scholarly journals Long-Term Morbidity Following IGA Vasculitis in Childhood

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Johannes Nossent ◽  
Warren Raymond ◽  
Milica Ognjenovic ◽  
Helen Keen ◽  
David Preen ◽  
...  
Keyword(s):  
Rate Ratio ◽  
Medical Procedures ◽  
Iga Vasculitis ◽  
Surgical Interventions ◽  
Severe Comorbidity ◽  
Observational Cohort ◽  
Comorbidity Index ◽  
Ed Visits ◽  
Linked Administrative Health Data

Background/ObjectivePatients with IgA vasculitis (IgAV aka Henoch Schonlein) may require aggressive initial treatment, are prone to disease relapses and may have sustained abnormal IgA responsiveness. We investigated whether the relatively rare diagnosis of childhood IgAV is associated with subsequent comorbidity, hospitalisation and interventions. MethodsUsing linked administrative health data from the Western Australian Rheumatic Disease Registry we performed an observational cohort study comparing hospitalisation and ED visit rates(per 1000 person years), comorbidity accrual (Charlson comorbidity index; CCI) and procedures between 494 IgAV patients < 20 years and 1385 matched controls over a twenty-year period. ResultsHospitalisation was proportionally (73.5 vs 51.5%) and by rate (21.7 vs 18.9; rate ratio 1.15, p<0.01) increased in IgAV patients. IgAV patients more often underwent diagnostic and medical procedures than controls, who had higher rates of surgical interventions. ED visit frequency (25 vs 16%) and rate (10.8 vs 8.43, rate ratio 1.29, (p<0.01) was also increased in IgAV patients, who more often accrued peptic ulcer and renal disease than controls and had an increased accrual of CCI ≥3. Conclusions/ImplicationsA diagnosis of IgAV in childhood significantly increases the risk and rate of subsequent hospital admission, ED visits and accrual of severe comorbidity. Although often considered a self-limiting disease, the occurrence of childhood IgAV signifies the presence of a sustained predisposition to illness, likely related to abnormal IgA functioning.

scholarly journals SAT0594 LONG-TERM MORBIDITY FOLLOWING IGA VASCULITIS IN CHILDHOOD

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1255.3-1256
Author(s):  
J. “. Nossent ◽  
W. Raymond ◽  
M. Ognjenivic ◽  
H. Keen ◽  
D. Preen ◽  
...  
Keyword(s):  
Maximum Likelihood Estimates ◽  
Iga Vasculitis ◽  
Surgical Interventions ◽  
Increased Risk ◽  
Severe Comorbidity ◽  
Observational Cohort ◽  
Comorbidity Index ◽  
Ed Visits ◽  
Rate Ratios

Background:IgA vasculitis (IgAV) in children is considered a mostly self-limiting disease. However, patients may require aggressive initial treatment, are prone to disease relapses and conceivably have a sustained abnormality in mucosal and /or circulating IgA responsiveness, that can predispose to the development of other conditions.Objectives:To determine whether childhood IgAV predisposes to comorbidity later in life.Methods:Observational cohort study examining rates of hospitalization, ED visits, procedures and accrual of comorbidity (by Charlson comorbidity index; CCI) comparing 494 IgAV patients <20 years at diagnosis with 1385 non-exposed matched controls over a 20-year period. Maximum likelihood estimates were used to obtain Odds (OR) and Rate ratios per 1000 person-years (RR).Results:Hospitalization was increased proportionally (73.5 vs 51.5%) and by rate (21.7 vs 18.9; rate ratio 1.15) (both p<0.01) for IgAV patients, who underwent more diagnostic and medical procedures whereas controls had higher rates of surgical interventions. IgAV patients had an higher overall ED attendance (25 vs 16%) and visit rate (10.8 vs 8.43, RR 1.29) (each p<0.01)) and accrued more often peptic ulcer and renal disease and developed severe comorbidity (CCI ≥3) at a higher rate (OR 2.9, 95% CI 0.79-11.6) than controls.Conclusion:A diagnosis of IgAV in childhood associates with increased risk and rate of subsequent hospital admission, ED attendance and severe comorbidity. The occurrence of childhood IgAV thus signifies the presence of a sustained predisposition to illness.Acknowledgments:Supported by an unrestricted grant from the Arthritis Foundation of Western AustraliaDisclosure of Interests:Johannes (“Hans”) Nossent Speakers bureau: Janssen, warren raymond: None declared, milica ognjenivic: None declared, Helen Keen Speakers bureau: Pfizer Austrlaia, Abbvie Australia, David Preen: None declared, Charles Inderjeeth Grant/research support from: UCB Australia, Speakers bureau: Eli Lilly

scholarly journals Predictive importance of comorbidity in patients with myocardial infarction and different strategy of treatment

2019 ◽  
Vol 2 (30) ◽  
pp. 33-36 ◽  
Author(s):  
M. V. Zykov ◽  
V. V. Kashtalap ◽  
V. A. Poltaranina ◽  
N. V. Dyachenko ◽  
I. V. Lukyanchenko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Conservative Treatment ◽  
Coronary Intervention ◽  
Number Needed To Treat ◽  
City Hospital ◽  
Percutaneous Coronary ◽  
Severe Comorbidity ◽  
Comorbidity Index ◽  
Long Term Prognosis

The aim of the study was to compare the 1-year results of conservative and invasive tactics of treating myocardial infarction (MI) in patients with different severity of comorbid background.Material and methods. The presented results are based on registry in City Hospital No. 4 of Sochi. The present analysis included patients with a diagnosis of myocardial infarction (n = 1 176). Upon discharge from the hospital, all patients underwent analysis of the severity of comorbidity using the Charlson Comorbidity Index (CCI). A year later, 791 patients managed to find out the prognosis after discharge from the hospital. 1-year mortality was 12.6 % (n = 100).Results. The frequency of coronary angiography (CA) and percutaneous coronary intervention (PCI) in patients with CCI = 0 (no or minimal comorbidity, n = 408) was 84.3 % and 63.5 %, with a CCI of 1–2 (moderate comorbidity), n = 438) was 68.0 % and 44.8 %, with CCI ≥ 3 (expressed comorbidity, n = 330) was 50.3 % and 25.8 %, respectively. At the same time, conducting PCI at the hospital observation stage was associated with a decrease mortality during the year after discharge from the hospital from 18.5 % to 5.8 %, p < 0.0001. The greatest positive effect of PCI for optimizing the long-term prognosis of (1 year) was achieved in the group of patients with severe comorbidity (CCI ≥ 3), where the NNT (number needed to treat) was 7. The relative risk of 1-year mortality in patients with severe comorbidity compared to the minimum in the PCI group was 6.75, in the conservative treatment group was 4.63.Conclusion. The results of this study showed that PCI in MI is more often performed by younger, less comorbid patients with a lower risk on the GRACE scale. At the same time, the 1-year survival of patients with MI was significantly higher after PCI compared to the primary conservative treatment strategy, regardless of the severity of comorbidity, and the greatest improvement in the long-term prognosis of PCI was observed in patients with severe comorbidity, as determined by the CCI ≥ 3.

scholarly journals The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Median Number ◽  
Small Sample ◽  
Age At Diagnosis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

scholarly journals Body dysmorphic disorder in children and young people

2021 ◽  
Vol 30 (3) ◽  
pp. 160-164
Author(s):  
Chloe Watson ◽  
Sasha Ban
Keyword(s):  
Social Media ◽  
Body Image ◽  
Young People ◽  
Suicide Prevention ◽  
Adolescent Development ◽  
Body Dysmorphic Disorder ◽  
Children And Young People ◽  
Surgical Interventions ◽  
Positive Body Image

The incidence of body dysmorphic disorder (BDD) in young people is increasing. Causes of BDD are related to the prevalence of social media and adolescent development, especially the role that brain neuroplasticity has on influencing perception. There are long-term impacts of BDD, including depression and suicide. Prevention and promotion of positive body image are part of the nurse's role; treatment can prevent unnecessary aesthetic surgical interventions.

scholarly journals 556. Evaluation of Hydroxychloroquine-based Combination Therapies for the Treatment of COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S343-S343
Author(s):  
Andrew David Berti ◽  
Pramodini Kale-Pradhan ◽  
Christopher Giuliano ◽  
Bianca Aprilliano ◽  
Christopher R Miller ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sofa Score ◽  
Laboratory Data ◽  
Organ Damage ◽  
Secondary Outcome ◽  
Mortality Data ◽  
Observational Cohort ◽  
Comorbidity Index ◽  
Significant Change ◽  
Investigational Agents

Abstract Background During the early COVID-19 pandemic a large number of investigational agents were utilized due to lack of therapeutic options. We evaluate the utility of commonly-used investigational agents combined with hydroxychloroquine (HCQ). Methods This multicenter observational cohort study included patients admitted with COVID-19 between March - May 2020 in Detroit, Michigan who received at least 2 doses of HCQ. Our primary outcome was the change in Sequential Organ Failure Assessment (SOFA) score from presentation to day 5 of HCQ therapy with a secondary outcome of in-hospital mortality. Data collected included demographics, Charlson Comorbidity index (CCI), daily SOFA score, laboratory data and COVID-directed therapies. Multiple linear regressions were performed to control for potential confounders between different therapies and change in SOFA score. Results Three hundred thirty-five patients receiving HCQ were included. Patients were 62 ± 14.8 years of age, male (54%) and African-American (82%) with a mean CCI of 1.7 ± 1.9. In our cohort, 32% were admitted to the intensive care unit and 35% expired. Therapies received by more than 20% of patients in addition to HCQ included azithromycin (80%), zinc (76%) and vitamin D (29%). In our unadjusted analysis, a significant improvement in SOFA score was observed with zinc (0.76) while no significant change was observed with azithromycin (-0.46) or vitamin D (0.05). However, there was no significant change in SOFA score after adjusting for confounders for azithromycin, zinc and vitamin D. No difference in mortality was observed between the groups. Conclusion Overall, no benefit in end-organ damage or mortality was observed with the addition of azithromycin, zinc or vitamin D to HCQ. Further studies are needed to confirm this observation. Disclosures All Authors: No reported disclosures

Beyond implantation effect? Long-term seizure reduction and freedom following intracranial monitoring without additional surgical interventions

2020 ◽  
Vol 111 ◽  
pp. 107231
Author(s):  
Jennifer Percy ◽  
Hitten Zaveri ◽  
Robert B. Duckrow ◽  
Jason Gerrard ◽  
Pue Farooque ◽  
...  
Keyword(s):  
Seizure Reduction ◽  
Surgical Interventions

Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study

2018 ◽  
Vol 5 (5) ◽  
pp. 424-431 ◽  
Author(s):  
Jesse R Fann ◽  
Anette Riisgaard Ribe ◽  
Henrik Schou Pedersen ◽  
Morten Fenger-Grøn ◽  
Jakob Christensen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Population Based ◽  
Observational Cohort Study ◽  
Observational Cohort

scholarly journals US Emergency Department Visits for Adverse Drug Events From Antibiotics in Children, 2011–2015

2018 ◽  
Vol 8 (5) ◽  
pp. 384-391 ◽  
Author(s):  
Maribeth C Lovegrove ◽  
Andrew I Geller ◽  
Katherine E Fleming-Dutra ◽  
Nadine Shehab ◽  
Mathew R P Sapiano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Drug Events ◽  
Emergency Department Visits ◽  
Drug Event ◽  
Injury Surveillance System ◽  
Adverse Event Data ◽  
Systemic Medication ◽  
Ed Visits ◽  
Pharmacy Dispensing Data

Abstract Background Antibiotics are among the most commonly prescribed medications for children; however, at least one-third of pediatric antibiotic prescriptions are unnecessary. National data on short-term antibiotic-related harms could inform efforts to reduce overprescribing and to supplement interventions that focus on the long-term benefits of reducing antibiotic resistance. Methods Frequencies and rates of emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children were estimated using adverse event data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project and retail pharmacy dispensing data from QuintilesIMS (2011–2015). Results On the basis of 6542 surveillance cases, an estimated 69464 ED visits (95% confidence interval, 53488–85441) were made annually for antibiotic ADEs among children aged ≤19 years from 2011 to 2015, which accounts for 46.2% of ED visits for ADEs that results from systemic medication. Two-fifths (40.7%) of ED visits for antibiotic ADEs involved a child aged ≤2 years, and 86.1% involved an allergic reaction. Amoxicillin was the most commonly implicated antibiotic among children aged ≤9 years. When we accounted for dispensed prescriptions, the rates of ED visits for antibiotic ADEs declined with increasing age for all antibiotics except sulfamethoxazole-trimethoprim. Amoxicillin had the highest rate of ED visits for antibiotic ADEs among children aged ≤2 years, whereas sulfamethoxazole-trimethoprim resulted in the highest rate among children aged 10 to 19 years (29.9 and 24.2 ED visits per 10000 dispensed prescriptions, respectively). Conclusions Antibiotic ADEs lead to many ED visits, particularly among young children. Communicating the risks of antibiotic ADEs could help reduce unnecessary prescribing. Prevention efforts could target pediatric patients who are at the greatest risk of harm.

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