Objectives ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- and older-onset patients are still incompletely understood. Methods We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: <65 years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). Results A total of 1338 patients with AAV were included: 66% had disease onset at <65 years of age [female 50%; mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54%; mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27%; P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97); P = 0.03]. Conclusion Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.
ObjectiveCoding of obesity using the International Classification of Diseases (ICD) in healthcare administrative databases is under‐reported and thus, unreliable for measuring prevalence or incidence. This study aimed to develop and test a rule‐based algorithm for automating detection and severity of obesity using height and weight collected in several sections of the Electronic Medical Records (EMR).MethodsIn this cross‐sectional study, 1904 inpatient charts randomly selected in three hospitals in Calgary, Canada between January and June 2015 were reviewed and linked with AllScripts Sunrise Clinical Manager EMRs. A rule‐based algorithm was created which looks for patients' height and weight values recorded in EMRs. Clinical notes were split into sentences and searched for height and weight, and BMI was computed.ResultsThe study cohort consisted of 1904 patients with 50.8% female and 43.3% > 64 years of age. Final model to identify obesity within EMRs resulted in a sensitivity of 92.9%, specificity of 98.4%, positive predictive value of 96.7%, negative predictive value of 96.6%, and an F1 score of 94.8%.ConclusionsThis study developed a highly valid rule‐based EMR algorithm that detects height and weight. This could allow large scale analyses using obesity that were previously not possible.This article is protected by copyright. All rights reserved.
C hronic suppurative otitis media (CSOM) is one of the most common chronic childhood infections worldwide. Considerable variation in prevalence is noted globally; the highest prevalence rates are reported in Aboriginal, and particularly, Inuit children populations, in which this disease is considered endemic. Literature on CSOM therapy primarily uses short-term clearance of ear drainage as the primary outcome. While the literature on CSOM has shortcomings in terms of length of follow-up, sample size, methodological quality and lack of paediatric studies, there is reasonable evidence for the efficacy of topical quinolones following aural toilet. Part a: EvidEncE-BasEd answEr and summaryThe WHO defines CSOM as "otorrhea through a perforated tympanic membrane present for at least two weeks" (1). CSOM can occur when acute otitis media (AOM) causes acute perforation of the tympanic membrane or when AOM occurs in conjunction with chronic perforation or tympanostomy tubes (2). The most common sequela of CSOM is conductive or sensorineural hearing loss (3). The Cochrane Database of Systematic Reviews and Google Scholar were searched in January 2012, identifying three rel- The WHO guidelines, covering the relative effectiveness of topical and systemic antibiotics, drew on a 1998 Cochrane review of all interventions for CSOM, which was comprised of only adult trials (7). The evidence on topical versus systemic antibiotics was taken from six studies and favoured topical antibiotics (OR 0.46 [95% CI 0.30 to 0.68]) for resolving otorrhea and eradicating middle ear bacteria; the effect estimate was strengthened when heterogeneity was decreased by excluding the two lowest quality trials from the analysis (OR 0.19 [95% CI 0.1 to 0.32]). The Cochrane review concluded that of the topical antibiotics studied, topical quinolones were more effective than topical nonquinolones (OR 0.36 [95% CI 0.22 to 0.59]), and that there was no additive benefit from combining systemic and topical antibiotics (7). The guideline authors also note that "there is general agreement that aural toilet must be part of the standard medical treatment for CSOM" (3), because it reduces the quantity of infected material, thereby facilitating penetration of topical treatments.The The benefits of exclusively analyzing paediatric data motivated Woodfield and Dugdale (6) to rerun the searches from the Cochrane reviews, selecting only the trials involving children. None of these directly compared topical with systemic antibiotics. Nonetheless, they concluded that topical quinolones alone were the most effective short-term treatment for CSOM in children.There are some theoretical reasons for the superiority of topical over systemic administration of antibiotics for CSOM. Due to poor vascularization of the middle ear mucosa, systemically delivered antibiotics do not penetrate well. For example, oral amoxicillin at 90 mg/kg results in a middle ear concentration of only 6 µg/mL to 10 µg/mL compared with 3000 µg/mL of antibiotic following application of a 0.3% antibioti...
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