Risk of Venous Thromboembolism in Acute Necrotizing Pancreatitis: A Large Database Study.

OBJECTIVES: Studies on the incidence of venous thromboembolism (VTE) in acute pancreatitis (AP) are scarce. We conducted a large database study to evaluate this relationship. METHODS: Data were extracted from a large electronic health record (Explorys; IBM Watson Health, Armonk, NY). We identified patients with AP in 2018 and 2019, analyzing VTE incidence at 30 days after diagnosis of AP. Univariate and multivariate analyses were performed to identify risk factors associated with VTE. RESULTS: A total of 25,620 cases of acute necrotizing pancreatitis (ANP) and 155,800 cases of acute nonnecrotizing pancreatitis (ANNP) were identified. The incidence of VTE was 7.1% for ANP, compared with 2.8% in ANNP (P < 0.001). On multivariate analysis, ANP conferred significantly greater odds of VTE (adjusted odds ratio, 2.78; 95% confidence interval, 2.73-2.84; P < 0.001), independent of other variables. In those with ANP, the presence of VTE was associated with a significantly higher mortality (23.5% vs 15.9%, P < 0.001). CONCLUSIONS: Acute necrotizing pancreatitis carries near 2.5-fold risk of VTE, and a 3-fold risk of PE, compared with those with ANNP. Venous thromboembolism development in ANP is associated with higher mortality.

Prevalence and manifestations of diagnosed fibromuscular dysplasia by sex and race: Analysis of >4500 FMD cases in the United States.

OBJECTIVE: Fibromuscular Dysplasia (FMD) is a rare non-atherosclerotic non-inflammatory vascular disease associated with arterial aneurysms and dissections. The epidemiology of FMD is not well understood. We sought to characterize the epidemiology of FMD utilizing a large aggregated electronic medical record database. METHODS: We used a commercial database (Explorys, IBM Watson), which aggregates data from electronic health records from 26 major integrated healthcare systems in the United States. Fibromuscular dysplasia cases were identified using a unique systemized nomenclature of medical terminology (SNOMED CT) term. We calculated the overall and age-, race-, and sex-based prevalence of FMD, and evaluated sex and race-specific differences in manifestations. RESULTS: A total of 40,566,670 individuals were active in the database from January 2015 to January 2020. Of these, 4860 had a diagnosis of FMD with an overall prevalence of 12.0 cases per 100,000 individuals. The majority of patients with FMD were female (n=4130, 85.0%), Caucasian (n=3960, 80.5%) and adults aged 18 to 65 years (n=2610, 53.7%). FMD was more common in women (prevalence 18.4 per 100,000) than men (4.0 per 100,000) and among Caucasians (15.8 per 100,000) than African Americans (11.2 per 100,000). Men and African Americans with FMD were more likely to have traditional atherosclerotic risk factors (hypertension, diabetes mellitus type 2, smoking, obesity, hyperlipidemia, chronic kidney disease), and vascular manifestations (stroke, renal infarction, claudication), compared with women and Caucasians. Men with FMD were more likely to have dissection of aorta and renal artery as well as aneurysm of vertebral artery, coronary artery, aorta and iliac artery. African-Americans were more likely to have ruptured aortic aneurysms than Caucasians. CONCLUSIONS: The overall prevalence of FMD in this large aggregated electronic medical record study is estimated at 12.0 per 100,000 persons. FMD is more common in women and Caucasians, with variable characteristics and manifestations.

Health Related Quality of Life in Patients with Single Lower Limb Amputation.

OBJECTIVE: To determine the effects of age, cause of amputation, and anatomic level of amputation on the health related quality of life (HRQOL) in individuals with unilateral lower limb amputation. STUDY DESIGN: Across-sectional survey. PLACE AND DURATION OF STUDY: The Armed Forces Institute of Rehabilitation Medicine, from August 2014 to February 2015. METHODOLOGY: Short Form-36 (SF-36) health related quality of life (HRQOL). Survey questionnaire was used to collect data. The responses were scored by using the quality metric health outcomes™ scoring software 4.5. The scores were entered and analysed in SPSS version 21. RESULTS: Atotal of 52 patients were inducted with mean age of 30.71 ±7.50 years. Mean physical component summary (PCS) was lower than mental component summary (MCS) (38.7 vs. 44.8). RP and RE scores were found to be significantly associated with gender (p=0.024 and p=0.003, respectively). Age group was also significantly associated with RP(p=0.037) and SF (p=0.041). When SF-36 domains were compared with level of amputation (i.e. trans-tibial and transfemoral), none of the domains showed any statistically significant results. CONCLUSION: Age and indication affect different aspects of quality of life but level of amputation did not. If these are known and anticipated before any type of rehabilitation, this could help in anticipation of health consequences and prevention accordingly.

Knowledge and attitude regarding Ebola virus disease among medical students of Rawalpindi: A preventable threat not yet confronted.

OBJECTIVE: To assess the knowledge and attitude regarding Ebola virus disease (EVD) among medical students of Rawalpindi. METHODS: A descriptive cross sectional study was carried out in a medical college of Rawalpindi from September 2014-November 2014. About 400 students were inducted with 77% (n=308) response rate. After taking informed verbal consent from students and administration, a pre-designed and pre-tested questionnaire was circulated among students of third, fourth and final year MBBS as well as third and fourth year BDS. The data collected was entered and analyzed using SPSS 20. RESULTS: The response rate was 77% (308/400). About 244 (79.2%) of students had heard about EVD before. One hundred and sixty four (53.2%) of the students correctly identified that no treatment is available for EVD as yet. Also 163 (52.9%) said that no vaccine was available against the virus either. Washing hands every time after touching a patient in clinics/wards was important for 151 (49.0%) while 223 (72.4%) claimed to use proper techniques to dispose off used injections. CONCLUSION: Students have basic knowledge regarding EVD. However, there is deficient information regarding the diagnosis and precautionary measures required to control it.