scholarly journals Hyperbaric Oxygen Therapy with Iloprost Improves Digit Salvage in Severe Frostbite Compared to Iloprost Alone

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1284
Author(s):  
Marie-Anne Magnan ◽  
Angèle Gayet-Ageron ◽  
Pierre Louge ◽  
Frederic Champly ◽  
Thierry Joffre ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Prospective Cohort ◽  
Freezing Injury ◽  
Inclusion Criteria ◽  
Historical Cohort ◽  
Cross Border ◽  
Treatment Start ◽  
Historical Group ◽  
Cellular Oxygen ◽  
Injury Outcomes

Background and Objectives: Frostbite is a freezing injury that can lead to amputation. Current treatments include tissue rewarming followed by thrombolytic or vasodilators. Hyperbaric oxygen (HBO) therapy might decrease the rate of amputation by increasing cellular oxygen availability to the damaged tissues. The SOS-Frostbite study was implemented in a cross-border program among the hyperbaric centers of Geneva, Lyon, and the Mont-Blanc hospitals. The objective was to assess the efficacy of HBO + iloprost among patients with severe frostbite. Materials and Methods: We conducted a multicenter prospective single-arm study from 2013 to 2019. All patients received early HBO in addition to standard care with iloprost. Outcomes were compared to a historical cohort in which all patients received iloprost alone between 2000 and 2012. Inclusion criteria were stage 3 or 4 frostbite and initiation of medical care <72 h from frostbite injury. Outcomes were the number of preserved segments and the rate of amputated segments. Results: Thirty patients from the historical cohort were eligible and satisfied the inclusion criteria, and 28 patients were prospectively included. The number of preserved segments per patient was significantly higher in the prospective cohort (mean 13 ± SD, 10) compared to the historical group (6 ± 5, p = 0.006); the odds ratio was significantly higher by 45-fold (95%CI: 6-335, p < 0.001) in the prospective cohort compared to the historical cohort after adjustment for age and delay between signs of freezing and treatment start. Conclusions: This study demonstrates that the combination of HBO and iloprost was associated with higher benefit in patients with severe frostbite. The number of preserved segments was two-fold higher in the prospective cohort compared to the historical group (mean of 13 preserved segments vs. 6), and the reduction of amputation was greater in patients treated by HBO + iloprost compared with the iloprost only.

scholarly journals Hyperbaric oxygen therapy effects on pulmonary functions: a prospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amir Hadanny ◽  
Tal Zubari ◽  
Liat Tamir-Adler ◽  
Yair Bechor ◽  
Gregory Fishlev ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hyperbaric Oxygen ◽  
Prospective Cohort Study ◽  
Hyperbaric Oxygen Therapy ◽  
Prospective Cohort ◽  
Oxygen Therapy ◽  
Pulmonary Functions

Long-Term Follow-Up Confirms the Benefit of All-Trans Retinoic Acid (ATRA) and Arsenic Trioxide (As2O3) as Front Line Therapy for Newly Diagnosed Acute Promyelocytic Leukemia (APL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 565-565 ◽  
Author(s):  
Yuan-Fang Liu ◽  
Yong-Mei Zhu ◽  
Zhan-Zhong Shi ◽  
Jun-Min Li ◽  
Li Wang ◽  
...  
Keyword(s):  
Remission Induction ◽  
Newly Diagnosed ◽  
Front Line ◽  
Current Group ◽  
Historical Cohort ◽  
Term Survival ◽  
Long Term Survival ◽  
Historical Group

Abstract PURPOSE: To further confirm the benifit of front-line use of all-trans retinoic acid (ATRA) combined with arsenic trioxide (As2O3) in patients with newly diagnosed acute promyelocytic leukemia (APL), we observed the long-term survival of the current group (median follow-up: 48 months) and compared it with our historical control. PATIENTS AND METHODS: There were two groups of patients with newly diagnosed APL enrolled in this analysis. The current cohort of patients includes 60 patients since April 2001. The historical cohort of patients included 56 patients from May 1998 to March 2001. No statistically significant differences were found between these two groups in terms of clinical characteristics including sex and age distribution or hematological data before treatment. For the current cohort of patients, all patients received 25mg/m2 ATRA orally and 0.16mg/kg As2O3 intravenously per day till CR. Once CR achieved, they were given 3 courses of consolidation chemotherapy and then 5 cycles of sequential treatment of ATRA, As2O3 and 6-MP/MTX. For the historical group, ATRA was given either 25mg/m2 daily till CR, chemotherapy was added in case of leukocytosis. The post-remission therapy consists of chemotherapy with or without ATRA. Quantitative real-time reverse transcription-polymerase chain reaction (RQ-RT-PCR) measurements of PML-RARa mRNA were retrospectively assessed before treatment, after CR, after consolidation, after maintenance and during follow-up period. The efficacy of these two protocol in terms of remission induction, molecular response and long-term survival were compared with our historical control. RESULT: In the current group, 56 (93.3%) patients achieved CR, and the median time to CR was 27 days. Compared with the historical group, the combined therapy induced an early hematological response. Till the last follow-up at April 2006, two patients underwent extramedullary relapse, one of them also relapsed in marrow thereafter, one patient died from CNS leukemia, and all the other patients were alive and remained in hematological remission. With a median follow-up of 48 months (25 to 60 months), the 4-year OS and EFS was estimated 98.1%±1.8% and 94.2%±3.3%. For the historical group, after a median follow-up of 56 months (12 to 79 months), the 4-year OS and EFS was estimated 83.4%±5.4% (P=0.012) and 45.6%±7.6% (P<0.00001). For the current group, PML-RARa normalized dose was more significantly decreased after remission induction and after consolidation as compared with the historical cohort. In the last follow-up, all of the available event-free patients of the current group remain in molecular remission (PML-RARa DoseN undetectable). CONCLUSION: These 4-year data of follow-up demonstated a benefit of front-line combination of ATRA and As2O3 regarding long-term survival (OS or EFS) of patients with newly diagnosed APL. With prolonged follow-up, we might be able to find a better chance of curing the disease.

scholarly journals Transmission of Acute Respiratory Infections during Aerosol Generating Medical Procedures (AGMPs): An Updated Review

2021 ◽  
Author(s):  
Jenine Leal ◽  
Mark Hofmeister ◽  
Liza Mastikhina ◽  
John Taplin ◽  
Joyce Li ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Prospective Cohort ◽  
Healthcare Workers ◽  
Respiratory Infections ◽  
Medical Procedures ◽  
Acute Respiratory Infections ◽  
Inclusion Criteria ◽  
Prospective Cohort Studies

Objectives: To review the literature from 2011 until March 31st, 2020 to identify the risk of transmission of ARIs to healthcare workers caring for patients undergoing AGMPs compared with the risk of transmission when caring for patients not undergoing AGMPs. Results: Only two prospective cohort studies were identified meeting inclusion criteria. One found that performance or assistance with AGMP during the previous week was significantly associated with symptomatic influenza (adjusted OR: 2.29, 95% CI: 1.3 to 4.2). The second study found that performance of AGMP was significantly associated with clinical respiratory infections (RR 2.9, 95% CI 1.42-5.87, p<0.01), laboratory-confirmed virus or bacteria (RR 2.9, 95% CI 1.37-6.22, p=0.01), and laboratory-confirmed virus (RR 3.3, 95% CI 1.01-11.02, p=0.05). Further evidence is needed regarding what constitutes an AGMP and the risk of ARI transmission during presumed AGMPs. Organizations need to interpret these findings with caution when establishing AGMP lists requiring airborne precautions.

scholarly journals INTERLEUKIN 18 LEVELS AS A PREDICTORS OF SEVERITY IN SEPSIS PATIENTS ARE ASSOCIATED WITH SOFA SCORES AT THE ICU H. ADAM MALIK HOSPITAL MEDA

2020 ◽  
pp. 1-3
Author(s):  
Saiful Hendra Romado ◽  
Achsanuddin Hanae* ◽  
Ratna Akbari Gani
Keyword(s):  
Mortality Rate ◽  
Global Health ◽  
Health Problem ◽  
Sofa Score ◽  
Prospective Cohort ◽  
Inclusion Criteria ◽  
Interleukin 18 ◽  
The Third ◽  
Global Health Problem

Background: Sepsis is still a global health problem because the mortality rate is quite high. There are many markers being evaluated to assess the severity of sepsis, including IL-18. The purpose of this study is to nd out whether IL-18 levels can be used as a predictor of severity in sepsis patients associated with SOFA scores. Methods: Design of this study was a prospective cohort. 42 patients with sepsis who were treated in ICU H. Adam Malik Medan Hospital who met the inclusion criteria were included in this study. Samples were examined for IL-18 for the rst day and the third day, as well as SOFA scores for the rst day and the third day. Results and Discussion: The rst day level of IL-18 had a signicans relationship with the rst day of SOFA score (p<0.05) and the third day level of IL-18 had a signicans relationship with the third day of SOFA score (p<0.05). Conclusions: IL-18 levels can be used as an alternative parameter to assess the severity in sepsis patients in addition to the SOFA Score

Abstract WP293: Simplified Prehospital Prediction Models to Estimate the Likelihood of 4 Types of Stroke: 7-Item Japan Urgent Stroke Triage (Just-7) Score

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kazutaka Uchida ◽  
Shinichi Yoshimura ◽  
Fumihiro Sakakibara ◽  
Norito Kinjo ◽  
Hayato Araki ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort ◽  
Primary Care Physicians ◽  
Prediction Models ◽  
Prediction Rule ◽  
Predictive Ability ◽  
Receiver Operating Curve ◽  
Vessel Occlusion ◽  
Historical Cohort ◽  
Disturbance Of Consciousness

Background and Purpose: Prehospital prediction models to estimate the likelihood of several types of stroke (large vessel occlusion [LVO], intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH], and other strokes) should be useful to transfer those with suspected stroke to appropriate facilities. Japan Urgent Stroke Triage score with 21 items had excellent predictive abilities, but we tried to simplify the score with parsimonious items and comparable predictive abilities. Methods: We conducted historical and prospective multicenter cohort studies from June 2015 to July 2017. We developed the prediction rule with select variables from JUST score for LVO, ICH, SAH and other strokes using historical cohort study with 2236 patients and validated the developed score using prospective cohort study with 964 patients. We used multivariable logistic regression models to develop the prediction models using the same variables for each stroke type. Result: In the historical cohort, there were 1150 stroke, including 235 LVO, 352 ICH, 107 SAH and 456 other stroke. We developed the score with 7 items (high blood pressure, arrhythmia, conjugate deviation, headache, dysarthria, disturbance of consciousness, paralysis of upper limbs) which showed area under the receiver operating curve (AUC) of 0.84 for any type of stroke, 0.89 for LVO, 0.79 for ICH, and 0.90 for SAH in the historical cohort. The score was validated with good predictive ability in the prospective cohort (AUC of 0.76 for any type of stroke; 0.81 for LVO, 0.73 for ICH, and 0.85 for SAH). Conclusions: The simplified 7-item JUST (JUST-7) score had good predictive ability and can help paramedics or primary care physicians to estimate the likelihood of different type of stroke and decide the referral hospital.

scholarly journals Leg ischaemia management collaboration (LIMb): study protocol for a prospective cohort study at a single UK centre

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031257
Author(s):  
John S M Houghton ◽  
Sarah Nduwayo ◽  
Andrew T O Nickinson ◽  
Tanya J Payne ◽  
Sue Sterland ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Cardiac Mri ◽  
Prospective Cohort ◽  
Amputation Rate ◽  
Type I ◽  
Cognitive Assessments ◽  
Historical Cohort ◽  
Biomarker Analysis

IntroductionSevere limb ischaemia (SLI) is the end stage of peripheral arterial occlusive disease where the viability of the limb is threatened. Around 25% of patients with SLI will ultimately require a major lower limb amputation, which has a substantial adverse impact on quality of life. A newly established rapid-access vascular limb salvage clinic and modern revascularisation techniques may reduce amputation rate. The aim of this study was to investigate the 12-month amputation rate in a contemporary cohort of patients and compare this to a historical cohort. Secondary aims are to investigate the use of frailty and cognitive assessments, and cardiac MRI in risk-stratifying patients with SLI undergoing intervention and establish a biobank for future biomarker analyses.Methods and analysisThis single-centre prospective cohort study will recruit patients aged 18–110 years presenting with SLI. Those undergoing intervention will be eligible to undergo additional venepuncture (for biomarker analysis) and/or cardiac MRI. Those aged ≥65 years and undergoing intervention will also be eligible to undergo additional frailty and cognitive assessments. Follow-up will be at 12 and 24 months and subsequently via data linkage with NHS Digital to 10 years postrecruitment. Those undergoing cardiac MRI and/or frailty assessments will receive additional follow-up during the first 12 months to investigate for perioperative myocardial infarction and frailty-related outcomes, respectively. A sample size of 420 patients will be required to detect a 10% reduction in amputation rate in comparison to a similar sized historical cohort, with 90% power and 5% type I error rate. Statistical analysis of this comparison will be by adjusted and unadjusted logistic regression analyses.Ethics and disseminationEthical approval for this study has been granted by the UK National Research Ethics Service (19/LO/0132). Results will be disseminated to participants via scientific meetings, peer-reviewed medical journals and social media.Trial registration numberNCT04027244.

594 Racial and Ethnic Disparities in Burn Patient Outcomes: A Review of the Literature

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S148-S149
Author(s):  
Jasmine N Peters ◽  
Mariel S Bello ◽  
Leigh J Spera ◽  
Justin Gillenwater ◽  
Haig A Yenikomshian
Keyword(s):  
Risk Factors ◽  
Native American ◽  
Burn Injury ◽  
Ethnic Disparities ◽  
Burn Patients ◽  
Inclusion Criteria ◽  
Burn Care ◽  
Race Ethnicity ◽  
Injury Outcomes ◽  
Racial And Ethnic Minority

Abstract Introduction Racial and ethnic disparities in outcomes for surgical trauma populations has been an expanding field in recent years. Despite this, disparities in prevention, treatment, and recovery outcomes for burn patients of racial and ethnic minority backgrounds have not been well-studied. Our study aims to review the literature regarding risk factors and burn outcomes among racial and ethnic minority populations to develop culturally-tailored burn care for minority burn patients. Methods A systematic review of literature utilizing PubMed was conducted for articles published between 2000–2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Asian OR Hispanic OR Latino OR Native American OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the U.S. that discussed disparities in burn injury outcomes or burn injury risk factors associated with race/ethnicity. Results 1,031 papers were populated, and 38 articles were reviewed. 26 met inclusion criteria (17 for adult patients, 9 for pediatric patients). All but 4 of the included papers were written in the last 10 years. 17 of the 26 articles describe differences in outcomes or risk factors for Black Americans, 8 discuss Latinx, 5 discuss Native Americans, 3 discuss Asian Americans, and 1 referred to “Non-White” minorities, collectively. Majority of studies showed that racial and ethnic minorities (vs. Whites) exhibited poorer burn injury outcomes such as higher mortality rates, greater scar complications, and longer duration for length of stay. Conclusions Few studies exist on outcomes for minority burn populations. Interestingly, most have been published in the last 10 years, which may indicate a trend in increased awareness. There is also a discrepancy in which minorities are included in each study with the least amount of data collected on Asian, Latinx, and Native American communities. More research with a larger base of minority populations will help further investigate this problem and develop better culturally-appropriate burn treatment.

scholarly journals Laparoscopic Nephroureterectomy is Associated with Higher Risk of Adverse Events compared to Laparoscopic Radical Nephrectomy

2016 ◽  
Vol 10 (3-4) ◽  
pp. 126 ◽  
Author(s):  
Ravin Bastiampillai ◽  
Luke T. Lavallée ◽  
Sonya Cnossen ◽  
Kelsey Witiuk ◽  
Ranjeeta Mallick ◽  
...  
Keyword(s):  
Radical Nephrectomy ◽  
Multivariable Analysis ◽  
P Value ◽  
Inclusion Criteria ◽  
Short Term ◽  
Improvement Program ◽  
Historical Cohort ◽  
Surgical Quality ◽  
Laparoscopic Radical Nephrectomy ◽  
Laparoscopic Nephroureterectomy

<p><strong>Background: </strong>Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may counsel both patients groups the same regarding peri-operative risks. The objective of this study is to compare complications following LRN and LNU.</p><p><strong>Patients and methods: </strong>A historical cohort of patients who received LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient and surgical characteristics, and outcomes up to 30-days post-operative were abstracted. Univariable and multivariable associations between procedure (LRN or LNU) and any adverse event were determined.</p><p><strong>Results: </strong>During the study period, 4904 patients met inclusion criteria. Of these, 4159 (85%) received a LRN while 745 (15%) received a LNU. LNU was associated with more complications than LRN (21% vs. 12%, respectively, p-value &lt;0.01). The most common complications for LNU vs. LRN, respectively, were: bleeding requiring blood transfusion (9.0% vs. 6.0%), urinary tract infection (4.6% vs. 1.5%), wound infection (1.3% vs. 1.8%), and unplanned intubation (2.3% vs. 0.9%). On multivariable analysis, LNU was associated with higher risk of any complication compared to LRN (RR 1.41, 95% CI 1.16-1.72).  </p><p><strong>Conclusions: </strong>Post-operative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery.<strong></strong></p>

scholarly journals Quality Improvements in Management of Children with Acute Diarrhea Using a Multiplex-PCR-Based Gastrointestinal Pathogen Panel

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1175
Author(s):  
In Hyuk Yoo ◽  
Hyun Mi Kang ◽  
Woosuk Suh ◽  
Hanwool Cho ◽  
In Young Yoo ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Prospective Cohort ◽  
Antibiotic Use ◽  
Quality Improvements ◽  
Clinical Value ◽  
Historical Cohort ◽  
Clinical Benefits ◽  
Conventional Methods ◽  
A Prospective Study ◽  
Community Onset

Conventional methods for etiologic diagnoses of acute gastroenteritis (AGE) are time consuming and have low positive yield leading to limited clinical value. This study aimed to investigate quality improvements in patient management, antibiotic stewardship, and in-hospital infection transmission prevention using BioFire® FilmArray® Gastrointestinal Panel (GI Panel) in children with acute diarrhea. This was a prospective study recruiting children <19 years old with new onset diarrhea during the study period, and a matched historical cohort study of children diagnosed with AGE during the 4 years prior. Patients in the prospective cohort underwent stool testing with GI Panel and conventional methods. A total of 182 patients were included in the prospective cohort, of which 85.7% (n = 156) had community-onset and 14.3% (n = 26) had hospital-onset diarrhea. A higher pathogen positivity rate for community-onset diarrhea was observed by the GI Panel (58.3%, n = 91) compared to conventional studies (42.3%, n = 66) (p = 0.005) and historical cohort (31.4%, n = 49) (p < 0.001). The stool tests reporting time after admission was 25 (interquartile range, IQR 17–46) hours for the GI Panel, and 72 (IQR 48–96) hours for the historical cohort (p < 0.001). A significant reduction in antibiotic use was observed in the prospective cohort compared to historical cohort, 35.3% vs. 71.8%; p < 0.001), respectively. Compared to the GI Panel, norovirus ICT was only able to detect 4/11 (36.4%) patients with hospital-onset and 14/27 (51.8%) patients with community-onset diarrhea. The high positivity rate and rapid reporting time of the GI Panel had clinical benefits for children admitted for acute diarrhea, especially by reducing antibiotic use and enabling early adequate infection precaution and isolation.

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