New insight in cardiorenal syndrome. from biomarkers to therapy

Cardiorenal syndrome consists in the coexistence of acute or chronic dysfunction of heart and kidneys resulting in a cascade of feedback mechanisms and causing damage to both organs associated with high morbidity and mortality. In the last few years, different biomarkers have been investigated with the aim to achieve an early and accurate diagnosis of cardiorenal syndrome, to provide a prognostic role and to guide the development of targeted pharmacological and non- pharmacological therapies. In such a context, sodium-glucose cotransporter 2 (SGLT2) inhibitors, recommended as the first-line choice in the management of heart failure, might represent a promising strategy in the management of cardiorenal syndrome due to their efficacy in reducing both cardiac and renal outcomes. In this review, we will discuss the current knowledge on the pathophysiology of cardiorenal syndrome in adults, as well as the utility of biomarkers in cardiac and kidney dysfunction and potential insights into novel therapeutics

Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities.

The aim of this study was to establish the incidence, risk factors, and the management of pharyngocutaneous fistula (PCF) after primary and salvage total laryngectomy. A retrospective, match-paired analysis of 86 patients who developed fistula after total laryngectomy was carried out and compared with a control group of 86 patients without fistula, randomly selected from a pool of 352 total laryngectomies, performed between January 1999 to October 2014. The overall incidence of PCF in the series was 24.4%; we recorded rates of 19.0%, 28.6% and 30.3% following primary total laryngectomy (PTL), salvage laryngectomy post-radiotherapy (RT-STL) and salvage laryngectomy postchemoradiotherapy (CRT-STL), respectively. Multivariate analysis revealed that the relative risk of fistula was respectively 2.47, 3.09 and 7.69 for hypoalbuminaemia ≤3.5 g/dL, RT-STL and CRT-STL. An early onset of PCF within 10 postoperative days was recorded in case of salvage total laryngectomy. The management of PCF significantly differed between PTL, RT-STL and CTRT-STL, with exclusive conservative treatment for PTL (93.55%), while in the CRT-STL group surgical closure with regional flaps (58.82%) prevailed. Conservative management, adjuvant hyperbaric oxygen therapy and surgical closure were equally distributed in the RT-STL group. Thorough knowledge of patient-related risk factors and its prognostic value, allows the surgeon to better evaluate preventive strategies with the aim of minimising fistula formation, hospitalisation times and related costs

HUBUNGAN BENTUK KOMUNIKASI PERAWAT DENGAN TINGKAT KECEMASAN KELUARGA PASIEN KANKER DI RUANG RAWAT INAP BLUD RUMAH SAKIT UMUM DR. ZAINOEL ABIDIN BANDA ACEH TAHUN 2013

Praktek keperawatan profesional memegang peranan yang sangat penting dalam memberikan asuhan keperawatan pada pasien maupun keluarga. Komunikasi yang efektif dapat mengurangi kecemasan yang dialami keluarga pasien kanker di ruang rawat inap. Jenis penelitian deskriptif korelatif dengan desain cross sectional. Populasi penelitian adalah keluarga pasien kanker di ruang rawat inap yang berjumlah 76 orang dengan cara nonprobability sampling, Uji Chi Square menunjukkan adanya hubungan yang signifikan antara bentuk komunikasi perawat dengan tingkat kecemasan keluarga pasien kanker (p = 0.014> nilai ? 0.05) yang terdiri dari komunikasi verbal (p = 0.016> nilai ? 0.05) dan komunikasi nonverbal (p = 0.005> nilai ? 0.05). Diharapkan kepada perawat agar dapat mempertahankan dan meningkatkan komunikasi terapeutik karena akan mempengaruhi kecemasan keluarga pasien.Banda Ace

How to avoid life-threatening complications following head and neck space infections: an algorithm-based approach to apply during times of emergency. When and why to hospitalise a neck infection patient

AbstractBackground:Head and neck space infections present with a potential mortality rate of 40–50 per cent. This paper proposes an algorithm-based management of head and neck space infection to prevent life-threatening events.Methods:A total of 225 patients with head and neck space infection were prospectively analysed at our institution. An experimental scoring system determined the level of clinical risk for the development of major complications. Accordingly, patients were classified into three risk groups: low-, intermediate- and high-risk.Results:Only intermediate- and high-risk patients were hospitalised. Intermediate-risk patients received intravenous medical therapy with daily re-evaluation; 18 of them required delayed surgery. Of the high-risk patients, three required immediate surgical treatment and five received delayed surgery, while in five cases medical therapy was the only treatment received. Low-risk patients were treated in an out-patient setting.Conclusion:The algorithm-based management of head and neck space infection was successful in enabling the avoidance of lethal complications onset.</jats:sec

Primary parapharyngeal leiomyosarcoma: A case report.

Leiomyosarcoma is a rare malignant soft-tissue tumor whose cells resemble smooth-muscle tissue. It has been reported to arise in different areas of the head and neck region. Primary leiomyosarcoma of the parapharyngeal space, however, is extremely rare, as only 4 cases have been previously reported to date. We describe the somewhat urgent case of a primary leiomyosarcoma of the right parapharyngeal space in a 30-year-old man. We also review the diagnostic and therapeutic challenges that clinicians face in managing this rare tumor