Nonsteroidal anti-inflammatory drug therapy: Clinical use in a high-risk group -- the elderly

1988 ◽  
Vol 55 (5) ◽  
pp. 419-425 ◽  
Author(s):  
D. G. VIDT ◽  
A. W. BAKST ◽  
D. J. MAZANEC
Keyword(s):  
Drug Therapy ◽  
High Risk ◽  
Risk Group ◽  
The Elderly ◽  
High Risk Group ◽  
Clinical Use ◽  
Inflammatory Drug ◽  
Anti Inflammatory

scholarly journals Depression in Age-Related Macular Degeneration

2008 ◽  
Vol 102 (10) ◽  
pp. 591-599 ◽  
Author(s):  
Robin Casten ◽  
Barry Rovner
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
General Population ◽  
Macular Degeneration ◽  
Risk Group ◽  
The Elderly ◽  
High Risk Group ◽  
Age Related Macular Degeneration ◽  
Age Related

Age-related macular degeneration (AMD) is a major cause of disability in the elderly, substantially degrades the quality of their lives, and is a risk factor for depression. Rates of depression in AMD are substantially greater than those found in the general population of older people, and are on par with those of other chronic and disabling diseases. This article discusses the effect of depression on vision-related disability in patients with AMD, suggests methods for screening for depression, and summarizes interventions for preventing depression in this high-risk group.

The Profile of Endothelial Function in Children with ALL Is Associated with the Risk Stratification Determining the Outcome – a Pilot Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4230-4230
Author(s):  
Ewa Niedzielska ◽  
Adrian Doroszko ◽  
Alicja Chybicka ◽  
Andrzej Szuba
Keyword(s):  
Lipid Peroxidation ◽  
High Risk ◽  
Risk Stratification ◽  
Endothelial Function ◽  
Risk Group ◽  
High Risk Group ◽  
No Bioavailability ◽  
Anti Inflammatory ◽  
Standard Risk ◽  
Pai 1

Abstract Abstract 4230 Background: Endothelial dysfunction (ED) is characterized by impaired balance between pro- and anti-aggregatory, pro- and anti-inflammatory factors as well as vasodilative and vasoconstrictive action of numerous metabolic and signaling pathways. ED is an important factor worsening the outcome in severe diseases. The aim of this study was to assess if the profile of endothelial function during the treatment of ALL might be associated with the risk stratification and with the outcome. Material and Methods: N=18 children at age of 4–18 years with ALL, treated with the ALLIC- BFM 2002 protocol were investigated. Plasma levels of the NO pathway metabolites (L-Arginine, ADMA – an endogenous competive eNOS inhibitor), markers of endothelial inflammatory and aggregatory function (VCAM-1, ICAM-1, E-selectin, P-selectin and PAI-1), lipid peroxidation (MDA – malonyldialdehyde) were analyzed at baseline, then during the 33rd and 78th day of treatment. Results were compared between three subgroups: standard risk, intermediate risk and high risk. Results: Subjects in the high risk groups were characterized by increased baseline lipid peroxidation, as assessed by the MDA levels in comparison to those in the standard risk group (8.56±2.14U/ml vs. 3.57±0.81U/ml, respectively, p<0.05). In the high risk group low E-selectin levels at baseline (32.1±6.1ng/ml vs. 101.3±11.8ng/ml in the standard risk group, respectively, p<0.05), as well as high NO production at the beginning of the M protocol, assessed by the L-Arg/ADMA ratio (88.6±11.6ng/ml vs. 41.7±6.4ng/ml, respectively, p<0.05) were observed. Moreover, increase in the PAI-1 level during the therapy was associated with smaller risk for poor outcome. Conclusions: Increased lipid peroxidation, low E-selectin at baseline, as well as increased NO bioavailability, decreased PAI-1 levels at the beginning of the M protocol are common feature in children classified to the high risk group. Low NO bioavailability at baseline and high at the beginning of the M protocol as well as decreased anti-inflammatory and antiaggregatory function of endothelium at the beginning of the M protocol are associated with higher risk for poor prognosis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A novel hyperinflammation clinical risk tool, HI5-NEWS2, predicts mortality following early dexamethasone use in an observational cohort of hospitalised COVID-19 patients.

2021 ◽  
Author(s):  
Michael R Ardern-Jones ◽  
Hang T.T. Phan ◽  
Florina Borca ◽  
Matthew Stammers ◽  
James Batchelor ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
Dexamethasone Treatment ◽  
Dexamethasone Therapy ◽  
Risk Patients ◽  
Anti Inflammatory

Background The success of early dexamethasone therapy for hospitalised COVID-19 cases in treatment of Sars-CoV-2 infection may predominantly reflect its anti-inflammatory action against a hyperinflammation (HI) response. It is likely that there is substantial heterogeneity in HI responses in COVID-19. Methods Blood CRP, ferritin, neutrophil, lymphocyte and platelet counts were scored to assess HI (HI5) and combined with a validated measure of generalised medical deterioration (NEWS2) before day 2. Our primary outcome was 28 day mortality from early treatment with dexamethasone stratified by HI5-NEWS2 status. Findings Of 1265 patients, high risk of HI (high HI5-NEWS2) (n=367, 29.0%) conferred a strikingly increased mortality (36.0% vs 7.8%; Age adjusted hazard ratio (aHR) 5.9; 95% CI 3.6-9.8, p<0.001) compared to the low risk group (n= 455, 36.0%). An intermediate risk group (n= 443, 35.0%) also showed significantly higher mortality than the low risk group (17.6% vs 7.8%), aHR 2.2, p=0.005). Early dexamethasone treatment conferred a 50.0% reduction in mortality in the high risk group (36.0% to 18.0%, aHR 0.56, p=0.007). The intermediate risk group showed a trend to reduction in mortality (17.8% to 10.3%, aHR 0.82, p=0.46) which was not observed in the low risk group (7.8% to 9.2%, aHR 1.4, p =0.31). Interpretation The HI5-NEWS2 measured at COVID-19 diagnosis, strongly predicts mortality at 28 days. Significant reduction in mortality with early dexamethasone treatment was only observed in the high risk group. Therefore, the HI5-NEWS2 score could be utilised to stratify randomised clinical trials to test whether intensified anti-inflammatory therapy would further benefit high risk patients and whether alternative approaches would benefit low risk groups. Considering its recognised morbidity, we suggest that early dexamethasone should not be routinely prescribed for HI5-NEWS2 low risk individuals with COVID-19 and clinicians should cautiously assess the risk benefit of this intervention. Funding No external funding.

Risk of Venous Thromboembolism in Patients with Myelodysplatic Syndrome

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5245-5245
Author(s):  
Mohamad A. Younes ◽  
Javier Munoz ◽  
Ammar Khanshour ◽  
Jessica Schering ◽  
George Yaghmour ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Elderly Population ◽  
Risk Group ◽  
Prognostic Significance ◽  
The Elderly ◽  
High Risk Group ◽  
Treatment Modalities ◽  
Vte Prophylaxis ◽  
The Mean

Abstract Abstract 5245 Introduction: The myelodysplastic syndromes (MDS) comprise a heterogeneous group of malignant stem cell disorders characterized by dysplastic and ineffective blood cell production and a variable risk of transformation to acute leukemia (AML). Treatment of MDS with immunomodulatory drugs and eryrthropoitin is a well known risk factor for venous thromboembolic disease (VTE) and has been cited in several reports. However, the frequency of VTE in MDS patients as an independent risk factor regardless of treatment modalities has not been characterized before. Methods: We reviewed all cases of MDS diagnosed between 2000 and 2010 in our institution and did a retrospective analysis on the incidence of VTE in these patients prior or during different modalities and also according to different MDS subtypes and prognostic scores. The study also sub-classified the VTE according to being provoked or not. Results: Between 2000 and 2010, 291 patients were diagnosed with MDS in our institution. Seventeen (5.8%) patients developed VTE. Of these patients, 4(23.5%) had unprovoked VTE compared to 13(76.5%) with provoked VTE. All patients with unprovoked VTE (100%) had their venous event prior to the MDS diagnosis with a median time of 154 days (range 5–150 days). 75% (3 patients) of these patients had an intermediate-1 IPSS group and 25% (1 patient) belonged to the low risk group. In the group of patients with provoked VTE, 6 (46.2%) patients had the venous event prior to MDS diagnosis with a median time of 434 days (range 90–943 days). 83.3% (5 patients) had an intermediate-1 IPSS group and 16.7% (1 patient) belonged to the high risk group. On the other hand, 7 (53.8%) patients had provoked VTE after the MDS diagnosis with a median time of 294 days (range 14–718 days). Treatment modalities during which these VTE occurred were as follows, 3 (42.8%) patients were on erythropoietin stimulating agents (ESA), 1 (14.2%) patient was on revlimid, 2 (28.5%) patients were on active chemotherapy, and 1 (14.2%) patient was on no treatment. The IPSS group distribution for post MDS diagnosis patients with provoked VTE was as follows: 0% in the low risk group, 28.5% belonged to intermediate-1 risk group, 28.5% belonged to intermediate-2 risk group and 43% belonged to the high risk group. In patients with unprovoked VTE, the median age was 77.7 years (range 76–81 years) with equal distribution between males and females (50% each). In patients with provoked VTE, the median age was 69.6 years (range 56–85 years) with 46.1% males and 53.9% females. Discussion: The results of this study shows an increased risk of VTE in patients with MDS (5.8%) compared to that in the general population which is reported to occur in about 1 per 1000 persons per year. It also shows that all the unprovoked VTE events occurred prior to the MDS diagnosis with a median time of around 5 months. Due to this finding, we recommend that part of the workup for unprovoked VTE in the elderly population (as the mean age for unprovoked VTE was 77.7 years) include at least a CBCD and a peripheral smear to rule out cytopenias or morphologic changes suggestive of MDS. Since 46.2% of the provoked VTE happened before MDS diagnosis, we also recommend checking a CBCD in the elderly population (as the mean age for provoked VTE was 69.6 years) due to its low cost and especially if the provoking factor for VTE was not strong enough. Since 42.8% of patients with provoked VTE were on ESA during the event, we encourage aggressive VTE prophylaxis in moderate/high risk situations for these patients. The study did not show a higher prevalence of the intermediate-2 or high IPSS risk groups among patients with unprovoked (0%) or provoked VTE (46%). However, we encourage further research to study the prognostic significance of VTE in MDS patients and its relationship to progression to AML and to overall survival. Conclusion: Our study showed that a higher risk of VTE is present in patients with MDS compared to the general population and we recommend that aggressive VTE prophylaxis be given in moderate/high risk situations especially for patients who are taking ESA. We also recommend further research to be done on the prognostic significance of VTE in patients with MDS regarding overall survival and progression to AML. Disclosures: No relevant conflicts of interest to declare.

The Elderly and Hospital-Acquired Diarrhoea: A High-Risk Group

1995 ◽  
Vol 24 (suppl 2) ◽  
pp. P17-P17
Author(s):  
L Kyne ◽  
A Moran ◽  
C Keane ◽  
D O'Neill
Keyword(s):  
High Risk ◽  
Risk Group ◽  
The Elderly ◽  
High Risk Group ◽  
Hospital Acquired

Acromegaly and Obstructive Sleep Apnea: Identifying the High-Risk Group

2019 ◽  
Author(s):  
Xiaojun Zhan ◽  
Chandala Chitguppi ◽  
Ethan Berman ◽  
Gurston Nyquist ◽  
Tomas Garzon-Muvdi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Obstructive Sleep

Anamnestic factors that shape reproductive health of women with repeated unsuccessful popygamy in vitro fertilization

2016 ◽  
pp. 140-143
Author(s):  
N.V. Cotsabin ◽  
◽  
O.M. Makarchuk ◽  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Polycystic Ovary ◽  
High Risk Group ◽  
Stress Factors ◽  
Control Group ◽  
Fertilization In Vitro ◽  
Infertile Women ◽  
Group I

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p <0.05), secondary infertility - mostly in the second and third experimental groups (p <0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p <0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p<0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

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