RESUMEN
Introduction: Determining the optimal dexamethasone dosage for facilitating extubation in extremely low birth weight (ELBW) infants with bronchopulmonary dysplasia (BPD) remains uncertain. This study aims to compare the effectiveness of low-dose (DART) and enhanced low-dose dexamethasone regimens in achieving successful extubation in these infants. Methods: We conducted a retrospective cohort study at the Women's Wellness and Research Center (WWRC) involving ELBW infants who received dexamethasone for BPD prevention or treatment, or for extubation between January 1st, 2015, and December 31st, 2019. Our goal was to assess successful extubation within various time points of treatement. Results: A total of 77 patients, matched in gestational age and BW, were enrolled in the study, receiving a total of 121 dexamethasone courses. Low-dose dexamethasone courses were administered 75 times to 49 infants, while 46 courses of enhanced low-dose were given to 28 infants. Treatment commenced at 30.8 ± 3.4 weeks post-menstrual age, compared to 32.1 ± 2.5 weeks in the enhanced low-dose group (p = 0.014). The median (IQR) course duration was seven (3-10) days in the low-dose group, while it was 10 (8-14) days in the enhanced low-dose group (p < 0.001). The median (IQR) course dose was 0.73 (0.53-0.86) mg/kg in the low-dose group and 1.27 (0.97-2.05) mg/kg in the enhanced low-dose group (p < 0.001). There were no differences in extubation success at any time point between the two groups at 72â h and seven days after treatment initiation, by course completion, and within seven days after treatment completion. However, regression analysis identified several predictors of successful extubation; baseline FiO2, course duration, and duration of invasive mechanical ventilation were negatively associated with successful extubation at various time points, while received dose per kg and cumulative dose positively correlated with successful extubation at different time points. No significant differences were observed in secondary outcomes, including death or BPD. Conclusion: The choice between low-dose and enhanced low-dose dexamethasone regimens may not significantly impact extubation success. However, careful consideration of dosing, ventilation status, and treatment duration remains crucial in achieving successful extubation. This study highlights the need for personalized dexamethasone therapy in ELBW infants.
RESUMEN
The onset of type 2 diabetes increases the risk of vascular complications and death. We know now that that this risk begins long before the diabetes diagnosis. Prediabetes and type 2 diabetes are not separate entities in practice and exist within a continuum of dysglycaemia and vascular risk that increases in severity over time. This excess risk requires early intervention with lifestyle therapy supported with pharmacologic antidiabetic therapy, intensified promptly where necessary throughout the duration of the diabetes continuum. Metformin is an evidence-based treatment for preventing prediabetes and improves cardiovascular outcomes in people with type 2 diabetes from diagnosis onwards. Newer agents (SGLT2 inhibitors and GLP-1 agonists) are appropriate for people presenting with type 2 diabetes and significant cardiovascular comorbidity. Additional therapies should be used without delay to achieve patients' individualised HbA1c goals and to minimise cardiovascular risk.
RESUMEN
INTRODUCTION: The term Spondylodiscitis (SD) involves infection of the vertebra (Spondylitis), infection of the intervertebral disc (Discitis), or both (Spondylodiscitis). SD represents a diagnostic and therapeutic challenge to any spine surgeon. Any delay in its diagnosis or management may cause serious long-term morbidity or even lead to mortality. In this study, we report the experience of our Institution in the management of severe and complicated cases of SD. METHODS: Over a period of 1 year, 39 patients with the diagnosis of SD were surgically treated in Assiut University Hospital, Assiut, Egypt. The management processes were tailored according to the clinical condition, radiological and lab studies of each case; and patients were then prospectively followed-up until they were cured (for a minimum of 6 months). The outcomes were analyzed, to be able to give recommendations while aiming to improve the overall outcome of such dangerous health issue. RESULTS: In this series, patients were managed surgically by drainage and debridement of the infection site with/without instrumented fusion. Results included: satisfactory fusion was achieved in 97.3% of patients (confidence interval [CI] = 0.6856-1.3421). Neurological Improvement Rate (NIR) was 71.5% (Statistically significant improvement P-value = 0.014) and reoperation rate was 5% (CI = 0.00621-0.18525). Mortality rate was 7.7% (CI = 0.016-0.209). Several aspects were analyzed in each case. CONCLUSION: Surgical management of severe and complicated cases of SD allows for effective debridement and rapid cure of inflammation, earlier patient mobilization and significantly shorter duration of antibiotic usage.
