المؤلفون: Ian Lake

المصدر: Current Opinion in Endocrinology, Diabetes & Obesity. 28:453-462

مصطلحات موضوعية: Adult, Blood Glucose, Pediatrics, medicine.medical_specialty, Calorie, Diabetic ketoacidosis, Strength training, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Diabetic Ketoacidosis, Endocrinology, Diabetes mellitus, Internal Medicine, medicine, Humans, Insulin, Type 1 diabetes, Nutrition and Dietetics, business.industry, Ketosis, Middle Aged, medicine.disease, Diabetes Mellitus, Type 1, Mood, business

الوصف: Purpose of review The objective of this study was to test the feasibility of exercising over a 5-day period while fasting, in those with and without type 1 diabetes mellitus (T1DM).Eight individuals, ages 29--62 years, two with T1DM, walked/ran around 20 miles per day for five consecutive days while only consuming water. All eight individuals completed the project with no physical injuries or problems with diabetes control. The blood glucose levels ranged from less than 3 mmol/l to 7 mmol/l in those without T1D, and less than 3 mmol/l to 9 mmol/l in those with T1D. The continuous glucose traces in those with T1D showed little variability in glucose levels. The participants without T1D had no symptoms from blood glucose under 3 mmol/l. Ketone levels ranged from 0.3 to 7.5 and the ketones for those with T1D were no different to ketones in those without T1D. The respiratory quotient was overwhelmingly in the fat-burning range. There was very little subjective hunger, nor did it negatively affect mood. In keto-adapted individuals, with or without T1DM, prolonged exercise for 5 days while in nutritional ketosis was feasible, and well tolerated. Recent findings Eight adults, ages 28-62 years, trained for and completed a 5-day zero calorie fast covering 100 miles over 5 days. Training involved each individual preparing for the event according to their own programme. Typically, it involved both cardiovascular and strength training with the addition of practice water only fasts over 24-72 h or more based upon the individual's assessment of what was needed to complete the event. There was no formal protocol provided for this. The recommendation was that the participants would be keto adapted and trained to a level sufficient to complete the 5-day event. Keto adaptation was measured by ketone blood testing of betahydroxybutyrate. Two people had type 1 diabetes. All but one person was keto-adapted ahead of the event. All eight individuals completed the project with no physical injuries or problems with diabetes control. Prolonged fasting did neither lead to hunger nor did it negatively affect mood, which, if anything, was enhanced in most individuals. All keto-adapted people were shown to be burning fat stores throughout the 5 days, and everyone was measured to be in a state of nutritional ketosis. In type 1 diabetes, and ketones were in the same range as those without diabetes, insulin volumes were considerably reduced, and glucose control was close to physiological: nutritional ketosis is not a risk factor for diabetic ketoacidosis; consumption of sugar for energy is not required for distances of up to 100 miles in keto-adapted people; people who inject insulin do not necessarily need to consume carbohydrates unless rescuing a hypoglycaemic attack. Summary The findings from this project should provide reassurance to those clinicians who want to provide the option of a ketogenic lifestyle to their patients with type 1 diabetes. They also confirm that the fat stores are available for aerobic respiration without apparent negative consequences on physical or mental function. Video abstract http://links.lww.com/COE/A24Test.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::82097265b956fbc6ef24311af0049ea8Test
https://doi.org/10.1097/med.0000000000000666Test

المؤلفون: Yuzhuo Liu, Jing He, Jiang Zhu, Fansu Huang, Wenjing Zou, Zhiguang Zhou, Xiongzhao Zhu, Hongyu Du, Xia Li, Chuting Li, Yuting Xie, Fang Liu

المصدر: Psychosomatic Medicine. 83:906-912

مصطلحات موضوعية: Adult, Type 1 diabetes, medicine.medical_specialty, business.industry, Wechsler Adult Intelligence Scale, Disease, medicine.disease, Hypoglycemia, Psychiatry and Mental health, Cognition, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Internal medicine, Diabetes mellitus, medicine, Humans, Juvenile, Cognitive Dysfunction, Attention deficits, Age of onset, business, Applied Psychology, Depression (differential diagnoses)

الوصف: Objective This study aimed to investigate whether patients with juvenile-onset type 1 diabetes mellitus (T1DM) have poorer sustained attention than their counterparts with adult-onset T1DM, and whether there is a relationship between diabetes-related variables and sustained attention. Methods This study included 76, 68, and 85 participants with juvenile-onset and adult-onset T1DM, and healthy controls (HCs), respectively. All participants completed the Sustained Attention to Response Task, Beck Depression Inventory-II, and the Chinese version of the Wechsler Adult Intelligence Scale. Results The juvenile-onset group showed more omission errors (p = .007) than the adult-onset group and shorter reaction time (p = .005) than HCs, while the adult-onset group showed no significant differences compared with HCs. Hierarchical linear regression analysis revealed that the age of onset was associated with omission errors in T1DM participants (β = -0.275, t = -2.002, p = .047). In the juvenile-onset group, the omission error rate were associated with the history of severe hypoglycemia (β = 0.225, t = 1.996, p = .050), while reaction time was associated with the age of onset (β = -0.251, t = -2.271, p = .026). Fasting blood glucose levels were significantly associated with reaction time in both the juvenile-onset and adult-onset groups (β = -0.236, t = -2.117, p = .038 and β = 0.259, t = 2.041, p = .046, respectively). Conclusion Adults with juvenile-onset T1DM have sustained attention deficits, in contrast to their adult-onset counterparts, suggesting that the disease adversely affects the developing brain. Both the history of severe hypoglycemia and fasting blood glucose levels are factors associated with sustained attention impairment. Early diagnosis and treatment in juvenile patients are required to prevent the detrimental effects of diabetes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::21558dae09fc80439cae10046373827bTest
https://doi.org/10.1097/psy.0000000000000992Test

المؤلفون: Samar R. El Khoudary, Rachel G. Miller, Debra Rubinstein, Yan Yi, Trevor J. Orchard, Tina Costacou, Jeanine M. Buchanich

المصدر: Menopause

مصطلحات موضوعية: Adult, medicine.medical_specialty, endocrine system diseases, General Mathematics, medicine.medical_treatment, 030209 endocrinology & metabolism, Article, Diabetes Complications, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Diabetes mellitus, Epidemiology, medicine, Humans, Insulin, Child, Reproductive History, Reproductive health, Type 1 diabetes, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Applied Mathematics, Obstetrics and Gynecology, medicine.disease, Menopause, Diabetes Mellitus, Type 1, Female, Hormone therapy, business, Hormone

الوصف: OBJECTIVE Women with type 1 diabetes (T1D) are thought to experience menopause earlier than women without diabetes, although not all studies agree. We assessed metabolic predictors of the age at which natural menopause occurs among women with T1D participating in the Epidemiology of Diabetes Complications study. METHODS Women with childhood-onset (

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::77512168ad3a1735808f413eed08acfaTest
https://doi.org/10.1097/gme.0000000000001772Test

المؤلفون: Nasia Dai, Philip Gerretsen, Kevin Z Wang, Vincenzo De Luca, Ariel Graff, Clement C. Zai, Andrea de Bartolomeis

المصدر: Journal of Nervous & Mental Disease. 210:111-115

مصطلحات موضوعية: Adult, Male, Suicide, Attempted, 1 year follow up, Logistic regression, Suicidal Ideation, Life Change Events, Young Adult, Risk Factors, medicine, Humans, Suicidal ideation, business.industry, Life events, Odds ratio, Middle Aged, medicine.disease, Suicide, Psychiatry and Mental health, Cross-Sectional Studies, Logistic Models, Schizophrenia, Sample size determination, Cohort, Female, Schizophrenic Psychology, medicine.symptom, business, Stress, Psychological, Follow-Up Studies, Clinical psychology

الوصف: Half of patients with schizophrenia experience suicidal ideation. Only few studies have examined the effects of recent stress on both current and emergent suicidal ideation.A cohort of 85 patients with schizophrenia spectrum disorders was assessed. The study was divided into a cross-sectional and longitudinal arms to test the effect of recent stress on suicidal ideation. Analysis was done using logistic regression models.After correcting for covariates, recent stress had no significant effect on current suicidal ideation. However, increased total stress (odds ratio [OR] = 1.099 [1.032-1.170], p = 0.003) and health-related stress (OR = 1.331 [1.074-1.650], p = 0.009) at follow-up were predictive of emergent suicidal ideation.With this sample size, we were unable to draw firm conclusions regarding the effect of specific life events on suicidal ideation. Further studies involving larger samples that investigate the interplay between several risk factors are needed.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9332fe45c9abbb55f6a79385bb1cc574Test
https://doi.org/10.1097/nmd.0000000000001424Test

المؤلفون: Weizhan Wang, Qingmian Xiao, Xun Gao, Yongjian Liu, Baoyue Zhu

المصدر: Journal of Cardiovascular Pharmacology. 78:572-580

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Heart Diseases, Heart disease, Action Potentials, macromolecular substances, Creatine, Correlation, Carbon Monoxide Poisoning, Electrocardiography, chemistry.chemical_compound, Heart Conduction System, Heart Rate, Predictive Value of Tests, Internal medicine, Troponin I, Heart rate, Creatine Kinase, MB Form, Humans, Medicine, Pharmacology, Receiver operating characteristic, business.industry, Carbon monoxide poisoning, Incidence (epidemiology), Middle Aged, Prognosis, medicine.disease, Interleukin-1 Receptor-Like 1 Protein, Up-Regulation, chemistry, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers

الوصف: This study aimed to explore the correlation between QTc dispersion (QTcd) and soluble growth-stimulating gene 2 protein (sST2) after heart rate correction in patients with acute carbon monoxide poisoning (ACOP) heart disease. Among the 150 patients, 35 cases had severe toxic heart disease. The concentrations of sST2, cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) in the severe group began to increase from admission, 24 h and 2 d, respectively, and their detected values were all higher than those in the non-severe group and the normal control group. There were statistically significant differences in sST2 and QTcd between the poisoning, non-severe and normal control groups before the treatment. There was a statistically significant difference between the indexes of the poisoning groups at different degrees 2 d and 3 d after poisoning. Receiver Operating Characteristic (ROC) curve analysis confirmed the sensitivity and specificity of sST2 and QTcd. The correlation analysis showed that sST2 and QTcd levels were positively correlated with the incidence of severe heart disease at admission. Generally, the combined observation of sST2 and QTcd improved the prediction sensitivity and were early predictor indexes of toxic heart disease.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::27de528a2e6c36323d3b24f05255942cTest
https://doi.org/10.1097/fjc.0000000000001090Test

المؤلفون: Dong-Eog Kim, Hee-Joon Bae, Kyung Bok Lee, Dae-Hyun Kim, Jay Chol Choi, Sung Il Sohn, Tai Hwan Park, Byung-Chul Lee, Joon-Tae Kim, Mi Sun Oh, Jeong-Ho Hong, Yong-Jin Cho, Ji Sung Lee, Keun-Sik Hong, Chulho Kim, Jong-Moo Park, Moon-Ku Han, Dong-Ick Shin, Jun Young Chang, Jee Hyun Kwon, Sang-Hwa Lee, Wook-Joo Kim, Soo Joo Lee, Jae Kwan Cha, Beom Joon Kim, Jun Lee

المصدر: Neurology. 97:e1717-e1726

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Myocardial Infarction, 1 year follow up, Glycemic Control, Cohort Studies, Fasting glucose, Recurrence, Risk Factors, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Humans, Myocardial infarction, Stroke, Aged, Retrospective Studies, Glycemic, Aged, 80 and over, Glycated Hemoglobin, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Clinical research, Cardiology, Female, Neurology (clinical), business, Follow-Up Studies

الوصف: Background and ObjectivesWe evaluated the association between admission glycated hemoglobin (HbA1c) and subsequent risk of composite vascular events, including stroke, myocardial infarction (MI), and vascular death, in patients with acute ischemic stroke and diabetes.MethodsPatients who had a TIA or an acute ischemic stroke within 7 days of symptom onset and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, MI, and vascular death, during 1-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.ResultsOf the 18,567 patients, 1,437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%–7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of HbA1c associated with minimal risks for composite vascular events were lowest for the small vessel occlusion subtype (6.6 [95% confidence internal [CI], 6.3–6.9]) compared to the large artery atherosclerosis (7.3 [95% CI, 6.8–7.9]) or the cardioembolic subtype (7.4 [95% CI, 6.3–8.5]).DicussionIn patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of admission HbA1c was below 6.8%–7.0% and differed according to the ischemic stroke subtype.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::42d38829e4ac7103a74456d74e665d19Test
https://doi.org/10.1212/wnl.0000000000012729Test

المؤلفون: Zechuan Zhang, Huihui Chen, Minglu Zhang, Quan Zhang, Beicheng Sun, Wenjie Zhang, Jianbo He, Yin Yin, Wenfang Tian, Zetao Ji, Wen-Ming Chu, Yijun Lu, Runqiu Jiang, Chang Zheng, Fei Yang

المصدر: Hepatology. 74:3110-3126

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Peroxiredoxin 1, Diet, High-Fat, Mice, Young Adult, Liver disease, Non-alcoholic Fatty Liver Disease, Fibrosis, GNAI2, Internal medicine, Autophagy, medicine, Animals, Humans, Mice, Knockout, Hepatology, Chemistry, Lipid metabolism, Peroxiredoxins, medicine.disease, Disease Models, Animal, Endocrinology, Liver, Hepatocytes, Female, Tumor necrosis factor alpha, GTP-Binding Protein alpha Subunit, Gi2, Steatosis, Steatohepatitis, Protein Binding, Signal Transduction

الوصف: BACKGROUND AND AIMS NASH is an advanced stage of liver disease accompanied by lipid accumulation, inflammation, and liver fibrosis. Guanine nucleotide-binding protein G(i) subunit alpha-2 (GNAI2) is a member of the "inhibitory" class of α-subunits, and recent studies showed that Gnai2 deficiency is known to cause reduced weight in mice. However, the role of GNAI2 in hepatocytes, particularly in the context of liver inflammation and lipid metabolism, remains to be elucidated. Herein, we aim to ascertain the function of GNAI2 in hepatocytes and its impact on the development of NASH. APPROACH AND RESULTS Human liver tissues were obtained from NASH patients and healthy persons to evaluate the expression and clinical relevance of GNAI2. In addition, hepatocyte-specific Gnai2-deficient mice (Gnai2hep-/- ) were fed either a Western diet supplemented with fructose in drinking water (WDF) for 16 weeks or a methionine/choline-deficient diet (MCD) for 6 weeks to investigate the regulatory role and underlying mechanism of Gnai2 in NASH. GNAI2 was significantly up-regulated in liver tissues of patients with NASH. Following feeding with WDF or MCD diets, livers from Gnai2hep-/- mice had reduced steatohepatitis with suppression of markers of inflammation and an increase in lipophagy compared to Gnai2flox/flox mice. Toll-like receptor 4 signals through nuclear factor kappa B to trigger p65-dependent transcription of Gnai2. Intriguingly, immunoprecipitation, immunofluorescence, and mass spectrometry identified peroxiredoxin 1 (PRDX1) as a binding partner of GNAI2. Moreover, the function of PRDX1 in the suppression of TNF receptor-associated factor 6 ubiquitin-ligase activity and glycerophosphodiester phosphodiesterase domain-containing 5-related phosphatidylcholine metabolism was inhibited by GNAI2. Suppression of GNAI2 combined with overexpression of PRDX1 reversed the development of steatosis and fibrosis in vivo. CONCLUSIONS GNAI2 is a major regulator that leads to the development of NASH. Thus, inhibition of GNAI2 could be an effective therapeutic target for the treatment of NASH.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::237a4a277a02d556b781bbf228bb412cTest
https://doi.org/10.1002/hep.32078Test

المؤلفون: Taishi Takahara, Kazuyuki Shimada, Shigeo Nakamura, Akira Satou, Seiichi Kato, Tasuku Kawano, Mayuko Mori, Masato Nakaguro, Yuta Tsuyuki, Yuka Suzuki, Ayako Sakakibara

المصدر: American Journal of Surgical Pathology. 45:1606-1615

مصطلحات موضوعية: Adult, Male, Epstein-Barr Virus Infections, Herpesvirus 4, Human, Pathology, medicine.medical_specialty, Time Factors, Adrenal Gland Neoplasms, Tumor cells, Disease, B7-H1 Antigen, Pathology and Forensic Medicine, Programmed cell death ligand 1, Immune system, Japan, Risk Factors, hemic and lymphatic diseases, Antineoplastic Combined Chemotherapy Protocols, Biomarkers, Tumor, medicine, Humans, Immunodeficiency, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Adrenalectomy, Middle Aged, medicine.disease, Progression-Free Survival, Lymphoma, RNA, Viral, Female, Surgery, Pd l1 expression, Lymphoma, Large B-Cell, Diffuse, Anatomy, Rituximab, business, Diffuse large B-cell lymphoma

الوصف: Primary adrenal diffuse large B-cell lymphoma (PA-DLBCL) is rare. We investigate 23 Japanese patients with PA-DLBCL to understand the clinicopathologic features and biological behavior of this disease. The 17 males and 6 females had a median age of 74 years (range: 40 to 86 y). Tumor cells harbored Epstein-Barr virus-encoded small RNA (EBER) in 9 (39%) samples, including samples from the 2 patients with methotrexate-associated B-cell lymphoproliferative disorder. Programmed cell death ligand 1 (PD-L1) expression was detected in tumor cells of 6 (26%) samples, including 1 EBER+ and 5 EBER- samples. Four (17%) patients exhibited an intravascular proliferating pattern, and all 4 patient samples showed positive staining for PD-L1 in tumor cells. Among those patients, 3 showed intravascular proliferating pattern accompanied by a diffuse extravascular proliferation of tumor cells, and 1 patient was diagnosed with intravascular large B-cell lymphoma. We divided the 23 patients into 3 groups: EBER+ (n=9, 39%), EBER-PD-L1+ (n=5, 22%), and EBER-PD-L1- (n=9, 39%). A comparison of the outcomes among the 3 groups showed significant differences in overall survival (P=0.034). The EBER+ group had the worst prognosis, and the EBER-PD-L1- group had the best prognosis. We also compared the outcomes among the 3 groups that received rituximab-containing chemotherapies. Both the overall survival and progression-free survival were significantly different among these groups (P

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b0686eafac1652ca09a4707e44d45e0eTest
https://doi.org/10.1097/pas.0000000000001809Test

المؤلفون: Circe McDonald, Jeffrey J. Wallin, Anh Hoa Nguyen, Diana Y. Chen, Edward Gane, Priyanka Arora, Kumar Visvanathan, Hyung Joon Kim, Young-Suk Lim, Susanna K. Tan, Anuj Gaggar, Yoon Jun Kim, Stuart K. Roberts

المصدر: Hepatology. 74:1737-1749

مصطلحات موضوعية: Adult, Male, 0301 basic medicine, Agonist, medicine.medical_specialty, Sustained Virologic Response, Nausea, medicine.drug_class, medicine.disease_cause, Placebo, Antiviral Agents, Dizziness, Gastroenterology, 03 medical and health sciences, Hepatitis B, Chronic, 0302 clinical medicine, Pharmacokinetics, Internal medicine, medicine, Clinical endpoint, Humans, Adverse effect, Hepatitis B virus, Dose-Response Relationship, Drug, Hepatology, Interleukin-12 Subunit p40, business.industry, Headache, Middle Aged, Interleukin 1 Receptor Antagonist Protein, Pyrimidines, 030104 developmental biology, Toll-Like Receptor 8, Pharmacodynamics, Female, 030211 gastroenterology & hepatology, medicine.symptom, Hexanols, business

الوصف: Background and aims In patients with chronic hepatitis B (CHB) infection, activation of toll-like receptor 8 may induce antiviral immunity and drive functional cure. Selgantolimod, a toll-like receptor 8 agonist, was evaluated in patients with CHB who were virally suppressed on oral antiviral treatment or viremic and not on oral antiviral treatment. Approach and results In this phase 1b study, patients were randomized 4:1 to receive either selgantolimod or placebo once weekly. Virally suppressed patients received either 1.5 mg (for 2 weeks) or 3 mg (for 2 weeks or 4 weeks). Viremic patients received 3 mg for 2 weeks. The primary endpoint was safety, as assessed by adverse events (AEs), laboratory abnormalities, and vital sign examination. Pharmacokinetic and pharmacodynamic parameters were assessed by plasma analysis. A total of 38 patients (28 virally suppressed, 10 viremic) were enrolled from six sites in Australia, New Zealand, and South Korea. Twenty patients (53%) experienced an AE and 32 (84%) had laboratory abnormalities, all of which were mild or moderate in severity. The most common AEs were headache (32%), nausea (24%), and dizziness (13%). With a half-life of 5 hours, no accumulation of selgantolimod was observed with multiple dosing. Selgantolimod induced transient dose-dependent increases in serum cytokines, including IL-12p40 and IL-1RA, which are important for the expansion and activity of multiple T- cell subsets and innate immunity. Conclusion Selgantolimod was safe and well-tolerated in virally suppressed and viremic patients with CHB and elicited cytokine responses consistent with target engagement. Further studies with longer durations of selgantolimod treatment are required to evaluate efficacy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3eaee717e84933eb95f6de3ac41a3f49Test
https://doi.org/10.1002/hep.31795Test

المؤلفون: Wendy Klein-Schwartz, James B. Leonard, Faisal Syed Minhaj, Hyunuk Seung

المصدر: Journal of Cardiovascular Pharmacology. 78:474-479

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Poison Control Centers, Antidotes, Patient characteristics, Hemorrhage, Time-to-Treatment, Predictive Value of Tests, Interquartile range, Internal medicine, medicine, Humans, heterocyclic compounds, In patient, International Normalized Ratio, cardiovascular diseases, Blood Coagulation, Aged, Retrospective Studies, Pharmacology, Maryland, business.industry, Warfarin dose, Warfarin, Anticoagulants, Retrospective cohort study, Vitamin K 1, Middle Aged, Antifibrinolytic Agents, Time to peak, Female, Drug Overdose, Cardiology and Cardiovascular Medicine, business, Warfarin overdose, medicine.drug

الوصف: Guidelines exist on the management of supratherapeutic/subtherapeutic international normalized ratio (INR) values for patients on warfarin. However, there is a paucity of the literature relating to an acute overdose of warfarin. This is a retrospective cohort study for all acute and acute-on-chronic (AOC) warfarin overdoses reported to the Maryland Poison Center in patients ≥12 years between January 1st, 2000, until October 31st, 2019, managed in a health care facility. The primary outcome was to determine the time after presentation to peak INR. Secondary outcomes included risk factors associated with INR >10 and describing patient characteristics. A total of 163 overdoses were included, 68 acute and 95 AOC. In patients who did not receive reversal therapies, INR peaked at a median value of 3.8 (interquartile range 2.6-5.5) between 24 and 36 hours. The median time to phytonadione was 22.0 hours. Most patients received phytonadione (62.0%), with fewer receiving blood products (16.6%). The median warfarin dose ingested was 75 mg. The AOC group had a greater mean age (56 vs. 43 years), median INR value (2.4 vs. 1.4), and men (62.1% vs. 41.2%). Factors associated with an INR > 10 included initial INR and reported quantity ingested. Peak INR was greater in the AOC than the acute overdose group (6.1 vs. 3.4), although the bleeding rate was similar. Peak INR values after warfarin overdose occur between 24 and 36 hours after presentation. Initial INRs and reported quantity ingested may be useful to predict those needing treatment.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5d7ce865fcaecbebc6c152a9610097e6Test
https://doi.org/10.1097/fjc.0000000000001070Test