scholarly journals Increased Risk of Graves´ophthalmopathy in Patients With Increasing TRAb After Radioiodine Treatment and the Impact of CTLA4 on TRAb Titres

2021 ◽  
Author(s):  
Bushra Shahida ◽  
Kleoniki Tsoumani ◽  
Tereza Planck ◽  
Vijayachitra Modhukur ◽  
Pernilla Asp ◽  
...  
Keyword(s):  
Previous Treatment ◽  
University Hospital ◽  
P Value ◽  
Graves Ophthalmopathy ◽  
Increased Risk ◽  
Orbital Tissue ◽  
One Year ◽  
The Impact ◽  
The Relationship

Abstract Introduction. Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO) but the link between thyroid and orbital tissue remains undefined.The aim was to investigate the relationship between GO and TRAb after treatment with radioiodine and to define the impact of risk genes.Methods. GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed one year later for registration of GO development. The study was performed at a University Hospital Clinic; referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were development of TRAb, anti-TPO, anti-TG after three months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, CYR61).Results. Three months of radioiodine TRAb increased in two thirds of patients (p<0.0005) but not in the other third. Anti-TPO was associated with TRAb (R=0.362, p <0.0001) but not anti-TG. At follow-up one year later (n=204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb and 30 % in the group with unchanged or lower TRAb (p-value <0.0005). Patients with GO had higher levels of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p<0.005) associated with TRAb levels above the median three months after radioiodine.Conclusions. The increase in TRAb after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher levels of TRAb.

scholarly journals Increased risk of Graves´ophthalmopathy in patients with increasing TRAb after radioiodine treatment and the impact of CTLA4 on TRAb titres

Endocrine ◽  
2021 ◽  
Author(s):  
Bushra Shahida ◽  
Kleoniki Tsoumani ◽  
Tereza Planck ◽  
Vijayachitra Modhukur ◽  
Pernilla Asp ◽  
...  
Keyword(s):  
Previous Treatment ◽  
University Hospital ◽  
Risk Genes ◽  
Graves Ophthalmopathy ◽  
Increased Risk ◽  
Orbital Tissue ◽  
The Impact ◽  
The Relationship ◽  
Hospital Clinic

Abstract Introduction Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO), and the link between thyroid and orbital tissue may be the presence of TSH-receptors. Radioiodine increases the titers of TRAb and the aim was to investigate the relationship between GO and TRAb titers after treatment with radioiodine and to define the impact of risk genes. Methods GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed 1 year later for the registration of GO development. The study was performed at a University Hospital Clinic; a referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were the development of TRAb, anti-TPO, and anti-TG after 3 months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, and CYR61). Results Three months of radioiodine TRAb titers increased in two thirds of patients (p < 0.0005) but not in the other third. Anti-TPO titers were associated with TRAb (R = 0.362, p < 0.0001) but not anti-TG. At follow-up 1 year later (n = 204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb titers and 30% in the group with unchanged or lower TRAb titers (p-value < 0.0005). Patients with GO had higher titers of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p < 0.005) associated with TRAb titers above the median three months after radioiodine. Conclusions The increase in TRAb titers after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher titers of TRAb.

Abstract P148: Effect of Apparent Treatment Resistant Hypertension on Cardiovascular Disease Events and Modification by Sex

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Julianne Nelson ◽  
Longjian Liu
Keyword(s):  
Resistant Hypertension ◽  
Health Benefit ◽  
Health Concern ◽  
Lipid Lowering ◽  
P Value ◽  
Treatment Resistant ◽  
Increased Risk ◽  
The Relationship ◽  
Increase In Risk

Apparent treatment resistant hypertension (ATRH) is an important health concern in the U.S. affecting approximately 9% of all hypertensive adults and growing. However, long-term prognosis of those with ATRH remains to be fully investigated, especially with regard to the presence of differences by sex. Using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) we examined the relationship between ATRH and CVD and effect modification by sex. Subjects in ALLHAT were 55 years or older (N male = 13,597 and N female = 11,919) and were randomized to one of four antihypertensive medications for the purposes of the trial. We used Cox Proportional Hazard models and tested for interaction of sex through use of a multiplicative interaction term, stratified analyses, the Aalen Additive Hazards model, and joint effects. Missing blood pressure readings were imputed using multiple imputation as a sensitivity analysis. Due to the design of ALLHAT, ATRH was assessed at the year 2 follow-up visit and subjects were then followed for an additional 6 years (average follow-up 4.7 years) during this time there were 5,030 CVD events. Overall (N=25,516), ATRH was associated with an approximate 30% increased risk of CVD (HR 1.30, 95% CI 1.19 – 1.42) compared to those without ATRH. This risk was greater in women than in men (p interaction <.0001). In women, ATRH was associated with an approximate 62% increase in risk of CVD (HR 1.62, 95% CI 1.41 – 1.86) while in men, ATRH was associated with an approximate 13% increase in risk of CVD (HR 1.13, 95% CI 1.01 – 1.27). Sex was also a modifier of the relationship on the additive scale (p-value 0.003). ATRH is associated with an increased risk of developing CVD and women with ATRH were at a greater risk of developing CVD compared to men. These findings provide important insights into the complex relationship between ATRH and cardiovascular health, and suggest that women, in particular, may be a high-risk subgroup. Thus future studies should examine these differences to aid in development of targeted treatment and interventions which would have a significant public health benefit.

scholarly journals Experiences of Mindfulness-Based Cognitive Therapy for Premanifest Huntington’s Disease

2021 ◽  
pp. 1-15
Author(s):  
Fiona J.R. Eccles ◽  
David Craufurd ◽  
Alistair Smith ◽  
Rhys Davies ◽  
Kristian Glenny ◽  
...  
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Cognitive Therapy ◽  
Emotional Management ◽  
Qualitative Component ◽  
One Year ◽  
Anxiety Depression ◽  
The Impact ◽  
The Relationship

Background: Psychological difficulties such as anxiety, depression, and irritability are common in Huntington’s disease, even for premanifest individuals. However, very little evidence exists of psychological approaches to manage this distress. We have conducted a feasibility study with an embedded qualitative component to investigate the possibility of using mindfulness-based cognitive therapy (MBCT) and present here the findings from the qualitative data. Objective: To investigate the experience of premanifest individuals learning and practising mindfulness through completing a course of MBCT. Methods: Twelve premanifest individuals completed a course of MBCT and attended three follow up reunion meetings over the following year. Eleven participants agreed to be interviewed post-course and ten participants one year post-course about their experience of the course and any impact on their lives. Seven participants nominated a friend or relative (supporter) to be involved in the research, of whom six agreed to be interviewed post-course and two at one year about the impact of the course on the participants. Data were analysed using reflexive thematic analysis. Results: Four themes were constructed from the data: 1) A meeting of minds: the group facilitating learning and support; 2) Mindfulness is hard, but enables more effective emotional management; 3) Mindfulness can change the relationship with self and others; and 4) Benefiting from mindfulness: the importance of persistence. Conclusion: The participants who completed the course found it beneficial. Some participants reported reductions in psychological distress, a greater sense of calm and better emotion regulation, with some of these positive changes also noticed by supporters. MBCT is worthy of further investigation for this population.

scholarly journals AB0201 IMPACT OF TREATMENT INITIATION DELAY ON DISEASE ACTIVITY DURING RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1401.3-1401
Author(s):  
H. Bettaieb ◽  
A. Fazaa ◽  
S. Miladi ◽  
M. Sellami ◽  
O. Kmar ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Symptom Onset ◽  
Lag Time ◽  
Therapeutic Window ◽  
P Value ◽  
Sustained Remission ◽  
One Year ◽  
The Impact

Background:During rheumatoid arthritis (RA), initiating conventional synthetic Disease Modifying Anti-Rheumatic Drug (csDMARD) at the early stages of the disease is a mandatory condition to achieve DMARD-free sustained remission (1). Limited data studying the relationship between RA treatment delay and disease activity are available.Objectives:The aim of this study was to assess the impact of csDMARD initiation delay during RA on disease activity.Methods:This is a cross-sectional study including patients with RA (ACR/EULAR criteria).Delays were collected from patients’ interview and were represented respectively by D1, D2 and D3. D1 stands for the lag time separating the first RA symptom onset and rheumatologist consultation. D2 stands for the lag time separating the first RA symptom onset and RA diagnosis. D3 stands for lag time separating the first RA symptom onset and csDMARD initiation. Disease activity was evaluated by: Visual Analogue Scale for pain (VAS), number of tender joints, number of swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Disease Activity Score28 (DAS28).The data were analyzed with descriptive statistics, Student’s t test, chi (2) test, and Spearman correlation using the SPSS statistical package. A p value < 0.05 was considered significant.Results:The study included 100 RA patients (86 women and 14 men), with a mean age of 56.5 ± 12.4 years. The mean age at the onset of RA was 47.5 ± 12.4 years. Median D1, D2 and D3 were respectively 12 months [0-242], 15.7 months [2-252] and 18 months [2-270].Methotrextate was prescribed in 86% of cases. At RA diagnosis, the median values for the following parameters were: VAS 80 [30-100], number of tender joints 10[0-28], number of swollen joints 5 [0-17], ESR 43mm/hour [6-133], CRP 14.1 mg/l [1-120], DAS28 (ESR) 5.22 [2-7.52] and DAS28 (CRP) 4.6 [1-6.93]. After one year of follow-up, the median parameters of the disease activity were respectively: VAS 60 [0-100], number of tender joints 6[0-28], number of swollen joints 2 [0-22], ESR 32 mm/hour [2-106], CRP 7.5 mg/l [1.2-94], DAS28 (ESR) 4.1 [1.4-7.1] and DAS28 (CRP) 3.7 [1.68-6.22]. Significant positive correlation was found between delays in csDMARD initiation and DAS28 (CRP) scores over the first year (p=0.02, r=0.29).Conclusion:In this study, delays in treatment were associated with higher DAS28 (CRP) scores after one year of follow-up. Our results suggest that early identification and treatment of RA leads to improved outcomes and even improved rates of drug-free remission.References:[1]Van Nies JA, Krabben A, Schoones JW, et al. What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review. Ann Rheum Dis 2014;73:861–70.Disclosure of Interests:None declared

scholarly journals CLUB FOOT AFTER TREATMENT

2018 ◽  
Vol 25 (04) ◽  
pp. 514-519
Author(s):  
Nusrat Rasheed ◽  
Ghulam Mustafa Kaim Khani ◽  
Itaat Hussain Zaidi
Keyword(s):  
Club Foot ◽  
Previous Treatment ◽  
Primary Treatment ◽  
University Hospital ◽  
Pirani Score ◽  
Study Results ◽  
One Year ◽  
Initial Correction

Background: Ponseti technique for club foot treatment has become morepopular during the last decade. But the most common problem following correction byPonseti technique is the relapse of deformity. Setting: Dow University Hospital as well asother hospitals were included in the study. Period: April 2013 to April 2016. Methods: 335children with idiopathic club foot presented in OPD with relapse, treated with Ponseti technique.Pirani scoring was used to assess the severity of relapse. Children with both unilateral andbilateral involvement, aged up to 5 years were included. 335 children with idiopathic club feetwho underwent treatment with Ponseti technique, presented with relapse of deformity wereenrolled in the study. Results: There were 207(59.7%) boys and 128(37%) girls. Mean age atpresentation for casting (previous treatment age) was 5.98 months (SD ±6.07), and 153(44.2%)had Right sided involvement, 112 (32.4%) had left sided involvement and 69(19.9%) hadbilateral involvement. Mean age at which relapse occurred was 24.7 months (SD ±7.35). Themean Pirani score was 4.78 (SD ±4.30). Percutaneous heel cord tenotomy was done in 286(82.7%) children. Number of cast to maintain initial correction was 7.58 (SD ±1.19).Out of 335patients 246(71.1) used brace and out of them 123 (50%) used brace up to one year, 70 (25.5%)used for1-2 years, 30 (15.5%) used for 2-3 years and 23 (9%) used for 3-4 years. Conclusion:Ponseti method is safe and effective method of treatment for club foot. Despite the proper use ofPonseti method, relapses and recurrences still occurs due to certain factors. The best treatmentfor recurrent club foot is prevention in the form of consistent primary treatment, constant use ofbraces and regular follow up

scholarly journals The Effects of Noncompliance to Prolia (Denosumab) on the Changes in Bone Mineral Density: A Retrospective Review

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Matthew Wong-Pack ◽  
Aashish Kalani ◽  
Jacob Hordyk ◽  
George Ioannidis ◽  
Robert Bensen ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Retrospective Review ◽  
Mineral Density ◽  
Eligibility Criteria ◽  
Multivariable Regression ◽  
One Year ◽  
The Impact ◽  
The Relationship

Although denosumab (Prolia) has been shown to be a safe and efficacious therapy for osteoporotic patients in numerous clinical trials, few studies have determined its effectiveness in real world clinical practice. A retrospective review of patients prescribed Prolia assessing the impact that noncompliance from the regular dosing regimen of six months for denosumab has on bone mineral density (BMD) was performed. 924 patient records were reviewed between August 2012 and September 2013 with 436 patients meeting the eligibility criteria. Patients were divided into three groups: subsequent injection of denosumab (1) less than five months, (2) between five and seven months, and (3) more than seven months after their initial subcutaneous injection. A multivariable regression analysis was conducted comparing the differences among the three prespecified groups in BMD change (g/cm2) after one year of denosumab therapy at both the lumbar spine (LS) and femoral neck (FN). The differences in LS and FN BMD have shown that the relationship between the timing of drug administration in these three groups and change in BMD over 1 year was not clinically or statistically significant (p>0.05). A follow-up study with a larger sample size and longer follow-up duration is required to further characterize this relationship.

Psychiatric sequelae of traumatic brain injury (TBI)

2020 ◽  
Vol 11 (5) ◽  
pp. 77-82
Author(s):  
Ambarish Ghosh ◽  
Birva Desai ◽  
Arghya Halder ◽  
Aniruddha Ghosh ◽  
Priyanka Das ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
P Value ◽  
Medical College ◽  
Increased Risk ◽  
Psychiatric Sequelae ◽  
One Year ◽  
First Interview ◽  
Severe Anxiety

Background: Traumatic brain injury (TBI), a leading cause of morbidity and mortality worldwide, is an alteration in brain function, caused by an external force. With rapid surge in urbanization, motorization and economic liberalization in India, risk of TBI is increased, raising a cause for concern about its neurological as well as psychiatric sequelae. Aims and Objectives: This study was planned to understand the magnitude of the problem which could give us insights to manage/ rehabilitate it in a more comprehensive manner. Materials and Methods: The current study included 50 patients aged 18-60 years at DY Patil Medical College, Pune. GCS scores were noted for severity of TBI. Patients were assessed through MMSE, BCRS, HAM-A & BDI. Results: On GCS, 20% cases had severe head injury; 22% moderate and 58% had mild. On MMSE initially, at six months and one year; 26.19%, 21.88% & 11.1% cases had cognitive impairment respectively. On BCRS, 38.10%, 34.4% & 37.10% cases had cognitive deterioration initially, at six month & at one year respectively. On HAM-A, mild & moderate to severe anxiety was found in 64.3% & 35.7% cases respectively. On BDI, initially 7.14% cases had depression, 25% at six months and 37.05% after one year. No statistically significant change was seen in BCRS score during follow up. Comparison of the mean scores at first interview and at six months demonstrated statistically significant (P-value p<0.005) differences in MMSE as well as BDI. Conclusion: TBI is associated with n increased risk of psychiatric disorders and may need psychiatric interventions later.

scholarly journals Weight change and risk of cardiovascular disease among adults with type 2 diabetes: more than 14 years of follow-up in the Tehran Lipid and Glucose Study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Seyyed Saeed Moazzeni ◽  
Reyhane Hizomi Arani ◽  
Niloofar Deravi ◽  
Mitra Hasheminia ◽  
Davood Khalili ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Weight Gain ◽  
Weight Change ◽  
P Value ◽  
Increased Risk ◽  
History Of ◽  
The Impact

Abstract Background To examine the impact of weight change on incident cardiovascular disease and coronary heart disease (CVD/CHD) among an Iranian population with type 2 diabetes mellitus (T2DM). Methods The study population included 763 participants with T2DM aged ≥ 30 years without a history of CVD and cancer at baseline. Two weight measurements done at baseline and about 3 years later. Based on their weight change, they categorized into: > 5% loss, 3–5% loss, stable (± < 3%), 3–5% gain, > 5% gain. Participants were then followed for incident CVD/CHD annually up to 20 March 2018. Multivariable Cox proportional hazard models, adjusted for age, sex, body mass index, educational level, current smoking, glucose-lowering drug use, family history of CVD, hypertension, hypercholesterolemia, chronic kidney disease, and fasting plasma glucose (FPG) were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for incident CVD/CHD, considering stable weight as reference. Results After the weight change measurement, during a median follow-up of 14.4 years, 258 CVD and 214 CHD occurred. Over 5% weight gain was associated with reduced risks of CVD and CHD development by the HRs of 0.70 [95% CI 0.48–1.01; P-value: 0.058] and 0.61 [0.40–0.93], respectively, in multivariable analysis. After further adjustment for FPG change, the HRs of weight gain > 5% were attenuated to 0.75 [0.51–1.10; P-value: 0.138] and 0.66 [043–1.01; P-value: 0.053] for incident CVD and CHD, respectively. The effect of weight loss > 5% was in opposite direction among those older versus younger than 60 years; with suggestive increased risk (not statistically significant) of incident CHD/CVD for the older group. Moreover, weight gain > 5% significantly reduced the risk of CHD only among those older than 60 years (P-value for interaction < 0.2). Furthermore, weight gain > 5% had an association with lower risk of CVD and CHD among sulfonylurea users (0.56 [0.32–0.98] for CVD and 0.54 [0.29–0.99] for CHD). Conclusions Our results with a long-term follow-up showed that weight gain > 5% was associated with better CVD/CHD outcomes among Iranian participants with T2DM, especially older ones. Moreover, we did not find an unfavorable impact on incident CVD/CHD for sulfonylurea-induced weight gain.

scholarly journals Association between Long COVID and Overweight/Obesity

2021 ◽  
Vol 10 (18) ◽  
pp. 4143
Author(s):  
Luigi Vimercati ◽  
Luigi De Maria ◽  
Marco Quarato ◽  
Antonio Caputi ◽  
Loreto Gesualdo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Disease ◽  
Respiratory Diseases ◽  
Close Contact ◽  
University Hospital ◽  
P Value ◽  
Hospital Managers ◽  
Increased Risk ◽  
Work Tasks ◽  
One Year

Background: Long COVID is a syndrome characterized by the persistence of SARS-CoV-2 infection symptoms. Among HCWs, prolonged COVID symptoms could lead to the inability to perform work tasks. The aim of this study is to investigate 35-day long-COVID (35-LC) characteristics and risk factors in a one-year period. Methods: We carried out a retrospective cohort study during the COVID-19 pandemic at University Hospital of Bari. A total of 5750 HCWs were tested for close contact with a confirmed case, in the absence of personal protective equipment, or for symptom development. Results: Each positive HCW was investigated for cardiovascular risk factors or respiratory diseases. An amount of 352 HCWs (6.1%) were infected by SARS-CoV-2, and 168 cases evolved to long COVID. The 35-LC group showed mean BMI values higher than the non-35-LC group (25.9 kg/m2 vs. 24.8 kg/m2, respectively), and this difference was significant (p-value: 0.020). Moreover, HCWs who suffered from pulmonary disease (OR = 3.7, CL 95%: 1.35–10.53; p-value = 0.007) or overweight (OR = 1.6 CL 95%: 1.05–2.56; p-value = 0.029) had an increased risk of developing 35-LC. Conclusions: Long COVID is an emerging problem for hospital managers as it may reduce the number of HCWs deployed in the fight against COVID-19. High BMI and previous pulmonary disease could be risk factors for 35-LC development in exposed HCWs.

Prospective evaluation for gastrointestinal bleedings at the University Hospital St. Pölten – one year of follow-up

2019 ◽  
Author(s):  
M Stättermayer ◽  
F Riedl ◽  
S Bernhofer ◽  
A Stättermayer ◽  
A Mayer ◽  
...  
Keyword(s):  
University Hospital ◽  
Prospective Evaluation ◽  
One Year ◽  
The University
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