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Biomedical subjects

Susan Murin

Publications and source records attributed to Susan Murin.

9 recordsLinked to original sources
PubMed2006

Racial and gender differences in the incidence of recurrent venous thromboembolism.

Men have been reported to have a higher incidence of recurrent venous thromboembolism than women. However, it is not known if this gender effect holds among different racial/ethnic groups and for both venous thrombosis and pulmonary embolism. We conducted a retrospective analysis of 18- to 65-year-old Caucasian, African-American and Hispanic cases hospitalized in California with unprovoked venous thromboembolism. The principal outcome was recurrent venous thromboembolism 7-60 months after the index event. Among 11,514 cases that were followed for a mean of 3.0 years, men had a significantly higher rate (events/100 patient-years) of recurrent venous thromboembolism than women for both venous thrombosis [rate ratio (RR) = 1.5, 95% confidence interval (CI):1.3-1.8] and pulmonary embolism [RR = 1.3, 95%CI:1.0-1.6]. Among men the recurrence rate did not vary significantly between the racial/ethnic groups (p > 0.05). However, the recurrence rate among Hispanic women with venous thrombosis was significantly higher than in Caucasian women (p < 0.001) and was comparable to the rate in men. Both Hispanic and African-American women with pulmonary embolism had a higher recurrence rate compared with Caucasian women (p < 0.02) that was comparable to the rate in men. We conclude that women in California had a 40% lower risk of recurrent venous thromboembolism compared to men. Rates were comparable among men of different races, but there were significant inter-racial differences among women, which also varied with the type of initial event. The effect of gender on the risk of recurrent venous thromboembolism can not be generalized because it varies between racial/ethnic groups and with the type of index event.

Adolescent↗
PubMed2005

Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996.

There have been very few studies that have describe the epidemiology of first-time venous thromboembolism (VTE) in a large, ethnically diverse population. The California Discharge Data Set was used to identify a cohort of cases with incidentVTE in 1996. Cases associated with traditional provoking risk factors were identified and the remaining cases were labeled as idiopathicVTE. Direct standardization using census information was performed to compare incidence rates across races, gender, and gender within race. There were 21,002 cases with incident VTE in 1996, a crude incidence of 90 events per 100,000 adults. Thirty percent of all VTE events were pulmonary embolism. The directly standardized incidence per 100,000 California adults was 93+/-1.7 (+/-95% CI) in women, 85+/-1.7 in men, 103+/-2.1 in Caucasians, 138+/-6.5 in African- Americans, 61+/-2.8 in Hispanics and 29 +/- 2.4 in Asian-Pacific Islanders (p<0.001 for all inter-group comparisons). After adjusting for misclassification of race, the incidence of VTE per 100,000 was 104 in Caucasians, 141 in African-Americans, 55 in Hispanics, and 21 in Asian/Pacific-Islanders. The incidence of idiopathic VTE was significantly lower among both Hispanics and Asian/Pacific-Islanders (p<0.001) than Caucasians or African-Americans. African-Americans were more likely, and Hispanics less likely, to be diagnosed with idiopathic pulmonary embolism compared to Caucasians. The 28 day case-fatality rate among cases with idiopathic VTE was 2%, and it was significantly higher among African-Americans (4.1%) compared to Caucasians (1.8%, p<0.001). There are important differences in the incidence of total and idiopathicVTE and in the proportion of events diagnosed as pulmonary embolism among each of the major racial/ethnic groups in California. Further research is needed to explain these observed differences among the different racial/ethnic groups.

Adolescent↗
PubMed2005

Respiratory tract infections: another reason not to smoke.

Smoking is a risk factor for a number of pulmonary infections, probably because of its adverse effects on respiratory defenses. It is associated with increased morbidity and mortality from pneumonia and influenza, as well as more days lost from work from lesser respiratory infections. Patients who smoke need to be informed about their increased risk of respiratory infections and of the benefits of both being vaccinated and stopping smoking.

Common Cold↗
PubMed2004

Sex and gender issues and venous thromboembolism.

At least 250,000 episodes of VTE leading to hospitalization or death are estimated to occur in the United States each year. A number of clinical and demographic risk factors for VTE are recognized,with the latter including both age and race. Overall,the incidence of VTE does not appear to vary significantly by sex, as evidenced by a lack of consistency in the magnitude and even direction of effect of sex in a variety of epidemiologic studies of varying design. Several studies have shown a higher incidence among women than men during childbearing age. The issue of a gender effect on the natural history of VTE has not been well studied. The main influence of gender on VTE is the relationship between female gender and several well-recognized clinical risk factors for VTE:oral contraceptive use, hormone replacement therapy, estrogen receptor modulator therapy, and pregnancy. Hormonal therapies are associated with a twofold to threefold increase in VTE incidence. Risk is higher with some formulations than others, during initial use, and among women who are obese, smoke, or have one of several forms of heritable thrombophilia. The pregnant state is associated with a threefold to fivefold increase in VTE risk, and thromboembolism is a major cause of peripartum death. Heritable thrombophilias are also important co-determinants of VTE risk in pregnancy. The mechanisms through which pregnancy and hormonal therapies increase VTE risk have not been definitively established, but hormonal effects on levels of coagulation and anticoagulation factors likely play a role. Venous compression and venous injury also contribute to increased risk during pregnancy and the puerperium. Approaches to diagnosis of VTE in the pregnant woman are largely the same as in the nonpregnant patient, but special treatment considerations do apply. Warfarin is embryopathic, particularly between the 6th and 12th weeks of pregnancy, and should be avoided in favor or heparin or low-molecular weight heparin when treatment of the pregnant woman is necessary. Guidelines have been published to assist the clinician in decision making about prophylaxis of pregnant women at increased risk or pregnancy-related or post-partum VTE.

Contraceptives, Oral↗
PubMed2004

The effect of cigarette smoke exposure on pulmonary metastatic disease in a murine model of metastatic breast cancer.

INTRODUCTION: Women who smoke have a higher rate of fatal breast cancer than nonsmoking women. An association between smoking and pulmonary metastases from breast cancer has been suggested by epidemiologic studies. STUDY OBJECTIVES: To examine the relationship between exposure to cigarette smoke and pulmonary metastasis in a murine model of metastatic mammary cancer. STUDY DESIGN: Prospective, randomized study. SETTING: Animal research laboratory. EXPERIMENTAL SUBJECTS: Female sexually mature BALB/cAnN mice. INTERVENTIONS: Mice were randomly divided into experimental and control groups. Experimental animals were exposed to cigarette smoke in specialized exposure chambers, at concentrations chosen to approximate active cigarette smoking. Control animals were exposed to filtered air. One week after the initiation of exposures, mouse mammary tumor cells (tumor cell line 4526) were injected into the tail veins of experimental animals at one of three concentrations (50,000, 100,000, or 150,000 cells per 100 micro L). Three weeks later, the mice were killed, and pulmonary metastases were counted and measured. RESULTS: The mean metastatic burden in the lungs was consistently greater for smoke-exposed animals at each concentration of cells injected (at 50,000 cells per 100 micro L, 9.8 vs 4.8 micro m(3), respectively [p < 0.01]; at 100,000 cells per 100 micro L, 34.5 vs 17.4 micro m(3), respectively [p < 0.10]; and at 150,000 cells per 100 micro L, 54.0 vs 31.5 micro m(3), respectively [p < 0.05]). This was largely attributable to a significant increase in the number of metastatic nodules per animal (at 50,000 cells per 100 micro L, 8.7 vs 4.8, respectively [p < 0.001]; at 100,000 cells per 100 micro L, 24.3 vs 14.0, respectively [p > 0.10]; and at 150,000 cells per 100 micro L, 42.0 vs 20.1, respectively [p < 0.02]) rather than to a change in nodule size. CONCLUSIONS: Cigarette smoke exposure is associated with an increase in the total pulmonary metastatic burden in this murine model of metastatic mammary cell cancer. This study provides experimental support for an adverse effect of smoking on the metastatic process and suggests a possible mechanism for smokers' increased breast cancer mortality.

Animals↗
PubMed2002

Epidemiology, etiology, and prevention of lung cancer.

Over the past century, lung cancer has gone from an obscure disease to the leading cause of cancer death worldwide. Initially an epidemic disease among men in industrialized nations, lung cancer now has become the leading cancer killer in both sexes in the United States and an increasingly common disease of both sexes in developing countries. Lung cancer incidence largely mirrors smoking prevalence, with a latency period of several decades. Other important risk factors for the development of lung cancer include environmental exposure to tobacco smoke, radon, occupational carcinogens, and pre-existing nonmalignant lung disease. Studies in molecular biology have elucidated the role that genetic factors play in modifying an individual's risk for lung cancer. Although chemopreventive agents may be developed to prevent lung cancer, prevention of smoking initiation and promotion of smoking cessation are currently the best weapons to fight lung cancer. No other malignancy has been shown to have such a strong epidemiologic relation between a preventable behavior and incidence of disease. Despite this knowledge, more than 20% of all Americans smoke, and tobacco use is exploding in developing countries. Based on current and projected smoking patterns, it is anticipated that lung cancer will remain the leading cause of cancer death in the world for decades to come.

Age Factors↗
PubMed2002

Systemic lupus erythematosus in the intensive care unit.

SLE causes significant morbidity and mortality by multisystem organ involvement. Infections are the leading cause of morbidity and mortality in patients with SLE. Meticulous exclusion of infection is mandatory in patients with SLE, because infections may masquerade as exacerbation of underlying disease; and the immunosuppression used to treat severe forms of exacerbation of lupus can have catastrophic consequences in patients with infections. Corticosteroids are the first-line therapy for most noninfectious complications of SLE, with various adjuvant immunosuppressive agents such as cyclophosphamide being increasingly used in combination with plasmapheresis. Some recent series have shown an improved survival rate, but this improvement needs to be confirmed by further studies. Controlled trials comparing various therapeutic options are lacking, and optimal therapy has not been defined.

Cardiovascular Diseases↗
PubMed2002

Comparison of outcomes after hospitalization for deep venous thrombosis or pulmonary embolism.

Venous thrombosis and pulmonary embolism are commonly viewed as different manifestations of a single disease process, venous thromboembolism. Recent evidence suggests that there may be important differences between patients who manifest these two conditions. Using linked hospital discharge records we analyzed 71,250 patients hospitalized with a principal diagnosis of venous thrombosis alone or pulmonary embolism and analyzed predictors of rehospitalization within 6 months for venous thrombosis or pulmonary embolism. There were 51233 patients diagnosed with venous thrombosis alone and 21,625 diagnosed with pulmonary embolism. Comparing patients initially diagnosed with venous thrombosis alone to patients with pulmonary embolism, the relative risk of being rehospitalized with venous thrombosis within 6 months for venous thrombosis was 2.7. Conversely, when patients with pulmonary embolism were compared to patients with venous thrombosis alone, the relative risk of rehospitalization within 6 months with a diagnosis of pulmonary embolism was 4.2. In multivariate models the strongest predictor of recurrent thromboembolism manifest as pulmonary embolism was an initial diagnosis of pulmonary embolism and the strongest predictor of recurrence as venous thrombosis was an initial diagnosis of venous thrombosis. We conclude that the initial clinical manifestation of thromboembolism strongly predicts the manifestation of a recurrence. Venous thrombosis and pulmonary embolism appear to be distinct, albeit overlapping, clinical entities with different natural histories.

Aged↗