Clinical Medicine Insights. Cardiology最新文献

{"title":"Impact of Comorbidity Burden on Cardiac Implantable Electronic Devices Outcomes.","authors":"Temitope Ajibawo,&nbsp;Oluwatimilehin Okunowo,&nbsp;Adeniyi Okunade","doi":"10.1177/11795468221108212","DOIUrl":"https://doi.org/10.1177/11795468221108212","url":null,"abstract":"Background: There is limited data on the impact of comorbidity burden on clinical outcomes of patients undergoing cardiac implantable electronic devices (CIED) implantation. Objectives: Our aim was to assess trends in CIED implantations and explore the relationship between comorbidity burden and outcomes in patients undergoing de novo implantations. Methods: Using the National Inpatient Sample database from 2000 to 2014, we identified adults ⩾18 years undergoing de novo CIED procedures. Comorbidity burden was assessed by Charlson comorbidity Index (CCI), and patients were classified into 4 categories based on their CCI scores (CCI = 0, CCI = 1, CCI = 2, CCI ⩾3). Annual implantation trends were evaluated. Logistic regression was conducted to measure the association between categorized comorbidity burden and outcomes. Results: A total of 3 103 796 de-novo CIED discharge records were identified from the NIS database. About 22.4% had a CCI score of 0, 28.2% had a CCI score of 1, 22% had a CCI score of 2, and 27.4 % had a CCI score ⩾3. Annual de-novo CIED implantations peaked in 2006 and declined steadily from 2010 to 2014. Compared to CCI 0, CCI ⩾3 was independently associated with increased odds of in-hospital mortality, bleeding, pericardial, and cardiac complications (all P < .05). Length of stay and hospital charges increased with increasing comorbidity burden. Conclusions: CCI is a significant predictor of adverse outcomes after CIED implantation. Therefore, comorbidity burden needs to be considered in the decision-making process for CIED implant candidates.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":" ","pages":"11795468221108212"},"PeriodicalIF":3.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bf/f6/10.1177_11795468221108212.PMC9247999.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40467815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Spike Protein-Related Myocarditis Becoming a Common Disease?","authors":"Doepp, Manfred Md","doi":"10.52845/cmi/2022-3-1-5","DOIUrl":"https://doi.org/10.52845/cmi/2022-3-1-5","url":null,"abstract":"","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"33 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74494332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary malignant largeB-cell non-Hodgkin’s lymphoma of the scalpand cranial vault: a case report and an overview","authors":"Mehdi Borni","doi":"10.52845/cmi/2022-3-1-1","DOIUrl":"https://doi.org/10.52845/cmi/2022-3-1-1","url":null,"abstract":"","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78687028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of the nutritionalstatus of end-stage renal disease patients onmaintenance hemodialysis in Hawary Kidney center and nephrology unit atBenghazi Medical Center","authors":"Safia S. Elramli","doi":"10.52845/cmi/2022-3-1-4","DOIUrl":"https://doi.org/10.52845/cmi/2022-3-1-4","url":null,"abstract":"Background: Malnutrition, which is a powerful predictor of morbidity and mortality, is common in patients undergoing hemodialysis. There-fore, adequate nutrition is very important for such patients. Nutritional management in hemodialysis patients is a very important factor for prognosis , a better overall outcome and quality of life. Objectives: The current study mainly aimed to determine the nutritional status and prevalence of malnutrition and to investigate the relationship between nutritional markers, anthropometric parameters such as body mass index (BMI), and routine laboratory parameters with SGA in patients undergoing hemodialysis. Patients and Methods: A cross-sectional study was carried out on HD patients in Hawari Nephro Center and Nephro Unit of Beng-hazi Medical Center from December 2019 to January 2020. A total of 155 HD patients were recruited for this study and assessed for nutritional status include both Male and females aged 18 years and over with regular hemodialysis. Outcome measures: Measurements included questionnaire that elicited information on social demographic characteristics, Patient’s medical history , and duration of hemodialysis. Anthropometry, biochemical parameters were measured. Seven-Point Subjective Global Assessment (7-point SGA) was used to assess the nutritional state of HD patients. Biochemical tests were obtained during the study period from medical files of the studied patients. Data were analyzed using descriptive statistics. The Chi-Square test was applied to examine the study data. Results: Data shows that 58% of HDP were well-nourished while the remaining 39%, 3%had mild-to-severe malnutrition. Regarding the prevalence of malnutrition in both gender, males group was mor preva-lent of malnourished than female group. SGA score results indicated some significant correlations with patient’s post dialysis BMI and albumin ,however, there was a negative correlation between demographic characteristics as gender, income, education level, comorbid disease , clinical variable such as duration and frequency of HD and some biochemical tests as electrolytes, phosphorous ,hemoglobin, cholesterol with SGA scores. In addition, results show that insignificant correlation between nutrients intake, meals pattern of HD patients with SGA. Conclusions: Observations of nutritional status are necessary to maintain the health status of dialysis patients. Every strategy should be used to avoid complications of hemodialysis manifested in uremic state including anorexia, nausea, vomiting leading to malnutrition, fluid and electrolyte imbalance leading to volume overload, hyperkalemia, metabolic acidosis, and hyperphosphatemia, as well as abnormalities related to hormonal or systemic dysfunction such as hypertension, anemia, hyperlipidemia, and bone disease, Timely diagnosis of protein-energy-wasting (PEW) is important for early initiation of nutritional intervention and treatment. In addition, education plans should be prepared t","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"94 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90436484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Update on Vasoactive Medication in the Management of Cardiogenic Shock.","authors":"Aditi Shankar,&nbsp;Gayathri Gurumurthy,&nbsp;Lakshmi Sridharan,&nbsp;Divya Gupta,&nbsp;William J Nicholson,&nbsp;Wissam A Jaber,&nbsp;Saraschandra Vallabhajosyula","doi":"10.1177/11795468221075064","DOIUrl":"https://doi.org/10.1177/11795468221075064","url":null,"abstract":"<p><p>This is a focused review looking at the pharmacological support in cardiogenic shock. There are a plethora of data evaluating vasopressors and inotropes in septic shock, but the data are limited for cardiogenic shock. This review article describes in detail the pathophysiology of cardiogenic shock, the mechanism of action of different vasopressors and inotropes emphasizing their indications and potential side effects. This review article incorporates the currently used specific risk-prediction models in cardiogenic shock as well as integrates data from many trials on the use of vasopressors and inotropes. Lastly, this review seeks to discuss the future direction for vasoactive medications in cardiogenic shock.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":" ","pages":"11795468221075064"},"PeriodicalIF":3.0,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/8d/10.1177_11795468221075064.PMC8829716.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39620379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post Myocardial Infarction Ventricular Septal Rupture Revealed By Acute Liver Failure Symptoms: A Case Report.","authors":"Leila Haddar,&nbsp;Amine Bouchlarhem,&nbsp;Salma Bouyaddid,&nbsp;Asmae Kasimi,&nbsp;Noureddine Oulali,&nbsp;Noha El Ouafi,&nbsp;Nabila Ismaili","doi":"10.1177/11795468221075059","DOIUrl":"https://doi.org/10.1177/11795468221075059","url":null,"abstract":"<p><strong>Introduction: </strong>The mechanical complications of acute myocardial infarction (AMI) still kill despite the evolution of medicine. Early diagnosis and adequate management are necessary to improve the prognosis, and this requires first, a good clinical examination that should raise the suspicion of a mechanical complication, then the echocardiography is performed to confirm the diagnosis.</p><p><strong>Case presentation: </strong>We present a case of a 64-year-old patient admitted to the emergency room for jaundice with delayed ST-segment elevation myocardial infarction (STEMI). Physical examination revealed signs of right heart failure, which led us to associate jaundice with signs of acute liver failure secondary to right heart failure. Echocardiography confirmed the diagnosis of a ventricular septal rupture (VSR) with left-right shunt, and a significant dilation of the right ventricle. The patient underwent surgical closure of the VSR with fatal evolution.</p><p><strong>Discussion: </strong>VSR is a rare life-threatening mechanical complication of AMI. The clinical signs depend on the left-right shunt and the onset of heart failure, which are 2 major determinants of the therapeutic strategy and the timing of the surgery. Despite surgical closure of the VSR, the mortality remains high, but the prognosis is better in patients treated with surgery than in patients who are treated medically only.</p><p><strong>Conclusion: </strong>The clinical presentation of VSR may differ from a patient to another. Good clinical sense and echocardiography are essential to set early diagnosis, and thus decide on the adequate management at the right time.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":" ","pages":"11795468221075059"},"PeriodicalIF":3.0,"publicationDate":"2022-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/e1/10.1177_11795468221075059.PMC8808021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39770208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management.","authors":"Joseph Assad,&nbsp;Giuseppe Femia,&nbsp;Patrick Pender,&nbsp;Tamer Badie,&nbsp;Rohan Rajaratnam","doi":"10.1177/11795468211065782","DOIUrl":"https://doi.org/10.1177/11795468211065782","url":null,"abstract":"<p><p>Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":" ","pages":"11795468211065782"},"PeriodicalIF":3.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/a6/10.1177_11795468211065782.PMC8733363.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39888936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Peek at LVADs Pumping to Recovery.","authors":"Samiullah Arshad,&nbsp;Rachel D Cutting,&nbsp;Daniel J Stephens,&nbsp;Ythan H Goldberg,&nbsp;Claudius Mahr,&nbsp;Mahender Vyasabattu,&nbsp;Ahmed H Abdelfattah,&nbsp;Gaurang N Vaidya","doi":"10.1177/11795468221144352","DOIUrl":"https://doi.org/10.1177/11795468221144352","url":null,"abstract":"<p><p>Left ventricular assist devices (LVADs) have revolutionized the management of patients with advanced heart failure refractory to medical therapy. Current indications of LVADs include Bridge to Transplantation (BTT), Destination Therapy (DT) for long-term use, Bridge to the Decision (BTD) used as a temporary measure, and lastly Bridge to Recovery (BTR). Here, we briefly review the clinical evidence and the molecular mechanisms behind myocardial recovery following LVAD placement. We also share institutional protocols used at 2 major medical centers in the USA.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"16 ","pages":"11795468221144352"},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/e4/10.1177_11795468221144352.PMC9806425.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10839644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myxedema Coma: A Rare Case of Shock Post-Pericardial Window Procedure.","authors":"Blerina Asllanaj,&nbsp;Mark Olson,&nbsp;Yi McWhorter","doi":"10.1177/11795468221141302","DOIUrl":"https://doi.org/10.1177/11795468221141302","url":null,"abstract":"<p><p>The clinical features of severe hypothyroidism vary in presentation, ranging from subclinical symptoms to multiorgan failure referred to as myxedema coma. The cornerstone treatments of myxedema coma include aggressive thyroid hormone replacement combined with excellent supportive care in the intensive care unit. We report a rare case of a 56-year-old female with history of hypothyroidism treated with levothyroxine, who developed myxedema coma post-pericardial window surgery for a large pericardial effusion. She was supported with substantial doses of vasopressors and inotropes for shock. In addition, she was initiated on lung-protection ventilation for acute respiratory distress syndrome. After the diagnosis of myxedema coma was made, she was started on intravenous levothyroxine and hydrocortisone with great sustained clinical response. This case illustrated myxedema coma as an unusual cause of shock in post-operative patients with past medical history of hypothyroidism.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"16 ","pages":"11795468221141302"},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/cc/10.1177_11795468221141302.PMC9726846.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10324000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Diuretics for De-resuscitation in Septic Patients With Left Ventricular Dysfunction","authors":"Timothy W. Jones, A. Chase, R. Bruning, Naphun Nimmanonda, S. Smith, A. Sikora","doi":"10.1177/11795468221095875","DOIUrl":"https://doi.org/10.1177/11795468221095875","url":null,"abstract":"Introduction: De-resuscitation practices in septic patients with heart failure (HF) are not well characterized. This study aimed to determine if diuretic initiation within 48 hours of intensive care unit (ICU) admission was associated with a positive fluid balance and patient outcomes. Methods: This single-center, retrospective cohort study included adult patients with an established diagnosis of HF admitted to the ICU with sepsis or septic shock. The primary outcome was the incidence of positive fluid balance in patients receiving early (<48 hours) versus late (>48 hours) initiation of diuresis. Secondary outcomes included hospital mortality, ventilator-free days, and hospital and ICU length of stay. Continuous variables were assessed using independent t-test or Mann-Whitney U, while categorical variables were evaluated using the Pearson Chi-squared test. Results: A total of 101 patients were included. Positive fluid balance was significantly reduced at 72 hours (−139 mL vs 4370 mL, P < .001). The duration of mechanical ventilation (4 vs 5 days, P = .129), ventilator-free days (22 vs 18.5 days, P = .129), and in-hospital mortality (28 (38%) vs 12 (43%), P = .821) were similar between groups. In a subgroup analysis excluding patients not receiving renal replacement therap (RRT) (n = 76), early diuretics was associated with lower incidence of mechanical ventilation (41 [73.2%] vs 20 (100%), P = .01) and reduced duration of mechanical ventilation (4 vs 8 days, P = .018). Conclusions: Diuretic use within 48 hours of ICU admission in septic patients with HF resulted in less incidence of positive fluid balance. Early diuresis in this unique patient population warrants further investigation.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"7 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73341577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}