Medicine
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Knee osteoarthritis is a degenerative disease and its prevalence tends to increase. Clinical practice guidelines (CPGs) are evidence-based recommendations for treatment that help policymakers, practitioners, and patients make more appropriate and efficient decisions during the course of management. This study aimed to evaluate the quality of knee osteoarthritis CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. ⋯ Auxiliary materials for the treatment process of knee OA should be supplemented in future revised versions for quality improvement of knee OA CPGs. Also, more evidence should be accumulated to support the recommendation of traditional oriental medical treatments in the clinical field. From the perspective of integrative medicine, along with conventional pharmacological treatment, exercise, weight loss, and acupuncture can be combined together in clinical situations.
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Observational Study
Clinical features of patients with Legionnaires disease showing initial clinical improvement but radiological deterioration: A retrospective single-center analysis.
Patients with Legionnaires disease occasionally experience initial clinical improvement but radiological progression. However, data on this issue are so far limited. The aim of this study was to investigate changes in chest radiograph findings in patients with Legionnaires disease who showed initial clinical improvement and to identify risk factors and outcomes in these patients. ⋯ Mortality did not significantly differ between those with initial clinical improvement but radiological deterioration and those with both initial clinical and radiological improvement (28% vs 12%, P = .49). About one-fifth of patients with Legionnaires disease, especially those who had a high pneumonia severity index score and underwent mechanical ventilation, showed radiological deterioration despite of clinical improvement 1 week after appropriate treatment, while outcomes were not significantly worse in these patients. Therefore, our findings support that close monitoring without modification of antibiotics use is warranted in those who have clinical improvement regardless of radiologic findings.
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Studies of infective endocarditis (IE) have relied on International Classification of Disease (ICD) codes to identify cases, a method vulnerable to misclassification. Clinical narrative data could offer greater accuracy and richness to cohort identification. We evaluated two algorithms: 1. a standard query of ICD-9/10 billing codes, with or without procedure codes for echocardiogram and 2. a text query of discharge summaries (DS) that selected on the term “endocarditis” in fields headed by “Discharge Diagnosis” or “Admission Diagnosis” or similar. ⋯ Specificity was high for all queries >94%. The DS query also yielded valve data (prosthetic, tricuspid, aortic, etc) in 60% and microbiologic agent in 73% of identified cases with an accuracy of 94% and 90%, respectively when assessed by chart review. Compared with ICD-based queries, text-based queries of discharge summaries have the potential to improve precision of IE case ascertainment and extract key clinical variables.
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Review Case Reports
Management of inflammatory bowel disease and serum level of infliximab in newborn exposed to anti-TNF therapy during pregnancy: Case report and literature review.
Heightened inflammatory bowel disease (IBD) activity during pregnancy is associated with higher rates of preterm birth, miscarriage, and low birth weight. Therefore, its adequate treatment is essential, considering the risk-benefit of medication use. Although previous literature has described the management of IBD during pregnancy, few studies have assessed the pharmacokinetics of IBD drugs in the newborn. In this case report, we describe the management of ulcerative colitis during pregnancy and discuss the benefits of checking serum levels of infliximab in newborns exposed to the medication during pregnancy. ⋯ Our case suggests that the use of infliximab is safe in pregnancy, and drug discontinuation could be considered from the 24th week of pregnancy onward to reduce placental transfer to the newborn in patients at low risk of relapse. Vaccines with live attenuated organisms should be delayed for at least 6 months or until the serum level of the medication is undetectable.
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Review Case Reports
Centralization of ulna with wrist fusion for failure of reconstructed distal radius by allograft bone or prosthesis: A case report and literature review.
Centralization of the ulna is commonly used in the treatment of radius developmental deformity in children. The secondary distal radius deficiency in adults is different from the developmental deformity of the radius in children. There is no report on the ulna centralization with wrist fusion for the failure of the reconstructed distal radius by allograft bone or prosthesis for osteosarcoma in adults. ⋯ For adult patients who have failed resection and reconstruction of giant cell tumors, osteosarcoma, and other tumors of bone on the distal radius, ulna centralization is a simple and effective option.