Abstract 16396: The Anti-inflammatory Role of Chronic Maintenance Statin Therapy in Hospitalized Coronavirus Disease 2019 (covid-19) Patients: An Exploratory Assessment

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohsin S Mughal ◽  
Ali R Jaffery ◽  
Ikwinder P Kaur ◽  
Chang Wang ◽  
Hasan Mirza ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Clinical Outcomes ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Categorical Variables ◽  
Cardiac Complications ◽  
Continuous Variables ◽  
Limited Information ◽  
Anti Inflammatory

Introduction: The role of inflammation in the spectrum of COVID-19 disease is well documented. Statins are one of the most commonly used prescription medications for the treatment of hyperlipidemia. Additionally, statins have been shown to decrease intracellular pro-inflammatory compounds and thus reduce overall inflammation in the vasculature and myocardium. Limited information is available about their anti-inflammatory role in COVID-19. Hypothesis: We hypothesize that chronic maintenance statin therapy can prevent cardiac complications (acute cardiac injury) and mitigate the hyper-inflammatory state in COVID-19. Methods: In this single-center study, adult patients who were hospitalized from March 1 to April 20, 2020, with RT-PCR confirmed SARS-CoV-2 infection were included. Patients were divided into two cohorts; cohort 1 included the patients who were on maintenance statin therapy (regardless of dosage) and cohort 2 included patients who were not on statins. We retrospectively analyzed lab findings and compared clinical outcomes among the two cohorts. Median two-sample test (for continuous variables), chi-square test, and Fisher's exact test (for categorical variables) were utilized for statistical analysis. Results: Out of 120 patients, 44 patients were on statin therapy. Acute cardiac injury, defined as an elevation of cardiac biomarkers, was seen in 13.64% and 2.63% of patients in cohorts 1 and 2, respectively. Median values of peak inflammatory markers (LDH, CRP, Ferritin, and IL-6) were higher in cohort 1. Conclusion: Chronic maintenance statin therapy showed no additional benefit in hospitalized COVID-19 patients. We suspect that the higher median age and underlying vascular disease in cohort 1 likely played a significant role in worse clinical outcomes. However, we speculate that statin therapy should be investigated while adjusting for age and comorbidities to understand their anti-inflammatory role in COVID-19.

scholarly journals Clinical Outcomes of Trans-caesarean and Vaginal Post-placental CuT380A IUCD Insertions: A Comparative Study

2021 ◽  
pp. 46-57
Author(s):  
C. P. Okoye ◽  
D. N. Onwusulu ◽  
C. P. Nnamani
Keyword(s):  
Clinical Outcomes ◽  
Post Partum ◽  
Sampling Technique ◽  
Categorical Variables ◽  
P Value ◽  
Contraceptive Device ◽  
Continuous Variables ◽  
Expulsion Rate ◽  
Post Placental ◽  
Pregnant Mothers

Background: Immediate postpartum CuT380A intrauterine contraceptive device (PPIUCD) insertion provides a novel approach in reducing the unmet contraceptive needs of family planning. The insertion can be trans-caesarean or vaginal following delivery of the placenta. The clinical outcomes of the different routes of insertion have not been adequately studied. Aim: The study aimed at comparing the clinical outcomes following trans-caesarean and vaginal post-placental insertions of CuT380A IUCD. Methodology: The study was a prospective cohort study of 81 pregnant mothers managed at a tertiary health institution in southern Nigeria. They were recruited into two groups using a convenient sampling technique; 27 and 54 mothers in the caesarean and vaginal delivery groups respectively. The pregnant mothers were followed up till delivery and at the six weeks postnatal visit. Information on their socio-demographic characteristics, Obstetrics and Gynecology history were obtained with the aid of a proforma. The proforma was updated with the clinical outcomes of immediate PPIUCD insertions in the two groups, at the six weeks visit. Data obtained were analyzed using statistical package of social sciences version 21. Continuous variables were expressed as means and standard deviations. The Chi square test was used for dichotomous or categorical variables. A p-value of less than 0.05 was considered statistically significant. Results: The study showed that PPIUCD is a safe practice in both vaginal and caesarean deliveries with no significant differences in clinical outcomes. However, incidence of missing string was higher in the caesarean group compared to vaginal group (81.5% vs 51.9%; p value-0.01); and expulsion rate was also high in the vaginal group but not significant. (13.0% vs 7.4%; p value 0.45). Conclusion: Immediate postpartum CuT380A contraception, irrespective of route of insertion, is convenient, effective, and safe. Although there is a relatively higher incidence of missing strings, including expulsions after vaginal PPIUCD insertions, immediate post-partum contraception should be encouraged. This will help to reduce high unmet contraceptive needs in our environment and loss to follow up irrespective of route of delivery. Recommendation: Immediate PPIUCD, irrespective of the route, should be encouraged and integrated into the existing Maternal and Child Health Programme. Awareness should be created to promote acceptance in our environment.

How Informed is “Informed Consent” for Robotic Cardiothoracic Surgery?

2009 ◽  
Vol 4 (6) ◽  
pp. 307-310 ◽  
Author(s):  
Sean Ryan ◽  
Vasu Chirumamilla ◽  
Ricardo A. Bello ◽  
David A. D'Alessandro ◽  
Robert E. Michler ◽  
...  
Keyword(s):  
Informed Consent ◽  
Patient Education ◽  
Cardiothoracic Surgery ◽  
Categorical Variables ◽  
Socioeconomic Background ◽  
Continuous Variables ◽  
Robotic Assisted ◽  
Education Of Patients ◽  
Invasive Techniques

Objective The education of patients in the informed consent process remains a challenge for many surgeons. In cardiothoracic surgery, emerging minimally invasive techniques including robotics add another level of complexity to the patient education process. We sought to evaluate our patients’ perceptions and informed knowledge after robotic-assisted cardiothoracic surgery. Methods A survey containing questions designed to elicit patients’ perceptions about robotic cardiothoracic surgery was given postoperatively by telephone 1 month to 12 months after surgery. The survey included questions about the type of procedure, function of the organ operated on, purpose of the operation, primary “surgeon” (robot vs. human), patients’ opinion about robotic-assisted surgery, educational level, and socioeconomic background. Continuous variables are reported as mean ± SD. Continuous and categorical variables were compared using the Student t test and Pearson χ2 test, respectively. Ordinal variables were compared using the Mann-Whitney U test. P values of <0.05 were considered significant. Results Between 2002 and 2007, 198 patients underwent robotic cardiothoracic surgery. One hundred fifty patients (76%) were contacted and 89 (45%) fully completed the survey. Of the respondents, there were 31 coronary artery bypasses, 33 pacemaker lead implantations, esophageal resections, 8 thymectomies, and 9 others. The mean age of the patients was 61.1 ± 15 years (range, 23–87) and there were 52 men (58.4%). A total of 96.6% of patients were satisfied with the information provided by the surgeon and 92.1% felt that they understood the information. The diagnosis, target organ, and procedure were correctly identified by 81 (91.0%), 83 (93.3%), and 76 (85.4%) of the patients, respectively. A total of 80 (89.9%) knew a robot was involved and 73.8% understood the role of the robot in the surgery. These results were independent of age, income, and education level achieved. Conclusions Overall, patients demonstrated an understanding of the role of the robot in their cardiothoracic surgery. Despite the increasing complexity of robotics, preoperative patient education can result in patients who are both satisfied and well educated about their cardiothoracic surgery procedures.

The Clinical Role of Micrornas (miRs) in Cytogenetically Normal (CN) Acute Myeloid Leukemia (AML): miR-155 Upregulation Independently Identifies High-Risk Patients (Pts)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1387-1387 ◽  
Author(s):  
Guido Marcucci ◽  
Kati Maharry ◽  
Klaus H. Metzeler ◽  
Stefano Volinia ◽  
Yue-Zhong Wu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Conflicts Of Interest ◽  
Disease Free Survival ◽  
Gene Expression Signature ◽  
White Blood Count ◽  
Categorical Variables ◽  
Prognostic Impact ◽  
Continuous Variables ◽  
Wild Type

Abstract Abstract 1387 miR-155 is upregulated in aggressive subtypes of solid tumors and leukemia. In AML, higher miR-155 expression is associated with FLT3-ITD. However, whether miR-155 upregulation impacts on clinical outcome independently from FLT3-ITD and other prognosticators is unknown. We evaluated the prognostic impact of miR-155 in 363 CN-AML pts (153 age <60 y; 210 age ≥60 y) that were treated with cytarabine-daunorubicin-based regimens and had a median follow-up of 7.9 y (range, 2.3–12.9). miR-155 levels were measured in pretreatment marrow or blood by the NanoString nCounter assay quantifying expression of the encoding gene MIR155HG; other molecular markers were assessed centrally. High miR-155 expressers (miR-155) had higher WBC (P<.001) and were more often FLT3-ITD-positive (pos; P<.001), RUNX1-mutated (mut; <.001), WT1-mut (P=.03), ↑ ERG (P=.02) and ↑ BAALC (P=.002), and less often CEBPA-mut (P=.003), IDH2-mut (P=.004) and FLT3-TKD-pos (P=.08) than low expressers (↓ miR-155). ↑ miR-155 had lower CR rates (P<.001), shorter DFS (P=.001) and OS (P<.001), than ↓ miR-155. In multivariable analyses (MVA; Table), ↑ miR-155 was associated with lower CR rates (P=.007) and shorter OS (P<.001). Among younger pts, ↑ miR-155 had lower CR rates (P=.03) and shorter DFS (P<.001) and OS (P<.001) than ↓ miR-155. In MVA (Table), ↑ miR-155 status remained associated with worse CR rate (P=.06), shorter DFS (P=.003) and OS (P=.01). Among older pts, ↑ miR-155 had lower CR rates (P=.008) and shorter OS (P<.001); in MVA (Table), ↑ miR-155 remained associated with worse CR (P=.03) and shorter OS (P=.05). In the European LeukemiaNet classification, younger ↑ miR-155 in the Favorable (Fav) Genetic Group (GG; CEBPA-mut and/or NPM1-mut without FLT3-ITD) had lower CR rates (P=.03) and shorter DFS (P=.04) and OS (P=.02) than ↓ miR-155. In the younger Intermediate-I (Int-I) GG pts (with wild-type CEBPA, NPM1-mut with FLT3-ITD, or wild-type NPM1), miR-155 expression did not impact independently on outcome. In older pts, ↑ miR-155 had a shorter OS both in the Fav (P=.06) and Int-I GGs (P=.05) than ↓ miR-155. To gain biologic insights, we derived an Affymetrix gene-expression signature that comprised 196 mRNAs significantly correlated with miR-155 expression. Consistent with previous mechanistic studies, Gene Ontology analysis revealed that the ↑ miR-155-associated signature was enriched for genes involved in anti-apoptotic, proliferative and inflammatory activities (FDR<0.05). ↑ miR-155 was not significantly correlated with that of any other microRNAs (miRs) thereby supporting the unique role of miR-155 among the miRs in AML. In summary, miR-155 expression is independently associated with clinical outcome in CN-AML and may allow for better evaluation of molecular risk, especially in pts lacking FLT3-ITD, like those in the ELN Fav GG. Moreover, given its role in deregulation of fundamental mechanisms of cell homeostasis and the emergence of miR inhibitors, miR-155 may become a novel therapeutic target. Table. MVA in pts with primary CN-AML Group CR DFS OS OR P HR P HR P All pts miR-155 expression not significantly associated with DFS a     miR-155, ↑ v ↓ 0.46 .007 1.62 <.001     NPM1, mut v wt 2.42 .005     BAALC, ↑ v ↓ 0.37 .002 2.16 <.001     WBC, each 50 units 0.65 <.001     Age group, older v younger 0.43 .003 2.38 <.001     FLT3-ITD, pos v neg 1.78 <.001     Race, white v nonwhite 1.62 .03 Pts age < 60 y     miR-155, ↑ v ↓ 0.39 .06 2.13 .003 1.84 .01     RUNX1, mut v wt 0.21 .01     Age, each 10 y increase 0.45 .004     WBC, each 50 units 1.49 <.001     FLT3-ITD, pos v neg 2.82 <.001 1.82 .01     FLT3-TKD, pos v neg 3.27 <.001     BAALC, ↑ v ↓ 2.66 <.001 2.33 <.001     Race, white v nonwhite 2.81 .02     CEBPA, mut v wt 0.47 .02     WT1, mut v wt 2.25 .005 Pts age ≥ 60 y miR-155 expression not significantly associated with DFS     miR-155, ↑ v ↓ 0.46 .03 1.36 .05     NPM1, mut v wt 2.45 .03     BAALC, ↑ v ↓ 0.32 .004 2.18 <.001     WBC, each 50 units 0.65 .005     Age, each 10 y increase 0.48 .02     FLT3-ITD, pos v neg 1.56 .006 ↑, high expression; ↓, low expression; CR, complete remission; DFS, disease-free survival; HR, hazard ratio; mut, mutated; neg, negative; OR, odds ratio; OS, overall survival; pos, positive; WBC, white blood count; wt, wild-type. Odds ratios > (<) 1.0 mean higher (lower) CR rate and HRs > (<) 1.0 mean higher (lower) risk of relapse or death (DFS) or death (OS) for the higher values of continuous variables and the 1st category listed for categorical variables. Disclosures: No relevant conflicts of interest to declare.

Role of biomarkers in cardioncology

2011 ◽  
Vol 49 (12) ◽  
Author(s):  
Daniela Cardinale ◽  
Michela Salvatici ◽  
Maria T. Sandri
Keyword(s):  
Troponin I ◽  
Cardiac Injury ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Current Standard ◽  
Converting Enzyme Inhibitors ◽  
Ventricular Ejection Fraction

AbstractCardiotoxicity is a serious adverse effect of anticancer drugs, impacting on quality of life and overall survival of cancer patients. According to the current standard for monitoring cardiac function, cardiotoxicity is usually detected only when a functional impairment has already occurred, precluding any chance of preventing its development. Over the last decade, however, a new approach, based on the use of cardiac biomarkers, has emerged, and has proven to be an effective alternative strategy for early detection of subclinical cardiac injury. In particular, the role of troponin I in identifying patients at risk of cardiotoxicity and of angiotensin-converting enzyme inhibitors in preventing left ventricular ejection fraction reduction and late cardiac events represent an effective tool for the prevention of this complication.

scholarly journals Clinical Outcomes Following the Use of Archived HIV-1 DNA Sequencing to Guide Antiretroviral Therapy Regimen Adjustment and Simplification

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S425-S425
Author(s):  
Kristen Ellis ◽  
George Nawas ◽  
Connie Chan ◽  
Lawrence York ◽  
Alexander Mar ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Outcomes ◽  
Limit Of Detection ◽  
Medical Center ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Therapy Regimen ◽  
Hiv Rna ◽  
Number Of Patients

Abstract Background While favorable new antiretroviral therapy (ART) options are available for HIV disease, the Department of Health and Human Services guidelines recommend against switching suppressive regimens unless there is evidence that the new regimen will be fully active. A new assay analyzes archived HIV pro-viral DNA and can detect resistance mutations when HIV RNA is below the limit of detection, when standard genotyping (GT) is not possible. Small studies have correlated archived DNA GT to historical plasma RNA GT, but there is minimal available data on treatment outcomes when using this assay to determine antiretroviral therapy switch strategies. We evaluated clinical outcomes following ART adjustment based upon results of archived DNA GT testing. Methods A retrospective review of electronic medical records was performed at our medical center from October 2014 to October 2016. Inclusion criteria included age ≥ 18 years, archived DNA GT result available, ART changed after archived GT result, and follow up HIV RNA available after ART switch. Data was collected prior to and after ART switching. McNemar’s test was used for categorical variables and paired t-test for continuous variables. Results A total of 38 patients were included. Most patients were male (89%), Caucasian (66%), had a history of AIDS diagnosis (45%), had HIV for &gt;10 years (74%), and had baseline ART resistance (24% resistant to 1 class, 37% resistant to ≥ 2 classes). Median baseline CD4 was 532 cells/mm3. At baseline, 31 (82%) patients had HIV RNA &lt; 50 copies/mL. Compared with baseline, 35 (92%) patients were undetectable at furthest follow up (P = 0.22). Median time to furthest follow up was 146.5 days (range 12–485). Overall, 36 (95%) patients had at least one undetectable HIV RNA after switching. None of the patients with an initial undetectable HIV RNA became detectable after switching ART. Average number of pills per day and administrations per day decreased from 3.84 to 1.97 (P &lt; 0.001) and 1.47 to 1.05 (P &lt; 0.001) respectively. The number of patients on protease inhibitors (PIs) decreased from 66% to 21% (P &lt; 0.001). Conclusion The use of archived DNA GT to guide ART adjustment may result in maintained viral suppression while allowing for regimens with optimized long-term safety and decreased pill burden. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Outcomes in Patients with Hematologic Malignancy (HM) and COVID-19

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 3-4
Author(s):  
Michael Roderick Cook ◽  
Kaitlyn C Dykes ◽  
Katherine White ◽  
Jaeil Ahn ◽  
Nathan Cobb ◽  
...  
Keyword(s):  
General Population ◽  
B Cell ◽  
Clinical Outcomes ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Icu Admission ◽  
Remission Status ◽  
History Of

Background: SARS-CoV-2 infection has been associated with profound infection-induced inflammatory changes including coagulopathy (Connors et al. Blood 2020). Furthermore, venous thromboembolism (VTE) has been described as a common complication among patients with COVID-19 (Tang et al. J Thromb Haemost 2020). Patients with a history of HM who contract SARS-CoV-2 may be at an even higher risk for VTE, given their elevated baseline VTE risk; however, there is limited clinical data for this patient population. Therefore, we performed a retrospective chart review to evaluate clinical outcomes in patients with COVID-19 and a history of HM. Methods: A REDCap database was created using all patients who were evaluated in the emergency department or admitted to MedStar Georgetown University Hospital/Washington Hospital Center with a confirmed SARS-CoV-2 diagnostic test between March and May 2020. Data extraction was performed on all patients to identify demographic and clinical parameters. All data collected reflects clinical encounters related to COVID-19 infection. Our primary end-point was rate of VTE and cerebrovascular accident (CVA) in patients with HM compared to the general population. Secondary outcomes assessed were COVID-19 related mortality, Intensive Care Unit (ICU) admission rates, and length of ICU stay. Continuous variables were summarized by median quartiles (Q1 and Q3) and categorical variables were summarized by frequency counts and percentages for each category. The two-sample t-test for continuous variables and binomial exact test or Pearson chi square test for categorical variables were conducted to compare the means/distributions of each variable between HM patients and the general population, respectively. The Kaplan-Meier method and log-rank test were used to evaluate and compare the median overall survival (OS) between the two groups, exclusively for patients who died from COVID-19, censored at 28 days from admission. Results: As of July 1st, 2020, 737 pts with COVID-19 have been identified and included in this preliminary analysis. Twenty-two pts had a HM: plasma cell dyscrasia (n=7, 31.8%; multiple myeloma n=6, MGUS n=1), chronic lymphocytic leukemia (n=3, 13.6%), chronic myelomonocytic leukemia (n=2, 9.1%), diffuse large B-cell lymphoma (n=2, 9.1%), hodgkin's lymphoma (n=2, 9.1%), and one patient (4.5%) with each of the following malignancies: acute promyelocytic leukemia, anaplastic large cell lymphoma, B-cell lymphoma not otherwise specified, follicular lymphoma, mantle cell lymphoma and marginal zone lymphoma. With respect to HM treatment status, the majority of the patients were in surveillance (n=14, 63.6%); the other eight (36.4%) were on active treatment at time of COVID-19 infection. In patients who had a remission status documented, eight showed complete remission (36.4%), five with partial remission (22.7%), and one patient with progressive disease (4.5%). Six patients (27.3%) either did not yet have a remission status evaluated or were treatment naïve. The HM cohort was found to be older (median age 72 vs. 55) and have a higher rate of historical VTE prior to COVID-19 infection (18.2% vs. 4.3%). Other demographic data for the HM cohort and the general population can be found in Table 1. CVA was more prevalent in the HM cohort compared to our general population cohort (11.1% vs. 1.6%, p = 0.048). Rates of VTE were not statistically different between the two groups (5.6% vs. 3.6%, p=0.494). A higher percentage of HM pts required ICU admission (40.9% vs. 19.2%, p = 0.0246). Our data suggested a trend towards higher rate of case fatality in the HM cohort (27.3% vs. 11.2%, p = 0.069) and a trend towards longer duration of ICU admission (9 days vs. 5 days, p=0.756). The median OS in fatal COVID-19 infection (Figure 1) was 9.5 days (95% CI, 7 to NA) in the HM cohort compared to 9 days (95% CI, 7 to 10, p=0.891) for the general population. Conclusion: Our preliminary findings suggest among patients with COVID-19, there is an increased incidence of CVA in HM patients, but similar rates of VTE when compared to the general population. Our HM cohort had higher rates of ICU admission, but did not have a statistically significant mortality difference at 28 days. Data collection is ongoing, final analysis will be completed with a larger cohort of HM patients. Disclosures Lai: Abbvie: Consultancy; Agios: Consultancy; Macrogenics: Consultancy; Astellas: Speakers Bureau; Jazz: Speakers Bureau.

scholarly journals Role of advanced imaging in COVID-19 cardiovascular complications

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Federica Catapano ◽  
Livia Marchitelli ◽  
Giulia Cundari ◽  
Francesco Cilia ◽  
Giuseppe Mancuso ◽  
...  
Keyword(s):  
Multimodality Imaging ◽  
Cardiac Injury ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Advanced Imaging ◽  
Cardiovascular Involvement ◽  
Diagnostic Delays

AbstractClinical manifestations of COVID-19 patients are dominated by respiratory symptoms, but cardiac complications are commonly observed and associated with increased morbidity and mortality. Underlying pathological mechanisms of cardiac injury are still not entirely elucidated, likely depending on a combination of direct viral damage with an uncontrolled immune activation. Cardiac involvement in these patients ranges from a subtle myocardial injury to cardiogenic shock. Advanced cardiac imaging plays a key role in discriminating the broad spectrum of differential diagnoses. Present article aims to review the value of advanced multimodality imaging in patients with suspected SARS-CoV-2-related cardiovascular involvement and its essential role in risk stratification and tailored treatment strategies. Based on our experience, we also sought to suggest possible diagnostic algorithms for the rationale utilization of advanced imaging tools, such as cardiac CT and CMR, avoiding unnecessary examinations and diagnostic delays.

706 Frostbite and Drugs of Abuse: Friend or Foe?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S184-S184
Author(s):  
Anne L Lambert Wagner ◽  
Kiran U Dyamenahalli ◽  
Tyler M Smith ◽  
Patrick Duffy ◽  
Elizabeth J Kovacs ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Drugs Of Abuse ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Homeless Population ◽  
Categorical Variables ◽  
Burn Patients ◽  
Continuous Variables ◽  
Exact Test

Abstract Introduction In the literature, the incidence of alcohol and/or drug use among burn patients ranges from 16.4%-69%. Burn patients with positive toxicology (tox) screens on admission are known to have increased rates of morbidity and mortality. To date little has been published on the effects of positive alcohol and/or drug screens on outcomes in the frostbite population. The objective of this study was to investigate the incidence of drugs and alcohol use in admitted patients with severe frostbite and their association with clinical outcomes. Methods A retrospective cohort study was conducted on 141 frostbite patients admitted to a verified burn center from November 2015 to March 2019. Patients were identified using our burn registry and relevant data was obtained through chart reviews. The primary comparison was between patients with and without a positive tox screen on admission, assessing administration of thrombolytics (tPA) and rates of amputation. Contingency analysis for categorical variables was performed using Fisher’s exact test, while the Mann-Whitney U test was used for continuous variables, reporting, two-tailed p values. Results Tox screens were positive in 77.3% (109) of frostbite patients: 52.5% (74) for marijuana and 56.7% (80) for alcohol. Homelessness accounted for 50.4% (71) and 63.1% (89) were tobacco users. Compared to patients with negative tox screens, significantly higher rates of amputation were found in those using marijuana (p=0.016), other drugs of abuse (p=0.008) and tobacco (p=0.0093). Significantly higher limb salvage rates were found in patients presenting with a negative tox screen (p=0.0077). Only tobacco users had a significantly greater length of stay (p=0.02). 36.2% (51) of the patients received tPA with no difference in administration rates between positive and negative tox screened patients. Patients receiving tPA had significantly lower rates of amputation (p=0.02). 51.8% (73) of admitted patients were homeless, with 83.6% (61) testing tox positive. Both increased hospital length of stay (p=&lt; 0.001) and amputation rates (p=0.0004) were observed in the homeless frostbite population. Conclusions Drugs, alcohol and homelessness significantly impact clinical outcomes in frostbite patients. Homelessness, marijuana, tobacco and other drugs of abuse are associated with significantly higher rates of amputation despite receiving tPA at the same rate. Administration of tPA is significant in lowering amputation rates. Applicability of Research to Practice The association between drugs of abuse, homelessness and frostbite highlight the need for increased preventative efforts especially in the homeless population.

The role of apoptosis in colorectal carcinogenesis and its prognostic value.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22131-e22131
Author(s):  
Julia Alcaide ◽  
Rafael Funez ◽  
Antonio Rueda ◽  
Elisabeth Pérez-Ruiz ◽  
Teresa Pereda ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Proportional Hazards ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Colorectal Carcinogenesis ◽  
Categorical Variables ◽  
Rank Test ◽  
Continuous Variables ◽  
Normal Epithelium

e22131 Background: Most colorectal cancers (CRCs) progress through a multistep process from normal tissue to adenoma to carcinoma. The role of apoptosis during this tumourigenesis sequence has not yet been completely clarified. The aim of our study was to determine the influence of apoptotic variations on the carcinogenesis and prognosis of CRC. Methods: A TUNEL assay was performed on the formalin-fixed, paraffin-embedded tissues from 103 CRCs resected at the Costa del Sol Hospital (after excluding patients previously treated with chemotherapy or radiation therapy), 26 adenomas and 20 samples of normal epithelia. Clinical data were obtained from the tumour registry and hospital charts. The study was approved by Research Ethics Committee. We used the median (m) of apoptotic percentage (1%, range: 0-6%) as a threshold value for survival (sv) studies. Analysis of association between apoptosis and prognostic factors used the X2test for categorical variables and the analysis of variance test for continuous variables (natural log transformed if necessary). We estimated sv using the Kaplan-Meier method, and sv curves were compared with the log rank test. Cox’s proportional hazards sv analysis was used to determine the relative risk (RR) through multivariate analyses. Results: Median follow-up was 50 months (mo). Apoptotic index (AI) was higher in CRCs (1.09 ± 0.13) than in adenomas (0.38 ± 0.23, p=0.059) and significantly greater than in normal epithelium (0.06 ± 0.04, p=0.001). AI was greater in stage IV than in other stages (p=0.017). Higher AI was associated with lower disease-free survival (DFS) and overall survival (OS) than lower AI (Table). In multivariate analysis, AI (RR=2.18, 95% CI 1.08-4.37) and TNM stage (RR=2.41, 95% CI 1.20-4.85) were independent prognostic factors for OS. Conclusions: Our study demonstrates an increase in apoptosis during colorectal carcinogenesis and a correlation between apoptotic rates and survival. Higher AIs are associated with more aggressive tumours and a poorer prognosis in CRC. [Table: see text]

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