Swiss medical weekly
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Swiss medical weekly · Jan 2012
ReviewNeglected tropical diseases: diagnosis, clinical management, treatment and control.
Branded in 2005, "neglected tropical diseases" have gained traction in terms of advocacy, interest for research, enhanced funding and political will for their control and eventual elimination. Starting with an initial set of 13 neglected tropical diseases--seven helminth, three bacterial and three protozoal infections--the list considerably expanded to more than 40 diseases that now also includes viral, fungal and ectoparasitic infections. In this review, we provide a comprehensive overview of the neglected tropical diseases, their causative agents and the current geographical distribution, including their importance for the general practitioners seeing returning travellers and migrants in Switzerland. ⋯ With an emphasis on neglected tropical diseases due to helminths, protozoa and ectoparasites, we review common diagnostic methods and current recommendations for treatment at the population level and the individual patient, thereby juxtaposing the situation in highly endemic countries on one side, with Switzerland on the other. We highlight the clinical presentation and management of the neglected tropical diseases in general and then elaborate on two examples, strongyloidiasis and leptospirosis. Our review provides a global perspective of neglected tropical diseases and we hope that it will prove useful for the general practitioner and clinician in Switzerland and elsewhere to enhance their suspicion index, differential diagnosis, clinical management and treatment, including referral to specialised clinics and laboratories when need be.
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Contrast-induced nephropathy (CIN) is an acute renal injury due to the renal toxicity of iodinated contrast media. It is classically defined as a relative (≥25%) or absolute (≥0.5 mg/dl; 44 μmol/l) increase in serum creatinine from baseline value. CIN accounts for 10 to 15% of hospital-acquired acute renal failure and may rarely lead to irreversible renal function loss. ⋯ Several plasmatic and urinary biomarkers have been studied in that view, with plasmatic cystatine-C and urinary NGAL being the most promising. As no treatment specifically targets CIN once it develops, the main goal for clinicians remains prevention, with hydration status optimisation being the only proven strategy to date. Here, we will review the recent evidence concerning CIN, its incidence, proposed early diagnostic biomarkers, as well as its treatment and prognostic implication.
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Malignant hyperthermia (MH) is a subclinical myopathy, usually triggered by volatile anaesthetics and depolarising muscle relaxants. Clinical symptoms are variable, and the condition is sometimes difficult to identify. Nevertheless, rapid recognition and specific as well as symptomatic treatment are crucial to avoid a lethal outcome. ⋯ There is no screening method to test for MH, as current tests are invasive (open muscle biopsy) or restricted to MH families with known MH-associated mutations (molecular genetic testing). The prevalence of the MH trait is unknown, because the clinical penetrance after contact with triggering agents is very variable. More recently, MH mutations have been associated with rhabdomyolysis following statin therapy or with non-pharmacological triggering, such as exertional heat stroke.
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Meta-analyses overcome the limitation of small sample sizes or rare outcomes by pooling results from a number of individual studies to generate a single best estimate. As long as a meta-analysis is not limited by poor quality of included trials, unexplainable heterogeneity and/or reporting bias of individual trials, meta-analyses can be instrumental in reliably demonstrating benefit or harm of an intervention when results of individual randomised controlled trials are conflicting or inconclusive. Therefore meta-analyses should be conducted as part of a systematic review, i.e., a systematic approach to answer a focused clinical question. ⋯ As opposed to meta-analysis based on aggregate study data, individual patient data meta-analyses offer the advantage to use standardised criteria across trials and reliably investigate subgroup effects of interventions. Network meta-analysis allows the integration of data from direct and indirect comparisons in order to compare multiple treatments in a comprehensive analysis and determine the best treatment among several options. We conclude that meta-analysis has become a popular, versatile, and powerful tool. If rigorously conducted as part of a systematic review, it is essential for evidence-based decision making in clinical practice as well as on the health policy level.
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Meta-analyses overcome the limitation of small sample sizes or rare outcomes by pooling results from a number of individual studies to generate a single best estimate. As long as a meta-analysis is not limited by poor quality of included trials, unexplainable heterogeneity and/or reporting bias of individual trials, meta-analyses can be instrumental in reliably demonstrating benefit or harm of an intervention when results of individual randomised controlled trials are conflicting or inconclusive. Therefore meta-analyses should be conducted as part of a systematic review, i.e., a systematic approach to answer a focused clinical question. ⋯ As opposed to meta-analysis based on aggregate study data, individual patient data meta-analyses offer the advantage to use standardised criteria across trials and reliably investigate subgroup effects of interventions. Network meta-analysis allows the integration of data from direct and indirect comparisons in order to compare multiple treatments in a comprehensive analysis and determine the best treatment among several options. We conclude that meta-analysis has become a popular, versatile, and powerful tool. If rigorously conducted as part of a systematic review, it is essential for evidence-based decision making in clinical practice as well as on the health policy level.