Ischemic Digital Ulcers Affect Hand Disability and Pain in Systemic Sclerosis

Objective.Ischemic digital ulcers (DU) are frequent and severe complications of systemic sclerosis (SSc). The purpose of our study was to assess the effect of DU on hand disability and pain in patients with SSc.Methods.The Evaluation of the Impact of Recurrent Ischemic DU on Hand Disability in Patients with SSc (ECLIPSE) is a prospective, multicenter, noninterventional study with a 2-year followup. Patients with SSc who experienced at least 1 DU in the previous year and received bosentan therapy were included between October 2009 and March 2011. This cohort is described at the time of inclusion.Results.There were 190 patients (132 females) from 53 centers. Mean age ± SD was 43 ± 15 years at SSc diagnosis and 53 ± 15 years at inclusion. In 105 patients (56.2%), DU were the first non-Raynaud symptoms of SSc. The mean time interval between the occurrence of Raynaud phenomenon and the first DU episode was 6.6 ± 9.1 years. The mean numbers of active DU and fingers affected per patient for both hands were 2.3 ± 1.8 and 2.2 ± 1.6, respectively. Presence of active DU at inclusion was significantly associated with pain and impaired hand function: Visual Analog Scale for pain (0 to 10) was 6.2 ± 2.6 versus 2.5 ± 2.4 (p < 0.0001) and Cochin Hand Function Scale for hand disability (0 to 90) was 38 ± 20 versus 25 ± 19 (p < 0.0001), respectively.Conclusion.DU represent a major sign of SSc, often affecting multiple fingers and both hands. They are significantly associated with pain and hand disability.

Download Full-text

O-146 Assessment of focal and diffuse adenomyosis lesions before and after pregnancy on magnetic resonance imaging : a cohort of 139 patients

Human Reproduction ◽

10.1093/humrep/deab127.014 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

L Legay ◽

L Marcellin ◽

P Santulli ◽

A E Millischer ◽

C Bordonne ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Time Interval ◽

Resonance Imaging ◽

Junctional Zone ◽

Pelvic Magnetic Resonance Imaging ◽

Before And After ◽

The Mean ◽

The Impact ◽

Mean Time

Abstract Study question How to assess the different adenomyosis phenotype before and after pregnancy on magnetic resonance imaging according to stringent validated criteria ? Summary answer Diffuse adenomyosis increases significantly after pregnancy while the rate of focal adenomyosis and the mean volume of focal adenomyosis lesions decrease significantly after pregnancy. What is known already Adenomyosis and endometriosis are benign hormone-dependent disorders associated with pelvic pain, dysmenorrhea and/or infertility. The natural course of adenomyosis and endometriosis is still unclear, particularly during pregnancy. Pregnancy is considered to have a positive impact on endometriosis. Several studies regarding the impact of adenomyosis on pregnancy are available. Adenomyosis can cause fertility disorders, miscarriage, preterm birth. However, available data evaluating the effect of pregnancy on adenomyosis are lacking. Study design, size, duration Between January 1st 2010 and September 30th 2020, 139 patients were followed in our referral care center (Gynecology department of Port-Royal Hospital, Paris) for symptomatic adenomyosis and or endometriosis. For each of them, a magnetic resonance imaging were performed before and after pregnancy. The data based on magnetic resonance imaging, pre- and post-pregnancy, were analyzed in a single retrospective study. Participants/materials, setting, methods Patients had to be over 18 years old, to be pregnant and to be followed for symptomatic adenomyosis or endometriosis without any previous surgery. Each pelvic magnetic resonance imaging were performed by a single experienced radiologist. The protocol was identical on a 1.5 T magnetic resonance imaging machine based on validated criteria. The rate of diffuse and focal adenomyosis, the volume of focal adenomyosis lesions and the thickness of maximal junctional zone were reported. Main results and the role of chance The mean age of patients was 34.6 ± 3.4 years old, 83 (59.7%) of patients underwent assisted reproductive technology to be pregnant. The mean time interval between the MRI and the delivery was 55.2 months and the mean time interval between the delivery and the MRI was 32.2 months. Before pregnancy, there was 96 (69.1%) patients with adenomyosis, all phenotype combined versus 111 (79.9%) after pregnancy (p = 0.04) on magnetic resonance imaging. The rate of diffuse adenomyosis increased significantly on magnetic resonance imaging after pregnancy compared to before pregnancy (n = 22 (15.8%) vs n = 41 (29.5%), p = 0.01). The thickness of junctional zone maximal was significantly higher after pregnancy (8.0 mm ± 5.1 vs 12.0 mm ± 4.8, p < 0.01). The rate of focal adenomyosis (n = 55 (39.6) vs n = 34 (24.5), p = 0.01) as well as the volume of focal adenomyosis lesions (6.7 mm3 2.5± vs 6.4 mm3 ± 2.3, p < 0.01) decreased significantly after pregnancy on magnetic resonance imaging. Limitations, reasons for caution This single-center study was conducted in a referral center whom patients presented more severe forms of adenomyosis, which could have affected the external validity of this study. The mean time interval between delivery and MRI was 32.2 month which implies a short follow up period to observe long term outcomes. Wider implications of the findings The hypothesis that a specific hormonal environment during pregnancy may imply a positively impact of the evolution of focal adenomyosis is raised by this study. The evolution of focal adenomyosis after pregnancy is similar to the evolution of endometriosis lesions volume that support shared etiopathogenic mechanisms between the two entities. Trial registration number ‘not applicable’

Download Full-text

Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.094193 ◽

2009 ◽

Vol 69 (01) ◽

pp. 214-217 ◽

Cited By ~ 93

Author(s):

L Mouthon ◽

C Mestre-Stanislas ◽

A Bérezné ◽

F Rannou ◽

P Guilpain ◽

...

Keyword(s):

Quality Of Life ◽

Systemic Sclerosis ◽

Hand Function ◽

Digital Ulcers ◽

Health Related Quality ◽

Disability And Health ◽

Related Quality ◽

Health Related ◽

The Impact

Objective:To assess the impact of digital ulcers (DUs) on disability and health-related quality of life (HRQoL) in systemic sclerosis (SSc).Methods:Two hundred and thirteen patients with SSc were evaluated at four annual meetings of a patient society between 2004 and 2007 (n = 177) or during hospital stay (n = 36). HRQoL was assessed by the SF-36, global disability by the health assessment questionnaire (HAQ), hand disability by the Cochin Hand Function Scale (CHFS) and global hand and wrist mobility by the Kapandji index.Results:Sixty-seven patients (31.4%) had at least one DU at the time of evaluation. Patients with DUs showed significantly more pitting scars (p<0.001) and calcinosis (p<0.0001) than others. Patients with DU had significantly greater HAQ (mean (SD) 1.218 (0.723) vs 0.930 (0.717), p = 0.008), CHFS (mean (SD) 27.38 (20.68) vs 16.73 (18.19), p<0.0001) and aesthetic prejudice (mean (SD) 6.1 (2.2) vs 3.9 (2.5), p<0.0001) scores than others. Hand and wrist mobility were significantly diminished in patients with DU (mean (SD) Kapandji score 75.3 (22.8) vs 81.7 (19.2), p<0.0001). The presence of a DU did not significantly alter the physical component but influenced the mental component (mean (SD) 43.38 (12.53) vs 39.58 (9.54), p = 0.026) of the SF36.Conclusion:Patients with SSc with DUs have reduced wrist and hand mobility, increased global and hand disabilities and decreased mental component of HRQoL.

Download Full-text

The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

Download Full-text

Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

Hospital Pharmacy ◽

10.1177/00185787211037540 ◽

2021 ◽

pp. 001857872110375

Author(s):

Frank A. Fanizza ◽

Jennifer Loucks ◽

Angelica Berni ◽

Meera Shah ◽

Dennis Grauer ◽

...

Keyword(s):

Hepatitis C ◽

Medication Adherence ◽

Hcv Treatment ◽

Clinical Pharmacists ◽

The Mean ◽

Group 2 ◽

Cure Rates ◽

The Impact ◽

Mean Time ◽

Group 1

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

Download Full-text

Telephone Calls to an Infectious Diseases Fellow

PEDIATRICS ◽

10.1542/peds.95.5.753 ◽

1995 ◽

Vol 95 (5) ◽

pp. 753-754

Author(s):

Mark F. Cotton

Keyword(s):

Infectious Disease ◽

Infectious Diseases ◽

Time Allocation ◽

Primary Care Physicians ◽

First Year ◽

Educational Value ◽

The Mean ◽

Telephone Calls ◽

The Impact ◽

Mean Time

Objective. There is no information on the impact and nature of telephone calls directed to subspecialists. The main objective was to document prospectively all calls directed to a first-year infectious diseases fellow, to determine their content, origin, educational value, and time allocation. Results. Three hundred fifty-nine calls were received over a 71-day period from March 24 through May 20, 1992. The mean number of daily calls was 5.1 ± 3.3. Mean time per call was 7 ± 5.4 minutes. Cumulatively, 41.7 hours were spent responding to telephone calls. The subgroup with the most calls (44.3%) was from pediatricians in practice. Seventy percent of calls were for advice about case management. Forty percent of calls were considered educational to the fellow. Conclusions. This study confirms the importance of the infectious disease subspecialist as a resource for primary care physicians.

Download Full-text

Time Intervals From Onset of Clinical Manifestations to Treatment in Patients With Cancer at Hospital General San Felipe, Tegucigalpa, Honduras

Journal of Global Oncology ◽

10.1200/jgo.19.00107 ◽

2019 ◽

pp. 1-7

Author(s):

José A. Sánchez ◽

Mayra G. Handal ◽

Juan F. Vílchez Rodriguez ◽

Sinthia I. Mejía ◽

Annye P. Pagoaga

Keyword(s):

Clinical Manifestations ◽

Cross Sectional Study ◽

Clinical Staging ◽

Time Interval ◽

Pathology Report ◽

Time Intervals ◽

Cross Sectional ◽

Patients With Cancer ◽

The Mean ◽

Mean Time

PURPOSE In cancer, clinical staging is related to outcomes, and this is linked to the evolution of the disease over time. In Honduras, cancer mortality is high, and time intervals from onset of symptoms to treatment of cancer are not known. We conducted a cross-sectional study to determine these intervals. PATIENTS AND METHODS This investigation was carried out from April 25 to August 30, 2018, and included 202 patients at the main cancer referral center in Honduras. For the purposes of the study, information was obtained from patients, their caregiver, medical records, or treatment cards. Patients older than age 18 years were included after informed consent was signed. RESULTS The mean time interval from onset of symptoms to cancer treatment was 232 days. Different intervals of time were identified, and the mean of these intervals was calculated in days as follows: 68 days from onset of symptoms to first medical evaluation; 146 days from first evaluation to oncologist consultation; 26 days from cancer specialist to the pathology report; and 86 days from the histopathologic diagnosis to the beginning of treatment. Once diagnosis was established, the average elapsed times to chemotherapy, radiotherapy, surgery, and chemoradiotherapy were 88, 102, 76, and 154 days, respectively ( P < .05, when surgery is compared against chemotherapy and radiotherapy). CONCLUSION The mean time interval from symptom presentation to treatment in patients with cancer is more than 7 months. This could explain the advanced stages of disease seen at the time of treatment in Honduras, which decrease chance of cure and increase the mortality rate of cancer). Appropriate intervention to decrease these intervals must be taken to reduce mortality.

Download Full-text

Recovery of Adrenal Insufficiency Is Frequent After Adjuvant Mitotane Therapy in Patients with Adrenocortical Carcinoma

Cancers ◽

10.3390/cancers12030639 ◽

2020 ◽

Vol 12 (3) ◽

pp. 639 ◽

Cited By ~ 4

Author(s):

Jonathan Poirier ◽

Nadia Gagnon ◽

Massimo Terzolo ◽

Soraya Puglisi ◽

Nada El Ghorayeb ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Hpa Axis ◽

Complete Recovery ◽

Time Interval ◽

Zona Fasciculata ◽

Adrenocortical Cancer ◽

Hormonal Profile ◽

Chronic Therapy ◽

The Mean ◽

Mean Time

Mitotane is a steroidogenesis inhibitor and adrenolytic drug used for treatment of adrenocortical cancer (ACC). Mitotane therapy causes adrenal insufficiency requiring glucocorticoid replacement in all patients. However, it is unclear whether chronic therapy with mitotane induces complete destruction of zona fasciculata and whether hypothalamic-pituitary-adrenal (HPA) axis can recover after treatment cessation. Our objective was to assess the HPA axis recovery in a cohort of patients after cessation of adjuvant mitotane therapy for ACC. We retrospectively reviewed patient files with stage I-II-III ACC in two referral centers in Canada and Italy. Data on demographics, tumor characteristics, hormonal profile, and HPA axis were collected. Data from 23 patients with pathologically proven ACC treated with adjuvant mitotane for a minimum of two years were analyzed. Eight patients were males and 15 were females and the median age was 41 years old (range 18 to 73). After mitotane cessation, 18/23 (78.3%) patients achieved a complete HPA axis recovery while 3/23 (13.0%) were unable to tolerate glucocorticoid withdrawal despite having normal hormonal test values and 2/23 (8.7%) never achieved recovery. The mean time interval between mitotane cessation and HPA axis recovery was 2.7 years. A high proportion of patients achieved HPA axis recovery following cessation of mitotane adjuvant therapy. However, complete recovery was often delayed up to 2.5 years and regular assessment of the hormonal profile is required.

Download Full-text

How promptly nonindustrial private forest landowners regenerate their lands after harvest: a duration analysis

Canadian Journal of Forest Research ◽

10.1139/x08-058 ◽

2008 ◽

Vol 38 (8) ◽

pp. 2109-2117 ◽

Cited By ~ 2

Author(s):

Xing Sun ◽

Ian A. Munn ◽

Changyou Sun ◽

Anwar Hussain

Keyword(s):

Duration Analysis ◽

Time Interval ◽

Private Forest ◽

Forest Types ◽

Forest Landowners ◽

Factors Associated ◽

The Mean ◽

Nonindustrial Private Forest ◽

Mean Time ◽

Private Forest Landowners

Understanding factors that influence how promptly landowners regenerate their timberlands after harvest, if at all, is critical to developing policies to improve forest productivity. Mississippi forest landowners with over 100 acres (1 acre = 0.404 ha) of forestland were surveyed in 2006 to collect harvest and regeneration data from 1996 to 2006. This study investigated the length of the time interval between harvest and reforestation. Nonparametric duration analysis was used to examine how long nonindustrial private forest landowners waited to reforest after harvesting. Parametric duration analysis was used to examine factors that influenced the length of this period. The mean time elapsed from harvest to regeneration was 11 months for landowners that regenerated their lands. The instantaneous probability of regeneration reached its highest value in the 16th month after harvest and, thereafter, decreased steadily until the 28th month, after which the probability of regeneration was essentially nil. Interest in timber production, employing a consultant, and ownerships that were predominantly pine forest types were factors associated with substantially shorter reforestation times. Lower stumpage prices and higher reforestation costs were associated with substantially longer reforestation times.

Download Full-text

An Adaptive and Time-Efficient ECG R-Peak Detection Algorithm

Journal of Healthcare Engineering ◽

10.1155/2017/5980541 ◽

2017 ◽

Vol 2017 ◽

pp. 1-14 ◽

Cited By ~ 18

Author(s):

Qin Qin ◽

Jianqing Li ◽

Yinggao Yue ◽

Chengyu Liu

Keyword(s):

Detection Algorithm ◽

Peak Detection ◽

Time Interval ◽

Detection Accuracy ◽

Ecg Signal ◽

Peak Detection Algorithm ◽

Wavelet Multiresolution Analysis ◽

The Mean ◽

Electrocardiogram Ecg ◽

Mean Time

R-peak detection is crucial in electrocardiogram (ECG) signal analysis. This study proposed an adaptive and time-efficient R-peak detection algorithm for ECG processing. First, wavelet multiresolution analysis was applied to enhance the ECG signal representation. Then, ECG was mirrored to convert large negative R-peaks to positive ones. After that, local maximums were calculated by the first-order forward differential approach and were truncated by the amplitude and time interval thresholds to locate the R-peaks. The algorithm performances, including detection accuracy and time consumption, were tested on the MIT-BIH arrhythmia database and the QT database. Experimental results showed that the proposed algorithm achieved mean sensitivity of 99.39%, positive predictivity of 99.49%, and accuracy of 98.89% on the MIT-BIH arrhythmia database and 99.83%, 99.90%, and 99.73%, respectively, on the QT database. By processing one ECG record, the mean time consumptions were 0.872 s and 0.763 s for the MIT-BIH arrhythmia database and QT database, respectively, yielding 30.6% and 32.9% of time reduction compared to the traditional Pan-Tompkins method.

Download Full-text

The impact of stroke on people living in central Uganda: A descriptive study

African Journal of Disability ◽

10.4102/ajod.v7i0.438 ◽

2018 ◽

Vol 7 ◽

Cited By ~ 1

Author(s):

Julius T. Kamwesiga ◽

Lena K. Von Kock ◽

Gunilla M. Eriksson ◽

Susanne G.E. Guidetti

Keyword(s):

Everyday Life ◽

Urban Areas ◽

Clinical Characteristics ◽

Hand Function ◽

Chronic Phase ◽

Mulago Hospital ◽

Stroke Severity ◽

Cross Sectional ◽

The Mean ◽

The Impact

Background: Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions.Objectives: To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda.Method: A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation.Results: The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample.Conclusion: People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

Download Full-text