RESUMEN
The outcomes of acute coronary syndromes (ACS) vary internationally, given regional differences in patient co-morbidities, access to health care, interventional procedures and adherence to guideline-based management practices. This study aimed to identify the predictors of mortality from a large ACS registry of patients admitted to a tertiary care cardiac centre in Dhaka, Bangladesh. This was a hospital record based retrospective cross sectional observational study that included all patients presenting with ACS to Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh from January 2013 to December 2013. Data were collected from cardiac catheterization laboratory database and hospital discharge records. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 16.0. A p value <0.05 was considered statistically significant. Ethical approval was obtained by Institutional Review Board of the hospital. A total of 1914 ACS patients were studied: 39.8% presented with ST-elevation myocardial infarction (STEMI), 39.7% with non-ST-elevation myocardial infarction (NSTEMI) and 20.5% with unstable angina (UA). There were 146 in-hospital deaths (7.6%). Mortality was highest among STEMI patients (10.5%), followed by NSTEMI (8.1%) and UA (1.03%). The mean age of expired patients was significantly higher than that of those who survived (64.82±12.14 years vs. 57.32±11.99 years; p<0.001). Male patients were 71.4%, with no significant gender differences observed between expired and surviving groups. Age >50 years {odds ratio (OR) 2.56, p=0.005}, chronic kidney disease (CKD) (OR 2.1, p<0.001), shock (OR 16.82, p<0.001), left ventricular failure (LVF) (OR 2.43, p<0.001) and STEMI (OR 1.92, p=0.002) were independent predictors of mortality among ACS patients. Although diabetes per se was not associated with mortality (OR 1.3; 95% CI=0.89-1.91; p=0.169), uncontrolled diabetes defined as HbA1c levels ≥7.5% had significant risk of mortality (OR 51.4, p<0.001). ACS patients who did not undergo angiography (OR 16.4; p<0.001) or PCI (OR 18.9; p<0.001) had greater risk of mortality. ACS patients complicated with shock, LVF, uncontrolled diabetes and CKD had increased risk of in-hospital mortality. Improved outcomes may be likely with prompt angiography and PCI during index admission. This study is a preliminary initiative, and prospective multi-centre registries with nation-wide involvement are warranted.
Asunto(s)
Síndrome Coronario Agudo , Infarto del Miocardio sin Elevación del ST , Intervención Coronaria Percutánea , Insuficiencia Renal Crónica , Infarto del Miocardio con Elevación del ST , Síndrome Coronario Agudo/terapia , Anciano , Angina Inestable , Bangladesh/epidemiología , Estudios Transversales , Hemoglobina Glucada , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.
Asunto(s)
Enfermedades Cardiovasculares , Procedimientos Quirúrgicos Cardiovasculares , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Bangladesh , Betacoronavirus , COVID-19 , Enfermedades Cardiovasculares/terapia , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , SARS-CoV-2RESUMEN
INTRODUCTION: Conflicting evidence exists from randomized controlled trials supporting both increased complications/fistulae and improved outcomes with drain placement after pancreatectomy. The objective was to determine drain practice patterns in the USA, and to identify if drain placement was associated with fistula formation. METHODS: Demographic, perioperative, and patient outcome data were captured from the most recent annual NSQIP pancreatic demonstration project database, including components of the fistula risk score. Significant variables in univariate analysis were entered into adjusted logistic regression models. RESULTS: Of 5013 pancreatectomy patients, 4343 (87%) underwent drain placement and 18% of patients experienced a pancreatic fistula. When controlled for other factors, drain placement was associated with ducts < 3 mm, soft glands, and blood transfusion within 72 h of surgery. Age, obesity, neoadjuvant radiation, preoperative INR level, and malignant histology lost significance in the adjusted model. Drained patients experienced higher readmission rates (17 vs. 14%; p < 0.05) and increased (20 vs. 8%; p < 0.01) pancreatic fistulae. Fistula was associated with obesity, no neoadjuvant chemotherapy, drain placement, < 3 mm duct diameter, soft gland, and longer operative times. Drain placement remained independently associated with fistula after both distal pancreatectomy (OR = 2.84 (1.70, 4.75); p < 0.01) and pancreatoduodenectomy (OR = 2.29 (1.28, 4.11); p < 0.01). CONCLUSIONS: Despite randomized controlled clinical trial data supporting no drain placement, drains are currently placed in the vast majority (87%) of pancreatectomy patients from > 100 institutions in the USA, particularly those with soft glands, small ducts, and perioperative blood transfusions. When these factors are controlled for, drain placement remains independently associated with fistulae after both distal and proximal pancreatectomy.
Asunto(s)
Drenaje/estadística & datos numéricos , Pancreatectomía/efectos adversos , Conductos Pancreáticos/patología , Fístula Pancreática/epidemiología , Pancreaticoduodenectomía/efectos adversos , Anciano , Drenaje/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Tempo Operativo , Tamaño de los Órganos , Fístula Pancreática/etiología , Readmisión del Paciente/estadística & datos numéricos , Factores de RiesgoRESUMEN
Ventricular lead perforation is an infrequent but it's a critical complication of pacemaker implantation. Perforation was usually associated with the use of small-caliber active fixation leads, and can occur beyond the first few days (sub acute) or even more than a month after implantation (late). We report the case of right ventricular perforation by a ventricular fixation lead in 61 years old man detected more than two months after implantation. Radiology and echocardiography can confirm the perforation by revealing progression of the lead beyond the cardiac silhouette or indirectly visualizing the presence of pericardial effusion. However, its pathophysiology and optimal management are currently unclear.
Asunto(s)
Estimulación Cardíaca Artificial/efectos adversos , Lesiones Cardíacas/etiología , Ventrículos Cardíacos/lesiones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We prospectively evaluated the long-term outcome of 158 consecutive patients who underwent revision total hip replacement using uncemented computer-assisted design-computer-assisted manufacture femoral components. There were 97 men and 61 women. Their mean age was 63.1 years (34.6 to 85.9). The mean follow-up was 10.8 years (10 to 12). The mean Oxford, Harris and Western Ontario and McMaster hip scores improved from 41.1, 44.2 and 52.4 pre-operatively to 18.2, 89.3 and 12.3, respectively (p < 0.0001, for each). Six patients required further surgery. The overall survival of the femoral component was 97% (95% confidence interval 94.5 to 99.7). These results are comparable to those of previously published reports for revision total hip replacement using either cemented or uncemented components.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Diseño Asistido por Computadora , Prótesis de Cadera , Diseño de Prótesis/métodos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/instrumentación , Cementación , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Radiografía , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
We present the 10- to 17-year results of 112 computer-assisted design computer-assisted manufacture femoral components. The total hip replacements were performed between 1992 and 1998 in 111 patients, comprising 53 men and 58 women. Their mean age was 46.2 years (24.6 to 62.2) with a mean follow-up of 13 years (10 to 17). The mean Harris Hip Score improved from 42.4 (7 to 99) to 90.3 (38 to 100), the mean Oxford Hip Score from 43.1 (12 to 59) to 18.2 (12 to 51) and the mean Western Ontario MacMasters University Osteoarthritis Index score from 57.0 (7 to 96) to 11.9 (0 to 85). There was one revision due to failure of the acetabular component but no failures of the femoral component. There were no revisions for aseptic loosening. The worst-case survival in this cohort of custom femoral components at 13.2 years follow-up was 98.2% (95% confidence interval 95 to 99). Overall survival of this series of total hip replacements was 97.3% (95% confidence interval 95 to 99). These results are comparable with the best medium- to long-term results for femoral components used in primary total hip replacement with any means of fixation.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Diseño Asistido por Computadora , Prótesis de Cadera , Diseño de Prótesis/métodos , Adulto , Cementación , Materiales Biocompatibles Revestidos , Durapatita , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Falla de Prótesis , Radiografía , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
We describe the case of a patient who developed a notch on the femoral neck following a hip resurfacing operation as a result of a displaced acetabular component. The acetabular cup displaced in the coronal plane and impinged on the femoral neck leading to a large notch in the inferior femoral neck.
Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/efectos adversos , Cuello Femoral/patología , Prótesis de Cadera/efectos adversos , Osteólisis/etiología , Falla de Prótesis , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/cirugía , Humanos , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Osteólisis/cirugía , Dolor Postoperatorio/etiología , Radiografía , ReoperaciónRESUMEN
The number of hip resurfacing procedures performed in the United Kingdom has doubled in the last four years reflecting its popularity among orthopaedic surgeons. Of the available options the Birmingham Hip Resurfacing (BHR) prosthesis has been the most popular choice in this country. Despite this revision rates have been shown to be higher in the resurfacing group compared to the total hip arthroplasty group particularly in the early postoperative period. Revision of the BHR acetabular component is technically demanding due to several unique design features of this component. We discuss these features and describe a novel reliable and reproducible technique for revision of the BHR cup.
Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Articulación de la Cadera/cirugía , Prótesis de Cadera , Complicaciones Posoperatorias/prevención & control , Falla de Prótesis , Humanos , Reoperación/efectos adversos , Reoperación/métodosRESUMEN
INTRODUCTION: Multi-Professional Triage Teams (MPTTs) were created to reduce the caseload of hospital orthopaedic clinics and this prospective study evaluated referrals made to a district general hospital orthopaedic department from a lower limb MPTT clinic. PATIENTS AND METHODS: Over 9 months, 277 referrals to a lower limb hospital orthopaedic clinic were assessed. The temporal delay to hospital clinic review between patients seen at the MPTT clinic and those referred directly by their general practitioner (GP) was analysed using an ANOVA test. A qualitative assessment of diagnoses given to patients reviewed at the MPTT clinic was performed. RESULTS: The 132 patients initially reviewed at the MPTT clinic and subsequently referred to a hospital consultant waited significantly longer (140 days compared to 62 days by direct GP referral; P < 0.05) to see an orthopaedic consultant. Over three-quarters of this patient cohort incorrectly identified the healthcare professional conducting their consultation at the MPTT clinic. One-third of cases (31%) had no diagnosis made and 22% were assessed as having an incorrect diagnosis. CONCLUSIONS: Time delays, patient confusion regarding professional roles and diagnostic indecision are significant problems for patients referred to hospital orthopaedic clinics from MPTT clinics. This risks sub-optimal patient care and may lead to future medicolegal implications.