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1.
N. Rouanes R. Sanchez C. Cazanave 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2018,39(1):54-56
Introduction
The incidence of Neisseria gonorrhoeae septic arthritis remains low in the general population. Its clinical and microbiological diagnostic remains difficult.Case report
We report a 44-year-old man who presented with a monoarthritis of the right ankle. The diagnosis of gonoccocal septic arthritis was obtained by PCR from the joint fluid. Treatment with ceftriaxone was effective.Conclusion
In patients with high risk of N. gonorrhoeae infection, PCR for detection of gonorrhea in synovial fluid could potentially facilitate the diagnostic of gonococcal septic arthritis. 相似文献2.
Juliann Saquib Nouf Abdulrahman AlRomaih Hanadi Mufakkir Al-Mutairi Renad Nasser Alenazi Reef Deyf Allah Al-Mutairi Dona Jamal AlHtlani Fatemah Saleh Al-Theyab Mnahel Ali Alhsaon Mohammed Imran Hassan Khalaf Nazmus Saquib 《Journal of the Saudi Heart Association》2018,30(3):240-246
Background
After myocardial infarction (MI), patients have an elevated risk for depression, which has a negative impact on morbidity and mortality for patients. As depression and memory function are associated, we examined them in the context of one another. Our objectives were to determine the proportion of patients with either depression only, memory loss only, or both depression and memory loss and to examine the correlates with each outcome.Methods
This study was a cohort of 264 patients who had myocardial infarction. Data sources included medical records and phone interviews.Results
The participants’ mean age was 62?±?12.2?years and mean body mass index was 28.4?±?5.8?kg/m2. Of the participants, 6.4% had memory loss alone, 23.17% had depression alone, and 6.1% had combined memory loss and depression. Activity level and poor health were significantly associated with depression only (p?<?0.05). Poor health was significantly associated with combined memory loss and depression (p?<?0.05).Conclusion
Activity level and poor health were identified as correlates of depression as well as combined memory loss and depression. Future studies should aim to improve screening for depression among post-MI patients and develop appropriate interventions to raise the level of activity. 相似文献3.
Sonia Rekik Imen Abdelkefi Soumaya Boussaid Ilhem Cheour Hela Sahli Mohamed Elleuch 《The Egyptian Rheumatologist》2018,40(4):255-260
Aim of the work
The aim of the present study was to evaluate effectiveness of anti-tumor necrosis factor-α (anti-TNFα) in the treatment of spondyloarthritis (SpA) and to assess their safety and drug survival.Patients and methods
Forty-two SpA patients (33 men, 9 women) were retrospectively studied. The disease was progressive in all patients. Response was assessed after 6 months using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Functional Index (BASFI) scores and other clinical parameters. A major clinical response was defined as 50% improvement of the initial BASDAI. Patients were grouped into those with ankylosing spondylitis (AS) (24 patients) or psoriatic arthritis (PsA) and enteropathic arthritis (EA) (18 patients) and the response to anti-TNF was compared.Results
The mean age of the patients was 41.3?±?9.7?years and disease duration 14.6?±?8.2?years. After 6?months, 74% of patients were BASDAI 50 responders. The mean BASDAI and BASFI scores varied from 56?±?20 and 61.8?±?26 to 19?±?19 and 24?±?25 respectively (p?<?.001). The two SpA groups had the same effectiveness profile. The comparison between them showed a greater reduction of morning stiffness duration and erythrocyte sedimentation rate in patients with PsA or EA (p?=?.04). At least, one adverse event developed by 48% of patients and it was severe in 12%. Bronchopulmonary infections were the most frequent (8 patients). Drug survival rate was estimated at 86% after 1?year of treatment.Conclusion
Anti-TNFα therapy has a good response rate in SpA patients and an acceptable safety profile which explains the high drug survival rates. 相似文献4.
Introduction
The inflammatory response is known to have an important role in tumourigenesis and the response to treatment. Previous studies have demonstrated that inflammatory cell ratios such as the neutrophil-to-lymphocyte ratio (NLR) can predict survival and recurrence following surgery for various cancers. The objective of this study was to demonstrate if pre-operative NLR has a role in predicting post-operative septic complications in patients undergoing rectal cancer surgery.Methodology
Consecutive patients undergoing scheduled resection for rectal cancer in a tertiary centre from July 2007 to Dec 2015 were included. Data was gathered from a prospectively held database of rectal cancer. Normally distributed data were compared with paired t tests (mean?±?standard error in the mean (SEM)), and proportions were compared with Fisher’s exact test. A p value of <?0.05 was considered statistically significant.Results
Three hundred fourteen patients were identified in this study. Sixty nine (22.0%) patients had a major septic complication following surgery for rectal cancer, which was associated with a poor survival outcome (p?<?0.01) Both pre and post-operative NLR and PLR (platelet lymphocyte ratio) were associated with post-operative septic complications (both p?<?0.01). A pre-operative NLR threshold level of 4 was chosen from ROC analysis, and this provided a relatively specific test to predict post-operative septic complications in these patients (specificity?=?83.7%, negative predictive value (NPV)?=?74.8%).Discussion
In this study, the pre-operative NLR and PLR were both predictive of major post-operative septic complications. A pre-operative NLR of less than 4 was strongly negative predictor of post-operative complications in rectal cancer surgery. It can be regarded as a predictive and prognostic factor for these patients.5.
Background
The diagnosis of coronary artery disease (CAD) in patients with LBBB represents a clinical challenge. The presence of fragmented QRS (fQRS) complex on surface ECG may be related to myocardial ischemia, scarring or fibrosis.Objectives
To investigate the relation between fQRS and the presence and severity of CAD in patients with LBBB.Patients and methods
56 patients with symptoms suggesting CAD and complete LBBB were submitted to full history taking and clinical examination, complete 12-leads electrocardiography (ECG) to confirm the diagnosis of LBBB and to diagnose the fragmented wide QRS (f-wQRS) complex, echocardiography, and coronary angiography; lesions with ?70% narrowing in major epicardial artery or ?50% narrowing in the left main coronary artery were considered significant; and Gensini score was calculated. Patients were classified into two groups according to the presence or absence of f-wQRS.Results
There were significantly more patients with obstructive CAD among patients with f-wQRS (p = 0.000053). Gensini score was significantly higher in patients with than in patients without fwQRS (p < 0.00001). f-wQRS was the only significant independent predictor of obstructive CAD. Sensitivity of f-wQRS in predicting obstructive CAD was 80.1%, specificity was 73.3%, positive predictive value was 72.4%, negative predictive value was 81.5%, and overall accuracy was 76.8%, p = 0.0022.Conclusion
Seeking for f-wQRS in patients with LBBB and suspected CAD is a simple, easy, available, method that may be helpful in noninvasive prediction of obstructive CAD. 相似文献6.
Colleen Juricek Teruhiko Imamura Ann Nguyen Ben Chung Daniel Rodgers Nitasha Sarswat Gene Kim Jayant Raikhelkar Takeyoshi Ota Tae Song Daniel Burkhoff Gabriel Sayer Valluvan Jeevanandam Nir Uriel 《Journal of cardiac failure》2018,24(4):249-254
Background
Recurrent gastrointestinal bleeding is one of the most significant adverse events in patients with left ventricular assist devices (LVADs).Methods
We enrolled LVAD patients who had received an intramuscular injection of 20?mg octreotide every 4 weeks as secondary prevention for recurrent gastrointestinal bleeding despite conventional medical therapies and repeated transfusions. The frequency of gastrointestinal bleeding and other associated clinical outcomes before and during octreotide therapy were compared.Results
Thirty LVAD patients (66.4?±?8.8 years old, 16 men [53%]) received octreotide therapy for 498.8?±?356.0 days without any octreotide-associated adverse events. The frequency of gastrointestinal bleeding was decreased significantly during octreotide therapy (from 3.4?±?3.1 to 0.7?±?1.3 events/year; P?<?.001), accompanied by significant reductions in red blood cell and flesh frozen plasma transfusions, days in hospital, and need for endoscopic procedures (P?<?.05 for all).Conclusions
Octreotide therapy reduced the frequency of recurrent gastrointestinal bleeding and may be considered for secondary prevention. 相似文献7.
Elnaz Javanshir Samad Ghaffari Reza Hajizadeh Hanieh Sakha Sahar Ghodratizadeh Hadiseh Kavandi 《Journal of electrocardiology》2018,51(5):870-873
Background
Electrocardiogram (ECG) is the first available modality used in patients with chest pain and dyspnea in emergency rooms.We aimed to study differences between acute coronary syndrome (ACS) and acute pulmonary embolism (APE) in patients presented primarily with abnormal negative T waves on their admission Electrocardiogram.Methods
This research was a retrospective study in which 297 patients (97 patients with APE and 200 with ACS) were included. The patients were admitted to the emergency ward of a tertiary heart center between 2015 and 2017. In addition to the evaluation of distribution of negative T waves, the depth of the inverted precordial T waves was measured.Results
The mean age of patients was 62.0?±?11.4 in ACS group and 60.7?±?17.6 in APE group (P value?=?0.563). Total negative T in V3 and V4 in ACS and APE groups was 9.1?mm and 4.2?mm respectively (P value <0.001).Total magnitude of negative T in anterior leads divided by total magnitude of negative T in inferior leads for ACS and APE groups were 15.1?±?12.0 and 5.4?±?3.6 respectively (P value?=?0.001).ROC curves showed that total magnitude of negative T in V4 divided by negative T in V1 can be valuable. A cutoff point of 1.75 with sensitivity of 73.5% and specificity of 84.9% (95% CI 0.79–0.91 P?<?0.001) could differentiate APE patients from ACS patients.Conclusion
This study suggests that total magnitude of negative T in left precordial leads divided by right precordial leads can be valuable in differentiating APE from ACS. 相似文献8.
Georgia Tsipoura Helen Lazaratou Dimitrios Damigos Olga Vougiouka 《The Egyptian Rheumatologist》2018,40(3):197-201
Aim of the work
To describe and compare sleep disturbance in children and adolescents with inactive juvenile idiopathic arthritis (JIA) and to study their relation to health-related quality of life (HRQoL).Patients and methods
Fifty JIA patients and 50 controls along with their parents were studied. Sleep disturbance was assessed by the Children's Sleep Habits Questionnaire (CSHQ) and HRQoL was assessed according to the revised KINDLR questionnaire.Results
The 50 JIA children were 14 boys (28%) and 36 girls (72%); 58% children and 42% adolescent. The mean age of participants was comparable between boys (11.6?±?2.9 years) and girls (11.4?±?3.3?years) either in JIA (p?=?.76) or control (p?=?.56). Patients enrolled had enthesitis-related arthritis in 6(12%), RF-positive polyarthritis in 8(16%), oligoarthritis in 32(64%), systemic arthritis in 2(4%) and psoriatic arthritis in 2(4%). Patients had higher CSHQ score (45.5?±?8.2) and a lower KINDLR (72.4?±?16.8) compared to the control (40.4?±?3.4 and 78.3?±?5.4; p?<?.0001 and p?=?.02 respectively). There were no differences between children and adolescents however, Sleep Onset Delay was significantly highest in systemic-onset children (p?=?.028) and KINDLR emotional subscale was significantly increased in those with oligoarthritis (81.6?±?16.6) (p?=?.02). All subscales significantly correlated with their corresponding total score (p?<?.01). Age at onset” with Emotional subscale were predictive of poor sleep and with number of hospitalizations for poor quality of life.Conclusions
Children and adolescents with inactive JIA, while taking medications, experience more disturbed sleep than matched control. This disturbance in their sleep entails in significant lower levels of HRQoL. 相似文献9.
Hana Sahli Asma Bachali Lamine Hamzaoui Mouna Medhioub Aida Bachrouch Khaled Bouzaidi Rawdha Tekaya Msaddak Azzouz 《The Egyptian Rheumatologist》2018,40(3):187-190
Aim of the work
To determine the frequency, clinical and radiological features of axial spondyloarthritis in patients with inflammatory bowel diseases (IBD) and to characterize differences between patients with and without axial spondyloarthritis.Patients and Methods
Patients included in this cross-sectional study were recruited from the Gastroenterology Department, University of Tunisia over six months. Sixty-four patients with IBD were questioned and examined for axial spondyloarthritis symptoms. Standard pelvic X-rays were performed for all and CT scans and MRI were done for some patients.Results
There were 42 men (65.6%) and 22 women (34.4%) with a mean age of 47?±?22 years. 32 patients (50%) had Crohn’s disease, 31 had ulcerative colitis and 1 patient has undifferentiated colitis. The disease was confined to the colon among a half of patients with ulcerative colitis. Regarding Crohn’s disease, all lesions were confined to the ileum and the colon. The mean IBD duration was 6.18±7.2 years. The occurrence of axial spondyloarthritis was 26.5% (17 patients who were symptomatic in 16 cases). The bowel disease preceded rheumatic manifestations in all cases. Nine patients (14.1%) had isolated sacroiliitis. The patients with and without axial spondyloarthritis had similar sociodemographic, anthropometric characteristics, comorbidities and bowel disease particularities except a higher percentage of corticosteroids use (p?=?.013).Conclusions
Due to the high frequency, an early diagnosis of spondyloarthritis in patients with inflammatory bowel disease by thorough clinical exam and standard pelvic X-rays should be recommended. 相似文献10.
Valérie Zeller Younes Kerroumi Vanina Meyssonnier Beate Heym Marie-Astrid Metten Nicole Desplaces Simon Marmor 《The Journal of infection》2018,76(4):328-334
Objectives
This study was undertaken to analyze prosthetic joint infection (PJI)-causing microorganisms and compare their distribution patterns according to PJI classification.Methods
Cohort study from a single referral center for bone-and-joint infections from January 2004 to December 2015.Results
Nine hundred and twenty-six patients, who developed 997 PJIs, involving the hip (62%), knee (35%) and/or shoulder (1%), were included. PJIs were classified as early postoperative (19%), late chronic (30%), hematogenous (35%) and undetermined (16%). Pathogens most frequently isolated from early-postoperative PJIs were staphylococci (57%), with 25% each Staphylococcus aureus or Staphylococcus epidermidis; 21% were polymicrobial and 10% Gram-negative rods. For late-chronic PJIs, the most frequent microbes were staphylococci (61%), predominantly S. epidermidis (35%); anaerobic bacteria were isolated from 15%; 11% were polymicrobial. Hematogenous PJIs were 99% monomicrobial. Although S. aureus was the most frequently isolated species (28%), streptococci were isolated slightly more often than staphylococci (39% vs. 36%). Among streptococci, group B streptococci were the most frequent (15%). The portal of entry was identified for 52% of hematogenous PJIs: 15% cutaneous, 11% dental, 9% gastrointestinal, 6% urinary, and 11% miscellaneous.Conclusion
Although a wide variety of microorganisms was isolated from PJIs, specific microbiological patterns were observed according to infection classification. 相似文献11.
Nobuo Tomizawa Yusuke Fujino Masaru Kamitani Shengpu Chou Kodai Yamamoto Shinichi Inoh Takeshi Nojo Sunao Nakamura 《Journal of diabetes and its complications》2018,32(6):609-615
Aims
To investigate the relationship of type 2 diabetes duration and myocardial blood flow (MBF) assessed by myocardial CT perfusion.Materials and methods
We prospectively included 140 patients with type 2 diabetes who underwent dynamic myocardial CT perfusion exam. MBF of the remote myocardium was calculated using the deconvolution technique and the Voronoi method. The relationships of MBF and diabetic duration, diabetic complications, conventional risk factors, coronary calcium, and coronary stenosis were assessed by logistic regression analysis.Results
A weak but significantly negative relationship was present between diabetes duration and MBF (R2?=?0.05, p?<?0.01). The average MBF of patients with a duration of >8?years was 13% lower than that of the remaining patients (1.11?±?0.35 vs 1.28?±?0.27?ml?min?1?g?1, p?<?0.01). Duration of one year was associated with a 6% increased risk for low MBF (<1.18?ml?min?1?g?1) (odds ratio 1.06, 95% confidence interval 1.01–1.12, p?<?0.05). Calcium score was also a significant factor for low MBF (odds ratio 1.08 (per 100 Agatston units), 95% confidence interval 1.01–1.17, p?<?0.05).Conclusion
Longer diabetes duration is associated with lower MBF independent of conventional cardiac risk factors or the presence of coronary stenosis. 相似文献12.
Osama A. Smettei Sawsan Sayed Abdullah M Al Habib Fahad Alharbi Rami M. Abazid 《Journal of the Saudi Heart Association》2018,30(3):165-171
Background
Coronary computed tomography angiography (CCTA) is increasingly being used for the evaluation of coronary artery disease; however, radiation exposure remains a major limitation of its use.Objective
To compare image quality and radiation exposure in two groups of patients undergoing CCTA using a 256-slice dual-source helical computed tomography scanner with high-pitch (FLASH) or prospective [step-and-shoot (SAS)] gating protocols.Methods
A prospective, single-center study was performed in our cardiac center. In total, 162 patients underwent CCTA with either FLASH or SAS scanning protocols. Subjective image quality was graded on the basis of a four-point grading system (1, non-diagnostic; 2, adequate; 3, good; 4, excellent). Objective image quality was assessed using image signal, noise, and signal-to-noise ratio (SNR). The effective radiation dose was also estimated.Results
The clinical and demographic characteristics of the patients in both groups were similar. The median age of the patients in both groups was 48.43?years, and males accounted for 63% and 68.7% of the FLASH and SAS groups, respectively. We found that the subjective image quality obtained with the FLASH protocol was superior to that obtained with the SAS protocol (3.35?±?0.6?mSv vs. 2.82?±?0.61?mSv; p?<?0.001). Image noise was higher in the FLASH group but was not statistically significant (25.0?±?6.13 vs. 24.0?±?6.8; p?=?0.10), whereas the signal and SNR was significantly higher with the FLASH protocol than with the SAS protocol [(469?±?116 vs. 397?±?106; p?>?0.001) and (21.6?±?8.7?mSv vs. 16.6?±?7.7?mSv; p?<?0.001), respectively]. Radiation exposure was 62% lower in the FLASH protocol than in the SAS protocol, (1.9?±?0.4?mSv vs. 5.12?±?1.8?mSv; p?<?0.001).Conclusion
The use of 256-slice CCTA performed with the FLASH protocol has a better objective and subjective image quality as well as lower radiation exposure when compared with the use of prospective electrocardiography gating. 相似文献13.
Oscar Murillo Imma Grau Joan Gomez-Junyent Celina Cabrera Alba Ribera Fe Tubau Carmen Peña Javier Ariza Roman Pallares 《Infection》2018,46(2):245-251
Purpose
The relationship between infective endocarditis (IE) and osteoarticular infections (OAIs) are not well known. We aimed to study the characteristics of patients with IE and OAIs, and the interactions between these two infections.Methods
An observational study (1993–2014) which includes two cohorts: (1) patients with IE (n = 607) and (2) patients with bacteremic OAIs (n = 458; septic arthritis of peripheral and axial skeleton, and vertebral and peripheral osteomyelitis). These two cohorts were prospectively collected, and we retrospectively reviewed the clinical and microbiological variables.Results
There were 70 cases of IE with concomitant OAIs, representing 11.5% of IE cases and 15% of bacteremic OAI cases. Among cases with IE, the associated OAIs mainly involved the axial skeleton (n = 54, 77%): 43 were vertebral osteomyelitis (61%), mainly caused by “less virulent” bacteria (viridans and bovis streptococci, enterococci, and coagulase-negative staphylococci), and 15 were septic arthritis of the axial skeleton (21%), which were mainly caused by Staphylococcus aureus. OAIs with involvement of the axial skeleton were associated with IE (adjusted OR = 2.2; 95% CI 1.1–4.3) independently of age, sex, and microorganisms.Conclusions
Among patients with IE, the associated OAIs mainly involve the axial skeleton. Transesophageal echocardiography should be carefully considered in patients presenting with these bacteremic OAIs.14.
Ghada Youssef Sherif Nagy Ahmed El-gengehe Amr Abdel Aal Magdy Abdel Hamid 《The Egyptian Heart Journal》2018,70(4):369-373
Background
There are limited data on ‘masked uncontrolled hypertension’ (MUCH) in patients with treated and apparently well-controlled BP is unknown.Objectives
To define the prevalence and predictors of MUCH among hypertensive patients with controlled office blood pressure.Methods
One hundred ninety-nine hypertensive patients presented to the specialized hypertension clinics at two University Hospitals. All patients had controlled office blood pressure (less than 140/90?mmHg). Patients were assessed regarding history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24?h, within a week after the index office visit. MUCH was diagnosed if average 24-h ABPM was elevated (systolic BP?≥?130?mmHg and/or diastolic BP?≥?80?mmHg) despite controlled clinic BP.Results
Sixty-six patients (33.2%) had MUCH according to 24-h ABPM criteria (mean age 53.5?±?9.3?years, 60.6% men). MUCH was mostly caused by the poor control of nocturnal BP; with the percentage of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that due to daytime BP elevation (57.3% vs. 27.1%, P?<?0.001). The most common predictors of MUCH were smoking, DM and positive family history of DM.Conclusion
The prevalence of masked suboptimal BP control is high. Office BP monitoring alone is thus inadequate to ascertain optimal BP control because many patients have an elevated nocturnal BP. ABPM is needed to confirm proper BP control, especially in patients with high cardiovascular risk profile. Smoking, DM and positive family history of DM were the most common predictors of MUCH. 相似文献15.
Hongying Jie Yunxiang Li Xuehua Pu Jilu Ye 《The American journal of the medical sciences》2017,353(3):242-246
Background
Useful biomarkers that can serve as prognostic predictors are of great value in clinical practice because of the complex individual response to sepsis. Pentraxin 3 (PTX3), as a multifunctional pattern-recognition molecule, has been reported to be closely associated with the severity of infectious diseases in intensive care units (ICU). The aim of this study was to investigate whether PTX3 could serve as a potential prognostic biomarker in patients with septic shock.Materials and Methods
This single-center prospective observational study was conducted during May 2012-May 2015 in the ICU of Taizhou People?s Hospital. We compared the clinical data and laboratory tests in surviving and deceased patients with septic shock within 28 days from admission. Potential independent prognostic factors for septic shock were analyzed by using univariate and multiple Cox proportional hazards regression analyses.Results
A total of 112 patients admitted to the ICU with septic shock were enrolled in our study with an overall 28-day mortality of 25.9% (29 of 112 patients). PTX3 level was the only independent risk factor for the 28-day mortality by univariate and multivariate Cox analysis (hazard ratio = 3.87; 95% CI: 1.66-8.81, P = 0.004). The deceased patients had significant higher levels of PTX3 at the 4 different points (baseline, day 1, day 2 and day 3) versus the survivors (P < 0.001). Results from Kaplan-Meier curves and log-rank test revealed that high PTX3 level (above the median value) was statistically associated with a lower 28-day survival rate (P = 0.014).Conclusions
The baseline PTX3 level was an independent predictor for 28-day mortality in patients with septic shock. 相似文献16.
Glenn M. Chertow Gerald B. Appel Geoffrey A. Block Melanie P. Chin Daniel W. Coyne Angie Goldsberry Kamyar Kalantar-Zadeh Colin J. Meyer Mark E. Molitch Pablo E. Pergola Philip Raskin Arnold L. Silva Bruce Spinowitz Stuart M. Sprague Peter Rossing 《Journal of diabetes and its complications》2018,32(12):1113-1117
Aims
Obesity is associated with progression of chronic kidney disease (CKD). Treatment with bardoxolone methyl in a multinational phase 3 trial, Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), resulted in increases in estimated glomerular filtration rate (eGFR) with concurrent reductions in body weight. We performed post-hoc analyses to further characterize reductions in body weight with bardoxolone methyl.Methods
Eligible patients with type 2 diabetes (T2DM) and CKD stage 4 (eGFR 15 to <30?mL/min/1.73?m2) were randomized 1:1 to receive once-daily oral dose of bardoxolone methyl (20?mg) or placebo.Results
BEACON enrolled 2185 patients. Patients randomized to bardoxolone methyl experienced significant reductions in body weight from baseline relative to patients randomized to placebo (?5.7?kg; 95% CI: ?6.0 to ?5.3?kg; p?<?0.001). In patients randomized to bardoxolone methyl, rate and magnitude of body weight loss were proportional to baseline BMI. Bardoxolone methyl resulted in significant reductions in waist circumference and improved glycemic control.Conclusions
Bardoxolone methyl resulted in significant weight loss in a generally obese patient population with T2DM and stage 4 CKD, with the magnitude and rate dependent on baseline BMI. 相似文献17.
Objectives
To evaluate the safety of using the stiff end of a coronary wire to perforate an atretic pulmonary valve (PV) in patients with pulmonary atresia with intact ventricular septum (PAIVS).Background
Radiofrequency perforation is an accepted modality to perforate the PV in patients PAIVS. However, the high cost precludes its widespread use.Patients and methods
This is a single-center experience that spanned from March 2013 to January 2016 and involved 13 neonates who were severely cyanotic with PAIVS and with ductal-dependent pulmonary circulation. The stiff end of a coronary wire was used to perforate the atretic PV anterogradely, followed by balloon pulmonary valvuloplasty.Results
The mean age of patients was 3.9?±?2.7?days and their mean weight was 2.8?±?0.19?kg. The mean oxygen saturation was 77.1?±?3.2%. All had membranous pulmonary atresia, with patent infundibulum and tripartite right ventricle. The valve was successfully perforated in 11 out of 13 patients. Death occurred in two patients (15.4%) owing to heart failure and sepsis. Patent ductus arteriosus stenting was performed 2?days after the procedure in one patient because of cyanosis followed by one and half ventricle repair at of age 5?months. Two patients (15.4%) had one and a half ventricle repair at age of 5?months and 6?months owing to insufficient anterograde pulmonary flow. Two patients (15.4%) underwent second intervention with balloon dilatation of the valve. The remaining seven patients (53.8%) had no further intervention. Two cases (15.4%) had femoral artery thrombosis treated with streptokinase. The mean duration of follow-up was 13.17?±?7?months. There was significant improvement in the degree of tricuspid incompetence. There was a significant growth in the tricuspid valve annulus during the follow-up (the mean Z score increased from ?0.8?±?0.9 to 0.1?±?0.9) (p?=?0.003). There was also a significant increase in the tricuspid valve annulus/mitral valve annulus ratio as its mean increased from 0.73?±?0.10 to 0.86?±?0.11 during follow-up (p?<?0.001).Conclusion
Perforation of the atretic PV in selected cases with membranous atresia and patent infundibulum using the stiff end of a coronary wire is an effective alternative to using radiofrequency perforation. 相似文献18.
Helen I. Keen Wendy A. Davis Erin Latkovic Jocelyn J. Drinkwater Johannes Nossent Timothy M.E. Davis 《Journal of diabetes and its complications》2018,32(4):400-405
Aims
The prevalence and consequences (articular and extra-articular) of hyperuricemia in type 2 diabetes, especially when asymptomatic (ASH), are incompletely understood. The aim of this study was to use ultrasonography to assess pathology associated with monosodium urate deposition in the joints of well-characterized hyperuricemic patients with type 2 diabetes.Methods
A subset of 101 participants (mean age 70.4?years, 59.8% males, median diabetes duration 14.6?years) with hyperuricemia (fasting serum uric acid ≥0.42?mmol/L) from the community-based observational Fremantle Diabetes Study Phase II were assessed by ultrasound for signs of intra-articular urate deposition and inflammation in 14 joints at increased risk of involvement in patients with gout.Results
Most participants had evidence of crystal deposition comprising aggregates (59.4%), tophi (19.8%) or a double contour sign (27.7%), and 37% had a power Doppler signal indicative of inflammation in at least one joint. There was no difference between the prevalence of these abnormalities in those with ASH (n?=?60) versus participants with a history of gout (n?=?41; P?≥?0.15). There was no association between a history of ischemic heart disease (reported by 17.8% of participants) and either any abnormality on joint ultrasound or inflammatory changes assessed by power Doppler (P?≥?0.41).Conclusions
Joint inflammation and/or urate deposition were present in the majority of community-based patients with type 2 diabetes and hyperuricemia regardless of whether there was a history of gout. Given the potential consequences of chronic inflammation for joint damage and extra-articular complications such as cardiovascular disease, these data have potential clinical implications. 相似文献19.
Anne Keats Dane Moran Siobhan Rothwell Timothy Woodcock Tammy Williams Nishi Rawat 《Journal of the Saudi Heart Association》2018,30(3):180-187
Objective
To improve compliance with a target door-to-electrocardiogram (EKG) time of 10?minutes or less in patients presenting with symptoms concerning for acute coronary syndrome.Methods
A pre-post study was performed between January 2014 and May 2016 at five emergency departments (EDs) in Saudi Arabia. Patients who presented to ED with symptoms concerning for acute coronary syndrome were included in the study. The primary outcome of interest was whether EKG was completed within 10?minutes after the patient arrival to ED. Quality improvement interventions consisted of human resources adjustments, education, technological improvements, and improved interdepartmental collaboration. Multivariate analysis was used to model the percentage of EKGs that were completed within the targeted time.Results
During the study period, 11,518 patients received EKGs. Prior to the intervention, compliance with a door-to-EKG time of 10?minutes or less was found to be 62.6%. Post intervention, compliance improved to 87.7%. On multivariate analysis, male patients were significantly more likely to receive EKG within 10?minutes than female patients (odds ratio?=?1.231, 95% confidence interval?=?1.113–1.361; p?<?0.001).Conclusion
A quality improvement project can successfully increase the percentage of patients receiving EKG within 10?minutes of presentation to ED. Further research is required to demonstrate the clinical significance of improved door-to-EKG times. 相似文献20.
Nasser Mohammad Taha Hany Taha Asklany Adel Hamdy Mahmoud Laila Hammoda Heba Rady Attallah Adel Mohammad Kamel Mohammad AbdelKader AbdelWahab 《The Egyptian Heart Journal》2018,70(3):167-171