scholarly journals Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Alfredo Escartín ◽  
Marta González ◽  
Elena Cuello ◽  
Ana Pinillos ◽  
Pablo Muriel ◽  
...  
Keyword(s):  
Disease Management ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Old Patients ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Very Old Patients ◽  
Grade Iii ◽  
Severe Grade

Background. The aim of this study was to evaluate the characteristics, management, and outcomes of acute cholecystitis in patients ≥80 years. Methods. This was a retrospective analysis of data from a prospective single-center patient registry. Results. The study population was composed of 348 patients, which were divided into two groups: those younger (Group A) and those older (Group B) than the median age (85.4 years). Although demographic and clinical characteristics of the two groups were similar, the disease management was clearly different, with older patients undergoing cholecystectomy less frequently (n=80 46.0% in Group A vs n=39 22.4% in Group B; p<0.001). The outcomes in both groups of age were similar, with 30-day mortality of 3.7%, morbidity of 17.2%, and readmissions of 4.2% and two-year AC recurrence in nonoperated patients of 22.5%. No differences were seen between operated and no operated patients. Severe (Grade III) AC was the only independent factor significantly associated with mortality (OR 86.05 (95% CI: 11–679); p<0.001). Conclusions. In elderly patients with AC, the choice of therapeutic options was not limited by the age per se, but rather by the disease severity (grade III AC) and/or poor physical status (ASA III-IV). In case of grade I-II AC, laparoscopic cholecystectomy can be safely performed and yield good results even in very old patients. Patients with grade III AC present high risk of morbidity and mortality, and the treatment should be individualized. ASA IV patients should avoid cholecystectomy, being antibiotic treatment and cholecystectomy the best option.

scholarly journals Efficacy and safety of capsule endoscopy in octogenarian and elderly patients: A retrospective study

2021 ◽  
Author(s):  
Alessandro Pezzoli ◽  
Matteo Guarino ◽  
Nadia Fusetti ◽  
Elena Pizzo ◽  
Marzia Simoni ◽  
...  
Keyword(s):  
Small Bowel ◽  
Elderly Patients ◽  
Transit Time ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Control Group ◽  
Efficacy And Safety ◽  
Old Patients ◽  
Group A ◽  
Group B

Abstract Background Life expectancy and the number of ultra-octogenarians increased significantly, thus making crucial the appropriateness of several endoscopic procedures in elderly patients. The aim of our study was to provide a retrospective analysis of the efficacy and safety of capsule endoscopy in patients aged over 80 years. Patients and Methods In this single-centre study, 900 patients underwent capsule endoscopy between 2002 and 2015 for different indications; of these 106 patients aged ≥ 80 years (group A) and 99 patients aged 40–60 years (control group B) were randomly selected. Results Occult gastrointestinal bleeding accounted for 62.1% of all indications for capsule endoscopy in group B, compared to 95.2% in group A (p < 0.001). Although not statistically significant, the diagnostic yield was higher in group A (71%) vs. group B (62%). The percentages of reaching the cecum and the median gastric transit time were uniform within the two groups. In contrast, small bowel transit time was longer in group A vs. B. Small bowel preparation was similar in the two groups. The exam was generally well tolerated in both groups, with capsule aspiration being one of the main adverse events, which occurred in two elderly patients. Conclusions Our data expand previous findings confirming that capsule endoscopy can be performed safely even in very old patients and show that the diagnostic yield is similar to that of younger patients.

scholarly journals ABO groups can play a role in susceptibility and severity of COVID-19

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
S. Samra ◽  
M. Habeb ◽  
R. Nafae
Keyword(s):  
Blood Group ◽  
Abo Blood Group ◽  
Infection Group ◽  
Mechanically Ventilated ◽  
Blood Group A ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
The Relationship ◽  
Seriously Ill

Abstract Background A few people infected by the coronavirus become seriously ill, while others show little to no signs of the symptoms, or are asymptomatic. Recent researches are pointing to the fact that the ABO blood group might play an important role in a person’s susceptibility and severity of COVID-19 infection. Aim of the study: try to understand the relationship between ABO groups and COVID-19 (susceptibility and severity). Results A total of (507) patients were included in this study. The study population was divided based on the ABO blood group into types A+, A−, B+, AB, O+, and O−. Blood group A was associated with high susceptibility of infection: group A, 381 (75.1%); and less common in group O, 97 (19.2%), group B, 18 (3.5%), and group AB, 11 (2.2%). The severity of COVID-19 infection was common in non-blood group O where (20 (7.1%), 4 (26.7%), 2 (11%), and 1 (9%) in type A+, A−, B+, and AB, respectively), while in type O 3.1%. And mechanically ventilated patients were 22 (5.9%), 2 (13.4%), 2 (11.1%), and 1 (1%). Mortality was high in blood groups A and B, 16 (4.37%) and 1 (5.5%), respectively, while in blood group O, it was 1%. Conclusion The incidence, severity, and mortality of COVID-19 were common in non-blood group O. While blood group O was protected against COVID-19.

scholarly journals Comparative study between two empirical antibiotic regime in the management of childhood malignancy with fever

2015 ◽  
Vol 5 (2) ◽  
pp. 329-331 ◽  
Author(s):  
Laila Helaly ◽  
Md Zakir Hossain Sarker ◽  
MA Mannan ◽  
Md Tafazzal Hossain ◽  
Shafi Ahmed ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Study Drug ◽  
Successful Outcome ◽  
Medical College ◽  
Pediatric Hematology ◽  
Pediatric Cancer Patients ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Oncology Unit

Objective : The present prospective randomized clinical trial was carried out to assess whether combined cefepime and amikacin as empirical antibiotic therapy was more effective than combined ceftriaxone and gentamicin in the treatment of febrile neutropenic children with malignant diseases.Material & Methods : The study was conducted in the Pediatric Hematology and Oncology unit of BSMMU over a period of 2 years. (From January 2006 to December 2007) Hospitalised pediatric cancer patients who developed febrile neutropenia following chemotherapy or radiotherapy were the study population. A total 64 cases were consecutively included in the study and were randomly assigned to either cefepime & amikacin group (Group- A) or ceftriaxone & gentamicin group (Group-B). The Group-A received cefepime 1500 mg/m2/dose infused over 15 minutes in two divided doses intravenously(IV) while amikacin was administered as thrice daily dose of 200 mg/m2/dose. Patients of Group-B received ceftriaxone 1500 mg/m2/dose in two divided doses and gentamicin 60 mg/m2/dose thrice daily IV. The therapy was continued until absolute neutrophil counts reached >1000 neutrophils/mm3. The treatment outcome was considered successful if fever resolves within 4 days and does not recur within 7 days of completion of therapy. Of the 64 patients, 13 cases were excluded from the final analysis.Results : Bacteria were isolated from culture in only 16.7% of cases Group-A and 9.5% of group-B. Patients E. coli was the most common isolate found in blood specimen (37%). Following intervention, 90% of cefepime & amikacin group and 85.6% of ceftriaxone & gentamicin group improved absolute neutrophil count to >1000/mm3 of blood. Persistence of fever after start of study drug and duration of antibiotic therapy were significantly less in the former group than those in later group (p = 0.049 and p = 0.004 respectively). Only 1 patient of group B had recurrence of infection within 7 days of treatment completion. The mean duration of hospital stay was less in the former group (7.97 ± 2.61 days) than that in the latter group (11.00 ± 3.42 days) (p = 0.06). Evaluation of final outcome shows that majority (86.6%) of cefepime & amikacin group had successful outcome, while majority of ceftriaxone & gentamicin group (81%) failed to resolve infection with continuation of fever for > 4 days.Conclusion : The study concluded that combined cefepime and amikacin is a better option for empirical treatment of fever and neutropenia in children with malignancies than combined ceftriaxone and gentamicin (p<0.001).Northern International Medical College Journal Vol.5(2) 2014: 329-331

THERAPEUTICAL DOSES OF SALBUTAMOL INHIBIT THE SOMATOTROPIC RESPONSIVENESS TO GROWTH HORMONE-RELEASING HORMONE IN ASTHMATIC CHILDREN

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 262-263
Author(s):  
Hemalini Mehta ◽  
Robert F. Lemanske
Keyword(s):  
Growth Hormone ◽  
Systemic Disease ◽  
Forced Expiratory Volume ◽  
Growth Hormone Releasing Hormone ◽  
Assay Sensitivity ◽  
Releasing Hormone ◽  
Children With Asthma ◽  
Group A ◽  
Study Population ◽  
Group B

Purpose of the Study. To determine the effects of therapeutic β2 agonists (specifically salbutamol) on growth hormone (GH) response to growth hormone releasing hormone (GHRH) in children with asthma. Study Population. Fifteen prepubertal children with asthma, ages 6-11 (average age of 9) with normal or normal short stature were studied. Those with an endocrine abnormality, nutritional deficiency, psychological deprivation, or other systemic disease were excluded. Only those children with known bronchial asthma, who showed a 15% decrease of the 1-second forced expiratory volume (FEV1) with methacholine challenge were included. All patients were asymptomatic, and had not experienced an asthma exacerbation, respiratory infection or allergen exposure in the month preceding the study. No child was on medications. Methods. Subjects were divided into two groups. Both groups had baseline GH response to GHRH determined. After an overnight fast, GH levels were obtained the following morning at -60, 0, and then every 15 minutes until 120 minutes after GHRH administration. Two days following this, Group A received salbutamol (0.125 mg/kg) orally at -60 minutes and GH response to GHRH was remeasured. Group B received aerosolized salbutamol (2 mg over 15 minutes) (details of administration were not specified by the authors). All serum GH levels were measured in duplicate by immunoradiometric assay (sensitivity of 0.1 µg/L). Findings. Basal GH levels were similar in both groups. Orally administered salbutamol (Group A) markedly inhibited GH response to GHRH (peak of 3.7 ± 0.6 vs. 18.6 ± 4.7 g/L). Inhaled salbutamol (Group B), although blunting the GHRH-induced GH response, did so to a lesser extent (peak of 20.0 ± 7.5 vs. 35.8 ± 9.4 g/L, P &lt; .02).

scholarly journals Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

2021 ◽  
Vol 15 (1) ◽  
pp. 91-94
Author(s):  
Muhammad Nasir ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Female Patients ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Conversion To Open Cholecystectomy ◽  
Group A ◽  
Male Patients ◽  
Group B

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

scholarly journals OUTCOME OF LAPAROSCOPIC CHOLECYSTECTOMY WITH &WITHOUT DRAIN

1969 ◽  
Vol 5 (1) ◽  
pp. 613-616
Author(s):  
MUHAMMAD ASLAM RAl ◽  
M FAWAD ASLAM ◽  
SARA ASLAM
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Prophylactic Antibiotic ◽  
Laparoscopic Approach ◽  
Preoperative Assessment ◽  
Open Conversion ◽  
Abdominal Drain ◽  
Port Infection ◽  
Group A ◽  
Group B

BACKGROUND: Cholecystitis is common health problem and laparoscopic approach to gallstonedisease is procedure of choice. Intra abdominal drain is used to pervert post operative sub hepaticcollection. However drain insertion may increase pain discomfort and delay in discharge.OBJECTIVE: To assess the benefits and harms of drain use in laparoscopic cholecystectomyMATERIAL AND METHODS: A prospective, single centre, Study conducted on 200 patients in needof laparoscopic cholecystectomy at Rai Medical Complex Sargodha (affiliated with Rai MedicalCollege) from April, 2009 to July 2011. All patients, after preoperative assessment, were operated undergeneral anesthesia. Prophylactic antibiotic, inj. cefuroxime 1.5 gm prior to anesthesia and two furtherdoses at 8 hour interval postoperatively were given in chronic cholecystitis and therapeutic doses, forseven days in acute cholecystitis. Patients having choledocholithiasis and open conversion wereexcluded from the study four port techniques were used for laparoscopic cholecystectomy. Patients weredivided randomly in to two groups, 100 patients in each Group A, without drain and group B with drain.Data was recorded on standardized performa.RESULTS: Out of 200 patients, 18 were male and 182 were female .Age range was 20 years to 90years. 02 patients from group B, having acute cholecystitis, had epigastric port infection on 15thpostoperative day. Drainage was done with uneventful healing. One patient from group A had s/hepaticabscess 03 weeks after surgery. Ultrasonographic guided aspiration was done in OPD with goodrecovery .No mortality, no open conversion and no CBD injury. Thirty patients from group A weredischarged within 24 hours , 3 patients having drain were discharged after 72 hours and all others fromboth groups within 48 hours.04 patients from group B had severe shoulder tip pain and relieved afterremoval of drain.Postoperative pain was significantly higher in patients who had drain placed, median VAS was 5(ranging 1-10) versus 3 in non drained group .Especially removal of drain was a painful procedure.CONCLUSION: Routine use of intra abdominal drain in laparoscopic cholecystectomy is of no benefitbut causes more discomfort to patient except in empyaema gallbladder.KEY WORDS: Laparoscopic cholecystectomy, intra abdominal drain.

scholarly journals The Impact of Unilateral or Bilateral Cataract Surgery on Visual Acuity and Life Quality of Elderly Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Lei Zuo ◽  
Haidong Zou ◽  
Xinfeng Fei ◽  
Weiqi Xu ◽  
Jianhong Zhang
Keyword(s):  
Visual Acuity ◽  
Elderly Patients ◽  
Cataract Surgery ◽  
Life Quality ◽  
Weighted Average ◽  
Bilateral Cataract ◽  
Surgical Methods ◽  
Group A ◽  
Group B ◽  
The Impact

In the current study, the CLVQOL was used to assess VRQOL before unilateral or bilateral cataract surgery and at the end of the follow-up period in order to determine the greater beneficial mode of surgery for patients, if one of the two surgical methods is more beneficial over the other. The patients were classified as receiving unilateral (group A) and bilateral cataract surgery (group B). There were no significant differences between groups A and B before the operation in terms of life quality scores, binocular weighted average LogMAR BCVA, age, educational level, gender, systematic and ocular comorbidities, and the complications of the operation. It was shown that visual acuity improved more significantly with bilateral cataract surgery than with unilateral surgery in elderly patients with a high preoperative disease burden in Shanghai city. However, the improvement in life quality was not different in patients receiving either bilateral or unilateral cataract surgery.

scholarly journals Review of Operative Treatment of Delayed Presentation of Acute Cholecystitis

2019 ◽  
Vol 85 (1) ◽  
pp. 98-102
Author(s):  
Ryan D. Eubanks ◽  
Kenneth R. Hassler ◽  
Grant Huish ◽  
Tammy Kopelman ◽  
Ross F. Goldberg
Keyword(s):  
Acute Cholecystitis ◽  
Symptom Onset ◽  
Postoperative Bleeding ◽  
Index Admission ◽  
Complication Rates ◽  
Delayed Presentation ◽  
Estimated Blood Loss ◽  
Before And After ◽  
Group A ◽  
Group B

Treatment of patients with delayed acute cholecystitis (AC) includes antibiotics and interval cholecystectomy based on proposed change at 72 hours from symptom onset to a chronic fibrotic phase with concern for increased complication rates. The purpose of our study was to compare the outcomes of patients undergoing laparoscopic cholecystectomy (LC) for AC before and after this golden 72-hour window. After institutional review board approval, a retrospective study was performed of patients presenting over two years with AC, who underwent LC during the index admission. A chart review was performed, and patients were divided into symptoms <72 hours (group A) and symptoms >72 hours (group B). Complications were defined as postoperative bleeding, return to operating room, and bile leaks. One hundred and eighty-four patients met the study criteria. Group A included 96 patients managed 5 to 71 hours after symptom onset, whereas Group B encompassed 88 patients with symptoms 72 to 336 hours. Both groups had similar baseline demographics and disease severity. No statistically significant differences were noted between the groups regarding overall complications or 30-day morbidity; however, Group B had an increased hospital stay length (P < 0.0001) and estimated blood loss (P = 0.028). LC seems safe despite duration of symptomatology and should be considered during the index admission in all AC patients.

scholarly journals Effect of atorvastatin on lipid and cardiovascular events in patients on maintenance hemodialysis

2019 ◽  
Vol 10 (1) ◽  
pp. 34-39
Author(s):  
Muhammed Arshad Ul Azim ◽  
Md Habibur Rahman ◽  
Abdus Salam ◽  
Sayed Mahtabul Islam ◽  
Shahryar Waheed
Keyword(s):  
Cardiovascular Events ◽  
Disease Patient ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Maintenance Hemodialysis ◽  
Prospective Clinical Study ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Lipid Abnormalities

Background: Cardiovascular disease is the major cause of death in chronic kidney disease patient as well as in patients on hemodialysis. Dyslipidaemia is highly prevalent in patients on maintenance haemodialysis which increases the risk for cardiovascular mortality. This study was designed to evaluate the lipid abnormalities, effect of atorvastatin on lipid profile and cardiovascular events in patients on maintenance hemodialysis. Methods: In this prospective clinical study, 55 end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis participated voluntarily. The study population was divided randomly into group-A (atorvastatin was prescribed) and group-B (without atorvastatin). We compared the lipid status and cardiovascular events of both groups after 6 months. Results: The two groups of patients were well matched in respect to baseline characteristics, history of risk factors and dialysis duration and session. Mean age of study population was about 48 years. Low density lipoprotein (LDL) cholesterol was reduced by 18.79%, total cholesterol was reduced by 9.32% and triglyceride was reduced by 22% in group-A. In group-A, high density lipoprotein (HDL) cholesterol was increased by 6% and it was reduced by 6% in group-B. In this study, myocardial ischemia/infarction on electrocardiogram (ECG) was present 22% in group-A and 14% in group-B at randomization. After 6 months, ischemia/infarction was found 33% in group-A and 25% in group-B. Statistically the ECG findings showed no significant changes after 6 months. In this study, mean ejection fraction (EF %) was 54% in group-A and 51% in group-B at 0 month, after 6 months atorvastatin group failed to show any significant change. In this study, after 6 months of statin therapy there was slight increase of serum glutamic pyruvic transaminase (16.13%) but that was not significant. Conclusion: In this study atorvastatin improved the lipid abnormalities significantly but a significant reduction of cardiovascular events was not achieved. Birdem Med J 2020; 10(1): 34-39

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