RESUMO
Acute kidney damage (AKI) is a common cause of pediatric intensive care unit (PICU) admissions. Implementing a reno-protective strategy for AKI prediction can significantly enhance outcomes. The renal angina index (RAI) is a risk stratification tool used to predict severe AKI. We aim to assess the reliability and accuracy of the RAI scoring system in predicting AKI as compared to other conventional AKI markers. A prospective, observational study was conducted in the PICU of 2 tertiary medical centers in the Middle East. A total of 446 patients, aged 1-month to 14-years, without chronic kidney disease were enrolled. The RAI was calculated using the renal risk and renal injury score within the first 8 to 12 hours of admission. The accuracy of RAI was compared to changes in serum creatinine from baseline. The outcome was assessed on Day 3 for presence of AKI according to the kidney disease improving global outcome (KDIGO) criteria and associated sequelae. A positive RAI (RA+) was defined as RAI readingsâ ≥â 8. Among the patients, 89 (19.9%) had a positive RAI within the first 8 to 12 hours of admission. The RAâ +â group had a significantly higher occurrence of Day 3 severe AKI (KDIGO stages 2&3) compared to the RA- group (60.6% vs 4.2%, Pâ <â .001). The RAâ +â group also had a significantly higher utilization of renal replacement therapy (RRT) (21.3% vs 1.1%, Pâ <â .001), longer mean PICU length of stay in days (11.1â ±â 3.5 vs 5.5â ±â 2.1, Pâ <â .001), and increased mortality (31.4% vs 2.8%, Pâ <â .001) compared to the RA- group. The RAI score demonstrated superior predictive ability for Day 3 AKI, with a sensitivity of 72%, specificity of 95%, and area under the curve (AUC) of 0.837, compared to changes in serum creatinine from baseline (sensitivity: 65%, specificity: 89%, AUC: 0.773), fluid overload (sensitivity: 43.7%, specificity: 79%, AUC: 0.613), and illness severity scores (sensitivity: 52.4%, specificity: 80.5%, AUC: 0.657). RAI proved to be a reliable and rapid bedside test for identifying critically ill children at risk of developing severe AKI. This enables physicians to implement reno-protective measures and intervene early, thereby improving prognosis.
Assuntos
Injúria Renal Aguda , Estado Terminal , Criança , Humanos , Creatinina , Estudos Prospectivos , Estado Terminal/terapia , Reprodutibilidade dos Testes , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Injúria Renal Aguda/epidemiologia , Angina Pectoris/complicaçõesRESUMO
BACKGROUND/AIM: To evaluate the clinical manifestations, diagnostic features, disease course and response to treatment among Saudi adults with predominantly hepatic Wilson's disease. A retrospective cohort study of 40 adult patients diagnosed with predominantly hepatic Wilson's disease between 1994 and 2008 at King Abdulaziz Medical City, Riyadh was carried out. PATIENTS AND METHODS: The diagnosis was based on varying combinations of clinical and laboratory evidence of liver disease, presence of Kayser Fleisher rings, low serum ceruloplasmin levels, elevated 24 hour urinary copper excretion and histopathological findings on liver biopsy. RESULTS: The most frequent clinical presentation was decompensated chronic liver disease in 19 (47.5%), followed by chronic hepatitis in 15 (37.5%) and fulminant hepatic failure (FHF) in 5 (12.5%) patients. Eight (20%) patients with end-stage liver disease had liver transplantation, while 24 (60%) patients followed up on medical treatment for a variable period of 1-12 years showed clinical and laboratory improvement. One patient was lost early in follow up. Eight (20%) patients died during the study period, 5 with FHF, and 2 with advanced hepatic and neurological disease and one seven years after liver transplantation. Mortality rate was 100% in FHF without liver transplantation. CONCLUSION: A predominantly hepatic Wilson's disease has varied clinical presentations with decompensated chronic liver disease being the most common among adult patients. Majority of the patients show stabilization of the disease on medical treatment. FHF in Wilson's disease has a grave prognosis without liver transplantation, the later remains a definitive treatment option for decompensated cirrhotics and patients with FHF.
Assuntos
Gerenciamento Clínico , Doença Hepática Terminal/etiologia , Degeneração Hepatolenticular/diagnóstico , Transplante de Fígado , Adolescente , Adulto , Progressão da Doença , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/epidemiologia , Feminino , Seguimentos , Degeneração Hepatolenticular/complicações , Degeneração Hepatolenticular/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo , Adulto JovemRESUMO
Variceal bleeding is a major event in the natural history of end-stage liver disease with a subsequent high mortality rate. Non-selective ß-blockers are currently the drugs of choice for preventing first variceal bleeding. Endoscopic rubber band ligation of high risk varices features as a first line option if cirrhotic patients cannot tolerate ß-blockers. Despite adequate ß-blockade, some patients may still present with variceal bleeding. The effect of carvedilol, a non-selective ß and α-1 receptor-blocker, on lowering portal pressure has been investigated in several clinical trials and found to be superior to propranolol in both acute and chronic hemodynamic studies. Recently, carvedilol has also been compared with band ligation for primary prophylaxis against variceal bleeding with equivalent results to band ligation. Patient tolerance to carvedilol in advanced liver disease remains a source of concern. This review examines the place of carvedilol as an alternative to the currently recommended pharmacological therapy in prophylaxis against variceal bleeding.
Assuntos
Anti-Hipertensivos/uso terapêutico , Carbazóis/uso terapêutico , Hipertensão Portal/tratamento farmacológico , Propanolaminas/uso terapêutico , Carvedilol , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/prevenção & controle , Humanos , Hipertensão Portal/complicaçõesRESUMO
AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no significant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no significant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 +/- 7.05 min vs 10.34 +/- 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 +/- 13.95 min vs 22.56 +/- 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not significantly different from SC in term of cecal intubation time and polyp detection rate.
Assuntos
Pólipos do Colo/diagnóstico , Colonoscópios , Colonoscopia/métodos , Adulto , Idoso , Catárticos/uso terapêutico , Distribuição de Qui-Quadrado , Competência Clínica , Colonoscopia/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/uso terapêutico , New South Wales , Valor Preditivo dos Testes , Estudos Prospectivos , Escopolamina/uso terapêutico , Fatores Sexuais , Fatores de TempoRESUMO
AIM: The goal of pre-surgical dental implant treatment planning is to position the optimum number and size of implant fixtures to achieve the best restorative results. The purpose of this article is to describe the use of radiographic imaging software to calibrate and measure anatomical landmarks to overcome inherent distortions associated with dental radiographs. The procedure along with its potential use as an adjunct to radiographic interpretation in routine clinical implant practice is presented. BACKGROUND: Diagnostic imaging is an essential component of implant treatment planning, and a variety of advanced imaging modalities have been recommended to assist the dentist in assessing potential sites for implants. Although technological advances have resulted in new imaging innovations for implant dentistry, dental radiography remains the most widely used tool for determining the quantity and quality of alveolar bone as it is a non-invasive procedure. However, the unreliable magnification factor associated with conventional radiographs remains a major problem when estimating the amount of bone available at the implant site. SUMMARY: This image measurement technique is capable of assessing the bone quantity by measuring the height and width of the alveolar crest for a specified region in a two dimensional plane in any direction related to the visible landmarks in the oral cavity. These measurements can be used by the clinician to select the type of implant and its position. Since there is no additional equipment or cost involved, the technique can be used as an important adjunct in implant practice.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Arcada Parcialmente Edêntula/diagnóstico por imagem , Radiografia Dentária Digital/métodos , Densidade Óssea , Implantação Dentária Endóssea , Implantes Dentários para Um Único Dente , Humanos , Arcada Parcialmente Edêntula/reabilitação , Planejamento de Assistência ao Paciente , Radiografia Panorâmica/métodos , SoftwareRESUMO
BACKGROUND: Cigarette smoking is a significant risk factor for the initiation and progression of periodontal disease. Studies have shown altered serum and gingival crevicular fluid inflammatory cytokine profiles, immune cell function, and altered proteolytic regulation in smokers. The observations are not consistent, and to date, there is no clear mechanism to explain how smoking may affect periodontal disease. Hence, the present study was undertaken to assess the alterations of serum immunoglobulin levels in smokers with periodontitis and its potential role as a risk indicator of the disease process. METHODS: In this study, 30 patients who smoked and 30 patients who did not smoke with chronic periodontitis and 30 healthy subjects were enrolled. Serum immunoglobulin (Ig) G, IgA, and IgM levels were estimated with immunoturbidimetric assay. The IgG subclass (IgG1, IgG2, IgG3, and IgG4) levels were performed using single radial immunodiffusion assay. RESULTS: Levels of serum IgG and IgA were significantly lower in smokers compared to non-smokers and healthy controls (P <0.001). Although IgM levels were low in smokers, it was not significant. Of the four subclasses of IgG studied, the IgG2 was found to be significantly lower among smokers with periodontitis. CONCLUSIONS: Current observations indicate that cigarette smoking may be associated with the suppression of B-cell function and immunoglobulin production. The alteration of antibody levels further explains the potential mechanism by which smoking exacerbates periodontal disease. Further studies at the molecular level may highlight the specific mechanism by which tobacco can interact with cells of the immune system and its impact on periodontal disease process.
Assuntos
Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Periodontite/imunologia , Fumar/imunologia , Adulto , Doença Crônica , Métodos Epidemiológicos , Humanos , Imunodifusão/métodos , Imunoglobulina G/classificação , Pessoa de Meia-Idade , Perda da Inserção Periodontal/sangue , Perda da Inserção Periodontal/imunologia , Periodontite/sangue , Arábia Saudita , Fumar/sangueRESUMO
Oral health status is an integral component of a general health and well-being of an individual. Knowledge about the link between periodontal disease and systemic diseases are growing rapidly. Increasing evidence is available from many investigators to indicate periodontitis as a risk factor for cardiovascular diseases, diabetes mellitus, low birth weight infants and pulmonary diseases. Both epidemiologists and researchers in oral microbiology have contributed significantly to the new paradigm of periodontal disease. Although additional studies are needed to determine the mechanisms by which such associations exist; available research clearly demonstrates that oral diseases and conditions are not only markers for underlying health problems, but also important determinants influencing the development and management of adverse chronic health conditions. Physicians and dentists should be aware of this link and provide treatment that will greatly benefit the patients. A review of the relationship between periodontal infections and its possible impact on systemic diseases is discussed.