predisposing factors

诱发因素
  • 文章类型: Journal Article
    支气管哮喘(BA)仍然是一种难以诊断的疾病。在BA的发展中已经描述了各种因素,但迄今为止,这种慢性疾病的病因没有明确的证据。COVID-19的出现导致了哮喘的大流行过程和免疫学特征。然而,没有明确的哮喘背景和COVID-19后的数据。引起支气管哮喘发展的各种触发因素之间存在相关性。现在很明显,SARS-CoV-2病毒是引发因素之一。COVID-19影响了哮喘的病程。目前,目前尚不清楚哮喘在COVID-19感染期间或之后是否进展。根据一些研究的结果,在COVID-19后的人群中发现哮喘的发展之间存在显着差异。轻度哮喘和中度哮喘不会增加COVID-19感染的严重程度。然而,重度BA的口服类固醇治疗和住院治疗与较高的COVID-19严重程度相关.SARS-CoV-2感染的影响是保护因素之一。它导致严重的支气管哮喘的发展。COVID-19期间严重哮喘患者使用奥马珠单抗的积累经验,在大流行期间接受奥马珠单抗,强烈建议继续使用奥马珠单抗治疗是安全的,可能有助于预防COVID-19的严重病程。使用奥马珠单抗进行哮喘的靶向治疗也可能有助于减少与COVID-19相关的严重哮喘。然而,需要进一步的研究来证明奥马珠单抗的效果.数据分析应该持续下去,根据COVID-19后哮喘病程的结果,有不同程度的严重程度。
    Bronchial asthma (BA) continues to be a difficult disease to diagnose. Various factors have been described in the development of BA, but to date, there is no clear evidence for the etiology of this chronic disease. The emergence of COVID-19 has contributed to the pandemic course of asthma and immunologic features. However, there are no unambiguous data on asthma on the background and after COVID-19. There is correlation between various trigger factors that provoke the development of bronchial asthma. It is now obvious that the SARS-CoV-2 virus is one of the provoking factors. COVID-19 has affected the course of asthma. Currently, there is no clear understanding of whether asthma progresses during or after COVID-19 infection. According to the results of some studies, a significant difference was identified between the development of asthma in people after COVID-19. Mild asthma and moderate asthma do not increase the severity of COVID-19 infection. Nevertheless, oral steroid treatment and hospitalization for severe BA were associated with higher COVID-19 severity. The influence of SARS-CoV-2 infection is one of the protective factors. It causes the development of severe bronchial asthma. The accumulated experience with omalizumab in patients with severe asthma during COVID-19, who received omalizumab during the pandemic, has strongly suggested that continued treatment with omalizumab is safe and may help prevent the severe course of COVID-19. Targeted therapy for asthma with the use of omalizumab may also help to reduce severe asthma associated with COVID-19. However, further studies are needed to prove the effect of omalizumab. Data analysis should persist, based on the results of the course of asthma after COVID-19 with varying degrees of severity.
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  • 文章类型: Journal Article
    简介:长期以来,人们一直认为创伤是甲癣最重要和最常见的诱发因素之一。然而,直接创伤在真菌指甲感染发病机制中的作用直到最近才在一系列32例创伤后单指甲真菌病中得到阐明。很少研究由于脚和脚趾异常引起的反复创伤的重要性。研究目的:这是一项在三个国家的专业指甲诊所进行的为期6年的多中心单作者观察研究。在此期间,作者拍摄的所有患者照片均经过脚趾甲改变筛查,检查所有的脚趾甲癣病例是否包含足够的信息来评估潜在的足部和脚趾异常。特别注意了外翻的存在,外翻指间,hallux直立人,大脚趾向内旋转,小脚趾向外旋转,以及张开的脚。只有通过两种组织病理学明确证明真菌指甲感染的病例,真菌学文化,或聚合酶链反应(PCR)被接受。结果:1653例,185个是甲癣,通过真菌学文化证明,PCR,或组织病理学。其中,179涉及至少一个大脚趾甲,和6影响一个或多个较小的脚趾甲。三个病人向我们咨询了另一种脚趾甲疾病,甲癣被诊断为第二种疾病。八名患者有明显的癣。相对较少的患者具有正常的大脚趾位置(n=9)。大多数病例有轻度至明显的外翻(HV)(105)和拇指外翻(HVI)(143),在43例患者中观察到了直立肌,观察到HV和HVI的组合83次。讨论:脚和脚趾变形的百分比非常高,令人惊讶。可以假设这不仅是一个重要的致病因素,而且可能在真菌感染的定位中起重要作用。因为在仅影响小脚趾的甲癣中没有发现明显的拇指偏差。由于甲癣的管理是一个复杂的过程,涉及确定病原真菌的确切诊断,指甲的生长速度,甲癣的类型,它的持续时间,和诱发因素,脚趾位置的异常可能很重要。最常见的诱发因素是外周循环功能不全,静脉淤滞,周围神经病变,免疫缺陷,和医源性免疫抑制,而足部问题没有得到足够的重视。不幸的是,许多诱发因素和加重因素难以治疗或纠正。一般来说,在向患者解释甲癣的治疗方法时,这些矫形改变的重要性没有得到充分讨论,或者只是没有得到充分讨论。鉴于治疗趾甲霉菌病所遇到的问题,应该改变这种态度,以使患者理解为什么尽管在实验室中具有出色的最低抑制药物浓度,但治愈率却如此低。
    Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory.
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  • 文章类型: Journal Article
    背景:我们进行了一项全国性的基于人群的病例对照研究,以分析胎儿期间存在的听力损失(HL)的潜在诱发因素,围产期,和早产儿童的产后时期。
    方法:这项研究招募了21,576名出生在妊娠37周以下的儿童;2002年至2015年间出生的3,596名HL和17,980名听力正常的儿童,性别匹配。诊断时的年龄,和注册时间。从三个全国性数据库的串联数据中提取总体危险因素,直到诊断HL。
    结果:孕产妇HL,母体糖尿病,特别是1型糖尿病,妊娠32周时或之前是HL的主要产科危险因素。通过剖宫产出生并接受产前类固醇和硫酸镁联合治疗的早产儿童发生HL的风险显着降低。耳朵畸形是HL的关键预测因子。出生后的主要危险因素包括癫痫发作和耳毒性药物的使用。早产儿诊断为支气管肺发育不良,坏死性小肠结肠炎,脑出血发生HL的风险增加。先天性CMV感染和复发性急性中耳炎也是早产儿童HL的独立产后因素。
    结论:为了减少早产儿童中儿童HL的发生率,对早产相关后果和可治疗原因的积极管理,以及早期发现和充分干预的纵向听力学随访至关重要.
    BACKGROUND: We conducted a nationwide population-based case-control study to analyse potential predisposing factors for hearing loss (HL) that present during the fetal, perinatal, and postnatal periods in prematurely born children.
    METHODS: This study enrolled 21,576 children born at < 37 weeks of gestation; 3,596 with HL and 17,980 with normal hearing born between 2002 and 2015, matched for sex, age at diagnosis, and enrollment time. Data were abstracted from the concatenation of three nationwide databases for overall risk factors till the diagnosis of HL.
    RESULTS: Maternal HL, maternal diabetes, particularly type 1 diabetes mellitus, and at or before 32 weeks of gestation were the major obstetric risk factors for HL. Prematurely born children who were born via cesarean section and received a combination of antenatal steroids and magnesium sulfate exhibited a significantly reduced risk of developing HL. Ear malformation was a critical predictor for HL. The major postnatal risk factors included seizure and ototoxic drugs use. Premature infants diagnosed with more than 1 diagnosis of bronchopulmonary dysplasia, necrotizing enterocolitis, and intracerebral hemorrhage were at an increased risk of developing HL. Congenital CMV infection and recurrent acute otitis were also independent postnatal factors for HL in prematurely born children.
    CONCLUSIONS: To reduce the incidence of childhood HL in prematurely born children, aggressive management of premature birth-related consequences and treatable causes and longitudinal audiological follow-up with early detection and adequate intervention are crucial.
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  • 文章类型: Journal Article
    沙尘污染对微机电系统(MEMS)中流量传感器敏感结构的影响是当前MEMS可靠性研究的热点问题。然而,先前关于沙尘污染的研究仅搜索了由于沙尘覆盖物中的热传导而导致的传感器精度下降,尚未搜索其他故障诱发因素。本文旨在通过采用模型模拟和样品测试相结合的方法,发现沙尘污染下MEMS流量传感器精度失效的其他诱发因素。流量传感器的精度主要体现在其热敏电阻的大小上,所以在这项研究中,选择热敏电阻值的输出值作为电气特性参数,以并排验证传感器精度的变化。结果表明,在排除热传导的影响后,当沙粒落在装置上时,沙粒之间的相互摩擦会产生静电电流;通过静电耗散到热敏电阻的原理,测量原理导致电阻值变小,当沙尘静止一段时间时,阻值恢复到预期水平。这一发现为在MEMS失效模式中寻找失效诱发因素提供了理论指导。
    The effect of sand and dust pollution on the sensitive structures of flow sensors in microelectromechanical systems (MEMS) is a hot issue in current MEMS reliability research. However, previous studies on sand and dust contamination have only searched for sensor accuracy degradation due to heat conduction in sand and dust cover and have yet to search for other failure-inducing factors. This paper aims to discover the other inducing factors for the accuracy failure of MEMS flow sensors under sand and dust pollution by using a combined model simulation and sample test method. The accuracy of a flow sensor is mainly reflected by the size of its thermistor, so in this study, the output value of the thermistor value was chosen as an electrical characterization parameter to verify the change in the sensor\'s accuracy side by side. The results show that after excluding the influence of heat conduction, when sand particles fall on the device, the mutual friction between the sand particles will produce an electrostatic current; through the principle of electrostatic dissipation into the thermistor, the principle of measurement leads to the resistance value becoming smaller, and when the sand dust is stationary for some time, the resistance value returns to the expected level. This finding provides theoretical guidance for finding failure-inducing factors in MEMS failure modes.
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  • 文章类型: Journal Article
    义齿性口腔炎(DS)是可移动的完整和部分义齿佩戴者中非常常见的疾病,全球患病率为20-67%。工业发达国家和贫困国家都受到这种疾病的影响。DS通常与假牙不合适或假丝酵母属真菌感染有关。念珠菌通常在口腔微生物群中发现,但它可能对患有潜在疾病的老年人的健康有害。因此,本研究的目的是提供有关流行病学的最新信息,病因学,通过系统评价与DS相关的念珠菌物种的全球分布。几个数据库,包括Medline,WebofScience,还有Scopus,被用来对前20年发表的文献进行广泛的搜索。研究的选择由两位作者进行。提取的数据如下:作者,出版年份,国家,样品,DS的频率,诊断口腔炎的方法,念珠菌的种类,危险因素,和疾病的病因。JBI关键评估工具用于评估研究质量。最终,28项研究纳入了系统评价.21项研究调查了DS,虽然有7项研究检查了使用可移动假牙的患者中的念珠菌定植。结果表明,DS的主要原因包括义齿的类型,连续佩戴假牙,和念珠菌生物膜的形成,这是由不良的牙齿卫生促进。此外,以前的研究已经确定了唾液流的重要性,唾液成分,和唾液pH值。当前审查的结果表明,监测假牙佩戴者对DS的外观至关重要,尤其是由于全身性疾病而导致免疫力受损的患者。最后,频繁的随访应包括临床检查和对腭粘膜和义齿粘膜表面的微生物拭子。
    Denture stomatitis (DS) is a very common disease in wearers of removable complete and partial dentures with a worldwide prevalence in the range of 20-67%. Both industrially developed and impoverished nations are affected by the illness. DS is often associated with ill-fitting dentures or a fungal infection with Candida spp. Candida is normally found in the oral cavity microbiota, but it can be harmful to the health of elderly people with underlying diseases. Therefore, the purpose of the present study is to offer the most recent information about the epidemiology, etiology, and global distribution of Candida species associated with DS through a systematic review. Several databases, including Medline, Web of Science, and Scopus, were used to conduct an extensive search of the literature published in the previous 20 years. The selection of studies was performed by two authors. The extracted data were as follows: author, year of publication, country, sample, frequency of DS, method of diagnosing stomatitis, species of Candida, risk factors, and etiology of the disease. The JBI Critical appraisal tools were used to assess the quality of the studies. Eventually, twenty-eight studies were included in the systematic review. Twenty-one studies investigated DS, while seven studies examined Candida colonization in patients using removable dentures. The results show that the main causes of DS include the type of dentures, continuous wearing of dentures, and the formation of a Candida biofilm, which is facilitated by poor dental hygiene. Additionally, previous studies have pinpointed the significance of the salivary flow, saliva composition, and salivary pH. The findings of the current review indicate that it is crucial to monitor denture wearers for the appearance of DS, especially the patients whose immunity has been impaired due to a systemic condition. Finally, frequent follow-ups should include a clinical examination and microbial swabs of the palatal mucosa and the mucosal surface of the denture.
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  • 文章类型: Journal Article
    背景:在过去的几十年中,全髋关节置换术(THA)的数量逐渐增加,假体周围骨折(PPF)的患者比例显著增加.在这种情况下,清楚了解THA后患者发生PPF的因素以及这些不良并发症对整体医疗负担的影响的必要性不可低估.
    方法:基于全国住院患者样本(NIS)数据库,我们确定了2016年至2019年在美国接受THA的患者(使用ICD-10CMP代码).将患者分为2组;A组-维持PPF的患者,B组-未维持PPF的患者。关于病人的人口统计资料,分析了医疗合并症;和住院时间(包括住院时间和发生的费用);并在两组之间进行了比较。
    结果:总体而言,367,890例患者接受了THA,其中4,425人(1.2%)患有PPF(A组)。其余患者归入B组(363,465名患者)。在多变量分析(MVA)的基础上,女性的比例明显更高,老年患者,A组的急诊入院(p<0.001),住院时间,A组的支出和死亡率也明显更高(p=0.001),基于MVA,唐氏综合征(奇数比3.15,p=0.01),H/O结肠造口术(奇数比2.09,p=0.008),肝硬化(奇数比2.01,p<0.001),帕金森病(奇数比1.49,p=0.004),病态肥胖(奇数比1.44,p<0.001),超级肥胖(奇数比1.49,p=0.03),和H/OCABG(冠状动脉旁路移植术;奇数比值1.21,p=0.03)显示与PPF显著相关(A组)。
    结论:PPF患者需要更高的紧急入院率,住院时间更长,入院相关支出增加。女性性别,高龄,病态或超级肥胖,和存在医疗合并症(如唐氏综合症,肝硬化,帕金森病,以前的结肠造口术,和先前的CABG)显着增加THA后PPF的风险。这些医疗条件必须保持在临床医生的头脑和密切随访需要在这种情况下,以减轻这些并发症。
    BACKGROUND: With a progressive rise in the number of total hip arthroplasties (THA) over the past decades, the proportion of patients sustaining peri-prosthetic fractures (PPF) has been substantially increasing. In this context, the need for clearly understanding the factors predisposing patients to PPF following THA and the impact of these adverse complications on the overall healthcare burden cannot be understated.
    METHODS: Based upon the Nationwide Inpatient Sample (NIS) database, the patients who underwent THA in the United States between 2016 and2019 (with ICD-10 CMP code) were identified. The patients were divided into 2 groups; group A - patients who sustained PPF and group B - those who did not. The information about the patients\' demographic profile, medical comorbidities; and hospital admission (including length of stay and expenditure incurred) were analysed; and compared between the 2 groups.
    RESULTS: Overall, 367,890 patients underwent THA, among whom 4,425 (1.2%) sustained PPF (group A). The remaining patients were classified under group B (363,465 patients). On the basis of multi-variate analysis (MVA), there was a significantly greater proportion of females, elderly patients, and emergent admissions (p < 0.001) in group A. The length of hospital stay, expenditure incurred and mortality were also significantly higher (p = 0.001) in group A. Based on MVA, Down\'s syndrome (odd\'s ratio 3.15, p = 0.01), H/O colostomy (odd\'s ratio 2.09, p = 0.008), liver cirrhosis (odd\'s ratio 2.01, p < 0.001), Parkinson\'s disease (odd\'s ratio 1.49, p = 0.004), morbid obesity (odd\'s ratio 1.44, p < 0.001), super obesity (odd\'s ratio 1.49, p = 0.03), and H/O CABG (coronary artery bypass graft; odd\'s ratio 1.21, p = 0.03) demonstrated significant association with PPF (group A).
    CONCLUSIONS: Patients with PPF require higher rates of emergent admission, longer hospital stay and greater admission-related expenditure. Female sex, advanced age, morbid or super obesity, and presence of medical comorbidities (such as Down\'s syndrome, cirrhosis, Parkinson\'s disease, previous colostomy, and previous CABG) significantly enhance the risk of PPF after THA. These medical conditions must be kept in clinicians\' minds and close follow-up needs to be implemented in such situations so as to mitigate these complications.
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  • 文章类型: Journal Article
    胃肠道线虫(GIN)加剧了干旱对牛生存的影响。传统系统的不足使得探索土著知识(IK)以创建耐旱和GIN弹性的牛群变得越来越重要。该研究的目的是评估干旱期间控制GIN的本地策略。与IK专家进行了面对面的访谈,以深入了解其重要性,GIN控制的方法和排名。专家们确定了86头牛,用来检验他们的断言。使用的控制方法是使用诱发因素识别易受高GIN负荷影响的牛,使用粪便外观诊断GIN负荷,和使用植物疗法的治疗。专家将诱发因素列为最关键的控制策略,并确定了身体状况,类,性别,外套颜色,妊娠状态和泌乳状态是高GIN负担的诱发因素。薄,年长的,深色的牛,以及怀孕和泌乳的奶牛,被认为容易患GIN。然而,怀孕状态,外衣颜色和性别与高GIN负担显著相关。奶牛有高GIN负担的可能性是公牛的2.6倍。深色牛比浅色牛更可能有3.5倍高的GIN负担,怀孕母牛的可能性是未怀孕母牛的4.9倍。深色怀孕母牛极易受到高GIN负担的影响。总之,在购买基金会股票时,易感因素的知识为选择决策提供了信息。易受高GIN负荷影响的牛在干旱期间优先考虑,或者在资源稀缺的地方被淘汰。
    Gastrointestinal nematodes (GIN) exacerbate the impact of droughts on the survival of cattle. The inadequacies of the conventional system make it increasingly important to explore indigenous knowledge (IK) to create drought-tolerant and GIN resilient herds. The objective of the study was to assess the indigenous strategies for controlling GIN during droughts. Face-to-face interviews with experts on IK were conducted to give insight into the importance, methods and ranking of GIN control. The experts identified 86 cattle that were used to test their assertions. The control methods used were identifying cattle that were susceptible to high GIN loads using predisposing factors, diagnosis of GIN burdens using faecal appearance, and treatment using phytotherapy. Experts ranked predisposing factors as the most critical control strategy and identified body condition, class, sex, coat colour, pregnancy status and lactation status as predisposing factors to high GIN burdens. Thin, older, dark-coloured cattle, as well as pregnant and lactating cows, were considered susceptible to GIN. However, pregnancy status, coat colour and sex were significantly associated with high GIN burdens. Cows were 2.6 times more likely to have high GIN burdens than bulls. Dark-coloured cattle were 3.5 times more likely to have high GIN burdens than light-coloured ones, and the likelihood of pregnant cows was 4.9 times higher than non-pregnant cows. A dark-coloured pregnant cow was extremely susceptible to high GIN burdens. In conclusion, knowledge of predisposing factors informs selection decisions when purchasing foundation stock. Cattle that are susceptible to high GIN loads are prioritised during droughts or culled where resources are scarce.
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  • 文章类型: Journal Article
    这项研究的目的是确定出院后30天内儿科人群中计划外再入院的患病率。找出他们背后可能的原因,并建立计划外录取的预测模型。
    对25,211名患者进行了回顾性图表回顾研究,以确定利雅得阿卜杜拉国王专业儿童医院(KASCH)出院后30天内再入院的患病率。沙特阿拉伯,2019年1月1日至2021年12月31日。使用BestCare电子健康记录系统收集数据,并使用Jamovi统计软件1.6版进行分析。
    在研究期间住院的25211名患者中,30天内计划外再入院的发生率为1291例(5.12%).在1291名患者中,1.91%的人随后有计划外再入院。在57.8%的病例中,第一次计划外再入院的原因与第一次入院的原因有关,在90.64%的病例中,随后的非计划再入院的原因与第一次非计划再入院的原因有关。首次非计划再入院的最常见原因是术后并发症(18.75%),而肺炎(10.81%)是随后非计划再入院的最常见原因.还发现大多数随后的计划外再入院的患者患有孤立的中枢神经系统病理或慢性复杂的医学状况。
    国际上,儿科患者在30天内的计划外再入院率估计为6.5%,这与我们的研究结果相当(5.12%)。发现第一次和随后的计划外再入院的大多数原因与初级入院有关。再入院的诊断/原因因患者年龄而异。应建立儿科再入院的预测模型,以便实施预防措施。
    UNASSIGNED: The objectives of this study were to determine the prevalence of unplanned readmissions in the pediatric population within 30 days of discharge, identify the possible reasons behind them, and develop a predictive model for unplanned admissions.
    UNASSIGNED: A retrospective chart review study of 25,211 patients was conducted to identify the prevalence of readmissions occurring within 30 days of discharge from the King Abdullah Specialized Children\'s Hospital (KASCH) in Riyadh, Saudi Arabia, between Jan 1, 2019, and Dec 31, 2021. The data were collected using the BestCare electronic health records system and analyzed using Jamovi statistical software version 1.6.
    UNASSIGNED: Among the 25,211 patients admitted to the hospital during the study period, the prevalence of unplanned readmission within 30 days was 1291 (5.12%). Of the 1291 patients, 1.91% had subsequent unplanned readmissions. In 57.8% of the cases, the cause of the first unplanned readmission was related to the cause of the first admission, and in 90.64% of the cases, the cause of the subsequent unplanned readmission was related to the cause of the first unplanned readmission. The most common reason for the first unplanned readmission was postoperative complications (18.75%), whereas pneumonia (10.81%) was the most common reason for subsequent unplanned readmissions. Most patients with subsequent unplanned readmissions were also found to have either isolated central nervous system pathology or chronic complex medical conditions.
    UNASSIGNED: Internationally, the rate of unplanned readmissions in pediatric patients has been estimated to be 6.5% within 30 days, which is comparable to the results of our study (5.12%). Most of the causes of first and subsequent unplanned readmission were found to be related to primary admission. The diagnosis/causes of readmission vary depending on the patient\'s age. A predictive model for pediatric readmission should be established so that preventive measures can be implemented.
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  • 文章类型: Journal Article
    目的:研究澳大利亚地区氯氮平停药的原因并测量氯氮平诱发的心肌炎(CIM)的发生率,将观察到的CMI率与澳大利亚和世界的报告进行比较,并讨论了该地区与CIM发病率相关的因素。
    方法:该研究是对327名服用氯氮平的患者进行的回顾性临床审核。在治疗的前六周,所有患者均通过mandatoryCIM监测方案进行监测。使用六个标准评估CIM诊断的有效性。分析了社会人口统计学和临床因素以及氯氮平处方实践与CIM的关联。该研究无法检查共存的医学疾病,共同开的精神药物,遗传学,和环境因素。
    结果:在平均治疗时间为19.5天后,9.8%的患者出现了CIM。CIM的诊断在所有病例中都被认为是有效的。性别,治疗开始时的年龄,种族,累积氯氮平剂量,剂量滴定,氯氮平/去甲氯氮平比率与CIM无关。
    结论:亨特地区的TheCIM率高于澳大利亚和世界其他地区,并且在采用监测方案后有所增加。过度诊断,患者的年龄和性别,种族,累积氯氮平剂量,加药滴定,氯氮平代谢率与高发生率无关。共病的可能作用,共同处方的精神药物,遗传,CIM的病因和环境因素需要进一步研究。亨特地区CIM率高的原因需要进一步探索。
    OBJECTIVE: To study the causes of clozapine treatment discontinuation and measure clozapine-induced myocarditis (CIM) rates in an Australian region, to compare the observed rates of CMI with reports from Australia and the world, and discuss factors related to CIM incidence rates in the region.
    METHODS: The study is a retrospective clinical audit of 327 patients prescribed clozapine. All patients were monitored by the mandatory CIM monitoring protocol for the first six weeks of treatment. The validity of a diagnosis of CIM was assessed using six criteria. Socio-demographic and clinical factors and clozapine prescription practices were analysed for their association with CIM. The study could not examine co-existing medical illness, co-prescribed psychotropic medication, genetics, and environmental factors.
    RESULTS: CIM occurred in 9.8 % of the cohort after a mean treatment duration of 19.5 days. The diagnosis of CIM was considered valid in all cases. Gender, age at the start of treatment, ethnicity, cumulative clozapine dose, dose titration, and clozapine/norclozapine ratio were unrelated to CIM.
    CONCLUSIONS: The CIM rate in the Hunter region was higher than in the rest of Australia and the world and increased after adopting the monitoring protocol. Over-diagnosis, patient\'s age and gender, ethnicity, cumulative clozapine dose, dosing titration, and clozapine metabolism rate were unrelated to the high occurrence rates. The possible role of comorbid illnesses, co-prescribed psychiatric medications, genetic, and environmental factors in the etiology of CIM requires further study. The reasons underlying the high rates of CIM in the Hunter region need further exploration.
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  • 文章类型: Journal Article
    众所周知,细菌菌斑是引起牙周疾病和龋齿疾病出现的主要病因。牙周病可以影响儿童和青少年,并以牙龈炎的形式表现出来,但也有慢性牙周炎的早期形式以及与局部或一般因素相关的侵袭性边缘性牙周炎。由于缺乏对特定症状的了解,临床医生经常无法诊断早期牙周炎。某些系统性疾病,比如心血管疾病,可以为牙周病的严重表现的出现和进展创造有利条件;最近的研究表明,患有牙周病的人患心血管疾病的风险增加。患有先天性或获得性心血管疾病的儿童由于口腔中微生物的生长而导致并发症的风险增加,有感染性心内膜炎的风险.具体目的是强调患有心血管疾病的儿童与没有这些疾病的儿童之间的牙周健康之间存在的差异。分析组包括124名患者,以儿童和青少年为代表,年龄在7至17岁之间,根据是否存在心血管疾病和牙周病,将其分为四个亚组。对每位患者进行了专门的临床检查,和牙周临床参数进行量化(菌斑指数,牙龈出血指数,牙龈指数,社区牙周指数的治疗需求)并与一般状况的诊断相关。被诊断患有牙周病的患者接受了专门的治疗,并在治疗后3个月被要求进行对照访问。统计学分析表明,对于心血管疾病患者,具有更高的临床参数值的亚组之间存在显着差异。此外,对照组无心血管疾病的患者对治疗的反应较好.本研究强调了三个因素在牙周病进展中的相互作用:牙龈下微生物群,免疫系统反应和环境因素。
    It is well known that bacterial plaque is the main etiological factor that causes the appearance of periodontal diseases and carious disease. Periodontal diseases can affect children and adolescents and are manifested in the form of gingivitis, but also the early form of chronic periodontitis as well as aggressive marginal periodontitis associated with local or general factors. Early periodontitis is frequently undiagnosed by clinicians due to a lack of knowledge of the specific symptoms. Certain systemic diseases, such as cardiovascular diseases, can create favorable conditions for the appearance and progression of severe manifestations of periodontal disease; also, recent research highlights that individuals with periodontal disease present an increased risk of developing cardiovascular diseases. Children with congenital or acquired cardiovascular diseases are at increased risk for complications resulting from the growth of microorganisms in the oral cavity, presenting a risk of infective endocarditis. The specific aim was to highlight the existing differences between the periodontal health of children with cardiovascular diseases and that of children without these diseases. The analyzed group included 124 patients, represented by children and adolescents, aged between 7 and 17 years, who were divided into four subgroups depending on the presence or absence of cardiovascular diseases and periodontal disease. A specialized clinical examination was performed for each patient, and periodontal clinical parameters were quantified (plaque index, gingival bleeding index, gingival index, community periodontal index of treatment needs) and associated with the diagnosis of general condition. Patients diagnosed with periodontal disease underwent specialized treatment and were called to a control visit 3 months after treatment. Statistical analysis showed significant differences between subgroups with much higher values of clinical parameters for patients with cardiovascular disease. Also, the response to the treatment was better in the case of patients in the control subgroup without cardiovascular diseases. The present study highlighted the interaction of three factors in the progression of periodontal diseases: subgingival microbiota, immune system response and environmental factors.
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