scholarly journals Acetaminophen Use Concomitant with Long-Lasting Flucloxacillin Therapy: A Dangerous Combination

2020 ◽  
Author(s):  
Luuk René van den Bersselaar ◽  
Judith Maria Dimphena van den Brule ◽  
Johannes Gerardus van der Hoeven
Keyword(s):  
Risk Factors ◽  
Metabolic Acidosis ◽  
Liver Function ◽  
Anion Gap ◽  
Advanced Age ◽  
Critical Attitude ◽  
Increased Risk ◽  
Toxicological Mechanism

Acetaminophen and flucloxacillin both interfere with the γ-glutamyl cycle. Long-lasting concomitant use of flucloxacillin and acetaminophen can lead to 5-oxoproline accumulation and severe high anion gap metabolic acidosis. Females and patients with sepsis, impaired kidney and/or liver function, malnutrition, advanced age, congenital 5-oxoprolinase deficiency and supratherapeutic acetaminophen and flucloxacillin dosage are associated with increased risk. Therefore, a critical attitude towards the prescription of acetaminophen concomitant with flucloxacillin in these patients is needed. We present the case of a 79-year-old woman with severe 5-oxoprolinaemia after long-lasting treatment with flucloxacillin and acetaminophen, explaining the toxicological mechanism and risk factors, and we make recommendations for acetaminophen use in patients with long-lasting flucloxacillin treatment.

scholarly journals Risk of venous thromboembolism associated with Janus kinase inhibitors for rheumatoid arthritis: case presentation and literature review

2021 ◽  
Author(s):  
Shunsuke Mori ◽  
Fumihiko Ogata ◽  
Ryusuke Tsunoda
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Disease Activity ◽  
Janus Kinase ◽  
Advanced Age ◽  
Jak Inhibitors ◽  
Increased Risk

AbstractJanus kinase (JAK) inhibitors have been developed as disease-modifying antirheumatic drugs. Despite the positive therapeutic impacts of JAK inhibitors, concerns have been raised regarding the risk of venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE). A recent post hoc safety analysis of placebo-controlled trials of JAK inhibitors in rheumatoid arthritis (RA) reported an imbalance in the incidence of VTE for a 4-mg daily dose of baricitinib versus placebo. In a recent postmarketing surveillance trial for RA, a significantly higher incidence of PE was reported in treatment with tofacitinib (10 mg twice daily) compared with tofacitinib 5 mg or tumor necrosis factor inhibitors. We also experienced a case of massive PE occurring 3 months after starting baricitinib (4 mg once daily) for multiple biologic-resistant RA. Nevertheless, the evidence to support the role of JAK inhibitors in VTE risk remains insufficient. There are a number of predisposing conditions and risk factors for VTE. In addition to the known risk factors that can provoke VTE, advanced age, obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking can also contribute to its development. Greater VTE risk is noted in patients with chronic inflammatory conditions, particularly RA patients with uncontrolled disease activity and any comorbidity. Prior to the initiation of JAK inhibitors, clinicians should consider both the number and strength of VTE risk factors for each patient. In addition, clinicians should advise patients to seek prompt medical help if they develop clinical signs and symptoms that suggest VTE/PE. Key Points• Patients with rheumatoid arthritis (RA) are at increased risk of venous thromboembolism (VTE), especially those with uncontrolled, high disease activity and those with comorbidities.• In addition to the well-known risk factors that provoke VTE events, advanced age and cardiovascular risk factors, such as obesity, diabetes mellitus, hypertension, hyperlipidemia, and smoking, should be considered risk factors for VTE.• Although a signal of VTE/pulmonary embolism (PE) risk with JAK inhibitors has been noted in RA patients who are already at high risk, the evidence is currently insufficient to support the increased risk of VTE during RA treatment with JAK inhibitors.• If there are no suitable alternatives, clinicians should prescribe JAK inhibitors with caution, considering both the strength of individual risk factors and the cumulative weight of all risk factors for each patient.

scholarly journals Advanced age and increased CRP concentration are independent risk factors associated with Clostridioides difficile infection mortality

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Agnieszka Bednarska ◽  
Dominik Bursa ◽  
Regina Podlasin ◽  
Marcin Paciorek ◽  
Agata Skrzat-Klapaczyńska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infectious Diseases ◽  
Advanced Age ◽  
Receiver Operating Curve ◽  
Multivariate Logistic Regression Model ◽  
Risk Of Death ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Independent Risk Factors

Abstract Clostridioides difficile (C.difficile) is a Gram-positive, spore-forming, toxin-producing anaerobic bacillus, which is one of the most common causes of health-care-associated infection developed mainly by elderly patients. The objective of this study was to assess mortality among the patients of the Hospital for Infectious Diseases in Warsaw related to C.difficile infection. Analysis was conducted of 1638 records reporting the medical histories of patients hospitalized for the first time due to Clostridioides difficile infection (CDI) in the Hospital for Infectious Diseases in Warsaw from 2010 to 2017. The inclusion criteria were any (principal or secondary) discharge diagnosis code for CDI according to ICD-10 and being an adult (≥ 18 years). 108 out of 1638 (7%) of the patients died. The median age in this group was 83 years. The largest number of deaths (90%) occurred in the group of patients aged 65 years or older and 81–90 years old (53% of all the deaths). In the multivariate logistic regression model relevant only to the age groups, not to sepsis—age over 80 and over 90 were independent predictors of death, increasing the risk of death by 3.4 and 1.8 times, respectively. The result of the receiver operating curve (ROC) analysis determined the age of 77 years as the threshold value, indicating the increased risk of death (AUC 0.727, standard error 0.025, 95% CI 0.678–0.776, p < 0.0001). In addition, other quantitative variables, namely CRP, creatinine and leucocytes were studied and turned out to be independent death predictors as well. The diagnosis of sepsis increased the risk of death fourfold (OR = 4.042; 95% Cl 2.4–6.7; p < 0.001). Increased inflammatory parameters, namely CRP and white blood cell count, advanced age, particularly over the age of 80, as well as a diagnosis of sepsis are independent risk factors for death and could be used as predictive markers of poor outcome in CDI.

scholarly journals Acquired pyroglutamic acidaemia in a critically ill patient with chronic paracetamol use: A case report

2022 ◽  
Vol 10 ◽  
pp. 2050313X2110685
Author(s):  
Lee Connolly ◽  
Ed Briggs
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Metabolic Acidosis ◽  
Critically Ill ◽  
Care Setting ◽  
Pyroglutamic Acid ◽  
Anion Gap ◽  
Critically Ill Patient ◽  
Glutathione Metabolism ◽  
Patient Morbidity

Pyroglutamic acid is an endogenous organic acid and a metabolite in the γ-glutamyl cycle, involved in glutathione metabolism. Accumulation of pyroglutamic acid is a rare cause of high anion gap metabolic acidosis. There are multiple risk factors for pyroglutamic acid accumulation, such as chronic paracetamol use and sepsis. In this case report, we discuss how we came to this diagnosis, how it was subsequently managed and why it is an important consideration for critically ill patients with risk factors who are likely to end up in an intensive care setting. Pyroglutamic acid recognition and treatment could benefit patients in the critically ill population as pyroglutamic acid is a rare cause of high anion gap metabolic acidosis, which is likely under-recognised and easily treated. Inappropriate management of metabolic disorders can contribute to patient morbidity and mortality. Therefore, the recognition and appropriate management of pyroglutamic acidaemia could benefit patients with risk factors for its development in a critical care setting.

scholarly journals BACK TO BASICS: HOPELESSNESS AS THE MEDIATING FACTOR FOR COMPLETED SUICIDE AMONG OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S269-S270
Author(s):  
Silvia C Hernandez ◽  
James C Overholser ◽  
James Lavacot ◽  
Kristie L Philips ◽  
Craig A Stockmeier
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Social Isolation ◽  
Structural Equation ◽  
Physical Illness ◽  
Advanced Age ◽  
Equation Modeling ◽  
Psychological Autopsy ◽  
Increased Risk ◽  
Increase Risk

Abstract Individuals 65 years and older are at high risk for completing suicide. Though risk factors have been established in the literature, the dominant atheoretical approach has left the field at an impasse. The present study aimed to integrate core risk factors of hopelessness, depression, physical illness, and social isolation by proposing a biopsychosocial framework of older adult suicide. A psychological autopsy was used to compare individuals 65 years and older who died either by suicide (n = 32) or natural causes (n = 45). Structural equation modeling results suggested that hopelessness was the only factor directly associated with suicide (B = .01, β = 0.84, SE = 13.31, p ≤ .001), fully mediating the relationships between suicide and social isolation, negative attitudes about physical health, and depression. The proposed model adequately fit the data, explaining 71% of the variance in cause of death. Advanced age (75+ years) moderately increased social isolation, which weakly increased hopelessness, contributing to suicide in a smaller magnitude than expected. Though individuals in the advanced age group had a wider range of physical illnesses, this did not increase risk. Rather, negative perceptions of health increased risk for all individuals 65 years and older via depression and hopelessness, irrespective of the presence of impairing physical illness. Findings support the claim that hopelessness plays a pivotal role in the progression from suicidal ideation to completion among older adults. Directly targeting hopelessness could help prevent at-risk older adults from acting on their thoughts of suicide.

scholarly journals Obesity, Anion Accumulation, and Anion Gap Metabolic Acidosis: A Cohort Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0003562021
Author(s):  
Douglas C. Lambert ◽  
Matthew K. Abramowitz
Keyword(s):  
Metabolic Acidosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Anion Gap ◽  
Acid Base ◽  
Unmeasured Anion ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Acid Base Disturbance ◽  
Base Disturbance

Background: Obesity is associated with low serum bicarbonate, an indicator of metabolic acidosis and a CKD risk factor. To further characterize acid-base disturbance and subclinical metabolic acidosis in this population, we examined prospective associations of body mass index (BMI) with elevated anion gap, and whether anion gap values in obesity associate with low bicarbonate. Methods: Data from adult outpatients (n = 94,448) in the Bronx, NY were collected from 2010-2018. Mixed effects models and Cox proportional hazards models were used to examine associations of BMI with elevated anion gap and anion gap metabolic acidosis, and of baseline anion gap with incident low bicarbonate and anion gap metabolic acidosis. Anion gap was defined using traditional and albumin-corrected calculations. Results: Greater BMI was associated with higher anion gap over time, and with progressively greater risk of developing an elevated anion gap (HRs for BMI ≥ 40 vs. 18-<25 kg/m2: 1.32 [95% CI: 1.23 - 1.42] for traditional and 1.74 [95% CI: 1.63 - 1.85] for corrected). Higher BMI was also associated with increased risk of developing anion gap metabolic acidosis (HR for BMI ≥ 40: 1.53 [95% CI: 1.39 - 1.69]). Among patients with obesity, higher anion gap was associated with increased risk of incident low bicarbonate (HRs for 4th vs 1st quartile: 1.29 [95% CI: 1.23 - 1.44] for traditional and 1.36 [95% CI: 1.26 - 1.48] for corrected); and higher risk of anion gap metabolic acidosis (HR for 4th vs 1st quartile 1.78 [1.59 - 1.99]). Conclusions: Obesity is characterized by unmeasured anion accumulation and acid retention or overproduction. Modest elevations in anion gap among patients with obesity are associated with previously unrecognized anion gap metabolic acidosis.

scholarly journals Prevalence, Incidence, and Associated Factors of Possible Sarcopenia in Community-Dwelling Chinese Older Adults: A Population-Based Longitudinal Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Zi Chen ◽  
Mandy Ho ◽  
Pui Hing Chau
Keyword(s):  
Risk Factors ◽  
Longitudinal Study ◽  
Associated Factors ◽  
Multivariable Analysis ◽  
Population Based ◽  
Community Dwelling ◽  
Advanced Age ◽  
Chinese Older Adults ◽  
Increased Risk ◽  
Older Chinese

Purpose: This study aimed to assess the prevalence, incidence, and associated factors of possible sarcopenia in a nationwide representative sample of the community-dwelling older Chinese population.Methods:This study used the data of participants aged 60 years and over from the China Health and Retirement Longitudinal Study (CHARLS). Data on participants from three waves (2011–2015) of CHARLS were extracted. Possible sarcopenia was defined as low muscle strength or low physical performance, based on the Asian Working Group for Sarcopenia 2019 consensus. We first described baseline prevalence and four-year incidence of possible sarcopenia. Then multiple logistic regression and multivariable parametric proportional hazard model with Weibull distribution were used to examine the association of risk factors with baseline prevalence and four-year incidence of possible sarcopenia, respectively.Results:The prevalence of possible sarcopenia was 46.0%. The four-year incidence of possible sarcopenia was 11.9 per 100 person-years. Multivariable analysis revealed that advanced age and depressive symptoms were associated with increased prevalence of possible sarcopenia, while receiving education and moderate or high physical activity were associated with a lower risk of possible sarcopenia prevalence. For incidence, only advanced age was associated with an increased risk of possible sarcopenia incidence.Conclusion:Our study revealed the substantial burden of possible sarcopenia and related risk factors in community-dwelling settings in China. It highlighted the importance of early detection and intervention in this subclinical group for the prevention of sarcopenia.

Abstract P57: Risk Factors for Incidentally Discovered Silent Brain Infarcts and White Matter Disease in a Real World Cohort Identified by Artificial Intelligence

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lester Y Leung ◽  
Yichen Zhou ◽  
Sunyang Fu ◽  
Chengyi Zheng ◽  
Hongfang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
White Matter ◽  
Language Processing ◽  
Real World ◽  
Stroke Risk ◽  
Advanced Age ◽  
White Matter Disease ◽  
Brain Infarcts ◽  
Increased Risk

Introduction: Silent brain infarcts (SBIs) and white matter disease (WMD) are highly prevalent and associated with increased risk of ischemic stroke in patients with traditional stroke risk factors (RFs) in prospective cohort studies. Their frequency and associations with stroke RFs have not been well described in real world populations. Methods: This was a cross-sectional study of patients age ≥ 50 in the Kaiser Permanente-Southern California (KPSC) health system between 2009-2019 with a head CT or MRI for non-stroke indications and no history of ischemic stroke, transient ischemic attack, or dementia. A natural language processing (NLP) algorithm developed at Mayo Clinic and Tufts Medical Center was applied to the KPSC EHR to identify individuals with reported SBIs or WMD. Multivariable Poisson regression with robust error variance was used to estimate risk ratios of demographics, stroke RFs (from the Framingham Stroke Risk Score), and scan modality on the presence of SBIs or WMD. Results: Among 262,875 individuals, the NLP identified 13,154 (5.0%) with SBIs and 78,330 (29.8%) with WMD. Stroke RFs were highly prevalent in this cohort. The majority underwent CTs (74.8%) instead of MRIs as their initial neuroimaging. After adjustment for demographics and RFs, advanced age demonstrated a strong association with increased risk of SBIs and WMD (table). MRI was associated with a reduced risk of reported SBIs (ARR: 0.87, 95% CI 0.83-0.91) and an increased risk of reported WMD (ARR 2.86, 95% CI 2.83-2.90). Despite being prevalent, traditional stroke RFs had weak associations with increased risk of SBIs or increased risk of WMD. Conclusions: Advanced age is strongly associated with incidentally discovered SBIs and WMD on neuroimaging studies obtained in routine care. The development of SBIs and WMD may not be fully attributable to traditional stroke RFs.

Therapeutic options in male osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 271-276 ◽  
Author(s):  
P. Farahmand ◽  
J. D. Ringe
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Public Health Problem ◽  
Male Osteoporosis ◽  
Individual Risk ◽  
Modes Of Action ◽  
Increased Risk ◽  
Study Results ◽  
Long Term Treatment ◽  
Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

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