Median Episode Duration Research Articles

Phenotypic characterization of paroxysmal dyskinesia in Maltese dogs.

BackgroundParoxysmal dyskinesias (PDs) are a group of central nervous system diseases characterized by episodes of abnormal involuntary hyperkinetic movement without altered consciousness that increasingly have been recognized in dogs.ObjectivesTo present the phenotypical characterization, treatment, and outcome of a PD observed in Maltese dogs.AnimalsClient‐owned Maltese dogs (n = 19) with presumed diagnosis of PD.MethodsData were collected retrospectively from medical records (2014‐2019), and supporting information was added prospectively by using a questionnaire directed to the owners of the affected dogs.ResultsThe episodes were characterized mainly by sudden dystonia of ≥1 limbs and generalized body tremors with preserved consciousness. The mean age of clinical onset was 5.4 years. Episode frequency varied widely both among and within individuals. Median episode duration was 4.5 minutes. Most episodes were stress‐ or exercise‐induced. Acetazolamide was administered to 6 dogs, and 4 dogs experienced a decrease in episode frequency. In 7 dogs that received a gluten‐free diet, 6 dogs became episode‐free. In 4 dogs, the episodes stopped spontaneously and in 2 dogs no medication or specific diet was given and the episodes continued at the same frequency.Conclusions and Clinical ImportanceGiven the breed predisposition and regional distribution of the disease, additional research should focus on elucidating the underlying genetic cause doing so might advance both our understanding of the pathophysiology and treatment of this disease, not only in dogs, but also in humans. Regardless of the treatment protocol selected, prognosis appears fair to good.

Constructing treatment episodes from concomitant medication logs: a prospective observational study

ObjectivesTo describe an approach using concomitant medication log records for the construction of treatment episodes. Concomitant medication log records are routinely collected in clinical studies. Unlike prescription and dispensing records,...

Efficacy of a topical herbal and mineral formulation (Dynamiclear) for the treatment of herpes simplex labialis in the community setting: study protocol for a randomised, double-blind placebo-controlled trial

IntroductionHerpes simplex labialis (HSL) is a common infection that can cause painful lesions on the oral mucosa, commonly referred to as cold sores. Current biomedical treatments include topical aciclovir, which...

P1907Propensity score matched analysis of antazoline mesylate vs. amiodarone or propafenone for pharmacological cardioversion of short-duration atrial fibrillation

Abstract Background Former studies corroborated promising quinidine-like properties of antazoline mesylate facilitating rapid cardioversion atrial fibrillation (AF). Still, paucity of data exists concerning direct comparison of antazoline to other antiarrhythmic agents. Purpose The study aimed to verify the hypothesis that intravenous antazoline is non-inferior to amiodarone and/or propafenone in terms of rhythm conversion rate and safety among patients with AF. Methods After reviewing 2344 consecutive medical records with I48 code of international classification of diseases (ICD), 505 eligible patients (21.5%) with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency department were enrolled in retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of attending physician. Antazoline group was separately matched with corresponding amiodarone (n=218) and propafenone (n=90) cohort using propensity score matching (PSM) with nearest neighbor algorithm (ratio 1:1), adjusting for age, sex, arterial hypertension, diabetes, depressed left ventricular ejection fraction, coronary artery disease, history of stroke, AF ablation, CHA2DS2-VASc score, chronic kidney disease and duration of AF episode. The primary endpoint was restoration of sinus rhythm in the emergency department. Results The study population (mean age of 67 (59; 74) years; 53.7% females) was characterized by median AF episode duration of 10.5 (5; 24) hours. Antazoline alone was administered in 23.4% of patients (n=118); amiodarone in 47.5% (n=240); propafenone in 9.9% (n=50); while 19.2% (n=97) received ≥2 antiarrhythmic drugs. Before PSM adjustment, antazoline had comparable rhythm conversion rate to propafenone (85.6% vs. 80.0%; P=0.367) and higher than amiodarone treatment (vs. 66.7%, P=0.0002), and greater than combined amiodarone/propafenone group (68.6%; RR 1.25; 95% CI: 1.12–1.39, P=0.0001). After PSM, the use of antazoline was associated with the efficacy similar to propafenone (82.2% vs. 80.0%, RR 1.03; 95% CI: 0.84–1.25, P=0.788) and superior to amiodarone (85.3% vs. 67.0%, RR 1.27, 95% CI: 1.09–1.48, P=0.0019, number needed to treat 5.5; Figure). No major adverse actions were reported in the antazoline group. Conclusion Antazoline appears to be an efficacious and safe drug for pharmacological cardioversion of AF in real-life setting, which is at least non-inferior to existing antiarrhythmic drugs. Acknowledgement/Funding None

Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a oral spray for children with recurrent streptococcal pharyngotonsillitis: a randomized placebo-controlled clinical study.

Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT. Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up. We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment. We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.

Is Heightened-Shoaling a Good Candidate for Positive Emotional Behavior in Zebrafish?

Simple SummaryDespite increasing interest in fish welfare, we still know very little about positive emotions in fish. This study had two aims: (1) to characterize a previously undescribed social behavior in zebrafish, “heightened-shoaling”, and (2) to evaluate whether heightened-shoaling may be a good candidate for future research into positive emotional behavior in zebrafish. Observing six groups of zebrafish housed in 110 L tanks furnished with a sloping gravel substrate, rocks, and artificial plants (10 fish/tank), we found that heightened-shoaling is marked by tight group cohesion, high behavioral synchrony (all fish engaging in the same behaviors at the same time), and low agonism. Episodes of heightened-shoaling occurred in all six groups, but rarely at the same time (only once out of 31 episodes), suggesting that the onset of heightened-shoaling is driven by internal group dynamics rather than external influences. Heightened-shoaling also appeared to be self-reinforcing as it had sustained durations—typically lasting for over 7 min and sometimes lasting for nearly half-an-hour. Collectively, these results are similar to the patterns that typify positive emotional behavior in other animals, for example, social grooming and social play. As the first description of heightened-shoaling, this research extends our knowledge of the range of zebrafish social dynamics and suggests a promising area for future research on positive emotions in fish.Zebrafish, a highly-social species of freshwater fish, are widely studied across many fields of laboratory science including developmental biology, neuroscience, and genomics. Nevertheless, as standard housing for zebrafish typically consists of small and simplistic environments, less is known about their social behavioral repertoire in more naturalistic settings. In particular, spontaneously occurring, socio-positive affiliative behaviors (e.g., social coordination and cohesion) that may be indicative of positive emotional experiences have rarely been reported or studied deliberately in zebrafish. Housing adult zebrafish (10 fish/tank) in large semi-natural tanks (110 L; n = 6) with sloping gravel substrate, rocks, and artificial plants, we observed a previously undescribed behavior: Distinct periods of spontaneous, synchronized, compact aggregations, what we call “heightened-shoaling”. This project aimed to quantify the characteristics of this distinctive behavior and compare parameters of heightened-shoaling to baseline periods (normal behavior) and pre-feed periods (feed-anticipatory behavior). First, across 4 days, we selected video-clips (100 s each) from within (i) instances of heightened-shoaling (n = 9), (ii) baseline periods (n = 18), and (iii) pre-feed periods (n = 18). For each of these video clips, we scan sampled every 10 s to determine fish orientations and location within the tank and agonistic behavior. Next, we used an all-occurrence sampling method to record the timing and duration of all episodes of heightened-shoaling behavior when tank-lights were on (8:00 h to 18:00 h) across 10 days. From the scan-sampling data, we found that compared to baseline periods, heightened-shoaling was characterized by increased shoal cohesion (p < 0.0001), increased adherence to the horizontal plane (p < 0.0001), decreased agonism (p < 0.0001), and no diving behavior (lower positions within the water column signal negative effect in zebrafish, p > 0.1). From the all-occurrence sampling data, we found 31 episodes of heightened-shoaling with instances observed in all six tanks and only a single case in which heightened-shoaling occurred in two tanks at the same time. The median episode duration was 7.6 min (Range 1.3–28.6). As the first systematic description of heightened-shoaling behavior, this research contributes to our knowledge of the range of zebrafish social dynamics living in naturalistic environments. Moreover, as a spontaneously occurring, protracted, affiliative behavior, heightened-shoaling appears to be a good candidate for future research into positive emotional behavior in zebrafish.

Effect of carglumic acid with or without ammonia scavengers on hyperammonaemia in acute decompensation episodes of organic acidurias

BackgroundHyperammonaemia is a key sign of decompensation in organic acidurias (OAs) and can contribute to severe neurological complications, thus requiring rapid treatment.MethodsA post-hoc analysis of two retrospective studies analysed the efficacy of carglumic acid ± ammonia (NH3) scavengers compared with scavengers alone for reducing plasma NH3 levels in patients with OAs and hyperammonaemia (plasma NH3 > 60 μmol/L) during decompensation episodes. NH3 was analysed in 12-h periods at 0–48 h and 24-h periods at 48–120 h. Treatment-emergent adverse events (TEAEs) were recorded.ResultsOf 98 episodes, 38 were treated with carglumic acid (34 patients), 33 with NH3 scavengers (22 patients) and 27 with carglumic acid combined with NH3 scavengers (27 patients). Overall, 45% (carglumic acid group), 46% (NH3 scavengers group) and 74% (combination group) of episodes occurred in neonates. Median episode duration was 6 days for the carglumic acid and combination groups, and 9 days for the NH3 scavenger group. Median baseline NH3 level was: 199 μmol/L, carglumic acid; 122 μmol/L, NH3 scavengers; and 271 μmol/L, combination; 13, 30 and 11% of episodes required extracorporeal detoxification (ED), respectively. Data were censored at ED initiation. While baseline NH3 levels were higher in the combination and carglumic acid groups, mean reduction in NH3 levels to 72 h in both groups was greater than the NH3 scavengers’ group; reductions were greatest in the combination group.Mean change in plasma NH3 vs baseline in the carglumic acid, NH3 scavengers and combination groups, respectively, was − 13, + 12% and − 27% at 0–12 h (p < 0.05 NH3 scavengers vs combination); − 47, − 22% and − 52% at 12–24 h (not significant); − 44, − 5% and − 61% at 24–48 h; and − 66, − 16% and − 76% at 48–72 h (p < 0.05 carglumic acid/combination groups vs NH3 scavengers for both timepoints). The number of TEAEs was similar between groups and mainly related to the disease/condition.ConclusionsCarglumic acid is a well-tolerated and efficacious treatment for OA decompensation episodes. When given alone or combined with NH3 scavengers, the reduction in NH3 was greater than with NH3 scavengers alone in the first 72 h.

Patterns of Immediate-Release and Extended-Release Opioid Analgesic Use in the Management of Chronic Pain, 2003-2014

Many stakeholders are working to improve the safe use of immediate-release (IR) and extended-release/long-acting (ER/LA) opioid analgesics. However, little information exists regarding the relative use of these 2 formulations in chronic pain management. To describe the distribution of IR and ER/LA opioid analgesic therapy duration and examine adding and switching patterns among patients receiving long-term IR opioid analgesic therapy, defined as at least 90 consecutive days of IR formulation use. A retrospective cohort study of 169 million individuals receiving opioid analgesics from across 90% of outpatient retail pharmacies in the United States from January 1, 2003, to December 31, 2014, using the IQVIA Health Vector One: Data Extract Tool. Analyses were conducted from March 2015 to June 2017. Receipt of dispensed IR or ER/LA opioid analgesic prescription. Distribution of therapy frequency and duration of IR and ER/LA opioid analgesic use, and annual proportions of patients receiving long-term IR opioid analgesic therapy who added an ER/LA formulation while continuing to use an IR formulation, switched to an ER/LA formulation, or continued receiving IR opioid analgesic therapy only. Among the 169 280 456 patients included in this analysis, 168 315 458 patients filled IR formulations and 10 216 570 patients filled ER/LA formulations. A similar percentage of women received ER/LA (55%) and IR (56%) formulations, although those receiving ER/LA formulations (72%) were more likely to be aged 45 years or older compared with those receiving IR formulations (46%). The longest opioid analgesic episode duration was 90 days or longer for 11 563 089 patients (7%) filling IR formulations and 3 103 777 patients (30%) filling ER/LA formulations. The median episode duration was 5 days (interquartile range, 3-10 days) for patients using IR formulations and 30 days (interquartile range, 21-74 days) for patients using ER/LA formulations. From January 1, 2003, to December 31, 2014, a small and decreasing proportion of patients with long-term IR opioid analgesic therapy added (3.8% in 2003 to 1.8% in 2014) or switched to (1.0% in 2003 to 0.5% in 2014) an ER/LA formulation. Most patients receiving opioid analgesics, whether for short or extended periods, use IR formulations. Once receiving long-term IR opioid analgesic therapy, patients are unlikely to add or switch to an ER/LA formulation.

Kangaroo mother care for clinically unstable neonates weighing ≤2000 g: Is it feasible at a hospital in Uganda?

BackgroundKangaroo mother care (KMC) for stable neonates ≤2000 g (g) is associated with decreased mortality, sepsis, hypothermia, and length of stay compared to conventional care. The World Health Organization states that KMC “should be initiated… as soon as newborns are clinically stable” [12]. However, the majority of deaths occur in unstable neonates. We aimed to determine the proportion of admitted neonates meeting proposed instability criteria, assess the feasibility of providing KMC to unstable neonates, and evaluate the acceptability of this intervention to parents and providers at Jinja Regional Referral Hospital in Uganda.MethodsThis was a mixed-methods study. We recorded data including birthweight, chronological age, and treatments administered from medical charts, and calculated the percentage of clinically unstable neonates, defined as the need for ≥2 medical therapies in the first 48 hours of admission. We enrolled a sample of neonates meeting pre-defined instability criteria. Mothers were counselled to provide KMC as close to continuously as possible. We calculated the median duration of KMC per episode and per day. To explore acceptability, we conducted semi-structured interviews with parents and newborn unit care providers, and analysed data using the thematic content approach.FindingsWe included 254 neonates in the audit, 10 neonates in the feasibility sub-study, and 20 participants in the acceptability sub-study. Instability criteria were easily implementable, identifying 89% of neonates as unstable in the audit. The median duration of individual KMC episodes ranged from 115 to 134 minutes. The median daily duration ranged from 4.5 to 9.7 hours. Seventy-five percent of interviewees felt KMC could be used in neonates concurrently receiving other medical therapies. Barriers included lack of resources (beds/space, monitoring devices), privacy issues, inadequate education, and difficulties motivating mothers to devote time to KMC. Recommendations included staff/peer counselling, resources, family support, and community outreach.ConclusionsThere remains a need for an evidence-based approach to consistently define stability criteria for KMC to improve care. We found that KMC for unstable neonates weighing ≤2000g was feasible and acceptable at Jinja Hospital in Uganda. Randomised controlled trials are needed to demonstrate the effect of KMC on survival among unstable neonates in low-resource settings.

Real-world healthcare costs of ipilimumab in patients with advanced cutaneous melanoma in The Netherlands.

There is limited evidence on the costs associated with ipilimumab. We investigated healthcare costs of all Dutch patients with advanced cutaneous melanoma who were treated with ipilimumab. Data were retrieved from the nation-wide Dutch Melanoma Treatment Registry. Costs were determined by applying unit costs to individual patient resource use. A total of 807 patients who were diagnosed between July 2012 and July 2015 received ipilimumab in Dutch practice. The mean (median) episode duration was 6.27 (4.61) months (computed from the start of ipilimumab until the start of a next treatment, death, or the last date of follow-up). The average total healthcare costs amounted to &OV0556;81 484, but varied widely (range: &OV0556;18 131-&OV0556;160 002). Ipilimumab was by far the most important cost driver (&OV0556;73 739). Other costs were related to hospital admissions (&OV0556;3323), hospital visits (&OV0556;1791), diagnostics and imaging (&OV0556;1505), radiotherapy (&OV0556;828), and surgery (&OV0556;297). Monthly costs for resource use other than ipilimumab were &OV0556;1997 (SD: &OV0556;2629). Treatment-naive patients (n=344) had higher total costs compared with previously-treated patients (n=463; &OV0556;85 081 vs. &OV0556;78 811). Although patients with colitis (n=106) had higher costs for resource use other than ipilimumab (&OV0556;11 426) compared with patients with other types of immune-related adverse events (n=90; &OV0556;9850) and patients with no immune-related adverse event (n=611; &OV0556;6796), they had lower total costs (&OV0556;76 075 vs. &OV0556;87 882 and &OV0556;81 480, respectively). In conclusion, this nation-wide study provides valuable insights into the healthcare costs of advanced cutaneous melanoma patients who were treated with ipilimumab in clinical practice. Most of the costs were attributable to ipilimumab, but the costs and its distribution varied considerably across subgroups.

Duration of major and minor depressive episodes and associated risk indicators in a psychiatric epidemiological cohort study of the general population.

Hardly any studies exist on the duration of major depressive disorder (MDD) and factors that explain variations in episode duration that lack biases. This limits clinical decision-making and leaves patients wondering when they will recover. Data were used from the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among a nationally representative adult population. Respondents with a newly originated depressive episode were selected: 286 MDD and 107 minor depressive disorder (MinDD) cases. DSM-IV diagnoses were assessed with the Composite International Diagnostic Interview 3.0 and episode duration with the Life Chart Interview. Among MDD cases, median episode duration was 6 months, mean duration was 10.7 months, and 12% had not recovered at 36 months. Longer duration was associated with comorbid dysthymia, anxiety disorder, psychotropic medication use (i.e. antidepressants or benzodiazepines prescribed by a mental health professional), mental health care use and suicidal behaviour. Better physical and mental functioning before depression onset predicted shorter duration. Among MinDD cases, shorter median duration (3 months) but similar mean duration (8.7 months), risk of chronicity (10% not recovered at 36 months) and risk indicators for episode duration were found. As the risk of chronicity was similar for MDD and MinDD, MinDD cannot be dismissed as a merely brief mood state.

Abstract P2-11-08: Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial

Abstract Background Stomatitis is the most frequent adverse event reported in trials of mTOR-inhibitors, including EVE. In the pivotal phase 3 BOLERO-2 study, stomatitis incidence in the EVE + exemestane (EXE) arm was 59%. The BOLERO-4 study (NCT01698918) evaluated the efficacy and safety of first-line EVE + LET in postmenopausal pts with HR+, HER2− metastatic or locally advanced breast cancer (ABC). BOLERO-4 also assessed the effectiveness of an alcohol-free dexamethasone (0.5 mg/ 5ml; DEX) oral rinse for treating stomatitis in a subset of pts (USA). Methods Postmenopausal pts with HR+, HER2− ABC previously untreated for advanced disease received EVE (10 mg/day) + LET (2.5 mg/day).At disease progression, pts were offered EVE (10 mg/day) + EXE (25 mg/day). Pts who had at least one episode of stomatitis received oral stomatitis daily questionnaire (OSDQ), which is a 6 question pt-reported outcome (PRO) survey (Stiff et al, JCO. 2006). A subset of these pts (USA) was randomized (1:1) to receive DEX or standard of care (SOC). The primary objective of investigator-assessed progression-free survival in the first-line setting for ABC was presented previously. A secondary objective was to evaluate the effectiveness of the DEX oral rinse in reducing the severity and duration of stomatitis, using OSDQ data. Results Of the total 202 pts enrolled in this study, 52 pts were enrolled in USA, of which, 24 (46.2%) were randomized to receive DEX (n=11) or SOC (n=13), upon confirmation of stomatitis. The median duration of first stomatitis episode was longer per OSDQ (DEX, not estimable vs SOC, 13.7 wk) compared with physician-reported duration (DEX, 1.6 wk vs SOC, 1.9 wk). PRO OSDQ results were similar in both arms. Among the 202 pts enrolled, 89 (44.1%) filled the OSDQ at their first stomatitis episode. The median time from treatment initiation to first stomatitis episode was 1.7 wk; median duration of stomatitis was 13.7 wk (OSDQ) vs 2.1 wk (physician reported). The majority of pts experiencing stomatitis had moderate/little/no soreness, moderate/low/no pain, and stomatitis had low/no effect on daily activities (Table 1). Table 1. OSDQ Key Results (N=87)Questions (Score)First Day of Stomatitis Episode, n (%)End of First Stomatitis Episode, n (%)Overall healthPoor (0-4)20 (23.0)23 (26.4)Moderate (5-7)40 (46.0)32 (36.8)Perfect (8-10)27 (31.0)32 (36.8)Mouth and throat sorenessNo/a little/moderate (0-2)64 (73.6)84 (96.6)A lot or extreme (3-4)23 (26.4)3 (3.4)Mouth pain severityNo/low/moderate (0-4)51 (58.6)73 (83.9)Severe (5-7)24 (27.6)10 (11.5)Unbearable (8-10)12 (13.8)4 (4.6)Effect on daily activitiesNo/low (0-4)70 (80.5)78 (89.7)Moderate (5-7)11 (12.6)4 (4.6)High (8-10)6 (6.9)5 (5.7) Conclusions Overall, patient-reported median duration of stomatitis was longer than that reported by physicians, most likely due to differences in perceptions and the challenges in collecting and cleaning PRO data. Overall good health score was maintained in the majority of pts experiencing stomatitis and stomatitis had low/no effect on daily activities. However, these results, especially in the randomized subset need to be interpreted with caution owing to the small sample size, missing data and lack of commercially available DEX in most countries. Citation Format: Villanueva C, Tsugawa K, Toyama T, Noh W, Jeong J, Cardoso F, Sriuranpong V, Srimuninnimit V, Ozguroglu M, Kendall S, Falkson C, Cianfrocca M, Manlius C, Lin JCJ, Ringeisen F, Ridolfi A, Royce M. Stomatitis in patients treated with first-line everolimus (EVE) plus letrozole (LET): Results from BOLERO-4 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-08.

Real-World Treatment Patterns, Healthcare Resource Utilization, and Costs in Patients with Newly Diagnosed Acute Myeloid Leukemia (AML)

Real-World Treatment Patterns, Healthcare Resource Utilization, and Costs in Patients with Newly Diagnosed Acute Myeloid Leukemia (AML)

Cryptogenic ischemic stroke and prevalence of asymptomatic atrial fibrillation: a prospective study.

Atrial fibrillation is responsible for up to one-third of ischemic strokes, and is also associated with silent cerebral infarctions and transient ischemic attacks (TIAs). The self-terminating and often asymptomatic nature of paroxysmal atrial fibrillation (PAF) may lead to its underdiagnosis. A continuous and long-term heart rhythm monitoring can be useful in unmasking PAF episodes. Prevalence of asymptomatic PAF in patients suffering a cryptogenic stroke, at risk for atrial fibrillation but without any history of arrhythmia or palpitations, using a continuous electrocardiographic monitoring. One hundred and forty-two consecutive patients were admitted to the Stroke Unit of 'Città della Salute e della Scienza' Hospital of Turin between June 2010 and March 2013 and discharged with the diagnosis of ischemic cryptogenic stroke. Sixty fulfilled predefined inclusion criteria. Follow-up was carried on and completed for the 54 patients who consented to implantable loop recorder (ILR) implantation. After ILR implantation, trans-telephonic data were collected monthly. Atrial fibrillation episodes lasting more than 5 min were recorded in 25 patients (46%), median detection time was 5.4 months (range 1-18) and median duration of atrial fibrillation episodes was 20 h (range 7 min-8 days) with 19 patients (76%) remaining asymptomatic and the others experiencing weakness and dyspnoea but not palpitations. Long-term heart rhythm monitoring is successful in unmasking silent atrial fibrillation in 46% of patients suffering a cryptogenic stroke with concomitant atrial fibrillation risk factors, but without history of arrhythmia or palpitations.

Clinical characteristics and treatment outcomes for benign paroxysmal positional vertigo comorbid with hypertension

Conclusions: Patients with BPPV comorbid with hypertension (h-BPPV) tend to receive a delayed diagnosis of BPPV. Comorbidity with hypertension did not influence the efficacy of the repositioning maneuver; however, comorbidity with hypertension was associated with an increased recurrence rate of BPPV.Objectives: To determine the clinical characteristics and outcomes of h-BPPV, as well as the clinical differences between h-BPPV and idiopathic BPPV (i-BPPV).Methods: The authors reviewed the medical records of 41 consecutive patients with h-BPPV (the h-BPPV group) from March to December 2014 and 47 patients with i-BPPV (the i-BPPV group) during the same period.Results: There were no significant differences in age, sex ratio, or the affected side between the h-BPPV and i-BPPV groups. The proportion of patients reporting an initial episode of positional vertigo was significantly lower in the h-BPPV group (51.22% vs 74.47%; p = .024). Patients in the h-BPPV group reported a longer median episode duration than did those in the i-BPPV group (60 days vs 15 days; p = .017). The results of treatment using repositioning maneuvers were similar between the two groups. At follow-up, 13 patients in the h-BPPV group were diagnosed with recurrent BPPV compared with six in the i-BPPV group (p = .031).

Early, de novo atrial fibrillation after coronary artery bypass grafting: Facts and features

PoAF episodes (N=327) and SVPBs (N=141,873) were characterized in 29 patients (63±9 years; 22 (76%) male) undergoing coronary artery bypass grafting and compared with a control group of patients without PoAF by using continuous cardiac rhythm monitoring during the first 5 days after surgery. Most patients (N=18, 62%) had multiple PoAF episodes; the median number of PoAF episodes per patient was 3 and varied between 1 and 139. The majority of PoAF episodes developed on the second and third post-operative day (55%). The averaged median duration of PoAF episodes per patient was 469±1085 min. Patients with PoAF had a higher SVPBs burden compared to subjects without PoAF (0.9% vs 0.2%, P<.001). SVPBs initiating PoAF had shorter coupling intervals than SVPBs which did not initiate PoAF episodes (58% vs 64% (P<.001) and were preceded by heart rate acceleration. PoAF episodes are mainly repetitive though transient in nature. There was a considerable inter-individual variation in both AF and SVPB characteristics, despite a similar underlying clinical profile. The SVPB burden is higher in patients with PoAF and the mode of onset is characterized by short coupled SVPBs. Determination of individual post-operative dysrhythmia profiles enables identification of patients at risk for developing PoAF.

Lifetime Duration of Depressive Disorders in Patients With Type 2 Diabetes.

OBJECTIVEDepression in patients with type 2 diabetes (T2D) is associated with long-term complications, disability, and early mortality. No studies have systematically examined the length of episodes and remission in adults with major depressive disorder (MDD) and T2D. This study examined the course of depressive disorders in patients with T2D and MDD.RESEARCH DESIGN AND METHODSParticipants (N = 50) enrolled in a behavioral intervention for adults with T2D and MDD were interviewed using the Structured Clinical Interview for DSM-IV-TR to assess history of depressive disorders at baseline (lifetime history), postintervention, and 3-month follow-up. Onset and remission dates were recorded for all Axis I depressive disorders from birth to final interview.RESULTSAverage number of MDD episodes was 1.8 with a mean duration of 23.4 months (SD 31.9; range 0.5–231.3). Over the life course, mean exposure to MDD was 43.1 months (SD 46.5; range 0.5–231.3). Kaplan-Meier survival curve analysis indicated median episode duration decreased with subsequent episodes (14 months, first episode; 9 months, second episode; P < 0.002). In patients with multiple depressive episodes, recovery time was shorter with each subsequent episode (P = 0.002). No differences in length of episode or remission were observed based on chronology of T2D diagnosis.CONCLUSIONSThe overall exposure to depression in this sample of adults with T2D represents a substantial period of time that can contribute to negative medical and psychiatric outcomes. Recurrent episodes decrease in duration as do recovery periods, resulting in a waxing and waning pattern. Findings from this study underscore the need to effectively diagnose and treat depression in patients with T2D to minimize risk of future depressive episodes.

Abstract P5-08-49: Incidence and prognostic importance of hyponatremia in a cohort of patients with breast cancer

Abstract Background: It has been suggested that hyponatremia (HN) may be a negative prognostic factor in patients with cancer but little research has been conducted specifically in breast cancer (BC). We measured the incidence of hyponatremia (hypervolemic and euvolemic) after BC diagnosis and its prognostic importance for progression free (PFS) and overall survival (OS). Methods: This retrospective cohort analysis utilized data from the Henry Ford Health System electronic medical record, tumor registry, and administrative databases. Study data were collected electronically and via medical record abstraction. Adults diagnosed (2002-2010) with incident invasive BC were selected if they had a known disease stage at the time of tumor registration, were classified as an analytic case, had ≥ 1 administration of chemo/radiation therapy ≤ 6 months from diagnosis, met continuous enrollment thresholds, and did not experience hypovolemic HN post index. Only the first tumor registered from each patient was considered study-eligible. Hypervolemic or euvolemic HN incidence (serum sodium ≤ 135 mEq/L) was measured per 1000 person-years (PY) of observation and classified as mild (131–135 mEq/L), moderate (125–130 mEq/L) or severe (&amp;lt;125 mEq/L) based on the lowest observed value. A Cox proportional hazards model was used to assess the prognostic value of HN as a time-varying covariate on PFS and OS while controlling for age, race, income, morphology code, diagnosis year, cancer stage at diagnosis, performance status at diagnosis, and hormone receptor status. Results: 527 patients were eligible (mean [SD] age 56.4±11.3 years, 61% Caucasian). Mean (SD) follow-up was 3.7±2.8 years. Eighty-five percent of patients had infiltrating ductal carcinoma; 72% and 65% had estrogen or progesterone sensitive tumor, respectively; 35% were HER2 positive; and 15% had triple negative disease. Eighty-two percent of patients had early stage (I, II) disease at time of diagnosis. HN episodes (n=377) occurred in 204 patients (39%) at a rate of 193 per 1000 PY (95% CI, 174–213.5), with 89% of the total episodes (337/377) classified as mild, 10% (36/377) as moderate, and 1% (4/377) as severe. Additionally, 7% of all BC patients (37/527) had at least one episode of moderate/severe HN. Median time to first HN episode was 174.5 days and the median HN episode duration was 24.0 days. Five year OS in patients developing HN was 92%, compared to 97% in patients who never developed HN. Hazard ratio (95% CI, p-value) for OS in the HN group was 4.4 (1.5-12.7; p=0.006) after controlling for age, diagnosis year, race, income, morphology, cancer stage, performance status, and hormone receptor status. Fifty patients had progressive disease during follow-up with a mean (SD) time to progression of 763.4 (758.1) days. Hazard ratio (95% CI, p-value) for PFS in the HN group was 1.4 (0.8-2.7; p=0.262) after controlling for age, race, income, morphology, cancer stage, performance status, and hormone receptor status. Conclusions: Incidence of hypervolemic or euvolemic HN is high (39%) after a BC diagnosis, and the occurrence is associated with significantly poorer OS. A significant impact on disease progression was not observed. Citation Format: Castillo JJ, Glezerman IG, Boklage SH, Lamerato LE, Chiodo JA, Tidwell BA, Schulman KL. Incidence and prognostic importance of hyponatremia in a cohort of patients with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-49.

Patterns of human herpesvirus-8 oral shedding among diverse cohorts of human herpesvirus-8 seropositive persons.

BackgroundHuman herpesvirus-8 (HHV-8), the etiologic agent of Kaposi sarcoma (KS), establishes lifelong latent infection with periodic lytic replication (“shedding”) at mucosal sites, especially the oropharynx. Patterns of HHV-8 shedding are not well understood, and require elucidation to better predict risk of HHV-8 related malignancies in those infected. We sought to characterize patterns of HHV-8 oropharyngeal shedding among diverse cohorts that enrolled HHV-8 seropositive persons.MethodsWe quantified HHV-8 oral shedding using PCR among HHV-8 seropositive persons who collected at least 14 days of oral swabs in 22 studies on 3 continents. We excluded persons taking antivirals during sampling or any prior use of antiretrovirals in those who were HIV-infected.Results248 participants were enrolled from the US, Peru, Cameroon, Uganda, and Kenya; 61 % were men, 58 % were HIV seropositive, and 16 % had KS. Overall, 3,123 of 10,557 samples (29.6 %) had HHV-8 detected. Quantity of virus shed was highly correlated with shedding rate, (ρ = 0.72, p < 0.0001). HHV-8 was detected in ≥1 sample in 55 % of participants with a median of 7 % of days in the US and Kenya, 0 % in Uganda and Peru, and 18 % in Cameroon. Median episode duration was three days, and episodes with high median quantity lasted longer (42 vs 3 days, p < 0.0001). In persons with multiple observations over time, 66 % of shedding rate variance was attributable to differences between individuals.ConclusionsIn HHV-8 infected individuals from diverse settings, oral mucosal shedding rate, quantity, and duration were correlated; individual shedding was highly variable. Studies are needed to determine factors accounting for between-person variation and the relationship of HHV-8 shedding to development of associated diseases.

A nationwide study of why and how acute adolescent psychiatric units use restraint

The purpose of this study was to examine the type, reason, and duration of restraint episodes in acute adolescent psychiatric units. In a retrospective design we included data from paper-based protocols on all episodes of restraint and data from electronic patient records during 2008–2010 in all acute adolescent psychiatric in-patient units in Norway (N=16). The episodes of restraint included mechanical and pharmacological restraint, seclusion and physical holding that was not part of the implementation of forced feeding. Six-and-a-half per cent of all 4099 adolescents admitted to the acute units experienced restraint. Of the 2277 episodes, 13.4% were mechanical restraint, 1.6% were pharmacological restraint, 5.9% were seclusion and 78.7% were physical holding. The median number of restraint episodes per patient was two, the range was 1–171 and 47 patients (18%) experienced ≥10 episodes. The most common reason for using restraint was harming others. The median duration of the mechanical restraint episodes was 3.5h. The median duration of seclusion was 30min and the median duration of physical holding was 10min.