A Systematic Review of In-situ Aortic Reconstructions for Abdominal Aortic Graft and Endograft Infections: Outcomes of Currently Available Options for Surgical Replacement.

BACKGROUND: This review synthetizes recent literature about in-situ aortic reconstructions for abdominal aortic graft or endograft infections (AGEIs), aiming to report outcomes individually related to currently available vascular substitutes (VSs). METHODS: We performed a systematic review of all published literature from January 2005 to December 2022. We included articles reporting on open surgical treatment of abdominal AGEIs, with removal of the infected graft and in-situ reconstruction with biological or prosthetic material. Articles not distinguishing between abdominal and thoracic aortic-related outcomes were excluded, as well as studies reporting on cumulative in-situ and extra-anatomic reconstruction results. RESULTS: Of 500 records identified through database searching (Pubmed: 226; Embase: 274), 8 of them were included in the present review. Overall, 30-days mortality rate was 8.7% (25/285), while the most frequent early complications were respiratory adverse events (46/346, 13.3%) and renal function deterioration (26/85, 30%). In 250/350 cases (71.4%), a biological VS was utilized. In 4 articles, the outcomes of different types of VSs were presented jointly. Patients analyzed in the remaining 4 reports were sorted in a "biological" and a "prosthetic" group (BG and PG). The cumulative mortality rate of the BG and PG were 15.6% (33/212) and 27% (9/33), respectively, while graft reinfection was 6.3% (15/236) in the BG, and 9% (3/33) in the PG. The cumulative mortality rate reported in articles focused on autologous veins was 14.8% (30/202), while their 30-days reinfection rate was 5.7% (13/226). CONCLUSIONS: Since abdominal AGEIs are uncommon conditions, literature focused on direct comparison between different types of VSs is scarce, particularly when related to materials other than autologous veins. Although we found a lower overall mortality rate in patients treated with biological material or with autologous veins only, in recent reports prosthesis provide promising results in terms of mortality and reinfection rate. However, none of the available studies distinguish and compares different types of prosthetic material. Large multicenter studies are advisable, especially focused on different types of VSs and their comparison.

Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy.

BACKGROUND: Mood and anxiety symptoms in chronic hepatitis C (CHC) may be related to the patient awareness of the diagnosis and prognosis, to side effects induced by interferon (IFN)-alpha treatment, as well as to substance abuse. However, the observation of metabolic alterations in patients with CHC has led to hypothesize a direct effect of hepatitis C virus (HCV) on brain function. This study was aimed at elucidating whether CHC is associated with specific anxiety or mood disorders independently of confounding factors. METHODS: Patient cohort: consecutive patients, 135 with CHC and 76 with chronic hepatitis B (CHB). EXCLUSION CRITERIA: previous treatment with IFN-alpha, co-infection with HCV and hepatitis B virus, infection with human immunodeficiency virus, drug or alcohol abuse, or malignancies. CONTROLS: subjects without evidence of hepatitis randomly extracted from the database of a previous epidemiological study; they were divided into two groups of 540 (332 males) and 304 (220 males) as controls for patients with CHC and CHB, respectively. The psychiatric diagnosis was formulated by means of the Composite International Diagnostic Interview Simplified carried out by a physician according to DSM-IV criteria. RESULTS: A higher lifetime prevalence of major depressive disorder (MDD) was observed among CHC compared to CHB or controls. The risk of MDD was not statistically different between CHB and controls. Both the CHC and CHB groups showed a significantly higher frequency of panic disorder when compared to controls. No statistical differences were observed in the prevalence of general anxiety disorder and social phobia when CHC or CHB were compared to controls. CONCLUSION: The present study provides the first evidence of an association between CHC and MDD, diagnosed on the basis of well-defined international criteria. This association is independent of treatment with IFN-alpha and is not influenced by substance or alcohol abuse. By contrast, anxiety disorders do not appear to be specifically associated with CHC.

Quetiapine as add-on treatment for bipolar I disorder: efficacy in preventing relapse of depressive episodes.

OBJECTIVE: To assess the long-term response to add-on quetiapine therapy in patients with bipolar I disorder who were not adequately responding to standard medications. METHODS: Outpatients with bipolar I disorder (DSM-IV-TR) responding inadequately to standard treatment were observed before and after the addition of quetiapine. Symptom severity was evaluated using the Clinical Global Impressions scale for Bipolar Disorder (CGI-BP) each month. Relapses included hospitalization, treatment in a day hospital or clinic, scores >/= 1 point higher than previous CGI-BP scores and/or upward titration of quetiapine or other medications. RESULTS: Sixty-one patients (age range of 18-68 years) were observed prospectively for an average of 7.5 months (range 3-18 months) prior to addition of quetiapine and subsequently followed for an average of 15.7 months (range 6-42 months). The final mean quetiapine dose was 537.1 +/- 91.7 mg/d. Prior to quetiapine addition, an annual relapse rate of 2.09 episodes was recorded, relating to 0.94 depressive and 1.15 manic or mixed episodes. Following quetiapine addition, annual relapse rates were reduced to 0.61 episodes, representing 0.14 depressive and 0.46 manic or mixed episodes. Compared with the period of add-on quetiapine treatment, the relative risk of relapse prior to quetiapine therapy was 3.4 for all episodes (chi2 = 24.8, P < 0.001), 6.7 for depressive episodes (chi2 = 24.7, P < 0.001), and 2.5 for manic or mixed episodes (chi2 = 9.0, P < 0.05). CONCLUSION: This naturalistic follow-up study provides preliminary evidence for the efficacy of long-term add-on quetiapine treatment in the prevention of relapses of manic or mixed and depressive episodes of bipolar I disorder, and particularly in the prevention of depressive episodes.

Combination quetiapine therapy in the long-term treatment of patients with bipolar I disorder.

OBJECTIVE: Determine the long-term effectiveness of quetiapine in combination with standard treatments in preventing relapses for patients with bipolar I disorders. METHOD: Twenty-one outpatients with type I bipolar disorder who had inadequate responses to ongoing standard therapies were treated with add-on quetiapine in an open-label study. The quetiapine dose was increased until clinical response occurred. Illness response was assessed using the Clinical Global Impression (CGI) scale. Relapse rates before and during quetiapine treatment were compared by calculating incidence risk ratios. RESULTS: Quetiapine was added to ongoing standard therapy for 26 to 78 weeks. Thirteen patients received combination therapy for at least 52 weeks. The mean quetiapine dose received was 518 +/- 244 mg/day. There were highly significant improvements in overall relapse rate, manic/mixed relapse rate, and depression relapse rate in the period during quetiapine treatment compared with the period before quetiapine was initiated. The calculated relative risk of relapse in the absence of quetiapine treatment was 2.9 overall (95% confidence interval, 1.5 approximately 5.6), 3.3 for manic/mixed relapse (95% confidence interval, 1.5 approximately 7.1), and 2.4 for depressive relapse (95% confidence interval, 1.3 approximately 4.4). The mean Clinical Global Impression scores improved significantly from baseline during 26 weeks of quetiapine treatment in 21 patients (p = 0.002) and remained significantly better during a 52-week treatment period in 13 patients (p = 0.036). CONCLUSION: Long-term treatment with quetiapine combination therapy reduced the probability of manic/mixed and depressive relapses and improved symptoms in patients with bipolar I disorder who had inadequate responses to ongoing standard treatment.