1
|
Sylvestre A, Forel JM, Textoris L, Gragueb-Chatti I, Daviet F, Salmi S, Adda M, Roch A, Papazian L, Hraiech S, Guervilly C. Outcomes of Severe ARDS COVID-19 Patients Denied for Venovenous ECMO Support: A Prospective Observational Comparative Study. J Clin Med 2024; 13:1493. [PMID: 38592410 PMCID: PMC10932228 DOI: 10.3390/jcm13051493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data are available concerning the outcome of patients denied venovenous extracorporeal membrane oxygenation (VV-ECMO) relative to severe acute respiratory distress syndrome (ARDS) due to COVID-19. Methods: We compared the 90-day survival rate of consecutive adult patients for whom our center was contacted to discuss VV-ECMO indication. Three groups of patients were created: patients for whom VV-ECMO was immediately indicated (ECMO-indicated group), patients for whom VV-ECMO was not indicated at the time of the call (ECMO-not-indicated group), and patients for whom ECMO was definitely contraindicated (ECMO-contraindicated group). Results: In total, 104 patients were referred for VV-ECMO support due to severe COVID-19 ARDS. Among them, 32 patients had immediate VV-ECMO implantation, 28 patients had no VV-ECMO indication, but 1 was assisted thereafter, and 44 patients were denied VV-ECMO for contraindication. Among the 44 patients denied, 30 were denied for advanced age, 24 for excessive prior duration of mechanical ventilation, and 16 for SOFA score >8. The 90-day survival rate was similar for the ECMO-indicated group and the ECMO-not-indicated group at 62.1 and 61.9%, respectively, whereas it was significantly lower (20.5%) for the ECMO-contraindicated group. Conclusions: Despite a low survival rate, 50% of patients were at home 3 months after being denied for VV-ECMO for severe ARDS due to COVID-19.
Collapse
Affiliation(s)
- Aude Sylvestre
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Laura Textoris
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Ines Gragueb-Chatti
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Florence Daviet
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Saida Salmi
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Mélanie Adda
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Antoine Roch
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Laurent Papazian
- Centre Hospitalier de Bastia, Service de Réanimation, 604 Chemin de Falconaja, 20600 Bastia, France;
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, Università di Corsica, IRD 190, Inserm 1207, IRBA), 13284 Marseille, France
| | - Sami Hraiech
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Christophe Guervilly
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| |
Collapse
|
2
|
Niemann A, Schrader NF, Speckemeier C, Abels C, Blase N, Weitzel M, Neumann A, Riederer C, Nadstawek J, Straßmeir W, Wasem J, Neusser S. Prescription of Opioid Analgesics for Chronic Non-Cancer Pain in Germany despite Contraindications: Administrative Claims Data Analysis. Int J Environ Res Public Health 2024; 21:180. [PMID: 38397671 PMCID: PMC10888146 DOI: 10.3390/ijerph21020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
In Germany, long-term opioid treatment (L-TOT) for chronic non-tumor pain (CNTP) is discussed as not being performed according to the German guideline on L-TOT for CNTP. In the present analysis, the occurrence and predictors of inappropriate care/overuse in a cohort of German insureds with L-TOT for CNTP by the presence of a contraindication with concurrent opioid analgesic (OA) therapy were investigated. We also analyzed whether prescribing physicians themselves diagnosed a contraindication. The retrospective cohort study was based on administrative claims data from a German statutory health insurance. Eight contraindication groups were defined based on the German guideline. Logistic regressions were performed in order to identify predictors for OA prescriptions despite contraindications. The possible knowledge of the prescribing physician about the contraindication was approximated by analyzing concordant unique physician identification numbers of OA prescriptions and contraindication diagnoses. A total of 113,476 individuals (75% female) with a mean age of 72 years were included. The most common documented contraindications were primary headaches (8.7%), severe mood disorders (7.7%) and pain in somatoform disorders (4.5%). The logistic regressions identified a younger age, longer history of OA therapy, opioid related psychological problems, and outpatient psychosomatic primary care as positive predictors for all contraindication groups.
Collapse
Affiliation(s)
- Anja Niemann
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Nils F. Schrader
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Christian Speckemeier
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Carina Abels
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Nikola Blase
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Milena Weitzel
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | | | - Joachim Nadstawek
- Association of German Doctors and Psychotherapists Practicing in Pain Medicine and Palliative Care (BVSD e.V.), Katharinenstraße 8, 10711 Berlin, Germany
| | - Wolfgang Straßmeir
- Association of German Doctors and Psychotherapists Practicing in Pain Medicine and Palliative Care (BVSD e.V.), Katharinenstraße 8, 10711 Berlin, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Silke Neusser
- Institute for Health Care Management and Research, University Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| |
Collapse
|
3
|
Lin J, Long D, Jiang C, Sang C, Tang R, Li S, Wang W, Guo X, Ning M, Sun Z, Yang N, Hao Y, Liu J, Liu J, Du X, Morgan L, Fonarow GC, Smith SC, Lip GY, Zhao D, Dong J, Ma C. Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation. Chin Med J (Engl) 2024; 137:172-180. [PMID: 38146256 PMCID: PMC10798766 DOI: 10.1097/cm9.0000000000002915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. METHODS Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. RESULTS A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001). CONCLUSIONS In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.
Collapse
Affiliation(s)
- Jing Lin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Zhaoqing Sun
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX 07076, USA
| | - Gregg C. Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles CA 90024, USA
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Gregory Y.H. Lip
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L143PE, UK
- Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing 100029 China
| |
Collapse
|
4
|
Crescioli G, Finocchietti M, Paoletti O, Brunori P, Sciancalepore F, Tuccori M, Addis A, Vannacci A, Lombardi N, Kirchmayer U. Potentially inappropriate drug use in myasthenia gravis: a real-world population-based cohort study in Italy. Front Neurol 2023; 14:1293626. [PMID: 38178892 PMCID: PMC10764541 DOI: 10.3389/fneur.2023.1293626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction To evaluate the use of pyridostigmine in presence of contraindications, and the use of concomitant potentially contraindicated drugs in a cohort of patients affected by Myasthenia Gravis (MG) in the Italian Regions of Lazio, Tuscany, and Umbria. Methods This is a retrospective cohort study. A multivariate logistic regression model was used to evaluate the determinants of pyridostigmine and of potentially contraindicated drugs use in MG patients. Results Among 591 incident pyridostigmine users affected by MG, 91 (15.4%) had at least one of the contraindications considered at the first prescription of pyridostigmine. Patients prescribed with pyridostigmine in presence of contraindications were more frequently affected by diabetes, obesity, and renal diseases. Age 75+ years (odds ratio, OR 4.94, 95% confidence interval, CI 1.60-15.22 for Latium; OR 3.78, 95%CI: 1.26-11.34 for Tuscany; OR 5.83, 95%CI 1.19-28.52 for Umbria), the presence of at least one specific comorbidity (OR 3.93; 95%CI 1.68-9.17 for Latium), and polytherapy (6+ drugs, OR 4.90, 95%CI: 1.35-17.85 for Tuscany) were found to be significantly associated with pyridostigmine use in presence of contraindications. Among patients affected by MG, 1,483 (62.6%) were treated with potentially contraindicated drugs in the first year of follow-up (67.06.9% in Latium; 59% in Tuscany; 57.6% in Umbria). Patients aged 75+ years, those with at least one specific complication or comorbidity, and those exposed to polytherapy were more likely to be treated with a potential contraindicated drug. Conclusion Among incident users of pyridostigmine, more than 15% of patients have at least one of the contraindications considered, and among patients diagnosed with MG, in the first year of follow-up >60% of subjects were treated with potentially contraindicated drugs.
Collapse
Affiliation(s)
- Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | | | - Olga Paoletti
- Pharmacoepidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy
| | - Paola Brunori
- Unit of Neurophysiopathology, Perugia Hospital, Perugia, Italy
| | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Marco Tuccori
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
- Department of Clinical and Experimental Medicine, Unit of Pharmacology and Pharmacovigilance, University of Pisa, Pisa, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
- Tuscan Regional Center of Pharmacovigilance, Florence, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | |
Collapse
|
5
|
AlDabeeb DS, Alakeel NS, Al Jfshar RM, Alkhalid TK. Endocrowns: Indications, Preparation Techniques, and Material Selection. Cureus 2023; 15:e49947. [PMID: 38058523 PMCID: PMC10697178 DOI: 10.7759/cureus.49947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 12/08/2023] Open
Abstract
Endodontic treatment is often necessary in the field of dentistry. As the tooth structure is lost during such treatment, the tooth may become weaker and lose some of its mechanical qualities. Endodontically treated posterior teeth require cuspal coverage because of their anatomical features. Endocrowns are regarded as a suitable choice for restoring teeth that have undergone endodontic treatment. These restorations are recommended when there is a substantial loss of tooth structure, restricted interocclusal space, or a short clinical crown. They are also contraindicated in case of severe loss of tooth structure where adhesion is not applicable. Endocrowns require a specific preparation design that is distinct from the conventional crown. They can be manufactured by two methods: heat pressing or computer-aided design/computer-aided manufacturing (CAD/CAM). Moreover, several materials have been used in fabricating endocrown restoration. Lithium disilicate glass-ceramic is the most recommended material as it possesses excellent mechanical properties and esthetic results with the ability to bond to tooth structure. In conclusion, several kinds of literature recommend using them for molars. Further research is needed to evaluate this technique for premolar and anterior teeth.
Collapse
Affiliation(s)
- Dalal S AlDabeeb
- Department of Restorative Dental Sciences, King Saud University, Riyadh, SAU
| | | | | | | |
Collapse
|
6
|
Lübbert C, Dykukha I, Pelz JP, Yearley H, Junker W, Gruber N, Escher S, Biereth K, Melnik S, Puschmann J. Individuals at risk for severe COVID-19 in whom ritonavir-containing therapies are contraindicated or may lead to interactions with concomitant medications: a retrospective analysis of German health insurance claims data. Drugs Context 2023; 12:2023-3-4. [PMID: 37415918 PMCID: PMC10321469 DOI: 10.7573/dic.2023-3-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
Background Nirmatrelvir/ritonavir is authorized for the treatment of COVID-19 but has several contraindications and potential drug-drug interactions (pDDIs) due to ritonavir-induced irreversible inhibition of cytochrome P450 3A4. We aimed to assess the prevalence of individuals with one or more risk factors for severe COVID-19 along with contraindications and pDDIs due to ritonavir-containing COVID-19 therapy. Methods Retrospective observational study of individuals with one or more risk factors according to Robert Koch Institute criteria for severe COVID-19 according to German statutory health insurance (SHI) claims data from the pre-pandemic years 2018-2019 based on the German Analysis Database for Evaluation and Health Services Research. Prevalence was extrapolated to the entire SHI population using age-adjusted and sex-adjusted multiplication factors. Results Nearly 2.5 million fully insured adults, representing 61 million people in the German SHI population, were included in the analysis. In 2019, prevalence of individuals that would have been at risk of severe COVID-19 was 56.4%. Amongst them, the prevalence of contraindications for treatment with ritonavir-containing COVID-19 therapy was approximately 2% according to presence of somatic comorbidities (severe liver or kidney disease). Prevalence of intake of medicines contraindicated for their potential interactions with ritonavir-containing COVID-19 therapy was 16.5% according to Summary of Product Characteristics and 31.8% according to previously published data. The prevalence of individuals at risk of pDDIs during ritonavir-containing COVID-19 therapy without adjustment of their concomitant therapy was 56.0% and 44.3%, respectively. Prevalence data for 2018 were similar. Conclusion Administering ritonavir-containing COVID-19 therapy can be challenging as thorough medical record review and close monitoring are required. In some cases, ritonavir-containing treatment may not be appropriate due to contraindications, risk of pDDIs, or both. For those individuals, an alternative ritonavir-free treatment should be considered.
Collapse
Affiliation(s)
- Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | | | | | | | | | | | | | | | - Sima Melnik
- Gesundheitsforen Leipzig GmbH, Leipzig, Germany
| | | |
Collapse
|
7
|
Robblee J. A survey study of headache specialists' comfort with triptan contraindications. Headache 2023; 63:692-693. [PMID: 36988188 DOI: 10.1111/head.14499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| |
Collapse
|
8
|
Muacevic A, Adler JR, Cardoso H. Spinal Anesthesia in Hemodynamic Instability: A Case Report. Cureus 2023; 15:e33821. [PMID: 36819454 PMCID: PMC9931365 DOI: 10.7759/cureus.33821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
Anesthetic dilemmas are not rare in daily practice. Frequently, patients present with comorbid conditions that make general anesthesia risky (e.g., difficult airway and severe pulmonary dysfunction) and contraindications to neuraxial anesthesia at the same time. Reports on the successful anesthetic management of these patients can provide useful information. We report a case of a patient with severe hemodynamic instability who underwent spinal anesthesia for surgical hip debridement. General anesthesia and airway manipulation were avoided because the patient had recently recovered from SARS-CoV-2 pneumonia amid the first wave of the coronavirus disease 2019 (COVID-19) pandemic when very little was known about the disease and no ventilators were available for postoperative care. We explain in detail the continuous spinal anesthesia technique using a conventional epidural catheter and prophylactic norepinephrine when cardiovascular instability was the major concern.
Collapse
|
9
|
Muacevic A, Adler JR. A Case of Acute Ischemic Stroke Treated With Alteplase Immediately After Transcatheter Aortic Valve Implantation: Which Procedures or Surgeries are Considered Contraindications to Thrombolytics? Cureus 2022; 14:e30136. [PMID: 36238419 PMCID: PMC9551621 DOI: 10.7759/cureus.30136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Undergoing a major surgery within 14 days is considered a contraindication for intravenous alteplase. However, there is no consensus as to what qualifies as major surgery or an invasive procedure. Occasionally, determining whether a procedure is "invasive" or too risky in the setting of emergency ischemic stroke thrombolytic management can be challenging. Stroke neurologists may not be able to make such a decision on their own. Guidance or clearance from the physicians who performed the procedure is essential. We report the case of a patient who received intravenous alteplase after developing a stroke immediately following transcatheter aortic valve implantation (TAVI).
Collapse
|
10
|
Andrikyan W, Then MI, Gaßmann KG, Tümena T, Dürr P, Fromm MF, Maas R. Use of medication data alone to identify diagnoses and related contraindications: application of algorithms to close a common documentation gap. Br J Clin Pharmacol 2022; 88:5399-5411. [PMID: 35877931 DOI: 10.1111/bcp.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS Automated checks for medication-related problems have become a cornerstone of medication safety. In many clinical settings medication checks remain confined to drug-drug interactions because only medication data are available in an adequately coded form, leaving possible contraindicated drug-disease combinations unaccounted for. Therefore, we devised algorithms that identify frequently contraindicated diagnoses based on medication patterns related to these diagnoses. METHODS We identified drugs that can identify diseases constituting common contraindications based on their exclusive use for these conditions (such as allopurinol for gout or salbutamol for bronchial obstruction). Expert-based and machine learning algorithms were developed to identify diagnoses based on highly specific medication patterns. The applicability, sensitivity and specificity of the approach were assessed by using an anonymized real-life sample of medication and diagnosis data excerpts from 3,506 discharge records of geriatric patients. RESULTS Depending on the algorithm, the desired focus (i.e. sensitivity vs. specificity) and the disease, we were able to identify the diagnoses gout, epilepsy, coronary artery disease, congestive heart failure and bronchial obstruction with a specificity of 44.0%-99.8% (95% CI 41.7%-100.0%) and a sensitivity of 3.8%-83.1% (95% CI 1.0%-86.1%). Using only medication data we were able to identify 123 (51.3%) of 240 contraindications identified by experts with access to medication data and diagnoses. CONCLUSION This study provides a proof of principle that some key diagnosis-related contraindications can be identified based on a patient's medication data alone, while others cannot be identified. This approach offers new opportunities to analyse drug-disease contraindications in community pharmacy or clinical routine data.
Collapse
Affiliation(s)
- Wahram Andrikyan
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Melanie I Then
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Karl-Günter Gaßmann
- Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany.,Geriatrics in Bavaria-Database, Nürnberg, Germany
| | | | - Pauline Dürr
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Pharmacy Department, Erlangen University Hospital, Erlangen, Germany
| | - Martin F Fromm
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
11
|
Assiri GA, Bannan DF, Alshehri GH, Alshyhani M, Almatri W, Mahmoud MA. The Contraindications to Combined Oral Contraceptives among Reproductive-Aged Women in an Obstetrics and Gynaecology Clinic: A Single-Centre Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19031567. [PMID: 35162588 PMCID: PMC8835169 DOI: 10.3390/ijerph19031567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/15/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to determine the estimated proportion of contraindications among women taking combined oral contraceptives (COCs) and to assess the risk factors associated with their contraindications. This study was cross-sectional. Reproductive-aged women (18–49 years) on any COCs between 2018 and 2020 were recruited from one obstetrics–gynaecology clinic in a university-affiliated hospital and were included. Contraindications were defined using the World Health Organization (WHO) Medical Eligibility Criteria (MEC) for Contraceptive Use. Data were collected from electronic medical records for all included women, as well as a standardised, pretested, structured survey for one-third of the women. In this cross-sectional study, 380 women using COCs were included. Their mean age was 31.645 ± 7.366 years. Among them, 131 (34.5%) participated via a survey and electronic records, while the other 249 (65.5%) participated via electronic records only. The majority of the participants had a Bachelor’s degree (59.0%) and were married (62.1%). The overall estimated proportion of patients with at least one contraindication to COCs according to category 3 (relative contraindications) or 4 (absolute contraindications) was 31.3% (95% CI 26.63–35.99). The most common contraindications observed were controlled hypertension, category 3 (12.1%); major surgery with prolonged immobilisation, category 4 (4.7%); migraine with aura at any age, category 4 (4.2%); breastfeeding from six weeks to less than six months postpartum, category 3 (4.0%); and diabetes mellitus with complications, category 4 (3.2%). Significant factors associated with contraindications to COCs were married women (OR 2.19, 95% CI 1.38–3.46), those aged 35 years or more (OR 2.33, 95% CI 1.49–3.66), and those with one or more live births (OR 2.19, 95% CI 1.38–3.46). Ensuring proper assessment prior to prescribing and considering alternatives suitable for long-term use among women taking an oral contraceptive regularly is recommended.
Collapse
Affiliation(s)
- Ghadah A. Assiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (W.A.)
- Correspondence:
| | - Douha F. Bannan
- Pharmacy Practice Department, King Abdulaziz University, Jeddah 80260, Saudi Arabia;
| | - Ghadah H. Alshehri
- Pharmacy Practice Department, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh 84428, Saudi Arabia;
| | - Manal Alshyhani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (W.A.)
| | - Walaa Almatri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia; (M.A.); (W.A.)
| | - Mansour A. Mahmoud
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Tibah University, Al-Madinah Al-Munawarah 42353, Saudi Arabia;
| |
Collapse
|
12
|
Du W, Dai R, Chen R, Shen F. Rotation-hinged knee prosthesis for the treatment of Charcot arthropathy: a case report and literature review. J Int Med Res 2021; 49:3000605211058871. [PMID: 34812073 PMCID: PMC8649473 DOI: 10.1177/03000605211058871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Charcot arthropathy is a type of destructive osteoarthropathy characterized by
neurotrophic and sensory disorders. The condition is relatively rare, with an
insidious onset, and it is easily misdiagnosed. Total knee arthroplasty (TKA)
can cause excessive joint wear, continuous inflammatory stimulation of the
prosthesis, postoperative residual cavity, prosthesis loosening and subsidence,
peripheral fracture, infection, and other complications. Furthermore, these
complications are more likely to occur in patients with Charcot arthropathy
because of disease-specific pathological characteristics, when TKA is performed.
Therefore, Charcot arthropathy was once a contraindication to TKA. Recently,
with the optimization of joint prostheses and the maturity of surgical
techniques, more studies have reported successful cases of TKA in patients with
Charcot arthropathy. We report a case of Charcot arthropathy in our hospital,
and describe the patient’s medical history, clinical symptoms, signs, imaging
findings, diagnosis, and the entire TKA process, to explore the TKA strategy and
prosthesis selection in a patient with Charcot arthropathy.
Collapse
Affiliation(s)
- Weibin Du
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Rongdan Dai
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Rongliang Chen
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Fuxiang Shen
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| |
Collapse
|
13
|
Ji C, Li M, Zeng Y, Liu Y, Wang X, Yao D, Guo J, Xu Y. Vaccination deferral among children with seizures in Zhejiang: influence, recommendation, safety and implications. Expert Rev Vaccines 2021; 20:1667-1675. [PMID: 34644217 DOI: 10.1080/14760584.2021.1993066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Delayed vaccination in children with seizures was common in China. This study aims to describe the vaccination status, reasons for vaccination deferral, vaccination recommendations and the safety for these patients in Zhejiang. METHODS 1539 children included were divided into febrile seizure (FS) group, epilepsy (EP) group, unclassified seizure group and other symptomatic seizure group. Medical records and reasons for the vaccination deferral were collected by questionnaire. Vaccination data and Adverse Event Following Immunization were retrieved from vaccination booklets. RESULTS The main diseases of children enrolled were FS (756, 49.1%) and EP (443, 28.8%). Most of them (95.6%) were vaccinated on time before the onset of seizure, but their vaccination was delayed after seizure occurred. 76.1% were recommended to receive vaccines normally, of which the FS group accounted for the highest proportion (90.3%). 88.73% of them were vaccinated as recommended, and no serious side effects or seizure occurred. The main reason for vaccination deferral was providers' and parents' hesitation to have them vaccinated. CONCLUSION Seizures were overestimated as a contraindication for vaccination in China. Routine vaccination was safe in most circumstances. It is essential to educate providers and parents about the benefits and contraindications of vaccination in children with seizures.
Collapse
Affiliation(s)
- Chai Ji
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mingyan Li
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Zeng
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xia Wang
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dan Yao
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Junxia Guo
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuyang Xu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| |
Collapse
|
14
|
Falco A, de Oliveira TB, Cacicedo J, Ospina AV, Ticona MÁ, Galindo H, Pereira MD, Aguilar-Ponce JL, Rueda-Domínguez A, Soria T, Taberna M, Iglesias L, Sowley T, Mesía R. Ibero-American Expert Consensus on Squamous Cell Carcinoma of the Head and Neck Treatment in Patients Unable to Receive Cisplatin: Recommendations for Clinical Practice. Cancer Manag Res 2021; 13:6689-6703. [PMID: 34471383 PMCID: PMC8405157 DOI: 10.2147/cmar.s322411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Cisplatin is the standard of treatment for squamous cell carcinoma of the head and neck (SCCHN) that has demonstrated efficacy, either in locally advanced disease when combined with radiotherapy at high doses, or in metastatic/recurrent disease when combined with other agents. However, the usual toxicities related to cisplatin, such as neurotoxicity, nephrotoxicity, ototoxicity, and hematologic toxicities, especially when high doses have been administered, have important implications in the patients' quality of life. The decision to administer cisplatin depends on several patient factors, such as age, performance status, weight loss, comorbidities, previous toxicities, chronic viral infection, or even the current SARS-CoV-2 pandemic. In order to establish recommendations for the management of patients with SCCHN, a group of experts in medical and radiation oncology from Spain and Latin-American discussed how to identify patients who are not candidates for cisplatin to offer them the most suitable therapeutic alternative.
Collapse
Affiliation(s)
- Agustín Falco
- Instituto Alexander Fleming, Asociación Argentina de Oncología Clínica (AAOC), Buenos Aires, Argentina
| | | | - Jon Cacicedo
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Aylen Vanessa Ospina
- ICCAL, Hospital Universitario Fundación Santa Fe de Bogotá, Asociación Colombiana de Hematología y Oncología (ACHO), Bogotá, Colombia
| | - Miguel Ángel Ticona
- Hospital Nacional Edgardo Rebagliati Martins de Lima, Sociedad Peruana de Oncología Médica (SPOM), Lima, Perú
| | - Héctor Galindo
- Pontificia Universidad Católica de Chile, Sociedad Chilena de Oncología Médica (SCOM), Santiago, Chile
| | - Marcos David Pereira
- Instituto de Oncología Ángel H. Roffo, Asociación Argentina de Oncología Clínica (AAOC), Buenos Aires, Argentina
| | - José Luis Aguilar-Ponce
- Instituto Nacional de Cancerología, Sociedad Mexicana de Oncología (SMeO), Mexico City, Mexico
| | - Antonio Rueda-Domínguez
- UGC Oncología Médica, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Tannia Soria
- Hospital SOLCA de Quito, Sociedad Ecuatoriana de Oncología (SEO), Quito, Ecuador
| | - Miren Taberna
- Institut Català d’Oncologia, ICO L’Hospitalet, Barcelona, Spain
| | | | - Taysser Sowley
- Instituto Oncológico Nacional (ION) de Panamá, Sociedad Panameña de Oncología (SPO), Panama City, Panama
| | - Ricard Mesía
- Institut Català d’Oncologia, ICO Badalona, Barcelona, Spain
| | - On behalf of TTCC group (Spanish Group for the Treatment of the Head and Neck Cancer)
- Instituto Alexander Fleming, Asociación Argentina de Oncología Clínica (AAOC), Buenos Aires, Argentina
- AC Camargo Cancer Center, Sociedade Brasileira de Oncologia Clínica (SBOC), São Paulo, Brazil
- Hospital Universitario Cruces/Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- ICCAL, Hospital Universitario Fundación Santa Fe de Bogotá, Asociación Colombiana de Hematología y Oncología (ACHO), Bogotá, Colombia
- Hospital Nacional Edgardo Rebagliati Martins de Lima, Sociedad Peruana de Oncología Médica (SPOM), Lima, Perú
- Pontificia Universidad Católica de Chile, Sociedad Chilena de Oncología Médica (SCOM), Santiago, Chile
- Instituto de Oncología Ángel H. Roffo, Asociación Argentina de Oncología Clínica (AAOC), Buenos Aires, Argentina
- Instituto Nacional de Cancerología, Sociedad Mexicana de Oncología (SMeO), Mexico City, Mexico
- UGC Oncología Médica, Hospital Universitario Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
- Hospital SOLCA de Quito, Sociedad Ecuatoriana de Oncología (SEO), Quito, Ecuador
- Institut Català d’Oncologia, ICO L’Hospitalet, Barcelona, Spain
- Hospital 12 de Octubre, Madrid, Spain
- Instituto Oncológico Nacional (ION) de Panamá, Sociedad Panameña de Oncología (SPO), Panama City, Panama
- Institut Català d’Oncologia, ICO Badalona, Barcelona, Spain
| |
Collapse
|
15
|
Yamashita S, Imai S, Momo K, Kashiwagi H, Sato Y, Sugawara M, Takekuma Y. Investigation of the Real-World Situation and Risk Factors Associated with Olanzapine Prescribed to Diabetes Patients by Using a Japanese Claims Database. Biol Pharm Bull 2021; 44:1151-1155. [PMID: 34334500 DOI: 10.1248/bpb.b21-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Olanzapine is effective for schizophrenia management; however, it is contraindicated in diabetes patients. In addition, olanzapine is useful for treating nausea and vomiting, such as in the case of chemotherapy-induced nausea and vomiting (CINV). Therefore, we hypothesized that the contraindicated prescription of olanzapine likely occurs among cancer patients with diabetes, especially by non-psychiatric physicians. Hence, we conducted a nationwide survey to elucidate the situation of such contraindicated prescriptions and the associated risk factors. We extracted the data of patients who were newly prescribed olanzapine between April 2015 and March 2017 from the health insurance claims database developed by JMDC, Inc., Tokyo. The patients who were prescribed contraindicated olanzapine were defined as those who were prescribed olanzapine after a diagnosis of diabetes and diabetes drug prescription. In all, the data of 7181 patients were analyzed. We evaluated the proportion of diabetes patients who were prescribed contraindicated olanzapine from among those who were prescribed olanzapine. Furthermore, we investigated the background of patients who were prescribed olanzapine for information such as olanzapine prescribers and history of cancer chemotherapy. In all, 100 diabetes patients (1.39%) were prescribed olanzapine. In these patients, the frequency of olanzapine prescription was higher by non-psychiatry/neurology physicians than by psychiatry/neurology physicians (3.25 and 0.85%, respectively). Additionally, all olanzapine prescriptions in cancer chemotherapy-treated diabetes patients were issued by non-psychiatry/neurology physicians. Thus, our study revealed there were diabetes patients who were prescribed olanzapine. Additionally, olanzapine for CINV management was more likely to be a contraindicated prescription.
Collapse
Affiliation(s)
- Shinsuke Yamashita
- Graduate School of Life Science, Hokkaido University.,Department of Pharmacy, Hokkaido University Hospital
| | - Shungo Imai
- Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| | | | - Yuki Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital.,Faculty of Pharmaceutical Sciences, Hokkaido University.,Global Station for Biosurfaces and Drug Discovery, Hokkaido University
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital
| |
Collapse
|
16
|
Harnisch LO, Moerer O. Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature. Membranes (Basel) 2021; 11:584. [PMID: 34436348 DOI: 10.3390/membranes11080584] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022]
Abstract
(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute-refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative-advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ -2 points, PRESET score ≥ 6 points, and "do not attempt resuscitation" order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.
Collapse
|
17
|
Li M, Ji C, Zeng Y, Yao D, Wang X, Shao J. Reasons of the delayed vaccination, recommendations and safety of vaccination in children with congenital heart disease in Zhejiang, China. Hum Vaccin Immunother 2021; 17:2065-2071. [PMID: 33577372 DOI: 10.1080/21645515.2021.1872343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
There has been a considerable controversy about vaccination practices in Children with congenital heart disease (CHD) in China. This study aims to identify the reasons for deferring vaccination among the patient population attending the Vaccination Consultation Clinic in Zhejiang Province and the safety of their vaccination. We analyzed the data of 2442 children with CHD, who visited to our clinic from January 2016 to March 2019. A questionnaire survey was conducted to investigate the reasons for their delayed vaccination. Information about the following vaccination and Adverse Events Following Immunization (AEFI) was collected. Most of the enrolled children did not receive vaccines on time before consultation. The reasons for their deferring vaccination included: 1. Providers in the community health center refused to administer vaccines (77.6%); 2. Parents' concerns about the safety of vaccines (19.0%); 3. Parents' doubts about the efficiency of vaccines after certain drug applications (3.4%). According to the evaluation reports issued by the Vaccination Consultation Clinic, 83.7% of CHD children were recommended to be vaccinated on the nationally recommended schedule, 14.4% were recommended to defer some specific vaccination, and 1.9% were recommended to defer all vaccination. Among the group who received vaccines on nationally recommended schedule, the AEFI rate was 33.5/100 000. No rare or serious rare vaccine reactions were observed. Our study provides evidence that routine vaccination is safe in the majority of this patient population.
Collapse
Affiliation(s)
- Mingyan Li
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chai Ji
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yan Zeng
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dan Yao
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xia Wang
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jie Shao
- Department of Child Health Care, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
18
|
Restivo V, Candore G, Barrale M, Caravello E, Graziano G, Onida R, Raineri M, Tiralongo S, Brusca I. Allergy to Polyethilenglicole of Anti-SARS CoV2 Vaccine Recipient: A Case Report of Young Adult Recipient and the Management of Future Exposure to SARS-CoV2. Vaccines (Basel) 2021; 9:vaccines9050412. [PMID: 33919151 PMCID: PMC8143141 DOI: 10.3390/vaccines9050412] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
The main contraindication to the anti-SARS CoV2 vaccine is an anaphylactic reaction to a vaccine component. The need to vaccinate allergic people who are at higher risk can be of public health interest and this report shows a case of an allergic reaction to PEG of a HCW who had received the first dose of anti-SARS CoV2 vaccine. For 5 h after the administration of the vaccine, she had the appearance of erythematous spots on the face and neck, and a feeling of a slurred mouth and hoarseness. In order to treat the event, she was administered 8 mg intravenous dexamethasone, 1 vial intravenous chlorphenamine maleate, 250 mL intravenous 0.9% NaCl, and conventional oxygen therapy (2 L/min) with complete resolution of the suspected adverse drug reaction. According to the contraindication to the cutaneous test for this patient, BAT was used for further investigations. The patient who suffered the adverse reaction to the COVID-19 vaccine and other five allergic patients who did not report any adverse reaction after the vaccination were tested. There was a significant activation of the vaccine-reactive patient’s basophils with 14.79 CD203chigh% at the concentration of 0.2 mg/mL, while other patients were negative. People who have a confirmed reaction to a vaccine component should undergo further investigation to discover other possible cross-reactions and select the right vaccine to immunize them.
Collapse
Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
- Correspondence:
| | - Giuseppina Candore
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
| | - Maria Barrale
- Laboratory of Clinical Pathology, “Buccheri La Ferla” Hospital, 90127 Palermo, Italy; (M.B.); (R.O.); (I.B.)
| | - Ester Caravello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
| | - Giorgio Graziano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
| | - Rosa Onida
- Laboratory of Clinical Pathology, “Buccheri La Ferla” Hospital, 90127 Palermo, Italy; (M.B.); (R.O.); (I.B.)
| | - Maurizio Raineri
- Department of Biopathology and Medical Biotechnologies, University of Palermo, 90127 Palermo, Italy;
| | - Salvatore Tiralongo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (E.C.); (G.G.); (S.T.)
| | - Ignazio Brusca
- Laboratory of Clinical Pathology, “Buccheri La Ferla” Hospital, 90127 Palermo, Italy; (M.B.); (R.O.); (I.B.)
| |
Collapse
|
19
|
Schnitzer ME, Platt RW, Durand M. A tutorial on dealing with time-varying eligibility for treatment: Comparing the risk of major bleeding with direct-acting oral anticoagulants vs warfarin. Stat Med 2020; 39:4538-4550. [PMID: 32812276 DOI: 10.1002/sim.8715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/05/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022]
Abstract
In this tutorial, we focus on the problem of how to define and estimate treatment effects when some patients develop a contraindication and are thus ineligible to receive a treatment of interest during follow-up. We first describe the concept of positivity, which is the requirement that all subjects in an analysis be eligible for all treatments of interest conditional on their baseline covariates, and the extension of this concept in the longitudinal treatment setting. We demonstrate using simulated datasets and regression analysis that under violations of longitudinal positivity, typical associational estimates between treatment over time and the outcome of interest may be misleading depending on the data-generating structure. Finally, we explain how one may define "treatment strategies," such as "treat with medication unless contraindicated," to overcome the problems linked to time-varying eligibility. Finally, we show how contrasts between the expected potential outcomes under these strategies may be consistently estimated with inverse probability weighting methods. We provide R code for all the analyses described.
Collapse
Affiliation(s)
- Mireille E Schnitzer
- Faculty of Pharmacy and the Department of Social and Preventative Medicine, School of Public Health, Université de Montréal, Montréal, Canada
| | - Robert W Platt
- Departments of Pediatrics and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada.,Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Madeleine Durand
- Internal Medicine Service, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Research Center of Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| |
Collapse
|
20
|
Busari AA, Oreagba IA, Oshikoya KA, Kayode MO, Olayemi SO. High Risk of Drug-drug interactions among Hospitalized Patients with kidney Diseases at a Nigerian Teaching Hospital: A Call for Action. Niger Med J 2020; 60:317-325. [PMID: 32180663 PMCID: PMC7053273 DOI: 10.4103/nmj.nmj_2_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/19/2019] [Accepted: 09/13/2019] [Indexed: 11/04/2022] Open
Abstract
Background Potential drug-drug interactions (DDIs) are increasingly common in clinical practice, especially among individuals with chronic conditions, such as chronic kidney dysfunction. However, data relating to DDIs among chronically ill patients are limited in Nigeria. We, therefore, investigated the prevalence and pattern of DDIs among patients with kidney diseases on admission at a tertiary hospital in Lagos, Nigeria. Materials and Methods This was a prospective observational study involving 61 adults with kidney diseases and on admission in medical wards of the study center, over a 3-month period. Data extractions were with a purposefully designed pro forma to extract relevant data on demographic, clinical, and dosing regimens of the prescribed drugs for individual patients. Potential DDIs were identified, and their severity was rated using the MICROMEDEX® software database (IBM® Watson-Truven Health Analytics), which is available online with limited access. Results Of the 61 patients evaluated, majority were males (34; 55.7%), were elderly (26; 42.6%), and had chronic kidney disease Stage 3 (40; 65.5%). The most common cause of kidney disease was hypertension (20; 32.8%). Out of the 542 prescriptions received by the patients, potential DDI was observed in 508 (93.7%) prescriptions. Clinically significant drug interactions (CSDIs) were detected in 486 (85.7%) prescriptions. Pharmacodynamic DDIs (466; 91.7%) were the most common. Pill burden exceeding 25 pills/day was present in nine (14.8%) patients. The severities of the potential DDIs were major (135; 24.9%), moderate (333; 61.4%), and minor (38; 7.1%). Only two different potential DDIs were rated X (contraindicated). Conclusion Exposure to drugs with potential DDIs was very common among patients with kidney diseases. Most of the CSDIs observed were of major severity. The use of DDI checker before prescribing drugs for individuals with kidney diseases could avert clinically significant interactions.
Collapse
Affiliation(s)
- Abdulwasiu Adeniyi Busari
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ibrahim A Oreagba
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Kazeem A Oshikoya
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Mary O Kayode
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sunday O Olayemi
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria
| |
Collapse
|
21
|
Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C, Doshi M, Cooper M, Friedewald J, Naik AS, Kaul DR, Ison MG, Rocco MV, Verbesey J, Hladunewich MA, Ibrahim HN, Poggio ED. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Am J Kidney Dis 2020; 75:299-316. [PMID: 32007233 DOI: 10.1053/j.ajkd.2019.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022]
Abstract
Living kidney donation is widely practiced throughout the world. During the past 2 decades, various groups have provided guidance about the evaluation and care of living donors. However, during this time, our knowledge in the field has advanced substantially and many agreed on the need for a comprehensive, unifying document. KDIGO (Kidney Disease: Improving Global Outcomes) addressed this issue at an international level with the publication of its clinical practice guideline on the evaluation and care of living kidney donors. The KDIGO work group extensively reviewed the available literature and wrote a series of guideline recommendations using various degrees of evidence when available. As has become recent practice, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) convened a work group to provide a commentary on the KDIGO guideline, with a focus on how these recommendations apply in the context of the United States. In the United States, the United Network for Organ Sharing (UNOS) guides and regulates the practice of living kidney donation. While the KDIGO guideline for the care of living kidney donors and UNOS policy are similar in most aspects of the care of living kidney donors, several important areas are not consistent or do not align with common practice by US transplantation programs in areas in which UNOS has not set specific policy. For the time being, and recognizing the value of the KDIGO guidelines, US transplantation programs should continue to follow UNOS policy.
Collapse
Affiliation(s)
| | - Peter P Reese
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Neetika Garg
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Carrie Schinstock
- Division of Nephrology and Hypertension, William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Mona Doshi
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - Matthew Cooper
- Georgetown University School of Medicine, MedStar Georgetown Transplant Institute, Washington, DC
| | - John Friedewald
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abhijit S Naik
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | | | - Michael G Ison
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Jennifer Verbesey
- MedStar Georgetown Transplant Institute and Children's National Health System, Washington, DC
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Nanji Family Kidney Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
22
|
Lopes S, O'Day K, Meyer K, Van Stiphout J, Punekar Y, Radford M, Haas JS. Comedication prescription patterns and potential for drug-drug interactions with antiretroviral therapy in people living with human immunodeficiency virus type 1 infection in Germany. Pharmacoepidemiol Drug Saf 2020; 29:270-278. [PMID: 31950545 DOI: 10.1002/pds.4928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/17/2019] [Accepted: 11/01/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE Various first-line recommended antiretroviral therapy (ART) regimens have different drug-drug interaction (DDI)/contraindication profiles. The aim of this study was to estimate the rate of potential DDIs/contraindications of real-world prescribed non-ART comedication with first-line recommended ART in people living with HIV (PLHIV) in Germany. METHODS A retrospective, cross-sectional cohort design was used to collect non-ART comedication prescription data from a representative sample of a German health insurance claims database. PLHIV who were prescribed ART during 2016 were included in the analysis. Patients were stratified by sex, age, comorbidities, and time on ART. Prescribed comedications were used to estimate potential DDIs/contraindications for each recommended first-line ART per patient based on criteria from www.hiv-druginteractions.org. RESULTS Records from 2680 PLHIV were analyzed. Prescriptions for non-ART comedications were common (mean of seven per patient in the overall population, 10.2 in PLHIV aged 50 years and older). Antiretroviral regimens with the lowest proportion of patients with at least 1 potential DDI/contraindication were unboosted integrase inhibitor, non-tenofovir disoproxil fumarate-based regimens that included raltegravir + emtricitabine/tenofovir alafenamide fumarate (13%), dolutegravir + lamivudine (14%), dolutegravir/abacavir/lamivudine (14%), dolutegravir/emtricitabine/tenofovir alafenamide fumarate (15%), and bictegravir/emtricitabine/tenofovir alafenamide fumarate (19%). Boosted regimens and efavirenz-based regimens presented the highest potential for DDIs/contraindications. CONCLUSIONS Comedication with potential DDIs/contraindications with ART is frequently prescribed among PLHIV in Germany. Potential risks for DDIs/contraindications vary by ART, with the lowest potential seen in unboosted integrase strand transfer inhibitor-based regimens, including raltegravir + emtricitabine/tenofovir alafenamide fumarate, followed by three dolutegravir-based regimens.
Collapse
Affiliation(s)
- Sara Lopes
- Global Health Outcomes, ViiV Healthcare, Brentford, UK.,Global Health Economics, Xcenda LLC, Palm Harbor, Florida, USA
| | - Ken O'Day
- Global Health Economics, Xcenda LLC, Palm Harbor, Florida, USA
| | - Kellie Meyer
- Global Health Economics, Xcenda LLC, Palm Harbor, Florida, USA
| | - Joris Van Stiphout
- Global HEOR and Market Access, Xcenda Switzerland GmbH, Bern, Switzerland
| | | | | | | |
Collapse
|
23
|
Yang MC, Liu HK, Wu HY, Tey SL, Yang YN, Wu CY, Wu JR. Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern. Front Pediatr 2020; 8:591441. [PMID: 33194925 PMCID: PMC7649389 DOI: 10.3389/fped.2020.591441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA. Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups. Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05). Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.
Collapse
Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsuan-Yin Wu
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, E-Da Hospital, Kaohsiung City, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
| |
Collapse
|
24
|
Tsivgoulis G, Katsanos AH, Schellinger PD, Köhrmann M, Steiner T, Caso V, Palaiodimou L, Strbian D, Ahmed N, Alexandrov A, Savitz SI. Intravenous thrombolysis in patients with acute ischaemic stroke with history of prior ischaemic stroke within 3 months. J Neurol Neurosurg Psychiatry 2019; 90:1383-1385. [PMID: 30995998 DOI: 10.1136/jnnp-2019-320422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/01/2019] [Accepted: 04/08/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, Athens, Greece .,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aristeidis H Katsanos
- Department of Neurology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Peter D Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - Martin Köhrmann
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | - Thorsten Steiner
- Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt, Germany.,Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Andrei Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sean I Savitz
- Neurology, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
| |
Collapse
|
25
|
Steinberg BA, Ballew NG, Greiner MA, Lippmann SJ, Curtis LH, O'Brien EC, Patel MR, Piccini JP. Ischemic and Bleeding Outcomes in Patients With Atrial Fibrillation and Contraindications to Oral Anticoagulation. JACC Clin Electrophysiol 2019; 5:1384-1392. [PMID: 31857036 DOI: 10.1016/j.jacep.2019.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/21/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to describe clinical outcomes among patients with atrial fibrillation (AF) and contraindications to oral anticoagulation (OAC). BACKGROUND Treatment with OAC prevents stroke and death in patients with AF, but may be contraindicated among patients at high bleeding risk. METHODS This was an observational, longitudinal analysis of a nationally representative 5% Medicare sample of patients with chronic AF and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score ≥2. They were stratified by both the presence of high bleeding risk contraindications to OAC and by OAC use. We assessed 3-year ischemic and bleeding outcomes using multivariable Cox proportional hazards models adjusted for relevant patient characteristics. RESULTS Among 26,684 AF patients not treated with OAC, 8,283 (31%) had a high bleeding risk contraindication, primarily a blood dyscrasia (75%) or history of gastrointestinal bleeding (40%). Without OAC, patients with contraindications had worse ischemic and bleeding outcomes at 3 years compared with those without contraindications. We also identified 12,454 patients with OAC contraindications who received OAC. Compared with patients not receiving OAC, use of OAC was associated with reduced mortality (adjusted hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.76 to 0.83), stroke (adjusted HR: 0.90; 95% CI: 0.83 to 0.99), and all-cause hospitalization (adjusted HR: 0.93; 95% CI: 0.90 to 0.96) but increased risk of intracranial hemorrhage (adjusted HR: 1.42; 95% CI: 1.17 to 1.72). CONCLUSIONS High bleeding risk contraindications to OAC are common among older patients with AF, and these patients have higher mortality compared with untreated patients without OAC contraindications. The use of OAC in these patients is associated with lower rates of all-cause stroke, hospitalization, and death but higher risk of intracranial hemorrhage.
Collapse
Affiliation(s)
- Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah.
| | - Nicholas G Ballew
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Steven J Lippmann
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Lesley H Curtis
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Emily C O'Brien
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Manesh R Patel
- Duke Clinical Research Institute, Durham, North Carolina; Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P Piccini
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina; Cardiology Division, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
26
|
Inohara T, Liang L, Kosinski AS, Smith EE, Schwamm LH, Hernandez AF, Bhatt DL, Fonarow GC, Peterson ED, Xian Y. Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding. Eur Stroke J 2019; 5:47-55. [PMID: 32232169 DOI: 10.1177/2396987319871784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background There are limited data on the safety of intravenous recombinant tissue plasminogen activator (rtPA) for treating acute ischemic stroke in patients with gastrointestinal malignancy or recent gastrointestinal bleeding within 21 days of their index stroke. Aims To evaluate clinical outcomes in patients treated with rtPA for acute ischemic stroke who had gastrointestinal malignancy or recent gastrointestinal bleeding. Methods We identified patients who were treated with rtPA for acute ischemic stroke between 2/2009 and 12/2015 from the Get With The Guidelines-Stroke linked to Medicare claims data. Gastrointestinal malignancy and recent gastrointestinal bleeding were defined as any gastrointestinal malignancy hospitalisation within one year prior to acute ischemic stroke and gastrointestinal bleeding hospitalisation within 21 days prior to acute ischemic stroke, respectively. Outcomes of interest included in-hospital mortality and bleeding complications. Results Among 40,396 patients aged 65 years or older treated with rtPA for acute ischemic stroke from 1522 sites (mean age [SD] 81.0 [8.1] years; 41.9% women), 136 (0.3%) had gastrointestinal malignancy (n = 96) or recent gastrointestinal bleeding (n = 43). Patients with gastrointestinal malignancy or bleeding had more severe stroke than those without (median NIHSS [interquartile range]: 14.0 [8.0-19.0] vs. 11.0 [6.0-18.0]). The rates of in-hospital mortality and life-threatening systemic haemorrhage were not significantly different between those with and without gastrointestinal malignancy or bleeding (mortality: 10.3% vs. 9.0%, adjusted odds ratio [aOR] 1.01, 95%CI 0.58-1.75; bleeding: 2.3% vs. 1.2%, aOR 1.72, 95%CI 0.58-5.11). Conclusions In this observational cohort, we did not find increased risk of in-hospital mortality and bleeding in rtPA-treated patients with gastrointestinal malignancy or recent gastrointestinal bleeding.
Collapse
Affiliation(s)
- Taku Inohara
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Li Liang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brian Institute, University of Calgary, Calgary, Canada
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.,Department of Neurology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
27
|
Kehr J, Binfield A, Maxwell F, Hornung T, Skinner JR. Fascicular tachycardia in infancy and the use of verapamil: a case series and literature review. Arch Dis Child 2019; 104:789-792. [PMID: 31005896 PMCID: PMC6662950 DOI: 10.1136/archdischild-2018-315617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Guidelines state that verapamil is contraindicated in infants. This is based on reports of cardiovascular collapse and even death after rapid intravenous administration of verapamil in infants with supraventricular tachycardia (SVT). We wish to challenge this contraindication for the specific indication of verapamil sensitive ventricular tachycardia (VSVT) in infants. DESIGN Retrospective case series and critical literature review. SETTING Hospitals within New Zealand. PATIENTS We present a series of three infants/young children with VSVT or 'fascicular VT'. RESULTS Three children aged between 8 days and 2 years presented with tachycardia 200-220 beats per minute with right bundle brunch block and superior axis. Adenosine failed to cardiovert and specialist review diagnosed VSVT. There were no features of cardiovascular shock. Verapamil was given as a slow infusion over 10-30 min (rather than as a push) and each successfully cardioverted without incident. Critical review of the literature reveals that cardiovascular collapses were associated with a rapid intravenous push in cardiovascularly compromised infants and/or infants given other long-acting antiarrhythmics prior to verapamil. CONCLUSIONS Verapamil is specifically indicated for the treatment of fascicular VT, and for this indication should be used in infancy, as well as in older children, as first-line treatment or after failure of adenosine raises suspicion of the diagnosis. We outline how to distinguish this tachycardia from SVT and propose a strategy for the safe intravenous slow infusion of verapamil in children, noting that extreme caution is necessary with pre-existing ventricular dysfunction.
Collapse
Affiliation(s)
- Jascha Kehr
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Alex Binfield
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
| | - Fraser Maxwell
- Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand
| | - Tim Hornung
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
- Department of Child Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|
28
|
Inohara T, Liang L, Kosinski AS, Smith EE, Schwamm LH, Hernandez AF, Bhatt DL, Fonarow GC, Peterson ED, Xian Y. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. J Am Heart Assoc 2019; 8:e012450. [PMID: 31327296 PMCID: PMC6761665 DOI: 10.1161/jaha.119.012450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Intravenous recombinant tissue‐type plasminogen activator (rtPA) remains the only medical therapy to improve outcomes for acute ischemic stroke (AIS), but the safety of rtPA in AIS patients with a history of recent myocardial infarction (MI) remains controversial. Methods and Results We sought to determine whether the presence of recent MI would alter the risk of mortality and rtPA‐related complications. Multivariate logistic regression models were used to compare in‐hospital outcomes between rtPA‐treated AIS patients with recent MI within 3 months and those with no history of MI from the Get With The Guidelines‐Stroke hospitals between February 2009 and December 2015. Among 40 396 AIS patients aged ≥65 years treated with rtPA, 241 (0.6%) had recent MI, of which 19.5% were ST‐segment–elevation myocardial infarction. Patients with recent MI had more severe stroke than those without (median National Institutes of Health Stroke Scale [interquartile range]: 13.0 [7.0–20.0] versus 11.0 [6.0–18.0]). Recent MI was associated with an increased risk of mortality compared with no history of MI (17.4% versus 9.0%; adjusted odds ratio 1.60 [95% CI, 1.10–2.33]; P=0.014), but no statistically significant differences in rtPA‐related complications (13.5% versus 9.4%; adjusted odds ratio 1.28 [0.88–1.86]; P=0.19). Recent ST‐segment–elevation myocardial infarction was associated with higher risk of death and rtPA‐related complications, but non–ST‐segment–elevation myocardial infarction was not. Conclusions Among older AIS patients treated with rtPA, recent MI was associated with an increased risk of in‐hospital mortality. Further investigations are necessary to determine whether the benefit of rtPA outweighs its risk among AIS patients with recent MI.
Collapse
Affiliation(s)
- Taku Inohara
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Li Liang
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Andrzej S Kosinski
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Eric E Smith
- Department of Clinical Neurosciences Hotchkiss Brian Institute University of Calgary Canada
| | - Lee H Schwamm
- Department of Neurology Massachusetts General Hospital Boston MA
| | - Adrian F Hernandez
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School Boston MA
| | - Gregg C Fonarow
- Division of Cardiology Ronald Reagan University of California Los Angeles Medical Center Los Angeles CA
| | - Eric D Peterson
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Ying Xian
- Duke Clinical Research Institute Duke University Medical Center Durham NC.,Department of Neurology Duke University Medical Center Durham NC
| |
Collapse
|
29
|
Turagam MK, Reddy VY, Dukkipati SR. EWOLUTION of Watchman Left Atrial Appendage Closure to Patients With Contraindication to Oral Anticoagulation. Circ Arrhythm Electrophysiol 2019; 12:e007257. [PMID: 30939907 DOI: 10.1161/circep.119.007257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohit K Turagam
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY
| |
Collapse
|
30
|
Tang Y, Yang K, Zhao J, Liang X, Wang J. Evidence of Repurposing Drugs and Identifying Contraindications from Real World Study in Parkinson's Disease. ACS Chem Neurosci 2019; 10:954-963. [PMID: 30702853 DOI: 10.1021/acschemneuro.8b00456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There is great unmet need in discovering novel treatment for Parkinson's disease (PD) and identifying the new agents potentially causing drug-induced parkinsonism. New indications and contraindications of drugs are typically approved following rigorous randomized controlled trial (RCT) evaluation. However, RCTs have their inherent limitations, since they are usually conducted in ideal conditions, with high cost and limited follow-up periods. In the past decade, large cohort studies with long follow-up outcome data was derived from a PD database in a real-world setting. Studies based on real world data (RWD) can help to augment and extrapolate data obtained in RCTs and provide information about the safety and effectiveness of a medication in heterogeneous, large populations. In the present review, we focus on the published real world studies designed to develop new treatment strategies for repurposing drugs and identifying contraindications for PD. We also outline the challenges and limitations in these studies. Subsequently we introduce PaWei app platform, which hopefully can facilitate PD management and address real-world problems associated with PD. Better understanding of RWD collection and analysis is needed if RWD is to achieve its full potential.
Collapse
Affiliation(s)
- Yilin Tang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ke Yang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jue Zhao
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaoniu Liang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jian Wang
- Department of Neurology and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| |
Collapse
|
31
|
Li M, Ji C, Wang B, Yao D, Wang X, Zeng Y, Shao J. Incomplete Vaccination Among Children With Special Health Care Needs in Zhejiang, China: Analysis of Retrospective Data. Front Pediatr 2019; 7:173. [PMID: 31119119 PMCID: PMC6506790 DOI: 10.3389/fped.2019.00173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/15/2019] [Indexed: 02/02/2023] Open
Abstract
Objective: There is a lack of data relating to vaccination of children with special health care needs (CSHCN) and its influencing factors in China. We investigated the disease spectrum of CSHCN at the Vaccination Consultation Clinic in Zhejiang province as well as the underlying factors of vaccination recommendations of these children. Methods: In this study, we retrospectively analyzed the data of 4,525 CSHCN, who visited to our clinic for a vaccination consultation from January 1, 2016 to May 30, 2018. Descriptive data were presented as mean ± standard deviation (SD) and percentages. Multivariate analysis was performed with non-conditional bivariate logistic regression to identify the underlying factors of vaccination recommendations. Subsequent information regarding the following vaccination and the occurrence of AEFI were also collected and analyzed. Results: The main diseases consulted were those relating to the circulatory and nervous systems as well as neonatal diseases. The distribution of diseases varied by age: 53.6% infants under 12 months were counseled for circulatory system diseases, while 44.6% children aged 12~24 months and 54.7% children over 25 months were counseled for nervous system diseases. According to the evaluation reports issued by the consultation clinic, 75.0% of CSHCN were recommended to be vaccinated normally, 21.2% were recommended to defer specific vaccination, while only 3.8% were recommended to defer all vaccinations. In logistic regression analysis, age, history of adverse events following immunization (AEFI) and the number of diseases combined were all strong correlative factors for vaccination recommendations. Children who were aged over 25-month-old (OR = 1.34, 95%CI: 1.11-1.61) or had a history of AEFI (OR = 3.77, 95%CI: 2.83~5.01) or those who had numerous diseases combined (OR = 2.00, 95%CI: 1.46~2.75) tended to have a higher rate of deferred vaccination recommendation. Among those CSHCN who received nationally-recommended vaccines, the estimated AEFI rate was 24.29/100 000. No uncommon or rare serious adverse reactions were detected. Conclusion: Age, history of AEFI, and the number of diseases combined were important factors that affected the vaccination recommendations of CSHCN. Most CSHCN can be safely vaccinated according to the nationally-recommended schedule.
Collapse
Affiliation(s)
- Mingyan Li
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Chai Ji
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Wang
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Yao
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Wang
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Zeng
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Shao
- Department of Child Health Care, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
32
|
Kong WJ, Ding XY, Wang YF, Wang WQ, Wang X, Wang W, Sun Y, Tang WL, Li XP, Zhang W, Chen Y, Wang ZY, Yang HD, Yang Q, Zhao Y, Hou ZH, Cui Y, Yu YJ. [Endoscopic ear surgery: flash in the pan or transformative innovation? (Ⅱ)]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:1531-1541. [PMID: 30400702 DOI: 10.13201/j.issn.1001-1781.2018.20.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 11/12/2022]
|
33
|
Majule DN, Jing C, Rutahoile WM, Shonyela FS. The Efficacy and Safety of the WATCHMAN Device in LAA Occlusion in Patients with Non-Valvular Atrial Fibrillation Contraindicated to Oral Anticoagulation: A Focused Review. Ann Thorac Cardiovasc Surg 2018; 24:271-278. [PMID: 29962388 PMCID: PMC6300422 DOI: 10.5761/atcs.ra.18-00014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The standard treatment for stroke risk patients with non-valvular atrial fibrillation (NVAF) is the use of oral anticoagulants (OACs). However, a substantial number of patients have relative or absolute contraindications to OACs due to concerns of major bleeding risk and other adverse effects while using oral anticoagulation therapy. Recently, occurrences of exclusion of the left atrial appendage (LAA) in patients with contraindication to anticoagulation therapy are widely expanding worldwide, causing major contentious discussions. The LAA is the commonest place of thrombus formation; therefore, the concept of LAA occlusion in reducing stroke and other embolic events in NVAF patients is very important. The current understanding of the available evidence on efficacy and safety of LAA closure (LAAC) with the Watchman device in patients contraindicated to OACs is the major aim of this focused review. After reviewing a significant body of literature, a world experience with no randomized trials, it is suggested that Watchman device implantation is effective and safe in high-risk patients with NVAF contraindicated to OACs therapy.
Collapse
Affiliation(s)
- David Nehemiah Majule
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Jing
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | | |
Collapse
|
34
|
Abstract
BACKGROUND Photobiomodulation (PBM) therapy is a rapidly growing approach to stimulate healing, reduce pain, increase athletic performance, and improve general wellness. OBJECTIVE Applying PBM therapy over the site of a tumor has been considered to be a contraindication. However, since another growing use of PBM therapy is to mitigate the side effects of cancer therapy, this short review seeks to critically examine the evidence of whether PBM therapy is beneficial or harmful in cancer patients. MATERIALS AND METHODS PubMed and Google Scholar were searched. RESULTS Although there are a few articles suggesting that PBM therapy can be detrimental in animal models of tumors, there are also many articles that suggest the opposite and that light can directly damage the tumor, can potentiate other cancer therapies, and can stimulate the host immune system. Moreover, there are two clinical trials showing increased survival in cancer patients who received PBM therapy. CONCLUSIONS PBM therapy may have benefits in cancer patients and should be further investigated.
Collapse
Affiliation(s)
- Michael R Hamblin
- 1 Department of Dermatology, Wellman Center for Photomedicine , Massachusetts General Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
35
|
Mihailidis T, Izadi D, Gujral S. Cutaneous Pyoderma Gangrenosum of the Hand. Eplasty 2018; 18:ic4. [PMID: 29487673 PMCID: PMC5799722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Toni Mihailidis
- aDepartment of Medicine, University of Bristol, Bristol, UK,Correspondence:
| | - David Izadi
- bDepartment of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, UK
| | - Sameer Gujral
- cDepartment of Plastic Surgery, Southmead Hospital, Bristol, UK
| |
Collapse
|
36
|
Abstract
When addressing the compatibility of breastfeeding with certain maternal conditions, we need to differentiate between "contraindication" and "obstacle." Failure to distinguish between the two confuses new mothers and their families, and engenders misconceptions about breastfeeding advice by health professionals. Health conditions that may simply impede the initiation and duration of breastfeeding are often wrongly referred to as true contraindications to breastfeed, under the assumption that they might harm the health of the mother and/or that of the nursing infant. Here, we discuss several topics, including breast surgery, prolactinoma, concurrent new pregnancy, hormonal contraception, and use of medications and contrast agents, that continue to raise controversy. While most conditions appear to be compatible with breastfeeding, the major determinants of a woman's final choice of whether to nurse her infant or not are the attitude of health professionals and the state of mind of being an informed mother.
Collapse
Affiliation(s)
- Riccardo Davanzo
- Division of Pediatrics and Neonatology, Department of Mother and Child Health, Ospedale Madonna delle Grazie, Matera, Italy.,Task Force on Breastfeeding, Ministry of Health, Rome, Italy
| |
Collapse
|
37
|
Dong Q, Dong Y, Liu L, Xu A, Zhang Y, Zheng H, Wang Y. The Chinese Stroke Association scientific statement: intravenous thrombolysis in acute ischaemic stroke. Stroke Vasc Neurol 2017; 2:147-159. [PMID: 28989804 PMCID: PMC5628383 DOI: 10.1136/svn-2017-000074] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 12/30/2022] Open
Abstract
The most effective medical treatment for acute ischaemic stroke (AIS) is to offer intravenous thrombolysis during the ultra-early period of time after the onset. Even based on the Consensus of Chinese Experts on Intravenous Thrombolysis for AIS in 2012 and 2014 Chinese Guidelines on the Diagnosis and Treatment of AIS, the rate of thrombolysis for AIS in China remained around 2.4%, and the rate of intravenous tissue plasminogen activator usage was only about 1.6% in real world. The indication of thrombolysis for AIS has been expanded, and contraindications have been reduced with recently published studies. In order to facilitate the standardisation of treating AIS, improve the rate of thrombolysis and benefit patients who had a stroke, Chinese Stroke Association has organised and developed this scientific statement.
Collapse
Affiliation(s)
- Qiang Dong
- Department of Neurology, Huashan Hospital affiliated to Fudan University, Shanghai Shi, China
| | - Yi Dong
- Department of Neurology, Huashan Hospital affiliated to Fudan University, Shanghai Shi, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| | - Anding Xu
- Department of Neurology and Stroke Center, First Affiliated Hospital, Jinan University, Guangzhou Shi, China
| | - Yusheng Zhang
- Department of Neurology and Stroke Center, First Affiliated Hospital, Jinan University, Guangzhou Shi, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
38
|
Ueki K, Yoshikawa K, Enoshiri T, Tanji M, Takeuchi M, Suzuki S. DIEP flap breast reconstruction preserving a lumbar peritoneal shunt tube. Case Reports Plast Surg Hand Surg 2017; 4:17-20. [PMID: 28470029 PMCID: PMC5404631 DOI: 10.1080/23320885.2017.1296362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/12/2017] [Indexed: 11/25/2022]
Abstract
We herein report a case of immediate deep inferior epigastric perforator flap (DIEP flap) breast reconstruction surgery in a 50-year-old female patient with a lumbar peritoneal shunt tube. We performed DIEP flap reconstruction in the patient by withdrawing and subsequently reinserting the abdominal side of an implanted shunt tube.
Collapse
Affiliation(s)
- Kentarou Ueki
- Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Katsuhiro Yoshikawa
- Department of Plastic and Reconstructive Surgery, Shiga Medical Center for Adults, Shiga, Japan
| | - Tatsuki Enoshiri
- Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Tanji
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Megumi Takeuchi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigehiko Suzuki
- Department of Plastic and Reconstructive Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
39
|
Shah M, Alnabelsi T, Patil S, Reddy S, Patel B, Lu M, Chandorkar A, Perelas A, Arora S, Patel N, Jacobs L, Eiger GG. IVC filters-Trends in placement and indications, a study of 2 populations. Medicine (Baltimore) 2017; 96:e6449. [PMID: 28328857 PMCID: PMC5371494 DOI: 10.1097/md.0000000000006449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Inferior vena cava filter (IVCF) placement appears to be expanding over time despite absence of clear directing evidence.Two populations were studied. The first population included patients who received an IVCF between January 2005 and August 2013 at our community hospital center. Demographic information, indications for placement, and retrieval rate was recorded among other variables. The second population comprised of patients receiving an IVCF from 2005 to 2012 according to the Nationwide Inpatient Sample (NIS) using ICD-9CM coding. Patients were divided into 2 groups based on the year of admission for comparison, that is, first group from 2005 to 2008 and the second from 2009 to 2012. In addition, we analyzed annual trends in filter placement, acute venothromboembolic events (VTE) and several underlying comorbidities within this population.At our center, 802 IVCFs were placed (55.2% retrievable); 34% for absolute, 61% for relative, and 5% for prophylactic indications. Major bleeding (27.5%), minor self-limited bleeding (13.7%), and fall history (11.2%) were the commonest indications. Periprocedural complication rate was 0.7%, and filter retrieval rate was 7%. The NIS population (811,487 filters) saw a decline in IVCF placement after year 2009, following an initial uptrend (Ptrend < 0.01). IVCF use among patients with neither acute VTE nor bleeding among prior VTE saw a 3-fold absolute reduction from 2005 to 2012 (33,075-11,655; Ptrend < 0.01). Patients from 2009 to 2012 were more likely to be male and had higher rates of acute VTE, thrombolytic use, cancer, bleeding, hypotension, acute cardiorespiratory failure, shock, prior falls, blood product transfusion, hospital mortality including higher Charlson comorbidity scores. The patients were younger, had shorter length of stay, and were less likely to be associated with strokes including hemorrhagic or require ventilator support. Prior falls (adjusted odds ratio-aOR 2.8), thrombolytic use (aOR 1.76), and shock (aOR 1.45) were most predictive of IVCF placement between 2009 and 2012 on regression analysis.Recent trends suggest that a higher proportion of patients receive temporary IVCF, for predominantly relative indications. Nationally, the number of filters being placed is decreasing, especially among those who did not experience acute VTE or bleeding events. Prior falls, thrombolytic therapy, and shock were most predictive of IVCF placement in latter half of the study period.
Collapse
Affiliation(s)
- Mahek Shah
- Department of Cardiology, Lehigh Valley Hospital, Allentown
| | | | | | - Shilpa Reddy
- Department of Radiology, Einstein Medical Center, Philadelphia, PA
| | - Brijesh Patel
- Department of Cardiology, Lehigh Valley Hospital, Allentown
| | | | | | | | | | - Nilay Patel
- Saint Peter's University Hospital, New Brunswick, NJ
| | - Larry Jacobs
- Department of Cardiology, Lehigh Valley Hospital, Allentown
| | - Glenn G. Eiger
- Division of Pulmonary and Critical Care, Einstein Medical Center, Philadelphia, PA
| |
Collapse
|
40
|
Gu X, Chen Z, Chen B, Fan Y, Chen X. [Application of blistering cupping]. Zhongguo Zhen Jiu 2016; 36:1191-1196. [PMID: 29231306 DOI: 10.13703/j.0255-2930.2016.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Blistering cupping is special as eliminating wind and dampness as well as removing phlegm and blood stasis, and it achieves effects through suction. In this paper we reviewed relevant literature combined with clinical experience so as to summarize its operation attention through exploring the origin, mechanism and application. We divide the progress into the blistering period, the phlegm-stasis-eliminating period, and the escharosis period according to the changes of bubble and the things pulled out. Blistering cupping creates ways to eliminate concrete unhealthy influences through smoothing meridians and collaterals, such as phlegm and retained fluid, dampness and blood stasis. Thus chronic diseases are relieved. Also,we propose the rules of "blistering acupoints being related to disease location as well as the nature of acupoints and diseases". The therapy has been used to treat diseases of respiratory system, osteoarticular, skin and subcutaneous tissue, mental and behavioral disorders, and tumor, among which the effects of intractable diseases of respiratory and osteoarticular systems are definite. It deserves to be further explored and promoted.
Collapse
Affiliation(s)
- Xingui Gu
- College of Acupuncture-Moxibustion and Tuina, Tianjin University of TCM, Tianjin 300193, China
| | - Zelin Chen
- College of Acupuncture-Moxibustion and Tuina, Tianjin University of TCM, Tianjin 300193, China.,Professional Committee of Pricking-Cupping Bloodletting, China Association of Acupuncture-Moxibustion, Tianjin 300193
| | - Bo Chen
- College of Acupuncture-Moxibustion and Tuina, Tianjin University of TCM, Tianjin 300193, China
| | - Yihua Fan
- College of Acupuncture-Moxibustion and Tuina, Tianjin University of TCM, Tianjin 300193, China
| | - Xianghong Chen
- College of Acupuncture-Moxibustion and Tuina, Tianjin University of TCM, Tianjin 300193, China
| |
Collapse
|
41
|
Liu J, Xu T, Liang J, Zhao S, Wu T, Su S, Yan R. [Adverse reactions of acupoint embedding and its treatment]. Zhongguo Zhen Jiu 2016; 36:1166-1168. [PMID: 29231301 DOI: 10.13703/j.0255-2930.2016.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper the adverse reactions of acupoint embedding and its treatment are summarized, including fever, infection, callosity, blood stasis, red swelling, numb swelling, pain, fester, ulcer, etc. It is consi-dered that adverse reactions are induced by the inappropriate operation, special constitution and embedding material. Thus we need to pay attention to standard manipulation, the contraindication, and cautious usage. Symptomatic treatment needs to be implemented timely once adverse reactions occur.
Collapse
Affiliation(s)
- Jia Liu
- The First Clinical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Tong Xu
- The First Clinical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Jiayu Liang
- The First Clinical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Siyu Zhao
- The First Clinical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Tong Wu
- The First Clinical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Shiyao Su
- The First Clinical College, Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Runhu Yan
- College of Cosmetology, Dalian Medical University, Dalian 116044, Liaoning Province, China
| |
Collapse
|
42
|
Wiedermann U, Sitte HH, Burgmann H, Eser A, Falb P, Holzmann H, Kitchen M, Köller M, Kollaritsch H, Kundi M, Lassmann H, Mutz I, Pickl WF, Riedl E, Sibilia M, Thalhammer F, Tucek B, Zenz W, Zwiauer K. [Guidelines for vaccination of immunocompromised individuals]. Wien Klin Wochenschr 2016; 128 Suppl 4:337-76. [PMID: 27457874 DOI: 10.1007/s00508-016-1033-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022]
Abstract
Immunosuppression of various origins is associated with an increased risk of infection; therefore the prevention of infectious diseases by vaccination is especially important in immunocompromised patients. However, the response to vaccinations is often reduced in these risk groups and the application of live vaccines is contraindicated during immunosuppression.In the following expert statement, recommendations for vaccination were created on the basis of current evidence and theoretical/immunological considerations. A first, general part elaborates on efficacy and safety of vaccinations during immunosuppression, modes of action of immunosuppressive medications and recommended time intervals between immunosuppressive treatments and vaccinations. A core piece of this part is a graduation of immunosuppression into three stages, i. e. no relevant immunosuppression, mild to moderate and severe immunosuppression and the assignment of various medications (including biologicals) to one of those stages; this is followed by an overview of possible and necessary vaccinations in each of those stages.The second part gives detailed vaccination guidelines for common diseases and therapies associated with immunosuppression. Primary immune deficiencies, chronic kidney disease, diabetes mellitus, solid and hematological tumors, hematopoetic stem cell transplantation, transplantation of solid organs, aspenia, rheumatological-, gastroenterologic-, dermatologic-, neurologic diseases, biologicals during pregnancy and HIV infection are dealt with.These vaccination guidelines, compiled for the first time in Austria, aim to be of practical help for physicians to facilitate and improve vaccination coverage in immunocompromised patients and their household members and contact persons.
Collapse
Affiliation(s)
- Ursula Wiedermann
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich.
| | - Harald H Sitte
- Institut für Pharmakologie, Medizinische Universität Wien, Wien, Österreich
| | - Heinz Burgmann
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Eser
- Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Wien, Wien, Österreich
| | - Petra Falb
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | | | - Maria Kitchen
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Marcus Köller
- Sozialmedizinisches Zentrum Sophienspital, Wien, Österreich
| | - Herwig Kollaritsch
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Wien, Österreich
| | - Michael Kundi
- Institut für Umwelthygiene, Medizinische Universität Wien, Wien, Österreich
| | - Hans Lassmann
- Abteilung für Neuroimmunologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Winfried F Pickl
- Institut für Immunologie, Medizinische Universität Wien, Wien, Österreich
| | - Elisabeth Riedl
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Maria Sibilia
- Institut für Krebsforschung, Medizinische Universität Wien, Wien, Österreich
| | - Florian Thalhammer
- Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - Barbara Tucek
- Medizinmarktaufsicht, Agentur für Gesundheit und Ernährungssicherheit, Wien, Österreich
| | - Werner Zenz
- Klinische Abteilung für allgemeine Pädiatrie, Medizinische Universität Graz, Graz, Österreich
| | - Karl Zwiauer
- Klinische Abteilung für Kinder- und Jugendheilkunde, Universitätsklinikum St. Pölten, St. Pölten, Österreich
| |
Collapse
|
43
|
Marinello PG, Amini MH, Peers S, O'Donnell J, Iannotti JP. Reverse total shoulder arthroplasty with combined deltoid reconstruction in patients with anterior and/or middle deltoid tears. J Shoulder Elbow Surg 2016; 25:936-41. [PMID: 26803931 DOI: 10.1016/j.jse.2015.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/24/2015] [Accepted: 10/24/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Deltoid disruption has traditionally been an absolute contraindication to performing a reverse total shoulder arthroplasty (RTSA), and options available to patients have been limited. We present a series of patients with deltoid tears that underwent concomitant RTSA with deltoid reconstruction. We hypothesize that this combined procedure provides an acceptable, functional alternative for this complex patient population. MATERIALS AND METHODS We retrospectively identified all patients who were treated by a single surgeon with a concomitant RTSA and deltoid reconstruction from 2004 to 2012 with minimum 24-month follow-up. Six shoulders in 5 patients met these criteria. The mean age was 69 years (range, 61-79 years), and the mean follow-up period was 76.8 months (range, 24-133 months). We compared preoperative and postoperative range of motion and Penn Shoulder Scores, including subscores, using paired t tests. RESULTS Mean forward elevation and external rotation increased from 48° and 12°, respectively, to 120° and 22°, respectively. Penn scores increased from 45.2 to 77.8 postoperatively (P = .03). The Penn satisfaction subscore, in particular, improved from 1.1 (of 10) to 9.0 (P = .005). There was a low rate of recurrent deltoid failure (1 of 6 shoulders), and there were no infections or revisions. DISCUSSION Deltoid reconstruction at the same time as RTSA is a viable treatment option as a salvage procedure for patients with deltoid deficiency who otherwise need RTSA for treatment of massive rotator cuff deficiency. In this small series, simultaneous RTSA and deltoid reconstruction resulted in a functional shoulder with a high level of satisfaction and good motion. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
Collapse
|
44
|
Milbury K, Lopez G, Spelman A, Wood C, Matin SF, Tannir NM, Jonasch E, Pisters L, Wei Q, Cohen L. Examination of moderators of expressive writing in patients with renal cell carcinoma: the role of depression and social support. Psychooncology 2016; 26:1361-1368. [PMID: 27145447 DOI: 10.1002/pon.4148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/23/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify groups most likely to benefit from an Expressive Writing (EW) intervention, we examined psychosocial variables as intervention moderators. We hypothesized that EW would be particularly effective for participants with high levels of depressive symptoms and social support at study entry. METHODS Patients (n = 277; 60.6% male) with kidney cancer were randomly assigned to either an expressive (EW) or neutral writing (NW) condition. Intervention outcomes included measures of depressive symptoms (CESD), cancer-related symptoms (MDASI), fatigue (BFI), and sleep disturbances (PSQI) assessed at baseline, 1, 4, and 10 months later. Moderators were measured at baseline. RESULTS As hypothesized, depressive symptoms and social support moderated intervention efficacy. When examining both moderators simultaneously, EW appeared to be most effective in terms of cancer-related symptoms (p < 0.05) and depressive symptoms (p < 0.01) for participants with elevated depressive symptoms who received high levels of social support at baseline relative to their counterparts in the NW condition. Moreover, participants in EW with high levels of social support at baseline reported lower levels sleep disturbances (p = 0.005) than their counterparts in NW. CONCLUSIONS Recognition of baseline depressive symptoms and social support as intervention moderators may lead to improved patient selection for EW interventions, as EW may be particularly beneficial regarding QOL outcomes for patients that have social support available including participants with depressive symptoms. EW may not be beneficial, or potentially even contraindicated, for participants lacking social support. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Kathrin Milbury
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Spelman
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Louis Pisters
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qi Wei
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
45
|
Maharaj S, Pandey S, Maharaj K, Sheik MS, Dhingra S. Significance of pharmaceutical excipients in prescribed medicines: a case report. Clin Case Rep 2014; 2:258-9. [PMID: 25548626 PMCID: PMC4270706 DOI: 10.1002/ccr3.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/10/2022] Open
Abstract
Key Clinical Message Pharmaceutical excipients need careful observation as they play a significant role in treatment outcomes. It is imperative for a physician to collect complete patient profile before prescribing new medications for current treatment. We present a case report on the significance of pharmaceutical excipients in prescribed medicines.
Collapse
Affiliation(s)
- Sandeep Maharaj
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago
| | - Sureshwar Pandey
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago
| | - Keshwar Maharaj
- Eastern Pharmacy Eastern Main Road, Sangre Grande, Trinidad and Tobago
| | - Meera Sharief Sheik
- Department of Paediatrics, The University of the West Indies St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago
| |
Collapse
|
46
|
Abstract
In congenital or aqcuired immune deficiencies, infectious diseases which can be prevented by vaccination have a severe course because of supression of the immune system by the disease itself or the treatment methods used. Therefore, vaccination is important in immune deficiency. Although the protective antibody levels achieved in healthy individuals can not be provided in patients with immune deficiency, there is no drawback in administering inactive vaccines in accordance with the vaccination program. On the other hand, live viral and bacterial vaccines should not be administered during periods of immunosupression in conditions where the immune system is strongly supressed by diseases or drugs, since they would cause to systemic infection. Physicians should have sufficient knowledge about contraindications of vaccination in individuals with immune deficiency and in people who live in the same house with these individuals.
Collapse
Affiliation(s)
- Ahmet Arvas
- Department of Pediatrics, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
47
|
Jame SZB, Sari AA, Majdzadeh R, Rashidian A, Arab M, Rahmani H. The extent of inappropriate use of magnetic resonance imaging in low back pain and its contributory factors. Int J Prev Med 2014; 5:1029-36. [PMID: 25489452 PMCID: PMC4258662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/16/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is an expensive and commonly used technology with a variety of indications in patient diagnosis and treatments. The aim of this study is to identify a comprehensive list of indications and contraindications for MRI in patients with low back pain (LBP) and to determine the appropriateness of using this technology in these patients on the basis of this list. METHODS A cross-sectional study was conducted in four radiographic centers in Tehran, Iran. A list of MRI indications and contraindications for LBP was developed by review of documents and expert panel. A pre structured checklist was designed and incorporated into a structured form. All 100 consecutive patients referring to four radiographic centers for performing MRI regarding LBP completed the questionnaire. Chi-square, Fisher's Exact Test and logistic Regression were used to assess statistical significance. RESULTS In this study, 187 patients (46.7%) had an indication for MRI, but 186 patients (46.5%) had no indication, 18 patients (4.5%) had indication and contraindication at the same time and nine patients (2.3%) had contraindication. Moreover, 71 patients (17.8%) underwent MRI for LBP during the past 2 years, of which 14 (19.7%) had normal results. Patients with complementary private insurance had a history of previous MRI about 20% more than other patients (P = 0.018). There was a statistically significant relationship between complementary private insurance coverage and number of MRI performed (P = 0.006). CONCLUSIONS About half of the patients referring to radiographic centers with LBP for MRI had no indication for this test.
Collapse
Affiliation(s)
- Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Dr. Ali Akbari Sari, Department of Health Management and Economics, School of Public Health, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, and Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hojjat Rahmani
- Department of Health Care Management, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
48
|
Uriel N, Nahumi N, Colombo PC, Yuzefpolskaya M, Restaino SW, Han J, Thomas SS, Garan AR, Takayama H, Mancini DM, Naka Y, Jorde UP. Advanced heart failure in patients infected with human immunodeficiency virus: is there equal access to care? J Heart Lung Transplant 2014; 33:924-30. [PMID: 24929646 DOI: 10.1016/j.healun.2014.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 04/05/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection has evolved from a highly stigmatized disease with certain progression to acquired immunodeficiency syndrome (AIDS) to a chronic disease affecting over 1 million Americans. With the success of current anti-retroviral therapies, cardiovascular disease, including advanced heart failure (HF), will be a major cause of morbidity and mortality in this population. METHODS A survey concerning heart transplantation (HT) and left ventricular assist device (LVAD) implantation attitudes and outcomes in HIV-infected patients was distributed to 103 American and 9 Canadian HT centers via fax, e-mail or telephone. RESULTS Eighty-nine centers (79%) responded. Eighteen HTs were performed in HIV(+) patients with 1-, 2- and 5-year survival of 100%, 100% and 63%, respectively. Eighty-two centers (92%) have never performed HT in HIV(+) patients and 51 centers (57%) marked HIV(+) status as a contraindication. Rationales for contraindication included: (1) high-risk patients should be avoided given the scarcity of organ supply (59%); (2) immunosuppression required for HT may induce progression to AIDS (51%); and (3) drug interactions may worsen patients' clinical outcomes (49%). Thirty-five left ventricular assist device (LVAD) implantations in HIV(+) patients were reported. Sixty-eight centers (76%) have never implanted an LVAD in an HIV(+) patient and 21 centers (20%) marked HIV(+) status as a contraindication, of which 61% indicated concern for device-related infection. CONCLUSIONS Most centers either explicitly consider HIV(+) status as a contraindication for or have never treated HIV(+) patients with advanced HF therapy. Our findings suggest unequal access to care and underscore the need to educate cardiovascular health-care providers on progress made with HIV therapies.
Collapse
Affiliation(s)
- Nir Uriel
- Division of Cardiology, University of Chicago, Chicago, Illinois.
| | - Nadav Nahumi
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Susan W Restaino
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Jason Han
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Sunu S Thomas
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Arthur R Garan
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Hiroo Takayama
- (c)Division of Cardiothoracic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Donna M Mancini
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- (c)Division of Cardiothoracic Surgery, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| | - Ulrich P Jorde
- Division of Cardiology, New York Presbyterian Hospital and Columbia University Medical Center, New York, New York
| |
Collapse
|
49
|
Oshikoya KA, Oreagba IA, Lawal S, Awodele O, Ogunleye OO, Senbanjo IO, Olayemi SO, Ezeaka VC, Temiye EO, Adeyemo TA, Opanuga O, Lesi OA, Akanmu SA. Potential drug-drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria. HIV AIDS (Auckl) 2014; 6:49-59. [PMID: 24741328 PMCID: PMC3982970 DOI: 10.2147/hiv.s52266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria. Methods The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination). Results Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs. Conclusion There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.
Collapse
Affiliation(s)
- Kazeem A Oshikoya
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibrahim A Oreagba
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Saheed Lawal
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olufunsho Awodele
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Idowu O Senbanjo
- Department of Paediatrics, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Sunday O Olayemi
- Department of Pharmacology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Veronica C Ezeaka
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Paediatrics, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Edamisan O Temiye
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Paediatrics, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Titilope A Adeyemo
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Oluranti Opanuga
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Pharmacy, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria
| | - Olufunmilayo A Lesi
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Medicine, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Sulaimon A Akanmu
- APIN Clinic, Lagos University Teaching Hospital, Lagos, Nigeria ; Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| |
Collapse
|
50
|
Santarelli S, Zeiler M, Monteburini T, Agostinelli RM, Marinelli R, Degano G, Ceraudo E. Videolaparoscopic catheter placement reduces contraindications to peritoneal dialysis. Perit Dial Int 2012. [PMID: 23209040 DOI: 10.3747/pdi.2011.00314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Videolaparoscopy is considered the reference method for peritoneal catheter placement in patients with previous abdominal surgery. The placement procedure is usually performed with at least two access sites: one for the catheter and the second for the laparoscope. Here, we describe a new one-port laparoscopic procedure that uses only one abdominal access site in patients not eligible for laparotomic catheter placement. METHOD We carried out one-port laparoscopic placement in 21 patients presenting contraindications to blind surgical procedures because of prior abdominal surgery. This technique consists in the creation of a single mini-laparotomy access through which laparoscopic procedures and placement are performed. The catheter, rectified by an introducer, is inserted inside the port. Subsequently, the port is removed, leaving the catheter in pelvic position. The port is reintroduced laterally to the catheter, confirming or correcting its position. Laparotomic placement was performed in a contemporary group of 32 patients without contraindications to blind placement. Complications and long-term catheter outcome in the two groups were evaluated. RESULTS Additional interventions during placement were necessary in 12 patients of the laparoscopy group compared with 5 patients of the laparotomy group (p = 0.002). Laparoscopy documented adhesions in 13 patients, with need for adhesiolysis in 6 patients. Each group had 1 intraoperative complication: leakage in the laparoscopy group, and intestinal perforation in the laparotomy group. During the 2-year follow-up period, laparoscopic revisions had to be performed in 6 patients of the laparoscopy group and in 5 patients of the laparotomy group (p = 0.26). The 1-year catheter survival was similar in both groups. Laparoscopy increased by 40% the number of patients eligible to receive peritoneal dialysis. CONCLUSIONS Videolaparoscopy placement in patients not eligible for blind surgical procedures seems to be equivalent to laparotomic placement with regard to complications and long-term catheter outcome. The number of patients able to receive peritoneal dialysis is substantially increased.
Collapse
|