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1.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479885

RESUMO

Meropenem is a broad-spectrum carbapenem widely used to treat both Gram-positive and negative bacterial infections, including extended-spectrum beta-lactamase-producing microbes. We describe the occurrence of thrombocytopenia and hypersensitivity in a boy receiving intravenous meropenem for intra-abdominal sepsis secondary to perforated appendicitis. The patient developed a pruritic maculopapular rash with occasional petechiae, associated with severe thrombocytopenia, after 7 days of meropenem administration. Investigations for other causes of thrombocytopenia, including possible line sepsis, were unfruitful, and the thrombocytopenia did not resolve until cessation of meropenem. Drug-induced reactions should be considered in children receiving meropenem who present with a rash and thrombocytopenia.


Assuntos
Infecções Bacterianas , Trombocitopenia , Antibacterianos/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Criança , Humanos , Masculino , Meropeném/efeitos adversos , Tienamicinas/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombocitopenia/tratamento farmacológico
2.
Can J Surg ; 64(5): E476-E483, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34580076

RESUMO

BACKGROUND: Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. METHODS: We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04-3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. CONCLUSION: Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes.

3.
CEN Case Rep ; 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34260011

RESUMO

Glomerulonephritis in tuberculosis may be a direct manifestation of renal infection or a result of immune-complex deposition complicating extra-renal infection, such as in pulmonary tuberculosis. A 17-year-old adolescent boy from Somalia was found to have pulmonary tuberculosis during routine health screening performed on entering Malta, with computed tomography of the chest showing scarring and calcification of the left upper lobe, left lower lobe consolidation, and a small left-sided pleural effusion. Five days after starting anti-tuberculous therapy, he developed lower limb and sacral oedema: urinary albumin: creatinine ratio was > 400 µg albumin/mg creatinine, and 24-h urinary protein showed nephrotic-range proteinuria of 4.963 g/day. In view of worsening lower limb, sacral and periorbital oedema and ascites, he was started on oral prednisolone, omeprazole and penicillin V prophylaxis. As heavy proteinuria persisted, a renal biopsy was performed after 8 days of prednisolone treatment, which confirmed the presence of mesangiocapillary glomerulonephritis (MCGN), with electron microscopy showing effacement of the podocytes, with hypercellularity and subendothelial immune deposits, confirming an immune-mediated pathophysiology. Ziehl-Neelsen staining did not reveal acid-fast organisms. The patient received a total of 3 weeks of oral prednisolone with subsequent tailing doses, 2 months of pyrazinamide and ethambutol and 6 months of rifampicin and isoniazid with complete resolution of his clinical and radiological signs, though heavy proteinuria persisted, so he was commenced on oral enalapril. This case highlights the potential association of MCGN with tuberculosis in adolescence. Timely recognition and treatment can prevent progression to chronic kidney disease.

5.
Surg Endosc ; 34(8): 3656-3662, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32458286

RESUMO

BACKGROUND: Patient positioning in colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. We sought to determine if the right lateral (RL) starting position compared to the standard left lateral (LL) starting position could improve outcomes in colonoscopy. METHODS: We conducted a randomized controlled trial of 185 patients who were undergoing an elective colonoscopy. Patients were randomized to either a right lateral decubitus starting position or a left lateral decubitus starting position and the primary outcome measure was cecal intubation time. Secondary outcome measures included cecal intubation rate, patient discomfort, and sedation dosage. All colonoscopists who had successfully completed a colonoscopy skills improvement course were included in the trial. A sample size was calculated prior to the start of the study and outcomes were analyzed using univariate and multiple regression analyses. RESULTS: A total of 94 patients were randomized to RL starting position and 91 patients were randomized to LL starting position. No difference was found in time to cecal intubation comparing the RL starting position (542.6 s, SD 360.7 s) to LL starting position (497.85 s, SD 288.3 s) (p = 0.354). Variables associated with prolonged cecal intubation time included female gender, General Surgery specialty, less than 5 years of endoscopist experience, a high patient discomfort score, amount of water used, and number of position changes required to reach the cecum. There was no difference in any of the secondary outcome measures aside from the amount of midazolam used, with more midazolam used for patients starting in the right lateral decubitus position. CONCLUSION: This study failed to show an association between cecal intubation time and patient position comparing right and left lateral starting position.


Assuntos
Colonoscopia/métodos , Posicionamento do Paciente/métodos , Adulto , Idoso , Ceco , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade
6.
Eur J Clin Microbiol Infect Dis ; 39(10): 1885-1897, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32418063

RESUMO

Invasive meningococcal disease (IMD) is a vaccine-preventable devastating infection that mainly affects infants, children and adolescents. We describe the population epidemiology of IMD in Malta in order to assess the potential utility of a meningococcal vaccination programme. All cases of microbiologically confirmed IMD in the Maltese population from 2000 to 2017 were analysed to quantify the overall and capsular-specific disease burden. Mean overall crude and age-specific meningococcal incidence rates were calculated to identify the target age groups that would benefit from vaccination. Over the 18-year study period, 111 out of the 245 eligible notified cases were confirmed microbiologically of which 70.3% had septicaemia, 21.6% had meningitis, and 6.3% had both. The mean overall crude incidence rate was 1.49/100,000 population with an overall case fatality rate of 12.6%. Meningococcal capsular groups (Men) B followed by C were the most prevalent with W and Y appearing over the last 6 years. Infants had the highest meningococcal incidence rate of 18.9/100,000 followed by 6.1/100,000 in 1-5 year olds and 3.6/100,000 in 11-15 year old adolescents. The introduction of MenACWY and MenB vaccines on the national immunization schedule in Malta would be expected to reduce the disease burden of meningococcal disease in children and adolescents in Malta.


Assuntos
Infecções Meningocócicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Malta/epidemiologia , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/prevenção & controle , Pessoa de Meia-Idade , Sepse/epidemiologia , Sepse/microbiologia , Sepse/prevenção & controle , Vacinação , Adulto Jovem
7.
Surg Obes Relat Dis ; 16(6): 751-759, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32273176

RESUMO

BACKGROUND: Bariatric surgery is an effective treatment for adults affected by obesity. Demand is greater than supply and a prioritization system for patients is needed. OBJECTIVE: Clinical practice guidelines recommends bariatric surgery as a management strategy for adults with severe obesity (body mass index ≥40 or 35-40 kg/m2 with co-morbidities). Eligible patient's access surgery on a first-come-first-serve basis and wait times can be several years. This study quantifies patient preferences toward attributes that could be evaluated when prioritizing patients for surgery. SETTING: A Canada-wide study of adults living with obesity. METHODS: A discrete choice experiment was conducted via email with a sample of Canadian adults with obesity. Six relevant attributes were identified through focus groups. Respondents completed 12 choice tasks and demographic and weight loss-related questions. A multinomial logit model was used to estimate preference weights of each attribute. RESULTS: A total of 515 individuals completed the survey. Fifty-nine percent were female, 97% made previous weight loss attempts, and 5% had bariatric surgery. On average patients prioritized individuals with significant problems with daily activities versus none (odds ratio [OR] 4.41; 95% confidence interval [CI] 4.31-4.52); 3 existing cardiovascular co-morbidities versus 0 (OR 4.24; 95%CI 4.12-4.36); extreme impact on mental health versus no impact (OR 3.73; 95%CI 3.64-3.84); 6 other co-morbidities versus 0 (OR 3.43; 95%CI 3.31-3.55); waiting 5 versus 1 year (OR 1.59; 95%CI 1.46-1.68); and a body mass index of 60 versus 40 (OR 1.52; 95%CI 1.43-.62). CONCLUSION: All 6 attributes were important to patients in the prioritization for bariatric surgery. However, the number of cardiovascular co-morbidities and the impact on daily activities were considered most important.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Adulto , Canadá , Feminino , Humanos , Masculino , Obesidade , Obesidade Mórbida/cirurgia , Preferência do Paciente
8.
BMJ Case Rep ; 13(2)2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32051153

RESUMO

A 4-year-old girl presented with confusion, ataxia and hallucinations 3 hours after an accidental overdose of 108 µg per kg of hyoscine hydrobromide (Kwells Kids). She was hypotensive and tachycardic at presentation. Investigations revealed QTc prolongation on ECG. The girl was admitted for observation overnight and was noted to have persistent visual and auditory hallucinations, which resolved without treatment. To our knowledge, this is the first reported case of an overdose of hyoscine hydrobromide at such a young age. Clinicians should be aware that unintentional ingestions in this age group may present with psychiatric manifestations. Hyoscine hydrobromide is easily accessible and available over the counter. It has serious consequences in overdose. Its packaging and appearance are attractive to young children making it susceptible to unintentional ingestions. We argue that its container should be altered to be more childproof.


Assuntos
Antagonistas Muscarínicos/envenenamento , Escopolamina/envenenamento , Ataxia , Pré-Escolar , Confusão , Overdose de Drogas , Feminino , Alucinações , Humanos
10.
Surg Endosc ; 34(11): 5142-5147, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-31820159

RESUMO

BACKGROUND: We aimed to assess the effect of a colonoscopy skills improvement (CSI) course on quality indicators at our institution. METHODS: This retrospective cohort study included ten surgeons and nine gastroenterologists practicing in a tertiary referral center who had undergone CSI training between 2014 and 2015. Procedural data for 50 colonoscopies by each physician was collected immediately before and after CSI training, and again 8 months after training. The primary outcome was adenoma detection rate (ADR) and secondary outcomes included colonoscopy completion rate (CCR), and withdrawal time (WT). Univariate analysis followed by stepwise multivariable logistic regression was performed to assess for predictors of these outcomes. These variables included patient age, gender, indication for colonoscopy, quality of bowel preparation, and CSI training. RESULTS: 2533 colonoscopies were included. There was no improvement in ADR for the entire group immediately after training and at 8 months (31.8% vs. 33.6% vs. 35.3%, p = 0.319). In subgroup analysis, the ADR of surgeons improved non-significantly immediately after completing the course and increased further at 8 months (30.9% vs. 31.6% vs. 37.6%, p = 0.065). The same changes were not observed for the gastroenterology subgroup (32.9% vs. 36.0% vs. 32.8%, p = 0.550). No change was noted in CCR or WT. In multivariate analysis of the surgical subgroup, increased patient age, male gender, and the 8-month time point following CSI training were associated with higher ADR. CONCLUSION: CSI training is associated with an improvement in ADR for surgeons at our institution.


Assuntos
Adenoma/cirurgia , Competência Clínica , Colonoscopia/educação , Neoplasias Colorretais/cirurgia , Gastroenterologia/educação , Adenoma/diagnóstico , Adulto , Idoso , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Melhoria de Qualidade , Estudos Retrospectivos , Resultado do Tratamento
11.
J Surg Res ; 243: 23-26, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31151033

RESUMO

BACKGROUND: It is commonly taught that a widened mediastinum (WM) on chest X-ray (CXR) is a marker for aortic injury (AI). We sought to describe the epidemiology of injuries for all patients with WM and compare their CXR to those of patients with confirmed AI. METHODS: Adults (age ≥ 18) sustaining blunt traumatic injuries from January 2017 to June 2017 with both CXR (supine, anterior-posterior) and chest CT were included. We excluded those whose CT preceded CXR and those with missing data. Basic demographics, injury characteristics, mediastinal width (MW), mediastinal-to-thoracic width ratio (MTR), and all thoracic imaging findings were analyzed. MW > 8 cm was considered WM. We also queried our registry for all AI patients over a 4-year period. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of WM on CXR for AI were calculated. Multivariate logistic regression was performed to identify factors associated with positive traumatic findings, controlling for body mass index (BMI), sex, high-energy mechanism, MTR, and mediastinal width. RESULTS: Of 749 included subjects, 502 (67%) had an MW > 8 cm: mean age was 48 ± 20 y, 381 (76%) were men, and BMI was 28 ± 5 kg/m2. Mechanism of injury was motor vehicle crash in 335 (67%); fall in 113 (23%); assault in 31 (6%); other (jet-ski accidents, etc.) in 17 (3%), and unknown in 6 (1%). Only 128 (26%) of patients with WM had positive findings on CT, with the most common [80 (16%)] being nontraumatic findings (pericardial infusion, lymph nodes, etc.), followed by hemomediastinum/pneumomediastinum [32 (6%)], sternal fractures [18 (4%)], multiple findings [15 (3%)], and vertebral fractures [6 (1%)]. Only 2 (1%) had AI. The sensitivity was 100%, specificity was 33%, PPV was 0.4%, NPV was 100%, and accuracy was 33%. From 2013 to 2017, 38 patients had AI: mean age was 46 ± 19 y, 26 (68%) were men, and BMI was 28 ± 4 kg/m2. Motor vehicle crash was the most common mechanism (89%), followed by "other" trauma mechanism (5%), fall (3%), and assault (3%). On univariate analysis, compared with all patients with WM, patients with AI had significantly greater MW (9.5 [8.8-10.4] versus 10.2 [9.1-11.1]; P = 0.042) and MTR (0.31 [0.28-0.34] versus 0.32 [0.31-0.37]; P = 0.001), although the actual differences were not clinically significant. The regression analysis did not identify any factors associated with traumatic CXR findings. CONCLUSIONS: Most bluntly injured adults have a WM, and the majority have either no findings or nontraumatic findings. The PPV of a WM for AI is <1%. WM on supine CXR is nonspecific and inaccurate for diagnosing traumatic injuries, especially AI.


Assuntos
Aorta/lesões , Mediastino/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radiografia Torácica , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/etiologia
12.
Surg Endosc ; 33(3): 879-885, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29998389

RESUMO

BACKGROUND: Current enhanced recovery guidelines suggest that opioid sparing medications should be used for analgesia whenever possible following colorectal surgery. The present study aims to assess whether post-operative NSAID use is associated with an increased anastomotic leak rate after a colonic or rectal anastomosis. METHODS: A systematic review was performed for studies investigating anastomotic leak rate following NSAID use vs control after colonic or rectal anastomosis. Meta-analysis was performed to assess for overall risk of anastomotic leak with NSAID use, as well as sub-group analysis to compare selective vs non-selective NSAIDs and drug-specific NSAID safety profiles. RESULTS: Seven studies were included in the final review. Use of an NSAID post-operatively was associated with an overall increased risk of anastomotic leakage [OR 1.58 (1.23, 2.03), P = 0.0003]. Non-selective NSAIDs were associated with an increased risk [OR 1.79 (1.47, 2.18), P < 0.00001], but selective NSAIDs were not. The non-selective NSAID diclofenac was associated with an increased leak rate [OR 2.79 (1.96, 3.96), P < 0.00001], but ketorolac was not [OR 1.36 (0.89, 2.06), P = 0.16]. CONCLUSIONS: Great caution must be taken when prescribing NSAIDs following colonic or rectal anastomotic creation. The safety profile varies within the NSAID class and further research is needed to clarify which NSAIDs are safe for use and which are not.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica , Anti-Inflamatórios não Esteroides , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Reto/cirurgia , Fístula Anastomótica/induzido quimicamente , Fístula Anastomótica/prevenção & controle , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Masculino , Risco Ajustado
14.
Travel Med Infect Dis ; 26: 16-24, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29462726

RESUMO

BACKGROUND: Mediterranean Spotted Fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii which is endemic in Malta, an island in the South Mediterranean that is a popular tourist destination. Diagnosis is frequently based on clinical manifestations as laboratory results are often limited to a retrospective diagnosis. We describe the clinical presentation, diagnosis and treatment of children <16 years who presented with MSF from 2011 to 2016. METHOD: The demographics, clinical findings, laboratory results, management and outcome of all children hospitalised with suspected MSF based on the presence of fever and an eschar, were retrieved from their case notes. RESULTS: Over the five-year study period six children, aged between 17 months and 15 years, were diagnosed with MSF. All children had contact with ticks and the majority presented in summer. Laboratory results were non-specific and included elevated inflammatory markers, lymphocytosis/lymphopenia and hyponatraemia. Serological and molecular techniques were used for diagnosis. Response to clarithromycin or doxycycline was immediate. CONCLUSION: MSF should be included in the differential diagnosis of fever, rash and an eschar in children who travel to Malta. Despite advances in molecular diagnostics, clinical diagnosis remains important in the management of children with suspected MSF.


Assuntos
Febre Botonosa/diagnóstico , Febre Botonosa/tratamento farmacológico , Doença Relacionada a Viagens , Adolescente , Animais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Claritromicina/uso terapêutico , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Feminino , Hospitalização , Humanos , Lactente , Masculino , Malta/epidemiologia , Necrose/diagnóstico , Estudos Retrospectivos , Rickettsia/imunologia , Testes Sorológicos , Pele/patologia , Carrapatos
16.
Obes Surg ; 28(8): 2261-2271, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29116560

RESUMO

BACKGROUND: The study aim was to determine the prevalence of abnormal serum biochemistries associated with micronutrient deficiencies before and after laparoscopic sleeve gastrectomy (LSG). METHODS: Two hundred and one patients had LSG surgery between May 2011 and May 2014. Using a prospective cohort study design, data were collected on ferritin, hemoglobin (Hgb), mean cell volume (MCV), calcium, albumin, 25-hydroxyvitamin D (25-OH-D), PTH, and vitamin B12 with follow-up of 75.6% (n = 152), 63.7% (n = 128), 52.7% (n = 106), and 40.3% (n = 81) at 6, 12, 18, and 24 months, respectively. RESULTS: Patients were female (81.6%) with mean ± SD, BMI (48.8 ± 6.8 kg/m2), weight (135.1 ± 23.6 kg), and age (44.0 ± 9.6 years). Mean values for all biochemical parameters pre- and post-LSG were within reference limits. After adjusting for age, weight, and supplement use, trend tests post-LSG were significant for mean differences in ferritin (p = 0.002), calcium (p = 0.017), and vitamin B12 (p = 0.034). Pre-LSG, the proportion of patients with values below reference limits included 25-OH-D (20.4%), ferritin (12.3%), and Hgb (10.0%), while the proportion above reference limits included PTH (29.1%) and ferritin (17.4%). After adjustment, hypoalbuminemia was more prevalent after 1 year; the proportion of patients with PTH levels in the upper reference limit was higher 6 months post-LSG (p < 0.05). Multivitamin use increased presurgery from 44 to 88% 2 years postsurgery. Vitamin B12 supplementation increased from 7% before surgery to 32% 2 years postsurgery. CONCLUSION: Abnormal serum biochemistries indicative of micronutrient deficiencies were prevalent before surgery; reduced abnormal values were observed after surgery, likely due to an increased use of multivitamins.


Assuntos
Gastrectomia , Laparoscopia , Desnutrição , Obesidade Mórbida , Adulto , Suplementos Nutricionais , Feminino , Ferritinas/sangue , Humanos , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Terapia Nutricional , Obesidade Mórbida/cirurgia , Período Pós-Operatório , Estudos Prospectivos , Vitamina B 12 , Vitamina D/análogos & derivados , Vitaminas
17.
Clin Biochem ; 52: 13-19, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29051034

RESUMO

INTRODUCTION: C-reactive protein (CRP) is often elevated in patients living with severe obesity (BMI≥35kg/m2). However, there is limited information on how CRP, and other inflammation responsive biomarkers, change in response to weight loss following laparoscopic sleeve gastrectomy (LSG). We studied how CRP, ferritin and albumin change following LSG surgery in relation to obesity, metabolic syndrome (MetS) ATPIII risk components and diabetes mellitus (DM). METHODS: Laboratory parameters (including CRP) were examined in 197 patients prior to LSG, and at 6, 12, 18 and 24months. Changes in laboratory parameters, and laboratory investigations, were also examined in a 125 patient subgroup at both pre-LSG and at the 12month follow-up visit. RESULTS: All patients had BMI≥35kg/m2. CRP levels positively correlated with BMI (r=0.171, p=0.016) and alkaline phosphatase (ALP; r=0.309; P<0.001), but negatively correlated with alanine aminotransferase (ALT; r=-0.260; P<0.001) and albumin (r=-0.358; P<0.001). LSG significantly reduced CRP and ferritin, which were maintained for at least 24months. At 12months post-LSG there was a significant decrease in weight (kgs) (p<0.001), CRP (p<0.001), ferritin (p=0.004), and various MetS risk components (p<0.001) but not albumin (p=0.057). Changes in CRP also correlated with changes in weight (r=0.233, p=0.018) and ALP (r=0.208, p=0.034) but not albumin (r=-0.186, p=0.058) or ferritin (r=0.160, p=0.113) after LSG. CONCLUSION: The negative correlation between CRP and albumin levels in obesity may indicate a low grade inflammatory process affecting both. LSG related weight loss decreased CRP and ferritin, likely explained by improvement in inflammatory status.


Assuntos
Proteína C-Reativa/análise , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Diabetes Mellitus , Feminino , Ferritinas/análise , Ferritinas/sangue , Seguimentos , Gastrectomia/métodos , Humanos , Inflamação/sangue , Laparoscopia/métodos , Masculino , Síndrome Metabólica , Pessoa de Meia-Idade , Obesidade/cirurgia , Período Pós-Operatório , Albumina Sérica Humana/análise , Resultado do Tratamento , Perda de Peso/fisiologia
19.
Drugs ; 77(17): 1881-1896, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29094312

RESUMO

MenACWY-TT (Nimenrix®) is a quadrivalent meningococcal tetanus toxoid conjugate vaccine licensed in Europe for active immunisation of individuals aged ≥ 6 weeks against invasive disease caused by Neisseria meningitidis capsular groups A, C, W and Y. MenACWY-TT is the first quadrivalent conjugate vaccine to be approved in Europe for use in infants as young as 6 weeks of age. Numerous phase II-IIIb clinical studies showed that intramuscular MenACWY-TT administered as primary or booster vaccination was highly immunogenic for all four vaccine capsular groups and had an acceptable reactogenicity profile in individuals aged 6 weeks to ≥ 56 years. MenACWY-TT is as immunogenic and safe as other previously licensed monovalent capsular group C or quadrivalent capsular groups A, C, W and Y meningococcal vaccines and can be coadministered with other routine vaccines without adversely affecting the immunogenicity or safety profiles of either vaccine. Current data indicate that primary and booster vaccination with MenACWY-TT is a valuable and safe option for broadening meningococcal protection against four capsular groups across a broad age range, starting as early as 6 weeks of age.


Assuntos
Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Vacinas Meningocócicas/imunologia , Europa (Continente) , Humanos , Imunização Secundária , Infecções Meningocócicas/imunologia , Vacinas Meningocócicas/efeitos adversos , Neisseria meningitidis/imunologia , Vacinação , Vacinas Conjugadas
20.
Can J Surg ; 60(5): 335-341, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28742012

RESUMO

BACKGROUND: Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. METHODS: We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. RESULTS: Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. CONCLUSION: The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.


Assuntos
Meios de Contraste , Diatrizoato de Meglumina , Fluoroscopia/normas , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Grampeamento Cirúrgico/efeitos adversos , Adulto , Endoscopia Gastrointestinal , Feminino , Fluoroscopia/economia , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo
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