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Multimodal Stratified Approach for Prevention of Thromboembolism in Patients Undergoing Total Hip Arthroplasty

Open Journal of Orthopedics 2018年第12期8卷 429-442页

作者： Elmano de Araujo Loures Glauco Mendonca Rocha Daniel Naya Loures isabel cristina goncalves leite Clarice Naya Loures University Hospital of the Federal University of Juiz de Fora Juiz de Fora MGBrasil Rio Branco Medical Center Juiz de Fora-MGBrasil School of Medicine of the Federal University of Juiz de Fora Juiz de Fora-MGBrasil Sao Paulo Federal University Sao Paulo-SPBrasil

Objective: To demonstrate the efficacy and safety of a multimodal stratified approach for prevention of thromboembolism in patients undergoing primary total hip arthroplasty. Method: A longitudinal retrospective clinical study of a cohort of 341 individuals undergoing total hip arthroplasty between March 2008 and July 2016. Of these, 242 patients met the criteria for inclusion in the study. Individuals with a history of deep vein thrombosis or pulmonary thromboembolism, thrombophilia, hypercoagulation conditions, and chronic users of anticoagulants before surgery received enoxaparin at a dose of 40 mg/day for 21 days. For the other group, acetylsalicylic acid was prescribed at a dose of 200 mg/day for 30 days. All patients had surgical risk assessed by the American Anesthesiology Association classified as I or II, and underwent regional anesthesia, effective hydration, the same protocol of early postoperative rehabilitation, and the use of compression stockings. Drug cost analysis was performed based on the Brasíndice. To date, there are no publications in PubMed and Scielo on this subject regarding the Brazilian population. Results: The need for blood transfusion in the enoxaparin group was higher and the overall complication and hemorrhagic rates were also significantly higher (p < 0.010) in this group. Aspirin prescription costs 39 times less than enoxaparin. Conclusion: In patients without predisposing factors to thromboembolism and undergoing primary total hip arthroplasty, the multimodal approach with acetylsalicylic acid seems to be effective, with low cost and a low rate of complications.

关键词： Anticoagulation Thromboembolism Total Hip Arthroplasty

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Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease

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世界胃肠病学杂志：英文版 2015年第29期21卷 8927-8934页

作者： Daniele Santetti Maria Inês de Albuquerque Wilasco cristina Toscani Leal Dornelles isabel cristina Ribas Werlang Fernanda Urruth Fontella Carlos Oscar Kieling Jorge Luiz dos Santos Sandra Maria goncalves Vieira Helena Ayako Sueno Goldani Post-Graduate Program of Child and Adolescent Health Faculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto Alegre Nutrition Service Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Laboratory of Translational Pediatrics-NESCA Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Pediatric Hepatology Unit Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto Alegre Pediatric Gastroenterology Unit Hospital de Clínicas de Porto Alegre and Post-Graduate Program of Child and Adolescent HealthFaculdade de MedicinaUniversidade Federal do Rio Grande do SulPorto Alegre

AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver ***: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease(MELD) and Pediatric End Stage Liver Disease(PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition(Z-score <-1.00) and malnutrition(Z-score <-2.00). Interleukin-1β(IL-1β), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. RESULTS: The median(25th-75 th centile) age of the study population was 60(17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease(72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values were increased in patients at nutritional risk(34.9%) compared with those who were well-nourished [7.12(0.58-34.23) pg/m L vs 1.63(0.53-3.43) pg/m L; P = 0.02], correlating inversely with triceps skinfold-for-age z-score(rs =-0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score(P = 0.001).

关键词： Cytokines Interleukin-6 Malnutrition Cirrhosis Child

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