Read by QxMD icon Read

Clinical uncertainity

Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Mahmoud Barbarawi, Yazan Zayed, Michael Hicks, Sahar Ahmed, Ghassan Bachuwa, Mustafa Hassan, Deepak L Bhatt
Dual antiplatelet therapy with aspirin and clopidogrel are recommended as adjuncts to fibrinolytic-treated patients with ST-elevation myocardial infarction (STEMI). However, the role of switching to ticagrelor within 24 h of fibrinolytics compared with clopidogrel continuation in this setting is uncertain. Hence, we conducted a comprehensive search of electronic databases for all randomized clinical trials (RCTs) that evaluated the safety and efficacy of ticagrelor versus clopidogrel after fibrinolytic therapy in patients with STEMI...
June 22, 2018: Journal of Thrombosis and Thrombolysis
Eric Courchesne, Tiziano Pramparo, Vahid H Gazestani, Michael V Lombardo, Karen Pierce, Nathan E Lewis
Autism spectrum disorder (ASD) has captured the attention of scientists, clinicians and the lay public because of its uncertain origins and striking and unexplained clinical heterogeneity. Here we review genetic, genomic, cellular, postmortem, animal model, and cell model evidence that shows ASD begins in the womb. This evidence leads to a new theory that ASD is a multistage, progressive disorder of brain development, spanning nearly all of prenatal life. ASD can begin as early as the 1st and 2nd trimester with disruption of cell proliferation and differentiation...
June 22, 2018: Molecular Psychiatry
David M Siebert, Ashwin L Rao
CONTEXT: Recombinant human growth hormone (rHGH) has become a target of abuse in the sporting world. Conversely, sports medicine clinicians may encounter athletes using rHGH to achieve normalcy in the context of growth hormone (GH) deficiency. EVIDENCE ACQUISITION: Medline and PubMed databases were queried using the following keywords: GH, GH physiology, GH deficiency, acromegaly, GH athlete, GH sports, GH athletic performance, and GH deficiency concussion. Articles focusing on GH physiology, deficiency, excess, and its effects in both deficient and healthy patients were included...
June 1, 2018: Sports Health
Susan Martin, Joy Martin
People living with long-term conditions are increasingly being cared for in care homes. Prognostication in this population is particularly challenging, and outcomes are often uncertain. This case history highlights some of the difficulties encountered when clinicians give a time-bound prognosis. It also illustrates how education programmes with high facilitation and ongoing support for care home staff can sustain practice development and enable staff to become highly skilled in working with uncertainty. Practice development programmes such as those based on the Six Steps to Success Programme for care homes give care home staff a framework within which to regularly review a resident's clinical status and the confidence to have the ongoing conversations that empower residents to contribute to decision making and focus on their own goals for care...
June 2, 2018: International Journal of Palliative Nursing
Melissa J Palmer, Sharmani Barnard, Pablo Perel, Caroline Free
BACKGROUND: Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors via lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor...
June 22, 2018: Cochrane Database of Systematic Reviews
Carmelo Diéguez Castillo, Alicia Martín-Lagos Maldonado, Rosa María Ríos Pelegrina, María Del Mar Díaz Alcázar, Amparo Roa Colomo, Elena Ruiz Escolano
Sarcoidosis is a systemic granulomatous disease with an uncertain etiology, characterized by the production of non-necrotizing granulomas. The most frequent presentation is pulmonary and mediastinal, although it might affect any other organ. Hepatic alterations occur in 50 to 65% of the cases. Nevertheless, it is commonly subclinical or detected during a study of the alteration of liver enzymes. It is very unusual that disease onset occurs as an isolated hepatic tumor. A hepatic biopsy is usually required to confirm the diagnosis...
June 22, 2018: Revista Española de Enfermedades Digestivas
Nuria Martín, Patricia Guilabert, Luis Abarca, Gemma Mª Usua, Jordi Serracanta, Maria J Colomina
Patients with major burn injury undergo a series of pathophysiologic changes that begin with a systemic inflammatory response and coagulation abnormalities, similar to those experienced by patients with sepsis or severe trauma. Coagulation changes in patients with burns are generally characterized by procoagulant abnormalities, but alterations in fibrinolysis and anticoagulation factors have also been observed. Around 40% of patients with major burn show changes on standard coagulation tests, and these have been related to the severity of the lesions, smoke inhalation, and administration of intensive fluid resuscitation therapy...
December 6, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
Philipp Ruile, Jan Minners, Philipp Breitbart, Simon Schoechlin, Michael Gick, Gregor Pache, Franz-Josef Neumann, Manuel Hein
OBJECTIVES: The aim of this study was to investigate medium-term outcomes in patients with leaflet thrombosis (LT). BACKGROUND: The clinical significance of early LT after transcatheter aortic valve replacement, diagnosed by computed tomography angiography in approximately 10% of patients, is uncertain. METHODS: In this observational study, computed tomographic angiography was performed a median of 5 days after transcatheter aortic valve replacement and assessed for evidence of LT...
June 25, 2018: JACC. Cardiovascular Interventions
Brian R Weil, Gen Suzuki, Rebeccah F Young, Vijay Iyer, John M Canty
BACKGROUND: The authors previously demonstrated that brief ischemia elicits cardiac troponin I (cTnI) release and myocyte apoptosis in the absence of necrosis. It remains uncertain whether other pathophysiological stresses can produce apoptosis and transient cTnI release without ischemia. OBJECTIVES: This study sought to determine whether a transient increase in left ventricular (LV) preload elicits cTnI release in the absence of ischemia. METHODS: Propofol-anesthetized swine (N = 13) received intravenous phenylephrine (PE) (300 μg/min) for 1 h to increase left ventricular end-diastolic pressure (LVEDP) to ∼30 mm Hg...
June 26, 2018: Journal of the American College of Cardiology
Anne L Dalle Ave, James L Bernat
The whole-brain criterion of death provides that a person who has irreversibly lost all clinical functions of the brain is dead. Bedside brain death (BD) tests permit physicians to determine BD by showing that the whole-brain criterion of death has been fulfilled. In a nonsystematic literature review, we identified and analyzed case reports of a mismatch between the whole-brain criterion of death and bedside BD tests. We found examples of patients diagnosed as BD who showed (1) neurologic signs compatible with retained brain functions, (2) neurologic signs of uncertain origin, and (3) an inconsistency between standard BD tests and ancillary tests for BD...
January 1, 2018: Journal of Intensive Care Medicine
Michele Basso, Vincenzo Dadduzio, Sabrina Rossi, Ettore D'Argento, Antonia Strippoli, Mariantonietta Di Salvatore, Armando Orlandi, Valeria Zurlo, Vincenzo Di Noia, Carlo Barone
This paper has been written because we have a differing idea concerning the suspected negative interference between oxaliplatin and anti-EGFR therapies in cancer patients. Several multicenter, randomized, controlled clinical trials investigated whether the efficacy of oxaliplatin-based chemotherapy is improved by the addition of anti-EGFR therapies in patients affected by KRAS wild-type advanced colorectal cancer. Results of these trials have produced puzzling findings, with some studies demonstrating improved survival and other studies showing no differences in overall survival between experimental and control arms...
June 21, 2018: Personalized Medicine
Conor F Underwood, Jacqueline K Phillips, Cara M Hildreth
Polycystic kidney disease (PKD) is a group of monogenetic conditions characterised by the progressive accumulation of multiple renal cysts and hypertension. One of the earliest features of PKD is a reduction in urinary concentrating capacity that impairs extracellular fluid conservation. Urinary concentrating impairment predisposes PKD patients to periods of hypohydration when fluid loss is not adequately compensated by fluid intake. The hypohydrated state provides a blood hyperosmotic stimulus for vasopressin release to minimise further water loss...
2018: Annals of Nutrition & Metabolism
Rahul P Patel, Madhur D Shastri, Long Chiau Ming, Syed Tabish R Zaidi, Gregory M Peterson
Lichen planus (LP) is an uncommon mucocutaneous inflammatory condition, that is immunologically mediated, typically pruritic and often recurs. The currently advocated therapies are either not highly effective or associated with severe side effects. Enoxaparin, a widely used anticoagulant, is composed of both anticoagulant and non-anticoagulant fragments. Enoxaparin is reported to have anti-inflammatory properties and it was found to be effective in LP. However, the results from clinical studies have varied substantially and, therefore, the clinical role of enoxaparin in LP remains uncertain...
2018: Frontiers in Pharmacology
F Rieder, D Bettenworth, C Ma, C E Parker, L A Williamson, S A Nelson, G van Assche, A Di Sabatino, Y Bouhnik, R W Stidham, A Dignass, G Rogler, S A Taylor, J Stoker, J Rimola, M E Baker, J G Fletcher, J Panes, W J Sandborn, B G Feagan, V Jairath
BACKGROUND: Fibrotic stricture is a common complication of Crohn's disease (CD) affecting approximately half of all patients. No specific anti-fibrotic therapies are available; however, several therapies are currently under evaluation. Drug development for the indication of stricturing CD is hampered by a lack of standardised definitions, diagnostic modalities, clinical trial eligibility criteria, endpoints and treatment targets in stricturing CD. AIM: To standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Chron's disease...
June 19, 2018: Alimentary Pharmacology & Therapeutics
Andreas Leidinger, Jose Piquer, Eliana E Kim, Hadia Nahonda, Mahmood M Qureshi, Paul H Young
BACKGROUND: Pediatric hydrocephalus is a health burden for East African countries with an estimated incidence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical outcomes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar. MATERIAL AND METHODS: From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of hydrocephalus...
June 16, 2018: World Neurosurgery
Elin M Svensson, Robin J Svensson, Lindsey H M Te Brake, Martin J Boeree, Norbert Heinrich, Sarah Konsten, Gavin Churchyard, Rodney Dawson, Andreas H Diacon, Gibson S Kibiki, Lilian T Minja, Nyanda E Ntingiya, Ian Sanne, Stephen H Gillespie, Michael Hoelscher, Patrick P J Phillips, Ulrika S H Simonsson, Rob Aarnoutse
Background: Tuberculosis remains a huge public health problem and the prolonged treatment duration obstructs effective tuberculosis control. Higher rifampicin doses have been associated with better bactericidal activity, but optimal dosing is uncertain. This analysis aimed to characterize the relationship between rifampicin plasma exposure and treatment response over 6 months in a recent study investigating the potential for treatment shortening with high-dose rifampicin. Methods: Data were analyzed from 336 patients with pulmonary tuberculosis (97 with pharmacokinetic data) treated with rifampicin doses of 10, 20, or 35 mg/kg...
June 18, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Kamal Maheshwari, Sandeep Khanna, Gausan Ratna Bajracharya, Natalya Makarova, Quinton Riter, Syed Raza, Jacek B Cywinski, Maged Argalious, Andrea Kurz, Daniel I Sessler
BACKGROUND: Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraoperative hypotension. METHODS: Patients ≥45 years old with American Society of Anesthesiologists physical status III or IV having moderate-to-high-risk noncardiac surgery with general anesthesia were included...
June 14, 2018: Anesthesia and Analgesia
M Juhani Junttila, Lauri Holmström, Katri Pylkäs, Tuomo Mantere, Kari Kaikkonen, Katja Porvari, Marja-Leena Kortelainen, Lasse Pakanen, Risto Kerkelä, Robert J Myerburg, Heikki V Huikuri
BACKGROUND: Myocardial fibrosis is a common postmortem finding among young individuals with sudden cardiac death. Because there is no known single cause, we tested the hypothesis that some cases of myocardial fibrosis in the absence of identifiable causes (primary myocardial fibrosis [PMF]) are associated with genetic variants. METHODS: Tissue was obtained at autopsy from 4031 consecutive individuals with sudden cardiac death in Northern Finland, among whom PMF was the only structural finding in 145 subjects with sudden cardiac death...
June 19, 2018: Circulation
Ning Ma, Joe Zhang, Ilanit Itzhaki, Sophia L Zhang, Haodong Chen, Francois Haddad, Tomoya Kitani, Kitchener D Wilson, Lei Tian, Rajani Shrestha, Haodi Wu, Chi Keung Lam, Nazish Sayed, Joseph C Wu
Background -The progression toward low-cost and rapid next-generation sequencing has uncovered a multitude of variants of uncertain significance (VUS) in both patients and asymptomatic "healthy" individuals. A VUS is a rare or novel variant for which disease pathogenicity has not been conclusively demonstrated or excluded, and thus cannot be definitively annotated. VUS, therefore, pose critical clinical interpretation and risk-assessment challenges, and new methods are urgently needed to better characterize their pathogenicity...
June 18, 2018: Circulation
Elizabeth Selvin, Dan Wang, Kunihiro Matsushita, Morgan E Grams, Josef Coresh
Background: Current clinical definitions of diabetes require repeated blood work to confirm elevated levels of glucose or hemoglobin A1c (HbA1c) to reduce the possibility of a false-positive diagnosis. Whether 2 different tests from a single blood sample provide adequate confirmation is uncertain. Objective: To examine the prognostic performance of a single-sample confirmatory definition of undiagnosed diabetes. Design: Prospective cohort study...
June 19, 2018: Annals of Internal Medicine
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"