Frequency Of Clinical Complications Research Articles

Pancreas-Kidney Transplantation: Do We Know the Frequency of Clinical Complications?

The objective of this study was to describe the most common medical complications in simultaneous pancreas-kidney recipients in our center. Retrospective and descriptive study of complications observed in a series of 73 simultaneous pancreas-kidney transplant recipients, which included 54 men and 19 women with an average age of 40.6 years, between February 2009 and April 2019. The study assessed the incidence of cytopenia, viral infections, tumors, and graft rejection. Frequency tables were created for each complication in the analysis. Cytopenia was the most common complication, either by itself or associated with a different complication, and it was found in 23.3% of all patients. The most common infection was cytomegalovirus, which was in 55.6% of all 9 patients who presented infections in spite of universal prophylaxis with valganciclovir, followed by herpes virus (11.1%), papillomavirus (11.1%), and polyoma BK virus (22.2%). Regarding tumors, the number of patients who presented this complication was low; 2 gynecologic tumors were detected (cervical intracellular neoplasia and one ovarian tumor), and 1 case of skin tumor was also observed. There were 3 cases of acute rejection, which represents 4.1% of all patients. Rejection was cellular and steroid-sensitive except for 1 case that was humoral, with good response to treatment. In spite of the doses of immunosuppressive drugs received by these patients, the incidence of infections was low, and cytomegalovirus was the most common infection. As a consequence of the drugs administered, virtually all patients developed cytopenia. The number of tumors observed in this series was low in spite of the immunosuppressive treatment.

Clinical complications during early treatment of anterior open bite.

The object of this study was to compare the clinical complications of 4 different appliances used in the early treatment of anterior open bite (AOB), and to test the null hypothesis that there is no difference in the number of complications among the appliances. Records from 99 Class I malocclusion patients with AOB treated using bonded spurs, BS, n = 25; chin cup, CC, n = 25; fixed palatal crib, FPC, n = 25; and removable palatal crib, RPC, n = 24) were examined. The total number and frequency of clinical complications that occurred over 12 months were described and compared by using chi-square and Kruskal-Wallis tests (Dunn's post-test) (α = 5%, CI = 95%). The incidence of clinical complications was 66.7%, comprising: breakage, bond failure, maladjustment, allergy, soft-tissue lesion, loss of removable appliance and abandonment. Eighteen patients gave up treatment; this occurred more frequently in the groups with removable appliances. Regarding the total number of complications per patient, Group BS exhibited a significantly higher number than the other groups (p < 0.0001). A low frequency of complications (1 to 3) was found in the groups, except for Group BS, in which 8% of the patients presented moderate frequency (4 to 6). In terms of appliance types (fixed or removable), there was no difference in the incidence of complications (p > 0.094). The null hypothesis was rejected, since the BS group exhibited the highest total number and frequency of complications. There was no difference between fixed and removable appliances in terms of incidence of clinical complications, although more patients using removable appliances abandoned their treatment.

Impact of diabetes, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, and statin use on presentation and outcomes in patients with giant cell arteritis.

Few, separate, small retrospective studies in giant cell arteritis (GCA) reported that patients: (a) with diabetes mellitus had less positive temporal artery biopsies (TAB); (b) on angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) experienced fewer relapses; and (c) on statins experienced the same frequency of clinical complications and relapses as non-exposed patients. This retrospective chart review study simultaneously investigated the impact of these 3 factors on a cohort of patients followed in 2 large Canadian centers (Hamilton and Toronto, ON). One hundred and thirty-seven patients diagnosed with GCA between 1993 and 2015 were included in the study. Presenting symptoms, TAB results, disease complications and outcomes (relapses, duration of glucocorticoid use) were compared between exposed (diabetes/ACE/ARB/statin) and non-exposed patients, with adjustment for main potential confounding variables. Temporal artery biopsies was less often positive in patients with pre-existing diabetes (relative risk 0.24; 95% CI: 0.069-0.81). Patients who developed diabetes after diagnosis had a lower relapse-free survival (adjusted hazards ratio [HR] 0.28; 95% CI: 0.095-0.84). Patients taking ARBs prior to diagnosis were more likely to successfully discontinue glucocorticoids without a flare in the following 3months (adjusted HR 2.46; 95% CI: 1.2-5.3). Clinical complications and relapse rates did not differ between patients on statin therapy or not. Diabetic patients with GCA were less likely to have a positive TAB, and more likely to relapse. ARB therapy prior to diagnosis showed an association with success at discontinuing glucocorticoids. Statin therapy did not alter the clinical presentation or course of GCA.

OUR EXPERIENCE IN THE TREATMENT OF CHILDREN WITH FOREIGN BODIES IN THE LOWER RESPIRATORY TRACT

Urrently, the problem of foreign bodies in the airways of children continues to be relevant. Aim - to assess the effectiveness of diagnostics and treatment of children with foreign bodies in tracheobronchial tree. Materials and methods. In the Department of otorhinolaryngology, the SBHI of MAMRRCI n.a. M.F. Vladimirskiy, we performed an integrated research of 189 children of different age, who had aspirated foreign bodies in the airways. We studied anamnestic, clinical, roentgenological and endoscopic criteria for the diagnosis of this pathology; we also studied the frequency of clinical complications caused by aspiration. Results. Follow-up observation of these children shows a significant frequency of remaining changes in the lungs after removal of foreign bodies. Discussion. In our opinion, for correct diagnosis and provision of qualified care to sick children it is necessary to raise awareness of parents and primary care physicians about the dangers of this pathology. If there is a reason to suspect a foreign body in the airways, consultation in a specialized institution is vitally important. The only correct method of treating children with foreign body in the airways, even at the slightest suspicion, is timely performed tracheobronchoscopy.

Adult-onset Still's disease with atypical cutaneous manifestations

The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests available, and diagnosis is usually based on a symptom complex and the well-described typical evanescent rash seen in the majority of patients. However, in recent years, other atypical cutaneous manifestations of AOSD have been reported. These atypical skin eruptions often present in addition to the typical evanescent rash but may also be the only skin manifestation, resulting in delayed diagnosis because of under-recognition.In this study, we present 3 new cases of AOSD with atypical cutaneous manifestations diagnosed during a 30-year period in our department and review 78 additional cases previously reported (PubMed 1990–2016). These 81 patients form the basis of the present analysis.The overall prevalence of atypical cutaneous manifestations in our AOSD population was 14%. These manifestations may appear at any time over the course of the disease, and usually occur in patients who have persistent and severe disease, with a considerable frequency of clinical complications (23%), including serositis, myopericarditis, lung involvement, abdominal pain, neurologic involvement, and reactive hemophagocytic syndrome.The most representative and frequent lesion among the nonclassical skin rashes is the development of persistent pruritic papules and/or plaques. Interestingly, these lesions show a distinctive histological pattern. Other, less frequently observed lesions include urticaria and urticaria-like eruptions, generalized or widespread non-pruritic persistent erythema, vesiculopustular eruptions, a widespread peau d’orange appearance of the skin, and edema of the eyelids mimicking dermatomyositis without any accompanying skin lesion.The great majority of these patients required medium or high doses of glucocorticoids (including intravenous methylprednisolone pulse therapy in some cases) and, in nearly 40%, a more potent or maintenance immunotherapy with immunosuppressant drugs and/or biologic agents (mainly anakinra or tocilizumab) to control or manage symptoms because of a polycyclic or chronic course. The development of atypical cutaneous manifestations seems to be associated with a potentially worse prognosis, with a mortality rate reaching 8% primarily because of infectious complications related to immunosuppressive therapy.In conclusion, the appearance of atypical cutaneous manifestations is not uncommon in AOSD. Recognition of this clinical variant is crucial for the early diagnosis of AOSD, as it might imply persistent disease activity and the need for more aggressive treatment.

Effectiveness of a red cell antigen‐matching transfusion protocol in sickle cell disease patients

Background and objectivesTo date, it is unclear whether antigen matching is effective in reducing antibody development and whether transfusing blood from non‐Caucasian donors reduces alloimmunization in sickle cell disease patients (SCP). This study was designed to evaluate the effectiveness of an antigen‐matching strategy supplied by a mixed donor population, in reducing alloimmunization in SCPs.MethodsEighty SCPs transfused with C‐, E‐ and K‐matched units and 2000 donors were genotyped for the most relevant RBC antigens, and resulting genotypic frequencies were compared. Also, alloantibodies specificity and clinical complications were evaluated in SCPs.ResultsA high alloimmunization rate was observed despite the prophylaxis protocol (62·1%). The main cause underlying lack of effectiveness was transfusion of non‐matched units in external hospitals. Even though our donor population was ethnically mixed, it still exhibited antigenic differences in relation to SCPs (C and Fya). Frequency of clinical complications was similar between alloimmunized and non‐alloimmunized patients.ConclusionsProspective antigen matching is an unattractive alloimmunization prophylaxis for SCPs if not associated with strategies to minimize the hazards related to transfusions at non‐index hospitals. Even in a highly mixed donor population, antigenic discrepancies in SCPs are high, increasing the risk of antibody development.

Can fasting plasma glucose and glycated hemoglobin levels predict oral complications following invasive dental procedures in patients with type 2 diabetes mellitus? A preliminary case-control study

OBJECTIVE:To evaluate the effects of the levels of glycemic control on the frequency of clinical complications following invasive dental treatments in type 2 diabetic patients and suggest appropriate levels of fasting blood glucose and glycated hemoglobin considered to be safe to avoid these complications.METHOD:Type 2 diabetic patients and non-diabetic patients were selected and divided into three groups. Group I consisted of 13 type 2 diabetic patients with adequate glycemic control (fasting blood glucose levels <140 mg/dl and glycated hemoglobin (HbA1c) levels <7%). Group II consisted of 15 type 2 diabetic patients with inadequate glycemic control (fasting blood glucose levels >140 mg/dl and HbA1c levels >7%). Group III consisted of 18 non-diabetic patients (no symptoms and fasting blood glucose levels <100 mg/dl). The levels of fasting blood glucose, glycated HbA1c, and fingerstick capillary glycemia were evaluated in diabetic patients prior to performing dental procedures. Seven days after the dental procedure, the frequency of clinical complications (surgery site infections and systemic infections) was examined and compared between the three study groups. In addition, correlations between the occurrence of these outcomes and the glycemic control of diabetes mellitus were evaluated.RESULTS:The frequency of clinical outcomes was low (4/43; 8.6%), and no significant differences between the outcome frequencies of the various study groups were observed (p>0.05). However, a significant association was observed between clinical complications and dental extractions (p = 0.02).CONCLUSIONS:Because of the low frequency of clinical outcomes, it was not possible to determine whether fasting blood glucose or glycated HbA1c levels are important for these clinical outcomes.

Extensive Coagulation Profile in Children with Sickle Cell Disease and Its Role in Cerebral Micro-Vasculopathy

AbstractAbstract 3247Activation of the coagulation system is present in adults with Sickle Cell Disease (SCD) who display higher levels of thrombin-antithrombin complex (TAT), prothrombin fragment F1+2, D-dimer, tissue factor and platelet activity. Whether the activation of the coagulation system is a bystander phenomenon or a main determinant of clinical complications is under investigation. Although thrombotic complications in SCD arise since infancy, the coagulation system in children has been poorly explored. We performed a comprehensive and systematic evaluation of the coagulation system in children with SCD and investigated its possible role in the development of the main clinical manifestations of SCD in childhood.The following markers of hemostatic and endothelial function were evaluated during steady state: factor VIII activity (FVIII), von Willebrand factor antigen (vWF:Ag) and collagen binding activity (vWF:CBA), PAI-1 antigen (PAI-1:Ag), t-PA antigen (t-PA:Ag), D-dimer, P-selectin, Nitric Oxide (NO), F1+2, TAT, ADAMTS-13 antigen (ADAMTS-13:Ag) and activity (ADAMTS-13:act). Markers of hemolysis (hemoglobin, reticulocytes, aptoglobin, bilirubin, LDH), inflammation (white blood cells, neutrophils, C reactive protein) were measured. Children were not in chronic transfusion.Magnetic Resonance (MRI), Angio Magnetic Resonance (MRA), Transcranial Doppler (TCD), Tricuspid Regurgitant Velocity (TRV) data and frequency of clinical complications were correlated with coagulation parameters. Continuous variables were compared using two-sided Student's t-test and Mann-Whitney non-parametric test, categorical variables using Chi-square and Fisher's exact test. Correlations between variables were evaluated by the Pearson or Spearman coefficient.Thirty-five HbS/HbS- 3 HbS/betathalassemia° (20 M and 18 F, mean age 6.49 years), and 6 HbS/HbC patients (3 M and 3 F, mean age 11.2 years) were evaluated. 60% of HbS/HbS and HbS/betathalassemia° children presented higher level of FVIII, D-dimer, F1+2 and lower level of NO, revealing coagulation activation since early age in HbS/HbS and HbS/betathalassemia° but not in HbS/HbC (Table 1). Coagulation variables correlated positively with markers of inflammation, hemolysis, endothelial activation demonstrating a broad involvement of the coagulation system in these processes, while correlated negatively with HbF (Table 2). No correlation was seen between coagulation variables and cerebral large vessel vasculopathy investigated by TCD and MRA nor TRV (p >0.05). Patients with Silent Infarcts on MRI (n.9) showed significant decrease in t-PA (4.53 vs 7.67, p 0.03) and ADAMTS-13 Ag (1.15 vs 1.50, p 0.05) -suggesting the presence of endothelial dysfunction- and a tendency toward higher D-dimer (2879.01 vs 1569.51), F1+2 (319 vs 231), TAT (17.17 vs 10.46) -suggesting a trend towards enhanced clotting activation compared to patients without Silent infarcts (n.21). Increase in D-dimer was associated with a Relative risk of 6 (p <0.05) to develop Silent Infarcts. No correlation was found between coagulation activation and Acute Chest Syndrome or Vaso-occlusive crisis.Table 1Coagulation profile in HbS/HbS-HbS/Betathalassemia° and HbS/HbC patientsHbS/HbS+HbS/Betathalassemia°HbS/HbCpVariableMeanFVIII:C %184.96119.220.003VWF:Ag %150.05100.630.013VWF:CBA %135.38107.360.124PAI:Ag ng/ml8.736.850.833t-PA ng/ml6.914.520.062D-dimer ng/ml1906.39366.480.000NO μmol/L7.188.70.336P-selectin ng/ml47.7629.700.010F1+2 pmol/l254.26118.500.037TAT ng/ml12.345.140.359ADAMTS-13:Ag μg/ml1.371.460.653ADAMTS-13:act %79.4278.940.801ADAMTS-13:act/VWF:Ag0.520.780.003Table 2Correlations between hematologic and coagulation parameters in HbS/HbS- HbS/Betathalassemia° (first value is Pearson or Spearman coefficient, second is p-value)White Blood CellsNeutrophilsPlateletsFetal HemoglobinReticulocytesLDHFVIII:C−0.3740.021VWF:Ag−0.3220.049VWF:CBA0.3680.023PAI:Ag0.4490.3690.3330.3520.0050.0250.0440.033t-PA0.3440.034D-dimer0.5590.438−0.3930.3890.4210.0010.0110.0210.0230.013P-selectin0.4610.4000.520−0.4130.3810.0040.0160.0010.0110.020F1+20.4000.5120.3370.0160.0010.044TAT0.3970.3810.3760.0170.0220.024ADAMTS-13 Ag0.4710.004 Disclosures:No relevant conflicts of interest to declare.

Efeitos do uso de aditivo no leite humano cru da própria mãe em recém-nascidos pré-termo de muito baixo peso

OBJETIVO: Comparar o ganho pôndero-estatural e a frequência de complicações clínicas em recém-nascidos pré-termo com peso inferior a 1.500 g, alimentados exclusivamente com leite humano cru da própria mãe com e sem aditivo até atingirem o peso de 1.800 g. MÉTODOS: Ensaio clínico prospectivo randomizado duplo-cego em 40 recém-nascidos pré-termo com peso de nascimento < 1.500 g e ≤ 34 semanas, internados em unidade de terapia intensiva neonatal no período de agosto de 2005 a abril de 2007. Foram randomizados em 2 grupos: controle (leite humano puro) e intervenção (leite humano com aditivo). A fortificação foi feita no leite humano cru ordenhado no momento da oferta, quando a dieta atingiu 100 mL/kg/dia (até os neonatos atingirem peso de 1.800 g). Foram comparados ganho de peso diário, crescimento e perímetro cefálico semanalmente, variáveis nutricionais e complicações clínicas. RESULTADOS: A fortificação resultou em melhor crescimento, com ganho de 1,09 e 0,87 cm/semana (p = 0,003) e perímetro cefálico observado de 0,73 e 1,02 cm/semana (p = 0,0001), respectivamente grupo intervenção e controle. O ganho de peso foi de 24,4 e 21,2 g/dia (p = 0,075). Quanto às complicações clínicas observadas, não houve diferença significante. CONCLUSÕES: O uso de aditivo no leite humano cru da própria mãe proporcionou melhor crescimento, com aumento significativo do comprimento e do perímetro cefálico.

Effects of the use of fortified raw maternal milk on very low birth weight infants

To compare the weight and height gain and the frequency of clinical complications in preterm newborns weighing less than 1,500 g, exclusively fed human milk or fortified human milk until reaching 1,800 g. Prospective double-blind randomized controlled trial involving 40 preterm infants weighing < 1,500 g at birth and <or= 34 weeks of gestational age, admitted to a neonatal intensive care unit from August 2005 to April 2007. Preterm infants were randomized into two groups: control (human milk) and intervention (fortified human milk). Fortifiers were added to manually expressed human milk when feeding volume reached 100 mL/kg/day until newborns reached 1,800 g. Daily weight gain, weekly length and head circumference gain, nutritional variables and clinical complications were compared. Human milk fortification resulted in better growth, with length gain of 1.09 and 0.87 cm/week (p = 0.003) and head circumference gain of 0.73 and 1.02 cm/week (p = 0.0001), respectively, for intervention and control groups. The weight gain was 24.4 and 21.1 g/day (p = 0.075). There were no significant clinical complications. Human milk fortification resulted in better growth, significant increase in length and head circumference.

Resistenza all’uso degli ipoglicemizzanti orali nel trattamento del diabete tipo 2: uno studio multicentrico

Type 2 diabetes is an important social and health care system variable due to its large diffusion, frequency of clinical complications and its health care costs. The studied population is relative to 4 italian centers distributed all over the country (Brescia, Roma, Rossano Calabro and Avola). This work has the aim to describe the Italian type 2 population according to treatment choice ruled by diabetes stage, glycemia control and HbA1c concentration. The analysis present a description of the therapeutic changes during the year of observation too, giving a complete picture of patients distribution and their treatment path through diabetes evolution in Italy.

Endoscopic pancreatic duct (PD) stent placement: Frequency of clinical complications: [formula omitted], ML Earnest, JE Geenen, MF Catalano, MJ Schmalz, GK Johnson, DJ Geenen, WJ Hogan, St Luke's Hospital, Racine, WI, Pancreatic Biliary Center, St Luke's Medical Center, Medical College of Wisconsin, Milwaukee, WI

Endoscopic pancreatic duct (PD) stent placement: Frequency of clinical complications: [formula omitted], ML Earnest, JE Geenen, MF Catalano, MJ Schmalz, GK Johnson, DJ Geenen, WJ Hogan, St Luke's Hospital, Racine, WI, Pancreatic Biliary Center, St Luke's Medical Center, Medical College of Wisconsin, Milwaukee, WI