Abstract 13688: Shocking: Cardioversion in Cardiogenic Shock Has Limited Success

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William A Janes ◽  
Wendy Y Craig ◽  
Jonathan M Nichols ◽  
Henry W Sesselberg
Keyword(s):  
Cardiogenic Shock ◽  
Medical Center ◽  
Sinus Bradycardia ◽  
P Value ◽  
Newly Diagnosed ◽  
Inclusion Criteria ◽  
Limited Success ◽  
Hemodynamic Deterioration ◽  
Maine Medical ◽  
Vasopressor Use

Introduction: Atrial fibrillation (AF) and atrial flutter (Aflutter) are common in cardiogenic shock patients in the Cardiac ICU (CICU). Electrical cardioversion (CV) can restore sinus rhythm, but carries the risk of transient hemodynamic deterioration. There has been little research in the efficacy and safety of electrical CV for AF/Aflutter in the CICU. Objective: Describe success of CV in AF/Aflutter in cardiogenic shock patients in the CICU. Methods: We identified Maine Medical Center CICU patients from 1/1/2015 to 12/31/19 who were in cardiogenic shock and underwent electrical CV for AF/Aflutter. Cardiogenic shock was defined by depressed cardiac index (<2.2L/m^2 or inotrope use), hypotension (systolic BP <90 mmHg, MAP <65 mmHg, or vasopressor use), and Lactate > 2mmol/L. If a patient had multiple CVs, only the first was analyzed. Results: Twenty patients met the inclusion criteria. Initially, 16 of 20 CVs were successful, however only 10 patients were in SR 24 hours after CV and only 7 were in SR at CICU discharge (Figure 1). The median LVEF was 20%, similar between groups (p-value = 0.52 initially, 0.37 at 24 hours, and 0.18 at CICU discharge). Only 1 patient was on mechanical support. The type of AF was varied (35% newly diagnosed, 55% paroxysmal, and 10% persistent). In patients with new AF, 85% were in SR initially, 57% at 24 hours, and 28% at CICU discharge. All patients received amiodarone. Inotrope use was similar, however no patients on vasopressors were in SR at CICU discharge (5/13 vs 0/7, p=0.11). Only 1 patient suffered an adverse effect (sinus bradycardia). Diabetes (p = 0.064) was the only characteristic to nearly predict lack of CV success at CICU discharge. Conclusions: 1. Electrical CV in patients admitted to the CICU in cardiogenic shock had a high initial success rate, however success was short-lived. 2. CV did not cause serious adverse effects. 3. Larger registries/trials are needed to predict which subgroups of CICU patients benefit from CV for Afib/Aflutter.

DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
I P Aanen ◽  
B Pullens ◽  
J van Rosmalen ◽  
R M H Wijnen
Keyword(s):  
Sensitivity And Specificity ◽  
Esophageal Atresia ◽  
Surgical Intervention ◽  
Medical Center ◽  
Primary Repair ◽  
Demographic Data ◽  
P Value ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Low Sensitivity

Abstract Aim of the Study The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia. Methods We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed. Main Results Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%). Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM. Conclusions Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.

scholarly journals Dyslipidemia in Newly Diagnosed Diabetic Patients With or Without Micro Albuminuria

2021 ◽  
Vol 10 (02) ◽  
pp. 129-132
Author(s):  
Naimatullah Khan ◽  
Javed Iqbal Khan ◽  
Tariq Mehmood ◽  
Aqeel Peter
Keyword(s):  
Cross Sectional Study ◽  
Military Hospital ◽  
P Value ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Inclusion Criteria ◽  
Chi Square ◽  
Cross Sectional ◽  
Qualitative Variables ◽  
Chi Square Test

Objective: To assess the dyslipidemia in newly diagnosed diabetic patients and compare it with or without micro albuminuria. Study Design and Setting: Cross-sectional study at Department of Medicine, Military Hospital Rawalpindi from 01 March 2015 to 31 August 2015. Methodology: A total of 150 patients who fulfilled the inclusion criteria were included after taking informed consent and approval from hospital ethical committee. Blood sample was obtained from each patient and samples were sent to hospital laboratory and reports were assessed by pathologist. Presence or absence of microalbuminuria, trigiyceridemia (200-499 mg/dl), raised LDL-C (>160 mg/dl) and decreased HDL-C (<40 mg/dl) were noted by researcher himself on a pre-designed performa. The collected data was analyzed statistically by using SPSS version 12.Quantitative variables like age, TG, LDL HDL levels were presented in form of mean ± S.D. Qualitative variables like gender, diabetes mellitus, micro albuminuria and dyslipidemia were presented as frequencies and percentages. Chi-square test was applied to find association between dyslipidemia and micro albuminuria. P value = 0.05 was considered as statistically significant. Results: Mean ± SD of age was 47.97±7.08 years. Out of 150 patients 60% were male and 40% were female. Dyslipidemia was found in 42% patients. Highly significant association was found between dyslipidemia and micro albuminuria, i.e. (P=0.0001). Conclusion: The frequency of dyslipidemia among newly diagnosed diabetic patients with micro albuminuria was significantly higher than in subjects without micro albuminuria

scholarly journals Regular exercise is associated with a lower risk of developing dementia in patients with a new diagnosis of atrial fibrillation: a nationwide population-based study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.H Lim ◽  
S.R Lee ◽  
E.K Choi ◽  
J.P Yun ◽  
H.J Ahn ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Vascular Dementia ◽  
Lower Risk ◽  
Alzheimer’S Dementia ◽  
P Value ◽  
Regular Exercise ◽  
Newly Diagnosed ◽  
Exercise Habit ◽  
New Diagnosis

Abstract Introduction Regular exercise is known to decrease the risk of dementia. There is a paucity of information about the impact of the change of exercise habit on cardiovascular outcomes after a new diagnosis of atrial fibrillation (AF). We aimed to investigate whether regular exercise is associated with the risk of developing dementia in patients with AF. Methods Using the Korean National Health Insurance Service database, we enrolled patients with newly diagnosed AF who had undergone health screening between 2010 and 2016. The study population was divided into four groups based on the consistency of regular exercise before and after AF diagnosis: (1) persistent non-exerciser, (2) exercise starter, (3) exercise quitter, and (4) exercise maintainer. We investigated the association between exercise and the risk of dementia. Results A total of 126,555 patients were included (mean age 62.7 years, male 62.0%, and mean CHA2DS2-VASc Score 2.7). During a median follow-up duration of 3.0 years, 5,943 patients were newly diagnosed as dementia (1.57 per 100 person-years). Among patients with incident dementia, 4,410 patients had Alzheimer's dementia and 951 patients had vascular dementia (1.16 and 0.25 per 100 person-years, respectively). Persistent non-exerciser, exercise starter, quitter, and maintainer groups were 65.1%, 12.8%, 12.7%, and 9.4%, respectively. After multivariable adjustment, we found that exercise was associated with a lower risk of developing overall dementia. When compared to persistent non-exerciser, exercise starter and maintainer showed reduced risk of developing dementia (hazard ratio [HR] 0.80, 95% confidence interval [95% CI] 0.73–0.88 and HR 0.63, 95% CI 0.54–0.73, respectively, all p-value &lt;0.0001), but exercise quitter showed no significant risk reduction (HR 0.95, 95% CI 0.88–1.03, Figure). Alzheimer's dementia showed consistent results: a 20% lower risk with exercise starter, and a 37% lower risk with exercise maintainer. Change of exercise habit, however, did not affect the risk of vascular dementia (all, p-value &gt;0.05, Figure). Conclusions Regular exercise showed a lower risk of dementia in patients with new-onset AF. Starting exercise even after the diagnosis of AF was beneficial to patients who had little physical activity previously. These findings may support physicians to recommend that AF patients should start exercise or keep their physical activity to reduce the risk of dementia. Funding Acknowledgement Type of funding source: None

scholarly journals Perinatal Asphyxia Among Neonates Admitted Jimma Medical Center, Jimma, Ethiopia

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098130
Author(s):  
Ebissa Bayana Kebede ◽  
Adugna Olani Akuma ◽  
Yonas Biratu Tarfa
Keyword(s):  
Gestational Age ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Large For Gestational Age ◽  
Systematic Sampling ◽  
P Value ◽  
Health Extension Workers ◽  
Severe Problem ◽  
Prolonged Labor

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

scholarly journals CT Simplified Radiomic Approach to Assess the Metastatic Ductal Adenocarcinoma of the Pancreas

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1843
Author(s):  
Mirko D’Onofrio ◽  
Riccardo De Robertis ◽  
Gregorio Aluffi ◽  
Camilla Cadore ◽  
Alessandro Beleù ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma ◽  
Newly Diagnosed ◽  
Inclusion Criteria ◽  
Permeability Index ◽  
Metastatic Tumors ◽  
Qualitative And Quantitative ◽  
Portal Phase ◽  
Phase Images ◽  
Adenocarcinoma Of The Pancreas

The aim of this study was to perform a simplified radiomic analysis of pancreatic ductal adenocarcinoma based on qualitative and quantitative tumor features and to compare the results between metastatic and non-metastatic patients. A search of our radiological, surgical, and pathological databases identified 1218 patients with a newly diagnosed pancreatic ductal adenocarcinoma who were referred to our Institution between January 2014 and December 2018. Computed Tomography (CT) examinations were reviewed analyzing qualitative and quantitative features. Two hundred eighty-eight patients fulfilled the inclusion criteria and were included in this study. Overall, metastases were present at diagnosis in 86/288 patients, while no metastases were identified in 202/288 patients. Ill-defined margins and a hypodense appearance on portal-phase images were significantly more common among patients with metastases compared to non-metastatic patients (p < 0.05). Metastatic tumors showed a significantly larger size and significantly lower arterial index, perfusion index, and permeability index compared to non-metastatic tumors (p < 0.05). In the management of pancreatic ductal adenocarcinoma, early detection and correct staging are key elements. The study of computerized tomography characteristics of pancreatic ductal adenocarcinoma showed substantial differences, both qualitative and quantitative, between metastatic and non-metastatic disease.

Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

2021 ◽  
Author(s):  
majdi abu sneineh ◽  
malek abu sneineh ◽  
Monther Abu Sneineh ◽  
mustafa abu sneineh ◽  
muneer abu snineh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Bariatric Procedure ◽  
P Value ◽  
Significant Difference ◽  
Symptomatic Gerd ◽  
Swallow Study ◽  
Contrast Swallow ◽  
Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

scholarly journals Effect of Ranibizumab Treatment in Cases of Choroidal Neovascular Membranes Secondary to Pathological Myopia versus Age-Related Macular Degeneration

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Abdaltawab ◽  
Z F Ismail ◽  
W M A Ebeid ◽  
S M Fawzy
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
P Value ◽  
Newly Diagnosed ◽  
Pathological Myopia ◽  
Age Related ◽  
Significant Difference ◽  
The Mean

Abstract Aim of the Work The aim of this work is to compare the response of treatment with ranibizumab in terms of visual acuity in cases of CNV secondary to pathological myopia versus CNV secondary to age-related macular degeneration. Methods This prospective, comparative study included ten eyes newly diagnosed as having CNV secondary to pathological myopia, and 10 eyes newly diagnosed as having subfoveal active CNV secondary to AMD. All patients had 3 monthly intravitreal Injections of 0.50 mg (in 0.05 ml of solution) ranibizumab with monthly evaluation of best corrected visual acuity (BCVA) by Landolt C chart, and also calculated in Logarithm of Minimum Angle of Resolution (Log MAR). Results pretreatment there was no significant difference between the two groups as the mean VA (Log Mar) was 1.31 ± 0.2 in AMD group and 1.17 ± 0.3 in MCNV group of P value = 0.431 and also post three IVI of ranibizumab showed no significant difference between the two groups as the mean VA (Log Mar) was 1.22 ± 0.2 for AMD and 1.22 ± 0.5 for MCNV of P value = 0.635. Conclusion there was no significant difference in BCVA between AMD and MCNV groups after three intravitreal injections of ranibizumab.

scholarly journals A Review of Brooke Army Medical Center Chaplaincy Service During the SARS-COV2 Pandemic: Implications for Service Structure and Patient Needs

2021 ◽  
Author(s):  
Zaith Bauer ◽  
Joseph Sherwin ◽  
Stanley Smith ◽  
Jason Radowsky
Keyword(s):  
Mortality Rate ◽  
End Of Life ◽  
Medical Center ◽  
Well Being ◽  
Primary Study ◽  
P Value ◽  
Inpatient Setting ◽  
Spiritual Support ◽  
Army Medical ◽  
Brooke Army Medical

ABSTRACT Introduction We aimed to evaluate the effect of the SARS-COV2 pandemic on chaplain utilization at Brooke Army Medical Center. Our hypothesis was that multiple pandemic-related factors led to a care environment with increased mental and spiritual stress for patients and their families, leading to an increased need for adjunct services such as chaplaincy. Materials and Methods This was a single-institution retrospective chart review study that evaluated the records of 10,698 patients admitted between July 1, 2019, and January 31, 2020, or between July 1, 2020, and January 31, 2021. Our primary study outcomes included the number of chaplain consultations, the number of visits per consultation, and the time of visits between the two study cohorts. Secondary outcomes included inpatient mortality and the number of end-of-life visits. We also isolated a subgroup of patients admitted with COVID-19 and compared their outcomes with the two larger cohorts. Statistical analysis included t-test or chi-squared test, based on the variable. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board (IRB ID C.2021.010e). Results Fewer consults were performed during the study period affected by the SARS-COV2 pandemic (4814 vs. 5884, P-value &lt;.01). There were fewer individual visits per consult during the study period affected by the SARS-COV2 pandemic (1.44 vs. 1.64, P-value &lt;.01), which led to fewer overall time spent per consult (37.41 vs. 41.19 minutes, P-value &lt;.01). The 2020 cohort (without COVID-19 cases) demonstrated a higher mortality rate than the 2019 cohort (2.8% vs. 1.9%, P-value &lt;.01). The COVID-19 diagnosis cohort demonstrated a much higher mortality rate compared to other patients in the 2020 cohort (19.3% vs. 2.8%, P-value &lt;.01). We demonstrated the relative need for EOL consults by presenting the ratio of EOL consults to inpatient deaths. This ratio was highest for the COVID-19 diagnosis cohort (0.76) compared to the 2020 cohort (0.50) and the 2019 cohort (0.60). Conclusions This study demonstrates that factors related to the SARS-COV2 pandemic resulted in fewer chaplaincy consults in our inpatient setting. We did not find other reports of a change in the rate of chaplaincy consultation, but available reports suggest that many centers have had difficulty balancing the spiritual needs of patients with local exposure guidelines. Although fewer individual chaplain consults occurred during the SARS-COV2 pandemic, our chaplain service innovated by utilizing various phone, video, and web-based platforms to deliver spiritual support to our community. Our study also suggests that the patients most greatly affected by the pandemic have an increased need for spiritual support, especially at the end of life. Future studies in this subject should examine the effect of various types of chaplain services as they relate to the health and well-being of hospitalized patients.

scholarly journals PERBANDINGAN EFEKTIVITAS CIRCULO MASSAGE DANSPORT MASSAGE DALAM MENGATASI KELELAHAN KERJAKARYAWAN LAKI - LAKI GADJAH MADA MEDICAL CENTER

MEDIKORA ◽  
2015 ◽  
Author(s):  
Kunto Prastowo dan Novita Intan Arovah
Keyword(s):  
Medical Center ◽  
Rank Test ◽  
P Value ◽  
Purposive Sampling ◽  
Signed Rank ◽  
Signed Rank Test

Penelitian ini bertujuan mengetahui perbandingan efektivitas circulo massage dansport massage dalam mengatasi kelelahan kerja karyawan Gadjah Mada Medical Center.Penelitian ini merupakan penelitian pra eksperimen dengan desain treatment bysubjects. Subjek penelitian ini adalah 15 karyawan laki-laki GMC yang direkrut denganteknik purposive sampling. Subjek diberi dua perlakuan yakni circulo massage dan sportmassage dengan selang waktu + 1 minggu. Sebelum dan sesudah perlakuan massagedilakukan pengukuran tingkat kelelahan kerja dengan menggunakan kuisioner kelelahankerja yang telah diujicoba dan dinyatakan valid dan koefisien reliabilitas sebesar 0,779.Teknik analisis data yang digunakan dalam penelitian ini adalah analisis deskriptif,analisis efektivitas (nilai posttest-pretest)/ pretest) dan uji beda dengan menggunakan ujiwilcoxon signed rank test dengan taraf signifikansi 5 %.Hasil penelitian menunjukkan bahwa nilai rata-rata pretest dan posttest kelelahankerja pada perlakuan circulo massage adalah 29 dan 20,53, uji efektivitas menunjukkanpenurunan 29,20 % (p value: 0,0012). Pada penelitian dengan perlakuan sport massagemenunjukkan bahwa nilai rata-rata pretest dan posttest kelelahan kerja adalah 29,9 dan17,5, uji efektivitas menunjukkan penurunan 41,47 % (p value : 0.0006). Perbandinganantara kelelahan kerja pada perlakuan efektivitas circulo massage dan sport massagemenghasilkan p value: 0,0287. Dapat disimpulkan sport massage lebih efektifdibandingkan circulo massage dalam mengatasi kelelahan kerja pada karyawan laki-lakiGadjah Mada Medical Center.Kata kunci : Circulo massage, sport massage, kelelahan kerja

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