Clinical effectiveness and tolerability of phytotherapy for benign prostatic hyperplasia - A systematic review of systematic reviews

Background: Benign prostatic hyperplasia (BPH) is defined as a progressive nonmalignant enlargement of smooth muscle and epithelial cells in the prostate. A lot of studies have been published on the efficacy and safety of phytotherapeutic agents against BPH, making it a daunting task to review comprehensively. Aim and Objectives: The present article aimed to review the existing systematic reviews of primary studies on the subject. Google Scholar and PubMed databases were used in searching the articles. Materials and Methods: After permission from the departmental ethics committee, the quality of the retrieved articles was assessed using a revised assessment of multiple systematic reviews scale. Results: Sixteen reviews were included, with the majority (11 out of 16) focusing on Serenoa repens extracts. Such evidence for other phytotherapeutic agents studied is either limited, conflicting, or lacking. Issues about the primary studies included in the reviews were discussed and some recommendations presented. Conclusion: The reviews that focused on the most widely studied hexanic extract of S. repens, Permixon, were consistent in their conclusions that the extract is beneficial in improving the symptoms of BPH.

Sublingual and oral zolpidem for insomnia disorder: a 3-month randomized trial

Objective: To evaluate the safety and efficacy of a 5 mg sublingual dose of zolpidem, compared to a 10 mg oral dose, at bedtime and "as needed" following middle-of-the-night awakenings. Methods: Participants were randomized into an oral group (oral zolpidem 10 mg and sublingual placebo at bedtime and "as-needed") and a sublingual group (oral placebo and sublingual zolpidem 5 mg at bedtime and "as-needed"). Participants underwent medical evaluation, polysomnography, the psychomotor vigilance test, and completed questionnaires. Results: Of 85 patients, 67 met the criteria for insomnia (48±10 years; 79% women) and were randomized. Of these, 46 completed 92±5 days of treatment. Mild-to-moderate adverse events were reported by 25% of the participants, including headache, sleepiness, and dizziness. Both treatments decreased middle-of-the-night awakenings by an average of -3.1±2.3 days/week and increased total sleep time by 1.5 hours. Changes in sleep quality and insomnia severity scores were also favorable and comparable between groups: variation depended on continuation of treatment. Regarding PSG findings, sleep latency decreased more in the sublingual group than the oral group (-14±42 vs. 10±29 min; p = 0.03). The psychomotor vigilance test showed minor residual effects 30 minutes after awakening, which reversed after 2 hours. Conclusions: The safety and efficacy of both zolpidem formulations are comparable. The sublingual 5 mg dose induced sleep more rapidly. Clinical trial registration: NCT01896336

Impacto de la implementación de un algoritmo en el tratamiento de niños hospitalizados por asma agudo / Impact of the implementation of an algorithm in the treatment of children hospitalized by acute asthma

Patients hospitalized for acute asthma treated with a pre-established algorithm could decrease hospital stay and critical bed (PICU) requirement. The objective of this article was to implement and evaluate the impact of a pre-established algorithm to treat children hospitalized for acute asthma. It is a cross-sectional and comparative study, with a prospective sample for convenience, of asthmatic children between 5 and 15 years admitted during 2017 without response to the first line of treatment in the emergency department. Patients with cardiorespiratory comorbidities and with direct admission to PICU were excluded. An algorithm was applied for 2 hours and its effectiveness was evaluated by a clinical score (PAS: English Pediatric Asthma Score). 55 patients were admitted, mean age 8.02 years, 41.8% female. The PAS decreased from 8 to 5 points at the end of the algorithm (p <0.001). When comparing the results obtained with the group treated the previous year, without algorithm application in 51 patients with similar demographic characteristics, a shorter hospitalization was observed (0.6 days versus 0.95 days (p <0.0368)). The algorithm in acute asthma unified treatment criteria and times in its application. A rapid decrease in clinical score and a shorter hospital stay were observed.

Los pacientes hospitalizados por asma agudo tratados con un algoritmo preestablecido, podrían disminuir la estancia hospitalaria y requerimiento de cama crítica (UCIP). El objetivo de este trabajo fue el de implementar y evaluar el impacto de un algoritmo preestablecido para tratar a niños hospitalizados por asma aguda. Es un estudio transversal y comparativo, con una muestra prospectiva por conveniencia, de niños asmáticos entre 5 y 15 años ingresados durante el 2017 sin respuesta a la primera línea de tratamiento en el servicio de urgencia. Se excluyeron pacientes con comorbilidades cardiorespiratorias y con ingreso directo a UCIP. Se aplicó un algoritmo durante 2 horas evaluando su efectividad mediante puntaje clínico (PAS, por su sigla en inglés Pediatric Asthma Score). Ingresaron 55 pacientes, edad media 8,02 años, 41,8% sexo femenino. El PAS disminuyó de 8 a 5 puntos al finalizar algoritmo (p <0,001). Al comparar los resultados obtenidos con el grupo tratado el año anterior, sin aplicación de algoritmo en 51 pacientes con similares características demográficas, se observó una hospitalización más breve (0,6 días versus 0,95 días (p < 0,0368)). El algoritmo en asma aguda unificó criterios de tratamiento y los tiempos en su aplicación. Se observó una rápida disminución del puntaje clínico y menor estancia hospitalaria.

Shovel-shaped electrode transurethral plasmakinetic enucleation versus plasmakinetic resection of the prostate in the treatment of benign prostatic hyperplasia / 中华男科学杂志

Objective@#To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enucleation of the prostate (PKEP) with those of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH).@*METHODS@#We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth People's Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the patients for 6 months postoperatively and compared the effects and safety of the two surgical strategies.@*RESULTS@#No statistically significant difference was observed between the PKEP and PKRP groups in the operation time (［69.3 ± 8.8］ vs ［72.2 ± 7.9］ min, P = 0.126), but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin (［3.9 ± 2.8］ vs ［13.9 ± 5.2］ g/L, P 0.05) and other postoperative complications.@*CONCLUSIONS@#Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.

Clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma / 中华肿瘤杂志

Objective@#To investigate the clinical effectiveness of postoperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).@*Methods@#A total of 379 HCC patients who received partial hepatectomy from January 2010 to December 2013 in Department of Hepatobiliary Surgery of Cancer Hospital, Chinese Academy of Medical Sciences were selected. Based on the nutritional method, all of the enrolled patients were divided into two group: 142 patients who received early enteral nutrition (EEN) combined with parenteral nutrition (PN) were identified as EEN+ PN group; 237 patients who received total parenteral nutrition (TPN) were identified as TPN group. These two groups were even divided into two subgroups, centrally located HCC (cl-HCC) and non-centrally located HCC (ncl-HCC). The clinical effectiveness of different groups was assessed and compared.@*Results@#The age, gender, body mass index (BMI), the maximum diameter of the tumor, the amount of operative bleeding and postoperative infective rate did not show statistically significant differences between EEN+ PN group and TPN group (P>0.05). On the seventh postoperative day (7th POD), aspartate transaminase (AST) of EEN+ PN group and TPN group were (41.6±2.0) IU/L and (50.4±3.2) IU/L respectively, and the difference was statistically significant (P<0.05). Alkaline phosphatase (ALP) of these two groups were (80.8±2.4) IU/L and (90.2±2.3) IU/L, respectively, and the difference was statistically significant (P<0.05). Total bilirubin (TBIL) of these two groups were (15.8±0.7) μmol/L and (19.1±0.7) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7th POD, AST in cl-HCC subgroups of EEN+ PN group and TPN group were (39.6±2.6) IU/L and (61.0±7.0) IU/L, respectively, and the difference was statistically significant (P<0.05). TBIL in cl-HCC subgroups of these two groups were (14.4±0.9) μmol/L and (20.7±1.3) μmol/L, respectively, and the difference was statistically significant (P<0.05). On the 7th POD, ALP in ncl-HCC subgroups of these two groups were (79.3±3.0) IU/L and (89.9±3.1) IU/L, respectively, and the difference was statistically significant (P<0.05). The total length of stay (t-LOS) of these two groups were (15.8±0.4) days and (17.1±0.4) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) of these two groups were (8.6±0.2) days and (10.1±0.3) days, respectively, and the difference was statistically significant (P<0.05). Total length of stay (t-LOS) in ncl-HCC subgroups of these two groups were (15.1±0.5) days and (16.6±0.3) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in ncl-HCC subgroups of these two groups were (8.4±0.2) days and (9.5±0.2) days, respectively, and the difference was statistically significant (P<0.05). Postoperative LOS (postop-LOS) in cl-HCC subgroups of these two groups were (8.7±0.2) days and (11.0±0.8) days, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses of these two groups were (20 855.0±549.8) yuan and (23 373.0±715.5) yuan, respectively, and the difference was statistically significant (P<0.05). Postoperative hospitalization expenses in cl-HCC subgroups of these two groups were (21 012.0±748.5) yuan and (24 697.0±1 409.0) yuan, respectively, and the difference was statistically significant (P<0.05).@*Conclusion@#EEN+ PN can improve the liver function, shorten the postoperative hospitalization time and reduce the postoperative hospitalization expenses of HCC patients in need of nutritional support.

Clinical effect of comprehensive intervention on submission rates of microbiological specimens / 中国感染控制杂志

Objective To investigate the effect of comprehensive intervention measures on submission of microbiological specimens before therapeutic use of antimicrobial agents.Methods August 2014 to August 2015 was as preintervention group,comprehensive intervention measures were started to carry out from September 2015,Septem ber 2015 to September 2016 was as post-intervention group.Microbiology specimen submission rates before therapeutic antimicrobial use,positive rate of blood culture,and rate of antimicrobial use in all departments and key departments were compared between pre-intervention group and post-intervention group.Results The submission rates of microbiological specimens before general,restricted,and special therapeutic antimicrobial use increased from 42.21％,45.19％,and 74.71％ of pre-intervention respectively to 53.54％,55.68％,and 89.70％ of postintervrntion respectively,showing significant difference (all P＜0.01);after intervention,except gastrointestinal surgery and trauma department of orthopedics,the other departments all met the requirements of the microbiological specimen submission rates set by the hospital;but submission rates of microbiological specimens from department of gastrointestinal surgery and trauma department of orthopedics increased from 5.46％ and 11.67％ before intervention to 11.66％ and 29.45％ respectively after intervention,difference was statistically significant (both P＜0.001).The missing report rate of healthcare-associated infection(HAI) dropped from 13.56％ before intervention to 10.98％ (P＜ 0.05),and the use rate of antimicrobial agents decreased from 57.36％ to 54.47％ (P＜0.001).Conclusion Comprehensive intervention measures can effectively improve the submission rates of microbiological specimens before therapeutic use of antimicrobial agents,reduce missing report rates of HAI and utilization rate of antimicrobial agents,and achieve certain clinical effectiveness.

Archibald Cochrane: evidencia, efectividad y toma de decisiones en salud / Archibald Cochrane: evidence, effectiveness and decision-making in health

Resumen: Actualmente, la Medicina Basada en Evidencia tiene un papel fundamental en la toma de decisiones médicas, ya que intenta, a través de los métodos de la ciencia, justificar las diferentes alternativas que se le pueden ofrecer a un paciente. Para entender la evolución histórica de esta forma de practicar la medicina, es necesario revisar la contribución de uno de los principales participantes en este movimiento cultural: Archibald Leman Cochrane, quien ayudó a definir el marco teórico que ha permitido incorporar la ciencia a la práctica de la medicina. Su papel, al insistir en la necesidad de integrar la evidencia científica y conjuntarla con la experiencia clínica, constituyó un elemento fundamental y decisivo en el desarrollo de una nueva disciplina, la Medicina Basada en Evidencia.

Abstract: Nowadays, Evidence-Based Medicine plays a fundamental role while making medical decisions, considering that through the methods of science, it attempts to justify the variety of alternatives that may be offered to patients. In order to understand the historical evolution of this way of practicing medicine, it is necessary to review the contribution of one of the main participants in this cultural movement: Archibald Leman Cochrane, who helped to define the theoretical framework that has allowed the integration of science into the practice of medicine. Since he insisted in the need of integrating scientific evidence into clinical experience, his role became a fundamental and decisive element in the development of a new discipline: Evidence-Based Medicine.

Clinical efficacy of two surgical treatment methods for anal fissures in elderly patients / 中华老年医学杂志

Objective To compare the clinical efficacy of two surgical methods for the treatment of anal fissures in elderly patients.Methods A total of 138 elderly patients with anal fissures treated at our hospital from January to December 2016 were randomly divided into the conventional method group(69 cases) and the modified method group (69 cases).Patients in the conventional method group were treated with lateral sphincterotomy,while patients in the modified method group were treated with modified longitudinal sphincterotomy with transverse suture.Outcomes of treatment,VAS scores,incision wound infection rates,postoperative voiding dysfunction rates and recurrence rates were compared.Results There was no significant difference in overall effectiveness between the modified method group (98.6％)and the conventional method group(94.2％) (x2=1.8677,P=0.1717).The rates of incision wound infection,moderate postoperative urinary retention and recurrence in the conventional method group(8.7％,42.0％ and 10.1 ％,respectively)were significantly higher than those in the modified methods group(0.0 ％,15.9 ％ and 0.0％,respectively) (x2 =4.3561,11.4061 and 5.4177,respectively,P =0.0369,0.0007 and 0.0199,respectively).At 12 hours after operation,favorable VAS scores and incision healing times were observed in the modified method group,compared with the conventional method group,and the differences were statistically significant(each P＜0.05).Conclusions Modified longitudinal sphincterotomy with transverse suture produces about the same overall effectiveness as does lateral sphincterotomy in the treatment of elderly patients with anal fissures,but it is superior in reducing incision wound infection,moderate postoperative voiding dysfunction,recurrence and pain intensity,and in promoting incision healing.

¿Cómo aporta la terapia ocupacional en el tratamiento de las demencias? / How does occupational therapy contribute to dementia care?

Occupational therapy is a profession concerned with the promotion of health and quality of life through occupation and engagement in activities. Dementia has an individual and social impact related to disability, dependency, need for daily support and exclusion from participation in situations and activities ofdaily living, matters ofinterest to occupational therapists. The aim of this article is to synthetize occupational therapy interventions in dementia care, describing perspectives of intervention, identifying current evidence for potential benefits and stablishing criteria for referral. Occupational therapy’sperspective in dementia care involves a dynamic view of the impact of cognitive, psychological and behavioral symptoms on the participation of the person with dementia in activities and situations ofdaily living and the relation with others and the physical environment. Increasing evidence suggests that occupational therapy can enhance the maintenance ofparticipation in activities of daily living as a way to moderate dependency and disability, to promote management ofcognitive, psychological and behavioral symptoms and adjusting the abilities of caregivers to face challenging situations of daily living. This synthesis has a clinical relevance as it helps to define occupational therapy framework in dementia care in order to contribute to the design and evaluation of occupational therapy interventions.

La terapia ocupacional es una profesión que busca la promoción de salud y calidad de vida a través de la ocupación y el involucramiento en actividades. El aumento del número de personas con demencia demanda progresivamente la intervención de terapia ocupacional en diferentes contextos de atención. La demencia tiene un impacto individual y social relacionado con discapacidad, dependencia, necesidad de apoyo diario y exclusión de participación, problemas de interés para los terapeutas ocupacionales. El propósito de este artículo es sintetizar intervenciones de terapia ocupacional en el tratamiento de las demencias, describiendo sus principales enfoques, identificando evidencia y potenciales y estableciendo recomendaciones para su referencia. Los enfoques de terapia ocupacional en demencia incluyen una perspectiva dinámica del impacto que los síntomas cognitivos, psicológicos y conductuales tiene usualmente en la participación de la persona con demencia en situaciones y actividades de la vida diaria, en los otros y en el ambiente físico. Existe evidencia creciente de los potenciales beneficios de terapia ocupacional en la mantención de participación en actividades de la vida diaria como moderadora de dependencia, de síntomas cognitivos, psicológicos y conductuales asociados con la patología, y del ajuste de las habilidades de cuidadores familiares. Esta síntesis tiene una relevancia clínica al colaborar en la delimitación de las acciones de terapia ocupacional en el tratamiento de las demencias, facilitando el diseño de intervenciones y su evaluación.

Organización vital de una muestra clínica que demanda atención psicológica / Life Functioning among a Clinical Sample Demanding Psychological Treatment

La asociación entre trastornos psicopatológicos y variables de funcionamiento psicosocial ha sido documentada, pero son escasos los estudios que evalúan su impacto sobre la eficacia de los tratamientos psicológicos. El objetivo de este estudio fue evaluar la organización vital de 78 pacientes de un servicio de atención psicológica y examinar la relación con variables clínicas y con el éxito del tratamiento. Esta organización se evaluó mediante una escala confeccionada ad hoc para este estudio. El área de pareja resultó la menos organizada frente a la familiar y personal, con las mayores puntuaciones. La organización vital se relacionó de forma significativa con distintos ejes del DSM-IV-TR. Se confirmó que pacientes con baja organización vital requieren un mayor número de objetivos terapéuticos.

The association between psychological disorders and psychosocial functioning variables has been previously documented, but relatively few studies have examined the impact of these variables on psychological treatment outcomes. The aim of this study was to assess the life functioning of 78 patients from a psychological service centre, and to examine its relationship with clinical variables and treatment success. Life functioning was evaluated with a scale elaborated ad hoc for this study. The partner area of functioning was the most impaired while family and personal areas obtained the highest functioning scores. Patient's life functioning was significantly associated with several axis of DSM-IV-TR. It was confirmed that patients with poorer life functioning required a greater number of treatment objectives.

Clinical Effectiveness of Electroconvulsive Therapy in a University Hospital Setting / 신경정신의학

OBJECTIVES: Electroconvulsive therapy (ECT) has become useful in psychiatric practice. This study was conducted to describe the clinical practice of ECT, including indications, efficacy, and side effects, in patients treated with modified unilateral or bilateral ECT. METHODS: The clinical records of patients treated with ECT during the period of January 2002 to December 2013 were evaluated retrospectively. A total of 107 patients (83 unilateral and 24 bilateral) were included in the analysis. Diagnostic categories treated were schizophrenia (46.7%), major depression (42.1%), bipolar disorder (9.3%), and obsessive-compulsive disorder (1.9%). Right unilateral or bilateral ECT was administered with brief pulse stimulation using modified ECT. Severity of illness and clinical improvement were measured using the Clinical Global Impressions (CGI) Scale. RESULTS: A positive response to ECT was found in 56.1% according to response criteria of the CGI-Improvement (CGI-I) score of 1 or 2. Response rates (based on CGI-I < or =2) for schizophrenia, major depression, bipolar disorder, and obsessive-compulsive disorder were 48.0%, 62.2%, 70.0%, and 50.0%, respectively (p=0.42). Although unilateral and bilateral ECT did not differ in rates of response, bilateral ECT resulted in more rapid onset of improvement. Bilateral ECT showed association with more adverse side effects (unilateral 31.3% vs. bilateral 70.8%). CONCLUSION: ECT is a highly effective and safe therapeutic option in the treatment of psychiatric illness, particularly in major mood disorder and schizophrenia. The use of ECT in a university hospital psychiatric unit in South Korea reflects similar results to those described in the international literature.

Clinical Effectiveness of Electroconvulsive Therapy in a University Hospital Setting / 신경정신의학

OBJECTIVES: Electroconvulsive therapy (ECT) has become useful in psychiatric practice. This study was conducted to describe the clinical practice of ECT, including indications, efficacy, and side effects, in patients treated with modified unilateral or bilateral ECT. METHODS: The clinical records of patients treated with ECT during the period of January 2002 to December 2013 were evaluated retrospectively. A total of 107 patients (83 unilateral and 24 bilateral) were included in the analysis. Diagnostic categories treated were schizophrenia (46.7%), major depression (42.1%), bipolar disorder (9.3%), and obsessive-compulsive disorder (1.9%). Right unilateral or bilateral ECT was administered with brief pulse stimulation using modified ECT. Severity of illness and clinical improvement were measured using the Clinical Global Impressions (CGI) Scale. RESULTS: A positive response to ECT was found in 56.1% according to response criteria of the CGI-Improvement (CGI-I) score of 1 or 2. Response rates (based on CGI-I < or =2) for schizophrenia, major depression, bipolar disorder, and obsessive-compulsive disorder were 48.0%, 62.2%, 70.0%, and 50.0%, respectively (p=0.42). Although unilateral and bilateral ECT did not differ in rates of response, bilateral ECT resulted in more rapid onset of improvement. Bilateral ECT showed association with more adverse side effects (unilateral 31.3% vs. bilateral 70.8%). CONCLUSION: ECT is a highly effective and safe therapeutic option in the treatment of psychiatric illness, particularly in major mood disorder and schizophrenia. The use of ECT in a university hospital psychiatric unit in South Korea reflects similar results to those described in the international literature.

Dietetic Clinical Effectiveness – would Therapy Outcome Measures be up to the Measure.

Background: It is challenging to identify single measures appropriate to meet the needs of the whole dietetic caseload, to measure the impact of clinical interventions. This has lead to failure to identify the impact of specific dietetic services and nutritional interventions. Having searched the literature, there were no validated outcome measures for dietetic interventions. In the absence of recognised measures the BDA [1] has produced guidance, covering six domains, to improve practice and demonstrate clinical and cost effectiveness, the only measure that included all six was the Therapy Outcome Measure (TOM) Enderby et al. [2]. The aim of the work was to develop and implement Dietetic TOMs to: - Establish whether interventions are effective. - Improve reflection on practice. - Support service development and improvement. - Demonstrate we provide services that are: clinically cost effective, efficient, responsive and equitable. Process: (NB Only for Innovative Service Development Abstracts) After identifying TOMs as the outcome measure of choice, we undertook training in TOM methodology and consistency of scoring with Professor Enderby, who developed TOMs. This was then subsequently cascaded to all staff. From whole service caseload, commissioning requirements and patient demographics and need, we identified six clinical areas that would provide a TOM for the majority of patients accessing the service, these were: obesity, under nutrition, home enteral feeding, diabetes, irritable bowel syndrome (IBS), and Cardiovascular Disease (CVD). The clinical teams working in these areas developed and piloted the relevant TOM. We undertook a six month pilot, firstly with case notes, and then with patients to test usability, validity, reliability, as well as issues of recording and reporting the data. We undertook a peer review process to ensure consistency of approach and language and then extended the pilot outside of the development teams to the whole service. After further review, the final TOMs were then validated by Professor Enderby. Outcomes: (NB Only for Innovative Service Development Abstracts) he Leeds Community Healthcare (LCH) Dietetic Service has developed and implemented six validated TOMs for dietetics in the Community. This is a validated tool developed by Prof Enderby and measures the clinical outcome of interventions. LCH Dietetics has developed and amended the framework to meet the needs of our teams and service users. The six TOMs are new frameworks and have Prof Enderby validation. The six TOMs developed cover the range of interventions offered in the broadest sense. Every service user will have at least two outcome measures recorded, (baseline and end point) to assess the quality and effectiveness of the dietetic intervention. This will not only demonstrate to our ‘customers’ the effectiveness of what we do, but also enable us as a dietetic service to assess our clinical effectiveness in dietetic practice and make improvements based on this knowledge, to ensure we continue to improve and deliver the best possible care to Leeds residents. Conclusion: TOMs ensure that LCH dietetics can identify the difference their specific dietary interventions make to patient care. TOMs enables effectiveness to be a measured in a consistent approach. This will demonstrate to all stakeholders, including commissioners, that dietetic services are clinically cost effective, efficient, responsive and equitable.

Eficacia clinica del hidrogel con plata iónica (silvercare®) en el control y cicatrización de heridas infectadas / Clinic efficacy of hydrogel with ionic silver (silvercare ®) in control and healing Of infected wounds

Objetivo: determinar la eficacia clínica de la plata iónica en hidrogel (SilverCare®), en pacientes con heridas agudas o crónicas con colonización crítica bacteriana o heridas infectadas que hayan sido intervenidos en el Servicio de Cirugía Cardiovascular del Hospital Universitario de Caracas, Venezuela, entre los meses de julio y diciembre del 2011. Pacientes y métodos: de un total de 34 pacientes con estudios bacteriológicos positivos, se incluyeron 25 pacientes entre 18 y 70 años, intervenidos por patología cardiaca central o periférica que presentaron heridas agudas o crónicas con colonización crítica o infección bacteriana registrada por cultivo de secreción. Resultados: de los 25 pacientes, 5 fueron pacientes con cirugía cardíaca, postoperados principalmente de revascularización miocárdica quirúrgica complicada con infección de herida esternal o safenectomía, y 20 fueron pacientes con postoperatorio de cirugía vascular periférica (exploración vascular por herida por arma de fuego 15 pacientes, otras cirugías periféricas 5 pacientes). Se registró un total de 25 resultados de cultivos positivos para los siguientes gérmenes: Escherichia coli (8 casos 32%), Acinetobacter baumannii (4 casos­16%), Stafilococo aureus meticilino resistente (4 casos ­ 16%), Psedomona aeruginosa (3 casos­12%), Acinetobacter SP multirresistente (1 caso­4%), Enterobacter agglomerans (1 caso­4%), Klebsiella S.P.P. (1 caso 4%), Dos o más gérmenes (3 casos­12%). Se encontró bacterias multiresistentes en 10 casos (40%). Se pudo determinar una reducción de más del 25% de los diámetros de las heridas a la cuarta semana de tratamiento en 23 casos (92%), control de la infección en 24 casos (96%), además de eliminación del dolor y olor en el 96% de los casos, disminución de la cantidad de exudado en 88%. No hubo recidiva de la infección en la herida a los 60 días de seguimiento. Conclusión: se confirma la eficacia clínica del uso de hidrogel con plata (SilverCare®) en el control de la infección y cicatrización en pacientes con heridas infectadas con poco a moderado exudado, considerando que la reducción de la velocidad de cicatrización fue debida al hidrogel y el control de la infección a la plata iónica(AU)

Objective: to determine the clinical efficacy of the ionic silver in hydrogel (SilverCare ®) in patients with acute or chronic bacterial critical colonization with wounds or infected wounds that have been operated in the service of Cardiovascular Surgery of the Hospital Universitario de Caracas, between the months of July and December 2011. Method: a total of 34 patients with positive bacteriological studies, included 25 patients between 18 and 70 years, operated by central or peripheral heart disease presenting with acute or chronic wounds with critical colonization or bacterial infection registered by culture of drainage. Results: of 25 patients, 5 were patients with cardiac surgery, undergone mainly myocardial revascularization surgery complicated with saphenectomy or sternal wound infection, and 20 patients with postoperative peripheral vascular surgery (vascular injury by firearm scan 15 patients, other peripheral surgeries 5 patients). There was a total of 25 results of positive cultures for the following germs: Escherichia coli (8 cases-32%), Acinetobacter baumannii (4 cases-16%), S. aureus aureus Methicillin resistant (4 cases - 16%), sedomona aeruginosa (3 cases-12%), multidrug-resistant Acinetobacter SP (1 case-4%), Enterobacter agglomerans (case 1-4%), Klebsiella S.P.P. (case 1-4%), two or more germs (3 cases-12%). Found multi-resistant bacteria in 10 cases (40%). It was determined a reduction of more than 25% of the diameters of the wounds a fourth week of treatment in 23 cases (92%), infection control in 24 cases (96%), in addition to eliminating the pain and smell in 96% of cases, decrease in the amount of exudate by 88%. There was no recurrence of the infection in the wound to 60 days of follow-up. Conclusion: is confirmed the clinical efficacy of the use of hydrogel with silver (SilverCare®) in the control of infection and scarring in patients with wounds infected with little to moderate exudate, considering that the reduction of the speed of healing was due to the Hydrogel and control of infection to the Ionic silver(AU)

Clinical Effectiveness of Restriction Fragment Mass Polymorphism Assay for Human Papillomavirus Genotyping / 임상검사와정도관리

BACKGROUND: Human papillomavirus (HPV) infection is the main cause of cervical cancer and with the advent of genotype specific vaccines, there is increased need for accurate, broad-spectrum and high-throughput methods for HPV genotyping. A MALDI-TOF mass spectrometry (MS)-based restriction fragment mass polymorphism (RFMP) assay has proven to accurately and reliably genotype a wide variety of HPV. METHODS: We evaluated the clinical utility of the RFMP assay in HPV genotyping by testing a total of 2,689 specimens taken from liquid-based cytology, which was composed of normal cytology, atypical squamous cells of undetermined significance (ASCUS), low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) and invasive squamous cervical cancer (SCC). RESULTS: Overall HPV positive rate of total specimens was 32.5% and the high-risk positivity was 16.4%. The HPV positive rates were increased as increasing severity level of cervical lesion. Predominant high-risk HPV genotypes were found as following order; 52 (18.6%), 16 (13.7%), 18 (3.8%), 58 (3.4%), 56 (2.6%) and 31 (2.5%). The high-risk HPV positivities according to cytologic diagnosis were 10.7% (238/2229), 31.7% (76/240), 50.0% (88/176), 86.0% (37/43), 100% (1/1) in normal, ASCUS, LSIL, HSIL and SCC subgroups, respectively. The concordance rate and Kappa value between sequencing and RFMP assays were 96.6% and 0.932 (95%CI: 0.908-0.956). CONCLUSIONS: The RFMP HPV genotyping assays showed high concordance with sequencing. The assay is simple, and can accurately detect and identify HPV genotypes in samples with various levels of cytological lesions. The results demonstrated that RFMP assay should be clinically suitable for HPV genotyping in laboratories.

Safety and Clinical Responses in Ankylosing Spondylitis after Three Months of Etanercept Therapy

We aimed to evaluate the safety and clinical responses in Korean ankylosing spondylitis (AS) patients after three months of etanercept therapy. AS patients satisfying the Modified New York Criteria were enrolled. They were assessed for safety and clinical responses at enrollment and after three months of etanercept therapy. A total of 124 patients completed the study. After three months, the rate of ASsessment in AS International Working Group 20% improvement (ASAS 20) response was 79.8%. The rates of ASAS 40 and ASAS 5/6 responses were 58.5 and 62.8%, respectively. Significant improvement of Korean version of Bath AS Disease Activity Index (KBASDAI) (p<0.0001), Bath AS Functional Activity Index (BASFI) (p<0.0001), and Bath AS Metrology Index (BASMI) (p=0.0009) were achieved after three months. Quality of life was also significantly improved after three months, as demonstrated by scores for SF-36 (p<0.0001) and EQ-5D (p<0.0001). Erythrocyte sedimentation rate and C-reactive protein were significantly decreased (p<0.0001, p<0.0001, respectively). None of the patients developed tuberculosis and there were no serious adverse event. AS patients with inadequate response to conventional therapy showed significant clinical improvement without serious adverse events after three months of etanercept therapy.

CT Detection of Hepatocellular Carcinoma in Advanced Liver Cirrhosis: Correlation of Helical CT and Explanted Liver / 대한간학회지

OBJECTIVE: The objective of this study was evaluate the diagnostic efficacy of three-phase helical dynamic CT in the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis. MATERIALS AND METFODS: Three-phase helical dynamic CT in 77 patients with advanced liver cirrhosis was evaluated prospectively before orthotopic liver transplantation. The histopathologically confirmed hepatocellular carcinomas in the explanted livers were compared with pretransplantation CT results by one-to-one correlation. RESULTS: Histopathologic examination of the explanted livers revealed 72 hepatocellular carcinomas in 41 patients. The size of the hepatocellular carcinomas was 0.5-14.0 cm (mean, 1.6 cm). The use of helical dynamic CT enabled the detection of 38 of 72 hepatocellular carcinomas (sensitivity, 53%). Fifteen of 35 (43%) hepatocellular carcinomas smaller than 2 cm and 23 of 37 (62%), hepatocellular carcinomas ranging from 2.0 cm to 14.0 cm were detected. Patient sensitivity and specificity in the detection of hepatocellular carcinoma were 81% (33/41) and 94% (34/36), respectively. CONCLUSIONS: Three-phase helical dynamic CT is insensitive for detection of hepatocellular carcinomas in patients with advanced liver cirrhosis, especially for hepatocellular carcinomas smaller than 2 cm.

Significance of CT Severity Index in Acute Pancreatitis

PURPOSE: To assess the usefulness of a CT severity index(CTSI) for the evaluation of acute pancreatitis and to correlate it with clinical findings. MATERIALS AND METHODS: We retrospectively evaluated contrast enhanced CT in 34 patients with acute pancreatitis. They were categorized into low-score(0-2), middle-score(3-6), and high-score(7-10) groups according to CTSI points, and those groups were correlated with duration of fasting period, days in hospital morbidity and mortality. We attempted to determine the differences in CTSI between pancreatitis caused by alcohol and by biliary tract disease. RESULTS: Of 34 patients, 11 were placed in the low-score group, 19 in the middle-score group, and 4 in the high-score group. The patients in the middle-score group experienced longer fasting period and stayed longer in hospital than those in the low-score group(p<.05 and p=.08, respectively). Morbidity was 0% in the low-score group, 37% in the middle-score group and 50% in the high-score group. Mortality occurred in two patients in high-score group, only. Alcohol-induced pancreatitis generally showed a higher CTSI and more severe clinical course than pancreatitis caused by biliary tract disease. CONCLUSION: In the evaluation of acute pancreatitis, CTSI can be a useful predictor of its prognosis.