Feasibility, acceptability and utility of an e-cardiovascular risk platform among physicians and patients in the primary care setting

Poster Session 1: Other Themes: P1-542link_to_OA_fulltextIEA World Congress of Epidemiology, Edinburgh, Scotland, United Kingdom, 7-11 August 2011. In Journal of Epidemiology & Community Health, 2011, v. 65 n. Suppl. 1, p. A216-A217, abstract no. P1-54

Reactivation of hepatitis B after irinotecan

Objective: To analyse the incidence of hepatitis B reactivation following treatment with irinotecan-based combined chemotherapy and the outcomes of patients with hepatitis B reactivation. Patients and Methods: A prospective phase II study investigating the response to irinotecan, leucovorin, and 5-fluorouracil in 34 patients with stage IV colorectal cancers. All patients had hepatitis B virus status checked at baseline. Results: Three patients were identified to be hepatitis B virus carriers. Two of the patients had hepatitis B reactivation after chemotherapy commenced, while the third patient, who was given lamivudine before commencement of chemotherapy, did not have any adverse hepatic event. Conclusions: In view of the increasing use of irinotecan as palliative treatment for advanced colorectal cancer, further studies on the probable causal relationship between irinotecan and reactivation of hepatitis B infection are recommended. The prophylactic use of lamivudine in patients at risk might be beneficial.link_to_subscribed_fulltex

Exhaled air dispersion distances during noninvasive ventilation via different respironics face masks

Background: As part of our influenza pandemic preparedness, we studied the exhaled air dispersion distances and directions through two different face masks (Respironics; Murrysville, PA) attached to a human-patient simulator (HPS) during noninvasive positive-pressure ventilation (NPPV) in an isolation room with pressure of -5 Pa. Methods: The HPS was positioned at 45° on the bed and programmed to mimic mild lung injury (oxygen consumption, 300 mL/min; lung compliance, 35 mL/cm H 2O). Airflow was marked with intrapulmonary smoke for visualization. Inspiratory positive airway pressure (IPAP) started at 10 cm H 2O and gradually increased to 18 cm H 2O, whereas expiratory pressure was maintained at 4 cm H 2O. A leakage jet plume was revealed by a laser light sheet, and images were captured by high definition video. Normalized exhaled air concentration in the plume was estimated from the light scattered by the smoke particles. Findings: As IPAP increased from 10 to 18 cm H 2O, the exhaled air of a low normalized concentration through the ComfortFull 2 mask (Respironics) increased from 0.65 to 0.85 m at a direction perpendicular to the head of the HPS along the median sagittal plane. When the IPAP of 10 cm H 2O was applied via the Image 3 mask (Respironics) connected to the whisper swivel, the exhaled air dispersed to 0.95 m toward the end of the bed along the median sagittal plane, whereas higher IPAP resulted in wider spread of a higher concentration of smoke. Conclusions: Substantial exposure to exhaled air occurs within a 1-m region, from patients receiving NPPV via the ComfortFull 2 mask and the Image 3 mask, with more diffuse leakage from the latter, especially at higher IPAP. © 2009 American College of Chest Physicians.link_to_subscribed_fulltex

Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial.

BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55-4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26-3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89-6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability