scholarly journals Effect of intraoperative goal-directed balanced crystalloid versus colloid administration on postoperative maximum NT-proBNP concentration in patients undergoing noncardiac surgery

2020 ◽  
Author(s):  
Christian Reiterer ◽  
Barbara Kabon ◽  
Alexander Taschner ◽  
Oliver Zotti ◽  
Andrea Kurz ◽  
...  
Keyword(s):  
Troponin T ◽  
Fluid Management ◽  
Wall Stress ◽  
Study Groups ◽  
Cardiovascular Complications ◽  
Secondary Outcome ◽  
Myocardial Wall ◽  
Significant Difference ◽  
Crystalloid Administration ◽  
To Receive

Abstract Background: N-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T are released during myocardial wall stress and/or ischemia and are strong predictors for postoperative cardiovascular complications. However, the effect of goal-directed crystalloid versus colloid administration on NT-proBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high risk abdominal surgery, still remains unclear. Thus, we evaluated in this sub-study the effect of a goal-directed crystalloid versus a goal-directed colloid fluid regimen on postoperative maximum NT-proBNP concentration. We further evaluated the incidence of MINS between both study groups. Methods: 30 patients were randomly assigned to receive additional intravenous fluid boluses of 6% hydroxyethyl starch 130/0.4 and 30 patients to receive lactated Ringer´s solution. Intraoperative fluid management was guided by oesophageal Doppler-according to a previously published algorithm. The primary outcome were differences in postoperative maximum NT-proBNP (maxNT-proBNP) between both groups. As our secondary outcome we evaluated the incidence of MINS between both study groups. We defined maxNT-proBNP as the maximum value measured within 2 hours after surgery and on the first and second postoperative day. Results: In total 56 patients were analysed. There was no significant difference in postoperative maximum NT-proBNP between the colloid group (258.7 ng/L (IQR 199.4 to 782.1)) and the crystalloid group (440.3 ng/L (IQR 177.9 to 691.2)) during the first 2 postoperative days (P = 0.29). 5 patients in the colloid group and 7 patients in the crystalloid group developed MINS (P = 0.75).Conclusions: Based on this relatively small study goal-directed colloid administration did not decrease postoperative maxNT-proBNP concentration as compared to goal-directed crystalloid administration. Trial registration: ClinicalTrials.gov (NCT01195883)

scholarly journals Effect of Intraoperative Goal-directed Balanced Crystalloid versus Colloid Administration on Postoperative Cardiac Outcome

2020 ◽  
Author(s):  
Christian Reiterer ◽  
Barbara Kabon ◽  
Alexander Taschner ◽  
Oliver Zotti ◽  
Andrea Kurz ◽  
...  
Keyword(s):  
Troponin T ◽  
Fluid Management ◽  
Wall Stress ◽  
Study Groups ◽  
Cardiovascular Complications ◽  
Secondary Outcome ◽  
Myocardial Wall ◽  
Significant Difference ◽  
Cardiac Outcome ◽  
To Receive

Abstract Background: N-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T are released during myocardial wall stress and/or ischemia and are strong predictors for postoperative cardiovascular complications. However, the effect of goal-directed crystalloid versus colloid administration on NT-proBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high risk abdominal surgery, still remains unclear. Thus, we evaluated in this sub-study the effect of a goal-directed crystalloid versus a goal-directed colloid fluid regimen on postoperative maximum NT-proBNP concentration. We further evaluated the incidence of MINS between both study groups. Methods: 30 patients were randomly assigned to receive additional fluid boluses of 6% hydroxyethyl starch 130/0.4 and 30 patients to receive lactated Ringer´s solution. Intraoperative fluid management was guided by oesophageal Doppler-according to a previously published algorithm. The primary outcome were differences in postoperative maximum NT-proBNP (maxNT-proBNP) between both groups. As our secondary outcome we evaluated the incidence of MINS between both study groups. We defined maxNT-proBNP as the maximum value measured within 2 hours after surgery and on the first and second postoperative day. Results: In total 56 patients were analysed. There was no significant difference in postoperative maximum NT-proBNP between the colloid group (258.7 ng/L (IQR 199.4 to 782.1)) and the crystalloid group (440.3 ng/L (IQR 177.9 to 691.2)) during the first 2 postoperative days (P = 0.29). 5 patients in the colloid group and 7 patients in the crystalloid group developed MINS (P = 0.75).Conclusions: Based on this relatively small study goal-directed colloid administration did not decrease postoperative maxNT-proBNP concentration as compared to goal-directed crystalloid administration. Nevertheless, there was a tendency of lower postoperative maximum NT-proBNP concentrations in patients receiving colloids.Trial registration: ClinicalTrials.gov (NCT01195883)

scholarly journals Effect of Intraoperative Goal-directed Balanced Crystalloid versus Colloid Administration on Postoperative Cardiac Outcome

2020 ◽  
Author(s):  
Christian Reiterer ◽  
Barbara Kabon ◽  
Alexander Taschner ◽  
Oliver Zotti ◽  
Andrea Kurz ◽  
...  
Keyword(s):  
Troponin T ◽  
Fluid Management ◽  
Wall Stress ◽  
Study Groups ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Myocardial Wall ◽  
Significant Difference ◽  
Cardiac Outcome ◽  
To Receive

Abstract Background : N-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T are released during myocardial wall stress and/or ischemia and are strong predictors for postoperative cardiovascular complications. However, the effect of goal-directed crystalloid versus colloid administration on NT-proBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high risk abdominal surgery, still remains unclear. Thus, we evaluated in this subanalysis the effect of a goal-directed crystalloid versus a goal-directed colloid fluid regimen on postoperative cardiac outcome. Methods: 30 patients were randomly assigned to receive additional fluid boluses of 6% hydroxyethyl starch 130/0.4 and 30 patients to receive lactated Ringer´s solution. Intraoperative fluid management was guided by oesophageal Doppler according to a previously published algorithm. The primary outcome were differences of maximum NT-proBNP (maxNT-proBNP) and maximum troponin T (maxTnT) concentrations during the first two postoperative days between both study groups. We defined maxNT-proBNP and maxTnT as maximum values measured 2 hours after surgery and on the first and second postoperative day. Results: In total 56 patients were analysed. There was no significant difference in postoperative maximum NT-proBNP between the colloid group (258.7 ng/L (IQR 199.4 to 782.1)) and the crystalloid group (440.3 ng/L (IQR 177.9 to 691.2)) during the first 2 postoperative days ( P = 0.29). 5 patients in the colloid group and 7 patients in the crystalloid group developed MINS ( P = 0.75). Conclusions: Postoperative cardiac outcome as defined by cardiac biomarkers was not significantly affected by goal-directed colloid administration; however, there was a tendency of lower maximum NT-proBNP concentrations in patients receiving colloids. Trial registration: ClinicalTrials.gov (NCT01195883)

scholarly journals Implant Stability Changes for a Single Implant Mandibular Overdenture

2021 ◽  
Author(s):  
Karim Fouda ◽  
Ahmed Fahmy ◽  
Khaled Aziz ◽  
Marwa Abdel Aal ◽  
Amr Naguib ◽  
...  
Keyword(s):  
Study Groups ◽  
First Year ◽  
Implant Stability ◽  
Edentulous Mandible ◽  
Significant Difference ◽  
Edentulous Patients ◽  
Mandibular Overdenture ◽  
To Receive ◽  
Single Implant

Abstract Objectives To compare the changes in implant stability for the nonsubmerged and submerged protocols for a single-implant retained mandibular overdenture using Cendres and Metaux Locator attachment throughout a 24-month follow-up. Materials and Methods Eighty edentulous patients who were seeking to install a single implant in the midline of the completely edentulous mandible. At the day of implant installation, patients were randomized into two groups using sealed envelopes: the nonsubmerged and submerged groups. After 3 months of healing period, randomization using sealed envelopes was performed and patients were randomized to receive the Cendres and Metaux Locator attachment. The periotest readings were recorded using the Periotest M device, every 3 months for the first year and annually in the second year. The scope of this clinical trial focused only on results of the Cendres and Metaux attachment. Statistical Analysis The Mann–Whitney U-test was used for comparison between study groups for independent samples. Two-sided p-values less than 0.05 were considered statistically significant. Results There was no statistically significant difference between the mean periotest readings of both groups throughout the 24-month follow-up. Both groups showed an improvement in mean periotest readings with the submerged group tending to show greater stability at 6, 12, and 24-month follow-ups. Conclusions The nonsubmerged and the submerged healing protocols resulted in reliable periotest readings with the submerged group showing greater improvement than the nonsubmerged, although this improvement is nonsignificant when using the Cendres and Metaux attachment for a single mandibular overdenture.

scholarly journals Systemic Antibiotics Versus Topical Treatments for Chronic Discharging Ears with Underlying Eardrum Perforations

1970 ◽  
Vol 19 (2) ◽  
pp. 86-90
Author(s):  
SHIA Masum ◽  
MAY Fakir
Keyword(s):  
Otitis Media ◽  
Combined Therapy ◽  
Study Groups ◽  
Behavioural Problem ◽  
Chronic Suppurative Otitis Media ◽  
Secondary Outcome ◽  
Suppurative Otitis Media ◽  
Topical Antibiotics ◽  
Significant Difference ◽  
Systemic Antibiotics

Context: Chronic suppurative otitis media (CSOM) is a common cause of preventable hearing impairment worldwide, particularly in low and middle-income countries. Untreated CSOM may result in permanent hearing loss, which in turn, may result in speech and language delays or permanent learning disabilities, as well as behavioural problem. Of the treatment options, the efficacy of using only topical antibiotics and combination of systemic antibiotics and topical antibiotics are most disputable. The present study was undertaken to investigate the role of adjuvant systemic antibiotics in the treatment CSOM. Methods: A randomized clinical trial was carried out on children with chronic suppurative otitis media at the ENT outpatient department of Dhaka Shishu Hospital from January to December 2009. Any patient presenting with a stage of ear disease in which there is chronic infection of the middle ear cleft, a non-intact tympanic membrane and a history of discharge for at least two weeks was considered as a case. A total of 112 cases of chronic suppurative otitis media were consecutively enrolled in the study. Of them, 72 completed 3rd follow up visit and hence, considered evaluable. Results: The results of the study demonstrated that the study groups were almost identical in terms of age, sex, socioeconomic class and residence. The peak age incidence of chronic suppurative otitis media was found between 4-6 years (around 75%). In both the groups, the patients were predominantly male, belonged to poor and lower middle class families and slum dwellers. No significant difference was observed between the study groups in terms of primary and secondary outcome as well as the complications encountered by the patients. Patients of who received combined therapy, 70% of them showed resolution of otorrhoea by 2 weeks and 95% by 3 weeks, which in the patients of topical antibiotics alone was 50% and 87.5% respectively. The trial did not show any adverse event except tinnitus complained by a few patients in both groups. Conclusion: Topical quinolone antibiotics (ciprofloxacin) are equally effective as topical plus oral antibiotics (ciprofloxacin) for resolution of otorrhoea from uncomplicated CSOM. However, for faster resolution of otorrhoea, a short course systemic antibiotic can be added. Key words: Chronic suppurative otitis media (CSOM); topical antibiotics; topical plus systemic antibiotics; primary outcome; secondary outcome. DOI: 10.3329/jdmc.v19i2.7075J Dhaka Med Coll. 2010; 19(2) : 86-90

COMPARISON OF TWO THICK SHELL MODELS PERFORMANCE IN NONINVASIVE EVALUATION OF MYOCARDIAL WALL STRESS

2021 ◽  
pp. 2150056
Author(s):  
MOHAMMAD JAVAD KHOSRAVANIPOUR ◽  
MANIJHE MOKHTARI-DIZAJI ◽  
FARSHID FARHAN ◽  
ROYA SATTARZADEH-BADKOUBEH
Keyword(s):  
Coronary Artery ◽  
Discriminant Analysis ◽  
Interventricular Septum ◽  
Wall Stress ◽  
Proximal Part ◽  
Severe Stenosis ◽  
Diastolic Phase ◽  
Myocardial Wall ◽  
Specificity And Sensitivity ◽  
Significant Difference

Coronary artery stenosis is the most common heart disease, leading to altered myocardial mechanics. This study aimed to compare Ghista–Sandler and Mirsky wall stress models and evaluate the discriminant analysis of noninvasive wall stress based on these models. 59 Coronary artery disease (CAD) patients were divided into two groups; moderate stenosis and severe stenosis in the left anterior descending artery proximal part were enrolled in this study. The wall stress in the end-systolic and end-diastolic phases at LV anterior and interventricular septum wall segments calculated by using the equation proposed by Ghista–Sandler and Mirsky. The specificity and sensitivity of wall stress at groups were calculated by Ghista–Sandler and Mirsky models. The wall thickness and principal radius of segments in healthy subjects and patients with severe and moderate stenosis were shown statistically differences in some segments of anterior and septum walls ([Formula: see text]). Statistical analysis showed that calculated stresses in myocardial wall segments of patients with severe and moderate coronary stenosis and healthy people had a significant difference in systole and diastolic phase. Results of the discriminant analysis showed the specificity value obtained by the Ghista–Sandler model were higher in most wall stress combinations than the Mirsky model. Sensitivity in identifying patients with severe stenosis was higher in the Ghista–Sandler model. It is concluded that specificity and sensitivity based on wall stresses calculated by the Ghista–Sandler model were higher in comparison with the Mirsky model. The Ghista–Sandler model has better performance than the Mirsky model in diagnosing patients with stenosis.

Pengaruh Penggunaan Model Pembelajaran dan Konsep Diri terhadap Kemampuan Berpikir Kretif Mahasiswa

2015 ◽  
Vol 3 (3) ◽  
Author(s):  
Nurul Hikmah
Keyword(s):  
Significant Interaction ◽  
Creative Thinking ◽  
Study Groups ◽  
Learning Model ◽  
Descriptive Statistics ◽  
Self Concept ◽  
Significant Interaction Effect ◽  
Significant Difference ◽  
Written Test ◽  
Self Learning

<p>The purpose of this study were to determine: 1) the influence of the learning <br />model of creative thinking; 2) the influence of self-concept to think creatively, and 3) the influence of the interaction and the concept of self-learning model for creative thinking. The research method used was experimental method. A sample of 80 people selected at random from the 13 study groups. The data was collected by administering a written test questions to measure variables studied. Data analysis using descriptive statistics and 2-way ANOVA. The results showed: 1) a significant difference to the learning model with the ability to think creatively sig = 0.000; 2) there is a significant effect of self-concept of <br />the ability to think creatively with sig = 0.000, and 3) there is a significant interaction effect of learning model and self-concept of the ability to think creatively with sig = 0.018. </p>

The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy – The Piece of a Much Larger Puzzle

2020 ◽  
Vol 18 ◽  
Author(s):  
Agnieszka Dębska-Kozłowska ◽  
Izabela Warchoł ◽  
Marcin Książczyk ◽  
Andrzej Lubiński
Keyword(s):  
Renal Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Resynchronisation Therapy ◽  
Study Groups ◽  
Creatinine Concentration ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Background: Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of heart failure (HF) patients, the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. Objectives: The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. Materials and methods: The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to New York Heart Association (NYHA) class improvement ≥1. Results: A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 μmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 μmol/l) as well as GFR CKD-EPI (63 ml/min/1.73m2 ) were empirically evaluated to predict favourable therapeutic CRT response. Conclusions: Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT were found relevant.

Success Rate of Obturation of Root Canals by Different Techniques in Primary Molars: A Comparative Clinical Study

2020 ◽  
Vol 2 (1) ◽  
pp. 36-44
Author(s):  
Satyawan G. Damle ◽  
Ritika Bansal ◽  
Dhanashree D. Sakhare
Keyword(s):  
Success Rate ◽  
Study Groups ◽  
Primary Molars ◽  
Control Group ◽  
Second Primary ◽  
Chi Square ◽  
Exact Test ◽  
Root Canals ◽  
Significant Difference ◽  
Comparative Clinical Study

Objective: To compare the success rate of different obturation procedures in primary mandibular second molars clinically and also by digital radiovisiography. Methods: A total of 40 children aged between 4-8 years with deeply carious mandibular second primary molars indicated for single session pulpectomy were selected. Canals were obturated with Metapex. The 3 study groups (Endodontic plugger, Handheld lentulospiral, Navi Tip syringe) were compared with the control group (reamer) both clinically and radiovisiographically. The data collected were statistically analyzed using Pearson’s Chi-square and Fisher’s exact test. Results: The use of Navi tip syringe led to the least number of voids followed by Endodontic plugger and Reamer and the highest number of voids was reported with Lentulospiral. Navitip presented maximum number of optimally filled cases followed by Endodontic plugger and Lentulospiral and least number of optimally filled cases with reamer. However, there was no statistically significant difference (p>0.05) in any of the groups with clinical (pain and tenderness to percussion) and radiographic parameters (presence or absence of voids and length of obturation). Conclusion: Within the limitations of the present study, though the clinical outcome was statistically insignificant, Navitip syringe exhibited encouraging results and is a promising option for obturation in primary teeth.

scholarly journals Comparison of leucocyte profiles between healthy children and those with asymptomatic and symptomatic Plasmodium falciparum infections

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Diana Ahu Prah ◽  
Linda Eva Amoah ◽  
Matthew P. Gibbins ◽  
Yaw Bediako ◽  
Aubrey J. Cunnington ◽  
...  
Keyword(s):  
T Cells ◽  
Plasmodium Falciparum ◽  
Peripheral Blood ◽  
Parasite Load ◽  
Study Groups ◽  
Healthy Children ◽  
Peripheral Cell ◽  
Peripheral Blood Leucocyte ◽  
Cell Counts ◽  
Significant Difference

Abstract Background The immune mechanisms that determine whether a Plasmodium falciparum infection would be symptomatic or asymptomatic are not fully understood. Several studies have been carried out to characterize the associations between disease outcomes and leucocyte numbers. However, the majority of these studies have been conducted in adults with acute uncomplicated malaria, despite children being the most vulnerable group. Methods Peripheral blood leucocyte subpopulations were characterized in children with acute uncomplicated (symptomatic; n = 25) or asymptomatic (n = 67) P. falciparum malaria, as well as malaria-free (uninfected) children (n = 16) from Obom, a sub-district of Accra, Ghana. Leucocyte subpopulations were enumerated by flow cytometry and correlated with two measures of parasite load: (a) plasma levels of P. falciparum histidine-rich protein 2 (PfHRP2) as a proxy for parasite biomass and (b) peripheral blood parasite densities determined by microscopy. Results In children with symptomatic P. falciparum infections, the proportions and absolute cell counts of total (CD3 +) T cells, CD4 + T cells, CD8 + T cells, CD19 + B cells and CD11c + dendritic cells (DCs) were significantly lower as compared to asymptomatic P. falciparum-infected and uninfected children. Notably, CD15 + neutrophil proportions and cell counts were significantly increased in symptomatic children. There was no significant difference in the proportions and absolute counts of CD14 + monocytes amongst the three study groups. As expected, measures of parasite load were significantly higher in symptomatic cases. Remarkably, PfHRP2 levels and parasite densities negatively correlated with both the proportions and absolute numbers of peripheral leucocyte subsets: CD3 + T, CD4 + T, CD8 + T, CD19 + B, CD56 + NK, γδ + T and CD11c + cells. In contrast, both PfHRP2 levels and parasite densities positively correlated with the proportions and absolute numbers of CD15 + cells. Conclusions Symptomatic P. falciparum infection is correlated with an increase in the levels of peripheral blood neutrophils, indicating a role for this cell type in disease pathogenesis. Parasite load is a key determinant of peripheral cell numbers during malaria infections.

scholarly journals Comparative Study of Intralesional Dexamethasone Plus Hyaluronidase & Oral Colchicine in Patients with Oral Submucous Fibrosis

2018 ◽  
Vol 14 (2) ◽  
pp. 60-65
Author(s):  
Ganesh Prasad Neupane ◽  
Maya Rai ◽  
R. S. Rathore ◽  
V. K. Bhargava ◽  
A. K. Mahat ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Oral Mucosa ◽  
Oral Submucous Fibrosis ◽  
Mouth Opening ◽  
Study Groups ◽  
T Test ◽  
Significant Difference ◽  
Intralesional Injections ◽  
Submucous Fibrosis ◽  
Larger Sample

Introduction: Oral Submucous Fibrosis (OSMF) is a precancerous condition of the oral mucosa. It is characterized by excessive production of collagen leading to inelasticity of the oral mucosa and atrophic changes of the epithelium.Aim and objective: To evaluate the efficacy of oral Colchicine in comparison to intralesional injections of Dexamethasone plus Hyaluronidase in the management of OSMF patients.Materials and Methods: Fourty patients with OSMF were randomly divided equally into two groups. 20 patients in Dexamethasone group received biweekly intralesional injections of Dexamethasone (4mg/ml) plus Hyaluronidase 1500 IU in buccal mucosa for a period of 12 weeks. Other 20 patients in Colchicine group received oral Colchicine 0.5 mg tablets twice daily for 12 weeks. Parameters taken in the study were burning sensation, and mouth opening. Descriptive statistics, paired t test and unpaired t test were used for statistical analysis.Results and Conclusions: The pre- and post-treatment differences were found to be statistically significant for both the groups (p<0.001) and for both the treatment outcomes. When the average difference of the treatment outcomes was compared between the two study groups, statistically highly significant difference was noted (p <0.001) only in mouth opening but not in burning sensation.These encouraging results should prompt further clinical trials with Colchicine on a larger sample size to broaden the therapeutic usefulness of the drug in the management of OSMF. JNGMC,  Vol. 14 No. 2 December 2016, Page: 60-65

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