Evidence Of Other Conditions Research Articles

Clinical characteristics and severity of COVID-19 among Mexican adults.

Obesity, diabetes, hypertension and age have been pointed at as factors that influence on the progression of COVID-19; however, evidence for other conditions is inconclusive. To identify which clinical characteristics are related to COVID-19 severity and to determine whether age acts a modifier of the relationship between cardio-metabolic comorbidities (CMC) and COVID-19 progression. Data on ≥ 20-year-old confirmed cases (n = 159,017) were analyzed. Hospitalization, development of pneumonia, intubation requirement, intensive care unit admission and death were the dependent variables in Poisson regression models estimation, whereas the interaction between age and different CMCs were the independent variables. Having CMCs, as well as other comorbidities, was directly related to COVID-19 progression, whereas chronic obstructive pulmonary disease was only related to an increase in the risk of dying. The risk for COVID-19 severity was lower as age was more advanced. Asthma and smoking were not risk factors for the progression of COVID-19. In the Mexican population, the risk of COVID-19 progression associated with comorbidities was higher in young adults.

Anticoagulant treatment patterns and thromboembolic events by tumor type among patients with VTE and cancer

Abstract Background Patients with venous thromboembolism (VTE) and cancer are at higher risk of adverse outcomes (mortality, recurrent VTE etc.) versus patients with cancer alone; as such, clinical guidelines recommend anticoagulant treatment for patients with VTE and cancer. There is limited real world data about how anticoagulant treatment and thromboembolic outcomes differ by tumor type in patients with VTE and cancer. Understanding such differences may help identify appropriate anticoagulant treatment for specific tumor types. Purpose To describe anticoagulant treatment patterns and thromboembolic outcomes by tumor type among patients with VTE and cancer. Methods Patients with VTE and cancer age ≥65 were identified from the Surveillance, Epidemiology and End Results (SEER) Medicare database from 1/1/2014–12/31/2019. Patients were required to be enrolled for ≥6-months prior to their first VTE diagnosis (index) and without evidence of other conditions requiring anticoagulant (i.e., atrial fibrillation) prior to index. Cancer status and tumor type were identified from SEER or Medicare database in the 6-months prior through 30-days post VTE. This analysis focused on the following specific tumor types: high risk (brain, pancreas, and stomach) and common tumor types (breast, and prostate). Patients treated with an anticoagulant within 30-days after index were included in the final population. Major bleeding (MB) and recurrent VTE events were measured during follow-up (index date through earliest of disenrollment, death or 12/31/2019). Results A total of 3,546 anticoagulated patients with VTE and cancer of interest met all study criteria (breast [n=1,197], prostate [n=849], pancreatic [n=995], brain [n=248] and stomach [n=257] cancer). Patient mean age ranged from 73 (brain) to 76 (stomach) at index. Anticoagulant treatment patterns varied by tumor type (Figure 1). LMWH was more likely to be used in the 3 high risk tumor types whereas apixaban and rivaroxaban were more likely to be used in the 2 common tumor types. The incidence rate of recurrent VTE and major bleeding events also varied among different tumor types: ranging from 1.4 (breast) to 6.4 (pancreatic) per 100 person-years for recurrent VTE and from 4.3 (prostate) to 15.1 (pancreatic) per 100 person-years for major bleeding (Figure 2). Conclusion There are notable variations in anticoagulant treatment patters and the risks of major bleeding and recurrent VTE events by tumor type among patients with VTE and cancer. Further research is needed to understand which anticoagulant treatment option is more appropriate for VTE patients with specific tumor type. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Pfizer Inc. and Bristol Myers Squibb Company

Diagnostic practices for patients with shortness of breath and presumed obstructive airway disorders: a cross-sectional analysis.

Dyspnea is a common symptom that has many causes, including obstructive airway disorders. We sought to examine previous diagnosis of obstructive airway disorders and other conditions in patients receiving treatment with inhaled medications for shortness of breath in a community setting. This cross-sectional study included consecutive patients aged 18 years and older receiving treatment for shortness of breath with inhaled medications for a minimum of 6 months. Study participants were recruited through community pharmacies in Edmonton and Saskatoon, Canada, between February 2009 and February 2012. Previous diagnosis of obstructive airway disorders by a primary care provider was assessed by patient self-report and review of health records. We conducted an assessment (as per guidelines from the American Thoracic Society and the European Respiratory Society), including pulmonary function tests; diagnoses were adjudicated by an expert physician panel (2 respirologists and 1 emergency physician). The agreement between diagnoses derived from pulmonary function tests and diagnoses from primary care providers was evaluated. A total of 328 patients (median age 50 yr, 57.3% female) underwent assessment; 134 (40.9%) of patients reported ever having a pulmonary function test performed. After adjudication, 138 (42.1%) were diagnosed with asthma only, 86 (26.2%) with chronic obstructive pulmonary disease only and 11 (3.4%) with both. Some patients (93, 28.4%) had no evidence of obstructive airway disorders and 20 (6.1%) had evidence of other conditions that cause shortness of breath, such as heart failure and pulmonary hypertension. Overall, 62 (18.9%) patients could not be assigned a diagnosis. In a group of community-based patients with shortness of breath being treated with inhalers, less than half ever had pulmonary function tests performed, and a considerable proportion had no evidence of lung disease or other conditions. These findings highlight the need for confirmatory testing, including pulmonary function tests, before prescribing inhalers for patients with presumed obstructive airway disorders.

Effects of increased distance to urgent and emergency care facilities resulting from health services reconfiguration: a systematic review

BackgroundService reconfigurations sometimes increase travel time and/or distance for patients to reach their nearest hospital or other urgent and emergency care facility. Many communities value their local services and perceive that proposed changes could worsen outcomes for patients.ObjectivesTo identify, appraise and synthesise existing research evidence regarding the outcomes and impacts of service reconfigurations that increase the time and/or distance for patients to reach an urgent and emergency care facility. We also aimed to examine the available evidence regarding associations between distance to a facility and outcomes for patients and health services, together with factors that may influence (moderate or mediate) these associations.Data sourcesWe searched seven bibliographic databases in February 2019. The search was supplemented by citation-tracking and reference list checking. A separate search was conducted to identify the current systematic reviews of telehealth to support urgent and emergency care.MethodsBrief inclusion and exclusion criteria were as follows: (1) population – adults or children with conditions that required emergency treatment; (2) intervention/comparison – studies comparing outcomes before and after a service reconfiguration, which affects the time/distance to urgent and emergency care or comparing outcomes in groups of people travelling different distances to access urgent and emergency care; (3) outcomes – any patient or health system outcome; (4) setting – the UK and other developed countries with relevant health-care systems; and (5) study design – any. The search results were screened against the inclusion criteria by one reviewer, with a 10% sample screened by a second reviewer. A quality (risk-of-bias) assessment was undertaken using The Joanna Briggs Institute Checklist for Quasi-Experimental Studies. We performed a narrative synthesis of the included studies and assessed the overall strength of evidence using a previously published method.ResultsWe included 44 studies in the review, of which eight originated from the UK. For studies of general urgent and emergency care populations, there was no evidence that reconfiguration that resulted in increased travel time/distance affected mortality rates. By contrast, evidence of increased risk was identified from studies restricted to patients with acute myocardial infarction. Increases in mortality risk were most obvious within the first 1–4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited. In the absence of reconfiguration, evidence mainly from cohort studies indicated that increased travel time or distance is associated with increased mortality risk for the acute myocardial infarction and trauma populations, whereas for obstetric emergencies the evidence was inconsistent. We included 12 systematic reviews of telehealth. Meta-analyses suggested that telehealth technologies can reduce time to treatment for people with stroke and ST elevation myocardial infarction.LimitationsMost studies came from non-UK settings and many were at high risk of bias because there was no true control group. Most review processes were carried out by a single reviewer within a constrained time frame.ConclusionsWe found no evidence that increased distance increases mortality risk for the general population of people requiring urgent and emergency care, although this may not be true for people with acute myocardial infarction or trauma. Increases in mortality risk were most likely in the first few years after reconfiguration.Future workResearch is needed to better understand how health systems plan for and adapt to increases in travel time, to quantify impacts on health system outcomes, and to address the uncertainty about how risk increases with distance in circumstances relevant to UK settings.Study registrationThis study is registered as PROSPERO CRD42019123061.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 31. See the NIHR Journals Library website for further project information.

Effects of service changes affecting distance/time to access urgent and emergency care facilities on patient outcomes: a systematic review

BackgroundReconfiguration of urgent and emergency care services often increases travel time/distance for patients to reach an appropriate facility. Evidence of the effects of reconfiguration is important for local communities and commissioners and providers of health services.MethodsWe performed a systematic review of the evidence regarding effects of service reconfigurations that increase the time/distance for some patients to reach an urgent and emergency care (UEC) facility. We searched seven bibliographic databases from 2000 to February 2019 and used citation tracking and reference lists to identify additional studies. We included studies of any design that compared outcomes for people with conditions requiring emergency treatment before and after service reconfiguration with an associated change in travel time/distance to access UEC. Studies had to be conducted in the UK or other developed countries. Data extraction and quality assessment (using the Joanna Briggs Institute checklist for quasi-experimental studies) were undertaken by a single reviewer with a sample checked for accuracy and consistency. We performed a narrative synthesis of the included studies. Overall strength of evidence was assessed using a previously published method that considers volume, quality and consistency.ResultsWe included 12 studies, of which six were conducted in the USA, two in the UK and four in other European countries. The studies used a variety of observational designs, with before–after and cohort designs being most common. Only two studies included an independent control site/sites where no reconfiguration had taken place. The reconfigurations evaluated in these studies reported relatively small effects on average travel times/distance.DiscussionFor studies of general UEC populations, there was no convincing evidence as to whether reconfiguration affected mortality risk. However, evidence of increased risk was identified from studies of patients with acute myocardial infarction, particularly 1 to 4 years after reconfiguration. Evidence for other conditions was inconsistent or very limited.ConclusionsWe found insufficient evidence to determine whether increased distance to UEC increases mortality risk for the general population of people requiring UEC, although this conclusion may not extend to people with specific conditions.

Radiofrequency-based treatment in therapy-related clinical practice – a narrative review. Part II: chronic conditions

Background: Radiofrequency (RF)-based electrophysical agents (EPAs) have been employed in therapy-related clinical practice for several decades. They are used to reduce pain and inflammation and promote tissue healing. Although deemed less popular in current therapy practice, surveys suggest that some of these EPAs are still used reasonably widely.Objective: To review the evidence for the use of non-invasive low-frequency RFs (30 kHz - 30 MHz) for treating chronic therapy-related clinical conditions.Major findings: All relevant peer-reviewed clinical studies published in English, concerning low-frequency RFs were sought. Identified literature was stratified as ‘acute’ and ‘chronic’ based on their clinical area. The studies on chronic conditions were reviewed for this paper and analysed to assess the volume and scope of current evidence. Out of 120 studies identified, 90 related to chronic conditions. The majority of them (82 studies) employed shortwave therapy (SWT) in continuous (CSWT) or pulsed (PSWT) modes. Only eight studies employed frequencies other than shortwave. Overall 67 studies investigated conditions relating to ‘pain and inflammation’, 16 to ‘tissue healing’ and 7 studies to other less reported conditions.Conclusions: Evidence favouring and against RF-based EPAs is available. There is moderate evidence favouring the use of SWT (mainly PSWT) in knee osteoarthritis. Some evidence also exists for CSWT in chronic low back pain and PSWT for treating chronic wounds. Evidence for other conditions is insufficient and conflicting. A general lack of research emphasis in the non-shortwave RF band is evident. Further and wider research in this area is necessary.

E-071 Organization of a Neurointerventional Fellowship Curriculum

IntroductionThe field of Neurointervention has attracted some of the very best physicians across the world. Given the interdisciplinary nature of this specialty, radiologists, neurosurgeons, and neurologists have been trained in...

Lagos leprosarium (Portugal): evidences of disease

In 2009, an archaeological intervention in the Valle da Gafaria (Lagos, Portugal) allowed the excavation of part of a leprosarium and an associated necropolis (15th–17th centuries). The individuals recovered were buried directly in the soil, in positions and orientations discordant to the prevailing Christian rules. The sample is made up of eleven adult individuals of both sexes.This paper discusses the differential diagnosis of unusual and distinct pathological changes in five of the individuals recovered. The differential diagnosis of the lesions gave rise to several possible pathological conditions, namely, leprosy, treponematosis, brucellosis, slipped femoral capital epiphysis, and Legg-Calvé-Perthes disease. Various macroscopic and radiological aspects led us to consider leprosy as the most probable diagnosis in two individuals. Treponematosis and brucellosis were the probable diagnosis in other two individuals, respectively. One individual presented lesions in the right femur compatible with Legg-Calvé-Perthes disease.Historical documents suggest that the poor, mentally disabled, and people suffering from syphilis, tuberculosis, among others, were also housed in leprosaria. Therefore, it is possible that evidence of other conditions is found in human remains uncovered at a leprosarium.The cases under study enrich the scanty osteoarchaeological documentation of palaeopathology in Portugal in the Modern Age, namely of leprosy, brucellosis, treponematosis, and Legg-Calvé-Perthes disease, and they can contribute to reduce the discrepancy between historical and biological evidences of disease.

Interventions to Enhance Adherence to Medications in Patients With Heart Failure

Prognosis remains poor for patients with chronic heart failure (CHF), despite improvements in the prevention and treatment of heart failure over the last 25 years. Recent estimates indicate that the median survival after a first episode of heart failure is 2.3 years for men and 1.8 years for women.1 It is suggested that the improvements in outcomes that have been achieved can be partly explained by increases in prescribing rates of medications such as angiotensin-converting enzyme inhibitors,2 β-blockers,3 and spironolactone4 over this period.1 Although the evidence on medication efficacy for certain subgroups of patients with CHF is clear, there are also compelling data showing that many of these patients do not take their medications as prescribed by health care providers.5,6 This “nonadherence” to medication therefore remains a significant barrier to enhancing the effectiveness of existing treatments. Estimates for nonadherence to medications in CHF have varied widely.5 One of the largest studies found that only 80% of patients with a prescription for angiotensin-converting enzyme inhibitors at hospital discharge completed the prescription form 30 days after discharge, and this rate subsequently fell to 60% over 1 year.7 Full adherence, defined as filing enough prescriptions to have daily medication available for 1 year, may be as low as 10% in CHF.8 Poor adherence to medication in CHF is associated with worse outcomes in observational studies, including shorter event-free survival.9 Therefore, strategies to enhance adherence provide a potentially valuable strategy for improving survival, reducing hospitalization and managing patient symptoms in CHF. In this report, we provide an up-to-date review and analysis of those studies that have developed and evaluated medication adherence interventions in CHF. Because CHF is typically symptomatic and includes medication with actions that are discernible to the patient within hours …

Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis

To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with <2 years of complete data prior to TKR or THR were excluded, as were those with evidence of other conditions for which TKR or THR may be performed (e.g., rheumatoid arthritis). We then examined patterns of health care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches.

Lithium Carbonate and Kidney Function

Three patients with manic-depressive illness who were successfully treated with lithium carbonate developed polyuria and polydipsia at varying periods after starting treatment. Water deprivation studies revealed a defect in renal concentrating ability which was not corrected by the administration of vasopressin injection. None of the patients had elevated urine volumes prior to lithium carbonate therapy, and there was no evidence of other conditions which might have affected renal concentrating ability.

Angiotensin Blood Levels during the Evolution of Acute Renal Failure

1. Angiotensin blood levels (ABL) have been measured in thirteen white patients with diagnoses of acute renal failure of different aetiologies during several stages of the disease and with no evidence of other conditions that could stimulate renin release by the kidney. 2. Mean ABL on admission was 770 SEM 62 ng/l. When daily urinary volume was higher than 1500 ml, these values were significantly lower: 114 SEM 49·6 ng/l. 3. A negative correlation between ABL and systolic blood pressure was obtained (r = −0·35, P = 0·01). The partial correlation coefficients between ABL and systolic blood pressure showed the same results. 4. A negative correlation between the logarithm of ABL and daily urinary volume was obtained. The partial linear correlation coefficients between ABL and urine volume confirmed this relationship. 5. There was no correlation between the ABL and the aetiology of the anuria, its final course, the duration of the disease, the arterial blood pressure and the plasma urea, sodium or potassium levels. 6. It is suggested that the decrease in the ABL has some connection with the re-establishment of the diuresis, possibly through an increase of glomerular filtration rate and in sodium excretion affecting the macula densa cells.

STUDIES OF THE AGING OF CONIDIA OF MONILINIA FRUCTICOLA (WINT.) HONEY: I.GERMINATION RATES AND LONGEVITY

Conidia of Monilinia fructicola (Wint.) Honey were stored 1–10 months at temperatures of 5°, 25°, and 35 °C. and at constant relative humidities approximating 0, 15, 45, 75, and 90%. The germination of these spores was tested on potato dextrose agar containing 6% glucose, and curves of the percentage germination against time are given for representative samples.A pronounced delay in germination developed under all conditions of storage. The rate at which this delay developed was virtually independent of the storage temperature. All spore samples gave 100% germination after 3 months but only those at 5 °C. gave; any germination after 10 months. Storage in a relative humidity of 75% gave the best preservation of spore vigor, there being evidence in other conditions of either high humidity or low humidity injury. Of the nutrient solutions tested, glucose was the only one which gave substantially better germination than water, the effect being most marked on spores stored for some months at high humidity. With glucose, such spores sometimes germinated faster than those stored at intermediate humidities.