Computer-aided National Early Warning #score to predict the risk of #sepsis following emergency medical admission to hospital: a model development and external validation study
http://www.cmaj.ca/content/191/14/E382
In hospitals in England, patients’ vital signs are monitored and summarized into the National Early Warning Score (NEWS); this score is more accurate than the Quick Sepsis-related Organ Failure Assessment (qSOFA) score at identifying patients with sepsis. We investigated the extent to which the accuracy of the NEWS is enhanced by developing and comparing 3 computer-aided NEWS (cNEWS) models (M0 = NEWS alone, M1 = M0 + age + sex, M2 = M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis.
From the 3 cNEWS models, model M2 is the most accurate. Given that it places no additional burden of data collection on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
Sepsis is a major cause of mortality in hospitals. Survival is dependent on early recognition and treatment. Although each hour of delay is associated with a 7% reduction in survival,1,2 studies have found that treatment delays are not uncommon in hospitals
http://www.cmaj.ca/content/191/14/E382
In hospitals in England, patients’ vital signs are monitored and summarized into the National Early Warning Score (NEWS); this score is more accurate than the Quick Sepsis-related Organ Failure Assessment (qSOFA) score at identifying patients with sepsis. We investigated the extent to which the accuracy of the NEWS is enhanced by developing and comparing 3 computer-aided NEWS (cNEWS) models (M0 = NEWS alone, M1 = M0 + age + sex, M2 = M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis.
From the 3 cNEWS models, model M2 is the most accurate. Given that it places no additional burden of data collection on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.
Sepsis is a major cause of mortality in hospitals. Survival is dependent on early recognition and treatment. Although each hour of delay is associated with a 7% reduction in survival,1,2 studies have found that treatment delays are not uncommon in hospitals
CMAJ
Computer-aided National Early Warning Score to predict the risk of sepsis following emergency medical admission to hospital: a…
BACKGROUND: In hospitals in England, patients’ vital signs are monitored and summarized into the National Early Warning Score (NEWS); this score is more accurate than the Quick Sepsis-related Organ Failure Assessment (qSOFA) score at identifying patients…
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Effect of the #ABO blood group on susceptibility to severe #malaria: A systematic review and meta-analysis
https://www.sciencedirect.com/science/article/pii/S0268960X1730125X?via%3Dihub
Understanding how ABO blood group interacts with Plasmodium falciparum (P. falciparum) infection may facilitate development of antimalarial treatments and vaccines. This study systematically summarizes information on the relationship of ABO blood group with severe P. falciparum infection, level of parasitemia and haemoglobin. A total of 1923 articles were retrieved from five databases.
After removal of duplicates, and two levels of screening, 21 articles were selected for inclusion in the meta-analysis. A meta-analysis of the studies showed an increased odds of severe P. falciparum infection among individuals with blood group A, B, AB or non-O compared with blood group O. However, the difference in the level of P. falciparum parasitemia was not significant among individuals with blood group A or non-O compared with blood group O. The difference in haemoglobin level among P. falciparum infected individuals was also not significant between those with blood group A, B or AB versus those with blood group O.
Effect of the #ABO blood group on susceptibility to severe #malaria: A systematic review and meta-analysis
https://www.sciencedirect.com/science/article/pii/S0268960X1730125X?via%3Dihub
Understanding how ABO blood group interacts with Plasmodium falciparum (P. falciparum) infection may facilitate development of antimalarial treatments and vaccines. This study systematically summarizes information on the relationship of ABO blood group with severe P. falciparum infection, level of parasitemia and haemoglobin. A total of 1923 articles were retrieved from five databases.
After removal of duplicates, and two levels of screening, 21 articles were selected for inclusion in the meta-analysis. A meta-analysis of the studies showed an increased odds of severe P. falciparum infection among individuals with blood group A, B, AB or non-O compared with blood group O. However, the difference in the level of P. falciparum parasitemia was not significant among individuals with blood group A or non-O compared with blood group O. The difference in haemoglobin level among P. falciparum infected individuals was also not significant between those with blood group A, B or AB versus those with blood group O.
Le nuove terapie dell'epatite C - new treatments for HCV Hepatitis - full article (article in Italian)
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Health effects of #dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of #disease Study 2017
Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated.
Findings
In 2017, 11 million (95% uncertainty interval [UI] 10–12) deaths and 255 million (234–274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs), low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs), and low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.
Interpretation
This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.
Health effects of #dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of #disease Study 2017
Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated.
Findings
In 2017, 11 million (95% uncertainty interval [UI] 10–12) deaths and 255 million (234–274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs), low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs), and low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.
Interpretation
This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.
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Effect of #Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing #Tonsillectomies
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2731129
Perioperative respiratory adverse events occurred in 67 of 241 children (27.8%) receiving albuterol and 114 of 238 children (47.9%) receiving placebo. After adjusting for age, type of airway device, and severity of obstructive sleep apnea in a binary logistic regression model, the likelihood of perioperative respiratory adverse events remained significantly higher in the placebo group compared with the albuterol group (odds ratio, 2.8; 95% CI, 1.9-4.2; P < .001). Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 11.8% vs 12 5.0%; P = .009), coughing (79 33.2% vs 27 11.2%; P < .001), and oxygen desaturation (54 22.7% vs 36 14.9%; P = .03).
Conclusions and Relevance Albuterol premedication administered before tonsillectomy under general anesthesia in young children resulted in a clinically significant reduction in rates of perioperative respiratory adverse events compared with the rates in children who received placebo. Premedication with albuterol should be considered for children undergoing tonsillectomy.
Effect of #Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing #Tonsillectomies
https://jamanetwork.com/journals/jamapediatrics/article-abstract/2731129
Perioperative respiratory adverse events occurred in 67 of 241 children (27.8%) receiving albuterol and 114 of 238 children (47.9%) receiving placebo. After adjusting for age, type of airway device, and severity of obstructive sleep apnea in a binary logistic regression model, the likelihood of perioperative respiratory adverse events remained significantly higher in the placebo group compared with the albuterol group (odds ratio, 2.8; 95% CI, 1.9-4.2; P < .001). Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 11.8% vs 12 5.0%; P = .009), coughing (79 33.2% vs 27 11.2%; P < .001), and oxygen desaturation (54 22.7% vs 36 14.9%; P = .03).
Conclusions and Relevance Albuterol premedication administered before tonsillectomy under general anesthesia in young children resulted in a clinically significant reduction in rates of perioperative respiratory adverse events compared with the rates in children who received placebo. Premedication with albuterol should be considered for children undergoing tonsillectomy.
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Long-Term #Weight Loss With #Metformin or Lifestyle Intervention in the Diabetes Prevention Program Outcomes Study
https://annals.org/aim/article-abstract/2731601/long-term-weight-loss-metformin-lifestyle-intervention-diabetes-prevention-program
After 1 year, 289 (28.5%) participants in the metformin group, 640 (62.6%) in the ILS group, and 137 (13.4%) in the placebo group had lost at least 5% of their weight. After the masked treatment phase ended, the mean weight loss relative to baseline that was maintained between years 6 and 15 was 6.2% (95% CI, 5.2% to 7.2%) in the metformin group, 3.7% (CI, 3.1% to 4.4%) in the ILS group, and 2.8% (CI, 1.3% to 4.4%) in the placebo group. Independent predictors of LTWL included greater weight loss in the first year in all groups, older age and continued metformin use in the metformin group, older age and absence of either diabetes or a family history of diabetes in the ILS group, and higher fasting plasma glucose levels at baseline in the placebo group.
Among persons with weight loss of at least 5% after 1 year, those originally randomly assigned to metformin had the greatest loss during years 6 to 15. Older age and the amount of weight initially lost were the most consistent predictors of LTWL maintenance.
Long-Term #Weight Loss With #Metformin or Lifestyle Intervention in the Diabetes Prevention Program Outcomes Study
https://annals.org/aim/article-abstract/2731601/long-term-weight-loss-metformin-lifestyle-intervention-diabetes-prevention-program
After 1 year, 289 (28.5%) participants in the metformin group, 640 (62.6%) in the ILS group, and 137 (13.4%) in the placebo group had lost at least 5% of their weight. After the masked treatment phase ended, the mean weight loss relative to baseline that was maintained between years 6 and 15 was 6.2% (95% CI, 5.2% to 7.2%) in the metformin group, 3.7% (CI, 3.1% to 4.4%) in the ILS group, and 2.8% (CI, 1.3% to 4.4%) in the placebo group. Independent predictors of LTWL included greater weight loss in the first year in all groups, older age and continued metformin use in the metformin group, older age and absence of either diabetes or a family history of diabetes in the ILS group, and higher fasting plasma glucose levels at baseline in the placebo group.
Among persons with weight loss of at least 5% after 1 year, those originally randomly assigned to metformin had the greatest loss during years 6 to 15. Older age and the amount of weight initially lost were the most consistent predictors of LTWL maintenance.
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Trends in #Sedentary Behavior Among the US Population, 2001-2016
https://jamanetwork.com/journals/jama/article-abstract/2731178
Prolonged sitting, particularly watching television or videos, has been associated with increased risk of multiple diseases and mortality.
The estimated prevalence of sitting watching television or videos for 2 h/d or more was high among all ages (children, 62% 95% CI, 57% to 67%; adolescents, 59% 95% CI, 54% to 65%; adults, 65% 95% CI, 61% to 69%; adults aged 20-64 years, 62% 95% CI, 58% to 66%; and ≥65 years, 84% 95% CI, 81% to 88% in the 2015-2016 cycle)..
..From 2007 to 2016, total hours per day of sitting time increased among adolescents (7.0 95% CI, 6.7 to 7.4 to 8.2 95% CI, 7.9 to 8.4, difference, 1.1 95% CI, 0.7 to 1.5) and adults (5.5 95% CI, 5.2 to 5.7 to 6.4 95% CI, 6.2 to 6.6; difference, 1.0 95% CI, 0.7 to 1.3; P for trend <.001 for both)..
Conclusions and Relevance In this nationally representative survey of the US population from 2001 through 2016, the estimated prevalence of sitting watching television or videos for at least 2 hours per day generally remained high and stable. The estimated prevalence of computer use during leisure-time increased among all age groups, and the estimated total sitting time increased among adolescents and adults.
Trends in #Sedentary Behavior Among the US Population, 2001-2016
https://jamanetwork.com/journals/jama/article-abstract/2731178
Prolonged sitting, particularly watching television or videos, has been associated with increased risk of multiple diseases and mortality.
The estimated prevalence of sitting watching television or videos for 2 h/d or more was high among all ages (children, 62% 95% CI, 57% to 67%; adolescents, 59% 95% CI, 54% to 65%; adults, 65% 95% CI, 61% to 69%; adults aged 20-64 years, 62% 95% CI, 58% to 66%; and ≥65 years, 84% 95% CI, 81% to 88% in the 2015-2016 cycle)..
..From 2007 to 2016, total hours per day of sitting time increased among adolescents (7.0 95% CI, 6.7 to 7.4 to 8.2 95% CI, 7.9 to 8.4, difference, 1.1 95% CI, 0.7 to 1.5) and adults (5.5 95% CI, 5.2 to 5.7 to 6.4 95% CI, 6.2 to 6.6; difference, 1.0 95% CI, 0.7 to 1.3; P for trend <.001 for both)..
Conclusions and Relevance In this nationally representative survey of the US population from 2001 through 2016, the estimated prevalence of sitting watching television or videos for at least 2 hours per day generally remained high and stable. The estimated prevalence of computer use during leisure-time increased among all age groups, and the estimated total sitting time increased among adolescents and adults.
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Duration of Symptom Relief and Early Trajectory of Adverse Events for Oral #NSAIDs in Knee #Osteoarthritis: A Systematic Review and Meta‐analysis
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23884
NSAIDs demonstrated moderate, statistically significant effects on pain that peaked at 2 weeks (SMD ‐0.43 ‐0.48, ‐0.38), but the magnitude of the effects decreased over time. The results for function were similar. The incidence of GI AEs was significantly higher in NSAID users than placebo users as early as 4 weeks (RR 1.38 1.21, 1.57). The incidence of CV AEs in NSAID users was not significantly different from placebo. Most GI and CV AEs were transient and of minor severity.
Conclusion
NSAIDs produced significant pain and function improvements that peaked at 2 weeks but decreased over time. The incidence of minor GI and CV AEs consistently rose, reaching significance as early as 4 weeks. Clinicians should weigh the durability of efficacy with the early onset of minor AEs along with patient tolerability and preferences when formulating an NSAID regimen.
Duration of Symptom Relief and Early Trajectory of Adverse Events for Oral #NSAIDs in Knee #Osteoarthritis: A Systematic Review and Meta‐analysis
https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23884
NSAIDs demonstrated moderate, statistically significant effects on pain that peaked at 2 weeks (SMD ‐0.43 ‐0.48, ‐0.38), but the magnitude of the effects decreased over time. The results for function were similar. The incidence of GI AEs was significantly higher in NSAID users than placebo users as early as 4 weeks (RR 1.38 1.21, 1.57). The incidence of CV AEs in NSAID users was not significantly different from placebo. Most GI and CV AEs were transient and of minor severity.
Conclusion
NSAIDs produced significant pain and function improvements that peaked at 2 weeks but decreased over time. The incidence of minor GI and CV AEs consistently rose, reaching significance as early as 4 weeks. Clinicians should weigh the durability of efficacy with the early onset of minor AEs along with patient tolerability and preferences when formulating an NSAID regimen.
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Association of Duration and Type of Surgical #Prophylaxis With Antimicrobial-Associated #Adverse Events
https://jamanetwork.com/journals/jamasurgery/article-abstract/2731307
The benefits of antimicrobial prophylaxis are limited to the first 24 hours postoperatively. Little is known about the harms associated with continuing antimicrobial prophylaxis after skin closure.
Adjusted odds of AKI increased with each additional day of prophylaxis (cardiac procedure: 24-<48 hours: adjusted odds ratio [aOR], 1.03; 95% CI, 0.95-1.12; 48-<72 hours: aOR, 1.22; 95% CI, 1.08-1.39; ≥72 hours: aOR, 1.82; 95% CI, 1.54-2.16; noncardiac procedure: 24-<48 hours: aOR, 1.31; 95% CI, 1.21-1.42; 48-<72 hours: aOR, 1.72; 95% CI, 1.47-2.01; ≥72 hours: aOR, 1.79; 95% CI, 1.27-2.53).
The risk of postoperative C difficile infection demonstrated a similar duration-dependent association (24-<48 hours: aOR 1.08; 95% CI, 0.89-1.31; 48-<72 hours: aOR, 2.43; 95% CI, 1.80-3.27; ≥72 hours: aOR, 3.65; 95% CI, 2.40-5.53).
The unadjusted numbers needed to harm for AKI after 24 to less than 48 hours, 48 to less than 72 hours, and 72 hours or more of postoperative prophylaxis were 9, 6, and 4, respectively; and 2000, 90, and 50 for C difficile infection, respectively.
Vancomycin receipt was also a significant risk factor for AKI (cardiac procedure: aOR, 1.17; 95% CI, 1.10-1.25; noncardiac procedure: aOR, 1.21; 95% CI, 1.13-1.30).
Conclusions and Relevance Increasing duration of antimicrobial prophylaxis was associated with higher odds of AKI and C difficile infection in a duration-dependent fashion; extended duration did not lead to additional SSI reduction. These findings highlight the notion that every day matters and suggest that stewardship efforts to limit duration of prophylaxis have the potential to reduce adverse events without increasing SSI.
Association of Duration and Type of Surgical #Prophylaxis With Antimicrobial-Associated #Adverse Events
https://jamanetwork.com/journals/jamasurgery/article-abstract/2731307
The benefits of antimicrobial prophylaxis are limited to the first 24 hours postoperatively. Little is known about the harms associated with continuing antimicrobial prophylaxis after skin closure.
Adjusted odds of AKI increased with each additional day of prophylaxis (cardiac procedure: 24-<48 hours: adjusted odds ratio [aOR], 1.03; 95% CI, 0.95-1.12; 48-<72 hours: aOR, 1.22; 95% CI, 1.08-1.39; ≥72 hours: aOR, 1.82; 95% CI, 1.54-2.16; noncardiac procedure: 24-<48 hours: aOR, 1.31; 95% CI, 1.21-1.42; 48-<72 hours: aOR, 1.72; 95% CI, 1.47-2.01; ≥72 hours: aOR, 1.79; 95% CI, 1.27-2.53).
The risk of postoperative C difficile infection demonstrated a similar duration-dependent association (24-<48 hours: aOR 1.08; 95% CI, 0.89-1.31; 48-<72 hours: aOR, 2.43; 95% CI, 1.80-3.27; ≥72 hours: aOR, 3.65; 95% CI, 2.40-5.53).
The unadjusted numbers needed to harm for AKI after 24 to less than 48 hours, 48 to less than 72 hours, and 72 hours or more of postoperative prophylaxis were 9, 6, and 4, respectively; and 2000, 90, and 50 for C difficile infection, respectively.
Vancomycin receipt was also a significant risk factor for AKI (cardiac procedure: aOR, 1.17; 95% CI, 1.10-1.25; noncardiac procedure: aOR, 1.21; 95% CI, 1.13-1.30).
Conclusions and Relevance Increasing duration of antimicrobial prophylaxis was associated with higher odds of AKI and C difficile infection in a duration-dependent fashion; extended duration did not lead to additional SSI reduction. These findings highlight the notion that every day matters and suggest that stewardship efforts to limit duration of prophylaxis have the potential to reduce adverse events without increasing SSI.
Jamanetwork
Association of Duration and Type of Surgical Prophylaxis With Antimicrobial-Associated Adverse Events
This national cohort study assesses the association of type and duration of prophylaxis with surgical site infection, acute kidney injury, and Clostridium difficile infection.
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Oral #immunotherapy for peanut #allergy (PACE): a systematic review and meta-analysis of efficacy and safety
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30420-9/fulltext
Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear.
12 trials (n=1041; median age across trials 8·7 years [IQR 5·9–11·2]) showed that oral immunotherapy versus no oral immunotherapy increased anaphylaxis risk (risk ratio [RR] 3·12 [95% CI 1·76–5·55], I 2=0%, risk difference [RD] 15·1%, high-certainty), anaphylaxis frequency (incidence rate ratio [IRR] 2·72 [1·57–4·72], I 2=0%, RD 12·2%, high-certainty), and epinephrine use (RR 2·21 [1·27–3·83], I 2=0%, RD 4·5%, high-certainty) similarly during build-up and maintenance (p interaction=0·92). Oral immunotherapy increased serious adverse events (RR 1·92 [1·00–3·66], I 2=0%, RD 5·7%, moderate-certainty), and non-anaphylactic reactions (vomiting: RR 1·79 [95%CI 1·35–2·38], I 2=0%, high-certainty; angioedema: 2·25 [1·13–4·47], I 2=0%, high-certainty; upper tract respiratory reactions: 1·36 [1·02–1·81], I 2=0%, moderate-certainty; lower tract respiratory reactions: 1·55 [0·96–2·50], I 2=28%, moderate-certainty).
In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed
Oral #immunotherapy for peanut #allergy (PACE): a systematic review and meta-analysis of efficacy and safety
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30420-9/fulltext
Oral immunotherapy is an emerging experimental treatment for peanut allergy, but its benefits and harms are unclear.
12 trials (n=1041; median age across trials 8·7 years [IQR 5·9–11·2]) showed that oral immunotherapy versus no oral immunotherapy increased anaphylaxis risk (risk ratio [RR] 3·12 [95% CI 1·76–5·55], I 2=0%, risk difference [RD] 15·1%, high-certainty), anaphylaxis frequency (incidence rate ratio [IRR] 2·72 [1·57–4·72], I 2=0%, RD 12·2%, high-certainty), and epinephrine use (RR 2·21 [1·27–3·83], I 2=0%, RD 4·5%, high-certainty) similarly during build-up and maintenance (p interaction=0·92). Oral immunotherapy increased serious adverse events (RR 1·92 [1·00–3·66], I 2=0%, RD 5·7%, moderate-certainty), and non-anaphylactic reactions (vomiting: RR 1·79 [95%CI 1·35–2·38], I 2=0%, high-certainty; angioedema: 2·25 [1·13–4·47], I 2=0%, high-certainty; upper tract respiratory reactions: 1·36 [1·02–1·81], I 2=0%, moderate-certainty; lower tract respiratory reactions: 1·55 [0·96–2·50], I 2=28%, moderate-certainty).
In patients with peanut allergy, high-certainty evidence shows that available peanut oral immunotherapy regimens considerably increase allergic and anaphylactic reactions over avoidance or placebo, despite effectively inducing desensitisation. Safer peanut allergy treatment approaches and rigorous randomised controlled trials that evaluate patient-important outcomes are needed
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#Plant-Based Diets and Incident #CKD and #kidney Function
https://cjasn.asnjournals.org/content/early/2019/04/24/CJN.12391018
During a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%).
Conclusions Higher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.
#Plant-Based Diets and Incident #CKD and #kidney Function
https://cjasn.asnjournals.org/content/early/2019/04/24/CJN.12391018
During a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%).
Conclusions Higher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.
American Society of Nephrology
Plant-Based Diets and Incident CKD and Kidney Function
Background and objectives The association between plant-based diets, incident CKD, and kidney function decline has not been examined in the general population. We prospectively investigated this relationship in a population-based study, and evaluated if risk…
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Association Between Longitudinal Plasma #Neurofilament Light and Neurodegeneration in Patients With #Alzheimer Disease
https://jamanetwork.com/journals/jamaneurology/article-abstract/2731440
Plasma neurofilament light (NfL) has been suggested as a noninvasive biomarker to monitor neurodegeneration in Alzheimer disease (AD), but studies are lacking
The NfL level was increased at baseline in patients with mild cognitive impairment and AD dementia (mean levels: cognitive unimpairment, 32.1 ng/L; mild cognitive impairment, 37.9 ng/L; and AD dementia, 45.9 ng/L; P < .001) and increased in all diagnostic groups, with the greatest increase in patients with AD dementia.
Faster increase in NfL levels correlated with faster increase in CSF biomarkers of neuronal injury, faster rates of atrophy and hypometabolism, and faster worsening in global cognition (all P < .05 in patients with mild cognitive impairment; associations differed slightly in cognitively unimpaired controls and patients with AD dementia).
Conclusions and Relevance The findings suggest that plasma NfL can be used as a noninvasive biomarker associated with neurodegeneration in patients with AD and may be useful to monitor effects in trials of disease-modifying drugs.
Association Between Longitudinal Plasma #Neurofilament Light and Neurodegeneration in Patients With #Alzheimer Disease
https://jamanetwork.com/journals/jamaneurology/article-abstract/2731440
Plasma neurofilament light (NfL) has been suggested as a noninvasive biomarker to monitor neurodegeneration in Alzheimer disease (AD), but studies are lacking
The NfL level was increased at baseline in patients with mild cognitive impairment and AD dementia (mean levels: cognitive unimpairment, 32.1 ng/L; mild cognitive impairment, 37.9 ng/L; and AD dementia, 45.9 ng/L; P < .001) and increased in all diagnostic groups, with the greatest increase in patients with AD dementia.
Faster increase in NfL levels correlated with faster increase in CSF biomarkers of neuronal injury, faster rates of atrophy and hypometabolism, and faster worsening in global cognition (all P < .05 in patients with mild cognitive impairment; associations differed slightly in cognitively unimpaired controls and patients with AD dementia).
Conclusions and Relevance The findings suggest that plasma NfL can be used as a noninvasive biomarker associated with neurodegeneration in patients with AD and may be useful to monitor effects in trials of disease-modifying drugs.
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Duration and life-stage of #antibiotic use and risk of #cardiovascular events in women
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz231/5477431
Growing data suggest that antibiotic exposure is associated with a long-lasting alteration in gut microbiota, and may be related to subsequent cardiovascular disease (CVD).
.. Women with long-term use of antibiotics (for ≥2 months) in late adulthood had a significantly increased risk of CVD (HR 1.32, 95% confidence interval 1.03–1.70) after adjustment for covariates (such as demographic factors, diet and lifestyle, reasons for antibiotic use, overweight or obesity, disease status, and other medication use), as compared to women who did not use antibiotics in this life-stage. Longer duration of antibiotic use in middle adulthood was also related to higher risk of CVD (P trend = 0.003) after controlling for these covariates. There was no significant relationship between the use in young adulthood and the risk of CVD.
Conclusion
In this study which examined the antibiotic use in different life-stages, longer duration of exposure to antibiotics in the middle and older adulthood was related to an increased risk of future CVD events among elderly women at usual risk.
Duration and life-stage of #antibiotic use and risk of #cardiovascular events in women
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz231/5477431
Growing data suggest that antibiotic exposure is associated with a long-lasting alteration in gut microbiota, and may be related to subsequent cardiovascular disease (CVD).
.. Women with long-term use of antibiotics (for ≥2 months) in late adulthood had a significantly increased risk of CVD (HR 1.32, 95% confidence interval 1.03–1.70) after adjustment for covariates (such as demographic factors, diet and lifestyle, reasons for antibiotic use, overweight or obesity, disease status, and other medication use), as compared to women who did not use antibiotics in this life-stage. Longer duration of antibiotic use in middle adulthood was also related to higher risk of CVD (P trend = 0.003) after controlling for these covariates. There was no significant relationship between the use in young adulthood and the risk of CVD.
Conclusion
In this study which examined the antibiotic use in different life-stages, longer duration of exposure to antibiotics in the middle and older adulthood was related to an increased risk of future CVD events among elderly women at usual risk.
OUP Academic
Duration and life-stage of antibiotic use and risk of cardiovascular events in women
AbstractAims. Growing data suggest that antibiotic exposure is associated with a long-lasting alteration in gut microbiota, and may be related to subsequent ca
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#Liraglutide in Children and #Adolescents with Type 2 Diabetes
https://www.nejm.org/doi/full/10.1056/NEJMoa1903822
Metformin is the regulatory-approved treatment of choice for most youth with type 2 diabetes early in the disease. However, early loss of glycemic control has been observed with metformin monotherapy. Whether liraglutide added to metformin (with or without basal insulin treatment) is safe and effective in youth with type 2 diabetes is unknown.
At the 26-week analysis of the primary efficacy end point, the mean glycated hemoglobin level had decreased by 0.64 percentage points with liraglutide and increased by 0.42 percentage points with placebo, for an estimated treatment difference of −1.06 percentage points (P<0.001); the difference increased to −1.30 percentage points by 52 weeks. The fasting plasma glucose level had decreased at both time points in the liraglutide group but had increased in the placebo group. The number of patients who reported adverse events was similar in the two groups (56 84.8% with liraglutide and 55 80.9% with placebo), but the overall rates of adverse events and gastrointestinal adverse events were higher with liraglutide.
CONCLUSIONS
In children and adolescents with type 2 diabetes, liraglutide, at a dose of up to 1.8 mg per day (added to metformin, with or without basal insulin), was efficacious in improving glycemic control over 52 weeks. This efficacy came at the cost of an increased frequency of gastrointestinal adverse events
#Liraglutide in Children and #Adolescents with Type 2 Diabetes
https://www.nejm.org/doi/full/10.1056/NEJMoa1903822
Metformin is the regulatory-approved treatment of choice for most youth with type 2 diabetes early in the disease. However, early loss of glycemic control has been observed with metformin monotherapy. Whether liraglutide added to metformin (with or without basal insulin treatment) is safe and effective in youth with type 2 diabetes is unknown.
At the 26-week analysis of the primary efficacy end point, the mean glycated hemoglobin level had decreased by 0.64 percentage points with liraglutide and increased by 0.42 percentage points with placebo, for an estimated treatment difference of −1.06 percentage points (P<0.001); the difference increased to −1.30 percentage points by 52 weeks. The fasting plasma glucose level had decreased at both time points in the liraglutide group but had increased in the placebo group. The number of patients who reported adverse events was similar in the two groups (56 84.8% with liraglutide and 55 80.9% with placebo), but the overall rates of adverse events and gastrointestinal adverse events were higher with liraglutide.
CONCLUSIONS
In children and adolescents with type 2 diabetes, liraglutide, at a dose of up to 1.8 mg per day (added to metformin, with or without basal insulin), was efficacious in improving glycemic control over 52 weeks. This efficacy came at the cost of an increased frequency of gastrointestinal adverse events
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Diagnostic Performance of Creatinine-Based #Equations for Estimating #Glomerular Filtration Rate in Adults 65 Years and Older
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2731708
To determine the performance of plasma-creatinine-based equations Chronic Kidney Disease–Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised, (LMR), full age spectrum (FAS), and Berlin Initiative Study (BIS) 1 in older adults across a broad spectrum of GFRs.
In subjects 75 years and older, with measured GFR less than 45 mL/min/1.73 m2, LMR and BIS 1 were more accurate than CKD-EPI and FAS (P30 = 74.5 [70.0-79.5] and 73.0 [68.0-78.0] vs 69.0 [64.5-74.0] and 69.0 [65.5-72.0]). In all patients, despite small statistical differences, the performance of CKD-EPI equation was not clinically different from that of LMR, FAS, or BIS 1.
Conclusions and Relevance In a referral group of patients 65 years and older who had GFR estimated using CDK-EPI, LMR, BIS 1, and FAS equations, a comparison with renal inulin clearance found that none of the equations had a superior diagnostic performance. Each had limitations regarding accuracy.
Diagnostic Performance of Creatinine-Based #Equations for Estimating #Glomerular Filtration Rate in Adults 65 Years and Older
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2731708
To determine the performance of plasma-creatinine-based equations Chronic Kidney Disease–Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised, (LMR), full age spectrum (FAS), and Berlin Initiative Study (BIS) 1 in older adults across a broad spectrum of GFRs.
In subjects 75 years and older, with measured GFR less than 45 mL/min/1.73 m2, LMR and BIS 1 were more accurate than CKD-EPI and FAS (P30 = 74.5 [70.0-79.5] and 73.0 [68.0-78.0] vs 69.0 [64.5-74.0] and 69.0 [65.5-72.0]). In all patients, despite small statistical differences, the performance of CKD-EPI equation was not clinically different from that of LMR, FAS, or BIS 1.
Conclusions and Relevance In a referral group of patients 65 years and older who had GFR estimated using CDK-EPI, LMR, BIS 1, and FAS equations, a comparison with renal inulin clearance found that none of the equations had a superior diagnostic performance. Each had limitations regarding accuracy.
Jamanetwork
Diagnostic Performance of Creatinine-Based Equations for Estimating Glomerular Filtration Rate in Older Adults
This cross-sectional study compares 4 equations used to estimate glomerular filtration rate against measurement of inulin 2247 older French adults with varying degrees of kidney health.
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#Mavacamten Treatment for Obstructive Hypertrophic #Cardiomyopathy: A Clinical Trial
https://annals.org/aim/article-abstract/2732081/mavacamten-treatment-obstructive-hypertrophic-cardiomyopathy-clinical-trial
Mavacamten, an orally administered, small-molecule modulator of cardiac myosin, targets underlying biomechanical abnormalities in obstructive hypertrophic cardiomyopathy (oHCM).
..Dyspnea scores improved in both cohorts. Mavacamten was well tolerated, with mostly mild (80%), moderate (19%), and unrelated (79%) adverse events. The most common adverse events definitely or possibly related to mavacamten were decreased LVEF at higher plasma concentrations and atrial fibrillation.
Conclusion:
Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM.
#Mavacamten Treatment for Obstructive Hypertrophic #Cardiomyopathy: A Clinical Trial
https://annals.org/aim/article-abstract/2732081/mavacamten-treatment-obstructive-hypertrophic-cardiomyopathy-clinical-trial
Mavacamten, an orally administered, small-molecule modulator of cardiac myosin, targets underlying biomechanical abnormalities in obstructive hypertrophic cardiomyopathy (oHCM).
..Dyspnea scores improved in both cohorts. Mavacamten was well tolerated, with mostly mild (80%), moderate (19%), and unrelated (79%) adverse events. The most common adverse events definitely or possibly related to mavacamten were decreased LVEF at higher plasma concentrations and atrial fibrillation.
Conclusion:
Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with oHCM.
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Pre-#eclampsia and risk of later #kidney disease: nationwide cohort study
https://www.bmj.com/content/365/bmj.l1516
..In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.
Conclusion s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.
Pre-#eclampsia and risk of later #kidney disease: nationwide cohort study
https://www.bmj.com/content/365/bmj.l1516
..In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.
Conclusion s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.
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#Preterm birth and risk of chronic #kidney disease from childhood into mid-adulthood: national cohort study
https://www.bmj.com/content/365/bmj.l1346
Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.
Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
#Preterm birth and risk of chronic #kidney disease from childhood into mid-adulthood: national cohort study
https://www.bmj.com/content/365/bmj.l1346
Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.
Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.