Risk Factors For Recurrent Episodes Research Articles

Рівень забезпеченості вітаміном D та особливості продукції IFN-γ і IL-4 у дітей раннього віку з повторним бронхообструктивним синдромом

Актуальність. Бронхообструктивний синдром (БОС), зокрема його повторний перебіг у дітей раннього віку, є актуальною проблемою сучасної педіатрії. Обтяжений алергологічний анамнез, прояви атопії традиційно розглядаються як фактори ризику повторних епізодів БОС, які, однак, присутні не в усіх випадках. Останнім часом обговорюється можлива роль вітаміну D (VD) у формуванні схильності до повторних епізодів БОС з огляду на його протиінфекційну дію, що забезпечується шляхом активації імунних механізмів. Мета: вивчення рівня забезпеченості VD і особливостей продукції інтерферону гамма (INF-g) та інтерлейкіну-4 (IL-4) у сироватці крові в дітей раннього віку з повторними епізодами БОС. Матеріали та методи. Обстежені 120 дітей віком від 6 місяців до 3 років з клінічним діагнозом «гострий обструктивний бронхіт» (J20), які були розподілені на дві групи (I група — 60 дітей з епізодичним БОС, II група — 60 дітей із повторним БОС). Групу контролю становили 30 клінічно здорових дітей віком від 6 місяців до 3 років. Усім хворим проводили оцінку анамнестичних даних, у тому числі рівня інсоляції, ступеня тяжкості БОС за 12-бальною оціночною шкалою, загальне клінічне обстеження, пульс­оксиметрію, розраховували прогностичний індекс бронхіальної астми (API). Лабораторні дослідження включали визначення на 2–3-й день захворювання концентрації 25-гідроксивітаміну D (25(OH)D) у сироватці крові електрохемілюмінесцентним методом на аналізаторі Cobas e411 (серійний номер 1041-24, виробник Roche Diagnostics GmbH, Німеччина), сироваткових концентрацій IFN-g, IL-4 методом імуноферментного аналізу за допомогою наборів «ІФА-Бест» (виробник «Вектор-Бест», Російська Федерація) та загального кальцію (Са) за загальноприйнятою методикою. При аналізі отриманих даних використовували непараметричні статистичні критерії. Різниця між показниками, що порівнювались, вважалась вірогідною при р < 0,05. Результати. Більшість пацієнтів із повторним перебігом захворювання (56,7 %) мали 4 епізоди БОС за останні 12 місяців. Аналіз анамнестичних показників, у тому числі алергологічного анамнезу, не виявив суттєвих відмінностей між групами (p > 0,05). У 78,3 % пацієнтів II групи був негативний API. Тяжкий перебіг БОС удвічі частіше реєструвався серед дітей II групи порівняно з I групою (23,3 і 10,0 % відповідно, c2 = 4,50, р = 0,034). Середній вміст 25(OH)D у сироватці крові у дітей I групи становив 33,0 (28,19; 41,97) нг/мл; II групи — 13,68 (7,96; 19,51) нг/мл (p < 0,001). Рівень забезпеченості VD у 75 % дітей II групи відповідав критеріям дефіциту, тоді як у I групі даний показник становив 6,6 % (c2 = 57,98, p < 0,001). Виявлено обернену залежність між рівнем VD і частотою (r = –0,27, р = 0,002), та тяжкістю перебігу БОС (r = — 0,24, р = 0,008). Рівень загального Са в сироватці крові в обох групах був у межах нормальних величин. Середній рівень IFN-g у дітей І групи становив 22,69 (8,98; 41,44) пг/мл та ІІ групи — 21,08 (8,57; 37,03) пг/мл, обидва показники були вищими, ніж у групі контролю, — 12,18 (5,31; 12,92) пг/мл (p = 0,016 для обох показників). Ми виявили, що досліджувані групи відрізнялись між собою за рівнем саплементації VD, показник якого становив 60 % у I групі та 5 % — у дітей II групи (p < 0,001). Середній вміст IL-4 у сироватці крові в дітей I групи був вірогідно вищим порівняно з відповідними показниками II групи та групи контролю (р = 0,012 за U-критерієм Манна — Уїтні для обох показників). Виявлено обернений кореляційний зв’язок між частотою БОС і вмістом IFN-g у крові в дітей I групи (r = –0,45, р < 0,001) та між ступенем тяжкості БОС і сироватковою концентрацією IL-4 у дітей II групи (r = –0,28, р = 0,030). У пацієнтів із повторним БОС також був виявлений прямий кореляційний зв’язок між вмістом IL-4 та IFN-g (r = 0,41, р < 0,001). Ніяких кореляцій між VD та імунологічними показниками ми не виявили. Висновки. БОС у дітей раннього віку переважно має вірусну етіологію. Тяжкий перебіг захворювання частіше зустрічається в дітей із повторними епізодами БОС, для переважної більшості яких характерний негативний прогностичний індекс бронхіальної астми. У 3/4 пацієнтів із повторним БОС рівень забезпеченості VD знаходиться в межах дефіциту. VD обернено корелює з тяжкістю й частотою епізодів БОС. На рівень забезпеченості вітаміном D у дітей раннього віку найбільше впливає рівень його саплементації. Перебіг БОС у дітей раннього віку супроводжується підвищенням рівня IFN-g у сироватці крові в гострий період захворювання незалежно від частоти епізодів БОС в анамнезі. За вмістом IL-4 у сироватці крові досліджувані групи не відрізняються між собою, при цьому за наявності повторних епізодів даний показник прямо корелює з IFN-g. Отже, IFN-g і IL-4 суттєво не впливають на частоту та ступінь тяжкості БОС у дітей раннього віку на відміну від вітаміну D, що може розглядатися як предиктор тяжкого перебігу БОС і розвитку його повторних епізодів.

Predictors and outcomes of recurrent diabetic ketoacidosis in Israeli adults

AimsTo identify risk factors for recurrent episodes of DKA that may allow the development of an effective prevention strategies. MethodsRetrospective analysis of admissions for DKA in adult patients between 2004, and 2017 in a tertiary hospital. The clinical characteristics and outcomes of DKA of patients were stratified into an isolated episode of DKA (group 1) and recurrent episodes (group 2). Results: 385 patients were included in the study, 281 had a single admission of DKA, and 104 had recurrent admissions. There were no statistically significant differences between the two groups in demographic or clinical variables. Patients in the recurrent DKA group had a younger age at diabetes diagnosis, 32.1 ± 17.08 vs. 36.13 ± 19.52 (p = 0.05). Patients with A1C greater than 9.0% were associated with recurrent DKA in cox regression analysis (HR 2.023; 95% Cl 1.112–3.679; p = 0.021). Recurrent DKA was a significant predictor of one-year mortality in cox regression analysis (HR 0.172; 95% CI 0.04–0.742; p = 0.018). ConclusionHigh A1C levels, which account for poorly controlled diabetes, was identified as the strongest predictor of recurrent DKA. This patient population warrants particular attention and the development of intervention strategies in further studies.

Demographics and risk factors for pediatric recurrent acute pancreatitis.

Approximately 20-30% of children who experience one episode of acute pancreatitis will have at least one additional episode. For some children, pancreatitis recurs multiple times and in a few years is followed by the diagnosis of chronic pancreatitis. Identifying risk factors for recurrent episodes and disease progression is critical to developing therapeutic interventions. Obesity is driving an increase in biliary stone disease and severe acute pancreatitis. Recurrent acute pancreatitis (RAP) may lead to the development of diabetes through autoimmune mechanisms. Cystic fibrosis or CFTR-related disorders may present as RAP and CFTR modulator therapy can increase or decrease the risk of acute pancreatitis in these populations. Children with Crohn disease have a three-fold risk of acute pancreatitis over the general population while children with ulcerative colitis are at increased risk for pediatric autoimmune pancreatitis, a disorder that may be distinct from autoimmune pancreatitis described in adults. Obstructive jaundice in the absence of identified mechanical factors may be a presenting sign of pediatric autoimmune pancreatitis. Pediatric RAP is a painful condition that leads to gland destruction and functional insufficiency. Risk factors are being clarified but preventive treatments remain elusive.

Demography of Priapism: Comparison between Sickle Cell and Non-Sickle Cell Disease Patients

Objectives: priapism is a relatively rare complication of sickle cell disease(SCD). In this study we aim to define the demography and risk factors for recurrent episodes of priapism in SCD and non-SCD patients. Methods: data on 28 males with priapism were retrospectively retrieved. The demographical, clinical, hematological, and biochemical parameters, management and its complications were studied. Comparison between SCD and non-SCD groups were done using statistical methods. Results: priapism patients were mostly adults (82%), presented at a young age (26 years). SCD was the most important cause of priapism (60.7%), painful erection (78.6%) the most common presentation, with median frequency of priapism episodes significantly higher in SCD than non-SCD patients (P= 0.004). SCD patients had significantly lower mean of Hb (P=0.001) and higher mean of WBC (P=0.011), platelets (P=0.017), ALT (P=0.011), bilirubin (P= 0.003) and LDH (P= 0.027) than non-SCD patients. For medical therapy 50% had hydroxyurea and blood transfusion; while for surgical therapy 17.9% had distal penile shunt with a complications rate of 28.6% (7% penile hematoma, 14.3% erectile dysfunction).As an outcome, 32% had detumescence, 14.3% persistent priapism, and 53.6% recurrent priapism. Conclusion: sickle cell disease is the major risk factor for ischemic and stuttering priapism. Patients with SCD presented with priapism were young adults with low Hb, high WBC, platelets, bilirubin, ALT and LDH. These findings can be used to monitor priapism patients at presentation to predict those who are at risk of recurrent episodes to prevent the complications of pain and erectile dysfunction.

İki yaş altı Çocuklarda Sigara Maruziyeti ve Tekrarlayan Bronşiyolit Atakları Arasındaki İlişkinin İncelenmesi

Objective: Recurrent episodes of wheezing are more common in infants especially with low socioeconomic status who are exposed to smoking, who are not breastfed and lives in crowded families. Material and Methods: This study was performed prospectively with infants diagnosed as first attack bronchiolitis from the outpatient clinics between 2009 to 2011. Results: The study included 500 infants aged between 1-24 months. Cigarette smoking was present in 46,6% (n=233) of the families. There was a significant relationship between recurrent episodes of bronchiolitis and exposure to cigarette smoke (p<0,001). Conclusion: In this study, exposure to cigarette smoke was detected as a risk factor for recurrent episodes of bronchiolitis. The decrease of smoking in the population can prevent recurrence of bronchiolitis.

Risk factors associated with severe and recurrent angioedema: an epidemic linked to ACE-inhibitors.

To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population. Institutional review board-approved retrospective review of a large, urban population. Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded. The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6%]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2% of patients experienced recurrent attacks of angioedema; of those patients, 25.9% were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1% of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies. Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations. 2b.

Allerjik uzak akrabalar ve ev ortamı tekrarlayan hışıltı ataklarına sebep olur mu?

Objective: Acute bronchiolitis is a lower respiratory tract infection of children under 2 years of age, characterized by bronchial obstruction. Atopy and genetic factors can play a predisposing role in the development of virus-related wheezing. In this study, we evaluated the relationship between recurrent wheezing attacks and the presence of atopy/asthma in relatives other than father, mother, siblings, and the presence of dust and/or moisture in the house. Methods: This study was performed prospectively with infants diagnosed as first attack bronchiolitis from the outpatient clinics from 2009 to 2011. Each patients’ age, sex, the presence of atopy/asthma in relatives other than father, mother, siblings, and the presence of dust and/or moisture in the house was evaluated. Results: The study included 500 infants aged between 1-24 months. Atopy and/or asthma was present in 20,2% (n=101) of relatives other than father, mother and siblings. Dust and/or moisture was present in 27% (n=135) of houses. When we compared the characteristics of infants, 92.6% of infant living in dust/moisture in the house, 65.2% of infants with no dust/moisture in the house, 91.1% of infants with family history of atopy/asthma in relatives other than mother, father, siblings, 67.9% with no family history had ?3 episodes of wheezing. Conclusion: In this study we found a significant relationship between recurrent episodes of wheezing and the presence of atopy/asthma in relatives other than father, mother, siblings. Presence of dust and/or moisture in the house is also a risk factor for recurrent episodes of wheezing.

Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

BackgroundOnly a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE). Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery.MethodsA total of 326 episodes of IE in 303 patients were treated during 1980–2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients.ResultsThe mean (SD) follow-up time for the 1-year survivors was 11.5 (7.3) years (range 25 days to 25.5 years). The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003) and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010) or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005) as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p < 0.001). Heart failure was also significantly associated with the long-term cardiac mortality (p = 0.032). Of all 303 patients, 20 had more than 1 disease episode. Chronic dialysis (p = 0.002), intravenous drug use (p = 0.002) and diabetes (p = 0.015) were significant risk factors for recurrent episodes of IE, but when analysed separately for the 1-year survivors, only chronic dialysis remained significant (p = 0.017). Recurrences and late valve surgery did not confer a poor prognosis.ConclusionHeart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery during the initial hospitalisation for IE faired significantly better than those who did not.

Risk factors for recurrent acute alcohol-associated pancreatitis: A prospective analysis

Objective. In an earlier retrospective study we showed that 46% of patients with acute alcoholic pancreatitis had recurrent attacks within 10–20 years, about 30% having a recurrence during the first 3 years. The aim of this prospective follow-up study was to determine the risk factors associated with recurrences. Material and methods. Sixty-eight patients, (59 M, 9 F, mean age 46 years, range 25–71 years) who survived their first acute alcohol-induced pancreatitis from January 2001 to January 2004 volunteered to participate in the study. The diagnostic criteria for acute pancreatitis were epigastric pain, serum amylase >3 times the upper normal range, elevated serum C-reactive protein (CRP), and signs of acute pancreatitis in imaging. Other etiologies were excluded. Alcohol consumption and dependency were detected by the Alcohol Use Disorders Identification Test (AUDIT) and the Short Alcohol Dependence Data (SADD), respectively, and by attempting to evaluate recent use in grams of pure alcohol. Social and demographic data of the patients, smoking, body mass index, and the severity of the pancreatitis were recorded. Serum and fecal markers of the endocrine and exocrine function and secretin-stimulated MRCP were studied. The patients were followed for a median 38 (25–61) months for recurrences, and at the 2-year time-point had a follow-up visit to investigate any changes in alcohol consumption. Results. Seventeen (25%) patients had recurrences of acute alcoholic pancreatitis during the follow-up. Pre-illness alcohol consumption, the severity of the pancreatitis, patient's social or demographic data, pancreatic function tests or morphologic changes in MRCP, or smoking did not correlate with recurrence. None of the 13 patients with consistent total abstinence from alcohol at 2 years developed recurrent pancreatitis compared with 17 out of 51 (33%) patients with at least some alcohol consumption (p=0.02). Use of other sedatives than alcohol before the first attack of pancreatitis was an independent risk factor associated with recurrence (HR = 6.95, 95% CI 2.45–19.72, p<0.001). A lower reduction in dependency on alcohol (less decreased SADD points) during 2 years was associated with a higher recurrence rate (HR = 0.921/each reduced point, 95% CI 0.872–0.974, p=0.004). Conclusions. Contrary to chronic pancreatitis, smoking was not found to be a risk factor for recurrent episodes after the first attack of acute alcoholic pancreatitis. Abstinence from alcohol protects against recurrent pancreatitis. Patients who developed recurrent acute pancreatitis had increased dependency on alcohol, demonstrated by the use of other sedatives in addition to alcohol and supported by the less decreased dependency during the follow-up.

Novel insight in the association between salmonellosis or campylobacteriosis and chronic illness, and the role of host genetics in susceptibility to these diseases

We studied the role of host genetics in the susceptibility to severe Salmonella and Campylobacter infections and chronic sequelae of these infections. Participants of a previous case-control study were sent a buccal swab kit and a questionnaire about occurrence of chronic sequelae. Single nucleotide polymorphisms (SNPs) in the TLR4 (rs4986790), IFNG (rs2430561 and rs1861493), STAT1 (rs1914408), IL1B (rs16944), NRAMP (SLC11A1 rs2276631), JUN (rs11688) and VDR (rs10735810) genes were determined. In total, 687 controls, 457 Campylobacter cases and 193 Salmonella cases participated. None of the SNPs were associated with Campylobacter or Salmonella infections. None of the participants developed Guillain-Barré, Miller-Fisher or Reiter's syndrome. Reactive arthritis occurred in 5% and 2% of cases and controls, respectively. Campylobacter cases more frequently experienced gastroenteritis episodes than controls. Campylobacter or Salmonella infection in women, use of proton pump inhibitors and an SNP in the IFNG gene were independent risk factors for reactive arthritis. Another SNP in the IFNG gene and use of proton pump inhibitors were risk factors for recurrent episodes of gastroenteritis. In conclusion, reactive arthritis and recurrent gastroenteritis episodes are common after infection and host genetic factors play a role in susceptibility to these long-term health effects.

Risk Factors for Recurrent Episodes of Work-Related Low Back Disorders in an Industrial Population

An observational longitudinal design. To characterize the rate of and risk factors for recurrent episodes of work-related low back disorder in industrial workers. Little data exist on risk factors for recurrent episodes of work-related low back disorders in employed persons. A total of 352 active hourly union employees who were diagnosed with a recent work-related low back disorder and who had at least one follow-up visit within 12 months enrolled for participation in a rehabilitation intervention study at the workplace. Information on clinical and job factors was obtained at each study visit. Job risk for low back disorder was quantified using the Lumbar Motion Monitor. The main outcome measure, recurrence of work-related low back pain, was derived from a computerized file of administrative records of visits to the plant's medical department. The rate of repeated episodes was 24.4%; an additional episode occurred in 2.3%. Adjusting for age, gender, health status and job exposures, lower levels of physical health, increasing back pain disability, spinal deformity, high stress, and increasing number of different jobs worked at the same plant were risk factors for a recurrent episodes of low back pain. Early identification of risk factors for a work-related low back disorder may signal the need for early and intense rehabilitation to prevent recurrent episodes. Because these findings were based on jobs with medium risk of low back disorders, other factors may be significant in higher risk jobs.

Risk factors for recurrent episodes of care and work disability: case of low back pain.

Recurrences of injuries are common and have significant socioeconomic consequences; it is important to identify associated risk factors as potential opportunities for prevention. This study was conducted to identify risk factors for low back pain (LBP) recurrence and the extent that variation in recurrence definition impacts identified risk factors. Patients with new claims for LBP reported in New Hampshire to a workers' compensation provider were selected (n = 2023) with a minimum of 3-year follow up. Alternative definitions of recurrence included a new episode of medical care and a new episode of lost work time (work disability). Risk factors better predicted disability-based than treatment-based recurrence. Longer durations of the initial episode of care or work disability were the most powerful predictors of recurrence, implying that shorter episodes of care and early return to work contribute to better outcomes.

Nicotine Replacement Therapy in Patients with Coronary Heart Disease

Cigarette smoking is a very important causative factor in cardiovascular disease (CVD). Smoking increases the risk of acute myocardial infarction, unstable angina and sudden death, and it is a risk factor for recurrent episodes of these diseases. It is well documented that patients with CVD who stop smoking, decrease their risk of future events markedly.

Improved glucose counterregulation and autonomic symptoms after intraportal islet transplants alone in patients with long-standing type I diabetes mellitus.

Defective glucose counterregulation and hypoglycemia unawareness are both well-recognized risk factors for recurrent episodes of severe hypoglycemia in patients with type I diabetes. At present, no conventional therapy is available to routinely overcome these acquired impairments in long-standing diabetes. To test the hypothesis that successful intraportal islet transplantation could improve this syndrome, hormonal counterregulatory responses and symptoms were studied during stepped hypoglycemic clamp tests before and after intraportal islet transplantation in three patients with type I diabetes who were prone to severe hypoglycemia. As compared with matched nondiabetic control subjects, before islet transplantation, glucagon responses were absent while epinephrine and cortisol responses were either markedly decreased or absent in all diabetic subjects. One patient also had decreased norepinephrine and growth hormone responses. Autonomic warning symptoms were absent in all patients during hypoglycemia. One month after successful islet transplantation, there was no improvement in the glucagon response. However, glycemic thresholds and/or peak incremental responses of epinephrine, norepinephrine, and cortisol improved in all patients. Moreover, all patients had developed autonomic warning symptoms so that glycemic thresholds were detectable within the examined range. We conclude that intraportal islet transplantation does not restore hypoglycemia-induced glucagon secretion, but it improves the responses of most counterregulatory hormones and hypoglycemic warning symptoms even in long-standing type I diabetes.

Association of Recurrent Candidal Vaginitis with Inheritance of Lewis Blood Group Antigens

A subset of women with candidal vulvovaginitis have no known risk factors for recurrent episodes. Although there are reports of an association of blood group antigens with various infections, no such association has been described with candidal vulvovaginitis. The ABO, P1, and Lewis group phenotypes of 35 women with recurrent vulvovaginitis but without other chronic infections were determined. These were compared with those of a control group of 40 women without a history of candidal vulvovaginitis. The distribution of ABO blood types and P blood group phenotype did not differ from those in controls. However, vulvovaginitis patients were more likely than controls to be classified as Lea-b- (chi 2 = 6.4, 1 df, P = .011). Women without known predisposing factors may have a genetic predisposition to recurrent vulvovaginitis, as evidenced by a higher frequency of Lea-b- phenotype profiles compared with controls.