Αναζήτηση αυτού του ιστολογίου

Τρίτη 30 Αυγούστου 2022

Urine leaks in children sustaining blunt renal trauma

alexandrossfakianakis shared this article with you from Inoreader
imageBACKGROUND Few consensus statements exist to guide the timely diagnosis and management of urine leaks in children sustaining blunt renal trauma (BRT). The aims of this study were to characterize kidney injuries among children who sustain BRT, evaluate risk factors for urine leaks, and describe the negative impact of urinoma on patient outcomes and resource consumption. METHODS A retrospective review was performed of 347 patients, younger than 19 years, who presented with BRT to a single American College of Surgeons–verified Level I Pediatric Trauma Center between 2005 and 2020. Frequency of and risk factors for urine leak after BRT were evaluated, and impact on patient outcomes and resource utilization were analyzed. RESULTS In total, 44 (12.7%) patients developed urine leaks, which exclusively presented among injury Grade 3 (n = 5; 11.4%), Grade 4 (n = 27; 61.4%), and Grade 5 (n = 12; 27.3%). A minority of urine leaks (n = 20; 45.5%) were discovered on presenting CT scan but all within 3 days. Kidney-specific operative procedures (nephrectomy, cystoscopy with J/ureteral stent, percutaneous nephrostomy) were more common among urine leak patients (n = 17; 38.6%) compared with patients without urine leaks (n = 3; 1.0%; p = 0.001). Patients with urine leak had more frequent febrile episodes during hospital stay (n = 24; 54.5%; p = 0.001) and showed increased overall 90-day readmission rates (n = 14; 33.3%; p
View on Web
στις Δεν υπάρχουν σχόλια:

Management of the open abdomen: A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma

alexandrossfakianakis shared this article with you from Inoreader
imageBACKGROUND Multiple techniques describe the management of the open abdomen (OA) and restoration of abdominal wall integrity after damage-control laparotomy (DCL). It is unclear which operative technique provides the best method of achieving primary myofascial closure at the index hospitalization. METHODS A writing group from the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of the current literature regarding OA management strategies in the adult population after DCL. The group sought to understand if fascial traction techniques or techniques to reduce visceral edema improved the outcomes in these patients. The Grading of Recommendations Assessment, Development and Evaluation methodology was utilized, meta-analyses were performed, and an evidence profile was generated. RESULTS Nineteen studies met inclusion criteria. Overall, the use of fascial traction techniques was associated with improved primary myofascial closure during the index admission (relative risk, 0.32) and fewer hernias (relative risk, 0.11.) The use of fascial traction techniques did not increase the risk of enterocutaneous fistula formation nor mortality. Techniques to reduce visceral edema may improve the rate of closure; however, these studies were very limited and suffered significant heterogeneity. CONCLUSION We conditionally recommend the use of a fascial traction system over routine care when treating a patient with an OA after DCL. This recommendation is based on the benefit of improved primary myofascial closure without worsening mortality or enterocutaneous fistula formation. We are unable to make any recommendations regarding techniques to reduce visceral edema. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level IV.
View on Web
στις Δεν υπάρχουν σχόλια:

Validation of acute pancreatitis among adults in an integrated healthcare system

alexandrossfakianakis shared this article with you from Inoreader

SocialThumb.00001648.DC.jpeg

Background: Acute pancreatitis is a serious gastrointestinal disease that is an important target for drug safety surveillance. Little is known about the accuracy of ICD-10 codes for acute pancreatitis in the US, or their performance in specific clinical settings. We conducted a validation study to assess the accuracy of acute pancreatitis ICD-10 diagnosis codes in inpatient, emergency department (ED), and outpatient settings. Methods: We reviewed electronic medical records for encounters with acute pancreatitis diagnosis codes in an integrated healthcare system from October 2015 to December 2019. Trained abstractors and physician adjudicators determined whether events met criteria for acute pancreatitis. Results: Out of 1,844 eligible events, we randomly sampled 300 for review. Across all clinical settings, 182 events met validation criteria for an overall positive predictive value (PPV) of 61% (95% CI, 55-66%). The PPV was 87% (95% CI, 79-92%) for inpatient codes, but only 45% for ED (95% CI, 35-54%) and outpatient (95% CI, 34-55%) codes. ED and outpatient encounters accounted for 43% of validated events. Acute pancreatitis codes from any encounter type with lipase >3 times the upper limit of normal had a PPV of 92% (95% CI, 86-95%) and identified 85% of validated events (95% CI, 79-89%), while codes with lipase
View on Web
στις Δεν υπάρχουν σχόλια:

Anterior cervical spine surgery and dysphagia

alexandrossfakianakis shared this article with you from Inoreader

SocialThumb.00020840.DC.jpeg

Purpose of review The purpose of this review is to summarize current evidence regarding dysphagia in anterior cervical spine surgeries (ACSS) and to present recent advances in evaluation and surgical technique. Recent findings Various risk factors for dysphagia have been identified, and they include female sex, smoking history, prior surgery and cervical lordotic angle. EAT-10 is a validated tool for the assessment of individuals with dysphagia post-ACSS. Local intraoperative corticosteroid application significantly reduced the incidence and magnitude of dysphagia in four out of five studies that were reviewed. Individuals who had undergone cervical disc replacement (CDR) and revision surgery by a zero-profile anchored spacer (ROI-C) device experienced less dysphagia than those who had anterior cervical discectomy with fusion (ACDF). Videofluoroscopic swallow study (VFSS) after ACSS demonstrated pharyngeal weakness and increased posterior pharyngeal wall thickness, while no other abnormality was found. Summary Different technique variations can reduce dysphagia severity in individuals undergoing ACSS. Surgeons are encouraged to continue performing randomized control studies to assist in choosing the most favourable technique for the patient.
View on Web
στις Δεν υπάρχουν σχόλια:

Clinical pharmacokinetics of nadolol: A systematic review

alexandrossfakianakis shared this article with you from Inoreader
Clinical pharmacokinetics of nadolol: A systematic review

This systematic review aimed to collect and analyse all the PK data of nadolol from studies conducted in healthy and diseased populations. Among the total 22 studies, 03 were IV, 07 were in diseased population, 06 studies were focused on drug–drug and drug-food interactions, and 01 study included lactating mothers. The analysis of these studies shows that the PK parameters such as C max, and AUC proportionally increase with dose in healthy subjects while the serum t ½ of nadolol was greatly increased in the patients with chronic kidney disease. Moreover, the bioavailability of nadolol was significantly reduced with the co-administration of green tea. The knowledge of all these altered PK parameters with disease states can be useful for making individualized dose adjustments.


Abstract

What is known and objective

Nadolol is a non-selective beta-adrenergic antagonist that is used for the treatment of hypertension and angina. The primary route for its administration is oral. It is given once daily as it has a longer half-life (t½). The purpose of conducting this systematic review is to provide a comprehensive view of all the available pharmacokinetic (PK) data on nadolol in humans. This review aimed to systematically collate and analyze publish data on the clinical PK of nadolol in humans and this can be beneficial for the clinicians in dosage adjustments.

Methods

Two electronic databases PubMed and Google Scholar were used for conducting a systematic literature search. All the relevant articles containing PK data of nadolol in humans were retrieved. A total of 1275 articles were searched from both databases and after applying eligibility criteria finally, 22 articles were included for conducting the systematic review.

Results and discussion

The area under the plasma concentration curve (AUC) and maximum plasma concentration (C max) of nadolol increased in a dose-dependent manner. The t½ of nadolol was increased to double (18.2–68.6 h) in the patients with chronic kidney disease while the serum t½ became shorter (3.2–4.3 h) when administered to the children. The bioavailability of nadolol was greatly reduced by the coadministration of green tea. Nadolol can be effectively removed by hemodialysis. It undergoes enterohepatic circulation thus activated charcoal decreased its bioavailability.

What is new and conclusion

Since, there is no previous report of a systematic review on the PK of nadolol, the current review encompasses all the relevant published articles on nadolol in humans. The analysis and understanding of PK parameters (AUC, C max, and t½) of nadolol may be helpful in the development and evaluation of PK models.
View on Web
στις Δεν υπάρχουν σχόλια:

Advances in Scaffolds Used for Pulp‐Dentine Complex Tissue Engineering – A Narrative Review

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Pulp necrosis in immature teeth disrupts root development and predisposes roots to fracture as a consequence of their thin walls and open apices. Regenerative endodontics is a developing treatment modality whereby necrotic pulps are replaced with newly formed healthy tissue inside the root canal. Many clinical studies have demonstrated the potential of this strategy to stimulate root maturation and apical root-end closure. However, clinical outcomes are patient-dependent and unpredictable. The development of predictable clinical protocols is achieved through the interplay of the three classical elements of tissue engineering, namely, stem cells, signaling molecules, and scaffolds. Scaffolds provide structural support for cells to adhere and proliferate and also regulate cell differentiation and metabolism. Hence, designing and fabricating an appropriate scaffold is a crucial step in tissue engineering. In this review, four main classes of scaffolds used to engineer pulp-dentine co mplexes, including bioceramic-based scaffolds, synthetic polymer-based scaffolds, natural polymer-based scaffolds, and composite scaffolds, are covered. Additionally, recent advances in the design, fabrication, and application of such scaffolds are analysed along with their advantages and limitations. Finally, the importance of vascular network establishment in the success of pulp-dentine complex regeneration and strategies used to create scaffolds to address this challenge are discussed.
View on Web
στις Δεν υπάρχουν σχόλια:

Asthma inflammatory phenotypes on four continents: most asthma is non-eosinophilic

alexandrossfakianakis shared this article with you from Inoreader
Abstract
Background
Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK).
Methods
We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016–20. All centres studied children and adolescents (age range 8–20 years), except the UK centre which involved 26–27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum.
Results
Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as ba seline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37–2.94) with lower odds in the LMICs: Brazil (0.73, 0.42–1.27), Ecuador (0.40, 0.24–0.66) and Uganda (0.62, 0.37–1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda.
Conclusions
This is the first time that sputum induction has been used to compare asthma inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and management, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally.
View on Web
στις Δεν υπάρχουν σχόλια:

A rare case of facial asymmetry caused by simultaneous development of osteochondroma and synovial chondromatosis at the temporomandibular joint

alexandrossfakianakis shared this article with you from Inoreader

Publication date: Available online 30 August 2022

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Ichiro Kaneko, Masaaki Karino, Rie Osako - Sonoyama, Shinji Ishizuka, Erina Toda, Junichi Kanayama, Satoe Okuma, Hiroto Tatsumi, Tatsuo Okui, Takahiro Kanno
View on Web
στις Δεν υπάρχουν σχόλια:

Transmission pattern of measles virus circulating

alexandrossfakianakis shared this article with you from Inoreader
Abstract
Background
To provide useful insights into the measles elimination progress in China, measles surveillance data was reviewed, and the transmission patterns of measles viruses circulating in China during 1993–2021 were analyzed.
Methods
Measles incidence data from the National Notifiable Disease Reporting System of the China Center for Disease Control and Prevention was analyzed. A total of 17,570 strains were obtained from 30 of 31 provinces in mainland China during 1993–2021. The recommended genotyping window was amplified. Genotyping analysis was conducted in comparison with the reference strains. Furthermore, phylogenetic analyses were performed to identify genetic relationships among different lineages within the genotypes.
Results
With high coverage of routine immunization and intensive supplementary immunization activities, measles incidence has shown a downward trend since 1993, despite two resurgences, reac hing a historic low level in 2020–2021 (average 0.5 per million). During 1993–2021, nine genotypes including domestic genotype H1, imported genotypes B3, D4, D8, D9, D11, G3, and H2, and vaccine-associated genotype A were identified. Among them, genotype H1 strain circulated endemically in China for over 25 years; the last strain was detected in Yunnan province in September 2019. Multiple imported genotypes were identified since 2009 showing different transmission patterns. Since April 2020, no imported strains have been detected, while vaccine-associated genotype A continues to be detected.
Conclusions
The evidence of low incidence during 2020–2021 and virological surveillance data in this study confirmed that China is currently approaching measles elimination.
View on Web
στις Δεν υπάρχουν σχόλια:

Rifapentine with and without moxifloxacin for pulmonary tuberculosis in people with HIV (S31/A5349)

alexandrossfakianakis shared this article with you from Inoreader
Abstract
Background
Tuberculosis (TB) Trials Consortium Study 31/AIDS Clinical Trials Group A5349, an international randomized open-label phase 3 non-inferiority trial showed that a 4-month daily regimen substituting rifapentine for rifampin and moxifloxacin for ethambutol had non-inferior efficacy and was safe for the treatment of drug-susceptible pulmonary TB (DS-PTB) compared with the standard 6-month regimen. We explored results among the pre-specified subgroup of people with HIV (PWH).
Methods
PWH and CD4 + counts ≥100 cells/μL were eligible if they were receiving or about to initiate efavirenz-based antiretroviral therapy (ART). Primary endpoints of TB disease-free survival 12 months post-randomization (efficacy) and ≥ grade 3 adverse events (AEs) on treatment (safety) were compared, using a 6.6% non-inferiority margin for efficacy. Randomization was stratified by site, pulmonary cavitation, and HIV-status. PWH were e nrolled in a staged fashion, to support cautious evaluation of drug-drug interactions between rifapentine and efavirenz.
Results
2,516 participants from 13 countries in sub-Saharan Africa, Asia, and the Americas were enrolled. Among 194 (8%) microbiologically eligible PWH, the median CD4 + count was 344 cells/μL (interquartile range: 223–455). The rifapentine-moxifloxacin regimen was non-inferior to control (absolute difference in unfavorable outcomes -7.4% [95% CI –20.8% to +6.0%]); the rifapentine regimen was not non-inferior to control (+7.5% [95% CI -7.3% to +22.4%]). Fewer AEs were reported in rifapentine-based regimens (15%) than the control regimen (21%).
Conclusions
In people with HIV-associated DS-PTB with CD4 + counts ≥100 cells/μL on efavirenz-based ART, the 4-month daily rifapentine-moxifloxacin regimen was non-inferior to the 6-month control regimen and was safe.
View on Web
στις Δεν υπάρχουν σχόλια:
Εγγραφή σε: Αναρτήσεις (Atom)