Incomplete Medical Record Research Articles

Mean Platelet Volume on Systemic Lupus Erythematosus Patients with and without Thrombocytopenia in Dr Hasan Sadikin Hospital Bandung: A Descriptive Study

Abstract
 Background : The aim of the study is to provide an insight about mean platelet volume (MPV) value in systemic lupus erythematosus (SLE) with and without thrombocytopenia patient. MPV wa expected to be used to determine the cause thrombocytopenia in lupus, so the patient could be treated appropriately.
 
 Method : The study design was descriptive categoric, and the data were obtained by using cross-sectional method from patient’s medical record and lab examination result in the period from January 1st 2016 – January 31st 2018. The sampling method are done using total sampling. The inclusion criteria of this study were SLE patients which MPV and platelet count had been examined at the same time, the data used is data that was first discovered in the period of the study. The exclusion criteria were incomplete medical record data, patient with thrombocytosis, and SLE with comorbidity such as thrombotic disease (ischemic stroke and deep vein thrombosis), other high inflammatory overlap diseases (such as rheumatoid arthritis and inflammatory bowel disease), and infection.
 
 Result : From 75 patients that match with the inclusion criteria, all patients were female and based on the age of diagnosis, most patients were in age group of 25-34 years old (41,33%). Based on the lab results, group with normal platelet count have 53 data of normal MPV and 12 data of high MPV, while group with thrombocytopenia have 6 data of normal MPV and 4 data of high MPV.
 
 Conclusion : Group with normal MPV value and normal platelet count has the largest proportion, while the group with thrombocytopenia in lupus and high MPV value has the lowest proportion.

Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study

ObjectivesTo determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.Setting1300-bed tertiary care private hospital located in the state of Kerala, India.Participants31 semistructured interviews and 4 focus...

Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Foveal Tear Repair in the United States Military

PurposeTo compare subjective and objective midterm functional clinical outcomes of knotless arthroscopic assisted transosseous (AAT) triangular fibrocartilage complex (TFCC) repairs specifically in a cohort of military service members.MethodsPatient charts were reviewed to identify all cases of TFCC repair by a single surgeon from 2012 to 2016. Primary outcome variables were the Quick–Disabilities of the Arm, Shoulder, and Hand score and return to full military duty. Secondary outcome variables were visual analog scale for pain, Mayo Modified Wrist Score, Single-Assessment Numeric Evaluation, and the number of push-ups in 2 minutes during a record physical fitness test. Inclusion criteria were adult active duty service members who underwent AAT TFCC repair with a minimum of 2 years’ follow-up. Terminal follow-up was determined by a telephone interview. Exclusion criteria were distal radioulnar joint instability, revision procedures, cases involving other ligamentous repair procedures, and those with an incomplete medical record or who could not be reached for the survey.ResultsFifteen patients, average age 21 years (range, 18–29 years), met inclusion and exclusion criteria with mean follow-up of 3.8 years (range, 2–5.9 years). Average Quick–Disabilities of the Arm, Shoulder, and Hand score was 9.7 (range, 0–29.5) and 93% were able to remain on active duty. Average secondary outcomes scores were: visual analog scale = 1.3 (range, 0–4); Single-Assessment Numeric Evaluation = 87.3 (range, 30–100); Mayo Modified Wrist Score = 84.3 (range, 55–100); and push-ups = 72 (range, 42–90) in 2 minutes. One patient required a secondary surgery.ConclusionsKnotless AAT TFCC repair may be a safe and effective procedure that may return military service members to a preinjury level of activity.Type of study/level of evidenceTherapeutic IV. To compare subjective and objective midterm functional clinical outcomes of knotless arthroscopic assisted transosseous (AAT) triangular fibrocartilage complex (TFCC) repairs specifically in a cohort of military service members. Patient charts were reviewed to identify all cases of TFCC repair by a single surgeon from 2012 to 2016. Primary outcome variables were the Quick–Disabilities of the Arm, Shoulder, and Hand score and return to full military duty. Secondary outcome variables were visual analog scale for pain, Mayo Modified Wrist Score, Single-Assessment Numeric Evaluation, and the number of push-ups in 2 minutes during a record physical fitness test. Inclusion criteria were adult active duty service members who underwent AAT TFCC repair with a minimum of 2 years’ follow-up. Terminal follow-up was determined by a telephone interview. Exclusion criteria were distal radioulnar joint instability, revision procedures, cases involving other ligamentous repair procedures, and those with an incomplete medical record or who could not be reached for the survey. Fifteen patients, average age 21 years (range, 18–29 years), met inclusion and exclusion criteria with mean follow-up of 3.8 years (range, 2–5.9 years). Average Quick–Disabilities of the Arm, Shoulder, and Hand score was 9.7 (range, 0–29.5) and 93% were able to remain on active duty. Average secondary outcomes scores were: visual analog scale = 1.3 (range, 0–4); Single-Assessment Numeric Evaluation = 87.3 (range, 30–100); Mayo Modified Wrist Score = 84.3 (range, 55–100); and push-ups = 72 (range, 42–90) in 2 minutes. One patient required a secondary surgery. Knotless AAT TFCC repair may be a safe and effective procedure that may return military service members to a preinjury level of activity.

Associated factors of dialysis-dependence among acute kidney injury patients in intensive care unit.

Acute kidney injury (AKI) is a common problem in hospitals and many end up requiring dialysis. The aim was to identify the associated factors of dialysis-dependent of AKI patients admitted to the intensive care units (ICUs). A retrospective cohort study was conducted where a list of 121 AKI patients admitted to ICU in Hospital Universiti Sains Malaysia was retrospectively reviewed. AKI patients aged below 18 years old, had kidney transplantation or chronic dialysis before ICU admission and had incomplete medical record were excluded from the study. Simple and multiple logistic regression analysis were used. The mean [standard deviation (SD)] age of patients was 56 (17.15) years. Majority of patients were males (63.2%) and Malay ethnic (54.1%). 49.3% of patients were in stage I, 48.3% in stage II and 76.2% in stage III. The mean (SD) duration of patients stayed in ICU was 7 days (6.92) for non-dialysis dependent and 12 days (8.37) for dialysis-dependent. The associated factors were male gender [adjusted odds ratio (OR): 3.68; 95% confidence interval [CI]: 1.53, 8.86; P = 0.004], AKI Stage III (adjusted OR: 4.51; 95% CI: 1.28, 15.91; P = 0.019), admitted in ICU (adjusted OR: 3.05; 95% CI: 1.28, 7.29; P = 0.012), and longer length of stay (adjusted OR: 1.10; 95% CI: 1.03, 1.18; P = 0.003). The factors influence of dialysis-requiring AKI were observed to be dependent on the male male gender, suffer from the advanced stage (Stage III), admitted to the ICU and had a longer length of stay in ICU. Therefore, it is important for physicians to identify patients who are at high risk of developing AKI and implement preventive strategies.

Evaluation of Clinical Outcomes of Sutureless vs Sutured Closure Techniques in Gastroschisis Repair

Sutureless gastroschisis repair offers an alternative to the traditional sutured method and has been associated with decreased intubation time. Published study results are inconsistent regarding the advantages of sutureless closure. To compare the clinical outcomes of sutureless and sutured gastroschisis repair. A single-center cohort review was performed of all consecutive patients (n = 97) who underwent gastroschisis repair from February 1, 2007, to April 30, 2017, at the University of California, San Francisco. Patients' medical records were evaluated for clinical characteristics and outcomes. Cases with incomplete data during initial hospitalization were excluded. Length of hospital stay, time to full enteral feeds, total parenteral nutrition duration, days requiring intravenous analgesia, days intubated, wound infection rate, antibiotic treatment duration, rate of umbilical hernias that required an operation, and readmission rate. In total, 97 patients (47 [48%] were female and 50 [52%] were male with a mean [SD] age of 2.8 [2.8] days) underwent gastroschisis repair, of which 7 were excluded for incomplete medical record. Of the 90 patients included in the study, 50 (56%) underwent sutured closure and 40 (44%) underwent sutureless closure. No statistical difference was found between the sutured and sutureless groups in length of hospital stay (mean [SD] days, 43.9 [40.4] vs 36.7 [21.2]; P = .71), time to full enteral feeds (mean [SD] days, 31.4 [20.2] vs 27.9 [17.3]; P = .22), total parenteral nutrition duration (mean [SD] days, 33.5 [29.8] vs 27.4 [18.2]; P = .23), wound infection rates (14 [28%] vs 10 [25%]; P = .81), and readmission rates (5 [10%] vs 7 [18%]; P = .36). The sutureless group, compared with the sutured group, had substantially fewer days receiving antibiotics (mean [SD], 7.2 [6.4] vs 12.4 [13.2]; P = .003), fewer days intubated (mean [SD], 2.8 [3.3] vs 6.8 [1.3]; P = .001), fewer days receiving intravenous analgesia (mean [SD], 4.2 [4.0] vs 7.1 [4.5]; P = .003), and fewer patients that required silo reduction (25 [63%] vs 48 [96%]; P < .001). Sutureless closures, compared with the sutured technique, had considerably more umbilical hernias requiring surgical repair (5 [13%] vs 0; P = .02). Sutureless repair of gastroschisis appears to be associated with a statistically significant reduction in mechanical ventilation duration and pain medication requirements but may increase umbilical hernia risk. Multicenter randomized clinical trials are necessary to determine the true advantages of the sutureless approach.

Subcutaneous Anterior Transposition Versus In Situ Decompression of the Ulnar Nerve in an Active Duty Military Population

There is no financial information to disclose. The objective of this study was to compare the subjective and objective midterm functional clinical outcomes of subcutaneous anterior transposition (SAT) versus in situ decompression (SD) of the ulnar nerve for the treatment of cubital tunnel syndrome (CuTS). We hypothesized that there would be no difference between the 2 cohorts with respect to outcome scores, return to full military duty, and complications. The United States Military Health System was queried to identify all cases of ulnar neruoplasty (CPT:64718) between 2006 and 2010. Primary outcome variables included Disability of the Arm Shoulder, and Hand (DASH) score, Mayo Elbow Performance Score (MEPS), and reoperation rates. Inclusion criteria were isolated primary SAT or SD and adult active duty service members with a minimum of 6-year follow-up. Terminal follow-up was determined by a telephone interview. Exclusion criteria were revision procedures, trauma, cases which included other procedures (to include medial epicondylectomy, submuscular transposition, arthroscopy, or fracture fixation) nonactive duty service members, those without a minimum 6-year follow-up, or those with an incomplete medical record or who could not be reached for the survey. Minor complications included those such as pain and parathesias, while major complications required a return to the operating room. The power of this analysis was determined to be 126 participants. The analysis of variance for the continuous variables and Fisher test for the binary variables were used to compare means or percentages. Sixty-five SD and 67 SAT met inclusion and exclusion criteria. The average age was 32.3 years for all patients with an average follow-up of 6.5 years for SD and 6.3 years for SAT. As compared to SAT, SD had superior of DASH (11, 21) and a lower rate of minor complications (45%, 70%) (P < .05). There was no difference in reoperation rate. Preoperative ulnar nerve subluxation was reported for half of each cohort and one-third of each cohort had a preoperative subluxating ulnar nerve (SAT: 13 of 37; 35% - SD: 18 of 51; 35%). Preoperative subluxation affected neither postoperative outcome nor reoperation rate. •SD had improved DASH and a lower rate of complications as compared to SAT.•For those had had a preoperative subluxating ulnar nerve, SD had a lower DASH score, equivalent grip strength, a lower minor complication rate, and an equivalent major complication rate.•In the active duty population there is no benefit for transposing the ulnar nerve for the surgical treatment of primary cubital tunnel syndrome, regardless of preoperative nerve stability.

Impact of Different Treatment Modalities on the Outcome of Pancreatic Cancer.

To analyze overall survival patterns of our pancreatic cancer patient population managed with a curative or palliative intent. Analytical study. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2000 till February 2015. Aretrospective review of the data of all of our pancreatic cancer patients was performed, using the hospital information system. Patients with tumor other than adenocarcinoma or a histopathologic diagnosis not made at our hospital are excluded from the study, along with patients having an incomplete medical record for all included variables. The main outcome measure was overall survival in months from the date of diagnosis. All results were segregated and analyzed according to the intervention modality used, i.e. group A: surgery with curative intent, group B: Palliative chemotherapy, and group C: Supportive care. Results were controlled for the confounding variables including age, gender, significant comorbid conditions, stage of disease at initial presentation, tumor location, and histological grade. Among the 197 patients fulfilling the inclusion criteria, 21 (10.7%) were excluded as they were lost to follow-up. Overall Kaplan-Meier survival analysis gave a 56% one-year survival, 22% at 3- and 16% at 5-year. The subset analysis on Cox-regression survival plot showed inferior survival with advancing stage of the disease and a treatment less than definitive surgical resection and adjuvant chemotherapy. On Cox-proportional regression analysis, stage of the disease and treatment modality were only independent predictive factors for overall survival (p < 0.01). Stage for stage, surgery with curative intent (group A) or palliative chemotherapy (group B) showed a trend towards improved survival as compared to supportive management (group C) alone. The results were more significant for surgical resection arm.

A Study of Hypoalbuminemia and Pleural Effusionin Pediatric Nephrotic Syndrome

Background : Nephrotic syndrome (NS) is a kidney disease that is most often found in children. Hypoalbuminemia in NS can cause a decrease in oncotic pressure causing extravasation of fluid into the interstitial space. In conditions of severe hypoalbuminemia, fluid extravasation may cause occurrence of pleural effusion. The objectives of this study was to analyze the correlation between hypoalbuminemia and pleural effusion in children with NS. Methods : An analytical study was conducted on 69 medical records of pediatric nephrotic syndrome from 1 January 2008–31 December 2013 in dr. Hasan Sadikin General Hospital. Inclusion criteria were pediatric patients between 1-14 years old with NS. Exclusion criteria were patients who already had albumin transfusion, malnutrition, patients with chronic disease, and incomplete medical record information. Contingency coefficient test was carried out to discover the correlation between variables. Results : Out of 89 samples, 69 samples were included. Characteristics of the included patients are male (n=48), female (n=21), age 1–5 (n=24), 6–10 (n=22), 11–14 (n=23), mild hypoalbuminemia (n=3), moderate hypoalbuminemia (n=27), severe hypoalbuminemia (n=39), patients with pleural effusion (n=23), and non-pleural effusion (n=46). There was a significant correlation between hypoalbuminemia and pleural effusion with p=0.000 (p<0.05) and moderate correlation (r=0.437). Conclusions : Hypoalbuminemia has correlation with pleural effusion in pediatric nephrotic syndrome. Keywords : Hypoalbuminemia, pediatric nephrotic syndrome, pleural effusion DOI: 10.15850/amj.v4n2.1075

Epidemiología del cáncer colorrectal en menores de 50 años en el Hospital Juárez de México

IntroductionColorectal cancer (CCR) is the third most common, and the third leading cause, of cancer death in men and women in the United States, and accounts for 2.68% of all malignant tumours in Mexico. CCR was considered as a disease of older adults, but a progressive and significant increase has been observed in the detection of CCR in younger people. Colonoscopy is the diagnostic method of choice, with a sensitivity and specificity of 98.2%. ObjectiveTo describe the epidemiological and histopathological characteristics of patients younger than 50 years old diagnosed with colorectal cancer in the Juarez Hospital of Mexico from January 2008 to January 2015. Material and methodsRetrospective and descriptive study. Inclusion criteriaPatients under 50 years old who underwent colonoscopy and colon cancer was documented with confirmatory histological study. Exclusion criteriaPatients with a negative pathology result for colon cancer, and followed-up by other health institutions. Elimination criteriaPatients with incomplete medical record or no record was found in clinical file. The analysis of results was with basic descriptive statistics and SPSS software 2012. ResultsIn the specified period of study, there were 2,197 colonoscopies, with 101 patients under 50 years and 614 patients older than 50 years confirmed with colon cancer by histology. Of the patients younger than 50 years, only 86 were included for analysis (15 were patients with incomplete file). The study included 46 (53.5%) men and 40 (46.5%) women, with a mean age of 41.63 years (range 19-49 years). Elective colonoscopy was performed in 83 (96.51%) and 3 (3.4%) were urgent. The most common symptom was abdominal pain in 62.8%, and weight loss, rectal bleeding and constipation in 41.9, 29, and 24.4%, respectively. The time of onset of symptoms ranged from 1one month to 3 years, appearing in most cases the fourth month (21%). Location: ascending colon (27.9%), descending colon (26.7%), sigmoid (13.95%), rectum (12.79%), blind (9.3%), and transverse (5.8%). Surgical treatment was performed in 83 (98.5%) and palliative care in 3 patients (3.48%). The most frequent endoscopic finding was neoplasm associated with partial stenosis (100%). The correlation between the endoscopic and histopathological diagnosis of the surgical specimen report was 100%. The histological type: moderately differentiated adenocarcinoma 50 (58.1%). There were 24 (27.9%) cases in clinical stage IIA, with 22 (25.58%) in stage IIB, and 10 (11.62%) in stage IIIA. The mortality associated with colon cancer was 23 (26.70%; 12 men, women 11 women). ConclusionsColorectal cancer in adults under 50 years in the Juarez Hospital in Mexico is similar to that reported in the literature. It predominates in the male gender, is more common in the right colon, with an increased tendency to stenosis, and adenocarcinoma as histological type and stage clinical IIA.

Risk factors and biomarkers for the recurrence of ovarian endometrioma: about the immunoreactivity of progesterone receptor isoform B and nuclear factor kappa B

Ovarian endometrioma is one of the important causes of poor ovarian reserve and up to half of them have been recurred. However, the treatment for recurrence prevention has limited efficiency and repeated surgery makes worsen the ovarian reserve. To find better management for recurrence prevention, we investigated risk factors and biomarkers for the recurrent endometriomas. The medical records of women with history of surgical dissection for ovarian endometrioma were collected. After exclusion of the cases with concurrent hysterectomy, been menopaused during follow-up, incomplete medical record, and loss of follow-up, a total of 134 women were enrolled. Immunohistochemical staining for progesterone receptor isoform B (PR-B) and nuclear factor kappa B (NFκB) was done with the fixed tissue blocks of their endometriomas which were collected at the time of surgery. Severity of dysmenorrhea and co-existence of adenomyosis had significant correlation with recurrence of endometrioma. Serum CA-125 level at the time of recurrence was higher than the highest level of CA-125 during follow-up in non-recurred group (55.6 versus 21.3 U/mL, p = 0.014). Increased PR-B (p = 0.041) and decreased NFκB (p = 0.036) immunoreactivity were found in recurrent group. However, to determine the possibility of immunoreactivity of PR-B and NFκB as biomarkers for recurrent endometrioma, further studies of various races and large numbers with prospective design are needed.

High daily doses of trimethoprim/sulfamethoxazole are an independent risk factor for adverse reactions in patients with pneumocystis pneumonia and AIDS

BackgroundTrimethoprim/sulfamethoxazole (TMP/SMX) is currently the most effective therapeutic agent for Pneumocystis jirovecii pneumonia (PJP) in patients with AIDS. The major drawback is the frequent occurrence of adverse reactions (ADRs).The current study was designed to determine the frequency and risk factors for TMP/SMX-related ADRs among patients with PJP and AIDS. MethodsA retrospective study was conducted in adult patients with PJP and AIDS who were admitted to the Veterans General Hospital in, Kaohsiung, Taiwan between January 2006 and December 2011. Charts were reviewed to determine the effect of age, risk behaviors, severity of illness, viral load, CD4 cell counts, use of corticosteroids, and dosage and duration of TMP/SMX on ADRs during hospitalization. Patients who received TMP/SMX for ≤ 5 days or with an incomplete medical record were excluded. Multivariate logistic regression was used to calculate the hazard ratio (HR) for ADRs. ResultsFifty two of 75 patients with PJP and AIDS met the study criteria. Of these patients, 21/52 (40.3%) developed an ADR. Among the 21 patients who suffered an ADR, skin rash was noted in 10 (47.6%), liver function impairment in nine (42.9%), elevated creatinine in eight (38.1%), fever in four (19%), and gastrointestinal symptoms in three (14.3%). Most of the ADRs occurred within the 1st 2 weeks of TMP/SMX therapy. Cox proportional hazards analysis revealed that a daily dose of TMP/SMX of ≥ 16 mg/kg (HR, 3.8; 95% confidence interval, 1.40–10.35; p = 0.009) and age 34 years (HR, 4.30; 95% confidence interval, 1.52–12.14; p = 0.006) were independently associated with ADRs. ConclusionWe found a high incidence of ADRs among patients with PJP and AIDS treated with TMP/SMX, and most involved the skin and liver. A daily dose of ≥ 16 mg/kg of TMP/SMX and age 34 years were independent risk factors for ADRs.

Lower Gastrointestinal Bleeding in Saudi Patients: A Retrospective Longitudinal Study

Aims/Objectives: The epidemiology of lower gastrointestinal bleeding (LGIB) in western populations has been well documented but there are scant reports about this condition in Saudi Arabia. This research studied the demographic characteristics of LGIB and assessed the specific colonoscopy findings in Saudi national patients who attended a large population based hospital in Riyadh, the capital city of Saudi Arabia. Methods: The present study took place at King Saud medical city, Riyadh, Saudi Arabia. A longitudinal retrospective analysis of patient endoscopy records was carried out covering the period from 2004 through to 2015. The patients included were Saudis aged 18 years and above who were receiving first time colonoscopy for an unknown etiology of bleeding. The patients were from a number of sources: emergency room (ER), inpatients or referred from other centres. Data were entered into Excel and then transferred to SPSS for statistical analysis. Results: A total of 1,137 patients were included in the study. 178 patients were excluded due to missed or incomplete medical record numbers leaving a total of 959 patients, consisting of 574 (60%) males and 385 (40%) females, with a median age of 51.9 years (SD 18.4, range 18 to 113 years). Most patients were in-patients/ER (346, 42.5%), or out patients (350, 43%), while 137 (14.5%) were referred from other centers. In all colonoscopy findings of LGIB there were significantly more male than female patients, with a male to female ratio of 1.5:1. The most common colonoscopy findings of LGIB were hemorrhoids (369) 38.5%, colitis (78) 8.1%, diverticulosis (116) 12.1%, neoplasm (95) 9.9% and polyps (47) 4.9%, respectively. The colon was normal in (140) 14.6% patients. Conclusions: Our research showed that hemorrhoids, rectal ulcers, colitis, diverticulosis and tumors were the most common colonoscopy findings of LGIB in a Saudi adult population, with men more predisposed to LGIB than women. These findings are broadly similar to those reported in western populations.

Feeding outcomes and parent perceptions after the pacifier‐activated music player with mother's voice trial

Feeding difficulties common in preterm infants often delay their initial discharge to home (1). Neonatal intensive care unit (NICU) graduates are then at high risk for rehospitalisation during the first year of life, and feeding problems such as aspiration contribute significantly to this morbidity. Gastrointestinal and respiratory diagnoses, primarily aspiration and feeding disorders, account for one-quarter of all readmissions and are among the most expensive readmissions (2). One possible aetiology for these problems is that feeding skills of preterm infants continue to mature to the level of term infants well after discharge from the NICU (3). The acquisition of optimal basic feeding skills in preterm infants before discharge to home can establish a solid basis for later learning of more complex skills and prevention of serious complications.

Deliveries by caesarean sections on request of women: legal-medical evidence

Introduction: In Italy the use of caesarean delivery has a rising trend moving away from European standards appeared on Euro-Peristat on maternal and child health, presenting the highest percentage of use of this procedure with significant regional differences. This study have analyzed the most recent data of a Sicilian reality about normal delivery and caesarean sections carried out in a hospital situated in Messina (Italy). Materials and methods: A total number of 1,573 medical records from 1st January 2011 to 31st December 2013 were analyzed and data gathered were statistically examined to describe general and specific parameters of the sample making use of Epi Info 7.1.4 software (CDC Atlanta – USA). Chi-square test was used to show any statistic differences among studied population. Results: Overall data showed that were carried out 38.27% of spontaneous deliveries, 7.06% of induced labor, and 54.67% of caesarean deliveries. There were no significant statistical differences between recourse to caesarean section and vaginal delivery in relation to nationality, age, level of education and/or work. The enrolled group, based on the parameters examined, was divided into appropriate caesarean section, in 79.49% of cases, inappropriate in 7.20% (mother’s request) and unjustified in 13.31% (with no indication, incomplete medical record). An examination of the anesthetic medical records showed that the caesarean section was considered to be urgent in 31.74% of the cases; however in 17.92% of these cases there is no information in the medical records justifying the use of emergency procedures. Conclusion: The reported data from the study that we conducted, lead to medical-legal and juridical considerations, especially as regards the use of caesarean delivery on the woman request. The complexity of the phenomenon requires the development of a variety of intervention strategies, not only for issues related to the reduction of health care costs, but also with regard to the clinical risk management and medical legal aspects related to the several profiles of professional responsibility.

Prevalence of Gestational Diabetes Mellitus in Patients with Polycystic Ovary Syndrome

Objective: To determine the prevalence of gestational diabetes mellitus in polycystic ovary syndrome. Research design and methods: We conducted a retrospective observational study in a tertiary care medical institution in Monterrey, Mexico. Ninety-one patients were enrolled. We excluded patients with twin pregnancies or with an incomplete medical record. Data were obtained in the postpartum wards by review of medical records. A diagnosis of gestational diabetes mellitus was made according to current criteria of the American Diabetes Association. Results: We included 91 patients with a mean age of 27 ± 6 years. Of these patients, 77% had a family history of type 2 diabetes mellitus, and 8% received treatment to become pregnant. The prevalence of gestational diabetes mellitus in our study cohort was 65%. Conclusion: Gestational diabetes mellitus has a high prevalence in patients with polycystic ovary syndrome. A consensus between early detection and classification criteria to standardize the diagnosis should be sought.

Percutaneous cholecystostomy (PC) in the management of acute cholecystitis in high risk patients.

To determine the role of ultrasound-guided percutaneous cholecystostomy (PC) regarding complications and outcome in the management of acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management. Observational case series. The study was carried out at The Aga Khan University Hospital, Karachi, from January 2003 to December 2007. The study included patients admitted with acute cholecystitis considered unfit for immediate surgery but not responding to conservative management. Percutaneous cholecystostomy was conducted under ultrasound guidance. The studied variables included patients' demographics, co-morbid, ultrasound findings of biliary tree, indication for percutaneous cholecystostomy, its route, complication during or after procedure, patient's clinical outcome (upto 48 hours) and 30 days follow-up. Those with incomplete medical record and follow-up were excluded. Data were analyzed and results compiled using SPSS 16.0 version. Mean and standard deviation for quantitative variable like age was derived. Proportions were computed for complications and patient's clinical outcome. Forty one patients with complete medical record were studied including 15 (37%) males and 26 (63%) females. Mean age was 65 +/-13.5 years. Indications for PC included calculus cholecystitis in 25, acalculous cholecystitis in 10, empyema in 04 and gallbladder perforation in 02 patients. No complication was seen during or after procedure in 31 (75%) patients. Complications occurred in 10 (25%) patients including vagal reaction, pain during procedure, tube blockage, catheter dislodgement and bile leakage. Favourable clinical response (improvement in clinical symptoms) was noted in 34 (83%) patients. Seven (17%) patients did not show any improvement in clinical condition after the procedure. On 30 days follow-up, 9 patients had undergone cholecystectomy, 5 (12%) patients expired due to underlying clinical conditions and the rest were settled without requiring an immediate cholecystectomy. There was no direct procedure-related mortality. Imaging guided PC is a safe and effective procedure for immediate management of non-resolving acute cholecystitis in patients high risk for surgery and anaesthesia and not responding to conservative management.

Intussusceptions in adults: clinical features and operative procedures.

To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions. Case series. The Aga Khan University Hospital, Karachi, from January 1988 to December 2008. Medical records of patients with diagnosis of intussusceptions in adults (above 15 years of age) from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 days-morbidity, mortality and recurrence of intussusceptions during follow-up period. The mean age of the 19 patients was 37 years with male predominance. Most patients presented with acute bowel obstruction. In 14 patients, small bowel were involved. CT scan diagnosed intussusception in 10 out of 12 patients. Benign lead point were found in 80% cases. Eighteen patients were treated surgically. Fourteen (70%) patients underwent resection with primary anastomosis while in 4 patients only reduction was done. In resection group, 11 patients had resection after reduction and in 3 patients only resection was done. There was no recurrence in resection group. One recurrence was noticed in the reduction group and one patient died of advanced gastrointestinal malignancy in the nonoperative group. Intussusception is a rare cause of acute intestinal obstruction in adult population. CT scan is a promising diagnostic tool to establish pre-operative diagnosis. Early surgical resection could achieve optimal outcome. Small bowel intussusception could be reduced before resection if there is no doubt about bowel viability. In most of the patients the lead point could be benign disease.

1450P - Effect of Prior Metformin Intake on First Diagnosis of Breast Cancer

ABSTRACT Introduction Metformin has been shown in pre clinical studies to have the ability to reduce tumor growth and exert anti cancer effects. It is being tested as a part of management of breast cancer (BC) in neoadjuvant and adjuvant settings and being entertained as a modality of chemoprevention in BC. We studied the effect of prior metformin intake on patients with first diagnosis of breast cancer. Methods All patients with a diagnosis of BC were identified from the Tumor Registry of our hospital, which serves the underserved population of Chicago, USA. All charts were retrospectively screened for age, tumor grade, node status at diagnosis, onset of diabetes mellitus (DM) prior to cancer diagnosis and intake of metformin including duration. Patients with a diagnosis of DM after cancer, intake of metformin less than 6 months or incomplete medical record were excluded. Difference in means was calculated using the student t-test. Results A total of 1569 patients were screened of which 133 patients were identified to have a diagnosis of DM before breast cancer and met the inclusion criteria. Of these, 95 patients were on metformin for an average 3.57 years (yrs) before BC diagnosis. Thirty-nine patients on metformin were younger than 60 yrs and 56 were older than 60 yrs age. Node positive disease was seen in 51.5% of metformin patients compared to 49% DM patients not on metformin (p = NS). However in patients younger than 60 yrs, node positive disease was seen in 66% of metformin patients compared to 86% non-metformin patients. The young patients on metformin had an average grade of 2.38 compared to non-metformin patients whose average grade was 2.83 (p = 0.02). More patients in young non-metformin group were Her2-neu positive (43%) compared to 23% in young metformin group. In older patients more non-metformin patients had triple negative disease (20%) compared to 9% in metformin group. Conclusions Prior metformin use may have a possible positive effect in patients with initial diagnosis of BC. This effect seems more pronounced in patients younger than 60 yrs of age where metformin intake was associated with a statistically significant reduction in tumor grade with a trend towards reduction in node positive disease and Her2 positivity. Further studies are needed to clarify the potential protective role of metformin in this younger group. Disclosure All authors have declared no conflicts of interest.

The American Heart Association's Recommendations for Expanding the Applications of Existing and Future Clinical Registries

Clinical registries play an important role in measuring healthcare delivery and supporting quality improvement for individuals with cardiovascular disease and stroke. Well-designed clinical registry programs provide important mechanisms to monitor patterns of care, evaluate healthcare effectiveness and safety, and improve clinical outcomes. The use of clinical registries is likely to grow given the increasing focus on measuring and improving healthcare delivery and patient outcomes by stakeholders in both the private and public sectors. The American Heart Association (AHA) has a longstanding commitment to promoting the innovative and effective use of clinical registries. The importance of clinical registries was highlighted recently in an AHA Scientific Statement on “Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke” in the United States.1 This policy statement expands on the previous scientific statement by providing recommendations to policy makers and the healthcare community for expansion of the applications of existing and future clinical registries. The term “clinical registry” is defined here as an observational database of a clinical condition, procedure, therapy, or population in which there are often no registry-mandated approaches to therapy and relatively few inclusion or exclusion criteria. The focus of clinical registries is to capture data that reflect “real-world” clinical practice in large patient populations. The data from clinical registries do not replace the need for traditional randomized controlled trials. Rather, registries and trials are complementary approaches, each with unique advantages and imperfections.2 Such clinical registries do not solely contain claims or administrative data yet may be linked to such data sources. There are at least 3 classifications of clinical registries based on the patient population, including procedure/therapy/encounter-based, disease-based, and population-based registries. Registries also can be classified from a functional perspective, such as whether the registry is used to conduct clinical research, …

Risk Factors for the Development of Metachronous Liver Metastasis in Colorectal Cancer Patients After Curative Resection

Metachronous liver metastasis (MLM) occurs in 20-40% of colorectal cancer (CRC) patients following surgical treatment. The aim of the present study was to determine the risk factors affecting the development of MLM in CRC patients following curative resection. A total of 1,356 patients who underwent curative intent resection for CRC were retrospectively studied. Of these patients, those who with 30 days postoperative mortality (n=23), incomplete medical record (n=32), synchronous liver metastasis (n=148) and UICC stage IV (n=54) were excluded, and finally 1,099 patients were analyzed, including 977 patients without liver metastasis and 122 patients with MLM-only. Clinical and pathological records for each patient were reviewed from medical charts. The clinicopathologic characteristics of 1,099 patients were investigated. The median timing of developing MLM was 13 months with a range of 4 to 79 months. Univariate analysis identified that preoperative serum carcinoembryonic antigen (CEA) level, depth of invasion, lymph nodes metastasis, vascular invasion, and perineural invasion were significantly correlated with the development of MLM (all P<0.05). Meanwhile, a multivariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) level>5 ng/ml (Odds Ratio [OR]=1.591; 95% Confidence Interval [CI], 1.065-2.377; P=0.024), tumor depth (OR=2.294; 95% CI, 1.103-4.768; P=0.026), positive lymph node metastasis (OR=2.004; 95% CI, 1.324-3.031; P=0.001) and positive vascular invasion (OR=1.872; 95% CI, 1.225-2.861; P=0.004) were independent prognostic factors contributing to the occurrence of MLM. The present study demonstrates that preoperative serum CEA level, tumor depth, lymph node metastasis, and positive vascular invasion could affect the occurrence of MLM in CRC patients following curative resection, and thus could help to define these high-risk patients who would benefit from enhanced surveillance and therapeutic program(s).