Arrêt cardiaque récupéré sous varénicline : à propos d’un cas
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Smoking is the leading preventable cause of morbidity and mortality in the US, and decreasing smoking prevalence is a public health priority. Patients achieve the greatest success when quit attempts involve behavioral therapy combined with pharmacotherapy. Varenicline is the most recent addition to the pharmacotherapeutic armamentarium for the treatment of tobacco dependence. Varenicline is efficacious and cost-effective. Smoking relapse and adverse treatment-related side effects may decrease medication adherence and patient satisfaction with varenicline. In the clinical setting, varenicline treatment can be optimized by reducing doses in patients who experience intolerable side effects, increasing the dose in partial responders, and providing long-term maintenance therapy for relapse prevention.
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In line with other medical journals, odds ratios are increasingly being reported in anaesthesia literature. the frequency of the use of odds ratio and how well it relates to the relative risk when it is interpreted as relative risk remains unknown. we investigated the use of odds ratio, and its relationship to relative risk and the incidence of outcome in this study. we identified 60 meta-analyses and 87 original articles that reported odds ratios. while relative risk could have been reported in 79% of the studies, only a small proportion (3%) of these studies have estimated and reported the relative risk in addition to the odds ratio. there is a significant bias if odds ratio is interpreted as relative risk, especially so when the incidence of outcome is high. while odds ratio is a valid measure of treatment effect in its own right, anaesthetists and investigators should be careful not to interpret odds ratio as equivalent to relative risk.
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Recent studies have indicated higher risk of fractures among coffee drinkers. To quantitatively assess the association between coffee consumption and the risk of fractures, we conducted this meta-analysis.We searched MEDLINE and EMBASE for prospective studies reporting the risk of fractures with coffee consumption. Quality of included studies was assessed with the Newcastle Ottawa scale. We conducted a meta-analysis and a cumulative meta-analysis of relative risk (RR) for an increment of one cup of coffee per day, and explored the potential dose-response relationship. Sensitivity analysis was performed where statistical heterogeneity existed.We included 10 prospective studies covering 214,059 participants and 9,597 cases. There was overall 3.5% higher fracture risk for an increment of one cup of coffee per day (RR = 1.035, 95% CI: 1.019-1.052). Pooled RRs were 1.049 (95% CI: 1.022-1.077) for women and 0.910 (95% CI: 0.873-0.949) for men. Among women, RR was 1.055 (95% CI: 0.999-1.114) for younger participants, and 1.047 (95% CI: 1.016-1.080) for older ones. Cumulative meta-analysis indicated that risk estimates reached a stabilization level (RR = 1.035, 95% CI: 1.019-1.052), and it revealed a positive dose-response relationship between coffee consumption and risk of fractures either for men and women combined or women specifically.This meta-analysis suggests an overall harm of coffee intake in increasing the risk of fractures, especially for women. But current data are insufficient to reach a convincing conclusion and further research needs to be conducted.
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Varenicline is a non-nicotinic medication developed as an aid for people who are trying to stop smoking and is the third class of drug, after nicotine replacement therapy and bupropion, to be approved for smoking cessation. Varenicline can be prescribed as a treatment for patients who have never tried medication for smoking cessation as well as for those in whom other treatments have not been successful. Practical suggestions are made for implementing smoking cessation with varenicline.
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Guidelines for cervical screening await scientific evaluationEditor-In a news item about cervical screening in England 1 Wise refers to a report by the National Audit Office. 2 The office is particularly critical of serious failings in the interpretation of cervical smears in a small number of laboratories.The laboratory at the Hospital of St Cross in Rugby is included among these laboratories.In fact, a massive rescreening exercise at the hospital did not find any serious errors of interpretation, and the original reports were considered to be substantially correct and within the accepted operating limits of the smear test.The National Audit Office and the public assume that any deviation from the national guidelines for reporting rates represents mistakes by the laboratory.It is therefore interesting that, although the results at the hospital in Rugby were outside these guidelines, no serious errors were identified.This raises the question of whether the guidelines are an appropriate measure of laboratory performance.The guidelines themselves have come under considerable criticism in the pathology literature because of the lack of scientific evidence on which they are based. 3 One of their own authors has been particularly outspoken on the subject. 4 Though some of these arguments may seem of academic interest, cytology departments are being forced to close or merge as a result of the guidelines, which await scientific evaluation.Many staff feel threatened by the prescriptive way in which the guidelines have been introduced and applied and by the lack of understanding by the lay public and media of the limitations of the smear test.The incidence of and mortality from cervical cancer in the United Kingdom have shown accelerated falls since the introduction of organised screening (J Patnick, NHS cervical screening programme information sheet, 21 Nov 1996).Of course there is room for improvement, but it is ironic that the publication of various reports designed to improve the service could lead to its eventual collapse through staff leaving the profession.
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Both relative risk (RR) and odds ratio (OR) are common measures of treatment effect on randomized controlled trials, systematic reviews and meta-analyses. However few scientists interpret properly these measures, and many scientists mix-up their meanings and use either of them unsystematically, thus leading to misinterpretations. PURPOSE To systematize the proper usage of RR and OR on randomized controlled trials. METHODS We analyzed the complete relation between risk from 0 to 1 and odds from 0 to infinite with a precision of 0.01 for risk. Then, the relation between RR and OR was analyzed separately for both RR and OR values of either greater or less than one. When both of them were greater than one, the OR/RR ratio was analyzed at different control (5, 10, 15, 20, 30, 40, 50, 60 and 70%) and treatment (from 6 to 99%, with 1% of precision) event rates; in these cases the treatment event rate was always higher than the control event rate. When both RR and OR were less than one, we analyzed the RR/OR ratio at other control (10, 20, 30, 40, 50, 60, 70, 80, 90 and 95%) and treatment (from 1 to 94%, with 1% of precision) event rates; in these cases, the treatment event rate was always less than the control event rate. RESULTS Although odds was always higher than risk for all possible values, such risk overestimation by odds was low when risk was low. Actually, when the risk rose above 20% the gap between the odds and the risk widened. Since OR and RR are calculated by dividing these measures, the differences between RR and OR began from both control and treatment event rates higher than 20%. These differences (> 25%) were enough to misinterpret results. CONCLUSION OR is misleading when both treatment and control event rates are higher than 20%. In these instances, RR must be used instead of OR on randomized controlled trials.
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Objective The aim of this analysis was to perform a meta-analysis evaluating gender difference of delayed healing risk in patients with venous leg ulcers. Methods We searched the PubMed and Web of Knowledge from their inception to 4 July 2015. The meta-analysis of pooled odds ratio and 95% confidence interval for venous leg ulcers healing risk were calculated. Results Twelve studies with 4453 patients were included in the meta-analysis. The pooled odds ratio for healing rate stratified by gender was 1.055 (95% CI 0.955–1.165; Z = 1.05, p = 0.292) by fix-effects model. The Begg's test (z = 2.67, p = 0.007), the Egger's test (t = 4.00, p = 0.003), and asymmetric funnel plot suggested there was significant publication bias. Subgroup analysis showed the pooled odds ratios were 1.048 (95% CI 0.945–1.162; Z = 0.88, p = 0.376) in prospective studies and 1.439 (95% CI 0.757–2.736; Z = 1.11, p = 0.266) in retrospective studies. Sensitivity analyses by only pooled adjusted odds ratios showed the pooled odds ratio was 1.049 (95% CI 0.946–1.163; Z = 0.91, p = 0.365), which indicated the results of meta-analysis were robust. Meta-regression analysis showed the healing rate odds ratio stratified by gender was not related with healing rate (t = 0.73, p = 0.484). Conclusion Our meta-analysis indicates that no gender difference existed for delayed healing in venous leg ulcers. Our results may be also useful in developing a risk score for failure of venous leg ulcers to heal.
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Varenicline is the first pharmacological aid for smoking cessation treatment to be approved in almost a decade. Varenicline is an α4β2 nicotinic acetylcholine receptor partial agonist. It may assist those who wish to quit smoking by producing partial activation at nicotinic receptors to ease craving and withdrawal symptoms; and by simultaneously blocking the effects of nicotine from cigarettes smoked, thereby reducing the satisfaction of continued smoking. The effectiveness of varenicline as an aid for smoking cessation has been demonstrated in several clinical trials versus placebo and sustained release bupropion. In addition, varenicline is well tolerated and has an acceptable safety profile. As an aid for smoking cessation, varenicline offers progress in the treatment of tobacco dependence.
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In line with other medical journals, odds ratios are increasingly being reported in anaesthesia literature. The frequency of the use of odds ratio and how well it relates to the relative risk when it is interpreted as relative risk remains unknown. We investigated the use of odds ratio, and its relationship to relative risk and the incidence of outcome in this study. We identified 60 meta-analyses and 87 original articles that reported odds ratios. While relative risk could have been reported in 79% of the studies, only a small proportion (3%) of these studies have estimated and reported the relative risk in addition to the odds ratio. There is a significant bias if odds ratio is interpreted as relative risk, especially so when the incidence of outcome is high. While odds ratio is a valid measure of treatment effect in its own right, anaesthetists and investigators should be careful not to interpret odds ratio as equivalent to relative risk.
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Diagnostic odds ratio
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Tobacco smoking is the leading cause of cardiovascular morbidity and mortality and quitting tobacco use should be fundamental for cardiovascular patients. Varenicline is a smoking cessation pharmacological therapy able to improve the possibilities to successfully achieve this result. In 2011 the US Food and Drug Administration issued a safety announcement that varenicline may be associated with an increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease. Following studies found no significant increase in cardiovascular serious adverse events associated with varenicline. For the first time in the literature, we describe the case of a cardiopathic hard smoker who received varenicline for 9 months without any side effect. By describing this case we want to underline the safety of varenicline, to illustrate the setting and the method that we used to support him and to underline the importance of promoting smoking cessation in heart patients. Varenicline was used to promote smoking cessation in a 52-year-old Caucasian man who smoked 40 cigarettes per day, despite two ischemic cardiovascular events. He asked for a consultation in a pharmacy’s smoking cessation service and after the assessment phase varenicline was prescribed. Due to his difficulty to quit smoking and given his good tolerance of the drug, we extended the treatment with varenicline to 9 months in order to achieve and maintain a complete smoking abstinence; intensive behavioural counselling was combined with the pharmacological therapy. By using exhaled carbon monoxide measurement we assessed smoking abstinence up to 2 years. The use of varenicline for a period longer than 6 months has not been described in the literature, particularly in heart patients. The extended varenicline therapy was clinically monitored and allowed the patient to consolidate his abstinence; the intensive behavioural counselling helped him to overcome his strong psychological dependence. Promoting smoking cessation in people who have cardiovascular disease is crucial. Currently available medications, such as varenicline, increase the chances of success and the risk of possible side effects is outweighed by the lifetime benefits and we hope that clinicians use them more frequently and confidently.
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