Higher Rate Of Acute Complications Research Articles

Characteristics of ESRD Patients who have been on Long-term Hemodialysis Therapy in Egypt

Background: It is well-known that hemodialysis extends the life of end-stage renal disease (ESRD) patients, who would have otherwise died. The characteristics of long-term patients on hemodialysis (HD) were not evaluated before in Egypt. We aimed at identifying the specific characteristics of the patients who have survived on hemodialysis for more than 20 years in Egypt. Subjects and Methods: During the years 2018 and 2019, the twenty-seven governorate health affairs Directories of the Egyptian Ministry of Health were contacted to participate in data collection. The dialysis physicians in each hemodialysis unit were sent a questionnaire form requesting to submit information, on the characteristics of patients who have been on HD therapy for twenty years or more.
 Results: Seventy-three patients were encountered from a total number of 26000 HD patients to have been on HD therapy; with a range between 20 and 30 years. Males constituted the majority of these patients. Sixty-eight patients were dialyzed through working arteriovenous fistulas (A-V fistulas). The mean urea reduction ratio (URR) of these patients was 0.65±0.095. Acute intradialytic complications afflicted only 20.3% of these patients. More than three-quarters of the patients had a positive serology test for HCV antibodies. None of these patients has diabetes mellitus. On the other hand, complaints related to the skeletal system were present in 47.4% of the patients. There is a statistically significant higher rate of acute complications in the female gender and a statistically significant higher fertility rate after hemodialysis in the male gender.
 Conclusion: Long-term dwellers on hemodialysis therapy are not unusual in Egyptian ESRD patients and their characteristics are reasonable.

Assessment of Some Inflammatory Biomarkers in Children with Febrile Seizure and Bacterial Meningitis

Introduction: Bacterial meningitis (BM) is a serious infection characterized by inflammation of themeninges, causing a high rate of acute complications in children. This research aimed to explain the effect ofprocalcitonin (PCT) in BM and its correlation with the others some inflammatory biomarkers.Method: The case-control study included Fifty children who were diagnosed with suspected bacterialmeningitis associated with febrile seizure according to the clinical investigation by specialized pediatricianand analysis of CSF and Forty children were enrolled as healthy control. The inflammatory biomarkersprocalcitonin, Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were estimated for eachparticipants in addition to measurement of CBC(complete blood count) by using an automated instrument.Results: Patients have significantly higher serum levels of PRO, CRP, ESR, total WBC count, ANC, andNLR than the control group. Elevating serum PRO and CRP levels in patients group were significantlyassociated with increased serum ANC levels. A significant relationship was also observed between PRO andNLR, indicating that the PRO, CRP and NLR had a suitable biomarkers in the diagnosis of BM.Conclusion: Serum procalcitonin is more specific and sensitive inflammatory biomarkers than the NLR andCRP for the evaluation of suspected bacterial meningitis, so the recommended to use PCT assays in the earlydiagnosis of children with BM.

Acute Complications of Diabetes Among Pilgrims During Hajj 2017: A Brief Report.

IntroductionDiabetes mellitus (DM) was reported as one of the most common non-communicable diseases during Hajj. However, few studies evaluated acute complications of DM during Hajj. Therefore, this study aims to explore the most common acute complications among pilgrims with DM during Hajj 2017 and its clinical presentations.MethodsThis is a descriptive cross-sectional study. Data were collected using an anonymous questionnaire from the database of pilgrims with DM, who sought medical care in mobile clinics in Mina during the peak period of Hajj from 31 August to 4 September 2017. Data were entered afterwards into an Excel sheet and analyzed using SPSS.ResultsIn this study, a total of 281 pilgrims were recruited, male to female ratio 3:1. Out of 281 pilgrims, 199 (70.8%) had foot injuries, 77 (27.4%) had hyperglycemia, and 37 (13.2%) had hypoglycemia, noting that some of them presented with more than one complication. Most of the participants who developed foot injuries, presented with redness (28.8%) and bullous (20.6%). The most reported symptoms among hyperglycemic pilgrims were polydipsia (17.1%) and dry mouth (16.4%). Also, the most reported symptoms of hypoglycemia were fatigue (14.9%) and headache (12.5%). In addition, pilgrims with type 2 DM reported a higher rate of acute complications compared to type 1 DM (81.8% versus 18.2%, p = 0.33).ConclusionThe most common acute complication of diabetes during Hajj is foot injury. Pilgrims who suffered from hyperglycemia presented mainly with polydipsia, while those who developed hypoglycemia presented mainly with fatigue. There was no statistically significant difference according to the association between the type of diabetes and the occurrence of acute complications.

Advances and continued controversy in coronary revascularization of patients with diabetes mellitus.

Introduction A controversial topic in interventional cardiology is the method of revascularization for patients with diabetes. Subanalyses from several studies have suggested that longterm mortality risk varies between percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) for diabetic patients, but there remain inconsistencies in the literature. Additionally, the clinical course of diabetic patients undergoing PCI is complicated by more frequent restenosis compared with nondiabetic patients, particularly in small-diameter vessels and a higher rate of acute complications. Recent therapeutic advances in PCI have demonstrated promise in improving outcomes for diabetic patients, and their application to this high-risk patient population specifically has become the focus of intense investigation. This commentary reviews the controversy regarding the type of revascularization for patients with diabetes, and discusses the impact of new technology advances in revascularization for these high-risk patients.

Effectiveness of rheolytic coronary thrombectomy with the AngioJet catheter

Thrombus-filled lesions are associated with a higher rate of acute complications and long-term restenosis following conventional coronary or saphenous vein graft (SVG) intervention. To evaluate the clinical effectiveness of rheolytic thrombectomy in a nonselected population in the glycoprotein IIb/IIIa blockade era, we reviewed clinical, angiographic, and procedural data on 119 patients who underwent 126 consecutive coronary AngioJet procedures (29% in SVGs, and 71% in native coronary arteries) from July 1998 to August 2000. Glycoprotein IIb/IIIa blockers were used in 88%. Most vessels (68% of SVGs, 74% of native coronary arteries) were occluded initially. Complete or substantial removal of filling defects was achieved in 76% of SVGs and 66% of native coronary cases. The AngioJet rheolytic thrombectomy device led to significant improvement in lumen diameter and Thrombolysis In Myocardial Infarction (TIMI) flow, with reduction in the thrombotic lesion length (p <0.05). Angiographic success (<30% residual stenosis, TIMI-3) was attained in 73% of SVGs and 87% of native coronary procedures. Distal embolization occurred in 13 cases, and was less likely to occur in patients treated with abciximab (0%) compared with patients treated with other glycoprotein IIb/IIIa blockers or heparin alone (17%, p = 0.02). A favorable response to the AngioJet (odds ratio 3.9) and freedom from embolization (odds ratio 14.6) were associated with a higher procedural success rate. In-hospital and long-term clinical outcomes were favorable. Thus, rheolytic thrombectomy resulted in significant reduction of the thrombus burden in most patients, restored TIMI-3 flow, and led to favorable short- and long-term outcomes.

Bacterial meningitis in children: critical care needs.

Acute bacterial meningitis (ABM) in children is associated with a high rate of acute complications and mortality, particularly in the developing countries. Most of the deaths occur during first 48 hours of hospitalization. Coma, raised intracranial pressure (ICP), seizures, shock have been identified as significant predictors of death and morbidity. This article reviews issues in critical care with reference to our experience of managing 88 children with ABM in PICU. Attention should first be directed toward basic ABCs of life-support. Children with Glasgow Coma Scale (GSC) score < 8 need intubation and supplemental oxygen. Antibiotics should be started, even without LP (contraindicated if focal neuro-deficit, papilledema, or signs of raised ICP). Raised ICP is present in most of patients; GCS < 8 and high blood pressure are good guides. Mannitol (0.25 gm/Kg) should be used in such patients. If there are signs of (impending) herniation short-term hyperventilation is recommended; prolonged hyperventilation (> 1 hour) must be avoided. Any evidence of poor perfusion, hypovolemia and/or hypotension needs aggressive treatment with normal saline boluses and inotropes, if necessary, to maintain normal blood pressure. Empiric fluid restriction is not justified. Seizures may be controlled with intravenous diazepam or lorazepam. Refractory status epilepticus may be treated with continuous diazepam (0.01-0.06) mg/kg/min) or midazolam infusion. Ventilatory support may be needed early for associated pneumonia, poor respiratory effort and/or coma, and occasionally to reduce work of breathing in shock. Provision of critical care to children with ABM may reduce the mortality significantly as experienced by us.

Ten-year follow-up of percutaneous transluminal coronary angioplasty for proximal left anterior descending coronary artery stenosis in 351 patients

Objectives. We sought to evaluate the short- and long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery.Background. Both the supposedly high rate of acute complications and relatively poor long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery have led to a search for alternative interventional techniques.Methods. We analyzed the success rates and long-term follow-up results in 351 consecutive patients who underwent balloon angioplasty for stenosis of the left anterior descending coronary artery proximal to its first side branch. The power of the study was >80% in detecting a difference of 9% in the proportion of patients who survived at 10 years, assuming an 80% survival rate in the control group.Results. There were 60 ostial and 291 nonostial stenoses. Follow-up lasted a median of 85 months (range 0 to 137) and was 100% complete. The angiographic success rate was 90.9%. The clinical success rate was 86.3%. Nine patients (2.6%) died, 17 (4.8%) needed emergency coronary artery bypass graft surgery, and 10 (2.8%) developed a myocardial infarction. Several patients had subsequent complications. The success and complication rates were not significantly different for patients with ostial and nonostial stenoses. Ten years after balloon angioplasty, freedom from mortality was 80%, freedom from cardiac death was 87%, freedom from myocardial infarction was 84%, freedom from vessel-related reinterventions was 66%, and freedom from angina pectoris was 33%. There were more reinterventions for ostial stenoses, with a 1-year relative risk of ostial versus nonostial stenoses for related reinterventions of 1.7 (95% confidence interval 1 to 2.8, p = 0.049).Conclusions. More than 10 years ago, balloon angioplasty for stenoses in the proximal left anterior descending coronary artery, either ostial or nonostial, had a high success rate. Although the long-term results are satisfactory, ostial stenoses are associated with a higher early clinical restenosis rate requiring more reinterventions.

810-1 Enhanced Inflammatory Acute Phase Response After Percutaneous Coronary Angioplasty in Patients with Unstable Angina

Elevated levels of C-reactive protein (CRP), a sensitive marker of inflammation, are independent predictors of short-term prognosis in patients (pts) with unstable angina (UA). The causes of the acute phase response in UA, however, are still unknown. Percutaneous transluminal coronary angioplasty (PTCA) is an useful model for the assessment of the effects of plaque disruption and myocardial ischemia on the acute phase response. Serum levels of CRP were measured in 21 pts with chronic stable angina (SA) (G 1) and in 22 pts with UA refractory to maximal medical treatment (G2), undergoing single-vessel PTCA. Venous blood samples were taken immediately before PTCA and 6, 24, 48, 72 hours after the end of the procedure. CRP values are expressed as median and range. Before PTCA, CRP was elevated (&gt; 3 mg/l) in 2/21 G1 pts (10%) and in 16/22 G2 pts (73%) (p &lt; 0.001): it was 2.4 (2–4.4) mg/l in Gl and 8 (2.4–29) mg/l in G2 (p &lt; 0.001). After PTCA, CRP increased to a peak value of 2.6 (2–16.4) mg/l 38 ± 13 hrs after the procedure in Gl, and to a peak value of 19.9 (2.8–49.4) mg/l 32 ± 14 hrs after the procedure in G2 (p &lt; 0.001. G1 vs G2). A significant increase in CRP after PTCA, defined as an increase &gt; 50% the basal values, was observed in 8/21 Gl pts and in 16/22 G2 pts (p &lt; 0.05). The percentage increase of CRP after PTCA was higher in G2 than in Gl (180 ± 239%, range 0–925% vs 118 ± 176%, range -13–489%, p &lt; 0.05). No difference in coronary stenosis severity before PTCA (84 ± 9% vs 89 ± 8%), residual stenosis (30 ± 7% vs 29 ± 10%), number of ballon inflations (6 ± 3.4 vs 5.3 ± 3.2), total inflation time (365 ± 202 vs 413 ± 197 sec) and mean inflation pressure (5 ± 0.9 vs 5 ± 1 atm) was found between Gl and G2 pts. Our study shows that the plaque disruption and the brief periods of myocardial ischemia caused by PTCA elicit a variable individual inflammatory acute phase response, that is greater in UA compared to SA pts. These data suggest a higher inflammatory responsiveness in patients with UA, that may playa pathogenetic role in acute coronary syndromes, and help explaining the higher rate of acute complications typically observed in patients with unstable angina undergoing PTCA.

Complications and long-term outcome after percutaneous coronary angioplasty in chronic hemodialysis patients

The objective of this investigation was to assess the acute and long-term outcome after coronary angioplasty in patients undergoing chronic hemodialysis. Previous studies have suggested a high incidence of restenosis after coronary angioplasty performed in patients with renal failure. Medical discharge abstracts for 8342 patients undergoing angioplasty during a 5-year period were searched to identify all coronary angioplasty procedures performed in patients undergoing chronic hemodialysis. Procedural and follow-up coronary angiograms were reviewed in a core angiographic laboratory. Hospital records and office visit notes were obtained to assess acute and long-term outcome. Twenty-one patients undergoing chronic hemodialysis had been treated by coronary angioplasty. The 9 men and 12 women had a mean age of 59 ± 10 years (range 37 to 78 years) and had been undergoing hemodialysis for 6.2 ± 6.4 years (range 1 to 19 years). Procedural success was achieved in 12 (57%) of 21 patients. Three (14%) patients died; 4 suffered nonfatal myocardial infarctions (19%); 1 (5%) required emergency bypass surgery; and 1 (5%) had abrupt vessel closure without complications. Of the 15 (71%) patients who were discharged with a patent angioplasty vessel, 4 (27%) died and 9 (60%) had recurrence of angina within 1 year. Of 9 patients with recurrent angina, 7 underwent a second angiography, and all showed evidence of restenosis at the previous angioplasty site. The results of coronary angioplasty in these 21 hemodialysis patients suggest a high rate of acute complications and poor long-term prognosis in this subgroup. Other strategies for revascularization should be considered for these patients.

Treatment of long coronary artery narrowings with long angioplasty balloon catheters

Balloon angioplasty of long coronary artery narrowings has been associated with a lower rate of acute success, and a higher rate of acute complications and restenosis than that observed for short narrowings. Angioplasty catheters with longer length balloons (30 and 40 mm) are now available, and the objective of this study was to determine the acute and long-term success for patients with long coronary artery narrowings treated with these longer balloons. All patients with long narrowings (≥10 mm) treated with long balloons at 1 institution over a 1-year period were identified (93 narrowings in 89 patients), and acute and long-term outcomes were carefully documented. Procedural success (residual stenosis ≤50%) was 97%. Abrupt closure occurred in 6% and major dissection in 11% of narrowings. Clinical success (procedural success without in-hospital death, bypass surgery or myocardial infarction) was achieved in 90% of patients. Repeat catheterization was performed in 61 patients (76% of those eligible), and restenosis was found in 50 to 55%, depending on the definition used. The treatment of long coronary artery narrowings using angioplasty catheters with longer balloons leads to high rates of acute success. However, there is a high rate of restenosis. New interventional devices for long lesions should be compared with long balloons in a randomized controlled trial.