scholarly journals EVALUATING THE EFFECTIVENESS OF PRIMARY ANALGESIC AND SUBSEQUENT COMBINED MET–THERAPY IN RENAL COLIC THERAPY

2020 ◽  
Vol 20 (3) ◽  
pp. 110-114
Author(s):  
D.M. Ivashchenko ◽  
M.O. Dudchenko ◽  
M.I. Kravtsiv ◽  
M.P. Shevchyk
Keyword(s):  
Renal Colic ◽  
Clinical Importance ◽  
Clinical Results ◽  
Acute Attack ◽  
Occurrence Rate ◽  
Pharmacological Management ◽  
Medical Expulsive Therapy ◽  
Pain Attack ◽  
Number Of Patients ◽  
Symptom Complex

Renal colic is an acute pathological symptom complex, which, despite all the achievements of medicine, demonstrates constant occurrence rate of about 12% in the human population. This condition is characterized by a pronounced sudden pain attack, which causes significant suffering to the patient. Therefore, the search for effective and safe methods of analgesia and the search for ways to correct urinary obstruction as a cause of pain are of great clinical importance. The aim of the study was to assess the effectiveness of analgesic and combined lithoeradicative therapy to improve the management of patients with acute attack of renal colic. The clinical study included 228 individuals admitted to the hospital with a diagnosis of renal colic. At the first stage, they were divided into three groups to assess the effectiveness of the pharmacological management of primary analgesia. At the second stage, 96 patients were examined, and then divided into 2 subgroups in order to assess the effectiveness of medical expulsive therapy in its mono–variant and in combination with spasmolytics. The results obtained demonstrated that during the primary analgesic therapy of renal colic, non–steroidal anti–inflammatory drugs have advantages over the opioid group that is manifested by a stronger analgesic effect and less severe adverse reactions. Diclofenac showed the best results in pain relief, superior to other drugs by 5–7%. When evaluating the effectiveness of combined medical expulsive therapy, the data obtained indicate an increase in the chances of calculi passage by 11% in the group, which received drotaverine additionally to the therapeutic scheme, and, consequently, a decrease in the number of patients requiring further surgery. This group also demonstrated a pain reduction by 6–7%. Summarizing the data obtained, we can recommend the administration of diclofenac in a dose of 75 mg for primary analgesia of renal colic, and when conducting medical expulsive therapy, combine α–blockers and spasmolytics should be applied. This will lead to improved clinical results in patients with renal colic.

scholarly journals Pharmacological management of seizures in patients with COVID-19: a systematic review

2021 ◽  
Vol 4 ◽  
pp. 29
Author(s):  
Priscilla Kolibea Mante ◽  
Nana Ofori Adomako ◽  
John-Paul Omuojine ◽  
Paulina Antwi
Keyword(s):  
Systematic Review ◽  
Sodium Valproate ◽  
Case Reports ◽  
Meta Analysis ◽  
Descriptive Data ◽  
Pharmacological Management ◽  
Drug Choice ◽  
Number Of Patients ◽  
Clonic Seizures ◽  
Antiepileptic Drug Therapy

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

scholarly journals Cervical arterial dissection: clinical characteristics in a neurology service in São Paulo, Brazil

2019 ◽  
Vol 77 (9) ◽  
pp. 632-637
Author(s):  
Danyelle Sadala Reges ◽  
Marcela Mazzeo ◽  
Rafael Rosalino ◽  
Vivian Dias Baptista Gagliardi ◽  
Leandro Gama Cerqueira ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Rare Event ◽  
Clinical Results ◽  
Medical Professional ◽  
Arterial Dissection ◽  
Common Risk Factor ◽  
Patients Âgés ◽  
Number Of Patients ◽  
Using Data

ABSTRACT Cervical arterial dissection accounts for only a small proportion of ischemic stroke but arouses scientific interest due to its wide clinical variability. Objective: This study aimed to evaluate its risk factors, outline its clinical characteristics, compare treatment with antiaggregation or anticoagulation, and explore the prognosis of patients with cervical arterial dissection. Methods: An observational, retrospective study using data from medical records on patients with cervical arterial dissection between January 2010 and August 2015. Results: The total number of patients was 41. The patients' ages ranged from 19 to 75 years, with an average of 44.5 years. The most common risk factor was smoking. Antiaggregation was used in the majority of patients (65.5%); 43% of all patients recanalized in six months, more frequently in patients who had received anticoagulation (p = 0.04). Conclusion: The presence of atherosclerotic disease is considered rare in patients with cervical arterial dissection; however, our study found a high frequency of hypertension, smoking and dyslipidemia. The choice of antithrombotic remains controversial and will depend on the judgment of the medical professional; the clinical results with anticoagulation or antiaggregation were similar but there was more recanalization in the group treated with anticoagulation; its course was favorable in both situations. The recurrence of cervical arterial dissection and stroke is considered a rare event and its course is favorable.

scholarly journals Childhood Asthma: Diagnosis and Treatment

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-18 ◽  
Author(s):  
Wim M. van Aalderen
Keyword(s):  
Asthma Control ◽  
Negative Impact ◽  
Airflow Limitation ◽  
Inhalation Technique ◽  
Pharmacological Management ◽  
School Aged Children ◽  
Number Of Patients ◽  
Incorrect Diagnosis ◽  
Poor Inhalation Technique

Many children suffer from recurrent coughing, wheezing and chest tightness. In preschool children one third of all children have these symptoms before the age of six, but only 40% of these wheezing preschoolers will continue to have asthma. In older school-aged children the majority of the children have asthma. Quality of life is affected by asthma control. Sleep disruption and exercised induced airflow limitation have a negative impact on participation in sports and social activities, and may influence family life. The goal of asthma therapy is to achieve asthma control, but only a limited number of patients are able to reach total control. This may be due to an incorrect diagnosis, co-morbidities or poor inhalation technique, but in the majority of cases non-adherence is the main reason for therapy failures. However, partnership with the parents and the child is important in order to set individually chosen goals of therapy and may be of help to improve control. Non-pharmacological measures aim at avoiding tobacco smoke, and when a child is sensitised, to avoid allergens. In pharmacological management international guidelines such as the GINA guideline and the British Guideline on the Management of Asthma are leading.

Effect of sleeved ceramic femoral heads on titanium ion release

2017 ◽  
Vol 28 (2) ◽  
pp. 139-144 ◽  
Author(s):  
Anthony Deny ◽  
Janie Barry ◽  
Jonathan R.B. Hutt ◽  
Martin Lavigne ◽  
Vincent Massé ◽  
...  
Keyword(s):  
Whole Blood ◽  
Metal Ion ◽  
Large Diameter ◽  
Clinical Signs ◽  
Clinical Importance ◽  
Clinical Results ◽  
Ion Release ◽  
Metal Debris ◽  
Metal Ion Release ◽  
Femoral Heads

Introduction: Metal ion release from wear and corrosion at the femoral head-stem taper junction can evoke local adverse reactions to metal debris (ARMD). In a specific large-diameter head (LDH) total hip arthroplasty (THA) system, ceramic femoral heads of 44 to 48 mm are available with a titanium (Ti) adaptor sleeve, while heads of 36- to 40-mm come without sleeves. The hypothesis of this study is that the Ti adaptor sleeve with LDH ceramic-on-ceramic (CoC) bearings will not cause wear or corrosion at the taper junction and, thus, will not generate high whole blood Ti ion levels. Methods: We compared whole blood Ti levels at minimum 1-year follow-up in 27 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48 mm using a Ti stem and acetabular component. Results: Although Ti ion levels in patients with 36- to 40-mm head diameters without Ti sleeve were found to be statistically significantly higher (2.3 μg/l: 1.6-3.1, SD 0.44) compared to those with a Ti sleeve (1.9 μg/l: 1.6-2.2, SD 0.19) (p = 0.020), the found difference has no clinical importance. No patients presented clinical signs of ARMD, and the clinical results in both groups were similar. Conclusions: LDH CoC THA Ti levels were low and probably related to unavoidable passive corrosion of implant surfaces. Measurement of Ti in subjects with ceramic LDH, with or without Ti adaptor sleeve, did not disclose undirected signs of trunnionosis.

scholarly journals The Metabolic Syndrome Is Associated with Complicated Gallstone Disease

2011 ◽  
Vol 25 (5) ◽  
pp. 274-276 ◽  
Author(s):  
Naim Ata ◽  
Metin Kucukazman ◽  
Bunyamin Yavuz ◽  
Hakan Bulus ◽  
Kursat Dal ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Gallstone Disease ◽  
Clinical Importance ◽  
Model Assessment ◽  
Biochemical Tests ◽  
The Metabolic Syndrome ◽  
Number Of Patients ◽  
Significant Difference

BACKGROUND: Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition.OBJECTIVE: To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components.METHODS: Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests.RESULTS: Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD.CONCLUSION: Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.

scholarly journals A Perspective on Robotic Assistance for Knee Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Nathan A. Netravali ◽  
Feimo Shen ◽  
Youngbae Park ◽  
William L. Bargar
Keyword(s):  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Clinical Results ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Implant Design ◽  
Robotic Assistance ◽  
Surgical Assistance ◽  
Number Of Patients ◽  
Assistance Systems

Knee arthroplasty is used to treat patients with degenerative joint disease of the knee to reduce pain and restore the function of the joint. Although patient outcomes are generally quite good, there are still a number of patients that are dissatisfied with their procedures. Aside from implant design which has largely become standard, surgical technique is one of the main factors that determine clinical results. Therefore, a lot of effort has gone into improving surgical technique including the use of computer-aided surgery. The latest generation of orthopedic surgical tools involves the use of robotics to enhance the surgeons’ abilities to install implants more precisely and consistently. This review presents an evolution of robot-assisted surgical systems for knee replacement with an emphasis on the clinical results available in the literature. Ever since various robotic-assistance systems were developed and used clinically worldwide, studies have demonstrated that these systems are as safe as and more accurate than conventional methods of manual implantation. Robotic surgical assistance will likely result in improved surgical technique and improved clinical results.

scholarly journals Comparison of radiological and clinical outcomes, complications, and implant removals in anatomically pre-contoured clavicle plates versus reconstruction plates - a propensity score matched retrospective cohort study of 106 patients

2020 ◽  
Author(s):  
Christian Fang ◽  
Ruiping Liu ◽  
Dennis King Hang Yee ◽  
Jackie Chau ◽  
Tak-Wing Lau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Plate Fixation ◽  
Clinical Results ◽  
Shoulder Range Of Motion ◽  
Locking Compression Plates ◽  
Number Of Patients

Abstract Background: Plate fixation is frequently used to treat displaced midshaft clavicular fractures, however the ideal plate choice remains subject to discussion; reconstruction locking compression plates (RLCPs) are cheaper and can be easily contoured, whereas anatomically pre-contoured locking compression plates (ALCPs) are thought to provide better stability and therefore lower rates of mechanical failure.Objective: To compare the incidence of mechanical failures, functional and radiological outcomes in patients with midshaft clavicular fractures treated with ALCPs versus RLCPs. Methods: A propensity score matched retrospective cohort study was conducted across two trauma centers. 106 consecutively recruited patients with displaced midshaft clavicular fractures, who were treated with plate fixation and had a minimum follow-up of 6 months, were matched on gender, age, fracture grading, energy of injury, and fracture location. The resulting groups included 53 ALCP-treated fractures and 53 matched controls treated with RLCPs. Results: During a mean follow-up of 20.5 months, there were no implant deformities in the ALCP group whereas the RLCP group had 6 patients (11.3%, p=0.012) with implant deformities (5 occurrences of plate bending with fracture union, and 1 plate breakage with nonunion). Despite the higher rate of plate deformities in the RLCP group, there were no statistically significant differences in number of patients recovering full shoulder range of motion (ALCP 90.6%, RLCP 88.7%, p=0.751), incidence of rest pain (ALCP 13.2%, RLCP 9.4%, p=0.542), or implant removals (ALCP 49.1%, RLCP 56.6%, p=0.439). Conclusion: ALCPs may be superior to RLCPs in terms of implant stability but appear to produce similar clinical results.

scholarly journals Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery

2020 ◽  
Vol 19 (4) ◽  
pp. 2540
Author(s):  
O. N. Dzhioeva ◽  
O. M. Drapkina
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Perioperative Complications ◽  
Risk Index ◽  
Clinical Importance ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Improvement Program ◽  
Deliberate Hypotension ◽  
Number Of Patients

Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications.  It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.

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