ABSTRACT
BACKGROUND: Pegylated interferon-2a (PegIFN-2a)+ribavirin treatment for chronic hepatitis C is often associated with depressive symptoms. Previous studies have failed to explore whether PegIFN-2a pharmacokinetic variability plays an etiologic role in PegIFN-2a-induced mood disorders. The objective of this investigation was to evaluate the association between trough PegIFN-2a concentration at treatment week 4 ("PegIFN-2a Cmin4") and an increase in depressive symptoms. METHODS: Using data from Virahep-C, the association between PegIFN-2a Cmin4 and the following depression outcomes were evaluated using the Center for Epidemiological Studies-Depression scale (CES-D): (1) change in CES-D score from baseline to week 12; (2) greatest difference in CES-D score between baseline and weeks 4, 12, or 24; and (3) occurrence of severe depressive symptoms (CES-D greater than 23) at weeks 4, 12, or 24. One post-hoc analysis examined whether PegIFN-2a exposure during the first week of treatment was associated with change in CES-D score from baseline to week 4. RESULTS: No significant associations between PegIFN-2a Cmin4 and the depression outcomes were observed (p>0.05). Exploratory analyses suggest a possible relationship between PegIFN-2a exposure during the first week of therapy and CES-D score change from baseline to week 4 (p=0.03). CONCLUSIONS: PegIFN-2a concentration levels from baseline to week 4 do not predict the onset and severity of depressive symptoms during 24 weeks of antiviral therapy; however PegIFN-2a levels during the first week of treatment may predict depressive symptoms in the first 4 weeks, earlier than anticipated and warrants further exploration.
Subject(s)
Antiviral Agents/adverse effects , Depression/chemically induced , Hepatitis C, Chronic/drug therapy , Interferon-alpha/adverse effects , Polyethylene Glycols/adverse effects , Adult , Area Under Curve , Depression/psychology , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Humans , Longitudinal Studies , Male , Middle Aged , Psychiatric Status Rating Scales , Recombinant Proteins/adverse effects , Self Report , Sensitivity and Specificity , Time Factors , United StatesSubject(s)
Military Medicine/organization & administration , Military Science , Aircraft , Ambulatory Care/organization & administration , Emergency Medical Services/organization & administration , Health Resources/organization & administration , Humans , Military Medicine/instrumentation , Poland , Transportation of Patients , United Kingdom , Wounds and Injuries/therapyABSTRACT
General practice secondments are being increasingly undertaken by specialist registrars in accident and emergency (A&E) medicine. This paper describes how two A&E trainees arranged general practice secondments and the experiences gained. There follows a discussion of the benefits to the general practice and trainees involved, together with a contemporary consideration of the interaction between general practice and A&E services in the UK.
Subject(s)
Education, Medical, Graduate , Emergency Medicine/education , Family Practice/education , Costs and Cost Analysis , Education, Medical, Graduate/economics , England , Health Knowledge, Attitudes, Practice , Humans , Urban HealthABSTRACT
A case is reported of a patient with acute primary muscle abscess who presented to the accident and emergency department with hip pain. Pyomyositis must be considered as a cause of muscle pain especially around the hip. A brief discussion of the diagnosis and management of pyomyositis is also presented.
Subject(s)
Abscess/diagnosis , Myositis/microbiology , Staphylococcal Infections/diagnosis , Abscess/drug therapy , Bacteremia/drug therapy , Bacteremia/microbiology , Diagnosis, Differential , Floxacillin/therapeutic use , Hip Joint , Humans , Male , Middle Aged , Myositis/drug therapy , Pain/diagnosis , Penicillins/therapeutic use , Staphylococcal Infections/drug therapy , SuppurationABSTRACT
OBJECTIVE: To compare intramuscular glucagon with intravenous glucose in the prehospital management of hypoglycaemia in adults. METHODS: In the first part of the trial all UK ambulance services were asked how their personnel treat prehospital episodes of hypoglycaemia. In the second part, two protocols for treating prehospital hypoglycaemia were studied. In phase 1, intramuscular glucagon 1 mg was used. In phase 2, intravenous glucose 25 g was used; if intravenous access was not possible, intramuscular glucagon was given. RESULTS: 33 out of 43 respondent ambulance services (76.7%) only use glucagon for prehospital hypoglycaemia; the remaining services use glucose and glucagon. In the second part of the study the median duration from diagnosis to full orientation (Glasgow coma score 15) was 28 minutes (95% confidence interval 18 to 49 minutes) in phase 1 and 11 minutes (95% confidence interval 8 to 19 minutes) in phase 2. This difference is statistically significant (P < 0.005). On-scene times were not significantly different. CONCLUSIONS: Intravenous glucose is the treatment of choice in prehospital hypoglycaemia but glucagon should also be available for intramuscular use when intravenous access is not possible.
Subject(s)
Emergency Medical Services/standards , Glucagon/administration & dosage , Glucose/administration & dosage , Hypoglycemia/drug therapy , Adult , Ambulances , Clinical Protocols , Emergency Medical Technicians , Health Care Surveys , Humans , Injections, Intramuscular , Injections, Intravenous , Statistics, Nonparametric , United KingdomABSTRACT
Victims of near hanging are being increasingly seen in accident and emergency (A&E) department. This paper reports on seven cases of near hanging seen over four years in a district general hospital. The mechanism of injury is ligature strangulation rather than cervical spinal cord injury. All cases of near hanging should be actively and vigorously resuscitated, as initial presenting features bear a poor correlation to eventual outcome.
Subject(s)
Neck Injuries , Suicide, Attempted , Adolescent , Adult , Emergencies , Emergency Service, Hospital , Female , Humans , Male , ResuscitationABSTRACT
Among the considerations affecting the therapeutic approach to patients with atherosclerosis of the lower extremities is their associated risk of death, myocardial infarction, stroke, and limb loss. To investigate the relationship of these events to the severity of peripheral vascular disease we undertook a 6-year review of 247 consecutive patients undergoing lower extremity noninvasive vascular assessment. There were 130 men and 117 women with a mean age of 65 +/- 15 years. Patients were categorized into four groups according to their ankle-brachial pressure indexes at their first visit. Ninety-seven patients had normal indexes (greater than or equal to 0.92), 86 had indexes of 0.50 to 0.91, 39 had indexes of 0.31 to 0.49, and 25 had indexes within the ischemic range, less than or equal to 0.30. At 6 years 64% of the patients with ischemic indexes were dead. This incidence was significantly higher than that of any other patient category (p less than 0.01). Diabetes also had a significantly adverse effect on survival. The incidence of stroke and myocardial infarction was similar for all disease groups. Thirteen percent and 32% of patients with indexes of 0.31 to 0.49 and less than or equal to 0.30, respectively, underwent limb amputation. We conclude that patients with evidence of mild to moderate peripheral vascular disease have a survival rate and risk of vascular-related disorders similar to those of patients of similar age with little evidence of disease, whereas an ankle-brachial pressure index less than or equal to 0.30 is associated with a malignant prognosis.
Subject(s)
Arteriosclerosis/mortality , Leg/blood supply , Adolescent , Adult , Aged , Aged, 80 and over , Arm/blood supply , Arteriosclerosis/complications , Arteriosclerosis/physiopathology , Blood Pressure , Cause of Death , Diabetic Angiopathies/complications , Diabetic Angiopathies/mortality , Diabetic Angiopathies/physiopathology , Female , Follow-Up Studies , Humans , Ischemia/complications , Ischemia/mortality , Ischemia/physiopathology , Male , Middle Aged , Prognosis , Regression AnalysisSubject(s)
Breast Neoplasms/etiology , Colonic Neoplasms/etiology , Rectal Neoplasms/etiology , Breast Neoplasms/epidemiology , Breast Neoplasms/genetics , Colonic Neoplasms/epidemiology , Colonic Neoplasms/genetics , Diet/adverse effects , Dietary Fats/adverse effects , Female , Food , Humans , Male , Rectal Neoplasms/epidemiology , Rectal Neoplasms/genetics , Risk , Transients and Migrants , Tryptophan/metabolism , United StatesSubject(s)
Intestinal Neoplasms/mortality , Occupational Diseases/mortality , Adult , Colonic Neoplasms/mortality , Female , Humans , Male , Middle Aged , Occupations , Rectal Neoplasms/mortality , Risk , Sex Factors , Social Class , United Kingdom , United StatesSubject(s)
Colonic Neoplasms/etiology , Diet/adverse effects , Rectal Neoplasms/etiology , Adult , Aged , Animals , Black People , Cattle , Colonic Neoplasms/mortality , Emigration and Immigration , Female , Fishes , Food , Georgia , Hawaii , Humans , Japan/ethnology , Male , Meat/adverse effects , Middle Aged , Poultry Products/adverse effects , Rectal Neoplasms/epidemiology , Sheep , Swine , United States , White PeopleSubject(s)
Mental Disorders , Neoplasms/mortality , Diet , Female , Hospitalization , Humans , Length of Stay , Male , Risk , SchizophreniaABSTRACT
It has long been recognized that international death rates for many cancer sites tend to be associated and are higher in the more "westernized" countries. The specific sites, with respect to cancer deaths among men, were identified in the present study through factor analysis of death rates by cancer site in 41 countries. Rates from the following cancer sites were found to be associated with a westernization factor: intestine, rectum, lung, skin, leukaemia and prostate.