Supportive Treatment Measures Research Articles

Bronchial Artery Einbolization for Treatment of Hemoptysis from Cavitary Lung Lesions

Background Treatment for liemoptysis is not limited to surgery, and among the various options, bronchial artery emboli/anon is regarded as an effective approach. Aim of the Work To evaluate the technique, efficacy, and safety of Bronchial Artery Embolization in patients with haemoptysis from cavitary lung lesions. Patients and Methods Our study was a reconstructive (retrospective and prospective) cohort study that was held during the period between March 2021 and September 2021. The study included 20 patients who presented with hacmoptysis due to cavitary lung lesions refractory to supportive treatment measures. Patients were referred from chest department to interventional Radiology Unit, Ain Shams University Hospitals. Results Massive hemoptysis was seen in 15 patients and recurrent mild-moderate in 5 patients. On imaging cavitary lesions were seen at left side in 8 patients, right side in 8 patients, and bilateral involvement in 4 patients. Bronchiectatic changes were the predominant pathology seen in 6 patients, immediate success was achieved in 20 patients, while recurrence within one month was noted at 4 patients. Minor complications such as chest pain were recorded in 13 patients yet no major complications such as spinal cord ischemic. Conclusion BAE is a safe and effective procedure with a negligible complication rate that can be performed routinely in patients presenting with heimoptysis,

Diagnosis and treatment of focal-segmental glomerulosclerosis-2023

The histopathological term focal-segmental glomerulosclerosis comprises different pathogenic processes with the unifying features of ahigh proteinuria and the name-giving glomerular lesion pattern seen on light microscopy. Adifferentiation according to the underlying cause into primary, secondary and genetic forms is therefore of utmost importance. The pathogenesis of primary focal-segmental glomerulosclerosis remains unknown but, like minimal-change disease, an autoimmune-mediated process leading to podocyte damage is assumed. Consequently, the unifying term "podocytopathy" is increasingly being used for both entities. Supportive treatment measures to preserve kidney function are important in all subtypes. In contrast, immunosuppressive treatment is only indicated in primary focal-segmental glomerulosclerosis. Steroid-dependence, steroid-resistance and frequently relapsing disease often complicate disease management and necessitate alternative treatment strategies. Here, the Austrian Society of Nephrology (ÖGN) provides consensus recommendations on how to best diagnose and manage patients with focal-segmental glomerulosclerosis.

A STUDY ON THE OUTCOME OF COVID-19 PATIENTS OF VARYING SEVERITY BASED ON VARIOUS MODALITIES OF OXYGEN SUPPLY

Introduction: The COVID 19 disease known to cause by severe acute respiratory syndrome corona virus 2(SARSCoV2) causes various symptoms among infected individuals of varying severity. Patients can be categorised as having mild, moderate or severe disease based on their oxygen saturation at room air at the time of presentation.The outcome of the patients on various modalities was asseseed. It isa restrospective observational study done Materials And Methods: in government general hospital, Vijayawada,in 100 patients between august 2020 to October 2020. Out of 100 selected cases 63 pat Results: ients were males and 37 were females. Mean age of patients57.96years Out of 100 cases 80 cases were severe and 20 cases were moderately severe. All 20 patients who belong to moderate severity received O2via face mask and all were discharged successfully. Among 80 patients who were severely affected 51 patients received O2 via face mask, 26 patients were on non invasive ventilation andt three patients on mechanical ventilator. The COVID-19 pandemic due to Discussion: SARS-CoV-2 has lead to substantial increase in hospitalisations for pneumonia with multi organ dysfunction. This infection is spread primarily via respiratory droplets. The most common symptoms are fever, dry cough and shortness of breath. Large number of infected patients were given oxygen supplementation by several means including oxygen via face mask, non invasive ventilation and mechanicalventilation. Along with oxygen support patients were also treated with antivirals, anticoagulants, steroids and other supportive treatment measures in various centers. Covid 19 is a pandemic spread by SARS CoV 2 which mainly infects respi Conclusion: ratory system and hypoxia is one of the primary cause that leads to death and multiple organ dysfunction.According to this study patients with severe disease at the time of presentation has less favourable outcome than moderate cases.

BRONCHIAL ARTERY EMBOLIZATION AS A THERAPEUTIC STRATEGY FOR MANAGEMENT OF MASSIVE HEMOPTYSIS

Background: Massive hemoptysis is an emergent and life-threatening condition with a high mortality rate. Bronchoscopy and MDCT scanning show significant contributing roles in delineating the etiology and the source of hemoptysis prior to bronchial artery arteriography.Aim of the work: To validate the role of the trans-catheter bronchial artery embolization in management of massive hemoptysis.Patients and Methods: Our study is a prospective cohort study that was held during the period between April 2017 and April 2019. The study included 20 patients who presented with massive hemoptysis refractory to supportive treatment measures with non-identifiable source of bleeding on fiber-optic bronchoscope. Patients were referred from chest department to angio unit.Results: Our findings are in accordance with the current literature supporting bronchial artery embolization as a safe and long-term non-invasive effective method of treatment for massive hemoptysis with a high initial rate of success. BAE may help to avoid surgery in patients who are not good surgical candidates. If hemoptysis recur in these patients, embolization can be safely performed with good response rate. If surgery is indicated, BAE can stabilize the patient prior to surgery.Conclusion: Advancements in angiographic equipment and technique continue to improve success rates, and with careful technique, it can be performed safely and with minimal risk. Embolization distal to the spinal artery may significantly decrease the number of complications and may allow a more thorough embolization.

Supportive Measures in Treatment of Aluminum Phosphide Poisoning

Supportive Measures in Treatment of Aluminum Phosphide Poisoning

The impact of docetaxel-related toxicities on health-related quality of life in patients with metastatic cancer (QoliTax)

Docetaxel is a widely used cytotoxic agent. This study evaluates the impact of docetaxel toxicities on patient's health-related quality of life (QoL). We conducted a multicenter, prospective, non-interventional trial, in which the QoL was assessed using the EORTC QLQ-C30 questionnaires at baseline and every 4 weeks up to 40 weeks in patients receiving a docetaxel-based chemotherapy for metastatic disease. Treatment-related adverse events were correlated with the corresponding QoL scores. Uni- and multivariate analyses were applied. From January 2008 to June 2011, a total of 2659 patients were included. The majority of patients (48.1%) had prostate cancer, followed by breast (17.1%) and non-small-cell-lung cancer (15.8%). Patients received a median of 5 docetaxel cycles with the median dose of 75 mg/m(2). The presence of grade 3/4 diarrhea showed the strongest effect on global health status/QoL average scores (50.91 versus 33.06), followed by vomiting (50.91 versus 35.17), dyspnea (50.94 versus 35.81), mucositis/stomatitis (50.88 versus 36.41), nausea (50.91 versus 36.68), infection (50.90 versus 37.14), fatigue (50.90 versus 43.82) and anemia (50.91 versus 41.03), P < 0.05 for all comparisons. Grade 3/4 leukopenia/neutropenia, alopecia, constipation, neurotoxicity and nail disorders had no significant impact on the global health status/QoL or other items. In this large non-interventional trial, docetaxel-associated grade 3 or 4 toxicities were shown to have a strong detrimental effect on patient's QoL. Notably, diarrhea and vomiting had the strongest negative impact on QoL measures. This has to be kept in mind while making therapeutic decisions and providing optimized supportive treatment measures. This study was registered at Deutsches Krebsstudienregister (DKSR, primary registry in the WHO Registry Network) with the ID 527.

2019 – Case report: comorbidity of malignant forms of anorexia nervosa and narcissistic personality disorder

Anorexia nervosa is a psychiatric disorder with a prevalence of circa five percent in young women population, with an increased tendency of frequent occurrence over the past twenty years. Although the diagnosis is relatively simple and straightforward, the treatment of these patients is often time-consuming and challenging for clinicians, as the occurrence of malignant and persistent forms of the condition is becoming ever more common. Resistant clinical diagnoses usually arise through comorbidity with other psychiatric disorders. Counted among them, first of all, are personality disorders. A.N. is treated by means of using various groups of psychopharmacological drugs in combination with psychotherapeutic treatment, with intention to establish a favorable therapeutic relationship and stability of the patient. Psychotherapeutic part of the treatment gains in importance when the condition occurs in comorbidity with personality disorders. Supportive treatment measures, namely aggressive rehydration, caloric values compensation via probes and and catheters are often an integral part of the treatment, and become particularly important when faced with treating malignant forms of the condition. Presented case will show that the malignant forms of Anorexia Nervosa can only be understood through insight into the psychological foundations of personality and frequently accompanying disorders on Axis II (DSM-IV). The female patient in question displays a base borderline personality structure with dominant narcissistic tendencies which prompted the development of a malignant form of the condition and thus made the treatment significantly more difficult. Only early intervention with emphasis on the psychotherapy treatment can ensure a better long-term prognosis in such cases.

Clenbuterol toxicosis in three Quarter Horse racehorses after administration of a compounded product

3 Quarter Horse racehorses were examined for suspected clenbuterol overdose 12 to 24 hours after administration by mouth of a compounded clenbuterol product. All horses developed sinus tachycardia, muscle tremors, hyperhidrosis, and colic. Abnormalities on serum biochemical analysis included hyperglycemia, azotemia, and high creatine kinase activity. The presence of clenbuterol in the serum of all 3 horses and in the product administered was confirmed and quantified by use of liquid chromatography-electrospray tandem mass spectrometry. Propranolol (0.01 mg/kg [0.005 mg/lb], IV) was administered to all 3 horses for antagonism of β-adrenergic effects and caused a transient decrease in heart rate in all patients. All horses also received crystalloid fluids IV and other supportive treatment measures. Two horses were euthanatized (2 and 4 days after admission) because of complications. One horse recovered and was discharged 4 days after admission to the hospital. In the 2 nonsurviving horses, skeletal and cardiac muscle necrosis was evident at necropsy, and tissue clenbuterol concentrations were highest in the liver. Clenbuterol is a β(2)-adrenergic receptor agonist licensed for veterinary use as a bronchodilator. At doses ≥ 10² μg/kg (4.5 μg/lb), in excess of those normally prescribed, β-adrenergic stimulation by clenbuterol may cause sustained tachycardia, muscle tremors, hyperglycemia, and cardiac and skeletal muscle necrosis. Laminitis, acute renal failure, rhabdomyolysis, and cardiomyopathy were fatal complications associated with clenbuterol overdose in 2 horses in the present report. At the dose administered, propranolol was effective for short-term control of sinus tachycardia, but it did not alleviate all clinical signs in patients in the present report. These cases demonstrated the risks associated with the use of nonprescribed compounded medications for which the ingredients may be unknown.

Long-Term Clinical Outcome in Children with Very Severe Aplastic Anemia

Introduction: The clinical course of pediatric patients with severe aplastic anemia (SAA) treated with immunosuppressive therapy (IST) or hematopoietic cell transplantation (HCT) is well known. However, reports on the course and prognosis of patients with very severe aplastic anemia (vSAA) are few. Here, we report on the characteristics and outcome of children with vSAA.Methods: We reviewed the medical records of patients diagnosed with vSAA at the Department of Pediatrics, St. Mary's Hospital, The Catholic University of Korea between January, 1995 to December, 2007. We analyzed the clinical characteristics of the patients at diagnosis, and the effects of IST, HSCT and other supportive treatment measures on patient outcome.Results: Forty three patients were diagnosed with vSAA during the study period, of whom 9 received supportive treatment measures only, 21 received IST consisting of cyclosporine A and either ATG or ALG, and 15 underwent HCT (including 2 patients who showed no response to initial IST). Of the 9 children who received supportive measures only, one patient recovered spontaneously and is surviving event-free for 22 months, 6 patients died from either severe infection or bleeding from 1 to 10 months after diagnosis (median 5 months), and the other two children are continuing to receive supportive transfusions. Of the patients with IST, two children showed a complete response (10.5%), 6 patients showed a partial response (31.6%), and eleven failed to respond (57.9%). Of the 11 patients who did not respond, 8 children died from infection or bleeding within 9 months after IST respectively, 2 patients were lost to follow-up, and 1 patient is receiving supportive transfusions. Of the 8 patients who showed a response, 2 have shown relapse and are being maintained with transfusions. Of the 15 HCT's, 12 were from HLA-matched sibling donors and 3 were from matched unrelated donors. Except for the 2 patients who died from serious infections at 5 and 9 months post-HSCT respectively, all are currently surviving disease-free. The 10-year survival of the patients who received supportive measures only, IST, or HCT is 33.3±15.7%, 47.4±14.0 and 86.7±8.8% respectively (P=0.009).Conclusion: As with SAA, HCT is the best treatment option for vSAA. If IST is undertaken, measures should be undertaken to prevent death from early infection. With only supportive care, median survival approximates only 6 months, calling for more intensive treatment strategies such as IST or HCT in the care of vSAA patients.

Supportive Treatment Measures in Severe Sepsis

Supportive Treatment Measures in Severe Sepsis