BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during inde...BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.展开更多
BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with ...BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with end stage renal disease who are on dialysis.AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis.METHODS A retrospective,multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1,2020 and December 31,2020.Primary endpoints were oxygen requirements,time to mortality and escalation of care needing mechanical ventilation.RESULTS A total of 45 patients were included in the study.Twenty patients received remdesivir,and 25 patients did not receive remdesivir.Most patients were caucasian,females with diabetes mellitus and hypertension being the commonest comorbidities.There was a trend towards reduced oxygen requirement(beta=-25.93,X^(2)(1)=6.65,P=0.0099,probability of requiring mechanical ventilation(beta=-28.52,X^(2)(1)=22.98,P<0.0001)and mortality(beta=-5.03,X^(2)(1)=7.41,P=0.0065)in patients that received remdesivir compared to the control group.CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.展开更多
文摘BACKGROUND Gallstone pancreatitis is one of the most common causes of acute pancreatitis.Cholecystectomy remains the definitive treatment of choice to prevent recurrence.The rate of early cholecystectomies during index admission remains low due toperceived increased risk of complications.AIMTo compare outcomes including length of stay, duration of surgery, biliarycomplications, conversion to open cholecystectomy, intra-operative, and postoperativecomplications between patients who undergo cholecystectomy duringindex admission as compared to those who undergo cholecystectomy thereafter.METHODSStatistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (randomeffects model).RESULTSInitial search identified 163 reference articles, of which 45 were selected andreviewed. Eighteen studies (n = 2651) that met the inclusion criteria were includedin this analysis. Median age of patients in the late group was 43.8 years while thatin the early group was 43.6. Pooled analysis showed late laparoscopiccholecystectomy group was associated with an increased length of stay by 88.96 h(95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled riskdifference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group.Pooled analysis showed no risk difference in intraoperative complications [riskdifference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [riskdifference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy[risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and latecholecystectomy groups. Pooled analysis showed the duration of surgery to beprolonged by 39.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy groupas compared to the early group.CONCLUSIONIn patients with mild gallstone pancreatitis early cholecystectomy leads to shorterhospital stay, shorter duration of surgery, while decreasing the risk of biliarycomplications. Rate of intraoperative, post-operative complications and chances ofconversion to open cholecystectomy do not significantly differ whethercholecystectomy was performed early or late.
文摘BACKGROUND Since the beginning of corona virus disease 2019(COVID-19)pandemic,there has been a widespread use of remdesivir in adults and children.There is little known information about its outcomes in patients with end stage renal disease who are on dialysis.AIM To assess the clinical outcomes with use of remdesivir in adult patients with end stage kidney failure on hemodialysis.METHODS A retrospective,multicenter study was conducted on patients with end stage renal disease on hemodialysis that were discharged after treatment for COVID-19 between April 1,2020 and December 31,2020.Primary endpoints were oxygen requirements,time to mortality and escalation of care needing mechanical ventilation.RESULTS A total of 45 patients were included in the study.Twenty patients received remdesivir,and 25 patients did not receive remdesivir.Most patients were caucasian,females with diabetes mellitus and hypertension being the commonest comorbidities.There was a trend towards reduced oxygen requirement(beta=-25.93,X^(2)(1)=6.65,P=0.0099,probability of requiring mechanical ventilation(beta=-28.52,X^(2)(1)=22.98,P<0.0001)and mortality(beta=-5.03,X^(2)(1)=7.41,P=0.0065)in patients that received remdesivir compared to the control group.CONCLUSION Larger studies are justified to study the effects of remdesivir in this high-risk population with end stage kidney disease on dialysis.
