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Journal of Ophthalmology 2020To characterize the clinical features in young patients with angle closure and to determine the characteristics associated with acquired anterior segment abnormality...
PURPOSE
To characterize the clinical features in young patients with angle closure and to determine the characteristics associated with acquired anterior segment abnormality following retinopathy of prematurity (ROP) treatment.
METHODS
We performed two retrospective case-control series. In the first series, we identified consecutive young angle closure patients without prior surgeries, with and without a history of ROP treatment; in the second series we identified consecutive patients who underwent ROP treatment, without and without anterior segment changes.
RESULTS
In the first series, 25 eyes of 14 consecutive angle closure patients were included: 19 eyes (11 patients, 78.6%) had a history of treated ROP, while 6 eyes (3 patients) belonged to full-term patients. The treated ROP eyes had significantly shallower anterior chambers (1.77 ± 0.17 mm vs 2.72 ± 0.18 mm, < 0.0001) and thicker lenses (5.20 ± 0.54 mm vs 3.98 ± 0.20 mm, = 0.0002) compared to the full-term controls. In the second series, 79 eyes of 40 patients were included, with median gestational age of 24.6 weeks. Acquired iridocorneal adhesion was noted in the eight eyes (10.1%) at a mean age of 4.7 years and was associated with prior zone 1 and plus disease ( = 0.0013), a history of initial intravitreal bevacizumab treatment (IVB, = 0.0477) and a history of requiring additional IVB after initial treatment ( = 0.0337).
CONCLUSIONS
Many young angle closure patients may have a history of treated ROP and may present with the triad of increased lens thickness, microcornea, and angle closure.
PubMed: 32454993
DOI: 10.1155/2020/7510903 -
The Cochrane Database of Systematic... 2000Inhibition of prostaglandin synthesis mediates closure of the ductus arteriosus and renal side effects after indomethacin administration. Because furosemide increases... (Review)
Review
BACKGROUND
Inhibition of prostaglandin synthesis mediates closure of the ductus arteriosus and renal side effects after indomethacin administration. Because furosemide increases prostaglandin production, it could potentially help prevent indomethacin-related toxicity but also decrease ductal response to indomethacin.
OBJECTIVES
The primary objectives of this review were to assess (1) whether furosemide affects the incidence of failure of ductal closure after indomethacin and that of indomethacin-related toxicity and (2) the effect of furosemide on mid-term and long-term outcome. The secondary objective was to determine whether the effect of furosemide on renal function and water balance depends on prior extracellular volume (assessed by blood urea nitrogen [BUN]/creatinine ratio).
SEARCH STRATEGY
We searched electronic databases (Medline, Embase and Cochrane) and selected abstract books, without language restriction.
SELECTION CRITERIA
We selected studies with (1) random allocation to either indomethacin alone or indomethacin and furosemide and (2) analysis of either short-term risk-benefit ratio of furosemide, mid- or long-term outcome, or the relationship between extracellular volume at study entry and changes in renal function.
DATA COLLECTION AND ANALYSIS
We assessed studies for possible bias and for quality of assessment of ductal patency. We assessed categorical variables using relative risk and absolute risk reduction. We assessed the effects of furosemide on renal function and fluid balance by comparing changes from baseline in the treatment group with those in controls. Subsets were determined a priori based on BUN/creatinine ratio at study entry.
MAIN RESULTS
All 3 studies fulfilling the entry criteria had limitations, including possible or definite bias. There was substantial heterogeneity among studies. Furosemide administration did not significantly increase the risk of failure of ductal closure; however, sample size was insufficient to rule out even a 31% increase. In the subset with initial BUN/creatinine ratio > 20 mg/mg, 2 of 18 patients receiving furosemide could not complete a 3-dose course of indomethacin because of toxicity. Minimal or no information was available about any of the other main outcome variables. Furosemide increased urine output regardless of the initial BUN/creatinine ratio, leading to a 5% weight loss during a 3-dose course, an undesired effect in patients with initial BUN/creatinine ratio > 20 mg/mg. Furosemide increased creatinine clearance only in patients with initial BUN/creatinine ratio <20 mg/mg.
REVIEWER'S CONCLUSIONS
There is not enough evidence to support the administration of furosemide to premature infants treated with indomethacin for symptomatic patent ductus arteriosus. Furosemide appears to be contraindicated in the presence of dehydration in those infants.
Topics: Cyclooxygenase Inhibitors; Diuretics; Ductus Arteriosus, Patent; Furosemide; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Kidney
PubMed: 10796253
DOI: 10.1002/14651858.CD001148 -
Journal of the Saudi Heart Association 2021This study aimed to determine the risk factors for the occurrence of arrhythmias after either transcatheter or surgical closure of atrial septal defect.
OBJECTIVES
This study aimed to determine the risk factors for the occurrence of arrhythmias after either transcatheter or surgical closure of atrial septal defect.
METHODS
This prospective study included 150 patients admitted for transcatheter or surgical closure of atrial septal defect. Transthoracic echocardiography together with a twelve-leads ECG were done during 1 and 3 months follow up. The paired T, chi-square and Logistic regression tests were used to detect any association between any arrhythmias and factors that may affect its occurrence.
RESULTS
One-hundred and twenty-three patients had percutaneous device closure while the remaining 27 patients had surgical closure. The youngest and oldest of the studied patients being 3 & 50 years old respectively with female (108) over male (42) predominance in incidence. After closure, 8 patients at one month and another 3 patients at three months follow up out of the total 150 patients had supraventricular arrhythmias in the form of frequent premature atrial contractions (6 patients), atrioventricular nodal re-entrant tachycardia (2 patients), and paroxysmal Atrial fibrillation (3 patients). No conduction abnormalities nor ventricular arrhythmias occurred. Multivariate analysis showed that age, P wave dispersion, systolic myocardial velocity of right ventricle, and systolic pulmonary artery pressure were independently associated with the occurrence of atrial arrhythmia after atrial septal defect repair.
CONCLUSION
Age, P wave dispersion, Systolic pulmonary artery pressure, and systolic myocardial velocity of the right ventricle are independent risk factors to develop arrythmias in patients after atrial septal defect closure.
PubMed: 35775085
DOI: 10.37616/2212-5043.1260 -
Journal of Osteopathic Medicine Oct 2021Oral isotretinoin, a systemic retinoid and a vitamin A derivative, has been widely utilized to treat acne in both adult and pediatric populations. Additionally, systemic... (Review)
Review
CONTEXT
Oral isotretinoin, a systemic retinoid and a vitamin A derivative, has been widely utilized to treat acne in both adult and pediatric populations. Additionally, systemic retinoids have also been utilized to treat neuroblastoma in pediatric patients. Common side effects associated with oral isotretinoin include dry eyes, dry mouth, elevated liver enzymes, depression, and arthralgia. Less common side effects of isotretinoin include hearing loss, pseudotumor cerebri, anaphylaxis, and skeletal abnormalities including growth arrest. The U.S. Food and Drug Administration (FDA) has received reports of premature epiphyseal closure in patients treated with isotretinoin retinoids, which are commonly prescribed by primary care providers as a treatment for acne. It is important to raise awareness of the potential side effects of isotretinoin to enable informed treatment decisions before beginning an isotretinoin regimen.
OBJECTIVES
This chapter aims to elucidate that isotretinoin, given at various doses and durations, has been associated with growth plate abnormalities, which can lead to premature epiphyseal closure.
METHODS
Two databases were utilized for the literature review and were conducted at different time periods. Our literature review was conducted between December 2020 and June 2021, utilizing PubMed with the following search terms: "isotretinoin" and "isotretinoin and premature epiphyseal closure." In April 2021, we searched the FDA's "Drug Data and Adverse Event Report System" utilizing the terms "isotretinoin" and "epiphysis premature fusion." We included in our query reports of patients worldwide under 18 years of age with premature epiphyseal closure or growth plate damage secondary to isotretinoin. Studies published in English between 1980 and 2020 were also included, as well as background sources relating to an isotretinoin profile with side effects and dosing. We narrowed our search to exclude patients with a history of growth plate disorders due to trauma, malignancy, or other pathological processes, as well as patients with growth arrest due to endocrine factors. Growth plate abnormalities associated with retinoid derivatives other than isotretinoin were also excluded.
RESULTS
A total of 28 items were selected for our literature review including: one FDA drug label, one FDA website of adverse reactions, 19 supplemental articles, six case reports, and one case series of premature epiphyseal closure secondary to isotretinoin. The FDA received 41 reports worldwide of premature epiphyseal closure related to isotretinoin in patients under 18 years of age. Additionally, premature epiphyseal closure and growth plate abnormalities occurred in nine patients with various durations and doses of isotretinoin ranging from the lowest dose of 0.5 mg/kg/day for a few months to 3.5 mg/kg/day for years.
CONCLUSIONS
Isotretinoin-induced premature epiphyseal closure and growth plate deformities seem to be linked to higher doses of isotretinoin for the duration of months to years. There have been reported cases of premature epiphyseal closure in individuals receiving therapeutic doses of isotretinoin for acne treatment, which are much lower compared to the high doses utilized for neuroblastoma. Based on this study, isotretinoin appears to impact the growth plates of proximal tibia and distal femur. A cause-and-effect relationship between isotretinoin and premature epiphyseal closure cannot be concluded.
Topics: Acne Vulgaris; Adolescent; Adult; Child; Growth Plate; Humans; Isotretinoin; Lower Extremity; United States
PubMed: 34626532
DOI: 10.1515/jom-2021-0108 -
BMC Cardiovascular Disorders Feb 2022Complications related to femoral artery access for coronary angiography (CAG) is a safety concern. Vascular closure devices (VCDs) have been developed to reduce the rate... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of MynxGrip vascular closure device and manual compression for closure after femoral access angiography: a randomized controlled trial: the closure devices used in every day practice study, CLOSE-UP III trial.
BACKGROUND
Complications related to femoral artery access for coronary angiography (CAG) is a safety concern. Vascular closure devices (VCDs) have been developed to reduce the rate of complications after femoral artery access. We compared the safety and efficacy of the MynxGrip VCD versus manual compression (MC) after femoral access CAG in a randomized controlled trial.
METHODS
The study was a randomized, single center, non-blinded, two-arm non-inferiority trial. The study was stopped prematurely because of low inclusion rate.
RESULTS
We randomized 869 patients to closure with the MynxGrip VCD or MC and 865 entered analyses. The incidence of the primary endpoint of major adverse vascular events (MAVE) after 30 days was 1.2% in the MynxGrip group and 0% in the MC group (p = 0.06). The median time to hemostasis was 4 [3:5] minutes and 10 [7:11] minutes in the MynxGrip group and MC group, respectively (p < 0.0001). The corresponding median times to mobilization was 73 [65:87] minutes and 76 [70:88] minutes (p = 0.01).
CONCLUSIONS
MAVE was rare after closure of femoral arterial access by both the MynxGrip VCD and MC. We found a numerical difference in favour of MC but this did not reach statistical significance. Time to hemostasis was shorter in the MynxGrip group when compared to the MC group.
TRIAL REGISTRATION
The study was approved by the local medical ethics committee and registered at clinicaltrials.org (ClinicalTrials identifier: NCT02237430 11/09/2014).
Topics: Coronary Angiography; Femoral Artery; Hemostatic Techniques; Humans; Punctures; Time Factors; Treatment Outcome; Vascular Closure Devices
PubMed: 35196986
DOI: 10.1186/s12872-022-02512-0 -
Diagnosis (Berlin, Germany) Sep 2015A 20-year-old man developed bilateral forearm paresthesias after propping his elbows on the desk studying. He was diagnosed with ulnar neuropraxia and instructed to...
A 20-year-old man developed bilateral forearm paresthesias after propping his elbows on the desk studying. He was diagnosed with ulnar neuropraxia and instructed to follow up with a neurologist. The symptoms continued and the patient was admitted for a formal workup of his neuritis. A Monospot test was positive. The patient was discharged with a diagnosis of infectious mononucleosis. A comment on his complete blood count, showing absolute lymphocytosis with atypical lymphocytes and rare blasts with flow cytometry recommended, was missed, possibly due to the fact that it was not highlighted red on the electronic medical record indicating an abnormal result. A month later, an outpatient diagnosis of B-lymphoblastic leukemia/lymphoma was made on flow cytometry. This case highlights cognitive errors in diagnosis, including premature closure and failing to 'see' key data, as well as vulnerabilities created by data display limitations of the electronic medical record.
PubMed: 29540032
DOI: 10.1515/dx-2015-0013 -
Archives of Cardiovascular Diseases 2021Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature...
Transcatheter patent arterial duct closure in premature infants: A new technique to ease access to the patent arterial duct, with particular benefit for the tricuspid valve.
BACKGROUND
Transcatheter patent arterial duct (PAD) closure in premature infants has been shown to be feasible. Since our early transcatheter PAD closure procedures in premature infants at Hôpital Necker Enfants Malades, we have changed our technique several times to advance the guidewire through the right heart to avoid tricuspid valve damage.
AIM
To describe the technique we have been using since May 2019, to report our results with a particular focus on tricuspid leaks and to analyse the potential mechanisms of tricuspid lesion development with previous methods.
METHODS
All premature infants weighing<2kg who underwent transcatheter PAD closure with this new technique were included. Demographic data, procedural data, outcome and procedural complications were reviewed, with particular attention to the occurrence of tricuspid regurgitation.
RESULTS
Between May 2019 and May 2020, 33 patients were included. Median gestational age was 25 weeks. Median birth weight and procedural weight were 690g (range 490-1065g; interquartile range [IQR] 620-785g) and 1160g (range 900-1900g; IQR 1030-1300g), respectively. Median age at procedure was 35 (IQR 30-46) days. PAD anatomy was evaluated on transthoracic echocardiography only. The median duct diameter was 3 (IQR 2.5-3.2) mm at the pulmonary end. Success rate was 100% (defined as successful closure without residual shunt). One patient had a renal vein thrombosis, which fully resolved with low-molecular-weight heparin anticoagulation. No tricuspid regurgitation or stenosis of the left pulmonary artery or the aorta was seen. One patient died of a superior caval vein obstruction with bilateral chylothorax related to a central catheter thrombosis 56 days after the procedure, unrelated to the catheter procedure.
CONCLUSION
In this prospective study, we describe a new technique to avoid tricuspid valve damage and facilitate delivery of the PAD device.
Topics: Birth Weight; Cardiac Catheterization; Ductus Arteriosus, Patent; Gestational Age; Heart Injuries; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Paris; Recovery of Function; Septal Occluder Device; Time Factors; Treatment Outcome; Tricuspid Valve; Tricuspid Valve Insufficiency; Tricuspid Valve Stenosis
PubMed: 34312100
DOI: 10.1016/j.acvd.2021.06.002 -
Clinical Pharmacology and Therapeutics Aug 2022Spontaneous closure of the ductus arteriosus depends on gestational age (GA) and might be delayed in preterm infants, resulting in patent ductus arteriosus (PDA)....
Spontaneous closure of the ductus arteriosus depends on gestational age (GA) and might be delayed in preterm infants, resulting in patent ductus arteriosus (PDA). Ibuprofen can be administered to enhance closure, but the exposure-response relationship between ibuprofen and the closure of PDA remains uncertain. We investigated the influence of patient characteristics and ibuprofen exposure on ductus closure. A cohort of preterm infants with PDA and treated with ibuprofen was analyzed. Ibuprofen exposure was based on a previously developed population pharmacokinetic study that was in part based on the same study population. Logistic regression analyses were performed with ductus closure (yes/no) as outcome, to analyze the contribution of ibuprofen exposure and patient characteristics. In our cohort of 263 preterm infants (median GA 26.1 (range: 23.7-30.0) weeks, birthweight 840 (365-1,470) g) receiving ibuprofen treatment consisting of 3 doses that was initiated at a median postnatal age (PNA ) of 5 (1-32) days, PDA was closed in 55 (21%) patients. Exposure to ibuprofen strongly decreased with PNA . Overall, the probability of ductus closure decreased with PNA (odds ratio (OR): 0.7, 95% CI: 0.6-0.8) and Z-score for birthweight (Z ; OR: 0.8, 95% CI: 0.6-1.0), and increased with GA (OR: 1.5, 95% CI: 1.1-1.9). For patients with PNA < 1 week, concentrations of ibuprofen, GA, and Z predicted probability of ductus closure. During a window of opportunity for ductus closure within the first days of life, probability of closure depends on GA, Z , and ibuprofen exposure. Increased, yet unstudied dosages might increase the effectivity of ibuprofen beyond the first week of life.
Topics: Birth Weight; Ductus Arteriosus, Patent; Gestational Age; Humans; Ibuprofen; Infant, Newborn; Infant, Premature
PubMed: 35429165
DOI: 10.1002/cpt.2616 -
Sudanese Journal of Paediatrics 2014The incidence of patent ductus arteriosus (PDA) in premature neonates varies according to the gestational age and respiratory status. Failure of PDA closure in preterm... (Review)
Review
The incidence of patent ductus arteriosus (PDA) in premature neonates varies according to the gestational age and respiratory status. Failure of PDA closure in preterm infants with respiratory distress syndrome results in a left to right shunt across the duct which may lead to pulmonary congestion and deterioration in respiratory status. Although indomethacin and ibuprofen are the main stay of medical treatment, conservative approach by restricted fluid and applying continuous positive airway pressure (CPAP) may be effective in prevention of PDA without complication. The daily clinical round debate on how to diagnose, when, and how to treat PDA in preterm neonates will be discussed with details in this review.
PubMed: 27493386
DOI: No ID Found -
Journal of Cardiovascular Development... Nov 2023Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized... (Review)
Review
Persistent patent ductus arteriosus is a very common condition in preterm infants. Although there is no management agreed by consensus, despite numerous randomized controlled trials, hemodynamically significant patent ductus arteriosus increases morbidity and mortality in these vulnerable patients. Medical treatment is usually offered as first-line therapy, although it carries a limited success rate and potential severe adverse events. In recent years, transcatheter patent ductus arteriosus closure has fast developed and become widely accepted as a safe and efficient alternative to surgical ductal ligation in extremely low birth weight infants >700 g, using most often the dedicated Amplatzer Piccolo Occluder device. This article aims to provide an appraisal of the patients' selection process, and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
PubMed: 38132644
DOI: 10.3390/jcdd10120476