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Objective Tracheal granulation is one of the common long term complications in patients after tracheostomy. Hypertrophic tracheal granulation may cause airway obstruction and further operation may be required to recreate an airway. Distal tracheal granulation is clinically challenging because of its position and surgical field limitation. This retrospective case review study evaluated the outcomes of PEAK PlasmaBlade-assisted tracheal surgery in patients with distal tracheal granulation. Methods This study retrospectively reviewed patients with distal tracheal granulation following long-term tracheostomy. All patients received PEAK PlasmaBlade assistance tracheal surgery (PATS) between February 2013 and December 2019. The surgery was performed using the PEAK PlasmaBlade with TnA type tip, powered by a PULSAR Generator, and guided by a 45 ° rigid endoscope. Patients were regularly followed up for a minimum of 12 months. Results A total 21 patients had completed PATS. None of the patients experience immediate life-threatening complications during or after the procedure. All the 21 patients were free of recurrent obstructive granulation within 12 months after operation. Conclusion PATS is practical, effective, and safe for distal tracheal granulation and can be performed by single surgeon. Furthermore, it is technically less demanding than other surgical approaches and it has a rapid learning curve.

SARS-CoV-2 has rapidly spread across the globe and infected hundreds of millions of people worldwide. As our experience with this virus continues to grow, our understanding of both short-term and long-term complications of infection with SARS-CoV-2 continues to grow as well. Just as there is heterogeneity in the acute infectious phase, there is heterogeneity in the long-term complications seen following COVID-19 illness. The purpose of this review article is to present the current literature with regards to the epidemiology, pathophysiology, and proposed management algorithms for the various long-term sequelae that have been observed in each organ system following infection with SARS-CoV-2. We will also consider future directions, with regards to newer variants of the virus and their potential impact on the long-term complications observed.

Resumen: Antecedentes y objetivo: La inclinación pélvica influye en la posición relativa de los componentes de la prótesis total de cadera (PTC) la cual a su vez se puede modificar por los cambios evolutivos que aparecen en la columna lumbar. Nuestro objetivo es estudiar la variación de la posición de la pelvis y del componente acetabular en pacientes con PTC durante 5 años y las posibles complicaciones. Material y métodos: El actual estudio retrospectivo incluye 48 pacientes intervenidos de PTC entre 2008 y 2012. Se recogen los datos clínicos, complicaciones y los cambios radiológicos en relación a los ángulos sacrofemoropúbicos, inclinación acetabular en la radiografía anteroposterior de pelvis y la anteversión lateral según Woo-y-Morrey. Las mediciones se realizaron preoperatoriamente, a las 6 semanas, al año, a los dos años y a los cinco años de la intervención. Resultados: El sacrofemoropúbico disminuyó de 60,6° preoperatorio a 58,8° a los cinco años (p > 0,05), más en mujeres (de 63,3° a 59,3°) que en varones (de 58,7° a 58,3°). La inclinación acetabular aumentó de 47,3° a las seis semanas después de la PTC a 48,2° a los cinco años (p > 0,05) y la anteversión de 24,3° a 36,1° (p .05), more in females (from 63.3 to 59.3) than males (58.7 to 58.3). Acetabular abduction increased from 47.3 at six-week postoperatively to 48.2 at five years (p > .05) and acetabular anteversion varied from 24.3∘ to 36.1∘ (p < .04). There were four dislocations: one late recurrent dislocation which required cup revision. Conclusion: Despite the sacro-femoral-pubic angle tendency to decrease and anteversion tendency to increase after five years, larger studies with longer follow-up are needed to confirm the potential increasing in long term complications.

The biggest concern about diabetes-related complications is that they are unrecognised in the early stages but can be immutable and devastating with time. Identifying the population at high risk of...

The review article includes information on data on the treatment of patients with essential hypertension and manifestations of metabolic syndrome and their effectiveness in preventing the development of long-term complications of COVID-19. The pandemic of acute respiratory syndrome caused by SARS-CoV-2 requires changes in the approach to the treatment and prevention of metabolic syndrome and essential hypertension, as the presence of these comorbidities worsens the course and prognosis of infectious disease. Some pathogenetic links have been identified that affect these pathological conditions. Emphasis is placed on the key role of a balanced and healthy diet, as a component of a healthy lifestyle, in maintaining the optimal functional state of the cardiovascular system. It is also noted that the course of infectious disease caused by SARS-CoV-2 in patients with metabolic syndrome is more severe and more often leads to complications. Since COVID-19 is recognized as a multi-organ disease with a wide range of manifestations and long-term symptoms, data on the course of this disease in patients with hypertension and metabolic syndrome were analyzed. Endothelial dysfunction is highlighted as one of the pathogenetic links that combines essential hypertension, insulin resistance and atherosclerosis, and options for its correction are considered. Standards for the treatment of essential hypertension and metabolic syndrome in view of the COVID-19 pandemic are presented. Information on the ability of statins to increase glycemia with long-term use, especially in patients with metabolic syndrome, is given. Conclusion. A number of drugs that have antioxidant, vasodilator and anti-inflammatory properties that do not cause an increase in glycemia, including quercetin, have been proposed. Its positive effect on the level of blood pressure has been revealed, which implies its use as an adjunct to antihypertensive therapy. The combination of quercetin and vitamin C is considered as an adjunct to basic therapy for COVID-19 disease and its long-term complications. Further studies are planned to determine the clinical value of quercetin supplements in therapy of essential hypertension, rehabilitation of patients after COVID-19, stabilization of dyslipidemia and insulin resistance, as well as dose adjustment and study of possible drug interactions between quercetin and antihypertensive drugs

Key words: Cardioneuroablation, Atrioventricular block, Syncope, Arrhythmia According to clinical guidelines a symptomatic atrioventricular block (AV block) is treated with a pacemaker. For young individuals such a therapy can be difficult due to possible long term complications such as infections, lead disruptions and pacemaker induced cardiomyopathy. We describe a twenty year old man with recurrent syncopes due to intermittent parasympathetic caused AV block of grade 2. The patient underwent cardioneuroablation where parasympathetic ganglia in the right atrium were ablated. After the procedure the PR interval normalized. This procedure has never been performed in Iceland before and there is a limited amount of case reports in the literature.

Objectives. The amount of patients with diabetes is increasing, and such patients experience several long-term complications. Therefore, finding a method to treat the disease and its complications is an urgent issue worldwide. In Vietnam, Phyllanthus amarus Schum. & Thonn. (PA) and Gymnema sylvestre R. Br. (GS) are common herbs used in traditional therapy including diabetes treatment. This study aimed to combine PA and GS to extend their bioactivities in antidiabetes, antioxidant, and anti-inflammatory treatments.Methods. Here, PA and GS powders were mixed at different ratios for extraction. Ethanolic extract was used to detect bioactive compounds, bioactivities, and appropriate ratios of the mixtures.Results. The optimal ratio for the PA and GS combination was 2 : 1 (g/g). The ethanolic extraction of the 2 : 1 sample at 50°C over two hours with a solid/liquid ratio of 1 : 10 achieved a high yield of 14.37%. This sample exhibited good α-glucosidase inhibition activity with a half-maximal inhibitory concentration (IC50) of 9.74 µg/mL, antioxidant activity with an IC50 of 29.87 µg/mL, and anti-inflammatory activity with an IC15 of 400 µg/mL.Conclusions. The study confirmed that combining PA and GS can have high α-glucosidase inhibition as well as antioxidant and anti-inflammatory effects.

Study Design: Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have been reported. Objective: We compared the long-term complications of patients with condylar fractures treated conservatively, with IMF, or with combined ORIF and IMF. Methods: We retrospectively analyzed all patients diagnosed with unilateral or bilateral condylar fracture, isolated or combined with a fracture of the mandibular body, admitted to the Department of Maxillofacial Surgery at UZ Leuven between January 2013 and January 2020. We collected data on age, gender, side of condylar fracture, presence of associated fracture of the mandibular body, referrals, initial treatment, long-term complications and secondary treatment. Long-term complications were defined as sequelae still present 6 weeks after initial treatment. Results: Among 192 patients, 68.8% had unilateral and 31.2% bilateral condylar fractures; an associated fracture of the mandibular body was seen in 45.8%, 31% received conservative treatment, 51% IMF only, and 18% combined ORIF and IMF. Forty-eight percent of all patients suffered from 1 or more long-term complications, most frequently malocclusion (24%), reduced mouth opening (15.1%), nerve disturbances (13.5%), pain (8.9%), and facial asymmetry (2.6%). Surgery as a secondary treatment was necessary in 25% of all cases. Conclusions: The presence of bilateral condylar fractures or associated fracture of the mandibular body is a risk factor for developing long-term complications. Most patients with long-term complications were initially treated with combined ORIF and IMF, but long-term complications after initial conservative or IMF treatment were treated with secondary surgery.

Aim: Traumatic dental injuries occur frequently in children. Treatment and follow ups are important to avoid short and long term complications. The aim of this study was to investigate the prevalence of sequelae in the permanent anterior teeth following the trauma in their predecessors in the period of 2005 to 2011. Methods: This study was performed retrospectively according the data from the records of 79 children (53 boys, 26 girls), who were treated for anterior deciduous tooth trauma. Of the 79 affected children (186 teeth), 35 (91 teeth, 22 boys and13 girls) were available for the follow-up examination. Kappa coefficient was calculated for inter-examiner reliability. Descriptive statistics including percentage and mean values were also calculated. Results: Sequelae were detected on 45(49.5%) of 91 successors of the traumatized deciduous teeth and enamel hypoplasia and/or discoloration was observed in 14 (31.1%) teeth. Eruption was disturbed in 14 (31.1%). In 13 teeth (28.9%) crown and root malformation, in three teeth (6.7%) only crown and in one tooth (2.2%) only root malformation was detected. Most frequent sequela of successors were observed after the intrusive luxation of the deciduous teeth (33%). Crown-root malformations of the successor teeth were most frequently occurred after the trauma at the age of 0 to 2 (61.53%). Conclusions: Early diagnosis and treatment of primary dental injuries and routine clinical and radiological follow up would minimize the sequelae which were observed in permanent successors..

Paediatric forearm fractures are common injuries accounting for 40% of all the fractures in children. They are traditionally treated conservatively with casting. However there has been short and long term complications associated with such treatment and in recent times, closed reduction and flexible nailing has shown favourable clinical outcomes. In this prospective study, we evaluated functional outcome in closed forearm diaphyseal fractures of children and adolescents treated with titanium elastic intramedullary nails. All cases achieved bony union at an average of eight weeks and excellent functional outcome without significant complications. Nails were removed under anaesthesia after radiological union. Intramedullary nailing with elastic nails is an effective method of treatment for these unstable diaphyseal fractures of forearm in children and adolescents.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 manifests mainly as respiratory symptoms. Extrapulmonary manifestations have also been detected and several vital organs may sustain irreversible or long-standing damage. These extrapulmonary manifestations can be detected in cardiovascular, hepatic, renal, and hematologic systems. Maxillofacial surgeons may encounter patients who have recovered from COVID-19 but are still suffering long-term morbidities as a result of this incompletely understood infection. Consequently, they have to be aware of the various systemic complications that may be encountered in these patients as they may interfere with their treatment plan or may necessitate certain modifications and precautions.In this report the authors present the long-standing systemic complications of COVID-19 reported so far, and discuss their implications within the context of maxillofacial surgery with regards to the modifications and precautions in the process of treatment planning.Graphical abstract shows the long-term complications of COVID-19 that may complicate maxillofacial surgical procedures.

Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Fifty percent of GDM patients develop type 2 Diabetes in next twenty years and as well as the newborn can also be affected by diabetes in their lifetime. So the long term complications for both the mother and the child cannot be ignored. In view of maternal morbidity and mortality as well as fetal complications, early diagnosis is an utmost necessity in the present scenario. In developing country like Bangladesh, early detection and prevention is not cost effective and usually troublesome. So, there is an urgent need for a well-designed method for the detection of gestational diabetes mellitus. The purpose of this study is to predict the GDM in the first trimester. This research presents and compares some Artificial Neural Network (ANN) models on the early detection of Gestational diabetes mellitus and chooses the best neural network model among them to detect GDM early.

Objective: To compare visual outcomes and complications between manual small incision cataract surgery (MSICS) and phacoemulsification. Methods: A retrospective study was conducted in the tertiary care center. A total of 1281 cases underwent manual small incision cataract surgery and phacoemulsification from January 2014 to December 2016. The postoperative best corrected visual acuity (BCVA) along with the rates of complications were compared between both groups. Results: Five hundred and twenty-one patients (40.67%) and 760 patients (59.33%) were subjected by staff members and residents, respectively. Altogether, 689 cases (53.79%) were subjected to MSICS technique and 592 cases (46.21%) to phacoemulsification. The MSICS group had significantly harder cataract (cataract grading ≥ 4+ :31.64% vs. 7.77%; p

Menopause is defined as permanent cessation of monthly menstrual periods due to permanent depletion of ovarian follicular activity which results in reduced production of ovarian steroids. This in turn causes short term and long term complications in postmenopausal women. Hormone replacement therapy (HRT) is considered as the treatment of choice in the management of these complications. However, unscheduled bleeding following HRT is a well known complication. Diagnosis of unscheduled bleeding is confirmed after careful assessment and exclusion of secondary endometrial pathologies. This can be managed effectively by adjusting or changing the hormone profile in HRT preparations.

Aim Proper arteriovenous fistula (AVF) management is crucial to avoid AVF complications and prolong its useful life for maintenance haemodialysis (MHD). Design Retrospective cohort study. Methods Patients on MHD who underwent AVF surgery at the Wuhan Third Hospital between January 2018 and July 2018. Results A total of 144 patients were included, with 56 in the integrated group and 88 in the routine group. There were no differences between the two groups in terms of sex (p = .61), age (p = .62) and type of primary kidney disease (p > .99). At 1 year, the integrated group had significantly fewer fistula‐related complications than the routine group (3.6% versus. 23.9%, p

Endometriosis involving the bowel requires a thorough evaluation prior to deciding upon surgical treatment. Patient symptoms, treatment goals, extent and location of disease, surgeon experience, and anticipated risks all play a part in the preoperative decision-making process. Short- and long-term complications after bowel surgery for endometriosis are the focus of this article. Unfortunately, the literature to date has inherent limitations that prevent generalizability. Most studies are retrospective or prospective single-center case series. Publication bias is unavoidable with mainly large volume experts sharing their experience. As a result, there is a need for high-quality prospective studies that standardize inclusion criteria and outcome measures among various centers with an aim to present long-term outcomes. In the meantime, care for those with endometriosis involving the bowel requires a thorough preoperative plan to minimize risks and a need for early diagnosis and management of complications unique to bowel surgery.

Gross hematuria, besides being a serious renal disorder, is quite worrisome for the patients. It merits evaluationto determine the underlying cause and initiate timely management in order to prevent long term complications as well as permanent renal damage in some cases. Anatomical abnormalities causing gross hematuria are rare and often asymptomatic, hence not diagnosed routinely. Here we present two cases of gross hematuria with underlying anatomical abnormality known as the Nut Cracker Syndrome (NCS). Keywords: Gross hematuria, Children, Non glomerular, Nut Cracker Syndrome

Diabetes, has been known to mankind for centuries, often described by its unique nature of sweet tasting urine or by the symptoms of excessive urination and thirst. Several renowned scientists have attempted to describe the symptoms, pathophysiology, diagnosis and various experimental treatment options with varying degrees of success. The current widely accepted classification focuses on etiology and pathogenesis to guide treatment and is very successful and adapted across the world. Diagnostic criteria underwent multiple changes to define glycemic targets which were more and more guided by better understanding of the disease pathogenesis. Recent research focuses on a more individualized approach to managing diabetes, better understanding and identifying individuals who are at an increased risk of complications at diagnosis itself to offer more personalized management to prevent long term complications. Early differentiation of individual based on multiple factors rather than a single parameter is the path being paved currently. BMI, Waist circumference, age at diagnosis, HbA1c, triglycerides, HDL cholesterol, GAD Antibodies, Homeostasis model assessment of Insulin Resistance (HOMA-2 IR), beta-cell dysfunction (HOMA2-Beta), and fasting and stimulated C-peptide, are core parameters in the current rationalized approach towards better long term outcomes for people with diabetes. Cluster based identification and focused treatment with individualistic targets is the way forward in Diabetes management.

Self-management in diabetic patients is vital to keep the illness under control and avert any long term complications. Effective management of diabetes is a difficult task without an adequate understanding of the existing level of knowledge, attitude, and practice related to self-management. Knowing the level of knowledge, attitude, and practice towards self-management may help to provide information for health policy-makers to design and implement effective interventions to reduce diabetes-related morbidity and mortality. To assess the level of knowledge, attitude, and practice towards self-management among patients with diabetes at Debre Tabor General Hospital chronic diseases follow up clinic. An institution-based cross-sectional study was conducted from February to March 2016. A systematic random sampling technique was employed to select 206 patients. A structured pretested interviewer-administered questionnaire was used to collect data. The data were entered and analyzed using SPSS version 20. More than half of the study participants 114 (55.3%) had poor knowledge about diabetic self-management. Poor attitude of diabetic self-management was detected among 109 (52.9%) of studied patients. Nearly two-thirds 136 (66.0%) of the study participants had poor practice towards self-management. More than half of the participants had poor knowledge and attitude towards self-management and nearly two-thirds of them had poor practice. It is better to emphasize the importance of the patient as the key person in diabetic management.

Traumatic brain injury (TBI) secondary to gunshot wounds is a common problem in the USA and presents with a unique set of acute and chronic complications. Recent publications in trauma and critical care literature have sought to better understand incidence, demographics, and acute complications of gunshot wounds to the head. These findings, coupled with literature on rehabilitation of TBI patients secondary to gun violence, may help brain injury physiatrists better understand issues which may arise during rehabilitation. Clinical commonalities among TBI patients with gunshot wounds to the head provide a foundation for suggested management paradigms. Patients with gunshot wounds to the head represent a unique subset of the TBI population associated with the pathophysiology of a penetrating brain injury, including intracranial infection, early seizures, and CSF leak. Mood and substance use disorders may further complicate rehabilitation and require attention to maximize patients’ benefit from rehabilitation.

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods . The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1 st group – in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2 nd group – in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3 rd group – in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4 th group – in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.8±12.5 months. Results . In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р=0.16)); myocardial infarction ((group 1 – 0%; group 2 – 0.4% (n=2); group 3 – 0%; group 4 – 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 – 4.2% (n=1); group 2 – 0.4% (n=2); group 3 – 0.2% (n=1); group 4 – 0%; р 1-2 =0.01; р 1-3 =0.009; р 1-4 =0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 – 4.2% (n=1), in group 2 – 1.2% (n=6), in group 3 – 0.4% (n=2), in group 4 – 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 – 25% (n=6); group 2 – 5.5% (n=27); group 3 – 7.3% (n=35); group 4 – 14% (n=16); р 1-2 =0.002; р 1-3 =0.008; р 2-4 =0.012)); lethal outcome from cardiovascular causes ((group 1 – 4.2% (n=1); group 2 – 3.6% (n=18); group 3 – 4.8% (n=23); group 4 – 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 – 12.5% (n=3); group 2 – 3.6% (n=18); group 3 – 5.4% (n=26); group 4 – 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 – 16.6% (n=4); group 2 – 6.3% (n=31); group 3 – 6% (n=29); group 4 – 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 – 54.2% (n=13); group 2 – 15.4% (n=76); group 3 – 18.7% (n=90); group 4 – 31.3% (n=36); р 1-2 =0.0001; р 1-3 =0.0001; р 1-4 =0.005; р 2-4 =0.0006; р 3-4 =0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

This study aims to propose a novel surgical technique to rehabilitate patients with long term complication of trachea-esophageal puncture and stomal stenosis. Ours is retrospective study. Ten patients with tracheo-esophageal puncture who developed long term complications and who failed conservative management were included in our study. Majority of our patients were males within the age group of 50–70 years of age. Most of our patients had received adjuvant radiotherapy (8/10). All patients had multiple change of prosthesis. Nine patients suffered from multiple complications of TEP. Most common complication was that of progressive thinning of trachea-esophageal wall. All the patients who underwent this procedure healed well without any major complications. Long term trachea-esophageal puncture may undergo significant modification in terms of position and size. This technique gives a satisfactory and viable method of excising the altered anatomy and establishes speech & swallowing in such patients who fail conservative management.

OBJECTIVE To compare the durations of surgery and anesthesia and the likelihoods of short- and long-term postoperative complications between cats positioned in sternal recumbency versus dorsal recumbency for perineal urethrostomy (PU). ANIMALS 247 client-owned cats that underwent PU between January 2004 and December 2015 at 6 veterinary teaching hospitals and 1 private veterinary referral hospital. PROCEDURES Medical records were reviewed, and signalment, presenting complaints, previous history of urethral obstruction or PU, diet fed, medications administered, indication for PU, durations of surgery and anesthesia for PU, suture type and size, suture pattern for skin closure, and short- and long-term postoperative complications were recorded. Univariable and multivariable analyses were performed to identify differences in durations of surgery and anesthesia and the likelihoods of short- and long-term complications between cats positioned in sternal recumbency and those positioned in dorsal recumbency. RESULTS Patient position was not associated with durations of surgery and anesthesia for PU, even if a concurrent cystotomy was necessary or the patient required repositioning from sternal to dorsal recumbency. Likewise, patient position was not associated with the likelihood of short- and long-term complications. CONCLUSIONS AND CLINICAL RELEVANCE The observed lack of differences in outcomes between sternal and dorsal recumbency suggested that logistic considerations and personal preference can continue to guide veterinarians when positioning cats for PU.

Fractures in the elderly are often challenging due to osteoporotic bone and co-morbidities and long term disability can occur. Surgery is the standard mode of treatment and hence a quick surgical treatment for early weight bearing and mobilization is required in order to prevent long term complications due to prolonged bed rest. All patients were documented prospectively, complete demographic details and clinical history was obtained. Clinical and radiographic evaluation was done in all the patients. Informed consent was taken and all patients were treated with DFLCP and retrograde nailing randomly. Duration of hospitalization was documented and follow up was done for 2 years. In this study, fracture union time was12-24 weeks with among the patients of the DLFP group with 75 percent have union and was 12-24weeks among the patients of the retrograde nailing group with union occurring in 80 percent of patients respectively. Significant results were obtained while comparing the mean fracture union time among the patients of the two study groups. In our study, follow up was done up to 2 years with 60% of patients followed up to 15 months in both the groups.

Purpose of review The current review will describe the current evidence and mechanisms of acute kidney injury (AKI) as a risk factor for long-term kidney complications, summarize the rationale for AKI follow-up and present an approach to monitoring children with AKI. Despite emerging evidence linking AKI with risk for long-term kidney and cardiovascular outcomes, many children who develop AKI are not followed for kidney disease development after hospital discharge. Better understanding of long-term complications after AKI and practical algorithms for follow-up will hopefully increase the rate and quality of post-AKI monitoring. Recent findings Recent evidence shows that pediatric AKI is associated with long-term renal outcomes such as chronic kidney disease (CKD) and hypertension, both known to increase cardiovascular risk. The mechanism of AKI progression to CKD involves maladaptive regeneration of tubular epithelial and endothelial cells, inflammation, fibrosis and glomerulosclerosis. Many AKI survivors are not followed, and no guidelines for pediatric AKI follow-up have been published. Summary Children who had AKI are at increased risk of long-term renal complications but many of them are not monitored for these complications. Recognizing long-term outcomes post-AKI and integration of follow-up programs may have a long-lasting positive impact on patient health.

Background The intracavitary electrocardiogram (IC-ECG) method has been used for the tip location of central venous access devices for the advantage of being safe, accurate and highly cost effective. However, long-term follow-up is rare. This randomized clinical trial aimed to evaluate the long-term complications of peripherally inserted central catheters (PICCs) positioned by the IC-ECG method. Methods We randomized 2250 patients who needed PICC placement to either a landmark length estimation supplemented by IC-ECG positioned group (ECG group) or the traditional landmark length estimation alone group (control group) in a 2:1 allocation. Post-procedural chest X-rays were applied to confirm tip position. Follow-up was performed monthly to six months. Standard statistics analyses were performed with the SAS 9.13 software, and p Results As evaluated by post-procedural chest X-ray, tip location in the ECG group had a first-attempt success (catheter tip located at optimal position) of 91.7% (95% confidence interval (CI): 90.3%–93.1%), significantly higher than 78.9% (95% CI: 76.0%–81.9%) observed in the control group (p 0.05), phlebitis (1.1%, p > 0.05), deep venous thrombosis (1.2%, p > 0.05), liquid extravasation (2.4%, p > 0.05) and mechanical failure (1.2%, p > 0.05). In the univariable logistic regression analysis, ECG method, other diseases and upper arms were the independent protective factors, and the number of adjustment procedures (n ≥ 2) were the independent risk factors of the complications. Conclusions The intra-procedural tip location by IC-ECG is more safe and accurate than the traditional method of verifying tip location only post-procedurally, by chest X-ray.

To determine the frequency at which patients with osteocutaneous free flap reconstruction of the head and neck develop long-term complications and identify predisposing perioperative factors.A prospectively maintained database of free flaps performed at a single institution over a 10-year period was queried.Single tertiary care referral center.In total, 250 osseous or osteocutaneous free flaps (OCFFs) for mandibular or maxillary reconstruction were analyzed. Data were collected on demographics, preoperative therapy, resection location, adjuvant treatment, complications, and subsequent surgeries, and multivariate analysis was performed. Subgroup analysis based on perioperative factors was performed.The median follow-up time was 23 months. In 185 patients with at least 6 months of follow-up, 17.3% had at least 1 long-term complication, most commonly wound breakdown, fistula or plate extrusion (13.5%), osteoradionecrosis or nonunion (6.5%), and infected hardware (5.9%). Prior chemoradiotherapy and cancer diagnosis predisposed patients to long-term complications. At the 5-year follow-up, 21.7% of patients had experienced a long-term complication.Long-term complications after OCFF occurred in 17% of patients. In this series, a preoperative history of chemoradiation and those undergoing maxillary reconstruction were at high risk for the development of long-term complications and thus warrant diligent follow-up. However, OCFFs can often enjoy long-term viability and survival, even in the case of perioperative complications and salvage surgery.

Zusammenfassung. Die Polymyalgia rheumatica (PMR) ist ein häufiges inflammatorisches Syndrom, welches zusammen mit einer Riesenzellarteriitis (RZA) auftreten kann. Die besondere Schwierigkeit besteht bei der PMR oft in der Diagnosestellung bei nur unspezifischen Symptomen und vielen Differenzialdiagnosen. Der Ultraschall, aber auch weitere bildgebende Verfahren haben die Diagnostik für PMR und RZA deutlich verbessert und beschleunigt, sodass Komplikationen wie Erblindung reduziert werden können. Glukokortikoide spielen immer noch eine wichtige Rolle bei der Primärtherapie beider Erkrankungen. Obwohl hinsichtlich der Prävention von und des Screenings auf Langzeitkomplikationen bei RZA weitere Forschung notwendig ist, hat der effektive Einsatz von Biologika wie Tocilizumab die Behandlungsmöglichkeiten der RZA deutlich erweitert und erlaubt eine Reduktion von Nebenwirkungen.

Background: While the short-term clinical outcome of patients with subarachnoid hemorrhage (SAH) is well described, there are limited data on long-term complications and their impact on social reintegration. This study aimed to assess the frequency of complications post-SAH and to investigate whether these complications attribute to functional and self-reported outcomes as well as the ability to return to work in these patients. Methods: This retrospective single-center study included patients with atraumatic SAH over a 5-year period at a tertiary care center. Patients received a clinical follow-up for 12 months. In addition to demographics, imaging data, and parameters of acute treatment, the rate and extent of long-term complications after SAH were recorded. The functional outcome was assessed using the modified Rankin Scale (mRS; favorable outcome defined as mRS = 0–2). Further outcomes comprised self-reported subjective health measured by the EQ-5D and return to work for SAH patients with appropriate age. Multivariable analyses including in-hospital parameters and long-term complications were conducted to identify parameters independently associated with outcomes in SAH survivors. Results: This study cohort consisted of 505 SAH patients of whom 405 survived the follow-up period of 12 months (i.e., mortality rate of 19.8%). Outcome data were available in 359/405 (88.6%) patients surviving SAH. At 12 months, a favorable functional outcome was achieved in 287/359 (79.9%) and 145/251 (57.8%) SAH patients returned to work. The rates of post-acute complications were headache (32.3%), chronic hydrocephalus requiring permanent ventriculoperitoneal shunting (VP shunt 25.4%) and epileptic seizures (9.5%). Despite patient’s and clinical characteristics, both presence of epilepsy and need for VP shunt were independently and negatively associated with a favorable functional outcome (epilepsy: adjusted odds ratio [aOR] (95% confidence interval [95% CI]): 0.125 [0.050–0.315]; VP shunt: 0.279 [0.132–0.588]; both p < 0.001) as well as with return to work (aOR [95% CI]: epilepsy 0.195 [0.065–0.584], p = 0.003; VP shunt 0.412 [0.188–0.903], p = 0.027). Multivariable analyses revealed presence of headache, VP shunt, or epilepsy to be significantly related to subjective health impairment (aOR [95% CI]: headache 0.248 [0.143–0.430]; epilepsy 0.223 [0.085–0.585]; VP shunt 0.434 [0.231–0.816]; all p < 0.01). Conclusions: Long-term complications occur frequently after SAH and are associated with an impairment of functional and social outcomes. Further studies are warranted to investigate if treatment strategies specifically targeting these complications, including preventive aspects, may improve the outcomes after SAH.

Long-term complications of type 1 diabetes (T1D) include microvascular complications and macrovascular disease. Despite the important advances in the treatment of T1D of the last decades, these complications still represent the leading cause of morbidity and mortality in patients with T1D. Extensive evidence indicates that structural and functional alterations of the kidney, retina, nerves and large arteries occur already in the first years after the onset of diabetes. We performed a comprehensive review of the available evidence on screening, diagnosis, prevention and treatment of vascular complications of T1D. In particular, we focused on three major challenges related to long-term complications of T1D: 1) finding of new biomarkers and diagnostic methods able to identify early signs of complications; 2) identifying specific risk factors for the development of these complications; 3) identifying and implementing new therapeutic strategies able to prevent the development and progression of vascular complications.

Gallengangsverletzungen konnen nach abdominellem Trauma, postoperativ nach Cholezystektomien, Leberresektionen oder Lebertransplantationen sowie als Komplikation einer endoskopischen retrograden Cholangiopankreatikographie (ERCP) auftreten. Das klinische Erscheinungsbild von Gallengangsverletzungen zeigt sich sehr variabel und hangt in erster Linie von der zugrunde liegenden Ursache ab. Neben einer hohen perioperativen Morbiditat konnen Gallengangsverletzungen nach erfolgreichem initialem Komplikationsmanagement zu erheblichen Langzeitkomplikationen fuhren. Ihre Therapie bedarf einer engen interdisziplinaren Zusammenarbeit zwischen Chirurgie, interventioneller Gastroenterologie sowie interventioneller Radiologie. Die Therapie von Gallengangsverletzungen hangt in erster Linie von dem Zeitpunkt der Diagnose (intraoperativ/postoperativ) und dem Ausmas der Verletzung ab und wird in dieser Ubersichtsarbeit im Weiteren beleuchtet.