scholarly journals Update of Neuroanaesthesia in Bangladesh

2009 ◽  
pp. 17-21
Author(s):  
Hasina Begum ◽  
Iqbal Hossain Chaudhury ◽  
AKM Azizul Hoque ◽  
UH Shahera Khatun
Keyword(s):  
Retrospective Study ◽  
General Anaesthesia ◽  
Outcome Measures ◽  
New Drugs ◽  
Perioperative Mortality ◽  
New Agents ◽  
New Methods ◽  
Number Of Patients ◽  
Cerebral Monitoring

In the last 20 years , new drugs and new methods of cerebral monitoring have been introduced, that have affected our choice & conduct of anaesthesia. Which affects significantly the outcome of neurosurgery. To consider the outcome from neurosurgical anaesthesia, both drugs & monitors have to be considered. This is a retrospective study of 2000 patients those who attended in BSMMU from 1985 to 2002 for craniotomy under general anaesthesia. Perioperative mortality (overall ) of that period was 5.5%. Perioperative mortality significantly reduced from 1985 to 2002. In first 6 years (1985 - 1990) mortality was 14%; in 2nd 6 years ( 1991 -1996 ) mortality was 6%; in 3rd 6 years (1997 -2002) mortality was only 2.48%. At the same time number of patients undergoing surgery greatly increased: In first 6 years ( 1985- 1990 ) it was 225 ; in 2nd 6 years ( 1991 - 1996 ) : 557 , in 3rd 6 years ( 1997 - 2002 ): 1169. All the above data shows markedly reduced mortality and increased number of surgery indicates tremendous improvement in the field of neuroanaesthesia both in drugs and monitors as well as skillness of neurosurgeons. To assess changes in outcome , outcome measures need to be defined for neuroanaesthesia. Because the effects of surgery markedly affect neurological or neurophysiological outcome, it can be difficult to distinguish the effects of surgery & anaesthesia and the effects of new agents. Journal of BSA, Vol. 18, No. 1 & 2, 2005 p.17-21

scholarly journals Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Stavros Spiliopoulos ◽  
Konstantinos Katsanos ◽  
Ioannis Paraskevopoulos ◽  
Martin Mariappan ◽  
Georgios Festas ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Survival Rate ◽  
Outcome Measures ◽  
Clinical Success ◽  
Coagulation Cascade ◽  
Secondary Outcome ◽  
Bleeding Diathesis ◽  
Technical Success ◽  
Number Of Patients ◽  
Life Threatening

Abstract Background We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis. Materials and methods This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding disorder at the time of embolization. All consecutive patients with uncorrected coagulation who underwent TAE for the treatment of haemorrhage, between January 1st and December 31th 2019 in three European centers were included. Inclusion criteria were thrombocytopenia (platelet count < 50,000/mL) and/or International Normalized Ratio (INR) ≥2.0, and/or activated partial thromboplastin time (aPTT) > 45 s, and/or a pre-existing underlying blood-clotting disorder such as factor VIII, Von Willebrand disease, hepatic cirrhosis with abnormal liver function tests. Primary outcome measures were technical success, rebleeding rate and clinical success. Secondary outcome measures included patients’ 30-day survival rate, and procedure-related complications. Results In total, 134 patients underwent TAE for bleeding control. A subgroup of 17 patients with 18 procedures [11 female, mean age 70.5 ± 15 years] which represent 12.7% of the total number of patients, presented with pathological coagulation parameters at the time of TAE (haemophilia n = 3, thrombocytopenia n = 1, cirrhosis n = 5, anticoagulants n = 7, secondary to bleeding n = 1) and were analyzed. Technical success was 100%, as in all procedures the bleeding site was detected and successfully embolised. Clinical success was 100%, as none of the patients died of bleeding during hospitalization, nor was surgically treated for bleeding relapse. Only one rebleeding case was noted (5.9%) that was successfully treated with a second TAE. No procedure-related complications were noted. According to Kaplan-Meier analysis the estimated 30-day survival rate was 84.2%. Conclusion TAE in selected patients with uncorrected bleeding diathesis should be considered as a suitable individualized management approach. Emergency TAE for life threatening haemorrhage in patients with coagulation cascade disorders should be used as an aid in realistic clinical decision making.

Breech Presentation: Vaginal Delivery or Caesarean Section?

2016 ◽  
Vol 2 (1) ◽  
pp. 153
Author(s):  
Tomescu Cezar Laurentiu ◽  
Rodica Sîrbu ◽  
Emin Cadar ◽  
Brezeanu Dragos ◽  
Aneta Tomescu
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Vaginal Delivery ◽  
Total Population ◽  
Population Sample ◽  
Breech Presentation ◽  
Current Paper ◽  
Clinical Hospital ◽  
Obstetrics And Gynaecology ◽  
Number Of Patients

The incidence of breech presentation is approximately 3,97%. Breech presentation is considered as being “borderline eutocic” and it requires carefully monitoring both the foetus and the mother. The aim of the current paper is to evaluate the preffered method of delivery in case of breech presentation. The paper presents a retrospective study performed in the Obstetrics and Gynaecology Departments of the County Emergency Clinical Hospital “Sf. Apostol Andrei” in Constanta, during a period of 5 years (2010-2014). The methods of birth were analyzed for a lot of 1104 patients with breech presentation with ages ranging between 16 and 44 years old. The total number of patients who gave birth through vaginal delivery was of 139 patients, amounting to 12.59% of the total population sample. The number of patients that gave birth through C-section was 965, which amounts to 87.4% of the total population sample. Birth through C-section is preferred by both obstetricians and patients alike, due to the fact that vaginal delivery is associated with a higher foetal risk in breech presentation.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

scholarly journals How Risky Is That Risk Sharing Agreement? Mean-Variance Tradeoffs and Unintended Consequences of Six Common Risk Sharing Agreements

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832199040
Author(s):  
Gregory S. Zaric
Keyword(s):  
Risk Sharing ◽  
Financial Risk ◽  
Unintended Consequences ◽  
Drug Costs ◽  
New Drugs ◽  
Total Drug ◽  
Number Of Patients ◽  
Clinical Benefits ◽  
The Impact ◽  
Mean Variance

Background. Pharmaceutical risk sharing agreements (RSAs) are commonly used to manage uncertainties in costs and/or clinical benefits when new drugs are added to a formulary. However, existing mathematical models of RSAs ignore the impact of RSAs on clinical and financial risk. Methods. We develop a model in which the number of patients, total drug consumption per patient, and incremental health benefits per patient are uncertain at the time of the introduction of a new drug. We use the model to evaluate the impact of six common RSAs on total drug costs and total net monetary benefit (NMB). Results. We show that, relative to not having an RSA in place, each RSA reduces expected total drug costs and increases expected total NMB. Each RSA also improves two measures of risk by reducing the probability that total drug costs exceed any threshold and reducing the probability of obtaining negative NMB. However, the effects on variance in both NMB and total drug costs are mixed. In some cases, relative to not having an RSA in place, implementing an RSA can increase variability in total drug costs or total NMB. We also show that, for some RSAs, when their parameters are adjusted so that they have the same impact on expected total drug cost, they can be rank-ordered in terms of their impact on variance in drug costs. Conclusions. Although all RSAs reduce expected total drug costs and increase expected total NMB, some RSAs may actually have the undesirable effect of increasing risk. Payers and formulary managers should be aware of these mean-variance tradeoffs and the potentially unintended results of RSAs when designing and negotiating RSAs.

scholarly journals Ordinal outcome analysis improves the detection of between-hospital differences in outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. Ceyisakar ◽  
N. van Leeuwen ◽  
Diederik W. J. Dippel ◽  
Ewout W. Steyerberg ◽  
H. F. Lingsma
Keyword(s):  
Logistic Regression ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Statistical Power ◽  
Ordinal Scale ◽  
Efficiency Gain ◽  
Number Of Patients ◽  
Dichotomous Outcomes ◽  
Ordinal Outcome

Abstract Background There is a growing interest in assessment of the quality of hospital care, based on outcome measures. Many quality of care comparisons rely on binary outcomes, for example mortality rates. Due to low numbers, the observed differences in outcome are partly subject to chance. We aimed to quantify the gain in efficiency by ordinal instead of binary outcome analyses for hospital comparisons. We analyzed patients with traumatic brain injury (TBI) and stroke as examples. Methods We sampled patients from two trials. We simulated ordinal and dichotomous outcomes based on the modified Rankin Scale (stroke) and Glasgow Outcome Scale (TBI) in scenarios with and without true differences between hospitals in outcome. The potential efficiency gain of ordinal outcomes, analyzed with ordinal logistic regression, compared to dichotomous outcomes, analyzed with binary logistic regression was expressed as the possible reduction in sample size while keeping the same statistical power to detect outliers. Results In the IMPACT study (9578 patients in 265 hospitals, mean number of patients per hospital = 36), the analysis of the ordinal scale rather than the dichotomized scale (‘unfavorable outcome’), allowed for up to 32% less patients in the analysis without a loss of power. In the PRACTISE trial (1657 patients in 12 hospitals, mean number of patients per hospital = 138), ordinal analysis allowed for 13% less patients. Compared to mortality, ordinal outcome analyses allowed for up to 37 to 63% less patients. Conclusions Ordinal analyses provide the statistical power of substantially larger studies which have been analyzed with dichotomization of endpoints. We advise to exploit ordinal outcome measures for hospital comparisons, in order to increase efficiency in quality of care measurements. Trial registration We do not report the results of a health care intervention.

scholarly journals Correction to: General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Furaha Nzanzu Blaise Pascal ◽  
Agnes Malisawa ◽  
Andreas Barratt-Due ◽  
Felix Namboya ◽  
Gregor Pollach
Keyword(s):  
Retrospective Study ◽  
General Anaesthesia ◽  
Limited Resource ◽  
Teaching Hospitals ◽  
Related Mortality

An amendment to this paper has been published and can be accessed via the original article.

Morbidity and Mortality of Carotid Endarterectomy under Local Anesthesia: A Retrospective Study

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 445-450 ◽  
Author(s):  
Mario Zuccarello ◽  
Hwa-shain Yeh ◽  
John M. Tew
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Local Anesthesia ◽  
Perioperative Complications ◽  
Minor Stroke ◽  
Perioperative Mortality ◽  
Occlusive Vascular Disease ◽  
Risk Patients ◽  
Ischemic Attack

Abstract It has been shown that carotid endarterectomy reduces the incidence of stroke in patients with symptomatic extracranial occlusive vascular disease in the absence of major perioperative complications such as stroke or death. We present a retrospective study of 106 carotid endarterectomies performed under local anesthesia in 100 patients in whom transient ischemic attack (TIA) or minor stroke had occurred. Nonfatal stroke occurred in 2%, and TIA occurred in 1%. There was no perioperative mortality. Our study suggests that, under local anesthesia, even high risk patients can be operated safely and the majority of carotid endarterectomies can be performed without the use of an indwelling shunt. Meticulous surgical technique is of great importance for achieving low perioperative complications.

Craniofacial Morphology in Children with Complete Bilateral Cleft Lip and Palate: Does Infantile Size of the Premaxilla Predetermine Outcome?

2004 ◽  
Vol 41 (4) ◽  
pp. 410-415 ◽  
Author(s):  
Yu-Fang Liao ◽  
Chiung-Shing Huang ◽  
Ya-Yu Tsai ◽  
M. Samuel Noordhoff
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Craniofacial Morphology ◽  
University Hospital ◽  
Cephalometric Analysis ◽  
Bilateral Cleft Lip ◽  
Dental Cast ◽  
Craniofacial Characteristics

Objective To evaluate the possible association between the size of the premaxilla in infants and craniofacial morphology in children with complete bilateral cleft lip and palate (CBCLP) and identify the characteristics of craniofacial morphology in children with CBCLP with median facial dysplasia (MFD). Design Retrospective study. Setting A university hospital craniofacial center. Subjects Thirty-four patients with nonsyndromic CBCLP, 24 boys and 10 girls, had large premaxilla (LP group). Thirty-six patients with nonsyndromic CBCLP, 16 boys and 20 girls, had small premaxilla (SP group). Thirteen CBCLP patients with MFD, five boys and eight girls (MFD group). Main Outcome Measures Infant maxillary dental cast at the age of 1 year was used to measure the size of the premaxilla. Cephalometric analysis was used to determine craniofacial morphology in children at the age of 5 years. Results The size of the premaxilla in infants with CBCLP varied greatly. The LP group tended to have a longer maxilla and a more protruded maxilla, producing a better interjaw relation. The opposite phenomena were observed in the MFD group; the SP group yielded results between those of the LP and the MFD groups. Conclusion The size of the premaxilla in infants with CBCLP can be used to predetermine subsequent craniofacial morphology at the age of 5 years. Children with nonsyndromic CBCLP had craniofacial characteristics that differed significantly from those of children with CBCLP with median facial dysplasia.

Namibian algae species: A review of their distribution, medicinal uses and chemical constituents

2020 ◽  
pp. 1-21
Author(s):  
Ateeq Rahman ◽  
Moola M. Nyambe ◽  
Jan-Heiner Küpper
Keyword(s):  
Neglected Tropical Diseases ◽  
Chemical Constituents ◽  
Structural Diversity ◽  
New Drugs ◽  
African Countries ◽  
New Agents ◽  
Medicinal Uses ◽  
Defense Strategies ◽  
Underdeveloped Countries ◽  
Popular Knowledge

The use of indigenous or remote popular knowledge to identify new drugs against diseases or infections is a well-known approach in medicine. The inhabitants of coastal regions in Namibia and other African countries are known to prepare algae extracts for the treatment of disorders and ailments such as wounds, fever and stomach aches, as well as for the prevention of arrhythmia, cancer, and many other diseases. Algae survive in a competitive environment and, therefore, developed defense strategies that have resulted in a significant level of chemical structural diversity in various metabolic pathways. The exploration of these organisms for pharmaceutical, nutritional and medical purposes has provided important chemical candidates for the discovery of new agents against neglected tropical diseases and stimulated the use of sophisticated physical techniques. This current review provides a broad picture on the taxonomy, various medical and nutritional uses of algae, which thus should be of relevance for the African continent and underdeveloped countries in the Global South.

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