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Continuous 4 Percent Albumin Versus Intermittent 20 Percent Albumin in Adults with Septic Shock: A Prospective, Phase IV, Open-label Randomized Trial
Francis Schneider,
Vincent Castelain,
Guillaume Morel,
Anne-Florence Dureau,
Antoine Poidevin,
Pierre-Olivier Ludes,
Thibaut Fabacher,
Bernard Senger,
Nicolas Meyer,
Marie-Hélène Metz-Boutigue
Issue:
Volume 8, Issue 3, May 2020
Pages:
89-100
Received:
13 March 2020
Accepted:
30 March 2020
Published:
23 April 2020
Abstract: Whether a specific way of infusing albumin affects outcome in patients with major oxidative stress remains uncertain. To determine whether outcome measurements (survival, organ failure and care-related infections) are different according to different regimens of albumin infusion, we conducted a phase IV, randomized, open-label trial to compare the effects of continuous infusion of 4 percent albumin versus intermittent 20 percent albumin on outcome measurements in three third level-hospital intensive care unit (ICU) patients with septic shock. We randomly assigned 125 consecutive patients with septic shock when serum albumin became <20g/L. Patients received either 4 percent albumin (12.5mL/kg) continuously or 20 percent albumin (100mL over 1h/8h) intermittently (controls) until serum albumin ranged between 25 and 30g/L and norepinephrine could be weaned. The primary outcome measure was death from any cause during the 28-day period after randomization. The other outcome parameters were ICU- and hospital length of stay, serum albumin concentrations, SOFA score and lactate over the 4 days following inclusion, care-related infections and tolerance of albumin over the 28-day period after randomization. Data were analyzed with Bayesian methods. Of the 125 patients who underwent randomization, 63 received 4 percent albumin and 62 received 20 percent albumin; groups had balanced baseline characteristics. There were 19 deaths in the experimental group, as compared with 20 in the control group (Pr=0.40). The proportion of patients with new multiple-organ failure (assessed by daily SOFA) was similar in the groups (RR=0.71 [0.29-1.41], Pr=0.14). There were no differences in the medians [IQR]) numbers of days spent in the ICU (12.0 [7.5; 22.0] versus 13 [8.0; 24.5] days, Pr=0.23), in days spent within hospital (29.0 [10.5; 44.0] versus 24 [14.0; 46.8] days, Pr=0.32). In contrast, there were fewer patients with care-related infection in the study group, (14.3% versus 45.2%, Pr<0.001). Limitations concern lack of double blinding related to different regimens of infusion: this may impact results. To conclude, the continuous supply of 4 percent albumin in septic shock patients with serum albumin <20g/L decreases care-related infection (by two third) but does not result in better survival.
Abstract: Whether a specific way of infusing albumin affects outcome in patients with major oxidative stress remains uncertain. To determine whether outcome measurements (survival, organ failure and care-related infections) are different according to different regimens of albumin infusion, we conducted a phase IV, randomized, open-label trial to compare the ...
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The Effect of Experimental Periodontitis on the Serum Levels of Leptin and IL-18 in Insulin-Treated Diabetic Rats
Eudoxie Pepelassi,
Ioanna Xynogala,
Despina Perrea,
Alkistis Pantopoulou,
George Agrogiannis,
Ioannis Vrotsos
Issue:
Volume 8, Issue 3, May 2020
Pages:
101-106
Received:
8 March 2020
Accepted:
3 April 2020
Published:
30 April 2020
Abstract: The aim of this study in rats was to assess the effect of ligature-induced periodontitis on insulin-treated type 1 diabetes in terms of serum levels of leptin and interleukin-18 (IL-18). Twenty five male Wistar rats were studied, out of 40 initially used: (1) 14 rats with insulin-treated diabetes (control, DI) and (2) 11 rats with combination of insulin-treated diabetes and periodontitis (test, DIP). For all rats, type 1 diabetes was streptozotocin-induced and insulin treatment started on day 5. For DIP group, periodontitis was induced by ligation on day 16. Serum levels of leptin and IL-18 were assessed on days 16 (baseline) and 77 (final) by using multiplex immunoassay. All rats were sacrificed on day 77 (end of the study). Insulin treatment in the newly-induced diabetes significantly increased serum leptin levels and significantly reduced serum IL-18 levels. In the newly-induced diabetes, the combination of the continuation of insulin treatment and periodontitis non-significantly increased serum leptin and IL-18 levels. Serum IL-18 levels were significantly higher for the combination of periodontitis and insulin-treated diabetes as compared to insulin-treated diabetes alone. Within its limits, this study in rats showed that experimental periodontitis induced changes in serum biomarker levels suggestive of alterations in the systemic inflammation generated by insulin-treated type 1 diabetes.
Abstract: The aim of this study in rats was to assess the effect of ligature-induced periodontitis on insulin-treated type 1 diabetes in terms of serum levels of leptin and interleukin-18 (IL-18). Twenty five male Wistar rats were studied, out of 40 initially used: (1) 14 rats with insulin-treated diabetes (control, DI) and (2) 11 rats with combination of in...
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Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke
Wenzhu Liu,
Yanping Chen,
Xiafeng Wu,
Zefeng Tan
Issue:
Volume 8, Issue 3, May 2020
Pages:
107-112
Received:
29 March 2020
Accepted:
15 April 2020
Published:
30 April 2020
Abstract: Background and purpose—Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of BPV on a 3-month functional outcome in patients with acute ischemic stroke or TIA. Methods—In this prospective observational study, a consecutive series of 400 patients were enrolled with acute ischemic stroke or TIA within 7 days. All patients were referred and monitored for BP at 2-hour intervals in the first 24 hours. Afterward, the BP was recorded every four hours up to the 7th day, with 1-hour deviation the daytime and 2 hours at night. All BP results were recorded into an electronic medical record (EMR) system. Average real variability (ARV) was used to analyze the blood pressure variability (BPV). All patients were followed up as planned for 90 days. The primary outcome was evaluated by the modified Rankin Scale (mRS); an unfavorable outcome was mRS≥2. For comparison, patients were respectively divided into two groups based on systolic blood pressure ARV (SBP ARV) or diastolic blood pressure ARV (DBP ARV). A multivariate logistic regression model was used to estimate the effect of between ARV BPV on functional outcomes. Results—Among the 400 patients, 46 (11.4%) had an unfavorable outcome (mRS>2) at 90 days. Their mean 24h DBP ARV was significantly higher than others (10.42±3.63 vs. 9.83±4.27 mm Hg; p=0.03). The high 24hDBPARV was defined above the median of 7.75 mmHg, which was statistically associated with an unfavorable outcome (64.7% vs. 35.3%; P=0.004). Further stepwise logistic regression analysis indicated that 24h high DBPARV was the independent predictor of an unfavorable outcome (adjusted OR 2.44%, 95% confidence interval: 1.24-4.74, P<0.01). Conclusions—High DBPARV during the acute phase is an independent and significant predictor of 90-day functional outcome for ischemic stroke or TIA.
Abstract: Background and purpose—Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of B...
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Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic
Maria Jose Zabala Ramirez,
Robert Lichtenberg
Issue:
Volume 8, Issue 3, May 2020
Pages:
113-120
Received:
14 April 2020
Accepted:
29 April 2020
Published:
15 May 2020
Abstract: Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.
Abstract: Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 hear...
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Leukemia B Lymphoblastic Lymphoma in a Child: With t (9.22) and Hyperdiploidy
Sophia Kahouli,
Hafid Zahid,
Saâd El kabbaj,
Majid Benkirane,
Nezha Messaoudi
Issue:
Volume 8, Issue 3, May 2020
Pages:
121-124
Received:
22 March 2020
Accepted:
6 May 2020
Published:
19 May 2020
Abstract: Introduction: Non-Hodgkin's lymphoblastic B lymphoma with lymph node location is exceptional in children. Unlike acute lymphoblastic leukemia, which is the first cancer in children around the age of 3 with a favorable prognosis with a survival of 5 years in 90%. Observation: child, 15 years old. The hospital admission examination showed a febrile patient (40°C), bilateral cervical and inguinal polyadenopathies, the absence of hepatosplenomegaly. The hemogram at entry found bicytopenia made up of angerogenic anemia and thrombocytopenia. On the haematological level, there has been an evolution towards pancytopenia. A lymph node biopsy showed medullary infiltration with lymphoma cells of phenotype B. The karyotype found hyper diploidy with t (9.22). The patient was put on corticosteroid therapy, hyperhydration and (Allopurinol) followed by COP type chemotherapy (Cyclophosphamide, Oncovin, Prednisone) with good tolerance. A year later the patient presented with a feverish peak (40°C). Only a hematological relapse in the form of acute leukemia. Therapeutically, it was decided to re-induce the patient according to the GRAALL catch-up protocol (Idarubicin-Aracytine) and to propose it for an allograft of bone marrow, but unfortunately the patient died. Conclusion: Lymphoblastic lymphoma / Acute lymphoblastic leukemia B, associated with t (9; 22) and hyperdiploidy in children is an exceptional hemopathy and has a negative diagnosis.
Abstract: Introduction: Non-Hodgkin's lymphoblastic B lymphoma with lymph node location is exceptional in children. Unlike acute lymphoblastic leukemia, which is the first cancer in children around the age of 3 with a favorable prognosis with a survival of 5 years in 90%. Observation: child, 15 years old. The hospital admission examination showed a febrile p...
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Multicenter, Open-Label, Long-term Extension to Describe the Safety of Tocilizumab in Patients with Early, Moderate to Severe Rheumatoid Arthritis
Irena Kafedziska,
Snezhana Mishevska-Perchinkova,
Dubravka Antova,
Mimoza Kotevska Nikolova,
Anzhelika Stojanovska,
Filip Guchev
Issue:
Volume 8, Issue 3, May 2020
Pages:
125-132
Received:
2 May 2019
Accepted:
27 January 2020
Published:
28 May 2020
Abstract: Introduction: Biologic DMARDs (Disease Modifying Anti Rheumatic Drugs) have shown to be effective in the treatment of rheumatoid arthritis (RA) resistant to the use of synthetic DMARDs. The primary goal of this study was to assess the long-term safety of the use of tocilizumab in patients with early rheumatoid arthritis, moderate to severe disease activity. The secondary goal was to assess the efficiency of tocilizumab in achieving and maintaining clinical remission of the disease. Methods: ML28133 is a long-term, extended study of 13 patients with rheumatoid arthritis treated with tocilizumab. Two patients were male (15.4%), 11 (84.61%) female. The average age of patients was 53.27+/-10.68. Patients received 8 mg/kg tocilizumab i.v. every four weeks, 104 weeks overall. Safety was assessed following side effects, blood tests, physical examination and vital signs. Efficiency was assessed by achieving and maintaining clinical remission according to DAS28 (Disease Activity Score 28), global assessment of disease activity, VAS score and HAQ-DI (Health Activity Score) questionnaire. Results: Incidence of side effects was 76.92%. Infections were of special interest and were most common (15.3%). Four patients had serious adverse events, three of which associated with tocilizumab, and therapy was stopped. In 11 (84.6%) of the 13 treated patients clinical remission was achieved at times. At the end of the study, 8 out of 9 patients were in remission. Conclusion: The results have shown significant therapeutic effect of tocilizumab even in the most severe forms of the disease, which gives hope for its use as a monotherapy.
Abstract: Introduction: Biologic DMARDs (Disease Modifying Anti Rheumatic Drugs) have shown to be effective in the treatment of rheumatoid arthritis (RA) resistant to the use of synthetic DMARDs. The primary goal of this study was to assess the long-term safety of the use of tocilizumab in patients with early rheumatoid arthritis, moderate to severe disease ...
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Glycemic Control of Stroke Patients and Their Outcomes in a Comprehensive Stroke Center at a Tertiary Care Hospital: A Retrospective Cohort
Mohammad Amir Hossain,
Barbara Wyczesany,
Dwyer Jackie,
Swapnil Patel,
Khushboo Agarwal,
Rabail Soomro,
Brian Yung,
Arda Akoluk,
Stephen Martino,
Jennifer Cheng,
Raquel Ong,
Arif Asif
Issue:
Volume 8, Issue 3, May 2020
Pages:
133-137
Received:
17 April 2020
Accepted:
9 May 2020
Published:
28 May 2020
Abstract: Background: Diabetes mellitus is one of the major modifiable risk factors for having a stroke and those who present with a stroke are found to have hyperglycemia. The association between hyperglycemia and stroke has been found in an increasing number of studies. Evidence indicates that persistent in-hospital hyperglycemia during the first 24 hours after acute ischemic stroke (AIS) is associated with worse outcomes than normoglycemia. We conducted a retrospective chart review to see the glycemic control of stroke patients and their hospital outcome over a 3-month period as part of a pre-evaluation assessment to develop a hyperglycemia protocol in the stroke unit. Methods: Institutional review board approval was obtained for this study. A total of 142 patients with acute stroke admitted in the Comprehensive Stroke Center at Jersey Shore University Medical Center over a 3-month period were included in this study. Demographic characteristics, comorbidities, glycemic patterns at admission and throughout the hospital stay, types of stroke, length of stay, NIH (National Institutes of Health) stroke scale on admission and discharge, discharge disposition and outcome were reviewed retrospectively. Statistical analysis was performed by SPSS and a nova with tukey as post-hoc analysis. For the graph, we used prism and for the regression analysis, stat disk was used. Results: Average age of the patients was 73 years, with male predominance (54%). Average BMI of the patients was 28.2. Most of the patients had an ischemic stroke (73%). Major comorbidities were hypertension (88%), dyslipidemia (66%), and diabetes (36%). About 8 of 143 (6%) patients were newly diagnosed with diabetes. Average Hba1C was 6.5. For a detailed statistical analysis, we divided patients into three groups by their blood glucose levels ranging from 80-140 mg/dl in group 1, 140-180 mg/dl in group 2, and more than 180 mg /dl in group 3. Then, we compared the length of stay (LOS), NIH scale admission/discharge, types of stroke and discharge disposition within the three groups. This study showed that the NIH stroke scale on admission in group 3 (blood glucose >180mg/dl) was higher compared to group 1 (blood glucose 80-140 mg/dl), with a p value of <0.01. Length of stay was more in group 3 compared to group 1 and 2, with a P value < 0.08. Conclusion: Although this study limited by smaller patient groups, but it concludes that higher blood glucose level associated with higher NIH stroke scale at admission and during discharge and have increased length of stay which is consistent with other similar studies
Abstract: Background: Diabetes mellitus is one of the major modifiable risk factors for having a stroke and those who present with a stroke are found to have hyperglycemia. The association between hyperglycemia and stroke has been found in an increasing number of studies. Evidence indicates that persistent in-hospital hyperglycemia during the first 24 hours ...
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An Experimental Bacteriostasis of the Banxiaxiexin Decoction and 7 Kinds of Single Taste Traditional Chinese Medicine on Helicobacter Pylori Resistant Strains in Vitro
Zhiwei Qu,
Mingjun Yu,
Airong Zhang,
Ailin Wang,
Liyuan Shun
Issue:
Volume 8, Issue 3, May 2020
Pages:
138-142
Received:
19 April 2020
Accepted:
3 May 2020
Published:
28 May 2020
Abstract: Objectives: To research experimental bacteriostasis on the Banxiaxiexin decoction and 7 kinds of single taste Traditional Chinese Medicine (TCM) for Helicobacter pylori resistant strains in vitro. Methods: Collecting specimens of gastric mucosa in patients with upper gastrointestinal disease, separated and identified 8 strains of Hp resistant strains, the E-test methods of metronidazole and clarithromycin, drug resistance status of amoxicillin, selected eight strains of clinical drug resistance strains; Using liquid dilution method to determine the Banxiaxiexin decoction and 7 kinds of single Chinese medicine clinical drug-resistant strains of 8 strains of antibacterial effect in vitro. Results: Banxiaxiexin decoction MIC is 0.31 mg/ml, MIC of Radix scutellariae is 0.09 mg/ml, Rhizoma coptidis MIC 0. 16 mg/ml, Glycyrrhizin realness MIC 0. 31 mg/ml, Ginseng MIC 0. 75 mg/ml, there are four of seven kinds of single taste Traditional Chinese Medicine of TCM has bacteriostatic action, the order of antibacterial strength: Scutellaria baicalensis>Coptis chinesis>Glycyrrhizin realness >Ginseng, three kinds of Pinellia, Jujube and dry Zingibe in vitro for H. P ylori no inhibition, the method of MIC with liquid dilution in this decoction were determined, the decoction of resistant isolates average MIC isolates was 0.20±0.09mg/ml, the results showed that this decoction have stronger antibacterial effect on eight kinds of drug resistant strains in vitro. Banxiaxiexin decoction and 4kinds of single taste TCM have stronger antibacterial effect on drug resistant strains in vitro. Conclusion: Banxiaxiexin decoction and 4 kinds of single TCM have strong bacteriostatic effect on the bacteria resistance of Helicobacter pylori strains in vitro, therefore, we suggest that this decoction could be used as an effective method in the treatment of resistant HP associated gastritis.
Abstract: Objectives: To research experimental bacteriostasis on the Banxiaxiexin decoction and 7 kinds of single taste Traditional Chinese Medicine (TCM) for Helicobacter pylori resistant strains in vitro. Methods: Collecting specimens of gastric mucosa in patients with upper gastrointestinal disease, separated and identified 8 strains of Hp resistant strai...
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