Reduction In Hemoglobin Research Articles

Intraoperative infrarenal aortic balloon occlusion in pregnancies with placenta accreta spectrum disorder

Background: The objective of this study was to evaluate the efficacy of intraoperative aortic balloon occlusion (IABO) during caesarean section for placenta accreta, increta or percreta and explore the relationship between different profile balloon catheters and catheter-related complications. Methods: This retrospective case control study included 295 patients with pathologically confirmed placenta accreta spectrum (PAS) disorder at the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital between 2013 and 2019. The characteristics of 162 patients who had aortic balloon occlusion (balloon group) were compared with those of 133 patients who had no catheterization (control group). Results: There were significant differences between the two groups in estimated blood loss, calculated blood loss, number of transfusions, transfused packed red blood cells (PRBCs), haemoglobin reduction, operation time and caesarean hysterectomy (P < 0.05). Regarding different PAS disorders, the estimated blood loss among women with placenta accreta and placenta increta was lower in the balloon group (n = 32 and 102, respectively) than in the non-balloon group (n = 33 and 85; P = 0.04 and P < 0.01, respectively). Only the placenta increta group showed a significant difference (P < 0.01) in transfused PRBCs. In patients who used the low-profile balloon catheters, we found a significant reduction in catheter-related complications compared with the high-profile group (n = 52 vs. 110, P = 0.04). Conclusions: Our study demonstrated that intraoperative infrarenal aortic balloon occlusion was effective in both reducing intraoperative haemorrhage and blood transfusion, and in preventing hysterectomy during caesarean section for pathologically diagnosed placenta accreta and increta. Low-profile balloon catheters can reduce catheter-related complications.

Effect of preoperative finasteride on perioperative blood loss during transurethral resection of the prostate and on microvessel density in patients with benign prostatic hyperplasia: An open label randomized controlled trial.

Objective:Transurethral resection of the prostate (TURP) is a common procedure for the treatment of benign prostatic hyperplasia (BPH). Previous studies on the effect of 5-alpha reductase inhibitors on perioperative blood loss in TURP and microvessel density (MVD) in the prostate are equivocal. We evaluated whether pretreatment with finasteride for 2 weeks before surgery can reduce perioperative blood loss in TURP and MVD in the prostate.Materials and Methods:Sixty-eight patients of BPH planned for TURP were randomized into two groups. The study group comprising 34 patients was treated with finasteride (5 mg/day) for 2 weeks and the placebo group comprising 34 patients received placebo for 2 weeks, before TURP. Blood loss was measured in terms of a reduction in the blood hemoglobin (Hb) and hematocrit (HCT) levels between preoperative values and 24 h after surgery. MVD was measured in the resected prostate tissue stained with anti-CD31 monoclonal antibody.Results:The reduction of Hb and HCT in the finasteride group was significantly lower than the reduction in the placebo group (P < 0.05). The artery (P = 0.005), vein (P = 0.05), and gland (P = 0.008) densities were significantly less in the finasteride group than in the placebo group. There was no significant correlation between blood loss and MVD.Conclusions:Our study suggests a clear advantage of the preoperative use of finasteride for 2 weeks by reducing the perioperative blood loss in TURP in patients with BPH. While there is a significant reduction in MVD in the prostate on treatment with finasteride, it is not clear that this is the mechanism of reduction in blood loss in TURP.

On the Possibility of Using Ozone in the Treatment of COVID-19

The review highlights the prospects of using ozone therapy in COVID-19, which is currently widely used for the treatment and prevention of various diseases. The therapeutic efficacy of ozone therapy is based on moderate and regulated oxidative stress caused by these reactions with various biological components, as well as on its antiviral and immunomodulatory properties. Ozone has certain biological properties that suggest a possible positive role in the treatment of COVID-19. The mechanisms of action and clinical efficacy of ozone therapy have been proven in other viral infections and have been shown to be very suitable for combating the SARS-CoV-2 virus. The high oxidative potential of ozone provides bactericidal, fungicidal and viricidal effects against the most important types of gram-positive and gram-negative bacteria, viruses, pathogenic fungi and protozoa. In addition, ozone increases the return of oxygen to insufficiently supplied tissues, promotes the reduction of hemoglobin, improves tissue respiration and normalizes the rheological properties of the blood. The immunomodulatory effect of ozone is based on its ability to activate phagocytosis due to the formation of peroxides and stimulation of cytokine production by lymphocytes and monocytes. Modification of the membranes of the blood cells and the ultrastructural organization of the vasculature together with a decrease in blood viscosity lead to an improvement in microcirculation and gas exchange at the tissue level. Thus, perhaps due to its physical and biological properties, ozone therapy can play a role in the treatment of COVID-19 as a supplement to standard treatment regimens.

An evaluation of PJP prophylaxis and anemia among renal transplant recipients.

Dapone and atovaquone are therapeutic options for PJP prophylaxis in renal transplant recipients. The objective of this study was to evaluate the incidence of anemia in renal transplant recipients receiving these agents. This is an IRB-approved, retrospective analysis of adult renal transplant recipients who received either dapsone or atovaquone. The primary endpoint was the change in hemoglobin within 90days of drug initiation. Other endpoints of interest included incidence and management of anemia at multiple time points post-transplant. Categorical variables were compared with Pearson's chi-squared or Fischer's exact test and continuous data were compared utilizing Wilcoxon rank-sum test. Statistical analyses were performed using Stata 14.2. A total of 478 patients were screened for inclusion; 50 patients were evaluated in both the dapsone and atovaquone groups. In the dapsone and atovaquone groups, the median age was 52 and 50.5years, 44% and 42% were Caucasian, and median time to treatment initiation was 27 and 39days post-transplant, respectively. All patients receiving dapsone had normal G6PD function. There was no difference in baseline hemoglobin between groups (9.7g/dL vs 9.8g/dL, P=.83). The median nadir hemoglobin values were 8.6g/dL and 9.6g/dL in the dapsone and atovaquone groups, respectively (P=.047). The median decrease in hemoglobin from baseline to nadir was 1.3g/dL in dapsone patients and 0.2g/dL in atovaquone patients (P=.001). Dapsone was discontinued in 46% of patients, whereas atovaquone was discontinued in 18% (P=.001). Among renal transplant recipients with normal G6PD activity, dapsone is associated with greater hemoglobin reductions and rates of drug discontinuation as compared to atovaquone.

Role of Vasopressin Injection Intramyometrial in Decreasing Blood Loss During Abdominal Myomectomy (A Randomized Controlled Trial)

Background: Abdominal myomectomy is a major operation. Massive blood loss is the most serious complication which should be taken in consideration to decrease morbidity and mortality. There are several modalities to decrease blood loss approached in different studies as preoperative GnRh, uterine artery tourniquet, tranexamic acid, vasopressin …etc.Aim: The aim of the study was to assess the role of vasopressin injection intramyometrial in decreasing blood loss during abdominal myomectomy. The study was done on women who were scheduled for abdominal myomectomy in Ain-Shams University Maternity Hospital.Materials and Methods: This study is a randomized clinical trial study which was conducted at Ain-Shams University Maternity Hospital on 60 women with uterine fibroid admitted for abdominal myomectomy to detect if vasopressin injection intramyometrial had a role in decreasing blood loss versus placebo or not.Results: The end results showed that that the mean of blood loss was 826.67cc with standard deviation 185.94 and 115.53cc with standard deviation 23.17 at control and vasopressin group respectively with p- value <0.001 which indicates that there a highly significant difference in blood loss between two groups. The mean reduction in hemoglobin was1.38 and 0.08 g/dl in control and vasopressin group respectively with p- value < 0.002 which showed that there was a significant difference between them, only 30% of the control group need blood transfusion and no need for transfusion in the vasopressin group.Conclusion:Intramyometrial vasopressin injection during abdominal myomectomy may effectively decreases the blood loss, need for blood transfusion and it causes less reduction in haemoglobin and haematocrit. Thereby it seems to be an effective method without having any risk of ischemic damage to the uterus.

Systemic iron homeostasis in female athletes: hepcidin, exercise and sex influence

Iron is necessary for adequate deliver oxygen to the tissues since it is an essential component of the haemoglobin. However, iron deficiency remains a common problem among athletes, particularly for women experiencing the menstrual bleeding every month. The iron losses through menstrual blood loss during the early follicular phase (or menses) and an inadequate dietary intake of iron are two important factors contributing to this disease. Furthermore, the large hormonal changes that women experience along the menstrual cycle, especially in oestrogen and progesterone may influence on the optimization of iron absorption. Iron absorption is mainly mediated by hepcidin hormone, which seems to be affected by several stimulus and factors such as oestrogen and progesterone concentrations. Moreover, the regular practice of exercise is another important modulator of this hormone. Therefore, premenopausal active females are the most susceptible population to develop an iron deficiency or iron deficiency anemia, affecting their health and performance due to the less iron availability within the body and consequently a reduction of haemoglobin which compromise the oxygen transport. To date, most studies have not explored the acute post-exercise hepcidin response taking endogenous and exogenous sexual hormones influence into account. This narrative review will focus on how iron homeostasis is modulated by different factors mainly influenced by exercise and female sexual hormones.

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

Background: Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. Objectives: The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. Methods: A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. Results: Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, p = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, p = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, p = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, p < 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, p = 0.04) when comparing RIRS with micro-PCNL. Conclusions: Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

Comparative Study Between Mini PCNL and RIRS in the Treatment of Renal Stones &lt;20mm : Our Experience in CMH Dhaka

Aim: The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter &lt;15 mm. Materials and Methods: This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software. Results: Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group. Conclusions: Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.199-204

Determining the therapeutic range for ribavirin in transplant recipients with chronic hepatitis E virus infection.

The aim of this study was to define the therapeutic range for ribavirin (RBV) in transplant recipients with chronic hepatitis E virus (HEV) infection. In this retrospective multicentre cohort study, data of adult transplant recipients with chronic HEV infection, who had been treated with RBV monotherapy between 01‐3‐2008 and 01‐08‐2018, were included. ROC curve analyses were performed, and the half‐maximal effective RBV concentration was calculated to determine a representative therapeutic range. In 96 patients, RBV monotherapy for a median of three months resulted in a sustained virologic response in 63.5% of the patients, while 88.5% of the patients developed anaemia. RBV plasma concentrations at steady state were significantly higher in clinical responders compared with clinical non‐responders: median 1.96 (IQR 1.81‐2.70) versus 0.49 (IQR 0.45‐0.73) mg/L, P = .0004. RBV caused a dose‐dependent haemoglobin reduction with higher RBV plasma concentrations resulting in more haemoglobin reduction. The therapeutic range for RBV for chronic HEV infection in transplant recipients ranges between 1.8 and 2.3 mg/L.

Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

BackgroundThere are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA.MethodsRandomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared.ResultsTotally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best.ConclusionsOur meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

Retrospective Real-World Analysis of the Primary Safety Outcomes in Venous Thromboembolism of High-Risk Major Bleeding Cancer Patients Receiving Therapeutic Anticoagulation

Introduction The therapeutic anticoagulation of cancer-associated venous thromboembolism (VTE) is challenging because of the increased risk for thromboembolic recurrence and major bleeds (MB). Direct oral anticoagulants (DOACs) have emerged over Low Molecular Weight Heparin (LMWH) as a preferred treatment option by improving efficacy without compromising safety. Despite these advantages, major bleeding was noted to be a safety concern in recent randomized clinical trials, mainly for gastrointestinal (GI) and genitourinary (GU) high-risk cancer patients. We evaluated our cancer center's institutional experience to determine the safety signals among VTE treatments and clinical risk factors which can predict an adverse outcome to further develop our clinical practice decisions in oncology patients. Methods This is a retrospective chart review of patients receiving DOACs and LMWH with histologically proven GI or GU malignancy and symptomatic or incidental VTE treated at The University of Arizona Cancer Center from November 2013 to February 2020. Patients were excluded if DOACs were prescribed for any other reason not related to VTE, or the thrombotic event was determined to be unrelated to active malignancy. The primary safety outcome was defined as documented major bleeding by hemoglobin reduction of ≥2 g/dL, transfusion of ≥2 units of Packed Red Blood Cells, bleeding in a critical site, or bleeding contributing to death. The secondary efficacy outcome was defined as documented recurrent deep vein thrombosis (DVT), nonfatal pulmonary embolism (PE), or fatal PE. Data was collected as individually and composite outcome (MB+rVTE) before six months. Continuous non-normally distributed data are compared using the non-parametric Kruskal-Wallis Rank Sum. Categorical data are compared using χ2 or Fisher's exact test. Logistic regression was used to assess the relationship between anticoagulant therapy and the 3 outcome measurements. The relationship between therapies was adjusted for clinical risk factors using logistic regression. Statistical analyses were performed using Stata16. Results Our review included 160 patients with similar baseline characteristics who were prescribed enoxaparin (n=53), apixaban (n=55), and rivaroxaban (n=52) except for white race and active smokers [Table 1]. Primary MB outcome events at six months were 7.5%, 10.9%, and 17.3% for enoxaparin, apixaban, and rivaroxaban, with no statistical difference among therapies or cancer type [p&amp;gt;0.05]. Secondary rVTE outcome events at six months were 7.5%, 3.6%, and 5.7% for enoxaparin, apixaban, and rivaroxaban, respectively, with no significant difference among therapies or cancer type [p&amp;gt;0.05]. There were no differences in individual or composite outcomes of LMWH, apixaban, rivaroxaban, or DOAC by GI or GU cancer type. There are no statistically significant clinical associations between anticoagulation therapy by the three outcome measurements in either GI or GU cancer. Beyond six months on enoxaparin, apixaban, and rivaroxaban, there were 5.6%, 3.6%, and 5.7% added events to MB, and 3.7%, 1.8%, and 0% to rVTE, respectively. Conclusions Our retrospective review has shown similar efficacy in preventing recurrent VTE among anticoagulants and indirectly equivalent to those published by the randomized clinical trials. Notably, the rate of MB for our real-world high-risk GI/GU cancer was 2.8 times higher in patients receiving DOACs compared to those on clinical trial [MB 6% SELECT-D Young et al. 2018 and MB 3.8% Caravaggio Agnelli et al. 2020] and in agreement with a recent meta-analysis [relative risk GI 1.9 and GU 4.9, Giustozzi et al. 2020]. We recognized there are inherited selection bias in both clinical trials and retrospective studies, although baseline characteristics are similar. Future clinical trial designs should consider including real-world high-risk patients according to associated clinical risk factors to aid in the appropriate choice of therapeutic anticoagulation. Disclosures No relevant conflicts of interest to declare.

Impact of patient characteristics on efficacy and safety of once-weekly semaglutide versus dulaglutide: SUSTAIN 7 post hoc analyses

ObjectiveIn SUSTAIN 7, once-weekly semaglutide demonstrated superior glycated haemoglobin (HbA1c) and body weight (BW) reductions versus once-weekly dulaglutide in subjects with type 2 diabetes (T2D). This post hoc analysis investigated...

HbA1c reduction following flash monitoring commencement is not independently associated with adverse diabetic eye disease outcomes in type 1 diabetes

IntroductionIntensification of therapy has been associated with early worsening of retinopathy prior to subsequent risk reduction. We sought to assess whether glycated hemoglobin (HbA1c) reduction, following flash monitoring, was associated...

OFF PUMP VERSUS ON PUMP CORONARY ARTERY BYPASS SURGERY in ISCHEMIC HEART DISEASE PATIENTS with IMPAIRED CONTRACTILITY and RENAL DYSFUNCTION ;ACOPARATIVE STUDY.

Background: Coronary artery bypass surgery using cardiopulmonary bypass [CPB] carries the risk of renal impairment, which cannot be attributed to a single factor. This study compared the off-pump technique with the on-pump technique on kidney function in ischemic heart disease patients. Aim of the work: The study aimed to compare off-pump with on-pump technique on kidney and heart functions in patients with renal impairment with no need for dialysis but with impaired Ejection fraction [EF]. Patients and methods: This prospective non-randomized study included 60 patients who presented with symptoms of ischemic heart disease and subsequently underwent myocardial revascularization with preoperative serum creatinine levels between 1.6 to 2.5 mg/dl and EF below 45%. Patients were as following: Group A patients [on-pump]: included those who underwent surgery on cardiopulmonary bypass. Group B patients [off-pump]: included those who underwent off-pump surgery. Both groups were compared in terms of renal impairment markers and needed for dialysis and early postoperative outcome. Results: Renal impairment needs management by dialysis was developed in nine patients [30%] in the pump group [group I] and two patients [7.67%] in the off-pump group, with a significant difference. Group [I] showed a significant increase of transfused blood, blood urea nitrogen, serum creatinine, acute kidney injury [13 patients], reopening for bleeding, postoperative renal impairment, need for renal dialysis, total intensive care unit stay, and the total duration of hospital admission. However, it had a significant reduction in hemoglobin and creatinine clearance. Conclusion: Off-pump coronary revascularization offers a better kidney function preservation and has a decreased risk for kidney dysfunction in patients with renal impairment without dialysis compared with coronary revascularization with cardiopulmonary bypass.

Reduction of Blood Loss by Intra‐articular Injection of Tranexamic Acid Combined with Knee and Hip Flexion at 45° During Primary Total Knee Arthroplasty: A Randomized Controlled Trial

ObjectiveTo explore the hemostatic effect of intra‐articular administration of tranexamic acid (TXA) combined with knee flexion in total knee arthroplasty (TKA).MethodsThis randomized controlled trial was conducted at the Third Affiliated Hospital of Southern Medical University (Guangzhou, China) from January 2017 to February 2018. The patients were randomized 1:1 to the TXA group (TXA 500 mg into the joint after closure, knee, and hip flexed at 45° for 4 h) or the control group (physiological saline, with limb fully extended). The primary endpoint was postoperative hemoglobin reduction. The postoperative levels of hemoglobin were measured at four time points: 6 h after operation, and on the first, second, and third postoperative days. Calculated blood loss (CBL) at 3 days, transfusion rate, range of motion (ROM), VAS pain score, and knee circumference increment were the secondary endpoints. Ninety‐four (47/group) patients were analyzed.ResultsPostoperatively, there were statistically significant differences between the TXA and control groups in CBL (791 ± 212 mL vs 1175 ± 273 mL, P < 0.05). Hemoglobin reduction was significantly lower in the TXA group (2.0 ± 0.9 g/dL vs 4.5 ± 0.7 g/dL, P < 0.05). Based on the transfusion criteria, 3 out of 47 (6.4%) patients in the TXA group and 13 out of 47 (27.6%) patients in the control group received blood transfusions (P = 0.006). ROM (90.8° ± 6.2° vs 87.6° ± 6.4°, P = 0.004), VAS pain score (4.1 ± 1.1 vs 4.8 ± 1.3, P = 0.004), and KCI (2.4 ± 0.9 cm vs 3.2 ± 1.0 cm, P = 0.01) were better in the TXA group compared with thecontrols. There was no deep venous thrombosis (DVT), wound infection or other adverse events in either group. In the control group, 2 patients had a fever after blood transfusion.ConclusionIntra‐articular injection of TXA combined with knee and hip flexion at 45° can effectively attenuate CBL and hemoglobin reduction during primary TKA, without an additional adverse event.

Intensive Insulin Therapy (Basal-Bolus).

Intensive insulin therapy (IIT) aims at achieving near-normal glycemic control and usually uses a basal-bolus (BB) schema to mimic physiologic insulin secretion. The treatment burden of IIT should be outweighed by improved glycemic control and reduction of chronic complications, but reviews summarizing the effects of IIT in subjects with T1DM and T2DM in glycated hemoglobin, hypoglycemia, insulin doses, and weight are limited. We performed a PubMed search to identify relevant randomized control trials (RCTs) comparing IIT and conventional insulin treatment in T1DM and T2DM subjects and addressing glycated hemoglobin, hypoglycemia, insulin requirements, and weight. We have identified 11 RCTs in T1DM subjects, published years ago and very heterogenous in design. Throughout the studies there was a consistent superiority of IIT in glycated hemoglobin reduction, a higher rate of severe hypoglycemia and more weight gain in the IIT group without a clear effect on insulin doses. We have identified 2 RCTs in T2DM subjects, only one of them using a definite BB schema in the IIT group. IIT induced more hypoglycemia and better HbA1c, but not more weight gain. IIT is the best option for treatment of subjects with T1DM in HbA1c reduction with a cost in the rate of hypoglycemia and weight gain. In subjects with T2DM, IIT also yields improvement in HbA1c versus conventional treatment, also at the cost of more hypoglycemic episodes, but not of higher weight gain. RCT treatment arms did not only differ in the insulin schema, but also in treatment goals, therapeutic education, and frequency of clinical visits among other characteristics. However, most evidence was gained using a BB insulin schema in the intensive arm and it is likely that the insulin schema had a relevant contribution in the results.

S1494 Gastroduodenal Artery Pseudoaneurysm in the Setting of Necrotizing Pancreatitis

INTRODUCTION: Gastroduodenal artery (GDA) pseudoaneurysms are a rare but fatal condition, representing about 1.5% of all visceral artery aneurysms.. If ruptured, mortality rate is high as 75%, particularly from severe upper gastrointestinal bleeding. Fortunately, the availability of imaging studies allows for early detection of these vascular events. Historically, they used to be treated either through surgical ligation or resection. Currently, minimally invasive endovascular procedures can be performed, resulting in a significant reduction in morbimortality. CASE DESCRIPTION/METHODS: 41 year old female with a history of Roux en Y gastric bypass, pancreatic divisum, chronic pancreatitis complicated by necrotic fluid collections was admitted for severe protein calorie malnutrition. She had a G tube place that persistently leaked, requiring a J arm for nutrition. Her hospital course was further complicated by peritonitis and serratia bacteremia, for which she received intravenous antibiotics. Six days after placement of her J arm, she began to have worsening epigastric pain. She became tachycardic up to the 140s. Abdominal exam was soft with epigastric tenderness without rebound or guarding. Labs were notable for new leukocytosis to 23 and a hemoglobin reduction from 8 to 6.6. CT imaging showed gastrostomy tube migration outside the stomach remnant, with spillage of gastric contents in the peritoneum. In addition to the known complicated necrotizing pancreatitis, the scan revealed a new development of a GDA pseudoaneurysm, 2 cm in size. Surgery was consulted to reposition the gastrostomy tube. Interventional radiology was also consulted for urgent GDA pseudoaneurysm coiling. Patient’s hemoglobin stabilized to her baseline the following days. DISCUSSION: Hemorrhagic complications of pancreatitis are rarely seen. Typically, patients with GDA pseudoaneurysms are asymptomatic or have non-specific abdominal pain. If ruptured, mortality rate is high as 75%. Fortunately, the availability of imaging studies allows for early detection of these vascular events. Gold standard diagnostic test is visceral angiography which provides both diagnostic and therapeutic value and has a 100% sensitivity. CT imaging is noninvasive and has a 67% sensitivity. Historically, they used to be treated either through surgical ligation or resection. We now are able to perform minimally invasive endovascular procedures, resulting in a significant reduction in morbimortality.Figure 1.: Gastroduodenal artery pseudoaneurysm (red arrow), 2cm in size, with surrounding complicated necrotizing pancreatitis.Figure 2.: Transcatheter selective embolization via coiling of the gastroduodenal artery pseudoaneurysm.

60 - Efficacy of Oral Semaglutide According to Race: An Exploratory Subgroup Analysis of the PIONEER Trial Program

The global PIONEER program investigated the efficacy and safety of oral semaglutide, a glucagon-like peptide-1 receptor agonist. Patients with type 2 diabetes were randomized to once-daily oral semaglutide (3, 7 or 14 mg, or flexibly dosed [flex]), placebo or active comparator (empagliflozin 25 mg, sitagliptin 100 mg or liraglutide 1.8 mg). This exploratory subgroup analysis evaluated the effect of race on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of treatment (week 26, 52 or 78). Data were analyzed from PIONEER 1–4, 7 and 8 by race (White, Asian, Black/African American). Baseline characteristics were generally similar across subgroups except for BW, which was lower in Asian patients. Generally, greater HbA1c reductions were observed with oral semaglutide 14 mg/flex vs comparators across subgroups (Table). In PIONEER 1, 4 and 8, there was a significant interaction between treatment and race, with greater HbA1c reductions and estimated treatment differences in Asian patients than in other subgroups (Table). Overall, BW reductions were greater for oral semaglutide vs comparators, regardless of subgroup and without significant interactions between treatment and race. Our findings in this exploratory subgroup analysis suggest that, in some PIONEER trials, Asian patients achieve greater HbA1c reductions than other race groups when treated with oral semaglutide.

Superior weight loss with once-weekly semaglutide versus other glucagon-like peptide-1 receptor agonists is independent of gastrointestinal adverse events

IntroductionGastrointestinal (GI) adverse events (AEs) are the most common AEs with glucagon-like peptide-1 receptor agonists (GLP-1RAs). Weight loss (WL) is slightly greater in people who experience GI AEs than those...

58 - Efficacy of Oral Semaglutide According to Background Medication: An Exploratory Subgroup Analysis of the PIONEER Trial Program

The global PIONEER program investigated the efficacy and safety of the first oral glucagon-like peptide-1 receptor agonist, oral semaglutide. Across PIONEER trials, patients with type 2 diabetes (T2D) were randomized to once-daily oral semaglutide (3, 7, 14 mg or flexibly dosed) or comparator. The present exploratory subgroup analysis evaluated the effect of background medications on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of trial (week 26, 52 or 78) in 5 PIONEER trials (3–5, 7–8). Data were analyzed from patients who received oral semaglutide or comparator (sitagliptin, liraglutide or placebo) based on background medication received: metformin, sulphonylurea, sodium–glucose cotransporter 2 inhibitor, insulin or combinations. Baseline characteristics were generally similar across subgroups. Reductions in HbA1c and BW were greater for oral semaglutide vs comparators (except liraglutide, with similar HbA1c reductions), regardless of background medication (Table). In general, there were no statistically significant interactions between treatment and subgroups. Estimated treatment differences were consistent within each trial and background medication subgroups. These findings support the use of oral semaglutide across a broad population of patients with T2D in combination with other commonly used glucose-lowering agents.