Combined Medical Treatment Research Articles

Long‐term successful outcome of a Streptococcus equi subspecies equi brain abscess

SummaryWe previously described successful treatment, including surgical drainage, of a Streptococcus equi subspecies equi brain abscess that caused severe neurological deficits in a 7‐year‐old Quarter Horse mare. This report details the long‐term successful outcome of the case, findings of a magnetic resonance imaging (MRI) study performed 14 years after surgery and necropsy findings 18 years after initial treatment. Despite persistent cerebral and midbrain lesions detected by MRI and at necropsy, the mare returned to serviceable function within a year of initial treatment and had a successful performance career for over 10 years until carpal arthritis prompted retirement. This case demonstrates that brain abscess in horses can be successfully managed by combined medical and surgical treatment.

Combined (physical and medical treatment) therapy versus physical treatment alone and medical treatment alone in the management of chronic pelvic inflammatory disease

ContextPelvic inflammatory disease (PID) is the inflammation of the upper genital tract involving the fallopian tubes as well as the ovaries. Symptoms of PID are fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, uterine and adnexal tenderness, and irregular menstruation.AimThe aim was to determine the therapeutic efficacy of combined shortwave diathermy and medical treatment in the management of chronic PID in comparison to either therapy alone.Materials and methodsSixty participants were recruited and diagnosed as chronic PID for more than 6 months by history, clinical examination, cervical swab, and ultrasonography. They were divided into three groups:Statistical analysisDescriptive and analytic study by SPSS version 16 on IBM compatible computer.ResultsThere was a statistically highly significant clinical improvement regarding itching, discharge and pain relief, laboratory improvement regarding the number of pus cells in cervical swab, and radiological improvement regarding US parameters in the first group of patients with PID compared with the baseline and compared with other groups.ConclusionThe greatest therapeutic efficacy can be obtained from combined physical and medical treatment compared with each line alone in the treatment of chronic PID.

The Clinical Study of a New Management Model Using Mobile Health for Senile Hypertension

Objective: To evaluate a new management model using mobile health for senile hypertension. Methods: This medical service combined traditional medical treatment with Mobile Health. We use it to explore a new and effective model of elderly hypertension management and the most effective and lowest cost management crowd. According to the randomized controlled design of trial, 105 old hypertensive patients participated in the study voluntarily in the Qingdao Municipal Hospital were randomly divided into the experimental group (75 cases) and control group (30 cases). Experimental group is divided into geriatric specialist group (25 cases), general practitioner group (25 cases) and nurse group (25 cases). Blood pressure was administered in experimental (with the new model) and control groups (with the traditional model) for 2 months to compare their blood pressure and the decrease of them. Results: Blood pressure was compared between the two groups before and after administration. The systolic blood pressure (SBP) of experimental group is 162.44 ± 13.970 mmHg before administration. SBP of experimental group is 147.69 ± 13.509 mmHg after administration, the difference is statistically significant (P = 0.000). The diastolic blood pressure (DBP) of experimental group is 91.58 ± 10.822 mmHg before administration. DBP of experimental group is 84.64 ± 10.412 mmHg after administration, P = 0.003. SBP of control group is 159.93 ± 15.238 mmHg before administration. The systolic blood pressure of control group is 152.33 ± 14.115 (mmHg) after administration. P is 0.167 (P > 0.05). The difference was not statistically significant. DBP of control group is 94.73 ± 12.401 (mmHg) before administration. DBP of control group is 90.60 ± 11.115 (mmHg) after administration. P is 0.345 (P > 0.05). The difference was not statistically significant. The decrease of SBP of geriatric specialist group, general practitioner group and nurse group is 18.40 ± 11.764 mmHg, 14.47 ± 9.44 mmHg, 10.80 ± 6.026 mmHg. The difference was not statistically significant (P > 0.05). The decrease of DBP of geriatric specialist group, general practitioner group and nurse group is 9.33 ± 7.451 mmHg vs. 5.33 ± 6.287 mmHg vs. 6.13 ± 5.069 mmHg (P > 0.05). Conclusion: The new model is effective and it works well for controlling blood pressure of elderly hypertensive patients. Especially with the doctors and patients’ families, the management effect has been obviously improved. Medical interventions make the new model more scientific. The management of geriatric specialists, general practitioners and nurses is equally valid.

Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis.

Study Design:Systematic literature review.Objectives:The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis.Methods:A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed.Results:Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference −0.61, CI −0.90 to −0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P < .001), but was subject to heterogeneity among studies (I 2 = 56%, P = .13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients.Conclusion:Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.

Amniotic Membrane Transplantation in Acute Severe Ocular Chemical Injury: A Randomized Clinical Trial

To compare the outcomes of conventional medical treatment vs combined medical treatment and amniotic membrane transplantation (AMT) in the management of patients with Roper-Hall grade IV ocular chemical injury. Randomized, parallel-controlled clinical trial. Setting: Single tertiary referral hospital. Sixty eyes of 60 patients with Roper-Hall grade IV ocular chemical injury with a minimum follow-up of 12months were enrolled in the study. Patients were randomly assigned to 2 groups: Group 1 (30 eyes) received topical preservative-free lubricating gel and drops, chloramphenicol, betamethasone, homatropine, oral vitamin C, and doxycycline; Group 2 (30 eyes) received amniotic membrane transplant (AMT) on the entire ocular surface in addition to the medical treatment provided in Group 1. The main outcome measure was time to complete corneal epithelialization. Secondary outcome measures were best-corrected visual acuity (BCVA) and neovascularization in the central 5mm of the cornea. Mean follow-up time was 20.3 ± 2.5months (range 13-24months). Corneal epithelial defects healed within 72.6 ± 30.4 (21-180) days in Group 1 vs 75.8±29.8 (46-170) days in Group 2 (P= .610). Mean BCVA was 2.06 ± 0.67 (0.4-2.6) logMAR vs 2.06 ± 0.57 (1-2.9) logMAR in Groups 1 and 2, respectively (P= .85). Group 1 developed more central corneal neovascularization (22 eyes; 73.3%) compared to Group 2 (16 eyes; 53.3%); however, it was not statistically significant (P= .108). In comparison to conventional medical therapy, combined amniotic membrane transplantation and medical therapy does not accelerate corneal epithelialization or affect final visual acuity in severe chemical injuries.

The role of multimodal treatment in Crohn's disease patients with perianal fistula: a multicentre retrospective cohort study.

Treatment paradigms for Crohn's disease with perianal fistulae (CD-pAF) are evolving. To study the impact of multimodality treatment in CD-pAF on recurrence rates and the need for re-interventions and to identify predictive factors for these outcomes. This was a multinational multicentre retrospective cohort study. Multimodality approach was defined as using a combination of medical treatments (anti-TNFs ± immunomodulators ± antibiotics) along with surgical approach (examination under anaesthesia (EUA) ± seton drainage) at diagnosis of CD-pAF. Univariable and multivariable analyses were performed for variables indicative of the need for reintervention. A total of 253 patients were included. 65% of patients received multimodality approach. Multimodality treatment resulted in complete fistula healing in 52% of patients. Re-intervention was needed in 27% of patients with simple and in 40.3% of those with complex fistula. On multivariable analysis multimodality treatment (OR: 0.35, 95% CI: 0.17-0.57, P=0.001), seton removal (OR: 0.090, 95% CI: 0.027-0.30, P=0.0001, therapy with infliximab (OR: 0.19, 95% CI: 0.06-0.64, P=0.007), and therapy with adalimumab (OR: 0.12, "95% CI: 0.026-0.56, P=0.007) were predictive of avoiding repeat surgery. Proctitis (OR: 3.76, 95% CI: 1.09-12.96, P=0.03) was predictive of the need for radical surgery (proctectomy, diverting stoma) while multimodality treatment reduced the need for radical surgery (OR: 0.21, 95% CI: 0.05-0.81, P=0.02). Multimodality treatment, anti-TNFs use, and removal of setons after multimodality treatment can result in improved outcomes in CD patients with perianal fistulae and reduce the need for repeat surgery and radical surgery.

Combination medical treatment for primary open angle glaucoma and ocular hypertension: a network meta-analysis

Combination medical treatment for primary open angle glaucoma and ocular hypertension: a network meta-analysis

INTERRELATION OF ANTIHYPERTENSIVE EFFECT OF COMBINATION OF VALSARTAN AND AMLODIPINE WITH VARIOUS POLYMORPHIC VARIANTS OF GENES CYP2C9 AND CYP11B2 IN PATIENTS WITH OBESITY

Aim. To assess the efficiency of combined antihypertensive therapy in patients with arterial hypertension and obesity depending on the polymorphism of CYP2C9 andCYP11B2 genes. Materials and methods. 80 patients with obesity and concomitant uncontrolled medicamentally arterial hypertension (1-2 stage) were included in our study. These patients took the fixed dose combination of the valsartan and amlodipine in a dose of 80-160/5-10mg per day. Blood pressure of all patients was measured by the procedure mentioned in the recommendations for diagnosis and treatment of arterial hypertension (ESH/ESC, 2013; РМОАГ, 2010) before and after 8 weeks of treatment. All tested people had venous blood sampling succeeded by DNA extraction from leukocytes. The amplification of the polymorphic variants CYP2C9 andCYP11B2 genes was performed in real time by means of primers and probes (Synthol, Russia) and Taq Man method (allele discrimination). Results. It is shown that the patients with *1/*2 variant of CYP2C9 gen reached the target level of the arterial blood pressure more often than patients who had polymorphism *1/*1 (92,8% against 47,3%) while analyzing the efficiency of the treatment with account of the polymorphic variants of CYP11B2 gene the reaching of the target level of the arterial blood pressure was seeing more often in the case of mutant polymorphism *2/*2 then in the case of *1/*2 polymorphism (76,5% against 50%). It was also determined that the accurate predominate of *2*2 polymorphism CYP11B2 gene over other its variants was seeing among the patients with more frequent polymorphism of CYP2C9 − *1/*1 who reached the target level of the arterial blood pressure after 8 weeks of the therapy. Conclusion. The interrelation between the antihypertensive combination of valsartan and amlodipine with the polymorphism of CYP2C9 and CYP11B2 genes witch was determined in our study can be considered in cases of the treatment of the patients who suffer from arterial hypertension and obesity. Probably, new usage of the genetic testing results as one of the individualized medicine direction may promote the optimization and effectiveness of the combined medical treatment among the patients with arterial hypertension and obesity.

Outcomes of combined medical and behavioral treatments for constipation within a specialty outpatient clinic.

Outcomes of combined medical and behavioral treatments for constipation within a specialty outpatient clinic.

Combined treatment of endometriosis: radical yet gentle

Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the management of individual patients. This should take into account the severity of the disease and whether the patient desires to have children. Particular emphasis is laid on the anatomical intersections which, when injured, can lead to persistent damage of the anterior, middle or posterior compartment and are not infrequently the cause of urological and urogynaecological follow-up measures. Typical symptoms of endometriosis include chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e. g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Approx. 50 % of all female teenagers and up to 32 % of all women of reproductive age who have been operated for chronic pelvic pain or dysmenorrhoea suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, causal treatment is still impossible. Treatment options include expectant management, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5 % and > 60 % and is very much dependent on integrated management and surgical skills. Consequently, to optimise the individual patient's treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should be reserved to appropriate centres - especially in the case of deep infiltrating endometriosis.

Osteomyelitis of the Pelvic Bones: A Multidisciplinary Approach to Treatment.

Background and Purpose: A case series review of chronic pelvic osteomyelitis treated with combined medical and surgical treatment by a multidisciplinary team.Methods: All patients treated with surgical excision of pelvic osteomyelitis at our tertiary referral centre between 2002 and 2014 were included. All received combined care from a clinical microbiologist, an orthopaedic surgeon and a plastic surgeon. The rate of recurrent infection, wound healing problems and post-operative mortality was determined in all. Treatment failure was defined as reoperation involving further bone debridement, a requirement for the use of long-term suppressive antibiotics or sinus recurrence.Results: Sixty-one adults (mean age 50.2 years, range 16.8-80.6) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 19 type II, 35 type III and 7 type IV cases. The ischium was the most common site of infection. Osteomyelitis was usually the result of contiguous focus infection associated with decubitus ulcers, predominantly in patients with spinal or cerebral disorders. Most patients with positive microbiology had polymicrobial infection (52.5%). Thirty patients required soft tissue reconstruction with muscle or myocutaneous flaps.Twelve deaths occurred a mean of 2.8 years following surgery (range 7 days-7.4 years). Excluding these deaths the mean follow-up was 4.6 years (range 1.5-12.2 years). Recurrent infection occurred in seven (11.5%) a mean of 1.5 years post-operatively (92 days - 5.3 years). After further treatment 58 cases (95.1%) were infection free at final follow-up.Interpretation: Patients in this series have many comorbidities and risk factors for poor surgical outcome. Nevertheless, the multidisciplinary approach allows successful treatment in the majority of cases.

Successful management of acute liver failure in Italian children: A 16-year experience at a referral centre for paediatric liver transplantation

BackgroundIdentifying the causes of acute liver failure (ALF) and predictors of death or liver transplantation (LTX) is crucial to decide its management. We aimed to describe features and outcome of ALF in Italian children. MethodsRetrospective review of cases presenting between 1996–2012. ALF was defined by high transaminases, INR ≥2.0 regardless of hepatic encephalopathy (HE), no evidence of underlying chronic liver disease. Results55 children (median age 2.6 years, range 0.1–15.1; M/F=31/24) had ALF due to autoimmune hepatitis (AIH) in 10 (18%), metabolic disorders in 9 (17%), paracetamol overdose in 6 (11%), mushroom poisoning in 3 (5%), viral infection in 1 (2%), indeterminate in 26 (47%); 25/55 recovered with supportive management (45%); 28/55 underwent LTX and 2 died on the waiting list (55%). On multivariate analysis severity of HE grade 3–4 and bilirubin ≥12mg/dl were independent predictors of death or LTX (p<0.05). After a median follow up of 4 years (range 2–15.0 years) the overall survival rate was 93%. ConclusionChildren with ALF can be managed successfully with combined medical treatment and transplantation, warranting a survival rate similar to children transplanted because of chronic conditions. In our cohort of patients severe HE and high bilirubin on admission were independent predictors of the need of LTX.

需求导向下的“医养结合”服务云平台建设研究—以成都市为例

随着我国老年人口的增多，人口老龄化问题的日益严重，养老问题受到社会各界广泛关注。然而我国的养老产业发展刚刚起步，尚未形成一个完整的养老服务体系，无法满足快速增长的养老需求。为解决这一问题，本文首先对成都市养老服务需求和产业现状进行了调研，分析梳理老人需求与养老服务相关行业及相关政府部门之间的关系机理，构建了“医养结合”的养老服务云平台，形成了一个完整的养老服务体系，以期对养老事业的发展起到一定助推作用。 With the increase of the elderly population, the problem of population aging is becoming more and more serious, and the issue of pension has begun to be concerned by the whole society. However, the development of China’s pension industry has just started and has not yet formed a complete pension service system, which resulted in the mismatching with the rapid growth of pension needs. In order to solve this problem, this paper analyzes the relationship between the needs of the elder, the related service sectors and relevant government departments, based on the investigation of the service demand and the current situation of the industry in Chengdu, constructing a “combination of medical treatment and health care” Pension service cloud platform, forming a complete pension service system, which contributes a certain economic value and social value.

Treatment methods of avoidant/restrictive food intake disorder: Review with therapeutic implications

Background: The introduction of Avoidant/Restrictive Food Intake Disorder (ARFID) have refined childhood and adolescent eating disorders, however it meant a significant change in the diagnostics. Hardly anything is known about its effective interventions and there is a lack of specific treatment guidelines. Thus, our aim was to review the risk factors, assessment methods, and chiefly the treatment methods of ARFID to support its clinical management and psychotherapy. Method: The reviewing process was conducted in two steps, with the primary focus on the literature since the introduction of ARFID using the term of 'avoidant/restrictive food intake disorder' with dates 2012 -2015. The PRISMA flow algorithm was applied to filter results. Results and discussion: Assessment methods involve structured DSM -V interview, supplemented with Bryant-Waugh's diagnostic guideline, and the Children's Eating Disorder Examination-Questionnaire, or the Eating Disturbances in Youth-Questionnaire. The heterogeneous treatment shall fit the patients' and families individual needs, and the different presentations ARFID (e.g. sensory-based selective eating, of chocking or vomiting phobia and interactional difficulties). A combination of medical treatment with the primary focus on the weight recovery, nutritional management, and psychotherapeutic interventions are suggested; in children parents should be involved. Behavior therapy with exposure, systematic desensitization, CBT with cognitive restructuring, anxiety management, and family based interventions seemed to be the most useful psychotherapeutic interventions. Conclusions: Studies should start assessing the effectiveness of different treatment approaches based on longitudinal researches to describe strict evidence-based guidelines for each presentations of ARFID.

Endoscopic vs. Medical Therapy for Bleeding Peptic Ulcers with Adherent Clot: A Randomized Comparative Trial

Upper gastrointestinal bleeding is the most common and potentially life threatening emergency. Despite great advances in the field of medicine, the optimal management of bleeding peptic ulcer with adherent clot on endoscopy is still controversial. The aim of this study is to compare the combined endoscopic and medical therapy with medical therapy alone for bleeding peptic ulcer with adherent clot (Forrest type IIB). During two-year study period, around 342 patients presented to our Tertiary care hospital with acute upper gastrointestinal bleeding. Out of these, 81 patients were noted to have adherent clot (Forrest type IIB) during endoscopy and were included in study. 40 patients received combined endoscopic and medical treatment, whereas 41 patients received medical treatment only. The base line characteristics of patients in two groups were comparable and statistically significant. Primary Outcome being recurrence of bleeding within 7 days of treatment was less in combined therapy group compared to medical therapy group (2.5% vs. 17.1%) This was statistically significant. Secondary outcome like recurrence of bleed in 30 days and need for repeat endoscopy were less in combined group compared to medical therapy group. These were statistically significant as well. Other secondary outcomes like necessity for surgery and mortality were fewer in combined group, but these were not statistically significant. In conclusion combination endoscopic therapy consisting of epinephrine injection, removal of the adherent clot, and treatment of underlying stigmata is more effective than medical therapy alone.

Combination of Medical and Physical Therapy in Management of Posttraumatic Headaches and Sleep Disturbances in Patients with Post-Concussion Syndrome

Some of the main symptoms of mild traumatic brain injury in the long term are headaches and sleep disturbances. The purpose of our study was to investigate the influence of the combination medical and physical treatment using darsonvalization and magnetic therapy on headaches and sleep disturbances in patients with postconcussion syndrome. Methods: We observed 67 patients with the consequences of mild traumatic brain injury. Patients were divided into two groups: the first group consisted of patients who received medical therapy. The second group included patients who received a similar medical therapy, adding physical therapy using the methods of magnetic therapy and darsonvalization. The treatment was controlled by Doppler ultrasound of the carotid arteries as well as by testing the patients according to MOS SF-36 quality of life questionnaire, which were carried out before and after the treatment. Results: The analysis of the data obtained from the first group showed the increase of blood flow velocity by 5.2%. The data obtained from the second group showed the significant increase of blood flow velocity by 14.7%, as well as reducing the indices of vascular resistance (PI and RI) by 39.3%. In second group we saw the positive effect of physical therapy using darsonvalization and magnetic therapy. We observed a significant decrease in autonomic manifestations of the disease, which results in a reduction of headaches (75%), palpitations (57.2%), distal hyperhidrosis (64.7%), normal sleep (72.4%), improved emotional background mood (86.5%). Conclusions: We suppose, that headache in patients with TBI can provoke increased sleep disturbances in turn this sleep disturbances later may lead to increased headache.Combination treatment with physical and medical therapy leads to subjective and objective improvement of the patients’ health. Combination physical and medical therapy is recommended for more effective treatment of the consequences of traumatic brain injury.

Anterior Stromal Puncture vs. Annular Keratotomy in the Treatment of Painful Bullous Keratopathy, Randomized Clinical Trial.

Purpose: Determine if anterior stromal puncture (ASP) has a more effective decrease in symptomatology (pain, photophobia, and foreign body sensation) compared to annular keratotomy (AK) in the treatment of painful bullous keratopathy (PBK) in patients with poor visual prognosis. Methods : Patients with PBK, refractory to combined medical treatment and poor visual prognosis were randomly assigned to one of two surgical procedures. Symptomatology, central corneal thickness (CCT), visual acuity (VA), and best corrected (BCVA) were evaluated with a 7-month follow up. Results: From 78 patients with PBK, 13 fulfilled inclusion criteria; ASP was performed to 7 and AK to 6 of them. There was improvement in the magnitude of symptoms in both groups; however, there was no difference when groups were compared. CCT showed a significant reduction from the basal, of 10.4% in the ASP group compared with a 9.6% increase in the AQ group (p=0.05). VA and BCVA in both groups were not modified. None of the groups presented complications related to the surgical procedures. Conclusions: In this clinical trial, we documented that ASP and AQ produce a similar improvement in the symptomatology of patients with PBK refractory to combined medical treatment and poor VA potential. The ASP group additionally presented a significant decrease in CCT. A longer follow-up period would be required to evaluate if this CCT reduction is able to modify the frequency of bullae development and symptoms relapse. Furthermore, the material used for ASP has a lower cost than the one used for AQ, which could represent an economic advantage for patients that attend our Hospital.

Risk factors for acute kidney injury after initial acute aortic dissection and their effect on long-term mortality

Several reports have discussed the risk factors for acute kidney injury (AKI) after thoracic aortic surgery and aortic dissection and the increased mortality in patients with AKI. However, there are few reports on the risk factors for AKI with combined medical and surgical treatment and the influence on mortality. The aim of this study was to clarify the risk factors and long-term effects of AKI on mortality and kidney function after acute aortic dissection in a cohort at our hospital. We retrospectively investigated 96 patients with initial acute aortic dissection between April 2012 and January 2015. We divided the subjects into two groups: 65 with AKI and 31 without AKI using RIFLE criteria. The outcomes were all-cause mortality and the decrease in kidney function after 6 and 12 months. We extracted the risk factors for AKI by multivariate logistic regression using clinical parameters. A history of hypertension, type A aortic dissection, and low platelet levels were statistically significant factors to predict AKI after aortic dissection (odds ratio [OR] 9.1, 95 % confidence interval [CI] 1.42–58.5, p = 0.02; OR 25.2, 95 % CI 3.1–205.0, p = 0.003; OR 0.82, 95 % CI 0.68-0.98, p = 0.033, respectively). Three patients with AKI died and 1 patient recovered from AKI. The kidney function in survivors was similar in those with and without AKI. Although there were no significant differences in long-term kidney function between groups, long-term mortality was worse in the AKI group (p = 0.017). Hypertension, type A aortic dissection, and low platelet levels were risk factors for AKI after aortic dissection, and AKI increased the 1-year all-cause mortality. A large-scale study is needed to verify our results.

Our Experience in the Management of Intestinal Tuberculosis

A descriptive study of 50 cases was conducted at Surgical Unit 1, Sir Ganga Ram Hospital, Lahore from May 2001 to Jan 2003 to evaluate clinical presentation of intestinal tuberculosis. Thirty eight patients were females and twelve males. Common presentation in operated cases were abdominal pain, tenderness, vomiting, distension and absolute constipation. While in non-operative cases presentation was vague abdominal pain, fever, weight loss, constipation and diarrhoea. Evidence of tuberculosis was achieved by ESR, X-ray chest, mantoux test and histopathology. These patients were managed either surgically or conservatively by anti-tuberculous chemotherapy. Out of fifty patients, forty patients were treated with combined medical and surgical treatment while ten cases were managed by medical treatment only. One patient expired with a mortality rate of 2.5% among operated cases. This patient developed faecal fistula due to leakage from suture line. Cause of death was poor nutrition, debility, anaemia and electrolyte imbalance.

Living with the unknown: Posttraumatic stress disorder in pediatric bone marrow transplantation survivors and their mothers

ABSTRACTBone marrow transplantation (BMT) is used to treat children with various hematologic, oncologic, and metabolic diseases. Although the treatment can be lifesaving, it is also physically and psychologically demanding for both the child and caregivers. In previous studies, BMT is found to be related with anxiety, posttraumatic stress disorder (PTSD), depression, and psychosocial problems both in children and parents. The aim of this study was to investigate PTSD in pediatric BMT survivors and their mothers compared with the healthy controls. Twenty-seven BMT survivors and their mothers and 28 healthy peers and their mothers were recruited as the study group and as the comparison group, respectively. All children were interviewed using Child Posttraumatic Stress Disorder—Reaction Index (CPTSD-RI) for assessing posttraumatic stress responses. As for mothers, Clinician-Administered PTSD Scale (CAPS) was used. In healthy children and mothers, instead of BMT, the most important traumatic event reported by them was included. All data were analyzed by a neutral statistician from the Department of Biostatistics of the university. The BMT group, both children and mothers, obtained significantly higher PTSD rates than the control group (66.5% and 17.8%, respectively, in children; 57.6% and 7%, respectively, in mothers). However, there was a weak correlation between survivors' and mothers' posttraumatic stress responses. These findings suggest that BMT is a significant stressor for both children and mothers. Clinicians should be aware of psychiatric symptoms of children who underwent such a life-threatening condition. Combination of medical treatment with psychosocial support is imperative.