Development Of Secondary Complications Research Articles

CVA case complicated by Aspiration Pneumonia– from ventilator to walking: A Case Report

Stroke or cerebrovascular accident is a leading cause of death and disability especially in the elderly population. The prognosis depends upon the early detection, extent of injury and the level of repair occurring within the CNS. Underlying pulmonary and cardiac risk factors like history of smoking, hypertension specifically have a significant effect on the development of poststroke aspiration pneumonia. Complications similar to these delay the path to rehabilitation significantly exposing the patient to the risks of prolonged immobilization, introduction of artificial airways for ventilation and development of secondary complications like pressure sores. In this case report, we aim to document the strategies applied for the complete rehabilitation of the individuals from the acute setting all the way till the rehabilitation in spite of hemodynamic instabilities to help professionals dealing with similar patients.

257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension

257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension

Serum levels of vitamin D, calcium, phosphorus, and oxidative parameters in healthy and diabetic people

Introduction: Diabetes mellitus is a metabolic disease that is a primary public health consideration. Low Vitamin D levels are linked to type 2 diabetes (T2DM), diminished insulin release, and enhanced insulin resistance in humans and animals. Vitamin D is also involved in the regulation of calcium and phosphorus homeostasis. Oxidative stress and antioxidant imbalances are important for the progression of diabetes as well. In this endeavor, the levels of vitamin D, calcium, phosphorus, and evaluation of the oxidant- antioxidant factors of malondialdehyde (MDA) and total antioxidant capacity (TAC) in healthy and diabetic people were compared.Methods: This descriptive-analytical study was conducted in 2020 in Shiraz, Fars province, Iran. The population included 40 T2DM patients (with HbA1c equivalent 6-8) without comorbidities, 20-60 years old for both genders, and 40 healthy individuals (female and male between 20-60 years old without comorbidities). The high-performance liquid chromatography (HPLC) method was adopted for measuring Vitamin D and for measuring other levels, the colorimetric method was used. Using SPSS 22, statistical analysis was performed. The Mann- Whitney U test for quantitative data was applied. P<0.05 was deemed significant.Results: There was a statistically significant difference between the two groups when it came to the means of vitamin D and MDA. In the diabetic group, vitamin D levels were lower (p=0.001) and MDA levels were higher (p<0.001). Comparing the level of calcium and phosphorus in diabetics and healthy people revealed no significant difference. This result was also true for the TAC test.Conclusions: According to our results, the mean of vitamin D in T2DM was significantly lower than healthy people and MDA in T2DM significantly increased compared to the control group, suggesting that increasing the activity of this enzyme in the development of secondary complications in diabetic patients is a predisposing factor.Keywords: Vitamin D, Diabetes mellitus, HPLC, Oxidative stress

A narrative review of echocardiography in infective endocarditis of the right heart.

Infective endocarditis (IE) is characterized by bacterial or fungal masses that form in the cardiac chambers and valves, and in severe cases invade the endocardium or intra-cardiac vessels. Right-sided IE accounts for 5% to 10% of cases, with a low mortality cited at 6%. A history of intravenous drug abuse (IVDU) is present in 90% of isolated right-sided IE cases, with normal intra-cardiac anatomy prior to infection in approximately 80%. Nevertheless, up to 50% of patients require early surgical intervention which is associated with significant peri-operative morbidity. Echocardiography is the gold standard for diagnosis with a sensitivity of 80% for the transthoracic modality and 95% for transesophageal studies; it provides important clinical information regarding the severity of infection and development of secondary complications. This includes identification of active infective vegetations, healed IE, prosthetic valve IE, and abscess formation and rupture. Prompt clinical, microbiologic, and imaging assessment of patients with suspected left or right-sided IE is of paramount importance and is reflected in the modified Duke criteria, the well-validated algorithm for accurate and timely diagnosis of IE. Data suggests the criteria sensitivity may be decreased in right-sided IE only, and thus, care must be taken to perform skilled and detailed echocardiographic assessments of the right heart in suspected cases. Herein we provide a review of IE of the right heart, with a focus on pathophysiology and its echocardiographic presentation and characteristics.

Neutrophil Phenotypes and Functions in Trauma and Trauma-Related Sepsis.

Physical trauma is one of the leading causes of mortality worldwide. Early post-traumatic upregulation of the pro-inflammatory immune response to traumatic injury is paralleled by an anti-inflammatory reaction. A prevalence of each has been associated with the development of secondary complications, including nosocomial infections, acute lung injury, acute respiratory distress syndrome, sepsis, and death after trauma. There is accumulating evidence that neutrophils, which are known to provide the first line of defense against invading pathogens or harmful agents, are considerably involved in the initiation and propagation of the inflammatory response to traumatic injury. In this review, we summarize and discuss recent findings about the impact of trauma and trauma-related sepsis as a secondary complication on neutrophil biology, which constitutes as the interface between homeostasis and tissue damage after a traumatic insult. Here, patient cohorts of physically injured patients with an overall injury severity score above 9 have been considered, including patients with blunt as well as penetrating injuries, and sepsis. Mechanisms were replenished by animal studies. Altered antigen presentation on neutrophils has been shown to possess biomarker features predicting both outcome and vulnerability to infectious complications in severely injured patients. Dysregulated activation of neutrophils following trauma affects their functions including phagocytizing capacity, production of reactive oxygen species, formation of neutrophil extracellular traps, which all together have been associated with the development of secondary complications. Thus, we highlight neutrophils and their functions as potential future targets for optimizing post-traumatic treatment strategies, which potentially may improve patient outcomes.

Design and clinical implementation of an open-source bionic leg

In individuals with lower-limb amputations, robotic prostheses can increase walking speed, and reduce energy use, the incidence of falls and the development of secondary complications. However, safe and reliable prosthetic-limb control strategies for robust ambulation in real-world settings remain out of reach, partly because control strategies have been tested with different robotic hardware in constrained laboratory settings. Here, we report the design and clinical implementation of an integrated robotic knee–ankle prosthesis that facilitates the real-world testing of its biomechanics and control strategies. The bionic leg is open source, it includes software for low-level control and for communication with control systems, and its hardware design is customizable, enabling reduction in its mass and cost, improvement in its ease of use and independent operation of the knee and ankle joints. We characterized the electromechanical and thermal performance of the bionic leg in benchtop testing, as well as its kinematics and kinetics in three individuals during walking on level ground, ramps and stairs. The open-source integrated-hardware solution and benchmark data that we provide should help with research and clinical testing of knee–ankle prostheses in real-world environments.

Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa.

A prospective, regional, population-based study. (1) Determine the mortality rate and factors associated with it 4 years after a TSCI and (2) The point prevalence of secondary medical complications of survivors at 4 years. Communities of the Cape metropolitan area, South Africa. All persons (n = 145) sustaining a TSCI from 15 September 2013 to 14 September 2014 were eligible for follow-up at 4 years. Participants were contacted after 4 years. The next of kin, via verbal autopsy, was used to establish cause of death. Those who were alive at 4 years were asked to indicate any secondary medical complications. Logistic regression techniques were used to identify independently associated risk indicators for death and development of secondary complications, respectively. Of the initial 145 persons, 87 were included and accounted for. Of these, 21 (24%) had died, 55 (63%) were alive and completed the survey, and 11 (13%) were classified as alive but did not submit the survey. The main cause of death reported was septicaemia (n = 7; 33%), followed by unknown natural causes (n = 7; 33%), then pressure injuries (n = 5; 24%). Out of the 55 persons alive, 89% had at least one medical complication at the time of enquiry, while more than 50% experienced 6 or more complications. The most common complications were pain (80%), muscle spasms (76%), sleeping problems (56%), and bladder dysfunction (44%). Almost one-quarter of persons with TSCI have died 4 years after injury. Also, secondary complications were found to be highly prevalent at 4 years. This information could be used to develop secondary complications prevention programmes to reduce premature deaths. This study was funded by the Medical Research Council of South Africa within the Research Capacity Development Initiative.

P0995EVALUATION OF ANTIDIABETIC, ANTIOXIDANT AND NEPHROPROTECTIVE ACTIVITY OF FLAVONOID RICH FRACTION OF HYBANTHUS ENNEASPERMUS IN DIABETIC RATS: IN-SILICO MOLECULAR DOCKING STUDIES FOR SOD, CATALASE, GPX, XANTHINE OXIDASE AND NF-KB

Abstract Background and Aims Diabetes mellitus is a chronic metabolic disease affected a wide range of population all over the world and leads to development of secondary complications. Enzymes play key role in the development of secondary complication. Method The flavonoid rich fraction was prepared using ethyl acetate. Oral glucose tolerance test normoglycemic effect of flavonoid rich fraction of Hybanthus enneaspermus (EHE) was evaluated at a dose of 45 and 90 mg/kg, p.o. Further effect of EHE on blood glucose, body weight, enzymes such as super oxide dismutase (SOD), catalase and thiobarbituric acid reactive substances (TBARS) and lipid parameters were estimated out at 45 and 90 mg/kg p.o. per day for 21 days in streptozotocin-induced type-2 diabetic rats. Molecular docking technique was also performed against Super Oxide Dismutase (SOD), Catalase, Glutathione Peroxidase (Gpx), xanthine oxidase and nuclear factor kappa B (NF-κB) for selected phytoconstituents. Results EHE contain significant amount of phenolic, tannin, flavonoid and saponin. EHE significantly decreased blood glucose level in diabetic rats. All the tested lipid parameters and enzyme level of SOD, Catalase and Gpx were significantly restored to the normal level in the EHE treated rats. Moreover, there was a significant increase in the body weight in the EHE treated rats. Docking study showed the best binding affinity and interaction of phytoconstituents with xanthine oxidase and NF-κB signified their role in kidney disorders. Conclusion EHE has very impressive profile as an antidiabetic, antioxidant and nephroprotective activity via enzymes modulation and it may prove to be effective treatment for kidney disorders in hyperglycemia.

Abstract 110: Hospitalizations for Heart Failure Among Patients With Reduced Renal Function Treated With Metformin or Sulfonylureas: A Retrospective Cohort Study

Background: Patients with type 2 diabetes are at risk for the development of secondary complications, including impaired renal function and heart failure (HF). Before 2016, safety concerns limited metformin use in patients with kidney disease. Metformin’s association with HF outcomes and type of HF exacerbation in those with reduced kidney function remains incompletely described. Objective: To compare HF hospitalization between patients treated with metformin versus sulfonylurea following development of reduced kidney function. Research Design/Methods: This national retrospective cohort combined data from Veterans Health Administration, Medicare, Medicaid and National Death Index from 2001 through 2016. We identified patients with new-onset type 2 diabetes by selecting those who were new users of metformin or a sulfonylurea. We followed these patients longitudinally and enrolled those who experienced a kidney function decline and persisted on metformin or sulfonylurea. Patients entered the study on the date of development of reduced kidney function (estimated Glomerular Filtration Rate &lt60 ml/min or serum creatinine &gt1.4 [female] or 1.5 [male] mg/dL) and were followed through the primary outcome: hospitalization for HF, or a competing risk: all cause death; drug non-persistence; or study end (December 31 st 2016). The primary analysis used a propensity score weighted model. Echocardiogram reports were obtained from 1 year prior to admission through 7 days after admission through natural language processing to determine the ejection fraction (EF) and HF type [reduced EF&lt40%; indeterminate EF 40-50% or preserved EF&gt50%] for that hospitalization. Results: The weighted cohort included 24,683 metformin and 24,802 sulfonylurea users who developed reduced kidney function. At cohort entry, median age was 70 years (63, 78), eGFR 55.8 ml/min/1.73m^2 (51.6, 58.2), and A1c 6.6% (6.1,7.2). Cardiac comorbidities were prevalent at cohort entry, as groups had 12.1% prevalence of CHF (2,987 of 24,683 metformin; 3,009 of 24,802 sulfonylurea), and 31.9% metformin (7,797 of 24,683) and 31.6% sulfonylurea (7,869 of 24,802) users had underlying cardiovascular disease. There were 775 and 991 HF hospitalizations among metformin and sulfonylurea users. HF hospitalizations were 16.9 (15.7, 18.1) vs. 20.7 (19.5, 22.0) per 1,000 person-years respectively (adjusted hazard ratio 0.85, 95% CI: 0.78, 0.93). Of the 775 metformin and 991 sulfonylurea users hospitalized for HF, 44% (339 of 775) vs 45% (447 of 991) did not have an echocardiogram; 28% (214 of 775) vs 31% (302 of 991) had reduced EF; 9% (74 of 775) vs 9% (85 of 991) had indeterminate EF; 19% (148 of 775) vs 16% (157 of 991) had preserved EF. Conclusions: Among patients with type 2 diabetes who develop worsening renal function, persistent metformin use is associated with reduced HF hospitalization compared to sulfonylurea.

Clinical Outcomes of COVID-19 Patients with Pre-existing, Compromised Immune Systems: A Review of Case Reports.

In the ongoing COVID-19 pandemic, all COVID-19 patients are naïve patients as it is the first-time humans have been exposed to the SARS-CoV-2 virus. As with exposure to many viruses, individuals with pre-existing, compromised immune systems may be at increased risk of developing severe symptoms and/or dying because of (SARS-CoV-2) infection. To learn more about such individuals, we conducted a search and review of published reports on the clinical characteristics and outcomes of COVID-19 patients with pre-existing, compromised immune systems. Here we present our review of patients who possess pre-existing primary antibody deficiency (PAD) and those who are organ transplant recipients on maintenance immunosuppressants. Our review indicates different clinical outcomes for the patients with pre-existing PAD, depending on the underlying causes. For organ transplant recipients, drug-induced immune suppression alone does not appear to enhance COVID-19 mortality risk - rather, advanced age, comorbidities, and the development of secondary complications appears required.

Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery.

Objective: This longitudinal observational study investigated how neural stretch-resistance in wrist and finger flexors develops after stroke and relates to motor recovery, secondary complications, and lesion location.Methods: Sixty-one patients were assessed at 3 weeks (T1), three (T2), and 6 months (T3) after stroke using the NeuroFlexor method and clinical tests. Magnetic Resonance Imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL) and to perform voxel-based lesion symptom mapping.Results: NeuroFlexor assessment demonstrated spasticity (neural component [NC] >3.4N normative cut-off) in 33% of patients at T1 and in 51% at T3. Four subgroups were identified: early Severe spasticity (n = 10), early Moderate spasticity (n = 10), Late developing spasticity (n = 17) and No spasticity (n = 24). All except the Severe spasticity group improved significantly in Fugl-Meyer Assessment (FMA-HAND) to T3. The Severe and Late spasticity groups did not improve in Box and Blocks Test. The Severe spasticity group showed a 25° reduction in passive range of movement and more frequent arm pain at T3. wCST-LL correlated positively with NC at T1 and T3, even after controlling for FMA-HAND and lesion volume. Voxel-based lesion symptom mapping showed that lesioned white matter below cortical hand knob correlated positively with NC.Conclusion: Severe hand spasticity early after stroke is negatively associated with hand motor recovery and positively associated with the development of secondary complications. Corticospinal tract damage predicts development of spasticity. Early quantitative hand spasticity measurement may have potential to predict motor recovery and could guide targeted rehabilitation interventions after stroke.

Анализ результатов ЭКГ и ЭхоКГ новорожденных с межпредсердными сообщениями

The birth of children with congenital heart disease is a serious problem due to the risk of infant mortality. Clinically, the atrial septal defect belongs to the low manifest defects. The severity of its symptoms depends on the size and location of the defect, as well as, to a greater extent, on the duration of the defect and the development of secondary complications. This situation dictates the need for early diagnosis of this congenital heart disease, dynamic observation, timely treatment, which determines the relevance of this study. In this article, we tried to analyze and evaluate in detail the results of ECG and EchoCG of newborns with interatrial communications. We carried out a retrospective analysis of 94 case histories of full-term newborns who are undergoing inpatient examination and treatment in the hospital of the city of Saransk for the period from December 2016 through March 2018. In the course of our study, it was found that the ECG study does not reveal specific signs suggesting the presence of MPS. Nevertheless, attention should be paid to the position of the electrical axis of the heart, the presence of signs of overloading of the right heart, especially the right ventricle. When EchoCG is studied in newborns with MPS, and more often with MPS sizes greater than 4 mm, an increase in the right ventricle and thickening of its anterior wall are diagnosed.

Анализ течения антенатального периода и клинической картины новорожденных с межпредсердными сообщениями

The birth of children with congenital heart disease is a serious problem due to the risk of infant mortality. Clinically, the interatrial septum defect belongs to the low manifest defects. The severity of its symptoms depends on the size and location of the defect, as well as, to a greater extent, on the duration of the defect and the development of secondary complications. This situation dictates the need for early diagnosis of this congenital heart disease, dynamic observation, timely treatment, which determines the relevance of this study. In this article, we tried to analyze in detail the characteristics of the course of the antenatal period and the clinical picture of newborns with atrial communication. Summing up our study, it should be noted that the clinical manifestations in interatrial communications in newborns are not specific. In most infants with interatrial communications, systolic noise of varying intensity can be heard, however, this noise is not associated with the presence of interatrial communications, but due to the presence of diagonally located chords in the left ventricle.

The treatment of clavicular shaft fractures with an innovative locked intramedullary device

Displaced and shortened clavicular shaft fractures can be treated by intramedullary fixation; however, hardware migration and soft tissue irritation at the insertion site have complicated its use. The aim of this study was to determine whether the new Sonoma CRx intramedullary device (Sonoma Orthopedic Products Inc, Santa Rosa, CA, USA) could be used successfully to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of shoulder without the development of secondary complications. Displaced and shortened clavicular shaft fractures in 47 consecutive patients were treated with the CRx device. Incision size was captured during the surgical procedure. The union rate was evaluated postoperatively. Shoulder function was assessed by Disabilities of the Arm, Shoulder and Hand (DASH) score, the Constant Shoulder Score, and a range of motion score. Patients were assessed after 3 to 6months (group I), 6 to 9months (group II), or 9 to 12months (group III) postoperatively. Union was achieved in all patients at the time of review, without any incidence of hardware migration. Postoperative complications developed in 3 patients, comprising infection in 1 and hardware failure in 2. No differences among the groups were found for the DASH score (P=.33), Constant Shoulder Score (P=.38), and range of motion score (P=.96). The DASH, Constant Shoulder, and range of motion scores were similar to other successful treatment options, such as plating. The Sonoma CRx is a good alternative device to treat displaced and shortened clavicular shaft fractures and restore the functional capacity of the shoulder. Future research should focus on when nailing and plating should be used to treat clavicular shaft fractures most optimally.

Meta-analysis of variant rs 7903146 of TCF7L2 gene with secondary complications of Type 2 Diabetes Mellitus

Persistent hyperglycemia in patients with Type 2 diabetes mellitus is driving force for developing secondary complications like neuropathy, retinopathy, nephropathy, cardiomyopathy and wound healing impairment in them. Other genetic risk factor includes variants of transcription factor 7-like 2 (TCF7L2) gene, which have been shown to be associated with these several secondary complications individually. The present study represents a systematic review and Meta analysis using electronic databases like PubMed, OMIM, ISI web of science and Embase to see the role of rs7903146 C>T variant of the TCF7L2 gene with secondary complications of T2DM. Data was collected using literature-based searching to perform a Meta analysis to pool the odds ratio (OR). This Meta analysis comprised of a total of 2060 cases with secondary complication of T2DM and 3049 age matched controls. Publication bias and study-between heterogeneity were also evaluated. The present Meta analysis of included studies showed a highly significant association of risk genotype TT with development of secondary complications in T2DM.

The prophylactic role ofd-saccharic acid-1,4-lactone against hyperglycemia-induced hepatic apoptosis via inhibition of both extrinsic and intrinsic pathways in diabetic rats

Sustained hyperglycemia and increased oxidative stress play major roles in the development of secondary complications in diabetes including liver injury. Dietary supplement of antioxidants is effective in preventing oxidative stress mediated tissue damage in diabetic pathophysiology. D-Saccharic acid 1,4-lactone (DSL), a derivative of D-glucaric acid, is present in many dietary plants and is known for its detoxifying and antioxidant properties. Our early investigation showed that DSL can ameliorate alloxan (ALX) induced diabetes mellitus and oxidative stress in rats by inhibiting pancreatic β-cell apoptosis. In the present study we investigated the protective role of DSL against hepatic dysfunction in ALX induced diabetic rats. ALX exposure elevated the blood glucose, serum ALP and ALT levels, the production of reactive oxygen species (ROS), and disturbed the intra-cellular antioxidant machineries. Oral administration of DSL restored all these alterations close to normal. By investigating the mechanism of its protective activity, we observed that DSL prevented hyperglycemia induced hepatic apoptosis by inhibiting both extrinsic and intrinsic pathways. Results showed that in the liver tissue, diabetes promoted a significant increase of TNF-α/TNF-R1 and led to the activation of caspase-8 and t-Bid. In addition, ALX exposure reciprocally regulated Bcl-2 family protein expression, disturbed mitochondrial membrane potential, and subsequently released cytochrome c from mitochondria to cytosol. As a consequence, a significant increase in caspase-3 expression was observed in the liver of diabetic animals. However, treatment of diabetic rats with DSL counteracted these changes, making it a promising approach in lessening diabetes mediated tissue damage.

Sex Differences in Long-term Opioid Use

Sex Differences in Long-term Opioid Use

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: septic patient.

Nutritional metabolic management, together with other treatment and support measures used, is one of the mainstays of the treatment of septic patients. Nutritional support should be started early, after initial life support measures, to avoid the consequences of malnutrition, to provide adequate nutritional intake and to prevent the development of secondary complications such as superinfection or multiorgan failure. As in other critically-ill patients, when the enteral route cannot be used to ensure calorie-protein requirements, the association of parenteral nutrition has been shown to be safe in this subgroup of patients. Studies evaluating the effect of specific pharmaconutrients in septic patients are scarce and are insufficient to allow recommendations to be made. To date, enteral diets with a mixture of substrates with distinct pharmaconutrient properties do not seem to be superior to standard diets in altering the course of sepsis, although equally there is no evidence that these diets are harmful. There is insufficient evidence to recommend the use of glutamine in septic patients receiving parenteral nutrition. However, given the good results and absence of glutamine-related adverse effects in the various studies performed in the general population of critically-ill patients, these patients could benefit from the use of this substance. Routine use of omega-3 fatty acids cannot be recommended until further evidence has been gathered, although the use of lipid emulsions with a high omega-6 fatty acid content should be avoided. Septic patients should receive an adequate supply of essential trace elements and vitamins. Further studies are required before the use of high-dose selenium can be recommended.

PDB21 Natural History of Beta Cell Rate of Decline and Its Effect on Development of Secondary Complications in Type 1 Diabetes

PDB21 Natural History of Beta Cell Rate of Decline and Its Effect on Development of Secondary Complications in Type 1 Diabetes

Peritonitis in horses: 55 cases (2004–2007)

Factors associated with the outcome of peritonitis in horses are seldom described. The objectives of this study were to determine the common clinical signs and clinicopathologic findings and to reveal prognostic factors associated with the outcome of peritonitis in equine patients. Data were examined in a retrospective manner in 55 horses diagnosed with and treated for peritonitis. The most common clinical and clinicopathologic findings were tachycardia (94%), increased amount of peritoneal fluid on ultrasound (84%), altered mucous membranes (82%), bacteria noted on the direct smear (67%), hyperfibrinogenaemia (58%) and left shift (40%). The most commonly isolated organism was E. coli (37%). Survival rates were as follow: 78% in the whole study, 81% in the abdominal lavage group, 93% in the medically and 46% in the surgically managed groups. Complications were more common in the non-survivor group (P < 0.001). Initial haematocrit and surgical interventions were strongly associated with non-survival in the multivariate logistic regression model (P = 0.049, OR: 1.07 and P = 0.01, OR: 9.87, respectively). Prognosis of peritonitis without gastrointestinal rupture depends on the initial hydration status, surgical interventions and development of secondary complications, while other clinical and clinicopathologic findings do not appear to correlate with survival. Prospective evaluation of hydration and perfusion parameters and abdominal lavage warrants further investigation.