Infliximab treatment does not result in an increased risk of intestinal strictures or obstruction in Crohn?s Disease patients: accent I study results

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

Download Full-text

A Meta-Analysis of Extracorporeal Anticoagulants in Pediatric Continuous Kidney Replacement Therapy

Journal of Intensive Care Medicine ◽

10.1177/0885066621992751 ◽

2021 ◽

pp. 088506662199275

Author(s):

Rupesh Raina ◽

Nirav Agrawal ◽

Kirsten Kusumi ◽

Avisha Pandey ◽

Abhishek Tibrewal ◽

...

Keyword(s):

Replacement Therapy ◽

Meta Analysis ◽

Kidney Injury ◽

Electrolyte Imbalance ◽

Therapeutic Modality ◽

Regional Citrate Anticoagulation ◽

Increased Risk ◽

Study Results ◽

Significant Difference ◽

Kidney Replacement Therapy

Objective: Continuous kidney replacement therapy (CKRT) is the primary therapeutic modality utilized in hemodynamically unstable patients with severe acute kidney injury. As the circuit is extracorporeal, it poses an increased risk of blood clotting and circuit loss; frequent circuit losses affect the provider’s ability to provide optimal treatment. The objective of this meta-analysis is to evaluate the safety and efficacy of the extracorporeal anticoagulants in the pediatric CKRT population. Data Sources: We conducted a literature search on PubMed/Medline and Embase for relevant citations. Study Selection: Studies were included if they involved patients under the age of 18 years undergoing CKRT, with the use of anticoagulation (heparin, citrate, or prostacyclin) as a part of therapy. Only English articles were included in the study. Data Extraction: Initial search yielded 58 articles and a total of 24 articles were included and reviewed. A meta-analysis was performed focusing on the safety and effectiveness of regional citrate anticoagulation (RCA) vs unfractionated heparin (UFH) anticoagulants in children. Data Synthesis: RCA had statistically significantly longer circuit life of 50.65 hours vs. UFH of 42.10 hours. Two major adverse effects metabolic alkalosis and electrolyte imbalance seen more commonly in RCA compared to UFH. There was not a significant difference in the risk of systemic bleeding when comparing RCA vs. UFH. Conclusion: RCA is the preferred anticoagulant over UFH due to its significantly longer circuit life, although vigilant circuit monitoring is required due to the increased risk of electrolyte disturbances. Prostacyclin was not included in the meta-analysis due to the lack of data in pediatric patients. Additional studies are needed to strengthen the study results further.

Download Full-text

Subclinical Cardiac Organ Damage in Patients with Moderate to Severe Psoriasis

Journal of Clinical Medicine ◽

10.3390/jcm10112440 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2440

Author(s):

Anja Linde ◽

Eva Gerdts ◽

Kåre Steinar Tveit ◽

Ester Kringeland ◽

Helga Midtbø

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Treatment Initiation ◽

Severity Index ◽

Organ Damage ◽

Left Ventricular ◽

Infliximab Treatment ◽

Increased Risk ◽

Psoriasis Severity

We explored the association between subclinical cardiac organ damage (OD) with comorbidities and psoriasis severity in 53 psoriasis patients on infliximab treatment (age 47 ± 15 years, 30% women) and 99 controls without psoriasis (age 47 ± 11 years, 28% women). Cardiac OD was assessed by echocardiography as the presence of increased left ventricular (LV) relative wall thickness (RWT), LV hypertrophy or dilated left atrium. Psoriasis severity was graded using the psoriasis area and severity index (PASI). The prevalence of hypertension was 66% in psoriasis vs. 61% in controls (p = 0.54) and cardiac OD seen in 51 and 73%, respectively (p = 0.007). Psoriasis was associated with a lower prevalence of cardiac OD (odds ratio (OR) 0.32, 95% confidence interval (CI) 0.13–0.77, p = 0.01) independent of age, sex, smoking, body mass index, and hypertension. Among psoriasis patients, hypertension was associated with increased risk of subclinical cardiac OD (OR 6.88, 95% CI 1.32–35.98, p = 0.02) independent of age, sex, and body mass index. PASI at treatment initiation was associated with a higher RWT at follow-up, independent of sex, age, and hypertension (β 0.36, p = 0.006) while no association with current PASI was found. In conclusion, cardiac OD was less prevalent in psoriasis patients on infliximab treatment than controls. Hypertension was the major covariable for subclinical cardiac OD in psoriasis.

Download Full-text

Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.6273 ◽

2021 ◽

Vol 67 (4) ◽

pp. 409-415

Author(s):

Köksal Sarıhan ◽

Hülya Uzkeser ◽

Akın Erdal

Keyword(s):

Social Isolation ◽

Fall Risk ◽

Nottingham Health Profile ◽

Risk Index ◽

Control Group ◽

Healthy Individuals ◽

Increased Risk ◽

Study Results ◽

Significant Difference ◽

Risk Of Falls

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

Download Full-text

Impact of Mobile Health Devices for the Detection of Atrial Fibrillation: Systematic Review

JMIR mhealth and uhealth ◽

10.2196/26161 ◽

2021 ◽

Vol 9 (4) ◽

pp. e26161

Author(s):

Tom E Biersteker ◽

Martin J Schalij ◽

Roderick W Treskes

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Mobile Health ◽

Standard Care ◽

Detection Rate ◽

Increased Risk ◽

Study Results ◽

Statistical Heterogeneity ◽

Study Participants

Background Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is increasing. Early diagnosis is important to reduce the risk of stroke. Mobile health (mHealth) devices, such as single-lead electrocardiogram (ECG) devices, have been introduced to the worldwide consumer market over the past decade. Recent studies have assessed the usability of these devices for detection of AF, but it remains unclear if the use of mHealth devices leads to a higher AF detection rate. Objective The goal of the research was to conduct a systematic review of the diagnostic detection rate of AF by mHealth devices compared with traditional outpatient follow-up. Study participants were aged 16 years or older and had an increased risk for an arrhythmia and an indication for ECG follow-up—for instance, after catheter ablation or presentation to the emergency department with palpitations or (near) syncope. The intervention was the use of an mHealth device, defined as a novel device for the diagnosis of rhythm disturbances, either a handheld electronic device or a patch-like device worn on the patient’s chest. Control was standard (traditional) outpatient care, defined as follow-up via general practitioner or regular outpatient clinic visits with a standard 12-lead ECG or Holter monitoring. The main outcome measures were the odds ratio (OR) of AF detection rates. Methods Two reviewers screened the search results, extracted data, and performed a risk of bias assessment. A heterogeneity analysis was performed, forest plot made to summarize the results of the individual studies, and albatross plot made to allow the P values to be interpreted in the context of the study sample size. Results A total of 3384 articles were identified after a database search, and 14 studies with a 4617 study participants were selected. All studies but one showed a higher AF detection rate in the mHealth group compared with the control group (OR 1.00-35.71), with all RCTs showing statistically significant increases of AF detection (OR 1.54-19.16). Statistical heterogeneity between studies was considerable, with a Q of 34.1 and an I2 of 61.9, and therefore it was decided to not pool the results into a meta-analysis. Conclusions Although the results of 13 of 14 studies support the effectiveness of mHealth interventions compared with standard care, study results could not be pooled due to considerable clinical and statistical heterogeneity. However, smartphone-connectable ECG devices provide patients with the ability to document a rhythm disturbance more easily than with standard care, which may increase empowerment and engagement with regard to their illness. Clinicians must beware of overdiagnosis of AF, as it is not yet clear when an mHealth-detected episode of AF must be deemed significant.

Download Full-text

Risk of nasopharyngeal cancer in productive sectors and formaldehyde exposure in bakeries industry

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1376 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Miligi ◽

S Massari ◽

R I Paredes Alpaca ◽

S Piro ◽

C Airoldi ◽

...

Keyword(s):

Occupational Exposure ◽

Nasopharyngeal Cancer ◽

Cancer Registries ◽

International Agency ◽

Work Process ◽

Occupational Risks ◽

Industrial Sectors ◽

Increased Risk ◽

Study Results ◽

Traditional Sector

Abstract Background The International Agency for Research on Cancer evaluated formaldehyde (F) as carcinogenic for human in association with Nasopharyngeal Cancer (NPC). Occupational exposure to F occurs in many industrial sectors also in those non-traditional. For example in Tuscany F was detected in a bakery where a NPC case had ever worked. Methods In this study a) A case control approach (OCCAM) was used for monitoring occupational risks based on current information sources. Three Italian Regional Operating Centres, collected NPC cases from cancer registries and/or hospital discharge records. Controls were randomly sampled from the regional health service population data. Occupational histories were available through record linkage with the social security pension database (INPS). Study results were reported by industrial sectors, area and gender. b) A specific study on F exposure was conducted in bakeries and pastry industry carrying out measurements to determine the concentration of F in specific tasks and positions. Results 717 cases linked with INPS database. Increased ORs for several industrial sectors such as iron and steel, wood and plastic were observed. In two regions also health and veterinary services and hairdressers were at increased risk, but based on few cases of exposed workers. In the non traditional sector of bakeries and pastry industries, where workplaces were monitored, high levels of F in personal air samplings were found, in particular in processes that involve a strong leavening. Conclusions Many productive sectors, in which F exposure could occurred, were observed to be at higher risk. The measurements performed in the non traditional sector monitored, confirmed the F exposure in some phases of the work process. With this study we contributed to increased knowledge on the risk of NPC within the monitoring system of occupational risks, and to deepen exposure to F in a non traditional productive sector such as bakeries and pastry industries. Key messages The epidemiological method used (OCCAM) in this study provides further information on the role of occupational exposure in the development of nasopharyngeal cancer. The measurements performed in the bakeries and pastry industries provide new additional information on the exposure to formaldehyde in some work process phases of a non-traditional productive sector.

Download Full-text

Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

QJM ◽

10.1093/qjmed/hcab113.030 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmed Zaky ◽

Hebatallah AM Shaaban ◽

Mohamed OA Dawoud ◽

Kareem SEF Madbouly ◽

Shaymaa M Deifalla

Keyword(s):

Mechanical Ventilation ◽

Rating Scale ◽

Neurodevelopmental Outcomes ◽

Neurodevelopmental Delay ◽

Increased Risk ◽

Study Results ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Significant Difference

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

Download Full-text

64 Association between Risk of Osteoporotic Fractures with Spinal Morphology, Muscle Strength and Physical Performance

Age and Ageing ◽

10.1093/ageing/afz164.64 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv13-iv17

Author(s):

Siew Kuan Chua ◽

Devinder ◽

KA Singh ◽

Bala S Rajaratnam ◽

Sabarul Afian Mokhtar ◽

...

Keyword(s):

Muscle Strength ◽

Fracture Risk ◽

Physical Performance ◽

Tracking System ◽

Osteoporotic Fractures ◽

Limited Information ◽

Functional Impairments ◽

Mineral Density ◽

Increased Risk ◽

Study Results

Abstract Osteoporotic related fractures (OF) are associated with functional impairments and declined quality of life. Low bone mineral density is one of the main risk factor for OF. However, there is limited information regarding the association of spinal morphology, muscle strength and physical performance with OF. The aim of the study was to examine association between risk of osteoporotic fractures with spinal morphology (thoracolumbar curvature and back extensors muscle strength), muscle strength and physical performance. 105 adults aged 50 years and above (69.3+ 8.5 years) were recruited for this cross-sectional study from a spine orthopaedic clinic. Thoracolumbar curvature, back extensors (BEMS) and handgrip (HGS) muscle strength were measured using an electromagnetic tracking system, a load-cell system and hand-held dynamometer respectively. Physical performance was assessed using Short Physical Performance Battery (SPPB). Participants were categorised for major osteoporotic fracture risk (major OF) with cut-point 10% using fracture risk calculator (FRAX®) with BMD. Student t-test analysis demonstrated that there is a significant (p<0.05) difference between participants with low risk and moderate to high risk of major OF for BEMS, HGS, and SPPB. Adjusted logistic models (forward and backward), showed that lower HGS and physical performance were associated with increased risk of major OF (HGS: OR = 0.18 [95% CI, 0.07–0.48]; SPPB: OR = 0.32[95% CI, 0.13–0.80]). Our study results suggest that declined muscle strength and physical performance is associated with higher risk of OF. It is important to promote optimum muscle strength and physical performance among older adults in the prevention of OF.

Download Full-text

Prescribing Analgesics to Older People: A Challenge for GPs

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17114017 ◽

2020 ◽

Vol 17 (11) ◽

pp. 4017

Author(s):

Ljiljana Trtica Majnarić ◽

Thomas Wittlinger ◽

Dunja Stolnik ◽

František Babič ◽

Zvonimir Bosnić ◽

...

Keyword(s):

Older People ◽

Chronic Diseases ◽

Musculoskeletal Diseases ◽

Age Groups ◽

Treatment Strategies ◽

Opioid Analgesics ◽

Psychotropic Medications ◽

High Rate ◽

Increased Risk ◽

Study Results

Background: Due to population aging, there is an increase in the prevalence of chronic diseases, and in particular musculoskeletal diseases. These trends are associated with an increased demand for prescription analgesics and an increased risk of polypharmacy and adverse medication reactions, which constitutes a challenge, especially for general practitioners (GPs), as the providers who are most responsible for the prescription policy. Objectives: To identify patterns of analgesics prescription for older people in the study area and explore associations between a long-term analgesic prescription and comorbidity patterns, as well as the prescription of psychotropic and other common medications in a continuous use. Methods: A retrospective study was conducted in 2015 in eastern Croatia. Patients were GP attenders ≥40 years old (N = 675), who were recruited during their appointments (consecutive patients). They were divided into two groups: those who have been continuously prescribed analgesics (N = 432) and those who have not (N = 243). Data from electronic health records were used to provide information about diagnoses of musculoskeletal and other chronic diseases, as well as prescription rates for analgesics and other medications. Exploratory methods and logistic regression models were used to analyse the data. Results: Analgesics have been continuously prescribed to 64% of the patients, mostly to those in the older age groups (50–79 years) and females, and they were indicated mainly for dorsalgia symptoms and arthrosis. Non-opioid analgesics were most common, with an increasing tendency to prescribe opioid analgesics to older patient groups aged 60–79 years. The study results indicate that there is a high rate of simultaneous prescription of analgesics and psychotropic medications, despite the intention of GPs to avoid prescribing psychotropic medications to patients who use any option with opioid analgesics. In general, receiving prescription analgesics does not exceed the prescription for chronic diseases over the rates that can be found in patients who do not receive prescription analgesics. Conclusion: Based on the analysis of comorbidities and parallel prescribing, the results of this study can improve GPs’ prescription and treatment strategies for musculoskeletal diseases and chronic pain conditions.

Download Full-text

717. Cumulative Incidence of Asthma/Wheezing Among Neonates/Infants/Toddlers Clinically Diagnosed with Respiratory Syncytial Virus Infection in the United States: A Retrospective Database Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.724 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S257-S258

Author(s):

Veronique Wyffels ◽

Maartje Smulders ◽

Sandra Gavart ◽

Debasish Mazumder ◽

Rohit Tyagi ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Syncytial Virus ◽

Cumulative Incidence ◽

The United States ◽

Term Infants ◽

Increased Risk ◽

Study Results ◽

Syncytial Virus ◽

Time Required

Abstract Background The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database. Methods Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0–<3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01 January 2008–31 March 2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/−), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses. Results 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF− were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the three cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis. 3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the three cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis. The CI rates of AW in the 1/3/5-year HRF+/− cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1. Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (P < 0.05) likelihood of AW, for HRF+ and HRF− patients at each follow-up year. Conclusion Thirty-eight percent of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF−, developed AW in the 5 years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results. Disclosures V. Wyffels, Janssen: Employee, Salary. M. Smulders, SmaertAnalyst: Consultant, Consulting fee. S. Gavart, Janssen: Employee, Salary. D. Mazumder, SmartAnalyst: Consultant, Consulting fee. R. Tyagi, SmartAnalyst: Consultant, Consulting fee. N. Gupta, SmartAnalyst: Consultant, Consulting fee. R. Fleischhackl, Janssen: Employee, Salary.

Download Full-text