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Shi R, Liu T, Liu Z, Zhang Y, Shen Z. Clinical Analysis of Classification and Prognosis of Ischemia-Type Biliary Lesions After Liver Transplantation. Ann Transplant 2018. [PMID: 29555897 PMCID: PMC6248068 DOI: 10.12659/aot.907240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this study was to classify ischemia-type biliary lesions after liver transplantation according to their imaging findings and severity of clinical manifestations and to analyze the relationship between such classification and prognosis. MATERIAL AND METHODS We collected clinical data of patients with ischemia-type biliary lesions (ITBL) after liver transplantation in the Organ Transplantation Center, the First Central Hospital of Tianjin, from August 2012 to July 2013; all patients were classified according to their imaging findings and relevant clinical data to analyze the relationship between their classification and prognosis. RESULTS The mean postoperative survival time, as well as the 1-, 3-, and 5-year survival rate, in Group ITBL showed statistical significance when compared with those in Group NITBL (log rank=12.13, P<0.001), but the mean postoperative survival times among the mild, moderate, and severe ITBL cases showed no statistical significance. The incidence rates of 1-, 3-, and 5-year adverse prognosis in Group ITBL showed statistical significance when compared with Group NITBL with <2% patients who had anastomotic biliary obstruction (log rank=277.06, P<0.001), among which the difference in the incidence rate of adverse prognosis between severe and moderate ITBL cases showed no statistical significance. The difference in the incidence rate of adverse prognosis between mild and moderate ITBL cases showed statistical significance (log rank=6.01, P=0.014), and the difference in the incidence rate of adverse prognosis between mild and severe ITBL cases showed statistical significance (log rank=10.98, P=0.001). CONCLUSIONS ITBL classification based on the severity of biliary imaging and bilirubin level can predict the prognosis of ITBL.
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Affiliation(s)
- Rui Shi
- Organ Transplantation Center, The First Central Hospital of Tianjin, Tianjin, China (mainland)
| | - Tong Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Zirong Liu
- Organ Transplantation Center, The First Central Hospital of Tianjin, Tianjin, China (mainland)
| | - Yamin Zhang
- Organ Transplantation Center, The First Central Hospital of Tianjin, Tianjin, China (mainland)
| | - Zhongyang Shen
- Organ Transplantation Center, The First Central Hospital of Tianjin, Tianjin, China (mainland)
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Hong-min W, Xiao-hong Z, Jing W. Drug-resistant Tuberculosis and the Prevention of Ongoing Transmission. Clin Infect Dis 2016; 62:266-7. [DOI: 10.1093/cid/civ832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Lancella L, Lo Vecchio A, Chiappini E, Tadolini M, Cirillo D, Tortoli E, de Martino M, Guarino A, Principi N, Villani A, Esposito S, Galli L. How to manage children who have come into contact with patients affected by tuberculosis. J Clin Tuberc Other Mycobact Dis 2015; 1:1-12. [PMID: 31723675 PMCID: PMC6850253 DOI: 10.1016/j.jctube.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/14/2015] [Accepted: 07/05/2015] [Indexed: 11/21/2022] Open
Abstract
Childhood tuberculosis (TB) indicates a recent infection, particularly in children aged < 5 years, and therefore is considered a sentinel event insofar as it highlights the presence of an undiagnosed or untreated source case. The risk of acquiring TB is directly proportional to the number of bacilli to which a subject is exposed and the environment in which the contact occurred. This document contains the recommendations of a group of Italian scientific societies for managing a child exposed to a case of TB based on an analysis of the risk factors for acquiring latent tuberculous infection (LTBI) and developing the disease, and the particular aspects TB transmission during the first years of life. The guidance includes a detailed description of the methods used to identify the index case, the tests that the exposed child should receive and the possibilities of preventive chemoprophylaxis depending on the patient's age and immune status, the chemotherapy and monitoring methods indicated in the case of LTBI, the management of a child who has come into contact with a case of multidrug-resistant or extensively drug-resistant TB, and the use of molecular typing in the analysis of epidemics. The group of experts identified risk factors for tuberculous infection and disease in pediatric age as well as gave recommendation on management of contacts of cases of TB according to their age, risk factors and exposure to multidrug-resistant or extensively drug-resistant TB.
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Affiliation(s)
- Laura Lancella
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Andrea Lo Vecchio
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Elena Chiappini
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
| | - Marina Tadolini
- Section of Infectious Diseases, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Cirillo
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Tortoli
- Microbiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Villani
- Unit of General Pediatrics and Pediatric Infectious Diseases, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Galli
- Pediatric Clinic, Meyer Hospital, University of Florence, Florence, Italy
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Chiappini E, Sollai S, Bonsignori F, Galli L, de Martino M. Controversies in preventive therapy for children contacts of multidrug-resistant tuberculosis. J Chemother 2013; 26:1-12. [PMID: 24090489 DOI: 10.1179/1973947813y.0000000105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) is emerging as an increasing problem worldwide and no consensus has been reached about the management of children contacts of DR-TB cases. OBJECTIVE To evaluate the role of post-exposure chemoprophylaxis in paediatric DR-TB contacts, focusing on literature findings and recommendations from existing international guidelines. METHODS We conducted a literature search of the Cochrane Library, MEDLINE by PubMed and EMBASE from database inception through September 2012, using an appropriate search strategy. RESULTS Eighteen articles were included: four retrospective and two prospective population studies, eight international guidelines and four narrative reviews. CONCLUSIONS General agreement exists that preventive therapy could be beneficial in specific high-risk groups, including immunocompromised children and those aged < 5 years. However, no consensus exists on the use of preventive therapy in older or immunocompetent children and on which regimen should be preferred.
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Shah NS, Yuen CM, Heo M, Tolman AW, Becerra MC. Yield of contact investigations in households of patients with drug-resistant tuberculosis: systematic review and meta-analysis. Clin Infect Dis 2013; 58:381-91. [PMID: 24065336 DOI: 10.1093/cid/cit643] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Contact investigations among individuals living with drug-susceptible tuberculosis patients (source cases) have shown a high yield of tuberculosis disease and latent tuberculosis, but the yield of such investigations in households of drug-resistant tuberculosis source cases is unknown. In this systematic review and meta-analysis, we found 25 studies that evaluated a median of 111 (interquartile range, 21-302) household contacts of drug-resistant tuberculosis source cases. The pooled yield was 7.8% (95% CI, 5.6%-10.0%) for active tuberculosis and 47.2% (95% CI, 30.0%-61.4%) for latent tuberculosis, although there was significant statistical heterogeneity (P < .0001). More than 50% of secondary cases with drug susceptibility test results were concordant with those of the source case. Among studies that followed household members, the majority of secondary cases were detected within 1 year of the source case's diagnosis. Household contact investigation around drug-resistant tuberculosis patients is a high-yield intervention for detection of drug-resistant tuberculosis and prevention of ongoing transmission.
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Affiliation(s)
- N Sarita Shah
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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Seddon JA, Hesseling AC, Finlayson H, Fielding K, Cox H, Hughes J, Godfrey-Faussett P, Schaaf HS. Preventive Therapy for Child Contacts of Multidrug-Resistant Tuberculosis: A Prospective Cohort Study. Clin Infect Dis 2013; 57:1676-84. [DOI: 10.1093/cid/cit655] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Resistencia de Mycobacterium tuberculosis a los fármacos antituberculosos en menores de 15 años en Colombia. BIOMEDICA 2010. [DOI: 10.7705/biomedica.v30i3.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mellado Peña M, Baquero-Artigao F, Moreno-Perez D. Documento de consenso de la Sociedad Española de Infectología Pediátrica sobre la tuberculosis resistente a fármacos. An Pediatr (Barc) 2009; 71:447-58. [DOI: 10.1016/j.anpedi.2009.07.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 07/20/2009] [Accepted: 07/23/2009] [Indexed: 12/11/2022] Open
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