ABSTRACT
INTRODUCTION AND OBJECTIVES: Acute on chronic liver failure (ACLF), leads to high mortality. These patients are at risk of being delisted for liver transplantation (LT). Emerging data shows 1y post-transplant survival of 80-92%. The Share 35 (S35) policy was implemented to prioritize patients with MELD ≥35 on the LT waitlist. Our aim was to compare the LT outcomes of ACLF patients as a result of S35. MATERIALS AND METHODS: Data from the UNOS scientific registry were used to classify ACLF patients using the NACSELD criteria. For the analyses, data were divided into two eras; 2 years before S35 (Era 1) and 2 years after S35 (Era 2). Waitlist status was classified into categories: Transplanted, Death or Too Sick to Transplant and Still Waiting/Other. LT cumulative incidence between the populations in the eras was calculated using Fine and Gray's method. A proportional hazards model was used to investigate the era effect on cumulative incidence of LT. RESULTS: 46,861 patients were reviewed, of which 817 had ACLF. 366 patients (mean MELD: 37.1) were identified in Era 1 and 451 patients (mean MELD: 37.3) in Era 2. We found that ACLF patients were more likely to receive a liver transplant in Era 2 (p=0.0074). In both eras, transplanted patients had a significantly higher survival than those who were not transplanted (p<0.0001). CONCLUSIONS: Our study shows that S35 improved LT rate for ACLF suggesting that there should be broader recognition of ACLF and early transplantation should be pursued.
Subject(s)
Acute-On-Chronic Liver Failure/mortality , Acute-On-Chronic Liver Failure/surgery , Health Services Accessibility/statistics & numerical data , Liver Transplantation/statistics & numerical data , Tissue and Organ Procurement/statistics & numerical data , Acute-On-Chronic Liver Failure/diagnosis , Adult , Aged , Female , Health Policy , Humans , Male , Middle Aged , Patient Selection , Proportional Hazards Models , Registries , Severity of Illness Index , Survival Rate , Waiting Lists , Young AdultABSTRACT
Nuestra población es llevada por la propaganda a consumir productos que argumentan combatir la fatiga, la debilidad nerviosa, mental y muscular, disminución de la capacidad intelectual, depresión psíquica, proporcionando deseos de trabajar y estudiar, reactiva la memoria, aumenta la capacidad de concentración, y mejorar la capacidad mental, los cuales hemos denominado "NEUROTONICOS". Evaluamos el efecto de los neurotónicos (CERENERVON), usando 2 médidas estándar de la función nerviosa, la velocidad de conducción periférica del nervio cubital y el tiempo de conducción del sistema nervioso central (SNC) por medio de potenciales evocados somatosensoriales (PESS)
Subject(s)
Adult , Neurotransmitter Agents/analysis , Neural Conduction , Evoked Potentials/drug effectsABSTRACT
Documents a proposal for activities aimed at enhancing the capability of identifying and appraising investment initiatives in the health and environment sectors of Suriname. Presents a macro-economic review which covers the Structural Adjustment Programme and the Multi-annual Development Plan, highlighting the health and environment sectors including legal regulations. Identifies and characterizes the key institutions in both sectors, determining their interrelationships and relating them to the stage in the flow of investments. Analyzes, trends in investments in both sectors; consistency between policies and investments; the degree of cooperation; and the existence of clear procedures for investment programming, budgeting and project preparation. (AU)
Subject(s)
Health Planning , Investments , Healthcare Financing , SurinameSubject(s)
Humans , Dogs , 21003 , Animals, Domestic , Antibodies, Bacterial/analysis , Leptospira/immunology , Agglutination Tests , Cattle , Cattle Diseases/epidemiology , Dog Diseases/epidemiology , Goats , Jamaica , Leptospirosis/epidemiology , Sheep , Sheep Diseases/epidemiology , Swine , Swine Diseases/epidemiologyABSTRACT
Determinó los niveles de Maneb y su metabolito en plantas de pimentón, utilizando (14c) Maneb. Las aplicaciones de este producto se realizaron a intervalos de 7 días durante las tres primeras semanas. Se colectaron muestras después de cada fumigación. A partir de la última fumigación, se colectaron muestras durante durante dos días consecutivos y después de esto cada 7 días durante 4 semanas. Las plantas y las frutas se trituraron y fueron extraídas con disolventes apropiados. Alícuotas del extracto fueron cromatografiadas en capa fina y las manchas de residuos marcados con (14c) localizadas por autorradiografía fueron cunatificadas por centelleo líquido. El (14c) Maneb padre insoluble remanente en el sólido fue extraído con EDTA 0.4 M, cuantificado también por centelleo líquido. El (14c) total de todos los metabolitos se determinó por combustión húmeda siendo luego cuantificados por centelleo líquido. Después de realizados todos los experimentos y analizados los resultados, se encontró que los niveles de etilentiuruea (ETU) en el fruto fueron bajos y altos en el tallo y las hojas, si se compara con los valores permisibles en el hombre