Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

2021 ◽  
Author(s):  
Jae Yun Sung ◽  
Ju Mi Kim ◽  
Jae yul Hwang ◽  
Kyoung Nam Kim ◽  
Jae young Kim ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Surgical Outcomes ◽  
Length Of Hospital Stay ◽  
Timing Of Surgery ◽  
Secondary Outcome ◽  
Control Group ◽  
Optimal Timing ◽  
Secondary Outcome Measure ◽  
Success Rates ◽  
Endoscopic Dacryocystorhinostomy

Abstract Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery.Methods: A retrospective review of the medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were surgical outcomes at the final follow-up examination. The secondary outcome measure was clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days).Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery. In subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stay, and the duration of antibiotics treatment were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the 2 groups (p = 1.000)Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR, performed within 3 days, leads to faster recovery and shortens the course of antibiotic treatment.

scholarly journals Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

2021 ◽  
Vol 10 (10) ◽  
pp. 2161
Author(s):  
Jae Yun Sung ◽  
Ju Mi Kim ◽  
Jae Yul Hwang ◽  
Kyoung Nam Kim ◽  
Jae Young Kim ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Surgical Outcomes ◽  
Timing Of Surgery ◽  
Secondary Outcome ◽  
Control Group ◽  
Optimal Timing ◽  
Secondary Outcome Measure ◽  
Success Rates ◽  
Endoscopic Dacryocystorhinostomy ◽  
And Gender

Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. Methods: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

scholarly journals Effects of a person-centred telephone support on fatigue in people with chronic heart failure: Subgroup analysis of a randomised controlled trial

2019 ◽  
Vol 19 (5) ◽  
pp. 393-400 ◽  
Author(s):  
Sara Wallström ◽  
Lilas Ali ◽  
Inger Ekman ◽  
Karl Swedberg ◽  
Andreas Fors
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Usual Care ◽  
Subgroup Analysis ◽  
Controlled Trial ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Secondary Outcome Measure ◽  
Telephone Support

Introduction: Fatigue is a prevalent symptom that is associated with various conditions. In patients with chronic heart failure (CHF), fatigue is one of the most commonly reported and distressing symptoms and it is associated with disease progression. Person-centred care (PCC) is a fruitful approach to increase the patient’s ability to handle their illness. Aim: The aim of this study was to evaluate the effects of PCC in the form of structured telephone support on self-reported fatigue in patients with CHF. Method: This study reports a subgroup analysis of a secondary outcome measure from the Care4Ourselves randomised intervention. Patients ( n=77) that were at least 50 years old who had been hospitalized due to worsening CHF received either usual care ( n=38) or usual care and PCC in the form of structured telephone support ( n=39). Participants in the intervention group created a health plan in partnership with a registered nurse. The plan was followed up and evaluated by telephone. Self-reported fatigue was assessed using the Multidimensional Fatigue Inventory 20 (MFI-20) at baseline and at 6 months. Linear regression was used to analyse the change in MFI-20 score between the groups. Results: The intervention group improved significantly from baseline to the 6-month follow-up compared with the control group regarding the ‘reduced motivation’ dimension of the MFI-20 (Δ -1.41 versus 0.38, p=0.046). Conclusion: PCC in the form of structured telephone support shows promise in supporting patients with CHF in their rehabilitation, improve health-related quality of life and reduce adverse events. Trial registration ISRCTN.com ISRCTN55562827

Near-Infrared Fluorescence Cholangiography can be a Useful Adjunct during Emergency Cholecystectomies

2020 ◽  
pp. 155335062095856
Author(s):  
Francesco Di Maggio ◽  
Naveed Hossain ◽  
Andrea De Zanna ◽  
Danya Husain ◽  
Luca Bonomo
Keyword(s):  
Bile Duct ◽  
Near Infrared ◽  
Extrahepatic Bile Duct ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Control Group ◽  
Biliary Anatomy ◽  
Conversion To Open Surgery ◽  
Complications Rate

Background. Emergency cholecystectomy is the gold standard treatment for acute cholecystitis according to National Institute for Health and Care Excellence recommendations. The procedure is feasible but carries a higher risk of iatrogenic injury to the bile duct, which should be considered preventable. Intraoperative fluorescence cholangiography following injection of indocyanine green (ICG) has been reported to aid identification of the extrahepatic bile duct. Data on its feasibility in the context of emergency cholecystectomies are missing. Materials and Methods. Fluorescent ICG was used intraoperatively to enhance the biliary anatomy during 33 consecutive emergency laparoscopic cholecystectomies at our institution. Primary outcomes of surgery were considered the length of hospital stay, conversion to open and complications rate, including bile duct injury. Secondary outcome was operating time. A historical population of emergency cholecystectomies was used as control. Results. There were no common bile duct injuries, no adverse effects from ICG, no conversion to open surgery and no deaths. 90% of patients went home within 48 hours after the operation in the absence of complications. ICG demonstrated intraoperative biliary anatomy allowing greater confidence to the surgeon performing emergency cholecystectomies. Six patients were operated beyond 72 hours from admission, without experiencing any complication Clavien-Dindo ≥3. ICG population had the same post-operative hospitalisation and complications rate of the control group, with a shorter operating time. Conclusion. Intraoperative augmented visualisation of biliary anatomy with ICG cholangiography can be a useful technology tool, with the potential to extend the 72 hours window of safety for emergency cholecystectomies.

What Is the Best Time to Initiate Peri-Operative Heparin Therapy In General Surgery Patients? A Risk-Benefit Dilemma.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1088-1088
Author(s):  
Nassir Rostambeigi ◽  
Susan Greenlee ◽  
Marianne Huebner ◽  
David Farley
Keyword(s):  
Hospital Stay ◽  
General Surgery ◽  
Conflicts Of Interest ◽  
Conditional Logistic Regression ◽  
Length Of Hospital Stay ◽  
Heparin Therapy ◽  
Control Group ◽  
Optimal Timing ◽  
Bleeding Events ◽  
Heparin Administration

Abstract Abstract 1088 Background: While many studies support the use of prophylactic heparin therapy around the time of operation in cancer patients, little data shows the optimal timing of such therapy in general surgery (GS) patients. Methods: From 2001–2008, 95 patients identified with thromboembolism reported in our GI/General Surgery Division and were compared with a matched control group for: age, gender, type of operation, date of operation, diagnosis of malignancy, and BMI. Timing of heparin therapy, characteristics of TE or bleeding events, driving distance from our institution, history of smoking or OCP use, anticoagulation use after operation, length of hospital stay, and mortality were collected. Peri-operative heparin therapy was defined as heparin given within a 24 hr window of incision. The McNemar's test for proportions was performed. Conditional logistic regression was used for the analysis of risk factors and survival curves were implemented for mortality comparisons. Results: mean age and BMI were similar (57 yrs, 33 kgM-2), 45% were female and 53% had malignancy in both groups. Duration of operation was similar (204 vs. 191 minutes, P=NS). peri-operative heparin administration was similar in the two groups (56%, 64%, p=0.05). But, pre-operative therapy was seen more in the control group (77% vs. 51%, p=0.01). Regression model showed a protective effect for heparin if it was given pre-operatively (OR=0.37, p=0.047) with no effect if it was given beyond 10 hours. Mean blood transfusion units (97 and 106 mL) and hemorrhagic events (4.5% and 5%) were similar (p=NS). Median (range) length of hospital stay was longer (19 days (0-201) vs. 6 (0-66), p=0.001) and two-year survival lower in the TE group (p=0.03). Conclusions: data from our institutional case-control study shows that heparin administration before GS is associated with more than 2-fold reduction in the risk of thromboembolism. The optimal period appears to be between 1–10 hours prior to the time of incision. Large prospective trials need to be desgined to more accurately determine the time of heparin therapy. Disclosures: No relevant conflicts of interest to declare.

Clinical Effects of Sensor AR40E Intraocular Lenses in Cataract Patients with Prominent Myopia

2020 ◽  
Vol 12 (4) ◽  
pp. 461-466
Author(s):  
Wenying Wang ◽  
Zhixue Wang ◽  
Yu Liu ◽  
Yuanyuan Zou ◽  
Xiangning Ji ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Group Treatment ◽  
Outcome Measure ◽  
Acupuncture Group ◽  
Intraocular Lenses ◽  
Secondary Outcome ◽  
Control Group ◽  
Secondary Outcome Measure ◽  
Clinical Effects

Cataracts are a complex group of eye disorders. Many studies suggest that blood circulation around the eyes, and a rise in intraocular pressure play important roles in glaucoma. Sensor AR40E artificial crystalline bodies can adjust intraocular pressure, improve activity in the optic nerve and increase blood flow to the eye fundus. BL1 can transport Yin and Yang. We designed a randomized, military blind, controlled clinical trial: Control group: (1) A Sensor only AR40E intraocular lens was applied to the skin of Qingming and retrobulbar acupoints on the rainy side, twice per week for 20 min every time, for two consecutive weeks; (2) acupuncture group: treatment was same as for the control group, but the eye was needled into Jingming and retrobulbar acupoints to achieve Qi; (3) Sensor AR40E intraocular lens group: treatment was the same as that for the acupuncture group, the main outcome measure was the change of intraocular pressure and the secondary outcome measure is the score change of WHOQOL ref (Taiwan version). Beneficial outcomes were realized in the right and left eye acupuncture groups and the Sensor AR40E intraocular lens group.

scholarly journals Remdesivir Efficacy in COVID-19 Treatment: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Sherief Abd-Elsalam ◽  
Ossama Ashraf Ahmed ◽  
Noha O. Mansour ◽  
Doaa H. Abdelaziz ◽  
Marwa Salama ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Hospital Stay ◽  
Standard Care ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Secondary Outcome ◽  
Control Group ◽  
Egyptian Patients

To date, no antiviral therapy has shown proven clinical effectiveness in treating patients with COVID-19. We assessed the efficacy of remdesivir in hospitalized Egyptian patients with COVID-19. Patients were randomly assigned at a 1:1 ratio to receive either remdesivir (200 mg on the first day followed by 100 mg daily for the next 9 days intravenously infused over 30–60 minutes) in addition to standard care or standard care alone. The primary outcomes were the length of hospital stay and mortality rate. The need for mechanical ventilation was assessed as a secondary outcome. Two hundred patients (100 in each group) completed the study and were included in the final analysis. The remdesivir group showed a significantly lower median duration of hospital stay (10 days) than the control group (16 days; P < 0.001). Eleven of the patients in the remdesivir group needed mechanical ventilation compared with eight patients in the control group (P = 0.469). The mortality rate was comparable between the two groups (P = 0.602). Mortality was significantly associated with older age, elevated C-reactive protein levels, elevated D-dimer, and the need for mechanical ventilation (P = 0.039, 0.003, 0.001, and < 0.001 respectively). Remdesivir had a positive influence on length of hospital stay, but it had no mortality benefit in Egyptian patients with COVID-19. Its use, in addition to standard care including dexamethasone, should be considered, particularly in low- and middle-income countries when other effective options are scarce.

scholarly journals P585 Evaluation and comparison of the safety profiles of different intravenous iron preparations and oral iron for treatment of iron deficiency anaemia: Preliminary results from the IBD subgroup analysis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S490-S490 ◽  
Author(s):  
A Aksan ◽  
H Işık ◽  
S Aksan ◽  
D Tuğal ◽  
A Dignass ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Outcome Measure ◽  
Oral Iron ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Preliminary Results ◽  
Increased Risk ◽  
Statistical Heterogeneity ◽  
Iv Iron

Abstract Background Current ECCO guidelines state that intravenous (IV) iron should be considered first-line treatment in patients with clinically active IBD, previous intolerance to oral iron, Hb below 100 g/l and patients who need erythropoiesis-stimulating agents. Several different IV iron products are available with differing therapeutic effectiveness and tolerability. In this ongoing study, we compare their safety profiles to establish whether any IV iron carries an increased risk compared with other IV iron products or with oral iron, and to determine which, if any, has a superior safety profile. We report preliminary results from an IBD subgroup analysis. Methods We performed a systematic review and network meta-analysis (NMA), searching PUBMED, SCOPUS, WoS and Cochrane Library up to July 2019. The primary outcome measure was the pooled total of drug-related adverse events (AEs) and serious AEs (SAEs) in proportion to the safety population. The secondary outcome measure was identification of the most common AEs. Results 8086 distinct publications were found. Of 171 relevant full-text articles on IBD, 5 RCTs (n = 1143) were eligible. Bayesian NMA was performed using a fixed effects model. Low statistical heterogeneity was determined (I2= 9%). AE rates did not differ significantly between the different IV iron products (ferric carboxymaltose/FCM; iron sucrose/IS; iron isomaltoside/IIM) or oral iron. Compared with oral iron; OR=0.69, 95% CrI [0.29;1.7] for FCM, OR=0.52, 95% CrI [0.22;1.2] for IS, OR=1.5, 95%CrI [0.80;3.1] for IIM. Compared with FCM; OR=0.74, 95% CrI [0.45;1.2] for IS, OR=2.2, 95% CrI [0.74;6.7] for IIM. Compared with IS; OR=0.1.3, 95% CrI [0.82;2.2] for IS, OR=3.0, 95% CrI [1.0;9.1] for ISM. Compared with IIM; OR=0.45, 95% CrI [0.15;1.3] for FCM, OR=0.33, 95% CrI [0.11;1.0] for IS. The most common AEs were headache (1.8%) and transient hyperferritinaemia (1.8%) for FCM; headache (1.5%), hyperferritinaemia and rigors (both 1.2%) for IS; flushing (2.7%), hypersensitivity and hepatic enzyme increase (both 1.8%) for IIM; diarrhoea (8.0%) and abdominal pain (7.7%) for oral iron. Hypophosphataemia was reported in only 1 RCT of FCM, here transient and clinically asymptomatic. Seven SAEs were recorded; 1/381 for FCM, 1/223 for IIM and 5/238 for oral iron. Conclusion None of the IV iron products was associated with an increased risk of AEs or SAEs compared with oral iron and all showed similarly low rates of AEs. However, their safety profiles differed: Whereas with FCM or IS, headaches were most commonly reported, IIM was more frequently associated with hypersensitivity reactions or increase in hepatic enzymes. On this evidence, while FCM, IS and IIM are all safe, their differing safety characteristics should be considered in therapeutic decision-making.

scholarly journals Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19

2020 ◽  
Vol 13 ◽  
pp. 175628482098067
Author(s):  
Theodor Voiosu ◽  
Andrei Voiosu ◽  
Ivo Boškoski ◽  
Marianna Arvanitakis ◽  
Michiel Bronswijk ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Multivariable Analysis ◽  
Secondary Outcome ◽  
Control Group ◽  
Minimal Risk ◽  
Technical Failure ◽  
Success Rates ◽  
Technical Success ◽  
Endoscopic Retrograde

Background: The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection. Methods: We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by the endoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case was matched in a 1:4 ratio with controls extracted from each center’s database in order to identify relevant changes in outcome measures compared with the pre-pandemic era. Results: Eighteen procedures performed in 16 COVID-19 patients [14 men, 65 years (9–82)] and 67 controls were included in the final analysis. Technical success was achieved in 14/18 COVID-19 cases, which was significantly lower as compared with the control group (14/18 versus 64/67, p = 0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse events was low in both groups (1/18 versus 10/67, p = 0.44). On multivariable analysis, COVID-19 status remained the only risk factor for technical failure of the procedure [odds ratio of 19.9 (95% confidence interval 1.4–269.0)]. Conclusions: The COVID-19 pandemic has affected the volume and practice of ERCP, resulting in lower technical success rates without significantly impacting patient safety. Prioritizing cases and following recommendations on safety measures can ensure good outcome with minimal risk in dedicated centers.

scholarly journals A PROSPECTIVE OBSERVATIONAL STUDY COMPARING CLINICAL OUTCOME OF IUGR NEONATES WITH NORMAL AND ABNORMAL UMBILICAL ARTERY FLOW DOPPLER

2020 ◽  
pp. 1-3
Author(s):  
Aarti Panchal ◽  
Sucheta Munshi ◽  
Halak Chauhan
Keyword(s):  
Umbilical Artery ◽  
Outcome Measure ◽  
Perinatal Asphyxia ◽  
Secondary Outcome ◽  
Control Group ◽  
Case Group ◽  
Secondary Outcome Measure ◽  
Perinatal Complications ◽  
Umbilical Artery Doppler ◽  
Artery Flow

Background: Intrauterine growth restriction (IUGR) is one of the causes of perinatal mortality and morbidity which affects approximately 9.65% of pregnancies worldwide. Doppler indices from the fetal circulation can reliably predict adverse perinatal outcome. Aims &objectives: To compare perinatal complications and outcome between term and preterm IUGR neonates having normal and abnormal umbilical artery flow Doppler. Methodology: 140 IUGR Neonates with abnormal and normal antenatal umbilical artery Doppler scan admitted in NICU of Civil Hospital, Ahmedabad were included in the study. Amongst them 52 were preterm and 88 were term neonates. Study was conducted between October 2019 to December 2019. Primary outcome measure is neonatal mortality and secondary outcome measure is neonatal morbidities like perinatal asphyxia, hypoglycemia, NEC, hyperbilirubinemia etc. Results: Amongst140 IUGR neonates Preterm were more in case group 36(51.4%) compared to control group 16(22.8 %.) Hypoglycaemia and NEC was observed more in preterm 19 (36.5%) and 14(26.9%) compared to 16(18.2%) and 11(12.5%) in term respectively. Birth asphyxia was observed more in term 26(29.5%) than preterm 7(13.5%). At birth perinatal asphyxia was observed more in case group, 27 out of 70 (38.5%), as compared to 6 out of 70 (8.5%) in control group (P <0.05). Hypoglycemia and NEC was noticed in 30(42.8%) and 24(34.2%) neonates in case group, as compared to 5(7.1%) and 2(2.8%) neonates in control group respectively. (P < 0.05) Conclusion: Neonates with abnormal Umbilical Artery Doppler flow are at increased risk of perinatal complications and needs extra care during this period.

When is the Best Time to Initiate Peri-operative Heparin Therapy in General Surgery Patients? A Risk-Benefit Dilemma

2011 ◽  
Vol 77 (11) ◽  
pp. 1539-1545 ◽  
Author(s):  
Nassir Rostambeigi ◽  
Susan M. Greenlee ◽  
Marianne Huebner ◽  
David R. Farley
Keyword(s):  
General Surgery ◽  
Length Of Hospital Stay ◽  
Heparin Therapy ◽  
Optimal Time ◽  
Control Group ◽  
Optimal Timing ◽  
Bleeding Events ◽  
Heparin Administration ◽  
Fold Reduction ◽  
Duration Of Operation

We sought optimal timing for heparin therapy in general surgery (GS) patients. From 2001 to 2008, 95 GS patients with documented thromboembolic events (TE) were identified and compared with matched controls (age, gender, type of operation, date of operation, malignancy, and body mass index [BMI]). Timing of heparin therapy, characteristics of TE or bleeding events, and risk factors for TE were collected. Mean age (57 years), BMI (33 kgM-2), gender (55% male), malignancy (53%), and duration of operation (204 vs 191 minutes, P = not significant) were similar in both groups. Peri-operative (within 24 hours) heparin administration (study 56% vs control 64%, P = 0.2) was no different. Preoperative therapy was more common in the control group (77% vs 51%, P = 0.001). The regression model showed a protective effect for heparin if given preoperatively (odds ratio = 0.37, P = 0.047) with no effect if started >10 hours from incision. Mean blood transfusion (97 and 106 mL) and hemorrhagic events (4.5% and 5%) were similar in both groups ( P = not significant). Median (range) length of hospital stay and mortality was higher in TE cases [19 (0-201) vs 6 (0-66) days, 11 vs 2 mortality in 100-person-years ( P < 0.05)]. Heparin administration before GS is associated with >2-fold reduction in TE. The optimal time to start heparin seems to be 1 to 10 hours before the time of incision.

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