Presence Of Potential Risk Factors Research Articles

Tibial implant design in primary TKA: retrospective comparison of two designs for the occurrence of radiolucent lines and aseptic loosening.

The purpose of this retrospective study was to study the effect of tibial implant design on the occurrence of radiolucent lines (RLLs) and aseptic loosening (AL) by comparing two different total knee arthroplasty (TKA) designs. Two types of total knee arthroplasty,different for tibial shape, size andkeeldesign were compared, 255 for the first and 774 for the second. The occurrence of RLLs and radiological signs of micro- and macro-mobility and aseptic looseningwas analyzed. Demographic data were compared, as well as the type and rate of RLLs, occurrence of aseptic loosening and the presence of potential risk factors. The first implant designis morphometric and has a squarer keel than the second implant TKA. The overall rate of RLLs was similar(21%vs 23%), despite of a significantly lower rates of radiological signs of macro-mobility of the tibial component with the first implant(2% vs 17%). Survivorship of both designs was overall comparable(99.6% vs 98.8 %) the first implantgroup had more potential risk factors for poor bone quality than the secondgroup (p<0.05). A morphometric design is more anatomic and offers better bone coverage of the epiphyseal tibial surface. RLLs, as a sign of implant micro-mobility, were equally present in both designs. Radiological signs of macro-mobility at the metaphysiswere less frequently observed in squared keel design. The morphometric implant did not show improved survivorship compared with a symmetric implant. III.

Social frailty increases the risk of all-cause mortality: A longitudinal analysis of the English Longitudinal Study of Ageing.

Social frailty is a common condition in older people, but its consequences are largely unknown. Therefore, in this longitudinal analysis, we aimed to investigate the association between social frailty and risk of all-cause mortality in a large sample of older people. Longitudinal, cohort. Older people participating to the English Longitudinal Study of Ageing (ELSA). Social frailty was defined based on financial difficulty, household status, social activity, and contacts with other people: social frailty was defined as ≥2 points, social pre-frailty (1 point), and robustness (0 points). Survival status during ten years of follow-up was assessed using administrative data. Cox proportional hazard models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) of the association between social frailty status and all-cause mortality. At baseline, compared to social robust participants, social frail subjects reported a significant higher presence of potential risk factors for all-cause mortality. During the ten years of follow-up, after adjusting for 10 potential confounders, social frailty at baseline (vs. robustness) was associated with a significantly higher risk of death (HR=1.31; 95% CI: 1.04-1.64; p=0.02), whilst social pre-frail was not. Among the single factors contributing to social frailty, poverty increased the risk of all-cause mortality by approximately 60% (HR=1.60; 95% CI: 1.33-1.93; p<0.0001) as well as living alone (HR=1.46; 95% CI: 1.10-1.94; p=0.009). Social frailty was significantly associated with all-cause mortality in a large cohort of older people, highlighting the importance of identifying this phenomenon in older adults to inform targeted intervention efforts.

Potential risk factors for peripheral neuropathy in patients with type 2 diabetes mellitus: a case control study from central Rajasthan

Background: Peripheral neuropathy is one of the most common and debilitating but preventable complications of diabetes mellitus, with significant morbidity as it often leads to foot ulceration and amputation. Therefore, this study was aimed to identify the potential risk factors for diabetic peripheral neuropathy (DPN) which can affect its progression.Methods: This case-control study was conducted on 240 patients with type 2 diabetes mellitus which included 120 patients with clinical evidence of DPN as cases and 120 patients without clinical evidence of DPN as controls. DPN was assessed clinically by neuropathic symptoms and neurological examination using 10 g 5.07 Semmes–Weinstein monofilament and vibration digital biothesiometer. Data regarding presence of potential risk factors were collected from all participants and analyzed using logistic regression analysis to measure an association with DPN.Results: A significant and independent association of advancing age, longer duration of diabetes, hyperglycemia, poor glycemic control, autonomic neuropathy and retinopathy with DPN (p&lt;0.05) was observed. Hypertension, dyslipidemia, smoking, gender, body mass index, method of diabetes control and angiotensin converting enzyme inhibitor usage were not found be associated with DPN.Conclusions: Since hyperglycemia and poor glycemic control were only modifiable risk factors for DPN, intensive glycemic control and primary prevention are the cornerstones for reducing the incidence or slowing the progression of neuropathy and improving quality of life in diabetic patients.

Characteristics and Risk Factors for Ischemic Ovary Torsion in Children.

Identifying ischemic ovary as a complication of ovary torsion (OT) is a significant challenge in children. This study identified risk factors for ischemic OT among pediatric OT patients to prevent delayed treatment. This retrospective study included pediatric inpatients who underwent operation for OT over 20 years. We employed multivariable logistic regression to find the risk factors associated with ischemic OT. Among the 118 patients included in this study, 78 (66.1%) had ischemic OT. Patients with ischemic OT tended to be younger; had more frequent vomiting; and had elevated White blood cell (WBC), C-Reactive protein (CRP), and segments in comparison with non-ischemic OT patients. Multivariable regression showed increased odds of ischemic ovary torsion, associated with higher WBC (12.3 × 103/mm3 vs. 8.7 × 103/mm3, p < 0.001), CRP (50.4 mg/L vs. 8.4 mg/L, p < 0.001), and vomiting (55.1% vs. 25%, p = 0.002) than in non-ischemic patients. A receiver-operating characteristic (ROC) analysis indicated that patients with vomiting, leukocytosis, or CRP ≧ 40 mg/L were more likely to have ischemic OT (sensitivity, 92%; specificity, 54%; PPV, 79.6; NPV, 78.9%). Ischemic OT is common among pediatric OT patients. The presence of potential risk factors of vomiting, leukocytosis, and CRP more significant than 40 mg/L may assist clinicians in ensuring an expedited surgical treatment.

Assessment of Seasonality and Extremely Preterm Birth in Denmark

Preterm birth, particularly extremely preterm birth, has been associated with substantial morbidity and mortality. Research during SARS-CoV-2-related lockdowns revealed reductions in the more severe subtypes of preterm birth in some countries, suggesting the presence of preventable risk factors, such as infectious diseases or social behavior. Seasonality may provide a similar means of assessing natural changes in the daily life of pregnant individuals that were similar to those experienced during the COVID-19 lockdown period. To evaluate the association between seasonality and extremely preterm birth. This nationwide cohort study included 1 136 143 pregnancies in Denmark with onset between January 1, 1997, and December 31, 2016, in which the fetuses survived 21 completed weeks of gestation. Pregnancies were followed up until preterm birth, fetal death, or 37 completed weeks of gestation. Data were analyzed from September 2020 to September 2021. Season during gestation (primary exposure) and season of pregnancy onset. The main outcome of extremely preterm birth was defined as a live birth occurring between 22 weeks, 0 days' gestation and 27 weeks, 6 days' gestation. Cox regression analyses were used to estimate hazard ratios (HRs) for season during gestation and season of pregnancy onset, with adjustment for socioeconomic and demographic factors. Among 662 338 pregnant individuals, the median age at pregnancy onset was 30.0 years (IQR, 6.0 years). Of 1 136 143 pregnancies, 2009 extremely preterm births (cumulative incidence, 0.18%) were identified during follow-up. Season during gestation was associated with extremely preterm birth, with cumulative incidences of 0.17% (95% CI, 0.16%-0.19%) in spring, 0.18% (95% CI, 0.17%-0.20%) in summer, 0.20% (95% CI, 0.18%-0.21%) in autumn, and 0.16% (95% CI, 0.14%-0.17%) in winter. Compared with winter, the adjusted HRs (AHRs) for the risk of extremely preterm birth were 1.11 (95% CI, 0.97-1.26) for spring, 1.15 (95% CI, 1.02-1.31) for summer, and 1.25 (95% CI, 1.10-1.42) for autumn. The number of extremely preterm births associated with the increased risk in the spring, summer, and autumn was 56.1 (95% CI, 18.2-99.7), representing 2.8% (95% CI, 0.9%-5.0%) of all extremely preterm births in the study. Season of pregnancy onset was not associated with the risk of extremely preterm birth in spring (AHR, 0.98; 95% CI, 0.95-1.01) or summer (AHR, 1.00; 95% CI, 0.96-1.03) compared with winter, but a slight increase in risk was observed in autumn (AHR, 1.05; 95% CI, 1.02-1.09) compared with winter. In this large, national cohort study, seasonality was associated with 2.8% of all extremely preterm births. Season during gestation was associated with the rate of extremely preterm birth, suggesting the presence of potential risk factors associated with season that may be preventable. Further research to identify risk factors for extremely preterm birth associated with seasonality is warranted.

Multifactorial aetiology of recurrent respiratory tract infections in children

Recurrent respiratory tract infections in children are a common health problem. Exposure to harmful environmental agents and coexistence of chronic diseases affect the severity and rate of infections. Ineffective outpatient treatment is an indication for a more comprehensive diagnostic workup. The aim of the study was to determine the cause of recurrent respiratory tract infections in children. The study group included 130 children aged 3–17 years who were referred for diagnostic investigation to determine the cause of recurrent respiratory tract infections. The eligibility criterion for the study group was the occurrence of 8 or more respiratory tract infections a year in children aged up to 6 years and 5 or more infections a year in children aged 7–17 years. The study group was subdivided into the following age groups: 3–5 years (n = 60), 6–9 years (n = 35), 10–13 years (n = 11) and 14–17 years (n = 24). The presence of potential risk factors for recurrent infection was analysed on the basis of questionnaires. Tests and examinations were also performed in order to exclude allergies, ear, nose and throat disorders and gastroesophageal reflux disease. Selected laboratory values (complete blood count, vitamin D concentration, immunoglobulin levels) were compared with those obtained from 86 healthy children from the control group. The majority of children had risk factors for recurrent respiratory tract infections. Adenoid hypertrophy was diagnosed in 44.6% of children, asthma in 36.9%, vitamin D deficiency in 30.7%, gastroesophageal reflux disease in 16.2% and immunodeficiency in 9.2% of children. Multimorbidity was found in 34.6% of the subjects. In the study group, there were higher vitamin D levels [study group: 25.6 ng/mL (25th percentile = 17; 75th percentile = 33.3), control group: 22.84 ng/mL (25th percentile = 16.3; 75th percentile = 28.7); p &lt; 0.044] and higher leukocyte levels [study group: 7.5 × 103/μL (25th percentile = 5.9; 75th percentile = 9.1), control group: 6.4 × 103/μL (25th percentile = 5.3; 75th percentile = 7.7); p &lt; 0.02]. The results indicate that children with recurrent respiratory tract infections are a heterogeneous group of patients. The youngest children were the largest group (n = 60). In the majority of children, the onset of symptoms was associated with the beginning of nursery/preschool or school attendance. In 1 in 3 children, a combined presence of a few diseases was found which increase susceptibility to recurrent respiratory tract infections.

The role of context in understanding the use of tactical officers: A brief research note

A small body of research suggests that the use of police tactical officers has become normalized in that they now commonly respond to “routine” calls rather than being restricted to high-risk situations. However, this research has tended to rely on crude data (i.e., call type), which fails to account for the context of the calls (e.g., the presence of potential risk factors that might warrant tactical resources). In this brief research note, we sought to expand upon previous literature by examining the risk factors associated with tactical calls in a Canadian police service. We found that various risk factors were present in many of the calls that tactical officers responded to, some of which might be classified as “routine” (suicide threats, well-being checks, domestic disturbances, etc.). The presence of such risk factors highlights the need to consider context when attempting to understand the use (and consequences) of tactical officers. More rigorous tracking of these factors by police services will facilitate such research and inform policies around the use of tactical resources.

Impact of COVID-19 outbreak on nurses’ mental health: A prospective cohort study

ObjectivesTo evaluate variations in nurses’ sleep quality and symptoms of depression, anxiety and stress during the COVID-19 outbreak, and to evaluate whether the presence of potential risk factors influenced these symptoms over time. MethodsThis prospective cohort study surveyed nurses three times – surveying personal factors, working conditions, family dynamics, and attitude towards COVID-19 – between March 31 and May 4, 2020. Nurses’ mental health was assessed through Depression Anxiety Stress Scales – short version (DASS-21); their sleep quality was assessed through a 5-point Likert scale question. ResultsNurses' sleep quality and symptoms of depression, anxiety and stress presented a positive variation over the COVID-19 outbreak. The only factors which are directly related to the COVID-19 outbreak and that were associated with the positive variation in nurses’ symptoms of depression, anxiety and stress were the fear to infect others and the fear to be infected (higher fear of being infected or to infect someone corresponded to increased symptoms of depression, anxiety and stress). ConclusionsAlthough the COVID-19 outbreak seems to have had an immediate impact on nurses' mental health, a psychological adaptation phenomenon was also observed. Future research should focus on assessing nurses’ symptoms of depression, anxiety and stress, after the COVID-19 pandemic, in order to compare and contrast the findings with the results of our study.

Factors affecting the outcome of septic arthritis of the shoulder joint with arthroscopic management

BackgroundGood results have been reported with arthroscopic therapy of septic arthritis of the shoulder; however, few studies have focused on the risk factors for failure of arthroscopic surgery. The purpose of this study was to identify the risk factors affecting the recurrence or death post-surgery in cases of septic arthritis of the shoulder. MethodsWe retrospectively assessed the records of patients who underwent surgical treatment for septic arthritis of the shoulder between 2009 and 2019. Patients were divided into 2 groups based on complete recovery, recurrence, or death after a single arthroscopic surgery: the eradicated group and the recurred/death group. To identify risk factors for the failure of arthroscopic surgery for septic arthritis of the shoulder, the following parameters were considered: age, sex, presentation of a rotator cuff tear, the arthroscopic staging of the infection, diabetes mellitus, the causative organism, preoperative white blood cell count, and C-reactive protein level in blood. We compared two groups with respect to the presence of potential risk factors. ResultsThis study included 22 patients with a mean age of 67.9 years. Septic arthritis of the shoulder was eradicated completely with a single arthroscopic surgery in 17 patients (77.3%). However, failure of the surgery resulting in recurrence or death was observed in 5 patients (22.7%). No significant differences were observed in other parameters between the two groups except for the causative organism. Methicillin-resistant Staphylococcus aureus was found in 1 patient (5.9%) in the eradicated group. On the other hand, Methicillin-resistant S. aureus was found in 3 patients (60%) in the recurred/death group (p = 0.024). ConclusionMost patients with septic arthritis of the shoulder are effectively treated with a single arthroscopic surgery. This study suggests that Methicillin-resistant S. aureus as the causative organism may be the most important prognostic factor in these cases.

Occurrence of BVDV Infection and the Presence of Potential Risk Factors in Dairy Cattle Herds in Poland.

Simple SummaryThe bovine viral diarrhea virus (BVDV) causes one of the most common and economically important viral diseases of cattle. It affected cattle reproductive disorders in breeding cattle as well as decreased productivity through increased forced culling, morbidity, and mortality, all of which can be observed on the herd level. The aim of our study was the estimation of the occurrence of BVDV infection in different regions of Poland and the analysis of the different factors that could be correlated with the productive results. We evaluated 354 cattle herds. The presence of antibodies against the BVD virus was found in 33.3% of examined herds, and the heterogenous distribution of BVDV-positive herds in all regions of Poland was confirmed. We found that the rate of BVDV infection was strongly correlated with the geographical location of the examined cattle populations in Poland, the grazing of the animals, and the purchasing of new animals to be introduced to herds.The aim of the study was to analyze the risk factors of BVDV infection, in different regions of Poland, with respect to certain parameters of animal health, including productivity, herd management practices, the presence of BVDV, and the effect of non-vaccination. A total of 354 cattle herds were estimated and linked to the analysis of the different factors that might be correlated with productive results. The presence of antibodies against BVDV was found in 33.3% of examined herds, and the heterogenous distribution of BVDV-positive herds in all regions of Poland (p = 0.001) was confirmed. We found statistical correlations between BVDV infection and pasture (p = 0.004) and the number of grazing animals (p < 0.001), and also the purchase of animals for replacement (p = 0.004) was observed. Production or clear clinical outcomes potentially linked to BVDV infection in the herd have not been observed. The results of this study indicate that the rate of BVDV infection was most strongly correlated with the geographical location of the examined cattle populations in Poland. The second most significant factors were the grazing of animals and the purchasing of new animals to be introduced to herds. The strengthened procedures of management, as well as the implementation of eradication programs, should be considered in the examined herds.

A standardized approach to bereavement risk-screening: a quality improvement project

Objectives: Identifying family members at-risk of poor bereavement outcomes poses a challenge for clinicians, resulting in inconsistent bereavement follow-up. The current quality improvement study tests a method for identification of at-risk family members, and describes follow-up they received from the bereavement service at Dana-Farber Cancer Institute.Design: A standardized bereavement risk assessment, referral and follow-up process was piloted as part of a quality improvement project using a plan-do-study-act approach (PDSA).Methods: A convenience sample of eleven clinical social workers completed paper and pencil bereavement risk-screening assessments using the Bereavement Risk-Screening Tool (BRST) on a sample of bereaved family members known to them. The results of the BRST were passed onto the bereavement program for follow-up.Findings: Eleven out of a total of 17 social workers participated in the study. Social workers screened 100% (52/52) of identified bereaved family members, corresponding to 52 patient deaths. Approximately half (28/52) were identified as being ‘at-risk’ of a poor bereavement outcome based on the social worker’s consideration of the presence of potential risk-factors and their response to a prediction-type question about the bereaved individual’s future coping. ‘Lack of preparation for the death’, ‘unexpected death within the context of an illness’ and ‘witnessing a difficult death’ were the most commonly identified risk factors. Of those individuals who were identified to be ‘at-risk’, 89% received an outreach attempt by telephone from the director of bereavement services, surpassing our project target of 80%. Conclusions: The BRST has the potential to help clinicians in health care settings identify those family members who might be considered at heightened risk of a poor bereavement outcome, facilitating early outreach and recommendations for support. The tool was easy to complete and helped streamline the referral process to the bereavement program.

HELLP Syndrome, Risk Factors in First and Second Pregnancy: A Population-based Cohort Study

(Acta Obstet Gynecol Scand. 2018;97:709–716) HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) is a rare disorder and is currently considered a form of severe preeclampsia. There may be specific risk factors for HELLP syndrome that differ from those for other forms of preeclampsia. In addition, the risk factors for HELLP syndrome may vary between the first and second pregnancies. Currently, population-based data on HELLP syndrome are limited. This study aimed to use a national birth registry to estimate the risks of developing HELLP syndrome in first and second pregnancies based on the presence of potential risk factors. In addition, the effect of adverse outcomes in the first pregnancy on the risk of HELLP syndrome in the second pregnancy was evaluated.

The Chronic Kidney Disease Epidemic in El Salvador: A Cross-Sectional Study.

INTRODUCTION Chronic kidney disease has reached epidemic levels in several Central American countries since the early years of this century. In El Salvador, it is the second cause of death in men, the fifth in persons over 18 years old and the third cause of hospital deaths in the adult population. Its features, especially those of a subtype unassociated with traditional risk factors such as diabetes and high blood pressure, are only partially understood. OBJECTIVE Estimate the magnitude of chronic kidney disease in the adult population of El Salvador, considering both prevalence of the disease in its diverse forms as well as presence of potential risk factors nationally and in major subpopulations. METHODS A descriptive, cross-sectional analysis was conducted on data obtained from the Survey of Chronic Non-communicable Diseases in Adults in El Salvador, completed in 2015. The original data (interviews and measurements) were collected between October 2014 and March 2015 from 4817 adults employing a two-stage probabilistic cluster sample, with stratification of primary sampling units. Our analysis, using 20 of the 118 primary variables included in the original survey, focused on point estimation of prevalence rates and means, related to both traditional biological risk factors and nontraditional ones, such as insufficient hydration, strenuous working conditions and exposure to toxic agents. A separate analysis was performed to estimate prevalence of chronic kidney disease from nontraditional causes. Corresponding confidence intervals were calculated with proper weighting. RESULTS The general prevalence of chronic kidney disease in El Salvador was 12.8% (men 18.0%; women 8.7%). Of the chronically ill kidney patients, 13.1% were between 20 and 40 years of age. Among biological risk factors, the most frequent was high blood pressure (37.0%). Among nontraditional risk factors, high levels of sugary drink consumption (81.0%), insufficient hydration (65.9%) and high levels of exposure to agrochemicals in the work environment (12.6%) were also observed. Prevalence of chronic kidney disease from nontraditional causes was 3.9% (men 6.1%; women 2.2%). CONCLUSIONS Chronic kidney disease has reached epidemic proportions in El Salvador. The data confirm a health tragedy that, although especially striking older men, also takes a severe toll on young men and women. The results confirm findings of previous research in several Salvadoran agricultural communities. The relatively high level of population exposure to agrochemicals is important and alarming, especially in rural areas, meriting health-impact studies that include and go beyond possible impact on chronic kidney disease. KEYWORDS Kidney, renal insufficiency, chronic, risk factors, epidemics, El Salvador.

The risk of developing post-arthroscopic shoulder stiffness is increased by the presence of gastroesophageal disorders

Aim The aim of this study was to document the incidence of post-arthroscopic shoulder stiffness (SS) and evaluate the role of certain or supposed risk factors in the development of this pathology. Background Postoperative SS is a complication of arthroscopic rotator cuff repair, which incidence has been reported variably in literature. Numerous risk factors have been described but gastroesophageal diseases have not yet been mentioned among them. Methods Two hundred and fourteen consecutive patients aged between 18 and 75 years with symptomatic degenerative posterosuperior rotator cuff tears that had failed conservative therapy and underwent arthroscopic rotator cuff repair were included. The incidence of post-operative SS and the presence of potential risk factors were documented prospectively. The presence of gastroesophageal reflux disease was specifically investigated with the GERDq questionnaire. Results The incidence of post-arthroscopic SS in the included patients was 7.9%. All but two patients were women, and sex was significantly associated to the development of the pathology (P = 0.0007). Both the presence of a subjective digestive discomfort (P = 0.0042) and the diagnosis gastroesophageal reflux disease (P = 0.0004) were found to be significantly associated with the development of post-arthroscopic SS. A present or past smoking habit were significantly associated with the absence of post-arthroscopic SS (P = 0.0443). Conclusions A significant association between the occurrence of post-arthroscopic SS and the presence of gastroesophageal diseases was identified. This finding deserves investigations with further studies. The incidence of post-arthroscopic SS encountered in this study falls among previously reported ranges, with females being significantly more affected than men.

Voice Disorders and Impact of Voice Handicap in Norwegian Student Teachers

The primary objectives of the present study were to determine the prevalence of voice disorders in students studying to become elementary school teachers and to investigate the presence of potential risk factors for voice disorders. The amount of voice training offered during the students' education and the connection between voice disorders were also explored. A web-based questionnaire was distributed to all elementary school student teachers throughout Norway. In total, 968 answers were received. The questionnaire consisted of questions on background, education, and risk factors; the Norwegian translation of the Voice Handicap Index (VHI-30(N)); and voice symptoms (Screen6). The results showed that 14.1% of the students had voice disorders, defined as experiencing two or more voice symptoms weekly or more often in Screen6. The most common symptoms were throat clearing, followed by strained or tired voice and sensation of pain or lump in the throat. The data showed a significant association between the scores of VHI-30(N) and results of Screen6. The amount of voice training within teacher education was not found to significantly reduce voice disorders. Results showed no significant differences in prevalence of voice disorders between female and male students. According to the answers given by the students participating in this study, voice problems appear to be common in student teachers. As they are to embark on a voice-demanding occupation, regular screening is paramount. More voice training is needed than offered in their education.

Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis.

AIM:The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions.MATERIAL AND METHODS:Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed.RESULTS:There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001).CONCLUSION:Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.

PD28-09 A POPULATION BASED ASSESSMENT OF THE RISK FACTORS FOR MESH REMOVAL OR REVISION AFTER FEMALE INCONTINENCE PROCEDURES

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Incontinence - Therapy II1 Apr 2015PD28-09 A POPULATION BASED ASSESSMENT OF THE RISK FACTORS FOR MESH REMOVAL OR REVISION AFTER FEMALE INCONTINENCE PROCEDURES Blayne Welk, Hana'a Al-Hothi, and Jennifer Winick-Ng Blayne WelkBlayne Welk More articles by this author , Hana'a Al-HothiHana'a Al-Hothi More articles by this author , and Jennifer Winick-NgJennifer Winick-Ng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1906AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The public is increasingly aware of incontinence mesh complications. Our objective was to determine the incidence and risk factors associated with surgical revision or removal of incontinence mesh. METHODS We conducted a retrospective, population-based study using administrative data. Our study population consisted of all women who underwent a stress incontinence procedure with mesh between 2002-2012 in Ontario, Canada. Patients who had mesh based prolapse repairs at any point were excluded. Our primary outcome was a composite of any surgical invention resulting in operative manipulation of the mesh (division, removal). Our primary exposure was surgeon volume; high volume surgeons were defined as the top 25th percentile of mesh implanters in a given year. Secondary exposures were multiple incontinence mesh procedures, and the presence of potential risk factors for mesh complications (pelvic radiation, fistula, urethral diverticulum, urethral injury). Other covariates included age, obesity, diabetes, health care utilization, comorbidity, socioeconomic status, surgical specialty and simultaneous surgical procedures. Primary analysis was an adjusted Cox proportional hazards model. RESULTS We identified 59,887 women with a median age of 52 (IQR 45-63) years. Median followup was 4.4 (IQR 2.4-6.9) years. A hysterectomy was done simultaneously in 13% of cases and non-mesh based prolapse repairs in 30% of cases. Within our cohort, 0.1% had risk factors for mesh complications, and 2.3% had multiple mesh slings placed. Our primary outcome was identified in 1307 patients (2.18%), and our overall event rate was 4.62/1000 person-years of followup. The cumulative incidence of mesh removal or revision increased from 1.2% after 1 year of followup to 2.5% after 10 years of followup. In our adjusted Cox regression analysis, high volume surgeons were significantly less likely to have patients with mesh removal or revision (HR 0.74, p<0.0001), and patients with multiple slings placed had a much higher rate of revision or removal (HR 6.57, p<0.0001). The presence of potential risk factors for mesh complications was not a significant risk factor (HR 0.55, p=0.5552). CONCLUSIONS The risk of surgical revision or removal of incontinence mesh is relatively rare, but does increase with time to 2.5% after 10 years of followup. Patients of high volume surgeons are significantly less likely to experience this complication, and women who have undergone multiple sling placements are at much higher risk of experiencing these complications. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e647 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blayne Welk More articles by this author Hana'a Al-Hothi More articles by this author Jennifer Winick-Ng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Exploring the Etiology of Noncarious Cervical Lesions: A Case Control Study

This case control investigation studied, the causal association of potential risk factors for noncarious cervical lesions (NCCLs), in patients reporting to the OPD of a dental Institute, in India. Total 52 patients, 26 with noncarious cervical lesions (7 females, 19 males, mean age 39.27±12.88 years) and 26 without noncarious cervical lesions in dentine (9 females, 17 males, mean age 34.96±10.27 years), were selected. All patients underwent a clinical and questionnaire assessment for the presence of potential risk factors for noncarious cervical lesions. Data were statistically analysed with SPSS version 17.2 software, using Chi-square test/Fisher exact test, t-test, Mann-Whitney test and multiple logistic regression analysis. Comparatively cases had a significant presence of good oral hygiene, bilateral group function, headaches, and prolonged usage of drugs for systemic illness. Multiple logistic regression analysis revealed a significant association of NCCLs with good oral hygiene and prolonged usage of drugs for systemic illness. Daily/weekly consumption of spicy dietary additives (chillies/pickles) exhibited marginally significant association with NCCLs. With no reported data on NCCLs causation in the Indian subcontinent, the present study reports that, apart from factors like better oral hygiene, daily/weekly consumption of spicy dietary additives; factors less researched like prolonged intake of drugs for systemic illness, monthly/yearly headaches; and factors considered doubtful, like lack of canine guidance: were significantly present in patients with noncarious cervical lesions.

Travel-related MERS-CoV cases: an assessment of exposures and risk factors in a group of Dutch travellers returning from the Kingdom of Saudi Arabia, May 2014.

BackgroundIn May 2014, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, with closely related viral genomes, was diagnosed in two Dutch residents, returning from a pilgrimage to Medina and Mecca, Kingdom of Saudi Arabia (KSA). These patients travelled with a group of 29 other Dutch travellers. We conducted an epidemiological assessment of the travel group to identify likely source(s) of infection and presence of potential risk factors.MethodsAll travellers, including the two cases, completed a questionnaire focussing on potential human, animal and food exposures to MERS-CoV. The questionnaire was modified from the WHO MERS-CoV questionnaire, taking into account the specific route and activities of the travel group.ResultsTwelve non-cases drank unpasteurized camel milk and had contact with camels. Most travellers, including one of the two patients (Case 1), visited local markets, where six of them consumed fruits. Two travellers, including Case 1, were exposed to coughing patients when visiting a hospital in Medina. Four travellers, including Case 1, visited two hospitals in Mecca. All travellers had been in contact with Case 1 while he was sick, with initially non-respiratory complaints. The cases were found to be older than the other travellers and both had co-morbidities.ConclusionsThis epidemiological study revealed the complexity of MERS-CoV outbreak investigations with multiple potential exposures to MERS-CoV reported such as healthcare visits, camel exposure, and exposure to untreated food products. Exposure to MERS-CoV during a hospital visit is considered a likely source of infection for Case 1 but not for Case 2. For Case 2, the most likely source could not be determined. Exposure to MERS-CoV via direct contact with animals or dairy products seems unlikely for the two Dutch cases. Furthermore, exposure to a common but still unidentified source cannot be ruled out. More comprehensive research into sources of infection in the Arabian Peninsula is needed to strengthen and specify the prevention of MERS-CoV infections.

Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study.

BackgroundCommunity-acquired MRSA (CA-MRSA) is rapidly increasing. Currently, it is unknown which reservoirs are involved. An exploratory hospital-based case-control study was performed in sixteen Dutch hospitals to identify risk factors for CA-MRSA carriage in patients not belonging to established risk groups.MethodsCases were in- or outpatients from sixteen Dutch hospitals, colonised or infected with MRSA without healthcare- or livestock-associated risk factors for MRSA carriage. Control subjects were patients not carrying MRSA, and hospitalised on the same ward or visited the same outpatients' clinic as the case. The presence of potential risk factors for CA-MRSA carriage was determined using a standardised questionnaire.ResultsRegular consumption of poultry (OR 2⋅40; 95% CI 1⋅08–5⋅33), cattle density per municipality (OR 1⋅30; 95% CI 1⋅00–1⋅70), and sharing of scuba diving equipment (OR 2⋅93 95% CI 1⋅19–7⋅21) were found to be independently associated with CA-MRSA carriage. CA-MRSA carriage was not related to being of foreign origin.ConclusionsThe observed association between the consumption of poultry and CA-MRSA carriage suggests that MRSA in the food chain may be a source for MRSA carriage in humans. Although sharing of scuba diving equipment was found to be associated with CA-MRSA carriage, the role played by skin abrasions in divers, the lack of decontamination of diving materials, or the favourable high salt content of sea water is currently unclear. The risk for MRSA MC398 carriage in areas with a high cattle density may be due to environmental contamination with MRSA MC398 or human-to-human transmission. Further studies are warranted to confirm our findings and to determine the absolute risks of MRSA acquisition associated with the factors identified.