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Frontiers in Endocrinology 2024Both glucose and albumin are associated with chronic inflammation, which plays a vital role in post-contrast acute kidney injury (PC-AKI). To explore the relationship...
PURPOSE
Both glucose and albumin are associated with chronic inflammation, which plays a vital role in post-contrast acute kidney injury (PC-AKI). To explore the relationship between random glucose to albumin ratio (RAR) and the incidence of PC-AKI after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).
PATIENTS AND METHODS
STEMI patients who underwent PCI were consecutively enrolled from January, 01, 2010 to February, 28, 2020. All patients were categorized into T1, T2, and T3 groups, respectively, based on RAR value (RAR < 3.377; 3.377 ≤ RAR ≤ 4.579; RAR > 4.579). The primary outcome was the incidence of PC-AKI, and the incidence of major adverse clinical events (MACE) was the second endpoint. The association between RAR and PC-AKI was assessed by multivariable logistic regression analysis.
RESULTS
A total of 2,924 patients with STEMI undergoing PCI were finally included. The incidence of PC-AKI increased with the increasing tertile of RAR (3.2% vs 4.8% vs 10.6%, P<0.001). Multivariable regression analysis demonstrated that RAR (as a continuous variable) was associated with the incidence of PC-AKI (adjusted odds ratio (OR) =1.10, 95% confidence interval (CI) =1.04 - 1.16, P<0.001) and in-hospital MACE (OR=1.07, 95% CI=1.02 - 1.14, P=0.012); RAR, as a categorical variable, was significantly associated with PC-AKI (T3 vs. T1, OR=1.70, 95% CI=1.08 - 2.67, P=0.021) and in-hospital MACE (T3 vs. T1, OR=1.63, 95% CI=1.02 - 2.60, P=0.041) in multivariable regression analyses. Receiver operating characteristic curve analysis showed that RAR exhibited a predictive value for PC-AKI (area under the curve (AUC)=0.666, 95% CI=0.625 - 0.708), and in-hospital MACE (AUC= 0.662, 95% CI =0.619 - 0.706).
CONCLUSIONS
The high value of RAR was significantly associated with the increasing risk of PC-AKI and in-hospital MACE after PCI in STEMI patients, and RAR offers a good predictive value for those outcomes.
Topics: Humans; Acute Kidney Injury; Female; Male; ST Elevation Myocardial Infarction; Middle Aged; Contrast Media; Percutaneous Coronary Intervention; Aged; Blood Glucose; Incidence; Serum Albumin; Retrospective Studies; Risk Factors; Prognosis
PubMed: 38957440
DOI: 10.3389/fendo.2024.1390868 -
Ghana Medical Journal Mar 2024Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
OBJECTIVES
Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds.
DESIGN
This was a prospective comparative hospital-based study.
SETTING
Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied.
PARTICIPANTS
Fifty patients aged 16 years and above who presented with secondary peritonitis.
INTERVENTION
Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not.
MAIN OUTCOME MEASURES
Development of incisional surgical site infection, wound dehiscence, and duration of post-operative hospital stay.
RESULTS
The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005).
CONCLUSION
Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantly reduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. The reduction in surgical wound dehiscence observed in this study was, however, not statistically significant.
FUNDING
None declared.
Topics: Humans; Male; Female; Surgical Wound Infection; Middle Aged; Prospective Studies; Adult; Peritonitis; Length of Stay; Surgical Wound Dehiscence; Abdominal Wound Closure Techniques; Aged; Sepsis; Drainage; Laparotomy; Suction; Young Adult
PubMed: 38957281
DOI: 10.4314/gmj.v58i1.5 -
Cureus Jun 2024Acute mesenteric ischemia is a critical condition marked by a sudden loss of blood supply to the intestines, often leading to rapid tissue necrosis and severe clinical...
Acute mesenteric ischemia is a critical condition marked by a sudden loss of blood supply to the intestines, often leading to rapid tissue necrosis and severe clinical outcomes if untreated. In the context of hypogammaglobulinemia, an immunodeficiency characterized by decreased levels of immunoglobulins, this vascular emergency becomes even more daunting. Hypogammaglobulinemia can impair the immune system's response to both infection and ischemic injury, intensifying the severity of intestinal damage. This report describes the case of a 52-year-old female with hypogammaglobulinemia who presented with severe abdominal pain. Surgical exploration revealed 100 cm of necrotic small bowel extending from 150 cm distal to the ligament of Treitz to within 10 cm of the ileocecal valve. The necrotic section was surgically removed, and primary anastomosis was performed. This instance highlights the significant impact of immunodeficiency on the progression and management of acute mesenteric ischemia, demonstrating the critical need for early intervention and tailored management strategies, especially in immunocompromised patients, to prevent severe outcomes. The case illuminates the importance of recognizing immunodeficiency as a complicating factor in acute gastrointestinal emergencies, stressing the necessity for prompt and effective medical and surgical interventions to improve prognosis and patient outcomes in complex clinical scenarios.
PubMed: 38957256
DOI: 10.7759/cureus.61531 -
Trauma Case Reports Aug 2024Pelvic fractures in pediatric trauma account for 0.5-1 % of total hospital admissions, whereas acetabular fracture occurs at a rate of one case per 100,000 children;...
BACKGROUND
Pelvic fractures in pediatric trauma account for 0.5-1 % of total hospital admissions, whereas acetabular fracture occurs at a rate of one case per 100,000 children; the low presentation rate is due to its unique characteristics. Standardized management for this age group is impossible. Conservative treatment has been commonly used but surgical correction has gained popularity. The purpose of this study was to report the authors' experience using a limited ilioinguinal approach for unstable pelvic fracture in two toddlers.
METHODS
Description of case studies.
RESULTS
Herein, we describe the treatment of two patients: a male patient struck by a vehicle (aged 1 year and 7 months) and a female patient ejected from a motor vehicle (aged 2 years and 1 month). They sustained an unstable type IV fracture in the modified Torode and Zieg classification. Surgical treatment was performed using a limited ilioinguinal approach, and stabilization was achieved using 3.5-mm reconstruction plate. There were no iatrogenic nerve injuries or infection. The female patient had left hip dislocation 2 months post-surgery and was unfortunately lost to follow-up. The male patient achieved radiological bone union without discrepancy, with no loss of reduction or evidence of pain during the mean follow-up period of 18 months.
CONCLUSION
Pelvic fracture in children is rare. Based on fracture patterns, surgical stabilization may be necessary to prevent major complications in the short, medium, or long term. The limited ilioinguinal approach was proven to be a viable alternative for managing unstable pelvic fracture in children aged <3 years with minimal blood lo and shorter operative time, allowing more anatomical and stable reduction.
PubMed: 38957174
DOI: 10.1016/j.tcr.2024.101054 -
Trauma Case Reports Aug 2024Irreducibility is a rare complication of pure posterior hip dislocation requiring surgical intervention.
INTRODUCTION
Irreducibility is a rare complication of pure posterior hip dislocation requiring surgical intervention.
CASE PRESENTATION
We present a case of a 22-year-old female with posterior hip dislocation following a motor vehicle accident. Despite unsuccessful closed reduction attempts, open surgical reduction successfully released the incarcerated muscles and achieved reduction. Follow-up examinations showed excellent functional outcomes without complications.
CLINICAL DISCUSSION
Irreducibility remains a rare complication of traumatic posterior hip dislocation. Three possible entities can cause soft tissue incarceration: labral buttonholing, intra-articular osteochondral bodies, and entrapment of the piriformis muscle. The posterior-lateral approach provides excellent exposure of the posterior hip structures, but it carries the risk of injury to the medial circumflex artery. After successfully reducing the dislocation, it is essential to perform a computed tomography (CT) scan to detect any osteochondral lesions, including femoral head impaction. Functional outcomes are better with early mobilization and prompt resumption of weight-bearing. However, femoral head osteonecrosis complicates 52.9 % of hip dislocations reduced beyond 6 h, whereas it occurs in only 4.8 % of dislocations reduced within this timeframe.
CONCLUSION
This case underscores the importance of prompt recognition and appropriate surgical intervention for irreducible hip dislocations to prevent further complications and optimize patient outcomes.
PubMed: 38957171
DOI: 10.1016/j.tcr.2024.101049 -
ERJ Open Research Jul 2024Few studies have compared the associations between long-term exposures to particulate matters (aerodynamic diameter ≤1, ≤2.5 and ≤10 µm: PM, PM and PM,...
BACKGROUND
Few studies have compared the associations between long-term exposures to particulate matters (aerodynamic diameter ≤1, ≤2.5 and ≤10 µm: PM, PM and PM, respectively) and asthma and asthma-related respiratory symptoms. The objective of the present study was to compare the strength of the aforementioned associations in middle-aged and elderly adults.
METHODS
We calculated the mean 722-day personal exposure estimates of PM, PM and PM at 1 km×1 km spatial resolution between 2013 and 2019 at individual levels from China High Air Pollutants (CHAP) datasets. Using logistic regression models, we presented the associations as odds ratios and 95% confidence intervals, for each interquartile range (IQR) increase in PM/PM/PM concentration. Asthma denoted a self-reported history of physician-diagnosed asthma or wheezing in the preceding 12 months.
RESULTS
We included 7371 participants in COPD surveillance from Guangdong, China. Each IQR increase in PM, PM and PM was associated with a greater odds (OR (95% CI)) of asthma (PM: 1.22 (1.02-1.45); PM: 1.24 (1.04-1.48); PM: 1.30 (1.07-1.57)), wheeze (PM: 1.27 (1.11-1.44); PM: 1.30 (1.14-1.48); PM: 1.34 (1.17-1.55)), persistent cough (PM: 1.33 (1.06-1.66); PM: 1.36 (1.09-1.71); PM: 1.31 (1.02-1.68)) and dyspnoea (PM: 2.10 (1.84-2.41); PM: 2.17 (1.90-2.48); PM: 2.29 (1.96-2.66)). Sensitivity analysis results were robust after excluding individuals with a family history of allergy. Associations of PM, PM and PM with asthma and asthma-related respiratory symptoms were slightly stronger in males.
CONCLUSION
Long-term exposure to PM is associated with increased risks of asthma and asthma-related respiratory symptoms.
PubMed: 38957167
DOI: 10.1183/23120541.00972-2023 -
Nursing Open Jul 2024To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients...
AIM
To determine the consensus and importance of care practices related to the management of peripheral venous catheter (PVC)-related phlebitis in hospitalized patients through the views of experts from different disciplines.
BACKGROUND
PVCs are commonly used in hospitals but are associated with complications such as phlebitis. Their management differs widely, and studies are heterogeneous.
DESIGN
Delphi method.
METHODS
Four stages: problem area (with Web of Science bibliometric review in July 2022), panel members, two Delphi rounds and closing criteria. In the Delphi survey, experts answered an online questionnaire based on assessment, treatment and follow-up dimensions (September 2022-February 2023). Statistical analyses were conducted of frequencies, percentages, measures of central tendency and levels of dispersion (QD). A space for comments was created, and a thematic analysis conducted of them.
RESULTS
Eighteen experts (nurses, doctors and pharmacists) participated in the Delphi rounds. Forty-five activities were identified: 19 in assessment, 15 in treatment and 11 in follow-up. A high consensus level (QD ≤ 0.6) was found in five activities (11.12%), moderate level (0.6 < QD < 1.0) in 19 (42.22%) and low level (QD > 1.0) in 21 (46.66%). Seven themes were determined (patient perspective, lack of consensus, low evidence-based practices, stage-based treatments, prevention activities, high variability in practice and specialist teams and interdisciplinary work).
CONCLUSION
The importance of systematic assessment scales is highlighted together with consensus on signs and symptoms (pain, redness, inflammation, palpable cord and induration). Treatment according to severity and daily visual recording and monitoring are emphasized along with the need for patient participation and healthcare literacy. A high level of consensus was obtained in 11% of the activities, showing the large variability of criteria and interventions for phlebitis management. Highlighted needs include working in a team, the use of specialist teams and promoting evidence- and prevention-based activities.
RELEVANCE TO CLINICAL PRACTICE
Clinical variability is noted and, therefore, the importance of consensus on standardized care for PVC phlebitis and evidence-based practice.
REPORTING METHOD
Delphi studies (CREDES).
PATIENT OR PUBLIC CONTRIBUTION
Experts contribution.
Topics: Humans; Delphi Technique; Phlebitis; Catheterization, Peripheral; Surveys and Questionnaires; Consensus; Female; Male; Adult; Middle Aged; Internationality
PubMed: 38957104
DOI: 10.1002/nop2.2229 -
European Journal of Anaesthesiology Aug 2024
Topics: Humans; Venous Thromboembolism; Orthopedic Procedures; Perioperative Care; Europe; Anticoagulants; Postoperative Complications
PubMed: 38957031
DOI: 10.1097/EJA.0000000000002020 -
European Journal of Anaesthesiology Aug 2024
Topics: Humans; Venous Thromboembolism; Perioperative Care; Europe; Anticoagulants; Urologic Surgical Procedures; Postoperative Complications
PubMed: 38957030
DOI: 10.1097/EJA.0000000000002012 -
European Journal of Anaesthesiology Aug 2024
Topics: Humans; Venous Thromboembolism; Perioperative Care; Wounds and Injuries; Europe; Anticoagulants; Postoperative Complications
PubMed: 38957029
DOI: 10.1097/EJA.0000000000002017