Nonsteroidal anti-inflammatory drug exposure and the risk of microscopic colitis.

BACKGROUND: Medication consumption has been suggested as a risk factor for microscopic colitis (MC), but studies of varying design have yielded inconsistent results. Our aim was to evaluate the association between medications and MC. METHODS: A hybrid cohort of prospectively identified patients undergoing colonoscopy with biopsies for suspicion of MC (N = 144) and patients with MC enrolled within three months of diagnosis into an MC registry (N = 59) were surveyed on medication use. Medication use was compared between patients with and without diagnosis of MC by chi-squared test and binomial logistic regression adjusted for known risk factors of MC: age and gender. RESULTS: In total, 80 patients with MC (21 new, 59 registry) were enrolled. Patients with MC were more likely to be older (p = 0.03) and female (p = 0.01) compared to those without MC. Aspirin and other non-steroidal anti-inflammatory drugs were more commonly used among patients who developed MC (p < 0.01). After controlling for age and gender, these medications remained independent predictors of MC with odds ratio for any non-steroidal anti-inflammatory drug use of 3.04 (95% CI: 1.65-5.69). No association between MC and other previously implicated medications including proton pump inhibitors and selective serotonin reuptake inhibitors was found. CONCLUSIONS: In this cohort of patients with chronic diarrhea, we found use of aspirin and non-steroidal anti-inflammatory drugs, but not other implicated medications to be associated with the development of MC. Whether these drugs trigger colonic inflammation in predisposed hosts or worsen diarrhea in undiagnosed patients is unclear. However, we feel that these findings are sufficient to discuss potential non-steroidal anti-inflammatory drug cessation in patients newly diagnosed with MC.

The Burden of Retinal Venous Occlusion: An Assessment of Fellow Eyes in 1000 Cases.

OBJECTIVE: To assess retinal vein occlusion (RVO) clinical features to create a simulation model quantifying the preference-based, patient value gain (benefit) and cost-utility (cost-effectiveness) of RVO therapy. DESIGN: Retrospective analysis data integrated with patient utilities and an ocular cost-utility model for RVO. PARTICIPANTS: One thousand consecutive Wills Eye Hospital Retina Service RVO patients seen from January 2010 through April 2011. METHODS: Value-Based Medicine analysis assessing the demographic features and vision in affected eyes and fellow eyes of RVO patients. MAIN OUTCOME MEASURES: Presenting vision, final vision, conversion incidence of fellow eyes to RVO, and patient value gain in quality-adjusted life-years (QALYs). RESULTS: Among 1000 patients, 332 (33.2%) presented with central retinal vein occlusion (CRVO), 53 (5.3%) with hemiretinal vein occlusion (HRVO), and 615 (61.5%) with branch retinal vein occlusion (BRVO). Mean follow-up for the entire RVO cohort was 3 years. One hundred and one patients (10.1%) had bilateral baseline RVO and, among the 826 unilateral cases seen more than once, 37 (4.5%) developed a fellow-eye RVO, a unilateral-to-bilateral conversion rate of 1.5%/year. Among the 101 baseline bilateral cases, 66% (66/101) had the same RVO variant bilaterally (CRVO/CRVO, HRVO/HRVO, or BRVO/BRVO). Mean CRVO baseline vision was 20/63-2 and final vision was 20/63-1 (P = 0.16). Thirty percent of patients had less than or equal to baseline fellow-eye vision. Within combined HRVO/BRVO cohorts, mean baseline vision was 20/50-2 and final vision was 20/50+1 (P = 0.0004). Thirty percent of patients also had less than or equal to baseline fellow-eye vision. The proportion of RVO patients with fellow-eye vision less than or equal to the RVO primary-eye baseline vision increased to 44% by year 16. CONCLUSIONS: Thirty percent of all RVO patients had less than or equal to baseline vision in the fellow eye. Among unilateral RVO cases, 1.5%/year developed fellow-eye RVO. These findings have implications for cost-utility analysis, because bilateral vision loss yields greater QALY loss and an increased financial burden compared with unilateral loss. Referent to total therapeutic QALY gain (100%), if a treated RVO was always considered the better-seeing eye, the actual clinical scenario demonstrates that the average CRVO patient gains 38% as much value and the average HRVO/BRVO patient gains 37% as much.

Interpatient distributions of bloodspot area per fixed volume of application: comparison between filter paper and non-cellulose dried matrix spotting cards.

BACKGROUND: Non-cellulose dried matrix spotting (DMS) cards are an alternative to filter paper (FP) for bloodspots. We compared the interpatient distributions of bloodspot areas between DMS and FP for a fixed volume of application of whole blood, and examined correlations of areas with hematocrit. METHODS: EDTA-whole blood adult patient samples (n=49; 25 males, 24 females) were utilized after routine measurement of hemoglobin and hematocrit. Replicate (4×) bloodspots were produced by bolus drop application of 50µL whole blood via a fixed-volume pipettor to either FP or DMS. Dried bloodspot areas were determined by image analysis. RESULTS: Hematocrits (HCT) were normally distributed (HCT=30.9±5.3%). For both FP and DMS, bloodspot areas (a, cm(2)) across patients were normally distributed: for FP, a=1.11±0.056cm(2) (±5.0%); for DMS, a=0.378±0.037cm(2) (±9.9%). Relative bloodspot area differences across the population range were >20% for both DMS and FP. Correlation of bloodspot areas to hematocrit was negative for FP (r=-0.80) but positive for DMS (r=+0.78). CONCLUSIONS: Interpatient variation in blood volume per area is a preanalytical variable for both DMS and FP bloodspots. Hematocrit is but one interpatient variable, as correlations of fixed-volume bloodspot areas with hematocrit across patients were substantially inexact (r(2)<0.65).