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Urinary frequency [keywords]
- What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases. [JOURNAL ARTICLE]
- Clin Orthop Relat Res 2014 Dec 19.
Total shoulder arthroplasty (TSA) is an effective treatment for end-stage glenohumeral joint pathology with good long-term results. Previous descriptions of morbidity and blood transfusion in TSA are limited by preoperative risk factors and postoperative complications considered and single-center studies.The purpose of this study was to define in a group of patients undergoing TSA (1) the type and incidence of complications; (2) the frequency of and risk factors for both minor and major complications; and (3) the risk factors for bleeding resulting in transfusion.We retrospectively queried the National Surgical Quality Improvement Program database using Current Procedural Terminology billing codes and identified 1922 cases of TSA performed between 2006 and 2011. Postoperative outcomes were divided into one of four categories: any complication, major morbidity (systemic life-threatening event or a substantial threat to a vital organ) or mortality, minor morbidity (localized to the operative upper extremity or not posing a major systemic threat to the patient), or bleeding resulting in transfusion. Univariate and multivariate analyses were then used to identify risk factors for complications.There were a total of 155 complications (8% of the 1922 patients identified). The most common complication was bleeding resulting in transfusion (82 patients [4.26%]) followed by urinary tract infections (27 patients [1.40%]), return to the operating room (14 patients [0.73%]), pneumonia (10 patients [0.52%]), and peripheral nerve injury (nine patients [0.47%]). The incidence of major morbidity was 2% (44 patients), which included five patients (0.26%) who died; the incidence of any minor morbidity was 7% (136 patients). After controlling for likely confounding variables, we found steroid use (odds ratio [OR], 3; 95% confidence interval [CI], 2-6), hematocrit < 38% (OR, 2; 95% CI, 1-3), American Society of Anesthesiologists (ASA) Class 4 (OR, 3; 95% CI, 1-7), and operating time > 2 hours (OR, 2; 95% CI, 1-3) as independent predictors of complication and congestive heart failure (OR, 12; 95% CI, 1-106) as an independent risk factor for major morbidity or mortality. Hematocrit < 38% (OR, 3; 95% CI, 2-6), resident involvement (OR, 3; 95% CI, 2-5), steroid use (OR, 3; 95% CI, 1-6), and ASA Class 3 versus 1 or 2 (OR, 2; 95% CI, 1-5) were independent risk factors for bleeding resulting in transfusion.Short-term morbidity after TSA is higher than previously reported. The prevalence of complications within 30 days of surgery and our outlined risk factors should guide surgeon-driven preoperative patient evaluation, management, and counseling. Surgeons who perform TSA should be aware operative time > 2 hours is associated with increased complications. Patients with preoperative hematocrit < 38%, history of steroid use, ASA Class > 2, and patients with congestive heart failure should receive medical optimization before TSA.Level III, therapeutic study.
- Genetic Contributions to Urgency Urinary Incontinence in Women. [JOURNAL ARTICLE]
- J Urol 2014 Dec 15.
To identify genetic variants associated with urgency urinary incontinence (UUI) in post-menopausal women.A two-stage genome wide association analysis was conducted to identify variants associated with UUI. The Women's Health Initiative-Genomics & Randomized Trials Network (GARNET) sub-study with 4,894 genotyped post-reproductive white women was randomly split into independent discovery and replication cohorts. Genome-wide imputation was performed using IMPUTE2 with the 1000-Genomes-ALL-Phase-I integrated variant set as a reference. Controls reported no UUI at enrollment or follow-up; cases reported monthly or greater UUI and leaked sufficiently to wet/soak underpants/clothes. Logistic regression models were used to predict UUI case versus control status based on genotype, assuming additive inheritance. Age, obesity, diabetes and depression were included in the models as covariates.Following quality control, 975,508 single nucleotide polymorphisms (SNPs) in 2,241 cases (discovery=1,102, replication=1,133) and 776 controls (discovery=405, replication=371) remained. Genotype imputation resulted in 9,077,347 SNPs and insertions/deletions with minor allele frequency >0.01 available for analysis. Meta-analysis of the discovery and replication samples identified six loci on chromosomes 5, 10, 11, 12 & 18 associated with UUI at p<10(-6). Three of the loci were within genes, the zinc finger protein 521 (ZFP521) gene on chromosome 18q11, the ADAMTS16 gene on chromosome 5p15, and the CIT gene on chromosome 12q24. The other three loci were intergenic.Although environmental factors also likely contribute, this first exploratory Genome-Wide Associated Study (GWAS) for UUI suggests that genetic variants in the ZFP521, CIT, and ADAMTS16 genes might account for some of the observed heritability of the condition.
- Prevalence and cardiovascular risk profile of chronic kidney disease in Italy: results of the 2008-12 National Health Examination Survey. [JOURNAL ARTICLE]
- Nephrol Dial Transplant 2014 Dec 18.
National surveys in countries outside Europe have reported a high prevalence (11-13%) of chronic kidney disease (CKD). Studies in Europe have provided a variable prevalence likely due to differences in study design, including age and extent of geographic areas, equation used to evaluate estimated glomerular filtration rate (eGFR) and CKD stages examined.The 2008-12 National Health Examination Survey in Italy randomly extracted samples from the general population aged 35-79 years, stratified by age and gender, from the resident list of each Italian region (440 persons/1.5 million of residents). We estimated the prevalence of CKD by means of urinary albumin : creatinine ratio and eGFR (CKD-EPI equation-enzymatic assay of serum creatinine). Cardiovascular (CV) risk profile was also evaluated.Three thousand eight hundred and forty-eight men and 3704 women were examined. In the whole population, mean age was 57 ± 12 and 56 ± 12 years in men and women, respectively; hypertension was prevalent in men and women, respectively (56 and 43%) and the same held true for overweight (48 and 33%), obesity (26 and 27%), diabetes (14 and 9%) and smoking (21 and 18%), whereas CV disease was less frequent (9 and 6%). Overall, the prevalence of CKD (95% confidence interval) was 7.05% (6.48-7.65). Early stages constituted 59% of the CKD population [Stage G1-2 A2-3: 4.16% (3.71-4.61) and Stage G3-5: 2.89% (2.51-3.26)]. At multivariate regression analysis, age, obesity, hypertension, diabetes, CV disease and smoking were all independent correlates of CKD.CKD has a relatively lower prevalence in Italy, in particular for advanced stages, when compared with similar national surveys outside Europe. This occurs despite older age and unfavourable CV risk profile of the whole population.
- Investigating the "Rule of W," a Mnemonic for Teaching on Postoperative Complications. [JOURNAL ARTICLE]
- J Surg Educ 2014 Dec 15.
To identify the timing and relative frequency of common postoperative complications in a contemporary, diverse surgical population and develop a mnemonic for teaching and clinical decision support.We enrolled a cohort of general and vascular surgical patients undergoing elective, inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database between 2005 and 2011. Index complications were noted by postoperative day (POD). Timing and incidence were compared within each day.Among 614,525 patients, 51,173 (9.88%) experienced the following index complications over 30 days: pneumonia (n = 5947), urinary tract infection (n = 9459), superficial surgical site infection (sSSI) (n = 20,460), deep/organ space surgical site infection (dSSI) infection (n = 11,847), venous thromboembolism (n = 4478), kidney injury (n = 2620), and myocardial infarction (n = 1813). Median time to complication differed significantly for index complications (p < 0.0001). On POD 0, the most common complication was myocardial infarction (incidence 4.26/10,000 patient days; 95% CI: 3.75-4.78). On POD 1 and 2, pneumonia was the most common complication, with peak incidence on POD 2 (20.36; 95% CI: 19.22-21.51). On POD 3, pneumonia (16.3; 95% CI: 15.27-17.33) and urinary tract infection (15.5; 95% CI: 14.49-16.51) were significantly more common than other complications. On POD 4, the most common complication was sSSI (16.24; 95% CI: 15.20-17.28). From POD 5 to POD 30, sSSI and dSSI were the 2 most common complications. Risk of venous thromboembolism declined only slightly through POD 30.We propose a mnemonic for postoperative complication timing and frequency, independent of fever, as follows: Waves (myocardial infarction), Wind (pneumonia), Water (urinary tract), Wound (sSSI and dSSI), and Walking (venous thromboembolism) in the order of likelihood.
- Chlorpyrifos Exposure and Respiratory Health among Adolescent Agricultural Workers. [JOURNAL ARTICLE]
- Int J Environ Res Public Health 2014; 11(12):13117-13129.
Chlorpyrifos (CPF) is a commonly used organophosphate insecticide (OP). In adults, exposure to OPs has been inconsistently associated with reduced lung function. OP exposure and lung function has not been assessed in adolescents. The objective of this study was to assess CPF exposure and lung function among Egyptian adolescents. We conducted a 10-month study of male adolescent pesticide applicators (n = 38) and non-applicators of similar age (n = 24). Urinary 3,5,6-trichloro-2-pyridinol (TPCy), a CPF-specific metabolite, was analyzed in specimens collected throughout the study. Spirometry was performed twice after pesticide application: day 146, when TCPy levels were elevated and day 269, when TCPy levels were near baseline. Applicators had higher levels of TCPy (mean cumulative TCPy day 146 = 33,217.6; standard deviation (SD) = 49,179.3) than non-applicators (mean cumulative TCPy day 146 = 3290.8; SD = 3994.9). Compared with non-applicators, applicators had higher odds of reporting wheeze, odds ratio = 3.41 (95% CI: 0.70; 17.41). Cumulative urinary TCPy was inversely associated with spirometric measurements at day 146, but not at day 269. Although generally non-significant, results were consistent with an inverse association between exposure to CPF and lung function.
- [Bacterial infections in patients with liver cirrhosis and ascites]. [English Abstract, Journal Article]
- Srp Arh Celok Lek 2014 Sep-Oct; 142(9-10):551-6.
Bacterial infections are common complications and the cause of death in patients with cirrhosis and ascites. There is no standard method for a rapid and low-cost diagnosis, and its prognosis is poor.The aim of this study was to determine the etiology and frequency of bacterial infections in patients with liver cirrhosis of different etiology, and the influence of bacterial infections on the prognosis in patients with liver cirrhosis and ascites.Sixty-four patients with cirrhosis and ascites were included in the study. The diagnosis of spontaneous bacterial peritonitis was established based on the diagnostic abdominal paracentesis and the results of biochemical, cytological and microbiologic analysis of ascitic fluid. The diagnosis of urinary infection and pneumonia were made according to the standard criteria.Spontaneous bacterial peritonitis was diagnosed in 23 (35.9%) patients, urinary infections in 16(25%) and pneumonia in 11 (17.2%). Gram positive and gram negative bacteria in spontaneous bacterial peritonitis were etiologically almost equally represented (52%; 48%).The most frequent causes were Escherichia coli and Staphylococcus aureus. In 81% of patients urinary infections were caused by gram negative bacteria (Escherichia coli in 44%). The most frequent cause of pneumonia was Streptococcus pneumoniae (46%).Spontaneous bacterial peritonitis, urinary infections and bronchopneumonia are the most frequent bacterial infections in patients with liver cirrhosis and ascites. A timely recognition of bacterial infections and the initiation of treatment have a positive effect on the prognosis of such patients.
- Effect of pregnancy on urinary functions in Thai nulliparous pregnant women. [Journal Article]
- J Med Assoc Thai 2014 Aug.:S164-70.
Many epidemiological studies have shown that lower urinary tract symptoms (LUTS) are common during the first pregnancy. Both prevalence and severity ofLUTSseem to increase through out pregnancy. It also compromised daily life of pregnant women. Both anatomical change and hormonal change during pregnancy can disrupt the normal urinary tract function.The aim of the present study is to identify the effect ofpregnancy in different trimesters ofpregnancy on urinary function of Thai nulliparous women by using free uroflowmetry.A prospective study of 111 Thai nulliparous pregnant women at 8-12, 24-28 and 32-38 gestational weeks. They attended the antenatal clinic in Thammasat Hospital. All women were interviewed about their urinary symptoms such as hesitancy, frequency, nocturia, stress incontinence, urge incontinence and difficulty in passing urine. The severity of each symptom was clarified as none, mild, moderate and severe. Free uroflowmetry was performed using a special-setting toilet in the clinic. Maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV) and residual urine volume were measured.Mean age of 111 women was 26.6±5.4 years and the mean body weight was 52.4±9.4 kilograms. The average gestational age was 8.6±1.9 weeks at first visit, 26.1±1.3 weeks at second visit and 34.1±1.6 weeks at last visit. The symptom ofurinary frequency and nocturia increased throughoutpregnancy. Only two women at 24-28 weeks and one woman at 34- 38 weeks reported moderate to severe stress incontinence. No women had moderate to severe urge incontinence. Maximum and average flow rates slightly increased toward the end ofpregnancy. But voided volume was slightly decreased in the second and third visits. Residual urine of less than 50 ml was found in all women and allperiods.Urinary frequency and nocturia were common in Thai nulliparous pregnancy. Most of them did not complain of stress nor urge incontinence. Maximum and average flow rate seem to increase consistently while gestational age increase and average voided volume were reduced in late pregnancy.
- Small cell carcinoma of the bladder. [JOURNAL ARTICLE]
- Einstein (Sao Paulo) 2014 Dec 16.:0.
Small cell carcinoma of the urinary bladder is an extremely aggressive and rare tumor. Even though small cell carcinoma most commonly arises from the lungs there are several reports of small cell carcinoma in extrapulmonary sites. Due to its low frequency there is no well-established management for this disease. We report the case of a 61 year-old man with small cell carcinoma of the bladder who underwent radical cystectomy following neoadjuvant chemotherapy. We also reviewed the literature for the optimal treatment strategy.
- Prenatal exposure to pyrethroid insecticides and birth outcomes in Rural Northern China. [JOURNAL ARTICLE]
- J Expo Sci Environ Epidemiol 2014 Dec 17.
Although pyrethroid insecticides are widely used, little is known about potential adverse effects on fetal growth. Participating 454 mother-infant pairs were recruited from a prospective birth cohort in rural northern China between September 2010 and 2012. We measured five non-specific pyrethroid metabolites in maternal urine at delivery and examined their association with birth outcomes including birth weight, length, head circumference, and gestational duration. The creatinine-adjusted medians of pyrethroid metabolites in urine were 0.51 μg/g for cis-DCCA, 0.65 μg/g for trans-DCCA, and 0.68 μg/g for 3-PBA. The pregnant women had substantially higher levels of urinary pyrethroid metabolites compared with those reported in developed countries. A increase in total (the sum of cis-DCCA, trans-DCCA, and 3-PBA) but not individual urinary metabolite levels was associated with a decrease in birth weight (adjusted β=-96.76 g per log10 unit increase, 95% confidence interval=-173.15 to -20.37). No associations were found between individual or total metabolite levels and birth length, head circumference, or gestational duration. We report an adverse association of prenatal exposure to pyrethroids as measured by urinary metabolites with birth weight. More studies are warranted in China given the relatively high levels of urinary metabolites in our study population.Journal of Exposure Science and Environmental Epidemiology advance online publication, 17 December 2014; doi:10.1038/jes.2014.86.
- Reliability of concentrations of organophosphate pesticide metabolites in serial urine specimens from pregnancy in the Generation R Study. [JOURNAL ARTICLE]
- J Expo Sci Environ Epidemiol 2014 Dec 17.
The widespread use of organophosphate (OP) pesticides has resulted in ubiquitous exposure in humans, primarily through their diet. Exposure to OP pesticides may have adverse health effects, including neurobehavioral deficits in children. The optimal design of new studies requires data on the reliability of urinary measures of exposure. In the present study, urinary concentrations of six dialkyl phosphate (DAP) metabolites, the main urinary metabolites of OP pesticides, were determined in 120 pregnant women participating in the Generation R Study in Rotterdam. Intra-class correlation coefficients (ICCs) across serial urine specimens taken at <18, 18-25, and >25 weeks of pregnancy were determined to assess reliability. Geometric mean total DAP metabolite concentrations were 229 (GSD 2.2), 240 (GSD 2.1), and 224 (GSD 2.2) nmol/g creatinine across the three periods of gestation. Metabolite concentrations from the serial urine specimens in general correlated moderately. The ICCs for the six DAP metabolites ranged from 0.14 to 0.38 (0.30 for total DAPs), indicating weak to moderate reliability. Although the DAP metabolite levels observed in this study are slightly higher and slightly more correlated than in previous studies, the low to moderate reliability indicates a high degree of within-person variability, which presents challenges for designing well-powered epidemiological studies.Journal of Exposure Science and Environmental Epidemiology advance online publication, 17 December 2014; doi:10.1038/jes.2014.81.