Supportive Therapy For Patients Research Articles

An Evaluation of Serum 25-Hydroxy Vitamin D Levels in Patients with COVID-19 in New York City

Aim Deterioration of patients from COVID-19 is associated with cytokine release syndrome attributed to an elevation in pro-inflammatory cytokines. Vitamin D reduces proinflammatory cytokines, and has the possibility of reducing complications from respiratory tract illnesses. Method This was a retrospective, observational, cohort study of patients with COVID-19 disease within a New York City Health System. Adult patients were included if they tested positive for SARS-CoV-2, and had a serum 25-hydroxy vitamin D level (25(OH)D) within the three previous months prior to their detected SARS-CoV-2 test. Patients were compared and evaluated based upon their 25(OH)D levels. The primary endpoints were hospitalization, need for oxygen support, and 90-day mortality. Results 437 COVID-19 patients were included [67 (IQR: 56–79) years] within this cohort. Deficient plasma 25(OH)D levels (<20 ng/ml) were associated with an increased likelihood of oxygen support [OR:2.23 (95% CI: 1.46–3.44, p = 0.0002)] from COVID-19. Deficient plasma 25(OH)D levels were not independently associated with 90-day mortality or risk of hospitalization. Hospitalization rates (98%), oxygen support (93%), and mortality rates (49%) were highest in patients who had 25(OH)D levels less than 10 ng/ml when compared to other 25(OH)D levels. Conclusion Serum 25-hydroxy vitamin D levels may affect the need for oxygen support therapy in patients with COVID-19.

Инвалидность по зрению вследствие глаукомы по данным МСЭ города Алматы

Glaucoma is a leading cause of irreversible blindness and visual impairment. Preventing of amblyopia and blindness can be a cost-effective intervention by health services and primary health- social care services. According to A.P. Nesterov (2008), the term 'glaucoma' encompasses a large group of eye diseases with a predominantly chronic course and serious prognosis. Despite the fact that in Kazakhstan modern achievements of science and technology of glaucoma are developed and introduced into practical healthcare the number of patients blinded due to glaucoma does not decrease. Aim. To carry out an analysis of data on visual impairment due to glaucoma in Almaty for three years (2016 - 2018). Material and methods. The data of primary visual impairment of Almaty city population of according to MSE 2016 - 2018 were studied. In 2016, 204 out of 948 primary visually impaired patients were diagnosed with glaucoma, in 2017 respectively out of 1331 patients 279 were disabled, and in 2018 256 out of 1018 disabled patients were diagnosed with glaucoma. A total of 739 disabled patients were analysed over three years. Results and discussion. In comparative analysis of data by disability group, it was found that primary open-angle glaucoma was the main cause of disability during the last years studied. Consequently, the vision of the better seeing eye ranged from zero to 0.04 with optimal vision correction. Moreover, the proportion of group one disability gradually increased from 68.7% in 2016 to 86.8% in 2018, while group two data, on the contrary, decreased from 80.7% to 67.3% (terminal stage from 89.5% to 59.1%); group three figures were 65.0 to 71.2% and 76.3% to 80.5% respectively. The increase in the group III disabilities was slow (from 65.0% to 71.2%). The analysis of disability groups over the years under study has shown that the leading cause of disability is a primary open-angle glaucoma, followed by primary closed-angle, secondary and congenital glaucoma. Moreover congenital glaucoma has been reported since 2017 with a decreasing trend (3.2% to 1.2%). Conclusion. Timely detection and observation in dynamics, regular supportive therapy in patients with primary glaucoma regardless of the type and stage of the disease (except for the terminal stage), treatment of existing general, especially vascular disease at the place of residence at least twice a year would contribute to preserving of visual functions and decreasing the number of the visually impaired people. Key words: glaucoma, open-angle, closed-angle, secondary, congenital, disability groups, visual impairment.

Effects of yoga on improving quality of life in patients with breast cancer: a meta-analysis of randomized controlled trials.

Complications of breast cancer treatment can cause physical and psychosocial distress in patients. Yoga demonstrates substantial potential as a supportive therapy for patients with breast cancer. Our aim is to conduct a meta-analysis of randomized controlled trials to evaluate the effectiveness of yoga in enhancing the quality of life (QoL) of patients with breast cancer. We searched for studies published before March 2020 in the PubMed, Embase, and Cochrane Library databases. Individual effect sizes were standardized, and the pooled effect size was calculated using a random effect model. Measured outcomes included QoL, anxiety and depression, stress, fatigue, pain severity, and sleep quality. In total, 26 trials involving 2069 patients were reviewed. Significant enhancement in QoL was observed immediately after the yoga intervention. The pooled mean differences in social (weighted mean difference [WMD]: 1.36, 95% confidence interval [CI] 0.12-2.61), emotional (WMD: 1.46, 95% CI 0.26-2.66), and functional well-being (WMD: 2.04, 95% CI 0.21-3.87) were significantly higher in the yoga group than in the control group. Patients practicing yoga exhibited significant improvements in physical well-being, mental well-being, and sleep quality as well as reductions in anxiety, depression, stress, fatigue, and pain severity after the intervention. Yoga may enhance QoL in patients with breast cancer experiencing post-treatment complications. Therefore, we recommend yoga as a supportive therapy for patients with breast cancer to relieve post-treatment distress.

Guiding value of dynamic lung ultrasound score in the respiratory support treatment of severe COVID-19

Objective: To explore the guiding value of dynamic changes of lung ultrasound score (LUS) for respiratory support therapy in patients with severe coronavirus disease 2019(COVID-19).

Efficacy of ultrasonic mechanical instrumentation with and without chlorhexidine in treatment of chronic periodontitis

Aim: The aim of the present study was to evaluate the effects of ultrasonic mechanical instrumentation (UMI) along with the professional use of chlorhexidine (CHX) compared with UMI alone during periodontal supportive therapy in patients with chronic periodontitis. Material and Methods: A total of twenty patients were included in the study and were divided into test and control group. The test group (ten patients) was treated with a single session of UMI along with subgingival irrigation under cavitation with CHX 0.02%. A 0.2% CHX solution was used for professional tongue brushing and mouth rinsing. The control group (ten patients) received a similar single session of UMI along with subgingival irrigation and professional tongue brushing and mouth rinsing with a control formulation. Clinical and microbiological parameters were assessed pre-treatment at 3 and 6 weeks post­treatment. Results: Results showed that there was a significant reduction of supragingival plaque and gingival inflammation as well as a significant reduction of subgingival bacterial pathogens in both test and control groups. The additional use of CHX did not result in any additional clinical and microbiological benefit with respect to UMI alone. Conclusion: CHX formulations in conjunction with UMI seems to produce no additional benefits over UMI alone during supportive therapy in chronic periodontitis patients. Keywords: Chlorhexidine, Chronic Periodontitis, Piezoelectric Ultrasonic, Subgingival Microbiota.

Possibilities of supportive therapy in patients with blood system tumors and malignant neoplasms

Finding opportunities to improve treatment outcomes of cancer patients remains a difficult and unresolved problem. Modern anticancer treatment due to the intensity and molecular biological orientation allows achieving higher efficiency and theoretically reducing the complications frequency. At the same time, the “increase in efficiency” in the modern oncology really exists, but a “decrease in the incidence of complications” is far from its solution. In many ways, the problems of diagnosis, treatment and monitoring of complications are associated with the impact on complex physiological processes in the body of an oncological patient. Timely implementation of modern and adequate programs for the prevention and treatment of these complications defines the concept of “supportive therapy”, which provides at least half of the effectiveness of anticancer treatment.The Multinational Association of Supportive Care in Cancer (MASCC) was formed in 1990. The main tasks of the association were the creation of supportive care system, its popularization and accumulation of scientific data. The MASCC was used not only oncologists experience, but also of specialists working in almost all areas of medicine. Supportive therapy provides prevention and treatment of complications from the moment of malignant disease develops, at all stages of anticancer treatment, during the rehabilitation period, and in patients in the terminal phase.An important stage in the development of maintenance care in Russia was the holding of annual conferences in Moscow with the support of MASCC. Russia is included in the European MASCC group and in working group on supportive therapy and palliative care of the Chemotherapists Society (ESMO). The Russian Society of Supportive care in Oncology (RASSC) was organized In Russia on June 1, 2017. In recent years, the main directions of supportive care have been developed in our country. Today, supportive therapy is an obligatory component of anticancer programs, which allows the patient to cope with severe but potentially reversible disorders of vital organs at all stages of treatment. This is a real way to increase the treatment efficacy and improve the quality of life of cancer patients.

Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy

BackgroundInhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). We analyzed the effects of single versus dual RAS blockaQueryde during our randomized STOP-IgAN trial.MethodsSTOP-IgAN participants with available successive information on their RAS treatment regimen and renal outcomes during the randomized 3-year trial phase were stratified post hoc into two groups, i.e. patients under continuous single or dual RAS blocker therapy over the entire 3 years of the trial phase. Primary and secondary STOP-IgAN trial endpoints, i.e. frequencies of full clinical remission, eGFR-loss ≥ 15 and ≥ 30 ml/min/1.73 m2 and ESRD onset, were analyzed by logistic regression and linear mixed effects models.ResultsAmong the 112 patients included in the present analysis, 82 (73%) were maintained on single and 30 (27%) on dual RAS inhibitor therapy throughout the trial. Neither RAS blocker strategy significantly affected full clinical remission, eGFR-loss rates, onset of ESRD. Proteinuria moderately increased in patients under dual RAS blockade by 0.1 g/g creatinine during the 3-year trial phase. This was particularly evident in patients without additional immunosuppression during the randomized trial phase, where proteinuria increased by 0.2 g/g creatinine in the dual RAS blockade group. In contrast, proteinuria decreased in patients under single RAS blocker therapy by 0.3 g/g creatinine. The course of eGFR remained stable and did not differ between the RAS treatment strategies.ConclusionIn the STOP-IgAN cohort, neither RAS blocker regimen altered renal outcomes. Patients on dual RAS blockade even exhibited higher proteinuria over the 3-year trial phase.

The pharmacoeconomic analysis of olaparib (Linparza®) application for the supporting therapy of patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer

Among women, one of the common localizations of malignant tumors is ovarian cancer (OC). Two genes have been identified, and their mutations lead to hereditary forms of breast and ovarian cancer – BRCA1 and BRCA2. Women with BRCA-associated OC respond better to targeted drugs and have better survival rates against specific treatments. Targeted drugs for the treatment of BRCA-mutated OC are specific inhibitors of enzymes of the group poly- (ADP-ribose) polymerase (PARP). Currently, the only PARP inhibitor registered in Ukraine is olaparib (Linparza® drug, AstraZeneca, United Kingdom).Aim. To assess the economic feasibility of the targeted olaparib therapy (Linparza® drug) for patients with BRCA mutated platinum-sensitive recurrent ovarian cancer (BRCA-MPS ROC) from the standpoint of the Ukrainian healthcare system.Materials and methods. Determination of treatment outcomes and associated costs was performed using Markov analytical modeling based on the results of a randomized multicenter, open-label phase II clinical trial D0810C0019-Study 19. The model time horizon is 15 years. Clinical efficacy and safety of olaparib and placebo (WW strategy) were compared as the supportive therapy for patients with BRCA-MPS ROC. Based on the results of Markov simulation the methods of “cost-effectiveness” and “cost-utility” were used. Years of the saved life (LYG) were used as a criterion of efficiency. The QALY index was used as a criterion of utility. The cost of direct medical expenses, which structure was determined in accordance with the current Protocol, was taken into account. The cost of medical treatment was determined according to the register of the Ministry of Health of Ukraine as of 7.08.2019. The cost of medical services was determined according to the available price lists. The cost of correction of side effects of the chemotherapy was also considered. Discounting was determined at the level of 5 % annually. The sensitivity analysis of the results was performed on the price and dose of olaparib and the observation horizon.Results. According to the simulation, the average life expectancy of patients with BRCA mutated platinum-sensitive recurrent ovarian cancer when using olaparib (Linparza® drug) as a supportive antitumor therapy is 4.8 LYG compared to 2.56 LYG in the WW strategy group. The olaparib supportive care strategy provides the patient with 3.61 years of quality of life compared to 1.87 years in the WW group. Thus, the use of olaparib provides the patient with an additional 2.24 years of life and 1.74 additional QALY. The total costs for the simulated period in the group of olaparib averaged 1893410.7 UAH, and in the WW group – 47466.9 UAH. The incremental coefficients of ICER (cost of 1 additional year of life) and ICUR (cost of 1 additional year of quality life) amounted to 824564,4 UAH, and 1063162.2 UAH, respectively.Conclusions. The pharmacoeconomic analysis based on Markov modeling and cost-effectiveness and cost-utility calculations has shown that olaparib (Linparza® drug) is highly effective in the treatment of BRCA-mutated platinum-sensitive recurrent ovarian cancer; it almost doubles the patients’ survival without recurrence. At the same time, olaparib is an expensive drug. The transition of half of the patients with BRCA-mutated platinum-sensitive recurrent ovarian cancer from the “watch-and-wait” strategy to the treatment with olaparib requires an additional annual cost of 10,548,250.3 UAH.

Venovenous Extracorporeal Membrane Oxygenation Therapy in Adults.

Extracorporeal membrane oxygenation (ECMO) therapy is used as supportive therapy for patients with respiratory failure, cardiac failure, and cardiopulmonary failure. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is one subtype used for respiratory failure as a supportive treatment for critically ill patients. The principle behind it is that the membrane lung (oxygenator) is placed sequentially with the normal lungs rather than in parallel like with cardiopulmonary bypass, therefore, the lungs do not have to work as hard to oxygenate the blood. Then using a drainage cannula, blood is drained from the right atrium (RA) and after going through the membrane lung, the newly oxygenated blood is returned back to the RA. Because of this, there is enough systemic oxygen delivery to manage metabolism and preserve the airway even at lower tidal volume ventilation settings. With ventilator settings placed at lower tidal volume, there is less risk of barotrauma. This is a review article discussing VV-ECMO therapy with adult patients. It will also go into detail regarding its indications, contraindications, configurations, patient assessment, vascular access, and complications.

Highlights from the Extracorporeal Life Support Organization Registry: 2006-2017.

Extracorporeal membrane oxygenation (ECMO) is a supportive therapy for patients with severe cardiovascular or respiratory failure refractory to conventional medical therapy. Improvements in ECMO technology, easy access to ECMO devices, and a greater understanding of care of ECMO patients have led to increased utilization of ECMO. The Extracorporeal Life Support Organization (ELSO) registry was established in 1984, to collect data on patients receiving ECMO support to help improve outcomes of these patients. The registry has grown to include over 400 contributing centers from 60 countries with data for more than 90,000 patients. Many investigators have used the ELSO registry to answer clinical questions on outcomes and care of this vulnerable patient population. This report provides a brief summary of 16 peer-reviewed articles that have advanced the knowledge and treatment of neonates, children, and adults supported with ECMO using data from the ELSO registry.

Therapy to improve sleep quality in ICU patients

Patients in intensive care units (ICU) are at risk of sleep disorders. Patients in Intensive Care Unit (ICU) with a history of cardiovascular disease, for example Coronary Heart Disease if have poor sleep quality can affect the healing process. This study aims to identify and analyze the positive effects of using Eyemask, Earplug and Dhikr Therapy on sleep quality in ICU patients. The research methods used are literature reviews on national and international articles published in the last 5-10 years. The use of Eye Mask and Ear Plug therapy and Dhikr Therapy can be applied as a supportive therapy for patients with sleep disorders in intensive care unit(ICU).

SUN-021 DUAL BLOCKADE OF THE RENIN-ANGIOTENSIN SYSTEM IN PATIENTS WITH IGA NEPHROPATHY - INSIGHTS FROM THE STOP-IGAN TRIAL

Inhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). In the randomized STOP-IgAN trial we observed that the addition of immunosuppressive therapy to optimized supportive care did not significantly improve renal outcomes over the 3-year study phase as compared to supportive measures alone. Here we analyzed the effects of single versus dual RAS blockade during the 6-month run-in phase that preceded the randomized study phase on renal endpoints.

Impact of preoperative extracorporeal life support on left ventricular assist device outcomes: A comparative study.

To investigate whether preoperative short-term extracorporeal life support therapy in patients undergoing continuous-flow left ventricular assist device implantation has an impact on the outcome regarding survival and adverse events. Between January 2011 and May 2018, 100 consecutive patients received HeartMate II, HeartWare, or HeartMate III for end-stage heart failure. Mean age was 64.2 ± 10.3 years. Three patient groups were identified: without preoperative extracorporeal life support (non-extracorporeal life support group, n = 80), with preoperative extracorporeal life support due to postcardiotomy shock after conventional cardiac surgery (postcardiotomy shock group, n = 9), and with preoperative extracorporeal life support without previous surgery (non-postcardiotomy shock group, n = 11). The primary endpoint was overall survival after device implantation. Secondary endpoints were adverse events during the follow-up period. Survival was significantly different between the groups (p < 0.05): 30-day, 6-month, and 1-year survival rates were 85%, 68%, and 61% for non-extracorporeal life support group; 44%, 22%, and 22% for postcardiotomy shock group; and 45%, 27%, and 24% for non-postcardiotomy shock group, respectively. Furthermore, in both extracorporeal life support groups (postcardiotomy shock and non-postcardiotomy shock), there were a higher incidence (p < 0.05) of postoperative right heart failure (30% vs 66.7% vs 54.5%), acute renal failure requiring dialysis (20% vs 77.8% vs 54.5%), and respiratory failure (31.3% vs 88.9% vs 81.8%). Continuous-flow left ventricular assist device implantation with prior extracorporeal life support appears to have a worse outcome regarding survival, right heart failure, renal and respiratory dysfunction (p < 0.05). Future studies have to be done to evaluate the outcome after extracorporeal life support bridge pre-left ventricular assist device, especially as ultima ratio in postcardiotomy shock patients.

Blood Transfusion Requests: An Audit in a Blood Transfusion Wing of a Referral Laboratory

Introduction: Transfusion of blood and its components such as Packed Red Cell (PRC), Platelet Rich Plasma (PRP) and Fresh Frozen Plasma (FFP) play an important role as a supportive therapy in patients admitted to a hospital.&#x0D; Objective: To conduct an audit of blood transfusion requests regarding demographic data of the recipients, the component therapy, blood groups of the issued units, cross-match transfusion ratio, expiry of the transfusion units, pattern of blood components usage and transfusion reaction for which blood was returned back to blood bank.&#x0D; Materials and Methods: This retrospective crosssectional study was conducted at the transfusion wing of a referral laboratory over a period of three months from January 2013 to March 2013 upon 3015 episodes of transfusion units of whole blood and different blood components.&#x0D; Results: Out of total 3015 episodes of transfusion unit in 1926 recipients, 930 were male and 996 female. About 41.0% requests of transfusion units received from the department of Obstetrics and Gynaecology (OBG) followed by the department of Surgery of about 28.7%. The most commonly used transfusion units was whole blood (55.3%) followed by platelet rich plasma (27.2%). Most of the recipients (62.3%) received single transfusion units and 37.7% recipients of ≥2 units. Out of 3769 cross-match, 3015 transfusion units were issued. In 12 (0.4%) cases, there were minor febrile and allergic reactions. During the study period, shelf life of six transfusion units had expired.&#x0D; Conclusion: This study suggests that either systems audit or medical practice audit of blood and blood component orders can help to reduce the inappropriate or indiscriminate transfusions and may be an important educational tool for the ordering physicians as well as for residents in training&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 3-6

Cognitive Behavioral Therapy for Psychosis (CBTp): Multicenter Randomized Clinical Trial on Specific Efficacy

Background: Cognitive behavioral therapy for psychosis (CBTp) is a specific form of psychotherapy recommended in evidence-based treatment guidelines for patients with psychosis. However, it remains unclear whether CBTp is more efficacious than unspecific psychotherapies such as supportive therapy (ST). Methods: This multicenter, single blind, randomized clinical trial used a parallel group design to compare CBTp and ST. In total, 330 patients with persistent positive symptoms were included. Participants received 20 sessions of CBTp or ST over a 9-month period. Therapy was provided in six outpatient clinics at university psychiatry departments. The primary endpoint was the severity of positive symptoms (Positive and Negative Syndrome Scale-positive) until post-treatment at 9 months after inclusion. Analysis was carried out by intention to treat with multilevel linear modeling. Findings: There was a between group effect size of g=0·33 (0·11-0·55) in favor of CBTp for positive symptoms, with pre-post effect sizes of g=0·93 (0·70-1·15) for CBTp and g=0·62 (0·40-0·84) for ST. CBTp showed favorable effects for hallucinations and social functioning, but not for negative symptoms and readmission rates. Ratings of the therapeutic relationship, number of adverse events, and antipsychotic medication did not differ between the groups. Positive symptoms decreased in both groups until the 24 month follow-up, with a between group difference of g=0·09 (-0·23-0·39). Interpretation: CBTp is more efficacious than ST in patients with persistent positive symptoms. CBTp effects cannot be explained by therapeutic attention alone. This indicates CBTp has specific mechanisms of action, and further supports the unrestricted recommendation of CBTp for the treatment of psychosis. Trial Registration Number: ISRCTN29242879 Funding Statement: The study was funded by the German ministry of education and research (grant no. 01GV0618). Declaration of Interests: All authors declare that there is no conflict of interest. Ethics Approval Statement: The study protocol was reviewed without objections by the ethics committee of the coordinating study center and the local ethics committees of all participating centers. Patients were included in the study after written informed consent was obtained, which was assured by external monitoring.

Clinical Application Significance of Nutritional Support Therapy in Patients with End-stage Malignant Tumor

【Abstract】Objective: To analyze the effect of nutritional support therapy on the clinical outcomes in patients with end-stage malignant tumors. Methods: Sample data collection was conducted from April 2015 to July 2018. Fifty-four patients with end-stage malignant tumors were enrolled in the study. They were divided into reference group (n=27) and experimental group (n= 27) by double-blind method. Conventional treatment was used in the reference group, while nutritional support therapy was used in the experimental group. The treatment effects of the two groups were compared. Results: Post-treatment effect of the experimental group and the reference group were compared using the parameters including total adverse reaction value, Cancer-Related Fatigue Score, quality of life, A/G, AS:AL, ALP, BUN, anorexia score, ALB, UA. The parameters such as A/G, AS:AL, ALP, BUN, anorexia score, ALB, UA were also used to compare between pre and post-treatment. The value of P &lt;0.05 was used to indicate the statistical significance of the test. Conclusion: Nutritional support therapy had a superior effect in patients with end-stage malignant tumors.

PR095: Clinical effects of medicinal clay in supportive therapy of patients with chronic periodontitis

PR095: Clinical effects of medicinal clay in supportive therapy of patients with chronic periodontitis

Early nutrition support therapy in patients with head-neck cancer.

weight loss is commonly observed in head-neck cancer patients, affecting 75-80% of them during their treatment period; weight loss is severe in 30-50% of cases. According to ESPEN publications, nutritional assessment in cancer patients should be frequently performed and nutrition support therapy must be started when any deficiency is observed. to evaluate the effect of early nutrition support (ENS) in nutritional markers and treatment response in patients with head-neck cancer receiving radiotherapy (RT). one hundred and two patients with head-neck cancer and more than two points in the malnutrition screening tool (MUST) before receiving RT were included. ENS was provided to all patients consisting in nutrition counselling, oral supplements and/or enteral nutrition. one hundred and two patients were included; 76% had a stage IV of disease. At the end of RT, after ENS, a slightly decreased body mass index (BMI) with an increased fat-free body mass was observed (p < 0.001); biochemical nutrition parameters remained stable despite decreased oral intake. Less than 40% of patients had severe epithelitis or mucositis; 92% of patients received the total amount and doses of originally planned RT sessions, while 22.8% required RT-sessions interruption. Patients with caloric malnutrition had a lower fulfillment of RT than those without caloric malnutrition (p < 0.001). Mortality was related to lower Karnosfsky, higher weight loss before RT and higher grade of mucositis/epitelitis (p < 0.05). patients who receive ENS keep their nutritional condition instead of associated effects due to RT. ENS represents an efficient treatment and could prevent malnutrition associated comorbidities in oncologic patients.

Use of supplemental oxygen in patients with pulmonary arterial hypertension in REVEAL.

Supplemental low-flow oxygen is recommended by treatment guidelines as supportive therapy for patients with pulmonary arterial hypertension (PAH), based largely on expert opinion. Reduced diffusing capacity of lung carbon monoxide (DLCO) is associated with increased mortality in PAH. Reduced DLCO is also associated with relative hypoxemia, making the effects of supplemental oxygen use of particular interest in this sub-population. Patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a 5-year observational study of Group 1 PAH, were categorized by presence or absence of supplemental oxygen use and by degree of DLCO reduction. Kaplan-Meier survival estimates were calculated by group. Of 3,046 patients, 57% used supplemental oxygen and 43% did not. Supplemental oxygen users had worse prognostic factors and more PAH-specific medication use. Of the 424 patients with severe DLCO reduction (<40% of predicted), 76% used oxygen and 24% did not. Patients with severe DLCO reduction who used supplemental oxygen had a significantly lower risk of all-cause mortality than those who did not (hazard ratio 0.56; 95% confidence interval 0.39 to 0.83; p = 0.0033). This was true for newly diagnosed and previously diagnosed patients. There was no relationship between oxygen use and outcomes in patients with no, mild, or moderate DLCO reduction. In this observational study, the risk of death was significantly lower for patients with severe DLCO reduction who received supplemental oxygen compared with those who did not. A randomized trial is warranted to further investigate the relationship between supplemental oxygen use and outcomes in PAH.

Engglis

Thrombocyte concentrate (TC) transfusion is an important supportive therapy in patients with thrombocytopenia. The risks in platelet transfusions may be related to the content of TC including the contaminant leukocytes. The aim of this study was to assess the risk of increased level of P-Selectin (CD62P) expression of non-leukodepleted TC transfusions.This was a quasi-experimental study. Subjects were children patients aged 1-18 years who received a non-leukodepleted or a leukodepleted TC transfusions. Comparison of the proportion of increased expression of CD62P in both groups expressed as relative risk. The subjects consisted of 51 patients who received non-leukodepleted and 52 patients who received leukodepleted TC transfusions. The risk of increased expression of CD62P in patients receiving non-leukodepleted TC transfusions were 2.38 (95%CI:1.60-3.53) times higher than those who received leukodepleted TC. Non-leukodepleted have significant higher risks of increased CD62P expression than leukodepleted TC transfusions.