journal article
LitStream Collection
Home
Naci, H.; Brugts, J.J.; Fleurence, R.; Ades, A.E.
doi: 10.1093/qjmed/hct041pmid: 23431221
Statins are important in the prevention of major cerebrovascular events. Whether, and the extent to which, individual statins differ in terms of their effect on these outcomes has not been studied. The aim of this review was to evaluate the comparative effects of individual statins on major cerebrovascular events. We systematically reviewed 61 trials including 187 038 individuals with, or at risk of developing, cardiovascular disease. We performed pair-wise and multiple-treatments meta-analyses for major cerebrovascular events, in addition to fatal and non-fatal strokes separately. Across all populations, statins were significantly more effective than control in reducing major cerebrovascular events [odds ratio (OR): 0.82, 95 CI: 0.77, 0.87], with no differences among individual statins. Statins were also effective in patients with established cardiovascular disease (OR: 0.83, 95 CI: 0.75, 0.91) and in those without (OR: 0.80, 95 CI: 0.71, 0.91). Considering individual statins, significant risk reductions were achieved with atorvastatin (OR: 0.74, 95 CI: 0.63, 0.85), pravastatin (OR: 0.86, 95 CI: 0.76, 0.97) and simvastatin (OR: 0.75, 95 CI: 0.62, 0.88) as compared with control on major cerebrovascular events across all populations. Statins led to significant reductions in the risk of non-fatal strokes (OR: 0.77, 95 CI: 0.71, 0.85) but not of fatal strokes (OR: 0.96, 95 CI: 0.80, 1.15). Findings were not sensitive to dose differentials of individual statins across the trials. No significant heterogeneity or inconsistency was detected. Statins significantly reduce the incidence of major cerebrovascular events as compared with control. Our analysis provided evidence to confirm the class effect of statins in preventing major cerebrovascular events.
doi: 10.1093/qjmed/hct022pmid: 23365141
Throughout much of the world, the incidence of non-tuberculous mycobacterial pulmonary infections in immunocompetent hosts is on the rise. These organisms are widespread in the natural environment; the explanation for what appears to be an increased susceptibility among human hosts is uncertain. Among more than 120 known species, the most common pathogenic isolate in the USA is Mycobacterium avium complex. The diagnosis of pulmonary disease caused by M. avium complex requires a compatible history, suggestive radiographic findings (on chest computed tomography) and microbiologic confirmation on culture of respiratory samples (sputum or direct lung sampling). Treatment options have improved with inclusion of macrolide antibiotics in a multi-drug regimen, but failure rates remain high (2040) even after a prolonged course of therapy. Newer, less toxic and more effective anti-mycobacterial agents are greatly needed for treatment of this increasingly common respiratory disease.
Soto-Varela, A.; Rossi-Izquierdo, M.; Snchez-Sellero, I.; Santos-Prez, S.
doi: 10.1093/qjmed/hct006pmid: 23404787
Benign paroxysmal positional vertigo (BPPV) is the most commonly diagnosed vestibular vertigo. BPPV can be diagnosed by clinical examination and its treatment is based on particle repositioning manoeuvres, and specialized equipment is not required. Therefore, most patients could be diagnosed and treated by their general practitioner. Unfortunately, not all positional vertigos are benign. Symptoms similar to those of BPPV can be caused by diseases that affect the central nervous system. It must be possible to define criteria that allow us to suspect, in a patient with symptoms of positional vertigo, the possibility of a cerebral origin (non-benign PV). Requests for magnetic resonance imaging must be justified by the fulfilment of these criteria. That is especially relevant in primary care, because these criteria should make possible to distinguish between patients with positional vertigo that could be treated by general practitioner and patients that need to be directed to especialized units. We propose the following revised criteria for suspected non-benign PV: (i) association with signs or symptoms of neurological disorder, (ii) nystagmus without dizziness in positional diagnostic tests, (iii) atypical nystagmus direction, (iv) poor response to therapeutic manoeuvres and (v) recurrence (confirmed by positional tests) on at least three occasions.
Aitken, E.; Carruthers, C.; Gall, L.; Kerr, L.; Geddes, C.; Kingsmore, D.
doi: 10.1093/qjmed/hcs237pmid: 23345468
Background: Deficiencies in management have been highlighted as contributory factors in the death of many patients with acute kidney injury (AKI). However, there is little evidence addressing the quality of care provided to patients with milder AKI.Aim: The aim of this study is to evaluate the quality of care provided to a non-select cohort of patients with AKI and evaluate discrepancies in causation, recognition and management.Design: Retrospective inception cohort study.Methods: Demographic data were collected for all 1577 patients admitted to a University Teaching Hospital during a 1-month period. Baseline, admission and peak creatinine were correlated with mortality and length of hospital admission. AKI was classified according to Kidney Disease Improving Global Outcomes criteria. A retrospective case note review of all patients with AKI was carried out to evaluate quality of documentation and clinical management of AKI. Multivariate analysis was undertaken to determine risk factors for AKI.Results: Incidence of AKI on admission was 4.6. A further 10.3 developed AKI while in hospital. All cause mortality was 4-fold higher among patients with AKI compared with those without (19 vs. 3.8; P < 0.001). Mortality was significantly higher in those patients who developed AKI while an in-patient compared with those with AKI on admission (27.3 vs. 11.8; P < 0.001). Diabetes, clinician perception of frailty, age and treatment with angiotensin-converting enzyme inhibitor prior to admission were found to be independent risk factors for AKI. AKI was unrecognized in 23.5 of patients, two-thirds of whom were discharged without resolution of renal function. Significant weaknesses in management were poorly kept fluid balance charts (48.2), failure to withhold nephrotoxic drugs (38.8) and failure to act upon abnormal biochemistry (41) in a timely fashion.Conclusions: AKI is common in hospitalized patients and associated with a significant increase in hospital stay and mortality. AKI is often found in conjunction with other organ failure and in many cases is not preventable. Nevertheless clinicians need to be more vigilant of small creatinine rises to permit early intervention particularly among elderly and frail patients.
Churilla, J.R.; Johnson, T.M.; Zippel, E.A.
doi: 10.1093/qjmed/hcs231pmid: 23256179
Background: Several studies illustrate the favorable association between physical activity (PA) and cholesterol levels. There is a paucity of data examining the PA patterns of individuals with and without hypercholesterolemia (HC).Aim: To examine self-reported moderate and vigorous PA (MVPA) patterns using the most recent PA guidelines among US adults with and without HC.Design: Cross-sectional study utilizing a secondary data analysis approach.Methods: We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS). PA categories were based on the 2008 Department of Health and Human Services (DHHS) guidelines.Results: The age-adjusted prevalence of self-reported HC in US adults was 34. When stratified by gender, the age-adjusted prevalence of HC was found to be significantly higher in men (36.2; 95 CI 35.6, 36.8) compared with women (31.8; 95 CI 31.3, 32.3). The age-adjusted prevalence of meeting the DHHS PA recommendation was 59.1 among participants reporting HC and 68.3 among participants not reporting HC (P < 0.05). Following adjustment for demographics and health history, the odds ratio for meeting the DHHS PA recommendation among participants with HC compared with those without HC was 0.86 (95 CI 0.83, 0.89).Conclusions: Although a large proportion of adults reporting HC report engaging in a volume of MVPA necessary to meet national guidelines, their odds of meeting these guidelines and their MVPA volume may be significantly lower than adults who did not report HC.
doi: 10.1093/qjmed/hcs230pmid: 23241274
Background: Although the accuracy of final height prediction using skeletal age development has been confirmed in many studies for children treated for congenital primary hypothyroidism, short normal children, constitutionally tall children, no studies compared the predicted adult height at young age with final stature in athletic population.Aim: In this study, the intention was to investigate to what extent the TannerWhitehouse (TW) method is adequate for prediction of final stature in young Caucasian male athletes.Design: Prospective observational study.Methods: Plain radiographs of the left hand and wrist were obtained from 477 athletic children (ranging in age from 8.0 to 17.9 years) who came to the outpatient clinic between 2000 and 2011 for adult height estimation, with no orthopedic trauma suspected. Adult height was estimated using bone age rates according to TW method. Height was measured both at baseline and follow-up (at the age of 19 years).Results: No significant difference was found between the estimated adult height (184.9 9.7 cm) and final stature (185.6 9.6 cm) [95 confidence interval (CI) 1.613.01, P 0.55]. The relationship between estimated and final adult height was high (r 0.96). BlandAltman analysis confirmed that the 95 of differences between estimated adult height and final stature lie between limits of agreement (mean 2 SD) (5.84 and 4.52 cm).Conclusion: TW method is an accurate method of predicting adult height in male normal-growing athletic boys.
Mamo, J.P.; Brij, S.O.; Enoch, D.A.
doi: 10.1093/qjmed/hct003pmid: 23365143
Introduction: Peterborough has one of the highest rates of tuberculosis in the East of England; 40 of TB treated locally is extra-pulmonary.Aim and methods: All adults diagnosed with abdominal tuberculosis (ATB) between January 2008 and September 2011 in Peterborough Hospitals were retrospectively evaluated with regard to their clinical history, investigation, management and outcomes.Results: In total, 17 patients diagnosed with ATB were reviewed. All the patients were from (or descended from) high-risk ethnic groups. Four had co-existing pulmonary TB. Intestinal and peritoneal TB were the most common findings. The most common clinical manifestations included abdominal pain (71), weight loss (59), diarrhoea (47) and pyrexia (41). Fifteen patients had samples sent for microbiological investigation; 1 (6) was smear positive and 9 (53) were culture positive. Two (12) were isoniazid resistant. No rifampicin resistance was detected. Anti-tuberculous therapy was given for 612 months. In total, 16 (94) patients completed the treatment; 1 patient died prior to regime completion (crude mortality: 6). There was one reported case of pyrazinamide intolerance and two episodes of isoniazid intolerance.Discussion: ATB is a diagnostic challenge, especially in absence of lung involvement. It mimics other diseases and clinical presentation is usually non-specific, which may lead to diagnostic delay and development of complications. Extreme vigilance should be used when dealing with unexplained abdominal symptoms to ensure timely diagnosis of ATB. Early diagnosis with early anti-tuberculous therapy and surgical treatment are essential to ensure as positive an outcome as possible.
Henderson, S.R.; Maitland, R.; Mustafa, O.G.; Miell, J.; Crook, M.A.; Kottegoda, S.R.
doi: 10.1093/qjmed/hcs238pmid: 23417910
Background: Severe hypertriglyceridaemia is a recognized complication of Type 2 diabetes mellitus (T2DM); however, there is no consensus on acute management despite the significant risk of developing associated complications such as acute pancreatitis and hyperviscosity syndrome.Aim: To identify the association between hyperglycaemia and severe hypertriglyceridaemia in patients with T2DM and assess the effect of continuous insulin infusion therapy on serum triglyceride (TG) concentrations and report any adverse events associated with this therapeutic approach.Design: Retrospective review of case records.Methods: Patients with uncontrolled hyperglycaemia and severe hypertriglyceridaemia (serum TG > 15 mmol/l) treated with continuous intravenous insulin infusion between October 2008 and September 2009 were retrospectively evaluated (n 15). Details recorded included demographics, admission details, lipid profiles, glycaemic control, serum amylase and adverse events. Patients receiving treatment-dose unfractionated heparin infusion were excluded.Results: Severe hypertriglyceridaemia is associated with hyperglycaemia in our heterogeneous group of patients with T2DM presenting with new-onset diabetes or established disease on pre-existing insulin or oral hypoglycaemic agents. Administration of continuous exogenous insulin not only achieved normoglycaemia but also dramatically corrected severe hypertriglyceridaemia in all patients (P 0.001).Conclusions: The administration of continuous insulin in patients with T2DM with severe hypertriglyceridaemia is a simple and safe method of significantly reducing the immediate risk associated with this metabolic complication and should be considered in any T2DM patient presenting with severe hypertriglyceridaemia and hyperglycaemia.
Showing 1 to 10 of 23 Articles