scholarly journals EFFECT OF FULL VACCINATION AND POST-COVID OLFACTORY DYSFUNCTION IN RECOVERED COVID-19 PATIENT. A RETROSPECTIVE LONGITUDINAL STUDY WITH PROPENSITY MATCHING.

2022 ◽  
Author(s):  
Bumi Herman ◽  
Pramon Viwattanakulvanid ◽  
Azhar Dzulhadj ◽  
Aye Chan Oo ◽  
Karina Patricia ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Neck Surgery ◽  
Olfactory Dysfunction ◽  
P Value ◽  
Online Questionnaire ◽  
Crude Odds Ratio ◽  
Symptomatic Disease ◽  
Increased Risk ◽  
Viral Vaccine ◽  
Propensity Matching

Background Symptoms after Coronavirus Disease (COVID-19) infection affect the quality of life of its survivor especially to the special senses including olfactory function. It is important to prevent the disability at an earlier stage. Vaccination as key prevention has been proven to be effective in reducing symptomatic disease and severity. However, the effects of vaccination on post COVID symptoms have not been evaluated. This study aimed to evaluate the possible protection of full vaccination and the occurrence of post-COVID olfactory dysfunction, specifically anosmia, and hyposmia in patients who were diagnosed with COVID-19. Method A longitudinal analysis using the retrospective cohort of the Indonesian patient-based Post-COVID-19 survey collected from July 2021 until December 2021, involving COVID-19 Patients confirmed by Real-Time Polymerase Chain Reaction (RT-PCR) and/or Antigen test. Variables including demography, comorbidities, health behavior, type of vaccine, symptoms, and treatment were collected through an online questionnaire based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Participants were matched (1:1) using propensity matching score into two exposure statuses, infected 1)>14 days of full vaccination and 2)<14 days or incomplete or unvaccinated. The olfactory dysfunction was assessed two weeks and four weeks after negative conversion with PCR using a self-measured olfactory questionnaire (MOQ). The Generalized Estimating Equation (GEE) was performed to assess the effect of full vaccination on post-COVID-19 olfactory dysfunction. The Receiver Operating Characteristic determined the sensitivity and specificity of the cutoff value of the days from fully vaccinated to diagnosis and the olfactory dysfunction. Results A total of 442 participants were extracted from the cohort and inoculated with the inactivated viral vaccine (99.5%). The prevalence of olfactory dysfunction in two weeks was 9.95% and 5.43% after four weeks. Adjusted by other variables, people who were infected >14 days after being fully vaccinated had a 69% (adjusted Odds Ratio / aOR 0.31 95% CI 0.102-0.941) probability of developing olfactory dysfunction. Longer days of fully vaccinated to infection are associated with increased risk (aOR 1.012 95% CI 1.002-1.022 p-value 0.015). A cut-off of 88 days of full vaccination-to-diagnosis duration has Area Under Curve (AUC) of 0.693 (p=0.002), the sensitivity of 73.9%, and specificity of 63.3% in differentiating the olfactory dysfunction event in two weeks after COVID-19 with a crude odds ratio of 4.852 (95% CI 1.831-12.855 p=0.001) Conclusion After 14 days of full vaccination, the protective effect could reduce the chance of post-COVID olfactory dysfunction although a longer full vaccination-to-diagnosis duration increases the risk. It is important to consider a booster shot starting from 89 days after the last dose in those who received the inactivated viral regimen.

scholarly journals HIV infection and increased risk of COVID-19 mortality: A Meta-Analysis

2021 ◽  
Author(s):  
J Hamidreza Kouhpayeh ◽  
Hossein Ansari
Keyword(s):  
Hiv Infection ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Hiv Positive ◽  
Forest Plot ◽  
P Value ◽  
Crude Odds Ratio ◽  
Increased Risk ◽  
Consistent Treatment ◽  
Immunodeficiency Syndrome

There are some concerns on the effect of infection with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) on the outcome and mortality of COVID-19. In this meta-analysis, we aimed to address this issue and assess the risk of mortality in COVID-19 patients who are co-infected with HIV. Two International electronic databases (PubMed, Scopus) were searched from the first time available to 12 August 2021. The targeted outcome was the pooled odds ratio to examine the effect of HIV infection on COVID-19 mortality. The crude odds ratio (OR) for all studies and the pooled OR were calculated with 95% confidence interval. The forest plot was used to graphically represent the result of conducted meta-analysis and calculated OR for individual studies. The I2 statistic was used to examine the Heterogeneity in the included studies. Eleven studies were included in our study consisting of 19,642,775 COVID-19 infected cases, 59,980 HIV-positive, and 4,373 deaths due to COVID-19 in HIV positive patients. The overall pooled odds ratio was 1.21 (CI: 1.02; 1.43) and P-value < 0.0277. The I^2 value was 89% (P-value < 0.0001), which shows that included studies are heterogeneous. In this study, the funnel plot analysis showed symmetry among the included studies. HIV-positive patients are 21% more likely to die because of COVID-19 infection than people without HIV. Special attention should be considered for the prevention and treatment of COVID-19 and consistent treatment for HIV infection, in HIV-positive patients.

Gestational Diabetes Risk in Migrants. A Nationwide, Register-Based Study of all Births in Denmark 2004 to 2015

2020 ◽  
Vol 105 (3) ◽  
pp. e692-e703 ◽  
Author(s):  
Karoline Kragelund Nielsen ◽  
Gregers Stig Andersen ◽  
Peter Damm ◽  
Anne-Marie Nybo Andersen
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Socioeconomic Position ◽  
Odds Ratio ◽  
Country Of Origin ◽  
P Value ◽  
Asian Countries ◽  
Substantial Variation ◽  
Increased Risk ◽  
Interaction Term

Abstract Background Much remains to be understood about socioeconomic position and body mass index (BMI) in the pathways linking ethnicity, migration, and gestational diabetes mellitus (GDM). We investigated differences in GDM prevalence according to maternal country of origin and the role played by socioeconomic position and BMI on this relationship. Finally, we examined how length of residency was associated with GDM. Methods A register-based cohort study of the 725 482 pregnancies that resulted in a birth in Denmark, 2004 to 2015. Of these, 14.4% were by women who had migrated to Denmark. A GDM diagnosis was registered in 19 386 (2.7%) pregnancies, of which 4464 (23.0%) were in immigrant women. The crude risk of GDM according to maternal country of origin compared to Danish-born women ranged from an odds ratio (OR) of 0.50 (95% CI 0.34-0.71) for women from Sweden to an OR of 5.11 (95% CI 4.28-6.11) for women from Sri Lanka. Adjustment for socioeconomic position slightly attenuated the risks. Adjusting for BMI resulted in increased ORs for women, especially from Asian countries. The separate and joint effects of migration and overweight on GDM risk differed substantially between the countries of origin (P value interaction term &lt; .001). Immigrants with 10 or more years of residency had a 56% increased risk of GDM (OR 1.56, 95% CI 1.44-1.68) compared to immigrants with less than 5 years in Denmark. This risk was somewhat diluted when adjusting for age and BMI. Conclusions This study demonstrates substantial variation in the risk of GDM according to country of origin. The risk associations are only slightly affected by socioeconomic position and BMI.

scholarly journals Hypertension as a prognostic factor in the prediction of mortality in patients with COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C D P Pagdanganan ◽  
J Juangco ◽  
Keyword(s):  
Prognostic Factor ◽  
Odds Ratio ◽  
Positive Association ◽  
Hazard Ratio ◽  
P Value ◽  
Comorbid Condition ◽  
Significant Positive Association ◽  
Prediction Of Mortality ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) brought the majority of the world into a halt when it started to spread outside the virus epicenter in Wuhan, China. With the alarming increase in the number of cases and deaths worldwide, the possible risk factors should be determined in order to have a general idea on those who are more susceptible to have this disease. Hypertension, being one of the world's leading causes of noncommunicable diseases, was identified by the CDC to be one of underlying medical conditions that might pose an increased risk for severe illness from COVID-19. Objective The aim of this study is to determine the predictive value of hypertension as a comorbidity in COVID-19 mortality. Materials and methods Participants included all patients clinically diagnosed with COVID-19, and have hypertension as their pre-existing medical condition. Studies were selected based on study design, participants, exposure, outcome, timing, setting and language. The following databases were searched from June to August 2020 for case control and cohort studies on MEDLINE and CINAHL, ScienceDirect, Clinical Key, OVID database, Wiley Online library, and UpToDate. The criteria for evaluation of risk of bias were based on the selection bias, comparability bias and outcome bias. All information gathered were collated and evaluated using the Newcastle-Ottawa Quality Assessment Scale and CEBM. Results Individual studies all showed a significant relationship between hypertension and mortality in COVID-19 patients. Odds ratio ranging from 1.75 to 28.88, and hazard ratio ranging from 1.49 to 3.32 are present in the studies. For the data analysis, Mantel Haenszel method and random effects model was used for case control studies with odds ratio as effect measure; while Inverse variance method and fixed model was used for cohort studies with hazard ratio as effect measure. Both groups showed significant positive association between mortality and hypertension as a prognostic factor. Overall odds ratio is 5.25 (2.42–11.40) with a p value of &lt;0.ehab724.23931, and the pooled hazard ratio is 2.21 (1.75–2.80) with a p value of &lt;0.ehab724.23931. This shows that there is an increased risk of mortality among COVID-19 patients with hypertension as a comorbid condition. Conclusions Hypertension as a comorbid condition is a prognostic factor in the prediction of mortality in hospitalized COVID-19 patients. The ten included studies showed that there is a significant positive association suggesting an increased risk of mortality in COVID-19 patients with hypertension. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): University of the East Ramon Magsaysay Memorial Medical Center College of Medicine Forest Plot HR Hypertension COVID

Venous Thromboembolism and Preoperative Steroid Use, a Retrospective Cohort Study from the ACS-NSQIP Database: Are Surgical Patients at Risk?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2865-2865
Author(s):  
Anthony Haddad ◽  
Rami Kantar ◽  
Hani Tamim ◽  
Faek R Jamali ◽  
Ali Taher
Keyword(s):  
Venous Thromboembolism ◽  
Urinary Tract ◽  
Adverse Events ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Surgical Patients ◽  
P Value ◽  
Steroid Use ◽  
Increased Risk ◽  
History Of

Abstract Background : Despite early ambulation, use of anticoagulation and several other strategies, postoperative venous thromboembolism (VTE) remains a major cause of morbidity and mortality. Therefore, the search for modifiable preoperative risk factors is crucial. Few reports in the literature mention an increased risk of VTE with exogenous steroid use and endogenous hypercortisolism. To date however, the direct relationship between steroid use and VTE remains unexplored. Objective: To assess if an association between preoperative steroid use and postoperative venous thromboembolism exists. Methods: Using data from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP), which is a prospective validated outcomes registry including around 548 hospitals in the United States and around the world, we identified patients with no history of thrombotic events. We excluded patients with a history of one or more deep venous thrombosis (DVT), and patients with sepsis. After analyzing patient characteristics, we used multivariate logistic regression to assess the crude and adjusted effect of steroids on VTE, our primary outcome. Results: We obtained data for 1 921 901 patients, 58 667 of whom were on steroids for at least 30 days before operative intervention. Amongst those, 1241 patients had a postoperative VTE. After adjustment for different variables, VTE was higher in patients on steroids with an adjusted odds ratio of 1.54, 95% confidence interval (CI) 1.45-1.64. Secondary assessed outcomes included mortality, urinary tract infection (UTI), wound occurrences, sepsis, cardiac and respiratory adverse events. Adjusted odds ratios for the latter were 1.42 (CI 1.35-1.49), 1.40 (CI 1.30-1.50), 1.58 (CI 1.51-1.66), 1.51 (CI 1.42-1.60), 1.19(CI 1.11-1.29) and 1.302 (CI 1.301-1.303) respectively. Discussion: Our results suggest that surgical patients with prolonged preoperative steroid intake are at a higher risk of developing postoperative VTE. This is an important finding since preoperative steroid use is a modifiable factor. Furthermore, our data also shows that the exposure of interest is associated with a number of secondary outcomes considered including: all-cause mortality, UTI, sepsis, wound occurrences, cardiac and respiratory adverse events. Association with wound occurrences, sepsis and UTI is concordant with the well-known inhibitory effect of prolonged steroid use on wound healing and immune functions. The association with mortality, cardiac and respiratory events might in fact be due to the association between preoperative steroid use and our main outcome Future perspectives include investigating the mechanism by which steroid use might lead to an increased risk of postoperative VTE with a particular emphasis on the coagulation cascade and potential interference with its normal physiologic function. Abstract 2865. Table 1. Various outcomes and steroid use Steroid intake No Steroid ORcrude CI p-value ORadj CI P-value Venous Thromboembolic Event 1241 14544 2.74 2.59-2.91 <.0001 1.54 1.45-1.64 <.0001 Mortality 2525 21868 3.78 3.63-3.94 <.0001 1.42 1.35-1.49 <.0001 Cardiac 852 11665 2.33 2.18-2.50 <.0001 1.19 1.11-1.29 <.0001 Respiratory 4094 44220 3.08 2.98-3.18 <.0001 1.302 1.301-1.303 <.0001 Urinary Tract 937 10752 2.79 2.61-2.99 <.0001 1.40 1.30-1.50 <.0001 Wound 2135 29221 2.37 2.26-2.47 <.0001 1.58 1.51-1.66 <.0001 Sepsis 1515 13286 3.69 3.49-3.89 <.0001 1.51 1.42-1.60 <.0001 Abbreviations: OR: Odds ratio, CI: confidence interval, adj: adjusted. Disclosures No relevant conflicts of interest to declare.

scholarly journals Observational Cohort Study of Pregnancy Outcome after First-Trimester Exposure to Fluoroquinolones

2014 ◽  
Vol 58 (8) ◽  
pp. 4392-4398 ◽  
Author(s):  
Stephanie Padberg ◽  
Evelin Wacker ◽  
Reinhard Meister ◽  
Mary Panse ◽  
Corinna Weber-Schoendorfer ◽  
...  
Keyword(s):  
Spontaneous Abortion ◽  
Birth Defects ◽  
Pregnancy Outcomes ◽  
Odds Ratio ◽  
Time Window ◽  
First Trimester ◽  
Specific Pattern ◽  
Fetal Ultrasound ◽  
Crude Odds Ratio ◽  
Increased Risk

ABSTRACTFluoroquinolones are avoided during pregnancy due to developmental toxicity in animals. The aim of this study was to assess the fetal risk after intrauterine fluoroquinolone exposure. We performed an observational study of a prospectively ascertained cohort of pregnant women exposed to a fluoroquinolone during the first trimester. Pregnancy outcomes were compared to those of a cohort exposed to neither fluoroquinolones nor teratogenic or fetotoxic drugs. The outcomes evaluated were major birth defects (structural abnormalities of medical, surgical, or cosmetic relevance), spontaneous abortion, and elective termination of pregnancy. Pregnancy outcomes of 949 women with fluoroquinolone treatment were compared with those of 3,796 nonexposed controls. Neither the rate of major birth defects (2.4%; adjusted odds ratio [ORadj], 0.91; 95% confidence interval [CI], 0.6 to 1.5) nor the risk of spontaneous abortion (adjusted hazard ratio [HRadj], 1.01; 95% CI, 0.8 to 1.3) was increased. However, there was a nonsignificant increase in major birth defects after exposure to moxifloxacin (6/93, 6.5%; crude odds ratio [ORcrude], 2.40; 95% CI, 0.8 to 5.6). Neither a critical exposure time window within the first trimester nor a specific pattern of birth defects was demonstrated for any of the fluoroquinolones. The rate of electively terminated pregnancies was increased among the fluoroquinolone-exposed women (HRadj, 1.32; 95% CI, 1.03 to 1.7). The gestational ages at delivery and birth weights did not differ between groups. Our study did not detect an increased risk of spontaneous abortion or major birth defects. These reassuring findings support the recommendation to allow fluoroquinolone use in early pregnancy in selected cases. After the use of moxifloxacin, a detailed fetal ultrasound examination should be considered.

scholarly journals Perioperative Complications after Parotidectomy Using a Standardized Grading Scale Classification System

Surgeries ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 20-34
Author(s):  
Natacha Terlinden ◽  
Marc Hamoir ◽  
Aline Van Maanen ◽  
Sandra Schmitz
Keyword(s):  
Hospital Stay ◽  
Odds Ratio ◽  
Perioperative Complications ◽  
P Value ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Grade Ii ◽  
Grading Scale ◽  
Almost All

Perioperative complications after parotidectomy are poorly studied and have a potential impact on hospitalization stay. The Clavien–Dindo classification of postoperative complications used in visceral surgery allows a recording of all complications, including a grading scale related to the severity of complication. The cohort analyzed for perioperative complications is composed of 436 parotidectomies classified into three types, four groups, and three classes, depending on extent of parotid resection, inclusion of additional procedures, and pathology, respectively. Using the Clavien–Dindo classification, complications were reported in 77% of the interventions. In 438 complications, 430 (98.2%) were classified as minor (332 grade I and 98 grade II), and 8 (1.8%) were classified as major (grade III). Independent variables affecting the risk of perioperative complications were duration of surgery (odds ratio = 1.007, p-value = 0.029) and extent of parotidectomy (odds ratio = 4.043, p-value = 0.007). Total/subtotal parotidectomy was associated with an increased risk of grade II-III complications (odds ratio = 2.866 (95% CI: 1.307–6.283), p-value = 0.009). Median hospital stay increased moderately in patients with complications. Use of Clavien–Dindo classification shows that parotidectomy is followed by a higher rate of perioperative complications than usually reported. Almost all complications are minor and have limited consequence on hospital stay.

scholarly journals Short-Term Complications of Emergency and Elective Tracheostomy; A Comparative Study

2021 ◽  
Vol 2 (2) ◽  
pp. 5
Author(s):  
Zaheer Ul Hassan ◽  
Farhan Akbar ◽  
Tarique Ahmed Maka
Keyword(s):  
Cardiac Arrest ◽  
Neck Surgery ◽  
Postoperative Hemorrhage ◽  
Military Hospital ◽  
P Value ◽  
Short Term ◽  
Cross Sectional ◽  
Emergency Tracheostomy ◽  
Increased Risk ◽  
Surgical Emphysema

Objective: To compare short-term complications in elective and emergency tracheostomy.Study Design: Comparative cross sectional. Place Duration of Study: The study was conducted in the Department of ENT, Head and Neck Surgery at Combined Military Hospital (CMH) Peshawar from 21th October 2018 to 20th October 2019. Materials and Methods: In this study 60 patients undergoing tracheostomy were included. Patients were divided into two groups, each with 30 participants. Patients in group A had elective whereas group B had emergency tracheostomy. Short term complications including hemorrhage, surgical emphysema, cardiac arrest and stomal infection were noted in both groups. Chi-square test was applied as test of significance to compare the two groups. Results: Emergency tracheostomy is associated with significantly increased risk of hemorrhage and surgical emphysema (p value being <0.05. There was no statistical difference in occurrence of stomal infection and cardiac arrest between the two groups. Conclusion: Tracheostomy performed in emergency is fraught with complications. Our study validates the fact that emergency tracheostomy is associated with significantly increased risk of postoperative hemorrhage and surgical emphysema.

The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis

2011 ◽  
Vol 42 (8) ◽  
pp. 1567-1580 ◽  
Author(s):  
G. Geulayov ◽  
D. Gunnell ◽  
T. L. Holmen ◽  
C. Metcalfe
Keyword(s):  
Suicidal Behaviour ◽  
Affective Disorders ◽  
Odds Ratio ◽  
Fixed Effects ◽  
Attempted Suicide ◽  
Meta Analysis ◽  
Female Offspring ◽  
Crude Odds Ratio ◽  
Increased Risk ◽  
The Impact

BackgroundChildren whose parents die by, or attempt, suicide are believed to be at greater risk of suicidal behaviours and affective disorders. We systematically reviewed the literature on these associations and, using meta-analysis, estimated the strength of associations as well as investigated potential effect modifiers (parental and offspring gender, offspring age).MethodWe comprehensively searched the literature (Medline, PsycINFO, EMBASE, Web of Science), finding 28 articles that met our inclusion criteria, 14 of which contributed to the meta-analysis. Crude odds ratio and adjusted odds ratio (aOR) were pooled using fixed-effects models.ResultsControlling for relevant confounders, offspring whose parents died by suicide were more likely than offspring of two living parents to die by suicide [aOR 1.94, 95% confidence interval (CI) 1.54–2.45] but there were heterogeneous findings in the two studies investigating the impact on offspring suicide attempt (aOR 1.31, 95% CI 0.73–2.35). Children whose parents attempted suicide were at increased risk of attempted suicide (aOR 1.95, 95% CI 1.48–2.57). Limited evidence indicated that exposure to parental death by suicide is associated with subsequent risk of affective disorders. Maternal suicidal behaviour and younger age at exposure were associated with larger effect estimates but there was no evidence that the association differed in sons versus daughters.ConclusionsParental suicidal behaviour is associated with increased risk of offspring suicidal behaviour. Findings suggest that maternal suicidal behaviour is a more potent risk factor than paternal, and that children are more vulnerable than adolescents and adults. However, there is no evidence of a stronger association in either male or female offspring.

scholarly journals Suboptimal Tongue Pressure Is Associated with Risk of Malnutrition in Community-Dwelling Older Individuals

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1821
Author(s):  
Ke-Vin Chang ◽  
Wei-Ting Wu ◽  
Lan-Rong Chen ◽  
Hsin-I Wang ◽  
Tyng-Guey Wang ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Odds Ratio ◽  
Handgrip Strength ◽  
Community Dwelling ◽  
Nutrition Status ◽  
Tongue Pressure ◽  
Older Individuals ◽  
Crude Odds Ratio ◽  
The Third ◽  
Increased Risk

The tongue plays an important role in swallowing, and its dysfunction theoretically leads to inadequate oral intake and subsequent malnutrition. This study aimed to explore how different levels of tongue pressure are related to malnutrition among community-dwelling older individuals. The target population was community-dwelling adults aged ≥ 65 years. Tongue pressure was measured using the Iowa Oral Performance Instrument, whereas the mini nutrition assessment (MNA) test was administered to determine the nutritional status. A full MNA score of less than 24 points was defined as risk of malnutrition. Multivariate logistic regression analyses were conducted to calculate the odds ratio (OR) of risk of malnutrition among different quartiles of tongue pressure. Among the 362 participants, 26 (7.1%) were classified as having risk of malnutrition. Body weight, body mass index, handgrip strength, skeletal muscle mass index, sum MNA score, and serum levels of albumin were lower in the malnutrition risk groups than in the normal nutrition status group. A positive correlation was identified between tongue pressure and the MNA score (r = 0.143, p < 0.01). Treating the subgroup of the highest quartile of tongue pressure as the reference, the crude odds ratio (OR) of having risk of malnutrition was 5.37 (95% CI, 1.14–25.28) in the subgroup at the third quartile, 3.10 (95% CI, 0.60–15.84) in the subgroup at the second quartile, and 3.95 (95% CI, 0.81–19.15) in the subgroup at the lowest quartile. After adjustment for age and sex, the subgroup in the third quartile still presented with a significantly higher risk (OR, 4.85; 95% CI, 1.02–22.99) of risk of malnutrition. Compared with the subgroup at the highest quartile of tongue pressure, the crude OR for all the subgroups in the lower three quartiles was 4.17 (95% CI, 0.96–18.04), showing borderline significance (p = 0.05). In conclusion, we found hints for an association between decreased tongue pressure and an increased risk of malnutrition in community-dwelling older individuals. Older people with suboptimal tongue pressure should undergo a thorough assessment of their nutritional status and swallowing function for the early identification of subclinical malnutrition and dysphagia.

Osteonecrosis of the Jaws in Myeloma: Time Dependent Correlation with Aredia® and Zometa® Use.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 756-756 ◽  
Author(s):  
Brian G.M. Durie ◽  
Michael Katz ◽  
Jason McCoy ◽  
John Crowley
Keyword(s):  
Odds Ratio ◽  
Multivariate Analyses ◽  
Dental Treatment ◽  
Time Dependent ◽  
Occurrence Rate ◽  
P Value ◽  
Steroid Use ◽  
Osteonecrosis Of The Jaws ◽  
Increased Risk ◽  
The Impact

Abstract Osteonecrosis of the jaws was evaluated in 812 myeloma patients responding to a web-based survey. Data items collected included age, sex, diagnosis, type and duration of bisphosphonate treatment, dental problems such as pain, bone spurs, tooth decay, poor healing, infection, gum disease, and other details, as well as treatment for dental problems. Information about other treatments was also recorded, including melphalan, cytoxan, thalidomide, bortozemib (VELCADE®), VAD, dexamethasone, prednisone, methylprednisone, erythropoietin, interferon, as well as high dose aklylating agents, as part of autologous and/or allogeneic or syngeneic transplants. Details of radiation therapy were gathered, with special reference to head and neck irradiation. There was the option to provide text details, which added helpful information. Of the 812 myeloma patients, 46 (5.7%) indicated a diagnosis of osteonecrosis of the jaws and an additional 46 patients had findings suspicious for early osteonecrosis, giving a total of 92 patients or 11.4% of respondents affected. The true occurrence rate of osteonecrosis in the U.S. myeloma population is currently unknown. A minimal estimate is 0.5 – 1% based upon the current plus accumulated reported cases thus far. The focus of these analyses is not the percentage, but the comparison of affected with unaffected patients. The strongest correlation was with use of Aredia and/or Zometa in both univariate and multivariate analyses (p < .0001). The only other therapy with a significant correlation was prednisone as part of melphalan/prednisone or alone, but not other steroid use. In an analysis of time dependency, only Aredia and/or Zometa use showed a significant correlation. The time dependence was assessed from 3 months to 36 months. The results are shown in Table 1. The odds ratio is > 1 at 3 months. The P-value becomes significant at 12 months; more so at 24 and 36 months. For these and other correlations, there was an identical trend with osteonecrosis and/or suspicious findings. Additional analysis assessed the interaction between steroid use, prednisone in particular, and increased risk combined with Aredia and/or Zometa. There was no indication of interaction. Both Aredia and/or Zometa and prednisone use were separate factors in the multivariate analyses. The full clinical details and the impact of dental treatment and preventative measures are being further evaluated. Preliminary analysis indicates increase risk in patients undergoing tooth extraction, root canal and other surgical procedures, as well as a decreased occurence in patients with recent dental prophylaxis, but these issues require further analysis and investigation. Conclusions: The new entity of osteonecrosis of the jaws in myeloma patients is most strongly associated with use of Aredia and/or Zometa. This risk is time-dependent and becomes significant at 12 months, increasing thereafter to 36 months. Prednisone is an additional and separate risk factor that is not time-dependent. Risk appears to be increased by major dental procedures and poor dental hygiene. These analyses can help form the basis for new recommendations for bisphosphonate use, as well as dental treatment and prevention strategies. Table 1 ≥ 3 months ≥ 6 months ≥ 9 months ≥ 12 months ≥ 24 months ≥ 36 months Odds Ratio 1.33 1.40 1.97 2.20 2.44 2.56 P-Value 0.46 0.32 0.06 0.03 0.004 0.004

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