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We report a unusual case of idiopathic nodular glomerulosclerosis mimicking changes that develop in diabetic nephropathy. A 66-year-old non-diabetic female developed nephrotic range proteinuria and the work up was unremarkable. Light and... more
We report a unusual case of idiopathic nodular glomerulosclerosis mimicking changes that develop in diabetic nephropathy. A 66-year-old non-diabetic female developed nephrotic range proteinuria and the work up was unremarkable. Light and electron microscopy showed mesangial expansion with Kimmelsteil-Wilson nodules and diffuse glomerular basement membrane thickening without any electron dense deposits. Diabetes mellitus was excluded by repeated clinical and laboratory investigations. Forty two similar cases have been reported. Exact etiology for the development of non-diabetic glomerulosclerosis is unclear. But, hypertension, smoking, obesity, intermittent hyperglycemia predating the diagnosis of diabetes possibly explain the development of nodular glomerulosclerosis in these patients. Long-term follow-up to screen for the delayed onset of diabetes or its complications may be worthwhile.
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Cocaine-induced acute renal failure has been reported in association with rhabdomyolysis. We describe a case of a young African American male who developed acute renal failure, which possibly occurred after inhalation of cocaine without... more
Cocaine-induced acute renal failure has been reported in association with rhabdomyolysis. We describe a case of a young African American male who developed acute renal failure, which possibly occurred after inhalation of cocaine without concomitant rhabdomyolysis. His renal function recovered with supportive hydration. The most likely mechanism was intense vasoconstriction. Clinicians need to be mindful of this unique feature of cocaine intoxication.
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A 74-year-old, white woman was admitted to the hospital for pleural effusion. Her medical history included orthotopic cardiac transplantation, hypertension, hypercholesterolemia, peripheral vascular disease, diabetes mellitus, and renal... more
A 74-year-old, white woman was admitted to the hospital for pleural effusion. Her medical history included orthotopic cardiac transplantation, hypertension, hypercholesterolemia, peripheral vascular disease, diabetes mellitus, and renal insufficiency secondary to cyclosporine. She was on ...
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Research Interests: Family Medicine, Chronic kidney disease, Medicine, Humans, Female, and 15 moreMale, Clinical Sciences, Health System, Aged, Middle Aged, Kidney Disease, Age Factors, Educational Status, Chronic Kidney Failure, Data Extraction, Minority Group, attitude to health, Delivery of Health Care, healthcare disparities, and Kidney function tests
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BACKGROUND: Hydroxychloroquine and chloroquine are widely used to treat hospitalized COVID-19 patients primarily based on antiviral activity in in vitro studies. Our objective was to systematically evaluate their efficacy and safety in... more
BACKGROUND: Hydroxychloroquine and chloroquine are widely used to treat hospitalized COVID-19 patients primarily based on antiviral activity in in vitro studies. Our objective was to systematically evaluate their efficacy and safety in hospitalized patients with COVID-19. METHODS: We systematically reviewed PubMed, ClinicalTrials.gov, and Medrxviv for studies of hydroxychloroquine and chloroquine in COVID-19 hospitalized patients on April 26, 2020. We evaluated the quality of trials and observational studies using the Jadad criteria and Newcastle Ottawa Scale, respectively. RESULTS: After a review of 175 citations, we included 5 clinical trials (total of 345 patients), 9 observational studies (n = 2529), and 6 additional studies (n = 775) reporting on the QT interval. Three studies reported treatment benefits including two studies reporting benefit on virologic outcomes, which was statistically significant in one study, and another reported significant improvement on cough symptoms....
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The influence of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus on the risk of hepatocellular carcinoma (HCC) is conflicting. We conducted a systematic review and meta-analysis to determine the incidence or recurrence... more
The influence of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus on the risk of hepatocellular carcinoma (HCC) is conflicting. We conducted a systematic review and meta-analysis to determine the incidence or recurrence of HCC associated with oral DAA therapy. We searched PubMed, Scopus, Embase from inception to August 2017 to identify observational studies reporting on HCC among patients treated with DAAs. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled by random-effects model. The primary outcome was the proportion of participants with incidence or recurrence of HCC (PROSPERO number CRD42017057040). After reviewing 2080 citations, we included 8 controlled studies and 36 uncontrolled studies. The pooled proportion for incident HCC was 1.5 % (95% CI 1.0% to 2.1%; I=90.1%; n= 542/39 145) from 18 uncontrolled studies and 3.3% (95% CI 1.2% to 9%; I =96%; n=109/6909) from 5 controlled studies, respectively. The pooled proportio...
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Recently, two large randomized controlled trials which only included patients with underlying cardiovascular disease (CVD) or patients at high risk for CVD showed that two sodium glucose co-transporter 2 inhibitors (SGLT-2is)... more
Recently, two large randomized controlled trials which only included patients with underlying cardiovascular disease (CVD) or patients at high risk for CVD showed that two sodium glucose co-transporter 2 inhibitors (SGLT-2is) significantly reduced hospitalization for heart failure (hHF), with an early separation in the survival curves for hHF. There were concerns whether SGLT-2i use could protect hHF in patients without CVD and how soon SGLT-2i-treated patients show a lower risk of hHF. Thus, we aimed to evaluate whether the heart failure protective effect of SGLT-2i differs depending on the underlying CVD and the prescription period compared with dipeptidyl peptidase-4 inhibitors (DPP-4i). We performed a nationwide retrospective observational study to estimate the effect of SGLT-2i on HF. The 59,479 SGLT-2i new-users were matched with same number of DPP-4i new-users through propensity score matching using 53 confounding variables. Kaplan-Meier (K-M) curves and Cox proportional haza...
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Research Interests: Engineering, Medicine, Physical Therapy, Biological Sciences, Osteoporosis, and 10 moreMedline, Meta Analysis, Systematic review, Outcomes, Randomized Controlled Trial, Observational Study, Nutritional and Metabolic Diseases, Musculoskeletal diseases, Medical and Health Sciences, and Cochrane Library
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To examine the relationship between different anti-diabetic therapies (dipeptidyl peptidase-4 (DPP-4), metformin and sulfonylureas) and risk of acute pancreatitis among type 2 diabetic patients in Taiwan, and explore each drug's... more
To examine the relationship between different anti-diabetic therapies (dipeptidyl peptidase-4 (DPP-4), metformin and sulfonylureas) and risk of acute pancreatitis among type 2 diabetic patients in Taiwan, and explore each drug's dose-response relationship. We derived a nationwide retrospective cohort of patients with type 2 diabetes in Taiwan. The inclusion criteria are adult diabetic patients with continuous baseline enrollment, new users of the studied drugs, and without missing demographics. There were 4113/101 498/44 772 DPP-4/Metformin/Sulfonylurea users. Adjusted hazards ratios for pancreatitis associated with DPP-4, derived from Cox proportional hazard models with propensity score weighting, were estimated; dose-response analyses were also conducted. Dipeptidyl peptidase-4 was statistically significantly associated with a decreased risk of acute pancreatitis compared with sulfonylureas (adjusted HR: 0.36, 95%CI [0.17, 0.75]) but not metformin (adjusted HR: 0.67, 95%CI [0....
Research Interests: Pharmacoepidemiology, Pancreatitis, Adolescent, Medicine, Applied Economics, and 15 moreHumans, Internal Medicine, Metformin, Diabetes mellitus, Female, Male, Cohort Study, Acute Pancreatitis, Aged, Middle Aged, Adult, Oral Hypoglycemic Agents, Pharmacoepidemiology and drug safety, Cohort Studies, and hazard ratio
Research Interests: Respiratory Medicine, Epidemiology, Risk assessment, Medicine, Humans, and 11 moreInternal Medicine, Pneumonia, Meta Analysis, Clinical Sciences, Prognosis, Biological markers, Risk Assessment, Sensitivity and Specificity, Bias (Epidemiology), Adrenomedullin, and Cardiovascular medicine and haematology
INTRODUCTION Grading the strength of a body of diagnostic test evidence involves challenges over and above those related to grading the evidence from health care intervention studies. This chapter identifies challenges and outlines... more
INTRODUCTION Grading the strength of a body of diagnostic test evidence involves challenges over and above those related to grading the evidence from health care intervention studies. This chapter identifies challenges and outlines principles for grading the body of evidence related to diagnostic test performance. CHALLENGES Diagnostic test evidence is challenging to grade because standard tools for grading evidence were designed for questions about treatment rather than diagnostic testing; and the clinical usefulness of a diagnostic test depends on multiple links in a chain of evidence connecting the performance of a test to changes in clinical outcomes. PRINCIPLES Reviewers grading the strength of a body of evidence on diagnostic tests should consider the principle domains of risk of bias, directness, consistency, and precision, as well as publication bias, dose response association, plausible unmeasured confounders that would decrease an effect, and strength of association, simil...
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Background.Many episodes of bleeding in the upper gastrointestinal tract are caused by Helicobacter pylori infection. Because these episodes present a life‐threatening complication in patients with bleeding disorders, we prospectively... more
Background.Many episodes of bleeding in the upper gastrointestinal tract are caused by Helicobacter pylori infection. Because these episodes present a life‐threatening complication in patients with bleeding disorders, we prospectively investigated the prevalence of H. pylori infection in patients with hemophilia A or B and with the von Willebrand syndrome.Methods.Seventy patients (54 men, 16 women, ages 40 ± 11 years) and 100 age‐related volunteers (63 men, 37 women, ages 39 ± 9 years) were tested for H. pylori infection using the 13C urea breath test. Fifty‐four patients with hemophilia and 16 patients with von Willebrand syndrome participated.Results.Thirty‐three (33%) of the controls and 24 (34.3%) of the patients showed positive 13C urea breath tests (p = .97). Nineteen (35.2%) patients with hemophilia and 5 (31.3%) patients with von Willebrand syndrome were positive for H. pylori. History of dyspeptic symptoms (28% vs. 26%) were not different in patients and controls (p = .91)....
Research Interests: Gastroenterology, Helicobacter pylori, Medicine, Biological Sciences, Prospective studies, and 15 moreHumans, Internal Medicine, Female, Male, Dyspepsia, Urea, Risk factors, Epidemiology of Helicobacter pylori infection, Prevalence, Middle Aged, Adult, Hemophilia A, Risk Factors, Gastrointestinal bleeding, and Medical and Health Sciences
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Network meta-analysis, in the context of a systematic review, is a meta-analysis in which multiple treatments (that is, three or more) are being compared using both direct comparisons of interventions within randomized controlled trials... more
Network meta-analysis, in the context of a systematic review, is a meta-analysis in which multiple treatments (that is, three or more) are being compared using both direct comparisons of interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator. To ensure validity of findings from network meta-analyses, the systematic review must be designed rigorously and conducted carefully. Aspects of designing and conducting a systematic review for network meta-analysis include defining the review question, specifying eligibility criteria, searching for and selecting studies, assessing risk of bias and quality of evidence, conducting a network meta-analysis, interpreting and reporting findings. This commentary summarizes the methodologic challenges and research opportunities for network meta-analysis relevant to each aspect of the systematic review process based on discussions at a network meta-analysis methodology meeting we hosted in ...
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Research Interests: Nephrology, Treatment, Kidney diseases, Medicine, Prevention, and 15 moreAcute renal failure, Humans, Internal Medicine, American, Metaanalysis, Meta Analysis, Systematic review, Clinical Sciences, Nephropathy, Adult, Odds ratio, Sodium Chloride, Sodium Bicarbonate, Contrast Media, and Randomized Controlled Trials as Topic
Prescribing cascades occur when a physician prescribes a new drug to address the side‐effect of another drug. Persons with Alzheimer's disease and related dementias (ADRD) are at increased risk for prescribing cascades. Our objective... more
Prescribing cascades occur when a physician prescribes a new drug to address the side‐effect of another drug. Persons with Alzheimer's disease and related dementias (ADRD) are at increased risk for prescribing cascades. Our objective was to develop an approach to estimating the proportion of calcium channel blocker‐diuretic (CCB‐diuretic) prescribing cascades among persons with ADRD in two U.S. health plans.
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To examine age-specific differences in the frequency and impact of cardiac and non-cardiac conditions among patients aged 65 years and older hospitalized with acute myocardial infarction (AMI). Study population consisted of 3863 adults... more
To examine age-specific differences in the frequency and impact of cardiac and non-cardiac conditions among patients aged 65 years and older hospitalized with acute myocardial infarction (AMI). Study population consisted of 3863 adults hospitalized with AMI at 11 medical centers in central Massachusetts on a biennial basis between 2001 and 2011. The presence of 11 chronic conditions (five cardiac and six non-cardiac) was based on the review of hospital medical records. Participants' median age was 79 years, 49% were men, and had an average of three chronic conditions (average of cardiac conditions: 2.6 and average of non-cardiac conditions: 1.0). Approximately one in every two patients presented with two or more cardiac related conditions whereas one in every three patients presented with two or more non-cardiac related conditions. The most prevalent chronic conditions in our study population were hypertension, diabetes, heart failure, chronic kidney disease, and peripheral vasc...
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Refugees and internally displaced persons who are affected by armed-conflict are at increased vulnerability to some forms of sexual violence or other types of gender-based violence. A validated, brief and easy-to-administer screening tool... more
Refugees and internally displaced persons who are affected by armed-conflict are at increased vulnerability to some forms of sexual violence or other types of gender-based violence. A validated, brief and easy-to-administer screening tool will help service providers identify GBV survivors and refer them to appropriate GBV services. To date, no such GBV screening tool exists. We developed the 7-item ASIST-GBV screening tool from qualitative research that included individual interviews and focus groups with GBV refugee and IDP survivors. This study presents the psychometric properties of the ASIST-GBV with female refugees living in Ethiopia and IDPs in Colombia. Several strategies were used to validate ASIST-GBV, including a 3 month implementation to validate the brief screening tool with women/girls seeking health services, aged ≥15 years in Ethiopia (N = 487) and female IDPs aged ≥ 18 years in Colombia (N = 511). High proportions of women screened positive for past-year GBV accordin...
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Log on/register Feedback | Support | My details. home | journals AZ | subject areas | advanced search | authors | reviewers | libraries | about | my BioMed Central. IDrugs Volume 11. Viewing options: Abstract; Full text; PDF (206KB ...
Research Interests: Microbiology, Research Design, Political Science, Africa, Developing Countries, and 15 moreInternational Cooperation, China, Japan, Medicine, India, Latin America, Humans, Biomedical Research, Drug Industry, Government Regulation, Clinical Trials as Topic, Guideline Adherence, guidelines as topic, Outsourced services, and Patient selection
Tetrabenazine, a treatment for chorea in Huntington disease, carries a boxed warning due to safety, especially related to suicidality. To compare the frequency of depressed mood and suicidality among a closely monitored cohort of... more
Tetrabenazine, a treatment for chorea in Huntington disease, carries a boxed warning due to safety, especially related to suicidality. To compare the frequency of depressed mood and suicidality among a closely monitored cohort of individuals with Huntington disease who were exposed and not exposed to tetrabenazine. A longitudinal prospective study involving 1360 individuals with HD evaluated at 48 research centers in Australia, Canada, and the United States was examined for frequency of depressed mood that triggered a risk assessment, suicidal thoughts, suicide attempts, and completed suicide among individuals with prior, new, and no exposure to tetrabenazine.. Seventy-seven individuals were on tetrabenazine at study enrollment (prior exposure), 64 individuals were exposed to tetrabenazine during the study's course (new exposure), and 1219 individuals had no exposure to tetrabenazine. The hazard ratio for depressed mood among those with prior exposure to tetrabenazine compared t...
Research Interests: Depression, Medicine, Humans, Female, Male, and 5 moreMiddle Aged, Suicidal Ideation, Adult, Huntington disease, and Tetrabenazine
Iopamidol, a water-soluble contrast agent, has been rarely associated with seizures. We describe a case of generalized tonic-clonic seizure after cervical myelography with iopamidol in a previously healthy young man. In patients... more
Iopamidol, a water-soluble contrast agent, has been rarely associated with seizures. We describe a case of generalized tonic-clonic seizure after cervical myelography with iopamidol in a previously healthy young man. In patients presenting with seizures, a history of recent myelography should be considered as an etiology. Iopamidol myelography may be associated with a risk of seizures. Clinicians need to be aware of this complication and inform their patients about such risk.
Research Interests: Medicine, Complication, Humans, Pubmed, Male, and 6 moreAnesthesia, Etiology, Middle Aged, Seizures, Contrast Media, and Myelography
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Research Interests: Bioinformatics, New Media, Family Medicine, Clinical Trial, Content Analysis, and 12 moreLife Sciences, Knowledge Transfer, Electronic Media, Health Policy, Medicine, Human right, Biomedical Research, Hiv Infection, Public health systems and services research, Study design, Access to Care, and High risk
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Research Interests: Medicine, Humans, BMJ, Mist, Inhaler, and 3 moreNasal sprays, Cholinergic antagonists, and Tiotropium bromide
From the Section of General Internal Medicine, Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, NC and the MPH Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
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A drug-induced lupus-like syndrome may present with arthralgias, myalgias, fever, and serositis but is distinguished from systemic lupus erythematosus by several characteristics. Sex ratios are nearly equal in drug-induced lupus and... more
A drug-induced lupus-like syndrome may present with arthralgias, myalgias, fever, and serositis but is distinguished from systemic lupus erythematosus by several characteristics. Sex ratios are nearly equal in drug-induced lupus and nephritis and central nervous ...
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High-throughput screening (HTS) of comprehensive approved drug libraries has revealed new uses for old drugs (1, 2). Although repurposing of drugs has been used for decades at the discretion of physicians (3), the Policy Forum... more
High-throughput screening (HTS) of comprehensive approved drug libraries has revealed new uses for old drugs (1, 2). Although repurposing of drugs has been used for decades at the discretion of physicians (3), the Policy Forum Repurposing with a difference by MS ...