Abnormal Baseline Lab Results Rarely Lead to Treatment Modification for Patients on Isotretinoin

Dermatology ◽  
2020 ◽  
Vol 236 (6) ◽  
pp. 517-520 ◽  
Author(s):  
Elizabeth Tkachenko ◽  
Priyank Sharma ◽  
Arash Mostaghimi
Keyword(s):  
Clinical Course ◽  
Liver Function Tests ◽  
Hepatic Disease ◽  
Clinical Implications ◽  
Treatment Modification ◽  
Total Treatment ◽  
Management Changes ◽  
Isotretinoin Therapy ◽  
Low Rate ◽  
Baseline Total Cholesterol

<b><i>Background:</i></b> Treatment modification and clinical course for patients initiating isotretinoin with abnormal baseline lab results is currently unknown, and no recommendations exist for monitoring this patient group. <b><i>Methods:</i></b> We performed a retrospective review of patients prescribed isotretinoin for acne from 2008 to 2016 at Brigham and Women’s and Massachusetts General Hospitals to investigate the characteristics, clinical implications, and management of patients initiating isotretinoin for acne with baseline laboratory abnormalities. <b><i>Results:</i></b> We identified a low rate (7.2%) of treatment modification, including interruption (3.6%) and early termination (3.6%), during isotretinoin therapy due to lab abnormalities for patients with baseline lab abnormalities. Abnormal baseline total cholesterol, triglyceride, and liver function tests did not predict management changes, as only 2 of 10 total treatment modifications were due to a lab result that was abnormal at baseline. Treatment modification was driven by ALT elevation not present at baseline that occurred in patients with liver comorbidities. <b><i>Conclusion:</i></b> Emphasizing relevant comorbidities, including hepatic disease or alcohol use, to inform our monitoring may be a superior predictor of abnormalities during treatment, as our work demonstrates that the value of baseline lab data prior to isotretinoin is unclear.

scholarly journals Substance use disorders and psychological trauma

2009 ◽  
Vol 33 (7) ◽  
pp. 257-260
Author(s):  
Shaheen Shora ◽  
Elizabeth Stone ◽  
Keron Fletcher
Keyword(s):  
Substance Use ◽  
Alcohol Dependence ◽  
Life Events ◽  
Substance Use Disorders ◽  
Best Practice ◽  
Clinical Course ◽  
Traumatic Events ◽  
Psychological Trauma ◽  
Clinical Implications ◽  
The Impact

Aims and MethodThe Impact of Events Scale was administered to 104 in-patients detoxing from alcohol or opiates to determine the prevalence of psychological trauma, the severity of its symptoms and the types of trauma responsible for symptoms.ResultsOut of the 104 in-patients undergoing detoxification, 75 had symptoms of psychological trauma; in 60 patients the symptoms were in the treatable range. Patients with alcohol-dependence were more severely affected. ‘Life events’ traumatised a higher proportion of individuals than ‘traumatic events’.Clinical ImplicationsPsychological trauma requiring treatment is commonly found in substance misusers. This is rarely addressed despite the cormorbid disorder running a complicated clinical course. There are conflicting opinions about best practice, but consideration should be given to providing patients with accessible treatments for psychological trauma.

scholarly journals Genetic disturbances in patients with bodily isomerism from a single center: clinical implications of affected genes and potential impact of ciliary dyskinesia

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Rohit S. Loomba ◽  
Peter C. Frommelt ◽  
Robert H. Anderson
Keyword(s):  
Clinical Course ◽  
Gene Mutations ◽  
Clinical Findings ◽  
Specific Gene ◽  
Clinical Implications ◽  
Single Center ◽  
Clinical Support ◽  
Potential Impact ◽  
Ciliary Dyskinesia

So-called heterotaxy or isomerism is characterized by abnormal lateralization and malformations of the bodily organs. The mechanism is unclear, although there is growing evidence that ciliary dyskinesia is involved. We reviewed genetic findings from patients with isomerism to determine if affected genes were known to be associated with isomerism and ciliary dyskinesia and determine associations between genotype and clinical findings. We identified patients with isomerism cared for over a 16-year period. Characteristics were compared between those with and without identified mutations. A total of 83 patients with isomerism were identified. Of those who had genotyping, 14/27 had mutations identified, most frequently involving the <em>CFC1</em> and <em>NODAL</em> genes. Specific mutations were associated with clinical findings, with <em>NODAL</em> mutations often portending need for increased clinical support. Genes associated with isomerism and/or ciliary dyskinesia were identified in the cohort. Specific gene mutations may help predict clinical course.

Diagnostic Effectiveness of Biochemical Liver-Function Tests, as Evaluated by Discriminant Function Analysis

1977 ◽  
Vol 23 (4) ◽  
pp. 627-630 ◽  
Author(s):  
Paul Phillip Sher
Keyword(s):  
Alkaline Phosphatase ◽  
Lactate Dehydrogenase ◽  
Discriminant Analysis ◽  
Liver Function ◽  
Function Analysis ◽  
Liver Function Tests ◽  
Diagnostic Value ◽  
Hepatic Disease ◽  
Stepwise Discriminant Analysis ◽  
Function Tests

Abstract I evaluated the diagnostic value of routinely ordered liver-function tests in 175 biopsy-proven cases of hepatic disease by use of stepwise discriminant analysis. The tests studied—total and "direct" bilirubin, alkaline phosphatase, lactate dehydrogenase, and aspartate aminotrans-ferase—correctly classified 45-73% of cases, depending on the homogeneity of the diagnostic groups. Aspartate aminotransferase and alkaline phosphatase were the best discriminators. When all tests were used in the most ho-mogeneous groups (tumors, cirrhosis, and hepatitis), there was a stepwise improvement in diagnostic accuracy from 51 to 73%.

scholarly journals Molecular Mechanism Underlying Lymphatic Metastasis in Pancreatic Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-15 ◽  
Author(s):  
Zhiwen Xiao ◽  
Guopei Luo ◽  
Chen Liu ◽  
Chuntao Wu ◽  
Liang Liu ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adverse Event ◽  
High Risk ◽  
Prognostic Factor ◽  
Lymphatic Metastasis ◽  
Clinical Course ◽  
Cellular Mechanisms ◽  
Poor Prognostic Factor ◽  
Dismal Prognosis ◽  
Low Rate

As the most challenging human malignancies, pancreatic cancer is characterized by its insidious symptoms, low rate of surgical resection, high risk of local invasion, metastasis and recurrence, and overall dismal prognosis. Lymphatic metastasis, above all, is recognized as an early adverse event in progression of pancreatic cancer and has been described to be an independent poor prognostic factor. It should be noted that the occurrence of lymphatic metastasis is not a casual or stochastic but an ineluctable and designed event. Increasing evidences suggest that metastasis-initiating cells (MICs) and the microenvironments may act as a double-reed style in this crime. However, the exact mechanisms on how they function synergistically for this dismal clinical course remain largely elusive. Therefore, a better understanding of its molecular and cellular mechanisms involved in pancreatic lymphatic metastasis is urgently required. In this review, we will summarize the latest advances on lymphatic metastasis in pancreatic cancer.

The Association Between Depression and Isotretinoin Use in Acne

2003 ◽  
Vol 37 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Chee Hong Ng ◽  
Isaac Schweitzer
Keyword(s):  
Psychological Impact ◽  
Clinical Implications ◽  
Review Of The Literature ◽  
Contributing Factors ◽  
Psychiatric Referral ◽  
Appropriate Treatment ◽  
Low Threshold ◽  
Acne Treatment ◽  
Isotretinoin Therapy ◽  
Uncommon Complication

Objective: The association between isotretinoin and depression has received little attention in the psychiatric literature despite an increasing number of reports in medical journals. The purpose of this paper is to highlight this association, examine the possible link and review the clinical implications. Method: A critical review of the literature pertaining to depression in patients with acne who were treated with isotretinoin was conducted. Results and Conclusions: The causal relationship between isotretinoin therapy and depression has not been clearly established and needs further study. Isotretinoin is likely to have a positive psychological impact for the majority of patients who benefit from such a highly efficacious anti-acne treatment. However, it is important to recognize that depression can occur as an idiosyncratic side-effect that requires urgent and appropriate treatment. Therefore, having a low threshold for detection of this uncommon complication and early psychiatric referral to address both the depression and its contributing factors may prevent serious consequences.

scholarly journals Community treatment orders in England: review of usage from national data

2018 ◽  
Vol 42 (3) ◽  
pp. 119-122 ◽  
Author(s):  
Susham Gupta ◽  
Elvan U. Akyuz ◽  
Toby Baldwin ◽  
David Curtis
Keyword(s):  
Mental Health ◽  
Service Provision ◽  
Psychiatric Service ◽  
Community Treatment ◽  
Clinical Implications ◽  
Economic Downturn ◽  
National Data ◽  
Community Treatment Orders ◽  
England And Wales ◽  
Low Rate

Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.ResultsAbout 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.Clinical implicationsThe introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.Declaration of interestNone.

scholarly journals Favorable Outcomes of Chinese HCV-Related Cirrhotic Patients with Sustained Virological Response after Pegylated Interferon Plus Ribavirin Treatment

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Geng-lin Zhang ◽  
You-ming Chen ◽  
Ting Zhang ◽  
Qing-xian Cai ◽  
Xiao-hong Zhang ◽  
...  
Keyword(s):  
Sustained Virological Response ◽  
Virological Response ◽  
Clinical Course ◽  
Laboratory Data ◽  
Pegylated Interferon ◽  
Liver Function Tests ◽  
Hcv Rna ◽  
Pegylated Interferon Plus Ribavirin ◽  
Cirrhotic Patients

Few studies have conducted follow-up investigations of the clinical course in HCV-related cirrhotic patients who achieved a sustained virological response (SVR) with pegylated interferon plus ribavirin treatment (PegIFN + RBV). We investigated the clinical course and laboratory data in a prospective cohort study enrolling HCV-related cirrhotic patients who received PegIFN + RBV between August 2008 and July 2013 in China. Complete blood counts, liver function tests, and HCV-RNA were serially examined. Liver-related complications were recorded. To detect hepatocellular carcinoma (HCC), alpha-fetoprotein assays, and ultrasound scans were repeated at 6-month intervals. Twenty-five patients were enrolled, including 8 patients with decompensation events before treatment. Eighteen patients achieved SVR with a mean follow-up period of 25.78 months. During the follow-up period, only one patient exhibited HCV-RNA positivity and no decompensation events were detected, but 4 patients developed HCC after SVR. APRI decreased more in patients with SVR than in patients with non-SVR (median, −1.33 versus 0.86,P<0.001). The albumin levels and platelet counts significantly increased during the follow-up period after SVR (44.27±4.09versus42.63±4.37,P=0.037and173.89±87.36versus160.11±77.97,P=0.047). These data indicated that HCV-related cirrhotic patients with SVR after PegIFN + RBV may have a favorable clinical course and improvements in laboratory data. Moreover, HCC should be monitored.

scholarly journals Psychiatry of learning disability – a future with mental health?

2002 ◽  
Vol 26 (8) ◽  
pp. 299-301 ◽  
Author(s):  
R. Alexander ◽  
A. Regan ◽  
S. Gangadharan ◽  
S. Bhaumik
Keyword(s):  
Mental Health ◽  
Learning Disability ◽  
Social Services ◽  
Service Provision ◽  
Postal Survey ◽  
Clinical Implications ◽  
Current Management ◽  
Process Of Change ◽  
Management Changes ◽  
Integrated Mental Health

Aims and MethodA postal survey was sent to all consultants in the psychiatry of learning disability from four English regions. Their views on job satisfaction, their core roles and the management re-structuring of services were elicited.ResultsThe proportion agreeing or strongly agreeing with each management option was 79% for integrated mental health–learning disability trusts, 61% for specialist learning disability trusts, 47% for care trusts, 10% for primary care trusts and 5% for social services. Only 34% felt consulted or able to influence the process of change and only 33% were satisfied with the current management changes within their trust but 67% were satisfied overall with their jobs.Clinical ImplicationsManagement from integrated mental health–learning disability trusts is the most preferred option for psychiatrists in learning disability. A large number of consultants, though otherwise satisfied with their jobs, feel excluded or unable to influence the current changes in management structures. A model of integrated service provision in line with the government's learning disability strategy is presented.

scholarly journals Evaluation of Idiopathic Choroidal Neovascularization with Indocyanine Green Angiography in Patients Undergoing Bevacizumab Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ryan B. Rush ◽  
Sloan W. Rush
Keyword(s):  
Visual Acuity ◽  
Indocyanine Green ◽  
Choroidal Neovascularization ◽  
Indocyanine Green Angiography ◽  
Clinical Course ◽  
Intravitreal Bevacizumab ◽  
Clinical Implications ◽  
Snellen Visual Acuity ◽  
Icg Angiography

Purpose. To examine the clinical implications of change in choroidal neovascularization (CNV) size on indocyanine green (ICG) angiography in subjects with idiopathic CNV undergoing bevacizumab therapy.Methods. The charts of subjects with an idiopathic CNV treated by a modified PRN regimen with intravitreal bevacizumab over a 12-month period were retrospectively reviewed.Results. There were 34 subjects included in the analysis. Baseline CNV sizes of less than 1.0 mm2on ICG angiography correlated with complete CNV resolution (P=0.0404), fewer injections delivered (P=0.0002), and better Snellen visual acuity (P=0.0098) at 12 months. Subjects that experienced a 33% or more reduction in CNV size on ICG angiography at 2 months had complete CNV resolution (P=0.0047) and fewer injections (P<0.0001) at 12 months compared to subjects that did not experience a 33% or more reduction in CNV size on ICG angiography at 2 months.Conclusions. Smaller baseline CNV size on ICG angiography resulted in better visual acuity and fewer injections at 12 months, and a reduction of 33% or more in CNV size after 2 months may predict a better clinical course in subjects with idiopathic CNV undergoing bevacizumab therapy.

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