Thrombin is an effective and safe therapy in the management of bleeding gastric varices:A real-world experience

Variceal haemorrhage is a severe complication of liver disease with high mortality. Human recombinant thrombin has gained popularity in the management of variceal haemorrhage. We report on the use of thrombin for gastric and ectopic varices at a regional tertiary care centre. This was a retrospective observational study. Patients with portal hypertension who received endoscopic injection of recombinant thrombin were identified and data collected on haemostasis and rebleeding rates, complications and mortality. Patients were grouped by indication for thrombin injection: gastric/oesophageal/ectopic varices and endoscopic band ligation (EBL)-induced ulceration. 155 patients (96M/59F, mean age 58.3 years) received endoscopic thrombin injection. Mean volume of thrombin injected at index endoscopy was 9.5 ml/2375IU. Initial haemostasis was achieved in 144 patients (92.9%). Rebleeding occurred in a total of 53 patients (36.8%) divided as follows: early rebleeding (<5 days from index endoscopy)—26 patients (18%); rebleeding within 30 days—42 patients (29.1%); delayed rebleeding (> 30 days)—11 patients (7.6%). There was statistically significant difference in rate of initial haemostasis between Child-Pugh A/B patients vs Child-Pugh C (p = 0.046). There was no significant difference in rebleeding rates between different indication groups (p = 0.78), by presence of cirrhosis or by Child-Pugh Score. All-cause mortality at 6 weeks was 18.7%; 1-year mortality 37.4% (median follow-up 48 months). There was no significant difference in mortality between groups (p = 0.37). No significant adverse events or complications were reported. Thrombin is effective and safe for gastric varices and other portal-hypertension-related bleeding including oesophageal varices, ulcers secondary to EBL and ectopic varices

Does the Hematopoietic Cell Transplantation Specific Comorbidity Index Predict Transplant Outcomes? A Validation Study in a Large Cohort of Umbilical Cord Blood and Matched Related Donor Transplants

AbstractThe hematopoietic cell transplantation specific comorbidity index (HCT-CI) has been recently proposed to predict the probability of nonrelapse mortality (NRM) and overall survival (OS) in allogeneic HCT recipients while taking into account any pretransplant comorbidity. We tested the validity of the HCT-CI in a cohort of 373 adult HCT recipients (184 matched-related donor and 189 unrelated umbilical cord blood) who received a myeloablative (N = 150) or nonmyeloablative (N = 223) conditioning regimen. HCT-CI scores of 0, 1, 2, and ≥3 were present in 58 (16%), 56 (15%), 64 (17%), and 195 (52%) patients, respectively. Pulmonary conditions were the most common comorbidity. Cumulative incidence of NRM at 2 years was 10%, 20%, 24%, and 28% for HCT-CI scores of 0, 1, 2, and ≥3, respectively (P = .01). The corresponding probability of OS at 2 years was 72%, 67%, 51%, and 48%, respectively (P < .01). On multivariate analyses adjusted for recipient age, disease risk, donor source, and conditioning regimen intensity, the relative risks for NRM for HCT-CI scores of 1, 2, and ≥3 (compared to a score of 0) were 2.0 (95% confidence intervals, 0.8–5.3), 2.6 (1.0–6.7), and 3.2 (1.4-7.4), respectively. The risks for overall mortality were 1.2 (0.6-2.1), 2.0 (1.1-3.4), and 2.1 (1.3-3.3), respectively. In subgroup analyses, the HCT-CI score did not consistently predict NRM and OS among different donor sources and conditioning regimens. The HCT-CI, although a useful tool for capturing pretransplant comorbidity and risk-assessment, needs to be further validated prior to adopting it for routine clinical use

When is forgetting not forgetting? A discursive analysis of differences in forgetting talk between adults with cystic fibrosis with different levels of adherence to nebulizer treatments

Forgetting is often cited as a reason why people struggle to adhere to treatments for chronic conditions. Interventions have tried to improve forgetting behavior using reminders. We used a discursive psychological approach to explore differences in how high and low adherers constructed forgetting their nebulizer treatments for cystic fibrosis. Interviews were conducted with 18 adults from a cystic fibrosis center in the United Kingdom. High adherers constructed forgetting treatments as occasional lapses in automaticity and temporary lapses in memory that they found easy to repair. Low adherers utilized forgetting to normalize more consistent nonadherence to treatments. However, it is important to contextualize forgetting as a discursive resource that helped these participants to negotiate moral discourses around adherence to treatment that reminder interventions cannot address; we therefore recommend a more behavioral, patient-focused, theory-driven approach to intervention development

She said she was in the family way': Pregnancy and infancy in modern Ireland

'She said she was in the family way' examines the subject of pregnancy and infancy in Ireland from the seventeenth to the twentieth century. It draws on exciting and innovative research by early-career and established academics, and consider topics that have been largely ignored by historians in Ireland. The book will make an important contribution to Irish women’s history, family history, childhood history, social history, crime history and medical history, and will provide a reference point for academics interested in themes of sexuality, childbirth, infanthood and parenthood

Wetland Characteristics Associated with Amphibian Presence in the Rocky Mountain Region

Hydroperiod (the annual period that open water is available) is an important factor in studies of wetland ecology. It has been linked to amphibian development, distribution, and rates of survival as well as the presence of exotic species. However, hydroperiod is rarely measured directly. Typically wetland size is used as a surrogate measurement of hydroperiod. Recent studies suggest that wetland size may not be as closely related to hydroperiod as was previously thought. To investigate the role of hydroperiod and its relationship with other habitat parameters, I conducted a study of 23 wetlands located in west-central Montana. Each wetland was surveyed three times during the summer of 2002 and estimates were made for: wetland size, area of open water, hydroperiod, rate of water loss, presence of Rana luteiventris, and presence of Ambystoma macrodactylum. Analysis showed that hydroperiod was not correlated with the other wetland measurements, nor was it an accurate predictor of the presence of amphibian species. Total wetland area was correlated with the presence of R. luteiventris, but was not an accurate predictor of the presence of A. macrodactylum. Area of open water was correlated with the presence of both species of amphibians. In this study area, there was not a large gradient of hydroperiods. Future studies should be conducted to minimize year-to-year variation within this wetland and more accurately assess the impact of hydroperiod. However, my results suggest that the area of open water may be a better predictor of amphibian presence than is hydroperiod

Evidence in practice-number 7:Can postpartum depression be prevented?

Clinical question - is there any preventive treatment for postpartum depression in a lady with previous episodes?This question was sent to us at the Centre for General Practice, University of Queensland, Australia. We were providing a literature search service in collaboration with the Department of Primary Health Care at the University of Newcastle upon Tyne (funded through the NHS Northern and Yorkshire Regional Library Advisory Service), for GPs in the North of England, modelled on one run in Australia.1 GPs sent requests for answers to questions arising during clinical consultations. We then undertook a search for the best available published evidence, briefly interpreted it, and quickly (within days) returned the answer to the GP.Our response to one of the questions received is presented. Under the Update section, we present relevant research published subsequent to the initial search.Full Tex