Lipoprotein apheresis efficacy and challenges: single center experience

Abstract Introduction Lipoprotein apheresis (LA) is an extracorporeal therapy which removes apolipoprotein B-containing particles from the circulation. We evaluated techniques and efficiency of lipoprotein apheresis procedures applied to patients with familial and non-familial hypercholesterolemia (FH) at our center. Methods We retrospectively evaluated 250 LA procedures applied to 27 patients with dyslipidemia between March 2011 and August 2019. Results A total of 27 patients, of whom 19 (70.4%) were male and 8 (29.6%), female, were included. Eighteen (66.7%), 6 (22.2%) and 3 (11.1%) patients were diagnosed with non-FH, homozygous FH (HoFH) and heterozygous FH (HeFH), respectively. Two different apheresis techniques, direct adsorption of lipoproteins (DALI) (48.8%) and double filtration plasmapheresis (DFPP) (51.2%), were used. The change in the serum total cholesterol (TC) level was the median 302 mg/dl (171-604 mg/dl) (60.4%) in HoFH patients, 305 mg/dl (194-393 mg/dl) (60.8%) in HeFH patients and 227 mg/dl (75-749 mg/dl) (65.3%) in non-FH patients. The change in the serum low-density lipoprotein (LDL) level was the median 275 mg/dl (109-519 mg/dl) (64.2%), 232 mg/dl (207-291 mg/dl) (64.5%) and 325 mg/dl (22-735 mg/dl) (70.9%) in patients with HoFH, HeFH and non-FH, respectively. A significantly effective reduction in serum lipid levels, including TC, LDL and triglycerides, was achieved in all patients, regardless of the technique, p< .001. The decrease in the serum TC and LDL levels was significantly higher in the DFPP, compared to the DALI, being 220 mg/dl (-300 to 771) vs 184 mg/dl (64-415), p< .001 and 196 mg/dl (11-712) vs 157 mg/dl (54-340), p< .001, respectively. Conclusions Our results showed that LA is a highly effective treatment in reducing serum lipid levels and safe, without any major adverse event.

Role of Computerized Physician Order Entry Usability in the Reduction of Prescribing Errors / 대한의료정보학회지

OBJECTIVES: Some hospitals have implemented computerized physician order entry (CPOE) systems to reduce the medical error rates. However, research in this area has been very limited, especially regarding the impact of CPOE use on the reduction of prescribing errors. Moreover, the past studies have dealt with the overall impact of CPOE on the reduction of broadly termed "medical errors", and they have not specified which medical errors have been reduced by CPOE. Furthermore, the majority of the past research in this field has been either qualitative or has not used robust empirical techniques. This research examined the impacts of usability of CPOE systems on the reduction of doctors' prescribing errors. METHODS: One hundred and sixty-six questionnaires were used for quantitative data analyses. Since the data was not normally distributed, partial least square path modelling-as the second generation of multivariate data analyses-was applied to analyze data. RESULTS: It was found that the ease of use of the system and information quality can significantly reduce prescribing errors. Moreover, the user interface consistency and system error prevention have a significant positive impact on the perceived ease of use. More than 50% of the respondents believed that CPOE reduces the likelihood of drug allergy, drug interaction, and drug dosing errors thus improving patient safety. CONCLUSIONS: Prescribing errors in terms of drug allergy, drug interaction, and drug dosing errors are reduced if the CPOE is not error-prone and easy to use, if the user interface is consistent, and if it provides quality information to doctors.

Etiology of pleural effusion among adults in the State of Qatar: a 1-year hospital-based study

There have been no systematic studies of diseases causing pleural effusion in Qatar. This prospective, hospital-based study involved all adult patients [> 15 years] with pleural effusions who were admitted to referral hospitals over a 1-year period. A total of 200 cases of pleural effusion were identified [152 males and 48 females]; mean age 45.1 [SD 18.5] years. A majority of patients [73.5%] were non-Qataris, mostly from the Asian subcontinent. The most frequent cause of pleural effusions was tuberculosis [32.5%], followed by pneumonia [19%], cancer [15.5%] and cardiac failure [13%]. The most frequent cause of malignant effusion was bronchogenic carcinoma [38.7%], whereas Gram-positive organisms were the most frequent isolates from empyema fluid [62.5%]. Histological examination and culture of pleural biopsy were the most useful diagnostic workup for tuberculosis effusions, whereas repeated cytological examination of pleural fluid and pleural biopsy were most useful for malignant effusions

Anaplastic myeloma with deposits in three different sites: Case report and literature review

Anaplastic myeloma is a rare aggressive disease that is resistant to most chemotherapeutic agents and radiotherapy. It develops usually after a diagnosis of classical multiple myeloma and is associated with at least one extramedullary plasmacytoma site. We report a case of this rare disease in a patient who had no previous illness and presented to us with more than one extramedullary plasmacytoma site: a mass in the right anterior chest wall, a swollen scrotum and multiple nodular skin lesions mainly in the legs

effect of physical activity during pregnancy on preterm delivery and birth weight

A historical cohort study was carried out to assess the impact of employment during pregnancy on the foetal birth weight and the duration of pregnancy. 517 pregnant Sudanese women with singleton uncomplicated pregnancies and certain dates were studied, 131 had been employed during current pregnancy. Employment was associated with a preterm delivery of 6.9% compared to 4.9% in housewives, a difference, which is not statistically significant. However post term delivery is significantly increased in housewives. 9.3% compared to 2.3% in the employees. There was no significant deference in the birth weight of the two groups. Working duration in terms of total number of calendar months worked, or working hours per week was associated with a non- significant increase of preterm labour and low birth weight in working mothers. Feeling of fatigue was significantly associated with decreased pregnancy duration and low birth weight among both employed and unemployed housewives. It is concluded that employment during pregnancy does not precipitate preterm delivery, or result in preterm babies

Local experience of CT scanning in neurosurgical cases

Between 1984 and 1994, the author studied 4500 Cranial Scans. Limited availability of the C. T. Scan in Pakistan is responsible for a bias in patient selection, those with obvious clinical signs of an S.O.L. and those requiring emergency operation i.e. traumatic mass lesions, abscesses, tuberculoma etc., form a sizeable proportion of the pathologies detected with C.T in Pakistan. Chronic, less urgent neurological disorders are seen less frequentle

Syringomyelia: syringosubarachnoid shunt

Syringomyelia, a disease first recognised and treated almost a century ago, has been diagnosed and treated more readily since the advent of modern neuroradiological investigations like delayed Myelo C.T. and MRI. In our Department, during the last 9 months, four patients have been investigated and treated with syringosubarachnoid shunt. No patient had associated hind brain abnormality; one had a past history of tuberculous disease of the spine, while in three cases, no cause could be identified. Operative results are being presented and pathophysiology of syringomyelia discussed