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Rob Allen,1 Uma Sharma,2 Suna Barlas31Formerly of Pfizer Inc, Collegeville, Pennsylvania, PA, USA; 2MMS Holdings Inc, Canton, MI, USA; 3Pfizer Inc, Collegeville, Pennsylvania, PA, USAPurpose: To assess the safety and efficacy of the serotonin–norepinephrine reuptake inhibitor desvenlafaxine in adults with painful diabetic peripheral neuropathy (DPN).ClinicalTrials.gov identifiers: NCT00283842, NCT01050218.Patients and methods: This was a 13-week, randomized, double-blind, placebo-controlled, fixed-dose study of desvenlafaxine in adults with painful DPN. The primary efficacy endpoint was change from baseline in numeric rating scale (NRS) score. Patients who completed the 13-week trial could continue in a 9-month open-label, flexible-dose extension study.Results: A total of 412 patients were randomized to treatment with placebo or desvenlafaxine 50, 100, 200, or 400 mg/day. Of those, 240 patients continued in the extension study. After a planned interim analysis, conducted when the first 225 patients had completed 6 weeks of treatment in the short-term study, randomization to the 50 mg or 400 mg doses was stopped. At week 13, the mean change from baseline in NRS score was significantly greater compared with placebo in the desvenlafaxine 200 mg (difference [95% confidence interval {CI}]: 1.10 [0.50 to 1.70]; P

OBJECTIVE: To compare early complications in patients with/without stents following renal transplantation and to determine whether routine stenting should be used in all renal transplant patients or not. PATIENTS AND METHODS: 194 patients (108 males, 86 females, mean age: 45.2 ± 13.2 years) who were followed-up at the Division of Nephrology of Istanbul Bilim University between 2006 and 2013 were included in the study. Demographic characteristics, etiologies of renal disease, comorbidities, type of renal transplantation, early complications, delayed graft function were retrospectively recorded. All patients were divided into two groups according to stent replacement. Early complications were compared. RESULTS: 101 patients were inserted double-J(DJ) stent (48 females, mean age 46.5 ± 13.7 years, mean body mass index [BMI] 26.1 ± 4.7 kg/m²) and 93 patients were not inserted stent (38 females, mean age 43.7 ± 12.6 years, mean BMI 24.3 ± 4.2 kg/m²). The rate of early complications of urinary tract infections, lymphocele, urinary leaks, wound infection and perirenal hemorrhage of patients with stent were 28.9%,3.0%,4.0%, 5.1% and 1.3%, respectively, while these rates among patients without stent were 35.5%, 2.2%,3.2%,6.5% and 1.2%,respectively. There was no significant difference between with stent and without stent groups with regard to early complications. CONCLUSIONS: Routine DJ stenting in all renal transplant patients is not necessary. Prophylactic use of DJ stent has no effect on early complications. Prophylactic DJ stent replacement can be used in obese patients, in patients receiving cadaveric transplants or in patients receiving transplants from unrelated donors. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study evaluated the accuracy of 2 administrative claims-based selection rules to identify patients with hypertension (HTN) using medical records as the gold standard. RESEARCH DESIGN: The claims database consisted of inpatient, outpatient, pharmacy, and eligibility claims for members of a single insurance company from January 2000 through March 2003. Medical records were abstracted for 258 matched patient pairs selected by Rule A (at least 1 HTN-related International Classification of Diseases, 9th Revision [ICD-9] claim) and 138 pairs selected by Rule B (at least 1 HTN-related ICD-9 and at least 1 HTN prescription claim) from 31 provider sites. Sensitivity and specificity of the 2 selection rules were computed using medical chart review as the gold standard for a diagnosis of HTN. SUBJECTS: Of patients selected by Rule A, chart review identified 281 patients with and 235 patients without HTN. Of patients selected by Rule B, chart review identified 172 patients with and 104 patients without HTN. RESULTS: The sensitivity and specificity was 70.8% and 74.9% for Rule A and 76.2% and 93.3% for Rule B. The kappa score was 0.45 for Rule A and 0.65 for Rule B. CONCLUSION: To identify patients with HTN, a selection rule using both a diagnosis and prescription claim has greater sensitivity and specificity than a rule using a diagnosis claim only. [ABSTRACT FROM AUTHOR]

Rectal prolapse is believed to develop secondary to anatomical defects. Rectosigmoid tumors are rare causes of this condition. This must be kept in mind in patients with prolapse; colonoscopic examination is recommended and biopsy should be performed when necessary. In this case report, we present an elderly patient with rectal prolapse. The mass that precipitated the prolapse was biopsied and identified as adenocarcinoma. The cancer was treated and patient was discharged.

The ARRA is mandating enormous changes in the way patient records are stored and shared. Some argue that there are still many glitches standing in the way of full implementation. [ABSTRACT FROM AUTHOR]

Gunshot might have unexpected findings in the victim owing to the ballistics of the injury. The trajectory of the bullet plays a central role in the surprising findings in gunshot injuries. We are presenting a case with pellets seen in the stomach after a gunshot.