Biomedical subjects

F Derderian

Publications and source records attributed to F Derderian.

4 recordsLinked to original sources

PubMed2006

[Treatment of hydroxychloroquine poisoning with extracorporeal circulation].

We report a case of massive overdose of hydroxychloroquine treated with circulatory assistance by peripheral extracorporeal circulation (ECC). We expose the case of a 39-year-old woman who ingested 12 g of hydroxychloroquine with bromazepam, paroxetine, and zolpidem, in a suicide attempt. Patient has developed central nervous system depression, hemodynamic failure, life-threatening ventricular arrhythmias, and serious hypokalemia. Initially the patient has received conventional treatment with gastric lavage and activated charcoal for gastrointestinal decontamination, blood volume expansion and vasopressive drugs, intubation and mechanical ventilation, high dose of diazepam, and potassium replacement. A ventricular fibrillation was treated with external cardiac massage. In spite of this treatment, cardiogenic shock was uncontrolled, and imposed circulatory assistance. After extracorporeal circulation, we observed a spectacular improvement of hemodynamic parameters and electrocardiographic normalization at day one. Extracorporeal circulation could be used as a rescue treatment of cardiotrope and hydroxychloroquine overdoses.

Adult↗

PubMed1998

Comparison of efficacy and cost among lipid-lowering agents in patients with primary hypercholesterolemia.

OBJECTIVE: To compare efficacy and cost of lipid-lowering agents in patients with primary hypercholesterolemia. DESIGN: A meta-analysis was conducted to determine estimates of efficacy for lipid-lowering agents. Efficacy was defined as the change in the ratio of total cholesterol:high density lipoprotein (HDL) induced by treatment. This ratio was selected because of its good predictive value for the risk of coronary disease. Lipid-lowering agents were grouped into three categories according to the decrease in the total cholesterol:HDL ratio. Acquisition prices for drugs were obtained from the Quebec provincial drug formulary. An analysis determined which drugs in each category 'purchased' the greatest decrease in ratio for the lowest cost. SETTING: Clinical trial study centres. PATIENTS: The population analyzed had a mean baseline total cholesterol:HDL ratio of 7.3, an average age of 50.5 years and mean proportion of men of 62.5%. INTERVENTIONS: Twelve lipid-lowering therapies at various doses were investigated. RESULTS: Drugs that were more recently introduced had the greatest effect on the total cholesterol:HDL ratio. A direct dose-effect relationship was not evident, although there was a trend in this direction. In each of the three categories, there was wide range of cost, suggesting that the same effect is available at a broad range of prices. The drugs with the greatest effect on the ratio at the lowest cost were fluvastatin 60 mg/day, fenofibrate (micronized) 200 mg/day and simvastatin 20 mg/day. CONCLUSION: These results can be useful for clinicians in the selection of agents that achieve a specified goal of therapy at the lowest cost.

Anticholesteremic Agents↗

PubMed1997

Discrepancies between meta-analyses and subsequent large randomized, controlled trials.

BACKGROUND: Meta-analyses are now widely used to provide evidence to support clinical strategies. However, large randomized, controlled trials are considered the gold standard in evaluating the efficacy of clinical interventions. METHODS: We compared the results of large randomized, controlled trials (involving 1000 patients or more) that were published in four journals (the New England Journal of Medicine, the Lancet, the Annals of Internal Medicine, and the Journal of the American Medical Association) with the results of meta-analyses published earlier on the same topics. Regarding the principal and secondary outcomes, we judged whether the findings of the randomized trials agreed with those of the corresponding meta-analyses, and we determined whether the study results were positive (indicating that treatment improved the outcome) or negative (indicating that the outcome with treatment was the same or worse than without it) at the conventional level of statistical significance (P<0.05). RESULTS: We identified 12 large randomized, controlled trials and 19 meta-analyses addressing the same questions. For a total of 40 primary and secondary outcomes, agreement between the meta-analyses and the large clinical trials was only fair (kappa= 0.35; 95 percent confidence interval, 0.06 to 0.64). The positive predictive value of the meta-analyses was 68 percent, and the negative predictive value 67 percent. However, the difference in point estimates between the randomized trials and the meta-analyses was statistically significant for only 5 of the 40 comparisons (12 percent). Furthermore, in each case of disagreement a statistically significant effect of treatment was found by one method, whereas no statistically significant effect was found by the other. CONCLUSIONS: The outcomes of the 12 large randomized, controlled trials that we studied were not predicted accurately 35 percent of the time by the meta-analyses published previously on the same topics.

Humans↗

PubMed1995

Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias?

Although they usually claim a very thorough search to retrieve every pertinent work, most meta-analyses published in English restrict their search to papers which were also published in English. We reviewed all the meta-analyses printed from 1 January 1991 to 1 April 1993 in 8 medical journals published in English and selected those who stated linguistic restrictions for inclusion in the analysis. The computerized search methods used in these meta-analyses were then duplicated looking specifically for publications written in the excluded languages. Each meta-analysis was then redone with identical statistical tests to determine if its conclusions would have been different if the paper(s) absent only for linguistic reasons had been included. A total of 36 meta-analyses of which 28 had language restrictions were identified. The computer searches yielded 19 papers scientifically acceptable but excluded for linguistic reasons. Eleven of these articles were retained as having the potential to modify their corresponding 7 meta-analyses. One meta-analysis which concluded that selective decontamination of the digestive tract in intensive care units did not produce a significant change in mortality between treatment and control patients (OR 0.70; 95% CI 0.45-1.09) would have arrived at a different conclusion (OR 0.67; 95% CI 0.47-0.95) if a paper written in German in a Swiss journal had been included in the analysis. Our study demonstrates that, in at least one out of 36 consecutive meta-analyses the exclusion of papers for linguistic reasons produced results different from those which would have been obtained if this exclusion criteria had not been used.

Clinical Trials as Topic↗