scholarly journals Frailty at the beginning of dialysis; is it a prognostic factor?

2021 ◽  
Vol 7 (1) ◽  
pp. e13-e13
Author(s):  
Santiago Silva ◽  
Cristina Milano ◽  
Gonzalo García ◽  
Anabel Abib ◽  
Carlos Díaz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Mean Value ◽  
Dialysis Patients ◽  
Dialysis Therapy ◽  
Dialysis Treatment ◽  
Native Fistula ◽  
Physiological Reserve ◽  
The Mean ◽  
One Year

Introduction: Frailty (F) refers to the cumulative organic damage caused by aging, as a consequence of a diminished physiological reserve. Frailty’s prevalence is 73% in dialysis. Objectives: Our aim was to identify the prevalence of F in patients starting hemodialysis (HD) or hemodiafiltration online (HDF) treatment. To asses change in frailty during a six-month period of dialysis Patients and Methods: This prospective cohort study evaluated 67 incident patient starting-HD or HDF at one year, with a follow-up period of at least six months. The frailty was assessed by the Fried frailty method. According to this test, we divided the population in two groups: Pre-frail (0-2) and frail (3-5). Results: Mean age was 64 years, 64% were male and 92% were treated with HD. A total of 35.8% of the patients were admitted to dialysis with a prosthetic or native fistula. The prevalence of F at the beginning of dialysis was 65.7%. The mean value of Charlson index (CHI) was 5.2 ± 2. There was a significant correlation between CHI and frailty test (P<0.0001). Basal F score (n=67) improved after 6 month (n=52): 3 (2-4) versus1 (1-2) (P<0.0001). Hematocrit (28 versus 32% P=0.05) and calcium levels (8.6 and 8.9 mg/dL, P<0.002) also increased after sixth-month. Global mortality was 7.5%. In the multivariate analysis CHI (P<0.001) and albumin (P=0.003) were frailty predictors. Conclusion: The prevalence of F in patients who start dialysis therapy is high. There was an improvement in F score after six-month of dialysis treatment. Patients with higher F score had higher mortality with higher CHI

scholarly journals Investigation of manual chest compression in CPR on the dialysis chair

2020 ◽  
Author(s):  
Takeshi Ifuku ◽  
Yoshfumi Kawakubo ◽  
Takashi Hitosugi ◽  
Tanaka Tomoyuki ◽  
Kazuto Doi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Mean Value ◽  
Adult Males ◽  
Chest Compressions ◽  
Dialysis Patients ◽  
Dialysis Therapy ◽  
Fluctuation Range ◽  
Manual Chest Compression ◽  
The Mean

Abstract Background: Heart failure is the leading cause of death in dialysis patients. Cardiac arrest due to hypotension may also occur during dialysis therapy. If cardiac arrest is elicited, manual chest compressions (MCC) should be started as soon as possible. However, if MCC is applied during the patient is being treated on the dialysis chair, the backrest of the dialysis chair is horizontal to the floor and there is no support between the backrest and the floor, so that will shake and become unstable.Methods: we investigated whether a round chair is effective for supporting the dialysis chair for MCC. Four adult males performed MCC on three dialysis chairs using a manikin. MCC was performed with 2 sets (1 set was 100 times per minute) per person, with or without a round chair. A total of 4,800 times were performed by four executors.Results: When the chair was not used as a stabilizer, the mean value of fluctuation range were 20.8 ± 8.1 mm, 18.7 ± 5.5 mm, and 12.8 ± 1.8 mm, respectively. When the chair was used, the mean value of fluctuation range were 6.1 ± 1.1 mm, 7.5 ± 2.1 mm, and 1.0 ± 0 mm, decreasing by 70%, 59%, and 92%.Conclusion: MCC with the stool under the backrest as a stabilizer was effective for dialysis chairs.

scholarly journals Follow up of Patients with Parathyroid Adenoma Detected by Parathyroid Scan

2018 ◽  
Vol 20 (2) ◽  
pp. 119
Author(s):  
Shahnaz Begum ◽  
Fatima Begum ◽  
Shamima Yeasmin ◽  
Tania Sultana ◽  
Afroza Begum ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Clinical Status ◽  
Mean Value ◽  
Biochemical Profile ◽  
Sestamibi Scan ◽  
Male Patients ◽  
The Mean ◽  
One Year ◽  
The One

<p><strong><em>Background:</em></strong> Primary hyperparathyroidism (PHPT) is the third most endocrine disorder after diabetes and thyroid disease. The objective of this study was to observe the outcome of those patients who had positive parathyroid scan with Technetium-99m (<sup>99m</sup>Tc) sestamibi scan  referred to National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS) to perform parathyroid scan.<strong></strong></p><p><strong><em>Patients and Methods</em></strong><em>:</em> This longitudinal observational type of study was carried out at NINMAS, from January 2016 to December 2016. A total number of 43 hyperparathyroid patients who had positive parathyroid scan were included in this study during one year follow up period. There clinical status, biochemical profile &amp; treatment history were evaluated Chi-quire and paired t-test were used to analyze the variables.</p><p><strong><em>Results:</em></strong><strong> </strong>Among 43 study patients, number of male patients was 26 (60.5%) and female patients were 17 (39.5%). The mean ± SD age was 42.44 ± 12.11 years and majority was in age group 41-50 years<strong>. </strong>It was observed that 40 (93.0%) patients were symptomatic and only 3 (7.0%) were asymptomatic. Regarding symptoms, majority (81.4%) patients had bone pain followed by renal stone (58.1%). More than half (55.8%) patient had abdominal pain or cramps. Twenty nine (67.4.0%) patients undergone operation and 14 (32.6%) patients did not receive operative treatment at the one year follow up period.  Among 43 patients 29 (67.4%) were operated and all operated patients relieved their symptoms whereas patients 14 (32.6%) had not undergone operation and their symptoms persisted. There was strong statistical significant association (P&lt;0.05) between operation and relief of symptoms. The biochemical profile of study patients showed that preoperative mean serum calcium level was 10.92±2.85 mg/dl which reduced after operation (7.53±2.75 mg/dl). The mean value of serum parathyroid hormone (PTH) level also reduced from 748±744.77 pg/ml to 171.61±168.23 pg/ml.</p><p><strong><em>Conclusion:</em></strong> Among all patients, 67.4% received operative treatment and were relieved from symptoms at one year follow up. Significant number of hyperparathyroid patients (32.6%) failed to receive operative treatment due to poor economic condition. More awareness is needed among physicians and patients about immediate operative treatment to alleviate their sufferings as well as to avoid crippling complications.</p><p>Bangladesh J. Nuclear Med. 20(2): 119-123, July 2017</p>

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23&deg;; increased proximal articular angle (PAA&gt;8&deg;), and range of motion of the metatarsophalangeal joint in flexion and extension &gt;40&deg;. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8&plusmn;1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7&plusmn;2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1&plusmn;2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6&deg; (pre-operative mean value: 37.5&deg;) which was statistically significant (p&lt;0.01). The IMA improved by an average of 5.96&deg; from a pre-operative mean value of 15.4&deg; (p&lt;0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

scholarly journals Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited

2017 ◽  
Vol 11 (1) ◽  
pp. 1041-1048 ◽  
Author(s):  
Mehmet Bekir Unal ◽  
Kemal Gokkus ◽  
Evrim Sirin ◽  
Eren Cansü
Keyword(s):  
Pearson Correlation ◽  
Mean Value ◽  
Cutaneous Nerve ◽  
Digital Nerve ◽  
Mean Values ◽  
Nerve Grafts ◽  
The Mean ◽  
The Difference ◽  
Mean Time

Objective: The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries. Patients and Methods: 13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis. Results: The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated. Conclusion: Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

scholarly journals P1502IS AGE JUST A NUMBER? - HEMODIALYSIS IN OCTOGENARIAN PATIENTS IN A PORTUGUESE CENTRAL HOSPITAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Daniela Alferes ◽  
Marinha Silva ◽  
Joana Couto ◽  
Ana Ventura ◽  
Clemente Sousa ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Vascular Access ◽  
Functional Activity ◽  
Hospital Admissions ◽  
Central Hospital ◽  
Karnofsky Score ◽  
Dialysis Therapy ◽  
Dialysis Treatment

Abstract Background and Aims The option of a non-dialytic or conservative approach to elderly patients with End-Stage Renal Disease (ESRD) as an alternative to dialysis has a great interest in clinical practice. Among elderly patients with ESRD, the octogenarian ones raise the most difficult decisions with respect to indication and dialysis therapy management, furthermore the evidence about the clinical outcomes is lacking in this group of patient. The main objectives of this study were the analysis the comorbidities and clinical condition of pre-ESRD octogenarians who initiated dialysis and the estimation of the effect of such treatment on this patient group’s comorbid status. Method The authors performed a retrospective and statistical analysis on patients with aged ≥ 80 years who initiated hemodialysis treatment in a Portuguese Central Hospital between 2007 and 2017. A total of 88 patients were included in the study. Results The mean age of the group was 84±2.8 years; 61.4% were men. Nearly all the patients (97.7%) had one or more comorbid conditions of which the most common were hypertension (86.4%), heart disease (58%) and diabetes (43.2%). In 60.2% of the patients the functional activity was normal (Karnofsky score ≥80). Hemodialysis was initiated in an emergency situation in 58% of the patients and the majority (59.1%) had an arteriovenous fistula as vascular access. In the 2 years previous to dialysis therapy, most patients (54.5%) had at least one hospitalization (min=1; max=4). During the two years of follow-up, the number of hospital admissions decreased (p=0.034) and only 39.8% of the patients required hospital admission (min=1; max=3) (table 1), with shorter average hospital stay (p=0.013) (table 2). The main causes of hospitalization in the pre-dialysis period were renal related-diseases, in contrast the admissions were due to non-access related infections and vascular access complications after dialysis had initiated. Most patients died (67%) at the end of follow-up mainly due to non-vascular access infections or sepsis (32.2%). The significant causes of death found by Cox regression were chronic kidney disease secondary to systemic disease, Karnofsky score and hospital stay in the 2-year-dialysis period (table 3). Conclusion Advanced age in itself should not be used as an excluding factor of dialysis treatment. Comorbidity and performance status are the factors that should exert the greatest influence on such decision. In this sample, the majority of patients had few comorbidities, a good functional activity and they initiated dialysis by an autologous vascular access which may have contributed to the good outcomeS. This study found a decrease in the number of hospitalizations in the dialysis period which can be explained by regular clinical monitoring in every dialysis treatment, preventing or even treating intercurrent illnesses and avoiding hospital admissions.

scholarly journals Effect of phacoemulsification with intraocular lens implantation in eyes with cataract and functioning filtering blebs

2013 ◽  
Vol 13 (2) ◽  
pp. 33-41
Author(s):  
Devendra Maheshwari ◽  
Rengappa Ramakrishanan ◽  
Mohideen Abdul Kader ◽  
Neelam Pawar ◽  
Ankit Gupta
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Intraocular Lens Implantation ◽  
Corrected Visual Acuity ◽  
Lens Implantation ◽  
The Mean ◽  
One Year ◽  
Best Corrected Visual Acuity

Aim: To evaluate the effect of phacoemulsification with intraocular lens implantation in eyes with pre-existing trabeculectomy.Methods: This prospective single-center clinical study evaluated intraocular pressure in 60 eyes of 60 patients who underwent phacoemulsification and implantation of a foldable intraocular lens after a previous successful trabeculectomy. Patients who had a trabeculectomy more than one year prior to the study were included. Intraocular pressure, number of antiglaucoma medications, bleb appearance, and visual acuity were recorded preoperatively, and at each follow-up examination and 12 months after phacoemulsification.Results: The mean intraocular pressure before phacoemulsification was 12.42 mmHg (SD, 4.60 mmHg), which increased to 14.98 mmHg (SD, 4.18 mmHg), 14.47 mmHg (SD, 3.58 mmHg), 15.44 mmHg (SD, 3.60 mmHg), and 15.71 mmHg (SD, 3.47 mmHg) after one, three, six, and 12 months, respectively. At each follow-up visit, the mean IOP was significantly higher than the preoperative value (p < 0.001, p = 0.015, p ≤ 0.001, and p = 0.001 at month one, three, six, and 12, respectively). The mean preoperative best-corrected visual acuity was 0.98 logMAR (SD, 0.44 logMAR) and the mean postoperative best-corrected visual acuity at 12 months was 0.20 logMAR (SD, 0.21 logMAR) [p = 0.0001]. The mean preoperative number of antiglaucoma medications used was 0.57 (SD, 0.63), which increased to 0.65 (SD, 0.63 ), 0.70 (SD, 0.72 ) 0.68, (SD, 0.70), and 0.67 (SD, 0.77 ) at one, three, six, and 12 months, respectively, but there were no statistically significant differences. Bleb size decreased clinically after phacoemulsification. Nineteen of 60 eyes (32%) developed fibrosis of bleb with decreased bleb size.Conclusion: Phacoemulsification with intraocular lens implantation significantly increased intraocular pressure and increased the number of antiglaucoma medications in eyes with pre-existing functioning filtering blebs.

scholarly journals Observations on radiological correction of acetabular dysplasia by Dega transiliac osteotomy

2017 ◽  
Vol 5 (5) ◽  
pp. 1991
Author(s):  
Wazir Fahad Jan ◽  
Sanjay Sarup ◽  
Mohd Yahya Dar ◽  
Alamgir Jahan ◽  
Ovais Nazir Khan
Keyword(s):  
Acetabular Dysplasia ◽  
Mean Value ◽  
P Value ◽  
Preoperative Period ◽  
Radiological Parameters ◽  
Male Patients ◽  
The Mean ◽  
Paediatric Orthopaedic ◽  
Age Range

Background: Several osteotomies have been described for the correction of acetabular dysplasia associated with variable outcomes. The purpose of our study was to evaluate the effect of Dega transiliac osteotomy in radiological correction of acetabular dysplasia by assessing the change in various radiological parameters from preoperative period to postoperative period and at a follow up of two years.Methods: This was a prospective observational study conducted on 35 patients of either sex, in the age range of 18 months to 8 years, presenting to the paediatric orthopaedic OPD, of Artemis Health Institute, Gurgaon, Haryana, India between January 2012 and September 2014 in whom a diagnosis of acetabular dysplasia was made. All the patients underwent Dega transiliac osteotomy and the effectiveness of this osteotomy in the correction of acetabular dysplasia was assessed by measuring various radiological parameters preoperatively, postoperatively, and at a follow up of two years. The various radiological parameters included acetabular index (AI), centre edge angle of wiberg (CEAW), reimer’s extrusion index (REI) and the shenton’s line (SL).Results: In present study sample of 35 cases, 29 had DDH, 4 were secondary to cerebral palsy and 2 had developed dysplasia following septic arthritis of the hip. The sex distribution showed 19 females and 16 male patients. All the patients underwent Dega transiliac osteotomy at a mean age of 42.94±21.68 months. The mean value of AI improved from 42.43±4.77 degrees in preoperative period to 19.86±2.45 degrees at follow up. The mean value of CEAW improved from - 32.49±21.60 degrees in preoperative period to 32.06±5.48 degrees at follow up. The mean value of REI, improved from 91.06±21.43 % in preoperative period to 0.29±1.18 % at follow up. The SL was broken in all the 35 patients preoperatively, while at follow up it was continuous in all the patients. These changes in all the four parameters were statistically highly significant (p value<0.001).Conclusions: Thus results of present study demonstrate that Dega osteotomy is a safe, effective and versatile surgical procedure for the treatment of acetabular dysplasia secondary to DDH and other disorders. Since the majority of the patients included in this study had the diagnosis of DDH, the results of this study are more representative of dysplasia associated with DDH.

Outcomes of conbercept therapy for choroidal neovascularization secondary to pathological myopia

2021 ◽  
Vol 2 (4) ◽  
pp. 210-213
Author(s):  
Zheng-Feng Liu ◽  
◽  
Da-Dong Guo ◽  
Mei-Hua Ding ◽  
Hong-Sheng Bi ◽  
...  
Keyword(s):  
Choroidal Neovascularization ◽  
Fundus Fluorescein Angiography ◽  
Pathological Myopia ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
The Mean ◽  
One Year

AIM: To evaluate the one-year outcome of intravitreal conbercept injections for the treatment of choroidal neovascularization secondary to pathological myopia (pm-CNV) by optical coherence tomography angiography (OCTA). METHODS: The medical records of 26 consecutive eyes of 23 patients who received intravitreal injections of conbercept for pm-CNV with a follow-up of one year were retrospectively reviewed. All the patients were diagnosed by fundus fluorescein angiography (FFA) and OCTA at the first visit. All approaches were performed as “1+PRN” treatment. Outcomes included best-corrected visual acuity (BCVA), central foveal thickness (CFT) and the mean CNV area by OCTA. RESULTS: Mean Logarithm BCVA improved from (0.66±0.51) at baseline to (0.39±0.38) at one year (t=3.528, P=0.004). The CFT before treatment and after one year after were 275.08±48.74) μm and (205.15±43.74) μm respectively (t=4.630, P=0.001). The mean pm-CNV areas before treatment and after one year treatment were (0.48±0.24) mm2 and (0.15±0.11) mm2 respectively, with a significant difference among them (t=5.329, P=0.000). Twenty-one eyes had no needs after the first treatment. Four eyes received 2 injections and only one eye received 3 injections. No severe adverse events were noted relevant to the therapy. CONCLUSION: Intravitreal conbercept can improve the vision and relieve CFT and CNV area for the treatment of pm-CNV with “1+PRN” by OCTA for one year, however, long-term follow-up still need to be performed.

STUDIES ON FOLIC ACID IN INFANCY

PEDIATRICS ◽  
1964 ◽  
Vol 33 (4) ◽  
pp. 507-511
Author(s):  
Yehuda Matoth ◽  
Ariela Pinkas ◽  
Rina Zamir ◽  
Fouad Mooallem ◽  
Nathan Grossowicz
Keyword(s):  
Folic Acid ◽  
Folinic Acid ◽  
Economic Status ◽  
Mean Value ◽  
First Year ◽  
Mean Values ◽  
Healthy Infants ◽  
Initial Drop ◽  
The Mean ◽  
One Year

The level of folic and folinic acid in whole blood was assayed in 373 healthy infants from birth to one year. Folic acid was high at birth and dropped gradually over the first 8 postnatal weeks. The mean value for the remainder of the first year was significantly below the adult mean. Folinic acid was likewise high at birth and dropped parallel with the folic acid. However, following the initial drop, folinic acid mean values remained well above the adult mean. Folic and folinic acid values were higher in breast-fed than in artificially fed infants and lower in infants whose economic status was poor than in babies belonging to families of higher income.

scholarly journals An Epidemic of Primary Tuberculosis in a Canadian Aboriginal Community

1991 ◽  
Vol 2 (4) ◽  
pp. 133-141 ◽  
Author(s):  
Manuel W Mah ◽  
Elizabeth Anne Fanning
Keyword(s):  
Positive Skin ◽  
Aboriginal Community ◽  
Primary Tuberculosis ◽  
Delay In Diagnosis ◽  
The Family ◽  
Source Case ◽  
The Mean ◽  
One Year ◽  
Isoniazid Prophylaxis

In 1987, an outbreak of primary tuberculosis occurred in a Canadian aboriginal community of 350 people. The source case was a young woman who had been symptomatic for four months with smear positive cavitary pulmonary tuberculosis. Her 17 siblings and their families were frequent close contacts. Among the 626 persons surveyed in the community and environs, 35 additional active cases of tuberculosis were identified. The mean age of cases was 13 years and the median age 10 years. The method of diagnosis was bacteriological in 20 and radiological in 16. There were 257 positive tuberculin reactors of whom 120 had no previous record of a positive skin test. Isoniazid prophylaxis was recommended to all new reactors, close household contacts, reactors under the age of 35 years and reactors with lung scars. One late case was identified at one year of follow-up in a contact who had refused prophylaxis. The rates of infection and disease were higher in the family (65% and 46%, respectively) than in the community and environs (19% and 5.6%, respectively). This report illustrates the nature of a point source epidemic of primary tuberculosis in a susceptible community with a predictable reservoir of infection. The delay in diagnosis of the source case allowed numerous new infections to occur. However, prompt aggressive contact follow-up was successful in containing the epidemic. To prevent future outbreaks, the reservoir of infected persons must be identified and administered chemoprophylaxis.

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