Minor Risk Factors Research Articles

The impact of cardiac risk factors on short-term outcomes for children undergoing a Ladd procedure

Background/PurposeThe purpose of this study was to describe the outcomes of children with and without congenital heart disease who undergo a Ladd procedure. MethodsThe 2012–2014 National Surgical Quality Improvement Program Pediatric (NSQIP-P) data were queried for patients undergoing a Ladd procedure. Utilizing NSQIP-P definitions, patients were categorized into four cardiac risk groups (none, minor, major, severe) based on severity of cardiac anomalies, previous cardiac procedure(s), and ongoing cardiac dysfunction. Ladd procedures were elective/non-elective. Outcomes included length of stay, adverse events, and mortality. Results878 patients underwent Ladd procedures. 633 (72%) patients had no cardiac risk factors and 84 (10%), 109 (12%), and 52 (6%) had minor, major, and severe cardiac risk factors, respectively. Children with congenital heart disease experienced increased morbidity and mortality and longer hospital stays (all p<0.05). Elective Ladd procedures were associated with similar morbidity but shorter length of stay and lower mortality than non-elective procedures. Older age at time of operation was associated with fewer adverse events. ConclusionsAlthough overall mortality remains low, children with higher risk cardiac disease experience increased morbidity and mortality when undergoing a Ladd procedure. Older age at the time of the Ladd procedure was associated with improved outcomes in children.

Adjuvant Small Pelvic Radiation Therapy in Cervical Cancer Patients With Minor Risk Factors

Adjuvant Small Pelvic Radiation Therapy in Cervical Cancer Patients With Minor Risk Factors

Low Rates of Revascularization and High In-Hospital Mortality in Patients With Ischemic Lower Limb Amputation: Morbidity and Mortality of Ischemic Amputation.

To assess the nationwide contemporary burden of cardiovascular risk factors, comorbidities, and in-hospital mortality in patients with lower limb amputation (LLA) due to peripheral arterial disease and critical limb ischemia (CLI) in Germany. German nationwide data for 2005 and 2009 were analyzed regarding in-hospital rates of major and minor ischemic LLA, risk factors, comorbidities, surgical and endovascular revascularizations, and in-hospital mortality. In 2005, a total of 22 479 major (7.8%) and 28 262 minor (9.8%) LLAs were performed with a relative decrease of -21.8% in major LLA, yet with a relative increase of +2% in minor LLA rate in 2009. The overall revascularization rate before amputation was 46% in 2005 and 57% in 2009. In-hospital mortality for non-CLI, minor, and major amputees was 3.3%, 4.6%, and 19.8%, respectively (P < .001 for major vs minor LLA and non-CLI). The total number of ischemic LLA and amputation-related in-hospital mortality remains high in Germany in the 21st century. The poor outcome of patients with CLI might in part be due to underuse of revascularizations prior to amputation.

Identification of High-Risk Subgroups of Patients With Oral Cavity Cancer in Need of Postoperative Adjuvant Radiotherapy or Chemo-Radiotherapy.

Patients with oral cavity squamous cell carcinoma (OSCC) undergoing surgery are recommended to receive adjuvant radiation therapy with or without chemotherapy if there are unfavorable prognostic factors. A positive resection margin (PRM) and extra-capsular extension (ECE) of lymph nodes are well-known major prognostic factors. However, there is no agreement on whether oral cavity cancer patients should receive postoperative chemo-radiotherapy (CCRT) if they present with other risk factors or a combination of 2 or more risk factors. In this study, we investigated this issue and provide suggestions for adjuvant treatments.From January 2002 to December 2013, 567 OSCC patients who had undergone radical surgery were retrospectively reviewed. The 5-year loco-regional control (LRC), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) were analyzed.In univariate analysis, pathological T classification, positive node, tumor depth, ECE, lymphatic or vascular or perineural invasion and histology grade are significant prognostic factors for LRC, DMF, DFS, or OS. By multivariate analysis, pathological T4 (pT4), positive node, positive surgical margin are prognostic factors for LRC. pT4, positive node and lymphatic invasion predicted for higher rate of distant metastasis. pT4, positive node, and poor differentiation tumor were prognostic factors for DFS. pT4, positive nodes, and ECE were prognostic factors for OS. These factors were used to define risk groups. We proposed PRM and ECE as major risk factors and pT4, positive nodes, close margin (≤ 5 mm, > 1 mm), tumor depth ≥ 1 cm, lymphatic invasion, vascular invasion, perineural invasion, and poor differentiation as minor risk factors. By subgroups analysis, 192 patients with at least 2 minor prognostic factors and no other major risk factors, postoperative radiotherapy (RT), or CCRT yielded significantly better 5-year LRC, DFS, and OS compared to surgery only group. For 179 patients with at least 3 minor prognostic factors and/or at least 1 major risk factor, patients receiving postoperative CCRT showed significantly better 5-year LRC, DFS, and OS compared with post-OP RT or surgery alone.Patients with 2 minor risk factors should receive postoperative RT. For patients with PRM, ECE, or >2 minor risk factors, postoperative CCRT is recommended.

Tracheostomy Placement in Children Younger Than 2 Years: 30-Day Outcomes Using the National Surgical Quality Improvement Program Pediatric.

Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric demonstrated that the highest contribution to composite morbidity in otolaryngology is seen in children younger than 2 years undergoing tracheostomy. To determine predictive factors for complications following tracheostomy placement in patients younger than 2 years that, if targeted for reduction in quality initiatives, might result in improved surgical outcomes. The NSQIP Pediatric reports predefined 30-day postoperative outcomes for surgical cases from participating institutions for quality improvement. All 206 cases of elective tracheostomy performed in children younger than 2 years from 2012 to 2013 among 61 participating institutions and documented in the NSQIP Pediatric public use file were included. Data analysis was conducted from December 1, 2014, to June 30, 2015. Surgical placement of tracheostomy in children younger than 2 years. Demographics and clinical and perioperative characteristics for children who did and did not experience a major complication from elective tracheostomy were compared. Continuous variables were compared using Wilcoxon rank sum tests and categorical variables were compared using Pearson χ2 tests or Fisher exact tests where appropriate. A logistic regression model was fit to identify adjusted odds ratios (aORs) with 95% CIs of preoperative factors predictive of occurrence of a major complication. Of the 206 children younger than 2 years who underwent tracheostomy, 50 (24.3%) experienced a major complication within 30 days. The most common complications were pneumonia (16 [7.8%]), postoperative sepsis (12 [5.8%]), death (12 [5.8%]), and deep or organ space surgical site infections (8 [3.9%]). Neonatal age (aOR, 2.38; 95% CI, 1.06-5.37; P = .04), intraventricular hemorrhage (aOR, 2.72; 95% CI, 1.01-7.32; P = .048), and comorbid cardiac risk factors (relative to none: minor risk factors, aOR, 2.94; 95% CI, 1.19-7.24; major or severe risk factors, aOR, 1.31; 95% CI, 0.44-3.84; P = .04 for all cardiac risk factors) were independently predictive of major complications. Young children undergoing tracheostomy tube placement have high rates of morbidity. This analysis identifies the need for additional procedure-specific outcome variables and improved variable definitions to incorporate into a detailed module for NSQIP Pediatric that will more effectively promote national, specialty-specific targeted quality improvement efforts.

Minor and Adult Domestic Sex Trafficking Risk Factors in Ohio

AbstractObjective: Sex trafficking is a pressing issue in Ohio—a major node in national sex trafficking networks; however, no quantitative analysis of risk factors specific to Ohio victims has been conducted. Method: Using a survey conducted by the Ohio Human Trafficking Commission representing Ohio urban, street-based sex workers (N = 328), this study uses a life-course theory framework to identify and measure the effect of direct risk factors on domestic minor and adult sex-trafficking outcomes using multivariate logistic regressions. Variables of specific interest include peer influence, experiences during transience, prior minor victimization, and a lack of support while attempting to escape. Results: Survival sex and peer influence increase the odds of minor victimization, and a lack of available support and resources for victims while attempting to escape significantly increase the odds of adult victimization. Conclusion: This analysis produces a better understanding of risk factors facing Ohio’s se...

Risk of Stroke in Migraineurs Using Triptans. Associations with Age, Sex, Stroke Severity and Subtype

BackgroundIdentifying migraineurs by triptan utilization we studied risk for stroke in migraineurs compared to the general population. MethodsA cohort study including all citizens 25–80years of age in Denmark 2003–2011 was conducted. All persons prescribed triptans, and all those hospitalized for a first stroke were identified in the Danish Registries. Information on stroke severity/subtype and cardiovascular risk factors was available for stroke patients. FindingsOf the 49,711 patients hospitalized for a first stroke, 1084 were migraineurs using triptans. Adjusting for age, sex, income, and educational level, risk for stroke was higher among migraineurs in respect to all strokes (RR 1.07; CI 1.01–1.14) and ischemic strokes (RR 1.07; CI 1.00–1.14). Risk for hemorrhagic stroke was increased but only in women (RR 1.41; CI 1.11–1.79). Risk was for mild strokes (RR 1.31; CI 1.16–1.48) while risk for severe strokes was lower among migraineurs (RR 0.77; CI 0.65–0.91). Risk was age-related; highest among women 25–45years (RR≈1.7). Risk was unrelated to numbers of dispensations. InterpretationMigraineurs identified by triptan utilization had higher risk for stroke. Strokes were minor and cardiovascular risk factors were less prevalent pointing to a migraine-specific etiology of stroke different from that of thromboembolism.

Addressing the ESRD Risks of the Young Living Kidney Donor: Putting “Normal for Now” into Practice

Individuals who are free of traditional clinical risk factors for kidney diseases at the time of living kidney donation have been thought to be at low risk of end-stage renal disease (ESRD) after donor nephrectomy. However, the reassuring low rates of ESRD in available donor follow-up studies have captured only the risks of very rapidly progressing kidney diseases that begin during the study interval, not the higher risks of diabetic ESRD and other slowly evolving diseases that are far more common over a lifetime. The natural histories and age-related characteristics of renal diseases in the general population predict considerable undetected risk, particularly for normal young individuals, who typically will not reach ESRD until late in life. This makes the low long-term absolute risks of ESRD after donation that are suggested by two recent studies problematic. But these studies also suggest an 8–11-fold increased relative risk from donation, which they are well-designed to capture. These relative risks have been attributed to loss of GFR at donor nephrectomy and are consistent with well-accepted GFR-related risks in the general population. These observations indirectly implicate low-normal predonation GFR as an important ESRD risk factor, particularly for young donors. Even if relative risks are half of published estimates, some currently acceptable young donors—especially black donors—will have significantly higher risk for ESRD over their remaining lifespans than many older candidates with minor renal risk factors who are currently denied donation. Selection practices must be reformulated to recognize a uniform, ethically defensible risk standard for acceptance and exclusion of living kidney donors.

PERIOPERATIVE PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ROUTINE ONCOSURGERY

The article is devoted the problem of prevention of perioperative venous thromboembolic complications (VTEC) in cancer patients. The study identifies the causes of thrombosis in this category of patients and describes in details the major and minor risk factors for the development of VTEC. The results of studies on the influence of the morphological characteristics of the tumor, the stage and location of tumor on the risk of development of VTEC are performed. It is noted that along with the likelihood of thrombosis, cancer patients at the stages of surgical treatment there is an alternative risk factor – bleeding. The frequency of hemorrhagic complications and their risk increases in the presence of disintegration of the tumor, its proximity to the main vessels, extent of surgical aggression, as well as due to the introduction of anticoagulants. The approaches to the selection of the optimal method is specific or nonspecific prevention of VTEC depending on the nature and volume of the intervention, estimated blood loss and patients’ rehabilitation time are described. We show the advantages of low molecular weight heparins compared with unfractionated heparin for the prevention of VTEC in Oncology. The article presents long-term experience of employees of one of the leading cancer institutions in Russia – P. Hertsen MORI, whose team took an active part in the development of Russian clinical guidelines for the prevention and treatment of VTEC in Oncology.

Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes.

To assess the risk of severe hypoglycemia related to glycated hemoglobin A1c (HbA1c) levels in a population-based cohort of pediatric type 1 diabetes patients during two time periods since 1995. The association between HbA1c levels and severe hypoglycemia (defined as requiring assistance from another person) or hypoglycemic coma (loss of consciousness or seizures) was analyzed by multivariable regression analysis in children and adolescents with type 1 diabetes from the DPV Diabetes Prospective Follow-up in Germany and Austria in 1995-2003 (n = 15 221 patients) and 2004-2012 (n = 22 318 patients). Mean adjusted rates of severe hypoglycemia and hypoglycemic coma decreased from 19.18 [95% confidence interval (CI), 17.95-20.48] and 4.36 (3.93-4.83) per 100 patient-years in 1995-2003 to 15.01 (14.18-15.88) and 2.15 (1.94-2.39) in 2004-2012, respectively (p < 0.001). From the first to the second period, the relative risk (RR) for severe hypoglycemia and hypoglycemic coma per 1% lower HbA1c decreased from 1.22 (1.15-1.30) to 1.06 (1.01-1.12) and from 1.27 (1.15-1.40) to 1.04 (0.94-1.16), respectively. Risk of severe hypoglycemia and coma declined most in patients with HbA1c levels of 6-6.9% (RR 0.70 and 0.43, respectively) and with HbA1c of 7-7.9% (RR 0.63 and 0.38, respectively). Mean HbA1c levels fell from 8.4% in 1995-2003 to 8.2% in 2004-2012, while the use of insulin pumps, short- and long-acting insulin analogs, and glucose monitoring increased (p < 0.001). In contrast to 1995-2003, low HbA1c has become a minor risk factor for severe hypoglycemia and coma in pediatric patients with type 1 diabetes in the 2004-2012 period.

Adjuvant Small Pelvic Radiation Therapy in Cervical Cancer Patients With Minor Risk Factors

To retrospectively evaluate the efficacy of adjuvant small pelvic radiation therapy (RT) in cervical cancer patients with minor risk factors after radical surgery. Seventy-six patients with at least 2 minor risk factors (tumor size > 4cm, lymphovascular space invasion (LVSI), deep stromal invasion (DSI) and adenocarcinoma histology) after surgery were treated with small pelvic RT from January 2001 through April 2013 in our department. None of the patients received concomitant chemotherapy. Median age was 54 years (range, 34-70 years). Surgery was in the form of type 3 in 72 (95%) and type 2 radical hysterectomy in 4 (5%) patients. The mean number of dissected lymph nodes (LN) was 47 (13-120). Vaginal surgical margin was positive in 4 patients (5%) and closer than 0.5cm margin in 4 (5%) patients; in addition, carcinoma in situ was detected on the surgical margin in 3 patients (3.9%). From 2001 through 2007, pelvic RT was administered as 2-dimensional RT with field borders between L5-S1 in superior, below obturator foramens in inferior and bony pelvis in lateral directions. After 2007, pelvic RT was in the form of 3-dimensional conformal RT, and the clinical target volume included primary tumor bed, proximal vagina, parametrial bed, and presacral lymphatic region as defined by RTOG. External RT was performed to small pelvis, which comprised surgical bed and presacral LNs. The median fraction dose was 1.8 Gy (range, 1.8-2 Gy), and the median total dose was 50.4 Gy (range, 45-50.4 Gy). In 9 (12%) patients with surgical margin positivity or close surgical margins, a total median dose of 21 Gy (range, 15-28 Gy) of additional brachytherapy (BRT) was also performed with median 7 Gy (range, 5-7 Gy) fraction doses. Median follow-up time was 78 months (range, 4-169 months). Local recurrence, regional recurrence or distant metastasis developed in 6 (7.9%), 3 (3.9%), and 4 (5%) patients, respectively. Median local recurrence-free survival (LRFS) was 76 months (range, 4-169 months), regional recurrence-free survival (RRFS) was 76 months (range, 4-169 months), and distant metastasis-free survival (DMFS) was 78 months (range, 4-169 months). Five-year cancer specific survival (CSS) rate was 94%; disease-free survival (DFS) rate was 86%; LRFS rate was 92%; RRFS rate was 96%; DMFS rate was 94%, respectively. In multivariate analysis, no statistically significant factor was found for CSS and DFS; however, the presence of LVSI was found significant for LRFS (P=.017). Following RT, rectovaginal fistula in 1 patient after 5 months, enterovesical fistula in 1 patient after 35 months, and rectovesical fistula in 1 patient after 40 months were observed. Our results confirmed us that small pelvic RT in patients with minor risk factors after definitive surgery is highly effective treatment strategy with high local and regional control, and DFS rates with low toxicity profile.

Epidemiology of stroke in Finnish patients with Huntington's disease.

Diabetes mellitus and hypercholesterolemia are known risk factors of stroke, and altered glucose and cholesterol metabolism has been reported in patients with Huntington's disease (HD). We investigated the incidence and risk factors of stroke in this population. National registries were used to identify a cohort of 192 patients with HD. Data on stroke, silent cerebral infarcts and risk factors were obtained from the patient records. Five patients with an ischemic stroke (IS) were found suggesting a crude incidence of 42/100,000 person years. Silent brain infarcts were found in 13 patients and a hemorrhagic stroke in two patients, while none were found with a transient ischemic attack (TIA). The cumulative incidence of IS was 2.7% and that of silent cerebral infarct 6.7% by age of 65 years. The CAG age product (CAP) score, an estimate of genetic burden, was 495 ± 117 for the patients with IS or silent cerebral infarct and 568 ± 126 for the patients without ischemic events (P = 0.025 for difference). The frequency of diagnoses of stroke risk factors was at least twofold higher among the patients with IS or silent infarcts than among those without. Cerebrovascular disease is as common in patients with HD as in the general population, but minor cerebrovascular events and vascular risk factors may remain unrecognized. Genetic burden of the HTT mutation does not appear to increase the risk of stroke.

Abstract 2766: Advanced paternal age as a possible risk factor for retinoblastoma

Abstract Retinoblastoma is a pediatric tumor arising in the retina with an incidence of 1 in 15000 to 18000 live births. Retinoblastoma is initiated by the inactivation of both the alleles of RB1 and it may be inherited or sporadic. There are several possible risk factors suggested for sporadic retinoblastoma including advanced paternal age.We evaluated the father's age in 42 children with retinoblastoma attending the Aravind Eye Hospital, Madurai, India from Mar 2013 to Feb 2014 retrospectively. Fathers with age 40 and above at the time of conception were included in the analysis. Patients with a positive family history were excluded from the analysis. Genetic analysis of RB1 was carried out in the tumor and blood samples of these patients of older father and their family.There were 5 patients (3 unilateral and 2 bilateral) having fathers with age 40 years and above. Genetic analysis identified RB1 mutations in the tumor samples of 4 patients and these mutations were not present in the blood samples of patient and family members. Since all these patients had somatic mutations, the involvement of paternal age impact was ruled out. In blood sample of one bilateral patient, we found de novo germline RB1 mutation possibly suggesting a role of advanced paternal age.In conclusion, the advanced paternal age seems to be a minor risk factor for retinoblastoma. Further study of large number of patients may provide a better understanding of the impact of advanced paternal age in retinoblastoma. Citation Format: Vanniarajan Ayyasamy, Namrata Gaikwad, Thirumalairaj Kannan, Aloysius A. Abraham, Veerappan Muthukkaruppan, Usha Kim. Advanced paternal age as a possible risk factor for retinoblastoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2766. doi:10.1158/1538-7445.AM2015-2766

Rectal indomethacin versus placebo to reduce the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography: results of a controlled clinical trial.

BackgroundAcute pancreatitis is the most common major complication after endoscopic retrograde cholangiopancreatography (ERCP). Many drugs have been evaluated for prophylaxis, including nonsteroidal anti-inflammatory drugs (NSAIDs), which are potent inhibitors of phospholipase A2 and play a role in the pathogenesis of acute pancreatitis. Rectal NSAIDs have been shown in prospective studies to decrease the incidence of this complication, but the indication is not generalized in clinical practice. The aim of this study was to evaluate the efficacy of rectal administration of indomethacin in reducing the incidence of post-ERCP pancreatitis in high-risk patients.MethodsThis was a controlled clinical trial where patients with an elevated risk of developing post-ERCP pancreatitis were assigned to receive 100 mg of rectal indomethacin or a 2.6 g suppository of glycerin immediately after ERCP, without placement of a pancreatic stent. The patients were determined to be at high risk based on validated patient- and procedure-related risk factors. Post-ERCP pancreatitis was defined as the presence of new upper abdominal pain, hyperamylasemia/hyperlipasemia (at least three times the upper limit) 2 hours after the procedure and hospitalization at least 48 hours because of the complication. Pancreatitis severity was defined according to Cotton’s criteria.ResultsOne hundred sixty-six patients were included; 82 in the study group and 84 in the placebo group. Patients had at least one major and/or two minor risk factors for developing post-ERCP pancreatitis. The incidence of the complication was 4.87 % (4/82) in the study group and 20.23 % (17/84) in the placebo group; this difference was significant (P = 0.01). According to Cotton’s criteria, 17 patients (80.9 %) developed mild pancreatitis and 4 (19.1 %) had moderate pancreatitis; 3 of these 4 patients belonged to the placebo group (P = 0.60). Based on these results, an absolute risk reduction of 0.15 (15 %), a relative risk reduction of 0.75 (75 %) and a number needed to treat of 6.5 patients were calculated to prevent an episode of post-ERCP pancreatitis. There was no mortality.ConclusionsRectal indomethacin reduced the incidence of post-ERCP pancreatitis among patients at high risk of developing this complication.Trial registrationNational Clinical Trials NCT02110810. Date April 7, 2014.

Clinical scoring system may improve yield of head CT of non-trauma emergency department patients.

The positive rate of head CT in non-trauma patients presenting to the emergency department (ED) is low. Currently, indications for imaging are based on the individual experience of the treating physician, which contributes to overutilization and variability in imaging utilization. The goals of this study are to ascertain the predictors of positive head CT in non-trauma patients and demonstrate feasibility of a clinical scoring algorithm to improve yield. We retrospectively reviewed 500 consecutive ED non-trauma patients evaluated with non-contrast head CT after presenting with headache, altered mentation, syncope, dizziness, or focal neurologic deficit. Medical records were assessed for clinical risk factors: focal neurologic deficit, altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age. Data was analyzed using logistic regression and receiver operator characteristic (ROC) curves and three derived algorithms. Positive CTs were found in 51 of 500 patients (10.2%). Only two clinical factors were significant: focal neurologic deficit (adjusted odds ratio (OR) 20.7; 95% confidence interval (CI) 9.4-45.7) and age >55 (adjusted OR 3.08; CI 1.44-6.56). Area under the ROC curve for all three algorithms was 0.73-0.83. In proposed algorithm C, only patients with focal neurologic deficit (major risk factor) or ≥2 of the five minor risk factors (altered mental status, nausea/vomiting, known malignancy, coagulopathy, and age) would undergo CT imaging. This may reduce utilization by 34% with only a small decrease in sensitivity (98%). Our simple scoring algorithm utilizing multiple clinical risk factors could help to predict the non-trauma patients who will benefit from CT imaging, resulting in reduced radiation exposure without sacrificing sensitivity.

Etiology, Outcome and Mortality Risk Factors in Children Burn

Mortality rate of burn patients can serve as an objective criterion for quality control and as a measure for research and preventive programs. A prospective study of burn victims, from data of burn registry program, was conducted to determine the etiology, risk factors of mortality and outcome of pediatric burns. We had 514 patients below 15 years old. Burns caused by scalding were the most frequent (55.4%) followed by flames (35.8%). Mean (SD) of age was 3.72 (3.19) years. Male to female ratio was 1.62:1. Mean hospital stay was 14.17 days (range 0 - 46 days). The mean TBSA (SD) was 15.22% (14.31%). Fifty three patients had inhalation injury (11.25%). Inhalation injury increases the risk of death (Odds Ratio: 8.75, p = 0.009). Length of stay increased in accordance with burn area (p < 0.002). Burn wound infection was present in (35.4%) of our patients. The univariate statistics analysis and a pooled, cross-sectional, multivariate logistic regression were done. The major risk factors were: Inhalation injury (OR = 8.75, p = 0.009) and lack of intra-venous fluid resuscitation before reaching the hospital (OR = 40.5%, p = 0.001), cause of burn (flame and chemical) and referral cases from other centers (OR = 3.66, p < 0.0001). The minor risk factor was age. About 83% of our patients discharged with partial recovery, 10% with complete recovery, 0.1% referred to other hospitals and 1.36% died.

Thrombosis Associated with Viral Hepatitis

Viral hepatitis may promote the development of venous thromboembolism (VTE) and, more specifically, portal vein thrombosis (PVT). In this narrative review, we summarize the clinical data and discuss the possible pathogenetic roles of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and hepatitis A, B, and C viruses (HAV, HBV, HCV) in the occurrence of VTE. CMV is the first qualified candidate to enter the list of VTE minor risk factors, and in the rare case of fulminant infection, both EBV and CMV, like any severe infection or inflammatory disease, increase risk for thrombosis. In chronic hepatitis B and C, it remains controversial whether antiphospholipid antibodies are important for thrombotic complications or merely an epiphenomenon. Retinal vein occlusion described in chronic hepatitis C is usually attributed to the treatment with interferon. Eltrombopag, used for HCV-related thrombocytopenia, has been associated with increased thrombotic risk. The imbalance between procoagulant and anticoagulant factors associated with chronic liver disease may have clinical implications. This may help to explain why these patients are not protected from clinical events such as VTE, PVT, and the progression of liver fibrosis.

Grading and interpretation of white matter hyperintensities using statistical maps.

We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke. We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability. We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0-9.4%, median=0.6%, of the measured brain volume). For younger (≤69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (≥70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH. We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice.

Hip fractures are risky business: An analysis of the NSQIP data

IntroductionHip fractures are one of the most common types of orthopaedic injury with high rates of morbidity. Currently, no study has compared risk factors and adverse events following the different types of hip fracture surgeries. The purpose of this paper is to investigate the major and minor adverse events and risk factors for complication development associated with five common surgeries for the treatment of hip fractures using the NSQIP database. MethodsUsing the ACS-NSQIP database, complications for five forms of hip surgeries were selected and categorized into major and minor adverse events. Demographics and clinical variables were collected and an unadjusted bivariate logistic regression analyses was performed to determine significant risk factors for adverse events. Five multivariate regressions were run for each surgery as well as a combined regression analysis. ResultsA total of 9640 patients undergoing surgery for hip fracture were identified with an adverse events rate of 25.2% (n=2433). Open reduction and internal fixation of a femoral neck fracture had the greatest percentage of all major events (16.6%) and total adverse events (27.4%), whereas partial hip hemiarthroplasty had the greatest percentage of all minor events (11.6%). Mortality was the most common major adverse event (44.9–50.6%). For minor complications, urinary tract infections were the most common minor adverse event (52.7–62.6%). Significant risk factors for development of any adverse event included age, BMI, gender, race, active smoking status, history of COPD, history of CHF, ASA score, dyspnoea, and functional status, with various combinations of these factors significantly affecting complication development for the individual surgeries. ConclusionsHip fractures are associated with significantly high numbers of adverse events. The type of surgery affects the type of complications developed and also has an effect on what risk factors significantly predict the development of a complication. Concerted efforts from orthopaedists should be made to identify higher risk patients and prevent the most common adverse events that occur postoperatively.

PO-1012 Evaluation Of Asthma Biomarkers And Pulmonary Function Tests In Children With Asthma

Asthma is a chronic inflammatory disease of respiratory tract. Many different invasive and noninvasive tests are performed to diagnose asthma. Yet no definite criteria for diagnosing asthma are determined. <h3>Background and aim</h3> In our study we aimed to show the relation between blood parameters and pulmonary function tests (PFT) with the asthma severity in patients with a diagnosis of asthma, and post-treatment changes in these parameters. <h3>Method</h3> Children aged 0–14 years with asthma seen in our outpatient policlinic were prospectively evaluated. Complete blood count, ECP, specific IgE, Total IgE levels of the patients are recorded at the beginning of the study. Children &gt;6 years performed spirometry. All patients filled a study registration form that includes major and minor risk factors. We classified the severity of the disease according to GINA (Global Initiative for Asthma) and we followed the treatment protocol. The severity of the disease did not show any significant correlations with the gender, atopic history and family history. <h3>Results</h3> A statistically significant difference was found between the ECP, Total IgE levels and severity of asthma. We observed a decrease in the asthma severity during 2nd visit. <h3>Conclusion</h3> Our results showed that serum ECP levels are significantly correlated with the severity of asthma and may be useful in the assessment of asthma control. Hence the PFT is quite difficult to perform in children, noninvasive parameters are becoming more important for the follow up of the treatment.