Social media is increasingly utilized as a resource in healthcare. We sought to identify per

BackgroundNigeria has an annual population of ~ 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with the increased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria.MethodsIn this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12 months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use.ResultsOut of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were 30 years old or less. Two-thirds (268, 67.2%) of the cohort analyzed had 1–2 children at baseline; 24.8% (n = 99) had 3–4 children, and 8.0% (n = 32) had > 4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR = 2.0, 95% CI: 1.2–3.3; p = 0.01) and receipt of family planning counselling (aOR = 2.3, 95% CI: 1.1–4.8; p = 0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates.ConclusionsFamily planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates.Clinical trials registrationClinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.

Objective: To evaluate the impact of pre-intensive care unit admission (pre-ICU) statin use on all-cause in-hospital mortality and ICU length of stay (LOS). Design: Retrospective cohort study. Setting: Adult ICUs at tertiary hospitals. Patients: Adult critically ill patients diagnosed with sepsis admitted to the ICUs. Intervention: The exposure was pre-ICU statin prescription (statin users); unexposed represented absence of pre-ICU prescription (non-users). Measurement and Main Results: We used the 2001-2012 Medical Information Mart for Intensive Care-III (MIMIC-III) database to determine average treatment effect (ATE) of pre-ICU statin use on 30-day ICU mortality, ICU LOS, and 30-day in-hospital mortality using the Augmented Inverse Propensity Weighted technique (AIPW), after adjusting for confounding factors (age, race, health insurance, corticosteroids use, vital signs, laboratory tests, and Sequential Organ Failure Assessment score (SOFA). We measured 30-day ICU mortality as deaths within 30 days of admission to the ICU, and ICU LOS was measured in fractional days. A 30-day in-hospital mortality was measured as death within 30 days of hospital admission. A total of 8200 patients with sepsis were identified; 19.8% (1623) were statin users, and 80.2% (6577) were non-users. Most were Caucasian, aged 80 years and above, and male. After adjusting for confounding factors, pre-ICU statin use decreased 30-day ICU mortality (ATE,

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STUDY OBJECTIVES Continuous intravenous (IV) infusion bumetanide has been associated with severe myalgia in case reports, and the package labeling lists a reported incidence of 0.2% for severe myalgia. The primary objective of this study was to quantify the incidence of bumetanide infusion-induced severe myalgia in patients with acute heart failure (AHF). Secondary objectives were to assess a dose-response relationship between bumetanide infusion rate and occurrence of myalgia and to investigate potential risk factors associated with bumetanide-induced myalgia. DESIGN Retrospective analysis. SETTING Large academic medical center. PATIENTS Adults hospitalized with AHF who required bumetanide (≥ 0.5 mg/hr [464 patients]) or furosemide (≥ 20 mg/hr [197 patients]) by continuous IV infusion between September 2015 and May 2017. MEASUREMENTS AND MAIN RESULTS The incidence of severe myalgia with IV furosemide infusion was assessed to measure confounding by indication bias. Electronic medical records were used to identify patients exposed to bumetanide 0.25-mg/ml or furosemide 2-mg/ml continuous IV infusions. We defined severe myalgia as a diffuse myalgia with a physician's documented suspicion of bumetanide-or furosemide-induced myalgia unresponsive to electrolyte repletion and necessitating a change to alternative diuretics. The incidence of severe myalgia during bumetanide therapy was 5.8%, with the incidence increasing with higher bumetanide infusion rates: 2.6% for an infusion rate ≤ 1 mg/hour and 10.3% for a rate > 1 mg/hour (p=0.0005). In the multivariate logistic regression analysis, a bumetanide infusion rate > 1 mg/hour was independently associated (odds ratio 4.8, 95% confidence interval 1.94-12.02, p=0.0007) with severe myalgia compared to that with a rate ≤ 1 mg/hour. No patients receiving furosemide continuous IV infusion experienced severe myalgia, although infusion rates were lower in potency than bumetanide infusion rates. CONCLUSION The incidence of severe myalgia in patients with AHF receiving bumetanide infusion was 5.8%, 29-fold higher than incidence rate listed in the package labeling. Patients receiving infusion rates > 1 mg/hour were 4-fold more likely to experience bumetanide-induced severe myalgia than those receiving rates ≤ 1 mg/hour. KEY WORDS heart failure, bumetanide, myalgia, adverse event.

mastectomy were examined based on RxNorm. Descriptive and chi-square analyses were conducted using the in-built analytics TriNetX platform. Results: Analyses of TriNetX revealed 7,429 patients who had undergone a simple mastectomy during 2011-2018. Hypertension (47%), joint disorders (46%), osteoarthritis (28%), thyroid disorders (28%), and diabetes (18%) were among the most frequent comorbidities. Opioid analgesics were prescribed to 76% of mastectomy patients (n=5,628). Approximately 82% of African Americans (n=946) were prescribed opioids within one month post-mastectomy compared to 77% of White non-Hispanics (n=4,234). Opioid analgesics were prescribed to 60% of White Hispanics (n=281) and 50% of Asians (n=167). Chi-square analyses revealed statistically significant differences in opioid prescribing practices by race/ethnicity after simple mastectomy. Bivariate analyses revealed that African Americans were 1.3 times (OR=1.32; 95% CI 1.12 -1.56) more likely to receive prescription of opioids compared to White non-Hispanics counterparts. Compared to all other races/ethnicities, African Americans were 1.5 times (OR=1.54; 95% CI 1.32 -1.82) more likely to receive prescription of opioids within one month post-mastectomy. Conclusions: Racial/ethnic variability exists in opioid prescribing practices among patients who have undergone a simple mastectomy. Further research is needed to examine racial/ethnic disparities in both access to opioids and treatment.

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