Dudleyself5094
To explore the risk factors of cerebral neurological complications after surgery for Stanford type A aortic arch surgery.
One hundred sixteen patients who received Stanford type A aortic dissection from January 2012 to December 2019 were recruited. All patients received surgery under deep hypothermic circulatory arrest (DHCA) and general anesthesia. They were grouped by degree of postoperative cerebral neurological complication. The related factors of cerebral neurological complications were analyzed by single-factor analysis and multi-factor logistic regression.
Postoperative neurological complications were observed in 31 cases (26.72%). Two groups were identified permanent neurological dysfunction (PND) was observed in seven cases, and temporary neurological dysfunction (TND) was observed in 24 cases. In-hospital mortality was 9.48% (11/116), with six in the cerebral complication groups and five in the non-complication group. Single-factor analysis showed the associated factors were age, stroke histor during treatment to reduce cerebral neurological complications.
Ventilator-associated pneumonia (VAP) is one of the most frequently encountered causes of hospital-acquired infection and results in high morbidity among intubated patients. Few trials have investigated the efficacy of oral care with chlorhexidine (CHX) mouthwash for the prevention of VAP in the paediatric population.
The objective of this study was to assess the efficacy of CHX mouthwash in the prevention of VAPand to determine risk factors for VAP in children aged 1 month to 18 years admitted to the paediatric intensive care unit (PICU).
This was a prospective, randomised, controlled, double-blind trial performed in the PICU. Patients were randomised into two groups receiving CHX (0.12%) (n=88) or placebo (0.9% NaCl) (n=86) and were followed up for VAP development. The main outcome measures were incidence of VAP, duration of hospital stay, duration of PICU stay, duration of ventilation, mortality, and the characteristics of organisms isolated in cases with VAP.
No difference was observed in the incidence of VAP and the type and distribution of organisms in the two groups (p>0.05). In the CHX and placebo groups, we identified 21 and 22 patients with VAP, respectively. Incidence per 1000 ventilation days was 29.5 events in the CHX group and 35.1 events in the placebo group. Gram-negative bacteria were most common (71.4% in CHX vs. 54.5% in placebo). The use of 0.12% CHX did not influence hospital stay, PICU stay, ventilation, and mortality (p>0.05). Multivariate analysis identified duration of ventilation as the only independent risk factor for VAP (p=0.001).
The use of 0.12% CHX did not reduce VAP frequency among critically ill children. The only factor that increased VAP frequency was longer duration on ventilation. It appears that low concentration of CHX is not effective for VAP prevention, especially in the presence of multiresistant bacteria. CLINICALTRIALS.
NCT04527276.
NCT04527276.
The objective of this study was to answer the question Do conventional radiographs (periapical/panoramic) afford better diagnostic outcomes than cone beam computed tomography (CBCT) as a complement for clinical diagnosis of apical lesions with persistent apical periodontitis or disease after root canal treatment?
Five electronic databases were searched and provided information to enable construction of a table to determine primary diagnostic measures and secondary parameters. The evidence was appraised with the Quality Assessment of Diagnostic Accuracy Studies tool and GRADEpro software.
Twenty-seven articles (9903 diagnostic images) were included. The pooled sensitivity, specificity, area under the receiver operating characteristic curve (AUC
), positive predictive value, negative predictive value, negative likelihood ratio, and accuracy were 0.58, 1, 0.77, 1, 0.68, 0.45, and 0.79, respectively.
Moderate certainty evidence suggested that conventional radiographs showed poor sensitivity and excellent specificity but good diagnostic performance in terms of AUC
and accuracy. Sensitivity, AUC
, and negative likelihood ratio values could be reduced if the time elapsed to diagnosis after root canal treatment exceeded 5 years. The use of CBCT with a reduced field of view or a 2D radiographic technique should be weighed considering patient-specific and indication-oriented criteria as taking precedence over the therapeutic goal.
Moderate certainty evidence suggested that conventional radiographs showed poor sensitivity and excellent specificity but good diagnostic performance in terms of AUCROC and accuracy. Sensitivity, AUCROC, and negative likelihood ratio values could be reduced if the time elapsed to diagnosis after root canal treatment exceeded 5 years. The use of CBCT with a reduced field of view or a 2D radiographic technique should be weighed considering patient-specific and indication-oriented criteria as taking precedence over the therapeutic goal.
To explore the meaning of palliative care as perceived by the family caregiver and the patient with advanced cancer.
Information was collected through in-depth interviews and field diaries to conduct this qualitative research study, with an interpretative phenomenological approach. We adopted Heidegger's perspective for the development of hermeneutic interpretation, and therefore followed the stages of intentionality, reduction, and constitution. We used Bardin's constructs of pre-analysis, coding, categorisation, and interpretation for the discourse analysis.
Seventeen patient-family caregiver dyads were considered. The perceptions of palliative nursing care focused on transpersonal relationships and the discourses referred to a lack of closeness between nursing staff and the patient. This was mainly expressed as a lack of emotional understanding and unmet needs. Themes were drawn from these findings based on developing a transpersonal relationship as a priority, including meeting needs and providing the empathic accompaniment that is fundamental for emotional well-being.
From the perspective of the dyads, palliative care covers intangible aspects of care. This requires nursing staff to work collaboratively with colleagues, with other health professionals and interprofessionally, including the institutions involved in care. Further work is required to implement these actions.
From the perspective of the dyads, palliative care covers intangible aspects of care. This requires nursing staff to work collaboratively with colleagues, with other health professionals and interprofessionally, including the institutions involved in care. Further work is required to implement these actions.
To analyse the relationship between health-related quality of life (HRQoL) and sociodemographic and clinical factors in patients with diabetes mellitus, also comparing with Spanish population-based reference values.
Cross-sectional descriptive-analytical observational study through nonprobability sampling on diabetic patients from San Roque Primary Health Centre (Badajoz, Spain), using a questionnaire regarding sociodemographic and diabetes care data, SF-36 and Duke-UNC questionnaires, and clinical history data.
Sixty patients (55% women) fundamentally with type 2 diabetes and a mean age of 68.67±11.09 years were studied. Women older than 75 presented poorer HRQoL than their reference group. Women showed worse HRQoL than men. Age, evolution of diabetes, presence of acute and chronic complications, and comorbidities, pharmacological treatment, and glycaemic control affect HRQoL in these patients. Living alone, having a low socioeconomic status, and needing help with diabetes-related self-care can negatively affect quality of life.
HRQoL assessment allows us to detect alterations in the different domains and perform an early intervention. This way, we can incorporate these aspects into the nursing evaluation and interventions in the nursing care plan; allowing us to develop individualized care strategies and diabetes education programmes that contribute to improving HRQoL in patients with diabetes.
HRQoL assessment allows us to detect alterations in the different domains and perform an early intervention. This way, we can incorporate these aspects into the nursing evaluation and interventions in the nursing care plan; allowing us to develop individualized care strategies and diabetes education programmes that contribute to improving HRQoL in patients with diabetes.
Andrographis paniculata (Burm.f.) Nees has been well-researched for its immunomodulatory effects.
To investigate the immunomodulatory effects of standardized A.paniculata extract (SAPE) in healthy adults.
The study was an open-label, single-centre study conducted for 30 days. Thirty participants with absolute lymphocyte counts of 1000-4000cells/mm
were enrolled and were instructed to ingest 200mg of SAPE daily for 30 days. The participants visited the clinic at baseline, and days 3, 7, and 30. Immune cells such as NK cell (CD3-CD16+CD56+), T cells (CD3+), T helper cells (CD3+CD4+), T cytotoxic cells (CD3+CD8+) were measured using flow cytometry. Serum cytokines that include interferon gamma (IFN-γ), interleukin-4 (IL-4), interleukin-2 (IL-2), interleukin-12 (IL-12), and tumor necrosis factor alpha (TNF-α) were measured using ELISA. The SAPE used in this study was a standardized proprietary extract (AP-Bio®/KalmCold®) developed from the leaf extracts of A.paniculata.
SAPE increased T cells, T helper cells and significantly increased IFN-γ, IL-4, and decreased IL-2 at day 30. A subgroup analysis of participants with absolute lymphocyte counts of 1000-3000cells/mm
indicated that there is a significant increase in the T cells, T helper cells at day 7 and 30 and significant increase in IFN-γ, IL-4 and decrease in IL-2 at day 30. There was no treatment related adverse effects following SAPE intake for 30 days.
Supplementation of SAPE resulted in immunomodulatory effects evidenced by its effects on immune cells and cytokines and it was found to be safe and tolerable.
Supplementation of SAPE resulted in immunomodulatory effects evidenced by its effects on immune cells and cytokines and it was found to be safe and tolerable.
Nishamalaki is an Ayurvedic herbal formulation used to treat type 2 diabetes mellitus (T2DM), comprises Emblica officinalis and Curcuma longa.
One of the main cause of T2DM is Insulin Resistance (IR) hence, this study was planned to evaluate IR lowering effect of a standardized Nishamalaki extract "EmbliQur" in high-fat diet (HFD) and streptozotocin (STZ) induced T2DM rats.
Curcuminoids (23.89% w/w), gallic acid (5.27% w/w) and tannins (25.44% w/w) were quantified from EmbliQur. selleck kinase inhibitor Rats were fed HFD throughout the study of 45 days and received STZ (40 mg/kg, i.p) on the 15th day of the study. Rats with more than 250 mg/dl of fasting blood glucose level (FBGL) were considered diabetic and selected for administration of EmbliQur (500 mg and 1000 mg/kg) or the standard drug metformin (120 mg/kg, p.o) from the 18th day of the study for the next 27 days. FBGL and insulin levels of all rats were measured weekly and an oral glucose tolerance test (OGTT) was done at the end of the study. The values of FBGL and insulin were used to calculate IR by the HOMA-IR, QUICKI and Matsuda methods.
