Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors

Background: There is a sparsity of data on the use of ethiodized poppy seed oil (EPO) contrast agent (Lipiodol) in patients. We investigated the safety of EPO in children, adolescents, and some adults for diagnostic and therapeutic interventions. Methods: All patients who underwent procedures with EPO between 1995 and 2014 were retrospectively included. Demographic characteristics, diagnosis, dose, route of administration, preparation of EPO in combination with other agents, and complications were recorded. Results: In 1422 procedures, EPO was used for diagnostic or treatment purposes performed in 683 patients. The mean patient age was 13.4 years (range: 2 months–50 years); 58% of patients were female. Venous malformations (n = 402, 58.9%) and arteriovenous malformations (n = 60, 8.8%) were the most common diagnosis. Combined vascular anomalies included capillary–lymphatic–venous malformations, fibroadipose vascular anomalies (n = 54, 7.9%), central conducting lymphatic anomalies (n = 31, 4.5%), lymphatic malformations (n = 24, 3.5%), aneurysmal bone cysts (n = 22, 3.2%), and vascularized tumors (n = 11, 1.6%). In 1384 procedures (96%), EPO was used in various combinations with sclerosing and embolization agents, including sodium tetradecyl sulfate, ethanol, and glue. The mean volume of EPO used in interventions was 3.85 mL (range: 0.1–25 mL) per procedure with a mean patient weight of 45.9 kg (range: 3.7–122.6 kg) and a weight-adjusted dose of 0.12 mL/kg (range: 0.001–1.73 mL/kg). In 56 procedures (4%), EPO was used as a single agent for diagnostic lymphangiography. The mean volume was 4.8 mL (range: 0.3–13 mL) per procedure with a mean patient weight of 27.4 kg (range: 2.4–79.3 kg) and a weight-adjusted dose of 0.2 mL/kg (range: 0.04–0.54 mL/kg). Procedural-related complications occurred in 25 (1.8%) procedures. The 20 minor and 5 major complications were related to the primary treatment agents. None of them were directly related to EPO. No allergic reactions were noted. Conclusion: The use of an ethiodized poppy seed oil contrast agent in children, adolescents, and adults for diagnostic or therapeutic purposes is safe.

Severity of SARS-CoV-2 infection and albumin levels recorded at the first emergency department evaluation: a multicentre retrospective observational study

BackgroundThe aim of this study was to investigate the association between serum albumin levels in the ED and the severity of SARS-CoV-2 infection.MethodsThis is a retrospective observational study conducted from 15 March 2020 to 5 April 2020 at the EDs of three different hospitals in Italy. Data from 296 patients suffering from COVID-19 consecutively evaluated at EDs at which serum albumin levels were routinely measured on patients’ arrival in the ED were analysed. Albumin levels were measured, and whether these levels were associated with the presence of severe SARS-CoV-2 infection or 30-day survival was determined. Generalised estimating equation models were used to assess the relationship between albumin and study outcomes, and restricted cubic spline (RCS) regression was used to plot the adjusted dose-effect relationship for possible clinical confounding factors.ResultsThe mean albumin level recorded on entry was lower in patients with severe SARS-CoV-2 infection than in those whose infections were not severe (3.5 g/dL (SD 0.3) vs 4 g/dL (SD 0.5)) and in patients who had died at 30 days post-ED arrival compared with those who were alive at this time point (3.3 g/dL (SD 0.3) vs 3.8 g/dL (SD 0.4)). Albumin <3.5 g/dL was an independent risk factor for both severe infection and death at 30 days, with adjusted odd ratios of 2.924 (1.509–5.664) and 2.615 (1.131–6.051), respectively. RCS analysis indicated that there was an adjusted dose–response association between the albumin values recorded on ED and the risk of severe infection and death.ConclusionAlbumin levels measured on presentation to the ED may identify patients with SARS-CoV-2 infection in whom inflammatory processes are occurring and serve as a potentially useful marker of disease severity and prognosis.

Effectivity of Erythropoietin-Alpha between Fixed- and Adjusted-Dose in Chronic Kidney Disease Patients With Anemia on Hemodialysis

Anemia is a common complication in chronic kidney disease (CKD) patient with hemodialysis. The cause of anemia is mainly due to erythropoetin deficiency because the kidneys as a erythropoetin producer are damaged. The most appropriate management of anemia in CKD with hemodialysis is the administration of Erythropoietin Stimulating Agent (ESA) or erythropoetin (Epo). The effectiveness of Epo therapy is influenced by the type of Epo used, the dose of Epo given, the route and frequency of Epo administration, as well as several conditions that affect it such as infection or inflammation, absolute and functional iron deficiency, and malnutrition. Therapeutic targets can be achieved if the dose given is in accordance with the needs of the patient, based on the patient's weight The purpose of this study was to determine the differences in the achievement of Epo-alpha fixed-dose administration compared with adjustment-dose in patients with CKD anemia with hemodialysis after administration of Epo-alpha for 4 weeks in outpatient poly hemodialysis units at Bhayangkara H.S Hospital. Samsoeri Mertojoso Surabaya. In this study, there were 20 patients who met the inclusion criteria (15 male and 5 female) divided into 2 groups, 10 patients in the fixed-dose group and 10 patients in the adjustment-dose group. In the fixed-dose group with a adequacy level of 132.25 ± 29.17, the average Hb change achievement was 0.68 ± 0.63 g / dL (p=0.008), whereas in the adjustment-dose group the achievement of the average Hb change the mean was 1.09 ± 0.82 g / dL (p=0.002). For the Hct parameter, the average Hct change in the fixed-dose group was 2.77 ± 2.23% (p=0.004), while in the adjustment-dose group the average Hct change achievement was 4.02 ± 2.63 g / dL (p=0.001). There was no difference in the achievement of the effectiveness of Epo on the two parameters Hb (p=0.224) and Hct (p=0.256) in the fixed-dose group compared with adjustment-dose.

Aplicação de cianamida hidrogenada na quebra da dormência das gemas de videira da variedade Merlot

The objective of the experiment was to evaluate the effect of hydrogenated cyanamide (0%, 2%, 4% and 6%) on breaking dormancy and production of the Merlot vine variety. Variables: number of shoots and bunches, sprouting and fertility index, bunches mass, yield, 0Brix and cost benefit ratio. The doses of 4 and 6% increased bud sprouting without affecting their fertility. Except for the fertility index, the Merlot variety showed a linear response to the application of hydrogenated cyanamide (Dormex®) to the other parameters evaluated, however, the results varied little between the doses of 4 and 6%, indicating the most adjusted dose as 4% considering productivity per hectare.

Risk of Polymyxin B-induced Acute Kidney Injury in Non-adjusted Dose Versus Adjusted Dose based on Renal Function: a retrospective cohort study

BackgroundThis study aimed to observe the difference in risk of polymyxin B-induced acute kidney injury with or without dose adjustment by patients’ renal function.MethodA retrospective cohort analysis was carried out for patients who were treated with polymyxin B in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from November 2018 to October 2019. Patients were divided into adjusted dosage group and non-adjusted dosage group depended on dosage adjustment with renal function or not. A comparison of acute kidney injury incidence between the two groups was the primary outcome of this research. The secondary outcome included hospital length of stay, microbiological cure, clinical cure, and 30-day mortality.ResultA total of 115 patients met the requirements of this study and were included in the analysis. Thirty-five patients were included in the non-adjusted dosage group and 80 in the adjusted dosage group. Patients from both groups had similar characteristics. The total daily dose of polymyxin B in the Non-adjusted dosage group was significantly higher than the adjusted dosage group (1.98 mg/kg/d vs 1.59 mg/kg/d, P=0.001). For the primary outcome of this research, no significant difference in the incidence of acute kidney injury was observed in these two groups (47.5% vs 37.14%, P=0.304), as well as the secondary outcomes, including hospital length of stay, microbiological cure, clinical cure, 30-day mortality.ConclusionDosing adjustment renally could not lower the risk of polymyxin B-induced acute kidney injury significantly. A non-adjusted dosing strategy of polymyxin B is recommended when patients suffered from various levels of renal impairment.