scholarly journals Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus

2021 ◽  
Vol 9 (1) ◽  
pp. e001797
Author(s):  
Molly J Y Zhao ◽  
Julia C Prentice ◽  
David C Mohr ◽  
Paul R Conlin
Keyword(s):  
Diabetes Mellitus ◽  
Hemoglobin A1c ◽  
Severe Hypoglycemia ◽  
International Classification Of Diseases ◽  
Baseline Period ◽  
Veterans Health ◽  
Health Administration ◽  
Classification Of Diseases ◽  
The Impact

IntroductionTo study the impact of hemoglobin A1c (A1c) variability on the risk of hypoglycemia-related hospitalization (HRH) in veterans with diabetes mellitus.Research design and methods342 059 veterans with diabetes aged 65 years or older were identified for a retrospective cohort study. All participants had a 3-year baseline period from January 1, 2005 to December 31, 2016, during which they had at least four A1c tests. A1c variability measures included coefficient of variation (A1c CV), A1c SD, and adjusted A1c SD. HRH was identified during a 2-year follow-up period from Medicare and the Veterans Health Administration through validated algorithms of International Classification of Diseases (ICD)-9 and ICD-10 codes. Logistic regression modeling was used to evaluate the relationship between A1c variability and HRH risk while controlling for relevant clinical covariates.Results2871 patients had one or more HRH in the 2-year follow-up period. HRH risk increased with greater A1c variability, and this was consistent across A1c CV, A1c SD, and adjusted A1c SD. Average A1c levels were also independently associated with HRH, with levels <7.0% (53 mmol/mol) having lower risk and >9% (75 mmol/mol) with greater risk. The relationships between A1c variability remained significant after controlling for average A1c levels and prior HRH during the baseline period.ConclusionIncreasing A1c variability and elevated A1c levels are associated with a greater risk of HRH in older adults with diabetes. Clinicians should consider A1c variability when assessing patients for risk of severe hypoglycemia.

scholarly journals Modern Look at Transverse Myelitis and Inflammatory Myelopathy

2021 ◽  
Vol 8 (6) ◽  
pp. e1071
Author(s):  
Justin R. Abbatemarco ◽  
Jonathan R. Galli ◽  
Michael L. Sweeney ◽  
Noel G. Carlson ◽  
Verena C. Samara ◽  
...  
Keyword(s):  
Transverse Myelitis ◽  
Population Level ◽  
International Classification Of Diseases ◽  
Mortality Data ◽  
Veterans Health ◽  
Health Administration ◽  
Level Data ◽  
High Prevalence ◽  
Classification Of Diseases

Background and ObjectivesTo characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA).MethodsThis retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria.ResultsWe identified 4,084 patients with an International Classification of Diseases (ICD) code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2–4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes (p = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57–2.40) and tobacco use (OR 1.87, 95% CI, 1.17–2.99).DiscussionThis national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.

scholarly journals Population genealogy resource shows evidence of familial clustering for Alzheimer disease

2018 ◽  
Vol 4 (4) ◽  
pp. e249
Author(s):  
Lisa Anne Cannon-Albright ◽  
Sue Dintelman ◽  
Tim Maness ◽  
Johni Cerny ◽  
Alun Thomas ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
International Classification Of Diseases ◽  
Veterans Health ◽  
Health Administration ◽  
Significant Excess ◽  
Relative Risks ◽  
Multiple Phenotypes ◽  
The Us ◽  
Familial Clustering ◽  
Classification Of Diseases

ObjectiveTo show the potential of a resource consisting of a genealogy of the US record linked to National Veterans Health Administration (VHA) patient data for investigation of the genetic contribution to health-related phenotypes, we present an analysis of familial clustering of VHA patients diagnosed with Alzheimer disease (AD).MethodsPatients with AD were identified by the International Classification of Diseases code. The Genealogical Index of Familiality method was used to compare the average relatedness of VHA patients with AD with expected relatedness. Relative risks for AD were estimated in first- to fifth- degree relatives of patients with AD using population rates for AD.ResultsEvidence for significant excess relatedness and significantly elevated risks for AD in relatives was observed; multiple pedigrees with a significant excess of VHA patients with AD were identified.ConclusionsThis analysis of AD shows the nascent power of the US Veterans Genealogy Resource, in early stages, to provide evidence for familial clustering of multiple phenotypes, and shows the utility of this VHA genealogic resource for future genetic studies.

scholarly journals Incidence of COVID-19 in patients exposed to chloroquine and hydroxychloroquine: results from a population-based prospective cohort in Catalonia, Spain, 2020

2021 ◽  
Vol 26 (9) ◽  
Author(s):  
Rosa Maria Vivanco-Hidalgo ◽  
Israel Molina ◽  
Elisenda Martinez ◽  
Ramón Roman-Viñas ◽  
Adrián Sánchez-Montalvá ◽  
...  
Keyword(s):  
Care Service ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Health Administration ◽  
Risk Of Infection ◽  
Control Cohort ◽  
Male Population ◽  
Classification Of Diseases

Background Several clinical trials have assessed the protective potential of chloroquine and hydroxychloroquine. Chronic exposure to such drugs might lower the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or severe coronavirus disease (COVID-19). Aim To assess COVID-19 incidence and risk of hospitalisation in a cohort of patients chronically taking chloroquine/hydroxychloroquine. Methods We used linked health administration databases to follow a cohort of patients with chronic prescription of hydroxychloroquine/chloroquine and a control cohort matched by age, sex and primary care service area, between 1 January and 30 April 2020. COVID-19 cases were identified using International Classification of Diseases 10 codes. Results We analysed a cohort of 6,746 patients (80% female) with active prescriptions for hydroxychloroquine/chloroquine, and 13,492 controls. During follow-up, there were 97 (1.4%) COVID-19 cases in the exposed cohort and 183 (1.4%) among controls. The incidence rate was very similar between the two groups (12.05 vs 11.35 cases/100,000 person-days). The exposed cohort was not at lower risk of infection compared with controls (hazard ratio (HR): 1.08; 95% confidence interval (CI): 0.83–1.44; p = 0.50). Forty cases (0.6%) were admitted to hospital in the exposed cohort and 50 (0.4%) in the control cohort, suggesting a higher hospitalisation rate in the former, though differences were not confirmed after adjustment (HR: 1·46; 95% CI: 0.91–2.34; p = 0.10). Conclusions Patients chronically exposed to chloroquine/hydroxychloroquine did not differ in risk of COVID-19 nor hospitalisation, compared with controls. As controls were mainly female, findings might not be generalisable to a male population.

scholarly journals Severity of hypertension as a predictor of initiation of dialysis among study participants with and without diabetes mellitus

2020 ◽  
pp. jim-2020-001489
Author(s):  
Taeko Osawa ◽  
Kazuya Fujihara ◽  
Mayuko Harada Yamada ◽  
Masahiko Yamamoto ◽  
Masaru Kitazawa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
International Classification Of Diseases ◽  
Medical Procedures ◽  
Future Studies ◽  
Initiation Of Dialysis ◽  
Classification Of Diseases ◽  
Study Participants ◽  
The Impact

To determine associations between severity of hypertension and risk of starting dialysis in the presence or absence of diabetes mellitus (DM). A nationwide database with claims data on 258 874 people with and without DM aged 19–72 years in Japan was used to elucidate the impact of severity of hypertension on starting dialysis. Initiation of dialysis was determined from claims using International Classification of Diseases-10 codes and medical procedures. Using multivariate Cox modeling, we investigated the severity of hypertension to predict the initiation of dialysis with and without DM. Hypertension was significantly associated with the initiation of dialysis regardless of DM. The incidence of starting dialysis in those with systolic blood pressure (SBP) ≤119 mm Hg and DM (DM+) was almost the same as in those with SBP ≥150 mm Hg and absence of DM (DM−). In comparison with SBP ≤119 mm Hg, SBP ≥150 mm Hg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM−. Compared with DM− and SBP ≤119 mm Hg, the HR for DM+ and SBP ≥150 mm Hg was 6.88 (95% CI 3.66 to 12.9). Although the risks of hypertension differed only slightly regardless of the presence or absence of DM, risks for starting dialysis with DM+ and SBP ≤119 mm Hg were equivalent to DM− and SBP ≥150 mm Hg, indicating more strict blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are required to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure.

scholarly journals Development and validation of an electronic medical record (EMR)-based computed phenotype of HIV-1 infection

2017 ◽  
Vol 25 (2) ◽  
pp. 150-157 ◽  
Author(s):  
Devon W Paul ◽  
Nigel B Neely ◽  
Meredith Clement ◽  
Isaretta Riley ◽  
Mashael Al-Hegelan ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Sensitivity And Specificity ◽  
International Classification Of Diseases ◽  
Veterans Health ◽  
Health Administration ◽  
Classification Of Diseases ◽  
Novel Algorithms ◽  
Sensitivity Specificity

Abstract Background Electronic medical record (EMR) computed algorithms allow investigators to screen thousands of patient records to identify specific disease cases. No computed algorithms have been developed to detect all cases of human immunodeficiency virus (HIV) infection using administrative, laboratory, and clinical documentation data outside of the Veterans Health Administration. We developed novel EMR-based algorithms for HIV detection and validated them in a cohort of subjects in the Duke University Health System (DUHS). Methods We created 2 novel algorithms to identify HIV-infected subjects. Algorithm 1 used laboratory studies and medications to identify HIV-infected subjects, whereas Algorithm 2 used International Classification of Diseases, Ninth Revision (ICD-9) codes, medications, and laboratory testing. We applied the algorithms to a well-characterized cohort of patients and validated both against the gold standard of physician chart review. We determined sensitivity, specificity, and prevalence of HIV between 2007 and 2011 in patients seen at DUHS. Results A total of 172 271 patients were detected with complete data; 1063 patients met algorithm criteria for HIV infection. In all, 970 individuals were identified by both algorithms, 78 by Algorithm 1 alone, and 15 by Algorithm 2 alone. The sensitivity and specificity of each algorithm were 78% and 99%, respectively, for Algorithm 1 and 77% and 100% for Algorithm 2. The estimated prevalence of HIV infection at DUHS between 2007 and 2011 was 0.6%. Conclusions EMR-based phenotypes of HIV infection are capable of detecting cases of HIV-infected adults with good sensitivity and specificity. These algorithms have the potential to be adapted to other EMR systems, allowing for the creation of cohorts of patients across EMR systems.

scholarly journals Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

2021 ◽  
Vol 10 (15) ◽  
pp. 3375
Author(s):  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Takashi Hirai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cervical Spine ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Posterior Longitudinal Ligament ◽  
Lower Extremity Function ◽  
Cervical Spine Surgery ◽  
The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes

2017 ◽  
Vol 41 (S1) ◽  
pp. S575-S576
Author(s):  
Z. Mansuri ◽  
S. Patel ◽  
P. Patel ◽  
O. Jayeola ◽  
A. Das ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Temporal Trends ◽  
International Classification Of Diseases ◽  
Trend Test ◽  
Classification Of Diseases ◽  
Competing Interest ◽  
Armitage Trend Test ◽  
The Impact

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trisomy 18 Pregnancies: Is there an Increased Maternal Risk?

2017 ◽  
Vol 34 (11) ◽  
pp. 1054-1057
Author(s):  
Kayli Senz ◽  
Whitney Humphrey ◽  
Vanessa Lee ◽  
Aaron Caughey ◽  
Sarah Dotters-Katz
Keyword(s):  
International Classification Of Diseases ◽  
Vital Statistics ◽  
Trisomy 18 ◽  
Trisomy 13 ◽  
Obstetric Outcomes ◽  
Maternal Risk ◽  
Increased Risk ◽  
Multiparous Women ◽  
Classification Of Diseases ◽  
The Impact

Objective Characterize the impact of a trisomy 18 (T18) fetus on maternal and obstetric outcomes in a cohort including T18-affected deliveries. Study Design Retrospective cohort study of singleton deliveries in California from 2005 to 2008 using linked vital statistics and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) data to compare deliveries affected by T18 to those without known aneuploidy. Outcomes of interest included gestational diabetes mellitus (GDM), preterm delivery (PTD), preeclampsia, cesarean delivery (CD), and intrauterine fetal demise (IUFD). The χ2 and paired t-tests were used to compare the outcomes. Multiple logistic regression was used to further characterize these risks and control potential confounders. Results Of 2,029,000 deliveries, 298 involved T18. Compared with unaffected deliveries, T18 was associated with GDM (10.7 vs. 6.5%, p = 0.003), PTD < 37 (40.6 vs. 9.9%, p < 0.001) and < 32 weeks (14.8 vs. 1.4%, p < 0.001), and cesarean section (56 vs. 30.2%, p < 0.001), but not preeclampsia. In adjusted analyses, T18 pregnancies were associated with an increased risk of PTD < 37 and < 32 weeks (adjusted odds ratio [AOR]: 5.48, 95% confidence interval [CI]: 4.29, 6.99; AOR: 10.4, 95% CI: 7.26, 14.8), and an increased odd of CD for primiparous and multiparous women (AOR: 2.41, 95% CI: 1.48, 3.91; AOR: 5.42, 95% CI: 3.90, 7.53). Risk of GDM did not persist. Conclusion Unlike trisomy 13 (T13), pregnancies complicated by fetal T18 did not appear to result in an increased risk of preeclampsia. However, there is an increased risk of a range of other obstetric complications.

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