Introduction: Limited data are available on the associations between hidradenitis suppurativa (HS) and inflammatory bowel diseases (IBD). We sought to determine the prevalence of HS in IBD, as well as the prevalence of IBD in patients with HS, at a single US tertiary medical center. We also aimed to describe differences in the clinical characteristics of IBD and HS as compared to those with IBD alone. Methods: We performed a single center retrospective cohort between 2004-2015. We used billing international classification of diseases, 9th codes (ICD-9) to identify cases of IBD and HS at the center. We calculated prevalence of HS in IBD and IBD in HS. We then performed a nested case-control study via detailed chart review, comparing clinical characteristics of patients with HS-IBD to a random sample of patients with IBD alone via bivariate analyses. We then described treatment outcomes of HS in IBD patients. Results: We identified a total of 12,889 patients with IBD and 2,558 patients with HS treated at the center. Of these, there were 93 with both IBD and HS (HS-IBD). The prevalence of HS in patients with IBD was 0.7% while the prevalence of IBD in patients with HS was 3.6%. Among patients with HS-IBD, 75 (80%) had Crohn's disease (CD). When compared to controls with only IBD, the IBD-HS population had more women, African Americans (AA), and higher rates of smoking. Among CD patients, the HS-IBD population had higher rates of penetrating disease (67% vs. 43%, p=0.001) and perianal disease (54% vs. 26%, p < 0.001). There was a predominance of colonic disease in HS-IBD (p < 0.001) (Table 1). A total of 59 HS-IBD had follow-up to assess treatment response. The most common HS locations were the groin (57%), axilla (46%) and perianal/buttocks (39%). A total of 23.7% were on anti-TNF use for HS-IBD. The most common treatment modality prescribed for HS was antibiotic therapy, with 62% of patients on clindamycin and 25% on rifampin. Approximately half of the patients (29/59) had documentation of surgical treatment for HS. At follow-up, 16 patients (28%) had entered remission and 22 (39%) had a documented improvement in HS symptoms. A lack of clinical response was seen in 19 patients (33%). Conclusion: The prevalence of IBD in this tertiary care center population of patients with HS is >3 fold higher than the reported prevalence of IBD in the general population. IBD patients with HS were more likely to be female, AA, have penetrating, colonic and perianal disease. HS patients with IBD had higher rates of groin and perianal HS than what is reported in the general HS population, with difficult to treat HS.Figure
Background. Chronic kidney disease (CKD) is associated with cardiovascular (CV) events, a leading complication in liver transplant recipients (LTRs). Timely subspecialty care is associated with improved clinical outcomes in patients with CKD. This study sought to assess associations between nephrology comanagement and CV events among LTRs at risk for or with CKD. Methods. LTRs with CKD plus those at risk were identified in an inception cohort at a single tertiary care network between 2010 and 2016, using electronic health record data and manual chart review. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m 2 or International Classification of Diseases 9th or 10th revision code for CKD and at-risk CKD as estimated glomerular filtration rate 60–89 mL/min/1.73 m 2 . Cox proportional hazard models assessed the association between nephrology comanagement and CV events among LTRs with or at risk for CKD. Results. Among 602 LTRs followed for up to 6 y posttransplant, prevalence of CKD plus those at risk increased yearly (71% in year 1, 86% in year 6) ( P < 0.0001). Rates of nephrology comanagement decreased yearly posttransplant (35% in year 1, 28% in year 6). In multivariable models, nephrology comanagement was associated with lower CV events (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33–0.99). Conclusions. Among LTRs with CKD, nephrology comanagement may be associated with lower CV events. A prospective study is needed to identify the reasons for improved outcomes and barriers to nephrology referral.
While the apparent cardiovascular benefits of olive oil have been proven in studies examining European populations, new research from a team of Harvard physicians is shedding light on impact in US patients.
New research from a team of European investigators suggests age at the onset of puberty could serve as an independent risk factor for type 2 diabetes (T2D).
A new study presented at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC) has revealed a low birth weight could serve as an indicator for increased risk of cardiovascular disease in mothers.
Hospital admission for the treatment of acute decompensated heart failure is an unfortunate certainty in the vast majority of patients with heart failure. Regardless of the etiology, inpatient treatment for acute decompensated heart failure portends a worsening prognosis.
Purpose of review Systemic hypertension (HTN) is a common complication arising in the heart transplant recipient. This article aims to review the most current literature and update readers on the epidemiology, pathophysiology and management of HTN in heart transplant patients. Recent findings In contrast to the general nontransplant hypertensive patient population, traditional risk factors, including family history of HTN, obesity and diabetes, play a minor role in the genesis of posttransplant HTN. Dysregulation in sodium and water balance, vascular stiffness, endothelial dysfunction, abnormal cardiorenal neural reflexes resulting from immunosuppression and cardiac denervation seem to be the predominant factors leading to postheart transplant HTN. Calcineurin inhibitors induced nephrotoxicity and steroid use further contributes to posttransplant HTN. Summary Owing to the paucity of data, particularly randomized controlled trials to guide the evaluation and management of HTN in the cardiac transplant patients, much of the available data come from the renal transplant population. The choice of antihypertensive should be based on timing related to transplantation and patient's comorbidities. Although calcium channel blockers and loop diuretics are the preferred agents in the early postheart transplant period, angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers may be beneficial in the late postheart transplant period especially in the setting of diabetes and in the presence of proteinuria.
