cumulative incidence of blastomycosis was 0.11% with a median time to infection following transplant of 743 days. Of the 19 cases, the majority of patients were SOT recipients (90%). Supratherapeutic immunosuppression within 30 days of diagnosis was observed in 42% of cases with documented drug monitoring. Urine antigen testing was highly sensitive (100%). Fourteen (73.7%) patients received induction therapy with liposomal amphotericin B followed by azole therapy for a minimum of 12 months. Despite appropriate treatment, 1-year mortality was high at 26.3%, with attributable mortality of 21.1%. While rates of blastomycosis remain low among SOT and HCT recipients, infection is associated with poor posttransplant outcomes. Antigen testing can aid in timely assessment of disease severity and initiation of appropriate therapy. Among survivors, no relapses were observed while on lifelong secondary suppression. Future studies should aim to better define risk factors associated with developing blastomycosis and establish effective strategies for prevention.

Patients with severe odontogenic infections receive insufficient dental treatment before hospitalization - a retrospective cross-sectional study.

The aim was to provide an in-depth characterization of patients hospitalized with severe odontogenic infections (SOI), especially in relation to the origin of the infection. Furthermore, the aim was to generate an overview of which kind of treatment the patients had received before hospitalization and to analyze risk factors for prolonged length of hospital stay. The study was a retrospective cross-sectional study, which included patients hospitalized at the University Hospital of Copenhagen, Denmark, with SOI from November 2012 through 2019. Data were extracted from medical hospital records. Analysis was performed using the χ2 test, analysis of variance, multiple correspondence analysis (MCA), and logistic regression. A total of 384 eligible patients were included. The most frequent origin of infection was apical periodontitis (46.9%), infection after tooth extraction (25.8%), multiple infectious foci (8.6%), and pericoronitis (6.0%). Significant differences in concomitant diseases (p = 0.017) were found between the groups of origin of infection. The MCA model showed little to no ability to generate an in-depth characterization of the group of patients. Eleven patients (2.9%) were treated with incision and drainage before hospitalization, and 131 patients (34.3%) received no kind of antibiotic before hospitalization. The results indicate that clusters of variables could not be related to the origin of infection. In general, patients received insufficient treatment before hospitalization. Future studies should define risk factors for developing SOI and examine dental records of dental treatment before hospitalization. To improve prehospital treatment with patients with SOI, general dental practitioners should treat the origin of the infection, attempt drainage, and optimize the prescription of antibiotics.

Development of a New Score Based on Image Defined Risk Factors to Standardize Surgical Risk in Neuroblastoma Resection - A SIOPEN Collaborative Study.

Image Defined Risk Factors (IDRFs) assess surgical risk in neuroblastoma (NB) and guide neoadjuvant therapy. Despite chemotherapy IDRFs may persist in 70% of cases. Several studies have suggested that not all IDRFs hold equal significance and that the presence of an IDRF does not inherently signify unresectability. This current study seeks to stratify and assign a score to each IDRF based on its impact on surgical risk. This collaborative study entailed retrospective collection of patient data from NB operations conducted between 2016 and 2020, together with the computation of a Surgical Complexity Index (SCI) for every patient. The SCI values obtained were correlated with preoperatively identified IDRFs. Mann-Whitney statistical test was employed to assign a relevance score to the association between individual IDRFs and SCI. 14 centers contributed 427 neuroblastoma index cases meeting study inclusion criteria. 303 patients had 1 or more IDRFs. The presence and number of IDRFs in all patients significantly correlated with the SCI value (p<0.0001). The most frequently encountered IDRF was renal pedicle involvement. There was a significant association observed between clusters of abdominal IDRFs and the occurrence of post-operative complications (p<0.05), while a weak association link was found with intra-operative complications. A relevance score for individual IDRFs allowed their stratification based on surgical risk. The most relevant IDRFs were extension within two anatomical body compartments, infiltration of the hepato-pancreatic block, encasement of the superior mesenteric artery and coeliac axis, and tumor compressing the trachea. This current study has facilitated the assignment of a relevance score to each IDRF, correlating it with surgical risks. Considering this stratification of surgical risk alongside oncologic risk as defined by the neuroblastoma treatment patient risk grouping should facilitate a more precise definition of surgical objectives and the optimal conditions favoring gross tumor resection. Clinical Research - Study of Diagnostic Test. III.

Unintended Pregnancy After Kidney Transplantation

OBJECTIVE: To define risk factors, obstetric morbidity, and allograft outcomes associated with an unintended pregnancy after kidney transplant. METHODS: This is a retrospective cohort study of pregnancies in women after kidney transplantation enrolled in the Transplant Pregnancy Registry International with births between 1967 and 2019, with cohorts categorized as intended pregnancies and unintended pregnancies. The primary outcome was acute kidney rejection during pregnancy or by 6 weeks postpartum. Secondary outcomes included allograft loss, severe maternal morbidity, and neonatal composite morbidity. Multivariable logistic regression, Kaplan–Meier curves, and Cox proportional hazards regression models were performed, with adjustment for covariates pertinent to allograft function. RESULTS: Among 1,723 pregnancies of kidney transplant recipients, 1,081 (62.7%) were intended and 642 (37.3%) were unintended pregnancies. Risk factors for unintended pregnancy included younger age, Black race, nulliparity, chronic hypertension, and transplant from a deceased donor. Exposure to mycophenolate products (16.0% vs 5.7%) and termination (4.7% vs 0.4%) were more common in unintended pregnancies (P&lt;.001). Unintended pregnancy was not associated with acute kidney rejection (2.3% vs 0.9%, adjusted odds ratio [AOR] 2.38, 95% CI, 0.91–6.30, P=.08). Unintended pregnancy was independently associated with allograft loss at 2 years from the end of pregnancy (8.1% vs 3.5%, AOR 2.27, 95% CI, 1.32–3.94, P=.003) but not allograft survival (adjusted hazard ratio 1.22, 95% CI, 1.00–1.49, P=.05). There were no differences in severe maternal morbidity (3.3% vs 3.6%) or neonatal composite morbidity (12.9% vs 14.3%) by pregnancy intention. CONCLUSION: Unintended pregnancy was not associated with acute kidney allograft rejection in the peripartum period, but it was associated with mycophenolate exposure and allograft loss at 2 years from pregnancy. The same social vulnerabilities that underlie difficulty in accessing reproductive care may be similarly important for transplant health. We recommend prepregnancy counseling and longitudinal follow-up of transplant recipients to reduce rates of unintended pregnancy and to optimize transplantation success over time.

Central nervous system relapse after allogeneic HCT in FLT3-mutated AML

Central nervous system (CNS) relapse in acute myeloid leukemia (AML) is rare, but prognostically extremely unfavorable and associated with very high mortality rates. Aim of our single-center study was to define risk factors for CNS relapse in patients with FLT3-mutated AML after allogeneic hematopoietic cell transplantation (HCT) and to determine the impact of pre-emptive or salvage therapy with FLT3-inhibitors (FLT3i) on occurrence of CNS relapse and overall prognosis. We analyzed 39 FLT3-mutated AML patients who were treated with intensive induction therapy and consecutively underwent HCT at our institution. We observed that the remission status before HCT was strongly associated with relapse probability. Notably, FLT3-mutated AML showed a high propensity for CNS relapse with a cumulative incidence of 50% (95% confidence interval [CI], 16–77) at 2 years in non-responders pre-HCT compared to 0% in responders (cause-specific hazard ratio, 24.5, 95% CI, 2.9-206.2; p = 0.003). This was not abrogated by pre-emptive or salvage therapy with FLT3i in first relapse. Targeted therapies prior to transplant, use of intrathecal chemoprophylaxis or closer monitoring may be considered in patients with FLT3-mutated AML with active disease prior to HCT in order to prevent CNS relapse.

Safety of Beta-Blocker Administration in STEMI Patients With Risk Factors for Cardiogenic Shock.

Beta-blockers are recommended in the first 24 hours after ST-segment elevation myocardial infarction (STEMI) except in those at risk of cardiogenic shock. This retrospective cohort study aimed to assess if early beta-blocker use was associated with cardiogenic shock development in STEMI patients. Cardiogenic shock was assessed in adult patients with STEMI undergoing percutaneous coronary intervention (PCI) with guideline defined risk factors for shock (age above 70 years, systolic blood pressure below 120 mmHg, and heart rate above 120 bpm or below 60 bpm) who did or did not receive a beta-blocker within 24 hours of PCI. Multivariable logistic regression was used to assess the association between cardiogenic shock development and early beta-blocker administration. A total of 216 patients were included, 85 with early beta-blocker administration and 131 without. Patients who received an early beta-blocker versus those who did not had a median (interquartile range) age of 63 (52-71) versus 66 (54-76; P = .2260) and peak troponin of 58.3 (15.0-132.4) ng/mL versus 51.6 (16.6-139.5; P = .9884). Cardiogenic shock occurred in 4.7% (n = 4) patients with early beta-blocker use versus 12.2% (n = 16; P = .0909) without. After backward stepwise logistic regression, early beta-blocker use was not associated with cardiogenic shock (adjusted odd ratio [aOR] 0.334, 95% confidence interval (CI) 0.106-1.047; P = .0599), but those with a peak troponin over 56 ng/mL had an over three-fold increased risk of developing cardiogenic shock (aOR 3.434, 95% CI 1.191-9.902; P = .0224) regardless of beta blocker administration. Early beta-blocker administration in STEMI patients may not be associated with shock development.

Disease recurrence in patients undergoing mastectomy for ductal carcinoma in situ.

With DCIS incidence on the rise, up to 30% of patients undergo mastectomy for Ductal carcinoma in situ (DCIS) (Nash and Hwang, in: Ann Surg Oncol 30(6):3206-3214, 2023). Local recurrence rates after mastectomy for DCIS are reportedly low, but risk factors for recurrence are not known (Kim et al., in: J Cancer Res Ther 16(6):1197-1202, 2020). We aim to define risk factors associated with ipsilateral breast cancer recurrence in patients undergoing mastectomy for DCIS. We aimed to identify risk factors that may contribute to recurrence of breast cancer following mastectomy for pure DCIS. We hypothesized that close or positive mastectomy margins, age at diagnosis, extent of breast disease and mutation carriers would be associated with increased risk of recurrence. We performed a retrospective chart review of patients who underwent unilateral or bilateral mastectomies for pure DCIS at a single academic tertiary referral center from 2013 to 2023. There were 165 patients who met inclusion criteria with an average length of follow-up of 39.9months. On final surgical pathology, the average span of DCIS was 33.7mm (± 24.6mm). Hormone receptor positive disease was identified in 80.6% of the patient cohort. For margin status, 23 patients (14%) had < 1mm margins on final pathology and of those, 1 received adjuvant radiation therapy and 4 returned to the OR for re-excision. Only 1 (0.6%) patient had ipsilateral disease recurrence during the study period. Recurrence after mastectomy for pure DCIS is a rare event and in our study sample, only one recurrence occurred. Risk factors for recurrence appear unrelated to margin status, age, extent of DCIS, or pathogenic mutation (ElSherif et al., in Am J Surg 226(5):646-651, 2023).

Mother-to-child Transmission using the National HBV Perinatal Prevention Data in Korea, 2002-2021

Abstract Aims To define risk factors associated with mother-to-child transmission (MTCT) and to create supporting evidence for the National Hepatitis B Perinatal Prevention Program (HBPPP) in Korea. Methods We analyzed HBPPP mother-infant pair data enrolled from 2002 to 2021. The major outcome was the HBsAg status of the infant resulting from post-vaccination serological testing. Additionally, we used prescription records of antivirals against the hepatitis B virus (telbivudine, tenofovir disoproxil fumarate) from 2010 to 2021 by data linkage with the National Health Insurance claims data. To select significant risk factors by maternal HBeAg status based on the data from 34 to 42 weeks of pregnancy, multivariate logistic regression analysis was used. Results Data from 232,242 mother-infant pairs were analyzed. Among 154,331 (66.5%) infants with post-vaccination serological testing results, 3,620 (2.3%) were HBsAg-positive. The incidence of MTCT has shown a decreasing trend, from 4.1% in 2002 to 1.0% in 2021. However, the rate was high at 5.5% (1822/32986) for infants of HBeAg-positive mothers. Maternal antiviral prescription during the pregnancy period, old age, HBeAg negative, delivery type (C-section), and breastfeeding were significant factors in decreasing the risk of MTCT. Among the HBeAg-positive, there was a significant difference in the antiviral prescription 0.7% (11/1692) compared to the non-prescription 4.9% (789/16264) [aOR, 7.71; 95% CI, 4.24-14.02]. The result was similar for the HBeAg-negative group, 0.7% (302/44888). Conclusions To eradicate the hepatitis B virus on a national level, MTCT must be further reduced. To achieve this, it is necessary to introduce strong additional preventive measures, including quantitative HBV DNA testing for mothers with chronic hepatitis B and administering antiviral prophylaxis at the third trimester of pregnancy with HBV-DNA ≥200,000 IU/mL into the HBPPP. Key messages • The incidence of mother-to-child transmission has shown a decreasing trend, from 4.1% in 2002 to 1.0% in 2021. • Maternal antiviral prescription, old age, HBeAg negative, delivery type (C-section), and breastfeeding were significantly decrease the risk of mother-to-child transmission.

The effects of gender-affirming testosterone therapy in transgender men on the development of acne, acne severity and the relationship with clinical parameters: a three-year follow-up study.

Acne can result from increased testosterone concentrations after gender-affirming masculinizing testosterone therapy (GATT) initiation. The aim of this study was to determine the prevalence and risk factors of acne and acne severity in transgender individuals while receiving GATT. A prospective multicenter follow-up study (2010-2019) was performed to assess self-reported acne and acne severity, and define risk factors for acne in transgender men during the first three years after initiation of GATT (n=323). Investigated risk factors included: age at initiation of GATT, body mass index (BMI), type of testosterone administration, use of lynestrenol, alcohol use, smoking and serum testosterone concentrations during therapy. The prevalence of moderate/severe acne increased from 11.8% to 39.1% after one year of GATT. Multivariate analyses showed BMI >25kg/m2 (relative risk [RR]: 1.46; 95% confidence interval [CI]: 1.18-1.80), age: 18-25 years (RR: 1.98; 95%CI: 1.19-3.33), testosterone concentration >10 nmol/L (RR: 1.91; 95%CI: 1.28-2.84) and the presence of acne at baseline (RR: 1.82; 95%CI: 1.47-2.25) to be risk factors for development of moderate/severe acne. Acne is a common side effect of GATT. Risk factors that influence the occurrence of moderate to severe acne in testosterone-treated transgender men are high BMI, younger age at initiation of GATT and testosterone concentrations within or above the target range. These observations could be taken into account when counselling transgender men starting GATT.

Evaluation of Image-Defined Risk Factors Efficacy on Neuroblastoma Surgical Resectability

Abstract Background Neuroblastoma (NB) is one of the most prevalent extracranial solid cancers in children that commonly occur in the adrenal glands (49%). Thus, monitoring the diagnosis, staging, treatment planning, response evaluation, and updating and discovering new International Neuroblastoma Risk Groups (INRGs) is an important method to facilitate the treatment process. Patients and Methods The clinical, radiological, pathological, and surgical data of 30 neuroblastoma patients were analyzed, preoperative image-defined risk factors (IDRFs) were present in 23 cases with the most two frequent IDRFs were encasement of aorta then invasion of the renal pedicles. Results The statistical analysis data represented 30 cases showed that there was significant correlation with preoperative IDRFs and the type of surgery as well as significant correlation between IDRF and primary tumor location. The results affirm that IDRFs remain a useful prognostic tool for neuroblastoma patients both for short and long-term outcomes. Conclusion Hence, the efficiency of using the image defined risk factor was predictable of surgical resectability and complication.

Risk Factors for Neonatal Clavicular Fractures: A Population-Based Case-Control Study.

Neonatal clavicular fractures represent the most common fracture during delivery. We aimed to define risk factors associated with these fractures in a large population-based database. Data were extracted from Clalit Health Services' electronic health records from 2000 to 2020. Newborns with clavicular fractures were compared with a healthy control group. The following parameters were compared-for the newborns: sex, birth weight, birth height, and head circumference; for the delivery process: assisted delivery, cesarean section, use of epidural, birth week, and number of fetuses; and for the mother: age at delivery, socioeconomic status, height, weight, and body mass index (BMI). We found a rate of 0.28% for neonatal clavicular fractures (5015 clavicular fractures/1 755 660 deliveries). Male gender and heavier birth weight were found to be significantly associated with clavicular fractures (P < .001). Increased risk was also associated with lower socioeconomic status, baseline weight, and maternal BMI (P < .001 for all). Assisted delivery increased the risk of clavicular fracture (OR = 2.274; 95% CI, 1.661-3.115; P < .0001), while cesarean section and use of epidural were found to be protective (OR = 0.149; 95% CI, 0.086-0.26; P < .0001; and OR = 0.687; 95% CI, 0.0531-0.89; P < .004, respectively). This study provides insight into the risk factors associated with neonatal clavicular fractures on the largest group of patients reported to date.

Association of antibiotic resistance and biofilm formation in Escherichia coli ST131/O25b.

Urinary tract infections are becoming difficult to treat every year due to antibiotic resistance. Uropathogenic Escherichia coli (UPEC) isolates pose a threat with a combined expression of multidrug-resistance and biofilm formation. ST131 clone is a high-risk pandemic clone due to its strong association with antimicrobial resistance, which has been reported frequently in recent years. This study aims to define risk factors, clinical outcomes, and bacterial genetics associated with ST131/O25b UPEC. In this study, antibiotic susceptibility and species-level identification of 61 clinical E. coli strains were determined by automated systems. Detection of extended-spectrum beta-lactamases was assessed by double-disk synergy test. Biofilm formation was quantified by spectrophotometric method. Virulence genes (iutA, sfa cnf-1, iroN, afa, papA, fimA), antibiotic resistance genes (blaCTX-M, blaTEM, blaSHV, blaOXA, qnrA, qnrB, qnrS, ant(2')-Ia, ant(3)-Ia, aac(3)-IIa, mcr-1, mcr-2, mcr-3, mcr-4) were investigated by PCR. The following beta-lactamase genes were identified, blaTEM (n = 53, 86.8%), blaCTX-M (n = 59, 96.7%), blaSHV (n = 47, 77.0%), and blaOXA-1 (n = 27, 44.2%). Our data revealed that 93.4% of (57/61) E. coli isolates were biofilm-producers. O25pabBspe and trpA2 were investigated for the presence of ST131/O25b clone. Among multidrug resistant isolates, co-existence of O25pabBspe and trpA2 was detected in 29 isolates (47.5%). The fimH30 and H30Rx subclones were detected in four isolates that are strong biofilm-producers. These results suggest that clinical E. coli strains may become reservoirs of virulence and antibiotic resistance genes. This study demonstrates a significant difference in biofilm formation between E. coli ST131 and non-ST131 isolates. Moreover, 86.21% (n = 25) of ST131 isolates produced strong to moderate biofilms, while only 43.75% (n = 14) of non-ST131 isolates showed the ability to form strong biofilms. Presence of iutA and fimA genes in the majority of ST131 strains showed an important role in biofilm formation. These findings suggest application of iutA and fimA gene suppressors in treatment of infections caused by biofilm-producing drug-resistant ST131 strains.

Unsupervised Machine Learning to Identify Risk Factors of Pyeloplasty Failure in Ureteropelvic Junction Obstruction.

Introduction: In adult patients with ureteropelvic junction obstruction (UPJO), little data exist on predicting pyeloplasty outcome, and there is no unified definition of pyeloplasty success. As such, defining pyeloplasty success retrospectively is particularly vulnerable to bias, allowing researchers to choose significant outcomes with the benefit of hindsight. To mitigate these biases, we performed an unsupervised machine learning cluster analysis on a dataset of 216 pyeloplasty patients between 2015 and 2023 from a multihospital system to identify the defining risk factors of patients that experience worse outcomes. Methods: A KPrototypes model was fitted with pre- and perioperative data and blinded to postoperative outcomes. T-test and chi-square tests were performed to look at significant differences of characteristics between clusters. SHapley Additive exPlanation values were calculated from a random forest classifier to determine the most predictive features of cluster membership. A logistic regression model identified which of the most predictive variables remained significant after adjusting for confounding effects. Results: Two distinct clusters were identified. One cluster (denoted as "high-risk") contained 111 (51.4%) patients and was identified by having more comorbidities, such as old age (62.7 vs 35.7), high body mass index (BMI) (26.9 vs 23.8), hypertension (66.7% vs 17.1%), and previous abdominal surgery (72.1% vs 37.1%) and was found to have worse outcomes, such as more frequent severe postoperative complications (7.2% vs 1.0%). After adjusting for confounding effects, the most predictive features of high-risk cluster membership were old age, low preoperative estimated glomerular filtration rate (eGFR), hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO. Conclusions: Adult UPJO patients with older age, lower eGFR, hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO naturally cluster into to a group that more commonly suffers from perioperative complications and worse outcomes. Preoperative counseling and perioperative management for patients with these risk factors may need to be thought of or approached differently.

Is using inhaled corticosteroid effective against COVID-19 pneumonia severity and mortality?

It is known that the use of inhaled corticosteroids increases the incidence of pneumonia in patients followed up with the diagnosis of chronic asthma and chronic obstructive pulmonary disease (COPD). This study aimed to investigate the contribution of inhaled steroid use to pneumonia severity and mortality in cases with COVID-19 pneumonia. The study is a retrospective, observational study. Among the cases admitted to the pandemic clinic, patients diagnosed with COVID-19 pneumonia were included. The plan was to compare cases who received and did not receive inhaled corticosteroids in terms of pneumonia severity and mortality. In order to define risk factors for mortality, univariate and multivariable negative binomial regression analyses were performed. In our study, it was observed that n= 540 (75%) cases did not receive inhaled corticosteroids (group 1), and 180 (25%) cases used inhaled corti costeroids (group 2). Group 1 and group 2 cases were compared in terms of pneumonia severity with no significant difference between the two groups (p= 0.11). Then, risk factors affecting mortality in all cases were examined with univariate analyses. Increasing age, applying mechanical ventilation, having severe pneumonia, having interstitial lung disease, and applying prone position were found to be statistically significant factors in mortality (p < 0.05). In conclusion, in our study, it was observed that the use of inhaled corticosteroids did not increase the severity of pneumonia and mortality. It was thought that the treatment they received could be continued when the patients treated with inhaled corticosteroids due to asthma and COPD had COVID-19 pneumonia.

Gastrointestinal Helminthic Infection among the Population in Northern Thailand.

Gastrointestinal (GI) helminthic infections pose substantial public health threat, particularly in northern Thailand, with a heightened concern in Nan province. This study aims to evaluate the prevalence of GI helminthic infections in Nan province and identify associated risk factors in local population. A cross-sectional survey was conducted in 2022. Fecal specimens were collected and examined using Kato-Katz technique and Formalin Ethyl-Acetate Concentration Technique (FECT). Univariate analysis employed the Chi-square test to explore correlations, while logistic regression was defined risk factors associated with parasite infections. Among 739 individuals surveyed, 14.34% were revealed GI helminthic infections. Notably, infection rates were higher in males (20.40%) compared to females (8.95%), with a notable prevalence among individuals aged ≥ 60 (17.78%) and high infection rate was demonstrated in Kiew Chan village (21.67%). The most commonly detected helminths were minute intestinal flukes (MIFs) (10.01%) and Capillaria spp. (3.11%). Males were significantly associated with GI helminthic infections, while individuals aged 40-49 and aged 50-59 commonly displayed of parasite infections. Additionally, Kiew Chan village exhibited a significant association with GI helminthic infections, followed by Sop Puen village. Furthermore, fecal specimens of 13 rodent specimens were frequency revealed Strongyloides spp. (92.30%) and mostly exposed Ancylostoma caninum (41.93%) among 93 canines. These findings highlight the imperative for immediate public health interventions in Nan province and analogous areas in northern Thailand. Implementing strategies to enhance sanitation infrastructure and promote hygiene education can significantly contribute for reducing the prevalence of GI helminthic infections and improve overall community health.

Acute kidney injury in nonagenarians: clinical characteristics and mortality.

Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

Ruptured Aortic Valve Aneurysm Caused by Infective Endocarditis in a SARS-CoV-2-Positive Autopsy Case.

Aortic valve aneurysm, an extremely rare complication secondary to infective endocarditis (IE), may cause heart failure due to rupture of the aneurysm. Coronavirus disease 2019 (COVID-19) has been reported to cause cardiovascular complications and alter susceptibility to secondary infections such as IE. Herein, we report a case of IE with a fatal outcome caused by rupture of an aortic valve aneurysm in a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive autopsy case. The patient was a 67-year-old male diagnosed with heart failure after presenting with edema and weight gain. He was found dead in bed 2 weeks after initial symptom presentation. Autopsy revealed an aneurysmal sac in the center of the noncoronary cusp of the aortic valve with an opening of approximately 1 cm in the center of the aneurysmal wall. Histologically, aortic valve vegetation, destruction of the aortic valve cusp, rupture of the aneurysmal wall, and an abscess under the aortic intima were observed. Gram staining of the aneurysmal wall showed a gram-positive coccus. The reverse transcription quantitative polymerase chain reaction assay was positive for SARS-CoV-2. Because no defined risk factors for IE other than SARS-CoV-2 infection were observed, the association between IE and COVID-19 was highly likely.

Risk factors for developing intra-abdominal abscess following appendicectomy for acute appendicitis: a retrospective cohort study

BackgroundLaparoscopic appendicectomy is commonly performed in Australia for treatment of acute appendicitis. Intra-abdominal abscess (IAA) is a potential complication following appendicectomy for acute appendicitis. Risk factors for developing post-operative IAA remain controversial and poorly defined. Laparoscopic washout may be performed for patients who develop complication(s) including IAA. The aim of this study was to define risk factors for both the development of IAA and identify patients who may require laparoscopic washout following appendicectomy.MethodsData were obtained from 423 patients who underwent laparoscopic appendicectomy over a five-year period (2012–2017). Clinical (fever, haemodynamics, examination findings), biochemical (white cell count, neutrophil count, C-reactive protein, bilirubin, albumin), radiological (CT free fluid), and operative factors (inflammation, suppuration, free-fluid, perforation, histopathology) collected in the pre-, peri-, and post-operative period(s) were analysed.Results23 (5.4%) patients developed post-operative IAA. Duration of intravenous antibiotics was significantly longer in patients who developed IAA and in those who required laparoscopic washout (p < 0.0001). C-reactive protein (CRP) on admission (p < 0.05) and appendiceal perforation (p = 0.0005) were significantly higher in patients who either developed IAA or needed laparoscopic washout. No clinical or radiological finding predicted either the development of IAA or need for laparoscopic washout.ConclusionElevated CRP on admission may predict the development of post-operative IAA formation or the need for laparoscopic washout post-appendicectomy. Prolonged post-operative antibiotic use appears independent of the development of IAA as well as the need for laparoscopic washout. These data highlight the need for clear guidelines on peri-operative antibiotic use following appendicectomy.

The role of different acetabular morphologies on patient-reported outcomes following periacetabular osteotomy in borderline hip dysplasia

IntroductionThe treatment option for borderline hip dysplasia (BHD) includes hip arthroscopy and periacetabular osteotomy (PAO). To the present day the controversial discussion remains, which intervention to prefer. Literature reports supporting an educated choice are scare, based on small patient cohorts and do not address the variability of acetabular morphology. Consequently, we intended to report PAO outcomes, from patients diagnosed with BHD, dependent on acetabular morphology, in a large patient cohort and aimed to define risk factors for poor clinical results and patient satisfaction.Materials and methodsA prospective monocentre study was conducted. Patients enrolled underwent PAO for symptomatic BHD (LCEA, 18°–25°). A total of 107 hips were included with 94 complete data sets were available for evaluation with a minimum follow-up of 1 year and a mean follow-up of 2.3 years. The mean age was 31 ± 8.2 years, and 81.3% were female. As the primary outcome measure, we utilized the modified Harris hip score (mHHS) with minimal clinically important change (MCID) of eight to define clinical failure. Results were compared after a comprehensive radiographic assessment distinguishing between lateral deficient vs. anterior/posterolateral deficient acetabular and stable vs. unstable hip joints.ResultsOverall, clinical success was achieved in 91.5% of patients and the mHHS improved significantly (52 vs. 84.7, p < 0.001). Eight hips failed to achieve the MCID and four had radiographic signs of overcorrection. Comparing variable joint morphologies, the rate of clinical success was higher in patients with an anterior/posterolateral deficient acetabular covarage compared to lateral deficient acetabular (95.2% vs. 90.4%). tThe highest rate of clinical failure was recorded in unstable hip joints (85.7% vs. 92.5% in stable hips).ConclusionsThis study demonstrates that PAO is an effective means to treat symptomatic BHD with variable acetabular morphologies, achieving a clinical success in 91.5% of all patients. To maintain a high level of safety and patient satisfaction technical accuracy appears crucial.