scholarly journals Aplicação retrospectiva dos escores KDPI e EPTS em pacientes de um Centro de Transplantes Brasileiro / Retrospective application of the KDPI and EPTS scores in patients from a Brazilian Transplant Center

2020 ◽  
Vol 65 (1) ◽  
pp. 1
Author(s):  
Luana Costa de Aguiar ◽  
Bruma Baptista ◽  
Arthur Ferraz Jong Mun Lee ◽  
Filipe Bissoli ◽  
Vinícius Bortoloti Péterle ◽  
...  
Keyword(s):  
Loss Rate ◽  
Graft Loss ◽  
The United States ◽  
Kidney Transplants ◽  
The North ◽  
Kidney Recipients ◽  
Transplant Center ◽  
Deceased Donors ◽  
One Year

Introdução: KDPI e EPTS são escores implantados nos Estados Unidos em 2014 para guiar a alocação de enxertos renais. O objetivo deste trabalho é correlacionar valores desses escores com desfechos dos transplantes renais realizados em um Centro de Transplantes brasileiro, avaliando sua capacidade de predizer prognóstico nesta população. Métodos: Estudo observacional, individuado, longitudinal e retrospectivo com 163 pares receptor-doador de transplantes renais com doadores falecidos, realizados entre 2012 e 2017, com acompanhamento até 2019. Resultados: Pacientes com enxertos de KDPI menor ou igual à mediana obtiveram menor mortalidade após um ano (p = 0,02); menor taxa de perda de enxerto até um ano (p = 0,00) e após um ano (p = 0,03) e menor nível de creatinina (p = 0,00). Receptores com EPTS menor ou igual à mediana obtiveram taxa de perda de enxerto significativamente menor, se comparados aos com valores acima da mediana (p = 0,01). O coeficiente de correlação entre KDPI e EPTS foi da ordem de 0,016 (p = 0,84). Conclusão: O KDPI evidenciou-se como ferramenta objetiva e de fácil aplicação para predizer prognóstico e, assim, direcionar os rins a serem transplantados. O EPTS mostrou caráter promissor para avaliação dos receptores renais. Esses dados podem ser complementados com futuros estudos nacionais para possível validação e implementação dos escores no país. Conclusão: Por fim, observou-se que não houve correlação direta entre os valores de KDPI do enxerto com os valores de EPTS de seus receptores, distanciando-se do que é preconizado pela literatura norte-americana.Palavras Chave: Transplante de rim, Seleção de doadores, Sobrevivência de enxertoABSTRACTIntroduction: KDPI and EPTS are scores implemented in the United States in 2014 to guide the allocation of kidney grafts. The objective of this work is to correlate values of these scores with outcomes of kidney transplants performed in a Brazilian Transplant Center, evaluating their ability to predict prognosis in this population. Methods: Observational, individual, longitudinal and retrospective study with 163 recipient-donor pairs of kidney transplants with deceased donors, carried out between 2012 and 2017, with follow-up until 2019. Results: Patients with grafts with KDPI less than or equal to the median had lower mortality after one year (p = 0.02); lower graft loss rate up to one year (p = 0.00) and after one year (p = 0.03) and lower creatinine level (p = 0.00). Recipients with EPTS less than or equal to the median had a significantly lower graft loss rate, compared to those with values greater than the median (p = 0.01). The correlation coefficient between KDPI and EPTS was of about 0.016 (p = 0.84). Conclusion: KDPI proved to be an objective and easy to apply tool to predict prognosis and, thus, direct the kidneys to be transplanted. EPTS showed a promising character for the evaluation of kidney recipients. These data can be complemented with future national studies for possible validation and implementation of such scores in the country. Conclusion: Finally, it was observed that there was no direct correlation between the KDPI values of grafts and the EPTS values of its recipients, distancing from what is recommended by the North American literature.Keywords: Kidney transplantation, Donor selection, Graft survival

scholarly journals Increased Early Revision Rate with the INFINITY Total Ankle Prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Elizabeth Cody ◽  
Michel Taylor ◽  
James Nunley ◽  
Selene Parekh ◽  
James DeOrio
Keyword(s):  
United States ◽  
Tibial Component ◽  
Revision Rate ◽  
The United States ◽  
Additional Patient ◽  
Foot And Ankle ◽  
Early Revision ◽  
One Year ◽  
Component Loosening

Category: Ankle Arthritis Introduction/Purpose: Modern total ankle arthroplasties (TAAs) have demonstrated improved survival rates at early- and mid-term follow-up, with revision rates ranging from 4 to 8% at five years. The INFINITY total ankle system (Wright Medical Technology, Arlington, TN) was first used in the United States in 2014. Its advantages include the ability to use patient-specific instrumentation and the option to choose between talar dome resurfacing and flat-cut talar components. While this implant is currently popular in the United States, clinical outcomes have not yet been reported. Our aim was to identify the rate of early revision among patients receiving the INFINITY prosthesis. Methods: Patients from two prospectively-collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary TAA with the INFINITY prosthesis and who were at least one year postoperative were included. All surgeries were performed by one of two orthopaedic foot and ankle surgeons with extensive experience in total ankle arthroplasty. The primary outcome was the need for revision surgery, which was defined as removal of one or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Anteroposterior and lateral radiographs at most recent follow-up were graded for lucency independently by two reviewers, both orthopaedic foot and ankle fellows, for individual peri-implant zones (Figure). Each zone was only considered “lucent” if recorded as such by both reviewers. Results: 160 patients underwent TAA with the INFINITY prosthesis between August 2014 and November 2016 with a mean 20 months of follow-up (range, 12-37). Six patients were lost to follow-up. Sixteen patients (10%) underwent revision a mean 1.2 years postoperatively. Revision was performed most commonly for tibial component loosening (seven patients, 4.4%) and deep infection (five patients, 3.1%). Of cases with tibial loosening, progressive lucency and/or subsidence was obvious radiographically in four patients; one patient had equivocal radiographs but loosening was suggested on single-photon emission computed tomography; and two patients revised for persistent pain had loosening confirmed intraoperatively. Of the 108 patients with retained components and at least one year of radiographic follow-up, eight (7.4%) had global lucency around the tibial component at most recent follow-up. Conclusion: Our initial review of patients undergoing TAA with the INFINITY prosthesis demonstrates an elevated early revision rate due to tibial component loosening. The reasons for this finding remain unclear, but could possibly include inadequate bony purchase of the implant’s three prongs, particularly in patients with large preoperative deformities or with imperfect component alignment. We plan to further investigate the possible reasons for this finding in the future by assessing additional patient factors, including age, sex, arthritis type, tobacco use, pre- and postoperative coronal and sagittal alignment, and presence of ipsilateral hindfoot fusion.

Abstract 284: Length Of Stay In Index Hospitalization Of Decompensated Heart Failure With Preserved Ejection Fraction As A Factor For 30-day Readmission And 1-year Mortality

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sunil Saith ◽  
Ciril Khorolsky ◽  
Anuragh Trikha ◽  
Tamta Chkhikvadze ◽  
Jung-eun Ha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
The United States ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Index Hospitalization ◽  
One Year

Introduction: Heart Failure is one of the leading causes of readmission in the United States. Heart Failure with preserved Ejection Fraction (HFpEF) accounts for a growing proportion of heart failure hospitalizations and accounts for approximately half of hospitalizations today. Unlike Heart Failure with reduced Ejection Fraction (HFrEF), there are no consensus-driven guidelines for the management of HFpEF. Methods: We collected demographic data, co-morbidities, laboratory and echocardiographic data on patients hospitalized with HFpEF throughout our health care system between August 2016 to August 2017. We assessed length of stay (LOS), whether the patient was re-admitted for any cause within 30 days and whether the patient died within 1 year of index hospitalization. We performed a Wilcoxon rank-sum test comparing patients who were both readmitted within 30 days for any reason and died within 1 year, against patients who were readmitted but were verified alive at one-year follow-up. Results: There were 366 patients hospitalized for HFpEF during the study period. Overall 30-day readmission rate was 24.3%, with a one-year mortality of 19.9%. One-year outcomes was verifiable for 359 patients. There were 27 patients who were readmitted within 30 days and died within one year of follow-up. Median LOS was significantly greater in patients during index hospitalization who died within 1 year of follow-up (Median LOS: 8 days, IQR 5-10 days), compared to patients who were readmitted within 30 days, but were alive at 1-year follow-up (Median LOS: 5 days, IQR: 3-8 days; p-value = 0.001). Conclusions: Among patients who were re-hospitalized within 30 days of an index hospitalization for HFpEF, LOS was significantly greater than patients who died within one year, compared to patients who remained alive at one-year follow-up. This may help identify a high-risk subset on index hospitalization and assist care transition teams and primary care physicians at follow-up in regarding discussions on goals of care and life sustaining treatments.

The Effects of a Health Partner Program on Alleviating Depressive Symptoms Among Healthy Overweight/Obese Individuals

2018 ◽  
Vol 32 (4) ◽  
pp. 400-412
Author(s):  
Tingting Liu
Keyword(s):  
Depressive Symptoms ◽  
Stress Reduction ◽  
Action Plan ◽  
Negative Mood ◽  
Secondary Data ◽  
Well Being ◽  
The United States ◽  
Normal Weight ◽  
One Year

Background and Purpose: Although lifestyle interventions have been shown to be effective in losing weight and increasing physical activity in community settings, little is known whether these programs may also ameliorate negative mood states in healthy overweight/obese adults when such programs are delivered in workplace settings. The aim of the study was to determine whether a health partner program may alleviate depressive symptoms among healthy overweight/obese individuals at 1 year. Methods: A secondary data analysis was performed using the Center for Health Discovery and Well Being database at Emory University in the United States. A total of 297 healthy overweight/obese university employees were recruited from the health partner program. Participants worked with health partners to establish an individualized health action plan, which might include changes in diet or exercise, modification of risk-related behaviors (e.g., tobacco use, alcohol use), and stress reduction strategies such as yoga. Depressive symptoms were measured by the Beck Depression Inventory-II at baseline and one-year follow-up. Results: At baseline, 9.7% of participants had depressive symptoms. At one-year follow-up, these participants had a small-to-moderate improvement in depressive symptoms (Cohen’s d = 0.423), and the changes in depressive symptoms were statistically significant (p < 0.001). Implications for Practice: Since overweight/obese individuals are more likely to experience depressive symptoms than normal-weight individuals, early interventions to steer these individuals to better mental health are therefore essential. This study has demonstrated the potential benefits of a health partner program on alleviating depressive symptoms among overweight/obese individuals and this should be integrated into clinical practice.

scholarly journals The causes and frequency of kidney allograft failure in a low-resource setting: Data from Iraqi Kurdistan

2021 ◽  
Author(s):  
Alaa Abbas Ali ◽  
Safaa E Almukhtar ◽  
Kais H Abd ◽  
Zana Sidiq M Saleem ◽  
Dana A Sharif ◽  
...  
Keyword(s):  
Graft Failure ◽  
Interstitial Fibrosis ◽  
Graft Loss ◽  
The United States ◽  
Failure Rates ◽  
Antibody Mediated Rejection ◽  
Iraqi Kurdistan ◽  
Resource Setting ◽  
Long Term Treatment ◽  
One Year

Abstract Background In the developing world, transplantation is the most common long-term treatment for patients with end-stage renal disease, but rates and causes of graft failure are uncertain. Methods In 2019, in Iraqi Kurdistan, 301 of 871 renal transplant patients had indicated graft biopsies. Outcomes were followed over the subsequent year of 2020. Results The post-transplantation time ranged from one day to 18 years. All donors were living. Approximately 15% of transplants were preemptive. Pretransplant hemodialysis (HD) was twice weekly and less than one year. The median recipient age was 39 (IQR 28 to 48) years. 5.5% of recipients had previous transplants; 3.7% had pretransplant donor-specific antibodies (DSA). The Kaplan-Meier estimated graft failure rates for all-cause, return to HD, and death with functional graft (DWFG) were 9.1%, 6.3%, and 2.9% at one year and 23.8%, 6.3%, and 7.4% at five years. The median death-censored graft survival was 15 years. The most frequent biopsy diagnoses associated with graft failure were interstitial fibrosis and tubular atrophy (IF/TA) (23.1%), transplant glomerulopathy (13.7%), and acquired active antibody-mediated rejection (11.1%). The significant predictors of graft loss were C4d + biopsies (P < 0.01) and advanced IF/TA (P < 0.001). Conclusions These Iraqi patients had estimated graft failure rates similar to the United States (US) Renal Data System living-donor outcomes reported for the year 2000. The inability to approach recent US graft survivals may owe to inadequate pretransplant dialysis. Nevertheless, prolonged survival made chronic disorders and acquired DSA the leading causes of graft failure and is creating a need for second transplants.

scholarly journals Releasable Suture versus Autologous Blood for Pterygium Surgery using Conjunctival Autografts

2020 ◽  
Author(s):  
Gautam Singh Parmar ◽  
Bhushan Ghodke ◽  
Ashok Kumar Meena
Keyword(s):  
Autologous Blood ◽  
Graft Loss ◽  
Patient Comfort ◽  
Duration Of Surgery ◽  
Pterygium Surgery ◽  
The Mean ◽  
One Year ◽  
Retrospective Comparative Study ◽  
Single Suture

Purpose: To evaluate the efficacy of releasable single suture (RS) for conjunctival autograft (CAG) and to compare it with sutureless gluefree (SG) technique in pterygium surgery. Methods: We conducted a retrospective comparative study on patients with primary pterygium who underwent CAG. In 150 patients, CAG was additionally secured by a single 10-0 nylon releasable suture (RS) which was released on the first postoperative day. In 47 patients, no suture was applied, and CAG was allowed to stick to the scleral bed by autologous fibrin only (SG group). The duration of surgery and size of CAG (in mm2) was noted in both groups. All patients completed one year of follow-up. Factors that were studied included graft stability, patient comfort, complications, and recurrence. Results: The mean age of patients in RS and SG groups was 39.6 ± 11.8 and 47.3 ± 13.8 years, respectively. The mean duration of surgery was 4.84 ± 1.34 min in RS group and 4.90 ± 1.42 min in SG group (P = 0.001). The size of CAG used in both groups was comparable with more stability in RS group postoperatively. Graft retraction rate in RS group was 5.3% (1 mm retraction in CAG more than 36 mm2) with no event of graft loss. The graft loss occurred in 6.3% of eyes in SG group. The recurrence rate in RS group was 4%, while in SG group it was 6.3% (P = 0.4). Conclusion: RS, by augmenting the autologous blood mechanism, may offer an easy-to-learn option for pterygium surgery with good stability even in large-sized CAGs.

Dispelling the myth of Asian homogeneity: Improved outcomes of Chinese Americans after kidney transplantation

2018 ◽  
Vol 3 ◽  
pp. 5-9
Author(s):  
Farah Karipineni ◽  
Afshin Parsikia ◽  
PoNan Chang ◽  
John Pang ◽  
Stalin Campos ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Graft Loss ◽  
Graft Function ◽  
Chinese Americans ◽  
The United States ◽  
Chinese Patients ◽  
One Year ◽  
Patient And Graft Survival

Objectives: Asians represent the fastest growing ethnic group in the United States. Despite significant diversity within the group, many transplant studies treat Asians as a homogeneous entity. We compared patient and graft survival among major Asian eth- nicities to determine whether any subgroup has superior out- comes. Methods: We conducted a retrospective analysis of kidney trans- plants on Asian and White patients between 2001 and 2012. Co- variates included gender, age, comorbidities, and donor category. Primary outcomes included one-year patient and graft survival. Secondary outcomes included delayed graft function (DGF) and rejection as cause of graft loss and death. Results: Ninety-one Asian patients were identified. Due to the large proportion of Chinese patients (n=37), we grouped other Asians into one entity (n=54) for statistical comparison among Chinese, other Asians, and Whites (n=346). Chinese subjects had significantly lower body mass index (BMI) (p=0.001) and had the lowest proportion of living donors (p>0.001). Patient survival was highest in our Chinese cohort (p>0.001)Discussion: Our study confirms outcome differences among Asian subgroups in kidney transplantation. Chinese demonstrate better patient survival at one year than Whites and non-Chinese Asians despite fewer live donors. Lower BMI scores may partly explain this. Larger, long-term studies are needed to elucidate outcome disparities among Asian subgroups

scholarly journals Frequency of Early Refills for Opioids in the United States

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1818-1824
Author(s):  
David M Kern ◽  
M Soledad Cepeda ◽  
Maribel Salas ◽  
Syd Phillips ◽  
Matthew H Secrest ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Immediate Release ◽  
The United States ◽  
Prescription Opioid ◽  
Opioid Prescription ◽  
National Drug ◽  
One Year ◽  
Long Acting ◽  
Opioid Users

Abstract Objective Refilling an opioid prescription early is an important risk factor of prescription opioid abuse and misuse; we aimed to understand the scope of this behavior. This study was conducted to quantify the prevalence and distribution of early refills among patients prescribed opioids. Methods We conducted a retrospective cohort study utilizing dispensed prescription records. Patients filling one or more prescription opioids were identified and followed for one year. Early refills were defined as having a second prescription filled ≥15% early relative to the days’ supply of the previous prescription for the same opioid (according to the National Drug Code [NDC]). The distribution of the number of early refills and patient characteristics were assessed. Results A total of 60.6 million patients met the study criteria; 28.8% had two or more opioid prescriptions for the same opioid during follow-up. Less than 3% of all patients receiving an opioid had an early refill. Approximately 10% of those with two or more opioid prescriptions for the same drug had an early refill. For patients with multiple fills (N = 1.5 million with extended-release long-acting [ER/LA] opioids; N = 17.1 million with immediate-release short-acting [IR/SA] opioids), early refills were more common among patients with an ER/LA opioid (18.5%) compared with an IR/SA opioid (8.7%). Three-quarters of patients with an early refill had only one (70.9% and 78.4% for ER/LA and IR/SA, respectively). Conclusion Refilling an opioid prescription with the same opioid early is an infrequent behavior within all opioid users, but more common in ER/LA users. Patients who refilled early tended to do so just once.

Sign in / Sign up

Export Citation Format

Share Document