Surgical Treatment of Cardiac Tamponade Secondary to Non-Surgical Pericardial Effusion

Amaç Perikardiyal effüzyona bağlı tamponad gelişen hastalarda çeşitli tedavi seçenekleri bulunmaktadır. Nedenin belirlenmesinde effüzyon sitolojisinin incelenmesi önemlidir. Materyal ve Metod Selçuk Üniversitesi Etik Kurul Komitesi’nden etik kurul onayı alındı. Ocak 2009 –Nisan 2012 tarihleri arasında Konya Eğitim ve Araştırma Hastanesi Kalp Damar Cerrahisi Kliniği’nde cerrahi dışı perikardiyal efüzyon ve eşlik eden kardiyak tamponad nedeniyle subksifoid yaklaşım ile opere edilen 21 hasta retrospektif olarak incelendi. Bulgular 21 hastadan 18 tanesi semptomatik idi; 3 hastaya semptomları olmamasına rağmen yaygın perikardiyal effüzyon nedeniyle müdahale edildi. Etyolojide 14 hastada İdiyopatik (%66.66), 5 hastada malignite (%23.8), 1 hastada İmmunosupresyon (Bruton Agammaglobulinemi) ve 1 hastada geçirilmiş tüberküloz tespit edildi. Üç hastada rekürrens nedeniyle tekrar tüp takıldı; bu hastaların hepsinde malignite mevcuttu. Sonuç Perikardiyal tamponat kardiyak acillerden biridir ve hastanın klinik durumu hızlıca kötüleşebilir. Nedenden bağımsız olarak, tedavi konusunda hızlı karar verilmesi gerekli olmaktadır. Subksifoidal perikardiyal yaklaşım, uygun hastalarda, düşük mortalite, morbidite, komplikasyon ve rekürrens oranlarıyla birlikte güvenilir ve yararlı bir tedavi şeklidir.Aim There are various treatment options for cardiac tamponade due to pericardial effusion. Effusion cytology sampling is important to address the cause. Materials and Methods This retrospective study was approved by the Selçuk University Ethics Committee and includes the results of 21 patients who underwent surgery for cardiac tamponade due to non-surgical pericardial effusion in Konya Education and Research Hospital Cardiovascular Surgery Department between January 2009 and April 2012. Results Eighteen of 21 patients were symptomatic; the other 3 patients had extensive pericardial effusion. Etiology of the effusion was idiopathic in 14 patients (66.66%), malignancy was seen in 5 patients (23.8%), 1 patient had immunosuppression (Bruton agammaglobulinemia) and 1 patient had tuberculosis history. Recurrent effusion was seen in 3 patients and they all had malignancy. Conclusion Pericardial tamponade is a cardiac emergency that patient’s clinical condition may deteriorate rapidly. Regardless of the main cause, it is important to decide operation quickly for treatment. Subxiphoidal pericardial approach is a safety and effective procedure with low mortality, morbidity, complication and recurrence rates for appropriate patients

Frequency and Risk Factors of Re-hospitalization in Geriatric Inpatient Wards: A Multicenter Retrospective Analysis

Purpose We aimed to evaluate frequency and risk factors of re-hospitalization which are not stated in comorbidity indexes in geriatric wards. Methods A total of 585 patients who were admitted to tertiary care geriatric inpatient clinics at least once between 1 September 2017 and 1 September 2018 and who survived to discharge during initial hospitalization were included in this cross-sectional retrospective multicenter study. Results Overall, 507(86.7%) patients were hospitalized once for treatment during the study period, while re-hospitalization occurred in 78(13.3%) patients. Rates of previous surgery (10.3 vs. 3.0%, p = .006), urinary incontinence (UI) (50.0 vs. 36.3%, p = .021), controlled hypertension (64.1 vs. 46.4%, p = .024), malnutrition (55.1 vs. 29.6%, p = .014) were significantly higher in re-hospitalized patients. Re-hospitalized patients were younger (mean +/- SD 76.4 +/- 8.3 vs. 79.6 +/- 7.9 years, p = .002) than once-hospitalized patients. Multivariate logistic regression analysis revealed the younger patient age (OR, 0.942, 95% CI 0.910 to 0.976, p = .001), higher Modified Charlson Comorbidity Index (MCCI) score (OR, 1.368, 95% CI 1.170 to 1.600, p < .001) to significantly predict the increased risk of re-hospitalization. Conclusions Our findings showed that previous history of surgery and geriatric syndromes such as UI, malnutrition were determined to significantly predict the increased risk of re-hospitalization. We suggest that these risk factors be added to prognostic tools designed for elderly patients

Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

WOS: 000384041400052PubMed ID: 27583892This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients

Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from ramses study

Objective No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. Methods Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared. Results Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8 ± 9.8 vs. 68.7 ± 11.4 years, p &lt; 0.001), had a lower socioeconomic status, had a higher CHA2DS2VASc and HASBLED scores (3.4 ± 1.4 vs. 3.1 ± 1.7, p &lt; 0.001 and 1.7 ± 1.0 vs. 1.6 ± 1.1, p &lt; 0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p &lt; 0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p &lt; 0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p &lt; 0.001). Conclusion This study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs