223 research outputs found
„Centrális véna – nővér módra?” Perifériáról bevezetett centrális vénás kanülökkel szerzett tapasztalataink | Nurse style of central vein! Our experience in the peripherally inserted central venous catheter
Absztrakt:
Mi is az a PICC (peripherally inserted central catheter) line kanül? A PICC egy
puha, rugalmas katéter, amely poliuretánból vagy szilikonból készült, a kar vagy
láb perifériás vénáin keresztül a vena cava superior vagy inferior érhető el
vele. A perifériáról bevezetett centrális vénás kanülöket az 1950-es években
írták le először. Megjelenése óta nyilvánvalóan nagy változáson esett át mind a
metodikát, mind az alkalmazott eszközöket tekintve. Szeretnénk bemutatni a
vénabiztosítás e formáját, az előnyeivel, a hátrányaival és a felhasznált
eszközrendszereivel együtt. Közleményünkben összefoglaljuk a klinikánkon végzett
PICC line beültetések során szerzett tapasztalatainkat. A Pécsi Tudományegyetem
ez idáig Magyarországon úttörő abban a tekintetben, hogy kizárólag ápoló
implantálja ezeket a kanülöket (külföldön ez már bevett szokásnak számít), és
bízunk benne, hogy ez a metodika az ápolói kompetencia fejlődésével hazánkban is
elterjed. Orv Hetil. 2017; 158(22): 856–863.
|
Abstract:
What is PICC line insertion? The PICC is a soft, flexible catheter which is made
of polyurethane or silicone, and is inserted via an upper or lower extremity
peripheral vein into superior or inferior vena cava. The origin of PICC line
dates back to the early 1950s. Since the introduction of the PICC catheter, this
method of venous catheterization has gone through many changes as regards the
technique of insertion or the type of catheter used. Despite the routine use of
PICC line worldwide, little progress has been made in its use in Hungary. In
this short review we will briefly summarise the use of PICC line, its
indications, advantages, disadvantages, and on complementary devices which are
necessary during the procedure. We discuss our experience in insertion of PICC
line at Pécs University, where the procedure is solely done by a certified
registered nurse. We hope that with continuous progression of nurse competency,
this procedure will be implemented at a higher scale in Hungary. Orv Hetil.
2017; 158(22): 856–863
Increased Prevalence of Celiac Disease in Patients with Cystic Fibrosis: A Systematic Review and Meta-Analysis
Objectives: Immune regulation seems to be altered in cystic fibrosis (CF), thus potentially predisposing patients to developing autoimmune diseases (AID). In this meta-analysis, we aimed to evaluate the prevalence of celiac disease (CeD) among CF patients as by far the most commonly reported autoimmune disease in this population and, secondly, to review the observations on other, less frequently studied autoimmune diseases. Methods: We conducted a systematic literature search for studies that discussed AIDs among CF patients. Following standard selection and data collection, we calculated pooled raw prevalence with 95% confidence intervals (CI) for biopsy-verified CeD and seropositivity. Results: Out of the 21 eligible studies, 15 reported on CeD. Pooled prevalence of biopsy-verified CeD was 1.8% (CI 1.1–2.7%) according to a homogeneous dataset from six prospective, consecutive screening studies, while it proved to be 2.3% (CI 1.1–4.7%) according to a heterogeneous dataset from the other studies. Tissue transglutaminase IgA positivity was detected in 4.5% of CF cases (CI 2.8–6.9%), while tissue transglutaminase IgA–endomysial antibody IgA double positivity was found in 2.4% of them (CI 1.5–3.9%). Findings on other AIDs were strongly limited. Conclusions: The pooled prevalence of CeD in CF seemed to be more than twice as high compared to the global prevalence; therefore, routine screening of CeD could be considered in CF
A másodlagos hypogammaglobulinaemia, a fertőzések és a halálozás összefüggései és a preventív immunglobulin-pótlás szükségessége krónikus lymphoid leukaemiás betegekben = Correlations between secondary hypogammaglobulinaemia, infections and mortality and the need for preventive immunoglobulin replacement in patients with chronic lymphoid leukaemia
Absztrakt:
Krónikus lymphoid leukaemiában szenvedő 186 betegnél vizsgáltuk az immunstatust
2012. január és 2015. március között. Elemeztük az infekciók előfordulását, a
mortalitást azoknál, akik nem részesültek profilaktikus
immunglobulin-kezelésben. Az immunglobulin-G (IgG)-szint a betegek 62,37%-ában
normális (7–17,8 g/l), 35,48%-ában csökkent volt, néhány esetben mértünk magas
immunglobulinszintet (2,15%). Az előrehaladottabb betegségstádiumokban
(Rai-stádium) egyre alacsonyabbak az immunglobulinszintek. Ezzel fordított
arányban növekedtek a fertőzések. A hypogammaglobulinaemia jelenléte fontosabb
volt a fertőzés kialakulásának szempontjából, mint a betegség progressziója. A
leggyakoribb infekció a felső légúti fertőzés (33,07%) és a szepszis (18,90%)
volt. A kemoterápia után két hónappal a kezdetben normális immunglobulinszint
átlagosan 21%-kal csökkent, ugyanakkor emelkedett az infekciók kialakulása. A
leggyakoribb halálok a szepszis volt: 30% alacsony immunglobulinszint mellett,
illetve 20% normális immunglobulinszintnél. A krónikus lymphoid leukaemiás és
immunhiányos betegeknél mind a morbiditás, mind a mortalitás csökkentésére az
irodalom szerint indokolt a profilaktikus immunglobulin-kezelés. Az irodalmi
ajánlások szerint a súlyos vagy közepesen súlyos, visszatérő bakteriális
infekció esetén a hypogammaglobulinaemiát korrigálni kell. Az
immunglobulin-profilaxis lehet kis dózisú (10 g), fix adagú (18 g) vagy betegre
szabottan nagyobb dózisú (300–400 mg/ttkg). Az intravénás kezelés 3 hetente
minimum 6 hónapig ajánlott, az immunglobulinszint folyamatos ellenőrzése
mellett. Az ajánlás szerint a nagyobb dózisú, 6 alkalommal 3 hetente adott
profilaktikus, személyre szabott immunglobulin-infúzió effektívebb és
költséghatékony. Ezzel a dózissal az ismétlődő infekcióban szenvedő betegek
50%-át fertőzésmentesen lehet tartani. Orv Hetil. 2019; 160(38): 1487–1494.
|
Abstract:
Immune status was investigated in 186 patients with chronic lymphoid leukaemia
between January 2012 and March 2015. Incidences of infections and mortality were
analysed in patients who did not receive prophylactic immunoglobulin therapy.
Immunoglobulin G (IgG) levels were normal (7–17.8 g/L) or decreased in 62.37%
and 35.48% of patients, respectively. We measured high immunoglobulin levels
only in a few cases (2.15%). Immunoglobulin levels became increasingly lower in
more advanced disease stages (Rai stages). The number of infections was
inversely proportional to that. Hypogammaglobulinaemia proved to be more
important than disease progression in terms of the development of infections.
The most common infections were upper respiratory tract (33.07%) and sepsis
(18.90%). Two months after chemotherapy, initially normal immunoglobulin levels
decreased by an average of 21%, and at the same time the incidence of infections
increased. The most common cause of death was sepsis: 30% occurred at low
immunoglobulin levels, while 20% at normal immunoglobulin levels. According to
literature, prophylactic immunoglobulin treatment is indicated in patients with
chronic lymphoid leukaemia and immunodeficiency for decreasing both morbidity
and mortality. According to recommendations in literature, replacement treatment
must be administered in severe or moderately severe recurrent bacterial
infections. Immunoglobulin prophylaxis may be provided as low dose (10 g), fix
dose (18 g) or individually customized higher dose (300–400 mg/kg body weight)
treatment. According to recommendations, higher dose immunoglobulin prophylaxis,
administered every three weeks on six occasions, is more efficient when
customized. With this dose, infection-free condition may be achieved in 50% of
patients. Orv Hetil. 2019; 160(38): 1487–1494
Comorbidities and outcomes of patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: a real-world, nationwide, retrospective study from Hungary
Purpose: This study aimed to provide real-world evidence on the characteristics, treatment patterns, and outcomes of patients with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitor (TKI) treatment in Hungary between 2011 and 2019.Patients and methods: This nationwide, retrospective study included patients who were newly diagnosed with CML in Hungarian clinical practice between January 2011 and December 2019. The analysis was based on the reimbursed prescription claims for imatinib, bosutinib, dasatinib, nilotinib, or ponatinib with the ICD-10 code C9210 in a public pharmacy between January 2009 and December 2019 using data from the National Health Insurance Fund (NHIF) of Hungary. CML incidence and prevalence, TKI treatment patterns, comorbidities, and overall survival (OS) were examined.Results: Between 2011 and 2019, altogether 1,407 patients were diagnosed with CML, with an annual average of 156 patients. The number of patients newly initiating first-line TKI therapy for CML significantly increased between 2011 and 2019 (2011: n = 136 vs. 2019: n = 191; p = 0.0043). Nilotinib was typically prescribed for younger patients (≤64 years), while older patients (≥65 years) mostly received imatinib. The most common comorbidity of CML patients was hypertension, and the proportion of patients with other malignancies was relatively high in all treatment groups. 5-year OS was 77.1% during the whole study period. Patients initiating first-line TKI treatment for CML in 2015 had significantly better 4-year OS compared to those starting treatment in 2011 (82.4% vs. 73.5%, respectively, (HR 0.53 (95%CI 0.32–0.87) p = 0.0118).Conclusion: This study is the first to provide insights into the characteristics, treatment patterns, and outcomes of CML patients treated with TKIs in Hungarian clinical practice between 2011 and 2019. We found slightly lower OS rates compared to other European countries, however, there was a statistically significant improvement in 4-year OS during the study period. The management of CML was in line with international guidelines and recommendations
Pregnancy outcomes of women whom spouse fathered children after tyrosine kinase inhibitor therapy for chronic myeloid leukemia : A systematic review
The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized the therapy of chronic myeloid leukemia (CML). Although the efficacy of TKIs is beyond dispute, conception-related safety issues are still waiting to be explored, particularly in males. This systematic review aimed to summarize all available evidence on pregnancy outcomes of female spouses of male CML patients who fathered children after TKI treatment for CML.We performed a systematic search in seven electronic databases for studies that reported on male CML patients who did or did not discontinue TKI treatment before conceiving, and the pregnancy outcomes of their female spouse are available. The search centered on the TKI era (from 2001 onward) without any other language or study design restrictions.Out of a total of 38 potentially eligible papers, 27 non-overlapping study cohorts were analyzed. All were descriptive studies (case or case series studies). Altogether, 428 pregnancies from 374 fathers conceived without treatment discontinuation, 400 of which (93.5%) ended up in a live birth. A total of ten offspring with a malformation (2.5%) were reported: six with imatinib (of 313 live births, 1.9%), two with nilotinib (of 26 live births, 7.7%), one with dasatinib (of 43 live births, 2.3%), and none with bosutinib (of 12 live births). Data on CML status were scarcely reported. Only nine pregnancies (from nine males) and no malformation were reported in males who discontinued TKI treatment before conception.Malformations affected, on average 2.5% of live births from fathers who did not discontinue TKI treatment before conception, which is comparable with the rate of malformations in the general population. Large-scale studies with representative samples are awaited to confirm our results
Automated Detection and Forecasting of COVID-19 using Deep Learning Techniques: A Review
Coronavirus, or COVID-19, is a hazardous disease that has endangered the
health of many people around the world by directly affecting the lungs.
COVID-19 is a medium-sized, coated virus with a single-stranded RNA. This virus
has one of the largest RNA genomes and is approximately 120 nm. The X-Ray and
computed tomography (CT) imaging modalities are widely used to obtain a fast
and accurate medical diagnosis. Identifying COVID-19 from these medical images
is extremely challenging as it is time-consuming, demanding, and prone to human
errors. Hence, artificial intelligence (AI) methodologies can be used to obtain
consistent high performance. Among the AI methodologies, deep learning (DL)
networks have gained much popularity compared to traditional machine learning
(ML) methods. Unlike ML techniques, all stages of feature extraction, feature
selection, and classification are accomplished automatically in DL models. In
this paper, a complete survey of studies on the application of DL techniques
for COVID-19 diagnostic and automated segmentation of lungs is discussed,
concentrating on works that used X-Ray and CT images. Additionally, a review of
papers on the forecasting of coronavirus prevalence in different parts of the
world with DL techniques is presented. Lastly, the challenges faced in the
automated detection of COVID-19 using DL techniques and directions for future
research are discussed
Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19 : a systematic review and meta-analysis
Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMDALC = - 0.35 × 109/L [CI - 0.43, - 0.27], p < 0.001, I2 = 94.2%; < 0.8 × 109/L, ORALC = 3.74 [CI 1.77, 7.92], p = 0.001, I2 = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention
- …