Incidence and Predictive Factors for Orthopedic Surgery in Patients with Psoriatic Arthritis

Objective.To investigate the incidence of orthopedic procedures in patients with psoriatic arthritis (PsA), and how patient characteristics, time of diagnosis, and treatment affect the need for surgery.Methods.We reviewed the medical history of 1432 patients with possible PsA at Haukeland University Hospital in Bergen, Norway. There were 590 patients (mean age 49 yrs, 52% women) who had sufficient journal information and a confirmed diagnosis of PsA, and who were included in the present study. Relevant orthopedic procedures were obtained from the hospital’s administrative patient records. Survival analyses were completed to evaluate the effect of different factors such as year of diagnosis, age, sex, radiographic changes, disease activity, and treatment, on the risk of surgery.Results.There were 171 procedures (25% synovectomies, 15% arthrodesis, and 53% prostheses) performed on 117 patients. These factors all increased the risk of surgery: female sex [relative risk (RR) 1.9, p = 0.001], age ≥ 70 years at diagnosis (RR 2.4, p = 0.001), arthritis in initial radiographs (RR 2.2, p = 0.006), and maximum erythrocyte sedimentation rate 30–59 mm/h (RR 1.6, p = 0.026). Time period of diagnosis had no effect on the outcome. In a subanalysis of surgery exclusive of hip and knee arthroplasty, diagnosis in earlier years (1954–1985 vs 1999–2011) was a risk factor (RR 2.1, p = 0.042). Antirheumatic treatment changed significantly over time.Conclusion.There were 20% of patients with PsA who needed surgery. We found that the prognosis of patients with PsA did not change regarding the risk of orthopedic surgery, despite the change in treatment. A possible explanation is the increase in large joint replacements in the general population.

Download Full-text

Abstract 14697: Nt-probnp and Outcomes in Patients With and Without Heart Failure Hospitalized With Severe Covid-19 Pneumonia

Circulation ◽

10.1161/circ.142.suppl_3.14697 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jeanwoo Yoo ◽

Prabhjot Grewal ◽

Aikaterini Papamanoli ◽

Azad Mojahedi ◽

Jacquelyn Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Regression Models ◽

Cox Regression ◽

Patient Characteristics ◽

High Flow ◽

University Hospital ◽

Entire Cohort ◽

History Of ◽

Artery Disease ◽

Worse Prognosis

Introduction: The value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in hospitalized patients with severe coronavirus disease 2019 (COVID-19) is unclear. Hypothesis: Elevated NT-proBNP is associated with worse prognosis in hospitalized COVID-19 patients regardless of history of HF. Methods: We evaluated the in-hospital course of 469 adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (need for high-flow O 2 ). We excluded patients who required mechanical ventilation (MV) or died within 24h of admission. We used Cox regression models to examine the association of admission NT-proBNP with mortality and the composite of death or MV. Results: Admission NT-proBNP was available in 399 patients (85.1%) of this cohort. Table 1 summarizes the patient characteristics according to history of HF (41/399 [10.3%]). After a median of 13 days (8-22), 107 patients (26.8%) died and 86 additional patients (21.6%) required MV and survived. Both HF (HR 3.65; 95%CI 2.32-5.77; P<0.001) and admission NT-proBNP (HR per log-2 [doubling] 1.35; 95%CI 1.27-1.44; P<0.001) were strongly associated with mortality. In models adjusting for age, sex, race, body mass index, hypertension, diabetes, coronary artery disease, atrial fibrillation, chronic lung disease, chronic kidney disease, and baseline 0 2 saturation, every log-2 higher admission NT-proBNP was associated with 28% higher mortality in patients with HF (HR 1.28; 95%CI 1.02-1.61; P=0.037) and 26% higher mortality in patients without HF (HR 1.26; 95%CI 1.14-1.40; P<0.001), P for interaction 0.92. Admission NT-proBNP was also associated with the composite of death or MV in the entire cohort (adjusted HR per log-2 1.09; 95%CI 1.02-1.17; P=0.017). Conclusions: In these high-risk COVID-19 patients, admission NT-proBNP was strongly predictive of mortality regardless of HF. Elevated NT-proBNP may thus identify patients in need of cardioprotective measures.

Download Full-text

AB0543 CHARACTERISTICS AND TREATMENT CHANGES IN PATIENTS WITH PSORIATIC ARTHRITIS SEEN IN A COMBINED DERMATOLOGY-RHEUMATOLOGY CLINIC

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1640 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1304.1-1304

Author(s):

K. Klavdianou ◽

M. Stavropoulou ◽

P. Panagakis ◽

M. Papoutsaki ◽

A. Panagiotopoulos ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Systemic Therapy ◽

Patient Characteristics ◽

Final Diagnosis ◽

University Hospital ◽

Research Grants ◽

Pasi Score ◽

Synthetic Agents ◽

Treatment Changes

Background:Data on patients with Psoriasis (PSO) referred to a combined Dermatology-Rheumatology outpatient Clinic (Derm-Rheum) with suspected psoriatic arthritis (PsA) are limited.Objectives:To assess patient characteristics and treatment changes in PsA patients referred to a Derm-Rheum Clinic.Methods:Prospective study of PSO patients referred to a combined Derm - Rheum Clinic from February 2018 to June 2020 in a Tertiary University Hospital.Results:Among 151 patients with PSO referred to the Clinic, 129 (85%) with a final diagnosis of PsA were included. In 73% of patients (n=94) PsA was diagnosed there for the 1st time. 56% were females with a mean age of 55 years and a median disease duration of 14.2 years. At initial evaluation, 95% had peripheral arthritis, 45% nail involvement, 23% axial involvement, 12% enthesitis and 6% dactylitis with a median DAPSA score of 20.5 and PASI score of 1.6, respectively. 31% of the patients were not receiving any systemic treatment, 45% were on biologics (30% as monotherapy, 15% in combination with non-biologics), 29% were on non-biologics (14% as monotherapy, 15% in combination with biologics or targeted synthetic agents] and 10% were on targeted synthetic (ts) agents. At last visit (median follow-up: 15 months) only 8% did not receive any systemic therapy (p<0.001 compared to 1st visit), 62% were on biologics (39% monotherapy – 23% in combination with non-biologics, p=0.009), 46% were on non-biologics (20% as monotherapy – 26% in combination with biologics or ts agents, p=0.01) and 10% of the patients were on apremilast. The median DAPSA and PASI scores at last visit were 5.3 and 0, respectively.Conclusion:About 2/3 of patients with PSO referred to a combined Derm - Rheum Clinic with suspicious musculoskeletal complaints were diagnosed for the 1st time as PsA. During follow-up the percentage of PsA patients who started or continued systemic therapy significantly increased with significant improvement of disease activity indices. These data emphasize the value of combined Derm - Rheum Clinics for earlier diagnosis and more efficacious treatment of PsA patients.Acknowledgements:This work was supported by research grants from the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece.Disclosure of Interests:None declared.

Download Full-text

Orthopedic surgery related infections; study of the importance of associated comorbidities in relationship with septic evolution

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2020-0015 ◽

2020 ◽

Vol 3 (2) ◽

pp. 95-102

Author(s):

Mihnea Popa ◽

Bogdan Şerban ◽

Sergiu Iordache ◽

Alexandru Lupu ◽

Georgian Iacobescu ◽

...

Keyword(s):

General Population ◽

Orthopedic Surgery ◽

University Hospital ◽

Motor Vehicles ◽

Frequent Use ◽

Number Of Patients ◽

Microbial Infections ◽

Technological Developments ◽

History Of ◽

Foreign Materials

AbstractThe current socio-economic development has improved the standard of living of the general population. Technological evolution has led to the use of an increasing number of motor vehicles. Associated with the growing violence observed globally, orthopedic surgery involves frequent use of osteosynthesis materials and prostheses. Therefore, an increasing number of patients live with these implants, having a higher risk, compared to the general population, to develop complications. Although technological developments have increased the quality of life, it must not be forgotten that these foreign materials come with certain risks, the most feared being the associated infections.We conducted an epidemiological study on infections identified in patients treated in the Orthopedics and Traumatology Department of Bucharest Emergency University Hospital, from 01.01.2016 to 01.06.2019. We were able to extract data about patients without neglecting their confidentiality.The information sought, primarily involved the pathogen causing the infection, but at the same time we tried to build a more accurate history of each patient in order to determine the cause of infection and the risks posed by various associated pathologies. During these 4 years we were able to identify 139 patients who suffered an infection in the musculoskeletal system. In most cases we identified mono-microbial infections, but there were 7 cases in which two pathogens were identified.

Download Full-text

The Tempo and mode(S) of Prebiotic Evolution

International Astronomical Union Colloquium ◽

10.1017/s0252921100014937 ◽

1997 ◽

Vol 161 ◽

pp. 419-429 ◽

Cited By ~ 1

Author(s):

Antonio Lazcano

Keyword(s):

Origin Of Life ◽

Organic Compounds ◽

Biological Evolution ◽

Current Evidence ◽

Early Diversification ◽

Time Period ◽

The Galaxy ◽

History Of ◽

Widespread Phenomenon ◽

The Origin Of Life

AbstractDifferent current ideas on the origin of life are critically examined. Comparison of the now fashionable FeS/H2S pyrite-based autotrophic theory of the origin of life with the heterotrophic viewpoint suggest that the later is still the most fertile explanation for the emergence of life. However, the theory of chemical evolution and heterotrophic origins of life requires major updating, which should include the abandonment of the idea that the appearance of life was a slow process involving billions of years. Stability of organic compounds and the genetics of bacteria suggest that the origin and early diversification of life took place in a time period of the order of 10 million years. Current evidence suggest that the abiotic synthesis of organic compounds may be a widespread phenomenon in the Galaxy and may have a deterministic nature. However, the history of the biosphere does not exhibits any obvious trend towards greater complexity or «higher» forms of life. Therefore, the role of contingency in biological evolution should not be understimated in the discussions of the possibilities of life in the Universe.

Download Full-text

A Very Brief History of Internet Jurisdiction

10.1093/oso/9780198795674.003.0004 ◽

2017 ◽

Author(s):

Dan Jerker B. Svantesson

Keyword(s):

Academic Community ◽

Court Decisions ◽

Time Period ◽

Technological Developments ◽

History Of

This chapter provides a brief history of Internet jurisdiction taking account of key court decisions, legislation as well as developments in the academic thinking on the topic. In doing so, it divides the history of Internet jurisdiction into four relatively distinct phases. The discussion in the chapter highlights facts such as that: (1) law has largely been reactive, responding to technological developments; (2) the level of creativity applied in the search for workable solutions was seemingly higher in the earlier stages than in more recent times; and (3) unsurprisingly, the attitudes of courts, legislators, and the academic community have varied considerably over the time period examined.

Download Full-text

Gas-filled urachal abscess with a pinging sound in a heifer calf

Veterinární Medicína ◽

10.17221/61/2019-vetmed ◽

2019 ◽

Vol 64 (No. 8) ◽

pp. 362-366 ◽

Cited By ~ 1

Author(s):

R Sato ◽

K Yamada ◽

Y Shinozuka ◽

H Ochiai ◽

K Onda

Keyword(s):

Fistulous Tract ◽

Failure To Thrive ◽

Abdominal Distension ◽

Intravenous Urography ◽

University Hospital ◽

Growth Depression ◽

Poor Growth ◽

History Of ◽

Heifer Calf ◽

Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

Download Full-text

Temporal trends in utilization of transcatheter aortic valve implantation and patient characteristics – a nationwide cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2618 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.E Strange ◽

C Sindet-Pedersen ◽

G Gislason ◽

C Torp-Pedersen ◽

E.L Fosboel ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Temporal Trends ◽

Patient Characteristics ◽

P Value ◽

Transcatheter Aortic Valve ◽

History Of ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

First Time

Abstract Introduction In recent years, there has been a surge in the utilization of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis. Randomized controlled trials have compared TAVI to surgical aortic valve replacement (SAVR) in patients at high-, intermediate-, and low perioperative risk. As TAVI continues to be utilized in patients with lower risk profiles, it is important to investigate the temporal trends in “real-world” patients undergoing TAVI. Purpose To investigate temporal trends in the utilization of TAVI and examine changes in patient characteristics of patients undergoing first-time TAVI. Methods Using complete Danish nationwide registries, we included all patients undergoing first-time TAVI between 2008 and 2017. To compare patient characteristics, the study population was stratified according to calendar year in the following groups: 2008–2009, 2010–2011, 2012–2013, 2014–2015, and 2016–2017. Results We identified 3,534 patients undergoing first-time TAVI. In 2008–2009, 180 patients underwent first-time TAVI compared with 1,417 patients in 2016–2017, resulting in a 687% increase in TAVI procedures performed. During the study period, the median age remained stable (2008–2009: Median age 82 year [25th–75th percentile: 78–85] vs. 2016–2017: Median age 81 years [25th–75th percentile: 76–85]; P-value: 0.06). The proportion of men undergoing first-time TAVI increased over the years (2008–2009: 49.4% vs 2016–2017: 54.9%; P-value for trend: <0.05), also the proportion with diabetes increased (2008–2009: 12.2% vs. 2016–2017: 19.3%; P-value for trend: <0.05). The proportion of patients with a history of stroke decreased over the years (2008–2009: 13.9% vs. 2016–2017: 12.1%; P-value for trend: <0.05). The same trend was seen in patients with a history of myocardial infarction (2008–2009: 24.4% vs. 2016–2017: 11.9%; P-value for trend: <0.05), ischaemic heart disease (2008–2009: 71.7% vs. 2016–2017: 29.4%; P-value for trend: <0.05), and heart failure (2008–2009: 45.6% vs. 2016–2017: 29.4%; P-value for trend: <0.05). Conclusions In this nationwide study, there was a marked increase in the utilization of TAVI in the years 2008–2017. Patients undergoing first-time TAVI had a decreasing comorbidity burden, while the age of the patients at first-time TAVI remained stable. Funding Acknowledgement Type of funding source: None

Download Full-text

Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

BMC Infectious Diseases ◽

10.1186/s12879-021-05914-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Damlin ◽

Katarina Westling

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Clinical Characteristics ◽

National Registry ◽

Injection Drug ◽

University Hospital ◽

Prosthetic Heart Valves ◽

Increased Risk ◽

History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P < 0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P < 0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P < 0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P < 0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P < 0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P < 0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P < 0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P < 0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P < 0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

Download Full-text

Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.221 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

D Vallone ◽

A Tamburrano ◽

C Carrozza ◽

A Urbani ◽

A Cambieri ◽

...

Keyword(s):

Cost Estimation ◽

Laboratory Tests ◽

Quality Care ◽

Clinical Decision Support Systems ◽

Patient Characteristics ◽

Clinical Decision ◽

University Hospital ◽

Specific Patient ◽

Global Rate ◽

Common Laboratory

Abstract Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units. This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified. During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p < 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. Key messages It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

Download Full-text

Malaria among migrants in a university hospital in Colombia during 2018: A case series

Tropical Doctor ◽

10.1177/0049475520981301 ◽

2020 ◽

pp. 004947552098130

Author(s):

Fabián R Carreño-Almánzar ◽

Adán Coronado-Galán ◽

Sonia A Cala-Gómez ◽

Agustín Vega-Vera

Keyword(s):

Latin American ◽

Previous History ◽

Case Series ◽

Cross Sectional Study ◽

Imported Malaria ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

History Of ◽

Clinical Profiles

Imported malaria has increased in Colombia since 2015 and has been attributed to migrants coming from Venezuela. We present a series of malaria cases, nested in a retrospective cross-sectional study between 2017 and 2018, aimed at calculating the prevalence of medical diseases among immigrants in a University Hospital in Colombia. Among 154 immigrants admitted for medical causes between 2017 and 2018, 8 were diagnosed with malaria, all due to Plasmodium vivax. Of these, seven had uncomplicated malaria, five had a previous history of malaria, one was critically ill, but none died. We highlight that, similar to other case series of imported malaria, Latin American migrants were young, with similar clinical profiles, having a low proportion of severe cases, and P. vivax was the most frequent cause.

Download Full-text