scholarly journals Description and Analysis of a Novel Subtype of the Anti-Synthetase Syndrome Characterized by Frequent Attacks of Fever and Systemic Inflammation in a Single-Center Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Shuhui Sun ◽  
Zhiwei Chen ◽  
Danting Zhang ◽  
Wenwen Xu ◽  
Wanlong Wu ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Retrospective Cohort ◽  
Multivariate Analyses ◽  
Attack Frequency ◽  
Drug Survival ◽  
Autoimmune Rheumatic Diseases ◽  
Inflammatory Phenotype ◽  
Fever Attacks ◽  
Inflammation Group

ObjectivesThe aim of this study was to investigate anti-synthetase syndrome (ASyS) patients who presented with recurrent episodes of fever and systemic inflammation.MethodsA retrospective cohort of Chinese ASyS patients (n=126) in our center (between January 2013 and January 2020) was included. Patients presenting with concomitant autoimmune rheumatic diseases or malignancies were subsequently excluded. The number of non-infectious fever attacks and attack frequency were recorded and calculated. Patients with two or more attacks and within the upper three quartiles of attack frequency were defined as high-inflammation group. Univariate and multivariate analyses were carried out to characterize the high-inflammation subtype.ResultsOut of 113 eligible patients with an average of 5 years follow up, 25 patients were defined as the high-inflammation group (16 for anti-Jo1, 9 for anti-PL7), with an average of 1.12 attack/patient-year. Compared to low-inflammation group (0–1 attack only and a frequency lower than 0.5 attack/patient-year), the high-inflammation group had higher occurrence of fever and rapid progressive interstitial lung disease (RPILD) as the first presentation (84% vs. 21% and 40% vs. 9%, respectively, both p<0.01). Anti-PL-7 was related to the more inflammatory phenotype (p=0.014). Cumulative disease-modifying agent exposures (>=3) were much higher in the high-inflammation group (60% vs. 26%), while biological agents, i.e., rituximab and tocilizumab, showed better “drug survival” for Jo-1+ and PL-7+ ASyS patients with high inflammation, respectively, in our cohort.ConclusionsASyS with recurrent systemic inflammatory episodes reflects a subtype of more aggressive and refractory disease in the spectrum of ASyS. Increased awareness of this subtype might lead to more appropriate management.

Progression of keratoconus in children and adolescents

2021 ◽  
pp. bjophthalmol-2020-316481
Author(s):  
Jay J Meyer ◽  
Akilesh Gokul ◽  
Hans R Vellara ◽  
Charles N J McGhee
Keyword(s):  
New York ◽  
Children And Adolescents ◽  
Retrospective Cohort ◽  
Associated Factors ◽  
Multivariate Analyses ◽  
Advanced Disease ◽  
High Rate ◽  
Rate Of Progression ◽  
Corneal Tomography

AimsTo evaluate the rates of keratoconus progression and associated factors in eyes of children and adolescents.MethodsRetrospective, cohort study of individuals ≤18 years old at the time of keratoconus diagnosis and with at least 6 months of follow-up. Corneal tomography was performed using an Orbscan tomographer (Bausch & Lomb, Rochester, New York, USA) to determine whether progression occurred. Tomographic progression of keratoconus was defined as a change in any of the investigated parameters (keratometry values, KMAX, maximum anterior or posterior elevation, central pachymetry, thinnest pachymetry) beyond the limits of repeatability.Results148 eyes of 106 patients with a mean age of 15.2±2.5 years were studied over a mean follow-up period of 2.9±2.2 years. The overall rate of tomographic progression was 77.0% (114/148 eyes). Eyes that progressed had more advanced disease at presentation with higher anterior curvature (KMAX55.4±6.3 vs 52.2±5.4 dioptres; p<0.01), posterior elevation (108.2±40.9 vs 86.3±35.6 µm; p<0.01) and lower central pachymetry measurements (442.1±56.7 vs 454.4±47.5 µm; p=0.01). Age at presentation, gender, atopy, documented eye rubbing, ethnicity and duration of follow-up were not significantly associated with progression in the multivariate analyses. There was a higher rate of bilateral progression if at least one eye had severe keratoconus (73.9%) compared with no severe keratoconus in either eye (36.8%; p=0.03).ConclusionsA high rate of progression was identified in keratoconic eyes of children and adolescents. More advanced disease at initial presentation may increase the risk of further keratoconus progression.

Status and Determinants of Treatment Outcomes Among New Tuberculosis Patients in South Korea: A Retrospective Cohort Study

2021 ◽  
pp. 101053952110005
Author(s):  
Hyunjin Son ◽  
Jeongha Mok ◽  
Miyoung Lee ◽  
Wonseo Park ◽  
Seungjin Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Facilities ◽  
Tuberculosis Patients ◽  
Lost To Follow Up

This is a retrospective cohort study using notification data in South Korea. We evaluated the nationwide status, regional differences, and the determinants of treatment outcomes among tuberculosis patients. Treatment success rate improved from 77.0% in 2012 to 86.0% in 2015. The lost to follow-up rate was higher among older people, males, and foreign nationals. Health care facilities designated for the Public-Private Mix (PPM) project showed higher success rate and lower rate of lost to follow-up. Moreover, municipalities with low regional deprivation index had higher PPM project coverage. Since there is a large regional difference in the coverage of the PPM project, an additional community-based support program should be implemented, especially for tuberculosis patients residing in region with low PPM project coverage.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

scholarly journals Interim Estimates of COVID-19 Vaccine Effectiveness in a Mass Vaccination Setting: Data from an Italian Province

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 628
Author(s):  
Maria Elena Flacco ◽  
Graziella Soldato ◽  
Cecilia Acuti Martellucci ◽  
Roberto Carota ◽  
Rossano Di Luzio ◽  
...  
Keyword(s):  
Adverse Event ◽  
Retrospective Cohort ◽  
Cox Model ◽  
National Health System ◽  
Vaccine Dose ◽  
Vaccine Hesitancy ◽  
Serious Adverse Event ◽  
Italian Province ◽  
Official Data

This retrospective cohort study compared the rates of virologically-confirmed SARS-CoV-2 infections, symptomatic or lethal COVID-19 among the residents of the Italian province of Pescara who received one or two doses of COVID-19 vaccines, versus the unvaccinated. The official data of the National Health System were used, and a total of 69,539 vaccinated adults were compared with 175,687 unvaccinated. Among the subjects who received at least one vaccine dose, 85 infections (0.12%), 18 severe and 3 lethal COVID-19 cases were recorded after an average follow-up of 38 days. Among the unvaccinated, the numbers were 6948 (4.00%), 933 (0.53%) and 241 (0.14%), respectively. The serious adverse event reports—yet unconfirmed—were 24 out of 102,394 administered doses. In a Cox model, adjusting for age, gender, and selected comorbidities, the effectiveness of either BNT162b2, ChAdOx1 nCoV-19 or mRNA-1273 vaccines was higher than 95% in preventing infections (mostly due to B.1.1.7 variant), symptomatic or lethal COVID-19. No differences were observed across genders, and among the 691 subjects who received the second dose of vaccine later than the recommended date. Although preliminary, these findings support current immunization policies and may help reducing vaccine hesitancy.

scholarly journals Serum C-reactive protein metabolite (CRPM) is associated with incidence of contralateral knee osteoarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Christine Bay-Jensen ◽  
Asger Bihlet ◽  
Inger Byrjalsen ◽  
Jeppe Ragnar Andersen ◽  
Bente Juhl Riis ◽  
...  
Keyword(s):  
Phase Iii ◽  
Response To Treatment ◽  
C Reactive Protein ◽  
Two Phase ◽  
Knee Oa ◽  
Reactive Protein ◽  
Inflammatory Phenotype ◽  
The Mean ◽  
Using Data

AbstractThe heterogeneous nature of osteoarthritis (OA) and the need to subtype patients is widely accepted in the field. The biomarker CRPM, a metabolite of C-reactive protein (CRP), is released to the circulation during inflammation. Blood CRPM levels have shown to be associated with disease activity and response to treatment in rheumatoid arthritis (RA). We investigated the level of blood CRPM in OA compared to RA using data from two phase III knee OA and two RA studies (N = 1591). Moreover, the association between CRPM levels and radiographic progression was investigated. The mean CRPM levels were significantly lower in OA (8.5 [95% CI 8.3–8.8] ng/mL, n = 781) compared to the RA patients (12.8 [9.5–16.0] ng/mL, n = 60); however, a significant subset of OA patients (31%) had CRPM levels (≥ 9 ng/mL) comparable to RA. Furthermore, OA patients (n = 152) with CRPM levels ≥ 9 ng/mL were more likely to develop contra-lateral knee OA assessed by X-ray over a two-year follow-up period with an odds ratio of 2.2 [1.0–4.7]. These data suggest that CRPM is a blood-based biochemical marker for early identification OA patients with an inflammatory phenotype.

scholarly journals Relationship between heavy metal exposure and type 2 diabetes: a large-scale retrospective cohort study using occupational health examinations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039541
Author(s):  
Jun Ho Ji ◽  
Mi Hyeon Jin ◽  
Jung-Hun Kang ◽  
Soon Il Lee ◽  
Suee Lee ◽  
...  
Keyword(s):  
Heavy Metals ◽  
Type 2 Diabetes ◽  
Heavy Metal ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Metal Exposure ◽  
Heavy Metal Exposure ◽  
Lead And Cadmium

ObjectivesTo investigate the associations between heavy metal exposure and serum ferritin levels, physical measurements and type 2 diabetes mellitus (DM).DesignA retrospective cohort study.SettingChangwon, the location of this study, is a Korean representative industrial city. Data were obtained from medical check-ups between 2002 and 2018.ParticipantsA total of 34 814 male subjects were included. Of them, 1035 subjects with lead exposure, 200 subjects with cadmium exposure and the 33 579 remaining were assigned to cohort A, cohort B and the control cohort, respectively. Data including personal history of alcohol and smoking, age, height, weight, the follow-up duration, haemoglobin A1c (HbA1c), fasting blood sugar (FBS), ferritin levels, and lead and cadmium levels within 1 year after exposure were collected.Primary outcome measureIn subjects without diabetes, changes in FBS and HbA1c were analysed through repeated tests at intervals of 1 year or longer after the occupational exposure to heavy metals.ResultsIn Cohort A, DM was diagnosed in 33 subjects. There was a significant difference in lead concentrations between the subjects diagnosed with DM and those without DM during the follow-up period (3.94±2.92 mg/dL vs 2.81±2.03 mg/dL, p=0.002). Simple exposure to heavy metals (lead and cadmium) was not associated with DM in Cox regression models (lead exposure (HR) 1.01, 95% CI: 0.58 to 1.77, p 0.971; cadmium exposure HR 1.48, 95% CI: 0.61 to 3.55, p=0.385). Annual changes in FBS according to lead concentration at the beginning of exposure showed a positive correlation (r=0.072, p=0.032).ConclusionOur findings demonstrated that simple occupational exposure to heavy metals lead and cadmium was not associated with the incidence of DM. However, lead concentrations at the beginning of the exposure might be an indicator of DM and glucose elevations.

scholarly journals Pioglitazone use and Parkinson’s disease: a retrospective cohort study in Taiwan

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023302 ◽  
Author(s):  
Hsiu-Feng Wu ◽  
Li-Ting Kao ◽  
Jui-Hu Shih ◽  
Hui-Han Kao ◽  
Yu-Ching Chou ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Asian Population ◽  
Secondary Outcome ◽  
Study Cohort ◽  
Patients With Diabetes

ObjectivesMany researchers have expected pioglitazone to serve as an effective neuroprotective agent against Parkinson’s disease (PD). Therefore, we conducted this cohort study to investigate the association between pioglitazone use and PD by using a large Asian population-based dataset in Taiwan.DesignRetrospective cohort study.SettingTaiwan.Participants7906 patients with diabetes who had received pioglitazone were defined as the study cohort, and 7906 matched patients with diabetes who had not received pioglitazone were defined as the comparison cohort.Primary and secondary outcome measuresWe tracked each patient individually over a 5-year follow-up period to identify those diagnosed as having PD during this period. We performed Cox proportional hazard regression analyses to evaluate the HRs for PD between the study and comparison cohorts.ResultsThe findings indicated that among the sampled patients, PD occurred in 257 (1.63%): 119 (1.51%) pioglitazone users and 138 (1.75%) non-users. The adjusted HR for PD within the follow-up period was 0.90 (95% CI: 0.68 to 1.18) in the patients who had received pioglitazone compared with the matched patients who had not received pioglitazone. Moreover, this study revealed that pioglitazone use was not associated with PD incidence in men (HR: 1.06, 95% CI: 0.71 to 1.59) or women (HR: 0.84, 95% CI: 0.61 to 1.15).ConclusionsThis study did not find the relationship between pioglitazone use and PD incidence, regardless of sex, among an Asian population of patients with diabetes.

scholarly journals Danish teleophthalmology platform reduces optometry referrals into the national eye care system

2021 ◽  
Vol 6 (1) ◽  
pp. e000671
Author(s):  
Danson Vasanthan Muttuvelu ◽  
Heidi Buchholt ◽  
Mads Nygaard ◽  
Marie Louise Roed Rasmussen ◽  
Dawn Sim
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Care Service ◽  
Posterior Segment ◽  
Eye Care ◽  
Use Of Technology ◽  
New Models ◽  
Electronic Referral ◽  
Care System

ObjectiveThe purpose of this study was to evaluate the stratification of follow-up and referral pathways after implementation of a systematic cloud-based electronic-referral teleophthalmological service for optometry-initiated ocular posterior segment disease referrals to the Danish national eye care system.Methods and AnalysisA retrospective cohort study was conducted in the period from 1 August 2018 to 31 July 2019. Patients with suspected ocular posterior segment disease reviewed by the telemedical ophthalmology service were included. The service stratified patients into the categories: no need for follow-up, follow-up by optometrist, follow-up by the telemedical service and referral to the national Danish eye care service.ResultsFrom a pool of 386 361 customers, 9938 patients were enrolled into this study. 19.5% of all patients were referred to the Danish national eye care system, while 80.5% of the patients in the telemedical service were not, in the period from 1 August 2018 to 31 July 2019. 14.4% of the optometrist referrals did not need any follow-up, while a majority of 66.1% needed some follow-up either by the optometrist themselves or within the telemedical service.ConclusionOptometrist posterior segment disease referrals can be considerably reduced with a risk stratified approach and optimal use of technology. New models can improve and streamline the healthcare system.

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