In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV) dysfunction and myocardial injury.Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediatehigh risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in-hospital and 30 days follow-up data of patients from medical records.Results: During the in-hospital stay (9.5 +/- 4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multivariate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI, 0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality.Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality

Correlation of pulse oximetry oxygen saturation with blood gas arterial oxygen saturation in patients with heart failure reduced ejection fraction: Prospective cohort study

Abstract Aim: An estimation of accurate oxygen saturation is a critical in the management of patients with heart failure (HF). However, obtaining peripheral arterial blood samples may be technically difficult in some cases. The purpose of this study was to evaluate the correlation of pulse oximetry SO2 with arterial SO2 in patients with HF reduced ejection fraction (HFrEF). Material and Methods: In total, 29 consecutive patients who were admitted to cardiology clinics with HFrEF were prospectively enrolled in this study. We enrolled all patients if the chief physician ordered an atrial blood gas analysis. Simultaneous atrial blood gas sample and pulse oximetry measurements were collected and compared. The strength of association between atrial blood gas and pulse oximetry measurements was determined by Pearson correlation and Bland and Altman analysis. Results: We evaluated 29 heart failure patients (the mean age was; 70.7±10.9, 44.8 % of patients were male) with a mean EF of 29.6 ± 5.5. We observed that the mean pulse oximetry SO2 and arterial SO2 in the study were 92.8 ± 4.4 and 93 ± 5.2, respectively. We found significantly positive linear correlation between two methods according to Pearson analysis (r = 0.683, p < 0.001). A low bias was found between two methods according to Bland and Altman method (-0.2296, p = 0.23). Conclusion: The present data may suggest that pulse oximetry oxygen saturation is an acceptable substitute for the arterial oxygen saturation in patients with HFrEF

Loküle perikart efüzyonunun sağ parasternal perikardiyosentez ile başarılı tedavisi

A 46-year-old woman with a previous diagnosis of inoperable stage IV small cell lung cancer presented to the emergency department with shortness of breath. Physical examination showed apale woman who appeared malnourished. Her vital signs were as follows: pulse rate 115 beats/min,respiration rate 22 breaths/min, body temperature 37.5°C, and blood pressure 95/65 mm Hg. Breathsounds were diminished on the left base and widespread coarse crackles were heard over the leftlung. Other system examination fi ndings were within normal limits. A 12-lead electrocardiogramshowed sinus tachycardia and lower voltage without marked ST changes. A chest X-ray showedinfi ltrates on the left upper zones, and a large left-sided pleural effusion (Figure 1A). Transthoracicechocardiograpy (TTE) showed a large loculated pericardial effusion measuring 3.2 cm inmaximal width on the right side of the heart with cardiac tamponade, which was also confi rmedby multislice computed tomography (Figure 1B). Due to the increased risk of general anesthesia

Zakkum zehirlenmesine bağlı olarak gelişen mobitz tip II atriyoventriküler bloklu olgunun digoksin-spesifik fab antikoru ile başarılı tedavisi

Nerium oleander is a popular ornamental plant grown in many tropical and subtropical countries and in the Mediterranean region. It is dangerous because it has been shown to contain several types of cardiac glycosides, and hence can cause cardiac arrhythmias resembling digoxin in their toxicologic manifestations. We report a patient present- ing to our hospital with Mobitz type II atrioventricular block after drinking herbal tea prepared from oleander leaves. Three hours after admission, a 200-mg empiric dose of digoxin-specific Fab antibody fragments was administered intravenously over 30 minutes. A 12-lead electrocardiogram (ECG) revealed sinus rhythm at the end of infusion. After 72 hours, the patient was discharged without any symptoms.Zakkum (Nerium oleander) tropikal, subtropikal ve Akdeniz bölgesinde yetişen popüler bir süs bitkisidir. Çe- şitli kalp glikozidleri içerdiği gösterilmiştir ve tehlikeli ola- bilmektedir. Bu yüzden zakkum zehirlenmesi, digoksinin toksik bulgularını taklit eden aritmilere neden olabilmekte- dir. Yazımızda zakkum yapraklarından yaptığı çayı içtikten sonra Mobitz tip II atriyoventriküler blok ile başvuran bir hasta sunuldu. Başvurusundan üç saat sonra, 200 mg’lık ampirik dozda digoksin-spesifik antikoru 30 dakikalık in- füzyon şeklinde uygulandı. İnfüzyonun bitiminde, 12 deri- vasyonlu elektrokardiyogramda (EKG) sinüs ritmi izlendi. Hasta, 72 saat sonra herhangi bir semptomu olmadan ta- burcu edildi

The impact of COVID-19 on patients with chronic obstructive pulmonary disease

BACKGROUND: The aim of this study was to evaluate the risk of serious adverse outcomes in patients with chronic obstructive pulmonary disease (COPD) related to COVID-19 by stratifying the comorbidity status.METHODS: This is a prospective cohort study based on 1264 male and female patients, which were 25-75 years old. Nine hundred five (71.5%) patients gave consent to participate. The collected data included demographics, clinical, bio-chemistry, microbiology information, and the presence of disease. We performed descriptive and multivariate regression analyses to analyze the COVID-19 disease in the context of COPD.RESULTS: There was a significant difference between COPD versus control subjects with respect to age groups, BMI, smoking cigarette, comorbidity, infection, hypertension, stroke, coronary heart failure (CHF), diabetic and cerebral (P<0.001). The highly statistically significant differences were observed between COPD versus control subjects regard-ing, hemoglobin (P=0.022), HbA1C (P<0.001), glucose (P=0.040), vitamin D (P<0.001), vitamin B12 (P=0.020), triglyc-eride, uric acid (P<0.001), ferritin (P=0.002), Fe (P=0.004), and TSH (P=0.008), creatine-kinase (CK) (P=0.004), white blood cell (WBC) (P<0.001), hematocrit (P<0.001), monocytes (P<0.001), neutrophil (P<0.001), lymphocyte (P<0.001), platelet (P<0.001), aspartate transaminase-AST (P=0.018), alanine transaminase-ALT (P=0.008), respectively. The mul-tivariate stepwise regression analysis indicated that monocyte (P<0.001), hematocrit (P<0.001), lymphocyte (P<0.001), smoking (yes) (P<0.001), vitamin D (P<0.001), uric acid (P<0.001), diastolic BP (P<0.001), ferritin (P=0.002), infection (yes) (P=0.002), creatine kinase (P=0.006), metabolic syndrome (IDF) (P=0.008) and BMI kg/m2 (P=0.009) can be con-sidered as risk predictors of the COPD among COVID-19 patients after adjusting for age and gender.CONCLUSIONS: This study determined that COPD disease was the most prevalent comorbidity with CHF, hypertension and diabetes disease among COVID-19 patients. Interestingly, the current study revealed that 22.8% of COPD patients stated being smokers. The current study supports the evidence that COPD patients have worse outcomes from COVID-19 and explored the multiple factors responsible.(Cite this article as: Bener A, Kok K, Naser A, Barisik CC, Nurkalem Z. The impact of COVID-19 on patients with chronic obstructive pulmonary disease. Minerva Respir Med 2023;62:69-75. DOI: 10.23736/S2784-8477.22.02009-5)Istanbul Medipol University :10840098-604.01.01-E.1418

Urban legend or real fact: Coronary artery size varies with demographics

WOS: 000433094100005PubMed ID: 29607427OBJECTIVE: This study aimed to determine the relationship between the diameter of coronary artery stents and age, gender, diabetes mellitus (DM), left ventricular ejection fraction (LVEF), renal dysfunction, and the clinical presentation of myocardial ischemia in the cohort of patients with implanted stents in coronary arteries with severe stenotic lesions. METHODS: This study included 2256 patients (mean age, 59.3 +/- 10.9 years; men, 62%) who underwent percutaneous coronary intervention (PCI). The clinical status of the patients at presentation was subcategorized as follows: ST-segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, unstable angina pectoris, and stable angina pectoris. The diameters, without any type or brand differentiation, were divided into two groups as follows: Group I, which included 2.5-and 2.75-mm-diameter stents, and Group II, which included >= 3-mm-diameter stents. RESULTS: The type of procedure, including primary PCI, early invasive strategy, and elective stenting, was not found to be a significant factor affecting the diameter of coronary artery stents. Univariate and multivariate analyses revealed a relationship between the diameter of coronary artery stents and age, gender, DM, and LVEF. CONCLUSION: This study demonstrated that the diameter of coronary artery stents was independently associated with gender, age, a history of DM, and moderate-to-severe systolic left ventricular dysfunction

Inappropriate use of digoxin in patients presenting with digoxin toxicity

WOS: 000351866700008PubMed ID: 25870617Background Digoxin remains widely used today despite its narrow therapeutic index and toxicity. The objective of this study was to investigate the percentage of inappropriate use of digoxin and long-term outcomes of elderly patients hospitalized for digoxin toxicity. Methods The study included 99 consecutive patients hospitalized for digoxin toxicity. The other study criteria for the inappropriate use of digoxin was regarded if participants having depressed left ventricular systolic function (ejection fraction < 45%) who were not on optimal medical therapy including beta-blocker and angiotensin-converting-enzyme inhibitor therapy or if participants having permanent AF who were not on optimal beta-blocker therapy. Results Appropriate digoxin usage was confirmed in 33 of patients in spite of its narrow therapeutic index. A total of 16 of 99 patients died, with a mean follow-up time of 22.1 +/- 10.3 months. Conclusions Contrary to popular belief, the rate of inappropriate digoxin usage remains high. On account of its narrow therapeutic index and toxicity, digoxin should be used more carefully according to the current evidence and guidelines

ST yükselmeli miyokart enfarktüsü sonrası gelişen kalp durması nedeniyle tedavi amaçlı hipotermi uygulanan hastalarda nörolojik sonlanım: Üçüncü basamak merkez tecrübesi

WOS: 000375094600003PubMed ID: 27111307Objective: Therapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI). Methods: Thirteen patients (11 male, 2 famele; mean age was 39.6+/-9.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score. Results: Anterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-to-invasive cooling were 32.9+/-20.1 and 286.1+/-182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed. Conclusion: In comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality.Amaç: Kalp durması sonrası tedavi amaçlı hipotermi uygulamasının nörolojik prognoz üzerine olumlu etkisi gösterilmiştir. Bu yazıda, ST yükselmeli miyokart enfarktüsüne (STYME) bağlı kalp durması geçiren hastalarda damariçi yöntemle yapılan soğutma tedavisine ilişkin çalışmamız sunuldu. Yöntemler: ST yükselmeli miyokart enfarktüsü sonrası kalp durması nedeniyle damariçi yöntemle tedavi amaçlı hipotermi uygulanan 13 hasta (11 erkek, 2 kadın; ortalama yaş 39.6±9.4 yıl) çalışmaya dahil edildi. Klinik, demografik ve soğutma işlemine ait veriler incelendi. Nörolojik takipler Serebral Performans Kategorisi skorlaması kullanılarak yapıldı. Bulgular: Dokuz hastada akut ön duvar miyokart enfarktüsü tespit edildi. Bir hasta kardiyojenik şok nedeniyle kaybedildi. Ortalama kardiyopulmoner canlandırma süresi ve kapı invaziv soğutma süresi sırasıyla 32.9±20.1 ve 286.1±182.3 dakikaydı. Soğutma öncesi dokuz hastada Glaskow Koma Skalası 3 bulundu; 12 hasta taburcu edildi, 11 hastanın bir yıllık takipte Serebral Peformans Kategorisi skoru 1 olarak saptandı. Soğutma işleminden kaynaklanan ciddi komplikasyon gözlenmedi. Sonuç: ST yükselmeli miyokart enfarktüsü sonrası koma halinde bulunan hastalarda damariçi yöntemle yapılan tedavi amaçlı hipotermi faydalı ve güvenli bir tedavi seçeneğidir