scholarly journals Prevalence of Osteopenia and Osteoporosis in Patients with Moderate to Severe Asthma in Western Canada

2015 ◽  
Vol 38 (1) ◽  
pp. 23 ◽  
Author(s):  
Pen Li ◽  
Laith Ghazala ◽  
Erin Wright ◽  
Jeremy Beach ◽  
Donald Morrish ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Retrospective Chart Review ◽  
Systemic Steroid ◽  
Mineral Density ◽  
Systemic Steroids ◽  
Inhaled Steroids ◽  
Asthma Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Purpose: Steroids, inhaled and systemic, are used to treat airway inflammation in patients with asthma; however, steroids are recognized to cause a number of side effects, including osteoporosis. We evaluated the prevalence of osteopenia/osteoporosis in patients with moderate-severe asthma managed through the Edmonton Regional Severe Asthma Centre. Methods: We performed a retrospective chart review and analyzed 57 charts on patients with moderate-severe asthma followed through the specialty clinic, and recorded their bone mineral density (BMD). Steroid use was reviewed and the frequency of osteopenia/osteoporosis was compared in patients requiring continuous systemic steroids (Group 1, n=15), intermittent systemic steroids (Group 2, n=15) or inhaled steroids only (Group 3, n=27). Results: The mean age (mean±SD) was 50±14.8 years. Cumulative systemic steroid dose of prednisone equivalent was higher in Group 1 (12.5 mg/day) than Group 2 (3.2 mg/day) (p=0.002). The frequency of osteopenia / osteoporosis was not significantly different between patients in Group 1(67%) and Group 2 (53%, p=0.46) but was significantly greater in patients from Group 1 in comparison with Group 3 (33%, p=0.038). Conclusion: Patients with moderate-severe asthma have a high prevalence of reduced bone density. Many patients treated with intermittent systemic steroids for exacerbations, or who were stable on inhaled steroids, had either osteopenia or osteoporosis before the age of 50. National and international osteoporosis guidelines should emphasize earlier screening for asthma patients; and increase awareness of the detrimental effects of short-term systemic steroids and inhaled steroids on BMD, especially when started at an early age and in northern climates.

Abstract 196: The Characteristics of Patients with Kawasaki disease Presented with Fever and Cervical Lymphadenopathy at Admission

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
yeo hyang kim ◽  
Chae Ok Shin ◽  
Myung Chul Hyun ◽  
Dong Seok Lee
Keyword(s):  
Intravenous Immunoglobulin ◽  
Cervical Lymphadenopathy ◽  
Systemic Steroid ◽  
Line Treatment ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Group 3 ◽  
Group 2 ◽  
White Blood Cell Counts ◽  
Group 1

Purpose: Of the principal diagnostic criteria of Kawasaki disease (KD), cervical lymphadenopathy is the least common. However, it may be misdiagnosed as bacterial cervical lymphadenitis. We evaluated the characteristics of patients with KD presenting with only fever and cervical lymphadenopathy at admission. Methods: This study enrolled patients diagnosed KD from January 2013 to May 2014. All of patients were divided to three groups: group 1 had only fever and cervical lymphadenopathy at admission; group 2 had typical manifestations with cervical lymphadenopathy; group 3 had typical manifestations without cervical lymphadenopathy. Results: Ninety eight patients (group 1 in 13, group 2 in 31, group 3 in 54) were examined. The median age of group 1 was significantly older than group 2 and 3 ( P =0.001). The duration of fever before admission at our hospital was more prolonged in group 1 than in group 2 and 3 ( P =0.001). In comparison between groups, the laboratory results at the admission day were not significantly different. However, group 1 showed significantly elevated white blood cell counts, elevated neutrophil counts, and decreased lymphocyte counts after first intravenous immunoglobulin administration ( P =0.001, P =0.001, and P =0.003). The frequency of additional intravenous immunoglobulin treatment did not have significant difference. Group 1 had significantly increased duration of hospitalization, and frequency of second line treatment such as systemic steroid or infliximab than group 2 and 3 ( P =0.000, P =0.024, and P =0.007). The development of a coronary artery dilatation (z score >2.5) was higher in group 1 than in group 3 ( P =0.008). Conclusions: KD with cervical lymphadenopathy as main presentation indicates a severe form of KD associated with increased risks of second line treatment such as systemic steroid or infliximab and coronary artery dilatation. KD should be suspected in the older children with antibiotics non-responsive, prolonged fever and cervical lymphadenopathy. For differentiation between responder and non-responder for first line treatment, white blood cell counts and their subset after first intravenous immunoglobulin administration may be beneficial.

scholarly journals Reduction in daily hydrocortisone dose improves bone health in primary adrenal insufficiency

2016 ◽  
Vol 174 (4) ◽  
pp. 531-538 ◽  
Author(s):  
Julia Schulz ◽  
Kathrin R Frey ◽  
Mark S Cooper ◽  
Kathrin Zopf ◽  
Manfred Ventz ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Crisis ◽  
Mineral Density ◽  
Primary Adrenal Insufficiency ◽  
Group Reduction ◽  
Group 3 ◽  
Group 2 ◽  
Over Time ◽  
Group 1

ObjectiveIndividuals with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) replacement therapy. Current daily GC doses are still higher than the reported adrenal cortisol production rate. This GC excess could result in long-term morbidities such as osteoporosis. No prospective trials have investigated the long-term effect of GC dose changes in PAI and CAH patients.MethodsThis is a prospective and longitudinal study including 57 subjects with PAI (42 women) and 33 with CAH (21 women). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry at baseline and after 2 years. Subjects were divided into three groups (similar baseline characteristics) depending on changes in daily hydrocortisone equivalent dose (group 1: unchanged 25.2±8.2 mg (mean±s.d., n=50); group 2: increased 18.7±10.3 to 25.9±12.0 mg (n=13); group 3: decreased 30.8±8.5 to 21.4±7.2 mg (n=27)).ResultsSubjects in group 1 showed normal lumbar and femoral Z-scores which were unchanged over time. Group 2 subjects showed a significant decrease in femoral neck Z-scores over time (−0.15±1.1 to −0.37±1.0 (P<0.05)), whereas group 3 subjects showed a significant increase in lumbar spine and hip Z-scores (L1–L4: −0.93±1.2 to –0.65±1.5 (P<0.05); total hip: −0.40±1.0 to −0.28±1.0 (P<0.05)). No changes in BMI over time were seen within any group. Reduction in GC dose did not increase the risk of adrenal crisis.ConclusionThis study demonstrates for the first time that cautious reduction in hydrocortisone equivalent doses leads to increases in BMD, whereas dose increments reduced BMD. These data emphasize the need for the lowest possible GC replacement dose in AI patients to maintain health and avoid long-term adverse effects.

scholarly journals Comparative characteristics of the quality of life of asthma patients with different types of airway hyperresponsiveness to physical stimules

2021 ◽  
pp. 55-61
Author(s):  
N. L. Perelman
Keyword(s):  
Quality Of Life ◽  
Airway Hyperresponsiveness ◽  
Group 4 ◽  
Sf 36 ◽  
Different Types ◽  
Asthma Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To compare the nature and degree of influence of different types of airway hyperresponsiveness (AHR) on the general and specific quality of life (QoL) of patients with asthma and control over the disease.Materials and methods. 234 patients with mild-to-moderate asthma, aged from 18 to 60 years old, were interviewed and examined. Depending on the presence of one or another type of AHR, 4 groups were formed: group 1 included 60 patients with cold AHR, group 2 – 75 patients with hypoosmotic AHR, group 3 – 35 patients with hyperosmotic AHR, group 4 – 64 patients with exercise-induced bronchoconstriction (EIB). QoL and the state of the emotional sphere were assessed using the SF-36, AQLQ, HADS questionnaires. The level of asthma control was determined using the ACT questionnaire. Lung function was assessed by spirometry.Results. When comparing QoL between groups, statistical differences were obtained for most of the SF-36 scales, with the exception of the domains “Role Physical” (RP) and “Bodily Pain” (BP), and their presence and significance varied depending on the types of AHR being compared. The lowest QoL indices were found in group 1 of patients with cold AHR according to the domains “Physical Activity” (PA), RP, BP, and “Role Emotional” (RE). The lowest indices for the domains “General Health” (GH), “Vitality” (V) and “Mental health” (MH) were found in the respondents of the 2nd group. Most of the highest QoL indicators in the compared groups were found in patients of group 4 with EIB in the domains PA, RP, V, RE, and MH. When carrying out a comparative analysis, the maximum number of significant differences was found between the groups with cold AHR and EIB. A comparative study of QoL using a special AQLQ questionnaire showed the lowest indices for the “Activity” and “Symptoms” domains in groups 1 and 2 of asthma patients. In addition, in group 1, the minimum QoL values were recorded for the “General QoL” domain (3.6±0.2 points), and in group 2, for the “Environment” domain (2.9±0.3 compared with 3.9±0.2 points in group 3, p<0.01).Conclusion. This study has demonstrated the multifaceted effect of AHR on health-related QoL, dependent on sensitivity to a particular physical stimulus and the season of maximum trigger action. The subjective assessment of psychosocial functioning is most differentiated according to the GH domain of the SF-36 questionnaire. The greatest negative impact on the QoL indices is exerted by the cold and hypoosmotic AHR, the least – by the EIB. The assessment of QoL allows to get a full picture of the perception of the patient's health level at the moment and in the given conditions.

Early Troponin I Levels in Newborns Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Residual Encephalopathy at Discharge

2020 ◽  
Author(s):  
Upender K. Munshi ◽  
Meredith Monaco Brown ◽  
Kate A. Tauber ◽  
Michael J. Horgan
Keyword(s):  
Therapeutic Hypothermia ◽  
Predictive Value ◽  
Troponin I ◽  
Retrospective Chart Review ◽  
Hypoxic Ischemic Encephalopathy ◽  
Mri Findings ◽  
Group 3 ◽  
Group 2 ◽  
Ischemic Encephalopathy ◽  
Group 1

Objective Elevation of serum troponin I has been reported in newborns with hypoxic ischemic encephalopathy (HIE), but it is diagnostic and prognostic utility for newborn under 6 hours is not clear. Study the predictive value of early serum troponin I levels in newborns with HIE undergoing therapeutic hypothermia (TH) for persistent residual encephalopathy (RE) at discharge. Study Design Retrospective chart review of newborns admitted with diagnosis of HIE to neonatal intensive care unit (NICU) for TH over a period of 3 years. Troponin levels were drawn with the initial set of admission laboratories while initiating TH. Newborns were followed up during hospital course and stratified into three groups based on predischarge examination and their electrical encephalography and cranial MRI findings: Group 1: no RE, Group 2: mild-to-moderate RE, and Group 3: severe RE or needing assisted medical technology or death. Demographic and clinical characteristics including troponin I levels were compared in each group. Results Out of 104 newborns who underwent TH, 65 infants were in Group 1, 26 infants in Group 2, and 13 newborns in Group 3. All groups were comparable in demographic characteristics. There was a significant elevation of serum troponin in group 2 (mild-to-moderate RE) and group 3 (severe RE) as compared with group 1 (no RE). Receiver operator curve analysis for any RE (groups 2 and 3) compared with group 1 (no RE as control) had 0.88 (0.81–0.95) area under curve, p < 0.001. A cut-off level of troponin I ≥0.12 µg/L had a sensitivity of 77% and specificity of 78% for diagnosis of any RE, positive predictive value of 68%, and a negative predictive value of 84%. Conclusion In newborns undergoing TH for HIE, the elevation of troponin within 6 hours of age predicts high risk of having RE at discharge. Key Points

Factors Influencing Intravitreal Bevacizumab and Triamcinolone Treatment in Patients with Diabetic Macular Edema

2017 ◽  
Vol 27 (6) ◽  
pp. 746-750 ◽  
Author(s):  
Tai K. Kim ◽  
Hye Y. Shin ◽  
Su Y. Kim ◽  
Young C. Lee ◽  
Mee Y. Lee
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Retrospective Chart Review ◽  
Diabetic Control ◽  
The Other ◽  
Intravitreal Triamcinolone ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Purpose To evaluate factors associated with response to intravitreal bevacizumab (IVB) and intravitreal triamcinolone acetonide (IVTA) in diabetic macular edema (DME). Methods Ninety-one eyes of 88 patients diagnosed with DME were enrolled in this retrospective chart review. Group 1 included eyes that showed good response to IVB. Group 2 included eyes that did not respond to IVB but responded to IVTA. Group 3 included eyes that responded to neither. Clinical factors, HbA1c, and optical coherence tomography (OCT) findings including patterns of macular edema were compared among the 3 groups. Results A total of 44, 27, and 20 eyes were included in groups 1, 2, and 3, respectively. HbA1c was higher in group 3 than in the other groups. Proportion of full (combination of all patterns) type edema was higher in group 3 than in the other 2 groups. In group 1, the proportion of sponge-like diffuse retinal thickening type was higher and cystoid macular edema type was lower than in the other groups. Conclusions The degree of diabetic control and morphologic subtypes with OCT should be considered to better predict the prognosis after treatment in DME.

scholarly journals Intraocular lens power calculation formulas accuracy in combined phacovitrectomy: an 8-formulas comparison study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Diogo Hipólito-Fernandes ◽  
Maria Elisa Luís ◽  
Diogo Maleita ◽  
Pedro Gil ◽  
Vitor Maduro ◽  
...  
Keyword(s):  
Intraocular Lens ◽  
Prediction Error ◽  
Retrospective Chart Review ◽  
Absolute Error ◽  
Power Calculation ◽  
Myopic Shift ◽  
Iol Power ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Our study aimed to assess and compare the accuracy of 8 intraocular lens (IOL) power calculation formulas (Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane and PEARL-DGS) in patients submitted to combined phacovitrectomy for vitreomacular (VM) interface disorders. Methods Retrospective chart review study including axial-length matched patients submitted to phacoemulsification alone (Group 1) and combined phacovitrectomy (Group 2). Using optimized constants in both groups, refraction prediction error of each formula was calculated for each eye. The optimised constants from Group 1 were also applied to patients of Group 2 – Group 3. Outcome measures included the mean prediction error (ME) and its standard deviation (SD), mean (MAE) and median (MedAE) absolute errors, in diopters (D), and the percentage of eyes within ± 0.25D, ± 0.50D and ± 1.00D. Results A total of 220 eyes were included (Group 1: 100; Group 2: 120). In Group 1, the difference in formulas absolute error was significative (p = 0.005). The Kane Formula had the lowest MAE (0.306) and MedAE (0.264). In Group 2, Kane had the overall best performance, followed by PEARL-DGS, EVO 2.0 and Barrett Universal II. The ME of all formulas in both Groups 1 and 2 were 0.000 (p = 0.934; p = 0.971, respectively). In Group 3, a statistically significant myopic shift was observed for each formula (p < 0.001). Conclusion Surgeons must be careful regarding IOL power selection in phacovitrectomy considering the systematic myopic shift evidenced—constant optimization may help eliminating such error. Moreover, newly introduced formulas and calculation methods may help us achieving increasingly better refractive outcomes both in cataract surgery alone and phacovitrectomy.

A COMPARATIVE STUDY ON RISK OF OSTEOPOROSIS ASSOCIATED WITH THE USE OF VALPROATE VERSUS LEVETIRACETAM IN EPILEPTIC PATIENTS AND ITS RELATIONSHIP WITH METHYLENE TETRA-HYDRO FOLATE REDUCTASE GENOTYPES

2021 ◽  
pp. 78-82
Author(s):  
MOHAMMED FAREEDULLAH ◽  
REHAB RAFI ◽  
NEHA NAAZ ◽  
MOHAMMED BARKATH ALI SHAMS ◽  
SYEDA SHAISTA BABAR ◽  
...  
Keyword(s):  
Mthfr Gene ◽  
Mineral Density ◽  
Mthfr Polymorphism ◽  
Recommended Treatment ◽  
Epileptic Patients ◽  
Healthy Control ◽  
Group 3 ◽  
Clonic Seizures ◽  
Group 2 ◽  
Group 1

Objective: The study objects at assessing and comparing the intensity of the effect of valproate (VPA) and levetiracetam (LV) on the bone mass in young adult epileptic patients while distinguishing their methylene tetra-hydro folate reductase (MTHFR) genotypes and correlating MTHFR polymorphism and antiepileptic drugs (AEDs) usage with the risk of development of osteoporosis. Methods: The study design was a comparative, prospective, and observational study. It was conducted at Princess Esra Hospital (PEH), Hyderabad and genotype testing was carried out at Salar-e-Millat Research lab (PEH). The consent was obtained from total 70 subjects, divided into three groups: Group 1: 18 patients receiving sodium VPA monotherapy Group 2: 17 patients receiving LV monotherapy Group 3: 35 healthy control subjects from general population. Patients of either gender within age group of 15–40 years, experiencing generalized tonic-clonic seizures or focal seizures, receiving the AED for duration of time ≥2 years were included in the study. Results: Our study showed significant correlation between the AEDs treatment and MTHFR polymorphism in predisposing osteoporosis. Conclusion: The variants of MTHFR gene (C677T) are prone to develop increased levels of homocysteine as a result of decreased activity of the enzyme in their bodies which are further increased in patients receiving AEDs. Monitoring of homocysteine levels in epileptic patients especially in the mutants of MTHFR gene along with their periodic testing of bone mineral density levels is recommended. Treatment for low folate and calcium levels is recommended in these patients to correct their deficiencies.

scholarly journals Efficacy of nebulized budesonide suspension in acute severe asthma: a controlled trial

2005 ◽  
pp. 66-72
Author(s):  
V. P. Sereda ◽  
A. S. Svistov
Keyword(s):  
Severe Asthma ◽  
Controlled Trial ◽  
Oral Prednisolone ◽  
Acute Severe Asthma ◽  
Systemic Steroids ◽  
Group 2 ◽  
Inhaled Budesonide ◽  
Step Therapy ◽  
And Control ◽  
Group 1

A goal of the study was to evaluate efficacy of inhaled budesonide suspension via nebulizer compared with systemic steroids in acute severe bronchial asthma. We examined 68 patients admitted for acute severe asthma (FEV1 < 40 %pred., PEF < 150 L / min). A first step therapy included inhaled salbutamol 5 to10 mg, oxygen, prednisolone IV for 1.5 to 2 h. Then the patients were divided into 2 groups: good respondents (n = 32) with increase in FEV 1 up to 50 %pred. at least and patients with insufficient response (n = 36) and co existing COPD which still had FEV1 < 40 %pred. The group 1 patients were randomized in 2 subgroups: experimental (budesonide 4 mg / day) and control (prednisolone 120 mg / day IV). All of the group 2 patients received oral prednisolone 30 mg / day and were also randomized in experimental (prednisolone + budesonide 4 mg / day) and control (prednisolone + placebo) subgroups. The clinical course and pulmonary function were assessed after 5 days of the treatment. As a result, the efficacy of budesonide in the group 1 was similar to that of IV steroids. The group 2 patients receiving budesonide demonstrated faster clinical improvement and better FEV1 and PEF dynamics as compared to the controls (p < 0.05). Administration of budesonide allowed reducing the duration of the steroid therapy. So, inhaled budesonide can replace systemic steroids in patients with acute severe asthma and good response to the first step therapy. Early addition of budesonide to prednisolone in patients with more severe asthma and COPD allows to reach the asthma control faster and to reduce doses of steroids.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

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