Prospective Single Center Research Articles

A study of intracoronary thrombolytic agents in high thrombotic burden lesions during primary PCI

Abstract Objectives High thrombus burden during Primary PCI begets worst possible outcomes, studies on adjunctive intracoronary thrombolytic agents show heterogeneous1,2 results & have limited long term follow-up. Although early studies support mechanical thrombectomy devices, larger randomized trial show that they are not able to reduce the MACE3, 4. There is no randomised clinical data for sustained mechanical thrombectomy devices till now. Purpose of the study The main purpose of this study is to analyse long term outcomes of low bleeding risk group patients undergoing Primary PCI with high thrombus burden, receiving intracoronary thrombolytic agents as an adjunctive therapy. Methods In this prospective observational single centre study, we analysed one year follow-up data of 108 consecutive primary PCI patients with high thrombus burden (G4, G5) and low bleeding risk, who were stratified into two groups basing on whether they receive intracoronary thrombolytic agent as an adjunctive agent before stent implantation. The primary outcome was NACE (Net Adverse Clinical Events, which include MACE, Death, ST/MI, major bleeding events), secondary outcomes include the individual components of the primary outcomes when analysed separately. Results The primary outcome events occurred in 21 patients (26%) in Primary stent group(PS, n=80), whereas it occurred in 2 patients(6%) in primary intra coronary thrombolysis group(PIT, n=28). Log-Rank (Mantel Cox) NACE curves show that PS group has high events when compared to PIT group(26% Vs 7%, p value – 0.042, Hazard ratio - 2.56; 95% CI - 0.76 – 8.57), there is no statistically significant difference in all other key secondary outcome event curves. Conclusion In patients presenting with STEMI, undergoing primary PCI, with high thrombus burden & low bleeding risk group, those receiving intracoronary thrombolytic agent as the adjunctive therapy before stent implantation, are able to reduce the NACE event rates during the one year of follow-up.Fig1:Log Rank (Mantel Cox) NACE curve

Predicting cardiovascular death 1-year after transcatheter aortic valve implantation: an artificial-intelligence based risk model

Abstract Background Prediction of cardiovascular death after transcatheter aortic valve implantation (TAVI) remains difficult. Currently, more lower risk patients are considered for TAVI and predicting not only immediate survival, but more longer-term outcomes seems important. Most developed risk tools use standard statistical approaches and focus mainly on short-term (30 days post-TAVI) outcomes. Purpose The aim of this project was to identify important predictors for worse outcomes after aortic valve replacement using machine learning features. Furthermore, we want to develop and artificial intelligence (AI) -model to predict cardiovascular death 1 year after TAVI. Methods For our analysis we used 725 patients with severe AS that underwent TAVI between 2008 and 2022 and were included in a prospective single centre observational study. Leveraging an automated machine learning framework, we systematically evaluated various machine learning algorithms including Random Forest, AdaBoost, Neural Networks, Randomized Decision Trees and and Gradient Boosting. Results We constructed prediction models utilizing three feature subsets: the top 10 most important features, the top 15 most important features (Figure 1), and all available features (n=66). Our analyses yielded area under curve (AUC) values of 0.71, 0.83, and 0.92, respectively (Figure 2). The best model was obtained by Randomized Decision Trees. NYHA classification, left ventricular ejection fraction, Charlson comorbidity index, posterior wall thickness and myocardial infarction 90-days before TAVI appeared as the most influential predictors for cardiovascular death within one year after TAVI. Conclusions Our model was able to identify the most important features indicating high risk for patients undergoing TAVI. Using the 15-feature model, we were able to accurately predict cardiovascular death 1 year after TAVI. AI-models to predict risk can be used to better inform/select patients undergoing TAVI.

Evaluation of moderate periorbital cellulitis and home-based therapy in children (EPOCH study, Part 2): A prospective single centre cohort study.

Paediatric periorbital cellulitis, a common eye condition, typically requires inpatient admission for intravenous antibiotics due to concerns about orbital spread. This study aimed to assess the safety and effectiveness of ambulatory management for children with moderate periorbital cellulitis. Over a 24-month period, we prospectively enrolled 84 children aged 1 to 16 years who presented with moderate periorbital cellulitis to the emergency department. Demographic and clinical data were collected. Following a guideline-based decision tree, eligible children received intravenous antibiotics and were discharged with a peripheral cannula for follow-up in ambulatory care and ophthalmology clinics. Descriptive statistics were used for data presentation. Among the 84 children, 62 (73.8%) were managed through the ambulatory care model. Within the category of moderate POC, those who were admitted to the hospital did not have higher CRP or White Cell counts and received IV antibiotics for the same length of time. The ambulatory care clinic provided a total of 132 daily doses of intravenous antibiotics. Two children treated on this pathway required inpatient admission due to clinical deterioration, one of whom required ophthalmic surgical intervention. There was no mortality or sight-threatening complications in this study. Implementing a directed ambulatory care pathway for children with moderate periorbital cellulitis proved to be an effective and safe management strategy. This approach reduces the strain on hospital bed occupancy while promoting community-based patient care.

Prospective evaluation of extended reality for neonatal intubation education

Purpose360° immersive videos may be useful in procedure-based healthcare settings. We hypothesized that extended reality (XR) neonatal intubation education is a feasible alternative to live demonstration in skill and knowledge transfer.MethodsThis was a prospective single center evaluation of an educational XR intubation video using Premature Anne™ (Laerdal Medical, Stavanger, Norway) comparing to a live demonstration. Participants were randomly allocated to either live demonstration or XR group. Each group received 20 min of teaching from the pediatric respiratory care education specialist, either in person or in video format. Intubation success, knowledge and skill acquisition were measured using a questionnaire and checklist.ResultsWe had a total of 23 participants, XR (n = 11) and live demonstration (n = 12). The groups were heterogeneous in experience level.The XR group was successful at intubating 73% of the time (n = 8), which was not significantly different to the live demonstration group 58% (n = 7) (p = 0.667). For patients who achieved intubation, there was no difference between groups in the mean time to successful intubation; 98 s (SD 73) for the XR group and 65 s (SD 22) for the live demonstration group (p = 0.685).When comparing scores between groups there were no statistically significant differences regarding knowledge scores (p = 0.514), skill scores (p = 0.826) and total scores (p = 0.926).ConclusionThese preliminary findings indicated no significant differences between the XR and live demonstration groups in terms of intubation success, knowledge acquisition, skill performance, total scores or time to successful intubation.

Impact of Pelvic Calcification Severity on Renal Transplant Outcomes: A Prospective Single-Center Study.

Background: Vascular calcifications (VC) are increasingly prevalent in patients with chronic kidney disease. This study aimed to assess the incidence of iliac artery calcifications in kidney transplant (KT) patients and explore the relationship between iliac VC burden measured by pelvic calcification score (PCS) and renal transplant outcomes. Methods: This prospective study involved 79 KT recipients. VC quantification, using a pre-transplant computed tomography (CT) scan, was performed by assessing calcifications in the common and external iliac arteries bilaterally, resulting in an overall PCS ranging from 0 (no calcifications) to 44 (extensive calcifications). Based on PCS values, patients were divided into three equal-sized groups: PCS Group 1 (PCS 0-4), PCS Group 2 (PCS 5-19), and PCS Group 3 (PCS > 19). Post-transplant outcomes tracked for at least 1 year were patient and graft survival, graft function (urea, creatinine, MAG-3 clearance), and incidence of MACE during the first post-transplant year. Results: Calcifications were present in at least one arterial segment in 61 patients (77.2%). One-year patient survival was 95%, and one-year graft survival was 92.4%. Patients in PCS Group 3 had significantly lower one-year patient and graft survival compared to those in PCS Group 1 and 2 (p = 0.006 and p = 0.008, respectively). MACE and renal function indicators 1-year post-transplant were similar across all PCS groups. Conclusions: Our study demonstrated that a significant majority of KT recipients exhibited iliac VC during pre-transplant CT assessments. Patients in PCS Group 3 exhibited significantly lower one-year patient and graft survival rates compared to those in PCS Groups 1 and 2, indicating that this subgroup may require more intensive post-transplant monitoring and management.

Impact of Pemphigus on Sleep Quality: A Prospective Observational Single-Center Case-Control Study.

Pemphigus, an autoimmune disorder, significantly impacts the quality of life for those affected. This study examined the sleep quality in patients with pemphigus, a domain for which the existing literature provides limited data without a focused analysis. A total of 156 individuals, 52 in the case and 104 in the control group, completed several questionnaires (Pittsburgh Sleep Quality Index [PSQI], General Health Questionnaire-12 [GHQ-12], and ABQOL [Autoimmune Bullous Disease Quality of Life]). Disease severity was evaluated using the Pemphigus disease area index (PDAI index). The case group exhibited significantly higher levels of psychological distress, reflected in GHQ-12 scores (P = 0.00), and notably poorer sleep quality compared to controls across various parameters (sleep latency [SL], disturbances [SDi], medication [SM], daytime sleep dysfunction [DSD]), and the global PSQI score (GS)] (P = 0.00)). Significant correlations were observed between PDAI scores and sleep duration (SDu) (P = 0.01), SM (P=0.03), SL (P =0.03), and GS (P=0.00). An association was found between the equivalent steroid intake and SDu (P=0.00) as well as GS (P=0.02). No statistically significant correlation emerged between disease duration and PSQI scores. Our findings indicated a correlation between poor sleep quality and cutaneous rather than mucosal manifestations (p=0.01). Pemphigus affects sleep quality. Severe disease showed heightened SDi, correlating with higher steroid doses, and in the chronic phase, the impact seems to have been more influenced by the pro-inflammatory stage of the disease. Patients with cutaneous pemphigus exhibited reduced sleep quality compared to those with oral pemphigus. Understanding that pemphigus worsens sleep quality can be beneficial for the holistic management of individuals with this condition.

Presepsin Does Not Predict Risk of Death in Sepsis Patients Admitted to the Intensive Care Unit: A Prospective Single-Center Study.

Background: Sepsis is defined as life-threatening organ dysfunction caused by an abnormal host response to infection. The study aimed to evaluate the utility of presepsin (P-SEP) in predicting the risk of death in patients with sepsis at the time of intensive care unit (ICU) admission. Methods: Adult patients were included in the study if they met SEPSIS-3 criteria at ICU admission. Demographic and clinical data were collected. The following inflammatory parameters were determined: C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and presepsin (P-SEP). Material was collected for microbiological testing depending on the suspected source of infection. The primary endpoint was patient death before ICU discharge. The secondary endpoint was a positive microbiological test result. Results: Eighty-six patients were included in the study. Thirty patients (35%) died before discharge from the ICU. There was no difference in P-SEP, CRP, PCT, and IL-6 values between patients who survived and those who died (p > 0.05 for all). P-SEP, CRP, PCT, and IL-6 were determined at ICU admission and did not accurately predict the risk of death in ROC curve analysis (p > 0.05 for all). Confirmation of the location of the focus of bacterial infection by microbiological testing was obtained in 43 (49%) patients. P-SEP, PCT, CRP, and IL-6 were significantly higher in patients with positive microbiological findings. Conclusions: In patients with suspected sepsis admitted to the Intensive Care Unit, presepsin does not accurately predict the risk of in-hospital death, but it can predict a positive microbiological culture.

Physical, Cognitive, Emotional, and Social Health Outcomes of Children in the First 6 Months After Childhood Critical Illness: A Prospective Single-Center Study

Objectives: To describe physical, cognitive, emotional, and social health outcomes of children and their trajectory in the first 6 months after PICU discharge. Design: Prospective, longitudinal observational cohort study. Setting: PICU in a tertiary pediatric hospital in Singapore from January 2021 to June 2022. Patients: One hundred thirty-five children (1 mo to 18 yr), admitted for greater than or equal to 48 hours with at least one organ dysfunction and received PICU therapy. Interventions: None. Measurements and Main Results: Serial self/parent proxy-reported assessments were obtained at: PICU admission, PICU discharge, and 1, 3, and 6 months after PICU discharge. The Pediatric Quality of Life Inventory (PedsQL) scale, Functional Status Scale (FSS), and measures of post-traumatic stress disorder (PTSD) using the Young Child PTSD Screen and the Child and Adolescent PTSD Screen-Parent Version were used. Trajectory groups were identified using group-based trajectory model. One hundred thirty-five children (mean [sd] age, 5.6 yr [5.5 yr]) were recruited. Seventy-eight (52%) were male. The mean (sd) Pediatric Index of Mortality III score was 3.2 (4.1) and PICU length of stay was 10.0 days (21.0 d). The mean (sd) PedsQL total scores were 66.5 (21.1) at baseline, 69.7 (21.4), 75.6 (19.7), and 78.4 (19.8) at 1, 3, and 6 months after PICU discharge, respectively. Overall, the PedsQL and FSS plateaued at 3 months. Our model revealed three distinct trajectory groups. Seventeen and 103 children in the mild and moderate trajectory groups, respectively, demonstrated recovery to baseline. Fifteen children in the severe trajectory group were older in age (mean [sd] 8.3 yr [6.4 yr]), with higher proportion (11/15) of preexisting illness. Five of 15 children in the severe group experienced posttraumatic stress syndrome (PTSS) at 6 months post-discharge. Conclusions: In our cohort of PICU patients, we found three unique trajectory groups. Children in the severe group were older, more likely to have preexisting conditions and at increased risk for PTSS. Early identification and intervention may improve recovery in patients with severe PICU trajectories.

ID: 317876 Real World SCS Outcomes in the Pandemic: 12-month prospective single centre data

ID: 317876 Real World SCS Outcomes in the Pandemic: 12-month prospective single centre data

TCT-199 Left Ventricular Systolic Dysfunction Detection by Artificial Intelligence Enhanced 6-Lead Portable Electrocardiogram Device: A Prospective Single-Center Cohort Study

TCT-199 Left Ventricular Systolic Dysfunction Detection by Artificial Intelligence Enhanced 6-Lead Portable Electrocardiogram Device: A Prospective Single-Center Cohort Study

S2088 Racial and Ethnic Disparities and Their Association With Obesity Phenotypes: A Prospective Single-Center Registry ACG Outstanding Research Award in the Obesity Category (Trainee)

S2088 Racial and Ethnic Disparities and Their Association With Obesity Phenotypes: A Prospective Single-Center Registry ACG Outstanding Research Award in the Obesity Category (Trainee)

Impact of Reactive Balance Training on a Perturbation Treadmill on Physical Performance in Geriatric Patients:Results of a Single-Center, Assessor Blinded Randomized Controlled Trial.

Background/Objectives: Falls and related injuries are a frequent and serious health problem in older persons. Among the various strategies, different forms of active physical training, in particular, have demonstrated success in reducing fall risk. A task-specific training approach is perturbation-based training of reactive balance. Performing this training modality on a perturbation treadmill, secured with a safety harness, is an innovative new approach facilitating task-specific training with unannounced perturbations in a safe environment. The aim of this study was to investigate the feasibility and effectiveness of this specific training in multimorbid older hospitalized patients with prefrailty and frailty. Methods: The trial was conducted as a prospective single-center, assessor-blinded randomized controlled trial. A total of 127 acute-care geriatric hospitalized patients were enrolled in a program either involving a minimum of 60 min perturbation-based treadmill training or treadmill training without perturbations on the identical device and for a comparable training period. Results: Participants were 81 ± 6 years old (64% female) with a baseline FRAIL Scale, SPPB, and MoCA scores of 3.5 ± 1.6, 8.3 ± 2.6, and 21 ± 5 points, respectively. The training was performed on six occasions with an average total training period of 89 min during a mean hospital stay of 17 ± 3 days. Between the baseline and up to 2 days after the last training, the Short Physical Performance Battery score, which was considered the primary endpoint, improved by 1.4 ± 2.1 points in the intervention group compared to 0.5 ± 1.7 in the control group, with a 0.9-point difference between the groups (p < 0.001). Conclusions: a relatively short training period of approximately 90 min on a perturbation treadmill led to a significant and clinically meaningful increase in the physical performance of frail and prefrail hospitalized geriatric patients. However, its effectiveness in reducing fall risk is yet to be proven in this population.

Association of corticosteroid therapy with reduced acute kidney injury and lower NET markers in severe COVID-19: an observational study

BackgroundAcute kidney injury (AKI) is common in critical cases of coronavirus disease 2019 (COVID-19) and associated with worse outcome. Dysregulated neutrophil extracellular trap (NET) formation is one of several suggested pathophysiological mechanisms involved in the development of COVID-19 associated AKI. The corticosteroid dexamethasone was implemented as a standard treatment for severe COVID-19 as of June 2020. A sub-analysis of a prospective observational single center study was performed to evaluate the effect of corticosteroid treatment on AKI development and NET markers in critical cases of COVID-19.ResultsTwo hundred and ten adult patients admitted to intensive care at a tertiary level hospital due to respiratory failure or shock secondary to SARS-CoV-2-infection between March 13th 2020 and January 14th 2021 were included in the study. Ninety-seven of those did not receive corticosteroids. One hundred and thirteen patients were treated with corticosteroids [dexamethasone (n = 98) or equivalent treatment (n = 15)], but the incidence of AKI was assessed only in patients that received corticosteroids before any registered renal dysfunction (n = 63). Corticosteroids were associated with a lower incidence of AKI (19% vs 55.8%, p < 0.001). Fewer patients demonstrated detectable concentrations of extracellular histones in plasma when treated with corticosteroids (8.7% vs 43.1%; p < 0.001). Extracellular histones and in particular non-proteolyzed histones were observed more frequently with increasing AKI severity (p < 0.001). MPO-DNA was found in lower concentrations in patients that received corticosteroids before established renal dysfunction (p = 0.03) and was found in higher concentrations in patients with AKI stage 3 (p = 0.03). Corticosteroids did not ameliorate established AKI during the first week of treatment.ConclusionCorticosteroid treatment in severe COVID-19 is associated with a lower incidence of AKI and reduced concentrations of NET markers in plasma.

Association of Free-to-Total PSA Ratio and 18F-DCFPyL Prostate-Specific Membrane Antigen PET/CT Findings in Patients with Biochemical Recurrence After Radical Prostatectomy: A Prospective Single-Center Study.

In Canada and across the globe, access to PSMA PET/CT is limited and expensive. For patients with biochemical recurrence (BCR) after treatment for prostate cancer, novel strategies are needed to better stratify patients who may or may not benefit from a PSMA PET scan. The role of the free-to-total prostate-specific antigen (PSA) ratio (FPSAR) in posttreatment prostate cancer, specifically in the PSMA PET/CT era, remains unknown. Our aim in this study was to determine the association of FPSAR in patients referred for 18F-DCFPyL PSMA PET/CT in the BCR setting and assess the correlation between FPSAR and 18F-DCFPyL PSMA PET/CT positivity (local recurrence or distant metastases). Methods: This prospective study included 137 patients who were referred for 18F-DCFPyL PSMA PET/CT and had BCR with a total PSA of less than 1 ng/mL after radical prostatectomy (RP) (including adjuvant or salvage radiotherapy). Blood samples were collected on the day of 18F-DCFPyL PSMA PET/CT. FPSAR was categorized as less than 0.10 or as 0.10 or more. A positive 18F-DCFPyL PSMA PET/CT scan was defined by a PROMISE classification lesion score of 2 or 3, irrespective of the site of increased tracer uptake (e.g., prostate, pelvic nodes, bone, or viscera). Results: Overall, 137 blood samples of patients with BCR after RP were analyzed to calculate FPSAR. The median age at 18F-DCFPyL PSMA PET/CT was 68.6 y (interquartile range, 63.0-72.4 y), and the median PSA at 18F-DCFPyL PSMA PET/CT was 0.3 ng/mL (interquartile range, 0.3-0.6 ng/mL). Eighty-six patients (62.8%) had an FPSAR of less than 0.10, whereas 51 patients (37.2%) had an FPSAR of 0.10 or more. An FPSAR of 0.10 or more was identified as an independent predictor of a positive 18F-DCFPyL PSMA PET/CT scan, with an odds ratio of 6.99 (95% CI, 2.96-16.51; P < 0.001). Conclusion: An FPSAR of 0.10 or more after RP independently correlated with increased odds of a positive 18F-DCFPyL PSMA PET/CT scan among BCR post-RP patients. These findings may offer an inexpensive method by which to triage access to 18F-DCFPyL PSMA PET/CT in jurisdictions where availability is not replete.

Local and systemic side effects of COVID-19 vaccine in Tunisian cancer patients: A prospective single center study.

We aimed to evaluate the local and systemic side effects of the COVID-19 vaccine in cancer patients. we conducted a cross-sectional study including cancer patients treated at Habib Bourguiba Hospital in Sfax, Tunisia between January and March 2022. Patients should have received at least 1 dose of a COVID-19 vaccine. We interviewed a total of 106 patients, of which 80.2% were actively treated. Mean age was 52.52. Patients were vaccinated by the Pfizer/BioNTech in 59.8% and the Oxford/AstraZeneca in 22.5%. The most frequent grade 1 or 2 adverse events occurring within 7 days were: pain at injection site (71.7%) and fatigue (38.7%). Only 2 patients developed grade 3 toxicity following vaccination. The most systemic side effects were fatigue (35.8%), fever (25.4%), headache (16.9%) and arthralgia (15.1%). They were more common after the first dose of Oxford/AstraZeneca vaccine compared to the Pfizer/BioNTech vaccine (69.6% vs 42.6%; p = 0.03). Risk of any grade toxicity (local or systemic) following the first dose was correlated with female sex (p = 0.033). Our study showed that systemic side effects were more common after the first dose of Oxford/AstraZeneca vaccine compared to the Pfizer/BioNTech vaccine in cancer patient, with the predominance of any grade of local or systemic toxicity in women.

Interim results of a prospective randomised single-centre phase III study comparing mFOLFIRINOX and mFOLFOX6 regimens in the first-line treatment of HER2-negative gastric adenocarcinoma

Given the poor treatment outcomes of disseminated gastric cancer (dGC), the search for new drug treatment options remains a pressing issue. According to some literature, the use of a chemotherapeutic triplet in the first line improves patient survival rates. An interim analysis of a prospective randomised phase III trial examines the comparison of the chemotherapeutic regimens mFOLFIRINOX and mFOLFOX6 in the first-line treatment of HER2-negative gastric adenocarcinoma. In this interim analysis, significant differences between patients receiving mFOLFIRINOX or mFOLFOX6 regarding the primary endpoint of mVBP were detected only in the group of patients with dissemination to the retroperitoneal lymph nodes. Overall, based on the results of this work, it can be concluded that the majority of patients do not require intensification of first-line treatment for gastric adenocarcinoma in the form of mFOLFIRINOX chemotherapy. However, final conclusions on the efficacy of the triple combination can only be drawn upon completion of the entire study.

Epidemiology And Outcomes Of Community Acquired Acute Kidney Injury: A Prospective Single Center Study

Purposes Community Acquire AKI (CAAKI) develops outside the hospital settings and imposes significant burden on healthcare with its high mortality rate and long-term consequences in selected cases. Infective causes are commonly incriminated and thus CAAKI incidence can be curtailed with social and preventive aspect of modern medicine. We studied patients of CAAKI admitted at our institute with follow-up for 6 months. Methods All patients aged &gt;18yrs, with diagnosis of CAAKI admitted to our Institute, a tertiary care centre located in northern part of India, was included in the study for a period of 3 years (2019-2022). The etiological spectrum and renal and patient outcomes of CA-AKI at the index visit and at 1-month, 3-month and 6 month follow-ups were analyzed. Findings Sepsis (38.8%) was the most common cause of AKI followed by Acute Gastroenteritis. Drug induced AKI was the third most common cause with 9.4% of total cases. Mortality at the index admission was 8.5% and Complete recovery at discharge was observed in 14% of patients. Remaining patients (77.5%) had partial recovery on discharge. On follow Up at 6 Months, 13 patients (5.5%) had persistent renal dysfunction of which 2 (0.85%) were on Renal replacement therapy. Conclusion Infective causes remain the common culprits of CAAKI with large contribution from Drug induced AKI. Significant number of patients progress to CKD and/or ESRD. Improving Socio-economic status is likely to lower the incidence of CAAKI.

Reduction of peritoneal dialysis associated infections using a novel exit-site care practice.

Peritoneal dialysis (PD) related infections are a significant obstacle leading to PD discontinuation. Since catheter related infections (CRI), defined as exit site infections and/or tunnel infection, can progress to peritonitis, vigorous efforts are implemented in CRI prevention. Following an increased CRI rate in our institution, partially related to environmental organisms found in water distribution systems, we hypothesized that exit site care that includes prevention of water exposure-related pathogens may reduce CRI. In this prospective single center study, we compared a contemporary cohort consisting of PD patients who implemented the modified exit-site care protocol, mainly including water avoidance during shower with stoma bag usage and local Mupirocin ointment against a historical control group before the protocol implementation. The historical cohort was allowed water exposure and used local gentamicin ointment. The primary outcome was the development of a CRI. Secondary outcomes were PD associated peritonitis and infection related outcomes. There were 55 patients in contemporary cohort and 58 in historical group. The CRI rate was significantly lower in study group (0.11/episodes per patient year [EPP]) compared to control group (0.71 EPP), p < 0.001. A multivariate Cox regression analysis demonstrated a protective effect of being in the contemporary cohort compared to historical group (HR for first CRI = 12.0 95%CI: 4.0-35.7, p < 0.001). Peritonitis rate was significantly lower in contemporary cohort (0.19/EPP) compared to the historical group (0.40/EPP), p = 0.011. Transfer to hemodialysis was significantly lower in contemporary cohort than historical group (7.3% vs 31.0% in contemporary and historical group respectively, HR = 0.2, 95%CI; 0.05-0.6, p = 0.001). An exit site care protocol that includes water avoidance and local Mupirocin use reduced substantially both CRI and peritonitis rate in patients treated with PD.

The effect of pain neuroscience education on chronic postsurgical pain after total knee arthroplasty: a randomized controlled trial.

Chronic postsurgical pain after total knee arthroplasty (TKA) is frequent and may be reduced by pain neuroscience education (PNE), teaching people about pain from a neurobiological perspective. This study investigated primarily the effectiveness of 2 individual sessions of PNE versus usual care on pain levels 3 months postoperatively in patients undergoing TKA. Secondary outcomes were physical functioning, stiffness, health-related quality of life, pain catastrophizing, attention to pain, and levels of anxiety and depression. A prospective single-center, parallel-group randomized controlled trial was undertaken including patients aged 18 years or older scheduled for primary TKA. 68 patients were randomly assigned to PNE or usual care. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score 3 months postoperatively. Outcomes were measured preoperatively, at 2 weeks (acute phase), and at 3 and 12 months postoperatively. We found no statistically significant difference (0.4 points; 95% confidence interval [CI] -1.7 to 2.4) in WOMAC pain scores 3 months after TKA between the PNE and control group. We found a statistically significant difference between the 2 groups for attention to pain at 3 months in favor of PNE (P = 0.02). This RCT showed that PNE was not superior to usual care in terms of reducing pain at 3 months after TKA. Attention to pain, as a secondary outcome, was significantly lower in the PNE group compared with usual care. Other secondary outcome measures showed no significant differences.

Cardiac surgery associated acute kidney injury, incidence, and predictors. Prospective observational single center study.

Acute kidney injury (AKI) is a condition characterized by a sudden decline in kidney function, leading to accumulation of waste products and fluids in the body. It is a common and serious complication in patients with cardiovascular diseases, and it is associated with increased morbidity and mortality.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Aim&lt;/b&gt;&lt;br /&gt; In this study, we explore the relationship between cardiac issues and the development of AKI, as well as strategies for its prevention and management. The primary aim of this study is to examine the incidence and risk factors for the AKI in patients admitted to the cardiac intensive care unit/CICU), as well as the impact of AKI on patient outcomes.&lt;br /&gt; &lt;b&gt;&amp;nbsp;&lt;/b&gt;&lt;br /&gt; &lt;b&gt;Methods&lt;/b&gt;&lt;br /&gt; We conducted prospective observational single center study. 292 consecutive patients admitted to ICU after open heart surgery by sternotomy were included. Patients were monitored in ICU for frequency of AKI, perioperative risk factors, cardiac surgery-associated acute kidney injury (CSA-AKI) and their impact on patients’ outcome.&lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; After admission to the intensive care unit, 33 patients (11.3%) developed CSA-AKI in the postoperative period. According to the analysis, male gender (p=0.03), decreased GFR (p=0.02) as well as high EuroSCORE II (p=0.013), hemoglobin level before surgery (p = 0.002) and the presence of diabetes and chronic kidney disease (p=0.03) were independent predictors of AKI after open-heart surgery. In patients who developed AKI, the duration of artificial lung ventilation was increased (21.3 vs 9.9 hours p = 0.001) and the duration of stay in the intensive care unit (4.3 vs. 1.9 days, P = 0.02).&lt;br /&gt; &lt;b&gt;&amp;nbsp;Conclusion:&lt;/b&gt;&lt;br /&gt; Patients often have AKI after heart surgery. EuroSCORE II, gender, diabetes, time of cardiopulmonary bypass and chronic kidney disease are independent predictors of AKI development. The appearance of AKI is due to an unfavorable outcome of events. The appearance of acute kidney injury is associated with adverse consequences.&lt;br /&gt; &lt;b&gt;&amp;nbsp;Key words: &lt;/b&gt;Acute kidney injury, cardiac surgery, predictors of AKI, postoperative period.&lt;br /&gt; &lt;br /&gt; &amp;nbsp;&lt;b&gt;Conflict of interests: &lt;/b&gt;The authors declare no conflict of interest.