scholarly journals HLA-A*03:01 is associated with increased risk of fever, chills, and more severe reaction to Pfizer-BioNTech COVID-19 vaccination

2021 ◽  
Author(s):  
Alexandre Bolze ◽  
Iva Neveux ◽  
Kelly M Schiabor Barrett ◽  
Simon White ◽  
Magnus Isaksson ◽  
...  
Keyword(s):  
Side Effects ◽  
Genetic Research ◽  
Fold Increase ◽  
Severe Reaction ◽  
Increased Risk ◽  
The Us ◽  
General Feeling ◽  
Discovery Project ◽  
Similar Sample ◽  
Increase In Risk

COVID-19 vaccines are safe and highly effective, but some individuals experience unpleasant reactions to vaccination. As the majority of adults in the US have received a COVID-19 vaccine this year, there is an unprecedented opportunity to study the genetics of reactions to vaccination via surveys of individuals who are already part of genetic research studies. Here, we have queried 17,440 participants in the Helix DNA Discovery Project and Healthy Nevada Project about their reactions to COVID-19 vaccination. Our GWAS identifies an association between severe vaccine side effects and HLA-A*03:01. This association was statistically significant only for those who received the Pfizer-BioNTech vaccine (BNT162b2; p=4.70E-11), but showed a trending association in those who received the Moderna vaccine (mRNA-1273; p=0.005) despite similar sample sizes for study. In Pfizer-BioNTech recipients, HLA-A*03:01 was associated with a two-fold increase in risk of severe vaccine side effects. The effect was consistent across ages, sexes, and whether the person had previously had a COVID-19 infection. The reactions experienced by HLA-A*03:01 carriers were driven by associations with chills, fever, fatigue, and in general feeling unwell.

Epidemiology

2020 ◽  
pp. 5-15
Keyword(s):  
Fold Increase ◽  
Hashimoto Thyroiditis ◽  
Iodine Intake ◽  
Age Group ◽  
Thyroid Antibodies ◽  
Papillary Thyroid ◽  
Common Cause ◽  
Increased Risk ◽  
Age Range ◽  
Increase In Risk

Hashimoto thyroiditis (HT) remains the most common cause of spontaneous hypothyroidism in areas of adequate iodine intake, such as North America. The incidence of HT is estimated to be 10-15 times higher in females. The most commonly affected age range is 30-50 years, with the peak incidence in men occurring 10-15 years later, but it may be seen in any age group, including children. Hashimoto's thyroiditis appears to occur in more than 10% of patients presenting with thyroid nodule and may be associated with other autoimmune disorders. The occurrence of papillary thyroid carcinoma in HT ranges widely from 0.5-30% of cases. The prevalence of thyroid antibodies is twice more common in women than in men, and higher in whites and Asians than Blacks or Mexicans. There is approximately a 30-fold increase in risk for developing HT in children and 20-fold increased risk in siblings of patients with HT, with females being significantly more often affected than males. This chapter explores the epidemiology of Hashimoto's disease.

scholarly journals Elevated von Willebrand Factor Antigen is an Early Predictor of Mortality and Prolonged Length of Stay for Coronavirus Disease 2019 (COVID-19) Inpatients

2021 ◽  
Author(s):  
Alexander H. Cotter ◽  
Su-Jau T. Yang ◽  
Hedyeh Shafi ◽  
Timothy M. Cotter ◽  
Darryl Erik Palmer-Toy
Keyword(s):  
Length Of Stay ◽  
Fold Increase ◽  
Prolonged Length ◽  
Risk Of Death ◽  
Increased Risk ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Factor Antigen ◽  
D Dimer ◽  
Increase In Risk

ABSTRACT Context: Coagulation factor and endothelial injury marker, von Willebrand factor antigen (vWF:Ag), is elevated in coronavirus disease 2019 (COVID-19). Objective: To assess prognostic value of vWF:Ag for COVID-19 inpatients. Design: Citrated plasma samples collected from COVID-19 inpatients for D-dimer measurement were tested for vWF:Ag. Measurements of vWF:Ag and common acute phase reactants (APRs) were correlated with clinical outcomes and length of stay (LOS). Results: We included 333 samples from a diverse group of 120 COVID-19 inpatients. There was a clear association of higher peak measurements of vWF:Ag and other APRs with adverse clinical outcomes. Peak vWF:Ag >300% was associated with a 5-fold increased risk of death (Odds Ratio 5.08, P<.001) and a 30-fold increased risk of prolonged (>4 days) LOS (OR 29.65, P =.001). Peak D-dimer >3.8 FEU mg/L was associated with a 15-fold increase in risk of death (OR 14.73, P <.001) and a 5-fold increased risk of prolonged LOS (OR 4.55, P=.02). Using the earliest paired measurements of vWF:Ag and D-dimer from each patient and the same cut-offs, vWF:Ag was associated with a 3.5-fold increase in risk of death (OR 3.54, P=.004) and a 20-fold risk of prolonged LOS (OR 20.19, P=.004). Yet D-dimer was not significantly associated with either death (OR 1.9, P=.29) or prolonged LOS (OR 1.02, P=.98). Conclusions: Both peak and early post-admission vWF:Ag >300% were highly predictive of death and prolonged length of stay among COVID-19 inpatients. Measurement of vWF:Ag may prove a valuable tool to guide escalation of COVID-19 treatment, particularly anticoagulation.

Abstract 3603: Extreme Lipoprotein(a) Levels Predict a 3–4 Fold Increase in Risk of Myocardial Infarction in the General Population

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Pia R Kamstrup ◽  
Marianne Benn ◽  
Anne Tybjćrg Hansen ◽  
Børge G Nordestgaard
Keyword(s):  
Myocardial Infarction ◽  
General Population ◽  
Fold Increase ◽  
Threshold Effect ◽  
Lipoprotein A ◽  
Hazard Ratios ◽  
Heart Study ◽  
Increased Risk ◽  
Increase In Risk

Background: Elevated lipoprotein(a) levels associate with increased risk of myocardial infarction in some, but not all studies. Limitations of previous studies include lack of risk estimates for extreme lipoprotein(a) levels, measurements in long-term frozen samples and no correction for regression dilution bias. We tested the hypothesis that extreme lipoprotein(a) levels predict myocardial infarction in the general population, measuring levels shortly after sampling and correcting for regression dilution bias. Methods and Results: We examined 9330 men and women from the Danish general population, The Copenhagen City Heart Study. During 10 years follow-up, 498 participants developed myocardial infarction. In women, multifactorially adjusted hazard ratios for myocardial infarction for elevated lipoprotein(a) levels were 1.1(95% confidence interval 0.6 –1.9) for 5–29 mg/dL, 1.7(1.0 –3.1) for 30 – 84 mg/dL, 2.6(1.2–5.9) for 85–119 mg/dL (>90 th percentile), and 3.6(1.7–7.7) for ≥120 mg/dL (>95 th percentile) versus levels <5 mg/dL (figure , p-values are test for trend of hazard ratios). Equivalent values in men were 1.5(0.9 –2.3), 1.6(1.0 –2.6), 2.6(1.2–5.5), and 3.7(1.7– 8.0). Conclusions: We observed a stepwise increase in risk of myocardial infarction with increasing levels of lipoprotein(a) in both genders, with no evidence of a threshold effect. Extreme lipoprotein(a) levels predict a 3– 4 fold increase in risk of myocardial infarction in the general population. Figure. Risk of myocardial infarction by levels of lipoprotein(a)

Patient Characteristics Associated with Defects of the Peritoneal Cavity Boundary

2005 ◽  
Vol 25 (4) ◽  
pp. 367-373 ◽  
Author(s):  
Claudia M.A. Van Dijk ◽  
Steven G. Ledesma ◽  
Isaac Teitelbaum
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fold Increase ◽  
Female Gender ◽  
Patient Characteristics ◽  
The United States ◽  
Cystic Disease ◽  
Increased Risk ◽  
Cavity Boundary ◽  
Increase In Risk

Background Conflicting literature exist regarding the patient characteristics that may confer an increased risk for anatomic complications of the peritoneal cavity boundaries. Methods We collected data from 75 randomly selected units in the United States and Canada, representing a total of 1864 peritoneal dialysis (PD) patients. Results 200 of these patients experienced a total of 217 anatomic complications between July 2000 and June 2001; 16 patients had more than 1 complication. Hernias comprised 60.4% of all complications: 24.9% inguinal, 18.9% umbilical, 13.8% ventral, 2.3% femoral, and 0.5% intrathoracic. Other complications included pericatheter or subcutaneous leak (25.3%), hydrothorax (6.0%), and miscellaneous (8.3%). Peritoneal dialysis modalities in use at the time of complication were automated PD (52.3%), continuous ambulatory PD (38.6%), and nocturnal intermittent PD (9.1%). The overall incidence of hernias was 7%. Conclusions Logistic regression analysis found no association between hernias and age, body surface area, PD modality, volume of dialysate, time of largest dwell (day/upright vs night/recumbent), or type of catheter used. Cystic disease conferred a 2.5-fold increase in risk for anatomic complications ( p < 0.001); female gender conferred an 80% reduction in risk ( p < 0.0001), and Kt/V ≥2.0 conferred a 52% reduction in risk ( p < 0.05) for hernia.

97Ultrasound guided vascular access puncture to decrease vascular complications of TAVR

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Vincent ◽  
H Spillemaeker ◽  
M Kyheng ◽  
T Denimal ◽  
B Verdier ◽  
...  
Keyword(s):  
Vascular Access ◽  
Vascular Complications ◽  
Fold Increase ◽  
Adverse Outcomes ◽  
Bleeding Complications ◽  
Fluoroscopic Guidance ◽  
Us Guidance ◽  
Increased Risk ◽  
The Us ◽  
The Impact

Abstract Background Major vascular (VAC) and life-threatening or major bleeding (LT/MB) complications still represent one of the most frequent adverse outcomes of percutaneous transfemoral TAVR (TF-TAVR) and are associated with an increased risk of mortality. Ultrasound guidance technique allows to puncture in the non-calcified central and horizontal segment of common femoral artery. However the clinical impact of ultrasound (US)-guidance has never been studied in TF-TAVR in comparison of standard fluoroscopic guidance and could explain the lack of adoption of US guidance. We sought first to evaluate in our study the impact of US-guidance on the vascular and bleeding complications. Methods US-guidance for vascular access was implemented as the default approach in our institution in June 2013 for all TF-TAVR and was applied by all operators after a short training course. Thus, we defined three period and groups of consecutive patients according to the method of percutaneous puncture (fluoroscopic or US-guidance) and the generation of THV (2nd or 3rd gen.). US-guided-2nd gen. group: TF-TAVR with 2nd generation THV and performed via US-guidance. This group refers to the period patients from June 2013 to November 2014 (n=119). Fluo-guided-2nd gen. group: The last TF-TAVR with 2nd gen. THV and performed via fluoroscopic guidance (n=119). US-guided-3rd gen. group: Patients implanted with 3rd gen. THV (SAPIEN 3, Evolut R) from November 2014 to December 2018 while US-guidance was systematic for all TF-TAVR (n=308). Patients performed with US-guidance were 1:1 successfully matched with 95 patients performed with fluoroscopic guidance (fluo-guided group) with propensity-score (10 variables). We separately analyzed the consecutive patients of the US-guided-3rd gen. group. Results After propensity-matching, resulting in similar baseline characteristics, all the vascular and bleeding complications were reduced in the US-guided-2nd gen. group compared to Fluo-guided-2nd gen. group with respectively: VAC (6.3% vs 16.8%; OR=0.31; 95% CI: 0.12–0.85; p=0.023); LT/MB (22.1% vs 6.3%; OR=0.24, CI: 0.09–0.63; p=0.004); and VAC related to vascular access (12.6 vs 4.2%; OR=0.31; CI: 0.10–1.01; p=0.052). We also observed a reduction of the mean fluoroscopic time (1753±620 min vs 1228±405 min; p<0.001). No difference was observed between groups on survival (HR=0.68; CI: 0.42 to 1.10); p=0.125). In the US-guided-3rd gen. group (n=308), the US-guided puncture achieved a rate of VAC of 3.2% (CI: 1.6–5.9) and of LT/MB of 3.6% (CI: 1.8–6.3). In the overall population (n=546), we observed that LT/MB (p=0.02) was associated with a 1.7-fold increase of mortality risk. Conclusion The present study is the first and the largest to evaluate the impact of US-guidance in TF-TAVR. We demonstrated that US-guided cannulation is able to reduce the risk of vascular and bleeding complications. These data endorses US-guidance as the standard method of puncture for TAVR.

scholarly journals Angiogenic factors during pregnancy in Asian women with elevated blood pressure in early pregnancy and the risk of preeclampsia: a longitudinal cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032237 ◽  
Author(s):  
Jing Zhu ◽  
Jun Zhang ◽  
Mor Jack Ng ◽  
Bernard Chern ◽  
George SH Yeo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Early Pregnancy ◽  
Fold Increase ◽  
Angiogenic Factors ◽  
Arterial Blood ◽  
Increased Risk ◽  
Plgf Ratio ◽  
Increase In Risk ◽  
Risk Of Preeclampsia

ObjectiveIt remains unclear what roles placenta-originated angiogenic factors play in the pathogenesis of preeclampsia among hypertensive women. We compared maternal soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) levels throughout pregnancy in women with normal blood pressure (BP), elevated BP and hypertension in early pregnancy and their risks of developing preeclampsia.DesignA prospective cohort study.SettingKK Women’s and Children’s Hospital, Singapore.Participants923 women with singleton pregnancy <14 weeks of gestation were included in the prospective Neonatal and Obstetrics Risks Assessment cohort between September 2010 and October 2014. Systolic, diastolic, mean arterial blood pressure (MAP) were measured at 11–14 weeks.Primary and secondary outcomesMaternal serum sFlt-1, PlGF and sFlt-1/PlGF ratio were tested at 11–14, 18–22, 28–32 and 34 weeks onwards of gestation. Preeclampsia was main pregnancy outcome.ResultsWomen were divided based on their BP in early pregnancy: normal (n=750), elevated BP (n=98) and hypertension (n=75). Maternal sFlt-1 levels and sFlt-1/PlGF ratios were higher in hypertensive women throughout pregnancy, but maternal PlGF levels were not significantly lower. Rise in maternal systolic, diastolic BP and MAP at 11–14 weeks were significantly associated with higher sFlt-1/PlGF ratios during pregnancy. A 10 mm Hg increase in MAP was associated with a 5.6-fold increase in risk of preterm preeclampsia and a 3.3-fold increase in risk of term preeclampsia, respectively.ConclusionWomen with elevated BP in early pregnancy already had a higher sFlt-1/PlGF ratio in early gestation and throughout pregnancy, and an increased risk of preeclampsia. In contrast, PlGF levels in these women remained normal.

scholarly journals POS1143 GOUT AND JOINT REPLACEMENTS IN THE US

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 851.1-851
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Knee Joint ◽  
Confidence Intervals ◽  
Knee Replacement ◽  
Joint Replacement ◽  
Economic Burden ◽  
Hip Replacement ◽  
Average Charge ◽  
Joint Replacements ◽  
Increased Risk ◽  
The Us

Background:Irreversible joint damage in gout has been linked to a possible increase in knee and hip joint replacements1. In addition, the strong association between gout and osteoarthritis2,3 could also lead to an increased risk of joint replacements in patients with gout. Population-based data from the UK and Taiwan have shown hazard rates of 1.14 and 1.16 respectively for knee replacements in patients with gout compared to age and gender matched controls1. However, there is little national data in the US on clinical and economic burden of joint replacements in patients with gout.Objectives:To evaluate total or partial hip and knee joint replacements in patients with gout in the US and to estimate their economic impactMethods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD)10 diagnosis and procedure codes, age, gender, length of stay, payer, charges, comorbidities etc. is available. We examined hospitalizations in patients with gout with hip and knee joint replacements in NIS 2018, the most recent year of data.Results:In 2018, there were 914,510 hospitalizations with primary or secondary diagnosis of gout in the US. Of these 43,615 were for joint replacement surgeries (knee (24,840) and hip (18,755)). Patients with knee replacement were on an average 68.5 years old (95% confidence intervals 68.2 years -68.8 years). Patients with hip replacement were slightly older (mean age 70.3 years, 95% confidence intervals 69.8 years -70.7 years). Unlike general population statistics, men formed a majority of these joint replacements (68% for the knee and 72% for the hip). The average charge per hospitalization was $69,279 and $72,944 for knee and hip replacement respectively. The total annual national cost estimate was $3.09 billion, with government insurances (Medicare and Medicaid) responsible for 67% of knee replacement and 70% of hip replacement costs.Conclusion:Joint replacements in gout patients have a large clinical and economic burden in the US. This calls for an increased awareness and management of associated hip and knee arthritis in patients with gout.References:[1]Kuo CF, Chou IJ, See LC, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology. Dec 1 2018;57(12):2129-2139.[2]Howard RG, Samuels J, Gyftopoulos S, et al. Presence of gout is associated with increased prevalence and severity of knee osteoarthritis among older men: results of a pilot study. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases. Mar 2015;21(2):63-71.[3]Roddy E, Zhang W, Doherty M. Are joints affected by gout also affected by osteoarthritis? Annals of the rheumatic diseases. Oct 2007;66(10):1374-1377.Disclosure of Interests:Gurkirpal Singh Shareholder of: Pfizer, Merck, Sanofi, Grant/research support from: Horizon, Maanek Sehgal: None declared, Alka Mithal: None declared.

scholarly journals Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

2021 ◽  
Author(s):  
Gayathri S. Kumar ◽  
Jenna A. Beeler ◽  
Emma E. Seagle ◽  
Emily S. Jentes
Keyword(s):  
Health Outcomes ◽  
Physical Health ◽  
Public Health Practice ◽  
The United States ◽  
Inclusion Criteria ◽  
Physical Health Outcomes ◽  
Increased Risk ◽  
The Us ◽  
Bhutanese Refugee

AbstractSeveral studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

scholarly journals Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999–2015

2020 ◽  
Author(s):  
Kosuke Inoue ◽  
Roch Nianogo ◽  
Donatello Telesca ◽  
Atsushi Goto ◽  
Vahe Khachadourian ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Regression Models ◽  
Machine Learning Algorithms ◽  
Logistic Regression Models ◽  
Health And Nutrition ◽  
Increased Risk ◽  
The Us ◽  
All Cause Mortality ◽  
Hba1c Levels

Abstract Objective It is unclear whether relatively low glycated haemoglobin (HbA1c) levels are beneficial or harmful for the long-term health outcomes among people without diabetes. We aimed to investigate the association between low HbA1c levels and mortality among the US general population. Methods This study includes a nationally representative sample of 39 453 US adults from the National Health and Nutrition Examination Surveys 1999–2014, linked to mortality data through 2015. We employed the parametric g-formula with pooled logistic regression models and the ensemble machine learning algorithms to estimate the time-varying risk of all-cause and cardiovascular mortality by HbA1c categories (low, 4.0 to &lt;5.0%; mid-level, 5.0 to &lt;5.7%; prediabetes, 5.7 to &lt;6.5%; and diabetes, ≥6.5% or taking antidiabetic medication), adjusting for 72 potential confounders including demographic characteristics, lifestyle, biomarkers, comorbidities and medications. Results Over a median follow-up of 7.5 years, 5118 (13%) all-cause deaths, and 1116 (3%) cardiovascular deaths were observed. Logistic regression models and machine learning algorithms showed nearly identical predictive performance of death and risk estimates. Compared with mid-level HbA1c, low HbA1c was associated with a 30% (95% CI, 16 to 48) and a 12% (95% CI, 3 to 22) increased risk of all-cause mortality at 5 years and 10 years of follow-up, respectively. We found no evidence that low HbA1c levels were associated with cardiovascular mortality risk. The diabetes group, but not the prediabetes group, also showed an increased risk of all-cause mortality. Conclusions Using the US national database and adjusting for an extensive set of potential confounders with flexible modelling, we found that adults with low HbA1c were at increased risk of all-cause mortality. Further evaluation and careful monitoring of low HbA1c levels need to be considered.

scholarly journals Sleep Duration and Waking Activities in Relation to the National Sleep Foundation’s Recommendations: An Analysis of US Population Sleep Patterns from 2015 to 2017

2021 ◽  
Vol 18 (11) ◽  
pp. 6154
Author(s):  
Michael Osei Mireku ◽  
Alina Rodriguez
Keyword(s):  
Sleep Duration ◽  
Time Use ◽  
Variance Estimation ◽  
Estimation Method ◽  
Short Sleep Duration ◽  
Weighted Estimates ◽  
American Time Use Survey ◽  
Increased Risk ◽  
The Us ◽  
Time Use Survey

The objective was to investigate the association between time spent on waking activities and nonaligned sleep duration in a representative sample of the US population. We analysed time use data from the American Time Use Survey (ATUS), 2015–2017 (N = 31,621). National Sleep Foundation (NSF) age-specific sleep recommendations were used to define recommended (aligned) sleep duration. The balanced, repeated, replicate variance estimation method was applied to the ATUS data to calculate weighted estimates. Less than half of the US population had a sleep duration that mapped onto the NSF recommendations, and alignment was higher on weekdays (45%) than at weekends (33%). The proportion sleeping longer than the recommended duration was higher than those sleeping shorter on both weekdays and weekends (p < 0.001). Time spent on work, personal care, socialising, travel, TV watching, education, and total screen time was associated with nonalignment to the sleep recommendations. In comparison to the appropriate recommended sleep group, those with a too-short sleep duration spent more time on work, travel, socialising, relaxing, and leisure. By contrast, those who slept too long spent relatively less time on each of these activities. The findings indicate that sleep duration among the US population does not map onto the NSF sleep recommendations, mostly because of a higher proportion of long sleepers compared to short sleepers. More time spent on work, travel, and socialising and relaxing activities is strongly associated with an increased risk of nonalignment to NSF sleep duration recommendations.

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