What is the diagnostic approach to a patient with leg cramps?

Leg cramps are very common (strength of recommendation [SOR]: C, case series), and most cases have no detectable cause (SOR: C, expert opinion). Arterial vascular disease and neurological diseases are more prevalent among male patients with leg cramps (SOR: C, small case series). History and physical should focus on detecting precipitating factors for iron deficiency anemia (gastrointestinal bleeding, frequent blood donations, menorrhagia), electrolyte imbalance (renal disease, fluid losses), endocrine disorders (thyroid, Addison's disease), neuromuscular disorders (neuropathies and myopathies), and medication use (antidepressants and diuretics). Laboratory testing is guided by the history and physical and may include ferritin, electrolytes, blood sugar, magnesium, zinc, creatinine, blood urea nitrogen, liver function test, and thyroid-stimulating hormone (SOR: C, expert opinion and nonsystematic review)

Can calcium supplements cause serious adverse effects in healthy people?

Calcium supplements with or without vitamin D increase the risk of myocardial infarction (MI), with numbers needed to harm (NNH) over 5 years of 69 to 240 (strength of recommendation [SOR]: B, meta-analyses of randomized controlled trials [RCTs] that evaluated a predominantly older female population and were limited by study designs). Calcium supplements with or without vitamin D may increase the risk of stroke, with an NNH over 5 years of 283 (SOR: B, meta-analyses of RCTs). Calcium supplementation, but not a diet rich in calcium, also increases the risk of renal calculi, with an NNH over 7 years of 272 (SOR: B, RCT and a cohort study, which also evaluated a predominantly older female population)

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially