scholarly journals Improvement of level MDA and SOD Using of Ganoderma Lucidum as Adjunctive Treatment for Statin Based Therapy in High Risk Patient Based on Framingham Score

2019 ◽  
Vol 39 (3) ◽  
Author(s):  
Vitriyaturrida Vitriyaturrida ◽  
M Saifur Rohman ◽  
Djanggan Sargowo ◽  
Dadang Hendrawan
Keyword(s):  
High Risk ◽  
Standard Therapy ◽  
Ganoderma Lucidum ◽  
Angiotensin Receptor Blockers ◽  
High Risk Patient ◽  
Adjunctive Treatment ◽  
Channel Blockers ◽  
Framingham Score ◽  
High Risk Patients ◽  
Risk Patients

It is well known from previous research on the importance of antioxidants to inhibit the progression of coronary heart disease in high-risk patients based on framingham scores. Statins are routinely administered in high-risk patients  based on the Dyslipidemia 2016 ESC guidelines but the effects of adding Ganoderma are known to have antioxidant effects, in patients who have received statins. This study aims to assess the effect of antioxidants through measurement of SOD and MDA in patients given a combination of Ganoderma lucidum with statins.Method: A total of 24 patients with high-risk patients based on the Framingham score > 20% were selected as sample of study. Patients with respondents who had never received statin therapy or ACEi or ARB or CCB or beta blocker, or did not routinely consume the drug for 2 weeks were excluded from this study. The addition of Ganoderma lucidum dose of 3x250 mg was added to statins as the first group and Ganoderma lucidum dose of 3x250 mg was added to the Statin combination of Angiotensin Converting Enzym inhibitors (ACE inhibitors) or Angiotensin Receptor Blockers (ARB) and or Calcium Channel Blockers (CCB) and or Beta blockers as second group for 90 days. SOD and MDA levels were measured before and after the administration of Ganoderma Lucidum with the ELISA method.Result: After the administration of Ganoderma Lucidum with standard therapy, there was a decrease in MDA levels and an increase in SOD levels after 90 days in two groups. Conclusion: The addition of Ganoderma Lucidum to standard therapy can reduce oxidant levels in high-risk patients based on framingham scores. Keyword: Superoxyde-dismutase, Malondyaldehide, Oxidative Stress, Antioxidant, Ganoderma Lucidum, Statin

PS 02-02 Effect Ganoderma lucidum Polysaccharide Peptides as Anti-hypertension, Anti-lipid, Anti-oxidant, Anti-inflammation in High Risk Patients of Atherosclerosis

2016 ◽  
Vol 34 (Supplement 1) ◽  
pp. e105
Author(s):  
Djanggan Sargowo ◽  
Nizammudin Ubaidillah ◽  
Olivia Handayani ◽  
Adriyawan Widya ◽  
Vittryaturida Vittryaturida ◽  
...  
Keyword(s):  
High Risk ◽  
Ganoderma Lucidum ◽  
High Risk Patients ◽  
Risk Patients ◽  
Anti Oxidant ◽  
Anti Inflammation

scholarly journals Rate of device-related infections using an antibacterial envelope in patients undergoing cardiac resynchronisation therapy re-operations

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Frausing ◽  
JC Nielsen ◽  
JB Johansen ◽  
OD Joergensen ◽  
C Gerdes ◽  
...  
Keyword(s):  
High Risk ◽  
Propensity Score Analysis ◽  
Controlled Trial ◽  
High Risk Patient ◽  
Cardiac Resynchronisation Therapy ◽  
High Risk Patients ◽  
Cardiac Resynchronisation ◽  
Risk Patients ◽  
Resynchronisation Therapy ◽  
Very High

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Karen Elise Jensen Foundation Background Cardiac resynchronisation therapy (CRT) re-operations are associated with a particularly high risk of device-related infection (DRI). An antibacterial envelope has been shown to reduce the occurrence of DRIs in a broad population of moderate-to-high risk patients. Purpose To investigate the efficacy of an antibacterial envelope in a very high-risk patient population undergoing CRT re-operation. Methods In this Danish two-centre, observational cohort study, we included consecutive patients who underwent a CRT pacemaker- or defibrillator re-operation procedure between January 2008 and November 2019. We obtained data from the Danish Pacemaker and ICD Register and through systematic medical chart review. Follow-up was restricted to two years. Results A total of 1943 patients were included in the study; 736 (38%) patients received an antibacterial envelope. Envelope patients had more independent risk factors for infection than non-envelope patients. Sixty-seven (3.4%) patients met the primary end point of DRI requiring device system extraction; 50 in the non-envelope group and 17 in the envelope group (4.1% vs. 2.3%, adjusted hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.30-0.90, p = 0.021). This difference persisted in propensity score analysis (HR 0.51 95% CI 0.29-0.90, p = 0.019). Conclusion Use of an antibacterial envelope was associated with a clinically and statistically significant reduction in DRIs in patients undergoing CRT re-operations. Our results were comparable to those recently reported from a large randomized controlled trial, which suggests a proportional effect of the envelope even in very high risk patients.

scholarly journals Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin-Receptor Blockers (ARBs) in Patients at High Risk of Cardiovascular Events: A Meta-Analysis of 10 Randomised Placebo-Controlled Trials

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Hean Teik Ong ◽  
Loke Meng Ong ◽  
Jacqueline Judith Ho
Keyword(s):  
High Risk ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Total Mortality ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
High Risk Patients ◽  
Risk Patients ◽  
Receptor Blockers

Context. Whether angiotensin converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are useful in high risk patients without heart failure is unclear. We perform a meta-analysis of prospective randomized placebo-controlled ACEI or ARB trials studying patients with a combination of risk factors to assess treatment impact on all cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI) and stroke. Method. A PubMed search was made for placebo-controlled trials recruiting at least 1,200 high risk patients randomized to either ACEI or ARB, with follow-up of at least 2 years. Meta-analysis was performed using the RevMan 5 program and Mantel-Haenszel analysis was done with a fixed effects model. Results. Ten trials recruiting 77,633 patients were reviewed. All cause mortality was significantly reduced by ACEI (RR 0.89; P=0.0008), but not by ARB treatment (RR 1.00; P=0.89). Cardiovascular mortality and nonfatal MI were also reduced in the ACEI trials but not with ARB therapy. Stroke was significantly reduced in the ACEI trials (RR 0.75; P<0.00001) and more modestly reduced in the ARB trials (RR 0.90; P=0.01). Conclusion. ACEI treatment reduced stroke, nonfatal MI, cardiovascular and total mortality in high risk patients, while ARB modestly reduced stroke with no effect on nonfatal MI, cardiovascular and total mortality.

scholarly journals Profilaktikus sztentek alkalmazása az endoszkópos retrográd cholangiopancreatographiát követő pancreatitis megelőzésében

2021 ◽  
Vol 162 (1) ◽  
pp. 31-38
Author(s):  
Zsolt Dubravcsik ◽  
István Hritz ◽  
Attila Szepes ◽  
László Madácsy
Keyword(s):  
High Risk ◽  
High Risk Patient ◽  
Stent Group ◽  
Endoscopic Retrograde ◽  
High Risk Patients ◽  
Proximal Migration ◽  
Risk Patients ◽  
The Difference ◽  
Stented Group ◽  
Prospective Database

Összefoglaló. Bevezetés: Az endoszkópos retrográd cholangiopancreatographiát (ERCP) követő pancreatitis (PEP) incidenciája a magas kockázatú betegcsoportban 14,7%. Célkitűzés: A munkacsoportunk által szerzett tapasztalatok elemzése. Módszerek: A profilaktikus pancreassztentes (PPS), magas kockázatú betegek adatait tartalmazó prospektív adatbázisunkat elemeztük retrospektív módon. Az adatokat a PEP-incidencia és a súlyosság tekintetében összehasonlítottuk a korábbi, hasonlóan magas kockázatú, sztent nélküli beteganyagunkkal, illetve a sztenteléssel kapcsolatos szövődményeket és a különböző sztenttípusokat is elemeztük. A Cotton-kritériumok szerint értékeltük a PEP-t. Eredmények: A 317, magas kockázatú betegből 288 esetben (90,9%) volt sikeres a PPS-implantáció. A sztent nélküli kontrollcsoportba 121, magas kockázatú beteget választottunk be. A sikeresen sztentelt betegekben a PEP incidenciája 10,0% volt. Ez és a PEP súlyossága (enyhe: 8,3%, középsúlyos: 1,4%, súlyos: 0,3%) is szignifikánsan alacsonyabb volt a PPS nélküli beteganyaghoz (PEP: 31,4%, enyhe: 15,7%, középsúlyos: 10,7%, súlyos: 5,0%) és a sikertelenül sztentelt betegekhez (PEP: 41,3%, enyhe: 24,1%, középsúlyos: 13,8%, súlyos: 3,4%) képest. Az utóbbi két csoport közötti különbség nem volt szignifikáns. A sztenttel kapcsolatos szövődmények közül a leggyakrabban a korai sztentkicsúszást (5/288 beteg, 1,74%) és a proximalis sztentmigrációt (3/288 beteg, 1,04%) észleltük. A sztenttípusok közül a legkedvezőbb mellékhatás-profilúnak a Freeman-típusú, belső füllel és külső „pigtail” véggel ellátott sztenteket találtuk. Következtetés: A profilaktikus pancreassztentelés hatékonyan csökkenti a PEP incidenciáját, és a súlyosságát az enyhébb esetek felé tolja el. Alkalmazása viszonylag egyszerű, azonban ismerni kell használatának megfelelő technikáját, időben történő eltávolításának és a szövődmények felismerésének fontosságát. Eredményeink és a nemzetközi ajánlások alapján magas PEP-rizikójú betegekben a PPS rutinszerű alkalmazása minden ERCP-laborban ajánlott. Orv Hetil. 2021; 162(1): 31–38. Summary. Introduction: The most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP pancreatitis (PEP). Its incidence in the high-risk patient population is 14.7%. Objective: To analyze 10 years experiences of our working group. Methods: We retrospectively analyzed our prospective database of high-risk patients treated with prophylactic pancreatic stents (PPS) including the period between 2009 and 2014. We compared PEP incidence and severity findings with our historical data of pre-PPS period of similarly high-risk patients (no-stent group), furthermore analyzed the complications of PPS insertion and different stent types. PEP was defined and categorized according to the Cotton criteria. Results: In 317 high-risk patients, PPS implantation was successful in 288 cases (90.9%). The no-stent group comprised of 121 patients. Incidence and the severity of PEP in the successfully stented group (all: 10.0%; mild: 8.3%, moderate: 1.4%, severe: 0.3%) were significantly lower compared to the no-stent group (all: 31.4%; mild: 15.7%, moderate: 10.7%, severe: 5.0%) and the unsuccessfully stented group (all: 41.3%; mild: 24.1%, moderate: 13.8%, severe: 3.4%). The difference between the latter two groups was not significant. Only early dislodgment (5/288 patients, 1.74%) and proximal migration (3/288 patients, 1.04%) were observed as stent-related complications. Freeman type (single inner flange, outer pigtail end) stent was the best based on the complication profile. Conclusion: Prophylactic pancreatic stenting effectively lowers the incidence and severity of PEP. We should recognize the proper technic of its application and the importance of proper timing of its extraction and identification of complications. Utilization of PPSs in high-risk patients is strongly recommended in every ERCP center. Orv Hetil. 2021; 162(1): 31–38.

LBPS 01–05 GANODERMA LUCIDUM POLYSACCHARIDE PEPTIDES AS ANTIOXIDANT, ANTI-INFLAMMATION, ANTI-HYPERTENSION AND ANTI-LIPID IN HIGH-RISK PATIENTS OF ATHEROSCLEROSIS

2016 ◽  
Vol 34 (Supplement 1) ◽  
pp. e175 ◽  
Author(s):  
Olivia Handayani ◽  
Djanggan Sargowo ◽  
Kartika Siwi ◽  
Nizamuddin Ubaidillah ◽  
Adriyawan Widya ◽  
...  
Keyword(s):  
High Risk ◽  
Ganoderma Lucidum ◽  
High Risk Patients ◽  
Risk Patients ◽  
Anti Inflammation

scholarly journals Factors Determining Periprocedural and Long-term Complications of High Risk Carotid Artery Stenting

2015 ◽  
Vol 42 (1) ◽  
pp. 48-54
Author(s):  
Vincent Dinculescu ◽  
Anne C.M. Ritter ◽  
Marlise P. dos Santos ◽  
Ravi M. Mohan ◽  
Betty A. Schwarz ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Large Scale ◽  
High Risk Patient ◽  
Patient Characteristics ◽  
High Risk Patients ◽  
Risk Patients

ABSTRACTBackground and Purpose: Carotid artery stenting (CAS) has been, historically, an alternative to open endarterectomy (CEA) for stroke prevention in high risk patients with carotid atherosclerosis. We sought to determine the rates of periprocedural and long-term stroke or death and the risk factors for complications after CAS in our high risk patient population. Methods: Clinical and treatment variables of consecutive CAS procedures performed between 2002 and 2011 were analyzed. Using univariate and multivariate logistic regression analyses we examined how patient characteristics influenced outcomes and changes in modified Rankin Score (mRS). Results: In 152 patients, the composite total of periprocedural death, stroke, transient ischemic attack (TIA) and myocardial infarction (MI) rate was 3.95% (6/152). Chronic kidney disease (CKD) was strongly associated with periprocedural complications (p<0.001). Coronary artery disease/peripheral vascular disease (CAD/PVD) (p=0.03), dyslipidemia (p=0.02), CKD (p=0.01), and contralateral internal carotid artery stenosis (p=0.02) were non-modifiable risk factors for mRS increase. There were 25 deaths, 8 strokes, 11 TIAs, and 1 MI (mean follow-up 38.4 months, range 0-116 months). The presence of CAD/PVD (p=0.009) and dyslipidemia (p=0.002) were significantly associated with long-term complications. Conclusion: CAS was performed with low periprocedural complications in high-risk patients. Our rates compare very favorably to large-scale trials that have ideal patients. This data encourages the consideration of CAS in patients considered high risk for CEA and provides possible patient characteristics (CKD) to help with periprocedural risk stratification.

scholarly journals P4: EXTERNAL VALIDATION OF THE OUTCOMES AFTER KIDNEY INJURY IN SURGERY (OAKS) PROGNOSTIC SCORE TO PREDICT POSTOPERATIVE ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING MAJOR ELECTIVE COLORECTAL SURGERY

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Angiotensin Receptor Blockers ◽  
Prognostic Score ◽  
External Validation ◽  
Kidney Injury ◽  
Elective Colorectal Surgery ◽  
High Risk Patients ◽  
Risk Patients ◽  
Postoperative Aki

Abstract Background Postoperative Acute Kidney Injury (AKI) is associated with significant morbidity and mortality following major gastrointestinal surgery. The Outcomes After Kidney injury in Surgery (OAKS) prognostic score risk stratifies patients undergoing major gastrointestinal surgeries for 7-day postoperative acute kidney injury (AKI). This study aimed to perform external validation of an international elective colorectal cohort. Method The Ileus MAnagement INternational (IMAGINE) audit (January to April 2018) included consecutive adults undergoing elective colorectal resection or stoma reversal across Europe and Australasia. Multivariate logistic regression was performed using data on 7-day AKI and the OAKS prognostic variables (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery, and preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Discrimination and calibration (Hosmer–Lemeshow test) were assessed on prediction of patients at high-risk (&gt;20%) of postoperative AKI. Result Of 4046 patients included across 338 centres, 13.4% (n=542) developed 7-day AKI. The model discrimination was 0.67 (95% CI = 0.65-0.70), identifying high-risk patients with low sensitivity (0.28, 95% CI: 0.25-0.32) but high specificity (0.90, 95% CI = 0.89-0.91). Furthermore, the model demonstrated good calibration (p=0.518). Conclusion Discrimination of the OAKS score for patients at high-risk of postoperative AKI in this cohort is good, and remains consistent with the derivation cohort. High-risk patients identified may represent a feasible target for interventions aimed at mitigating AKI. Take-home message Prognostic risk scores may be helpful in predicting risk of postoperative acute kidney injury in patients undergoing major abdominal surgery.

scholarly journals Intramedullary Nail Fixation of the Fibula as a Treatment Alternative of Ankle Fractures in a High Risk Patient Population

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Christian Moody ◽  
Brian Weatherby
Keyword(s):  
High Risk ◽  
Soft Tissue ◽  
Patient Population ◽  
High Risk Patient ◽  
Risk Patient ◽  
Tourniquet Time ◽  
High Risk Patients ◽  
Risk Patients ◽  
Alternative Fixation

Category: Trauma Introduction/Purpose: Traditional plate osteosynthesis for ankle fractures in a high risk patient population can predispose to complications as a result of the necessary soft tissue dissection and periosteal stripping. Complication rates among patients with multiple comorbidities has been shown to be as high as 30% in those who undergo traditional plate and screw fixation. 1 An alternative fixation construct, thought not widely used or recognized in the American literature is the locking intramedullary fibular nail. Intramedullary nails offer the theoretical advantages of stable fixation while utilizing smaller, percutaneous incisions and no periosteal stripping. The purpose of this study is to analyze the outcomes and complications of high risk patients who underwent ankle surgery using the intramedullary fibular nail. Methods: The medical records of all high risk patients who underwent ankle fracture fixation with a locking intramedullary fibular nail from 1/2011 through 6/2015 at our institution were reviewed. Fracture patterns included unstable lateral malleolar, bimalleolar, and trimalleolar fractures. Patients were considered high risk if they had medical comorbidities at the time of injury that have been shown in current literature to increase surgical complication risk. These comorbidities include neuropathy, uncontrolled diabetes, peripheral vascular disease, congestive heart failure, etc. We recorded patient demographics, fracture type, period of post-op NWB, time until discharge, time to weight bearing, complications, tourniquet time, size and length of nail implanted, and estimated blood loss. Attempts were made to contact all patients to complete a follow-up questionnaire regarding their satisfaction. Results: Twenty-two high risk patients with 23 ankle fracture were included. The average age was 64.8 years (SD 10.2, range 41- 82). The average follow up was 5.7 months (SD 5.7, range 2-30). There were no surgical site infections, wound complications, or non-unions. Two (8.7%) required a return to the operating room for symptomatic screw removal. The average tourniquet time was 35.8 minutes (SD 20.1, range 0-72) and the average operative time was 49.3 minutes (SD 14.3, range 25-70) respectively. The Olerud & Molander average score was 77.9 (SD 17.7, range 40-100). Fourteen of the twenty two patients could be contacted for a follow up questionnaire and 13 of the 14 (93%) said they were either very satisfied (64%) or satisfied (29%) with their injury outcome. Conclusion: The locking intramedullary fibular nail provides an alternative fixation technique that allows for protection of soft tissue, stable fracture fixation and satisfactory outcomes in the high risk patient population.

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