Safety of parathyroidectomy in older vs. younger patients with primary hyperparathyroidism

Background: Primary hyperparathyroidism is a prevalent endocrinopathy for which surgery is the only curative option. Parathyroidectomy is primarily recommended in younger and symptomatic patients, while there are still concerns regarding surgical complications in older patients. We therefore assessed the association of age with surgical outcomes in patients undergoing parathyroidectomy in a large population in Switzerland. Methods: Population-based cohort study of adult patients with primary hyperparathyroidism undergoing parathyroidectomy in Switzerland between 2012 and 2018. The cohort was divided into four age groups (<50 years, 50-64 years, 65-74 years, ≥75 years). The primary outcome was a composite of in-hospital postoperative complications. Secondary outcomes were intensive care unit (ICU) admission, unplanned 30-day-readmission, and prolonged length of hospital stay. Results: We studied 2642 patients with a median (IQR) age of 62 (53 – 71) years. Overall, 111 patients had complications including surgical re-intervention, hypocalcemia, and vocal cord paresis. As compared to <50 year-old patients, older patients had no increased risk for in-hospital complications after surgery (50-64 years: OR 0.51 [95% CI 0.28 to 0.92]; 65-74 years: OR 0.72 [95% CI 0.39 to 1.33]; ≥75 years: OR 1.03 [95% CI 0.54 to 1.95]), respectively. There was also no association of age and rates of ICU-admission and unplanned 30-day-readmission, but oldest patients had longer hospital stays (OR 2.38 [95% CI 1.57 – 3.60]). Conclusion: ≥50 year-old patients undergoing parathyroidectomy had comparable risk of in-hospital complications as compared with younger ones. These data support parathyroidectomy in even older patients with primary hyperparathyroidism as performed in clinical routine.

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SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽

10.1136/gutjnl-2020-323364 ◽

2021 ◽

pp. gutjnl-2020-323364

Author(s):

Sanjay Pandanaboyana ◽

John Moir ◽

John S Leeds ◽

Kofi Oppong ◽

Aditya Kanwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Collaborative Study ◽

Length Of Hospital Stay ◽

Secondary Outcome ◽

Icu Admission ◽

Local Complications ◽

Persistent Organ Failure ◽

Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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Melanoma is associated with an increased risk of bullous pemphigoid: a large population-based longitudinal study

Archives of Dermatological Research ◽

10.1007/s00403-021-02211-4 ◽

2021 ◽

Author(s):

Khalaf Kridin ◽

Jennifer E. Hundt ◽

Ralf J. Ludwig ◽

Kyle T. Amber ◽

Dana Tzur Bitan ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Statistical Significance ◽

Large Population ◽

Underlying Mechanism ◽

Population Based ◽

Control Subjects ◽

Increased Risk ◽

Bidirectional Association ◽

History Of ◽

Incident Cases

AbstractThe association between bullous pemphigoid (BP) and melanoma is yet to be investigated. We aimed to assess assess the bidirectional association between BP and melanoma and to delineate the epidemiological features of patients with both diagnoses. A population-based cohort study was performed comparing BP patients (n = 3924) with age-, sex- and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of melanoma. A case–control design was additionally adopted to estimate the risk of BP in individuals with a preexisting diagnosis of melanoma. The prevalence of preexisting melanoma was higher in patients with BP than in control subjects (1.5% vs. 1.0%, respectively; P = 0.004). A history of melanoma confers a 50% increase in the risk of subsequent BP (OR 1.53; 95% CI 1.14–2.06). This risk was higher among males (OR 1.66; 95% CI 1.09–2.54) and individuals older than 80 years (OR 1.63; 95% CI 1.11–2.38), and persisted after adjustment for multiple putative confounders including PD-1/PDL-1 antagonists (adjusted OR 1.53; 95% CI 1.14–2.06). Conversely, the risk of melanoma among patients with BP was slightly elevated, but did not reach the level of statistical significance (adjusted HR 1.13; 95% CI 0.73–1.74). Patients with a dual diagnosis of BP and melanoma were older at the onset of BP and had lower body mass index. A history of melanoma is associated with a 50% increase in the incidence of subsequent BP. Physicians managing patients with both conditions should be aware of this association. Further research is warranted to reveal the underlying mechanism of these findings.

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Adjuvant Hormonotherapy and Cardiovascular Risk in Post-Menopausal Women with Breast Cancer: A Large Population-Based Cohort Study

Cancers ◽

10.3390/cancers13092254 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2254

Author(s):

Matteo Franchi ◽

Roberta Tritto ◽

Luigi Tarantini ◽

Alessandro Navazio ◽

Giovanni Corrao

Keyword(s):

Breast Cancer ◽

Heart Failure ◽

Adjuvant Therapy ◽

Large Population ◽

Positive Association ◽

Population Based ◽

Study Cohort ◽

Increased Risk ◽

Post Menopausal ◽

New Diagnosis

Background: Whether aromatase inhibitors (AIs) increase the risk of cardiovascular (CV) events, compared to tamoxifen, in women with breast cancer is still debated. We evaluated the association between AI and CV outcomes in a large population-based cohort of breast cancer women. Methods: By using healthcare utilization databases of Lombardy (Italy), we identified women ≥50 years, with new diagnosis of breast cancer between 2009 and 2015, who started adjuvant therapy with either AI or tamoxifen. We estimated the association between exposure to AI and CV outcomes (including myocardial infarction, ischemic stroke, heart failure or any CV event) by a Cox proportional hazard model with inverse probability of treatment and censoring weighting. Results: The study cohort included 26,009 women starting treatment with AI and 7937 with tamoxifen. Over a median follow-up of 5.8 years, a positive association was found between AI and heart failure (Hazard Ratio = 1.20, 95% CI: 1.02 to 1.42) and any CV event (1.14, 1.00 to 1.29). The CV risk increased in women with previous CV risk factors, including hypertension, diabetes and dyslipidemia. Conclusions: Adjuvant therapy with AI in breast cancer women aged more than 50 years is associated with increased risk of heart failure and combined CV events.

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Self-reported goiter is associated with a significantly increased risk of gastric noncardia adenocarcinoma in a large population-based Chinese cohort

International Journal of Cancer ◽

10.1002/ijc.21993 ◽

2006 ◽

Vol 119 (6) ◽

pp. 1508-1510 ◽

Cited By ~ 13

Author(s):

Christian C. Abnet ◽

Jin-Hu Fan ◽

Farin Kamangar ◽

Xiu-Di Sun ◽

Philip R. Taylor ◽

...

Keyword(s):

Large Population ◽

Population Based ◽

Increased Risk ◽

Chinese Cohort

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PREVALENCE AND FEATURES OF GERIATRIC SYNDROMES TREATMENT IN OLD PATIENTS (CLINICAL AND EPIDEMIOLOGICAL STUDY)

Успехи геронтологии ◽

10.34922/ae.2020.33.2.016 ◽

2020 ◽

pp. 331-338

Author(s):

Е. Д. Голованова ◽

Н. Е. Титова ◽

Т. Е. Афанасенкова ◽

И. А. Аргунова ◽

Т. Н. Янковая ◽

...

Keyword(s):

Geriatric Patients ◽

Age Groups ◽

Older Age ◽

Age Dependence ◽

Old Patients ◽

Increased Risk ◽

Planning Treatment ◽

Risk Of Falls ◽

Gender Characteristics ◽

Outpatient Practice

Изучали распространенность хронических неинфекционных заболеваний (ХНИЗ) у пациентов пожилого и старческого возраста во взаимосвязи с синдромом старческой астении, распространенность саркопении в зависимости от гендерных особенностей и частоту встречаемости синдрома падений у пациентов старших возрастных групп с саркопенией. Анализировали особенности медикаментозной терапии в амбулаторной практике. Использовали метод комплексной гериатрической оценки у 528 пациентов, разделенных на три возрастные группы (65-74 года, 75-84 года, 85 лет и старше). Оказалось, что в структуре ХНИЗ у пациентов гериатрического профиля преобладают артериальная гипертензия, ИБС, а также их осложнения - ХСН и фибрилляция предсердий, частота встречаемости которых имеет выраженную возрастную зависимость и увеличивается у больных со старческой астенией. Для пациентов старших возрастных групп обоего пола характерно увеличение частоты встречаемости саркопении и связанного с ней повышенного риска синдрома падений, что необходимо учитывать при планировании лечебно-реабилитационных мер как в стационаре, так и при оказании первичной медикосоциальной помощи. We studied the prevalence of chronic non-communicable diseases (CND) in elderly and senile patients in conjunction with the syndrome of senile asthenia, the prevalence of sarcopenia depending on gender characteristics and the frequency of occurrence of the falls syndrome in patients with sarcopenia of older age groups. The features of drug therapy in outpatient practice were analyzed. The method of complex geriatric assessment was used in 528 patients divided into 3 age groups (65-74 years, 75-84 years, 85 years or more). It turned out that in the structure of CND in geriatric patients dominated: arterial hypertension, coronary heart disease, and their complications - chronic heart failure and atrial ﬁ brillation their incidence has a pronounced age dependence and increases in patients with senile asthenia. Patients of older age groups of both sexes are characterized by an increase in the incidence of sarcopenia and the associated increased risk of falls syndrome, which must be taken into account when planning treatment and rehabilitation measures both in the hospital and when providing primary medical and social care.

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Sleep problems increase the risk of musculoskeletal pain in boys but not girls: a prospective cohort study

European Journal of Pediatrics ◽

10.1007/s00431-020-03667-8 ◽

2020 ◽

Vol 179 (11) ◽

pp. 1711-1719

Author(s):

Alessandro Andreucci ◽

Paul Campbell ◽

Lisa K Mundy ◽

Susan M Sawyer ◽

Silja Kosola ◽

...

Keyword(s):

Cohort Study ◽

Musculoskeletal Pain ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Sleep Problems ◽

Large Population ◽

Population Based ◽

School Aged Children ◽

Increased Risk ◽

One Year

Abstract Adults with sleep problems are at higher risk for onset of musculoskeletal pain, but the evidence is less clear for children. This prospective cohort study investigated whether children with sleep problems are at higher risk for onset of musculoskeletal pain and explored whether sex is a modifier of this association. In a prospective cohort study of Australian schoolchildren (n = 1239, mean age 9 years), the associations between sleep problems at baseline and new onset of both musculoskeletal pain and persistent musculoskeletal pain (pain lasting > 3 months) 1 year later were investigated using logistic regression. The potential modifying effect of sex was also assessed. One-year incidence proportion for musculoskeletal pain onset is 43% and 7% for persistent musculoskeletal pain. Sleep problems were associated with musculoskeletal pain onset and persistent musculoskeletal pain onset in boys, odds ratio 2.80 (95% CI 1.39, 5.62) and OR 3.70 (1.30, 10.54), respectively, but not girls OR 0.58 (0.28, 1.19) and OR 1.43 (0.41, 4.95), respectively. Conclusions: Rates of musculoskeletal pain are high in children. Boys with sleep problems are at greater risk of onset of musculoskeletal pain, but girls do not appear to have higher risk. Consideration of sleep health may help prevent persistent musculoskeletal pain in children. What is Known:• Sleep problems are associated with the onset of musculoskeletal pain in adults.• It is not clear if the association between sleep problems and the onset of musculoskeletal pain is present also in children and if sex plays a role in this association. What is New:• This is the first large population-based study that has prospectively investigated the relationship between sleep problems and onset of musculoskeletal pain in school-aged children.• Children, especially boys with sleep problems, were at increased risk for the development of persistent musculoskeletal pain.

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Blood Neutrophil Counts are Associated with Exacerbation Frequency and Mortality in COPD

10.21203/rs.3.rs-16064/v1 ◽

2020 ◽

Author(s):

Mike Lonergan ◽

Alison J Dicker ◽

Megan L Crichton ◽

Holly R Keir ◽

Melissa K. Van Dyke ◽

...

Keyword(s):

Large Population ◽

Real Life ◽

Population Based ◽

Blood Eosinophil ◽

Blood Neutrophil ◽

Disease Heterogeneity ◽

Disease Information ◽

Increased Risk ◽

Eosinophil Counts

Abstract Background Identifying patients with COPD at increased risk of poor outcomes is challenging due to disease heterogeneity. Potential biomarkers need to be readily available in real-life clinical practice. Blood eosinophil counts are widely studied but few studies have examined the prognostic value of blood neutrophil counts (BNC). Methods In a large population-based COPD registry in the East of Scotland (TARDIS: Tayside Allergic and Respiratory Disease Information System), BNC were compared to measures of disease severity and mortality over up to 15 years follow-up. Potential mechanisms of disease modification by BNC were explored in a nested microbiome substudy. Results 178120 neutrophil counts were obtained from 7220 people (mean follow up 9 years) during stable disease periods. Median BNC was 5200cells/µL (IQR 4000-7000cells/µL). Mortality rates among those 34% with elevated BNCs (defined as 6000-15000cells/µL) at the study start were 80% higher (14.0/100 person years v 7.8/100py, P<0.001) than those with BNC in the normal range (2000-6000cells/µL). People with elevated BNC were more likely to be classified as GOLD D (46% v 33% P<0.001), have more exacerbations (mean 2.3 v 1.3/year, P<0.001), and were more likely to have severe exacerbations (13% vs. 5%, P<0.001) in the following year. Eosinophil counts were much less predictive of these outcomes. In a sub-cohort (N=276), patients with elevated BNC had increased relative abundance of Proteobacteria and reduced microbiome diversity. Conclusion High BNC may provide a useful indicator of risk of exacerbations and mortality in COPD patients.

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Effect of IBD medications on COVID-19 outcomes: results from an international registry

Gut ◽

10.1136/gutjnl-2020-322539 ◽

2020 ◽

pp. gutjnl-2020-322539 ◽

Cited By ~ 3

Author(s):

Ryan C Ungaro ◽

Erica J Brenner ◽

Richard B Gearry ◽

Gilaad G Kaplan ◽

Michele Kissous-Hunt ◽

...

Keyword(s):

Combination Therapy ◽

Reference Group ◽

Large Population ◽

Random Effect ◽

Estimating Equation ◽

Population Based ◽

Interleukin 12 ◽

International Registry ◽

Increased Risk ◽

Tnf Antagonist

ObjectiveWe sought to evaluate COVID-19 clinical course in patients with IBD treated with different medication classes and combinations.DesignSurveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a large, international registry created to monitor outcomes of IBD patients with confirmed COVID-19. We used multivariable regression with a generalised estimating equation accounting for country as a random effect to analyse the association of different medication classes with severe COVID-19, defined as intensive care unit admission, ventilator use and/or death.Results1439 cases from 47 countries were included (mean age 44.1 years, 51.4% men) of whom 112 patients (7.8%) had severe COVID-19. Compared with tumour necrosis factor (TNF) antagonist monotherapy, thiopurine monotherapy (adjusted OR (aOR) 4.08, 95% CI 1.73 to 9.61) and combination therapy with TNF antagonist and thiopurine (aOR 4.01, 95% CI 1.65 to 9.78) were associated with an increased risk of severe COVID-19. Any mesalamine/sulfasalazine compared with no mesalamine/sulfasalazine use was associated with an increased risk (aOR 1.70, 95% CI 1.26 to 2.29). This risk estimate increased when using TNF antagonist monotherapy as a reference group (aOR 3.52, 95% CI 1.93 to 6.45). Interleukin-12/23 and integrin antagonists were not associated with significantly different risk than TNF antagonist monotherapy (aOR 0.98, 95% CI 0.12 to 8.06 and aOR 2.42, 95% CI 0.59 to 9.96, respectively).ConclusionCombination therapy and thiopurines may be associated with an increased risk of severe COVID-19. No significant differences were observed when comparing classes of biologicals. These findings warrant confirmation in large population-based cohorts.MKH should be changed to MDK for co-last author line

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Marked Increase in Incident Gynecomastia: A 20-Year National Registry Study, 1998 to 2017

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa440 ◽

2020 ◽

Vol 105 (10) ◽

pp. 3134-3140 ◽

Cited By ~ 1

Author(s):

Trine Koch ◽

Elvira V Bräuner ◽

Alexander S Busch ◽

Martha Hickey ◽

Anders Juul

Keyword(s):

Age Groups ◽

Population Based ◽

Incidence Rates ◽

National Registry ◽

Registry Study ◽

Age Related ◽

Danish Health ◽

Increased Risk ◽

National Patient ◽

First Time

Abstract Context Gynecomastia, the proliferation of mammary glandular tissue in the male, is a frequent but little-studied condition. Available prevalence data are based on selected patient populations or autopsy cases with their inherent bias. Objective The objective of this work is to evaluate the age-related incidence and secular trends in gynecomastia in the general population. Design An observational, 20-year national registry study was conducted. Setting This population-based study used nationwide registry data. Participants Participants included all Danish males (age 0-80 years) with a first-time diagnosis of gynecomastia. Main Outcome Measures All Danish males (age 0-80 years) were followed up for incident diagnosis of gynecomastia in the Danish National Patient Registry from 1998 to 2017 using the International Codes of Diseases, 10th revision, and the Danish Health Care Classification System. Age-specific incidence rates were estimated. The hypothesis tested in this study was formulated prior to data collection. Results Overall, a total 17 601 males (age 0-80 years) were registered with an incident diagnosis of gynecomastia within the 20-year study period, corresponding to 880 new cases per year and an average 20-year incidence of 3.4 per 10 000 men (age 0-80 years). The average annual incidence was 6.5/10 000 in postpubertal males age 16 to 20 years and 4.6/10 000 in males age 61 to 80 years, with a respective 5- and 11-fold overall increase in these 2 age groups over the 20-year period. Conclusions The incidence of gynecomastia has dramatically increased over the last 20 years, implying that the endogenous or exogenous sex-steroid environment has changed, which is associated with other adverse health consequences in men such as an increased risk of prostate cancer, metabolic syndrome, type 2 diabetes, or cardiovascular disorders.

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SURVIVAL ADVANTAGE OF APOE2

Innovation in Aging ◽

10.1093/geroni/igz038.2313 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S621-S621

Author(s):

Sudha Seshadri

Keyword(s):

Lower Risk ◽

Large Population ◽

Population Based ◽

European Ancestry ◽

Aggregated Data ◽

Risk Of Death ◽

Apoe Ε4 ◽

Increased Risk ◽

Ε4 Allele

Abstract Apolipoprotein E is a glycoprotein mediator and regulator of lipid transport and uptake. The APOE-ε4 allele has been associated with higher risk of Alzheimer’s disease and of mortality, but the effect of the less prevalent APOE-ε2 on survival remains elusive. We aggregated data of 38,537 individuals of European ancestry (mean age 65.5 years; 55.6% women) from six large population-based cohorts to determine the association of APOE-ε2, with survival in the general population. During a mean follow-up of 11.7 years, 17,021 individuals died. Compared with homozygous APOE-ε3 carriers, APOE-ε2 carriers were at lower risk of death (hazard ratio,95% confidence interval: 0.94,0.90-0.99; P=1.1*10-2), whereas APOE-ε4 carriers were at increased risk (HR 1.17,1.12-1.21; P=2.8*10-16). Risk was lowest for homozygous APOE-ε2 (HR 0.89,0.74-1.08), and highest for homozygous APOE-ε4 (HR 1.52,1.37-1.70). Results did not differ by sex. The association was unaltered after adjustment for baseline LDL or cardiovascular disease. Larger, multiethnic collaborations are ongoing.

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