Cec and You Shall Find: Cecal Perforation in a Patient with COVID-19

Digestive Diseases and Sciences -     

Komplikationen bei skleranahtfixierter Kunstlinsenimplantation

Die Sklerafixation einer Kunstlinse ist bei insuffizientem Kapselapparat eine häufig gewählte Versorgung. Als nachteilig gilt das potenzielle Komplikationsprofil. Analyse des postoperativen Komplikationsprofils. In dieser monozentrischen, retrospektiven Analyse einer konsekutiven Fallserie von Patienten mit standardisierter, skleranahtfixierter Kunstlinsenimplantation (2007 bis 2017) wurden die dokumentierten Komplikationen in „dauerhaft visusbedrohend“ (Endophthalmitis, Aderhautblutung, Ablatio retinae) und „klinisch relevant, aber nicht dauerhaft visusbedrohend“ (z. B. Blutungen, Hypotonie) kategorisiert. Zudem wurde der Zeitpunkt der erstmaligen Dokumentation der Komplikationen erfasst und in 3 Zeiträume eingeordnet (0 bis 3, 4 bis 30 und ≥31 Tage). Vorliegend handelt es sich um das bislang größte publizierte Patientenkollektiv einer Studie mit Skleranahtfixierung einer Hinterkammerlinse (HKL). Es wurden 338 Augen von 338 Patienten in die Studie eingeschlossen (Frauen: 47 %), die mediane Nachbeobachtungszeit betrug 60 Tage (min.: 1 Tag, max.: 5833 Tage). In 68 % der Fälle wurden Komplikationen dokumentiert. „Dauerhaft visusbedrohende Komplikationen“ traten bei 3 % (n = 10) der Patienten auf. Als „klinisch relevante Komplikationen“ wurden ermittelt: okuläre Hypotension auf Werte ≤10 mm Hg (n = 119; 35 %), entrundete Pupille (n = 93; 28 %), Hyphäma, Iris- oder Glaskörperblutungen (n = 34; 10 %), Sekundärglaukom (n = 32; 9 %) und Iris-Capture (n = 17; 5 %); 41 % der Komplikationen traten innerhalb der ersten 3 Tage und 70 % innerhalb der ersten 30 Tage auf. Zu Revisionsoperationen kam es bei 4,5 % (n = 15) der Patienten. Obwohl bei ca. zwei Dritteln aller Eingriffe Komplikationen auftraten, war die Zahl der dauerhaft visusbedrohenden Komplikationen gering. Die Sklerafixation der Kunstlinse ist weiterhin ein vertretbarer Eingriff.     

Development of a protocol for maintaining viability while shipping organoid‐derived retinal tissue

Retinal organoid technology enables generation of an inexhaustible supply of three‐dimensional retinal tissue from human pluripotent stem cells (hPSCs) for regenerative medicine applications. The high similarity of organoid‐derived retinal tissue and transplantable human fetal retina provides an opportunity for evaluating and modeling retinal tissue replacement strategies in relevant animal models in the effort to develop a functional retinal patch to restore vision in patients with profound blindness caused by retinal degeneration. Because of the complexity of this very promising approach requiring specialized stem cell and grafting techniques, the tasks of retinal tissue derivation and transplantation are frequently split between geographically distant teams. Delivery of delicate and perishable neural tissue such as retina to the surgical sites requires a reliable shipping protocol and also controlled temperature conditions with damage‐reporting mechanisms in place to prevent transplantation of tissue damaged in transit into expensive animal models. We have developed a robust overnight tissue shipping protocol providing reliable temperature control, live monitoring of the shipment conditions and physical location of the package, and damage reporting at the time of delivery. This allows for shipping of viable (transplantation‐competent) hPSC‐derived retinal tissue over large distances, thus enabling stem cell and surgical teams from different parts of the country to work together and maximize successful engraftment of organoid‐derived retinal tissue. Although this protocol was developed for preclinical in vivo studies in animal models, it is potentially translatable for clinical transplantation in the future and will contribute to developing clinical protocols for restoring vision in patients with retinal degeneration.     

Iodine status of breastfed infants and their mothers' breast milk iodine concentration

Iodine is an essential nutrient for growth and development during infancy. Data on iodine status of exclusively (EBF) and partially breastfed (PBF) infants as well as breast milk iodine concentration (BMIC) are scarce. We aimed to assess (a) infant iodine nutrition at the age of 5.5 months by measuring urinary iodine concentration (UIC) in EBF (n = 32) and PBF (n = 28) infants and (b) mothers' breast milk iodine concentration (n = 57). Sixty mother–infant pairs from three primary health care centres in Reykjavik and vicinities provided urine and breast milk samples for iodine analysis and information on mothers' habitual diet. The mother–infant pairs were participants of the IceAge2 study, which focuses on factors contributing to infant growth and development, including body composition and breast‐milk energy content. The median (25th–75th percentiles) UIC was 152 (79–239) μg/L, with no significant difference between EBF and PBF infants. The estimated median iodine intake ranged from 52 to 86 μg/day, based on urinary data (assuming an average urine volume of 300–500 ml/day and UIC from the present study). The median (25th–75th percentiles) BMIC was 84 (48–114) μg/L. It is difficult to conclude whether iodine status is adequate in the present study, as no ranges for median UIC reflecting optimal iodine nutrition exist for infants. However, the results add important information to the relatively sparse literature on UIC, BMIC, and iodine intake of breastfed infants.     

Standards und Entwicklungen in der Behandlung von Cholangiokarzinomen

best practice onkologie - Gallengangskarzinome werden entsprechend ihrer Lokalisation in distale, perihiläre und intrahepatische Cholangiokarzinome (CCA) unterteilt. Neben unterschiedlichen...     

Low-dose hydrocortisone in patients with COVID-19 and severe hypoxia (COVID STEROID) trial—Protocol and statistical analysis plan

Introduction

Severe acute respiratory syndrome coronavirus-2 has caused a pandemic of coronavirus disease (COVID-19) with many patients developing hypoxic respiratory failure. Corticosteroids reduce the time on mechanical ventilation, length of stay in the intensive care unit and potentially also mortality in similar patient populations. However, corticosteroids have undesirable effects, including longer time to viral clearance. Clinical equipoise on the use of corticosteroids for COVID-19 exists.

Methods

The COVID STEROID trial is an international, randomised, stratified, blinded clinical trial. We will allocate 1000 adult patients with COVID-19 receiving ≥10 L/min of oxygen or on mechanical ventilation to intravenous hydrocortisone 200 mg daily vs placebo (0.9% saline) for 7 days. The primary outcome is days alive without life support (ie mechanical ventilation, circulatory support, and renal replacement therapy) at day 28. Secondary outcomes are serious adverse reactions at day 14; days alive without life support at day 90; days alive and out of hospital at day 90; all-cause mortality at day 28, day 90, and 1 year; and health-related quality of life at 1 year. We will conduct the statistical analyses according to this protocol, including interim analyses for every 250 patients followed for 28 days. The primary outcome will be compared using the Kryger Jensen and Lange test in the intention to treat population and reported as differences in means and medians with 95% confidence intervals.

Discussion

The COVID STEROID trial will provide important evidence to guide the use of corticosteroids in COVID-19 and severe hypoxia.