Costing Urologic Complications Following Pelvic Radiation Therapy.

OBJECTIVES: To describe patients presenting with urologic complications following pelvic radiation therapy and estimate the financial costs incurred in their treatment. PATIENTS AND METHODS: In the year ending June 2018, all urology admissions at Royal Newcastle Centre were reviewed for diagnostic codes pertaining to urethral or ureteric strictures, cystitis, and haematuria. Presentations were complications following radiotherapy if a diagnosis of radiation cystitis or stricture was recorded, and there was relevant prior radiotherapy. The Independent Hospital Pricing Authority's National Weighted Activity Unit (NWAU) 2018 calculators, admission data and the National Efficient Price were used to estimate costs of care. HNELHD HREC granted ethics approval (AU201808-10). RESULTS: Complications following radiotherapy accounted for 65 admissions in 53 discrete patients, accounting for 206 bed days and 3.7% of the 1748 total urology admissions in 1 year. The majority (86%) of admissions had at least 1 operation. Mean time since radiotherapy was 7 years (range 1-30). Mean number of operations related to complications following radiotherapy was 3 (range 0-11). Readmissions were more frequent (mean 1.9 admissions/year) than other urology inpatients (mean 1.3 admissions/year, P < .001). Mean NWAU18 value was 4.12 (range 2-8.3). Admission and procedure costs were AUD $1,346,700, secondary malignancies were $9,000 and emergency department costs were $45,864 for a combined total of $1,401,591. CONCLUSION: Patients requiring urological admission with complications following radiotherapy use more resources, stay for longer, have more operations and return more frequently than other urology patients. Conservative estimates of cost $25,900 per patient in the study year alone.

Metabolic and tissular effects of artemisinin supplemented diets in broiler chicken.

Artemisinin is a powerful antimalarial drug, useful in the treatment of many diseases, including chickens coccidiosis. Its toxic effects have been well studied in humans and experimental animals, but not sufficiently in broiler chickens. Therefore, in the present study, we aimed to assess the side effects of artemisinin in chickens, by measuring the serum level of proteins and enzymes (ALT, AST, GGT, ALP, CK), by histopathological examination and by the evaluation of relative weight of organs (liver, kidney, heart). Artemisinin was administered in the standard feed for chickens in three different concentrations: 5, 50 and 500 ppm. Each concentration of artemisinin increased the total serum proteins, gamma-globulins and the serum activity of CK and decreased the serum ALP level. The values of ALT and GGT were higher in the chickens treated with 50 and 500 ppm of artemisinin. Multifocal liver necrosis and inflammatory infiltrate were detected in the chickens that received the 50 and 500 ppm dosage of artemisinin. Minimal tubular necrosis, renal tubular epithelium vacuolation, multifocal interstitial nephritis and mild uric nephrosis were detected in chickens treated with the drug. Artemisinin administration produced no significant changes in the organs relative weight. Artemisinin, at a concentration of 5 mg/kg of feed is well tolerated by broiler chickens, but the concentrations of 50 and 500 mg/ kg feed can produce toxic effects.

Effects of aspirin and non-steroidal anti-inflammatory drugs on the risk of cholangiocarcinoma: a meta-analysis.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) can suppress the proliferation of cholangiocarcinoma (CCA) cells in vitro through inhibition of cyclooxygenase-2. However, the effects of aspirin and NSAIDs on the risk of CCA remain unclear. We performed this meta-analysis to assess the risk of biliary tract cancers in patients who take aspirin and/or NSAIDs. METHODS: A systematic review was conducted utilizing MEDLINE, EMBASE, Cochrane databases from inception through October 2017 to identify studies that assessed the association of aspirin and/or NSAIDs use with risk of biliary tract cancers including CCA, gallbladder cancer and ampulla of Vater cancer. Effect estimates from the studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Five observational studies with a total of 9 200 653 patients were enrolled. The pooled OR of CCA in patients with aspirin use was 0.56 (95% CI, 0.32-0.96). Egger's regression asymmetry test was performed and showed no publication bias for the association between aspirin use and CCA with P = 0.42. There was no significant association between NSAIDs use and CCA, with a pooled OR of 0.79 (95% CI, 0.28-2.21). One study showed a significant association between aspirin use and reduced risk of gallbladder cancer with OR of 0.37 (0.17-0.80). However, there was no significant association between aspirin and ampulla of Vater cancer with OR of 0.22 (0.03-1.65). CONCLUSIONS: Our study demonstrates a significant association between aspirin use and a 0.56-fold decreased risk of CCA. However, there is no association between the use of NSAIDs and CCA.

Pulmonary embolism mimicking acute myocardial infarction.

Pulmonary embolism is a major cause of death in the United States. A high index of suspicion is required to achieve an accurate diagnosis. We report a case of a patient with syncope, ischemic electrocardiographic changes, and an elevated troponin I level, presenting just like acute myocardial infarction. The case highlights the value of an early use of 2-dimensional echocardiography in obtaining an accurate diagnosis, thus avoiding unnecessary and inappropriate treatment.

Variability of measurements of visual acuity in a large eye clinic.

PURPOSE: The aim of this study was to determine the variability of visual acuity in a large eye clinic. METHODS: A cross-sectional study using 50, consecutively presenting adult patients with visual acuity of at least 6/60 and aged between 18 and 75 years was performed. Measurements of visual acuity obtained under normal clinical conditions were compared to measurements obtained using standard clinical research protocols. The variability of visual acuity was assessed by determining the 95% limits of agreement between test and retest measures. RESULTS: There were no significant differences between test-retest measurements of visual acuity, either aided or unaided. Pearson r correlation coefficients between test and retest measurements were high for both aided and unaided visual acuity. The 95% limits of agreement revealed repeatability of about +/-1.5 logMAR or 1.5 lines on a standard logMAR chart. CONCLUSION: In large eye clinics, in order to be confident that a real change in visual acuity has occurred between measurements, a difference of at least 0.15 logMAR (8 letters on a standard logMAR visual acuity chart) is required.

Pasteurella multocida peritonitis in peritoneal dialysis.

Pasteurella multocida infection may occur in multiple sites to include rare involvement of the peritoneal cavity in peritoneal dialysis patients. Six cases of peritonitis associated with this organism have been reported in patients undergoing continuous peritoneal dialysis. A history of close contact with household cats was noted in all cases, with direct trauma to the dialysis tubing frequently seen. In this setting the organism appears to have a short incubation period with florid growth within 24 hours of known contamination. We report a case of Pasteurella multocida peritonitis in a patient treated with continuous cycling peritoneal dialysis and review the literature.

Accumulation of Tc-99m-DTPA in uterine myoma.

A case is presented in which concentration of Tc-99m-iron ascorbate-DTPA has been demonstrated in a benign leiomyoma of the uterus. Increased vascularity in the tumor might be the cause of the Tc-99m-DTPA uptake.