scholarly journals Neurological Complications after Liver Transplantation According to Immunosuppressive Therapy

2020 ◽  
pp. 1-5
Author(s):  
Laura Tortolero ◽  
Laura Tortolero ◽  
Javier Nuño ◽  
Patricia Luengo ◽  
Luis Gajate ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Renal Failure ◽  
Immunosuppressive Therapy ◽  
Opportunistic Infections ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Number Of Patients ◽  
Group A ◽  
One Year ◽  
Group B

Background: Neurological complications (NC) after liver transplantation (LT) are frequent, appearing in up to 60% of patients. Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections. The use of basiliximab allows for less toxic immunosuppressive therapies. The aim of this study was to evaluate the neurological complications present during the first 30 days after LT and to evaluate its relationship with renal function, immunosuppressive therapy, and mortality. Methods: A total of 231 recipients were included in the retrospective, longitudinal, and nonrandomized study under 2 different immunosuppression protocols (with -group B- or without basiliximab -group A-). Results: NC were present in 14.3% of patients (n: 33), the average age of these patients was 55.4 years. The incidence of NC was significantly higher in group A than in group B (19.5% vs. 9.3% p <0.05), with no differences in the incidence of infection or rejection between both groups. The incidence of acute renal failure, the need for renal replacement therapy, the days of admission to the ICU, the days of hospital admission, as well as mortality during admission and one year after LT were higher among patients with NC. However, when analyzing patients with a neurological complication, patients in group A had a higher incidence of complications than in group B. Conclusion: The use of immunosuppressive therapies that apply lower doses of anticalcineurinics and with a later onset, classically called nephroprotective as used in group B, could also be neuroprotective, reducing the appearance of neurological complications and, therefore, morbidity. These findings most be verified in studies with a larger number of patients and randomized.

scholarly journals Effects of Intraoperative Lung-Protective Ventilation on Clinical Outcomes in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Lulu Jiang ◽  
Yujuan Wu ◽  
Yang Zhang ◽  
Dahao Lu ◽  
Keshi Yan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Controlled Trial ◽  
Neurological Complication ◽  
Serum Levels ◽  
Neurological Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Group A ◽  
Group B

Abstract Background: Secondary lung injury is the most common non-neurological complication after traumatic brain injury (TBI). Lung-protective ventilation (LPV) has been proven to improve perioperative oxygenation and lung compliance in some critical patients. This study aimed to investigate whether intraoperative LPV could improve respiratory function and prevent postoperative complications in emergency TBI patients.Methods: Ninety TBI patients were randomly allocated to three groups (1:1:1): Group A, conventional mechanical ventilation [tidal volume (VT) 10mL/kg only]; Group B, small VT (8mL/kg) + positive end-expiratory pressure (PEEP) (5cmH2O); Group C, small VT (8mL/kg) + PEEP (5cmH2O) + recruitment maneuvers (RMs). Primary outcomes were intraoperative respiratory mechanics parameters and incidences of postoperative pulmonary complications; Secondary outcomes were serum levels of brain injury markers and incidences of postoperative neurological complications.Results: Seventy-nine patients completed final analysis. Intraoperative PaO2 and dynamic pulmonary compliance of Group B and C were higher than those of Group A (P=0.028; P=0.005), while their airway peak pressure and plateau pressure were lower than those of group A (P=0.004; P=0.005). Compared to Group A, postoperative 30-day incidences of hypoxemia, pulmonary infection and atelectasis of the other two groups significantly decreased (52.0% vs. 14.3% vs. 19.2%, P=0.005; 84.0% vs. 50.0% vs. 42.3%, P=0.006; 24.0% vs. 3.6% vs. 0.0%, P=0.004). Moreover, intraoperative hypotension in Group C was more frequent than that in Group A and B (P=0.007). At the end of surgery, serum levels of glial fibrillary acidic protein and ubiquitin carboxyl-terminal hydrolase isozyme L1 in Group B were lower than those in group A and C (P=0.002; P<0.001). Postoperative incidences of neurological complications among three groups were comparable. Conclusions: Intraoperative continuous administration of small VT + PEEP is beneficial to TBI patients. Additional RMs with caution can be performed to prevent the disturbance of the stability of cerebral hemodynamics.Trial registration: Chinese Clinical Trial Registry (ChiCTR2000038314), retrospectively registered on September 17, 2020.

Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0220-0228 ◽  
Author(s):  
Marion Vircoulon ◽  
Carine Boulon ◽  
Ileana Desormais ◽  
Philippe Lacroix ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Medical Group ◽  
Consensus Definition ◽  
Transcutaneous Oxygen ◽  
European Consensus ◽  
Group A ◽  
One Year ◽  
Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

scholarly journals Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

2019 ◽  
Vol 6 (1) ◽  
pp. 8-13
Author(s):  
Birendra Kumar Yadav ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parish Mani Shrestha
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Operation Time ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Stone Characteristics ◽  
Negative Urine Culture ◽  
Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

2021 ◽  
Author(s):  
Beniamino Brunetti ◽  
Rosa Salzillo ◽  
Stefania Tenna ◽  
Bruno Brunetti ◽  
Mario Alessandri Bonetti ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Locoregional Recurrence ◽  
Demographic Data ◽  
Exact Test ◽  
Significant Difference ◽  
Chi Squared ◽  
Group A ◽  
The Aesthetic ◽  
One Year ◽  
Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

Immunity to Diphtheria, Pertussis, Tetanus, and Poliomyelitis in Children with Acute Lymphocytic Leukemia After Cessation of Chemotherapy

PEDIATRICS ◽  
1981 ◽  
Vol 67 (2) ◽  
pp. 222-229 ◽  
Author(s):  
A. van der Does-van den Berg ◽  
J. Hermans ◽  
J. Nagel ◽  
G. van Steenis
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Lymphocytic Leukemia ◽  
First Year ◽  
Healthy Children ◽  
Healthy Control ◽  
Antibody Titers ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Antibody Levels

Antibody titers to diphtheria, pertussis, tetanus, and poliomyelitis (types I to III) were measured in previously vaccinated children with acute lymphocytic leukemia in remission after cessation of therapy. The response to revaccination one year after therapy was stopped was also studied. The patients' antibody titers were compared with those of healthy children, matched for age and sex. Two groups of patients were studied: one group (group A, N = 30) was given two drugs (6-mercaptopurine, methotrexate); the other group (group B, N= 19) was given three drugs (6-mercaptopurine, methotrexate, and cyclophosphamide) for maintenance treatment. In general, the patients' antibody titers were lower than those of healthy children, but in most patients they were still at levels considered to be protective. No significant differences in antibody levels between the two patient groups were found. A spontaneous rise in antibody titers in the first year after termination of therapy was not observed. After revaccination the rise in antibody titers was correlated with preexisting antibody titers in the same way in patients as in healthy children, and the antibody titers in patients and in healthy control subjects were on roughly the same level.

scholarly journals Association of Hematuria with Renal Progression and Survival in Patients Who Underwent Living Donor Liver Transplant

2021 ◽  
Vol 10 (19) ◽  
pp. 4345
Author(s):  
Kai-Chieh Chang ◽  
Yao-Peng Hsieh ◽  
Huan-Nung Chao ◽  
Chien-Ming Lin ◽  
Kuo-Hua Lin ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Living Donor ◽  
Donor Liver ◽  
Living Donor Liver Transplant ◽  
Group A ◽  
Renal Progression ◽  
Group B ◽  
Donor Liver Transplant

Background: This study aimed to determine the association between episodic or persistent hematuria after liver transplantation and long-term renal outcomes. Methods: Patients who underwent living donor liver transplantation between July 2005 and June 2019 were recruited and divided into two groups based on the finding of microscopic or gross hematuria after transplantation. All patients were followed up from the index date until the end date in May 2020. The risks of chronic kidney disease, death, and 30% and 50% declines in estimated glomerular filtration rate (eGFR) were compared between groups. Results: A total of 295 patients underwent urinalysis for various reasons after undergoing transplantation. Hematuria was detected in 100 patients (group A) but was not present in 195 patients (group B). Compared with group B, group A had a higher risk of renal progression, including eGFR decline >50% [aHR = 3.447 (95%CI: 2.24~5.30), p < 0.001] and worse survival. In addition, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) continuously for over seven days within six months before transplant surgery had high risks of rapid renal progression, including a >30% decline in eGFR [aHR = 1.572 (95%CI: 1.12~2.21), p = 0.009)]. Conclusion: Development of hematuria after surgery in patients who underwent living donor liver transplant and were exposed to NSAIDs before surgery were associated with worse long-term renal dysfunction and survival.

scholarly journals INTRAVENOUS REGIONAL ANESTHESIA (BIERS BLOCK);

2012 ◽  
Vol 19 (05) ◽  
pp. 710-714
Author(s):  
Muhammad ASGHER ◽  
ASIM GHAURI ◽  
MUHAMMAD ABDULLAH ◽  
Tariq Abassi
Keyword(s):  
Regional Anaesthesia ◽  
Military Hospital ◽  
P Value ◽  
Complete Evaluation ◽  
Intravenous Regional Anesthesia ◽  
Number Of Patients ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Intravenous Regional Anaesthesia

Objective: To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regionalanaesthesia technique with those of Lidocaine (0.5%) alone to prevent post operative pain after intravenous regional anaesthesia (Biersblock). Study design: Randomized Control Trial. Place and duration of study: The study was carried out at Department of Anaesthesiology,Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. Patients and Methods: Thestudy was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients weredivided into two equal groups (group A and group B). The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution.The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale(VAS) on 15,30minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, wascompared using student’s t - test. p value of less than 0.05 was considered statistically significant. Results: In group A 33 males and 42 femaleswere enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 ± 6.03years while in group B was 32.99 ± 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classifiedas ASA – I and 63 patients as ASA – II. Group B which received Ketorolac in addition to Lidocaine for Bier’s block had low visual analogue scoresas compared to group A which received only Lidocaine for Bier’s block. P values obtained after the comparison of the mean VAS of two groupsat 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 (0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour,0.004 for 1.5 hours and 0.001 for 2 hours). Conclusions: Ketorolac improves the postoperative analgesia markedly when used with Lidocainein intravenous regional anaesthesia.

scholarly journals Amino acid infusion in oligohydromnios and increase in AFI and impact on perinatal outcome

2019 ◽  
Vol 8 (2) ◽  
pp. 617
Author(s):  
Isha Sunil ◽  
Chejerla Sunitha ◽  
Harkirat Kaur
Keyword(s):  
Amino Acid ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Apgar Scores ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Vaginal Deliveries ◽  
Group A ◽  
One Year ◽  
Group B

Background: Decreased amniotic fluid is related to adverse maternal and perinatal outcomes. The purpose of this study was to evaluate the role of amino acid infusion in patients of oligohydromnios and compare the perinatal outcome in the two groups.Methods: This study was conducted in the Department of Obstetrics and Gynaecology, ASCOMS Hospital, Jammu for a period of one year from October 2017 to September 2018. A total of 50 women with AFI <8 cm were enrolled in the study . They were divided into two groups of 25 each. Group A were given amino acid infusion and Group B were not given any intervention. These were compared for increase in AFI and perinatal outcome.Results: In the present study, the gain in AFI in Group A was 2.32 ± 0.67 and in group B was 1.32 ± 1.03 which was statistically significant. The perinatal outcome was better Group A compared to Group B with decreased incidence of meconium stained liquor, low birth weight, low APGAR scores and NICU admissions and increase in vaginal deliveries as compared to caesarean sections.Conclusions: The present study suggests that parentral transfusion of amino acid in cases of oligohydromnios significantly increases the AFI of the patient and decreases the incidence of caesarean sections, meconium stained liquor, low APGAR scores and NICU admissions.

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

Single-choice or multiple true false questions (Kprime):Direct comparison of online tests in pharmacology over one year (Preprint)

2021 ◽  
Author(s):  
Joachim Neumann ◽  
Stephanie Simmrodt ◽  
Beatrice Bader ◽  
Bertram Opitz ◽  
Ulrich Gergs
Keyword(s):  
Medical Students ◽  
Multiple Choice ◽  
Test Group ◽  
Learning Objectives ◽  
Multiple Choice Questions ◽  
Online Test ◽  
True Answer ◽  
Group A ◽  
One Year ◽  
Group B

BACKGROUND There remain doubts about whether multiple choice answer formats (single choice) offer the best option to encourage deep learning or whether SC formats simply lead to superficial learning or cramming. Moreover, cueing is always a drawback in the SC format. Another way to assess knowledge is true multiple-choice questions in which one or more answers can be true and the student is not aware of how many true answers are to be anticipated (K´ or Kprime question format). OBJECTIVE Here, we compared both single-choice answers (one true answer, SC) with Kprime answers (one to four true answers out of four answers, Kprime) for the very same learning objectives in a study of pharmacology in medical students. METHODS Two groups of medical students were randomly subjected to a formative online test: group A) was first given 15 SC (#1-15) followed by 15 different Kprime questions (#16-30). The opposite design was used for group B. RESULTS The mean number of right answers was higher for SC than for Kprime questions in group A (10.02 vs. 8.63, p < 0.05) and group B (9.98 vs. 6.66, p < 0.05). The number of right answers was higher for nine questions of SC compared to Kprime in group A and for eight questions in group B (pairwise T-Test, p < 0.05). Thus, SC is easier to answer than the same learning objectives in pharmacology given as Kprime questions. One year later, four groups were formed from the previous two groups and were again given the same online test but in a different order: the main result was that all students fared better in the second test than in the initial test; however, the gain in points was highest if initially mode B was given. CONCLUSIONS Kprime is less popular with students being more demanding, but could improve memory of subject matter and thus might be more often used by meidcal educators.

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