RESUMEN
BACKGROUND: More than a million people a year in the United States experience sepsis or sepsis-related complications, and sepsis remains the leading cause of in-hospital deaths. Unlike many other leading causes of in-hospital mortality, sepsis detection and treatment are not dependent on the presence of any technology or services that differ between tertiary and non-tertiary hospitals. OBJECTIVE: To compare sepsis mortality rates between tertiary and non-tertiary hospitals in Washington State. METHODS: A retrospective longitudinal, observational cohort study of 73 Washington State hospitals for 2010-2015 using data from a standardized state database of hospital abstracts. Abstract records on adult patients (n = 86,378) admitted through the emergency department (ED) from 2010 through 2015 in all tertiary (n = 7) and non-tertiary (n = 66) hospitals in Washington State. RESULTS: The overall mortality rate for all hospitals was 6.5%. In the fully adjusted model, the odds ratio for in-hospital death was higher in non-tertiary hospitals compared with tertiary hospitals (odds ratio 1.25; 95% confidence interval 1.17-1.35; p < 0.001). CONCLUSIONS: We observed higher sepsis mortality rates in non-tertiary hospitals, compared with tertiary hospitals. Because most patients who are treated for sepsis are treated outside of tertiary hospitals, and the number of patients treated for sepsis in non-tertiary hospitals seems to be rising, a better understanding of the cause or causes for this differential is crucial.
Asunto(s)
Mortalidad Hospitalaria , Sepsis/mortalidad , Centros de Atención Terciaria/normas , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Sepsis/terapia , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricos , WashingtónAsunto(s)
Inhibidores de la Angiogénesis/efectos adversos , Bevacizumab/efectos adversos , Neoplasias Encefálicas/tratamiento farmacológico , Colon Sigmoide/efectos de los fármacos , Glioblastoma/tratamiento farmacológico , Perforación Intestinal/inducido químicamente , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Acute type A aortic dissection is a catastrophic situation, often accompanied by aortic regurgitation. A rarely described cause of aortic regurgitation, in this clinical scenario, is the prolapse of an intimal flap into the left ventricular outflow tract. We present here a case of acute type A aortic dissection with a circumferential intimal flap, prolapsing into the left ventricular outflow tract and causing massive aortic regurgitation.
Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Disección Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/cirugía , Endotelio Vascular/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Adulto , Dolor en el Pecho/etiología , Ecocardiografía Transesofágica , Humanos , MasculinoRESUMEN
OBJECTIVE: The aim of this study was to evaluate the demographic characteristics of patients with bilateral bisphosphonate-related low-energy femoral shaft fractures. METHODS: The clinical registry was reviewed for patients with bisphosphonate-related low-energy fractures localized at femoral shaft between January 2008 and January 2012. Patients with a diagnosis of postmenopausal osteoporosis, bisphosphonate usage of at least 5 years and prodromal pain prior to fracture were included the study. RESULTS: Five women met the inclusion criteria. All patients had bilateral low-energy sequential femoral shaft fractures. Fracture patterns were similar and atypical (transverse-short oblique fractures with lateral cortical thickening). Mean period of bisphosphonate treatment was 8.6 years. Mean patient age was 76.2 years. Union time of three patients was between 20 and 28 weeks. The remaining two fractures were revised for delayed union or nonunion. CONCLUSION: Long-term (over 5 years) use of bisphosphonates may cause insufficiency fractures due to increased fragility and brittleness which have a close relationship with depressed bone remodeling. While there is still no causal relationship between bisphosphonates and atypical, low-energy femoral shaft fractures, we have some concerns about the optimal usage time and long-term safety of bisphosphonate drugs.
Asunto(s)
Alendronato/efectos adversos , Conservadores de la Densidad Ósea/efectos adversos , Fracturas del Fémur/inducido químicamente , Fracturas del Fémur/diagnóstico , Osteoporosis Posmenopáusica/complicaciones , Anciano , Anciano de 80 o más Años , Alendronato/administración & dosificación , Conservadores de la Densidad Ósea/administración & dosificación , Remodelación Ósea/efectos de los fármacos , Diagnóstico Precoz , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/mortalidad , Humanos , Osteoporosis Posmenopáusica/diagnóstico , Osteoporosis Posmenopáusica/tratamiento farmacológico , Dolor/etiología , Radiografía , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Takotsubo syndrome (TTS)/cardiomyopathy is a syndrome that mimics acute myocardial infarction in the absence of coronary artery disease and is characterized by acute onset of chest pain, electrocardiographic abnormalities, and reversible left ventricular dysfunction. It is usually induced by emotional and physical stress. Fluorouracil is one of the most frequently used chemotherapy agents and a relatively common adverse reaction of fluorouracil is cardiotoxicity. Herein we describe a patient without a history of cardiovascular disorder who developed severe heart failure during infusion of fluorouracil for metastatic gastric cancer. Remarkably, the patient did not develop TTS during prior chemotherapy regimen, which also included fluorouracil. The patient's findings were consistent with the proposed TTS diagnostic criteria and coronary angiography was normal, without obstructive coronary artery disease. With supportive care, the patient's cardiac functions returned to normal. TTS is not a well known syndrome to clinicians and this condition appears to occur more frequently than previously thought. In addition to the presented case, a review of the clinical features and outcome of 10 reported cases of fluorouracil-induced TTS is presented.