Background: We report post-coronary artery bypass outcomes and factors affecting the outcomes from the Genesee County, MI, where the population is distinctly characterized by a higher prevalence of renal failure (RF), diabetes, obesity and smoking than the national average. Methods: We performed a retrospective cohort study on 1133 patients undergoing isolated CABG at our hospital from June 2012 to July 2017. Primary outcome was the association between preoperative hemoglobin A1c (HbA1c) and all-cause postoperative mortality after CABG, secondary outcomes included the association between HbA1c and a composite of postoperative infections including sternal-wound infections, leg harvest-site infections, pneumonia or sepsis. Logistic Regression analyses were also performed. Results: There was no difference in the mortality rate (OR 1.0, 95% CI 0.4-2.3) and composite of all infections (OR 1.0, 95% CI 0.7-1.6) between the controlled (HbA1c ≤7%) and uncontrolled (HbA1c >7%) groups. However, RF (OR 5.9, 95% CI 1.5-22.9), smoking (OR 3.7, 95% CI 1.3-11.2) and ejection fraction <35% (OR 3.4, 95% CI 1.4-8.3) were independently associated with increased mortality after CABG. Additionally, low EF (OR 2.4, 95% CI 1.4-4.1) and smoking (OR 2.3, 95% CI 1.2-4.1) were associated with an increased rate of composite of all infections after CABG. Conclusion: Although not different in controlled and uncontrolled diabetic groups, mortality, in our population was associated with comorbidities like RF, smoking and congestive heart failure that are highly prevalent, emphasizing the need for interventions at primary care level to improve the postoperative outcomes after CABG.
Traumatic brain injury is described as a blow to the head or a penetrating head damage which disturb the normal function of the brain. Traumatic brain injuries, in children are common and sometimes are powerful in threatening the life and are leading causes of acquired disability and death. Traumatic brain injury is responsible for nearly 1.4 million injuries and 52 000 deaths annually in the United States. Therefore, in this paper we reviewed the new and recent advances about the management and neuromonitoring in pediatric traumatic brain injury. And to provide a summary of the empirical research on management and rehabilitation in pediatric traumatic brain injury (TBI). Studies of the effectiveness of interventions with children with TBI are hampered by difficulty with combining subjects with various levels of TBI, problems with random assignment to treatment groups, and varying age levels at injury. While these are areas of concern, there are emerging studies that indicate both applied behavioral analysis (ABA) and positive behavioral interventions are helpful to many children. For some children, ABA is not successful, and a shift to positive behavioral interventions has been found to be helpful. Transitions to home and school can be difficult particularly if there are family issues that predated the injury. This review provides additional information for the pediatric neuropsychologist to assist with transition to school and home. Studies utilizing the Internet for family interventions have revealed promising results. Conclusion: Neuromonitoring technology is still at an early stage in pediatric TBI. These improvements have provided the possibility of true multimodal monitoring for useful treatments. But, using clinical functional neuromonitoring would help clinicians to evaluate the managements in hospitals. Studies have indicated that children with severe TBI show significant difficulties with emotional and behavioral adjustment that pose more challenges for intervention and reentry to home and school compared with cognitive and physical issues.
Objectives: To investigate the value of plasma D-dimer as a prognostic marker in severe traumatic brain injury in children and to compare the results of plasma D-dimer level in plasma and the clinical condition of the case and the results of its routine laboratory investigations.
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