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Muñoz-Fernandez SS, Garcez FB, Alencar JCG, Bastos AA, Morley JE, Cederholm T, Aprahamian I, de Souza HP, Avelino-Silva TJ, Bindels LB, Ribeiro SML. Gut microbiota disturbances in hospitalized older adults with malnutrition and clinical outcomes. Nutrition 2024; 122:112369. [PMID: 38422755 DOI: 10.1016/j.nut.2024.112369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Malnutrition is one of the most threatening conditions in geriatric populations. The gut microbiota has an important role in the host's metabolic and muscular health: however, its interplay with disease-related malnutrition is not well understood. We aimed to identify the association of malnutrition with the gut microbiota and predict clinical outcomes in hospitalized acutely ill older adults. METHODS We performed a secondary longitudinal analysis in 108 geriatric patients from a prospective cohort evaluated at admission and 72 h of hospitalization. We collected clinical, demographic, nutritional, and 16S rRNA gene-sequenced gut microbiota data. Microbiota diversity, overall composition, and differential abundance were calculated and compared between patients with and without malnutrition. Microbiota features associated with malnutrition were used to predict clinical outcomes. RESULTS Patients with malnutrition (51%) had a different microbiota composition compared to those who were well-nourished during hospitalization (ANOSIM R = 0.079, P = 0.003). Patients with severe malnutrition showed poorer α-diversity at admission (Shannon P = 0.012, Simpson P = 0.018) and follow-up (Shannon P = 0.023, Chao1 P = 0.008). Differential abundance of Lachnospiraceae NK4A136 group, Subdoligranulum, and Faecalibacterium prausnitzii were significantly lower and inversely associated with malnutrition, while Corynebacterium, Ruminococcaceae Incertae Sedis, and Fusobacterium were significantly increased and positively associated with malnutrition. Corynebacterium, Ruminococcaceae Incertae Sedis, and the overall composition were important predictors of critical care in patients with malnutrition during hospitalization. CONCLUSION Older adults with malnutrition, especially in a severe stage, may be subject to substantial gut microbial disturbances during hospitalization. The gut microbiota profile of patients with malnutrition might help us to predict worse clinical outcomes.
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Affiliation(s)
- Shirley S Muñoz-Fernandez
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil.
| | - Flavia B Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil; Departamento de Medicina, Hospital Universitario, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - Julio C G Alencar
- Disciplina de Emergencias Clínicas, Departamento de Clínica Medica, Faculty of Medicine, University of São Paulo, São Paulo, Sao Paulo, Brazil
| | - Amália A Bastos
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil
| | - John E Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, Jundiaí Medical School, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Sao Paulo, Brazil
| | - Heraldo P de Souza
- Disciplina de Emergencias Clínicas, Departamento de Clínica Medica, Faculty of Medicine, University of São Paulo, São Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Sao Paulo, Brazil
| | - Laure B Bindels
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Sandra M L Ribeiro
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Sao Paulo, Brazil; School of Arts, Science, and Humanity, University of São Paulo, São Paulo, Sao Paulo, Brazil
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Liu HH, Lin Y, Lin G, Wang LJ, Wan YL. Ultrasonography of acute retroperitoneum. Ultrasonography 2024:usg.23232. [PMID: 38589285 DOI: 10.14366/usg.23232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 04/10/2024] Open
Abstract
The retroperitoneum is an important space in the human body that is often implicated in a range Epub ahead of print of acute medical conditions, some of which can be life-threatening. Ultrasonography may serve as a pivotal first-line imaging technique when assessing patients with suspected retroperitoneal abnormalities. Effective ultrasonography of the retroperitoneum requires a comprehensive grasp of its anatomy, adjacent structures, and potential pathologies. Being well-acquainted with the imaging characteristics of acute conditions can meaningfully assist in an accurate diagnosis and guide subsequent management. This review article summarizes and illustrates the acute conditions involving the retroperitoneum through the lens of ultrasound imaging.
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Affiliation(s)
- Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, Tucheng District, New Taipei City, Taiwan
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Li-Jen Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Matsuo K, Yoneki K, Tamiya S, Mibu K, Furuzono K, Kobayashi K, Yasuda S, Onoda D, Tatsuki H, Iseki H. Impact of sarcopenia and malnutrition on swallowing function utilizing ultrasonography in patients with acute heart failure: A retrospective cohort study. Clin Nutr ESPEN 2024; 59:296-306. [PMID: 38220390 DOI: 10.1016/j.clnesp.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/25/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS This study aimed to determine the impact of sarcopenia and nutritional risk on swallowing-related muscles by ultrasonography and dysphagia occurrence in older patients with acute heart failure (AHF) during hospitalization. METHODS Patients with AHF aged ≥65 years without dysphagia (Food Intake LEVEL Scale [FILS] score ≥9) before admission were classified into four groups at admission: robust group, sarcopenia group (Asian Working Group for Sarcopenia 2019), nutritional risk group (geriatric nutritional risk index <92), and complicated group (with both sarcopenia and nutritional risk). Swallowing function (maximal hyoid displacement, geniohyoid muscle area and brightness, and maximal tongue pressure) and FILS were investigated from the medical records. RESULTS In total, 131 patients with AHF (mean age 82.8 ± 7.1 years, 71 males) were enrolled during the study period; 33, 58, 5, and 35 were classified into the robust, sarcopenia, nutritional risk, and complicated groups, respectively. In the covariance analysis adjusted for age, sex, comorbidities, and cardiac function, the complicated group had significantly worse swallowing function than the sarcopenia and robust groups (P < 0.05). In the Cox proportional hazards model, in which event occurrence was defined as the first-time FILS score of ≥9 obtained during hospitalization, the sarcopenia group (hazard ratio [HR]: 0.83, 95 % confidence interval [CI]: 0.51-1.34, P = 0.438) and nutritional risk group (HR: 0.77, 95 % CI:0.25-2.32, P = 0.637) were not significantly different, but the complicated group (HR: 0.54, 95 % CI: 0.31-0.95, P = 0.033) had significantly lower cumulative event rates with the robust group as the reference. CONCLUSION Sarcopenia and nutritional risk in older patients with AHF are risk factors for decreased swallowing function.
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Affiliation(s)
- Koji Matsuo
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kei Yoneki
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
| | - Seiji Tamiya
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kazuhiro Mibu
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kento Furuzono
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Kikka Kobayashi
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Shiori Yasuda
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Daiki Onoda
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Hiroaki Tatsuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Harukazu Iseki
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital, Sagamihara, Japan
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Wang X, Chen Y, Wen D, You C, Ma L. Effect of extended duration of thromboprophylaxis for medically ill patients. Eur J Intern Med 2023; 113:22-30. [PMID: 37029050 DOI: 10.1016/j.ejim.2023.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND There are knowledge gaps regarding the comparative efficacy and safety of various venous thromboprophylaxis regimens with extended timing in patients hospitalized for acute medical illnesses. This study aims to investigate the optimal regimen for the prevention of venous thromboembolism in these patients. METHODS We conducted a Bayesian network meta-analysis of randomized controlled trials (RCTs) comparing different venous thromboprophylaxis regimens for acutely ill medical patients. Outcomes included venous thromboembolism, major bleeding, and all-cause mortality. Risk ratios (RR) and associated 95% credible interval (CrI) were estimated. In addition, we assessed the most effective interventions in a subgroup of patients with stroke. RESULTS We identified five RCTs involving 40,124 patients. Extended thromboprophylaxis with direct oral anticoagulant (DOAC) (RR 0.78, 95% CrI 0.68 to 0.89) and low molecular weight heparin (LMWH) (RR 0.62, 95% CrI 0.45 to 0.84) were superior to standard therapy in the prevention of venous thromboembolism. However, both of them (DOAC: RR 1.99, 95% CrI 1.38 to 2.92; LMWH: RR 2.56, 95% CrI 1.26 to 5.68) lead to a significant increase in major bleeding). Moreover, both LMWH (RR 0.76, 95% CrI 0.57 to 1.00) and DOAC (RR 0.86, 95% CrI 0.76 to 0.98) with extended thromboprophylaxis showed favorable net clinical benefit compared to standard therapy. CONCLUSIONS Extended thromboprophylaxis, especially with LMWH, showed better efficacy in venous thromboembolism reduction with increased risk of major bleeding. The beneficial effect of LMWH with extended timing has also been shown in stroke patients. Overall, extended thromboprophylaxis is associated with a positive net clinical benefit.
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Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Yuqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China; West China Brain Research Centre, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.
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Mundhra S, Thomas D, Jain S, Sahu P, Vuyyuru S, Kumar P, Kante B, Panwar R, Sahni P, Chaudhry R, Das P, Makharia G, Kedia S, Ahuja V. Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India. Indian J Gastroenterol 2023; 42:411-417. [PMID: 37171781 DOI: 10.1007/s12664-022-01336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/25/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND The incidence of Clostridioides difficile infection (CDI) is high in ulcerative colitis and is associated with disease flares and adverse outcomes. However, the data on the dynamics of CDI in patients with acute severe ulcerative colitis (ASUC) is rather scarce. We evaluated the prevalence of CDI in patients with ASUC. METHODS This retrospective analysis of a prospectively maintained cohort admitted to the All India Institute of Medical Sciences, India, from May 2016 to December 2021, included patients with ASUC (as per Truelove and Witts criteria) who were tested for CDI. CDI testing was performed using enzyme-linked immunoassay for toxins A and B. Risk factors for developing CDI were analyzed along with short-term outcomes of ASUC. Steroid failure was defined as the need for medical rescue therapy or colectomy. RESULTS Total 153 patients with ASUC were included (mean age 34.92 ± 12.24 years; males 56.2%; disease duration 36 (IQR: 16-55.5) months, pancolitis 67.3%). Ninety-eight (63.4%), 72 (47%) and 10 (6.5%) patients, respectively, had received steroids, azathioprine and biologics in the past. Forty patients (26.14%) had a prior history of ASUC. Among risk factors for CDI, 14% of the patients had prior admission within 30 days, 22.2% had a recent history of antibiotics and 3.9% had long-term non-steroidal anti-inflammatory drug intake. Only one sample was positive for Clostridioides difficile toxin assay. Tissue Cytomegalovirus DNA-PCR positivity was noted in 57 patients (37.3%). Fifty-seven patients (37.3%) had steroid failure, 35 required medical rescue therapy and 30 (19.6%) required colectomy (eight after medical rescue therapy failure). CONCLUSION Despite antecedent risk factors for CDI, the overall prevalence of CDI in ASUC was low and the outcomes were determined by underlying disease severity.
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Affiliation(s)
- Sandeep Mundhra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - David Thomas
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Saransh Jain
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Pabitra Sahu
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Sudheer Vuyyuru
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Peeyush Kumar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rajesh Panwar
- Department of GI Surgery, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Peush Sahni
- Department of GI Surgery, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110 029, India.
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Baker JA, Houin PR. Comparison of National and Global Asthma Management Guiding Documents. Respir Care 2023; 68:114-128. [PMID: 36566032 PMCID: PMC9993509 DOI: 10.4187/respcare.10254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Asthma is a common chronic disease that affects both adults and children, and that continues to have a high economic burden. Asthma management guidelines were first developed nearly 30 years ago to standardize care, maintain asthma control, improve quality of life, maintain normal lung function, prevent exacerbations, and prevent asthma mortality. The two most common asthma guidelines used today were developed by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Working Group and the Global Initiative for Asthma Science Committee. Both guiding documents use scientific methodology to standardize their approach for formulating recommendations based on pertinent literature. Before the 2020 National Asthma Education and Prevention Program (Expert Panel Report 4), nothing had been released since the 2007 guidelines, whereas the Global Initiative for Asthma publishes updates annually. Although each of these asthma strategies is similar, there are some noted differences. Over the years, the focus of asthma treatment has shifted from acute to chronic management. Frontline respiratory therapists and other health-care providers should have a good understanding of these 2 guiding references and how they can impact acute and chronic asthma management. The primary focus of this narrative is to look at the similarities and differences of these 2 guiding documents as they pertain to the 6 key questions identified by the Expert Panel of the National Asthma Education and Prevention Program.
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Affiliation(s)
- Joyce A Baker
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado.
| | - Paul R Houin
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Ichihara S, Komiya K, Yamatani I, Omori S, Umeki K, Hiramatsu K, Kadota JI. Acute eosinophilic pneumonia in twins. Respir Investig 2023; 61:1-4. [PMID: 36400689 DOI: 10.1016/j.resinv.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022]
Abstract
The pathogenesis of eosinophilic pneumonia is currently poorly understood, and this disease has not been reported in twins since 1983. Herein, we report a case of acute eosinophilic pneumonia in twins, which appeared to be triggered by initial smoking at different times by both patients. One patient resumed smoking after recovering from eosinophilic pneumonia, with no observed recurrence. This study discussed the possibility of an association between susceptibility to eosinophilic pneumonia and genetic factors in twins.
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Affiliation(s)
- Shogo Ichihara
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Izumi Yamatani
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Shota Omori
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kenji Umeki
- Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, 879-7761, Japan
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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Roson Gradaille N, Narbona Díez A, Garriga Farriol MV, Pruna Comella X, Pedraza Gutiérrez S, López Cano M, Badia JM. Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes. Radiologia (Engl Ed) 2023; 65:32-42. [PMID: 36842784 DOI: 10.1016/j.rxeng.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PATIENTS This retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. RESULTS A total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. CONCLUSIONS US should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.
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Abstract
OBJECTIVE To evaluate the effectiveness and safety of Rotarex mechanical thrombectomy system in treating acute lower limb ischemia. METHODS From December 2017 to December 2019, the clinical data of 23 acute lower limb ischemia cases treated with Rotarex mechanical thrombectomy system were retrospectively analyzed. There were 14 males and 9 females from 53- to 84-year-old patients and the mean age was (69.1±9.1) years. Duration of symptoms was 6 hours to 14 days (median time 7 days). In the study, 8 acute thromboembolism cases and 15 acute thrombosis cases were included (In which, there was one thromboangiitis obliterans case and two in-stent restenosis cases). In 5 cases, the lesions were located above the groin; in 16 cases, the lesions were located below the groin, and in the other 2 cases, the lesions were located both above and below the groin. All the cases were treated with Rotarex mechanical thrombectomy system. When residual stenosis was greater than 50%, percutaneous transluminal angioplasty (PTA) was used, and stent was used only when it was necessary. Heparin was used 24 h after the procedure, and after that, antiplatelet agents were used in acute thrombosis cases, and oral anti-coagulants were used in acute thromboembolism cases. Doppler ultrasonography was taken during the follow-up. RESULTS In all the 23 cases, there were 22 successful cases and 1 unsuccessful case, the mean procedure time was (68.2±15.6) min. Percutaneous transluminal angioplasty was used in 18 cases, 7 of which were implanted stents (3 stents were implanted in iliac artery and 4 in superficial femoral artery). There were 3 procedure related complications. The first one was arterial wall injury which resulted in contrast medium extravazation, and in this case, we solved it with prolonged balloon inflation. The second one was distal embolism. We took out the thrombus with guiding catheter. The last one was acute occlusion in a stent, and thrombectomy was applied urgently, and the result was good. Mean hospital stay were (3.6±1.7) days. The ankle brachial index (ABI) increased from 0.25±0.10 to 0.85±0.16 after treatment (t=12.901, P < 0.001). All the patients were followed up for 4.0-28.0 months, and the median time was 12.0 months. One patient stopped antiplatelet agents, which resulted in acute thrombosis 2 months later. Another percutaneous mechanical thrombectomy and PTA were taken. In the failed case, the patient suffered amputation above the knee 3 months later and in another case, the patient died of heart failure 8 months after the procedure. Two target lesion restenosis occurred during the follow-up. Because the patients' symptom was not sever, no procedure was taken. CONCLUSION Percutaneous mechanical thrombectomy using Rotarex catheter is safe and effective in treating acute lower limb ischemia. For one side, it can restore blood flow to the affected limbs quickly, and for the other, it has the characteristics of minimally invasive and good repeatability. So it should be considered that this me-thod can be widely used for acute lower limb ischemia.
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Tu TM. Large-Bore Aspiration Thrombectomy: Catalyst for a Revolution in Treating Pulmonary Embolism. Tex Heart Inst J 2021; 48:475485. [PMID: 34911083 DOI: 10.14503/thij-21-7570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Muñoz Fernandez SS, Garcez FB, Alencar JCGD, Cederholm T, Aprahamian I, Morley JE, de Souza HP, Avelino da Silva TJ, Ribeiro SML. Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study. Clin Nutr 2021; 40:5447-5456. [PMID: 34653825 DOI: 10.1016/j.clnu.2021.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). METHODS We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. RESULTS GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). CONCLUSION GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.
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Affiliation(s)
| | - Flavia Barreto Garcez
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Julio César García de Alencar
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - John Edward Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Heraldo Possolo de Souza
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | - Sandra Maria Lima Ribeiro
- Nutrition Department, School of Public Health, University of Sao Paulo, São Paulo, Brazil; School of Arts, Science, and Humanity, University of Sao Paulo, São Paulo, Brazil
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12
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Kabadi RA, Shah M, Marhefka GD, George G, Awsare B, Terai M, Sato T. Rapid, Fatal Acute Right Ventricular Failure After Locoregional Cytokine Therapy for Uveal Melanoma Liver Metastases. Tex Heart Inst J 2021; 47:224-228. [PMID: 32997782 DOI: 10.14503/thij-18-6762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Locoregional cytokine treatment, or immunoembolization, is an experimental targeted therapy for uveal melanoma metastatic to the liver. Unlike systemic cytokine treatments that have been associated with substantial toxicity, this method of drug delivery appears to be better tolerated. Because this newer therapy is being prescribed more widely, oncologists, interventional radiologists, cardiologists, pulmonologists, critical care specialists, and other providers should become familiar with potential adverse reactions. We describe the case of a 67-year-old man who had metastatic uveal melanoma. Before he underwent liver-directed immunoembolization, he had elevated markers of endothelial dysfunction. He died after the rapid onset of acute right ventricular failure from severe pulmonary hypertension with possible superimposed isolated right ventricular takotsubo cardiomyopathy. In discussing this rare case, we focus on the differential diagnosis.
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Affiliation(s)
- Rajiv A Kabadi
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Mital Shah
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Gregary D Marhefka
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Gautam George
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
| | - Bharat Awsare
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107
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13
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Jin L, Fan K, Tan S, Liu S, Wang Y, Yu S. Analysis of the characteristics of outpatient and emergency diseases in the department of otolaryngology during the "COVID-19" pandemic. Sci Prog 2021; 104:368504211036319. [PMID: 34323155 PMCID: PMC10358545 DOI: 10.1177/00368504211036319] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The pandemic of "Corona Virus Disease 2019" (COVID-19) has changed the lives of people. There have been changes in common outpatient and emergency cases in otolaryngology, so an analysis of data pertaining to this was completed. This study is to evaluate the impact of viral infection disease in otolaryngological common disease. This study uses the data of common diseases in the outpatient and emergency department during the "COVID-19" pandemic (from February to April 2020) and the same period in the past 3 years from the Department of Otolaryngology. During the "COVID-19" period compared with the same period last year, the ranking of cases by diseases has changed. Diseases such as chronic pharyngitis, allergic rhinitis, sudden deafness, and tinnitus increased, meanwhile acute pharyngitis and acute laryngopharyngitis decreased (p < 0.05). The viral infection has impacted the mental behaviors of people, therefore mental-related disease cases of the department of Otolaryngology have increased indirectly. This study provides real data to illustrate mental-related diseases. It also provides experience and shows the importance of keeping and maintaining mental health.
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Affiliation(s)
| | | | - Shiwang Tan
- Department of Otolaryngology, Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuangxi Liu
- Department of Otolaryngology, Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yang Wang
- Department of Otolaryngology, Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shaoqing Yu
- Department of Otolaryngology, Head and Neck Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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14
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Chacko S, De Bono J, Marshall H, Haseeb YB, Haseeb S, Morris K, Thorne S. Acute heart failure in pregnancy: Importance of a timely multidisciplinary approach to recognition and management. ACTA ACUST UNITED AC 2021. [PMID: 34042387 DOI: 10.2478/rjim-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Indexed: 11/20/2022]
Abstract
Increased cardiovascular demands of pregnancy may unmask occult diseases, such as dilated cardiomyopathy or valvular stenosis, or precipitate peripartum cardiomyopathy. We report a case of the emergency management and delivery of a young pregnant woman who presented with acute decompensated heart failure that was not immediately recognized. An emergency transfer to a tertiary care institution was arranged. Once diagnosed, the patient received multidisciplinary care shared between cardiologists, obstetricians, cardiac anesthetists, a neonatologist, and a midwife, resulting in good maternal and fetal outcomes.
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15
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Li L, Zhang Y, Wang P, Chong W, Hai Y, Xu P, Fang F. Conservative versus liberal oxygen therapy for acutely ill medical patients: A systematic review and meta-analysis. Int J Nurs Stud 2021; 118:103924. [PMID: 33774265 DOI: 10.1016/j.ijnurstu.2021.103924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of conservative versus liberal oxygen therapy for acutely ill patients remains controversial. OBJECTIVE To systematically review the available evidence regarding the efficacy and safety of conservative oxygen therapy compared with liberal oxygen therapy for acutely ill patients. METHODS A systematic search of Medline, Embase, and the Cochrane Central Register was conducted from their inception until April 5, 2020. Randomized clinical trials evaluating a high-target (liberal) or a low-target (conservative) oxygenation strategy in adults with an acutely ill condition were eligible for inclusion. A meta-analysis using random-effects models was conducted to calculate the risk ratio with corresponding 95% confidence intervals. Heterogeneity and publication bias were evaluated. RESULTS The analyses included 33 randomized clinical trials with a total of 17,780 participants. Compared with conservative oxygen therapy, liberal oxygen therapy was not associated with increased mortality at 30 days (risk ratio 1.09, 95% confidence intervals 0.98-1.22; I2=0%), at 90 days (risk ratio 1.00, 95% confidence intervals 0.88-1.13, I2=37%), or at the longest follow-up (risk ratio 1.04, 95% confidence intervals 0.96-1.12, I2=0%). Good functional outcome was similar between groups. Findings were robust to trial sequential, subgroup, and sensitivity analyses. CONCLUSIONS Compared with liberal oxygen therapy, conservative oxygen therapy was not associated with decreased mortality. Tweetable abstract: Compared with liberal oxygen therapy, conservative oxygen therapy was not associated with decreased mortality.
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Affiliation(s)
- Linjie Li
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Yu Zhang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China; Clinical research center, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- Clinical research center, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Zucker School of Medicine at Hofstra/Northwell, New York, NY USA
| | - Ping Xu
- Sichuan University Library, Chengdu, Sichuan, China
| | - Fang Fang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.
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16
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Roson Gradaille N, Narbona Díez A, Garriga Farriol MV, Pruna Comella X, Pedraza Gutiérrez S, López Cano M, Badia JM. Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: value of current severity classification schemes. Radiologia (Engl Ed) 2021:S0033-8338(21)00028-X. [PMID: 33612278 DOI: 10.1016/j.rx.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PATIENTS This retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. RESULTS A total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist's lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. CONCLUSIONS US should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.
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Affiliation(s)
- N Roson Gradaille
- Servicio de Diagnóstico por la imagen, Hospital Universitari Vall d'Hebron, Institut de Diagnòstic per la Imatge (IDI), Barcelona, España.
| | - A Narbona Díez
- Servicio de Diagnóstico por la Imagen, Hospital General de Granollers, Granollers, Barcelona, España
| | - M V Garriga Farriol
- Servicio de Diagnóstico por la Imagen, Hospital Universitari Josep Trueta, Institut de Diagnòstic per la Imatge (IDI), Girona, España
| | - X Pruna Comella
- Servicio de Diagnóstico por la Imagen, Hospital General de Granollers, Granollers, Barcelona, España
| | - S Pedraza Gutiérrez
- Servicio de Diagnóstico por la Imagen, Hospital Universitari Josep Trueta, Institut de Diagnòstic per la Imatge (IDI), Girona, España
| | - M López Cano
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J M Badia
- Servicio de Cirugía General y Aparato Digestivo, Hospital General de Granollers, Granollers, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
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17
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Baldwin CE, Phillips AC, Edney SM, Lewis LK. Core Domains for Research on Hospital Inactivity in Acutely Ill Older Adults: A Delphi Consensus Study. Arch Phys Med Rehabil 2020; 102:664-674. [PMID: 33253693 DOI: 10.1016/j.apmr.2020.10.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/24/2020] [Accepted: 10/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify core domains for research studies of physical activity and sedentary behavior during hospitalization for older adults with an acute medical illness. DESIGN A 4-Round Delphi consensus process. Round 1 invited responses to open-ended questions to generate items for the core domains research. In rounds 2-4, participants were invited to use a Likert scale (1-9) to rate the importance of each core domain for research studies of physical activity and/or sedentary behavior in hospitalized older adults with an acute medical illness. SETTING Online surveys. PARTICIPANTS A total of 49 participants were invited to each round (international researchers, clinicians, policy makers and patients). Response rates across rounds 1-4 were 94%, 88%, 83% and 81%, respectively. INTERVENTIONS None. MAIN OUTCOME MEASURES Consensus was defined a priori as ≥70% of respondents rating an item as "critical" (score≥7) and ≤15% of respondents rating an item as "not important" (score≤3). RESULTS In round 2, a total of 9 of 25 core domains reached consensus agreement (physical functioning, general, role functioning, emotional functioning, global quality of life, hospital, psychiatric, cognitive functioning, carer burden). In round 3, an additional 8 reached consensus (adverse events, perceived health status, musculoskeletal, social functioning, vascular, cardiac, mortality, economic). Round 4 participants provided further review and a final rating of all 17 core domains that met consensus in previous rounds. Four core domains were rated as "critically important" to evaluate: physical functioning, social functioning, emotional functioning, and hospital outcomes. CONCLUSIONS This preliminary work provides international and expert consensus-based core domains for development toward a core-outcome set for research, with the ultimate goal of fostering consistency in outcomes and reporting to accelerate research on effective strategies to address physical activity and/or sedentary behavior in older adults while hospitalized.
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Affiliation(s)
- Claire E Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Anna C Phillips
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah M Edney
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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18
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Abstract
Seit 2018 ist es nach einer Novellierung des SGB V psychiatrischen Kliniken möglich, stationäre aufsuchende Behandlung im Lebensumfeld psychiatrisch Erkrankter zu realisieren. Dabei sind besondere Strukturmerkmale und Dokumentationspflichten zu beachten. So muss dem Behandlungsteam neben einem Mitglied der ärztlichen und der pflegerischen Berufsgruppe auch mindestens ein Mitglied einer dritten Berufsgruppe angehören (z. B. Ergotherapie, Sozialarbeit, Physiotherapie). Die Leistungsvergütung wird zwischen der jeweiligen Klinik und den Krankenkassen verhandelt und schließt, regional divergent, Abrechnungen nach Pauschalen, nach geleisteten Minuten oder gemischte Modelle ein. Aus psychiatrisch-psychotherapeutischer Sicht bietet die Behandlung gerontopsychiatrischer Patienten in ihrem Wohnumfeld und damit in ihren sozialen Kontexten viele Vorteile. Voraussetzung für ein Gelingen dieses Ansatzes ist ein auch in somatischen Erkrankungen erfahrenes und logistisch hochflexibles multiprofessionelles Behandlungsteam. Unter den Bedingungen der Coronapandemie stellen sich besondere Herausforderungen aufgrund der Besuchsverbote in Pflegeheimen und der mit aufsuchender Arbeit verbundenen Infektionsgefahr für Patienten und Mitglieder des Behandlungsteams.
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Affiliation(s)
- S Spannhorst
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - S Weller
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland
| | - C Thomas
- Klinik für Psychiatrie und Psychotherapie für Ältere, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland.
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Abstract
The major component of non-traumatic thoracic aortic emergencies is the acute aortic syndromes. These include acute aortic dissection, intramural haematoma and penetrating atherosclerotic ulcer, grouped together because they are indistinguishable clinically and highly fatal. All three entities involve disruption to the tunica intima and media and may be complicated by rupture, end-organ ischaemia or aneurysmal transformation. Early diagnosis is vital to allow timely and appropriate management. Paired unenhanced and electrocardiogram-gated computed tomography angiography of the chest, extending more distally if required, is recommended for diagnosis. Specific computed tomography features of all three entities are reviewed, with a focus on morphological features associated with complications. Those with type A pathology are usually managed with open surgery because this has a high risk of complication. Patients with uncomplicated type B pathology are usually managed with best medical therapy whereas those with complicated type B pathology are usually offered either surgery or thoracic endovascular aortic repair. The limited evidence regarding the use of thoracic endovascular aortic repair in patients with subacute uncomplicated type B pathology is briefly discussed.
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Affiliation(s)
- Jian Ping Jen
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Akif Malik
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth Lewis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin Holloway
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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20
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Saleh QW, Diederichsen ACP, Lindholt JS. Ascending Aortic Diameter after Dissection Does Not Reflect Size before Dissection. EJVES Vasc Forum 2020; 49:20-22. [PMID: 33089224 PMCID: PMC7567910 DOI: 10.1016/j.ejvsvf.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Current guidelines for prophylactic resection of ascending aortic aneurysms are based on post-dissection aortic diameter. However, this may not reflect the diameter prior to dissection. Report Pre- and post-dissection aortic diameters were compared in 34 patients with available computerised tomography scans. The median time interval between these scans was 536 days (interquartile range 354 – 1237). Discussion There was a statistically significant difference in diameters from the sinotubular junction to the proximal abdominal aorta, the largest was in the ascending aorta with a mean of 7.6 mm (standard deviation 4.5). This suggests that the ascending aortic diameter is a poor predictor of dissection in most patients. Ascending aortic diameter expands due to acute dissection. Post-dissection aortic diameters probably overestimate pre-dissection diameters. Following ascending dissection, diameter expansion is not limited to aorta ascendens. In this sample, estimated pre-dissection ascending aortic diameters were below 60 mm in 91% of patients and below 50 mm in 85%.
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Affiliation(s)
- Qais W Saleh
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark
| | - Axel C P Diederichsen
- Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark.,Department of Cardiology, Odense University Hospital, Denmark
| | - Jes S Lindholt
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Centre for Individualised Medicine in Arterial Diseases (CIMA), Odense University Hospital, Denmark.,Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense University Hospital, Denmark
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21
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Knudsen JS, Heide-Jørgensen U, Mortensen FV, Sørensen HT, Ehrenstein V. Acute pancreatitis: 31-Year trends in incidence and mortality - A Danish population-based cohort study. Pancreatology 2020; 20:1332-1339. [PMID: 32958367 DOI: 10.1016/j.pan.2020.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Objectives: Increasing incidence rates and declining mortality rates have made acute pancreatitis a common cause of hospitalization. We aimed to examine 31-year trends in first-time hospitalization for acute pancreatitis, the subsequent short-term and long-term mortality, and the prognostic impacts of age, sex, and comorbidity. METHODS In this nationwide Danish population-based cohort study of 47,711 incident cases, we computed the annual sex-specific age-standardized incidence rates of acute pancreatitis for 1988-2018. Among patients with incident hospitalization for acute pancreatitis, we computed sex-specific 30-day and 31-365-day mortality rates, stratified them, and performed proportional-hazards regression to estimate mortality rate ratios adjusted for sex, age, and comorbidity, measured by Charlson Comorbidity Index categories. RESULTS From 1988 to 2018, the standardized incidence rate of acute pancreatitis per 100,000 person-years increased by 29% for men (28.8-37.0%) and by 148% for women (15.7-38.9%). Among patients with pancreatitis, the 30-day mortality declined from 10.0% in those diagnosed in 1988-1992 to 6.3% for those diagnosed in 2013-2017. The corresponding 31-365 day mortality increased from 5.5% to 6.0%. In comparing periods 1988-1992 and 2013-17, the adjusted 30-day mortality rate ratio was 0.36 (95% confidence interval: 0.32-0.41) and the adjusted 31-365 day mortality rate ratio was 0.64 (95% confidence interval: 0.56-0.74). Comorbidity was a strong predictor of mortality among patients with pancreatitis. CONCLUSIONS Over the 31 years of observations, annual rates of acute pancreatitis more than doubled among women, converging with those among men. The comorbidity burden was a strong prognostic factor for short and long-term mortality. Treatments for acute pancreatitis should focus on existing comorbidities.
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Affiliation(s)
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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22
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Ranakusuma RW, McCullough AR, Safitri ED, Pitoyo Y, Widyaningsih W, Del Mar CB, Beller EM. Oral prednisolone for acute otitis media in children: a pilot, pragmatic, randomised, open-label, controlled study (OPAL study). Pilot Feasibility Stud 2020; 6:121. [PMID: 32874679 PMCID: PMC7455987 DOI: 10.1186/s40814-020-00671-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/19/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Acute otitis media (AOM) is associated with high antibiotic prescribing rates. Antibiotics are somewhat effective in improving pain and middle ear effusion (MEE); however, they have unfavourable effects. Alternative treatments, such as corticosteroids as anti-inflammatory agents, are needed. Evidence for the efficacy of these remains inconclusive. We conducted a pilot study to test feasibility of a proposed large-scale randomised controlled trial (RCT) to assess the efficacy of corticosteroids for AOM. METHODS We conducted a pilot, pragmatic, parallel, open-label RCT of oral corticosteroids for paediatric AOM in primary and secondary/tertiary care centres in Indonesia. Children aged 6 months-12 years with AOM were randomised to either prednisolone or control (1:1). Physicians were blinded to allocation. Our objectives were to test the feasibility of our full RCT procedures and design, and assess the mechanistic effect of corticosteroids, using tympanometry, in suppressing middle ear inflammation by reducing MEE. RESULTS We screened 512 children; 62 (38%) of 161 eligible children were randomised and 60 were analysed for the primary clinical outcome. All study procedures were completed successfully by healthcare personnel and parents/caregivers, despite time constraints and high workload. All eligible, consenting children were appropriately randomised. One child did not take the medication and four received additional oral corticosteroids. Our revised sample size calculation verified 444 children are needed for the full RCT. Oral corticosteroids did not have any discernible effects on MEE resolution and duration. There was no correlation between pain or other symptoms and MEE change. However, prednisolone may reduce pain intensity at day 3 (Visual Analogue Scale mean difference - 7.4 mm, 95% confidence interval (CI) - 13.4 to - 1.3, p = 0.018), but cause drowsiness (relative risk (RR) 1.8, 95% CI 1.1 to 2.8, p = 0.016). Tympanometry curves at day 7 may be improved (RR 1.8, 95% CI 1.0 to 2.9). We cannot yet confirm these as effects of corticosteroids due to insufficient sample size in this pilot study. CONCLUSIONS It is feasible to conduct a large, pragmatic RCT of corticosteroids for paediatric AOM in Indonesia. Although oral corticosteroids may reduce pain and improve tympanometry curves, it requires an adequately powered clinical trial to confirm this. TRIAL REGISTRATION Study registry number: ACTRN12618000049279. Name of registry: the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of registration: 16 January 2018.
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Affiliation(s)
- Respati W. Ranakusuma
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Amanda R. McCullough
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| | - Eka D. Safitri
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Yupitri Pitoyo
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Widyaningsih Widyaningsih
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Christopher B. Del Mar
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| | - Elaine M. Beller
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
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Förch S, Ritter B, Mayr E. [Acute appendicitis after bone grafting from the right anterior iliac crest-difficult differential diagnosis]. Orthopade 2020; 49:913-915. [PMID: 32632650 DOI: 10.1007/s00132-020-03943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To fill bony defects, an iliac crest bone graft is often used. Typical complications are hematoma, nerve injuries, infection or donor site related pain. This article reports the case of a young patient with acute appendicitis after bone grafting from the right iliac crest. Because of the preceding operation, the correct diagnosis was difficult and was only possible by a differentiated clinical examination followed by machine-aided diagnosis.
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Affiliation(s)
- S Förch
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - B Ritter
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - E Mayr
- Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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Harfouch N, Stern J, Chowdhary V, Arias Y, Demissie S, Scheiner J, Khodorkovsky B, Hayim M. Utility of ultrasound after a negative CT abdomen and pelvis in the emergency department. Clin Imaging 2020; 68:29-35. [PMID: 32563722 DOI: 10.1016/j.clinimag.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study is to assess the utility of an abdominal and/or pelvic ultrasound (US) performed within 24 h after a negative CT of the abdomen and pelvis (CTAP) in the emergency department (ED). The secondary endpoint is to assess whether there is a significant increase in length of stay (LOS) in the ED due to immediate US reimaging. METHOD We reviewed the imaging reports of 335 patients over the course of 3 years in our ED who had an US within 24 h after a negative CTAP. We then assessed type of US and whether the US showed any acute findings. We also evaluated LOS in the ED. RESULTS Out of 335 patients, there were only three US cases suspicious for acute surgical pathology (3/335 or 0.9%). On 30-day clinical follow-up, only one of the three cases was confirmed as cholecystitis on pathology. The most common non-surgical findings on US not initially reported on CTAP were ovarian cysts (29/83) and gallstones (9/83). Additionally, the LOS for patients who received both a CTAP and US was 119 min longer than patients who only received a CTAP. CONCLUSION US abdomen and/or pelvis reimaging within 24 h following a negative CTAP is unlikely to change surgical management in the acute setting. US reimaging can still be useful in diagnosing non-surgical pathology, which could serve to explain the patient's pain. US reimaging after negative CTAP is associated with an average increase in the ED LOS.
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Affiliation(s)
- Nassier Harfouch
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA.
| | - Jonathan Stern
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Varun Chowdhary
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Yuly Arias
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Seleshi Demissie
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Jonathan Scheiner
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Boris Khodorkovsky
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
| | - Morris Hayim
- Staten Island University Hospital, Northwell Health, 475 Seaview Ave, Staten Island, NY 10305, USA
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Ham S, Min YG, Chae MK, Kim HH. Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea. Clin Exp Emerg Med 2020; 7:43-51. [PMID: 32252133 PMCID: PMC7141981 DOI: 10.15441/ceem.19.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to analyze the differences in epidemiological aspects and clinical courses of acute poisonings in each region of the Gyeonggi-do province in Korea. METHODS This retrospective study analyzed data from the National Emergency Department Information System of Korea. We retrospectively reviewed cases of acute poisonings between April 2006 and March 2015 recorded at 13 emergency departments in eight different cities of Gyeonggi-do province in Korea. The differences in the incidence, age distribution, causative agent, and clinical course of poisonings among regions were the main outcomes measured. RESULTS The proportion of poisonings in the ≤9 age group was high in Yongin (17.44%) and that in ≥65 age group was high in Gwangmyeong (21.76%). The proportion of cases involving carbon monoxide was high in Ansan (8.82%) in patients hospitalized and the proportion of cases involving pesticides was high in Pyeongtaek (52.78%) in patients admitted to the intensive care unit. The admission rate of poisoned patients was high in Osan (36.02%). CONCLUSION In this study, differences in the characteristics of poisoned patients between 8 cities were noted. Therefore, hospitals need to arrange treatment resources for poisoned patients according to the characteristics of the specific region. The. RESULTS of this study may serve as evidence for new strategies to prepare for the acute poisonings in hospitals.
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Affiliation(s)
- Seungho Ham
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Minjung Kathy Chae
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyuk-Hoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
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26
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Qing G, Yang S, Li Q, Zhang LL, Yuan GD, Chen SY, Lü SX, Huang GC, Chen Y, Wang X, Guo SL, Yan XF. [Clinical and imaging features of acute histoplasmosis]. Zhonghua Yi Xue Za Zhi 2019; 99:3603-7. [PMID: 31826579 DOI: 10.3760/cma.j.issn.0376-2491.2019.46.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical and imaging characteristics of acute histoplasmosis. Methods: The clinical and imaging data of 10 patients with acute histoplasmosis were studied. Their clinical and imaging characteristics were analyzed. All the patients returned from a South American republic in April 2019 and were treated at the Chongqing public health medical treatment center. Results: All the 10 patients were male, aged 30-56 years old, with an average age of 43.8 years old. Four of them were engaged in soil clearing, 2 in gas cutting, 2 in moving tools, and 2 in inspection. The disease in all the 10 patients was caused by inhaling a large amount of bacteria-bearing dust in a short time, with an incubation period of 9-13 days, and the main clinical manifestations were fever, insomnia, dizziness, headache, cough, poor appetite, rash and diarrhea. One patient's head CT showed extensive thickening and increased density of bilateral frontotemporal, parietal and occipital meninges, while the other 9 patients showed no obvious abnormalities. Chest CT findings were as follows: (1) Multiple nodular shadow: the chest CT findings of 4 patients were miliary nodular shadow with diffuse distribution in both lungs. Most of the nodules were less than 5 mm in diameter and distributed evenly or unevenly. CT findings of 6 cases showed scattered nodular shadows in both lungs, with diameters ranging from 2 to 15 mm, and obvious distribution in subpleural and inferior lobes of both lungs. (2) Consolidation shadow: in 2 cases, the size of the shadow was uneven and the density increased, mainly distributed in the subpleura and the lower lobe of both lungs. (3) Ground glass density shadow: mainly distributed around nodules, halo signs can be seen around some nodules. (4) Mediastinum and/or hilar lymph nodes were enlarged. (5) Pleural effusion: a small amount of pleural effusion was found in 4 cases. (6) Pericardial effusion in 3 cases. Abdominal CT showed splenomegaly in 8 cases and hepatomegaly in 1 case. Conclusions: Acute histoplasmosis has no specificity in clinical manifestations. However, there are still some features in CT manifestations, including multiple nodules in both lungs accompanied by halo, enlarged liver, spleen and mediastinal lymph nodes, and multiple serous cavity effusions.
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Wang LM, Dong LJ, Liu X, Huang LY, Liu W, Lyu YJ, Li XR, Liu AH. [Proteomic analysis of aqueous humor in acute primary angle-closure glaucoma]. Zhonghua Yan Ke Za Zhi 2019; 55:687-694. [PMID: 31495154 DOI: 10.3760/cma.j.issn.0412-4081.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the difference among expression of aqueous humor proteins in acute primary angle-closure glaucoma (APACG). Methods: Case-control study. The patients with APACG combined cataract (APACG with cataract group) and patients with cataract (cataract group), who had undertaken surgical treatment at the Tianjin Medical University Eye Hospital from October 2016 to June2017 were collected. Upon receipt of patient's consent, 50 μl of aqueous humor were collected with 1 ml syringe and No.1 needle through the surgical access during the surgery, and then injected into a sterile collection tube to be stored at -80 ℃. Those proteins extracted from aqueous humor were analyzed by quantitative proteomic mass spectrometry. The differential significance test was performed by Maxquant significances A approach. The differential proteins of the two groups were screened and determined with the conditions of P<0.05 and difference multiple>2. The functions and signal pathway of differential proteins in aqueous humor were annotated in biological big data, on the basis gene ontology (GO) and the Kyoto gene and genomic encyclopedia (KEGG) analyses. Results: There were 3 males and 7 females with an average age of (68±6) years in the APACG group. The cataract group included 2 males and 8 females with an average age of (71±8) years. There were no statistical differences in gender ratio and age between the two groups (both P>0.05). A total of 91 differential proteins were detected in this experiment, including 50 up-regulated proteins (annexinA1, vimentin, S100 calcium binding protein A8, interleukin 6, C reactive protein, laminin β2, etc.) and 41 down-regulated (keratin 85, γ-crystallin D, syntaxin-binding protein 5, semaphoring 4B, matrilin 2, cathepsin O, cadherin 4, semaphoring 3B, platelet-derived growth factor D, transforming growth factor β, etc.). On one hand, the functions of differential proteins involved in many aspects. AnnexinA1, CD163, S100 calcium-binding protein A8, C reactive protein, interleukin 6 are involved in the inflammatory reaction, cadherin 4 and laminin β2 regulate cell adhesion, matrilin 2, vimentin and laminin β2 participate in tissue fibrosis; on the other hand, KEGG analysis showed that the differential proteins participate diverse signaling pathways such as phosphatidylinositol-3-kinase-protein kinase B signaling pathway, transformation growth factor β signaling pathway, mitogen activated protein kinase signaling pathway, Toll-like receptor signaling pathway, the nuclear factor κ-light chain enhancer of the activated B cells signaling pathway, focal adhension and extracellular matrix receptor interaction pathway and so on. Conclusions: The expression of annexin A1 is significantly up-regulated in the aqueous humor in APACG, while some other factors such as transformation growth factor β, cadherin-4, and matrilin 2 are down-regulated. The change of proteins in aqueous humor is related with the outbreak of APACG. (Chin J Ophthalmol, 2019, 55: 687-694).
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Affiliation(s)
- L M Wang
- Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin 300384, China
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Si-Mohamed S, Dupuis N, Tatard-Leitman V, Rotzinger D, Boccalini S, Dion M, Vlassenbroek A, Coulon P, Yagil Y, Shapira N, Douek P, Boussel L. Virtual versus true non-contrast dual-energy CT imaging for the diagnosis of aortic intramural hematoma. Eur Radiol 2019; 29:6762-6771. [PMID: 31264015 DOI: 10.1007/s00330-019-06322-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess whether virtual non-contrast (VNC) images derived from contrast dual-layer dual-energy computed tomography (DL-DECT) images could replace true non-contrast (TNC) images for aortic intramural hematoma (IMH) diagnosis in acute aortic syndrome (AAS) imaging protocols by performing quantitative as well as qualitative phantom and clinical studies. MATERIALS AND METHODS Patients with confirmed IMH were included retrospectively in two centers. For in vitro imaging, a custom-made phantom of IMH was placed in a semi-anthropomorphic thorax phantom (QRM GmbH) and imaged on a DL-DECT at 120 kVp under various conditions of patient size, radiation exposure, and reconstruction modes. For in vivo imaging, 21 patients (70 ± 13 years) who underwent AAS imaging protocols at 120 kVp were included. In both studies, contrast-to-noise ratio (CNR) between hematoma and lumen was compared using a paired t test. Diagnostic confidence (1 = non-diagnostic, 4 = exemplary) for VNC and TNC images was rated by two radiologists and compared. Effective radiation doses for each acquisition were calculated. RESULTS In both the phantom and clinical studies, we observed that the CNRs were similar between the VNC and TNC images. Moreover, both methods allowed differentiating the hyper-attenuation within the hematoma from the blood. Finally, we obtained equivalent high diagnostic confidence with both VNC and TNC images (VNC = 3.2 ± 0.7, TNC = 3.1 ± 0.7; p = 0.3). Finally, by suppressing TNC acquisition and using VNC, the mean effective dose reduction would be 40%. CONCLUSION DL-DECT offers similar performances with VNC and TNC images for IMH diagnosis without compromise in diagnostic image quality. KEY POINTS • Dual-layer dual-energy CT enables virtual non-contrast imaging from a contrast-enhanced acquisition. • Virtual non-contrast imaging with dual-layer dual-energy CT reduces the number of acquisitions and radiation exposure in acute aortic syndrome imaging protocol. • Dual-layer dual-energy CT has the potential to become a suitable imaging tool for acute aortic syndrome.
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Affiliation(s)
- Salim Si-Mohamed
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France.
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France.
| | - Nicolas Dupuis
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
- Anatomy Lab, Rockefeller Faculty, Lyon Est, Lyon, France
| | - Valérie Tatard-Leitman
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
| | - David Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital , Lausanne, Switzerland
| | - Sara Boccalini
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
| | - Matthias Dion
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
- Anatomy Lab, Rockefeller Faculty, Lyon Est, Lyon, France
| | | | | | - Yoad Yagil
- Global Advanced Technologies, CT, Philips, Haifa, Israel
| | - Nadav Shapira
- Global Advanced Technologies, CT, Philips, Haifa, Israel
| | - Philippe Douek
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
| | - Loic Boussel
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France
- Radiology Department, Hospices Civils de Lyon, CHU Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France
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Al Alkeem F, Loney T, Aziz F, Blair I, Sonnevend Á, Sheek-Hussein M. Prevalence and factors associated with infectious intestinal diseases in Ras Al Khaimah, United Arab Emirates, 2017: A population-based cross-sectional study. Int J Infect Dis 2019; 85:188-194. [PMID: 31202907 DOI: 10.1016/j.ijid.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The United Arab Emirates (UAE) is a rapidly developing high-income country that has experienced significant population growth, urbanization, and improvements in the standard of living since its formation in 1971. Published estimates on the prevalence of infectious intestinal diseases (IID) in the UAE are scarce and exclusively based on hospital data. The aim of this study was to provide the first prevalence estimates of IID in the UAE. METHODS A population-based cross-sectional study design using a telephone-based questionnaire was used to estimate the IID prevalence in the previous 4 weeks in a representative sample of the Ras Al Khaimah (RAK) population from January to September 2017. RESULTS Data were collected from 1254 participants (57.3% male; 25.2% <18 years). The prevalence of IID was 4.2% in the 4 weeks prior to the interview. Multivariate logistic regression analysis identified that being female (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2-5.1) and having a middle-range monthly household income (approx. USD 4080-<6800: OR 5.42, 95% CI 1.15-25.48; approx. USD 6800-<9530: OR 7.13, 95% CI 1.47-34.57) were positively associated with IID. Age ≥6 years was negatively associated with IID (OR 0.95, 95% CI 0.90-0.99). Forty-nine percent of participants with an IID sought medical care and 20.8% took over-the-counter medication. CONCLUSIONS This study provides the first population-based prevalence estimates of IID in the UAE, which are similar to those reported in China (4%), but lower than those reported in Canada (10%), the Netherlands (7%), and the USA (6%).
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Affiliation(s)
- F Al Alkeem
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates.
| | - T Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, PO Box 505055, Dubai, United Arab Emirates.
| | - F Aziz
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates.
| | - I Blair
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates.
| | - Á Sonnevend
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates.
| | - M Sheek-Hussein
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, PO Box 17666, United Arab Emirates.
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Alqahtani F, Munir MB, Aljohani S, Tarabishy A, Almustafa A, Alkhouli M. Surgical Thrombectomy for Pulmonary Embolism: Updated Performance Rates and Outcomes. Tex Heart Inst J 2019; 46:172-174. [PMID: 31708697 DOI: 10.14503/thij-18-6751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Treatments for pulmonary embolism are numerous and often complex. Current data on surgical thrombectomy are important but are not readily available. We studied the National Inpatient Sample to evaluate trends in the performance rates and outcomes of surgical thrombectomy in the United States from 2003 through 2014. We think that our findings have meaningful application to the triage and risk stratification of patients who have hemodynamically significant pulmonary embolism.
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Teng Y, Teng YF. [The clinical characteristics and pathologic mechanisms of acute macular neuroretinopathy]. Zhonghua Yan Ke Za Zhi 2019; 55:311-5. [PMID: 30982294 DOI: 10.3760/cma.j.issn.0412-4081.2019.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Acute macular neuroretinopathy (AMN) is a rare macular disorder. The clinical diagnosis of AMN is difficult and complicated since the retinal symptoms of patients with AMN are usually unclear or untypical. Spectral domain optical coherence tomography (SD-OCT) is a reliable examination for imaging the retinal structure, which improved the insight of AMN in etiology and pathogenesis. This review summarizes and analyzes the recent clinical reports and research progress, in an effort to present a more accurate clinical recognition of AMN. (Chin J Ophthalmol, 2019, 55:311-315).
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Tulai IM, Penciu OM, Raut R, Rudinskaya A. Catastrophic Antiphospholipid Syndrome Presenting as Congestive Heart Failure in a Patient with Thrombotic Microangiopathy. Tex Heart Inst J 2019; 46:48-52. [PMID: 30833839 DOI: 10.14503/thij-17-6472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Thrombotic microangiopathic syndromes are characterized by thrombus formation leading to microangiopathic hemolytic anemia, thrombocytopenia, and end-organ injury that most often affects the kidney and brain. Patients with thrombotic microangiopathy can also present with cardiac involvement, which has been shown to worsen their prognosis. We describe the case of a 46-year-old woman who presented with acute congestive heart failure as a manifestation of catastrophic antiphospholipid syndrome, which is characterized by rapidly progressing multiorgan involvement. Targeted therapy improved our patient's cardiomyopathy and saved her life. Increased recognition of thrombotic microangiopathy as an underlying pathophysiologic mechanism in heart failure and initiation of timely treatment may help to prevent death in patients with thrombotic microangiopathy.
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Abstract
Infections from coxsackie B2 viruses often cause viral myocarditis and, only rarely, multisystem organ impairment. We present the unusual case of a 42-year-old man in whom coxsackie B2 virus infection caused multiorgan infection, necessitating distal pancreatectomy, splenectomy, renal dialysis, and venoarterial extracorporeal membrane oxygenation with mechanical ventilation. In addition, the patient had a rapid-eye-movement sleep-related conduction abnormality that caused frequent sinus pauses of longer than 10 s, presumably due to myocarditis from the coxsackievirus infection. He recovered after permanent pacemaker placement and was discharged from the hospital. We discuss our aggressive supportive care and the few other reports of multiorgan impairment from coxsackieviruses.
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Basu Ray I, Shah SK. Formulating a More Comprehensive Stroke-Risk Evaluation Scale. Tex Heart Inst J 2018; 45:168-171. [PMID: 30072855 DOI: 10.14503/thij-18-6686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Medical healthcare for refugees is strictly regulated by law in Germany but the great regional variation in the implementation is currently a huge challenge for healthcare providers. Providers are often not familiar with the specific local regulations and especially in emergencies it is often not possible to clarify open questions before treating patients. The high influx of refugees in the summer and fall of 2015 led to a situation that could only be managed with the voluntary and pragmatic help of all healthcare personnel involved. This article explains the most relevant regulations covering medical healthcare for refugees and asylum seekers. In addition, the procedure for the approval of asylum status in itself can have a direct or indirect impact on the health status of these individuals; therefore, some comments are made regarding this aspect.
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Affiliation(s)
- P Klein
- Sächsische Landesärztekammer, Schützenhöhe 16, 01099, Dresden, Deutschland.
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Murphy K, Waldo O, Lohrmann GM, Tazelaar HD, Jokerst CE, Mookadam F. Eosinophilia and Ulcerative Colitis Associated with Eosinophilic Myocarditis. Tex Heart Inst J 2017; 44:219-222. [PMID: 28761405 DOI: 10.14503/thij-16-5859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Reactive eosinophilia is associated with inflammatory bowel disease, but its association with eosinophilic myocarditis is rare. We report a case of a 42-year-old man who presented with hypovolemic shock secondary to diarrhea and recently diagnosed nonischemic cardiomyopathy (left ventricular ejection fraction, 0.29). Laboratory evaluation revealed marked peripheral eosinophilia. Cardiac magnetic resonance imaging showed evidence of subacute-to-chronic myocarditis, and endomyocardial biopsy results were consistent with eosinophilic myocarditis. Colonic biopsy specimens revealed ulcerative colitis and no eosinophils. Hematologic evaluation was negative for an alternative cause of eosinophilia. The patient was given corticosteroids; his diarrhea resolved, but there was no short-term improvement in his ejection fraction, so an implantable cardioverter-defibrillator was placed. Follow-up at one year showed that the patient's left ventricular ejection fraction had improved to 0.42.
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Castaño M, Gualis J, Martínez-Comendador JM, Martín E, Maiorano P, Castillo L. Emergent aortic surgery in octogenarians: is the advanced age a contraindication? J Thorac Dis 2017; 9:S498-S507. [PMID: 28616346 DOI: 10.21037/jtd.2017.04.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Surgery of both the ascending and descending aortic segments in the context of an acute aortic syndrome is one of the greatest challenges for the cardiac surgeon. In the case of surgery of the descending aorta, surgical risk increases due to the technical complexity, the required aggressive approach and because surgical indication is usually established as a result of complications and therefore involves, almost always, critically ill patients. The aging of the population is causing such surgery to be considered in an increasing number of octogenarians. The present review analyzes the available scientific evidence on the surgical indications and outcomes of these complex procedures in this population, particularly in the emergent scenario. Ascending and descending thoracic aortic diseases are reviewed separately, and the role of both the current risk scores and frailty assessments are comprehensively discussed.
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Affiliation(s)
- Mario Castaño
- Department of Cardiac Surgery, University Hospital of Leon, León, Spain
| | - Javier Gualis
- Department of Cardiac Surgery, University Hospital of Leon, León, Spain
| | | | - Elio Martín
- Department of Cardiac Surgery, University Hospital of Leon, León, Spain
| | - Pasquale Maiorano
- Department of Cardiac Surgery, University Hospital of Leon, León, Spain
| | - Laura Castillo
- Department of Cardiac Surgery, University Hospital of Leon, León, Spain
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da Silva S, Rocha M, Pinto-de-Sousa J. Acute Pancreatitis Etiology Investigation: A Workup Algorithm Proposal. GE Port J Gastroenterol 2016; 24:129-136. [PMID: 28848797 DOI: 10.1159/000452692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/26/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute pancreatitis represents a significant number of hospital admissions. Most of the patients are admitted in an acute setting. Early identification of its etiology is an essential step toward the rational approach, both for its implications in the immediate therapy and the prevention of recurrence. Although often obvious, the etiological workup of acute pancreatitis can be challenging. CONCLUSION There are several studies emphasizing the multiple etiologies underlying acute pancreatitis but lacking structured diagnostic workups to allow a rational and organized study. The main goal of this work is to develop an algorithm proposal, which aims to serve as a guide for the investigation of the etiology of acute pancreatitis based on a review of already published literature, adjusted to the reality of our hospital and the available resources.
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Affiliation(s)
- Sílvia da Silva
- General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Mónica Rocha
- General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - João Pinto-de-Sousa
- General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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Hamada T, Yasunaga H, Nakai Y, Isayama H, Matsui H, Fushimi K, Koike K. No weekend effect on outcomes of severe acute pancreatitis in Japan: data from the diagnosis procedure combination database. J Gastroenterol 2016; 51:1063-72. [PMID: 26897739 DOI: 10.1007/s00535-016-1179-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the early phase of severe acute pancreatitis, timely multidisciplinary management is required to reduce mortality. The aim of this observational study was to evaluate the impact of weekend hospital admission on outcomes using population-based data in Japan. METHODS Data on adult patients (≥20 years) with severe acute pancreatitis were extracted from a nationwide Japanese administrative database covering over 1000 hospitals. In-hospital mortality, length of stay, and total costs were compared between weekend and weekday admissions, with adjustment for disease severity according to the current Japanese severity scoring system for acute pancreatitis, and other potential risk factors. RESULTS In total, 8328 patients hospitalized during the study period 2010-2013 were analyzed (2242 admitted at weekends and 6086 on weekdays). In-hospital mortality rates were not significantly different: 5.9 vs. 5.4 % for weekend and weekday admissions, respectively (multivariate-adjusted odds ratio, 1.06; 95 % confidence interval, 0.83-1.35). The impact of weekend admission was not significant either for length of hospitalization (median, 18 vs. 19 days) and total costs (median, 6161 vs. 6233 US dollars) (both p > 0.19 in multivariate-adjusted linear regression). The rates of, and time to, specific treatments were also similar between patients with weekend and weekday admissions. CONCLUSIONS A weekend effect in severe acute pancreatitis admissions was not evident. Adjustments to weekend staffing and selective hospital referral of patients admitted at weekends are not indicated for severe acute pancreatitis in current clinical practice in Japan.
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Wei Q, Liu H, Tu Y, Tang RN, Wang YL, Pan MM, Liu BC. The characteristics and mortality risk factors for acute kidney injury in different age groups in China-a cross sectional study. Ren Fail 2016; 38:1413-1417. [PMID: 27756185 DOI: 10.1080/0886022x.2016.1227618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIM Age is an independent risk factor for acute kidney injury (AKI). The causes and outcomes of AKI in children, middle-aged, and older patients are different. The objective of this country-based study was to identify the characteristics and mortality factors for AKI in different age groups in China. METHODS Using data from 374,286 adult patients (≥18 years) admitted to 44 study hospitals, we investigated the characteristics and mortality risk factors for AKI in four different age groups: 18-39 years of age, 40-59 years of age, 60-79 years of age, and ≥80 years of age. The identification criteria for AKI included the 2012 KDIGO AKI definition and an expanded criterion. RESULTS The country-based survey included 7604 AKI patients (7604/374,286, 2.03%). The proportions of AKI in the four age groups were 11.52%, 30.79%, 41.03%, and 16.66%, respectively. In any age group, the patients with AKI stage 1 were the majority (43.4%, 42.4%, 46.4%, and 52.2%, respectively), and the most common classification of AKI was pre-renal AKI (44.3%, 51.3%, 52.3%, and 56.4%, respectively). The higher AKI peak stage occurred for the in-hospital mortality factors for AKI in all age groups; except for the AKI stage 2 patients in the 18-39 age group. CONCLUSION The characteristics and mortality factors for AKI vary by age in China. Elderly patients were the primary population with AKI, and the most common type of AKI was pre-renal AKI. Special caution should be taken to the old population in hospitalized patients to prevent the pre-renal AKI.
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Affiliation(s)
- Qing Wei
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
| | - Hong Liu
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
| | - Yan- Tu
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
| | - Ri-Ning Tang
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
| | - Yan-Li Wang
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
| | - Ming-Ming Pan
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
| | - Bi-Cheng Liu
- a Department of Nephrology, Zhongda Hospital, School of Medicine , Southeast University , Nanjing , China
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Dizdarević-Hudić L, Kusljugić Z, Baraković F, Hajder M, Hudić I. Do growth hormone and insulin-like growth factor 1 affect prognosis in patients with killip I and II class acute myocardial infarction? Acta Clin Croat 2016; 55:345-353. [PMID: 29045090 DOI: 10.20471/acc.2016.55.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1)
and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance
and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association
between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up
study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI.
There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed
for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac
events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1
was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and
IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found
significant between-group differences in other markers of insulin resistance (HbA1c, glycemia,
HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH
and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left
ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might
be a result of inflammatory/immune response and therefore it could be a useful prognostic marker.
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Affiliation(s)
- Larisa Dizdarević-Hudić
- Department of Cardiology, Clinical Department of Internal Medicine,Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Zumreta Kusljugić
- Department of Cardiology, Clinical Department of Internal Medicine,Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Fahir Baraković
- Department of Cardiology, Clinical Department of Internal Medicine,Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Mithad Hajder
- Department of Endocrinology, Clinical Department of Internal Medicine,Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina
| | - Igor Hudić
- School of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
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Jergović I, Budinčević H, Planjar-Prvan M, Bielen I. Transient Obstructive Hydrocephalus in Patients with Intracerebral Hemorrhage: Report of Two Cases. Acta Clin Croat 2016; 55:497-500. [PMID: 29046016 DOI: 10.20471/acc.2016.55.03.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Obstructive hydrocephalus is a relatively common complication of intraventricular
hemorrhage resulting in high morbidity and mortality. We report two cases of transient obstructive
hydrocephalus caused by obstruction of mesencephalic duct in patients that presented with altered
consciousness which resolved spontaneously in a few hours. In very rare cases, obstructive hydrocephalus
due to intraventricular hemorrhage may be transient and does not need neurosurgical or
invasive procedures for lowering raised intracranial pressure, which otherwise are currently preferred
treatment options.
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Affiliation(s)
- Ilija Jergović
- Stroke and Intensive Care Unit, Clinical Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
| | - Hrvoje Budinčević
- Stroke and Intensive Care Unit, Clinical Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Miljenka Planjar-Prvan
- Stroke and Intensive Care Unit, Clinical Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
| | - Ivan Bielen
- Stroke and Intensive Care Unit, Clinical Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Abstract
Acute interstitial nephritis is a common cause of acute kidney injury. Acute interstitial nephritis is most commonly induced by drug although the cause may also be infective, autoimmune, or idiopathic. Although eosinophilia and eosinophiluria may help identify this disease entity, the gold standard for diagnosis remains renal biopsy. Prompt diagnosis is important because discontinuation of the culprit drugs can reduce further kidney injury. We present a patient with an underlying psychiatric disorder who was subsequently diagnosed with clozapine-induced acute interstitial nephritis. Monitoring of renal function during clozapine therapy is recommended for early recognition of this rare side-effect.
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Affiliation(s)
- S Y Chan
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - C Y Cheung
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - P T Chan
- Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - K F Chau
- Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong
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Langsrud K, Vaaler AE, Kallestad H, Morken G. Sleep patterns as a predictor for length of stay in a psychiatric intensive care unit. Psychiatry Res 2016; 237:252-6. [PMID: 26805566 DOI: 10.1016/j.psychres.2016.01.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/13/2015] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
Systematic evaluations of the relationship between sleep patterns and length of stay in psychiatric intensive care units (PICUs) are lacking. The aims of the present study were to explore if sleep duration or night-to-night variations in sleep duration the first nights predict length of stay in a PICU. Consecutive patients admitted to a PICU were included (N=135) and the nurses registered the time patients were observed sleeping. In the three first nights, the mean sleep duration was 7.5 (±3.2)h. Sleep duration the first night correlated negatively with the length of stay for patients with schizophrenia. The mean difference in sleep duration from night one to night two were 3.3 (±3.0)h and correlated with length of stay for the whole group of patients, but especially for patients with schizophrenia. Patients of all diagnostic groups admitted to a PICU had pronounced intra-individual night-to-night variations in sleep duration. Stabilizing night-to-night variations of sleep duration might be a major goal in treatment.
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Affiliation(s)
- Knut Langsrud
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne E Vaaler
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Kallestad
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnar Morken
- Department of Psychiatry, St Olavs University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Kanitz FA, Cargnelutti JF, Anziliero D, Gonçalves KV, Masuda EK, Weiblen R, Flores EF. Respiratory and neurological disease in rabbits experimentally infected with equid herpesvirus 1. Microb Pathog 2015; 87:45-50. [PMID: 26187161 DOI: 10.1016/j.micpath.2015.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/28/2015] [Accepted: 07/11/2015] [Indexed: 11/24/2022]
Abstract
Equid herpesvirus type 1 (EHV-1) is an important pathogen of horses worldwide, associated with respiratory, reproductive and/or neurological disease. A mouse model for EHV-1 infection has been established but fails to reproduce some important aspects of the viral pathogenesis. Then, we investigated the susceptibility of rabbits to EHV-1 aiming at proposing this species as an alternative model for EHV-1 infection. Weanling rabbits inoculated intranasal with EHV-1 Kentucky D (10(7) TCID50/animal) shed virus in nasal secretions up to day 8-10 post-inoculation (pi), presented viremia up to day 14 pi and seroconverted to EHV-1 (virus neutralizing titers 4 to 64). Most rabbits (75%) developed respiratory disease, characterized by serous to hemorrhagic nasal discharge and mild to severe dyspnea. Some animals (20%) presented neurological signs as circling, bruxism and opisthotonus. Six animals died during acute disease (days 3-6); infectious virus and/or viral DNA were detected in the lungs, trigeminal ganglia (TG), olfactory bulbs (OBs) and cerebral cortex/brain (CC). Histological examination showed necrohemorrhagic, multifocal to coalescent bronchointerstitial pneumonia and diffuse alveolar edema. In two rabbits euthanized at day 50 pi, latent EHV-1 DNA was detected in the OBs. Dexamethasone administration at day 50 pi resulted in virus reactivation, demonstrated by virus shedding, viremia, clinical signs, and increase in VN titers and/or by detection of virus DNA in lungs, OBs, TGs and/or CC. These results demonstrate that rabbits are susceptible to EHV-1 infection and develop respiratory and neurological signs upon experimental inoculation. Thus, rabbits may be used to study selected aspects of EHV-1 biology and pathogenesis, extending and complementing the mouse model.
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Affiliation(s)
- Fábio A Kanitz
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Av. Roraima, 1000, prédio 20, sala 4200, Santa Maria, RS, CEP 97105-900, Brazil; 9(a) Supervisão Regional da Secretaria da Agricultura e Pecuária do Rio Grande do Sul, Rua Mário Santo Dani, 100, Osório, RS, CEP 95520-000, Brazil
| | - Juliana F Cargnelutti
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Av. Roraima, 1000, prédio 20, sala 4200, Santa Maria, RS, CEP 97105-900, Brazil
| | - Deniz Anziliero
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Av. Roraima, 1000, prédio 20, sala 4200, Santa Maria, RS, CEP 97105-900, Brazil; Escola de Medicina, Faculdade Meridional - IMED, Senador Pinheiro, 304, Passo Fundo, RS, CEP 99070-220, Brazil
| | - Kelley V Gonçalves
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Av. Roraima, 1000, prédio 20, sala 4200, Santa Maria, RS, CEP 97105-900, Brazil
| | - Eduardo K Masuda
- Axys Análises Laboratório Veterinário e Consultoria Diagnóstica, Rua Pedro Chaves Barcelos, 475, Bairro Montserrat, Porto Alegre, RS, CEP 90450-010, Brazil
| | - Rudi Weiblen
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Av. Roraima, 1000, prédio 20, sala 4200, Santa Maria, RS, CEP 97105-900, Brazil
| | - Eduardo F Flores
- Setor de Virologia, Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Av. Roraima, 1000, prédio 20, sala 4200, Santa Maria, RS, CEP 97105-900, Brazil.
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Cowie MR, Anker SD, Cleland JGF, Felker GM, Filippatos G, Jaarsma T, Jourdain P, Knight E, Massie B, Ponikowski P, López-Sendón J. Improving care for patients with acute heart failure: before, during and after hospitalization. ESC Heart Fail 2015; 1:110-145. [PMID: 28834628 DOI: 10.1002/ehf2.12021] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.
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Affiliation(s)
- Martin R Cowie
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Stefan D Anker
- Charité-University Medical Centre, Campus Virchow-Klinikum, Berlin, Germany
| | - John G F Cleland
- National Heart and Lung Institute, Imperial College London and Harefield Hospital, London, UK.,University of Hull, Hull, UK
| | | | | | - Tiny Jaarsma
- Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrick Jourdain
- René Dubos Hospital, Pontoise, France.,Paris Descartes University, Paris, France
| | | | - Barry Massie
- San Francisco Veterans Affairs Medical Center, University of California, San Francisco, CA, USA
| | | | - José López-Sendón
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
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Cramer S, Fonager K. Risk factors of 30-days re-hospitalization after Hospital at Home in a cohort of patients treated with parenteral therapy. Eur J Intern Med 2014; 25:895-9. [PMID: 25468737 DOI: 10.1016/j.ejim.2014.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/11/2014] [Accepted: 10/24/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital at Home provides acute medical treatment in the patient's home. To prevent re-hospitalization in these outpatients, it is decisive to identify high-risk groups. This study aimed to identify patient characteristics for increased risk of 30 days re-hospitalization, after referral to Hospital at Home. METHODS A registry-based study was conducted using information from a hospital and a team providing Hospital at Home treatment. A total of 379 patients above the age of 18, who had received parenteral therapy by the team, in the period 01.03.2011 to 31.12.2012, were identified. Comorbid conditions were defined using Charlson's Comorbidity Index and divided into groups of score (0, 1 and ≥ 2). Cox regression analysis was used to estimate a risk of 30 days re-hospitalization by computing the hazard ratios (HR) with 95% confidence interval (95% CI). RESULTS Within 30 days after referral to Hospital at Home 32.5% of the population was re-hospitalized. An increased risk of readmission was found in patients with a comorbidity score ≥ 2 (HR 2.06, 95% CI 1.33-3.18) and in patients referred to Hospital at Home from a hospital department (HR 1.56, 95% CI 1.02-2.38). Primary care tended to reduce the risk of readmission although not significant (HR 0.65, 95% CI 0.41-1.04). CONCLUSIONS This study suggests that, patients with comorbidities and/or patients referred by the hospital are in a greater risk of readmission. Further readmission may be prevented in patients receiving primary care.
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Affiliation(s)
- Susanne Cramer
- Department of Public Health, Aarhus University, Bartholins Allé 2 - Building 1260, 8000 Aarhus C, Denmark.
| | - Kirsten Fonager
- Department of Social Medicine, Faculty of Medicine, Aalborg University Hospital, Havrevangen 1, 2nd floor, 9000 Aalborg, Denmark; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Niels Jernes Vej 14, 2nd floor, 9220 Aalborg Ø, Denmark.
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Micovic S, Nezic D, Vukovic P, Jovanovic M, Lozuk B, Jagodic S, Djukanovic B. Concomitant reconstruction of arch vessels during repair of aortic dissection. Tex Heart Inst J 2014; 41:421-4. [PMID: 25120398 DOI: 10.14503/thij-13-3250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Surgery for acute aortic dissection is challenging, especially in cases of cerebral malperfusion. Should we perform only the aortic repair, or should we also reconstruct the arch vessels when they are severely affected by the disease process? Here we present a case of acute aortic dissection with multiple tears that involved the brachiocephalic artery and caused cerebral and right upper-extremity malperfusion. The patient successfully underwent complete replacement of the brachiocephalic artery and the aortic arch during deep hypothermic circulatory arrest, with antegrade cerebral protection. We have found this technique to be safe and reproducible for use in this group of patients.
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Affiliation(s)
- Slobodan Micovic
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
| | - Dusko Nezic
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
| | - Petar Vukovic
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
| | - Marko Jovanovic
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
| | - Branko Lozuk
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
| | - Sinisa Jagodic
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
| | - Bosko Djukanovic
- Departments of Cardiac Surgery (Drs. Djukanovic, Jovanovic, Micovic, Nezic, and Vukovic), Vascular Surgery (Dr. Lozuk), and Anesthesiology (Dr. Jagodic), Cardiovascular Institute Dedinje, 11000 Belgrade, Serbia
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Cagli K, Gedik HS, Korkmaz K, Budak B, Yener U, Lafci G. Transventricular mitral valve repair in patients with acute forms of ischemic mitral regurgitation. Tex Heart Inst J 2014; 41:312-5. [PMID: 24955051 DOI: 10.14503/thij-13-3201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transventricular mitral valve surgery combined with left ventricular restoration avoids atriotomy and provides a larger operative field. We describe a series of 5 patients in whom we performed transventricular mitral valve repair by various techniques, such as band annuloplasty, papillary muscle reattachment, chordal cutting, and edge-to-edge repair. The more acute forms of ischemic mitral regurgitation, as found in our patients, can coexist with post-myocardial infarction contained rupture or post-myocardial infarction ventricular septal rupture. Because these patients already have an indication for ventriculotomy, concomitant transventricular repair of the mitral valve can render a separate atriotomy unnecessary and thereby shorten the duration of cardiopulmonary bypass. Moreover, in patients with acute presentations, the absence of atrial dilation (this last associated with chronic cases) might make transventricular repair a better choice than the more difficult atrial approach.
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Affiliation(s)
- Kerim Cagli
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Hikmet Selcuk Gedik
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Kemal Korkmaz
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Baran Budak
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Umit Yener
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
| | - Gokhan Lafci
- Department of Cardiovascular Surgery (Drs. Cagli and Lafci), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Cagli), Hitit University, 19000 Corum; and Department of Cardiovascular Surgery (Drs. Budak, Gedik, Korkmaz, and Yener), Ankara Numune Research and Education Hospital, 06100 Ankara; Turkey
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Prins HAB, Mugo P, Wahome E, Mwashigadi G, Thiong'o A, Smith A, Sanders EJ, Graham SM. Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice. Int Health 2014; 6:82-92. [PMID: 24842982 PMCID: PMC4049276 DOI: 10.1093/inthealth/ihu024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.
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Affiliation(s)
- Henrieke A B Prins
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Peter Mugo
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Grace Mwashigadi
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Alexander Thiong'o
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Adrian Smith
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7BN, UK
| | - Eduard J Sanders
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Susan M Graham
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya University of Washington, Seattle, WA 98195, USA
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