scholarly journals OP0271 REAL-WORLD CLINICAL BURDEN AND GLUCOCORTICOID USE IN PATIENTS WITH POLYMYALGIA RHEUMATICA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 169.1-169
Author(s):  
R. Punekar ◽  
P. Lafontaine ◽  
J. H. Stone
Keyword(s):  
Cardiovascular Disease ◽  
Health Plan ◽  
Polymyalgia Rheumatica ◽  
Data Availability ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Rank Tests ◽  
Medical Claim ◽  
Diagnosis Codes

Background:Polymyalgia rheumatica (PMR) is a chronic inflammatory condition characterized by aching and morning stiffness in the neck, shoulders and pelvic girdle. It is a common inflammatory rheumatic disease in patients age >50 years, particularly women. While giant cell arteritis (GCA) is present in 9–21% of PMR cases, many PMR patients have symptoms independent of GCA. Current treatment options are limited to long-term glucocorticoid (GC), however, with risks of GC-related complications, including cardiovascular disease, osteoporosis, and diabetes mellitus.Objectives:To compare GC use and subsequent GC-related complications in patients with PMR vs a general population (GnP) cohort.Methods:This retrospective, observational cohort study was based on Optum’s de-identified Clinformatics®Data Mart Database (study period 01Jan2006-30June2018). The PMR cohort included patients with ≥1 inpatient or ≥2 outpatient claims ≥30 days apart with PMR related diagnosis codes (ICD-9: 725.xx or ICD-10: M35.3x) between 01Jan2006–30June2017 (patient identification period) during which first occurrence of a PMR-related medical claim was set as the index date (ID). Patients with ≥1 medical claim related to rheumatoid arthritis (RA) or GCA during the study period were excluded. The GnP cohort included patients without any RA, GCA or PMR diagnosis codes during the study period, with their ID set as 12 months from the start of continuous health plan enrollment. Patients in both cohorts were required to be age ≥50 years (on ID) with continuous health plan enrollment ≥12 months pre- and post-ID. Cohorts were 1:1 propensity score matched. GC use and incidence of GC-related complications were assessed from GC initiation, starting from the baseline period (12-months pre-ID) through to the end of GC use during the post-index period (i.e. the end of data availability, end of the study period or death [whichever occurred first]). Mean, standard deviation (SD) and median values for continuous variables, and frequency (n and %) for categorical variables were compared between the matched cohorts. Wilcoxon sum rank tests andt-tests on continuous variables and Chi-square tests or Fisher’s exact tests on categorical variables between matched cohorts were conducted. Duration of GC use was analyzed using the Kaplan-Meier method and compared between matched cohorts using log-rank tests.Results:In each of the PMR and GnP cohorts, 16,865 patients were included. In both matched cohorts, median age was 76 years, median Elixhauser comorbidity index score was 2.0, and the majority (~65%) were women. The median follow-up duration was 45 months and 51 months in the PMR and GnP cohorts, respectively. A higher proportion of patients in the PMR cohort than the matched GnP cohort (90.4% vs 62.8%;p<0.001) used GC. The mean (SD) duration of GC therapy was significantly longer in the PMR cohort than in the matched GnP cohort (242.1 [±317.2] days vs 35.5 [±124.6] days;p<0.001). Although patients in the PMR cohort had a lower average daily dose of GC (prednisone equivalent) vs the GnP cohort (mean [SD] mg 16.3 [± 21.9] vs 27.8 [±24.5], respectively [p<0.0001)], the cumulative GC dose was significantly higher in the PMR cohort than the GnP cohort (2125.4 [±3689.5] mg vs 476.6 [±1450.9] mg;p<0.001). This indicates PMR patients used chronic low dose GC while the GnP patients utilized higher dose GC burst therapy less frequently. The number of incident complications associated with GC use were significantly greater in the PMR cohort, and included hypertension, diabetes, skin toxicity, infections, neuropsychiatric effects, endocrine abnormalities, renal dysfunction/ failure, ocular effects, and cardiovascular disease (p<0.05).Conclusion:The overall GC burden in patients with PMR is high. With a higher incidence of GC-related comorbidities among PMR patients, early onset of these complications may be a significant contributor to long-term healthcare costs in these patients.Acknowledgments:This study was funded by Sanofi, Inc. Medical writing, under the direction of authors, was provided by Gauri Saal, MA Economics, Prime, Knutsford, UK, and funded by Sanofi.Disclosure of Interests:Rajeshwari Punekar Shareholder of: Sanofi, Employee of: Sanofi, Patrick LaFontaine Shareholder of: Sanofi, Employee of: Sanofi, John H. Stone Grant/research support from: Roche, Consultant of: Roche

scholarly journals OP0275 REAL-WORLD CLINICAL BURDEN AND GLUCOCORTICOID USE IN PATIENTS WITH GIANT CELL ARTERITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 171.2-172
Author(s):  
R. Punekar ◽  
P. Lafontaine ◽  
J. H. Stone
Keyword(s):  
General Population ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Health Plan ◽  
Data Availability ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Rank Tests ◽  
Diagnosis Codes ◽  
The Mean

Background:Giant cell arteritis (GCA) is a rare form of vasculitis usually manifesting in people aged ≥50 yr and is more common in women. Symptoms include headache, jaw claudication, fatigue, polymyalgia; and blindness if untreated. While risks of complications can be reduced with promptly administered high-dose glucocorticoids (GC; 20-60 mg for 2-4 wk, then slowly tapered), further risks of high GC exposure and related complications over the course of therapy remain.Objectives:To compare GC use and GC-related complications in GCA patients (pts) vs a general population (GnP) cohort.Methods:This retrospective, observational cohort study was based on Optum’s de-identified Clinformatics®Data Mart Database (01/01/06-30/06/18, study period). The GCA cohort included pts with ≥1 inpatient or ≥2 outpatient claims ≥30 days apart with GCA-related diagnosis codes (ICD-9: 446.5x/ICD-10: M31.6x) between 01/01/06-30/06/17 (pt identification period) during which first occurrence of a GCA-related medical claim was set as index date (ID). The GnP cohort included pts without any medical claims for rheumatoid arthritis, GCA or polymyalgia rheumatica diagnosis codes during the study period, with their ID set as 12 mo from start of continuous health plan enrollment. Pts in both cohorts were required to be age ≥50 yr (on the ID) with continuous health plan enrollment ≥12 mo pre- and post-ID. Cohorts were 1:1 propensity score matched. GC use and incidence of GC-related complications were assessed from GC initiation, starting from the baseline period (12-mo pre-ID) to the end of GC use during the post-index period (ie the end of data availability, end of the study period, or death, whichever occurred first). Descriptive analyses included mean, standard deviation (SD) and median values for continuous variables, and frequency (n and %) for categorical variables. Continuous variables were compared between matched cohorts usingt-tests and Wilcoxon sum rank tests. Categorical variables were compared between matched cohorts using Chi-square tests or Fisher’s exact tests. Duration of GC use was analyzed using the Kaplan-Meier method and compared between matched cohorts using log-rank tests.Results:There were 6071 pts included in each of the GCA and matched GnP cohorts; median age per cohort was 76 yr, median Elixhauser comorbidity index score was 3.0, and the majority (~75%) were women. The median follow-up duration was 44 and 48 mo in the GCA and GnP cohorts, respectively. A higher proportion of pts in the GCA cohort than the GnP cohort (90.6 vs 63.8%;p<0.001) used GC. The mean (SD) duration of GC therapy was 230.5 (±326.8) days in the GCA cohort vs 36.3 (±107.2) days in the GnP cohort (p<0.001). Although the mean (SD) daily dose of GC (prednisone equivalent) was similar in both cohorts (27.6 [±28.20] vs 27.7 [±25.18] mg), the mean (SD) cumulative GC dose was significantly higher in the GCA cohort than the GnP cohort (3503.0 (±4622.6) mg vs 503.7 (±1593.51) mg;p<0.001). This indicates that GCA pts had chronic GC exposure over the study period while GnP pts likely utilized higher dose GC burst therapy less frequently. The number of incident complications associated with GC use were significantly greater in the GCA cohort, and included hypertension, diabetes, skin toxicity, infections, neuropsychiatric effects, gastrointestinal complications, ocular effects, and cardiovascular disease (p<0.05).Conclusion:The overall GC burden in pts with GCA is significantly higher than the general population and may result in downstream complications related to GC exposure. The incidence of GC-related complications was statistically significantly higher in GCA pts compared with GnP pts, even with a short duration of GC use. The early onset of these complications may be a significant contributor to long-term healthcare costs in GCA pts.Acknowledgments:Study and medical writing (provided by Gauri Saal, MA, Economics, Prime, Knutsford, UK, under the direction of authors) were funded by Sanofi, Inc.Disclosure of Interests:Rajeshwari Punekar Shareholder of: Sanofi, Employee of: Sanofi, Patrick LaFontaine Shareholder of: Sanofi, Employee of: Sanofi, John H. Stone Grant/research support from: Roche, Consultant of: Roche

scholarly journals Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Maryam Kabootari ◽  
Samaneh Asgari ◽  
Seyedeh Maryam Ghavam ◽  
Hengameh Abdi ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Population Based ◽  
World Health ◽  
Incident Diabetes ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Diabetes Status ◽  
Adjusted Model

Abstract Background Fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2 h-PCPG), whether as continuous or categorical variables, are associated with incident cardiovascular disease (CVD) and diabetes; however, their role among patients with existing CVD is a matter of debate. We aimed to evaluate associations of different glucose intolerance states with recurrent CVD and incident diabetes among subjects with previous CVD. Methods From a prospective population-based cohort, 408 Iranians aged  ≥  30 years, with history of CVD and without known diabetes were included. Associations of impaired fasting glucose (IFG) according to the American Diabetes Association (ADA) and World Health Organization (WHO) criteria, impaired glucose tolerance (IGT), newly diagnosed diabetes (NDM) with outcomes of interest were determined by multivariable Cox proportional hazard models after adjustment for traditional risk factors. Furthermore, FPG and 2 h-PCPG were entered as continuous variables. Results Over a decade of follow-up, 220 CVD events including 89 hard events (death, myocardial infarction and stroke) occurred. Regarding prediabetes, only IFG-ADA was associated with increased risk of hard CVD [hazard ratio(HR), 95%CI: 1.62,1.03–2.57] in the age-sex adjusted model. In patients with NDM, those with FPG ≥ 7 mmol/L were at higher risk of incident CVD/coronary heart disease(CHD) and their related hard outcomes (HR ranged from 1.89 to 2.84, all P < 0.05). Moreover, those with 2 h-PCPG ≥ 11.1 mmol/L had significant higher risk of CVD (1.46,1.02–2.11), CHD (1.46,1.00–2.15) and hard CHD (1.95:0.99–3.85, P = 0.05). In the fully adjusted model, each 1 SD increase in FPG was associated with 20, 27, 15 and 25% higher risk of CVD, hard CVD, CHD and hard CHD, respectively; moreover each 1 SD higher 2 h-PCPG was associated with 21% and 16% higher risk of CVD, and CHD, respectively. Among individuals free of diabetes at baseline (n = 361), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes (all P < 0.05); significant associations were also found for FPG and 2 h-PCPG as continuous variables (all HRs for 1-SD increase > 2, P < 0.05). Conclusions Among subjects with stable CVD, NDM whether as high FPG or 2 h-PCPG, but not pre-diabetes status was significantly associated with CVD/CHD and related hard outcomes.

scholarly journals The “Real R0”: A Resection Margin Smaller Than 0.1 cm is Associated with a Poor Prognosis After Oncologic Esophagectomy

2021 ◽  
Author(s):  
Penelope St-Amour ◽  
Michael Winiker ◽  
Christine Sempoux ◽  
François Fasquelle ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Resection Margin ◽  
Cox Regression ◽  
Tumor Biology ◽  
Disease Free Survival ◽  
Recurrence Risk ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Kaplan Meier

Abstract Background Although resection margin (R) status is a widely used prognostic factor after esophagectomy, the definition of positive margins (R1) is not universal. The Royal College of Pathologists considers R1 resection to be a distance less than 0.1 cm, whereas the College of American Pathologists considers it to be a distance of 0.0 cm. This study assessed the predictive value of R status after oncologic esophagectomy, comparing survival and recurrence among patients with R0 resection (> 0.1-cm clearance), R0+ resection (≤ 0.1-cm clearance), and R1 resection (0.0-cm clearance). Methods The study enrolled all eligible patients undergoing curative oncologic esophagectomy between 2012 and 2018. Clinicopathologic features, survival, and recurrence were compared for R0, R0+, and R1 patients. Categorical variables were compared with the chi-square or Fisher’s test, and continuous variables were compared with the analysis of variance (ANOVA) test, whereas the Kaplan-Meier method and Cox regression were used for survival analysis. Results Among the 160 patients included in this study, 113 resections (70.6%) were R0, 34 (21.3%) were R0+, and 13 (8.1%) were R1. The R0 patients had a better overall survival (OS) and disease-free survival (DFS) than the R0+ and R1 patients. The R0+ resection offered a lower long-term recurrence risk than the R1 resection, and the R status was independently associated with DFS, but not OS, in the multivariate analysis. Both the R0+ and R1 patients had significantly more adverse histologic features (lymphovascular and perineural invasion) than the R0 patients and experienced more distant and locoregional recurrence. Conclusions Although R status is an independent predictor of DFS after oncologic esophagectomy, the < 0.1-cm definition for R1 resection seems more appropriate than the 0.0-cm definition as an indicator of poor tumor biology, long-term recurrence, and survival.

Short Paper: Risk Factors for Long-Term Persistent Symptoms in COVID-19 in an Outpatient Cohort (Preprint)

2020 ◽  
Author(s):  
James O'Keefe ◽  
Ghazala A Datoo O’Keefe ◽  
Anthony Mufarreh
Keyword(s):  
Risk Factors ◽  
Categorical Variables ◽  
Short Paper ◽  
Symptom Duration ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Persistent Symptoms ◽  
Long Term Follow Up

BACKGROUND Symptom descriptions in outpatients with COVID-19 are limited to cross-sectional surveys and longitudinal follow-up of long term symptoms has not been reported. Symptom duration is important for patient and provider knowledge in managing outpatient COVID-19. OBJECTIVE Describe the presence of symptoms at long term follow-up of patients managed in an outpatient telemedicine program for acute COVID-19. METHODS Chart review of clinical notes for acute COVID-19 and long term follow-up calls. Descriptive analysis were conducted using Wilcoxon rank-sum for continuous variables and chi-square or Fisher’s Exact as appropriate for categorical variables. RESULTS Minor symptoms were reported by 55 patients (34.8%) and 7 (4.4%) reported major ongoing symptoms at follow-up call. Factors associated with prolonged symptoms include older age, provider reported higher symptom severity at intake visit, and BMI >30. Symptoms which persisted include shortness of breath on exertion, wheeze, nausea, and joint pain. CONCLUSIONS Persistence of symptoms after acute COVID-19 in outpatients is common. Risk factors may help predict which patients are more likely to have prolonged symptoms.

scholarly journals Poincaré plots to analyze photoplethysmography signal between non-smokers and smokers

2022 ◽  
Vol 12 (2) ◽  
pp. 1565
Author(s):  
Bagus Haryadi ◽  
Po-Hao Chang ◽  
Akrom Akrom ◽  
Arifan Q. Raharjo ◽  
Galih Prakoso
Keyword(s):  
Cardiovascular Disease ◽  
Early Warning System ◽  
Blood Circulation ◽  
Detection System ◽  
Warning System ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Disease Group ◽  
Poincaré Plot ◽  
Exact Test

<span>An analysis of blood circulation was used to identify variations of heart rate and to create an early warning system of autonomic dysfunction. The Poincaré plot analyzed blood circulation using photoplethysmography (PPG) signals between non-smokers and smokers in three different indices: SD1, SD2, and SD1 SD2 ratio (SSR). There were twenty subjects separated into non-smoker and smoker groups with sample sizes of 10, respectively. An independent sample t-test to compare the continuous variables. Whereas, the comparison between two groups employed Fisher’s exact test for categorical variables. The result showed that SD1 was found to be considerably lower in the group of smokers (0.03±0.01) than that of the non-smokers (0.06±0.03). Similarly, SSR was recorded at 0.0012±0.0005 and 0.0023±0.0012 for smoking and non-smoking subjects, respectively. As a comparison, SD2 for non-smokers (25.7±0.5) was lower than smokers (27.3±0.4). In conclusion, we revealed that the parameters of Poincaré plots (SD1, SD2, and SSR) exert good performances to significantly differentiate the PPG signals of the group of non-smokers from those of smokers. We also supposed that the method promises to be a suitable method to distinguish the cardiovascular disease group. Therefore, this method can be applied as a part of early detection system of cardiovascular diseases.</span>

scholarly journals MO824PREDICTORS OF MORTALITY OF COVID-19 IN CHRONIC HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Catarina Almeida ◽  
Marina Sofia Rodrigues Reis ◽  
Daniela Alferes ◽  
Catarina Isabel Ribeiro ◽  
Sara Daniela Rodrigues ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Dialysis Patients ◽  
Hospitalization Time ◽  
Bacterial Superinfection

Abstract Background and Aims Coronavirus disease 2019 (COVID-19) has affected the care of patients on chronic hemodialysis (HD). It has been reported that older adults and those with comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease and chronic kidney disease are prone to develop severe disease and poorer outcomes. By virtue of their average old age, multiple comorbidities, immunosuppression and frequent contact with other patients in dialysis facilities, chronic HD patients are at particular risk for severe COVID-19 infection. The aim of this study was to compare clinical presentation, laboratory and radiologic data and outcomes between HD and non-HD COVID-19 patients and find possible risk factors for mortality on HD patients. Method A single center retrospective cohort study including patients on HD hospitalized with a laboratory confirmed COVID-19 infection, from March 1st to December 31st of 2020 and matched them to non-dialysis patients (non-HD) (1:1). Data regarding patient baseline characteristics, symptoms, laboratory and radiologic results at presentation were collected, as well as their outcomes. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. A paired Student’s t-test was performed on parametric continuous values or Mann-Whitney for non-parametric continuous variables. Chi-squared test was performed for comparing categorical variables. Logistic regression was used to identify risk factors for mortality on HD patients. A p-value of less than 0,05 indicated statistical significance. Results A total of 34 patients HD patients were included, 70,6% male, mean age of 76,5 years, median time of dialysis of 3,0 years. Among them 85,3% were hypertensive, 47,1% diabetic, 47,1% had cardiovascular disease, 30,6% pulmonary chronic disease and 23,5% cancer. The most frequent symptoms were fever (67,6%), shortness of breath (61,8%) and cough (52,9%). At admission, 55,9% of patients needed oxygen supply, one required mechanic ventilation and was admitted to intensive care unit. Regarding laboratory data, the most common features were lymphopenia in 58,9% (median- 795/uL), elevated LDH in 64,7% (median- 255 U/L), raised C-reactive protein in 97,1% (median-6,3 mg/dlL, raised D-dimer in 95,8% (median 1,7 ng/mL), and all patients presented high ferritin (median 1658 ng/mL) and elevated Troponin T (median 130ng/mL). The majority presented with radiologic changes, particularly bilateral infiltrates in 29,4%. Concerning clinical outcomes, the median hospitalization time was 11 days and 13 patients (38,2%) developed bacterial superinfection. Mortality rate was 32,4%. When matched to 34 non-HD patients there was no statistical significant differences in sex, age and comorbidities. The HD group had a tendency to more ventilator support need (p=0,051), higher ferritin and troponin levels (p=&lt;0,001 for both), whereas the non-HD group presented with greater levels of transaminases (p= 0,017). There was o significant difference in hospitalization time (median of 11 vs 7 days, p=0,222) neither in mortality (median of 32,4 vs 35,3%, p=0,798). When the logistic regression was performed, only bacterial superinfection was a predictor for mortality on hemodialysis patients (p=0,004). Conclusion Our study compared outcomes for COVID-19 patients on chronic HD to non-dialysis patients and showed no difference in hospitalization time nor in death rate. In spite of these results, the mortality in patients on chronic HD is still not negligible, with up to 32% of in-hospital mortality. Bacterial superinfection is a predictive risk factor for mortality. Hence the importance of interventions to mitigate the burden of COVID-19 in these patients, by preventing its spread, particularly in hemodialysis centers.

scholarly journals Clinical status and evolution in moyamoya: which angiographic findings correlate?

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Andrea Rosi ◽  
Coleman P Riordan ◽  
Edward R Smith ◽  
R Michael Scott ◽  
Darren B Orbach
Keyword(s):  
Digital Subtraction Angiography ◽  
Clinical Status ◽  
Arterial Stenosis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Digital Subtraction ◽  
Correlation Studies ◽  
Presenting Symptoms

Abstract Moyamoya is a progressive steno-occlusive cerebrovascular pathology of unknown aetiology that usually involves the terminal portions of the internal carotid arteries and/or the proximal portions of the anterior and middle cerebral arteries bilaterally. The pre-operative Suzuki staging system and post-operative Matsushima grade are nearly universally used markers of natural history and surgical revascularization results, respectively, but their correlation with clinical and radiographic manifestations of moyamoya has not been systematically evaluated in a large cohort. This study evaluated the strength of correlations between pre- and post-operative angiographic parameters and clinical status among paediatric patients with moyamoya. The participants included 58 patients of mean age 11 years at the time of surgery who underwent bilateral indirect revascularization in the same procedure at Boston Children’s Hospital, between January 2010 and December 2015. All included patients had available pre-operative and 1-year post-operative digital subtraction angiography. Clinical data included presenting symptoms, degree of functional incapacity, and peri-operative and long-term complications. Radiographic data included pre-operative Suzuki stage, degree of arterial stenosis, a novel collateral score, the presence of hypovascular territories on digital subtraction angiography, and post-operative Matsushima grade and evolution of stenosis. Chi-squared test and Pearson coefficient were used for correlation studies for categorical variables and Spearman’s rho was used for correlation studies for continuous variables. Results showed that Suzuki stage, collateral score and degree of stenosis were insufficient to predict clinical presentation, pre-operative incapacity and radiographic presentation, whereas the presence of hypovascular territories was correlated with all of these. At 1-year follow-up, Matsushima grade was insufficient for predicting peri-operative or long-term complications, nor did it correlate with post-operative incapacity. The presence of hypovascular territories at 1-year follow-up was correlated with the incidence of post-operative ischaemic symptoms.

scholarly journals Cannabis use is not associated with increased balance disturbances in HIV-infected individuals

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Patrick Kiendrebeogo ◽  
David Grelotti ◽  
Mariana Cherner ◽  
Raeanne C. Moore ◽  
Bin Tang ◽  
...  
Keyword(s):  
Cannabis Use ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Continuous Variables ◽  
Exact Test ◽  
Persistent Inflammation ◽  
History Of ◽  
Opioid Medications

Abstract Background The association between long-term cannabis use and balance disturbances has not been investigated in people living with HIV (PWH). We hypothesized that long-term cannabis use in PWH might be associated with more deleterious effects on balance than in HIV seronegative individuals due to potential neurotoxic interactions between HIV and cannabis. Methods Three thousand six-hundred and forty-eight participants with and without HIV completed an interviewer-administered timeline follow-back assessment to assess lifetime days and quantity of cannabis use and other cannabis use characteristics. A structured clinical interview was used to collect any history of balance disturbance. Comparisons between HIV+ vs the HIV− groups and moderate-severe vs. no or minimal imbalance in participant characteristics (demographics, cannabis use, medication currently used, and neurological disease) were performed using Student t tests for continuous variables and Fisher’s exact test for binary and categorical variables. Multivariate logistic regression was applied to determine the interaction effect of total quantity of cannabis use with HIV status on balance disturbance. Age, gender, cDSPN symptoms, gait ataxia, opioid medications, and sedatives were included as covariates in the adjusted model after variable selection. The effect sizes are presented as Cohen’s d or odds ratios. Results On average, participants were 45.4 years old (SD = 11 years), primarily male (77.7%), and non-Hispanic white (48.1%). A majority of participants were HIV+ (79.1%). Four hundred thirty (11.9%) of the participants reported balance disturbances within the past 10 years. PWH were more likely to have balance disturbances than demographically matched HIV-uninfected participants (odds ratio [OR] 2.66, 95% CI 1.91–3.7). Participants with moderate-severe balance disturbances did not differ from those with no or minimal imbalance in the proportion who had ever used cannabis (73.8% vs. 74.4%; p = 0.8) (OR 1.03, 95% CI 0.80–1.32) neither did they have a higher total amount of cannabis use (4871 vs. 4648; p = 0.3) (Cohen’s d 0.11, 95% CI 0.01–0.14). In the HIV− population, those with balance disturbances reported more total amount of cannabis use as compared to those with normal balance (11316 vs 4154; p = 0.007). In the HIV+ population on the other hand, there was no significant association (4379 vs 4773; p = 0.6). Conclusions We found unexpectedly that while long-term cannabis use in HIV− individuals was associated with more severe balance disturbances, there were no associations in HIV+ individuals. This suggests that cannabis use in HIV is safe with respect to balance disturbances. Given that HIV is related to persistent inflammation despite virologic suppression on antiretroviral therapy, future mechanistic studies are needed to determine whether HIV-associated inflammation contributes to the higher prevalence of balance disturbance in HIV+ individuals and whether cannabinoids have anti-inflammatory effects that mitigate HIV-associated balance disturbance.

scholarly journals The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer

2011 ◽  
Vol 93 (3) ◽  
pp. 246-249 ◽  
Author(s):  
Jeffrey T Lordan ◽  
Katherine M Stenson ◽  
Nariman D Karanjia
Keyword(s):  
Liver Resection ◽  
Sensitivity And Specificity ◽  
Intraoperative Ultrasound ◽  
Preoperative Imaging ◽  
Categorical Variables ◽  
Histopathological Analysis ◽  
Continuous Variables ◽  
Chi Square ◽  
Term Survival

INTRODUCTION Liver resection is proved to offer potential long-term survival for colorectal liver metastases (CRLM). Accurate radiological assessment is vital to enable an appropriate surgical approach. The role of intraoperative ultrasound (IOUS) has been controversial. This study was designed to analyse the accuracy of IOUS compared with that of preoperative imaging (POI) in these patients. MATERIALS AND METHODS A prospective analysis of 51 consecutive patients who underwent liver resection for CRLM was undertaken. The accuracy of POI and IOUS were correlated and compared with histopathological analysis. Statistical analyses included t-tests, to compare continuous variables, and chi-square and Fisher’s exact tests to compare categorical variables. p<0.05 was considered significant RESULTS POI correlated with histology in 35 patients (68.6%). The sensitivity and specificity were 82.4% and 86.3% respectively. IOUS correlated with histology in 31 (60.8%) patients. The sensitivity and specificity were 84.3% and 76.5% respectively. There was no difference in accuracy between modalities. The accuracy of POI combined with IOUS correlated with histology in 40 patients (78.4%). The sensitivity and specificity were 88.2% and 84.3% respectively. The accuracy of combined modalities was significantly greater than IOUS or POI alone. CONCLUSIONS POI combined with IOUS may significantly increase the diagnostic accuracy of patients undergoing liver resection for CRLM.

scholarly journals Lifestyle behaviours in patients with established cardiovascular diseases: a European observational study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Diana Fernández ◽  
Carlos Brotons ◽  
Irene Moral ◽  
Mateja Bulc ◽  
Mélanie Afonso ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Risk Factor ◽  
Cross Sectional Study ◽  
Lifestyle Changes ◽  
Clinical Event ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Eating Behaviours ◽  
Cross Sectional

Abstract Background Patients who have experienced a cardiovascular clinical event such as a myocardial infarction or stroke qualify for intensive risk factor evaluation and management. The aim of this study is to explore lifestyle changes as well as the achievement of targets for risk factors in patients with established cardiovascular disease. Methods Cross-sectional study conducted in primary care practices. The study was carried out in six European countries (Croatia, France, Portugal, Slovenia, Spain and Turkey). Patients with established cardiovascular disease (coronary heart disease and stroke) attended in primary care were selected and assessed from January to June 2016. Patients were recruited and assessed at the practice by research assistants between 6 months and 3 years after the event. Statistical comparisons were done with the unpaired two-sided Student’s t-test for continuous variables and Chi-square test for categorical variables. Results Nine hundred and seventy-three patients (32.4% females) were assessed. About 14% of them were smokers, 32% were physically inactive, and 30% had nutritionally poor eating behaviours. LDL cholesterol target value below 70 mg/dl was achieved in about 23% of patients, and in general, women were less cardio-protected by drugs than men. Conclusions Many patients with established cardiovascular disease who attended in general practice still fail to achieve the lifestyle, risk factor, and therapeutic targets set by European guidelines. These results are relevant to general practitioners because these patients have a high risk of subsequent cardiovascular events, including MI, stroke, and death.

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