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2.
Ann Clin Microbiol Antimicrob ; 22(1): 90, 2023 Oct 10.
Article in English | MEDLINE | ID: mdl-37817167

ABSTRACT

BACKGROUND: Diagnosing COVID-19-associated pulmonary aspergillosis (CAPA) can be challenging since radiological and clinical criteria in the critically ill patient are nonspecific. Microbiological diagnostic support is therefore crucial. The aim of this study was to document the incidence of aspergillosis using bronchoalveolar lavage (BAL) as the diagnostic method and to determine the performance of the current mycological diagnostic tests most widely used for the diagnosis of CAPA, together with evaluation of the Asp lateral flow device (LFD). METHODS: Prospective cohort study conducted between March 2020 and June 2022. Inclusion criteria were critically ill patients admitted to the ICU with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. Diagnostic bronchoscopy and BAL were performed at the beginning of invasive mechanical ventilation. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (LR + and LR-) of BAL culture, direct examination with calcofluor white stain, ELISA (Platelia) and LFD (AspLFD) for detection of galactomannan (GM) were evaluated. Aspergillus-qPCR was applied when discrepancies between diagnostic tests arose. RESULTS: Of the 244 critically ill patients with SARS-CoV-2 pneumonia admitted to the ICU, the majority (n = 200, 82%) required invasive mechanical ventilation. Diagnostic bronchoscopic procedures were performed in 160 patients (80%), who were enrolled in this study. The incidence of CAPA was 18.7% (n = 30). LFD-GM demonstrated a sensitivity of 84%, specificity of 99%, PPV 94%, NPV 97%, LR(+) of 84, and LR(-) of 0.16. At GM-ELISA indices of ≥ 0.5 and ≥ 1.0, sensitivity was 92% and 79%, specificity was 95% and 99%, PPV 76% and 91%, NPV 99% and 96%, LR(+) 18 and 79, and LR(-) 0.08 and 0.21, respectively. The optimal cut-off index from the ROC curve was 0.48, with sensitivity of 95% and specificity of 95%. CONCLUSIONS: Using a diagnostic strategy based on bronchoscopy and BAL, we documented a high incidence of pulmonary aspergillosis in patients with severe SARS-CoV-2 pneumonia. Asp-LFD showed moderate sensitivity and excellent specificity, with a high PPV, and could be used for rapid diagnosis of patients with suspected CAPA.


Subject(s)
Aspergillosis , COVID-19 , Invasive Pulmonary Aspergillosis , Humans , SARS-CoV-2 , Critical Illness , Prospective Studies , Bronchoalveolar Lavage Fluid/microbiology , Sensitivity and Specificity , COVID-19/complications , COVID-19/diagnosis , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/microbiology , Mannans/analysis , COVID-19 Testing
3.
Aesthet Surg J ; 43(12): NP1001-NP1009, 2023 11 16.
Article in English | MEDLINE | ID: mdl-37439225

ABSTRACT

BACKGROUND: Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically. OBJECTIVES: The authors conducted a systematic review with pooled analysis of data, with the aim of determining the effectiveness and complications related to operative management of the deformity. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted in performing this systematic review. A simplified classification system for tuberous breast deformity was developed to accurately compare data and guide analysis. RESULTS: The review identified 38 studies, reporting a total of 897 patients undergoing tuberous breast surgery. The mean age of patients was 24 years (range 13-53 years). Mean follow-up was 39 months. A combination of tissue rearrangement and implant augmentation was the most common technique (73% of patients) followed by fat transfer alone (9%). Breast implants were employed in 83% of patients. The mean implanted volume per breast was 263 cc. Fat grafting was performed in 13% of patients and mean volume of fat grafted per breast was 185 cc. An overall complication rate of 20% was reported. Subjective assessment of patient satisfaction was 99%, and the mean score on BREAST-Q for satisfaction with clinical outcome was 86.7. Future studies should focus on robust study designs including randomized and cohort studies, use of patient-reported outcome measures, and long-term follow-up. CONCLUSIONS: The surgical techniques to correct tuberous breast deformity are safe, effective, and have a high satisfaction rate. Fat transfer has the capacity to provide promising results in treating tuberous breast deformity.


Subject(s)
Breast Diseases , Breast Neoplasms , Mammaplasty , Humans , Adolescent , Young Adult , Adult , Middle Aged , Female , Mammaplasty/adverse effects , Mammaplasty/methods , Treatment Outcome , Adipose Tissue/transplantation , Breast/surgery , Breast/abnormalities , Breast Diseases/surgery , Breast Neoplasms/surgery , Retrospective Studies
4.
Plast Reconstr Surg ; 152(1): 57-63, 2023 07 01.
Article in English | MEDLINE | ID: mdl-36728192

ABSTRACT

BACKGROUND: Traditionally, liposuction is performed on the deeper layer of fat. However, in 1983, Illouz described a liposuction technique targeting the superficial layer of fat. High-definition liposuction (HDL) is an advanced technique of liposuction that generates a desirable profile of anatomical area while promoting skin retraction. Although the safety profile of basic or traditional liposuction has been extensively studied, data relevant to HDL are limited. A systematic review to determine the effectiveness and complications was conducted. METHODS: Across the 21 articles included in the synthesis, a total of 6964 patients underwent HDL procedures. Of the cases where gender was reported, 44% were female patients ( n = 1241) and 56% were male patients ( n = 1556). The average age of patients was 38 years (range, 15 to 76 years) and body mass index was 25 kg/m 2 (range, 18 to 38 kg/m 2 ). RESULTS: An overall complication rate of 14.4% ( n = 994) was calculated, with only 0.2% ( n = 13) of complications classified as major. Transient hyperpigmentation was the most frequently reported complication, affecting 260 patients (3.8%), followed by seroma in 231 (3.3%) and transient soft-tissue fibrosis in 185 (2.7%). Despite an absence of uniform reporting, satisfaction rates of 92.6% ( n = 1497) were reported. CONCLUSIONS: There is a high demand for HDL surgery globally, and this systematic review illustrates the safety and efficacy of HDL. Major complication rates across the entirety of the literature reviewed were 0.2%, with minor complications seen in 14.2% across the 6964 cases reported. High patient satisfaction of 92.6% from HDL procedures was achieved, indicating the efficacy of this procedure.


Subject(s)
Lipectomy , Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Lipectomy/adverse effects , Lipectomy/methods , Body Mass Index , Patient Satisfaction , Seroma/etiology
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