Cardiovascular Comorbidities in a United States Patient Population with Hemophilia a: A Comprehensive Chart Review

Abstract Introduction: Two previous retrospective claims database analyses (Pocoski J, et al. Haemophilia. 2014;20(4):472-478 and Humphries TJ, et al. Am J Hematol. 2016;91(5):E298-299) reported increased prevalence and earlier onset of cardiovascular (CV) comorbidities in patients with vs without hemophilia A (HEM A). Because of many known limitations of claims databases, a comprehensive chart review at a large integrated delivery network was conducted to assess differential CV comorbidities. Aim: This study was designed to confirm the previous findings on CV risk factors and associated diseases in 2 large claims databases of male patients with HEM A in the United States. Methods: This was a retrospective chart review study conducted at the Henry Ford Health System in patients diagnosed with HEM A (n=74) and matched Control patients (3:1) without a diagnosis of HEM A (Control, n=222). Baseline demographics, bleeding events, treatment parameters, co-existing diseases, hemophilia-associated events, and the prevalence of 12 CV risk factors and associated diseases were compared between the HEM A and Control cohorts. P values generated from a chi-square test for categorical variables and a t test for continuous variables were reported. To address the small sample size, statistical differences between the cohorts were also assessed using absolute standardized difference (SDiff), where a value ≥0.10 was considered statistically meaningful. Results: The Control cohort was well matched to the HEM A group by age, race, healthcare payer, and study year. As expected, the prevalence of hepatitis B and C, hepatocellular carcinoma, and HIV/AIDS was much higher in the HEM A cohort. Gastrointestinal, intracranial, muscle, and joint bleeds occurred only in HEM A patients. Bleeds of various types were recorded in 35 HEM A patients vs 1 in the Control group. HEM A was severe in 52.7% of patients, moderate and mild in 10.8% each, and unknown in 25.7%. The prevalence of hypertension, diabetes, obesity, hyperlipidemia, coronary artery disease, heart failure, stroke, venous and arterial thrombosis, ventricular arrhythmias, atrial fibrillation, and chronic renal disease was numerically higher in the Control cohort, but differences were statistically significant (P≤0.05) for diabetes and hyperlipidemia only. Statistical significance using SDiff was not reached for venous and arterial thrombosis and atrial fibrillation. Conclusions:The results of this retrospective chart review did not confirm diffuse statistically significant differences in CV comorbidities and their earlier onset in HEM A vs Controls. Reasons for the lack of confirmation are not clear but may include differences in methodology and patient populations among the studies. The Control group in this current study may have a greater medical burden than in the published studies. Our current results suggest numerically higher comorbidities in Controls for most variables. The conclusions of this study are limited by the small sample size of the hemophilia cohort and a potential selection bias associated with identification of the Control cohort. Disclosures Pocoski: Bayer: Employment. Rule:Bayer: Employment. Ogbonnaya:Takeda: Research Funding. Lamerato:Amgen, Inc.: Research Funding. Lunacsek:Bayer: Research Funding. Humphries:Bayer: Employment.

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Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475418823529 ◽

2019 ◽

Vol 23 (3) ◽

pp. 270-276 ◽

Cited By ~ 6

Author(s):

Meghan L. McPhie ◽

Alanna C. Bridgman ◽

Mark G. Kirchhof

Keyword(s):

Disease Severity ◽

Hidradenitis Suppurativa ◽

Chart Review ◽

Small Sample Size ◽

Demographic Data ◽

Severe Disease ◽

Treatment Protocol ◽

Retrospective Chart Review ◽

Small Sample ◽

Combination Therapies

Background: Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. Objectives: The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. Methods: We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. Results: Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. Conclusions: This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

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Time in Therapeutic Range Using a Nomogram for Dose Adjustment of Warfarin in Patients on Hemodialysis With Atrial Fibrillation

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211046079 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110460

Author(s):

Kimberly Defoe ◽

Jenny Wichart ◽

Kelvin Leung

Keyword(s):

Atrial Fibrillation ◽

Therapeutic Range ◽

Chart Review ◽

Warfarin Therapy ◽

Small Sample Size ◽

Retrospective Chart Review ◽

Small Sample ◽

Time In Therapeutic Range ◽

Increased Risk ◽

Chi Square Analysis

Background: Patients treated with hemodialysis and prescribed warfarin typically have lower time in therapeutic range (TTR) compared to the general population. This may result in less benefit or increased risk of over anticoagulation in these patients. Objective: To assess effectiveness of use of an electronic nomogram for the management of warfarin therapy in patients treated with hemodialysis. Design: Retrospective chart review. Setting: Adult patients treated with hemodialysis. Patients: Patients on hemodialysis receiving warfarin for the management of atrial fibrillation (AF) with therapy managed by nursing led electronic nomogram. Measurements: Time in therapeutic range (as fraction and Rosendaal). Methods: Retrospective chart review over 1 year of international normalized ratio (INR) results was completed, and TTR was calculated. Comparison of patients with TTR greater than 60% to those less than 60% was completed using chi-square analysis. Results: Of 43 patients with warfarin therapy managed by the nomogram, the mean TTR was 55.2% (calculated by fraction method) or 61.2% (calculated by Rosendaal method). More than half of the patients (63.5%) had moderate to good control, defined as TTR greater than 60%. Female sex, liver disease, or history of substance use and more medication holds were associated with lower TTR. Limitations: Small sample size and retrospective nature of review. Conclusions: The results of this review supports the use of an electronic, nursing-led nomogram for the maintenance management of warfarin therapy in stable patients treated with hemodialysis, as use results in TTR greater than 60% for more than half of patients.

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Toxic Epidermal Necrolysis (TEN)/Stevens-Johnson Syndrome (SJS) Epidemiology and Mortality Rate at King Fahad Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia: A Retrospective Study

Dermatology Research and Practice ◽

10.1155/2020/7524726 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Abdullah Alajaji ◽

Jagannath Chandra Shekaran ◽

Omar Mohammed Aldhabbah ◽

Hajar Abdullah Alhindi ◽

Nouf Salem Almazyad ◽

...

Keyword(s):

Saudi Arabia ◽

Mortality Rate ◽

Toxic Epidermal Necrolysis ◽

Chart Review ◽

Small Sample Size ◽

Retrospective Chart Review ◽

Small Sample ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Life Threatening

Background. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening conditions caused by drug reactions. There are multiple causative drugs and different risk factors associated with SJS/TEN. Objectives. To study the epidemiology of SJS/TEN and associated mortality rate in Qassim region, Saudi Arabia. Methodology. A retrospective chart review of all patients with the diagnosis of SJS/TEN who were admitted to King Fahad Specialist Hospital (KFSH) in Qassim region, Saudi Arabia, for the period between Jan 2014 to Jan 2019. The Careware information health system is used at KFSH, and patients were identified searching the diagnosis SJS/TEN. Results. Total of 10 patients with diagnosis of SJS/TEN were admitted to KFSH for the period from Jan 2014 to Jan 2019. Antibiotics were the culprit in 5 out of 10 patients. 9 out of 10 patients survived with good outcome. One patient with the diagnosis of TEN died, given extensive skin involvement complicated by sepsis. Conclusion. Despite the limitation of this study given small sample size, this is the first study of its kind that discusses the epidemiology of SJS/TEN in Saudi Arabia. We found the estimated incidence rate of SJS/TEN in Qassim region to be 7.6 cases per million person-years. Antibiotics and antiepileptics were the culprits in 8 out of 10 patients.

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The Use of Dalbavancin for Primary Bloodstream Infections and Infectious Endocarditis: A Retrospective Chart Review

10.21203/rs.3.rs-144625/v1 ◽

2021 ◽

Author(s):

Connor Evins ◽

Harrison Lancaster MS- ◽

Amanda E. Schnee

Keyword(s):

Chart Review ◽

Small Sample Size ◽

Retrospective Chart Review ◽

Bloodstream Infections ◽

Small Sample ◽

Inclusion Criteria ◽

Hospital Stays ◽

Positive Results

Abstract Background: Dalbavancin is a semisynthetic antibiotic used as an alternative to vancomycin for skin infections as well as osteomyelitis. It is particularly useful due to its safety profile as well as long half-life, which allows for weekly outpatient infusions. This decreases the need for patients to have long term IV access and reduces hospital stays. This study analyzes the effectiveness of Dalbavancin for bacteremia and infective endocarditis Methods: Upon IRB approval, the authors performed a retrospective chart analysis on patients who fit our inclusion criteria between 2014 and 2020. Their hospitalizations were analyzed for demographics, medical history, indication, and follow up. The results were then analyzed using descriptive statistics. Results: Our cohort had 23 patients treated with Dalbavancin for endocarditis or bloodstream infections. There were no reported side effects from the medication, no readmissions for worsened infection, and no deaths from the infection. 11 patients were treated due to refusal of medical care, and 15 patients had follow-up visits within 90 days. Conclusions: Overall, patients responded well. The lack of readmission to the hospital is promising as it indicates a possible outpatient treatment. This would help decrease cost and comorbidities of long-term hospital stays. These positive results are limited by small sample size and treatment of other antibiotics prior to receiving Dalbavancin. Further research is required to accurately estimate the efficacy of Dalbavancin on bloodstream infections and endocarditis, but these results are promising especially for patients who are not candidates for long term hospitalization or IV access.

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Longitudinal assessment of S100B serum levels and clinical factors in youth patients with mood disorders

Scientific Reports ◽

10.1038/s41598-021-91577-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Aleksandra Rajewska-Rager ◽

Monika Dmitrzak-Weglarz ◽

Pawel Kapelski ◽

Natalia Lepczynska ◽

Joanna Pawlak ◽

...

Keyword(s):

Mood Disorders ◽

Calcium Binding ◽

Clinical Symptoms ◽

Small Sample Size ◽

Serum Levels ◽

Small Sample ◽

Drop Out ◽

Control Group ◽

Longitudinal Assessment ◽

Depressed Group

AbstractMood disorders have been discussed as being in relation to glial pathology. S100B is a calcium-binding protein, and a marker of glial dysfunctions. Although alterations in the S100B expression may play a role in various central nervous system diseases, there are no studies on the potential role of S100B in mood disorders in adolescents and young adults . In a prospective two-year follow-up study, peripheral levels of S100B were investigated in 79 adolescent/young adult patients (aged 14–24 years), diagnosed with mood disorders and compared with 31 healthy control subjects. A comprehensive clinical interview was conducted which focused on clinical symptoms and diagnosis change. The diagnosis was established and verified at each control visit. Serum S100B concentrations were determined. We detected: lower S100B levels in medicated patients, compared with those who were drug-free, and healthy controls; higher S100B levels in a depressed group with a family history of affective disorder; correlations between age and medication status; sex-dependent differences in S100B levels; and lack a of correlation between the severity of depressive or hypo/manic symptoms. The results of our study indicate that S100B might be a trait-dependent rather than a state-dependent marker. Due to the lack of such studies in the youth population, further research should be performed. A relatively small sample size, a lack of exact age-matched control group, a high drop-out rate.

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ECT rekindles pharmacological response in schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2009.04.005 ◽

2009 ◽

Vol 24 (8) ◽

pp. 521-525 ◽

Cited By ~ 16

Author(s):

H. Hustig ◽

R. Onilov

Keyword(s):

Small Sample Size ◽

Antipsychotic Agents ◽

Pharmacological Therapy ◽

Small Sample ◽

Clinical Population ◽

Control Group ◽

Clinical Notes ◽

Symptom Profiles ◽

Pharmacological Response ◽

Maintenance Ect

AbstractObjectiveThe aim of our naturalistic-observational study was to determine the efficacy and utility of electroconvulsive therapy (ECT) in clinical population of individuals with schizophrenia where pharmacological response was suboptimal.MethodsThe cohort comprised 27 patients suffering from schizophrenia with refractoriness to antipsychotic agents and with severe, disabling symptoms. They only interventional assessing tool was clinical global impression (CGI-S) performed at the baseline and at the end of the treatment.ResultsThe administration of ECT resulted in overall clinical improvement reflected in CGI scales and descriptions in clinical notes. On 12 months follow-up period, 10 patients (37.1%) maintained improvement and were able to continue with pharmacological therapy only, suggesting its rekindling effect, especially with Clozapine. Conversely, 17 patients (62.9%) deteriorated and required an additional course of ECT to maintain improvement. In some cases, maintenance ECT treatment was required. The group who engaged in self-harming behaviour at baseline demonstrated they were more likely to relapse into psychosis at the end of the first course of ECT, their self-harming behaviour abated, especially when maintenance ECT was undertaken.ConclusionsAlthough limited by lack of control group, small sample size, heterogeneous symptom profiles and various concurrent neuroleptic agents, the ECT proved as valuable and safe augmentative procedure when unsatisfactory response to pharmacological interventions had been demonstrated prior to interventions. This effect was evident despite the chronicity of the illness.

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Mesenchymal Stem Cell Therapy for Acetaminophen-Related Liver Injury: A Systematic Review and Meta-Analysis of Experimental Studies in Vivo

Current Stem Cell Research & Therapy ◽

10.2174/1574888x16666211007092055 ◽

2021 ◽

Vol 16 ◽

Author(s):

Li Wang ◽

Yiwen Zhang ◽

Jiajun Zhong ◽

Yuan Zhang ◽

Shuisheng Zhou ◽

...

Keyword(s):

Systematic Review ◽

Stem Cell ◽

Liver Injury ◽

Mesenchymal Stem Cell ◽

Small Sample Size ◽

Meta Analysis ◽

Experimental Studies ◽

Small Sample ◽

Control Group

Objective: The efficacy of mesenchymal stem cell (MSC) therapy in acetaminophen-induced liver injury has been investigated in animal experiments, but individual studies with a small sample size cannot be used to draw a clear conclusion. Therefore, we conducted a systematic review and meta-analysis of preclinical studies to explore the potential of using MSCs in acetaminophen-induced liver injury. Methods: Eight databases were searched for studies reporting the effects of MSCs on acetaminophen hepatoxicity. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. SYRCLE’s risk of bias tool for animal studies was applied to assess the methodological quality. A meta-analysis was performed by using RevMan 5.4 and STATA/SE 16.0 software. Results: Eleven studies involving 159 animals were included according to PRISMA statement guidelines. Significant associations were found for MSCs with the levels of alanine transaminase (ALT) (standardized mean difference (SMD) − 2.58, p < 0.0001), aspartate aminotransferase (AST) (SMD − 1.75, p = 0.001), glutathione (GSH) (SMD 3.7, p < 0.0001), superoxide dismutase (SOD) (SMD 1.86, p = 0.022), interleukin 10 (IL-10) (SMD 5.14, p = 0.0002) and tumor necrosis factor-α (TNF-α) (SMD − 4.48, p = 0.011) compared with those in the control group. The subgroup analysis showed that the tissue source of MSCs significantly affected the therapeutic efficacy (p < 0.05). Conclusion: Our meta-analysis results demonstrate that MSCs could be a potential treatment for acetaminophen-related liver injury.

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Biofilm Formation by and Antifungal Susceptibility of Candida Isolates from Urine

Applied and Environmental Microbiology ◽

10.1128/aem.02439-06 ◽

2007 ◽

Vol 73 (6) ◽

pp. 1697-1703 ◽

Cited By ~ 86

Author(s):

N. Jain ◽

R. Kohli ◽

E. Cook ◽

P. Gialanella ◽

T. Chang ◽

...

Keyword(s):

Risk Factors ◽

Growth Medium ◽

Biofilm Formation ◽

Chart Review ◽

Antifungal Susceptibility ◽

Retrospective Chart Review ◽

Urine Samples ◽

Rpmi Medium

ABSTRACT Biofilm formation (BF) in the setting of candiduria has not been well studied. We determined BF and MIC to antifungals in Candida spp. isolates grown from urine samples of patients and performed a retrospective chart review to examine the correlation with risk factors. A total of 67 Candida spp. isolates were grown from urine samples from 55 patients. The species distribution was C. albicans (54%), C. glabrata (36%), and C. tropicalis (10%). BF varied greatly among individual Candida isolates but was stable in sequential isolates during chronic infection. BF also depended on the growth medium and especially in C. albicans was significantly enhanced in artificial urine (AU) compared to RPMI medium. In nine of the C. albicans strains BF was 4- to 10-fold higher in AU, whereas in three of the C. albicans strains and two of the C. glabrata strains higher BF was measured in RPMI medium than in AU. Determination of the MICs showed that planktonic cells of all strains were susceptible to amphotericin B (AMB) and caspofungin (CASPO) and that three of the C. glabrata strains and two of the C. albicans strains were resistant to fluconazole (FLU). In contrast, all biofilm-associated adherent cells were resistant to CASPO and FLU. The biofilms of 14 strains (28%) were sensitive to AMB (MIC50 of <1 μg/ml). Correlation between degree of BF and MIC of AMB was not seen in RPMI grown biofilms but was present when grown in AU. A retrospective chart review demonstrated no correlation of known risk factors of candiduria with BF in AU or RPMI. We conclude that BF is a stable characteristic of Candida strains that varies greatly among clinical strains and is dependent on the growth medium. Resistance to AMB is associated with higher BF in AU, which may represent the more physiologic medium to test BF. Future studies should address whether in vitro BF can predict treatment failure in vivo.

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An experimental study on the effects of exposure to magazine advertising on children's food choices

Public Health Nutrition ◽

10.1017/s1368980010002983 ◽

2010 ◽

Vol 14 (8) ◽

pp. 1337-1344 ◽

Cited By ~ 21

Author(s):

Sandra C Jones ◽

Lisa Kervin

Keyword(s):

Small Sample Size ◽

Food Preferences ◽

Food Choices ◽

Small Sample ◽

Control Group ◽

Snack Food ◽

South Wales ◽

Children's Magazines ◽

Food Advertisements ◽

Effects On Children

AbstractObjectiveThe present study sought to determine the feasibility of an experimental research design to investigate the effects of exposure to magazine advertising on children's food choices.DesignChildren were randomized to read either a magazine with food advertisements or a magazine with no food advertisements. They then chose two food items from the intervention ‘store’ to eat after the session. Data were also collected on attitudes to advertising and snack food preferences. Finally, participants’ parents were provided with a self-completion survey on food choices and other variables (n24).SettingThree vacation care centres in regional New South Wales, Australia.SubjectsChildren aged 5–12 years (n47).ResultsChildren in the experimental condition were more likely to choose advertised foods than those in the control group. Interestingly, the majority reported taste and healthiness as the most important factors in snack food choices; however, when faced with the actual food choice, they predominantly chose unhealthy foods (eighty-two unhealthy and only twelve healthy items were chosen).ConclusionsThis was the first study to assess the effects on children of exposure to food advertising within the context of reading a child-targeted magazine. Importantly, even with the small sample size and venue limitations, we found that exposure to magazine advertising influenced food choices. Children's magazines are an under-researched and poorly regulated medium, with considerable potential to influence children's food choices. The present study shows that the methodology is feasible, and future studies could replicate this with larger samples.

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Prevalence, Symptoms and Duration of Post Acute Effects in SARS-CoV-2 Positive Children – a Nationwide Cohort Study

10.21203/rs.3.rs-839948/v1 ◽

2021 ◽

Author(s):

Luise Borch ◽

Mette Holm ◽

Maria Knudsen ◽

Svend Ellermann-Eriksen ◽

Soeren Hagstroem

Keyword(s):

Cohort Study ◽

Muscle Weakness ◽

School Children ◽

Small Sample Size ◽

Risk Difference ◽

Small Sample ◽

Control Group ◽

Respiratory Problems ◽

Danish Health ◽

Registration Number

Abstract Background: Most children have a mild course of acute COVID-19, but only a few mainly non-controlled studies with small sample size, have evaluated the long-term recovery from SARS-CoV-2 infection in children (‘long COVID’).Methods: We conducted a nationwide cohort study of 37,522 children age 0-17 years with RT-PCR verified SARS-CoV-2 infection and a control group of 78,037 randomly selected children. An electronic questionnaire was sent to both groups of children from March 24th until May 9th 2021.Results: Long COVID symptoms were reported by 12-51% of SARS-CoV-2 infected children. Among pre-school children, fatigue Risk Difference (RD) 0.05 (CI 0.04-0.06), loss of smell RD 0.01 (CI 0.01-0.01), loss of taste RD 0.01 (CI 0.01-0.02) and muscle weakness RD 0.01 (CI 0.00-0.01) were statistically significant symptoms of ‘long COVID’.Among school children the most significant symptoms were loss of smell RD 0.12 (CI 0.12-0.13), loss of taste RD 0.10 (CI 0.09-0.10), fatigue RD 0.05 (CI 0.05-0.06), respiratory problems RD 0.03 (CI 0.03-0.04), dizziness RD 0.02 (CI 0.02-0.03), muscle weakness RD 0.02 (CI 0.01-0.02), and chest pain RD 0.01 (CI 0.01-0.01). Children in the control group experienced significantly more concentration difficulties, headache, muscle- and joint pain, cough, nausea, diarrhea and fever than the SARS-CoV-2 infected. In most children ‘long COVID’ symptoms resolved within 1-5 months.Conclusions: This study provides new evidence of ‘long COVID’ symptoms in children.Trial registration number: The study was approved by The Danish Health Data Authority and registered at Central Denmark region (# 1-16-02-621-20).

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