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.
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