User login
Multidisciplinary care improves surgical outcomes for elderly patients
and were able to leave the hospital after a shorter stay, according to findings from a case-control study of nearly 400 patients.
Data from previous studies suggest that preoperative assessment by geriatric experts can improve outcomes for the elderly, who are more likely than are younger patients to develop preventable postoperative complications, and “this evidence supports the formulation of a different approach to preoperative assessment and postoperative care for this population,” wrote Shelley R. McDonald, DO, of Duke University, Durham, N.C., and colleagues.
The intervention, known as the Perioperative Optimization of Senior Health (POSH), was described as “a quality improvement initiative with prospective data collection.” Patients in a geriatrics clinic within an academic center were selected for the study if they were at high risk for complications linked to elective abdominal surgery. High risk was defined as older than 85 years of age, or older than 65 years of age with conditions including cognitive impairment, recent weight loss, multiple comorbidities, and polypharmacy (JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513).
The POSH intervention patients received preoperative evaluation from a team including a geriatrician, geriatric resource nurse, social worker, program administrator, and nurse practitioner from the preoperative anesthesia testing clinic. Patients and families were advised on risk management and care optimization involving cognition, comorbidities, medications, mobility, functional status, nutrition, hydration, pain, and advanced care planning.
Patients in the POSH group were on average older, had more comorbidities, and were more likely to be smokers. But despite these disadvantaging characteristics, they still had better outcomes in several important variables than did those in the control group.
The POSH group had significantly shorter hospital stays, compared with controls (4 days vs. 6 days), and significantly lower all-cause readmission rates at both 7 days (2.8% vs. 9.9%) and 30 days (7.8% vs. 18.3%). The significance persisted whether the surgeries were laparoscopic or open.
The overall complication rate was lower in the POSH group, compared with the controls, but fell short of statistical significance (44.8% vs. 58.7%, P = .01). However, rates of specific complications were significantly lower in the POSH group, compared with controls, including postoperative cardiogenic or hypovolemic shock (2.2% vs. 8.4%), bleeding, either during or after surgery (6.1% vs. 15.4%), and postoperative ileus (4.9% vs. 20.3%).
“Delirium was identified in POSH patients at higher rates than in the control group, which is not unexpected because higher postoperative delirium rates are known to be identified with increased screening,” the researchers noted. “Collaborative care allows for increasing the recognition of geriatric syndromes like delirium, more focus on symptom management, and proactively anticipating complications,” they said.
The study results were limited by several factors including a long enrollment period for the POSH patients, and potential changes in surgical protocols, the researchers said. However, the findings support the need for further research and more refined analysis to identify the most beneficial aspects of care, and to support better clinical decision making about the timing of interventions and the type of patient who could benefit, they noted.
The researchers had no financial conflicts to disclose. The John A. Hartford Foundation Center of Excellence National Program Award provided salary and database support.
SOURCE: McDonald S et al. JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513.
and were able to leave the hospital after a shorter stay, according to findings from a case-control study of nearly 400 patients.
Data from previous studies suggest that preoperative assessment by geriatric experts can improve outcomes for the elderly, who are more likely than are younger patients to develop preventable postoperative complications, and “this evidence supports the formulation of a different approach to preoperative assessment and postoperative care for this population,” wrote Shelley R. McDonald, DO, of Duke University, Durham, N.C., and colleagues.
The intervention, known as the Perioperative Optimization of Senior Health (POSH), was described as “a quality improvement initiative with prospective data collection.” Patients in a geriatrics clinic within an academic center were selected for the study if they were at high risk for complications linked to elective abdominal surgery. High risk was defined as older than 85 years of age, or older than 65 years of age with conditions including cognitive impairment, recent weight loss, multiple comorbidities, and polypharmacy (JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513).
The POSH intervention patients received preoperative evaluation from a team including a geriatrician, geriatric resource nurse, social worker, program administrator, and nurse practitioner from the preoperative anesthesia testing clinic. Patients and families were advised on risk management and care optimization involving cognition, comorbidities, medications, mobility, functional status, nutrition, hydration, pain, and advanced care planning.
Patients in the POSH group were on average older, had more comorbidities, and were more likely to be smokers. But despite these disadvantaging characteristics, they still had better outcomes in several important variables than did those in the control group.
The POSH group had significantly shorter hospital stays, compared with controls (4 days vs. 6 days), and significantly lower all-cause readmission rates at both 7 days (2.8% vs. 9.9%) and 30 days (7.8% vs. 18.3%). The significance persisted whether the surgeries were laparoscopic or open.
The overall complication rate was lower in the POSH group, compared with the controls, but fell short of statistical significance (44.8% vs. 58.7%, P = .01). However, rates of specific complications were significantly lower in the POSH group, compared with controls, including postoperative cardiogenic or hypovolemic shock (2.2% vs. 8.4%), bleeding, either during or after surgery (6.1% vs. 15.4%), and postoperative ileus (4.9% vs. 20.3%).
“Delirium was identified in POSH patients at higher rates than in the control group, which is not unexpected because higher postoperative delirium rates are known to be identified with increased screening,” the researchers noted. “Collaborative care allows for increasing the recognition of geriatric syndromes like delirium, more focus on symptom management, and proactively anticipating complications,” they said.
The study results were limited by several factors including a long enrollment period for the POSH patients, and potential changes in surgical protocols, the researchers said. However, the findings support the need for further research and more refined analysis to identify the most beneficial aspects of care, and to support better clinical decision making about the timing of interventions and the type of patient who could benefit, they noted.
The researchers had no financial conflicts to disclose. The John A. Hartford Foundation Center of Excellence National Program Award provided salary and database support.
SOURCE: McDonald S et al. JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513.
and were able to leave the hospital after a shorter stay, according to findings from a case-control study of nearly 400 patients.
Data from previous studies suggest that preoperative assessment by geriatric experts can improve outcomes for the elderly, who are more likely than are younger patients to develop preventable postoperative complications, and “this evidence supports the formulation of a different approach to preoperative assessment and postoperative care for this population,” wrote Shelley R. McDonald, DO, of Duke University, Durham, N.C., and colleagues.
The intervention, known as the Perioperative Optimization of Senior Health (POSH), was described as “a quality improvement initiative with prospective data collection.” Patients in a geriatrics clinic within an academic center were selected for the study if they were at high risk for complications linked to elective abdominal surgery. High risk was defined as older than 85 years of age, or older than 65 years of age with conditions including cognitive impairment, recent weight loss, multiple comorbidities, and polypharmacy (JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513).
The POSH intervention patients received preoperative evaluation from a team including a geriatrician, geriatric resource nurse, social worker, program administrator, and nurse practitioner from the preoperative anesthesia testing clinic. Patients and families were advised on risk management and care optimization involving cognition, comorbidities, medications, mobility, functional status, nutrition, hydration, pain, and advanced care planning.
Patients in the POSH group were on average older, had more comorbidities, and were more likely to be smokers. But despite these disadvantaging characteristics, they still had better outcomes in several important variables than did those in the control group.
The POSH group had significantly shorter hospital stays, compared with controls (4 days vs. 6 days), and significantly lower all-cause readmission rates at both 7 days (2.8% vs. 9.9%) and 30 days (7.8% vs. 18.3%). The significance persisted whether the surgeries were laparoscopic or open.
The overall complication rate was lower in the POSH group, compared with the controls, but fell short of statistical significance (44.8% vs. 58.7%, P = .01). However, rates of specific complications were significantly lower in the POSH group, compared with controls, including postoperative cardiogenic or hypovolemic shock (2.2% vs. 8.4%), bleeding, either during or after surgery (6.1% vs. 15.4%), and postoperative ileus (4.9% vs. 20.3%).
“Delirium was identified in POSH patients at higher rates than in the control group, which is not unexpected because higher postoperative delirium rates are known to be identified with increased screening,” the researchers noted. “Collaborative care allows for increasing the recognition of geriatric syndromes like delirium, more focus on symptom management, and proactively anticipating complications,” they said.
The study results were limited by several factors including a long enrollment period for the POSH patients, and potential changes in surgical protocols, the researchers said. However, the findings support the need for further research and more refined analysis to identify the most beneficial aspects of care, and to support better clinical decision making about the timing of interventions and the type of patient who could benefit, they noted.
The researchers had no financial conflicts to disclose. The John A. Hartford Foundation Center of Excellence National Program Award provided salary and database support.
SOURCE: McDonald S et al. JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513.
FROM JAMA SURGERY
Key clinical point: A preoperative surgical intervention improved outcomes and shortened hospital stays for seniors.
Major finding: The POSH group had significantly shorter hospital stays compared with controls (4 days vs. 6 days).
Study details: The data come from a study of 183 surgery patients and 143 controls.
Disclosures: The researchers had no financial conflicts to disclose.
Source: McDonald S JAMA Surg. 2018 Jan 3. doi: 10.1001/jamasurg.2017.5513
Comparing arterial ratios may aid risk assessment in IPF
An arterial ratio can help identify idiopathic pulmonary fibrosis (IPF) patients with a poor prognosis, suggests the findings of registry data from 50 adults.
The ratio of the main pulmonary artery diameter (PA) to the ascending aorta diameter (A) as seen on a chest CT correlates with pulmonary artery pressure, M. Faisal Siddiqui, MD, a pulmonologist in New York, and his colleagues wrote in an abstract from the agenda of the CHEST annual meeting. To determine whether higher PA:A ratios were associated with more biomarker abnormalities, the researchers reviewed 122 CT scans from 50 adults with IPF.
Overall, 48% of the patients had a PA:A ratio of at least 1, according to Dr. Siddiqui and his coauthors. These patients had significantly higher fibrosis scores (P = .0006), GAP index scores (P = .0144), brain natriuretic peptide scores (P = .0046), and pulmonary arterial systolic pressure (P = .0063) compared with patients who had PA:A ratios of less than 1, according to the Kruskal-Wallis test. This test also showed no significant differences on measures of coronary artery calcium, aortic value calcifications, mitral valve calcifications, bronchial wall thickening, emphysema, and spirometry data between the two patient groups, based on PA:A ratios.
Use of the Pearson correlation revealed a positive relationship between PA:A ratios greater than 1 and coronary artery calcium scores, fibrosis scores, and pulmonary arterial systolic pressure, but a negative relationship between a high PA:A ratio and both diffusing capacity and forced vital capacity.
Although the findings were limited by a small study population, the results suggest that clinicians can use the finding of an increased PA:A ratio to help identify IPF patients at greater risk for poor outcomes. Such patients might benefit from pharmacotherapy or transplants, the researchers noted.
Dr. Siddiqui and his coauthors had no financial conflicts to disclose.
An arterial ratio can help identify idiopathic pulmonary fibrosis (IPF) patients with a poor prognosis, suggests the findings of registry data from 50 adults.
The ratio of the main pulmonary artery diameter (PA) to the ascending aorta diameter (A) as seen on a chest CT correlates with pulmonary artery pressure, M. Faisal Siddiqui, MD, a pulmonologist in New York, and his colleagues wrote in an abstract from the agenda of the CHEST annual meeting. To determine whether higher PA:A ratios were associated with more biomarker abnormalities, the researchers reviewed 122 CT scans from 50 adults with IPF.
Overall, 48% of the patients had a PA:A ratio of at least 1, according to Dr. Siddiqui and his coauthors. These patients had significantly higher fibrosis scores (P = .0006), GAP index scores (P = .0144), brain natriuretic peptide scores (P = .0046), and pulmonary arterial systolic pressure (P = .0063) compared with patients who had PA:A ratios of less than 1, according to the Kruskal-Wallis test. This test also showed no significant differences on measures of coronary artery calcium, aortic value calcifications, mitral valve calcifications, bronchial wall thickening, emphysema, and spirometry data between the two patient groups, based on PA:A ratios.
Use of the Pearson correlation revealed a positive relationship between PA:A ratios greater than 1 and coronary artery calcium scores, fibrosis scores, and pulmonary arterial systolic pressure, but a negative relationship between a high PA:A ratio and both diffusing capacity and forced vital capacity.
Although the findings were limited by a small study population, the results suggest that clinicians can use the finding of an increased PA:A ratio to help identify IPF patients at greater risk for poor outcomes. Such patients might benefit from pharmacotherapy or transplants, the researchers noted.
Dr. Siddiqui and his coauthors had no financial conflicts to disclose.
An arterial ratio can help identify idiopathic pulmonary fibrosis (IPF) patients with a poor prognosis, suggests the findings of registry data from 50 adults.
The ratio of the main pulmonary artery diameter (PA) to the ascending aorta diameter (A) as seen on a chest CT correlates with pulmonary artery pressure, M. Faisal Siddiqui, MD, a pulmonologist in New York, and his colleagues wrote in an abstract from the agenda of the CHEST annual meeting. To determine whether higher PA:A ratios were associated with more biomarker abnormalities, the researchers reviewed 122 CT scans from 50 adults with IPF.
Overall, 48% of the patients had a PA:A ratio of at least 1, according to Dr. Siddiqui and his coauthors. These patients had significantly higher fibrosis scores (P = .0006), GAP index scores (P = .0144), brain natriuretic peptide scores (P = .0046), and pulmonary arterial systolic pressure (P = .0063) compared with patients who had PA:A ratios of less than 1, according to the Kruskal-Wallis test. This test also showed no significant differences on measures of coronary artery calcium, aortic value calcifications, mitral valve calcifications, bronchial wall thickening, emphysema, and spirometry data between the two patient groups, based on PA:A ratios.
Use of the Pearson correlation revealed a positive relationship between PA:A ratios greater than 1 and coronary artery calcium scores, fibrosis scores, and pulmonary arterial systolic pressure, but a negative relationship between a high PA:A ratio and both diffusing capacity and forced vital capacity.
Although the findings were limited by a small study population, the results suggest that clinicians can use the finding of an increased PA:A ratio to help identify IPF patients at greater risk for poor outcomes. Such patients might benefit from pharmacotherapy or transplants, the researchers noted.
Dr. Siddiqui and his coauthors had no financial conflicts to disclose.
FROM CHEST 2017
Shorter walk test predicts IPF outcomes
, based on data from 179 adults. The findings were presented at the CHEST annual meeting.
The 6-minute test is often used to evaluate functional capacity in IPF patients, but is not always practical in a busy clinic setting, according to Flavia S. Nunes, MD, of Inova Fairfax Hospital in Falls Church, VA, and colleagues.
“Among the clinical and physiologic predictors associated with survival in IPF, the 6MWT has been increasingly used over the past 5 years as a secondary endpoint in the efficacy analyses of potential therapies for IPF. Validation of shorter time of walking might make the test more feasible to be applied in routine clinical care,” she said.
To determine the predictive value of the first minute of the 6-minute test, the researchers reviewed data from 142 men and 37 women at a tertiary referral center between May 2010 and February 2017. The average age of the patients was 68 years, the average body mass index was 28.3 kg/m2, and 27% used oxygen supplementation during the walk test.
Overall, the mean distance for the 6-minute test was 372 m, and the average distance for the 1-minute test was 65 m. Study participants who achieved a 6-minute walk distance greater than 372 m were defined as high walkers, and those with a 6-minute walk distance less than 372 m were defined as low walkers. A strong correlation appeared between the 6-minute distance and 1-minute distance in terms of predicting survival, and 1-year transplant-free survival was significantly better in high walkers than in low walkers (27 months vs. 22 months; P = .015).
Dr. Nunes said she was not surprised by the results, in part because previous research has shown a strong correlation among 2-minute, 6-minute, and 12-minute walking tests.
Although more research is needed to validate the findings, the results suggest that the 1-minute test might be a practical substitute for the 6-minute test by providing similar prognostic information more quickly and easily than the 6-minute test, the researchers said.
“It is important for clinicians to know that the time chosen to assess exercise tolerance by walking tests might not be critical,” said Dr. Nunes. “Shorter walks are not only less time consuming, and easier for both patients and clinicians, but are also reproducible and discriminatory of survival.
“We need to validate the test performance characteristics and prognostic value of distance walked in a 1MWT compared to the standard 6MWT in an independent cohort of patients with IPF,” Dr. Nunes noted. “Additionally, the evaluation of alternate instruction, for example changing the wording from ‘walk as far’ to ‘walk as fast’ might facilitate a better effort, and a greater distance with improved reproducibility. Other novel parameters and modifications to the 6MWT or 1MWT might further improve the utility of these tests in the management of IPF and other patients,” she added.
The researchers had no financial conflicts to disclose.
, based on data from 179 adults. The findings were presented at the CHEST annual meeting.
The 6-minute test is often used to evaluate functional capacity in IPF patients, but is not always practical in a busy clinic setting, according to Flavia S. Nunes, MD, of Inova Fairfax Hospital in Falls Church, VA, and colleagues.
“Among the clinical and physiologic predictors associated with survival in IPF, the 6MWT has been increasingly used over the past 5 years as a secondary endpoint in the efficacy analyses of potential therapies for IPF. Validation of shorter time of walking might make the test more feasible to be applied in routine clinical care,” she said.
To determine the predictive value of the first minute of the 6-minute test, the researchers reviewed data from 142 men and 37 women at a tertiary referral center between May 2010 and February 2017. The average age of the patients was 68 years, the average body mass index was 28.3 kg/m2, and 27% used oxygen supplementation during the walk test.
Overall, the mean distance for the 6-minute test was 372 m, and the average distance for the 1-minute test was 65 m. Study participants who achieved a 6-minute walk distance greater than 372 m were defined as high walkers, and those with a 6-minute walk distance less than 372 m were defined as low walkers. A strong correlation appeared between the 6-minute distance and 1-minute distance in terms of predicting survival, and 1-year transplant-free survival was significantly better in high walkers than in low walkers (27 months vs. 22 months; P = .015).
Dr. Nunes said she was not surprised by the results, in part because previous research has shown a strong correlation among 2-minute, 6-minute, and 12-minute walking tests.
Although more research is needed to validate the findings, the results suggest that the 1-minute test might be a practical substitute for the 6-minute test by providing similar prognostic information more quickly and easily than the 6-minute test, the researchers said.
“It is important for clinicians to know that the time chosen to assess exercise tolerance by walking tests might not be critical,” said Dr. Nunes. “Shorter walks are not only less time consuming, and easier for both patients and clinicians, but are also reproducible and discriminatory of survival.
“We need to validate the test performance characteristics and prognostic value of distance walked in a 1MWT compared to the standard 6MWT in an independent cohort of patients with IPF,” Dr. Nunes noted. “Additionally, the evaluation of alternate instruction, for example changing the wording from ‘walk as far’ to ‘walk as fast’ might facilitate a better effort, and a greater distance with improved reproducibility. Other novel parameters and modifications to the 6MWT or 1MWT might further improve the utility of these tests in the management of IPF and other patients,” she added.
The researchers had no financial conflicts to disclose.
, based on data from 179 adults. The findings were presented at the CHEST annual meeting.
The 6-minute test is often used to evaluate functional capacity in IPF patients, but is not always practical in a busy clinic setting, according to Flavia S. Nunes, MD, of Inova Fairfax Hospital in Falls Church, VA, and colleagues.
“Among the clinical and physiologic predictors associated with survival in IPF, the 6MWT has been increasingly used over the past 5 years as a secondary endpoint in the efficacy analyses of potential therapies for IPF. Validation of shorter time of walking might make the test more feasible to be applied in routine clinical care,” she said.
To determine the predictive value of the first minute of the 6-minute test, the researchers reviewed data from 142 men and 37 women at a tertiary referral center between May 2010 and February 2017. The average age of the patients was 68 years, the average body mass index was 28.3 kg/m2, and 27% used oxygen supplementation during the walk test.
Overall, the mean distance for the 6-minute test was 372 m, and the average distance for the 1-minute test was 65 m. Study participants who achieved a 6-minute walk distance greater than 372 m were defined as high walkers, and those with a 6-minute walk distance less than 372 m were defined as low walkers. A strong correlation appeared between the 6-minute distance and 1-minute distance in terms of predicting survival, and 1-year transplant-free survival was significantly better in high walkers than in low walkers (27 months vs. 22 months; P = .015).
Dr. Nunes said she was not surprised by the results, in part because previous research has shown a strong correlation among 2-minute, 6-minute, and 12-minute walking tests.
Although more research is needed to validate the findings, the results suggest that the 1-minute test might be a practical substitute for the 6-minute test by providing similar prognostic information more quickly and easily than the 6-minute test, the researchers said.
“It is important for clinicians to know that the time chosen to assess exercise tolerance by walking tests might not be critical,” said Dr. Nunes. “Shorter walks are not only less time consuming, and easier for both patients and clinicians, but are also reproducible and discriminatory of survival.
“We need to validate the test performance characteristics and prognostic value of distance walked in a 1MWT compared to the standard 6MWT in an independent cohort of patients with IPF,” Dr. Nunes noted. “Additionally, the evaluation of alternate instruction, for example changing the wording from ‘walk as far’ to ‘walk as fast’ might facilitate a better effort, and a greater distance with improved reproducibility. Other novel parameters and modifications to the 6MWT or 1MWT might further improve the utility of these tests in the management of IPF and other patients,” she added.
The researchers had no financial conflicts to disclose.
FROM CHEST 2017
Cesarean delivery reduces some risks, raises others
Cesarean deliveries may reduce a woman’s risk for urinary incontinence and pelvic organ prolapse but may raise her risk of complications with future pregnancies, based on data from a literature review including nearly 30,000,000 women.
Rates of cesarean delivery in 2016, often without medical indication, were approximately 25%, 32%, and 41% in Western Europe, North America, and South America, respectively, wrote Oonagh E. Keag, MD, of the Royal Infirmary of Edinburgh and colleagues in a study published in PLOS Medicine.
The researchers reviewed data from 79 observational studies and 1 randomized, controlled trial for a study population of 29,928,274 individuals.
Overall, women who had cesarean deliveries had a significantly lower risk of urinary incontinence (odds ratio, 0.56) and pelvic organ prolapse (OR, 0.29), compared with women who had vaginal deliveries.
No significant association appeared between type of delivery and risk of perinatal death, but women with a history of cesarean delivery were significantly more likely to experience miscarriage or stillbirth on a subsequent pregnancy, as well as placenta previa, placenta accreta, and placental abruption.
In addition, children born via cesarean delivery were significantly more likely than those born via vaginal delivery to have asthma at age 12 years (OR, 1.21) and to be obese up to age 5 years (OR, 1.59).
The findings were limited by the observational nature of most of the data, which does not imply causation, the researchers said. In addition, the study was not designed for subanalysis of elective vs. emergency cesarean delivery.
Although women will attach varying degrees of significance to the risks and benefits associated with cesarean delivery, “it is imperative that clinicians take care to ensure that women are made aware of any risk that they are likely to attach significance to,” the researchers said. “Women and clinicians thus should be aware of both the short- and long-term risks and benefits of cesarean delivery and discuss these when deciding on mode of delivery,” they noted.
The researchers had no financial conflicts to disclose.
SOURCE: Keag OE et al. PLoS Med. 2018 Jan 23. 15(1):e1002494.
As health care practitioners, ob.gyns. must continually evaluate potential consequences of a management strategy to our patients’ health and well-being. This is especially true when determining the best method of delivery – vaginal or cesarean section – because our approach can affect not only the mother but also the baby.
It is well known that vaginal deliveries can be associated with long-term complications for women, including pelvic floor disorders (that is, prolapse), pelvic injury, and incontinence. For women who have undergone a cesarean section, the uterine scars caused by the surgery can lead to increased risk for placenta previa or, more seriously, placenta accreta, as well as possible miscarriage or stillbirth.
Because the best possible care must also be informed care, every ob.gyn. should conduct periodic reviews of the scientific literature. Research continually advances our knowledge and our practice. For example, the recent work on the use of statins to prevent preeclampsia is an area of intense interest. Although we’ve known about hypertensive disorders of pregnancy for many years, management and prevention strategies are adequate at best. This new and exciting line of research has the potential to solve a conundrum we’ve grappled with for centuries.
The study by Keag et al. analyzes the findings from observational studies on the risks and benefits of cesarean versus vaginal delivery, within certain limitations. The study authors found that cesarean deliveries are associated with lower risk of urinary incontinence and pelvic prolapse, but higher risk of placenta previa, miscarriage, and stillbirth. Additionally, the authors reported that babies delivered by cesarean section had a higher risk of developing asthma and obesity.
Although the results of the study are not surprising, the findings reinforce the idea that ob.gyns must make decisions on a case-by-case basis and on obstetrical indications. We cannot use a set of possible complications as a reason to choose one delivery route over another. Every patient is unique. Every circumstance is unique. Every delivery requires us to make an informed decision to achieve the best possible outcome. Otherwise, we run the great risk of doing a disservice to our patients and their families.
E. Albert Reece, MD , PhD, MBA, specializes in maternal-fetal medicine and is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He has no relevant financial disclosures.
As health care practitioners, ob.gyns. must continually evaluate potential consequences of a management strategy to our patients’ health and well-being. This is especially true when determining the best method of delivery – vaginal or cesarean section – because our approach can affect not only the mother but also the baby.
It is well known that vaginal deliveries can be associated with long-term complications for women, including pelvic floor disorders (that is, prolapse), pelvic injury, and incontinence. For women who have undergone a cesarean section, the uterine scars caused by the surgery can lead to increased risk for placenta previa or, more seriously, placenta accreta, as well as possible miscarriage or stillbirth.
Because the best possible care must also be informed care, every ob.gyn. should conduct periodic reviews of the scientific literature. Research continually advances our knowledge and our practice. For example, the recent work on the use of statins to prevent preeclampsia is an area of intense interest. Although we’ve known about hypertensive disorders of pregnancy for many years, management and prevention strategies are adequate at best. This new and exciting line of research has the potential to solve a conundrum we’ve grappled with for centuries.
The study by Keag et al. analyzes the findings from observational studies on the risks and benefits of cesarean versus vaginal delivery, within certain limitations. The study authors found that cesarean deliveries are associated with lower risk of urinary incontinence and pelvic prolapse, but higher risk of placenta previa, miscarriage, and stillbirth. Additionally, the authors reported that babies delivered by cesarean section had a higher risk of developing asthma and obesity.
Although the results of the study are not surprising, the findings reinforce the idea that ob.gyns must make decisions on a case-by-case basis and on obstetrical indications. We cannot use a set of possible complications as a reason to choose one delivery route over another. Every patient is unique. Every circumstance is unique. Every delivery requires us to make an informed decision to achieve the best possible outcome. Otherwise, we run the great risk of doing a disservice to our patients and their families.
E. Albert Reece, MD , PhD, MBA, specializes in maternal-fetal medicine and is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He has no relevant financial disclosures.
As health care practitioners, ob.gyns. must continually evaluate potential consequences of a management strategy to our patients’ health and well-being. This is especially true when determining the best method of delivery – vaginal or cesarean section – because our approach can affect not only the mother but also the baby.
It is well known that vaginal deliveries can be associated with long-term complications for women, including pelvic floor disorders (that is, prolapse), pelvic injury, and incontinence. For women who have undergone a cesarean section, the uterine scars caused by the surgery can lead to increased risk for placenta previa or, more seriously, placenta accreta, as well as possible miscarriage or stillbirth.
Because the best possible care must also be informed care, every ob.gyn. should conduct periodic reviews of the scientific literature. Research continually advances our knowledge and our practice. For example, the recent work on the use of statins to prevent preeclampsia is an area of intense interest. Although we’ve known about hypertensive disorders of pregnancy for many years, management and prevention strategies are adequate at best. This new and exciting line of research has the potential to solve a conundrum we’ve grappled with for centuries.
The study by Keag et al. analyzes the findings from observational studies on the risks and benefits of cesarean versus vaginal delivery, within certain limitations. The study authors found that cesarean deliveries are associated with lower risk of urinary incontinence and pelvic prolapse, but higher risk of placenta previa, miscarriage, and stillbirth. Additionally, the authors reported that babies delivered by cesarean section had a higher risk of developing asthma and obesity.
Although the results of the study are not surprising, the findings reinforce the idea that ob.gyns must make decisions on a case-by-case basis and on obstetrical indications. We cannot use a set of possible complications as a reason to choose one delivery route over another. Every patient is unique. Every circumstance is unique. Every delivery requires us to make an informed decision to achieve the best possible outcome. Otherwise, we run the great risk of doing a disservice to our patients and their families.
E. Albert Reece, MD , PhD, MBA, specializes in maternal-fetal medicine and is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He has no relevant financial disclosures.
Cesarean deliveries may reduce a woman’s risk for urinary incontinence and pelvic organ prolapse but may raise her risk of complications with future pregnancies, based on data from a literature review including nearly 30,000,000 women.
Rates of cesarean delivery in 2016, often without medical indication, were approximately 25%, 32%, and 41% in Western Europe, North America, and South America, respectively, wrote Oonagh E. Keag, MD, of the Royal Infirmary of Edinburgh and colleagues in a study published in PLOS Medicine.
The researchers reviewed data from 79 observational studies and 1 randomized, controlled trial for a study population of 29,928,274 individuals.
Overall, women who had cesarean deliveries had a significantly lower risk of urinary incontinence (odds ratio, 0.56) and pelvic organ prolapse (OR, 0.29), compared with women who had vaginal deliveries.
No significant association appeared between type of delivery and risk of perinatal death, but women with a history of cesarean delivery were significantly more likely to experience miscarriage or stillbirth on a subsequent pregnancy, as well as placenta previa, placenta accreta, and placental abruption.
In addition, children born via cesarean delivery were significantly more likely than those born via vaginal delivery to have asthma at age 12 years (OR, 1.21) and to be obese up to age 5 years (OR, 1.59).
The findings were limited by the observational nature of most of the data, which does not imply causation, the researchers said. In addition, the study was not designed for subanalysis of elective vs. emergency cesarean delivery.
Although women will attach varying degrees of significance to the risks and benefits associated with cesarean delivery, “it is imperative that clinicians take care to ensure that women are made aware of any risk that they are likely to attach significance to,” the researchers said. “Women and clinicians thus should be aware of both the short- and long-term risks and benefits of cesarean delivery and discuss these when deciding on mode of delivery,” they noted.
The researchers had no financial conflicts to disclose.
SOURCE: Keag OE et al. PLoS Med. 2018 Jan 23. 15(1):e1002494.
Cesarean deliveries may reduce a woman’s risk for urinary incontinence and pelvic organ prolapse but may raise her risk of complications with future pregnancies, based on data from a literature review including nearly 30,000,000 women.
Rates of cesarean delivery in 2016, often without medical indication, were approximately 25%, 32%, and 41% in Western Europe, North America, and South America, respectively, wrote Oonagh E. Keag, MD, of the Royal Infirmary of Edinburgh and colleagues in a study published in PLOS Medicine.
The researchers reviewed data from 79 observational studies and 1 randomized, controlled trial for a study population of 29,928,274 individuals.
Overall, women who had cesarean deliveries had a significantly lower risk of urinary incontinence (odds ratio, 0.56) and pelvic organ prolapse (OR, 0.29), compared with women who had vaginal deliveries.
No significant association appeared between type of delivery and risk of perinatal death, but women with a history of cesarean delivery were significantly more likely to experience miscarriage or stillbirth on a subsequent pregnancy, as well as placenta previa, placenta accreta, and placental abruption.
In addition, children born via cesarean delivery were significantly more likely than those born via vaginal delivery to have asthma at age 12 years (OR, 1.21) and to be obese up to age 5 years (OR, 1.59).
The findings were limited by the observational nature of most of the data, which does not imply causation, the researchers said. In addition, the study was not designed for subanalysis of elective vs. emergency cesarean delivery.
Although women will attach varying degrees of significance to the risks and benefits associated with cesarean delivery, “it is imperative that clinicians take care to ensure that women are made aware of any risk that they are likely to attach significance to,” the researchers said. “Women and clinicians thus should be aware of both the short- and long-term risks and benefits of cesarean delivery and discuss these when deciding on mode of delivery,” they noted.
The researchers had no financial conflicts to disclose.
SOURCE: Keag OE et al. PLoS Med. 2018 Jan 23. 15(1):e1002494.
FROM PLOS MEDICINE
Key clinical point: Cesarean delivery was associated with a reduced risk for incontinence and prolapse.
Major finding: Urinary incontinence and pelvic organ prolapse were less likely after cesarean vs. vaginal deliveries (OR, 0.56 and 0.29, respectively).
Study details: The data come from a review of 80 studies.
Disclosures: The researchers had no financial conflicts to disclose.
Source: Keag OE et al. PLoS Med. 2018 Jan 23. 15(1):e1002494.
Low-dose rituximab cuts infection risk
Treating rheumatoid arthritis patients with lower doses of rituximab for long-term maintenance reduced the risk of serious infections and saved money, based on data from approximately 1,200 patients in a French registry.
In a study published in Rheumatology, Julien Henry, MD, of Institut pour la Sante et la Recherche Medicale, Paris, and colleagues reviewed data from 1,278 patients; 1,093 (85.5%) received a standard dose of rituximab, and 185 (14.5%) received a reduced dose for maintenance therapy. A standard dose was 1,000 mg per infusion given in two infusions 2 weeks apart), and a reduced dose was 500 mg per infusion given in two infusions 2 weeks apart.
After 5 years, maintenance was 55.5% in the standard group and 53.8% in the reduced group; with no significant difference (hazard ratio, 1.03). However, the cumulative dose for retreatment was 39% less in the reduced group (1.4 g per year vs. 2.3 g per year), “which is greatly cost effective,” the researchers wrote.
In addition, the rate of serious infections was significantly lower in the reduced-dose group, compared with the standard-dose group (2.2 per 100 patient-years vs. 4.1 per 100 patient-years; adjusted hazard ratio = 0.50).
“Of note, factors associated with risk of serious infection, such as baseline low gamma globulin or IgG levels, chronic lung or cardiac disease, and extra-articular involvement, did not differ between groups,” the researchers said.
The study findings were limited by several factors including the observational design and lack of data on certain RA outcome measures such as radiographic progression and function, the researchers noted. However, the results support data from similar studies and suggest that a lower dose of rituximab for retreatment of RA “did not alter the maintenance of the treatment at 5 years and is associated with a significant lower rate of serious infections,” they said.
Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.
SOURCE: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.
Treating rheumatoid arthritis patients with lower doses of rituximab for long-term maintenance reduced the risk of serious infections and saved money, based on data from approximately 1,200 patients in a French registry.
In a study published in Rheumatology, Julien Henry, MD, of Institut pour la Sante et la Recherche Medicale, Paris, and colleagues reviewed data from 1,278 patients; 1,093 (85.5%) received a standard dose of rituximab, and 185 (14.5%) received a reduced dose for maintenance therapy. A standard dose was 1,000 mg per infusion given in two infusions 2 weeks apart), and a reduced dose was 500 mg per infusion given in two infusions 2 weeks apart.
After 5 years, maintenance was 55.5% in the standard group and 53.8% in the reduced group; with no significant difference (hazard ratio, 1.03). However, the cumulative dose for retreatment was 39% less in the reduced group (1.4 g per year vs. 2.3 g per year), “which is greatly cost effective,” the researchers wrote.
In addition, the rate of serious infections was significantly lower in the reduced-dose group, compared with the standard-dose group (2.2 per 100 patient-years vs. 4.1 per 100 patient-years; adjusted hazard ratio = 0.50).
“Of note, factors associated with risk of serious infection, such as baseline low gamma globulin or IgG levels, chronic lung or cardiac disease, and extra-articular involvement, did not differ between groups,” the researchers said.
The study findings were limited by several factors including the observational design and lack of data on certain RA outcome measures such as radiographic progression and function, the researchers noted. However, the results support data from similar studies and suggest that a lower dose of rituximab for retreatment of RA “did not alter the maintenance of the treatment at 5 years and is associated with a significant lower rate of serious infections,” they said.
Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.
SOURCE: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.
Treating rheumatoid arthritis patients with lower doses of rituximab for long-term maintenance reduced the risk of serious infections and saved money, based on data from approximately 1,200 patients in a French registry.
In a study published in Rheumatology, Julien Henry, MD, of Institut pour la Sante et la Recherche Medicale, Paris, and colleagues reviewed data from 1,278 patients; 1,093 (85.5%) received a standard dose of rituximab, and 185 (14.5%) received a reduced dose for maintenance therapy. A standard dose was 1,000 mg per infusion given in two infusions 2 weeks apart), and a reduced dose was 500 mg per infusion given in two infusions 2 weeks apart.
After 5 years, maintenance was 55.5% in the standard group and 53.8% in the reduced group; with no significant difference (hazard ratio, 1.03). However, the cumulative dose for retreatment was 39% less in the reduced group (1.4 g per year vs. 2.3 g per year), “which is greatly cost effective,” the researchers wrote.
In addition, the rate of serious infections was significantly lower in the reduced-dose group, compared with the standard-dose group (2.2 per 100 patient-years vs. 4.1 per 100 patient-years; adjusted hazard ratio = 0.50).
“Of note, factors associated with risk of serious infection, such as baseline low gamma globulin or IgG levels, chronic lung or cardiac disease, and extra-articular involvement, did not differ between groups,” the researchers said.
The study findings were limited by several factors including the observational design and lack of data on certain RA outcome measures such as radiographic progression and function, the researchers noted. However, the results support data from similar studies and suggest that a lower dose of rituximab for retreatment of RA “did not alter the maintenance of the treatment at 5 years and is associated with a significant lower rate of serious infections,” they said.
Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.
SOURCE: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.
FROM RHEUMATOLOGY
Key clinical point: A reduced dose of rituximab for RA maintenance resulted in fewer infections and lower cost.
Major finding: A long-term low dose of rituximab for RA patients led to a 39% total dose reduction.
Study details: An observational study of data from 1,278 adult patients in the Autoimmunity and Rituximab registry.
Disclosures: Dr. Henry had no financial conflicts to disclose. Several coauthors disclosed relationships with multiple drug companies, but the study received no specific funding from any of these companies.
Source: Henry J et al. Rheumatology. 2017 Dec 15. doi: 10.1093/rheumatology/kex446.
Gonadotropins succeed where clomifene fails
Switching to gonadotropins increased the odds of live births for women with normogonadotropic anovulation with little success for continuing with clomifene citrate, based on data from 666 women.
Women who have not become pregnant after six cycles of clomifene are often defined as having failed the treatment, but the effectiveness of continuing clomifene citrate or switching to gonadotropins had not been addressed in randomized trials, wrote Nienke S. Weiss, MD, of VU University Medical Center, Amsterdam, and her colleagues.
In a study published online in the Lancet, the researchers randomized 166 women to gonadotropins and intrauterine insemination, 165 to gonadotropins and intercourse, 163 to clomifene citrate and intrauterine insemination, and 172 to clomifene citrate and intercourse. The study population included women aged 18 years and older who had not become pregnant after six cycles of clomifene citrate. The clomifene citrate was given as oral doses of 50-150 mg daily, and gonadotropin was given subcutaneously at a starting dose of 50 IU or 75 IU daily.
Overall, live births were significantly more likely for women given gonadotropins, compared with those given clomifene citrate (52% of 327 women vs. 41% of 334 women, respectively; P = .0124). Rates of multiple pregnancies were similar and relatively low among the treatment groups.
Intrauterine insemination had no significant impact on live birth rates, compared with intercourse (49% vs. 43%, respectively; P = .1152).
A total of three adverse events were reported including one stillbirth and one case of congenital abnormality in the clomifene group and one delivery at 20 weeks’ gestational age caused by cervical insufficiency in the gonadotropin group. More miscarriages were reported in the gonadotropin group than in the clomifene group, but the study was not powered to address this difference, which should be addressed in future studies, the researchers said.
The findings were limited by each center’s use of its own ovulation induction protocols, the researchers noted. “Our results can be used by couples treated with first-line ovulatory drugs who weigh the pros and cons of switching to gonadotropins and addition of intrauterine insemination,” they said.
The study was supported by the Netherlands Organization for Health Research and Development.
SOURCE: Weiss N et al. Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736(17)33308-1.
The study findings will be useful to clinicians in practice because infertile couples often balk at the idea of trying another several months of medication rather than trying in vitro fertilization (IVF) after 6 months of failed medical treatment, wrote Cynthia Farquhar, MD, in an accompanying editorial (Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736[17]33310-X).
Data from previous studies have shown that ovarian induction and intrauterine insemination are as successful as IVF treatments, but many couples feel time pressured and want to move to IVF earlier, and data to support the success of medical treatments after 6 months have been lacking, she said.
Although intrauterine insemination had no additional effect on the live birth rates, the study results for both clomifene citrate and gonadotropins suggest that fertility clinics should offer ovulation induction for 12 months using either clomifene citrate or gonadotropins, according to cost and convenience, she said.
“If there is one thing to take away from this study, it is to offer up to 12 cycles of ovulation induction in women with normogonadotropic anovulation before offering assisted reproductive technology,” Dr. Farquhar noted.
Dr. Farquhar is affiliated with the department of obstetrics and gynaecology and the faculty of medical and health sciences at the University of Auckland, New Zealand. She had no financial conflicts to disclose.
The study findings will be useful to clinicians in practice because infertile couples often balk at the idea of trying another several months of medication rather than trying in vitro fertilization (IVF) after 6 months of failed medical treatment, wrote Cynthia Farquhar, MD, in an accompanying editorial (Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736[17]33310-X).
Data from previous studies have shown that ovarian induction and intrauterine insemination are as successful as IVF treatments, but many couples feel time pressured and want to move to IVF earlier, and data to support the success of medical treatments after 6 months have been lacking, she said.
Although intrauterine insemination had no additional effect on the live birth rates, the study results for both clomifene citrate and gonadotropins suggest that fertility clinics should offer ovulation induction for 12 months using either clomifene citrate or gonadotropins, according to cost and convenience, she said.
“If there is one thing to take away from this study, it is to offer up to 12 cycles of ovulation induction in women with normogonadotropic anovulation before offering assisted reproductive technology,” Dr. Farquhar noted.
Dr. Farquhar is affiliated with the department of obstetrics and gynaecology and the faculty of medical and health sciences at the University of Auckland, New Zealand. She had no financial conflicts to disclose.
The study findings will be useful to clinicians in practice because infertile couples often balk at the idea of trying another several months of medication rather than trying in vitro fertilization (IVF) after 6 months of failed medical treatment, wrote Cynthia Farquhar, MD, in an accompanying editorial (Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736[17]33310-X).
Data from previous studies have shown that ovarian induction and intrauterine insemination are as successful as IVF treatments, but many couples feel time pressured and want to move to IVF earlier, and data to support the success of medical treatments after 6 months have been lacking, she said.
Although intrauterine insemination had no additional effect on the live birth rates, the study results for both clomifene citrate and gonadotropins suggest that fertility clinics should offer ovulation induction for 12 months using either clomifene citrate or gonadotropins, according to cost and convenience, she said.
“If there is one thing to take away from this study, it is to offer up to 12 cycles of ovulation induction in women with normogonadotropic anovulation before offering assisted reproductive technology,” Dr. Farquhar noted.
Dr. Farquhar is affiliated with the department of obstetrics and gynaecology and the faculty of medical and health sciences at the University of Auckland, New Zealand. She had no financial conflicts to disclose.
Switching to gonadotropins increased the odds of live births for women with normogonadotropic anovulation with little success for continuing with clomifene citrate, based on data from 666 women.
Women who have not become pregnant after six cycles of clomifene are often defined as having failed the treatment, but the effectiveness of continuing clomifene citrate or switching to gonadotropins had not been addressed in randomized trials, wrote Nienke S. Weiss, MD, of VU University Medical Center, Amsterdam, and her colleagues.
In a study published online in the Lancet, the researchers randomized 166 women to gonadotropins and intrauterine insemination, 165 to gonadotropins and intercourse, 163 to clomifene citrate and intrauterine insemination, and 172 to clomifene citrate and intercourse. The study population included women aged 18 years and older who had not become pregnant after six cycles of clomifene citrate. The clomifene citrate was given as oral doses of 50-150 mg daily, and gonadotropin was given subcutaneously at a starting dose of 50 IU or 75 IU daily.
Overall, live births were significantly more likely for women given gonadotropins, compared with those given clomifene citrate (52% of 327 women vs. 41% of 334 women, respectively; P = .0124). Rates of multiple pregnancies were similar and relatively low among the treatment groups.
Intrauterine insemination had no significant impact on live birth rates, compared with intercourse (49% vs. 43%, respectively; P = .1152).
A total of three adverse events were reported including one stillbirth and one case of congenital abnormality in the clomifene group and one delivery at 20 weeks’ gestational age caused by cervical insufficiency in the gonadotropin group. More miscarriages were reported in the gonadotropin group than in the clomifene group, but the study was not powered to address this difference, which should be addressed in future studies, the researchers said.
The findings were limited by each center’s use of its own ovulation induction protocols, the researchers noted. “Our results can be used by couples treated with first-line ovulatory drugs who weigh the pros and cons of switching to gonadotropins and addition of intrauterine insemination,” they said.
The study was supported by the Netherlands Organization for Health Research and Development.
SOURCE: Weiss N et al. Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736(17)33308-1.
Switching to gonadotropins increased the odds of live births for women with normogonadotropic anovulation with little success for continuing with clomifene citrate, based on data from 666 women.
Women who have not become pregnant after six cycles of clomifene are often defined as having failed the treatment, but the effectiveness of continuing clomifene citrate or switching to gonadotropins had not been addressed in randomized trials, wrote Nienke S. Weiss, MD, of VU University Medical Center, Amsterdam, and her colleagues.
In a study published online in the Lancet, the researchers randomized 166 women to gonadotropins and intrauterine insemination, 165 to gonadotropins and intercourse, 163 to clomifene citrate and intrauterine insemination, and 172 to clomifene citrate and intercourse. The study population included women aged 18 years and older who had not become pregnant after six cycles of clomifene citrate. The clomifene citrate was given as oral doses of 50-150 mg daily, and gonadotropin was given subcutaneously at a starting dose of 50 IU or 75 IU daily.
Overall, live births were significantly more likely for women given gonadotropins, compared with those given clomifene citrate (52% of 327 women vs. 41% of 334 women, respectively; P = .0124). Rates of multiple pregnancies were similar and relatively low among the treatment groups.
Intrauterine insemination had no significant impact on live birth rates, compared with intercourse (49% vs. 43%, respectively; P = .1152).
A total of three adverse events were reported including one stillbirth and one case of congenital abnormality in the clomifene group and one delivery at 20 weeks’ gestational age caused by cervical insufficiency in the gonadotropin group. More miscarriages were reported in the gonadotropin group than in the clomifene group, but the study was not powered to address this difference, which should be addressed in future studies, the researchers said.
The findings were limited by each center’s use of its own ovulation induction protocols, the researchers noted. “Our results can be used by couples treated with first-line ovulatory drugs who weigh the pros and cons of switching to gonadotropins and addition of intrauterine insemination,” they said.
The study was supported by the Netherlands Organization for Health Research and Development.
SOURCE: Weiss N et al. Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736(17)33308-1.
FROM THE LANCET
Key clinical point: Gonadotropins surpassed clomifene citrate for women with normogonadotropic anovulation.
Major finding: Live births occurred in 52% of women assigned to gonadotropins vs. 41% of those given clomifene citrate.
Study details: A randomized trial of 666 women aged 18 years and older.
Disclosures: The study was supported by the Netherlands Organization for Health Research and Development.
Source: Weiss N et al. Lancet. 2017 Dec 19. doi: 10.1016/S0140-6736(17)33308-1.
Tracheobronchial tree size changes may predict IPF outcomes
Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.
To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.
The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.
Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.
No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.
“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.
“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.
Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.
Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.
To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.
The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.
Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.
No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.
“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.
“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.
Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.
Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.
To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.
The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.
Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.
No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.
“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.
“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.
Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.
FROM CHEST 2017
Bariatric surgery comes with some risk of complications
that should acknowledged by clinicians and understood by patients, a large cohort study has shown.
Gunn Signe Jakobsen, MD, of Vestfold Hospital Trust, Tønsberg, Norway, and her colleagues wrote in an article published in JAMA, “Few studies report long-term complication rates. ... No large-scale clinical practice–based study has compared the long-term association of bariatric surgery and specialized medical obesity treatment with obesity-related somatic and mental comorbidities, nor the irrespective complication rates.”
The investigators compared outcomes from 932 patients who underwent bariatric surgery and 956 who underwent specialized medical treatment that involved either individual or group lifestyle intervention programs. The study population included 1,249 women and 639 men with an average age of 44 years and an average baseline body mass index of 44 kg/m2.
The surgery patients were more likely than the medical treatment patients to have hypertension remission (absolute risk 32% vs. 12%, respectively), and less likely to develop new-onset hypertension (absolute risk 4% vs. 12%, respectively). Diabetes remission was significantly higher among surgery patients, compared with medical treatment patients (58% vs. 13%) as was the likelihood of dyslipidemia remission (43% vs. 13%). Surgery patients also were less likely to develop new-onset diabetes or dyslipidemia than the medical treatment patients.
However, more patients who underwent bariatric surgery had low ferritin levels, compared with the medical treatment patients (26% vs. 12%). The surgery patients were significantly more likely than the medical treatment patients to develop new-onset depression (adjusted relative risk, 1.5; 95% confidence interval, 1.4-1.7), anxiety and sleep disorders (aRR, 1.3; 95% CI, 1.2-1.5), and treatment with opioids (aRR, 1.3; 95% CI, 1.2-1.4). In addition, bariatric patients were more likely to have at least one additional gastrointestinal surgical procedure (aRR, 2.0; 95% CI, 1.7-2.4), an operation for intestinal obstruction (aRR, 10.5; 95% CI, 5.1-21.5), abdominal pain (aRR, 1.9; 95% CI, 1.6-2.3), and gastroduodenal ulcers (aRR, 3.4; 95% CI 2.0-5.6).
The study was limited by several factors, including selection bias of younger, heavier patients in the bariatric surgery group, the lack of data on actual weight loss, incomplete laboratory data, and a relatively homogeneous white population, the researchers noted. However, the nearly 100% follow-up over approximately 6 years adds to the strength of the findings, which suggest that “the risk for complications should be considered in the decision-making process,” for obese patients considering bariatric surgery, they said.
Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
SOURCE: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
that should acknowledged by clinicians and understood by patients, a large cohort study has shown.
Gunn Signe Jakobsen, MD, of Vestfold Hospital Trust, Tønsberg, Norway, and her colleagues wrote in an article published in JAMA, “Few studies report long-term complication rates. ... No large-scale clinical practice–based study has compared the long-term association of bariatric surgery and specialized medical obesity treatment with obesity-related somatic and mental comorbidities, nor the irrespective complication rates.”
The investigators compared outcomes from 932 patients who underwent bariatric surgery and 956 who underwent specialized medical treatment that involved either individual or group lifestyle intervention programs. The study population included 1,249 women and 639 men with an average age of 44 years and an average baseline body mass index of 44 kg/m2.
The surgery patients were more likely than the medical treatment patients to have hypertension remission (absolute risk 32% vs. 12%, respectively), and less likely to develop new-onset hypertension (absolute risk 4% vs. 12%, respectively). Diabetes remission was significantly higher among surgery patients, compared with medical treatment patients (58% vs. 13%) as was the likelihood of dyslipidemia remission (43% vs. 13%). Surgery patients also were less likely to develop new-onset diabetes or dyslipidemia than the medical treatment patients.
However, more patients who underwent bariatric surgery had low ferritin levels, compared with the medical treatment patients (26% vs. 12%). The surgery patients were significantly more likely than the medical treatment patients to develop new-onset depression (adjusted relative risk, 1.5; 95% confidence interval, 1.4-1.7), anxiety and sleep disorders (aRR, 1.3; 95% CI, 1.2-1.5), and treatment with opioids (aRR, 1.3; 95% CI, 1.2-1.4). In addition, bariatric patients were more likely to have at least one additional gastrointestinal surgical procedure (aRR, 2.0; 95% CI, 1.7-2.4), an operation for intestinal obstruction (aRR, 10.5; 95% CI, 5.1-21.5), abdominal pain (aRR, 1.9; 95% CI, 1.6-2.3), and gastroduodenal ulcers (aRR, 3.4; 95% CI 2.0-5.6).
The study was limited by several factors, including selection bias of younger, heavier patients in the bariatric surgery group, the lack of data on actual weight loss, incomplete laboratory data, and a relatively homogeneous white population, the researchers noted. However, the nearly 100% follow-up over approximately 6 years adds to the strength of the findings, which suggest that “the risk for complications should be considered in the decision-making process,” for obese patients considering bariatric surgery, they said.
Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
SOURCE: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
that should acknowledged by clinicians and understood by patients, a large cohort study has shown.
Gunn Signe Jakobsen, MD, of Vestfold Hospital Trust, Tønsberg, Norway, and her colleagues wrote in an article published in JAMA, “Few studies report long-term complication rates. ... No large-scale clinical practice–based study has compared the long-term association of bariatric surgery and specialized medical obesity treatment with obesity-related somatic and mental comorbidities, nor the irrespective complication rates.”
The investigators compared outcomes from 932 patients who underwent bariatric surgery and 956 who underwent specialized medical treatment that involved either individual or group lifestyle intervention programs. The study population included 1,249 women and 639 men with an average age of 44 years and an average baseline body mass index of 44 kg/m2.
The surgery patients were more likely than the medical treatment patients to have hypertension remission (absolute risk 32% vs. 12%, respectively), and less likely to develop new-onset hypertension (absolute risk 4% vs. 12%, respectively). Diabetes remission was significantly higher among surgery patients, compared with medical treatment patients (58% vs. 13%) as was the likelihood of dyslipidemia remission (43% vs. 13%). Surgery patients also were less likely to develop new-onset diabetes or dyslipidemia than the medical treatment patients.
However, more patients who underwent bariatric surgery had low ferritin levels, compared with the medical treatment patients (26% vs. 12%). The surgery patients were significantly more likely than the medical treatment patients to develop new-onset depression (adjusted relative risk, 1.5; 95% confidence interval, 1.4-1.7), anxiety and sleep disorders (aRR, 1.3; 95% CI, 1.2-1.5), and treatment with opioids (aRR, 1.3; 95% CI, 1.2-1.4). In addition, bariatric patients were more likely to have at least one additional gastrointestinal surgical procedure (aRR, 2.0; 95% CI, 1.7-2.4), an operation for intestinal obstruction (aRR, 10.5; 95% CI, 5.1-21.5), abdominal pain (aRR, 1.9; 95% CI, 1.6-2.3), and gastroduodenal ulcers (aRR, 3.4; 95% CI 2.0-5.6).
The study was limited by several factors, including selection bias of younger, heavier patients in the bariatric surgery group, the lack of data on actual weight loss, incomplete laboratory data, and a relatively homogeneous white population, the researchers noted. However, the nearly 100% follow-up over approximately 6 years adds to the strength of the findings, which suggest that “the risk for complications should be considered in the decision-making process,” for obese patients considering bariatric surgery, they said.
Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
SOURCE: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
FROM JAMA
Key clinical point: Bariatric surgery was associated with reduced hypertension but more complications, including iron deficiency and ulcers.
Major finding: Obese adults who had bariatric surgery were at greater risk for new-onset depression (aRR, 1.5), anxiety and sleep disorders (aRR, 1.3), and ulcers (aRR 3.4).
Study details: A cohort study of 1,888 adults treated with bariatric surgery or medical therapy.
Disclosures: Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
Source: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
Disparities persist in infant safe sleep practices
Sleep-related deaths among infants in the United States decreased during the 1990s as a result of recommendations to place babies on their backs to sleep. However, the decline has leveled off in recent years, and health care providers should proactively counsel caregivers about safe sleep practices, wrote Jennifer M. Bombard, MSPH, of the Centers for Disease Control and Prevention and her colleagues in a study published online in the Morbidity and Mortality Weekly Report.
Overall, 22% of respondents from 32 states and New York City in 2015 reported placing babies in a position other than their backs to sleep. In addition, 61% of respondents from 14 states reported bed sharing, and 39% from 13 states and New York City reported using soft bedding, including bumper pads and thick blankets.
Unsafe sleep practices varied by maternal demographics; nonsupine sleep positioning was more likely among non-Hispanic blacks, individuals aged 25 years or younger, those with 12 years or less of education, and those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
“These findings highlight the need to implement and evaluate interventions to continue improving safe sleep practices,” Ms. Bombard and her associates said.
They cited the Study of Attitudes and Factors Effecting Infant Care Practices, in which caregivers who received appropriate advice on safe sleep practices were significantly less likely to place infants in a nonsupine position to sleep. “Evidence-based approaches to increase use of safe sleep practices include developing health messages and educational tools for caregivers and educating health and child care professionals on safe sleep practices,” they noted.
The study was limited by several factors, including reliance on self reports and inclusion of only states with Pregnancy Risk Assessment Monitoring System records, the researchers said.
Ms. Bombard and her associates had no relevant financial disclosures.
pdnews@frontlinemedcom.com
SOURCE: Bombard J et al. MMWR. 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
Sleep-related deaths among infants in the United States decreased during the 1990s as a result of recommendations to place babies on their backs to sleep. However, the decline has leveled off in recent years, and health care providers should proactively counsel caregivers about safe sleep practices, wrote Jennifer M. Bombard, MSPH, of the Centers for Disease Control and Prevention and her colleagues in a study published online in the Morbidity and Mortality Weekly Report.
Overall, 22% of respondents from 32 states and New York City in 2015 reported placing babies in a position other than their backs to sleep. In addition, 61% of respondents from 14 states reported bed sharing, and 39% from 13 states and New York City reported using soft bedding, including bumper pads and thick blankets.
Unsafe sleep practices varied by maternal demographics; nonsupine sleep positioning was more likely among non-Hispanic blacks, individuals aged 25 years or younger, those with 12 years or less of education, and those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
“These findings highlight the need to implement and evaluate interventions to continue improving safe sleep practices,” Ms. Bombard and her associates said.
They cited the Study of Attitudes and Factors Effecting Infant Care Practices, in which caregivers who received appropriate advice on safe sleep practices were significantly less likely to place infants in a nonsupine position to sleep. “Evidence-based approaches to increase use of safe sleep practices include developing health messages and educational tools for caregivers and educating health and child care professionals on safe sleep practices,” they noted.
The study was limited by several factors, including reliance on self reports and inclusion of only states with Pregnancy Risk Assessment Monitoring System records, the researchers said.
Ms. Bombard and her associates had no relevant financial disclosures.
pdnews@frontlinemedcom.com
SOURCE: Bombard J et al. MMWR. 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
Sleep-related deaths among infants in the United States decreased during the 1990s as a result of recommendations to place babies on their backs to sleep. However, the decline has leveled off in recent years, and health care providers should proactively counsel caregivers about safe sleep practices, wrote Jennifer M. Bombard, MSPH, of the Centers for Disease Control and Prevention and her colleagues in a study published online in the Morbidity and Mortality Weekly Report.
Overall, 22% of respondents from 32 states and New York City in 2015 reported placing babies in a position other than their backs to sleep. In addition, 61% of respondents from 14 states reported bed sharing, and 39% from 13 states and New York City reported using soft bedding, including bumper pads and thick blankets.
Unsafe sleep practices varied by maternal demographics; nonsupine sleep positioning was more likely among non-Hispanic blacks, individuals aged 25 years or younger, those with 12 years or less of education, and those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
“These findings highlight the need to implement and evaluate interventions to continue improving safe sleep practices,” Ms. Bombard and her associates said.
They cited the Study of Attitudes and Factors Effecting Infant Care Practices, in which caregivers who received appropriate advice on safe sleep practices were significantly less likely to place infants in a nonsupine position to sleep. “Evidence-based approaches to increase use of safe sleep practices include developing health messages and educational tools for caregivers and educating health and child care professionals on safe sleep practices,” they noted.
The study was limited by several factors, including reliance on self reports and inclusion of only states with Pregnancy Risk Assessment Monitoring System records, the researchers said.
Ms. Bombard and her associates had no relevant financial disclosures.
pdnews@frontlinemedcom.com
SOURCE: Bombard J et al. MMWR. 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
FROM MMWR
Key clinical point: Health care providers can improve safe sleep for babies by counseling caregivers.
Major finding: Of respondents from 32 states and New York City in 2015, 22% reported placing babies in a position other than their backs to sleep.
Study details: The data come from the 2009-2015 Pregnancy Risk Assessment Monitoring System.
Disclosures: The researchers had no relevant financial disclosures.
Source: Bombard J et al. MMWR 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
Alopecia tied to nearly fivefold increase in fibroids in African American women
based on data from more than 400,000 women.
In a study published in JAMA Dermatology, researchers reviewed data from 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017. Overall, 14% of women with central centrifugal cicatricial alopecia (CCCA) also had a history of uterine fibroids, compared with 3% percent of black women without CCCA.
“Alopecia is more than just a cosmetic problem. … It could signal an increased risk of developing other conditions,” corresponding author Crystal Aguh, MD, of Johns Hopkins University in Baltimore said in an interview. “To our knowledge, this is the first time that an association has been noted between these two conditions. We believe that the fact that both are related to excess scarring and fibrous tissue deposition may reflect similarities in how both [conditions] develop, but this is still unknown.” 
Overall, 62 of 447 women who met criteria for CCCA also had fibroids, representing a nearly fivefold increase in fibroid risk for women with CCCA.
“I was definitely surprised by the findings,” said Dr. Aguh. “I thought it would be interesting to look at any possible correlation between the two diseases, but did not expect to see such a large difference between black women with and without this form of hair loss,” she noted.
As fibroids are often asymptomatic, “physicians should screen their patients with CCCA for symptoms of fibroids such as painful menstrual cycles, heavy bleeding, unexplained anemia, or difficulty conceiving,” said Dr. Aguh. “In those patients who may not know they have fibroids, early recognition that allows for treatment will be especially beneficial.”
The findings were limited by the retrospective nature of the study. “I believe that larger studies are warranted to help us fully understand how these two conditions are connected,” Dr. Aguh said.
Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
SOURCE: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163
based on data from more than 400,000 women.
In a study published in JAMA Dermatology, researchers reviewed data from 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017. Overall, 14% of women with central centrifugal cicatricial alopecia (CCCA) also had a history of uterine fibroids, compared with 3% percent of black women without CCCA.
“Alopecia is more than just a cosmetic problem. … It could signal an increased risk of developing other conditions,” corresponding author Crystal Aguh, MD, of Johns Hopkins University in Baltimore said in an interview. “To our knowledge, this is the first time that an association has been noted between these two conditions. We believe that the fact that both are related to excess scarring and fibrous tissue deposition may reflect similarities in how both [conditions] develop, but this is still unknown.”
Overall, 62 of 447 women who met criteria for CCCA also had fibroids, representing a nearly fivefold increase in fibroid risk for women with CCCA.
“I was definitely surprised by the findings,” said Dr. Aguh. “I thought it would be interesting to look at any possible correlation between the two diseases, but did not expect to see such a large difference between black women with and without this form of hair loss,” she noted.
As fibroids are often asymptomatic, “physicians should screen their patients with CCCA for symptoms of fibroids such as painful menstrual cycles, heavy bleeding, unexplained anemia, or difficulty conceiving,” said Dr. Aguh. “In those patients who may not know they have fibroids, early recognition that allows for treatment will be especially beneficial.”
The findings were limited by the retrospective nature of the study. “I believe that larger studies are warranted to help us fully understand how these two conditions are connected,” Dr. Aguh said.
Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
SOURCE: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163
based on data from more than 400,000 women.
In a study published in JAMA Dermatology, researchers reviewed data from 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017. Overall, 14% of women with central centrifugal cicatricial alopecia (CCCA) also had a history of uterine fibroids, compared with 3% percent of black women without CCCA.
“Alopecia is more than just a cosmetic problem. … It could signal an increased risk of developing other conditions,” corresponding author Crystal Aguh, MD, of Johns Hopkins University in Baltimore said in an interview. “To our knowledge, this is the first time that an association has been noted between these two conditions. We believe that the fact that both are related to excess scarring and fibrous tissue deposition may reflect similarities in how both [conditions] develop, but this is still unknown.”
Overall, 62 of 447 women who met criteria for CCCA also had fibroids, representing a nearly fivefold increase in fibroid risk for women with CCCA.
“I was definitely surprised by the findings,” said Dr. Aguh. “I thought it would be interesting to look at any possible correlation between the two diseases, but did not expect to see such a large difference between black women with and without this form of hair loss,” she noted.
As fibroids are often asymptomatic, “physicians should screen their patients with CCCA for symptoms of fibroids such as painful menstrual cycles, heavy bleeding, unexplained anemia, or difficulty conceiving,” said Dr. Aguh. “In those patients who may not know they have fibroids, early recognition that allows for treatment will be especially beneficial.”
The findings were limited by the retrospective nature of the study. “I believe that larger studies are warranted to help us fully understand how these two conditions are connected,” Dr. Aguh said.
Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
SOURCE: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163
FROM JAMA DERMATOLOGY
Key clinical point: Dermatologists should screen patients with central centrifugal cicatricial alopecia for potential fibroids.
Major finding: Women with CCCA were nearly five times more likely to have fibroids, compared with controls.
Data source: The data come from a review of 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017.
Disclosures: Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
Source: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163.