scholarly journals 527. Lower Risk of ICU Admission with Remdesivir in Patients Hospitalized with COVID-19 Pneumonia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
Sarah Lim ◽  
Pamela Schreiner ◽  
Alan Lifson ◽  
Erica Bye ◽  
Kathryn Como-Sabetti ◽  
...  
Keyword(s):  
Lower Risk ◽  
Treated Group ◽  
Supplemental Oxygen ◽  
Population Based ◽  
Chest Imaging ◽  
Inpatient Mortality ◽  
Surveillance Network ◽  
Icu Admission ◽  
Metro Area ◽  
The Mean

Abstract Background Remdesivir (RDV) was approved by FDA in October 2020 for use in hospitalized patients with COVID-19. We examined the association between RDV treatment and ICU admission in patients hospitalized with COVID-19 pneumonia requiring supplemental oxygen (but not advanced respiratory support) in MN. Methods COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) is population-based surveillance of hospitalized laboratory confirmed cases of COVID-19. We analyzed COVID-NET cases ≥18 years hospitalized between Mar 23, 2020 and Jan 23, 2021 in MN for which medical record reviews were complete. On admission, included cases had evidence of COVID-19 pneumonia on chest imaging with oxygen saturation < 94% on room air or requiring supplemental oxygen. Cases were excluded if treated with RDV after ICU admission. Multivariable logistic regression was performed to assess the association between RDV treatment and ICU admission. Results Complete records were available for 8,666 cases (36% of admissions statewide). 1,996 cases were included in the analysis, of which 908 were treated with RDV. 83% of cases were residents of the 7-county metro area of Minneapolis-St. Paul. Mean age was 59.7 years (IQR 48-72), 55% were male, and the mean RDV treatment duration was 4.8 days (range 2-15). The proportion of cardiovascular disease (30.6% vs 23.9%, p=.003), renal disease (16.6% vs 7.6%, p< .001), and diabetes (34.7% vs 29.5%, p=0.01) was higher in the RDV untreated group, while obesity (22.3% vs 8.4%, p< .001) and dexamethasone use (54.7% vs 15%, p< .001) was more common in the RDV treated group. RDV untreated patients were more likely to be admitted to an ICU (18% vs 8.9%, p< .001) and had higher inpatient mortality than those treated with RDV (11% vs 4.4%, p< .001). After adjustment for dexamethasone use, age, sex and diabetes, treatment with RDV was associated with 48% lower odds of ICU admission (OR 0.52, 0.39-0.7, p< .001). Conclusion We found RDV treatment associated with a significantly lower risk of ICU admission in patients admitted to hospital requiring supplemental oxygen, suggesting that treatment may prevent disease progression in this group. Further studies should assess the potential benefit of RDV combination treatment with dexamethasone. Disclosures Ruth Lynfield, MD, Nothing to disclose

scholarly journals COVID-19 Severity in Multiple Sclerosis

2021 ◽  
Vol 9 (1) ◽  
pp. e1105
Author(s):  
Maria Pia Sormani ◽  
Irene Schiavetti ◽  
Luca Carmisciano ◽  
Cinzia Cordioli ◽  
Massimo Filippi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lower Risk ◽  
Risk Group ◽  
Population Based ◽  
Italian Population ◽  
Icu Admission ◽  
Risk Patients ◽  
Edss Score ◽  
Anti Cd20 ◽  
Age And Sex

Background and ObjectivesIt is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19–related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population.MethodsHospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs).ResultsThe risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04).DiscussionOverall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.

Protective Effect of Moringa Oleifera Leaves Against TramadolInduced Nephrotoxicity in Mice

2017 ◽  
Vol 9 (02) ◽  
Author(s):  
Ashraf Albrakati
Keyword(s):  
Oral Dose ◽  
Moringa Oleifera ◽  
Treated Group ◽  
Control Group ◽  
Serum Urea ◽  
Kidney Function Tests ◽  
Mean Values ◽  
Intraperitoneal Dose ◽  
Moringa Oleifera Leaves ◽  
The Mean

Tramadol, a broadly in recent years, is an effective analgesic agent for the treatment of moderate to acute pain. Its metabolites are excreted by the kidney which may cause nephrotoxicity. Moringa oleifera leaves are commonly used to provide herbal and plant-derived medicinal products especially in developing nations. The present study was carried out to determine the biochemical and histopathological changes in the kidney of tramadol-treated albino mice and to evaluate the possible protective role of Moringa oleifera leaves against tramadol-induced nephrotoxicity. Twenty adult albino mice were divided into four groups. Control group (group i) received daily intraperitoneal injection of normal saline only, group ii received oral dose of Moringa oleifera leaves extract (20 mg/kg/bw) for three weeks, group iii received daily intraperitoneal dose of tramadol (0.3 mg/kg/bw) for the same period, group iv, received daily oral dose of Moringa oleifera leaves extract, (20 mg/kg/bw) three hours before injecting intraperitoneal dose of tramadol (0.3 mg/kg/bw), for the same period. Blood samples were withdrawn at the end of the experiment for kidney function tests and specimens from the kidney were processed for histological study. No significant differences in the mean values of the kidney function tests were noticed between Moringa oleifera group and control group. However, there was highly significant increase in the mean values of serum, urea and creatinine in tramadol-treated group as compared to the control group. Although tramadol + Moringa oleifera group revealed significant difference in the mean values of urea and creatinine when compared with tramadol-treated group. So, Moringa oleifera leaves extract have been shown to attenuate the renal dysfunction, improve the renal architecture, with nearly normalization of serum urea and creatinine levels which indicate improvement of renal function. In conclusion, in the light of biochemical results and histological findings, co-administration of Moringa oleifera leaves lessened the negative effects of tramadol-induced nephrotoxicity; possibly by its antioxidant action. Further investigation of these promising protective effects of Moringa oleifera leaves against tramadol-induced renal injury may have considerable impact on developing an adjunct therapy aiming to improve the therapeutic index of some nephrotoxic drugs.

Fracture Risk in Patients with Myasthenia Gravis: A Population-Based Cohort Study

2021 ◽  
pp. 1-8
Author(s):  
Charles Kassardjian ◽  
Jessica Widdifield ◽  
J. Michael Paterson ◽  
Alexander Kopp ◽  
Chenthila Nagamuthu ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Lower Risk ◽  
Cox Regression ◽  
Large Population ◽  
Population Based ◽  
Osteoporosis Prevention ◽  
Inception Cohort ◽  
Hazard Ratios ◽  
Multiple Covariates ◽  
Region Of Residence

Background: Prednisone is a common treatment for myasthenia gravis (MG), and osteoporosis is a known potential risk of chronic prednisone therapy. Objective: Our aim was to evaluate the risk of serious fractures in a population-based cohort of MG patients. Methods: An inception cohort of patients with MG was identified from administrative health data in Ontario, Canada between April 1, 2002 and December 31, 2015. For each MG patient, we matched 4 general population comparators based on age, sex, and region of residence. Fractures were identified through emergency department and hospitalization data. Crude overall rates and sex-specific rates of fractures were calculated for the MG and comparator groups, as well as rates of specific fractures. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results: Among 3,823 incident MG patients (followed for a mean of 5 years), 188 (4.9%) experienced a fracture compared with 741 (4.8%) fractures amongst 15,292 matched comparators. Crude fracture rates were not different between the MG cohort and matched comparators (8.71 vs. 7.98 per 1000 patient years), overall and in men and women separately. After controlling for multiple covariates, MG patients had a significantly lower risk of fracture than comparators (HR 0.74, 95% CI 0.63–0.88). Conclusions: In this large, population-based cohort of incident MG patients, MG patients were at lower risk of a major fracture than comparators. The reasons for this finding are unclear but may highlight the importance osteoporosis prevention.

Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Kim ◽  
H Jung ◽  
P.S Yang ◽  
H.T Yu ◽  
T.H Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Middle Age ◽  
Population Based ◽  
Entire Cohort ◽  
Incident Dementia ◽  
Increased Risk ◽  
Diagnosis Of Dementia ◽  
History Of ◽  
The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p&lt;0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p&lt;0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

scholarly journals Sense of Purpose in Life Is Associated with Lower Risk of Incident Dementia: A Meta-Analysis

2021 ◽  
pp. 1-10
Author(s):  
Angelina R. Sutin ◽  
Damaris Aschwanden ◽  
Martina Luchetti ◽  
Yannick Stephan ◽  
Antonio Terracciano
Keyword(s):  
Lower Risk ◽  
Meta Analysis ◽  
Random Effect ◽  
Purpose In Life ◽  
Population Based ◽  
Primary Data ◽  
Or Education ◽  
Total N ◽  
Sense Of Purpose ◽  
Incident Dementia

Background: A sense of purpose in life has been associated with healthier cognitive outcomes across adulthood, including risk of dementia. The robustness and replicability of this association, however, has yet to be evaluated systematically. Objective: To test whether a greater sense of purpose in life is associated with lower risk of dementia in four population-based cohorts and combined with the published literature. Methods: Random-effect meta-analysis of prospective studies (individual participant data and from the published literature identified through a systematic review) that examined sense of purpose and risk of incident dementia. Results: In six samples followed up to 17 years (four primary data and two published; total N = 53,499; n = 5,862 incident dementia), greater sense of purpose in life was associated with lower dementia risk (HR = 0.77, 95%CI = 0.73–0.81, p <  0.001). The association was generally consistent across cohorts (I2 = 47%), remained significant controlling for clinical (e.g., depression) and behavioral (e.g., physical inactivity) risk factors, and was not moderated by age, gender, or education. Conclusion: Sense of purpose is a replicable and robust predictor of lower risk of incident dementia and is a promising target of intervention for cognitive health outcomes.

scholarly journals Healthcare trajectories before and after critical illness: population-based insight on diverse patients clusters

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Youenn Jouan ◽  
Leslie Grammatico-Guillon ◽  
Noémie Teixera ◽  
Claire Hassen-Khodja ◽  
Christophe Gaborit ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Length Of Stay ◽  
Population Based ◽  
Hospital Length Of Stay ◽  
Healthcare Use ◽  
Icu Admission ◽  
Icu Discharge

Abstract Background The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories. Results Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU. Conclusion For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.

scholarly journals OP0073 RISK OF DEVELOPING RHEUMATIC DISEASES IN PATIENTS WITH PALINDROMIC RHEUMATISM IN SOUTH KOREA: A NATION-WIDE POPULATION-BASED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 49.2-49
Author(s):  
J. K. Ahn ◽  
J. Hwang ◽  
J. Lee ◽  
H. Kim ◽  
G. H. Seo
Keyword(s):  
Health Insurance ◽  
South Korea ◽  
Rheumatic Diseases ◽  
Index Date ◽  
Claims Data ◽  
Population Based ◽  
Palindromic Rheumatism ◽  
Psoriatic Arthropathy ◽  
Increased Risk ◽  
The Mean

Background:Palindromic rheumatism (PR) has known to be three patterns of disease course: clinical remission of attacks, persistent attacks, and evolution to chronic arthritis or systemic disease. The spectrum in progression to chronic diseases of PR, however, is quite variable; rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren’s syndrome (SjS), ankylosing spondylitis (AS), relapsing polychondritis (RP), Behçet’s disease (BD), sarcoidosis, and psoriatic spondylitis and arthropathy. Because of the small numbers in case-control studies and too aged investigations, now we needs to shed new light on the fate of PR.Objectives:The aim was to investigate the epidemiology of PR and the risk of developing various rheumatic diseases compared with non-PR individuals, employing the National Health Insurance Service (NHIS) medical claims data, which covers all medical institutions of South Korea.Methods:The study used 2007-2018 claims data from the Korean Health Insurance Review and Assessment Service (HIRA). The identified 19,724 PR patients from 2010 to 2016 were assessed for the incidence rate (IR) compared with the population in the given year by 100,000 person-year (py). The date of diagnosis was the index date. After matching with non-PR individuals (1:10) for age, sex and the year of index date, we calculated the hazard ratios (HRs) with 95% confidence intervals (CIs). The risk of developing the various rheumatic diseases and adult immunodeficiency syndrome (AIDS) as the outcome diseases in PR cohort was estimated. This risk was compared with that of matched non-PR cohort.Results:Of 19,724 PR patients (8,665 males and 11,059 females), the mean age was 50.2 ± 14.9 years (47.7 ± 14.4 years in males and 52.6 ± 14.9 years in females,p< 0.001). The ratio of male to female patients with PR was approximately 1:1.28. The annual IR of PR was 7.02 (6.92-7.12) per 100,000 py (6.22 (6.09-6.35) and 7.80 (7.66-7.95) per 100,000 py in males and females, respectively). The mean duration to develop the outcome diseases was significantly shorter in PR cohort compared that of non-PR cohort (19.4 vs. 35.8 months,p< 0.001). The most common outcome disease was RA (7.34% of PR patients; 80.0% of total outcome diseases), followed by AS, SLE, BD, SjS, MCTD, DM/PM, SSc, RP, psoriatic arthropathy, and AIDS in PR cohort. The patients with PR had an increased risk of RA (HR 46.6, 95% CI [41.1-52.7]), psoriatic arthropathy (44.79 [15.2-132.4]), SLE (24.5 [16.2-37.2]), MCTD (22.0 [7.7-63.3]), BD (21.0 [13.8-32.1]), SjS (12.4 [8.5-17.9]), AS (9.0 [6.7-12.2]), DM/PM (6.1 [2.6-14.8]), and SSc (3.8 [1.5-9.6]) but not of AIDS. The risk of developing RA was greater in male patients (HR 58.9, 95% CI [45.6-76.2] vs. 43.2 [37.4-49.8],pfor interaction = 0.037) while female patients encountered a higher risk of developing AS (15.8 [8.9-28.1] vs. 7.2 [5.0-10.3],pfor interaction = 0.023). The risk of developing RA, SLE, SjS, and BD were significantly more highly affected in younger age (pfor interaction < 0.001, = 0.003, 0.002, and 0.017, at each).Conclusion:This nationwide, population-based cohort study demonstrated that patients with PR had an increased risk of developing various rheumatic diseases, not only RA but also psoriatic arthropathy. Therefore, patients with PR needs to be cautiously followed up for their potential of diverse outcome other than RA: RA, SLE, SjS, and BD in younger patients, RA in males, and AS in females, in particular.Disclosure of Interests:None declared

scholarly journals Salt intake and blood pressure in Iranian children and adolescents: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad Hassan Emamian ◽  
Hossein Ebrahimi ◽  
Hassan Hashemi ◽  
Akbar Fotouhi
Keyword(s):  
Blood Pressure ◽  
Rural Areas ◽  
Urban Areas ◽  
Salt Intake ◽  
Daily Intake ◽  
Population Based ◽  
World Health ◽  
Second Phase ◽  
Salt Consumption ◽  
The Mean

Abstract Background Previous studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure. Methods A random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.’s formula. Results Among 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5–9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4–11.2)] was higher than urban areas [9.4 (95% CI 9.3–9.6)], in people with hypertension [10.8 (95% CI 10.3–11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3–9.6)], and in boys [9.8 (95% CI 9.7–10.0)] was more than girls [9.3 (95% CI 9.1–9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure. Conclusion Daily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.

scholarly journals Exercise and the Risk of Dementia in Patients with Newly Diagnosed Atrial Fibrillation: A Nationwide Population-Based Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3126
Author(s):  
Jaehyun Lim ◽  
So-Ryoung Lee ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
Jin-Hyung Jung ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Reduction ◽  
Lower Risk ◽  
Population Based ◽  
Newly Diagnosed ◽  
Incident Dementia ◽  
Before And After ◽  
Korean National Health Insurance ◽  
New Diagnosis ◽  
New Onset

Background: It is unclear whether exercise would reduce dementia in patients with a new diagnosis of atrial fibrillation (AF). Therefore, we aimed to evaluate the association between the change in physical activity (PA) before and after new-onset AF and the risk of incident dementia. Methods: Using the Korean National Health Insurance Service database, we enrolled a total of 126,555 patients with newly diagnosed AF between 2010 and 2016, who underwent health examinations within two years before and after their diagnosis of AF. The patients were divided into four groups: persistent non-exercisers, exercise starters, exercise quitters, and exercise maintainers. Results: Based on a total of 396,503 person-years of follow-up, 5943 patients were diagnosed with dementia. Compared to persistent non-exercisers, exercise starters (adjusted hazard ratio (aHR) 0.87; 95% confidence interval (CI) 0.81–0.94), and exercise maintainers (aHR 0.66; 95% CI 0.61–0.72) showed a lower risk of incident dementia; however, the risk was similar in exercise quitters (aHR 0.98; 95% CI 0.92–1.05) (p-trend < 0.001). There was a J-shaped relationship between the dose of exercise and the risk of dementia, with the risk reduction maximized at 5–6 times per week of moderate-to-vigorous PA among exercise starters. Conclusion: Patients who initiated or continued regular exercise after diagnosis of AF were associated with a lower risk of dementia than persistent non-exercisers, with no risk reduction associated with exercise cessation. Our findings may provide evidence for the benefit of exercise prescription to patients with new-onset AF to prevent incident dementia regardless of their current exercise status.

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