scholarly journals Gradual, but Not Sudden, Dose-Dependent Increase of ONJ Risk With Bisphosphonate Exposure: A Nationwide Cohort Study in Women With Osteoporosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jung-Hyun Park ◽  
Min-Jeong Kwoen ◽  
Jae-Ryun Lee ◽  
Keun-Suh Kim ◽  
Hyo-Jung Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
National Health ◽  
Cumulative Dose ◽  
Osteonecrosis Of The Jaw ◽  
Risk Increase ◽  
Defined Daily Doses ◽  
Increased Risk ◽  
Icd 10 ◽  
Dose Dependent Increase ◽  
Dose Dependent

BackgroundA causal relationship of bisphosphonate (BP) exposure with osteonecrosis of the jaw (ONJ) has been reported; however, a definite dose-dependent risk remains to be elucidated beyond current vague recommendations of 4-year oral BP for ONJ risk increase.ObjectiveTo identify the effect of bisphosphonate cumulative dose on ONJ development in women with osteoporosis.MethodsA retrospective cohort study was designed using the National Health Insurance Service—National Health Screening database of Korea. Females over the age of 50 were diagnosed with osteoporosis based on the International Classification of Diseases 10th revision (ICD-10) codes (M80, M81, and M82) with bisphosphonate prescriptions. The cumulative dose of bisphosphonate was calculated using defined daily doses (DDD) to provide an accurate BP cumulative effect on ONJ occurrence. Osteonecrosis of the jaw was identified using both ICD-10 codes and related procedure codes. The incidence rates of ONJ and hazard ratios were estimated according to the bisphosphonate cumulative dose.ResultsAmong 74,491 included subjects, 190 cases of ONJ were identified. The incidence rate substantially increased after BP cumulative dose over 1 year (25.75 for DDD < 365, which increased to 53.43 for 365 ≤ DDD < 730). Compared to subjects with a cumulative dose of DDD < 365, subjects with a cumulative dose of 365 ≤ DDD < 730 had 2.36-fold hazard for developing ONJ (p < 0.001).ConclusionA bisphosphonate cumulative dose of more than 1 year had an increased risk of ONJ development. A gradual, but not sudden, dose-dependent increase in ONJ risk with BP exposure needs to be considered in providing the optimal BP treatment duration.

scholarly journals Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study

Rheumatology ◽  
2015 ◽  
Vol 54 (7) ◽  
pp. 1244-1249 ◽  
Author(s):  
Yi-Ming Chen ◽  
Ching-Heng Lin ◽  
Tsuo-Hung Lan ◽  
Hsin-Hua Chen ◽  
Shih-Ni Chang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Cumulative Dose ◽  
Population Based ◽  
Incident Diabetes ◽  
High Dose ◽  
Dependent Manner ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Dose Dependent

Abstract Objective. SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLE patients. Methods. This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001–10, 8628 newly diagnosed SLE patients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication. Results. Two hundred and twenty-one newly diagnosed diabetes mellitus patients were identified among SLE patients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g. Conclusion. In SLE patients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use.

scholarly journals Primary Sjogren syndrome increases the risk of bisphosphonate-related osteonecrosis of the jaw

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pei-I Kuo ◽  
Tzu-Min Lin ◽  
Yu-Sheng Chang ◽  
Tsung-Yun Hou ◽  
Hui-Ching Hsu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Osteonecrosis Of The Jaw ◽  
Sjögren Syndrome ◽  
Cox Proportional Hazards Model ◽  
Matched Pair ◽  
Sjogren Syndrome ◽  
Research Database ◽  
Primary Sjögren Syndrome ◽  
Defined Daily Doses ◽  
Increased Risk

AbstractThe risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in primary Sjogren syndrome (pSS) has rarely been explored. To explore the association between BRONJ and pSS, we conducted a population-based propensity-score-matched cohort study using Taiwan’s National Health Insurance Research Database, including pSS patients receiving antiosteoporotic therapy and patients without pSS receiving antiosteoporotic therapy. A 1:4 matched-pair cohort based on propensity score was created. The stratified Cox proportional hazards model compared the risk of BRONJ in the pSS and non-pSS groups. In the study, 23,280 pSS patients and 28,712,152 controls were enrolled. After matching, 348 patients with pSS receiving antiosteoporotic drugs and 50,145 without pSS receiving antiosteoporotic drugs were included for analysis. The risk of developing BRONJ was 1.96 times higher in pSS patients compared with non-pSS patients after adjustment for age, sex, and comorbidities. No dose–response effect was observed in the bisphosphonate-treated pSS cohorts, documented as the cumulative defined daily doses of either < 224 or ≥ 224 (hazard ratio [HR]: 2.407, 95% confidence interval [CI] 1.412–7.790; HR: 2.143, 95% CI 1.046–4.393, respectively) increased risk of developing osteonecrosis of the jaw. In conclusion, the risk of BRONJ is significantly higher in patients with pSS compared with the general population.

scholarly journals Association between height and the risk of primary brain malignancy in adults: A nationwide population-based cohort study

2021 ◽  
Author(s):  
Stephen Ahn ◽  
Kyungdo Han ◽  
Jung Eun Lee ◽  
Sin-Soo Jeun ◽  
Yong Moon Park ◽  
...  
Keyword(s):  
National Health ◽  
Asian Population ◽  
Population Based ◽  
Health Examination ◽  
National Health Insurance System ◽  
Increased Risk ◽  
Icd 10 ◽  
Korean National Health Insurance ◽  
Using Data ◽  
Brain Malignancy

Abstract Purpose The association between height and the risk of developing primary brain malignancy remains unclear. We evaluated the association between height and risk of primary brain malignancy based on a nationwide population-based database of Koreans. Methods Using data from the Korean National Health Insurance System cohort, 6,833,744 people over 20 years of age that underwent regular national health examination were followed from January 2009 until the end of 2017. We documented 4,771 cases of primary brain malignancy based on an ICD-10 code of C71 during the median follow-up period of 7.30 years and 49,877,983 person-years. Results When dividing the population into quartiles of height for each age group and sex, people within the highest height quartile had a significantly higher risk of brain malignancy, compared to those within the lowest height quartile (HR 1.21 CI 1.18–1.32) after adjusting for potential confounders. We also found that the risk of primary brain malignancy increased in proportion with the quartile increase in height. After analyzing subgroups based on older age (≥ 65) and sex, we found positive relationships between height and primary brain malignancy in all subgroups. Conclusions This study is the first to suggest that height is associated with increased risk of primary brain malignancy in the East-Asian population. Further prospective and larger studies with precise designs are needed to validate our findings.

Longitudinal Cohort Study of Risk Factors in Cancer Patients of Bisphosphonate-Related Osteonecrosis of the Jaw

2009 ◽  
Vol 27 (32) ◽  
pp. 5356-5362 ◽  
Author(s):  
Konstantinos Vahtsevanos ◽  
Athanassios Kyrgidis ◽  
Evgenia Verrou ◽  
Eirini Katodritou ◽  
Stefanos Triaridis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cohort Study ◽  
Smoking Status ◽  
Underlying Disease ◽  
Osteonecrosis Of The Jaw ◽  
Relative Risks ◽  
Increased Risk ◽  
Increase Risk ◽  
History Of

Purpose The reported incidence of osteonecrosis of the jaw (ONJ) ranges from 0.94% to 18.6%. This cohort study aimed to calculate the incidence of and identify the risk factors for ONJ in patients with cancer treated with intravenous zoledronate, ibandronate, and pamidronate. Patients and Methods Data analyzed included age, sex, smoking status, underlying disease, medical and dental history, bisphosphonates (BP) type, and doses administered. Relative risks, crude and adjusted odds ratios (aORs), and cumulative hazard ratios for ONJ development were calculated. Results We included 1,621 patients who received 29,006 intravenous doses of BP, given monthly. Crude ONJ incidence was 8.5%, 3.1%, and 4.9% in patients with multiple myeloma, breast cancer, and prostate cancer, respectively. Patients with breast cancer demonstrated a reduced risk for ONJ development, which turned out to be nonsignificant after adjustment for other variables. Multivariate analysis demonstrated that use of dentures (aOR = 2.02; 95% CI, 1.03 to 3.96), history of dental extraction (aOR = 32.97; 95% CI, 18.02 to 60.31), having ever received zoledronate (aOR = 28.09; 95% CI, 5.74 to 137.43), and each zoledronate dose (aOR = 2.02; 95% CI, 1.15 to 3.56) were associated with increased risk for ONJ development. Smoking, periodontitis, and root canal treatment did not increase risk for ONJ in patients receiving BP. Conclusion The conclusions of this study validated dental extractions and use of dentures as risk factors for ONJ development. Ibandronate and pamidronate at the dosages and frequency used in this study seem to exhibit a safer drug profile concerning ONJ complication; however, randomized controlled trials are needed to validate these results. Before initiation of a bisphosphonate, patients should have a comprehensive dental examination. Patients with a challenging dental situation should have dental care attended to before initiation of these drugs.

scholarly journals Association between CVDs and initiation and adherence to statin treatment in patients with newly diagnosed hypercholesterolaemia: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e045375
Author(s):  
In Sun Ryou ◽  
Jooyoung Chang ◽  
Joung Sik Son ◽  
Ahryoung Ko ◽  
Seulggie Choi ◽  
...  
Keyword(s):  
Cohort Study ◽  
National Health ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Statin Treatment ◽  
Health Screening ◽  
Secondary Outcome ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Late Initiation

ObjectivesTo evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia.DesignA population-based retrospective cohort study.SettingThis study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea.ParticipantsThis study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS.Primary and secondary outcome measuresThe primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation.ResultsEarly statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30).ConclusionsAmong statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.

scholarly journals PF-06869206 is a selective inhibitor of renal Pi transport: evidence from in vitro and in vivo studies

2020 ◽  
Vol 319 (3) ◽  
pp. F541-F551
Author(s):  
Linto Thomas ◽  
Jianxiang Xue ◽  
Viktor N. Tomilin ◽  
Oleh M. Pochynyuk ◽  
Jessica A. Dominguez Rieg ◽  
...  
Keyword(s):  
Collecting Duct ◽  
Inhibitory Effect ◽  
In Vivo Studies ◽  
Open Probability ◽  
Ok Cells ◽  
Increased Risk ◽  
Dose Dependent Increase ◽  
Dose Dependent

Plasma phosphate (Pi) levels are tightly controlled, and elevated plasma Pi levels are associated with an increased risk of cardiovascular complications and death. Two renal transport proteins mediate the majority of Pi reabsorption: Na+-phosphate cotransporters Npt2a and Npt2c, with Npt2a accounting for 70–80% of Pi reabsorption. The aim of the present study was to determine the in vitro effects of a novel Npt2a inhibitor (PF-06869206) in opossum kidney (OK) cells as well as determine its selectivity in vivo in Npt2a knockout (Npt2a−/−) mice. In OK cells, Npt2a inhibitor caused dose-dependent reductions of Na+-dependent Pi uptake (IC50: ~1.4 μmol/L), whereas the unselective Npt2 inhibitor phosphonoformic acid (PFA) resulted in an ~20% stronger inhibition of Pi uptake. The dose-dependent inhibitory effects were present after 24 h of incubation with both low- and high-Pi media. Michaelis-Menten kinetics in OK cells identified an ~2.4-fold higher Km for Pi in response to Npt2a inhibition with no significant change in apparent Vmax. Higher parathyroid hormone concentrations decreased Pi uptake equivalent to the maximal inhibitory effect of Npt2a inhibitor. In vivo, the Npt2a inhibitor induced a dose-dependent increase in urinary Pi excretion in wild-type mice (ED50: ~23 mg/kg), which was completely absent in Npt2a−/− mice, alongside a lack of decrease in plasma Pi. Of note, the Npt2a inhibitor-induced dose-dependent increase in urinary Na+ excretion was still present in Npt2a−/− mice, a response possibly mediated by an off-target acute inhibitory effect of the Npt2a inhibitor on open probability of the epithelial Na+ channel in the cortical collecting duct.

scholarly journals Type of dietary fat intakes in relation to all-cause and cause-specific mortality in US adults: an iso-energetic substitution analysis from the American National Health and Nutrition Examination Survey linked to the US mortality registry

2018 ◽  
Vol 119 (4) ◽  
pp. 456-463 ◽  
Author(s):  
Cristian Ricci ◽  
Jeannine Baumgartner ◽  
Manja Zec ◽  
Herculina Salome Kruger ◽  
Cornelius M. Smuts
Keyword(s):  
National Health ◽  
Mortality Risk ◽  
Dietary Fat ◽  
Saturated Fat ◽  
Fat Intake ◽  
Polyunsaturated Fat ◽  
Health And Nutrition ◽  
Risk Increase ◽  
Increased Risk ◽  
Specific Mortality

AbstractAccumulating evidence indicates that saturated fat intake is related to mortality risk increase, whereas unsaturated fat intake is associated with reduced mortality risk. The aim of the present study was to estimate the mortality risk reduction related to a dietary change from saturated fat to mono- or polyunsaturated fat intake. The American National Health and Nutrition Examination Surveys conducted between 1999 and 2010 were linked to the 2011 national US death registry resulting in an observational prospective mortality study. Proportional hazards Cox models were used to evaluate the association between saturated, monounsaturated and polyunsaturated fat with all-cause and cause-specific mortality. Substitution analysis was conducted to estimate an iso-energetic substitution of 10 % of the energy from dietary fat intake applied to the substitution of saturated fat with an equal amount of energy from monounsaturated or polyunsaturated fat. The highest tertile intakes of saturated fat resulted in an increased risk (12 %) of all-cause and specific-cause mortality, whereas the highest tertile intakes of polyunsaturated fat resulted in a reduced risk (7 %) of all-cause and specific-cause mortality when compared with the corresponding lowest tertile. Iso-energetic substitution revealed that a substitution of 10 % of energy (from total fat) from saturated fat to an equal amount of energy from monounsaturated or polyunsaturated fat resulted in a significant reduction of the mortality risk ranging from 4 to 8 %. Iso-energetic substitution of saturated fat with monounsaturated and polyunsaturated fat reduced all-cause and specific-cause mortality in US adults.

scholarly journals Type 2 diabetes and COVID-19 related mortality in the critical care setting: A national cohort study in England, March-July 2020

2020 ◽  
Author(s):  
John M. Dennis ◽  
Bilal A Mateen ◽  
Raphael Sonabend ◽  
Nicholas J Thomas ◽  
Kashyap A Patel ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Critical Care ◽  
Cohort Study ◽  
Care Setting ◽  
Critical Care Setting ◽  
Risk Of Death ◽  
Risk Increase ◽  
Increased Risk ◽  
All Cause Mortality

<b>Objective: </b>To describe the relationship between type 2 diabetes and all-cause mortality amongst adults with COVID-19 in the critical care setting. <p><b>Research Design and Methods: </b>Nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between March 1, 2020 and July 27, 2020. Cox proportional hazards models were used to estimate 30 day in-hospital all-cause mortality associated with type 2 diabetes, adjusted for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease).</p> <p><b>Results: </b>19,256 COVID-19 related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70), and 5,447 ICU admissions (mean age 58). 3,524 (18.3%) had type 2 diabetes. 5,077 people (26.4%) died during the study period. People with type 2 diabetes were at increased risk of death (adjusted hazard ratio (aHR) 1.23 [95%CI 1.14;1.32]), results were consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with increasing age (age 18-49 aHR 1.50 [95%CI 1.05;2.15]; age 50-64 1.29 [1.10;1.51]; age 65 or greater 1.18 [1.09;1.29], p-value for age:type 2 diabetes interaction 0.002).</p> <b>Conclusions: </b>Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people.<b><u><br> </u></b>

scholarly journals Inherited Thrombophilias Are Associated with an Increased Risk of COVID-19 Associated Venous Thromboembolism: A Prospective Population-Based Cohort Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3214-3214
Author(s):  
Hannah P Stevens ◽  
Rodrigo Canovas ◽  
Karlheinz Peter ◽  
Huyen Tran ◽  
Zane Kaplan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Population Based ◽  
Uk Biobank ◽  
Factor V Leiden Mutation ◽  
Genome Wide ◽  
A Genome ◽  
Increased Risk ◽  
Icd 10 ◽  
The Impact

Abstract Background: COVID-19 is associated with high rates of venous thromboembolism (VTE). The impact of common inherited thrombophilias on the development of COVID-19-associated VTE (COVID-19 VTE) is not well understood. Objective: To determine if the presence of inherited thrombophilias modifies the risk of COVID-19 VTE or COVID-19 mortality. Methods: Prospective population-based cohort study evaluating adult participants of the UK Biobank diagnosed with COVID-19 between November 2019 and May 2021. Individuals were of European descent and aged between 45 and 69 at recruitment to UK Biobank. We evaluated six single nucleotide polymorphisms including rs6025 (Factor V Leiden mutation) and rs1799963 (Prothrombin mutation) in addition to two polygenic risk scores (PRS-VTE and PRS-ABO). A genome-wide association study was performed for associations with COVID-19 VTE. COVID-19 VTE was defined using International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for VTE following COVID-19 diagnosis. COVID-19 mortality was defined using ICD-10 codes for COVID-19 on the death certificate. Results: Demographic and clinical characteristics are shown in Table 1. Of the 13 712 COVID-19 positive individuals included in the analysis, the median age was 54 years and 52.5% were female. There were 197 (1.4%) cases of COVID-19 VTE and 890 (6.5%) died due to COVID-19. The rs6025 variant, synonymous with FVL, was associated with a 1.8-fold risk of COVID-19 VTE (95% CI 1.040-2.931) (Table 2). The risk of COVID-VTE was also increased with rs2066865 (OR 1.345; 95% CI 1.074-1.675) and the PRS-VTE (OR 1.262; 95% CI 1.081-1.468) (Table 2). COVID-19 VTE was associated with increased COVID-19 mortality (OR 2.731; 95% CI 1.885-3.901) but this study found no association between the studied inherited thrombophilias and COVID-19 mortality (Table 2). On genome-wide analysis, two novel SNPs, rs4975019 and rs2875853, located on chromosomes 4 and 16 respectively, were associated with an increased occurrence of COVID-19 VTE. Conclusions: These data demonstrate that several inherited thrombophilias increase the risk of COVID-19 VTE and suggest that two novel SNPs are associated with COVID-19 VTE. These results suggest that certain inherited thrombophilias may assist in characterising a subgroup of COVID-19 patients at higher risk of thrombotic events who require individualised antithrombotic therapy. Future prospective studies are required to evaluate inherited thrombophilias in this patient cohort. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Association between de Quervain syndrome and herpes zoster: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e046891
Author(s):  
Chao-Yu Hsu ◽  
Der-Shin Ke ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Herpes Zoster ◽  
National Health Insurance ◽  
National Health ◽  
Population Based ◽  
Control Group ◽  
Research Database ◽  
Increased Risk ◽  
De Quervain

ObjectiveBoth physical diseases such as infection and chronic pain and psychological disorders such as depression have been associated with herpes zoster (HZ) reactivation. However, the relationship between de Quervain syndrome (DQS), a painful tenosynovitis and HZ remains unclear. We investigated whether DQS increases the risk of HZ reactivation.DesignA retrospective population-based cohort study.SettingTaiwan.ParticipantsWe used a subset of Taiwan’s National Health Insurance Research Database, the Longitudinal Health Insurance Database which contains the registration files and original claims data of 1 million randomly selected individuals from the National Health Insurance programme. The case group in this study comprised patients newly diagnosed with DQS between 2000 and 2012. Individuals without DQS comprised the control group. Cases and controls were 1:1 matched by age, sex and index year (defined as the year of DQS diagnosis).ResultsApproximately 55% of the participants were ≤49 years. Most participants were women (77%). The incidence rate of HZ in the DQS group was 8.39 per 1000 person years. After adjustments for age, sex and comorbidities, patients with DQS had a 1.30 times higher risk of HZ reactivation than the control group. Stratification analysis revealed taht DQS increases the HZ risk in individuals ≤64 years, women, and patients without comorbidities.ConclusionDQS is associated with an increased risk of HZ. Clinicians should be aware of this risk when dealing with patients with DQS, particularly in young adults.

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