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1.
Plast Reconstr Surg ; 145(2): 251e-262e, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985611

RESUMEN

BACKGROUND: The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. METHODS: Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. RESULTS: One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm. CONCLUSIONS: Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Asunto(s)
Neoplasias de la Mama/cirugía , Isquemia/etiología , Mastectomía/métodos , Pezones/cirugía , Tratamientos Conservadores del Órgano/métodos , Adulto , Anciano , Femenino , Humanos , Incidencia , Isquemia/epidemiología , Modelos Logísticos , Mastectomía/efectos adversos , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/efectos adversos , Complicaciones Posoperatorias/etiología , Análisis de Regresión , Factores de Riesgo
2.
Mymensingh Med J ; 29(1): 43-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915334

RESUMEN

Hypertension is a major public health challenge to population in socio-economic and epidemiological transition. It is a risk factor for cardiovascular mortality which accounts for 20-50 per cent of all deaths. Hypertension has been recognized among young adults more frequently in recent years. Data regarding hypertension in Bangladesh is often insufficient. The purpose of the study was to find out the risk factors of hypertension in young adults of Bangladesh. The study was conducted among 322 purposively selected young adults aged 20 to 49 years attending in the outpatient department of one public and five private hospitals of Mymensingh and Dhaka division of Bangladesh during the period of January 2018 to December 2018. More than half (54.4%) of the patients were at or below the age of 40 years. Mean age of the patients was 38.7±7.8 years and 58.7% were male. Maximum patients (87.6%) were married and with variable educational and occupational status. More than three fourth of the patients (76.7%) were from urban area whereas 14.3% from rural and 9.0% were from sub-urban area. Family history of hypertension was positive in 86.6% of patients. Blood pressure was categorized according to JNC 7. About half (49.4%) of the patients were stage I hypertensive; 22.4% were stage II hypertensive and 28.3% were pre-hypertensive. The major risk factor was tobacco smoking (46.0%), obesity (29.2%), dyslipidaemia (25.2%), high salt intake 21.8% and use of chewable tobacco (13.7%). Serum creatinine was found raised in 11.5%, cardiomegaly in 2.2% and concentric left ventricular hypertrophy in 18.6% of patients. In 38.5% patients hypertension was complicated affecting heart (27.0%) and kidney (11.5%). Common comorbidities were ischaemic heart diseases (20.5%) and diabetes mellitus (13.4%). Tobacco use, obesity, dyslipidaemia and high salt intake are the major modifiable risk factors found in hypertensive young adults. In addition to medication these factors should be addressed for prevention and effective control of hypertension.


Asunto(s)
Presión Sanguínea/fisiología , Diabetes Mellitus/epidemiología , Cardiopatías/epidemiología , Hipertensión/epidemiología , Adulto , Bangladesh/epidemiología , Comorbilidad , Femenino , Humanos , Hipertensión/diagnóstico , Isquemia/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural/estadística & datos numéricos , Clase Social , Población Urbana/estadística & datos numéricos , Adulto Joven
3.
BMC Surg ; 19(1): 170, 2019 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-31722699

RESUMEN

BACKGROUND: We aimed to explore the surgical outcomes of major lower extremity amputation (MLEA) and influencing factors at an academic tertiary referral centre in north Jordan, optimistically providing a platform for future health care policies and initiatives to improve the outcomes of MLEA in Jordan. METHODS: Clinical records of patients who had undergone MLEA between January 2012 and December 2017 were identified and retrospectively reviewed. International Classification of Diseases codes were used to identify the study cohort from a prospectively maintained computerised database. We included adult patients of both genders who underwent amputations for ischemic lower limb (acute and chronic) and diabetic foot syndrome (DFS). We excluded patients for whom MLEA surgery was performed for other indications (trauma and tumors). Outcomes of interest included patient demographics and comorbidities, type of amputation and indications, length of hospital stay (LOS), the need for revision surgery (ipsilateral conversion to a higher level of amputation), and cumulative mortality rate at 1 year. The impact of the operating surgeon's specialty (vascular vs. non-vascular surgeon) on outcomes was evaluated. RESULTS: The study cohort comprised 140 patients who underwent MLEA (110 below-knee amputations [BKA] and 30 above-knee amputations [AKA]; ratio: 3:1; 86 men; 54 women; mean age, 62.9 ± 1.1 years). Comorbidities included diabetes, hypertension, dyslipidaemia, ischaemic heart disease, congestive heart failure, chronic kidney disease, stroke, and Buerger disease. The only associated comorbidity was chronic kidney disease, which was more prevalent among BKA patients (p = 0.047). Indications for MLEA included DFS, and lower limb ischaemia. Acute limb ischaemia was more likely to be an indication for AKA (p = 0.006). LOS was considerably longer for AKA (p = 0.035). The cumulative mortality rate at 1 year was 30.7%. Revision surgery rates and LOS improved significantly with increased rate of vascular surgeon-led MLEA. CONCLUSIONS: In developing countries, the adverse impact of MLEA is increased because of limited resources and increased prevalence of diabetes-related foot complications. Vascular surgeon-led MLEA is associated with decreased revision rates, LOS and possibly improved outcomes, particularly when it is performed for vascular insufficiency. It is important to formulate national health care policies to improve patient outcomes in these countries.


Asunto(s)
Amputación/estadística & datos numéricos , Isquemia/cirugía , Extremidad Inferior/cirugía , Centros de Atención Terciaria , Anciano , Femenino , Estudios de Seguimiento , Humanos , Isquemia/epidemiología , Jordania/epidemiología , Tiempo de Internación , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
4.
J Vasc Surg ; 70(3): 996-1006.e7, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31445653

RESUMEN

OBJECTIVE: Readmission to the hospital after revascularization for peripheral artery disease (PAD) is frequently reported. No consensus exists as to the exact frequency and risk factors for readmission. This review aimed to determine the incidence of and risk factors for 30-day readmission after revascularization for PAD. METHODS: PubMed/Medline (Ovid), Scopus, Web of Science, the Cochrane Library, and CINAHL were searched systematically from inception until May 20, 2018. Studies were eligible for inclusion if they included patients with diagnosed PAD undergoing revascularization and reported the readmission rate and a statistical evaluation of the association of at least one risk factor with readmission. Studies were excluded if data for other procedures could not be distinguished from revascularization. Two authors undertook study selection independently with the final inclusion decision resolved through consensus. The PRISMA and Meta-analyses of Observational Studies in Epidemiology guidelines were followed regarding data extraction and quality assessment, which was performed by two authors independently. Data were pooled using a random effects model. RESULTS: The primary outcome was readmission within 30 days of revascularization. Fourteen publications reporting the outcomes of 526,008 patients were included. Reported readmission rates ranged from 10.9% to 30.0% with a mean of 16.4% (95% confidence interval [CI], 15.1%-17.9%). Meta-analyses suggested the following risk factors had a significant association with readmission: female sex (odds ratio [OR], 1.13; 95% CI, 1.05-1.21), black race (OR, 1.36; 95% CI, 1.28-1.46), dependent functional status (OR, 1.72; 95% CI, 1.43-2.06), critical limb ischemia (OR, 2.12; 95% CI, 1.72-2.62), emergency admission (OR, 1.75; 95% CI, 1.43-2.15), hypertension (OR, 1.39; 95% CI, 1.26-1.54), heart failure (OR, 1.82; 95% CI, 1.50-2.20), chronic pulmonary disease (OR, 1.19; 95% CI, 1.08-1.32), diabetes (OR, 1.47; 95% CI, 1.32-1.63), chronic kidney disease (OR, 1.93; 95% CI, 1.62-2.31), dialysis dependence (OR, 2.08; 95% CI, 1.75-2.48), smoking (OR, 0.83; 95% CI, 0.78-0.89), postoperative bleeding (OR, 1.70; 95% CI, 1.23-2.35), and postoperative sepsis (OR, 4.13; 95% CI, 2.02-8.47). CONCLUSIONS: Approximately one in six patients undergoing revascularization for PAD are readmitted within 30 days of their procedure. This review identified multiple risk factors predisposing to readmission, which could potentially serve as a way to target interventions to reduce readmissions.


Asunto(s)
Procedimientos Endovasculares/efectos adversos , Claudicación Intermitente/cirugía , Isquemia/cirugía , Readmisión del Paciente , Enfermedad Arterial Periférica/cirugía , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Anciano , Anciano de 80 o más Años , Comorbilidad , Enfermedad Crítica , Femenino , Estado de Salud , Humanos , Incidencia , Claudicación Intermitente/diagnóstico , Claudicación Intermitente/epidemiología , Isquemia/diagnóstico , Isquemia/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento
5.
Crit Care ; 23(1): 266, 2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31362770

RESUMEN

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an increasingly adopted life-saving mechanical circulatory support for a number of potentially reversible or treatable cardiac diseases. It is also started as a bridge-to-transplantation/ventricular assist device in the case of unrecoverable cardiac or cardio-respiratory illness. In recent years, principally for non-post-cardiotomy shock, peripheral cannulation using the femoral vessels has been the approach of choice because it does not need the chest opening, can be quickly established, can be applied percutaneously, and is less likely to cause bleeding and infections than central cannulation. Peripheral ECMO, however, is characterized by a higher rate of vascular complications. The mechanisms of such adverse events are often multifactorial, including suboptimal arterial perfusion and hemodynamic instability due to the underlying disease, peripheral vascular disease, and placement of cannulas that nearly occlude the vessel. The effect of femoral artery damage and/or significant reduced limb perfusion can be devastating because limb ischemia can lead to compartment syndrome, requiring fasciotomy and, occasionally, even limb amputation, thereby negatively impacting hospital stay, long-term functional outcomes, and survival. Data on this topic are highly fragmentary, and there are no clear-cut recommendations. Accordingly, the strategies adopted to cope with this complication vary a great deal, ranging from preventive placement of antegrade distal perfusion cannulas to rescue interventions and vascular surgery after the complication has manifested.This review aims to provide a comprehensive overview of limb ischemia during femoral cannulation for VA-ECMO in adults, focusing on incidence, tools for early diagnosis, risk factors, and preventive and treating strategies.


Asunto(s)
Oxigenación por Membrana Extracorpórea/efectos adversos , Extremidades/irrigación sanguínea , Isquemia/prevención & control , Isquemia/terapia , Cateterismo Periférico/instrumentación , Oxigenación por Membrana Extracorpórea/métodos , Extremidades/fisiopatología , Humanos , Incidencia , Isquemia/epidemiología , Factores de Riesgo
6.
Biomed Res Int ; 2019: 8919230, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31317041

RESUMEN

Several previous studies demonstrated the risk of stroke in asthma patients. The aim of this study was to evaluate the risk of hemorrhagic and ischemic stroke in asthma patients, independent of age, sex, income, region of residence, and past medical histories. The Korean Health Insurance Review and Assessment Service-National Sample Cohort from 2002 through 2013 was used. Overall, 111,364 asthma patients ≥ 20 years old were matched to 111,364 control participants for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia. Asthma was classified using ICD-10 codes (J45 and J46) and medication history. The admission histories were investigated for hemorrhagic stroke (I60-I62) and ischemic stroke (I63) using ICD-10 codes. The crude and adjusted (age, sex, income, region of residence, hypertension, diabetes, dyslipidemia, ischemic heart disease, and depression) hazard ratios (HRs) for hemorrhagic and ischemic stroke in asthma patients were analyzed using a Cox proportional hazards model. Subgroup analyses were conducted according to age and sex. Hemorrhagic and ischemic stroke were found in 0.7% (795/117,364) and 2.4% (922/117,364) of the asthma group and in 0.8% (922/117,364) and 2.6% (93,079/117,364) of the control group, respectively. The asthma group demonstrated adjusted HRs of 0.86 (95% confidence interval [CI] = 0.78-0.94, p = 0.002) for hemorrhagic stroke and 0.91 (95% CI = 0.86-0.95, p = 0.002) for ischemic stroke. None of the subgroups of asthma patients showed higher HRs for stroke. Asthma did not elevate the risk of either hemorrhagic or ischemic stroke.


Asunto(s)
Asma/epidemiología , Hemorragia/epidemiología , Isquemia/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Asma/complicaciones , Asma/fisiopatología , Femenino , Estudios de Seguimiento , Hemorragia/etiología , Hemorragia/fisiopatología , Humanos , Isquemia/etiología , Isquemia/fisiopatología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , República de Corea , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Adulto Joven
7.
Vasc Health Risk Manag ; 15: 187-208, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31308682

RESUMEN

Peripheral arterial disease is a chronic vascular disease characterized by impaired circulation to the lower extremities. Its most severe stage, known as critical limb ischemia (CLI), puts patients at an increased risk of cardiovascular events, amputation, and death. The objective of this literature review is to describe the burden of disease across a comprehensive set of domains-epidemiologic, clinical, humanistic, and economic-focusing on key studies published in the last decade. CLI prevalence in the United States is estimated to be approximately 2 million and is likely to rise in the coming years given trends in important risk factors such as age, diabetes, and smoking. Hospitalization for CLI patients is common and up to 60% are readmitted within 6 months. Amputation rates are unacceptably high with a disproportionate risk for certain demographic and socioeconomic groups. In addition to limb loss, CLI patients also have reduced life expectancy with mortality typically exceeding 50% by 5 years. Given the poor clinical prognosis, it is unsurprising that the quality of life burden associated with CLI is significant. Studies assessing quality of life in CLI patients have used a variety of generic and disease-specific measures and all document a substantial impact of the disease on the patient's physical, social, and emotional health status compared to population norms. Finally, the poor clinical outcomes and increased medical resource use lead to a considerable economic burden for national health care systems. However, published cost studies are not comprehensive and, therefore, likely underestimate the true economic impact of CLI. Our summary documents a sobering assessment of CLI burden-a poor clinical prognosis translating into diminished quality of life and high costs for millions of patients. Continued prevention efforts and improved treatment strategies are the key to ameliorating the substantial morbidity and mortality associated with this disease.


Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud , Isquemia/economía , Isquemia/terapia , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/economía , Enfermedad Arterial Periférica/terapia , Amputación/economía , Enfermedad Crítica , Humanos , Incidencia , Isquemia/diagnóstico , Isquemia/epidemiología , Recuperación del Miembro , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Prevalencia , Calidad de Vida , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiología
8.
Haemophilia ; 25(4): e223-e230, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31045306

RESUMEN

INTRODUCTION: With the increasing life expectancy of patients with haemophilia (PWH), the number of PWH with age-related comorbidities, such as ischaemic events, is increasing. AIM: We conducted this multicentre observational study to identify the risk factors for major ischaemic events in PWH. METHODS: This study was the first multicentre observational study, conducted with the participation of five haemophilia treatment centres in Japan, conducted in ≥30-year-old adult PWH. The latest data recorded in the medical charts between 1 January and 31 December 2016 were reviewed. Healthcare data collected from the National Health and Nutrition Survey were used as the control data. RESULTS: Data of a total of 711 patients were collected. Only two PWH (0.3%) had a history of ischaemic events. Age-adjusted analysis indicated that the prevalence of hypertension defined as a blood pressure of 140/90 mm Hg or over was similar in the PWH to that in the males of the general population. However, when hypertension was defined more strictly (≥130/85 mm Hg), the prevalence was significantly lower in PWH than in the general male population. The hypertension in PWH was associated with the age, BMI, CKD, HIV infection and inhibitors. In particular, the odds ratio for the presence of inhibitors was high (odds ratio = 7.529). CONCLUSION: Whether the present results can be attributed to Japanese ethnicity or to the presence of haemophilia per se remains uncertain. We propose to initiate a prospective study for further investigation.


Asunto(s)
Comorbilidad , Hemofilia A/epidemiología , Hipertensión/epidemiología , Isquemia/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
9.
Thromb Haemost ; 119(7): 1182-1193, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31079414

RESUMEN

BACKGROUND: The ischemic/bleeding risk of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is still uncertain. We sought to develop a tool to predict ischemic and bleeding events in East Asians receiving 2nd generation drug-eluting stents (DESs) PCI. METHODS: A pooled cohort of 13,172 East Asian patients receiving PCI with 2nd generation DES (the Grand DES cohort) was analyzed to develop a scoring system. A net score was calculated by subtracting the bleeding score from the ischemic score. External validation was performed in the HOST-ASSURE and NIPPON trials. RESULTS: Among the total population, ischemic and bleeding events occurred in 195 patients (1.5%) and 166 patients (1.3%), respectively. The score to predict ischemic events included previous myocardial infarction (MI) or PCI, presentation as acute MI, anemia, stent diameter < 3 mm, and total stent length of ≥30 mm, while that for bleeding events included older age, low creatinine clearance, and anemia. C-statistics of the ischemic and bleeding model was 0.708 and 0.665, respectively. Patients with a net score of ≥1 had a higher ischemic risk compared with bleeding risk, and patients with a net score of ≤-1 had a higher bleeding risk compared with ischemic risk. The validation cohort showed a C-statistic of 0.647 for ischemic events and 0.633 for bleeding events. CONCLUSION: We developed a tool to predict ischemic and bleeding events in East Asian patients received PCI with 2nd generation DES. This system can be used to assess clinical event risks, and to determine the adequate duration of DAPT in East Asians.


Asunto(s)
Hemorragia/epidemiología , Isquemia/epidemiología , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complicaciones Posoperatorias/epidemiología , Anciano , Quimioterapia Combinada , Stents Liberadores de Fármacos , Lejano Oriente/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos de Investigación , Medición de Riesgo
10.
Epidemiol Serv Saude ; 28(1): e2017405, 2019 03 21.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30916238

RESUMEN

OBJECTIVE: to analyze frailty prevalence and associated factors in the elderly in the city of Pelotas, RS, Brazil, in 2014. METHODS: this was a cross-sectional, population-based study of a sample of individuals aged 60 years old or older; a modified version of the Edmonton Frail Scale was used to assess frailty; prevalence ratios (PR) and their 95% confidence intervals (95%CI) were estimated using Poisson regression. RESULTS: frailty prevalence was 13.8% and was higher among individuals aged 75 years or older (PR 4.33 - 95%CI 2.94;6.39), those of the female gender (PR 1.46 - 95%CI 1.06;2.03) and those living without a partner (PR 1.54 - 95%CI 1.16;2.04); epilepsy (PR 3.58 - 95%CI 2.19;5.85), ischemia (PR 2.56 - 95%CI 2.00;3.28), and heart failure (PR 2.48 - 95%CI 1.92;3.19) were the morbidities most highly associated with frailty. CONCLUSION: frailty was associated with older individuals, the female gender, those living without a partner and those affected by multiple morbidities.


Asunto(s)
Composición Familiar , Anciano Frágil/estadística & datos numéricos , Fragilidad/epidemiología , Factores de Edad , Anciano , Brasil/epidemiología , Estudios Transversales , Epilepsia/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Isquemia/epidemiología , Masculino , Persona de Mediana Edad , Distribución de Poisson , Prevalencia , Factores de Riesgo , Factores Sexuales
11.
Fertil Steril ; 111(4): 714-721, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30826115

RESUMEN

OBJECTIVES: To evaluate the association of fresh and frozen embryo transfer with the development of ischemic placental disease (IPD), hypothesizing that differences in implantation environment affect placentation and thus pregnancy outcomes. DESIGN: We performed a secondary analysis of a retrospective cohort study of deliveries linked to IVF cycles. SETTING: Tertiary hospital and infertility treatment center. PATIENT(S): We included all women who underwent an autologous IVF cycle and had a live-born infant or an intrauterine fetal demise (IUFD). We excluded women less than 18 years of age. INTERVENTION(S): We compared pregnancies resulting from frozen embryo transfer (frozen) cycles with those resulting from fresh embryo transfer (fresh) cycles. MAIN OUTCOME MEASURE(S): The primary outcome was a composite outcome of IPD or IUFD due to placental insufficiency. Ischemic placental disease included pre-eclampsia, placental abruption, and small for gestational age (SGA). We calculated risk ratios (RRs) and 95% confidence intervals (CIs). RESULT(S): Compared with fresh cycles, frozen cycles had a lower risk of IPD or IUFD from placental insufficiency (RR 0.75, 95% CI 0.59-0.97). Frozen cycles also conferred a lower risk of SGA than fresh cycles (RR 0.58, 95% CI 0.41-0.81). Risks of pre-eclampsia (RR 1.3, 95% CI 0.84-1.9) and abruption (RR 1.2, 95% CI 0.56-2.4) were similar. CONCLUSION(S): There was a lower risk of IPD among frozen cycles compared with fresh cycles. This association was largely driven by lower risk of SGA among frozen cycles.


Asunto(s)
Transferencia de Embrión/métodos , Isquemia/etiología , Enfermedades Placentarias/epidemiología , Placenta/irrigación sanguínea , Adulto , Blastocisto , Criopreservación , Transferencia de Embrión/efectos adversos , Femenino , Muerte Fetal/etiología , Congelación , Humanos , Recién Nacido , Infertilidad/epidemiología , Infertilidad/terapia , Isquemia/epidemiología , Nacimiento Vivo/epidemiología , Masculino , Placenta/patología , Enfermedades Placentarias/etiología , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Factores de Riesgo
12.
Int J Stroke ; 14(2): 159-166, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29553306

RESUMEN

BACKGROUND: Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. AIMS: To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. METHODS: Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010-2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. RESULTS: Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53-4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708-$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81-0.89) for those with atrial fibrillation compared to those without. CONCLUSIONS: The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.


Asunto(s)
Fibrilación Atrial/economía , Costos y Análisis de Costo , Isquemia/economía , Tiempo de Internación/estadística & datos numéricos , Resumen del Alta del Paciente/estadística & datos numéricos , Accidente Cerebrovascular/economía , Adulto , Fibrilación Atrial/epidemiología , Bases de Datos Factuales , Humanos , Pacientes Internos , Isquemia/epidemiología , Modelos Económicos , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Estados Unidos/epidemiología
13.
Rev Esp Cardiol (Engl Ed) ; 72(3): 215-223, 2019 Mar.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30029980

RESUMEN

INTRODUCTION AND OBJECTIVES: The PARIS score allows combined stratification of ischemic and hemorrhagic risk in patients with ischemic heart disease treated with coronary stenting and dual antiplatelet therapy (DAPT). Its usefulness in patients with acute coronary syndrome (ACS) treated with ticagrelor or prasugrel is unknown. We investigated this issue in an international registry. METHODS: Retrospective multicenter study with voluntary participation of 11 centers in 6 European countries. We studied 4310 patients with ACS discharged with DAPT with ticagrelor or prasugrel. Ischemic events were defined as stent thrombosis or spontaneous myocardial infarction, and hemorrhagic events as BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding. Discrimination and calibration were calculated for both PARIS scores (PARISischemic and PARIShemorrhagic). The ischemic-hemorrhagic net benefit was obtained by the difference between the predicted probabilities of ischemic and bleeding events. RESULTS: During a period of 17.2 ± 8.3 months, there were 80 ischemic events (1.9% per year) and 66 bleeding events (1.6% per year). PARISischemic and PARIShemorrhagic scores were associated with a risk of ischemic events (sHR, 1.27; 95%CI, 1.16-1.39) and bleeding events (sHR, 1.14; 95%CI, 1.01-1.30), respectively. The discrimination for ischemic events was modest (C index = 0.64) and was suboptimal for hemorrhagic events (C index = 0.56), whereas calibration was acceptable for both. The ischemic-hemorrhagic net benefit was negative (more hemorrhagic events) in patients at high hemorrhagic risk, and was positive (more ischemic events) in patients at high ischemic risk. CONCLUSIONS: In patients with ACS treated with DAPT with ticagrelor or prasugrel, the PARIS model helps to properly evaluate the ischemic-hemorrhagic risk.


Asunto(s)
Síndrome Coronario Agudo/terapia , Hemorragia/epidemiología , Isquemia/epidemiología , Clorhidrato de Prasugrel/administración & dosificación , Sistema de Registros , Medición de Riesgo/métodos , Ticagrelor/administración & dosificación , Anciano , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Hemorragia/etiología , Humanos , Incidencia , Isquemia/etiología , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Clorhidrato de Prasugrel/efectos adversos , Estudios Retrospectivos , Ticagrelor/efectos adversos , Resultado del Tratamiento
14.
Angiology ; 70(6): 506-514, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30477334

RESUMEN

Surveillance of cardiovascular Events in Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN (SEASON) is a 2-year, prospective, real-world, registry study conducted in Japan from 2009 to 2013. This post hoc analysis evaluated risk factors for limb ischemia in patients with peripheral arterial disease (PAD) and ankle-brachial index (ABI) <0.90. Vascular events were adjudicated by an Efficacy Endpoint Review Committee. Cox regression identified predictors of limb-specific peripheral vascular events (amputation, development of critical limb ischemia, and acute limb ischemia). Patients (n = 6565) were stratified according to ABI: normal (≥1.0; n = 1300), borderline (0.90 ≤ ABI ≤ 1.0; n = 776), and abnormal (<0.90; n = 4489). Compared to normal ABI, patients with ABI <0.90 had a significantly higher risk of any vascular event, all-cause death, and any limb-specific peripheral vascular event. Risk factors for limb-specific vascular events included history of lower extremity revascularization/amputation (adjusted hazard ratio: 2.18; 95% confidence interval [CI]: 1.49-3.20), chronic kidney disease (2.00; 1.33-3.00), diabetes (1.71; 1.16-2.52), and ABI <0.4 (4.45; 2.62-7.55) or <0.7 (1.78; 1.15-2.76). These findings from a Japanese real-world population confirm the increased vascular risk of patients with PAD and ABI <0.90 and identified risk factors for limb-specific peripheral vascular events.


Asunto(s)
Isquemia/epidemiología , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/epidemiología , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Amputación , Índice Tobillo Braquial , Enfermedad Crítica , Progresión de la Enfermedad , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/mortalidad , Isquemia/terapia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/terapia , Inhibidores de Agregación Plaquetaria/uso terapéutico , Pronóstico , Estudios Prospectivos , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
16.
Can J Gastroenterol Hepatol ; 2018: 6598960, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30425975

RESUMEN

Gastrointestinal and peritoneal ischemic disease due to unknown etiology present with intestinal obstruction and/or peritonitis otherwise in healthy patient emerged as fatal disease at Arba Minch General Hospital. This disorder was diagnosed based on intraoperative finding. Clinical presentation and natural history of disease progression were similar. It is estimated that about 6-10 lives are being claimed each year at Arba Minch Hospital with this disease of unidentified cause accounting for the largest figure of surgical department. Here we report case analysis and literature review illustrating clinical presentation, workup, preoperative diagnosis, intraoperative diagnosis, and final outcome of fatal gastrointestinal and peritoneal ischemic disease.


Asunto(s)
Obstrucción Intestinal/etiología , Intestinos/irrigación sanguínea , Isquemia/etiología , Peritoneo/irrigación sanguínea , Peritonitis/etiología , Estómago/irrigación sanguínea , Adolescente , Adulto , Niño , Etiopía/epidemiología , Resultado Fatal , Femenino , Humanos , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/cirugía , Intestinos/cirugía , Isquemia/epidemiología , Isquemia/cirugía , Masculino , Persona de Mediana Edad , Peritoneo/cirugía , Peritonitis/epidemiología , Peritonitis/cirugía , Estómago/cirugía , Adulto Joven
17.
J Am Heart Assoc ; 7(16): e008644, 2018 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-30369315

RESUMEN

Background We conducted an analysis of data from the ARIC (Atherosclerosis Risk in Communities) study to assess the independent association of obesity with peripheral artery disease ( PAD ) and critical limb ischemia ( CLI ). Methods and Results All black and white ARIC participants without prevalent PAD at baseline (1987-1989) were included. We used Cox proportional hazards models adjusting for potential confounders and then potential mediators to quantify the association between body mass index ( BMI ) and incident hospitalizations related to PAD without CLI and with CLI through 2013. Our analysis included 13 988 men and women followed for a median of 24 years. Incident PAD without CLI and PAD with CLI occurred in 373 and 201 participants, respectively. After adjusting for potential confounders, higher BMI at baseline was associated with increased risk of PAD without CLI when BMI was modeled continuously (hazard ratio per 1- SD increment in BMI: 1.23; 95% confidence interval, 1.11-1.37) and with PAD with CLI regardless of whether BMI was modeled categorically ( P<0.05) or continuously (hazard ratio per 1- SD increment in BMI: 1.51; 95% confidence interval, 1.34-1.69). The associations of BMI with PAD without CLI and with CLI were attenuated after further accounting for potential mediators but remained significant for PAD with CLI when BMI was linearly modeled (hazard ratio per 1- SD increment in BMI: 1.19; 95% confidence interval, 1.04-1.36). The positive association between BMI and PAD with CLI was stronger than the association between BMI and PAD without CLI for all models ( P<0.001). Conclusions In the general population, BMI is positively associated with incident hospitalized PAD after adjusting for potential confounders, particularly its most severe form of CLI . Maintaining an optimal weight, in addition to controlling other cardiovascular risk factors, may play a role in reducing risk of PAD with CLI .


Asunto(s)
Extremidades/irrigación sanguínea , Hospitalización/estadística & datos numéricos , Isquemia/epidemiología , Obesidad/epidemiología , Enfermedad Arterial Periférica/epidemiología , Delgadez/epidemiología , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sobrepeso/epidemiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Estados Unidos/epidemiología
18.
Tunis Med ; 96(3): 178-181, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30325484

RESUMEN

INTRODUCTION: Acute limb ischemia is a common pathology. Etiological diagnosis is not always easy to make, and the prognosis depends mainly on the underlying cause and time management. AIM: To report the experience of our service, and analyze the different aspects of ischemia and their support in the light of a review of the literature. METHODS: It is a retrospective study, from January 2009 to December 2013, with 112 hospitalized patients in our service for management of acute lower limb ischemia. Were excluded all patients admitted for trophic disorders and ischemia secondary to trauma. Were analyzed elements diagnosis and etiologic and therapeutic means. RESULTS: Epidemiological data were collected. The reason for consultation was a coldness of member in 70% cases, pain in 79% cases, cyanosis in 56% of cases, pallor in 32% of patients and paralysis in 12% cases. In 25% of cases it was a consumed ischemia. Involvement of the left lower limb was dominant with 58% and bilateral involvement is reported in two cases. Doppler ultrasound was performed in 55% and CT angiography in 20% of cases. The origin was embolic in 85% of cases, atherosclerotic vascular disease in 8 case and a blue phlebitis in 6 case. We realized 28 amputations and we deplore seven deaths. CONCLUSION: Acute ischemia of the lower limbs are more frequent than those of the upper limbs, they are serious and unpredictable course. An active and early approach to this pathology improves prognosis and avoid a disastrous outcome.


Asunto(s)
Isquemia/diagnóstico , Extremidad Inferior/irrigación sanguínea , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Embolia/epidemiología , Embolia/etiología , Embolia/terapia , Femenino , Humanos , Isquemia/epidemiología , Isquemia/etiología , Isquemia/terapia , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
19.
J Am Coll Cardiol ; 72(14): 1563-1572, 2018 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-30261955

RESUMEN

BACKGROUND: Lower extremity revascularization (LER) is a common treatment in patients with peripheral artery disease (PAD), but long-term outcomes are poorly defined. OBJECTIVES: The aim was to analyze LER in the EUCLID (Examining Use of tiCagreLor In paD) trial to determine predictors and cardiovascular outcomes. METHODS: Patients were grouped according to whether they received a post-randomization LER (n = 1,738) or not (n = 12,147). All variables were assessed for significance in univariable and parsimonious multivariable models. The primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death; major adverse limb events (MALE) included acute limb ischemia or major amputation. RESULTS: A post-randomization LER occurred in 12.5% of patients and was an endovascular LER in 74.7%. Endovascular LERs were performed more often in North America, whereas surgical procedures occurred more frequently in Europe. Independent factors predicting LER were prior and type of prior LER, geographic region, limb symptoms, diabetes, and smoking. A post-randomization LER was associated with an increased risk for the primary endpoint (hazard ratio: 1.60; 95% confidence interval: 1.35 to 1.90; p < 0.0001) and MALE (hazard ratio: 12.0; 95% confidence interval: 9.47 to 15.30; p < 0.0001). Event rates for the primary endpoint after LER were numerically higher in the surgical subgroup, but MALE were similar between surgical and endovascular LER. CONCLUSIONS: In the EUCLID trial, LER was most often endovascular. Following LER, there was an increased hazard for the primary endpoint (with higher event rates in the surgical group) and a markedly increased risk for MALE events (with similar event rates between surgical and endovascular LER procedures). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).


Asunto(s)
Procedimientos Endovasculares , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/cirugía , Enfermedad Arterial Periférica/cirugía , Anciano , Amputación/estadística & datos numéricos , Implantación de Prótesis Vascular , Endarterectomía , Femenino , Arteria Femoral/cirugía , Hemorragia/epidemiología , Humanos , Isquemia/epidemiología , Masculino , Infarto del Miocardio/epidemiología , Arteria Poplítea/cirugía , Accidente Cerebrovascular/epidemiología
20.
PLoS One ; 13(8): e0200807, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30133454

RESUMEN

BACKGROUND AND OBJECTIVE: Markov micro-simulation models are being increasingly used in health economic evaluations. An important feature of the Markov micro-simulation model is its ability to consider transition probabilities of heterogeneous subgroups with different risk profiles. A survival analysis is generally performed to accurately estimate the transition probabilities associated with the risk profiles. This study aimed to apply a flexible parametric survival model (FPSM) to estimate individual transition probabilities. MATERIALS AND METHODS: The data were obtained from a cohort study investigating ischemic stroke outcomes in Western China. In total, 585 subjects were included in the analysis. To explore the goodness of fit of the FPSM, we compared the estimated hazard ratios and baseline cumulative hazards, both of which are necessary to the calculate individual transition probabilities, and the Markov micro-simulation models constructed using the FPSM and Cox model to determine the validity of the two Markov micro-simulation models and cost-effectiveness results. RESULTS: The flexible parametric proportional hazards model produced hazard ratio and baseline cumulative hazard estimates that were similar to those obtained using the Cox proportional hazards model. The simulated cumulative incidence of recurrent ischemic stroke and 5-years cost-effectiveness of Incremental cost-effectiveness Ratios (ICERs) were also similar using the two approaches. A discrepancy in the results was evident between the 5-years cost-effectiveness and the 10-years cost-effectiveness of ICERs, which were approximately 0.9 million (China Yuan) and 0.5 million (China Yuan), respectively. CONCLUSIONS: The flexible parametric survival model represents a good approach for estimating individual transition probabilities for a Markov micro-simulation model.


Asunto(s)
Cadenas de Markov , Modelos Estadísticos , Modelos de Riesgos Proporcionales , Anciano , China , Estudios de Cohortes , Simulación por Computador , Análisis Costo-Beneficio/estadística & datos numéricos , Humanos , Isquemia/epidemiología , Isquemia/mortalidad , Masculino , Persona de Mediana Edad , Probabilidad , Reproducibilidad de los Resultados , Riesgo , Accidente Cerebrovascular , Análisis de Supervivencia
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