Burden of Chronic and Acute Conditions and Symptoms in People With Epilepsy

Objective:People with epilepsy, one-third of whom in the US are on Medicaid, experience a wide range of chronic and physical comorbidities that influence their care and outcomes. In this study, we examine the burden and racial/ethnic disparities of chronic and acute conditions, injuries, and symptoms in a large and diverse group of people with epilepsy on Medicaid.Methods:Using 5 years of Medicaid claims data we identified adult people with epilepsy and used all available claims and diagnoses to identify each person’s Clinical Classification Codes groups diagnosed during the study period. Using association rule mining we identified the top combinations of conditions and stratified these by race/ethnicity to identify potential prevalence disparities. Additionally, we examined the top combinations of conditions in high utilizers – that is individuals in the top quartile of hospitalizations and emergency department visits.Results:Among 81,963 patients the most common conditions were: anxiety and mood disorders (46.5%), hypertension (36.9%), back problems (35.2%), developmental disorders (31.6%), and headache (29.5%). When examining combinations of conditions, anxiety and mood disorders continued to have an outsized prevalence – appearing in nearly every combination. There were notable disparities in disease burden, with American Indians and Alaskan Natives having a substantially higher prevalence of developmental disabilities, while Black individuals had a higher prevalence of hypertension. These disparities persisted to the higher-order combinations that included these conditions. High utilizers had a much higher disease burden, with 75.8% having an anxiety or mood disorder, as well as a higher burden of injuries.Significance:This study shows a high prevalence of psychiatric and physical conditions and identifies racial and ethnic disparities affecting people with epilepsy. Targeting interventions to consider the comorbidities, race and ethnicity has potential to improve clinical care and reduce disparities.

Secondary Precipitants of Atrial Fibrillation and Anticoagulation Therapy

Background Atrial fibrillation (AF) commonly occurs in the setting of acute conditions. We aimed to identify the acute conditions associated with secondary AF (AF precipitants) including pneumonia/sepsis, pneumothorax, respiratory failure, myocarditis, pericarditis, alcohol intoxication, thyrotoxicosis, cardiothoracic surgery, other surgery in patients with newly diagnosed AF and determine their association with subsequent oral anticoagulant use. Methods and Results We assembled a cohort of patients in the UMass Memorial Healthcare system with a new diagnosis of AF with and without AF precipitants. We used combinations of International Classification of Diseases , Tenth Revision ( ICD‐10 ) codes, Current Procedural Terminology codes, laboratory values, imaging reports, and physician notes including discharge summary texts to identify AF precipitants. We then manually reviewed the individual charts to validate presence of AF precipitants. The study sample consisted of 185 patients with and 172 patients without AF precipitants. Pneumonia/sepsis, myocardial infarction, respiratory failure, and cardiothoracic surgery were the most common precipitants identified. In multivariable analyses adjusting for age, sex, patient comorbidities, left atrial enlargement, left ventricular ejection fraction, and antiplatelet use, patients with AF precipitants were less likely to receive subsequent anticoagulation therapy at 30 days after the initial AF diagnosis (odds ratio, 0.31; 95% CI, 0.19–0.52). The association was persistent after excluding men with CHA 2 DS 2 ‐VASc score <2 and women with CHA 2 DS 2 ‐VASc score <3. Conclusions Our study highlights lower usage of oral anticoagulant in secondary AF in contemporary clinical practice.

Copeptin and Stress

Vasopressin (AVP) and copeptin are released in equimolar amounts from the same precursor. Due to its molecular stability and countless advantages as compared with AVP, copeptin perfectly mirrors AVP presence and has progressively emerged as a reliable marker of vasopressinergic activation in response to osmotic and hemodynamic stimuli in clinical practice. Moreover, evidence highlighting the prognostic potential of copeptin in several acute diseases, where the activation of the AVP system is primarily linked to stress, as well as in psychologically stressful conditions, has progressively emerged. Furthermore, organic stressors induce a rise in copeptin levels which, although non-specific, is unrelated to plasma osmolality but proportional to their magnitude: suggesting disease severity, copeptin proved to be a reliable prognostic biomarker in acute conditions, such as sepsis, early post-surgical period, cardiovascular, cerebrovascular or pulmonary diseases, and even in critical settings. Evidence on this topic will be briefly discussed in this article.

JUDICIAL UTILIZATION OF KUPIPAKWA AND POTTALI RASAYANAS BOON FOR AYURVEDIC PRACTICE

Parada Murchana (Mercurial Preparations) forms the backbone of Rasashastra which signifies the formulations of mercury after Shodhan (purification) termed as Rasachikitsa which includes Kharaliya, Parpati Kupipakwa & Pottali Rasayanas. Amongst them, Kupipakwa Rasayana (KPR) & Pottali Rasayana (PTR) are unique pharmaceutical preparations designed to achieve potential therapeutic efficacy by stabilizing the stronger bonds between ingredients. Judicial utilization of these mercurial preparations provides quicker action and synergistic effects with suitable Anupana (adjuvants), Kala (time) at low doses without producing toxic effects. KPR and PTR give miraculous results in Complicated, Chronic as well as Acute conditions. In the present era, people hesitate to use these medicines due to a lack of knowledge & awareness. This review aims to bring into the limelight the importance of KPR & PTR in the modern era where modern medicines have failed or attained resistance against diseases and also to overcome difficulties that may arise because of the extinction of many herbal drugs. Keywords: Kupipakwa, Pottali, Rasayana, Rasachikitsa, Murchana, Mercurial preparations

White Nail as a Static Physical Finding: Revitalization of Physical Examination

Physical examinations are critical for diagnosis and should be differentiated into static and dynamic categories. One of the static findings is white nail, such as Terry’s and Lindsay’s nails. Here, we report the cases of two older patients with acute diseases who had nail changes that aided evaluation of their clinical course. Two elderly women who presented with acute conditions were initially thought to have normal serum albumin levels. They were found to have white nail with differences in nail involvement of the first finger, which subsequently revealed their hypoalbuminemia. The clinical courses were different following the distribution of nail whitening. Our findings show that examination of a white nail could indicate the previous clinical status more clearly than laboratory data. It can be useful for evaluating preclinical conditions in patients with acute diseases. Further evaluation is needed to establish the relationship between clinical outcomes and the presence of white nail in acute conditions among older patients.