Continuous Aspirin Use Does Not Increase Bleeding Risk of Split-Thickness Skin Transplantation Repair to Chronic Wounds

Background: Discontinuation of aspirin therapy before cutaneous surgery may cause serious complications. Objectives: The aim of this prospective study was to evaluate the bleeding risk of split-thickness skin transplantation repair to chronic wounds in patients on aspirin therapy. Methods: A total of 97 patients who underwent split-thickness skin transplantation surgery of chronic wounds during a 2-year period were enrolled. They were categorized on the basis of aspirin therapies. The primary outcome was postoperative bleeding and bleeding complications. Univariate analysis was performed to examine the association between aspirin and bleeding complications. Among the 26 patients taking aspirin continuously in group A, there were 5 bleeding complications (19.23%). Among the 55 nonusers in group B, there were 10 bleeding complications (18.18%). Among the 16 discontinuous patients in group C, there were 3 bleeding complications (18.75%). No statistical differences were found among the groups ( P = .956). Univariate analysis showed that continuous aspirin use was not significantly associated with bleeding complications (odds ratio, 0.933; 95% confidence interval, 0.283-3.074; P = .910 in the aspirin and control groups) and that discontinuous aspirin use was not significantly associated with bleeding complications (odds ratio, 0.963; 95% confidence interval, 0.230-4.025; P = .959 in the aspirin and control groups; odds ratio, 0.969; 95% confidence interval, 0.198-4.752; P = .969 in the aspirin and discontinuous groups). Conclusions: Continuous aspirin use does not produce an additional bleeding risk in patients who undergo split-thickness skin transplantation repair of chronic wounds.

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Physician Concussion Knowledge and the Effect of Mailing the CDC’s “Heads Up” Toolkit

Clinical Pediatrics ◽

10.1177/0009922811410970 ◽

2011 ◽

Vol 50 (11) ◽

pp. 1031-1039 ◽

Cited By ~ 47

Author(s):

Sara P. Chrisman ◽

Melissa A. Schiff ◽

Frederick P. Rivara

Keyword(s):

American Medical Association ◽

Medical Association ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Intervention Group ◽

Return To Play ◽

Control Groups ◽

Concussion Knowledge ◽

And Control

Background. The Centers for Disease Control and Prevention’s (CDC) “Heads Up” toolkit was designed to educate physicians about concussion, but it has not been well studied. This study proposed to evaluate the effect of receiving the toolkit on physician concussion knowledge. Methods. The authors obtained a sample of physicians from the American Medical Association masterfile and randomly selected half to be mailed the CDC’s “Heads Up” toolkit. All physicians were then sent a survey on concussion knowledge. Data were analyzed to evaluate the effect of the toolkit on concussion knowledge. Results. The survey was completed by 414 physicians (183 intervention, 231 control). There were no differences in general concussion knowledge between intervention and control groups, but physicians in the intervention group were significantly less likely to recommend next day return to play after a concussion (adjusted odds ratio = 0.31, 95% confidence interval = 0.12-0.76). Conclusions. Mailing the CDC’s “Heads Up” toolkit appears to affect physicians’ recommendations regarding returning to play after a concussion.

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The effectiveness of nonsteroidal anti-inflammatory drugs and acetaminophen in reduce the risk of amyotrophic lateral sclerosis? A meta-analysis

Scientific Reports ◽

10.1038/s41598-020-71813-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Min Cheol Chang ◽

Sang Gyu Kwak ◽

Jin-Sung Park ◽

Donghwi Park

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Meta Analysis ◽

Convincing Evidence ◽

Cochrane Library ◽

Control Group ◽

Inclusion Criteria ◽

Control Groups ◽

Significant Difference ◽

And Control

Abstract To test the hypothesis that aspirin, non-aspirin nonsteroidal anti-infammatory drugs (NA-NSAIDs), or acetaminophen can reduce the risk of ALS, we conducted a systematic review and meta-analysis of related previous studies. A comprehensive search was conducted on the PubMed, Embase, Cochrane Library and SCOPUS databases. It included studies published up to 29 February 2020 that fulfilled our inclusion criteria. Aspirin, acetaminophen and NA-NSAIDs use information, between the ALS and control groups, was collected for the meta-analysis. Rates of aspirin, NA-NSAID, and acetaminophen use in ALS group, compared with control group were investigated. In the results, only three studies that relate the risk of ALS to aspirin, NA-NSAIDs and acetaminophen use satisfied the inclusion criteria for the meta-analysis. Regarding aspirin, the studies did not show any statistically significant difference in aspirin use between the ALS and control groups (Odds ratio, 1.04 [95% confidence interval, 0.90–1.21]). NA-NSAIDs and acetaminophen use, however, did show up statistically significant differences in between the ALS and control groups. (Odds ratio, 0.82 [95% confidence interval, 0.73–0.91]) and (Odds ratio, 0.80 [95% confidence interval, 0.69–0.93]). However, our study has some limitations. Firstly, we only included a small number of studies. Secondly, the included studies did not control for past medical history, which may have confounded their results, and in turn, could have caused bias in our study. Thirdly, in this meta-analysis, the ALS patients were not subdivided into sporadic or familial type. Lastly, the studies also did not consider the types of NSAIDs and dosages used of each drug. For more convincing evidence regarding the effectiveness of aspirin, NA-NSAIDs and acetaminophen to reduce the risk of ALS occurrence, more qualified prospective studies are required. In conclusion, the use of NA-NSAIDs and acetaminophen is associated with a decreased risk for the development of ALS. In contrast, aspirin did not have any effect on the reduction of the risk of ALS occurrence.

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Abstract TP74: Early Administration of Tissue-plasminogen Activator Improves the Long-term Clinical Outcome at 5 Years After Onset

Stroke ◽

10.1161/str.47.suppl_1.tp74 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Junya Aoki ◽

Kazumi Kimura ◽

Yuki Sakamoto

Keyword(s):

Regression Analysis ◽

Confidence Interval ◽

Plasminogen Activator ◽

Clinical Outcomes ◽

Tissue Plasminogen Activator ◽

Odds Ratio ◽

Univariate Analysis ◽

Favorable Outcome ◽

Tissue Plasminogen

Introduction & Hypothesis: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5 years after tPA therapy and investigated factors related to long-term clinical outcomes. Methods: Telephone interviews were used to assess the to the the modified Rankin Scale (mRS) scores at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after tPA therapy after written informed consent was obtained. When a telephone interview was not successfully accomplished, an interview letter was sent as an alternative method. Favorable outcome was defined as mRS 0-2, and unfavorable outcome was as mRS 3-6. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5 years after tPA therapy. Results: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males) patients were enrolled. The onset-to-treatment time (OTT) was 153 (120-176) minutes. At 3 months after tPA therapy, the median mRS score was assessed as 3 (1-5). Kaplan-Meier curve showed that favorable outcomes after 5 years after tPA therapy occurred in 45% patients and that the mortality rate was 40%. Univariate analysis showed that OTT was 123 (107-172) minutes in patients with favorable outcomes and 155 (124-172) minutes in patients with non-favorable outcomes (p=0.046). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.97, 95% confidence interval 0.95-0.99, p=0.008) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001). Receiver operating characteristic curve analysis showed that OTT ≥ 136 minutes was the optimal cut-off value to predict favorable outcome at 5 years after tPA therapy, with a sensitivity of 0.67, a specificity of 0.70, and an area under curve (AUC) of 0.662 (p=0.016), and that to predict death within 5 years after tPA therapy, with a sensitivity of 0.70, a specificity of 0.66, and an AUC of 0.679 (p=0.001). Conclusion: Early tPA administration can improves long-term clinical outcomes.

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Increased Postoperative Bleeding Risk among Patients with Local Flap Surgery under Continued Clopidogrel Therapy

BioMed Research International ◽

10.1155/2015/120903 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Wolfgang Eichhorn ◽

Martina Haase ◽

Lan Kluwe ◽

Jürgen Zeuch ◽

Ralf Smeets ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Univariate Analysis ◽

Postoperative Bleeding ◽

Tumor Resection ◽

Bleeding Risk ◽

Skin Tumor ◽

Bleeding Complications ◽

Skin Grafts ◽

Clopidogrel Therapy ◽

Study Population

Purpose. The purpose of the study was to evaluate the influence of a continued antiplatelet therapy with clopidogrel on postoperative bleeding risk in patients undergoing skin tumor resection and reconstruction with local flaps or skin grafts under outpatient conditions.Patients and Methods. The authors designed and implemented a retrospective clinical cohort study at the General Hospital Balingen. The primary endpoint was the bleeding ratio in patients with clopidogrel treatment in comparison to patients without any anticoagulant or antiplatelet therapy. Wound healing was evaluated on days 1, 3, 5, 7, 10, and 14.Results. 650 procedures were performed, 123 of them under continued clopidogrel therapy. There were significantly more postoperative bleeding complications among patients with continued antiplatelet therapy. Regarding the whole study population, malignant lesions, a larger defect size, and skin grafts were accompanied by a higher rate of bleeding incidents. However, there were no significant findings in the univariate analysis of the clopidogrel group. All bleeding incidents were easily manageable.Conclusion. Despite an increased bleeding ratio among patients under continued clopidogrel therapy, the performance of simple surgical procedures can be recommended. However, cautious preparation and careful hemostasis are indispensable.

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Abstract TP14: Predictors of Good Outcome after Endovascular Therapy for Acute Posterior Circulation Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp14 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mehdi Bouslama ◽

Ashutosh Jadhav ◽

Diogo C Haussen ◽

Amin Aghaebrahim ◽

Leticia C Rebello ◽

...

Keyword(s):

Confidence Interval ◽

Scale Score ◽

Endovascular Therapy ◽

Odds Ratio ◽

Univariate Analysis ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Patient Specific ◽

Posterior Circulation Stroke ◽

Good Outcome

Background and Purpose: Endovascular therapy (ET) is increasingly utilized in acute ischemic stroke treatment and is now considered the gold standard approach for select patient populations. Prior studies have demonstrated that eventual patient outcome depend on both patient specific factors as well as procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome after ET for acute posterior circulation stroke Methods: We reviewed our prospectively collected endovascular databases at two tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015. Baseline characteristics, procedural data and outcomes were evaluated. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 214 qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score (NIHSS), anesthesia modality (conscious sedation vs general anesthesia), procedural length and reperfusion status were significantly associated with outcomes in the univariate analysis Multivariate logistic regression indicated that only smoking (odds ratio, 2.49; 95% confidence interval 1.16-5.36; P=0.019), low NIHSS (odds ratio, 0.92; 95% confidence interval 0.88-0.96; P<0.001), and successful reperfusion (mTICI 2b-3) (odds ratio, 13.65; 95% confidence interval 1.71-108.76; P=0.014), were independent predictors of good outcomes. Conclusion: Our study suggests that baseline NIHSS, smoking and reperfusion status are independent predictors of good outcomes after ET for acute posterior circulation stroke.

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Evaluation of the Effect of Platelet-Rich Fibrin on Wound Healing at Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled, Triple-Blind Study

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619900432 ◽

2020 ◽

pp. 153473461990043 ◽

Cited By ~ 1

Author(s):

Mojtaba Vaheb ◽

Maryam Karrabi ◽

Mahtab Khajeh ◽

Alireza Asadi ◽

Ehsan Shahrestanaki ◽

...

Keyword(s):

Wound Healing ◽

Chronic Wounds ◽

Outcome Evaluation ◽

Control Group ◽

Platelet Rich Fibrin ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Significant Difference ◽

The Mean ◽

And Control

Split-thickness skin grafting (STSG) is widely used to heal wounds resulting from trauma, burns, and chronic wounds. This study aimed to determine the true effect of platelet-rich fibrin (PRF) on patients with burn wounds requiring STSG during treatment of donor wounds. This randomized, triple-blind clinical trial was conducted on patients who referred to the burn ward of Vasei Hospital of Sabzevar, Iran, from May 2017 to May 2018. The donor site was randomly divided into 2 groups: PRF and control (Vaseline petrolatum gauze) using Vaseline gauze. In the intervention group, the PRF gel was applied to the wound and covered with Vaseline gauze and wet dressing. Conversely, only Vaseline gauze and wet dressing were applied to the control group. Outcome evaluation was conducted using paired t test and Wilcoxon signed rank-sum test, as appropriate, on days 8 and 15. The mean age of the patients was 33.10 ± 2.60 years, and 51.50% were male. The mean wound healing time in the PRF and control groups was 11.80 ± 3.51 and 16.30 ± 4.32 days, respectively ( P < .001). The PRF group showed significantly higher wound healing rates than the control group at 8 and 15 days dressing ( P < .001 and P < .001, respectively). Moreover, the mean wound healing for all wound healing indices diagnosed by 2 specialists in PRF was higher than control group on days 8 and 15 ( P < .001). We found a statistically significant difference on days 8 and 15 regarding the mean pain levels between the 2 groups ( P < .001). The findings showed that PRF can significantly increase the time and rate of donor wound healing compared with conventional treatment and also reduce the severity of pain.

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Perioperative blood loss in total hip and knee arthroplasty: Outcomes associated with intravenous tranexamic acid use in an academic medical center

SAGE Open Medicine ◽

10.1177/2050312116637024 ◽

2016 ◽

Vol 4 ◽

pp. 205031211663702 ◽

Cited By ~ 16

Author(s):

Craig A Hogan ◽

Larry K Golightly ◽

Suzanne Phong ◽

Michael R Dayton ◽

Clark Lyda ◽

...

Keyword(s):

Treatment Group ◽

Blood Loss ◽

Confidence Interval ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Control Group ◽

Control Groups ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

And Control

Objectives: Clinical trials have reported decreased blood loss with the use of tranexamic acid during joint reconstruction. The purpose of this study was to assess the individual practice implications of tranexamic acid use in joint replacement surgery. Methods: Health records of adults undergoing total knee arthroplasty and total hip arthroplasty over a 12-month period were retrospectively reviewed. The treatment group comprised patients who received intravenous tranexamic acid perioperatively. The control group comprised patients who did not receive tranexamic acid. Results: Patients in the treatment group (n = 64) and the control group (n = 99) were well matched for demographics, orthopedic diagnosis, and comorbidities. In-hospital postsurgical mean decreases in hemoglobin concentrations were −4.05 g/dL and −4.94 g/dL in the treatment and control groups, respectively (p < 0.001). Postsurgical mean decreases in hematocrit levels were −11.2% and −14.2% in the treatment and control groups, respectively (p < 0.001). Three patients in the treatment group (5%) and 21 patients in the control group (21%) received red blood cell transfusions (p = 0.006). As compared to control, the relative risk of transfusion in the treatment group was 0.23 (95% confidence interval = 0.07–0.76) and the number needed to treat to avoid one transfusion was 7.0 (95% confidence interval = 3.8–14.4). No evidence of thromboembolism or other serious complications were observed in either group. Conclusions: In patients undergoing joint replacement surgery, perioperative administration of tranexamic acid was associated with diminished blood loss and lesser resource utilization.

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Prevalence of vulvovaginitis and bacterial vaginosis in patients with koilocytosis

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600008 ◽

2008 ◽

Vol 126 (6) ◽

pp. 333-336 ◽

Cited By ~ 5

Author(s):

Ana Claudia Camargo Campos ◽

Ruffo Freitas-Junior ◽

Luiz Fernando Jubé Ribeiro ◽

Régis Resende Paulinelli ◽

Cleomenes Reis

Keyword(s):

Confidence Interval ◽

Bacterial Vaginosis ◽

Odds Ratio ◽

Bacterial Colonization ◽

Univariate Analysis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

P Values ◽

The City

CONTEXT AND OBJECTIVE: Empirical discussion regarding an association between koilocytosis and vulvovaginitis often occurs. Thus, the objective of this study was to assess the prevalence of microorganisms associated with bacterial vaginosis and vulvovaginitis in women with and without koilocytosis. DESIGN AND SETTING: Analytical cross-sectional study including two cohorts of women (with and without koilocytosis) who attended a cancer hospital in the city of Goiânia, state of Goiás. METHODS: A total of 102 patients entered the study. The whiff test, Gram and Papanicolaou staining and bacterial and fungal culturing were performed. The results were observed using univariate analysis. The odds ratio and confidence interval (CI) of the variables were calculated; P-values < 0.05 were considered significant. RESULTS: The prevalence of bacterial colonization was similar in patients with and without koilocytosis. The odds ratio for candidiasis was 1.43 (CI 1.05-1.95) and the odds ratio for trichomoniasis was 1.78 (CI 1.49-2.12), in patients with koilocytosis. CONCLUSIONS: The prevalence of candidiasis and trichomoniasis seems to be higher in patients with koilocytosis.

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Ultrasonography of the Vagus Nerve in the Diagnosis of Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2020/2627471 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Ovidijus Laucius ◽

Renata Balnytė ◽

Kęstutis Petrikonis ◽

Vaidas Matijošaitis ◽

Neringa Jucevičiūtė ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Confidence Interval ◽

Vagus Nerve ◽

Motor Symptom ◽

Control Groups ◽

Dorsal Nucleus ◽

And Gender ◽

The Right ◽

And Control

Background. It is currently impossible to diagnose Parkinson’s disease (PD) in the premotor phase even though at the time of motor symptom onset the number of already degenerated dopaminergic substantia nigra neurons is considerable. Degeneration of the dorsal nucleus of the vagus nerve (VN) has been reported early in the disease course, and it could lead to impaired function of the VN, resulting in certain nonmotor symptoms of PD. Therefore, we raised a hypothesis that the loss of VN neurons could result in a smaller diameter of the VN among PD patients. Methods. 20 PD patients and 20 age- and gender-matched individuals without any neurodegenerative disease were enrolled in a pilot study. The diameters of the right and left VNs were measured using ultrasonography, their average was calculated, and the narrower VN diameter was noted separately. Results. No difference was found between the PD and control groups neither in the average VN diameter (mean 1.17; 95% confidence interval (CI) 1.10–1.24 vs. 1.13; 1.07–1.18, mm; p=0.353) nor in the narrower VN diameter (mean 1.11; 95% confidence interval (CI) 1.02–1.20 vs. 1.07; 1.02–1.13, mm; p=0.421). The narrower VN diameter and the average VN diameter were not able to distinguish between PD patients and controls (area under curve (AUC) = 0.588, 95% CI = 0.408–0.767, and p=0.344; and AUC = 0.578, 95% CI = 0.396–0.759, and p=0.402). Conclusions. To conclude, no differences were found in VN diameter between the PD and control groups. Therefore, our data do not support the hypothesis that PD could be associated with a smaller diameter of the VN.

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Smoking increases the risk of surgical site infection after hydrocelectomy in adults: a retrospective cohort study in Brazil

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9450 ◽

2018 ◽

Vol 11 (12) ◽

pp. 950-956

Author(s):

Thiago Silva Da Costa ◽

Paulo José De Medeiros ◽

Mauro José Costa Salles

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Confidence Interval ◽

Surgical Site Infection ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Univariate Analysis ◽

Smoking Habits ◽

Site Infection

Introduction: Surgical site infection (SSI) following hydrocelectomy is relatively uncommon, but it is one of the main post-operative problems. We aimed to describe the prevalence of SSI following hydrocelectomy among adult patients, and to assess predisposing risk factors for infection. Methodology: This retrospective cohort study was carried out at a university hospital and included hydrocelectomies performed between January 2007 and December 2014. Diagnosis of SSI was performed according to the Center for Diseases Control (CDC) guidelines. Multivariable logistic regression analysis was used to identify independent risk factors. Results: A total of 196 patients were included in the analysis. Overall, 30 patients were diagnosed with SSI (15.3%) and of these, 63.3% (19/30) were classified as having superficial SSI, while 36.7% (11/30) had deep SSI. The main signs and symptoms of infection were the presence of surgical wound secretion (70%) and inflammatory superficial signs such as hyperemia, edema and pain (60%). Among the 53 patients presenting chronic smoking habits, 26.4% (14⁄53) developed SSI, which was associated with a higher risk for SSI (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.27 to 6.35, p < 0.01) in the univariate analysis. In the adjusted multivariable analysis, smoking habits were also statistically associated with SSI after hydrocelectomy (odds ratio [OR] = 2.84, 95% confidence interval [CI] = 1.30 to 6.24, p = 0.01). No pre-, intra-, or post-operative variable analyzed showed an independent association to SSI following hydrocelectomy. Conclusions: Smoking was the only independent modifiable risk factor for SSI in the multivariate analysis.

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