Risultati per: Linee-guida GOLD 2023,cosa cambia?

Objective
The objective of the study was to determine the magnitude of and the factors associated with late presentation for induced abortion care services at hospitals in the South Gondar district of Ethiopia.

Design
This study employed an institution-based, cross-sectional design.

Setting
The study was conducted at five hospitals in the South Gondar district of Ethiopia.

Participants
A total of 381 women recruited through systematic random sampling techniques from October 2022 to February 2023 participated in the study. All women presenting for safe abortion care services at selected hospitals during the data collection period were included, whereas induced abortion care service due to the pregnancy being a high risk to maternal health or at high risk for fetal anomaly were excluded from the study. Data were collected at the abortion clinic at the time of presentation through face-to-face interviews using a pretested and structured questionnaire.

Outcome measures
The magnitude of and the factors associated with late presentation for induced abortion care service were assessed in the study.

Statistical analysis
The collected data were entered and coded using EpiData V.4.6, and SPSS V.25 was used for analysis. Binary logistic regression analyses were undertaken to identify the factors associated with the outcome variable. The level of significance was declared at a p value of

Casi aumentati del 20% in un anno, oltre 100 mila morti

Casi aumentati del 20% in un anno, oltre 100 mila morti

‘Necessaria la sorveglianza delle infezioni nelle strutture sanitarie’

Medicinali più consumati sono per cuore, intestino e sangue

This study examines the prescribing trends of 3 oral preexposure prophylaxis medications and a long-acting injectable option from 2013 to 2023.

Circulation, Volume 150, Issue Suppl_1, Page A4138603-A4138603, November 12, 2024. Introduction:Kawasaki disease (KD) is a pan-vasculitis that primarily affects children and rarely adults. Available data on adult-onset KD are based on case reports and case series, both of which are limited by small sizes. We aimed to characterize the epidemiology, presentation, hospital course, and outcomes of adult-onset KD published in the English literature from 1980 through 2023.Methods:We retrospectively reviewed and included published articles with a diagnosis of KD in patients age ≥18 years. We searched PubMed and Google scholar for case reports/series published in English using the keywords “adult”, “Kawasaki disease”, and “mucocutaneous lymph node syndrome”. We extracted data from individual articles onto an Excel spreadsheet for analysis. Outcomes of interest were the demographic characteristics of patients, clinical presentation and hospital course, management, and complications. Descriptive statistics were used to analyze the data.Results:A total of 137 patients from 29 countries were included in this study. The majority were male (90/137, 64.9%; M:F ratio 1.8) and the median age was 25 years (range, 18-68). The median time to clinical presentation was 5 days (range, 4-60). The main signs and symptoms were fever (95.7%), skin rash (92.9%), conjunctivitis (89.3%), extremity changes (84.3%), oral changes (85.7%), and cervical lymphadenopathy (73.7%). The majority of the patients had no co-morbidities (125/137, 91.2%). EKG changes were not reported in 48 patients (35%). In the remaining 89, 26 (29.2%) had normal EKG or sinus tachycardia, 9 (10.1%) had ST segment elevation, and 9 (10.1%) had arrythmias or abnormal EKGs. Pharmacotherapy included IVIG (80/137, 58.4%), Aspirin (105/137, 76.6%), steroids (31/137, 22.6%) and antibiotics (68/137, 49.6%). For complications, 18.2% (25/137) had aneurysms, 8% (11/137) had myocardial infarction, 10.9% (15/137) had myocarditis, 10% had pericarditis/pericardial effusion, and 10.9% (15/137) had KD shock syndrome. The median length of stay was 14 days (range, 1-60 days). Three patients (2%) died from KD.Conclusion:Adult-onset KD is rare and is associated with significant cardiovascular complications. Clinicians should have high index of suspicion for prompt diagnoses and initiate appropriate treatment to improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4138622-A4138622, November 12, 2024. Cardiac Rhabdomyosarcoma (CR) is a rare malignant neoplasm of the heart occurring in all age groups and genders. It can arise anywhere in the heart with varied clinical presentation. Available data on CR are mainly from case reports and series that are limited by small sizes. The purpose of this study was to characterize the epidemiology, presentation, management, hospital course, and outcomes of CR published in the English literature from 1980-2023.Methods:We reviewed and included all published case reports with a diagnosis of CR in adult patients (age >18 years) on PubMed and Google Scholar using the keywords “primary cardiac tumor” and “cardiac rhabdomyosarcoma”. Data was extracted onto an Excel spreadsheet for analysis and the outcomes of interest were demographics, clinical presentation, diagnostic modalities, management, complications, and outcomes. We used descriptive statistics to analyze the data.Results:Among a total of 97 patients from 19 countries included in this study, 54% were males and the median age was 49 years (range 18-80). The main symptoms were dyspnea (37.1%), palpitations (23.7%), chest pains (16.5%) and syncope (6.5%). Hypotension or heart failure and arrhythmias were present in 10.3% and 9.3%, respectively and 5.2% had pericardial effusion. In addition to those with metastatic tumors, 22.7% had chronic co-morbidities. The majority of the cases were primary tumors (85.6%), and the remainder were (14.4%). All patients had at least one imaging modality including echocardiography (89%) and CT/MRI (84%). The commonest sites of cardiac involvement were the left atrium (35%), right atrium (33%), right ventricle (20%), and left ventricle (12%). Approximately 68% involved a single cardiac site while 32% involved multiple sites. Among the patients, 96% underwent surgery while 33% and 25% had chemotherapy and 25% radiotherapy, respectively. The median length of hospital stay was 11 days (range, 2-68 days), and mortality was recorded in 79.3% (77/97) of the patients. The median survival time was reported in 42 patients, and it was 6 months (range, 0-36 months).Conclusion:Cardiac rhabdomyosarcoma is a rare and aggressive malignant neoplasm. Most cases are primary tumors with poor outcomes such as a very short median survival time and a very high mortality rate despite the combination of surgery, chemotherapy, and radiotherapy. This calls for further research into the early diagnosis and optimal management strategies to improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4146283-A4146283, November 12, 2024. Objective:The incidence of cognitive decline following coronary artery bypass grafting (CABG) is well-documented, significantly impacting patient morbidity, mortality, and quality of life. We conducted a systematic review that examines cognitive outcomes in CABG randomized controlled trials (RCTs) to identify which cognitive assessments were used, their administration frequency, attrition rates, and their effectiveness in detecting perioperative cognitive changes in control groups.Methods:We conducted a search of MEDLINE, EMBASE, Cochrane Library, and PsycINFO for CABG RCTs that included cognitive assessments, from January 2005 to December 2023. Descriptive statistics were used to summarize the frequency, domains, and attrition rates of each cognitive task. For tasks assessed both pre- and post-operatively in at least three RCTs, control group scores and standard deviations were reported.Results:Out of 3337 screened studies, 2163 were CABG RCTs, and only 69 (3.2%) included cognitive evaluations (Figure 1). These trials involved 15,839 subjects (79% male, mean age 64.4, median follow-up time 90 days) and used 145 unique cognitive tasks. The Trailmaking Test Part B (40/69; 58.0%) and Part A (38/69; 55.0%) were the most frequently used. Only 7 tasks had means and standard deviations reported before and after surgery in more than three RCTs, and none detected significant pre- to post-operative changes. Attrition rates averaged 19.3%, with a wide range from 0% to 62%. Figure 2 demonstrates the decline in cognitive assessments in CABG trials over the years, with a sharp decline after 2014. Trials that assessed cogntion after 2014 tended to favor screening tasks (MMSE/MoCA) alone.Conclusion:Cognitive assessments are infrequent in CABG trials, and existing tests fail to consistently detect cognitive changes. To effectively evaluate and address cognitive impact after CABG, new assessment strategies that are resilient to attrition and practical for use in diverse trial settings are needed.

Circulation, Volume 150, Issue Suppl_1, Page A4147009-A4147009, November 12, 2024. Introduction:Political advocacy is crucial for combating health inequities, improving population health, increasing funding of cardiovascular research, and promoting clinician wellbeing. The political activities of major cardiovascular organizations have not previously been characterized.Methods:Lobbying expenditures for six major cardiovascular professional societies were queried from OpenSecrets. Campaign finance data for three cardiovascular political action committees (PACs), ACC’s HeartPAC, SCAI-PAC, and STS-PAC, were obtained directly from the Federal Election Commission. Descriptive statistics of each organization’s lobbying expenditures and PAC donations from members were compared to other medical specialties. Data were aggregated per year to assess trends between 2003-2023.Results:From 2003-2023, the ACC and AHA spent $34,130,110 and $14,285,652 on lobbying, respectively. Other societies reported less robust and consistent lobbying expenditure over the study period: American Society of Echocardiography ($2,080,000), Heart Rhythm Society ($1,450,918), American Society of Nuclear Cardiology ($759,000), and Heart Failure Society of America ($140,000). Annually, the ACC and AHA spent more on lobbying compared to all other societies combined ($2,526,767 vs. $224,000). Temporal analysis revealed a meaningful increase for ACC, from $80,068 in 2003 to $1,890,000 by 2023 and a numerical decrease for AHA, from $570,000 in 2003 to $550,000 by 2023. Notably the American Society of Nuclear Cardiology and American Society of Echocardiography showed increases in annual lobbying expenditure over the study period ($10,000 to $90,000 and $40,000 to $200,000). HeartPAC and SCAI-PAC collected 19,326 donations from 2003-2023. HeartPAC received $7,015,821 from 6266 donors (median, $250) and SCAI PAC received $358,643 from 256 donors (median, $500). STS-PAC received $3,160,192 from 2231 donors (median, $500). Most donations to HeartPAC and SCAI-PAC came from cardiologists (95.5%), followed by administrators (1.0%) and executives (1.0%), and 2870 donations (14.9%) came from university-affiliated individuals.Conclusion:The ACC and AHA remain key stakeholders in cardiovascular lobbying efforts. Several other medical specialties raise >two-fold greater PAC contributions compared to cardiovascular medicine. With the rising importance of advocacy to affect issues facing clinicians, enhancing cardiovascular society engagement would be an important political strategy.

Circulation, Volume 150, Issue Suppl_1, Page A4140005-A4140005, November 12, 2024. Introduction:Cocaine and methamphetamine, stimulants with potent central nervous system effects, are known to be cardiotoxic. They increase the risk of hypertension, coronary artery disease, coronary vasospasm, arrhythmias, cardiomyopathy, cardiac arrest, and stroke. Despite these well-documented risks, the National Survey on Drug Use and Health reports that illicit stimulant use is increasing.Research Question:How have mortality rates changed over time when cardiovascular disease (CVD) is the underlying cause of death and illicit stimulant use is a contributing factor?Aims:To describe trends in cardiovascular mortality rates from 1999-2023 and to stratify the analysis by race, ethnicity, sex, age, CVD subcategories, and stimulant type.Methods:We leveraged CDC WONDER data to model age-adjusted CVD mortality rates from 1999 to 2023 using joinpoint regression. For each stimulant type, demographic group, and CVD subcategory, we report annual percent changes (APCs) for each time segment and average annual percent changes (AAPCs) to estimate overall trend direction and magnitude.Results:From 1999 to 2023, stimulant-involved CVD mortality rates increased significantly, with an AAPC of 6.4%, contrasting sharply with the 2.0% decline in overall CVD mortality rates (Table). Each subcategory of CVD mortality (ischemic heart disease, hypertension; cerebrovascular disease) showed AAPC increases when stimulants were involved, with hypertensive diseases experiencing the largest AAPC rise at 9.1%.Stratifying by drug type, methamphetamine-involved CVD death rates increased by 14.9% AAPC, compared to a 3.1% increase for cocaine-involved deaths. Demographic stratification revealed additional differences. Non-Hispanic White individuals had the highest AAPC (9.2%), followed by Asian/Pacific Islander (5.6%), Hispanic (5.4%), Non-Hispanic Black (3.0%), and American Indian/Alaskan Native individuals (1.9%). A higher AAPC also was observed among those aged ≥65 years (14.6%).Conclusions:Cardiovascular deaths where stimulants were a contributing cause have increased rapidly over the past 25 years despite the overall decline in the CVD mortality rate during the same period. The largest increases were seen in hypertensive diseases, methamphetamine-involved deaths, non-Hispanic White individuals, and older individuals. This study extends our understanding but is limited by potential inaccuracies in the recorded causes of death.