| 1. |
- Vermeulen, Bram D., et al.
(författare)
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Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation : an individual patient data meta-analysis
- 2021
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 35:7, s. 3492-3505
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Tidskriftsartikel (refereegranskat)abstract
- Background: Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave’s syndrome (BS). Methods: We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. Results: Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8–5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2–7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2–6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p < 0.001), compared with late TOD. In BS, no associations between TOD and outcomes were found. When combining IEP and BS, early TOD was associated with a 6% decrease in overall mortality (10% vs. 16%, OR 2.1, 95% CI 1.1–3.9), a 19% decrease in re-interventions (26% vs. 45%, OR 1.9, 95% CI 1.1–3.2) and a 35% decrease in mean length of hospital stay (16 vs. 22 days, p = 0.001), compared with late TOD. Conclusions: This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome.
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| 2. |
- Gross, O, et al.
(författare)
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Stem cell therapy for Alport syndrome: the hope beyond the hype
- 2009
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Ingår i: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. - : Oxford University Press (OUP). - 1460-2385. ; 24:3, s. 731-734
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Uehara, A, et al.
(författare)
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A hybridization-based enrichment strategy to increase the accuracy of next generation sequencing in phylogenetic analysis of dengue viruses in Sri Lanka
- 2015
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Ingår i: Tropical medicine & international health. - : Wiley-Blackwell. - 1360-2276 .- 1365-3156. ; 20:Suppl. 1, s. 120-120
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Sri Lanka has experienced confirmed dengue outbreaks since the 1960s although severe dengue disease (DHF/DSS) didn’t appear until 1989. Since then, cyclical outbreaks associated with severe disease have occurred throughout the island. The most recent epidemic began in 2009 with the apparent introduction of a new genotype of DENV-1. To better understand the mechanisms underlying the persistence of this ongoing epidemic, a longitudinal study was conducted in hospitals in the Colombo district from April 2012 to March 2014. In order to glean as much information as possible about the viral genetics from this large cohort, we developed a novel Next Generation Sequencing (NGS) platform that can function without any a priori knowledge of the target dengue genome.Methods: The principle problem encountered when employing NGS directly on patient samples is the high ratio of host to viral RNA. To compensate for this, we developed a hybridization-based enrichment strategy consisting of DENV-specific 120nt, biotinylated oligodeoxynucleotides to capture DENV genomic material from an NGS library prepared directly from patient sera.Results: The strategy developed here allowed us to enrich DENV genomic material over 5000 fold relative to unenriched material. Full genome data and phylogenetic analysis indicate that the DENV-1 are predominantly genotype 1 although a smaller number of genotype 5 isolates was also identified.Conclusion: The platform developed for this study has the inherent ability to capture all four serotypes of DENV and can significantly increase the virus to host RNA ratio. The principle driver of the current dengue epidemic in Sri Lanka is the same DENV-1 genotype that has been in circulation since 2009.This research was funded by the Singapore Infectious Disease Initiative (SIDI/2013/012) and the European Union 7th Framework Programme through ‘DengueTools’. (www.dengue-tools.net).Disclosure: Nothing to disclose.
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| 4. |
- Tissera, H, et al.
(författare)
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Assessment of severity among adult dengue patients in Colombo district, Sri Lanka
- 2015
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Ingår i: Tropical medicine & international health. - : Wiley-Blackwell. - 1360-2276 .- 1365-3156. ; 20:Suppl. 1, s. 416-416
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Dengue is a major acute febrile illness in Sri Lanka and reported in epidemic proportions. From 2009 to 2013 an average of 35 000 cases were reported annually with over 60% above 15 years of age. Clinical case classification of dengue was originally based on paediatric patients. Here we assess severity of dengue illness among adults according to both WHO classical and TDR classifications.Methods: A study was conducted in 100 adult patients presenting to ID Hospital, Colombo with fever <7 days, in 2013. All were tested for dengue ELISA NS1/IgM and RT-PCR. Of them 88 were confirmed as having dengue, and were classified into two WHO classifications. Type of care received was categorized into three levels as:Category 1 – general ward,Category 2 – special dengue unit,Category 3 – intensive care unit.Results: According to classical classification, 47 (53.4%) were Dengue Fever (DF) patients. Of them 31and 16 received Category 1 and 2 care respectively. None received Category 3 care. 41 (46.6%) Dengue Haemorrhagic Fever (DHF) patients. Of them 14 received category 1 care while 25 and two received Category 2 and Category 3 care respectively. Classical classification and level of care sensitivity was 62.8% (CI 48–78) while specificity was 68.9% (CI 55–82). According to TDR classification 29 (32.9%) were Dengue patients without warning signs. Of them 22 and 07 received Category 1 and 2 level of care respectively and none went into category 3. 48 (55%) were Dengue with warning signs and 11 (13%) severe dengue patients. Of them 18 received Category 1 care while 39 and two received category 2 and category 3 care respectively. TDR classification and level of care sensitivity was 85.4% (CI 75–95) Specificity 55% (CI 39–70).Conclusions: WHO TDR classification captures more patients who need closer observation in Category 2 and three levels of care than classical classification. This may warrant additional hospital resources in developing country settings.Disclosure: This research was funded by the European Union 7th Framework Programme through 'DengueTools'.
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