An evaluation of the utility of routine laboratory monitoring of juvenile idiopathic arthritis (JIA) patients using non-steroidal anti-inflammatory drugs (NSAIDs): a retrospective review

<p>Abstract</p> <p>Background</p> <p>No consensus evidence-based guidelines for the routine laboratory monitoring of children with JIA receiving non-steroidal anti-inflammatory drugs (NSAIDs) exist. The purpose of this study is to evaluate the clinical utility of routine laboratory monitoring of hemoglobin, transaminases, blood urea nitrogen, serum creatinine, and urinalysis in patients with juvenile idiopathic arthritis (JIA) receiving NSAIDs.</p> <p>Methods</p> <p>The medical records of 91 children with JIA followed between 1996 and 2006 were retrospectively reviewed for laboratory results and clinically significant adverse effects attributed to NSAID use. Laboratory abnormalities were documented, with potential adverse clinical sequelae, including if NSAID use was discontinued.</p> <p>Results</p> <p>Abnormal laboratory results were recorded for 24 of 91 patients. Nearly all abnormalities were mild and not associated with adverse clinical sequelae. All patients but one continued to receive NSAID therapy after the abnormality was detected.</p> <p>Conclusions</p> <p>Although detection of abnormal laboratory values occurred while on NSAIDs, these abnormalities did not correlate with adverse clinical signs and symptoms. The routine monitoring of laboratory tests in asymptomatic children treated with NSAIDs is of questionable utility.</p

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

A Study of Adenosine Deaminase Level in Patients with Pleural Effusion

"Introduction: Pleural fluid is an abnormal collection of fluid in the pleural cavity. Tuberculosis is a major health problem in India and globally and it is a second most common cause of death from infectious diseases. Present study is to find out the role of Adenosine Deaminase level and its diagnostic utility in patients with pleural effusion. Methods: This study includes 100 patients admitted in SCL General hospital and VS General Hospital Ahmedabad from September 2012 to July 2014 which was diagnosed as having pleural effusion. Result: Pleural fluid ADA level of the study group ranged from 51 -145 IU/L with a mean of 76.38+- 21.33IU/L and (P value of < 0.0001) was statistically significant. Sensitivity and Specificity of the test was found 95% and 100% respectively. Conclusion: All patients with TB pleural effusion had elevated ADA levels in pleural fluid. In this study there was a statistical significant association P value (<0.0001) of ADA levels. This pleural fluid ADA estimation seems to have the potential for being one of the reliable tests for the diagnosis of TB pleural effusion which is adequately sensitive and specific and easy to perform. " [Natl J Community Med 2016; 7(1.000): 41-43

A Study of Glycosylated Hemoglobin (HbA1c) in Acute Coronary Syndrome

"Background: In non diabetic patients, HbA1C could be utilised for risk stratification of CAD and its severity; independent of traditional cardiovascular risk factors. Objectives: To study the blood levels of HbA1C in patients of ACS at time of admission and its relation with early outcome and complications in ACS. Method- A total of 100 indoor patients without known diabetes, with confirmed diagnosis of ACS are included in study. HbA1C was done along with other routine investigations. Coronary Angiography was performed in all patients. Results-Out of 44 patients with HbA1C value > 6.5%, 20 (45.5%) had Anterior wall (A/W) MI, 15(34.1%) had Inferior wall (I/W) MI, 2 (0.05%) had Lateral wall (L/W) MI, 5(11.4%) had NSTEMI and 1 (0.02%) had UA. While of 56 patients with HbA1C value < 6.5%, 19 (33%) had A/W MI, 18 (32.1%) had I/W MI, 5 (0.09%) L/W MI, 2 (0.04%) had NSTEMI and 12 (21.4%) had UA. Out of 88 patients with normal RBS on admission, 33 patients had HbA1C > 6.5% i.e. in diabetic range. 31.8% of patients of raised HbA1C had complicated MI while complication rate in normal HbA1C group was 14.3% only. Conclusion- Patients with high HbA1C levels were associated with more severe disease and complication rate was also higher. " [Natl J Community Med 2016; 7(2.000): 106-110

A Study of Factors Affecting Sputum Conversion in Patients of Pulmonary Tuberculosis

"Background: In the era of direct observation treatment (DOT) for tuberculosis, clinicians need to focus on high risk groups. We present sputum conversion rate at 2 months and factors influencing it. Objectives: To determine factors that prolong sputum smear conversion among smear positive pulmonary tuberculosis patients at the end of the Intensive Phase. Method: 150 adult (> 18 years) patients of sputum smear positive pulmonary tuberculosis were included. 2 months following DOT, sputum was retested to determine sputum conversion rate. Results: Of 150 sputum positive TB cases, 123 (82%) patients were sputum negative 2 months after DOT. In this study we found that among 43 patients of age > 50, after two months of treatment, 15 (35%) patients were sputum smear positive. Among 66 smoker patients, 19 (20%) patients were sputum smear positive. Among 24 pa-tients of bilateral X-Ray involvement, 12 (50%) patients were sputum smear positive. Out of 40 patients of +3 bacillary load, 17 (42%) were sputum smear positive. Conclusion: Factors affecting sputum conversion in this study were male patients, patients with age > 50 years, smokers, patients with past history of pulmonary tuberculosis, bilateral involvement in chest x ray and high bacillary load (+3). " [Natl J Community Med 2016; 7(2.000): 142-146