In this edited volume, updates in the field of health and disease are presented. Chapter One studies the incidence of hearing loss in patients with congenital cytomegalovirus infections. Chapter Two ...reviews the current literature concerning the multifactorial theories and etiologies of glaucomatous optic disc change and visual field loss in patients with normal-tension glaucoma. Chapter Three discusses the effectiveness of endovascular treatment for peripheral arterial disease, which is common in dialysis patients. Chapter Four describes a new technique for severely calcified infrapopliteal artery lesions called percutaneous intraluminal needle cracking. Chapter Five aims to identify the occurrence of chronic kidney disease in the family members of chronic hemodialysis patients. Chapter Six describes methods for the outpatient management of oncologic patients with solid tumors and febrile neutropenia. Chapter Seven ascertains the suitability of peritoneal dialysis as a first choice for treatment of acute kidney injury patients. Chapter Eight reports on the application of a cathodically pretreated boron-doped diamond electrode for the determination of phenylbutazone using the differential pulse voltammetry, as a simple alternative method for quality control of this drug. Chapter Nine investigates the liaison between contaminated foods and the occurrence of illness in consumers to provide a clear picture of reports during the years 2010-2020. Lastly, Chapter Ten reviews the benefits and limitations of sodium-glucose cotransporter 2 inhibitors and the evidence behind the recommendations to support their use in different patient populations.
OBJECTIVE To clarify the clinical presentation and course of patients with spontaneous pneumomediastinum (SP) and to determine the usefulness of diagnostic testing in these patients. PATIENTS AND ...METHODS We conducted a retrospective review of 62 consecutive adult patients (age ≥18 years) diagnosed as having SP during an 11-year period from July 1, 1997, to June 30, 2008. The study cohort included 41 men and 21 women (median age, 30 years; interquartile range, 20-69 years). RESULTS Among the 62 study patients, the most common presenting symptoms were chest pain (39 patients 63%), cough (28 45%), and dyspnea (27 44%). Preexisting lung diseases were identified in 27 patients (44%) and included interstitial lung disease, asthma, lung malignancies, bronchiolitis obliterans syndrome, chronic obstructive pulmonary disease, bronchiectasis, and cystic lung lesions. The initial diagnosis of SP was achieved by chest radiography in 52 patients (84%); the remaining cases were diagnosed by computed tomography. Forty-seven patients (76%) were hospitalized for a median duration of 2.5 days. Additional diagnostic procedures were performed in 27 patients (44%) and included contrast esophagography, bronchoscopy, and esophagogastroduodenoscopy; however, they did not yield a pathologic cause in any patient. Pneumothorax was identified in 20 patients (32%), but less than one-third of these patients underwent chest tube thoracostomy. No episodes of mediastinitis or sepsis occurred. Recurrence of SP was seen in 1 patient, and thoracoscopic surgery was performed in 1 patient for persistent air leak (pneumothorax). CONCLUSION Spontaneous pneumomediastinum was associated with a relatively benign clinical course; however, pneumothorax was seen in 32% of cases. Diagnostic testing to determine a pathologic cause yielded little clinically relevant information in these patients.
AbstractObjectivesWe aimed to provide a systematic overview of freely available tools which may help to plan or monitor costs for randomised clinical trials (RCTs). Study Design and SettingWe ...systematically searched MEDLINE, EMBASE and EconLit and conducted internet searches via Google (last search October 2018). We included all freely available tools and determined their specific purpose, which parts of clinical trial projects and which types of costs they covered, and if they were user tested or validated in any form. ResultsWe identified 25 available tools. Most tools were downloadable on websites from institutions related to clinical research. Seven tools were developed to plan the budget for an entire RCT, 17 tools for calculating budgets of an individual trial centre, and one tool for monitoring costs of ongoing RCTs. 18 tools considered fixed, variable, and indirect costs. Only two tools were clearly user tested or validated. ConclusionSeveral freely available tools aim to support investigators in planning costs of an entire trial or in planning the budget for a clinical trial site. How valid and useful they are remains to be shown for most of them. Future tools should be openly shared, user tested, and validated.
AbstractObjectiveTo develop a new population-based risk stratification tool (Chronic Related Score, CReSc) for predicting 5-year mortality and other outcomes. Study Design and SettingThe score ...included 31 conditions selected from a list of 65 candidates whose weights were assigned according to the Cox model coefficients. The model was built from a sample of 5.4 million National Health Service (NHS) beneficiaries from the Italian Lombardy Region, and applied to the remaining 2.7 million NHS beneficiaries. Predictive performance was assessed by discrimination and calibration. CReSc ability in predicting secondary endpoints (i.e., hospital admissions and healthcare costs) was investigated. Finally, the relationship between CReSc and income was considered. ResultsAmong individuals aged 50-85 years, CReSc performance showed (i) an area under the receiver operating characteristic curve of 0.730, (ii) an improved reclassification from 44% to 52% with respect to other scores, and (iii) a remarkable calibration. A trend towards increasing rates of all the considered endpoints as CReSc increases was observed. Compared with individuals on low-intermediate income, NHS beneficiaries on high income showed better CReSc profile. ConclusionWe developed a risk stratification tool able to predict mortality, costs and hospital admissions. The application of CReSc may generate clinically and operationally important effects.
Conclusion Bérard, Anick, PhD; Gorgui, Jessica, MSc; Sheehy, Odile, MSc ...
Canadian Medical Association journal (CMAJ),
2019, Volume:
191, Issue:
7
Journal Article
Peer reviewed
ABSTRACT Background While topical azoles are the first-line treatment for fungal infections, oral fluconazole is frequently used during pregnancy. We aimed to assess the effect of exposure to low and ...high doses of fluconazole during pregnancy on the occurrence of spontaneous abortions, major congenital malformations and stillbirths. Methods Within the Quebec Pregnancy Cohort (1998–2015), we identified women exposed to low- (≤ 150 mg) and high-dose (> 150 mg) fluconazole, and women who were not exposed. For each case of spontaneous abortion or stillbirth, up to 5 controls were randomly selected using an incidence density sampling method matched on gestational age at diagnosis of spontaneous abortion or stillbirth (index date) and the year of the last menstrual period. For cases of major congenital malformation, we considered all liveborn babies as controls. Generalized estimation equation models were used to analyze the 3 main outcomes separately. Results Within a cohort of 441 949 pregnancies, 320 868 pregnancies were included in the analyses of spontaneous abortions, 226 599 of major congenital malformations and 7832 of stillbirths. Most (69.5%) women exposed to fluconazole in pregnancy received the common single therapeutic dose of 150 mg (low dose); the remainder received a dose of > 150 mg (high dose). Use of oral fluconazole during early pregnancy was associated with an increased risk of spontaneous abortion compared with no exposure (adjusted odds ratio OR for 345 cases exposed to low-dose treatment 2.23, 95% confidence interval CI 1.96–2.54; adjusted OR for 249 cases exposed to high-dose treatment 3.20, 95% CI 2.73–3.75). Exposure to fluconazole during the first trimester did not increase the risk of overall major congenital malformations; however, exposure to a high dose during the first trimester was associated with an increased risk of cardiac septal closure anomalies (adjusted OR 1.81, 95% CI 1.04–3.14; 13 exposed cases) compared with no exposure. No association was found between exposure to fluconazole during pregnancy and the risk of stillbirth. Interpretation Any maternal exposure to fluconazole during pregnancy may increase risk of spontaneous abortion and doses higher than 150 mg during the first trimester may increase risk of cardiac septal closure anomalies.
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