scholarly journals Treatment of MIS-C in Children and Adolescents

2022 ◽  
Author(s):  
Sanaa Mahmoud ◽  
Mostafa El-Kalliny ◽  
Alyaa Kotby ◽  
Mona El-Ganzoury ◽  
Eman Fouda ◽  
...  
Keyword(s):  
Management Strategies ◽  
Biologic Agents ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Thrombotic Risk ◽  
Future Studies ◽  
Management Plans ◽  
Short And Long Term ◽  
Inflammatory Syndrome

Abstract Purpose of Review Different treatment approaches have been described for the management of COVID-19-related multisystem inflammatory syndrome in children (MIS-C), the pathogenesis of which has not yet been fully elucidated. Here, we comprehensively review and summarize the recommendations and management strategies that have been published to date. Recent Findings MIS-C patients are treated with different regimens, mostly revolving around the use of immunomodulatory medications, including IVIG and glucocorticoids as first-tier therapy. Refractoriness to IVIG and glucocorticoids warrants a step-up of immunomodulatory therapy to biologic agents such as anakinra, tocilizumab, and infliximab. Summary We review the current evidence regarding the use of monotherapy versus combination therapy, as well as the current recommendations for assessing thrombotic risk and administering antiplatelet and anticoagulant therapy. We anticipate that future studies will provide evidence for management plans that maximize short- and long-term outcomes.

scholarly journals Current Status of Distal Embolization in Femoropopliteal Endovascular Interventions

2018 ◽  
Vol 52 (6) ◽  
pp. 440-447 ◽  
Author(s):  
Alessandro Cannavale ◽  
Mariangela Santoni ◽  
Marianna Gazzetti ◽  
Carlo Catalano ◽  
Fabrizio Fanelli
Keyword(s):  
Management Strategies ◽  
Major Amputation ◽  
Current Status ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Distal Embolization ◽  
Endovascular Interventions ◽  
Atherosclerotic Lesions ◽  
Short And Long Term

The application of advanced endovascular techniques in very complex femoropopliteal atherosclerotic lesions has shown to expose patients to a higher risk of distal embolization (DE). This complication can affect both the short- and long-term outcomes, leading to worsening ischemia, early minor/major amputation, and longer hospital stay. Recently, there has been an increasing body of evidence on pathophysiology and clinical–radiological management of DE that however has not been systematically addressed by guidelines. The aim of this review was to analyze the current evidence outlining definition and classification, risk assessment, prevention, and management strategies of DE in femoropopliteal endovascular interventions.

Managing growth overfishing with multiannual compromise strategies

1997 ◽  
Vol 54 (10) ◽  
pp. 2255-2276 ◽  
Author(s):  
P Marchal
Keyword(s):  
Management Strategies ◽  
Fishing Effort ◽  
Reference Points ◽  
Long Term Outcomes ◽  
Northeast Atlantic ◽  
Factors Influencing ◽  
Optimal Balance ◽  
Short And Long Term ◽  
Mobile Target

Most of the Northeast Atlantic stocks are currently fished above the biological reference points (e.g., Fmax). In attempting to achieve such targets, advisers and managers have faced two main problems. First, it is impractical to (i) simultaneously maximize yields, stabilize fisheries, and safeguard stocks and (ii) optimize both short- and long-term outcomes for the industry. Second is the lack of predictability, several years ahead, in factors influencing decisions. This study addresses these twin issues by exploring the relative performances of various multiannual and compromise (or composite) management strategies. Multiannual fishing efforts are set in advance for a ``resolution'' period of several years, at the end of which they are updated. They are calculated to satisfy a prior weighted compromise amongst three criteria: (i) minimizing fishing effort variability, (ii) minimizing catch variability, and (iii) reaching a ``mobile target:'' the latter is defined with a second weighted compromise between the long-term target and the fishing effort at the beginning of the resolution period. A safe and optimal balance between all the short- and long-term fishery outcomes is found with a 5-year resolution period, during which the mobile target is split into 40-60% of the long-term target, and 60-40% of the fishing effort at the start of the resolution period, while criteria i, ii, and iii are weighted equally.

Acute Postoperative Pain

2017 ◽  
Author(s):  
Kelly Zach ◽  
Julio A. Gonzalez-Sotomayor
Keyword(s):  
Postoperative Pain ◽  
Patient Characteristics ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Analgesic Regimen ◽  
Potential Benefits ◽  
Short And Long Term ◽  
Selection Of

Inadequate management of acute postoperative pain increases morbidity and mortality. Poorly controlled pain results in delayed hospital discharge and may lead to the development of chronic pain. Current evidence supports the implementation of a multimodal analgesic regimen, where different pharmacologic and nonpharmacologic interventions are used. The selection of the different components of this multimodal analgesic approach should consider their potential benefits and limitations, as well as the unique patient characteristics and the surgical procedure. It is the responsibility of the perioperative health care provider to formulate an optimal pain management strategy to ultimately enhance patient satisfaction and improve short- and long-term outcomes.

Perioperative Management of Bleeding and Transfusion for Lung Transplantation

2019 ◽  
Vol 24 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Joseph J. Pena ◽  
Brandi A. Bottiger ◽  
Andrea N. Miltiades
Keyword(s):  
Lung Transplantation ◽  
Point Of Care ◽  
Factor Vii ◽  
Current Evidence ◽  
Blood Product Transfusion ◽  
Long Term Outcomes ◽  
Transfusion Requirements ◽  
Coagulation Testing ◽  
Short And Long Term

Perioperative allogeneic blood product transfusion is common in lung transplantation and has various implications on the short- and long-term outcomes of lung recipients. This review summarizes the effect of transfusion on outcomes including primary graft dysfunction, chronic lung allograft dysfunction, and all-cause mortality. We outline known risk factors for increased transfusion requirement in lung transplantation and present current evidence regarding the effect of hemostatic agents including antifibrinolytics, recombinant factor VII, and prothrombin complex concentrates. Finally, we highlight the roles of point-of-care coagulation testing and goal-directed transfusion strategies in reducing transfusion requirements in lung transplantation.

Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

2020 ◽  
Vol 132 (6) ◽  
pp. 1675-1682 ◽  
Author(s):  
Jin Wook Kim ◽  
Hee-Won Jung ◽  
Yong Hwy Kim ◽  
Chul-Kee Park ◽  
Hyun-Tai Chung ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Management Strategies ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Years Of Experience ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

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