641 CLINICAL SYMPTOM PATTERNS IN PATIENTS WITH REFLUX ASPIRATION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Oleksandr Khoma ◽  
Jinsoo Park ◽  
Felix Lee ◽  
Hans Van der Wall ◽  
Gregory L Falk
Keyword(s):  
Large Volume ◽  
Symptom Clusters ◽  
Inclusion Criteria ◽  
Oesophageal Motility ◽  
Main Symptom ◽  
Presenting Symptoms ◽  
Throat Clearing ◽  
Specialist Centre ◽  
Symptom Patterns ◽  
Reported Data

Abstract   Multiple papers have discussed pulmonary manifestation of gastro-oesophageal reflux disease (GORD), however little primary reported data exists on presenting symptoms of patients in whom reflux aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux aspiration. Methods Data was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright. Results Inclusion criteria were met by 243 patients (33% males; mean age 59). Most common symptoms amongst patients with aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Clusters analysis demonstrated two main symptom clusters one suggestive of proximal large volume reflux symptoms (regurgitation, heartburn) and the other with IBS type symptoms (bloat, dysphagia, constipation). Conclusion Combination of typical symptoms of GORD and a respiratory or upper aero-digestive complaint should prompt consideration of reflux aspiration. Cluster analysis of symptoms in this group supports previously postulated hypothesis of reflux aspiration pathogenesis by either large volume proximal reflux or by ineffective oesophageal motility.

scholarly journals Different clinical symptom patterns in patients with reflux micro-micro-aspiration

2021 ◽  
pp. 00508-2021
Author(s):  
Oleksandr Khoma ◽  
Jin-soo Park ◽  
Felix Michael Lee ◽  
Hans Van der Wall ◽  
Gregory L Falk
Keyword(s):  
The Other ◽  
Inclusion Criteria ◽  
Voice Change ◽  
Main Symptom ◽  
Presenting Symptoms ◽  
Throat Clearing ◽  
Specialist Centre ◽  
Inflammatory Bowel ◽  
Symptom Patterns ◽  
Reported Data

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.

Reflux aspiration associated with oesophageal dysmotility but not delayed liquid gastric emptying

2020 ◽  
Author(s):  
Oleksandr Khoma ◽  
Maite Jeanne Mendu ◽  
Amita Nandini Sen ◽  
Hans Van der Wall ◽  
Gregory Leighton Falk
Keyword(s):  
Gastric Emptying ◽  
Reflux Disease ◽  
Inclusion Criteria ◽  
Treatment Resistant ◽  
Oesophageal Motility ◽  
Oesophageal Manometry ◽  
Oesophageal Dysmotility ◽  
The Relationship ◽  
Clinical Subtype

Abstract Introduction Severe oesophageal dysmotility is associated with treatment resistant reflux and pulmonary reflux aspiration. Delayed solid gastric emptying (SGE) has been associated with oesophageal dysmotility, however the role of delayed liquid gastric emptying (LGE) in the pathophysiology of severe reflux disease remains unknown. The purpose of this study is to examine the relationship between delayed LGE, reflux aspiration and oesophageal dysmotility. Methods Data was extracted from a prospectively populated database of patients with severe treatment resistant gastro-oesophageal reflux disease (GORD). All patients with validated reflux aspiration scintigraphy (RASP) and oesophageal manometry were included in the analysis. Patients were classified by predominant clinical subtype as gastro-oesophageal (GOR) or laryngo-pharyngeal (LPR) reflux. LGE time of 22 minutes or longer was considered delayed. Results Inclusion criteria were met by 631 patients. Normal LGE time was found in 450 patients, whilst 181 had evidence of delayed LGE. Mean liquid half-clearance was 22.81min. Refux aspiration was evident in 240 patients (38%). Difference in the aspiration rates between delayed LGE (42%) and normal LGE (36%) was not significant (p=0.16). Severe ineffective oesophageal motility (IOM) was found in 70 patients (35%) and was independent of LGE time. Severe IOM was strongly associated with reflux aspiration (p<0.001). GOR dominant symptoms were more common in patients with delayed LGE (p=0.03). Conclusion Severe IOM was strongly associated with reflux aspiration. Delayed LGE is not associated with reflux aspiration or severe IOM. Delayed LGE is more prevalent in patients presenting with GOR dominant symptoms.

Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Goda Hassan Mohammad ◽  
Khaled Ahmed Mahmoud Reyad ◽  
Ahmed Ali Hassan ◽  
Osama Fouad Mohamed Abdelgawad
Keyword(s):  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Hypospadias Repair ◽  
Inclusion Criteria ◽  
Meatal Stenosis ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Reported Data ◽  
Reconstructive Techniques

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

scholarly journals The use, quality and effectiveness of pelvic examination in primary care for the detection of gynaecological cancer: a systematic review

2018 ◽  
Vol 36 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Pauline Williams ◽  
Peter Murchie ◽  
Maggie E Cruickshank ◽  
Christine M Bond ◽  
Christopher D Burton
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Data Extraction ◽  
Diagnostic Delay ◽  
Gynaecological Cancer ◽  
Pelvic Examination ◽  
Inclusion Criteria ◽  
Cancer Symptoms ◽  
Presenting Symptoms ◽  
Critical Appraisal Skills

Abstract Background Urgent suspected cancer referral guidelines recommend that women with gynaecological cancer symptoms should have a pelvic examination (PE) prior to referral. We do not know to what extent GPs comply, their competency at PE, or if PE shortens the diagnostic interval. Objectives We conducted a systematic review of the use, quality and effectiveness of PE in primary care for women with suspected gynaecological cancer. Method PRISMA guidelines were followed. Three databases were searched using four terms: PE, primary care, competency and gynaecological cancer. Citation lists of all identified papers were screened independently for eligibility by two reviewers. Data extraction was performed in duplicate and independently. Paper quality was assessed using the relevant Critical Appraisal Skills Programme checklist. Emergent themes and contrasting issues were explored in a narrative ecological synthesis. Main Findings Twenty papers met the inclusion criteria. 52% or less of women with suspicious symptoms had a PE. No papers directly explored GPs’ competence at performing PE. Pre-referral PE was associated with reduced diagnostic delay and earlier stage diagnosis. Ecological synthesis demonstrated a complex interplay between patient and practitioner factors and the environment in which examination is performed. Presenting symptoms are commonly misattributed by patients and practitioners resulting in misdiagnosis and lack of PE. Conclusion We do not know if pre-referral PE leads to better outcomes for patients. PE is often not performed for women with gynaecological cancer symptoms, and evidence that it may result in earlier stage of diagnosis is weak. More research is needed.

scholarly journals A Meta-analysis of Major Complications between Traditional Pacemakers and Leadless Pacemakers

2020 ◽  
Author(s):  
Yun-Qing Chen
Keyword(s):  
Pericardial Effusion ◽  
Risk Ratio ◽  
Clinical Effect ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
Cardiac Perforation ◽  
Major Complications ◽  
Central Register ◽  
Reported Data

Objectives: We aim to compare the major complications between leadless pacemakers and traditional pacemakers.Background: Leadless pacemakers, which are increasingly used in clinical practice, have several advantages compared with traditional pacemakers in avoiding pocket- and lead-related complications. However, the clinical effect of leadless pacemakers remains controversial.Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the CNKI database, and the Wanfang database were searched from July 2013 to December 2019. Studies comparing leadless pacemakers and traditional pacemakers were included. The primary end point was major complications. The secondary end points were cardiac perforation/pericardial effusion, device revision or extraction, loss of device function, and death.Results: Six studies fulfilled the inclusion criteria. Only four of the six studies reported data on major complications.Leadless pacemakers were associated with a lower incidence of major complications (risk ratio 0.33, 95% confidenceinterval 0.25–0.44, P < 0.00001, I² = 49%). We extracted data on cardiac perforation/pericardial effusion, device revisionor extraction, loss of device function, and death from six studies. Our meta-analysis showed that leadless pacemakershave a higher risk of cardiac perforation or pericardial effusion (risk ratio 4.28, 95% confidence interval 1.66–11.08,P = 0.003, I² = 0%). No statistically significant differences were found for mortality, device revision or extraction, andloss of device function.Conclusion: Compared with traditional pacemakers, leadless pacemakers have a significantly decreased risk of majorcomplications, but have a higher risk of cardiac perforation or pericardial effusion.

scholarly journals Complications of Stapled Haemorrhoidectomy for Primary Haemorrhoid – Our Experience in ShSMCH

2018 ◽  
Vol 9 (2) ◽  
pp. 78-82
Author(s):  
Krishna Pada Saha ◽  
Md Ibnul Hasan ◽  
Fayem Chowdhury ◽  
Abdullah Md Abu Ayub Ansary ◽  
Sadia Imdad ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Clinical Examination ◽  
Rectal Bleeding ◽  
Anal Pain ◽  
Main Symptom ◽  
Mild Pain ◽  
Operative Complication ◽  
Presenting Symptoms ◽  
Stapled Haemorrhoidectomy ◽  
Flatus Incontinence

Objective: The aim of the study was to cheek the rate of significant complications amongst the patients undergoing Stapled haemorrhoidectomy. This study reflects our experience with Stapled haemorrhoidectomy in our Population.Methods: Two hundred and ninety patients with primary hemorrhoid of different degree underwent staple Hemorrhoidectomy in ShSMCH since January 2011 to December 2016. All patients were evaluated by history, clinical examination and proctosigmoidoscopy. They were followed up post operatively at 1, 3, 6, 12, 15, 18 Month.Result : Regarding presenting symptoms (pain less) per rectal bleeding was the main symptom (89%). Bulk of the pt were 3rd degree(50.16%). Regarding post operative complication – Urgency of defecation was most frequent (19%). Others were Urinary retention (4.5%), anal pain (4.01%), reactionary hemorrhage (4.01%). Regarding late post operative complication most frequent was mild pain (3.34%); others were – flatus incontinence, stenosis, recurrent haemorrhoid, fissure.Conclusion : Stapled haemorrhaidectomy is widely used, quick, safe and effective method of treating all degree of primary hemorrhoid with some complications. Therefore surgeon should be well aware of the type and post operative complicationsJ Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 78-82

scholarly journals Safety of Metoclopramide in Traumatic Brain Injury (TBI) Patients

2020 ◽  
Author(s):  
Said Al Jaadi ◽  
Yahya Al-Kindi ◽  
Tariq Al-Saadi
Keyword(s):  
Side Effect ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Antiemetic Agent ◽  
Presenting Symptoms ◽  
The Central Nervous System ◽  
Multiple Variables ◽  
Cns Side Effects

Abstract Introduction Traumatic brain injuries (TBIs) occur due to severe head assault to a hard object, with headache and vomiting being amongst the most common presenting symptoms. Metoclopramide is an old antiemetic agent that has been used widely for nausea and vomiting in TBI patients. Aim A systematic review of the literature to investigate the safety of metoclopramide in treating TBI patients. Methods A literature review was conducted in six databases, where we determined the pertinence of a study to the inclusion criteria by assessing the title, keywords, and abstracts. Five studies were found to be relevant. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed. Results The collective sample size was 93 patients with an average of age 38.5 years. As much as 51.6% were male and 48.6% were females. Most patients received 10 mg metoclopramide IV with a percentage of 77.4%, while only 22.5% received 20 mg IV metoclopramide. Seventy-one patients received metoclopramide alone and 22 received combination therapy. Headache was the most common reported side effect (46.2%), followed by anxiety and drowsiness with (39.7%) and (27.9%), respectively. Fatigue was reported in 24.7%, while dystonia was the least common and developed in only 5.3% of patients. Conclusion Metoclopramide is a common medication used to treat TBI patients in the emergency department. However, the review demonstrated that the central nervous system (CNS) side effect is excepted. Treatments with lower CNS side effects may be better options.

scholarly journals Clinical Features and Severity of Leptospirosis Cases Reported in the Hawke’s Bay Region of New Zealand

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Paul Sellors ◽  
Rebecca F. Watson ◽  
Rachel Bate ◽  
Gemma L. Bentham ◽  
Kathryn Haigh
Keyword(s):  
New Zealand ◽  
Severe Disease ◽  
Laboratory Data ◽  
Reference Laboratory ◽  
Inclusion Criteria ◽  
Chain Reaction ◽  
Presenting Symptoms ◽  
Bay Area ◽  
Polymerase Chain ◽  
Biochemical Abnormalities

Aims. To record demographics, symptoms, signs, and laboratory features of confirmed leptospirosis cases in the Hawke’s Bay area of New Zealand to aid clinicians in diagnosis and recognition of severity. Methods. Review of suspected leptospirosis cases referred to the reference laboratory from hospitals in the Hawke’s Bay region between March 2003 and March 2012. Inclusion criteria were IgM positivity and diagnosis confirmed with either polymerase chain reaction (PCR) or microscopic agglutination test (MAT). A retrospective systematic review of case notes was completed for demographic and laboratory data. Results. Forty-three cases were included. Most common presenting symptoms were pyrexia (93%), myalgia, and headache (both 86%). 93% of patients worked in the farming or meat industries. The most common biochemical abnormalities were elevated CRP (100%) and abnormal urinalysis (93%). There was no difference in disease severity between icteric and anicteric patients. Compared to other studies, patients in New Zealand have less severe disease. Conclusion. Contrary to popular understanding, this study has not found icteric leptospirosis to be related to more severe disease. Anicteric leptospirosis should be a differential diagnosis in patients presenting with pyrexia, myalgia, and headache who have elevated CRP and abnormal urinalysis.

scholarly journals Outcome of COVID-19 and Match-Population Analysis with Compassionate Use of Remdesivir

2020 ◽  
Vol 1 ◽  
pp. 2-4
Author(s):  
Olga Vasylyeva ◽  
Tara Chen ◽  
John Hanna
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Population Analysis ◽  
Exclusion Criterion ◽  
Invasive Ventilation ◽  
Inclusion Criteria ◽  
Compassionate Use ◽  
Reported Data

Abstract: Objectives:  To analyze treatment outcomes for patients with COVID-19 with and without compassionate use of Remdesivir. Methods:  A retrospective review of electronic medical records for patients who did not receive Remdesivir due to unavailability. Match-population analysis based on inclusion criteria for compassionate use Remdesivir of the patient population who received Remdesivir as reported in literature and patients without Remdesivir.  Results: Sixty-six percent of patients met the criteria for compassionate use Remdesivir, 41% required intensive care unit admission, 20% invasive ventilation, and 10% died. The median time of hospitalization for survivors was eight days.  In the separate group of patients who did not meet the criteria for compassion use Remdesivir, mortality among patients with CrCl > 30 ml min, an exclusion criterion, was significantly higher as compared with patients with CrCl < 30 ml min. Conclusion: When compared with previously reported data from patients who received compassionate use Remdesivir, our population had notably fewer patients requiring invasive ventilation. 

Effects of CYP2C8 and SLCO1B1 Genetic Polymorphisms on Repaglinide Pharmacokinetics: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 20 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Shuang Zhou ◽  
Qian Xiang ◽  
Guangyan Mu ◽  
Lingyue Ma ◽  
Shuqing Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Glucose ◽  
Genetic Polymorphisms ◽  
Blood Glucose Concentration ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Current Systematic Review ◽  
Potential Impact ◽  
Reported Data ◽  
Insufficient Number

Objective: The purpose of this systematic review and meta-analysis was to summarize the potential impact of CYP2C8 and SLCO1B1 genetic polymorphisms on repaglinide pharmacokinetics. Methods: A systematic search was conducted using electronic databases. Eligible studies reported data from pharmacokinetic evaluations of repaglinide in healthy adults according to different categories of CYP2C8 and SLCO1B1 genetic polymorphisms. Results: Six studies including a total of 191 participants met the inclusion criteria. We noted that CYP2C8 *1/*3 carriers exhibited lower AUC(0-∞) (SMD: -0.77; 95%CI: -1.23 to -0.30; P=0.001) and Cmax (SMD: -0.94; 95%CI: - 1.41 to -0.47; P<0.001) than CYP2C8 *1/*1 carriers. There were no significant differences in AUC(0-∞), Cmax, t1/2 and mean change in blood glucose concentration between *1/*4 and *1/*1 carriers. Further, *3/*3 carriers had lower Cmax (SMD: -1.42; 95%CI: -2.66 to -0.17; P=0.026) than *1/*1 carriers. Additionally, *3/*3 carriers had lower Cmax than *1/*3 carriers (SMD: -1.20; 95%CI: -2.40 to -0.00; P=0.050). Finally, we noted that repaglinide pharmacokinetics did not differ by SLCO1B1 genotype. Conclusion: The current systematic review and meta-analysis indicated that the genotype of CYP2C8, but not SLCO1B1, may affect repaglinide pharmacokinetics. However, because of the comparatively insufficient number of published studies included, our conclusions require support from additional studies.

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