scholarly journals Does the timing of surgery affect short-term prognosis in newborn infants with meningomyelocele?

2020 ◽  
Author(s):  
Mustafa Kurthan Mert ◽  
Ali İhsan Ökten
Keyword(s):  
Primary Repair ◽  
Newborn Infants ◽  
Early Surgery ◽  
Associated Anomalies ◽  
Short Term ◽  
Surgery Group ◽  
Number Of Patients ◽  
Csf Leakage ◽  
Antibiotic Duration ◽  
Average Size

Abstract Objective: To investigate the effect of postnatal primary repair surgery time on short-term (first 30 days) prognosis in neonates with meningomyelocele (MMC).Methods: The records of meningomyelocele patients treated at Adana City Training and Research Hospital between June 30, 2015 and August 1, 2019 were retrospectively reviewed. Demographic and clinical characteristics, surgical time, hospitalization and antibiotic duration, complications and associated anomalies were recorded.Results: Data of 41 patients were evaluated. The patients were divided into two groups according to the time of surgery. There were 18 patients in the early surgery (≤3 days) group and 23 patients in the late surgery (>3 days) group. There was no difference between groups in terms of birth weight, gestational week, head circumference, sex and type of delivery (p>0.05). The length of hospitalization was 17.2 ± 8.2 in the early surgery group and 24.8 ± 16.1 in the late surgery group (p>0.05). Antibiotic duration was 11.8 ± 7.6 in the early surgery group and 13.8 ± 10.1 in the late surgery group (p>0.05). There was no difference between the two groups between the average size of the MMC sac (5.4±1.1 vs 6.1±2.3, p>0.05). The number of patients with postoperative complications in early surgery group was 8 (44.4%) and in late surgery group was 7 (30.4%), and the number of patients reoperated in the first 30 days in early surgery group was 5 (27.7%) and in late surgery group was 6 (26.1%). The number of patients requiring ventriculoperitoneal shunt (VPS) was 9 (50%) in the early surgery group and 13 (56.5%) in the late surgery group. Surgical complications minor-major dehiscences, CSF leakage, local infection, meningitis and ventriculitis are not statistically different between the groups (p>0.05).Conclusion: Although postnatal early surgical intervention in MMC positively affects short-term outcomes, short-term prognosis is also determined by the presence of associated anomalies, VPS placement time, and rupture of the sac.

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

COMBINED IMMUNIZATION AGAINST DIPHTHERIA, TETANUS AND PERTUSSIS IN NEWBORN INFANTS

PEDIATRICS ◽  
1949 ◽  
Vol 3 (2) ◽  
pp. 181-194
Author(s):  
PAUL A. DI SANT'AGNESE
Keyword(s):  
Booster Dose ◽  
Newborn Infants ◽  
Active Immunization ◽  
Striking Difference ◽  
Tetanus Antitoxin ◽  
The Third ◽  
Number Of Patients ◽  
Diphtheria Antitoxin ◽  
Antibody Titers ◽  
One Year

Additional serologic studies are presented of a group of newborn infants whose antibody production following combined prophylactic inoculation against tetanus, diphtheria and pertussis was reported in a previous paper. Duration of Antibody Titers: In the 10 months following the last injection of triple combined antigen a steady decline in diphtheria antitoxin titers was observed which was more marked in patients who had achieved high antibody levels. A similar decrease was found in the percentage of infants with high titers of tetanus antitoxin, but there were no cases whose tetanus antitoxin level dropped to less than the "protective" titer (0.1 unit/cc.). Progressive decrease in diphtheria and tetanus antitoxin titers with passage of time is in agreement with findings of others. After the third and last immunizing injection, a rapid initial decrease was noted in the number of patients with "protective" pertussis agglutinin titers (1:400 or higher); then a levelling off took place and no further change was noted in the next six months. On the other hand, a steady decline was found in the percentage of infants with "high" agglutinin levels (1:3200). To our knowledge this has not been observed before. The young age of our patients at the time of the basic injections may have been responsible for the findings. Antibody Titers After Booster Dose: One group of infants was reinjected at the age of six months (four months after the third and last immunizing injection), another group at one year of age (10 months after the last injection). All booster doses consisted of 0.5 cc. of the same triple combined antigen used in basic immunization. After booster a marked increase was noted in diphtheria antitoxin titers to a level higher than that observed following the basic immunizing injections. Tetanus antitoxin response was considered to have been equally good, although more difficult to evaluate because of the high antitoxin levels present before reinjection. In the case of pertussis agglutinins, it appeared as if there were a "ceiling" of about 60% of infants who could, even after reinjection, develop a "protective" agglutinin titer (1:400 or higher). A striking difference was observed in both pertussis agglutinin levels and diphtheria antitoxin titers achieved by infants reinjected at six months and one year of age. This was thought to be due to immaturity of the immune mechanisms in the younger age group. An added factor in the case of diphtheria antitoxin in some patients may have been the persistence of passive antibodies acquired transplacentally. Antibody titers also were determined six months after booster dose in the infants who had been reinjected at the age of six months. A marked decrease was observed in the percentage of patients with "protective" pertussis agglutinin titers and "high" (1.0 unit/cc.) diphtheria antitoxin levels. No reduction was noted in tetanus antitoxin titers. Effects of Passive immunity to Diphtheria on Active immunization with Diphtheria Toxoid: With only one exception, all infants tested after a booster dose had been administered between 6 and 12 months of age had "protective" diphtheria antitoxin titers (0.03 units/cc. or more). Active immunization against diphtheria was therefore considered to have been achieved in all cases (with one exception) despite the passively transmitted antitoxin present at birth in over half the cases. While passive diphtheria antitoxin present at birth did not prevent "sensitization" of the antibody-forming tissues to the diphtheria antigen, it did decrease significantly the amounts of antitoxin actively produced in response to basic inoculation. Reasons for the success of active diphtheria immunization in this series are discussed. Arguments against active immunization of mothers in pregnancy for protection of their offspring are considered.

scholarly journals Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome?

2018 ◽  
Vol 100 (1) ◽  
pp. 26-32 ◽  
Author(s):  
L Ramage ◽  
C Yen ◽  
S Qiu ◽  
C Simillis ◽  
C Kontovounisios ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Short Form ◽  
Primary Repair ◽  
Obstetric Anal Sphincter Injury ◽  
Short Term ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.

ESTIMATION OF THE SAFETY OF LOW-INTENSITY LASER RADIATION IN TREATMENT OF PATIENTS WITH PROFESSIONAL POLYNEUROPATHIES OF THE UPPER LIMBS

2021 ◽  
Author(s):  
S.V. Grebenkov ◽  
◽  
N.Y. Malkova ◽  
O.A. Kochetova ◽  
Keyword(s):  
Laser Radiation ◽  
Side Effects ◽  
Upper Extremities ◽  
Projection Area ◽  
Outpatient Basis ◽  
Short Term ◽  
Low Intensity ◽  
Number Of Patients ◽  
Intensity Laser ◽  
Local Side

Abstract: The inclusion of low-intensity laser radiation in the complex treatment of professional polyneuropathies of the upper extremities, due to its numerous biological effects, contributes to a statistically significant reduction in pain in the hands of patients, and improves the conduction of nerve impulses along the peripheral nerves of the hands. In addition to describing the positive clinical and neurophysiological trends achieved during treatment, the issue of the safety of the developed therapy method is important. The aim of the study is to assess the safety of the proposed method of low-intensity laser therapy (LILT) in patients with professional polyneuropathies of the upper extremities. Material and methods: on the basis of the department of occupational pathology, 116 patients (60 men, 56 women) with occupational polyneuropathies of the upper extremities were treated using LILT. Therapeutic measures were carried out using a semiconductor laser apparatus for red spectrum radiation (650 nm) with fiber-optic light guides for percutaneous therapy "ALP-01-Laton" in the sitting position of patients. Diffuse scattered laser radiation of the red region of the spectrum with an energy illumination of 0.7-1.1 mW / cm2 directly affected the projection area of the exit of the median nerve from the carpal tunnel to the hand. There were 5-10 procedures per course, the energy exposure of laser radiation and the number of sessions were determined individually. Results: To ensure the safety of the therapy, patients were included in the study strictly in accordance with the developed inclusion and non-inclusion criteria. Patients were treated in a specially equipped room with the use of personal protective equipment; safety rules were followed during the operation of the device. During treatment, all 116 patients treated with LILT did not have systemic side effects. A number of patients developed short-term complaints associated with local reactions: short-term tingling sensations and "goose bumps" in the hands, warmth, slight burning sensation, etc. All recorded local side effects occurred directly during LILT-procedures and were completely stopped within 1-5 minutes after their completion. In general, LILT-exposure did not cause serious side effects and was well tolerated by patients. 13.5% of patients noted a decrease in pain in the arms directly during the LILT treatment procedures. Conclusion. The developed method of LILT of professional polyneuropathies of the upper extremities is simple and convenient for use in clinical practice: it is applicable both in a hospital and on an outpatient basis. LILT has a limited list of contraindications, and is generally well tolerated by patients with minimal local side effects.

scholarly journals Sensitivity and specificity of different imaging modalities in diagnosing necrotising enterocolitis in a Polish population of preterm infants: a diagnostic test accuracy study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e033519
Author(s):  
Joanna Seliga-Siwecka ◽  
Jakub Rutkowski ◽  
Wojciech Margas ◽  
Joanna Puskarz- Gąsowska ◽  
Renata Bokiniec
Keyword(s):  
Very Low Birth Weight ◽  
Clinical Symptoms ◽  
Newborn Infants ◽  
Pneumatosis Intestinalis ◽  
Abdominal Ultrasound ◽  
Necrotising Enterocolitis ◽  
Test Accuracy ◽  
Detection Rates ◽  
Vlbw Infants ◽  
Number Of Patients

IntroductionNecrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases ahead of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in diagnosing and managing NEC.Methods and analysisThe hypothesis being tested is that preforming an AR in patients with clinical symptoms of NEC, but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at <32 weeks. Additionally, the time needed to initiate treatment, according to decision made based on AR or AR and AUS will also be compared. The use of AUS together with AR as an add-on test may increase the accuracy of diagnosing NEC and expedite life-saving treatment. We plan to recruit 200 VLBW infants, who are most prone to NEC. It will also be the first multicentre study evaluating the use of AUS as an add-on test, enabling us to recruit a significantly higher number of patients compared with published studies.Ethics and disseminationThe Bioethical Committee of the Medical University of Warsaw has approved the study (KB 130/2017). We plan to submit our findings to international peer-reviewed journals. Abstract will be submitted to local and international conferences.Trial registration numberNCT03188380; Protocol version: V.2.08.2019; Pre-results.

scholarly journals 2033. A Systematic Review of Systematic Reviews: Procalcitonin in the ICU to Guide Antibiotic Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S683-S683
Author(s):  
Joshua York ◽  
Maithili Varadarajan ◽  
James Wilson ◽  
Gavin Barlow
Keyword(s):  
Antimicrobial Resistance ◽  
Systematic Reviews ◽  
A Priori ◽  
Study Groups ◽  
Health Crisis ◽  
Consistent Finding ◽  
Number Of Patients ◽  
Antibiotic Duration ◽  
Course Length ◽  
The Impact

Abstract Background Antimicrobial resistance is an emerging global health crisis with overall antimicrobial use a key contributor. Strategies to safely reduce antibiotic course length are important. Procalcitonin (PCT) is a serum biomarker produced in the presence of bacterial infection. There have been many systematic reviews (SRs) evaluating PCT in various populations but its use remains controversial. The aim of this SR of SRs was to evaluate the extent to which PCT in critical care (ICU) impacts antibiotic duration and other reported outcomes. Methods A systematic search of major databases using an “a priori” strategy and protocol was performed. SRs were included if one of the reported outcomes related to antibiotic duration or initiation in the ICU. Data were extracted by an author, checked and corrected independently by another author. The quality of SRs was assessed by 2 authors independently using AMSTAR II. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1). Results Figure 1 shows the PRISMA diagram. 19 SRs were included. The number of patients included ranged from 308 to 6,037 (median = 1,316) across SRs. Overall, there was a consistent finding of a statistically significant (sf) reduction in antibiotic duration in study groups using PCT cessation protocols (all studies in Table 1). 3 SRs did not contain suitable statistics for inclusion in Table 1. SRs that presented the antibiotic duration outcome as a mean or median difference in exposure days (N = 16) showed a median reduction of 2.10 days (range −1.19 to -5) with PCT use. 1 SR found an sf decrease in mortality with PCT use. 4 SRs included antibiotic initiation as an outcome: 2 found an sf decrease in antibiotic prescription rate with PCT; 2 found no difference. Conclusion SRs have found that PCT use in ICU leads to an sf reduction in antibiotic duration without impacting mortality. There are no data presented in the SRs about the impact of this on antimicrobial resistance. Few SRs detail the infections included; thus the applicability of these findings to a single ICU remains challenging. Other outcomes, such as length of stay, are not affected by PCT use in ICU. Disclosures All authors: No reported disclosures.

Clinical Development of Antidepressive Drugs - the Viewpoint of the Industry

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. de Bodinat ◽  
B. Delalleau
Keyword(s):  
Depressive Disorders ◽  
Rating Scale ◽  
Development Program ◽  
Placebo Response ◽  
Clinical Development ◽  
Short Term ◽  
Double Blind ◽  
Clinical Development Program ◽  
Term Efficacy ◽  
Number Of Patients

The clinical development program strategy of a new treatment of depression to be registered in Europe must be built in agreement with recommendations of the CHMP guidance.Demonstration that an antidepressant is effective in treatment of major depressive disorders requires consideration of specific recommendations notably regarding the use of placebo and reference drugs, efficacy assessment, designs features and safety aspects.In the field of depression, comparisons between test medicinal product and reference drugs are difficult to interpretate since the level of placebo response is high and variable. An adequate evaluation of antidepressant efficacy is firstly based on randomised double blind comparison versus placebo. For short term efficacy, studies with 6 week-treatment period are required and three arm trials including placebo and active control are recommended. Regarding the long term efficacy, relapse prevention study is the design recommended for demonstrating that the short term effect can be maintained over time.Assessment of efficacy criteria includes both clinical relevance and statisitical significance, particularly:Improvement expressed as difference between baseline and post-treatment score in symptomatology and as proportion of responders.Remission, defined as a condition where no or only few signs remained, with a justified cut-off on a validated rating-scale.In randomised withdrawal trials, efficacy is expressed as number of patients relapsing and/or time to relapse.The acceptable scales for use as primary endpoint include the HAM-D17 scale, the MADRS scale. Cautions regarding designs features, safety assessment and the global methodological issues faced in conducting such program will be detailed in the presentation.

Short-term outcome of newborn infants born by a modified procedure of cesarean section A prospective randomized study

1998 ◽  
Vol 77 (9) ◽  
pp. 929-931 ◽  
Author(s):  
Carlo Dani ◽  
MariaF. Reali ◽  
Rocco Oliveto ◽  
GianfrancoF. Temporin ◽  
Giovanna Bertini ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Randomized Study ◽  
Newborn Infants ◽  
Prospective Randomized Study ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

scholarly journals A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy

2020 ◽  
Author(s):  
Q. Z. Ruan ◽  
W. English ◽  
A. Hotouras ◽  
C. Bryant ◽  
F. Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Safe Procedure ◽  
Stapled Haemorrhoidopexy ◽  
Short Term ◽  
Period 2 ◽  
Number Of Patients ◽  
Study Characteristics ◽  
The Moment

Abstract Background Symptomatic haemorrhoids affect a large number of patients throughout the world. The aim of this systematic review was to compare the surgical outcomes of stapled haemorrhoidopexy (SH) versus open haemorrhoidectomy (OH) over a 20-year period. Methods Randomized controlled trials published between January 1998 and January 2019 were extracted from Pubmed using defined search criteria. Study characteristics and outcomes in the form of short-term and long-term complications of the two techniques were analyzed. Any changes in trend of outcomes over time were assessed by comparing article groups 1998–2008 and 2009–2019. Results Twenty-nine and 9 relevant articles were extracted for the 1998–2008 (period 1) and 2009–2019 (period 2) cohorts, respectively. Over the two time periods, SH was found to be a safe procedure, associated with statistically reduced operative time (in 13/21 studies during period 1 and in 3/8 studies during period 2), statistically less intraoperative bleeding (3/7 studies in period 1 and 1/1 study in period 2) and consistently less early postoperative pain on the visual analogue scale (12/15 studies in period 1 and 4/5 studies in period 2) resulting in shorter hospital stay (12/20 studies in period 1 and 2/2 studies in period 2) at the expense of a higher cost. In the longer term, although chronic pain in SH and OH patents is comparable, patient satisfaction with SH may decline with time and at 2-year follow-up OH appeared to be associated with greater patient satisfaction. Conclusions SH appears to be safe with potential advantages, at least in the short term, but the evidence is lacking at the moment to suggest its routine use in clinical practice.

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