A prospective study of costs associated with the evaluation of allergic reactions to radiological contrast media

Background: The prevalence of hypersensitivity reactions to radiological contrast media (RCM) is increasing due to the greater performance of diagnostic and therapeutic tests that require RCMs. Objective: We carried out a year-long real-life observational study to prospectively evaluate the patients referred to the Allergy Service from Primary Care, Emergency Room, and other Services with suspected moderate to severe RCM hypersensitivity. Methods: To study the costs of RCM hypersensitivity evaluation, we systematically recorded direct and indirect costs. Results: Sixty-nine patients with previous reactions to RCM were evaluated in the Allergy Service from June 1st, 2017, to May 31st, 2018. Total direct health care costs were € 10715.84, with a mean cost per patient of € 155.30 ± 77.08. Specifically, direct non-health costs reached € 1605.42 (mean € 23.27 ± 41.14), and indirect costs were € 6490.85 (mean € 94.07 ± 110.61). In summary, the total cost was € 18812.11, which means a mean cost of € 272.64 ± 164.77. Conclusions: Our study reflects that the costs of an elective evaluation of hypersensitivity to RCM are low. This fact reaffirms that correct and safe management of these patients could be cost-effective, so our efforts should be directed to implement the necessary logistics.

Histopathology and Renal Function in Wistar Rats after Intravascular Injection of Iodinated Contrast Media Iohexol and Iopamidol

This research aimed to analyze the histopathology (tubular necrosis and proteinaceous casts) and renal function (SCr and BUN) differences of male Wistar strain white rats (Rattus norvegicus) after intravascular injection of iodinated contrast media Iohexol and Iopamidol. This research is an experimental laboratory with a post-test only control group design. Male Wistar rats that fit the criteria were divided into three groups by random sampling technique: Control (K), Treatment 1 (P1, Iohexol 350 mg iodine/mL), and Treatment 2 (P2, Iopamidol 370 mg iodine/mL). Iohexol and Iopamidol were injected at a dose of 1600 mg iodine/kg BW. The histopathology differences were observed under a light microscope with a magnification of 400x, which were analyzed semi-quantitatively through slides formed by the paraffin method and H&E staining. SCr and BUN levels were checked using an automatic analysis machine with blood samples taken through the cardiac ventricle. Kruskal-Wallis test (α= 0.05) on renal histopathology scores, both tubular necrosis and protein casts showed Asymp. Sig. value > 0.05, which means there is no significant difference between the groups (K, P1, and P2). Kruskal-Wallis test (α= 0.05) on SCr levels also showed the Asymp. Sig. value > 0.05 and One-Way ANOVA Comparative Test on BUN levels showed the Sig. value > 0.05 which means there is no significant difference in renal function between the groups. This study proved no difference in histopathology and renal function in Wistar rats after injection of iodinated contrast media Iohexol and Iopamidol.

Effectiveness of Boiling Method Using Aquadest Solvent in Oolong Tea Extraction Producing Mangenese Particle as a Contrast Media on Magnetic Resonance Cholangiopancreatography (MRCP)

Magnetic Resonance Cholangiography (MRCP) examines the pancreas and ductus billiaris using magnetic resonance imaging with a negative contrast media administered orally. Oolong tea is possible to be an alternative of an oral negative contrast media due to its manganese contained. This study will elaborate on the best method of oolong tea extraction to get the best mangenese substance and its capability to suppress inevitable organs. This is an experimental study with various methods of extraction, which are the maceration method with ethanol solvent, maceration method with aquadest solvent, and boiling method. The whole process includes collecting and preparing plant materials, sample identification, sample processing, extraction, and extract characterization. The manganese level is checked with Atomic Absorption Spectroscopy (AAS) followed by scanning the extracted oolong tea in bottles and MRCP scanning examination. Results showed that manganese level with three different extraction methods is maceration method with ethanol is 1.23 mg/dl, maceration method with aquadest solvent is 0.82 mg/dl, and the extraction using the boiling method with aquadest solvent 0.94 mg/dl, and manufactured tea 1.40 mg/dl respectively. Scanning the extracted oolong tea in bottles showed that the best suppression is on the bottle, which contains extracted oolong tea using a boiling method with aquadest solvent. The image enhancement on MRCP showed that biliary trees are all enhanced using all the extraction methods; however, the best suppression for the stomach and duodenum is using the boiling method with aquadest solvent. The best choice for oolong tea extraction to get the best image to enhance and maximum suppression for disturbing organs is the boiling method with aquadest solvent. For the oolong tea, oral media contrast is to consider the level of manganese substance and its capability to suppress the disturbing organ to provide the best image for MRCP

Contrast-Enhanced Ultrasound Qualitative and Quantitative Characteristics of Parathyroid Gland Lesions

Background and Objectives: preoperative differentiation of enlarged parathyroid glands may be challenging in conventional B-mode ultrasound. The aim of our study was to analyse qualitative and quantitative characteristics of parathyroid gland lesions, using multiparametric ultrasound protocol—B-mode, Colour Doppler (CD), and contrast-enhanced ultrasound (CEUS)—and to evaluate correlation with morphology in patients with hyperparathyroidism (HPT). Materials and Methods: consecutive 75 patients with 88 parathyroid lesions and biochemically confirmed HPT prior to parathyroidectomy were enrolled in the prospective study. B-mode ultrasound, CD, and CEUS were performed with the subsequent qualitative and quantitative evaluation of acquired data. We used 1 mL or 2 mL of intravenous ultrasound contrast agent during the CEUS examination. Correlation with post-surgical morphology was evaluated. Results: seventy parathyroid adenomas were hypoechoic and well contoured with increased central echogenicity (44.3%), peripheral-central vascularization (47%), and polar feeding vessel (100%). Twelve hyperplasias presented with similar ultrasound appearance and were smaller in volume (p = 0.036). Hyperplasias had a tendency for homogenous, marked intense enhancement vs. peripherally enhanced adenomas with central wash-out in CEUS after quantitative analysis. No significant difference was observed in contrasting dynamics, regardless of contrast media volume use (1 mL vs. 2 mL). We achieved 90.9% sensitivity and 72.7% specificity, 93% positive predictive value (PPV), 87.3% negative predictive value (NPV), and 87.3% accuracy in the differentiation of parathyroid lesions prior to post-processing. In a quantitative lesion analysis, our sensitivity increased up to 98%, specificity 80%, PPV 98%, and NPV 80% with an accuracy of 96.4%. Conclusions: CEUS of parathyroid lesions shows potential in the differentiation of adenoma from hyperplasia, regardless of the amount of contrast media injected. The quantitative analysis improved the sensitivity and specificity of differentiation between parathyroid lesions. Hyperplasia was characterized by homogeneous enhancement, fast uptake, and homogeneous wash-out appearance; adenoma—by peripheral uptake, central wash-out, and reduced hemodynamics. The use of CEUS quantification methods are advised to improve the ultrasound diagnostic role in suspected parathyroid lesions.

Fatal Events Associated with Adverse Drug Reactions in the Korean National Pharmacovigilance Database

Adverse drug reactions (ADRs) pose a global public health threat, substantially contributing to death. Due to the relative paucity of clinical evidence regarding fatal ADRs, this study was performed to characterize the epidemiology of fatal ADRs in Korea. This was a retrospective, cross-sectional analysis of ADR cases reported to the Korea Adverse Event Reporting System from 2010 to 2019. All ADRs were coded using the World Health Organization-Adverse Reaction Terminology system and classified as either fatal or non-fatal events. Logistic regression was performed to identify factors associated with fatal events. Among 289,756 ADR records, 629 fatal events (0.2%) occurred. The most common causative agent of fatal ADRs was antibacterials (20.3%), followed by antimycobacterials (5.4%), analgesics (4.0%), and contrast media (1.9%). Among antimicrobials, vancomycin was most frequently implicated without significantly increasing the risk of fatal events. The risk for fatal ADRs was significantly increased with male sex; advanced age; polypharmacy; piperacillin/β-lactamase inhibitor; cefotetan; ceftriaxone; combination antimycobacterial therapy consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol; morphine; and iopromide (reporting odds ratio > 1, p < 0.05 for all). Although fatal ADRs are uncommon (<1%) in Korea, they are primarily caused by commonly used medications including antibiotics, analgesics, and contrast media.

Hypotension at Hospital Presentation and Post-contrast Acute Kidney Injury Following Computed Tomography with Contrast Media

Background: Post-contrast acute kidney injury (PC-AKI) is a major complication of contrast media usage, and risks for PC-AKI are generally evaluated before performing computed tomography (CT) with contrast at the emergency department (ED). Although persistent hypotension (systolic blood pressure [sBP] <80 mmHg for 1 h) is associated with increased PC-AKI incidence, it remains unclear whether tentative hypotension that is hemodynamically stabilised before CT is a risk for PC-AKI. We hypothesised that hypotension on ED arrival would be associated with higher PC-AKI incidence; even if CT with contrast was performed after patients are appropriately resuscitated. Methods: This multicenter retrospective observational study was conducted at three tertiary care centres during 2013–2014. We identified 280 patients who underwent CT with contrast at ED and whose kidney function was subsequently evaluated. Patients were divided into two groups based on sBP on arrival (<80 vs ≥80 mmHg); hypotension was considered as tentative because CT with contrast has always been performed after patients were stabilised at participating hospitals. PC-AKI incidence was compared between the groups, and inverse probability weighting (IPW) was conducted to adjust background characteristics, including age, sex, comorbidities, anaemia, and acute physiology and chronic health evaluation II score. Results: Eighteen patients were excluded due to chronic haemodialysis, cardiac arrest on arrival, or died within 72 h, and 262 were eligible for this study. PC-AKI incidence was higher in the tentative hypotension group than in the normotension group (7/27 [28.6%] vs 24/235 [10.2%], odds ratio [OR] 3.08 [95% confidence interval (CI) 1.18–8.03], p = 0.026), which was confirmed by IPW (OR 3.25 [95% CI 1.99–5.29], p < 0.001). Similar results were obtained in subgroups with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. Conclusion: Tentative hypotension at ED was associated with PC-AKI development.