The Uncertain Effect of Antimicrobial Therapy in the Treatment of Patients with Ischemic Colitis

Although antimicrobial therapy is recommended for patients with moderate or severe ischemic colitis, its beneficial effects are unclear. In the present study, the role of antimicrobial therapy in the treatment of ischemic colitis was investigated. Patients with ischemic colitis were retrospectively identified between January 2004 and June 2019. The characteristics and outcomes of patients who received antibiotics (antibiotics group) and those who did not (no-antibiotics group) were compared. Clinical outcomes included death, surgery, and readmission within 30 days, fasting duration, and hospital stay. Data from 186 patients were analyzed; 122 patients were in the antibiotics group and 64 in the no-antibiotics group. Composite outcome of death, surgery, and readmission within 30 days occurred in 3.3% of patients in the antibiotics group and 3.1% of patients in the no-antibiotics group (p > 0.999). Fasting duration was not significantly different between the two groups (median days, 4.0 vs. 4.0, p = 0.253). However, hospital stays were longer in the antibiotics group than in the no-antibiotics group (median days, 9.0 vs. 7.0, p = 0.043). In patients with ischemic colitis, there was no statistically significant difference in the incidence of death, surgery, and readmission within 30 days between patients who received antibiotics and those who did not receive antibiotics.

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Effects of early corticosteroid use in patients with severe coronavirus disease 2019

BMC Infectious Diseases ◽

10.1186/s12879-021-06221-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jong Hoon Hyun ◽

Moo Hyun Kim ◽

Yujin Sohn ◽

Yunsuk Cho ◽

Yae Jee Baek ◽

...

Keyword(s):

Hospital Stay ◽

Clinical Outcomes ◽

Case Fatality ◽

Length Of Hospital Stay ◽

Corticosteroid Treatment ◽

Threshold Value ◽

Steroid Use ◽

Corticosteroid Administration ◽

Significant Difference ◽

Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

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Repeat Local Treatment of Recurrent Colorectal Liver Metastases, the Role of Neoadjuvant Chemotherapy: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Cancers ◽

10.3390/cancers13194997 ◽

2021 ◽

Vol 13 (19) ◽

pp. 4997

Author(s):

Madelon Dijkstra ◽

Sanne Nieuwenhuizen ◽

Robbert S. Puijk ◽

Florentine E. F. Timmer ◽

Bart Geboers ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Hospital Stay ◽

Colorectal Liver Metastases ◽

Local Treatment ◽

Length Of Hospital Stay ◽

Progression Free Survival ◽

Free Survival ◽

Significant Difference ◽

Subgroup Analyses

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).

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Role of Prostate Ultrasonography to Predict The Efficacy of Bipolar Prostatectomy in Benign Prostatic Hyperplasia

10.21203/rs.3.rs-497241/v1 ◽

2021 ◽

Author(s):

Ali Ibrahim ◽

Diaaeldin Taha ◽

Mona Talaat ◽

Hossam Nabeeh ◽

Tarek Abdelbaky

Keyword(s):

Benign Prostatic Hyperplasia ◽

Clinical Outcomes ◽

Transurethral Resection ◽

Erectile Function ◽

Urine Volume ◽

Close Correlation ◽

Prostatic Hyperplasia ◽

Significant Difference ◽

Maximum Improvement

Abstract Background: We evaluated the role of prostatic ultrasonography to predict the clinical outcomes of Bipolar Transurethral resection of the prostate. Methods: 109 Patients complaining of lower urinary tract symptoms (LUTs) due to Benign Prostatic Hyperplasia (BPH) were evaluated preoperatively and postoperatively (at 1, 3, and 6 months) using ultrasonography (pelvi-abdominal and transrectal ), the International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume (PVR), ejaculatory domain, and the erectile function domain of the International Index of Erectile Function (IIEF-ED). The safety of the procedure was assessed by Modified Clavien classification of complications.Result: There was a close correlation between residual tissue of prostate detected by ultrasonography and clinical outcomes. The prostate volume was significantly decreased postoperatively with a concomitant significant improvement of IPSS, Qmax, and PVR over six months of follow-up (P <0.001 ). 57.8 % of the cases in this study were sexually active, and there was no significant difference in the IIEF-ED score between preoperative and postoperative evaluation.Conclusion: Prostate ultrasonography has a significant predictive value as a single investigating tool to evaluate the clinical outcomes after bipolar transurethral resection of the prostate (TURP). The maximum improvement in IPSS and ultrasonographic measurements were detected at six months postoperatively.

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Early reperfusion and clinical outcomes in patients with M2 occlusion: pooled analysis of the PROACT II, IMS, and IMS II studies

Journal of Neurosurgery ◽

10.3171/2014.7.jns131430 ◽

2014 ◽

Vol 121 (6) ◽

pp. 1354-1358 ◽

Cited By ~ 15

Author(s):

Ralph Rahme ◽

Sharon D. Yeatts ◽

Todd A. Abruzzo ◽

Lincoln Jimenez ◽

Liqiong Fan ◽

...

Keyword(s):

Clinical Outcomes ◽

Functional Independence ◽

Pooled Analysis ◽

Modified Rankin Scale ◽

Early Reperfusion ◽

Glucose Levels ◽

Significant Difference ◽

Baseline Characteristics ◽

The Impact

Object The role of endovascular therapy in patients with acute ischemic stroke and a solitary M2 occlusion remains unclear. Through a pooled analysis of 3 interventional stroke trials, the authors sought to analyze the impact of successful early reperfusion of M2 occlusions on patient outcome. Methods Patients with a solitary M2 occlusion were identified from the Prolyse in Acute Cerebral Thromboembolism (PROACT) II, Interventional Management of Stroke (IMS), and IMS II trial databases and were divided into 2 groups: successful reperfusion (thrombolysis in cerebral infarction [TICI] 2–3) at 2 hours and failed reperfusion (TICI 0–1) at 2 hours. Baseline characteristics and clinical outcomes were compared. Results Sixty-three patients, 40 from PROACT II and 23 from IMS and IMS II, were identified. Successful early angiographic reperfusion (TICI 2–3) was observed in 31 patients (49.2%). No statistically significant difference in the rates of intracerebral hemorrhage (60.9% vs 47.6%, p = 0.55) or mortality (19.4% vs 15.6%, p = 0.75) was observed. However, there was a trend toward higher incidence of symptomatic hemorrhage in the TICI 2–3 group (17.4% vs 0%, p = 0.11). There was also a trend toward higher baseline glucose levels in this group (151.5 mg/dl vs 129.6 mg/ dl, p = 0.09). Despite these differences, the rate of functional independence (modified Rankin Scale Score 0–2) at 3 months was similar (TICI 2–3, 58.1% vs TICI 0–1, 53.1%; p = 0.80). Conclusions A positive correlation between successful early reperfusion and clinical outcome could not be demonstrated for patients with M2 occlusion. Irrespective of reperfusion status, such patients have better outcomes than those with more proximal occlusions, with more than 50% achieving functional independence at 3 months.

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Initial Clinical Outcomes of Percutaneous FullEndoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e512 ◽

2017 ◽

Vol 4 (20;4) ◽

pp. E507-E512 ◽

Cited By ~ 4

Author(s):

Jun-ichiro Nakamura

Keyword(s):

Hospital Stay ◽

Clinical Outcomes ◽

Disc Herniation ◽

Operative Time ◽

Small Sample ◽

Lumbar Discectomy ◽

Interlaminar Approach ◽

Significant Difference ◽

Endoscopic Discectomy ◽

The Mean

Background: Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported. Objective: This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF. Study Design: Retrospective evaluation. Setting: An urban minimally invasive spine hospital. Methods: Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1. Results: The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.). Limitations: A small sample size and a short follow-up period. Conclusions: The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation. Keywords: Percutaneous full-endoscopic lumbar discectomy, interlaminar approach, clinical outcome, herniated nucleus pulpous, MacNab criteria, intracanalicular disc herniation, learning curve

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Evaluation of the Effect of Fruit Juice Containing Bacillus Coagulans Probiotic Supplement on the Level of Immunoglobulins A, M and Lymphocytes in Two-Speed Athletes

10.5772/intechopen.98370 ◽

2021 ◽

Author(s):

Elahe Ebrahimi ◽

Maryam Golshahi ◽

Samane Yazdi ◽

Mohammad Mehdi Pirnia

Keyword(s):

Immune System ◽

Respiratory Infections ◽

Bacillus Coagulans ◽

Control Group ◽

Male Athlete ◽

Beneficial Effects ◽

Significant Difference ◽

Probiotic Strains ◽

Experimental Group

Probiotics exert beneficial effects on their host health by creating microbial balance in the digestive system. The role of some probiotic strains in strengthening the immune system and reducing the risk of diseases, especially respiratory infections, has been proven in previous studies. Aim: The aim of this study was to evaluate the effect of probiotic supplementation containing Bacillus coagulans on the Runner athletes immune system. In this study, the effect of Bacillus coagulans probiotic on immunoglobulins A, M and monocytes count 60 male athlete sprints Evaluates that which were randomly divided into two groups of 30.For 3 months, the experimental group received a daily glass of probiotic juice containing 109 cfu / ml containing probiotic supplement and the control group received plain and no supplemental juice. During the study period, once every 2 weeks, One day after exercise (running 200 meters), blood samples were taken from all participants Then In the collected samples, IgA, IgM and lymphocytes were evaluated. Consumption of probiotic juice containing 2 × 109 f cfu/ml Bacillus coagulans probiotic supplement showed a significant difference in the amount of IgA, IgM and Lymphocyte between the experimental group and the control group. The results of this study showed that the consumption of juice containing probiotic supplement Bacillus coagulans can increase the level of immune factors IgM, IgA, lymphocytes and prevent the occurrence of diseases, especially respiratory infections, by improving the function of the immune system.

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Effects of green tea and chamomile tea on plaque pH, salivary pH, Streptococcus mutans count

Indian Journal of Pharmaceutical and Biological Research ◽

10.30750/ijpbr.5.4.1 ◽

2017 ◽

Vol 5 (04) ◽

pp. 01-03

Author(s):

M.A. Adil Ahmed ◽

B. Pavani ◽

Tasneem L. Tanzila ◽

Gabby Dharshana S. Thanga ◽

B. Thejaswini ◽

...

Keyword(s):

Streptococcus Mutans ◽

Green Tea ◽

Test Results ◽

Beneficial Effects ◽

Regular Consumption ◽

Plaque Ph ◽

Significant Difference ◽

Before And After ◽

Interesting Alternative

Aim: Green tea is healthy beverage and is a part of our day to day life. Similarly, chamomile tea is known for its aspirin like properties. Beneficial effects of these tea includes protection against dental caries, periodontal disease and tooth loss and found that can a decrease in streptococcus mutans count as well as increase in pH. Hence the present study was to compare the pH of saliva and plaque, before and after the intake of green tea and to evaluate the role of green tea and chamomile tea on growth of s.mutans in culture using saliva. Material and Methods: Salivary samples were collected from 30 healthy individuals aged 20-30 years with certain criteria. The pH of saliva was determined by collecting samples before, immediately after and 15 min, 30 min after drinking tea using pH meter. Similarly the microbial colonies were also counted. The Data obtained were analyzed using Wilcoxon’s, Friedman's and Mann Whitney test. Results: There was statistically no significant difference between salivary streptococcus mutans count before and after (p 0.001) intake of green tea and chamomile tea. Conclusion: The result of the present study has proved that consumption of green tea and chamomile tea inhibit salivary Streptococcus mutans count and cause reduction of pH in saliva. So, it is advisable to encourage the regular consumption of this widely available, tasty and inexpensive beverage as an interesting alternative to other drinks.

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Pharmacokinetic and pharmacodynamic principles of antimicrobials

10.1093/med/9780198758792.003.0009 ◽

2016 ◽

Author(s):

Menino Osbert Cotta ◽

Jason Roberts

Keyword(s):

Antimicrobial Resistance ◽

Protein Binding ◽

Clinical Outcomes ◽

Antimicrobial Therapy ◽

Potential Role ◽

Volume Of Distribution ◽

Pharmacokinetics And Pharmacodynamics ◽

Dosing Regimens ◽

Dosing Strategies

The continual threat of antimicrobial resistance means that optimizing current antimicrobial therapy is of paramount importance. Antimicrobial pharmacokinetics and pharmacodynamics (PK/PD) play a central role in developing dosing regimens that target maximal clinical outcomes and microbiological eradication. This chapter describes the three main PK/PD indices into which current antimicrobials are categorized. Elements of PK that require due consideration when optimizing antimicrobial therapy, including volume of distribution, antimicrobial clearance, and protein binding, are also discussed. Finally, specific attention is paid to antimicrobial dosing among challenging populations, namely the critically ill and obese, and the potential role of alternative dosing strategies, such as use of loading doses and extended/continuous infusions, is also outlined.

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Drain versus non drain in thyroid surgery

Kurdistan Journal of Applied Research ◽

10.24017/science.2016.1.2.5 ◽

2016 ◽

Vol 1 (2) ◽

pp. 26-29

Author(s):

Fadhil Ahmed Mohialdeen ◽

Abdul-Wahid M Salih ◽

Mohammed IM Gubari ◽

Soran Ameen Hama-law

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Total Thyroidectomy ◽

Thyroid Surgery ◽

Length Of Hospital Stay ◽

Pain Patient ◽

Histopathological Diagnosis ◽

Suction Drain ◽

Significant Difference ◽

Hospital Stays

The use of a suction drain in thyroid surgery is common practice in order to avoid hematomas or seromas. The aim of this study was to determine the efficacy of inserting a routine drainage tube after thyroid surgery. In this retrospective study, 102 patients who underwent either a total thyroidectomy for thyroid disorders were assigned to either the drained or the non-drained groups. The length of hospital stays, postoperative pain, patient comfortability and complications were retrieved. Both groups were homogeneous according to age, gender, type of procedure performed, histopathological diagnosis residency and marital status. No significant difference was found between the two groups in post- operative complications, but the length of hospital stay was significantly reduced in non-drained group (p<0.0001), and drained group needed one more dose of analgesics compared to non-drained group to alleviate the post-operative pain.Our findings, suggesting that the use of drain for thyroid surgery cannot lower the incidence of complications. Furthermore, the use of drains may increase length of hospital stay, postoperative-pain,and the need of analgesic and contribute to the discomfort of the patients. Hence, the routine insertion of drains after total thyroidectomy for benign disorders might not be necessary.

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Role of drains in cases of peptic ulcer perforations: comparison between single drain versus no drain

International Surgery Journal ◽

10.18203/2349-2902.isj20200287 ◽

2020 ◽

Vol 7 (2) ◽

pp. 404 ◽

Cited By ~ 1

Author(s):

Rajneesh Kumar ◽

Ankur Hastir ◽

Lakshay Chopra ◽

Sonali Jindal ◽

R. P. S. Walia ◽

...

Keyword(s):

Peptic Ulcer ◽

Hospital Stay ◽

Peritoneal Cavity ◽

Wound Dehiscence ◽

Peptic Ulcer Perforation ◽

Ulcer Perforation ◽

Operative Duration ◽

Relative Safety ◽

Significant Difference

Background: Peptic ulcer perforation is one of the commonest causes of peritonitis and needs immediate surgical intervention after prompt resuscitation if mortality and morbidity are to be contained. Aims and objectives of the study was to compare role of Intra-abdominal drains prophylactically after plugging of these perforations single drain or no drain.Methods: In this study, we compared the relative safety and efficacy of putting single drain prophylactically near operation site or in natural abdominal fossae (hepato-renal pouch or sub hepatic) and no drain in cases of peritonitis due to peptic ulcer perforation. Study was done on 60 patients (one drain put in 30 patients Group A and no drain was put in other 30 patients of Group B). We handle the perforation after thorough peritoneal lavage with warm saline and metrogyl. All the perforation was closed by Grahm’s Patch.Results: No significant difference between drain and non-drain group as far age and sex concerned. Significant difference was seen in operative duration, hospital stay, wound dehiscence and post-operative fever, intraperitoneal collection or abscess formation. So use of drains are not effective in preventing post-operative infection rather there are chances of its blockage due to debris, intestine or omentum and tubes itself are source of infection as foreign body and there are chances of migration of bacteria from exterior to peritoneal cavity via these drains.Conclusions: Non drainage of peritoneal cavity after peptic ulcer perforation surgery is an effective method to reduce operative duration, hospital stay and wound dehiscence and post-operative pyrexia.

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