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Frontiers in Cardiovascular Medicine 2022A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and...
BACKGROUND
A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and hospital stay. Patients suffering from atrial fibrillation and undergoing cardiovascular electronic implantable device (CIED) surgery are widely prescribed and treated with direct oral anticoagulants (DOACs). In this study, the use of a novel compression device was evaluated to examine its ability to decrease the incidence of pocket hematomas following device implantation with uninterrupted DOACs.
METHODS
A total of 204 participants who received DOACs and underwent CIED implantation were randomized into an experimental group (novel compression device) and a control group (elastic adhesive tape with a sandbag). The primary outcome was pocket hematoma, and the secondary outcomes were skin erosions and patient comfort score. Grade 3 hematoma was defined as a hematoma that required anticoagulation therapy interruption, re-operation, or prolonged hospital stay.
RESULTS
The baseline characteristics of both groups had no significant differences. The incidence of grades 1 and 2 hematomas was significantly lower in the compression device group than in the conventional pressure dressing group (7.8 vs. 23.5 and 2.0 vs. 5.9%, respectively; < 0.01). Grade 3 hematoma occurred in 2 of 102 patients in the experimental group and 7 of 102 patients in the control group (2.0 vs. 6.9%; = 0.03). The incidence rates of skin erosion were significantly lower, and the patient comfort score was much higher in the compression device group than in the control group ( < 0.01). Multivariable logistic regression analysis showed that the use of novel compression device was a significant protective factor for pocket hematoma (OR = 0.42; 95% CI, 0.29-0.69, = 0.01).
CONCLUSIONS
The incidence of pocket hematomas and skin erosions significantly decreases when the proposed compression device is used for patients undergoing device implantation with uninterrupted DOACs. Thus, the length of hospital stay and re-operation rate can be reduced, and patient comfort can be improved.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn, identifier: ChiCTR2100049430.
PubMed: 35282349
DOI: 10.3389/fcvm.2022.817453 -
BMC Public Health Jun 2020The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for 'corruption' in... (Review)
Review
The influence of corruption and governance in the delivery of frontline health care services in the public sector: a scoping review of current and future prospects in low and middle-income countries of south and south-east Asia.
BACKGROUND
The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for 'corruption' in the LMICs of south and south-east Asia region. 'Corruption' works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protection, especially while delivering frontline health care services. This scoping review examines current situation regarding health sector corruption at frontlines of service delivery in this region, related policy perspectives, and alternative strategies currently being tested to address this pervasive phenomenon.
METHODS
A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted, using three search engines i.e., PubMed, SCOPUS and Google Scholar. A total of 15 articles and documents on corruption and 18 on governance were selected for analysis. A PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist was filled-in to complete this report. Data were extracted using a pre-designed template and analysed by 'mixed studies review' method.
RESULTS
Common types of corruption like informal payments, bribery and absenteeism identified in the review have largely financial factors as the underlying cause. Poor salary and benefits, poor incentives and motivation, and poor governance have a damaging impact on health outcomes and the quality of health care services. These result in high out-of-pocket expenditure, erosion of trust in the system, and reduced service utilization. Implementing regulations remain constrained not only due to lack of institutional capacity but also political commitment. Lack of good governance encourage frontline health care providers to bend the rules of law and make centrally designed anti-corruption measures largely in-effective. Alternatively, a few bottom-up community-engaged interventions have been tested showing promising results. The challenge is to scale up the successful ones for measurable impact.
CONCLUSIONS
Corruption and lack of good governance in these countries undermine the delivery of quality essential health care services in an equitable manner, make it costly for the poor and disadvantaged, and results in poor health outcomes. Traditional measures to combat corruption have largely been ineffective, necessitating the need for innovative thinking if UHC is to be achieved by 2030.
Topics: Asia; Developing Countries; Fraud; Government; Health Care Sector; Health Personnel; Health Policy; Humans; Income; Medical Assistance; Private Sector; Public Sector; Residence Characteristics
PubMed: 32513131
DOI: 10.1186/s12889-020-08975-0 -
Journal of Cardiac Surgery Nov 2013Left ventricular assist device (LVAD) pocket infection is a serious and potentially fatal complication. Not infrequently, the device erodes externally through the... (Review)
Review
Left ventricular assist device (LVAD) pocket infection is a serious and potentially fatal complication. Not infrequently, the device erodes externally through the thoracoabdominal wall or internally into the peritoneum. In this article, we report two cases to illustrate the presentation and challenges associated with management of LVAD-pocket infection and wound necrosis. Afterward, we review the current therapeutic strategies for LVAD erosion.
Topics: Abdominal Wall; Anti-Bacterial Agents; Device Removal; Drainage; Heart Ventricles; Heart-Assist Devices; Humans; Male; Middle Aged; Patient Education as Topic; Peritoneum; Prosthesis Failure; Prosthesis-Related Infections; Pseudomonas Infections; Surgical Procedures, Operative; Thoracic Wall; Treatment Outcome
PubMed: 24033369
DOI: 10.1111/jocs.12207 -
Pacing and Clinical Electrophysiology :... Jul 2018Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of...
BACKGROUND
Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of prepectoral leads and generator to a submuscular pocket for relief of erosion and pain with minimal pectoral trauma is possible by applying a variant of a previously described submammary tunneling technique.
METHODS
All patients presenting for device follow-up, elective battery replacement, or system upgrade over an 8-month period were considered for relocation if experiencing significant thinning or pain over their prepectoral implant. Those selected for relocation then had their system moved subpectorally via the tunneling technique. Patients were followed for 6 months postoperatively for procedurally related complications and resolution of preprocedure symptoms.
RESULTS
Thirty-two leads in 14 patients were all successfully relocated. Of the relocated leads, five (16%) were a three-pin connector implantable cardioverter defibrillator lead. Three patients (21%) in the group required short-term prescription analgesia in the immediate postdischarge period. Pain and erosion concerns abated in the study group by the 3-month follow-up.
CONCLUSIONS
Relocation of superficial pacing leads with CIED generator to a subpectoral pocket facilitated by this tunneling method is successful, safe, and can accommodate single and multipin leads with minimal pectoral trauma and no nerve damage.
Topics: Defibrillators, Implantable; Humans; Pacemaker, Artificial; Pain; Pectoralis Muscles; Postoperative Complications; Prosthesis Implantation
PubMed: 29745977
DOI: 10.1111/pace.13366 -
Frontiers in Pediatrics 2024Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially...
BACKGROUND
Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications of cholesteatoma. This study assessed the functional and anatomical results of cartilage grafting in children with severe RP of the TM.
METHODS
This was a retrospective review of 212 children from a tertiary referral center.
RESULTS
We identified significant differences in hearing results, indication criteria, and location of TM fixation between stages II and III of RP (according to Charachon). We observed a significantly higher incidence of RP in boys than in girls.
CONCLUSIONS
Cartilage tympanoplasty for retraction pocket of the tympanic membrane in children is a safe procedure with good anatomical and hearing results.
PubMed: 38425661
DOI: 10.3389/fped.2024.1314184 -
Sexual Medicine Jun 2014Erosion through skin of connecting tubing of an inflatable penile prosthesis (IPP) has not been previously reported.
INTRODUCTION
Erosion through skin of connecting tubing of an inflatable penile prosthesis (IPP) has not been previously reported.
AIM
The aim of this study was to present a case of tubing erosion, review the pertinent literature, and discuss the possible causes and management options, including preservation of the device and its components.
METHODS
A 42-year-old male failing to respond to medical treatment for erectile dysfunction underwent insertion of an AMS 700 IPP in 1986. Six years later, a revision was necessary because of a leak in the right cylinder and 4 years after, the pump was replaced. Fourteen years after the original implant, he presented with a portion of the tube connecting the pump to the right cylinder eroding through the skin. There was no infection. The skin area involved was resected and the original pump and tubing were buried in a new scrotal pocket after thorough irrigation.
RESULTS
The IPP remained in place, allowing vaginal penetration and without infection for another 11 years. Three years later, it was de-functionalized, converted into a fixed volume device. It eventually was replaced 25 years after originally implanted with a semirigid prosthesis because it did not provide sufficient rigidity and because of concerns about the presence of "screws" detected during pelvic imaging.
CONCLUSIONS
Mechanical failures in the early IPP models, as illustrated in this case, were expected. However, the long survival of the device is remarkable. Erosion of the connecting tubing through the skin is unique and, under exceptional circumstances, may be managed conservatively without replacing components of the IPP. Clinicians unfamiliar with procedures involving inflatable devices need to be aware of "foreign bodies" visible in radiological examinations in men who have had revisions of an IPP. Morales A. Tubing erosion of an inflatable penile prosthesis long after implantation. Sex Med 2014;2:103-106.
PubMed: 25356305
DOI: 10.1002/sm2.30 -
GeroScience Apr 2024Oral health plays a significant role in the quality of life and overall well-being of the aging population. However, age-related changes in oral health are not well...
Oral health plays a significant role in the quality of life and overall well-being of the aging population. However, age-related changes in oral health are not well understood due to challenges with current animal models. In this study, we analyzed the oral health and microbiota of a short-lived non-human primate (i.e., marmoset), as a step towards establishing a surrogate for studying the changes that occur in oral health during human aging. We investigated the oral health of marmosets using cadaveric tissues in three different cohorts: young (aged ≤6 years), middle-aged, and older (>10 years) and assessed the gingival bacterial community using analyses of the V3-V4 variable region of 16S rRNA gene. The oldest cohort had a significantly higher number of dental caries, increased dental attrition/erosion, and deeper periodontal pocket depth scores. Oral microbiome analyses showed that older marmosets had a significantly greater abundance of Escherichia-Shigella and Propionibacterium, and a lower abundance of Agrobacterium/Rhizobium at the genus level. Alpha diversity of the microbiome between the three groups showed no significant differences; however, principal coordinate analysis and non-metric multidimensional scaling analysis revealed that samples from middle-aged and older marmosets were more closely clustered than the youngest cohort. In addition, linear discriminant analysis effect size (LEFSe) identified a higher abundance of Esherichia-Shigella as a potential pathogenic biomarker in older animals. Our findings confirm that changes in the oral microbiome are associated with a decline in oral health in aging marmosets. The current study suggests that the marmoset model recapitulates some of the changes in oral health associated with human aging and may provide opportunities for developing new preventive strategies or interventions which target these disease conditions.
Topics: Humans; Animals; Aged; Middle Aged; Callithrix; Oral Health; RNA, Ribosomal, 16S; Dental Caries; Quality of Life; Aging
PubMed: 37775702
DOI: 10.1007/s11357-023-00939-7 -
Revista Portuguesa de Cardiologia :... Oct 1995To assess the value of a morphologic classification of pocket lesions in eroded-infected permanent pulse generators and its influence in the efficacy or surgical...
OBJECTIVE
To assess the value of a morphologic classification of pocket lesions in eroded-infected permanent pulse generators and its influence in the efficacy or surgical management without removal and with system reutilization.
DESIGN
Retrospective evaluation of patients, presenting with eroded-infected pacemaker, submitted to surgery.
SETTING
Pacing Center and Cardiology Department of Faro District Hospital.
PATIENTS
43 consecutive patients treated by the same surgeon between 1985 and 1994.
INTERVENTIONS
We considered three groups, based on morphologic characterization of the pocket lesions: G1-partial extrusion from the pulse generator with focal, adherent, discoloured and eroded skin; G2-identical to the previous group but with inclusion of lead segments or only lead extrusion; G3-tender pacing sites with fluctuation and, usually, fistula formation without the skin lesions of the other groups. In every patients a new ipsilateral generator pocket has been created just aside from the previous one with reimplantation of the same pacemaker. Failure was defined as the need for explantation of the system, with a new pacemaker implantation on the contralateral site, after the first attempt in G3 and a second in the other two groups.
MEASUREMENTS AND RESULTS
The erosion-infection rate was 6.9%. Recurrences appeared in, 8.3%, 36.3% and 75% for, respectively, G1, G2 and G3. The initial and final success rates of G1 were significantly different from G3 success rates (p, respectively, < 0.07 and < 0.001). At the end of our study, reutilization surgery was successful in 91.4% of G1 and G2 assembled patients compared with 25% of the G3 patients (p < 0.003). Mean hospital stay for G3 patients was 7.4 +/- 1.0 days while G1 and G2 were managed as outpatients. The mean follow-up of patients without recurrences of pocket erosion-infection was 32.8 months.
CONCLUSIONS
Our data suggest that a morphologic classification of lesions is very useful for treatment choice. It is possible, then, to select patients that may successfully managed by ipsilateral reimplantation without removal of pacing systems or hospital stay. The differences in the appearance of lesions and management results must reflect different etiopathogenic mechanisms.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Child; Combined Modality Therapy; Equipment Failure; Female; Humans; Incidence; Male; Middle Aged; Pacemaker, Artificial; Recurrence; Reoperation; Retrospective Studies
PubMed: 7492399
DOI: No ID Found -
Visceral Medicine Apr 2018Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms... (Review)
Review
Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established. Pharmacological augmentation of the lower esophageal sphincter may represent another approach to diminish reflux, but the clinical efficacy of compounds tested so far is limited. Altered e-sophageal perception represents a major component involved in the generation of reflux symptoms, particularly in non-erosive reflux disease, but effective pharmacological intervention is largely lacking. Presumed reflux-induced respiratory symptoms (cough, laryngitis, etc.) in the absence of typical esophageal symptoms (e.g., heartburn) remain a hot topic, but recent research points towards a hypersensitivity syndrome and only a minor role of gastroesophageal reflux. Treatment options for this condition are still pending.
PubMed: 29888239
DOI: 10.1159/000486692 -
Journal of Cardiovascular... May 2021Cardiac implantable electronic device (CIED) pocket related problems such as infection, hematoma, and device erosion cause significant morbidity and the clinical...
INTRODUCTION
Cardiac implantable electronic device (CIED) pocket related problems such as infection, hematoma, and device erosion cause significant morbidity and the clinical consequences are substantial. Bioabsorbable materials have been developed to assist in the prevention of these complications but there has not been any direct comparison of these adjunctive devices to reduce these complications. We sought to directly compare the TYRX absorbable antibacterial and CanGaroo extracellular matrix (ECM) envelopes in an animal model susceptible to these specific CIED-related complications (i.e., skin erosion and infection).
METHODS AND RESULTS
Sixteen mice undergoing implantation with biopotential transmitters were divided into three groups (no envelope = 4, TYRX = 5, and CanGaroo = 7) and monitored for device-related complications. Following 12 weeks of implantation, gross and histological analysis of the remaining capsules was performed. Three animals in the CanGaroo group (43%) had device erosion compared to none in the TYRX group. The remaining capsules excised at 12 weeks were qualitatively thicker following CanGaroo compared to TYRX and no envelope and histological evaluation demonstrated increased connective tissue with CanGaroo.
CONCLUSION
CanGaroo ECM envelopes did not reduce the incidence of device erosion and were associated with qualitatively thicker capsules and connective tissue staining at 12 weeks compared to no envelope or TYRX. Further studies regarding the use of these envelopes to prevent device erosion and their subsequent impact on capsule formation are warranted.
Topics: Animals; Anti-Bacterial Agents; Defibrillators, Implantable; Electronics; Mice; Models, Animal; Prosthesis-Related Infections
PubMed: 33010088
DOI: 10.1111/jce.14766