Assessing Adherence by Combining the Test of Adherence to Inhalers With Pharmacy Refill Records.

BACKGROUND AND OBJECTIVE: The Global Initiative for Asthma (GINA) recommends the concurrent use of self-report and pharmacy refill data to assess treatment adherence. However, clinical evidence to support this combined approach is limited. Objective: To determine nonadherence to inhaler medication based on a validated questionnaire (Test of Adherence to Inhalers; TAI) and prescription refill data in a community sample of patients with chronic obstructive pulmonary disease (COPD) or asthma. Secondarily, we sought to determine the degree of concordance between these two measures. METHODS: Cross-sectional, observational multicenter study in patients with asthma or COPD. Sociodemographic and clinical data were obtained from clinical records. Refill data were retrieved from electronic pharmacy databases. Participants completed the 12-item TAI during a single visit as part of routine care. Nonadherence was defined as TAI <50 or <80% pharmacy refill rate (PRR) in the previous 6 months. RESULTS: A total of 816 patients (mean age, 60) were included. Nonadherence rates were 58.1% (TAI) and 28.6% (PRR) compared with 64.6% for the combined data (P<.0001). Concordance between the 2 measures was weak (к=0.205). CONCLUSIONS: These findings confirm the GINA recommendations, indicating that concomitant use of the TAI and pharmacy refill data identifies a higher percentage of nonadherent asthma or COPD patients than either instrument alone.

[Spinalcord compression secondary to metastases from a non-previous diagnosed thyroid cancer]. / L'image du mois. Compression médullaire liée à une métastase d'un cancer thyroïdien préalablement non diagnostiqué.

We presented a case of a 73-year-old woman presenting to the emergency department with a spinal cord compression secondary to a T2 mass lesion and needing emergency surgery. The lesion was consistent with a papillary thyroid carcinoma. The patient had a previous history of thyroidectomy in a setting of a multinodular goiter 6 years before. A rereading of the previous anatomopathological thyroid tissue confirmed the presence of a papillary thyroid carcinoma that was initially misdiagnosed.

Nous présentons le cas clinique d'une femme âgée de 73 ans se présentant au service des Urgences avec une compression de la moelle épinière secondaire à une lésion de masse au niveau de la vertèbre T2 et nécessitant une intervention chirurgicale d'urgence. La lésion est compatible avec un carcinome papillaire de la thyroïde. La patiente avait bénéficié d'une thyroïdectomie dans un contexte de goitre multinodulaire 6 ans auparavant. Une relecture de la pièce anatomopathologique confirme la présence d'un carcinome papillaire de la thyroïde non diagnostiqué au départ.

[Thyroid abscess due to Salmonella enteritidis in an immunocompetent patient]. / Le cas clinique du mois. Abcès thyroïdien à Salmonella enteritidis chez un patient immunocompétent.

The thyroid gland is usually resistant to infections due to its anatomy. However, suppurative thyroiditis could be found in immunocompromised patients or those with previous thyroid diseases. We report a case of thyroid abscess secondary to Salmonella enteritidis infection in an immunocompetent patient. We were not able to establish the source of infection. Clinical improvement was achieved under antibiotic treatment without complications. Early diagnosis is important as thyroid abcess may be a life threatening condition.

La thyroïde est une glande endocrine généralement résistante aux infections en raison de sa localisation et présentation anatomique. Cependant, une thyroïdite suppurée est susceptible de survenir chez des patients immunodéprimés ou ayant déjà présenté un dysfonctionnement thyroïdien. Nous rapportons un cas d'abcès thyroïdien consécutif à une infection à Salmonella enteritidis chez un patient immunocompétent. Nous n'avons pas pu établir la source de l'infection. Une amélioration clinique a été obtenue sous traitement antibiotique sans complications. Un diagnostic précoce est essentiel afin d'éviter toutes complications graves mettant en jeu le pronostic vital.

Presentación de un caso con hipertensión arterial asociada a litiasis hipercalciúrica, osteopenia y alteraciones dentales / Case presentation of hypertension with associated hypercalciuric lithiasis, osteopeny and dental alteration

Un varón de 51 años fue evaluado por hipertensión arterial en nuestro hospital en 1996, objetivándose en el seguimiento alteraciones dentales, hipercalciuria, hiperuricosuria, litiasis renal, osteopenia y una aceptable respuesta al tratamiento antihipertensivo con verapamilo, tiazidas y alopurinol. Se comenta la elevada prevalencia de esta situación en los hipertensos estudiados en nuestro hospital, de perfil familiar en algunas ocasiones, y la aceptable respuesta de la hipertensión arterial al tratamiento cuando se incluyen tiazidas, combinándolo con alopurinol, si existen alteraciones del metabolismo del ácido úrico

A 51 year-old-man was evaluated for hypertension in our hospital in 1996. Follow up observations included dental alteration, hypercalciuria, hyperuricosuria, renal lithiasis and osteopeny. The patient was also observed to acceptably respond to antihypertensive treatment with verapamil, thiazides and allopurinol. Discussed are the facts that this situation is quite prevalent among hypertensive patients in our hospital, some having a family history of such, and that the hypertension responds favourably to treatment when thiazides are included in combination with allopurinol if alterations in uric acid metabolism are present