scholarly journals Adrenal Insufficiency at the Time of COVID-19: A Retrospective Study in Patients Referring to a Tertiary Center

2020 ◽  
Author(s):  
Giulia Carosi ◽  
Valentina Morelli ◽  
Giulia Del Sindaco ◽  
Andreea Liliana Serban ◽  
Arianna Cremaschi ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Case Control Study ◽  
Infection Risk ◽  
Adrenal Crisis ◽  
Retrospective Case ◽  
Tertiary Center ◽  
Severe Impairment ◽  
Positive Results ◽  
Control Study

Abstract Context Coronavirus disease 2019 (COVID-19) represents a global health emergency, and infected patients with chronic diseases often present with a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased infection risk, which could trigger an adrenal crisis. Objective Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients. Design and Setting We conducted a retrospective case-control study. All patients were on active follow-up and lived in Lombardy, Italy, one of the most affected areas. Patients We enrolled 279 patients with primary and secondary AI and 112 controls (patients with benign pituitary lesions without hormonal alterations). All AI patients had been previously trained to modify their replacement therapy on stress doses. Intervention By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences. Results In February through April 2020, the prevalence of symptomatic patients (complaining at least 1 symptom of viral infection) was similar between the 2 groups (24% in AI and 22.3% in controls, P = 0.79). Highly suggestive COVID-19 symptoms (at least 2 including fever and/or cough) also occurred equally in AI and controls (12.5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n = 12), as indicated by sanitary regulations, limiting conclusions on the exact infection rate (2 positive results in AI and none in controls, P = 0.52). Conclusions AI patients who are adequately treated and trained seem to display the same incidence of COVID-19-suggestive symptoms and disease severity as controls.

Adrenal insufficiency in kidney transplant patients during low-dose prednisolone therapy: a cross-sectional case–control study

2019 ◽  
Vol 35 (12) ◽  
pp. 2191-2197 ◽  
Author(s):  
Amalie Valentin ◽  
Stina Willemoes Borresen ◽  
Marianne Rix ◽  
Thomas Elung-Jensen ◽  
Søren Schwartz Sørensen ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Low Dose ◽  
Case Control Study ◽  
Case Control ◽  
Adrenal Crisis ◽  
Control Group ◽  
Cross Sectional ◽  
Prednisolone Treatment ◽  
Synacthen Test ◽  
Control Study

Abstract Background Maintenance immunosuppressive regimens after renal transplantation (RTx) most often include prednisolone, which may induce secondary adrenal insufficiency, a potentially life-threatening side effect to glucocorticoid (GC) treatment due to the risk of acute adrenal crisis. We investigated the prevalence of prednisolone-induced adrenal insufficiency in RTx patients receiving long-term low-dose prednisolone treatment. Methods We performed a case–control study of patients on renal replacement therapy differing in terms of GC exposure. The study included 30 RTx patients transplanted >11 months before enrolment in the study and treated with prednisolone (5 or 7.5 mg prednisolone/day for ≥6 months) and 30 dialysis patients not treated with prednisolone. Patients underwent testing for adrenal insufficiency by a 250-µg Synacthen test performed fasting in the morning after a 48-h prednisolone pause. Normal adrenal function was defined as P-cortisol ≥420 nmol/L 30 min after Synacthen injection. This cut-off is used routinely for the new Roche Elecsys Cortisol II assay and is validated locally based on the Synacthen test responses in 100 healthy individuals. Results Thirteen RTx patients {43% [95% confidence interval (CI) 27–61]} had an insufficient response to the Synacthen test compared with one patient in the control group [3% (95% CI 0.6–17)] (P = 0.0004). Insufficient responses were seen in 9/25 and 4/5 RTx patients treated with 5 and 7.5 mg prednisolone/day, respectively. Conclusions We found a high prevalence of adrenal insufficiency among RTx patients receiving low-dose prednisolone treatment. We therefore advocate for increased clinical alertness towards prednisolone-induced adrenal insufficiency in RTx patients and thus their potential need of rescue GC supplementation during stress.

Evaluating the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures

Trauma ◽  
2020 ◽  
pp. 146040862097814
Author(s):  
Justin Vaida ◽  
Alexander DB Conti ◽  
Justin J Ray ◽  
Daniel A Bravin ◽  
Michelle A Bramer
Keyword(s):  
Lower Extremity ◽  
Case Control Study ◽  
Smoking Status ◽  
Case Control ◽  
Wound Complications ◽  
Control Group ◽  
Retrospective Case ◽  
Vancomycin Powder ◽  
Control Study

Introduction Optimal management of lower extremity fractures includes early antibiotics administration, thorough irrigation and debridement, consideration of soft tissue injury, and definitive skeletal management. The purpose of this study was to evaluate the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures. Methods This was a retrospective case control study in which open lower extremity fractures at our institution were reviewed for development of infection (including species and sensitivity if present) and the development of unanticipated wound complications requiring intervention. Patients from 2010-2015 were treated with standard of care consistent with evidence-based literature (IV antibiotics with external fixator, intramedullary nail, etc.). Patients from 2016–18 were additionally treated with vancomycin powder applied directly to the wound before closure. All patients were monitored per the treating surgeon’s standard follow-up protocol and had follow-up of at least two months. Results This retrospective case control study comprised 434 patients. The historical control group (n = 388 patients) and treatment group (n = 46 patients) were similar for age, sex, BMI (body mass index), diabetes, smoking status, and Injury Severity Score (ISS). There were 36 infections (9.28%) in the control group compared to four infections (8.70%) in the vancomycin powder group (p = 0.901). No significant difference was seen after adjusting for age, sex, BMI, diabetes, smoking status, and ISS. The vancomycin powder group experienced significantly more wound complications (15.2%) compared to the control group (6.4%; p = 0.039), which remained significant when adjusting for multiple covariates. Conclusions Topical vancomycin powder did not reduce the infection rate when applied in the surgical site of open lower extremity fractures. Instead, the addition of topical vancomycin powder resulted in significantly more wound complications in patients with open lower extremity fractures.

Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy

2020 ◽  
Vol 134 (4) ◽  
pp. 350-353
Author(s):  
M Narayan ◽  
S Limbachiya ◽  
D Balasubramanian ◽  
N Subramaniam ◽  
K Thankappan ◽  
...  
Keyword(s):  
Total Laryngectomy ◽  
Small Volume ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Study Group ◽  
Retrospective Case ◽  
Control Study ◽  
Pharyngocutaneous Fistulae

AbstractObjectivesPharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3–5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.MethodsA retrospective case–control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3–5 ml) post-operative gastrografin videofluoroscopy.ResultsIn the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.ConclusionSmall-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.

scholarly journals False positive results of tests for syphilis and outcome of pregnancy: a retrospective case-control study.

BMJ ◽  
1987 ◽  
Vol 295 (6594) ◽  
pp. 355-356 ◽  
Author(s):  
J G Thornton ◽  
G A Foote ◽  
C E Page ◽  
A D Clayden ◽  
L A Tovey ◽  
...  
Keyword(s):  
False Positive ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Positive Results ◽  
Control Study

Predictors of Knee Arthrofibrosis and Outcomes after Arthroscopic Lysis of Adhesions following Ligamentous Reconstruction: A Retrospective Case–Control Study with Over Two Years' Average Follow-Up

2018 ◽  
Vol 32 (06) ◽  
pp. 536-543 ◽  
Author(s):  
Blake M. Bodendorfer ◽  
Laura E. Keeling ◽  
Evan M. Michaelson ◽  
Henry T. Shu ◽  
Nicholas A. Apseloff ◽  
...  
Keyword(s):  
Knee Injury ◽  
Case Control Study ◽  
Cruciate Ligament ◽  
Case Control ◽  
Retrospective Case ◽  
Inadequate Sample Size ◽  
Severity Of Injury ◽  
Ligamentous Reconstruction ◽  
Control Study

AbstractArthrofibrosis can be a devastating complication after ligamentous knee reconstruction. Beyond early range of motion (ROM), manipulation under anesthesia (MUA) and arthroscopic lysis of adhesions (LOAs) are the most frequently employed interventions for the condition. There is a paucity of data regarding predictive factors of arthrofibrosis requiring MUA and LOA, and even less data regarding changes in validated patient-reported outcome measures following the procedure. A retrospective case–control study was performed at an academic, urban Level I trauma center of patients that developed arthrofibrosis requiring MUA and LOA following ligamentous reconstruction. The indication for LOA was failure to achieve a 90° arc of ROM by 6 weeks. Seventeen cases and 141 controls were identified. Follow-up for cases was 26.9 ± 17.1 months (mean ± standard deviation). Time from initial reconstruction to LOA was 75.2 ± 27.9 days. Cases had higher body mass indices by a mean of 2.9 (p = 0.024). The most significant risk factors for stiffness were concomitant anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner/lateral collateral ligament injury (odds ratio [OR], 17.08), knee dislocation (OR, 12.84), and use of an external fixator (OR, 12.81, 95% confidence interval [CI], 3.03–54.20) (all p < 0.0026). Mean Knee Injury and Osteoarthritis Outcome Scores, Western Ontario and McMaster Universities Osteoarthritis Indices, and International Knee Documentation Committee scores improved by 47.5, 50.5, and 47.3% (all p < 0.0038), respectively. All patients reported improvement in pain, with maximum daily pain scores improving by a mean of 4.1 points on the Numeric Pain Rating Scale (p < 0.001). Mean ROM arc improved by 38.8° (p < 0.001). All 17 cases were satisfied with the procedure. Twelve cases (70.59%) reported a full return to preinjury level of activity. No factors were identified that predicted success from the procedure, likely due to inadequate sample size. Arthrofibrosis following knee injury and ligamentous reconstruction can be predicted by the severity of injury and early intervention with MUA and arthroscopic LOA can lead to a satisfactory outcome for the patient.

Does Physiologic Breakdown Mask Significant Pathology in Endometrial Biopsies? A Retrospective Case-Control Study

2006 ◽  
Vol 130 (12) ◽  
pp. 1847-1849
Author(s):  
Mark Galan ◽  
Young Bae Kim ◽  
Jonathan L. Hecht
Keyword(s):  
Case Control Study ◽  
Medical Center ◽  
Case Control ◽  
Endometrial Biopsy ◽  
Control Group ◽  
Retrospective Case ◽  
Significant Pathology ◽  
Initial Sampling ◽  
Control Study

Abstract Context.—Adequacy criteria for endometrial biopsy samples do not exist. Objective.—To assess the sensitivity of endometrial sampling for detecting neoplasia in the setting of extensive glandular and stromal breakdown. Design.—Retrospective case-control study. Surgical pathology records between 1996 and 2005 at Beth Israel Deaconess Medical Center (Boston, Mass) were searched for endometrial samples with diagnoses containing the key words “menstrual” or “extensive breakdown.” Hospital records for these women were parsed for demographics, clinical indications, and follow-up with rebiopsy within 6 months. Age cutoffs enriched the population for women at higher risk for carcinoma. A control group, consisting of 2 age-matched control patients for each test patient, was also studied; each control patient had an endometrial sample taken within a 6-month period and was not diagnosed with extensive breakdown, menstrual endometrium, or neoplasia on initial sampling. Results.—Fifty-four cases were identified. The primary biopsy reports had benign descriptive diagnoses (ie, proliferative, secretory, polyp). Follow-up biopsies showed benign pathology in all cases and specific causes of bleeding—including polyp, leiomyoma, or endometritis—in 28 (52%) of 54. In the control group, neoplasia was found in 2 of the 108 follow-up biopsies. Only 5 other controls had specific diagnoses; all were polyps. Conclusions.—Extensive breakdown or menstrual-pattern endometrium may mask other specific benign pathologies but does not commonly mask cancer.

scholarly journals Volumetric changes and peri-implant health at implant sites with or without soft tissue grafting in the esthetic zone, a retrospective case-control study with a 5-year follow-up

2017 ◽  
Vol 28 (11) ◽  
pp. 1459-1465 ◽  
Author(s):  
Stefan P. Bienz ◽  
Ronald E. Jung ◽  
Vitor M. Sapata ◽  
Christoph H. F. Hämmerle ◽  
Jürg Hüsler ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Control Study
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