Comparison of plasmapheresis with medical apheresis in terms of efficacy and cost in the acute treatment of hypertriglyceridemia in children with lipoprotein lipase deficiency

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sahin Erdol ◽  
Huseyin Bilgin ◽  
Halil Saglam
Keyword(s):  
Lipoprotein Lipase ◽  
Triglyceride Level ◽  
Acute Treatment ◽  
Lipid Lowering ◽  
Cost Of Treatment ◽  
Before And After ◽  
The Mean ◽  
The Cost ◽  
Turkish Lira

Abstract Objectives We aimed to compare plasmapheresis and medical apheresis as lipid-lowering therapies in children with familial lipoprotein lipase (LPL) deficiency. Methods The data of 13 patients who were followed up after a diagnosis of LPL deficiency were retrospectively analyzed. Plasma triglyceride, cholesterol, amylase, and lipase values and complications were recorded before and after each patient underwent plasmapheresis or medical apheresis. Results The mean follow-up period of the patients was 99.64 ± 52.92 months in the medical apheresis group and 118 ± 16.97 months in the plasmapheresis group. While the mean triglyceride level before plasmapheresis was 1,875.38 ± 547.46 mg/dL, it was 617 ± 228.28 mg/dL after plasmapheresis. While the mean triglyceride level before medical apheresis was 1,756.86 ± 749.27 mg/dL, it was found to be 623.03 ± 51.36 mg/dL after medical apheresis. Triglyceride levels were decreased by 59.62% with medical apheresis and 65.57% with plasmapheresis. The cost of treatment for medical apheresis was found to be lower compared to plasmapheresis 296.93 ± 29.94 Turkish lira (USD 43.34 ± 4.01) vs. 3,845.42 ± 156.17 Turkish lira (USD 561.37 ± 20.93; p<0.001). Conclusions Although there is no standardized strategy for the acute treatment of hypertriglyceridemia due to LPL deficiency, medical apheresis is a safe and effective treatment with a low risk of side effects. Unlike plasmapheresis, medical apheresis can be performed in any center, which is another important advantage of the procedure.

scholarly journals Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Ogawa ◽  
H Sekiguchi ◽  
K Jujo ◽  
E Kawada-Watanabe ◽  
H Arashi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Primary Outcome ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Hypertensive Patients ◽  
Mean Values ◽  
Comprehensive Management ◽  
The Mean ◽  
Artery Disease

Abstract Background There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial. Methods HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of &lt;130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up. Results During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP. Conclusions The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

scholarly journals Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

2021 ◽  
Vol 10 (18) ◽  
pp. 4062
Author(s):  
François-Victor Prigent ◽  
Kévin Guillen ◽  
Pierre-Olivier Comby ◽  
Julie Pellegrinelli ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Volume Reduction ◽  
Renal Angiomyolipoma ◽  
Cyanoacrylate Glue ◽  
Selective Arterial Embolization ◽  
Before And After ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Postembolization Syndrome

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume.

scholarly journals Coagulation performance evaluation of alginate as a natural coagulant for the treatment of turbid water

2021 ◽  
Author(s):  
Packiam Saranya ◽  
S. T. Ramesh ◽  
R. Gandhimathi
Keyword(s):  
Calcium Ions ◽  
Functional Materials ◽  
Capsular Polysaccharides ◽  
Cost Of Treatment ◽  
Coagulation And Flocculation ◽  
Coagulation Performance ◽  
Before And After ◽  
Box Structure ◽  
The Cost ◽  
Flocculation Process

Abstract Alginates are quite abundant in nature as they occur both as a structural component in marine brown algae (Phaeophyceae) comprising up to 40% of dry matter and as capsular polysaccharides in soil bacteria. Alginic acid is the only polysaccharide, which naturally contains carboxyl groups in each constituent residue, and possesses various abilities for functional materials. Experiments were carried out for the water of turbidity 300 NTU. Alginate as such doesn't act as a coagulant instead it should be converted to calcium alginate by adding calcium ions. Calcium chloride was used for imparting calcium ions necessary for the reaction. The dosage of calcium was fixed as 50 mg/L, 75 mg/L, 100 mg/L, 150 mg/L, 200 mg/L, and alginate doses between 2 to 10 mg/L. Calcium dosage below 50 mg/L was not sufficient enough for the formation of egg-box structure which is responsible for the coagulation and flocculation process. For the mechanism of charge neutralization to take place effectively, calcium should be added first followed by alginate. pH and conductivity of the sample remain constant before and after the treatment. The dosage of alginate required for the treatment is less so the cost of treatment also will be very less, thus alginate can replace the usage of chemical coagulants like alum.

Factors associated with early and late failure after goniotomy for primary pediatric glaucoma

2018 ◽  
Vol 30 (1) ◽  
pp. 162-167 ◽  
Author(s):  
Dina H Hassanein ◽  
Ahmed Awadein ◽  
Hala Elhilali
Keyword(s):  
Risk Factors ◽  
Intraocular Pressure ◽  
First Year ◽  
Failure Rates ◽  
Factors Associated ◽  
Pediatric Glaucoma ◽  
Late Failure ◽  
Before And After ◽  
The Mean

Purpose: To analyze the risk factors associated with early and late failure after goniotomy for primary pediatric glaucoma. Methods: A retrospective study was done on infants who underwent goniotomy as the initial surgical procedure for primary pediatric glaucoma, and had a follow-up period ⩾48 months after surgery. Early and late failures were defined as intraocular pressure ⩾18 mmHg or signs of glaucoma progression before and after the end of first year, respectively. Results: A total of 81 eyes of 47 children were included. The mean age at the time of surgery was 6.1 ± 6.7 months, 34 children (72.3%) were bilateral. The mean follow-up was 5.9 ± 2.8 years. Of the included eyes, 41 eyes (50.6%) showed success, 25 eyes (30.9%) showed an early failure, and 15 eyes (18.5%) showed a late failure. The mean survival time was 43 months. However, only surgery before the end of the first month and positive consanguinity of the parents (P < 0.01 for both) were independent risk factors for early and late failure of goniotomy for primary pediatric glaucoma. Patients with late failure showed a statistically significant lower preoperative intraocular pressure (P = 0.02). A larger preoperative corneal diameter and a male gender were associated with higher but statistically insignificant failure rates. There were no differences in the early or late failure rates between unilateral and bilateral cases. Conclusion: A positive consanguinity of the parents and surgery before the end of the first month are the major predictors of failure of goniotomy.

Abstract P183: Lipid Control in Veterans Following Percutaneous Intervention

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Sloane A McGraw ◽  
Chris Healy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
Adhir Shroff
Keyword(s):  
Total Cholesterol ◽  
Therapeutic Option ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Management ◽  
Beneficial Effects ◽  
The Mean ◽  
Lipid Control ◽  
Statin Use

Background: Management of lipids is vital in patients with underlying coronary artery disease (CAD). According to the American College of Cardiology (ACC) guidelines, all patients with CAD should have low density lipoproteins (LDL) goals to be less than 100 mg/dl with the therapeutic option of treatment to less than 70 mg/dl. This can be achieved using multiple lipid lowering agents, however statin use is encouraged in CAD patients due to its multiple beneficial effects. Methods: We conducted a retrospective cohort study focusing on lipid management and statin use in 857 veterans undergoing percutaneous coronary intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Values were collected both pre-intervention as well as at six month follow up. Results: Both pre and post PCI, focus was maintained on the total cholesterol as well as the LDL levels. The mean total cholesterol prior to intervention was 166mg/dl and decreased to150mg/dl at six month follow up. The LDL mean pre-PCI was 98mg/dl and at six months the mean LDL decreased to 86mg/dl. With regards to ACC guidelines, the percent at goal for LDL less than 100mg/dl increased from 59% pre-PCI to 74% post-PCI Furthermore, treatment to less than 70mg/dl increased from 22 to 32% at six months. Lastly, the use of statins increased from 72 to 89%. Conclusions: There were in improvements in both total cholesterol and LDL values at six months post-PCI. There were also improvements in the percentage of patients who met the ACC recommended goal of LDL cholesterol less than 100mg/dl and the suggested goal of 70mg/dl. At six months, there was also an increase in usage of statin therapy.

Revision Functional Endoscopic Sinus Surgery: Objective and Subjective Surgical Outcomes

2005 ◽  
Vol 19 (4) ◽  
pp. 344-347 ◽  
Author(s):  
K. Christopher McMains ◽  
Stilianos E. Kountakis
Keyword(s):  
Medical Therapy ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Patient Symptom ◽  
Before And After ◽  
Revision Sinus Surgery ◽  
Preoperative Ct ◽  
The Mean

Background The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS). Methods We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999–2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0–10) before and after surgery. All patients had a minimum 2-year follow-up. Results The mean number of prior sinus procedures was 1.9 ± 0.1 (range, 1–7) and the mean preoperative CT grade was 13.4 ± 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 ± 1.3 and 7.3 ± 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 ± 0.6 and 2.1 ± 0.4, respectively (p < 2.8 X 10-10). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis. Conclusion Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.

scholarly journals Costs of care provided in a university hospital for children exposed to or infected with the HIV/AIDS

2007 ◽  
Vol 23 (suppl 3) ◽  
pp. S402-S413 ◽  
Author(s):  
Heloisa Helena de Sousa Marques ◽  
Bernard François Couttolenc ◽  
Maria do Rosário Dias de Oliveira Latorre ◽  
Maria Zilda de Aquino ◽  
Maria Ignez Garcia Aveiro ◽  
...  
Keyword(s):  
Medical Records ◽  
University Hospital ◽  
Accounting System ◽  
Cost Of Treatment ◽  
Costs Of Treatment ◽  
The Mean ◽  
Cost Accounting System ◽  
The Cost ◽  
Mean Cost ◽  
Hiv Aids

The objective of this study was to estimate and analyze the costs of treating children with HIV/AIDS at a university hospital in São Paulo, Brazil. The study collected and analyzed data from 291 medical records of children treated at the hospital as of March 2002. The costs of treatment were estimated for each category of patient (exposed and infected) and severity, based on the quantity of inputs and procedures used in treating each child, based on the cost accounting system used at the hospital. The total cost of treatment for children exposed to the HIV was R$ 956.41 and for those infected with HIV R$ 8,092.71 per year. The mean cost of ambulatory care was R$ 6,047.28 for children with severe conditions, R$ 3,714.45 for those with light/moderate conditions, and R$ 948.63 for the exposed. Hospitalized children had annual costs of R$ 19,353.34, R$ 18,823.16, and R$ 871.03, respectively. The medication was a major factor in the cost of treatment. Our estimates are comparable to the findings from other studies, but lower than corresponding findings from the international literature.

scholarly journals Infrared Thermography Follow-Up After Lower Limb Revascularization

2020 ◽  
pp. 193229682091231
Author(s):  
Arjaleena Ilo ◽  
Pekka Romsi ◽  
Matti Pokela ◽  
Jussi Mäkelä
Keyword(s):  
Skin Temperature ◽  
Infrared Thermography ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Clear Correlation ◽  
Before And After ◽  
Patients With Diabetes ◽  
The Mean

Background: The purpose of this study was with a simple clinical setting to compare skin temperature changes in the feet before and after revascularization and to identify possible correlation between ankle brachial index (ABI) and toe pressure (TP) values and foot skin temperature patient with and without diabetes. Methods: Forty outpatient clinic patients were measured ABI, TP, and the skin temperature using infrared thermography (IRT) at the foot before and after revascularization. Patients in the revascularization group were divided into subgroups depending on whether they had diabetes or not and a wound or not. Results: There were clear correlation between increase of ABI and TP and increase of the mean skin temperature on the feet after revascularization. The temperature was higher and the temperature change was greater among patients with diabetes. Side-to-side temperature difference between the revascularized feet and contralateral feet decreased after treatment. The mean temperature was higher in the feet with wound whether patient had diabetes mellitus or not. Conclusion: The simple, prompt, and noninvasive IRT procedure showed its potential as a follow-up tool among patients with diabetes or peripheral arterial disease and previous lower limb revascularization.

Phytonadione Education Program in a Community Hospital

2003 ◽  
Vol 38 (5) ◽  
pp. 458-462 ◽  
Author(s):  
Lisa M. Murphey ◽  
Debbie C. Byrd
Keyword(s):  
Patient Outcomes ◽  
Community Hospital ◽  
Medication Use ◽  
Education Session ◽  
Routes Of Administration ◽  
Baseline Group ◽  
Before And After ◽  
Post Test ◽  
The Mean

Purpose Pharmacists and physicians were educated regarding updated guidelines on phytonadione indications, dosing, and routes of administration. Study objectives were to evaluate the use of phytonadione in a community hospital, educate pharmacists and physicians about phytonadione use, and assess the value of education in terms of patient outcomes. Methods Baseline and follow-up data on phytonadione indications, dosages, and routes of administration were collected. Pretests and post-tests were administered before and after an education session. A Pharmacy and Therapeutics newsletter article highlighting the appropriate use of phytonadione was published. Results The baseline and follow-up medication use evaluations (MUEs) revealed that 53% and 62% of patients had an appropriate indication for phytonadione, respectively (P = 0.181). Among patients with an appropriate indication, 44% were administered an appropriate dose in the baseline group and 46% in the follow-up (P = 0.876). The baseline MUE revealed that 20% of phytonadione routes of administration were appropriate; 18% were considered appropriate in the follow-up (P = 0.842). Pharmacists' knowledge showed improvement after education efforts, with the mean score improving from 57% to 93.4% from pretest to post-test (P < 0.05) and the median score changing from 50% to 100%. Conclusion Improving pharmacists' knowledge is beneficial and necessary; however, it was not enough to change practice in this study. Additional steps must be taken to encourage routine application of the knowledge.

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