Risk Factors For PE Research Articles

Substance use and sociodemographic background as risk factors for lifetime psychotic experiences in a non-clinical sample

IntroductionPsychotic experiences (PE) are relatively common in the general population. PE is associated with mental health impairment and may be predictive of clinical psychosis. Substance use predicts PE, but the association is insufficiently understood, particularly the role of illicit substances. The purpose of this study was to describe PE (visual and auditory hallucinations and delusions of reference and persecution) in a population characterized by high levels of substance use and to investigate substance use and sociodemographic background characteristics as risk factors for PE. MethodsWe used data from the Norwegian Offender Mental Health and Addiction Study (NorMA), a cross-sectional survey of 1499 individuals from Norwegian prisons. The outcome was one, two, three or four types of PE during the lifetime. The association between different variables and PE was investigated using multinomial logistic regression with three outcome categories: 0 PE, 1–2 PE and 3–4 PE. ResultsThe prevalence of lifetime PE was 53.7%. Several substances were strongly associated with PE: For cannabis, the adjusted relative risk ratio (RRR) of 1–2 PE was 2.78 (95% CI 1.89–4.10) and of 3–4 PE it was 4.36 (2.58–7.36). For amphetamine, the RRR of 1–2 PE was 3.26 (2.11–5.05) and of 3–4 PE it was 5.93 (3.72–9.46). For all variables, the association to PE was stronger with more types of PE. ConclusionsHigh levels of alcohol use, and lifetime use of cannabis, amphetamine and heroin were associated with PE. These effects were robust even when the substance use variables were adjusted against each other.This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Lifestyle Factors and Premature Ejaculation: Are Physical Exercise, Alcohol Consumption, and Body Mass Index Associated With Premature Ejaculation and Comorbid Erectile Problems?

IntroductionPremature ejaculation (PE) is a common sexual problem in men, but its etiology remains uncertain. Lifestyle factors have long been hypothesized to be associated with sexual problems in general and have been proposed as risk factors for PE. AimTo explore associations among physical exercise, alcohol use, body mass index, PE, and erectile dysfunction. MethodsA population-based sample of Finnish men and a sample of Finnish men diagnosed with PE were surveyed for statistical comparisons. Participants using selective serotonin reuptake inhibitors or other medications known to affect symptoms of PE were excluded from analyses. Main Outcome MeasuresSelf-report questionnaires: Multiple Indicators of Premature Ejaculation, International Index of Erectile Function–5, Alcohol Use Disorders Identification Test, and Godin Leisure-Time Exercise Questionnaire. ResultsThe clinical sample reported lower levels of physical exercise (mean = 27.53, SD = 21.01, n = 69) than the population-based sample (mean = 34.68, SD = 22.82, n = 863, t930 = 2.52, P = .012), and the effect size was large (d = 0.85). There was a small negative correlation between levels of physical exercise and symptoms of PE (r = −0.09, P < .01, n = 863) in the population-based sample. The association between physical exercise and PE remained significant after controlling for effects of age, erectile dysfunction, alcohol use, and body mass index. ConclusionIf future studies show that the direction of causality of this association is such that physical activity alleviates PE symptoms, then including physical activity in PE treatment interventions could be a promising addition to treatment regimes.

127 Hypertension at an early stage of prenatal is a major risk factor for adverse neonatal outcomes

Objective To analyze which of the maternal risk factors for PE is more predictive unfavorable perinatal outcomes between women diagnosed with Severe PE. Methods Over a period of twelve months, (2014–2015), 208 cases of severe preeclampsia were included in a observational and retrospective cohort study. This study was conducted at the Maternity School Assis Chateaubriand in Fortaleza, State of Ceara, Brazil. The maternal risk factors were analized by the Student ’T’ test and logistic regression Results Of the 208 patients analyzed obtained in perinatal outcomes 39 (18%) cases of SGA, 17 (8.17%) cases of intrapartum anoxia and 10 (4.8%) cases of fetal death. Early- and late-onset severe preeclampsia differed from each other remarkably. The increased arterial systolic and diastolic pressure early in the prenatal care was the most important predictive factor to unfavorable perinatal outcomes (OR = 1.13, CI- 1.00 to 1.06; p = 0,03) Conclusion women with Hypertension in the beginning of prenatal care was an important risk factor to early preeclampsia and unfavorable perinatal outcomes; therefore, the Primiparity was protector parameter.

Pulmonary Embolism in a Young Adult: A Case Report

SESSION TITLE: Pulmonary Vascular Disease SESSION TYPE: Case Report Poster PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM INTRODUCTION: We report the case of a young male adult with PE secondary to deep venous thrombosis that developed during his work as a long-haul truck driver. He was successfully treated with aggressive anticoagulation and antiplatelet treatment. CASE PRESENTATION: A 27-year-old male long-haul truck driver was admitted to our hospital after a 4-day history of severe chest pain and a 1-day history of sputum contained some blood and swollen left lower extremity. Ambulatory pulmonary computed tomography showed a patchy shadow in the lingula of the left lung, and the edges of both lower lobes showed decreased sharpness. Routine blood test results showed a white blood cell level of 13.17 × 109/L, neutrophil percentage of 72.0%, D-dimer level of 1.11 μg/mL, and fibrinogen level of 5.00 g/L. Color Doppler ultrasound of the veins of both lower extremities demonstrated acute-phase thrombosis in the left common femoral vein, superficial femoral vein, and popliteal vein and lymphedema in the left lower leg. Considering all of these findings, we could not exclude the possibility of acute PE. Computed tomography angiography revealed an intraluminal filling defect low-density transect in the basal segment of the left and right lower pulmonary artery branches and transects low density in the lumen of the left upper lobe pulmonary artery branch, which established the diagnosis. Because his condition was classified as low-risk PE. Anticoagulant therapy was administered. The patient’s chest pain was resolved after 5 days, and the anticoagulant therapy was continued. DISCUSSION: PE treatment and diagnosis are frequently delayed because of the complex and nonspecific clinical manifestations[1]. Only 30% of patients are diagnosed to PE who accepted to normal test[2]. Young patients have little basic disease, making it more difficult to diagnose PE, so prevention of PE should be paid more attention. The main risk factors for PE are external injuries, bone fractures, and thrombosis in the veins of the lower extremities. Research indicates that 70% to 90% of thrombi in patients with acute PE originate in the peritoneal cavity, pelvic cavity, and deep veins [3]. Thus, we could reduce the incidence of PE if we remove the risk factors. For young patients, external injuries and bone fractures have been evaluated, but vocational factors have been largely overlooked, such as long-haul truck drivers, electric welders, office workers, pipeline fabricators, therfore those in similar professions should exercise their lower extremities often and take regular physical examination. CONCLUSIONS: It is very important to identify vocational risk factors associated with the development of PE, especially in young adults. Reference #1: Konstantinides, SV. Acute pulmonary embolism revisited: thromboembolic venous disease. Heart. 2008;94:795-802. Reference #2: Blann, AD, and Lip, GY. Venous thromboembolism. BMJ. 2006;332:215-219. Reference #3: Somarouthu, B, Abbara, S, and Kalva, SP. Diagnosing deep vein thrombosis. Postgrad Med. 2010;122:66-73. DISCLOSURE: The following authors have nothing to disclose: Ying Liu, Lianlian Zhang, Luyao Sun, Qianqian Yu, Zhenxiang Yu No Product/Research Disclosure Information

Emergency Evaluation for Pulmonary Embolism, Part 1: Clinical Factors that Increase Risk

BackgroundPulmonary embolism (PE) can be fatal, but profligate testing for PE can harm patients. ObjectivesWith consideration of potential medicolegal implications, this two-part review provides current evidence about the care of patients with suspected and diagnosed PE in the emergency department (ED) setting. DiscussionIn part 1, we review published evidence to describe the epidemiology, risk factors, and clinical presentation of PE in the ED setting. Older age, surgery requiring endotracheal intubation within the past 30 days, new use of oral contraceptives, and prior unprovoked venous thromboembolism in nonanticoagulated patients are clear risk factors for PE in ED patients. Recent history of unexplained dyspnea, pleuritic chest pain, and hemoptysis increase probability, but the effect of syncope is less clear. Treated and inactive cancer, smoking, obesity, and pregnancy have not been found to increase the probability of PE in symptomatic ED patients. Unexplained dyspnea, tachycardia, and a low pulse oximetry reading increase probability of PE. Finding of wheezing on lung auscultation reduces the probability of PE, and findings that suggest deep venous thrombosis increase the probability of PE. ConclusionsUnderstanding of risk factors, historical data, and physical findings that have been found to increase or decrease the probability of PE in symptomatic ED patients can help create rational guidelines for the diagnostic approach to PE.

Enfermedad tiroidea y gestación (actualizado julio 2013)

We have recently investigated the association between the risk of developing PE and clinical, hemostatic, inflammatory and genetic parameters of 108 severe preeclamptic women. A multivariate logistic regression analysis was performed to assess what variables are independent risk factors for PE. Univariate analysis was performed including the variables in age, smoking condition, multiple pregnancy, blood group, phenotypes and alleles of IL-4, IL-5, IL-10, IL-6, IL-8, IL-12, IL-1β, IFN-γ, TNF-α, and the plasma levels of FVII, FVIIa, FVIIa-AT, FVIII, FVW, ADAMTS13, D-Di, PAI-1, ADMA. Those variables whose P < 0.20 (smoking, multiple pregnancy, blood group, phenotype IL-6, IFN-γ allele, IL-10 allele and FVII) were selected to the multivariate logistic regression. In the final model, only FVII, IFN-γ allele and smoking were independently associated to severe PE (P < 0.0001, P < 0.0001 and P = 0.008, respectively). Increased FVII plasma levels and IFN-γ "T" allele were associated to an increased probability of developing PE (OR 1.001, 95% CI [1.001–1.002], and OR 4.81 95% CI [2.42–9.60], respectively). On the other hand, smoker status was associated with a 4.72 decreased chance of PE occurrence (OR 4.72, 95% CI [1.51–14.75]). In this article we also reviewed the studies that investigate the risk of PE in pregnant women who smoked, as well as the effect of tobacco extract in cells or animal models. The hypotheses proposed to explain the biological mechanism by which smoking during pregnancy reduces the risk of PE was also discussed.

Unprovoked proximal venous thrombosis is associated with an increased risk of asymptomatic pulmonary embolism

IntroductionPulmonary embolism (PE) is common in patients with deep venous thrombosis (DVT). The outcome of DVT with concomitant symptomatic PE is worse than the outcome of isolated DVT. The risk factors for DVT and simultaneous asymptomatic PE have not been systematically studied yet. AimTo evaluate the frequency and risk factors for asymptomatic PE in patients with DVT. Patients/methodsIn 155 consecutive patients with a first episode of DVT and no PE symptoms, a ventilation-perfusion lung scan was performed. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated and concentrations of D-dimer, high-sensitivity CRP (hsCRP), tissue plasminogen activator (t-PA) and troponin were measured. Laboratory tests for thrombophilia were performed. ResultsAsymptomatic PE was present in 36% of patients. No differences in gender, age, BMI and WHR were found between the patients with and without PE. PE was more common in patients with proximal DVT than in those with distal DVT (42% vs. 17%, p<0.01), and in patients with unprovoked DVT compared to patients with provoked DVT (51% vs. 28%, p<0.01). The risk of silent PE was the highest in patients with unprovoked proximal DVT (OR, 6.9; 95% CI, 2.3–21.0). Patients with asymptomatic PE had significantly higher values of D-dimer, hsCRP, t-PA and troponin than patients with isolated DVT. ConclusionsAsymptomatic PE affected more than one third of patients with a first DVT. Unprovoked proximal DVT is the most important risk factor for the occurrence of silent PE.

Pulmonary embolism- monitoring of anticoagulation therapy at Transfusion Center Maribor in 2011

Background: Pulmonary embolism is a common and often fatal disease. Mortality can be reduced with prompt diagnosis and therapy. PE is caused by obstruction of the pulmonary artery or its branches by thrombus. Diagnois is based on clinical exam, CT scan, perfusion scintigraphy, and laboratory tests. There are many risk factors for venous thromboembolism (VTE) and PE. Almost all hospitalized patients have one risk factor for VTE and about 40 % have three or more risk factors. Methods: In our center, patients with previous PE are controlled after hospitalization.INR is measured from venous citrate blood using Siemens BCS instrument. Patients’ data were obtained from hospital program Medis. Results: In the past year, 373 patients were controlled because of PE. Patients taking coumarin in the last year because of other reasons, mechanical valves, atrial fibrillation, or who had PE more than 15 years ago were excluded from the study. After this exclusion, we searched data for 284 patients. Summary/conclusion: Among 284 patients controlled in our center there were 174 (61 %) women and 110 (39 %) men. 269 (95 %) were taking warfarin, only 15 (5 %) were taking acenocoumarol. 71 ( 25 % ) of patients have already had TE (thromboembolism) in the past, 14 (5 %) of them had a PE recurrence.

PP058. The additive effect of plasma levels of sFlt-1/PLGF ratio following the risk classification using both blood pressure levels and uterine artery blood flow impedance in the second trimester on the later occurrence of preeclampsia

The multivariate model including circulating levels of soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratios, maternal factors, blood pressure (BP) levels and uterine artery (UtA) doppler in the first to second trimester has been reported to be clinically useful to predict PE more accurately. However, the effects of levels of sFlt-1/PlGF ratio after the stratification of women using two major risk factors for PE, BP levels and UtA blood flow imdedance (BFI) have not been evaluated. Our aim was to evaluate the additive effect of plasma levels of sFlt-1/PlGF ratio following the risk classification using both mean blood pressure (MBP) levels and the combination of two UtABFI, mean pulsatility index (mPI) and mean notch depth index (mNDI), on the later occurrence of PE. 1161 women were recruited into a prospective cohort study during 2004 and 2008. Clinical BPs were measured twice during 16 and 23 weeks, UtA doppler was performed twice during 16 and 23 weeks, and the mPI and mNDI was measured. Plasma samples were drawn once at 20-23weeks, and were stored at -20°C until use. The levels of sFlt-1/PlGF ratio were measured by automated electrochemiluminescent immunoassay (Roche Diagnostics K.K.). The cutoff value of mean BP (MBP) was determined as 91.3mmHg using ROC curve, and that of sFlt-1/PlGF ratio was 13.0, the 97.5th percentile of log10(sFlt-1/PlGF) at 20-23 weeks in normal pregnant women. If the mPI was <90th percentile of the gestational-age specific reference range of mPI, or the mNDI was <90th percentile of the gestational-age specific reference range of mNDI, we defined that the UtABFI was low; if the mPI was ⩾90th percentile and the mNDI was ⩾90th percentile, we defined that the UtABFI was high. When women were stratified to 4 groups: low BP and low UtABFI, high BP but low UtABFI, high UtABFI but low BP, high BP and high UtABFI, the PPVs were 0.7%, 6.9%, 6.2% and 39.1%, respectively. In women with low BP and low UtABFI, the high sFlt-1/PlGF changed the PPV to 11.1%; the interval from the sampling to the onset of PE in women with high sFlt-1/PlGF ratio was significantly shorter than in those with low sFlt-1/PlGF ratio (mean±SD [weeks]: 5.9±1.5 vs. 16.5±2.1, p<0.01). In women with high BP but low UtABFI, the high sFlt-1/PlGF changed the PPV to 18.2%; the interval from the sampling to the onset of PE in women with high sFlt-1/PlGF ratio was significantly shorter than in those with low sFlt-1/PlGF ratio (8.0±5.7 vs. 12.6±3.7, p<0.05). Although these effects of sFlt-1/PlGF ratio on the occurrence of PE were not confirmed in women with high BP and high UtABFI, PE occurred in all women with three risk factors (5/5), and the interval from the sampling to the onset of PE was6.8±4.1 weeks. Women with both high BP and high UtABFI, especially those with additional risk of high sFlt-1/PlGF ratio, were the highest risk of PE. In the lowest risk group of low BP and low UtABFI, the addition of sFlt-1/PlGF ratio improved the PPV and the interval from the sampling to the onset of PE. These results clearly indicated the clinical importance of measuring sFlt-1/PlGF ratio in addition to BP levels and UtABFI in all pregnant women in the second trimester.

O4. Predisposing factors for early- and late-onset preclampsia

Objectives: Early (34.0 wks) and late (>34.0 wks) onset preeclampsia (EO–LO PE) are supposed to have different etiologies, vascular and inflammatory disfunction respectively. The aim of our study is to evaluate general characteristics of women affected by either EO or LO PE, to identify risk factors for the two forms of disease. Study design: Retrospective cohort study of 197 consecutive singleton women diagnosed as preeclamptic at 22.4– 41.4 wks, from 1/2005 to 9/2009, evaluating demographic, clinical, and ultrasonographic (US) variables on hospital admission, in relation to EO vs LO PE. HELLP syndrome and stillbirth cases, and fetus with congenital anomalies were excluded. Obesity was defined as a BMI 30 kg/m2. First abnormal uterine arteries (UtA) Doppler, evaluated in women with history of APO (previous PE/IUGR/SGA), was defined as mean RI > 0.58 or bilateral Notch within 26.0 wks. IUGR was considered as an US AC 35 yrs and UtA Doppler related to EO PE (Table 2), whereas WG > 12 kg to LO PE (p = 0.04; OR = 4.6, CI (95%) = 2.39–8.87). Conclusions: Age > 35 yrs and UtA Doppler appeared risk factors for EO PE, whereas WG > 12 kg for the late form, supporting the hypothesis of a different pathogenesis.

O5. Low-dose aspirin therapy in pregnant women with chronic hypertension

Objectives: Early (34.0 wks) and late (>34.0 wks) onset preeclampsia (EO–LO PE) are supposed to have different etiologies, vascular and inflammatory disfunction respectively. The aim of our study is to evaluate general characteristics of women affected by either EO or LO PE, to identify risk factors for the two forms of disease. Study design: Retrospective cohort study of 197 consecutive singleton women diagnosed as preeclamptic at 22.4– 41.4 wks, from 1/2005 to 9/2009, evaluating demographic, clinical, and ultrasonographic (US) variables on hospital admission, in relation to EO vs LO PE. HELLP syndrome and stillbirth cases, and fetus with congenital anomalies were excluded. Obesity was defined as a BMI 30 kg/m2. First abnormal uterine arteries (UtA) Doppler, evaluated in women with history of APO (previous PE/IUGR/SGA), was defined as mean RI > 0.58 or bilateral Notch within 26.0 wks. IUGR was considered as an US AC 35 yrs and UtA Doppler related to EO PE (Table 2), whereas WG > 12 kg to LO PE (p = 0.04; OR = 4.6, CI (95%) = 2.39–8.87). Conclusions: Age > 35 yrs and UtA Doppler appeared risk factors for EO PE, whereas WG > 12 kg for the late form, supporting the hypothesis of a different pathogenesis.

Standing Our Ground

The phone rang with yet another protocol request from the CT technologist. “Dr End, the ED has requested a CT pulmonary embolus protocol for Mrs Brown.” “What's the indication?” he asked. “It only says ‘rule out PE,'” the tech responded. I watched my colleague scribble down the patient's medical record number and do some sleuthing in our hospital information system to uncover additional clinical history. What he discovered worried me. Mrs Brown was a 24-year-old woman with no significant risk factors for PE.

Cardiology patient pages. Prothrombin 20210 mutation (factor II mutation).

Testing for the prothrombin 20210 mutation, also called factor II mutation, may have been offered by your doctor because you or someone in your family, has had (1) a blood clot in one of the deep veins of the body (also called deep vein thrombosis or DVT); (2) a blood clot that has traveled to the lung (called a pulmonary embolism or PE); (3) a blood clot in an unusual site (such as the mesenteric or cerebral sinus vein); (4) a heart attack or stroke at a young age; or (5) a history of recurrent pregnancy loss or stillbirth. A history like this in yourself or a family member may be indicative of an underlying thrombophilia. Thrombophilia is a term that describes a state in which the blood has an increased tendency to clot. People can have this increased tendency because they (1) have one or more inherited (genetic) risk factors, (2) have developed a chronic condition that puts them at increased risk, such as obesity, cancer, inflammatory bowel disease, or the persistence of certain antibodies (antiphospholipid antibodies), or (3) have a temporary condition that leads to an increased clotting tendency, such as recent surgery, trauma, a cast, prolonged immobility, pregnancy, or the use of oral contraceptives or hormone replacement therapy. The purpose of this Cardiology Patient Page is to provide more information about the prothrombin mutation, which is the second most common cause of hereditary thrombophilia. Normally, there is a fine balance in the body which ensures that there is not too much bleeding or blood clotting. If this balance is disrupted, a blood clot may occur. Throughout the course of a normal day, the blood vessels sustain many minor injuries of which you are not aware. In response, the body naturally triggers the “clotting cascade”—a sequence of events …

The Kasai portoenterostomy for biliary atresia: a review of a 27-year experience with 81 patients

Purpose The aim of this study was to utilize clinical outcome methodology through multivariable analysis of perioperative factors to predict a successful Kasai-portoenterostomy (PE). Methods Records of 81 patients treated for biliary atresia (BA) were reviewed. Outcome was defined as successful if the patient was alive and had no liver transplant (LT). To predict future successful or failed PE, patients were categorized at 6 months post-PE into 2 groups: Success: direct bilirubin (DB) less than 2.0 mg/dL; Failure: DB greater than 2 mg/dL, or the patient was listed/had undergone LT, or had died. Groups were analyzed for positive or negative predictive values (PPV, NPV) at 2 and 5 years after PE. Cox regression was used to determine risk factors for PE. Results PE was successful in 38% and failed in 62%. PPV of future success was 96% at 2 years post-PE and 95% at 5 years post-PE, NPV of failure was 76% and 74%, respectively. Bridging liver fibrosis at the time of PE and postoperative cholangitic episodes were interdependent risk factors for a failed PE ( P < .05). Other covariates showed no significant relationship for PE outcome. Conclusion Classifying of patients 6 months postoperatively allowed us to determine a successful PE outcome. Bridging liver fibrosis at the time of the Kasai, and the increased number of postoperative cholangitic episodes were predictive of a poor PE outcome.

82-Year-Old Man With Recurrent Syncope

82-Year-Old Man With Recurrent Syncope