Metabolic Correlates of Theophylline Therapy: A Concentration-Related Phenomenon

OBJECTIVE: To determine the relationship of serum theophylline concentration with electrolyte and glucose abnormalities across a broad range of theophylline concentrations. DESIGN: Retrospective review of a computerized laboratory database between June 1, 1984 and June 1, 1986. SETTING: A midwestern university medical center. PATIENTS: Eight hundred sixty-nine patients with serum theophylline concentrations of >5.5 μmol/L and a random unmatched sample (control group) of 350 in- and outpatient adults and children with no history of reactive airways disease or theophylline exposure. RESULTS: Patients with measurable theophylline had a higher risk of hypokalemia, hyponatremia, hyperglycemia, hypophosphatemia, and hypomagnesemia compared with the unexposed control group. Unadjusted odds ratios (OR) were: (1) hypokalemia OR=4.2 (95 percent CI 2.2 to 7.9); (2) hyponatremia OR=5.4 (95 percent CI 2.0 to 12.9); (3) hypomagnesemia OR=1.6 (95 percent CI 1.0 to 2.5); (4) hyperglycemia OR=2.3 (95 percent CI 1.7 to 3.0); and (5) hypophosphatemia OR=2.7 (95 percent CI 1.2 to 5.3). A linear concentration—response relationship was documented between serum theophylline concentration and all metabolic disturbances. conclusions: Measurable theophylline was associated with increased risk for glucose and electrolyte abnormalities in a concentration-related fashion across a broad range of theophylline concentrations from 5.5 to ≥110 μmol/L.

Download Full-text

Are frequent dental x-ray examinations associated with increased risk of vestibular schwannoma?

Journal of Neurosurgery ◽

10.3171/2012.5.gks12615 ◽

2012 ◽

Vol 117 (Special_Suppl) ◽

pp. 78-83 ◽

Cited By ~ 9

Author(s):

Yueh-Ying Han ◽

Oren Berkowitz ◽

Evelyn Talbott ◽

Douglas Kondziolka ◽

Maryann Donovan ◽

...

Keyword(s):

Vestibular Schwannoma ◽

Medical Center ◽

Cell Phones ◽

Control Group ◽

X Rays ◽

University Of Pittsburgh ◽

X Ray ◽

Increased Risk ◽

History Of ◽

Wireless Phones

Object The authors evaluated the potential role of environmental risk factors, including exposure to diagnostic or therapeutic radiation and to wireless phones that emit nonionizing radiation, in the etiology of vestibular schwannoma (VS). Methods A total of 343 patients with VSs who underwent Gamma Knife surgery performed between 1997 and 2007 were age and sex matched to 343 control patients from the outpatient degenerative spinal disorders service at the University of Pittsburgh Medical Center. The authors obtained information on previous exposure to medical radiation, use of wireless phone technologies, and other environmental factors thought to be associated with the development of a VS. Conditional multivariate logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results After adjusting for race, education, cigarette smoking, alcohol consumption, occupational exposure to noise, use of cell phones, and family history of cancer, the authors identified only a single factor that was associated with a higher risk of VS: individuals exposed to dental x-rays once a year (aOR = 2.27, 95% CI = 1.01–5.09) or once every 2–5 years (aOR = 2.65, 95% CI = 1.20–5.85), compared with those exposed less than once every 5 years. Of interest, a history of exposure to radiation related to head or head-and-neck computed tomography was associated with a reduced risk of VS (aOR = 0.52, 95% CI = 0.30–0.90). No relationship was found between the use of cell phones or cordless phones and VS. Conclusions Patients with acoustic neuromas reported significantly more exposure to dental x-rays than a matched cohort control group. Reducing the frequency of dental x-ray examinations may decrease the potential risk of VS.

Download Full-text

Insulin Resistance and Inflammation in Black Women with and without Breast Cancer: Cause for Concern

Ethnicity & Disease ◽

10.18865/ed.26.4.513 ◽

2016 ◽

Vol 26 (4) ◽

pp. 513 ◽

Cited By ~ 2

Author(s):

Kathleen A. Griffith ◽

Seon Yoon Chung ◽

Shijun Zhu ◽

Alice S. Ryan

Keyword(s):

Breast Cancer ◽

Insulin Resistance ◽

Black Women ◽

White Women ◽

Cancer Recurrence ◽

Control Group ◽

Study Objective ◽

Increased Risk ◽

Tnf Α ◽

History Of

Objective: After chemotherapy for breast cancer, Black women gain more weight and have an increased mortality rate compared with White women. Our study objective was to compare biomarkers associated with obesity in Black women with and without a history of breast cancer.Design: Case-controlSetting: Academic/federal institutionParticipants: Black women with a history of breast cancer (cases) and age-matched controls.Methods: We compared insulin resistance, inflammation, and lipids in overweight and obese Black women with a history of breast cancer (n=19), age similar controls (n=25), and older controls (n=32). Groups did not differ on mean body mass index (BMI), which was 35.4 kg/m2, 36.0 kg/m2, and 33.0 kg/m2, respectively.Main Outcome Measures: Insulin resistance (HOMA-IR); inflammation (TNF-α, IL-1b, IL-6, IL-8, CRP); lipids (cholesterol, triglycerides).Results: Cases had 1.6 and 1.38 times higher HOMA-IR values compared with age similar and older controls, respectively (P≤.001 for both). TNF-α and IL-1b were significantly higher in cases compared with both control groups (P<.001 for both). IL-6 was also higher in cases compared with age-similar controls (P=.007), and IL-8 was lower in cases compared with older controls (P<.05). Lipids did not differ between cases and either control group.Conclusions: Black women with breast cancer were significantly more insulin resistant with increased inflammation compared not only with age similar controls but with women who were, on average, a decade older. These biomarkers of insulin resistance and inflammation may be associated with increased risk of breast cancer recurrence and require ongoing evaluation, especially given the relatively abnormal findings compared with the controls in this underserved group. Ethn Dis. 2016;26(4):513-520; doi:10.18865/ed.26.4.513

Download Full-text

P525 Patients’ Perception of Risks of biologic therapy During Covid-19 Pandemic in Israel Orly Lior, Ilia Sergeev, Nahum Ruhimovich, Michal Openheim, Fabiana Benjaminov, Dan Feldman, Yehuda Ringel, Timna Naftali Division of Gastroenterology and Liver Diseases, Meir Medical Center, Kfar Saba, Israel

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.647 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S501-S501

Author(s):

O Lior ◽

I Sergeev ◽

N Ruhimovich ◽

M Openheim ◽

F Benjaminov ◽

...

Keyword(s):

Medical Center ◽

Severe Disease ◽

Treatment Decision ◽

Mild Disease ◽

Treatment Decision Making ◽

Increased Risk ◽

Increase Risk ◽

History Of ◽

Stopping Treatment ◽

Theoretical Question

Abstract Background Current inflammatory bowel disease (IBD) therapies are highly effective. However, compliance with treatment is influenced by patients’ perception of benefits versus risks. Understanding these perceptions and their influence on patients’ treatment decision-making is crucial for achieving compliance, especially during Covid-19 pandemic. Aim: to assess patients’ perception of risks of IBD exacerbation and SARS-CoV-2 infection, and their influence on patients’ decisions regarding biologic and immunosuppressive treatments during Covid-19 pandemic in Israel. Methods A prospective internet-based survey among Meir Medical Center, IBD clinic patients. Results 116 patients have responded. Mean age 42 (18–84), 44 (38%) males, 75 (64%) Crohn’s disease, 38 (32%) ulcerative colitis, 34 (29%) with history of abdominal surgery, 47 (40%) were in remission and 9(7.5%) with severe disease. 18 (15%) patients were on Immunosuppressive and 76 (66%) on biologic treatments. Concerns of contracting SARS-CoV-2 infection: 56 (48%) patients considered their risk as equal to that of the general population whereas 53 (46%) considered it to be increased. 55% of the patients related the increase risk of COVID-19 infection to their IBD treatment, whereas 47% related it to having IBD. Patients treated with biologics were more concerned of becoming infected with SARS-CoV-2 then those who were not. There was also a significant association between depression and anxiety levels and the fear of becoming infected (r= 0.3 for depression and 0.4 for anxiety). Adherence to IBD treatment: Only 8 (7.5%) patients considered stopping their IBD treatment, and only 4 (3.7%) patients actually stopped their treatment. Patients with more severe disease were more inclined to stop their treatment compared to those with mild disease. Reasons for not stopping treatment were fear of disease exacerbation in 37 (32%) patients, and reassuring information received from medical providers, in 25 (21.5%) patients. When faced with a theoretical question of trading long-term remission versus risk of SARS-CoV-2infection, 34 (29%) patients were willing to accept a 10% infection risk for a 10-year remission Conclusion Significant portion of the patients with IBD believe that they are at increased risk of contracting SARS-CoV-2 infection, and more than half of them related the increase risk to their IBD treatment. However, despite their fear most patients felt safe enough to continue their treatment. Patients with more severe disease and treated with biologics experienced higher levels of anxiety, depression and fear of COVID-19 infection. Identifying and addressing these fears early might increase patient’s adherence to treatment and prevent the hazardous effects of discontinuation of treatment.

Download Full-text

Abstract 18516: Regional Dysfunction of Left Atrial Appendage and its Association with Stroke in Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.18516 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Abdullah A Alissa ◽

Yuko Inoue ◽

Jochen Cammin ◽

Qiulin Tang ◽

Elliot Fishman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Control Group ◽

Prior History ◽

Area Change ◽

Increased Risk ◽

History Of ◽

Regional Dysfunction

Background: Atrial Fibrillation (AF) is associated with an increased risk of cardioembolic stroke. Previous studies demonstrate that the Left atrial appendage (LAA) is the most common site of intracardiac thrombus, and the LAA morphology alone may determine the risk of stroke. We aimed to determine the association between LAA regional dysfunction using novel, noninvasive, image-based motion-estimation CT (iME) and prior history of stroke in patients with AF. Methods: Among the patients with history of AF referred for ablation who underwent pre-ablation CT with retrospective ECG gating, we identified 18 patients with a prior history of stroke or TIA, and 18 age- and gender-matched controls. The patients in AF at the time of CT were excluded. Four-dimensional motion vector field was estimated from reconstructed CT images using iME at every 5% RR interval. To assess myocardial deformation, area change ratio and area change rate were calculated over the endocardial surface of the LA and LAA. Univariate and multivariate comparisons were made by using binary logistic regression model. Results: A total of 36 patients (mean age 67.6 ± 8.1 years, 66.7% male, 16.7% persistent AF) were included in the study. Univariate analysis showed that the LA pre-atrial contraction area change ratio and LAA maximum area change ratio were significantly lower (P= 0.02 and 0.04, respectively) in the stroke/TIA group compared to the control group. These changes remained statistically significant in multivariate analysis (P=0.03 and 0.04, respectively) after adjusting for age, sex, body mass index, LV ejection fraction, type of AF, and CHADS score. Conclusions: LAA regional dysfunction is associated with stroke/TIA in patients with AF. LAA regional dysfunction detected by iME could represent a marker for stroke and a possible therapeutic target.

Download Full-text

The Relationship of Drug Abuse to Unexplained Sudden Death

Archives of Pathology & Laboratory Medicine ◽

10.5858/132.12.1903 ◽

2008 ◽

Vol 132 (12) ◽

pp. 1903-1906

Author(s):

Amy C. Gruszecki ◽

Gerald McGwin, Jr ◽

C. Andrew Robinson, Jr ◽

Gregory G. Davis

Keyword(s):

Drug Abuse ◽

Cause Of Death ◽

Control Group ◽

Manner Of Death ◽

Increased Risk ◽

History Of ◽

Matched Case ◽

Relationship Of ◽

The Relationship ◽

Control Study

Abstract Context.—Forensic pathologists regularly investigate the deaths of individuals with a history of drug abuse. Autopsy, including toxicology testing, reveals no cause for death in a subset of this cohort. Objective.—To determine whether deaths with an undetermined cause and manner of death are associated with a history of drug abuse. Design.—Retrospective matched case-control study of 52 decedents whose cause of death remained undetermined following autopsy, matched 1:2 to a control group of living patients admitted for cholecystectomy according to age and date of death or procedure. Results.—Individuals whose cause of death was undetermined were 5.3 times (95% confidence interval, 1.9– 14.5) more likely to have a history of drug abuse than were patients with cholecystitis. Conclusions.—Decedents with a history of chronic drug abuse appear to be at an increased risk of dying by their chronic drug abuse, even in the absence of any anatomical or toxicologic finding at autopsy to account for death.

Download Full-text

History of Depression and Increased Risk of Sternal Wound Infection After Cardiothoracic Surgery: A Novel and Potentially Modifiable Risk Factor

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz083 ◽

2019 ◽

Vol 6 (3) ◽

Author(s):

Deborah A Theodore ◽

Renee D Goodwin ◽

Yuan (Vivian) Zhang ◽

Nancy Schneider ◽

Rachel J Gordon

Keyword(s):

Risk Factors ◽

Wound Infection ◽

Medical Center ◽

Academic Medical Center ◽

Cardiothoracic Surgery ◽

Sternal Wound Infection ◽

Composite Variable ◽

Increased Risk ◽

History Of ◽

History Of Depression

Abstract Background Sternal wound infection (SWI) is a leading cause of postoperative disease and death; the risk factors for SWI remain incompletely understood. The goal of the current study was to investigate the relationship between a preoperative history of depression and the risk of SWI after cardiothoracic surgery. Methods Among patients undergoing cardiothoracic surgery in a major academic medical center between 2007 and 2012, those in whom SWI developed (n = 129) were matched, by date of surgery, with those in whom it did not (n = 258). Multivariable logistic regression was used to examine the strength of relationships between risk factors and development of infection. History of depression was defined as a composite variable to increase the sensitivity of detection. Results History of depression as defined by our composite variable was associated with increased risk of SWI (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.7; P = .01). Staphylococcus aureus was the most common organism isolated. Conclusions History of depression was associated with increased risk of SWI. Future prospective studies are warranted to further investigate this relationship. Depression is highly treatable, and increased efforts to identify and treat depression preoperatively may be a critical step toward preventing infection-related disease and death.

Download Full-text

Effect of intravenous furosemide on serum theophylline concentration

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/38.9.1345 ◽

1981 ◽

Vol 38 (9) ◽

pp. 1345-1347

Author(s):

Paul F. Conlon ◽

Geoffrey R. Grambau ◽

Cary E. Johnson ◽

John G. Weg

Keyword(s):

Theophylline Concentration ◽

Serum Theophylline Concentration ◽

Serum Theophylline

Download Full-text

Risk factors for pre-eclampsia among women at antenatal booking in Kano, Northern Nigeria

Healthcare in Low-resource Settings ◽

10.4081/hls.2013.e12 ◽

2013 ◽

Vol 1 (1) ◽

pp. 12 ◽

Cited By ~ 1

Author(s):

Ibrahim A. Yakasai ◽

Imran O. Morhason-Bello

Keyword(s):

Risk Factors ◽

Early Onset ◽

Multiple Logistic Regression Analysis ◽

Control Group ◽

Northern Nigeria ◽

Degree Relative ◽

Factors Associated ◽

Increased Risk ◽

History Of ◽

At Home

Pre-eclampsia (PE) is an important cause of maternal mortality. There have been several studies on risk factors assessment with conflicting reports across the globe on this disease; however, rigorous recent evaluation of these factors is uncommon in this region. The aim of the present study was to determine the risks factors in the early-onset PE in Aminu Kano Teaching Hospital (AKTH), Kano (Northern Nigeria). We conducted a case-control study in Nigeria between April 2009 and January 2010 to identify the risk factors associated with the early-onset PE in women attending antenatal clinic in AKTH. Information on socio-cultural characteristics, medical history, previous obstetrics history, level of stress at home, and type of family were obtained and recorded in a proforma designed for the study. Multiple logistic regression analysis was used to determine the risk factors for PE at 95% confidence level. Pregnant women with early-onset PE (150 in each case and control group). Risk factors associated with increased risk of early-onset PE were: history of pre-eclampsia/eclampsia (PE/E) in a previous pregnancy [adjusted odds ratio (AOR) 2.09]; exposure to passive smoking (AOR 1.34); inadequate antenatal supervision (AOR 15.21); family history of hypertension in one or more 1st-degree relative (AOR 8.92); living in a joint family (AOR 6.93); overweight (120% to 150% of pre-pregnancy ideal body weight, AOR 4.65). Risk factors among women in Northern Nigeria are similar to those reported from other studies. Good antenatal cares, early detection, reduction of stressful conditions at home are the most important preventive measures of early-onset severe PE among these women.

Download Full-text

Risk factors for childhood and adult primary brain tumors

Neuro-Oncology ◽

10.1093/neuonc/noz123 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1357-1375 ◽

Cited By ~ 15

Author(s):

Quinn T Ostrom ◽

Maral Adel Fahmideh ◽

David J Cote ◽

Ivo S Muskens ◽

Jeremy M Schraw ◽

...

Keyword(s):

Risk Factors ◽

Ionizing Radiation ◽

Brain Tumors ◽

The United States ◽

Primary Brain Tumors ◽

Clinical Databases ◽

Increased Risk ◽

History Of ◽

Adults And Children ◽

Race Ethnicity

Abstract Primary brain tumors account for ~1% of new cancer cases and ~2% of cancer deaths in the United States; however, they are the most commonly occurring solid tumors in children. These tumors are very heterogeneous and can be broadly classified into malignant and benign (or non-malignant), and specific histologies vary in frequency by age, sex, and race/ethnicity. Epidemiological studies have explored numerous potential risk factors, and thus far the only validated associations for brain tumors are ionizing radiation (which increases risk in both adults and children) and history of allergies (which decreases risk in adults). Studies of genetic risk factors have identified 32 germline variants associated with increased risk for these tumors in adults (25 in glioma, 2 in meningioma, 3 in pituitary adenoma, and 2 in primary CNS lymphoma), and further studies are currently under way for other histologic subtypes, as well as for various childhood brain tumors. While identifying risk factors for these tumors is difficult due to their rarity, many existing datasets can be leveraged for future discoveries in multi-institutional collaborations. Many institutions are continuing to develop large clinical databases including pre-diagnostic risk factor data, and developments in molecular characterization of tumor subtypes continue to allow for investigation of more refined phenotypes. Key Point 1. Brain tumors are a heterogeneous group of tumors that vary significantly in incidence by age, sex, and race/ethnicity.2. The only well-validated risk factors for brain tumors are ionizing radiation (which increases risk in adults and children) and history of allergies (which decreases risk).3. Genome-wide association studies have identified 32 histology-specific inherited genetic variants associated with increased risk of these tumors.

Download Full-text