Markers of increased risk of death in polytrauma patients with associated chest trauma

Introduction. Polytrauma patients represent one of the most difficult pathology. Therefore, developing methods of assessing the risk of death in these patients is a continuous challenge for physicians. The aim of the study was to evaluate the levels of creatine kinase isoenzyme MB (CK-MB) and troponin, as markers of increased risk of death in the first 24 hours after admission, in polytrauma patients with associated chest trauma. Material and methods. The study included 33 polytrauma patients treated in the Emergency Department of the County Clinical Emergency Hospital Constanta, Romania, between 2014-2017. In all these patients, clinical evaluation and paraclinical investigations have been performed, including measurements of CK-MB levels. The results of the study suggest that CK-MB does not offer additional information for the risk of death in these patients, while in the case of troponin, higher values were observed in patients that didn’t survive after 24 hours. Conclusions. The results of our study suggest that troponin values may be useful in identifying the increased risk of death in polytrauma patients

ARRHYTHMIAS IN ACUTE AND PERSISTENT DEPRESSION IN PATIENTS WITH MYOCARDIAL INFARCTION

ABSTRACT. Acute and persistent depression is recognized as a risk factor for coronary artery disease. Significant depressive symptoms are found in 40-65 percent of patients with myocardial infarction. Depression is often persistent and exacerbates cardiac symptoms. It increases the frequency of arrhythmias, angina, morbidity and mortality (through sudden cardiac death). The therapy with serotonin reuptake inhibitor antidepressants improves depression and has favorable effects on the severity of cardiovascular symptoms, on morbidity and mortality. Keywords: acute and persistent depression, arrhythmias, myocardial infarction. REZUMAT. Depresia acută și persistentă este recunoscută ca un factor de risc pentru boala coronariană. La aproximativ 40-65% dintre pacienţii cu infarct miocardic, identificăm simptome semnificative de depresie. Depresia este frecvent persistentă și exacerbează simptomele cardiace. Crește frecvenţa aritmiilorși a anginei, morbiditatea și mortalitatea (prin moarte subită). Terapia cu antidepresive, de tipul inhibitorilor recaptării serotoninei, ameliorează depresia și are efect favorabil asupra simptomelor cardiovasculare, a morbidităţii și a mortalităţii. Cuvinte cheie: depresie acută și pesistentă, aritmii, infarct miocardic

Analysis of Functionalized Ferromagnetic Memory Alloys from the Perspective of Developing a Medical Vascular Implant

Durable biocompatible metal vascular implants are still one of the significant challenges of contemporary medicine. This work presents the preparation of ferromagnetic biomaterials with shape memory in metal strips based on FePd (30 at% Pd) that is either not doped or doped with Ga and Mn, coated with poly(benzofuran-co-arylacetic acid) or polyglutamic acid. The coating of the metal strips with polymers was achieved after the metal surface had been previously treated with open-air cold plasma. The final functionalization was performed to induce anti-thrombogenic/thrombolytic properties in the resulting materials. SEM-EDX microscopy and X-ray photoelectron microscopy (XPS) determined the morphology and composition of the metal strips covered with polymers. In vitro tests of standardized thromboplastin time (PTT) and prothrombin time (PT) were performed to evaluate the thrombogenicity of these biofunctionalized materials for future possible monitoring of the implant in patients

The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p  30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality

Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal

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