31 research outputs found
Polyester stent graft devices and higher risk of post-implantation syndrome after EVAR: single-center analysis of 367 patients
No full textBackground: The post-implantation syndrome may occur shortly after endovascular aneurysm repair in patients treated for abdominal aortic aneurysm. Different types of biomaterials may provoke varying inflammatory responses in patients receiving different endografts. The purpose of this article is to evaluate the PIS after EVAR and the influence of different types of device fabric. Methods: All patients submitted to elective AAA endovascular repair at our institution from January 2014 to December 2019 were enrolled. The PIS was defined by a body temperature of >38°C and WBC >12’000/μl without any evidence of an infection during (48h) the observation period. Results: Three hundred and sixty-seven patients (89% males) were enrolled in this study and post-implantation syndrome occurred in 41 cases (11.2%). The incidence of PIS was significantly higher (P< 0.001) in patients treated with polyester stent grafts (39/201, 19,4%) compared to patients with PTFE stent grafts (2/166, 1,2%). CRP was related to the presence of PIS with a cut-off values of 109.31 mg/dL (P = 0.0052). The median in-hospital stay considering the polyester group was 6,2 days, while in the PTFE group it was 5,6 days (P = 0.04). Conclusions: The postoperative inflammatory response after EVAR seems significantly higher by using polyester stent graft compared to PTFE devices. CRP could be a useful biomarker in defining PIS. Multi-center studies are necessary to confirm these data
Serious complications associated with nasogastric, orogastric or enteral tube misplacement over the decades: a systematic review
Get PDFBackground: Gastrointestinal tube (GIT) insertion is common in surgical, medical and intensive care unit settings, with approximately 170,000 annual insertions in the UK alone. Despite its apparent simplicity, GIT placement can lead to acute complications, ranging from mucosal lesions to life-threatening conditions. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching on PubMed, Cochrane, EMBASE and Scopus, all case reports and series describing harm from nasogastic, orogastric, or enteral tube placement. Results: A total of 148 studies reported acute GIT complications in 168 patients (70 patients received an enteral feeding tube). The number of publications increased over time. Half (91 patients, 52%) of the displacements involved the respiratory tract, but other organs were also affected, including the brain (33 patients, 20%), gastrointestinal tract (23 patients, 14%) and intravascular system (6 patients, 4%). Brain misplacement had the highest mortality (60.6%), while for respiratory tract misplacement mortality was 20.9%. Mortality was high in emergency department procedures and acute trauma, while it was low when enteral feeding tubes were involved. Only 30% of the manuscripts reported adherence to guidelines, which was associated with a trend towards decreased mortality. Conclusions: Our findings identify an increasing reporting of GIT misplacement complications and emphasize a variety of involved anatomical sites, from the well-known brain, respiratory tract, and pleural space mispositioning, to gastrointestinal and abdomen perforation, to the extremely uncommon spleen and intravascular mispositioning. The importance of implementing standardized protocols and maintaining heightened clinical vigilance is crucial to mitigate complications related to GIT misplacement. The PROSPERO Registration: PROSPERO CRD42024491074
COMBINED TREATMENT OF CAROTID LESIONS IN PATIENTS CANDIDATE FOR CABG: CAN CAS 24/48H FIRST BE THE RIGHT STRATEGY?
No full textIntroduction
The aim of the present study was to analyze retrospectively the results of patients who
underwent early-staged, i.e., within 24–48 h, carotid artery stenting (e-s CAS) before coronary
artery bypass grafting (CABG).
Methods
Between December 2014 and December 2022, 1046 consecutive patients underwent CABG;
31 of these patients (3%) were subjected to e-s CAS prior to CABG (e-s CAS + CABG group).
Preoperative and intraoperative variables and early and mid-term results of the e-s CAS +
CABG group were compared with those of patients who underwent isolated CABG (CABG
group).
Results
As compared with the CABG group, the e-s CAS + CABG group showed a worse clinical risk
profile due to higher Euroscore-2 values and incidence of obstructive pulmonary disease
and bilateral carotid artery and peripheral artery diseases (p < 0.05, for all comparisons).
The combined end point of operative mortality, periprocedural myocardial
infarction, and stroke was 3.2% (0%/0%/3.2%) in the e-s CAS + CABG group vs. 5.9%
(2.2%/2.8%/0.9%) in the CABG group (p > 0.5, for all measurements). At 5 years, actuarial
survival was 74% ± 16% in the e-s CAS + CABG group vs. 93% ± 4.0% in the CABG group,
freedom from cardiac death was 100% vs. 98% ± 1.0% (p = 0.6), and freedom from MACCEs was 85% ± 15% vs. 97% ± 2.5% (p > 0.1, for all comparisons). Independent predictors of all-causes death were advanced age at the operation (p < 0.0001), a lower value for left ventricular ejection fraction (p = 0.05), and a high Euroscore-2 (p = 0.04).
Conclusions
CABG preceded by e-s CAS appears to be associated with satisfactory early outcomes while
limiting the risk of myocardial infarction to a very short time interval between the two
procedures. Freedom from late all-causes death, cardiac death, and MACCEs were comparable and equally satisfactory, underscoring the positive protective effects of CAS and CABG on the carotid and coronary territories over time
antiandrogen agents in cOVid-19: a meta-analysis of randomized trials
No full textiNTrOdUcTiON: antiandrogen therapy can reduce the expression of transmembrane protease 2, which is essential for severe acute respiratory syndrome coronavirus-2 to enter the host cells. Prior trials suggested the efficacy of antiandrogen agents in patients with cOVid-19. We investigated whether antiandrogen agents reduce mortality compared to placebo or usual care. eVideNce acQUiSiTiON: We searched for randomized controlled trials comparing antiandrogen agents with placebo or usual care alone in adults with cOVid-19 in PubMed, eMBaSe, the cochrane Library, the reference lists of retrieved articles, and publications by manufacturers of antiandrogen agents. The primary outcome was mortality at the longest follow-up available. The secondary outcomes included clinical worsening, the need for invasive mechanical ventilation, admission to the intensive care unit, hospitalization, and thrombotic events. We registered this systematic review and meta-analysis in PrOSPerO international Prospective register of Systematic reviews (crd42022338099). eVideNce SYNTHeSiS: We included 13 randomized controlled trials enrolling 1934 cOVid-19 patients. We found that antiandrogen agents reduced mortality at the longest follow-up available (91/1021 [8.9%] vs. 245/913 [27%]; risk ratio =0.40; 95% confidence interval, 0.25-0.65; P=0.0002; I2=54%). antiandrogen therapy also reduced clinical worsening (127/1016 [13%] vs. 298/911 [33%]; risk ratio =0.44; 95% confidence interval, 0.27-0.71; P=0.0007; I2=70%) and hospitalization (97/160 [4.4%] vs. 24/165 [15%]; risk ratio =0.24; 95% confidence interval, 0.10-0.58; P=0.002; I2=44%). There was no significant difference in the other outcomes between the two treatment groups. cONcLUSiONS: antiandrogen therapy reduced mortality and clinical worsening in adult patients with cOVid-19
Interventions reducing mortality in COVID-19 patients: a systematic review of randomized evidence
No full textINTRODUCTION: COVID-19 pandemic changed the way medical research is published, possibly forever. as the need for rapidity led to the rise of preprint servers, the undeniable drop in the overall quality of scientific publications requires an in-depth review of all available evidence. The present manuscript aims to identify and summarize all treatments which have been reported to reduce mortality in randomized trials in hospitalized COVID-19 patients. EVIDENCE ACQUISITION: independent investigators searched MedLiNe/PubMed, Scopus, and embase databases to identify all randomized trials of any intervention influencing mortality in hospitalized COVID-19 patients up to August 18th, 2022. Articles were selected only when they fulfilled all the following: randomized trial design; dealing with any kind of interventions in adult hospitalized COVID-19 patients; and statistically significant reduction in mortality. EVIDENCE SYNTHESIS: We identified 28 interventions (42 manuscripts) reducing mortality in hospitalized COV-ID-19 patients. About 60% of the studies (26/42) were multicentric, for a total of 1140 centers involved worldwide. Several of these studies were published in high-ranked, peer-reviewed journals. interventions with randomized evidence of mortality reduction in hospitalized COVID-19 patients belonged to 5 domains: corticosteroids, immunomodulators, antimicrobials, supportive therapies, and other drugs. CONCLUSIONS: Many interventions have the potential to reduce mortality in COVID-19 hospitalized patients. The correct treatment of future pandemics relies on large, multicentric randomized clinical trials for further evaluation of these promising strategies
Corticosteroids for Patients With Coronavirus Disease 2019 (COVID-19) With Different Disease Severity: A Meta-Analysis of Randomized Clinical Trials
No full textObjectives: Efficacy and safety of corticosteroids in patients with 2019-nCoV (novel coronavirus 2019) infection still are debated. Because large randomized clinical trials (RCTs) and a well-conducted meta-analysis on the use of corticosteroids, focused on patients with coronavirus disease (COVID-19) in intensive care units, recently were published, a meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity was performed to evaluate the effect on survival. Design: A meta-analyses of RCTs was performed. Setting: Patients admitted to hospital. Participants: Patients with coronavirus disease. Interventions: Administration of corticosteroids. Measurements and Main Results: A search was performed for RCTs of adult patients with acute hypoxemic failure related to 2019-nCoV infection who received corticosteroids versus any comparator. The primary endpoint was mortality rate. Five RCTs involving 7,692 patients were included. Overall mortality of patients treated with corticosteroids was slightly but significantly lower than mortality of controls (26% v 28%, relative risk {RR} = 0.89 [95% confidence interval {CI} 0.82-0.96], p = 0.003). The same beneficial effect was found in the subgroup of patients requiring mechanical ventilation (RR = 0.85 [95% CI 0.72-1.00], p = 0.05 number needed to treat {NNT} = 19). Remarkably, corticosteroids increased mortality in the subgroup of patients not requiring oxygen (17% v 13%, RR = 1.23 [95% CI 1.00-1.62], p = 0.05 number needed to harm {NNH} = 29). Tests for comparison between mechanically ventilated subgroups and those not requiring oxygen confirmed that treatment with corticosteroids had a statistically significant different effect on survival. Patients treated with corticosteroids had a significantly lower risk of need for mechanical ventilation. Conclusions: Corticosteroids may be considered in severe critically ill patients with COVID-19 but must be discouraged in patients not requiring oxygen therapy. Urgently, further trials are warranted before implementing this treatment worldwide
