Does hypertension impact on the mortality of hemodialysis patients?

Hypertension is very common in standard haemodialysis patients in spite of a wide use of antihypertensive medications. Up to the last decade it was reported in dialysis nts, as in the general population, as a powerful mortality risk factor. More recently several reports have challenged this view, and hypotension rather than hypertension has been claimed as the real culprit. That a risk factor has an opposite effect on mortality in conditions such as dialysis than in the general population has been termed - reverse epidemiology ,,, and suggests that our therapeutic approach toward blood pressure control in dialysis should be reconsidered. In fact, this counter intuitive concept is explained by the effect of time. Hypertension is a long-term mortality risk factor, that in a population crippled by short-acting risk factors (e.g. diabetes, congestive heart failure, malnutrition...) has not the opportunity to express itself. The clear cut noxious effect of hypertension on mortality in the years when dialysis patients were young and fit has disappeared in the present aged and highly co-morbid population. This does not mean that hypertension becomes beneficial once dialysis has been started. Hypotension is a marker of a high risk of early mortality, hypertension is a cause of late mortality. There is no evidence that hypertension might be protective in dialysis patients. Avoiding hypertension remains a capital goal of maintenance dialysis.     

The implications of the foot health status in Parkinson patients: A case–control study

Parkinson's disease (PD) is a neurodegenerative disorder that affects both health of the feet, as to gait patterns. This study aimed to find out about foot problems and their impact on self-perceived quality of life and related to foot health in Parkinson's patients compared to a group of healthy subjects and to measure it with Spanish Podiatry Health Questionnaire (PHQ-S). It is about a case–control study in a sample of Parkinson's patients n = 62, healthy controls n = 62. The PHQ-S was reported, it describes perception the subject has in each of podiatric 6 dimensions consulted, assessing appreciation of health status of interviewee's feet and a self-rated the foot health score on the visual analog scale (VAS). There were statistically significant differences (P < 0.05) in the dimensions that assessed problems with walking and moving, nail trimming, concern feet state, and affectation of quality of life related foot health. Regarding the self-perception of state of their feet, Parkinson's patients perceive a worse state of health of their feet than healthy subjects. The mean value was 4.8 (SD 2.2) for Parkinson's patients and 3.8 (SD 2.3) for healthy subjects. In conclusion, patients with PD have problems in walking or moving, foot pain, difficulties in foot hygiene and in cutting for their nails, as well as the concern they suffer from deterioration in state of their feet affect them and decrease their quality of life. Podiatric problems in Parkinson's patients have a great impact in reducing quality of life related to foot health.     

The future: surgery of the spinal cord?

Surgery of the spinal cord is still experimental, and outcomes must be confirmed by more cases. In this field, knowledge and research are still figuratively in the Stone Age. Nevertheless, the author is confident that in the future, with the improvement of surgical and resuscitation techniques and with the introduction of new biotechnologic drugs and molecules that favor axon regeneration and inhibitor blocking, CNS-peripheral nerve connections can be performed with some functional improvement, even in tetraplegia.     

Dual-eligible,dual-risk? A brief review on the impact of dual-eligible status on health disparities and peripheral artery disease

Peripheral artery disease (PAD) has been associated with poorer outcomes based on particular social determinants of health, including insurance status. A unique population to study treatment outcomes related to PAD is those with dual-eligible status—those who qualify for both Medicare and Medicaid—comprising more than 12 million people. We performed a systematic review of the literature surrounding dual-eligible patients and impact on PAD, with final inclusion of six articles. Dual eligibility has been associated with higher rates of comorbidities; more severe symptoms at initial presentation for PAD; and poorer treatment outcomes, including mortality. Further studies are needed to specifically look at the association between PAD and dual-eligible status, but what is clear is that patients in this population would benefit from early identification to prevent disease progression and improve equity.     

The effect of chemical noxae on the health status of a group of workers in the chemical industry of Săvineşti

The paper presents the study on the effect of the industrial xenobiotics against some biochemical indicators, in view to detect, precociously, the probable significant changes. There are presented the medium, minimum, maximum and median value for the following parameters: total proteins, haemoglobin and glucose for 112 workers exposed or not exposed to specific noxae--benzen, phenol, cyclohexanone. The analysis of the results shows decreased values for some workers, even at the inferior limit, in rapport with the normal values, for the parameters studied. These persons have been directed for complex investigations, in view to determine the causes and to establish the adequate treatment.     

Do blood groups have effect on prognosis of patients undergoing radical cystectomy?

Purpose

The purpose of the study was to investigate the effect of ABO blood groups and Rhesus (Rh) factor on prognosis of patients undergoing radical cystectomy.

Materials and methods

In this study, total number of 290 patients who underwent radical cystectomy between January 1990 and September 2012 were evaluated retrospectively. Patients were grouped as O and non-O according to ABO antigens; also positive and negative according to Rh factor. Parameters such as age, sex, stage, lymph node involvement and positive surgical margins were investigated. Disease-free and overall survival rates have been compared. Multivariate analysis were performed to determine independent prognostic factors.

Results

A total of 260 (89.7 %) male and 30 (10.3 %) female patients participated in the study. Mean follow-up was 37.7 ± 18.9 months. A total of 180 patients were non-O (62.1 %),while the 110 patients had the blood group O (37.9 %). The number of Rh positive and negative patients were 247 (85.2 %) and 43 (14.8 %), respectively. According to the univariate and multivariate analyses, ABO blood groups and Rh factor did not exhibit any significant impact on overall and disease-specific survival.

Conclusion

ABO blood group and Rh factor were not associated with the prognosis of bladder cancer patients who underwent radical cystectomy. However, prospective studies are needed in larger patient series for further evaluations.     

The impact of comorbidities on postoperative outcomes of ventral hernia repair: the patients’ perspective

Hernia - Ventral hernia repair (VHR) outcomes can be adversely affected by modifiable patient co-morbidities, such as diabetes, obesity, and smoking. Although this concept is well accepted among...     

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently spontaneous, required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in spontaneous SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.     

The antioxidant effect of β-Glucan on oxidative stress status in experimental spinal cord injury in rats

This study was performed to investigate the antioxidant effect of beta-Glucan in experimental spinal cord injury (SCI). Injury was produced using weight-drop technique in rats. beta-Glucan was given by intraperitoneal injection following trauma. The rats were sacrificed at the sixth day of injury. Oxidative stress status was assessed by measuring the spinal cord tissue content of Malonyldialdehyde (MDA), Superoxide Dismutase (SOD) and Gluthatione Peroxidase (GSH-Px) activities. No effect of beta-Glucan on SOD and MDA activities was found but, GSH-Px levels were found to decrease to the baseline (preinjury) levels when it was compared to untreated group (U=0.000; p=0.002). According to our results, beta-Glucan works like a scavenger and has an antioxidant effect on lipid peroxidation in spinal cord injury.     

The effect of Fluosol-DA® on the reticuloendothelial system in surgical patients

The effect of Fluosol-DA^® (Perfluorochemicals), an oxygen carrying blood substitute, on the function of the reticuloendothelial system (RES) was investigated by means of Ferrichondroitin sulfate in a series of patients undergoing gastrectomy for cancer of the stomach. In 20 patients, 500ml of blood were replaced with the same amount of either Fluosol-DA^® or hydroxyethylstarch (HES) prior to surgery. Changes of perioperative cellular immunity were studied by PHA-stimulated T-lymphocyte transformation. It was found that the RES functions were significantly depressed postoperatively and fairly recovered by the sixth postoperative day in the Fluosol-DA^® group. A prolongation of the suppression of cellular immunity with sustained fever was noted in this gastrectomized series. In analyzing the decay of infused Perfluolochemicals in blood, the half life of Fluorodecalin (FDC) was 4.9 ± 0.1hr, for Perfluorotripropylamine (FTPA) it was 5.1 ± 0.1hr. The prolonged depression of the RES function might be caused by saturation of RES with particles of Perfluorochemicals.(Suzuki C: The effect of Fluosol-DA^® on the reticuloendothelial system in surgical patients. J Anesth 1: 8–14, 1987)     

Assessment of health status in patients with cerebral palsy: what is the role of quality-of-life measures?

Measuring quality of life (QOL) in a population with a functional range as large as that of the pediatric cerebral palsy population is challenging. This study assessed the utility of two common QOL instruments in this population: the Child Health Questionnaire (CHQ) and the Pediatric Outcomes Data Collection Instrument (PODCI). The goal was to determine the efficacy of these questionnaires in detecting subtle differences in the QOL among children with cerebral palsy and to demonstrate the need for dynamic assessment when evaluating QOL within this group. There were 180 subjects between the ages of 5 and 18 years, split into three diagnostic groups-diplegic, hemiplegic, and quadriplegic. The PODCI was more sensitive to differences in the diplegic and hemiplegic groups, but quadriplegics exhibited a floor effect (50% or more scored at most 15 out of 100) in three of the five domains. The CHQ was more effective for the quadriplegic group, but the diplegic and hemiplegic diagnostic groups exhibited a ceiling effect on 2 of the 12 domains in that questionnaire. Because an instrument that uses dynamic assessment bases subsequent questions on the patient's response to the first ones, dynamic assessment would help to avoid ceiling and floor effects by asking questions more pertinent to the patient's actual condition, and it would save time that would have been wasted answering irrelevant questions about function and QOL.     

The impact of therapy on quality of life and mood in neuropathic pain: what is the effect of pain reduction?

Mood and quality of life (QOL) outcomes vary widely in neuropathic pain trials. This may be a result of variable analgesia and other treatment effects. We evaluated the relationship between pain reduction and mood/QOL in neuropathic pain. Pain, side effects, QOL, and mood from a trial of morphine, gabapentin, and a morphine-gabapentin combination were examined. Baseline QOL was impaired according to Short Form Health Survey (SF-36) scores. Baseline mood, according to Profile of Mood States scores, was comparable to that of a nondepressed population. Pain reduction with all three active trial treatments correlated with improved QOL. Pain reduction with morphine and with gabapentin correlated with improved mood. Pain reduction with a morphine-gabapentin combination correlated with improvement in only one of several domains of the Profile of Mood States. Severity of sedation, constipation, and dry mouth during any treatment did not correlate with mood/QOL changes. These results can be interpreted to imply that larger analgesic treatment effect sizes lead to more substantial improvements in QOL and/or mood. However, other beneficial or adverse treatment-related side effects may also affect mood/QOL. Therefore, future studies are needed to also evaluate the impact of treatment-related side effects on mood/QOL in analgesic trials.     

Fluorescein application in spinal ependymomas: have we come so far?

Neurosurgical Review -