Wide Range Of Incidence Research Articles

Prevalence of Adverse Reactions to Radiopaque Contrast Reported by Patients Presenting for Interventional Pain Procedure

Adverse reactions to radiopaque contrast media (RCM) are well documented with a wide range of incidences reported. The objective of this study was to determine how many patients in a sample of 200 who presents for interventional pain treatments report a history of adverse reactions to RCM. Data from 200 outpatients were collected using a self-administered questionnaire. The questionnaire was designed to obtain information about prior exposure to RCM and any adverse events plus other general information about allergic reactions including known risk factors for allergic reactions. Demographic data and information about past medical history were obtained from each patient. Of the 200 patients surveyed, 16 reported having had an allergic reaction to RCM. The events met criteria for immediate hypersensitivity reaction. Chemotoxic reactions cannot be ruled out. Of factors associated with risk of allergic reaction, none were clearly more prevalent in subjects reporting an allergic reaction vs. subjects who did not. Atopic patients generally considered susceptible to contrast allergy reported no hypersensitivity reaction. The number of medications and foods the subjects reported caused them to have allergic reactions was extensive. Patients with a history suggestive of an immediate hypersensitivity reaction to RCM may report for interventional pain procedures normally performed with RCM. Patients who have experienced an immediate hypersensitivity reaction to RCM have increased risk for another reaction if injected again with contrast agent. Therefore, facilities should be prepared to implement measures to prevent recurrent reactions.

Antibiotic Prophylaxis for Dental Procedures

The possibility that bacteremia from the mouth could cause infective endocarditis (IE) was first suggested >100 years ago, and it was later reinforced by others who targeted the viridans group streptococci from poor oral hygiene and dental extractions.1–3 These observations, along with the advent of antibiotics, eventually led to the first guidelines from the American Heart Association (AHA) in 1955. Antibiotic prophylaxis (AP) became the primary focus for prevention of IE and a standard of care for countries around the world. Controversy concerning efficacy and safety issues has existed for >30 years, and there has been a progressive reduction in the patient populations and the procedures suggested for AP since that time. Of concern, and in spite of a decreasing emphasis on AP for cardiac patients, upwards of 25 noncardiac patient populations are recommended for AP by some clinicians out of concern for systemic infections that might originate from dental procedures (eg, prosthetic joints).4 Article see p 60 Significant differences in recommendations from experts in the United States, United Kingdom, and other countries over the years highlight the lack of convincing data to either support or reject this practice. The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom issued new recommendations in 2006, which took the bold step of eliminating AP altogether.5 Current (2007) AHA guidelines narrow the focus to only 4 cardiac groups at higher risk for a bad outcome from IE but who represent ≈10% of all people at risk for IE.6 The AHA-defined moderate-risk groups represent ≈90% of people at risk for IE, all of whom were recommended for AP before 2007. There are, therefore, no …

1388 STUDY OF ETIOLOGY AND PROGNOSTIC FACTORS OF ACUTE LIVER FAILURE IN CHILDREN

methods of case ascertainment. A wide range of incidence was reported internationally in 24/35 (68.5%) articles, with higher incidence in Japan, Taiwan and French Polynesia. There was insufficient evidence to suggest seasonal variation of BA incidence. Overall survival rates at 10 years range from 66.7% to 89%. Native liver survival rates range from 20.3% to 75.8% at 1–3 years, from 32% to 59.7% at 5 years and from 24% to 52.8% at 10 years following diagnosis. Early hepatoportoenterostomy is a predictor of improved NLS if performed <60 days. There was insufficient evidence to recommend centralization of procedure to high case volume centers. Infant stool color card was reported effective for early detection resulting in early Kasai and improved NLS in Taiwan, but no other jurisdiction. Conclusion: Incidence of BA varies widely worldwide. Age at Kasai operation was reported as a predictive factor for improved NLS. Centralization of procedure to high case volume centers is controversial and cannot be recommended based on current literature. Early diagnosis and subsequent early corrective surgery could be achieved by the infant stool color card. Global implementation of such a tool may help improve outcomes of BA.

Acute Kidney Injury

While acute kidney injury (AKI), a newer term for acute renal failure, has long been recognized as a common and serious complication of hospitalized patients, the study of AKI epidemiology has lagged. An important advance took place with the introduction of consensus AKI definitions by expert panels—first the Risk, Injury, Failure, Loss, and ESRD (RIFLE) criteria by the Acute Dialysis Quality Initiative in 2004,1 and then the Acute Kidney Injury Network (AKIN) criteria in 2007.2 These have allowed researchers to examine AKI epidemiology using a common case definition and to overcome one important limitation in the prior literature when cases were defined using different criteria in different studies, rendering it difficult to interpret variations in reported disease incidence. Since then, several studies have characterized AKI incidence in various settings, with wide range of incidences across different hospital and intensive care unit cohorts,3,4 but relatively few studies have examined secular trends in AKI epidemiology. In this issue of the Archives, Amin et al5 used a large registry of electronic records from 56 US hospitals to explore the temporal trend in the AKI incidence among patients hospitalized with acute myocardial infarction. They observed an overall decline in crude AKI incidence from 26.6% in 2000 to 19.7% in 2008, an overall adjusted decline of 4.4% per year. The study is strengthened by the authors' careful consideration to extensively adjust for demographic variables (age, race/ethnicity, sex) and comorbidities (presence of diabetes mellitus, heart failure, cardiogenic shock, and baseline renal function) that are known AKI risk factors, along with surveillance patterns for AKI, to ensure that the observed temporal trend is not due to an aging and sicker population over time or due to differences in vigilance of renal function monitoring. The data's robustness is further supported by the authors' thoughtful sensitivity analyses ensuring that the duration of hospital participation in the database and severity of AKI did not account for the observed overall trend. The findings are different from those of prior studies demonstrating a rising incidence of AKI. One study using national representative hospital discharge data had shown an increase in AKI incidence on a population level from 1988 to 2002 in the United States.6 Another study using data from a large Northern California integrated health system found a parallel increase in the population incidence of both dialysis-requiring and non–dialysis requiring AKI from 1996 to 2003.7 The availability of actual serum creatinine measurements in the latter study is important since International Classification of Diseases, Ninth Revision (ICD-9) codes for non–dialysis requiring AKI is known to be insensitive and suffer “code-creep” bias.8 These discrepant trends suggest that AKI may be occurring more frequently overall but occurs less commonly in certain subgroups of patients (eg, those with acute myocardial infarction). Certain clues from the current study shed light on possible reasons AKI incidence is declining, specifically in patients with acute myocardial infarction. The authors performed important stratified analyses demonstrating a more prominent decline in AKI incidence in patients with acute myocardial infarction who underwent cardiac catheterization than in those who did not. In addition, they also demonstrated a significant trend in the increasingly more pervasive use of N-acetyl cysteine over time. Since it is not clear that N-acetyl cysteine is effective,9 its use may be a marker for better process of care. These findings suggest that the decline in AKI incidence may be due to improved efforts at preventing contrast-induced AKI in those undergoing cardiac catheterization, such as adequate hydration and limiting contrast load. The interesting subanalysis finding of wide hospital variations in AKI incidence after multivariable adjustment further support that differing practice patterns (ie, systems-based protocols or angiographer skill levels) may play a role specifically in the incidence of contrast-induced AKI. This is a hopeful message. Although current treatment after onset of AKI is largely supportive, prevention of AKI may be a fruitful area of endeavor. Future work needs to be performed on several fronts. One, further population-based epidemiology studies should be conducted to better define contemporary AKI disease incidence—overall and in specific demographic, clinical, and geographic subgroups.10 Two, if the incidence of AKI is increasing overall but falling in some subgroups (eg, among patients with acute myocardial infarction), we need to understand what is driving up the AKI rate in other groups. Three, we need to understand determinants of variations in AKI in a particular setting and identify modifiable risk factors in order to find effective preventive therapies. Finally, in the future, we may be able to adopt AKI incidence among hospitalized patients as a quality and safety outcome measure, akin to the incidence of central line infections, or the incidence of decubitus ulcers among hospitalized patients,11 as focusing attention to this may translate into considerable improvements in patient outcomes.

Pitfall in nephrology: contrast nephropathy has to be differentiated from renal damage due to atheroembolic disease

The topic of contrast-induced nephropathy (CIN) has been receiving an enormous amount of interest in recent times; however, this review is not a review of what CIN is, but what it is not. We will review the main topics demonstrating that the post hoc ergo propter hoc assumption that renal impairment occurring after contrast medium (CM) infusion is necessarily because of it, is wrong, as we are dealing with different diseases, depending on the way the CM is administered and on the type of patient. After >1,000 often repetitive papers, we must deal with an unacceptably wide range of incidences of CIN, with completely different prognoses and astonishingly conflicting results regarding the efficacy of preventive measures with the exception of hydration. So what went wrong? How to separate tares from wheat? When years ago we challenged the diagnosis of CIN, the words cholesterol embolism had never appeared in this setting. Now, we can split the possible renal dysfunctions following CM administration into CM-related hemodynamic and/or tubular damage, cholesterol embolism, ischemia from acute blood loss or hypotension/hypoperfusion and nephrotoxicity from concomitant drugs. In a setting regarding millions of patients and millions of dollars/year, in order to clarify the true renal damage directly related to CM, we ask for prospective studies differentiating cohorts receiving intravenous and intra-arterial, transradial and transfemoral injections, and clinically relevant renal outcomes, thus avoiding the dangers that can come from the idolatry of a surrogate end point such an asymptomatic 25% transient increase of serum creatinine. To avoid that, patients may lose the possibility of a more useful radiological diagnosis, because of an exaggerated suspicion of risk.

Neuraxial Morphine and Respiratory Depression

Morphine is a drug commonly administered via the epidural or intrathecal route, and is regarded by many as the 'gold-standard' single-dose neuraxial opioid due to its postoperative analgesic efficacy and prolonged duration of action. However, respiratory depression is a recognized side effect of neuraxial morphine administered in the perioperative setting. We conducted an extensive review of articles published since 1945 that examine respiratory depression or failure associated with perioperative intrathecal or epidural morphine use. Respiratory depression was previously thought to result from the interaction of opioid in the cerebrospinal fluid with ventral medullary opioid receptors. More recently, the preBötzinger complex located in the medulla has been identified as the site responsible for the decrease in respiratory rate following systemic administration of opioids. Neurons in the preBötzinger complex expressing neurokinin-1 receptors are selectively inhibited by opioids, and therefore are the mediators of opioid-induced respiratory depression. Epidural, intrathecal and plasma pharmacokinetics of opioids are complex, vary between neuraxial compartments, and can even differ within the epidural space itself depending upon level of insertion. Caution should be exercised when prescribing systemic opioids (intravenous or oral) in addition to neuraxial morphine as this can compound the potential for early or delayed respiratory depression. There is a wide range of incidences for respiratory depression following neuraxial morphine in a perioperative setting. Disparity of definitions used for the diagnosis of respiratory depression in the literature precludes identification of the exact incidence of this rare event. The optimal neuraxial opioid dose is a balance between the conflicting demands of providing optimal analgesia while minimizing dose-related adverse effects. Dose-response studies show that neuraxial morphine appears to have an analgesic efficacy 'ceiling'. The optimal 'single-shot' intrathecal dose appears to be 0.075-0.15 mg and the ideal 'single-shot' epidural morphine dose is 2.5-3.75 mg. Analgesic efficacy studies have not been adequately powered to show differences in the incidence of clinically significant respiratory depression. Opioid antagonists such as naloxone to prevent or treat opioid-induced respiratory depression have a number of limitations. Researchers have recently focused on non-opioid drugs such as serotonin receptor agonists. Early evidence suggests that ampakine (α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid [AMPA]) receptor modulators may be effective at reducing opioid-induced respiratory depression while maintaining analgesia. Sodium/proton exchanger type 3 (NHE3) inhibitors, which act centrally on respiratory pathways, also warrant further study.

VOLUMINEUX HEMATOME GENITAL SECONDAIRE A UN THROMBUS VULVOVAGINAL : A PROPOS D’UN CAS

The vulva-vaginal thrombus or puerperal haematoma results from an under mucous shearing of the vulva’s connective tissue, the vagina or of the parameters causing vascular wounds leading into a dissecting haemorrhage. It is a rare pathology with a wide incidence range. We are relating a case of voluminous genitalia thrombus treated at the maternity of Le Dantec’s Teaching Hospital in Dakar. The literature review reveals a global lack of consensus on this pathology. The aetiologies are various and the fac- tors of risks are dominated by the episiotomy and the instrumental extractions and the primipara. The main symptom is often atrocious pain. The treatment, which is not unanimous, is subjected to many controversies. The aggressive surgical treatment that depends on the lesion check up must be quick and effective because the puerperal haematoma can involve the vital pre- diction. The elective embolism seems the most entic- ing and less risky technique unless you have an ade- quate staff and technical plateau. The prevention remains unfortunately random particularly since the haematoma may occur during a normal delivery.

Epidemiology of pediatric inflammatory bowel disease: A systematic review of international trends

Temporal trends in the incidence of pediatric-onset inflammatory bowel disease (IBD) are controversial and a wide range of estimates have been reported worldwide. We conducted a systematic review of research describing the epidemiology of childhood-onset IBD to assess changes in incidence rates over time and to evaluate international differences. The following electronic databases were searched for articles published 1950-2009: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane IBD/Functional Bowel Disorders Group Specialised Trial Register. All included studies reported incidence or prevalence of IBD, Crohn's disease (CD) or ulcerative colitis (UC). Two authors independently completed the data extraction form for each eligible study. Choropleth maps demonstrated the international incidence of IBD, CD, and UC. Incidence of CD and UC was graphed using data from studies reporting rates in multiple time periods. The search yielded 2209 references and review resulted in 139 included studies from 32 countries. A wide range of incidence was reported internationally; however, rates of IBD were not described in most countries. Twenty-eight studies (20.1%) used statistical analysis to assess trends over time, and 77.8% reported statistically significantly increased incidence of pediatric IBD. Of studies calculating statistical trends in CD incidence, 60% reported significantly increased incidence. Of similar UC studies, 20% reported significantly increased incidence. Globally rising rates of pediatric IBD (due primarily to the rising incidence of CD) was demonstrated in both developed and developing nations; however, most countries lack accurate estimates. Analyzing incidence trends may help identify specific environmental and genetic risk factors for pediatric IBD.

A Novel Technique for Nipple-Sparing Mastectomy and Immediate Reconstruction in Patients with Macromastia

A Novel Technique for Nipple-Sparing Mastectomy and Immediate Reconstruction in Patients with Macromastia

Clearing the Air on Smoking and Colorectal Cancer

Clearing the Air on Smoking and Colorectal Cancer

Characterization of inclined GaSb nanopillars by Mueller matrix ellipsometry

Inclined GaSb nanopillars prepared by low energy ion sputtering with oblique ion beam incidence have been characterized by two different Mueller matrix ellipsometric tools. The optical properties of the nanopillars were found to be well described by a uniaxial anisotropic graded effective medium model. The pillar height and inclination angle were determined by fitting the parameters of the effective medium model to spectroscopic (1.44–2.88 eV) Mueller matrix measurements at multiple azimuth sample orientations. A set of different samples with various average pillar height and inclination angle was studied; results from the optical characterization correspond well with those from scanning electron microscopy analysis. For samples with nanopillars inclined by 45° or less, the height could be determined from a single Mueller matrix measurement at only one azimuth orientation, allowing real-time in situ observation of the formation. The nanopillars were also studied using a single wavelength angle resolved Mueller polarimeter, which also can be used to determine height and inclination of the pillars, in addition to validating the optical model over a wide range of incident and azimuth angles.

Flow Physics of a Race Car Wing With Vortex Generators in Ground Effect

This paper experimentally investigates the use of vortex generators for separation control on an inverted wing in ground effect using off-surface flow measurements and surface flow visualization. A typical racing car wing geometry is tested in a rolling road wind tunnel over a wide range of incidences and ride heights. Rectangular vane type of sub-boundary layer and large-scale vortex generators are attached to the suction surface, comprising counter-rotating and corotating configurations. The effects of both device height and spacing are examined. The counter-rotating sub-boundary layer vortex generators and counter-rotating large-scale vortex generators suppress the flow separation at the center of each device pair, while the counter-rotating large-scale vortex generators induce horseshoe vortices between each device where the flow is separated. The corotating sub-boundary layer vortex generators tested here show little evidence of separation control. Increasing the spacing of the counter-rotating sublayer vortex generator induces significant horseshoe vortices, comparable to those seen in the counter-rotating large-scale vortex generator case. Wake surveys show significant spanwise variance behind the wing equipped with the counter-rotating large-scale vortex generators, while the counter-rotating sub-boundary layer vortex generator configuration shows a relatively small variance in the spanwise direction. The flow characteristics revealed here suggest that counter-rotating sub-boundary layer vortex generators can provide effective separation control for race car wings in ground effect.

Metamaterial-induced band-gap of surface plasmon propagation

Surface plasmon propagation along a periodically corrugated metallic–air interface can be completely suppressed due to the formation of an equivalent dielectric metamaterial layer with a large real part of its effective refractive index. The effect can be explained by the transformation of the surface plasmon excitation conditions into a Brewster effect. This phenomenon leads to a high absorption of the incident light over a very wide range of incidence. One-dimensional periodicity (classical grating) leads to a single-polarization absorption, while two-dimensional periodicity (crossed grating) results in omnidirectional absorption in unpolarized light.

Total light absorption in a wide range of incidence by nanostructured metals without plasmons

Metals structured by nanocavities have recently been demonstrated to efficiently absorb light in a wide range of angles of incidence. It has been assumed that nanovoid plasmons are at the origin of the strong absorption. It is shown that it is possible to totally absorb incident light without plasmons. To avoid their excitation, a diffraction grating consisting of cylindrical cavities in a metallic substrate is illuminated in transverse electric polarization. It is found that cylindrical cavities can sustain cavity resonances with a high enhancement of the light intensity, provoking a total absorption of light in a wide range of incidence.

Encountering Patient Suicide: A Requirement of the Residency Program Curriculum

The article entitled “Encountering Patient Suicide: A Resident’s Experience” (1) is an interesting description of the personal toll that the suicide of a patient may take on an early career resident. The authors review the limited data on the curriculum of residency training programs that specifically address educational programs designed to help residents after a patient suicide. The authors recommend additional formal supports within psychiatry training programs. We wholeheartedly concur with these recommendations and feel they are long overdue. We would add that similar supports should be implemented in medicine and surgery residency programs. Residents in these programs also encounter the unexpected death of a patient but have limited resources available to assist them in processing this loss. Many of the recommendations made in this article should be used to design effective programs for medical and surgical residents. Psychiatry and psychology training programs can, and should, take the lead in developing these programs. The authors report that the experience of a patient suicide is not uncommon (a wide range of incidence of patient

Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures

Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures

A prospective national study of acute renal failure treated with RRT: incidence, aetiology and outcomes

Acute renal failure (ARF) is a diverse condition with no standardized definition and is managed in several sub-specialty areas within hospitals. Its incidence and aetiology are unknown and studies show a wide range of incidences. ARF is becoming more common as the population ages leading to the hypothesis that the incidence is much higher than previous estimates. This prospective population study investigated the incidence, aetiology and outcomes of ARF based on a standardized classification of ARF treated by renal replacement therapy (RRT) in all sub-specialty areas within hospitals where such treatment takes place. Data were collected prospectively on all patients starting RRT for ARF within three 12-week periods in 2002. Two hundred eighty-six adults per million population (pmp) per year received RRT for ARF. The incidence increased with age and pre-existing comorbid illness. Two hundred twelve adults pmp per year had no evidence of pre-existing chronic kidney disease (CKD) and the remainder had acute on CKD. The median age was 67 years. Fifty-one percent of the patients received their first RRT treatment in a critical care setting. Sepsis was the most common aetiological insult contributing to ARF in 48% of the patients. Mortality was high with 48% dying within 90 days of starting RRT. Age, comorbidity, sepsis and recent surgery were independent risk factors for death in those with no pre-existing CKD. This is the first national study to describe ARF treated with RRT in all hospital locations. The hypothesis that ARF occurs more frequently than previously thought has been confirmed. This study provides data upon which to base effective decision making for prevention, patient care and resource planning for patients with ARF.

RIFLE classification of acute kidney failure in intensive care

The wide range of incidence of acute renal failure is partly the result of the lack of a reliable definition. The RIFLE classification allows acute renal failure to be stratified for severity, and different outcomes depend on the degree of severity. This review discusses how the RIFLE criteria fit into the whole picture.

Role of infection in irritable bowel syndrome

Infection by pathogenic organisms leads to mucosal damage and disruption of the gut's extensive commensal flora, factors which may lead to prolonged bowel dysfunction. Six to 17% of unselected irritable bowel syndrome (IBS) patients believe their symptoms began with an infection, which is supported by prospective studies showing a 4%-31% incidence of postinfectious IBS-(PI) following bacterial gastroenteritis. The wide range of incidence can be accounted for by differences in risk factors, which include in order of magnitude; severity of initial illness > bacterial toxigenicity > hypochondriasis, depression and neuroticism, and adverse life events in the previous 3 months. PI-IBS has been reported after Campylobacter, Salmonella, and Shigella infections. Serial biopsies after Campylobacter jejuni gastroenteritis show an initial inflammatory infiltrate, with an increase in enterochromaffin (EC) cells, which in most cases subsides over the next 6 months. Those who go on to develop IBS show increased numbers of EC and lymphocyte cell counts at 3 months compared with those who do not develop IBS. Interleukin-1beta mRNA levels are increased in the mucosa of those who develop PI-IBS, who also show increased gut permeability. Recover can be slow, with approximately 50% still having symptoms at 5 years. Recent studies suggest an increase in peripheral blood mononuclear cell cytokine production in unselected IBS, an abnormality that may be ameliorated by probiotic treatment. The role of small-bowel bacterial overgrowth in IBS is controversial, but broad-spectrum antibiotics do have a temporary benefit in some patients. More acceptable long-term treatments altering gut flora are awaited with interest.

The epidemiology of acute renal failure in the world

The aim of this article is to describe our current understanding of the epidemiology of acute renal failure, especially in severe cases requiring renal replacement therapy. Some data from an international observational study (the Beginning and Ending Supportive Therapy (BEST) for the kidney study) are also presented. Multiple epidemiological studies for acute renal failure have been conducted in different populations using various criteria and reported a wide range of incidence and mortality. In several multicenter studies reporting the incidence of renal replacement therapy requirement in a general intensive care unit population, however, renal replacement therapy requirement and hospital mortality was quite similar among the studies, approximately 4% and 60%, respectively. In North and South America, nephrologists typically manage acute renal failure patients with intermittent renal replacement therapy. On the other hand, in Asia, Australia and Europe, intensivists are commonly responsible for managing these patients with continuous renal replacement therapy. Although the epidemiology of acute renal failure is varied among regions and centers, the average incidence of renal replacement therapy requirement and hospital mortality in critical illness are similar in multicenter studies. Continuous renal replacement therapy is gaining popularity and intensivists are becoming responsible for managing patients with it. More studies are needed to understand acute renal failure epidemiology worldwide. To conduct such studies, consensus criteria for acute renal failure and a well performed acute renal failure-specific severity score will be required.