Gynecologic Malignancy-Associated Venous Thromboembolism and Predictive Tool at Thammasat University Hospital

Objectives: Aims were to investigate the prevalence and risk factors of venous thromboembolism (VTE) in gynecologic malignancy cases. Value of screening tool (Caprini) for prediction of VTE was also assessed. Study design: A retrospective study of gynecologic malignancy subjects who underwent major gynecological operation via exploratory laparotomy at Thammasat University Hospital, Pathum Thani, Thailand from January 2015 to December 2020. Participants were categorized into VTE and non-VTE groups. Caprini score, associated laboratory and clinical factors of both groups were evaluated. Results: A total of 392 subjects were recruited into the study. Prevalence of VTE was 7.4 (29/392) percent. VTE was diagnosed in subjects with endometrial, ovarian and cervical cancer at percentage of 7.8 (15/192), 7.9 (11/138) and 5.7 (3/53), respectively. Demographic characters of both groups were comparable. VTE group had significant more Caprini score, platelets count and platelet lymphocyte ratio (PLR) than non-VTE group. Modified Caprini score (2 multiply Caprini score plus 1 multiply PLR) was generated for better VTE prediction. Sensitivity and specificity of Caprini (≥5.5) and modified Caprini scores (≥22.8) were 72.4 vs 39.4, and 79.3 vs 52.1 percent, respectively. Conclusion: Prevalence of VTE among gynecologic malignancy cases was 7.4 percent. The modified Caprini score was an alternative VTE predictive tool. Cut-off point of modified Caprini score at equal or more than 22.8 was proposed.     

Prevalence and pathophysiology of early dumping in patients after primary Roux-en-Y gastric bypass during a mixed-meal tolerance test

Background

Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB).

Prevalence and Associated Factors of Diabetes Mellitus in a Very Elderly Chinese Population: A Cross-sectional Study

Objectives This paper aimed to investigate the prevalence of diabetes mellitus(DM) and explore the associated risk factors in a very elderly southwest Chinese population.Methods From September 2015 to June 2016, a cross-sectional survey was conducted to obtain a representative sample of 1,326 participants over 80 years old living in Chengdu. The presence of DM was based on fasting plasma glucose(FPG) and 2-h plasma glucose(2-h PG) levels during an oral glucose tolerance test(OGTT). A logistic regression model was used to calculate the odds ratios(ORs) and 95%confidence intervals(CIs) of the potential associated factors.Results The participants' mean age was 83.5 ± 3.1 years. The overall prevalence of DM was 27.4%. The prevalence was higher in males(30.2%) than females(24.7%)(P = 0.02). The prevalence of DM increased with body mass index(BMI) and decreased with aging. The multivariate analysis suggested that male sex(OR = 1.433; 95% CI, 1.116–1.843), hypertension(OR = 1.439; 95% CI, 1.079–1.936), overweight or obesity(OR = 1.371; 95% CI, 1.023–1.834), high heart rate(≥ 75 beats/min; OR = 1.362; 95% CI,1.063–1.746), and abdominal obesity(OR = 1.615; 95% CI, 1.216–2.149) were all significantly positively correlated with DM. However, age was negatively correlated with DM(OR = 0.952; 95% CI,0.916–0.989).Conclusions The prevalence of DM and newly diagnosed DM in a very elderly southwest Chinese population was high. OGTT screening should be performed regularly in people aged ≥ 80 years to ensure timely diagnosis of DM.     

The late stage of Parkinson's –results of a large multinational study on motor and non-motor complications

IntroductionThere is little information on the late stages of parkinsonism.MethodsWe conducted a multicentre study in 692 patients with late stage parkinsonism in six European countries. Inclusion criteria were disease duration of ≥7 years and either Hoehn and Yahr stage ≥4 or Schwab and England score of 50 or less.ResultsAverage disease duration was 15.4 (SD 7.7) years and mean total UPDRS score was 82.7 (SD 22.4). Dementia according to MDS-criteria was present in 37% of patients. Mean levodopa equivalence dose was 874.1 (SD 591.1) mg/d. Eighty two percent of patients reported falls, related to freezing (16%) or unrelated to freezing (21% of patients) or occurring both related and unrelated to freezing (45%), and were frequent in 26%. Moderate-severe difficulties were reported for turning in bed by 51%, speech by 43%, swallowing by 16% and tremor by 11%. Off-periods occurred in 68% and were present at least 50% of the day in 13%, with morning dystonia occurring in 35%. Dyskinesias were reported by 45% but were moderate or severe only in 7%. Moderate-severe fatigue, constipation, urinary symptoms and nocturia, concentration and memory problems were encountered by more than half of participants. Hallucinations (44%) or delusions (25%) were present in 63% and were moderate-severe in 15%. The association with overall disability was strongest for severity of falls/postural instability, bradykinesia, cognitive score and speech impairment.ConclusionThese data suggest that current treatment of late stage parkinsonism in the community remains insufficiently effective to alleviate disabling symptoms in many patients.