scholarly journals Early Outcomes of Emergency Surgery for Left-Sided Mechanical Valve Thrombosis

2021 ◽  
Vol 24 (6) ◽  
pp. E983-E987
Author(s):  
Hesham Saleh ◽  
Mohamed Azzam ◽  
Ahmed AH Swailum ◽  
Alaa Farouk
Keyword(s):  
Emergency Surgery ◽  
Clinical Characteristics ◽  
Operative Mortality ◽  
Mechanical Valve ◽  
Early Mortality ◽  
Precipitating Factors ◽  
Study Results ◽  
Valve Thrombosis ◽  
The Mean ◽  
Overall Mortality

Background: Valve thrombosis is a potentially lethal complication of mechanical cardiac valves. We examined the clinical characteristics as well as the early outcomes of patients undergoing emergency surgery for left-sided mechanical valve thrombosis. Methods: Between January 2012 and May 2020, 104 consecutive patients were offered an emergency redo surgery for acute mechanical valve thrombosis. Ninety-seven of these patients were included in the current study. Results: The mean age was 34.2 ± 10.3 years. Most of the patients were females (61 patients), and 27 patients (27.8%) were pregnant. The mitral valve was the site of thrombosis in 81 patients. Inadequate anticoagulation was found in 60.8% of patients. The overall early mortality was 32.9% (32 patients) with an operative mortality of 25.7%. Outcomes in the pregnant subgroup tended to be worst with a maternal mortality in the range of 37%, and with fetal and neonatal survival as low as 33.3%. Conclusion: The overall mortality in cases of mechanical valve thrombosis warranting surgery remains high. Since inadequate anticoagulation seems to be one of the major precipitating factors, the current study highlights the need for improvements in anticoagulation practices. The use of tissue valves should also be contemplated more seriously in some younger patients, especially females expressing the desire for future pregnancies.

scholarly journals Clinical characteristics and outcome of vasculitides

2016 ◽  
Vol 3 (2) ◽  
pp. 3-9
Author(s):  
Buddhi Prasad Paudyal ◽  
Anjana Education Rajbhandari
Keyword(s):  
Medical Records ◽  
Clinical Characteristics ◽  
Cross Sectional Study ◽  
Health Sciences ◽  
Small Vessel ◽  
Small Vessel Vasculitis ◽  
Cross Sectional ◽  
The Mean ◽  
Schonlein Purpura ◽  
Overall Mortality

 Introductions: Vasculitides can cause significant morbidity and mortality if not treated on time. There is lack of data locally. This study aims to define the pattern, clinical characteristics, and outcome of vasculitides.Methods: This was a cross sectional study between January 2011 and December 2015 at Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. The medical records of patients diagnosed with vasculitides in adults rheumatology service of the hospital were reviewed.Results: Ninety six patients were diagnosed with vasculitides during the study period. The mean age was 42.2 years. Sixty nine (71.8%) patient had small vessel, 20 (20.8%) large vessel and five (5.2%) had variable vessel vasculitides. Seventy five patients (78.1%) had primary and 21 (21.8%) secondary vasculitides. Cutaneous leucocytoclasticangitis was seen in 27 (28.1%), Takayasu arteritis in 17 (17.7), Henoch-Schonlein purpura in 11 (11.4%) and Rheumatoid arthritis associated vasculitis in nine patients. Purpura was present in all 96 (100%). The overall mortality was 9 (9.3%).Conclusions: Primary vasculitides were more common than secondary forms. Small vessel vasculitis was the most common. Cutaneous symptoms were predominant features. The mortality was attributed to active disease, sepsis, and complications of the primary disease. Journal of Patan Academy of Health  Sciences. 2016 Dec;3(2):3-9

scholarly journals 1143 Wake-up Stroke In Hispanic Veterans: Clinical Characteristics

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A435-A435
Author(s):  
M Colon-Feliciano ◽  
N Prats ◽  
A Sierra-Gonzalez ◽  
G Jovet ◽  
L Jimenez
Keyword(s):  
Risk Factor ◽  
Puerto Rican ◽  
Clinical Characteristics ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Study Results ◽  
Intravenous Alteplase ◽  
The Mean ◽  
Sectional Analysis ◽  
Prior Stroke

Abstract Introduction Wake-up stroke (WUS) is a stroke that occurs during sleep and accounts for 14-29.6% of all acute ischemic stroke (AIS) cases. The use of intravenous alteplase, the therapeutic standard, requires identifying time of stroke onset. Recent studies suggest that obstructive sleep apnea (OSA) is an independent risk factor for WUS. This study aims to describe a population of Puerto Rican Veterans with WUS and to evaluate clinical differences between patients WUS and non-WUS (NWUS). Methods The study was a cross-sectional analysis of all patient records with AIS from April 2018 to July 2019. One hundred forty records were reviewed. Patients who woke up with new AIS symptoms were labeled as WUS. Study variables included demographics, comorbidities, medications, sleep disorders, prior stroke, administration of alteplase and the National Institute of Health Stroke Scale (NIHSS). Results Among 140 participants predominantly male (98.6%), 27.1% had WUS. The mean age was 75 (range 21-89). NIHSS mean was 5.9. Comorbidities for WUS vs NWUS were as follows: overweight or obese (60% vs 62.6% p=0.667), hypertension (100% vs 95.1% p=0.323), hyperlipidemia (95% vs 93% p=0.999), diabetes mellitus (55.3% vs 67% p=0.212), atrial fibrillation (26.3% vs 24.5% p=0.826), anxiety (36.8% vs 33.3% p=0.697), depression (55.3% vs 51.0% p=0.652), non-smokers (89.% vs 89%), smokers (10.5% vs 11.1%), and prior stroke (34.2% vs 35.3% p=0.905). Insomnia was observed in 42% vs 40% (p= 0.838) and 24% vs 23% (p=0.955) had OSA. Conclusion There were no significant differences in clinical characteristics between patients with WUS and NWUS in this sample of Puerto Rican Veterans. OSA was less prevalent than previously reported. Lack of recognition of OSA as a risk factor for stroke and under-diagnosis of OSA might explain the study results. Support  

scholarly journals Clinical Characteristics of Mechanically Ventilated Patients Treated in Non-ICU Settings in Japan: A Retrospective Analysis

2020 ◽  
Author(s):  
Yoshiaki Iwashita ◽  
Shinnosuke Morimoto ◽  
Sukenari Koyabu ◽  
Kazuo Maruyama ◽  
Hiroshi Imai
Keyword(s):  
Clinical Characteristics ◽  
Inspiratory Time ◽  
Predicted Body Weight ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Number Of Patients ◽  
The Mean ◽  
Icu Physicians ◽  
Ventilated Patients ◽  
Overall Mortality

Abstract Background:The number of patients requiring mechanical ventilation (MV) is increasing worldwide. Patients requiring MV are commonly managed in an intensive care unit (ICU); however, Japan is unique in that many of these patients are treated in non-ICU settings. The characteristics of these patients, nevertheless, are unknown. We sought to identify disease severity and MV settings of patients in non-ICU settings in Japan.Methods: We retrospectively analyzed the clinical data of Kinan Hospital and Owase General Hospital, where there are no ICUs or ICU physicians. Data for adult patients who required MV for more than 3 d from January through December 2018 in those hospitals were collected.Results:A total of 171 patients received MV; 29 patients were treated for more than 3 d. Of that subset, the mortality rate was 44.8% (13 patients). Thirteen patients survived to discharge, and three were transferred to a higher-level facility. The median age of patients treated for more than 3 d was 80 (72–84) years. The mean Acute Physiologic Assessment and Chronic Health Evaluation II score was 20.9 ± 8.1, and predicted mortality was 0.42 ± 0.25. Tidal volume per predicted body weight was 8.8 ± 2.1 mL/kg; set inspiratory time was 1.6 ± 0.3 sec. Preventable non-ICU death (patients who might have been saved if treated in an ICU setting), was 10.3%.Conclusions:The overall mortality of patients treated with MV in a non-ICU setting in the East Kishu area was not inferior to the mortality if they had been treated in an ICU; however, MV settings should be improved.

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

CLINICAL CHARACTERISTICS OF THE CHRONIC DACRYOCYSTITIS AND THE SUCCESS RATE OF EXTERNAL DACRYOCYSTORHINOSTOMY

2015 ◽  
pp. 29-34
Author(s):  
Van Nam Phan ◽  
Ba Kien Tran
Keyword(s):  
Success Rate ◽  
Key Words ◽  
Clinical Characteristics ◽  
Lacrimal Duct ◽  
Interventional Study ◽  
Chronic Dacryocystitis ◽  
External Dacryocystorhinostomy ◽  
The Mean

Purpose: To determine the clinical characteristics of the chronic dacryocystitis and the success rate of external dacryocystorhinostomy. Methods: The retrospective, interventional study without comparing on 27 patients (32 eyes) of chronic dacryocystitis who underwent dacryocystorhinostomy (DCR) from 2010 to 2011. Results were evaluated with standards: epiphora, purelence, lacrimal duct irrigation. Results: Over period of 6 months, 27 patients including 25 (92.59%) female, 2 (7.41%) male. The mean age was 49.8 years (range, 22-79 years). All patients demonstrated epiphera (range, 3 months – 11 years). Dacryocystorhinostomy was performed unilaterally in 81.48%, bilateral 18.52%. Successrate was 90.06% overall. Conclusions: Although techniques in dacryocystorhinostomy of DUPUY-DUTEMPS is old, its result is mainstay of treatment for chronic dacryocystitis in Vietnam. Key words: Dupuy-Dutemps, chronic dacryocystitis

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma

2021 ◽  
pp. 112067212110177
Author(s):  
Ayse Gul Kocak Altintas ◽  
Cagri Ilhan
Keyword(s):  
Clinical Characteristics ◽  
Pseudoexfoliation Glaucoma ◽  
Filtration Surgery ◽  
Glaucoma Filtration Surgery ◽  
Mean Values ◽  
Time Parameters ◽  
The Mean ◽  
Group 2 ◽  
Surgical Manipulations ◽  
Phaco Time

Purpose: To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. Methods: In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. Results: The mean ages and male-to-female ratios of the groups were similar ( p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups ( p > 0.05, for all). Some surgical manipulations, including pupillary stretching ( p = 0.004), pupillary membrane peeling ( p = 0.021), iris hook using ( p = 0.041), and capsular tension ring implantation ( p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar ( p > 0.05, for both), the mean APP value was significantly lower in Group 2 ( p = 0.011). Conclusion: The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

scholarly journals Surgical Interventions in Patients Hospitalised with COVID-19. A Review of Seven Months of Experience Working in a COVID-19 Dedicated Centre

2021 ◽  
Vol 10 (3) ◽  
pp. 395
Author(s):  
Justyna Rymarowicz ◽  
Michał Pędziwiatr ◽  
Piotr Major ◽  
Bryan Donohue ◽  
Karol Ciszek ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Surgical Procedure ◽  
Surgical Care ◽  
Major Surgery ◽  
Surgical Specialty ◽  
Surgical Interventions ◽  
Face To Face ◽  
Overall Mortality

The Coronavirus Disease 2019 (COVID-19) pandemic has made changes to the traditional way of performing surgical consultations. The aim of the present study was to assess the need for surgical care performed by various surgical specialties among patients infected with COVID-19 hospitalized in a COVID-19 dedicated hospital. All surgical consultations performed for patients infected with COVID-19 in a COVID dedicated hospital in a seven month period were evaluated. Data on demographics, surgical specialty, consult reason, procedure performed, and whether it was a standard face to face or teleconsultation were gathered. Out of 2359 COVID-19 patients admitted to the hospital in the seven month period, 229 (9.7%) required surgical care. Out of those 108 consultations that did not lead to surgery, 71% were managed by telemedicine. A total of 36 patients were operated on while suffering from COVID-19. Out of them, only three patients admitted primarily for COVID-19 pneumonia underwent emergency surgery. The overall mortality among those operated on was 16.7%. Conclusions: Patients hospitalised with COVID-19 may require surgical care from various surgical specialties, especially during peaks of the pandemic. However, they rarely require a surgical procedure and only occasionally require major surgery. A significant portion of potentially surgical problems could be managed by teleconsultations.

Elimination of three doses of gentamicin over three consecutive days using a polyacrylonitrile-derived filter: An in vitro assessment

2021 ◽  
pp. 039139882110322
Author(s):  
Frédéric J Baud ◽  
Vanessa Seif ◽  
Pascal Houzé ◽  
Jean-Herlé Raphalen ◽  
Benoît Pilmis ◽  
...  
Keyword(s):  
Life Span ◽  
Bolus Dose ◽  
Central Compartment ◽  
Daily Session ◽  
Progressive Decrease ◽  
Time Dependency ◽  
Study Results ◽  
In Vitro Assessment ◽  
The Mean

Introduction: Adsorption of gentamicin in a polyacrylonitrile filter was previously evidenced in a session lasting 6 h using the NeckEpur model. We extended the study over three consecutive days to mimic the 72-h life span of a filter. Methods: Prismaflex® monitor and ST150® filter were used in the continuous diafiltration (CDF) mode at a 2.5 L/h flowrate. The daily session started with a 6-h session of CDF. Thereafter, the 5-L central compartment was changed using a bag free of gentamicin to assess gentamicin release over the following 18 h. Experiments were repeated on Day 2 and stopped at the end of the 6-h session of CDF on Day 3. The experiment was performed in duplicate. Results: At a 2.5 L/h diafiltration flowrate, the mean daily clearances of gentamicin were 5.5, 4.0, and 3.3 L/h, respectively. The mean diafiltration and adsorption ratios in the daily elimination of gentamicin were 32/68%, 58/42%, and 88/12%, respectively. During days 1 and 2, the mean amount of gentamicin released from the ST150® filter were 14 and 34 mg, respectively. Conclusion: The pharmacokinetics of gentamicin over 3 days is strongly altered by adsorption in the same filter with a progressive decrease of elimination by adsorption, suggesting saturation of the filter. One limitation of our study results from the mode of administration using a bolus dose instead of an infusion over 30 min. Adsorption adds a clearance to those of diafiltration. The time-dependency of gentamicin clearance precludes using a constant dosage regimen over the filter’s life span.

scholarly journals 369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S254-S254
Author(s):  
Victoria Bengualid ◽  
Maria Martinez ◽  
Zhenisa Hysenaj ◽  
Debra M Willner ◽  
Judith Berger
Keyword(s):  
Oxygen Saturation ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Altered Mental Status ◽  
Channel Blockers ◽  
First Case ◽  
Overall Mortality

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

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