Recent guidelines recommend further reduction of low-density lipoprotein cholesterol (LDL-C) in high-risk populations. The use of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) enables many patients to achieve profound reduction in LDL-C. However, in patients with low cholesterol, the commonly used Friedewald equation tends to underestimate LDL-C, which may result in undertreatment. We aimed to compare Friedewald LDL-C estimation with the more novel Martin/Hopkins method in PCSK9i-treated patients achieving low LDL-C.
Methods
We investigated high-risk patients treated by PCSK9i in whom Friedewald LDL-C levels were <?70 mg/dL and triglycerides ≤?300 mg/dL. LDL-C was additionally assessed by the Martin/Hopkins method. The compatibility between estimations was evaluated using methods of concordance and reclassification between LDL-C categories (<?25, 25–40, 40–55, 55–70 mg/dL) and according to triglyceride strata.
Results
Mean age was 65?±?10 years. The correlation coefficient between LDL-C estimations was r?=?0.898. Martin/Hopkins reclassified 269 of the 608 patients (44%) to a higher LDL-C category, with 14% of the patients reaching LDL-C >?70 mg/dL. Of the 390 patients achieving Friedewald LDL-C <?55 mg/dL, 113 (29%) were estimated to have LDL-C ≥?55 mg/dL by the Martin/Hopkins equation. The magnitude of discordance between LDL-C estimates was more pronounced in hypertriglyceridemic patients in whom LDL-C reclassification from <?55 to ≥?55 mg/dL was observed in 48%.
Conclusions
In real-world practice of high-risk patients achieving low LDL-C under PCSK9i, Martin/Hopkins algorithm displayed significant proportion of LDL-C upward discordance compared to the Friedewald equation, particularly observed in patients with elevated triglycerides, identifying patients that may need treatment intensification.
At least 193 cases of cutaneous leishmaniasis occurred in eight villages of Mowaqqar area, Jordan, between December 1982 and April 1983. Peak transmission of the disease is thought to have taken place in late summer 1982. Approximately 67% of the cases were below 15 years of age and the lesions seen were of the dry type. The sand jird, Psammomys obesus, and the sandfly, Phlebotomus papatasi, the potential animal reservoir and vector of the disease respectively, were found in the affected area. Furthermore, Leishmania amastigotes were seen in smears from ears of seven out of 11 jirds collected from the area suggesting the zoonotic nature of the disease there. 相似文献
OBJECTIVES: In patients with atrial flutter (AFL) and postoperative right atrial incisional scars, we sought to assess if the use of additional ablative lesions that targeted all potential re-entrant circuits, regardless of the presenting type of flutter, would prevent long-term recurrence. BACKGROUND: Patients with AFL and incisional scars have a complex atrial substrate that may promote multiple mechanisms of intra-atrial re-entry. METHODS: Twenty-nine patients with single right atrial incisional scars undergoing ablation for scar-dependent (n = 15) and cavotricuspid isthmus (CTI)-dependent (n = 14) flutter were studied. RESULTS: In the scar-dependent group, 9 of 15 (60%) patients had inducible or spontaneous CTI-dependent flutter immediately after ablation. In the group with CTI flutter, 7 of 14 (50%) patients had scar-related flutter immediately after ablation. If a second type of flutter was found during the initial ablation, a second ablation was performed either along the isthmus (scar-dependent group) or from the scar to another anatomic boundary (isthmus-dependent group). Patients were followed for 24 +/- 5 months and 18 +/- 6 months in the scar- and CTI-dependent groups, respectively. In the scar-dependent group, five of six (83%) who underwent only a single flutter line had recurrence at 3 +/- 1 months. In the isthmus-dependent group, three of seven (42%) patients who had only one flutter line performed had recurrence at 5 +/- 3 months. There was no flutter recurrence in patients who initially received two different flutter lines or in patients who subsequently underwent a second flutter line at follow-up. CONCLUSIONS: In patients with postoperative right atrial incisional scar and flutter, multiple ablation lines that target both scar-related and classic isthmuses appear necessary to prevent long-term recurrence. 相似文献
Understanding the demographics of patellofemoral pain is important to determine the best practices in diagnosis and treatment of this difficult pathology. The occurrence of patellofemoral pain has been reported from isolated sports medicine clinics and from within the military, but its incidence has never been examined in the general population within the United States.
Purpose
The purpose of this study was to examine the reported occurrence of patellofemoral pain for those individuals seeking medical care and to compare that to all other pathologies that result in anterior knee pain, such as tendinopathies, patella subluxation, osteoarthritis, or meniscal and bursal conditions. Occurrence rates were examined across sex, age and region within a large healthcare provider database that contains over 30 million individuals.
Methods
Data were queried with the PearlDiver Patient Record Database, a national database containing orthopedic patient records. Two common International Classification of Disease, Ninth Revision (ICD‐9) codes for patellofemoral pain (717.7 – Patella Chondromalacia and 719.46 – Pain in joint, lower leg) were utilized and were searched from the years 2007‐2011. The top twenty additional ICD‐9 codes that were concurrently coded with 717.7 and 719.46 were removed from the data. Chi‐squared and Mantel‐Haenszel tests were utilized to identify statistically significant differences in the diagnosis of patellofemoral pain between sex, age, and year.
Results
During this five‐year period, there were 2,188,753 individuals diagnosed with patellofemoral pain. The diagnosis was more common in females compared to males with 1,211,665 and 977,088 cases respectfully (p<0.001). Statistically significant differences between ages was found, with 50‐59 year olds having the most cases with 578,854, p<0.001. And, during the five‐year examination period, there was a steady increase between 2007‐2011, p<0.01.
Conclusion
Patellofemoral pain was diagnosed between 1.5% and 7.3% of all patients seeking medical care within the United States. Females experienced patellofemoral pain more often than males and there was a steady increase of cases in the United States during the 2007‐2011 examination period. The diagnosis of patellofemoral pain increased with age and the 50‐59 year old age group had the most cases.
Pantothenamides inhibit blood-stage Plasmodium falciparum with potencies (50% inhibitory concentration [IC50], ∼20 nM) similar to that of chloroquine. They target processes dependent on pantothenate, a precursor of the essential metabolic cofactor coenzyme A. However, their antiplasmodial activity is reduced due to degradation by serum pantetheinase. Minor modification of the pantothenamide structure led to the identification of α-methyl-N-phenethyl-pantothenamide, a pantothenamide resistant to degradation, with excellent antiplasmodial activity (IC50, 52 ± 6 nM), target specificity, and low toxicity. 相似文献
