Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study.

Objective: To evaluate the association between overweight and obesity on the clinical course and outcomes in patients hospitalized with COVID-19. Design: Retrospective, observational cohort study. Methods: We performed a multicenter, retrospective, observational cohort study of hospitalized COVID-19 patients to evaluate the associations between overweight and obesity on the clinical course and outcomes. Results: Out of 1634 hospitalized COVID-19 patients, 473 (28.9%) had normal weight, 669 (40.9%) were overweight, and 492 (30.1%) were obese. Patients who were overweight or had obesity were younger, and there were more women in the obese group. Normal-weight patients more often had pre-existing conditions such as malignancy, or were organ recipients. During admission, patients who were overweight or had obesity had an increased probability of acute respiratory distress syndrome [OR 1.70 (1.26-2.30) and 1.40 (1.01-1.96)], respectively and acute kidney failure [OR 2.29 (1.28-3.76) and 1.92 (1.06-3.48)], respectively. Length of hospital stay was similar between groups. The overall in-hospital mortality rate was 27.7%, and multivariate logistic regression analyses showed that overweight and obesity were not associated with increased mortality compared to normal-weight patients. Conclusion: In this study, overweight and obesity were associated with acute respiratory distress syndrome and acute kidney injury, but not with in-hospital mortality nor length of hospital stay.

[Agranulocytosis/granulocytopenia after long-term use of thiamazole]. / Agranulocytose na langdurig gebruik van thiamazol.

Agranulocytosis/granulocytopenia is a rare side effect of thyreostatics. Earlier publications state that for thiamazole this side effect occurs during the first few months of treatment. In two patients this thiamazole-induced agranulocytosis/granulocytopenia only occurred after years of treatment. A 53-year-old man presented with fever after a visit to Suriname. He had used thiamazole for 12 years for Graves' hyperthyroidism. The second patient, a 31-year-old woman, presented at the emergency department with fever and sore throat after 13 years of intermittent treatment with thiamazole. Both patients had an agranulocytosis/granulocytopenia and leukopenia. This was thought to be a side effect of thiamazole and blood values normalised after cessation of therapy. Both patients were treated empirically with broad-spectrum antibiotics during the agranylocytic period. They then received radioactive sodium iodide. To our knowledge this case report is the first to describe agranulocytosis/granulocytopenia following long-term treatment with thiamazole.

[Gastric bypass surgery effective for morbid obesity]. / Maagbypassoperatie effectief bij morbide obesitas.

OBJECTIVE: Evaluation of the results of Roux-en-Y gastric bypass in morbid obesity. DESIGN: Descriptive. METHODS: All patients undergoing gastric bypass surgery in St. Antonius Hospital in Nieuwegein, the Netherlands, between 2002 and 2008 were analysed. Indications were a body mass index (BMI) >or= 40 kg/m2 or a BMI >or= 35 kg/m2 with severe co-morbidity. Principal outcomes were excess weight loss after at least 1 year of follow-up, surgery-related morbidity and mortality. RESULTS: 290 patients with a median age of 42.5 years (range: 21-66) underwent gastric bypass surgery (open: n = 233, laparoscopic: n = 57). The median preoperative overweight above standard weight was 78.7 kg (range: 30.1-190.3) and the median BMI was 49.5 kg/m2 (range: 33.2-84.9). This concerned a secondary intervention after a previous unsuccessful bariatric procedure in 99/290 patients (34.1%). There were 189 patients with a follow-up of more than 1 year. The procedure was successful (>or= 50% excess weight loss) in 135/189 patients (71.4%). The median excess weight loss was 58.6% (range: 7.7-102.4). The BMI decreased by a median of 16.2 kg/m(2) (range: 0.9-42.9). Patients undergoing primary surgery lost a higher percentage of excess weight than patients undergoing secondary surgery (median percentage excess weight loss 61.4% versus 53.5% , and a median decrease in BMI of 17.8 versus 11.9 kg/m2). The most frequently occurring early complications (within 30 days of surgery) were anastomotic leak (n = 15) and wound infection (n = 11). Late complications included anastomotic stricture (n = 18) and cicatricial hernia (n = 15). Mortality was 0.7% (n = 2). CONCLUSION: Gastric bypass surgery was an effective treatment strategy for morbid obesity and had acceptable surgery-related morbidity and mortality.

Antihypertensive medication and the risk of acute pancreatitis: the European case-control study on drug-induced acute pancreatitis (EDIP).

OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and diuretics have been associated with acute pancreatitis. We quantified the risk of acute pancreatitis associated with the use of antihypertensive medication in the European study on drug-induced acute pancreatitis (EDIP). MATERIAL AND METHODS: The EDIP study is a multicenter population-based European case-control investigation of the association between drug use and acute pancreatitis. Patients between 40 and 85 years of age hospitalized for acute pancreatitis were included in the study between 1 October 1994 and 31 December 1998. For each case, age- and gender-matched community controls were recruited. Detailed information on drug use and potential confounders (e.g. comorbidity, alcohol use) was obtained through a structured interview. RESULTS: In all, 724 patients with acute pancreatitis and 1791 community controls were identified and interviewed. Use of ACE inhibitors in the week prior to the index date was associated with an increased risk of acute pancreatitis (adjusted odds ratio 1.5; 95% CI: 1.1-2.2). The risk of acute pancreatitis associated with ACE inhibitors increased with higher daily doses and was highest in the first 6 months of therapy. Calcium channel blockers increased the risk of acute pancreatitis (adjusted odds ratio 1.5; 95% CI: 1.1-2.1) without an apparent dose- or response relationship. Loop and thiazide diuretic use was not associated with an increased risk of acute pancreatitis. Potassium-sparing diuretics elevated the risk of acute pancreatitis, albeit non-significantly. CONCLUSION: Use of ACE inhibitors is associated with a modest increase in the risk of acute pancreatitis during the first months of treatment.

Determinants for drug prescribing to children below the minimum licensed age.

OBJECTIVES: In the light of the undesired effects that unlicensed and off-label drug use might have, it is necessary to study the determinants affecting the prescribing of such drugs. Prescription of drugs to children younger than the minimum licensed age may carry the highest risk of adverse reactions. To obtain insight into the factors that affect prescription of drugs to children below the minimum licensed age, we conducted a population-based case-control study. METHODS: The case-control study was nested in a cohort of 13,426 children aged 0-16 years, who were registered in the Integrated Primary Care Information (IPCI) project, a longitudinal observational general practitioners' database in the Netherlands. "Cases" were children who received a drug prescription for which they were below the minimum licensed age. To each case we matched up to four controls based on GP practice and patient age. As potential risk factors we evaluated the use of health care resources, and acute and chronic morbidity. RESULTS: We identified 447 cases who were matched to 1355 controls. The cases consulted their GPs significantly more often during the preceding half year, had more drug prescriptions, and had more specialist referrals than the controls. Respiratory diseases were the most important determinants for the prescription of drugs to children below the minimum licensed age. In adolescents, migraine and other headaches were the most important reasons. CONCLUSIONS: This study showed that children suffering from respiratory disease or migraine have the highest risk of receiving a drug prescription for which the patient is below the minimum licensed age. Regulatory authorities and the pharmaceutical industry should be stimulated to improve the evaluation of drug efficacy and safety in children.