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Environmental, Iatrogenic and Nutritional Disease
Published in Jeremy R. Jass, Understanding Pathology, 2020
A major class of disease is iatrogenic disease caused by clinical management, particularly the administration of drugs with harmful side effects. Drug side effects are common, varied in their manifestations, and their consequences range from mild to life threatening. Nevertheless, drugs remain in use because their benefits greatly outweigh their potential for harm. The possibility that particular signs or symptoms could be drug induced must always be considered and explored by taking a full drug history. The link may be obvious if, for example, a skin rash occurs soon after the administration of an antibiotic, whereas the connection may be less obvious if the patient is on many drugs, the side effects are internal, the complication has not been described previously, and/or the presentation is obscured by symptoms or signs of other disease. In such cases a very high level of suspicion will be required in order to reach the correct diagnosis.
The kidneys
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
This is a well-documented form of iatrogenic disease being described in association with an increasing number of drugs, most commonly antibiotics, NSAIDs, diuretics, and more recently proton pump inhibitors. The disease usually begins about 2 weeks after exposure to the drug and may be characterized by systemic illness such as fever and eosinophilia with or without a skin rash. In many patients acute renal impairment is the only abnormality. On histological examination of renal biopsies performed in patients with drug-induced interstitial nephritis there is pronounced oedema and infiltration of the tubules and interstitium by lymphocytes and macrophages. Eosinophils and neutrophils may be present in significant numbers. Plasma cells are found in more longstanding cases. There is a variable degree of tubular damage and regeneration is usually evident. The glomeruli are, for the most part, normal in acute tubulointerstitial nephritis. The clinical features and morphology suggest a hypersensitivity reaction that is not dose related but rather is idiosyncratic. It is important to recognize drug-induced interstitial nephritis because it responds satisfactorily to withdrawal of the offending drug, and the patient should be made aware of the risk of recurrence on subsequent exposure to the drug.
Cost containment in the EU: an overview
Published in Elias Mossialos, Julian Le Grand, Health Care and Cost Containment in the European Union, 2019
Elias Mossialos, Julian Le Grand
Advances in medical knowledge and technology have created the potential for hospital patients to have a shorter length of stay or to be transferred from an in-patient ward to day surgery. This allows savings to be made in terms of bed provision and nursing care without any loss of quality, at least in terms of patient outcome. There is also a reduced risk of iatrogenic disease and less trauma for children. In addition, there is less disruption and inconvenience caused to the normal day-to-day activities of the patient.
Long-Term Follow-Up of a 150° Arc-Length Intrastromal Corneal Ring Segment Implantation in Post-LASIK Ectasia
Published in Current Eye Research, 2023
Lucía Ibares-Frías, Luis Fernández-Vega-Cueto, Belén Alfonso-Bartolozzi, Aranzazu Poo-López, David Madrid-Costa, José F. Alfonso
Cornea ectasia is an uncommon complication after corneal refractive surgery, with an estimated incidence of 0.033–0.09% for LASIK1,2 and 0.02% for PRK.1 Despite its low incidence, it is essential to note that it is an iatrogenic disease that induces corneal steepening and increases in corneal irregularity and higher-order aberrations. Consequently, this iatrogenic affection can seriously affect the visual quality and, thus, the quality of life of the patient who suffered this complication. Hence, even though it is a rare condition, finding the best treatment strategy is mandatory. Several treatment approaches have been proposed, such as contact lens fitting, corneal collagen cross-linking (CXL), intrastromal corneal ring segment (ICRS) implantation, corneal transplantation, and the combination of two or three of these procedures.3
Secondary and tertiary preventions of thyroid disease
Published in Endocrine Research, 2018
Fereidoun Azizi, Ladan Mehran, Farhad Hosseinpanah, Hossein Delshad, Atieh Amouzegar
At this level of prevention, physicians should optimize medical care and management of patients with thyroid disease, in order to avoid complications and disabilities. Avoidance of iatrogenic disease is a prominent feature of tertiary prevention.