Medicine
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There are studies on the effect of low-dose amitriptyline on pain control, but there is a lack of studies on the use of amitriptyline for chronic pain and the factors associated with the prescription of traditional doses. We used a national sample cohort of patients aged ≥ 18 years who were prescribed amitriptyline along with chronic pain, without psychiatric disorders, between 2002 to 2015. We categorized the prescriptions into 2 groups according to the daily dose: low doses (≤25 mg) and traditional doses (>25 mg). ⋯ The prevalence of prescriptions and proportion of traditional doses of amitriptyline tended to decrease during the study period. Male sex (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05-1.13); age 65-80 years (OR 1.12, 95% CI 1.08-1.16), especially ≥ 80 years (OR 1.55, 95% CI 1.45-1.65); headaches (OR 1.18, 95% CI 1.10-1.27), receiving medical aids (OR 2.58, 95% CI 2.46-2.71); and being prescribed benzodiazepines or zolpidem concomitantly (OR 1.10, 95% CI 1.06-1.15) were significantly associated with traditional dose prescriptions of amitriptyline. Although traditional dose prescriptions of amitriptyline have been declining, close monitoring is still required in the presence of the above-mentioned factors.
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Case Reports
Use total portosystemic shunt to rescue an emergency PNF with intractable hypotension: A case report.
Living donor allogeneic liver transplantation is a surgical treatment for patients with end-stage liver disease, wherein a healthy liver is implanted in the patient, facilitating the recovery of the liver function in patients with end-stage liver disease. However, primary nonfunction (PNF) may occur as a result of this procedure. ⋯ The lesson we have learned is that total portosystemic shunt composited with careful anesthesia management can rescue the event of PNF with intractable hypotension in liver transplantation surgery. At the same time, we give attention to blood pressure, electrocardiogram, albumin, calcium, potassium, acidosis, coagulopathy, anti-infection, and protection of vital organs is essential for successful retransplant outcomes.
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MET-TKI is a late-stage treatment for drug-resistant NSCLC that has been marketed in recent years, and interstitial lung disease may be a rare adverse reaction. This case reports the development of interstitial lung disease in a patient with advanced lung cancer who developed during treatment with savolitinib after resistance to osimertinib. ⋯ This case reported interstitial lung disease following osimertinib plus savolitinib. This suggests that healthcare providers should be aware of early symptoms of interstitial lung disease during treatment and treat them appropriately to prevent symptoms from worsening.
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Few studies examined several anticoagulation (AC) dosage strategy therapies for various outcomes among coronavirus disease-2019 (COVID-19) patients. However, this AC dosage strategy therapy has not been investigated to assess the length of stay (LOS) and all-cause mortality among critically ill COVID-19 patients admitted to the intensive care unit (ICU), especially in the eastern province of Saudi Arabia. Thus, this study aimed to examine the association of AC dosage strategy therapy with the LOS and all-cause mortality among critically ill COVID-19 patients admitted to the ICU. ⋯ Patients (n = 114) who received a therapeutic dose but not a prophylaxis dose were categorized as receiving a "therapeutic dose." The 30-day ICU LOS was the main outcome, while all-cause mortality was the secondary outcome. The covariate-adjusted logistic regression analysis revealed that the therapeutic dose was significantly associated with a 1.74-fold longer ICU LOS and 6.60-fold greater mortality risk than the prophylaxis dose. Critically ill COVID-19 patients who received the therapeutic dose had a longer ICU LOS and higher mortality than those who received the prophylaxis dose.
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Cardiovascular diseases (CVDs) are a very common occurrence in patients with chronic kidney disease (CKD) and that was the main cause of mortality in these patients. The aims of the present study were to examine the effects of inflammation, malnutrition, and an oxidative stress in patients undergoing long-term hemodialysis or/and kidney transplant patients or patients with late-stage CKD, with its coherent consequences during a 38-month follow-up period. The present study included 137 patients with renal insufficiencies (48 patients had CKD, 29 patients had kidney transplants, and 60 CKD patients underwent hemodialysis [HD] and 39 normal individuals [controls]; aged 49 ± 20 years, 96 males and 80 females). ⋯ As the disease progressed, the survival function decreased to 30% due to the malnutrition in patients with CKD. Lipid oxidation and malnutrition/inflammation are associated with in various stages of CKD patients. With progressing CKD patients' biomarkers of lipid oxidation and malnutrition/inflammation show an increasing trend.