Usefulness of CHADS2 and CHA2DS2-VASc scores in the prediction of new-onset atrial fibrillation: A population-based study | Classification, diagnosis, and management of progestogen hypersensitivity | Effect of ACE inhibitors on gait
August 25, 2016
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Usefulness of CHADS2 and CHA2DS2-VASc scores in the prediction of new-onset atrial fibrillation: A population-based study
CHADS2 and CHA2DS2-VASc are validated scores used to predict stroke in patients with atrial fibrillation. Many of the individual risk factors included in these scores are also risk factors for atrial fibrillation. We aimed to examine the performance of CHADS2 and CHA2DS2-VASc scores in predicting new-onset atrial fibrillation in subjects without pre-existing diagnosis of atrial fibrillation.
The American Journal of Medicine (8/2016) 
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Clinical Updates
Classification, diagnosis, and management of progestogen hypersensitivity
Autoimmune progesterone dermatitis (APD) is a poorly recognized syndrome associated with progesterone hypersensitivity (PH). Symptoms present heterogeneously, which may complicate diagnosis. Recently an increasing number of cases have been reported with in vitro fertilization (IVF). Twenty-four cases of PH were evaluated retrospectively. Symptom onset was classified as a reaction to either endogenous progesterone (42%) or exogenous progestogens (58%). Symptoms were heterogeneous and included cyclical dermatitis, urticaria, angioedema, asthma, and anaphylaxis. Desensitization in 11 patients resulted in symptom control in eight patients, IVF medication tolerance in three patients, and two pregnancies. Women with cyclical allergic symptoms, including those undergoing IVF, should be evaluated for PH and considered for desensitization.
The Journal of Allergy and Clinical Immunology: In Practice (8/2016) 
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Effect of ACE inhibitors on gait
Can ACE inhibitors lead to worsened gait in hypertensive patients? Poor gait can lead to falls, hospitalization, or even mortality in older persons. Bronx, New York, researchers found that when measuring velocity, stride length, swing time, stride length variability, and swing time variability in older persons on ACE inhibitors versus those on other antihypertensive medications, ACE inhibitor use meant worsened gait performance. Perhaps physicians should monitor gait speed in their patients who are on ACE inhibitors.
Journal of the American Medical Directors Association (8/2016) 
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Sitting affects all-cause mortality
Recent studies have shown that sitting time is associated with increased risk of all-cause mortality, independent of moderate to vigorous physical activity. Surveys on sitting time distribution from 54 countries and one published meta-analysis were analyzed to determine the population attributable fraction for all-cause mortality associated with sitting time and the gains in life expectancy related to the elimination of this risk factor. Sitting time was found to be responsible for 3.8% of all-cause mortality among those 54 countries. Eliminating sitting time would increase life expectancy by 0.20 years in those countries.
American Journal of Preventive Medicine (8/2016) 
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Reduced health status in adolescents with abnormal cholesterol screening results
Adolescents and parents of adolescents perceive reductions in the adolescents' current health status in response to abnormal cholesterol screening results. The cognitive, emotional, and behavioral impact of abnormal cholesterol results is related to the predicated age of future heart disease.
Journal of Adolescent Health (8/2016) 
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Antibiotics in the first 2 years of life and weight development
Alterations in the gut microbiome have been documented to affect body weight. Although previous studies have shown that early antibiotic exposure may affect weight development, the effects of antibiotic class and timing of exposure are unknown. This study examined the influence of timing of antibiotic exposure, type of antibiotics used, and number of exposures on height and weight development up to 10 years of age. Increased weight and height z-scores were observed in children exposed to one course of antibiotics in the first 6 months of life and in children with two or more courses during the second year of life. These associations were mainly seen in exposure to broad- and narrow-spectrum β-lactams. Exposure later in life was not associated with anthropometric outcomes. If causality of obesity can be established in the future, this illustrates the need for judicious antibiotic use early in life.
The Journal of Pediatrics (8/2016) 
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Effective phantom limb pain reduction
This research evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in landmine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled parallel group, single-center trial. These findings conclude that high-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induces a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with phantom limb pain caused by landmine explosions.
The Journal of Pain (8/2016) 
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Medical News
MRI study sheds light on brain damage from congenital Zika virus
Researchers examined MRI scans from 45 babies and fetuses in Brazil whose mothers were either confirmed or suspected to have Zika virus infections during gestation and found that nearly 100% had ventriculomegaly or enlarged brain ventricles, while about 100% and nearly 80% of those in the confirmed and presumed groups, respectively, had corpus callosum abnormalities. The findings in the journal Radiology, also showed that fetuses and infants had other brain abnormalities such as loss of gray and white matter, fluid buildup, and brain stem problems.
Reuters (8/23),  Time.com (8/23) 
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CDC reports increasing breast-feeding rates in the US
CDC researchers found that 81.1% of mothers in the US breast-fed their newborns in 2013, compared with 75% and 70% in 2008 and 2000, respectively, with 51.8% of mothers breast-feeding when their babies were 6 months old and 30.7% breast-feeding at 12 months. The findings also showed that 29 states, Washington, D.C., and Puerto Rico have met the 81.9% goal of breast-fed infants, while Utah and Mississippi had the highest and lowest breast-feeding rates, respectively.
United Press International (8/22),  LiveScience.com (8/22) 
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Smoking tied to higher A1C levels in type 1 diabetes, study finds
Austrian researchers found that type 1 diabetes patients who smoke had significantly higher A1C, LDL cholesterol and triglyceride levels than nonsmokers. The findings in Diabetes Care, based on data from the T1D Exchange Registry in the US and the Prospective Diabetes Follow-up Registry in Austria and Germany involving 20,405 adults with type 1 diabetes, also showed smoking may increase the risk of vascular complications.
Diabetes.co.uk (U.K.) (8/23) 
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Business Practice News
Health care groups ask CMS to finalize 90-day MU reporting period
More than a dozen health care organizations sent a letter to acting CMS Administrator Andy Slavitt asking him to finalize the 90-day reporting period for EHR meaningful use under the proposed outpatient prospective payment rule. "Finalizing the 90-day reporting period as quickly as possible will reduce the number of providers who must rely on a hardship exemption in 2016 and if the finalization of the policy is similarly delayed, CMS must be prepared to provide hardship exemptions as was done in 2015," they said in the letter.
Healthcare Finance News (8/22) 
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Research links teaching hospital status to lower cardiac arrest mortality
A study linked teaching hospital status with lower rates of in-hospital mortality for cardiac arrest patients, researchers reported in the American Journal of Cardiology. "The differences in mortality disappeared after adjusting for in-hospital procedures, indicating that routine application of novel therapeutic methods in patients with CA in teaching hospitals could translate into improved survival outcomes," study authors said.
PhysiciansBriefing.com/HealthDay News (8/19) 
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Patient's Perspective
Study: Social business diet may increase heart risks
Researchers said people who followed a "social business" diet had a poorer cardiovascular risk profile and a higher risk of atherosclerosis than those who ate a Mediterranean or Western diet. The study in the Journal of the American College of Cardiology defined a social business diet as one of restaurant meals of red meat, processed foods, sweet drinks and alcohol.
HealthDay News (8/19) 
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