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Nagore D, Candela A, Bürge M, Monedero P, Tamayo E, Alvarez J, Murie M, Wijeysundera Dn DN, Vives M. Hydroxyethyl starch and acute kidney injury in high-risk patients undergoing cardiac surgery: A prospective multicenter study. J Clin Anesth 2021; 73:110367. [PMID: 34090184 DOI: 10.1016/j.jclinane.2021.110367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients admitted to intensive care unit (ICU) for medical indications. We conducted a cohort study to evaluate the renal safety of modern 6% HES solutions in high-risk patients having cardiac surgery. METHOD In this multicentre prospective cohort study, we recruited 261 consecutive patients at high-risk for developing cardiac surgery-associated AKI, based on a Cleveland score ≥ 4 points, from July to December 2017th in 14 hospitals in Spain and the United Kingdom. Multivariable logistic regression modeling and propensity-score matched-pairs analysis were used to determine the adjusted association between administration of HES and AKI. RESULTS Of the cohort, 95 patients (36.4%) received 6% HES 130/0.4 either intraoperatively or postoperatively. Postoperative AKI occurred in 145 patients (55.5%). The unadjusted odds of AKI was significantly higher in the HES group, when compared to those not receiving HES (OR 2.22, 95% CI 1.30-3.80, p = 0.003). In multivariable logistic regression models, modern HES was not associated with significantly increased risk of AKI (adjusted OR 0.84, 95% CI 0.41-1.71, p = 0.63). In propensity score match-pairs analysis of 188 patients, the HES group experienced similar adjusted odds of AKI (OR 1.05, CI 95% 0.87-1.27, p = 0.57) and RRT (OR 1.06, CI 95% 0.92-1.22, p = 0.36). CONCLUSIONS The use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with an increased risk of AKI nor dialysis in this cohort of patients at elevated risk for developing AKI after cardiac surgery.
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Affiliation(s)
- David Nagore
- Department of Anaesthesia & Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Angel Candela
- Department of Anesthesiology & Perioperative Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Martina Bürge
- Department of Anaesthesia & Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Pablo Monedero
- Department of Anesthesiology & Critical Care Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Eduardo Tamayo
- Department of Anesthesiology & Perioperative Medicine, Hospital Clínico Universitario de Valladolid, Spain
| | - J Alvarez
- Department of Anesthesiology & Perioperative Medicine, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Manuel Murie
- Department of Neurology, Clínica San Miguel, Pamplona, Spain
| | - Duminda N Wijeysundera Dn
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada; Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marc Vives
- Department of Anesthesia and Perioperative Medicine, Hospital Universitari de Girona Dr J Trueta, University of Girona, Instut d'Investigació Biomédica de Girona (IDIBGI), Spain.
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Watts GF, Catapano AL, Masana L, Zambon A, Pirillo A, Tokgözoğlu L. Hypercholesterolemia and cardiovascular disease: Focus on high cardiovascular risk patients. ATHEROSCLEROSIS SUPP 2020; 42:e30-4. [PMID: 33589221 DOI: 10.1016/j.atherosclerosissup.2021.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The widespread use of statins has largely improved the treatment of hypercholesterolemia, but many patients still fail to achieve the LDL-C targets recommended by guidelines. Furthermore, some patients continue to present a very high cardiovascular (CV) risk or even an extreme risk despite being well treated, mainly due to the presence of co-morbidities such as diabetes or peripheral artery disease, which significantly increase their global CV risk. For these very high CV risk patients, the most recent European guidelines have reviewed the LDL-C goals and recommend an LDL-C reduction of at least 50% and a goal of <55 mg/dL or even <40 mg/dL. Recent clinical trials have shown that patient stratification based on the presence or absence of atherothrombotic risk factors may represent a valuable tool to identify patients at extremely high CV risk who may benefit more from an aggressive LDL-C-lowering approach. In these patients it may be appropriate to aim for the lowest LDL-C level, independently of recommended goals, with all the available pharmacological approaches.
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Beshyah SA, Ali KF, Hafidh K, Hajjaji IM. Ramadan fasting and diabetes 2019: The year in review. Diabetes Res Clin Pract 2021; 172:108593. [PMID: 33316310 DOI: 10.1016/j.diabres.2020.108593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The literature on health aspects of Ramadan fasting is widely spread in many journals making it not readily available to those interested in the subject. MATERIALS AND METHODS A narrative, non-systematic review of the international literature from two major online databases (viz. Scopus, PubMed) in one year (2019). The search term "Ramadan fasting AND Diabetes" was used, and relevant literature was narrated in a concise thematic account. RESULTS Research design included qualitative, quantitative, and mixed methods. Articles included controlled trials, critical appraisals, literature narrations, and systematic reviews, and meta-analyses. The publications spanned a vast array of topics related to Ramadan fasting, including assessments of current safety and efficacy profiles of newer diabetes therapies, modes of insulin delivery, and utilization of advanced technology for the treatment and monitoring of blood glucose during Ramadan fasting. Increased interest was particularly evident in capturing the experience element manifested by perceptions, attitudes, and practices of both patients and healthcare professionals during Ramadan. The current literature consolidates previous data on the safety of fasting practices amongst the well-controlled. On the other hand, it emphasizes the need for more aggressive interventions for high-risk patients, promoting the usage of newer anti-diabetic agents and advanced glucose monitoring technology for safer fasting practices. CONCLUSIONS The volume of global literature production related to Ramadan fasting and Diabetes remains modest. Observational studies of small size prevail. Greater improvements in both quality and quantity of research on Ramadan are needed.
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Affiliation(s)
- Salem A Beshyah
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates; The Endocrinology Clinic, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates.
| | - Khawla F Ali
- Department of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Adliya, Bahrain
| | - Khadija Hafidh
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates; Department of Diabetes and Endocrinology, Rashid Hospital, DHA, Dubai, United Arab Emirates
| | - Issam M Hajjaji
- National Centre for Diabetes, Tripoli, Libya; Department of Medicine, Faculty of Medicine, University of Tripoli, Tripoli, Libya
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Jancsó Z, Rurik I, Kolozsvári L, Mester L, Nánási A, Oláh C, Ungvári T, TCs KV, Kalabay L, Torzsa P. Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement. BMC Fam Pract 2020; 21:83. [PMID: 32384878 PMCID: PMC7210674 DOI: 10.1186/s12875-020-01150-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
Abstract
Background Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. studies. Methods Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. Results There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. Conclusions Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.
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Affiliation(s)
- Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Lajos Mester
- Institute of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csaba Oláh
- Central and University Teaching Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Katalin Vraukó TCs
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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Nitschke J, Sünkel Z, Mokros A. [Forensic preventive assertive community treatment : Pilot project to prevent violent crimes in the context of psychiatric disorders]. Nervenarzt 2018; 89:1054-1062. [PMID: 30051175 DOI: 10.1007/s00115-018-0573-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Since 2012, a forensic preventive outpatient clinic has been established at Ansbach District Hospital to fill a gap in general psychiatric care for patients with schizophrenia or severe personality disorders and having a high risk for violent behavior. An interdisciplinary team drawing on forensic psychiatric knowledge applies instruments for forensic risk prognosis and treatment or interventions to prevent violent crimes and to protect potential victims. Admissions depend on certain criteria, e.g., increased risk potential for violent crimes against the background of schizophrenia or severe personality disorders. OBJECTIVE How can a forensic psychiatric preventive treatment be organized, which helps to avoid detention in a forensic commitment and is complementary to general psychiatric treatment structures? Can such a model project reach the target group? MATERIAL AND METHOD In forensic preventive outpatient care the treatment is based on violence prevention (e.g., psychoeducation, group training, individual treatment on violence risk co-management). Data are collected using general psychiatric and forensic instruments on, e.g., risk of violence (HCR-20), global functional level (GAF), violent behavior (SDAS-9) on a regular basis. The values with respect to these instruments on admission were compared to published key factors from population samples with general and forensic psychiatric patients. RESULTS A total of 146 patients between the ages of 18 and 79 years have so far been treated. About 4,000,000 EUR could be saved during the duration of the project because of preventing involuntary admission to a forensic hospital apart from preventing violent crimes. In contrast 3,000,000 EUR had to be spent for the new outpatient service. CONCLUSION Indications for the efficacy of a forensic preventive care for patients with schizophrenia and severe personality disorders with a risk for violence are confirmed. Therefore, an institutionalization and a statewide implementation of forensic preventive care in terms of the forensic preventive out-patient clinic are recommended.
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Affiliation(s)
- J Nitschke
- Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Feuchtwanger Str. 38, 91522, Ansbach, Deutschland.
| | - Z Sünkel
- Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Feuchtwanger Str. 38, 91522, Ansbach, Deutschland
| | - A Mokros
- FernUniversität in Hagen, Hagen, Deutschland
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Gasteiger L, Eschertzhuber S, Tiefenthaler W. Perioperative management of liver surgery-review on pathophysiology of liver disease and liver failure. Eur Surg 2018; 50:81-86. [PMID: 29875796 PMCID: PMC5968074 DOI: 10.1007/s10353-018-0522-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
An increasing number of patients present for liver surgery. Given the complex pathophysiological changes in chronic liver disease (CLD), it is pivotal to understand the fundamentals of chronic and acute liver failure. This review will give an overview on related organ dysfunction as well as recommendations for perioperative management and treatment of liver failure-related symptoms.
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Affiliation(s)
- Lukas Gasteiger
- Department of Anaesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stephan Eschertzhuber
- Department of Anaesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- Department of Anaesthesia and Intensive Care, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Werner Tiefenthaler
- Department of Anaesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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Horta AB, Salgado C, Fernandes M, Vieira S, Sousa JM, Papoila AL, Xavier M. Clinical decision support tool for Co-management signalling. Int J Med Inform 2018; 113:56-62. [PMID: 29602434 DOI: 10.1016/j.ijmedinf.2018.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Co-management between internists and surgeons of selected patients is becoming one of the pillars of modern clinical management in large hospitals. Defining the patients to be co-managed is essential. The aim of this study is to create a decision tool using real-world patient data collected in the preoperative period, to support the decision on which patients should have the co-management service offered. METHODS Data was collected from the electronic clinical health records of patients who had an International Classification of Diseases, 9th edition (ICD-9) code of colorectal surgery during the period between January 2012 and October 2014 in a 200 bed private teaching hospital in Lisbon. ICD-9 codes of colorectal surgery [48.5 and 48.6 (anterior rectal resection and abdominoperineal resection), 45.7 (partial colectomy), 45.8 (Total Colectomy), and 45.9 (Bowel Anastomosis)] were used. Only patients above 18 years old were considered. Patients with more than one procedure were excluded from the study. From these data the authors investigated the construction of predictive models using logistic regression and Takagi-Sugeno fuzzy modelling. RESULTS Data contains information obtained from the clinical records of a cohort of 344 adult patients. Data from 398 emergent and elective surgeries were collected, from which 54 were excluded because they were second procedures for the same patients. Four preoperative variables were identified as being the most predictive of co-management, in multivariable regression analysis. The final model performed well after being internally validated (0.81 AUC, 77% accuracy, 74% sensitivity, 78% specificity, 93% negative predictive value). The results indicate that the decision process can be more objective and potentially automated. CONCLUSIONS The authors developed a prediction model based on preoperative characteristics, in order to support the decision for the co-management of surgical patients in the postoperative ward setting. The model is a simple bedside decision tool that uses only four numerical variables.
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Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA. Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth 2018; 46:3-7. [PMID: 29316474 DOI: 10.1016/j.jclinane.2018.01.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE More stable perioperative hemodynamic conditions, lower costs and a lower perioperative complication rate were reported in young healthy patients undergoing lumbar spine surgery in spinal anesthesia (SA) compared to general anesthesia (GA). However, the benefits of SA in high risk patients (ASA≥II suffering from cardiovascular and/or pulmonary pathologies) undergoing this surgery are unclear. Our objective was to analyze whether SA leads to an improved perioperative hemodynamic stability and to a more cost-effective management compared to GA in high risk patients undergoing this surgery. METHODS In a retrospective analysis 146 ASA II-III patients who underwent lumbar spine surgery in SA were compared with 292 ASA I-III patients who were operated in GA between 2000 and 2014. Hemodynamic effects, hospitalization times, complications, and costs according to the Swiss billing system were assessed. The data extraction was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative for cohort studies. RESULTS The patients in the SA group were older (75years (±9.6) vs 69 (±11.5), p<0.001), had a lower BMI (25.8kg/m2 (±4.8) vs 27.2 (±4.7), p=0.003) and showed a higher ASA score (3 vs 2, p<0.001). However, SA was associated with significantly better perioperative hemodynamic stability with less need for intraoperative vasopressors (15% vs 57%, p<0.001), volume supplementation (1113ml ±458 vs 1589±644, p<0.001) and transfusions (0% vs 4%, p<0.001). Additionally, the number of hypotension episodes was lower in the SA group (15% vs 47%, p<0.001). Furthermore, the SA group showed a significantly shorter duration of surgery (70min (±1.2) vs 91 (±41), p<0.001), lower postoperative nausea and vomiting (PONV) (4% vs 28%, p<0.001) and pain in the post anesthesia care unit (PACU) (visual analogue scale (VAS) 2.3 (±1.1) vs 0.8 (±0.8), p<0.001), whereas pain after 24h did not differ (VAS 0.9 (±1) vs 0.8 (±1.1), p=ns). The postoperative complication (7% vs 5%, p=0.286) and revision rates (4% vs 5%, p=0.626) were similar in both groups. Total costs (United States Dollars (USD) 6377 (±2332) vs 7018 (±4056), p=0.003) and PACU time were significantly lower in the SA group (35min (±12) vs 109 (±173), p<0.001). CONCLUSIONS Lumbar spine surgery in cardiovascular high risk patients with SA is safe, allows good perioperative hemodynamic stability and might lead to lower health care costs. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Marco Muster
- Division of Anesthesiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Andrea Saporito
- Anesthesiology Department, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland.
| | - Muriel Brada
- Division of Anesthesiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - José A Aguirre
- Division of Anesthesiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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Sargowo D, Ovianti N, Susilowati E, Ubaidillah N, Widya Nugraha A, Vitriyaturrida, Siwi Proboretno K, Failasufi M, Ramadhan F, Wulandari H, Waranugraha Y, Hayuning Putri D. The role of polysaccharide peptide of Ganoderma lucidum as a potent antioxidant against atherosclerosis in high risk and stable angina patients. Indian Heart J 2017; 70:608-614. [PMID: 30392496 PMCID: PMC6204443 DOI: 10.1016/j.ihj.2017.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives Antioxidants can reduce oxidative radicals that affect the early phase of atherogenesis, that is endothelial dysfunction. Polysaccharide Peptide (PsP) derived from Ganoderma lucidum has an active substance in the form of β-glucan. Previous studies have proven the PsP of Ganoderma lucidum as an effective antioxidant in atherosclerotic rats and shows no toxicity in animal model. This study aims to prove the effect of PsP as potent antioxidant in high risk and stable angina patients. Method This is a clinical trial conducted to 37 high risk and 34 stable angina patients, which were determined based on ESC Stable CAD Guidelines and Framingham risk score, with pre and post test design without control group. The parameters are superoxide dimustase (SOD) and malondialdehyde (MDA) concentration, circulating endothelial cell (CEC) and endothelial progenitor cell (EPC) counts. The patients were given PsP 750 mg/day in 3 divided dose for 90 days. Paired t-test was performed for normally distributed data, and Wilcoxon test for not normally distributed data, and significant level of p ≤ 0,05. Results SOD level in high risk patients slightly increased but not statistically significant with p = 0,22. Level of SOD in stable angina group significantly increased with p = 0,001. MDA concentration significantly reduced in high risk and stable angina patients with p = 0.000. CEC significantly reduced both in high risk and stable angina patients, with p = 0.000 in both groups. EPC count significantly reduced in high risk and stable angina with p = 0.000. Conclusion PsP of Ganoderma lucidum is a potent antioxidant against pathogenesis of atherosclerosis in stable angina and high risk patients
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Affiliation(s)
- Djanggan Sargowo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Nadia Ovianti
- Master Program of Biomedical Science, Faculty of Medicine, Brawijaya University, Malang, Indonesia.
| | - Eliana Susilowati
- Master Program of Biomedical Science, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Nizamuddin Ubaidillah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Adriyawan Widya Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Vitriyaturrida
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Kartika Siwi Proboretno
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Mirza Failasufi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Fadhli Ramadhan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Hesti Wulandari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Yoga Waranugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
| | - Dinarsari Hayuning Putri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Brawijaya University/Saiful Anwar General Hospital, Malang, Indonesia
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Tin K, Sobani ZA, Anyadike N, Serur A, Mayer I, Iswara K, Tsirlin Y. Percutaneous endoscopic sigmoidopexy using T-fasteners for management of sigmoid volvulus. Int J Colorectal Dis 2017; 32:1073-6. [PMID: 28424872 DOI: 10.1007/s00384-017-2821-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sigmoid volvulus (SV) is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. SV has traditionally been managed via endoscopic detorsion and decompression followed by non-emergent surgical resection owing to the high risk of recurrence. Most cases of SV occur in elderly debilitated patients with multiple comorbidities and may not be candidates for surgical resection. Endoscopic sigmoidopexy has been described as an alternative to surgical resection. Here, we describe our experience with endoscopic sigmoidopexy using T-fasteners. METHODS Three patients with recurrent SV that were identified as poor surgical candidates by our colorectal surgery team underwent endoscopic sigmoidopexy. The patients received preoperative bowel preparation. A colonoscope was inserted and the site of the volvulus was visualized and assessed for adequate decompression. Subsequently, four points of fixation were identified and T-fasteners were deployed. RESULTS Two patients underwent successful sigmoidopexy without any complications or recurrence on follow-up. One patient developed post procedure pneumoperitoneum that was successfully treated conservatively; however, he passed away from their underlying comorbidities. CONCLUSION Overall, preliminary results for sigmoidopexy using T-fasteners have been promising, offering a potential option to prevent recurrence in high risk patients unsuitable for surgical intervention.
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Brescia A, Tomassini F, Berardi G, Pezzatini M, Dall'Oglio A, Pindozzi F, Gasparrini M. Post-incisional ventral hernia repair in patients undergoing chemotherapy: improving outcomes with biological mesh. World J Surg Oncol 2016; 14:257. [PMID: 27716306 PMCID: PMC5053042 DOI: 10.1186/s12957-016-1011-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background Patients requiring ventral hernia (VH) repair during perioperative chemotherapy have a higher risk for post-operative complications. The aim of the study was to perform a case-controlled analysis in patients undergoing chemotherapy who underwent VH repair using biological mesh or synthetic mesh. Methods From January 2013 to December 2015, 32 patients, within 8 weeks from chemotherapy administration, were treated electively for VH repair using a biological mesh (BIOMESH). A control group (CG) receiving chemotherapy within the same time interval and treated with synthetic meshes was selected. There were no differences regarding sex, age, American Society of Anesthesiologists (ASA) score III, BMI, and size of the defect. Morbidity, type of complications, and recurrence rate were investigated and compared between the two groups. Results In the BIOMESH group, eight patients (25 %) experienced complications. Wound dehiscence occurred in four (12.5 %) patients and was treated conservatively. Only three small seromas not requiring treatment were observed. The CG presented a higher mean Clavien-Dindo complication grade (1.94 ± 0.44 vs 1.63 ± 0.52; p = 0.13) and a higher incidence of wound dehiscence (n = 9/32, 28.1 % vs n = 4/32, 12.5 %; p = 0.11). Five patients developed seroma treated by wound drainage. One patient experienced an intra-abdominal collection treated by percutaneous drainage. At the univariate and multivariate analysis use of traditional mesh, BMI and the ASA III were predictive factors of post-operative complications. Two patients (6.3 %) developed a VH recurrence only in the CG. Conclusions Biological meshes could be considered a valid option to improve post-operative short-term outcomes in selected high-risk patients undergoing chemotherapy treated for VH repair.
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Affiliation(s)
- A Brescia
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - F Tomassini
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
| | - G Berardi
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - M Pezzatini
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - A Dall'Oglio
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - F Pindozzi
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - M Gasparrini
- Department of General Surgery, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
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Puddu PE, Iannetta L, Placanica A, Cuturello D, Schiariti M, Manfrini O. The role of Glycoprotein IIb/IIIa inhibitors in acute coronary syndromes and the interference with anemia. Int J Cardiol 2016; 222:1091-1096. [PMID: 27522492 DOI: 10.1016/j.ijcard.2016.07.207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 11/27/2022]
Abstract
The role played by glycoprotein (GP) IIb/IIIa inhibitors (GPI) has continuously evolved until the most recent Guidelines whereby they were stepped down from class I to class II recommendation for treating acute coronary syndromes (ACS). GPI compete with a wider use of ADP inhibitors and novel anticoagulant drugs although GPI use has greatly narrowed. However, GPI may still have a role. Several criteria were proposed to define post-PCI anemia which is strictly related to bleeding and transfusion. In ACS, it should be important to define anemia in comparative terms versus baseline levels: ≥ 15% of red blood cell decrease should be a practical cut-off value. If one wishes to concentrate on hemoglobin (Hb), a≥2g/dl Hb decrease from baseline should be considered. It is important to recognize post-PCI anemia in the setting of ACS. There are sub-populations exposed to short-term hemorrhagic and/or long-term ischemic risks. Ischemic and hemorrhagic risks need to be carefully evaluated along with thrombocytopenia and its prognostic significance in order to put all these blood and rheological parameters into a clinically oriented perspective on which therapeutical decisions should be based. Definition of high risk procedures (complexity, angiographic characteristics and patient's risk profile, regardless whether STEMI or NSTEMI) may help selecting GPI. There are positive elements in GPI use: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration. All these elements should be evaluated when selecting these agents for therapeutics.
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Affiliation(s)
- Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy.
| | - Loredana Iannetta
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy.
| | - Attilio Placanica
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy.
| | - Domenico Cuturello
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy.
| | - Michele Schiariti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy.
| | - Olivia Manfrini
- Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater University, Bologna, Italy.
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Ozturk C, Celik T, Ozturk A, Balta S, Iyisoy A. Duration of antiplatelet or anticoagulant therapy after transcatheter aortic valve implantation in high risk patients; longer or shorter. Int J Cardiol 2016; 210:14-5. [PMID: 26922705 DOI: 10.1016/j.ijcard.2016.02.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/14/2016] [Indexed: 11/20/2022]
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Toyoda S, Kikuchi M, Komatsu T, Hori Y, Nakahara S, Kobayashi S, Sakai Y, Inoue T, Taguchi I. Impact of the oral adsorbent AST-120 on oxidative stress and uremic toxins in high-risk chronic kidney disease patients. Int J Cardiol 2014; 177:705-7. [PMID: 25449490 DOI: 10.1016/j.ijcard.2014.09.196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Migaku Kikuchi
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Takaaki Komatsu
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Yoshihiko Sakai
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan.
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Victor SM, Gnanaraj A, S V, Deshmukh R, Kandasamy M, Janakiraman E, Pandurangi UM, Latchumanadhas K, Abraham G, Mullasari AS. Risk scoring system to predict contrast induced nephropathy following percutaneous coronary intervention. Indian Heart J 2014; 66:517-24. [PMID: 25443605 PMCID: PMC4223201 DOI: 10.1016/j.ihj.2014.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/27/2014] [Accepted: 05/18/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Contrast induced nephropathy (CIN) is associated with significant morbidity and mortality after percutaneous coronary intervention (PCI). The aim of this study is to evaluate the collective probability of CIN in Indian population by developing a scoring system of several identified risk factors in patients undergoing PCI. METHODS This is a prospective single center study of 1200 consecutive patients who underwent PCI from 2008 to 2011. Patients were randomized in 3:1 ratio into development (n = 900) and validation (n = 300) groups. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 hours after PCI when compared to baseline value. Seven independent predictors of CIN were identified using logistic regression analysis - amount of contrast, diabetes with microangiopathy, hypotension, peripheral vascular disease, albuminuria, glomerular filtration rate (GFR) and anemia. A formula was then developed to identify the probability of CIN using the logistic regression equation. RESULTS The mean (±SD) age was 57.3 (±10.2) years. 83.6% were males. The total incidence of CIN was 9.7% in the development group. The total risk of renal replacement therapy in the study group is 1.1%. Mortality is 0.5%. The risk scoring model correlated well in the validation group (incidence of CIN was 8.7%, sensitivity 92.3%, specificity 82.1%, c statistic 0.95). CONCLUSION A simple risk scoring equation can be employed to predict the probability of CIN following PCI, applying it to each individual. More vigilant preventive measures can be applied to the high risk candidates.
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Affiliation(s)
- Suma M Victor
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
| | - Anand Gnanaraj
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - VijayaKumar S
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Rajendra Deshmukh
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Ezhilan Janakiraman
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ulhas M Pandurangi
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - K Latchumanadhas
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Georgi Abraham
- Institute of Kidney Diseases, Urology and Organ Transplantation, Madras Medical Mission, India
| | - Ajit S Mullasari
- Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
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16
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Mann RM, Bult P, van Laarhoven HWM, Span PN, Schlooz M, Veltman J, Hoogerbrugge N. Breast cancer size estimation with MRI in BRCA mutation carriers and other high risk patients. Eur J Radiol 2013; 82:1416-22. [PMID: 23567481 DOI: 10.1016/j.ejrad.2013.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/02/2013] [Accepted: 03/10/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the value of breast MRI in size assessment of breast cancers in high risk patients, including those with a BRCA 1 or 2 mutation. Guidelines recommend invariably breast MRI screening for these patients and therapy is thus based on these findings. However, the accuracy of breast MRI for staging purposes is only tested in sporadic cancers. METHODS We assessed concordance of radiologic staging using MRI with histopathology in 49 tumors in 46 high risk patients (23 BRCA1, 12 BRCA2 and 11 Non-BRCA patients). The size of the total tumor area (TTA) was compared to pathology. In invasive carcinomas (n=45) the size of the largest focus (LF) was also addressed. RESULTS Correlation of MRI measurements with pathology was 0.862 for TTA and 0.793 for LF. TTA was underestimated in 8(16%), overestimated in 5(10%), and correctly measured in 36(73%) cases. LF was underestimated in 4(9%), overestimated in 5(11%), and correctly measured in 36(80%) cases. Impact of BRCA 1 or 2 mutations on the quality of size estimation was not observed. CONCLUSIONS Tumor size estimation using breast MRI in high risk patients is comparable to its performance in sporadic cancers. Therefore, breast MRI can safely be used for treatment planning.
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Affiliation(s)
- R M Mann
- Radboud University Nijmegen Medical Centre, Department of Radiology, Nijmegen, The Netherlands.
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Iannetta L, Puddu PE, Cuturello D, Saladini A, Pellicano M, Schiariti M. Is There Still a Role for Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes? Cardiol Res 2013; 4:1-7. [PMID: 28348696 PMCID: PMC5358181 DOI: 10.4021/cr251w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 01/08/2023] Open
Abstract
The role played by glycoprotein (GP) IIb/IIIa inhibitors has continuously evolved from the initial introduction in mid 90 s until the most recent guidelines for treating acute coronary syndromes, and competed with a wider use of ADP inhibitors and novel anticoagulant drugs, to the extent that they stepped down from class I to class II recommendation in the routine setting of acute coronary syndromes. As a consequence, GP IIb/IIIa use was greatly narrowed. The purpose of this review is to define the roles that GP IIb/IIIa inhibitors may still have in acute ischemic settings by explaining why in high risk patients they might be preferable and/or whether they might be added to ADP inhibitors also emphasizing the underlying mechanistic actions. It is concluded that there might be a more extensive use of GP IIb/IIIa inhibitors in patients presenting with acute coronary syndromes, strictly based on the definition for a high risk procedure: complexity, angiographic characteristics and patient's risk profile, regardless whether STEMI or NSTEMI. The positive elements one should appreciate in GP IIb/IIIa inhibitors are: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration.
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Affiliation(s)
- Loredana Iannetta
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
| | - Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
| | - Domenico Cuturello
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
| | | | - Mariano Pellicano
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
| | - Michele Schiariti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy
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