https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)60601-1.pdf

Autosomal dominant polycystic kidney disease

Experience with 1509 patients undergoing thoracoabdominal aortic operations

Adverse drug reactions (ADRs) result in major health problems in the United States in both the inpatient and outpatient setting. ADRs are broadly categorized into predictable (type A and unpredictable (type B) reactions. Predictable reactions are usually dose dependent, are related to the known pharmacologic actions of the drug, and occur in otherwise healthy individuals, They are estimated to comprise approximately 80% of all ADRs. Unpredictable are generally dose independent, are unrelated to the pharmacologic actions of the drug, and occur only in susceptible individuals. Unpredictable reactions are subdivided into drug intolerance, drug idiosyncrasy, drug allergy, and pseudoallergic reactions. Both type A and B reactions may be influenced by genetic predisposition of the patient

Drug allergy: an updated practice parameter.

Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline

/pdf/guidelines-of-diagnostics-and-treatment-of-acute-left-sided-1po8mr4e3z.pdf

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Background
Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency.

Objectives
To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs.

Search methods
We searched the Database of Abstracts of Reviews of Effectiveness (DARE), the Effective Practice and Organisation of Care (EPOC) Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED and Global Health. We also searched the reference lists of relevant articles and contacted relevant professional organisations.

Selection criteria
Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies comparing stand alone clinical pathways with usual care as well as clinical pathways as part of a multifaceted intervention with usual care.

Data collection and analysis
Two review authors independently screened all titles to assess eligibility and methodological quality. Studies were grouped into those comparing clinical pathways with usual care and those comparing clinical pathways as part of a multifaceted intervention with usual care.

Main results
Twenty-seven studies involving 11,398 participants met the eligibility and study quality criteria for inclusion. Twenty studies compared stand alone clinical pathways with usual care. These studies indicated a reduction in in-hospital complications (odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.94) and improved documentation (OR 11.95: 95%CI 4.72 to 30.30). There was no evidence of differences in readmission to hospital or in-hospital mortality. Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions. A decrease in hospital costs/ charges was also observed, ranging from WMD +261 US$ favouring usual care to WMD -4919 US$ favouring clinical pathways (in US$ dollar standardized to the year 2000). Considerable heterogeneity prevented meta-analysis of length of stay and hospital cost results.  An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken.

Seven studies compared clinical pathways as part of a multifaceted intervention with usual care. No evidence of differences were found between intervention and control groups.

Authors' conclusions
Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs.

/pdf/clinical-pathways-effects-on-professional-practice-patient-2sl6tkljsx.pdf

Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs

Biotin transport in the human intestine: inhibition by anticonvulsant drugs.

https://www.annalsthoracicsurgery.org/article/S0003-4975(10)63200-6/pdf

Thiopental Modification of Ischemic Spinal Cord Injury in the Dog

Transport of biotin across human intestinal brush-border membrane (BBM) was examined using brush-border membrane vesicle (BBMV) technique. Uptake of biotin by BBMV is mostly the result of transport of the substrate into an active intravesicular space with little binding to membrane surfaces. The transport of biotin was carrier mediated and was 1) Na+ (but not K+) gradient dependent with a distinct "over-shoot" phenomenon, 2) saturable as a function of concentration in the presence of a Na+ (but not a K+) gradient with an apparent Km and Vmax for the Na+ gradient-dependent system of 5.26 microM and 13.47 pmol.mg protein-1.20 s-1, respectively, and 3) inhibited by structural analogues and related compounds. Unlike the electrogenic transport of D-glucose, transport of the anionic biotin in the presence of a Na+ gradient (out greater than in) was not affected by imposing a relatively positive intravesicular electrical potential, suggesting that biotin transport is most likely an electroneutral process. These results demonstrate the existence of a carrier-mediated system for biotin transport in human BBM and show that the transport process is Na+ gradient dependent and electrically silent. It is suggested that biotin transport across the BBM is driven by a Na+ gradient most probably through a biotin-Na+ cotransport system.

A carrier-mediated, Na+ gradient-dependent transport for biotin in human intestinal brush-border membrane vesicles

Colonic complications after renal transplantation are uncommon but have a high mortality rate. Some have recommended colonic screening in patients over 50 years of age prior to transplantation to lessen the impact of colonic diverticular disease. We report our 9-year experience of colonic screening for diverticular disease in potential recipients over the age of 50 and compare these results to the overall colonic complication rate in the same time period. From 1981-1990, 1186 renal transplants in 1019 patients were performed, during which time all potential recipients over the age of 50 yr were required to undergo colon evaluation prior to transplantation. Twenty cases of diverticular disease were found with more than a quarter of the cases in patients with adult polycystic disease. All underwent renal transplantation without a pre-transplant colectomy, and none had post transplant symptomatic colon disease. During that same time period a total of 14 colonic complications requiring surgical intervention were encountered with a mortality rate of 40%. Acute diverticulitis occurred in 5 patients, all of whom were over 50 yr of age, on low-dose immunosuppression, and in most cases it occurred remotely after transplantation. Colonic dysplasia/neoplasia also occurred remotely after transplantation in 2 patients over the age of 50. Cytomegalovirus (CMV) colitis was the next most common complication, accounting for 3 cases. This complication, which occurred in younger patients, was associated with high-dose steroid immunosuppression and had a high mortality rate, in spite of surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic screening prior to renal transplantation and its impact on post-transplant colonic complications.

https://www.gastrojournal.org/article/0016-5085(88)90007-8/pdf

Biotin transport in basolateral membrane vesicles of human intestine

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