Abstract Allostatic load (AL) is a biological measure of cumulative exposure to socioenvironmental stressors (e.g., poverty). This study aims to examine the association between allostatic load (AL) and postoperative complications (POC) among patients with breast cancer. Females ages 18+ with stage I-III breast cancer who received surgical management between 01/01/2012-12/31/2020 were identified in the Ohio State Cancer registry. The composite AL measure included biomarkers from the cardiovascular, metabolic, immune, and renal systems. High AL was defined as composite scores greater than the cohort’s median (2.0). POC within 30 days of surgery were examined. Univariable and multivariable regression analysis examined the association between AL and POC. Among 4459 patients, 8.2% had POC. A higher percentage of patients with POC were unpartnered (POC 44.7% vs no POC 35.5%), government-insured (POC 48.2% vs no POC 38.3%) and had multiple comorbidities (POC 32% vs no POC 20%). Patients who developed POC were more likely to have undergone sentinel lymph node biopsy followed by axillary lymph node dissection (POC 51.2% vs no POC 44.6%). High AL was associated with 29% higher odds of POC (aOR 1.29, 95% CI 1.01–1.63). A one-point increase in AL was associated with 8% higher odds of POC (aOR 1.08, 95% CI 1.02-1.16) and a quartile increase in AL was associated with 13% increased odds of POC (aOR 1.13, 95% CI 1.01–1.26). Among patients undergoing breast cancer surgery, increased exposure to adverse socioenvironmental stressors, operationalized as AL, was associated with higher odds of postoperative complications.
Background: Trauma has been demonstrated to be responsible for a considerable number of emergency visits worldwide.Abdominal trauma participates significantly in the morbimortality of trauma cases.Of note, there were several studies that evaluated the role of Shock Index (SI) in the context of abdominal traumas.However, fewer researches only that emphasized on the role of FASILA score.Objective: To compare these three scoring systems (FASILA Score versus Shock Index (SI) and Assessment of Blood Consumption (ABC Score)) to detect which is a better predictor for MTP activation in cases with abdominal traumas.Patients and Methods: This was an observational prospective study conducted on a total of 54 patients admitted to the Emergency Department (ED) with abdominal trauma.The FASILA score was evaluated in terms of cases with abdominal injuries, for the initial prediction of massive blood transfusion (MBT) together with being an acronym for FAST+SI+lactate. Results:The median SI, ABC and FASILA score were 1.4, 3 and 6 respectively.Cases with MBT were accompanied by a considerable increase in FASILA score compared to MBT free ones, while SI and ABC demonstrated insignificant differences between both groups (P>0.05).ABC could be used as a predictor for MBT with a higher sensitivity (Sn) and lower specificity (Sp).FASILA could be used as a significant predictor for MBT with higher Sn and Sp. Conclusion:The FASILA score may be used as a promising feasible and simple modality, which predicts the need for BT and MTP activation, in patients with abdominal trauma.
Background: Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites, having a tendency to enlarge rapidly and to complicate.The treatment of umbilical hernia in these patients is a surgical challenge.Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, mesh repair is associated with lower recurrence rate, but with higher surgical site infection when compared to conventional fascial suture.Intraperitoneal mesh repair has advantages of avoiding recurrence, decreasing ascetic leak and wound infection.Objective: The purpose of this study was to compare the safety and effectiveness of surgical management of umbilical and paraumbilical hernia via anatomical repair and intraperitoneal mesh repair in relation to conservative treatment in ascetic patients.Patients and methods: This randomized controlled study included 94 patients presented with umbilical and paraumbilical hernia with ascites.The study was conducted in Mansoura University Hospitals through the period from 2016 to 2018.The patients were divided randomly into 3 groups; Conservative treatment group (28 cases), anatomical repair group (36 cases) and intraperitoneal mesh repair via composite mesh group (30 cases).Comparison was done for effectiveness and complications.Results: Conservative treatment had high rate of complications (60%) and deterioration of hepatic condition (18%), elective surgical correction appeared more safe, intraperitoneal composite mesh repair decreased leak and significantly reduced recurrence and associated complications compared to anatomical repair (17% versus 3%).Conclusion: Both elective anatomical repair and intraperitoneal mesh repair of umbilical and paraumbilical hernia in ascetic patients were safer and better than conservative treatment.Intraperitoneal mesh repair has advantages of avoiding recurrence and decreasing ascetic leak.
Patients with breast cancer residing in socioeconomically disadvantaged communities often face poorer outcomes (eg, mortality) compared with individuals living in neighborhoods without persistent poverty.
An estimated 257 million individuals are living with hepatitis B Virus (HBV) worldwide. While the aggregate rate of HBV infection has been firmly decreasing in the United States, Asian males continue to experience the highest risk of infection. This study aims to investigate the racial and gender disparities in HBV vaccination coverage among Asian American adults using the 2012–2015 National Health Interview Survey (NHIS). The study sample included 125,399 adults aged 18 to 85 who participated in the 2012–2015 NHIS. The main outcome was HBV vaccination status. Race/ethnicity was categorized into White-non-Hispanics, Black-non-Hispanics, Hispanics, Other, Asian-Indian, Chinese, Filipino, and Other-Asian (Korean, Vietnamese, Japanese, and other Asian subgroups). Complex survey methods were applied to all models to provide statistical estimates that are representative of US adults. Multivariable logistic regression models adjusting for age, education, region of residence, survey year, health insurance access, chronic liver disease, influenza vaccination, marital, employment and health status were fit to examine the associations between gender, race/ethnicity and HBV vaccinations status. An estimated 39.66% (95% CI; 38.07%, 41.25%) of Asian adults living in the US received HBV vaccination. Vaccination prevalence among male Asian adults was lower than their female counterparts 38.05% (95% CI; 35.66%, 40.44%) vs. 41.09% (95% CI; 38.96%, 43.21%). Among Asian adults, the adjusted odds ratio (AOR) of HBV vaccination for females were 1.20 (95% CI; 1.04, 1.39) times higher than males. The AORs of HBV vaccinations were significantly higher when compared with white 1.21 (95% CI; 1.03, 1.41), 1.29 (95% CI; 1.10, 1.51), respectively for Chinese and Filipino Adults. We observed significant gender disparities in HBV vaccination AOR for Asian-Indian and Chinese adults. In both groups, females had higher AOR of HBV vaccination when compared with males, Asian-Indian 1.42 (95% CI; 1.04, 1.94) and Chinese 1.39 (95% CI; 1.07, 1.80). Among Asian-Indian and Chinese adult residents of the United States, the association between race and HBV vaccination status differs by gender, with males having lower vaccination rates than females. Healthcare resources should be directed to these target populations to improve these rates. V. Rustgi, Genfit: Grant Investigator and Investigator, Research support. Gilead: Speaker’s Bureau, Speaker honorarium. Abbvie: Speaker’s Bureau, Speaker honorarium.
Introduction: Venous Thromboembolism (VTE) prophylaxis (ppx) is a balance between bleed and clot risk. We used the IMPROVE Predictive Score for VTE (IMPROVE) for clot risk, and platelets (plts), and INR for bleed risk. We aim to see if these factors affect physician VTE ppx patterns before, during, and after endoscopic procedure (procedure). High VTE risk is defined as a score >3 on IMPROVE which equates to a 3.1% risk of VTE within 3 months. High plt is defined as >50k and high INR is defined as > 1.5. Low plt has an odds ratio of 3.37 and high INR has an odds ratio of 2.18 for bleeding, both from the IMPROVE trial. Methods: Retrospective cohort study chart review was done for 6 months in all procedures in patients with length of stay ≥ 3 days. Information analyzed include IMPROVE, plts, INR, VTE ppx decision prior, during, and after endoscopy. Logistic regression models were used to estimate the relationship between IMPROVE, plts, INR on VTE ppx decision patterns. Chi square tests were used to determine significance. Bleeding and patients on anticoagulants were excluded. Results: 723 procedures were reviewed with all 723 analyzed for VTE ppx prior to procedure. Odds of receiving VTE ppx were (OR 5.094; 95% Cl 2.036-15.4470; P=0.0013) for high plts, (OR 2.169; 95% Cl 1.262-3.81; P=0.0058) for high IMPROVE, and (OR 0.978; 95% Cl 0.451-2.094; P=0.9539) for high INR. 327 were started on VTE ppx prior to procedure. Among these 327, the odds of stopping ppx during the procedure were (OR 0.379; 95% Cl 0.148-1.05; P=0.0611) for high plts, (OR 1.155; 95% Cl 0.488-3.195; P=0.7562) for high IMPROVE, and (OR 0.72; 95% Cl 0.12-3.289; P=0.6360) for high INR. 664 were included for analysis of VTE ppx after procedure after excluding those who continued VTE ppx throughout procedure. The odds of resuming ppx were (OR 2.959 95% Cl 1.103-9.317; P=0.0306) for high plts, (OR 1.492; 95% Cl 0.85-2.652; P=0.1638) for high IMPROVE, and (OR 1.348; 95% Cl 0.604-3.085; P=0.4661) for high INR.Table 1: The Odds of Prophylactic Outcomes in Relation to the Platelets, IMPROVE Predictive Score for VTE, and INR of PatientFigure 1Conclusion: The trend of decrease in odds ratio of VTE ppx prior compared to after procedure for those with high IMPROVE and high plts imply that physicians are under prophylaxing as one does not expect a significant change in their bleed or VTE risk after procedure. This is important as patients with high IMPROVE score should be receive VTE ppx after procedure. The same trend observed for plts suggests that it is not the bleed risk that is detering VTE ppx. Appropriate VTE ppx post procedure is an area of need of improvement.
Introduction: Venous thromboembolism (VTE) is the most common preventable cause of hospital death. We sought to evaluate whether a recently instituted electronic medical alert (EMA) tool for VTE prophylaxis (ppx) could affect the timing of VTE ppx after endoscopic procedure compared by procedure risk. ASGE defines high-risk as a ≥ 1% chance of needing transfusion or a therapeutic intervention to stop bleeding. Methods: Retrospective cohort study chart review was done 3 months prior and after institution of EMA for all inpatient procedures in patients with length of stay ≥ 3 days. Information analyzed includes timing of the procedure, risk of procedure, and the timing and decision of VTE ppx after procedure. Logistic regression models were used to estimate the relationship between procedure risk and physicians' decision patterns. Chi square tests were used to test the differences between physicians' decision patterns and endoscopic procedure risk. Patients with active bleeding and those on anticoagulants were excluded. Results: 723 procedures were reviewed. 664 fit inclusion and exclusion criteria for behavior of VTE ppx after procedure. 266 occurred prior to EMA. 108 of these were high-risk procedures and 158 were low risk. 398 occurred after EMA. 150 were high-risk procedure and 248 were low risk procedure. Excluding those who continued VTE ppx throughout the procedure, the odds of resuming ppx within 24 hours after EMA were (OR 2.718; 95% Cl 1.739-4.277; P= < 0.001) among those with high-risk as compared to low-risk procedures, and (OR 1.809; 95% Cl 1.035-3.177; P=0.0379) prior to EMA. From between the time frames of 24 and 48 hours, VTE resumption odds were (OR 2.369; 95% Cl 0.546-10.294; P=0.2326) after EMA and (OR 2.207; 95% Cl 0.816-6.153; P=0.1192) prior to EMA. From after 48 hours VTE ppx resumption odds were (OR 0.898; 95% Cl 0.408-1.961; P=0.7893) after EMA and (OR 0.611; 95% Cl 0.252-1.372; P=0.2498) prior to EMA.Table 1: Odds of Resuming venous thromboembolism prophylaxis after Endoscopic Procedure Associated with High-Risk Procedure Compared to Low-risk - Prior to and After the Implementation of Electronic Medical Alert ToolConclusion: VTE development is well-known to be a time-dependent phenomenon as demonstrated in studies in surgical patients. Earlier VTE is likely more important in patients with higher VTE risk. The EMA tool increased the odds that a high-risk procedure would receive VTE ppx within 24 hours though no direct comparison could be made with prior to EMA given overlapping confidence intervals. The EMA tool for VTE ppx could potentially improve quality of patient care in patients undergoing inpatient endoscopic procedures.
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