In the present era, post-ERCP pancreatitis (PEP) stands out as one of the most commonly occurring complications associated with endoscopic choledochal lithiasis extraction. The ability to predict the ...occurrence of such an event, particularly by utilizing absolute values and ratio dynamics of the emergency blood tests, constitutes the primary step in effectively managing a patient with a complex pathology. The study involved 134 patients who performed ERCP to extract choledochal lithiasis (n = 48 with PEP and n = 86 without PEP). The results revealed increased risks of post-ERCP pancreatitis in women and lower risks in those who benefited from manipulation of the main bile duct with the Dormia probe and dilatation balloon (OR: 2.893 CI 95%: 1.371–6.105, p = 0.005 and respectively OR: 0.346 CI 95%: 0.156–0.765, p = 0.009), without biliary stent placement. Moreover, the results brought novel elements to the literature, showing that higher values of CRPR (OR: 4.337 CI 95%: 1.945–9.668; p < 0.001), TBIR (4.004 CI 95%: 1.664–9.634; p = 0.002) and NLR post-ERCP (3.281 CI 95%: 1.490–7.221; p = 0.003) are predictive for PEP. Nevertheless, lower total bilirubin levels upon admission are predictive of PEP with an OR of 5.262 (95% confidence interval: 2.111–13.113, p < 0.001).
The prevalence of diabetes has increased dramatically over the past decade, especially in developing countries, reaching pandemic proportions. Although has been the most important factor influencing ...the prevalence of type 2 diabetes, the prevalence of type 2 diabetes is on the increase among younger adults. The subsequent rate of increase with age is variable, which is more evident in societies where the general prevalence of the disease is higher. Based on clinical and statistical data obtained from the patients who were admitted to The First and Second Surgery Wards in the Sibiu County Emergency University Clinical Hospital (Sibiu, Romania) and the Proctoven Clinic (Sibiu, Romania) between January 2018 and December 2020, the present study attempted to devise a risk score that can be applied for the benefit of patients. The ultimate aim was that this risk score may be eventually applied by diabetologists and surgeons to assess the risk of amputation in patients with diabetic foot lesions. An important part in the therapeutic management of diabetic foot injuries is the assessment of risk factors. Using this risk score system devised, the risk factors that were found to exert influence in aggravating diabetic foot injuries are smoking, obesity, dyslipidaemia, unbalanced diabetes mellitus (glycated haemoglobin greater than or equal to 7.5%), duration of diabetes >5 years, hepatic steatosis and the co-existence of various heart diseases. To conclude, all these risk factors aforementioned can decrease the effectiveness of treatment and can have a significant impact on the quality of life, if they are not well known. Key words: diabetic foot, risk factors, amputation
In a mutually beneficial connection with its host, the gut microbiota affects the host's nutrition, immunity, and metabolism. An increasing number of studies have shown links between certain types of ...disease and gut dysbiosis or specific microorganisms. Fecal microbiota transplantation (FMT) is strongly advised for the treatment of recurrent or resistant Clostridium difficile infection (CDI) due to its outstanding clinical effectiveness against CDI. The therapeutic potential of FMT for other disorders, particularly inflammatory bowel diseases and malignancies, is currently gaining more and more attention. We summarized the most recent preclinical and clinical evidence to show the promise of FMT in the management of cancer as well as complications related to cancer treatment after reviewing the most recent research on the gut microbiota and its relationship to cancer.
Background: Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement ...regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair. Methods: Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included. Results: Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications. Conclusions: Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience.
Hemorrhage is a detrimental event present in traumatic injury, surgery, and disorders of bleeding that can become life-threatening if not properly managed. Moreover, uncontrolled bleeding can ...complicate surgical interventions, altering the outcome of surgical procedures. Therefore, to reduce the risk of complications and decrease the risk of morbidity and mortality associated with hemorrhage, it is necessary to use an effective hemostatic agent that ensures the immediate control of bleeding. In recent years, there have been increasingly rapid advances in developing a novel generation of biomaterials with hemostatic properties. Nowadays, a wide array of topical hemostatic agents is available, including chitosan-based biomaterials that have shown outstanding properties such as antibacterial, antifungal, hemostatic, and analgesic activity in addition to their biocompatibility, biodegradability, and wound-healing effects. This review provides an analysis of chitosan-based hemostatic biomaterials and discusses the progress made in their performance, mechanism of action, efficacy, cost, and safety in recent years.
The study evaluated the effects of different starch sources on the coefficients of total tract apparent digestibility (CTTAD) of macronutrients, metabolizable energy (ME), intestinal fermentative ...metabolites, fecal microbiota, and postprandial glycemic response in dogs. Seven diets containing corn, brown rice, sorghum, potato starch, sweet potato flour, chickpea, and pea flour were evaluated. Fourteen adult Beagle dogs were randomly distributed in blocks (periods) and were fed the experimental diets for 15 days during three periods, totaling 6 repetitions. In general, diets with brown rice and pea had higher CTTAD of nutrients, followed by diets containing sorghum, chickpea, and potato. The diet containing sweet potato had the lowest CTTAD of nutrients. Diets containing corn and brown rice presented the highest ME content. Dogs fed the chickpea diet had lower fecal pH, ammonia concentration, and dry matter content (P < 0.05). Generally, higher fecal concentrations of short-chain fatty acids were observed in dogs fed the sweet potato and chickpea diets compared to the potato and brown rice diets (P < 0.05). Pulse-based diets resulted in a higher abundance of Bacteroides plebeius, Prevotella copri, Blautia, and Turicibacter in feces (P < 0.05). A higher abundance of Faecalibacterium prausnitzii and Blautia was observed in the feces of dogs fed the sweet potato diet (P < 0.05). Blood samples collected from dogs fed corn and potato diets indicated a greater increase in glycemic peak concentration and maximum glycemia than the other starch sources (P < 0.05). The period until the glycemic peak was longer for diets containing sorghum and chickpea (P < 0.05). The results obtained in this study showed that sweet potato and pulses improve indicators of gastrointestinal functionality, and help controlling the postprandial glycemic response in dogs.
•Corn and potato diets may increase the glycemic peak in dogs.•Sweet potato and pulses may control the glycemic response of dogs.•Sweet potato and pulses may improve the gut functionality of dogs.
Monitoring of hormonal control represents a key part of the management of congenital adrenal hyperplasia (CAH). Monitoring strategies remain suboptimal because they rely on frequent blood tests and ...are not specific for adrenal-derived hormones. Recent evidence suggests the crucial role of adrenal-specific 11-oxygenated-C19 androgens in the pathogenesis of CAH.
To establish a correlation between plasma and salivary adrenal-specific androgens in CAH as a noninvasive monitoring strategy.
This prospective cross-sectional study recruited patients between 2015 and 2018.
Multicenter study including 13 tertiary centers in the United Kingdom.
Seventy-eight children with CAH and 62 matched healthy controls.
Using liquid chromatography-tandem mass spectrometry, plasma and salivary concentrations of five steroids were measured: 17-hydroxyprogesterone (17OHP), androstenedione (A4), testosterone (T), 11-hydroxyandrostenedione (11OHA4), and 11-ketotestosterone (11KT). The correlation between plasma and salivary steroids was analyzed to assess their use in clinical practice.
Strong correlations between plasma and salivary steroid concentrations in patients with CAH were detected: 17OHP (rs = 0.871; P < 0.001), A4 (rs = 0.931; P < 0.001), T (rs = 0.867; P < 0.001), 11OH4A (rs = 0.876; P < 0.001), and 11KT (rs = 0.944; P < 0.001). These results were consistent for patient subgroups based on sex and age. Analysis of patient subgroups based on 17OHP concentrations established clear correlations between plasma and salivary concentrations of the adrenal-specific androgen 11KT.
The current study identified tight correlations between plasma and saliva for the adrenal-derived 11-oxygenated C19 androgen 11KT, as well as 17OHP and A4, which are widely used for monitoring treatment in CAH. This combination of steroid hormones will serve as an improved noninvasive salivary test for disease monitoring in patients with CAH.
ABSTRACT This paper aims the identification of the Organization Designation Authorization (ODA) regulatory approaches adopted by the United States, using the Boeing 737 MAX 8 certification process as ...a basis, by revising the ODA’s certification role and what can be enhanced on the ODA program, considering the data from the Federal Aviation Administration (FAA), the U.S. Department of Transportation, AND the Office of Inspector General (OIG), and comparing them to the regulatory basis in Europe and in Brazil. An assessment of undue pressure on ODA Unit members and other aspects, such as conflicting restraints, analysing their consequences and roles for the process’ safety, is presented, as well as a comparison with the independent design assurance system adopted by the other two agencies. Therefore, the discussion around the ODA’s aircraft certification processes highlights the ODA model drawbacks, and what can be learned from other models to improve it, so the industry and the society can fully benefit from this system.
Abstract
Context
Quality of life (QoL) has been inconsistently reported in children and young people (CYP) with congenital adrenal hyperplasia (CAH).
Objective
Assess QoL in CYP with CAH in the UK ...alongside biometric and androgen profiles.
Design
To define the evidence base for health care delivery, we conducted a cross-sectional study in CYP with CAH in the UK. Questionnaire results were compared with normative data and between groups, and modelled for association with sex, height, weight, body mass index, or steroid biomarkers of CAH control.
Setting
Tertiary care in 14 UK centers.
Patients
Results from 104 patients, 55% female, mean age 12.7 years (SD 3.0), paired responses from parents.
Interventions
Strengths and Difficulties questionnaire (SDQ) and pediatric QoL questionnaire.
Main Outcome Measure
Total QoL scores as assessed by SDQ and a pediatric QoL questionnaire in comparison to normative data.
Results
Total scores were worse in parents than normative data, but similar in patients. Patient QoL was rated better in social functioning but worse in emotional, school, and peer domains by patients, and worse in total scores and domains of peer problems, and psychosocial, emotional, and school functioning by parents. Parents consistently scored QoL of their children lower than their child. Larger height-SD score and lower weight-SD score were associated with better QoL. Girls with lower steroid biomarkers had worse SDQ scores.
Conclusions
In CYP with CAH, reduced height, increased weight, and hormonal biomarkers consistent with overtreatment were associated with worse QoL; addressing these problems should be prioritized in clinical management.
Clinical Trials Registration Number: SCH/15/088
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