Previous Medication Use Research Articles

Regional Anesthesia and Readmission Rates After Total Knee Arthroplasty.

Total knee arthroplasty is a commonly performed procedure and an important contributor to national health care spending. Reducing the incidence of readmission could have important consequences for patient well-being and relevant financial implications. Whether regional anesthesia techniques are associated with decreased readmission rates and costs among privately insured patients remains unknown. Using administrative claims data, we identified 138,362 privately insured patients 18-64 years of age who underwent total knee arthroplasty between 2002 and 2013. We then examined whether the use of a nerve block was associated with decreases in readmission rates and related costs during the 90 days after discharge. Our analyses were adjusted for potential confounding variables including medical comorbidities and previous use of opioids and other medications. After adjusting for patient demographics, comorbidities, and preoperative medication use, the adjusted 90-day readmission rate was 1.8% (95% confidence interval [CI], 1.1-2.4) among patients who did not receive a block compared to 1.7% (95% CI, 1.1-2.4) among patients who did (odds ratio, 0.99; 95% CI, 0.91-1.09; P = .85). The adjusted readmission-related postoperative cost for patients who did not receive a block was $561 (95% CI, 502-619) and $574 (95% CI, 508-639) for patients who did (difference, $13; 95% CI, -75 to 102; P = .74). This lack of statistically significant differences held for subgroup and sensitivity analyses. Nerve blocks were not associated with improved measures of long-term postoperative resource use in this younger, privately insured study population.

Multiple sclerosis is associated with low bone mineral density and osteoporosis

To compare measures of bone mineral density (BMD) between people with and without MS. Using population-based administrative data from Manitoba, Canada, we identified people with MS who received BMD screening and controls who received BMD screening matched 5:1 on age, sex, region of residence, and date of BMD screening. We determined the BMD T-scores for the femoral neck, total hip, and lumbar spine and frequency of osteoporosis (defined as T-score -2.5 or lower). We compared the groups with respect to the femoral neck T-score using multivariable linear regression, adjusting for age, sex, region, disability, continuity of care, recent previous fracture, falls history, medication use, and comorbidities. We compared the odds of osteoporosis between groups using multivariable logistic regression analysis. We identified 783 MS cases who underwent BMD screening and 3,915 matched controls. The mean (SD) femoral BMD T-score was lower in MS cases (-1.48 [1.08]) than in matched controls (-1.12 [0.98], p < 0.001), and the prevalence of osteoporosis was higher among the MS cases (range across BMD sites: 16%-26%) vs controls (6%-15%). MS was associated with a lower femoral neck BMD T-score after accounting for covariates (β = -0.24; 95% CI: -0.32 to -0.17) and more than 2-fold increased odds of osteoporosis (covariate-adjusted OR 2.41; 95% CI: 1.82-3.19). People with MS have lower BMD and a higher prevalence of osteoporosis compared with people of similar age and sex without MS. These findings indicate the importance of addressing bone health as part of comprehensive MS care.

Drug interactions in maternal intensive care: prevalence, risk factors, and potential risk medications.

ABSTRACTObjective:To characterize severe potential drug interactions in maternal intensive care, and to determine their frequency, risk factors and potential risk medications.Methods:An observational and longitudinal study conducted between December 2014 and December 2015 in a maternal intensive care unit. Clinical data were collected and severe potential drug interactions were identified on pregnant inpatients. The drug interactions were classified by type, prevalence and exposure rate. A multivariate logistic regression model was used to identify the severe potential drug interactions and the related drugs (p<0.05).Results:A total of 95.1% of patients were exposed to, at least, one potential drug interaction; in that, 91.7% 33.9% were related to, respectively, moderate and severe potential drug interactions. The patients were exposed, on average, on 69.2% of days they were in the intensive care unit. The main drugs involved in more severe drug interactions were magnesium sulfate, metoclopramide, propranolol and diazepam.Conclusion:The severe potential drug interactions were observed in almost all patients of the study, and, approximately one third of those interactions were related to greater severity and resulted in exposure during long hospital stay. The higher number of prescribed drugs and its previous use of medications at home increase the occurrence of severe potential drug interactions.

Test Accuracy of the Screening Tool for Early Predictors of Post-traumatic Stress Disorder for Post-injury Mental Health in a Managed-Medicaid Population

To determine the Screening Tool for Early Predictors of Post-Traumatic Stress Disorder (STEPP) test accuracy in identifying children with new mental health diagnoses and psychotropic medications prescribed within 12months after unintentional injuries in a managed-Medicaid population. We conducted a secondary analysis of a retrospective cohort that investigated mental health diagnoses and psychotropic medications pre- and post-injury in children ≤18years of age treated at a pediatric trauma center from 2005 to 2015 (n=2208). For this study, we analyzed children with STEPP scores from their injury admission (n=85). For children without previous mental health diagnoses or psychotropic prescriptions, we calculated the sensitivity, specificity, and positive and negative predictive values for the child and parent STEPP. Of 78 children without previous diagnoses, 12 had post-injury mental health diagnoses. Of 68 children without previous psychotropic medication use, 10 had psychotropic medications prescribed. The child STEPP sensitivity was 8.3% for mental health diagnoses (95% CI 0.2, 38.5) and 10% for psychotropic medications (95% CI 0.3, 44.5). The child STEPP specificity was 77.3% for mental health diagnoses (95% CI 65.3, 86.7) and 75.9% for psychotropic medication (95% CI 62.8, 86.1). We found that the STEPP performed poorly in identifying children who received new mental health diagnoses and new psychotropic medications following injury.

Efficacy and Safety of Sofosbuvir and Ribavirin for Treating Chronic Hepatitis C, Genotype 3: Experience of a Tertiary Care Hospital at Karachi, Pakistan.

BackgroundIt is estimated that approximately 10 million individuals in Pakistan are infected with hepatitis C virus (HCV). Historically, it was very difficult not just to cure but even treat HCV as available options did not have desirable outcomes. However, the approval of directly acting antiviral (DAA) drugs has revolutionized treatment and management. These are specific proteases and polymerase inhibitors with profound capability for accomplishing elimination and overtime eradication of the virus.ObjectiveThe aim of this study was to evaluate the efficacy and safety of sofosbuvir (SOF) in combination with ribavirin (RIB) for the treatment of chronic hepatitis C virus with genotype 3.Materials and methodsThis prospective observational study was conducted at the gastroenterology section of Medical Unit IV, Jinnah Post-graduate Medical Center, Karachi and Medical Unit II, Dow University of Health Sciences, Ojha Campus, Karachi from January 2016 to December 2016. Patients aged 18 years or older of either gender having chronic active HCV infection as demonstrated by a positive Anti-HCV (ELISA) test and a qualitative polymerase chain reaction (PCR) analysis along with genotype analysis showing only type 3 were inducted into the study.Treatment was initiated with either 12-week or 24-week regimen of SOF 400 mg once daily along with weight-adjusted RIB orally. Successful treatment was indicated by the elimination of the virus, i.e., undetectable viral load/levels by PCR qualitative analysis. Rapid virological response (RVR), end of treatment response (ETR), and sustained virological response (SVR) were defined as the undetectable viral load at four, 12, and 24 weeks, respectively.ResultsA total of 300 patients were inducted into the study, predominantly female (57%). The mean age of presentation was 41.14 ± 11.48, and most (70.33%) were treatment naïve. The mean alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) levels at presentation were 41.89 ± 46.23 IU/l, 68.57 ± 83.62 IU/l, and 54.52 ± 77.57 IU/l, respectively.ALT, AST, and GGT levels at 24 weeks were 33.84 ± 13.60 IU/l, 32.44 ± 16.16 IU/l, and 37.59 ± 22.41 IU/l, respectively, showing significant improvement. ETR was achieved in 99.1% (209) treatment-naïve patients and 98.9% (88) treatment-experienced patients. SVR rates were almost similar with 98% (208) achieving it in the treatment-naïve group and 96.6% (86) achieving it in the treatment-experienced group.ConclusionSOF in combination with RIB is safe and remarkably efficacious in the treatment of chronic HCV, genotype 3. Not only is this regimen associated with the elimination of viral replication but it also improved transaminase levels. Outcomes are rarely, if ever, affected by previous use of antiviral medications.

Association between prior somatic disease and 5-year relapse risk among 11,856 incident patients with schizophrenia

BackgroundSomatic diseases have been associated with an increased risk for subsequent schizophrenia; however, it is unknown whether prior somatic diseases negatively affect early treatment outcomes after a first-time schizophrenia diagnosis. MethodsWe included all individuals born in Denmark after January 1st, 1977 and first-time diagnosed with schizophrenia between January 1st, 1996 and December 31st, 2015. We identified all life-time somatic hospital contacts and all prescriptions within the year before the first-time schizophrenia diagnosis and followed patients for up to five years regarding risk for schizophrenia (re)-hospitalization (relapse). We performed Cox regression analyses calculating hazard rate ratios (HRR) including 95%-confidence intervals (CI) and adjusted for relevant confounders. ResultsWe followed a total of 11,856 patients with a first-time schizophrenia diagnosis (58.7% male, mean age 23.1 (SD = 4.7) years) for 39,033 person-years, whereof 5506 (46.4%) had relapse with schizophrenia re-hospitalization during 5-year of follow-up. Somatic hospital contacts ever before (95.4%; HRR = 1.30; 95%-CI = 1.07–1.59), and specifically during the year before schizophrenia diagnosis (42.5%; HRR = 1.36; 95%-CI = 1.11–1.66) were associated with an increased risk of schizophrenia relapse as were a greater number of prior somatic hospital contacts (p < 0.001). Individuals with up to four different prescriptions for somatic medications showed a trend towards a slightly lower risk of relapse. ConclusionSomatic diseases and health seeking patterns might have an impact on the course of schizophrenia, where severe somatic comorbidity, specifically during the year before first-time schizophrenia diagnosis, seem to negatively affect early treatment course, whereas previous somatic medication use may indicate a better compliance and help-seeking behavior.

Implementation of a Palivizumab Order Panel to Decrease Inappropriate Use.

Palivizumab is a monoclonal antibody used to prevent infection from respiratory syncytial virus (RSV) in certain patients who are at high risk for complications. A previous medication use evaluation (MUE) demonstrated 12% of our palivizumab use did not meet criteria for use. Prior to the start of the 2016-2017 RSV season, an order panel was implemented requiring prescribers to select the approved criterion for each patient prescribed palivizumab. In addition, our restriction policy changed to state that palivizumab use outside of preapproved criteria would require authorization from pediatric infectious diseases or the antimicrobial stewardship team. An MUE was conducted during the summer of 2017 to determine whether the order panel had an impact on appropriate prescribing of palivizumab. Medication orders for patients who received palivizumab from December 2015 to April 2016 and from December 2016 to April 2017 were reviewed to determine the proportion of patients who did not meet the preapproved restriction criteria. Charts were reviewed to verify indications of palivizumab for each patient during both seasons. A χ2 test was used to compare the proportion of inappropriate orders between the 2 seasons. During the 2015-2016 RSV season, of the 80 palivizumab orders, there were 11 inappropriate administrations (13.8%). During the 2016-2017 RSV season, 70 orders were administered to patients, and 4 doses (5.7%) were inappropriate. The cost of palivizumab increased from year 1 to year 2 (acquisition cost of $2477.44 per 100 mg/mL vial during year 1, $2613.71 per 100 mg/mL vial during year 2). An estimated cost avoidance of $12,807.18 was observed due to the decrease in the number of inappropriate administrations of palivizumab following implementation of the order panel (n = 7). There was an overall reduction in the number of inappropriate orders from year 1 to year 2 (8.1%); however, the reduction was not significant (p = 0.102). Following the implementation of the order panel plus restriction policy, we observed a decrease in the proportion of inappropriate doses that were administered from the preimplementation period to the postimplementation period, which also resulted in a cost avoidance of approximately $13,000.

Lower airway microbiota associates with inflammatory phenotype in severe preschool wheeze

Lower airway microbiota associates with inflammatory phenotype in severe preschool wheeze

Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data.

PurposeTo identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics.Patients and methodsSwedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6–79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose.ResultsIn total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46–65 years vs 6–12 years 17.5, 95% CI 14.3–21.3), and was higher in men (OR 1.4, 95% CI 1.3–1.5) and individuals with low income (OR 1.1, 95% CI 1.0–1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3–1.6), health care visits (OR 1.3, 95% CI 1.2–1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4–2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0–2.3).ConclusionAmong individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

Quo Vadis Botulinum Toxin: Normative Constraints and Quality of Life for Patients With Idiopathic OAB?

Background: Idiopathic overactive bladder (iOAB), with or without urge incontinence (UI), has significant psychosocial effects on patients' quality of life (QoL). The first choice of treatment for iOAB is anticholinergics and, alternatively, the β-3-adrenoceptor agonist mirabegron. However, systemic side effects and contraindications should be considered for both medications.Objective: We report the efficacy, safety and effects on QoL of botulinum toxin therapy (onabotulinum toxin type A, BOTOX®, Allergan) among patients with iOAB ± UI.Patients and Methods: Between 2005 and 2013, 51 patients were treated with onabotulinum toxin A (100 units). The inclusion criteria were the presence of confirmed iOAB ± UI with previous use of anticholinergic medication. Micturition frequency, pad count, postvoid residual volume and QoL were evaluated using two validated questionnaires [the Client Satisfaction Questionnaire-8 (CSQ-8) and the King's Health Questionnaire (KHQ)]. Statistical analysis was performed with SPSS 24.0 (p < 0.05).Results: After botulinum toxin injection, a significant improvement in iOAB ± UI symptoms was observed. The micturition frequency decreased from 10.4 ± 0.5 to 5.2 ± 0.4 micturitions per day (p = 0.026), and the pad count decreased from 3.6 ± 1.0 to 1.2 ± 0.3 pads per day (p = 0.033). Anticholinergics were not used during the administration of botulinum toxin therapy. Complications and postoperative need for intermittent self-catheterization (ISC) were not observed. Overall, 72 and 24% of patients reported being “satisfied” or “very satisfied” with the treatment. Additionally, 66% of patients would choose botulinum toxin again for the treatment of iOAB.Conclusion: Botulinum toxin therapy is an efficient, safe, and life-improving treatment for iOAB.

Demography, baseline disease characteristics, and treatment history of psoriasis patients with self-reported psoriatic arthritis enrolled in the PSOLAR registry

BackgroundTo evaluate demographics, family history, and previous medication use at enrollment in a subset of psoriasis patients with self-reported psoriatic arthritis (PsA) enrolled in Psoriasis Longitudinal Assessment and Registry (PSOLAR).MethodsPSOLAR is an international, prospective, longitudinal, disease-based registry that collects data in patients receiving, or are eligible to receive, systemic or biologic treatments for psoriasis. Baseline demographic, disease characteristics, medical history, and prior medication use at enrollment were evaluated in PSOLAR psoriasis patients self-reporting PsA (n = 4315); a subset of which had their diagnosis of PsA established by a healthcare provider (HCP; n = 1719); patients with psoriasis only (n = 7775); and the overall PSOLAR population (n = 12,090).ResultsAt enrollment, demographic characteristics were distinct between psoriasis patients self-reporting PsA and psoriasis only patients. Of the patients with psoriasis self-reporting PsA, 44.4% had cardiovascular disease (CVD), 26.3% had psychiatric illness, and 3.2% had inflammatory bowel disease (IBD), with each more prevalent than among patients with psoriasis only (p < 0.001). Overall, 17.5% of psoriasis patients self-reporting PsA had a family history of PsA, 29.8% had used systemic steroids, 39.5% had used nonsteroidal anti-inflammatory drugs, and 83.5% had used biologics.ConclusionsDemographics, family history, and previous medication use were generally comparable between “PsA established by a HCP” patients and psoriasis patients self-reporting PsA in the PSOLAR registry, but there were statistical differences compared with the psoriasis only group regarding the prevalence of certain comorbidities (CVD, psychiatric illness, and IBD). These analyses provide important data regarding characteristics of psoriasis patients with self-reported PsA in PSOLAR.Trial registrationNCT00508547.

Comparative Effectiveness of Generic Latanoprost Versus Branded Prostaglandin Analogs for Primary Open Angle Glaucoma

ABSTRACTPurpose: The purpose of the study is to determine the comparative effectiveness of generic latanoprost (GL) to its branded (BL) counterpart and other brand-name prostaglandin analogs (bPGAs) in preventing the need for additional therapy in the treatment of primary open angle glaucoma (POAG).Methods: Retrospective cohort study using US commercial medical claims data. All new POAG patients from 2000 to 2015 who initiated treatment with either GL or BL were included. Exclusion occurred for having less than 2 years of time in the plan prior to diagnosis, previous use of glaucoma medications, or any diagnosis of glaucoma other than POAG at any time. Analyses compared GL to BL and also to those who received any branded PGA after 2011 (when the generic became available). Cox proportional hazard regression was used to assess the hazards of filling a prescription for a second IOP-lowering medication or having surgical intervention, individually and either outcome combined.Results: A total of 6317 and 4150 POAG patients were treated with GL and BL, respectively. After 2010, 6317 GL and 3703 brand-name prostaglandin analog (bPGA) POAG patients met criteria for inclusion. After adjustment, compared to BL, the GL conferred a reduced hazard of having a glaucoma procedure performed (hazard ratio [HR] = 0.72, 95% CI: 0.62–0.84, p < 0.001) and the combined outcome (HR = 0.90, 95% CI: 0.83–0.97, p = 0.006) but was not associated with having a second IOP medication (HR = 0.95, 95% CI: 0.87–1.03, p = 0.18). Compared to the bPGAs, however, GL conferred a reduced hazard in each comparison (second IOP medication HR = 0.87, 95% CI: 0.81–0.94, p < 0.001; surgery HR = 0.70, 95% CI: 0.61–0.81, p < 0.001; combined HR = 0.85, 95% CI: 0.79–0.92, p < 0.001). Sensitivity analyses confirmed these findings.Conclusions: GL was no less and possibly more effective in preventing the need for additional intervention than branded PGAs.

Amantadine and the Risk of Dyskinesia in Patients with Early Parkinson's Disease: An Open-Label, Pragmatic Trial.

Objective We examined whether amantadine can prevent the development of dyskinesia.Methods Patients with drug-naïve Parkinson’s disease (PD), younger than 70 years of age and in the early stage of PD (Hoehn and Yahr scale < 3), were recruited from April 2011 to December 2014. The exclusion criteria included the previous use of antiparkinsonian medication, the presence of dyskinesia, significant psychological disorders, and previous history of a hypersensitivity reaction. Patients were consecutively assigned to one of 3 treatment groups in an open label fashion: Group A-1, amantadine first and then levodopa when needed; Group A-2, amantadine first, dopamine agonist when needed, and then levodopa; and Group B, dopamine agonist first and then levodopa when needed. The primary endpoint was the development of dyskinesia, which was analyzed by the Kaplan-Meier survival rate.Results A total of 80 patients were enrolled: Group A-1 (n = 27), Group A-2 (n = 27), and Group B (n = 26). Twenty-four patients were excluded from the analysis due to the following: withdrawal of amantadine or dopamine agonist (n = 9), alternative diagnosis (n = 2), withdrawal of consent (n = 1), and breach in the protocol (n = 12). After exclusion, 5 of the 56 (8.93%) patients developed dyskinesia. Patients in Group A-1 and A-2 tended to develop dyskinesia less often than those in Group B (cumulative survival rates of 0.933, 0.929, and 0.700 for A-1, A-2, and B, respectively; p = 0.453).Conclusion Amantadine as an initial treatment may decrease the incidence of dyskinesia in patients with drug-naïve PD.

Self-medication practice and associated factors among pregnant women in Addis Ababa, Ethiopia

BackgroundSelf-medication which is the act of obtaining and using one or more medicines without medical supervision is a common practice among pregnant women. Unless proper caution is taken, it may result in maternal and fetal adverse outcomes. In Ethiopia, information on self-medication practice during pregnancy is scanty. Hence, this study aimed to assess self-medication practice and associated factors among pregnant women in government health centers in Addis Ababa.MethodsAn institution-based mixed study design using a sequential explanatory approach was employed among 617 pregnant women and nine key informants in Addis Ababa from May 8, 2017, to June 30, 2017. Multi-stage sampling technique was used to select study participants, and purposive sampling technique was used to select the key informants. The quantitative data were collected using a structured interview questionnaire and analyzed using Statistical Product and Service Solutions (SPSS) version 23.0 whereas semi-structured questionnaire was used for in-depth interviews. Binary logistic regression was used for quantitative data analysis, and thematic analysis method was used for qualitative data.ResultsThe prevalence of self-medication practice was 26.6%. Previous medication use (Adjusted odds ratio (AOR) = 4.20, 95% CI 2.70–6.53), gestational period (AOR = 0.63, 95% CI 0.41–0.98), education on self-medication (AOR = 0.36, 95% CI 0.21–0.62), previous pregnancy and delivery related problems (AOR = 1.71, 95% CI 1.06–2.76), and knowledge about risk of self-medication (AOR = 0.64, 95% CI 0.42–0.97) were significantly associated with self-medication practice. Lack of attention and priority of program designers, absence of strategies and guidelines; weak screening mechanisms, and regulatory enforcement were cited by the key informants as contributing factors for self-medication practices.ConclusionsConsiderable proportion of pregnant women practiced self-medication, including medicines categorized to have high risks. Gestational period, previous medication use, education on self-medication, previous pregnancy- and delivery-related problems, and knowledge were significantly associated with self-medication practice. In addition, there are correctable gaps in program designing, screening of pregnant women, regulatory enforcement, and strategies and guidelines. Hence, necessary measures at all levels must be taken to reduce risks of self-medication during pregnancy.

Sex differences in the association between a previous cancer diagnosis and the use of medication.

We aimed to quantify the association between a previous cancer diagnosis and medication use, depicting possible sex differences. We analysed data from a representative sample of the Portuguese adult population (n=32 610), which was collected through face-to-face interviews, using a structured questionnaire. The effect of a previous diagnosis of cancer was quantified through prevalence ratios (PR), adjusted for age, education and region of residence. Cancer survivors (CS) reported higher use of prescribed medication, with greater adjusted PR among men (1.25 vs. 1.13, P for interaction=0.001). Compared with the general population, male CS reported higher use of drugs for sleep problems, allergies and antibiotics, whereas female CS reported greater consumption of drugs for depression, anxiety, sleep problems and pain. This study contributes towards understanding sex disparities in the impact of cancer survival on medication use.

Association of translocator protein total distribution volume with duration of untreated major depressive disorder: a cross-sectional study

People with major depressive disorder frequently exhibit increasing persistence of major depressive episodes. However, evidence for neuroprogression (ie, increasing brain pathology with longer duration of illness) is scarce. Microglial activation, which is an important component of neuroinflammation, is implicated in neuroprogression. We examined the relationship of translocator protein (TSPO) total distribution volume (VT), a marker of microglial activation, with duration of untreated major depressive disorder, and with total illness duration and antidepressant exposure. In this cross-sectional study, we recruited participants aged 18-75 years from the Toronto area and the Centre for Addiction and Mental Health (Toronto, ON, Canada). Participants either had major depressive episodes secondary to major depressive disorder or were healthy, as confirmed with a structured clinical interview and consultation with a study psychiatrist. To be enrolled, participants with major depressive episodes had to score a minimum of 17 on the 17-item Hamilton Depression Rating Scale, and had to be medication free or taking a stable dose of medication for at least 4 weeks before PET scanning. Eligible participants were non-smokers; had no history of or concurrent alcohol or substance dependence, neurological illness, autoimmune disorder, or severe medical problems; and were free from acute medical illnesses for the previous 2 weeks before PET scanning. Participants were excluded if they had used brain stimulation treatments within the 6 months before scanning, had used anti-inflammatory drugs lasting at least 1 week within the past month, were taking hormone replacement therapy, had psychotic symptoms, had bipolar disorder (type I or II) or borderline antisocial personality disorder, or were pregnant or breastfeeding. We scanned three primary grey-matter regions of interest (prefrontal cortex, anterior cingulate cortex, and insula) and 12 additional regions and subregions using 18F-FEPPA PET to measure TSPO VT. We investigated the duration of untreated major depressive disorder, and the combination of total duration of disease and duration of antidepressant treatment, as predictor variables of TSPO VT, assessing their significance. Between Sept 1, 2009, and July 6, 2017, we screened 134 participants for eligibility, of whom 81 were included in the study (current major depressive episode n=51, healthy n=30). We excluded one participant with a major depressive episode from the analysis because of unreliable information about previous medication use. Duration of untreated major depressive disorder was a strong predictor of TSPO VT (p<0·0001), as were total illness duration (p=0·0021) and duration of antidepressant exposure (p=0·037). The combination of these predictors accounted for about 50% of variance in TSPO VT in the prefrontal cortex, anterior cingulate cortex, and insula. In participants who had untreated major depressive disorder for 10 years or longer, TSPO VT was 29-33% greater in the prefrontal cortex, anterior cingulate cortex, and insula than in participants who were untreated for 9 years or less. TSPO VT was also 31-39% greater in the three primary grey-matter regions of participants with long duration of untreated major depressive disorder compared with healthy participants (p=0·00047). Microglial activation, as shown by TSPO VT, is greater in patients with chronologically advanced major depressive disorder with long periods of no antidepressant treatment than in patients with major depressive disorder with short periods of no antidepressant treatment, which is strongly suggestive of a different illness phase. Consistent with this, the yearly increase in microglial activation is no longer evident when antidepressant treatment is given. Canadian Institutes of Health Research and Neuroscience Catalyst Fund.

Exacerbations and healthcare resource utilization among COPD patients in a Swedish registry-based nation-wide study

BackgroundExacerbations of chronic obstructive pulmonary disease (COPD) are an important measure of disease severity in terms of impaired disease progression, increased recovery time, healthcare resource utilization, overall morbidity and mortality. We aimed to quantify exacerbation and healthcare resource utilization rates among COPD patients in Sweden with respect to baseline treatments, exacerbation history, and comorbidities.MethodsPatients with a COPD or chronic bronchitis (CB) diagnosis in secondary care at age of ≥40 years on 1.7.2009 were identified and followed until 1.7.2010 or death. Severe exacerbations were defined as hospitalizations due to respiratory disease, and healthcare resource utilization was measured by all-cause hospitalizations and secondary care visits. Poisson regression was used adjusting for age, gender, time since COPD/CB diagnosis, and Charlson comorbidity index.ResultsIn 88,548 patients (54% females, mean age 72 years), previous respiratory hospitalizations and current high use of COPD medication (double or triple therapy) predicted an 8.3-fold increase in severe exacerbation rates and 1.8-fold increase in healthcare resource utilization rates in the following year, compared to patients without combination treatment and/or history of severe exacerbations.ConclusionsCOPD/CB patients with history of severe exacerbations and high use of COPD medication experienced a significantly increased rate of severe exacerbations and healthcare resource utilization during the one-year follow-up.

Abstract TP327: Predictors of Spontaneous Hemorrhagic Transformation in Patients Not Treated With Recanalization Therapies

Hemorrhagic transformation (HT) is an important complication after ischemic stroke and might be associated with a worse clinical prognosis. Predictors of (HT) in patients treated with recanalization therapies were extensively evaluated, however predictors of spontaneous HT are less well described. Hypothesis: we evaluated the hypothesis that clinical and neuroimaging variables can predict spontaneous HT in patients with ischemic stroke. Methods: We evaluated patients admitted with ischemic stroke and not treated with recanalization therapies to a tertiary stroke center. The rates of hemorrhagic transformation were evaluated in follow up CT scans (within at least 24 hours), using the ECASS II criteria. Univariate predictors of HT were identified. We used logistic regression analysis to investigate independent predictors of HT. Results: A total of 258 patients were evaluated (mean age 64 ± 14,=6 years, 59.3% males.) The overall prevalence of HT was 21.3% (n = 55), with 45.5% (n = 25) of symptomatic HT. Patients with HT had higher NIHSS at admission (13 [10-15,5] versus 8 [4-17], p &lt;0.01), lower ASPECTS scores (7 [6-8] 9 [8-9] p&lt;0.01) and a trend towards being more hypertensive at admission (76.1% versus 68.1%, p=0.2). Cardio-aortic embolism was more frequent among patients with HT (39,3% versus 23,2%, p= 0.02). ASPECTS scores at admission (OR 0.60 (0.44-0.82) ≤0.01), admission glucose levels (OR 1.01 (1.01-1.01) p≤0.01), being hypertensive at admission (OR 3.03 (1.08-8.48) p=0.03) and having a previous history of coronary artery disease (OR 4.01 (1.24-12.93) p=0.02) were independent predictors of HT. Previous use of antithrombotic medications was not associated with HT. Patients with HT had a lower frequency of independence at discharge (mRS&lt;=2), p=0.03. Symptomatic and asymptomatic HT were associated with a higher chance of death during hospitalization (OR 3.28, 95% CI 1-11.20, p= 0.05 and OR 4.61, 95% CI 1.35-15, 71, p = 0.01, respectively). Conclusion: In conclusion, HT is not uncommon in acute ischemic stroke not treated with recanalization therapies. Clinical, neuroimaging and laboratorial data characteristics can be used to identify patients at higher risk for HT. Even asymptomatic HT seems to be associated with worse clinical outcomes

Adherence to Nucleoside/Nucleotide Analogue Treatment in Patients with Chronic Hepatitis B.

Background:Adherence to medication is an important aspect of preventing drug resistance and treatment failure in patients receiving nucleos(t)ide analogues for chronic hepatitis B.Aims:To assess adherence to nucleoside/nucleotide analogues in chronic hepatitis B treatment and to determine factors associated with non-adherence.Study Design:Cross-sectional study.Methods:The study enrolled 85 chronic hepatitis B patients who had been receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was completed by patients themselves, and adherence was evaluated based on patients’ self-reporting. The use of at least 95% of the drugs in the previous month was considered as adequate adherence.Results:Adherence was adequate in 82.4% of patients. Female gender (p=0.003), unemployment (p=0.041) and lower monthly family income (p=0.001) were related to lower adherence. Better adherence was significantly linked to adequate basic knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than 12 months (p<0.001), previous use of other medications for chronic hepatitis B (p=0.014) and regular follow-up by the same physician (p<0.001).Conclusion:Counselling patients about their disease state and the consequences of non-adherence is an important intervention for enhancing adherence. Naïve patients should be followed up more frequently to reinforce adherence.

Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil.

BackgroundSeveral studies have demonstrated that platelet counts in Helicobacter pylori-positive patients with chronic idiopathic thrombocytopenic purpura improved significantly after successful eradication of the infection. However, depending of the geographical region of the study the results have been highly divergent.ObjectiveThe purpose of this study was to evaluate the effect of H. pylori eradication therapy on platelet count in a cohort of chronic idiopathic thrombocytopenic purpura patients from northeastern Brazil.MethodH. pylori status was determined in 28 chronic idiopathic thrombocytopenic purpura patients using the rapid urease test and histology. H. pylori-positive patients received standard triple therapy for one week. The effect of the eradication therapy was evaluated using the 13C-urea breath test two to three months after treatment.ResultsThe prevalence of H. pylori infection was similar to that found in the general population. Twenty-two patients (78.5%) were H. pylori-positive. Fifteen were treated, 13 (86%) of whom successfully. At six months, 4/13 (30%) displayed increased platelet counts, which remained throughout follow-up (12 months). Platelet response was not associated to mean baseline platelet count, duration of chronic idiopathic thrombocytopenic purpura, gender, age, previous use of medication, or splenectomy.ConclusionsH. pylori eradication therapy showed relatively low platelet recovery rates, comparable with previous studies from southeastern Brazil. The effect of H. pylori eradication on platelet counts remained after one year of follow-up suggesting that treating H. pylori infection might be worthwhile in a subset of chronic idiopathic thrombocytopenic purpura patients.