In the United Kingdom, donation after circulatory death (DCD) kidney transplant activity has increased rapidly, but marked regional variation persists. We report how increased DCD kidney transplant activity influenced waitlisted outcomes for a single center. Between 2002-2003 and 2011-2012, 430 (54%) DCD and 361 (46%) donation after brain death (DBD) kidney-only transplants were performed at the Cambridge Transplant Centre, with a higher proportion of DCD donors fulfilling expanded criteria status (41% DCD vs. 32% DBD; p = 0.01). Compared with U.K. outcomes, for which the proportion of DCD:DBD kidney transplants performed is lower (25%; p < 0.0001), listed patients at our center waited less time for transplantation (645 vs. 1045 days; p < 0.0001), and our center had higher transplantation rates and lower numbers of waiting list deaths. This was most apparent for older patients (aged >65 years; waiting time 730 vs. 1357 days nationally; p < 0.001), who received predominantly DCD kidneys from older donors (mean donor age 64 years), whereas younger recipients received equal proportions of living donor, DBD and DCD kidney transplants. Death-censored kidney graft survival was nevertheless comparable for younger and older recipients, although transplantation conferred a survival benefit from listing for only younger recipients. Local expansion in DCD kidney transplant activity improves survival outcomes for younger patients and addresses inequity of access to transplantation for older recipients.
disorder clinic were reviewed. All participants underwent brain magnetic resonance imaging to augment diagnostic accuracy. For the same reason, metaiodobenzylguanidine (MIBG) cardiac scintigraphy was performed in most participants. Individuals with a history of abdominal surgery, gastrointestinal diseases such as ulcerative colitis and cholecystolithiasis, diabetes mellitus, and other systemic diseases that might potentially cause IPO or volvulus were excluded. For the same reason, individuals patients taking trihexyphenidyl and other anticholinergic agents were excluded.Two-hundred fifty individuals with PD (132 men, 118 women; mean age 67 (range 46-84); mean disease duration 5.3 years (range 1-15 years)) were enrolled in the study. Of these, six (2.4%) had been admitted to the gastroenterology unit because of emergency IPO (five cases) or sigmoid colon volvulus (case 3 and at the second admission of case 6) ( Table 1). All six patients had acute onset of abdominal bloating, pain, nausea, or vomiting. 1 Abdominal X-ray and computed tomography showed dilation of the colon with or without the small intestine in all six individuals. 1 Two cases with volvulus showed a double loop sign at the sigmoid colon, 1,4,5 which required emergency endoscopic reposition. The clinical features of the six individuals were as follows: mean age 78.5 (range 69-82); three male, three female; ordinary Hoehn Yahr motor grade 3.2 (range 2-5); illness duration 5.3 years (range 2-9 years; taking a large levodopa dose 420 mg/d (in 5); constipation; regular bowel medication (e.g., magnesium oxide) (in 5); urinary dysfunction (in 5); mean hospital stay 44 days (range 1-112 days); no recurrence after discharge for mean 1.3 years (range 1-4 years). One patient (case 2) died from aspiration pneumonia.Mechanisms of constipation in PD are prolonged colonic transit (autonomic) and disturbed defecation (somatic and autonomic), 1 reflecting Lewy body pathology in the myenteric plexus. 1 The incidence of IPO and volvulus in our cases (2.4%, 6/250) is almost in accordance with that found in the previous study (7.1%, 8/ 112). 2 After hospitalization, patients were started on mosapride (selective 5HT-4 stimulating agent), 6 domperidone (peripheral dopaminergic blocker), and Dai-Kenchu-Tou (an herbal medicine containing hydroxy-beta-sanshool with 5HT-3-stimulating properties), 7 which seemed to prevent the recurrence of IPO. In conclusion, the incidence of emergency IPO in individuals with PD at a movement disorder and gastroenterology clinics was 2.4%; all were older adults. Although rare, emergency IPO requires hospitalization and may have a poor outcome. Therefore, preventative treatment of constipation with prokinetic drugs is necessary particularly in older adults with PD.The present study was approved by the ethics committee at
Objective : This study aimed to report the severity of COVID-19 in a cohort of Egyptian patients with multiple sclerosis (MS) with particular attention on the impact of disease modifying drugs (DMDs). Methods and study population : We included 119 MS patients recruited from two centers, Ain-Shams university and Cairo university with confirmed or suspected COVID-19 during the period from May to September 2020 as a part of the MuSC-19 project. Univariate logistic regression was fitted to assess risk factors for severe COVID-19 (at least one outcome among hospitalization, ICU admission and death). Results : Females were 77%, mean age was 34 years, mean duration of MS was 5.28 years, median EDSS was 3, most of the patients (83%) had RRMS, while 15% and 2% had respectively SPMS and PPMS. Only eleven patients (9% of study population) had a severe outcome and 3 patients (3%) died. Headache was the only symptom significantly associated with the severity of COVID-19 (OR=10.85, P = 0.001). There was no association between any of the DMDs and severe COVID-19 outcome. Conclusion : This study showed an acceptable safety profile of DMDs in Egyptian MS patients who developed COVID-19, as 91% of the cohort had a favorable outcome. Headache as a symptom associated with severe outcome in Egyptian patients’ needs further validation.
BACKGROUND: Hand surgical procedures are common interventions in elective and emergency settings. The complex nature of the injuries and management by multiple specialities could be a potential source of medical errors and never events (NEs). Awareness of the common NEs could potentially help prevent their occurrence in the future. OBJECTIVE: To analyse the NHS England database to identify the common NEs in hand surgery and present a simple, practical safety checklist for hand surgery. METHODS: The NHS NEs database from 2012 to 2021 has been analysed to identify the common hand surgery-related never events. We identified the common categories and themes within. Our theme development process is based on anatomical considerations and the nature of the incidents. Additionally, we designed a simple Safety Checklist for hand surgery. RESULTS: We identified a total of 3742 never events with 50 incidents related to hand surgery, representing (1.3%). Wrong-site surgery was the commonest category (n = 30), representing 60% of the hand surgery-related NEs. We identified seven different themes under wrong-site surgery. Wrong finger or digit surgery was the commonest theme, with 17 reported incidents representing 57% of wrong-site surgeries. This is followed by five wrong digits injections and three wrong k wire placements representing 16.6% and 10%, respectively. The second most common category was wrong incisions (n = 15), representing 30%; 13 patients had wrong finger incisions. Two patients had carpal tunnel incisions before surgeons realised that the procedures were for trigger finger release. The third category included four wrong procedures, with two incidents of carpal tunnel release instead of trigger finger operation or Dequervain tendon release. Finally, one patient had an injection for carpal tunnel intended for another patient. CONCLUSION: Hand surgery-related NEs represent a small fraction (1.3%) of all NEs within the NHS database. We identified 50 hand surgery-related NEs arranged into 14 different themes. Additionally, we proposed a hand surgery-specific safety checklist to reduce the incidence of these incidents in the future.
Background Hepatic Encephalopathy (HE) is defined as alteration of mental state in the absence of other causes of encephalopathy due to liver failure and/or abnormal shunting of blood from portal to systemic circulation often accompanied by elevated blood ammonia. Objectives The aim of this study was to determine the relation between the Helicobacter pylori infectionand minimal hepatic encephalopathy (MHE) in cirrhotic patients and to assess the outcome after treatment of H. pylori. Patients and Methods This study was can•ied out at Egyptian Railway Medical Centre at the in-patients section at Gastroenterology and Hepatology Medicine Department with chronic liver disease who agreed to participate in the study. After performing the psychometric tests the patients were allocated in one of the two groups according to test results: Group I: consisted of 30 consecutive patients who have chronic liver disease and presented with evidence of Minimal hepatic encephalopathy (MHE), as recognized by positive psychometric tests, Group Il: included 30 consecutive patients who presented with chronic liver disease and did not have Minimal hepatic encephalopathy, as confirmed by negative psychometric test. Results In this study a significant reduction was found in blood ammonia levels in MHE and non- MHE after triple-drug anti-H. pylori treatment (p < 0.001). This reduction was more marked in patients with MHE group compared to non-MHE group with % improvement in ammonia level 26.1 ± 8.36 umol/L and 17.79 ± 7.308 for MHE and non-MHE respectively. This finding indicates that H. pylori may contribute to the development of hyperammonemia in patients with liver disease and MHE. The role of H. pylori in the pathogenesis of hyperammonemia has been shown in previous studies which showed a reduction in blood ammonia levels after eradication of H.pylori infection. Conclusion Helicobacter Pylori infection was more prevalent in patients with MHE than without MHE. Serum arnrnonia levels were significantly higher in MHE patients than without MHE and even higher in H.pylori positive patients than without H.pylori infection. Helicobacter Pylori eradication treatment significantly improves ammonia levels, results of psychometric tests and improves manifestations of MHE.
IntroductionLimb amputation can cause residual limb pain (RLP) and/or phantom limb pain (PLP). Although targeted muscle reinnervation (TMR) was initially introduced to facilitate the control of prosthetic limbs, it has been noted that these patients experience less pain and improved prosthetic functional outcomes. As a result, the use of TMR in managing neuroma‐related RLP is increasing. The aim of this review is to assess the quality and strength of the evidence supporting the effectiveness of TMR in managing amputation‐related pain.MethodsFive different databases, including MEDLINE (PubMed), Scopus, Web of Science, Cochrane Library, and Embase, were searched from inception to March 2022. The protocol for this systematic review has been registered in the PROSPERO database (CRD42020218242). To be included, studies needed to compare pre‐ and postoperative pain outcomes or different techniques for adult patients who underwent TMR following amputation. Eligible studies also needed to use patient‐reported outcome measures (PROMS) and be clinical trials or observational studies published in English. Excluded studies were case reports, case series, reviews, proof of concept studies, and conference proceedings. A meta‐analysis was performed on studies that had similar intervention and control groups to examine treatment effects using a random‐effects model. Studies were weighted using the inverse variance method, and a statistically significant p‐value was considered to be less than or equal to 0.05.ResultsThis review included five studies for qualitative analysis and four studies for quantitative analysis. Reviewed studies enrolled a total of 127 patients. The TMR group was compared with standard treatment at 12 months follow‐up. The TMR group showed significantly better PLP as assessed by the numerical rating score RLP, and PLP assessed using Patient‐Reported Outcomes Measurement Information System (PROMIS) also showed significantly lower pain intensity in the TMR group.ConclusionThere is limited evidence of good quality favoring TMR in reducing postamputation PLP and RLP pain compared with standard care. Randomized clinical trials are encouraged to compare the efficacy of different surgical techniques.
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