Controlled Observational Studies Research Articles

Effect of kidney donation on bone mineral metabolism.

Kidney donation results in reductions in kidney function and lasting perturbations in phosphate homeostasis, which may lead to adverse cardiovascular sequelae. However, the acute effects of kidney donation on bone mineral parameters including regulators of calcium and phosphate metabolism are unknown. We conducted a prospective observational controlled study to determine the acute effects of kidney donation on mineral metabolism and skeletal health. Biochemical endpoints were determined before and after donation on days 1, 2 and 3, 6 weeks and 12 months in donors and at baseline, 6 weeks and 12 months in controls. Baseline characteristic of donors (n = 34) and controls (n = 34) were similar: age (53±10 vs 50±14 years, p = 0.33), BMI (26.3±2.89 vs 25.9±3.65, p = 0.59), systolic BP (128±13 vs 130±6 mmHg, p = 0.59), diastolic BP (80±9 vs 81±9 mmHg, p = 0.68) and baseline GFR (84.4±20.2 vs 83.6±25.2 ml/min/1.73m2, p = 0.89). eGFR reduced from 84.4±20.2 to 52.3±17.5 ml/min/1.73m2 (p<0.001) by day 1 with incomplete recovery by 12 months (67.7±22.6; p = 0.002). Phosphate increased by day 1 (1.1(0.9–1.2) to 1.3(1.1–1.4) mmol/L, p <0.001) but declined to 0.8(0.8–1.0) mmol/L (p<0.001) before normalizing by 6 weeks. Calcium declined on day 1 (p = 0.003) but recovered at 6 weeks or 12 months. PTH and FGF-23 remained unchanged, but α-Klotho reduced by day 1 (p = 0.001) and remained low at 6 weeks (p = 0.02) and 1 year (p = 0.04). In this study, we conclude that kidney donation results in acute disturbances in mineral metabolism characterised by a reduced phosphate and circulating α-Klotho concentration without acute changes in the phosphaturic hormones FGF23 and PTH.

Factores de riesgo asociados a bacteriemia en lactantes. Servicio de Clínicas Pediátricas. 2019

Introducción: la bacteriemia no tiene nada que ver con algo tóxico. Se considera una etapa temprana de la sepsis. Objetivo: identificar algunos factores de riesgo que se asociaron a bacteriemia en lactantes ingresados en el servicio de clínicas pediátricas del Hospital Provincial Pediátrico Docente “General Milanés” en el período comprendido del 1ro enero al 31 diciembre 2019, en Granma. Método: se realizó un estudio observacional analítico de caso y control que investigó la asociación entre la bacteriemia y factores de riesgo relacionados con la edad, sexo, desnutrición, bajo peso al nacer, prematuridad, no lactancia materna exclusiva, uso previo de antimicrobianos y hospitalización reciente. Se seleccionaron 48 casos y 144 controles. Se utilizaron métodos teóricos y empíricos y se calculó el Odd Ratio. Resultados: en el análisis univariado la edad (OR=2,51, IC= 1,28 - 4,91; p=0,01), la desnutrición (OR=30,88, p=0,00; IC=8,28-115,17), la prematuridad (OR=71,51, p=0,00; IC=13,55-77,35), el bajo peso al nacer (OR = 6,90, p = 0,01 IC=3,27-14,58), la no lactancia materna exclusiva (OR=6,90, IC=3,15-15,12; p=0,00), el uso previo de antimicrobianos (OR=19,67, IC=7,03-55,06, p=0,00) y la hospitalización reciente (OR=16,75, IC=6,45-43,40; p=0,00) contribuyeron al riesgo de bacteriemia en lactantes. El sexo no tuvo relación estadísticamente significativa (OR=1,55, IC= 0,81-2,98; p= 0,24). Conclusiones: La hospitalización reciente y la desnutrición fueron los de mayor riesgo. Se concluye que con los valores del modelo de la regresión logística binaria, se podrá estimar el riesgo de padecer esta enfermedad.

Plasma adenosine and neurally mediated syncope: ready for clinical use.

Either central or peripheral baroreceptor reflex abnormalities and/or alterations in neurohumoral mechanisms play a pivotal role in the genesis of neurally mediated syncope. Thus, improving our knowledge of the biochemical mechanisms underlying specific forms of neurally mediated syncope (more properly termed 'neurohumoral syncope') might allow the development of new therapies that are effective in this specific subgroup. A low-adenosine phenotype of neurohumoral syncope has recently been identified. Patients who suffer syncope without prodromes and have a normal heart display a purinergic profile which is the opposite of that observed in vasovagal syncope patients and is characterized by very low-adenosine plasma level values, low expression of A2A receptors and the predominance of the TC variant in the single nucleotide c.1364 C>T polymorphism of the A2A receptor gene. The typical mechanism of syncope is an idiopathic paroxysmal atrioventricular block or sinus bradycardia, most often followed by sinus arrest. Since patients with low plasma adenosine levels are highly susceptible to endogenous adenosine, chronic treatment of these patients with theophylline, a non-selective adenosine receptor antagonist, is expected to prevent syncopal recurrences. This hypothesis is supported by results from series of cases and from observational controlled studies.

Evaluation of Central and Peripheral Corneal Thicknesses in Patients with Systemic Lupus Erythematosus.

PurposeTo evaluate the corneal pachymetric and topographic parameters of systemic Lupus Erythematosus (SLE) patients using Dual Scheimpflug Imaging.MethodsThis observational cross-sectional controlled study included the right eye of 30 SLE patients and 30 age-matched controls. Corneal measurements were acquired by dual Scheimpflug imaging including anterior and posterior corneal curvatures, central, mid-peripheral corneal thickness (measured at the 5 mm zone) and peripheral pachymetry (measured at the 7 mm zone). SLE disease activity index (SLEDAI) was calculated and correlated with corneal pachymetry.ResultsSLE patients had significantly thicker corneal periphery than controls. Mean central corneal pachymetry was 530.4± 27.3 microns (SD) in SLE and 547.5±31.5 microns (SD) in control group, p = 0.032. The corneal periphery – except superiorly – was significantly thicker in SLE patients than controls (p ˂0.001). Nasal peripheral corneal thickness positively correlated with disease activity index SLEDAI (p=0.03).ConclusionSLE patients present with thicker corneal periphery than controls characteristically sparing the superior quadrant. Possible corneal photosensitivity leading to peripheral immune complex deposition as well as flatter posterior corneal surface at the periphery are proposed explanations for these findings.

The Benefit and Safety of Vitamin B Combination to Reduce Fatigue and Improve Quality of Life in Chronic Kidney Disease Patients

Background: Chronic kidney disease (CKD) patients often have a chronic fatigue and lower QoL, thus may increase morbidity and mortality in CKD patients. Objective: The objective was to identify the benefit and safety of administration of intravenous vitamin B combination to reducing fatigue, measure the prevalence of fatigue and QoL in CKD patients. Method: This study was an observational non control study for 4 weeks in CKD patients with routine hemodyalisis 2 times/week. Every subject has a routine administration of intravenous vitamin B combination, consist of 100 mg vitamin B1, 100 mg vitamin B6, and 5000 mcg vitamin B12, after each hemodyalisis. Visual analogue scale (VAS) used to measure the degree of fatigue. QoL measured using SF-8 questionnaire, consist of total, physical (PCS), and mental component (MCS). Results: The prevalence of fatigue is high. The mean VAS score was 3.4±2.1 at baseline and there were 46.7% subjects with VAS score above the mean VAS score. After 4 weeks administration of vitamin B combination intravenously, the mean VAS score was decreasing from 3.4 to 2.7. The prevalence of fatigue was decreasing from 46.7% to 41%. This shifting was statistically significant (p:0.008). There was a score reduction in total component (20.19±4.8 to 19.29±4.9), PCS (13.44±3.1 to 12.99±3.5), and MCS (6.75±2.1 to 6.31±1.9). This score reduction indicated a better QoL. However, the reduction was not statistically significant. Conclusion: The prevalence of fatigue is high. Intravenous vitamin B combination considered to be effective and safe to reducing the degree of fatigue in CKD patients.&#x0D; Keywords: chronic kidney disease, fatigue, hyperhomocysteinemia, vitamin B combination, quality of life

The clinical performance of midline catheters-An observational study.

The use of peripheral venous catheters (PVCs) is hampered by short dwell time, and central venous catheters (CVCs) are often preferred for medium- to long-time intravenous treatment. Ultrasound techniques allow for easy catheter insertion into the major veins of the upper arm. A new generation of midline catheters, PowerGlide Pro, utilises a one-hand Seldinger technique and can be inserted by one single operator without assistance. This study aimed to evaluate the clinical performance of the PowerGlide Pro midline catheter. Consecutively inserted midline catheters were followed in a prospective, observational quality control study. Endpoints were dwell time, the incidence of premature catheter removal, causes of catheter removal and the dwell time and incidence rates of predefined subgroups representing potential effect modifiers. Hundred midline catheters, of which 98 were accessible to follow-up, were inserted in 70 patients. Median dwell time was 8days and 60 catheters were removed before the indication for intravenous therapy had ceased. The overall incidence for premature catheter removal was 71.8/1000days and no significant effects of subgroups (sex, body mass index, catheter reinsertions, significant comorbidity, anticoagulant therapy, irritant infusions) were identified for either dwell time or the incidence rate for premature midline catheter removal. The most frequent reasons for premature catheter removal were pain during infusion, clotted catheter or signs of infection. The median dwell time of the midline catheters was 8days with substantial variation, whereas the incidence for premature catheter removal was 71.8/1000 catheter days. The majority of midline catheters were removed prematurely.

Safety of transcutaneous electrical sensory stimulation of the neck in terms of vital parameters in dysphagia rehabilitation

Transcutaneous electrical sensory stimulation (TESS) devices are approved for use in Japan, but their safety when used through the neck skin for dysphagia rehabilitation has not been reported. This study aimed to verify the safety of TESS use through the neck skin. Twenty patients (mean age 86.5 ± 5.1 years) with aspiration pneumonia undergoing dysphagia rehabilitation were included in this retrospective observational and matched control study. We compared vital signs in 10 subjects who underwent swallowing rehabilitation with the TESS device, and matched control patients over 7 days. The results were the following: tachycardia, 0.60 ± 1.07 vs. 0.70 ± 0.67 days; high blood pressure, 0.40 ± 0.70 vs. 0.50 ± 1.08 days; low blood pressure, 0.40 ± 0.70 vs. 0.10 ± 0.32 days; low oxygen saturation, 0.60 ± 1.58 vs. 0.50 ± 1.08 days, p = 0.870; oxygen administration, 0.80 ± 2.20 vs. 1.20 ± 2.15 days; tachypnea, 0.50 ± 0.71 vs. 0.50 ± 0.53 days; elevated body temperature, 2.00 ± 1.41 vs. 1.60 ± 1.96 days. There were no significant differences in clinical stability between the TESS and control groups of patients with aspiration pneumonia. TESS through the neck appears safe as an intervention in dysphagia rehabilitation.

The Usefulness of Zhukovsky Double Balloon in Obstetric Hemorrhage

Abstract Objective: To evaluate the effectiveness of the use of a modified Zhukovsky double (vaginal and uterine) balloon to improve the results of treatment in women with obstetric hemorrhage. Methods: We conducted an observational controlled study including 701 puerperas, which were divided into two groups: The main group consisted of 508 women, who underwent a combined management, that is, traditional (transfusion of fresh frozen plasma, erythrocyte mass, uterotonics, hemostatic agents), surgical hemostasis in cases of caesarean section, and insertion of a double Zhukovsky balloon; while the comparison group included 193 patients, who were managed traditionally. The main group and the comparison group were divided into subgroups according to the main etiology of obstetric hemorrhage: IA and IB—postpartum; IIA and IIB—placenta accreta; IIIA and IIIB—postpartum hysterectomy. Results: The most frequent causes of massive obstetric hemorrhage were atony of the uterus (39.2%), placenta previa (29.1%), and placental abruption (11.5%). Of the 508 balloon insertions, 345 (70.7%) were inserted for hemorrhage during cesarean section and 148 (29.3%) for obstetric hemorrhage after spontaneous delivery. Among the obstetric hemorrhage at caesarean section, lower segment bleeding prevailed (78.1%), caused mainly by placenta previa, placenta accreta, placental abruption, polyhydramnios, and uterine scar defects. Combined management, including surgical hemostasis and insertion of vaginal and uterine balloon of Zhukovsky, reduced blood loss by 1.5 times and the number of hysterectomies by 6.72 times compared to controls. Conclusion: The use of a modified Zhukovsky double balloon in the management of obstetric hemorrhage may reduce the number of hysterectomies and the amount of blood loss.

Improving coding and primary care management for patients with chronic kidney disease: an observational controlled study in East London.

The UK national chronic kidney disease (CKD) audit in primary care shows diagnostic coding in the electronic health record for CKD averages 70%, with wide practice variation. Coding is associated with improvements to risk factor management; CKD cases coded in primary care have lower rates of unplanned hospital admission. To increase diagnostic coding of CKD (stages 3-5) and primary care management, including blood pressure to target and prescription of statins to reduce cardiovascular disease risk. Controlled, cross-sectional study in four East London clinical commissioning groups (CCGs). Interventions to improve coding formed part of a larger system change to the delivery of renal services in both primary and secondary care in East London. Quarterly anonymised data on CKD coding, blood pressure values, and statin prescriptions were extracted from practice computer systems for 1-year pre- and post-initiation of the intervention. Three intervention CCGs showed significant coding improvement over a 1 year period following the intervention (regression for post-intervention trend P<0.001). The CCG with highest coding rates increased from 76-90% of CKD cases coded; the lowest coding CCG increased from 52-81%. The comparison CCG showed no change in coding rates. Combined data from all practices in the intervention CCGs showed a significant increase in the proportion of cases with blood pressure achieving target levels (difference in proportion P<0.001) over the 2-year study period. Differences in statin prescribing were not significant. Clinically important improvements to coding and management of CKD in primary care can be achieved by quality improvement interventions that use shared data to track and monitor change supported by practice-based facilitation. Alignment of clinical and CCG priorities and the provision of clinical targets, financial incentives, and educational resource were additional important elements of the intervention.

Cardiac Pathology and Genomics of Sudden Death in Racehorses From New York and Maryland Racetracks.

Postmortem evaluation of racehorses has focused primarily on musculoskeletal injuries; however, horses also die suddenly on the track (sudden death [SD]). Although cardiac conditions are frequently suspected as a cause of death, SD racehorses are often autopsy negative; however, previous studies have been limited due to inconsistent or insufficient cardiac sampling and lack of controls. SD in New York (NY) and Maryland (MD) racehorses was evaluated in an observational case vs control study comparing clinical information, postmortem evaluation including cardiac dissection, and cardiac conduction system histopathology. In the study period, there were 40 cases of SD. In NY, SD occurred in 12% (37/316) of submissions, and 36 (11%) cases of SD were exercise associated (EASD); 3 EASD cases occurred in MD. In NY/MD EASD cases with histologic examination of the heart, 11 of 36 (31%) had significant lesions, including mesenteric artery rupture (1), axial trauma (2), systemic inflammation (2), pulmonary hemorrhage (1), and cardiac disease (5). Mild myocardial fibrosis, mild inflammation, coronary arteriosclerosis, and variation in cardiac nodal connective tissue were present in both SD cases and controls and thus were not considered to be causes of SD. While not excluding a genetic basis for SD, analysis of the genotypes (GGP Equine 70 K Array) of cases and controls did not reveal significant differences in allele frequencies at any locus. Most SD racehorses were autopsy negative; further research using standardized protocols and controls is needed to understand the underlying causes of SD, which is crucial to protecting the viability of racing.

Contribution of anticoagulant therapy adherence to the risk of complications of atrial fibrillation

Aim.To study compliance and its role in the development of the fatal complications of anticoagulant therapy in patients with atrial fibrillation (AF).Material and methods. Antithrombotic therapy and compliance were studied in an open observational controlled prospective study with 109 AF patients. The dynamics and presence of thromboembolic and hemorrhagic complications were recorded.Results. For the first time in patients with AF, we detected a significantly high relative risk of development of life-threatening and lethal complications of anticoagulant therapy with warfarin with insufficient compliance (RR=8,0; [1,728;37,027]; p&lt;0,05) and drug therapy (RR=70; [1,493;32,819]; p&lt;0,05). At the same time, patients with AF could not detect any links between the level compliance and the risk of treatment with directly acting oral anticoagulants (DAOC) — patients who achieved a common primary endpoint had no association between the relative risk and the level of compliance (RR=1,0; [0,106;9,445]; p&lt;0,05).Conclusion.The study showed for the first time that in patients with AF, the most unfavorable prognostic factor in the development of life-threatening and lethal complications with warfarin taking is low adherence to lifestyle modification and drug therapy. At the same time, in patients with AF, who receive DAOK as anticoagulants, there was no connection between compliance and the development of hemorrhagic or thromboembolic complications.

Clinical Outcomes Associated With Sickle Cell Trait: A Systematic Review.

Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes. To evaluate associations between SCT and clinical outcomes in children and adults. English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles. Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality. A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus. Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low. Publication bias was possible, and high-quality evidence was scant. Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT. National Human Genome Research Institute.

Cataract Surgery under Local Anaesthesia - Search for Safer One

Background: Cataract surgery is usually done under local anaesthesia. But till now there are no absolutely safe local anaesthetics. Current study is done to find out a safer local anaesthetic for cataract surgery.Objective: To evaluate the onset, duration, quality, side effects and safety of bupivacaine and lignocaine in peribulbar block (PBB) for cataract surgery.Materials and method: This was a randomized observational controlled clinical study done in Monno Medical College Hospital, Manikganj, Bangladesh, in the period of October, 2014 to October, 2015. Two hundred cataract patients attending ophthalmology department were allocated to receive either 4 mL 0.5% bupivacaine+4 ml 2% lignocaine or 8 mL of 2% lignocaine for peribulbar block during cataract surgery. Onset, duration, quality of anaesthesia and after effects were used as a clinical parameter for the study.Results: Mean anaesthetic durations of lignocaine and bupivacaine+lignocaine were 75 minutes and 120 minutes respectively. Least complications were observed in subjects with lignocaine.Conclusion: Peribulbar blocks with 2% lignocaine provide better anaesthesia for cataract surgery and success rates are high without any complications. Anaesthetic time of lignocaine alone is enough for cataract surgeryDelta Med Col J. Jan 2018 6(2): 68-72

The Safety of Continuing Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor during Ramadan Fasting in Muslim Patients with Type 2 Diabetes

Methods: This is a single-centre, prospective observational controlled cohort study. Muslim patients aged 18 to 75 years with type 2 diabetes and estimated glomerular rate (eGFR) ≥ 45 ml/min/1.73 m2 were eligible if they had no contraindication to observe Ramadan fasting. Patients in study group received stable dose of SGLT2 Inhibitor for ≥ 3 months prior to enrolment and during study period, while patients in control group were not on SGLT2 inhibitor before and during study period. All participants were to attend baseline visit within 2 months before Ramadan and follow-up visit during Ramadan. Results: A total of 68 patients of similar baseline characteristics were included in the study: 35 in study group and 33 in control group. During Ramadan fasting, patients from study and control group had similar change in weight (LS mean change of -1.8 vs. -1.1kg, p=0.205), eGFR (LS mean change of -6.0 vs. -4.2ml/min/1.73m2; p= 0.399), sitting systolic BP (LS mean change of - 8.0 vs. -10.4mmHg, p=0.569), sitting diastolic BP (LS mean change of -3.7 vs. - 3.5mmHg, p=0.934) and plasma β-hydroxybutyrate level (LS mean change of -0.01 vs. -0.02mmol/L, p=0.649). Conclusions: Continued use of SGLT2 Inhibitors during Ramadan in the study had no increased risk in eGFR deterioration, ketonemia, hypoglycaemia and postural hypotension. Disclosure Y. Shao Yanli: None. G.J. Lim: None. C. Chua: None. Y. Wong: None. E. Yeoh: None. K. Low: None. C. Sum: None.

The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes

ObjectiveThe effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. MethodsThis is a single-centre prospective observational controlled cohort study. Muslim patients aged 21–75 years with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73 m2 were eligible if they had no contraindication to observe Ramadan fasting. Patients in study group were on stable dose of SGLT2 inhibitor for at least 3 months before enrolment and continued during study period, while patients in control group were not on SGLT2 inhibitor before and during study period. All participants attended baseline visit before Ramadan and follow-up visit during Ramadan. ResultsA total of 68 patients of similar baseline characteristics were included in the study: 35 in study group and 33 in control group. During Ramadan fasting, patients from study and control group had similar change in weight (LS mean change of −1.8 versus −1.1 kg, p = 0.205), eGFR (LS mean change of −6.0 versus −4.2 ml/min/1.73 m2, p = 0.399), sitting systolic BP (LS mean change of −8.1 versus −10.4 mmHg, p = 0.569), sitting diastolic BP (LS mean change of −3.7 versus −3.5 mmHg, p = 0.934) and plasma β-hydroxybutyrate level (LS mean change of −0.01 versus −0.02 mmol/L, p = 0.649). ConclusionsRamadan fasting was associated with significant changes in weight, BP and eGFR regardless whether patients were on SGLT2 inhibitor treatment. Continued use of SGLT2 Inhibitors during Ramadan did not increase ketonemia, nor increase risk of eGFR deterioration and hypoglycaemia.

Analysis of characteristics and outcomes by growth hormone treatment duration in adult patients in the Italian cohort of the Hypopituitary Control and Complications Study (HypoCCS)

PurposeTo examine differences in effects according to growth hormone (GH) treatment duration in adult GH-deficient patients.MethodsIn the Italian cohort of the observational Hypopituitary Control and Complications Study, GH-treated adults with GH deficiency (GHD) were grouped by duration of treatment; ≤ 2 years (n = 451), > 2 to ≤ 6 years (n = 387) and > 6 years (n = 395). Between-group differences in demographics, medical history, physical characteristics, insulin-like growth factor-I standard deviation score (IGF-I SDS) and lipid profile at baseline, last study visit and changes from baseline to last study visit were assessed overall, for adult- and childhood-onset GHD and by gender using ANOVA for continuous variables and Chi-squared test for categorical variables.ResultsAt baseline, treatment duration groups did not differ significantly for age, gender, body mass index, GHD onset, IGF-I SDS, lipid profile, and quality of life. Mean initial GH dose did not differ significantly according to treatment duration group in any subgroup, except female patients, with highest mean dose seen in the longest duration group. In the longest duration group for patients overall, adult-onset patients and male patients, there were significant decreases in GH dose from baseline to last visit, and in total and low-density lipoprotein (LDL)-cholesterol concentrations. IGF-I SDS increased, to a greater extent, in the longest duration group for patients overall and female patients.ConclusionsThe results show that long-term GH treatment is associated with decreasing GH dose, increased IGF-I, decreased LDL-cholesterol and the presence of surrogate markers that help to give confidence in a diagnosis of GHD.

Induction immunosuppressive therapy in cardiac transplantation: a systematic review and meta-analysis.

Approximately 50% of heart transplant programs currently employ a strategy of induction therapy (IT) with either interleukin-2 receptor antagonists (IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early postoperative period. However, the overall utility of such therapy is uncertain and data comparing induction protocols are limited. The authors searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through January 2018 for randomized controlled trials (RCTs) or observational controlled studies of IT vs no IT and IL2RA vs ATG. Inverse variance fixed effects models with odds ratio (OR) as the effect measure were used for primary analyses. Main outcomes include moderate and severe rejection, all-cause mortality, infection, and cancer. The authors' search retrieved 2449 studies, of which 11 met criteria for inclusion (8 RCTs and 3 observational case-control studies). Quality of evidence for RCTs was moderate to high. Overall, patients receiving IT had similar risk of moderate-to-severe rejection, all-cause death, infection, and cancer with patients who did not receive IT. The use of IL2RA was associated with significantly higher risk of moderate-to-severe rejection than ATG (OR 3.4; 95% CI 1.4 to 8.1), but similar risk of death, infections, and cancer. The use of IT was not associated with any benefits or harms compared with no IT. Moderate-to-severe rejection may be reduced by ATG compared with IL2RA.

HEART RATE VARIABILITY IN HEMODIALYSIS PATIENTS

There are a small number of works that have studied heart rhythm variability parameters in patients treated with hemodialysis.&#x0D; Aim. To investigate the peculiarities of heart rhythm variability parameters in patients treated with hemodialysis.&#x0D; Methods. The observational controlled study included 55 patients treated with hemodialysis, aged 24 to 75 years, including 29 men and 26 women. The control group consisted of 20 healthy individuals of comparable age and sex. Heart rhythm variability parameters were investigated in all patients.&#x0D; Results. In the study of heart rhythm variability in patients treated with hemodialysis comparatively with the control group time parameters and most of frequency indexes were decreased.&#x0D; Conclusions. Our study found the diminishment of the total power of neurohumoral regulation in patients treated hemodialysis, as evidenced by the low values SDNN, rNN50, CV.

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review.

Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition. A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers. In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.

Emergency versus standard response: time efficacy of London’s Air Ambulance rapid response vehicle

ObjectiveThe potential increased risk of an emergency response using a rapid response vehicle (RRV) should only be accepted when it allows a clinically significant time saving for management of patients...