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OBJECTIVE: To describe the prescription patterns of home, non-intravenous rescue benzodiazepines (non-IV-rBZDs) for febrile seizures and the factors associated with their prescription. METHODS: Retrospective descriptive study using the MarketScan Commercial Database, a large database of employer-sponsored privately insured patients in the United States. We used data from January 1st 2006 to December 31st 2022. We studied patients with febrile seizures as the main code for the healthcare encounter (identified with International Classification of Diseases codes) with age from 6 months to 5 years of age and with at least 1 month of follow-up. RESULTS: There were a total of 82,835 patients [median (p25-p75) age 1.0 (1.0-2.0) years, 56.7 % males] with at least one febrile seizure, of whom 9,737 (11.8 %) filled at least one non-IV-rBZD prescription. Among the 9,737 patients who filled at least one prescription, the median (p25-p75) time from first febrile seizure to non-IV-rBZD prescription was 27 (2-186) days. Among the factors known at the time of the first febrile seizure, complex febrile seizure (OR: 3.51, 95 % CI: 3.24-3.79), and an initial inpatient hospitalization for febrile seizure (OR: 3.53, 95 % CI: 3.29-3.79) were the factors most strongly associated with filling a non-IV-rBZD prescription. In contrast, sex, rural patient's residence, and salary employment (versus other employment class) were not independently associated with filling a non-IV-rBZD prescription. Among the factors known at the end of follow-up, complex febrile seizures, type of initial encounter, and an eventual diagnosis of epilepsy were major independent factors associated with filling a non-IV-rBZD prescription. CONCLUSION: Only approximately 12 % of children with a febrile seizure filled a prescription for a home non-IV-rBZD. The major factors independently associated with prescription were complex febrile seizure, hospital admission, recurrent febrile seizures, and an eventual diagnosis of epilepsy.
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OBJECTIVE: This review summarizes the safety profile, stent patency, and clinical effectiveness of dedicated venous stents for the treatment of chronic deep venous disease. The approaches to stenting and post-procedural management of different vascular units are also explored. METHODS: The MEDLINE and Embase databases were searched for pertinent literature published from January 2010 to January 2023. Outcomes related to post-stenting symptoms and health-related quality of life were described narratively. A meta analysis was conducted to evaluate stent patency, ulcer healing, bleeding, and 30-day stent thrombosis, and these outcomes were presented as proportion event rates. RESULTS: Seventeen studies were identified comprising of 2218 patients. 62.7% of individuals had post-thrombotic stenosis or occlusion. The majority of patients (78.6%) were noted to have complete occlusions of their deep veins before stenting. Eleven different dedicated venous stents were deployed. At 12 months, the primary patency rate was 83% (95% confidence interval [CI]: 76%-90%), the primary-assisted patency rate was 90% (95% CI: 85%-96%), and the secondary patency rate was 95% (95% CI: 92%-98%). A significant improvement in health-related quality of life was demonstrated after intervention. In total, 68.8% (95% CI: 52.0%-83.7%) of ulcers healed at the last follow-up. The remaining symptomatic changes were described narratively; improvements in pain, venous claudication, and edema after stenting were observed. Seventeen deaths occurred, but none were linked to the stenting procedures. A total of 159 cases (7.2% of patients) of in-stent stenosis were observed, whereas 110 stents (5.0% of patients) were occluded. The incidence of major and minor bleeding was 1.7% (95% CI: 1.0%-2.5%) and 3.2% (95% CI: 1.3%-5.6%), respectively, more commonly seen in patients undergoing hybrid intervention. CONCLUSIONS: Deep venous stenting using dedicated venous stents is a safe technique to treat chronic deep venous stenosis and/or occlusion. Within the limitations of this study, deep venous stenting is associated with good patency rates and symptomatic improvement.
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Claudicación Intermitente , Calidad de Vida , Humanos , Constricción Patológica , Resultado del Tratamiento , Stents , Vena Ilíaca , Estudios Retrospectivos , Enfermedad CrónicaRESUMEN
OBJECTIVE: Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort. SETTING AND DESIGN: This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health. PARTICIPANTS: There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children. MEASURES: The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form. RESULTS: The sample (N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion. CONCLUSIONS AND RELEVANCE: ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.
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INTRODUCTION: Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure. METHODS: A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated. RESULTS: A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA regarding readmission (RR: 0.61; 95% confidence interval [CI]: [0.29-1.31]; p = .21), ischemic stroke after discharge (RR: 1.16; 95% CI: [0.49-2.73]), peri-device leak >5 mm (RR: 1.27; 95% CI: [0.42-3.85], and all-cause mortality (RR: 0.60; 95% CI: [0.36-1.02]). The same-day discharge study group had significantly lower major bleeding or vascular complications (RR: 0.71; 95% CI: [0.54-0.94]). CONCLUSIONS: This meta-analysis of seven observational studies showed no significant difference in patient safety outcomes and post-discharge complications between same-day discharge versus HA. These findings provide a solid basis to perform a randomized control trial to eliminate any potential confounders.
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Apéndice Atrial , Fibrilación Atrial , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Apéndice Atrial/cirugía , Alta del Paciente , Cuidados Posteriores , Resultado del Tratamiento , Estudios Observacionales como AsuntoRESUMEN
INTRODUCTION/BACKGROUND: This study was designed to describe real-world changes in biomarker testing among patients with non-squamous, metastatic non-small cell lung cancer (mNSCLC) in a community oncology setting from 2015 to 2020. PATIENTS AND METHODS: This retrospective study randomly selected 500 adult patients diagnosed with nonsquamous mNSCLC to undergo chart review and data extraction. Data were extracted and validated by 2 independent abstractors. Biomarker testing rates were described before and after national guideline updates and FDA approval of targeted agents. RESULTS: At least 1 biomarker test was received by 89.4% of patients with mNSCLC. Of all patients, 46.6%, 34.6%, and 8.2% received both single-gene and next generation sequencing (NGS)-based testing, single-gene testing only, and NGS-based testing only, respectively. However, there were changes in testing rates at the time of drug approvals for targeted agents. Biomarker testing increased for ALK (45.0% before to 78.3% after ALK-targeted drug approval), BRAF (from 20.0% to 67.8%), EGFR (from 20.0% to 78.2%), NTRK (from 34.6% to 55.7%), and ROS1 (increased from 29.6% before approval to 74.2% after). Biomarker testing increased after changes were made to national guidelines for BRAF (from 18.8% before to 68.1% after inclusion in guidelines), NTRK (from 37.2% to 56.5%), and ROS1 (increased from 40.8% to 74.5% after guideline updates). Targeted therapy was received by 62.4% of patients with a positive biomarker. CONCLUSION: Increases in biomarker testing rates were observed relative to targeted agent approvals and national guideline updates. However, many patients with non-squamous mNSCLC did not receive full genotyping in accordance with national guidelines and represent an opportunity to identify reasons and solutions for barriers to care.
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Antineoplásicos , Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Adulto , Humanos , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/genética , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/tratamiento farmacológico , Proteínas Tirosina Quinasas/uso terapéutico , Estudios Retrospectivos , Proteínas Proto-Oncogénicas B-raf , Mutación , Proteínas Proto-Oncogénicas/uso terapéutico , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/genética , Proteínas Tirosina Quinasas Receptoras/genéticaRESUMEN
Aim: To examine characteristics of and treatment duration and real-world overall survival (rwOS) in patients receiving cetuximab as second-line (2L) or third-line (3L) treatment for metastatic colorectal cancer. Materials & methods: This was a retrospective study of 1096 and 684 patients in 2L and 3L cohorts, respectively. Results: The most common cetuximab-based regimens were cetuximab + folinic acid, fluorouracil and irinotecan (2L: 44%; 3L: 32%) and cetuximab + irinotecan (2L: 28%; 3L: 35%). Kaplan-Meier survival estimates and stepwise Cox regression model analysis demonstrated median treatment duration and rwOS of 3.7 and 14.4 months, respectively, in patients receiving treatment in the 2L cohort. In the 3L cohort, treatment duration was 3.3 months and rwOS was 12.0 months. Conclusion: This large real-world study provides evidence of rwOS in patients with metastatic colorectal cancer receiving cetuximab-based regimens as 2L or 3L treatment.
In this retrospective study, the authors examined baseline characteristics of and treatment duration and real-world overall survival (rwOS) in 1096 and 684 patients with metastatic colorectal cancer receiving cetuximab as second-line (2L) and third-line (3L) treatment, respectively. The most common cetuximab-based regimens were cetuximab + folinic acid, fluorouracil and irinotecan (2L: 44%; 3L: 32%) and cetuximab + irinotecan (2L: 28%; 3L: 35%). Median treatment duration and rwOS were 3.7 and 14.4 months, respectively, in patients receiving treatment in the 2L cohort. In the 3L cohort, median treatment duration was 3.3 months and rwOS was 12.0 months. This large real-world study provides evidence of rwOS in patients with metastatic colorectal cancer receiving cetuximab-based regimens as 2L or 3L treatment.
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Neoplasias del Colon , Neoplasias Colorrectales , Neoplasias del Recto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Camptotecina/uso terapéutico , Cetuximab/efectos adversos , Neoplasias del Colon/etiología , Neoplasias Colorrectales/patología , Fluorouracilo/efectos adversos , Humanos , Irinotecán/uso terapéutico , Leucovorina/efectos adversos , Neoplasias del Recto/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Vital signs are critical in assessing the severity and prognosis of infections, for example, COVID-19, influenza, sepsis, and pneumonia. This study aimed to evaluate a new method for rapid camera-based non-contact measurement of heart rate, blood oxygen saturation, respiratory rate, and blood pressure. METHODS: Consecutive adult patients attending a hospital emergency department for suspected COVID-19 infection were invited to participate. Vital signs measured with a new camera-based method were compared to the corresponding standard reference methods. The camera device observed the patient's face for 30 s from â¼1 m. RESULTS: Between 1 April and 1 October 2020, 214 subjects were included in the trial, 131 female (61%) and 83 male (39%). The mean age was 44 years (range 18-81 years). The new camera-based device's vital signs measurements were, on average, very close to the gold standard but the random variation was larger than the reference methods. CONCLUSIONS: The principle of contactless measurement of blood pressure, pulse, respiratory rate, and oxygen saturation works, which is very promising. However, technical improvements to the equipment used in this study to reduce its random variability is required before clinical implementation. This will likely be a game changer once this is sorted out. CLINICAL TRIAL REGISTRATION: Universal Trial Number (UTN) U1111-1251-4114 and the ClinicalTrials.gov Identifier NCT04383457.
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COVID-19 , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea , COVID-19/diagnóstico , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Saturación de Oxígeno , Frecuencia Respiratoria , Signos Vitales , Adulto JovenRESUMEN
Adrenocortical carcinoma (ACC) is a rare form of cancer with an annual incidence of two per million. The risk of venous thromboembolism increases sevenfold in patients with cancer. This case report describes an iliac vein deep vein thrombosis (DVT) as an atypical presentation of an ACC and highlights the value of further imaging investigation in patients with unprovoked DVTs.
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Neoplasias de la Corteza Suprarrenal , Carcinoma Corticosuprarrenal , Tromboembolia Venosa , Trombosis de la Vena , Neoplasias de la Corteza Suprarrenal/complicaciones , Neoplasias de la Corteza Suprarrenal/diagnóstico por imagen , Neoplasias de la Corteza Suprarrenal/cirugía , Carcinoma Corticosuprarrenal/complicaciones , Carcinoma Corticosuprarrenal/diagnóstico por imagen , Carcinoma Corticosuprarrenal/cirugía , Humanos , Vena Ilíaca/diagnóstico por imagen , Factores de Riesgo , Tromboembolia Venosa/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiologíaRESUMEN
INTRODUCTION: Regeneration of the pulp-dentin complex hinges on functionally diverse growth factors, cytokines, chemokines, signaling molecules, and other secreted factors collectively referred to as trophic factors. The delivery of exogenous factors and the induced release of endogenous dentin-bound factors by conditioning agents have been explored toward these goals. The aim of this study was to investigate a promising regeneration strategy based on the conditioning of dental pulp cells (DPCs) with polyinosinic-polycytidylic acid (poly[I:C]) for the amplification of endogenous trophic factors. METHODS: DPCs were isolated from human dental pulps, propagated in culture, and treated with an optimized dose of poly(I:C). The 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assay and metabolite analysis were conducted to monitor the cytotoxicity of poly(I:C). Enzyme-linked immunosorbent assays and quantitative polymerase chain reaction assays were performed to quantify the induction of trophic factors in response to DPC conditioning. Statistical significance was P < .05. RESULTS: The analysis of 32 trophic factors involved in Wnt signaling, cell migration and chemotaxis, cell proliferation and differentiation, extracellular matrix remodeling and angiogenesis, and immunoregulation revealed that DPCs abundantly express many trophic factors including AMF, BDNF, BMP2, FGF1, FGF2, FGF5, HGF, MCP1, NGF, SDF1, TGFß1, TIMP1, TIMP2, TIMP3, and VEGFA, many of which were further induced by DPC conditioning; induction was significant for BDNF, EGF, HGF, LIF, MCP1, SDF1, IL6, IL11, MMP9, and TIMP1. Both DPC proliferation and lactate production (P < .05) were inhibited by 8 µg/mL poly(I:C) relative to the control. CONCLUSIONS: In vitro DPC conditioning through poly(I:C) activation of toll-like receptor 3 led to the amplification of trophic factors involved in tissue repair. The strategy offers promise for endodontic regeneration and tooth repair and warrants further investigation.
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Pulpa Dental , Poli I-C , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Diferenciación Celular , Células Cultivadas , Humanos , Poli I-C/metabolismo , Poli I-C/farmacología , Receptor Toll-Like 3/metabolismoRESUMEN
OBJECTIVE: A number of dedicated self expanding nitinol stents have been developed for use in the venous system, with both open cell (OC) and closed cell (CC) designs available. Data comparing these different designs are lacking. The objective of this study was to evaluate outcomes in patients treated with open and closed cells for unilateral chronic iliac vein obstruction. METHODS: A single centre retrospective cohort study was conducted, including all patients treated with a dedicated nitinol venous stent between 2014 and 2019. Stent patency and details of re-interventions (including lysis, venoplasty, reinforcement, extension, arteriovenous fistula formation) were examined in the first post-operative year. Subgroup analysis described outcomes for patients treated with OC and CC stents ending above the inguinal ligament and those who required extension into the common femoral vein. Cox regression analysis was used to identify factors associated with loss of primary patency. RESULTS: A total of 207 patients were included (OC 100 patients, CC 107 patients). There was no significant difference between the groups for age (OC 42 years, CC 44 years); gender (OC and CC 67% female); presence of post-thrombotic lesions (OC 71%, CC 73%); stenting across the inguinal ligament (OC 58%, CC 56%), or presence of inflow disease (OC 49%, CC 47%). Primary and cumulative patency at 12 months were similar between groups (primary: OC 63%, CC 65%; cumulative: OC 93%, CC 90%). Patients with a CC stent across the inguinal ligament had a greater risk of needing multiple re-interventions at one year compared with those with an OC stent (odds ratio 2.84, 95% confidence interval [CI] 1.16 - 6.9) but overall, the only factor significantly associated with loss of primary patency was inflow vessel disease (hazard ratio 3.39, 95% CI 1.73 - 6.62, p < .001). CONCLUSION: OC and CC dedicated nitinol venous stents were observed to perform similarly in terms of patency and symptom improvement at one year. Disease of the inflow vessels was the most important factor associated with a loss of stent patency irrespective of stent design.
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Vena Ilíaca , Enfermedades Vasculares , Adulto , Aleaciones , Femenino , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/cirugía , Rayos Láser , Masculino , Estudios Retrospectivos , Stents , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
OBJECTIVES: This systematic review investigated the incidence of stent migration in patients with acute and chronic deep venous iliofemoral disease who were treated with dedicated venous stents. Procedural approaches, clinical and stent patency outcomes, and other complications are described. METHODS: MEDLINE and Embase were searched for literature published from January, 2012 to December, 2021. Evidence on the study population and procedural characteristics, and outcomes related to symptomatic changes, health-related quality of life, stent patency and complications was presented. RESULTS: Fourty-two studies were identified from 857 articles found through the database searches. Five-hundred seventy acute deep vein thrombosis patients and 2,859 chronic disease patients were included. Ten dedicated venous stent brands were employed. There were six episodes of stent migration (0.17% of patients) of which three involved a closed-cell stent and one involved a hybrid-design stent. The 12-month primary patency rate in patients with acute deep vein thrombosis ranged from 86 to 88%, whilst secondary patency was 96%. Amongst the chronic-disease cohort the primary and secondary patency were noted to range from 59 to 94%, and 87 to 100%, respectively. The pooled 12-month primary and secondary stent patency rates were 73.8% and 91.5%, respectively. CONCLUSIONS: Iliofemoral stenting using dedicated venous stents is associated with a low rate of stent migration although this may be due to a lack of reporting. Further research with specific surveillance protocols is necessary to reliably determine the true incidence of stent migration.
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Enfermedades Vasculares , Trombosis de la Vena , Enfermedad Crónica , Humanos , Vena Ilíaca/diagnóstico por imagen , Incidencia , Calidad de Vida , Estudios Retrospectivos , Stents , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/epidemiología , Trombosis de la Vena/terapiaRESUMEN
OBJECTIVE: To investigate the outcomes of treatment strategies for proximal and iliofemoral deep vein thrombosis (DVT). METHODS: Randomised controlled trials (RCTs) investigating outcomes of catheter directed thrombolysis (CDT), ultrasound assisted CDT (USCDT), percutaneous aspiration thrombectomy (PAT), and best medical therapy (BMT) for proximal DVT from 2000 onwards were considered. MEDLINE, EMBASE, and CINAHL were searched using the Healthcare Databases Advanced Search interface developed by the National Institute for Health and Care Excellence. The primary outcome was the rate of post-thrombotic syndrome (PTS), which was defined using the Villalta scoring system (score of ≥5). Secondary outcomes included vessel patency, recurrence, bleeding, and mortality. The network of evidence was summarised using network plots, and random effects network meta-analyses were performed. The certainty of evidence was assessed using the Certainty In Network Meta-Analysis (CINeMA) approach. RESULTS: Seven RCTs meeting the inclusion criteria were identified. There were direct comparisons between medical therapy, CDT, and USCDT across outcomes, except for patency. There were no direct comparisons between medical therapy and PAT (except for patency), and USCDT and PAT. There was no significant difference observed in PTS between the treatment modalities for proximal and iliofemoral DVT (low certainty). There was a significant difference in patency rates between medical therapy and USCDT (odds ratio [OR] 9.46, 95% confidence interval [CI] 3.05 - 29.35; low certainty) and CDT (OR 2.03, 95% CI 1.46 - 2.80; low certainty) in favour of USCDT and CDT, respectively, for proximal DVT. USCDT significantly improved patency rates compared with CDT (OR 4.67, 95% CI 1.58 - 13.81; very low certainty) for proximal DVT. There was no significant difference in DVT recurrence, bleeding, or mortality between treatment groups for proximal and iliofemoral DVT (low to moderate certainty for most comparisons). CONCLUSION: USCDT may improve patency rates compared with BMT and the other interventional treatment modalities used for the management of proximal DVT. However, no treatment modality showed superiority with regard to a reduction in PTS, and overall, the quality of available evidence is poor.
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Trombolisis Mecánica/métodos , Síndrome Postrombótico/epidemiología , Trombectomía/métodos , Terapia Trombolítica/métodos , Trombosis de la Vena/terapia , Anticoagulantes/uso terapéutico , Humanos , Metaanálisis en Red , Síndrome Postrombótico/etiología , Síndrome Postrombótico/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Trombosis de la Vena/complicacionesRESUMEN
BACKGROUND: There is growing evidence identifying coronavirus disease 2019 (COVID-19) as a significant risk factor for thrombosis in inpatients. However, it remains uncertain if patients in the community have been influenced during the COVID-19 pandemic and national lockdown. This study, across four centres in the United Kingdom (UK), reviewed outpatients with deep vein thrombosis (DVT). AIM: This study aims to find out whether lockdown and COVID-19 led to a change in the characteristics of DVT and patients who are afflicted with it, alongside a review of DVT service. METHODS: Data was collected retrospectively from electronic patient records system for the following periods: April 1 to June 30, 2019, and April 1 to June 30, 2020. These were the key months during the first national lockdown in UK. Data were analysed for patient demographics, risk factors, characteristics of DVT, management, and DVT reoccurrence. Statistical analyses were performed using GraphPad Prism 8 (Dotmatics, Boston, Massachusetts, United States). RESULTS: During the study periods, 227 outpatients from the community sustained DVT in 2019 and 211 in 2020. Of these patients, 13 in 2020 were COVID-19 positive. There was a difference in gender distribution with 128 males and 99 females in 2019, and 93 males and 118 females in 2020 (p= 0.0128). No significant difference was noted in the incidence of thrombophilia with nine in 2019 and three in 2020 (p=0.1437). Fewer long-haul journeys were made in 2020 (only two), compared to 16 in 2019 (p=0.012). Fewer patients had immobility as a risk factor in 2020 (n=55) compared to 2019 (n=79) (p=0.0494). However, there were more patients using oral contraceptive pills, with one in 2019 and nine in 2020 (p=0.0086) . CONCLUSION: There is no significant difference in the characteristics, extent, and management of DVT prior to and during the COVID-19 lockdown. National lockdowns do not affect DVT in the community; however, it is important to highlight the surrounding inpatient numbers.
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OBJECTIVE: This review aims to summarise the efficacy and safety of dedicated venous stenting for the treatment of obstructive chronic deep venous disease. The approaches to stenting and post-procedural management of different vascular units are also highlighted. METHODS: MEDLINE and Embase were searched to identify relevant literature on dedicated venous stents published from January 2010 to May 2020. The patient population and study characteristics; procedural characteristics; and outcomes related to post-stenting symptoms, health-related quality of life, patency, and complications were analyzed. RESULTS: Sixteen single-arm observational studies were included from 2366 studies identified from key word searches. In total, 1688 patients were included, of which 70.5% had post-thrombotic syndrome and the remainder had nonthrombotic iliac vein lesions. Nine studies (n = 848) stated whether lesions were stenotic (36.6%) or occlusive (63.4%). Seven studies did not report the lesion characteristics (n = 840). Eight different dedicated venous stent brands were used. At the last follow-up, 73.4% of ulcers had healed. The remaining symptomatic changes were described narratively; sustained improvements in pain, venous claudication, and edema after stenting were observed. Significant post-stenting improvements in health-related quality of life were noted, as measured by the Chronic Venous Insufficiency Questionnaire-20 instrument. Overall, the most frequently reported complications were in-stent occlusion (n = 204), in-stent stenosis (n = 149), and minor bleeding (n = 77). At 12 months, the primary patency ranged from 59% to 94%, whereas the secondary patency ranged 87% to 100%. The pooled primary and secondary stent patency rates at 12 months were 74.0% and 90.4%, respectively. The incidence of major and minor bleeding was 1.9% and 4.7%, respectively; bleeding complications were more common in patients undergoing hybrid interventions. CONCLUSIONS: Deep venous stenting using dedicated venous stents is a safe technique to treat obstructive chronic deep venous disease and within the limitations of this study, is associated with good patency outcomes and symptomatic improvement.
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Stents , Enfermedades Vasculares/cirugía , Enfermedad Crónica , Procedimientos Endovasculares/métodos , Humanos , Diseño de PrótesisRESUMEN
Symptomatic inferior vena cava (IVC) and iliac vein thrombosis is increasingly being treated with thrombolysis, thrombus retrieval and deep venous stenting. If the IVC stent occludes, endovenous intervention is indicated to restore patency. An 18-year-old male with Behçet's disease presented with deep vein thrombosis (extending from the IVC to the popliteal segments bilaterally) which was initially treated with thrombolysis and stenting. Fifteen months later, the patient experienced symptomatic deterioration; a chronically-occluded IVC stent was identified and reconstructed using a double-barrel stenting technique. Patient compliance to post-stenting anticoagulation therapy is paramount to maintain stent patency. A multi-disciplinary approach including haematologists can be beneficial for patients with a background of thrombophilic disorders.
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Understanding the holistic impact of long-term conditions (LTCs) on a patient, due to their high prevalence, morbidity, mortality and cost, is an important part of the primary care undergraduate medicine curriculum. Increasingly, we set learning outcomes for our students anticipating what the patient would want them to know. But are our expectations congruent with what patients would want them to know? In this leading article, we propose that patient involvement in curriculum design remains inadequate. We base our argument on (1) an existing strong theoretical premise that increasing patient incorporation enhances the delivery of medical education, (2) recommendations from major health organisations, our regulator and leading healthcare educationalists and (3) a growing body of evidence that what is important to physicians may not reflect what is important to patients. We advocate that patient involvement in curriculum design will result in a better understanding of how LTCs affect their physical, psychological and social health and of their journey through health care and community support services. This learning is essential, but unfortunately often overlooked, if we are to ensure that students in their future roles plan patient care using an empathic, holistic, patient-centred and socially accountable approach.
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Educación de Pregrado en Medicina , Educación Médica , Médicos , Curriculum , Atención a la Salud , Humanos , Responsabilidad SocialRESUMEN
Deep vein thrombosis (DVT) is a frequent complication in patients suffering from inflammatory bowel disease (IBD), especially in those with frequent relapses of the disease or extensive inflammatory lesions. The aetiology for the increased risk is multifactorial. Current evidence on management of acute iliofemoral DVT in IBD patients is scarce. This case series highlights two cases of active IBD, who developed acute iliofemoral DVTs and were treated with catheter-directed thrombolysis (CDT). This report demonstrates that CDT is effective in clearing the clot burden and producing significant symptomatic improvement in the absence of major complications. An individualised approach must be taken for the management of IBD patients with acute iliofemoral DVT.
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AIM: To compare the cost of biweekly regimens of first-line (1L) treatments of cetuximab-folinic acid, fluorouracil, and irinotecan (FOLFIRI) versus panitumumab-folinic acid, fluorouracil, and oxaliplatin (FOLFOX) in patients with Kirsten's rat sarcoma wild type (KRAS WT) metastatic colorectal cancer (mCRC) in the United States, across varying weights and body surface areas (BSAs). MATERIALS AND METHODS: Cost-minimization analysis (CMA) was performed to estimate per-patient cost differences of cetuximab-FOLFIRI versus panitumumab-FOLFOX. The CMA estimated the costs of RAS testing, premedication, drug acquisition, treating infusion reactions (IRs), supportive therapy, and biweekly administration of chemotherapy, cetuximab (500 mg/m2), and panitumumab (6 mg/kg) over 43 weeks (median progression-free survival). To calculate dose and cost, weight and height data were gathered from an electronic health record-derived de-identified database (n = 7,669; January 2013-October 2020). Base case analysis utilized mean weight/BSA of the overall cohort (82.04 kg/1.92 m2), and alternate scenarios were based on 88.18 kg/2.03 m2 (men, n = 4,477) and 73.43 kg/1.76 m2 (women, n = 3,192). RESULTS: For the base case, total treatment costs were $167,853 for cetuximab-FOLFIRI and $168,254 for panitumumab-FOLFOX; cost savings per patient receiving cetuximab-FOLFIRI was $400. Cost savings in alternate scenarios (men, $15,138; women, $15,004) resulted from lower drug acquisition costs for cetuximab (men, $14,833; women $14,854) and administration cost ($440) versus panitumumab. Cost savings of cetuximab-FOLFIRI in treating IR ($353) were similar across all scenarios. LIMITATIONS: With no head-to-head clinical trial data in the 1L setting, assumptions of similarity in efficacy and safety of cetuximab versus panitumumab were based on published network meta-analysis and the ASPECCT trial. This model did not consider a lifetime horizon. Costs of managing all adverse events (except IR) were not included. CONCLUSIONS: Biweekly cetuximab-FOLFIRI offers cost savings compared with panitumumab-FOLFOX for 1L therapy of patients with KRAS WT mCRC in the United States. These cost differences were observed for the overall population and across different BSA and weights for men and women.
Asunto(s)
Neoplasias Colorrectales , Proteínas Proto-Oncogénicas p21(ras) , Anticuerpos Monoclonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cetuximab/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/genética , Costos y Análisis de Costo , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Panitumumab/uso terapéutico , Proteínas Proto-Oncogénicas p21(ras)/genética , Estados UnidosRESUMEN
Multilabel recognition of morphological images and detection of cancerous areas are difficult to locate in the scenario of the image redundancy and less resolution. Cancerous tissues are incredibly tiny in various scenarios. Therefore, for automatic classification, the characteristics of cancer patches in the X-ray image are of critical importance. Due to the slight variation between the textures, using just one feature or using a few features contributes to inaccurate classification outcomes. The present study focuses on five different algorithms for extracting features that can extract further different features. The algorithms are GLCM, LBGLCM, LBP, GLRLM, and SFTA from 8 image groups, and then, the extracted feature spaces are combined. The dataset used for classification is most probably imbalanced. Additionally, another focal point is to eradicate the unbalanced data problem by creating more samples using the ADASYN algorithm so that the error rate is minimized and the accuracy is increased. By using the ReliefF algorithm, it skips less contributing features that relieve the burden on the process. Finally, the feedforward neural network is used for the classification of data. The proposed method showed 99.5% micro, 99.5% macro, 0.5% misclassification, 99.5% recall rats, specificity 99.4%, precision 99.5%, and accuracy 99.5%, showing its robustness in these results. To assess the feasibility of the new system, the INbreast database was used.