Risultati per: Le cause della polmonite nei bambini

Circulation, Volume 148, Issue Suppl_1, Page A17006-A17006, November 6, 2023. Background:The use of oral anticoagulants (OAC) in atrial fibrillation (AF) patients increases the risk of bleeding. However, the relationship between OAC use before and after non-major bleeding and all-cause mortality remains unknown.Purpose:We aimed to investigate the association between OAC prescription before and after non-major bleeding and all-cause mortality in AF patients.Method:In the Fushimi AF Registry, follow-up data were available in 4,496 patients by the end of February 2022. Patients were divided into four groups based on OAC prescription before and after non-major bleeding: G1 (OAC prescribed both before and after), G2 (OAC prescribed before but not after), G3 (OAC not prescribed before but prescribed after), and G4 (OAC neither prescribed before nor after). Non-major bleeding was defined as all bleeding except for major bleeding according to the criteria of the International Society on Thrombosis and Haemostasis.Result:During the median follow-up of 1,448 days, 733 patients experienced non-major bleeding. G1 had 452 patients, G2 had 54, G3 had 63, and G4 had 164. G1 and G2 were more often non-paroxysmal AF and had significantly higher prevalence of previous stroke or systemic embolism, heart failure and dyslipidemia and had higher CHADS2 scores than G3 and G4. All-cause mortality after non-major bleeding occurred in 91 patients in G1, 54 in G2, 63 in G3, and 164 in G4. (G1: 5.1%, G2: 13.0%, G3: 7.1%, and G4: 6.8% per patient-year, p=0.0004). Multivariate analysis showed that the G2 group had a higher incidence of all-cause mortality as compared with G1 (HR 2.49, 95%CI 1.58-3.93; p

Circulation, Volume 148, Issue Suppl_1, Page A15580-A15580, November 6, 2023. Introduction:There is widespread concern that blood transfusion has a strong adverse impact on early/late surgical survival, so hematocrit is often allowed to drift very low. We investigate whether this adverse impact of transfusion is seen in aortic surgery.Methods:The records of 870 patients who underwent open ascending aortic or arch surgery from 2004 to 2016 by one surgeon at a large hospital were reviewed. Of these patients, 347 (39.9%) received a blood transfusion. The mean number of intra-op units transfused was 0.89, and the mean total units transfused (intra+post-op) was 2.45. High-volume transfusion (over 5 units) was needed for only 24 (6.9%) patients. We aimed to maintain a post-operative Hct of above 28%. Mean follow-up was 6.5 years.Results:We found no significant difference in 30-day or 1-year mortality between the transfused and non-transfused groups, nor between high- and low-volume transfused patients. However, the long-term mortality beyond 1 year was higher in the transfused group than in the non-transfused group (13% vs 5.7%; p=0.0003). Notably, the transfused group was older than the non-transfused group (64.9 vs 57.7). On Kaplan-Meier analysis (Fig.1), there remained a significant adverse effect of transfusion overall (p=0.004), but this effect was eliminated if patients were propensity matched for age (p=0.18). There was no difference in high- vs low-volume K-M survival (p=0.58). Amongst those transfused, the total units transfused was not a predictor of mortality in any time-frame on multivariate regression when adjusting for pre-op Hct, blood transfusions, DHCA, type A dissection, and operation urgency (p=0.95, 0.56, and 0.45 for 30d, 1yr, and beyond 1yr respectively).Conclusions:Transfusion and transfusion volume had no significant effect on early mortality, or even on late mortality after appropriate age adjustment. Should patient condition warrant, surgeons need not be concerned that transfusion will further reduce survival.

Circulation, Volume 148, Issue Suppl_1, Page A15592-A15592, November 6, 2023. Introduction:Myocardial strain, a marker of heart muscle deformation, is crucial for assessing cardiac function and prognosis in cardiovascular diseases. Speckle Tracking Echocardiography (STE) is the preferred non-invasive method for strain. However, STE’s accuracy can vary due to image quality, vendor-dependence, and operator inconsistency. STE-derived Global Longitudinal Strain (manual GLS) changes are key in early detection of cancer treatment-related cardiotoxicity.Hypothesis:We hypothesized that AI-derived GLS would have a stronger correlation with all-cause mortality (ACM) than STE-derived GLS.Methods:We retrospectively analyzed 1,224 echocardiograms, from 762 patients, with STE GLS values from Harrington Heart and Vascular Institute Cardio-Oncology studies performed between Jan 2021 – Jun 2022. Images were analyzed using EchoGo Core (Ultromics Ltd), a cloud-based, AI-powered software employing convolutional neural networks. Pearson’s correlation coefficients and Bland-Altman analysis compared STE and AI-derived GLS (R-Studio). Both methods were evaluated using Receiver Operating Characteristic (ROC) curves. Patients were divided into tertiles based on their GLS values to assess ACM hazard ratios (HR).Results:Out of 762 patients, a moderate correlation (r=0.63, p

Circulation, Volume 148, Issue Suppl_1, Page A18434-A18434, November 6, 2023. Introduction:The Amanita mushroom family is known for use as a means of suicide or for psychedelic effects. The manifestations of Amanita mushroom poisoning include gastrointestinal poison, cholinergic effects and organ failure. In this paper, we will discuss the first observed study of a patient who developed new onset atrial fibrillation (AF) with rapid ventricular response (RVR) after withdrawal from accidental chronic poisoning ofAmanita muscariaandpantherinaover the course of three weeks.Case:A 29 year-old male with no prior past medical history presented with three days of palpitations. He began takingA. pantherinaandmuscariathree weeks prior to help treat sexual addiction. He started with 0.35 mcg twice a day, then doubled the dose after one week, then three days prior to presentation he started taking three grams twice per day. He noticed palpitations as he increased his dose, but then acutely worsened after he stopped taking mushrooms. In the emergency department, he was found to have new onset atrial fibrillation with rapid ventricular rate as well as frequent episodes of nonsustained ventricular tachycardia. An alcohol level and urine drug screen were unremarkable. Thyroid stimulating hormone was within range. His heart rate did not respond to intravenous diltiazem. He was transitioned to an esmolol infusion that responded with rapid improvement in heart rate as well as ventricular ectopy suppression. He eventually underwent a transesophageal echocardiogram and was transitioned to oral beta blocker therapy. He was discharged with no complications and near full recovery.Discussion:A report published in 1869 described the first description of the pharmacological effect ofA. muscariashowing it is 143 times more toxic than acetylcholine due to the inability of cholinesterase to hydrolyse or inhibit its effect. The acute cardiovascular toxicities are well described, however, this case is the first description of chronic cardiac toxicity manifesting as new onset AF with RVR, caused byA. muscariaandpantherinawithdrawal. We suggest that cardiovascular monitoring, including event monitors, are essential for complications ofA. muscariaandpantherina. More detailed studies need to be done.

Circulation, Volume 148, Issue Suppl_1, Page A14850-A14850, November 6, 2023. Introduction:Cardiac tamponade is an emergency medical condition referring to the buildup of fluid in the pericardial sac, which can compress the heart and lead to hemodynamic instability. Streptococcus constellatus, a member of the Streptococcus viridans group, has been implicated as a rare cause of cardiac tamponade with only 3 cases reported in the medical literature. We present a unique case of Streptococcus constellatus (S. constellatus) induced purulent pericarditis leading to cardiac tamponade and constrictive pericarditis.Case presentation:A 56-year-old female with no significant past medical history presented with intermittent fever, non-productive cough, and worsening shortness of breath for 2 weeks. She initially went to Convenient Care a week ago for a sore throat with a low-grade fever and was sent home with oral antibiotics. Initial vitals revealed hypotension, high-grade fever, and tachycardia. Physical examination was remarkable for elevated jugular venous pressure and muffled heart sounds. Lab work showed significant leukocytosis. EKG was remarkable for diffuse ST-elevation, low QRS voltage, and electrical alterans. A transthoracic echocardiogram (TTE) revealed severe pericardial effusion. Emergent pericardiocentesis was performed draining 370 ml of purulent fluid and post-operative TTE revealed trace pericardial effusion. Blood and pericardial fluid cultures came back positive for S. constellatus. Another trans-esophageal echocardiogram (TEE) was performed during the hospital stay that was negative for any vegetation however, revealed thickened pericardium with septal bounce suggesting constrictive pericarditis. Cardiothoracic surgery recommended repeat TTE in 3 months for possible pericardiectomy if pericardial changes persist. The patient was discharged on oral antibiotics and colchicine in stable condition.Discussion:S. constellatus is typically part of oral, respiratory, and gastrointestinal flora. It can reach the pericardial space through hematogenous spread or direct extension from nearby infections. Our case highlights prompt identification and appropriate treatment which are crucial for managing this potentially life-threatening and unique condition.

Da polmonite a meningite, in molti casi efficacia dimezzata

Permette di avere vaccini più mirati e diete meno restrittive

Permette di avere vaccini più mirati e diete meno restrittive

Parmitano e Patassa ambasciatori nuovo Ps del Buzzi di Milano

Manovre efficaci già a 10 anni, a 6 riescono a chiamare soccorso

Manovre efficaci già a 10 anni, a 6 riescono a chiamare soccorso

Exposure to lead through sources such as contaminated food, soil, and paint might have contributed to 5.5 million adult cardiovascular disease deaths and 765 million lost IQ points among children younger than 5 years in 2019, according to a new analysis of countries’ blood lead level estimates.