scholarly journals Comparison of Survival Between Patients Receiving General Ambulatory Palliative Care and Patients Receiving Other Palliative Care - Analysis of Data of a Statutory Health Insurance Data

2021 ◽  
Author(s):  
Kilson Moon ◽  
Laura Rehner ◽  
Wolfgang Hoffmann ◽  
Neeltje van den Berg
Keyword(s):  
Palliative Care ◽  
Health Insurance ◽  
Median Survival ◽  
Statutory Health Insurance ◽  
Survival Curves ◽  
Specialized Care ◽  
Group A ◽  
One Year ◽  
Group B

Abstract Background The care of palliative patients takes place as non-specialized and specialized care, in both ambulatory and stationary settings. However, palliative care is largely provided as non-specialized care in the ambulatory sector (AAPV). This study aimed to investigate whether the survival curves of AAPV patients differed from those of the more intensive palliative care modalities and whether AAPV palliative care was appropriate in terms of timing.Methods The study is based on claims data from a large statutory health insurance. The analysis included 4,177 patients who received palliative care starting in 2015 and who were fully insured one year before and one year after palliative care or until death. The probability of survival was observed for 12 months. Patients were classified into group A, which consisted of patients who received palliative care only with AAPV, and group B including patients who received stationary or specialized ambulatory palliative care. Group A was further divided into two subgroups. Patients who received AAPV on only 1 day were assigned to Subgroup A1, and patients who received AAPV on two or more days were assigned to Subgroup A2. The survival analysis was carried out using Kaplan-Meier curves. The median survival times were compared with the log-rank test.Results The survival curves differed between groups A and B, except in the first quartile of the survival distribution. The median survival was significantly longer in group A (137 days, n=2,763) than in group B (47 days, n=1,424, p<0.0001) and shorter in group A1 (35 days, n=986) than in group A2 (217 days, n=1,767, p<0.0001). The survival rate during the 12-month follow-up was higher in group A (42%) than in group B (11%) and lower in group A1 (38%) than in group A2 (44%).Conclusions The results of the analysis revealed that patients who received the first palliative care shortly before death suspected insufficient care, especially patients who received AAPV for only 1 day and no further palliative care until death or 12-month follow-up. Palliative care should start as early as necessary and be continuous until the end of life.

One-year outcomes of the BeGraft stent graft used as chimney graft in conjunction with the Endurant device for the treatment of complex abdominal diseases

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Gergana T Taneva ◽  
Marco V Usai ◽  
Georgios A Pitoulias ◽  
Giovanni Torsello ◽  
Martin Austermann ◽  
...  
Keyword(s):  
Stent Graft ◽  
Subgroup Analysis ◽  
Primary Patency ◽  
Metal Stents ◽  
Type Ia ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Chimney Graft

Aim To evaluate the performance of two different flexible devices, the balloon-expandable BeGraft stent as on-label chEVAR use with the Endurant (Medtronic, Santa Rosa, USA) stent graft compared to the self-expandable off-label employment of Viabahn (Gore Flagstaff, Arizona, USA). Methods All patients treated for pararenal aortic pathologies between 2008 and 2017 using Endurant II (Medtronic, Santa Rosa, CA, USA) abdominal endograft in combination with Viabahn (Gore, Flagstaff, AZ, USA) or BeGraft (Bentley, Hechingen, Germany) at our institution were retrospectively analyzed. Patients were divided into two groups according to the employed chimney graft, namely Viabahn (group A) and BeGraft (group B). The primary endpoint was the incidence of type IA endoleak at one month and last follow-up. Secondary endpoints included reintervention rates, primary patency of the chimney graft, and need for additional placement of bare metal stents also known as relining. Results A total of 27 patients (mean age: 76 years) were treated with overall 47 chimney grafts. In particular, 11 patients received 21 Viabahn and 16 patients underwent placement of 26 BeGraft stents. Mean follow-up was 14.3 ± 9.0 months for group A and 13.0 ± 13.7 for group B, p = .451. The mean chimney graft length was 85.1 ± 38.9 mm for group A and 34.9 ± 9.8mm for group B ( p < .001). The oversizing rate at the proximal sealing zone was significantly higher in group B (Group A: 23.1 ± 16.5% vs. Group B: 33.6 ± 7.6%, p = .007). The primary patency rates were similar between groups ( p = .250). The subgroup analysis showed a significantly higher early (9–42.9% vs. 2–7.7%, p = .005) and at last CT follow-up (5–23.8% vs. 0–0.0%, p = .011) type IA endoleak, higher primary relining (14–66.7% vs. 5–19.2%, p = .001) and reintervention rates (5–23.8% vs. 0–0.0%; p = .011) for group A chimney stent grafts. Conclusions Both chEVAR combinations displayed similar patency rate, showing the BeGraft-Endurant composition less need for relining and fewer one-year type IA endoleak and reintervention rates in the subgroup analysis.

Patterns of Disease Relapse and Progression in Patients with Multiple Myeloma After First Line Therapy with Autologous Stem Cell Transplantation: Implications for Patient Monitoring After Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 825-825
Author(s):  
Dmitriy Zamarin ◽  
Manisha Bhutani ◽  
Danielle Chimento ◽  
Sergio Giralt ◽  
Nikoletta Lendvai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissue ◽  
First Line ◽  
Post Transplant ◽  
First Line Therapy ◽  
Line Therapy ◽  
Group A ◽  
One Year ◽  
Group B

Abstract Abstract 825 BACKGROUND: Autologous stem cell transplantation (ASCT) is a widely used therapeutic option in first line treatment of multiple myeloma (MM). However, many patients eventually relapse. While precise knowledge of relapse and progression (R/PD) patterns would be important to generate evidence based surveillance recommendations after ASCT, such data is limited in the literature, especially in the era following the introduction of the free light chain assay. The purpose of this study is to examine the patterns of post-ASCT relapse and to derive evidence based recommendations for optimal surveillance of patients. METHODS: We performed a retrospective analysis on 258 patients with MM who underwent ASCT within one year of diagnosis at MSKCC between 2000 and 2010, as part of first line therapy. We used the IMWG standard criteria for serologic and clinical R/PD. We first determined for all patients the date of serologic R/PD. Patients identified as having serologic R/PD were further examined to determine whether clinical (anemia, renal failure, hypercalcemia, development of soft tissue lesions), radiologic (skeletal survey) or urinary R/PD had anteceded serologic R/PD. Several groups of patients were derived and further analyzed in terms of relapse patterns and adequacy of follow up. RESULTS: Among 258 patients, 173 were determined to have serologic R/PD at a median of 19.2 months post-transplant. Among these patients, on the dates of their serologic R/PD, 17 (9.8%) had concurrent overt symptomatic evidence of clinical/radiologic R/PD (Group A symptomatic R/PD), while 156 (90.2%) were found to have isolated asymptomatic serologic R/PD without apparent evidence of concomitant clinical/radiologic R/PD (Group B asymptomatic R/PD). Group A included patients with distinct and sometimes coinciding clinical characteristics (poor risk cytogenetics with aggressive disease (n=3), leptomeningeal relapse (n=1), soft tissue relapse (n=4) and acute severe anemia at relapse (n=3)); patients with IgA gammopathy (n=5); and patients considered to have inadequate serologic follow up intervals (range of follow up interval between date of serologic R/PD and prior serologic testing 149 to 245 days) (n=6). Upon further examination of group B, 44 patients had radiologic imaging at the time of serologic R/PD (within 4 weeks following the date of serologic R/PD). Fourteen among them (32%) had evidence of new bone lesions. Among all 173 patients with serologic R/PD, 83 patients had a skeletal survey within one year prior to the date of serologic R/PD. Only 3 (3.6%) had evidence of radiologic R/PD anteceding serologic R/PD. All 3 patients were considered to have had inadequate serologic follow up interval (Range 208 to 252 days). Abnormal urine immunofixation (UIF) anteceded serologic R/PD in 5 out of 41 (12%) patients tested who had achieved CR post transplant. In these patients the abnormal UIF anteceded the serologic R/PD by a mean of 2.4 months. Abnormal UPEP anteceded serologic R/PD by 1.9 months in only 1 out of 40 (2.5%) patients tested who had achieved less than CR post transplant. CONCLUSIONS: Based on the results of this analysis, several conclusions can be drawn: 1) The vast majority of R/PD in patients with MM are asymptomatic R/PD detected first by serologic studies. A small percentage of patients (those with aggressive cytogenetics, specific relapse types including soft tissue, severe cytopenia, and IgA gammopathy) will have symptomatic R/PD with overt concomitant evidence of clinical and/or radiologic R/PD at the time of serologic R/PD; 2) Among patients who have apparent asymptomatic R/PD, a significant percentage will have evidence of skeletal lesions and therefore imaging should be recommended in these patients; 3) In the absence of serological R/PD, routine surveillance screening with yearly skeletal surveys cannot be recommended based on this analysis since this test was not useful in any of the analyzable patients in whom it was obtained; 4) Aside from few patients in CR whose relapse may be detected earlier by UIF (with probably no clinical benefit), all patients with multiple myeloma whose disease progresses will have serologic R/PD at the time of progression and follow up limited to serologic testing may well be sufficient for monitoring patients with MM post transplant. Disclosures: No relevant conflicts of interest to declare.

scholarly journals DORSAL WRIST GANGLION

2016 ◽  
Vol 23 (03) ◽  
pp. 246-250
Author(s):  
Yousaf Jan ◽  
Waqas Ahmad ◽  
Shaukat Hussain ◽  
Muhammad Shah ◽  
Ahmad Din
Keyword(s):  
Surgical Excision ◽  
Success Rates ◽  
Research Committee ◽  
Patients With Cancer ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Study Setting ◽  
Dorsal Wrist Ganglion

Objectives: To evaluate and compare the effect of aspiration plus methylprednisone injection versus surgical excision of the dorsal wrist ganglions in terms of resolution,complications and recurrence. Study Design: Prospective study. Setting: Surgical wardHayatabad Medical Complex, Peshawar. Period: June 2009 to December 2011. Methodology:After taking permission from ethical and research committee. Included patients were all adult ofboth gender with dorsal wrist ganglion. Patients with cancer, bleeding disorders and diabeteswere excluded from the study. The patients were divided in two groups: Group A includedpatients for aspiration and injection treatment, while Group B included patients underwentsurgical excision. All the patients were followed for complete resolution of ganglion, anycomplications of treatment and recurrence within one year. Follow up arranged at 7th day, 1,3, 6 and 12 months. Results: Total of 80 patients was included in the study. Out of 80, 65%(n=52) were females while 35% (n=28) were males. The mean age was 26.37±5.62 years.Group A and group B patients had overall success rates of 75% and 95%, with recurrence of25% and 5% in group A and group B respectively. In methylprednisolone group, mild pain wasreported by 70% (n=28), while in the surgical excision group, all the patients experienced mildto moderate pain postoperatively which necessitated oral analgesics for few days. Conclusion:Surgical excision is superior to injection-aspiration method for dorsal wrist ganglion treatmentbecause of high success and low recurrence rate. As injection-aspiration treatment

Outcome of Partial Nail Avulsion Followed by Matricectomy Either With Phenol (80-88%) or With Electro Cautery for Toenails

2021 ◽  
Vol 15 (8) ◽  
pp. 2043-2045
Author(s):  
Tahir Hamid ◽  
Muhammad Rizwan Qadir ◽  
Ahmad Raza Nsar ◽  
Rizwan Saleem ◽  
Abdur Rehman ◽  
...  
Keyword(s):  
Late Complications ◽  
Purulent Discharge ◽  
P Value ◽  
Serous Discharge ◽  
Group A ◽  
The Mean ◽  
One Year ◽  
Group B ◽  
Ingrown Toenails

Aim: To compare partial nail avulsion followed by matricectomy either with phenol (80-88%) or with electro cautery for Stage 2 & 3 ingrown toenails for early and late postoperative complications. Methods: This study was conducted at department of surgery Nawaz Sharif social security teaching hospital Lahore for one year from 01-01-2018 to 31-12-2018. One hundred patients full filling inclusion criteria were included in the study and divided into two equal groups A and B. Partial nail avulsion done in both groups followed by chemical matricectomy with phenol (80-88%) in group A and patients in group B matricectomy done with electrocautry. Results: The mean age in group A is 19.7± 8.08 years and in group B is 20.20± 6.9 years, both groups comparable p-value (0.74).In early post-operative complications in group A 17(34%) patients and 14(28%) patients in group B experienced mild pain p-value is (0.66). 6(12%) of group A patients and 6(12%) of group B patients experienced moderate pain p-value (01). 1(2%) of group A patient and 2(4%) of group B patients experienced severe pain p-value (01). 02(4%) patients of group A and 02(4%) patients of group B had serous discharge p-value(01). 1(2%) of group B patients have purulent discharge, however, no patients in group A patients have purulent discharge p-value (01). 1(2%) patients of group A and 2(4%) patients of group B had recurrence at three months follow up p-value (01). 2(4%) patients of group A and 4(8%) patients of group B had recurrence at six months follow up p-value (0.68). Conclusion: Partial nail avulsion followed by matricectomy either with Phenol 80-88% or with electrocautry are comparable in early and late complications. Keywords: Ingrown toenails, partial matricectomy

scholarly journals Pathological changes of liver one year later in CHB patients with negative HBV DNA

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Wu Shanshan ◽  
Du Xinfang ◽  
Yu Shuihong ◽  
Lai Kecong ◽  
Qi Jinjin ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Hepatitis B Surface Antigen ◽  
Hbv Dna ◽  
Hepatitis B E Antigen ◽  
Viral Therapy ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Anti Viral Therapy

Abstract Background In this study, we aim to determine the hepatic pathological changes in HBV DNA-negative chronic Hepatitis B (CHB) patients after 12-month antiviral therapy. Methods Blood routine indicators including platelet count (PLT) and white blood cell (WBC) were determined. The coagulation function was evaluated by determining the prothrombin time (PT) and prothrombin time activity (PTA), together with the HBV DNA quantification and alpha fetoprotein (AFP). The virology data included hepatitis B surface antigen (HBsAg)/antibodies against hepatitis B surface antigen (anti-HBs), hepatitis B e antigen (HBeAg)/antibodies against hepatitis B e antigen (anti-HBe) and antibodies against hepatitis B core antigen (anti-HBc) were tested. Pathological assay was performed to the liver puncture tissues. Based on the HBV DNA data in the 12-month follow-up of the cases that received anti-viral therapy during this time, the experimental group was divided into group A (HBV DNA negative at the baseline level, HBV DNA negative after 12 months, N = 79) and group B (HBV DNA negative at the baseline level, HBV DNA turning to be positive after 12 months, N = 13). Statistical analysis was performed on the each test index of the two groups. Results The inflammation grade of group A showed significant improvement after 12-month treatment (P < 0.05). The pathological inflammation grade of group B was increased after one year, and the liver function indices and the PTA (P < 0.05) levels were all increased. Pathological results indicated that the proportion of disease progression in group A was decreased after 12-month follow-up while that proportion was increased in group B. Significant differences were noticed in AFP levels between the patients with progression in group A and those with progression in group B. Conclusion Negative HBV DNA does not mean a controlled hepatitis B. Hepatitis B patients transferred to HBV DNA positivity during the anti-viral therapy are easily to show disease progression, and then special attention should be paid to the HBV DNA monitoring. Meanwhile, close monitoring to the changes of liver function, PTA and AFP levels may help to detect changes on the disease in a timely manner.

scholarly journals LASIK-induced Corneal Changes after Correction of Hyperopia with and without Application of Mitomycin-C

2019 ◽  
Author(s):  
Ehab M. Moawad ◽  
Ahmed A. Abd Elghany ◽  
Amr A. Gab-Alla ◽  
Osama M. Elbassiouny ◽  
Mohsen S. Badawy
Keyword(s):  
Mitomycin C ◽  
Clinical Trial Registry ◽  
Uncorrected Distance Visual Acuity ◽  
Group A ◽  
Randomized Control ◽  
One Year ◽  
Group B ◽  
Control Study

Abstract Background The study aimed to assess the role of intraoperative mitomycin-C (MMC) application during hyperopic LASIK correction (+1.00 D to +6.00 D) by examining topographic corneal changes and incidence of regression over a one-year follow-up period. Methods This comparative randomized control study included 136 eyes of 68 hyperopic patients divided into two groups; Group A included 68 eyes of 34 patients that had LASIK with the application of 0.02% MMC for 10 seconds on the stromal bed after excimer laser treatment, and group B included 68 eyes of 34 patients that had LASIK without MMC application. Uncorrected distance visual acuity (UDVA), refraction, keratometry and topography were recorded at 1st week and 1st, 3rd, 6th, and 12th months postoperation. Predictability and treatment efficacy were also recorded at the end of the follow-up period. Results Better predictability was noted in group A than in group B at the 6 month and 12 month follow-up visits, with a mean cycloplegic refraction SE of +0.5 ± 0.31 D in group A and +0.67 ± 0.39 D in group B at the 6 month visit, and +0.63 ± 0.37 D in group A and +0.89 ± 0.48 D in group B at the 12 month visit. The efficacy of the treatment at the end of the follow up period was better in group A than in group B. Group A showed fewer topographic corneal changes than group B. Conclusions Intraoperative MMC application during hyperopic LASIK achieves better predictability and efficacy and induces fewer topographic changes and lower regression rate of hyperopia during the first postoperative year. Trial registration: the Pan African Clinical Trial Registry PACTR201901543722087, on 29 January 2019.

Prognosis of new-onset of atrial fibrillation in acute coronary syndrome: Portuguese experience

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Santos ◽  
M Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mortality Rates ◽  
The Other ◽  
Coronary Syndrome ◽  
Group A ◽  
One Year ◽  
Group B ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term. Objective Evaluate the impact and prognosis of new-onset AF in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up. Results 9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p &lt; 0.001) and left ventricular ejection fraction (LVEF) &gt;50% (69.2 vs 45.1%, p &lt; 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p &lt; 0.001), female (26.9 vs 34.0%, p &lt; 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p &lt; 0.001), Killip-Kimball classification &gt; I (12.8 vs 34.8%, p &lt; 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p &lt; 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p &lt; 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p &lt; 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p &lt; 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p &lt; 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515. Conclusions New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

2019 ◽  
Vol 34 (9) ◽  
pp. 604-610
Author(s):  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Maria Grazia Sibilla ◽  
Diana Neuhardt ◽  
Elisa Maietti ◽  
...  
Keyword(s):  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
Significant Difference ◽  
Effective Option ◽  
Procedural Time ◽  
Group A ◽  
One Year ◽  
Group B

Objectives Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) ( P= ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes ( p<0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) ( p<0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk.

scholarly journals Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 160
Author(s):  
Boris Wittekindt ◽  
Nora Doberschuetz ◽  
Andrea Schmedding ◽  
Till-Martin Theilen ◽  
Rolf Schloesser ◽  
...  
Keyword(s):  
Health Insurance ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Routine Data ◽  
Outcome Data ◽  
Insurance Fund ◽  
Clinical Registries ◽  
Specialized Care ◽  
One Year

Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail.

scholarly journals LASIK-induced Corneal Changes after Correction of Hyperopia with and without Application of Mitomycin-C

2019 ◽  
Author(s):  
Ehab M. Moawad ◽  
Ahmed A. Abd Elghany ◽  
Amr A. Gab-Alla ◽  
Osama M. Elbassiouny ◽  
Mohsen S. Badawy
Keyword(s):  
Mitomycin C ◽  
Clinical Trial Registry ◽  
Uncorrected Distance Visual Acuity ◽  
Group A ◽  
Randomized Control ◽  
One Year ◽  
Group B ◽  
Control Study

Abstract Background The study aimed to assess the role of intraoperative mitomycin-C (MMC) application during hyperopic LASIK correction (+1.00 D to +6.00 D) by examining topographic corneal changes and incidence of regression over a one-year follow-up period. Methods This comparative randomized control study included 136 eyes of 68 hyperopic patients divided into two groups; Group A included 68 eyes of 34 patients that had LASIK with the application of 0.02% MMC for 10 seconds on the stromal bed after excimer laser treatment, and group B included 68 eyes of 34 patients that had LASIK without MMC application. Uncorrected distance visual acuity (UDVA), refraction, keratometry and topography were recorded at 1st week and 1st, 3rd, 6th, and 12th months postoperation. Predictability and treatment efficacy were also recorded at the end of the follow-up period. Results Better predictability was noted in group A than in group B at the 6 month and 12 month follow-up visits, with a mean cycloplegic refraction SE of +0.5 ± 0.31 D in group A and +0.67 ± 0.39 D in group B at the 6 month visit, and +0.63 ± 0.37 D in group A and +0.89 ± 0.48 D in group B at the 12 month visit. The efficacy of the treatment at the end of the follow up period was better in group A than in group B. Group A showed fewer topographic corneal changes than group B. Conclusions Intraoperative MMC application during hyperopic LASIK achieves better predictability and efficacy and induces fewer topographic changes and lower regression rate of hyperopia during the first postoperative year. Trial registration: the Pan African Clinical Trial Registry PACTR201901543722087, on 29 January 2019.

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