Assessment of racial and ethnic differences of atopic dermatitis severity and treatment patterns in a diverse outpatient cohort in the United States: a retrospective observational study.

Previous population-based studies in the United States found racial/ethnic differences of atopic dermatitis (AD) severity and treatment patterns. It is unclear whether these differences are from differences of disease characteristics or disparities. To examine racial/ethnic differences in severity and treatment patterns in a diverse outpatient patient cohort of AD patients (n = 833). There were no significant associations of highest-reported body surface area (BSA; Fisher's exact test, P = 0.19 and P = 0.44) or physician's global assessment (PGA; P = 0.63 and P = 0.57) with race or ethnicity; nor interactions of race/ethnicity with gender or age as predictors of BSA or PGA. Asian and multiracial/other patients were more likely than White or Black patients to use topical calcineurin inhibitors (Chi-square, P = 0.01). Dupilumab use differed by race (Multiracial/other = 35.0%; White = 20.1%; Asian = 15.7%; Black = 13.6%; Chi-square, P = 0.03), but not ethnicity (P = 0.88). Use of oral corticosteroids (Chi-square, P = 0.74), immunosuppressants (P = 0.98) or GABAergics (P = 0.16) or NBUVB (P = 0.42) did not differ by race. There were no interactions of race/ethnicity with gender or age as predictors of treatment use. Similar treatment patterns were observed across racial/ethnic groups. Though, topical calcineurin inhibitors were more commonly used in Asian and multiracial/other patients; dupilumab use was more common in multiracial/other patients.

Early Postoperative Vital Signs Predict Subsequent 90-Day Mortality After Pancreaticoduodenectomy.

BACKGROUND: While complication rates after pancreaticoduodenectomy (PD) have improved in recent decades, surgical-related death remains a possibility. Postoperative vital signs offer an untapped opportunity to identify predictors of 90-day mortality. METHODS: We performed a retrospective chart review interrogating postoperative day (POD 0-7) vital sign measurements from patients undergoing a PD at Thomas Jefferson University Hospital, Philadelphia, PA (2009-2014). Five specific vital signs were examined as predictors of mortality: temperature, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure. Statistical analyses and logic algorithms were employed to rank vital sign parameters, with cut-points, to identify those associated with the highest risk of mortality and the most clinical relevance. RESULTS: In our cohort, 11/750 patients (1.5%) died within 30 days of surgery, and 21/750 patients (2.8%) died within 90 days of surgery. Vital sign perturbations associated with the highest risk of mortality included mean SBP < 95 mmHg on POD 7 (odds ratio 51.46) and the mean temperature < 96.9℉ on POD 3 (odds ratio 22.63) with specificities exceeding 99%. The most clinically relevant predictor (i.e., a higher sensitivity) was DBP < 60.5 mmHg on POD 7 (odds ratio 12.45, sensitivity of 75%). These predictors remained statistically significant in a multivariable model. CONCLUSIONS: Vital signs can be more effectively utilized to predict 90-day mortality after pancreaticoduodenectomy. Values beyond an informative threshold can potentially identify patients for more intensive monitoring with a goal of rescuing patients and preventing death.

Assessment of the validity of international classification of disease tenth revision codes for atopic dermatitis.

Little is known about the validity of ICD-10-CM codes for atopic dermatitis (AD) in healthcare claims databases. We assessed the validity of ICD-10-CM codes for identifying adult patients with AD. The healthcare claims database from a large metropolitan tertiary care medical center was queried for diagnostic codes of L20.x and L30.9. Medical records were reviewed for demographics, comorbidities, Hanifin & Rajka (H-R), and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPVs) were calculated. Overall, 833 patients were identified with ≥ 1 occurrence of the aforementioned ICD-10 codes for AD. Using H-R and UKWP criteria as the gold-standard definitions of AD, the PPV of any aforementioned L20.x ICD-10 codes was 39.1% and 51.4%, with sensitivity of 98.1% and 97.4%, respectively. The PPV was 25% and 50% for L20.82; 66.7% and 100% for L20.84; 37.5% and 62.5% for L20.89; 60.1% and 51.4% for L20.9, respectively. PPV generally increased when case definitions combined ICD-10 codes with coexistent ICD-10 codes for asthma or hay fever, food allergy, and allergic rhinitis, and to a lesser extent coding of the ICD-10 code for AD by a dermatologist. Among patients with all these criteria, PPV increased to 100% and 80% based on H-R and UKWP criteria, but sensitivity decreased to 83.3% and 80.0%, respectively. In conclusion, ICD-10-CM codes for AD alone had poor PPV for identifying AD in a healthcare claims database. Combined ICD-10 codes for AD and comorbid atopic disease improved PPV and specificity of classification at the expense of sensitivity.

Autonomic development in preterm infants is associated with morbidity of prematurity.

BACKGROUND: Previous studies have described an association between preterm birth and maturation of the autonomic nervous system (ANS); however, this may be impacted by multiple factors, including prematurity-related complications. Our aim was to evaluate for the effect of prematurity-related morbidity on ANS development in preterm infants in the NICU. METHODS: We compared time and frequency domains of heart rate variability (HRV) as a measure of ANS tone in 56 preterm infants from 2 NICUs (28 from each). One cohort was from a high-morbidity regional referral NICU, the other from a community-based inborn NICU with low prematurity-related morbidity. Propensity score matching was used to balance the groups by a 1:1 nearest neighbor design. ANS tone was analyzed. RESULTS: The two cohorts showed parallel maturational trajectory of the alpha 1 time-domain metric, with the cohort from the high-morbidity NICU having lower autonomic tone. The maturational trajectories between the two cohorts differed in all other time-domain metrics (alpha 2, RMS1, RMS2). There was no difference between groups by frequency-domain metrics. CONCLUSIONS: Prematurity-associated morbidities correlate with autonomic development in premature infants and may have a greater impact on the extrauterine maturation of this system than birth gestational age. IMPACT: Autonomic nervous system development measured by time-domain metrics of heart rate variability correlate with morbidities associated with premature birth. This study builds upon our previously published work that showed that development of autonomic tone was not impacted by gestational age at birth. This study adds to our understanding of autonomic nervous system development in a preterm extrauterine environment. Our study suggests that gestational age at birth may have less impact on autonomic nervous system development than previously thought.

Ultrasound assisted crystallization of mefenamic acid: Effect of operating parameters and comparison with conventional approach.

The current work investigates the application of low intensity ultrasonic irradiation for improving the cooling crystallization of Mefenamic Acid for the first time. The crystal shape and size has been analyzed with the help of optical microscope and image analysis software respectively. The effect of ultrasonic irradiation on crystal size, particle size distribution (PSD) and yield has been investigated, also establishing the comparison with conventional approach. It has been observed that application of ultrasound not only enhances the yield but also reduces the induction time for crystallization as compared to conventional cooling crystallization technique. In the presence of ultrasound, the maximum yield was obtained at optimum conditions of power dissipation of 30W and ultrasonic irradiation time of 10min. The yield was further improved by application of ultrasound in cycles where the formed crystals are allowed to grow in the absence of ultrasonic irradiation. It was also observed that the desired crystal morphology was obtained for the ultrasound assisted crystallization. The conventionally obtained needle shaped crystals transformed into plate shaped crystals for the ultrasound assisted crystallization. The particle size distribution was analyzed using statistical means on the basis of skewness and kurtosis values. It was observed that the skewness and excess kurtosis value for ultrasound assisted crystallization was significantly lower as compared to the conventional approach. XRD analysis also revealed better crystal properties for the processed mefenamic acid using ultrasound assisted approach. The overall process intensification benefits of mefenamic acid crystallization using the ultrasound assisted approach were reduced particle size, increase in the yield and uniform PSD coupled with desired morphology.