Browsing by Subject "Morbidity"
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Item A DAT1 gene and APOE ε4 interaction is associated with apathy and structural brain changes in Alzheimer’s Disease(Wiley, 2025-01-09) Malik, Rubina; Beaton, Derek; Saykin, Andrew J.; Nho, Kwangsik; Finger, Elizabeth; Radiology and Imaging Sciences, School of MedicineBackground: Apathy in patients with Alzheimer’s disease (AD) is associated with significant morbidity. We examined whether interactions between genetic variants related to neurotransmitter systems and regional brain atrophy are associated with apathy in patients with mild cognitive impairment (MCI) and AD. Method: For 1162 participants in the Alzheimer’s Disease Neuroimaging Initiative, including those with AD, MCI and cognitively normal individuals, a partial least squares correspondence analysis (PLS‐CA) modeled interactions between single nucleotide polymorphisms (SNPs), structural whole‐brain imaging variables, and apathy. Result: An interaction between apathy, the possession of an APOE (apolipoprotein E) ε4 allele combined with minor homozygosity for the DAT1 (dopamine transporter 1) gene, and brain atrophy. Conclusion: The results point to an association of a dopaminergic genetic marker and apathy in AD and may inform future design of clinical trials of apathy, as well as new treatment targets.Item Associations of opioid prescription dose and discontinuation with risk of substance-related morbidity in long-term opioid therapy(Wolters Kluwer, 2022) Quinn, Patrick D.; Chang, Zheng; Bair, Matthew J.; Rickert, Martin E.; Gibbons, Robert D.; Kroenke, Kurt; D’Onofrio, Brian M.; Medicine, School of MedicineEfforts to reduce opioid-related harms have decreased opioid prescription but have provoked concerns about unintended consequences, particularly for long-term opioid therapy (LtOT) recipients. Research is needed to address the knowledge gap regarding how risk of substance-related morbidity changes across LtOT and its discontinuation. This study used nationwide commercial insurance claims data and a within-individual design to examine associations of LtOT dose and discontinuation with substance-related morbidity. We identified 194,839 adolescents and adults who initiated opioid prescription in 2010 to 2018 and subsequently received LtOT. The cohort was followed for a median of 965 days (interquartile range, 525-1550), of which a median of 176 days (119-332) were covered by opioid prescription. During follow-up, there were 17,582 acute substance-related morbidity events, defined as claims for emergency visits, inpatient hospitalizations, and ambulance transportation with substance use disorder or overdose diagnoses. Relative to initial treatment, risk was greater within individual during subsequent periods of >60 to 120 (adjusted odds ratio [OR], 1.29; 95% CI, 1.12 to 1.49) and >120 (OR, 1.48; 95% CI, 1.24-1.76) daily morphine milligram equivalents. Risk was also greater during days 1 to 30 after discontinuations than during initial treatment (OR, 1.19; 95% CI, 1.05-1.35). However, it was no greater than during the 30 days before discontinuations, indicating that the risk may not be wholly attributable to discontinuation itself. Results were supported by a negative control pharmacotherapy analysis and additional sensitivity analyses. They suggest that LtOT recipients may experience increased substance-related morbidity risk during treatment subsequent to initial opioid prescription, particularly in periods involving higher doses.Item Characterization of Hepatic Dysfunction in subjects diagnosed with Chronic GVHD by NIH Consensus Criteria(Elsevier, 2022) Yang, Alexander H.; Han, Ma Ai Thanda; Samala, Niharika; Rizvi, Bisharah S.; Marchalik, Rachel; Etzion, Ohad; Wright, Elizabeth C.; Cao, Liang; Hakim, Frances T.; Jones, Elizabeth; Kapuria, Devika; Hickstein, Dennis D.; Fowler, Daniel; Kanakry, Jennifer A.; Kanakry, Christopher G.; Kleiner, David E.; Koh, Christopher; Pavletic, Steven Z.; Heller, Theo; Medicine, School of MedicineHepatic chronic graft-versus-host disease (cGVHD) causes morbidity and current diagnostic criteria are nonspecific. An accurate diagnosis is imperative because overdiagnosis can lead to unnecessary treatment with immunosuppressive agents and raising the risk of opportunistic infections. We aim to characterize different patterns of liver injury and cytokine profiles associated with hepatic dysfunction in cGVHD, to evaluate the accuracy of the NIH Consensus Criteria (NCC) for hepatic cGVHD and to explore predictors for hepatic cGHVD. Patients were evaluated in this prospective cross-sectional study of patients with cGVHD recruited under a natural history protocol. Laboratory tests and cytokines were measured. The cGVHD were diagnosed and scored based on NCC. Clinically indicated liver biopsy specimens or autopsies were reviewed by an expert hepatopathologist (D.E.K.). Comparisons were made between groups, and univariable and multivariable logistic regression were calculated. Of the 302 patients enrolled, 151 fulfilled hepatic cGVHD based on NCC; however, 69% had at least 1 abnormal liver test result. Abnormal alanine aminotransferase (ALT) and aspartate aminotransferase were associated with lower platelets, higher total bilirubin (TB), total cholesterol, serum amyloid A, and IL 15. Abnormal ALP and gamma-glutamyl transpeptidase were associated with higher cholesterol, and IL7. Lower platelet count was associated with higher ALT, TB, and triglycerides and lower albumin. Of the 27 with liver tissue, 16 had histologic features of GVHD, only eight met clinical criteria for hepatic GVHD. Sensitivity and specificity of NCC in identifying hepatic GVHD were 50% and 27% (Kappa = -0.23). Only 6 had only hepatic GVHD, whereas 10 had hepatic GVHD with either iron overload, nodular regenerative hyperplasia, or steatosis. Multivariable logistic regression showed that ALP and total cholesterol were associated with hepatic GVHD and total cholesterol >220 mg/dL increased the sensitivity for histologic hepatic GVHD. In conclusion, abnormal liver enzymes in cGVHD are nonspecific and have poor correlation with histologic evidence for hepatic GVHD, highlighting the importance of histology. Cytokines provide insight into the pathogenesis of hepatic cGVHD. Decreased platelet count was associated with factors associated with liver disease including portal vein diameter, which may suggest progression of liver disease. This highlights the need of incorporating these factors in natural history study and using liver biopsy to understand the development of liver dysfunction in hematopoietic stem cell transplantation and to develop better instruments to decreased hepatic cGVHD related morbidity and mortality.Item Comorbid Depression and Psychosis in Parkinson's Disease: A Report of 62,783 Hospitalizations in the United States(Cureus, 2019-07-24) Imran, Sundus; Patel, Rikinkumar S.; Onyeaka, Henry K.; Tahir, Muhammad; Madireddy, Sowmya; Mainali, Pranita; Hossain, Sadaf; Rashid, Wahida; Queeneth, Uwandu; Ahmad, Naveed; Neurology, School of MedicineBackground Depression and psychosis are common comorbidities that significantly affects the quality of life and disease outcomes in Parkinson's disease (PD) patients. Objective The aim of this study was to analyze and discern the differences in the hospitalization outcomes, comorbidities, and utilization of deep brain stimulation (DBS) in PD patients with comorbid depression and comorbid psychosis. Methods We used the Nationwide Inpatient Sample (2010-2014) and identified PD as a primary diagnosis (N = 62,783), and depression (N = 11,358) and psychosis (N = 2,475) as co-diagnosis using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Pearson's chi-square test and independent-sample t-test were used for categorical data and continuous data, respectively. Results White male, older age, and comorbid psychosis were significantly associated with higher odds of having major severity of illness in PD inpatients. The mean length of stay (LOS) was higher in PD patients with psychosis compared to PD with depression (7.32 days vs. 4.23 days; P < 0.001), though the mean total charges of hospitalization were lower in psychosis ($31,240 vs. $38,581; P < 0.001). Utilization of DBS was lower in PD patients with psychosis versus with depression (3.9% vs. 24.3%; P < 0.001). Conclusion Psychiatric comorbidities are prevalent in PD patients and are associated with more disease severity, impaired quality of life, and increased use of healthcare resources (higher LOS and cost). They should be considered an integral part of the disease, and a multidisciplinary approach to managing this disease is crucial to improve the health-related quality of life of PD patients.Item Correction to: Antibiotics in the pipeline: a literature review (2017-2020)(Springer, 2022) Al‑Tawfiq, Jaffar A.; Momattin, Hisham; Al‑Ali, Anfal Y.; Eljaaly, Khalid; Tirupathi, Raghavendra; Haradwala, Mohamed Bilal; Areti, Swetha; Alhumaid, Saad; Rabaan, Ali A.; Al Mutair, Abbas; Schlagenhauf, Patricia; Medicine, School of MedicineCorrection to: Infection 10.1007/s15010-021-01709-3Item Critical Illness Cholangiopathy in COVID-19 Long-haulers(Elsevier, 2022) Saleem, Nasir; Li, Betty H.; Vuppalanchi, Raj; Gawrieh, Samer; Gromski, Mark A.; Medicine, School of MedicineItem In-Hospital Mortality and Morbidity in Cancer Patients with COVID-19: A Nationwide Analysis from the United States(MDPI, 2022-12-30) Abuhelwa, Ziad; Alsughayer, Anas; Abuhelwa, Ahmad Y.; Beran, Azizullah; Sayeh, Wasef; Khokher, Waleed; Sajdeya, Omar; Khuder, Sadik; Assaly, Ragheb; Medicine, School of MedicineBackground: Coronavirus disease 2019 (COVID-19) caused significant mortality and mortality worldwide. There is limited information describing the outcomes of COVID-19 in cancer patients. Methods: We utilized the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) 2020 database to collect information on cancer patients hospitalized for COVID-19 in the United States. Using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system, adult (≥18 years) patients with COVID-19 were identified. Adjusted analyses were performed to assess for mortality, morbidity, and resource utilization among cancer patients. Results: A total of 1,050,045 patients were included. Of them, 27,760 had underlying cancer. Cancer patients were older and had more comorbidities. The all-cause in-hospital mortality rate in cancer patients was 17.58% vs. 11% in non-cancer. After adjusted logistic regression, cancer patients had a 21% increase in the odds of all-cause in-hospital mortality compared with those without cancer (adjusted odds ratio (aOR) 1.21, 95%CI 1.12−1.31, p-value < 0.001). Additionally, an increased odds in acute respiratory failure rate was found (aOR 1.14, 95%CI 1.06−1.22, p-value < 0.001). However, no significant differences were found in the odds of septic shock, acute respiratory distress syndrome, and mechanical ventilation between the two groups. Additionally, no significant differences in the mean length of hospital stay and the total hospitalization charges between cancer and non-cancer patients. Conclusion: Cancer patients hospitalized for COVID-19 had increased odds of all-cause in hospital mortality and acute respiratory failure compared with non-cancer patients.Item Moving Away from Segregated Lung Function Equations: Effects of Transitioning to Race-Neutral References in Children(American Thoracic Society, 2025) Krupp, Nadia L.; Forno, Erick; Pediatrics, School of MedicineItem Nipple–Areolar Complex Neurotization Following Nipple-sparing Mastectomy and Breast Reconstruction for Solitary Breast Neurofibroma(Wolters Kluwer, 2025-05-22) Ahmed, Shahnur; Fernandez Olivera, Maria; Hulsman, Luci; Danforth, Rachel M.; Fisher, Carla S.; Hassanein, Aladdin H.; Surgery, School of MedicineNeurofibromatosis type 1 (NF1) is a rare clinical entity when associated with breast tumors. Women diagnosed with NF1 are 5 times more likely to develop breast cancer from a preexisting neurofibroma lesion. Previous studies have recommended earlier breast cancer screening starting at age 30 for NF1 patients. Morbidity associated with NF1 lesions include pain, paresthesia, and motor deficits, which contribute to a decreased quality of life. Although breast involvement is rare, the most common location of neurofibromas involving the breast is the nipple-areolar complex (NAC). Mastectomy incision type and management of the NAC have not been well studied in NF1 patients with NAC-sparing breast neurofibromas. The purpose of this case report is to describe a 23-year-old woman with a severe breast deformity diagnosed with NF1 who underwent nipple-sparing mastectomy with immediate latissimus flap reconstruction and nipple neurotization. Neurotization of the nipple may restore sensation in NF1 patients who undergo nipple-sparing mastectomy and immediate breast reconstruction for an NAC-sparing solitary breast neurofibroma. Collaboration between surgical oncology and plastic surgery should guide surgical decision-making to optimize patient treatment and satisfaction outcomes.Item Non-Transfusion-Dependent Thalassemia: An Update on Complications and Management(MDPI, 2018-01-08) Sleiman, Joseph; Tarhini, Ali; Bou-Fakhredin, Rayan; Saliba, Antoine N.; Cappellini, Maria Domenica; Taher, Ali T.; Medicine, School of MedicinePatients with non-transfusion-dependent thalassemia (NTDT) experience many clinical complications despite their independence from frequent transfusions. Morbidities in NTDT stem from the interaction of multiple pathophysiological factors: ineffective erythropoiesis, iron overload (IOL), and hypercoagulability. Ineffective erythropoiesis and hemolysis are associated with chronic hypoxia and a hypercoagulable state. The latter are linked to a high prevalence of thromboembolic and cerebrovascular events, as well as leg ulcers and pulmonary hypertension. IOL in NTDT patients is a cumulative process that can lead to several iron-related morbidities in the liver (liver fibrosis), kidneys, endocrine glands (endocrinopathies), and vascular system (vascular disease). This review sheds light on the pathophysiology underlying morbidities associated with NTDT and summarizes the mainstays of treatment and some of the possible future therapeutic interventions.