scholarly journals The unnoticed truth: Patients on the heart transplantation waiting list are becoming cachexic

2021 ◽  
Vol 12 (1) ◽  
pp. 225-229
Author(s):  
Ozlem Balcioglu ◽  
Ulvan Ozad ◽  
Umit Kahraman

Heart transplantation is a major lifesaving surgery practiced globally on daily basis. The scarcity of donors has led to long waiting lists for the surgery. Both physiology and psychology of patients are affected severely during this period. The nutritional status is known to be correlated with postoperative outcomes. The aim of this study was to investigate the significance of the weight loss of patients by comparing their weights and ideal body weights. The data of 259 patients were used in this study and unpaired t-test was applied to the patient groups. The weight difference of the patient population was found as extremely significant (p<0.0001). The results demonstrated that the weight difference of female patient group was very significant (p=0.0012) and the male patient group was extremely significant (p<0.0001). The weight difference of young patients (18-34 years) was not significant (0.7309), middle aged patients (35-64 years) was extremely significant (p<0.0001) and elderly patients (65 years and above) was not significant (p=0.3540). Therefore, weight change is prominent in most of the patients who are on heart transplantation waiting list. Employment of a dietitian or nutrition specialist to transplant multidisciplinary teams is advised, to minimize patient cachexia.

2021 ◽  
pp. 097172182096024
Author(s):  
Alex Faulkner ◽  
Kate Bloor ◽  
Vahsti Hale

States that claim responsibility for citizens’ healthcare try to deal with knowledge uncertainties while preserving a duty of care. Production of clinical guidelines in disputed medical conditions or where uncertainty is high, is difficult. Patient groups may advocate non-credentialed evidence, contribute to debates and form alliances with established policy actors. In this context, Lyme disease, especially highly contested ‘chronic’ Lyme disease is a good case with which to examine how official governance institutions are managing diagnostic uncertainty and evidence for tests. The healthcare state has been provoked to develop extensive policy for Lyme disease. In the UK, national Health Technology Assessment agency, NICE, began a consultation process in 2016. NICE and other policy actors are moving towards more participatory modes of decision-making. The article analyses NICE’s recently published guidelines and consultation documents; patient groups’ contributions; observations of consultations and of evidence review processes; and recent Department of Health systematic reviews, including patient group participation. We draw on concepts of participatory governance, patient group activism and guideline involvement. We find an increased level of participation by patient groups in recent policy and evidence review processes, and hence legitimation of them as ‘stakeholders’, alongside a strengthened state position on pre-existing diagnostic and testing standards.


2019 ◽  
Vol 3 (3) ◽  
pp. 1-1 ◽  
Author(s):  
Petr A. Fedotov ◽  
◽  
Maria A. Simonenko ◽  
Yulia V. Sazonova ◽  
Mariya A. Bortsova ◽  
...  

2014 ◽  
Vol 33 (4) ◽  
pp. S66-S67 ◽  
Author(s):  
E.M. Hsich ◽  
R.C. Starling ◽  
E. Blackstone ◽  
J. Rogers ◽  
D.O. Taylor ◽  
...  

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Barry Maron ◽  
William C Roberts ◽  
Michael Arad ◽  
Carolyn Y Ho ◽  
Tammy S Haas ◽  
...  

Mutations in the X-linked lysosome-associated membrane protein gene (LAMP2; Danon disease) produce a morphologic phenocopy of sarcomeric hypertrophic cardiomyopathy (HCM) in young patients, characterized by extreme left ventricular (LV) hypertrophy and pre-excitation. However, the natural history of this newly recognized cardiomyopathy is incompletely resolved. Seven young asymptomatic patients with LAMP2 cardiomyopathy were identified at ages 8 to 15 years; 6 were male. LV hypertrophy was particularly marked (septal thickness 25– 65 mm; mean 42±17) in the presence of nondilated LV cavity. On each ECG, Wolff-Parkinson-White pre-excitation pattern was associated with markedly increased voltages (74±38mm for R- or S-wave). Over the 7±3 year follow-up from initial cardiac diagnosis, all 7 patients experienced particularly adverse disease consequences associated with progressive LV wall thinning and cavity dilatation and systolic dysfunction (ejection fraction, 29±7%) by the ages of 12 – 24 years (mean 20). Of the 7 patients, 5 either died of progressive heart failure, had heart transplantation or were considered for a donor heart; 2 others had sudden death events, including one fatal ventricular tachyarrhythmia refractory to defibrillator therapy and one appropriate defibrillator shock in an asymptomatic female survivor. Pathologic examination of hearts at autopsy showed histopathologic findings compatible with both HCM due to sarcomere protein mutations (i.e., extensive myocyte disarray, intramural small vessel disease, myocardial replacement scarring), and also evidence of a storage disease process (i.e., clusters of myocytes with vacuolated sarcoplasm within fibrotic areas). Heart weights, 1266 and 1425 grams, are the most substantial recorded for hypertrophic cardiomyopathies. LAMP2 cardiomyopathy is a uniformly profound, and particularly deleterious disease entity, causing refractory heart failure with systolic dysfunction as well as sudden death in young patients < 25 years of age. This novel phenocopy of sarcomeric HCM underscores the power of molecular diagnosis for predicting prognosis, and should also raise consideration for intervention with early heart transplantation.


2014 ◽  
Vol 98 ◽  
pp. 10
Author(s):  
M. Molina ◽  
E. Gonzalez ◽  
E. Gutierrez ◽  
A. Sevillano ◽  
J. Cabrera ◽  
...  

Blood ◽  
1954 ◽  
Vol 9 (10) ◽  
pp. 953-958 ◽  
Author(s):  
LUIS ANGELONE ◽  
DAVID H. WATKINS ◽  
CLIFFORD A. ANGERER

Abstract Blood was obtained from patients who were divided into four groups: (A) euthyroid, (B) untreated hyperthyroid, (C) iodine-treated hyperthyroid and (D) hypothyroid. The erythrocytes from each patient group were washed and resuspended in Krebs-phosphate solution for study by the Warburg respirometric technic. When the erythrocytes obtained from patient groups B, C and D are compared with group A (control), a +92 per cent, +23 per cent and -15 per cent change is noted, respectively, in their mean QOO2 values when QOO2 values for erythrocytes for each patient in each patient group (excluding group C) are plotted relative to their respective serum PBI concentration (µg. per cent), a curve of exponential order appears to be the curve of best probable fit for these data. The mean QOO2 value for the iodine-treated hyperthyroid group falls on the ordinate of this curve (fig. 1) between the euthyroid and untreated hyperthyroid groups, though the mean serum PBI value (abscissa), of course, has no meaning for this group.


2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Shekhar Gogna ◽  
Roberto Bergamaschi ◽  
Agon Kajmolli ◽  
Mahir Gachabayov ◽  
Aram Rojas ◽  
...  

Background. Anal canal adenocarcinoma (AA) is an uncommon tumor of the gastrointestinal tract. We seek to provide a detailed description of the incidence, demographics, and outcome of this rare tumor in the United States. Methods. The data on anal canal adenocarcinoma from SEER Program, between 1973–2015, were extracted. We analyzed the incidence rates by demographics and tumor characteristics, followed by analysis of its impact on survival. Results. The incidence of AA increased initially by 4.03% yearly from 1973 to 1985 but had a modest decline of 0.32% annually thereafter. The mean age for diagnosis of AA was 68.12 ± 14.02 years. Males outnumbered females by 54.8 to 45.2%. Tumors were mostly localized on presentation (44.4%) and moderately differentiated (41.1%). Age generally correlated with poor overall cancer survival. However, young patients (age <40 years) also showed poor long-term survival. Patients with localized disease and well-differentiated tumors showed better survival outcomes. Surgical intervention improved survival significantly as compared to patients who did not (116.7 months vs 42.7 months, p<0.01). Conclusions. Anal canal adenocarcinoma demonstrated a poor bimodal cancer-free survival in both younger and older patient groups. Surgery significantly improves odds of survival and should be offered to patients amenable to intervention.


2020 ◽  
Vol 21 (22) ◽  
pp. 8428
Author(s):  
Guido Santos ◽  
Julio Vera

Bacterial pneumonia is one of the most prevalent infectious diseases and has high mortality in sensitive patients (children, elderly and immunocompromised). Although an infection, the disease alters the alveolar epithelium homeostasis and hinders normal breathing, often with fatal consequences. A special case is hospitalized aged patients, which present a high risk of infection and death because of the community acquired version of the Streptococcus pneumoniae pneumonia. There is evidence that early antibiotics treatment decreases the inflammatory response during pneumonia. Here, we investigate mechanistically this strategy using a multi-level mathematical model, which describes the 24 first hours after infection of a single alveolus from the key signaling networks behind activation of the epithelium to the dynamics of the local immune response. With the model, we simulated pneumonia in aged and young patients subjected to different antibiotics timing. The results show that providing antibiotics to elderly patients 8 h in advance compared to young patients restores in aged individuals the effective response seen in young ones. This result suggests the use of early, probably prophylactic, antibiotics treatment in aged hospitalized people with high risk of pneumonia.


Circulation ◽  
2009 ◽  
Vol 119 (5) ◽  
pp. 717-727 ◽  
Author(s):  
Christopher S.D. Almond ◽  
Ravi R. Thiagarajan ◽  
Gary E. Piercey ◽  
Kimberlee Gauvreau ◽  
Elizabeth D. Blume ◽  
...  

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