Patients Of Group1 Research Articles

ROLE OF TOPICAL INSULIN EYE DROP AND ITS COMPARISON WITH PACK-CXL IN CASE OF NON HEALING CORNEAL ULCER

Present study evaluates efcacy of topical insulin eye drops and PACK-CXL in treatment of non-healing corneal ulcer. For this total 20 patients of corneal ulcer were taken and categorise as two groups, Group-1 and Group-2. Patients of Group-1 were treated with topical insulin eye drop, while 2 Group-2 with PACK-CXL. In result, mean area of ulcer before starting treatment in Group-1 was 25.45 ± 16.5 mm and we observed complete corneal reepithelization in all patients, with mean duration of reepithelization seen in 35 days. In group-2 mean area of non-healing ulcer before 2 starting treatment was 20.58±10.63 mm , after PACK-CXL, we observed complete corneal reepithelization in all patients with, mean duration of 25.4 days. Final visual acuity was improved from baseline in both groups. Both topical Insulin eye drop and PACK-CXL can promote and accelerate corneal reepithelization of non-healing corneal ulcers but topical insulin eye drop is cost-effective with no adverse effect

Randomized comparison of 4.5/6 Fr versus 6/7.5 Fr ureteroscopes for laser lithotripsy of lower/middle ureteral calculi: towards optimization of efficacy and safety of semirigid ureteroscopy

Background and purposeTo compare 4.5/6 Fr versus 6/7.5 Fr semirigid ureteroscopes in terms of safety and efficacy in adult non-obese patients with middle or lower ureteric stones.Materials and methodsA total of 198 patients with middle/lower ureteric stone and a BMI ≤ 30 kg/m2 were recruited. Patients were randomized according to the size of ureteroscope into two groups: group 1 where a 4.5/6 Fr semi-rigid ureteroscope was used, and group 2 where a 6/7.5 Fr semi-rigid ureteroscope was used. Patient’s demographic, stone characteristics, intraoperative and postoperative outcomes including stone-free rate (SFR) and complications were compared.ResultsPreoperative characteristics in terms of age, sex, BMI, and stone location, side, size, and HU were comparable between both groups (p values > 0.05). The overall SFR was significantly higher in group 1 (0.004). Balloon dilatation was not required in all patients of group-1 compared with 33% of group-2 (p = 0.0001). The JJ stent was required in 10% of group-1 compared with 30% of group-2 (p = 0.0004). Failure to reach the stone due to tight ureter occurred in 8% of group 2 (p = 0.003), respectively. Traxer’s grade 1 ureteral injury occurred in 2% of group-1 versus 14% of group-2 (p = 0.001). Consequently, hematuria was significantly lower in group-1 (1% vs. 8%; p = 0.01), respectively. The hospital stay < 9 h was significantly higher in group 1 (p = 0.0001).ConclusionsThe 4.5/6 Fr semi-rigid Ureteroscope was associated with significantly higher SFR and shorter hospital stay, with lower ureteral injury, fewer double-J stenting, and without the need for intraoperative balloon dilatation for the ureter.

Antiastenic effect of sequential levocarnitine and acetylcarnitine therapy in patients with cardiovascular diseases

Evaluation of the antiasthenic effect of sequential therapy with levocarnitine (LC) and acetylcarnitine (ALC) in patients with arterial hypertension and/or ischemic heart disease (CHD) with asthenic syndrome (AS). An open comparative study included 120 patients aged 54-67 years in patients with arterial hypertension and/or coronary artery disease with AS. Patients of group1 (n=60), in addition to basic therapy for the underlying disease, received LC (Elcar solution for intravenous and intramuscular injection of 100 mg/ml, the company PIQ-PHARMA) intravenously for 10 days at a dose of 1000 mg/day, followed by a transition to oral administration of ALC (Carnicetine, the company PIQ-PHARMA) 500 mg (2 capsules) 2 times a day for 2 months. Group2 patients (n=60) received only basic therapy for major diseases. The duration of observation was 70 days. The severity of AS was assessed using the MFI-20 questionnaire (MultidiMensional Fatigue Inventory) and the visual analog scale VAS-A (Visual Analog Scale Measuring fatigue). In patients of group1, a statistically significant decrease in various manifestations of AS was noted. The differences were significant both in comparison with the baseline level and in comparison with the 2nd group. The endothelium-protective effect of LC and ALC has been established. The results obtained indicate that in such comorbid patients, the use of LC and ALC reduces the severity of AS manifestations, and the established endotheliotropic properties of the drugs allow them to be recommended as part of the complex personalized therapy of patients with cardiovascular diseases.

479 Safety and effectiveness of left atrial appendage occlusion in patients with chronic kidney disease

Abstract Aims Left atrial appendage occlusion (LAAO) might be particularly attractive in chronic kidney disease (CKD) patients, owing to a high thromboembolic risk and an even higher risk of bleeding. We sought to evaluate the safety and effectiveness of LAAO in CKD patients. Methods and results A total of 1238 patients undergoing LAAO at six centres were enrolled. On the basis of kidney function, as assessed via the CKD-EPI formula, patients were classified in two groups. Group1 had a GFR value ≤60 ml/min/1.73 m2 (CKD stages 3a-b, 4, and 5), whereas Group2 had a function &amp;gt;60 ml/min/1.73 m2 (CKD stages 1 and 2). Predicted annual rates of TE or major bleeding events were compared to the annualized observed risk of the two populations. Compared to Group 2 (n = 720, 47.5% males), patients in Group 1 (n = 518, 86.5% males) were older (mean age: 78 ± 8 vs. 75 ± 8, P &amp;lt; 0.001), and were at higher risk (CHA2DS2-VASc: 4.7 ± 1.4 vs. 4.4 ± 1.4; HAS-BLED: 3.8 ± 1.1 vs. 3.2 ± 1.0; P &amp;lt; 0.001 for both). Procedural complications (within 7 days) were observed in 3.1% of patients in Group1 and 4.6% of those in Group2 (P = 0.18); of them, major procedural adverse events occurred in 10 patients of Group1 [1.9%; four gastrointestinal (GI) bleedings, four tamponades, one myocardial infarction, one retroperitoneal hematoma] and in 15 (2.1%; seven pericardial tamponades, five retroperitoneal hematomas, two strokes, and one GI bleeding) of Group2 (P = 0.84). During a mean follow-up of 11.5 ± 7 months (1183 pt/years), 10 stroke/TIA (1.9%) and 25 major bleeding events (4.8%; 18 GI and 7 intracranial) were observed in Group1. Rate of TE events was not statistically different between groups (1.9% vs. 2.6%; P = 0.41); major bleedings had a significantly higher incidence in Group 1 (4.8% vs. 2.4%, P = 0.02). Based on the estimated annual TE risk according to the CHA2DS2-VASc score (4.76% in Group1 and 4.51% in Group 2), the % risk reduction after LAAO was 57.5% and 38.8%, respectively. Based on the estimated annual major bleeding risk based on the HAS-BLED score (7.31% in Group1 and 5.39% in Group2), the % bleeding risk reduction was 30.9% and 54.2%. Conclusions LAAO is a safe and effective approach in CKD patients. Given the increased risk of bleeding and contraindications to oral anticoagulation, CKD patients might be good candidates for LAA occlusion.

Comparison of the outcome of transverse and circumferential capitonnage in surgical treatment of pulmonary hydatid cyst - a single centre study

Background and objectives: The enucleation of the pulmonary hydatid cyst is followed by individual closure of bronchial air leaks and obliteration of the residual pericystic cavity by capitonnage, either by circumferential or interrupted transverse suture. The objective of the study was to compare the surgical outcome of transverse and circumferential capitonnage in terms of postoperative recovery course, residual cavitations, air leaks, cavitatory or pleural collections and the recurrence of primary disease after enucleation of the pulmonary hydatid cyst.&#x0D; Methods: Patients with pulmonary hydatid cyst were included in the study and divided into two groups. Each group consisted of 30 patients. Patients of Group-1 underwent enucleation of the hydatid cyst followed by closure of bronchial air leaks with classical circumferential closure of the cavity and patients of Group-2 had enucleation of the hydatid cyst and closure of the cavity by transverse capitonnage.&#x0D; Results: Ten cases (33.33%) of Group-1 had hospital stay for more than 5 days compared to 4(13.33%) in Group-2 (p=0.03). Out of 30 patients who had undergone circumferential closure of the hydatid cavity, 5 (16.67%) patients had residual cavitatory fluid collection while there was none in the other group. In Group-1, 7 (23.3%) cases had reactionary intrapleural fluid collection compared to 2 (6.6%) in Group-2 (p=0.035). After 3 months of follow-up, 4 patients in circumferential capitonnage had mild haemoptysis and 1 had aspergilloma while no such complication occurred in any patient in the transverse capitonnage group. No recurrence of cyst occurred in any case in both groups.&#x0D; Conclusion: There was a considerable advantage of transverse capitonnage of the hydatid lung cavity after enucleation in terms of short hospital stay, minimal or no reactionary intrapleural or intra cavitatory collections and less air leaks.&#x0D; Ibrahim Med. Coll. J. 2021; 15(2): 13-17

Dissecting the AML Patients with FLT3-ITD into High-Risk and Low-Risk Relapsed Ones Based on Pre-Transplantation Minimal Residual Disease Determined By Multiparameter Flow Cytometry

Acute myeloid leukemia (AML) with fms-related tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD) often have a poor clinical prognosis. Though several previous studies had demonstrated that allogeneic hematopoietic stem cell transplantation (allo-HSCT) could improve its outcomes, there were a number of studies indicated that FLT3 mutational status was still an independent risk factor for adverse outcomes after allo-HSCT in AML. The minimal residual disease prior to transplantation (pre-MRD) has been proved to be able to predict leukemia relapse after allo-HSCT. However, due to limitation of detecting techniques, FLT3-ITD is not a very suitable marker of MRD. Thus, in this study we attempted to investigate that impact of pre-MRD determined by multiparameter flow cytometry (MFC) on the transplant outcomes of AML patients with FLT3-ITD mutation. Total 20 patients who received human leukocyte-antigen (HLA)-matched sibling donor transplantation (MSDT) and 63 patients who received unmanipulated haploidentical HSCT (haplo-HSCT) were enrolled in this study. Pre-MRD was determined using MFC. The results showed that all patients acquired stable neutrophil engraftment. Patients who received haplo-HSCT with positive pre-MRD had a longer period of time to neutrophil engraftment compared to those with negative pre-MRD (median: 15 days vs. 13 days, P=0.033). Patients undergoing MSDT or haplo-HSCT were classified into four groups based on the status of pre-MRD: group 1, with positive pre-MRD before MSDT; group 2, with negative pre-MRD before MSDT; group 3, with positive pre-MRD before haplo-HSCT; group 4, with negative pre-MRD before haplo-HSCT. The cumulative incidence of grade II-IV° acute graft-versus-host disease (aGVHD) and chronic GVHD were comparable between group 1 and 2 as well as group 3 and group 4 (P>0.05). Through Kaplan-Meier analysis, it showed that patients of group1 had the worst clinical outcomes. They had the highest cumulative incidence of relapse (2-year CIR, 75.0%), the lowest leukemia-free survival (2-year LFS, 25.0%) and the overall survival (2-year OS, 25.0%) among all four groups. The other three groups of patients had the comparable CIR (2-year CIR: group 2 vs. group 3 vs. group 4, 12.5% vs.30.3% vs. 20.9%, P>0.05) and LFS (2-year LFS: group 2 vs. group 3 vs. group 4, 87.5% vs. 62.5% vs. 66.5%, P>0.05). Multivariate analysis indicated that disease status (>CR1) and pre-MRD were associated with a higher CIR and a lower LFS when patients were classified into above four groups determined by MFC and transplant type. These results indicated that the AML patients with FLT3-ITD were able to be dissected into high-risk and low-risk relapsed groups based on pre-transplantation MRD determined by MFC. In addition, haplo-HSCT might overcome the negative impact of pre-MRD on patient outcomes compared to MSDT. DisclosuresNo relevant conflicts of interest to declare.

Comparison of outcomes of thrombocytopenic and non-thrombocytopenic culture proven neonatal sepsis

Background: Due to high incidence of sepsis as a main cause of neonatal mortality, early detection and proper treatment are important in reducing neonatal mortality. Thrombocytopenia is a common hematological problem encountered during neonatal period, particularly in neonatal sepsis. This study was done to know the incidence of thrombocytopenia in neonatal sepsis and to compare clinical outcome in patients with thrombocytopenic and non-thrombocytopenic neonatal sepsis.Methods: This was a prospective study carried out at neonatal intensive care unit of a tertiary care teaching hospital of western Gujarat, India, from October 2018 to August 2020. 2739 neonates were admitted with probable sepsis during study period. 299 neonates with positive blood cultures were recruited for the study. They were divided into two groups; group-1 had patients with thrombocytopenia, while group-2 included patients without thrombocytopenia. Severity of thrombocytopenia was assessed in group-1. Micro-organisms isolated and outcome of sepsis were compared in both the groups. Results: There were 208 neonates in group-1 (thrombocytopenic) and 91 in group-2 (non-thrombocytopenic). There was no significant difference in demographic profiles of neonates in both groups. Klebsiella pneumonia was the most common organism isolated from 79 patients of group-1 and 19 patients of group-2 (p=0.033). Coagulase negative Staphylococci and Candida were the second and third most common micro-organisms isolated from 30.2% and 15.1% of blood cultures respectively. In group-1, 85 (40.8%), 72 (34.6%) and 51 (24.5%) neonates had severe, moderate and mild thrombocytopenia respectively. Klebsiella pneumoniae (45.9%) was the commonest organism isolated in severe thrombocytopenic neonates, followed by Candia (22.4%) and Enterococcus (14.1%).Conclusions: Thrombocytopenia is a specific marker of neonatal sepsis. The platelet count is a simple test that facilitates diagnostic orientation and the establishment of an early empirical treatment. Klebsiella pneumoniae was the commonest organism isolated in severe thrombocytopenic neonates.

Investigation of the efficacy and safety of eltrombopag to correct thrombocytopenia in moderate to severe dengue patients - a phase II randomized controlled clinical trial.

Investigation of the efficacy and safety of eltrombopag to correct thrombocytopenia in moderate to severe dengue patients - a phase II randomized controlled clinical trial.

Can addition of low level laser therapy to conventional physical therapy be beneficial for management of pain and cervical range of motion in patients with trigger point of upper trapezius?

Objective: Trigger points commonly develop in upper trapezius muscle. These might be associated with neck pain arising from trigger points of trapezius. This study was conducted to compare the effectiveness of conventional physical therapy (CPT) with and without low level laser therapy (LLLT) on pain and cervical range of motion (ROM) in patients with trigger point of upper trapezius muscle.&#x0D; Methodology: An RCT was conducted with a sample size of 62 patients. The study was completed within 9 months after approval of synopsis. Data were collected from Health Care Physiotherapy, Sports, Spine &amp; Rehabilitation Center, Faisalabad (Pakistan). Patients were randomly allocated into two equal groups; 31 patients of Group-1 received low-level laser therapy with CPT, while Group-2 (n=31) patients received CPT as the only treatment protocol. Patients pain level was assessed using Numeric Pain Rating Scale (NPRS) and cervical ROM was measured by goniometry at baseline and subsequently at 2nd and 4th week follow-ups.&#x0D; Results: Results of the study obtained by applying repeated measures ANOVA showed that there was mean reduction in pain scores from day 1 to week 4 in within group analysis of LLLT + CPT Group (Group=1) and within group analysis of CPT Group (Group=2) (p &lt; 0.05). Statistically significant improvement was observed in all mean cervical ROMs especially for lateral flexion ROM for both groups in within group analysis (p &lt; 0.05). Statistically significant improvement was seen in NPRS score at week four between Group-1 and 2, measured by independent sample t-test with p &lt; 0.05. Whereas, independent sample t-test results showed no significant improvement in cervical ROMs at week four between Group-1 and 2 (p ˃ 0.05).&#x0D; Conclusion: Conventional physical therapy and low level laser therapy used in combination are more effective than conventional physical therapy alone in patients of trigger points of upper trapezius.&#x0D; Citation: Waseem I, Tanveer F, Fatima A. Can addition of low level laser therapy to conventional physical therapy be beneficial for management of pain and cervical range of motion in patients with trigger point of upper trapezius? Anaesth pain &amp; intensiv care 2019;23(2):__&#x0D; DOI: https://doi.org/10.35975/apic.v24i1.&#x0D; Received – 4 September 2019,&#x0D; Reviewed – 31 December 2019, 26 January 2020,&#x0D; Revised – 18 March 2020,&#x0D; Accepted – 9 May 2019

Evaluation of baseline hemoglobin levels and creatinine clearance as independent prognostic factors for patients undergoing primary percutaneous coronary intervention

Objective: The objective is to evaluate the impact of baseline hemoglobin (Hb) levels and creatinine clearance (CrCl) levels in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Methods: This was a single-center, prospective observational study conducted at a tertiary-care center in India. We enrolled 337 STEMI patients between November 2015 and December 2016. Patients were divided into four groups on the basis of baseline Hb and CrCl levels: Group-1: patients with normal Hb and normal CrCl (102 [30.2%]); Group-2: patients with low Hb and normal CrCl (78 [23.2%]); Group-3: patients with normal Hb and low CrCl (79 [23.4%]); and Group-4: patients with low Hb and low CrCl (78 [23.2%]). Results: The mean age group at presentation was 40–70 years. In-hospital complications were observed in 11 (10.8%) patients of Group-1, 11 (14.1%) patients of Group-2, 37 (46.8%) patients of Group-3, and 52 (66.7%) patients of Group-4, respectively (P = 0.03). Adverse events at 30-day follow-up were found to be higher in Group-4 (15 [19.2%] patients) followed by Group-3 (8 [10.1%] patients), Group-2 (4 [5.1%] patients), and Group-1 (2 [2%] patients), respectively (P = 0.01). Death was observed in one (1%) patient of Group-1, three (3.8%) patients of Group-2, five (6.3%) patients in Group-3, and eight (10.3%) patients of Group-4 (P = 0.03). Conclusion: Low Hb levels and CrCl levels in acute STEMI patients undergoing primary PCI were associated with increased risk of 30-day event rates.

Уремический синдром вызывает нарушение деформационно-функциональных характеристик эритроцитов у пациентов хронического гемодиализа

End stage of chronic kidney disease (CKD-V) is associated with alterations in erythrocyte structure and functions which are the potential risk factors to interrupt erythrocyte proper activity however the mechanisms of such changes remain understudied. We used laser diffraction approach for investigation of CKD and hemodialysis (HD) effects on deformability of CKD-V patients red blood cells. HD did not affect red blood cell (RBCs) deformability however we showed two-stage alteration in renal patients’ RBCs deformability corresponding to the time of HD treatment or/and susceptibility to uremic syndrome. The first stage was characterized by increase in initial velocity of cell swelling (Vi) and decrease in the time to peak hemolysis rate (Tmax), and indicated the increase in RBCs fragility in patients receiving HD treatment up to 25 months (Group 1). The second stage outlined the decrease in Vi and increase in Tmax, that indicated the increase in rigidity of RBCs in patients receiving HD treatment from 25 months to 250 months (Group 2). In interdialytic periods the increase in concentration of uremic toxins (urea, uric acid) was detected, at the same time there were no changes in sodium and glucose concentrations. The increase in uremic toxins lead to osmolality accrual up to 330 mOsm/kg in patients of Group1 before HD, up to 340mOsm/kg in patients of Group 2 before HD. In summary, HD did not affect the functional parameters of RBCs, however our data clearly indicated the two-stage deformability alteration in renal patients’ RBCs that is triggered by uremic syndrome and potentially may lead to renal anemia and cardio-vascular complications specifically attributed to CKD-V patients.

Prospective randomized study comparing Video assisted thoracoscopic surgery (VATS) resection versus cautery for treatment of primary hyperhydrosis

BackgroundEndoscopic thoracic sympathectomy (ETS) can predictably eliminate the disabling symptoms of palmar and axillary hyperhidrosis. There is debate over different techniques, including excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic ganglia.The present study was done to compare the results achieved by thoracoscopic resection and electro-cautery ablation. MethodsThis prospective randomized study was conducted in our centers along 3 years and included 40 patients with palmar and/or axillary hyperhidrosis who underwent a thoracoscopic sympathectomy. They were randomized into 2 groups; each of 20 patients. Group 1 (ABLATION GROUP); the sympathetic chains and ganglia were cauterized and group 2 (RESECTION GROUP); the sympathetic chains with T2, T3 and T4 ganglia were resected. Results40 patients with palmar and/or axillary hyperhidrosis underwent thoracoscopic sympathectomy. The procedures were performed through two 5 mm ports in all patients of group1. In group 2 we used one 10 mm port with a single 5 mm port in 12 patients, and one 10 mm port with two 5 mm ports in 8 patients. Success rate (defined as dramatic disappearance of sweating) and patient satisfaction were 100% in both groups. Moderate to severe postoperative pain was observed more in Group 2 {with Two patients (10%) in group 1 and 8 patients (40%) in group 2} requiring more analgesics than the standard doses. Also, minor bleeding that was controlled by diathermy in 1 patient (5%) in group 1 and 3 patients (15%) in group 2. Pneumothorax requiring chest drainage in 2 patients (10%) in group 2, compensatory hyperhidrosis, affecting 2 patients (10%) one in each group, recurrence of symptoms occurred in 1 patient (5%) in group1. ConclusionsThere is no statistically significant difference between VATS cautery ablation and complete resection of T2, 3, 4 regarding success rate and patient satisfaction; On the other hand, cauterization carry less postoperative pain and pneumothorax as well as less hospital stay.

Effect of prolonged fasting and low molecular weight heparin or warfarin therapies on 2-deoxy-2-[18F]-fluoro-D-glucose PET cardiac uptake

BackgroundWhether anticoagulants other than unfractionated heparin are able to suppress cardiac PET uptake of 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) is unknown. MethodsOne-hundred-seventy-four patients without history and clinical evidence of cardiac dysfunction and/or coronary heart disease underwent a 18F-FDG PET/CT study. All patients were studied with a >12-hours fasting and divided into 2 groups: group-1 without anticoagulant therapy (n:75); group-2 patients on low molecular weight heparin (n:60) or warfarin therapy (n:39). Cardiac 18F-FDG uptake was estimated qualitatively using a 4-point scale and semiquantitatively as total LV glycolysis (LVG) and metabolic volume (MV), drawing isocontour volume of interest (VOI) including the whole LV. ResultsQualitatively, LV 18-FDG uptake was scored 0 or 1, indicating a good suppression, in 10/75 (13%) patients of group-1 and 77/99 (78%) of group-2 (p < .001). Semiquantitatively, patients of group-1 showed higher values of 18-FDG uptake than patients of group-2, assessed as LVG (802,649 ± 468,442 vs 198,989 ± 261,439, p < .0001) or MV (219 ± 77 vs 57 ± 48 cm3, p < .0001). Subanalysis for anticoagulant drugs showed similar results. ConclusionsProlonged fasting combined to anticoagulants other than unfractionated heparin is able to minimize glucose cardiac metabolism. Our data confirm previous observation on the possibility to influence the metabolic pattern of the heart before the PET scan and broadens the spectrum of pharmacological options.

Surgical treatment of patients, suffering an acute biliary pancreatitis and biliary hypertension

Objective. To improve the results of treatment in patients, suffering an acute biliary pancreatitis with biliary hypertension, applying individual approach in choosing surgical procedure in early phase of the disease.&#x0D; Маterials and methods. The results of diagnosis and treatment of 140 patients, suffering an acute biliary pancreatitis, were analyzed. There were 33 men and 107 women, ageing 22 – 88 yrs, and median age – 57.6 yrs old. In all the patients biliary origin of pancreatitis was diagnosed in accordance to criteria, proposed by Holland’s Investigation Group for Pancreatitis Studying. The patients were divided into two groups, in accordance to periods for conduction of decompressive treatment procedures. Into Group 1 were included 70 patients, in whom decompressive surgical interventions were performed in the first 72 h after primary appearance of abdominal pain, independent from time of admittance to the clinic, and into Group 2 – 70 patients, in whom the wait–and–see tactics with conservative therapy was applied in accordance to the disease severity, decompressive methods were used later than 72 h after the disease beginning.&#x0D; Results. In patients of Group1 49 fibrogastroduodenoscopies (FGDS) with papillosphincterotomy and lithoextraction, 10 transcutaneous puncture drainages, 13 laparoscopic cholecystectomies with external draining of extrahepatic biliary ducts (in 5 patients laparoscopic choledochoscopy with lithoextraction) were performed. Necrotic forms of an acute pancreatitis were revealed in 26 (37.1%) patients, in 12 (46.2%) of them the infectioning have occurred. Average duration of treatment have constituted 15.48 days, and lethality – 8.57%. In patients of Group 2 22 FGDS with papillosphincterotomy and lithoextraction,5 transcutaneous puncture drainages, 6 cholecystectomies (of them 5 – with external draining of common biliary duct), 18 necrsequestrectomies (in 11 patients cholecystectomy was done additionally and in 7 – drainage of extrahepatic biliary ducts) were performed. Necrotic forms of an acute pancreatitis have developed in 38 (54.3%) patients, of them in 25 (65.8%) the infectioning have occurred. Average duration of treatment have constituted 22.2 days, and lethality – 17.14%.&#x0D; Conclusion. Application of decompressive operative interventions for elimination of biliary hypertension in patients, suffering an acute biliary pancreatitis in the first 72 h after the disease beginning, make possible to reduce the occurrence rate for necrotic and infected forms, the disease severity, the lethality level and the stationary state duration.

The role of modern methods for&#x0D; intravascular visualization of coronary arteries in diagnostics and treatment of coronary heart disease in the employees of the Russian&#x0D; Railways joint stock company related to train movements.

The aim of this study was to show the importance of modern non X-ray diagnostic techniques of coronary arteries for diagnosis and treatment of CHD. Material and methods. 110 patients, who took part in the study, were divided into two groups according to their coronarography: group 1 - patients with intermediate coronary stenosis (n = 80) and group 2 - patients with normal coronary arteries (n = 30). All patients of group1 underwent FFR measurement in the magistral arteries. On the base of FFR value the second group was conventionally divided into two subgroups: Ia (47.5% patients) - with a positive FFR value (≤0,8), in which the lesion was considered functionally significant and responsible for ischemia, and Ib (52.5% patients) - with a negative FFR value (&gt;0,8). In the case of positive FFR value patients underwent IVUS-guided PCI. Results. Survival index free of MACE and readmissions was not significantly different in the group II and subgroup Ib and were 100 and 95.2%, respectively (p &gt; 0.05). A comparison of this index in the subgroups Ia and Ib was no significantly different (97.3% and 95.2%, respectively, p &gt; 0.05). The rate of restenosis in the Ia subgroup, which required re-intervention, was 2.7%, which corresponds to the data in the literature. Late stent thrombosis was not revealed. Conclusions. Survival index free of MACE and readmissions is not different in the long-term period in the study groups.

Tumor Suppressor Gene Mutations in Iraqi Women with Breast Cancer and Their Relatives

Background: Breast cancer is characterized by various malignant tumors arise from breast tissues,age, genetic factors,diet and environmental factors,reproductive and hormonal factors, some types of benign breast disease andsocio-economic factors are factors correlated to an enlarged risk of breast cancer.Tumor suppressor genes are genes whose loss of roleresults in the elevation of malignancy. Aim of the Study: The present study was conducted to verify the tumor suppressor gene mutations in breast cancer women and their relatives. Material and Methods: Three groups of samples were included. The first consisted of 100 blocks of formalinfixed, paraffinembedded(FFPE) breast cancer tissuesof women(group 1). The second contained blood samples of 46 breast cancerwomen(group 2). The third comprised blood samples of46 apparently healthy women who were relatives to the breast cancer patients of group two(group 3). The ages of patients of samples tissue were 46.78±11.5 years, while for samples of blood patients were 47.34±11.18 years. The ages of the healthy relatives were 40.79±9.84 years. Five tumor suppressor gene mutations were examined.BRCA1 185delAG, BRCA1 5382insC and BRCA2 6174delT mutations were evaluated by mutagenically separated polymerase chain reaction, while CHEK2 1100delC and Tp53 exon 7 mutations were analyzed by RFLP. Results: The amplification of BRCA1gene for185 delAG mutation revealed amplicons of 335 bp for the wild type and 354 bp for the mutant gene, whereas for 5382 insC mutation exhibited 2 amplicons of sizes 271 bp for the wild type and 295 bp for the mutant gene. The analysis of BRCA26174 delT mutation indicated 2 amplicons of 151 bp for the wild type and 171 bp for the mutant gene. Tp53 exon 7 mutation analysis highlighted an amplicon of 125 bp size. Digestion of thisamplicon with the Hae III enzyme resulted in 2 fragments with sizes of 83 bp and 42 bp for the wild type. CHEK2 1100 delC mutation evaluation showed an amplicon of 116 bp size. Digestion of this amplicon with Sca I enzyme exhibited 2 fragments with sizes of 92 bp and 24 bpfor the wild type. Data analysis demonstrated that 27 (27%) out of the 100 enrolled breast cancer patients of tissue samples have mutations in tumor suppressor genes, 11 (23.9%) out of 46enrolled breast cancer patients of blood samples have such mutations, while 8 (17.4%) out of 46 relatives have these mutations. Nine (9%) patients of group1 were indicated to have BRCA1 185delAGmutation, while 4 (8.7%) and 3 (6.5%)women from groups 2 and3 exhibited the same mutationrespectively. BRCA15382insC mutation was identified in 7 (7%), 3 (6.5%) and 1 (2.2%) women of groups 1, 2 and 3 respectively. The BRCA2 6174delT mutation was observed in 5 (6%), 2 (4.3%) and 2 (4.3%)women of groups 1,2 and 3 respectively. Three (3%) patients of group1, 1 (2.2%) and 1 (2.2%) women from groups 2 and 3 were found to have CHEK2 1100delC respectively. Tp53exon 7 mutation was evident in 2 (2%), 1 (2.2%) and 1 (2.2%) women of groups 1, 2 and 3 respectively. No patient had more than one mutation. Conclusions: About one quarter of the investigated breast cancer patients have mutations in their tumor suppressor genes and 17% of their relatives have such mutations. Most of breast cancer patients enrolled in this study are sporadic not familial breast cancer.

Comparison between the effects of two enteral nutrition support algorithms on nutrition care outcome in critically ill adult patients

Background The use of enteral nutrition (EN) algorithm optimizes nutrition by increasing the intake of calories in critically ill patients, but it does not compensate for loss of feeding time due to frequent interruptions as during fasting for operation or investigation.Aims were to compare implementation of enteral feeding support algorithm based on the SCCM/A.S.P.E.N guidelines and modifications to this algorithm (using a protocol that shifted from an hourly rate target goal to a twenty four hour volume goal). Settings and Design Case control study in the surgical ICU of zagazig university hospital. Methods and Material Patients of group1 were given caloric requirements as five bolus meals, patients of group 2 were given Fresubin by continuous infusion with hourly rate target goal and in Group 3 there was a Shift from hourly rate target goal to 24 hour volume goal and metoclopramide 10 mg I.V. q. 6 hours with the start of EN. Results There were statistically significant differences between groups regarding adequacy of caloric intake in 2nd, 3rd days and the overall adequacy of calories in all four days, where Group 2 provided more EN adequacy than Group 1 (P=0.02, 0.001, 0.01) respectively, and Group 3 provided more calories adequacy than Group1in 3rd day and overall adequacy (P=0.008 and 0.007) respectively. Also Patients in Group 2and 3 started accommodating EN earlier and had less episodes of vomiting than patients in group 1, (P value=0.043 and0.003 respectively). Conclusion The use of EN protocol provides more adequacy of calories and proteins from EN in comparison to bolus meals.

ДИФЕРЕНЦІЙОВАНИЙ ПІДХІД ДО ЛІКУВАННЯ ХВОРИХ З ГОСТРИМ ХОЛАНГІТОМ, УСКЛАДНЕНИМ БІЛІАРНИМ СЕПСИСОМ

Гнійний холангіт – одне з найчастіших і найтяжчих ускладнень доброякісних і злоякісних захворювань жовчних шляхів.Мета дослідження – покращення результатів хірургічного лікування хворих із гострим холангітом шляхом диференційованого застосування міні-інвазивних методів попередньої декомпресії жовчовивідних шляхів та удосконаленого методу детоксикації – плазмаферезу.Матеріали і методи. Дослідження проводили на базі клініки Самаркандського державного медичного інституту. Було включено 217 пацієнтів із гіпербілірубінемією, гострим холангітом, біліарним сепсисом і тяжким біліарним сепсисом. Для 17 пацієнтів (перша група) застосовували традиційне лікування з інфузійною та антибіотикотерапією; для 18 хворих (друга група) було застосовано плазмаферез у поєднанні з непрямою електрохімічною оксигенацією (НЕХО) плазми гіпохлоритом натрію; ще для 18 пацієнтів (третя група) з додатковим озонуванням плазми (ПА з НЕХО + Озон) із наступною реінфузією детоксикованої плазми.Результати досліджень та їх обговорення. У хворих із тяжким ступенем ендогенної інтоксикації у післяопераційному періоді найбільш тяжко виражений ендотоксикоз та поліорганна недостатність були у хворих першої групи. В той час як серед пацієнтів другої та третьої груп відмічалися кращі результати хірургічного лікування завдяки розробленому лікувально-діагностичному алгоритмові.Висновки. Розроблена диференційна двоетапна хірургічна тактика з виконанням міні-інвазивних декомпресій та із застосування плазмаферезу дозволяє купірувати явища ендотоксикозу, холестазу та дисфункції печінки, таким чином поліпшуючи результати лікування хворих із гострим холангітом.

Comparison of Endoscopic Papillary Large Balloon Dilation and Endoscopic Sphincterotomy for Retrieval of Choledocholithiasis

Background: Endoscopic sphincterotomy (EST) combined with balloon catheters and/or baskets are the routine endoscopic techniques for stone extraction in the great majority of patients. Whereas large common bile duct (CBD) stones are treated conventionally with mechanical lithotripsy, large balloon papillary dilation after endoscopic sphincterotomy (ELPBD) represents the onset of an era in large CBD stone extraction and the management of “impaction”. That is because it seems effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. Studies comparing the efficacy and safety of EPLBD with EST have reported mixed outcomes. The aim of the study to compare the success and complications rates between endoscopic papillary balloon dilation and endoscopic sphincterotomy for enlargement of papillary opening during endoscopic removal of common bile duct stones. Methods: Randomized prospective comparative study was conducted on seventy four patients with CBD stone(s), subjective to therapeutic ERCP procedures for endoscopic extraction of common CBD(s). The enrolled patients were randomly divided into two groups according to the maneuver for dilate the papillary orifice into: Group I: Thirty one patients underwent EPLBD technique combined with balloon catheters and/or baskets for stone extraction. Group II: Forty three patients underwent EST combined with balloon catheters and/or baskets, which is considered as conventional endoscopic technique for stone extraction in the great majority of patients. Results: Complete extraction CBD stones among the patients of group1; EPLBD was effective for clearance of (92.5%) of CBD stones in patients with the stone sized 1cm, (overall clearance rate=87%). Overall adverse effects of patients of group1 was (29%) as mild self-limiting post ERCP pain occurred in (9.6%) and mild intra- procedure bleeding occurred in (9.6%), whereas more serious complication as melena which occurred in (3.2%), and mild pancreatitis occurred in (6.4%). Whereas complete CBD stones clearance among the patients of group 2; EST was effective in (96%) of patients with the stone sized 1cm, (overall clearance rate=79%). Overall adverse effects of patients of group 2 was (18.5%) as mild self-limiting post ERCP pain occurred in (7%) and mild intra-procedure bleeding occurred in (4.6%), whereas more serious complications as mild pancreatitis developed in (4.6%), and post ERCP cholangitis in (2.3%). The comparison between the two groups regarding the extraction of CBD stones revealed combination of papillary large balloon dilation after EST is not required in patients whose the CBD stone size 1cm among the group 1 was (83%) which better than among the group 2 which was (56%) with nearly statistical difference (P value=0.07). Conclusion: Conventional EST is an effective method for removal of common bile duct stones 1cm which is difficult to be extracted by conventional sphincterotomy and extraction devices. Endoscopic papillary large balloon dilation is an adjunctive tool to endoscopic sphincterotomy for removing large or difficult CBD stones.

Stem cell therapy facilitates tolerance in renal transplantation

Background: Strategies for tolerance induction (TI) include induction of chimerism and/or clonal deletion. We present 5-year experience of TI in living-donor related renal transplantation (LDRT) using adipose derived mesenchymal stem cell (AD-MSC) and hematopoietic SC (HSC) infusion with supportive therapy. Methods: Twenty patients divided in 2 equal, demographically balanced groups underwent LDRT under TI protocol (TIP) consisting of conditioning with Bortezomib, Methyl prednisone, rabbit-anti-thymoglobulin and Rituximab. Group-1 were administered in-vitro generated AD-MSC and HSC, group-2 were administered donor specific transfusion. Transplantation was carried out with acceptable lymphocyte cross-match, T and B-cell flow cross-match, single antigen assay and negative mixed lymphocyte reaction (MLR). No conventional immunosuppression was to be administered. Monitoring included serum creatinine (SCr-mg/dL), donor specific antibodies (DSA) and MLR. Protocol biopsies were planned after 100 days and yearly in willing patients. In event of rejection/ DSA/ MLR, rescue immunosuppression was planned. Results: Over mean 5.4 (range: 4.9-6.3) year follow-up patient survival was 80% in group-1 and 90% in group-2; deathcensored graft survival was 90% in group-1 and 70% in group-2. Mean SCr was 1.52 in group-1, and 1.97 in group-2. Five patients from group-1 and 3 from group-2 were on no conventional immunosuppression, 2 patients of group-1 and 1 of group-2 were on two immunosuppressants and 1 patient of group-2 was on 3 immunosuppressants. DSA appeared in 2 patients of group-1 without affecting graft function and 4 of group-2 causing graft dysfunction. MLR was negative in both groups. Conclusion: SCs facilitate TI in LDRT under non-myeloablative conditioning.