2009 July 18

Derm diagnoses you can’t afford to miss.

Jul 182009

Derm diagnoses you can't afford to miss.

J Fam Pract. 2009 Jun;58(6):298-306

Authors: Hazin R, Abuzetun JY, Khatri KA

Management of hereditary angioedema should include fresh frozen plasma containing C1 inhibitor (C1-INH), whenever possible; if C1-INH-containing plasma is unavailable, fresh frozen plasma can be used instead. Do not give neomycin to patients with suspected cellulitis; the drug may promote antibiotic resistance in Staphylococcus aureus, a pathogen often associated with this condition. Whenever a patient presents with erythematous skin lesions and a recent history of receiving penicillin or a cephalosporin antibiotic, a sulfa derivative, or an anticonvulsant, the suspected medication should be stopped until Stevens-Johnson syndrome is ruled out.

PMID: 19508842 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Efficacy of low- molecular- weight- heparin versus vitamin K antagonists for long term treatment of cancer-associated venous thromboembolism in adults: a systematic review of randomized controlled trials.

Thromb Res Start a Discussion »

Jul 182009

Efficacy of low- molecular- weight- heparin versus vitamin K antagonists for long term treatment of cancer-associated venous thromboembolism in adults: a systematic review of randomized controlled trials.

Thromb Res. 2009 Apr;123(6):837-44

Authors: Louzada ML, Majeed H, Wells PS

BACKGROUND: Patients with malignancy have a 4-fold increase in the risk of developing a venous thrombosis and a 3-fold increase in risk of bleeding. Both low-molecular-weight-heparin (LMWH) and vitamin K antagonists (VKA) have been used for treatment of cancer-associated thrombosis. However, the best anticoagulation approach remains a matter of debate. OBJECTIVE: In adult patients with cancer and an acute venous thromboembolic event we sought to determine the rates of recurrent venous thromboembolism (VTE) and major hemorrhage when treated with prolonged LMWH therapy compared to vitamin-K antagonists. PATIENTS/METHODS: A systematic literature search strategy was used to identify potential trials on MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and Medline in-process using an OVID interface. Risk assessment of bias of randomized controlled trials (RCTs) was performed according to the Cochrane Collaboration-Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome measure was symptomatic VTE recurrence rate during the anticoagulation period. Relative risk (RR) was used as the primary measurement with 95% confidence intervals (CIs). Pooled measurements were calculated using random -effects and fixed-effects model. RESULTS: Five articles met our inclusion criteria. All compared LMWH and VKA for secondary prevention of VTE. The pooled RR of VTE recurrence was 0.53 (95% CI: 0.36-0.76; p=0.007). The pooled RR of major bleeding was 0.98 (95% CI: 0.49-1.93, p=0.95). Minor bleeding events and all cause mortality were similar between the 2 intervention arms. CONCLUSIONS: The results of our review suggest that the long term use of LMWH after the acute first week of treatment is superior to VKAs for secondary prevention of venous thromboembolism in adult patients with cancer.

PMID: 18977517 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events.

J Epidemiol Community Health Start a Discussion »

Jul 182009

Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events.

J Epidemiol Community Health. 2008 Dec;62(12):1022-9

Authors: Aranaz-Andrés JM, Aibar-Remón C, Vitaller-Murillo J, Ruiz-López P, Limón-Ramírez R, Terol-García E,

OBJECTIVE: To determine the incidence and incidence density of adverse events (AEs) in Spanish hospitals (including the pre-hospitalisation period). METHOD: Retrospective cohort study. RESULTS: The incidence of patients with AEs relating directly to hospital care was 8.4% (95% CI 7.7% to 9.1%) and rose 9.3% (95% CI 8.6% to 10.1%), including those from the pre-hospitalisation period. The incidence density was 1.2 AEs per 100 patient-days (95% CI 1.1 to 1.3). The incidence of moderate and serious AEs was 5.6 AEs per 1000 patient-days (95% CI 4.9% to 6.3%). In 66.3% of AEs, additional procedures were required and in 69.9% additional treatments were required. In total 42.8% of AEs were considered as avoidable. Of the subjects with some intrinsic risk factors, 13.2% developed AEs compared with 5.2% of the subjects who had no risk factors (p<0.001), and 9.5% of the subjects who had some extrinsic risk factors developed AEs compared with 3.4% of the subjects who had not (p<0.001). Patients older than 65 years of age showed a higher frequency of AEs than those under this age (12.4% vs 5.4%, p<0.001, RR 2.5). The most frequent AEs were those associated with medication (37.4%), hospital infections of any type (25.3%) and those relating to technical problems during a procedure (25.0%). A total of 31.4% of the AEs involved an increase in the length of stay. The AEs associated with medical assistance caused 6.1 additional hospital stays by patient. CONCLUSIONS: The incidence of patients with AE related to medical assistance in Spanish hospitals was relevant and similar to those found in the studies from Canada and New Zealand that had been conducted with comparable methodology. Patient vulnerability has been identified therein as playing a major role in generating healthcare-related AEs. These and other recent results indicate the need for AEs to be considered a public health priority in Europe.

PMID: 19008366 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Utility of daytime polysomnography for in-patients with suspected sleep-disordered breathing.

Neurol Neurochir Pol Start a Discussion »

Jul 182009

Utility of daytime polysomnography for in-patients with suspected sleep-disordered breathing.

Neurol Neurochir Pol. 2009 Mar-Apr;43(2):140-7

Authors: Al-Jawder S, Bahammam A

BACKGROUND AND PURPOSE: Obstructive sleep apnoea (OSA) is a common medical problem with significant adverse consequences. Delays in diagnosing and treating OSA have increased with increasing demand for sleep services. The aim of the study was to assess the utility of daytime poly-somnography (PSG) in in-patients who were suspected during admission to have sleep disordered breathing. MATERIAL AND METHODS: We compared 80 in-patients who had daytime PSG with a random sample of 180 patients who had overnight PSG. We analyzed demographic data, medical history, PSG results, and results of continuous positive airway pressure (CPAP) titration. RESULTS: The diagnosis of OSA was made in 70 (87.5%) daytime patients and 180 (100%) overnight patients. The daytime patients were older (53.5 +/-12.2 years vs. 46.8 +/-14 years, p < 0.001) and had a higher body mass index (BMI) than the overnight patients (43.3 +/-13.3 vs. 35 +/-8, p < 0.001). There was no significant difference between the two groups with regard to apnoea-hypopnoea index (AHI) or desaturation and arousal indices. CPAP titration was successful in 89.5% of the daytime patients and 81.5% of the overnight patients. Daytime patients had more medical co-morbidities. Obesity hypoventilation syndrome (OHS) was diagnosed in 31.3% of the daytime group. CONCLUSIONS: Daytime PSG is as useful as overnight PSG in diagnosing OSA and titrating CPAP in in-patients. It is best suited to inpatients, patients with multiple co-morbidities, and patients with OHS.

PMID: 19484691 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Tularemia – Missouri, 2000-2007.

MMWR Morb Mortal Wkly Rep Start a Discussion »

Jul 182009

Tularemia - Missouri, 2000-2007.

MMWR Morb Mortal Wkly Rep. 2009 Jul 17;58(27):744-8

Authors:

Tularemia is an uncommon but potentially fatal zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis. Approximately 40% of all tularemia cases reported to CDC each year occur in Arkansas, Oklahoma, and Missouri. To define the epidemiologic and clinical features of tularemia in Missouri, the Missouri Department of Health and Senior Services (MDHSS) analyzed surveillance data and conducted a retrospective clinical chart review of cases that occurred during 2000--2007. This report describes the results of that analysis, which identified 190 cases (87 confirmed and 103 probable), for an average annual incidence of 0.4 cases per 100,000 population statewide. Most cases occurred during the summer months (78%) and among males (66%). Analysis of 121 clinical charts revealed that children were more likely than adults to be diagnosed with glandular tularemia, whereas adults were more likely to be diagnosed with pneumonic tularemia. Sixty-three (52%) patients were hospitalized; one patient died. Among 78 cases with a documented exposure source, 72% were associated with tick bite. In 33 (85%) of 39 culture-confirmed cases, the laboratory received specimens without any indication of suspicion of a tularemia diagnosis. Clinicians should 1) be aware of the range of tularemia symptoms, 2) consider the diagnosis in patients reporting fever and tick or animal exposure, and 3) initiate empiric antimicrobial therapy while awaiting laboratory confirmation. Laboratory staff should take appropriate precautions when processing culture specimens from tularemia-endemic regions, even if suspicion of tularemia is not noted when the specimen is submitted.

PMID: 19609248 [PubMed - in process]

Link to Article at PubMed

Intensive-care patients with severe novel influenza A (H1N1) virus infection – Michigan, June 2009.

MMWR Morb Mortal Wkly Rep Start a Discussion »

Jul 182009

Intensive-care patients with severe novel influenza A (H1N1) virus infection - Michigan, June 2009.

MMWR Morb Mortal Wkly Rep. 2009 Jul 17;58(27):749-52

Authors:

In April 2009, CDC reported the first two cases in the United States of human infection with a novel influenza A (H1N1) virus. As of July 6, a total of 122 countries had reported 94,512 cases of novel influenza A (H1N1) virus infection, 429 of which were fatal; in the United States, a total of 33,902 cases were reported, 170 of which were fatal. Cases of novel influenza A (H1N1) virus infection have included rapidly progressive lower respiratory tract disease resulting in respiratory failure, development of acute respiratory distress syndrome (ARDS), and prolonged intensive care unit (ICU) admission. Since April 26, communitywide transmission of novel influenza A (H1N1) virus has occurred in Michigan, with 655 probable and confirmed cases reported as of June 18 (Michigan Department of Community Health [MDCH], unpublished data, 2009). This report summarizes the clinical characteristics of a series of 10 patients with novel influenza A (H1N1) virus infection and ARDS at a tertiary-care ICU in Michigan. Of the 10 patients, nine were obese (body mass index [BMI] >or=30), including seven who were extremely obese (BMI =40); five had pulmonary emboli; and nine had multiorgan dysfunction syndrome (MODS). Three patients died. Clinicians should be aware of the potential for severe complications of novel influenza A (H1N1) virus infection, particularly in extremely obese patients.

PMID: 19609249 [PubMed - in process]

Link to Article at PubMed

Older Entries

July 2009
M	T	W	T	F	S	S
« Jun				Aug »
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30	31