Preserving fertility: using cyclophosphamide and other cytotoxics in young people

2019 ◽  
Vol 20 (2) ◽  
pp. 148-153
Author(s):  
David Ledingham ◽  
Michael Plant ◽  
Fayez Mustafa ◽  
Bhimanagouda Patil

Cytotoxic agents such as cyclophosphamide are infrequently used in neurological practice. When they are, it is commonly in critically ill patients or in those with refractory inflammatory disorders. Cyclophosphamide in particular has a well-recognised negative impact on both female and male long-term fertility. This article summarises the data with regards the impact of cytotoxics on long-term fertility and describes the current options to preserve fertility in these patients. We hope this will provide neurologists with a useful aid for counselling patients for whom they are considering these treatments.

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Grace Amin

Bullying is deliberate aggressive action, using an imbalance of strength physically or mentally by hurting physical, verbal, or emotional / psychological forms repeatedly. In the last decade, cases of bullying in Indonesia continue to increase and if not handled properly will increasingly have a negative impact on the development of the children of the nation's next generation. Bullying does not only affect children who are bullied but can also affect children who bully, children who witness bullying. Some of the effects of bullying include anxiety, depression, and low self-esteem. The purpose of community engagement is to socialize the impact of bullying and how to increase self-esteem to adolescents. Through psychoeducation programs in adolescents such as schools and teenagers religious communities in the Cikarang - Bekasi region, young people gain an in-depth understanding of bullying, its effects and how to increase their confidence. Through this psychoeducation, teenagers understand the understanding, types and effects of bullying both short term and long term so they promise to resist bullying starting from themselves. Teenagers learn that humans are social beings who need each other. They learn about the meaning of diversity and bhineka tunggal ika and try to implement it in their next lives by respecting the differences in their environment. These teenagers learn to respect themselves more, see the positive things that God has given them. They try to always believe in themselves that they are perfect and valuable beings in God's eyes so that even though the environment around them may not appreciate, they can still see positive things in themselvesABSTRAK:Bullying adalah tindakan agresif yang disengaja, menggunakan ketidakseimbangan kekuatan secara fisik atau mental dengan cara menyakiti bentuk fisik, verbal, atau emosional/ psikologis secara berulang – ulang. Dalam satu decade terakhir, kasus bullying di Indonesia terus meningkat dan bila tidak ditangani dengan baik akan semakin berdampak negative bagi perkembangan anak – anak generasi penerus bangsa. Tindakan bullying tidak hanya berdampak pada anak yang di-bully tetapi juga dapat berdampak pada anak yang mem-bully, anak yang menyaksikan bullying. Beberapa dampak bullying diantaranya kecemasan, depresi, serta rendahnya harga diri (self-esteem). Tujuan dari pengabdian kepada masyarakat ini adalah untuk mensosialisasikan dampak bullying serta cara meningkatkan self-esteem kepada para remaja. Melalui program psikoedukasi di lingkungan remaja seperti sekolah maupun komunitas keagamaan remaja wilayah Cikarang – Bekasi, para remaja mendapatkan pemahaman mendalam mengenai bullying, dampaknya serta bagaimana cara meningkatkan kepercayaan diri mereka. Melalui psikoedukasi ini, para remaja memahami pengertian, jenis serta dampak bullying baik jangka pendek maupun jangka panjang sehingga mereka berjanji untuk bersikap menolak bullying mulai dari diri mereka sendiri. Para remaja belajar bahwa manusia adalah mahluk social yang saling membutuhkan. Mereka belajar tentang makna keberagaman dan Bhineka Tunggal Ika serta berusaha mengimplementasikannya dalam kehidupan mereka selanjutnya dengan cara menghargai perbedaan yang ada di lingkungannya. Remaja ini belajar untuk lebih menghargai diri mereka, melihat hal positif yang telah diberikan Tuhan kepada mereka. Mereka mencoba untuk selalu menanamkan dalam diri bahwa mereka adalah mahluk yang sempurna dan berharga di mata Tuhan sehingga walaupun lingkungan di sekitar mereka mungkin tidak menghargai, mereka tetap dapat melihat hal positif dalam diri mereka.


2021 ◽  
Author(s):  
zengli xiao ◽  
Qi Wang ◽  
Xuebin Li ◽  
Youzhong An

Abstract Background Both new-onset atrial fibrillation (NOAF) and candidemia occurred frequently in critically ill patients, which are associated with poor outcomes. But, the association between NOAF and critically ill patients with candidemia is still uncertain. This study is try to identify the impact of NOAF on short-term and long-term mortality of critically ill patients with candidemia. Methods We retrospectively identified NOAF in all patients with candidemia admitted to a non-cardiac intensive care unit (ICU) from January 2011 to March 2018 in a teaching hospital. We categorized these patients into 3 groups (NOAF, Prior AF, No AF) and compared clinical information between groups. Risk factors for these patients’ short-term and long-term mortality were also analyzed. Results Ninety-two patients with candidemia were identified from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their hospital stay. The multivariable logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also the independent risk factor for 1 year mortality. Conclusions There was a high incidence of NOAF in critically ill patients with candidemia, which was associated with in-hospital mortality and 1 year mortality after hospital discharge. Further multicenter studies should be conducted to help confirm this relationship and to find effective interventions that reduce short-term and long-term mortality.


BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033521
Author(s):  
Taylor Lincoln ◽  
Anne-Marie Shields ◽  
Praewpannarai Buddadhumaruk ◽  
Chung-Chou H Chang ◽  
Francis Pike ◽  
...  

IntroductionAlthough shortcomings in clinician–family communication and decision making for incapacitated, critically ill patients are common, there are few rigorously tested interventions to improve outcomes. In this manuscript, we present our methodology for the Pairing Re-engineered Intensive Care Unit Teams with Nurse-Driven Emotional support and Relationship Building (PARTNER 2) trial, and discuss design challenges and their resolution.Methods and analysisThis is a pragmatic, stepped-wedge, cluster randomised controlled trial comparing the PARTNER 2 intervention to usual care among 690 incapacitated, critically ill patients and their surrogates in five ICUs in Pennsylvania. Eligible subjects will include critically ill patients at high risk of death and/or severe long-term functional impairment, their main surrogate decision-maker and their clinicians. The PARTNER intervention is delivered by the interprofessional ICU team and overseen by 4–6 nurses from each ICU. It involves: (1) advanced communication skills training for nurses to deliver support to surrogates throughout the ICU stay; (2) deploying a structured family support pathway; (3) enacting strategies to foster collaboration between ICU and palliative care services and (4) providing intensive implementation support to each ICU to incorporate the family support pathway into clinicians’ workflow. The primary outcome is surrogates’ ratings of the quality of communication during the ICU stay as assessed by telephone at 6-month follow-up. Prespecified secondary outcomes include surrogates’ scores on the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the modified Patient Perception of Patient Centredness scale, the Decision Regret Scale, nurses’ scores on the Maslach Burnout Inventory, and length of stay during and costs of the index hospitalisation.We also discuss key methodological challenges, including determining the optimal level of randomisation, using existing staff to deploy the intervention and maximising long-term follow-up of participants.Ethics and disseminationWe obtained ethics approval through the University of Pittsburgh, Human Research Protection Office. The findings will be published in peer-reviewed journals.Trial registration numberNCT02445937


2021 ◽  
Author(s):  
Zengli Xiao ◽  
Anqi Du ◽  
Youzhong An

Abstract Background: Both new-onset atrial fibrillation (NOAF) and candidemia occurred frequently in critically ill patients, which are associated with poor outcomes. But, the association between NOAF and critically ill patients with candidemia is still uncertain. This study is try to identify the impact of NOAF on short-term and long-term mortality of critically ill patients with candidemia.Methods: We retrospectively identified NOAF in all patients with candidemia admitted to a non-cardiac intensive care unit (ICU) from January 2011 to March 2018 in a teaching hospital. We categorized these patients into 3 groups (NOAF, Prior AF, No AF) and compared clinical information between groups. Risk factors for these patients’ short-term and long-term mortality were also analyzed.Results: Ninety-two patients with candidemia were identified from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their hospital stay. The multivariable logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also the independent risk factor for 1 year mortality.Conclusions: There was a high incidence of NOAF in critically ill patients with candidemia, which was associated with in-hospital mortality and 1 year mortality after hospital discharge. Further multicenter studies should be conducted to help confirm this relationship and to find effective interventions that reduce short-term and long-term mortality.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Johanna Helmersson-Karlqvist ◽  
Miklos Lipcsey ◽  
Johan Ärnlöv ◽  
Max Bell ◽  
Bo Ravn ◽  
...  

AbstractDecreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.


Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.


Work ◽  
2021 ◽  
pp. 1-11
Author(s):  
Yan Xu ◽  
Wantian Cui

BACKGROUND: China’s atmospheric PM2.5 pollution is serious, and PM2.5 exerts a negative impact on the human respiratory system, cardiovascular, and mental health, and even more serious health risk for the elderly with weak immunity. OBJECTIVE: This work aims to analyse the impacts of PM2.5 microenvironment exposure on the health of the elderly and provide corresponding countermeasures. METHODS: The survey subjects are 118 retired elderly people in the community. PM2.5 exposure concentrations are monitored in summer (June 10 ∼ July 10, 2019) and winter (November 25 ∼ December 25, 2019). RESULTS: The exposure concentration in winter is higher than that in summer, with statistical difference (P <  0.05). Under the impact of PM2.5 microenvironment exposure, smoking in the elderly can increase the concentration of PM2.5, and long-term exposure to PM2.5 in the elderly can cause mental health problems. CONCLUSION: Long-term exposure of the elderly to the PM2.5 microenvironment leads to physical diseases and even psychological problems, which requires attention.


Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 557
Author(s):  
Matthias Gijsen ◽  
Erwin Dreesen ◽  
Ruth Van Daele ◽  
Pieter Annaert ◽  
Yves Debaveye ◽  
...  

The impact of ceftriaxone pharmacokinetic alterations on protein binding and PK/PD target attainment still remains unclear. We evaluated pharmacokinetic/pharmacodynamic (PK/PD) target attainment of unbound ceftriaxone in critically ill patients with severe community-acquired pneumonia (CAP). Besides, we evaluated the accuracy of predicted vs. measured unbound ceftriaxone concentrations, and its impact on PK/PD target attainment. A prospective observational cohort study was carried out in adult patients admitted to the intensive care unit with severe CAP. Ceftriaxone 2 g q24h intermittent infusion was administered to all patients. Successful PK/PD target attainment was defined as unbound trough concentrations above 1 or 4 mg/L throughout the whole dosing interval. Acceptable overall PK/PD target attainment was defined as successful target attainment in ≥90% of all dosing intervals. Measured unbound ceftriaxone concentrations (CEFu) were compared to unbound concentrations predicted from various protein binding models. Thirty-one patients were included. The 1 mg/L and 4 mg/L targets were reached in 26/32 (81%) and 15/32 (47%) trough samples, respectively. Increased renal function was associated with the failure to attain both PK/PD targets. Unbound ceftriaxone concentrations predicted by the protein binding model developed in the present study showed acceptable bias and precision and had no major impact on PK/PD target attainment. We showed suboptimal (i.e., <90%) unbound ceftriaxone PK/PD target attainment when using a standard 2 g q24h dosing regimen in critically ill patients with severe CAP. Renal function was the major driver for the failure to attain the predefined targets, in accordance with results found in general and septic ICU patients. Interestingly, CEFu was reliably predicted from CEFt without major impact on clinical decisions regarding PK/PD target attainment. This suggests that, when carefully selecting a protein binding model, CEFu does not need to be measured. As a result, the turn-around time and cost for ceftriaxone quantification can be substantially reduced.


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