Medication as a risk factor for hospitalization due to heart failure and shock: a series of case-crossover studies in Swiss claims data.

PURPOSE: Heart failure is among the leading causes for hospitalization in Europe. In this study, we evaluate potential precipitating factors for hospitalization for heart failure and shock. METHODS: Using Swiss claims data (2014-2015), we evaluated the association between hospitalization for heart failure and shock, and prescription of oral potassium supplements, non-steroidal anti-inflammatory drugs (NSAIDs), and amoxicillin/clavulanic acid. We conducted case-crossover analyses, where exposure was compared for the hazard period and the primary control period (e.g., 1-30 days before hospitalization vs. 31-60 days, respectively). Conditional logistic regression was applied and subsequently adjusted for addressing potential confounding by disease progression. Sensitivity analyses were conducted and stratification for co-medication was performed. RESULTS: We identified 2185 patients hospitalized with heart failure or shock. Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid was significantly associated with an increased risk for hospitalization for heart failure and shock with crude odds ratios (OR) of 2.04 for potassium (95% CI 1.24-3.36, p = 0.005, 30 days), OR 1.8 for NSAIDs (95% CI 1.39-2.33, p < 0.0001, 30 days), and OR 3.25 for amoxicillin/clavulanic acid (95% CI 2.06-5.14, p < 0.0001, 15 days), respectively. Adjustment attenuated odds ratios, while the significant positive association remained (potassium OR 1.70 (95% CI 1.01-2.86, p = 0.046), NSAIDs OR 1.50 (95% CI 1.14-1.97, p = 0.003), and amoxicillin/clavulanic acid OR 2.26 (95% CI 1.41-3.62, p = 0.001). CONCLUSION: Prescription of potassium supplements, NSAIDs, and amoxicillin/clavulanic acid is associated with increased risk for hospitalization. Underlying conditions such as pain, electrolyte imbalances, and infections are likely contributing risk factors. Physicians may use this knowledge to better identify patients at risk and adapt patient management.

Analysis of Drug-Drug Interactions in Swiss Claims Data Using Tizanidine and Ciprofloxacin as a Prototypical Contraindicated Combination.

BACKGROUND: Potential drug-drug interactions (pDDIs) are described in various case reports, but few studies have evaluated the impact of specific combinations on a population level. OBJECTIVE: To analyze the type and frequency of multiple contraindicated (X-pDDIs) and major interactions (D-pDDIs) and to subsequently assess the impact of the particular combination of tizanidine and ciprofloxacin on outpatient physician visits and hospitalizations. METHODS: Anonymized Swiss claims data from 524 797 patients in 2014-2015 were analyzed. First, frequencies of X- and D-pDDIs were calculated. Next, a retrospective cohort study was conducted among patients prescribed tizanidine and ciprofloxacin (exposed, n = 199) or tizanidine and other antibiotics (unexposed, n = 960). Hospitalizations and outpatient physician visits within 7, 14, and 30 days after initiation of antibiotic therapy were evaluated using multiple binary logistic regression and multiple linear regression. RESULTS: The relative frequencies of X- and D-pDDIs were 0.4% and 6.65%, respectively. In the cohort study, significant associations between exposure to tizanidine and ciprofloxacin and outpatient physician visits were identified for 14 and 30 days (odds ratio [OR] = 1.61 [95% CI = 1.17-2.24], P = 0.004, and OR = 1.59 [95% CI = 1.1-2.34], P = 0.016). A trend for increased risk of hospitalization was found for all evaluated time periods (OR = 1.68 [95% CI = 0.84-3.17], OR = 1.52 [95% CI = 0.63-3.33], and OR = 2.19 [95% CI = 0.88-5.02]). Conclusion and Relevance: The interaction between tizanidine and ciprofloxacin is not only relevant for individual patients, but also at the population level. Further investigation of the impact of other clinically relevant DDIs is necessary to improve patient safety and reduce avoidable health care utilization.

The effect of surface modification on the retention strength of polyetheretherketone crowns adhesively bonded to dentin abutments.

STATEMENT OF PROBLEM: The mechanical properties of polyetheretherketone (PEEK) make it an ideal material for fixed dental prostheses; however, insufficient information is available about the cementation of these restorations. PURPOSE: The purpose of this study was to evaluate the retention strength of differently pretreated and conditioned PEEK crowns luted to dental abutments. MATERIAL AND METHODS: Human teeth were prepared in a standardized manner, and PEEK crowns were milled (N=160, n=10 per group) and conditioned as follows: airborne-particle abrasion, sulfuric etching, piranha etching, and no conditioning. These groups were divided into adhesive systems: visio.link, Signum PEEK Bond, Ambarino P60, and no adhesive and luted to dentin abutments. After water storage (60 days) and thermocycling (5000 cycles, 5°C/55°C), the retention strength of the crowns was determined with a pull-off test, and failure types were classified. The data were analyzed with the Kruskal-Wallis, 1-way ANOVA, and χ(2) test (α=.05). RESULTS: Crowns that were unconditioned and piranha etched and/or adhesively untreated or pretreated with Ambarino P60 had the lowest retention strength. The highest values were found for the airborne-particle abrasion and sulfuric etched groups and/or crowns adhesively pretreated with Signum PEEK Bond and visio.link. Composite resin cement that remained on dentin was observed more frequently for unconditioned groups in combination with Ambarino P60 and no adhesive pretreatment. Mixed failure types were found more frequently in the airborne-particle abrasion group in combination with visio.link, Signum PEEK Bond, and no adhesive pretreatment, in the sulfuric acid etched group combined with Ambarino P60 and no adhesive pretreatment, and after the piranha acid pretreatment in combination with visio.link or Signum PEEK Bond. CONCLUSIONS: The adhesion of the tested PEEK crowns to dentin was satisfactory after treatment with airborne-particle abrasion or etching with sulfuric acid and/or when additional adhesive systems such as visio.link or Signum PEEK Bond were used.

Phototherapy with UVB narrowband, UVA/UVBnb, and UVA1 differentially impacts serum 25-hydroxyvitamin-D3.

BACKGROUND: Ultraviolet (UV) B radiation increases serum 25-hydroxyvitamin-D3 [25(OH)D], but the influence of UVA1 and UVA/narrowband UVB (UVBnb) phototherapy on serum vitamin D is unknown. OBJECTIVE: We sought to investigate the influence of UVBnb, UVA1, and UVA/UVBnb phototherapy on serum levels of 25(OH)D and related parameters in patients with an inflammatory skin condition. METHODS: 25(OH)D, as well as calcium, parathormone, phosphate, and albumin were measured before therapy, 2 weeks after start, and after completion of the phototherapy. Diagnoses were divided in 4 groups: atopic dermatitis, psoriasis, morphea, and others. RESULTS: We surveyed 116 dermatologic patients undergoing phototherapy with UVA1 (n = 38), UVA/UVBnb (n = 30), or UVBnb (n = 48) 2 to 3 times a week for 53 to 90 days. UVBnb phototherapy increased serum 25(OH)D from 22.1 to 39.5 ng/mL after the therapy (P < .001). The lower the baseline 25(OH)D level was, the steeper the increase in 25(OH)D was upon application of UVBnb phototherapy. UVA/UVBnb therapy also increased serum 25(OH)D, from 23.9 to 50.3 ng/mL (P = .003). Conversely, in the UVA1 therapy group, 25(OH)D serum levels decreased significantly from 21.9 to 19.0 ng/mL (P < .001). LIMITATIONS: The study design was open trial without randomization. An influence of a precise skin disease cannot be excluded because of the heterogeneous diagnoses. Bias may have arisen from patient preference for treatment at our center, referral, unrecognized differences in underlying skin disease, and other factors. CONCLUSION: Phototherapy with UVBnb and UVA/UVBnb increased 25(OH)D serum level significantly. UVA1 therapy alone induced a reduction in serum 25(OH)D concentrations.

Discoloration of manually fabricated resins and industrially fabricated CAD/CAM blocks versus glass-ceramic: effect of storage media, duration, and subsequent polishing.

This study determined the discoloration of five CAD/CAM resins, four manually polymerized resins, and glass-ceramic as control group. Specimens were divided into three groups (N=300, n=30) to be stored in coffee, black tea and red wine (n=10). The discoloration was measured using a spectrophotometer after 1, 7, 29, 90, 180 days storage. All tested groups showed color change (ΔE) at all time points. The manually polymerized resin composites GD (Gradia) and CM (CronMix K), and the CAD/CAM resin composite HC (Blanc High-class) showed significantly higher ΔE compared to all other groups in all tested media. The discoloration was extrinsic and decreased after polishing for the majority of the tested materials. Except CAD/CAM resin HC (Blanc High-class), all CAD/CAM resins showed similar color stability compared to the control group.

Impact of air-abrasion on fracture load and failure type of veneered anterior Y-TZP crowns before and after chewing simulation.

The purpose of this study was to determine the fracture load and failure types of veneered zirconia crowns that were air-abraded on either the veneering or cementation surface. Fracture loads were determined before and after chewing simulation. Standardized Y-TZP frameworks (n = 360) for canines were fabricated and divided into one control group (n = 72) and 12 test groups (n = 24). The test groups were air-abraded using alumina powder (10 s, 2 bar, distance: 10 mm) with particle size of 50 µm resp. 110 µm and veneered with one of the veneering ceramics: Triceram, Zirox, or VITA VM9. The crowns were cemented on their corresponding CoCr abutment. The initial fracture load was measured in one half of each group (n = 12), and the other half (n = 12) was subjected to chewing cycling. The data were analyzed using three-way and one-way ANOVA, a post-hoc Scheffé test, two sample Student's t-test, and Weibull statistics (p < 0.05). Thus, nonaged, air-abraded groups of two veneering ceramics (Triceram, VITA VM9) showed higher mean fracture load compared to control groups. After chewing simulation, air-abraded groups showed lower mean fracture load compared to control groups. Aging decreased the Weibull modulus of all tested groups, and air-abraded groups showed lower Weibull moduli compared to control groups.

Effect of surface conditioning with airborne-particle abrasion on the tensile strength of polymeric CAD/CAM crowns luted with self-adhesive and conventional resin cements.

STATEMENT OF PROBLEM: Adhesively bonded, industrially polymerized resins have been suggested as definitive restorative materials. It is claimed that such resins present similar mechanical properties to glass ceramic. PURPOSE: The purpose of this study was to assess the tensile strength of polymeric crowns after conditioning with 2 different protocols: luted with self-adhesive or with conventional resin cements to dental abutments. MATERIAL AND METHODS: Human teeth were prepared for crowns and divided into 13 groups (N=312, n=24 per group). Polymeric crowns were CAD/CAM fabricated and divided into 3 groups depending on different surface conditioning methods: A) No treatment, B) airborne-particle abrasion with 50 µm alumina, and C) airborne-particle abrasion with 110 µm alumina. Thereafter, the crowns were luted on dentin abutments with the following cements: 1) RXU (RelyX Unicem, self-adhesive), 2) GCM (G-Cem, self-adhesive), 3) ACG (artCem GI, conventional), and 4) VAR (Variolink II, conventional). Glass ceramic crowns milled and cemented with dual-polymerized resin cement (Variolink II) served as the control group. The tensile strength was measured initially (n=12) and after aging by mechanical thermocycling loading (1 200 000 cycles, 49 N, 5°C to 50°C) (n=12). The tensile strength (MPa) of all crowns was determined by the pull-off test (Zwick/Roell Z010; Ulm, Germany, 1mm/min). Subsequently, the failure types were classified. Data were analyzed with 2-way and 1-way ANOVA followed by a post hoc Scheffé test and t test (α=.05). RESULTS: No adhesion of the tested cements was observed on unconditioned polymeric CAD/CAM crowns and those luted with VAR. Among the tested cements, GCM showed significantly higher values after airborne-particle abrasion with 110 µm (initial: 2.8 MPa; after aging: 1 MPa) than 50 µm alumina (initial: 1.4 MPa; after aging: 0 MPa). No significant effect was found between 50 and 110 µm particle size alumina in combination with the other 2 cements. After aging, the tensile strength of the crowns luted with GCM (50 µm: 0 MPa and 110 µm: 1 MPa) and ACG (50 µm: 1 MPa and 110 µm: 1.2 MPa) was significantly lower than those luted with RXU (50 µm: 1.9 MPa and 110 µm: 2 MPa). All airborne particle abraded polymeric CAD/CAM crowns (initial: 1.4-2.8; 0-2 MPa) showed significantly lower tensile strength values than the control group (initial: 7.3 MPa; after aging: 6.4 MPa). Although with all polymeric specimens, failure type was adhesive between the cement and the crowns, the control group showed exclusively cohesive failures within the ceramic. CONCLUSIONS: Airborne-particle abrasion before cementation of polymeric CAD/CAM crowns minimally improved the tensile strength. Both the failure types and the tensile strength values of adhesively luted glass ceramic crowns showed superior results to adhesively cemented polymeric ones. Although the tensile strength results were low, crowns cemented with RXU showed, after aging, the highest tensile strength of all other tested groups.

The impact of in vitro aging on the mechanical and optical properties of indirect veneering composite resins.

STATEMENT OF PROBLEM: Flexural strength, hardness, surface roughness, discoloration, and abrasion resistance are important properties of veneering composite resins. Recently introduced veneering resins are purported to have enhanced mechanical properties due to their composition, but their long-term durability is not known. PURPOSE: The purpose of this study was to test the impact of aging on 3 different veneering composite resins. MATERIAL AND METHODS: Indirect composite resins, GC Gradia, VITA VM LC, and Sinfony were prepared for flexural strength (n=165 per group), Martens hardness (n=10), surface roughness (n=10), discoloration measurement (n=30), and abrasion resistance (n=6) testing. After initial flexural strength measurement, the remaining specimens were stored in water or subjected to thermocycling for 1, 7, 28, 90, or 180 days, and hardness and surface roughness (water stored: n=5 and thermocycling: n=5) were tested. The discoloration specimens were divided into 3 groups: coffee, black tea, and red wine; n=10), and age and discoloration were measured. Abrasion resistance was determined after 120,000, 240,000, 640,000, and 1,200,000 mechanical thermocycling loading. One-way ANOVA was used, followed by a post hoc Scheffé test and t test. The longitudinal observations were analyzed by using linear mixed models (α=.05). RESULTS: When considering all 5 of the properties tested, Sinfony demonstrated the best results, followed by GC Gradia and VITA VM LC. CONCLUSIONS: The veneering composite resin, Sinfony, showed the most stable properties.

Impact of long-term iron chelation therapy on growth and endocrine functions in thalassaemia.

A large number of children treated from the time of diagnosis with modern transfusion and chelation therapy are now entering early adolescence or early adulthood, and only now can we evaluate how many complications, secondary to iron overload, can be prevented by daily s.c. desferrioxamine (DFX) therapy. In 1989, we planned a multi-centre study on growth and endocrine complications in patients who started chelation therapy with DFX early in life. Height, weight, endocrine complications, haematological variables and compliance with DFX were evaluated in a study group of 238 patients aged 2-17 years with beta-thalassaemia major regularly followed in 13 paediatric and haematological Italian centres. The LMS method by Cole and Green and the Mann-Whitney test were applied for statistical analysis. Twenty-six patients with thalassaemia (12.4%) had growth hormone insufficiency, five patients (2.1%) had primary hypothyroidism and four patients (1.7%) had hypoparathyroidism. Delayed puberty was present in 18.4% of boys and 17.7% of girls. At the beginning of chelation, standing height was in the normal range when compared to Swiss standards, while in the following years a progressive decline of growth was observed in both sexes. In conclusion, our study noted a positive effect of DFX therapy on sexual maturation and endocrine complications. Nevertheless, short stature has persisted despite major advances in treatment.