Mortality in American Veterans with the HLA-B27 Gene

Objective.To compare survival in American veterans with and without the HLA-B27 (B27) gene.Methods.Mortality was evaluated in a national cohort of veterans with clinically available B27 test results between October 1, 1999, and December 31, 2011. The primary outcome was the mortality difference between B27-positive and B27-negative veterans, adjusted for age, sex, race, and diagnoses codes for diseases that may have influenced both B27 testing and mortality, including psoriasis, inflammatory bowel disease, spondyloarthritis (SpA), and other types of inflammatory arthritis. The secondary outcomes were the adjusted mortality HR for B27+ and B27− veterans, in subgroups with and without SpA.Results.Among veterans with available B27 test results, 27,652 (84.7%) were B27− and 4978 (15.3%) were B27+. The mean followup time was 4.6 years. Mortality was higher in the B27+ group than in the B27− group (HR 1.15, 95% CI 1.03–1.27). Mortality was also higher in the B27+ subgroups with SpA (HR 1.35, 95% CI 1.06–1.72) and without SpA (HR 1.11, 95% CI 0.99–1.24), but the difference was significant only in the subgroup with SpA.Conclusion.B27 positivity was associated with an increased mortality rate in a cohort of veterans clinically selected for B27 testing, after adjustment for SpA. In the subgroup with SpA, the mortality rate was associated with B27 positivity, and in the subgroup without SpA, there was a nonsignificant association between B27+ and mortality.

Download Full-text

Efficacy of intravitreal conbercept injection in the treatment of retinopathy of prematurity

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311662 ◽

2018 ◽

Vol 103 (4) ◽

pp. 494-498 ◽

Cited By ~ 4

Author(s):

Yichen Bai ◽

Huanjie Nie ◽

Shiyu Wei ◽

Xiaohe Lu ◽

Xiaoyun Ke ◽

...

Keyword(s):

Retinopathy Of Prematurity ◽

Laser Photocoagulation ◽

Primary Outcome ◽

Safety And Efficacy ◽

Postmenstrual Age ◽

Zone Ii ◽

The Mean ◽

Secondary Outcomes ◽

Number Of Injections

BackgroundTo evaluate the safety and efficacy of intravitreal conbercept (IVC) injection in the treatment of retinopathy of prematurity (ROP).MethodsPatients with ROP who underwent IVC injection in Zhujiang Hospital from June 2015 to July 2016 were studied retrospectively. The primary outcome was defined as the regression of plus disease. The secondary outcomes were defined as the presence of recurrence, number of injections and the final regression of disease.ResultsA total of 48 eyes of 24 patients with ROP were included. Among them, 9 eyes of 5 patients had zone I ROP, 35 eyes of 18 patients had zone II ROP and 4 eyes of 2 patients had aggressive posterior ROP. The mean gestational age was 28.5±1.6 weeks, the mean birth weight was 1209.6±228.6 g, the mean postmenstrual age of first injection was 34.2±1.9 weeks and the mean follow-up period was 31.0±4.7 weeks. Forty of 48 eyes (83.3%) received IVC only once, and the regression of plus disease occurred at an average of 3.5±1.5 weeks after the first injection of conbercept. For eight recurrent eyes (16.7%), four eyes received a second IVC and the remaining four eyes received laser photocoagulation, and the regression of plus disease occurred in 3 weeks. No lens opacity, vitreous haemorrhage, entophthalmia or retinal detachment was observed during follow-up.ConclusionIVC injection is an effective treatment for ROP.

Download Full-text

Binocular game versus part-time patching for treatment of anisometropic amblyopia in Chinese children: a randomised clinical trial

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313815 ◽

2019 ◽

Vol 104 (3) ◽

pp. 369-375

Author(s):

Jing Yao ◽

Hye-Won Moon ◽

Xiaomei Qu

Keyword(s):

Clinical Trial ◽

Primary Outcome ◽

Randomised Clinical Trial ◽

Chinese Children ◽

Interocular Suppression ◽

Anisometropic Amblyopia ◽

Minimum Angle ◽

Part Time ◽

Secondary Outcomes ◽

The Difference

AimsTo compare amblyopic-eye visual acuity (VA) and binocularity improvement of a binocular game with part-time patching in the treatment of Chinese children with anisometropic amblyopia.Methods103 Chinese children aged 3–13 years with anisometropic amblyopia were recruited in a randomised clinical trial. Eligible participants were randomly assigned to the binocular, patching and combined groups. Primary outcome was amblyopic-eye VA improvement at 3 months. Secondary outcomes included reduction of suppression and change of stereoacuity.ResultsOf 85 completed participants, 44 (52%) were women and mean (SD) age was 5.99 (2.33) years. At 3 months, mean (95% CI) amblyopic-eye VA improved 0.18 (0.10–0.26), 0.28 (0.19–0.36) and 0.30 (0.21–0.39) logarithm of the minimum angle of resolution in the binocular, patching and combined groups, respectively. After adjusting for baseline VA, the difference was statistically significant (F=6.29, p=0.003), favouring as follows: the combined group, the patching group and the binocular group. After treatment, Titmus (x2binocular=9.75, p=0.007; x2combined=9.35, p=0.009) and dynamic stereoacuity (x2binocular=12.56, p=0.01; x2combined=12.66, p=0.01) improved only in the binocular and combined groups. Among groups, only Titmus improvement differed significantly (F=49.55, p<0.001). Changes of other types of stereoacuity and interocular suppression were similar.ConclusionsThe binocular game used in this study could improve amblyopic-eye VA and binocularity in Chinese children with anisometropic amblyopia, but it was less effective than patching in amblyopic-eye VA improvement and showed no superiority in binocularity over patching. It remains unclear whether the low treatment response of this binocular game was due to limitations of the study or its low treatment effect.

Download Full-text

Salbutamol nebulization for management of transient tachypnea of newborn (TTN).

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.01.4614 ◽

2021 ◽

Vol 28 (01) ◽

pp. 52-59

Author(s):

Fatima Maroof ◽

Tehmina Maqbool ◽

Hafiz Muhammad Irfan ◽

Beenish Bashir Mughal ◽

Ayesha ◽

...

Keyword(s):

Placebo Group ◽

Respiratory Rate ◽

Test Results ◽

Demographic Information ◽

Significant Difference ◽

Nebulized Salbutamol ◽

The Mean ◽

Randomized Control ◽

The Difference ◽

Trial Setting

Objective: To compare the mean change in respiratory rate with salbutamol nebulization versus placebo for treatment of transient tacyopnea of newborn. Study Design: Randomized Control Trial. Setting: Department of Neonatology, Federal Government Polyclinic (PGMI), Islamabad. Period: 8th August 2017 to 7th February 2018. Material & Methods: 100 neonates fulfilling selection criteria were enrolled in the study. Informed consent was obtained from parents. Demographic information was also noted. All baseline respiratory rate were noted. Neonates were divided into two groups by lottery method. Neonates in Treatment group were nebulized with Salbutamol. Placebo group was nebulized with Normal Saline. Then neonates were followed-up in N.I.C.U after 4 hours of second nebulization. After 4 hours, respiratory rates were assessed and change in respiratory rate was noted. Both groups were compared for mean reduction in respiratory rate by using independent sample t-test. Results: In nebulized salbutamol, group, mean respiratory rate was changed from 79.62±8.18bpm to 52.06±4.96bpm. This was a significant decrease (p<0.05). In placebo group, mean respiratory rate was changed from 81.88±8.86bpm to 62.50±6.75bpm. This was significant decrease (p<0.05). The difference between both groups at baseline was insignificant while after 4 hours was significant. The mean changed in respiratory rate with nebulized salbutamol was 27.56±6.83bpm while with placebo was 19.35±9.83bpm. There was significant difference in mean reduction in respiratory rate (p<0.05). Conclusion: It has been proved that nebulized salbutamol can be helpful in reducing respiratory rate significantly in neonates with TTN as compared to placebo.

Download Full-text

Evaluation of Levetiracetam for Early Post-Traumatic Seizure Prophylaxis: A Level II Trauma Center Experience

10.21203/rs.3.rs-1075454/v1 ◽

2021 ◽

Author(s):

Timothy A. Amin ◽

Steven F. Nerenberg ◽

Osama A. Elsawy ◽

Antai Wang ◽

Jackie P. Johnston

Keyword(s):

Trauma Center ◽

Chart Review ◽

Primary Outcome ◽

Retrospective Chart Review ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Level Ii ◽

Post Traumatic ◽

The Mean ◽

Secondary Outcomes

Abstract Background: Traumatic brain injury (TBI) can induce early or late post-traumatic seizures (PTS). While PTS incidence is low, prophylaxis is used despite a lack of consensus on agent or duration. Levetiracetam (LEV) for early PTS prophylaxis is preferred due to its safety and efficacy. The purpose of this study was to evaluate LEV for early PTS prophylaxis.Methods: A single-center, retrospective chart review of TBI patients > 18 years who received LEV for early PTS prophylaxis between August 2018 - July 2019. The primary outcome was LEV duration. Secondary outcomes were incidence of seizure, intensive care unit (ICU) and hospital length of stay (LOS).Results: Of the 137 included, mean age was 59±20 years and 69.3% were male. The mean admission GCS was 13±4 and 77.4% had mild TBI. Median LEV duration was 7 (IQR 4-10) days and 13.9% met recommended 7-day duration. Those prescribed LEV > 7 days had more than twice the median LEV duration than those prescribed ≤ 7 days (10.25 (8.5-15.5) vs 4 (1.5-4.5) days, p < 0.0001). EEG-confirmed PTS occurred in 2.2%, with an early PTS incidence of 0.73%. Median ICU and hospital LOS were 2 (IQR 1-7) and 7 (IQR 3-16) days, respectively. Conclusions: The incidence of PTS was low as most patients in our study had mild or moderate TBI. Early PTS prophylaxis with LEV for 7 days is appropriate, although the majority of patients did not meet the recommended duration. Efforts to standardize and implement PTS prophylaxis protocols are needed.

Download Full-text

Effectiveness and tolerability of oral versus subcutaneous methotrexate in patients with rheumatoid arthritis

Rheumatology ◽

10.1093/rheumatology/keab313 ◽

2021 ◽

Author(s):

Janne Heuvelmans ◽

Nathan den Broeder ◽

Geke A H van den Elsen ◽

Alfons A den Broeder ◽

Bart J F van den Bemt

Keyword(s):

Rheumatoid Arthritis ◽

Retrospective Cohort ◽

Primary Outcome ◽

Real Life ◽

Treat To Target ◽

Oral Methotrexate ◽

Real Life Setting ◽

Significant Difference ◽

The Mean ◽

Secondary Outcomes

Abstract Objectives The aim of this study was to compare the effectiveness and tolerability between oral methotrexate (MTX) and subcutaneous MTX in a large group of rheumatoid arthritis (RA) patients in a real-life setting. Methods In this retrospective cohort study, adult patients with clinical diagnosis of RA who started MTX treatment (monotherapy or combined with hydroxychloroquine), either started with oral or subcutaneous MTX. The primary outcome was superiority testing of between group difference in change in DAS28CRP between baseline and 3–6 months, and subsequent non inferiority testing (NI margin 0.6) analyses in case of non-superiority. Secondary outcomes included MTX dose, side effects, laboratory abnormalities, and use of comedication. Results 640 RA patients were included: 259 started with oral MTX and 381 with subcutaneous. There was no significant difference in ΔDAS28CRP, after adjusting for confounding, 0.13 (95%-CI: -0.14, 0.40), and oral MTX strategy was non inferior to subcutaneous. The mean MTX dose was slightly lower for the oral strategy (18.0 SD6.9 vs 19.9 SD8.2, p= 0.002), which was accompanied by a lower cumulative incidence of adverse events (41% vs 52%, p= 0.005). No differences were seen in use of other comedication. Conclusions Starting with oral MTX in RA in a real-life setting is non inferior to a subcutaneous MTX treatment with regard to disease activity control, at least when used in dosages up to 25 mg and on a background of HCQ cotreatment and a treat-to-target approach. In addition, tolerability was better. This supports the strategy of starting with oral MTX.

Download Full-text

International normalized ratio (INR) testing in Europe: between-laboratory comparability of test results obtained by Quick and Owren reagents

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0976 ◽

2018 ◽

Vol 56 (10) ◽

pp. 1698-1703 ◽

Cited By ~ 3

Author(s):

Piet Meijer ◽

Karin Kynde ◽

Antonius M.H.P. van den Besselaar ◽

Marjan Van Blerk ◽

Timothy A.L. Woods

Keyword(s):

Plasma Sample ◽

International Normalized Ratio ◽

Test Results ◽

Local Calibration ◽

The Mean ◽

The Difference ◽

Clinically Significant ◽

Single Plasma ◽

Better Than

Abstract Background: This study was designed to obtain an overview of the analytical quality of the prothrombin time, reported as international normalized ratio (INR) and to assess the variation of INR results between European laboratories, the difference between Quick-type and Owren-type methods and the effect of using local INR calibration or not. In addition, we assessed the variation in INR results obtained for a single donation in comparison with a pool of several plasmas. Methods: A set of four different lyophilized plasma samples were distributed via national EQA organizations to participating laboratories for INR measurement. Results: Between-laboratory variation was lower in the Owren group than in the Quick group (on average: 6.7% vs. 8.1%, respectively). Differences in the mean INR value between the Owren and Quick group were relatively small (<0.20 INR). Between-laboratory variation was lower after local INR calibration (CV: 6.7% vs. 8.6%). For laboratories performing local calibration, the between-laboratory variation was quite similar for the Owren and Quick group (on average: 6.5% and 6.7%, respectively). Clinically significant differences in INR results (difference in INR>0.5) were observed between different reagents. No systematic significant differences in the between-laboratory variation for a single-plasma sample and a pooled plasma sample were observed. Conclusions: The comparability for laboratories using local calibration of their thromboplastin reagent is better than for laboratories not performing local calibration. Implementing local calibration is strongly recommended for the measurement of INR.

Download Full-text

Incremental Absenteeism Due to Headaches in Migraine: Results from the Mig-Access French National Cohort

Cephalalgia ◽

10.1046/j.1468-2982.1999.019005503.x ◽

1999 ◽

Vol 19 (5) ◽

pp. 503-510 ◽

Cited By ~ 37

Author(s):

P Michel ◽

JF Dartigues ◽

G Duru ◽

J Moreau ◽

R Salamon ◽

...

Keyword(s):

Community Dwelling ◽

Annual Number ◽

Work Situation ◽

Medical Reason ◽

Two Samples ◽

Related Absenteeism ◽

National Cohort ◽

The Mean ◽

The Difference

Objective To assess the costs of headache-related absenteeism of community-dwelling migraineurs, and to compare the amount of absenteeism between migraineurs aged 18 and older and age, sex, and occupation-matched nonheadache-prone subjects. Design Follow-up over a 3-month period. Samples 385 migraineurs and 313 nonheadache subjects representative of the setting. Methods Every day, the participants recorded the presence of headache, if any, and the work situation (unemployment, holiday, weekend, medical reason, nonmedical reason). Sickness-related absenteeism was the number of workdays missed or interrupted for medical reasons. Headache-related absenteeism was the sickness-related absenteeism during workdays with headaches. The annual headache-related absenteeism costs in France were extrapolated from these data in accordance with the mean income per occupational category. The incremental absenteeism and related costs were the difference between the two samples. Results Of working migraineurs, 20% had at least one period of absenteeism. During the 3 months, they missed or interrupted on average 1.4 days for medical reasons, 0.25 of which for headaches. Sickness-related absenteeism was statistically higher in migraineurs than in nonheadache-prone subjects. This difference was due to a higher absenteeism for comorbidity reasons, not for headache reasons, representing 20% of all sickness-related absenteeism. Migraineurs avoided sick leave for headache reasons. As an incremental total, 1.68 days or approximately 0.7% of the annual number of working days are lost on average per individual with migraine. The annual incremental headache-related absenteeism cost was 5.22 billions, i.e. 1,551 FF (US$240) per migraineur.

Download Full-text

Perbedaan Pengaruh Antara Penggunaan Abm Kruk Dengan Prostesis Terhadap Mobilitas Pasien Pasca Amputasi Transtibial

Interest : Jurnal Ilmu Kesehatan ◽

10.37341/interest.v8i1.116 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Yopi Harwinanda Ardesa ◽

Cica Tri Mandasari Ningsih

Keyword(s):

Research Design ◽

Comparison Group ◽

Statistical Test ◽

P Value ◽

Test Results ◽

Patient Mobility ◽

Transtibial Amputation ◽

Group Research ◽

The Mean ◽

The Difference

Background: To know the difference between using crutches utch and prosthesis on patient mobility after transtibial amputation, Research Design is a type of pre-experimental study with static comparison group research design. The subjects of this study were transtibial amputation patients divided into two groups. Each group consists of 15 people. Methods: The type of group in this study is a paired group in which one person gets two treatments. PT Kuspito Ortotik Prostetik Karanganyar, Time: June to October 2017. One person gets two treatments in the form of Kruk and prosthesis, prosthesis user will be tested with AMPpro test and Kruk user usage will be tested using AMPnopro, Measurements: AMPpro 20 test and AMPnopro 21 test, different test with Wilcoxon Signed Ranks Test. Results: Showed an average balance in the crutches group (15,32) while the mean balance was in the prosthesis group (45,38). The result of the statistical test with man Whitney shows p-value 0,000 <0,05 so there is a difference in the effect of crutch and prosthesis on patient mobility after transtibial amputation. Conclusion: The results of this study indicate that there is a difference between the use of Kruk and the prosthesis of mobility, the mobility of the prosthesis user has a higher level at the level of k-4, while the Kruk level is the k-3 level.

Download Full-text

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Journal of Fungi ◽

10.3390/jof7110985 ◽

2021 ◽

Vol 7 (11) ◽

pp. 985

Author(s):

Salman Hussain ◽

Abanoub Riad ◽

Ambrish Singh ◽

Jitka Klugarová ◽

Benny Antony ◽

...

Keyword(s):

Mortality Rate ◽

Selection Criteria ◽

Primary Outcome ◽

Meta Analysis ◽

Epidemiological Studies ◽

Pooled Prevalence ◽

All Cause Mortality ◽

The Mean ◽

Pooled Sample ◽

Humanistic Burden

Mucormycosis, a secondary fungal infection, gained much attention in the ongoing COVID-19 pandemic. This deadly infection has a high all-cause mortality rate and imposes a significant economic, epidemiological, and humanistic burden on the patients and healthcare system. Evidence from the published epidemiological studies showed the varying prevalence of COVID-19-associated mucormycosis (CAM). This study aims to compute the pooled prevalence of CAM and other associated clinical outcomes. MEDLINE, Embase, Cochrane COVID-19 Study Register, and WHO COVID-19 databases were scanned to retrieve the relevant articles until August 2021. All studies reporting the prevalence of mucormycosis among COVID-19 patients were eligible for inclusion. Two investigators independently screened the articles against the selection criteria, extracted the data, and performed the quality assessment using the JBI tool. The pooled prevalence of CAM was the primary outcome, and the pooled prevalence of diabetes, steroid exposure, and the mortality rate were the secondary outcomes of interest. Comprehensive Meta-Analysis software version 2 was used for performing the meta-analysis. This meta-analysis comprised six studies with a pooled sample size of 52,916 COVID-19 patients with a mean age of 62.12 ± 9.69 years. The mean duration of mucormycosis onset was 14.59 ± 6.88 days after the COVID-19 diagnosis. The pooled prevalence of CAM (seven cases per 1000 patients) was 50 times higher than the highest recorded background of mucormycosis (0.14 cases per 1000 patients). A high mortality rate was found among CAM patients with a pooled prevalence rate of 29.6% (95% CI: 17.2–45.9%). Optimal glycemic control and the judicious use of steroids should be the approach for tackling rising CAM cases.

Download Full-text

Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness

BMJ ◽

10.1136/bmj.k1332 ◽

2018 ◽

pp. k1332 ◽

Cited By ~ 16

Author(s):

Miriam Santer ◽

Matthew J Ridd ◽

Nick A Francis ◽

Beth Stuart ◽

Kate Rumsby ◽

...

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Topical Corticosteroid ◽

Primary Outcome ◽

Control Group ◽

Significant Difference ◽

The Mean ◽

Secondary Outcomes ◽

Bath Additives

AbstractObjectivesTo determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children.DesignPragmatic randomised open label superiority trial with two parallel groups.Setting96 general practices in Wales and western and southern England.Participants483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded.InterventionsParticipants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants.Main outcome measuresThe primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed.Results483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score over the 16 week period was 7.5 (SD. 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group (95% confidence interval −0.27 to 1.10), below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects.ConclusionsThis trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes.Trial registrationCurrent Controlled Trials ISRCTN84102309.

Download Full-text