Evaluation of the Modified SAMe-TT2R2 Score to Predict Good Anticoagulation Control with Warfarin Among non-valvular Atrial Fibrillation Patients

Background: The SAMe-TT2 R2 Score was developed to identify vitamin K antagonists control outliers before non-valvular atrial fibrillation (AF) patients start treatment. SAMe-TT2 R2 Score was derived and validated using a primarily white Caucasian population to predict TTR. Given that non-Caucasian race already confers 2 points in this score, the SAMe-TT2 R2 score requires validation and/or re-calibration despite race of population. Method: We conducted a cohort retrospective study that included all non-valvular atrial fibrillation patients who were on warfarin therapy from January to December 2019. Then we calculated the modified SAMe-TT2 R2 and SAMe-TT2 R2 for all study populations and we correlated the result with patients' TTR. The TTR was calculated through the Rosendaal's method. Results: We had 662 patient using warfarin therapy, among those 662, 60.9% were under cardiology and using it for cardiac indication, and only 18.1% diagnosed to have non-valvular AF. Modified SAMe-TT2 R2 score has good relation to original SAMe-TT2 R2 score as showed 75.71% (95% CI. 63.99 to 85.17%), 100% (95% CI. 92.89 to 100%) and 15% (95% CI. 3.21 to 77.95%); accuracy, sensitivity and specificity in relation to SAMe-TT2 R2 respectively. In addition to that in this small cohort we found that there is universal relationship between SAMe-TT2 R2 score, Modified SAMe-TT2 R2 score and TTR; TTR >=65% associate with low score (<2) of both SAMe-TT2 R2 , Modified SAMe-TT2 R2 score. Conclusion: The use of Modified SAMe-TT2 R2 score allows clinicians to make an informed decision on whether to start vitamin K antagonist or other non-vitamin K antagonist oral anticoagulant despite the race of the patients.

Mapping of choriocapillaris vascular density in young and aged healthy subjects

Purpose To compare macular vascular density (VD) of the choriocapillaris (CC) between young and aged healthy individuals. Methods A cross-sectional study was performed enrolling young and senior healthy individuals of Caucasian race and an axial length (AL) lower than 26 mm, and without systemic or ophthalmological diseases. CC VD was imaged with DRI Triton OCTA using a 6 × 6 mm macular analysis. Internal software delimited CC boundaries and gave colour pictures, which were analysed and codified into numbers, and a grid of 30 × 30 VD values was obtained. Two-dimension (2D) and three-dimension (3D) representations were created. Results 53 eyes of 53 young healthy individuals and 30 eyes of 30 senior healthy individuals were enrolled. Mean age was 27.17 ± 3.90 years, and 67.00 ± 7.41 years, respectively (p < 0.001). There were no differences in intraocular pressure (IOP) or AL (23.73 ± 0.79 mm, 23.18 ± 0.80 mm, respectively, p = 0.24). There were differences in foveal VD and in temporal perifoveal macula, but not in nasal perifoveal macula. Foveal VD was the highest in both groups. Conclusions Foveal CC VD has been found to be considerably high with this method, and it is the area which most decreases with age. Nasal perifoveal VD is not reduced in older individuals. These outcomes are opposite to other studies using different methods but they are in line with previous histological findings.

Moyamoya disease as a possible cause of ischemic stroke in adult patients

Moyamoya disease (MMD) is a rare progressive idiopathic arteriopathy that usually leads to ischemic stroke (IS) in young children, especially of East Asian origin. MMD can cause IS in the Caucasian race, too, but often remains unverified. The diagnosis of MMD relies on diagnostic radiology findings. Magnetic resonance imaging (MRI) is widely used in Japan to identify asymptomatic individuals with hereditary predisposition to MMD. There are no official statistics on MMD in Russia. A patient experiencing an acute cerebrovascular accident (CVA) is hospitalized to a stroke unit, where they undergo a multislice computed tomography (MSCT) scan of the brain. Below, we report the results of a complex radiological examination, which included MRI (T2, FLAIR, SWI, 3D-TOF), cerebral MSCT perfusion imaging, CT angiography of intracranial arteries, duplex ultrasonography of brachiocephalic arteries and was conducted in 4 adult Caucasian patients (3 men and 1 woman aged 38, 39, 51, and 57 years, respectively) with a past IS caused by MMD. We hope that the findings of different imaging techniques may be helpful in establishing the timely diagnosis of MMD and optimizing the treatment strategies.

Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown

This is a retrospective, multicenter study of consecutive patients with nAMD scheduled for a visit and/or a treatment with an intravitreal injection (IVI) during the 3 months before lockdown in the Ophthalmology Departments of six centers of Europe.The study was conducted on 546 patients, of which 55.13% were females, almost 100% of the patients were White/Caucasian race, and 71.53% of the patients presented a type 1 macular neovascularization (NVM). A total of 62.82% of patients (343 patients) that were on scheduled clinic visits and/or intravitreal injection treatment during the 3 months before the quarantine did not attend either to visit or for treatment during the lockdown. The mean number of injections during the lockdown was significantly reduced. This was followed by a significant reduction in the mean best-corrected visual acuity (BCVA) between the 3 months before the lockdown (mean BCVA of 60.68 ± 19.77 letters) and 6 months after lockdown (mean BCVA of 56.98 ± 22.59 letters). Patients with better BCVA before the lockdown and the ones showing neovascular activity were more likely to attend their scheduled visits and/or IVI treatments. The COVID-19 pandemic and the lockdown have led to a decrease in the number of IVI treatments in patients with nAMD, evidencing a significant vision loss at 6 months.

Loving GOD, Loving Others: The Evil of Hatred by Accidental Differences in Humankind

The rise of ideologies in the West that promote prejudicial treatment of others based on accidental (humanly uncontrollable) features (distinguishing ethnic physical traits, geographic origin, physical or mental capacities, or native cultures, viz., Western Civilization, that in all of its vicissitudes, has produced distinctive behavioral, socio-religious, and intellectual norms) is an illogical, cruel, and nationally self-destructive worldview that must be exposed and rejected. The premise of “races” of human beings (Caucasian race, negroid race, mongoloid race, etc.) , rather than the “race of Mankind,” male and female, all originating from a common set of ancestors, created by God, with “in-species” genetic variety (e.g., melanin production creating darker or lighter skin color) is not only unsupported by the teachings of the Old and New Testaments, but singled out as sins against God. The author examines a recent case of a medical doctor dreaming of murdering white people. The statement is considered from both scientific and spiritual viewpoints. The author cites personal experience in the United States military, as well as peer-reviewed articles, to establish the hypothesis that the rise of violent tribalism (“Balkanization”) produces Socialistic authoritarianism, which forcibly reunites divided “tribes” under the flag of autocratic rule. This opinion-editorial article concludes by asserting that the Gospel of Jesus Christ is the powerful antidote that liberates people from the pestilent consequences of original sin to discover authentic fraternity in our common Imago Dei (the image of God in Man), and transformative freedom from the effects of the Fall, i.e., to embrace and be embraced by a divine love that transcends our sin. Only in knowing such love can we be free from the hatred that divides, the bitterness that excludes, and the pain and sorrow that inevitably follows.

Loving GOD, Loving Others: The Evil of Hatred by Accidental Differences in Humankind

The rise of ideologies in the West that promote prejudicial treatment of others based on accidental (humanly uncontrollable) features (distinguishing ethnic physical traits, geographic origin, physical or mental capacities, or native cultures, viz., Western Civilization, that in all of its vicissitudes, has produced distinctive behavioral, socio-religious, and intellectual norms) is an illogical, cruel, and nationally self-destructive worldview that must be exposed and rejected. The premise of “races” of human beings (Caucasian race, negroid race, mongoloid race, etc.) , rather than the “race of Mankind,” male and female, all originating from a common set of ancestors, created by God, with “in-species” genetic variety (e.g., melanin production creating darker or lighter skin color) is not only unsupported by the teachings of the Old and New Testaments, but singled out as sins against God. The author examines a recent case of a medical doctor dreaming of murdering white people. The statement is considered from both scientific and spiritual viewpoints. The author cites personal experience in the United States military, as well as peer-reviewed articles, to establish the hypothesis that the rise of violent tribalism (“Balkanization”) produces Socialistic authoritarianism, which forcibly reunites divided “tribes” under the flag of autocratic rule. This opinion-editorial article concludes by asserting that the Gospel of Jesus Christ is the powerful antidote that liberates people from this pestilent consequences of original sin to discover authentic fraternity in our common Imago Dei (the image of God in Man), and transformative freedom from the effects of the Fall, i.e., to embrace and be embraced by a divine love that transcends our sin. Only in knowing such love can we be free from the hatred that divides, the bitterness that excludes, and the pain and sorrow that inevitably follows.

Impact of delirium on mortality in patients hospitalized for heart failure

Objective Heart Failure (HF) is one of the leading causes of hospitalization in the United States accounting for ≈800,000 hospital discharges and $11 billion in annual costs. Delirium occurs in approximately 30% of elderly hospitalized patients and its incidence is significantly higher among those admitted to the critical care units. Despite this, there has been limited exploration of the clinical and economic impact of delirium in patients hospitalized with acute HF. We hypothesized that delirium in HF is associated with excess mortality and hospital costs. Methods We queried the 2001-2014 Nationwide Inpatient Sample to identify hospitalizations that included a primary discharge diagnosis of HF (ICD-9-CM: 428.xx) and stratified them by presence or absence of delirium (ICD-9-CM: 239.0, 290.41, 293.0, 293.1, 348.31). Differences in in-hospital mortality, length of stay (LOS), and hospital costs were assessed using propensity-score matched cohorts. Results Major predictors of delirium included advanced age, Caucasian race, underlying dementia or psychiatric diagnoses, higher Elixhauser Comorbidity Index, renal failure, cardiogenic shock, and coronary artery bypass surgery. In the propensity-score matched analysis of 76,411 hospitalization with delirium compared to 76,612 without delirium, in-hospital mortality (odds ratio: 1.67, 95% CI: 1.51–1.77), LOS (rate ratio [RR]: 1.47, 95% CI: 1.45–1.51), and hospital costs (RR: 1.44, 95% CI: 1.41–1.48) were all statistically higher in the presence of delirium (all p < 0.001). Conclusion In patients hospitalized with HF, delirium is an independent predictor of increased in-hospital mortality, longer LOS, and excess hospital costs despite adjustment for baseline characteristics.

Loving GOD, Loving Others: The Evil of Hatred by Accidental Differences in Humankind

The rise of ideologies in the West that promote prejudicial treatment of others based on accidental (humanly uncontrollable) features (distinguishing ethnic physical traits, geographic origin, physical or mental capacities, or native cultures, viz., Western Civilization, that in all of its vicissitudes, has produced distinctive behavioral, socio-religious, and intellectual norms) is an illogical, cruel, and nationally self-destructive worldview that must be exposed and rejected. The premise of “races” of human beings (Caucasian race, negroid race, mongoloid race, etc.) , rather than the “race of Mankind,” male and female, all originating from a common set of ancestors, created by God, with “in-species” genetic variety (e.g., melanin production creating darker or lighter skin color) is not only unsupported by the teachings of the Old and New Testaments, but singled out as sins against God. The author examines a recent case of a medical doctor dreaming of murdering white people. The statement is considered from both scientific and spiritual viewpoints. The author cites personal experience in the United States military, as well as peer-reviewed articles, to establish the hypothesis that the rise of violent tribalism (“Balkanization”) produces Socialistic authoritarianism, which forcibly reunites divided “tribes” under the flag of autocratic rule. This opinion-editorial article concludes by asserting that the Gospel of Jesus Christ is the powerful antidote that liberates people from this pestilent consequences of original sin to discover authentic fraternity in our common Imago Dei (the image of God in Man), and transformative freedom from the effects of the Fall, i.e., to embrace and be embraced by a divine love that transcends our sin. Only in knowing such love can we be free from the hatred that divides, the bitterness that excludes, and the pain and sorrow that inevitably follows.

INTOXICAÇÃO POR MEDICAMENTOS EM TRÊS MICRORREGIÕES DO INTERIOR DE SÃO PAULO: PERFIL EPIDEMIOLÓGICO

A intoxicação por medicamentos é o tipo de intoxicação exógena de maior incidência no Brasil. Este estudo tem como objetivo descrever e analisar o perfil epidemiológico das vítimas de intoxicação por medicamentos das microrregiões de Santa Fé do Sul, Jales e Fernandópolis no período de 2015 a 2019. É um estudo retrospectivo, descritivo e exploratório, com abordagem quantitativa. Os dados secundários foram fornecidos pelo Grupo de Vigilância Epidemiológica XXX. Durante o período, foram registrados 1855 casos, com uma média de 371 casos ao ano. O ano com maior ocorrência foi 2019, com 451 casos registrados. Houve uma maior incidência no sexo feminino (76,3%). Em relação à raça, destacou-se a branca (78%). A faixa etária com maior ocorrência foi de 20 a 29 anos, nos primeiros anos, porém, em 2019, houve um aumento de casos na faixa de 10 a 19 anos. Conclui-se que houve um aumento de 17,7% dos casos em 2019, com prevalência entre mulheres e adolescentes. Há necessidade de incentivo da notificação e prevenção dessas intoxicações, visto que sugerem que a maior causa sejam as tentativas de suicídio, sendo este um problema de saúde pública. MEDICATION POISONING IN THREE MICRO-REGIONS OF SÃO PAULO COUNTRYSIDE: EPIDEMIOLOGIC PROFILE ABSTRACT Medication poisoning is the kind of exogenous poisoning with the highest incidence in Brazil. This paper aims at describing, and analyzing the epidemiologic profile of medication poisoning victims in the micro-regions of Santa Fé do Sul, Jales, and Fernandópolis in the period from 2015 to 2019. It is a retrospective, descriptive and exploratory study, quantitative approach. Secondary data was provided by Grupo de Vigilância Epidemiológica XXX. During that period 1855 cases were reported with an average of 371 cases per year. The year with the highest occurrence was 2019 when 451 cases were reported. The highest incidence was in females (76,3%). Regarding race, the Caucasian race stood out (78%). The age group with the highest incidence was the 20-29 years old, in the early years, although, in 2019, there was an increase of cases in the 10-19 age group. We conclude that there was an increase of 17,7% in cases in 2019, with the prevalence of women and teenagers. It is necessary to encourage the notification and prevention of poisoning, since they suggest that the main cause of them were due to suicide attempts, which makes it a public health problem. Descriptors: Emergency; Nursing and emergency. Poisoning. Epidemiology. Surveillance.

Association of chronic use of proton pump inhibitors with an increased risk of immune checkpoint inhibitor-induced colitis in renal cell carcinoma.

e16550 Background: Immune checkpoint inhibitors (ICI) have become standard of care in metastatic renal cell carcinoma (mRCC) but are associated with immune-related adverse events (irAEs) including immune-related colitis (irC). Growing evidence suggests that proton pump inhibitors (PPIs) are associated with an increased risk of inflammatory bowel disease (IBD). Given the pathophysiological overlap between IBD and irC, we sought to evaluate the relationship between PPI use and irC in mRCC patients. Methods: We performed a retrospective study of adult patients who received ICI for mRCC between 2015 and 2018 at two tertiary care centers. Clinical characteristics, oncological outcomes, irC details, and PPI use were collected by manual chart review. The diagnosis of irC was made via biopsy when available, or when unavailable (or inconclusive) by clinical criteria. Univariable and multivariable logistic regression analyses were conducted to assess PPI use and other potential risk factors of irC. Results: A total of 176 patients received immunotherapy for mRCC, of which 16 (9.1%) were diagnosed with irC. There were no significant differences between patients with and without irC in age, gender, medical comorbidities, RCC subtype, treatment history, and overall survival. However, Caucasian race, exposure to ipilimumab, and PPI use were more frequently observed in patients with irC than those without. Patients with irC presented with elevated stool lactoferrin and calprotectin and a wide range of endoscopic and histologic findings. In univariable and multivariable logistic regression analyses, Caucasian race, exposure to ipilimumab and chronic use of PPIs >8 weeks were significantly associated with irC (Table). Conclusions: PPI use may be a modifiable risk factor for irC development in patients with mRCC.[Table: see text]