Risk factors for sudden cardiac death in hypertrophic cardiomyopathy

Aim of this study was the evaluation of six non invasive clinical indices as risk factors for sudden death (SD)in hypertrophic cardiomyopathy (HCM). Previous syncope, family history of SD, non sustained ventricular tachycardia, abnormalblood pressure response during exercise, excessive hypertrophy ≥3 cm and left ventricular outflow tract obstructionwith a peak gradient ≥30 mmHg were evaluated in a cohort of 166 patients(112 males, 51.8 ± 15.6 years), followed up for amedian of 32.4 months (range 1 to 209 months). During follow up 13 patients reached study’s endpoints: SD, cardiac arrest,documented sustained ventricular tachycardia and/or Implantable Cardioverter Defibrillator (ICD)-discharge. Patients havingexperienced syncope or presenting with a Maximum Wall Thickness ≥3cm in echocardiography were more sensitive to SDemergence since they had a 13.07 (95%CI: 4.00-46.95, p < 0.0001) and a 10.07 (95%CI: 2.92-34.79, p = 0.003) greater relativerisk respectively. In our cohort of patients only two of the six ‘recognised’ potential risk factors for SD were found sensitive,a result causing scepticism about the validity of criteria used for ICD implantation in HCM patients for SD prevention

Identification of high risk patients with hypertrophic cardiomyopathy in a northern Greek population

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Hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm formation in a single family: case report

<p>Abstract</p> <p>Background</p> <p>Hypertrophic cardiomyopathy (HCM) is an extremely heterogeneous disease. An under recognized and very often missed subgroup within this broad spectrum concerns patients with left ventricular (LV) apical aneurysms in the absence of coronary artery disease.</p> <p>Case presentation</p> <p>We describe a case of HCM with midventricular obstruction and apical aneurysm formation in 3 patients coming from a single family. This HCM pattern was detected by 2D-echocardiography and confirmed by cardiac magnetic resonance imaging. A cardioverter defibrillator was implanted in one of the patients because of non-sustained ventricular tachycardia detected in 24-h Holter monitoring and an abrupt drop in systolic blood pressure during maximal exercise test. The defibrillator activated 8 months after implantation by suppression of a ventricular tachycardia providing anti-tachycardia pacing. The patient died due to refractory heart failure 2 years after initial evaluation. The rest of the patients are stable after a 2.5-y follow-up period.</p> <p>Conclusion</p> <p>The detection of apical aneurysm by echocardiography in HCM patients may be complicated. Ventricular tachycardia arising from the scarred aneurysm wall may often occur predisposing to sudden death.</p

Management of an extrasphincteric fistula in an HIV-positive patient by using fibrin glue: a case report with tips and tricks

<p>Abstract</p> <p>Background</p> <p>Individuals with impaired immunity are at higher risk of perianal diseases. Concerning complex anal fistulas impaired healing and complication rates are also higher. Definitive treatment of a fistula aims controlling the purulent discharge and prevents its recurrence. It depends mainly on the trajectory of the fistula and the underlying disease.</p> <p>We present a case of a HIV-positive patient with a complex extrasphincteric anal fistula who was treated successfully with fibrin glue application. We further, discuss tips and tricks when applying fibrin glue as plugging material in complex anal fistulas.</p> <p>Case presentation</p> <p>A sixty-one-year-old HIV-positive male referred to us for warts and extrasphincteric fistula. Because of the patients' immunological status, we opted against surgery and recommended fibrin glue plugging. The patient was discharged the same day. A follow-up examination was performed 5 days after the initial fibrin glue application showing that the fistula canal was obstructed. Three months and a year post-intervention the fistula tract remains closed.</p> <p>Conclusion</p> <p>The best treatment for a disease gives at least the same result with the other treatments with minimised risk for the life of the patient and minimal application effort. Conservative closure of fistula with fibrin plugging is simple, safe and with less morbidity than surgery. Our patient was successfully treated without endangering his life despite his precarious medical state. Not everybody believes in the effectiveness of fibrin glue application, however we consider this solution in cases of complex fistulas at least as primary procedure in special populations such as the immunosupressed.</p

Risk factors for postoperative cervical haematoma in patients undergoing thyroidectomy: a retrospective, multicenter, international analysis (REDHOT study)

Background Postoperative cervical haematoma represents an infrequent but potentially life-threatening complication of thyroidectomy. Since this complication is uncommon, the assessment of risk factors associated with its development is challenging. The main aim of this study was to identify the risk factors for its occurrence.Methods Patients undergoing thyroidectomy in seven high-volume thyroid surgery centers in Europe, between January 2020 and December 2022, were retrospectively analysed. Based on the onset of cervical haematoma, two groups were identified: Cervical Haematoma (CH) Group and No Cervical Haematoma (NoCH) Group. Univariate analysis was performed to compare these two groups. Moreover, employing multivariate analysis, all potential independent risk factors for the development of this complication were assessed.Results Eight thousand eight hundred and thirty-nine patients were enrolled: 8,561 were included in NoCH Group and 278 in CH Group. Surgical revision of haemostasis was performed in 70 (25.18%) patients. The overall incidence of postoperative cervical haematoma was 3.15% (0.79% for cervical haematomas requiring surgical revision of haemostasis, and 2.35% for those managed conservatively). The timing of onset of cervical haematomas requiring surgical revision of haemostasis was within six hours after the end of the operation in 52 (74.28%) patients. Readmission was necessary in 3 (1.08%) cases. At multivariate analysis, male sex (P &lt; 0.001), older age (P &lt; 0.001), higher BMI (P = 0.021), unilateral lateral neck dissection (P &lt; 0.001), drain placement (P = 0.007), and shorter operative times (P &lt; 0.001) were found to be independent risk factors for cervical haematoma.Conclusions Based on our findings, we believe that patients with the identified risk factors should be closely monitored in the postoperative period, particularly during the first six hours after the operation, and excluded from outpatient surgery

Epidemiological and clinical study of decubital ulcers in hospitalized and post-hospitalized patients

Aim: The aim of the present study is to collect clinical and epidemiological data on decubital ulcers (DUs) of AHEPA hospital patients, during as well as after their hospitalization. In our study, we also introduced and estimated DU surface, a new clinical parameter of DUs. Methodology: We distributed a questionnaire on “prevention and treatment of decubitus ulcers” to the hospital nurses, in order to assess the level of care provided to DU patients. The prevalence and incidence of DUs every three months were recorded. We retrospectively recorded for every patient the risk factors that precipitated the DU, the preventive measures that were taken and the treatment that was chosen. We collected demographic data and important clinical parameters of the ulcer. The further post-hospital assessment was performed every 3 months, during the year following their initial recording. At the same time, we studied the change in the patient’s quality of life, through the modified Barthel index. We also studied the change in quality of life of the patient’s family environment, through completion of a questionnaire by the closest caring relative. The questionnaire was based on the thematic analysis of quality of life, according to Miles M.B. and Huberman A.M. The financial burden at hospital and family level was assessed through two different analysis models, the activity based costing and the health technology assessment. Results: All of the nurses answered that they did not know of, were never informed about and were never trained to cope with two of the meanest DU risk factors: urine and fecal incontinence and malnutrition. In the Greek medical practice, DU is an underestimated disease. From our data emerged the fact that there are serious mistakes and omissions in the disease management, in all levels: medical, nursing and administrative. Knowledge of DU treatment was deficient. The lack of a therapeutic plan or protocol was decisive. The DUs of the patients registered in the study seemed to have been better treated after their discharge. Elementary rules of prevention and treatment were applied in the majority of the cases. However, both quality of life and household budget of the patients’ family were negatively affected. The surface of the ulcer can play an important role in both the prognosis and assessment of the disease course. An ulcer surface of more than 20 cm2 is considered to be an alarming point. Conclusions: Given the particularity of our national healthcare system, we delineated some feasible suggestions, to be implemented by nurses, medical staff, hospital administration, as well as by the university and the ministry of health.Στόχος: Ο στόχος της παρούσας εργασίας είναι η μελέτη των ασθενών με έλκος κατάκλισης (ΕΚ) στο Π.Γ.Ν. ΑΧΕΠΑ, αλλά και τη μελέτη της πορείας των ασθενών μετά την έξοδο από το νοσοκομείο. Στην μελέτη εισήχθη και εκτιμήθηκε μία καινούργια κλινική παράμετρος των ΕΚ, η έκταση του έλκους. Μεθοδολογία: Στους νοσηλευτές του νοσοκομείου διανεμήθηκε ερωτηματολόγιο με θέμα «αντιμετώπιση και πρόληψη των ΕΚ», με σκοπό να αξιολογηθεί το επίπεδο παροχής των απαραίτητων υπηρεσιών υγείας στους ασθενείς αυτούς. Διενεργήθηκε η καταγραφή του επιπολασμού και της επίπτωσης των ασθενών με ΕΚ. Σε κάθε ασθενή καταγράφηκαν αναδρομικά οι παράγοντες κινδύνου που οδήγησαν στην έναρξη του ΕΚ, τα προληπτικά μέτρα που ελήφθησαν και η θεραπεία που επιλέχθηκε. Ακολούθησε η περαιτέρω μελέτη των ιδίων ασθενών μετανοσοκομειακά, για χρονικό διάστημα ενός έτους επιπλέον. Κατά το ίδιο χρονικό διάστημα μελετήθηκε η ποιότητα ζωής του ασθενούς με τη χρήση της τροποποιημένης κλίμακας του Barthel. Επίσης, μελετήθηκε η ποιότητα ζωής του οικογενειακού περιβάλλοντος του ασθενούς. Το οικονομικό κόστος στο επίπεδο του νοσοκομείου και της οικογένειας εκτιμήθηκε μέσω 2 διαφορετικών μοντέλων ανάλυσης της κοστολόγησης βάσει της δραστηριότητας και αποτίμησης των τεχνολογιών υγείας. Αποτελέσματα: Όλοι οι νοσηλευτές απάντησαν ότι δεν είχαν ποτέ ενημερωθεί και ότι δεν είχαν εκπαιδευτεί στην αντιμετώπιση δύο εκ των κυριοτέρων παραγόντων κινδύνου εμφάνισης των ΕΚ: την ακράτεια ούρων και κοπράνων και τον υποσιτισμό. Στην ελληνική ιατρική πραγματικότητα το ΕΚ αποτελεί υποτιμημένη νόσο. Από τα δεδομένα μας, προέκυψε ότι υπήρχαν λάθη και παραλείψεις στην αντιμετώπιση της νόσου σε όλα τα επίπεδα: στο ιατρικό, στο νοσηλευτικό και στο διοικητικό. Η γνώση της θεραπείας των ΕΚ είναι ελλιπής. Η έλλειψη ενός θεραπευτικού πλάνου-πρωτοκόλλου είναι καθοριστική. Τα ΕΚ των ασθενών της μελέτης φαίνεται ότι έτυχαν καλύτερης αντιμετώπισης μετά την έξοδό τους από το νοσοκομείο, λόγω της ιδιαίτερης φροντίδας των συγγενών και οικείων τους και της τήρησης των ιατρικών οδηγιών που εδόθησαν με την χειρουργική επίβλεψη κατά διαστήματα της πορείας του έλκους. Στην οικία του ασθενούς εφαρμόζονταν οι στοιχειώδεις κανόνες πρόληψης και θεραπείας. Η ποιότητα ζωής των οικείων των ασθενών, όσο και ο οικονομικός τους προϋπολογισμός επηρεάστηκαν αρνητικά. Η έκταση του έλκους μπορεί να παίξει σημαντικό ρόλο τόσο στην πρόγνωση όσο και στην αξιολόγηση της πορείας της νόσου. Σημείο συναγερμού θεωρείται το έλκος έκτασης πέραν των 20 εκ.2. Συμπεράσματα: Από την ανάλυση των δεδομένων της εργασίας προέκυψαν προτάσεις που θα μπορούσαν να εφαρμοστούν τόσο από το νοσηλευτικό, όσο και από το ιατρικό και διοικητικό προσωπικό των νοσοκομείων. Το πανεπιστήμιο και το υπουργείο υγείας μπορούν επίσης να συμβάλλουν σημαντικά στη θετική εξέλιξη και αντιμετώπιση της πάθησης