Index Of Jannat 2
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Index Of Jannat 2
Given the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.
Patients completed the visual analog scale (VAS) questionnaire to assess their perceived level of neck pain at the preoperative, immediate postoperative, and postoperative follow-up time points (6 weeks, 12 weeks, 6 months). The VAS rates pain on a scale of 0 (no pain) to 10 (extreme pain).25 Other measured outcomes included the inpatient and postoperative complication rates, arthrodesis rates, and reoperation rates. Arthrodesis was defined as the presence of bony bridging on 3 sequential coronal and sagittal sections on CT scans routinely performed at 6 months after surgery. If fusion was not achieved at 6 months postoperatively and the patient was symptomatic at 1 year postoperatively, an additional CT scan was performed. The incidence of reoperation was evaluated for a 2-year period after each index procedure.
Statistical analysis was performed using Stata/MP 13.1 for Mac (StataCorp LP). Body mass index category was tested for an association with demographic, comorbidity, and operative characteristics using chi-square analysis or 1-way ANOVA for categorical and continuous variables, respectively. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in VAS pain scores, incidence of complications, arthrodesis rates, reoperation rates, and costs. Multivariate analyses were adjusted for patient age, sex, smoking status, diabetes status, modified CCI, and number of operative levels. Statistical significance was set at p
Rates of arthrodesis and the need for reoperation were also similar across the BMI spectrum in the present study. This suggests that patients, regardless of their BMI status, should be counseled similarly regarding the risks of undergoing an operation subsequent to their index procedure. This finding is in agreement with much of the literature regarding both cervical and lumbar fusion procedures.8,14,23 In a study of 672 patients undergoing ACDF, van Eck et al. determined that the need for revision was not affected by variables such as BMI, age, sex, smoking status, or number of levels fused.23 Owens et al., utilizing propensity-matched cohorts among 560 lumbar fusion patients with long-term follow-up, demonstrated that the revision rate and time between the index and revision surgeries did not differ among normal-weight, overweight, and obese groups.14 However, Jiang et al. presented contrasting findings in a meta-analysis of patients undergoing spine surgery, noting that obese patients had higher revision rates than nonobese patients.8 It is important to note, however, that the majority of revisions in that study were attributable to recurrent disc herniations after decompression procedures without fusion. This may indicate that BMI and body habitus play a different biomechanical role following decompression-only spinal procedures compared with fusion procedures.
Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists via a secure web browser-based platform. A semi-quantitative scoring index composed of 11 parameters encompassing tissue injury and response patterns commonly observed in routine clinical practice was constructed by three gastrointestinal pathologists, with input from EED experts. The pathologists then read the WSIs using the EED histology index, and inter-observer reliability was assessed. The histology index was further used to identify within- and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype.
We propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world.
The study of EED has been limited by the lack of a rigorously tested, reproducible histology index that can provide insight to the pathogenesis of this entity. In this study we report the first duodenal histology index that was developed using an unbiased approach, with excellent inter-observer reproducibility, for the study of EED. The EED histology index readily identified histologic features that are common or unique to cohorts of distinct geographic locations. Incorporating the histology index into future clinical studies will provide useful insight into the pathogenesis and for intervention strategy development.
Citation: Liu T-C, VanBuskirk K, Ali SA, Kelly MP, Holtz LR, Yilmaz OH, et al. (2020) A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth. PLoS Negl Trop Dis 14(1): e0007975.
It will be important to determine if the initial findings reported here extend to a larger and more diverse cohort of patients with EED. This scoring index is currently being applied to the approximately 550 biopsies by an expanded study team across five diverse sites: Zambia, Pakistan, Bangladesh and two North American comparison sites. This robust application will allow for refinement of the scoring system. This could include elimination of parameters that continue to demonstrate low performance in detection of EED and construction of a weighted algorithm of the index to more accurately define EED (e.g., certain parameters carry more weight toward the final score than others).
In summary, we described the development and validation of a new tool in the investigation of EED: a histology index designed for the study of small intestinal biopsies. The histology index can be used reproducibly by histopathologists to create parameter specific as well as overall pathology scores to compare to clinical and laboratory attributes in EED cohorts. The adoption of this index will aid not only in comparison of data within studies but in the comparison of data from separate studies. Given the durability of histologic specimens, there is an opportunity for this index to be used on archival samples from previous studies to provide historical comparison of cohorts in addition to those of contemporaneous and prospective studies. Perhaps most importantly, because the EED histopathology scoring index includes specific parameters indicative of injury processes, the system can be applied to identify histopathologic processes that distinguish EED from other enteropathies and to inform novel intervention targets and assess response to interventions.
In this study, comorbidity index was associated with signs of poor prognosis such as erosions, coxitis, and atlanto-axial dislocation. This confirmed the hypothesis that comorbidity can be a threat to the improvement in the long-term prognosis in RA patients.
A number of comorbidity instruments have been created to assess comorbidities in patients with rheumatic disease [12]. Comorbidity indices are tools used to quantify the total burden of comorbidity and help in the identification of patients with worse prognosis in terms of heightened mortality, hospitalization risk as well as decline in health-related quality of life. There are no guidelines stratifying the use of those different tools in clinical practice. Many tools have been created such as the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) [12]. But, there are not specific to rheumatic diseases. The rheumatic disease comorbidity index (RDCI) was developed for use specifically in rheumatology patients and was considered as RA-specific indices [13]. It has been used in only few studies [13,14,15,16,17,18]. It showed his superiority to predict physical disability and mortality for RA patients [12]. However, the link between RDCI and different disease characteristics in particular structural damages and the occurrence of extra-articular manifestations as pulmonary involvement is not well known. This study aimed to quantify the impact of comorbidities among RA patients using a validated tool in RA (the RDCI) and to explore the association between comorbidities and disease characteristics.