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Cholelithiasis in patients on the kidney transplant waiting list
Brito, André Thiago Scandiuzzi;Azevedo, Luiz Sergio;Nahas, Willian Carlos;Matheus, André Siqueira;Jukemura, José;
Clinics , 2010, DOI: 10.1590/S1807-59322010000400007
Abstract: objectives: to evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. introduction: the prevalence and management of cholelithiasis in renal transplant patients is not well established. methods: a total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index). results: cholelithiasis was found in 41 out of 342 patients (12%). twelve of these patients, all symptomatic, had previously undergone cholecystectomies. five out of 29 patients who had not undergone surgery were symptomatic. overall, 17 patients (41.5%) were symptomatic. their mean age was 54 (range 32-74) years old; 61% were female, and their mean body mass index was 25.4. nineteen (76%) out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. conclusions: the frequency of cholelithiasis was similar to that reported in the literature for the general population. however, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.
The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study
Romy Lauche,Holger Cramer,Claudia Hohmann,Kyung-Eun Choi,Thomas Rampp,Felix Joyonto Saha,Frauke Musial,Jost Langhorst,Gustav Dobos
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/429718
Abstract: Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, =25) or waiting list control group (WL, =25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: −17.9 mm VAS, 95%CI −29.2 to −6.6; PM: −19.7, 95%CI −32.2 to −7.2; PaDi: −1.5 points on NRS, 95%CI −2.5 to −0.4; all <0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all <0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both <0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP.
The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain - a randomised controlled pilot study
Romy Lauche, Holger Cramer, Kyung-Eun Choi, Thomas Rampp, Felix Saha, Gustav J Dobos, Frauke Musial
BMC Complementary and Alternative Medicine , 2011, DOI: 10.1186/1472-6882-11-63
Abstract: Fifty patients (50.5 ± 11.9 years) were randomised to a treatment group (TG) or a waiting-list control group (WL). Patients in the TG received a series of 5 cupping treatments over a period of 2 weeks; the control group did not. Self-reported outcome measures before and after the cupping series included the following: Pain at rest (PR) and maximal pain related to movement (PM) on a 100-mm visual analogue scale (VAS), pain diary (PD) data on a 0-10 numeric rating scale (NRS), Neck Disability Index (NDI), and health-related quality of life (SF-36). In addition, the mechanical-detection thresholds (MDT), vibration-detection thresholds (VDT), and pressure-pain thresholds (PPT) were determined at pain-related and control areas.Patients of the TG had significantly less pain after cupping therapy than patients of the WL group (PR: Δ-22.5 mm, p = 0.00002; PM: Δ-17.8 mm, p = 0.01). Pain diaries (PD) revealed that neck pain decreased gradually in the TG patients and that pain reported by the two groups differed significantly after the fifth cupping session (Δ-1.1, p = 0.001). There were also significant differences in the SF-36 subscales for bodily pain (Δ13.8, p = 0.006) and vitality (Δ10.2, p = 0.006). Group differences in PPT were significant at pain-related and control areas (all p < 0.05), but were not significant for MDT or VDT.A series of five dry cupping treatments appeared to be effective in relieving chronic non-specific neck pain. Not only subjective measures improved, but also mechanical pain sensitivity differed significantly between the two groups, suggesting that cupping has an influence on functional pain processing.The trial was registered at clinicaltrials.gov (NCT01289964).Neck pain is a very common condition, the average lifetime prevalence being 48.5% [1]. The causes of chronic neck pain are manifold and can include inflammatory diseases, degenerative processes, trauma, space-occupying lesions, or systemic conditions. However, in most patients neck pain i
Morbid obesity: postsurgical predictive factors and prioritization of the waiting list
Sabench Pereferrer,F.; Hernández González,M.; Abelló Salas,M.; Domènech Calvet,J.; Blanco Blasco,S.; Castillo Déjardin,D. del;
Revista Espa?ola de Enfermedades Digestivas , 2005, DOI: 10.4321/S1130-01082005000300004
Abstract: aim: to study a sample of patients with morbid obesity who are on the waiting list for a surgical intervention, to establish various scores of surgical risk (possum and severity score), and to assess potential criteria for list prioritization. design: we calculated physiological and surgical possum scores for every patient, and analysed comorbidities and other associated factors to calculate the severity score. likewise, we calculated the predictive rates of morbimortality. differences between associated comorbidities in body mass index (bmi) were also analyzed. the correlation between possum score, prediction rates, and severity score were analyzed. patients: fifty-two patients on the surgical waiting list in our institution (san juan university hospital, reus) from 26/4/02 to 5/03/04. results: the mean qualitative score is significantly higher in the female sex. invalidating arthropathy and socio-occupational and/or psychiatric criteria are significantly higher in women. there is a significant correlation between the severity score and possum score. age does not correlate with any of the variables studied. conclusions: possum scores are significantly related to bmi, particularly in terms of morbidity rates. the degree of correlation between the possum score and the qualitative score tells how useful the latter is to cover other determinant factors in the severity of this condition. socio-occupational and psychiatric criteria, and invalidating arthropathy are the main variables to be taken into account for postsurgical prediction, and are directly related to bmi degree.
Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study
Emmanuelle Corruble, Caroline Barry, Isabelle Varescon, Antoine Durrbach, Didier Samuel, Philippe Lang, Denis Castaing, Bernard Charpentier, Bruno Falissard
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-182
Abstract: Patients on waiting list for liver or kidney transplantation were classified for report or non-report of depressive symptoms on waiting list. 339 were transplanted 6 months later on average, and followed prospectively. The main outcome measures were graft failure and mortality 18 months post-transplantation.Among the 339 patients, 51.6% reported depressive symptoms on waiting list, 16.5% had a graft failure and 7.4% died post-transplantation.Report of depressive symptoms on waiting list predicted a 3 to 4-fold decreased risk of graft failure and mortality 18-months post-transplantation, independently from age, gender, current cigarette smoking, anxiety symptoms, main primary diagnosis, UNOS score, number of comorbid diagnoses and history of transplantation. Data were consistent for liver and kidney transplantations. Other baseline predictive factors were: for graft failure, the main primary diagnosis and a shorter length since this diagnosis, and for mortality, older age, male gender and the main primary diagnosis.Further studies are needed to understand the underlying mechanisms of the association between report of depressive symptoms on waiting list and decreased risk of graft failure and mortality after transplantation.The growing population of patients who have survived liver and kidney transplantation [1,2] has intensified the need to identify risk factors for less favourable outcomes such as graft failure and mortality.Some risk factors for graft failure and mortality are related to the transplantation and the post-transplantation period. Others are already known for earlier stages, when transplantation candidates are on waiting list. These are recipient characteristics, such as age, gender, diagnosis of primary medical disease, United Network for Organ Sharing (UNOS) priority status, cigarette smoking status or self-reported medication nonadherence and depressive symptoms [3-9].Whether or not the report of depressive symptoms on waiting list by future recipie
Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation
Daniel Gotthardt, Karl Weiss, Melanie Baumg?rtner, Alexandra Zahn, Wolfgang Stremmel, Jan Schmidt, Thomas Bruckner, Peter Sauer
BMC Gastroenterology , 2009, DOI: 10.1186/1471-230x-9-72
Abstract: Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores.In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p < 0.05), whereas serum creatinine and urea showed no difference.Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of ≥9 and a MELD score of ≥14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091).The long term prediction of mortality or removal from waiting list in patients awaiting liver transplantation might be better assessed by the CTP score than the MELD score. This might have implications for the development of new improved scoring systems.Liver transplantation (LTx) provides the only curative treatment option with excellent long-term results in patients with decompensated cirrhosis of the liver [1]. The Child-Turcotte-Pugh (CTP) sco
Double-dose hepatitis B vaccination in cirrhotic patients on a liver transplant waiting list
Bonazzi, Patricia R.;Bacchella, Telesforo;Freitas, Angela C.;Osaki, Karina T.;Lopes, Marta H.;Freire, Maristela P.;Machado, Marcel C.C.;Abdala, Edson;
Brazilian Journal of Infectious Diseases , 2008, DOI: 10.1590/S1413-86702008000400009
Abstract: development of immunity to hepatitis b virus in cirrhotic patients waiting for liver transplantation is highly desirable. though a double-dose regimen is available, little is know about its effectiveness. we examined the efficacy of double-dose hepatitis b virus vaccination in cirrhotic patients waiting for liver transplantation. we studied 43 patients who were waiting for liver transplantation. they were vaccinated with three doses of 40 mg hepatitis b vaccine at 0, 1 and 6 months; the normal dose is 20 mg. efficacy was measured based on seroconversion of anti-hbs. global response to the primary vaccination scheme was 67.5% (29 patients). forty-one per cent of responders had anti-hbs titers above 1,000 iu/ml. no factors were associated with response, based on multivariate analysis. the vaccination scheme of 40 mg at 0, 1 and 6 months was superior to conventional vaccination doses (20 mg) for cirrhotic patients on a waiting list for liver transplantation.
Survival tree and meld to predict long term survival in liver transplantation waiting list  [PDF]
Emilia Matos do Nascimento,Basilio de Braganca Pereira,Samanta Teixeira Basto,Joaquim Ribeiro Filho
Statistics , 2008,
Abstract: Background: Many authors have described MELD as a predictor of short-term mortality in the liver transplantation waiting list. However MELD score accuracy to predict long term mortality has not been statistically evaluated. Objective: The aim of this study is to analyze the MELD score as well as other variables as a predictor of long-term mortality using a new model: the Survival Tree analysis. Study Design and Setting: The variables obtained at the time of liver transplantation list enrollment and considered in this study are: sex, age, blood type, body mass index, etiology of liver disease, hepatocellular carcinoma, waiting time for transplant and MELD. Mortality on the waiting list is the outcome. Exclusion, transplantation or still in the transplantation list at the end of the study are censored data. Results: The graphical representation of the survival trees showed that the most statistically significant cut off is related to MELD score at point 16. Conclusion: The results are compatible with the cut off point of MELD indicated in the clinical literature.
An Updated Review of the Efficacy of Cupping Therapy  [PDF]
Huijuan Cao, Xun Li, Jianping Liu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0031793
Abstract: Background Since 1950, traditional Chinese medicine (TCM) cupping therapy has been applied as a formal modality in hospitals throughout China and elsewhere in the world. Based on a previous systematic literature review of clinical studies on cupping therapy, this study presents a thorough review of randomized controlled trials (RCTs) to evaluate the therapeutic effect of cupping therapy. Method Six databases were searched for articles published through 2010. RCTs on cupping therapy for various diseases were included. Studies on cupping therapy combined with other TCM treatments versus non-TCM therapies were excluded. Results 135 RCTs published from 1992 through 2010 were identified. The studies were generally of low methodological quality. Diseases for which cupping therapy was commonly applied were herpes zoster, facial paralysis (Bell palsy), cough and dyspnea, acne, lumbar disc herniation, and cervical spondylosis. Wet cupping was used in most trials, followed by retained cupping, moving cupping, and flash cupping. Meta-analysis showed cupping therapy combined with other TCM treatments was significantly superior to other treatments alone in increasing the number of cured patients with herpes zoster, facial paralysis, acne, and cervical spondylosis. No serious adverse effects were reported in the trials. Conclusions Numerous RCTs on cupping therapy have been conducted and published during the past decades. This review showed that cupping has potential effect in the treatment of herpes zoster and other specific conditions. However, further rigorously designed trials on its use for other conditions are warranted.
The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in S?o Paulo, Brazil  [PDF]
Eleazar Chaib,Eduardo Massad,Bruno Butturi Varone,Andre Leopoldino Bordini,Flavio Henrique Ferreira Galv?o,Alessandra Crescenzi,Arnaldo Bernal Filho,Luiz Augusto Carneiro D’Albuquerque
Journal of Transplantation , 2014, DOI: 10.1155/2014/219789
Abstract: Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of S?o Paulo, Brazil. After this date, MELD has been the basis for the allocation of deceased donor livers for adult transplantation. Our aim was to compare the waitlist dynamics before MELD (1997–2005) and after MELD (2006–2012) in our state. A retrospective study was conducted including the data from all the liver transplant candidate waiting lists from July 1997 to December 2012. The data were related to the actual number of liver transplantations (Tr), the incidence of new patients on the list (I), and the number of patients who died while being on the waitlist (D) from 1997 to 2005 (the pre-MELD era) and from 2006 to 2012 (the post-MELD era). The number of transplantations from 1997 to 2005 and from 2006 to 2012 increased nonlinearly, with a clear trend to levelling to equilibrium at approximately 350 and 500 cases per year, respectively. The implementation of the MELD score resulted in a shorter waiting time until liver transplantation. Additionally, there was a significant effect on the waitlist dynamics in the first 4 years; however, the curves diverge from there, implying a null long-range effect on the waitlist by the MELD scores. 1. Introduction The global liver allocation system in use until 2002 was based on the Child-Turcotte-Pugh (CTP) scale and other scores as well as on the waiting time; the system became the major discriminator of patients on the waitlist without reflecting their actual liver dysfunction. The system for prioritising adult patients on the waitlist in the USA has since changed from a status-based algorithm using the CTP scale to a system using a continuous model for end-stage liver disease (MELD) [1]. The MELD score was originally developed to predict the survival after a transjugular intrahepatic portosystemic shunt procedure (TIPS) [2]. In S?o Paulo, the time on the waiting list was the primary criterion adopted to allocate deceased donor livers until July 15, 2006. After this date, MELD was the basis for the allocation of deceased donor livers for adult transplantation. The MELD score primarily sought to increase access to transplantation for severely ill patients as a means to reduce the mortality rate of the waiting list patients. The MELD score does not consider the posttransplant benefit. Our aim was to compare the waitlist dynamics in the pre-MELD (1997–2005) and post-MELD (2006–2012) periods in the state of S?o Paulo, Brazil. 2. Material and Methods A retrospective study was initially
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