The reported ranges of aortic root (AR) diameters are limited by small sample size, different measurement sites, and heterogeneous cohorts. The aim of this study was to explore the full spectrum of ...AR diameters by 2-dimensional transthoracic color Doppler echocardiography (TTE) in a large cohort of healthy adults. From June 2007 to December 2013, a total of 1,043 Caucasian healthy volunteers (mean age 44.7 ± 15.9 years, range 16 to 92 years, 503 men 48%) underwent comprehensive TTE. TTE measurements of the AR were made at end-diastole in parasternal long-axis views at 4 levels: (1) annulus, (2) sinuses of Valsalva, (3) sinotubular junction, and (4) proximal ascending aorta. The absolute aortic diameters were significantly greater in men than in women at all levels, whereas body surface area–indexed aortic diameters were greater in women (p = 0.0001). No significant gender differences were registered for sinuses of Valsalva and sinotubular junction to annulus diameter ratios (p = 0.9), whereas ascending aorta to annulus diameter ratio was higher in women (p = 0.0001). There was a straight correlation between aortic diameters (absolute and indexed values), their ratios, and age in both genders (p = 0.0001). In conclusion, we provide the full range of AR diameters by TTE. Knowledge of upper physiological limits of aortic dimensions is mandatory to detect aorta dilatation, follow up the disease over time, and plan appropriate therapeutic interventions.
Objectives Recent authoritative studies suggested that low preoperative hemoglobin concentration may affect cardiac surgery outcomes. This study aimed, primarily, to investigate whether preoperative ...anemia is an independent determinant of adverse events after coronary artery bypass grafting and, secondarily, to evaluate the potential dose responsiveness between anemia severity and primary end points. Methods This single-center prospective study investigated 1214 consecutive patients undergoing coronary artery bypass grafting between January 2004 and June 2007, collecting 100 variables per patient. In 1047 patients (median age 64 years, 18.8% female, 38.9% diabetic, 31.9% urgent/emergency, 15.3% with low preoperative left ventricular ejection fraction) who underwent on-pump procedures and received no preoperative transfusion, the prevalence of preoperative anemia (according to World Health Organization definition) and its unadjusted and adjusted relationships with in-hospital death, cardiac morbidity, and acute kidney injury (AKI–RIFLE Risk, Injury, Failure, Loss, End-stage kidney disease criteria) were obtained. Results The prevalence of preoperative anemia was 28%. In-hospital death averaged 3.9%, cardiac morbidity 7.3%, and acute kidney injury 4%. Unadjusted odds ratios (Ors) for in-hospital death, cardiac morbidity, and acute kidney injury were 3.8 (95% confidence interval CI 2.0–7.3), 1.7 (95% CI 1.1–2.8), and 4.0 (95% CI 2.1–7.6), respectively. Adjusting for anemia in confounders proved an independent predictor of acute kidney injury (OR 2.06; 95% CI 1.14–3.70), whereas the cardiac morbidity and in-hospital mortality were independently predicted by kidney function. No dose–response relationship emerged between anemia severity and acute kidney injury. Conclusions Preoperative anemia is independently associated with acute kidney injury after coronary artery bypass grafting. Further studies are warranted to determine whether preoperative low hemoglobin concentration is a marker of severity of illness or a modifiable risk factor.
Abstract Background: Functional exercises represent an important link between disaster planning and disaster response. Although these exercises are widely performed, no standardized method exists for ...their evaluation. Study Objectives: To describe a simple and objective method to assess medical performance during functional exercise events. Methods: An evaluation tool comprising three data fields (triage, clinical maneuvers, and radio usage), accompanied by direct anecdotal observational methods, was used to evaluate a large functional mass casualty incident exercise. Results: Seventeen medical responders managed 112 victims of a simulated building explosion. Although 81% of the patients were assigned the appropriate triage codes, evacuation from the site did not follow in priority. Required maneuvers were performed correctly in 85.2% of airway maneuvers and 78.7% of breathing maneuvers, however, significant under-treatment occurred, possibly due to equipment shortages. Extensive use of radio communication was documented. In evaluating this tool, the structured markers were informative, but further information provided by direct observation was invaluable. Conclusion: A three-part tool (triage, medical maneuvers, and radio usage) can provide a method to evaluate functional mass casualty incident exercises, and is easily implemented. For the best results, it should be used in conjunction with direct observation. The evaluation tool has great potential as a reproducible and internationally recognized tool for evaluating disaster management exercises.
Abstract Purpose During partial ventilatory support, pulse pressure variation (PPV) fails to adequately predict fluid responsiveness. This prospective study aims to investigate whether ...patient-ventilator asynchrony affects PPV prediction of fluid responsiveness during pressure support ventilation (PSV). Materials and methods This is an observational physiological study evaluating the response to a 500-mL fluid challenge in 54 patients receiving PSV, 27 without (Synch) and 27 with asynchronies (Asynch), as assessed by visual inspection of ventilator waveforms by 2 skilled blinded physicians. Results The area under the curve was 0.71 (confidence interval, 0.57-0.83) for the overall population, 0.86 (confidence interval, 0.68-0.96) in the Synch group, and 0.53 (confidence interval, 0.33-0.73) in the Asynch group ( P = .018). Sensitivity and specificity of PPV were 78% and 89% in the Synch group and 36% and 46% in the Asynch group. Logistic regression showed that the PPV prediction was influenced by patient-ventilator asynchrony (odds ratio, 8.8 2.0-38.0; P < .003). Of the 27 patients without asynchronies, 12 had a tidal volume greater than or equal to 8 mL/kg; in this subgroup, the rate of correct classification was 100%. Conclusions Patient-ventilator asynchrony affects PPV performance during partial ventilatory support influencing its efficacy in predicting fluid responsiveness.
Over the last century, the number of disasters has increased. Many governments and scientific institutions agree that disaster medicine education should be included in the standard medical ...curriculum. Italian medical students' perceptions of mass casualty incidents and disasters and whether-and if so to what extent-such topics are part of their academic program were investigated.
A Web-based survey was disseminated to all students registered with the national medical students' association (Segretariato Italiano Studenti Medicina), a member of the International Federation of Medical Students' Associations. The survey consisted of 14 questions divided into four sections.
Six hundred thirty-nine medical students completed the survey; 38.7 percent had never heard about disaster medicine; 90.9 percent had never attended elective academic courses on disaster medicine; 87.6 percent had never attended non-academic courses on disaster medicine; 91.4 percent would welcome the introduction of a course on disaster medicine in their core curriculum; and 94.1 percent considered a knowledge of disaster medicine important for their future career.
Most of the students surveyed had never attended courses on disaster medicine during their medical school program. However, respondents would like to increase their knowledge in this area and would welcome the introduction of specific courses into the standard medical curriculum.
Health professional preparedness is a key element of disaster response; overall there is a need for increased disaster medicine training worldwide. The objective of this study was to design and ...develop a curriculum in community-based disaster medicine for Saudi Arabian medical undergraduates.
A structured five-step approach was used to develop a curriculum. Expert stakeholders from the Saudi Arabian and international disaster medicine communities were surveyed to determine objectives and content. Learning strategies were carefully considered to maximize participation and retention. Particular attention was paid to equipping learners with the teaching skills required to promote disaster preparedness in their local communities.
The course consists of 2 weeks of classroom activities followed by 8 weeks of e-learning structured within five domains of disaster medicine. The curriculum introduces core principles in emergency medicine, public health, and disaster management. Simulations, experiential activities, case studies, and role-playing activities are all used to promote higher levels of cognitive engagement. Special content addresses the adult-learning process, and students design their own community-based seminars in disaster preparedness.
The curriculum is designed to promote learning in disaster medicine. Given the paucity of disaster medicine educators in the region, student graduates of this program would be able to improve disaster preparedness in Saudi Arabia by launching their own community-based disaster preparedness initiatives. The program could also be adapted for use throughout the Middle East.
Purpose: To describe clinical and functional features of a patient with Bietti crystalline dystrophy and atypical electroretinogram responses.
Methods: The patient underwent a thorough medical ...anamnesis, genetic counseling, peripheral blood draw for CYP4V2 gene analysis and electron microscopy, and a complete ophthalmological assessment including optical coherence tomography, indocyanine green angiography, microperimetry, full-field electroretinogram and multifocal electroretinogram.
Results: The most striking features of the retina were deposits of yellowish-white glistening crystals and focal lobular areas of choriocapillary atrophy at the posterior pole and midperiphery. The full-field electroretinogram was normal and the multifocal electroretinogram showed extinguished central recordings. Mutation analysis revealed a homozygous c. 332T>C p.I111T mutation in exon 3 of the CYP4V2 gene. Typical cytoplasmic inclusions containing crystalline-like structure and large degenerative lysosomes were seen on electron microscopy of peripheral leukocytes.
Conclusion: Here we describe a patient with Bietti crystalline dystrophy with a CYP4V2 gene mutation and typical leukocyte inclusions who showed the classical retinal lesions but had a normal electroretinogram. This suggests the existence of less severe forms of BCD related to relatively mild CYP4V2 mutations.
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