The incidence and management of complications of venous access in home parenteral nutrition (HPN): A 19 year longitudinal cohort series.

BACKGROUNDS AND AIMS: Long term central venous access for Home Parenteral Nutrition (HPN) is associated with catheter related complications. The most studied and well known of these is Catheter Related Blood Stream Infection (CRBSI). This paper looks at other venous access complications, including blocked and damaged catheters, catheter related thrombosis and CRBSI. This paper will also present treatment outcomes for each of these complications. This paper will also examine if there are any correlating patient or catheter related factors that can help predict future catheter related complications. By demonstrating the treatment outcomes for each line complication, it is hoped this will contribute to the literature that could be used for standard setting in complications related to long term central venous access. METHODS: HPN data were analysed from the Greater Glasgow and Clyde (GGC) Home Parenteral Nutrition Database (HPN) which is a comprehensive, prospectively maintained electronic record of all HPN patients treated in GGC. The time period of data collection was 1998-2017. Descriptive statistics were used to report data frequency, age, and catheter days' distributions. Data were not normally distributed and so non-parametric tests were used. Spearman's Rho correlation was used to measure correlation between two numeric groups. Catheter complications were reported as a rate in count data, meaning that more than one event could be recorded per patient, with 1000 catheter days as the person-time denominator. Poisson means test and Fisher exact tests were used to compare different rates, as complications were treated as count data increasing over variable total time periods. P < 0.05 with 95% confidence interval (CI) was considered significant in all tests. Comparisons between binary data sets used two sample t-tests to compare the groups. RESULTS: From 169 patients, 101 (59.8%) were female and 68 (40.2%) were male. The age when first starting HPN ranged from 16 to 79 years old with a median of 56 years. Total catheter days was 173,151 derived from 408 catheter insertions on 169 patients. 282 complications occurred in 85 patients over the study period. An overall catheter complication rate of 1.62/1000 days was found. 84 patients did not experience a single complication. There were 171 proven catheter infections in 66 patients over the study period. Infection rate from the entire period of report was 1.35 infections/1000 catheter days. This decreased over time. Infection was found to be correlated with length of time on HPN, catheter location, catheter diameter and use of Taurolock-Hep100. Thrombosis (n = 16) was associated with total time on HPN (r2 = 0.187, P < 0.05) and the number of infections (r2 = 0.207, P < 0.05). Damage was strongly associated with increasing time on HPN with (r2 of 0.494 and P < 0.005). Blockage was not associated with any patient or catheter factors. Overall catheter salvage rate for CRBSI by antibiotic treatment was 61.87%. Success varied according to organism cultured. Catheter salvage was less successful in other complications and overall catheter salvage rate was 41,115 catheters were salvaged from 282 complications. CONCLUSIONS: This study has provided a baseline for rates of less common venous access complications in HPN and their management. Catheter salvage is possible after at least 41% of complications. It is likely that experience is helpful whether that of individual patient, the team or a clinical network. Our results support the use of smaller central venous catheters, in upper body veins, and the use of Taurolock-Hep100 in patients who have recurrent infections.

Quality of life of cervical cancer patients after completion of treatment - A study among Bangladeshi women.

Cervical cancer is the main cause of malignancy-related death among women living in developing countries. The aim of this study is to evaluate the quality of life (QOL) among Bangladeshi cervical cancer survivors and its relationships with demographic and disease related factors A cross-sectional study was carried out onlone hundred nine consecutive cervical cancer survivors in National Institute of cancer Research and Hospital, Dhaka from September 2014 to february 2015 using European organization-for Research and treatment of cancer core Questionnaires (QOL-C30 and QOL- CX24). Demographic condition like education level, occupation and disease related factors like stages, treatment modality and duration of follow-up time were taken as investigating factors against functional scales. Cronbach's alpha was calculated to asses' internal consistency among items. Cervical cancer survivors stated a moderate QOL. Sub-domains of QOL score and global health status were significantly associated with physical function(PF) scales (p=.000), fatigue (p=.045), nausea and vomiting (p=.000), Appetite loss (p=.001), constipation (p=.005), symptom experience (p=.005) and menopausal symptoms (p=.015). QOL mean score were negatively associated with emotional function(EF) scales, pain, fatigue, nausea, appetite loss and financial problems. Education level showed significant association with physical function(PF) (p=.001), emotional function(EF) (p=.027), Cognitive function(CF) (p=.000) and sexual function (p=.001). Duration (Follow-up) time was significance association with PF (p=.005), EF (p=.012), symptoms experience (p=.001). Although, the QOL in cervical cancer survivors was moderate, treatment of related symptoms and improvement of demographic condition can influence the QOL and survivors improve the care of cervical cancer. So, improve the QOL among cervical cancer survivors.

[Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension]. / Rachianesthésie pour césarienne: remplissage, vasopresseurs et hypotension.

OBJECTIVE: To analyze the different preventive and curative strategies for the management of hypotension during spinal anaesthesia for caesarean section. DATA SOURCES: Data related to hypotension during spinal anesthesia for caesarean section were searched in the Medline database. Trials published in English or French were reviewed. DATA SYNTHESIS: Hypotension during caesarean section under spinal anaesthesia is very frequent (55 to 90%) if not prevented. It can induce complications for the mother and/or the fetus. Crystalloid preload alone is ineffective. Colloid preload is effective but might be better used as a second line treatment. Ephedrine has been the vasopressor of choice for long, but has a weak prophylactic efficacy. In addition, it can induce maternal cardiovascular adverse effects and fetal acidosis. Prophylactic phenylephrine, with or without ephedrine according to maternal heart rate, is at least as effective as ephedrine, with less adverse effects. Crystalloid loading at the time of spinal injection ("co-/post-loading") enhances the haemodynamic control provided by vasopressors. CONCLUSION: Hypotension during spinal anesthesia for caesarean section must be systematically detected, prevented and treated without delay. The association of vasopressor(s) (phenylephrine with or without ephedrine) with a rapid crystalloid loading at the time of spinal injection represents the most interesting strategy nowadays.

Differentiation of carbohydrate gums and mixtures using fourier transform infrared spectroscopy and chemometrics.

Guar gum, a nonionic galactomannan, is used as an economical thickener and stabilizer in the food industry and is often combined with xanthan, locust bean gum (LBG), or carboxymethylcellulose (CMC) to promote synergistic changes in viscosity or gelling behavior via intermolecular interactions; however, the adulteration of LBG with guar gum is a well-known industrial problem. The ability to identify the purity of gums and concentrations of individual gums in mixtures would be advantageous for quality control in the food industry. Fourier transform infrared spectroscopy (FTIR) methods are rapid and require minimum sample preparation. The objectives of this study were to evaluate the ability of FTIR techniques to (1) differentiate LBG with a variety of mannose/galactose (M/G) ratios, (2) differentiate guar, LBG, tara, and fenugreek gums, (3) differentiate pure guar gum from guar gum mixed with LBG, xanthan gum, or CMC, (4) quantify LBG, xanthan gum, and CMC in guar gum, and (5) quantify guar gum in LBG. Two FTIR methods were used: diffuse reflectance (DRIFT) on powdered gum samples added to KBr at 5%, w/w, and attenuated total reflectance (ATR) on 1%, w/w, gum solutions. Spectra were collected and then analyzed by multivariate statistical procedures (chemometrics). The DRIFT method provided better discrimination and quantitative results than the ATR method. Canonical variate analysis (CVA) of DRIFT spectra (1200-700 cm(-1)) was able to classify LBG with various M/G ratios, pure galactomannans, and pure versus mixtures of gums with 100% accuracy. Quantification of an individual gum in gum mixtures (0.5-15%, w/w) was possible using partial least-squares (PLS) analysis of DRIFT spectra with R2 > 0.93 and using this approach for quantifying guar gum added to LBG resulted in an R2 > 0.99, RMSEC = 0.29, and RMSEP = 3.31. Therefore, the DRIFT FTIR method could be a useful analytical tool for quality control of select gums and gum mixtures used in the food industry.

Analysis of hard-to-cook red and black common beans using Fourier transform infrared spectroscopy.

Extracted fractions from black and red common beans (Phaseolus vulgaris) were studied using Fourier transform infrared spectroscopy (FT-IR). Beans were stored under three conditions: control at 4 degrees C; hard-to-cook (HTC) at 29 degrees C, 65% RH for 3.5 months; and refrigerated at 2 degrees C, 79% RH for 3.5 months after a HTC period (called HTC-refrigerated). Two fractions isolated from the beans, the soluble pectin fraction (SPF) and the water insoluble residue of the cell wall (WIRCW), were analyzed using diffuse reflectance (DRIFTS) FT-IR. The soaking water and cooking water from the beans were also studied using attenuated total reflectance (ATR) FT-IR. The DRIFTS FT-IR results from the SPF and WIRCW fractions were consistent with previously published data for Carioca beans showing that in general, more phenolic compounds were associated with the SPF of HTC beans than in the control beans. Results also showed that HTC-refrigerated beans had higher concentrations of phenolic compounds than control beans in the SPF. The ATR FT-IR results for soaking and cooking waters from the HTC-refrigerated and HTC beans had higher concentrations of absorbing compounds than the control beans, indicating that they lost more constituents to the water. Additionally, results indicate that the mechanism(s) for reversibility of the HTC defect could be different than the one(s) involved in the development of the defect.

FTIR determination of ligand-induced secondary and tertiary structural changes in bovine plasminogen.

Human plasminogen undergoes a large tertiary structural change in the presence of lysine derivatives (e.g. epsilon-amino caproic acid, EACA). This change facilitates human plasminogen activation by human plasminogen activators, resulting in elevated blood plasmin levels. It is hypothesized that this structure-function relationship is similar for bovine plasminogen. The objectives of this study were to investigate the effect of the ligand EACA on the secondary structure of plasminogen (bovine, human, and rabbit) and the tertiary structure of bovine plasminogen using Fourier-transform infrared spectroscopy (FTIR). Spectra of plasminogen, EACA, and a mixture of plasminogen and EACA in water and deuterium were collected using FTIR. Fourier-self deconvoluted spectra in the amide I region (1700-1600 cm(-1)) were used to detect changes in secondary structure of plasminogen after EACA addition. Change in bovine plasminogen tertiary structure was determined by comparing ratios of amide II (1600-1500 cm(-1)) to amide I bond intensities over time for samples in deuterium. No differences in secondary structure were observed for any plasminogen in the presence of EACA; however, addition of EACA significantly changed tertiary structure of bovine plasminogen. This tertiary structural change indicates a transition from a folded to an unfolded state, which could be more easily converted to plasmin. These results are consistent with reported human plasminogen studies using neutron scattering (tertiary structure) and circular dichroism (secondary structure) methods.

Dietary supplement oil classification and detection of adulteration using Fourier transform infrared spectroscopy.

Fourier transform infrared spectroscopy (FT-IR) methods and common chemometric techniques [including discriminant analysis (DA), Mahalanobis distances, and Cooman plots] were used to classify various types of dietary supplement oils (DSO) and less expensive, common food oils. Rapid FT-IR methods were then developed to detect adulteration of DSO with select common food oils. Spectra of 14 types of DSO and 5 types of common food oils were collected with an FT-IR equipped with a ZnSe attenuated total reflectance cell and a mercury cadmium telluride A detector. Classification of DSO and some common food oils was achieved successfully using FT-IR and chemometrics. Select DSO were adulterated (2-20% v/v) with the common food oils that had the closest Mahalanobis distance to them in a Cooman plot based on the DA analysis, and data were also analyzed using a partial least-squares (PLS) method. The detection limit for the adulteration of DSO was 2% v/v. Standard curves to determine the adulterant concentration in DSO were also obtained using PLS with correlation coefficients of >0.9. The approach of using FT-IR in combination with chemometric analyses was successful in classifying oils and detecting adulteration of DSO.

Detection of hazelnut oil adulteration using FT-IR spectroscopy.

Fourier transform infrared spectroscopy (FT-IR) was used to detect the adulteration of hazelnut oil with different types of oils and to detect the adulteration of extra-virgin olive oil with hazelnut oil. Spectra of hazelnut oil, seven other types of oils, extra-virgin olive oil, and the adulterated oils were collected with a FT-IR equipped with a ZnSe-ATR accessory and a MCTA detector. Discriminant analysis and partial least-squares analysis were used to analyze the data. Classification of hazelnut oil, olive oil, and the other types of oils was achieved successfully with FT-IR. The detection level for sunflower oil adulteration of hazelnut oil was 2%, and the correlation coefficient for the PLS model was 0.99. Adulteration of virgin olive oil with hazelnut oil could be detected only at levels of 25% and higher.

An appraisal of the appropriateness of the indications for hysterectomy.

Over a five-year period, 197 hysterectomies were performed at King Khalid University Hospital (KKUH). Indications for the procedures vary from menstrual disorders and symptomatic fibroids to ovarian malignancy. The most common indication was found to be menorrhagia. Among multiple pre-operative indications, only the first listed major indication for hysterectomy was chosen. There were 145 abdominal and 52 vaginal hysterectomies and all were elective gynaecological procedures, majority of which were performed on women in their fourth and fifth decades of life. Verification of pre-operative diagnosis, when correlated with pathological findings, showed that some of the indications for the procedure deserve a more critical reappraisal. Since hysterectomy carries substantial economic and medical consequences, indications for undertaking the procedure deserve more careful scrutiny given the surgical and nonsurgical options that are currently available. There may be a need, therefore, to assess the appropriateness or otherwise of the use of hysterectomy in many of the patients in future.