Earlobe Crease Shapes and Cardiovascular Events Rodríguez-López, Claudia, MD; Garlito-Díaz, Hugo, MD; Madroñero-Mariscal, Raquel, MD ...
The American journal of cardiology,
07/2015, Letnik:
116, Številka:
2
Journal Article
Recenzirano
Earlobe crease (ELC) has been linked to coronary artery disease; however, systematic evaluations of the earlobe and its relation to ischemic stroke are lacking. The objectives were to define the ELC ...using a single-blind approach and to determine through multivariate analysis its association with cardiovascular events (CVEs) comprising coronary, ischemic cerebrovascular, and peripheral vascular diseases. A single-blind cross-sectional study was performed in 2 phases: (1) an initial study (n = 300) to define ELC classification criteria and (2) a confirmation stage (n = 1,000) to analyze ELC association with CVEs. Each of the participants' pinnae were photographed and classified blindly by joint decision according to ELC's inclination, length, depth, and bilateralism. Patients' medical histories were reviewed for age, cardiovascular risk factors, and CVEs. The concordance rate after the classification of all photographs was 89.6%. The first phase did not find any correlation between the different depth degrees or vertical creases and CVEs. The second stage concluded that diagonal bilateral ELC prevalence in patients with CVEs was 43% compared with 29% in the control patients (p <0.001). The multivariate analysis showed an association between ELC and CVEs (odds ratio 1.45, 95% confidence interval CI 1.08 to 1.93, p = 0.012), with a sensitivity and specificity of 43% and 70%, respectively. Ischemic stroke alone was also associated with diagonal bilateral ELC (odds ratio 1.67, 95% confidence interval 1.1 to 2.51, p = 0.015). In conclusion, diagonal bilateral ELC is independently associated with CVEs in the hospitalized population. An independent association with ischemic stroke has also been demonstrated for the first time.
...in previous small clinical series analyzing the effect of therapeutic hypothermia (TH) in patients who undergo PPCI, it was observed that there was an increased rate of stent thrombosis (ST) in ...TH- compared with non-TH-treated patients (2). In the present observational study, even under the prelude of greater hemodynamic support and a higher frequency of hemorrhagic complications in the PPCI-TH-treated patients, the incidence of ST was almost identical to that of patients not treated with TH. ...under the need of further prospective trials, we believe that adequate antithrombotic management could be achieved in this population with both the progressive introduction of third-generation P2Y12 inhibitors and consideration that the route (intravenous aspirin and crushed nasogastric P2Y12) (5) and time (before PPCI) of administration may influence the final result.
Abstract Purposes To evaluate the effects of a computerized physician order entry (CPOE) system in the cardiac intensive care unit by detecting prescription errors (PEs) and also to assess the impact ...on working conditions. Methods A longitudinal, prospective, before-after study was conducted during the periods before and after the implementation of the CPOE system. Clinical pharmacists were responsible for the registration, description and classification of PEs, and their causes and severity, according to an international taxonomy. Professionals were also surveyed for their opinion, concerns, and level of satisfaction. Results A total of 470 treatment orders containing 5729 prescriptions were evaluated. The CPOE resulted in a marked reduction in the number of PEs: error rate was 44.8% (819 errors among 1829 prescriptions) with handwritten orders and 0.8% (16 among 2094 prescriptions) at the final electronic phase ( P < .001). Lapses were the main cause of error in both prescription methods. Most errors did not reach the patients. Errors related with the computerized system were scarce. Most users were satisfied with many aspects of this technology, although a higher workload was reported. Conclusions Computerized physician order entry in the cardiac intensive care unit proved to be a safe and effective strategy in reducing PEs and was globally well received by professionals.
A 26-year-old woman presented with acute hemolysis 1 month after percutaneous closure of an atrial septal defect. Three-dimensional transesophageal echocardiography was used to establish the ...diagnosis of a fistula from the aorta, toward the device and both atria. The patient required urgent surgical correction. Transcatheter closure of atrial septal defects has proven to be a highly successful alternative to surgery in the appropriate patient. Cardiac perforation and device erosion of the aortic wall are infrequent but potentially lethal complications of percutaneous occluder device insertion. Supportive features of device erosion include a wrong preimplantation assessment of the rims, the device extends across the atrial septum, and the device encroaches on the surrounding structures. In this case, the presumed mechanism of aortic fistula was aortic erosion by the left atrial disk of the occluder device.
This retrospective study evaluates the influence of an invasive strategy of urgent coronary revascularization on the in-hospital mortality of patients with acute myocardial infarction (AMI) ...complicated early by cardiogenic shock. Among 1,981 patients with AMI admitted to our institution from 1994 to 1997, 162 patients (8.2%) developed cardiogenic shock unrelated to mechanical complications. The strategy of management was considered invasive if an urgent coronary angiography was indicated within 24 hours of symptom onset. Every other strategy was considered conservative. Fifty-seven patients who developed the shock late or after a revascularization procedure, or who died on admission, were excluded. The strategy was invasive in 73 patients (70%). Five of them died before angiography could be performed and 65 underwent angioplasty (success rate 72%). By univariate analysis the invasive strategy was associated with a lower mortality than conservative strategy (71% vs 91%, p = 0.03), but this association disappeared after adjustment for baseline characteristics. Older age, nonsmoking, and previous ischemic heart disease were independent predictors of mortality. In conclusion, we have failed to demonstrate that a strategy of urgent coronary revascularization within 24 hours of symptom onset for patients with AMI complicated by cardiogenic shock is independently associated with a lower in-hospital mortality. This strategy was limited by the high mortality within 1 hour of admission in patients with cardiogenic shock, the modest success rate of angioplasty in this setting, and the powerful influence of some adverse baseline characteristics on prognosis.
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