Presence Of Multiple Risk Factors Research Articles

Metabolic syndrome associated risk factors: Findings among female undergraduate university students

Aim: Evaluating the risk factors predisposing to Metabolic Syndrome (MetS) among female undergraduate university students. Method: A cross-sectional study was conducted at Ajman University, United Arab Emirates. A total of 200 female students 18–26 years old were recruited in the study. A structured questionnaire was designed then filled by the students; it considered their personal information, socio-demographic data, medication history and family history of medical diseases. It also described their dietary and lifestyle profiles. Weight, height, waist/hip circumferences, blood pressure and random glucose were measured. Statistical analysis was performed by SPSS version 24. Results: Study showed that 20% of the participants have BMI > 25 kg/m2and 12% of them have waist circumference >35 inches. Significant correlations were found between anxiety symptoms and both physical inactivity and excess eating, smoking and increased waist circumference. Also skipping breakfast was significantly correlated with weight gain, high blood pressure as well as high glucose levels. Family history of diseases was evidenced to be an important risk factor. Family history of diabetes was significantly correlated with increased plasma glucose levels, family history of heart attack and both hypertension and increased blood glucose levels. Conclusion: Results revealed that female students are prone to suffer from MetS, due to presence of multiple risk factors. It is imperative for individuals to be advised on what would help reduce their risks of developing MetS.

Association of Risk Factors with Coronary Angiographic Findings of Female Patients with Acute Myocardial Infarction at a Tertiary Hospital of Bangladesh

Background: Coronary artery disease (CAD) is the leading cause of mortality and morbidity of women in developed and developing country. Although women in low and middle income countries have worse situation they are least studied. Cardiovascular risk factors assessment and their correlation with angiographic severity in female patients is essential to take preventive strategy and timely intervention.
 Aim: The aim of this study was to evaluate the major risk factors of coronary artery disease and to study the relation of those cardiovascular risk factors with coronary angiographic findings in female patients with AMI .
 Methods: This was a cross-sectional observational study carried out in the department of Cardiology, Chittagong Medical College Hospital (CMCH) from January 2017 to December 2017. One hundred and fifty consecutive female patients diagnosed as acute myocardial infarction (AMI) who subsequently underwent coronary angiography (CAG) during the study period were included in the study. Data regarding demographic, clinical & laboratory features were recorded. Severity of CAG findings was assessed by Gensini score.
 Results: The mean age of the study population was 53.19(±10.71) years. Hypertension was the commonest cardiovascular risk factor (78%) in this study followed by obesity (68%), dyslipidaemia (62%) and diabetes mellitus (57.3%). About 80% patients had clustering of ≥3 risk factors. Proportion of patients having STsegment elevation myocardial infarction (STEMI) and non ST-segment elevation myocardial infarction (NSTEMI) were 47% and 53% respectively. Thrombolytic was the most frequently used treatment modality for the management of STEMI patients. Double Vessel Disease, type B lesion with Gensini score ≥20 were the most common CAG findings. Triple vessel disease and severe CAD (Gensini score ≥20) were more in women with three or more risk factors. A significant (p<0.05) linear correlation was found between Gensini score and age, triglyceride level and total cholesterol level. Other factors, including, obesity, family history, hypertension, diabetes mellitus, menopausal status were found to be more prevalent among severe coronary artery disease on CAG but the differences were not statistically significant (p>0.05).
 Conclusion: The present study showed a significant relation of having multiple cardiovascular risk factors with developing more aggressive angiographic findings. It also revealed that Bangladeshi female patients of AMI had clusters of cardiovascular risk factors and presence of multiple risk factors is a predictor of severe coronary artery disease.
 Bangladesh Heart Journal 2019; 34(2) : 100-110

Characteristics, risk factors and management of venous thromboembolism in immune thrombocytopenia: a retrospective multicentre study.

An increased risk of thrombosis has been reported in immune thrombocytopenic purpura (ITP), but the characteristics, risk factors of occurrence, recurrence and management of venous thromboembolic events (VTE) have been poorly investigated. To describe VTE and ITP characteristics, distribution of VTE risk factors and their impact on VTE features and recurrence. A retrospective study of patients with ITP and VTE registered in databases of three reference French centres of ITP. Among 49 patients, 66 VTE were recorded. The platelet count at the time of the first VTE was <100 × 109 /L for 28/43 (65%) patients. In total, 19/48 (40%) patients had at least one positive antiphospholipid test result. For the 10 VTE occurring in eight patients with platelet count <50 × 109 /L, ITP treatment was efficient in 7. One haemorrhagic complication associated with anticoagulant (AC) therapy was recorded. For 31/49 (63%) patients, long-term AC therapy could have been discussed after the first VTE, but only 13 received it. A second VTE occurred in 13 (27%) patients. The risk of recurrence was increased in patients with unprovoked VTE before ITP diagnosis or active cancer. VTE in ITP mainly occurred in the presence of multiple risk factors of TE. A low platelet count does not protect against VTE. Management with AC therapy despite persistently low platelet count seems possible. Risk of VTE recurrence is high, particularly with a history of unprovoked VTE or active cancer. In this setting, indefinite AC therapy could be discussed.

Composição corporal na síndrome metabólica: Proposta de um protocolo de ensaio clínico randomizado avaliando o efeito do exercício de vibração de corpo inteiro

Introduction: Metabolic syndrome (MetS) is characterized bya group of cardiovascular risk factors, such as hypertension,hyperglycemia, hypercholesterolemia, low high-density cholesteroland increased abdominal fat. Over the years, changesin body composition occur, with accelerated loss of lean massand increased fat mass, favoring cardiometabolic disorders.A strong relationship exists between physical inactivity andthe presence of multiple risk factors for MetS. Thus, physicalexercise has been recommended for the prevention of cardiovascular,chronic and MetS diseases. Whole-body vibration(WBV) exercise can be considered to be an exercise modalitythat benefits the muscular strength and cardiovascular healthof elderly, sick and healthy people. Individuals with MetSare unmotivated to perform physical exercise regularly and,therefore, new approaches to intervention for this populationare desirable. Objectives: The aim of this study is to presenta protocol to verify the effect of WBV exercise on the bodycomposition of MetS individuals. Methods: Randomized controlledtrial with MetS individuals that will be allocated to anintervention group (WBVG) and a control group (CG). Participantswill be placed barefoot on the base of a side alternatingvibrating platform, with 130º knee flexion. Individuals (WBVGand CG) will perform the protocol for 12 weeks, twice a week.The CG subjects will perform the exercises at 5Hz throughoutthe intervention and those from the WBVG will perform the5Hz exercises in the first session, adding 1Hz per session, endingthe protocol at 16Hz. The body composition will be evaluatedbefore and after the protocol using bioelectrical impedanceanalysis. Discussion: Studies involving WBV exercise haveshown improvement in composition in individuals withdifferent conditions (healthy and unhealthy). Conclusion: Theproposed protocol will permit the acquisition of findings thatwill be relevant in the evaluation of the effect of the WBV onthe body composition of MetS individuals due to its ease ofrealization, low cost and safety.Keywords: Whole body vibration exercise; Metabolic syndrome;Physical activity.

Dapagliflozin and cardiovascular mortality and disease outcomes in a population with type 2 diabetes similar to that of the DECLARE-TIMI 58 trial: A nationwide observational study.

AimsTo investigate cardiovascular (CV) safety and event rates for dapagliflozin versus other glucose‐lowering drugs (GLDs) in a real‐world type 2 diabetes population after applying the main inclusion criteria and outcomes from the DECLARE‐TIMI 58 study.MethodsPatients with new initiation of dapagliflozin and/or other GLDs were identified in Swedish nationwide healthcare registries for the period 2013 to 2016. Patients were included if they met the main DECLARE‐TIMI 58 inclusion criteria: age ≥40 years and established CV disease or presence of multiple‐risk factors, e.g. men aged ≥55 years and women aged ≥60 years with hypertension or dyslipidaemia. Propensity scores for the likelihood of dapagliflozin initiation were calculated, then 1:3 matching was carried out. DECLARE‐TIMI 58 outcomes were hospitalization for heart failure (HHF) or CV‐specific mortality, and major adverse CV events (MACE; CV‐specific mortality, myocardial infarction, or stroke). Cox survival models were used to estimate hazard ratios (HRs).ResultsAfter matching, a total of 28 408 new‐users of dapagliflozin and/or other GLDs were identified, forming the population for the present study (henceforth referred to as the DECLARE‐like cohort. The mean age of this cohort was 66 years, and 34% had established CV disease. Dapagliflozin was associated with 21% lower risk of HHF or CV mortality versus other GLDs (HR 0.79, 95% confidence interval [CI] 0.69‐0.92) and had no significant association with MACE (HR 0.90, 95% CI 0.79‐1.03). HHF and CV mortality risks, separately, were lower at HR 0.79 (95% CI 0.67‐0.93) and HR 0.75 (95% CI 0.57‐0.97), respectively. Non‐significant associations were seen for myocardial infarction and stroke: HR 0.91 (95% CI 0.74‐1.11) and HR 1.06 (95% CI 0.87‐1.30), respectively.ConclusionIn a real‐world population similar to those included in the DECLARE‐TIMI 58 study, dapagliflozin was safe with regard to CV outcomes and resulted in lower event rates of HHF and CV mortality versus other GLDs.

Clinical Course of Chronic Pancreatitis in Elderly Patients

Background: Several guidelines recommend the risk-adapted monitoring of patients with chronic pancreatitis (CP). However, dedicated risk stratification is widely missing in CP. Elderly-CP (disease onset with 60 or more years of age) may represent a subgroup of CP subjects with a distinct course of disease. Aims: We aimed to investigate the clinical presentation of elderly-CP, and if elderly-CP requires an adapted monitoring. Methods: Seven hundred forty one patients with CP were analyzed in a multicenter (Mannheim/Germany, n = 537; Gießen/Germany, n = 100; Donetsk/Ukraine, n = 104), cross-sectional, retrospective study and classified according to the M-ANNHEIM classification. Results: The frequency of elderly-CP was 20% (148/741). In comparison with non-elderly-CP, elderly-CP was less frequently caused by alcohol and nicotine dependency or genetic mutations. In contrast, the frequency of efferent duct abnormalities (p = 0.009, chi-square test) and idiopathic CP (p < 0.0001, chi-square test) increased significantly. The presence of multiple risk factors was found less frequently in elderly-CP than in non-elderly patients (p < 0.0001; chi-square test). Furthermore, elderly-CP was associated with increased rates of pseudocysts (p = 0.0002; chi-square test), endocrine insufficiency (p = 0.001; chi-square test), and the absence of pain (p = 0.04; chi-square test) in the first year of the disease. Conclusion: In elderly-CP, the course of disease significantly differs from non-elderly-CP. Therefore, individualized monitoring strategies for elderly-CP might be necessary.

Diagnosis and management of acute esophageal necrosis.

Acute esophageal necrosis is a rare syndrome classically characterized by a striking endoscopic image of diffuse and circumferential black mucosal discoloration of distal esophagus, with an abrupt transition at the gastroesophageal junction and variable proximal extension. The typical patient is an older male with general debilitation and multiple comorbidities presenting with hematemesis or melena. The pathophysiology usually involves a combination of esophageal ischemia, backflow injury from gastric chemical contents and impaired mucosal reparative mechanisms associated with debilitated physical states. It may arise in the setting of hemodynamic compromise, diabetic ketoacidosis, hypothermia, alcoholic intoxication, trauma, inflammatory diseases, esophageal local infection, solid organ transplantation, postoperative status, drugs or acute gastric outlet obstruction, usually in the background of a chronic debilitating process, where the concurrent presence of multiple risk factors, including diabetes mellitus, hypertension, malnutrition, malignancy or alcohol abuse, places a patient at higher risk. The characteristic endoscopic appearance establishes the diagnosis. Biopsy is supportive but not required. Management is mainly supportive and consists of correcting coexisting conditions, fluid therapy, bowel rest, intravenous proton pump inhibitor therapy and red blood cell transfusion as needed. Although this is a serious life-threatening condition, appropriate treatment may result in a favorable outcome in the majority of patients.

Atherosclerosis or nonatherosclerotic vasculopathy? Moyamoya disease in a mid-aged adult

All causes of cerebrovascular disease should be considered in any patient presenting with ischemic stroke, despite the patient have concomitant risk factors for atherosclerosis. Here, we reported a case of Moyamoya disease (MMD) at a rather old age and with the presence of multiple risk factors for atherosclerosis. It is difficult to consider MMD at first glance, and it is easy to choose the wrong treatment in the first place. The key radiological feature for differentiation is the bilateral intracranial stenosis, rather than atherosclerotic changes, which are characterized as plaques with an uneven surface.

Use of Intravenous Immunoglobulin Therapy at Unconventional Doses in Refractory Fulminant Systemic Lupus Erythematosus.

The use of human intravenous immunoglobulins (IVIg) in systemic lupus erythematosus (SLE) currently relies on evidence from small case series and is mainly regarded as an off-label strategy in cases that are refractory to conventional therapies or poorly controlled with high doses of corticosteroids. Standard dosage regimens typically entail the administration of a total amount of 2 g/kg of IVIg divided into five consecutive days in order to minimize the risk of severe adverse events. We herein describe the case of a 28-year-old woman with a known history of antiphospholipid syndrome (APS) who was admitted to our hospital following fulminant onset of SLE in spite of ongoing immunosuppressive therapy. Acute renal insufficiency with nephrotic-range proteinuria, central nervous system involvement, severe thrombocytopenia, malar rash, pancreatic injury and moderate-severe aortic valve steno-insufficiency were the most prominent clinical manifestations, along with high titres of anti-dsDNA antibodies. Pulses of methyl-prednisolone followed by high-dose corticosteroids proved ineffective. Strikingly, IVIg therapy delivered at unconventional doses (1.2 g/kg) due to the presence of multiple risk factors for adverse events resulted in a significant, comprehensive clinical improvement. Although large-scale randomized double-blind studies are needed, the use of IVIg might constitute a valuable therapeutic modality as a last-resort strategy in cases of fulminant SLE. The total dose of immunoglobulins should be dictated by the clinical response as well as the presence of pre-existing risk factors for adverse events.LEARNING POINTSThe use of immunoglobulins in the treatment of systemic lupus erythematosus is mainly based on small prospective studies and case series.Their use as a rescue strategy in cases of systemic lupus erythematosus that are refractory to conventional immunosuppressive therapy may be a valid therapeutic alternative in selected patients.The short-term clinical response and the presence of risk factors for adverse effects should dictate the overall dose of immunoglobulins administered to the patient.

Primary prevention of coronary artery disease: let's start with calcium score.

Primary prevention of coronary artery disease: let's start with calcium score.

Predicting risk of pelvic floor disorders 12 and 20 years after delivery

Little progress has been made in the prevention of pelvic floor disorders, despite their significant health and economic impact. The identification of women who are at risk remains a key element in targeting prevention and planning health resource allocation strategies. Although events around the time of childbirth are recognized clinically as important predictors, it is difficult to counsel women and to intervene around the time of childbirth because of an inability to convey a patient's risk accurately in the presence of multiple risk factors and the long time lapse, which is often decades, between obstetric events and the onset of pelvic floor disorders later in life. Prediction models and scoring systems have been used in other areas of medicine to identify patients who are at risk for chronic diseases. Models have been developed for use before delivery that predict short-term risk of pelvic floor disorders after childbirth, but no models that predict long-term risk exist. The purpose of this study was to use variables that are known before and during childbirth to develop and validate prognostic models that will estimate the risks of these disorders 12 and 20 years after delivery. Obstetric variables were collected from 2 cohorts: (1) women who gave birth in the United Kingdom and New Zealand (n=3763) and (2) women from the Swedish Medical Birth Register (n=4991). Pelvic floor disorders were self-reported 12 years after childbirth in the United Kingdom/New Zealand cohort and 20 years after childbirth in the Swedish Register. The cohorts were split so that data during the first half of the cohort's time period were used to fit prediction models, and validation was performed from the second half (temporal validation). Because there is currently no consensus on how to best define pelvic floor disorders from a patient's perspective, we chose to fit the data for each model using multiple outcome definitions for prolapse, urinary incontinence, fecal incontinence, ≥1 pelvic floor disorder, and ≥2 pelvic floor disorders. Model accuracy was measured in the following manner: (1) by ranking an individual's risk among all subjects in the cohort (discrimination) with the use of a concordance index and (2) by observing whether the predicted probability was too high or low (calibration) at a range of predicted probabilities with the use of visual plots. Models were able to discriminate between women who experienced bothersome symptoms or received treatment at 12 and 20 years, respectively, for pelvic organ prolapse (concordance indices, 0.570, 0.627), urinary incontinence (concordance indices, 0.653, 0.689), fecal incontinence (concordance indices, 0.618, 0.676), ≥1 pelvic floor disorders (concordance indices, 0.639, 0.675), and ≥2 pelvic floor disorders (concordance indices, 0.635, 0.619). Route of delivery and family history of each pelvic floor disorder were strong predictors in most models. Urinary incontinence before and during the index pregnancy was a strong predictor for the development of all pelvic floor disorders in most models 12 years after delivery. The 12- and 20-year bothersome symptoms or treatment for prolapse models were accurate when predictions were provided for risk from 0% to approximately 15%. The 12- and 20-year primiparous model began to over predict when risk rates reached 20%. When we predicted bothersome symptoms or treatment for urinary incontinence, the 12-year models were accurate when predictions ranged from approximately 5-60%; the 20-year primiparous models were accurate from 5% and 80%. For bothersome symptoms or treatment for fecal incontinence, the 12- and 20-year models were accurate from 1-15% risk and began to over predict at rates at >15% and 20%, respectively. Models may provide an opportunity before birth to identify women who are at low risk of the development of pelvic floor disorders and may provide institute prevention strategies such as pelvic floor muscle training, weight control, or elective cesarean section for women who are at higher risk. Models are provided at http://riskcalc.org/UR_CHOICE/.

Risk Factors and Management of Venous Thromboembolic Diseases in Donor of Living Donor Liver Transplant

Background: liver transplantation surgically replaces a failing or diseased liver with one that is normal and healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine reliably performs all of the functions of the liver. Aim of the Work: this study aimed to highlight risk factors of the venous thromboembolism in donors of living donor liver transplant and its management. Patients and Methods: this study included 40 patients who underwent hepatectomy for living donor liver transplant. All patients were evaluated extensively, including history and physical examination and specialty consultations when indicated. All patients did haematological studies to detect the risk factors of thromboembolic disease. Results: in patients with manifestations of venous thromboembolism 2 donors have single risk factor for venous thromboembolism and 4 donors have double risk factors. Conclusion: presence of multiple risk factors for venous thromboembolism led to increase in its incidence, so during preoperative assessment of the donors, if they have multiple risk factors for thrombosis some precautions should be taken to avoid venous thrombosis. Recommendations: preoperative precautions include heamatological consultations for the donors and prophylaxis dose of anticoagulant. Intra operative precautions included pneumatic calf pressure, elastic stocking. Finally postoperative precautions should be continued , these donors should take therapeutic doses of anticoagulants and follow up by lower limb venous duplex.

Brugada type 1 electrocardiogram: Should we treat the electrocardiogram or the patient?

Patients with a Brugada type 1 electrocardiogram (ECG) pattern may suffer sudden cardiac death (SCD). Recognized risk factors are spontaneous type 1 ECG and syncope of presumed arrhythmic origin. Familial sudden cardiac death (f-SCD) is not a recognized independent risk factor. Finally, positive electrophysiologic study (+EPS) has a controversial prognostic value. Current ESC guidelines recommend implantable cardioverter defibrillator (ICD) implantation in patients with a Brugada type 1 ECG pattern if they have suffered a previous resuscitated cardiac arrest (class I recommendation) or if they have syncope of presumed cardiac origin (class IIa recommendation). In clinical practice, however, many other patients undergo ICD implantation despite the suggestions of the guidelines. In a 2014 cumulative analysis of the largest available studies (including over 2000 patients), we found that 1/3 of patients received an ICD in primary prevention. Interestingly, 55% of these latter were asymptomatic, while 80% had a + EPS. This means that over 30% of subjects with a Brugada type 1 ECG pattern were considered at high risk of SCD mainly on the basis of EPS, to which a class IIb indication for ICD is assigned by the current ESC guidelines. Follow-up data confirm that in clinical practice single, and often frail, risk factors overestimate the real risk in subjects with the Brugada type 1 ECG pattern. We can argue that, in clinical practice, many cardiology centers adopt an aggressive treatment in subjects with a Brugada type 1 ECG pattern who are not at high risk. As a result, many healthy persons may be treated in order to save a few patients with a true Brugada Syndrome. Better risk stratification is needed. A multi-parametric approach that considers the contemporary presence of multiple risk factors is a promising one.

Hypothermia due to Antipsychotic Medication: A Systematic Review.

Hypothermia is a rare, but potentially fatal adverse effect of antipsychotic drug (APD) use. Although the opposite condition, hyperthermia, has been researched extensively in the context of the malignant antipsychotic syndrome, little is known about hypothermia due to APDs. This study aimed to review the literature on hypothermia in the context of APD use, and formulate implications for research and clinical care. A systematic search was made in PubMed and Ovid Medline. The literature search yielded 433 articles, including 57 original case descriptions of hypothermia developed during APD use with non-toxic plasma levels. All cases together indicate that the risk of developing hypothermia is highest during the 7 days following initiation, or increase in dosage, of APDs, especially in the presence of additional predisposing factors, such as advanced age, exposure to cold, adjuvant use of benzodiazepines, and (subclinical) hypothyroidism. In addition, data derived from drug-monitoring agencies suggest that the prevalence of APD-related hypothermia is at least 10 times higher than suggested by the literature. We conclude that health-care professionals need to monitor the body temperature of patients starting with (an increased dose of) APDs for a duration of 7-10 days to prevent hypothermia, especially in the presence of multiple risk factors. Moreover, systematic studies are needed to establish the actual prevalence of APD-related hypothermia as well as the relative risk for individual APDs.

Risk of metachronous ovarian cancer after ovarian conservation in young women with stage I cervical cancer

While there is an increasing trend of ovarian conservation at the time of surgical treatment for young women with stage I cervical cancer, the risk for subsequent ovarian cancer after ovarian conservation has not been well studied. We sought to examine the incidence of and risk factors for metachronous ovarian cancer among young women with stage I cervical cancer who had ovarian conservation at the time of hysterectomy. The Surveillance, Epidemiology, and End Results Program was used to identify women aged <50 years who underwent hysterectomy with ovarian conservation for stage I cervical cancer from 1983 through 2013 (n= 4365). Time-dependent analysis was performed for ovarian cancer risk after cervical cancer diagnosis. Mean age at cervical cancer diagnosis was 37 years, and the majority of patients had stage IA disease (68.2%) and squamous histology (72.9%). Median follow-up time was 10.8 years, and there were 13 women who developed metachronous ovarian cancer. The 10- and 20-year cumulative incidences of metachronous ovarian cancer were 0.2% (95% confidence interval, 0.1-0.4) and 0.5% (95% confidence interval, 0.2-0.8), respectively. Mean age at the time of diagnosis of metachronous ovarian cancer was 47.5 years, and stage III-IV disease was seen in 55.6%. Age (≥45 vs <45 years, hazard ratio, 4.22; 95% confidence interval, 1.16-15.4; P= .018), ethnicity (non-white vs white, hazard ratio, 4.29; 95% confidence interval, 1.31-14.0; P= .009), cervical cancer histology (adenocarcinoma or adenosquamous vs squamous, hazard ratio, 3.50; 95% confidence interval, 1.17-10.5; P= .028), and adjuvant radiotherapy use (yes vs no, hazard ratio, 3.69; 95% confidence interval, 1.01-13.4; P= .034) were significantly associated with metachronous ovarian cancer risk. The presence of multiple risk factors was associated with a significantly increased risk of metachronous ovarian cancer compared to the no risk factor group: 1 risk factor (hazard ratio range, 2.96-8.43), 2 risk factors (hazard ratio range, 16.6-31.0), and 3-4 risk factors (hazard ratio range, 62.3-109), respectively. Metachronous ovarian cancer risk after ovarian conservation for women with stage I cervical cancer is <1%. Older age, non-white ethnicity, adenocarcinoma or adenosquamous histology, and adjuvant radiotherapy may be associated with an increased metachronous ovarian cancer risk.

Predictive model of urinary tract infection after surgical treatment for women with endometrial cancer.

The aim of the study was to identify risk factors associated with postoperative urinary tract infections (UTIs) following hysterectomy-based surgical staging in women with endometrial cancer. This is a retrospective study utilizing an institutional database (2008-2016) of stage I-IV endometrial cancer cases that underwent hysterectomy-based surgery. UTIs occurring within a 30-day time period after surgery were examined and correlated to patient clinico-pathological demographics. UTIs were observed in 44 (6.4%, 95% confidence interval 4.6-8.2) out of 687 cases subsequent to the diagnosis of endometrial cancer. UTI cases were significantly associated with obesity, advanced stage, prolonged operative time, hysterectomy type, pelvic lymphadenectomy, non-β-lactam antibiotics, and intraoperative urinary tract injury (all, p<0.05). On multivariate analysis, three independent risk factors were identified for UTIs: prolonged operative time [odds ratio (OR) 3.36, 95% CI 1.65-6.87, p=0.001], modified-radical/radical hysterectomy (OR 5.35, 95% CI 1.56-18.4, p=0.008), and an absence of perioperative β-lactam antibiotics use (OR 3.50, 95% CI 1.46-8.38, p=0.005). In a predictive model of UTI, the presence of multiple risk factors was associated with significantly increased risk of UTI: 4.1% for the group with no risk factors, 7.3-12.5% (OR 1.85-3.37) for single risk factor group, and 30.0-30.8% (OR 10.1-10.5) for two risk factor group. Urinary tract infections are common in women following surgical treatment for women with endometrial cancer with risk factors being a prolonged surgical time, radical hysterectomy, and non-guideline perioperative anti-microbial agent use. Consideration of prophylactic anti-microbial agent use in a high-risk group of postoperative urinary tract infection merits further investigation.

The Significance of Inflow Artery and Tourniquet Derived Cephalic Vein Diameters on Predicting Successful Use and Patency of Arteriovenous Fistulas for Haemodialysis

To investigate the significance of inflow artery and cephalic vein diameters on predicting patency of radiocephalic and brachiocephalic arteriovenous fistulas (AVFs). Single centre study with retrospective analysis of prospectively collected data between November 2010 and July 2015. A detailed history and physical examination was undertaken, including age, gender, history and duration of haemodialysis, cause of chronic kidney disease, and the presence of comorbidities/risk factors. Pre-operative arterial and venous upper extremity mapping was performed and inner vessel diameter was recorded, using a tourniquet for the veins. Outcome measures included AVF use (functionality), primary, primary assisted, secondary, and functional secondary patency. One hundred and thirty five AVFs (57 and 78 radiocephalic and brachiocephalic AVFs, respectively) were constructed and followed up for 5 years. A cephalic vein diameter <4.3mm (lower three quartiles) was the single independent predictor of inferior secondary and also functional secondary patency of radiocephalic AVFs (p=.02, HR 11.2, 95% CI 1.44-90.9). A brachial artery diameter ≤4.1mm (lowest quartile) was an independent predictor of AVF functionality (57% vs. 83% for larger arteries, p=.017), and inferior primary, primary assisted, secondary, and functional secondary patency of brachiocephalic AVFs (primary assisted patency 21.9% vs. 55.9% at 3 years, p=.001/log-rank test, HR 3.1, p=.002/Cox regression). The presence of lower extremity PAD or use of dual antithrombotics was also independently associated with an inferior secondary patency. The number of risk factors (brachial artery diameter ≤4.1mm, PAD, and use of dual antithrombotics) demonstrated risk stratification capabilities for functional secondary patency. Among patients undergoing radiocephalic AVFs, a tourniquet derived cephalic vein diameter <4.3mm was the single independent predictor of inferior secondary and functional secondary patency. Among patients undergoing brachiocephalic AVFs, all patency rates were inferior in the presence of a brachial artery diameter ≤4.1mm and secondary patency was inferior in the presence of multiple risk factors.

Pattern of mortality in sudden death: an autopsy study

Background: Sudden death has plagued mankind from time Immemorial. Clinical presentations include wide spectrum from symptom complex to completely asymptomatic. Sudden cardiac death in many cases, ‘first and only symptom. The high incidence, sudden, unexpected nature, combining with the low successful rate of resuscitation, make sudden cardiac deaths a major unsolved problem. Therefore, this study was conducted to illustrate etiolopathology, risk factors and triggers of sudden death with the expectation to provide new insight in epidemiological aspects of sudden death, which will help in care of patients, and prevention of premature cardiac deaths.Methods: A study of 50 cases of sudden death was conducted at tertiary care hospital. After evaluating detailed history from the family members, autopsy has been performed to find out cause of sudden death.Results: Principal culprit of sudden death is cardiovascular disease. Highest numbers of sudden death are in middle age group and having male preponderance might be due to presence of multiple risk factors, which have added or multiplicative effect. There are few autopsy negative cases, which are unexplained sudden death.Conclusions: Sudden and unexpected deaths in young population frequently become the subject of pathologic investigation to determine the cause of death.

Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma

BackgroundTo examine recurrence patterns in women with stage I uterine carcinosarcoma (UCS) stratified by adjuvant therapy pattern. MethodsWe examined 443 cases of stage I UCS derived from a retrospective cohort of 1192 UCS cases from 26 institutions. Adjuvant therapy patterns after primary hysterectomy-based surgery were correlated to recurrence patterns. ResultsThe most common adjuvant therapy was chemotherapy alone (41.5%) followed by chemotherapy/radiotherapy (15.8%) and radiotherapy alone (8.4%). Distant-recurrence was the most common recurrence pattern (5-year cumulative rate, 28.1%) followed by local-recurrence (13.3%). On multivariate analysis, chemotherapy but not radiotherapy remained an independent prognostic factor for decreased risk of local-recurrence (5-year cumulative rates 8.7% versus 19.8%, adjusted-hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.25–0.83, P=0.01) and distant-recurrence (21.2% versus 38.0%, adjusted-HR 0.41, 95%CI 0.27–0.62, P<0.001). The chemotherapy/radiotherapy group had a lower 5-year cumulative local-recurrence rate compared to the chemotherapy alone group but it did not reach statistical significance (5.1% versus 10.1%, adjusted-HR 0.46, 95%CI 0.13–1.58, P=0.22). Radiotherapy significantly decreased local-recurrence when tumors had high-grade carcinoma, sarcoma component dominance, and deep myometrial tumor invasion (all, P<0.05); and combining radiotherapy with chemotherapy was significantly associated with decreased local-recurrence compared to chemotherapy alone in the presence of multiple risk factors (5-year cumulative rates, 2.5% versus 21.8%, HR 0.12, 95%CI 0.02–0.90; P=0.013) but not in none/single factor (P=0.36). ConclusionAdjuvant chemotherapy appears to be effective to control both local- and distant-recurrences in stage I UCS; adding radiotherapy to chemotherapy may be effective to control local-recurrence when the tumor exhibits multiple risk factors.

Infections in Cancer Patients with Solid Tumors: A Review.

Solid tumors are much more common than hematologic malignancies. Although severe and prolonged neutropenia is uncommon, several factors increase the risk of infection in patients with solid tumors, and the presence of multiple risk factors in the same patient is not uncommon. These include obstruction (most often caused by progression of the tumor), disruption of natural anatomic barriers such as the skin and mucosal surfaces, and treatment-related factors such as chemotherapy, radiation, diagnostic and/or therapeutic surgical procedures, and the increasing use of medical devices such as various catheters, stents, and prostheses. Common sites of infection include the skin and skin structures (including surgical site infections), the bloodstream (including infections associated with central venous catheters), the lungs, the hepato-biliary and intestinal tracts, and the urinary tract, and include distinct clinical syndromes such as post-obstructive pneumonia, obstructive uropathy, and neutropenic enterocolitis. The epidemiology of most of these infections is changing with resistant organisms [MRSA, Pseudomonas aeruginosa, extended spectrum beta-lactamase (ESBL)-producing organisms] being isolated more often than in the past. Polymicrobial infections now predominate when deep tissue sites are involved. Conservative management of most of these infections (antibiotics, fluid and electrolyte replacement, bowel rest when needed) is generally effective, with surgical intervention being reserved for the drainage of deep abscesses, or to deal with complications such as intestinal obstruction or hemorrhage. Infected prostheses often need to be removed. Reactivation of certain viral infections (HBV, HCV, and occasionally CMV) has become an important issue, and screening, prevention and treatment strategies are being developed. Infection prevention, infection control, and antimicrobial stewardship are important strategies in the overall management of infections in patients with solid tumors. Occasionally, infections mimic solid tumors and cause diagnostic and therapeutic challenges.