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Bilateral pulmonary embolism while receiving tranexamic acid: a case report.
No full textBACKGROUND
We present a case of a suspected tranexamic acid-related bilateral pulmonary embolism in a healthy and active middle-aged woman who was receiving tranexamic acid for menorrhagia with no other known significant risk factors for thromboembolism.
CASE PRESENTATION
A 46-year-old Asian woman who was usually fit and well with no remarkable past medical history except for menorrhagia of 1-year duration for which she was receiving tranexamic acid presented to our accident and emergency department with a 2-week history of intermittent pleuritic central chest pain. She was reviewed and discharged to home with a diagnosis of musculoskeletal pain on two hospital visits because she had no significant risk factors for thromboembolism and her workup investigation results for pulmonary embolism and other differential diagnoses were largely unremarkable. On her third visit to the emergency ambulatory clinic with recurring symptoms of pleuritic chest pain, a pulmonary computed tomographic angiogram confirmed bilateral subsegmental pulmonary embolism.
CONCLUSION
This case report reinforces the possible increased risk of thromboembolism in patients receiving tranexamic acid
Inpatient Burden and Mortality of Heat Stroke in the United States.
No full textBACKGROUND
This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilization of hospitalization for heat stroke in the United States. Additionally, this study aimed to explore factors associated with in-hospital mortalities of heat stroke.
METHODS
The 2003-2014 National Inpatient Sample database was used to identify hospitalized patients with a principal diagnosis of heat stroke. The inpatient prevalence, clinical characteristics, in-hospital treatments, outcomes, length of hospital stay, and hospitalization cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality.
RESULTS
A total of 3,372 patients were primarily admitted for heat stroke, accounting for an overall inpatient prevalence of heat stroke among hospitalized patients of 36.3 cases per 1,000,000 admissions in the United States with an increasing trend during the study period (p<0.001). Age 40-59 was the most prevalent age group. During hospital stay, 20% required mechanical ventilation, and 2% received renal replacement therapy. Rhabdomyolysis was the most common complication. Renal failure was the most common end-organ failure, followed by neurological, respiratory, metabolic, hematologic, circulatory, and liver systems. The in-hospital mortality rate of heat stroke hospitalization was 5% with a decreasing trend during the study period (p<0.001). The presence of end-organ failure was associated with increased in-hospital mortality, whereas more recent year of hospitalization was associated with decreased in-hospital mortality. The median length of hospital stay was 2 days. The median hospitalization cost was $17372.
CONCLUSION
The inpatient prevalence of heat stroke in the United States increased, while the in-hospital mortality of heat stroke decreased
Path-based extensions of local link prediction methods for complex networks.
No full textLink prediction in a complex network is a problem of fundamental interest in network science and has attracted increasing attention in recent years. It aims to predict missing (or future) links between two entities in a complex system that are not already connected. Among existing methods, local similarity indices are most popular that take into account the information of common neighbours to estimate the likelihood of existence of a connection between two nodes. In this paper, we propose global and quasi-local extensions of some commonly used local similarity indices. We have performed extensive numerical simulations on publicly available datasets from diverse domains demonstrating that the proposed extensions not only give superior performance, when compared to their respective local indices, but also outperform some of the current, state-of-the-art, local and global link-prediction methods
Safety and efficacy of bipolar transurethral resection of the prostate versus monopolar transurethral resection of prostate in the treatment of moderate-large volume prostatic hyperplasia: a systematic review and meta-analysis.
No full textAIMS
To compare outcomes of monopolar versus bipolar transurethral resection of the prostate (TURP) in the management of exclusively moderate-large-volume prostatic hyperplasia in terms of maximum flow rate as a surrogate for clinical efficacy, duration of catheterization, hospital stay, operative time, resection weight, Trans Urethral Resection (TUR) syndrome, acute urinary retention (AUR), clot retention and blood transfusion. Methods We conducted a search of electronic databases (PubMed, MEDLINE, EMBASE, CINAHL and CENTRAL), identifying studies comparing the outcomes of monopolar and bipolar TURP in the management of large-volume prostatic hyperplasia. The Cochrane risk-of-bias tool for randomised control trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess included studies. Random effects modelling was used to calculate pooled outcome data. Results Three RCTs and four observational studies were identified, enrolling 496 patients. No difference was observed in the clinical efficacy between each procedure at 3 months postoperatively (P=0.99), 6 months (P=0.46) and 12 months (P=0.29). The use of bipolar TURP was associated with significantly shorter inpatient stay (P=0.01) and a shorter duration of catheterisation (P=0.05). Monopolar TURP was associated with an increased risk of TUR syndrome (P=0.03). Operative time (P=0.58), resection weight (P=0.16), acute urinary retention (P=0.96), clot retention (P=0.79) and blood transfusion (P=0.39), were similar in both groups. Conclusion Our meta-analysis demonstrated that bipolar TURP in the treatment of moderate-large volume prostatic disease may be associated with a significantly lower rate of TUR syndrome and shortened length of hospital stay, with similar efficacy when compared with monopolar TURP. Further high quality RCTs with adequate sample sizes are required in order to compare both monopolar and bipolar TURP to open prostatectomy or laser enucleation in the treatment of exclusively large-volume prostates with stricter definition of size
Very high bone mineral density in a monogenic form of obesity-associated insulin resistance.
No full textINTRODUCTION
Alström syndrome (ALMS) is an ultra-rare metabolic disorder caused by biallelic loss-of-function in the Alms1 gene which encodes a ubiquitously expressed centrosomal protein of the primary cilium. Although ALMS is characterised by several metabolic and hormonal dysfunctions that can lead to an increased risk of developing osteoporosis and bone fracture, an increased BMD have been observed. The aim of this study was to characterise the anthropometric, clinical, genetic and densitometric features of bone health in a large adult UK cohort of subjects with ALMS.
METHODS
Twenty-three patients with ALMS and 23 age-matched male control subjects were recruited. Lumbar spine (LS) and total hip (TH) bone mineral density (BMD) were evaluated by DXA in all subjects. A CT scan to assess the spinal bone architecture was performed in ALMS patients with raised lumbar density. Blood analysis for biochemical parameters and thyroid and sex hormones was performed in all ALMS patients.
RESULTS
LS Z-score levels were higher than +2 SD in 35% of all ALMS study participants, of whom 75% were men and 25% were women. TH Z-scores were higher than +1 SD 13% of patients and all of them have higher than expected lumbar Z-score. An extremely high BMD was found in two of the oldest patients (LS Z-score +10.8 and +15.3 SD).
CONCLUSION
ALMS patients tend to have high levels of BMD that increase with age, in particular of the trabecular bones. Although obesity and lifelong IR can be responsible for the increase in BMD, at least in part, of a possible signalling role of Alms1 protein as a bone-forming factor is plausible
Six-year experience of detection and investigation of possible Middle East Respiratory Syndrome coronavirus cases, England, 2012-2018.
No full textOBJECTIVES
Surveillance for Middle East Respiratory Syndrome (MERS) has been undertaken in the UK since September 2012. This study describes the surveillance outcomes in England from 2012 to 2018.
STUDY DESIGN
This was a descriptive study using surveillance data.
METHODS
Local health protection teams in England report possible MERS cases to the National Infection Service with clinical and laboratory data.
RESULTS
A total of 1301 possible MERS cases were identified in the study period. Five cases were laboratory-confirmed MERS. The majority of cases had travelled to Saudi Arabia (56.7%) and United Arab Emirates (25.9%). Fifty-four percent of cases were men and 43.7% were women. The majority of cases (65.1%) were aged 45 years or older. The number of tests increased in the period after Hajj each year. Laboratory-confirmed alternative diagnoses were available for 513 (39.4%) cases; influenza was the most common virus detected (n = 255, 52.4%).
CONCLUSIONS
Our study highlights the importance of differential diagnosis of influenza and other respiratory pathogens and early influenza antiviral treatment
Clinical trials in critical care: can a Bayesian approach enhance clinical and scientific decision making?
No full textRecent Bayesian reanalyses of prominent trials in critical illness have generated controversy by contradicting the initial conclusions based on conventional frequentist analyses. Many clinicians might be sceptical that Bayesian analysis, a philosophical and statistical approach that combines prior beliefs with data to generate probabilities, provides more useful information about clinical trials than the frequentist approach. In this Personal View, we introduce clinicians to the rationale, process, and interpretation of Bayesian analysis through a systematic review and reanalysis of interventional trials in critical illness. In the majority of cases, Bayesian and frequentist analyses agreed. In the remainder, Bayesian analysis identified interventions where benefit was probable despite the absence of statistical significance, where interpretation depended substantially on choice of prior distribution, and where benefit was improbable despite statistical significance. Bayesian analysis in critical care medicine can help to distinguish harm from uncertainty and establish the probability of clinically important benefit for clinicians, policy makers, and patients
Increased superoxide in GCH1 mutant fibroblasts points to a dopamine-independent toxicity mechanism.
No full textAre all blood-based postal sampling kits the same? A comparative service evaluation of the performance of dried blood spot and mini tube sample collection systems for postal HIV and syphilis testing.
No full textOBJECTIVES
We comparatively evaluated two HIV and syphilis blood sampling kits (dried blood spot (DBS) and mini tube (MT)) as part of an online STI postal sampling service that included tests for chlamydia and gonorrhoea. We aimed to see how the blood collection systems compared regarding sample return rates and result rates. Additionally, we aimed to observe differences in false-positive results and describe a request-to-result ratio (RRR)-the required number of kit requests needed to obtain one successful result.
METHODS
We reviewed data from an online postal STI kit requesting service for a client transitioning from MT to DBS blood collection systems. We described service user baseline characteristics and compared kit requests, kit and blood sample return rates, and the successful resulting rates for HIV and syphilis for MT and DBS. Pearson's χ and Fisher's exact test were used to determine statistical differences, and statistical formulae were applied to produce CIs for differences in proportions.
RESULTS
5670 STI postal kit requests from a Midlands region were reviewed from 6 September 2016-2 January 2019 (1515 MT and 4155 DBS). Baseline characteristics between the two groups were comparable (68.0% female, 74.0% white British and 87.5% heterosexual, median age 26 years). Successful processing rates for DBS were 94.6% and 54.4% for MT (p<0.001) with a percentage difference of 40.2% (95% CI 36.9% to 43.4%). The RRR for MT was 2.9 cf. 1.6 for DBS. False-positive results for MT samples were 5.2% (HIV) and 0.4% (syphilis), and those for DBS were 0.4% (HIV) and 0.0% (syphilis).
CONCLUSIONS
This comparative analysis demonstrated the superior successful processing rates for postal DBS collection systems compared with MT. Reasons for this included insufficient volumes, high false-positive rates and degradation of blood quality in MT samples. A postal sampling service using DBS to screen for HIV, syphilis and other blood-borne viruses could be a viable alternative
Sarcopenia in Chronic Liver Disease: Mechanisms and Countermeasures.
No full textSarcopenia, a condition of low muscle mass, quality and strength, is commonly found in cirrhotic patients and is associated with adverse clinical outcomes including: reduction in quality of life, increased mortality and post-transplant complications. In chronic liver disease (CLD) it is most commonly defined through the measurement of the skeletal muscle index of the third lumbar spine. A major contributor to sarcopenia in CLD is the imbalance in muscle protein turnover, which likely occurs due to a decrease in muscle protein synthesis and an elevation in muscle protein breakdown. This imbalance is assumed to arise due to a number of factors including: accelerated starvation, hyperammonemia, amino acid deprivation, chronic inflammation, excessive alcohol intake and physical inactivity. In particular, hyperammonemia is a key mediator of the liver-gut axis and is known to contribute to mitochondrial dysfunction and an increase in myostatin expression. Currently, the use of late-evening snacks, branched-chain amino acid supplementation and physical activity have been proposed to help the management and treatment of sarcopenia. However, little evidence exists to comprehensively support their use in clinical settings. A number of new, pharmacological strategies, including myostatin inhibition and the nutraceutical Urolithin A have recently been proposed to treat age-related sarcopenia, and may also be of use in CLD. This review highlights the potential molecular mechanisms contributing to sarcopenia in CLD alongside a discussion of existing and potential new treatment strategies