Fatigue has been shown to be more frequent than previously thought in immune-mediated polyneuropathies. However, fatigue has not been reported as the main cause of referral in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. Between January 2001 and December 2003, we investigated 11 patients referred for fatigue, for which we established a final diagnosis of CIDP. All patients had at least two clinical examinations including assessment of the fatigue severity scale (FSS) and one electrophysiological and laboratory work up. Additionally, 10 of the 11 patients had a nerve biopsy. There were 11 male patients. Mean age at onset was 53 AE 11 years. Main cause of referral was fatigue in all patients. Additional symptoms included cramps (one case), distal paresthesias (six cases), limb pain (seven cases) and vasomotor disturbances (one case). Cerebrospinal fluid (CSF) analysis displayed a moderate increase in protein content in four patients. Electrophysiological analysis showed abnormalities in all patients. Among 11 patients, one fulfilled the American Academy of Neurology electrodiagnostic criteria for CIDP and three fulfilled the inflammatory neuropathy cause and treatment group or the Nicolas et al. criteria. In the eight remaining patients, a nerve biopsy confirmed the diagnosis of CIDP. Ten patients were treated, among which seven showed a significant improvement based on the FSS scale. This study shows that fatigue is a possible cause of referral for patients with CIDP and, like previous reports, emphasizes the lack of sensitivity of widely accepted electrophysiological criteria of CIDP. Long-term follow up of these patients is warranted to determine the prognosis of these minimal forms of CIDP and establish the best therapeutic strategy in such cases.
Background Dabigatran is indicated for primary prevention of venous thromboembolism (VTE) in adult patients undergoing surgery for total hip or knee replacement. Purpose To analyse the prescription and adaptation to the approved indications for dabigatran in a tertiary hospital. Materials and methods Retrospective observational study lasting 12 months (January 2010-December 2010) which included patients treated with dabigatran. Results During the study period, 236 interventions were made for which dabigatran treatment was suitable (94 hip and 142 knee replacements). Dabigatran was prescribed in 11 patients (9 women and 2 men), mean age 61 years (36-77): 5 for hip replacement, 2 for knee replacement, 1 for partial femoral neck fracture and 3 patients had not undergone prosthetic intervention. Dose adjustment was necessary only in two patients aged over 75 years: a 77-year-old woman treated with 110 mg/day and a 76-year-old man with 150 mg/day. Only in 63.63% of cases (n=7) did the prescription conform to the approved indications. Conclusions Despite being newly introduced to the hospital's formulary, it is necessary to remark that one third of the prescriptions did not conform to the approved indications for use in the hospital. Therefore, it is necessary to create and disseminate standard rules for use in the medical wards. This will increase adherence to the recommendations of use, reduce prescribing errors and establish corrective actions for them.
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