-
Journal of the American College of... Mar 2021In cholesterol guidelines, low-density lipoprotein (LDL) cholesterol remains the primary target while apolipoprotein B (apoB) and non-high-density lipoprotein (non-HDL)...
BACKGROUND
In cholesterol guidelines, low-density lipoprotein (LDL) cholesterol remains the primary target while apolipoprotein B (apoB) and non-high-density lipoprotein (non-HDL) cholesterol are secondary targets.
OBJECTIVES
This study sought to determine if elevated apoB and/or non-HDL cholesterol are superior to elevated LDL cholesterol in identifying statin-treated patients at residual risk of all-cause mortality and myocardial infarction.
METHODS
In total, 13,015 statin-treated patients from the Copenhagen General Population Study were included with 8 years median follow-up. Cox regressions among apoB, non-HDL cholesterol, and LDL cholesterol, respectively, and all-cause mortality or myocardial infarction were examined on continuous scales by restricted cubic splines and by categories of concordant and discordant values defined by medians.
RESULTS
High apoB and non-HDL cholesterol were associated with increased risk of all-cause mortality and myocardial infarction, whereas no such associations were found for high LDL cholesterol. Compared with concordant values below medians, discordant apoB above the median with LDL cholesterol below yielded hazard ratios of 1.21 (95% confidence interval [CI]: 1.07 to 1.36) for all-cause mortality and 1.49 (95% CI: 1.15 to 1.92) for myocardial infarction. Corresponding values for high non-HDL cholesterol with low LDL cholesterol were 1.18 (95% CI: 1.02 to 1.36) and 1.78 (95% CI: 1.35 to 2.34). In contrast, discordant high LDL cholesterol with low apoB or non-HDL cholesterol was not associated with increased risk of all-cause mortality or myocardial infarction. Also, discordant high apoB with low non-HDL cholesterol yielded hazard ratios of 1.21 (95% CI: 1.03 to 1.41) for all-cause mortality and of 0.93 (95% CI: 0.62 to 1.40) for myocardial infarction. Furthermore, dual discordant apoB and non-HDL cholesterol above the medians with LDL cholesterol below presented hazard ratios of 1.23 (95% CI: 1.07 to 1.43) for all-cause mortality and 1.82 (95% CI: 1.37 to 2.42) for myocardial infarction.
CONCLUSIONS
In statin-treated patients, elevated apoB and non-HDL cholesterol, but not LDL cholesterol, are associated with residual risk of all-cause mortality and myocardial infarction. Discordance analysis demonstrates that apoB is a more accurate marker of all-cause mortality risk in statin-treated patients than LDL cholesterol or non-HDL cholesterol, and apoB in addition is a more accurate marker of risk of myocardial infarction than LDL cholesterol.
Topics: Aged; Apolipoproteins B; Biomarkers; Causality; Cholesterol, LDL; Denmark; Female; Heart Disease Risk Factors; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Male; Mortality; Myocardial Infarction; Registries; Risk Assessment
PubMed: 33736827
DOI: 10.1016/j.jacc.2021.01.027 -
BMC Medical Research Methodology Feb 2012The results of Randomized Controlled Trials (RCTs) on time-to-event outcomes that are usually reported are median time to events and Cox Hazard Ratio. These do not...
BACKGROUND
The results of Randomized Controlled Trials (RCTs) on time-to-event outcomes that are usually reported are median time to events and Cox Hazard Ratio. These do not constitute the sufficient statistics required for meta-analysis or cost-effectiveness analysis, and their use in secondary analyses requires strong assumptions that may not have been adequately tested. In order to enhance the quality of secondary data analyses, we propose a method which derives from the published Kaplan Meier survival curves a close approximation to the original individual patient time-to-event data from which they were generated.
METHODS
We develop an algorithm that maps from digitised curves back to KM data by finding numerical solutions to the inverted KM equations, using where available information on number of events and numbers at risk. The reproducibility and accuracy of survival probabilities, median survival times and hazard ratios based on reconstructed KM data was assessed by comparing published statistics (survival probabilities, medians and hazard ratios) with statistics based on repeated reconstructions by multiple observers.
RESULTS
The validation exercise established there was no material systematic error and that there was a high degree of reproducibility for all statistics. Accuracy was excellent for survival probabilities and medians, for hazard ratios reasonable accuracy can only be obtained if at least numbers at risk or total number of events are reported.
CONCLUSION
The algorithm is a reliable tool for meta-analysis and cost-effectiveness analyses of RCTs reporting time-to-event data. It is recommended that all RCTs should report information on numbers at risk and total number of events alongside KM curves.
Topics: Algorithms; Data Interpretation, Statistical; Humans; Kaplan-Meier Estimate; Meta-Analysis as Topic; Observer Variation; Proportional Hazards Models; Randomized Controlled Trials as Topic; Reproducibility of Results; Research Design; Survival Analysis
PubMed: 22297116
DOI: 10.1186/1471-2288-12-9 -
Seizure Jan 2016We conducted a comprehensive review of the epidemiology of epilepsy in the Arab world. (Review)
Review
PURPOSE
We conducted a comprehensive review of the epidemiology of epilepsy in the Arab world.
METHODS
Epidemiological literature about epilepsy from 22 countries of the Arab League was searched in French and English using several keywords (specific and wider) and combinations, individually for each country. The search was conducted on Google first and then on PubMed. The results are presented as counts, proportions, and medians along with 95% confidence intervals (CI). Unpaired t-test with unequal variance and regressions were performed, altogether and individually, for lifetime and active epilepsy prevalence as well as incidence.
RESULTS
Google provided 21 prevalence, four camp and nine incidence estimates while PubMed provided ten such estimates; none of them was identified by Google. No epidemiological data about epilepsy was found from 10/22 countries. Excluding pediatric studies, 13 prevalence estimates from six countries were identified. Including pediatric studies, 21 estimates from nine countries were found. Median lifetime and active epilepsy prevalence were 7.5/1000 (95% CI 2.6-12.3, range 1.9-12.9) and 4.4/1000 (95% CI 2.1-9.3, range 2.1-9.3), respectively, excluding pediatric studies (1984-2014, N=244081). Median incidence was 56.0/100,000 (n=9, N=122484, 95% CI 13.7-147.9, range 10.4-190).
CONCLUSION
The fact that no epidemiological data about epilepsy is available in the public domain for almost one half of all Arab countries offers opportunities for future research. This thorough review of existing literature demonstrates a prevalence of epilepsy three times higher than previously reported for this region. The median incidence is similar to other regions of the world, e.g. North America. Google yielded additional valuable sources not indexed in PubMed and provided pertinent references more quickly.
Topics: Epilepsy; Humans; Middle East; Prevalence
PubMed: 26724591
DOI: 10.1016/j.seizure.2015.12.002 -
Toxins Mar 2022Animal feed (including forage and silage) can be contaminated with mycotoxins. Here, 200 maize silage samples from around China were collected in 2019 and analyzed for...
Animal feed (including forage and silage) can be contaminated with mycotoxins. Here, 200 maize silage samples from around China were collected in 2019 and analyzed for regulated mycotoxins, masked mycotoxins (deoxynivalenol, 3-acetyldeoxynivalenol, 15-acetyldeoxynivalenol, and deoxynivalenol-3-glucoside), and emerging mycotoxins (beauvericin, enniatins, moniliformin, and alternariol). Deoxynivalenol and zearalenone were detected in 99.5% and 79.5% of the samples, respectively. Other regulated mycotoxins were detected in fewer samples. The highest deoxynivalenol and zearalenone concentrations were 3600 and 830 μg/kg, respectively. The most commonly detected masked mycotoxin was 15-acetyldeoxynivalenol, which was detected in 68.5% of the samples and had median and maximum concentrations of 61.3 and 410 μg/kg, respectively. The emerging mycotoxins beauvericin, alternariol, enniatin A, enniatin B1, and moniliformin were detected in 99.5%, 85%, 80.5%, 72.5%, and 44.5%, respectively, of the samples but at low concentrations (medians <25 μg/kg). The samples tended to contain multiple mycotoxins, e.g., the correlation coefficients for the relationships between the concentrations of beauvericin and deoxynivalenol, deoxynivalenol and zearalenone, and zearalenone and beauvericin were 1.0, 0.995, and 0.995, respectively. The results indicated that there needs to be more awareness of the presence of one or more masked and emerging mycotoxins in maize silage in China.
Topics: Animal Feed; Animals; Food Contamination; Mycotoxins; Silage; Zea mays; Zearalenone
PubMed: 35448850
DOI: 10.3390/toxins14040241 -
Journal of Cachexia, Sarcopenia and... Apr 2023Magnetic resonance imaging (MRI) is the gold standard for evaluating body composition. However, the reference ranges have not been established.
BACKGROUND
Magnetic resonance imaging (MRI) is the gold standard for evaluating body composition. However, the reference ranges have not been established.
METHODS
Three lean tissue and seven adipose tissue parameters based on MRI data from the UK Biobank were used in this study. Participants with European ancestry and data on at least one parameter were screened. Age- and sex-specific percentile curves were generated using the lambda-mu-sigma method. Three levels of reference ranges were provided, which were equivalent to the mean ± 1 standard deviation (SD), 2 SDs and 2.5 SDs.
RESULTS
The final analysis set for each parameter ranged from 4842 to 14 148 participants (53.4%-56.6% women) with a median age of 61. For lean tissue parameters, compared with those at age 45, the median total lean tissue volume and total thigh fat-free muscle volume at age 70 were 2.83 and 1.73 L, and 3.02 and 1.51 L lower in men and women, respectively. The median weight-to-muscle ratios at age 45 were 0.51 and 0.83 kg/L lower compared with those at age 70 in men and women, respectively. Adipose tissue parameters showed inconsistent differences. In men, the median muscle fat infiltration, visceral adipose tissue (VAT) volume, total abdominal adipose tissue index and abdominal fat ratio were 1.48%, 0.32 L, 0.08 L/m and 0.4 higher, and the median abdominal subcutaneous adipose tissue (ASAT) volume and total adipose tissue volume were 0.47 and 0.41 L lower, respectively, at age 70 than at age 45. The median total trunk fat volume was approximately 9.53 L at all ages. In women, the median muscle fat infiltration and VAT volume were 1.68% and 0.76 L higher, respectively, at age 70 than at age 45. The median ASAT volume, total adipose tissue volume, total trunk fat volume, total abdominal adipose tissue index and abdominal fat ratio were 0.35 L, 0.78 L, 1.12 L, 0.49 L/m and 0.06 higher, respectively, at age 60 than at age 45. The medians of the former three parameters were 0.33 L, 0.14 L and 0.20 L lower, at age 70 than at age 60. The medians of the latter two parameters were approximately 3.64 L/m and 0.55 at ages between 60 and 70.
CONCLUSIONS
We have established reference ranges for MRI-measured body composition parameters in a large community-dwelling population. These findings provide a more accurate assessment of abnormal adipose and muscle conditions.
Topics: Male; Humans; Female; Middle Aged; Aged; Reference Values; Biological Specimen Banks; Body Composition; Muscle, Skeletal; Magnetic Resonance Imaging; United Kingdom
PubMed: 36717370
DOI: 10.1002/jcsm.13181 -
American Journal of Preventive Medicine Sep 2017The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of... (Review)
Review
CONTEXT
The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension.
EVIDENCE ACQUISITION
The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S. dollars.
EVIDENCE SYNTHESIS
Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12-13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $369 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC.
CONCLUSIONS
SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined.
Topics: Blood Pressure Monitoring, Ambulatory; Cost of Illness; Cost-Benefit Analysis; Health Care Costs; Humans; Hypertension; Models, Economic; Patient Care Team; Quality-Adjusted Life Years; Stroke
PubMed: 28818277
DOI: 10.1016/j.amepre.2017.03.002 -
BMC Infectious Diseases May 2022Monitoring of antimicrobial resistance (AMR) is of great importance due to the frequency of strains becoming increasingly resistant to antibiotics. This review, using a... (Review)
Review
BACKGROUND
Monitoring of antimicrobial resistance (AMR) is of great importance due to the frequency of strains becoming increasingly resistant to antibiotics. This review, using a public health focused approach, which aims to understand and describe the current status of AMR in Morocco in relation to WHO priority pathogens and treatment guidelines.
METHODS
PubMed, ScienceDirect and Google Scholar Databases and grey literature are searched published articles on antimicrobial drug resistance data for GLASS priority pathogens isolated from Morocco between January 2011 and December 2021. Articles are screened using strict inclusion/exclusion criteria. AMR data is extracted with medians and IQR of resistance rates.
RESULTS
Forty-nine articles are included in the final analysis. The most reported bacterium is Escherichia coli with median resistance rates of 90.9%, 64.0%, and 56.0%, for amoxicillin, amoxicillin-clavulanic acid, and co-trimoxazole, respectively. Colistin had the lowest median resistance with 0.1%. A median resistance of 63.0% is calculated for amoxicillin-clavulanic acid in Klebsiella pneumonia. Imipenem resistance with a median of 74.5% is reported for Acinetobacter baumannii. AMR data for Streptococcus pneumonie does not exceed 50.0% as a median.
CONCLUSIONS
Whilst resistance rates are high for most of GLASS pathogens, there are deficient data to draw vigorous conclusions about the current status AMR in Morocco. The recently join to the GLASS system surveillance will begin to address this data gap.
Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drug Resistance, Bacterial; Escherichia coli; Humans; Morocco
PubMed: 35525923
DOI: 10.1186/s12879-022-07412-4 -
JACC. Clinical Electrophysiology Oct 2021This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD)... (Review)
Review
OBJECTIVES
This study aimed to review the utility of quinidine in patients presenting with recurrent sustained ventricular arrhythmia (VA) and limited antiarrhythmic drug (AAD) options.
BACKGROUND
Therapeutic options are often limited in patients with structural heart disease and recurrent VAs. Quinidine has an established role in rare arrhythmic syndromes, but its potential use in other difficult VAs has not been assessed in the present era.
METHODS
We performed a retrospective analysis of 37 patients who had in-hospital quinidine initiation after multiple other therapies failed for VA suppression at our tertiary referral center. Clinical data and outcomes were obtained from the medical record.
RESULTS
Of 30 patients with in-hospital quantifiable VA episodes, quinidine reduced acute VA from a median of 3 episodes (interquartile range [IQR]: 2 to 7.5) to 0 (IQR: 0 to 0.5) during medians of 3 days before and 4 days after quinidine initiation (p < 0.001). VA events decreased from a median of 10.5 episodes per day (IQR: 5 to 15) to 0.5 episodes (IQR: 0 to 4) after quinidine initiation in the 12 patients presenting with electrical storm (p = 0.004). Among the 24 patients discharged on quinidine, 13 (54.2%) had VA recurrence during a median of 138 days. Adverse effects in 9 of the 37 patients (24.3%) led to drug discontinuation, most commonly gastrointestinal intolerance.
CONCLUSIONS
In patients with recurrent VAs and structural heart disease who have limited treatment options, quinidine can be useful, particularly as a short-term therapy.
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Humans; Quinidine; Retrospective Studies; Ventricular Fibrillation
PubMed: 34217656
DOI: 10.1016/j.jacep.2021.03.024 -
BJU International Nov 2022To demonstrate that surgical sperm retrieval (SSR) and spermatogonial stem cell retrieval (SSCR) in an oncological context are safe and successful.
OBJECTIVES
To demonstrate that surgical sperm retrieval (SSR) and spermatogonial stem cell retrieval (SSCR) in an oncological context are safe and successful.
PATIENTS AND METHODS
This a retrospective study in a tertiary hospital in the UK. Patients requiring fertility preservation from December 2017 to January 2020 were included. Data were analysed with Microsoft Excel 2016 and the Statistical Package for the Social Sciences (version 20).
RESULTS
Among 1264 patients referred to the Reproductive Medical Unit at the University College of London Hospitals for cryopreservation prior to gonadotoxic treatment, 39 chose to go forward with SSR/SSCR because they presented as azoo-/cryptozoospermic or an inability to masturbate/ejaculate. Interventions were testicular sperm extraction (23 patients) or aspiration (one), electroejaculation (one), and testicular wedge biopsy for SSCR (14). The median (range) age was 15.0 (10-65) years and the median testosterone level was 4.4 nmoL/L. Primary diagnoses were sarcoma in 11 patients, leukaemia in nine, lymphoma in eight, testicular tumour in five, other oncological haematological entities in two, other solid cancers in two, while two patients had non-oncological haematological diseases. SSR/SSCR could be offered within 7.5 days on average. Chemotherapy could follow within 2 days from SSR/SSCR, and bone marrow transplant occurred within 19.5 days (all expressed as medians). The success rate for SSR was 68.0% (at least one vial/straw collected). The mean (SD) Johnsen score of testicular biopsies was 5.23 (2.25) with a trend towards positive correlation with SSR success (P = 0.07). However, age, hormonal profile and type of cancer did not predict SSR outcome.
CONCLUSION
We show that SSR and SSCR in an oncological context are valid treatment options with a high success rate for patients in which sperm cryopreservation from semen is impossible. By providing an effective pathway, fertility preservation is possible with minimal delay to oncological treatment.
Topics: Adolescent; Adult; Aged; Humans; Male; Middle Aged; Young Adult; Cryopreservation; Fertility Preservation; Retrospective Studies; Semen; Testicular Neoplasms; Testosterone; Urologists; Child
PubMed: 35535513
DOI: 10.1111/bju.15772 -
International Journal of Environmental... Mar 2022Food-based analyses of the healthiness, environmental sustainability and affordability of processed and ultra-processed foods are lacking. This paper aimed to determine...
Food-based analyses of the healthiness, environmental sustainability and affordability of processed and ultra-processed foods are lacking. This paper aimed to determine how ultra-processed and processed foods compare to fresh and minimally processed foods in relation to nutritional quality, greenhouse gas emissions and cost on the food and food group level. Data from the National Diet and Nutrition Survey nutrient databank year 11 (2018/2019) were used for this analysis. Median and bootstrapped medians of nutritional quality (NRF8.3 index), greenhouse gas emissions (gCO2-equivalents) and cost (in GBP) were compared across processing categories. An optimal score based on the medians was created to identify the most nutritional, sustainable, and affordable options across processing categories. On a per 100 kcal basis, ultra-processed and processed foods had a lower nutritional quality, lower greenhouse gas emissions, and were cheaper than minimally processed foods, regardless of their total fat, salt and/or sugar content. The most nutritious, environmentally friendly, and affordable foods were generally lower in total fat, salt, and sugar, irrespective of processing level. The high variability in greenhouse gas emissions and cost across food groups and processing levels offer opportunities for food swaps representing the healthiest, greenest, and most affordable options.
Topics: Carbohydrates; Diet; Energy Intake; Environment; Fast Foods; Food Handling; Greenhouse Gases; Nutritive Value; Sugars; United Kingdom
PubMed: 35328877
DOI: 10.3390/ijerph19063191