scholarly journals PREDICTING INFECTIOUS COMPLICATIONS IN ACUTE PANCREATITIS COMPLICATED BY ASCITIS AND PERITONITIS

2020 ◽  
Vol 20 (3) ◽  
pp. 114-118
Author(s):  
V.V. Kasian
Keyword(s):  
Acute Pancreatitis ◽  
Early Stage ◽  
Statistical Significance ◽  
Early Period ◽  
Infectious Complications ◽  
Study Group ◽  
Oral Antibiotic ◽  
Septic Complications ◽  
Surgical Department ◽  
Significant Difference

Ascites and peritonitis are fairly common complications of acute pancreatitis in the early stage of the disease. At the beginning of acute severe pancreatitis, in most cases, death occurs as a result of multiple organ failure, and starting from the second week, infectious complications can play a more serious and adverse role. However, the diagnosis of infected pancreatitis is difficult as the clinical picture does not differ from the inflammatory reaction caused by pancreatitis itself. Although the peak of infectious complications is observed mainly from the second to the fourth week since the onset of the disease, the timing of infection in pancreatic necrosis is variable and unpredictable. The aim of the study was to analyze the prognostic potential of procalcitonin in predicting the development of infectious complications in the dynamic course of acute pancreatitis complicated by ascites and peritonitis. We analyzed the findings obtained from a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites and peritonitis, including 13 patients who were treated at the surgical department of M. Sklifosovskiy Poltava Regional Clinical Hospital, and 5 patients at other emergency care settings in Poltava for 2017 – 2019. In addition to standards examination methods, procalcitonin was assessed as a biomarker to predict the adverse course of the disease in the early period. Statistical analysis of the findings was performed by the program "STATISTICA 10.0" (StatSoft, Inc., USA); methods of descriptive statistics to calculate qualitative indicators as frequencies and their percentages in the study groups were applied. The statistical significance of differences was determined by a nonparametric method between the indicators of independent groups using Fisher's exact test. Differences at p <0.05 were considered statistically significant. Infectious complications in the dynamics of the disease occurred in 39% of patients in the study group. 86% of them demonstrated an increased procalcitonin concentration at admission to the hospital. A significant difference was found (p = 0.005) when comparing differences in the occurrence of infectious complications in the dynamics of the disease in the patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospital admission. We can suggest that measuring procalcitonin to predict the occurrence of infectious complications in the dynamics of the disease will allow us to detect patients in who reduced risk of flora translocation by parenteral drugs being tropic to pancreatic tissue and early oral antibiotic prophylaxis may lessen the incidence of septic complications.

scholarly journals PROCALCITONIN IN EARLY PREDICTION OF ACUTE SEVERE PANCREATITIS

2020 ◽  
Vol 73 (7) ◽  
pp. 1370-1372
Author(s):  
Volodymyr V. Kasian ◽  
Volodymyr D. Sheiko ◽  
Tetiana V. Mamontova ◽  
Liudmyla E. Vesnina ◽  
Oksana A. Shlykova
Keyword(s):  
Acute Pancreatitis ◽  
Early Period ◽  
Infectious Complications ◽  
Pancreatic Tissue ◽  
Screening Methods ◽  
Oral Antibiotic ◽  
Septic Complications ◽  
Key Words Acute Pancreatitis ◽  
Surgical Department ◽  
Significant Difference

The aim of the study was to analyze the prognostic potential of procalcitonin in acute pancreatitis complicated by ascites-peritonitis. Materials and methods: The study analyzed the results of a comprehensive examination and treatment of 18 patients with acute pancreatitis complicated by enzymatic ascites-peritonitis, including 13 patients who were treated in the surgical department of KP “Poltava Regional Clinical Hospital. MV Sklifosovsky POR “, and 5 patients of other emergency hospitals in Poltava, in the period from 2017 to 2019. In addition to standard screening methods, these patients were additionally tested for procalcitonin to predict an adverse course in the early period. Results: To assess the relationship between the presence of elevated procalcitonin levels at the time of hospitalization of 0.5 ng / ml and above and unsatisfactory treatment results, differences were assessed using an accurate Fisher test. When comparing differences in the development of infectious complications in the dynamics of the disease in patients of the study group depending on the presence of elevated concentrations of procalcitonin or its absence at the time of hospitalization, a significant difference was found (p <0.05). Conclusions: In our opinion, the use of procalcitonin as a predictor of infectious complications in the dynamics of the disease will determine the category of patients in whom reducing the risk of flora translocation through the use of early oral antibiotic prophylaxis and parenteral drugs tropic to pancreatic tissue may reduce the incidence of purulent complications. In another category of patients, antibacterial therapy is not advisable due to the low risk of purulent-septic complications. KEY WORDS: acute pancreatitis, procalcitonin, ascites-peritonitis, severity of the condition

Comparative study of Clinical Characteristics in Patients with Mild and Severe Reflux Esophagitis

2020 ◽  
Vol 66 (1) ◽  
pp. 19-22
Author(s):  
Melania Macarie ◽  
Simona Maria Bataga ◽  
Monica Pantea ◽  
Razvan Opaschi ◽  
Simona Mocan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Ratio ◽  
Hiatal Hernia ◽  
Statistical Significance ◽  
Erosive Esophagitis ◽  
Male Gender ◽  
Consecutive Series ◽  
Study Group ◽  
Entire Study ◽  
Significant Difference

AbstractObjective: This study aims to determine the correlation between risk factors and erosive esophagitis development.Methods: We conducted a retrospective observational study on a consecutive series of 19.672 patients who underwent upper gastrointestinal endoscopy between 01.01.2011-31.12.2017. A total of 3005 patients, diagnosed with erosive esophagitis, were included in the present study and stratified according to Los Angeles classification.Results: During the studied period we found 3005 patients with erosive esophagitis, sex ratio male to female was 1.3/1, the most common forms of esophagitis being grade A and B: 74.54% patients with esophagitis grade A, 14.80% patients with grade B; 5.29% patients were with grade C and 5.35% patients with esophagitis grade D. In severe esophagitis the male predominance was more prevalent (249 males, 71 female), with a sex ratio 3.50/1. The correlation of male gender with severe esophagitis was highly statistically significant (p < 0.0001, OR 2.97; 95% CI 2.25-3.91). Hiatal hernia was diagnosed in 1171 patients, the presence of large hiatal hernias, being an important predictor, with statistical significance (p < 0.0001, OR 3.41; 95% CI 2.22-5.21), for severe esophagitis development. Incidence of Helicobacter pylori infection was 11.51%, in the entire study group, with no statistical significant difference between patients with mild or severe esophagitis (12.02% vs 7.18%).Conclusion: Erosive esophagitis is a frequent disease, the most common forms being grade A and B. Male gender and the presence of hiatal hernia are the most important risk factors for erosive esophagitis development, in our study group.

scholarly journals Introducing intrauterine antibiotic infusion as a novel approach in effectively treating chronic endometritis and restoring reproductive dynamics: a randomized pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Konstantinos Pantos ◽  
Mara Simopoulou ◽  
Evangelos Maziotis ◽  
Anna Rapani ◽  
Sokratis Grigoriadis ◽  
...  
Keyword(s):  
Fertility Restoration ◽  
Statistical Significance ◽  
Antibiotic Administration ◽  
Oral Antibiotic ◽  
Treatment Rate ◽  
Chronic Endometritis ◽  
Vitro Fertilization ◽  
Significant Difference ◽  
Antibiotic Infusion

AbstractThe chronic nature of Chronic Endometritis (CE) along with the challenging management and infertility entailed, call for cutting-edge therapeutic approaches. This study introduces the novel treatment of intrauterine antibiotic infusion (IAI) combined with oral antibiotic administration (OAA), and it assesses respective performance against the gold standard treatment of OAA. Data sourced herein reports on treatment efficiency and fertility restoration for both patients aiming to conceive naturally or via In Vitro fertilization. Eighty CE patients, 40 presenting with recurrent implantation failure, and 40 with recurrent pregnancy loss, were enrolled in the IVF and the natural conception arm respectively. Treatment was subjected to randomization. Effectively treated patients proceeded with either a single IVF cycle or were invited to conceive naturally over a 6-month period. Combination of IAI and OAA provided a statistically significant enhanced effectiveness treatment rate (RR 1.40; 95%CI 1.07–1.82; p = 0.01). No statistically significant difference was observed regarding the side-effects rate (RR 1.33; 95%CI 0.80–2.22; p = 0.52). No statistically significant difference was observed for either arm regarding live-birth rate. Following an intention-to-treat analysis, employment of IAI corresponds to improved clinical pregnancy rate-albeit not reaching statistical significance. In conclusion, complimentary implementation of IAI could provide a statistically significant enhanced clinical treatment outcome.

scholarly journals The Connection of the Level of Estradiol in Serum and Obesity with the Endometrial Bleeding in Postmenopausal Women

2019 ◽  
Vol 7 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Valentina Tofiloska ◽  
Maria Krstevska ◽  
Ana Daneva-Markova ◽  
Viktorija Jovanovska
Keyword(s):  
Endometrial Cancer ◽  
Statistical Significance ◽  
Abnormal Uterine Bleeding ◽  
Control Group ◽  
Prospective Clinical Study ◽  
Study Group ◽  
Gynecology And Obstetrics ◽  
Increased Risk ◽  
Significant Difference ◽  
Post Menopausal

BACKGROUND: Postmenopausis is a period that begins one year after the last menstrual period. Abnormal uterine bleeding could be of different origins. AIM: This study aimed to determine the association of serum estrogen hormone levels and obesity with the occurrence of endometrial bleeding in post-menopausal women. MATERIAL AND METHODS: Prospective clinical study involving 120 postmenopausal patients treated at the University Clinic for Gynecology and Obstetrics-Skopje, divided into two groups: control and study. The control group consisted of 40 postmenopausal patients without endometrial bleeding, hospitalised and operated due to urogenital pathology. The study group consisted of 80 patients with endometrial bleeding who were divided into three subgroups according to the thickness of the endometrium: from 5-8 mm, 8-11 mm and above 11 mm. In all subjects, estradiol and BMI was determined. RESULTS: Estradiol levels were statistically higher in the study group compared to control while statistically significant difference among the three subgroups according to the thickness of the endometrium about the levels of estradiol in blood is not found. About BMI, the results showed that there was no statistical significance between the two examined groups. CONCLUSION: Patients with endometrial bleeding have increased levels of estradiol and are at increased risk of endometrial cancer about controls, the likelihood of endometrial cancer significantly increases by 1,108 times.

Effect of Presurgical Nasoalveolar Molding on Nasal Symmetry in Unilateral Complete Cleft Lip/Palate Patients after Primary Cheiloplasty without Concomitant Nasal Cartilage Dissection

2018 ◽  
Vol 55 (7) ◽  
pp. 935-940 ◽  
Author(s):  
Zhigang Liang ◽  
Jinfeng Yao ◽  
Philip K.T. Chen ◽  
Cangshang Zheng ◽  
Jiying Yang
Keyword(s):  
Repeated Measures ◽  
Cleft Lip ◽  
Early Stage ◽  
Statistical Significance ◽  
Deformity Correction ◽  
Nasal Cartilage ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Nasoalveolar Molding

Objective: The objective of this study was to assess the efficacy of presurgical nasoalveolar molding (PNAM) on long-term nasal symmetry and shaping after primary cheiloplasty in patients with unilateral complete cleft lip/palate (UCL/P). Design: This was a two-group, parallel, retrospective, randomized clinical trial. Setting: The setting for this study was the Chang Gung Craniofacial Center in Taoyuan, Taiwan. Patients: Patients were divided into one of the following two groups: infants with UCL/P who underwent PNAM (PNAM group, n = 42) and infants with UCL/P who did not undergo PNAM (non-PNAM group, n = 42). Interventions: Interventions included PNAM and primary cheiloplasty without nasal cartilage dissection. Main Outcome Measures: In this study, 4- to 5-year postoperative full-face and submental oblique photographs were taken of all patients and scored from 1 to 5 points by 10 medical evaluators. The scores were statistically analyzed using repeated-measures analysis of variance, and P < .05 was considered to represent statistical significance. Results: After 1 to 3 months of PNAM but before primary cheiloplasty, the displaced nasal and alveolar cartilage showed obvious improvement. However, the scores in the PNAM and non-PNAM groups at 4 to 5 years postoperatively were 66.62 ± 14.25 and 66.31 ± 15.08, respectively. There was no significant difference between the two groups ( F = 0.009, P = .923). Conclusion: PNAM as an early-stage adjunctive therapy for nasal deformity correction is beneficial before primary cheiloplasty, but it is insufficient to maintain long-term nostril symmetry after primary cheiloplasty without nasal cartilage dissection.

scholarly journals Tooth abnormalities in pediatric patients submitted to antineoplastic treatment for central nervous system neoplasms

2016 ◽  
Vol 19 (3) ◽  
pp. 39
Author(s):  
Ornella Florio Demasi ◽  
Marcelo Fava ◽  
Camila Merida Carrillo ◽  
Terezinha Garrett de Freitas Sampaio Amaral ◽  
Vicente Odone Filho
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pediatric Patients ◽  
Statistical Significance ◽  
Control Group ◽  
Study Group ◽  
Central Nervous System Neoplasms ◽  
Tooth Abnormalities ◽  
Significant Difference ◽  
Nervous System Neoplasms

<strong>Objective</strong>: The aim of this study was to evaluate the frequency of tooth abnormalities in pediatric patients treated for central nervous system neoplasms. <strong>Material and methods: </strong>This cross-sectional study assessed thirty-one patients, median age 14.2 years (range 5 - 25), who were off therapy for at least one year, comparatively with a control group of thirty-one healthy patients matched for age with the study group. Tooth abnormalities were evaluated by panoramic radiographs. <strong>Results: </strong>There was no statistical significant evidence that patients of the study group (age range 5 - 25 years) have more frequency of tooth abnormalities comparatively with controls.   However, in children who were diagnosed before 5 years of age, microdontia was the most common abnormality with statistically significant difference (<em>P=</em>0.037). Root shortening grade III was observed in patients over 10 years of age at the time of radiographic examination, also with statistical significance (<em>P=</em>0.046). <strong>Conclusions: </strong>Tooth abnormalities frequency in patients treated for central nervous system neoplasms is directly related to the age of diagnosis and stage of odontogenesis. Microdontia and reduced root surface areas, the most common abnormalities observed, can lead to future oral health impairment due to malocclusion and less periodontal support. It is important to give parents and patients early orientation about maintenance of good oral hygiene and proper treatment by orthodontics or dentofacial orthopedics.

scholarly journals DIFFERENTIAL DIAGNOSIS OF STERILE AND I NFECTED PANCREONECROSIS

2021 ◽  
pp. 31-35
Author(s):  
V. V. Boyko ◽  
V. M. Lykhman ◽  
A. O. Merkulov ◽  
D. O. Myroshnychenko ◽  
S. V. Tkach ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Differential Diagnosis ◽  
Pancreatic Necrosis ◽  
Clinical Laboratory ◽  
Practical Importance ◽  
Modern Medicine ◽  
Infectious Complications ◽  
Infected Pancreatic Necrosis ◽  
Septic Complications ◽  
Great Practical Importance

Summary. Introduction. The search for objective methods for diagnosing the form and severity of acute pancreatitis, accurate prediction and timely prevention of infectious complications in this surgical pathology is of great practical importance for modern medicine. Materials and methods. According to clinical, morphological and bacteriological data, groups of patients were selected. The first group included 33 patients with sterile pancreatic necrosis (SP), the second group consisted of 29 patients with infected pancreatic necrosis (IP). Results and discussion. The program of differential diagnosis of sterile and infected pancreatic necrosis with calculation of the index of differential diagnosis (IDD) for each clinical-laboratory and instrumental indicator used in this system is developed. The development and evaluation of diagnostic possibilities of the method of verification of purulent-septic complications of acute pancreatitis and the transition of a sterile form of pancreatic necrosis to an infected one was carried out. Conclusions. The use of the developed method of diagnosis of sterile and infected pancreatic necrosis with the calculation of the index of differential diagnosis allowed in 93% of cases to distinguish sterile pancreatic necrosis from infected and timely determine the scope and tactics of treatment.

D Gene Usage Predicts Clinical Outcome in Patients with Low Rai Risk Unmutated B-CLL.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2779-2779
Author(s):  
Renee C. Tschumper ◽  
Susan M. Geyer ◽  
Megan E. Campbell ◽  
Neil E. Kay ◽  
Tait D. Shanafelt ◽  
...  
Keyword(s):  
Model Building ◽  
Early Stage ◽  
Statistical Significance ◽  
Clinical Importance ◽  
Lymphocytic Leukemia ◽  
Antigenic Specificity ◽  
Mutation Status ◽  
Molecular Features ◽  
Significant Difference ◽  
Gene Usage

Abstract Mutation status of the immunoglobulin heavy chain variable region (IgVH) in B cell chronic lymphocytic leukemia (B-CLL) is a critical prognostic tool. Although patients with unmutated (UM) IgVH genes exhibit an overall shorter survival than those with mutated (M) IgVH genes, considerable heterogeneity in clinical progression exists among UM B-CLL patients. The goal of this study was to evaluate UM CLL patients (n=215) in a large B-CLL cohort for Ig V, D, and J gene usage and relevant clinical parameters to identify Ig molecular features in addition to UM vs. M status that have prognostic value. Consistent with the literature, the most commonly expressed IgVH gene in our UM B-CLL cohort was VH 1–69 (69/215). We first evaluated D and J usage in VH 1-69 vs. non-VH 1–69 UM patients. The factors that were significantly different between VH1–69 vs. non-VH 1–69 cohorts were JH6 usage (p=0.0014), D3–3 usage (p=0.0025), and the combination of JH6 and D3–3 usage (p=0.0002). We then examined potential associations between patient time to treatment (TTT) and specific IgVH molecular features. Although there was a trend that VH 1–69 patients exhibited a shorter TTT than non-VH 1–69 patients, the association did not reach statistical significance (p=0.06). When all UM patients were instead grouped on the basis of D and J usage, JH6 usage was not significantly associated with TTT, but D3–3 usage, irrespective of VH or JH usage, significantly correlated with shorter TTT (p=0.005). Of interest, when JH6 patients were excluded from the analysis, differences in TTT between those with and without D3–3 usage were particularly pronounced (p=0.011). We next explored whether a specific D3–3 reading frame (RF) is associated with TTT. Within the group of D3–3 patients, we evaluated differences in TTT between those with RF 2 (n=38) vs. RF 3 (n=19) but did not study RF1 patients due to small numbers (n=6). Comparison of D3–3/RF 3 patients (n=19) with all other UM patients (n=190), did not reveal a significant difference in TTT, however, there was a significant difference (p=0.012) in TTT between D3–3/RF 2 patients (n=38) and all other UM patients (n=171). Rai risk was still the best overall prognostic factor, and was the only significant factor (p<0.0001) in the multivariable (MV) setting for TTT using the entire UM cohort. However, when we categorized patients by both Rai risk (low vs. intermediate/high) and D3–3 usage, the most pronounced differences for TTT were observed based on D3–3 usage in the low Rai risk = 0 patients. Thus, the D3–3 cohort within the Rai 0 risk group displayed a significantly shorter TTT than did the non-D3–3 Rai 0 risk cohort (p=.0006). In model-building approaches in the MV setting using both the stepwise and score statistic methods for Rai 0 patients, D3–3 usage was the only significant factor for TTT (p=0.0004) even when RF 2 usage, JH6 usage, and absolute mutation percentage were also considered. These data illustrate for the first time the clinical importance of D gene usage and D gene RF in disease progression in early stage UM B-CLL. Moreover, this study adds further support to the notion that there is selection for specific Ig receptors in B-CLL and that the antigenic specificity of certain receptors may be associated with aggressive disease. Finally, these data demonstrate that the prognostic utility of IgVH mutation testing goes beyond simply determining categorical IgVH mutation status.

scholarly journals Parenteral nutrition versus enteral nutrition in severe acute pancreatitis

2010 ◽  
Vol 25 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Josiel Paiva Vieira ◽  
Gutemberg Fernandes de Araújo ◽  
José Raimundo Araújo de Azevedo ◽  
Alberto Goldenberg ◽  
Marcelo Moura Linhares
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Average Length ◽  
Infectious Complications ◽  
Pancreatic Tissue ◽  
Septic Complications ◽  
Disease Etiology ◽  
The Difference ◽  
Length Of Hospitalization

PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.

scholarly journals Evaluation of Ranson’s Score, Glasgow, Apache II, Apache O, Balthazar CTSI in Acute Pancreatitis Patients

2020 ◽  
Vol 3 (1) ◽  
pp. 132-135
Author(s):  
Vijaykumar C Bada ◽  
K Ravindranath
Keyword(s):  
Acute Pancreatitis ◽  
Scoring Systems ◽  
Apache Ii ◽  
Study Group ◽  
Biliary Pancreatitis ◽  
Severe Pancreatitis ◽  
Significant Difference

Background: Pancreatitis is an inflammation of the glandular parenchyma leading to injury or destruction of acinar components. This study was conducted to evaluate Ranson’s score, Glasgow, APACHE II, APACHE O, Balthazar CTSI in acute pancreatitis patients. Subjects and Methods: This study was conducted at Department of surgical Gastroenterology, Global hospital Hyderabad to evaluate Ranson’s score, Glasgow, APACHE II, APACHE O, Balthazar CTSI in acute pancreatitis patients. Results: 34% of the patients in the study were aged 31-40 years and only 6% of the patients were aged >60 years. The etiologic factors for acute pancreatitis in the study group included alcoholism (n= 27, 50.94%), Idiopathic (n=15, 28.30%), biliary pancreatitis (n= 10, 18.87%) and hypertriglyceridemia (n=1, 1.89%). A significant difference in all scoring systems was found between cases of mild and severe pancreatitis (P< 0.05). Among the multifactor scoring systems, Ranson’s was found to be a better predictor than APACHE-II. There was not much difference between APACHE-O and APACHE-II. Overall, CTSI found to be the best predictor, followed by APACHE-II. Conclusion: The authors found that there was no significant difference among the multifactor scoring systems, although Glasgow and APACHE-II fare better.

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