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Hennebelle A, Ismail L, Materwala H, Al Kaabi J, Ranjan P, Janardhanan R. Secure and privacy-preserving automated machine learning operations into end-to-end integrated IoT-edge-artificial intelligence-blockchain monitoring system for diabetes mellitus prediction. Comput Struct Biotechnol J 2024; 23:212-233. [PMID: 38169966 PMCID: PMC10758733 DOI: 10.1016/j.csbj.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Diabetes Mellitus, one of the leading causes of death worldwide, has no cure to date and can lead to severe health complications, such as retinopathy, limb amputation, cardiovascular diseases, and neuronal disease, if left untreated. Consequently, it becomes crucial to be able to monitor and predict the incidence of diabetes. Machine learning approaches have been proposed and evaluated in the literature for diabetes prediction. This paper proposes an IoT-edge-Artificial Intelligence (AI)-blockchain system for diabetes prediction based on risk factors. The proposed system is underpinned by blockchain to obtain a cohesive view of the risk factors data from patients across different hospitals and ensure security and privacy of the user's data. We provide a comparative analysis of different medical sensors, devices, and methods to measure and collect the risk factors values in the system. Numerical experiments and comparative analysis were carried out within our proposed system, using the most accurate random forest (RF) model, and the two most used state-of-the-art machine learning approaches, Logistic Regression (LR) and Support Vector Machine (SVM), using three real-life diabetes datasets. The results show that the proposed system predicts diabetes using RF with 4.57% more accuracy on average in comparison with the other models LR and SVM, with 2.87 times more execution time. Data balancing without feature selection does not show significant improvement. When using feature selection, the performance is improved by 1.14% for PIMA Indian and 0.02% for Sylhet datasets, while it is reduced by 0.89% for MIMIC III.
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Affiliation(s)
- Alain Hennebelle
- School of Computing and Information Systems, The University of Melbourne, Australia
| | - Leila Ismail
- School of Computing and Information Systems, The University of Melbourne, Australia
- Intelligent Distributed Computing and Systems Lab, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, United Arab Emirates
- National Water and Energy Center, United Arab Emirates University, United Arab Emirates
| | - Huned Materwala
- Intelligent Distributed Computing and Systems Lab, Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, United Arab Emirates
- National Water and Energy Center, United Arab Emirates University, United Arab Emirates
| | - Juma Al Kaabi
- College of Medicine and Health Sciences, Department of Internal Medicine, United Arab Emirates University, United Arab Emirates
- Tawam and Mediclinic Hospitals, Al Ain, Abu Dhabi, United Arab Emirates
| | - Priya Ranjan
- School of Computer Science, Internet of Things Center of Excellence, University of Petroleum and Energy Studies, India
| | - Rajiv Janardhanan
- Faculty of Medical & Health Sciences, SRM Institute of Science & Technology, India
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Michael TJF, Wright DFB, Chan JS, Coleshill MJ, Aslani P, Hughes DA, Day RO, Stocker SL. Patient-Led Urate Self-Monitoring to Improve Clinical Outcomes in People With Gout: A Feasibility Study. ACR Open Rheumatol 2024. [PMID: 38591107 DOI: 10.1002/acr2.11666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE Self-monitored point-of-care urate-measuring devices are an underexplored strategy to improve adherence to urate-lowering therapy and clinical outcomes in gout. This study observed patient-led urate self-monitoring practice and assessed its influence on allopurinol adherence, urate control, and health-related quality of life. METHODS People with gout (n = 31) and prescribed allopurinol self-monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (Medication Event Monitoring System cap). Time spent below the target urate concentration (<0.36 mmol/L) was determined. Health-related quality of life was measured using a survey (EuroQoL EQ-5D-5L). Gout flares were recorded. Two-tailed Spearman correlation and the Wilcoxon matched-pairs signed-rank test (P < 0.05) were used for statistical comparisons. RESULTS Most participants were male (94%) and had urate concentrations below the target (74%) at baseline. Overall, seven participants demonstrated repeated periods of "missed doses" (two or fewer allopurinol doses missed consecutively) and "drug holidays" (three or more missed doses). Most participants (94%) persisted with allopurinol. Time spent within the target urate concentration increased 1.3-fold (from 79% to 100%; P = 0.346), and the incidence of gout flares decreased 1.6-fold (from 8 to 5; P = 0.25) in the final quarter compared to that in the first quarter of the study. Health-related quality of life was reduced for participants reporting at least one gout flare (median utility values 0.9309 vs 0.9563, P = 0.04). CONCLUSION Patient-led urate self-monitoring may support the maintenance of allopurinol adherence and improve urate control, thus reducing the incidence of gout flares. Further research on patient-led urate self-monitoring in a randomized controlled study is warranted.
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Affiliation(s)
- Toni J F Michael
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Jian S Chan
- St. Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Matthew J Coleshill
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Randwick, Australia
| | - Parisa Aslani
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Dyfrig A Hughes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Richard O Day
- St. Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, Australia, and Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Darlinghurst, Australia
| | - Sophie L Stocker
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, and Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Darlinghurst, Australia
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Soueid R, Michael TJF, Cairns R, Charles KA, Stocker SL. A Scoping Review of Pharmacogenomic Educational Interventions to Improve Knowledge and Confidence. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100668. [PMID: 38331197 DOI: 10.1016/j.ajpe.2024.100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Poor knowledge and confidence in pharmacogenomics are key barriers to implementation. Education of future health care professionals is required to enhance appropriate use of pharmacogenomics; however, the optimal education approach is unclear. This systematic scoping review evaluates pharmacogenomic educational interventions to improve knowledge and confidence. FINDINGS A total of 24 studies were included. Most (90%) studies delivered pharmacogenomic education to pharmacy students and consisted of didactic lectures and workshops with case studies. To supplement case studies, self or class aggregated (52%, 12 of 23), mock (43%, 10 of 23) or faculty member provided (4%, 1 of 23) pharmacogenomic data were used in the case scenarios. All studies used quantitative methods, including student assessments and scaled surveys to assess the impact of the educational intervention on knowledge and/or confidence in pharmacogenomics. On average, the educational interventions improved knowledge acquisition by 21%, confidence in pharmacogenomic data interpretation by 37%, confidence in communication of pharmacogenomic information to patients by 41% and to health care professionals by 44%. Improvement in communication with other health care professionals was greater in students involved in interprofessional learning compared to self-pharmacogenomic testing. SUMMARY The measures used to determine the effect of educational interventions on student knowledge and confidence varied. Innovative pedagogy, specifically interactive case-based learning and simulation such as interprofessional learning, enhances the knowledge and confidence of students in pharmacogenomics. Course-embedded self-pharmacogenomic testing may offer a supplementary, interactive component to case-based learning by using real-life reports as the foundation of knowledge and confidence acquisition.
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Affiliation(s)
- Ruby Soueid
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Toni J F Michael
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rose Cairns
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Kellie A Charles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sophie L Stocker
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Healthy, University of New South Wales, Sydney, NSW, Australia; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Sydney, NSW, Australia.
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Sigurdardottir V, Svärd A, Jacobsson L, Dehlin M. Gout in Dalarna, Sweden - a population-based study of gout occurrence and compliance to treatment guidelines. Scand J Rheumatol 2023; 52:498-505. [PMID: 36300710 DOI: 10.1080/03009742.2022.2132055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This study aimed to describe the incidence and prevalence of gout, describe the use of allopurinol among prevalent gout cases, and determine persistence with allopurinol and degree of compliance with treat-to-target recommendations before and after the publication of Swedish national guidelines in 2016. METHOD Prospectively registered data on gout diagnoses and allopurinol prescriptions were used to calculate incidence and prevalence, and the proportion of prevalent patients on allopurinol. Gout patients starting allopurinol during 2013-2015 versus 2016-2018 were compared regarding persistence and compliance with treat-to-target principles. RESULTS The incidence of gout was 221-247 per 100 000 person-years during 2014-2019, prevalence in 2018 was 2.45%. Among prevalent cases, the proportion on allopurinol ranged from 21% to 25%. Allopurinol persistence was better for individuals starting therapy during 2016-2018 compared with 2013-2015 (45% vs 39%, p = 0.031), as were several outcomes related to treat-to-target principles, e.g. measuring baseline serum urate (SU) (84% vs 77%, p < 0.001), follow-up SU (50% vs 36%, p < 0.001), and the proportion of patients reaching an SU level < 360 µmol/L (45% vs 30%, p < 0.001). CONCLUSION Incidence and prevalence were slightly higher than in previous Swedish reports. Allopurinol use among prevalent gout patients did not increase during 2014-2019. Only a minor improvement in persistence was seen, and a moderate increase in compliance with guidelines, suggesting a need for improved management and extended patient involvement to increase and optimize the use of urate lowering therapy.
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Affiliation(s)
- V Sigurdardottir
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - A Svärd
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Lth Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kurniasari MD, Karwur FF, Rayanti RE, Shih YW, Yuliana S, Miao NF, Chou KR, Shen CJ, Tsai HT. Immersion in Water Between 20-30 oC Mediated Inflammations Marker to Reduced Pain Among Indonesian With Gout Arthritis: A Community-Based Randomized Controlled Trial. Biol Res Nurs 2023; 25:267-281. [PMID: 36207143 DOI: 10.1177/10998004221132843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gout is triggered by high urate levels and causes inflammation, pain, and an impaired quality of life. Immersion in water at 20-30°C reduces inflammation and pain in arthritis. Yet, relationships of immersion in water at 20-30°C with urate levels and the nucleotide-binding domain (NOD)-like receptor protein 1 (NLRP1) inflammasome have never been clarified. OBJECTIVES We aimed to investigate the effects of immersion in water at 20-30°C on urate levels, the NLRP1 inflammasome, pain, and quality of life among acute gout patients. METHODS A community-based randomized control trial design was used with 2 parallel-intervention groups: immersion in water at 20-30°C (20 min/day for 4 weeks) group and a control group. In total, 76 eligible participants in Tomohon City, Indonesia, were assigned using block randomization. We analyze the results (coef. β) and 95% confidence intervals (CIs) using a generalized estimating equation model. We analyzed mediating effects using a path analysis. RESULTS Significant pain alleviation (β = -2.06 [95% CI = -2.67∼-1.45]; β = -2.42 [95% CI = -2.97∼-1.87]) and improved quality of life (β = 5.34 [95% CI = 3.12-7.57]; β = 9.93 [95% CI = 7.02-12.83]) were detected at 2 and 4 weeks of follow-up compared to the pre-test and control group. Urate levels (β = -0.34 [95% CI = -0.52∼-0.16]) were reduced at the 2-week follow-up, but there was no significant change in the NLRP1 inflammasome compared to the pre-test and control group after immersion in water at 20-30°C. Both the NLRP1 inflammasome (β = -0.48 [95% CI = -0.63∼-0.34]); water 0.01) and urate levels (β = -0.11 [95% CI = -0.24∼-0.03]; p < 0.01) had partial indirect (mediating) effects on the link between immersion in water at 20-30°C and pain at the 4-week follow-up. CONCLUSIONS Immersion in water at 20-30°C significantly decreased pain and increased the quality of life. Immersion in water at 20-30°C mediated NLRP1 and urate levels to decrease pain, although it had no significant effect on the NLRP1 inflammasome concentration after 4 weeks of follow-up and reduced urate levels only at 2 weeks after immersion in water at 20-30°C.
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Affiliation(s)
- Maria Dyah Kurniasari
- Faculty of Medicine and Health Science, 106208Universitas Kristen Satya Wacana, Salatiga, Indonesia
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan
| | - Ferry Fredy Karwur
- Faculty of Medicine and Health Science, 106208Universitas Kristen Satya Wacana, Salatiga, Indonesia
| | - Rosiana Eva Rayanti
- Faculty of Medicine and Health Science, 106208Universitas Kristen Satya Wacana, Salatiga, Indonesia
| | - Ya Wen Shih
- School of Nursing, 38028National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Sri Yuliana
- Department of Nursing, Yahya Health Science Institute of Bima, West Nusa Tenggara, Indonesia
| | - Nae Fang Miao
- Post-Baccalaureate Program in Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan
| | - Kuei Ru Chou
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan
| | - Chia Jung Shen
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, 38032Taipei Medical University, Taipei, Taiwan
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Russell MD, Rutherford AI, Ellis B, Norton S, Douiri A, Gulliford MC, Cope AP, Galloway JB. Management of gout following 2016/2017 European (EULAR) and British (BSR) guidelines: An interrupted time-series analysis in the United Kingdom. Lancet Reg Health Eur 2022; 18:100416. [PMID: 35814340 PMCID: PMC9257653 DOI: 10.1016/j.lanepe.2022.100416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Following studies reporting sub-optimal gout management, European (EULAR) and British (BSR) guidelines were updated to encourage the prescription of urate-lowering therapy (ULT) with a treat-to-target approach. We investigated whether ULT initiation and urate target attainment has improved following publication of these guidelines, and assessed predictors of these outcomes. Methods We used the Clinical Practice Research Datalink to assess attainment of the following outcomes in people (n = 129,972) with index gout diagnoses in the UK from 2004-2020: i) initiation of ULT; ii) serum urate ≤360 µmol/L and ≤300 µmol/L; iii) treat-to-target urate monitoring. Interrupted time-series analyses were used to compare trends in outcomes before and after updated EULAR and BSR management guidelines, published in 2016 and 2017, respectively. Predictors of ULT initiation and urate target attainment were modelled using logistic regression and Cox proportional hazards. Findings 37,529 (28.9%) of 129,972 people with newly-diagnosed gout had ULT initiated within 12 months. ULT initiation improved modestly over the study period, from 26.8% for those diagnosed in 2004 to 36.6% in 2019 and 34.7% in 2020. Of people diagnosed in 2020 with a serum urate performed within 12 months, 17.1% attained a urate ≤300 µmol/L, while 36.0% attained a urate ≤360 µmol/L. 18.9% received treat-to-target urate monitoring. No significant improvements in ULT initiation or urate target attainment were observed after updated BSR or EULAR management guidance, relative to before. Comorbidities, including chronic kidney disease (CKD), heart failure and obesity, and diuretic use associated with increased odds of ULT initiation but decreased odds of attaining urate targets within 12 months: CKD (adjusted OR 1.61 for ULT initiation, 95% CI 1.55 to 1.67; adjusted OR 0.51 for urate ≤300 µmol/L, 95% CI 0.48 to 0.55; both p < 0.001); heart failure (adjusted OR 1.56 for ULT initiation, 95% CI 1.48 to 1.64; adjusted OR 0.85 for urate ≤300 µmol/L, 95% CI 0.76 to 0.95; both p < 0.001); obesity (adjusted OR 1.32 for ULT initiation, 95% CI 1.29 to 1.36; adjusted OR 0.61 for urate ≤300 µmol/L, 95% CI 0.58 to 0.65; both p < 0.001); and diuretic use (adjusted OR 1.49 for ULT initiation, 95% CI 1.44 to 1.55; adjusted OR 0.61 for urate ≤300 µmol/L, 95% CI 0.57 to 0.66; both p < 0.001). Interpretation Initiation of ULT and attainment of urate targets remain poor for people diagnosed with gout in the UK, despite updated management guidelines. If the evidence-practice gap in gout management is to be bridged, strategies to implement best practice care are needed. Funding National Institute for Health Research.
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Affiliation(s)
- Mark D Russell
- Centre for Rheumatic Diseases, King's College London, SE5 9RJ, UK
- Corresponding author at: Centre for Rheumatic Diseases, Weston Education Centre, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.
| | - Andrew I Rutherford
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Benjamin Ellis
- Department of Rheumatology, Imperial College Healthcare NHS Foundation Trust, London
| | - Sam Norton
- Centre for Rheumatic Diseases, King's College London, SE5 9RJ, UK
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, SE1 1UL, UK
| | - Martin C Gulliford
- School of Population Health and Environmental Sciences, King's College London, SE1 1UL, UK
| | - Andrew P Cope
- Centre for Rheumatic Diseases, King's College London, SE5 9RJ, UK
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, SE5 9RJ, UK
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Bardin T, Magnat E, Clerson P, Richette P, Rouchon B. Epidemiology of gout and hyperuricemia in New Caledonia. Joint Bone Spine 2021; 89:105286. [PMID: 34601114 DOI: 10.1016/j.jbspin.2021.105286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES New Caledonia is a Pacific island of 270,000 inhabitants with mixed ethnicities, including Polynesians (10.2%), people from European ancestry (27.2%), and Melanesians (39.1%),. This study aimed at determining the prevalence of gout and hyperuricemia in the general population and the various ethnicities of New Caledonia. METHODS A 3-degree random sample of the population aged 18 to 60 years was adjusted according to the 2014 New Caledonia census. Face-to-face planned interviews and physical measurements were performed by trained nurses. All consenting participants underwent capillary measurement of creatinine; all consenting men and only women older than 40 years underwent point-of-care uricemia testing. Gout was defined by a validated algorithm. Two definitions of hyperuricemia were used: capillary level equivalent to plasma uric acid level>360μmol/l (6mg/dl) and>420μmol/l (7mg/dl) and/or urate-lowering drug treatment for both thresholds. RESULTS We included 1144 participants (adjusted mean age 37.7±12.0 years; adjusted sex ratio 50.4% men). The adjusted prevalence of gout was 3.3% (95% confidence interval 2.2-4.9). Prevalence was 6.7% (2.5-16.8), 4.1% (1.8-8.9), and 2.6% (1.4-4.7) for Polynesians, Europeans and Melanesians, respectively, and 1.9% (0.5-6.6) for other ethnicities. Prevalence of hyperuricemia, determined in 658 participants, was 67.0% (61.9-71.6) and 37.0% (32.3-42.0) for the 360- and 420-μmol/l thresholds, respectively, and was significantly greater for Polynesians and Melanesians than Europeans for both thresholds. CONCLUSIONS The prevalence of gout and hyperuricemia in New Caledonia was high, including in patients of European descent.
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Affiliation(s)
- Thomas Bardin
- Department of Rheumatology, Lariboisière hospital APHP Paris Nord, and Université de Paris, INSERM U1132, Paris, France.
| | | | | | - Pascal Richette
- Department of Rheumatology, Lariboisière hospital APHP Paris Nord, and Université de Paris, INSERM U1132, Paris, France
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Dyah Kurniasari M, Karwur FF, Rayanti RE, Huruta AD, Lin YH, Weng SF, Tsai HT. Increased Systolic Blood Pressure Mediates the Relationship Between Urate and Gout Risk in Indonesia: A Novel Application of a Partial Least Squares-Structural Equation Model. Biol Res Nurs 2021; 24:40-47. [PMID: 34340595 DOI: 10.1177/10998004211029044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout. OBJECTIVE We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model. METHOD A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting. RESULT We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48-7.09) and an AOR of 4.44 (95% CI: 3.07-6.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02-0.08], p < 0.001). CONCLUSION Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.
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Affiliation(s)
- Maria Dyah Kurniasari
- School of Nursing, College of Nursing, Taipei Medical University, Republic of China.,Faculty of Medicine and Health Sciences, Department of Nursing, Universitas Kristen Satya Wacana, Salatiga City, Indonesia
| | - Ferry Fredy Karwur
- Faculty of Medicine and Health Sciences, Department of Nutrition, Universitas Kristen Satya Wacana, Salatiga City, Indonesia
| | - Rosiana Eva Rayanti
- Faculty of Medicine and Health Sciences, Department of Nursing, Universitas Kristen Satya Wacana, Salatiga City, Indonesia
| | - Andrian Dolfriandra Huruta
- Faculty of Economics and Business, Universitas Kristen Satya Wacana, Salatiga, Indonesia.,PhD Program in Business, Chung Yuan Christian University, Zhongli District, Taoyuan, Republic of China
| | - Yu Huei Lin
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Republic of China
| | - Shuen Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Republic of China.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Republic of China
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Republic of China.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Republic of China
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Kurniasari MD, Karwur FF, Rayanti RE, Dharmana E, Rias YA, Chou KR, Tsai HT. Second-Hand Smoke and Its Synergistic Effect with a Body-Mass Index of >24.9 kg/m 2 Increase the Risk of Gout Arthritis in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4324. [PMID: 33921811 PMCID: PMC8073587 DOI: 10.3390/ijerph18084324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
To analyze the association between smoking status (active smoking and exposure to Second-Hand Smoking (SHS)) and the synergistic effect of smoking status and BMI with gout risk, a community-based case-control design was undertaken among 385 participants, including 304 healthy controls and 81 gout patients from seven community health services. Adjusted Odd Ratios (AORs) and 95% Confidence Interval (CIs) of gout for active smoking and SHS were 3.26 (95% CI = 1.07~9.90) and 4.67 (95% CI = 2.18~10.00) compared to non-smokers. Time-dependent manner of active smoking and SHS significantly increased gout risk with AORs and 95% CIs of 5.95 (1.41~25.03) and 10.12 (3.51~29.14). Dose-dependency of active smokers and SHS showed AORs and 95% CIs of 5.15 (1.28~20.63) and 4.37 (1.33~14.28). Smoking 20 cigarettes (one pack) per day for one year is equivalent to one pack-year. Active smoking >20 pack-year and SHS > 26.5 pack-year increased gout risk with AORs and 95% CIs of 7.18 (1.53~33.67) and 9.95 (3.64~27.22). Participants who smoked (active smoking and SHS) and with Body Mass Index (BMI) of > 24.9 kg/m2 synergistically increased gout risk, with an AOR of 9.65 and 95% CI of 3.25~28.65, compared to BMI ≤ 24.9 kg/m2 and non-smoker. Smoking status (active smoking and SHS) and the synergistic effect of smoking status and BMI increased gout risk in Indonesia.
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Affiliation(s)
- Maria Dyah Kurniasari
- School of Nursing, College of Nursing, Taipei Medical University, Wu-Xing Street, No 250, Taipei City 11031, Taiwan; (M.D.K.); (K.R.C.)
- Department of Nursing, Faculty of Medicine and Health Sciences, Universitas Kristen Satya Wacana, Diponegoro Street, No 52-60, Salatiga City 50711, Indonesia;
| | - Ferry Fredy Karwur
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universitas Kristen Satya Wacana, Diponegoro Street, No 52-60, Salatiga City 50711, Indonesia;
| | - Rosiana Eva Rayanti
- Department of Nursing, Faculty of Medicine and Health Sciences, Universitas Kristen Satya Wacana, Diponegoro Street, No 52-60, Salatiga City 50711, Indonesia;
| | - Edi Dharmana
- Faculty of Medicine, Universitas Diponegoro, Prof. Sudarto Street, No.13, Semarang City 50275, Indonesia;
| | - Yohanes Andy Rias
- Faculty of Health and Medicine, Institut Ilmu Kesehatan Bhakti Wiyata Kediri, College of Nursing, KH Wachid Hasyim Street, No.65, Kediri City 64114, Indonesia;
| | - Kuei Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Wu-Xing Street, No 250, Taipei City 11031, Taiwan; (M.D.K.); (K.R.C.)
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei 23561, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Hsiu-Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Wu-Xing Street, No 250, Taipei City 11031, Taiwan; (M.D.K.); (K.R.C.)
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Wu-Xing Street, No 250, Taipei 11031, Taiwan
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10
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Hoque KM, Dixon EE, Lewis RM, Allan J, Gamble GD, Phipps-Green AJ, Halperin Kuhns VL, Horne AM, Stamp LK, Merriman TR, Dalbeth N, Woodward OM. The ABCG2 Q141K hyperuricemia and gout associated variant illuminates the physiology of human urate excretion. Nat Commun 2020; 11:2767. [PMID: 32488095 PMCID: PMC7265540 DOI: 10.1038/s41467-020-16525-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
The pathophysiological nature of the common ABCG2 gout and hyperuricemia associated variant Q141K (rs2231142) remains undefined. Here, we use a human interventional cohort study (ACTRN12615001302549) to understand the physiological role of ABCG2 and find that participants with the Q141K ABCG2 variant display elevated serum urate, unaltered FEUA, and significant evidence of reduced extra-renal urate excretion. We explore mechanisms by generating a mouse model of the orthologous Q140K Abcg2 variant and find male mice have significant hyperuricemia and metabolic alterations, but only subtle alterations of renal urate excretion and ABCG2 abundance. By contrast, these mice display a severe defect in ABCG2 abundance and function in the intestinal tract. These results suggest a tissue specific pathobiology of the Q141K variant, support an important role for ABCG2 in urate excretion in both the human kidney and intestinal tract, and provide insight into the importance of intestinal urate excretion for serum urate homeostasis. The common ABCG2 variant Q141K contributes to hyperuricemia and gout risk. Here, using a human interventional study and a new orthologous mouse model, the authors report a tissue specific pathobiology of the Q141K variant, and support a significant role for ABCG2 in urate excretion in both the kidney and intestine.
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Affiliation(s)
- Kazi Mirajul Hoque
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eryn E Dixon
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raychel M Lewis
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jordyn Allan
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gregory D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | | | - Anne M Horne
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Owen M Woodward
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA.
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11
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Dalbeth N, Reid S, Stamp LK, Arroll B. Making the right thing the easy thing to do: strategies to improve outcomes in gout. THE LANCET. RHEUMATOLOGY 2019; 1:e122-e131. [PMID: 38229339 DOI: 10.1016/s2665-9913(19)30004-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022]
Abstract
The burden of gout is increasing worldwide. Although urate-lower ing drugs have been available for more than half a century, the initiation and persistence of urate-lowering therapy remain low. Health-care system, practitioner, and patient barriers contribute to the clinical inertia in gout management. Pervasive beliefs about gout as a disease of an indulgent lifestyle that should be managed primarily with dietary modification are key barriers that prevent patients from receiving effective therapy. In light of safety concerns about newer urate-lowering medications, allopurinol, an inexpensive generic medication, is likely to remain the first-line urate-lowering therapy for the foreseeable future. Ensuring that allopurinol is optimally and persistently prescribed is a priority for improved gout management. A health literacy approach that focuses on patient understanding of gout as a chronic disease that requires behaviour change to take long term urate-lowering therapy is important. This approach provides a clear rationale for long-term urate-lowering therapy that is able to dissolve the monosodium urate crystals and ultimately prevent the symptoms of gout. Patient-centred models that use the skills of nurses and pharmacists to facilitate patient understanding can lead to major improvements in gout care. Additionally, systematic quality improvement approaches within practices, while reducing inconvenience and cost to patients, should be a priority.
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Affiliation(s)
- Nicola Dalbeth
- Department of Medicine, Health Literacy New Zealand, Auckland, New Zealand.
| | - Susan Reid
- University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Bruce Arroll
- Department of General Practice and Primary Healthcare, Health Literacy New Zealand, Auckland, New Zealand
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12
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Riches PL, Sing K, Berg K. Point-of-care uric acid testing is useful in routine clinical care of gout. Arthritis Res Ther 2019; 21:117. [PMID: 31072349 PMCID: PMC6509753 DOI: 10.1186/s13075-019-1891-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Philip L Riches
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK.
| | - Kristen Sing
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Kathryn Berg
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
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13
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Raja S, Kumar A, Aahooja RD, Thakuria U, Ochani S, Shaukat F. Frequency of Hyperuricemia and its Risk Factors in the Adult Population. Cureus 2019; 11:e4198. [PMID: 31106098 PMCID: PMC6504021 DOI: 10.7759/cureus.4198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Hyperuricemia (HU) does not only predispose to gouty arthritis but also increases the risk of major cardiovascular events and chronic kidney disease and decreases the overall quality of life. Although the incidence of hyperuricemia is increasing in the Asian population, prevalence studies from healthy asymptomatic adults are still scarce. The aim of this study was to determine the frequency of HU in the general population of Karachi, Pakistan. Methods A cross-sectional study was conducted in various out-patient clinics across Karachi in January 2019. Serum uric acid (SUA) levels were recorded using UASure Blood Uric Acid Monitoring System. Age, gender, body mass index (BMI), the frequency of activity, the frequency of meat consumption, and the presence of hypertension were noted. For hypertensives, the use of thiazide diuretics was noted. Data were entered and analyzed using SPSS v. 22. Results This study was completed by 375 individuals including 208 (55.5%) men and 167 (44.5%) women. Their mean age was 48.78 ± 13.399 years and the mean SUA level was 5.92 ± 1.73 mg/dl. There were 83 (39.9%) men and 30 (17.9%) women with elevated SUA levels. The overall prevalence of HU was 30.1%. Patient characteristics including gender, hypertension, the use of diuretics frequency of meat consumption, sedentary lifestyle, and BMI showed statistical significance with mean SUA levels. Eta-squared indicated a weak effect of SUA with gender, age, and use of thiazide diuretics. A moderate effect was seen with hypertension, the frequency of meat consumption, sedentary lifestyle, and BMI. Conclusion Hyperuricemia is a health hazard and its incidence is high in Pakistan. Patients who have risk factors for elevated SUA levels must be monitored for hyperuricemia at regular intervals.
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Affiliation(s)
- Sooraj Raja
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Akshay Kumar
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Ramesh D Aahooja
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Ujala Thakuria
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, PAK
| | - Simran Ochani
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Faizan Shaukat
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
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