Risk Factors of Subsequent Primary Melanomas in Austria.
Müller Christoph,Wendt Judith,Rauscher Sabine,Sunder-Plassmann Raute,Richtig Erika,Fae Ingrid,Fischer Gottfried,Okamoto Ichiro
Importance:Information on risk factors of subsequent melanomas would be helpful to identify patients at risk after the diagnosis of their first melanomas. Objective:To determine risk factors of subsequent melanomas. Design, Setting, and Participants:In this retrospective case-control study, 1648 participants with histologically verified cutaneous melanoma diagnosed from January 1, 1968, though March 16, 2015, were recruited from a tertiary referral center as part of the Molecular Markers of Melanoma study. CDKN2A was sequenced in 514 and MC1R in 953 participants. Data were analyzed from March 7, 2008, through March 25, 2015. Main Outcomes and Measures:Phenotypic traits and internal and external risk factors for the development of a second, third, or fourth melanoma. Results:In total, 1648 patients (53.6% men; mean [SD] age, 54  years) were enrolled, including 1349 with single and 299 with multiple primary melanoma. Mean (SD) age at recruitment was 57 (15) years for the single-melanoma and 62 (14) years for the multiple-melanoma groups. From the internal risk factors, family history (odds ratio [OR], 1.76; 95% CI, 1.22-2.55; P = .006), CDKN2A high-risk mutations (OR, 4.03; 95% CI, 1.28-12.70; P = .02), and high numbers of nevi as a phenotypic risk factor (ORs, 2.23 [95% CI, 1.56-3.28, P < .001] for 20-30 smaller nevi and 2.56 [95% CI, 1.50-4.36; P = .003] for 20-30 larger nevi) were significantly associated with the risk of developing a subsequent primary melanoma using multivariate logistic regression analysis. Nonmelanoma skin cancer (OR, 2.57; 95% CI, 1.84-3.58; P < .001) and signs of actinic skin damage, particularly on the back (ORs, 1.91 [95% CI, 1.12-3.25; P = .04] for freckling and 1.92 [95% CI, 1.29-3.08; P = .007] for solar lentigines), additionally increased risk of a subsequent melanoma. All those factors were also associated with an earlier development of the second melanoma. Patients with 3 melanomas developed their second melanoma earlier than patients with only 2 melanomas (mean [SD] age, 55  years for those with 2 primary melanomas; 52  years for those with 3 primary melanomas). Time spent outdoors, solarium use, outdoor occupation, and hair color had no significant associations in these models. Conclusions and Relevance:According to the results of this study, internal factors (family history and genetic variants), number of nevi, and actinic damage on the back are more relevant for the development of subsequent melanomas than skin phototype or hair color. Patients with many nevi were younger at the time of the diagnosis of their first melanoma. This finding could help to identify persons at increased risk of developing multiple primary melanomas.
Incidence and Risk Factors of Keratinocyte Carcinoma After First Solid Organ Transplant in Ontario, Canada.
Park Christina K,Fung Kinwah,Austin Peter C,Kim S Joseph,Singer Lianne G,Baxter Nancy N,Rochon Paula A,Chan An-Wen
Importance:Keratinocyte carcinoma (KC), also known as nonmelanoma skin cancer, is the most common malignancy after solid organ transplant. Epidemiologic data on posttransplant KC in North America are limited by a lack of KC capture in cancer and transplant registries. Objective:To estimate the incidence and identify risk factors for posttransplant KC. Design, Setting, and Participants:This population-based inception cohort study in Ontario, Canada, used linked administrative databases and a health insurance claims-based algorithm. Participants were adult recipients of a first kidney, liver, heart, or lung transplant from January 1, 1994, to December 31, 2012. The cohort (n = 10 198) was followed up to December 31, 2013. Data were analyzed from May 31, 2016, to April 21, 2017. Exposures:Solid organ transplant with functioning graft. Main Outcomes and Measures:Age- and sex-adjusted standardized incidence ratio for KC in the transplant cohort was compared with that in the general population. Cumulative incidence of posttransplant KC was estimated using cumulative incidence functions, accounting for the competing risks of death or kidney graft loss. The association between KC and patient-, transplant-, and health services-related factors was evaluated with a multivariable cause-specific hazards model. Results:A total of 10 198 transplant recipients were included in the study. The median (interquartile range [IQR]) age at transplant was 51 (41-59) years, with most recipients being male (6608 [64.8%]) and white (5964 [58.5%]). Posttransplant KC was diagnosed in 1690 patients (16.6%) after a median (IQR) of 3.96 (1.94-7.09) years, with an incidence rate of 2.63 per 100 patient-years (95% CI, 2.51-2.76). The rate of KC was significantly higher after transplant compared with the general population (standardized incidence ratio, 6.61; 95% CI, 6.31-6.93). The highest 10-year cumulative incidence was in the subsets of patients with a history of pretransplant skin cancer (66.5%), older than 50 years at transplant (27.5% for 51-65 years; 40.5% for >65 years), and of the white race (24.1%). The strongest independent risk factors for KC included older age at transplant (adjusted hazard ratio [aHR], 9.27; 95% CI, 7.08-12.14 for >65 years vs 18-35 years), white vs black race (aHR, 8.50; 95% CI, 4.03-17.91), pretransplant invasive skin cancer (aHR, 4.30; 95% CI, 3.72-4.98), and posttransplant precancerous skin lesions (aHR, 4.32; 95% CI, 3.77-4.95). Conclusions and Relevance:The incidence of KC appeared to be substantially increased after transplant, particularly in patients who were older at transplant, were white, and had a history of cancerous or precancerous skin tumors; intensified skin cancer screening, education, and early use of chemopreventive interventions may be warranted for these high-risk patient subsets.
Localized Non-melanoma Skin Cancer: Risk Factors of Post-surgical Relapse and Role of Postoperative Radiotherapy.
Caparrotti Francesca,Troussier Idriss,Ali Abdirahman,Zilli Thomas
Current treatment options in oncology
OPINION STATEMENT:The mainstay treatment of localized non-melanoma skin cancer (NMSC) is surgical excision or Mohs surgery. However, approximately 5% of patients with NMSC harbor high-risk clinicopathologic features for loco-regional recurrence, and distant metastasis. Prognostic factors such as close or positive margins, tumor size ≥ 2 cm, poor tumor differentiation, perineural invasion, depth of invasion, and immunosuppression have all been associated with increased loco-regional recurrence and impaired survival rates. In these patients more aggressive treatments are needed and radiotherapy (RT) is often discussed as adjuvant therapy after surgical resection. Due to the retrospective setting and the heterogeneity of the available studies, indications for adjuvant RT in patients with localized resected NMSC harboring high-risk features remain debated. Studies highlighting the limitations of our current understanding of the independent prognosis of each risk factor are needed to better define the role of adjuvant RT on outcome of localized NMSC and standardize its indications in the clinical setting.
Prevalence and risk factors of small airway dysfunction, and association with smoking, in China: findings from a national cross-sectional study.
Xiao Dan,Chen Zhengming,Wu Sinan,Huang Kewu,Xu Jianying,Yang Lan,Xu Yongjian,Zhang Xiangyan,Bai Chunxue,Kang Jian,Ran Pixin,Shen Huahao,Wen Fuqiang,Yao Wanzhen,Sun Tieying,Shan Guangliang,Yang Ting,Lin Yingxiang,Zhu Jianguo,Wang Ruiying,Shi Zhihong,Zhao Jianping,Ye Xianwei,Song Yuanlin,Wang Qiuyue,Hou Gang,Zhou Yumin,Li Wen,Ding Liren,Wang Hao,Chen Yahong,Guo Yanfei,Xiao Fei,Lu Yong,Peng Xiaoxia,Zhang Biao,Wang Zuomin,Zhang Hong,Bu Xiaoning,Zhang Xiaolei,An Li,Zhang Shu,Cao Zhixin,Zhan Qingyuan,Yang Yuanhua,Liang Lirong,Liu Zhao,Zhang Xinran,Cheng Anqi,Cao Bin,Dai Huaping,Chung Kian Fan,He Jiang,Wang Chen,
The Lancet. Respiratory medicine
BACKGROUND:Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. METHODS:From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV and FEV/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV and FEV/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. FINDINGS:Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 μm (PM) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m. The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM, and increase of BMI by 5 kg/m were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. INTERPRETATION:In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM exposure and increase of BMI by 5 kg/m. Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. FUNDING:Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China.
Incidence and risk factors of vascular complications in people with impaired fasting glucose: a national cohort study in Korea.
Yu Eun Sun,Hong Kwan,Chun Byung Chul
This study aimed to evaluate the risk of vascular complications of impaired fasting glucose (IFG). This population-based study included 425,608 participants from the National Health Screening Cohort in Korea in 2003 and 2004 who were followed-up until 2015. The participants were classified into normal, IFG, and diabetes groups based on fasting plasma glucose levels. Incidence rate (per 1000 person-year) was evaluated for the following vascular complications: cardiovascular (ischemic heart disease, cerebrovascular disease, arterial and capillary disease), renal, and retinal diseases. Hazard ratios (HR) of IFG for diabetes were estimated after adjusting for patient characteristics. Among the 88,330 IFG participants, the incidence of cardiovascular, chronic renal and retinal diseases were 11.52, 0.47, and 1.08 per 1000 person-years, respectively. Furthermore, IFG patients with a family history of diabetes, past history of hypertension, and high body mass index had significantly increased risk of vascular complications [adjusted HR, cardiovascular: 1.39 (95% CI 1.33-1.46); renal: 2.17 (95% CI 1.66-2.83); and retinal: 1.14 (95% CI 0.98-1.32)]. IFG patients have a substantial risk of cardiovascular, chronic renal and retinal diseases. Therefore, early preventative interventions are beneficial, especially for those with high-risk factors, in whom should emphasize on maintaining a healthy lifestyle, early screening and continuous follow-up.
The incidence rates and risk factors of Parkinson disease in patients with psoriasis: A nationwide population-based cohort study.
Lee Ji Hyun,Han Kyungdo,Gee Heon Yung
Journal of the American Academy of Dermatology
BACKGROUND:The association between psoriasis and Parkinson disease has not been established. OBJECTIVE:To determine the incidence rates and risk factors of Parkinson disease in patients with psoriasis. METHODS:We conducted a nationwide population-based cohort study. The data from patients with psoriasis (N = 548,327, ≥20 years of age, 53.32% men and 46.68% women) and age- and sex-matched control patients (N = 2,741,635) without psoriasis were analyzed in this study. RESULTS:The incidence rates of Parkinson disease per 1000 person-years were 0.673 and 0.768 in the control and psoriasis groups, respectively. The psoriasis group showed a significantly increased risk of developing Parkinson disease (hazard ratio [HR] 1.091, 95% confidence interval [CI] 1.029-1.115). The risk of Parkinson disease was significantly higher among the psoriasis patients who were not receiving systemic therapy (HR 1.093, 95% CI 1.031-1.159) and lower among the psoriasis patients on systemic therapy (HR 1.04, 95% CI 0.806-1.316). LIMITATIONS:The limitations of this study included the retrospective design, patient inclusion solely on the basis of diagnostic codes, and unavailability of data on confounding factors. CONCLUSION:Systemic anti-inflammatory agents might mitigate the risk of Parkinson disease in psoriasis patients.
The clinical impact and risk factors of latent pancreatic fistula after pancreatoduodenectomy.
Ohgi Katsuhisa,Yamamoto Yusuke,Sugiura Teiichi,Okamura Yukiyasu,Ito Takaaki,Ashida Ryo,Uesaka Katsuhiko
Journal of hepato-biliary-pancreatic sciences
BACKGROUND:Latent pancreatic fistula (LPF) is difficult to diagnose during the early postoperative phase because of initially normal drain fluid amylase (DFA) levels. The present study investigated the clinical significance and risk factors of LPF after pancreatoduodenectomy. METHODS:A total of 662 patients who underwent pancreatoduodenectomy between 2010 and 2018 were retrospectively analyzed. LPF was defined as pancreatic fistula that developed later regardless of initially low DFA levels. RESULTS:Among the 372 patients with DFA ≤375 U/L (three times the upper limit for serum) on postoperative day (POD) 3, LPF occurred in 37 (10%). The rates of postoperative hemorrhaging (11% vs 1.5%), intraabdominal abscess (57% vs 7.2%) and reintervention (46% vs 2.7%) were significantly higher in the patients with LPF than in those without LPF. A multivariate analysis revealed that a body mass index ≥25 kg/m , a non-combined portal vein resection, a DFA on POD 1 ≥650 U/L and a C-reactive protein level on POD 3 ≥11 mg/dL were independent risk factors for LPF. CONCLUSIONS:Latent pancreatic fistula was significantly associated with severe complications and worse outcomes after pancreatoduodenectomy. Early drain removal may be unfavorable for patients with some of these risk factors.
Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up.
Kimura Yuka,Sasaki Eiji,Yamamoto Yuji,Sasaki Shizuka,Tsuda Eiichi,Ishibashi Yasuyuki
The American journal of sports medicine
BACKGROUND:One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. PURPOSE:To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). RESULTS:The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection ( = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; = .032), and follow-up period after ACL reconstruction (OR, 1.02; = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. CONCLUSION:Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.
Prevalence and risk factors of migraine and non-migraine headache in older people - results of the Heinz Nixdorf Recall study.
Schramm Sara,Tenhagen Isabell,Schmidt Börge,Holle-Lee Dagny,Naegel Steffen,Katsarava Zaza,Jöckel Karl-Heinz,Moebus Susanne
Cephalalgia : an international journal of headache
BACKGROUND:The prevalence of migraine and non-migraine headache declines with age. METHODS:Data from the third visit (2011-2015) of the population-based Heinz Nixdorf Recall study were analysed (n = 2038, 51% women, 65-86 years). Possible risk factors for headache activity (obesity, education, smoking, sports, alcohol, partnership status, living alone, having children, sleep quality, depression, hypertension, diabetes mellitus, stroke, coronary heart disease, medication), and headache symptoms were assessed. We estimated the lifetime prevalence and the prevalence of current active headache of migraine with and without aura, and non-migraine headache. The associations between possible risk factors and headache activity (active vs. inactive) were estimated by age and sex-adjusted odds ratios and 95% confidence intervals (OR [95% CI]) using multiple logistic regression. RESULTS:The lifetime prevalence of migraine was 28.6% (n = 584). One hundred and ninety-two (9.4%) had still-active migraine, 168 (3.5%) had migraine with aura, and 416 (5.9%) had migraine without aura. One hundred and sixty-eight (8.2%) had "episodic infrequent migraine, 0-8 headache days/month", 10 (0.5%) had "episodic frequent migraine, 9-14 headache days/month", and five (0.2%) had "chronic migraine, ≥15 headache days/month". Overall, 10 (0.5%) had "chronic headache, any headache on ≥15 days/month". Female gender and younger age were the most important associated migraine risk factors. Depression (1.62 [1.06; 2.47]) and poor sleep (1.06 [1.00; 1.12]) were associated with migraine and headache activity in general. Antihypertensives were associated with headache remission (0.80 [0.64; 1.00]). Additionally, undertaking less sports (0.72 [0.51; 1.03]) was associated with higher migraine activity. CONCLUSIONS:Headaches and migraines are not rare in the older population. They are related to mood and sleep disturbance, and migraine even to less physical activity. Antihypertensives are related to headache remission.
Frequency and Risk Factors of Acute Kidney Injury During Diabetic Ketoacidosis in Children and Association With Neurocognitive Outcomes.
Myers Sage R,Glaser Nicole S,Trainor Jennifer L,Nigrovic Lise E,Garro Aris,Tzimenatos Leah,Quayle Kimberly S,Kwok Maria Y,Rewers Arleta,Stoner Michael J,Schunk Jeff E,McManemy Julie K,Brown Kathleen M,DePiero Andrew D,Olsen Cody S,Casper T Charles,Ghetti Simona,Kuppermann Nathan,
JAMA network open
Importance:Acute kidney injury (AKI) occurs commonly during diabetic ketoacidosis (DKA) in children, but the underlying mechanisms and associations are unclear. Objective:To investigate risk factors for AKI and its association with neurocognitive outcomes in pediatric DKA. Design, Setting, and Participants:This cohort study was a secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a prospective, multicenter, randomized clinical trial comparing fluid protocols for pediatric DKA in 13 US hospitals. Included DKA episodes occurred among children age younger than 18 years with blood glucose 300 mg/dL or greater and venous pH less than 7.25 or serum bicarbonate level less than 15 mEq/L. Exposures:DKA requiring intravenous insulin therapy. Main Outcomes and Measures:AKI occurrence and stage were assessed using serum creatinine measurements using Kidney Disease: Improving Global Outcomes criteria. DKA episodes with and without AKI were compared using univariable and multivariable methods, exploring associated factors. Results:Among 1359 DKA episodes (mean [SD] patient age, 11.6 [4.1] years; 727 [53.5%] girls; 651 patients [47.9%] with new-onset diabetes), AKI occurred in 584 episodes (43%; 95% CI, 40%-46%). A total of 252 AKI events (43%; 95% CI, 39%-47%) were stage 2 or 3. Multivariable analyses identified older age (adjusted odds ratio [AOR] per 1 year, 1.05; 95% CI, 1.00-1.09; P = .03), higher initial serum urea nitrogen (AOR per 1 mg/dL increase, 1.14; 95% CI, 1.11-1.18; P < .001), higher heart rate (AOR for 1-SD increase in z-score, 1.20; 95% CI, 1.09-1.32; P < .001), higher glucose-corrected sodium (AOR per 1 mEq/L increase, 1.03; 95% CI, 1.00-1.06; P = .001) and glucose concentrations (AOR per 100 mg/dL increase, 1.19; 95% CI, 1.07-1.32; P = .001), and lower pH (AOR per 0.1 increase, 0.63; 95% CI, 0.51-0.78; P < .001) as variables associated with AKI. Children with AKI, compared with those without, had lower scores on tests of short-term memory during DKA (mean [SD] digit span recall: 6.8 [2.4] vs 7.6 [2.2]; P = .02) and lower mean (SD) IQ scores 3 to 6 months after recovery from DKA (100.0 [12.2] vs 103.5 [13.2]; P = .005). Differences persisted after adjusting for DKA severity and demographic factors, including socioeconomic status. Conclusions and Relevance:These findings suggest that AKI may occur more frequently in children with greater acidosis and circulatory volume depletion during DKA and may be part of a pattern of multiple organ injury involving the kidneys and brain.
Long-term incidence and risk factors of ocular hypertension following Dexamethasone-implant injections. The SAFODEX-2 study.
Rezkallah Amina,Mathis Thibaud,Abukhashabah Amro,Voirin Nicolas,Malclès Ariane,Agard Émilie,Lereuil Théo,Denis Philippe,Dot Corinne,Kodjikian Laurent
Retina (Philadelphia, Pa.)
PURPOSE:To analyze the incidence, risk factors and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of Dexamethasone implant (DEX-I) and to evaluate the long-term cumulative probability of intraocular pressure elevation. METHODS:Eyes of patients having received at least one DEX-I IVI between October 2010 and February 2015 were included in the present study. OHT was defined as IOP > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline IOP. RESULTS:494 eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion (RVO), glaucoma treated with a double or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (p=0.248). CONCLUSION:This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of IOP elevation in a large cohort of eyes treated with DEX-I IVI. Repeat injections of DEX-I neither increase nor decrease the risk of OHT.
Prevalence and Risk Factors of Anxiety and Depression in Patients with Postherpetic Neuralgia: A Retrospective Study.
Du Jingyi,Sun Guoliang,Ma Han,Xiang Ping,Guo Yue,Deng Yifan,Li Shangrong,Li Xiang
Dermatology (Basel, Switzerland)
OBJECTIVES:Pain and psychological disorders are the 2 most commonly occurring symptom clusters in patients with postherpetic neuralgia (PHN). This study aimed to investigate the risk factors for anxiety and depressive disorders in patients with PHN. METHODS:Retrospectively, we examined the potential risk factors of anxiety and depression among patients with PHN from the clinic medical records of the Third Affiliated Hospital of Sun Yat-Sen University from 2017 to 2019. The Chinese version of the Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Patients were retrospectively allocated to 2 groups - PHN with and without anxiety/depression - and compared to identify the differential patient characteristics. RESULTS:Cases of 661 patients who were diagnosed with PHN were included. Anxiety and depression developed in 69.0% (456/661) and 65.8% (435/661) of the enrolled patients with PHN, respectively. Results of univariate regression analyses showed that female sex, magnitude of pain intensity, time from onset of rash and extent of spread of rashes were significantly associated with anxiety and depression in patients with PHN. Multivariate analysis revealed that both anxiety and depression states significantly correlated with female sex, magnitude of pain intensity, and extent of spread of rashes. CONCLUSIONS:Anxiety and depression were not uncommon in patients with PHN. Women with PHN who experience severe pain and develop extensive rashes have a high risk of developing anxiety and depressive disorders.
Prevalence and risk factors of nonalcoholic fatty liver disease in patients with inflammatory bowel diseases: A cross-sectional and longitudinal analysis.
Hoffmann Peter,Jung Victoria,Behnisch Rouven,Gauss Annika
World journal of gastroenterology
BACKGROUND:Nonalcoholic fatty liver disease (NAFLD) is common in the German population, with an even higher prevalence in inflammatory bowel disease patients. AIM:To investigate the risk factors for NAFLD in inflammatory bowel disease patients. METHODS:This monocentric retrospective study with a cross-sectional and a longitudinal part included 694 patients. Inclusion criteria were diagnosed inflammatory bowel disease, age ≥ 18 years, availability of at least one abdominal ultrasound. Patients with infectious or suspected alcoholic fatty liver disease were excluded. NAFLD was defined by increased echogenicity at liver ultrasound. Demographic characteristics, disease activity and medications were analyzed as potential risk factors. Parameters influencing the course of NAFLD were identified by a generalized linear mixed model. RESULTS:Forty-eight percent of Crohn's disease (CD) patients and 44% of ulcerative colitis patients suffered from NAFLD. Its occurrence was associated with greater age, hypertension and body mass index (BMI) in both groups, and with higher disease activity and dyslipidemia in CD. 2467 ultrasound results were included in the longitudinal analysis. Risk factors for NAFLD were age, BMI, higher disease activity, bowel resection(s), endoscopic activity and azathioprine use in CD; and BMI and endoscopic activity in ulcerative colitis. CONCLUSION:NAFLD was highly prevalent in this cohort of German inflammatory bowel disease patients. Its risk increased mainly with rising age and BMI. This analysis provides a rationale for non-invasive liver screening in inflammatory bowel disease patients.