Risk of aortic aneurysm and dissection following exposure to fluoroquinolones, common antibiotics, and febrile illness using a self-controlled case series study design: Retrospective analyses of three large healthcare databases in the US

Objective Recent observational studies suggest increased aortic aneurysm or dissection (AAD) risk following fluoroquinolone (FQ) exposure but acknowledge potential for residual bias from unreported patient characteristics. The objective of our study is to evaluate the potential association between FQ, other common antibiotics and febrile illness with risk of AAD using a self-controlled case series (SCCS) study design. Design Retrospective database analysis–SCCS. Setting Primary and Secondary Care. Study population 51,898 patients across 3 US claims databases (IBM® MarketScan® commercial and Medicare databases, Optum Clinformatics). Exposure FQ or other common antibiotics or febrile illness. Outcome AAD. Methods We studied patients with exposures and AAD between 2012 and 2017 in 3 databases. Risk windows were defined as exposure period plus 30 days. Diagnostic analyses included p-value calibration to account for residual error using negative control exposures (NCE), and pre-exposure outcome analyses to evaluate exposure-outcome timing. The measure of association was the incidence rate ratio (IRR) comparing exposed and unexposed time. Results Most NCEs produced effect estimates greater than the hypothetical null, indicating positive residual error; calibrated p (Cp) values were therefore used. The IRR following FQ exposure ranged from 1.13 (95% CI: 1.04–1.22 –Cp: 0.503) to 1.63 (95% CI: 1.45–1.84 –Cp: 0.329). An AAD event peak was identified 60 days before first FQ exposure, with IRR increasing between the 60- to 30- and 29- to 1-day pre-exposure periods. It is uncertain how much this pre-exposure AAD event peak reflects confounding versus increased antibiotic use after a surgical correction of AADs. Conclusion This study does not confirm prior studies. Using Cp values to account for residual error, the observed FQ-AAD association cannot be interpreted as significant. Additionally, an AAD event surge in the 60 days before FQ exposure is consistent with confounding by indication, or increased use of antibiotics post-surgery. Registration NCT03479736.

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Early and long-term complications following transanal pull through Soave technique in infants with Hirschsprung's diseaseric infants with Hirschsprung's disease

Medicine and Pharmacy Reports ◽

10.15386/mpr-1314 ◽

2019 ◽

Author(s):

Manoochehr Ghorbanpour ◽

Mohammad Ali Seyfrabie ◽

Babak Yousefi

Keyword(s):

Intestinal Obstruction ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Statistical Tests ◽

Case Series ◽

P Value ◽

Short Term ◽

Case Series Study ◽

The Mean

Objective. Patients undergoing Soave surgery for Hirschsprung's disease are at risk for some complications. The aim of this study was to investigate such short-term and long-term complications and evaluate the outcome of the operation in these patients. Methods. A case series study was carried out during the last 12 years, during 2007 to 2018 in Besat hospital of Hamadan. Data collection conducted using a checklist includes questions about demographic information, clinical features, and short-term and long-term complications, and consequences of post-operative surgery. The findings of the study were analyzed using SPSS software version 20 and appropriate statistical tests. P-value less than 0.05 was considered statistically significant. Results. A total of 55 children underwent Soave surgery during the last 12 years in Besat Hospital Hamadan, Iran. The mean age of the patients was 38±10 days during surgery, of which 56.4% were female. The mean hospital stay was 7.3 days. Also, the mean weight of children at birth was 2970±447 gr. Most of the patients were born as NVD (52.7%) and term (74.5%). The most common comorbidity was congenital heart disease. The most common short-term complication was intestinal obstruction in 14 patients (25.5%) and the most frequent long-term complication was intestinal obstruction and constipation (27.3% each cases). The mortality rate of patients in this study was 14.5% in total. Conclusions. One stage surgical procedure in Hirschsprung's disease is a safe and effective method, but care should be taken in choosing patients and patients should be monitored for possible complications, so that they can be considered and implemented for proper treatment.

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Acute Kidney Injury with Hemolytic Uremic Syndrome

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd4184 ◽

2021 ◽

Vol 4 (1) ◽

pp. 193-198

Author(s):

Rubina Naqvi ◽

Khawar Abbas ◽

Syed Fazal Akhtar

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Uremic Syndrome ◽

Case Series ◽

Kidney Injury ◽

Febrile Illness ◽

Renal Recovery ◽

P Value ◽

Co Morbidity ◽

Uremic Syndrome

We report here, case series of patients with acute kidney injury (AKI) developing in associationwith hemolytic uremic syndrome (HUS). Different causes of HUS and outcome of patients in this group of patients is aimed to be reported. Patients and Methods: subjects for the study reported here comprised of a cohort of 105 patients admitted with the diagnosis of AKI due to HUS. AKI was defined according to RIFLE criteria and HUS on basis of hematological, biochemical and/or histological features. All patients had normal size kidneys on ultrasonography and no previous co- morbidity. Results: One hundred and five patients with AKI due to HUS were brought to this institute from January 2000 - July 2019; among these 76 were females, mean age of these patients was 27.83±10.50 years. Causes of HUS were febrile illness, with or without diarrhea, diarrhea alone, pregnancy related complications and one each from snake bite, HCV infection / IFN therapy and use of combination of drugs. In pregnancy related HUS one patient had HUS during pregnancy while rest were during postpartum. Renal replacement was required in 95.23 % patients. Complete renal recovery was observed in 22 patients, while 15 died during acute phase of illness. CKD-V developed in 24 patients, 41 patients lost long term follow up, but were dialysis free till last follow up. Treatment with plasmapheresis revealed significantly better renal recovery (p value 0.026) in this group of patients. Conclusion: HUS can be severe life threatening disease; AKI with background of HUS may remain irreversible in many of these patients. Plasmapheresis should be offered to patients with established diagnosis of HUS.

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Vector Analysis of Anticipated Residual Astigmatism and Actual Residual Astigmatism in Toric IOL Implantation using Callisto-Eye

Ophthalmologica Indonesiana ◽

10.35749/journal.v43i1.145 ◽

2019 ◽

Vol 43 (1) ◽

pp. 87

Author(s):

Kukuh Prasetyo ◽

Ucok Pasaribu ◽

Setiyobudi Riyanto ◽

Johan Hutauruk

Keyword(s):

Case Series ◽

Vector Analysis ◽

P Value ◽

Spherical Equivalent ◽

Toric Iol ◽

Iol Implantation ◽

Image Guided ◽

Case Series Study ◽

Significant Difference ◽

Refraction Vector

Purpose: The aim of this study is to investigate the differences of actual residual astigmatism and anticipated residual astigmatism using Alpin’s Vector Analysis from toric IOL implantation using Image Guided System (Callisto EyeTM) and other method. Method: This was a retrospective case series study done in Jakarta Eyte Center. Data was taken consecutively from medical records of Toric IOL implantation from January 2016 to November 2017. Primary data taken were demographic data, anticipated residual astigmatism, refractive examination both subyectively and objectively. Secondary data was analized using Alpin’s Vector Analysis to substract anticipated residual astigmatism from actrual residual astigmatism. Spherical equivalent and axis shifting also taken from refractive ecamination results. Data was divided into subgrup of Toric IOL implantation using Image Guided System and subgrup of Toric IOL implantation using other method. Results: There was a statically significant difference of subjective refraction vector analysis result between subgroups with differnce of 0.312 dioptri (p value 0.004). Objective refraction vector analysis shows no statistically difference between two subgrups (p value 0.286). Spherical equivalent both subjectively and objectively not differ (p value 0.721 and 0,689). Axis shifting from refractive examination also not statistically significant differ between two subgrups (p value 0.432 and 0.358) Conclusion: Difference between actual residual astigmatism from subjective refraction and anticipated residual astigmatism is lower whrn usingCallisto EyeTM.

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Frequency of High Neutrophil and Lymphocyte Ratio (NLR) Among NSTEMI/USA patients

10.53350/pjmhs211582031 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2031-2034

Author(s):

Afaq Shamim ◽

Aijaz Zeeshan Khan Chachar ◽

Miqdad Haider ◽

Mohsin Asif ◽

Sajjad Ali ◽

...

Keyword(s):

Myocardial Infarction ◽

Chronic Stable Angina ◽

Case Series ◽

Neutrophil To Lymphocyte Ratio ◽

Total Leucocyte Count ◽

P Value ◽

Lymphocyte Ratio ◽

Case Series Study ◽

History Of ◽

St Elevation

Background: Neutrophil to lymphocyte ratio (NLR) is comparatively a new prognostic marker used in patients with chronic stable angina (CSA). NLR can help in predicting short and long term moralities in NSTEMI patients. Aim: To evaluate the frequency of high neutrophil and lymphocyte ratio among NSTEMI/USA patients and to compare frequency of mortality in patients of NSTEMI/USA having high NLR with those without high NLR. Study design& duration: Descriptive, case series study from 25th November 2020 to 24th May 2021. Study settings: Department of Medicine and Cardiology, Fatima Memorial Hospital, Lahore. Methods: 185 patients having non ST elevation myocardial infarction (NSTEMI) and/or unstable angina (UA) having 30 to 70 years age and both males and females were included. Patients with sepsis having total Leucocyte count (TLC>11,000/<4000), history of surgery or on steroids in the past three months, history of hematological malignancy, late for fibrinolysis or those with contraindication to fibrinolysis were excluded were excluded. Demographic information (name, age, address, and education) was also noted. Results: Mean age of the participants was 57.99 ± 6.10 years while the age range was from 30 to 70 years. Most of patients 164 were included in the age group of 51 to 70 years. 110 (59.46%) patients were male and 75 (46.54%) of them were females. Frequency of neutrophil and lymphocyte ratio among NSTEMI/USA patients was found in 91 (49.19%) patients. My study has shown higher frequency of mortality in patients of NSTEMI/USA having high NLR 26 (28.57%) compared to normal NLR 06 (6.38%) with p value = 0.0001. Conclusion: Frequency of high neutrophil and lymphocyte ratio among NSTEMI/USA patients is very high with higher mortality in high Neutrophil-to-lymphocyte ratio group as compared to low NLR group. Keywords: Myocardial infarction, Non ST elevation, Neutrophil-to-lymphocyte ratio

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The Influence of Breast Cancer on the Distribution of Cherry Angiomas on the Anterior Thoracic Wall: A Case Series Study

Dermatology ◽

10.1159/000493974 ◽

2018 ◽

Vol 235 (1) ◽

pp. 65-70 ◽

Cited By ~ 2

Author(s):

Antonio Guastafierro ◽

Vincenzo Verdura ◽

Bruno Di Pace ◽

Mario Faenza ◽

Corrado Rubino

Keyword(s):

Breast Cancer ◽

Statistical Significance ◽

Case Series ◽

Thoracic Wall ◽

Rank Test ◽

P Value ◽

Unilateral Breast Cancer ◽

Case Series Study ◽

Signed Rank Test ◽

The Difference

Background/Aims: Cherry angiomas (CAs) are one of the most common vascular manifestations of the skin. By and large, these benign lesions often only represent an aesthetic problem. In the literature, few authors have focused on the pathogenesis of these lesions, and some risk factors have been identified, such as the presence of cutaneous and non-skin neoplasias. In this study, the correlation between the distribution of CAs and breast cancer was investigated. Methods: We carried out a study whereby 50 women with unilateral breast cancer and the presence of CAs on the anterior thoracic wall were evaluated, with a particular focus on the difference in the number of CAs between the two haemithoraces. The data was elaborated using the Wilcoxon signed-rank test in order to evaluate whether there was a statistical significance in the distribution of CAs. Results: In 31 patients we found that the number of CAs was greater on the cancerous breast than on the contralateral one (p value <0.0001). This was confirmed both in the group of patients suffering from ductal breast cancer and in the group with early invasive breast tumours. Conclusion: It is not clear whether CAs develop prior to or following breast cancer, indicating the possibility that this cutaneous manifestation could take on a predictive, prognostic development or represent only an epiphenomenon. Further in-depth studies into the pathogenesis of CAs and the relationship with breast cancer could lead to noteworthy diagnostic-therapeutic advances.

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Prevalence, risk factors and awareness of diabetic retinopathy among admitted diabetic patients at a tertiary level hospital in Kathmandu

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v6i1.10760 ◽

2014 ◽

Vol 6 (1) ◽

pp. 24-30 ◽

Cited By ~ 10

Author(s):

Raba Thapa ◽

Deepak Man Joshi ◽

Aparna Rizyal ◽

Nhukesh Maharjan ◽

Rajesh Dhoj Joshi

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Case Series ◽

Systemic Hypertension ◽

P Value ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Case Series Study ◽

Systemic Problems ◽

Clinically Significant

Introduction: Diabetic retinopathy (DR) is one of the commonest causes of visual impairment and blindness in Nepal. Objectives: The study aims to explore the prevalence, risk factors and awareness of DR among admitted diabetic patients. Materials and methods: A non-interventional case series study was conducted among the inpatient diabetic cases referred for ophthalmic consultation. The patients’ detailed demographics, awareness on DR, concurrent systemic problems, and glycemic control status were recorded. DR was graded using the Early Treatment Diabetic Retinopathy Study Criteria. Main outcome measures: The prevalence, risk factors and awareness of diabetic retinopathy among the study participants was analyzed. Results: A total of 277 diabetic patients were enrolled in the study. The mean age was 62.25 ± 13.26 years. Only one-third (34.6 %) of the cases were admitted for sugar control and newly diagnosed cases comprised of 19.49 %. Nearly half of the cases (46.6 %) were not aware of diabetic retinopathy and dilated fundus evaluation was done for the first time in 44.4 %. DR was found in 38.26 % of the cases and was diagnosed in 13 % of the new cases. Almost four-fifths (78 %) of the diabetics had had the disease for a duration of 16 to 20 years. Clinically significant macular edema was found in 5.78 % and proliferative DR in 2.52 %. DR was significantly associated with the duration of diabetes (P value = 0.001) and concurrent hypertension (P value = 0.004). Conclusion: The prevalence of DR was 38 % among the admitted diabetic cases and the DR was significantly associated with the duration of diabetes and systemic hypertension. Almost half of the cases had been unaware of DR before referral. This emphasizes the importance of the collaboration of the physician and the ophthalmologist for an early DR detection. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10760 Nepal J Ophthalmol 2014; 6 (2): 24-30

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Tympanoplasty Type-I using tragal perichondrium graft: Our experience

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.421 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 2

Author(s):

Fazali Wahid ◽

Sajid Rashid Nagra

Keyword(s):

Tertiary Care ◽

Case Series ◽

Pure Tone Audiometry ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

P Value ◽

Type I ◽

Care Hospital ◽

Female Ratio ◽

Case Series Study

Objective: To determine the efficacy of tragal perichondrium graft used in tympanoplasty Type-I at a tertiary care hospital. Methods: This descriptive case-series study was performed at the department of E.N.T, Head and Neck Surgery, Medical Teaching Institution/Lady Reading Hospital (MTI/LRH), Peshawar, Pakistan from June 2017 to May 2018. After approved from IREB, a well informed consent was taken. Pure Tone Audiometry (PTA) was performed before surgery and post-operatively at three and six months interval. The mean ± SD Air-Bone Gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). Chi-square (X2) test of significance was used taking confidence interval at 95%. The p-value ≤0.05 was considered significant. Results: Total patients were 36; male 21 (58.3%), female 15(41.7%) with male: female ratio of 1.4:1. Mean ± SD age was 27.14 ± 7.49 years (Range 15 – 50Years). Tympanic membrane perforation was commonly found on right side 22 (61.1%), predominantly involving anterioinferior site 19 (52.8%) and medium sized perforation outnumbered 22 (61.1%). Mean pre-operative air-conduction of 49.72 dB was significantly reduced to 18.27 dB with pvalue of <0.05. Similarly the pre-operative mean air bone gap on PTA of 45.63 ± 8.35dB was also reduced to statistically significant level of 7.41 ± 3.51 dB on post-operative PTA with p-value of <.05. Graft was taken up well in 34 cases (94.4%). Conclusion: Tragal perichondrial graft is an effective grafting material used for tympanoplasty due to its possessing qualities. doi: https://doi.org/10.12669/pjms.35.4.421 How to cite this:Wahid FI, Nagra SR. Tympanoplasty type I using tragal perichondrium graft: Our experience. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.421 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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MALIGNANCY IN SOLITARY COLD NODULE THYROID

Annals of King Edward Medical University ◽

10.21649/akemu.v21i4.763 ◽

2016 ◽

Vol 21 (4) ◽

pp. 231

Author(s):

Usman Habib Virk ◽

Yar Muhammad ◽

Khalid Masood Gondal ◽

Humayun Siddique

Keyword(s):

Local Population ◽

Case Series ◽

Sampling Technique ◽

Clinical Problem ◽

Clinical Findings ◽

P Value ◽

Endocrine Gland ◽

Case Series Study ◽

Palpable Nodule ◽

Cold Nodule

AbstractIntroduction:The thyroid gland is one of the largest endocrine gland constitute of two lobes connected by an isthmus. Thyroid nodules are a frequent clinical problem and its incidence is rising. The solitary nodules are the palpable nodule in otherwise normal gland whereas dominant nodules are the palpable nodule in an enlarged gland. There is a variable frequency of malignancy in solitary cold nodule. Our study is aimed to find its frequency in local population.Objective:To determine the frequency of Maligna-ncy in solitary cold nodule thyroid.Material and Methods:This is the descriptive case series study conducted at East Surgical Ward, Mayo Hospital Lahore in 1 year duration from 01-01-2014 to 31-12-2014. 140 patients age more than 12 years of either sex with confirmed solitary cold nodule thyroid of any size on physical examination, ultrasound and thyroid scan through non-probability purposive sampling technique were included in the study. A biopsy of the cold nodule was sent to hospital laboratory to determine the frequency of malignancy. All demographic and clinical findings were recorded on a predesigned proforma. All collected data was entered and analyzed by using SPSS 20. Quantitative variables like age and size of nodule was presented in the form of mean SD and qualitative variables like gender and malignancy was presented in the form of frequency and percentages. Post-stratification chi-square test was applied, P-value ? 0.05 as significant.Results:The mean age of the patients was noted as 40.10 11.62 years. There were 47.14% male patients while 52.86% female. Malignancy was found in 23 (16.43%) patients whereas absent in 117 (83.57%) patients.Conclusion:It is concluded that the malignancy is more frequent in solitary cold nodule thyroid in our local population and in timely intervention and proper screening is recommended.Keywords:Malignancy, Cold Nodule Thyroid, Thy-roid Scan, Biopsy.

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Volitional cycling augmented by functional electrical stimulation in hemiparetic adolescents: A case series study

Journal of Automatic Control ◽

10.2298/jac1301037p ◽

2013 ◽

Vol 21 (1) ◽

pp. 37-42 ◽

Cited By ~ 4

Author(s):

Elisabetta Peri ◽

Emilia Ambrosini ◽

Alessandra Pedrocchi ◽

Emanuela Pagliano ◽

Daria Riva ◽

...

Keyword(s):

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Case Series ◽

Control Group ◽

P Value ◽

Walking Ability ◽

Clinical Scales ◽

Case Series Study ◽

Series Study ◽

Cycling Training

The aim of this work was to assess the feasibility of a treatment based on volitional cycling augmented by Functional Electrical Stimulation (FES) on hemiparetic adolescents. Six chronic hemiparetic adolescents were included in a case series study. Patients underwent FES-cycling training combined with voluntary pedaling. The intervention consisted of 21 sessions lasting 30 minutes each. Patients were evaluated before, after training, and at a 3-month follow-up visit through clinical scales (Winter scale, observational gait scale, gross motor function measurement, Boyd test and Ashworth scale), a standard gait analysis and a voluntary pedaling test. Results were compared with an age-matched healthy control group (N=6). Two subjects withdrew the study before the completion of the intervention. Concerning the four remaining subjects, the clinical scales showed a slight level of disability already at baseline and no changes were observed after the intervention. In terms of walking ability, some significant improvements (Kruskal-Wallis test, p-value<0.05) were obtained after training in two out of four subjects: an increase of about 16% and 41% of the ankle range of motion and of about 18% and 33% of the ankle propelling power were achieved for two subjects, respectively. During pedaling, the work produced by the paretic leg while pulling the pedal significantly increased in 3 out of 4 subjects. In one subject a more symmetrical cycling movement was observed, whilst for another subject a significant improvement in terms of co-contraction between rectus femoris and biceps femoris was achieved. In conclusion, this study assessed the feasibility of FES-cycling training on hemiparetic adolescents, but did not provide evidences about the effectiveness of this intervention in improving motor recovery and walking ability. However, since only a small group of patients with a low level of disability was involved in the study, further investigations are needed to provide conclusive results.

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SEVERITY OF SNAKE BITE WITH EARLY PREDICTORS OF THROMBOCYTOPENIA AND ALBUMINURIA IN ACUTE KIDNEY INJURY

10.36106/gjra/3104201 ◽

2020 ◽

pp. 1-3

Author(s):

Ashmitha Padma ◽

Pramila Devi

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Case Series ◽

Kidney Injury ◽

P Value ◽

Medical College ◽

Urine Albumin ◽

Early Predictors ◽

Case Series Study ◽

Prospective Case Series

Snakebites are very common public health problems which is caused by venomous arthropods effecting many organs and causing fatal emergencies. Snakebite can cause direct or indirect nephro toxicity, especially hematotoxic snakebites. It is important to know the early predictors of acute kidney injury so as to prevent the complications early. Methods: This is a prospective case series study conducted at S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Research center, Bagalkot from June 2018 to June 2019. Results: Total of 51 patients were included in this study who satisfied the inclusion and exclusion criteria. It was found that 35 patients had thrombocytopenia with p value of <0.002, which was highly significant. Serum creatinine was found to be more than 1.2mg/dl in 35 patients and the p value was <0.002 which was highly significant and urine albumin was also found to be more which p avalue was<0.001. among the study subjects 70% of them were found to have thrombocytopenia with albuminuria and increase in serum creatinine.

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