scholarly journals Rates of Ischemia Amongst Asymptomatic Patients with High Coronary Artery Calcium Scores

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Aaron Jones ◽  
Dustin Thomas
Keyword(s):  
Heart Disease ◽  
Statistical Difference ◽  
Stress Testing ◽  
Small Sample Size ◽  
Demographic Data ◽  
Cost Effective ◽  
Small Sample ◽  
Lifestyle Changes ◽  
Coronary Angiogram ◽  
Asymptomatic Patients

CACS may be used to recommend lifestyle changes or other treatment recommendations to reduce the risk of heart disease. The incidence of asymptomatic ischemia in patients with elevated CACS is poorly defined.  Furthermore, the CACS cut-off above which it is clinically important and cost effective to look for and diagnose ischemia is also not well defined. The purpose of this study is to better define the incidence of asymptomatic ischemia in Parkview Heart Institute (PHI) patients with elevated CACS, including an examination of demographic data that may also influence the rate of ischemia. 118 Patients who were screened for CAD, received CACS ≥ 400, and subsequently had stress testing or invasive coronary angiogram within 6 months were admitted into the study. Through statistical analysis it was determined there was no statistical difference in rates of ischemia between patients with CACS of 400-999 and those >1000. However, due to a small sample size this study will be continued to strengthen its results and investigate if demographics play a role in rates of ischemia.

scholarly journals Mediterranean Diet and Lifestyle Habits during Pregnancy: Is There an Association with Small for Gestational Age Infants? An Italian Single Centre Experience

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1941
Author(s):  
Rachele De Giuseppe ◽  
Manuela Bocchi ◽  
Silvia Maffoni ◽  
Elsa Del Bo ◽  
Federica Manzoni ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Mediterranean Diet ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Small Sample Size ◽  
Demographic Data ◽  
Small Sample ◽  
Activity Level ◽  
Lifestyle Habits ◽  
Increased Risk

Background. The small-for-gestational-age (SGA) in infants is related to an increased risk of developing Non-Communicable Diseases later in life. The Mediterranean diet (MD) is related to lower odds of being SGA. The study explored retrospectively the association between SGA, maternal MD adherence, lifestyle habits and other SGA risk factors during pregnancy. Methods. One hundred women (16–44 years) with a pregnancy at term were enrolled. Demographic data, parity, pre-gestational BMI, gestational weight gain, pregnancy-related diseases, and type of delivery were collected. The MD adherence (MEDI-LITE score ≥ 9), physical activity level, and smoking/alcohol consumption were registered. SGA neonates were diagnosed according to the neonatal growth curves. Results. Women were divided into “SGA group” vs. “non-SGA group”. The MD was adopted by 71% of women and its adherence was higher in the “non-SGA group” (p = 0.02). The prevalence of pregnancy-related diseases (gestational diabetes/pregnancy-induced hypertension) was higher in the “SGA group” (p = 0.01). The logistic regression showed that pregnancy-related diseases were the only independent risk factor for SGA. Conclusions. MD may indirectly reduce the risk of SGA since it prevents and exerts a positive effect on pregnancy-related diseases (e.g., gestational diabetes and hypertension). The small sample size of women in the SGA group of the study imposes a major limitation to the results and conclusions of this research, suggesting however that it is worthy of further investigation.

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

2019 ◽  
Vol 23 (3) ◽  
pp. 270-276 ◽  
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.

scholarly journals Transitional interventions to reduce early psychiatric readmissions in adults: systematic review

2013 ◽  
Vol 202 (3) ◽  
pp. 187-194 ◽  
Author(s):  
Simone N. Vigod ◽  
Paul A. Kurdyak ◽  
Cindy-Lee Dennis ◽  
Talia Leszcz ◽  
Valerie H. Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Small Sample Size ◽  
Psychiatric Patients ◽  
Absolute Risk ◽  
Cost Effective ◽  
Small Sample ◽  
Future Research ◽  
Post Discharge ◽  
Psychiatric Readmission ◽  
Patient Provider Communication

BackgroundUp to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission.AimsTo describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission.MethodSystematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission.ResultsThe review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias.ConclusionsMany effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.

A study of atherosclerosis in patients after radiation for early breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 260-260
Author(s):  
V. G. Kirtani ◽  
M. Chang ◽  
A. M. Dobrescu ◽  
S. Zeldis ◽  
J. A. Haas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Coronary Arteries ◽  
Background Radiation ◽  
Small Sample Size ◽  
Screening Method ◽  
Calcium Score ◽  
Small Sample ◽  
Left Hemithorax ◽  
Asymptomatic Patients ◽  
Number Of Patients

260 Background: Radiation therapy (RT) is widely used as part of curative treatment of breast cancer. However, older studies have shown increased cardiac morbidity and mortality from breast RT. A screening method is needed to detect early cardiac damage in this population. Recent data have shown that Electron beam computed tomography (EBCT) can detect early atherosclerosis in coronary arteries by identifying the amount of calcification in the coronaries. In our study we employed this tool to detect occult atherosclerosis caused by breast RT. Methods: We evaluated 20 asymptomatic patients, less than 60 years of age, treated with RT at least 5 years prior to enrollment. Nine received RT to the left and 11 to the right hemithorax. Average interval between RT and CT was 7.7 years (5-14). All patients were treated with external beam RT using tangential technique. The breast was treated to a dose of 4500-5040 cGy and the tumor bed was boosted to a total dose of 6000-6600 cGy. All patients underwent EBCT to compute the volumetric and agatston calcium scores in the coronary arteries and the aorta. Results: Of the 11 patients who had RT to right hemithorax, 8 had calcium score of 0, 2 had very minimally elevated scores and 1 had significantly elevated score (patient 19, interval -14 years). Of the 9 patients who had RT to left hemithorax, 7 had calcium score of 0. None had significantly elevated scores. In the aorta, 11 patients had score of 0 and 8 had minimally elevated scores. Conclusions: Occult atherosclerosis was not detected using EBCT calcium scores in coronaries and aorta in a significant number of patients treated with RT for breast cancer. However, the study is limited by a small sample size. [Table: see text]

Breast cancer frequency and survival by molecular subtype in central Illinois.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13631-e13631
Author(s):  
Hamsa Sahib ◽  
Sabree Abedrabo ◽  
Zurain Niaz ◽  
Cameron Koester ◽  
Ruby Maini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Statistical Difference ◽  
Triple Negative ◽  
Molecular Subtype ◽  
Small Sample Size ◽  
Cox Proportional Hazards ◽  
Small Sample ◽  
Future Research ◽  
Luminal A ◽  
Central Illinois

e13631 Background: Breast cancer is the most common female malignancy. In 2019, it is estimated that there were 268,000 new cases of female breast cancer. The most common subtype was HR+/HER2 based on 2012-2016 cases, a much higher rate than triple negative breast cancer. Best survival rates are found among women with HR+/HER2- subtype followed by HR+/HER2+ and HR-/HER+ subtypes. Triple negative subtype comparatively had a poorer survival.Our objective was to determine breast cancer rate and survival by molecular subtype in the central Illinois population. Methods: A cohort of 478 patients diagnosed with breast cancer between January 2014 and December 2017 was identified by using ICD codes. Eligibility criteria included pathology confirmed breast cancer.Categorical variables were summarized as frequencies and percentages. Predictors of survival were assessed with Cox proportional hazards regression analyses.All significance was assumed at the p < 0.05 level. Results: Luminal A breast cancer was the most common type in our population. In the cohort of 478 patients, 208 patients (74%) were found to have Luminal A. whereas, 37 patients (13.21%) had Basal subtype, 20 patients (7.14%) had Luminal B and 13 patients (5.36%) had Her2 enriched subtype. However, there was no statistical difference in survival between the subtypes. Conclusions: Although the frequency of cancer subtypes in our population is comparable to the national epidemiology data,we observed that there is no statistical difference in survival as compared to NCI SEERS data. This could be due to optimum care and patient’s adherence to chemo-radiation or due to small sample size. This could be an important area of future research to investigate if we can increase survival of poor prognosis subtypes (as triple negative) by following the same measures. Long term follow up for the patients in the study might also be necessary.

scholarly journals Incidence of congenital anomalies in newborns born to mothers with heart disease

2021 ◽  
Vol 8 (2) ◽  
pp. 346
Author(s):  
Kalpana R. Y. ◽  
Patil S. J.
Keyword(s):  
Heart Disease ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Congenital Anomalies ◽  
Heart Diseases ◽  
Small Sample Size ◽  
Small Sample ◽  
Medical Disorders ◽  
Study Population

Background: Heart disease is seen in 1% pregnancies. Prior studies have either looked at only the prevalence of congenital heart diseases (CHD) in newborns or the congenital anomalies (CA) in babies born to those with chronic medical disorders as a whole. There is only sparse literature looking specifically at their prevalence in mothers with heart disease.Methods: We aimed to study incidence of CAs in newborns born to mothers with heart disease and to study other relevant outcomes like prematurity, low birth weight and intrauterine growth retardation which have significant associations with CAs. The present study was a descriptive study consisting of retrospective and prospective data and consisted of pregnant women with heart disease from 2006 to 2010 and their newborns.Results: 55 pregnant women with their 55 newborns were selected. Among the 55 newborns, 15% babies had congenital anomalies including CHD, 13% had only CHDs. 21% babies with CHDs were born to CHD mothers and none of the mother baby diagnosis was completely concordant. No statistically significant outcome of CA in newborns born to mothers with heart disease was found. No statistically significant associations among low birth weight, prematurity and CAs was found.Conclusions: 15% had congenital anomalies including CHD. No statistically significant outcome of CA in newborns born to mothers with heart disease was found. Since the study population comprised of a small sample size, significant derivations could not be made. Further studies are required in this direction to see if associations are significant.

Assessment of time from cytoreductive nephrectomy (CN) to initiation of targeted therapy (TT) in patients with metastatic renal cell carcinoma (mRCC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 540-540
Author(s):  
Winston Vuong ◽  
Mark Chang ◽  
Nora Ruel ◽  
Joann Hsu ◽  
Courtney Carmichael ◽  
...  
Keyword(s):  
De Novo ◽  
Small Sample Size ◽  
Demographic Data ◽  
Small Sample ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cytoreductive Nephrectomy ◽  
Impaired Wound Healing ◽  
Estimated Blood Loss ◽  
Surgical Data

540 Background: For patients (pts) with de novo mRCC, the initiation of TT typically occurs at a window of 4-6 weeks following CN. Although this practice is thought to mitigate impaired wound healing, bleeding and other complications (cx) in the perioperative period potentially related to antiangiogenic TT, there is limited data to support this practice. Methods: An institutional database including over 670 pts with RCC was interrogated. Pts with de novo mRCC who had received CN and subsequent TT were identified. When available, demographic data, Charlson comorbidity index (CCI), body mass-index (BMI) and surgical data (estimated blood loss [EBL], intraoperative cx, etc.) were recorded. ICD-9 codes recorded up to 90 days following CN were evaluated; newly applied diagnoses with possible relationship to surgery were considered to be potential postoperative cx. For continuous variables, the Spearman correlation test was used to determine associations with time to TT. For categorical variables, Kaplan-Meier analyses were conducted to determine if time to TT varied across subgroups. Results: Of 270 pts with mRCC, 79 pts received cytoreductive nephrectomy. Of these, 36 pts received TT as an initial treatment strategy (others received IL-2, IFN or chemotherapy), and 30 pts had a documented date of TT initiation. Two pts were removed given receipt of preoperative TT, resulting in a total of 28 pts in the current analysis. Median time to TT was 46 days (range, 28-93). Median overall survival for the overall cohort was 17.2 months. No association was found between age, BMI, CCI, number of sites of metastasis and time to TT. Time to TT did not vary by race (Caucasian v other) or class of TT (VEGF-directed therapy v mTOR inhibitor). Furthermore, EBL and the frequency of intraoperative cx did not vary by time to TT. The most frequently encountered postoperative cx included pleural effusion, pain, fatigue and nausea. Conclusions: With the caveat of our small sample size, the lack of an association between operative cx and time to TT suggests that an abbreviated timeframe between CN and TT may be entertained. These findings warrant exploration in larger series and/or prospective validation.

P–137 Male embryos take longer to develop to the blastocysts stage

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Fraire-Zamora ◽  
M Martínez ◽  
D García ◽  
R Vassena ◽  
A Rodríguez
Keyword(s):  
Statistical Difference ◽  
Small Sample Size ◽  
Time Lapse ◽  
Study Groups ◽  
Blastocyst Stage ◽  
Small Sample ◽  
Preimplantation Embryos ◽  
Specific Difference ◽  
Male And Female ◽  
Morphokinetic Parameters

Abstract Study question Are there any differences in developmental timings between male and female preimplantation embryos? Summary answer There is a tendency for statistical difference in the time to reach blastocyst stage for male embryos compared to female embryos What is known already Differences in gene expression and metabolic uptake between male and female preimplantation embryos have been found in animal models and humans. These differences could affect the developmental timings of embryos resulting in differences in either sex. Morphokinetic parameters can precisely assess developmental timings. Only a few studies have analyzed morphokinetic parameters between male and female preimplantation embryos and no consensus has been reached on whether there is any sex-specific difference. The objective of this study is to compare morphokinetic parameters between male and female preimplantation embryos to determine any sex-specific developmental differences. Study design, size, duration This is a retrospective study including 102 preimplantation embryos from February 2018 to February 2020. The morphokinetic parameters obtained from time-lapse records of each embryo were: time to pronuclear fading (tPNf), times to 2–8 cells (t2, t3, t4, t5, t6, t7, t8), time to start of blastulation (tSB) and time to full blastocyst stage (tB). A two-tailed Student’s t-test was used to compare morphokinetic parameters between embryo sexes. A p &lt; 0.05 was considered statistically significant. Participants/materials, setting, methods The study included retrospective time-lapse data from preimplantation embryos giving rise to 51 baby boys and 51 baby girls, as seen at birth. This is a single-center study with standardized culture conditions. Embryos in both study groups issued from cycles with donated oocytes. Only elective blastocyst stage single-embryo transfers (SET) on day 5 were assessed. Main results and the role of chance A tendency to statistical difference (p = [0.1–0.05]) was observed for blastocyst-related morphokinetic parameters: tSB (mean time was 89.6±6.3 hours in male embryos vs. 86.9±8.1 hours in female embryos, p = 0.06) and tB (100.2±5.9 hours versus 97.9±6.5 hours, p = 0.07). Male embryos showed an increased average time of 2.7 hours to tSB and 2.3 hours to tB, while no differences were found in the mean times of all the other morphokinetic paraments measured (p &gt; 0.50): tPNf (∼21.8±3.0 hours) t2 (∼24.4±3.2 hours); t3 (∼35.6±3.9 hours); t4 (∼36.6±4.6 hours); t5 (∼46.9±6.0 hours); t6 (∼53.5±7.0 hours); t7 (∼54.1±7.3 hours) and t8 (∼54.1±7.3 hours). This finding suggests a sex-specific difference in reaching blastocyst stages. Limitations, reasons for caution The main limitation of the study is its retrospective nature and the small sample size. We analyzed the data of embryos leading to a live birth (high-quality embryos), therefore, caution should be made when generalizing results to non-implanting embryos (of potentially lower quality). Wider implications of the findings: Sex-specific differences in developmental timings of preimplantation embryos at blastocyst stage, as evidenced by time-lapse data, should be considered to avoid selection biases during embryo transfers in ART clinic. Trial registration number Not applicable

scholarly journals Clinical features and predictors for patients with severe SARS-CoV-2 pneumonia at the start of the pandemic: a retrospective multicenter cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chao Cao ◽  
Li He ◽  
Jingping Ma ◽  
Meiping Chen ◽  
Yiting Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Features ◽  
Lymphocyte Count ◽  
Odds Ratio ◽  
Small Sample Size ◽  
Demographic Data ◽  
Small Sample ◽  
Clinical Trial Registry ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

Abstract Background This study was performed to investigate clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases at the start of the pandemic in China. Methods In this retrospective, multicenter cohort study, patients with mild to moderate SARS-CoV-2 pneumonia were included. Demographic data, symptoms, laboratory values, and clinical outcomes were collected. Data were compared between non-severe and severe patients. Results 58 patients were included in the final analysis. Compared with non-severe cases, severe patients with SARS-CoV-2 pneumonia had a longer: time to clinical recovery (12·9 ± 4·4 vs 8·3 ± 4·7; P = 0·0011), duration of viral shedding (15·7 ± 6·7 vs 11·8 ± 5·0; P = 0·0183), and hospital stay (20·7 ± 1·2 vs 14·4 ± 4·3; P = 0·0211). Multivariate logistic regression indicated that lymphocyte count was significantly associated with the rate of converting to severe cases (odds ratio 1·28, 95%CI 1·06–1·54, per 0·1 ×  109/L reduced; P = 0·007), while using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0·14, 95%CI 0·02–0·80; P = 0·0275). Conclusions The low peripheral blood lymphocyte count was an independent risk factor for SARS-CoV-2 pneumonia patients converting to severe cases. However, this study was carried out right after the start of the pandemic with small sample size. Further prospective studies are warranted to confirm these findings. Trial registration Chinese Clinical Trial Registry, ChiCTR2000029839. Registered 15 February 2020 - Retrospectively registered.

scholarly journals 213. Assessment of Compliance with Order Set and Bundle for Management of Staphylococcus aureus Bacteremia

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S214-S215
Author(s):  
Ryan R Flynn ◽  
Marilee Obritsch ◽  
Veronica Lesselyoung ◽  
Joe Strain ◽  
John Kappes
Keyword(s):  
Staphylococcus Aureus ◽  
Statistical Difference ◽  
Small Sample Size ◽  
Small Sample ◽  
Single Center ◽  
Recurrence Rates ◽  
Adequate Treatment ◽  
Single Center Study ◽  
Center Study ◽  
Order Set

Abstract Background Staphylococcus aureus (S. aureus) is an aerobic gram-positive coccus that causes a variety of infections. S. aureus bloodstream infections, also known as bacteremias, have significant morbidity and mortality and are difficult to eradicate. A single-center study showed a 9.4% recurrence rate for S. aureus bacteremia, despite adequate treatment. The Infectious Disease Society of America (IDSA) recognizes the seriousness of S. aureus infections, particularly methicillin-resistant S. aureus (MRSA), and has released guidance for treatment of these infections. Guidance for S. aureus bacteremias include identification and removal of the source and early optimization of antibiotics. Serial imaging and laboratory monitoring, including repeat blood cultures, are also necessary to establish the duration of therapy, ensure microbiologic eradication, and reduce the risk of long-term complications. Due to the complexity of S. aureus bacteremia, early involvement of infectious diseases (ID) specialists is strongly recommended. Methods This retrospective, single-center study was designed to evaluate the current management of S. aureus bacteremias, including compliance to the elements of the S. aureus order set and bundle. Patients 18 years and older who had a positive blood culture for S. aureus were included in this study. Recurrence of S. aureus infection was assessed at 6 months. Data was analyzed to compare patients with and without ID consults. Results Eighty-four patients met inclusion criteria. ID consultation resulted in a higher percentage of patients achieving 100% compliance with the bundle elements compared to patients without ID consults (73% vs 25%, respectively; p=0.009). For further breakdown of compliance see Table 1. No statistical difference was detected in recurrence rates (11% vs 33%, respectively; p=0.18) or mortality (8% vs 25%, respectively; p= 0.17) possibly due to the small sample size. Table 1. Outcomes Conclusion ID specialist involvement for the treatment of S. aureus bacteremia resulted in greater compliance with the S. aureus bacteremia bundle. No statistical difference in recurrence or mortality rates was detected. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document