scholarly journals Dynamic of radiographic and ultrasonographic indices of hip joints in patients with ankylosing spondylitis under treatment with tumor necrotic factor ― alpha inhibitors

2020 ◽  
Vol 2 (37) ◽  
pp. 54-58
Author(s):  
A. V. Petrov ◽  
Y. O. Shevnina ◽  
A. S. Gaffarova ◽  
A. A. Petrov
Keyword(s):  
Ankylosing Spondylitis ◽  
Synovial Membrane ◽  
Structural Changes ◽  
Dynamic Monitoring ◽  
Hip Joints ◽  
Hip Arthritis ◽  
Factor Alpha ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background. Inflammation of the hip joints in ankylosing spondylitis (AS) is a frequent and severe manifestation of the disease, which in 7–8 % of patients is accompanied by the requirements of hip joints prosthesis. In the treatment of hip arthritis associated with AS non-steroidal anti-inflammatory drugs (NSAIDs), sulfasalazine (SSZ) and tumor necrosis factor-alpha blockers were used. However, the influence of these treatment on the dynamics of structural changes in hip joints is not studied.Purpose. To evaluate the dynamics of clinical, radiologic and ultrasonographic indices of hip joints in patients with AS who take different treatment methods for 12 months: NSAIDs, SSZ and adalimumab (ADA).Materials and methods. Dynamic monitoring of 78 patients with AS (corresponding to the New York modified criteria of 1984), who also had clinical, ultrasonographic and radiographic signs of inflammation of hip joints. The patients were divided into three groups: patients of the group 1 (n = 25) were been receiving NSAIDs; patients of group 2 (n = 26) had started to take SSZ (2–3 grams per day) on background of NSAIDs; patients of group 3 (n = 27) were started to take ADA (subcutaneously, 40 mg once every 2 weeks) on the background of NSAID. In addition to the generally accepted clinical and laboratory studies, all patients were being underwent by X-ray examination with an evaluation of the BASRI-Hip index and ultrasonography of hip joints during 12 months of follow-up.Results and discussion. In patients of group 2 treatment with SSZ during 12 months had been resulted in a decrease in the severity of pain from the visual analogue scale (VAS) at hip joint motion (26.1 [13.9, 42.7] vs 69.3 [56.8, 79, 3]), CRP (4.4 [1.5, 6.9] mg/L vs 15.2 [8.3, 21.8] mg/L) and a decrease in the thickness of the hip synovial membrane (6.7 [5.8, 8.5] mm vs 9.6 [7.9, 11.8] mm) compared with the initial data. In patients of the group 3 treatment with ADA had been lead to decreasing of pain VAS (14.2 [5.2, 26.7], vs. 72.1 [65.3, 89.1], BASDAI and ASDASCRP (1.7 [1.1, 3.1] and 1.4 [1.1, 2.2] vs. 7.5 [5.9, 8.6] and 3.1 [2.6, 3.9]), CRP (2.7 [0.2, 5.8] mg/L vs. 24.3 [17.4, 35.9]) and decrease in the thickness of hip synovial membrane (6.3 [5.0, 7.7] mm vs. 9.9 [8.1, 12.6] mm) and an increase of the thickness of the hyaline cartilage covering the head of the femur in comparison with group 1 (0.15 [0.09; 0.22] mm vs. —0.08 [–0.12, —0.04] mm). The effect of both drugs on the dynamics of the radiographic index BASRI-Hip and the formation of new osteophytes in hip joints was not noted.Conclusion. Inclusion of SSZ and ADA in a complex of treatment of patients with hip arthritis associated with AS leads to a decrease of synovitis of hip joints. Usage of ADA is accompanies by ultrasonographic signs of the restoration of hip joints cartilage.

scholarly journals Association of tumor necrosis factor-alpha and interleukin-10 levels with ultrasound characteristics of atherosclerotic plaques in patients with essential hypertension

2020 ◽  
Vol 19 (6) ◽  
pp. 2287
Author(s):  
A. G. Polupanov ◽  
T. B. Zalova ◽  
Yu. N. Geleskhanova ◽  
A. Sh. Sarybaev ◽  
T. A. Romanova ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Duplex Ultrasound ◽  
Interleukin 10 ◽  
Atherosclerotic Plaques ◽  
Necrosis Factor Alpha ◽  
Factor Alpha ◽  
Group 3 ◽  
Group 2 ◽  
Necrosis Factor ◽  
Group 1

Aim. To study the association  of ultrasound characteristics of carotid atherosclerotic  plaques  (ASPs) with the concentration  of tumor necrosis factor-alpha  (TNFα) and interleukin-10 (IL-10) in patients  with essential hypertension.Material and methods. The study included 117 patients  (men, 75; women, 42) with essential hypertension aged 40 to 75 years (mean age, 55,8±7,5 years). All patients  underwent anthropometric  measurements (height, weight, body mass index, waist circumference),  assessment of blood pressure  and heart rate, blood tests (levels of glucose, creatinine with the calculation of glomerular filtration rate using CKD-EPI equation, lipid profile), duplex ultrasound of the carotid arteries.  Also, the blood concentration  of TNFα and IL-10 by the enzyme-linked immunosorbent assay using CYTOKIN-STIMUL-BEST (Novosibirsk,Russia) kit was determined.Results.  According to the  results  of carotid  duplex ultrasound,  3 groups of patients  were identified. Group 1 included 48 patients  with homogeneous hyperechoic ASPs; group 2 — 56 patients with dominant hyperechoic  ASPs (>50% of areas);  group 3 — 13 patients  with anechoic, unstable,  low-density ASPs. TNFα concentration  in group 3 patients, amounting to 10,51±2.23 pg/ml, was significantly higher than in patients of group 1 (7,26±0,64 pg/ml (p<0,001)) and group 2 (8,93±0,98 pg/ml (p<0,001)).  Similar results were obtained for IL-10. The logistic regression  showed that the TNFα concentration  is an independent  factor associated with unstable  ASsP (relative risk, 2,72; 95% confidence interval 1,44-5,15  (p<0,02)). It was also revealed that TNFα >10 pg/ml increased the risk of ASP instability by ~8 times.Conclusion.  An increase  in TNFα >10 pg/ml with a high specificity (95%) was associated with vulnerable unstable carotid ASPs.

scholarly journals Cognitive and brain structural changes in long-term oligodendroglial tumor survivors

2019 ◽  
Vol 21 (11) ◽  
pp. 1470-1479 ◽  
Author(s):  
Nuria Cayuela ◽  
Esteban Jaramillo-Jiménez ◽  
Estela Càmara ◽  
Carles Majós ◽  
Noemi Vidal ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Structural Changes ◽  
Volumetric Analysis ◽  
World Health ◽  
Cross Sectional ◽  
Oligodendroglial Tumor ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background We identify cognitive impairment and MRI structural brain changes in long-term oligodendroglial tumor survivors treated with radiation therapy (RT) alone (21%) or with chemotherapy (CT) (79%). Methods Oligodendroglial tumor patients (based on the World Health Organization [WHO] 2007 classification) who completed RT ± CT at least 2 years before the study initiation, were classified into 3 groups according to the time treatment was completed: Group 1 = 2–5 years (n = 22), Group 2 = 6–10 years (n = 13), and Group 3 >10 years (n = 13). All patients had a cross-sectional neuropsychological evaluation (n = 48) and a longitudinal volumetric analysis (gray matter [GM; n = 34]) between postsurgical and last follow-up MRI. White matter (WM) changes on MRI were assessed using a qualitative scale. Results There were no differences regarding tumor or treatment-related characteristics between groups. Six of 22 patients (27.3%) in Group 1; 5/13 (38.5%) in Group 2; and 9/13 (69.2%) in Group 3 had cognitive impairment that was considered severe in 3/22 patients (13.6%) in Group 1; 4/13 (30.8%) in Group 2; and 6/13 (46.2%) in Group 3. Patients in Groups 2 and 3 showed significant GM atrophy and more leukoencephalopathy than Group 1. Cognitive deficits were associated with brain atrophy and WM changes. Conclusions Long-term oligodendroglial tumor survivors who underwent standard RT ± CT treatment, mainly >5 years of its completion, present cognitive impairment, especially on memory and executive functions, associated with late GM and WM damage, thus highlighting the need of developing future strategies in patients with oligodendroglial tumor and long expected survival.

Association of Conductive Hearing Loss with the Structural Changes in the Organ of Corti

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Sinan Eroglu ◽  
Rasit Cevizci ◽  
Handan Turan Dizdar ◽  
Hasan Deniz Tansuker ◽  
Erdogan Bulut ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Inner Ear ◽  
Cell Morphology ◽  
Hair Cells ◽  
Structural Changes ◽  
Organ Of Corti ◽  
Outer Hair Cells ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

<b><i>Objective:</i></b> The aim of the study was to evaluate the association of conductive hearing loss (CHL) with the structural changes in the organ of Corti. <b><i>Methods:</i></b> Twenty ears of 10 healthy adult Wistar albino rats were included in the study. The right ears (<i>n</i> = 10) of the animals served as controls (group 1), and no surgical intervention was performed in these ears. A tympanic membrane perforation without annulus removal was performed under operative microscope on the left ears (<i>n</i> = 5) in 5 of 10 animals (group 2). A tympanic membrane perforation with annulus removal was performed under operative microscope on the left ears (<i>n</i> = 5) of the remaining 5 animals (group 3). Auditory brainstem response testing was performed in the animals before the interventions. After 3 months, the animals were sacrificed, their temporal bones were removed, and inner ears were investigated using scanning electron microscopy (SEM). The organ of Corti was evaluated from the cochlear base to apex in the modiolar axis, and the parameters were scored semiquantitatively. <b><i>Results:</i></b> In group 1, the pre- and post-intervention hearing thresholds were similar (<i>p</i> &#x3e; 0.05). In group 2, a hearing decrease of at least 5 dB was encountered in all test frequencies (<i>p</i> &#x3e; 0.05). In group 3, at the frequency range of 2–32 kHz, there was a significant hearing loss after 3 months (<i>p</i> &#x3c; 0.01). After 3 months, the hearing thresholds in group 2 and 3 were higher than group 1 (<i>p</i> &#x3c; 0.01). The hearing threshold in group 3 was higher than group 2 (<i>p</i> &#x3c; 0.01). On SEM evaluation, the general cell morphology and stereocilia of the outer hair cells were preserved in all segments of the cochlea in group 1 with a mean SEM score of 0.2. There was segmental degeneration in the general cell morphology and outer hair cells in group 2 with a mean SEM score of 2.2. There was widespread degeneration in the general cell morphology and outer hair cells in group 3 with a mean SEM score of 3.2. The SEM scores of group 2 and 3 were significantly higher than group 1 (<i>p</i> &#x3c; 0.05). The SEM scores of group 3 were significantly higher than group 2 (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> CHL may be associated with an inner ear damage. The severity of damage appears to be associated with severity and duration of CHL. Early correction of CHL is advocated in order to reverse or prevent progression of the inner ear damage, which will enhance the success rates of hearing restoration surgeries. Subjective differences and compliance of the hearing aid users may be due to the impact of CHL on inner ear structures.

scholarly journals Golimumab administered subcutaneously every 4 weeks in ankylosing spondylitis: 104-week results of the GO-RAISE study

2011 ◽  
Vol 71 (5) ◽  
pp. 661-667 ◽  
Author(s):  
Jürgen Braun ◽  
Atul Deodhar ◽  
Robert D Inman ◽  
Désirée van der Heijde ◽  
Michael Mack ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Safety Profile ◽  
Activity Index ◽  
Disease Activity Index ◽  
Subcutaneous Injections ◽  
Treatment Regimens ◽  
Group 3 ◽  
Group 2 ◽  
Necrosis Factor ◽  
Group 1

ObjectiveTo assess the efficacy and safety of golimumab over 104 weeks in patients with active ankylosing spondylitis.MethodsAt baseline, patients with active ankylosing spondylitis (n=356) were randomly assigned (1:1.8:1.8) to subcutaneous injections of placebo (group 1), golimumab 50 mg (group 2) or golimumab 100 mg (group 3) every 4 weeks. At week 16, patients in groups 1 and 2 with <20% improvement in total back pain and morning stiffness entered early escape to 50 or 100 mg, respectively. At week 24, patients still receiving placebo crossed over to golimumab 50 mg. Findings through week 24 were previously reported; those through week 104 are presented herein.ResultsAt week 104, 38.5%, 60.1% and 71.4% of patients in groups 1, 2 and 3, respectively, had at least 20% improvement in the Assessment in SpondyloArthritis international Society response criteria (ASAS20); 38.5%, 55.8% and 54.3% had an ASAS40 response and 21.8%, 31.9% and 30.7% were in ASAS partial remission. Mean Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores were <3 at week 104 for all the treatment regimens. Golimumab safety through week 104 was similar to that through week 24.ConclusionClinical response that was achieved by patients receiving golimumab through 24 weeks was sustained through 52 and 104 weeks. The golimumab safety profile appeared to be consistent with the known safety profile of tumour necrosis factor inhibitors.

scholarly journals Efficiency of drug therapy for coxitis in patients with ankylosing spondylitis according to the data of a 12-month prospective follow-up

2019 ◽  
Vol 56 (6) ◽  
pp. 727-730
Author(s):  
A. V. Petrov ◽  
V. A. Beloglazov ◽  
Yu. O. Shevnina ◽  
A. A. Petrov
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Synovial Membrane ◽  
Time Course ◽  
Structural Changes ◽  
Activity Index ◽  
Disease Activity Index ◽  
Membrane Thickness ◽  
Group 2 ◽  
Factor Α

Hip joint (HJ) inflammation in ankylosing spondylitis (AS) is a frequent manifestation and an unfavorable prognostic feature of the disease and it requires total hip arthroplasty in 7–8% of patients. Nonsteroidal anti-inflammatory drugs (NSAIDs), sulfasalazine (SSZ), and tumor necrosis factor-α inhibitors are used to treat AS-associated coxitis. However, the influence of these treatments on the time course of HJ structural changes has not been currently studied.Objective: to estimate the time course of HJ changes clinical, X-ray, and ultrasonographic examination was performed in AS patients receiving various drugs: NSAIDs, SSZ, and adalimumab (ADA) during 12 months.Subjects and methods. Seventy-eight AS patients who had clinical, ultrasonographic, and radiological signs of HJ inflammation were followed up. The patients were divided into three groups: 1) 25 patients who took NSAIDs daily; 2) 26 patients who received NSAIDs and SSZ in a daily dose of 2–3 g; 3) 27 patients who were treated with NSAIDs and subcutaneous injections of ADA 40 mg once every 2 weeks. In addition to conventional clinical and laboratory investigations, all the patients underwent radiography with Bath Ankylosing Spondylitis Radiology HIP Index (BASRI-Hip) estimation and HJ ultrasonography.Results and discussion. In Group 2, 12-month SSZ use led to a reduction in median pain intensity during HJ movements on a visual analog scale (VAS) from 26.1 [13.9; 42.7] to 69.3 [56.8; 79.3] mm (p<0.05), CRP levels from 4.4 [1.5; 6.9] to 15.2 [8.3; 21.8] mg/l (p<0.05), and synovial membrane thickness from 6.7 [5.8; 8.5] to 9.6 [7.9; 11.8] mm (p<0.05) compared to the basic data. In Group 3, ADA administration resulted in pain reduction from 14.2 [5.2; 26.7] to 72.1 [65.3; 89.1] mm (p<0.05), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score based on C-reactive protein (ASDAS-CRP) from 1.7 [1.1; 3.1] and 1.4 [1.1; 2.2] to 7.5 [5.9; 8.6] and 3.1 [2.6; 3.9], respectively (p<0.05), CRP levels from 2.7 [0.2; 5.8] to 24.3 [17.4; 35.9] mg/l (p<0.05), and HJ synovial membrane thickness from 6.3 [5.0; 7.7] to 9.9 [8.1; 12.6] mm (p<0.05). SSZ and ADA did not substantially affect the time course of changes in BASRI-Hip and the process of new osteophyte formation in HJ.Conclusion. The use of SSZ and ADA in the complex treatment of patients with AS-associated coxitis leads to a lower HJ synovitis activity.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

Analysis of the quality of early diagnostics of cardiovascular diseases in students of educational institutions of Khabarovsk (according to the data of preventive examinations)

2020 ◽  
pp. 13-16
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Sinus Tachycardia ◽  
Blood Pressure Level ◽  
Educational Institutions ◽  
Conduction Disturbances ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

To identify the prevalence of early pathology of cardiovascular diseases, a survey of 400 200 girls) in the age group 15 and 17 years old was conducted as a part of routine medical of the level of blood pressure (BP) was carried out, with the calculation of the average level pressure on the basis of three separate measurements estimated by percentile tables for a registration of a standard resting ECG in 12 leads. According to the results of the survey, into 3 groups: with an increase in blood pressure above 95 ‰ (group 1 – 16 people), which recorded in males (p<0,05); Group 2 (67 people) – adolescents with a normal blood pressure level and group 3 of adolescents with a decrease in blood pressure below 5 ‰ changes in the form of rhythm and conduction disturbances were noted in almost every a predominance of sinus tachycardia in the first group. In the third group of adolescents, form of ectopic rhythm and pacemaker migration were significantly more frequently only 78 % of adolescents were referred for consultation and in-depth examination by a pediatric cardiologist.

Does Perioperative Hemoglobin A1c Level Affect the Incidence, Pattern and Mortality of Lower Extremity Amputation?

2019 ◽  
Vol 17 (4) ◽  
pp. 354-364
Author(s):  
Hassan Al-Thani ◽  
Moamena El-Matbouly ◽  
Maryam Al-Sulaiti ◽  
Noora Al-Thani ◽  
Mohammad Asim ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Lower Extremity ◽  
Hazard Ratio ◽  
Lower Extremity Amputation ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Extremity Amputation ◽  
Group 1

Background: We hypothesized that perioperative HbA1c influenced the pattern and outcomes of Lower Extremity Amputation (LEA). Methods: A retrospective analysis was conducted for all patients who underwent LEA between 2000 and 2013. Patients were categorized into 5 groups according to their perioperative HbA1c values [Group 1 (<6.5%), Group 2 (6.5-7.4%), Group 3 (7.5-8.4%), Group 4 (8.5-9.4%) and Group 5 (≥9.5%)]. We identified 848 patients with LEA; perioperative HbA1c levels were available in 547 cases (Group 1: 18.8%, Group 2: 17.7%, Group 3: 15.0%, Group 4: 13.5% and Group 5: 34.9%). Major amputation was performed in 35%, 32%, 22%, 10.8% and 13.6%, respectively. Results: The overall mortality was 36.5%; of that one quarter occurred during the index hospitalization. Mortality was higher in Group 1 (57.4%) compared with Groups 2-5 (46.9%, 38.3%, 36.1% and 31.2%, respectively, p=0.001). Cox regression analysis showed that poor glycemic control (Group 4 and 5) had lower risk of mortality post-LEA [hazard ratio 0.57 (95% CI 0.35-0.93) and hazard ratio 0.46 (95% CI 0.31-0.69)]; this mortality risk persisted even after adjustment for age and sex but was statistically insignificant. The rate of LEA was greater among poor glycemic control patients; however, the mortality was higher among patients with tight control. Conclusion: The effects of HbA1c on the immediate and long-term LEA outcomes and its therapeutic implications need further investigation.

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