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Clin Gastroenterol Hepatol ; 14(7): 1001-1010.e5, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26905906


BACKGROUND & AIMS: The prevalence of obesity and number of patients undergoing bariatric surgery are increasing. Obesity has adverse effects in patients with acute pancreatitis (AP). We investigated whether bariatric surgery affects outcomes of patients with AP. METHODS: We performed a retrospective study, collecting data from the US Nationwide Inpatient Sample (2007-2011) on all adult inpatients (≥18 years) with a principal diagnosis of AP (n = 1,342,681). We compared primary clinical outcomes (mortality, acute kidney injury, and respiratory failure) and secondary outcomes related to healthcare resources (hospital stay and charges) among patient groups using univariate and multivariate analyses. We performed a propensity score-matched analysis to compare outcomes of patients with versus without bariatric surgery. RESULTS: Of patients admitted to the hospital with a principal diagnosis of AP, 14,332 (1.07%) had undergone bariatric surgery. The number of patients that underwent bariatric surgery doubled, from 1801 in 2007 to 3928 in 2011 (P < .001). AP in patients that had undergone bariatric surgery was most frequently associated with gallstones. Multivariate analysis associated prior bariatric surgery with decreased mortality (odds ratio, 0.41; 95% confidence interval, 0.18-0.92), shorter duration of hospitalization (0.65 days shorter; P < .001), and lower hospital charges ($3558 lower) than in patients with AP not receiving bariatric surgery (P < .001). A propensity score-matched cohort analysis found that mortality and odds of acute kidney injury were similar between patients with versus without history of bariatric surgery, whereas respiratory failure was less frequent in patients who received bariatric surgery (1.34% vs 4.42%; P < .001). CONCLUSIONS: Prior bariatric surgery in patients hospitalized with AP is not adversely associated with in-hospital mortality, development of organ failure, or healthcare resource use. Bariatric surgery may mitigate the obesity-associated adverse prognostication in AP. These observations are pertinent for future research, because the prevalence of obesity and AP-related hospitalizations is increasing.

Cirurgia Bariátrica/efeitos adversos , Obesidade/cirurgia , Pancreatite Necrosante Aguda/complicações , Injúria Renal Aguda/epidemiologia , Adulto , Idoso , Feminino , Custos de Cuidados de Saúde , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/mortalidade , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos
J Glaucoma ; 24(2): 117-21, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23807346


PURPOSE: To investigate differences in ocular blood flow in individuals of African descent (AD) and European descent (ED) with open angle glaucoma (OAG). PATIENTS AND METHODS: A retrospective data analysis was performed on OAG patients of AD and ED who were previously examined for ocular blood flow within the Department of Ophthalmology at Indiana University School of Medicine. Data analysis included blood pressure, heart rate, visual fields, intraocular pressure, ocular perfusion pressure, and color Doppler imaging of retrobulbar vessels. Color Doppler imaging measurements were performed on ophthalmic, central retinal, and nasal and temporal short posterior ciliary arteries, with peak systolic (PSV) and end diastolic velocities (EDV) as well as the Pourcelot vascular resistive index calculated for each vessel. Two-sample t tests of unequal variance were performed with P values <0.05 considered statistically significant. RESULTS: OAG patients of AD had statistically significant lower retrobulbar blood flow values than patients of ED including lower ophthalmic artery PSV (P=0.0001), ophthalmic artery EDV (P=0.0008), central retinal artery PSV (P=0.01), temporal short posterior ciliary artery PSV (P=0.0037), and nasal short posterior ciliary artery PSV (P<0.0001). No significant differences were found in terms of intraocular pressure or visual field parameters. CONCLUSIONS: Significantly lower blood flow values were identified in all retrobulbar blood vessels in AD compared with ED OAG patients. These findings suggest that the contribution of ocular blood flow to the disease process may be different in AD compared with ED OAG patients.

Afro-Americanos/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Glaucoma de Ângulo Aberto/etnologia , Glaucoma de Ângulo Aberto/fisiopatologia , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Artérias Ciliares/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Artéria Retiniana/fisiologia , Estudos Retrospectivos , Tonometria Ocular , Ultrassonografia Doppler em Cores , Campos Visuais/fisiologia
Diabetes Educ ; 39(2): 187-94, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23427241


PURPOSE: The purpose of this study was to examine the role of initial diabetes education delivery at an academic medical center (AMC) versus non-AMCs on long-term glycemic control. METHODS: We performed a retrospective study of children with type 1 diabetes referred to an AMC after being educated at non-AMCs. These children were matched to a group of children diagnosed and educated as inpatients at an AMC. The A1C levels at 2, 3, and 5 years from diagnosis were compared between the 2 groups of children. RESULTS: Records were identified from 138 children. Glycemic control was comparable in the non-AMC-educated versus AMC-educated patients at 2, 3, and 5 years from diagnosis. The A1C was also highly consistent in each patient over time. CONCLUSIONS: Long-term glycemic control was independent of whether initial education was delivered at an AMC or non-AMC. Formal education and location at time of diagnosis do not appear to play a significant role in long-term glycemic control. Novel educational constructs, focusing on developmental stages of childhood and reeducation over time, are likely more important than education at time of diagnosis.

Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Hemoglobina A Glicada/metabolismo , Adaptação Psicológica , Criança , Serviços de Saúde da Criança , Pré-Escolar , Comunicação , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Indiana/epidemiologia , Lactente , Masculino , Educação de Pacientes como Assunto , Relações Profissional-Família , Estudos Retrospectivos , Autocuidado , Resultado do Tratamento
Br J Ophthalmol ; 97(3): 253-7, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23143788


The purpose of this review is to discuss the process of genericisation of medications in the US and Europe with a focus on ophthalmic drugs. Regulatory guidelines of the US Food and Drug Administration and the European Medicines Agency will be discussed, and the advantages and concerns of genericisation will be explored. We will look at various studies concerning the safety and efficacy of generic drugs compared to their branded counterparts. In particular, the challenges of assuring bioequivalence and therapeutic equivalence in topical ophthalmic drugs will be examined.

Medicamentos Genéricos/uso terapêutico , Oftalmopatias/tratamento farmacológico , Oftalmologia , Humanos