Internal and emergency medicine
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Comment Letter Case Reports
Unexpected hypertension associated to silent renal failure in a "healthy" young woman.
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Letter Case Reports
Remission of autoimmune hyperthyroidism after chemotherapy for cancer.
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Dual antiplatelet therapy with aspirin and clopidogrel reduces cardiovascular events following an acute coronary syndrome or stent implantation, but the associated increased risk of gastro-intestinal bleeding often leads to the co-administration of proton pump inhibitors (PPIs). PPIs have been shown to decrease antiplatelet effects of clopidogrel ex vivo, raising concerns about the cardiovascular safety of this drug combination. Clinical trials investigating PPI-clopidogrel interactions have provided conflicting results and are all subject to methodological critiques. ⋯ Indeed, the Clopidogrel and the Optimization of GI Events Trial, which would have had such characteristics, was stopped prematurely. As a consequence, the question of the PPI-clopidogrel interaction is still unresolved, and clinical consequences cannot be excluded. At this time such combination therapy should, therefore, be provisionally advocated only for patients at high risk of bleeding (prior upper gastro-intestinal bleeding, advanced age, concomitant use of warfarin, steroidal or non-steroidal anti-inflammatory drugs and Helicobacter pylori infection) and avoiding PPIs with strong affinity for cytochrome CYP2C19, such as omeprazole and esomeprazole.
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Comparative Study Observational Study
Comparison of video laryngoscopy to direct laryngoscopy for intubation of patients with difficult airway characteristics in the emergency department.
The objective of the study is to compare the efficacy of video laryngoscopy (VL) to direct laryngoscopy (DL) on the first pass intubation success of patients with difficult airway characteristics (DACs) in the emergency department (ED). Over a 6-year period, between July 1 2007 and June 30 2013, all intubations performed in an academic ED were recorded in a continuous quality improvement (CQI) database by the operators. The CQI form included information such as patient demographics, operator level of training, device(s) used, number of attempts and outcome of each attempt. ⋯ After adjusting for potential confounders, VL was associated with higher odds of first pass success for patients with no DACs (aOR 2.0, 95 % CI 1.2-3.3), one DAC (aOR 3.2, 95 % CI 1.9-5.6), two DACs (aOR 2.3, 95 % CI 1.1-4.9), and three or more DACs (aOR 2.9, 95 % CI 1.5-5.5). In patients with DACs, VL was associated with a higher first pass success than DL. VL is recommended as the primary intubating device for patients with predicted difficult airways in the ED.