Burden Of Depression Among Individuals With Irritable Bowel Syndrome(IBS) In The Medicaid Population

Objective: to determine the period prevalence of IBS and comorbid depression among individuals with Irritable Bowel Syndrome (IBS) in multi-state Medicaid population, and to assess the impact of comorbid depression on healthcare utilization and costs among individuals with IBS enrolled in fee-for-service Medicaid program. Methods: a retrospective cohort study was conducted using 2006-2008 Medicaid analytic extract files for 39 states. Beneficiaries with IBS were identified based on any medical claims for the disease. Beneficiaries with one or more medical claims for depression during the study period were considered to have had comorbid depression. For each beneficiary, the first claim for IBS in 2007 was considered as the index date. 12-month post index date all-cause and IBS-related healthcare utilization and costs were computed for each of the four medical service components “inpatient, outpatient, emergency room, and prescription drug. Generalized linear models were used to assess the impact of comorbid depression on healthcare utilization and costs. Results: the period prevalence of IBS in the population was 4.4 per 1,000 Medicaid beneficiaries. The period prevalence of comorbid depression among beneficiaries with IBS was 26.88%. Beneficiaries with IBS and depression had significantly greater all-cause and IBS-related inpatient, IBS-related outpatient, all-cause emergency room, all-cause and IBS-related prescription drug utilization, and IBS-related outpatient, all-cause and IBS-related emergency room, and all-cause and IBS-related prescription drug costs as compared to those without depression. Conclusion: given the impact on healthcare use and costs, there is a need for better screening and management of depression in this population

Efficacy and safety of D,L-3-hydroxybutyrate (D,L-3-HB) treatment in multiple acyl-CoA dehydrogenase deficiency

PURPOSE: Multiple acyl-CoA dehydrogenase deficiency (MADD) is a life-threatening, ultrarare inborn error of metabolism. Case reports described successful D,L-3-hydroxybutyrate (D,L-3-HB) treatment in severely affected MADD patients, but systematic data on efficacy and safety is lacking.METHODS: A systematic literature review and an international, retrospective cohort study on clinical presentation, D,L-3-HB treatment method, and outcome in MADD(-like) patients.RESULTS: Our study summarizes 23 MADD(-like) patients, including 14 new cases. Median age at clinical onset was two months (interquartile range [IQR]: 8 months). Median age at starting D,L-3-HB was seven months (IQR: 4.5 years). D,L-3-HB doses ranged between 100 and 2600 mg/kg/day. Clinical improvement was reported in 16 patients (70%) for cardiomyopathy, leukodystrophy, liver symptoms, muscle symptoms, and/or respiratory failure. D,L-3-HB appeared not effective for neuropathy. Survival appeared longer upon D,L-3-HB compared with historical controls. Median time until first clinical improvement was one month, and ranged up to six months. Reported side effects included abdominal pain, constipation, dehydration, diarrhea, and vomiting/nausea. Median D,L-3-HB treatment duration was two years (IQR: 6 years). D,L-3-HB treatment was discontinued in 12 patients (52%).CONCLUSION: The strength of the current study is the international pooling of data demonstrating that D,L-3-HB treatment can be effective and safe in MADD(-like) patients.</p

Additional file 2: of Minimal clinically important difference for the 6-min walk test: literature review and application to Morquio A syndrome

Percent change from MOR-004 baseline in 6-min walk test (6MWT) distance at 2 years in the MOR-005 Modified Per-Protocol (MPP) population (excluding patients who had orthopedic surgery during the extension study or missed ≥20% of their scheduled elosulfase alfa infusions) and comparable, untreated patients from the MorCAP natural history study. (DOCX 12 kb

Incidence and risk factors of immune‐related adverse events induced by immune checkpoint inhibitors among older adults with non‐small cell lung cancer

Abstract Background Immune checkpoint inhibitor (ICI) treatment has been linked to a variety of immune‐related adverse events (irAEs), which can affect any organ system. The incidence and risk factors of irAEs have not been adequately evaluated among older adults with NSCLC. Methods A cohort study was conducted using 1999–2019 SEER‐Medicare data among beneficiaries aged ≥65 years with a diagnosis of NSCLC who received nivolumab, pembrolizumab, or atezolizumab. Incident irAEs were identified post‐ICI initiation. Demographic, cancer‐related characteristics, and clinical history risk factors of irAEs were evaluated with competing events considered. Results A total of 8175 older NSCLC patients were included (with 46.8% experiencing irAEs). Pneumonitis (16.5%), hypothyroidism (10.5%), arrhythmia (11.18%), and acute kidney injury (AKI) (5.8%) were the most common irAEs. The median time to first irAE was 82 days (IQR: 29–182 days). The earliest onset of irAE occurrence was for hematologic irAEs, while the latest were gastrointestinal, dermatologic, and musculoskeletal irAEs. Fine–Gray regression modeling revealed significantly greater hazards of irAE occurrence in patients who received pembrolizumab at index, did not have CNS metastases, had a history of autoimmune disorder, and had chemotherapy in combination with ICI. Race, socioeconomic status, previous radiation therapy, and comorbidity burden were found to be associated with the occurrence of certain type of irAEs. Conclusion A significant proportion of older patients with NSCLC develop an irAE after receiving ICI treatment. Factors related to cancer and treatment as well as demographics contribute to the increased risk of irAEs. Close monitoring and prediction of irAE among older patients receiving ICI is warranted

Synthesis and Property of Copper-Impregnated alpha-MnO2 Semiconductor Quantum Dots

Because of the superior optical and electrical properties, copper-impregnated size tuneable high-temperature stable manganese dioxide semiconductor quantum dots (SQDs) have been successfully synthesized by a modified chemical synthesis technique. Their size-dependent dielectric properties, semiconducting properties, and current voltage (I-V) characteristics have been investigated. X-ray diffraction pattern and Raman spectra confirmed that the required phase is present. Because of the different sintering temperature tuneable size of SQDs has been found and confirmed by high resolution transmission electron microscopy. The band gap energy of the material is found to be 1.25-1.67 eV, measured from Tauc plot using UV-vis absorbance spectrum and their semiconducting properties have been confirmed by the non linear current voltage (I-V) behavior. Most intense green emission peak of photoluminescence (PL) spectroscopy confirms the oxygen vacancy defect state. The stoke shifting of Raman spectra, UV absorption, and PL emission are the footprint of quantum confinement effect. Incorporation of a little amount of Cu in tetragonal hollandite structure of alpha-MnO2 generates strain within that structure. This leads to create sufficient crystal defect state as well as rise in dielectric constant accompanied with low dielectric loss and higher ac conductivity. All these highly desirable properties make the SQDs a potential candidate for developing multifunctional photo-electronic devices. Owing to the tuneable band gap and electronic transport of the SQDs, we realized that the controllable size paves the way for designing SQDs possessing unique properties for optical and electronic device applications. Using this material as a high dielectric separator, a high-performance supercapacitor has been successfully fabricated which can light up 15 light-emitting diodes for 47 min 23 s after charging them only for 30 s