To assess whether the number of patients with a cardiac chief complaint and their characteristics differed between before and after two major earthquakes that struck Croatia in 2020.
We collected ...data on all visits of patients with a cardiac chief complaint examined in the emergency departments of six hospitals nearest to the epicenters. Patients seen during the 7 days before the earthquake were compared with those seen on the day and during the 6 days after the earthquake.
Patients seen after the earthquake were younger (68 59-79 vs 72.5 65-80; P<0.001) and less frequently had cardiovascular disease (32.9% vs 42.8%; P<0.001). This group less frequently had the primary diagnosis of acute myocardial infarction (AMI) (15.6% vs 21.9%; P=0.005), heart failure (9.3% vs 19.4%; P<0.001), dysregulated hypertension (13.9% vs 19.4%; P=0.01), but more frequently had non-anginal chest discomfort (28.8% vs 18.0%; P<0.001). In a subgroup analysis of patients seen in hospitals located within 20 km from the epicenter, significantly more patients seen after the earthquake compared with those seen before the earthquake presented with AMI (14.5% vs 22.8%; P=0.028), acute elevation of blood pressure (10% vs 21.8%, P=0.001), and paroxysmal arrhythmias treated with electrocardioversion (0.9% vs 4.5%, P=0.022).
After two moderately strong earthquakes, hospitals within 20 km from the epicenter saw a significant increase in acute cardiac conditions such as elevated blood pressure, AMI, and cardioverted arrhythmias. Eventually, these earthquakes had no impact on the outcomes of the studied population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To determine the relationship between plasminogen activator inhibitor-1 (PAI-1) activity rise during the first 24 hours of ST-elevation myocardial infarction (STEMI) treatment and death after 5 ...years.
From May 1, 2009 to March 23, 2010, 87 STEMI patients treated with primary percutaneous coronary intervention (PCI) at the Sestre Milosrdnice University Hospital Center were consecutively enrolled in prospective single-center cohort study. PAI-1 activity was determined on admission and 24 hours later. The primary end-point was death after 5 years. The predictive value of PAI-1 activity variables as biomarkers of death was assessed using receiver operating characteristic (ROC) curve, independent predictors of death were assessed using multivariate Cox regression, and covariates independently related to higher PAI-1 activity rise were assessed using linear regression.
Two patients died during the hospital treatment and 11 during the follow-up. PAI-1 activity rise had the largest area under curve (0.748) for predicting death rate (optimal cut-off point 3.7 U/mL, sensitivity 53.8%, specificity 90.5%). Patients with PAI-1 activity rise higher than 3.7 U/mL had significantly higher mortality (P<0.001). Kaplan-Meier survival curve diverged within the first year after STEMI. Independent predictors of death were PAI-1 rise and final Thrombolysis in Myocardial Infarction flow. PAI-1 activity rise was independently related to heart failure, thrombus aspiration, and body weight.
PAI-1 activity rise higher than 3.7 U/mL is associated with higher 5-year death rate in STEMI patients treated with primary PCI.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In this brief review of the broad field of research of Academician Predrag
Piper, we tried to point out some typologically relevant similarities and
differences between Slavic languages, especially ...regarding pronouns and
numbers (which were much less discussed in the Slavic scientific
community), as well as morphological-syntactic categories of impersonality
and personality. Predrag Piper?s work on describing morphological and
syntactic categories in Slavic languages concerning their semantic and
functional content, based on the theory of semantic localizations, offered
numerous answers and provided authoritative and plausible insight and
explanations for a large number of issues that had rarely been investigated.
Predrag Piper left numerous solutions and ideas in the field of semantic
categories, in which new directions have opened for typological examinations
of categorial meanings within modern linguistic theories.
A routine protocol of therapeutic hypothermia was accomplished with targeted temperature of 32 to 34°C. Consecutive laboratory findings showed significant increase in creatine kinase (peak level of ...2,214 U/L) and high-sensitivity troponin I (peak level of 31,288 ng/L) levels signifying myocardial infarction with non-obstructive coronary arteries. ST-segment elevation with patent coronary arteries is reported in 3% to 4% of the patients with myocardial infarction who presented without OHCA.3 It would be of great concern to report the incidence of myocardial infarction with non-obstructive coronary arteries in patients with OHCA and the relevant patient characteristics related to this association, as such data have not been previously published. In some centers, therapeutic hypothermia is routinely delayed after percutaneous coronary intervention, leading to delays in achieving optimal body temperature required for brain preservation.4 Avoiding unnecessary procedures could benefit the patient and caregivers involved.Disclosures The authors have no conflicts of interest to disclose.Supplementary Data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.amjcard.2018.02.027.Supplementary Data The following is the supplementary data to this article:
To determine whether therapeutic hypothermia (TH) improves survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors.
This retrospective cohort study enrolled patients ...treated for OHCA with a return of spontaneous circulation admitted to the Cardiac Intensive Care Unit from October 2000 until March 2019. Data were collected from medical archives. Propensity score matching was used. The primary endpoint was death during hospital stay and secondary endpoint was cerebral performance category (CPC) score at discharge.
Out of 152 patients included in the study, 58 (38.7%) underwent TH treatment. After matching (which left 70 patients in the analysis), death during hospital stay occurred less often in TH group (28.6% vs 57.1%, P=0.029), while the difference in CPC score was not significant. Cox proportional hazards model showed the predictors of death during hospital stay to be TH (hazard ratio HR 0.29, 95% confidence interval CI 0.13-0.68, P=0.004), initial Glasgow Coma Scale score of 3 (HR 7.55, 95% CI 1.44-39.63, P=0.017), and heart failure (HR 2.35, 95% CI 1.02-5.34, P=0.045). TH was not an independent predictor of CPC score. Mann-Whitney U test and linear regression model showed that TH was associated with higher gain in GCS.
TH was associated with better survival and certain variables suggesting improved neurological outcomes, suggesting that TH is a vital treatment option for comatose OHCA survivors.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
...eGFR is a powerful predictor of outcome in patients with acute myocardial infarction (MI) and is more useful for this purpose than serum creatinine 3 .
The appearance of MI is more frequent during winter 1-6,14,20 . Because of acclimatization, people in cold regions (Finland) may not experience more winter excess mortality than those in mild regions ...(London) 21,22 . ...we would like to emphasize the need for decreasing the upper lawful limits of air pollutants as it increases the number of patients with MI.
Obesity is an important risk factor for the development of dyslipidemia, diabetes mellitus, hypertension, coronary artery disease, ventricular dysfunction, congestive heart failure (HF), stroke, and ...cardiac arrhythmias.
This meta-analysis brings comprehensive evaluation about still controversial association between the body mass index (BMI) and the outcomes of acute coronary syndrome.
PubMed/ScienceDirect databases were systematically searched for studies with baseline parameters, primary (HF, cardiogenic shock, cardiac arrest, reinfarction, stroke, death, total in-hospital complications) and secondary outcomes (reinfarction, stroke, death, total major adverse cardiovascular events MACE) in relation to BMI strictly classified into four groups (underweight <18.5 kg/m2, normal weight 18.5-24.9 kg/m2, overweight 25.0-29.9 kg/m2, and obese ≥30.0 kg/m2, grouped into mildly obese 30.0-34.9 kg/m2 and severely obese ≥35.0 kg/m2).
We included 24 studies, with 585,919 participants (55.5% males), aged 66.8 years. Underweight was negatively associated with hypertension, hyperlipidemia and diabetes, and positively with primary outcomes {HF (odds ratio OR = 1.37, confidence interval CI 1.15-1.63), cardiogenic shock (OR = 1.43, CI 1.04-1.98), stroke (OR = 1.21, CI 1.05-1.40), overall death (OR = 1.64, CI 1.20-2.26), total in-hospital complications (OR = 1.39, CI 1.24-1.56)} and secondary outcomes during 34-month follow-up {cardiovascular/overall death (OR = 3.78, CI 1.69-8.49/OR = 2.82, CI 2.29-3.49), respectively, total MACE (OR = 2.77, CI 2.30-3.34)} (for all p < 0.05). Obesity had positive association with hypertension, hyperlipidemia, diabetes and smoking, and negative with primary outcomes {reinfarction (OR = 0.83, CI 0.76-0.91), stroke (OR = 0.67, CI 0.54-0.85), overall death (OR = 0.55, CI 0.49-0.63), total in-hospital complications (OR = 0.81, CI 0.70-0.93)} and secondary outcomes {cardiovascular/overall death (OR = 0.77, CI 0.66-0.88/OR = 0.62, CI 0.53-0.72), respectively, total MACE (OR = 0.63, CI 0.60-0.77)} (for all p < 0.05). This negative association with several primary outcomes (cardiogenic shock, overall death, total in-hospital complications) and secondary outcomes (cardiovascular/overall death, total MACE) was more pronounced in mild obesity (p < 0.05). These results give an "obesity paradox" with a bimodal pattern (slightly U-shaped).
Obesity is positively associated with traditional cardiovascular risk factors and negatively with primary and secondary outcomes, which confirms the persistence of overall "obesity paradox."
PDF
