Tag: pubmed

Rev Bras Ter Intensiva. 2021 Apr-Jun;33(2):290-297. doi: 10.5935/0103-507X.20210037.

ABSTRACT

OBJECTIVE: To analyze the impact of Resolution 2.173/2017 of the Federal Council of Medicine on results from the Central Estadual de Transplantes de Santa Catarina.

METHODS: This was a cross-sectional observational study of medical records of all patients (1,605) with suspected brain death notified to the Central Estadual de Transplantes de Santa Catarina; for this study, procedures to confirm this diagnosis were initiated between July 2016 and December 2017 and between January 2018 and June 2019. The median duration of the protocol in each period was considered for the comparison between the intervals. The collected data were transformed into rates (per million population). The mean rates for the periods before and after the implementation of the protocol were analyzed by Student’s t-test, and qualitative variables were analyzed by Pearson’s chi-squared test.

RESULTS: The mean duration of brain death confirmation procedures decreased more than 1 hour in the second period compared to the first period, with statistical significance (p = 0.001). The rates of harvested livers and transplanted pancreas, the number of notifications by hospital size and the rate of cardiac arrest in the macro-region of the Itajaí Valley were significantly different between the two periods.

CONCLUSION: In the period after the new resolution on brain death, there was a reduction in the duration for diagnosis. However, other indicators did not change significantly, providing evidence for the multidimensional nature of the organ transplantation process in Santa Catarina and the need for further studies to better understand and optimize the process.

PMID:34231810 | DOI:10.5935/0103-507X.20210037

Rev Bras Ter Intensiva. 2021 Apr-Jun;33(2):304-311. doi: 10.5935/0103-507X.20210039.

ABSTRACT

For extubation in pediatric patients, the evaluation of readiness is strongly recommended. However, a device or practice that is superior to clinical judgment has not yet been accurately determined. Thus, it is important to conduct a review on the techniques of choice in clinical practice to predict extubation failure in pediatric patients. Based on a search in the PubMed®, Biblioteca Virtual em Saúde, Cochrane Library and Scopus databases, we conducted a survey of the predictive variables of extubation failure most commonly used in clinical practice in pediatric patients. Of the eight predictors described, the three most commonly used were the spontaneous breathing test, the rapid shallow breathing index and maximum inspiratory pressure. Although the disparity of the data presented in the studies prevented statistical treatment, it was still possible to describe and analyze the performance of these tests.

PMID:34231812 | DOI:10.5935/0103-507X.20210039

Rev Bras Epidemiol. 2021 Jun 30;24:e210025. doi: 10.1590/1980-549720210025. eCollection 2021.

ABSTRACT

OBJECTIVE: To assess mortality during the COVID-19 pandemic according to social vulnerability by areas of Belo Horizonte (BH), aiming at strategies for vaccination.

METHODS: Ecological study with mortality analysis according to census tracts classified by the Health Vulnerability Index, a composite indicator that includes socioeconomic and sanitation variables. Deaths by natural causes and by COVID-19 were obtained from the “Mortality Information System”, between the 10th and 43rd epidemiological weeks (EW) of 2020. Excess mortality was calculated in a time series model, considering observed and expected deaths per EW, between 2015 and 2019, per census tracts. Mortality rates (MR) were calculated and age-standardized using population estimates from the 2010 census, by the Brazilian Institute of Geography and Statistics (IBGE).

RESULTS: Excess mortality in BH was 16.1% (n = 1,524): 11, 18.8 and 17.3% in low, intermediate and high vulnerability areas, respectively. The differences between observed and expected age-standardized MR by natural causes were equal to 59/100,000 inhabitants in BH, increasing from 31 to 77 and 95/100,000 inhabitants in the areas of low, intermediate and high vulnerability, respectively. There was an aging gradient in MR by COVID-19, ranging from 4 to 611/100,000 inhabitants among individuals aged 20-39 years and 75+ years. The COVID-19 MR per 100,000 older adults (60+ years) was 292 in BH, increasing from 179 to 354 and 476, in low, intermediate and high vulnerability areas, respectively.

CONCLUSION: Inequalities in mortality, particularly among older adults, combined with the limited supply of doses, demonstrate the importance of prioritizing socially vulnerable areas during vaccination against COVID-19.

PMID:34231827 | DOI:10.1590/1980-549720210025

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S358. doi: 10.14701/ahbps.EP-159.

ABSTRACT

INTRODUCTION: The systemic inflammation response index (SIRI, neutrophil x monocyte/lymphocyte) is emerged in predicting oncological prognosis in various type of cancer. We investigated to examine whether SIRI is significant as a prognostic factor even in neo-adjuvant settings, and whether changes in SIRI values after neo-adjuvant chemotherapy are related to prognosis.

METHODS: Medical records were investigated retrospectively about patients underwent pancreatic surgery following neo-adjuvant chemotherapy for pancreatic cancer, from 2006 to 2019. All 160 patients were investigated. In order to find the meaningful SIRI values and their changes, values of division and as well SIRI pre-neoadjuvant and SIRI post-neoadjuvant were calculated. Among calculated SIRI values, statistically significant SIRI values were found using statistical techniques to determine the effect on the survival rate.

RESULTS: The value of SIRI post-neoadjuvant < 0.8710 affected the prognosis of patients in the univariate* and multivariate analysis** (p-value* = 0.0317, p-value** = 0.0066). The value of ΔSIRI < 0.9516 affected the prognosis of patients in the univariate* and multivariate analysis** (p-value* = 0.0380, p-value** = 0.00462). In Kaplan-Meier curve, the disease free survival was significantly different between the group of SIRI post-neoadjuvant < 0.8710 and SIRI post-neoadjuvant ≥ 0.8710 (p = 0.0303). The overall survival was significantly different between the group of SIRI post-neoadjuvant/pre-neoadjuvant < 0.9516 and SIRI post-neoadjuvant/pre-neoadjuvant ≥ 0.9516 (p = 0.0368).

CONCLUSIONS: An SIRI can be used to predict the survival of patients with pancreatic cancer after pancreatic resection following neo-adjuvant chemotherapy.

PMID:34230422 | DOI:10.14701/ahbps.EP-159

JBI Evid Synth. 2021 Jul 6. doi: 10.11124/JBIES-20-00257. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this review is to investigate the association between the use of cardiovascular medicines and the risk of mild cognitive function impairment and dementia in people with cardiovascular disease.

INTRODUCTION: Cardiovascular disease is one of the most important modifiable factors for mild cognitive function impairment and dementia. The current evidence about the effectiveness of cardiovascular disease medicine on the risk of dementia is inconclusive; hence, it is imperative to conduct a comprehensive investigation on the effect of cardiovascular disease medicine on the risk of mild cognitive function impairment and dementia.

INCLUSION CRITERIA: This review will include studies involving participants (age ≥18 years) who were using cardiovascular medicine for hypertension, myocardial infarction, atrial fibrillation, stroke, or heart failure. The eligible studies will include observational studies and randomized controlled trials.

METHODS: MEDLINE (Ovid), Embase (Ovid), and PsycINFO (Ovid) will be searched from 2000 to the present. We will only include studies published in English. Title, abstracts, and full texts will be screened by authors independently. The methodological quality of included studies will be assessed using the JBI critical appraisal checklist for observational studies and randomized controlled trials. The data to be extracted will include the basic study characteristics, populations, drug groups, clinical indicators, and outcomes. Studies will be pooled using statistical meta-analysis, where possible. Alternatively, the findings will be presented in narrative form where statistical pooling is not possible.

SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175386.

PMID:34230444 | DOI:10.11124/JBIES-20-00257

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S350. doi: 10.14701/ahbps.EP-152.

ABSTRACT

INTRODUCTION: Pancreatic cancer has an extremely poor prognosis. Adjuvant chemotherapy is recommended for patients with resected pancreatic cancer. However, optimal adjuvant therapy for resected pancreatic cancer remains controversial. This study aimed to evaluate the efficacy of adjuvant chemotherapy according to the cancer status.

METHODS: We assessed a 253 patients with pancreatic ductal adenocarcinoma who underwent surgery in between January, 2011 and August, 2019 at Kyungpook National University Chilgok Hospital. Among 253 patients, 132 patients with R0 resection and no prior radiation or chemothrapy were retrospectively analyzed.

RESULTS: Of the 132 patients analyzed, 67 (50.8%) were men and 65 (49.2%) were women and the median age was 67 (42-85). Overall median survival was 21.8 months. Fifty-seven patients (43.2%) received adjuvant chemotherapy, whereas 75 (56.8%) did not receive adjuvant cheomtherapy after surgery. Although not statistically significant, patients who received chemotherapy seemed to be improved median OS compared with surgery alone (25.6 versus 17.4 months, p = 0.077). Strtified by different lymph node status, the benefit of adjuvant chemotherapy was only seen among the patients with nodal metastasis (HR = 1.78, 95% CI, 1.11-2.87; p = 0.018).

CONCLUSIONS: This study suggests adjuvant chemotherapy for resected pancreatic cancer is associated with improved survival in selected patients. Adjuvant chemotherapy seems to favorably impact on overall survival for resected pancreatic cancer with nodal metastasis.

PMID:34230415 | DOI:10.14701/ahbps.EP-152

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S354. doi: 10.14701/ahbps.EP-156.

ABSTRACT

INTRODUCTION: Postoperative pancreatic fistula (POPF) is one of the most critical complications following pancreatic surgery. The aim of this study was to evaluate selective use of prophylactic octreotide for patients stratified by their individual risks of POPF.

METHODS: From June 2019 to July 2020, a total of 243 patients underwent pancreatoduodenectomy with pancreatojejunostomy in Samsung Medical Center. Individual POPF risk scores were calculated with previously developed nomogram and clinicopathological data of the patients were retrospectively reviewed.

RESULTS: There were 81 patients in low-risk group and 182 patients in high-risk group. No statistically significant differences were found in clinically relevant POPF (CR-POPF) rates between the control group and the octreotide group in both low- (3.0% vs. 7.1%, p = 0.439) and high- (23.6% vs. 16.1%, p = 0.206) risk groups. In risk factor analyses, postoperative use of octreotide was not an independent risk factor for CR-POPF in all (p = 0.897) patients, low- (p = 0.436), and high- (p = 0.614) risk group. Drain fluid amylase on the first postoperative day was significantly correlated with CR-POPF, regardless of individual risks.

CONCLUSIONS: Selective use of octreotide, even in high risk patients, showed no protective effect against POPF. Routine use of postoperative octreotide would not be recommended.

PMID:34230419 | DOI:10.14701/ahbps.EP-156

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S338. doi: 10.14701/ahbps.EP-140.

ABSTRACT

INTRODUCTION: Acute cholecystitis is a major complication of biliary lithiasis. Cholecystectomy is the gold standard treatment for gallbladder disease. According to the 2015 Statistics Office in Korea, 4.51% of the population is aged 80 to 89 years and 0.3% is aged 90 to 99 years. The safety and feasibility of cholecystectomy in octogenarians have been proven in many studies. In this study, we aimed to assess the outcomes of cholecystectomy in octogenarians and nonagenarians with acute cholecystitis.

METHODS: A total of 393 patientsaged 80 to 89 years (352 octogenarians) and 90 to 99 years (41 nonagenarians) diagnosed with acute cholecystitis underwent cholecystectomy between March 2012 and June 2020. All patients were classified according to the Tokyo guidelines. The evaluated parameters included demographic data, surgical outcomes, American Society of Anesthesiologists score (ASA), and Tokyo guidelines. All data were analyzed with SPSS ver. 1.0.0.1406.

RESULTS: All 393 patients were analyzed and divided into two groups according to age: octogenarians (83.57 ± 2.64 years) and nonagenarians (92.98 ± 3.15 years). The survival rate was 97.7% for octogenarians and 97.6% for nonagenarians. Laparoscopic surgery was performed more in both groups (96.8% in octogenarians and 92.7% in nonagenarians) than open surgery (3.2% in octogenarians and 7.3% in nonagenarians). The incidences of postoperative complications in the octogenarian and nonagenarian groups were as follows: pneumonia, 5.7% and 7.3%; bleeding, 1.7% and 2.4%; gastrointestinal symptoms, 6.0% and 2.4%.

CONCLUSIONS: Cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in both octogenarians and nonagenarians.

PMID:34230403 | DOI:10.14701/ahbps.EP-140

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S339. doi: 10.14701/ahbps.EP-141.

ABSTRACT

INTRODUCTION: Statins are widely prescribed both for primary and secondary prevention of cardiovascular diseases. Preclinical studies indicate that statins have anticancer properties. Epidemiological studies have shown that statin use is associated with decreased risks of various cancer and cancer related mortality. We performed a meta-analysis of all existing studies investigating the association between statin use and the risk of developing cholangiocarcinoma (CCA), which to the best of our knowledge is the first meta-analysis on this issue.

METHODS: A comprehensive literature search for articles and abstracts published up to June 2020 was carried out. For inclusion, studies had to report odds ratio (OR), relative risk, or hazard ratio, with 95% confidence interval (CI). Pooled adjusted ORs with corresponding 95% CIs were calculated using random effects model. Publication bias was assessed through Egger’s test and Begg test. Heterogeneity was accessed by means of the I2 value.

RESULTS: Five observational studies were included in our analysis, with 8,450 CCA subjects and 978,008 healthy controls. Administration of statins significantly reduced the incidence of CCA (OR = 0.79, 95% CI: 0.73-0.86, p = 0.0001). No heterogeneity was found in the study (I² = 46%, p = 0.12). No evidence of publication bias was observed in this meta-analysis.

CONCLUSIONS: Our study shows statistically significant association between the use of statins and 0.79-fold decreased risk of CCA.

PMID:34230404 | DOI:10.14701/ahbps.EP-141

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S349. doi: 10.14701/ahbps.EP-151.

ABSTRACT

INTRODUCTION: Apart from bacterial infections Procalcitonin (PCT) also increases in burns, trauma, and surgery.

METHODS: In a prospective study 45 cases (30 male and 15 female) of hepatobiliary and gastrointestinal cancer were taken, which were undergone surgery. It included the cases without (34) and with (11) prior radiotherapy. TPO and PCT were measured (ELISA) on day-1 preoperatively and day-3 (D3) & 5 (D5) postoperatively.

RESULTS: At base level prior to surgery lower value of TPO was noted in the group not given RT (174.8 ± 98.2 pg/mL) than the group who were given (220.3 ± 120.7 pg/mL), although statistically insignificant (p-value 0.2). On D3, TPO value in the cases without RT was 287.2 ± 177.3 pg/mL and in the cases with RT, it was 472.6 ± 265.2 pg/mL, was statistically significant (p-value 0.01). On D5, TPO in patients without RT was 409.57 ± 318.34 pg/mL (further increased) & in cases with RT 585.00 ± 469.61 pg/mL (further increased), p-value 0.2, was statistically insignificant. The corresponding PCT preoperatively was 171.6 ± 563.7 pg/mL & 100.0 ± 42.08 pg/mL in the cases without RT & with RT respectively (p-value 0.2, statistically insignificant). On D3, PCT value was 668.56 ± 1,114.09 pg/mL and 400.63 ± 660.64 pg/mL in the cases without & with RT respectively; p-value 0.4, statistically insignificant. On D5, PCT was 265.54 ± 513.77 & 648.27 ± 1,771.99 pg/mL in cases without & with RT respectively; p-value 0.3, statistically insignificant.

CONCLUSIONS: – Higher TPO level after surgery or radiotherapy is indicator of better response. – TPO level may be indicator therapeutic response after radiotherapy or cancer surgery.

PMID:34230414 | DOI:10.14701/ahbps.EP-151