Summary
Background
Chronic kidney disease is a common comorbidity in elderly patients with heart failure. Evidence supports the use of angiotensin inhibitors for patients with heart failure. However, ...there is little evidence with which to assess the risk and benefits of this treatment in elderly patients with renal dysfunction.
Objective
To determine the efficacy and safety of angiotensin inhibitor reduction in patients with heart failure, chronic kidney disease and anaemia.
Study design
Open randomized controlled clinical trial.
Setting
Complexo Hospitalario Universitario A Coruña (Spain).
Patients
Patients ≥ 50 years old, with heart failure, haemoglobin (Hb) < 12 mg/dl and creatinine clearance <60 ml/min/1.73 m2 admitted to hospital, in treatment with angiotensin inhibitors. Informed consent and Ethical Review Board approval were obtained.
Intervention
A 50% reduction of angiotensin inhibitor dose of the basal treatment on admission (n = 30) in the intervention group. Control group (n = 16) with the standard basal dose.
Main outcome measure
Primary outcome was difference in Hb (gr/dl), creatinine clearance (ml/min/1.73 m2) and protein C (mg/dl) between admission and 1–3 months after discharge. Secondary outcome was survival at 6–12 months after discharge.
Results
Patients in the intervention group experienced an improvement in Hb (10.62–11.47 g/dl), creatinine clearance (32.5 ml/min/1.73 m2 to 42.9 ml/min/1.73 m2), and a decrease in creatinine levels (1.98–1.68 mg/dl) and protein C (3.23 mg/dl to 1.37 mg/dl). There were no significant differences in these variables in the control group. Survival at 6 and 12 months in the intervention and control group was 86.7% vs. 75% and 69.3% vs. 50%, respectively.
Conclusion
The reduction of the dose of angiotensin inhibitors in the intervention group resulted in an improvement in anaemia and kidney function, decreased protein C and an increased survival rate. Trial registration: EudraCT: 2008‐008480‐10.
Abstract We present the largest optical photometry compilation of Gamma-Ray Bursts (GRBs) with redshifts (z). We include 64813 observations of 535 events (including upper limits) from 28 February ...1997 to 18 August 2023. We also present a user-friendly web tool grbLC which allows users to visualise photometry, coordinates, redshift, host galaxy extinction, and spectral indices for each event in our database. Furthermore, we have added a Gamma-ray Coordinate Network (GCN) scraper that can be used to collect data by gathering magnitudes from the GCNs. The web tool also includes a package for uniformly investigating colour evolution. We compute the optical spectral indices for 138 GRBs, for which we have at least 4 filters at the same epoch in our sample, and craft a procedure to distinguish between GRBs with and without colour evolution. By providing a uniform format and repository for the optical catalogue, this web-based archive is the first step towards unifying several community efforts to gather the photometric information for all GRBs with known redshifts. This catalogue will enable population studies by providing light curves (LCs) with better coverage since we have gathered data from different ground-based locations. Consequently, these LCs can be used to train future LC reconstructions for an extended inference of the redshift. The data gathering also allows us to fill some of the orbital gaps from Swift in crucial points of the LCs, e.g., at the end of the plateau emission or where a jet break is identified.
The Safe Practice of Female Genital Plastic Surgery Furnas, Heather J.; Canales, Francisco L.; Pedreira, Rachel A. ...
Plastic and reconstructive surgery. Global open,
07/2021, Letnik:
9, Številka:
7
Journal Article
Recenzirano
Odprti dostop
The purpose of this article is to guide surgeons in the safe practice of female genital plastic surgery when the number of such cases is steadily increasing. A careful review of salient things to ...look for in the patient’s motivation, medical history, and physical examination can help the surgeon wisely choose best candidates. The anatomy is described, with particular attention given to the variations not generally described in textbooks or articles. Descriptions are included for labiaplasty, including clitoral hood reduction, majoraplasty, monsplasty, and perineoplasty with vaginoplasty. Reduction of anesthetic risks, deep venous thromboses, and pulmonary emboli are discussed, with special consideration for avoidance of nerve injury and compartment syndrome. Postoperative care of a variety of vulvovaginal procedures is discussed. Videos showing anatomic variations and surgical techniques of common female genital procedures with recommendations to reduce the complication rate are included in the article.
Abstract
Background
The evaluation of the small bowel (SB) in known Crohn’s disease (kCD) has a significant impact on prognosis with potential therapeutic implications. The treat-to-target strategy ...is widely accepted, emphasizing that endoscopic healing is associated with improved long-term outcomes. Although capsule endoscopy (CE) shows promise in monitoring the small bowel in kCD, there is limited evidence supporting routine use. The aim of this study was to investigate clinical utility of CE to assess activity and extension of kCD and to evaluate whether the results of CE modify the therapeutic decisions.
Methods
We conducted a single center retrospective cohort study. Adult patients submitted to CE for kCD from Nov-2012 to Nov-2023 were included. Data on demography, previous research, medications for IBD and follow-up were analyzed. Univariate analysis was carried out to identify CE features associated with changes in therapeutic management. A p value <0.05 was considered statistically significant.
Results
A total of 572 CE protocols were performed, of which 76 were in kCD adult patients. The mean age was 36 years (range 16–76), 59% were males and median disease duration was 5.4 years. The CE reached the cecum in 97% and retention was observed in only two patients (2.6%) without necessity of surgical removal. Thirty two of 76 CE protocols (42%) had findings consistent with mucosal activity of CD. The lesions identified by CE included ulcers 30 (39%), erythema and villous edema 21 (28%), stenosis 2 (3%) and were distributed mainly in the distal part of the SB (3rd tertile) in 27 (35%), but in 15 (20%) the proximal SB (1st and 2nd tertile) was also affected. The mean Lewis Score (LS) was 576 (135-5392). Normal or clinically insignificant inflammatory changes (LS <135) ruled out SB mucosal activity in 44 (58%) patients. The results of the CE modified therapeutic decisions in 29 (38%) patients as follows: 17 were started new biological therapy and 7 were optimized. CEs consistent with mucosal inflammatory activity (LS ≥135) were more frequently associated with changes in therapeutic management (OR: 11, 95% CI 4-35, p: 0.04). When both magnetic resonance enterography (MRE) and CE were utilized to assess SB mucosal activity, diagnostic yields of MRE and CE were 45% and 42% respectively. But of the 8 patients with proximal SB affected in CE, only 1 showed inflammatory activity in the MRE.
Conclusion
In our cohort, CE in patients with kCD added valuable clinical information and had a great impact on therapeutic decisions. These results suggest that CE could be incorporated into the treat-to-target strategy for patients with CD. However, randomized controlled trials are required to confirm this recommendation.
The prevalence of drug resistance mutations was 12.1% among 198 persons who experienced human immunodeficiency virus (HIV) seroconversion identified in Spain during 1997–2004. There was a significant ...increase of K103N and of non-B subtypes over time. Transmission of HIV infection around the time of seroconversion was shown in 8 couples and in 2 clusters of 3 individuals.
Introduction
Etravirine has become an alternative in HIV/HCV coinfected patients because of safety and lack of interactions with anti‐HCV drugs. The aim of this study was to establish the risk of ...liver toxicity in HIV/HCV coinfected patients receiving etravirine in the clinical setting, according to the degree of liver fibrosis and different accompanying drugs.
Material and Methods
Cohort study of 211 patients initiating etravirine as part of their antiretroviral regimen. HCV coinfection was defined as a positive RNA‐HCV, whereas baseline liver fibrosis was assessed by transient elastography at baseline. Hepatotoxicity was defined as an increased AST/ALT, 5‐fold higher over upper, normal limits for patients with normal baseline values, or 3.5‐fold if altered at baseline.
Results
HCV coinfection was observed in 145 patients (69%) with a longer time of HIV infection and time on HAART than mono‐infected patients, and a lower nadir (182 vs 227 cells/mL; p=0.02) and baseline CD4+ count (446 vs 552 cells/mL; p=0.02). Etravirine was used with two nucleoside analogues in 62%, with boosted darunavir in 17%, with raltegravir in 10%, and with darunavir plus raltegravir or maraviroc in 10% of patients without differences according to HCV serostatus. Transient elastography in 117 patients performed at etravirine initiation (median, 33 days) showed fibrosis 1 and fibrosis 4 in 37% and 24% of cases, and median stiffness value was 8.25 kPa (3.5–69). During an accumulated follow‐up of 449.3 patient‐years (median, 611 days), only one coinfected patient with fibrosis 4 (stiffness value, 50.1 kPa), receiving a rescue regimen including darunavir/r plus maraviroc plus two nucleoside analogues, developed a grade 3‐4 of liver toxicity (0.5%). There were no other episodes of liver toxicity, as defined, and only 6 (3%) and 9 patients (4%) had a grade 1 and 2 of toxicity, respectively, in most cases related to HCV coinfection (6 and 6 cases). Moreover, HCV coinfection or advanced fibrosis was not associated to a higher risk of etravirine discontinuation (26% vs 21%; p=0.27, log‐rank test) or virologic failure (9% vs 11%, p=0.56). CD4+ cell count increase was lower in HCV patients (+23 vs +86 at 6 month; p=0.02).
Conclusions
Etravirine is safe in HIV/HCV coinfected patients, even in presence of moderate and advanced liver fibrosis and as part of different antiretroviral regimens.
Aims
The aim of this study was to determine the intestinal microbiota of pirarucu (Arapaima gigas) in different growth stages (adult and fingerlings) and to isolate and identify potential probiotic ...bacteria.
Methods and Results
High‐throughput sequencing analysis of the intestinal contents revealed that the majority of sequences belonged to the Proteobacteria, Fusobacteria and Firmicutes phyla. At the genus level, the greatest number of sequences belonged to Bradyrhizobium in adult fish, while Cetobacterium was the most abundant in juvenile fish. Twenty‐three lactic‐acid bacteria (LABs) were isolated on MRS agar from healthy juvenile fish. The isolates were tested in vitro for probiotic properties. Two isolates (identified as strains of Lactococcus lactis subsp. lactis and Enterococcus faecium) displayed antagonism against all 10 pathogens tested, were nonhaemolytic and maintained good viability for at least 3 weeks when supplemented to fish diets. The presence of a number of antibiotic resistance genes (ARGs), conferring resistance to erythromycin, tetracycline and chloramphenicol, was investigated by PCR.
Conclusions
The absence of ARGs investigated the potential to antagonize pathogens, and favourable growth and survival characteristics indicate that these autochthonous isolates have the potential to be considered probiotics, which will be studied in future in vivo experiments.
Significance and Impact of the Study
This study has demonstrated, for the first time, the normal microbiota in the A. gigas intestine during different life stages and the presence of LAB strains. It also demonstrated LAB antibiotic resistance and antagonistic behaviour against pathogens isolated from the same fish.
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