This randomized trial compared outcomes of 539 European patients with acute ischemic stroke treated with either endovascular treatment (EVT) alone or intravenous alteplase followed by EVT. The trial found no significant difference in functional outcomes at 90 days between the two treatment groups as measured by the modified Rankin scale. Rates of death and symptomatic intracerebral hemorrhage were also similar between groups. Therefore, the trial demonstrated that EVT alone was neither superior nor non-inferior to intravenous alteplase followed by EVT for acute ischemic stroke patients in Europe.
This randomized controlled trial studied 998 patients with septic shock to compare mortality outcomes of a lower hemoglobin threshold (7 g/dL) versus a higher threshold (9 g/dL) for red blood cell transfusion. Patients received single unit transfusions when their hemoglobin level fell below the assigned threshold. The lower threshold group received fewer median transfusions (1 unit) than the higher threshold group (4 units). At 90 days, mortality was similar between the groups, with 43.0% of the lower threshold group and 45.0% of the higher threshold group deceased. Rates of ischemic events and life support use were also similar between the groups. The study found that a lower hemoglobin threshold for transfusion in
Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the legs. It can be classified as proximal or distal based on location. Risk factors include age, immobilization, surgery, cancer, prior history of DVT, and genetic factors. Symptoms range from mild leg pain and swelling to severe cases involving skin discoloration. Diagnosis involves a clinical probability assessment, D-dimer testing, and ultrasound imaging of the legs. Treatment consists of anticoagulation medications to prevent clot propagation and reduce risk of pulmonary embolism, with options including heparin, low molecular weight heparin, and novel oral anticoagulants.
This document describes a study that derived and validated a new severity assessment model called CURB-65 for stratifying patients with community acquired pneumonia (CAP) into different risk groups upon hospital admission. The study combined data from previous CAP studies involving over 1000 patients. Using logistic regression, factors independently associated with 30-day mortality were identified as age over 65, albumin level under 30 g/dl, and CURB score over 2 (which evaluates confusion, urea, respiratory rate, blood pressure). These factors were used to create the CURB-65 score, which stratifies patients into risk groups from 0.7% to 57% 30-day mortality risk based on their score. The validation cohort confirmed similar mortality risks based on
Guidelines for the use of echocardiography as a monitor for therapeutic inter...Alexandra Victoria
This document provides guidelines for using echocardiography as a monitoring tool to guide therapy in critically ill patients. It outlines specific echocardiographic parameters that can be used for hemodynamic monitoring, including left ventricular dimensions, inferior vena cava size and collapsibility, mitral inflow, tissue Doppler imaging, and calculated parameters like stroke volume, cardiac output, and pulmonary artery pressure. The guidelines discuss advantages and recommendations for echocardiography as a monitoring tool and provide examples of its use in clinical scenarios such as acute congestive heart failure, critical care, pericardial tamponade, and various perioperative settings.
The prevalence of venous thromboembolism (VTE) in patients with severe novel coronavirus pneumonia (NCP) in the intensive care unit of a hospital in Wuhan, China was studied. The incidence of VTE in these 81 patients was 25% (20 patients). Patients with VTE tended to be older, have lower lymphocyte counts, longer activated partial thromboplastin time, and higher D-dimer levels. An elevated D-dimer level above 1.5 μg/mL predicted VTE with 85% sensitivity and 88.5% specificity. This study suggests VTE is common in severe NCP patients and D-dimer can help identify those at high risk.
This document discusses using intrathoracic impedance measures from implantable cardiac devices to monitor changes in intravascular fluid volume during volume reduction therapy for heart failure patients. It found that two impedance vectors, between the right atrial ring to left ventricular ring and the left ventricular ring to right ventricular ring, were most closely associated with changes in plasma volume as measured by hematocrit levels. Monitoring these specific impedance vectors may help more accurately guide volume reduction therapy by tracking changes in the intravascular fluid compartment.
This document summarizes a study that evaluated the use of 256 slice MDCT pulmonary angiography (MDCT-PA) to diagnose pulmonary embolism (PE) in 100 unselected patients with clinically suspected PE. The study found that 35% of patients had thromboembolic disease, with 32% having acute PE and 8% having acute deep vein thrombosis (DVT). MDCT-PA allowed direct visualization of thrombi in the pulmonary arteries and veins. The study concludes that MDCT-PA is an effective first-line imaging method for evaluating patients suspected of having a PE due to its non-invasive nature and ability to directly identify thrombotic material.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
This randomized controlled trial studied 998 patients with septic shock to compare mortality outcomes of a lower hemoglobin threshold (7 g/dL) versus a higher threshold (9 g/dL) for red blood cell transfusion. Patients received single unit transfusions when their hemoglobin level fell below the assigned threshold. The lower threshold group received fewer median transfusions (1 unit) than the higher threshold group (4 units). At 90 days, mortality was similar between the groups, with 43.0% of the lower threshold group and 45.0% of the higher threshold group deceased. Rates of ischemic events and life support use were also similar between the groups. The study found that a lower hemoglobin threshold for transfusion in
Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the legs. It can be classified as proximal or distal based on location. Risk factors include age, immobilization, surgery, cancer, prior history of DVT, and genetic factors. Symptoms range from mild leg pain and swelling to severe cases involving skin discoloration. Diagnosis involves a clinical probability assessment, D-dimer testing, and ultrasound imaging of the legs. Treatment consists of anticoagulation medications to prevent clot propagation and reduce risk of pulmonary embolism, with options including heparin, low molecular weight heparin, and novel oral anticoagulants.
This document describes a study that derived and validated a new severity assessment model called CURB-65 for stratifying patients with community acquired pneumonia (CAP) into different risk groups upon hospital admission. The study combined data from previous CAP studies involving over 1000 patients. Using logistic regression, factors independently associated with 30-day mortality were identified as age over 65, albumin level under 30 g/dl, and CURB score over 2 (which evaluates confusion, urea, respiratory rate, blood pressure). These factors were used to create the CURB-65 score, which stratifies patients into risk groups from 0.7% to 57% 30-day mortality risk based on their score. The validation cohort confirmed similar mortality risks based on
Guidelines for the use of echocardiography as a monitor for therapeutic inter...Alexandra Victoria
This document provides guidelines for using echocardiography as a monitoring tool to guide therapy in critically ill patients. It outlines specific echocardiographic parameters that can be used for hemodynamic monitoring, including left ventricular dimensions, inferior vena cava size and collapsibility, mitral inflow, tissue Doppler imaging, and calculated parameters like stroke volume, cardiac output, and pulmonary artery pressure. The guidelines discuss advantages and recommendations for echocardiography as a monitoring tool and provide examples of its use in clinical scenarios such as acute congestive heart failure, critical care, pericardial tamponade, and various perioperative settings.
The prevalence of venous thromboembolism (VTE) in patients with severe novel coronavirus pneumonia (NCP) in the intensive care unit of a hospital in Wuhan, China was studied. The incidence of VTE in these 81 patients was 25% (20 patients). Patients with VTE tended to be older, have lower lymphocyte counts, longer activated partial thromboplastin time, and higher D-dimer levels. An elevated D-dimer level above 1.5 μg/mL predicted VTE with 85% sensitivity and 88.5% specificity. This study suggests VTE is common in severe NCP patients and D-dimer can help identify those at high risk.
This document discusses using intrathoracic impedance measures from implantable cardiac devices to monitor changes in intravascular fluid volume during volume reduction therapy for heart failure patients. It found that two impedance vectors, between the right atrial ring to left ventricular ring and the left ventricular ring to right ventricular ring, were most closely associated with changes in plasma volume as measured by hematocrit levels. Monitoring these specific impedance vectors may help more accurately guide volume reduction therapy by tracking changes in the intravascular fluid compartment.
This document summarizes a study that evaluated the use of 256 slice MDCT pulmonary angiography (MDCT-PA) to diagnose pulmonary embolism (PE) in 100 unselected patients with clinically suspected PE. The study found that 35% of patients had thromboembolic disease, with 32% having acute PE and 8% having acute deep vein thrombosis (DVT). MDCT-PA allowed direct visualization of thrombi in the pulmonary arteries and veins. The study concludes that MDCT-PA is an effective first-line imaging method for evaluating patients suspected of having a PE due to its non-invasive nature and ability to directly identify thrombotic material.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
Cerebral Venous Thrombosis in a Mexican Multicenter Registry of Acute Cerebro...Erwin Chiquete, MD, PhD
Background: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular
disease that is usually not mentioned in multicenter registries on all-type acute
stroke. We aimed to describe the experience on hospitalized patients with CVT in
a Mexican multicenter registry on acute cerebrovascular disease. Methods: CVT
patients were selected from the RENAMEVASC registry, which was conducted
between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging,
and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed.
Results: Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had
CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%),
contraceptive use (18%), and pregnancy (12%) were the main risk factors in women.
In 67% of men, CVTwas registered as idiopathic, but thrombophilia assessment was
suboptimal. Longitudinal superior sinus was the most frequent thrombosis location
(78%). Extensive (.5 cm) venous infarction occurred in 36% of patients. Only 81% of
patients received anticoagulation since the acute phase, and 3% needed decompressive
craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic
thromboembolism (8.5%) were the main in-hospital complications. The 30-day case
fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards
model, only age ,40 years was associated with a mRS score of 0 to 2 (functional independence;
rate ratio, 3.46; 95% CI, 1.34-8.92). Conclusions: The relative frequency
of CVT and the associated in-hospital complications were higher than in other registries.
Thrombophilia assessment and acute treatment was suboptimal. Young age
is the main determinant of a good short-term outcome.
1. A study of 6,856 patients who received intravenous thrombolysis for acute ischemic stroke from 10 European centers found that treatment within 90 minutes of symptom onset was independently associated with excellent 3-month outcome in patients with moderate (NIHSS 7-12) and mild (NIHSS 0-6) stroke severity.
2. For patients with NIHSS 7-12, treatment within 90 minutes was associated with a 37% higher likelihood of excellent outcome compared to later treatment.
3. For patients with mild symptoms (NIHSS 0-6), treatment within 90 minutes was associated with a 51% higher likelihood of full recovery (mRS=0) to overcome the ceiling effect of spontaneous good recovery
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
This study assessed the relationship between electrocardiographic (ECG) left ventricular hypertrophy (LVH) and blood pressure (BP) control in 17,312 hypertensive patients from China. 1) 8.1% of patients had ECG-LVH, which was more prevalent in males. 2) Patients with ECG-LVH had a significantly higher rate of unsatisfactory BP control, with an odds ratio of 1.42, compared to those without ECG-LVH. 3) Notable differences in BP control were also seen between males and females and in patients with diabetes, with ECG-LVH patients having poorer control.
Does Type of Dialysis Affect BNP in Fluid Overload Patients?Premier Publishers
This study investigated how type of dialysis affects brain natriuretic peptide (BNP) levels in fluid overload patients. The study compared 24 hemodialysis patients and 35 peritoneal dialysis patients. It found that BNP, left ventricular mass, and left ventricular mass index levels were significantly higher in hemodialysis patients, possibly due to hemodynamic changes during hemodialysis. BNP levels correlated with left ventricular mass index in both hemodialysis and peritoneal dialysis patients. Predialysis BNP levels in hemodialysis patients were significantly higher than postdialysis levels. The type of dialysis had a significant effect on BNP levels regardless of whether patients had hypertension.
This study evaluated the incidence of thrombotic complications in 184 critically ill ICU patients with COVID-19 pneumonia in 3 Dutch hospitals. The cumulative incidence of venous thromboembolism (VTE) or arterial thrombotic events was 31%, with pulmonary embolism being the most common complication. Independent risk factors for thrombotic complications included older age and coagulopathy. Despite prophylactic anticoagulation, the 31% incidence of thrombotic complications was remarkably high, suggesting thrombotic risks are elevated in critically ill COVID-19 patients and more intensive prophylaxis may be needed.
This study evaluated the performance of 239 bipolar steroid-eluting epicardial pacing leads implanted in 114 pediatric patients over up to 12.2 years. The leads demonstrated low median pacing thresholds below 1.2 V and excellent sensing characteristics. Lead survival was 99% and 94% at 2 and 5 years for atrial leads, and 96% and 85% for ventricular leads. Subanalysis showed superior sensing for left ventricular leads. The leads provide an alternative approach for permanent pacing in children, with favorable longevity considering patient growth.
This document provides a summary of the November 2014 issue of the UTSW Internal Medicine Journal Watch. It includes summaries of articles on topics such as assessing acid-base disturbances, managing Staphylococcus aureus bacteremia, community acquired pneumonia, predicting hepatocellular carcinoma in hepatitis C patients, and guidelines for prioritizing patients for new hepatitis C treatments. It also reviews articles related to infectious diseases, critical care, nephrology, cardiology, and more.
Statin therapy associated with improved thrombus resolution in patients with ...TÀI LIỆU NGÀNH MAY
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tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
This study evaluated the use of hand-held echocardiography (HHE) as point-of-care ultrasound scanning (POCUS) to detect potential sources of embolism in 130 patients with non-lacunar ischemic stroke within 24 hours of onset. Main sources of embolism (MSEs) detected by HHE included embolic valvulopathies and severe ventricular dysfunction, and were confirmed in 19.23% of patients by comparison with transthoracic echocardiography (TTE). Large vessel occlusion and chronic heart failure independently predicted the detection of MSEs. HHE also identified an enlarged left atrium as an independent predictor of later detection of atrial fibrillation in patients
This randomized, double-blind, placebo-controlled trial evaluated the effects of transendocardial delivery of autologous bone marrow mononuclear cells (BMCs) in 92 patients with chronic heart failure. The primary objectives were to determine if BMC administration improved left ventricular end-systolic volume (LVESV), maximal oxygen consumption, or reversibility of perfusion defects on single-photon emission computed tomography (SPECT) compared to placebo at 6 months. Results showed no statistically significant differences between the BMC and placebo groups in changes in LVESV, maximal oxygen consumption, or reversible defect size by SPECT. There were also no differences in any secondary outcomes, including echocardiographic or clinical measures. Thus, tran
This study evaluated the effects of prenatal corticosteroid treatment on 56 fetuses diagnosed with isolated congenital atrioventricular block (CAVB) in the Netherlands between 2003-2013. The study found no differences in outcomes between fetuses treated with dexamethasone (n=14) and those receiving expectant management (n=42). Specifically, there were no differences in rates of AV block progression, survival to birth, pacemaker implantation, or development of dilated cardiomyopathy. However, fetuses treated with dexamethasone demonstrated more in utero growth restriction. The data provide no evidence to support routine prenatal corticosteroid treatment for isolated CAVB.
This study compared the effects of levosimendan, dobutamine, and vasodilator therapy on ongoing myocardial injury in patients with acute decompensated heart failure. The study found that while all treatments were associated with decreases in cardiac troponin I levels and improvements in hemodynamic and functional indicators, levosimendan treatment showed the most pronounced improvements, especially in left ventricular ejection fraction and systolic pulmonary artery pressure. However, none of the treatments significantly reduced cardiac troponin I levels compared to each other. The study demonstrated beneficial effects of short-term use of levosimendan, dobutamine, and nitroglycerin on ongoing myocardial injury in acute decompensated heart failure.
This study summarizes a case series of 394 young stroke patients aged 14-47 years who were admitted to a hospital in Rome, Italy between 1992-2001. The annual incidence of young stroke was found to be 8.8 per 100,000 people. Common risk factors included smoking (56%), hypertension (23%), and oral contraceptive use (38% of women). The most common causes of stroke were determined to be cardioembolism (34%), atherothrombosis (12%), and non-atherosclerotic vasculopathies like arterial dissection (14%). Despite limitations, the study highlights the importance of thorough diagnostic evaluation for determining the cause of young ischemic strokes.
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
Aim: To study the value of BNP as a screening tool to identify silent ischemia and diastolic dysfunction in asymptomatic type II
diabetic patients.
Objectives: The objective of the study is how far BNP value will be useful in early detection of LV dysfunction and ischemia without subjecting the patient to treadmill test and ECHO, as both are even though specific but not sensitive. Our effort is to identify a simple blood test which is highly sensitive in identifying them.
Prognosis of pulmonary arterial hypertensiongisa_legal
1) The expected survival of patients with pulmonary arterial hypertension (PAH) varies based on the underlying cause, with idiopathic PAH having a median survival of 2.8 years based on historical studies.
2) Medical therapies like epoprostenol have improved survival rates, with studies showing 1, 2, and 3 year survival rates with epoprostenol between 63-87%, compared to 27-52% historically.
3) The prognosis is worse for PAH associated with scleroderma or collagen vascular diseases, with median survival around 1-2 years, while PAH associated with congenital heart disease has a better prognosis, with reported 3 year survival of 77%.
The recalibrated thoracic revised cardiac risk index (ThRCRI) aims to predict cardiac risk for patients undergoing lung resection. This study externally validates the ThRCRI in 2,621 patients who underwent lobectomy or pneumonectomy. Patients were grouped into four risk classes by the ThRCRI. The incidence of major cardiac complications increased from 0.9% in the lowest risk class to 18% in the highest risk class, demonstrating the ThRCRI's ability to stratify risk. Bootstrapping analysis supported the ThRCRI's reliability in predicting cardiac risk across different patient populations. The ThRCRI is a useful tool for identifying patients needing further cardiac testing before lung resection.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
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Similar to alteplase antes de terapia endovascular.pdf
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
Cerebral Venous Thrombosis in a Mexican Multicenter Registry of Acute Cerebro...Erwin Chiquete, MD, PhD
Background: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular
disease that is usually not mentioned in multicenter registries on all-type acute
stroke. We aimed to describe the experience on hospitalized patients with CVT in
a Mexican multicenter registry on acute cerebrovascular disease. Methods: CVT
patients were selected from the RENAMEVASC registry, which was conducted
between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging,
and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed.
Results: Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had
CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%),
contraceptive use (18%), and pregnancy (12%) were the main risk factors in women.
In 67% of men, CVTwas registered as idiopathic, but thrombophilia assessment was
suboptimal. Longitudinal superior sinus was the most frequent thrombosis location
(78%). Extensive (.5 cm) venous infarction occurred in 36% of patients. Only 81% of
patients received anticoagulation since the acute phase, and 3% needed decompressive
craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic
thromboembolism (8.5%) were the main in-hospital complications. The 30-day case
fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards
model, only age ,40 years was associated with a mRS score of 0 to 2 (functional independence;
rate ratio, 3.46; 95% CI, 1.34-8.92). Conclusions: The relative frequency
of CVT and the associated in-hospital complications were higher than in other registries.
Thrombophilia assessment and acute treatment was suboptimal. Young age
is the main determinant of a good short-term outcome.
1. A study of 6,856 patients who received intravenous thrombolysis for acute ischemic stroke from 10 European centers found that treatment within 90 minutes of symptom onset was independently associated with excellent 3-month outcome in patients with moderate (NIHSS 7-12) and mild (NIHSS 0-6) stroke severity.
2. For patients with NIHSS 7-12, treatment within 90 minutes was associated with a 37% higher likelihood of excellent outcome compared to later treatment.
3. For patients with mild symptoms (NIHSS 0-6), treatment within 90 minutes was associated with a 51% higher likelihood of full recovery (mRS=0) to overcome the ceiling effect of spontaneous good recovery
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
This study assessed the relationship between electrocardiographic (ECG) left ventricular hypertrophy (LVH) and blood pressure (BP) control in 17,312 hypertensive patients from China. 1) 8.1% of patients had ECG-LVH, which was more prevalent in males. 2) Patients with ECG-LVH had a significantly higher rate of unsatisfactory BP control, with an odds ratio of 1.42, compared to those without ECG-LVH. 3) Notable differences in BP control were also seen between males and females and in patients with diabetes, with ECG-LVH patients having poorer control.
Does Type of Dialysis Affect BNP in Fluid Overload Patients?Premier Publishers
This study investigated how type of dialysis affects brain natriuretic peptide (BNP) levels in fluid overload patients. The study compared 24 hemodialysis patients and 35 peritoneal dialysis patients. It found that BNP, left ventricular mass, and left ventricular mass index levels were significantly higher in hemodialysis patients, possibly due to hemodynamic changes during hemodialysis. BNP levels correlated with left ventricular mass index in both hemodialysis and peritoneal dialysis patients. Predialysis BNP levels in hemodialysis patients were significantly higher than postdialysis levels. The type of dialysis had a significant effect on BNP levels regardless of whether patients had hypertension.
This study evaluated the incidence of thrombotic complications in 184 critically ill ICU patients with COVID-19 pneumonia in 3 Dutch hospitals. The cumulative incidence of venous thromboembolism (VTE) or arterial thrombotic events was 31%, with pulmonary embolism being the most common complication. Independent risk factors for thrombotic complications included older age and coagulopathy. Despite prophylactic anticoagulation, the 31% incidence of thrombotic complications was remarkably high, suggesting thrombotic risks are elevated in critically ill COVID-19 patients and more intensive prophylaxis may be needed.
This study evaluated the performance of 239 bipolar steroid-eluting epicardial pacing leads implanted in 114 pediatric patients over up to 12.2 years. The leads demonstrated low median pacing thresholds below 1.2 V and excellent sensing characteristics. Lead survival was 99% and 94% at 2 and 5 years for atrial leads, and 96% and 85% for ventricular leads. Subanalysis showed superior sensing for left ventricular leads. The leads provide an alternative approach for permanent pacing in children, with favorable longevity considering patient growth.
This document provides a summary of the November 2014 issue of the UTSW Internal Medicine Journal Watch. It includes summaries of articles on topics such as assessing acid-base disturbances, managing Staphylococcus aureus bacteremia, community acquired pneumonia, predicting hepatocellular carcinoma in hepatitis C patients, and guidelines for prioritizing patients for new hepatitis C treatments. It also reviews articles related to infectious diseases, critical care, nephrology, cardiology, and more.
Statin therapy associated with improved thrombus resolution in patients with ...TÀI LIỆU NGÀNH MAY
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https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
This study evaluated the use of hand-held echocardiography (HHE) as point-of-care ultrasound scanning (POCUS) to detect potential sources of embolism in 130 patients with non-lacunar ischemic stroke within 24 hours of onset. Main sources of embolism (MSEs) detected by HHE included embolic valvulopathies and severe ventricular dysfunction, and were confirmed in 19.23% of patients by comparison with transthoracic echocardiography (TTE). Large vessel occlusion and chronic heart failure independently predicted the detection of MSEs. HHE also identified an enlarged left atrium as an independent predictor of later detection of atrial fibrillation in patients
This randomized, double-blind, placebo-controlled trial evaluated the effects of transendocardial delivery of autologous bone marrow mononuclear cells (BMCs) in 92 patients with chronic heart failure. The primary objectives were to determine if BMC administration improved left ventricular end-systolic volume (LVESV), maximal oxygen consumption, or reversibility of perfusion defects on single-photon emission computed tomography (SPECT) compared to placebo at 6 months. Results showed no statistically significant differences between the BMC and placebo groups in changes in LVESV, maximal oxygen consumption, or reversible defect size by SPECT. There were also no differences in any secondary outcomes, including echocardiographic or clinical measures. Thus, tran
This study evaluated the effects of prenatal corticosteroid treatment on 56 fetuses diagnosed with isolated congenital atrioventricular block (CAVB) in the Netherlands between 2003-2013. The study found no differences in outcomes between fetuses treated with dexamethasone (n=14) and those receiving expectant management (n=42). Specifically, there were no differences in rates of AV block progression, survival to birth, pacemaker implantation, or development of dilated cardiomyopathy. However, fetuses treated with dexamethasone demonstrated more in utero growth restriction. The data provide no evidence to support routine prenatal corticosteroid treatment for isolated CAVB.
This study compared the effects of levosimendan, dobutamine, and vasodilator therapy on ongoing myocardial injury in patients with acute decompensated heart failure. The study found that while all treatments were associated with decreases in cardiac troponin I levels and improvements in hemodynamic and functional indicators, levosimendan treatment showed the most pronounced improvements, especially in left ventricular ejection fraction and systolic pulmonary artery pressure. However, none of the treatments significantly reduced cardiac troponin I levels compared to each other. The study demonstrated beneficial effects of short-term use of levosimendan, dobutamine, and nitroglycerin on ongoing myocardial injury in acute decompensated heart failure.
This study summarizes a case series of 394 young stroke patients aged 14-47 years who were admitted to a hospital in Rome, Italy between 1992-2001. The annual incidence of young stroke was found to be 8.8 per 100,000 people. Common risk factors included smoking (56%), hypertension (23%), and oral contraceptive use (38% of women). The most common causes of stroke were determined to be cardioembolism (34%), atherothrombosis (12%), and non-atherosclerotic vasculopathies like arterial dissection (14%). Despite limitations, the study highlights the importance of thorough diagnostic evaluation for determining the cause of young ischemic strokes.
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
Aim: To study the value of BNP as a screening tool to identify silent ischemia and diastolic dysfunction in asymptomatic type II
diabetic patients.
Objectives: The objective of the study is how far BNP value will be useful in early detection of LV dysfunction and ischemia without subjecting the patient to treadmill test and ECHO, as both are even though specific but not sensitive. Our effort is to identify a simple blood test which is highly sensitive in identifying them.
Prognosis of pulmonary arterial hypertensiongisa_legal
1) The expected survival of patients with pulmonary arterial hypertension (PAH) varies based on the underlying cause, with idiopathic PAH having a median survival of 2.8 years based on historical studies.
2) Medical therapies like epoprostenol have improved survival rates, with studies showing 1, 2, and 3 year survival rates with epoprostenol between 63-87%, compared to 27-52% historically.
3) The prognosis is worse for PAH associated with scleroderma or collagen vascular diseases, with median survival around 1-2 years, while PAH associated with congenital heart disease has a better prognosis, with reported 3 year survival of 77%.
The recalibrated thoracic revised cardiac risk index (ThRCRI) aims to predict cardiac risk for patients undergoing lung resection. This study externally validates the ThRCRI in 2,621 patients who underwent lobectomy or pneumonectomy. Patients were grouped into four risk classes by the ThRCRI. The incidence of major cardiac complications increased from 0.9% in the lowest risk class to 18% in the highest risk class, demonstrating the ThRCRI's ability to stratify risk. Bootstrapping analysis supported the ThRCRI's reliability in predicting cardiac risk across different patient populations. The ThRCRI is a useful tool for identifying patients needing further cardiac testing before lung resection.
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