Factors associated with outcomes in congenital duodenal obstruction: population-based study.
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ABSTRACT:
SUBMITTER: Bethell GS
PROVIDER: S-EPMC10416685 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
Publications
Factors associated with outcomes in congenital duodenal obstruction: population-based study.
Bethell George S GS Long Anna-May AM Knight Marian M Hall Nigel J NJ
The British journal of surgery 20230801 9
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Project description:BACKGROUND: Understanding disease seasonality can provide guidance for future biomedical research. OBJECTIVE: To examine whether meteorological factors and calendar months impact duodenal ulcer (DU) exacerbations. DESIGN: We conducted a retrospective time series analysis of population-based claims data. PARTICIPANTS: DU inpatients (1997-2003; all endoscopy confirmed) from Taiwan, a small island nation, n = 160,510. Inpatient admission was used as a proxy for exacerbation because 98.5% of cases had hemorrhage or perforation or both. MEASUREMENTS: We used multivariate autoregressive integrated moving average (ARIMA) modeling to examine if DU admissions/100,000 was associated with calendar month, ambient temperature, relative humidity, rainfall, atmospheric pressure, and sunshine hours, controlling for available DU-relevant comorbidities. RESULTS: DU admissions increased with age. ARIMA modeling showed a February (Chinese New Year-related) trough in all age groups (all p < 0.001; adjusted for meteorological variables and comorbidities), consistent with a February dip in all-cause admissions. Among 35-49 and 50+ age groups, DU admissions were negatively associated with temperature (both p < 0.05; model R2 = 0.875 and 0.920, respectively), representing a winter peak and summer trough. Among the < or = 19 age group, sunshine hours and rainfall are positively associated with DU admissions (both p < 0.001; R2 = 0.565), representing a summer peak. CONCLUSION: Meteorological variables are associated with DU exacerbations, although the potential role of nonsteroidal anti-inflammatory drug (NSAID) use because of seasonal acute respiratory illness cannot be ruled out. We recommend in-depth studies using chart reviews of DU patients admitted during peak and trough (incidence) months to clarify whether meteorological factors or the associated seasonal peaks of respiratory and other illnesses involving NSAID use are responsible for the observed seasonality.
| S-EPMC2305852 | biostudies-other
Project description:IntroductionAnomalous congenital bands are a rare cause of intestinal obstruction, with only five previously reported cases involving duodenal obstruction. We present a fifth case of duodenal obstruction due to two congenital bands and provide a comprehensive literature review summarizing the clinical features of this condition.Case reportAn eight-year-old girl was admitted to our department with recurrent bilious vomiting and abdominal pain lasting six days. She had no significant past medical history, with no previous abdominal surgeries or trauma. Physical examination revealed abdominal tenderness and decreased bowel sounds. Contrast x-ray showed an obstructed passage of contrast through the third part of the duodenum. Abdominal ultrasound identified a strip-like hypoechoic structure compressing the third part of the duodenum. A diagnosis of duodenal obstruction was confirmed, and laparoscopic surgery combined with gastroduodenoscopy was performed. The procedure revealed two congenital bands adjacent to the duodenum: one extending from the duodenum to the transverse colon, and the other from the duodenum to the root of the mesentery. The bands were resected, and gastroduodenoscopy confirmed the resolution of the obstruction.DiscussionWe reviewed 93 cases of anomalous congenital bands, including the present one, comprising 33 adults and 60 children, with 71.0% of the cases involving males. Common symptoms included vomiting and abdominal pain, with physical examinations often showing tenderness and distension. Imaging techniques like plain x-ray, contrast x-ray, ultrasound, and computed tomography often indicated intestinal obstruction but were less effective in directly identifying congenital bands. All cases required abdominal surgery for diagnosis and treatment. Congenital bands were primarily found attached to the ileum or its mesentery and were resected in all cases, with a favorable postoperative prognosis. This case and the literature review provide valuable insights for clinical diagnosis and treatment.
| S-EPMC11784611 | biostudies-literature
Project description:BackgroundCardiac anomalies occur frequently in patients with congenital duodenal obstruction (DO). However, the exact occurrence and the type of associated anomalies remain unknown. Therefore, the aim of this systematic review is to aggregate the available literatures on cardiac anomalies in patients with DO.MethodsIn July 2022, a search was performed in PubMed and Embase.com. Studies describing cardiac anomalies in patients with congenital DO were considered eligible. Primary outcome was the pooled percentage of cardiac anomalies in patients with DO. Secondary outcomes were the pooled percentages of the types of cardiac anomalies, type of DO, and trisomy 21. A meta-analysis was performed to pool the reported data.ResultsIn total, 99 publications met our eligibility data, representing 6725 patients. The pooled percentage of cardiac anomalies was 29% (95% CI 0.26-0.32). The most common cardiac anomalies were persistent foramen ovale 35% (95% CI 0.20-0.54), ventricular septal defect 33% (95% CI 0.24-0.43), and atrial septal defect 33% (95% CI 0.26-0.41). The most prevalent type of obstruction was type 3 (complete atresias), with a pooled percentage of 54% (95% CI 0.48-0.60). The pooled percentage of Trisomy 21 in patients with DO was 28% (95% CI 0.26-0.31).ConclusionThis review shows cardiac anomalies are found in one-third of the patients with DO regardless of the presence of trisomy 21. Therefore, we recommend that patients with DO should receive preoperative cardiac screening.Level of evidenceII.
| S-EPMC10040397 | biostudies-literature
Project description:We report a rare case of incomplete congenital duodenal obstruction (Type 1 duodenal atresia) in association with situs inversus totalis presenting with gastric perforation in a neonate. The infantogram was suggestive of perforation with air under diaphragm along with dextrocardia. On exploration, a pin point perforation at fundus near lesser curvature along with situs inversus was noted. Primary closure of gastric perforation was done. Patient was then discharged on full breast feeds but was readmitted with intolerance to feeds and recurrent bilious vomiting. Further, upper GI contrast study revealed partial duodenal obstruction. On re-exploration, duodenal web with central aperture was seen and duodeno-duodenostomy was done.
| S-EPMC5538601 | biostudies-other
Project description:Neck pain is a musculoskeletal condition with high prevalence that may affect the physical, social, and psychological aspects of the individual, contributing to the increase in costs in society and business.To determine the prevalence of neck pain and associated factors in a population-based sample of adults aged 20 and more.Cross-sectional study based on a population survey. A total number of 600 individuals were interviewed in their homes, and the following data were collected: (1) participant characteristics (demographic, socioeconomic, and work-related aspects) using a pre-coded questionnaire; (2) physical activity level using the IPAQ; and (3) musculoskeletal symptoms using the Nordic questionnaire. Descriptive, bivariate, and Poisson regression analyses were performed.The prevalence of neck pain was 20.3% (95% CI 17.3-23.7). The adjusted analyses showed that individuals who were widowers or separated (PR=2.26; 1.42-5.88), had a low income (PR=1.32; 1.22-6.27) or low educational level (PR=1.83; 1.02-5.26), worked while sitting and leaning (PR=1.55; 1.08-2.40), and who reported having two or more diseases (PR=1.71; 1.55-6.31) remained associated with neck pain.This study reveals the high prevalence of neck pain and remarkable association with widowed/separated people who have low income and low educational level, who perform their occupational activities in sitting and leaning positions, and who reported having two or more diseases. Knowledge of these risk factors will contribute to the development of forms of assistance in which neck pain can be prevented and better managed.
| S-EPMC5537482 | biostudies-other
Project description:IntroductionThere has been an increase in the birth prevalence of congenital hypothyroidism (CH) since the introduction of newborn screening, both globally and in the UK. This increase can be accounted for by an increase in CH with gland in situ (CH-GIS). It is not known why CH-GIS is becoming more common, nor how it affects the health, development and learning of children over the long term. Our study will use linked administrative health, education and clinical data to determine risk factors for CH-GIS and describe long-term health and education outcomes for affected children.Methods and analysisWe will construct a birth cohort study based on linked, administrative data to determine what factors have contributed to the increase in the birth prevalence of CH-GIS in the UK. We will also set up a follow-up study of cases and controls to determine the health and education outcomes of children with and without CH-GIS. We will use logistic/multinomial regression models to establish risk factors for CH-GIS. Changes in the prevalence of risk factors over time will help to explain the increase in birth prevalence of CH-GIS. Multivariable generalised linear models or Cox proportional hazards regression models will be used to assess the association between type of CH and school performance or health outcomes.Ethics and disseminationThis study has been approved by the London Queen Square Research Ethics Committee and the Health Research Authority's Confidentiality Advisory Group CAG. Approvals are also being sought from each data provider. Obtaining approvals from CAG, data providers and information governance bodies have caused considerable delays to the project. Our methods and findings will be published in peer-reviewed journals and presented at academic conferences.
| S-EPMC8969044 | biostudies-literature
Project description:BackgroundUterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications.MethodsThis is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were reviewed retrospectively.ResultsA total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10000 births. Among the 41 cases, 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all cases, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcomes, such as fetal death. 24 (59.0%) of the ruptures occurred in anterior lower uterine segment. Changes in Fetal heart rate monitoring were the most reliable signs for rupture.ConclusionsIncidence of uterine rupture in the study area, Shanghai, China was consistent with developed countries. Further improvements in obstetric care and enhanced collaboration with referring health facilities were needed to ensure maternal and perinatal safety.
| S-EPMC8805328 | biostudies-literature
Project description:Congenital anomalies (CAs) are a leading cause of morbidity and mortality in early life. We aimed to assess the incidence, risk factors, and outcomes of major CAs in the State of Qatar. A population-based retrospective data analysis of registry data retrieved from the Perinatal Neonatal Outcomes Research Study in the Arabian Gulf (PEARL-Peristat Study) between April 2017 and March 2018. The sample included 25,204 newborn records, which were audited between April 2017 and March 2018, of which 25,073 live births were identified and included in the study. Maternal risk factors and neonatal outcomes were assessed for association with specific CAs, including chromosomal/genetic, central nervous system (CNS), cardiovascular system (CVS), facial, renal, multiple congenital anomalies (MCAs) using univariate and multivariate analyses. The incidence of any CA among live births was 1.3% (n = 332). The most common CAs were CVS (n = 117; 35%), MCAs (n = 69, 21%), chromosomal/genetic (51; 15%), renal (n = 39; 12%), CNS (n = 20; 6%), facial (14, 4%), and other (GIT, Resp, Urogenital, Skeletal) (n = 22, 7%) anomalies. Multivariable regression analysis showed that multiple pregnancies, parity ≥ 1, maternal BMI, and demographic factors (mother's age and ethnicity, and infant's gender) were associated with various specific CAs. In-hospital mortality rate due to CAs was estimated to be 15.4%. CAs were significantly associated with high rates of caesarean deliveries (aOR 1.51; 95% CI 1.04-2.19), Apgar < 7 at 1 min (aOR 5.44; 95% CI 3.10-9.55), Apgar < 7 at 5 min (aOR 17.26; 95% CI 6.31-47.18), in-hospital mortality (aOR 76.16; 37.96-152.8), admission to neonatal intensive care unit (NICU) or perinatal death of neonate in labor room (LR)/operation theatre (OT) (aOR 34.03; 95% CI 20.51-56.46), prematurity (aOR 4.17; 95% CI 2.75-6.32), and low birth weight (aOR 5.88; 95% CI 3.92-8.82) before and after adjustment for the significant risk factors. This is the first study to assess the incidence, maternal risk factors, and neonatal outcomes associated with CAs in the state of Qatar. Therefore, a specialized congenital anomaly data registry is needed to identify risk factors and outcomes. In addition, counselling of mothers and their families may help to identify specific needs for pregnant women and their babies.
| S-EPMC9905082 | biostudies-literature
Project description:Background/aimsSelf-expandable metal stents (SEMSs) can be applied to relieve colorectal obstruction secondary to incurable primary colorectal cancer or extracolonic malignancy. We aimed to identify factors associated with clinical success and the reintervention-free survival (RFS) after palliative stenting.MethodsCases of palliative SEMS placement between 2005 and 2019 were retrieved from the institutional database and reviewed retrospectively. Logistic regression and log-rank testing followed by Cox proportional hazard analyses were performed to investigate the predictors of the clinical success of palliative stenting and factors associated with RFS, respectively.ResultsA total of 593 patients underwent palliative stenting for malignant colonic obstruction (MCO). The technical and clinical success rates were 92.9% and 83.5%, respectively. Peritoneal carcinomatosis was a predictor of clinical failure (odds ratio, 0.33; 95% confidence interval [CI], 0.17 to 0.65) in the multivariate analysis. Peritoneal carcinomatosis (hazard ratio [HR], 2.48; 95% CI, 1.69 to 3.64) and stent expansion >90% on day 1 (HR, 1.62; 95% CI, 1.05 to 2.50) were associated with a shorter RFS. Neither clinical success nor RFS was associated with extracolonic malignancy. Re-obstruction, stent migration, and perforation were responsible for most reinterventions after clinically successful palliative stenting.ConclusionsIn patients requiring palliative stenting for MCO, peritoneal carcinomatosis was associated with both clinical failure and short RFS. Stent expansion >90% on postprocedural day 1 was another predictor of a short RFS after clinically successful stenting. A large prospective study is warranted to establish factors associated with RFS after successful palliative stenting for MCO.
| S-EPMC8283298 | biostudies-literature
Project description:ImportanceDetection of congenital cytomegalovirus (cCMV) infection has previously relied on targeted screening programs or clinical recognition; however, these approaches miss most cCMV-infected newborns and fail to identify those infants who are asymptomatic at birth but at risk for late-onset sensorineural hearing loss.ObjectiveTo determine the feasibility of using routinely collected newborn dried blood spots (DBS) in a population-based cCMV screen to identify infants at risk for hearing loss and describe outcomes of infants screened.Design, setting, and participantsThis diagnostic study of a population-based screening program in Ontario, Canada, took place from July 29, 2019, to July 31, 2023. All newborns with a DBS sample collected as part of routine care were screened using polymerase chain reaction (PCR) analysis for cCMV as a risk factor for hearing loss. Infants with positive DBS PCR results for cCMV were referred for confirmation of infection by urine PCR (the gold standard), as well as complete medical and audiologic assessments for sequelae of cCMV infection. Infants with possible or confirmed symptomatic cCMV were referred to pediatric infectious disease specialists for evaluation for potential treatment with valganciclovir.ExposureDetection of cCMV by polymerase chain reaction assay on a newborn DBS.Main outcomes and measuresNumber of infants with positive screening results successfully retrieved and confirmed to have cCMV and the timeliness of retrieval and symptomatic evaluation.ResultsOf 565 987 infants born in the screening period, 551 034 (97.4%) received cCMV screening on the DBS (45.7% female, 54.3% male). Of these infants, 689 (0.13%) screened positive for cCMV; 601 (87.2%) had cCMV infection confirmed and a complete assessment of sequelae of their congenital infection. Ninety-six infants with completed assessments (16.0%) were deemed to have cCMV symptoms, and 63 of these (65.6%) began valganciclovir treatment. Sensorineural hearing loss was confirmed in 34 of 96 infants (35.4%).Conclusions and relevanceThis program found acceptable and feasible implementation of a population-based screening program using routinely collected DBS samples, suggesting that it may serve as a template for jurisdictions considering universal cCMV screening. The program had a much lower than expected prevalence of cCMV-positive screens but still identified many children who would otherwise not have been diagnosed and who would benefit from ongoing audiologic surveillance.
| S-EPMC11877178 | biostudies-literature