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The #economic cost of inadequate #sleep
https://academic.oup.com/sleep/advance-article/doi/10.1093/sleep/zsy083/5025924
The estimated overall cost of inadequate sleep in Australia in 2016–2017 (population: 24.8 million) was $45.21 billion. The financial cost component was $17.88 billion, comprised of as follows: direct health costs of $160 million for sleep disorders and $1.08 billion for associated conditions; productivity losses of $12.19 billion ($5.22 billion reduced employment, $0.61 billion premature death, $1.73 billion absenteeism, and $4.63 billion presenteeism); nonmedical accident costs of $2.48 billion; informal care costs of $0.41 billion; and deadweight loss of $1.56 billion. The nonfinancial cost of reduced well-being was $27.33 billion.
Conclusions
The financial and nonfinancial costs associated with inadequate sleep are substantial. The estimated total financial cost of $17.88 billion represents 1.55 per cent of Australian gross domestic product. The estimated nonfinancial cost of $27.33 billion represents 4.6 per cent of the total Australian burden of disease for the year. These costs warrant substantial investment in preventive health measures to address the issue through education and regulation.
The #economic cost of inadequate #sleep
https://academic.oup.com/sleep/advance-article/doi/10.1093/sleep/zsy083/5025924
The estimated overall cost of inadequate sleep in Australia in 2016–2017 (population: 24.8 million) was $45.21 billion. The financial cost component was $17.88 billion, comprised of as follows: direct health costs of $160 million for sleep disorders and $1.08 billion for associated conditions; productivity losses of $12.19 billion ($5.22 billion reduced employment, $0.61 billion premature death, $1.73 billion absenteeism, and $4.63 billion presenteeism); nonmedical accident costs of $2.48 billion; informal care costs of $0.41 billion; and deadweight loss of $1.56 billion. The nonfinancial cost of reduced well-being was $27.33 billion.
Conclusions
The financial and nonfinancial costs associated with inadequate sleep are substantial. The estimated total financial cost of $17.88 billion represents 1.55 per cent of Australian gross domestic product. The estimated nonfinancial cost of $27.33 billion represents 4.6 per cent of the total Australian burden of disease for the year. These costs warrant substantial investment in preventive health measures to address the issue through education and regulation.
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Association of #Metformin Use With Risk of Lactic #Acidosis Across the Range of #Kidney Function
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2682516
Compared with alternative diabetes management, time-dependent metformin use was not associated with incident acidosis overall (adjusted hazard ratio HR, 0.98; 95% CI, 0.89-1.08) or in patients with eGFR 45 to 59 mL/min/1.73 m2 (adjusted HR, 1.16; 95% CI, 0.95-1.41) and eGFR 30 to 44 mL/min/1.73 m2 (adjusted HR, 1.09; 95% CI, 0.83-1.44). On the other hand, metformin use was associated with an increased risk of acidosis at eGFR less than 30 mL/min/1.73 m2 (adjusted HR, 2.07; 95% CI, 1.33-3.22). Results were consistent when new metformin users were compared with new sulfonylurea users (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 0.77; 95% CI, 0.29-2.05), in a propensity-matched cohort (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 0.71; 95% CI, 0.45-1.12), when baseline insulin users were excluded (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 1.16; 95% CI, 0.87-1.57), and in the replication cohort (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 0.86; 95% CI, 0.37-2.01).
Conclusions and Relevance In 2 real-world clinical settings, metformin use was associated with acidosis only at eGFR less than 30 mL/min/1.73 m2. Our results support cautious use of metformin in patients with type 2 diabetes and eGFR of at least 30 mL/min/1.73 m2.
Association of #Metformin Use With Risk of Lactic #Acidosis Across the Range of #Kidney Function
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2682516
Compared with alternative diabetes management, time-dependent metformin use was not associated with incident acidosis overall (adjusted hazard ratio HR, 0.98; 95% CI, 0.89-1.08) or in patients with eGFR 45 to 59 mL/min/1.73 m2 (adjusted HR, 1.16; 95% CI, 0.95-1.41) and eGFR 30 to 44 mL/min/1.73 m2 (adjusted HR, 1.09; 95% CI, 0.83-1.44). On the other hand, metformin use was associated with an increased risk of acidosis at eGFR less than 30 mL/min/1.73 m2 (adjusted HR, 2.07; 95% CI, 1.33-3.22). Results were consistent when new metformin users were compared with new sulfonylurea users (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 0.77; 95% CI, 0.29-2.05), in a propensity-matched cohort (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 0.71; 95% CI, 0.45-1.12), when baseline insulin users were excluded (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 1.16; 95% CI, 0.87-1.57), and in the replication cohort (adjusted HR for eGFR 30-44 mL/min/1.73 m2, 0.86; 95% CI, 0.37-2.01).
Conclusions and Relevance In 2 real-world clinical settings, metformin use was associated with acidosis only at eGFR less than 30 mL/min/1.73 m2. Our results support cautious use of metformin in patients with type 2 diabetes and eGFR of at least 30 mL/min/1.73 m2.
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Revised Pooled Cohort Equations for Estimating #Atherosclerotic #Cardiovascular Disease Risk
http://annals.org/aim/article-abstract/2683613/clinical-implications-revised-pooled-cohort-equations-estimating-atherosclerotic-cardiovascular-disease
The 2013 pooled cohort equations (PCEs) are central in prevention guidelines for cardiovascular disease (CVD) but can misestimate CVD risk
The 2013 PCEs overestimated 10-year risk for atherosclerotic CVD by an average of 20% across risk groups. Misestimation of risk was particularly prominent among black adults, of whom 3.9 million (33% of eligible black persons) had extreme risk estimates (<70% or >250% those of white adults with otherwise-identical risk factor values). Updating these equations improved accuracy among all race and sex subgroups. Approximately 11.8 million U.S. adults previously labeled high-risk (10-year risk ≥7.5%) by the 2013 PCEs would be relabeled lower-risk by the updated equations.
Revised Pooled Cohort Equations for Estimating #Atherosclerotic #Cardiovascular Disease Risk
http://annals.org/aim/article-abstract/2683613/clinical-implications-revised-pooled-cohort-equations-estimating-atherosclerotic-cardiovascular-disease
The 2013 pooled cohort equations (PCEs) are central in prevention guidelines for cardiovascular disease (CVD) but can misestimate CVD risk
The 2013 PCEs overestimated 10-year risk for atherosclerotic CVD by an average of 20% across risk groups. Misestimation of risk was particularly prominent among black adults, of whom 3.9 million (33% of eligible black persons) had extreme risk estimates (<70% or >250% those of white adults with otherwise-identical risk factor values). Updating these equations improved accuracy among all race and sex subgroups. Approximately 11.8 million U.S. adults previously labeled high-risk (10-year risk ≥7.5%) by the 2013 PCEs would be relabeled lower-risk by the updated equations.
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Intake of Different Dietary #Proteins and Risk of #Heart Failure in Men
http://circheartfailure.ahajournals.org/content/11/6/e004531
..During the mean follow-up of 22.2 years, 334 incident HF cases occurred. Higher intake of total protein indicated a trend toward increased risk of HF (multivariable-adjusted hazard ratio in the highest versus lowest quartile=1.33; 95% confidence interval: 0.95–1.85; P-trend=0.05). The associations between specific types and sources of protein with incident HF were consistent with this overall finding although not all associations reached statistical significance. For example, the hazard ratio in the highest versus lowest quartile was 1.43 (95% confidence interval: 1.00–2.03; P-trend=0.07) for total animal protein and 1.17 (95% confidence interval: 0.72–1.91; P-trend=0.35) for total plant protein.
Conclusions: In middle-aged men, higher protein intake was marginally associated with increased risk of HF.
Intake of Different Dietary #Proteins and Risk of #Heart Failure in Men
http://circheartfailure.ahajournals.org/content/11/6/e004531
..During the mean follow-up of 22.2 years, 334 incident HF cases occurred. Higher intake of total protein indicated a trend toward increased risk of HF (multivariable-adjusted hazard ratio in the highest versus lowest quartile=1.33; 95% confidence interval: 0.95–1.85; P-trend=0.05). The associations between specific types and sources of protein with incident HF were consistent with this overall finding although not all associations reached statistical significance. For example, the hazard ratio in the highest versus lowest quartile was 1.43 (95% confidence interval: 1.00–2.03; P-trend=0.07) for total animal protein and 1.17 (95% confidence interval: 0.72–1.91; P-trend=0.35) for total plant protein.
Conclusions: In middle-aged men, higher protein intake was marginally associated with increased risk of HF.
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Liquid-filled #Intragastric #Balloons by Apollo Endosurgery and ReShape Lifesciences: Letter to Health Care Providers - New Labeling About Potential Risks
https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm609761.htm
Instruct patients regarding symptoms of potentially life-threatening complications such as balloon deflation, gastrointestinal obstruction, ulceration, and gastric and esophageal perforation
Monitor patients closely during the entire term of treatment with liquid-filled intragastric balloon systems for potential complications, including acute pancreatitis and spontaneous hyperinflation as stated in our February 2017 letter to health care providers
Liquid-filled #Intragastric #Balloons by Apollo Endosurgery and ReShape Lifesciences: Letter to Health Care Providers - New Labeling About Potential Risks
https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm609761.htm
Instruct patients regarding symptoms of potentially life-threatening complications such as balloon deflation, gastrointestinal obstruction, ulceration, and gastric and esophageal perforation
Monitor patients closely during the entire term of treatment with liquid-filled intragastric balloon systems for potential complications, including acute pancreatitis and spontaneous hyperinflation as stated in our February 2017 letter to health care providers
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OPTIMIZING PATIENT SELECTION FOR #ENDOVASCULAR TREATMENT IN ACUTE ISCHEMIC #STROKE (SELECT): A PROSPECTIVE NON-RANDOMIZED MULTICENTER COHORT STUDY OF IMAGING SELECTION
https://cmoffice.kenes.com/cmsearchableprogrammeV15/conferencemanager/programme/personid/anonymous/ESOC18/normal/b833d15f547f3cf698a5e922754684fa334885ed#!abstractdetails/0000097150
In this prospective cohort study, consecutive anterior circulation LVOs up-to-24hours were enrolled, (1/16-2/18), at 9 centers. Patients received both NCCT and CTP with mismatch determination using RAPID software. Imaging selection modality was documented by treating physicians prior to thrombectomy. A blinded independent core-lab adjudicated imaging profiles (Good CT=ASPECTS≥6, Good CTP=core-volume<70cc,mismatch-volume≥10cc and mismatch/ratio>1.2). The primary outcome (90day-mRS=0-2) was compared between NCCT and CTP groups, and for different NCCT and CTP profiles.
Good outcome rates were similar in CT versus CTP selected patients, however, both modalities excluded a similar number of patients who could potentially benefit from thrombectomy.
OPTIMIZING PATIENT SELECTION FOR #ENDOVASCULAR TREATMENT IN ACUTE ISCHEMIC #STROKE (SELECT): A PROSPECTIVE NON-RANDOMIZED MULTICENTER COHORT STUDY OF IMAGING SELECTION
https://cmoffice.kenes.com/cmsearchableprogrammeV15/conferencemanager/programme/personid/anonymous/ESOC18/normal/b833d15f547f3cf698a5e922754684fa334885ed#!abstractdetails/0000097150
In this prospective cohort study, consecutive anterior circulation LVOs up-to-24hours were enrolled, (1/16-2/18), at 9 centers. Patients received both NCCT and CTP with mismatch determination using RAPID software. Imaging selection modality was documented by treating physicians prior to thrombectomy. A blinded independent core-lab adjudicated imaging profiles (Good CT=ASPECTS≥6, Good CTP=core-volume<70cc,mismatch-volume≥10cc and mismatch/ratio>1.2). The primary outcome (90day-mRS=0-2) was compared between NCCT and CTP groups, and for different NCCT and CTP profiles.
Good outcome rates were similar in CT versus CTP selected patients, however, both modalities excluded a similar number of patients who could potentially benefit from thrombectomy.
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Association of #Hypertensive Disorders of Pregnancy With Risk of #Neurodevelopmental Disorders in Offspring
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2681643
Although research suggests an association between hypertensive disorders of pregnancy (HDP) and autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental disorders in offspring, consensus is lacking
.. Ten studies reported estimates for ADHD. Six of these (including 1 395 605 participants) reported adjusted estimates, with a pooled adjusted OR of 1.29 (95% CI, 1.22-1.36). Subgroup analyses according to type of exposure (ie, preeclampsia or other HDP) showed no statistically significant differences for ASD or ADHD. Thirty-one studies met inclusion criteria for all other neurodevelopmental disorders. Individual estimates reported for these were largely inconsistent, with few patterns of association observed.
Conclusions and Relevance Exposure to HDP may be associated with an increase in the risk of ASD and ADHD. These findings highlight the need for greater pediatric surveillance of infants exposed to HDP to allow early intervention that may improve neurodevelopmental outcome
Association of #Hypertensive Disorders of Pregnancy With Risk of #Neurodevelopmental Disorders in Offspring
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2681643
Although research suggests an association between hypertensive disorders of pregnancy (HDP) and autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental disorders in offspring, consensus is lacking
.. Ten studies reported estimates for ADHD. Six of these (including 1 395 605 participants) reported adjusted estimates, with a pooled adjusted OR of 1.29 (95% CI, 1.22-1.36). Subgroup analyses according to type of exposure (ie, preeclampsia or other HDP) showed no statistically significant differences for ASD or ADHD. Thirty-one studies met inclusion criteria for all other neurodevelopmental disorders. Individual estimates reported for these were largely inconsistent, with few patterns of association observed.
Conclusions and Relevance Exposure to HDP may be associated with an increase in the risk of ASD and ADHD. These findings highlight the need for greater pediatric surveillance of infants exposed to HDP to allow early intervention that may improve neurodevelopmental outcome
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Association between reappearance of #myeloperoxidase‐antineutrophil cytoplasmic antibody and relapse in antineutrophil cytoplasmic antibody‐associated #vasculitis: Subgroup analysis of nationwide prospective cohort studies
https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40538
Of 271 patients, 183 were classified as having microscopic polyangiitis, 34 as having granulomatosis with polyangiitis, 15 as having eosinophilic granulomatosis with polyangiitis, and 39 were unclassifiable. The median age was 73 years and 165 (61%) were female. In 195 patients (72%), MPO‐ANCA levels decreased to normal levels within 6 months after commencement of treatment, and MPO‐ANCA reappeared in 73 (40%) of 181 patients with complete follow‐up data. Reappearance of MPO‐ANCA was more frequent in patients with relapse than in 75 age‐ and sex‐matched control patients without relapse (odds ratio 95% confidence interval: 26.2 8.2–101, P < 0.0001) after adjusting for confounding factors.
Conclusion
Reappearance of MPO‐ANCA could be a clinically useful biomarker for predicting relapse in remitted patients with MPO‐ANCA positive AAV. This suggests that routine MPO‐ANCA monitoring should be implemented in this patient population
Association between reappearance of #myeloperoxidase‐antineutrophil cytoplasmic antibody and relapse in antineutrophil cytoplasmic antibody‐associated #vasculitis: Subgroup analysis of nationwide prospective cohort studies
https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40538
Of 271 patients, 183 were classified as having microscopic polyangiitis, 34 as having granulomatosis with polyangiitis, 15 as having eosinophilic granulomatosis with polyangiitis, and 39 were unclassifiable. The median age was 73 years and 165 (61%) were female. In 195 patients (72%), MPO‐ANCA levels decreased to normal levels within 6 months after commencement of treatment, and MPO‐ANCA reappeared in 73 (40%) of 181 patients with complete follow‐up data. Reappearance of MPO‐ANCA was more frequent in patients with relapse than in 75 age‐ and sex‐matched control patients without relapse (odds ratio 95% confidence interval: 26.2 8.2–101, P < 0.0001) after adjusting for confounding factors.
Conclusion
Reappearance of MPO‐ANCA could be a clinically useful biomarker for predicting relapse in remitted patients with MPO‐ANCA positive AAV. This suggests that routine MPO‐ANCA monitoring should be implemented in this patient population
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#Hypertension and intracerebral #hemorrhage recurrence among white, #black, and Hispanic individuals
http://n.neurology.org/content/early/2018/06/06/WNL.0000000000005729
We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95% confidence interval 1.14–2.00, p = 0.004) and black (hazard ratio = 1.98, 95% confidence interval 1.36–2.86, p < 0.001) patients remained at higher risk of ICH recurrence.
Conclusion Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.
#Hypertension and intracerebral #hemorrhage recurrence among white, #black, and Hispanic individuals
http://n.neurology.org/content/early/2018/06/06/WNL.0000000000005729
We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95% confidence interval 1.14–2.00, p = 0.004) and black (hazard ratio = 1.98, 95% confidence interval 1.36–2.86, p < 0.001) patients remained at higher risk of ICH recurrence.
Conclusion Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.
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A new risk assessment model for the stratification of the #thromboembolism risk in medical patients: the #TEVERE score
https://www.ncbi.nlm.nih.gov/m/pubmed/29856190/?i=1&from=l%27angiocola
...The TEV risk factors with more statistical significance (p<0.01) are: previous VTE, active cancer, known thrombophilic condition, immobilization, chronic venous insufficiency, hyperhomocysteinemia, central venous catheter, recent hospitalization. Obesity, recent surgery, family history of VTE, hormone therapy and treatment with drugs that stimulate hematopoiesis are resulted at intermediate statistical significance (p<0.05 but >0.01). A multiple logistic regression was used with robust standard errors and forward selection of the candidate variables using the Bayesian information criterion. A new score is developed, the "TEVere Score", which shows an higher specificity and sensitivity (respectively 43.3 and 87.5, with accuracy 72.1) compared with the Padua, the Kuscer and the Chopard score. TEVere score also exhibits a greater predictive validity for thromboembolism risk (AUROC 0.7266; 95% CI, 0.71 to 0.73) than the Kuscer score..
CONCLUSIONS: The TEVere score has proven to exhibit a higher accuracy than the other scores commonly used in clinical practice to stratify the thromboembolism risk.
A new risk assessment model for the stratification of the #thromboembolism risk in medical patients: the #TEVERE score
https://www.ncbi.nlm.nih.gov/m/pubmed/29856190/?i=1&from=l%27angiocola
...The TEV risk factors with more statistical significance (p<0.01) are: previous VTE, active cancer, known thrombophilic condition, immobilization, chronic venous insufficiency, hyperhomocysteinemia, central venous catheter, recent hospitalization. Obesity, recent surgery, family history of VTE, hormone therapy and treatment with drugs that stimulate hematopoiesis are resulted at intermediate statistical significance (p<0.05 but >0.01). A multiple logistic regression was used with robust standard errors and forward selection of the candidate variables using the Bayesian information criterion. A new score is developed, the "TEVere Score", which shows an higher specificity and sensitivity (respectively 43.3 and 87.5, with accuracy 72.1) compared with the Padua, the Kuscer and the Chopard score. TEVere score also exhibits a greater predictive validity for thromboembolism risk (AUROC 0.7266; 95% CI, 0.71 to 0.73) than the Kuscer score..
CONCLUSIONS: The TEVere score has proven to exhibit a higher accuracy than the other scores commonly used in clinical practice to stratify the thromboembolism risk.
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Association of Coprescription of #Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With #Serotonin Syndrome
https://jamanetwork.com/journals/jamaneurology/article-abstract/2673391
Serotonin syndrome was suspected in 17 patients. Only 2 patients were classified as having definite serotonin syndrome (incidence rate, 0.6 cases per 10 000 person-years of exposure; 95% CI, 0.0-1.5). Five patients were classified as having possible serotonin syndrome (incidence rate with these 5 cases added to the 2 definite cases, 2.3 cases per 10 000 person-years of exposure; 95% CI, 0.6-3.9). The proportion of patients with triptan prescriptions who were coprescribed an SSRI or SNRI antidepressant was relatively stable during the study, ranging from 21% to 29%.
Conclusions and Relevance The risk of serotonin syndrome associated with concomitant use of triptans and SSRIs or SNRIs was low. Coprescription of these drugs is common and did not decrease after the 2006 FDA advisory. Our results cast doubt on the validity of the FDA advisory and suggest that it should be reconsidered
Association of Coprescription of #Triptan Antimigraine Drugs and Selective Serotonin Reuptake Inhibitor or Selective Norepinephrine Reuptake Inhibitor Antidepressants With #Serotonin Syndrome
https://jamanetwork.com/journals/jamaneurology/article-abstract/2673391
Serotonin syndrome was suspected in 17 patients. Only 2 patients were classified as having definite serotonin syndrome (incidence rate, 0.6 cases per 10 000 person-years of exposure; 95% CI, 0.0-1.5). Five patients were classified as having possible serotonin syndrome (incidence rate with these 5 cases added to the 2 definite cases, 2.3 cases per 10 000 person-years of exposure; 95% CI, 0.6-3.9). The proportion of patients with triptan prescriptions who were coprescribed an SSRI or SNRI antidepressant was relatively stable during the study, ranging from 21% to 29%.
Conclusions and Relevance The risk of serotonin syndrome associated with concomitant use of triptans and SSRIs or SNRIs was low. Coprescription of these drugs is common and did not decrease after the 2006 FDA advisory. Our results cast doubt on the validity of the FDA advisory and suggest that it should be reconsidered
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Association of Long-Term Risk of Respiratory, #Allergic, and #Infectious Diseases With Removal of #Adenoids and Tonsils in Childhood
https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2683621
Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk RR, 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher.
Conclusions and Relevance In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy
Association of Long-Term Risk of Respiratory, #Allergic, and #Infectious Diseases With Removal of #Adenoids and Tonsils in Childhood
https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2683621
Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk RR, 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher.
Conclusions and Relevance In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy
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Acute #Kidney Injury and Risk of #Heart Failure and #Atherosclerotic Events
http://m.cjasn.asnjournals.org/content/13/6/833
At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events (adjusted hazard ratio aHR, 1.18; 95% confidence interval 95% CI, 1.13 to 1.25) even after adjustment for demographics, comorbidities, preadmission eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, intensive care unit (ICU) admission, length of stay, and predicted in-hospital mortality. This was driven by an excess risk of subsequent heart failure (aHR, 1.44; 95% CI, 1.33 to 1.56), whereas there was no significant association with follow-up atherosclerotic events (aHR, 1.05; 95% CI, 0.98 to 1.12).
Conclusions AKI is independently associated with a higher risk of cardiovascular events, especially heart failure, after hospital discharge
Acute #Kidney Injury and Risk of #Heart Failure and #Atherosclerotic Events
http://m.cjasn.asnjournals.org/content/13/6/833
At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events (adjusted hazard ratio aHR, 1.18; 95% confidence interval 95% CI, 1.13 to 1.25) even after adjustment for demographics, comorbidities, preadmission eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, intensive care unit (ICU) admission, length of stay, and predicted in-hospital mortality. This was driven by an excess risk of subsequent heart failure (aHR, 1.44; 95% CI, 1.33 to 1.56), whereas there was no significant association with follow-up atherosclerotic events (aHR, 1.05; 95% CI, 0.98 to 1.12).
Conclusions AKI is independently associated with a higher risk of cardiovascular events, especially heart failure, after hospital discharge
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Invasive Methicillin-Resistant #Staphylococcus aureus Infections Among Persons Who Inject #Drugs — Six Sites, 2005–2016
https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a2.htm
What is already known about this topic?
The ongoing opioid epidemic is associated with increases in human immunodeficiency virus and hepatitis C infections and infection syndromes such as endocarditis.
What is added by this report?
Persons who inject drugs were an estimated 16.3 times more likely to develop invasive methicillin-resistant Staphylococcus aureus (MRSA) infections than others. Invasive MRSA from injecting drugs increased from 4.1% of invasive MRSA cases to 9.2% (2011–2016).
What are the implications for public health practice?
Increases in nonsterile injection drug use can cause increases in MRSA infections, underscoring the importance of public health interventions, including prevention of opioid misuse, providing medication-assisted treatment, syringe services programs, and education on safer injection practices to prevent infections from skin flora
Invasive Methicillin-Resistant #Staphylococcus aureus Infections Among Persons Who Inject #Drugs — Six Sites, 2005–2016
https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a2.htm
What is already known about this topic?
The ongoing opioid epidemic is associated with increases in human immunodeficiency virus and hepatitis C infections and infection syndromes such as endocarditis.
What is added by this report?
Persons who inject drugs were an estimated 16.3 times more likely to develop invasive methicillin-resistant Staphylococcus aureus (MRSA) infections than others. Invasive MRSA from injecting drugs increased from 4.1% of invasive MRSA cases to 9.2% (2011–2016).
What are the implications for public health practice?
Increases in nonsterile injection drug use can cause increases in MRSA infections, underscoring the importance of public health interventions, including prevention of opioid misuse, providing medication-assisted treatment, syringe services programs, and education on safer injection practices to prevent infections from skin flora
This is the link to the first number of the International Journal of Prevention Diagnostic and Therapeutic Medicine - IJPDTM.. Have a nice read (some articles in English too..)
https://simedet.eu/rivista-scientifica/#1529060280892-ce4a48e0-cd2a
https://simedet.eu/rivista-scientifica/#1529060280892-ce4a48e0-cd2a
SIMEDET
Rivista scientifica - SIMEDET
L’Italian Journal of Prevention, Diagnostic and Therapeutic Medicine (IJPDTM) è la rivista ufficiale della Società Italiana di Medicina Diagnostica e Terapeutica (SIMEDET).
2Medical.News pinned «This is the link to the first number of the International Journal of Prevention Diagnostic and Therapeutic Medicine - IJPDTM.. Have a nice read (some articles in English too..) https://simedet.eu/rivista-scientifica/#1529060280892-ce4a48e0-cd2a»
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#Antipsychotic treatment of very late-onset schizophrenia-like #psychosis (ATLAS): a randomised, controlled, double-blind trial
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30141-X/fulltext
..Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyrimidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C). No deaths were related to treatment.
Interpretation
Low-dose amisulpride is effective and well tolerated as a treatment for very late-onset schizophrenia-like psychosis, with benefits maintained by prolonging treatment.
#Antipsychotic treatment of very late-onset schizophrenia-like #psychosis (ATLAS): a randomised, controlled, double-blind trial
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30141-X/fulltext
..Fewer participants who were allocated amisulpride than placebo stopped treatment because of non-efficacy in stage 1 (p=0·010) and stage 2 (p=0·031). Serious adverse events were reported more frequently in the amisulpride group than in the placebo group in stage 1 (p=0·057) and stage 2 (p=0·19). The most common serious adverse events were infection (five patients in the amisulpride group, three in the placebo group) and extrapyrimidal side-effects (three patients in the amisulpride group, none in the placebo group). Five patients died during the study, one from a gastric ulcer bleed before treatment started (group B), two while taking stage 2 treatment (one in group A and one in group C), and two who stopped trial treatment in stage 1 and died many weeks later (one in group B and one in group C). No deaths were related to treatment.
Interpretation
Low-dose amisulpride is effective and well tolerated as a treatment for very late-onset schizophrenia-like psychosis, with benefits maintained by prolonging treatment.
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#Gender-based differences in host behavior and gut #microbiota composition in response to high fat diet and stress in a mouse model
https://www.nature.com/articles/s41598-017-11069-4
The results revealed distinct gender differences in the impacts of obesity and stress on anxiety-like behaviors, activity levels, and composition of the gut microbiota. Male mice were more vulnerable to the anxiogenic effects of the high fat diet, and obese male mice showed decreased locomotion activity in response to stress whereas obese female mice did not. In females, stress caused the gut microbiota of lean mice to more closely resemble that of obese mice. Taken together, these results suggest the importance of considering gender as a biological variable in studies on the role of gut microbiota in obesity-related mood disorders.
#Gender-based differences in host behavior and gut #microbiota composition in response to high fat diet and stress in a mouse model
https://www.nature.com/articles/s41598-017-11069-4
The results revealed distinct gender differences in the impacts of obesity and stress on anxiety-like behaviors, activity levels, and composition of the gut microbiota. Male mice were more vulnerable to the anxiogenic effects of the high fat diet, and obese male mice showed decreased locomotion activity in response to stress whereas obese female mice did not. In females, stress caused the gut microbiota of lean mice to more closely resemble that of obese mice. Taken together, these results suggest the importance of considering gender as a biological variable in studies on the role of gut microbiota in obesity-related mood disorders.
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Immunization with #Mycobacterium vaccae induces an anti-inflammatory milieu in the CNS: Attenuation of #stress-induced microglial priming, alarmins and anxiety-like behavior
https://www.sciencedirect.com/science/article/pii/S088915911830196X
Exposure to stressors induces anxiety- and depressive-like behaviors, which are mediated, in part, by neuroinflammatory processes. Recent findings demonstrate that treatment with the immunoregulatory and anti-inflammatory bacterium, Mycobacterium vaccae (M. vaccae), attenuates stress-induced exaggeration of peripheral inflammation and stress-induced anxiety-like behavioral responses. However, the effects of M. vaccae on neuroimmune processes have largely been unexplored. In the present study, we examined the effect of M. vaccae NCTC11659 on neuroimmune regulation, stress-induced neuroinflammatory processes and anxiety-like behavior
The present findings suggest that M. vaccae enhances immunomodulation in the CNS and mitigates the neuroinflammatory and behavioral effects of stress, which may underpin its capacity to impart a stress resilient phenotype.
Immunization with #Mycobacterium vaccae induces an anti-inflammatory milieu in the CNS: Attenuation of #stress-induced microglial priming, alarmins and anxiety-like behavior
https://www.sciencedirect.com/science/article/pii/S088915911830196X
Exposure to stressors induces anxiety- and depressive-like behaviors, which are mediated, in part, by neuroinflammatory processes. Recent findings demonstrate that treatment with the immunoregulatory and anti-inflammatory bacterium, Mycobacterium vaccae (M. vaccae), attenuates stress-induced exaggeration of peripheral inflammation and stress-induced anxiety-like behavioral responses. However, the effects of M. vaccae on neuroimmune processes have largely been unexplored. In the present study, we examined the effect of M. vaccae NCTC11659 on neuroimmune regulation, stress-induced neuroinflammatory processes and anxiety-like behavior
The present findings suggest that M. vaccae enhances immunomodulation in the CNS and mitigates the neuroinflammatory and behavioral effects of stress, which may underpin its capacity to impart a stress resilient phenotype.
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Assessment of the Diagnostic Accuracy of Biparametric Magnetic #Resonance Imaging for #Prostate Cancer in Biopsy-Naive Men
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2683950
A total of 1020 men were enrolled, with a median age of 67 years (interquartile range, 61-71 years) and a median prostate-specific antigen level of 8.0 ng/mL (interquartile range, 5.7-13.0 ng/mL). Combined biopsies detected any and significant prostate cancer in 655 of 1020 men (64%) and 404 of 1020 men (40%), respectively. Restricting combined biopsies to men with suspicious bpMRI findings meant 305 of 1020 men (30%) with low-suspicious bpMRIs could avoid prostate biopsies (biopsy in 715 men with suspicious bpMRIs vs all 1020 men who required standard biopsies 70%; P < .001). Significant prostate cancer diagnoses were improved by 11% (396 vs 351 men; P < .001), and insignificant prostate cancer diagnoses were reduced by 40% (173 vs 288 men; P < .001) compared with our current diagnostic standard, standard biopsies alone in all men. The NPV of bpMRI findings in ruling out significant prostate cancer was 97% (95% CI, 95%-99%).
Conclusions and Relevance Low-suspicion bpMRI has a high NPV in ruling out significant prostate cancer in biopsy-naive men. Using a simple and rapid bpMRI method as a triage test seems to improve risk stratification and may be used to exclude aggressive disease and avoid unnecessary biopsies with its inherent risks. Future studies are needed to fully explore its role in clinical prostate cancer management.
Assessment of the Diagnostic Accuracy of Biparametric Magnetic #Resonance Imaging for #Prostate Cancer in Biopsy-Naive Men
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2683950
A total of 1020 men were enrolled, with a median age of 67 years (interquartile range, 61-71 years) and a median prostate-specific antigen level of 8.0 ng/mL (interquartile range, 5.7-13.0 ng/mL). Combined biopsies detected any and significant prostate cancer in 655 of 1020 men (64%) and 404 of 1020 men (40%), respectively. Restricting combined biopsies to men with suspicious bpMRI findings meant 305 of 1020 men (30%) with low-suspicious bpMRIs could avoid prostate biopsies (biopsy in 715 men with suspicious bpMRIs vs all 1020 men who required standard biopsies 70%; P < .001). Significant prostate cancer diagnoses were improved by 11% (396 vs 351 men; P < .001), and insignificant prostate cancer diagnoses were reduced by 40% (173 vs 288 men; P < .001) compared with our current diagnostic standard, standard biopsies alone in all men. The NPV of bpMRI findings in ruling out significant prostate cancer was 97% (95% CI, 95%-99%).
Conclusions and Relevance Low-suspicion bpMRI has a high NPV in ruling out significant prostate cancer in biopsy-naive men. Using a simple and rapid bpMRI method as a triage test seems to improve risk stratification and may be used to exclude aggressive disease and avoid unnecessary biopsies with its inherent risks. Future studies are needed to fully explore its role in clinical prostate cancer management.