scholarly journals THU0600 Cumulative adverse childhood experiences are associated with poor outcomes in adults with systemic lupus erythematosus

2017 ◽  
Author(s):  
K DeQuattro ◽  
L Trupin ◽  
PP Katz ◽  
C Lanata ◽  
EH Yelin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Adverse Childhood Experiences ◽  
Systemic Lupus ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Poor Outcomes

scholarly journals Relationships Between Adverse Childhood Experiences and Health Status in Systemic Lupus Erythematosus

2020 ◽  
Vol 72 (4) ◽  
pp. 525-533 ◽  
Author(s):  
Kimberly DeQuattro ◽  
Laura Trupin ◽  
Jing Li ◽  
Patricia P. Katz ◽  
Louise B. Murphy ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Health Status ◽  
Lupus Erythematosus ◽  
Adverse Childhood Experiences ◽  
Systemic Lupus ◽  
Childhood Experiences ◽  
Adverse Childhood

scholarly journals FRI0224 IDENTIFICATION OF RISK AND PROGNOSTIC FACTORS FOR POLYARTERITIS NODOSA PATIENTS WITH DIGITAL GANGRENE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 695.2-695
Author(s):  
D. Xu ◽  
X. Tian ◽  
X. Zeng ◽  
F. Zhang ◽  
L. Zhao ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Polyarteritis Nodosa ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Response To Therapy ◽  
Smoking History ◽  
Systemic Lupus ◽  
Poor Outcomes

Background:Polyarteritis nodosa (PAN) is a segmental, necrotizing vascular disease that primarily impacts medium-sized muscle arteries. The estimated annual incidence of PAN is still lacking in China. Digital gangrene is an ischemic manifestation of the limb. However, the causes and the treatment methods vary from case to case, and the outcome is unpredictable. These features emphasize the need to identify measurable variables that accelerate digital gangrene development in PAN patients. However, little effort has been made to identify the clinical and laboratory factors that affect PAN patients with digital gangrene to anticipate their natural history and response to therapy.Objectives:Many patients with polyarteritis nodosa (PAN) complicated with digital gangrene have poor outcomes and related research information is limited. This study was carried out to identify the associated risk and prognostic factors.Methods:We conducted a retrospective study of 148 PAN patients admitted to Peking Union Medical College Hospital (PUMCH) from September 1986 to December 2018. The characteristics, therapeutic regimens, and outcome data for patients with and without gangrene were compared. The Kaplan–Meier method and Cox hazard regression model were used to evaluate the prognostic factors.Results:Forty-seven (31.8%) PAN patients had digital gangrene complications. The average age was 40.4±17.9 years and the average disease duration was 11 (4-27) months. The presence of digital gangrene was correlated with smoking history [odds ratio (OR), 4.27; 95% confidence interval (95% CI), 1.56-11.66] and eosinophil elevation (28.12; 10.30-76.8). Thirty-two (68.1%) gangrene patients received methylprednisolone pulse therapy and all of these patients were treated with cyclophosphamide. Nine patients suffered irreversible organ injury and two died. Disease duration ≥ 24 months and elevated serum C-reactive protein (CRP) were identified as hazardous factors for poor prognosis in patients with gangrene (P=0.003, HR=8.668, 95% CI 2.11, 35.55 andP=0.042, HR=27.062, 95% CI 1.13, 648.57, respectively).Conclusion:Smoking history and eosinophil elevation in PAN patients were more prone to digital gangrene and high serum CRP level predicted poor outcomes. PAN patients with smoking history and elevated eosinophils need to be seriously evaluated by clinicians. Furthermore, the CRP level should be efficiently controlled for good prognosis.References:[1]De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: A contemporary overview. Autoimmun Rev. 2016;15:564-70.[2]Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616-26.[3]Xu D, You X, Wang Z, Zeng Q, Xu J, Jiang L, et al. Chinese Systemic Lupus Erythematosus Treatment and Research Group Registry VI: Effect of Cigarette Smoking on the Clinical Phenotype of Chinese Patients with Systemic Lupus Erythematosus. PLoS One. 2015;10:e0134451.Acknowledgments:NoDisclosure of Interests:Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared, Lin Zhao: None declared, Shangzhu Zhang: None declared, Jiaxin Zhou: None declared, Jiu-liang Zhao: None declared, Xiaodan Kong: None declared

Poor Outcomes After Acute Myocardial Infarction in Systemic Lupus Erythematosus

2009 ◽  
Vol 36 (3) ◽  
pp. 570-575 ◽  
Author(s):  
MANSI A. SHAH ◽  
AMBER M. SHAH ◽  
ESWAR KRISHNAN
Keyword(s):  
Myocardial Infarction ◽  
Systemic Lupus Erythematosus ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Prolonged Hospitalization ◽  
Hazard Ratios ◽  
Acute Mi ◽  
Poor Outcomes

Objective.Systemic lupus erythematosus (SLE) is associated with higher risk for acute myocardial infarction (MI); but the post-infarction outcomes among these patients are unknown. Our objective was to compare post-acute MI outcomes in patients with SLE to those with diabetes mellitus (DM) and those with neither condition.Methods.We analyzed the risk for prolonged hospitalization and in-hospital mortality following acute MI in the 1993–2002 US Nationwide Inpatient Sample. We used logistic regression to calculate odds ratios (OR) for prolonged hospitalization and Cox proportional hazards regression to calculate hazard ratios (HR) for in-hospital mortality with and without adjustments for age, sex, race/ethnicity, socioeconomic status, and presence of congestive heart failure.Results.For the SLE (n = 2192), DM (n = 236,016), SLE/DM (n = 474), and control (n = 667,956) groups, the in-hospital mortality rates were 8.3%, 6.2%, 5.7%, and 4.7%, respectively. In multivariable regression models, all 3 disease groups had higher adverse outcome risk compared to control. The OR for prolonged hospitalization was higher for those with SLE (OR 1.48, 95% CI 1.32–1.79) compared to those with DM (OR 1.30, 95% CI 1.28–1.32). A similar pattern was observed for hazard ratios for in-hospital mortality as well (SLE, HR 1.65, 95% CI 1.33–2.04; DM, HR 1.11, 95% CI 1.07–1.14).Conclusion.SLE, like DM, increases risk of poor outcomes after acute MI. These patients need to be triaged appropriately for aggressive care.

Multiple Maltreatment and Adverse Childhood Experiences: Exploring Cumulative Threats to Attachment Quality

2020 ◽  
pp. VV-D-19-00158
Author(s):  
James E. Barnett ◽  
Tasha R. Howe
Keyword(s):  
Emerging Adults ◽  
Adverse Childhood Experiences ◽  
Attachment Styles ◽  
Cumulative Risk ◽  
Screening Tools ◽  
Childhood Experiences ◽  
Attachment Quality ◽  
Adverse Childhood ◽  
Poor Outcomes ◽  
Socioemotional Outcomes

Child maltreatment and other adverse childhood experiences (ACEs) often cooccur and are related to negative socioemotional outcomes; however, limited research differentiates how maltreatment versus other ACEs predict such outcomes. These efforts are necessary to determine whether cumulative ACE screening efforts best predict those at risk for poor outcomes. We examined cumulative childhood ACEs, cumulative maltreatment subtypes, and adult attachment quality in 379 young and middle-aged adults. This sample enabled comparison between emerging adults and older adults who have navigated additional developmental tasks that may counteract the effects of early ACEs. More ACEs and maltreatment experiences predicted insecure anxious, avoidant, and fearful attachment styles; however, maltreatment failed to predict unique variance in attachment quality beyond other ACEs. Results suggest that maltreatment may be best categorized as part of a general cumulative risk profile predicting poor socioemotional outcomes. Findings support burgeoning trends in medical and social service settings assessing ACEs using simple dichotomous screening tools to identify those requiring intervention and support services.

Adverse Childhood Experiences: Developments in Trauma and Resilience Aware Services

2020 ◽  
Author(s):  
Trevor Spratt ◽  
Mary Kennedy
Keyword(s):  
Adverse Childhood Experiences ◽  
Policy Development ◽  
Physical And Mental Health ◽  
Short Term ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Poor Outcomes ◽  
The Uk ◽  
The Life Course ◽  
Research And Policy

Abstract Research has demonstrated conclusively that the experience of adversities in childhood increases the risks for poor outcomes in the domains of physical and mental health and economic and social circumstances across the life course. This has produced a wave of interest in the effects of Adverse Childhood Experiences internationally, with developments in policy across the UK nations reflective of this. The translation of such research and policy development has witnessed the growing dominance of the ‘toxic stress model’ as underpinning the early signalling of troubles in children. Such signals are further conceptualised as the presence of ‘trauma’. It is upon these conceptual pillars that therapeutically orientated services are being built. In this article, we describe these developments, offering as they do, challenges to short-term interventions as well as providing opportunities for social workers to appropriate the developing knowledge base so as to inform more effective ways of working.

scholarly journals ACEs: Evidence, Gaps, Evaluation and Future Priorities

2019 ◽  
Vol 18 (3) ◽  
pp. 415-424 ◽  
Author(s):  
Andrew Steptoe ◽  
Theresa Marteau ◽  
Peter Fonagy ◽  
Kathryn Abel
Keyword(s):  
Adverse Childhood Experiences ◽  
Research Priorities ◽  
Evidence Base ◽  
Biological Mechanisms ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Poor Outcomes ◽  
The Individual ◽  
Mental And Physical Health

There is strong evidence linking adverse childhood experiences (ACEs) and poor outcomes in adulthood both in terms of mental and physical health. Gaps in both the evidence base and research priorities still exist. These include understanding how to identify and assess risk in children who have experienced ACEs, and also the development and, importantly, the evaluation of interventions. Outstanding gaps include whether there are sensitive periods during childhood, the role of resilience/protective factors, the causal relationships, biological mechanisms and relative risk of ACEs for particular negative outcomes. ACEs affect individual children differently and chronic exposure appears to increase the risk of poor outcomes in adulthood, meaning interventions should also be tailored to the individual children, families and communities. Generally, there needs to be better evaluation of interventions and dissemination of this information to ensure that their use is evidence based. More input from affected communities, clinicians, funding bodies and Government departments is required to identify research priorities and ensure gaps in the evidence base are addressed.

scholarly journals Systemic lupus erythematosus is not a risk factor for poor outcomes after total hip and total knee arthroplasty

Lupus ◽  
2015 ◽  
Vol 24 (9) ◽  
pp. 900-908 ◽  
Author(s):  
U H Shah ◽  
L A Mandl ◽  
C Mertelsmann-Voss ◽  
Y Y Lee ◽  
M M Alexiades ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Total Knee Arthroplasty ◽  
Risk Factor ◽  
Knee Arthroplasty ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Total Hip ◽  
Total Knee ◽  
Poor Outcomes

Organized Intraglomerular Deposits in NZB Mouse Disease

1971 ◽  
Vol 29 ◽  
pp. 544-545
Author(s):  
Francis R. Comerford ◽  
Alan S. Cohen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Human Systemic Lupus Erythematosus ◽  
Systemic Lupus ◽  
Glomerular Lesion ◽  
Ultrastructural Studies ◽  
Dense Deposits ◽  
Experimental Nephritis ◽  
Glomerular Lesions

Mice of the inbred NZB strain develop a spontaneous disease characterized by autoimmune hemolytic anemia, positive lupus erythematosus cell tests and antinuclear antibodies and nephritis. This disease is analogous to human systemic lupus erythematosus. In ultrastructural studies of the glomerular lesion in NZB mice, intraglomerular dense deposits in mesangial, subepithelial and subendothelial locations were described. In common with the findings in many examples of human and experimental nephritis, including many cases of human lupus nephritis, these deposits were amorphous or slightly granular in appearance with no definable substructure.We have recently observed structured deposits in the glomeruli of NZB mice. They were uncommon and were found in older animals with severe glomerular lesions by morphologic criteria. They were seen most commonly as extracellular elements in subendothelial and mesangial regions. The deposits ranged up to 3 microns in greatest dimension and were often adjacent to deposits of lipid-like round particles of 30 to 250 millimicrons in diameter and with amorphous dense deposits.

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