Impact of RAAS Inhibitors on Clinical Outcome and Mortality in Patients With STEMI During the COVID-19 Era: A Multicenter Observational Study

Conflicting results are available regarding the influence of ACEi/ARBs on the risk of COVID-19 infection, while less is known about their impact on the clinical outcome of patients with STEMI diagnosed with COVID-19. Our aim was to evaluate the impact of ACEi/ARBs therapy on in-hospital mortality and clinical outcomes of patients with STEMI during the COVID-19 pandemic. We retrospectively analyzed consecutive patients with STEMI hospitalized from February 20 to May 10, 2020 in four Hospitals in Lombardy. SARS-COV-2 diagnosis was performed by nasopharyngeal swab test. Procedural outcome, respiratory complications, and in-hospital mortality were reported. Univariate and multivariate analyses were performed by logistic regressions. Our population was represented by 182 patients with STEMI, 76.9% of which were males, and mean age was 67 ± 12.5. Hypertension was reported in 53.3%, and 29.1% was treated with ACEi/ARBs. COVID-19 diagnosis was confirmed in 17.1% of the patients. In-hospital mortality (13.2%) was significantly higher in patients with COVID-19 (31 vs. 10%, p = 0.003), even if ejection fraction [OR 0.93 (95% CI) 0.87–0.99; p = 0.03] and respiratory complications [OR 9.39 (95% CI) 1.91–45.9; p = 0.006] were the only two independent predictors. The incidence of COVID-19 infection was not influenced by ACEi/ARBs (16.5 in naïve vs. 18.8%) whose presence on admission did not correlate with respiratory complications or mortality both in the case of discontinuation and maintenance. In conclusion, in a high-risk population, such as that of patients with STEMI, the potential benefit of ACEi/ARB discontinuation in patients with COVID-19 is overcome by its detrimental effect. Intensive care, additional preventive respiratory investigations, regardless of swab test result, should be suggested for all patients admitted for STEMI during the pandemic.

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Initial Institutional Experience with Thoracoscopic Assisted Esophagectomy

The American Surgeon ◽

10.1177/000313481007600730 ◽

2010 ◽

Vol 76 (7) ◽

pp. 735-740

Author(s):

Adrian L. Lata ◽

Timothy Oaks ◽

Edward A. Levine

Keyword(s):

Clinical Outcome ◽

Blood Loss ◽

Hospital Mortality ◽

Median Number ◽

Surgical Approaches ◽

Open Approach ◽

Initial Experience ◽

Respiratory Complications ◽

Open Esophagectomy ◽

Institutional Experience

We report our initial experience with thoracoscopic assisted esophagectomy (TAE) in patients with esophageal carcinoma. Clinical outcome measures are reported for 14 consecutive patients who underwent thoracoscopically assisted esophagectomy at our institution between January 2007 and June 2009. These outcomes were compared with 18 patients who underwent open esophagectomy (OE) during this time. All 14 patients were male, with a median age of 63. All had distal esophageal adenocarcinoma: stage I (7), II A (2), II B (3), and III (2). Surgical approaches included laparotomy combined with thoracoscopy and cervical (n = 12), or intrathoracic anastomosis (n = 2). Compared with an open approach, the thoracoscopic assisted esophagectomies were longer (median time 460 vs 386 minutes), and they were associated with less blood loss (250 mL vs 500 mL) and less respiratory complications (14.3% vs 27.8%). In our TAE group more lymph nodes were removed (median number 12 in TAE vs 10 in OE). The overall morbidity was similar in both groups (42.8% in TAE vs 50% in OE group), but the in-hospital mortality was reduced with TAE (7.1% with TAE vs 16.7% with OE). TAE is feasible with a low conversion rate, acceptable morbidity, and low mortality.

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Tandem occlusions in acute ischemic stroke – impact of antithrombotic medication and complementary heparin on clinical outcome and stent patency

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015596 ◽

2020 ◽

Vol 12 (11) ◽

pp. 1088-1093 ◽

Cited By ~ 2

Author(s):

Ulf Neuberger ◽

Konstantina Moteva ◽

Dominik F Vollherbst ◽

Silvia Schönenberger ◽

Tilman Reiff ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Fatal Outcome ◽

Carotid Stenting ◽

Anterior Circulation ◽

Stent Patency ◽

Logistic Regressions ◽

Antithrombotic Medication ◽

The Impact

Background and purposeMechanical thrombectomy (MT) and acute carotid stenting (ACS) of patients with acute ischemic stroke due to tandem occlusions (TO) of the anterior circulation was proven to be safe and effective, but the implications of periprocedural antithrombotic medications are only known to a limited extent.MethodsWe conducted a retrospective analysis of 162 consecutive patients who presented with TO and were treated with MT and ACS in our center. Patients initially either received dual antiplatelet therapy (DAT) or tirofiban periprocedurally. Some patients were also treated with unfractionated heparin. The frequency of intracranial hemorrhages (ICH), as well as the impact on clinical outcome and stent patency of different medical regimes, were evaluated using univariate tests and adjusted multivariate logistic regressions.ResultsPatients who received supportive treatment with heparin had significantly higher occurrences of any (OR, 2.46; 95% CI, 1.15 to 5.28) and symptomatic ICH (OR, 3.71; 95% CI, 1.18 to 14.95). Additionally, these patients were less likely to have a moderate clinical outcome after 90 days (modified Rankin scale 0–3; OR, 0.33; 95% CI, 0.15 to 0.72), but were more likely to have a fatal outcome after 90 days (OR, 2.84; 95% CI 1.10 to 7.31). These findings persisted in patients who received both DAT and heparin, but not for patients who received both tirofiban and heparin.ConclusionSupportive administration of heparin in patients with TO and treatment with MT and ACS should be carefully considered, especially in patients who primarily receive DAT.

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Gender-Dependent Clinical Outcome and Other Predictors of In-Hospital Mortality Following Out-Of-Center Extracorporeal Membrane Oxygenation and Extracorporeal Life Support: A Single Center Experience

The Heart Surgery Forum ◽

10.1532/hsf.2987 ◽

2020 ◽

Vol 23 (3) ◽

pp. E343-E349

Author(s):

Florian Rückert ◽

Christoph Raspé ◽

Giuseppe D’Ancona ◽

Huesyin Ince ◽

Efstratios I. Charitos ◽

...

Keyword(s):

Clinical Outcome ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Patient Selection ◽

Life Support ◽

Extracorporeal Life Support ◽

Tertiary Care ◽

Membrane Oxygenation ◽

Cardiovascular Center ◽

The Impact

Background: Out-of-center extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) implantation for the treatment of acute cardiorespiratory failure with subsequent transport to a tertiary care center has been introduced successfully into the medical practice. However, due to the very specific and resource intensive nature of this therapeutic concept, it seems important to generate algorithms for adequate patient selection. The aim of our study was to analyze the impact of patients’ gender on early clinical outcome in this specific therapeutic scenario. Methods: Ninety-seven consecutive patients treated by out-of-center ECMO/ECLS implantation and subsequent transport and treatment in our tertiary care cardiovascular center within the Hallesche Extracorporeal Life Support Program (HELP) retrospectively were analyzed, regarding the impact of patients’ gender on early clinical outcome. Results: Mechanical circulatory support successfully was weaned in two-thirds of the male patients. This result was achieved in only one-third of the female patients (59.4% in male vs. 33.3% in female, P = .0267). Overall survival significantly was higher in the male group (62.5% in male versus 30.3% in female, P = .0052). In uni- and multivariate logistic regression analysis, female gender was an independent predictor of in-hospital mortality (uni: OR:3.833, CI:1.597-9.745, P = .0034; multi: OR:3.477, CI:1.146-11.494, P = .0322). Worse outcome also was associated with following independent predictors, age, SOFA score, lactate and ventilation time pre-ECMO/ECLS implantation. Conclusion: The current study demonstrates a worse early survival for women, following emergent out-of-center ECMO/ECLS implantation and subsequent transport and treatment in our tertiary care cardiovascular center. Gender should be included in patient selection algorithms while basic research approaches are needed to better understand the mechanisms underlying these gender-specific outcome disparities.

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Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019

Clinical Infectious Diseases ◽

10.1093/cid/ciaa851 ◽

2020 ◽

Cited By ~ 37

Author(s):

Reed Magleby ◽

Lars F Westblade ◽

Alex Trzebucki ◽

Matthew S Simon ◽

Mangala Rajan ◽

...

Keyword(s):

New York ◽

Viral Load ◽

Severe Acute Respiratory Syndrome ◽

Hospital Mortality ◽

Smoking Status ◽

High Viral Load ◽

Hospitalized Patients ◽

Nasopharyngeal Swab ◽

Viral Loads ◽

The Impact

Abstract Background Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on these outcomes is unknown. Methods We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality. Results We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct <25; n = 220), 17.6% (Ct 25–30; n = 216), and 6.2% (Ct >30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio [aOR], 6.05; 95% confidence interval [CI], 2.92–12.52) and intubation (aOR, 2.73; 95% CI, 1.68–4.44). Conclusions Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.

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Impact of bridging thrombolysis on clinical outcome in stroke patients undergoing endovascular thrombectomy: a retrospective analysis of a regional stroke registry

Neuroradiology ◽

10.1007/s00234-020-02619-1 ◽

2020 ◽

Author(s):

Fatih Seker ◽

Susanne Bonekamp ◽

Susanne Rode ◽

Sonja Hyrenbach ◽

Martin Bendszus ◽

...

Keyword(s):

Clinical Outcome ◽

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Stroke Patients ◽

Short Term ◽

Endovascular Thrombectomy ◽

Stroke Registry ◽

Good Outcome ◽

Symptomatic Intracranial Hemorrhage ◽

The Impact

Abstract Purpose It is unclear whether stroke patients undergoing endovascular thrombectomy (EVT) should receive bridging intravenous thrombolysis (IVT), if eligible. This study aims at analyzing the impact of bridging IVT on short-term clinical outcome. Methods In a prospective regional stroke registry, all stroke patients with premorbid modified Rankin Scale (mRS) score of 0–2 who were admitted within 4.5 h after onset and treated with EVT were analyzed retrospectively. Patients receiving “IVT prior to EVT” (IVEVT) were compared to those undergoing “EVT only” regarding the ratio of good outcome, discharge mRS, mRS shift, hospital mortality, and occurrence of symptomatic intracranial hemorrhage. Results In total, 2022 patients were included, 816 patients (40.4%) achieved good clinical outcome; 1293 patients (63.9%) received bridging IVT. There was no significant difference between both groups regarding the ratio of good outcome (IVEVT 41.4% vs. EVT 38.5%, P = 0.231), discharge mRS (median, IVEVT 3 vs. EVT 3, P = 0.178), mRS shift (median, IVEVT 3 vs. EVT 3, P = 0.960), and hospital mortality (IVEVT 19.3% vs. EVT 19.5%, P = 0.984). Bridging IVT was not a predictor of outcome (adjusted OR 1.00, 95% CI 0.79–1.26, P = 0.979). However, it was an independent predictor of symptomatic intracranial hemorrhage (adjusted OR 1.79, 95% CI 1.21–2.72, P = 0.005). Conclusions The results of the present study suggest that bridging IVT does not seem to improve short-term clinical outcome of patients undergoing EVT. Nonetheless, there might be a subgroup of patients that benefits from IVT. This needs to be addressed in randomized controlled trials.

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Transcription factor NFkB a potential molecular marker for predicting and improving treatment efficacy in esophageal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10065 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10065-10065

Author(s):

J. G. Izzo ◽

T. Wu ◽

U. Malhotra ◽

J. Ensor ◽

R. Luthra ◽

...

Keyword(s):

Clinical Outcome ◽

Treatment Efficacy ◽

Cancer Biology ◽

Clinical Stage ◽

Gastroesophageal Junction ◽

Pathologic Complete Response ◽

High Risk Population ◽

Cancer Resistance ◽

Pre Treatment ◽

The Impact

10065 Background: Esophageal/gastroesophageal junction adenocarcinoma (E/GEJAC) remains one of the most aggressive malignancies. Chemoradiotherapy (CTXRT) followed by surgery has been used for localized E/GEJAC. Patients (pts) achieving pathologic complete response (pathCR) have an improved survival, but ≈70% of pts exhibit at surgery resistant residual, highly aggressive tumors despite CTXRT. There is a need to identify this high-risk population and target molecular pathways associated with cancer resistance. We have shown that nuclear NFκB was associated with poor clinical outcome of E/GEJAC pts undergoing 5FU, Docetaxel and Cisplatinum therapy. To validate our findings, we examined the impact of nuclear NFκB on clinical outcome of pts undergoing diverse CTXRT regimens. Methods: Pre- treatment tumor biopsies and post-treatment resected residual tumors were analyzed from pts receiving neo-adjuvant CT or CTXRT. NFκB protein expression was assessed by immunochemistry and correlated to pathCR and clinical outcome. Tumors were considered NFκB positive (pos) when ≥5% of cells expressed nuclear NFκB. Results: 80 pts, clinically staged II, III and IVA, were studied. All pts received antifolates, and 80%, 65% & 31% received taxanes, topo-1 inhibitors and/or platinum analogues, respectively. Radiation therapy was 50.4 Gy at 1.8 Gy once a day to all pts. 75/80 pts had available pre-treatment biopsies, all 58 pts with <pathCR had available residual tumors. Pre-treatment NFκB was predictive for lack of response to CTXRT [NFκB pos: 2/22 pathCR vs 27/53 <pathCR; P=.006]. In multivariate analysis, including clinical stage, tumor histology, pathCR and lymph nodes metastasis, pre-treatment NFκB was an independent prognostic factor of progression-free (P=.0029, HR=2.90, 95%CI:1.44–5.86) and overall (P=.0073,HR=2.70, 95%CI:1.30–5.60) survivals. NFκB was associated with recurrent disease [pre-treatment NFκB pos 14/29 (48%) vs NFκB negative11/46 (24%), P=.04; pre- or post- NFκB pos 22/47 (47%) vs NFκB neg 4/33 (12%), P=.003]. Conclusions: our data suggest that NFκB defines cancer biology and patterns to therapy response irrespective of the type of chemoradiation used. NFκB may serve as potential molecular target to improve treatment efficacy. No significant financial relationships to disclose.

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EXPRESS: Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome

International Journal of Stroke ◽

10.1177/17474930211035647 ◽

2021 ◽

pp. 174749302110356

Author(s):

Martina SebÃ¶k ◽

Isabel C. Hostettler ◽

Emanuella Keller ◽

Ilari Rautalin ◽

Bert A. Coert ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Hospital Mortality ◽

Primary Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Data Access ◽

Antiplatelet Agents ◽

Poor Clinical Outcome ◽

The Impact ◽

Thrombocyte Transfusion

Background: Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage (aSAH). Aims: To investigate the association between clinical outcome and prehemorrhage use in aSAH patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome. Methods: Data were collected from prospective databases of two European tertiary reference centers for aSAH patients. Patients were divided into âantiplatelet-userâ and ânon-userâ according to the use of acetylsalicylic acid (ASA) prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1-3). Secondary outcomes were in-hospital mortality, and impact of thrombocyte transfusion. Results: One hundred and sixty-one of 1,033 patients (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, WFNS score, infarction and heart disorder, pre-hemorrhage ASA use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08 to 3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome. Conclusion: In this multicenter study, the prehemorrhage ASA use in aSAH patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months. Data access statement: The data that support this study are available upon reasonable request.

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Investigating the Relationship Between Self-Esteem and Stigma Among Young Adults With History of Suicide Attempts

Crisis ◽

10.1027/0227-5910/a000399 ◽

2016 ◽

Vol 37 (4) ◽

pp. 265-270 ◽

Cited By ~ 10

Author(s):

Meshan Lehmann ◽

Matthew R. Hilimire ◽

Lawrence H. Yang ◽

Bruce G. Link ◽

Jordan E. DeVylder

Keyword(s):

Young Adults ◽

Suicide Attempts ◽

Self Esteem ◽

High Risk Population ◽

High Functioning ◽

People With Mental Illness ◽

History Of ◽

The Individual ◽

The Impact ◽

The Relationship

Abstract. Background: Self-esteem is a major contributor to risk for repeated suicide attempts. Prior research has shown that awareness of stigma is associated with reduced self-esteem among people with mental illness. No prior studies have examined the association between self-esteem and stereotype awareness among individuals with past suicide attempts. Aims: To understand the relationship between stereotype awareness and self-esteem among young adults who have and have not attempted suicide. Method: Computerized surveys were administered to college students (N = 637). Linear regression analyses were used to test associations between self-esteem and stereotype awareness, attempt history, and their interaction. Results: There was a significant stereotype awareness by attempt interaction (β = –.74, p = .006) in the regression analysis. The interaction was explained by a stronger negative association between stereotype awareness and self-esteem among individuals with past suicide attempts (β = –.50, p = .013) compared with those without attempts (β = –.09, p = .037). Conclusion: Stigma is associated with lower self-esteem within this high-functioning sample of young adults with histories of suicide attempts. Alleviating the impact of stigma at the individual (clinical) or community (public health) levels may improve self-esteem among this high-risk population, which could potentially influence subsequent suicide risk.

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Pupil with Obsessive-Compulsive Disorder

Lifelong Learning ◽

10.11118/lifele201707027 ◽

2017 ◽

Vol 7 (2) ◽

pp. 7-25

Author(s):

Karolina Diallo

Keyword(s):

Obsessive Compulsive Disorder ◽

School Performance ◽

School Environment ◽

Detrimental Effect ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

The Past ◽

And Performance ◽

The Impact

Pupil with Obsessive-Compulsive Disorder. Over the past twenty years childhood OCD has received more attention than any other anxiety disorder that occurs in the childhood. The increasing interest and research in this area have led to increasing number of diagnoses of OCD in children and adolescents, which affects both specialists and teachers. Depending on the severity of symptoms OCD has a detrimental effect upon child's school performance, which can lead almost to the impossibility to concentrate on school and associated duties. This article is devoted to the obsessive-compulsive disorder and its specifics in children, focusing on the impact of this disorder on behaviour, experience and performance of the child in the school environment. It mentions how important is the role of the teacher in whose class the pupil with this diagnosis is and it points out that it is necessary to increase teachers' competence to identify children with OCD symptoms, to take the disease into the account, to adapt the course of teaching and to introduce such measures that could help children reduce the anxiety and maintain (or increase) the school performance within and in accordance with the school regulations and curriculum.

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