3 research outputs found
CaracterĂsticas radiolĂłgicas encontradas en las cardiopatĂas congĂ©nitas en pacientes de 0 a 5 años evaluados por angiotomografĂa computada. Instituto Nacional de Salud del Niño. Breña año 2016
PublicaciĂłn a texto completo no autorizada por el autorDetermina las caracterĂsticas radiolĂłgicas encontradas en las cardiopatĂas congĂ©nitas de pacientes de 0 a 5 años evaluados por angiotomografĂa computada en el Instituto Nacional de Salud del Niño de Breña atendidos en el año 2016. La investigaciĂłn es de tipo observacional, descriptivo, retrospectivo, transversal, con enfoque cuantitativo. Participan 63 historias clĂnicas de pacientes con cardiopatĂas congĂ©nitas que se realizan una angiotomografĂa computada de corazĂłn y grandes vasos. La tĂ©cnica utilizada es el anĂĄlisis documental, obteniĂ©ndose los datos de las historias clĂnicas y de los informes angiotomogrĂĄficos siendo procesados en SPSS versiĂłn 22.0. Asimismo, se realiza un anĂĄlisis univariado estimĂĄndose frecuencias absolutas y relativas. Los resultados revelan que las caracterĂsticas radiolĂłgicas observadas son: origen de la aorta de lado izquierdo (66.7%), luz conservada (82.5%); presencia de estenosis de la arteria pulmonar (82.5%), luz de arteria pulmonar conservada (55.6%); cuatro venas pulmonares (93.7%), luz de la venas pulmonares conservadas (85.7%); persistencia del ductus arterioso (49.2%); la aurĂcula derecha (79.4%) e izquierda (82.5%) conservadas; ventrĂculo derecho aumentado (50.8%) y ventrĂculo izquierdo conservado (65.1%). Los tipos de cardiopatĂas congĂ©nitas mĂĄs frecuentes son atresia pulmonar (23.8%) y tetralogĂa de Fallot (15.9%) para cardiopatĂas cianĂłticas; y comunicaciĂłn interventricular (44.4%) y persistencia del ductus arterioso (42.9%) para las cardiopatĂas acianĂłticas.Tesi
Assessment of plasma chitotriosidase activity, CCL18/PARC concentration and NP-C suspicion index in the diagnosis of Niemann-Pick disease type C : A prospective observational study
Niemann-Pick disease type C (NP-C) is a rare, autosomal recessive neurodegenerative disease caused by mutations in either the NPC1 or NPC2 genes. The diagnosis of NP-C remains challenging due to the non-specific, heterogeneous nature of signs/symptoms. This study assessed the utility of plasma chitotriosidase (ChT) and Chemokine (C-C motif) ligand 18 (CCL18)/pulmonary and activation-regulated chemokine (PARC) in conjunction with the NP-C suspicion index (NP-C SI) for guiding confirmatory laboratory testing in patients with suspected NP-C. In a prospective observational cohort study, incorporating a retrospective determination of NP-C SI scores, two different diagnostic approaches were applied in two separate groups of unrelated patients from 51 Spanish medical centers (n = 118 in both groups). From Jan 2010 to Apr 2012 (Period 1), patients with â„2 clinical signs/symptoms of NP-C were considered 'suspected NP-C' cases, and NPC1/NPC2 sequencing, plasma chitotriosidase (ChT), CCL18/PARC and sphingomyelinase levels were assessed. Based on findings in Period 1, plasma ChT and CCL18/PARC, and NP-C SI prediction scores were determined in a second group of patients between May 2012 and Apr 2014 (Period 2), and NPC1 and NPC2 were sequenced only in those with elevated ChT and/or elevated CCL18/PARC and/or NP-C SI â„70. Filipin staining and 7-ketocholesterol (7-KC) measurements were performed in all patients with NP-C gene mutations, where possible. In total across Periods 1 and 2, 10/236 (4%) patients had a confirmed diagnosis o NP-C based on gene sequencing (5/118 [4.2%] in each Period): all of these patients had two causal NPC1 mutations. Single mutant NPC1 alleles were detected in 8/236 (3%) patients, overall. Positive filipin staining results comprised three classical and five variant biochemical phenotypes. No NPC2 mutations were detected. All patients with NPC1 mutations had high ChT activity, high CCL18/PARC concentrations and/or NP-C SI scores â„70. Plasma 7-KC was higher than control cut-off values in all patients with two NPC1 mutations, and in the majority of patients with single mutations. Family studies identified three further NP-C patients. This approach may be very useful for laboratories that do not have mass spectrometry facilities and therefore, they cannot use other NP-C biomarkers for diagnosis
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)