England, Bryant

Helget, Lindsay

Mikuls, Ted R

Petro, Alison D.

Roul, Punyasha

Sayles, Harlan

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Graduate Medical Education Research Journal Volume 3 Issue 1 Article 14 Risk Factors for Mortality Among Patients with Gout in the Veteran's Health Administration Lindsay Helget University of Nebraska Medical Center Bryant England University of Nebraska Medical Center Punyasha Roul University of Nebraska Medical Center Harlan Sayles University of Nebraska Medical Center Alison D. Petro University of Nebraska Medical Center See next page for additional authors Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj Digital Commons Network Logo  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Helget, L., England, B., Roul, P., Sayles, H., Petro, A. D., , Mikuls, T. R. Risk Factors for Mortality Among Patients with Gout in the Veteran's Health Administration. Graduate Medical Education Research Journal. 2021 Oct 04; 3(1). https://digitalcommons.unmc.edu/gmerj/vol3/iss1/14 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Risk Factors for Mortality Among Patients with Gout in the Veteran's Health Administration Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. Authors Lindsay Helget, Bryant England, Punyasha Roul, Harlan Sayles, Alison D. Petro, and Ted R. Mikuls This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol3/iss1/14 Sept. 2021  |  Vol. 3  |  Issue 1 Oral Presentations 33*Names in bold type indicate presenting author.Proceedings of the 3rd Annual Graduate Medical Education Research Symposium | Oral Presentations — Original ResearchNavnika Gupta1, Afsaneh Shirani1, Elizabeth Hartman1, Lakshman Arcot1, Rana Zabad11University of Nebraska Medical Center, College of Medicine, Department of Neurological SciencesMentor: Rana ZabadProgram: Neurological SciencesType: Original ResearchBackground: Autoantibodies against nodal and paranodal proteins, particularly anti-neurofascin (NF) antibodies, have been recently described in demyelinating disorders of the central and peripheral nervous system. There is an unmet need for further characterization of anti-NF associated demyelinating diseases. We describe the patients with anti-NF antibodies, and attempt to identify features that might guide clinicians to check for them.Methods: This is a retrospective chart review Nebraska Medical Center Multiple Sclerosis Clinic who tested positive for serum anti-NF antibodies by western blot.Results:female to male ratio was 4:1, and the median age at presentation was 60 years (range: 56-70). Clinical presentations included incomplete transverse myelitis (n=2), progressive myelopathy (n=1), recurrent symmetric polyneuropathy (n=1), and Atypical features prompting further workup included co-existing upper and lower motor neuron features, older age at presentation anti-NF antibody panel was positive for the Conclusions: Our case-series suggests that anti-NF antibodies are more commonly detected in the older populations and women. The clinical phenotype is pleiotropic. Atypical prompted further workup. Larger studies are needed to assess the impact of anti-NF antibodies on long-term clinical outcomes and their associated therapeutic implications. Seropositive Pediatric Autoimmune Encephalitis: A Single Center ExperiencePraveen Hariharan1, Daniel A. Crespo Artunduaga1 21University of Nebraska Medical Center, College of Medicine, Department of Neurological Sciences 2Children’s Hospital & Medical Center, Division of Pediatric NeurologyMentor: Geetanjali RathoreProgram: NeurologyType: Original research Background: The objective of the study is to describe the clinical characteristics and identify unique features associated with antibody-positive autoimmune encephalitis (AE). Methods: Charts of children aged below 18-years diagnosed with AE between 2005 and 2020 were reviewed. Demographics, clinical characteristics, laboratory, imaging, neurological-sequalae were collected.Results: Among 53 AE cases, 19 had serum or CSF antibodies. Among antibody-positive AE patients, there were 9 (47%) male and 10 (53%) female patients of whom; 10 (52.6%) had anti-NMDAR-antibodies, 5 (26%) anti-GAD65-antibodies. Clinical presentation included neuropsychiatric symptoms (68.4%), altered mental status (63%), movement disorders (57.9%), new-onset seizures epilepticus (10.5%) and sleep dysfunction admission and 9 (47.3%) experienced was abnormal with T2 hyperintensities in 13 patients (31.5%) - 3 in parietal lobe, 2 in temporal lobe and 2 in frontal lobe. Seven Nine patients (47.3%) had CSF pleocytosis and protein was normal in all patients. Acute management consisted of several different combination regimens including intravenous steroids (89%), intravenous immunoglobulin exchange (PLEX) (10.5%). Maintenance (36.8%) and 1 PLEX. Six patients (31.5%) attained complete remission and one patient underwent excision of ovarian teratoma. Long term sequalae included neurocognitive disturbances (52.6%), epilepsy (31.5%) and movement disorders (5%).Conclusion: The most frequent presentation of AE in our cohort was neuropsychiatric disturbances, followed by altered mental status. Given diverse clinical presentations, one should maintain broad differential diagnosis when evaluating pediatric  patients with subacute onset neurological symptoms. Risk Factors for Mortality Among Patients with Gout in the Veteran’s Health AdministrationLindsay N. Helget,1,2 Bryant R. England,1,2 Punyasha Roul,1,2 Harlan Sayles,2,3 Alison D. Petro,1,2 Ted R. Mikuls1,21Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE2University of Nebraska Medical Center, College of Medicine, Department of Internal Medicine, Division of Rheumatology3University of Nebraska Medical Center, College of Public Health, Department of BiostatisticsMentor: Ted MikulsProgram: RheumatologyType: Original ResearchBackground: A complete understanding of factors driving the increased all-cause mortality risk in patients with gout is lacking. The purpose of this study was to examine risk factors associated with mortality among Graduate Medical Education Research Journal34 Oral Presentations*Names in bold type indicate presenting author.Methods: We performed a retrospective cohort study, identifying patients with gout followed from the index date until death or censoring. Potential predictors of mortality Multivariable Cox regression models were constructed to identify independent predictors of all-cause mortality.Results: 4,250,477 patient-years of follow-up, there were 246,291 deaths. Multivariable adjusted associations with all-cause mortality are shown in Table 1. Risk factors associated with increased mortality risk included male sex, older age, Black non-Hispanic race, comorbidities, diuretic, opioid, ULT, colchicine, and steroid use. Factors associated with a lower risk of all-cause mortality included white Hispanic, black Hispanic, and Conclusion: multiple risk factors for mortality in veterans with gout with the strongest risk factors and cancer, as well as the use of steroids and opioids. Mechanisms underpinning associations between select medication use and survival will require additional study accounting for the effects of comorbid CKD severity.     Ming-yang Hung1, Nan Zhou1, Chi Zhang1 1University of Nebraska Medical Center, College of Medicine, Department of Radiation OncologyMentor: Chi ZhangProgram: Radiation OncologyType: Original ResearchBackground: Androgen receptor (AR) malignant gliomas, suggesting that AR plays an important role in tumor carcinogenesis. overexpression remains largely to be explored.Methods: AR gene expression at the levels of mRNA, protein expression, and clinical data were obtained from the Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA) databases. AR expression levels were compared across gliomas of different histopathologic and molecular subtypes. Lastly, Kaplan-Meier survival analyses in patients with different AR expression levels were investigated for the potential prognostic values of AR.Results: Compared to normal brain tissue, higher AR mRNA expression (p < .01). Furthermore, AR mRNA expression was more prominent in higher grade disease, regardless of histopathologic and molecular subtypes (p < 0.01). Similarly, at the protein level, AR protein was more abundant in GBM than in (p <0.0001). This was corroborated by a linear association between AR mRNA and protein expression (r = 0.65, p < 0.001). Finally, in LGG, both high AR gene and protein worse overall survival. Five-year overall survival for patients with LGG with high AR Table 1.Patient characteristics associated with all-cause mortality in veterans with gout.CharacteristicAge, Years 1.06 (1.06, 1.06)Male (vs. Female) Sex 1.07 (1.02, 1.12)Race and EthnicityWhite HispanicWhite Non-HispanicBlack HispanicBlack Non-HispanicAsianOtherMissing0.81 (0.78, 0.83) Referent 0.78 (0.69, 0.89) 1.06 (1.04, 1.07) 0.62 (0.59, 0.66) 1.07 (1.04, 1.09) 1.95 (1.93, 1.97)Service Connected Condition 0.84 (0.83, 0.85)Urban Residence (vs. Rural) 1.02 (1.02, 1.03)VHA Enrollment Duration, Years 0.95 (0.95, 0.95)Health Factors & ComorbiditiesBody Mass Index<20 kg/m220 to <25 kg/m225 to <30 kg/m20.97 (0.93, 1.02)Referent0.74 (0.73, 0.75)0.68 (0.67, 0.69)ComorbiditiesMyocardial infarction or atherosclerosis, %Other cardiovascular disease, %Stroke, %Hypertension, %Lung disease, %Depression, %Diabetes mellitus, %Ulcer or stomach problem, %Cancer, %1.11 (1.09, 1.13)1.46 (1.45, 1.47)1.17 (1.15, 1.19)0.90 (0.89, 0.91)1.59 (1.57, 1.61)1.15 (1.14, 1.17)1.34 (1.32, 1.35)1.06 (1.04, 1.08)1.23 (1.21, 1.24)Diuretic Use 1.37 (1.36, 1.39)ULT Use (Allopurinol, Febuxostat, Probenecid, Pegloticase)1.04 (1.03, 1.05)NSAID Use 0.87 (0.86, 0.88)Steroid Use 1.15 (1.13, 1.16)Colchicine Use 1.08 (1.07, 1.09)Opioid Use 1.17 (1.16, 1.19)0.99 (0.98, 1.00)*All variables included in multivariable model are shown in the tableAbbreviations: VHA, Veterans Health Administration; ULT, urate lowering therapy

Risk Factors for Mortality Among Patients with Gout in the Veteran\u27s Health Administration

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Risk Factors for Mortality Among Patients with Gout in the Veteran\u27s Health Administration

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