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- Khatri, C, et al.
(författare)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Tidskriftsartikel (refereegranskat)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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- Chartampilas, E, et al.
(författare)
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Current Imaging Diagnosis of Hepatocellular Carcinoma
- 2022
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Ingår i: Cancers. - : MDPI AG. - 2072-6694. ; 14:16
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Tidskriftsartikel (refereegranskat)abstract
- Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related death worldwide. Radiology has traditionally played a central role in HCC management, ranging from screening of high-risk patients to non-invasive diagnosis, as well as the evaluation of treatment response and post-treatment follow-up. From liver ultrasonography with or without contrast to dynamic multiple phased CT and dynamic MRI with diffusion protocols, great progress has been achieved in the last decade. Throughout the last few years, pathological, biological, genetic, and immune-chemical analyses have revealed several tumoral subtypes with diverse biological behavior, highlighting the need for the re-evaluation of established radiological methods. Considering these changes, novel methods that provide functional and quantitative parameters in addition to morphological information are increasingly incorporated into modern diagnostic protocols for HCC. In this way, differential diagnosis became even more challenging throughout the last few years. Use of liver specific contrast agents, as well as CT/MRI perfusion techniques, seem to not only allow earlier detection and more accurate characterization of HCC lesions, but also make it possible to predict response to treatment and survival. Nevertheless, several limitations and technical considerations still exist. This review will describe and discuss all these imaging modalities and their advances in the imaging of HCC lesions in cirrhotic and non-cirrhotic livers. Sensitivity and specificity rates, method limitations, and technical considerations will be discussed.
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- Koskolou, Maria D., et al.
(författare)
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Physiological responses of anemic women to exercise under hypoxic conditions
- 2023
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Ingår i: Physiologia. - : MDPI. - 2673-9488. ; 3:2, s. 247-258
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Tidskriftsartikel (refereegranskat)abstract
- When combining two conditions of reduced oxygen availability, anemia and hypoxia, human physiological responses are highly challenged to maintain arterial oxygen delivery, especially during whole-body exercise. The aim of this study was to compare the cardiorespiratory responses of mildly anemic women with those of healthy controls, while cycling in normobaric hypoxia. Two groups of young females were matched for age, weight, height, and involvement in physical activity, one with normal hemoglobin, hematocrit, and ferritin levels and another suffering from mild iron deficiency anemia (10 < (Hb) < 12 g/dL, 34 < Hct < 37%, ferritin < 15 μg/L). They cycled to exhaustion under normoxia and hypoxia (FIO2 0.21 and 0.14), and their physiological responses were compared at 40, 80, and 100% VO2max of the specific condition. The two groups differed (p < 0.05) mainly at the higher exercise intensities; the anemic participants exhibited similar heart rate but lower oxygen pulse than their control counterparts, as well as a larger drop in maximal oxygen uptake. However, they sustained maximal effort by employing the anaerobic metabolism to a larger extent, which stimulated a greater ventilatory response. It appears that iron deficiency anemia of mild severity, which is commonly observed in young athletic females, impacts physiological responses during whole-body exercise in the presence of moderate hypoxia.
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- Koussis, A. D., et al.
(författare)
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Cost-efficient management of coastal aquifers via recharge with treated wastewater and desalination of brackish groundwater: Application to the Akrotiri Basin and Aquifer, Cyprus
- 2010
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Ingår i: Hydrological Sciences Journal. - : Informa UK Limited. - 0262-6667 .- 2150-3435. ; 55:7, s. 1234-1245
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Tidskriftsartikel (refereegranskat)abstract
- We investigate the general methodology for an intensive development of coastal aquifers, described in a companion paper, through its application to the management of the Akrotiri aquifer, Cyprus. The Zakaki area of that aquifer, adjacent to Lemessos City, is managed such that it permits a fixed annual agricultural water demand to be met, as well as and a fraction of the water demand of Lemessos, which varies according to available surface water. Effluents of the Lemessos wastewater treatment plant are injected into the aquifer to counteract the seawater intrusion resulting from the increased pumping. The locations of pumping and injection wells are optimized based on least-cost, subject to meeting the demand. This strategy controls sea intrusion so effectively that desalting of only small volumes of slightly brackish groundwater is required over short times, while ∼2.3 m3 of groundwater is produced for each 1 m3 of injected treated wastewater. The cost over the 20-year period 2000-2020 of operation is ∼40 M€ and the unit production cost of potable water is under 0.2 €/m3. The comparison between the deterministic and stochastic analyses of the groundwater dynamics indicates the former as conservative, i.e. yielding higher groundwater salinity at the well. The Akrotiri case study shows that the proposed aquifer management scheme yields solutions that are preferable to the widely promoted seawater desalination, also considering the revenues from using the treated wastewater for irrigation.
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- Koussis, A. D., et al.
(författare)
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Cost-efficient management of coastal aquifers via recharge with treated wastewater and desalination of brackish groundwater: General framework
- 2010
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Ingår i: Hydrological Sciences Journal. - : Informa UK Limited. - 0262-6667 .- 2150-3435. ; 55:7, s. 1217-1233
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Tidskriftsartikel (refereegranskat)abstract
- Semi-arid coastal zones often suffer water-stress, as water demand is high and markedly seasonal, due to agriculture and tourism. Driven by scarcity of surface water, the communities in semi-arid coastal regions turn to aquifers as prime water source; but intensive exploitation of coastal aquifers causes seawater intrusion, which degrades the quality of groundwater. The cost-efficient and sustainable development of coastal aquifers can be achieved through a holistic management scheme which combines two non-traditional water sources: (a) saltwater, to be treated to the desired quality, and (b) wastewater, to be re-claimed to augment aquifer recharge for control of seawater intrusion, and also to meet certain demands. This management scheme is based on the idea that it is cost-advantageous to: (i) desalt brackish groundwater, instead of seawater, as the former requires far less energy, and (ii) to re-use wastewater at only the differential cost to any treatment already practiced. In this paper, we present the general framework of the proposed management scheme, and a decision aid tool (DAT) which has been developed to assist decision makers to explore the scheme's decision space. The DAT uses cost as optimization criterion to screen various management scenarios, via modelling of the dynamic natural-engineered system behaviour, and identifies those cost-efficient ones that meet the water demand and achieve aquifer protection.
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