scholarly journals Midodrine for Prevention of Intradialytic Hypotension in High Risk Patients at a Tertiary Referral Hospital: A Retrospective Study

2019 ◽  
Author(s):  
Saja M alhabardi ◽  
Maryam Aldhaefi ◽  
Mohammed Alessa ◽  
Maha Alammari ◽  
Yousef Alrajhi ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcomes ◽  
Prospective Trial ◽  
Final Analysis ◽  
Hemodialysis Patients ◽  
Considerable Proportion ◽  
Control Group ◽  
Intradialytic Hypotension ◽  
Tertiary Referral Hospital ◽  
Number Of Patients

Abstract Background: Intradialytic hypotension (IDH) is the most common complication during hemodialysis procedure. Midodrine, an oral α-1 adrenergic agonist, is commonly used to prevent IDH. However, limited data is available to demonstrate midodrine effectiveness in prevention of IDH in high-risk hemodialysis patients. Objective: To describe the clinical outcomes of using midodrine in patients receiving hemodialysis concerning the incidence of IDH. Also, we aimed to explore the appropriate dose for midodrine use to prevent IDH. Methodology A retrospective cohort of adult with end-stage-renal failure. Exposure: Midodrine. Outcomes measure: IDH was defined as a decline in systolic blood pressure (SBP) by ≥20 mmHg or a decline in main arterial pressure (MAP) by ≥10 mmHg during hemodialysis session. Recurrent IDH was defined as three or more episodes of IDH throughout a year of starting midodrine. Analysis: A descriptive analysis of the frequency of IDH and recurrent IDH. We also, compared the risk of recurrent IDH across various doses of midodrine use. Result: From a total of 68-screened patients’ charts, 45 patients were included in the final analysis. 41.8% (n=28) of the study population had an IDH that required additional interventions to restore the SBP and MAP. IDH occurred in 68% (n=19, P=0.03) of patients with hypoalbuminemia. Recurrent IDH occurred in 36% (n=16) of the patients over their hemodialysis procedure. Incidence of treatment failure (57%, p= 0.02) and recurrent IDH (36%, p=0.04) were statistically significant in patients who received midodrine three time per week (57%) in comparison to those who received more than three days per week Conclusion: This exploratory study shows that a considerable proportion of patients receiving midodrine did not develop IDH or recurrent IDH. A long-term follow-up study with larger number of patients in comparison to the control group would be useful to evaluate the magnitude of efficacy of midodrine in hemodialysis patients with high risk for IDH. Moreover, a future prospective trial that focus on an important clinical outcomes such as cardiovascular events and mortality with midodrin is warranted.

P1574EFFECTS OF BRAZILIAN GREEN PROPOLIS EXTRACT (EPP-AF) ON INFLAMMATION IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marcelo Silveira ◽  
Flavio Teles ◽  
Erica Melo ◽  
Valeria Borges ◽  
Filipe Miranda ◽  
...  
Keyword(s):  
Control Period ◽  
Prospective Trial ◽  
Hemodialysis Patients ◽  
Intermittent Hemodialysis ◽  
Plant Materials ◽  
Propolis Extract ◽  
End Point ◽  
Number Of Patients ◽  
The Impact ◽  
Brazilian Green Propolis

Abstract Background and Aims End-stage chronic kidney disease is associated with the condition of chronic inflammation, impacting increased cardiovascular mortality in this specific population. Patients on hemodialysis are known to be predisposed to several factors that predispose to inflammation: dialysis membranes, central venous catheters, oxidative stress, fluid overload, sodium overload, uraemic toxins. Propolis, a natural resin produced by bees from plant materials, has anti-inflammatory, immunomodulatory, and anti-oxidant properties. The aim of this study was to evaluate the impact of Brazilian green propolis extract on inflammation in hemodialysis patients. Here we present preliminary results of the trial NCT04072341. Method We performed a prospective trial, open-label 9-week crossover study examining the effect of Brazilian green propolis (250mg/day, in capsules) on inflammation in hemodialysis patients. We included patients over 18 years, under intermittent hemodialysis (thrice per week), on hemodialysis for at least 1 month and until now 37 patients were included. We excluded pregnant women, cancer carried and patients who developed infection or underwent any surgical procedure during the study period. Each period was 4 weeks in duration with a 1-week washout period in between. The primary end point was change in serum level of high-sensitivity c-reactive protein (HsCRP). Secondary end point evaluated the safety of propolis use in hemodialysis patients. Results Their mean age was 58.6 ± 15.2 years (mean ± SD), and 22 (59.4%) were men. The proportion of patients with hypertension was 14 (37.8%) and diabetes was 9 (24.3%). The number of patients using arteriovenous fistula were 26 (70.2%). The HsCRP presented (mean ± SE) 5.31 ± 1.02 mg/L at baseline, 4.26 ± 0.76 mg/L after propolis period and 4.56 ± 1.32 mg/L in control period, p = 0.0042. Safety parameters were analyzed such as amylase, aspartate aminotransferase (AST) and creatine phosphokinase (CPK); there was no difference between them before and after the use of propolis. None of the participants reported any adverse effects or allergic reactions during the treatment. Conclusion Patients on hemodialysis have an increased inflammatory state. For the best of our knowledge it was the first clinical trial who demonstrated the safety of propolis in hemodialysis patients. Brazilian green propolis demonstrated a tendency to reduce inflammation in these patients.

scholarly journals Reoperations Following Lumbar Discectomy Are Associated With Worse Clinical Outcomes and Greater Socioeconomic Burden 3 Years After the Primary Procedure

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Claudius Thomé ◽  
Ali Araghi ◽  
Jason Inzana ◽  
Jonathan Stieber ◽  
Joshua M Ammerman
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Discectomy ◽  
Control Treatment ◽  
Control Group ◽  
Closure Device ◽  
Number Of Patients ◽  
Patient Reported ◽  
Socioeconomic Burden ◽  
Index Level

Abstract INTRODUCTION Lumbar discectomy patients with large annular defects are at significantly greater risk for symptom recurrence and revision. Previous studies suggest that outcomes following revision surgery are less positive than outcomes from primary discectomy. This analysis aimed to assess the clinical and socioeconomic outcomes associated with postdiscectomy reoperations and the utility of a bone-anchored annular closure device (ACD) for avoiding reoperations. METHODS This study was a retrospective analysis of a prospective randomized controlled trial (RCT). Lumbar discectomy patients with large (>6 mm) annular defects were treated with discectomy alone (Control; n = 278) or discectomy with an ACD (n = 272). Patient-reported outcomes included visual analog scale (VAS) for ipsilateral leg or back pain and Oswestry Disability Index (ODI). At 3 yr, clinical outcomes were available for 75% of the patients. Comparisons of outcomes were made between reoperated (n = 64) and nonreoperated (n = 351) patients, regardless of ACD or Control treatment, at 3 yr following the primary surgery. RESULTS Reoperated patients had significantly worse scores for ODI (24 ± 19 vs 11 ± 13; P < .0001), VAS leg pain (28 ± 30 vs 12 ± 19; P < .0001), and VAS back pain (36 ± 31 vs 17 ± 21; P < .0001). Significantly more nonreoperated patients were working at 3 yr (97% vs 84%; P < .001). Based on Kaplan-Meier analysis, the proportion of subjects experiencing at least 1 index-level reoperation in 3 yr was 11% in the ACD group and 19% in the Control group (P = .007). CONCLUSION Index-level reoperations following lumbar discectomy are associated with worse outcomes and greater socioeconomic burden in patients with large annular defects (>6 mm). These findings are consistent with reports from large registry analyses, including the Spine Patient Outcomes Research Trial (SPORT) and the Swedish National Spine Registry (Swespine). The ACD reduced the number of patients experiencing index-level reoperation by 43%.

scholarly journals Clinical Characteristics and Outcomes From Percutaneous Coronary Intervention of Last Remaining Coronary Artery

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Ahmad Shoaib ◽  
Muhammad Rashid ◽  
Evangelos Kontopantelis ◽  
Andrew Sharp ◽  
Eoin F. Fahy ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
High Risk ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Percutaneous Coronary

Background: Patients with complex high-risk coronary anatomy, such as those with a last remaining patent vessel (LRPV), are increasingly revascularized with percutaneous coronary intervention (PCI) in contemporary practice. There are limited data on the outcomes of these high-risk procedures. Methods: We analyzed a large longitudinal PCI cohort (2007–2014, n=501 841) from the British Cardiovascular Intervention Society database. Clinical, demographic, procedural, and outcome data were analyzed by dividing patients into 2 groups; LRPV group (n=2432) and all other PCI groups (n=506 691). Results: Patients in the LRPV PCI group were older, had more comorbidities, and higher prevalence of moderate-severe left ventricular systolic dysfunction. Mortality was higher in the LRPV PCI group during hospital admission (12 % versus 1.5 %, P <0.001), at 30 days (15% versus 2%, P <0.001), and at one-year (24% versus 5%, P <0.001). In a propensity score matching analysis the adjusted risk of mortality during index admission (odds ratio, 2.05 [95% CI, 1.65–2.44], P <0.001), at 30 days (odds ratio, 2.13 [95% CI, 1.78–2.5], P <0.001), at 1 year (odds ratio, 1.81 [95% CI, 1.59–2.03], P <0.001), and in-hospital major adverse cardiovascular events (odds ratio, 1.8 [95% CI, 1.42–2.19], P <0.001) were higher in LRPV PCI group as compared to control group. In sensitivity analyses, similar clinical outcomes were observed irrespective of which major epicardial coronary artery was treated. Conclusions: In this contemporary cohort, patients who had PCI to their LRPV had a higher-risk profile and more adverse clinical outcomes, irrespective of the vessel treated.

Imatinib Plasma Levels and Its Correlation with Response in Chronic-Phase Chronic Myeloid Leukemia: Experience of One Centre.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4284-4284
Author(s):  
J. Valentin Garcia. Gutierrez ◽  
Jesús Odriozola ◽  
Pilar Herrera ◽  
Javier Lopez ◽  
Maria Calbacho ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Plasma Levels ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Plasma Concentrations ◽  
Chronic Phase ◽  
Control Group ◽  
Treatment Optimisation ◽  
Number Of Patients

Abstract Abstract 4284 Introduction Imatinib (IM), 400 mg/d. induces durable responses in chronic myeloid leukaemia (CML) in chronic phase (CP). However, although IM-biodisponibility is fairly good, its plasma levels are variable and can not be predicted. Recently, these plasma concentrations have been related both to the dose being administrated and to the cytogenetic and molecular responses. Thus, Imatinib pharmacokinetics could be an issue towards treatment optimisation in CML patients. Recent studies suggest that therapeutic IM plasma levels should be above 1040 ng/dl. Aims To evaluate the association between IM dose and throughout plasma levels with different clinical outcomes. Results In this study, we looked for an association between plasma concentrations and clinical outcomes in 16/86 CML chronic phase patients who did not achieve optimal responses following the European Leukemia Net guidelines (ELN) (table 1). Patients with optimal responses and treated with the same standard doses were also analysed as a control group. Patients receiving doses above 400 mg showed throughout plasma levels considered as appropriate. In 7 of 16 patients (47.5%) not achieving optimal responses (ELN criteria), plasma levels were below the supposed therapeutic ranges. We have found no evidence for a correlation between clinical risk factors at diagnosis and the measurement of optimal plasma levels. Conclusions IM plasma levels are well correlated with IM dose administrated in the patients studied. In almost 50% of patients who did not achieve optimal responses, IM plasma levels were under the ranges considered therapeutic. Probably these are the patients who may benefit of a dose increase. Obviously, to learn more about the practical value of these measurements a longer follow up with a larger number of patients is needed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 60. Evaluation of Outcomes Associated with Intermittent Versus Extended Infusion of Piperacillin/tazobactam in Acutely Ill Veterans

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S50-S51
Author(s):  
Marianne Angeli Encarnacion ◽  
Ariel Ma ◽  
Scott T Johns
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Final Analysis ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Protocol Group ◽  
Elevated Liver Enzymes ◽  
The Impact ◽  
Extended Infusion

Abstract Background Antibiotic dosing optimization is a key principle of antimicrobial stewardship. This study evaluated the impact of an extended infusion piperacillin/tazobactam dosing protocol on clinical outcomes in acutely ill veterans treated for infections at VA San Diego. Methods This retrospective cohort study looked at veterans admitted to the medical-surgical unit who were treated with piperacillin/tazobactam for at least 48 hours. The control group included patients who received treatment between 12/14/2017 to 7/22/2018, and the “protocol” or after protocol implementation group included patients who received treatment between 7/23/2018 to 2/28/2019. Excluded from the study were veterans with microbiological cultures showing intermediate sensitivity or resistance to piperacillin/tazobactam, those who experienced interruption in therapy, or those who required dialysis. Primary clinical outcomes included in-hospital mortality rate, 30-day mortality rate, hospital length of stay (LOS), and 30-day readmission rates. Rates of adverse effects such as elevated liver enzymes, thrombocytopenia, acute kidney impairment (AKI), and Clostridium difficile infection were also collected. χ 2, Fisher’s exact, and Mann-Whitney U tests were used for statistical analysis. Results 260 veterans were included in the final analysis: 96% male, mean age 65 years, mean BMI 29, 84 met SIRS criteria for sepsis, and 55% received at least 48 hours of concomitant vancomycin. Groups had similar outcomes for median LOS, in-hospital mortality, and 30-day mortality. The incidence of AKI was significantly lower in the protocol group (39.2% vs. 56.9%, p=0.004), in veterans on concomitant vancomycin (42.3% vs. 63.2%, p=0.011), and in veterans with obesity (36.4% vs. 70.8%, p=0.001). Rates of liver enzyme elevation, thrombocytopenia, and C. difficile infection were lower in the protocol group though these were not significant. Conclusion There was a significantly lower rate of AKI with EI dosing which supports enhanced patient safety. This may be the preferred method of administration for obese patients and/or those receiving vancomycin concurrently. This is the first study to demonstrate that EI piperacillin/tazobactam dosing significantly reduces rates of AKI in patients on concomitant vancomycin. Disclosures All Authors: No reported disclosures

scholarly journals TAVR in Patients on Hemodialysis: Outcome of A High-Risk Patient Group

2020 ◽  
Vol 23 (5) ◽  
pp. E611-E616
Author(s):  
Hendrik Ruge ◽  
Marcus-André Deutsch ◽  
Magdalena Erlebach ◽  
Melchior Burri ◽  
Sabine Bleiziffer ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Survival ◽  
Hemodialysis Patients ◽  
Valve Prosthesis ◽  
Term Survival ◽  
Number Of Patients ◽  
Structural Valve Deterioration

Background: Perioperative mortality is high and long-term survival is poor for patients on hemodialysis undergoing surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) offers a safe and effective therapy for high-risk patients suffering from aortic valve stenosis. However, in patients on hemodialysis only limited information is available on the outcome following TAVR. Methods: Of the 2613 consecutive patients in our single-center TAVR registry, all hemodialysis patients, were identified. Demographics, procedural details, clinical outcomes, mortality, and complications were evaluated. Results: Forty-two hemodialysis patients with a mean age of 75.2±8.2 years, a mean STS predicted risk of mortality of 11.1±9.5% and a mean logEuroScore of 27.9±18.8% underwent TAVR. Mean duration on hemodialysis prior to intervention was 62.8±49.6 months. A transfemoral access was chosen in 24 patients, a transapical in 16, and a transaxillary and a transaortic in one patient, respectively. Estimated survival at 30 days, one, three and five years was 83.3%, 68.3%, 37.7% and 18.9%, respectively. Estimated median survival was 1.8±0.4 years. VARC-2 defined perioperative complications included stroke in 7.1% (3/42), major bleeding in 16.7% (7/42), and vascular complications in 7.1% (3/42). In two patients, echocardiographic examination at three and four years, respectively, showed evidence for structural valve deterioration. Conclusion: A high number of patients with ESRD undergoing TAVR require a non-transfemoral access. Predominantly, bleeding events contribute to the perioperative morbidity. An estimated median survival of less than two years after TAVR allows only limited assessment of valve prosthesis durability. Cardiovascular and non-cardiovascular mortality contribute equally to the causes of death beyond the first year after TAVR.

scholarly journals Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rui Zhang ◽  
Jiajun Lin ◽  
Fenyong Chen ◽  
Wenge Liu ◽  
Min Chen
Keyword(s):  
3D Printing ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Cochrane Library ◽  
Control Group ◽  
Total Hip ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Abstract Background This study investigates whether three-dimensional (3D) printing-assisted revision total hip/knee arthroplasty could improve its clinical and radiological outcomes and assess the depth and breadth of research conducted on 3D printing-assisted revision total hip and knee arthroplasty. Methods A literature search was carried out on PubMed, Web of Science, EMBASE, and the Cochrane Library. Only studies that investigated 3D printing-assisted revision total hip and knee arthroplasty were included. The author, publication year, study design, number of patients, patients’ age, the time of follow-up, surgery category, Coleman score, clinical outcomes measured, clinical outcomes conclusion, radiological outcomes measured, and radiological outcomes conclusion were extracted and analyzed. Results Ten articles were included in our review. Three articles investigated the outcome of revision total knee arthroplasty, and seven investigated the outcome of revision total hip arthroplasty. Two papers compared a 3D printing group with a control group, and the other eight reported 3D printing treatment outcomes alone. Nine articles investigated the clinical outcomes of total hip/knee arthroplasty, and eight studied the radiological outcomes of total hip/knee arthroplasty. Conclusion 3D printing is being introduced in revision total hip and knee arthroplasty. Current literature suggests satisfactory clinical and radiological outcomes could be obtained with the assistance of 3D printing. Further long-term follow-up studies are required, particularly focusing on cost-benefit analysis, resource availability, and, importantly, the durability and biomechanics of customized prostheses using 3D printing compared to traditional techniques.

A large prospective trial of children with unilateral retinoblastoma with and without histopathologic high-risk features and the role of adjuvant chemotherapy: A Children’s Oncology Group (COG) study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9515-9515 ◽  
Author(s):  
Murali M. Chintagumpala ◽  
Bryan Langholz ◽  
Ralph Eagle ◽  
Daniel Albert ◽  
Mohammed Javed Ali ◽  
...  
Keyword(s):  
Optic Nerve ◽  
High Risk ◽  
Prospective Trial ◽  
International Study ◽  
Excellent Outcome ◽  
Preliminary Results ◽  
Number Of Patients ◽  
Definition Of

9515 Background: The definition of histopathologic high-risk features (HRF) in enucleated eyes of children with unilateral retinoblastoma and their contribution to metastases is controversial. The COG completed a large, prospective international study to determine the prevalence of strictly defined histopathologic HRF that are predictors of recurrence and the role of chemotherapy to prevent recurrences. Methods: All patients who underwent enucleation for unilateral retinoblastoma were eligible for the study. Pathology slides were submitted for central review within 21 days of enucleation. Patients with evidence of one or more high-risk features (posterior uveal invasion grades IIC and D, concurrent optic nerve and choroid involvement and post-lamina optic nerve involvement) as determined by central review, received 6 cycles of chemotherapy consisting of carboplatin, vincristine and etoposide. All others were observed. All patients were followed for extraocular recurrences. Results: Patients were enrolled from February of 2005 until May 2010. As of July 2011, the median follow-up from enrollment was 1.9 years (max=5.3 years). Of 312 patients with central histopathology review, 49 patients had their risk classification changed (13% with no HRF had HRF, 24% with HRF had no HRF). Two patients developed extraocular disease and one patient died of unknown cause. The death and one of the extraocular relapses occurred among the 93 (2/93=2.2%, upper 95% CI 3.4%) patients assigned by the central review to receive chemotherapy, while one patient experienced extraocular relapse among the 209 (1/209=0.5%, upper 95% CI 0.6%) assigned to observation only. There is no evidence of a difference in the EFS and OS in these two groups. Conclusions: Preliminary results strongly suggest that a central review of pathology can spare a significant number of patients from exposure to chemotherapy. Chemotherapy may have contributed to fewer relapses in patients with high-risk features as defined in this study. The preliminary results from this study indicate an excellent outcome with this approach.

MALNUTRITION-INFLAMMATION-ATHEROSCLEROSIS (MIA) SYNDROME IN HEMODIALYSIS PATIENTS

2016 ◽  
pp. 99-104
Author(s):  
Thi Khanh Trang Ngo ◽  
Bui Bao Hoang
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
High Risk ◽  
Cardiovascular Events ◽  
Inflammatory Marker ◽  
Hemodialysis Patients ◽  
Dialysis Patients ◽  
Number Of Patients ◽  
The Relationship ◽  
Mia Syndrome

Background: Mortality resulting from cardiovascular disease in patients with end-stage renal disease (ESRD) is high. In this study we study characteristics of the malnutrition, inflammation, atherosclerosis (MIA) syndrome; relationship between MIA syndrome and the cardiovascular events in hemodialysis patients. Subjects and methods: A total of 61 hemodialysis patients were enrolled. Inflammatory marker (hs CRP) and nutritional parameters (albumin, prealbumin, BMI) were determined. Carotid atherosclerosis was investigated by ultrasonographically evaluated carotid intima-media thickness (cIMT). Results: -The characteristics of the malnutrition, inflammation, atherosclerosis(MIA) syndrome in in peritoneal dialysis patients: + MIA2-3 group had an average age lower than MIA0 group + MIA2-3 group had lower albumin levels and BMI than MIA0 group. + The prevalence of malnutrition (50.8%), inflammation (27.9%), and atherosclerosis (52.5%); 24 (39.3%) of the patients had one risk factor; 22 (36.1%) of the patients had two risk factors; 4 (6.6%) of the patients had all three risk factors. No signs of either malnutrition, inflammation or atherosclerosis were seen in 11 (18.0%) of patients. Note that a considerable number of patients with malnutrition (23/31 patients) had signs of inflammation or atherosclerosis or both; 12/32 patients with atherosclerosis had signs of inflammation or malnutrition or both. - The relationship between MIA syndrome and the cardiovascular events in peritoneal dialysis patients: We have found the relationship between component M (malnutrition) and the cardiovascular events in syndrome MIA (HR: 4.23 95% CI: 1.89-9.50). Our study suggests that high risk cardiovascular events in patients with 2 or more elements in MIA syndrome (HR: 2.40 95% CI: 1.16-5.00). Conclusion: We had demonstrated an association between malnutrition, inflammation and atherosclerosis; component M (malnutrition) and the cardiovascular events in hemodialysis patients; high risk cardiovascular events in patients with 2 or more elements in MIA syndrome. Key words: Malnutrition-inflammation-atherosclerosis syndrome, hemodialysis

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