Application of risk factors for venous thromboembolism in patients with multiple myeloma starting chemotherapy, a real‐world evaluation

Venous thromboembolism causes significant morbidity and mortality in patients with multiple myeloma, but there is little evidence of efficacy of thromboprophylaxis guidelines. Our study shows that IMWG thromboprophylaxis guidelines may not be followed systematically, which highlights an area for significant clinical improvement. Additionally, multiple myeloma patients may clot later and increase or decrease their clotting risk over time, indicating a possible need for continual risk assessment throughout the disease course.

Abstract

Introduction

Within the first year of diagnosis, up to 1 in 3 multiple myeloma (MM) patients will experience a venous thromboembolism (VTE). The International Myeloma Working Group (IMWG) has thromboprophylaxis guidelines that stratify patients into low or high risk for thrombosis and subsequently recommend thromboprophylaxis, but it is unknown if these recommendations are being followed or if they are effective. The purpose of this study was to assess efficacy of the IMWG guidelines and investigate other potential VTE risk factors.

Methods

Study participants were treated at the University of Kansas Medical Center between 2007 and 2013, and charts were reviewed to extract data. Cases (MM and VTE) were matched to controls (MM and no VTE) at approximately 1:3 ratio based on gender, age (±5 years), and time of MM diagnosis (±5 years).

Results

A total of 80 cases and 211 controls were matched. Most patients (82%) were considered high risk for experiencing a VTE at the time of their MM diagnosis and 18% were considered low risk. Neither risk category (P = 0.16) nor thromboprophylaxis at baseline (P = 0.37) predicted VTE, though cases were more likely than controls to have an increased risk of thrombosis at the time of clot compared to their baseline risk (P = 0.09).

Conclusion

Our results suggest that IMWG guidelines are not being consistently followed and therefore could not be validated. Additional risk factors were not identified, but risk for VTE may change over time suggesting patients may require ongoing assessment of VTE risk and thromboprophylaxis throughout the disease course.

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Immediate provisionalization of bone level implants with a hydrophilic surface. A 5‐year follow‐up of a randomised controlled clinical trial

Abstract

Objectives

To follow‐up the radiographic bone level changes and the clinical outcomes of immediately provisionalized and conventionally restored implants with a hydrophilic surface following 5 years of function.

Materials and methods

This was a 5‐year follow‐up of a prospective, randomized, single blind controlled study involving 16 out of the 24 originally recruited patients in need of a single tooth replacement in the esthetic area. Implants were either immediately provisionalized with a non‐occluding temporary crown (test group, n=7), or left without a crown (control group, n=9). In both groups, the definitive restoration was placed 16 weeks after implant placement. Radiographic and clinical parameters were evaluated at 36, 48 and 60 months post‐implant placement, together with implant survival and success rates. The esthetic outcomes were measured with the Papilla Fill Index (PFI) and the Pink Esthetic Score (PES).

Results

At 60 months, similar peri‐implant bone loss was observed in the test (‐0.42 mm ± 0.17 mm) and in the control (‐0.37 mm ± 0.35 mm) groups. A tendency for an improved esthetic outcome from implant loading to the subsequent follow‐ups was noticed in both groups. Both groups presented with high levels of long‐term implant survival and success.

Conclusions

This study supports non‐functional immediate provisionalization as a viable long‐term option for the management of single‐tooth implants in the esthetic area. However, the small sample size does not allow statistical inference at 60 months of follow‐up and future adequately powered studies are warranted

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Superior performance of National Early Warning Score compared with quick Sepsis-related Organ Failure Assessment Score in predicting adverse outcomes: a retrospective observational study of patients in the prehospital setting

Background Early intervention and response to deranged physiological parameters in the critically ill patient improve outcomes. A National Early Warning Score (NEWS) based on physiological observations has been developed for use throughout the National Health Service in the UK. The quick Sepsis-related Organ Failure Assessment Score (qSOFA) was developed as a simple bedside criterion to identify adult patients outwith the ICU with suspected infection who are likely to have a prolonged ICU stay or die in hospital. We aim to compare the ability of NEWS and qSOFA to predict adverse outcomes in a prehospital population. Patients and methods All clinical observations taken by emergency ambulance crews transporting patients to a single hospital were collated along with information relating to mortality over a 2-month period. The performance of the NEWS and qSOFA in identifying the endpoints of 30-day mortality, ICU admission and a combined endpoint of 48 h. ICU admission or 30-day mortality was analysed. Results Complete data were available for 1713 patients. For the primary outcome of ICU admission within 48 h or 30-day mortality, the odds ratio for a qSOFA score of 3 compared with 0 was 124.1 [95% confidence interval (CI): 13.5–1137.7] and the odds ratio for a high NEWS category, compared with the low NEWS category was 9.82 (95% CI: 5.74–16.81). Comparison of qSOFA and NEWS performance was assessed using receiver operating characteristic curves. The area under the receiver operating characteristic curve for the primary outcome for qSOFA was 0.679 (95% CI: 0.624–0.733), for NEWS category was 0.707 (95% CI: 0.654–0.761) and for NEWS total score was 0.740 (95% CI: 0.685–0.795). Comparison of the receiver operating characteristic curves between NEWS total score and qSOFA using DeLong's test showed NEWS total score to be superior to qSOFA at predicting combined ICU admission within 48 h of presentation or 30-day mortality (P=0.011). Conclusion Our study shows qSOFA can identify patients at risk of adverse outcomes in the prehospital setting. However, NEWS is superior to qSOFA in a prehospital environment at identifying patients at risk of adverse outcomes. Correspondence to Alasdair R. Corfield, MB, ChB, MPH, MRCP, FRCEM, DipIMCRCSEd, Royal Alexandra Hospital, Paisley, UK E-mail: a.corfield@nhs.net Received March 27, 2018 Accepted December 1, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Value of Estimated Glomerular Filtration Rate and Albuminuria in Predicting Cardiovascular Risk in Patients with Type 2 Diabetes without Cardiovascular Disease

Introduction. Onset of nephropathy in patients with type 2 diabetes (T2DM) increases the cardiovascular disease (CVD) risk. Association of the parameters of diabetic nephropathy such as albuminuria and estimated glomerular filtration rate (eGFR) with predicted CVD risk has not been studied in Sri Lankan patients with T2DM. Methods. In a cross-sectional study of patients who underwent single visit screening at a diabetes center in Sri Lanka, we obtained demographic and biochemical data. Those with urine albumin excretion over 30 mg/g creatinine were considered as having albuminuria and eGFR was calculated using modified diet in renal disease (MDRD) formula. Ten-year coronary heart disease risk (CHDR) in all patients was calculated using United Kingdom Prospective Diabetes Study risk engine and those with CHDR > 10% were considered as having high risk. Spearman correlation was used to study the association between eGFR and CHDR, and logistic regression analysis was carried out to study the association of albuminuria and eGFR with high (>10%) CHDR. Results. Of the patients with diabetes studied (n=2434), 64 % (1563) were males. Mean (SD) age and duration of diabetes were 52 (11) and 9 (3) years, respectively. Normoalbuminuria, microalbuminuria, and macroalbuminuria were observed in 16.4 %, 14.8 %, and 68.7% of patients, respectively. Three hundred ninety-four (16.2%) patients had eGFR 60 ml/min (P

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Daily Caffeine Consumption Does Not Influence Acupuncture Analgesia in Healthy Individuals: A Preliminary Study

Animal studies suggest that caffeine may interfere with acupuncture analgesia. This study investigated the modulation effect of daily caffeine intake on acupuncture analgesia in 27 healthy subjects using a crossover design. We found that real acupuncture increased pain thresholds compared to sham acupuncture. Further, there was no association between caffeine intake measurements of daily caffeine use, duration of caffeine consumption, or their interaction and preacupuncture and postacupuncture pain threshold changes. Our findings suggest that daily caffeine intake may not influence acupuncture analgesia in the cohort of healthy subjects who participated in study. Accepted for publication November 12, 2018. Funding: J.K. is supported by R01 AT008563, R21 AT008707, and R61/R33 AT009310 from the National Institutes of Health/National Center for Complementary and Integrative Health. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to Jian Kong, MD, MS, MPH, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Bldg 120, Room 101 C, Charlestown, MA 02129. Address e-mail to jkong2@mgh.harvard.edu. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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In Response to Afreen Et Al

No abstract available

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