Abstract Background Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle ...the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. Methods We searched 6 databases until June 2015. Inclusion criteria: 1. Assessment of any previous SITB a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. Results From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR= 22.53, 95%CI: 18.40–27.58). Suicide attempts were also associated with a history of previous SITB (OR= 3.48, 95%CI: 2.71–4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. Limitations There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. Conclusions Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.
Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.
To assess ...sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.
A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.
Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.
Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.
Objective
To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults.
...Method
We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment childhood physical, sexual, emotional abuse, neglect, (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population‐based case–control or cohort studies; and (3) subjects aged 12–26 years. Random models were used for meta‐analyses (Reg: CRD42013005775).
Results
From 23 682 articles, 29 articles with 143 730 subjects for meta‐analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73–2.28); for child maltreatment, 2.25 (95% CI: 1.85–2.73); for bullying, 2.39 (95% CI: 1.89–3.01); for dating violence, 1.65 (95% CI: 1.40–1.94); and for community violence, 1.48 (95% CI: 1.16–1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46–25.07).
Conclusion
Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.
Objective
To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults.
Method
We conducted a systematic review of articles ...published until January 2017. We identified 26 883 potential papers; 1701 full‐text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta‐analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables.
Results
Finally, 41 studies were included, involving participants aged 12–26 years for a systematic review, and 24 articles were included for meta‐analysis. The meta‐analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65).
Conclusion
Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.
There is an increasing acknowledgment that suicidal behaviors are negatively affected by school failure in adolescents and young adults. However, no systematic reviews with meta-analysis have been ...performed to evaluate the strength of this association. We assessed the magnitude of association of school failure as risk factor for suicide behavior in adolescents and young adults. Six international databases were searched up until January 2017. Inclusion criteria were: (1) assessment of suicide attempt or suicide; (2) case–control or cohort studies; (3) subjects aged 12–26 years; (4) school failure evaluated, which includes low academic performance, school dropout, school expulsion, and grade repetition. Random effect models were used; population attributable risks (PARs) were estimated. From 26,883 potentially eligible articles, 14 (62,298 individuals) were included. Meta-analyses could only be performed for suicide attempt. A history of school dropout (OR 6.44, 95% CI 3.03–13.65), low academic performance (OR 1.48, 95% CI 1.22–1.81), and school failure (OR 1.98, 95% CI 1.49–2.64) were significant risks of suicide attempts. Highest PAR estimates were 9.9% for school dropout, 5.1% for low academic performance, and 6.7% for any school failure. Only one study has been found for suicide, but results suggest an association with school dropout. Results show that the students who had school failure are at higher risk of suicide attempt and probably for suicide. The development of effective programs to prevent suicidal behaviors in educational settings may be an effective strategy to reduce these behaviors. However, reliable conclusions from this review are limited by the small amount of included studies for analysis.
PROSPERO Registration Number
CRD42013005775.
INTRODUCTION AND OBJECTIVESRadical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer. ...Sixty-four percent of patients submitted to this procedure present postoperative complications, with urinary infection being responsible in 20-40% of cases. The aim of this project is to assess the rate of urinary infection as a cause of re-admission after cystectomy, and to identify protective and predisposing factors for urinary infection in our environment. Finally, we will evaluate the outcomes after the establishment of a prophylactic antibiotic protocol after removal of ureteral catheters. MATERIAL AND METHODSRetrospective descriptive study of cystectomized patients in the Urology Service of the Hospital Clínico Universitario of Zaragoza, from January 2012 to December 2018. A urinary tract infection (UTI) prevention protocol after catheter removal is established for all patients since October 2017. RESULTSUTI is responsible for 54.7% of readmissions, with 55.1% of these being due to UTI after removal of ureteral catheters. Of the patients who received with prophylaxis, 9.5% presented UTIs after withdrawal, compared to 10.6% in the group of patients without prophylaxis. The patient who is re-admitted for UTI after withdrawal has a mean catheter time of 24.3±7.2 days, compared to 24.5±7.4 days for patients in the group without UTI (P=.847). CONCLUSIONSThe type of urinary diversion performed is not related to the rate of urinary infection. The regression model does not identify antibiotic prophylaxis, nor catheter time, as independent factors of UTI after catheter removal.
The implementation of Enhanced Recover After Surgery (ERAS) multimodal rehabilitation protocols in radical cystectomy has shown to improve outcomes in hospital stay and complications. The aim of this ...analysis is to evaluate the impact of laparoscopic surgery on radical cystectomy within a multimodal rehabilitation program.
The study was carried out in a third level center between 2011 and 2020 including patients with bladder cancer submitted to radical cystectomy according to an ERAS (Enhanced Recovery After Surgery) protocol and the Spanish Multimodal Rehabilitation Group (GERM) with 20 items to be fulfilled.
A total of 250 radical cystectomies were performed throughout the study period, 42.8% by open surgery (OS) and 57.2% by laparoscopic surgery (LS). The groups are comparable in demographic and clinical variables (p > 0.05).
Operative time was longer in the LS group (248.4 ± 55.0 vs. 286.2 ± 51.9 min; p < 0.001). However, bleeding was significantly lower in the LS group (417.5 ± 365.7 vs. 877.9 ± 529.7 cc; p < 0.001), as was the need for blood transfusion (33.6% vs. 58.9%; p < 0.001). Postoperative length of stay (11.5 ± 10.5 vs. 20.1 ± 17.2 days; p < 0.001), total and major complications were also significantly lower in this group (LS). The readmission rate was lower in the LS group but not significantly (36.4% vs. 29.4%; p = 0.237). The difference between 90-day mortality in both groups was not statistically significant (2.8% LS vs. 4.3% OS; p = 0.546). The differences were maintained in the multivariate models.
Laparoscopic surgery within a multimodal rehabilitation program increases operative time but significantly decreases intraoperative bleeding, transfusion requirements, postoperative length of stay, and complications.
Los protocolos de rehabilitación multimodal ERAS en cistectomía radical han demostrado ser útiles para mejorar los resultados en la estancia hospitalaria y las complicaciones. El objetivo de este análisis es evaluar el impacto de la cirugía laparoscópica (CL) dentro de un programa de rehabilitación multimodal.
Se incluyeron en el estudio los pacientes intervenidos de cistectomía radical por cáncer vesical en un centro de tercer nivel, entre los años 2011 y 2020, según el protocolo Enhanced Recovery After Surgery (ERAS) y el Grupo Español de Rehabilitación Multimodal (GERM) con 20 ítems a cumplir.
Se realizaron 250 cistectomías radicales durante el periodo de estudio, el 42,8% cirugía abierta (CA) y el 57,2% CL. Los grupos son comparables para las principales variables demográficas y clínicas (p > 0,05).El tiempo quirúrgico es mayor en el grupo de CL (248,4 ± 55,0 vs. 286,2 ± 51,9 min; p < 0,001). Sin embargo, el sangrado es significativamente menor en CL (417,5 ± 365,7 vs. 877,9 ± 529,7 cc; p < 0,001), así como la necesidad de transfusión (33,6 vs. 58,9%; p < 0,001). También es significativamente menor en este grupo (CL) la estancia postoperatoria (11,5 ± 10,5 vs. 20,1 ± 17,2 días; p < 0,001), y las complicaciones totales y mayores. La tasa de reingresos fue menor en el grupo de CL, pero no de forma significativa (36,4 vs. 29,4%; p = 0,237). La diferencia entre mortalidad a 90 días de ambos grupos no resulta estadísticamente significativa (2,8 CL vs. 4,3% CA; p = 0,546). Las diferencias se mantienen en los modelos multivariantes.
La CL, dentro de un programa de rehabilitación multimodal, aumenta el tiempo quirúrgico, pero disminuye significativamente el sangrado intraoperatorio, la necesidad de transfusión, la estancia postoperatoria y las complicaciones.
Identification of very long-chain acyl-CoA dehydrogenase deficiency is possible in the expanded newborn screening (NBS) due to the increase in tetradecenoylcarnitine (C14:1) and in the C14:1/C2, ...C14:1/C16, C14:1/C12:1 ratios detected in dried blood spots. Nevertheless, different confirmatory tests must be performed to confirm the final diagnosis. We have revised the NBS results and the results of the confirmatory tests (plasma acylcarnitine profiles, molecular findings, and lymphocytes VLCAD activity) for 36 cases detected in three Spanish NBS centers during 4 years, correlating these with the clinical outcome and treatment. Our aim was to distinguish unambiguously true cases from disease carriers in order to obtain useful diagnostic information for clinicians that can be applied in the follow-up of neonates identified by NBS.
Increases in C14:1 and of the different ratios, the presence of two pathogenic mutations, and deficient enzyme activity in lymphocytes (<12% of the intra-assay control) identified 12 true-positive cases. These cases were given nutritional therapy and all of them are asymptomatic, except one. Seventeen individuals were considered disease carriers based on the mild increase in plasma C14:1, in conjunction with the presence of only one mutation and/or intermediate residual activity (18–57%). In addition, seven cases were classified as false positives, with normal biochemical parameters and no mutations in the exonic region of ACADVL. All these carriers and the false positive cases remained asymptomatic. The combined evaluation of the acylcarnitine profiles, genetic results, and residual enzyme activities have proven useful to definitively classify individuals with suspected VLCAD deficiency into true-positive cases and carriers, and to decide which cases need treatment.
Background and aimSEosinophilic esophagitis (EoE) is an ever growing clinical-pathological condition that generates great morbility and in which symptom control still presents itself as a challenge, ...having a variety of therapies described throughout the medical literature. The aim of this study is to review the cases handled by our unit in a 6 year period.MethodsRetrospective descriptive unicentric study which analyses clinic, diagnostic methods, indirect disease markers, allergy tests and therapy employed in patients diagnosed with EoE between january 2008 and december 2014. Diagnosis was established with>15 eosinophils (Eos) per high power field (HPF) in esophageal epitelium associated to unresponsiveness to exclusive antiacid treatment.ResultsData from 29 patients was collected, 75.9% male. Mean clinical debut age was 9.1±3.6 years, with a 0.4 years-delay to diagnostic (IQR 0.2–1) and follow-up time of 3 years (IQR 1.9–4). History of allergies was present in 31%. Sensitisation to food allergens was found in 44.7% of the patients, whilst 27.6% were sensitised to pneumoallergens. Various histological alterations were found, 2 of them with pronounced collagenation of the lamina propria in the whole length of the oesophagus, and 1 which presented simultaneous waves and incomplete relaxation of the lower esophageal sphincter in the manometry.Concerning treatment, 13.8% were on exclusion diet, 3.8% used elemental formulas and 37.9% carried out both simultaneously. Montelukast was employed in 27.6%, proton pump inhibitors in 41.4%, viscous oral budesonide (VOB) in 31%, swallowed fluticasone in 3,4%, whilst systemic steroids were used in 13.8%. Only 1 patient presented stenosis, and one other esophagical motor dysfunction.ConclutionSIt is worth highlighting male genre, dysphagia and history of food impaction, together with history of allergy and food sensitisation. Being the disease’s natural history still unkown, doubts arise concerning the clinical handling of these patients: wether to treat symptoms alone or to persue reversion of the changes in the mucosa to prevent complications such as stenosis. Esophageal samples must have enough lamina propria and a follow-up must be made in order to find relation between remodelling and motor dysphunction in adulthood. New therapies such as topic corticoids as viscous oral budesonide, are useful. It is important to prospectively analyse the efectiveness of this therapy for long-term symptom control.
Low concentrations of plasma citrulline and arginine have been reported in children under various pathological conditions.
Plasma citrulline and arginine levels undergo different kinetics during the ...early days of critical illness in children according to the severity of symptoms and can be correlated with other clinical and laboratory parameters associated with the SIR.
A single-center prospective observational study in patients 7 days to 14 years admitted to pediatric intensive care unit (PICU). Citrulline and arginine blood levels (blood in dry paper, analysis by mass spectrometry in tandem), acute phase reactants and clinical data were collected on admission, at 12 h, 24 h, 3 and 7 days.
A total of 44 critically ill patients were included and control group was formed by 42 healthy children. The citrulline and arginine kinetic analysis showed: 1) Citrulline falls significantly (P<.05) at 12 h of admission; levels remain low until day 7 and begin progressive increase again. 2) Arginine is already lowered at 6h, although an earlier rise occurs (3rd day). 3. The decrease of citrulline in the first 3 days of admission positively correlates with arginine kinetics. Bivariate analysis showed: 1) Correlation of elevated citrulline on the 7th day with shorter duration of mechanical ventilation, lower PICU stay and lower occurrence of complications. The levels of citrulline still descended at day 7 are associated with increased CRP/procalcitonin elevation at first 24 h. 2) The greatest decrease of arginine in the first 12 h is associated with a longer PICU stay and greater number of complications and increase of acute phase reactants at 3 days.
There are decreased levels of arginine and citrulline in the first days at PICU, with recovery at the 3rd and 7th day respectively, and a relationship between a greater decrease and a worse outcome and between a longer income and a higher serum CRP/procalcitonin.
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