scholarly journals Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

2019 ◽  
Vol 37 (4) ◽  
pp. 278-285 ◽  
Author(s):  
Kathleen M. Akgün ◽  
Supriya Krishnan ◽  
Shelli L. Feder ◽  
Janet Tate ◽  
Jean S. Kutner ◽  
...  
Keyword(s):  
Symptom Assessment ◽  
Assessment System ◽  
Advanced Illness ◽  
Cross Sectional ◽  
Chronic Medication ◽  
Parallel Group ◽  
Increased Risk ◽  
Dyspnea Score ◽  
The Mean ◽  
Using Data

Background: Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. Methods: Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. Results: The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]). Conclusion: Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.

scholarly journals Cognition, functionality and symptoms in patients under home palliative care

2018 ◽  
Vol 64 (10) ◽  
pp. 922-927
Author(s):  
Maria Aparecida Scottini ◽  
Rachel Duarte Moritz ◽  
José Eduardo de Siqueira
Keyword(s):  
Home Care ◽  
Severe Pain ◽  
Symptom Assessment ◽  
Cross Sectional Study ◽  
Assessment System ◽  
Cross Sectional ◽  
Palliative Home Care ◽  
Student’S T ◽  
State Examination

SUMMARY OBJECTIVE: Evaluating the degree of cognition, functionality, presence of symptoms and medications prescribed for patients under palliative home care. METHOD: Descriptive, cross-sectional study where 55 patients under palliative home care were interviewed. Cognition was evaluated using the Mini-Mental state examination (MM), with patients being separated into two groups: with preserved cognitive ability (MM>24), or altered (MM <24). The functionality was verified by the Palliative Performance Scale (PPS) and the patients were divided into two groups: PPS≤50 and PPS≥60. The symptoms presence was evaluated by ESAS (Edmonton Symptom Assessment System) being considered as mild (ESAS 1-3), moderate (ESAS 4-6) or severe (ESAS 7-10) symptoms. Medications prescribed to control the symptoms were registered. Statistical analysis used Student's t test (p <0.05). RESULTS: Most of the 55 patients were women (63.6%), 70.9% of these had MM> 24, 83.6% had PPS <50 and 78.2% presented chronic non-neoplastic degenerative disease. There was a significant relationship between PPS≤50 and MM≤24. Symptoms were present in 98% of patients. Asthenia was more frequently reported and was not treated in 67% of the cases. Severe pain was present in 27.3%: 46% without medication and 13% with medication, if necessary. Most patients with severe dyspnea used oxygen. CONCLUSIONS: Most of the analysed patients had their cognition preserved, presented low functionality and 98% reported the presence of symptoms. Severe pain was present in almost 1/3 of the patients without effective treatment. Re-evaluate palliative home care is suggested to optimize patient's quality of life.

Abstract 3356: Does Severe Obesity Cause Progressive Impairment of Left Ventricular Systolic Function?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Theophilus Owan ◽  
Kimberly Morley ◽  
Travis G Ault ◽  
Ronny Jiji ◽  
Nathaniel Hall ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Entire Group ◽  
Obese Patients ◽  
Cross Sectional ◽  
Increased Risk ◽  
Severely Obese ◽  
The Mean

Background: Obesity is associated with an increased risk of developing heart failure. Based on cross sectional studies, it has been hypothesized that the duration of obesity is the key factor leading to impaired cardiac function. However, longitudinal data to confirm this hypothesis are not available. Methods: We prospectively studied 62 severely obese patients at baseline, 2 and 5 years after randomization to nonsurgical therapy (NonSurg, n = 25) or Rouxen-Y gastric bypass surgery (GBS, n = 37). Echocardiography was used to measure left ventricular (LV) size and ejection fraction (EF). Results: At enrollment, the mean BMI was 46±9 and the mean age was 47±11 years (range 25– 66). GBS subjects lost 96± 26 vs. 6±18 lbs at 2 years and 78±42 vs. 17±42 lbs at 5 years compared to NonSurg (p<0.0001 for both). At baseline LVEF was not different between GBS and nonsurg (67±9 vs. 64±8%) and it did not change at 2 years (64±9 vs. 63±9%) or 5 years (63±9 vs. 63±10%). LV diastolic dimension did not change over time in control (4.3±1.0 vs. 4.2±0.6 vs. 4.5±0.3) or GBS patients (4.4±0.6 vs. 4.3±0.7 vs. 4.4±0.4). Stratifying the entire group by quartiles of age or duration of obesity (quartile 1 avg duration = 16 years, quartile 4 average duration = 56 years), we found no evidence of time-dependent changes in LV size or function. Conclusion: In this, prospective study of severely obese patients we found no evidence of progressive changes in LV size or EF over a period of 5 years. Moreover, we find no relationship between age or duration of obesity and LV size or LVEF. These data argue strongly that other factors such as the development of coronary disease are the most likely causes of heart failure in obese patients.

scholarly journals Evaluation of Serum Triglyceride and Total Cholesterol Status in Adolescent Smoker

1970 ◽  
Vol 1 ◽  
pp. 14-18
Author(s):  
L Afrin ◽  
R Sultana ◽  
S Ferdousi ◽  
A Ahmed ◽  
MR Amin
Keyword(s):  
Total Cholesterol ◽  
Serum Lipid ◽  
Serum Triglyceride ◽  
Adolescent Male ◽  
Serum Triglyceride Level ◽  
Cross Sectional ◽  
Cholesterol Levels ◽  
Increased Risk ◽  
The Mean ◽  
Dose Response Effect

Objectives: A cross sectional comparative study was performed to evaluate the changes of the serum lipid profile in apparently healthy adolescent male non smokers and smokers’ subjects. Method: This study was carried out in the department of Physiology of Dhaka Medical College from January to December 2005. For this purpose, total 80 subjects with age range 12-19 years were selected, of whom 20 were non smokers (control) and 60 were smokers (experimental) who smoked for at least one year. Again smokers were grouped according to the number of cigarettes smoked per week, ( mild < 19, moderate 20-59, heavy >60). Fasting serum Triglyceride and total Cholesterol levels of all subjects were measured. Data were compared between smokers and non smokers and between non smoker and mild moderate and heavy smokers and analyzed statistically by unpaired t test. Result: Mean ±SD Triglyceride levels were136.80mg/dl ± 42.18 vs. 153.12mg/dl ± 26.66 and Mean ±SD Total Cholesterol levels were 165.20mg/dl ± 15.13 vs165.36mg/dl ± 10.12 in non smokers and smokers respectively. there were no significant changes in the mean serum total cholesterol levels in adolescent smokers but the mean serum triglyceride level in smokers were significantly higher (p<0.01 )than that of non smokers. hyper Triglyceridemia (TG level> 150mg/dl) were observed in 56% of smoker subjects whereas 36% in non smokers. The dose response effect of smoking was observed in serum triglyceride levels of smoker subgroups. Mean ±SD TG levels in mild, moderate, heavy groups were 148.15mg/dl± 21.32,152.8mg/dl± 29.49,154.12mg/dl± 23.75 respectively. Conclusion: From the result of the present study it may be concluded that, cigarette smoking during adolescent period induces alteration in serum lipid levels in the direction of increased risk for coronary artery disease. J Bangladesh Soc Physiol. 2006 Dec;(1):14-18

Incidence of invasive pneumococcal disease in Scotland, 1988–99

2002 ◽  
Vol 128 (2) ◽  
pp. 139-147 ◽  
Author(s):  
M. H. KYAW ◽  
S. CLARKE ◽  
I. G. JONES ◽  
H. CAMPBELL
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Age Groups ◽  
The Elderly ◽  
Invasive Disease ◽  
Increased Risk ◽  
Influenza Activity ◽  
The Mean ◽  
Pneumococcal Bacteraemia ◽  
Using Data

A review of the epidemiology of invasive pneumococcal disease in Scotland was carried out using data from laboratory-based systems during the period 1988–99. This comprised 5456 (90·8%) isolates of Streptococcus pneumoniae from blood, 467 (7·8%) from cerebrospinal fluid (CSF) and 84 (1·4%) from other sterile sites. The mean annual incidence of invasive disease was 9·8/105 population (9·0/105 for bacteraemia and 0·8/105 for meningitis). Invasive disease was highest in children <2 years of age and in the elderly [ges ]65 years (44·9/105 and 28·4/105 population in these age groups respectively). The highest incidence of pneumococcal meningitis, 11·8/105 persons occurred in children <2 years of age. Males had a higher incidence of pneumococcal bacteraemia and meningitis than females (male[ratio ]female = 1·2[ratio ]1 for bacteraemia (RR = 1·17, 95% CI 1·11, 1·24) and 1·5[ratio ]1 for meningitis (RR = 1·41, 95% CI 1·18, 1·70)). Pneumococcal disease was highest in winter periods and coincided with influenza activity. The proportion of penicillin and erythromycin non-susceptible isolates increased from 4·2% in 1992 to 12·6% in 1999 and from 5·6% in 1994 to 16·3% in 1999 respectively. Our data confirm the substantial and increasing disease burden from pneumococcal disease and rise in prevalence of antibiotic non-susceptibility among pneumococci in Scotland. Continued surveillance of groups at increased risk for pneumococcal disease and the antibiotic susceptibility and serotype distribution of isolates are important to develop appropriate policies for the prevention of pneumococcal disease in Scotland.

Serum Ferritin Levels and Morbidity in β-Thalassemia Intermedia: A 10-Year Cohort Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1021-1021 ◽  
Author(s):  
Khaled M Musallam ◽  
Maria D Cappellini ◽  
Shahina Daar ◽  
Mehran Karimi ◽  
Amal El-Beshlawy ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Serum Ferritin ◽  
Characteristic Curve ◽  
Iron Chelation ◽  
Effect Estimate ◽  
Thalassemia Intermedia ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Mean

Abstract Abstract 1021 Background: An association between iron overload and morbidity in patients with β-thalassemia intermedia (TI) has been established. However, available studies relied on cross-sectional analysis (measures of prevalence rather than incidence) without a clear chronological relationship between risk factors and outcomes. Methods: We conducted a retrospective cohort study of TI patients treated at five comprehensive care centers in Italy, Lebanon, Oman, Iran and Egypt. We included all patients attending the centers since 01 January 2000 and regularly followed until 31 December 2009 or death. For each patient, we retrieved serum ferritin (SF) and total hemoglobin (Hb) levels for every year during the 10-year follow up period, and calculated the average SF and total Hb levels during the study period (10-year indices). Moreover, we retrieved data on the incidence of nine pre-defined morbidities during the study period. Data on splenectomy status was also retrieved. For this preliminary study, we analyzed data from the first 52 recruited patients. None of the patients were regularly transfused or iron chelated during the study period. Results: The mean age of patients at study entry was 24.1 ± 11.3 years with 48.1% of patients being males. Thirty (57.7%) patients were splenectomized. The mean SF-index was 714.3 ± 518.7 ng/ml (range: 38.4 to 1926.2 ng/ml) and the mean Hb-index was 8.9 ± 1.2 g/dl (range: 7–12 g/dl). None of the patients died during the study period. Thirty-six patients experienced a morbidity during the study period, giving a 10-year cumulative incidence of 69.2% (19 [36.5%] had a single morbidity while 17 [32.7%] had multiple morbidities). The most common morbidity was osteoporosis (48.1%) followed by extramedullary hematopoiesis (19.2%), liver disease (17.3%), hypothyroidism (9.6%), diabetes mellitus (7.7%), hypogonadism (7.7%), thrombosis (5.8%), pulmonary hypertension (1.9%), and hypoparathyroidism (1.9%). The mean SF-index was higher in patients who developed morbidity than those who did not (877.5 vs. 346.9 ng/ml, p<0.001). There was also a positive correlation between SF-index and the number of developed morbidities (r=0.507, p<0.001). On logistic regression analysis, the association between SF-index and the development of morbidity remained significant upon adjustment for age, sex, splenectomy and Hb-index (p=0.015). SF-index had a strong predictive power for morbidity (Area Under the Receiver Operating Characteristic Curve=0.816 ± 0.059, p<0.001). We also evaluated effect estimates for the development of morbidity for three SF-index thresholds, of clinical interest and representing quartile cut-offs. The relative risk of morbidity for patients with a SF-index of >300 ng/ml compared with ≤300 ng/ml was 8.00 (95% CI: 1.92 to 33.38); while it was 14.00 (95% CI: 2.73 to 71.86) for patients with a SF-index of >600 ng/ml compared with ≤600 ng/ml. The effect estimate for the >1000 ng/ml threshold was non-estimable (all patients with a SF-index of >1000 ng/ml developed a morbidity). Conclusion: There exists a clear association between elevations in SF level and an increased risk of morbidity in TI patients, further supporting the need for iron chelation therapy in this patient population. The relative risk becomes considerably high for increases beyond 300 ng/ml. Disclosures: Musallam: Novartis Pharmaceuticals: Honoraria. Cappellini:Novartis Pharmaceuticals: Speakers Bureau. Taher:Novartis: Honoraria, Research Funding.

scholarly journals Étude Des Aspects Épidémiologiques Du Choléra Dans Le District De Santé De Tcholliré (Nord- Cameroun)

2016 ◽  
Vol 12 (15) ◽  
pp. 278
Author(s):  
Justin Ndié ◽  
Isaac Bayoro ◽  
Isidore Takoukam ◽  
Paul Wina
Keyword(s):  
Sex Ratio ◽  
Diarrheal Disease ◽  
Cross Sectional Study ◽  
Health District ◽  
Ringer Lactate ◽  
Cross Sectional ◽  
Epidemiologic Surveillance ◽  
Timely Response ◽  
The Mean ◽  
Using Data

Cholera evolves in an endemo-epidemic mode in developing countries. In Cameroon, because of the weakness of our health system, mainly of the epidemiologic surveillance and inadequate timely response, many localities in our country are faced with intermittent cholera epidemics. This study was aimed at analyzing the epidemiological aspects of cholera in the Tcholliré Health District (North Region-Cameroon) in 2011. We therefore applied a retrospective cross-sectional study using data on cholera cases registered within the 27th and the 40th epidemiological weeks in the Tcholliré Health District in 2011. All patients infected with cholera were included. The demographic, clinical and therapeutic variables, as well as the origin and the evolution of cases were drawn from the cholera data base of the Tcholliré Health District. Data analysis was done using SPSS and Excel software. Between the 27th and 40th epidemiological weeks, 334 cases of cholera were notified in the Tcholliré Health District. The sex ratio was 1.27 (187M/147W), the men were most infected (56%). The mean age was 28±17 years, youths aged 16 to 34 were the age group that were most affected with 42.20%. The number of cases varied significantly based on the sex ratio and the health area (p = 0.012). The rate of relapse was 0.61 % and the mortality rate was 1.2%. All the patients had watery stools and vomiting. In addition, all patients were treated primarily with intravenous normal saline at 0.9% or Ringer Lactate and ORS for oral therapy. The antibiotic used was Doxycycline 100 mg. Cholera remains a diarrheal disease that threatens all regions in Cameroon. It comes about as a result of a deficiency in individual and collective hygienic practices, and a passive epidemiologic monitoring. Nevertheless, the institution of a monitoring system and also effective combat methods will significantly reduce the recurrence of cholera epidemics.

Cut-off points of anthropometric markers associated with hypertension and diabetes in Peru: Demographic and Health Survey 2018

2020 ◽  
pp. 1-11
Author(s):  
Akram Hernández-Vásquez ◽  
Diego Azañedo ◽  
Rodrigo Vargas-Fernández ◽  
Juan Pablo Aparco ◽  
Raul Martín Chaparro ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Cross Sectional Study ◽  
Age Group ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Mean ◽  
Conicity Index ◽  
Anthropometric Markers ◽  
Youden’S Index

Abstract Objective: To determine the optimal anthropometric cut-off points for predicting the likelihood ratios of hypertension and diabetes in the Peruvian population. Design: A cross-sectional study was performed to establish cut-off values for body mass index (BMI), waist circumference (WC), waist:height ratio (WHtR) and Conicity index (C-index) associated with increased risk of hypertension and diabetes. Youden’s index (YIndex), area under the curve (AUC), sensitivity and specificity were calculated. Setting: Peruvian households. Participants: Peruvian population over the age of 18 years. Results: A total of 31 553 subjects were included, 57 % being women. Among the women, 53·06 % belonged to the 25- to 44-year-old age group [mean age: 41·66 in men and 40·02 in women]. The mean BMI, WHtR and C-index values were higher in women 27·49, 0·61, 1·30, respectively, while the mean WC value was higher in men 92·12 cm (sd ± 11·28). The best predictors of hypertension in men were the WHtR (AUC = 0·64) and the C-index (AUC = 0·64) with an optimal cut-off point of 0·57 (YIndex = 0·284) and 1·301 (YIndex = 0·284), respectively. Women showed an AUC of 0·63 and 0·61 in the WHtR and C-index, respectively, with an optimal cut-off of 0·61 (YIndex = 0·236) and 1·323 (YIndex = 0·225). The best predictor for diabetes was the C-index: with an AUC = 0·67 and an optimal cut-off of 1·337 (YIndex = 0·346) for men and an AUC = 0·66 and optimal cut-off of 1·313 (YIndex = 0·319) for women. Conclusions: Our findings show that in Peruvian adults, the WHtR and the C-index have the strongest association with hypertension in both sexes. Likewise, the C-index had the strongest association with diabetes.

Determining the Accuracy of the Mandibular Canal Region in 3D Biomodels Fabricated from CBCT Scanned Data: A Cadaveric Study

2019 ◽  
Vol 15 (7) ◽  
pp. 645-653 ◽  
Author(s):  
Syed Yusoff Alzawawi Syed Abd Fattah ◽  
Firdaus Hariri ◽  
Phrabhakaran Nambiar ◽  
Zulkiflee Abu Bakar ◽  
Zainal Ariff Abdul Rahman
Keyword(s):  
Computed Tomography ◽  
Gold Standard ◽  
Mandibular Canal ◽  
Mean Value ◽  
Cone Beam ◽  
Cross Sectional ◽  
Measurement Protocol ◽  
Significant Difference ◽  
The Mean ◽  
Using Data

Objective:To validate the accuracy of the mandibular canal region in 3D biomodel produced by using data obtained from Cone-Beam Computed Tomography (CBCT) of cadaveric mandibles.Methods:Six hemi-mandible samples were scanned using the i-CAT CBCT system. The scanned data was transferred to the OsiriX software for measurement protocol and subsequently into Mimics software to fabricate customized cutting jigs and 3D biomodels based on rapid prototyping technology. The hemi-mandibles were segmented into 5 dentoalveolar blocks using the customized jigs. Digital calliper was used to measure six distances surrounding the mandibular canal on each section. The same distances were measured on the corresponding cross-sectional OsiriX images and the 3D biomodels of each dentoalveolar block.Results:Statistically no significant difference was found when measurements from OsiriX images and 3D biomodels were compared to the “gold standard” -direct digital calliper measurement of the cadaveric dentoalveolar blocks. Moreover, the mean value difference of the various measurements between the different study components was also minimal.Conclusion:Various distances surrounding the mandibular canal from 3D biomodels produced from the CBCT scanned data was similar to that of direct digital calliper measurements of the cadaveric specimens.

Relapse occurrence in women with multiple sclerosis during pregnancy in the new treatment era

Neurology ◽  
2018 ◽  
Vol 90 (10) ◽  
pp. e840-e846 ◽  
Author(s):  
Raed Alroughani ◽  
Maryam S. Alowayesh ◽  
Samar F. Ahmed ◽  
Raed Behbehani ◽  
Jasem Al-Hashel
Keyword(s):  
Multiple Sclerosis ◽  
Age At Onset ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Prior Use ◽  
The Mean ◽  
New Treatment ◽  
The Relationship

ObjectiveTo determine the rate of relapse occurrence during pregnancy and postpartum.MethodsIn a cross-sectional study using the national multiple sclerosis (MS) registry, pregnant women with relapsing MS were identified. Data on demographics, clinical characteristics, and disease-modifying therapies (DMTs), including washout periods, were collected. Timings and durations of relapses were extracted. A multivariate logistic regression was used to assess the relationship between relapses and prior use of different DMTs.ResultsCompleted data were available for 99 pregnancies (87 patients). Mean age and mean age at onset were 31.8 ± 5 and 24.4 ± 5.6 years, respectively, while the mean disease duration was 7.4 ± 4.6 years. Most pregnancies (89.9%) occurred in patients who were on DMTs in the year preceding pregnancy with a mean treatment duration of 63.4 ± 29 months. The rates of occurrence of relapses during pregnancy and postpartum were 17.2% and 13.7%, respectively. Most of the relapses occurred during the first (n = 6) and third (n = 7) trimesters. Rate of relapse was highest among patients receiving natalizumab and fingolimod before pregnancy. A longer washout period was significantly associated with relapse occurrence.ConclusionThe relapse occurrence during pregnancy is higher than the previously published rates. The use of high-efficacy therapies with long washout periods before conception was associated with an increased risk of relapses during pregnancy. Postpartum relapse occurrence was similar to that in previous reports.

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