Complications of therapeutic plasma exchange in patients with neurological disorders

2020 ◽  
Author(s):  
Mahdieh Afzali ◽  
Shahram Oveisgharan ◽  
Sahebeh Rajabkhah ◽  
Siamak Abdi
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Therapeutic Plasma Exchange ◽  
Health Providers ◽  
Tertiary Referral Hospital ◽  
Cross Sectional ◽  
Neurologic Disorders ◽  
Demyelinating Disorders

Background: Therapeutic plasma exchange (TPE) is the treatment of choice for many neurologic disorders. The safety of this procedure is a major concern for physicians. The aim of this study was to determine the complications of TPE in patients with neurologic disorders at a tertiary referral hospital. Methods: This retrospective cross-sectional study evaluated patients with various neurologic disorders receiving TPE in neurology department of Shariati Hospital, Tehran, Iran. Major and minor complications related to TPE were recorded. Results: Clinical information records of 417 TPE sessions (88 patients) were available. Mean age of patients was 40.0 ± 15.8 years. Underlying diseases included central demyelinating disorders, myasthenia gravis (MG), chronic neuropathy, Guillain-Barre syndrome (GBS), and autoimmune encephalopathy in 34.1%, 33.0%, 17.0%, 14.8%, and 1.1% of patients, respectively. Major complications occurred in 15.9% of patients and 37.5% of patients accounted for minor complications. Among major adverse effects, thrombosis, infection, and lifethreatening complications were seen more commonly in patients with central vascular access (P = 0.005, P = 0.003, and P = 0.010, respectively). Conclusion: TPE complications were seen more commonly in patients with central vascular access. Therefore, use of peripheral vascular access and vigilant patient monitoring by trained health providers can reduce its complications.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

scholarly journals The trends of complementary alternative medicine use among cancer patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abdul Rahman Jazieh ◽  
Khadega A. Abuelgasim ◽  
Husam I. Ardah ◽  
Mohammad Alkaiyat ◽  
Omar B. Da’ar
Keyword(s):  
Alternative Medicine ◽  
Cancer Patients ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Complementary Alternative Medicine ◽  
Cultural Changes ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
Cam Use ◽  
The Individual

Abstract Background The use of complementary and alternative medicine (CAM) is common among cancer patients and it may reflect the individual and societal beliefs on cancer therapy. Our study aimed to evaluate the trends of CAM use among patients with cancer between 2006 and 2018. Methods We included 2 Cohorts of patients with cancer who were recruited for Cohort 1 between 2006 and 2008 and for Cohort 2 between 2016 and 2018. The study is a cross-sectional study obtaining demographic and clinical information and inquiring about the types of CAM used, the reasons to use them and the perceived benefits. We compared the changes in the patterns of CAM use and other variables between the two cohorts. Results A total of 1416 patients were included in the study, with 464 patients in Cohort 1 and 952 patients in Cohort 2. Patients in Cohort 2 used less CAM (78.9%) than Cohort 1 (96.8%). Cohort 1 was more likely to use CAM to treat cancer compared to Cohort 2 (84.4% vs. 73%, respectively, p < 0.0001,); while Cohort 2 used CAM for symptom management such as pain control and improving appetite among others. Disclosure of CAM use did not change significantly over time and remains low (31.6% in Cohort 1 and 35.7% for Cohort 2). However, physicians were more likely to express an opposing opinion against CAM use in Cohort 2 compared to Cohort 1 (48.7% vs. 19.1%, p < 0.001, respectively). Conclusion There is a significant change in CAM use among cancer patients over the decade, which reflects major societal and cultural changes in this population. Further studies and interventions are needed to improve the disclosure to physicians and to improve other aspects of care to these patients.

scholarly journals Impact of Birth Control Use on Metabolic Syndrome Risk in Female College Students

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 165-165
Author(s):  
Lilah Chase ◽  
Jesse Morrell
Keyword(s):  
College Students ◽  
Metabolic Syndrome ◽  
At Risk ◽  
Birth Control ◽  
Cross Sectional Study ◽  
Female College Students ◽  
College Health ◽  
Health Providers ◽  
Cross Sectional ◽  
Female College

Abstract Objectives Research suggests birth control (BC) use alters blood lipids in women. The purpose of this study was to examine the differences in metabolic syndrome risk between birth control users vs. nonusers in a sample of female college students, 18–24 years old. Methods Data were collected between 2005–18 from the College Health and Nutrition Assessment Survey, an ongoing, cross-sectional study conducted at a midsized, northeastern university. Anthropometric, biochemical, and clinical measures were obtained in the fasted state and used to determine metabolic syndrome (MetS) prevalence. BC use was self-reported. Proportional differences between BC vs. non-BC users of MetS and individual MetS components were evaluated via chi-square tests. Results Forty-five % of the final sample (n = 6456) reported using BC. MetS (≥3 MetS criteria) was present in 3.9% of students; 16.7% of students had ≥ 2 MetS criteria. BC users vs. nonusers were more likely to have at-risk triglyceride levels (22.4 vs. 11.0%, P &lt; .001) but less likely to have at-risk HDL levels (21.2 vs. 27.7%, P &lt; .001) and abdominal obesity (14.3% vs. 16.4, P &lt; .05). No significant differences were observed in prevalence of elevated blood pressure or glucose between BC users vs. nonusers. Overall, MetS prevalence did not differ between groups (3.8 vs. 3.9%, P = .85). Conclusions Our findings suggest BC use is common and impacts different MetS criteria in college females. College health providers and nutrition educators can utilize research findings to tailor information for female students at risk for MetS and chronic disease. Funding Sources New Hampshire Agriculture Experiment Station and USDA National Institute of Food and Agriculture Hatch Project 1,010,738.

Effect modification of cardiorespiratory fitness, obesity, and physical activity in adults

2021 ◽  
Author(s):  
Maria do Socorro Simoes ◽  
Fernando Wehrmeister ◽  
Marcello Romiti ◽  
Antonio de Toledo Gagliardi ◽  
Rodolfo Arantes ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Body Mass ◽  
Cardiorespiratory Fitness ◽  
Vigorous Physical Activity ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Effect Modification ◽  
Cross Sectional ◽  
Arterial Blood

We investigated if cardiorespiratory fitness modifies the association between obesity and the level of physical activity. In this cross-sectional study, we analyzed data from 746 adults, free of diagnosed cardiorespiratory or locomotor diseases. We analyzed sociodemographic and clinical information, cardiovascular risk factors, cardiorespiratory fitness, anthropometry, and level of physical activity (time spent in moderate-to-vigorous physical activity). Those that spent more time in moderate-to-vigorous physical activity were younger, male, with lower body mass index, without self-reported arterial blood hypertension, diabetes and dyslipidemia, non-smokers, and presented with better cardiorespiratory fitness. The linear regression coefficients showed that cardiorespiratory fitness changes according to the level of physical activity and body mass index (obesity in low cardiorespiratory fitness: β 6.0, p = 0.213, 95%CI -3.5 to 15.6; in intermediate cardiorespiratory fitness: β 6.3, p = 0.114, 95%CI -1.5 to 14.2; in high cardiorespiratory fitness: β -6.3, p = 0.304, 95%CI -18.4 to 5.8). This effect modification trend was present after adjusting the model by covariates. Cardiorespiratory fitness potentially modifies the association between body mass index and the level of physical activity. It should be routinely assessed to identify persons with overweight/ obesity with low/ intermediate cardiorespiratory fitness to prescribe individualized training.

Early report on percutaneous endoscopic gastrostomy at Owerri, Nigeria

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Christopher Nonso Ekwunife ◽  
Kelechi E. Okonta ◽  
Stephen E. Enendu
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Early Report ◽  
Cross Sectional Study ◽  
Tube Placement ◽  
Safe Procedure ◽  
Cross Sectional ◽  
Endoscopic Gastrostomy ◽  
Neurologic Disorders ◽  
Superficial Skin ◽  
Peg Tube

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a well-established endoscopic procedure that is used predominantly to create enteral access for feeding. Its use has not been widespread in Nigeria despite its efficacy. This study is done to review the early experiences in the use of PEG in Federal Medical Centre, Owerri and Carez Clinic, Owerri. Material and Methods: This is a 4-year retrospective cross-sectional study of patients who had PEG from January 2015 to December 2018. The indications, complications, and outcomes of the procedure were analyzed. Results: A total of 13 patients had pull-type gastrostomy during this period. Six (46.1%) patients had the procedure on account of neurologic disorders, 4 (30.8%) patients had esophageal tumors, while 3 (23.1%) patients had esophageal motility disorders. The overall success rate for PEG tube placement was 100%. The most common complication was superficial skin infection 30.8% (4/13). No mortality was attributable to the procedure. Conclusion: PEG is still not commonly done in our setting, but it is a relatively safe procedure. Physicians should be encouraged to offer it to our teeming patients with neurologic disorders who may benefit from it.

Care coordination in two of Bogota’s public healthcare networks: A cross-sectional study among doctors

2019 ◽  
Vol 22 (3-4) ◽  
pp. 127-139 ◽  
Author(s):  
Andrés Daniel Gallego-Ardila ◽  
Ángela María Pinzón-Rondón ◽  
Amparo Susana Mogollón-Pérez ◽  
Carol Ximena Cardozo ◽  
Ingrid Vargas ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Care Coordination ◽  
Clinical Management ◽  
Waiting Times ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Public Healthcare ◽  
Sectional Study ◽  
Cross Sectional ◽  
High Level

Introduction Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination.

scholarly journals MO529PREVALENCE AND DETERMINANT FACTORS OF DEPRESSION AND ANXIETY IN PEOPLE WITH CHRONIC KIDNEY DISEASE : A MOROCCAN CROSS-SECTIONAL  STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Amina Chrifi Alaoui ◽  
Mohammed Omari ◽  
Noura Qarmiche ◽  
Omar Kouiri ◽  
Basmat Amal Chouhani ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Depression Scale ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
Determinant Factors ◽  
Before And After

Abstract Background and Aims The Chronic kidney disease (CKD), like many chronic illnesses, is invariably associated with various psychiatric conditions and poorer quality of life. This study aims to assess the prevalence of depression and anxiety among CKD patient and their determinant factors. Method this is a cross sectional single center study in a Moroccan university hospital. Patients aged ≥ 18 years old and followed for more than one year were included. The data was collected using a questionnaire for sociodemographic and clinical information and the Hospital anxiety and depression scale (HADS) to assess depression and anxiety prevalence. After the description of the population’s characteristics, the statistical analysis aimed to assess the association between depression and anxiety disorders and the estimated glomerular filtration rate before and after adjustment on several confounding factors. Results 88 patients were included (63.6% of them were women, the mean age was 61.8±14.0 years), 21 were on stage 3, 46 were on stage 4, and 21 were on stage 5 of the CKD. The median of depression sub-score was 5.00[2.00; 10.0], the median of anxiety sub-score was 6.00[4.00; 9.00], and the median of the global score was 11.0[7.00; 20.0], 22.0% of included patients had depression and 22.0% had anxiety. Both depression and anxiety scores were associated to eGFR before and after adjustment (p= 0.001, p&lt;0.001and p=0.04, p=0.03 respectively). Conclusion This study showed that depression and anxiety are strongly related to the CKD progression, which should motivate both doctors and nurses to improve their psychological care toward CKD patients.

scholarly journals Does Static Intra Access Pressure Monitoring of Arteriovenous Fistulas Predicts Intra Access Stenosis?

2021 ◽  
Vol 4 (03) ◽  
Author(s):  
Abaid ur Rehman ◽  
Muhammad Imran Khan ◽  
Omer Sabir ◽  
Muhammad Mohsin Riaz ◽  
Mubashar Dilawar ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Vascular Access ◽  
Doppler Ultrasonography ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Female Ratio ◽  
Arteriovenous Fistulas ◽  
Doppler Us ◽  
Sensitivity Specificity ◽  
Male To Female

The initiation of hemodialysis in patients with chronic kidney disease (CKD) requires vascular access formation. The choice of vascular access for individual patient depends on various factors however arteriovenous fistula (AVF) is conventionally considered to be the vascular access of choice. Once hemodialysis is initiated through a mature AVF, there is an ongoing need for surveillance of the AVF to ensure adequate function and prevent vascular access issues among which flow obstruction (both inflow and outflow) remains the most important. AVF stenosis can potentially lead to inadequate dialysis delivery and thrombosis thus leading to access loss. Physical examination and AVF Doppler ultrasonography (DUS) are useful for evaluation of stenosis in the  arteriovenous connection and the outflow tract. Periodic assessment of the AVF with Static Intra access Pressure (SIAPR) determination may be a reliable means of predicting vascular access stenosis. Material & Methods  A cross sectional study carried out at Department of Nephrology, Fatima Memorial Hospital, Lahore from July 2018 to December 2018. In total 113 patients were included, and all patients underwent SIAPR assessment and Doppler Ultrasound of AVF. Results Mean age of the patients was 56.81±9.38 years, male to female ratio of the patients was 1.8:1. In this study the SIAPR was suggestive of  stenosis in 87(76.99%) patients. The sensitivity, specificity and diagnostic accuracy of SIAPR against Doppler US of the AVF for detection of stenosis was 75.86%, 22.62% & 36.28% respectively Conclusion SIAPR has low specificity and diagnostic accuracy compared to Doppler US for detection of AVF stenosis.

scholarly journals Comparison of sensorineural hearing loss characteristics in different hemodialysis vascular accesses

2020 ◽  
Author(s):  
Behieh Kohansall ◽  
Nasser Saeedi ◽  
Moeinoddin Hossein Beigi ◽  
Azam Moslemi ◽  
Akram Valizadeh
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Vascular Access ◽  
Demographic Data ◽  
Life Quality ◽  
Cross Sectional Study ◽  
Sensorineural Hearing ◽  
Moderate Degree ◽  
Cross Sectional ◽  
Significant Difference

Background and Aim: Sensorineural hearing loss (SNHL) is one of the complications in hemodialysis patients. Vascular access (VA) represents a lifeline for these patients affecting their life quality and clinical outcomes. Arterio­venous fistula is the gold standard of VAs with minor complications and better hemodialysis adequacy. There is no study investigating hearing differences in hemodialysis VAs. Hence, this study aimed to compare SNHL characteristics amongst hemodialysis VAs. Methods: This cross-sectional study conducted on 64 patients aged 18−60 years received regular hemodialysis in 2019. Demographic data and comorbid conditions were recorded based on patients’ case records and electronic databases. After a physical examination, otoscopy, tympa­nometry, and conventional audiometry, patients were divided into fistula (n = 26), permanent catheter (n = 36), and temporary catheter (n = 2) groups according to vascular access type. Results: Prevalence rate of SNHL was 63.89%, 50% and 50% in the permanent catheter, fistula and temporary catheter groups, respectively. Most patients had mild sloping-SNHL in the per­manent catheter and fistula groups as against moderate degree in the other group. There was no significant difference in hearing thresholds, deg­ree and audiogram shape among VA groups. No significant relation was found between age, sex, hemodialysis duration and disease duration with hearing loss in all groups (p > 0.05). Conclusion: More patients had SNHL in per­manent catheter group. Vascular access types, longer duration of hemodialysis and disease dur­ation do not seem to be associated with SNHL. However, further investigation is needed to cla­rify the relationship. Keywords: Sensorineural hearing loss; vascular access; chronic renal failure; hemodialysis

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