Sneddon's syndrome with anticardiolipin antibodies complications and treatment

We investigated 2 patients with Sneddon's syndrome, elevated anticardiolipin antibodies and systemic complications, which included stroke, habitual abortions, cardiac valvular lesions, acrocyanosis, hypertension and renal insufficiency. Treatment with a combination of immunosuppressive agents and warfarin or aspirin prevented further complications and improved renal function. It is important for those in different specialties to be aware of this potentially treatable disorder

The CHEK2 1100delC mutation identifies families with a hereditary breast and colorectal cancer phenotype

Because of genetic heterogeneity, the identification of breast cancer-susceptibility genes has proven to be exceedingly difficult. Here, we define a new subset of families with breast cancer characterized by the presence of colorectal cancer cases. The 1100delC variant of the cell cycle checkpoint kinase CHEK2 gene was present in 18% of 55 families with hereditary breast and colorectal cancer (HBCC) as compared with 4% of 380 families with non-HBCC (P<.001), thus providing genetic evidence for the HBCC phenotype. The CHEK2 1100delC mutation was, however, not the major predisposing factor for the HBCC phenotype but appeared to act in synergy with another, as-yet-unknown susceptibility gene(s). The unequivocal definition of the HBCC phenotype opens new avenues to search for thi

Clinically relevant potential drug-drug interactions in intensive care patients: a large retrospective observational multicenter study

Purpose: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. Materials & methods: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. Results: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when con -sidering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. Conclusions: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients. ? 2020 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study

Purpose: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. Materials & methods: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. Results: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. Conclusions: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients

Avaliação de duas fontes de metionina a dois níveis de adição no desempenho de frangos de corte (1-49 dias) Evaluation of two synthetic sources of methionine, on the performance of broilers (1-49 days)

O experimento foi conduzido no Setor de Avicultura do Departamento de Zootecnia da Universidade Federal de Santa Maria (RS), no período de 12 de setembro à 01 de novembro de 1989, com o objetivo de avaliar os efeitos de diferentes fontes e níveis de adição de aminoácido metionina, através do desempenho de aves (machos e fêmeas) criados separadamente no período de 1 - 49 dias. Foram utilizados 640 pintos de corte, sexados, da linhagem Hubbard. O delineamento experimental utilizado foi o inteiramente casualizado, num esquema fatorial 2 x 2 x 2 (2 fontes x 2 níveis x 2 sexos) com quatro repetições de 20 aves cada unidade experimental. As fontes foram: DL-Metionina e Methionina Hidróxi-Análoga (MHA), com dois níveis de metionina suplementar: 1500 e 1050ppm, nível alto e baixo de cada, respectivamente; sendo que na fase inicial (1 - 20 dias) utilizou-se 100% destes níveis, no crescimento, (21 - 42 dias) 83,3% e na fase de terminação (43 - 49 dias), 75% destes níveis. As dietas foram calculadas para serem isonutritivas, diferindo apenas nos níveis de peso, consumo alimentar, conversão alimentar, viabilidade criatória e índice de eficiência produtiva. Apesar de ter havido diferenças significativas nos períodos inicial, crescimento e terminação enttre alguns tratamentos, no período total (1 - 49 dias) estas diferenças não foram significativas (P > 0,05) evidenciando uma compensação de ganho de peso. Na análise estatística do consumo alimentar verificou-se na fase inicial (1 - 20 dias) houve diferenças significativas (F = 5,97 P < 0,0223) para machos, onde o consumo alimentar foi maior na fonte de MHA em nível alto. Na fase de terminação (43 - 49 dias) houve diferença significativa (P< 0,01) entre sexos onde os machos obtiveram melhor conversão alimentar que as fêmeas. Para o item índice de eficiência produtiva, houve diferença significativa (P < 0,05), entre os sexos, onde os machos demonstraram ser 21,4% mais eficientes que as fêmeas. O escore de empenamento foi significativamente melhor para fêmeas. Gordura abdominal e rendimento de carcaça não foram influenciados pelas fontes ou níveis de metionina, mas diferenças altamente significativa entre sexos, onde as fêmeas tiveram 26,2% mais gordura abdominal que os machos e o rendimento de carcaça foi 2,7% melhor para machos. Conclui-se que ambas as fontes de metionina, em base equimolar de adição, podem ser usadas para frangos de corte, sem redução no desempenho.<br>This study was conducted in the Poultry Section of the Animal Science Department at the Federal University of Santa Maria, RS - Brazil, from September 12th to November 1st, 1989. The main objective was to evaluate the effect of two different sources and levels of synthetic methionine on the broiler performance, raised separetely by sex, from day old up to 49 days of age. A total of 640 dayold chicks, from both sexes, on pen floor were used. The experimental design was enterely randomized in a factorial 2 x 2 x 2 (source x level x sex) with 4 replicates of 20 chicks each. The sources of methionine were DL-Methionine and Methionine Hidroxy-analogue, and the levels were 1.500 and 1.050ppm for phase I (1 - 20 days); for phase II (20 - 42 days) and phase III (42 - 49 days), were 83.33 and 75.0% of the phase I, respectively. Diets contained 20.5, 19.5 and 17.5% of crude protein and 3.000, 3.050 and 3.100kcal/kg of ME for phase I, II and III, respectively. In all phases, males were significantly better than females for all parameters studied. Weight gain was different at phases I and III for sources and levels, but not in the overall period which demonstrates a compensatory growth through the period. Feed consumption and feed conversion for the overall period (1 - 49 days) did not show significant differences for sources or levels. Viability was similar between sexes and also related to sources or levels of methionine suplementation. The productive efficiency index (IEP) was 21.4% better for males than females. Feathering score was significantly better for females. The abdominal fat and carcass yield were not affected by sources or levels of methionine, but highly differents between sexes; females had 26.2% more abdominal fat deposition than males, and the carcass yield was 2.7% better for males. It was concluded that both sources of methionine (DL-Methionine or MHA) on a equimolar basis of adition for broiler diets, can be used without any reduction of performance