Abstract P361: Prevalence & Predictors of Orthostatic Hypotension at a Tertiary Care Hypertension Clinic With New Diagnostic Thresholds

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Swapnil Hiremath ◽  
Mohammad A Faraz ◽  
Brendan McCormick ◽  
Marcel Ruzicka
Keyword(s):  
Orthostatic Hypotension ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Renal Hypertension ◽  
Routine Practice ◽  
Sit To Stand ◽  
Hypertension Clinic ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
The Difference

Background: Orthostatic hypotension (OH), defined as a decrease of blood pressure (BP) of 20/10 mm Hg (systolic/diastolic) on change in posture from supine to standing is seldom assessed in routine practice because of logistical constraints. A recent study reported a sit-to-stand decrease of 15/7 mm Hg as also having good diagnostic yield. We measured the prevalence & risk factors associated with OH with the new threshold of sit-to- stand of either ≥ 15 mm Hg in systolic (SBP) or ≥ 7 mm Hg in diastolic BP (DBP). Methods: We reviewed medical charts of patients being followed at Renal Hypertension Center, a referral centre for difficult to control hypertension. Sitting BP is measured after 5 minutes of resting, as an average of 5 measurements with an automated device. Standing BP is measured three times at one minute intervals and averaged. OH was determined on the basis of the difference in either average SBP or DBP. Demographic characteristics, comorbidities, medication details, laboratory values and BP measurements were extracted. Results: Data from 219 patients was extracted (see table). The overall difference in SBP (sitting - standing)was 0.94 and DBP was 2.1 mm Hg. 190 patients (87%) did not have OH, whereas 29 (13%) had OH using either SBP or DBP thresholds. The difference in SBP and DBP was 17 mm and 6 mm Hg in those with OH, versus 1.6 and 3 mm Hg amongst those without OH respectively. Higher SBP was significantly associated with OH; age, gender, diabetes, number and hypertension drug class were not. Conclusion: Amongst referred patients to a specialist hypertension clinic, the prevalence of OH using a threshold of 15/7 mm Hg was 13%. The new diagnostic threshold allows for easy assessment of OH.

scholarly journals Optimal diagnostic thresholds for diagnosis of orthostatic hypotension with a ‘sit-to-stand test’

2017 ◽  
Vol 35 (5) ◽  
pp. 1019-1025 ◽  
Author(s):  
Brett H. Shaw ◽  
Emily M. Garland ◽  
Bonnie K. Black ◽  
Sachin Y. Paranjape ◽  
Cyndya A. Shibao ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Stand Test ◽  
Sit To Stand ◽  
Diagnostic Thresholds

The Role of Wireless Capsule Endoscopy (WCE) in the Detection of Occult Primary Neuroendocrine Tumors

2017 ◽  
Vol 26 (2) ◽  
pp. 151-156
Author(s):  
Manuele Furnari ◽  
Andrea Buda ◽  
Gabriele Delconte ◽  
Davide Citterio ◽  
Theodor Voiosu ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Capsule Endoscopy ◽  
Primary Tumor ◽  
Diagnostic Yield ◽  
Somatostatin Receptor ◽  
Tertiary Care ◽  
Wireless Capsule Endoscopy ◽  
First Line ◽  
Wireless Capsule

Background & Aims: Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with unclear etiology that may show functioning or non-functioning features. Primary tumor localization often requires integrated imaging. The European Neuroendocrine Tumors Society (ENETS) guidelines proposed wireless-capsule endoscopy (WCE) as a possible diagnostic tool for NETs, if intestinal origin is suspected. However, its impact on therapeutic management is debated. We aimed to evaluate the yield of WCE in detecting intestinal primary tumor in patients showing liver NET metastases when first-line investigations are inconclusive.Method: Twenty-four patients with histological diagnosis of metastatic NET from liver biopsy and no evidence of primary lesions at first-line investigations were prospectively studied in an ENETS-certified tertiary care center. Wireless-capsule endoscopy was requested before explorative laparotomy and intra-operative ultrasound. The diagnostic yield of WCE was compared to the surgical exploration.Results: Sixteen subjects underwent surgery; 11/16 had positive WCE identifying 16 bulging lesions. Mini-laparotomy found 13 NETs in 11/16 patients (9 small bowel, 3 pancreas, 1 bile ducts). Agreement between WCE and laparotomy was recorded in 9 patients (Sensitivity=75%; Specificity=37.5%; PPV=55%; NPV=60%). Correspondence assessed per-lesions produced similar results (Sensitivity=70%; Specificity=25%; PPV=44%; NPV=50%). No capsule retentions were recorded.Conclusions: Wireless-capsule endoscopy is not indicated as second-line investigation for patients with gastro-entero-pancreatic NETs. In the setting of a referral center, it might provide additional information when conventional investigations are inconclusive about the primary site.Abbreviations: DBE: double balloon enteroscopy; GEP-NET: gastro-entero-pancreatic neuroendocrine tumor; GI: gastrointestinal; ENETS: European Neuroendocrine Tumor Society; NET: neuroendocrine tumor; SSRS: somatostatin receptor scintigraphy; WCE: wireless capsule endoscopy.

scholarly journals Cangrelor Use in Routine Practice: A Two-Center Experience

2021 ◽  
Vol 10 (13) ◽  
pp. 2829
Author(s):  
Niels M. R. van der Sangen ◽  
Ho Yee Cheung ◽  
Niels J. W. Verouden ◽  
Yolande Appelman ◽  
Marcel A. M. Beijk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cox Regression ◽  
Tertiary Care ◽  
Routine Practice ◽  
Data Mining Algorithm ◽  
P2y12 Inhibitor ◽  
St Segment Elevation ◽  
Definite Stent Thrombosis

Cangrelor is the first and only intravenous P2Y12-inhibitor and is indicated when (timely) administration of an oral P2Y12 inhibitor is not feasible in patients undergoing percutaneous coronary intervention (PCI). Our study evaluated the first years of cangrelor use in two Dutch tertiary care centers. Cangrelor-treated patients were identified using a data-mining algorithm. The cumulative incidences of all-cause death, myocardial infarction, definite stent thrombosis and major bleeding at 48 h and 30 days were assessed using Kaplan–Meier estimates. Predictors of 30-day mortality were identified using uni- and multivariable Cox regression models. Between March 2015 and April 2021, 146 patients (median age 63.7 years, 75.3% men) were treated with cangrelor. Cangrelor was primarily used in ST-segment elevation myocardial infarction (STEMI) patients (84.2%). Approximately half required cardiopulmonary resuscitation (54.8%) or mechanical ventilation (48.6%). The cumulative incidence of all-cause death was 11.0% and 25.3% at 48 h and 30 days, respectively. Two cases (1.7%) of definite stent thrombosis, both resulting in myocardial infarction, occurred within 30 days, but after 48 h. No other cases of recurrent myocardial infarction transpired within 30 days. Major bleeding occurred in 5.6% and 12.5% of patients within 48 h and 30 days, respectively. Cardiac arrest at presentation was an independent predictor of 30-day mortality (adjusted hazard ratio 5.20, 95%-CI: 2.10–12.9, p < 0.01). Conclusively, cangrelor was used almost exclusively in STEMI patients undergoing PCI. Even though cangrelor was used in high-risk patients, its use was associated with a low rate of stent thrombosis.

Diagnostic yield of Archer FusionPlex PanHeme and solid panels: two-year experience from a pediatric tertiary care hospital

2021 ◽  
Vol 132 ◽  
pp. S39-S40
Author(s):  
Kathleen Schieffer ◽  
Eileen Stonerock ◽  
Vijayakumar Jayaraman ◽  
Heather Jenkins ◽  
Tim Peterson ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Hong ◽  
Chao Guo ◽  
Zhi-Hua Liu ◽  
Bo-Jie Wang ◽  
Shu-Zhe Zhou ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Assessment Instrument ◽  
Surgical Patients ◽  
Reference Standard ◽  
Diagnostic And Statistical Manual ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
Effective Instrument ◽  
Sensitivity Specificity ◽  
Selective Surgery

Abstract Background Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients. Methods This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the “gold standard”, and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD. Results A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001). Agreement between CAPD and reference standard was 0.849 (Kappa coefficient, P < 0.001). Conclusions This study found that Cornell assessment of pediatric delirium could be used as an effective instrument in diagnosis of delirium in pediatric surgical patients. Trial registration www.chictr.org.cn Identifier: ChiCTR-DDD-17,012,231, August 3, 2017.

ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 187-192
Author(s):  
Jared A. Warren ◽  
Oliver Scotting ◽  
Hiba K. Anis ◽  
James Bircher ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Musculoskeletal Infection ◽  
Hip Hemiarthroplasty ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
Prosthetic Joint ◽  
The Mean

AbstractDiagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

P.06.11: Histological Diagnostic Yield of 3 Different Needles for EUS-FNB: Bigger Size not Always Makes the Difference!

2017 ◽  
Vol 49 ◽  
pp. e169
Author(s):  
F. Attili ◽  
C. Spada ◽  
D. Pagliari ◽  
F. Inzani ◽  
G. Rindi ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
The Difference
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