Salottolo K.,Swedish Medical Center
Critical Care Medicine | Year: 2017
OBJECTIVES:: We sought to determine occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens in patients with traumatic injury. DESIGN:: Retrospective multicenter cohort study. SETTING:: Three U.S. trauma centers. PATIENTS:: Twenty-eight thousand one hundred one trauma patients admitted from 2010-2014. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Measures included occurrence of alcohol withdrawal syndrome and delirium tremens, injury characteristics, risk factors for alcohol withdrawal syndrome, clinical outcomes, pharmacologic treatment for alcohol withdrawal syndrome, and Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores. Alcohol withdrawal syndrome severity was defined by CIWA-Ar score as minimal (< 10), moderate (10–20), and severe (> 20). Alcohol withdrawal syndrome developed in 0.88% (n = 246), including 12% minimal, 36% moderate, and 53% severe. Alcohol withdrawal syndrome progressed to delirium tremens in 11%. Before adjustment, alcohol withdrawal syndrome severity was associated with injury severity, hypokalemia, baseline CIWA-Ar score, and established alcohol withdrawal syndrome risk factors. Logistic regression identified the following predictors of delirium tremens: baseline CIWA-Ar score greater than or equal to 10 (odds ratio, 6.05; p = 0.02) and age greater than or equal to 55 (odds ratio, 3.24; p = 0.03). In patients with severe alcohol withdrawal syndrome, severe head injury also predicted progression to delirium tremens (odds ratio, 6.08; p = 0.01), and hypokalemia was borderline significant (odds ratio, 3.23; p = 0.07). Clinical outcomes of hospital length of stay, ICU length of stay, and alcohol withdrawal syndrome complications differed significantly by alcohol withdrawal syndrome severity and were worse with more severe manifestations of alcohol withdrawal syndrome. Mortality also significantly differed by alcohol withdrawal syndrome severity but was only greater in patients who progressed to delirium tremens (11.1%; p = 0.02); otherwise, there were no differences in mortality by severity (4%, 4%, and 0% by minimal, moderate, and severe alcohol withdrawal syndrome). CONCLUSIONS:: Trauma patients with alcohol withdrawal syndrome experience a high occurrence of delirium tremens that is associated with significant mortality. These data demonstrate the predictive ability of baseline CIWA-Ar score, age, and severe head injury for developing delirium tremens. Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
News Article | May 28, 2017
— Des Hague, CEO of Hague Enterprises, is proud to support the “On the Right Track” Program hosted by Happy Clinic Denver (www.happyclinicdenver.com), working to help recovering drug addicts. This cause was set up by Happy Clinic Owner and Medical Director, Dr. Phil Nguyen, to provide services for recovering drug addicts who have been clean for a minimum of 12 months. The program’s objective is to remove all needle tract marks from individual’s arms and provide additional services on a case by case basis. "This program is near and dear to me," stated Dr. Nguyen, and continued, "I have firsthand experience of seeing the devastation created by drug addiction as one of my family members has battled addiction; he was the first member of the On the Right Track Program. I look forward to helping many more recovering addicts in the years ahead," concluded Dr. Nguyen. "I was recently introduced to Dr. Nguyen,” said Hague. “The passion and personal commitment that he has shown to aid our recovering addicts in the Colorado community is humbling.” Hague continued, “The anguish of drug abuse is known in many households across the world as our society is plagued by drugs with millions afflicted and many incarcerated. I am honored to serve alongside Dr. Nguyen as Chairman for Corporate Contributions for the program. My immediate goals will be to raise awareness and the vital funds to help our recovering addicts rehabilitate and reenter society without the stigma of visible needle tracts that could limit future employment opportunities," concluded Hague. You can make a difference by making an on-line contribution at www.gofundme.com/OnTheRightTrackCampaign or by mailing a check to Denver Happy Clinic at 1241 S Parker Rd Suite 100, Denver, CO 80231 About Dr. Phil Nguyen, MD Dr. Phil has been a licensed physician in the state of Colorado for the past 16 years. He also holds licenses in the states of Indiana and California. He graduated from Indiana University School of Medicine in 1998. He has been doing cosmetic/aesthetic procedures since 2001. Dr. Phil prides himself in being an artist and minored in Fine Arts Studio for his undergraduate studies. He paints, draws and sculpts. Thus, he naturally gravitated to the cosmetic/aesthetic field of medicine. Dr. Phil trained in family practice and did his internship at the University of Colorado Swedish Medical Center. Dr. Phil takes great pride in giving his patients a natural looking appearance, and has had over 14 years of experience performing injectable procedures. He personally sees about 1000 faithful patients a month, making him one of the most experienced and sought after cosmetic physician in the country. "We are all just a few millimeters away from looking like Angelina Jolie or Brad Pitt," and "Anyone can stick a needle into you, but it takes an artist to make it look good!" are two of his favorite quotes. Dr. Phil speaks English and Vietnamese fluently, and knows enough of Spanish, French, Thai and Mandarin to be dangerous. He is a world traveler and foodie, with his favorite place to visit being Southeast Asia. Dr. Phil is a member of the American Academy of Cosmetic Surgery. About Des Hague A renowned executive with over twenty-five years of leading global public and private companies, Des Hague has established himself as an innovative thinker in the international business world. His forward-thinking approach pushes companies toward sustainable growth, granting them a position as resilient competitors within their respective industries. His past positions include President of Safeway Inc., President of IHOP, President of Hot Stuff Foods LLC, Vice President of 7-Eleven Inc. and, most recently, President/CEO of CenterPlate Inc., the largest event hospitality company in North America. Hague is also the Co-Founder of Hague Enterprises, a Colorado-based advisory and investment company, focused in multiple sectors. In addition, Hague serves on the boards of DVETelepresence, PING HD, WC&P, Lessons For Life, World of Beer, Halls Cheese, Serenity Spa and Salon and the Stamford Youth Foundation along with advising on several start-up ventures. Along with his professional projects, Hague contributes significant amounts of time and energy to non-profit charitable work. Hague has helped raise more than $100 million over the past few years for many non-profits, including the Stamford Youth Foundation, a local organization offering multiple after-school programs for young people, and The Journey Home, a Baltimore-based Foundation fighting homelessness. Hague views Hague Enterprises, LLC as a perfect blending of business and philanthropic activities. For more information, please visit http://www.HagueEnterprises.com
News Article | May 26, 2017
"PotashCorp, The Boeing Company and Deputy Chief Jogmen have helped make our world a safer place to work and live," said Deborah A.P. Hersman, president and CEO of the National Safety Council. "We are proud to honor them and to recognize all the outstanding finalists that share the Council's goal of eliminating preventable deaths and injuries in our lifetime." PotashCorp recognized that tools and procedures designed to reduce injuries as a whole do not always affect serious injury and fatality (SIF) rates. To close the gap, PotashCorp developed a system to empower workers to identify potential SIF exposure before an incident and provides training so employees can identify potential problems in routine activities. The approach includes reviewing everyday tasks for risk, integrating injury prevention into all safety processes and following up on all incidents for SIF potential. The Boeing Company developed a fall protection system – the Piranha Lox True Interlock Harness – that disables a work platform if a worker is not properly hooked into his or her Personal Protective Equipment (PPE). Falls account for 10 percent of all occupational deaths each year; in more than 75 percent of those fatalities, PPE is available but either not used or used incorrectly. Deputy Chief Lou Jogmen spearheaded the inaugural Illinois Rail Safety Week in 2014 by gathering more than 300 independent police agencies, county sheriff departments, private firms and state agencies to promote public awareness through education, enforcement and rail safety engineering advances. The model has been expanded to other campaigns in Illinois, including distracted driving awareness, and was used to introduce National Rail Safety Week in 2016, co-sponsored by International Association of Chiefs of Police and Operation Lifesaver. The finalists were selected from over 50 applicants reviewed and evaluated by an external panel. Other finalists included Odebrecht Construction, Chatham County, Ga., Tracey Holmberg of Swedish Medical Center in Denver, Colo., and Trenda McPherson of the Florida Motorcycle Safety Coalition in Tallahassee, Fla. Visit greencross.nsc.org for additional information about each winner and finalist. About the National Safety Council Founded in 1913 and chartered by Congress, the National Safety Council, nsc.org, is a nonprofit organization whose mission is to save lives by eliminating preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. NSC advances this mission by partnering with businesses, government agencies, elected officials and the public in areas where we can make the most impact – distracted driving, teen driving, workplace safety, prescription drug overdoses and Safe Communities. Safety+Health magazine, the Council's flagship publication, is a leading source of occupational safety and health information. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/national-safety-council-announces-winners-of-its-prestigious-green-cross-for-safety-awards-300464395.html
Mease P.,Swedish Medical Center
Bulletin of the NYU Hospital for Joint Diseases | Year: 2012
Some of this past year's key papers or abstracts on psoriatic arthritis (PsA) assessment and treatment are reviewed in this paper. Treatment begins with identification of the PsA patient. Several screening questionnaires have been developed to be used in dermatology and primary care settings to identify which patients with psoriasis have developed PsA as opposed to other common musculoskeletal problems, such as osteoarthritis and fibromyalgia, thus increasing case-finding and targeting referral. PsA can present in a heterogeneous manner, involving arthritis, enthesitis, dactylitis, spondylitis, and skin and nail disease. Measures of these individual domains have been developed for use in clinical trials and improved PsA-specific composite measures of these domains are being evaluated as well. A quantitative therapy target, Minimal Disease Activity criteria, has been developed by the GRAPPA group. Treatment recommendations have been published by EULAR and GRAPPA. Obesity is a risk factor for the development of PsA and may adversely influence treatment outcomes. Although pharmacologic treatment often begins with methotrexate, a recent study does not provide clear evidence of its effectiveness. Anti-TNF therapies remain the gold standard of effectiveness. New therapeutic options are potentially emerging including ustekinumab, abatacept, several IL-17 inhibitors, apremilast, JAK inhibitors, and possibly IL-6 inhibitors.
Qiu C.,Swedish Medical Center
PloS one | Year: 2012
Heme oxygenase-1 (HO-1) concentrations have been recently reported to be elevated in impaired glucose tolerance and type 2 diabetes mellitus (T2DM). However, no study has examined the association between HO-1 concentrations and gestational diabetes mellitus (GDM). In a case-control study, nested within a prospective cohort of pregnant women (186 GDM cases and 191 women who remained eu-glycemic through pregnancy), we assessed the association of maternal serum HO-1 concentrations, measured in samples collected at 16 weeks gestation, on average, with subsequent risk of GDM. Maternal serum HO-1 concentrations were determined using ELISA. We fitted multivariate logistic regression models to derive estimates of odds ratios (ORs) and 95% confidence intervals (CIs). Median serum HO-1 concentrations in early pregnancy were lower in women who subsequently developed GDM compared with those who did not (1.60 vs. 1.80 ng/mL, p-value=0.002). After adjusting for maternal age, race, family history of T2DM and pre-pregnancy body mass index, women with HO-1 ≥ 3.05 ng/mL (highest decile) experienced a 74% reduction of GDM risk (95% CI; 0.09-0.77) compared with women whose concentrations were<1.23 ng/mL (lowest quartile). Serum HO-1 concentrations were inversely associated with subsequent GDM risk. These findings underscore the role of oxidative stress in the pathogenesis of GDM. Additional studies are warranted to confirm the clinical utility of serum HO-1 in diagnosis of GDM, particularly in the early pregnancy.
Mease P.,Swedish Medical Center
Bulletin of the Hospital for Joint Diseases | Year: 2013
Psoriatic arthritis (PsA) is a form of inflammatory arthritis that occurs in patients with psoriasis and is distinct from rheumatoid arthritis (RA). Methotrexate (MTX) is one of the most commonly used drugs for the treatment of PsA, yet there is scant controlled trial data to document its efficacy. Controlled trials have not demonstrated significant separation from placebo, but the studies have significant limitations which inhibit our ability to draw firm conclusions about the efficacy of MTX. A number of observational studies have described benefit for joint and skin disease. As yet unstudied, are the effects on enthesitis, dactylitis, and spondylitis of PsA. Psoriasis studies have shown modest benefit for psoriatic skin lesions. It is not yet known if MTX contributes an additive or synergistic benefit when used in combination with TNF inhibitors in PsA. The potential value of low dose MTX to suppress antibody formation against biologic therapies should be considered in a patient failing benefit from such therapy. Although adverse effects are similar to those seen in RA treatment with MTX, awareness of the tendency for PsA and psoriasis patients to be obese and have non-alcoholic steato-hepatosis, which may amplify transaminitis potential, should be borne in mind. © 2013, J. Michael Ryan Publishing Inc.All right reserved.
Morrison M.,Swedish Medical Center
Advances in Experimental Medicine and Biology | Year: 2013
Diabetes studies have increasingly been associated with several types of cancer. Diabetes and pancreatic cancer have a unique relationship. Genetic mutations, such as activation of the KRAS2 oncogene, inactivation of the tumor-suppressor gene CDKN2A, inactivation of the tumor-suppressor gene TP53 and deleted in pancreatic cancer 4 (DPC4) gene defects are seen in those with pancreatic cancer. Approximately 80% of those patients, diagnosed with pancreatic cancer, are identified as having concomitant diabetes with a poor prognostic factor. Damaged pancreatic tissue, secondary to pancreatic cancer, leads to diabetes as islet cells and β cells are taken over by malignancy. Additionally, those on certain anti-diabetic regimens are shown to be at a higher risk of developing pancreatic cancer due to the effect of stimulation on the pancreatic β and islet cells. Therefore, diabetes is thought to be both a potential cause and effect of pancreatic cancer. Diabetes has become a pandemic, and pancreatic cancer is one of the most lethal forms of malignancy known. In order to better understand these diseases and how they are associated, more research needs to be done. Particularly, research focusing on different types of diabetes in the setting of pancreatic cancer will be an important issue for further understanding of the link between diabetes and pancreatic cancer. © 2012 Landes Bioscience and Springer Science+Business Media.
Mease P.J.,Swedish Medical Center
Rheumatology | Year: 2011
Biological agents, including TNF inhibitors, have revolutionized the treatment of RA in recent years. Certolizumab pegol (CZP) is a novel pegylated anti-TNF approved for the treatment of adult patients with moderately to severely active RA. This article provides an overview of three published clinical trials of CZP in RA in patients with active disease who have shown an inadequate response to DMARDs, including MTX: RA prevention of structural damage (RAPID) 1 and 2, which evaluated the efficacy and safety of CZP added to MTX when dosed every 2 weeks, and efficacy and safety of CZP - 4 weekly dosage in rheumatoid arthritis (FAST4WARD), which evaluated CZP monotherapy when dosed every 4 weeks. In the trials, CZP plus MTX or as monotherapy significantly improved the signs and symptoms of RA and RA disease activity, and CZP plus MTX significantly inhibited the progression of radiographic joint damage as early as Week 16 of the treatment. In addition, CZP treatment significantly improved patient-reported outcome measures, providing significant reductions in pain and fatigue and improvements in physical function as early as Week 1 of treatment; improvements in health-related quality of life were evident at the first assessment at Week 12. CZP treatment improved productivity at work, significantly reducing the number of days of missed work as well as the number of days with reduced productivity, and also increased productivity within the home and improved participation in family, social and leisure activities. CZP was generally well tolerated when used either as monotherapy or added to MTX; most adverse events were mild or moderate. Taken together, the results of these trials suggest that CZP is an effective new option for the treatment of RA. © The Author(s) 2010. Published by Oxford University Press on behalf of The British Society for Rheumatology.
Mease P.J.,Swedish Medical Center
Current Opinion in Rheumatology | Year: 2015
PURPOSE OF REVIEW: In recent years, there has been an increasing understanding of the importance of the TH17 lineage of T cells and related cytokines, including interleukin (IL)17 and IL23, not only in the biology of innate host defense but also in the pathogenesis of inflammatory/autoimmune diseases. These diseases include psoriasis, psoriatic arthritis, the broader category of spondyloarthritides including ankylosing spondylitis and rheumatoid arthritis. It is postulated that in genetically predisposed individuals, external or internal stimuli such as microbial antigens, alterations in the intestinal microbiome, biomechanical stress and/or immunologic dysregulation may lead to an increased expression of cytokines such as IL23, which in turn stimulate the differentiation and activation of TH17 and other immune cells, which are a part of the innate immune system that trigger adaptive immune processes and chronic inflammatory diseases. Herein, we explore the effect of targeting this pathway therapeutically. RECENT FINDINGS: New drugs that are designed to inhibit steps in this pathway, the IL12/IL23 inhibitor, ustekinumab, the IL17A inhibitors secukinumab and ixekizumab, the IL17A receptor inhibitor, brodalumab, and the IL23 inhibitors guselkumab and tildrakizumab, have demonstrated significant effectiveness in treating these diseases, particularly psoriasis, psoriatic arthritis and ankylosing spondylitis. SUMMARY: This article reviews the relevant biology, efficacy and safety of new medications targeting the TH17 pathway, including inhibition of IL17 and IL23, particularly in psoriasis and psoriatic arthritis. Especially for patients who have not gained benefit from, lost effectiveness to or could not use antitumour necrosis factor (TNF) medications for safety or tolerability reasons, having effective medicines with an alternative mechanism of action will improve our ability to diminish disease activity impact on patient lives. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Mease P.J.,Swedish Medical Center |
Mease P.J.,University of Washington
Annals of the Rheumatic Diseases | Year: 2011
Psoriatic arthritis (PsA) is classified as a spondyloarthropathy and characterised by synovitis, enthesitis, dactylitis and spondylitis usually manifesting as skin and nail psoriasis. Our understanding about the PsA disease state, its genetics, pathophysiology and comorbidities, as well as the ability to assess and treat the disease, has advanced as a result of significant collaborative efforts by rheumatologists and dermatologists in the development of classification criteria, outcome measures to assess the various clinical domains, and treatment trials with agents also used for diseases such as rheumatoid arthritis (RA) and psoriasis. Biological agents, especially the antitumour necrosis factors, have demonstrated significant efficacy and reasonable safety in all clinical domains of the disease, resulting in amelioration of clinical symptoms, inhibition of structural damage and improvement of function and quality of life. Although there is considerable overlap with RA, there are some differences in pathophysiology and approach to assessment and management that are important to consider. This paper reviews these subjects, with an emphasis on recent data.