Number Of Possible Risk Factors Research Articles

Postattenuation neurologic signs after surgical correction of congenital portosystemic shunts in cats: A narrative review.

Development of postattenuation neurological signs (PANS) is a potentially severe complication after surgical attenuation of congenital portosystemic shunts in cats. This review summarizes findings of 15 publications that report occurrence of PANS in cats. PANS includes seizures but also milder neurologic signs such as blindness, ataxia, abnormal behavior, tremors, and twitching. Incidence of PANS and specifically postattenuation seizures in studies including a minimum of five cats ranges from 14.3% to 62.0% and 0% to 32.0%, respectively. Etiology of PANS in cats is unknown, however, several hypotheses have been proposed including central nervous system disease/derangement, perioperative hypoglycemia and electrolyte disturbances, and postoperative portal hypertension. A number of possible risk factors have been identified including lower grades of intraoperative postocclusion mesenteric portovenography and osmolality at 24 h postoperatively. Evidence for use of prophylactic antiepileptics such as levetiracetam to prevent or reduce incidence of PANS in cats is limited and does not support their use. Because the cause is unknown, treatment is aimed at controlling neurologic signs, preventing progression to more severe signs, and providing general supportive care. Prospective studies comparing the efficacy of different antiepileptics for treatment of PANS in cats are required. Prognosis for recovery is variable and dependent on severity of neurologic signs. For cats surviving to discharge, long-term survival is possible but persistence or recurrence of neurologic signs in the long-term is not uncommon.

Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study

ObjectiveMinimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA. MethodsThis is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients’ disability was done using Modified HAQ (MHAQ). ResultsA significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000). ConclusionAging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle.

Factors Associated with Risk and Prognosis of Intensive Care Unit Admission in Patients with Acute Myeloid Leukemia: A Danish Nationwide Cohort Study

Significance Patients with acute myeloid leukemia (AML) are at high risk of critical illness requiring admission to the intensive care unit (ICU) due to both disease- and treatment-related complications. A better understanding of risk factors for ICU admission and prognosis may help with prevention of life-threatening complications and informed decision-making when treating AML patients. Methods This study included all adult Danish AML patients, who received remission-induction chemotherapy alone or in combination with allogeneic stem cell transplantation from 2005 to 2016. The cohort was identified using the Danish Acute Leukemia Registry (DNLR) and information on ICU admission was obtained from the Danish Intensive Care Database. We examined risk of ICU admission within 1 and 3 years of diagnosis considering competing risk of death and investigated a number of possible risk factors for ICU admission. We computed 1-, 3-, and 5-year mortality from time of ICU admission and in the matched non-ICU comparison group using a risk set matching (1:1) on time since diagnosis, sex, and age. Finally, we used the pseudo-value approach to compute the relative risk (RR) of death in the ICU admitted cohort compared to the matched cohort. We adjusted for ECOG/WHO performance status (PS), year of diagnosis, cytogenetic risk group, number of comorbidities, and secondary/therapy-related AML. Results A total of 1383 AML patients were included in the study. The median follow-up time was 1.65 (IQR: 0.60-4.36) years. The risk of ICU admission within 1 year of AML diagnosis was 22.7%, and the risk within 3 years was 28.1%. Median time to ICU was 59 (IQR: 15-272) days. Male sex was associated with increased risk of ICU admission after 1 year (adjusted RR: 1.26, 95% CI: 1.01-1.57) and PS &gt;1 was associated with an increased risk after both 1 year (adjusted RR: 1.74, 95% CI: 1.33-1.30) and 3 years (adjusted RR: 1.54, 95% CI: 1.22-1.96). Other factors listed in Table 1 (age, comorbidity, cytogenetic risk group, secondary or therapy-related AML, and year of diagnosis) were not associated with increased risk of ICU admission. In AML patients admitted to the ICU, the 1-year mortality from time of ICU admission was 69.2%, compared to a 1-year mortality rate of 31.0% in the matched non-ICU patients (adjusted RR: 3.25, 95% CI: 2.56-4.12). Long-term mortality was increased in ICU patients; 3-year mortality was 82.1% compared to 49.7% (adjusted RR: 2.43, 95% CI: 1.97-3.01), and the 5-year mortality was 83.1% compared to 60.6%, (adjusted RR: 2.12, 95% CI: 1.70-2.66). Conclusion In this national population-based cohort study, more than one fourth of AML patients treated with remission-induction chemotherapy were admitted to an ICU within 3 years of diagnosis with the majority of ICU admissions occurring within the first year. ICU admission was associated with high mortality, especially within the first year after admission. The risk of mortality decreased over time but remained increased 3 and 5 years after admission compared to the matched cohort. Early monitoring and management of high-risk patients may be effective in preventing ICU admissions and PS may serve as a possible tool to identify patients at high risk of ICU admission. Disclosures No relevant conflicts of interest to declare.

Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study.

Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA. This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ). A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000). Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle.

Methotrexate‐induced pneumonitis in a patient with rheumatoid arthritis: a case report

AbstractBackgroundMethotrexate‐induced pneumonitis (MTX‐P) is rare and life threatening, and a number of possible risk factors have been suggested but none are consistent between studies. Nevertheless, it can be assumed that all patients starting MTX are at risk of MTX‐P.AimThe aim of the present report is to increase awareness of the association between methotrexate and the possible risk of induced pneumonitis.Clinical detailsA 50‐year‐old man presented to a rheumatologist complaining of generalised weakness and low‐grade fever after taking 7.5 mg methotrexate (MTX) twice weekly for 1.5 months for rheumatoid arthritis. The patient was admitted to hospital due to respiratory signs and symptoms. Physical examination revealed the patient was in acute respiratory distress and mildly dehydrated. Scattered coarse crepitations were heard bilaterally and diffusely over lung fields.OutcomeA chest radiograph revealed bilateral diffuse alveolar shadowing. High‐resolution computed tomography (HRCT) showed diffuse interstitial changes, diffuse bilateral patchy alveolar shadowing and nodules. The platelet count, blood urea, electrolytes, blood sugar and liver function tests were within normal limits, while the neutrophil percentage was 90%. Owing to the symptoms, MTX‐P was suspected, the drug was discontinued and the therapy switched to oral hydrocortisone, with an observed rapid symptomatic improvement.ConclusionOur patient had a probable diagnosis of MTX‐P. Also, as per the Naranjo casualty assessment scale, he had a probable adverse drug event to MTX (score 7). The drug should be withdrawn as soon as MTX‐P is suspected and an urgent HRCT must be arranged to confirm the diagnosis. The patient should be admitted for supportive measures and corticosteroid treatment. All patients taking MTX should be educated about the symptoms of the disease and must be advised to present early to a respiratory physician. Furthermore, the patient should not be re‐treated after a definite or probable case of MTX‐P.

Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review.

Breast-conserving surgery (BCS) is commonly used in breast cancer treatment. Despite its benefits, some women will be troubled by breast edema. Breast edema may cause an unsatisfactory cosmetic result, influencing the quality of life. The purpose of this systematic review is to investigate the incidence of breast edema and to identify risk factors of breast edema in breast cancer patients following BCS and radiotherapy. A systematic literature search was performed using different electronic databases (PubMed, Web of Science, Cochrane, Embase) until June 2014. Inclusion criteria were as follows: (1) research studies that included female breast cancer patients who were treated with BCS and radiotherapy and (2) studies that investigated the incidence of breast edema and/or risk factors of breast edema. Exclusion criteria were (1) reviews or case studies and (2) studies published before 1995. We identified in total 28 papers which represented 4,011 patients. There was a great variation in the incidence of breast edema (0-90.4 %). We identified several possible risk factors for breast edema namely increasing irradiated breast volume, increasing boost volume, the use of a photon boost, increasing breast separation, a higher density of the breast tissue, a large tumor, a higher specimen weight, postoperative infection, acute postoperative toxicity, and diabetes mellitus. However, their prognostic value remains uncertain. Breast edema is a common complaint after BCS and radiotherapy. A number of possible risk factors associated with breast edema were identified, but further research is warranted.

Etiopathogenesis of disk displacement of the temporomandibular joint: A review of the mechanisms

Disk displacement of the temporomandibular joint (TMJ) is a clinically important condition, showing a high prevalence in both patient and non-patient populations. Despite its clinical importance, there is incomplete understanding of the etiopathogenic mechanisms leading to disk displacement. A number of possible risk factors have been identified. This article analyzes the etiopathogenesis from both the clinical and the biomechanical viewpoints and also reviews the literature on the association between disk displacement and the main risk factors (i.e., trauma, altered disk shape and/or dynamic properties, occlusal abnormalities, steepness of the articular eminence, hyperactivity of the lateral pterygoid muscle, joint hypermobility, etc.). According to our interpretation of available data, an impairment of joint lubrication may be a common finding in cases of disk displacement, thus suggesting the need for future studies addressing both local and systemic neuroendocrine aspects influencing the friction coefficient of the TMJ. A full comprehension of the etiopathogenesis of disk displacement is far from being achieved, and clinicians must take into account this consideration when treating patients with temporomandibular disorders.

Association Between Histoplasma Exposure and Stroke

The rate of cerebrovascular events within the stroke belt, a geographic area defined in the Southeastern United States, exceeds that of the rest of the nation. Despite evaluation of multiple risk factors for this disparity, specific causes for the stroke belt have not been elucidated. More than 45 years ago, the US Public Health Service and US Navy cooperative skin-testing program (1958-1965) documented adolescent exposure to Histoplasma capsulatum. Our purpose was to evaluate the association between exposure to Histoplasma capsulatum and subsequent development of stroke. A cross-sectional study of stroke in a cohort of US Navy veterans was designed to assess our hypothesis. Medical records from 23,795 men who participated in the cooperative skin-testing program and who received medical care at Veterans Administration Hospitals and Clinics were reviewed. A logistic regression model was used to estimate the odds ratio of stroke while controlling for multiple covariates. Because of the large number of possible risk factors for stroke, propensity scores were used to reduce bias. The adjusted odds ratio for stroke in veterans exposed to Histoplasma capsulatum during adolescence was 1.34 (95% confidence interval: 1.1-1.6; P = .0033). The increased risk was independent of traditional cerebrovascular event risk factors. Less frequent risk factors (atrial fibrillation, coronary heart disease, rheumatic heart disease, and prosthetic cardiac valvular replacement) were not controlled in this model. Exposure to Histoplasma capsulatum during adolescence was associated with an increased risk of stroke.

European study on epidemiology and the management of HCV in the haemodialysis population--Part 1: centre policy.

Haemodialysis patients are known to be at risk of infection of Hepatitis C Virus (HCV) through nosocomial spread. This paper presents the first part of a study on epidemiology and management of HCV, in a haemodialysis population, conducted by the EDTNA/ERCA Research Board. Data on HCV management and infection control procedures was collected from 136 European centres using an electronic questionnaire. The study identifies a number of possible risk factors for transmission of the virus: failing to disinfect devices between patients, sharing of single-use vials to prepare drugs or infusions for different patients, inadequate sterilisation or cleaning of machines between dialysis sessions, unsatisfactory environmental cleaning and distance less than one metre between chairs.

Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density.

To determine whether the use of more elaborate diagnostic tests can identify possible risk factors for secondary osteoporosis and to evaluate the impact of these possible risk factors on the severity of bone disease in the study population. Cross-sectional study. We have investigated 377 subjects (285 females, 92 males) with osteoporosis (T-score less than -2.5 in dual energy X-ray absorption) or nontraumatic lumbar vertebral fractures; these patients were referred to our hospital, a secondary care centre, for evaluation and treatment of osteoporosis. Osteoporosis without attributable risk factor was diagnosed in 106 women (37%) and 30 men (33%). In 241 patients (179 women, 62 men) one or more possible risk factors for osteoporosis (in this paper also called subclinical disease) were revealed. The most common were lactose malabsorption, disturbed exocrine pancreatic function and renal tubular disturbances, including renal hypercalciuria, incomplete renal tubular acidosis and mild phosphate diabetes. The number of possible risk factors in the individual patient was significantly related to the severity of osteoporosis as assessed by Z-scores (Spearman correlation r = -0.43, P < 0.001, n = 172 for females; r = -0.28, P < 0.05, n = 65 for males). All the identified subclinical diseases would have remained undetected if the currently accepted guidelines for the investigation of patients with osteoporosis were applied. The statistically significant correlation between the number of identified possible risk factors and the severity of bone disease in the individual patient strongly suggests the pathogenetic significance of the identified subclinical diseases. It is yet to be shown, whether specific treatment of these subclinical diseases yields additional improvement of bone mass as compared with standard treatment of osteoporosis.

A study of potential risk factors for sexual abuse in childhood

Research aimed at identifying risk factors for childhood sexual abuse (CSA) is crucial for the development of preventative strategies. This study examined the relationship between a number of possible risk factors and CSA in a community sample of women using multivariate analysis and carefully operationalized variables. The variables significantly associated with CSA were physical abuse, having a mother who was mentally ill, not having someone to confide in, and being socially isolated. With the exception of physical abuse, different predictors emerged for abuse before and after age 12. Social isolation and experiencing the death of a mother were significant predictors for abuse before age 12, while the predictors of CSA after age 12 were physical abuse and a mentally ill mother. For abuse perpetrated by a family member, the significant predictors of CSA were physical abuse, having no one to confide in, having no caring female adult, and having an alcoholic father. For girls abused by someone outside of the family, the significant predictors were physical abuse, social isolation, mother's death, and having an alcoholic mother. While CSA can happen to any child, this study highlights circumstances that may increase the chances of abuse and should form the basis of prevention and intervention strategies.

A case-control study on the association of selected risk factors with the occurrence of bovine tuberculosis in the Republic of Ireland

We did a case-control study on the association between the occurrence of bovine tuberculosis in herds in the East Offaly area and a number of possible risk factors: herd size, the purchasing of cattle, the herd history, the status of contiguous herds, distance to the nearest badger sett, and animal factors such as age, breed and animal type. The characteristics of 100 herds that had a confirmed outbreak of tuberculosis at a herd test in 1988 were compared with those from an equal number of herds that passed at least one tuberculin test during that year. The study base consisted of 1379 herds mainly from the eastern part of County Offaly. The data were analysed at both herd and animal levels. Factors that were associated with an increased risk of tuberculosis breakdowns at the herd level were (i) the total number of animals in the herd and (ii) the restriction of a contiguous herd for tuberculosis within a period of 6 months prior to or following the herd under study. A number of factors were associated with an animal having an increased risk of failing a tuberculin test. After adjusting for all other variables in the model, cows, heifers and bullocks were 10.3, 14.8 and 8.0 times, respectively, more likely to fail a tuberculin test than calves. Cattle that had teen purchased since the previous herd test were less likely to fail a tuberculin test compared with cattle that had been present at the time of the preceding herd test.

A case-control study on the association of selected risk factors with the occurrence of bovine tuberculosis in the Republic of Ireland

We did a case-control study on the association between the occurrence of bovine tuberculosis in herds in the East Offaly area and a number of possible risk factors; herd size, the purchasing of cattle, the herd history, the0 status of contiguous herds, distance to the nearest badger sett, and animal factors such as age, breed and animal type. The characteristics of 100 herds that had a confirmed outbreak of tuberculosis at a herd test in 1988 were compared with those from an equal number of herds that passed at least one tuberculin test during that year. The study base consisted of 1379 herds mainly from the eastern part of County Offaly. The data were analysed at both herd and animal levels. Factors that were associated with an increased risk of tuberculosis breakdowns at the herd level were (i) the total number of animals in the herd, and (ii) the restriction of a contiguous herd for tuberculosis within a period of 6 months prior to or following the herd under study. A number of factors were associated with an animal having an increased risk of failing a tuberculin test. After adjusting for all other variables in the model, cows, heifers and bullocks were 10.3, 14.8 and 8.0 times, respectively, more likely to fail a tuberculin test than calves. Cattle that had been purchased since the previous herd test were less likely to fail a tuberculin test compared with cattle that had been present at the time of the preceding herd test.

Pre-transplant hypertension: a major risk factor for chronic progressive renal allograft dysfunction?

Despite of advances in 1-year survival rates of renal allografts, no comparable achievements have been made in long-term graft survival. To identify risk factors for chronic progressive renal allograft dysfunction we conducted a retrospective study in 639 patients transplanted between 1983 and 1990. Graft function was assessed by the slope of individual 1/creatinine regression lines and chronic progressive graft dysfunction was defined as a slope of the 1/creatinine line of > 0.1 dl/mg/year, indicating a loss of glomerular filtration rate of > 10 ml/min/year regardless of the initial serum creatinine value. A number of possible risk factors were determined and analysed by linear regression analysis. One hundred and six patients (16.6%) showed chronic progressive graft dysfunction. No correlation was found between the rate of functional deterioration and the age and gender of the donor or the recipient, the blood group, the prevalence of hepatitis B or C, the number of blood transfusions, the total ischaemia time, or the number of kidneys from female donors grafted into male recipients. Chronic progressive graft dysfunction was associated with the number of HLA-B/DR mismatches (P = 0.04) and with a first acute rejection episode later than 60 days after transplantation (P < 0.001). Chronic progressive graft dysfunction also occurred in the absence of an acute rejection episode. Significantly (P < 0.001) more patients with chronic progressive graft dysfunction were hypertensive not only 12 months after transplantation, but also at the time of transplantation, indicating that hypertension may not only be secondary to deteriorating graft function, but that hypertension per se leads to graft damage and initiates chronic progressive graft dysfunction. All efforts should be made to control blood pressure adequately to improve long-term survival of renal allografts.

Aspirin usage and its influence on femoro-popliteal vein graft patency

As part of the Femoro-popliteal Bypass Trial patients undergoing femoro-popliteal vein bypass were randomised to aspirin 300 mg and dipyridamole 150 mg twice daily or identical placebo tablets. Blood was taken from a subgroup of 145 patients (mean age 66.3 years) with patent grafts at 6 months. Serum salicylate analysis revealed that of the 65 randomised to receive placebo 18 (28%) had evidence of salicylate in their sample (greater than 50 ng ml-1). Similarly, in those randomised to active treatment and considered to be good compliers 16/61 (26%) had no evidence of salicylate in their serum sample (less than 50 ng ml-1). Analysis of primary graft patency by "intention to treat" failed to detect a difference by life table, the risk being slightly higher in the group assigned to placebo (RR = 1.33, 95% confidence internal C.I. 0.64-2.78, p = 0.438). When comparing patients with no detectable serum concentration (less than 50 ng ml-1) with patients with serum salicylate over 50 ng ml-1 there was a significant difference in graft patency at 66 versus 83% respectively at 3 years (RR = 2.38, 95%C.I. 1.08-5.26, p = 0.024). When corrected for a number of possible risk factors this significant difference was maintained (RR = 2.78, 95%C.I. 1.15-6.67, p = 0.017). Although these findings are based on observational data they provide indirect evidence of an improvement in graft patency with aspirin. This result combined with the finding of a significant reduction in cardiovascular events in the main trial results support the use of aspirin and dipyridamole in patients undergoing femoro-popliteal vein bypass.

A study of embolism in mitral valve disease and atrial fibrillation.

A number of possible risk factors, clinical, radiological, biochemical, and social have been examined in one group of 34 cases of mitral valve disease and four of lone atrial fibrillation, all of whom gave a history of embolism, and also in a group of 24 cases of mitral valve disease who gave no such history. All were on long-term anticoagulant treatment. Comparison of the two groups disclosed no features that would distinguish those who ran the greater risk of embolism from the remainder other than that the men in the former group were older and of shorter stature. At comparable age, the women with a history of embolism had smaller left atria. Examination of a special group of nine patients who had had embolism despite anticoagulant treatment also disclosed no special features, other than a greater age at the time of their first embolism. Fibrinolytic activity was less and the level of beta thromboglobulin was greater than normal in both groups. Those with proven risk of embolism were not distinguished by higher values of this platelet protein. Neither variable correlated with the type of heart disease. No positive association was found between cigarette smoking and the risk of embolism. Embolism was significantly more likely to occur between 0801 and 1600 hours than at other times of day.