Significant Predictive Risk Factors Research Articles

Prostate-specific antigen density during dutasteride treatment for 1year predicts the presence of prostate cancer in benign prostatic hyperplasia after the first negative biopsy (PREDICT study).

To prospectively evaluate the detection rate of prostate cancer, and to identify the risk factors of prostate cancer detection after a 1-year administration of dutasteride and first negative prostate biopsy. Patients with benign prostatic hyperplasia who presented high prostate-specific antigen levels after the first negative prostate biopsy were administered 0.5mg dutasteride daily for 1year. They underwent a repeat prostate biopsy after 1year. The primary end-point was the detection rate of prostate cancer. The secondary end-point was the ability of prostate-specific antigen kinetics to predict prostate cancer detection. Prostate-specific antigen was measured before the initial prostate biopsy and at 6, 9 and 12months after starting dutasteride. Patients were classified into a prostate cancer and a non-prostate cancer group. Prostate cancer was detected in 15 of 149 participants (10.1%). The total prostate-specific antigen change between the prostate cancer and non-prostate cancer group at 1year was significantly different (P=0.002). Although prostate-specific antigen levels at baseline did not significantly differ between study groups (P=0.102), prostate-specific antigen levels at 6, 9 and 12months were significantly different (P=0.002, P=0.001 and P<0.001, respectively). The mean reduction rate of prostate-specific antigen density between the prostate cancer and non-prostate cancer group at 1year was significantly different (-4.25±76.5% vs -38.0±28.7%, P=0.001). Using a multivariate analysis, a >10% increase of prostate-specific antigen density at 1year post-dutasteride treatment was the only predictive risk factor for prostate cancer after the first negative prostate biopsy (odds ratio 11.238, 95% confidence interval 3.112-40.577, P<0.001). In the present study cohort, >10% increase in prostate-specific antigen density represented the only significant predictive risk factor for prostate cancer diagnosis in patients with elevated prostate-specific antigen after the first negative prostate biopsy.

Evaluating tertiary adrenal insufficiency in rheumatology patients on long-term systemic glucocorticoid treatment.

Patients with rheumatic diseases are often treated with prolonged, high-dose systemic glucocorticoids which can cause hypothalamic-pituitary-adrenal (HPA) axis suppression and development of tertiary adrenal insufficiency. Adrenal insufficiency carries the risk of serious, potentially life-threatening adrenal crisis. Our study evaluated the prevalence, characteristics and recovery of patients with underlying rheumatology conditions who had received prolonged glucocorticoid treatment. Retrospective, cross-sectional study. We evaluated 238 patients seen in outpatient rheumatology clinic, managed in accordance with current nationally and internationally accepted clinical guidelines. Data collected included patient demographics, historical steroid data, 09.00h cortisol/short synacthen test (SST) results and follow-up data on those with repeat assessments. Overall, 65% of our cohort had a 09.00h cortisol <350nmol/L. On SST, 43% of patients demonstrated evidence of possible tertiary adrenal insufficiency. Prednisolone equivalent dose at time of SST was significantly higher in the group who failed SST vs. those who passed; mean of 5.57mg vs. 3.59mg (p=.005). 09.00h cortisol result correlated with 30-min cortisol on SST (R2 =.20, p=.002). 0-min cortisol on SST correlated more strongly with 30-min cortisol than 09.00h cortisol (R2 =.59, p-value<.001). Patients with 0-min cortisol >350nmol/L, all passed their SST. Patients who remained on prednisolone were more likely to recover (71%) vs. those switched to hydrocortisone (27%), P=.02. Peak steroid dose was predictive of recovery; significantly lower in those who recovered (mean of 22.3mg vs. 33.8mg, P=.03). Steroid duration was not found to be a predictor of recovery [recovery (64.2months) vs. non-recovery (55.6months), P=.58]. There was no correlation found to outcome on SST with age, sex, peak steroid dose, steroid duration, underlying rheumatological condition, additional exogenous steroid use or serum sodium. Forty three percent of our patients demonstrated sub-optimal adrenal function on SST. Steroid dose at the time of SST was the only significant predictive risk factor for tertiary adrenal insufficiency. 09.00h cortisol demonstrated good correlation with outcome on SST and could represent a valid screening test to reduce need for SST if 09.00h >350nmol/L. Further prospective data are required to further characterize risk factors, predictive features of recovery and establish optimal management strategy of steroids (prednisolone vs hydrocortisone) to encourage adrenal recovery.

Development and Validation of a Novel Nomogram for Predicting Tumor-Distant-Metastasis in Patients with Early T1-2 Stage Lung Adenocarcinoma.

BackgroundDistant metastasis in early T1-2 (diameter≤5 cm) stage lung adenocarcinoma (ET-LUAD) patients largely affect treatment strategies in clinical practice. However, the associated mechanism remains unclear and related studies is less. This study aimed to establish and validate a novel nomogram to predict the risk of distant metastasis in ET-LUAD.MethodsA total of 258 patients diagnosed with ET-LUAD and not receiving any treatment were recruited into this study. The patients were randomly divided into a training cohort and validation cohort in a ratio of 1:2. Univariate and multivariate logistic regression analysis was used to select the most significant predictive risk factors associated with distant metastasis in the training cohort. The established nomogram was validated by the consistency index (C-index), calibration curve, and decision curve analysis (DCA).ResultsThere were 124 patients with confirmed distant metastasis and 134 patients with non-distant metastases ET-LUAD were enrolled in the study. Multivariate logistic hazards regression analysis identified independent risk factors associated with distant metastasis to include platelet-to-lymphocyte ratios (PLR), lactate dehydrogenase (LDH), neural-specific enolase (NSE), carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (Cyfra211), which were included in the establishment of the nomogram. The nomogram achieved a high consistency (C-index=0.792), good calibration, and high clinical application value in the validation cohort.ConclusionThe established nomogram can be used to predict distant metastasis in high-risk ET-LUAD nonmetastasis patients and can also be used by doctors to guide preventive and individualized treatment for ET-LUAD patients.

Potential prognostic factors for hamstring muscle injury in elite male soccer players: A prospective study.

Hamstring injuries remain the most common injury type across many professional sports. Despite a variety of intervention strategies, its incidence in soccer players playing in the UEFA Champions League has increased by 4% per year over the last decade. Test batteries trying to identify potential risk factors have produced inconclusive results. The purpose of the current study was to prospectively record hamstring injuries, to investigate the incidence and characteristics of the injuries, and to identify possible risk factors in elite male soccer players, playing in the Kosovo national premier league. A total of 143 soccer players from 11 teams in Kosovo were recruited. To identify possible prevalent musculoskeletal or medical conditions a widespread health and fitness assessment was performed including isokinetic strength testing, Nordic hamstring strength test, functional tests, and a comprehensive anamnesis surveying previous hamstring injuries. On average 27.9% of the players sustained at least one hamstring injury with three players suffering bilateral strains with the re-injury rate being 23%. Injured players were significantly older and heavier and had a higher body mass index compared to non-injured ones (p < 0.05). There was a lower passing rate in the Nordic hamstring strength test and a higher injury incidence among the previously injured players compared to non-injured ones (p < 0.05). Except for hamstring/quadriceps ratio and relative torque at 60°/sec (p < 0.05) for dominant and non-dominant leg, there were no other significant differences in isokinetic strength regardless of the angular velocity. No differences were observed for functional tests between cohorts. Regression analysis revealed that age, Nordic hamstring strength test, previous injury history, and isokinetic concentric torque at 240°/sec could determine hamstring injuries by 25.9%, with no other significant predicting risk factors. The battery of laboratory and field-based tests performed during preseason to determine performance related skills showed limited diagnostic conclusiveness, making it difficult to detect players at risk for future hamstring injuries.

Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study.

ObjectivesThe association between tinnitus and anxiety disorder remains debated. We used a retrospective cohort study to investigate the relationship between anxiety disorder and tinnitus, aiming to decipher possible risk factors for tinnitus in patients with anxiety disorder.MethodData on a total of 7,525 patients with anxiety disorder and 15,050 patients without (comparison cohort) were extracted from the Longitudinal Health Insurance Database 2005 in Taiwan. The Kaplan–Meier estimator with the log rank test and the Cox proportional-hazard regression model were used to compare the incidence of tinnitus in both groups and to identify risk factors that predicted tinnitus.ResultsAfter adjusting for related covariates, the hazard ratio for the development of tinnitus during the follow-up period was 3.54 (95% confidence interval: 3.11–4.02, P < .001) for anxiety disorder cohort relative to comparison cohort. Age ≧ 60 years, female sex, hypertension, and hyperlipidemia were statistically significant predictive risk factors of tinnitus in patients with anxiety disorder.ConclusionA significant increase in the lifetime incidence of tinnitus was exhibited in patients with anxiety disorder. Elderly subjects, female sex, hypertension, and hyperlipidemia were risk factors. Clinicians should be alert to the possibility of tinnitus in subjects with anxiety disorder.

Hemoptysis complicating ultrasound-guided transthoracic needle lung biopsy: air bronchial sign is a risk predictor.

BackgroundHemoptysis is the most frequently reported complication of ultrasound-guided transthoracic needle lung biopsy (US-TTLB). However, factors influencing the occurrence of hemoptysis as a result of US-TTLB remain uncertain. Therefore, the aim of this study was to evaluate the incidence of hemoptysis as a complication of US-TTLB and to identify the related risk factors.MethodsWe retrospectively analyzed all data of patients who underwent US-TTLB from February 2013 through December 2016. The incidence, severity, and treatment of hemoptysis in each case were carefully recorded. Study variables were classified into patient-related factors (age, sex, smoking history, pulse oxygen saturation, laboratory tests and emphysema), biopsy-related factors (use of contrast agent, number of punctures and operators), and lesion-related factors (lesion location, size, pathology, length of puncture path and the grade of air bronchial sign). Univariate and multivariate logistic regression analyses were performed to analyze the risk factors of hemoptysis. We investigated whether incidence of hemoptysis increased according to increased grade of air bronchial sign by Mantel-Haenszel test.ResultsA total of 209 patients were evaluated. Hemoptysis occurred in 20 of the 209 patients (9.6%). In univariate analysis, the lesion pathology (P=0.037) and grade of air bronchial sign (P<0.001) were statistically significant factors between the hemoptysis group and the non-hemoptysis group. In multivariate analysis, the presence of multi-air bronchogram in sonographic image (odds ratio =8.946; 95% confidence interval: 2.873–27.863; P<0.001) was a statistically significant predictive risk factor for hemoptysis complicating US-TTLB. There was a significant tendency for incidence of hemoptysis with the grade of air bronchial sign (P<0.001).ConclusionsWe found that the rate of hemoptysis complicating US-TTLB was 9.6% and the severity of hemoptysis was not serious. Target lesion without air bronchogram is a safety sign, minor bronchogram means relatively low-risk, while multiple bronchogram is a highly dangerous ultrasound sign of hemoptysis.

Pediatric Subperiosteal Abscess Secondary to Acute Sinusitis: A Systematic Review and Meta-analysis.

The surgical versus medical management of subperiosteal abscess can be controversial. The purpose of this study was to summarize current literature and provide pooled analyses to help direct management decisions. Systematic review and meta-analysis. Patients <18 years old with subperiosteal abscess secondary to acute sinusitis were reviewed, and a meta-analysis was conducted. Studies including five or more patients written in English were the primary search focus. Thirty-eight studies met inclusion criteria for the systematic review, and seven studies contained sufficient data for the meta-analysis. A total of 1,167 patients between the ages of 10 days and 18 years were included. Eleven sign/symptom categories were identified, with restricted ocular motility (n = 289, 45.9%), proptosis (n = 277, 44%), and fever (n = 223, 35.4%) being most frequent. Staphylococcus aureus was the most common pathogen isolated from cultures. Patients with abscess volume greater than the threshold specified in each individual study were over three times more likely to require surgical intervention compared to those with smaller abscess volume (pooled risk ratio [RR] = 3.61, 95% confidence interval [CI]: 2.40-5.44). Proptosis and gaze restriction also significantly predicted surgical intervention (pooled RR = 1.65: 95% CI: 1.29-2.12 for proptosis/pooled RR = 1.90; 95% CI: 1.20-3.00 for gaze restriction). Approximately half of patients with a subperiosteal abscess undergo surgical drainage. Abscess volume appears to be the most significant predictive risk factor. Detailed data from future studies regarding radiologic and ophthalmologic parameters are needed to provide more definitive values predictive of which patients are likely to fail medical therapy. 2a Laryngoscope, 2020.

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma.

Intermediate-stage hepatocellular carcinoma (HCC) targeted for transcatheter arterial chemoembolization (TACE) corresponds to a highly heterogeneous population for whom the factors predicting TACE efficacy have not been established. This study aimed to evaluate the impact of hypovascular hepatic nodules coexisting with intermediate-stage HCC as a significant predictive factor for TACE refractoriness. A total of 66 patients with intermediate-stage HCC who received initial TACE were retrospectively analyzed. Hypovascular hepatic nodules were detected by dynamic computed tomography or magnetic resonance imaging, as well as angiography, before all initial TACE. The time to TACE refractoriness (TTTR) was defined as the period from initial TACE until the diagnosis of TACE refractoriness. Hypovascular hepatic nodules were detected in 36 patients (54.5%), 15 (41.7%) of whom had a single nodule, whereas 21 (58.3%) had multiple nodules, and the median size of the maximum nodule was 10mm (range 5-80mm). The median TTTR was 17.4months for all patients, and 7.3 and 33.1months for patients with and without hypovascular hepatic nodules, respectively. The TTTR was significantly shorter for patients with hypovascular hepatic nodules than that for the other patients. In the multivariate analysis, the presence of hypovascular hepatic nodules (HR 7.016, 95% CI 3.534-13.930; P < 0.001) and being out of the up-to-seven criteria (HR 2.861, 95% CI 1.493-5.486; P = 0.002) were independent risk factors for a short TTTR. The presence of hypovascular hepatic nodules with intermediate-stage HCC represents a significant predictive risk factor for TACE refractoriness.

Has the pancreatic fistula already occurred in the operation? An intraoperative predictive factor of clinical relevant-postoperative pancreatic fistula after the distal pancreatectomy

PurposeThe aim of this study was to assess the predictive effect of intraoperative amylase value from pancreatic remnant on the development of clinical relevant-postoperative pancreatic fistula after distal pancreatectomy. MethodsPatients undergoing distal pancreatectomy between June 2017 and October 2018 were studied retrospectively. The intraoperative amylase value was measured followed by drain fluid for amylase on postoperative day 3. The analysis of clinical relevant-postoperative pancreatic fistula predictors was carried out using the logistic regression. The receiver operating characteristic analysis was performed to evaluate the discriminative capacity of intraoperative amylase value as a predictive risk factor. ResultsThe study population consisted of 40 patients. The clinical relevant-postoperative pancreatic fistula occurred in 13 patients, no grade C pancreatic fistula (PF). The intraoperative amylase value correlated significantly with clinical relevant-postoperative pancreatic fistula. An intraoperative amylase value >3089 U/L was proposed as the cut-off level to predict clinical relevant-postoperative pancreatic fistula by the receiver operating characteristic curve. The sensitivity, specificity and accuracy of this level were respectively 84.6%, 88.9% and 88.5%. The multivariate logistic regression analysis revealed that intraoperative amylase value and suture closure for the pancreatic stump were the significant predictive risk factors for the clinical relevant-postoperative pancreatic fistula. ConclusionThe intraoperative amylase value can be early and easily measured as a predictive risk factor, which seems useful for postoperative management of clinical relevant-postoperative pancreatic fistula after distal pancreatectomy. While, the stapler closure might be a feasible way for the pancreatic transection during the operation.

Profile of Birth Injuries in a Tertiary Hospital in Enugu, Nigeria

Background: Birth injury is defined as structural damage of a newborn secondary to mechanical forces that occur during labor and/or delivery. This study determined the incidence, risk factors and outcome of birth injury. Methodology: This was an observational study of birth injuries in neonates, over a period of one year, carried out at a tertiary hospital in Enugu, south east, Nigeria. Results: Out of the 1,735 births recorded during the period of the study, there were 19 cases of birth injuries. This gave an incidence of 11 per 1000 live births. No neonate had more than one injury. They were thirteen males and six females that sustained birth injury. Cephalohematoma was the most common birth injury. Others are caput succedaneum, clavicular fracture, Erb’s palsy, femoral fracture, humeral fracture, shoulder dislocation and facial laceration. Mode of delivery, neonatal birth weight, gestational age and maternal parity were significant predictive risk factors for birth injury. Conclusion: In the current study, cephalohematoma was the most common birth injury, followed by caput succedaneum. There is need to reduce the morbidity and mortality associated with birth injuries.

2015 Paris terrorist attacks: Care guidance for the massive influx of psychologically traumatized civilian casualties. Helping victims to develop their capacity to create a safe and protective environment by leveraging social resources like family, and inner resources like mindfulness should optimize global resilience

IntroductionIn the event of a terrorist attacks emergency psychiatrists are forced to deal with a massive influx of psychologically traumatized civilian casualties. ObjectiveThe main objective of this study was to give guidelines on how to quickly and reliably identify the patients at risk of developing Post-Traumatic Stress Disorder (PTSD). MethodOur cohort comprised 82 subjects present inside the Bataclan (Paris, France) during the terrorist attack on November 13th 2015. The risk analysis considered all clinically relevant risk factors. All data was collected using an Internet based self-assessment questionnaire 5 to 10 months (6 months in average) after the attacks. Results74% of the subjects presented severe symptoms of Acute Stress Disorder (ASD). Seventeen percent were wounded by an automatic firearm. The prevalence of PTSD was 61%. We observed four significant predictive risk factors for PTSD: an elevated ASD (RR=3.1), a low-level of trait-mindfulness (RR=2.4), a low-level of education (RR=1.6) and a lack of family support (RR=1.4). ConclusionTerrorist attacks induce an unprecedented prevalence of PTSD. For optimum emergency psychological care after a terrorist attack, severe ASD symptoms should alert the physician. Helping victims to develop their capacity to create a safe and protective environment by leveraging social resources like family, and inner resources like mindfulness could optimize global resilience.

Modeling prognostic factors for poor neurological outcome in conservatively treated patients with intracerebral hemorrhage: A focus on TNF-α

ObjectivePrognostic models for Intracerebral hemorrhage (ICH), mainly based on clinical evaluation, have remained inherently confounded by subjective scoring assessments and limited accuracy. In this study, we aimed at assessing the risk for poor outcome after ICH based on peripheral biochemical markers (TNF-α, glutamate and glucose) and radiological variables (both at admission and five days after patient’s care), for modeling purposes of prognostication. Patients and MethodsThe defined initial variables of fifty non-comatose conservatively treated ICH patients without severe complications during the hospitalization process (as intraventricular bleeding, or hematoma expansion) were aligned with the evaluated parameters during re-evaluation (3 months later). A comprehensive statistical approach has been applied by using different modeling strategies for prediction of their functional status and outcome. ResultsHigher blood plasma glutamate, TNF-α and initial ICH volume at admission, as well as higher volumes of ICH and perihematomal edema after five days of care were significantly more likely associated with the poor outcome. Nevertheless, in all of the constructed models, TNF-α was estimated as the only significant predictive risk factor, thus outperforming the capacity of the initial ICH volume and the radiological variables after 5 days, both in terms of prognostication of the functional status and the 3-month neurological outcome. The constructed canonical variable that has fairly marked off the different outcomes was also mainly weighed by the admission TNF-α levels. For the first time, we have carefully developed probability functions for the neurological outcome as a response to the admission TNF-α levels; TNF-α levels >110.35 pg/mL were assessed as an optimal cutoff point fairly identifying patients who will fall into the group with poor outcome. ConclusionsTNF-α based models and admission TNF-α screening might be appropriate as a key component that assists more objective prognostication and management of patient’s care in clinical decision making, as rapid initial diagnosis and concentrated management are crucial for secondary prevention of further devastating neurological impairments after ICH.

Clinical Features and Risk Factors of Skeletal-Related Events in Genitourinary Cancer Patients with Bone Metastasis: A Retrospective Analysis of Prostate Cancer, Renal Cell Carcinoma, and Urothelial Carcinoma

Objective: The objective of the present study was to report the incidence of skeletal-related events (SREs) and identify risk factors for SREs in patients with genitourinary cancer with newly diagnosed bone metastasis. Methods: This retrospective study included 180 patients with bone metastasis from prostate cancer (PCa; n = 111), renal cell carcinoma (RCC; n = 43), and urothelial carcinoma (UC; n = 26). Clinical factors at the time of diagnosis of bone metastasis were evaluated with Cox proportional hazards regression analysis to identify independent risk factors for SREs. Results: During follow-up, 29 (26%) patients with PCa, 30 (70%) with RCC, and 15 (58%) with UC developed SREs. Treatment with bone-modifying agents (BMAs) before the development of SREs and within 6 months from the diagnosis of bone metastasis significantly delayed the time to first SRE as compared to nonuse of BMAs. Multivariate analysis identified type of primary cancer (PCa vs. RCC, PCa vs. UC), performance status, and bone pain as significant independent predictive risk factors for SREs. Conclusions: Treatment with BMAs significantly delayed the development of first SREs. The identified predictors of SREs might be useful to select patients who would benefit most from early treatment with BMAs.

Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy

ObjectiveTo evaluate early and long term anamnestic response to a booster dose of HBV vaccine among non-seroprotected children. Subjects and methodA national community based project was carried out on 3600 children aged 9 months to 16 years, fully vaccinated during infancy. They were recruited from 6 governorates representing Egypt. It revealed that 1535 children (42.8%) had non sero-protective anti-HBs (<10 IU/L) and were HBsAg or anti-HBc negative. A challenging dose of 10 μg of mono-valent Euvax HBV vaccine was given to 1121/1535 children. Quantitative assessment of anti-HBs was performed to detect early (2–4 weeks) and long term (one year) anamnestic responses. ResultsEarly anamnestic response developed among 967/1070 children (90.3%).Children having detectable anti-HBs (1–9 IU/L) significantly developed early anamnestic response (90%) compared to 85% with undetectable anti-HBs (<1 IU/L), P < 0.001. Multiple logistic analysis revealed that undetectable anti-HBs, living in rural residence and children aged 15–16 years were the most significant predicting risk factors for the absence of early anamnestic response (<10 IU/L), with AOR 2.7, 2.7 & 4.7 respectively. After one year, long term anamnestic response was absent among 15% of children who previously showed early response. Poor early anamnestic response and undetectable pre-booster anti-HBs were the significant predicting risk factors for absent long term anamnestic response, with AOR 18.7 & 2.7 respectively. ConclusionImmunological memory for HBV vaccine outlasts the presence of anti- HBs and HBV vaccination program provides effective long term protection even in children showing waning or undetectable concentrations of anti-HBs. This signifies no need for a booster dose especially to healthy children.

Low nocturnal diastolic ocular perfusion pressure as a risk factor for NTG progression: a 5-year prospective study.

To assess the relationship between baseline intraocular pressure (IOP), blood pressure (BP) and ocular perfusion pressure (OPP), and the 5-year visual field progression in normal-tension glaucoma (NTG) patients. Prospective, longitudinal study. Sixty-five NTG patients who were followed up for 5 years are included in this study. All the enrolled patients underwent baseline 24-h IOP and BP monitoring via 2-hourly measurements in their habitual position and were followed up for over 5 years with reliable VF tests. Modified Anderson criteria were used to assess VF progression. Univariable and multivariable analyses using Cox's proportional hazards model were used to identify the systemic and clinical risk factors that predict progression. Kaplan-Meier survival analyses were used to compare the time elapsed to confirmed VF progression in the presence or absence of each potential risk factor. At 5-year follow-up, 35.4% of the enrolled patients demonstrated visual field progression. There were statistically significant differences in the mean diastolic blood pressure (p < 0.05) and diastolic OPP (p < 0.05) between the progressing and the non-progressing group. There was no association between IOP parameters and NTG progression. Multivariable analysis identified low nocturnal DOPP at baseline as a significant predictive risk factor for glaucomatous visual field progression at 5 years. An mmHg decrease in nocturnal DOPP increases the hazard of progression by 1.4 times. Patients with DOPP < 35 mmHg have 2.3-fold higher probability of progressing compared to the patients with DOPP > 43.7 mmHg (log rank = 0.018). Diastolic parameters of BP and OPP were significantly lower in the NTG patients who progressed after 5 years. Low nocturnal DOPP is an independent predictor of glaucomatous visual field progression in NTG patients.

Mortality risk factors after percutaneous gastrostomy: Who is a good candidate?

The percutaneous gastrostomy tube (PG) is an effective and safe way for the delivery of enteral nutrition. The aim of this study was to identify predictive factors for mortality after PG placement. An observational and analytical cohort study was conducted. All endoscopic or radiological percutaneous gastrostomy tubes placed between January 2009 and July 2016 were evaluated. Mortality was the dependent variable. Initial clinical and analytical patient features and the development of complications during follow-up were recorded. Cox regression models were used to evaluate the risk of mortality associated to the studied variables. Hazard ratios with the corresponding 95% confidence intervals were retrieved from these models. A total of 289 patients underwent PG placement (57% male). The mean age was 70.1 (SD 13.6) years. The median follow-up period was 8.7 (IQR 18) months. One hundred and seventy-four patients died during the follow-up period. The overall mortality rate was 4.8 per 100 patients-month. The highest mortality rate was during the first month after PG placement (13.2 per 100 patients-month), subsequently decreasing. Multivariate regression analysis showed that age (HR1year=1.01; p=0.015), Charlson comorbidity index ≥4 (HR=1.69; p=0.011), the presence of degenerative neurological disease (HR=1.69; p=0.012) or malignancy (HR=2.02; p=0.012) and the development of aspiration pneumonia during the follow-up period (HR=3.29; p=0.001) were statistically significant independent predictive risk factors associated with mortality. A model to predict survival probability prior to placing the PG was developed from the variables of the multivariate analysis. Mortality after PG placement is high. Older age, higher comorbidity and the development of aspiration pneumonia are predictive factors for mortality. A more careful selection of candidates for PG placement should be done to improve the patient prognosis after the procedure.

Erectile dysfunction: A hidden epidemic

Erectile dysfunction is commonly faced by men with cardiovascular disease. We aimed to determine the prevalence of erectile dysfunction in patients with cardiovascular disease risk factors in Singapore. We conducted a cross-sectional survey on patients with cardiovascular disease risk factors from June 2014 to July 2014 at the outpatient cardiology clinics of our tertiary institution. The survey included patient demographics, comorbidities and an abridged version of the International Index of Erectile Function (IIEF-5). Erectile dysfunction severity was categorized as absent (IIEF-5 score: 22–25), mild (IIEF-5 score: 17–21), moderate (IIEF-5 score: 8–16) and severe (IIEF-5 score: &lt;8). Independent variables were demographic factors (i.e. age, race, occupation, etc.) and comorbidities (i.e. diabetes, hypertension, etc.). Primary dependent variable was the presence of erectile dysfunction and secondary dependent variable was the severity of erectile dysfunction. A total of 468 male respondents (mean age 57±11.2 years) were included. Sixty-nine per cent of respondents reported the presence of erectile dysfunction, with further breakdown into 29% with mild, 30% with moderate and 10% with severe erectile dysfunction. Multivariate analysis revealed that significant predictive risk factors of erectile dysfunction were old age (odds ratio (OR) 1.073, 95% confidence interval (CI) 1.050–1.097, p&lt;0.001), the presence of diabetes (OR 2.127, 95% CI 1.186–3.81, p=0.001) and a lower level of education (OR 2.392, 95% CI 1.387–4.125, p=0.002). These three factors were significant predictors for severity of erectile dysfunction ( p-values of 0.000). Prevalence of erectile dysfunction is high in patients with cardiovascular disease risk factors. Cardiologists should screen for erectile dysfunction particularly in patients with older age, diabetes and lower education levels.

Liver imaging reporting and data system category 4 observations in MRI: Risk factors predicting upgrade to category 5.

To identify demographic and imaging features in magnetic resonance imaging (MRI) that are associated with upgrade of Liver Imaging Reporting and Data System (LI-RADS) category 4 (LR-4) observations to category 5 (LR-5), and to assess their effects on risk of upgrade and time to upgrade. Institutional Review Board approval was obtained for this retrospective, dual-institution Health Insurance Portability and Accountability Act (HIPAA)-compliant study. Radiologists reviewed 1.5T and 3T MRI examinations for 181 LR-4 observations in 139 patients, as well as follow-up computed tomography (CT) and MRI examinations and treatment. A stepwise multivariate Cox proportional hazards model analysis was performed to identify predictive risk factors for upgrade to LR-5, including patient demographics and LI-RADS imaging features. Overall cumulative risk of upgrade was calculated by using the Kaplan-Meier method. The cumulative risks were compared in the presence/absence of significant predictive risk factors using the log-rank test. The independent significant predictive risk factors in the 56 LR-4 observations that upgraded to LR-5 were mild-moderate T2 hyperintensity (P < 0.001; hazard ratio = 1.84), growth (P < 0.001; hazard ratio = 3.71), and hepatitis C infection (P = 0.02; hazard ratio = 1.69). The overall 6-month cumulative risk of upgrade was 32.7%. The 6-month cumulative risk rate was significantly higher in the presence of T2 hyperintensity (P = 0.03; 48.1% vs. 25.4%). For LR-4 observations, mild-moderate T2 hyperintensity, threshold growth, and hepatitis C infection are associated with significantly higher risk of upgrade to LR-5. Although mild-moderate T2 hyperintensity was the most useful risk factor for predicting upgrade, actual risk level was only mildly elevated, and the risk of upgrade associated with LR-4 observations is similar across subtypes. 3 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:783-792.

The Evaluation of Internal Stent-Related Complications and Risk Factors of Stent Migration in Pancreaticoduodenectomy

The placement of an internal stent through a pancreatic anastomosis is one of the surgical techniques to reduce the incidence of pancreatic fistula. However, the fate of the internal stent after placement remains unclear. The aim of this study was to evaluate stent-related complications and risk factors of stent migration through pancreaticojejunostomy in pancreaticoduodenectomy. We retrospectively analyzed 159 patients who underwent pancreaticoduodenectomy or subtotal stomach-preserving pancreaticoduodenectomy. Stent migration and stent defecation were confirmed by computed tomography. Risk factors of delayed detachment and migration of the stent were analyzed. The median stent defecation time was 5.6 months and the stent was not expelled after 1 year in 33 patients (20.7%). Stent migration was detected in 11 patients (6.9%); the destination was always the hepatic duct. Stent-related complications were observed in 2 cases (1.3%). There were no significant risk factors of delayed detachment of the stent. Stent length ≤25 mm was the only significant predictive risk factor of stent migration into the hepatic duct in multivariate analysis. The low rate of stent-related complications and the absence of serious adverse effects observed in this study justifies that the placement of the internal stent during pancreaticoduodenectomy. Cases with delayed defecation require close and long-term follow-up, especially if a short stent was used.

Association of Vitamin D Deficiency with Acute Lower Respiratory Infection in Toddlers

Introduction: Pneumonia remains a significant health problem in India with significant morbidity and mortality. Objectives of this study were to identifying an effective nutritional agent that reduces the need for antibiotics, duration of pneumonia and length of hospitalization would be highly cost-beneficial.Material and Methods: This was a hospital-based case-control study: A total of 100 children including 50 cases and 50 controls, aged 2–60 months, were enrolled. Case definition of severe ALRI as given by the World Health Organization was used for cases. Controls were healthy children attending outpatients’ service for immunization or admitted for minor ailments other than ALRTI.Results: Mean 25(OH)D concentrations in children of the study group were lower than those of the control group (20.431 ng/mL vs. 27.67 ng/mL; p = 0.035). Factors significantly associated with decreased risk of ALRTI in univariate analysis were: exclusive breastfeeding in the first 6 months (cases 13/50 (26%), controls 42/50 (84%); p=0.000); adequate exposure to sunlight (cases 14/50 (28%), controls 42/50 (84%); P=0.000); and serum 25OHD3 &lt;20 ng/ml (cases 28/50 (56%), controls 0/50 (0%); p=.000). Multivariate logistic model indicated that severe vitamin D deficiency (OR=NA), exclusive breast feeding (OR=.174); 95% CI (.061- .521; p=.002) and adequate sunlight exposure (OR=.179) ;95%CI (.062-.519); p=.002) were significant independent predictive risk factors for ALRTI among the children between 2 months – 5 years of age (all p&lt;0.05).Conclusion: Severe vitamin D deficiency (&lt;20ng/ml), nonexclusive breastfeeding in the first six months of life, inadequate sun exposure were significant risk factors for ALRTI in Indian children.J Nepal Paediatr Soc 2016;36(1):14-18