scholarly journals Clinical and subclinical characteristics of brain-dead donors for liver transplantation in Viet Duc University Hospital

2021 ◽  
Vol 63 (4) ◽  
pp. 36-41
Author(s):  
Thanh Khiem Nguyen ◽  
◽  
Hong Son Trinh ◽  
Gia Anh Pham ◽  
Ham Hoi Nguyen ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Complete Blood Count ◽  
University Hospital ◽  
Standard Group ◽  
Electrolyte Disorders ◽  
Significant Difference ◽  
Liver Procurement ◽  
Brain Dead ◽  
Time Of Admission ◽  
The Brain

Since 2010, 49 cases of liver transplants from brain-dead donors were performed at Viet Duc University Hospital. This study is a descriptive cross-section cohort study with a combined analysis of retrospective and prospective occurrences of a series of cases of liver procurement from brain-dead donors in Viet Duc University Hospital from March 2010 to March 2020. The results of this study showed several features: the average age of the brain-dead donors was 29.8±10.9 (18-69), donors were mostly male (7.17/1, 87.8%), and the main cause of brain death was head trauma. Clinically, 40.8 and 63.3% of the subjects were hypothermic and diagnosed with diabetes insipidus, however, the subjects were all well resuscitated before procurement. Therefore, haemodynamic indices and temperatures were maintained at stable levels and there was no statistically significant difference. In subclinical aspects, haemoglobin and platelet levels decreased significantly but remained within the target criteria during resuscitation while blood sodium levels increased significantly during resuscitation when compared with levels at the time of admission (p<0.001) thus corresponding to diabetes insipidus. In general, 44.90% of donors were within the ideal standard, and in the extended standard group, the highest rate was electrolyte disorders (32.65%). In conclusion, there are many variations in clinical and paraclinical body signs as well as homeostasis in the brain-dead donors. Of these signs, the most prominent were changes in haemodynamics, temperature, urine output, complete blood count, blood clotting, and blood sodium levels. These are all factors that are included in the criteria to consider the selection of a liver donor.

Post Discharge Outcome of COVID 19 Cases Reported from Pakistan

2021 ◽  
Vol 15 (10) ◽  
pp. 2611-2613
Author(s):  
Sadia Ishaque ◽  
Beenish Syed ◽  
Saima Akhter ◽  
Talha Safeer ◽  
Yousra Mansoor ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Complete Blood Count ◽  
Hospital Data ◽  
Post Discharge ◽  
X Ray ◽  
Normal Limits ◽  
Significant Difference ◽  
Chest X Ray ◽  
Time Of Admission ◽  
Hospital Study

Aim: To characterize the clinical outcome of COVID-19 patients following discharge from the hospital. Study design: Prospective cohort study. Place and Duration of Study: Department of Infectious Diseases, Liaquat National Hospital, Karachi from 1st May to 31st August 2020. Methodology: Ninety six patients were included, age over 23 years and had a confirmed COVID-19 on PCR. At the time of admission and on discharge, in-hospital data were recorded. The demographic information, symptoms, complete blood count, inflammatory markers, and chest X-ray noted. Results: Diabetes (50%) and Ischemic heart disease (50%) were the most frequent comorbidities. The majority of patients (75%) improved their X-ray findings after being discharged from the hospital. At the time of discharge, 75% of the patients expressed fatigue; none of the patients developed a fever. There was a substantial significant difference in tiredness reported at discharge and in the fourth week. Significant variations in shortness of breath and oxygen consumption were also found between tiredness indicated at discharge and the fourth week. The majority of lab values were within normal limits. Conclusion: Most patients gradually improved after receiving appropriate treatment and supportive care in the hospital and later at home. The most prevalent and prolonged symptom reported by most patients was fatigue. By the fourth week, most symptoms had ameliorated significantly. Keywords: SARS-CoV2, Clinical outcome, Fatigue, COVID-19 follow-up

scholarly journals Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

2017 ◽  
Vol 44 (1) ◽  
pp. 54-63 ◽  
Author(s):  
MÔNICA LOUREIRO SANTOS ◽  
ANTÔNIO CARLOS IGLESIAS
Keyword(s):  
Clinical Trial ◽  
Blood Count ◽  
Complete Blood Count ◽  
Perioperative Complications ◽  
Anesthetic Management ◽  
University Hospital ◽  
Clinical Indication ◽  
Significant Difference ◽  
The Impact ◽  
Local Protocol

ABSTRACT Objective: to evaluate the impact of the use of a local protocol of preoperative test requests in reducing the number of exams requested and in the occurrence of changes in surgical anesthetic management and perioperative complications. Methods: we conducted a randomized, blinded clinical trial at the Gaffrée and Guinle University Hospital with 405 patients candidates for elective surgery randomly divided into two groups, according to the practice of requesting preoperative exams: a group with non-selectively requested exams and a protocol group with exams requested according to the study protocol. Studied exams: complete blood count, coagulogram, glycemia, electrolytes, urea and creatinine, ECG and chest X-ray. Primary outcomes: changes in surgical anesthetic management caused by abnormal exams, reduction of the number of exams requested after the use of the protocol and perioperative complications. Results: there was a significant difference (p<0.001) in the number of exams with altered results between the two groups (14.9% vs. 29.1%) and a reduction of 57.3% in the number of exams requested between the two groups (p<0.001), which was more pronounced in patients of lower age groups, ASA I, without associated diseases and submitted to smaller procedures. There was no significant difference in the frequency of conduct changes motivated by the results of exams or complications between the two groups. In the multivariate analysis, complete blood count and coagulogram were the only exams capable of modifying the anesthetic-surgical management. Conclusion: the proposed protocol was effective in eliminating a significant number of complementary exams without clinical indication, without an increase in perioperative morbidity and mortality.

scholarly journals AB0416 ANTIPHOSPHOLIPID SYNDROME IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOUS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1508.3-1508
Author(s):  
M. Jordhani ◽  
D. Ruci
Keyword(s):  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Complete Blood Count ◽  
University Hospital ◽  
Control Group ◽  
Systemic Lupus Erythematous ◽  
Systemic Lupus ◽  
Female Patients ◽  
Significant Difference ◽  
The Impact

Background:Antiphospholipid Syndrome (APS) is an autoimmune disorder characterized by venous/arterial thrombotic events and pregnancy morbidity in presence of pathogenic autoantibodies known as antiphospholipid antibodies (APL). APS is often associated with systemic autoimmune diseases, especially with Systemic Lupus Erythematous (SLE), being part of the latest criteria of SLE.1Objectives:The aim of this study was to evaluate the impact of Antiphospholipid syndrome in patients with Systemic Lupus Erythematous presented at our Rheumatology Clinic at University Hospital Center Mother Teresa in Tirana, Albania.Methods:This is an observational case-control study which included patients diagnosed with SLE from 16-51 years old, presented at our clinic during the period from 10 December 2014-10 September 2019.Seventy-three patients with SLE were included in the study. Patients were classified according to the presence of Antiphospholipid Syndrome or not, according to the current guidelines. The case study (patients with SLE and APS) consisted in 24 patients, and the control group consisted in 49 patients. Besides the usual laboratory tests (complete blood count, erythrosedimentation rate, C3, C4 complement fractions, urinalysis and 24h proteinuria, c-reactive protein), all patients underwent immunological tests for anti-nuclear antibodies, anti-DNA antibodies and antiphospholipid antibodies (Anti-cardiolipin IgM and IgG). If APL were found positive, according to EULAR recommendations, tests were repeated after 12 weeks. Female patients were asked about their pregnancy history and their possible miscarriages/aborts.Results:After our statistical analysis it resulted that there is a significant difference between C3 complement fraction (patients with APS and SLE tend to have more hypocomplementemia than the other group) (p= 0.006). Thrombocytopenia resulted to be an important feature, statistically significant in the cases’ group (p= 0.003). It was seen a statistically significant difference referring to the number of miscarriages/aborts in the history of female patients with APS and SLE in comparison to those with SLE without APS (p= 0.03). Proteinuria it has a tendency to be more marked in patients with APS and SLE, with a significant difference in comparison to the controls (p= 0.04).Conclusion:In this study was seen that patients with antiphospholipid Syndrome and Systemic Lupus Erythematous tend to have more hypocomplementemia C3, and thrombocytopenia. It resulted a statistically significant relationship with miscarriages or aborts in patients with APS and SLE in comparison to SLE patients. It was seen a significant tendency to have marked proteinuria in patients with SLE and APS compared to controls.Through this study it was seen a characteristic clinical and laboratory picture that may be useful in the identification of cases with APS in patients with SLE, in their follow-up and treatment.References:[1]Miyakis S, Lockshin MD, Atsumi T, et al.International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). Thromb Haemost 2006;4: 295–306.Disclosure of Interests:None declared

Plasma profiles of IL-6-like and TNF-like activities in brain-dead dogs

1991 ◽  
Vol 261 (5) ◽  
pp. R1133-R1140
Author(s):  
T. S. Huber ◽  
M. J. Kluger ◽  
S. P. Harris ◽  
L. G. D'Alecy
Keyword(s):  
Arterial Pressure ◽  
Brain Death ◽  
Operative Procedure ◽  
Systolic Arterial Pressure ◽  
Treated Group ◽  
Significant Elevation ◽  
Lps Challenge ◽  
Significant Difference ◽  
Brain Dead ◽  
The Brain

The progression to somatic death after brain death is poorly understood. The role of tumor necrosis factor (TNF) and interleukin-6 (IL-6) in this progression is unknown. TNF-like and IL-6-like plasma activities were assayed in a canine model of brain death in the presence and absence of a lipopolysaccharide (LPS) challenge (0.22 micrograms/kg). Bioassays for TNF-like and IL-6-like activities used WEHI and B9 cell lines, respectively. Brain death was induced by elevating and maintaining intracranial pressure above systolic arterial pressure. Anesthesia and the operative procedure did not cause a significant increase of either cytokine. Brain death (n = 8) itself did not cause a significant elevation of either cytokine compared with the sham brain-death control (n = 6) despite a significant decrease in mean arterial pressure (35 +/- 3 vs. 115 +/- 5 mmHg at 5 h). The brain-dead group treated with LPS (n = 6) responded with a significant elevation in IL-6-like and TNF-like activities compared with the vehicle-treated group. The rise of IL-6-like activity in response to LPS was greater in the brain-dead group than in the sham brain-dead group (n = 3); no significant difference was noted for the TNF-like response. We conclude that the progression to somatic death after brain death cannot be explained by increases in circulating TNF-like or IL-6-like activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of Coronavirus Disease 2019 in the Brain-Dead Candidates for Transplantation and Uncommon Manifestations of the Infection

2021 ◽  
Vol 17 ◽  
Author(s):  
Mohsen Aliakbarian ◽  
Rozita Khodashahi ◽  
Atefe Vakilian ◽  
Hamid Reza Naderi ◽  
Mandana Khodashahi ◽  
...  
Keyword(s):  
Brain Death ◽  
Laboratory Data ◽  
Clinical Information ◽  
Demographic Characteristics ◽  
Significant Difference ◽  
High Prevalence ◽  
Brain Dead ◽  
The Brain ◽  
Test Result ◽  
Pcr Test

Aim: This study aimed to evaluate the prevalence of Coronavirus Disease 2019 (COVID-19) positive cases meeting clinical brain death criteria; moreover, it was attempted to assess the uncommon manifestations of the infection in this study. Materials and Methods: This retrospective observational study was conducted on all brain-dead patients who were referred to the emergency department of hospitals in Mashhad, Iran, from February to October 2020. The demographic characteristics, clinical information, and laboratory data were collected and recorded in a researcher-made checklist. Results: In general, 70 patients were included in this study. The PCR test result was positive for COVID-19 in 54% of the patients, and syncope was reported in 16.1% of the cases (n=10). Furthermore, the majority of the patients (52.9%) showed central nervous system (CNS) hemorrhagic manifestations. A comparison was made between the patients with positive and negative PCR test result in terms of syncope; accordingly, there was a significant difference between them in this regard (χ2=4.5; P=0.03). The CNS hemorrhagic manifestations were significantly higher in patients with positive PCR compared to those with negative PCR (χ2=4.57, P=0.03). Moreover, the grand glass opacity and pleural effusion were the most common findings of the chest computed tomography in brain-dead patients with COVID-19. Conclusion: Due to the high prevalence of COVID-19 among brain-dead patients, it seems that syncope attack should be regarded as one of the possible symptoms of COVID-19. Moreover, syncope as a result of COVID-19 may itself cause traumatic events. It is worth mentioning that CNS hemorrhagic manifestations have been reported in more than half of the patients with brain death.

HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

2014 ◽  
pp. 47-50
Author(s):  
Duy Binh Ho ◽  
Nghi Thanh Nhan Le ◽  
Maasalu Katre ◽  
Koks Sulev ◽  
Märtson Aare
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Hip Fractures ◽  
Age Groups ◽  
Femoral Fractures ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
High Risk Population ◽  
Intertrochanteric Fractures ◽  
Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

scholarly journals Procedural times in early non-intubated VATS program - a propensity score analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabella Metelmann ◽  
Johannes Broschewitz ◽  
Uta-Carolin Pietsch ◽  
Gerald Huschak ◽  
Uwe Eichfeld ◽  
...  
Keyword(s):  
Propensity Score ◽  
Surgical Procedure ◽  
Recovery Time ◽  
Propensity Score Analysis ◽  
Wedge Resection ◽  
University Hospital ◽  
Implementation Phase ◽  
Score Analysis ◽  
Significant Difference ◽  
Procedural Time

Abstract Background Non-intubated video-assisted thoracic surgery (NiVATS) has been introduced to surgical medicine in order to reduce the invasiveness of anesthetic procedures and avoid adverse effects of intubation and one-lung ventilation (OLV). The aim of this study is to determine the time effectiveness of a NiVATS program compared to conventional OLV. Methods This retrospective analysis included all patients in Leipzig University Hospital that needed minor VATS surgery between November 2016 and October 2019 constituting a NiVATS (n = 67) and an OLV (n = 36) group. Perioperative data was matched via propensity score analysis, identifying two comparable groups with 23 patients. Matched pairs were compared via t-Test. Results Patients in NiVATS and OLV group show no significant differences other than the type of surgical procedure performed. Wedge resection was performed significantly more often under NiVATS conditions than with OLV (p = 0,043). Recovery time was significantly reduced by 7 min (p = 0,000) in the NiVATS group. There was no significant difference in the time for induction of anesthesia, duration of surgical procedure or overall procedural time. Conclusions Recovery time was significantly shorter in NiVATS, but this effect disappeared when extrapolated to total procedural time. Even during the implementation phase of NiVATS programs, no extension of procedural times occurs.

scholarly journals Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation

2021 ◽  
Author(s):  
Gurumayum Sonachand Sharma ◽  
Anupam Gupta ◽  
Meeka Khanna ◽  
Naveen Bangarpet Prakash
Keyword(s):  
Outcome Measures ◽  
Functional Outcomes ◽  
Rating Scale ◽  
Tertiary Care ◽  
Depression Scale ◽  
Inpatient Rehabilitation ◽  
University Hospital ◽  
Post Stroke ◽  
Significant Difference ◽  
Post Stroke Depression

Abstract Objective The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation. Patients and Methods The design involved is prospective observational study. The location involved is Neurological Rehabilitation unit in a tertiary care university hospital. The study period ranges from October 2019 to April 2020. The participants involved are the patients with first ever stroke, male and female with age ≥18 years and duration less than 1 year. All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression subscale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (MRS). Results There are a total of 30 participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (n = 17) had symptoms of depression (HADS-D >7). Participants in both groups (with and without depression) showed improvement in all the functional outcome measures (BI, SSS, MRS) at the time of discharge as compared with admission scores. The changes in the outcome measures were statistically significant within groups (p < 0.05) but not significant between the groups (p > 0.05). Conclusion The post-stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.

scholarly journals Short-Course Versus Long-Course Colistin for Treatment of Carbapenem-Resistant A.baumannii in Cancer Patient

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 484
Author(s):  
Wasan Katip ◽  
Suriyon Uitrakul ◽  
Peninnah Oberdorfer
Keyword(s):  
Clinical Response ◽  
Cancer Patients ◽  
Therapy Group ◽  
University Hospital ◽  
P Value ◽  
Chiang Mai ◽  
Carbapenem Resistant ◽  
Short Course ◽  
Significant Difference ◽  
Long Course

Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly reported nosocomial infections in cancer patients and could be fatal because of suboptimal immune defenses in these patients. We aimed to compare clinical response, microbiological response, nephrotoxicity, and 30-day mortality between cancer patients who received short (<14 days) and long (≥14 days) courses of colistin for treatment of CRAB infection. A retrospective cohort study was conducted in cancer patients with CRAB infection who received short or long courses of colistin between 2015 to 2017 at Chiang Mai University Hospital (CMUH). A total of 128 patients met the inclusion criteria. The results of this study show that patients who received long course of colistin therapy had a higher rate of clinical response; adjusted odds ratio (OR) was 3.16 times in patients receiving long-course colistin therapy (95%CI, 1.37–7.28; p value = 0.007). Microbiological response in patients with long course was 4.65 times (adjusted OR) higher than short course therapy (95%CI, 1.72–12.54; p value = 0.002). Moreover, there was no significant difference in nephrotoxicity (adjusted OR, 0.91, 95%CI, 0.39–2.11; p value = 0.826) between the two durations of therapy. Thirty-day mortality in the long-course therapy group was 0.11 times (adjusted OR) compared to the short-course therapy group (95%CI, 0.03–0.38; p value = 0.001). Propensity score analyses also demonstrated similar results. In conclusion, cancer patients who received a long course of colistin therapy presented greater clinical and microbiological responses and lower 30-day mortality but similar nephrotoxicity as compared with those who a received short course. Therefore, a long course of colistin therapy should be considered for management of CRAB infection in cancer patients.

scholarly journals High neutrophil-to-lymphocyte ratio predicts early neurological deterioration in spontaneous intracerebral hemorrhage patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Wafaa S. Mohamed ◽  
Amr E. Kamel ◽  
Ahmed H. Abdelwahab ◽  
Mohamed E. Mahdy
Keyword(s):  
Intracerebral Hemorrhage ◽  
Complete Blood Count ◽  
Absolute Lymphocyte Count ◽  
Neurological Deterioration ◽  
University Hospital ◽  
Stroke Severity ◽  
Low Grade ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Gcs Score

Abstract Background Intracerebral hemorrhage (ICH) is caused by bleeding, primarily into parenchymal brain tissue, and accounts for 9 to 27% of all strokes worldwide. Higher neutrophils, lower lymphocytes, and higher neutrophil-to-lymphocytes ratio (NLR) values predict worse outcomes after spontaneous intracranial hemorrhage (sICH) and could aid in the risk stratification of patients. Methods Eighty patients with sICH within the first 24 h of stroke onset and admitted into the neurology intensive care unit of an Egyptian university hospital and were assessed by GCS for consciousness level and NIHSS for stroke severity assessment, complete blood count, and special attention to NLR. Patients were reevaluated by GCS and NIHSS on the 7th day of the stroke. Early neurological deterioration (END) was defined as four points or a greater increase in the NIHSS score or two points or a greater decrease in GCS or death. Results END was recorded in 21.25% of patients while non-END was recorded in 78.75%. END was highly significantly associated with a low grade of GCS, high grade of NIHSS, elevated absolute lymphocyte count (ALC), and elevated NLR. Lower GCS score, higher NIHSS score, larger hematoma volume, and higher NLR values were independent predictors for END. The best cutoff of NLR in END prediction was > 9.1. Conclusion NLR is a trustworthy early predictor of sICH outcome.

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