Association between abciximab and length of stay in intensive care for patients undergoing percutaneous coronary intervention. A 2-stage econometric model in a naturalistic setting

OBJECTIVE: To examine the effect of abciximab treatment on intensive care length of stay for patients undergoing percutaneous coronary intervention (PCI). DESIGN AND SETTING: A retrospective study conducted in a naturalistic setting. METHODS: A 2-stage econometric model was used to control for the influence of possible selection bias across categories of patients and for both observable and unobservable factors correlated with each patient's treatment selection and length of stay in intensive care. Multivariate analysis was applied to control for a wide range of factors (patient demographics, insurance provider, health conditions, admission and discharge information, and hospital characteristics) that may influence intensive care length of stay. Retrospective data were obtained from HCIA's Clinical Pathways Database. PARTICIPANTS: Patients (n = 13,364) who were hospitalised in any of 87 hospitals across the US over the period from October 1, 1995 to December 1, 1996. RESULTS: After controlling for high-risk indications and selection bias, results indicated that administration of abciximab was associated with a significantly shorter length of stay in intensive care compared with not administering a GPIIb/IIIa inhibitor (0.45 fewer days; p < or = 0.0001). In a subgroup analysis of patients having an acute myocardial infarction (n = 4793), administration of abciximab was also associated with a significantly shorter intensive care stay (0.27 fewer days; p < 0.0001). CONCLUSION: Results of this study indicate that the administration of abciximab is associated with a reduction in the length of stay in intensive care. This reduction implies potential cost offsets for patients undergoing PCI who receive abciximab.     

Suicidal Ideation in Bipolar Disorder: The Relation with Clinical and Sociodemographic Variables

Psychiatric Quarterly - Bipolar disorder (BD) has the highest risk of suicide among all mental disorders. Thus, identifying factors related to suicidal ideation is essential for a better assessment...     

Effects of environmental factors on the number of emergency admissions to the Hospital Complex Juan Canalejo in La Coruña: creation of a prediction model

BACKGROUND: This study is aimed at establishing the possible associations between the number of admissions through the emergency room at the "Juan Canalejol" Hospital in Corunna in 1994-1994 due to organic, circulatory and respiratory reasons and the weather variables introduced as being exogenous for the purpose of preparing a prediction model. METHODS: The Box-Jenkins methodology is used for obtaining univariate ARIMA models of the time-based series taken into consideration. Cross-Correlation Functions (CCF's) are established among the series of residuals which afford the possibility of establishing weights and lags among the variables for a subsequent modeling by means of multivariate ARIMA models which include environmental variables. RESULTS: The emergency admissions for organic reasons significantly increase 0-2 days following a rise in temperature. The admissions due to respiratory ailments are associated with drops in temperature with 10-14 lags, whilst the admissions for circulatory reasons increase significantly due to long-lasting spells of hot weather (10 lags). For people over age 65, significant increases in emergency admissions for circulatory reasons are also recorded with cold snaps. The multivariate ARIMA models that take into account the effect of environmental variables provided the best adjustment for all of the admissions variables. CONCLUSIONS: The number of emergency room admissions at the "Juan Canalejo" Medical Center Complex in Corunna due to organic, respiratory and circulatory causes shows a seasonal behavior pattern. The admissions for respiratory reasons are associated with a drop in temperature, whilst the admissions for circulatory reasons are affected fundamentally by hot weather, although also by cold weather as regards people over age 65. The multivariate ARIMA models including climate-related variables provide a system for predicting admissions in terms of said variables that can be useful from the standpoint of hospital management.     

Successful embolization of a bleeding splenic artery pseudoaneurysm secondary to necrotizing pancreatitis

A case of successful obliteration of a bleeding splenic artery pseudoaneurysm secondary to necrotizing pancreatitis is reported. The material used for embolization was stainless steel coils. A variation of the technique is introduced. Instead of occluding the pseudoaneurysm cavity itself, embolization only of the afferent vessel is advised.     

Transposition of the external genitalia associated with caudal regression

Complete transposition of the external genitalia is a rare abnormality that occasionally is associated with the caudal regression syndrome. We report the pathological findings of this abnormality in a male stillborn and a female newborn. The male stillborn had extensive urogenital anomalies as well as complete transposition of the external genitalia and agenesis of the lumbar spine. The female patient had renal tract anomalies and ambiguous external genitalia with a phallic structure in the gluteal cleft. In surviving infants with transposition of the external genitalia immediate evaluation of the urogenital system is necessary to identify the full extent of any associated internal defects.     

A large-scale analysis of tissue-specific pathology and gene expression of human disease genes and complexes

Heritable diseases are caused by germ-line mutations that, despite tissuewide presence, often lead to tissue-specific pathology. Here, we make a systematic analysis of the link between tissue-specific gene expression and pathological manifestations in many human diseases and cancers. Diseases were systematically mapped to tissues they affect from disease-relevant literature in PubMed to create a disease–tissue covariation matrix of high-confidence associations of >1,000 diseases to 73 tissues. By retrieving >2,000 known disease genes, and generating 1,500 disease-associated protein complexes, we analyzed the differential expression of a gene or complex involved in a particular disease in the tissues affected by the disease, compared with nonaffected tissues. When this analysis is scaled to all diseases in our dataset, there is a significant tendency for disease genes and complexes to be overexpressed in the normal tissues where defects cause pathology. In contrast, cancer genes and complexes were not overexpressed in the tissues from which the tumors emanate. We specifically identified a complex involved in XY sex reversal that is testis-specific and down-regulated in ovaries. We also identified complexes in Parkinson disease, cardiomyopathies, and muscular dystrophy syndromes that are similarly tissue specific. Our method represents a conceptual scaffold for organism-spanning analyses and reveals an extensive list of tissue-specific draft molecular pathways, both known and unexpected, that might be disrupted in disease.     

Delayed Onset Dystonia Following Hemiplegic Migraine

SYNOPSIS
A 22-year-old woman developed complete left hemiplegia and sensory loss during an attack of migraine. She recovered almost totally but two months later incoordination and twisting of the left limb was noticeable. Examination showed tremor of the left arm and dystonia of the hand and foot secondary to a small infarction of the right posterolateral thalamic nuclei. Late onset dystonia may be another sequela of complicated migraine.     

Gastrointestinal involvement in neurofibromatosis: Angiographic presentation

A large neurofibroma associated with gastrointestinal hemorrhage was demonstrated by visceral arteriography. The findings are correlated with those of resected pathologic specimen.