Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region

ABSTRACT Background Subxiphoid pericardial window (SPW) remains a valuable diagnostic tool for patients at risk of occult cardiac injuries. However, how to select patients that could benefit from this procedure remains unclear. We aimed to identify clinical predictors of positive SPW in patients with penetrating precordial injuries. Materials and methods Prospective data collection of 183 patients who underwent SPW for the exclusion of penetrating cardiac injuries during 2002 – 2004 at a level I trauma centre in Cali, Colombia. Patient's demographics, clinical characteristics, and injury information were obtained. Independent predictors of positive SPW were assessed using stepwise logistic regressions. Results There were 41 positive SPW (22.4%). Unadjusted analyses demonstrated that stab/knife wounds (OR 2.48, 95% CI 1.17–5.25, p = 0.017), single wound (OR 14.61, 95% CI 1.9–110, p = 0.009), and clinical signs of pericardiac tamponade (OR 8.52, 95% CI 3.92–18.4, p < 0.001) were associated with increased odds of positive SPW. Conversely, systolic blood pressure (0.98, 95% CI 0.96–0.99) and stable physiological index (OR 0.31, 95% CI 0.14–0.65, p = 0.002) were associated with decreased odds. In multivariable analyses, signs of pericardiac tamponade (OR 6.37, 95% CI 2.78–14.6, p < 0.001), and single injuries (OR 12.99, 95% CI 1.6–102.7, p = 0.015) remained as independent predictors of positive SPW. Conclusion Emphasis on early recognition of the clinical signs of pericardiac tamponade could be the most important factor for the identification of occult cardiac injuries. Patients with multiple wounds to the precordial region who reached the hospital may not benefit from a SPW. However, high level of awareness is important because the incidence of occult cardiac injuries is not negligible. How to cite this article Sánchez ÁI, García AF, Velásquez M, Puyana JC. Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region. Panam J Trauma Crit Care Emerg Surg 2015;4(3):43-51.

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Tuberculous pericarditis in acquired immune deficiency syndrome patients

Jornal de Pneumologia ◽

10.1590/s0102-35862003000200009 ◽

2003 ◽

Vol 29 (2) ◽

pp. 98-100

Author(s):

Ruggero Bernardo Guidugli ◽

Paul Albert Hamrick ◽

Nancy Figueiroa de Rezende

Keyword(s):

Clinical Signs ◽

Specific Treatment ◽

Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Hiv Positive ◽

Pericardial Window ◽

High Prevalence ◽

Subxiphoid Pericardial Window ◽

Acquired Immune Deficiency ◽

High Possibility

Two quite dyspneic HIV positive patients were admitted to the Emergency Room; they presented clinical signs and images suggesting pericardial effusion. The analysis of an initial liquid puncture did not show any specificity and the patients did not exhibit any clinical improvement. Both patients were submitted to a subxiphoid pericardial window, all the effusion liquid was drained, and a biopsy of the pericardium tissue was completed, revealing a granulomatous process. Immediately after the onset of specific treatment, the patients showed a good evolution. Such findings draw attention to a high possibility of pericardial suffusion in AIDS patients being tuberculosis, particular if one considers the high prevalence of this disease in Brazil. The results also showed that the opening of a subxiphoid pericardial window and the specific triple scheme was a procedure that led to good therapeutic evolution in these patients.

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Clinico-microbiological profile of healthcare associated pneumonia in critically ill patients at level-I trauma centre of India

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_85_18 ◽

2018 ◽

Vol 10 (04) ◽

pp. 406-409

Author(s):

Minu Kumari ◽

Neha Rastogi ◽

Rajesh Malhotra ◽

Purva Mathur

Keyword(s):

Health Care ◽

Hospital Stay ◽

Trauma Center ◽

Early Recognition ◽

Fatal Outcome ◽

Length Of Hospital Stay ◽

Trauma Centre ◽

Trauma Patients ◽

Inhospital Mortality ◽

Level I

ABSTRACT INTRODUCTION: Device-associated infections constitute the majority of health-care infections in Intensive Care Units (ICUs). Trauma patients are more prone to acquire such infections; ventilator-associated pneumonia (VAP) being the most common Health care associated infections (HAI) in ICU has serious implications such as increased morbidity, prolonged hospital stay, and mortality. This study aims to compare the clinicomicrobiological profile of VAP and non-VAP trauma patients at Level I trauma center. MATERIALS AND METHODS: A 4-year retrospective study of prospectively maintained database was conducted at Level 1 trauma center from January 2013 to December 2016. The patients were classified into two groups named VAP and non-VAP patients. VAP patients were defined according to the criteria of the Centers for Disease Control and Prevention. The data were compiled and analyzed. Statistical data were analyzed using SPSS version 21 software. RESULTS: During the study period, 134 (13%) cases of VAP and 909 (87%) non-VAP cases were observed in our study. The total number of ventilator days for VAP patients was 5128 days, which ranged from 2 to 82 days (median 42 days). The length of hospital stay in non-VAP category ranged from 1 to 390 days (median 195.5 days). Inhospital mortality was observed in 62 (46%) patients with VAP. Three hundred and eighteen (35%) non-VAP patients had also had a fatal outcome. Gram-negative organisms, most commonly Acinetobacter spp. (13, 21%), were reported in the fatal VAP patients. CONCLUSION AND DISCUSSION: Higher rate of mortality was observed in patients with VAP in comparison to non-VAP patients, both being on mechanical ventilation. Early recognition of VAP, implementation of proper VAP preventive bundle strategies, and stringent infection control practices are essential mandates to prevent VAP.

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Heritability of the Effect of Corticosteroids on Intraocular Pressure

Acta geneticae medicae et gemellologiae ◽

10.1017/s1120962300025658 ◽

1970 ◽

Vol 19 (1-2) ◽

pp. 264-267 ◽

Cited By ~ 4

Author(s):

F.H. Reuling ◽

J.T. Schwartz

Keyword(s):

Intraocular Pressure ◽

Clinical Signs ◽

Topical Steroids ◽

Frequency Distributions ◽

Steroid Response ◽

Large Numbers ◽

Wide Range ◽

Allele Pair ◽

High Level ◽

Genetically Determined

In the late 1950's and early 1960's, it became evident that some glaucoma patients developed elevations of intraocular pressure, which were difficult to control, following prolonged use of systemic or ocular medications containing corticosteroids (Chandler, 1955, Alfano, 1963; Armaly, 1963). In addition, some patients without glaucoma, when treated with steroids for long periods of time, developed clinical signs of chronic simple glaucoma (McLean, 1950; François, 1954; Covell, 1958; Linner, 1959; Goldman, 1962). Fortunately, the elevation of intraocular pressure was reversible if the drug was discontinued.Over the past decade, extensive investigation of the “steroid response” has been undertaken. For this presentation, the steroid response may be considered as a gradual elevation of intraocular pressure, occurring over several weeks, in an eye being medicated with corticosteroid drops several times a day. The elevation in pressure is usually accompanied by a reduction in the facility of aqueous outflow. When relatively large numbers of subjects were tested with topical steroids, so that a wide range of responsiveness could be observed, a variation in individual sensitivity was demonstrated. Frequency distributions of intraocular pressure or change in pressure following steroids showed a skew toward the high side. On the basis of trimodal characteristics which they observed in such frequency distributions, Becker and Hahn (1964), Becker (1965) and Armaly (1965, 1966) considered the possible existence of several genetically determined subpopulations. These investigators distinguished three subpopulations on the basis of low, intermediate, and high levels of pressure response. It was hypothesized that these levels of response characterized three phenotypes, corresponding to the three possible genotypes of an allele pair, wherein one member of the pair determined a low level of response, and the other member determined a high level of response (Armaly, 1967).

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Protection against the New Equine Influenza Virus Florida Clade I Outbreak Strain Provided by a Whole Inactivated Virus Vaccine

Vaccines ◽

10.3390/vaccines8040784 ◽

2020 ◽

Vol 8 (4) ◽

pp. 784

Author(s):

Sylvia Reemers ◽

Sander van Bommel ◽

Qi Cao ◽

David Sutton ◽

Saskia van de Zande

Keyword(s):

Influenza Virus ◽

Virus Vaccine ◽

Clinical Signs ◽

Field Strain ◽

Equine Influenza Virus ◽

Outbreak Strain ◽

Virus Shedding ◽

Equine Influenza ◽

Vaccine Type ◽

High Level

Equine influenza virus (EIV) is a major cause of respiratory disease in horses. Vaccination is an effective tool for infection control. Although various EIV vaccines are widely available, major outbreaks occurred in Europe in 2018 involving a new EIV H3N8 FC1 strain. In France, it was reported that both unvaccinated and vaccinated horses were affected despite >80% vaccination coverage and most horses being vaccinated with a vaccine expressing FC1 antigen. This study assessed whether vaccine type, next to antigenic difference between vaccine and field strain, plays a role. Horses were vaccinated with an ISCOMatrix-adjuvanted, whole inactivated virus vaccine (Equilis Prequenza) and experimentally infected with the new FC1 outbreak strain. Serology (HI), clinical signs, and virus shedding were evaluated in vaccinated compared to unvaccinated horses. Results showed a significant reduction in clinical signs and a lack of virus shedding in vaccinated horses compared to unvaccinated controls. From these results, it can be concluded that Equilis Prequenza provides a high level of protection to challenge with the new FC1 outbreak strain. This suggests that, apart from antigenic differences between vaccine and field strain, other aspects of the vaccine may also play an important role in determining field efficacy.

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Research Trends in Anticoagulation Therapy over the Last 25 Years

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1718892 ◽

2020 ◽

Vol 46 (08) ◽

pp. 919-931

Author(s):

Mustafa K. Mian ◽

Subhashaan Sreedharan ◽

Neeraj S. Limaye ◽

Chris Hogan ◽

Jai N. Darvall

Keyword(s):

Conflicts Of Interest ◽

Relative Rate ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Citation Count ◽

Anticoagulation Therapy ◽

Journal Title ◽

Common Source ◽

Level I ◽

High Level

AbstractA large volume of literature has become available to practitioners prescribing anticoagulants. The aim of this study was to analyze the bibliometric characteristics of the top 100 most cited articles related to anticoagulation over the past 25 years, with special consideration to impact of direct or “nonvitamin K antagonist” oral anticoagulants (NOACs) compared with vitamin K antagonists. A bibliometric analysis of the 100 most cited journal articles related to anticoagulants published between 1994 and 2019 was performed in April 2019. The top 100 articles by citation count were analyzed to extract bibliometric data related to journal title, impact factor, year of publication, place of publication, anticoagulant studied, indication for anticoagulation, study design, and conflicts of interest. The median (interquartile range) number of citations per article was 806 (621–1,085). The anticoagulant most frequently researched was warfarin (37%). NOAC publications (21%) grew at a relative rate of 3.4 times faster compared with all publications. The indication most commonly researched was venous thromboembolism (26%). Eighty articles constituted level I or II evidence, with randomized controlled trials the most common type of study (74). A financial conflict of interest was declared in 87% of articles with private, for-profit organizations the most common source of funding (26%). In summary, top research related to anticoagulation is highly impactful but may be at risk of sponsorship bias. High-level evidence for NOACs continues to expand across a range of indications with citation metrics likely to soon approach or surpass that of older drugs.

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Scoring systems for early prediction of tibial fracture non-union: an update

International Orthopaedics ◽

10.1007/s00264-021-05088-0 ◽

2021 ◽

Author(s):

George D. Chloros ◽

Nikolaos K. Kanakaris ◽

James S. H. Vun ◽

Anthony Howard ◽

Peter V. Giannoudis

Keyword(s):

Tibial Fracture ◽

Scoring Systems ◽

Trauma Centre ◽

Predictive Values ◽

Non Union ◽

Post Operative Period ◽

Male Patients ◽

Level I ◽

Healing Score ◽

Tibial Shaft Fractures

Abstract Purpose To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations. Methods The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing. Results Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18–50); Union group: ten patients (8 males) with mean age 39.8 years (20–66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy. Conclusion The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.

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Overview of Tertiary Addictions Services response to Opioid dependence during the COVID-19 Pandemic

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2021.8 ◽

2021 ◽

pp. 1-14

Author(s):

K Hennigan ◽

E Corrigan ◽

N Killeen ◽

E Keenan ◽

M Scully

Keyword(s):

At Risk ◽

Opioid Dependence ◽

Medication Management ◽

Health Problems ◽

Healthcare Staff ◽

Addiction Services ◽

Patients At Risk ◽

Guidance Documents ◽

High Level ◽

Opioid Users

Abstract The emergence of the COVID-19 pandemic has presented the addiction services with an unprecedented set of challenges. Opioid users are particularly vulnerable because of their high level of pre-existing health problems and lifestyle factors. In order to minimise their risks to self and to others in the current Covid-19 crisis, the service has sought to urgently identify vulnerable individuals, and induct them into OST treatment promptly. Additionally, several guidelines have been created and regularly updated by the HSE for any healthcare staff working with opioid users. These include guidance documents, to facilitate prompt induction of patients onto the OST programme, the prescribing of naloxone to all patients at risk of overdose, eConsultation, medication management for those in self-isolation, and the delivery of injecting equipment. The guidance documents and resources will provide a template for a new way of working for the sector during these challenging times and into the future.

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