scholarly journals Initiation of Anti-dementia Medication in Older Adults Undergoing Pharmaceutical Management for Existing Chronic Conditions by the Assessment of Insurance Claims

2020 ◽  
Author(s):  
Nobuhiro Handa ◽  
Seigo Mitsutake ◽  
Tatsuro Tatsuro Ishizaki ◽  
Tetsuo Nakabayashi ◽  
Masahiro Akishita ◽  
...  

Abstract BACKGROUND The influences of co-prescribed medications for chronic co-morbid conditions in very older adults on clinical dementia onset are uncertain.OBJECTIVE To evaluate the influences of co-prescribed medications on clinical dementia onset, which was indicated by the initiation of a new prescription of anti-dementia medication (NPADM).METHODS This retrospective cohort study consisted of 42024 adults aged ≥77 years residing in a suburban city of Tokyo Metropolitan Area who did not take any anti-dementia medication on April 1, 2012. The primary outcome was NPADM during followed-up period until March 31, 2015 (35 months). Subjects were categorized into four age groups: Group I (77-81 years), Group II (82-86 years), Group III (87-91 years), and Group IV (≥92 years). Covariates were fourteen groups of medications prescribed between April 1, 2012 and June 31, 2012. RESULTS In a follow-up period of 1345457 patient-months (mean=32.0±7.5 months), NPADM occurred in 2365 subjects. NPADM incidence at 12 months was 1.9±0.1% (Group I: 0.9±0.1%, Group II: 2.1±0.1%, Group III: 3.2±0.2% and Group IV: 3.6±0.3%; P<0.0001). In addition to older age and female sex, the use of the following medications was associated with NPADM: statins (hazard ratio: 0.82, 95% confidence interval: 0.73-0.92; P=0.001), antihypertensives (0.80, 0.71-0.85; P<0.0001), non-steroidal bronchodilators (0.72, 0.58-0.88; P=0.002), antidepressants (1.79, 1.47-2.18; P<0.0001), post-stroke medications (1.45, 1.16-1.82; P=0.002), insulin (1.34, 1.01-1.78; P=0.046) and antineoplastics (1.12, 1.01-1.24; P=0.035)CONCLUSIONS These findings provide a benchmark for the management of dementia in the real-world setting, and contribute to evidence-based healthcare policymaking. (Clinical Trial Registration: UMIN-CTR UMIN000039040)

2018 ◽  
pp. 20-25
Author(s):  
B.M. Mirchuk ◽  
Y.V. Maksymov

As result of the presence of defects in the dentition, a range of morphological, aesthetic and functional changes arises, which considerably complicates the process of diagnosis and treatment of this pathology. Defects in the dentition, in combination with a variety of anomalies and deformations, often impede the implementation of rational prosthetics, and occasionally make it, impracticable at all one to this reason, one of the urgent problems in modern dentistry, which requires further, is the study of adverse factors that arise in the prosthetics of dental defects in adult patients with dentoalveolar anomalies and deformations of different etiologies. The aim is to investigate the prevalence of dental anomalies and deformities in adult patients’ prosthetic treatment. Materials and methods. 83 patients aged 20-60 and older were involved in prosthetic treatment. The diagnosis was based on classification have been of surveyed on Kennedy and D.A. Calveliss. Patients were divided into 4 age groups: Group I included 49 patients aged 20 to 30 years; Group II included 10 patients aged 31 to 40 years; Group III included 13 patients aged 41 to 50 years; IV group contained 11 patients aged 51 to 60 years and older. Results. In the 1st group, with coverage of 49 persons aged 20 to 30 years 12,5% of women suffered from defects of dentition which was under half the size of that of men (29,4%).All patients with dental defects needed prosthetic treatment. The prevailing majority of the surveyed-96,9% of females and 100% of males were diagnosed with dental anomalies. In group II, with 10 patients being examined in the 31-40 aged bracket, a significant increase in the number of persons with dental defects was observed: in women by 5.7 times up to 71,4% and in men-by 2.7 times up to 66,7% in comparing with those in Group I. Each of the examined patients with dental defects needed protection and orthodontic treatment. All patients in the third group (41-50 years) and the in IV group ( 51-60 years and older) of defects of dentitions were 50.0% women and 57.1% men of the third group and 71,4% of women and 75,0% of men of the IV group needed prosthetics of secondary dentition of teeth. Al l women of both subgroups have been diagnosed with dental anomalies, whereas in men. Orthodontic pathology was detected in 85,7% of individuals of group III and 75,0% of individuals group IV. Conclusions. Prosthetic treatment with restoration of the integrity of the dentition is one of the reasons for the significant growth of secondary deformations and the formation of dentoalveolar anomalies. According to our observations, patients 30 years of age or older who seek orthopedic help have defects in the dentition. Most often, these patients are diagnosed with included dentition defects in the lateral areas (from 35.3% to 63.6%), which are complicated by secondary deformations of the dentition (from 33.3% to 100%). The results of the studies confirm the need for further study of the state of the dentoalveolar system in patients with dentition defects, namely: the formation of secondary deformations, occlusion disorders, changes in the shape and size of the dentition, decrease in occlusion height, temporomandibular joint dysfunction, blockage or forced mandibular position etc.


2013 ◽  
Vol 12 (2) ◽  
pp. 63-69
Author(s):  
A. N. Sumin ◽  
R. A. Gaifullin ◽  
A. V. Bezdenezhnykh ◽  
E. V. Korok ◽  
A. V. Karpovich ◽  
...  

Aim. To compare the prevalence of multi-focal subclinical atherosclerotic pathology and its determinants in cardiovascular surgery patients.Material and methods. The study included 1018 patients — 825 en and 193 women (mean age 59,0±12,0 years) — who were hospitalised for a planned intervention on coronary or other arteries. Group I (n=542) was aged under 60 years, Group II (n=215) — 60–64 years, Group III (n=141) — 65–69 years, and Group IV (n=120) — 70 years or older. All participants underwent coronary angiography and Doppler ultrasound; peripheral angiography was performed, if necessary. Multi-focal atherosclerosis (MFA) criteria were the presence of stenosis (≥30%) or revascularisation in two or more vascular territories.Results. Subclinical atherosclerotic pathology of various localisation was observed in 52,3% of the patients. Advanced age was linked to an increase in the MFA prevalence: from 45,8% in Group I to 58,6% in Group II, 58,2% in Group III, and 63,3% in Group IV (p=0,0001). In Group I, MFA was associated with the intermittent claudication syndrome (ICS), decreased body mass index (BMI), increased intima-media thickness (IMT), elevated total cholesterol (TCH). However, in Groups II–IV, the only association observed was between MFA and ICS.Conclusion. Taking into account the subclinical (hemodynamically insignificant) arterial pathology had resulted in a high prevalence of MFA. Advanced age was associated with a higher MFA prevalence. Other factors linked to MFA were increased IMT, elevated TCH, decreased BMI, and ICS. 


2020 ◽  
Vol 8 (1) ◽  
pp. 32-35
Author(s):  
Naveen BS

Background: Thyroid diseases are among the most common endocrine disorders seen in all age groups. The present study was conducted to determine parenchymal thyroid diseases using Ultrasonography (USG) in adult patients. Subjects and Methods: This study was conducted   on 140 adult patients. Patients were divided into five groups such as Group I (normal); Group II had first detected, early untreated Hashimoto disease (EH); Group III comprised of chronic Hashimoto patients that are under treatment and/or follow up (H); Group IV had multinodular parenchymal hyperplasia (M); and Group V had nodular hyperplasia with Hashimoto (HM). They underwent spectral Doppler ultrasound and acoustic radiation force impulse using Siemens ACUSON S2000 machine. Results: The mean RI in group I was 0.54, in group II was 0.56, in group III was 0.42, in group IV was 0.48 and in group V was 0.49, mean AT in group I was 26.2, in group II was 25.3, in group III was 71.3, in group IV was 46.2 and in group V was 45.1, mean SWV in group I was 1.54, in group II was 1.72, in group III was 1.20, in group IV was 1.46 and in group V was 1.65. The difference was significant (P< 0.05). Conclusion: Authors found that resistivity index, acceleration time and shear wave velocity together are reliable for differential diagnosis of parenchymal thyroid diseases.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kang-Sheng Liu ◽  
Xiao-Dong Mao ◽  
Feng Pan ◽  
Rui Fang An

AbstractRecent years have seen a rising incidence of male infertility, mostly caused by the decline of sperm quality. The ratio of infertile males to infertile females has escalated from 3:7 in 2013 to current 5:5, which turns male infertility into the research focus of reproductive medicine. This study aimed to clarify the effect of reproductive tract infection by ureaplasma urealyticum (UU) and chlamydia trachomatis (CT) on the DNA integrity and routine semen parameters of infertile males. A retrospective study was performed. A total of 259 infertile males who were treated at the Andrological Laboratory Examination and Reproductive Medicine Center in our hospital were analyzed. qRT-PCR was used to examine the infection status of CT and UU. According to the eligibility criteria, we evaluated the semen parameters and biochemical data of 253 men. Based on the results of PCR, the subjects were divided into four groups: Group I (CT positive, 63 cases), Group II (UU positive, 60 cases), Group III (CT positive and UU positive, 62 cases), and Group IV (no infection, 68 cases). DNA fragmentation index (DFI), sperm count, vitality and morphology, elastase level, seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) were assessed. Compared to Group IV, three groups (Group I, Group II and Group III) showed difference in semen volume, proportion of sperm with normal morphology, sperm motility, progressive motility, and vitality (P < 0.05). Compared to Group IV, Group II and Group III showed difference in DFI (P < 0.05). Compared to Group IV, Group II and Group III showed difference in elastase level (P < 0.05). VCL, VSL, VAP, WOB, ROS, TM, HDS showed differences between groups of abnormal/normal WBC (*P < 0.01).UU infection significantly increased the level of seminal leukocytes only in Group II, but not in the other three groups, indicating that UU is a factor to increase the level of seminal leukocytes. Compared with the normal leukocyte group, there were significant differences in total motility, forward motility and normal sperm ratio between the two groups. The proportion of sperm with abnormal morphology (mostly in the head) showed obvious difference between groups of high and normal seminal leukocytic levels. At the same time, in this study, SCGE and SCD verified that leukocytes could damage sperm DNA by increasing ROS, which ultimately affects male fertility.


1994 ◽  
Vol 267 (5) ◽  
pp. F703-F708 ◽  
Author(s):  
M. Giordano ◽  
P. Castellino ◽  
E. L. McConnell ◽  
R. A. DeFronzo

We evaluated the dose-response relationship between the plasma amino acid (AA) concentration and renal hemodynamics in eight normal subjects. After an overnight fast, a balanced 10% AA solution was infused for 180 min at five separate infusion rates: 0.5 (group I), 1.0 (group II), 2.0 (group III), 4.0 (group IV), and 6.0 (group V) ml.kg-1.min-1 on separate days. Basal plasma AA concentration was 1.87 +/- 0.1 mmol/l and increased to 2.26 +/- 0.1 (group I), 2.66 +/- 0.2 (group II), 3.79 +/- 0.5 (group III), 5.81 +/- 0.4 (group IV), and 7.41 +/- 0.4 mmol/l (group V). Basal glomerular filtration rate (GFR) and renal plasma flow (RPF) averaged 95 +/- 4 and 476 +/- 29 ml.1.73 m-2.min-1, respectively, and rose to 98 +/- 5 and 506 +/- 40 (group I) [P = not significant (NS)], 102 +/- 3 and 533 +/- 30 (group II) (P < 0.05 vs. basal), 110 +/- 4 and 567 +/- 29 (group III), 115 +/- 7 and 610 +/- 55 (group IV), and 117 +/- 7 and 614 +/- 66 ml.1.73 m-2.min-1 (group V) (P = NS vs. group IV). Basal plasma glucagon concentration averaged 68 +/- 10 pg/ml and increased to 74 +/- 10 (group I), 83 +/- 11 (group II) (P < 0.05 vs. basal), 100 +/- 14 (group III), 121 +/- 14 (group IV), and 229 +/- 35 pg/ml (group V) (P < 0.01 vs. basal). Increases in plasma growth hormone (GH) and insulin levels were observed only during groups IV and V.(ABSTRACT TRUNCATED AT 250 WORDS)


2013 ◽  
Vol 5 (2) ◽  
pp. 101 ◽  
Author(s):  
Ritawaty Ritawaty ◽  
Indriyanti Rafi Sukmawati ◽  
Ilhamjaya Patellongi ◽  
Ferry Sandra

BACKGROUND: Gamma glutamyltransferase (GGT) was reported recently to be associated with inflammation, oxidative stress and increased amino acid. However, role of GGT in insulin resistance pathomechanism is not exactly known. Therefore correlation of GGT with inflammation, oxidative stress and elevated amino acid, in men with central obesity need to be confirmed.METHODS: A cross-sectional study was designed. Men with central obesity were recruited and selected. Anthropometric parameters, creatinine, hs-CRP, fasting glucose, fasting insulin, glutathione peroxidase (GPx) activity, GGT, plasma total cysteine (tCys) and fatty liver were measured. Subjects were then divided in 4 groups based on waist circumference (WC) and fatty liver: Group I: WC ≤100 cm, without fatty liver; Group II: WC ≤100 cm, with fatty liver; Group III: WC >100 cm, without fatty liver; Group IV: WC >100 cm, with fatty liver. All biochemical characteristics in each group were then statistically analyzed.RESULTS: Seventy-two men with central obesity were selected. Numbers of subjects in each group were: Group I: n=33; Group II: n=5; Group III: n=17; Group IV: n=17. We found significant difference of HOMA-IR between Group I and IV, significant correlation between GGT and HOMAIR, and significant negative correlation between tCys with HOMA-IR in Group IV.CONCLUSION: GGT was significantly correlated with HOMA-IR in men with WC >100 cm and fatty liver. Further investigation with more subjects is necessary to determine clear GGT cut-off to distinguish subjects with fatty liver and insulin resistance.KEYWORDS: GGT, hs-CRP, GPx, tCys, HOMA-IR, insulin resistance


2009 ◽  
Vol 56 (1) ◽  
pp. 35-40 ◽  
Author(s):  
A. Mikic ◽  
I. Pendjer ◽  
Z. Dudvarski ◽  
A. Trivic ◽  
M. Kreacic

Introduction: treatment of locoregional advanced hypopharyngeal cancers of grades III and IV would be surgery and/or radiotherapy. An increasing number of authors has emphasized favorable effects of neoadjuvant chemotherapy and radiotherapy with potentiation. The aim: the authors presented therapeutical results of three-year survived patients with squamocellular cancers of the hypopharynx (SCC Hy), grades III and IV, in relation to specific modalities of therapeutical approach. Methods: a series of 207 patients with grades III and IV of SCC Hy, treated in the period 1982 to 2002, was analyzed. Group I consisted of 131 patients who had surgery and postoperative radiotherapy (SUR-RT). Group II included 16 patients who underwent induction chemotherapy, surgery and postoperative radiotherapy (IC-SURRT). Group III consisted of 60 patients, who had primary radiotherapy (RT). Group IV involved 29 patients who were treated, in the period 2003-2006, by neoadjuvant chemotherapy followed by radiotherapy with potentiation (CHT-RT). Results: three-year survival in Group I was 67.94%, Group II - 50%, Group III - 30%, and in Group IV was 51.72%. Five-year survival was analyzed only in group IIII. The longest survival was observed in Group I - 33.59%. Conclusion: the best therapeutical results were achieved in patient group that was primarily operated on and then had postoperative radiotherapy, while the worst survival was recorded in patients who had primary radiotherapy.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Shaminur Rahman ◽  
M. Nazmul Hoque ◽  
Joynob Akter Puspo ◽  
M. Rafiul Islam ◽  
Niloy Das ◽  
...  

AbstractThe microbiome of the anaerobic digester (AD) regulates the level of energy production. To assess the microbiome diversity and composition in different stages of anaerobic digestion, we collected 16 samples from the AD of cow dung (CD) origin. The samples were categorized into four groups (Group-I, Group-II, Group-III and Group-IV) based on the level of energy production (CH4%), and sequenced through whole metagenome sequencing (WMS). Group-I (n = 2) belonged to initial time of energy production whereas Group-II (n = 5), Group-III (n = 5), and Group-IV (n = 4) had 21–34%, 47–58% and 71–74% of CH4, respectively. The physicochemical analysis revealed that level of energy production (CH4%) had significant positive correlation with digester pH (r = 0.92, p < 0.001), O2 level (%) (r = 0.54, p < 0.05), and environmental temperature (°C) (r = 0.57, p < 0.05). The WMS data mapped to 2800 distinct bacterial, archaeal and viral genomes through PathoScope (PS) and MG-RAST (MR) analyses. We detected 768, 1421, 1819 and 1774 bacterial strains in Group-I, Group-II, Group-III and Group-IV, respectively through PS analysis which were represented by Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, Spirochaetes and Fibrobacteres phyla (> 93.0% of the total abundances). Simultaneously, 343 archaeal strains were detected, of which 95.90% strains shared across four metagenomes. We identified 43 dominant species including 31 bacterial and 12 archaeal species in AD microbiomes, of which only archaea showed positive correlation with digester pH, CH4 concentration, pressure and temperature (Spearman correlation; r > 0.6, p < 0.01). The indicator species analysis showed that the species Methanosarcina vacuolate, Dehalococcoides mccartyi, Methanosarcina sp. Kolksee and Methanosarcina barkeri were highly specific for energy production. The correlation network analysis showed that different strains of Euryarcheota and Firmicutes phyla exhibited significant correlation (p = 0.021, Kruskal–Wallis test; with a cutoff of 1.0) with the highest level (74.1%) of energy production (Group-IV). In addition, top CH4 producing microbiomes showed increased genomic functional activities related to one carbon and biotin metabolism, oxidative stress, proteolytic pathways, membrane-type-1-matrix-metalloproteinase (MT1-MMP) pericellular network, acetyl-CoA production, motility and chemotaxis. Importantly, the physicochemical properties of the AD including pH, CH4 concentration (%), pressure, temperature and environmental temperature were found to be positively correlated with these genomic functional potentials and distribution of ARGs and metal resistance pathways (Spearman correlation; r > 0.5, p < 0.01). This study reveals distinct changes in composition and diversity of the AD microbiomes including different indicator species, and their genomic features that are highly specific for energy production.


2020 ◽  
Vol 5 (1) ◽  
pp. 153-155
Author(s):  
Sanjay Melville Masih ◽  
Rakesh Kumar Gupta

Background: The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. Subjects and Methods: The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. Results: The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P< 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P> 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P> 0.05). Conclusion: The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.


2020 ◽  
Author(s):  
Ramona Bill ◽  
Heiko Nathues ◽  
Alexander Grahofer

Abstract Background The duration of birth is an important factor influencing the survival of piglets and the health of sows. A prolonged parturition is usually treated with oxytocin, even though several undesirable side effects are described. Therefore, the aim of this study was to evaluate the safety and efficacy of Prostaglandin E2 (PGE2) of different concentrations as an intravaginal applied gel in sows. MethodsTwelve sows were randomly allocated to one of four treatment groups: Group I (control group) application of placebo gel; Group II application of 2.0 mg PGE2; Group III application of 1.0 mg PGE2; Group IV application of 0.5 mg PGE2. The gel was administered intravaginal after the birth of the fourth piglet. Total duration of birth (time between first piglet and last placenta), piglet interval and placenta expulsion duration (time between first and last placenta) were recorded, and each piglet was scored for meconium staining and vitality. Furthermore, stillborn piglets were categorized into ante-partum and intra-partum deaths. Results Although no significant differences between the groups were detected, a beneficial tendency in several parameters was observed in group III. The duration of birth was 284 min (average of 14.3 piglets per litter), whereas in all other groups it was more than 400 min (average of 18.0 piglets per litter). The piglet interval was 10.1 min in group II compared to 10.2 min in group III, 16 min in group IV and 21.4 min in group I. In group III the placenta expulsion duration was 119 min in contrast to the other groups with more than 266 min. Severe meconium staining in more than 10% of piglets was observed in group II and IV. Moreover, piglets of group II showed oedematous and haemorrhagic umbilical cords, lethargy and anoxia, and intra-partum deaths were recorded. Conclusion Although the sample size is limited in this study, it is assumed that an application of 1mg PGE2 intra-partum instead of lower or higher dosages has the most beneficial effects on the birth process in sows and on the vitality of piglets. Further investigation is necessary to confirm the positive effect of PGE2 in daily practise.


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