The model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and , infection-related deaths, and costs.
Aim. The aim of the paper is to determine association between H. pylori and colonic adenomatous polyps and to explore whether treatment or chronic PPI use can mitigate this risk. Methods. This case-control study included 943 patients who had H. pylori testing and underwent colonoscopy. Presence of polyps was the outcome of interest, whereas age, sex, race, H. pylori infection, triple therapy, and chronic PPI use were independent variables. Multivariate regression analysis was used to calculate odds ratios at 95% confidence intervals. This study was approved by the New York Medical College Institutional Review Board. Results. H. pylori was associated with increased odds of colonic adenomatous polyps (adjusted OR 1.43, 95% CI 1.04–1.77), with stronger association among patients older than 50 (OR 1.65, 95% CI 1.18–2.33). Triple therapy (OR 0.69, 95% CI 0.44–1.07) or chronic PPI use (OR 0.69, 95% CI 0.43–1.09) decreased odds of polyp formation. Analysis revealed a statistically significant reduction in patients who received both triple therapy and chronic PPI, lowering the odds by 60% (adjusted OR 0.43, 95% CI 0.27–0.67). Conclusion. There is increased risk of colonic adenomatous polyps among H. pylori-infected patients. Triple therapy or chronic PPI use may mitigate this risk, with further reduction when these two interventions are combined.
BackgroundThe R2CHADS2 is a new prediction rule for stroke risk in atrial fibrillation (AF) patients wherein R stands for renal risk. However, it was created from a cohort that excluded patients with advanced renal failure (defined as glomerular filtration rate of <30 mL/min). Our study extends the use of R2CHADS2 to patients with advanced renal failure and aims to compare its predictive power against the currently used CHADS and CHA2DS2VaSc.MethodsThis retrospective cohort study analyzed the 1-year risk for stroke of the 524 patients with AF at Metropolitan Hospital Center. AUC and C statistics were calculated using three groups: (i) the entire cohort including patients with advanced renal failure, (ii) a cohort excluding patients with advanced renal failure and (iii) all patients with GFR < 30 mL/min only.ResultsR2CHADS2, as a predictor for stroke risk, consistently performs better than CHADS2 and CHA2DS2VsC in groups 1 and 2. The C-statistic was highest in R2CHADS compared with CHADS or CHADSVASC in group 1 (0.718 versus 0.605 versus 0.602) and in group 2 (0.724 versus 0.584 versus 0.579). However, there was no statistically significant difference in group 3 (0.631 versus 0.629 versus 0.623).ConclusionOur study supports the utility of R2CHADS2 as a clinical prediction rule for stroke risk in patients with advanced renal failure.
In this paper we present an interesting case of acute kidney injury and severe metabolic alkalosis in a patient with a history of heavy heroin abuse. Urine microscopy showed numerous broomstick-like crystals. These crystals are also identified in light and electron microscopy. We hypothesize that heroin crystalizes in an alkaline pH, resulting in tubular obstruction and acute kidney injury. Management is mainly supportive as there is no known specific therapy for this condition. This paper highlights the utility of urine microscopy in diagnosing the etiology of acute kidney injury and proposes a novel disease called heroin crystal nephropathy.
Vitamin D levels, using two established cutoffs, are not significantly associated with increased odds of membership in the CP+ group. However, our data suggest a possible threshold effect of vitamin D at <30 ng/ml associated with increasing odds of being CP+.
This study suggests that total PTX+AT increases the risk for acute postRTX hypocalcemia but has no effect on long-term calcium homeostasis. We speculate that the acuity of the hypocalcemia may be compounded by high-dose glucocorticoids required for induction, in addition to the preoperative undetectable PTH. Thus, prior to RTX, physicians should take into account the type of remote PTX. If a patient had a total PTX+AT, then postRTX hypocalcemia is likely to occur. .
Resumen
Introducción: Siguiendo las recomendaciones de la OMS para eliminar la hepatitis C (2030) se han elaborado múltiples estrategias de micro/macroeliminación. Dentro de las estrategias de microeliminación debe incluirse la búsqueda activa y la simplificación del manejo de la infección en poblaciones de riesgo como los usuarios adictos a drogas.
Material y métodos: Se han analizado de manera descriptiva variables demográficas, clínicas, analíticas, virológicas, de adherencia y de tratamiento de los pacientes derivados desde dos centros de drogodependencia de Málaga capital a la Unidad de Hepatología de un Hospital Universitario en Málaga durante el año 2019 mediante un proceso de derivación simplificado.
Resultados: Se incluyeron un total de 24 pacientes de los cuales 17 (70,8%) acudieron a la primera consulta, resultando el 70,6% virémicos. Se pautaron 10 tratamientos con antivirales de acción directa. La adherencia al tratamiento fue del 80% y a consulta tras una primera visita en Hepatología fue del 91,6%.
Conclusiones: La estrategia implantada en este estudio piloto ha simplificado el diagnóstico y el tratamiento de los pacientes con adicciones y hepatitis C reduciendo el número de visitas de 9 a un máximo de 3 para la prescripción del tratamiento antiviral permitiendo el aumento de pacientes que acuden a la consulta especializada. A pesar de este avance, sigue habiendo un 29% de los pacientes enviados desde estos centros que no acuden a su primera visita. Por lo tanto, creemos de importancia seguir avanzando en la accesibilidad y la simplificación en el diagnóstico y tratamiento de estos pacientes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.