Phoebe Putney Memorial Hospital

About: Phoebe Putney Memorial Hospital is a healthcare organization based out in Albany, Georgia, United States. It is known for research contribution in the topics: Population & PET-CT. The organization has 83 authors who have published 108 publications receiving 2275 citations.

Peribulbar versus retrobulbar anaesthesia for cataract surgery.

Abstract: Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body by infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective and safer anaesthesia for cataract surgery than retrobulbar block. The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4); MEDLINE (1960 to December 2007); and EMBASE (1980 to December 2007). We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery. Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the methods used by the included stories for reporting the outcomes varied. We performed a subgroup analysis for globe akinesia. We included six trials involving 1438 participants. Two of the six trials had a low risk of bias; the remaining four had a moderate risk of bias. There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence Interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block. There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery in terms of acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare in PB and RB.

COVID-19 and Renal Failure: Challenges in the Delivery of Renal Replacement Therapy

Abstract: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first officially reported in December 2019 in Wuhan City, Hubei province, China, and has since lead to a pandemic. Most cases result in minor symptoms such as cough, fever, sore throat, myalgia, fatigue, nausea, diarrhea, loss of smell, and abdominal pain. As of April 8, 2020, more than 1,485,000 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in over 90,000 deaths. Outcomes are worse in elderly patients, particularly males, and those with comorbidities, but can affect any age group. The incidence of acute kidney injury in patients with COVID-19 infection is about 3-15%; and in patients with severe infection requiring care in the intensive care unit, the rates of acute kidney injury increased significantly from 15% to 50%. Acute kidney injury is an independent risk factor for mortality in COVID-19 patients. The nephrologists, as well as intensivists, are facing immense daily challenges while providing care for these patients in the inpatient setting as well as end-stage renal disease patients on chronic dialysis in both inpatient and outpatient settings. In the current review article, we discussed the epidemiology and etiology of acute kidney injury, management of acute kidney injury including renal replacement therapy options (both hemodialysis and peritoneal dialysis) for inpatient floor, as well as intensive care unit settings. We also discussed the challenges faced by the outpatient dialysis units with COVID-19 infection. We discussed measures required to limit the spread of infection, as well as summarized the guidance as per the Centers for Disease Control and Prevention (CDC), American Society of Nephrology (ASN), American Society of Diagnostic and Interventional Nephrology (ASDIN) and the Vascular Access Society of the Americas (VASA).

The expanding spectrum of modes of transmission of Zika virus: a global concern.

Abstract: During recent years, but particularly since 2015, concern on Zika virus has grown for multiple reasons, such as its association with the occurrence of Guillain–Barre syndrome and microcephaly [1, 2]. Nevertheless, in addition to all epidemiological implications of the outbreak in Latin America [3] the number of affected cases continue to rise and expected to reach over four million in 2016, adding to this the possibility of new modes of transmission. Zika virus is a zoonotic pathogen, naturally and experimentally hosted in non-human primates [4] as well as experimentally in Swiss albino mices [5, 6]. Then, rhesus monkeys can be the source in natural habitats of human infections, through the bite of Aedes aegypti and A. albopictus (multiple other species and genus have been implicated) (Fig. 1), in infected monkeys and later transmission to susceptible human hosts. Fig. 1 Summary of reported forms of transmission of Zika virus Zika virus is predominantly a vector-borne disease (Fig. 1), although after the epidemics in the Pacific region it was clear that transplacental and perinatal transmission [7, 8] could also occur. However, the associated risk of microcephaly has been identified and highlighted much more recently as evidences continue to be added in different studies (Fig. 1) [8, 9]. Before the current epidemics not a single study raised that relationship, and, right now a significant number of pregnant women and their newborns are being monitored in Brazil [9], Colombia and other countries in the region for central nervous system anomalies. Zika has been detected in newborns, placenta and umbilical cords, as well in pregnant women by RT-PCR [8, 9]. There have been no reports detecting viable and potentially infective virus in breast milk up to now. In addition to mother-to-child transmission, during the last decade, cases of sexual transmission have been reported [10–12], representing a non-vector borne form of transmission of Zika virus (Fig. 1). Zika virus has been detected in human saliva [13], blood, semen and urine [14]. It has been recently detected in semen and urine of, respectively, a patient after 62 days of infection [15] and another patient after 14 days of infection [16]. Also spread of the virus through blood transfusion and organ transplantation have been reported or suspected [17]. Zika virus infections have been documented through laboratory exposure [18]. Another emerging aspect of this zoonosis has been the possible transmission through bites of monkeys and other non-human primates (Fig. 1). This has also been recently reported [19]. Summarizing, Zika virus is primarily a vector-borne disease (mainly by A. aegypti), but there are also secondary modes of transmission (mother-to-child, sexual, blood transfusion, transplantation, non-human primate bites) (Fig. 1). This imply that prevention and control should consider all these ways of transmission, providing strategies to reduce new infections from this arbovirus that still need further basic, epidemiological and clinical assessment in order to clarify and understand its real impact on human health. Zika represents a real challenge for the medical and scientific community as well as for the world [20].

Analysis of outcomes of percutaneous coronary intervention in metastatic cancer patients with acute coronary syndrome over a 10-year period.

Abstract: Early medical palliative care has been shown to improve overall survival of patients with metastatic cancer, but the role of cardiac surgical interventions in such patients is not clear. The limited life expectancy of these patients often poses a dilemma to clinicians and involves a detailed analysis of the risks and benefits of such interventions. This study examines the outcomes of percutaneous coronary intervention (PCI) in patients with metastatic cancer. The National Inpatient Database of USA was used to identify patients aged ≥18 years who had a diagnosis of metastatic cancer and acute coronary syndrome (ACS) between 2000 and 2009 using ICD-9-CM codes. These were categorized into ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). The utilization of PCI was also identified using ICD-9-CM codes. The outcomes studied were in-hospital mortality, length of hospital stay and discharge disposition. The association between various outcomes and use of cardiac catheterization was assessed using multivariate regression models. There were 49,515 patients with metastatic disease who were discharged with a diagnosis of ACS. Of these, 15,964 had STEMI and 33,551 had NSTEMI. 3981 patients (24.9 %) with STEMI and 3209 patients (9.6 %) with NSTEMI received percutaneous coronary intervention. Caucasian male patients under age 65 years were more likely to receive PCI in the setting of an ACS. The hospital characteristics associated with higher use of PCI included academic affiliation, large bedsize, private for-profit hospitals and Midwestern and Western regions of USA. The adjusted odds of receiving PCI in this group of patient have gradually increased by 1.14 every year in last decade (95 % CI 1.11–1.16). The beneficial effect of PCI on in-hospital mortality has declined in NSTEMI such that by 2009, there was no significant difference between patients who received PCI and those who did not receive PCI. This has remained unchanged for STEMI patients. In metastatic cancer patients with ACS, the rate of PCI has increased over the last decade. In the current era, metastatic cancer patients with NSTEMI may perform equally well without PCI in terms of in-hospital mortality. The decision to provide such care may be considered on an individual basis based on the extent of their medical comorbidity and tumor burden.

Acute Kidney Injury Requiring Dialysis in Severe Sepsis

Abstract: Rationale: Understanding the changing incidence and impact of acute kidney injury requiring dialysis in patients with severe sepsis will allow better risk stratification, design of clinical trials, and guide resource allocation.Objectives: To assess the longitudinal incidence of acute kidney injury requiring dialysis and its impact on mortality in patients with severe sepsis.Methods: Retrospective cohort study of adults (≥20 yr) hospitalized with severe sepsis from 2000 to 2009 in the United States using a nationally representative database.Measurements and Main Results: We calculated the incidences of acute kidney injury requiring dialysis and mortality over time. We used linear regression to assess temporal trends. We used logistic regression to estimate the odds of acute kidney injury requiring dialysis and mortality. Of the estimated 5,257,907 hospitalizations with severe sepsis, 6.1% had acute kidney injury requiring dialysis. The odds of acquiring acute kidney injury requiring dialysis increased by ...