Changes In Physical Examination Findings Research Articles

Operation After Radiologic Embolization for Blunt Liver Trauma

Abstract Motor vehicle accidents and other blunt high-impact traumas occur with relative frequency in children and adolescents, potentially causing severe injury or death (Martin et al., 2017). A common consequence of blunt trauma is laceration to the solid organs such as liver, kidneys, or spleen. These injuries are typically managed nonoperatively, occasionally utilizing interventional radiology (IR) embolization (Arbra et al., 2017). This case report discusses a child with Grade V+ liver laceration, who underwent IR embolization and ultimately required laparoscopic evacuation of abdominal hemorrhage with peritoneal drain placement. As a complication of IR embolization, the patient developed an occlusive thrombus in his right common femoral artery. A systematic review of nonoperative management in pediatric trauma by the American Pediatric Surgical Association concluded that there is no need to put patients through the risks of an IR embolization procedure if the patient remains stable (Gates et al., 2019). Although the guidelines are useful, clinical judgment remains the best determinant for invasive intervention. From a trauma nursing perspective, these cases require serial abdominal examinations combined with excellent communication between nurses and physicians to highlight changes in physical examination findings. In addition, research on IR procedures in the context of hepatic injury needs further study.

Safety and tolerability of lersivirine, a nonnucleoside reverse transcriptase inhibitor, during a 28-day, randomized, placebo-controlled, Phase I clinical study in healthy male volunteers

Background: Lersivirine is a nonnucleoside reverse transcriptase inhibitor undergoing clinical development for the treatment of HIV-1. Objective: The goal of this study was to investigate the safety and tolerability of multiple oral doses of lersivirine administered to healthy male subjects to assist in the planning of longer term studies. Methods: This was a randomized, double-blind, double-dummy, placebo-controlled, parallel-group, multicenter, Phase I clinical study in fasting, healthy male volunteers. Subjects were randomly assigned in a ratio of 7:7:4:4 to receive lersivirine 500 mg BID, lersivirine 750 mg once daily, efavirenz 600 mg once daily, or placebo once daily for 28 days. Safety and tolerability were assessed throughout the study by continuous collection of adverse events (AEs), including adverse drug reactions, illnesses with onset during the study, exacerbation of previous illnesses, and clinically significant changes in physical examination findings. Vital sign measurements and ECGs were performed at screening; on day 1 (predose and 2, 3, and 4 hours postdose); on days 7, 14, 21, and 28 (predose); at discharge; and at follow-up. Safety laboratory tests (including hematology, chemistry, and urinalysis) were performed at screening; days 0, 7, 14, 21, and 27; and at follow-up. Results: Of the 66 healthy male subjects enrolled (age range, 21–51 years; body mass index, 18.1–29.9 kg/m 2), 40 were white, 22 were Asian, 3 were black, and 1 was of mixed race. There were no clinically significant laboratory abnormalities, including changes in lipid profile, liver or renal function test results, or ECG findings. Overall, 86% (18/21) of subjects in the lersivirine 500-mg BID group, 81% (17/21) in the lersivirine 750-mg once-daily group, 92% (11/12) in the efavirenz 600-mg once-daily group, and 92% (11/12) in the placebo group experienced at least one treatment-related AE. Eight subjects were permanently discontinued from the study; 4 subjects in the efavirenz group (3 of whom participated in the trial at the Brussels study center) were permanently discontinued due to AEs considered to be treatment related. No subjects receiving lersivirine permanently discontinued the study due to treatment-related AEs, although one subject temporarily discontinued treatment. In addition, 4 subjects withdrew consent (2 subjects [1 of whom was at the Brussels study center] receiving lersivirine 750 mg once daily and 2 subjects [1 of whom was at the Brussels study center] receiving efavirenz). There were no deaths or serious AEs in any of the study groups. Conclusion: Lersivirine appeared to be well tolerated after 28 days of continuous dosing in this small, selected group of young, healthy male volunteers.

Clinical, clinicopathologic, and radiographic findings in dogs with aspiration pneumonia: 88 cases (2004–2006)

To evaluate clinical, clinicopathologic, and radiographic findings in dogs with aspiration pneumonia. Retrospective case series. Animals-88 dogs with aspiration pneumonia. History, physical examination findings, and clinicopathologic data were obtained from medical records and analyzed for all 88 dogs. Thoracic radiographic findings for all dogs were reviewed to determine the type and location of pulmonary infiltrates. Aspiration pneumonia was evident at admission to the hospital in 65 (74%) dogs and developed during hospitalization in 23 (26%) dogs. Less than half of these affected dogs had high values for rectal temperature, heart rate, or respiratory rate; however, most (68%) affected dogs had increased, decreased, or adventitious lung sounds. Neutrophilia with a left shift was a common finding. Hypoalbuminemia was detected in 31 of 58 (53%) dogs. Hypoxemia and a high alveolar-arterial gradient in partial pressure of oxygen were detected in 22 of 28 (79%) dogs and 27 of 28 (96%) dogs, respectively. Among the 88 dogs, thoracic radiography revealed a predominantly alveolar infiltrate in 65 (74%) dogs and an interstitial pattern in 23 (26%) dogs; a single lung lobe was affected in 46 (52%) dogs, most commonly the right middle lung lobe (21/46 [46%] dogs). In dogs, aspiration pneumonia was often associated with abnormalities in pulmonary auscultation in the absence of objective changes in physical examination findings. However, neutrophilia, hypoalbuminemia, and hypoxemia were frequently detected, and radiographic evidence of infiltrates in the right middle lung lobe was common.

Fluvastatin administration of bedtime versus with the evening meal: A multicenter comparison of bioavailability, safety, and efficacy

Fluvastatin is a totally synthetic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor that is effective in reducing cholesterol when given in a single evening dose. Absorption and rate of bioavailability may be affected when administered with food, but the effect of mealtime dosing of efficacy and safety has not been evaluated. This multicenter, double-blind, placebo-controlled crossover study was performed in 44 patients with primary hypercholesterolemia. Patients received 20 mg of fluvastatin with the evening meal and placebo at bedtime for 6 weeks, followed by 12 weeks of placebo at mealtime and fluvastatin at bedtime (group 1). Group 2 received the opposite treatment schedule, and group 3 received placebo at mealtime and at bedtime for 12 weeks before receiving 20 mg of fluvastatin at bedtime instead of placebo for the final 6 weeks. Fluvastatin with the evening meal resulted in a marginally lower peak serum concentration (p <0.1) and a significantly delayed time to peak concentration compared with bedtime dosing, but there were no statistically significant differences in the extent of bioavailability. At the end of the first 6 weeks of treatment, similar reductions in low-density lipoprotein (LDL) cholesterol were obtained whether fluvastatin was given at mealtime (−21.8%; p <0.001) or at bedtime (−23.9%; p <0.001). After crossover of groups 1 and 2, the results remained constant. With fluvastatin, there were comparable reductions in total cholesterol (p <0.001) and in LDL:high-density lipoprotein (HDL) ratio (p <0.001) irrespective of the time of dosing. In conclusion, fluvastatin had a similar tolerability, safety, and efficacy, whether given with the evening meal or at bedtime. There were no serious adverse events nor changes in physical examination findings or laboratory values attributable to treatment.