A rare cause of refractory hyponatremia after traumatic brain injury: Acute post-traumatic hypopituitarism due to pituitary stalk transection

We report a 1.5-year-old boy with refractory hyponatremia related to pituitary stalk transection, which is a rare cause of hyponatremia after traumatic brain injury. The patient was referred to our hospital with a hyponatremic convulsion 6 days after head trauma. The patient's laboratory findings were compatible with syndrome of inappropriate antidiuretic hormone secretion (SIADH). The hyponatremic convulsion was treated with a hypertonic saline infusion and the SIADH was treated with fluid restriction, but serum levels of sodium did not increase. Acute post-traumatic hypopituitarism was diagnosed based on basal pituitary function tests and imaging. Hypophysis magnetic resonance imaging showed pituitary stalk transection. He was diagnosed with post-traumatic hypopituitarism due to pituitary stalk transection and given L-thyroxine and hydrocortisone. After the treatment, sodium and thyroid hormone levels returned to normal. Acute post-traumatic hypopituitarism is a potentially important cause of hyponatremia after traumatic brain injury, and can be mis-diagnosed as SIADH. Copyright (C) 2016, Taiwan Society of Emergency Medicine. Published by Elsevier Taiwan LLC

Deferasirox in children with transfusion-dependent thalassemia or sickle cell anemia: A large cohort real-life experience from Turkey (REACH-THEM)

Objectives To evaluate the long-term efficacy and safety of deferasirox therapy in a large observational cohort of children with transfusion-dependent thalassemia (TDT) and sickle cell anemia (SCA) in Turkey. Methods This was a multicenter, prospective cohort study including TDT and SCA patients aged 2-18 years with iron overload (>= 100 mL/kg of pRBC or a serum ferritin [SF] level >1000 mu g/L) receiving deferasirox. Patients were followed for up to 3 years according to standard practice. Results A total of 439 patients were evaluated (415 [94.5%] TDT, 143 [32.6%] between 2 and 6 years). Serum ferritin levels consistently and significantly decreased across 3 years of deferasirox therapy from a median of 1775.5 to 1250.5 mu g/L (P = 30 mg/kg/d (n = 120, -579.6 median reduction, P = 30 mg/kg/d) may be required to achieve iron balance

Invasive fungal diseases in patients with acute leukemia or allogeneic stem cell transplantion recepients: A prospective multicenter observational study

WOS: 00043485270033

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit