selection of patients
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2021 ◽  
Author(s):  
Dmitry Fedorovich Pokrovskiy

This review presents the main pros and cons of Immediately Sequential Bilateral Cataract Surgery (ISBCS) versus Delayed Sequential Bilateral Cataract Surgery (DSBCS). The main arguments against ISBCS versus DSBCS are the likelihood of postoperative bilateral endophthalmitis and refractive errors. At the same time, careful selection of patients, the implementation of safety recommendations and the use of intracameral antibiotics, combined with the improvement of formulas for calculating intraocular lenses, provide the advantages of ISBCS associated with the rapid rehabilitation of patients after surgery and economic reasons.


2021 ◽  
Vol 12 ◽  
Author(s):  
Wen-Juan Wang ◽  
Jing-Jing Lu ◽  
Li-Ping Liu ◽  
Jiao-Kun Jia ◽  
Xing-Quan Zhao

Aims: Although prognostic importance of ultraearly hematoma growth (uHG) in acute, non-traumatic intracerebral hemorrhage (ICH) has been established for early outcomes, longer-term clinical outcomes are lacking. We aimed to determine the association of uHG with early and 1-year clinical outcomes after acute ICH in a larger and broader range of patients.Methods: We studied 589 patients with acute (<6 h) spontaneous ICH. uHG was defined as baseline ICH volume/onset-to-imaging time (OIT) (ml/h). Multivariable logistic regression analyses were performed to determine the association of uHG with in-hospital mortality, 90-day, and 1-year poor outcome [3 ≤ modified Rankin Scale (mRS)] after ICH.Results: The median speed of uHG was 4.8 ml/h. uHG > 9.3 ml/h was independently related to in-hospital mortality [odds ratio (OR) 2.81, 95% CI 1.52–5.23], 90-day poor outcome (OR 3.34, 95% CI 1.87–5.95), and 1-year poor outcome (OR 3.59, 95% CI 2.01–6.40) after ICH. The sensitivity of uHG > 9.3 ml/h in the prediction of in-hospital mortality, 90-day poor outcome, and 1-year poor outcome was 68.8, 48.0, and 51.1%, respectively.Conclusions: Ultraearly hematoma growth was a useful predictor of in-hospital mortality, 90-day, and 1-year poor outcome after acute ICH. The combination of both uHG and baseline ICH volume could allow better selection of patients with ICH at high risk of poorest clinical outcomes for future clinical trials to improve early- and long-term clinical outcomes.


2021 ◽  
pp. 31-37
Author(s):  
V. V. Kryzhevskii ◽  
O. O. Bilyayeva ◽  
Yu. V. Pavlovych

The aim. To analyze the results of surgical treatment of gallstone disease (GD), methods of prevention of complications. Materials and methods. To analyze the results of surgical treatment of gallstone disease (GD), methods of preventing complications. Results and discussion. The data of 204 patients with GD who underwent laparoscopic cholecystectomy (LC) at the Kiev City Hospital No. 6 and the Medical Center “Universal Clinic Oberig” for 2018 were analyzed. Conclusions. The only radical method of treatment of CD is LC. To reduce the complications of LC, it is necessary to conduct the correct selection of patients and apply bail-out strategies to overcome complex LHE.


2021 ◽  
Vol 28 (6) ◽  
pp. 5084-5100
Author(s):  
Antonio Gómez Caamaño ◽  
Ana M. García Vicente ◽  
Pablo Maroto ◽  
Alfredo Rodríguez Antolín ◽  
Julián Sanz ◽  
...  

This review presents challenges and recommendations on different aspects related to the management of patients with localized muscle-invasive bladder cancer (MIBC), which were discussed by a group of experts of a Spanish Oncology Genitourinary (SOGUG) Working Group within the framework of the Genitourinary Alliance project (12GU). It is necessary to clearly define which patients are candidates for radical cystectomy and which are candidates for undergoing bladder-sparing procedures. In older patients, it is necessary to include a geriatric assessment and evaluation of comorbidities. The pathological report should include a classification of the histopathological variant of MIBC, particularly the identification of subtypes with prognostic, molecular and therapeutic implications. Improvement of clinical staging, better definition of prognostic groups based on molecular subtypes, and identification of biomarkers potentially associated with maximum benefit from neoadjuvant chemotherapy are areas for further research. A current challenge in the management of MIBC is improving the selection of patients likely to be candidates for immunotherapy with checkpoint inhibitors in the neoadjuvant setting. Optimization of FDG-PET/CT reliability in staging of MIBC and the selection of patients is necessary, as well as the design of prospective studies aimed to compare the value of different imaging techniques in parallel.


2021 ◽  
pp. 110113
Author(s):  
Sigmar Stelzner ◽  
Reinhard Ruppert ◽  
Rainer Kube ◽  
Joachim Strassburg ◽  
Andreas Lewin ◽  
...  

2021 ◽  
Vol 12 (1) ◽  
pp. 12-19
Author(s):  
Majda Handanović ◽  
Fuad Julardžija ◽  
Adnan Šehić ◽  
Amela Sofić ◽  
Merim Jusufbegović ◽  
...  

Introduction: Stroke is the second leading underlying cause of death globally and the leading cause of disability in adults. Stroke diagnosis should be performed quickly and efficiently to eliminate other potential causes of neurological deficits and to assess the time since the onset of clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential methods of detecting and evaluating stroke type and treatmentoptions. Diffusion and perfusion MR imaging is recommended for early stroke diagnosis, as well as for the selection of patients for recanalization therapy, and is considered effective in assessing treatment outcomes. The objectives of this study were to demonstrate the diagnostic value of diffusion and perfusion imaging in the diagnosis of acute ischemic stroke, analyze the role of magnetic resonance imaging in the selection of patients with acute stroke for recanalization therapy, and assess the effect of acute stroke complicity.Material and methods: The research is designed as a systematic review of the primary scientific research literature, which was published in English in relevant scientific databases (PubMed, Google Scholar, Medline) from 2014 to 2021.Results: 14 scientific research papers were singled out and the general characteristics of the study were analyzed (country, authors, year of publication, title of the study, type of study, study objectives, research methods, results and conclusion). A quality assessment of the included studies with cohort design and randomized controlled studies was performed, and most belong to the category of high-quality studies with a smaller number of medium-quality studies. The overall percentage of detected AIS cases in isolated studies using the DWI and/or PWI sequence was 90.8%. At the same time, the outcome of recanalization therapy was assessed using MRI studies (the number of patients who developed adverse events with functional data outcome 30 or 90 days after the procedure was observed). Comparison of MRI and CT imaging protocols provided data on the total percentage of detected acute stroke cases using CT imaging protocols (68.9%) and MRI imaging protocols (88.5%), which is why MRI is considered a superior method.Conclusion: Although CT is a suitable method for visualizing bleeding and also for early differentiation of hemorrhagic from ischemic stroke, if MRI imaging is available, it is recommended to use DWI, PWI, MRA sequences for a more accurate diagnosis of stroke in the acute phase.


Bioderecho.es ◽  
2021 ◽  
Author(s):  
Ana Belén Sánchez-García ◽  
María de la Paz Guillermo-Giménez ◽  
Josefa Muñoz-Sánchez ◽  
Cindia Gómez-Pérez ◽  
Diego J. García-Capilla ◽  
...  

La pandemia de la COVID-19 supone un reto para los profesionales de la salud desde un compromiso ético y moral hacia la individualidad del ser humano, quedó inmerso bajo dificultades y cargas extremas haciendo imposible responder a los principios de autonomía, beneficiencia, justicia, y no maleficiencia. El Ministerio de Sanidad refleja la importancia de ofrecer orientaciones éticas, una de éstas situaciones fue priorizar la asignación de recursos humanos y materiales bajo valores éticos en la toma de decisiones. El Comité de Bioética español propuso tener en cuenta el criterio de utilidad, equidad y protección para la no discriminación, priorización sobrecogedora en cuidados intensivos con la selección de pacientes con mayores posibilidades, repercutió en las residencias de mayores, la mala planificación de recursos produjo altos índices de mortandad. La vulnerabilidad patente ha promovido valores de empatía, solidaridad y compasión, ha dejado de lado emociones, intimidad y privacidad, lleva a reflexionar sobre una mayor humanización en los cuidados sanitarios. El principio de justicia, el razonamiento bioético, moral y el conocimiento científico, junto a la toma de decisiones desde el respeto al paciente durante su salud y muerte, es primordial en aras a apoyar a éstos profesionales en la toma de decisiones. The COVID-19 pandemic is a challenge for health professionals from an ethical and moral commitment to the individuality of the human being, immersed under extreme difficulties and burdens making it impossible to respond to the principles of autonomy, beneficence, justice, and non-maleficence. The Ministry of Health reflects the importance of offering ethical guidelines, one of these situations was to prioritise the allocation of human and material resources under ethical values in decision making. The Spanish Bioethics Committee proposed to take into account the criteria of usefulness, equity and protection for non-discrimination, overwhelming prioritisation in intensive care with the selection of patients with greater possibilities, had repercussions in nursing homes, poor resource planning led to high mortality rates. Overt vulnerability has promoted values of empathy, solidarity and compassion, and has put aside emotions, intimacy and privacy, leading to reflections on a greater humanisation of health care. The principle of justice, bioethical and moral reasoning and scientific knowledge, together with decision making based on respect for the patient during their health and death, is paramount in order to support these professionals in their decision making.


Author(s):  
Alexandro Corona ◽  
José M. Zepeda ◽  
Fabiola Bustos ◽  
Javier Contreras ◽  
Felix Osuna

In Mexico, the prevalence of biliary disease is 8.5% in men and 20.5% in women. Choledocholithiasis is a frequent clinical entity, predominantly in females and with well-defined risk factors. Obstruction of the bile duct due to stones is called giant choledocholithiasis when the largest diameter of the stone is greater than 15 mm. Endoscopic treatment fails in up to 88% of cases of giant choledocholithiasis. The authors presented the case of a patient suffering from giant choledocholithiasis, of 9 years of evolution, with an endoprosthesis, successfully treated by ERCP (endoscopic retrograde cholangiopancreatography). The selection of patients who will undergo this type of procedure must be careful, multidisciplinary management is essential to maintain the optimal conditions possible for each case, since the risks are usually high, it is a fact that the diameter of the distal bile duct it is the most important predictive factor when selecting the diameter of the balloon to use, since excessive dilation increases the risk of perforation.


2021 ◽  
Vol 9 (11) ◽  
pp. 2671-2677
Author(s):  
Amit Kumar Gautam ◽  
Kainat Ansari ◽  
Ketan Mahajan ◽  
Sachin Gupta

Background and Objective: BPH is a senile disorder, which leads to urinary symptoms like incomplete empty- ing, urgency etc. 90 % of the males over 80 years of age have histological evidence of BPH. Acharya Sushruta has described Vatastheela, as a type of Mutraghata. Owing to the various medical and surgical complications while treating the disease, an Ayurvedic approach using classical medicines in the management of BPH is re- quired. This study was conducted clinical evaluation of Matra Basti of Varun Taila and Kanchnar Guggulu in Vatastheela (BPH). Aim: In this clinical study the aim was to evaluate the effects of Matra Basti of Varun Taila and Kanchnar Guggulu in the management of Vatastheela (BPH). Material and Methods: Random selection of patients was done from OPD of Shalya Tantra Patanjali Ayurved Hospital Haridwar. The study is approved by the ethics and research committee of the same institute vide its latter no PAC/IEC/2018-19/04 and CTRI Registrationnumber CTRI/ 2020/11/029404. Based on the Inclusion and exclusion criteria a total of 30 patients were selected. Kanchnar Guggulu 2 TAB BD for 3 months and Varun Talia 72 ml Matra Basti for 1week. Observation: As- sessment was made on subjective and objective parameters. Observations were recorded before and after treat- ment. The grading of parameters was used for statistical analysis. Results: The results showed marked relief in subjective and objective parameters. Moreover, this therapy was well accepted by all patients and did not cause any hindrance in their daily routine work during period of management. Conclusion: We can conclude that the effects of Matra Basti of Varun Taila and Kanchnar Guggulu were significant and free from any complication. Since this study was on small size sample further evaluation is needed to be done and study should be repeated with large sample for longer duration for its establishment. Keywords: Varun Taila, Kanchnar Guggulu, Vatastheela, BPH.


2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Panagiota Berta Panagiotopoulou ◽  
Nikos Courcoutsakis ◽  
Apostolos Tentes ◽  
Panos Prassopoulos

AbstractCytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has revolutionized the survival and the quality of life in selected patients with peritoneal carcinomatosis. Preoperative CT is important for the selection of patients that may benefit from cytoreductive surgery and is useful for surgical planning. There are several tasks for the radiologist during CT interpretation: to describe cancerous implants on a “site-by-site” basis in the peritoneum, ligaments, mesenteries and visceral surfaces, to analyze patterns of involvement and to estimate the disease burden. Knowledge of the correlation between the CT and the surgical findings enhances the understanding of the disease and facilitates the communication between radiologists and surgeons.


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