scholarly journals Trends and Outcomes of Cardiac Transplantation in the Lowest Urgency Candidates

2021 ◽  
Author(s):  
Michael A. Fuery ◽  
Fouad Chouairi ◽  
Peter Natov ◽  
Jasjit Bhinder ◽  
Maya Rose Chiravuri ◽  
...  
Keyword(s):  
Cardiac Transplantation ◽  
Post Transplantation ◽  
Allocation System ◽  
Allocation Process ◽  
System P ◽  
Before And After ◽  
History Of ◽  
Allocation Patterns ◽  
One Year ◽  
Donor Characteristics

Abstract Background Due to discrepancies between donor supply and recipient demand, the cardiac transplantation process aims to prioritize the most medically urgent patients. It remains unknown how recipients with the lowest medical urgency compare to others in the allocation process. We aimed to examine differences in clinical characteristics, organ allocation patterns, and outcomes between cardiac transplantation candidates with the lowest and highest medical urgency. Methods and Results We performed a retrospective analysis of the United Network for Organ Sharing database. Patients listed for cardiac transplantation between January 2011 and May 2020 were stratified according to status at time of transplantation. Baseline recipient and donor characteristics, waitlist survival, and post‐transplantation outcomes were compared in the years before and after the 2018 allocation system change. Lower urgency patients in the old system were older (58.5 vs. 56 years) and more likely female (54.4% vs. 23.8%) compared to the highest urgency patients, and these trends persisted in the new system (p<0.001, all). Donors for the lowest urgency patients were more likely older, female, or have a history of CMV, hepatitis C, or diabetes (p<0.01, all). The lowest urgency patients had longer waitlist times, and under the new allocation system received organs from shorter distances with decreased ischemic times (178 vs. 269 miles, 3.1 vs 3.5 hours, p<0,001, all). There was no difference in post‐transplantation survival (p<0.01, all). Conclusions Patients transplanted as lower urgency receive hearts from donors with additional comorbidities compared to higher urgency patients, but outcomes are similar at one year.

scholarly journals Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247789
Author(s):  
Fouad Chouairi ◽  
Clancy W. Mullan ◽  
Sounok Sen ◽  
Makoto Mori ◽  
Michael Fuery ◽  
...  
Keyword(s):  
Positive Impact ◽  
Circulatory Support ◽  
Cardiac Transplant ◽  
Post Transplantation ◽  
Allocation Policy ◽  
Allocation System ◽  
Number Of Patients ◽  
Before And After ◽  
Donor Characteristics ◽  
The Impact

Background Patients with restrictive or hypertrophic cardiomyopathy (RCM/HCM) and congenital heart disease (CHD) do not derive clinical benefit from inotropes and mechanical circulatory support. Concerns were expressed that the new heart allocation system implemented in October 2018 would disadvantage these patients. This paper aimed to examine the impact of the new adult heart allocation system on transplantation and outcomes among patients with RCM/HCM/CHD. Methods We identified adult patients with RCM/HCM/CHD in the United Network for Organ Sharing (UNOS) database who were listed for or received a cardiac transplant from April 2017-June 2020. The cohort was separated into those listed before and after allocation system changes. Demographics and recipient characteristics, donor characteristics, waitlist survival, and post-transplantation outcomes were analyzed. Results The number of patients listed for RCM/HCM/CHD increased after the allocation system change from 429 to 517. Prior to the change, the majority RCM/HCM/CHD patients were Status 1A at time of transplantation; afterwards, most were Status 2. Wait times decreased significantly for all: RCM (41 days vs 27 days; P<0.05), HCM (55 days vs 38 days; P<0.05), CHD (81 days vs 49 days; P<0.05). Distance traveled increased for all: RCM (76 mi. vs 261 mi, P<0.001), HCM (88 mi. vs 231 mi. P<0.001), CHD (114 mi vs 199 mi, P<0.05). Rates of transplantation were higher for RCM and CHD (P<0.01), whereas post-transplant survival remained unchanged. Conclusions The new allocation system has had a positive impact on time to transplantation of patients with RCM, HCM, and CHD without negatively influencing survival.

Effect Of Prednisone On Platelet Function In Patients With Bleeding Disorders

1981 ◽  
Author(s):  
R McKenna ◽  
F Bachmann ◽  
O Pichairut ◽  
B Whittaker
Keyword(s):  
Platelet Count ◽  
Platelet Function ◽  
Bleeding Time ◽  
Platelet Factor ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Before And After ◽  
History Of ◽  
The Mean ◽  
One Year

There is considerable controversy regarding the effect of Prednisone on the hemostatic mechanism of normal people versus patients with bleeding diatheses. We administered Prednisone 15 mg TID to patients with a positive history of a bleeding disorder, and evaluated the bleeding time and other in-vitrc tests of platelet function prior to and between the 5th and 7th day after Prednisone.Eleven patients were admitted into this study over a one year period. All patients had a history of excessive bruising, epistaxis, bleeding after dental extractions, and gastrointestinal or other bleeding in various combinations. Two out of the eleven had template bleeding times of greater than 15 minutes both before and after the Prednisone. These two patients were subsequently proven to have von Willebrand’s disease by the washed platelet ristocetin assay. In the remaining 9 patients, the pre-Prednisone bleeding time was 9.3 ±3.7 minutes (x ± 1 S.D.) whereas the post-Prednisone bleeding time was 5.8 ±3.6 minutes (x ±1 S.D.). These results were significant(td=3.83;df:7;p=0.007).Platelet aggregation in response to exogenous ADP (1 μM, 3 μM) Sigma bovine tendon collagen (1.8 mg/ml F) and epinephrine (5.5 × 104M), platelet retention in a glass bead column or platelet factor 3 availability did not improve or worsen after Prednisone therapy. The mean platelet count of 328,000±94,000 (x ±1 S.D.) was significantly (p=0.05) higher than the mean pre-Prednisone platelet count of 268,000±77,000 (x ±1 S.D.).In conclusion, we have shown that large doses of Prednisone appear to shorten the bleeding time in patients with significant defects in the primary hemostatic mechanism. However the bleeding time improvement is not evident in patients with von Willebrand’s disease.

scholarly journals Evaluation of Racial and Ethnic Disparities in Cardiac Transplantation

2021 ◽  
Author(s):  
Fouad Chouairi ◽  
Michael Fuery ◽  
Katherine A. Clark ◽  
Clancy W. Mullan ◽  
James Stewart ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Cardiac Transplantation ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Post Transplantation ◽  
Allocation System ◽  
Post Transplant ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Background Racial and ethnic disparities contribute to differences in access and outcomes for patients undergoing heart transplantation. We evaluated contemporary outcomes for heart transplantation stratified by race and ethnicity as well as the new 2018 allocation system. Methods and Results Adult heart recipients from 2011 to 2020 were identified in the United Network for Organ Sharing database and stratified into 3 groups: Black, Hispanic, and White. We analyzed recipient and donor characteristics, and outcomes. Among 32 353 patients (25% Black, 9% Hispanic, 66% White), Black and Hispanic patients were younger, more likely to be women and have diabetes mellitus or renal disease (all, P <0.05). Over the study period, the proportion of Black and Hispanic patients listed for transplant increased: 21.7% to 28.2% ( P =0.003) and 7.7% to 9.0% ( P =0.002), respectively. Compared with White patients, Black patients were less likely to undergo transplantation (adjusted hazard ratio [aHR], 0.87; CI, 0.84–0.90; P <0.001), but had a higher risk of post‐transplant death (aHR, 1.14; CI, 1.04–1.24; P =0.004). There were no differences in transplantation likelihood or post‐transplant mortality between Hispanic and White patients. Following the allocation system change, transplantation rates increased for all groups ( P <0.05). However, Black patients still had a lower likelihood of transplantation than White patients (aHR, 0.90; CI, 0.79–0.99; P =0.024). Conclusions Although the proportion of Black and Hispanic patients listed for cardiac transplantation have increased, significant disparities remain. Compared with White patients, Black patients were less likely to be transplanted, even with the new allocation system, and had a higher risk of post‐transplantation death.

scholarly journals Reduction in Prevalence of Thrombotic Events in Sickle Cell Disease after Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 12-12
Author(s):  
Ameet Patel ◽  
Karina L Wilkerson ◽  
Kathryn A. Culos ◽  
Jennifer Green ◽  
Michael T. Byrne ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Research Funding ◽  
Inclusion Criteria ◽  
Cell Disease ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Before And After ◽  
History Of

Background: Venous thromboembolism (VTE) is a recognized complication of sickle cell disease (SCD). SCD confers a life-time risk of development of VTE, with a cumulative incidence of 11.3% by age of 40 years based on Cooperative group studies. Patients with SCD and VTE have a higher mortality rate (HR, 2.32; 95% CI, 1.20-4.46) compared to those without VTE (Naik et al, Am J Med. 2013;126(5):443-449). However, it remains unclear if this thrombotic pre-disposition improves after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: This is a retrospective single institution cohort study of SCD patients with history of VTE and/or cerebrovascular accident (CVA) who underwent allo-HSCT for indications of CVA, recurrent acute chest, or organ dysfunction related to SCD. Inclusion criteria included SCD genotype, VTE of any location, or CVA confirmed on ultrasound, V/Q scan, or CT/MRI angiography/venography. The number and proportion of VTE and CVA events were recorded before and after allo-HSCT. Patients who had VTE events prior to transplant did not have their anticoagulation or aspirin continued post-transplant. Statistical and clinically significant differences were identified using non-parametric analysis using McNemar's method with exact probability and binomial distribution. Multivariate analysis was done to identify potential explanatory variables within results. Results: 26 patients with SCD met inclusion criteria, all had HbSS genotype. 23 patients (88%) underwent HLA-haploidentical bone marrow transplant (haplo-BMT) with reduced intensity conditioning and 3 (12%) patients had myeloablative matched sibling donor transplants (MSD). Graft-versus-Host Disease (GVHD) prophylaxis included posttransplant cyclophosphamide/sirolimus/mycophenolate and cyclosporine/methotrexate in haplo-BMT and MSD, respectively. All patients had standard infection prophylaxis. The median age was 25 years (range: 8-54) at transplant and 17 patients were male (62%). 18 patients were taking hydroxyurea and 9 were on chronic transfusion therapy. Two patients had a second transplant for prior graft failure following haplo-BMT, all achieved 100% donor chimerism on days 30 and 100. Median follow up for the cohort was 74.5 (range:10-212) months total and 28.5 (range: 9-111) post allo-HSCT. Prior to allo-HSCT, 10 patients developed 7 deep vein thrombosis (DVT) and 3 pulmonary emboli. Seven of these (70%) were unprovoked events. 11 patients (40%) had ischemic CVA. Post-transplant, there were two provoked DVTs and one embolic stroke events in three patients, of which two had a history of provoked VTE (Figure). One DVT and the embolic stroke were associated with venous catheter use in a patient with PFO (patent foramen ovale). Only one patient had grade two acute GVHD after development of DVT. All events occurred within 30 days post transplantation and during acute hospitalization. No further VTE occurred after 3 months of anticoagulation in all patients. There was an absolute difference of 25% [95% CI=4.87- 26.9, p=0.015] in the prevalence of VTE events before and after allo-HSCT. In addition, there was an absolute 38.5% [95% CI=10.63-45.96, p=0.006] difference in the number of ischemic CVA before and after allo-HSCT. GVHD status, infection rates, age, history of pulmonary hypertension, and gender did not reach significance in explaining variation in results on logistic multivariate analysis (p &gt; 0.05). Conclusion : In patients with SCD with a history of thrombosis, there is an observed reduction in prevalence of VTE and stroke events post transplantation. Allogeneic stem cell transplantation may attenuate the ongoing activation of the coagulation cascade and hypercoagulable state in SCD. This needs to be validated in a larger prospective cohort study. Disclosures Green: Scripps: Honoraria, Other: travel; North American Thrombosis: Honoraria; CSL: Research Funding; Baxter,: Research Funding; Baxalta: Research Funding; Shire US Inc: Other: clinical trial support. Dholaria:bms: Research Funding; Poseida: Research Funding; Angiocrine: Research Funding; Takeda: Research Funding; J&J: Research Funding.

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

Conclusion: What is Speculative Empiricism?

2018 ◽  
Author(s):  
Didier Debaise
Keyword(s):  
Social Groups ◽  
Speculative Philosophy ◽  
System P ◽  
History Of ◽  
Selection Of

Process and Reality ends with a warning: ‘[t]he chief danger to philosophy is narrowness in the selection of evidence’ (PR, 337). Although this danger of narrowness might emerge from the ‘idiosyncrasies and timidities of particular authors, of particular social groups, of particular schools of thought, of particular epochs in the history of civilization’ (PR, 337), we should not be mistaken: it occurs within philosophy, in its activity, its method. And the fact that this issue arises at the end of Process and Reality reveals the ambition that has accompanied its composition: Whitehead has resisted this danger through the form and ambition of his speculative construction. The temptation of a narrowness in selection attempts to expel speculative philosophy at the same time as it haunts each part of its system.

Newton and the Origin of Civilization

2012 ◽  
Author(s):  
Jed Z. Buchwald ◽  
Mordechai Feingold
Keyword(s):  
Good Reason ◽  
History Of Mathematics ◽  
Primary Sources ◽  
Ancient History ◽  
Isaac Newton ◽  
History Of ◽  
Ancient Civilizations ◽  
And Mathematics ◽  
One Year ◽  
Radical Ideas

Isaac Newton’s Chronology of Ancient Kingdoms Amended, published in 1728, one year after the great man’s death, unleashed a storm of controversy. And for good reason. The book presents a drastically revised timeline for ancient civilizations, contracting Greek history by five hundred years and Egypt’s by a millennium. This book tells the story of how one of the most celebrated figures in the history of mathematics, optics, and mechanics came to apply his unique ways of thinking to problems of history, theology, and mythology, and of how his radical ideas produced an uproar that reverberated in Europe’s learned circles throughout the eighteenth century and beyond. The book reveals the manner in which Newton strove for nearly half a century to rectify universal history by reading ancient texts through the lens of astronomy, and to create a tight theoretical system for interpreting the evolution of civilization on the basis of population dynamics. It was during Newton’s earliest years at Cambridge that he developed the core of his singular method for generating and working with trustworthy knowledge, which he applied to his study of the past with the same rigor he brought to his work in physics and mathematics. Drawing extensively on Newton’s unpublished papers and a host of other primary sources, the book reconciles Isaac Newton the rational scientist with Newton the natural philosopher, alchemist, theologian, and chronologist of ancient history.

Study of Diabetic Mellitus and Knowledge of Lotion Foot Care on the Community

2018 ◽  
Vol 9 (3) ◽  
Author(s):  
Hariyadi DM ◽  
Athiyah U ◽  
Hendradi E ◽  
Rosita N ◽  
Erawati T ◽  
...  
Keyword(s):  
Blood Glucose ◽  
T Test ◽  
Small Scale ◽  
Scale Production ◽  
Foot Care ◽  
Diabetic Mellitus ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Before And After ◽  
History Of

The prevention of Diabetic Mellitus (DM) and its complications is the main aim of this study, in addition to the training of lotion foot care application and the development of small scale industry. The research team delivered knowledge in the form of training on Diabetic Mellitus, healthy food, treatment and prevention of complications, and small-scale production of cosmetic products. The aim of this study was to determine the correlation between training on diabetic and lotion foot care application as preventive measures against diabetic complications on the patient's blood glucose levels in the community of residents in Banyuurip Jaya, Surabaya. It was expected from this training that the knowledge of the residents increases and people living with diabetic undergo lifestyle changes and therefore blood sugar levels can be controlled. The parameters measured in this research were blood glucose levels, the anti diabetic drug types consumed, and compliance on diabetics. This study used the data taken from 60 patients with DM over a period of one month. Questionnaires and log books was used to retrieve data and changes in blood glucose levels in diabetic patients. The results showed the demographic data of patients with type 2 diabetic of 85% female and 15% male, with the range of patients aged of 61-70 years of 46.67% and had history of diabetic (90%). The history of drugs consumed by respondents was anti diabetic drugs such as metformin (40%), glimepiride (33.37%) and insulin (6.67%). In addition, the increased knowledge of DM patients after being given the training compared to before training was shown in several questions in the questionnaire. A statistical analysis using t-test analyzed a correlation between training provided in order to enhance understanding of the patient, as well as correlation with blood glucose levels. A paired T-test showed that there was a relationship between the knowledge of trainees before and after training (p less than 0.05). An interesting result was that there was no relationship between blood glucose levels before and after training provided (p> 0.05).

The Challenges in Dealing with Organized Crime and its Consequences in Modern Societies in Albania, Kosovo and Macedonia – the Balkan Peninsula

2015 ◽  
Vol 5 (1) ◽  
pp. 161
Author(s):  
Bashkim Selmani ◽  
Bekim Maksuti
Keyword(s):  
Organized Crime ◽  
Balkan Peninsula ◽  
Human Mind ◽  
Negative Consequences ◽  
The Public ◽  
Before And After ◽  
History Of ◽  
European Standards ◽  
Organized Crime Groups ◽  
Further Development

The profound changes within the Albanian society, including Albania, Kosovo and Macedonia, before and after they proclaimed independence (in exception of Albania), with the establishment of the parliamentary system resulted in mass spread social negative consequences such as crime, drugs, prostitution, child beggars on the street etc. As a result of these occurred circumstances emerged a substantial need for changes within the legal system in order to meet and achieve the European standards or behaviors and the need for adoption of many laws imported from abroad, but without actually reading the factual situation of the psycho-economic position of the citizens and the consequences of the peoples’ occupations without proper compensation, as a remedy for the victims of war or peace in these countries. The sad truth is that the perpetrators not only weren’t sanctioned, but these regions remained an untouched haven for further development of criminal activities, be it from the public state officials through property privatization or in the private field. The organized crime groups, almost in all cases, are perceived by the human mind as “Mafia” and it is a fact that this cannot be denied easily. The widely spread term “Mafia” is mostly known around the world to define criminal organizations.The Balkan Peninsula is highly involved in these illegal groups of organized crime whose practice of criminal activities is largely extended through the Balkan countries such as Kosovo, Albania, Macedonia, Serbia, Bosnia, Croatia, Montenegro, etc. Many factors contributed to these strategic countries to be part of these types of activities. In general, some of the countries have been affected more specifically, but in all of the abovementioned countries organized crime has affected all areas of life, leaving a black mark in the history of these states.

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