This study confirms that abrupt withdrawal of chronic dopamine agonist therapy, following 2 to 3 years of treatment is safe and associated with long-term remission in 30-40% of subjects with microprolactinomas. This therapeutic strategy is convenient and applicable in clinical practice.
The Fibroid Registry for Outcomes Data (FIBROID) was founded in 1999 to serve as a prospective multicenter database of women undergoing uterine embolization for leiomyomata. This paper presents an analysis of the short-term outcomes of patients enrolled at 72 participating sites. Of a total 3005 patients, 2729 had a 30-day follow-up interview, which provided information on any further medical care, adverse events, time to return to work, and time to return to normal activities. The Registry defined an adverse event as an unexpected problem that required an unanticipated clinic visit or unanticipated therapy.Seventy-four percent of all patients received preprocedure antibiotics and one fourth was also given antibiotics postprocedure. Uterine embolizations were generally carried out under intravenous conscious sedation and supplemented with narcotics, two thirds of which were patient-controlled. In one participating center, regional analgesia was used in 12% of cases. Overall, 5% of patients had postprocedure deep vein thrombosis (DVT) prophylaxis with automated intermittent compression boots.Seventy-four percent of procedures were technically successful. Technical failures occurred when only one uterine artery could be identified for embolization or when bilateral uterine artery catheterization was unsuccessful.The average hospital stay was 1.68 days. During hospitalization, 90 patients experienced 94 adverse events, of which 20 were major. Eleven of these prolonged the hospital stay. Pain and nausea were the most common conditions, but one patient had a femoral nerve injury, which resulted in permanent leg pain. Other problems included drug reaction, urinary retention, and contrast reaction. Of 74 minor complications, groin hematomas were the most common (n ϭ 22). Other minor complications included less severe nausea, pain, vessel injury, drug reaction, urinary retention, and contrast reaction, as well as device-related problems and nontarget embolization. Patients generally resumed normal activities after 2 weeks.Major and minor adverse events were combined for univariate analysis. Possible predictors for perioperative complications, including patient demographic variables, medical history variables, presenting signs and symptoms, medications used, procedure-related variables, and site-related variables, were included. Only length of procedure, site status (ie, core registry sites vs participating sites), and size of leiomyomata were found to have predictive value for operative complications (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.005-1.019; OR, 0.334; 95% CI, 0.15-0.76; OR, 1.0173; 95% CI, 1.0131-0138; respectively). After multivariate analysis, site status was no longer predictive of perioperative adverse advents.By the 1-month postprocedure evaluation, 710 patients had reported adverse events. Major complications (n ϭ 111; 4%) were persistent bleeding in 7 patients, infection or possible infection in 17, new hot flashes in 2, thromboembolism GYNECOLOGY Volume 60, Number 11 OBSTETRICAL AND GYN...
ObjectiveGenetic polymorphisms of CYP2C9 and VKORC1 play major role in pharmacokinetics and pharmacodynamics of warfarin, respectively. Purpose of our study was to assess the utility of pretesting patients for the above mutations in predicting tendency for bleeding and achieving target INR.MethodsThis was an audit of data collected between July 2011 and December 2016. For safety and efficacy, patients were divided into two subgroups: those with or without bleeding and those who achieved target INR or not. Chi square test was applied to compare the between group differences and crude Odds Ratio (cOR) calculated.ResultsAmong 521 patients evaluated, most common indication for warfarin therapy was valvular heart disease (210/521 = 40%); 36% (187/521) had at least one bleeding episode; 56% (269/479) had below target INR. 26% (136/521) had polymorphic alleles of CYP2C9 and 69% (358/521) had the GG haplotype of VKORC1. Polymorphic alleles of CYP2C9 or AG/AA haplotype had twice the odds of bleeding (cOR = 2.14 and 2.44 respectively) relative to those with wild CYP2C9 allele or GG haplotype. Combined CYP2C9 mutant alleles and/or AG/AA haplotypes had thrice the odds of bleeding (cOR = 3.12) relative to those with wild CYP2C9 alleles and GG haplotype. Those with GG haplotype had twice the odds (cOR = 1.81) and those with GG haplotype along with wild CYP2C9 allele had four times the odds (cOR = 4.27) of not achieving the target INR relative to those with other haplotype/alleles. All these associations were statistically significant (p < 0.05).ConclusionsPretesting patients for genetic polymorphisms could aid in individualizing warfarin therapy.
A novel coronavirus was reported in Wuhan, China in December 2019 to cause severe acute respiratory symptoms . In this meta-analysis, we estimated case fatality rate from COVID-19 infection by random effect meta-analysis model with country level data. Publicly accessible web database WorldOMeter (https://www.worldometers.info/coronavirus/) was accessed on 24th March 2020 GMT and reported total number of cases, total death, active cases and seriously ill/ critically ill patients were retrieved. Primary outcome of this meta-analysis was case fatality rate defined by total number of deaths divided by total number of diagnosed cases. Pooled case fatality rate (95% CI) was 1.78 (1.34-2.22) %. Between country heterogeneity was 0.018 (p<0.0001). Pooled estimate of composite poor outcome (95% CI) was 4.06 (3.24-4.88) % at that point of time after exclusion of countries reported small number of cases. Pooled mortality rate (95% CI) was 33.97 (27.44-40.49) % amongst closed cases (where patients have recovered or died)with. Meta regression analysis identified statistically significant association between health expenditure and case fatality rate (p=0.0017).
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