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1.
Zhenzhen Wang Biming Zhan Huihui Bao Xiao Huang Yanqing Wu Qian Liang Weifang Zhang Long Jiang Xiaoshu Cheng 《The American journal of the medical sciences》2019,357(3):230-241
Background
The present study performed a meta-analysis of randomized and prospective trials to compare the outcomes of percutaneous coronary intervention (PCI) with stents versus coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (UPLM) stenosis.Methods
The Cochrane Library, PubMed and EMBASE databases were systematically searched until July 2017. The Newcastle-Ottawa scale was used for quality assessment.Results
A total of 19 studies with 16,900 participants were included. Pooled analysis showed no significant differences in all-cause mortality (odds ratio [OR] 0.94; 95% CI 0.74-1.20) and cardiac death (OR 1.04; 95% CI 0.74-1.47). However, subgroup analysis showed that PCI was associated with a low all-cause mortality rate at 30-day follow up (OR 0.48; 95% CI 0.26-0.89). The stroke rate in PCI was lower in short-term follow up (OR 0.45; 95% CI 0.23-0.88) and long-term follow up (OR 0.36; 95% CI 0.27-0.47). On the other hand, PCI was associated with higher risk of myocardial infarction (OR 1.59; 95% CI 1.34-1.88), repeat revascularization (OR 2.47; 95% CI 1.80-3.37) and target vessel revascularization (OR 2.10; 95% CI 1.72-2.57) compared to CABG in the pooled analysis.Conclusions
The current evidence suggests that the risk of stroke was significantly reduced in PCI compared to that in CABG. Therefore, PCI is the preferred treatment for patients with a high risk of stroke. Additionally, in short-term follow up, PCI was reported to be safe and effective for UPLM patients compared to CABG. However, CABG caused fewer complications long term. 相似文献2.
Anna M. Nordenskjöld Bo Lagerqvist Tomasz Baron Tomas Jernberg Nermin Hadziosmanovic Harmony R. Reynolds Per Tornvall Bertil Lindahl 《The American journal of medicine》2019,132(3):335-346
Background
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.Methods
In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.Results
The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P?=?.54).Conclusions
About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD. 相似文献3.
Joanna Kamińska Anna Lisowska Olga M. Koper-Lenkiewicz Paula Mikłasz Kamil Grubczak Marcin Moniuszko Paweł Kiszło Halina Kemona Violetta Dymicka-Piekarska 《The American journal of the medical sciences》2019,357(5):421-434
Background
Monocyte-platelet interaction may favor the development of a proatherogenic monocyte phenotype. It is still uncertain which of the 3 monocyte subpopulations interact with platelets to form monocyte-platelet aggregates (MPAs) in acute myocardial infarctions. The aim of our study was to evaluate the monocyte subsets, the percentage of MPAs and the involvement of monocyte subsets in MPA formation among patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), and compared to patients with stable angina (SA).Methods
Monocyte subsets and MPAs formation were measured in blood collected in 3.2% sodium citrate tubes by means of flow cytometry.Results
Classical, intermediate and nonclassical monocyte percentages were statistically different when comparing patients with STEMI and NSTEMI. Moreover, classical and intermediate monocytes were statistically different when comparing the STEMI and SA group; however, only the classical monocyte subset was found to be higher in the acute myocardial infarction group compared to the SA group. The percentage of MPAs was significantly higher in STEMI (50.1%) compared to NSTEMI (22.9%). We found no differences in the involvement of monocyte subsets in MPA formation between patients with STEMI and NSTEMI and in comparison with the SA group.Conclusions
These findings suggest that the increase in circulating levels of classical monocytes in patients with STEMI as compared to NSTEMI reflects the severity of the acute event. The increased percentage of MPAs may favor the development of STEMI compared to NSTEMI. 相似文献4.
Kuan Ken Lee Ala Noaman Amar Vaswani Matthew Gibbins Megan Griffiths Andrew R. Chapman Fiona Strachan Atul Anand David A. McAllister David E. Newby Alasdair J. Gray Nicholas L. Mills Anoop S.V. Shah 《The American journal of medicine》2019,132(1):110.e8-110.e21
Background
High-sensitivity cardiac troponin assays may improve the diagnosis of myocardial infarction but increase the detection of elevated cardiac troponin in patients without acute coronary syndrome.Methods
In a prospective cohort study, we evaluated the prevalence, determinants, and outcome of patients with elevated cardiac troponin attending the emergency department without suspected acute coronary syndrome. We measured high-sensitivity cardiac troponin in 918 consecutive patients attending the emergency department without suspected acute coronary syndrome who had blood sampling performed by the attending clinician. Elevated high-sensitivity cardiac troponin I was defined as concentrations above the sex-specific 99th percentile threshold. Clinical demographics, physiological measures, and all-cause mortality at 1 year associated with elevated high-sensitivity cardiac troponin concentrations were recorded.Results
Elevated cardiac troponin concentration occurred in 114 (12.4%) patients, of whom 2 (0.2%), 3 (0.3%), and 109 (11.9%) were adjudicated as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Elevated troponin concentrations were associated with increasing age, worsening renal function, multimorbidity, and adverse physiology. Across a total of 912 patient-years follow-up, cardiac troponin concentration was a strong predictor of death (hazard ratio [HR] 1.26 per 2-fold increase, 95% confidence interval [CI] 1.06 to 1.49) independent of age, sex, multimorbidity, and adverse physiology.Conclusions
High-sensitivity cardiac troponin concentrations were elevated in 1 in 8 consecutive patients without suspected acute coronary syndrome attending the emergency department and were associated with increasing age, multimorbidity, adverse physiology, and death. Elevated cardiac troponin in unselected patients predominantly reflects myocardial injury rather than myocardial infarction. 相似文献5.
Medha Barbhaiya Candace H. Feldman Hongshu Guan Sarah K. Chen Michael A. Fischer Daniel H. Solomon Brendan M. Everett Karen H. Costenbader 《Seminars in arthritis and rheumatism》2019,48(5):840-846
Objective
Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLE patients.Methods
Within Medicaid (2000–2010), we identified patients aged 18–65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death.Results
Of 65,788 SLE patients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18–1.53), hemorrhagic stroke (HR 1.42 [1.00–2.01]), and ischemic stroke (HR 1.33 [1.15–1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06–1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22–2.61]), but not ischemic stroke, compared to Whites.Conclusion
Among SLE patients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics. 相似文献6.
Daniella Nero Stefan Agewall Maria Daniel Kenneth Caidahl Olov Collste Christina Ekenbäck Mats Frick Loghman Henareh Tomas Jernberg Karin Malmqvist Karin Schenck-Gustafsson Jonas Spaak Peder Sörensson Örjan Sundin Shams Y-Hassan Claes Hofman-Bang Per Tornvall 《The American journal of medicine》2019,132(3):374-381.e1
Objective
The purpose of this study was to describe type A behavior pattern and trait anger in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and compare them with patients with coronary heart disease and healthy controls. Type A behavior pattern and anger have been linked to coronary heart disease in previous studies. This is the first study to assess type A behavior pattern and trait anger in MINOCA patients.Methods
One hundred MINOCA patients, consecutively recruited during 2007-2011 at 5 coronary care units in Stockholm, were matched for sex and age to 100 coronary heart disease patients and 100 healthy controls. All participants completed the Bortner Rating Scale to quantify type A behavior pattern and the Spielberger Trait Anger Scale to quantify anger 3 months after the acute event.Results
MINOCA patients’ Bortner Rating Scale score was 70.9 ± 10.8 (mean ± SD) and Spielberger Trait Anger Scale score was 14 (12-17) (median; interquartile range). Coronary heart disease patients’ Bortner Rating Scale score was 70.5 ± 10.2 and Spielberger Trait Anger Scale score was 14 (12-17). Healthy controls’ Bortner Rating Scale score was 71.9 ± 9.1 and Spielberger Trait Anger Scale score was 13 (11-16).Conclusion
We found no significant differences in Bortner Rating Scale score and Spielberger Trait Anger Scale score among MINOCA, coronary heart disease patients, and healthy controls, regardless of whether total scores, subscales, or cutoffs were used to classify type A behavior pattern and trait anger. However, we cannot exclude the existence of an occasional episode of anger or mental stress in relation to the coronary event. This is the first study to assess type A behavior pattern and trait anger in patients with MINOCA, and future studies need to confirm the current findings before any firm conclusions can be made. 相似文献7.
Adelita Tinoco David W. Mortara Xiao Hu Cass Piper Sandoval Michele M. Pelter 《Heart & lung : the journal of critical care》2019,48(2):114-120
Background
Cheyne-Stokes respiration and periodic breathing (CSRPB) have not been studied sufficiently in the intensive care unit setting (ICU).Objectives
To determine whether CSRPB is associated with adverse outcomes in ICU patients.Methods
The ICU group was divided into quartiles by CSRPB (86 patients in quartile 1 had the least CSRPB and 85 patients in quartile 4 had the most CSRPB). Adverse outcomes (emergent intubation, cardiorespiratory arrest, inpatient mortality and the composite of all) were compared between patients with most CSRPB (quartile 4) and those with least CSRPB (quartile 1).Results
ICU patients in quartile 4 had a higher proportion of cardiorespiratory arrests (5% versus 0%, (p=.042), and more adverse events over all (19% versus 8%, p=.041) as compared to patients in quartile 1.Conclusions
CSRPB can be measured in the ICU and it's severity is associated with adverse outcomes in critically ill patients. 相似文献8.
Dong Kyu Oh Jong-Min Song Duk-Woo Park Sang Young Oh Jin-Sook Ryu Jaewon Lee Sang Do Lee Jae Seung Lee 《Heart & lung : the journal of critical care》2019,48(1):28-33
Background
Although guidelines have recommended that patients with chronic thromboembolic pulmonary hypertension (CTEPH) should be managed by a multidisciplinary team (MDT), there is a lack of clinical data indicating that the MDT improves CTEPH management.Objectives
The study aimed to identify the effect of an MDT on CTEPH management.Methods
We divided the study period into pre-MDT and post-MDT eras and compared the implementation rates of major diagnostic and therapeutic procedures.Results
Of 116 patients with CTEPH, 42 (36.2%) were diagnosed in the post-MDT era. The implementation rates of right heart catheterization (10.8% vs. 97.6%, p < 0.001) and pulmonary endarterectomy (32.4% vs. 59.5%, p < 0.005) were significantly increased in the post-MDT era. Balloon pulmonary angioplasty was not performed in the pre-MDT era but was performed in the post-MDT era.Conclusions
The MDT appears to be associated with improved CTEPH management. 相似文献9.
Post-Procedural Bivalirudin Infusion at Full or Low Regimen in Patients With Acute Coronary Syndrome
Giuseppe Gargiulo Greta Carrara Enrico Frigoli Sergio Leonardi Pascal Vranckx Gianluca Campo Ferdinando Varbella Paolo Calabrò Tiziana Zaro Davide Bartolini Carlo Briguori Giuseppe Andò Maurizio Ferrario Ugo Limbruno Salvatore Colangelo Paolo Sganzerla Filippo Russo Marco Stefano Nazzaro Marco Valgimigli 《Journal of the American College of Cardiology》2019,73(7):758-774
Background
The value of prolonged bivalirudin infusion after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients with or without ST-segment elevation remains unclear.Objectives
The purpose of this study was to assess efficacy and safety of a full or low post-PCI bivalirudin regimen in ACS patients with or without ST-segment elevation.Methods
The MATRIX program assigned bivalirudin to patients without or with a post-PCI infusion at either a full (1.75 mg/kg/h for ≤4 h) or reduced (0.25 mg/kg/h for ≤6 h) regimen at the operator’s discretion. The primary endpoint was the 30-day composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (composite of all-cause death, myocardial infarction, or stroke, or major bleeding).Results
Among 3,610 patients assigned to bivalirudin, 1,799 were randomized to receive and 1,811 not to receive a post-PCI bivalirudin infusion. Post-PCI full bivalirudin was administered in 612 (ST-segment elevation myocardial infarction [STEMI], n = 399; non–ST-segment elevation acute coronary syndromes [NSTE-ACS], n = 213), whereas the low-dose regimen was administered in 1,068 (STEMI, n = 519; NSTE-ACS, n = 549) patients. The primary outcome did not differ in STEMI or NSTE-ACS patients who received or did not receive post-PCI bivalirudin. However, full compared with low bivalirudin regimen remained associated with a significant reduction of the primary endpoint after multivariable (rate ratio: 0.21; 95% CI: 0.12 to 0.35; p < 0.001) or propensity score (rate ratio: 0.16; 95% CI: 0.09 to 0.26; p < 0.001) adjustment. Full post-PCI bivalirudin was associated with improved outcomes consistently across ACS types compared with the no post-PCI infusion or heparin groups.Conclusions
In ACS patients with or without ST-segment elevation, the primary endpoint did not differ with or without post-PCI bivalirudin infusion but a post-PCI full dose was associated with improved outcomes when compared with no or low-dose post-PCI infusion or heparin (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX [MATRIX]; NCT01433627). 相似文献10.
Kyle D. Buchanan Paul Kolm Micaela Iantorno Deepakraj Gajanana Toby Rogers Jiaxiang Gai Rebecca Torguson Itsik Ben-Dor William O. Suddath Lowell F. Satler Ron Waksman 《Cardiovascular Revascularization Medicine》2019,20(1):11-15
Background/Purpose
Appropriate patient selection for mechanical circulatory support following percutaneous coronary intervention (PCI) remains a challenge. This study aims to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI.Methods/Materials
We retrospectively analyzed all patients who underwent PCI for acute coronary syndrome (ACS) from 2003 to 2016. Coronary perfusion pressure was calculated for each patient and defined as the difference in mean arterial pressure and left ventricular end diastolic pressure (LVEDP). Logistic regression analysis was performed to determine predictor of composite outcome of in-hospital mortality, myocardial infarction (MI), congestive heart failure (CHF), and cardiogenic shock.Results
Nine hundred twenty-two patients were analyzed. Two-hundred twenty-eight (25%) presented with ST-elevation MI (STEMI) while 694 (75%) underwent PCI for unstable angina or non-Q-wave MI. The mean LVEDP was significantly higher in the STEMI patients (24?±?9 vs. 19?±?8?mm?Hg, p?<?0.05) and perfusion pressure significantly lower (68?±?24 vs. 74?±?18?mm?Hg, p?<?0.05). Eighty-seven (9.4%) reached the composite endpoint, and there was no difference between the STEMI and Not-STEMI groups. Neither LVEDP nor coronary perfusion pressure was a predictor of the composite outcome following multivariable logistic regression analysis for either STEMI or Not-STEMI patients. Increasing age, chronic renal insufficiency (CRI), CHF, and low left ventricular ejection fraction were predictors of the composite outcome for Not-STEMI patients, whereas only history of cerebrovascular accident and CRI were predictors for STEMI patients.Conclusions
In hemodynamically stable patients presenting with ACS, LVEDP and coronary perfusion pressure are not predictive of in-hospital cardiovascular collapse.Summary
The authors retrospectively analyzed 922 patients from a single center who underwent percutaneous coronary intervention (PCI) for acute coronary syndromes to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI. They found that neither coronary perfusion pressure nor left ventricular end diastolic pressure was predictive of in-hospital cardiovascular collapse. 相似文献11.
Stefanos Despotopoulos Anastasios Roumeliotis Nicholas G. Kounis Grigorios Tsigkas George Hahalis Periklis Davlouros 《Heart & lung : the journal of critical care》2019,48(2):138-140
Background
Kounis syndrome is a systemic complication following an allergic reaction, presenting with coronary artery spasm or thrombosis and occasionally with stent thrombosis that can have fatal outcome.Objectives
Heparins can induce allergic reactions via tissue antigenicity, heparin induced thrombocytopenia and contact system-activating effects of contaminants but allergy bivalirudin has not been reported so far.Methods
Herein, we describe a patient with fatal acute coronary in-stent thrombosis following an allergic reaction soon after an intra-arterial heparin dose and intravenous administration of bivalirudin during angioplasty.Results
The patient received intense myocardial infarction protocol treatment including angioplasty and defibillation together with antiallergic therapy but despite all of these efforts and measures, he succumbed 2 h later.Conclusions
Significant suspicion should be raised that life saving drugs such as heparin and bivalirudin could join forces with concurrent medication acting as antigens and induce fulminant and fatal stent thrombosis as a manifestation of Kounis syndrome 相似文献12.
Yi Xiao Zhe Geng Taoran Deng Di Wang Lijun Jiang 《The American journal of the medical sciences》2019,357(2):111-115
Background
Tumor necrosis factor receptor type 1-associated death domain protein (TRADD) mediates programmed cell death signaling as well as the Fas-induced cell death pathway. The downregulation of TRADD is found to be associated with the occurrence of many cancers. The present study was designed to investigate the association between TRADD and clinicopathologic features as well as its clinical significance in acute myeloid leukemia (AML).Methods
Real-time polymerase chain reaction was performed in 100 new AML, 23 AML complete remission patients, and 20 normal individuals. All statistical analysis was performed using SPSS software.Results
It was found that the expression of TRADD messenger RNA was lower in new AML patients as compared to healthy individuals and complete remission patients (P?=?0.00239). Moreover, TRADD messenger RNA levels were associated with clinical factors such as risk classification (P?=?0.0023) and complete remission (P?=?0.0147). Kaplan–Meier analysis revealed that the AML patients with high TRADD expression had significantly prolonged overall survival and higher complete remission compared with low TRADD expressing patients.Conclusions
It is concluded that downregulation of TRADD may be an independent potential prognostic biomarker in AML. 相似文献13.
Yoshitaka Okuhara Masanori Asakura Yoshiyuki Orihara Yoshiro Naito Takeshi Tsujino Masaharu Ishihara Tohru Masuyama 《Journal of cardiac failure》2019,25(1):44-50
Background
Weight loss is a strong prognostic factor in chronic heart failure (CHF); however, little is known about its effects in patients with mild CHF. Therefore, we investigated the effects of weight loss in patients with mild CHF.Methods and Results
We analyzed a total of 242 outpatients with mild CHF from the J-MELODIC study cohort. Weight loss was defined as ≥5% weight loss in 1 year. Twenty-seven patients (11.2%) lost ≥5% weight in 1 year. Weight loss was associated with higher rates of underweight and worsening renal function in 1 year compared with the absence of ≥5% weight loss. The predictors of weight loss included edema, B-type natriuretic peptide, and diabetes mellitus at baseline. Although weight loss was significantly associated with subsequent cardiovascular death or hospitalization for HF (log-rank P?=?.002) and subsequent death from any cause (log-rank P?=?.002), underweight was not associated with these outcomes (log-rank P?=?.356 and P?=?.168, respectively). Even after adjusting for covariates, weight loss was a significant and independent risk factor for subsequent cardiovascular death or hospitalization for HF (hazard ratio 3.22, 95% confidence interval 1.10–8.41; P?=?.034).Conclusions
In patients with mild CHF, ≥5% weight loss was a significant predictor for subsequent cardiovascular death or hospitalization for HF. 相似文献14.
Xianghui Zheng Yang Zheng Jing Ma Maomao Zhang Yongxiang Zhang Xianglan Liu Liangqi Chen Qingyuan Yang Yong Sun Jian Wu Bo Yu 《Heart & lung : the journal of critical care》2019,48(1):1-7
Background
Cardiac rehabilitation (CR) has been shown to provide the best social, psychological and physical conditions for patient recovery after myocardial infarction (MI).Objectives
The aim of present study was to quantify the efficacy of exercise-based CR treatments in terms of relief from symptoms of anxiety and depression symptoms among patients with MI.Methods
Literature published up to August 2017 was reviewed systematically using relevant keywords, MeSH terms, and Emtree headings to search PubMed, Embase, CINAHL (Ebsco), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science. The results of included studies were compared meta-analytically.Results
We found that exercise-based CR had a significant effect on decreasing anxiety and depression scores. Furthermore, exercise-based CR may alleviate anxiety and depressive symptoms at different time periods.Conclusions
For patients with MI, exercise-based CR has been demonstrated to alleviate anxiety and depressive symptoms. These findings highlight CR as essential and beneficial for minimizing MI patient anxiety and depression during recovery. 相似文献15.
Ruohui Wang Changkun Pan Xiaokun Wang Feng Xu Shuang Jiang Ming Li 《Heart & lung : the journal of critical care》2019,48(1):46-54
Background
The optimal timing of tracheotomy in critically ill ventilated patients remains controversial.Objectives
The objective of this meta-analysis was to assess tracheotomy timing for critically ill ventilated patients and determine the outcomes’ reliability.Methods
We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials.Results
Compared with late tracheotomy, early tracheotomy presented a lower incidence of ventilator-associated pneumonia (VAP), shorter duration of mechanical ventilation (MV), and shorter intensive care unit (ICU) stay. However, trial sequential analysis (TSA), a kind of cumulative meta-analysis, indicated that the evidence was unreliable and inconclusive.Conclusions
The Findings suggest that early tracheotomy seems to be associated with a lower incidence of VAP, shorter duration of MV, shorter duration of sedation, and shorter ICU stay. However, the apparent benefits revealed in traditional meta-analysis contrast with the post-TSA results. More fully powered, randomized controlled trials focused on the outcomes of tracheotomy are highly warranted. 相似文献16.
Antonia Scobie Sanch Kanagarajah Ross J. Harris Lisa Byrne Corinne Amar Kathie Grant Gauri Godbole 《The Journal of infection》2019,78(3):208-214
Listeriosis
is a foodborne illness that can result in septicaemia, Central Nervous System (CNS) disease, foetal loss and death in high risk patients.Objectives
To analyse the demographic trends, clinical features and treatment of non-perinatal listeriosis cases over a ten year period and identify mortality-associated risk factors.Methods
Reported laboratory-confirmed non-pregnancy associated cases of listeriosis between 2006 and 2015 in England were included and retrospectively analysed. Multivariate logistic regression analysis was performed to determine independent risk factors for mortality.Results
1357/1683 reported cases met the inclusion criteria. Overall all-cause mortality was 28.7%; however, mortality rates declined from 42.1% to 20.2%. Septicaemia was the most common presentation 69.5%, followed by CNS involvement 22.4%. CNS presentations were significantly associated with age?<?50 years, and septicaemia with older age. Age?>?80 years (OR 3.32 95% CI 1.92–5.74), solid-organ malignancy (OR 3.42 95% CI 2.29-5.11), cardiovascular disease (OR 3.30 95% CI 1.64–6.63), liver disease (OR 4.61 95% CI 2.47–8.61), immunosuppression (OR 2.12 95% CI 1.40-3.21) and septicaemia (OR 1.60 95% CI 1.17–2.20) were identified as independent mortality risk factors.Conclusions
High risk groups identified in this study should be the priority focus of future public health strategies aimed at reducing listeriosis incidence and mortality. 相似文献17.
Maria Daniel Stefan Agewall Felix Berglund Kenneth Caidahl Olov Collste Christina Ekenbäck Mats Frick Loghman Henareh Tomas Jernberg Karin Malmqvist Karin Schenck-Gustafsson Jonas Spaak Örjan Sundin Peder Sörensson Shams Y-Hassan Claes Hofman-Bang Per Tornvall 《The American journal of medicine》2018,131(9):1118-1124
Background
Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries.Methods
We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event.Results
Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P = .006) and similar to that of patients with coronary heart disease (30%; P = .954). Using the HADS anxiety subscale, we found that the prevalence of anxiety in patients with myocardial infarction with non-obstructive coronary arteries (27%) was higher than in healthy controls (9%; P = .002) and similar to that of patients with coronary heart disease (21%; P = .409). Using the HADS depression subscale, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (17%) was higher than in healthy controls (4%; P = .003) and similar to that of patients with coronary heart disease (13%; P = .466). Patients with myocardial infarction with non-obstructive coronary arteries and takotsubo syndrome scored higher on the HADS anxiety subscale than those without (P = .028).Conclusions
This is the first study on the mental health of patients with myocardial infarction with non-obstructive coronary arteries to show that prevalence rates of anxiety and depression are similar to those in patients with coronary heart disease. 相似文献18.
Kevin Bryan Lo Hafeez Ul Hassan Virk Vladimir Lakhter Pradhum Ram Carlos Gongora Gregg Pressman Vincent Figueredo 《The American journal of medicine》2019,132(4):505-509
Background
Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes.Methods
Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model.Results
Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate.Conclusion
This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use. 相似文献19.
Hester Groenewegen Wouter F.W. Bierman Konstantina Delli Pieter U. Dijkstra Willem Nesse Arjan Vissink Frederik K.L. Spijkervet 《The Journal of infection》2019,78(3):171-177
Objective
To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis.Design
cross-sectional controlled study.Methods
We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires.Results
Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p?=?0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists.Conclusions
Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients. 相似文献20.
Renato D. Lopes Jan Steffel Manuela Di Fusco Allison Keshishian Xuemei Luo Xiaoyan Li Cristina Masseria Melissa Hamilton Keith Friend Kiran Gupta Jack Mardekian Xianying Pan Onur Baser W. Schuyler Jones 《The American journal of medicine》2018,131(9):1075-1085.e4