Potential role of the geriatric nutritional risk index as a novel risk factor for the development of non-valvular atrial fibrillation in patients with heart failure

PURPOSE: The geriatric nutritional risk index (GNRI) is a simple and objective nutritional assessment tool for elderly patients. Lower GNRI values are associated with a worse prognosis in heart failure with reduced ejection fraction (HFrEF). Our aim is to investigate the relationship between malnutrition and follow-up cardiovascular (CV) events in HFrEF. METHODS: A retrospective study was performed on 362 patients with HFrEF. The baseline GNRI was calculated at the first visit. The patients were divided into three groups according to the GNRI: >98, no-risk group; 92 to <= 98, low risk group; 82 to <92, moderate-to-high-risk group. The study endpoint was a composite of follow-up CV events, including all-cause mortality, non-valvular atrial fibrillation (NVAF) , need for cardioverter defibrillator (ICD) therapy, HfrEF-related hospitalizations and need for percutaneous coronary interventions (PCIs). RESULTS: Follow-up data showed that the group with moderate-to-high risk had a significantly higher incidence of NVAF, PCIs and all-cause mortality compared to other groups (p0.05). Mean GNRI value was 83.3 in NVAF patients and 101.1 in patients without NVAF (p<0.001). Kaplan Meier survival analysis showed that patients from the group with moderate-to-high risk had a significantly worse survival rate (p < 0.001). In the multivariate Cox regression analysis, the group with moderate-to-high risk (HR =3.872) and ICD implantations (HR = 4.045) were associated with increased mortality. CONCLUSION: The GNRI value may have a potential role for predicting future events, especially NVAF in patients with HfrEF

After a urological laparoscopic training programme, which laparoscopic method is safer and more feasible in the management of proximal ureteral stones: Transperitoneal or retroperitoneal?

PubMedID: 27524530Objectives: To compare the results of the management of the first 25 transperitoneal laparoscopic ureterolithotomies with the first 25 retroperitoneal laparoscopic ureterolithotomies performed by two surgeons who had just completed a laparoscopic training programme. Methods: The retrospective study was conducted at Adana Numune Teaching and Research Hospital and comprised retroperitoneal laparoscopic ureterolithotomies and transperitoneal laparoscopic ureterolithotomies performed by two different surgeons on patients with proximal ureteral stones between November 2011 and March 2013. The transperitoneal and retroperitoneal procedures were categorised as Groups A and B, respectively. Patients in Group A were operated on by the same surgeon (DA) and those in Group B were operated on by the other surgeon (FK). Groups were compared according to operative time, duration of drainage and urethral catheter, hospital stay, stone size, surgical success and complications. Results: There were 50 patients in the study; 25(50%) in each of the two groups. Success rates in Group A and B were 21(84%) and 20(80%), respectively (p>0.05). Complications were seen in 8(32%) and 11(44%) patients in Group A and B, respectively (p>0.05). Conclusion: The transperitoneal approach was more advantageous than the retroperitoneal approach for less-experienced surgeons because it provided a wider operating field, a more familiar anatomy and more convenient suturing. © 2016, Pakistan Medical Association. All rights reserved

Emergency endovascular intervention after mortal complication of lumbar spinal operation

Intraoperative iatrogenic great vessel injuries that can be seen in lumbar disc hernia operation are rare conditions but it can he a fatal complication depending on its extension. Rapid diagnosis and treatment is vital. This type of iatrogenic vascular injuries can he applied to standard Open surgical techniques or endovascular procedures. We presented a case that had vascular injury complication during lumbar spinal surgery. Emergency endovascular intervention was discussed when it was detected