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2022 ◽  
pp. 152660282110687
Author(s):  
Victoria Linehan ◽  
Maria Doyle ◽  
Brendan Barrett ◽  
Ravindra Gullipalli

Purpose: Multiple randomized controlled trials have shown that both drug coated balloons (DCBs) and bare metal stents (BMSs) significantly reduce restenosis in femoropopliteal lesions compared with plain balloon angioplasty. However, few studies have directly compared DCB and BMS treatments. Therefore, the goal of our study was to determine if the rate of target lesion revascularization (TLR) differs between DCB and BMS treatment at our center. Materials and methods: We performed a retrospective chart review of femoropopliteal interventions at a single center from 2009 to 2017. The intervention, patient and lesion characteristics, and TLR events were recorded. Exclusion criteria were loss of follow-up, death, bail-out stenting, and amputation within 60 days of treatment. Freedom from TLR was analyzed over a 3 year period with Kaplan-Meier survival curves. Cox hazard ratios were calculated to account for patient and lesion characteristics. Results: A total of 322 lesions (234 patients) treated with DCBs and 225 lesions (194 patients) treated with BMSs were included in this study. There were significant differences in baseline patient and lesion characteristics between groups—a greater proportion of women, patients with dyslipidemia, and lesions with popliteal involvement were treated with DCBs. There was no difference in the freedom from TLR between DCBs and BMSs. Accounting for patient and lesion characteristics, there was still no difference between DCBs and BMSs on the hazard of TLR. While our analysis did not detect a difference in the rate of TLR, there was a significant difference in the type of TLR. Compared with DCBs, a greater proportion of lesions initially treated with BMSs were retreated via surgical bypass rather than endovascular intervention, suggesting that lesions treated with DCBs may be more amenable to future endovascular intervention. Conclusion: Our retrospective analysis showed no difference in the rate of TLR between lesions treated with DCBs and BMSs. However, DCBs were more often used in complicated lesions involving popliteal arteries and may also allow for easier endovascular reintervention.


Author(s):  
Sanket V. Madavi ◽  
Samruddhi Gujar ◽  
Ranjana Sharma ◽  
Ruchira Ankar ◽  
Savita Pohekar ◽  
...  

Introduction: A germ cell is a type of Tumor that arises from germ cell (GCT). Germ cell tumors are both cancerous and benign. The gonads contains majority of germ cell (ovary and testis). GCT that arise outside the gonads could be the result of embryo devlopment errors. Clinical Findings: Abdominal mass without pain, backache, and weight loss. Diagnostic Evaluation: HCG and alphafetoprotein level in the blood identifying women with malignant ovarian germ cell tumor is beneficial. Serum alphafetoprotein and HCG is elevated as condition progress. Therapeutic Intervention: Patient treated with inj. Bleomycin, inj. Cisplatin, inj.Etoposide, tab Pan 40 miligram and inj. Emset. Conclusion: A 3year old female was admitted in AVBRH Sawangi Meghe wardha with the major complaint of right abdominal swelling for 6 month, both when they observed abdominal mass without pain and swelling was small in size and backache and weight loss.


2021 ◽  
Vol 9 (10) ◽  
pp. 1144-1149
Author(s):  
Ranjan Kumar ◽  
◽  
Rajeev Chandra ◽  
Om Prakash ◽  
◽  
...  

Objective:To evaluate role of Diagnostic Nasal Endoscopy and CT scan in various Sinonasaldiseases with regards to diagnosis and surgical intervention. Patient and methods:This prospective study was carried out in Department of ENT, A.N.M.M.C.H., Gaya on 200 patients with clinical evidence of sinonasal disease who had presented between March 2016 to February 2019. All patients were evaluated with DNE using 0 degree 4mm endoscope and CT scan with 3 mm coronal cuts. Result: Female patients(56%) were more as compared to male(44%) with majority between 21 - 40 yrs. Most common finding on Diagnostic Nasal Endoscopy(DNE) was mucopurulent discharge in middle meatuswhile on CT Scan was maxillary sinusitis(60%). Sinonasal polyp detection was better with DNE.CT has better detection rate of anatomical variation of osteomeatal complex. Conclusion : DNE has become initial tool for diagnosis as it is cost effective and office based procedure. In patients where surgical intervention is required, CT scan has advantage as it provides detailed understanding of anatomical variations. So bothDNE and CT scan should be used in collaborative fashion. Source Of Support:Patients of A.N.M.C.H., Gaya. Conflict Of Interest:None.


Author(s):  
Nasir A. Magboul ◽  
Deafullah Al-Amri

<p>A 27 years old male patient victim of road traffic accident presented to emergency department by ambulance team with ankle swelling and decrease range of motion, seen by orthopedic team and admitted as case of right ankle fracture for surgical intervention. Patient then referred to otolaryngology regarding on and off nasal bleeding and right nasal swelling arising from inner surface of right lower lateral cartilage of the nose 6 hour after the facial trauma, we present this case of hematoma of lower lateral cartilage which consider as one of the unique and rare condition following nasal and facial trauma. Early recognition of this condition is important, also differentiation between alar hematoma and septal cartilage hematoma is not easy for non-otolaryngology doctor, so increase awareness of this condition as one of possible sequel of fecal trauma and early referral to otolaryngology services is crucial. We present here a case of right sided alar cartilage hematoma, including the approach, management and follow up of the patient. We recommend early surgical drainage to optimize aesthetic out come after trauma.</p>


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 277-277
Author(s):  
Divya Natesan ◽  
Helen Elizabeth Elizabeth Old ◽  
Aviva Emmons ◽  
Emily Hatheway ◽  
Yousuf Zafar ◽  
...  

277 Background: Oncology telehealth (TH) services may improve access, mitigate care delays, and augment care in select settings. However, logistical and workflow barriers hinder the sustainable adoption of TH services by providers. We created a novel oncology TH nurse (OTN) position to address these barriers. Methods: An OTN was introduced into oncology provider groups (physician + advanced practice provider) in a staggered, opt-in fashion across the Duke Cancer Institute between 9/2020 and 12/2020. The OTN performed individualized interventions to decrease provider burden, improve TH workflows, and increase TH utilization. Specific interventions performed by the OTN were recorded. We monitored the primary outcome, TH utilization, as a proportion of all visits at baseline (month 0) and 3 months post-OTN intervention. Patient TH satisfaction surveys were reviewed at baseline and 3 months post-OTN intervention. Provider surveys were sent 3 months post-OTN intervention. Results: The OTN was implemented across 10 provider groups and 25 providers [gastrointestinal (GI) medical oncology (n = 10), thoracic medical oncology (n = 3), melanoma medical oncology (n = 3), adult bone marrow transplant (n = 2), lung cancer screening (n = 2), melanoma surgical oncology (n = 1), hematological malignancies (n = 1), head and neck medical oncology (n = 1), central nervous system radiation oncology (n = 1), and GI radiation oncology (n = 1)]. 25 providers utilized 1 or more OTN interventions: support for patients on the TH platform (n = 13), construction of TH clinic schedule templates (n = 6), creation of workflows to order and obtain outside imaging/labs (n = 5), provider TH education (n = 4), creation of Epic SmartPhrases (n = 4), and identifying patients appropriate for TH (n = 3). Baseline TH utilization was 15.6% of all visits, and 3-month post-OTN utilization was 23.8%. TH patient satisfaction data was available for 10 providers at baseline and 13 providers at 3 months post-OTN. Patients’ global approval rating of TH was 85.0% at baseline and 98.5% at month 3. 16/25 providers returned the post-intervention survey. Providers requested continued assistance from the OTN for supporting patients on the TH platform (43.5%), staff TH education (43.5%), provider TH education (25%), creation of SmartPhrases (25%), and creation of TH clinic templates (13%). Providers requested new additional OTN support to 1) order and retrieve imaging/laboratory tests for TH visits and 2) explore patients' willingness to undergo TH visits. Conclusions: OTN interventions were individualized to providers and evolved over time. While TH utilization was increased at 3 months post-OTN, it is possible that utilization was confounded by the dynamic COVID-19 pandemic and provider/patient preferences over time. Nevertheless, these results demonstrate feasibility of OTN implementation and provide support for this novel role in promoting TH services in oncology.


2021 ◽  
Vol 12 (3) ◽  
pp. 723-725
Author(s):  
Sumeet Saini ◽  
Muralidhar P Pujar ◽  
Ashvini Kumar M

Introduction: Ankylosing spondylitis(AS) is a rheumatic disease that comes under the category of Spondyloarthritides. The symptoms of the disease are usually first noticed in late adolescence or early adulthood, with male to the female prevalence of 3:1. Which can be better managed by a combination of Panchakarma procedures and Ayurveda drugs. Clinical findings - We present a case of AS, having symptoms of low back pain along with stiffness unable to bend forward completely, and pain in the nape of the neck with stiffness and restricted movement so it was considered to be Gambhira Vatarakta. Intervention: Patient was treated with Panchakarma treatment Vaitrana Basti(Enema with medicated drugs) in Kala Schedule for 9 days and Jambeera Pinda Swedana(JPS)  for 6 days along with oral medicines. Outcomes - As oral Medication along with Panchakarma procedures help in relieving signs and symptoms like pain and restricted movement and providing best comfort to the patient by reducing the severity of the disability. Conclusion - so it can be concluded that Panchakarma is effective in the management of Ankylosing Spondylitis. 


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049476
Author(s):  
Kristin Gustafsson ◽  
Joanna Kvist ◽  
Marit Eriksson ◽  
Andrea Dell'Isola ◽  
Caddie Zhou ◽  
...  

ObjectivesTo describe the prevalence of comorbidities in a population referred to standardised first-line intervention (patient education and exercise) for hip and knee osteoarthritis (OA), in comparison with the general population. Furthermore, we aimed to evaluate if eventual differences were associated with socioeconomic inequalities.DesignRegister-based study.SettingPrimary healthcare, Sweden.ParticipantsIndividuals with hip and/or knee OA included in the Better Management for Patients with Osteoarthritis Register between 2008 and 2016 and and an age-matched, sex-matched and residence-matched reference cohort (1:3) from the general Swedish population.Outcome measuresComorbidities were identified with the RxRisk Index, the Elixhauser Comorbidity Index and the Charlson Comorbidity Index, and presented with descriptive statistics as (1) individual diseases, (2) disease categories and (3) scores for each index. The prevalence of comorbidities in the two populations was tested using logistic regression, with separate analyses for age groups and the most affected joint. We then adjusted the analyses for socioeconomic status.ResultsIn this OA population, 85% had ≥1 comorbidity compared with 78% of the reference cohort (OR; 1.62 (95% CI 1.59 to 1.66)). Cardiovascular/blood diseases were the most common comorbidities in both populations (OA, 59%; reference, 54%), with OR; 1.22 (95% CI 1.20 to 1.24) for the OA population. Younger individuals with OA were more comorbid than their matched references overall, and population differences decreased with age (eg, ≥3 comorbidities, aged ≤45 years OR; 1.74 (95% CI 1.52 to 1.98), ≥81 years OR; 0.95 (95% CI 0.87 to 1.04)). Individuals with knee OA were more comorbid than those with hip OA overall. Adjustment for socioeconomic status did not change the estimates.ConclusionComorbidities were more common among individuals with hip and knee OA than among matched references from the general population. The differences could not be explained by socioeconomic status.Trial registration numberNCT03438630.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Franchesca Rivera-Calonje ◽  
Shiu-Yi Emily Chen ◽  
Carl Lo ◽  
Sang Le ◽  
Makoto Nagoshi

Abstract Background We present a case of COVID-19–positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure. Case presentation A 12-year-old, COVID-19–positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor. Conclusion Spinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19–positive patient in perioperative setting to avoid minimize the risk to healthcare providers.


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