scholarly journals Encapsulating Peritoneal Sclerosis in the Era of a Multi-Disciplinary Approach Based on Biocompatible Solutions: The Next-Pd Study

2014 ◽  
Vol 34 (7) ◽  
pp. 766-774 ◽  
Author(s):  
Masaaki Nakayama ◽  
Masanobu Miyazaki ◽  
Kazuho Honda ◽  
Kenji Kasai ◽  
Tadashi Tomo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Multidisciplinary Approach ◽  
De Novo ◽  
Clinical Course ◽  
Clinical Status ◽  
The Past ◽  
Abdominal Symptoms ◽  
Risk Patients ◽  
Initiation Of Therapy ◽  
Development Outcomes

IntroductionEncapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis (PD). Over the past decade in Japan, a multidisciplinary approach has been adopted to minimize the incidence and improve outcomes of EPS. This strategy includes planned PD discontinuation for high-risk patients and the introduction of biocompatible solutions. This study examined the current clinical status of EPS in representative PD centers in Japan.Design, setting, participants and measurementsPatients ( n = 1,338) from 55 PD centers in Japan who were using neutral-pH solutions from the initiation of therapy (mean age, 62 years; median PD duration, 32 months; concomitant use of icodextrin, 35.2%; PD and hemodialysis combination therapy, 12.2%) were assessed every 6 months to ascertain the reasons for PD discontinuation and the development of EPS development. Outcomes were also recorded. The study period was from November 2008 to March 2012.ResultsThere were 727 patients who discontinued PD, including 163 deaths. Among all causes of PD withdrawal except for death, planned PD discontinuation to avoid EPS was utilized in 58 cases (7.1% in total). The strategy was increasingly utilized in proportion to the duration of PD: 0.5% for patients undergoing PD for < 3 years, 0.6% for patients undergoing PD for 5 years, 14.7% for patients undergoing PD for 8 years, and 35.5% for patients undergoing PD for > 8 years. Fourteen patients developed EPS (three cases after PD), which corresponded with an overall incidence of 1.0%. The incidence according to the duration of PD was 0.3% for PD < 3 years, 0.6% for PD = 5 years, 2.3% for PD = 8 years, and 1.2% for PD > 8 years. In terms of therapy, 11 patients were treated with prednisolone (PSL), and surgical enterolysis was utilized in two cases. Complete remission of abdominal symptoms was achieved in twelve patients (85.7%), and three died due to EPS (mortality rate of 21.4%).ConclusionsUse of the multidisciplinary approach described above reduces the risk of the development of EPS according to PD duration. In cases of de novo EPS cases in Japan, this strategy can also attenuate the clinical course of the condition.

Gallbladder Stones, Cholecystitis and Cholecystectomy in Patients on Continuous Ambulatory Peritoneal Dialysis

1984 ◽  
Vol 4 (4) ◽  
pp. 245-248 ◽  
Author(s):  
William Nelson ◽  
Ramesh Khanna ◽  
Raymond Mathews ◽  
Harry Yeung ◽  
George Wu ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Ultrasound Examination ◽  
Clinical Course ◽  
Gallbladder Disease ◽  
Abdominal Ultrasound ◽  
Toronto Western Hospital ◽  
The Past ◽  
Possible Cause ◽  
Abdominal Ultrasound Examination

This paper describes a prospective three-year study using abdominal ultrasound examination in 114 new CAPD patients. Gallbladder disease was common (22.8%) and four of 16 patients with gallstones (25%) required cholecystectomy after 1–14 (i 7.8 months) on CAPD. Two of these four had evidence of peritonitis in association with cholecystitis. Also we analyzed the clinical course of eight patients on chronic PD who underwent cholecystectomy. They had no serious morbidity, and all returned to chronic PD. While abdominal pain is one of the main features of CAPD-related peritonitis, other causes of abdominal pain may be more difficult to evaluate in the patient on peritoneal dialysis (PD); such causes potentially are more serious because they threaten the continuance of PD as a mode of therapy. Cholecystitis related to cholelithiasis is one such possible cause of abdominal pain. However, since ultrasonography can reliably and non-invasively detect the presence of gallstones, we have used it prospectively to screen patients entering our CAPD training program. This paper reports our findings and the subsequent course of those found to have gallstones during a three-year period. In addition we also reviewed the feasibility of cholecystectomy, its hazards and outcome in eight patients on chronic peritoneal dialysis who underwent this procedure at Toronto Western Hospital in the past seven years.

Impact of malnutrition on clinical presentation, clinical course, and mortality in MDR-TB patients

2010 ◽  
Vol 139 (1) ◽  
pp. 113-120 ◽  
Author(s):  
L. J. PODEWILS ◽  
T. HOLTZ ◽  
V. RIEKSTINA ◽  
V. SKRIPCONOKA ◽  
E. ZAROVSKA ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Multidrug Resistant ◽  
The Past ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Modifiable Factors ◽  
Mdr Tb ◽  
Risk Patients

SUMMARYDespite the adoption of strategies to prevent and treat multidrug-resistant tuberculosis (MDR-TB) over the past decade, Latvia continues to have one of the highest rates of MDR-TB in the world. It is important to identify modifiable factors that may impact on MDR-TB patient outcomes. A study was conducted to elucidate the association between nutritional status and clinical presentation, clinical course, and mortality in 995 adult patients treated for MDR-TB from 2000 to 2004. Twenty percent of patients were underweight, defined as a body mass index <18·5, at the time of diagnosis. These patients were significantly more likely to have clinical evidence of advanced disease, and had a greater risk of experiencing ⩾3 side-effects [adjusted odds ratio 1·5, 95% confidence interval (CI) 1·1–2·1] and death (adjusted hazard ratio 1·9, 95% CI 1·1–3·5) compared to patients who were normal or overweight. Interventions aimed at these high-risk patients, including nutritional supplementation as an adjunct to anti-TB therapy, should be considered and evaluated by TB programmes.

Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis

Heart ◽  
2020 ◽  
Vol 106 (24) ◽  
pp. 1878-1882
Author(s):  
Khawaja M Talha ◽  
Daniel C DeSimone ◽  
M Rizwan Sohail ◽  
Larry M Baddour
Keyword(s):  
At Risk ◽  
Infective Endocarditis ◽  
Clinical Course ◽  
Prosthetic Valve Endocarditis ◽  
Target Population ◽  
Significant Shift ◽  
The Past ◽  
Risk Patients ◽  
History Of ◽  
Viridans Group Streptococci

Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase ‘subacute bacterial endocarditis’, so-called ‘SBE’, was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.

1610: High-Risk Patients Undergoing Radical Prostatectomy Today are Less High-Risk than in the Past

2005 ◽  
Vol 173 (4S) ◽  
pp. 436-436
Author(s):  
Christopher J. Kane ◽  
Martha K. Terris ◽  
William J. Aronson ◽  
Joseph C. Presti ◽  
Christopher L. Amling ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
High Risk Patients ◽  
The Past ◽  
Risk Patients

The past and the present of peritoneal dialysis treatment

2008 ◽  
Vol 149 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Kálmán Polner
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Treatment ◽  
The Past

A szerző rövid áttekintést ad a peritonealis dialíziskezelés történetéről, kiemelve két magyar nefrológus, Stephen I. Vas és Taraba István munkásságának jelentőségét. A peritonealis dialíziskezelés fejlődése oda vezetett, hogy mára a hemodialízissel egyenrangú vesepótló kezelés lett. A maradék vesefunkció megőrzésével az első két évben a morbiditási, mortalitási mutatók és a betegek életminősége vonatkozásában felül is múlja azt. Gazdasági szempontból egyértelműen előnyösebb a hemodialízisnél, ezért az egyre több veseelégtelen beteg ellátásában várhatóan még nagyobb szerepet fog kapni. Az utóbbi években a technológia fejlődése és az automata peritonealis dialíziskezelések elterjedése is a minőség javítását segíti. A peritonealis dialíziskezelés a beteg önkezelése révén új kapcsolatrendszert alakít ki a betegek és az egészségügyi személyzet között, fokozódik a betegoktatás igénye, javul a betegek önbecsülése, együttműködése, ami összességében jobb rehabilitációs esélyeket és jobb életminőséget eredményez. A hazai peritonealis dialíziskezelés még elmarad az európai átlagtól, de a fejlődés dinamikus, és várhatóan a betegek száma is tovább fog növekedni.

scholarly journals What Has Clinical Research in Suicide Prevention Done for You Lately?

CNS Spectrums ◽  
2006 ◽  
Vol 11 (6) ◽  
pp. 440-441 ◽  
Author(s):  
Jan Fawcett
Keyword(s):  
Suicidal Ideation ◽  
Suicide Risk ◽  
Clinical Status ◽  
Panic Attacks ◽  
Current Evidence ◽  
Suicide Risk Assessment ◽  
Short Term ◽  
The Past ◽  
Standard Risk ◽  
Suicide Plan

What have you heard or read over the past 10 years that has improved you ability to assess and manage suicide risk in your patients?There has been a paucity of data. What little data there is reviewed in this month's articles.They highlight findings that you should know about. Clinicians seem to cling to the familiar, unless some intense marketing is done.For instance, are you aware that the current evidence shows that a denial of suicide thoughts, plans, or intent—even a contract for safety—means absolutely nothing in the absence of a full suicide risk assessment?Yet clinicians seem to rely on these ’reassurances“ from their patients and are shocked when the patient later commits suicide. Why should a patient who is deciding that life is too painful to live tell you the truth? Robert I. Simon, MD, and Daniel W. Shuman, JD, review these facts.Are you aware that severe psychic anxiety, panic attacks, agitation, and severe insomnia often precede suicide within hours, days, or weeks and can be rapidly modified with treatment?On the other hand, standard risk factors for suicide such as suicidal ideation, hopelessness, and past suicidal attempts are not good predictors of suicide in the short term. A suicide plan, recent high intent attempt, or refusal to contract for safety may well indicate immediate risk, but a denial of suicidal ideation or intent and a contract for no harm mean absolutely nothing without a full suicide assessment that takes current clinical status, past suicidal tendencies, social support, and willingness to accept help into account.

Nursing considerations for patients undergoing robotic-arm assisted joint replacements

2021 ◽  
Vol 30 (10) ◽  
pp. 580-587
Author(s):  
Ajay Asokan ◽  
Joanna Baawa-Ameyaw ◽  
Babar Kayani ◽  
Ganan T Radhakrishnan ◽  
Ahmed A Magan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Nursing Care ◽  
Functional Outcomes ◽  
Multidisciplinary Approach ◽  
Robotic Arm ◽  
Surgical Trauma ◽  
Pragmatic Approach ◽  
Joint Replacements ◽  
The Past ◽  
Implant Positioning

Robotic-arm assisted arthroplasty (RAA) has gained popularity over the past decade because of its ability to provide more accurate implant positioning with less surgical trauma than conventional manual arthroplasty. It has shown better early functional outcomes, less postoperative pain and shorter inpatient stays. A multidisciplinary approach is crucial in improving overall outcomes and ensuring this technology is implemented efficiently and safely, but there is limited published literature on the nursing considerations for managing patients undergoing RAA. This article aims to provide a pragmatic approach for nursing care in the pre-, intra-, and postoperative phases of RAA.

scholarly journals Genotype–phenotype correlations and novel molecular insights into the DHX30-associated neurodevelopmental disorders

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ilaria Mannucci ◽  
Nghi D. P. Dang ◽  
Hannes Huber ◽  
Jaclyn B. Murry ◽  
Jeff Abramson ◽  
...  
Keyword(s):  
De Novo ◽  
Clinical Course ◽  
Neurodevelopmental Disorder ◽  
Global Developmental Delay ◽  
Helicase Activity ◽  
Speech Impairment ◽  
Human Phenotype ◽  
Missense Variants ◽  
The Impact ◽  
Global Translation

Abstract Background We aimed to define the clinical and variant spectrum and to provide novel molecular insights into the DHX30-associated neurodevelopmental disorder. Methods Clinical and genetic data from affected individuals were collected through Facebook-based family support group, GeneMatcher, and our network of collaborators. We investigated the impact of novel missense variants with respect to ATPase and helicase activity, stress granule (SG) formation, global translation, and their effect on embryonic development in zebrafish. SG formation was additionally analyzed in CRISPR/Cas9-mediated DHX30-deficient HEK293T and zebrafish models, along with in vivo behavioral assays. Results We identified 25 previously unreported individuals, ten of whom carry novel variants, two of which are recurrent, and provide evidence of gonadal mosaicism in one family. All 19 individuals harboring heterozygous missense variants within helicase core motifs (HCMs) have global developmental delay, intellectual disability, severe speech impairment, and gait abnormalities. These variants impair the ATPase and helicase activity of DHX30, trigger SG formation, interfere with global translation, and cause developmental defects in a zebrafish model. Notably, 4 individuals harboring heterozygous variants resulting either in haploinsufficiency or truncated proteins presented with a milder clinical course, similar to an individual harboring a de novo mosaic HCM missense variant. Functionally, we established DHX30 as an ATP-dependent RNA helicase and as an evolutionary conserved factor in SG assembly. Based on the clinical course, the variant location, and type we establish two distinct clinical subtypes. DHX30 loss-of-function variants cause a milder phenotype whereas a severe phenotype is caused by HCM missense variants that, in addition to the loss of ATPase and helicase activity, lead to a detrimental gain-of-function with respect to SG formation. Behavioral characterization of dhx30-deficient zebrafish revealed altered sleep-wake activity and social interaction, partially resembling the human phenotype. Conclusions Our study highlights the usefulness of social media to define novel Mendelian disorders and exemplifies how functional analyses accompanied by clinical and genetic findings can define clinically distinct subtypes for ultra-rare disorders. Such approaches require close interdisciplinary collaboration between families/legal representatives of the affected individuals, clinicians, molecular genetics diagnostic laboratories, and research laboratories.

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