External Validation and Updating of Published Models for Predicting 7-day Risk of Symptomatic Intracranial Hemorrhage after Receiving Alteplase for Acute Ischemic Stroke: A Retrospective Cohort Study.

Background: Prediction scores for symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke patients receiving thrombolytic therapy have been widely developed, but the external validation of these scores, especially in the Thai population, is lacking. This study aims to externally validate existing models and update the selected model to enhance its performance in our specific context. Methods: This cohort study retrospectively collected data from medical records between 2013 and 2022. Acute ischemic stroke patients who received thrombolysis were included. All predictors were gathered at admission. External validation was performed on eight published prediction models; in addition, the observed and expected probabilities of sICH were compared. The most effective model for discrimination was then chosen for further updating using multivariable logistic regression and was bootstrapped for internal validation. Finally, a points-based system for clinical practice was developed from the optimism-corrected model. Results: Fifty patients (10% of the 502 included cohort members) experienced sICH after undergoing thrombolysis. The SICH score outperformed the other seven models in terms of discrimination (area under the receiver operating characteristic [AuROC] curve = 0.74 [95% confidence interval {CI} 0.67 to 0.81]), but it still overstated risk (expected-to-observed outcomes [E/O] ratio = 1.7). Once updated, the optimism-corrected revised SICH model showed somewhat better calibration (E/O = 1 and calibration-in-the-large = 0), slightly worse underprediction in the moderate-to-high risk group (calibration slope = 1.152), and marginally better discrimination (AuROC = 0.78). The points-based system also demonstrated substantial agreement (88.1%) with the risk groups predicted by the logistic regression model (kappa statistic = 0.78). Conclusion: Since the SICH score outperformed seven models in terms of discrimination, it was then modified to the Revised-SICH score, which predicted that patients with at least 5.5 points were at high risk of having sICH.

A score to predict Pseudomonas aeruginosa infection in older patients with community-acquired pneumonia.

BACKGROUND: In Thailand, the incidence of community-acquired pseudomonal pneumonia among 60- to 65-year-olds ranges from 10.90% to 15.51%, with a mortality rate of up to 19.00%. Antipseudomonal agents should be selected as an empirical treatment for elderly patients at high risk for developing this infection. The purpose of this study was to identify risk factors and develop a risk predictor for Pseudomonas aeruginosa infection in older adults with community-acquired pneumonia (CAP). METHODS: A retrospective data collection from an electronic database involved the elderly hospitalized patients with P. aeruginosa- and non-P. aeruginosa-causing CAP, admitted between January 1, 2016, and June 30, 2021. Risk factors for P. aeruginosa infection were analysed using logistic regression, and the instrument was developed by scoring each risk factor based on the beta coefficient and evaluating discrimination and calibration using the area under the receiver operating characteristic curve (AuROC) and observed versus predicted probability (E/O) ratio. RESULTS: The inclusion criteria were met by 81 and 104 elderly patients diagnosed with CAP caused by P. aeruginosa and non-P. aeruginosa, respectively. Nasogastric (NG) tube feeding (odd ratios; OR = 40.68), bronchiectasis (B) (OR = 4.13), immunocompromised condition (I) (OR = 3.76), and other chronic respiratory illnesses (r) such as atelectasis, pulmonary fibrosis, and lung bleb (OR = 2.61) were the specific risk factors for infection with P. aeruginosa. The "60-B-r-I-NG" risk score was named after the 4 abbreviated risk variables and found to have good predicative capability (AuROC = 0.77) and accuracy comparable to or near true P. aeruginosa infection (E/O = 1). People who scored at least two should receive empirically antipseudomonal medication. CONCLUSIONS: NG tube feeding before admission, bronchiectasis, immunocompromisation, atelectasis, pulmonary fibrosis and lung bleb were risk factors for pseudomonal CAP in the elderly. The 60-B-r-I-NG was developed for predicting P. aeruginosa infection with a high degree of accuracy, equal to or comparable to the existing P. aeruginosa infection. Antipseudomonal agents may be started in patients who are at least 60 years old and have a score of at least 2 in order to lower mortality and promote the appropriate use of these medications.

Incidence and Risk Factors of Tenofovir Disoproxil Fumarate Induced Nephrotoxicity and Renal Function Recovery, a Hospital Case-Control Study.

BACKGROUND: The incidence of tenofovir disoproxil fumarate (TDF)-induced nephrotoxicity ranges from 15.8 to 19.3 percent. Following cessation of TDF, approximately one-half of patients with nephrotoxicity regained full renal functions. This study aimed to determine the incidence and risk factors for nephrotoxicity, as well as the complete recovery of renal function, in human immunodeficiency virus (HIV)-infected patients receiving TDF regimens. MATERIALS AND METHODS: This was a retrospective case-control study of HIV-positive patients who received TDF regimens from 2 tertiary hospitals between 2012 and 2018. Signs of TDF-induced renal dysfunction, defined as having estimated glomerular filtration rate (eGFR) decline of greater than 25%, and proximal renal tubulopathy (PRT) were followed for 48 months. After discontinuing TDF due to nephrotoxicity, the renal parameters of patients were monitored for 48 months. Univariate and multivariate regression analyses were used to determine the factors associated with TDF-induced nephrotoxicity and renal function recovery. RESULTS: Twelve percent of 3,214 TDF-treated patients were diagnosed with renal dysfunction, whereas 303 patients (15.20%) were diagnosed with PRT. TDF-induced renal dysfunction was associated with older age (odds ratio [OR] = 2.851), smoking (OR = 1.972), and TDF use for more than 3 years (OR 1.928). Receiving trimethoprim-sulfamethoxazole (TMP/SMX) or nonsteroidal anti-inflammatory drugs (NSAIDs) and being elderly were associated with PRT (OR = 4.727, 4.313, and 3.357, respectively). Following the discontinuation of TDF, 12.96% of patients regained full renal function. Elderly patients and those taking renin-angiotensin-aldosterone system (RAAS) inhibitors or protease inhibitors (PIs) had a lower likelihood of full recovery (OR = 0.811, 0.793, 0.582, respectively). One-third experienced PRT recovery, whereas RAAS inhibitors use, old age, and receiving PIs decreased the likelihood of PRT recovery (OR = 0.709, 0.504, 0.311, respectively). TDF cessation at an eGFR greater than 60 mL/min/1.73 m² increased the likelihood of renal function recovery and PRT by 4.07 and 2.11 times, respectively. CONCLUSION: Twelve percent and 15 percent of patients receiving TDF developed renal dysfunction and PRT, respectively. Age, TMP/SMX, NSAIDs, and long-term TDF exposure were independent risk factors for TDF-induced nephrotoxicity. Thirteen and thirty-three percent of patients with renal dysfunction and PRT recovered from their conditions, respectively. The discontinuation of TDF at an eGFR greater than 60 mL/min/1.73 m² was advantageous for the recovery of renal function and PRT.

Hypoglycemic effect of bitter melon compared with metformin in newly diagnosed type 2 diabetes patients.

ETHNOPHARMACOLOGICAL RELEVANCE: Bitter melon (Momordica charantia L.) has been widely used as an traditional medicine treatment for diabetic patients in Asia. In vitro and animal studies suggested its hypoglycemic activity, but limited human studies are available to support its use. AIM OF STUDY: This study was conducted to assess the efficacy and safety of three doses of bitter melon compared with metformin. MATERIALS AND METHODS: This is a 4-week, multicenter, randomized, double-blind, active-control trial. Patients were randomized into 4 groups to receive bitter melon 500 mg/day, 1,000 mg/day, and 2,000 mg/day or metformin 1,000 mg/day. All patients were followed for 4 weeks. RESULTS: There was a significant decline in fructosamine at week 4 of the metformin group (-16.8; 95% CI, -31.2, -2.4 µmol/L) and the bitter melon 2,000 mg/day group (-10.2; 95% CI, -19.1, -1.3 µmol/L). Bitter melon 500 and 1,000 mg/day did not significantly decrease fructosamine levels (-3.5; 95% CI -11.7, 4.6 and -10.3; 95% CI -22.7, 2.2 µmol/L, respectively). CONCLUSIONS: Bitter melon had a modest hypoglycemic effect and significantly reduced fructosamine levels from baseline among patients with type 2 diabetes who received 2,000 mg/day. However, the hypoglycemic effect of bitter melon was less than metformin 1,000 mg/day.

Pharmacy student and preceptor perceptions of preceptor teaching behaviors.

OBJECTIVES: To compare PharmD students' and preceptors' perceptions of preceptors' teaching behaviors. METHODS: A 47-item survey instrument was developed and distributed to students and preceptors for rating the frequency and adequacy of each teaching behavior as not done, done but inadequate, and well done and adequate. RESULTS: Seventy-seven (99%) students and 53 (55%) preceptors responded to the survey. Students were somewhat satisfied with their preceptors' teaching behaviors. In comparison, preceptors overrated their own teaching behaviors as well done and adequate on 9 of 47 (19%; p