Independent Risk Factors For Presence Research Articles

High-grade Vesicoureteral Reflux in Patients With Anorectal Malformation From the ARM-Net Registry: Is Our Screening Sufficient?

BackgroundVesico-ureteral reflux (VUR) is a common associated urological anomaly in anorectal malformation (ARM)-patients. High-grade VUR requires antibiotic prophylaxis to prevent urinary tract infections (UTI's), renal scarring and -failure. The exact prevalence of high-grade VUR in ARM patients is unknown. Hence, the aim of this study was determining the incidence of high-grade VUR in ARM-patients, and its associated risk factors. MethodsA multicenter retrospective cohort study was performed using the ARM-Net registry, including data from 34 centers. Patient characteristics, screening for and presence of renal anomalies and VUR, sacral and spinal anomalies, and sacral ratio were registered. Phenotypes of ARM were grouped according to their complexity in complex and less complex. Multivariable analyses were performed to detect independent risk factors for high-grade (grade III-V) VUR. ResultsThis study included 2502 patients (50 % female). Renal screening was performed in 2250 patients (90 %), of whom 648 (29 %) had a renal anomaly documented. VUR-screening was performed in 789 patients (32 %), establishing high-grade VUR in 150 (19 %). In patients with a normal renal screening, high-grade VUR was still present in 10 % of patients. Independent risk factors for presence of high-grade VUR were a complex ARM (OR 2.6, 95 %CI 1.6–4.3), and any renal anomaly (OR 3.3, 95 %CI 2.1–5.3). ConclusionsAlthough renal screening is performed in the vast majority of patients, only 32 % underwent VUR-screening. Complex ARM and any renal anomaly were independent risk factors for high-grade VUR. Remarkably, 10 % had high-grade VUR despite normal renal screening. Therefore, VUR-screening seems indicated in all ARM patients regardless of renal screening results, to prevent sequelae such as UTI's, renal scarring and ultimately renal failure. Type of StudyObservational Cohort-Study. Level of EvidenceIII.

Middle cerebral artery bifurcation aneurysms are associated with patient age, sex, bifurcation angle, and vascular diameters

To investigate the relationship of the middle cerebral artery (MCA) bifurcation aneurysms with patients’ age and sex, vascular angles at the bifurcation, and diameters of the M1 and two M2 arteries, patients with and without MCA aneurysms were retrospectively enrolled. The lateral angles, MCA bifurcation angle and arterial diameter were measured and analyzed. Totally, 121 (19.0%) patients with and 517 (81.0%) without MCA aneurysms were enrolled. Most (n = 88 or 72.7%) aneurysms were present in the age range of 40–70 years, and significantly (P = 0.01) more women than men had the bifurcation aneurysms. The MCA bifurcation angle was significantly greater (149.2° ± 32.6° vs. 107.2° ± 26.3°; P < 0.0001) while both the smaller and larger lateral (M1/M2) angles were significantly smaller in patients with than without aneurysms (82.0° ± 23.7° vs. 109.1° ± 22.7° with P < 0.001 for the smaller and 123.2° ± 25.2° vs. 139.5° ± 16.9° with P < 0.001 for the larger lateral angle). 109 (90.1%) bifurcation aneurysms deviated towards the smaller lateral angle, and 103 (85.1%) aneurysms deviated towards the thinner M2 branch. The maximal aneurysm diameter ranged 1.6–13.8 (mean 5.4 ± 2.4) mm and was significantly (P < 0.05) positively correlated with the diameter of both M2 arterial branches (R = 0.57 and P = 0.01 for the smaller M2, and R = 0.69 and P = 0.002 for the larger M2) or the MCA bifurcation angle. A significant (P < 0.0001) negative correlation was detected between age and the smaller lateral angle but a significant (P < 0.0001) positive correlation between age and the MCA bifurcation angle in patients without MCA bifurcation aneurysms or in the total patients. MCA bifurcation angle was the only significant (P = 0.0001, odds ratio 2.7, 95% confidence interval 1.6–3.8) independent risk factor for MCA bifurcation aneurysm presence, with the bifurcation angle threshold of 124.1° and an area under the ROC curve of 0.86. In conclusion, significantly more MCA bifurcation aneurysms are present in older patients, females, and patients with a wider MCA bifurcation angle, and deviate towards the smaller lateral angle and the thinner M2 segment. MCA bifurcation angle is the only independent risk factor for presence of MCA bifurcation aneurysms with the threshold of 124.1°.

Abdominal Wall Hernias in Patients with Hiatal Hernias: Predictors of Association in a Large Cohort of Patients

Introduction: Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. Methods: A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. Results: The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P &lt;0 .0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P &lt;0 .0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P &lt; 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P &lt;0 .0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P &lt;0 .0001). Conclusion: The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.

Evde Bakım Hizmeti Alan Geriatrik Hastalarda Disfaji Sıklığı ve İlişkili Risk Faktörleri

Objective: In our study, it was aimed to determine dysphagia prevalence in patients 65 years of age and older who were received home care and to assess factors associated with dysphagia. Methods: This cross-sectional, descriptive study was conducted in patients who were registered to Home Care Services of Samsun Training and Research Hospital between December 1, 2021, and March 1, 2022. In all patients, demographic data, level of dependence, nutrition methods, use of enteral nutrition supplement, body mass index (BMI), and comorbidity were assessed by Charlson Comorbidity Index (CCI) while dysphagia symptoms were assessed by Eating Assessment Tool (EAT-10) and nutritional status was assessed by Nutritional Risk Screening-2002 (NRS) using face-to-face interview method. Results: A total of 413 patients were included in our study, of which 62.5% (n=258) were female. Dysphagia symptoms were present in 44.6% (n=184). The dysphagia prevalence was significantly high in male patients (p=0.025), in patients aged ≥85 years (p=0.001), in those with high CCI score (p&amp;lt;0.001), in those with cerebrovascular disease (p&amp;lt;0.001), dementia (p&amp;lt;0.001), and hemiplegia (p=0.001), and in bedridden patients (p&amp;lt;0.001). Similarly, dysphagia prevalence was higher in patient with nutritional risk and those using enteral nutrition supplement (p&amp;lt;0.001). In multivariate logistic regression analysis, it was found that dementia and increased nutritional risk were independent risk factors for presence of dysphagia symptoms (p&amp;lt;0.001). Conclusion: Our study showed a high prevalence of dysphagia in the geriatric patient population receiving home care. It has been determined that the rate of dysphagia is increased in patients with older age, nutritional risk, dementia, cerebrovascular disease, and multiple comorbidities.

The Relationship Between Obesity and Coronary Artery Ectasia in Patients Presenting with Acute Coronary Syndromes

Introduction Obesity is a global health burden with an increasing worldwide incidence. Coronary artery ectasia (CAE) is frequently associated with obstructive coronary artery disease and acute coronary syndrome (ACS). Obesity and CAE are risk factors for ACS. Considering this linkage, we aimed to investigate the role of obesity in presence of CAE in patients presenting with ACS. Methods Patients hospitalized with a diagnosis of ACS in our tertiary center between January 2015 and May 2020 were included in this retrospective, case-control study. The patients presenting with ACS involving a coronary artery ectasia segment formed ‘CAE group’. On the other hand, patients who were undergone coronary angiography with a diagnosis of ACS without coronary ectasia formed ‘control group’. Results There was a total of 274 patients. Patients who were presented with ACS involving a CAE segment were in higher body mass index (BMI) tertials and BMI was an independent predictor for presence of CAE in patients presenting with ACS. Additionally advanced age, diabetes mellitus, hypertension, current smoking, increased neutrophil/lymphocyte ratio, higher fasting blood glucose, triglyceride and lower high-density lipoprotein (HDL) levels were found as independent risk factors for presence of CAE in patients presenting with ACS. Conclusion We detected obesity (being overweight or obese) as an independent risk factor associated with the presence of CAE in patients presenting with ACS. Higher triglyceride and fasting blood glucose and lower HDL levels detected in our study support the idea that metabolic syndrome plays a role and insulin resistance is the underlying mechanism for CAE presence in patients presenting with ACS.

Psychosocial Perceptions as Significant Impact Modifiers - A Mixed Method Research Among Hospitalized Covid-19 Patients in A Tertiary Care Hospital in Coimbatore District, Tamil Nadu

Context: Covid 19 pandemic which evolved in successive waves had profound pyschosocial impact on affected individuals. Perceptions had impact on both individual and environmental level with potential behavioural consequences. The aim of the research is to study the psychosocial perception and psychological impact of COVID- 19 among hospitalized COVID-19 patients. Methodology: The study was a mixed method research (Quan-Qual sequential design) conducted in the Covid wards of a tertiary care hospital in Coimbatore district. The psychological impact was assessed using the General Health Questionnaire, Perceived Stress Scale. The results of quantitative analyses and qualitative analyses were expressed as proportions and done using thematic analysis using grounded theory respectively. Results: About 55% of the hospitalized Covid-19 patients had psychological impact. On multivariate analysis, the factors which emerged as independent risk factors for presence of psychological morbidities due to COVID were presence of high stress level, sleep disturbances and their perception of COVID as high threat. Conclusions: Focussed Counselling with specific reference to attend to spiritual health component in addition, would go a long way in diminishing immediate and long-term psychological impact due to covid-19 illness.

Efficacy of plasma atherogenic index in predicting malignancy in the presence of Prostate Imaging-Reporting and Data System 3 (PI-RADS 3) prostate lesions.

Plasma atherogenic index (PAI) was shown to be positively correlated with the presence of malignity in patients with suspicious findings for renal cell cancer and colon cancer in reported studies. In this study, we aimed to evaluate whether there is an association with the presence of malignity in patients PI-RADS 3 prostate lesions and PAI. This retrospective study reviewed the data of 139 patients who underwent transrectal ultrasonography-guided systematic and cognitive fusion prostate biopsy for PI-RADS 3 lesions in multiparametric magnetic resonance imaging. The patients were divided to two groups as malign (n = 33) and benign (n = 106). The association between age, body mass index, comorbidities, smoking status, prostate-specific antigen (PSA), PSA density, free/total PSA, prostate weight, lesion diameter, triglyceride value, high-density lipoprotein-cholesterol value, PAI value data and presence of malignity were investigated by descriptive, multivariate and receiver-operating characteristic (ROC) analysis. PSA, PSAD, lesion diameter and PAI value were statistically significantly higher in the malignant group compared to the benign group, and the free/total PSA ratio was lower. In multivariate logistic regression analysis, PSA > 9.9ng/ml, free/total PSA < 12.1%, lesion diameter > 13.5mm and PAI > 0.13 were identified as independent risk factors for presence of prostate malignancy. PAI was found to be a predictive parameter for prostate cancer in PI-RADS 3 prostate lesions. Our study can open new thoughts about PAI as metric to assess the prostate cancer risk.

Association between non-alcoholic fatty liver disease and endometrial cancer

Metabolic syndrome (MetS) increase the risk of endometrial cancer (EC). Non-alcoholic fatty liver disease (NAFLD) is related with MetS and share many risk factors with EC that may have significant roles in its development; however, the relationship between NAFLD and EC remains unclear. 207 patients who were operated for endometrial cancer in our hospital between 2011 and 2015, and 243 gynecological patients without a history of malignancy who were randomly selected as the control group. NAFLD was diagnosed based on abdominal ultrasonography findings. There was no significant difference presence of diabetes mellitus and ALT, AST levels between EC group and control group. In EC group, age, body masss indeks (BMI), hypertension and NAFLD were significantly higher than those in control group (P &lt; 0.001). Logistic regression analysis showed that age and NAFLD are independent risk factors for presence of EC. Age and NAFLD were a possible independent risk factor for EC in the present study. Therefore, a multi-center and large-population study will be needed to prove our conclusions.

Prevalence of Nicotine Dependence and Internet Addiction among University Students, and Relation between them

Background: Nicotine dependence and internet addiction are two important problems among university student. Aims: We aimed to determine the prevalence of ND and IA among the university students, and to investigate the parameters that affect these clinical problems. Study design: This study is designed as a descriptive, cross-sectional, epidemiological study. Methods: The academicians of Department of Family Medicine formed a questionnaire (9 questions). Turkish versions of Young’s Internet Addiction Test (YIAT) and Fagerstrom Test for Nicotine Dependence (FTND) were used as data collection tools. Sample volume was calculated as 1632 students, and a total of 1816 students were randomly selected. In classes, cafes and social fields we spoke to the students and informed them about the study. Voluntaries were requested to answer the questions in the questionnaire and fill the scales. Results: Mean age of the participants was 21.45±2.58 years (range 18-35 years), and 908 (50%) were male. The mean FTND score was 1.18±2.27 (range 0-10). Of the participants, 24.2% were moderate, high or very high nicotine dependent. Binary logistic regression analysis showed that the gender (p=0.000), place of residence (p=0.000), monthly intake (p=0.023) and presence of symptoms of IA (p=0.000) were independent risk factors for smoking. The mean YIAT score was 40.30±14.95 (range 20-100). Of the participants 76% were users without symptom, 19.6% were users with limited symptoms and 4.4% were pathologic internet users. Binary logistic regression analysis showed that gender (0.004), smoking (p=0.001) and the device used for internet connection (p=0.008) are independent risk factors for presence of symptoms of IA. The FTND score was significantly correlated with the YIAT score (Pearson correlation coefficient=0.164, p=0.000). Conclusion: Our results indicate that the prevalence of ND and IA are high among the university students. Also, there is a significant relation between ND and IA. Male gender, living in home alone and a higher monthly income are significant risk factors. The educational and preventive activities should take these risk factors into account.

Primary Sjögren's syndrome as independent risk factor for subclinical atherosclerosis.

To assess the prevalence of subclinical atherosclerosis in patients with primary Sjögren's syndrome (pSS) and its possible association with clinical and analytical parameters of the disease. In this cross-sectional study, 38 consecutive patients with pSS were compared with 38 age and sex healthy controls. Demographic variables and classic cardiovascular risk factors (CVRFs): Hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking habit were assessed in both groups, and also disease-related features were collected in pSS group. The presence of subclinical atherosclerosis was assessed by carotid ultrasound, with carotid intima-media thickness (CIMT) measurement and determination of the presence of atheromatous plaques. Subclinical atherosclerosis presence was remarkably greater in patients with pSS than in healthy controls (OR = 4.17, 95%CI [1.27-16.54]), as well as CIMT values (0.79 ± 0.43mm vs. 0.66 ± 0.27mm; P = .02). No differences for classic CVRFs were found between both groups. An association of subclinical atherosclerosis with erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) was observed in patients with pSS. This cohort showed a greater prevalence of subclinical atherosclerosis in patients with pSS, indicating this disease as an independent risk factor for presence of early vascular damage.

Risk factors for the development of endometrial fluid in women undergoing IVF: A retrospective cohort study✰

Research questionPresence of endometrial fluid (EF) is a poorly understood pathology and remains a challenge for clinicians, as very little data exists to explain its consequences and treatment. Our objective was to investigate risk factors for EF during IVF. DesignThis retrospective cohort study included all women with a freeze all embryos cycle (FAE) for EF between 2010 and 2016 at a university-affiliated private IVF center. Controls (2:1) were randomly selected out of the database of our fresh autologous IVF cycles during the same period. Main outcome measures were possible risk factors for EF, comprising polycystic ovarian syndrome (PCOS), ovarian hyperstimulation syndrome (OHSS), previous pelvic or endometrial surgery (polypectomy or synechia removal), cesarean section, myomas and severe endometriosis. A logistic regression model was used to assess independent risk factors for EF. ResultsOut of 9000 IVF cycles, 1204 were FAE cycles, among which we identified 86 EF cases. We then selected 171 controls. Independent risk factors for presence of EF were a history of previous myomectomy (adjusted odds ratio (aOR) 19.77, 95%CI [4.01–97.53]), severe endometriosis (aOR 5.97, 95%CI [2.09–17.05]), PCOS (aOR 5.72, 95%CI [2.66–12.33]) and previous cesarean section (aOR 5.17, 95%CI [1.84–14.49]). ConclusionsOur results are not only confirming the association between PCOS, severe endometriosis, previous cesarean procedure and EF, but also reporting for the first time an association between previous myomectomy and EF.

Correlation between Overactive Bladder Syndrome and Severity of Coronary Artery Disease in Postmenopausal Women.

To analyse the correlation of overactive bladder (OAB) and severity of coronary artery disease (CAD) by using Gensini score in postmenopausal women. Observational correlation study design. Haseki Training and Research Hospital, Istanbul, Turkey, from January 2016 to January 2018. Female patients in postmenopausal status, who had undergone coronary angiography due to CAD in tertiary academic care centre cardiology unit, were enrolled in the study. The Gensini score of each patient was calculated by two different cardiologists and the average score was taken. All participants filled the OAB-V8 questionnaire (Validated Turkish form). The participants were separated into two groups according to the severity OAB symptoms. Patients with OAB-V8 score ≥8, were included into OAB Group and patients with OAB-V8 score <8, were enrolled into group 2 Non-OAB Group. Two groups were compared according to patients' demographic characteristics, Gensini scores, OAB-V8 scores, blood test outcomes, urinary system ultrasound, and uroflowmetry findings. One hundred and two patients with OAB ≥8 score and 71 patients with OAB <8 score were compared. The median BMI was 28.7 (27.3-32.7) kg/m2 in OAB group and 27.5 (27.0-31.1) kg/m2 in non-OAB group (p=0.150). Additionally, OAB-V8 score and Gensini score were significantly higher in OAB group, compared to non-OAB group (25.0 (15.0-28.3) vs 4.0 (3.0-5.0), p<0.001 and 32.5 (27.8-42.7) vs.10.0 (10.0-12.0), p<0.001, respectively). In blood chemistry, LDL level was the only marker found significantly different between groups and was significantly higher in patients with OAB (120.0 (90.0-148.5) mg/dl vs 97.0 (70.0-125.0) mg/dl, p<0.001). Multivariate regression analysis revealed that Gensini score ≥ 20 was an independent risk factor for presence of OAB. Additionally, LDL level ≥100 m/dl was the only other predictive factor for presence of OAB (2.8 times). The frequency of OAB significantly correlated to severe CAD in postmenopausal women. Moreover, as an additional finding, postmenopausal women with higher LDL levels faced OAB syndrome more frequently. Key Words: Atherosclerosis, Coronary artery disease, Gensini score, Menopause, OAB-V8 form, Overactive bladder.

Relationship between mild renal dysfunction and coronary artery disease in young patients with stable angina pectoris.

Aim: We investigated the relationship between mild renal dysfunction (MRD) and the presence of coronary artery disease (CAD) in people under 60 years of age. Materials & methods:A total of634 (317 patients with vessel stenosis ≥50% and 317 with normal angiography) individuals diagnosed with stable angina pectoris and estimated glomerular filtration rate (eGFR) ≥60ml/min/1.73m2 were included in the present study. Results: The mean eGFR was lower (95.3±23.7 vs 109.7±22.3, respectively, p=0.002) and the number of patients with MRD was higher in patients with CAD (137, 43.2%) than in the control group (52, 16.4%, p<0.001). The multivariate analysis showed that lower eGFR is an independent risk factor for presence of CAD in people under 60 years of age with stable angina pectoris. Conclusion: According to our retrospective study, the risk of developing CAD appears to be slightly increased in individuals under 60 years of age with MRD.

974: Risk factors for the development of Intra-Amniotic Sludge

Intra-amniotic sludge (IAS), a sonographic finding of particulate matter in close proximity to the cervical os, has been implicated as a risk factor for preterm delivery and poor neonatal outcomes. Studies dedicated to identification of risk factors for the development of IAS are sparse. Our objective is to characterize risk factors for the development of IAS in women undergoing exam or ultrasound indicated cerclage. We performed a hospital-based, case-control study of women who underwent ultrasound or exam indicated cerclage over 3 years. Women with multiple gestation, cerclage placement at an outside institution, or missing data were excluded. The presence or absence of IAS was confirmed by review of sonographic images. Women with evidence of IAS served as cases, while those without served as controls. Risk factors for development of IAS and neonatal outcomes were compared in the two groups. We fit a multivariable logistic regression model to identify independent risk factors for presence of IAS. Of the 111 women included, 33 (29.7%) had sonographic evidence of IAS. The likelihood of developing IAS was similar between patients with exam and ultrasound indicated cerclage (OR 0.64 95% CI 0.28, 1.48). There was no statistically significant difference in maternal race, ethnicity, insurance type, marital status, parity, drug/alcohol/cigarette use, BMI, history of preterm birth, cervical length and cervical dilation prior to cerclage placement in patients with IAS and those without (Table 1). These findings were reiterated in a multivariable regression analysis, where no independent risk factor was identified (Table 2). Neonatal outcomes, including birth weight, seizures, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and demise were additionally similar between the groups. Our study shows that there are no significant risk factors associated with development of IAS among patients with exam or ultrasound indicated cerclage. The presence of IAS is also not predictive of adverse neonatal outcomes. A larger study is needed to verify our findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Analysis of risks of gastric cancer by gastric mucosa among Indonesian ethnic groups.

Indonesia is a big country with multiethnic populations whose gastric cancer risks have not been elucidated. We performed a nationwide survey and obtained histological specimens from 1053 individuals in 19 cities across the country. We examined the gastric mucosa, the topography, the atrophic gastritis risk factors, and the gastric cancer risk scores. Almost half (46.1%) of the patients with dyspeptic symptoms had histological abnormalities; chronic (36.3%) and atrophic gastritis (28.9%) being the most frequent. Individuals of the Timor ethnicity had the highest prevalence of acute (52.6%) and chronic gastritis (68.4%), even those negative for H. pylori. Our topographic analysis showed the majority of patients had predominantly antral acute and chronic gastritis. A multivariate logistic regression model showed age (Odds ratio [OR], 1.107), Timor ethnicity (OR, 8.531), and H. pylori infection (OR, 22.643) as independent risk factors for presence of atrophic gastritis. In addition, the gastric cancer risk score was highest in those from Timor, Papuan, and Bugis ethnic populations. Overall, Indonesia is a low-risk gastric cancer country. However, several ethnic groups displayed severe gastric mucosa symptoms suggesting policy makers should focus on those ethnic groups to perform gastric cancer screenings and to eradicate H. pylori.

A multicentre study evaluating the risk and prevalence of diabetic retinopathy in children and young people with type 1 diabetes mellitus

IntroductionThere is currently limited data published on the prognostic factors and prevalence of diabetic eye disease in children and young people (CYP) with Type 1 diabetes mellitus (T1DM), yet diabetic retinopathy remains one of the commonest causes of blindness in young adults. The aim of this study was to determine the risk and prevalence of diabetic retinopathy (DR) and to evaluate the risk factors associated with diabetic retinopathy in CYP with T1DM. MethodsAll CYP with Type 1 diabetes between 12 and 18 years of age, registered with the regional diabetic retinopathy screening programme were evaluated from 2012 to 2013 in four diabetes units within the north west region of the United Kingdom. Patients who had evidence of diabetic retinopathy were reviewed to identify risk factors for presence or absence of diabetic retinopathy. Results237 patients between the ages 12–18 years were included in the. The prevalence of diabetic retinopathy was 11%. Out of 27 patients with evidence of diabetic retinopathy, 44% were reported as background changes and 56% had pre-proliferative DR. Significant risk factors for diabetic retinopathy disease in the population using univariate analyses were duration of diabetes, puberty, age at diagnosis and mean HbA1c in the preceding 12 months. Multivariate logistic regression analysis found age of diagnosis (p = 0.04) and mean HbA1c as significant independent risk factors for presence of diabetic retinopathy (p = 0.02). ConclusionsThe prevalence of diabetic retinopathy in this paediatric population was 11%. Early age at diagnosis and poor metabolic control are independent risk factors for diabetic retinopathy.

Abstract TP46: The Probability of an Endovascular Intervention Target Independent of Time From Last Known Well

Introduction: Selection of patients based on treatment-related targets has been especially important for endovascular therapy. Recently presented trial evidence has demonstrated that cases with an eligible arterial occlusion and a target PWI-DWI mismatch were able to successfully receive treatment beyond the 6 hour window. Method: The LESION Study is a prospective cohort study of the baseline MR imaging (&lt;24 hrs from onset and prior to treatment) of 1,092 consecutive ischemic stroke presentations with admission NIHSS ≥4. Multiple therapeutic targets were assessed. Endovascular intervention target was defined as the presence of ischemia on MRA in the ICA or MCA-M1 arterial branches. Presence of PWI-DWI mismatch was qualitatively determined by vascular neurologists. Multivariate logistic regression was used to test for association of time from onset with presence of an endovascular target, while examining the roles of presentation and imaging characteristics. Results: Probability of an endovascular target decreases over the first 24 hours (OR=0.96; p=0.004). However, stratification or adjustment for a PWI-DWI mismatch signal and/or admission NIHSS confounds the effect of occlusion target over time. Stratification by mismatch demonstrates a consistently higher proportion of endovascular target presence in those with a concurrent target mismatch. For cases with a target mismatch, presentation within the 6 hour window is associated with just a 17% greater likelihood of endovascular target relative to those beyond 6 hours (OR=1.17; p &gt; 0.05). In multivariate modeling: NIHSS, mismatch, and sex were all identified as independent risk factors for presence of an endovascular target (all p &lt; 0.01), while time was not significantly associated with target presence. Discussion: While the presence of an arterial occlusion in territories relevant to endovascular intervention appear to be related to time from onset, stratified and adjusted analyses show that this relationship is not maintained when limited to cases with and without a target mismatch identified. This finding has clinical and methodological implications for selection of patients for intervention at varying time intervals.

Presence of Headache and Migraine in Asthma Patients.

Migraine is a diseases characterized with severe headaches, with neurological and systemic findings. The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders, parental history and migraine in asthma patients. A total of 288 asthma outpatients, who had the diagnosis by an early or late test of reversibility showing a reversible airway obstruction according to hospital database were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department and investigated about the presence of migraine. The diagnosis of migraine headache was made if patients fulfilled the International Headache Society (IHS) criteria. 60.4% of patients described a headache. There were 94 patients (32.6%) with headaches meeting the IHS criteria for migraine. Only 12 patients had migraine with aura. There were atopic symptoms in 86.8% of patients. According to parental history, there were asthma in 47.9%, atopic symptoms in 39.6% and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headaches (65.3%) "p=0.007". The prevalence of migraine was significantly high in patients with parental atopic symptoms (54%) "p=0.002". Multiple logistic regression analysis identified that gender, parental history of asthma, allergia and migraine, and smoking were independent risk factors for presence of migraine in asthmatics. There is a high prevalence of migraine headaches in patients with asthma. The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism; parental history, common genetic compounds and smoking may play role in this mechanism. The headaches in asthma patients, atopic symptoms and family history should be questioned, and clinicians should be careful about the presence of migraine.

The A1-A2 Diameter Ratio May Influence Formation and Rupture Potential of Anterior Communicating Artery Aneurysms

Specific morphological factors contribute to the hemodynamics of the anterior communicating artery (AComA). No study has examined the role of the A2 segment on AComA aneurysm presence and rupture. To examine the possibility that the ratio between A1 and A2 segments (A1-2 ratio) represents an independent risk factor for presence and rupture of AComA aneurysms (AComAAs). A retrospective review of an institutional aneurysm database was performed; patients with ruptured and unruptured AComAAs were identified. Two control groups were selected: group A (posterior circulation aneurysms) and group B (patients without intracranial aneurysms or other vascular malformations). Measurements of A1 and A2 diameters were obtained from digital subtraction angiography (64.1% of 3-D rotational digital subtraction angiography), and the A1-2 ratio calculated. From January 2009 to April 2011, 156 patients were identified (52 AComAAs, 54 control group A, and 50 control group B). Mean age at the time of presentation was 56.09 years. Compared with both control groups, patients with AComAAs had greater A1 diameter (P < .01) and A1-2 ratio (P < .001) and smaller A2 diameter (P < .01). The A1-2 ratio correlated positively with the presence of AComAAs (P < .001). Ruptured AComAAs were smaller than unruptured ones (5.91 mm vs 9.25 mm, P = .02) and associated with a higher A1-2 Ratio (P = .02). The presence of a dominant A1 did not predict AComAA rupture (P = .15). The A1-2 ratio correlated positively with the presence of ruptured AComAAs (P = .04). A1-2 ratio correlates positively with the presence and rupture of AComAAs and may facilitate treatment decision in cases of small, unruptured AComAAs.

Serum uric acid level is an independent risk factor for presence of calcium in coronary arteries: an observational case-controlled study

A link between uric acid levels and cardiovascular diseases has been previously reported. Coronary artery calcium score (CACS) is a marker of atherosclerotic disease and a predictor of cardiovascular events. We sought to determine if serum uric acid level is an independent risk factor for the presence of calcium in coronary arteries. Four hundred and forty-two patients who were evaluated in the cardiology outpatient clinic for suspected coronary heart disease with a low-moderate risk for coronary artery disease were included in this observational case-controlled study. Serum uric acid levels were measured with colorimetric methods. CACS were performed using a 64-slice CT scanner. Patients were divided to 3 groups according to their CACS value (Group 1: CACS=0, Group 2: CACS 1-100, Group 3: CACS>100). The demographical characteristics and laboratory findings of 3 groups were similar, except age, fasting glucose levels and serum uric acid levels. Serum uric acid levels were found to increase significantly with increasing CACS (p=0.001). Patients were grouped according to presence CAC (CACS=0 and CACS≥1) and in the multiple regression analysis, age (OR, 1.11, 95% CI, 1.07-1.16), smoking (OR, 3.83, 95% CI, 2.06-7.09), serum uric acid levels (OR, 1.26, 95% CI, 1.04-1.54) and average 10-year total risk of Framingham risk score (OR, 1.13, 95% CI, 1.04-1.09) appeared as independent factors predictive of presence of CAC (p<0.05). Serum uric acid level is an independent risk factor for presence of coronary calcium. Moreover, increasing levels of serum uric acid are associated with increasing CACS.