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Metamizole is commonly used as analgesic and antipyretic drug. The use of metamizole is prohibited in several countries due to its rare side effect of neutropenia and even agranulocytosis. Among the many symptoms of COVID-19, fever and diffuse pain predominant and therefore it can be assumed that metamizole may be widely used in the current epidemic period. So far, there have been no reports on the safety of metamizole in COVID-19 patients. We describe a series of 3 patients who developed severe neutropenia under metamizole treatment, raising a concern of a possible increased risk of this side effect among COVID-19 patients.
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COVID-19 , Neutropenia , Antiinflamatorios no Esteroideos/efectos adversos , Dipirona/efectos adversos , Humanos , Neutropenia/inducido químicamente , Neutropenia/epidemiología , SARS-CoV-2RESUMEN
BACKGROUND: The purpose of this study was to examine the correlation between research productivity in the field of rheumatology and various updated economic indicators of Countries of the Organisation for Economic Co-operation and Development (OECD). METHODS: The number of documents published, number of citable documents, number of citations, citations per document, and the H-index for the 36 OECD countries in the field of rheumatology between 1996 and 2017 were obtained from the The Scimago Journal and Country rank source. The recent data regarding gross domestic product (GDP) per capita, total health spending as percent of GDP, and the gross domestic expenditure on research and development as percent of GDP were collected from the World Bank, OECD, and United Nations Educational, Scientific, and Cultural Organization Web sites, accordingly. The relationship between economic indicators and scientific productivity for each of the OECD countries was analyzed. RESULTS: A total of 132,314 documents were analyzed. A moderate to strong significance correlation was found between health expenditure and the number of documents published (r = 0.67, p < 0.001), number of citable documents (r = 0.68, p < 0.001), number of citation (r = 0.76, p < 0.001), and H-index (r = 0.77, p < 0.001). CONCLUSIONS: This study provides a current highlight on the relationship between academic productivity in rheumatology and economic indicators of OECD countries. We showed a positive moderate to strong significant correlation between total health expenditure as percent of GDP and different bibliometric indicators, implying another possible advantage of national investment in this filed.
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Organización para la Cooperación y el Desarrollo Económico , Reumatología , Bibliometría , Producto Interno Bruto , HumanosRESUMEN
OBJECTIVE: The aim of this study was to compare the effect of biologic agents and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) on the psychologic status of patients with psoriatic arthritis (PsA) in remission or with low disease activity. METHODS: This is a case-control study of PsA patients in remission or with low disease activity treated at a single-center combined rheumatologic-dermatologic clinic between 2015 and 2017. Patients were assigned to 2 comparison groups according to their treatment (1) biologic drugs and (2) csDMARDs therapy. Psoriatic arthritis disease activity was evaluated by disease activity score-28. Anxiety, somatization, and depression were evaluated by patient health questionnaires (PHQ): generalized anxiety disorder-7, PHQ-15, and PHQ-9, respectively. Disability was assessed by the health assessment questionnaire disability index (HAQ-DI). RESULTS: Thirty PsA patients on biologic treatment (BT) and 14 PsA patients in csDMARDs were enrolled. No significant differences in disease duration and treatment duration between the 2 groups were found. Disease activity score-28 was significantly better in the BT group compared with the csDMARDs group (1.8 ± 0.4 vs 2.1 ± 0.4, respectively, p = 0.028). A nonsignificant tendency toward higher scores in psychologic questionnaires was seen among the non-BT group. Moderate to high correlations between all mental questionnaires and HAQ-DI were found in both groups (0.567 ≤ r ≤ 0.850, p < 0.05). Patients with mental disturbance (generalized anxiety disorder-7/PHQ-15/PHQ-9 ≥ 5) showed significant poorer performance in their HAQ-DI in comparison with patient without physiological comorbidities in both groups. CONCLUSIONS: Tight disease control in PsA patients, achieved with BT, may offer an improvement in psychological outcomes in addition to relieving clinical symptoms.
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Antirreumáticos , Artritis Psoriásica , Productos Biológicos , Antirreumáticos/uso terapéutico , Artritis Psoriásica/diagnóstico , Artritis Psoriásica/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Estudios de Casos y Controles , Humanos , Morbilidad , Resultado del TratamientoRESUMEN
PURPOSE: Prompted by the clinical concern that limited healthcare resources allocation affects physicians' research productivity, this study examines the association between bibliometric indices of ophthalmologic research and national economic indicators in Organisation for Economic Co-operation and Development (OECD) countries. METHODS: The Scimago Journal and Country rank source was searched for research productivity data in ophthalmology among OECD countries between 1996 and 2019. Bibliometric indices included: documents number, number and percent of citable documents, citations number, citations per document, and H-index. The updated economic indicators of each country (gross domestic product [GDP] per capita, health spending as percent of GDP (health expenditure), gross domestic expenditure on research, and development as percent of GDP [GERD]) were collected from the World Bank and the OECD websites. Correlation between economic and bibliometric metrics and multivariate linear regression analyses were performed. RESULTS: Among 267,444 documents analyzed, correlation analysis found a strong correlation between health expenditure and H index (r = 0.711, p < 0.001); a moderate correlation between health expenditure and documents number (r = 0.589, p < 0.001), number of citable document (r = 0.593, p < 0.001) and citations number (r = 0.673, p < 0.001); and a moderate correlation between GERD and H index (r = 0.564, p < 0.001). Multivariate regression analysis controlling for economic factors, population and language showed the independent association of these parameters with bibliometric indices. CONCLUSIONS: This study demonstrates a positive correlation between bibliometric indicators of ophthalmology research and economic factors, particularly health expenditure, among the OECD countries. Our results suggest an advantage of domestic investment in health to expand academic productivity in the field of ophthalmology.
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BACKGROUND: Heart failure is a major cause of morbidity and mortality among older adults. Sacubitril-Valsartan (Sac/Val) has been shown to improve patients' outcomes; however, its safety profile among older adults has not been adequately examined. We therefore aimed to examine its safety profile among this population. METHODS: We conducted a retrospective pharmacovigilance study utilizing the FDA's database of safety reports (FAERS). We employed disproportionality analysis comparing Sac/Val to angiotensin receptor blockers (ARBs). We aim to evaluate the reporting of pre-defined adverse events associated with Sac/Val (hypotension, acute kidney injury (AKI), hyperkalemia and angioedema) in two age groups: adults (< 75 years) and older adults (≥ 75). For each subgroup, we calculated reporting odds ratio (ROR) and compared them by calculating P for interaction. RESULTS: The FAERS database encompassed 18,432 unique reports of Sac/Val. Of them, 12,630 (68.5%) subjects were adults (< 75 years), and 5802 (31.5%) were older adults (≥ 75 years), with a median age (IQR) of 68 (59-77). When compared to ARBs, Sac/Val was associated with higher reporting of hypotension, lower reporting of acute kidney injury (AKI) and hyperkalemia, and similar reporting of angioedema. Notably, we did not observe a significant interaction between the age subgroups and the risk estimates (AKI: Pinteraction = 0.72, hyperkalemia: Pinteraction = 0.94, hypotension: Pinteraction = 0.31, and angioedema: Pinteraction = 0.61). CONCLUSIONS: In this postmarking study, none of the prespecified adverse events was reported more frequently in older adults. These findings provide reassurance for safety use of Sac/Val in older adults.
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Lesión Renal Aguda , Angioedema , Insuficiencia Cardíaca , Hiperpotasemia , Hipotensión , Humanos , Anciano , Estudios Retrospectivos , Tetrazoles/efectos adversos , Antagonistas de Receptores de Angiotensina/efectos adversos , Farmacovigilancia , Hiperpotasemia/inducido químicamente , Hiperpotasemia/diagnóstico , Hiperpotasemia/epidemiología , Inhibidores de la Enzima Convertidora de Angiotensina , Valsartán/efectos adversos , Aminobutiratos/efectos adversos , Compuestos de Bifenilo/efectos adversos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/inducido químicamente , Combinación de Medicamentos , Hipotensión/inducido químicamente , Hipotensión/diagnóstico , Hipotensión/epidemiología , Angioedema/inducido químicamente , Angioedema/diagnóstico , Angioedema/epidemiología , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Volumen SistólicoRESUMEN
BACKGROUND: Coronary artery disease (CAD) is a leading cause of death in the elderly population. Data regarding percutaneous coronary interventions (PCIs) in nonagenarians are scarce, and differences in long term outcomes between generations remain unclear. We aimed to study the pattern and temporal trends of nonagenarians treated with PCI. MATERIALS AND METHODS: A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. MATERIALS AND METHODS: A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. RESULTS: The number of nonagenarians undergoing PCI has increased substantially during the study time period, from 89 patients in the earlier time period (2009-2014) to 133 patients in the later time period (2015-2020). At 1-year, nonagenarians had significantly higher rates of both death (24.3% vs. 14.9%, p<0.01), and MACE (30.6% vs. 22.0%, p<0.01), as compared to octogenarians. The cumulative survival rate was higher among octogenarians both in the early and late time period (p<0.01 and p=0.039, respectively). A significant reduction in nonagenarian MACE rates were observed during the study time period, resulting in a non-significant difference in MACE rates in the later time period between both groups. CONCLUSION: The number of nonagenarians who undergo PCI is on the rise. While their clinical outcomes are inferior as compared to younger age groups, improvement was noted in the late time period.
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BACKGROUND: Acute ischemic stroke remains a serious complication of transcatheter aortic valve replacement (TAVR). Cerebral embolic protection devices (CEPD) were developed to mitigate the risk of acute ischemic stroke complicating TAVR (AISCT). However, the existing body of evidence does not clearly support CEPD efficacy in AISCT prevention. OBJECTIVES: In a cohort of patients with AISCT, we aimed to compare the characteristics and outcomes of patients who have had unprotected TAVR (CEPD-) vs CEPD-protected TAVR (CEPD+). METHODS: Data were derived from an international multicenter registry focusing on AISCT. We included all patients who experienced ischemic stroke within 72 hours of TAVR. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Primary outcomes were neurologic disability status according to the modified Rankin Score at 30 days, and 6-month all-cause death. Propensity score matched analysis was used to control for differences between groups. RESULTS: In 18,725 TAVR procedures, 416 AISCT (2.2%) within 72 hours were documented, of which 376 were in the CEPD- TAVR group and 40 in the CEPD+ TAVR group. Although the middle cerebral artery stroke rate was similar in both groups (29.7% CEPD- vs 33.3% CEPD+; P = 0.71), AISCT in the CEPD+ group was characterized by a lower rate of internal carotid artery occlusion (0% vs 4.7%) and higher rate of vertebrobasilar system strokes (15.4% vs 5.7%; P = 0.04). AISCT was severe (NIHSS ≥15) in 21.6% CEPD- and 23.3% CEPD+ AISCT (P = 0.20). Disabling stroke rates (modified Rankin Score >1 at 30 days) were 47.3% vs 42.5% (P = 0.62), and 6-month mortality was 31.3% vs 23.3% (P = 0.61), in the CEPD- and CEPD+ groups, respectively. In the propensity score matched cohort, disabling stroke rates were 56.5% vs 41.6% (P = 0.16), and 6-month mortality was 33% vs 19.5% (P = 0.35), in the CEPD- and CEPD+ groups, respectively. CONCLUSIONS: In a large cohort of patients with AISCT, the use of CEPD had little effect on stroke distribution, severity, and outcomes.
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Estenosis de la Válvula Aórtica , Dispositivos de Protección Embólica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Accidente Cerebrovascular Isquémico/etiología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Resultado del Tratamiento , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Factores de Riesgo , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugíaRESUMEN
PURPOSE: To examine pregnancy and perinatal outcomes in patients with mitral valve disorders [mitral valve prolapse and/or mitral regurgitation; mitral valve disorders (MVD)]. METHODS: A retrospective comparative study was conducted comparing all singleton deliveries, during the years 1988-2010, of women with and without known MVD. Women lacking prenatal care were excluded. Stratified analysis using logistic regression was performed to control for confounds. RESULTS: Out of 233,194 singleton deliveries that occurred during the study period, 390 deliveries occurred in women with MVD. Using a multivariate analysis, advanced maternal age (OR = 1.06; 95 % CI 1.05-1.08; P < 0.001), recurrent abortions (OR = 1.62; 95 % CI 1.15-2.28; P = 0.005), hypertensive disorders (OR = 1.62; 95 % CI 1.17-2.26; P = 0.004) and Jewish ethnicity (OR = 2.21; 95 % CI 1.76-2.79; P < 0.001) were found to be significantly associated with MVD. Since cesarean sections (CS) were significantly higher in deliveries of patients with MVD (17.9 vs. 14 %; P = 0.025), another multivariate analysis was constructed, with CS as the outcome variable. MVD was not found to be an independent risk factor for CS (OR = 1.05; 95 % CI 0.79-1.37; P = 0.74). CONCLUSIONS: MVD associated with advanced maternal age, recurrent abortions, Jewish ethnicity and hypertensive disorders were not found to be an independent risk factor for CS.
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Insuficiencia de la Válvula Mitral/epidemiología , Prolapso de la Válvula Mitral/epidemiología , Complicaciones Cardiovasculares del Embarazo/epidemiología , Resultado del Embarazo , Aborto Habitual/epidemiología , Adulto , Cesárea , Femenino , Humanos , Hipertensión Inducida en el Embarazo/epidemiología , Judíos , Modelos Logísticos , Edad Materna , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/etnología , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/etnología , Análisis Multivariante , Embarazo , Complicaciones Cardiovasculares del Embarazo/etnología , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: The Evolut R/Pro and the Sapien 3 are the most commonly valve systems used today for transcatheter aortic valve implantation (TAVI). However, there is a still uncertainty regarding the efficacy and safety comparison of these two valves. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies comparing the Evolut R/Pro versus the Sapien 3. The primary outcome was all-cause mortality (short and long-term). The secondary outcomes were stroke, bleeding, permanent pacemaker implantation (PPI), acute kidney injury (AKI), major vascular complication, device success, moderate- severe aortic regurgitation (AR), and pressure gradients. RESULTS: Twenty-one publications totaling 35,248 patients were included in the analysis. Evolut R/Pro was associated with higher risk of short-term all-cause mortality (OR = 1.31;95% CI 1.15-1.49, p < 0.001) and a trend of higher long-term mortality (OR = 1.07;95% CI 1.00-1.16, p = 0.06). The Evolut R/Pro was associated with higher risk of PPI and AR and lower risk for bleeding, major vascular complication, and pressure gradients. There was no significant difference between the groups regarding the risk of stroke, AKI and device success. CONCLUSIONS: The Evolut R/Pro valve system compared to the Sapien 3 is associated with higher risk of short-term mortality, significant AR and PPI while providing the advantage of lower risk of bleeding, major vascular complication, and lower residual transvalvular gradients.
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Lesión Renal Aguda , Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Accidente Cerebrovascular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Diseño de Prótesis , Resultado del Tratamiento , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Válvula Aórtica/cirugíaRESUMEN
(1) Background: The use of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis is expanding significantly. We aimed to perform a meta-analysis comparing the safety and efficacy of TAVI versus surgical aortic valve replacement (SAVR) during the early and mid-term follow-up period. (2) Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing 1- to 2-year outcomes between TAVI and SAVR. The study protocol was preregistered in PROSPERO and the results were reported according to PRISMA guidelines. (3) Results: The pooled analysis included data from eight RCTs totaling 8780 patients. TAVI was associated with a lower risk of all-cause mortality or disabling stroke (OR 0.87, 95%CI 0.77-0.99), significant bleeding (OR 0.38, 95%CI 0.25-0.59), acute kidney injury (AKI; OR 0.53, 95%CI 0.40-0.69) and atrial fibrillation (OR 0.28, 95%CI 0.19-0.43). SAVR was associated with a lower risk of major vascular complication (MVC; OR 1.99, 95%CI 1.29-3.07) as well as permanent pacemaker implantation (PPI; OR 2.28, 95%CI 1.45-3.57). (3) Conclusions: TAVI compared with SAVR during early and mid-term follow-up was associated with a lower risk of all-cause mortality or disabling stroke, significant bleeding, AKI and atrial fibrillation; however, it was associated with a higher risk of MVC and PPI.
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Background: This study aims to compare valve durability between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Methods: We conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The primary outcome was structural valve deterioration (SVD). Secondary outcomes were bioprosthetic valve failure, reintervention, effective orifice area (EOA), mean pressure gradient, and moderate-severe aortic regurgitation (AR, transvalvular and/or paravalvular). Results: Twenty-five publications from seven RCTs consisting of 7,970 patients were included in the analysis with follow-up ranges of 2-8 years. No significant difference was found between the two groups with regard to SVD [odds ratio (OR) 0.72; 95% CI: 0.25-2.12]. The TAVI group was reported to exhibit a statistically significant higher risk of reintervention (OR 2.03; 95% CI: 1.34-3.05) and a moderate-severe AR (OR 6.54; 95% CI: 3.92-10.91) compared with the SAVR group. A trend toward lower mean pressure gradient in the TAVI group [(mean difference (MD) -1.61; 95% CI: -3.5 to 0.28)] and significant higher EOA (MD 0.20; 95% CI: 0.08-0.31) was noted. Conclusion: The present data indicate that TAVI provides a comparable risk of SVD with favorable hemodynamic profile compared with SAVR. However, the higher risk of significant AR and reintervention was demonstrated. Systematic Review Registration: PROSPERO (CRD42022363060).
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BACKGROUND: Previous studies have demonstrated an association between proton pump inhibitors (PPI) use and vitamin B12 deficiency. However, data regarding PPI use and elevated serum homocysteine level, an important marker of vitamin B12 deficiency, are scant. METHODS: Data were collected from medical records of subjects examined at a screening center in Israel. Cross sectional analysis was conducted on 25,953 subjects. Levels of vitamin B12 and homocysteine were compared between subjects who consumed PPI medications and those who did not. RESULTS: The mean age of the study population was 45 years and 33% were females. Subjects who received PPI medications had a minor higher vitamin B12 levels (320 pmol/L vs 300 pmol/L, p=0.024). Levels of vitamin B12 remained higher in females receiving PPI medications after performing a stratified analysis according to subjects' gender. Homocysteine levels were higher in subjects receiving PPI medications as compared to those who did not (12.0 µmol/L vs 11.6 0 µmol/L, p<0.001). Levels remained higher in female subjects after performing a stratified analysis according to subjects' sex. There was no statistically significant difference in the prevalence of vitamin B12 deficiency (according to two cutoffs: vitamin B12≤200 or ≤140 pmol/L) as well as the prevalence of hyperhomocysteinemia (defined as homocysteine >15.0 µmol/L) between the two groups. CONCLUSIONS: According to our study, no association was found between PPI medication use and vitamin B12 deficiency or hyperhomocysteinemia. Patients receiving PPI medications had slightly higher levels of vitamin B12 and homocysteine, however these differences were too small to have any clinical relevance.
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Hiperhomocisteinemia , Deficiencia de Vitamina B 12 , Masculino , Humanos , Femenino , Persona de Mediana Edad , Vitamina B 12 , Estudios Transversales , Hiperhomocisteinemia/inducido químicamente , Hiperhomocisteinemia/epidemiología , Inhibidores de la Bomba de Protones/efectos adversos , Deficiencia de Vitamina B 12/inducido químicamente , Deficiencia de Vitamina B 12/epidemiología , Homocisteína , Ácido FólicoRESUMEN
OBJECTIVE: To elucidate the association between adolescent microscopic hematuria and early onset urothelial carcinoma and renal cell carcinoma. METHODS: Nationwide, population-based, retrospective cohort study using medical data of 970,366 adolescents aged 16 through 19 years (58.6% male) examined for fitness for military service between 1980 and 1997. Diagnoses of persistent isolated microscopic hematuria were given after thorough work up process excluding any other renal abnormalities. Incident cases of urothelial carcinoma and renal cell carcinoma diagnosed during the years of 1982-2012 were retrieved from the Israeli National Cancer Registry. Cox proportional hazards models were used to estimate the hazard ratio (HR) separately for urothelial carcinoma and renal cell carcinoma. RESULTS: During a cumulative follow-up of 22,115,629 person-years (median follow-up, 22.8), persistent isolated microscopic hematuria was diagnosed among 5509 (0.6%) adolescents. Urothelial carcinoma and renal cell carcinoma developed in 332 (3 among those with persistent isolated microscopic hematuria) and 292 (2) individuals, respectively. The adjusted HR for incident urothelial carcinoma among adolescents with isolated microscopic hematuria was 1.17 (95% CI, 0.38-3.66) and the adjusted HR for renal cell carcinoma was 1.02 (95% CI, 0.25-4.12). CONCLUSION: Persistent asymptomatic isolated microscopic hematuria at adolescence was not associated with increased risk for urothelial carcinoma nor renal cell carcinoma.
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Carcinoma de Células Renales , Carcinoma de Células Transicionales , Neoplasias Renales , Neoplasias de la Vejiga Urinaria , Neoplasias Urológicas , Adolescente , Masculino , Humanos , Femenino , Hematuria/diagnóstico , Hematuria/epidemiología , Hematuria/etiología , Carcinoma de Células Transicionales/complicaciones , Carcinoma de Células Renales/diagnóstico , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico , Neoplasias Renales/epidemiologíaRESUMEN
BACKGROUND: The optimal treatment for patients suffering from stable obstructive coronary artery disease (SOCAD) is controversial. Many studies have examined the value of performing percutaneous coronary intervention (PCI) in these patients but so far no study has been able to demonstrate an improvement in outcomes by performing PCI in addition to optimal medical therapy (OMT). This study aimed to examine the added value of performing PCI plus OMT vs. OMT alone regarding cardiovascular outcomes. METHODS AND RESULTS: We performed a systematic search and a meta-analysis for randomized controlled trials comparing PCI plus OMT vs. OMT in SOCAD patients. We included six trials (N = 11 144) with follow-up ranges 2.2-11.4 years. The pooled analysis showed no significant difference between PCI + OMT vs. OMT group regarding all-cause mortality, odds ratio (OR) = 0.98 [confidence interval (CI) 0.86-1.12, P = 0.79, I2 = 0%]. In addition, we have found no difference between the two groups regarding cardiovascular mortality, OR = 0.91 (CI 0.76-1.08, P = 0.27, I2 = 24%). Moreover, there was no difference in the incidence of myocardial infarction, OR = 0.92 (CI 0.81-1.04, P = 0.18, I2 = 49%). CONCLUSION: Our results suggest that there is no improvement in cardiovascular outcomes of patients with SOCAD by performing PCI plus OMT vs. OMT alone. This study provides an insight that should be taken under consideration in the management of SOCAD patients.
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Enfermedad de la Arteria Coronaria/clasificación , Intervención Coronaria Percutánea/métodos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/terapia , Humanos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricosRESUMEN
BACKGROUND: Previous studies have demonstrated a correlation between national economic indicators and academic productivity. However, such a relationship has not been studied in the field of internal medicine (IM). METHODS: The number of documents published, number of citable documents, number of citations, citations per document and the h index between 1996 and 2019 in the field of IM among the Organisation for Economic Co-operation and Development (OECD) countries were analysed. Data were derived from the The Scimago Journal and Country rank source. We analysed the correlation between these indicators to the gross domestic product (GDP) per capita, health spending as percent of GDP and gross domestic expenditure on research and development as percent of GDP (GERD). Economic data were collected from the OECD websites. RESULTS: A significant correlation was found between health expenditure and h index (r = 0.75, P < 0.001), number of citations (r = 0.72, P < 0.001), number of documents (r = 0.62, P < 0.001) and number of citable documents (r = 0.61, P < 0.001); between GERD and number of citations (r = 0.6, P < 0.001), h index (r = 0.6, P < 0.001), number of documents published (r = 0.53, P = 0.001) and citable documents (r = 0.51, P = 0.001); between the GDP per capita and number of citations (r = 0.46, P = 0.005), citations per document (r = 0.54, P = 0.001) and h index (r = 0.5, P = 0.002). CONCLUSIONS: This study demonstrated a positive correlation between academic productivity in the field of IM and economic indicators of the OECD countries, mainly health expenditure, implying the advantage of domestic investment in health.
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Bibliometría , Medicina Interna , Producto Interno Bruto , Gastos en Salud , Humanos , Medicina Interna/tendenciasAsunto(s)
Arteria Carótida Común , Prednisolona/administración & dosificación , Arteritis de Takayasu , Adulto , Antiinflamatorios/administración & dosificación , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Común/patología , Diagnóstico Precoz , Humanos , Angiografía por Resonancia Magnética , Masculino , Radiografía , Arteritis de Takayasu/sangre , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/tratamiento farmacológico , Ultrasonografía Doppler DúplexRESUMEN
BACKGROUND: The standard approach for urgent trans-venous temporary cardiac pacemaker (TVTP) implantation is fluoroscopy guidance. The delay in activation of the fluoroscopy-room and the transfer of unstable patients may be life-threatening. Echocardiography-guided TP implantation may increase the safety of the patients by obviating the need for in-hospital transfer. We examined the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TVTP implantation. METHODS: From January 2015 to September 2017 data for consecutive patients who needed emergent TVTP implantation were retrospectively reviewed. Ultrasound-guided TVTP protocol that was introduced in our center in January 2015 involved ultrasound guidance for both central venous access and pacing lead positioning. Access sites included femoral, subclavian, or jugular veins. Electrodes were placed in the right ventricular apex by means of echocardiographic monitoring in intensive care unit or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications. RESULTS: Sixty-six patients (17 echocardiography-guided and 49 fluoroscopy-guided) were included. There were no differences in pacing threshold between the echocardiography-guided group and the fluoroscopy-guided group (0.75 ± 0.58 mA vs. 0.57 ± 0.35 mA, p = 0.24). The access site for implantation was femoral vein in 27% for the fluoroscopy-guided vs. none for the echocardiography-guided approach (p = 0.015). One hematoma and one related infection occurred in the fluoroscopy-guided group. The need for electrode repositioning was observed in 1 patient in each group. There were no procedural-related deaths in either group. CONCLUSIONS: Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly lowers the need for in-hospital transfer.
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Arritmias Cardíacas/terapia , Cateterismo Cardíaco/métodos , Ecocardiografía/métodos , Marcapaso Artificial , Implantación de Prótesis/métodos , Anciano , Anciano de 80 o más Años , Bloqueo Atrioventricular/terapia , Estudios de Casos y Controles , Urgencias Médicas , Estudios de Factibilidad , Femenino , Fluoroscopía/métodos , Paro Cardíaco/terapia , Humanos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Estudios Retrospectivos , Síndrome del Seno Enfermo/terapia , Cirugía Asistida por Computador , Taquicardia Ventricular/terapia , Torsades de Pointes/terapiaRESUMEN
OBJECTIVES: To assess the correlation between prednisone and methotrexate (MTX) treatment duration and dosage with the TST induration diameter of the TST reaction among rheumatoid arthritis (RA) patients. METHOD: We retrospectively analyzed consecutive cases of RA patients who were TNF-i therapy candidates. TST measurements, prednisone and methotrexate dosages, and treatment durations were recorded. A control group was randomly selected from healthy subjects. We compared TST reaction size between the following three groups: RA patients with current prednisone treatment, RA prednisone naïve patients, and healthy individuals. RESULTS: Our study sample comprised 43 RA patients with prednisone treatment, 22 prednisone naïve patients, and 195 healthy subjects. There was no significant difference in mean TST between the groups (5.3±6.6, 7.8±6.2, and 7.6±7.0, respectively, p=0.149). No correlation was noted between TST size and prednisone u-y (r=0.229, p=0.140) or methotrexate u-y in patients with and without prednisone therapy (r=0.219, p=0.158; and r=-0.293, p=0.186, respectively). CONCLUSIONS: Our results show that the TST reaction size among RA patients may not be affected by prednisone therapy. In addition, the TST reaction of RA patients may present similarly to that of healthy individuals. Therefore, we suggest that the criterion of a TST reaction of 5 mm to define latent TB infection in our population should be reevaluated.
RESUMEN
PURPOSE: To compare the accuracy of intraocular lens power prediction for eyes with average keratometry (K) readings greater than 46.00 diopters (D) and lower than 42.00 D. SETTING: Ein-Tal Eye Center, Tel-Aviv, Israel. DESIGN: Retrospective case series. METHODS: Eyes having cataract extraction surgery with steep and flat preoperative corneal curvatures determined with the Lenstar-LS900 device were enrolled. Refractive prediction errors for the Barrett Universal II, Haigis, Hill-RBF, Hoffer-Q, Holladay 1, Holladay 2, Olsen, and SRK/T formulas were compared. Optimized K values for the SRK/T formula were back-calculated for each group. Validation was performed using an additional dataset. RESULTS: The study comprised 171 eyes (79, K reading >46.00 D; 92, K reading <42.00 D). For K readings greater than 46.00 D, myopic errors were noted using the SRK/T and Hill-RBF formulas and hyperopic errors using the Olsen C-constant and Haigis (-0.31 D, -0.17 D, 0.18 D, and 0.17 D, respectively). The percentage of eyes with an absolute error within ±0.50 D from target refraction ranged from 60.8% (SRK/T) to 83.0% (Hill-RBF). For K readings lower than 42.00 D, myopic errors were seen using the Haigis, Hill-RBF, Hoffer-Q, and Olsen-C formulas (-0.31 D, -0.14 D, -0.22 D, and -0.17 D, respectively) and a hyperopic error using the SRK/T formula (0.16 D). The refractive prediction within ±0.50 D ranged between 75.0% (Haigis) and 96.7% (Barrett Universal II). CONCLUSIONS: Power calculation for eyes with flat corneas and steep corneas requires the use of specific formulas for accurate postoperative results. An adjustment method of the SRK/T formula is proposed.