European journal of internal medicine
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Erdheim-Chester disease (ECD) is rare form of non-Langerhans cells histiocytosis with multiorgan involvement. Individuals are more frequently affected in their fifth decade and there is a slight male prevalence. Recent studies have demonstrated that ECD patients bare mutations in the proto-oncogene BRAF (and more rarely in other genes involved in the MAPK activation pathway), suggesting a critical role of this pathway in the pathogenesis and a possible clonal origin of the disease. ⋯ More recently, the BRAF-inhibitor vemurafenib has been used in small groups of ECD patients with optimal efficacy in all treated cases. Nevertheless, its adverse effects and the scanty data on its long-term efficacy and safety still discourage its use as a first-line option. Further studies are still warranted to better understand and treat this neglected and overlooked disease.
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Eur. J. Intern. Med. · May 2015
Review Meta AnalysisIndividual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies.
The association between acute kidney injury (AKI) and use of non-steroidal anti-inflammatory drugs (NSAIDs) is well established. However, little is known about the comparative risk of individual NSAIDs, including specific COX-2 inhibitors. ⋯ A statistically significant elevated AKI risk among traditional NSAID users has been demonstrated in this meta-analysis. The pooled risk ratios among individual traditional NSAIDs were not significantly different. The pooled risk ratios of specific COX-2 inhibitors and the two traditional NSAIDs with the most COX-2 selectivity (diclofenac and meloxicam) were also comparable with other traditional NSAIDs even though they did not achieve a statistical significance.
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Eur. J. Intern. Med. · May 2015
Higher risk of developing a subsequent migraine in adults with nonapnea sleep disorders: A nationwide population-based cohort study.
This nationwide population-based cohort study evaluated the effect of nonapnea sleep disorders (NSDs) on the subsequent development of a migraine. ⋯ The findings of this population-based cohort study indicate a higher risk of developing a subsequent migraine in patients with an NSD, which could be considered an independent, predisposing factor for developing subsequent a migraine in adulthood.
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Eur. J. Intern. Med. · May 2015
Factors associated with length of stay following an emergency medical admission.
Hospitals are under pressure to use resources in the most efficient manner. We have examined the factors predicting Length of Stay (LOS) in one institution, using a database of all episodes of emergency medical admissions prospectively collected over 12 years. ⋯ Predictor variables strongly correlated with LOS; there were linear increases within categories and summation between variables. More predictor variables may improve model reliability but predicting LOS ranges or quantiles may be more realistic, based on these results.
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Eur. J. Intern. Med. · May 2015
Statin adherence and LDL cholesterol levels. Should we assess adherence prior to statin upgrade?
Adherence to statin therapy has been shown to be suboptimal. In statin-treated patients with residual elevated low density lipoprotein cholesterol (LDL-C) levels the physician must decide whether to switch to a more potent statin or try and achieve better adherence. We examined the association between adherence and LDL-C within low, moderate and high intensity statin groups in a "real world" setting. ⋯ Increased adherence to statins beyond an MPR of 80% improves LDL levels only among patients given high intensity therapy. Switching from lower to higher intensity therapy may be more effective than further efforts to increase adherence.