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This study was conducted to investigate the long-term survival in male patients with systemic lupus erythematosus (SLE) and its predictors. The main demographic and clinical manifestations at the time of disease diagnosis were recorded retrospectively. Kaplan–Meier curves were used to calculate survival rates. Predictors of mortality were determined by backward Cox regression analysis. Eighty-four male patients with SLE were enrolled. During the 23-year study period, 11 patients died. Lupus nephritis (5 cases), infections (5 cases) and alveolar hemorrhage (1 case) were the most common causes of deaths. Overall survival rates at the end of 5, 10, 15, and 20 years after SLE disease diagnosis were 86%, 84%, 84% and 84%, respectively. In multivariate backward-regression analysis, the main determinants of death at the time of SLE diagnosis were oral ulcer (p = 0.004, HR = 7.69, 95% CI 1.92–33.33), thrombocytopenia (p = 0.012, HR = 5, 95% CI 1.41–16.66) and SLE disease activity index (SLEDAI, p = 0.05, HR = 1.08, 95% CI = 0.999–1.1). Observing oral ulcer, thrombocytopenia and high SLEDAI at the time of disease diagnosis were the main prognostic factors in male lupus patients. [ABSTRACT FROM AUTHOR]

Purpose: We sought to compare the effectiveness of a novel antibiotic irrigation device to the standard O-ring wound retractor in preventing surgical site infections (SSIs) following colorectal resections. Methods: This single-arm clinical trial included patients undergoing colorectal resections utilizing the novel device. A retrospective cohort of patients undergoing the same procedures with the O-ring retractor was selected as the control group. The primary outcome assessed was SSI. Secondary outcomes assessed were overall complications, hospital length of stay (LOS), and 30-day readmission. A univariable and multivariable logistic regression model was built to evaluate the association between SSI as the outcome variable and the use of the novel device as the main independent variable. The model was adjusted for any confounding variables. Results: Eighty-six novel device cases and 170 O-ring retractor cases were enrolled. There were no significant differences between the two groups in terms of demographics and preoperative comorbidities. Cases with the novel device had fewer Pfannenstiel incisions (1.2% vs. 14.6%, p < 0.001). There were no other significant differences in intraoperative variables. SSI rates were significantly lower in the novel device group (1.2% vs. 9.1%, p = 0.014). There were no other significant differences in postoperative complications. Multivariable logistic regression with backward elimination showed that the use of the novel device was significantly more effective against SSI by 92.5% compared to the use of the O-ring retractor. Conclusion: The novel device may contribute to lower SSI rates compared to the O-ring retractor following colorectal resection. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have suggested that coffee may shorten the postoperative ileus period. We sought to evaluate the impact of both coffee and caffeine on shortening the return of postoperative bowel function following minimally invasive colectomy. Methods: This was a single-center, randomized controlled clinical trial conducted in a tertiary hospital. Patients undergoing an elective robotic or laparoscopic small or large bowel operation were included in this study. Patients were randomized into one of three groups: warm water, decaffeinated coffee, and caffeinated coffee. Subjects were assigned to drink a 4-oz cup three times daily starting on postoperative day one. The primary endpoint was time to first bowel movement. Secondary endpoints included time to first flatus, length of hospital stay, and postoperative morbidity. Results: A total of 99 patients were included in this study: 31 warm water, 31 decaffeinated coffee, and 37 caffeinated coffee. The groups were similar in age and sex (p = 0.51 and 0.91, respectively). Mean (SD) time to the first bowel movement in days was 2.94 (1.4), 2.58 (1.2), and 2.86 (1.3), respectively (p = 0.53). There were no significant differences observed in postoperative morbidity (p = 0.52) between groups. Multivariate linear regression analysis did not reveal a statistically significant association between any interventions and time to first bowel movement or length of hospital stay. Conclusions: Coffee (caffeinated or decaffeinated) does not expedite the return of bowel function following minimally invasive operation. Trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT02639728 NCT02639728. [ABSTRACT FROM AUTHOR]

Background and objective: Acute pancreatitis is an increasingly common cause of hospital admission in the United States. The aim of this study was to evaluate independent predictors of mortality in adult patients with a diagnosis of acute pancreatitis and to assess the relationship of hospital length of stay (HLOS) with in-hospital mortality.Adult (18–64 years) patients with acute pancreatitis as the primary diagnosis who required emergency admission were analyzed using the National Inpatient Sample (NIS) database from 2005–2014. A nonlinear relationship between HLOS and mortality was assessed using a multivariable generalized additive model (GAM). A multivariable logistic regression model was performed on the ascending part of the plot to assess the odds of mortality.There were 344,120 patients studied. The mean (standard deviation) age of patients was 44.6 (11.55) years and 51% were females. The results are presented as EDF (effective degree of freedom), which is a summary statistic of GAM and reflects the degree of nonlinearity of a curve. Mean HLOS was 7 days. HLOS had a V-shaped relationship with mortality (EDF = 9.26, p < 0.001). The nadir of the V curve was at an HLOS of 3–6 days, with an increase in mortality for both a longer and a shorter stay. An HLOS longer than 6 days began to have a linear relationship with mortality. The associated logistic regression model had an odds ratio of 1.127 (95% confidence interval: 1.106–1.148) for HLOS. Age, sex, income quartile, and several comorbidities significantly increased in-hospital mortality.Mortality for adults with acute pancreatitis was lowest for an HLOS of 3–6 days. After 6 days, there was a linear relationship with morality, with each day increasing the mortality by 12.7%.Methods: Acute pancreatitis is an increasingly common cause of hospital admission in the United States. The aim of this study was to evaluate independent predictors of mortality in adult patients with a diagnosis of acute pancreatitis and to assess the relationship of hospital length of stay (HLOS) with in-hospital mortality.Adult (18–64 years) patients with acute pancreatitis as the primary diagnosis who required emergency admission were analyzed using the National Inpatient Sample (NIS) database from 2005–2014. A nonlinear relationship between HLOS and mortality was assessed using a multivariable generalized additive model (GAM). A multivariable logistic regression model was performed on the ascending part of the plot to assess the odds of mortality.There were 344,120 patients studied. The mean (standard deviation) age of patients was 44.6 (11.55) years and 51% were females. The results are presented as EDF (effective degree of freedom), which is a summary statistic of GAM and reflects the degree of nonlinearity of a curve. Mean HLOS was 7 days. HLOS had a V-shaped relationship with mortality (EDF = 9.26, p < 0.001). The nadir of the V curve was at an HLOS of 3–6 days, with an increase in mortality for both a longer and a shorter stay. An HLOS longer than 6 days began to have a linear relationship with mortality. The associated logistic regression model had an odds ratio of 1.127 (95% confidence interval: 1.106–1.148) for HLOS. Age, sex, income quartile, and several comorbidities significantly increased in-hospital mortality.Mortality for adults with acute pancreatitis was lowest for an HLOS of 3–6 days. After 6 days, there was a linear relationship with morality, with each day increasing the mortality by 12.7%.Results: Acute pancreatitis is an increasingly common cause of hospital admission in the United States. The aim of this study was to evaluate independent predictors of mortality in adult patients with a diagnosis of acute pancreatitis and to assess the relationship of hospital length of stay (HLOS) with in-hospital mortality.Adult (18–64 years) patients with acute pancreatitis as the primary diagnosis who required emergency admission were analyzed using the National Inpatient Sample (NIS) database from 2005–2014. A nonlinear relationship between HLOS and mortality was assessed using a multivariable generalized additive model (GAM). A multivariable logistic regression model was performed on the ascending part of the plot to assess the odds of mortality.There were 344,120 patients studied. The mean (standard deviation) age of patients was 44.6 (11.55) years and 51% were females. The results are presented as EDF (effective degree of freedom), which is a summary statistic of GAM and reflects the degree of nonlinearity of a curve. Mean HLOS was 7 days. HLOS had a V-shaped relationship with mortality (EDF = 9.26, p < 0.001). The nadir of the V curve was at an HLOS of 3–6 days, with an increase in mortality for both a longer and a shorter stay. An HLOS longer than 6 days began to have a linear relationship with mortality. The associated logistic regression model had an odds ratio of 1.127 (95% confidence interval: 1.106–1.148) for HLOS. Age, sex, income quartile, and several comorbidities significantly increased in-hospital mortality.Mortality for adults with acute pancreatitis was lowest for an HLOS of 3–6 days. After 6 days, there was a linear relationship with morality, with each day increasing the mortality by 12.7%.Conclusion: Acute pancreatitis is an increasingly common cause of hospital admission in the United States. The aim of this study was to evaluate independent predictors of mortality in adult patients with a diagnosis of acute pancreatitis and to assess the relationship of hospital length of stay (HLOS) with in-hospital mortality.Adult (18–64 years) patients with acute pancreatitis as the primary diagnosis who required emergency admission were analyzed using the National Inpatient Sample (NIS) database from 2005–2014. A nonlinear relationship between HLOS and mortality was assessed using a multivariable generalized additive model (GAM). A multivariable logistic regression model was performed on the ascending part of the plot to assess the odds of mortality.There were 344,120 patients studied. The mean (standard deviation) age of patients was 44.6 (11.55) years and 51% were females. The results are presented as EDF (effective degree of freedom), which is a summary statistic of GAM and reflects the degree of nonlinearity of a curve. Mean HLOS was 7 days. HLOS had a V-shaped relationship with mortality (EDF = 9.26, p < 0.001). The nadir of the V curve was at an HLOS of 3–6 days, with an increase in mortality for both a longer and a shorter stay. An HLOS longer than 6 days began to have a linear relationship with mortality. The associated logistic regression model had an odds ratio of 1.127 (95% confidence interval: 1.106–1.148) for HLOS. Age, sex, income quartile, and several comorbidities significantly increased in-hospital mortality.Mortality for adults with acute pancreatitis was lowest for an HLOS of 3–6 days. After 6 days, there was a linear relationship with morality, with each day increasing the mortality by 12.7%. [ABSTRACT FROM AUTHOR]

Background: In the current literature, the association between sleep and different lipids is inconsistent. We aimed to assess the association of sleep with HDL cholesterol, triglyceride, and LDL cholesterol in the National Health and Nutrition Examination Survey (NHANES), 2013/2014. Methods: We included 2705 participants from NHANES, 2013/2014. Cross-sectional information was measured on sleep duration and HDL cholesterol/triglyceride/LDL cholesterol. Generalized additive models (GAM) were constructed to assess the smooth relationship between the HDL cholesterol/triglyceride/LDL cholesterol, and the sleep duration. Models were adjusted for age, sex, race, marital status, household size, sitting time and physical activity. Effective degree of freedom (EDF) value in GAM indicated the amount of non-linearity of the smooth. EDF = 1 was indicative of a linear pattern of association. A value greater than 1 denoted a more complex association between outcome and sleep duration. Results: The highest mean HDL cholesterol level was observed in participants sleeping 8 h/day. There was a significant non-linear association between sleep duration and HDL cholesterol in unadjusted GAM (EDF = 2.58, P = 0.002) and adjusted GAM (EDF = 1.85, P = 0.003). The lowest mean triglyceride level was observed in people sleeping 6 h/day. There was a significant non-linear association between sleep duration and triglyceride in unadjusted GAM (EDF = 3.05, P = 0.02) and adjusted GAM (EDF = 1.78, P = 0.02). There was no significant non-linear association between sleep duration and LDL cholesterol in either unadjusted GAM (EDF = 1.01, P = 0.2) or adjusted GAM (EDF = 1.01, P = 0.8). Conclusion: Short sleep duration was associated with low HDL cholesterol/high triglyceride. Further longitudinal studies are warranted to shed extra light on this relationship. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the prevalence of metabolic syndrome (MetS) in Iranian patients with systemic lupus erythematosus (SLE) and its determinants. In a cross-sectional study, 98 patients with SLE and 95 controls were enrolled. Prevalence of MetS was determined based on American Heart Association and National Heart, Lung, and Blood Institute (AHA/NHLBI) and 2009 harmonizing criteria. In addition, demographic features and lupus characteristics such as disease duration, pharmacological treatment, laboratory data, SLE disease activity index (SLEDAI), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage index (SDI) were recorded. The predictors of MetS were obtained by backward stepwise regression analysis. Using AHA/NHLBI, MetS was observed in 35 (35.7%) patients and 28 (29.8%) controls (P = 0.4). Using harmonizing criteria, MetS was observed in 37 (37.7%) patients and 33 (35.1%) controls (P = 0.7). There was no difference in frequency distribution of MetS components between the patients and the controls. In multivariate regression analysis, low C3, blood urea nitrogen (BUN), and body mass index were independent determinants of MetS in lupus patients. BUN, low C3, and body mass index were the major determinants of MetS in lupus patients. [ABSTRACT FROM AUTHOR]

This study was conducted to assess the ability of the British Isles Lupus Assessment Group-2004 (BILAG-2004), the SLE Disease Activity Index-2K (SLEDAI-2K), the European Consensus Lupus Activity Measurement (ECLAM), and the Revised Systemic Lupus Activity Measure (SLAM-R) to detect the need to treatment change in daily clinical practice. One hundred and two patients with SLE were enrolled and followed up for 2 to 8 months and visited at least 3 times. Physician Global Assessment, BILAG-2004, SLEDAI-2K, SLAM-R, and ECLAM, were calculated in every visit. Treatment change, dependent variable, was categorized as decrease/no change vs. increase. The aforementioned indices, independent variables, were compared to learn their ability in predicting the treatment change. The probability of treatment change was measured by generalized linear-mixed effect model (GLMM) and generalized estimating equations (GEE). Adjusted odds ratios were calculated. Predictive power of indices was compared by area under the curve (AUC) in plots of sensitivity vs. 1-specificity and application of receiver operating characteristic curves (ROC). BILAG-2004 and SLEDAI-2K had substantial correlation with treatment change. Among different GLMM models, BILAG-2004 followed by SLEDAI-2K showed the highest associations with treatment change. Among various GEE models, similar findings were observed. Also, these 2 indices had the highest sensitivity (the largest AUC) towards treatment change; BILAG-2004 (AUC = 0.779, 95% CI = 0.710-0.848, p = 0.001) and SLEDAI-2K (AUC = 0.771, 95% CI = 0.698-0.843, p = 0.001). BILAG-2004 followed by SLEDAI-2K had the highest predictability of treatment change. [ABSTRACT FROM AUTHOR]

The aim was to determine the course, outcome, and determinants of mortality in patients with systemic lupus erythematosus (SLE) in intensive care unit (ICU). SLE patients admitted to ICU from 2004 to 2015 were recruited retrospectively. Demographic data, disease characteristics, causes of admission, baseline SLE disease activity index-2K (SLEDAI-2K) and Acute Physiologic and Chronic Health Evaluation II (APACHE) score, the outcome, and the causes of death were recorded. Predictors of mortality were compared between alive and dead patients by Cox regression analysis. Ninety-four patients with SLE were enrolled. Mean age at the time of ICU admission was 29.6 years. Average scores of SLEDAI and APACHE II were 11.3 and 19.8, respectively. The most common causes of ICU admission were pneumonia, diffuse alveolar hemorrhage (DAH), and seizure. Forty-seven patients (50%) died in ICU. The principal causes of death were septic shock (25.5%), multi-organ failure (12.5%), DAH (10.6%), and pneumonia (10.6%). After multivariate analysis, high APACHE II, septic shock, and duration of mechanical ventilation were indicators of survival outcome. Mean (95% CI) survival days in ICU in patients with and without respiratory failure were 14.6 (10.4-18.9) and 28.7 (17.9-39.5) days, respectively ( P = 0.001). This figure for those with and without septic shock was 13.5 (4.9-11.1) and 22.3 (9.3-24.7) days, respectively ( P = 0.016). High APACHE II, septic shock, and duration of mechanical ventilation were the main predictors of death in patients with SLE in ICU. Multicenter studies are needed to draw a fine picture of SLE behavior in ICU. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare survival of childhood-onset systemic lupus erythematosus (c-SLE) and adult-onset SLE (a-SLE) according to initial manifestations. This was a retrospective cohort study. All patients were categorized into c-SLE (≤18 years) and a-SLE (>18 years). The clinical and serological data at the time of diagnosis were recorded and compared. Kaplan-Meier curves were used to compare survival rates between the two groups. Predictors of mortality were obtained by a backward Cox regression. One hundred eighty patients with c-SLE and 394 patients with a-SLE were enrolled. The female/male ratio was higher in c-SLE ( P = 0.0001). Lupus nephritis ( P = 0.002) and valvular heart disease ( P = 0.025) were more common in c-SLE and a-SLE, respectively. In a 23-year follow-up, 20 patients (11.1%) with c-SLE and 35 patients (8.9%) with a-SLE died. Mortality was not significantly different between them ( P = 0.4). The main causes of death were nephritis (50% in c-SLE vs. 29% in a-SLE), infections (40% in c-SLE vs. 29% in a-SLE), and circulatory disease (10% in c-SLE vs. 37% in a-SLE). The difference was not significant ( P = 0.08). Cumulative survival rates after 5, 10, 15, and 20 years were 91, 87, 85, and 78% in c-SLE and 93, 90, 90, and 83% in a-SLE, respectively. By multivariate analysis, seizure, proteinuria, and nephritis in c-SLE and seizure, hematuria, and pericarditis in a-SLE had negative prognostic effect on survival. Both c-SLE and a-SLE patients with seizure or renal involvement should be monitored more carefully to prevent ominous outcomes. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the therapeutic effects of atorvastatin on systemic lupus erythematosus disease activity index (SLEDAI). Ninety patients with SLE were consented and randomized to receive either atorvastatin, 20 mg/day, or placebo for 3 months. The primary outcome was change in SLEDAI. Lipids, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were assessed as secondary end points. Analysis was done by 'intention to treat' (ITT) as the primary analysis and 'treatment completed analysis' (TCA) as the supplementary analysis. Demographic features, baseline characteristics, and distribution of medications were not significantly different between the two groups. Mean SLEDAI score at baseline in both groups was 3 ± 0.5. By TCA and ITT, mean SLEDAI scores decreased to 1.7 ± 0.4 and 2.7 ± 0.5, respectively, in the atorvastatin group and 3 ± 0.4 and 3 ± 0.5, respectively, in the control group. The difference between the two groups after intervention was significant by TCA ( P < 0.05) and nonsignificant by ITT analysis ( P = 0.1). The effect of atorvastatin therapy on lupus activity was inconclusive. [ABSTRACT FROM AUTHOR]