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The Frequency of Thromboembolism and Factors Associated with Thromboembolism in Patients Suffering from Polycythemia Vera
Mehmet Ali Uçar,
Simten Dağdaş,
Funda Ceran,
Mesude Falay,
Gülsüm Özet
Issue:
Volume 7, Issue 5, September 2019
Pages:
112-117
Received:
3 July 2019
Accepted:
27 July 2019
Published:
14 August 2019
Abstract: This study aimed to identify at what frequency of thromboembolic complications and the other risk factors that create a predisposition to thromboembolic complications occur in patients suffering from polycythemia vera (PV). In accordance with the 2001-2008 criteria put forth by World Health Organization, we reviewed the medical records of 207 patients who were diagnosed with PV between 2009 and 2017 at Ankara Numune Training and Research Hospital. We retrospectively looked at their demographical and clinical data, alongside their history of previous thrombotic events, what treatment they had received, and lab data at the time of diagnosis. We found that the mean hemoglobin and hematocrit levels, as well as their median white blood cell count and JAK2V617F positivity rate of those who had suffered thrombotic events were higher who had not. In addition, we also discovered that the mean age (60 vs. 55.3; p=0.012) and rate of tobacco use (62.9% vs. 23.7%; p<0.001) were both determined among the thrombotic groups versus the normal group. According to multivariate regression model of potential risk factors associated with thrombotic events, we had determined that smoking (OR=7.21; p<0.001), hypertension (OR=5.44; p=0.008), itching (OR=6.7; p=0.001), and JAK2V617F positivity (OR=2.61; p=0.043) were all independent risk factors that indicated the presence of an arterial event. We also arrived at the fact that smoking (OR=7.07; p=0.001) and itching (OR=12.9; p=0.001) were also independent risk factors predicting the presence of a venous event. Our findings conclusively reveal which risk factors are associated with thromboembolic events among PV patients. In light of that, we recommend that preventive measures be against these risk factors in order to decrease the frequency of thromboembolic complications that PV patients experience.
Abstract: This study aimed to identify at what frequency of thromboembolic complications and the other risk factors that create a predisposition to thromboembolic complications occur in patients suffering from polycythemia vera (PV). In accordance with the 2001-2008 criteria put forth by World Health Organization, we reviewed the medical records of 207 patie...
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Human Papilloma Virus Infection and Anal Cancer in Kidney Transplant Recipient
Kmar Mnif,
Soumaya Yaich,
Fatma Fendri,
Abdelrahmen Masmoudi,
Khaled Charfeddine,
Khawla Kammoun,
Jamil Hachicha,
Mohamed Ben Hmida
Issue:
Volume 7, Issue 5, September 2019
Pages:
60-63
Received:
5 February 2019
Accepted:
11 March 2019
Published:
16 October 2019
Abstract: Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and causes anal cancer. The incidence of HPV infections in renal transplant recipients is 17% to 45%. Using immunosuppression treatment has been associated with significantly lower risks of de novo malignancies and viral infections after kidney transplantation. We reported the results of switching Tacrolimus to Sirolimus in a kidney transplant recipient who suffered from severe cutaneous warts.
Abstract: Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and causes anal cancer. The incidence of HPV infections in renal transplant recipients is 17% to 45%. Using immunosuppression treatment has been associated with significantly lower risks of de novo malignancies and viral infections after kidney ...
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Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade
Gabriel Aranalde,
Román Martinez Lorenzin,
Martín Cánaves,
Cielo Gomez,
Domingo Cera
Issue:
Volume 7, Issue 5, September 2019
Pages:
118-123
Received:
23 July 2019
Accepted:
21 August 2019
Published:
4 September 2019
Abstract: The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and Effler in 1954. Even when most patients are asymptomatic, constrictive pericarditis or cardiac tamponade may be referred. Cardiac tamponade, the most serious complication, represents an entity characterized by fluid accumulation in the pericardial cavity. Claudius Galen from Pergamum (131-201 D. C.) described pericardial effusions in gladiators with stab injuries of the chest and Richard Lowe (1669) described its physiology. It took two hundred years for the term "cardiac tamponade" was coined by german surgeon Edmund Rose. Cardiac tamponade can be presented from asymptomatic setting to life-threatening conditions. By the former reason, the early recognition of this entity has crucial importance. Idiopathic chylopericardium occurs in all age groups and affects both sexes equally. Although several mechanisms have been proposed in order to explain the development of chylopericardium, the underlying pathophysiology remains unclear. Damaged lymphatic vessels with abnormal communication of the thoracic duct to the pericardial lymphatics and elevated pressure in the thoracic duct can justify the presence of chyle into the pericardial sac. Diagnosis is confirmed by pericardiocentesis which must reveal at least two of the classical five criteria. Chylopericardium may be managed through conservative or surgical treatment. The conservative treatment consist a medium chain triglyceride diet or total parenteral nutrition but has a high degree of recurrence, for which reason the safest option is thoracic duct ligation with a pericardial window. The present study reports a case of chylopericardium wherein the leak was diagnosed by lymphoscintigraphy that was successfully treated by a low-fat diet, rich in medium-chain triglycerides and octreotide infusion.
Abstract: The chylopericardium is defined as the accumulation of chylous fluid containing high concentrations of triglycerides in the pericardial space. It is quite an uncommon condition first described in 1888 by Hasebroek. The absence of an underlying etiology defines it as primary idiopathic chylopericardium, term initially used in a study by Groves and E...
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Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma
Naga Srinivas Sirikonda,
Abdulmonam Ali
Issue:
Volume 7, Issue 5, September 2019
Pages:
124-126
Received:
29 August 2019
Accepted:
21 September 2019
Published:
10 October 2019
Abstract: Sarcoidosis and other forms of co-existing granulomatous inflammation have been previously reported to occur along with bronchogenic carcinoma although rare. In addition, sarcoidosis has been reported as an independent risk factor for development of lung cancer. The histological findings of granulomatous inflammation can be misleading in patients with lung nodules and especially with a high pretest probability of lung cancer. We report a case of middle age Caucasian female with smoking history and obstructive lung disease who presented with multiple spiculated pulmonary nodules in both upper lobes. Pretest probability of lung cancer was high in this patient because of smoking history, location (upper lobe), appearance (spiculation) and abnormal Positron Emission Tomography (PET) scan. Initial needle biopsy by interventional radiologist revealed non-caseating granulomatous inflammation without any malignant cells leading to diagnosis of sarcoidosis. But patient underwent surgical lung biopsy because of no response to steroids that revealed the diagnosis of adenocarcinoma. Surgical lung biopsies also revealed coexisting granulomatous inflammation in the vicinity of the malignancy changes. It is difficult to establish whether the sarcoid finding in this case is an immunogenic reaction to malignancy or a precursor for malignancy. Sarcoid like reaction can rarely be seen in bronchogenic carcinoma misleading the diagnosis at times.
Abstract: Sarcoidosis and other forms of co-existing granulomatous inflammation have been previously reported to occur along with bronchogenic carcinoma although rare. In addition, sarcoidosis has been reported as an independent risk factor for development of lung cancer. The histological findings of granulomatous inflammation can be misleading in patients w...
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Atopic Dermatitis and Excessive Daytime Sleepiness: Analysis of Data from 8362 Adult Subjects in a Sub-Saharan Africa Country
Eric Walter Pefura-Yone,
Adamou Dodo Balkissou,
Amadou Djenabou,
Virginie Poka-Mayap,
Christopher Kuaban
Issue:
Volume 7, Issue 5, September 2019
Pages:
127-131
Received:
8 September 2019
Accepted:
26 September 2019
Published:
11 October 2019
Abstract: Sleep disorders in patients with atopic dermatitis (AD) are common and can have a negative impact on the quality of life of the affected subjects. Very little data are available on the association between AD and excessive daytime sleepiness (EDS) in adults. The objective of this study was to compare the prevalence of EDS in subjects with AD and those without AD, and to investigate the determinants of EDS in adults with AD. In this cross-sectional population-based study conducted from 2015 to 2018 in Cameroon, adult subjects aged at least 19 years were included by multi-level stratified random sampling. AD was defined as the presence of a chronic itchy dermatitis evolving intermittently over a period of at least 6 months and electively affecting certain areas (fronts of the elbows, back of the knees, front of the ankles, under the buttocks, around the neck, around the eyes or ears) during the last 12 months preceding the survey. EDS was defined by an Epworth score≥10. Logistic regression was used to investigate the independent association between EDS and AD. A difference was considered significant if p<0.05. A total of 8362 subjects (55.2% women) with median age (25th-75th percentiles) of 39 (27-54) years were included. There were 217 subjects (2.6%) with AD and 1022 subjects (12.2%) with EDS. The prevalence of EDS was higher in subjects with AD than in those without AD (22.1% vs. 12%, p<0.001). In multivariate analysis integrating potential confounders (area of recruitment, age, education level, body mass index, association with other allergic diseases), AD remained independently associated with EDS with an adjusted odds ratio (95% CI) of 2.18 (1.54-3.08). No independent associated factors to EDS were found in subjects with AD. There is an independent association between EDS and AD, and nearly one quarter of patients with AD has EDS in this setting. It is necessary to consider the systematic evaluation of EDS in subjects with AD to optimize their management.
Abstract: Sleep disorders in patients with atopic dermatitis (AD) are common and can have a negative impact on the quality of life of the affected subjects. Very little data are available on the association between AD and excessive daytime sleepiness (EDS) in adults. The objective of this study was to compare the prevalence of EDS in subjects with AD and tho...
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Advantage of B-ultrasound Guidance in Indwelling Needle Puncture of External Jugular Vein for Patients in General ICU
Su Qing,
Guo Xiaoxia,
Lv Weitao,
Huang Guohua
Issue:
Volume 7, Issue 5, September 2019
Pages:
132-135
Received:
9 September 2019
Accepted:
4 October 2019
Published:
15 October 2019
Abstract: The paper aims to investigate the advantage of B-ultrasound guidance in indwelling needle puncture of external jugular vein in the emergency treatment for critical patients with microcirculation failure. We included 70 microcirculation failure patients induced by different factors and with unclear external jugular veins that were admitted to the general ICU from September 2018 to June 2019 and performed indwelling needle puncture on them. We used random number table to divide the patients into control group and observation group with 35 patients in each group. The control group received traditional indwelling needle puncture and the observation group was given B-ultrasound guided indwelling needle puncture. The success rate, time and cost of indwelling needle puncture of two groups were compared. In the control group, 31 out of 35 cases of indwelling needle puncture were successful. The success rate was 88.6% and the average time consumed in each case was (9.09±2.35) min; in the observation group, 35 out of 35 cases of indwelling needle puncture were successful. The success rate was 100% and the average time consumed in each case was (2.13±0.52) minutes. Statistically, the results of observation group were significantly better than those of the control group (P<0.01). In the emergency treatment for critical patients with microcirculation failure, compared with the doctor-guided central venous catheterization, B-ultrasound guided indwelling needle puncture of the external jugular vein has the advantages of high success rate and time efficiency so as to open the vein access for critical patients quickly and help them take the medicine timely, which reduces the pressure of nurses and is well worth clinical application.
Abstract: The paper aims to investigate the advantage of B-ultrasound guidance in indwelling needle puncture of external jugular vein in the emergency treatment for critical patients with microcirculation failure. We included 70 microcirculation failure patients induced by different factors and with unclear external jugular veins that were admitted to the ge...
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Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use
Swapnil Patel,
Mohammed Shariff,
Jay Shah,
Natasha Campbell,
Shreya Gor,
Anas Alrefaee,
Ijaz Khan,
Arman Mushtaq,
Mohamed Bakr,
Christian Kaunzinger,
Michael Carson,
Elliot Frank,
Mohammad Amir Hossain,
Kim Carpenter,
David Kountz,
Kenneth Sable,
Tushar Vachharajani,
Arif Asif,
Adam Kaplan
Issue:
Volume 7, Issue 5, September 2019
Pages:
136-140
Received:
12 September 2019
Accepted:
4 October 2019
Published:
16 October 2019
Abstract: Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. The study included two groups. The house-staff covered patients (the intervention group) received the intervention. The non-house-staff covered patients did not receive the intervention and served as the control group. The intervention included the implementation of American Heart Association cardiac monitoring guidelines, daily tele-census and indication evaluation, and discussion around telemetry status during multidisciplinary rounds. Data were collected from the pre- (90 day) and post intervention (90 day) periods for both groups. The intervention resulted in a 49% relative decrease in the average telemetry days in the intervention group (pre-intervention=5.7 days vs. post-intervention=2.9 days; p<0.001). The number of patients maintained on telemetry for >48 hours also decreased by 56% in the intervention group. Overall, there were 9 less tele patients/day during the post intervention phase occupying a high cost tele-bed in the intervention group ($8,141 saved/day) and there were 810 less tele patients for the duration of the study. A resident led intervention program reduced inappropriate use of telemetry and minimized costs without compromising patient safety.
Abstract: Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. The study included two groups. The house-staff covered patients (the intervention group) received the inter...
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