RESUMO
Transcatheter aortic valve replacement (TAVR) has become a widely used therapy for patients with severe aortic stenosis. Carbohydrate antigen 125 (CA-125) is a promising biomarker in some cardiovascular diseases. This systematic review aims to assess the prognostic role of CA-125 in patients undergoing TAVR. We searched electronic databases from inception to March 2023 to include cohort studies evaluating the association between preprocedural CA-125 levels and mortality or heart failure (HF) readmission at 12 months in patients undergoing TAVR. We pooled crude (cHR) and adjusted hazard ratios (aHR) with their 95% confidence interval (CI) using a random-effects model. The risk of bias was evaluated using the QUIPS tool. The certainty of the evidence was assessed using the GRADE approach. We included five cohort studies involving 1594 patients. Higher levels of CA-125 were significantly associated with an increased risk of mortality or HF readmission using crude (cHR 2.79, 95% CI 1.45-5.36, I2 = 72%) and adjusted (aHR 3.27, 95% CI 2.07-5.18, I2 = 0%, high certainty) effect estimates compared with lower levels. Similarly, there was also associated with increased mortality using crude (cHR 2.68, 95% CI 1.99-3.60, I2 = 0%) and adjusted (aHR 2.17, 95% CI 1.54-3.07, I2 = 0%, high certainty) effect estimates. The risk of bias varied between low to moderate across studies. Our meta-analysis suggests that CA-125 has incremental prognostic value in patients undergoing TAVR. Further studies are needed to determine the clinical utility of CA-125 in guiding treatment decisions in this population.
Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/epidemiologia , Prognóstico , Fatores de Risco , Resultado do Tratamento , Valva Aórtica/cirurgiaRESUMO
Previous studies have shown that natriuretic peptide levels are increased in patients with restrictive cardiomyopathy (RCM) but not in constrictive pericarditis (CP). We performed a systematic review and meta-analysis to evaluate the diagnostic utility of B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) to differentiate CP and RCM. We searched electronic databases from inception to January 07, 2021. Studies involving adult patients that assessed the utility of natriuretic peptides to differentiate CP and RCM were included. All meta-analyses were performed using a random-effects model. Seven studies (four case-control and three cohorts) involving 204 patients were included. The mean age ranged between 25.7 and 64.1 years and 77% of patients were men. BNP levels were significantly lower (standardized median difference [SMD], -1.48; 95% confidence interval [CI], -2.33 to -0.63) in patients with CP compared to RCM. The pooled area under the curve (AUC) of the BNP level was 0.81 (95% CI, 0.70-0.92). NT-proBNP (SMD, -0.86; 95% CI, -1.38 to -0.33) and log NT-proBNP (SMD, -1.89; 95% CI, -2.59 to -1.20) levels were significantly lower in patients with CP compared to RCM. Our review shows that BNP and NT-proBNP levels were significantly lower in patients with CP compared to RCM. The pooled AUC of BNP level showed a good diagnostic accuracy to differentiate both conditions.
Assuntos
Cardiomiopatia Restritiva , Pericardite Constritiva , Adulto , Biomarcadores , Cardiomiopatia Restritiva/diagnóstico , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico , Peptídeos Natriuréticos , Fragmentos de Peptídeos , Pericardite Constritiva/diagnósticoRESUMO
There is limited evidence about the prognostic utility of right ventricular dysfunction (RVD) in patients with coronavirus disease 2019 (COVID-19). We assessed the association between RVD and mortality in COVID-19 patients. We searched electronic databases from inception to February 15, 2021. RVD was defined based on the following echocardiographic variables: tricuspid annular plane systolic excursion (TAPSE), tricuspid S' peak systolic velocity, fractional area change (FAC), and right ventricular free wall longitudinal strain (RVFWLS). All meta-analyses were performed using a random-effects model. Nineteen cohort studies involving 2307 patients were included. The mean age ranged from 59 to 72 years and 65% of patients were male. TAPSE (mean difference [MD], -3.13 mm; 95% confidence interval [CI], -4.08--2.19), tricuspid S' peak systolic velocity (MD, -0.88 cm/s; 95% CI, -1.68 to -0.08), FAC (MD, -3.47%; 95% CI, -6.21 to -0.72), and RVFWLS (MD, -5.83%; 95% CI, -7.47--4.20) were significantly lower in nonsurvivors compared to survivors. Each 1 mm decrease in TAPSE (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.08-1.37), 1% decrease in FAC (aHR, 1.09; 95% CI, 1.04-1.14), and 1% increase in RVFWLS (aHR, 1.33; 95% CI, 1.19-1.48) were independently associated with higher mortality. RVD was significantly associated with higher mortality using unadjusted risk ratio (2.05; 95% CI, 1.27-3.31), unadjusted hazard ratio (3.37; 95% CI, 1.72-6.62), and adjusted hazard ratio (aHR, 2.75; 95% CI, 1.52-4.96). Our study shows that echocardiographic parameters of RVD were associated with an increased risk of mortality in COVID-19 patients.
Assuntos
COVID-19 , Disfunção Ventricular Direita , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Sístole , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Função Ventricular DireitaRESUMO
AIMS: We performed a systematic review to summarize the clinical features, diagnostic methods, treatment, and outcomes of coronavirus disease 2019 (COVID-19) patients with pericarditis. METHODS: We searched electronic databases from inception to 17 December 2020. Studies that reported clinical data on patients with COVID-19 and pericarditis were included. Descriptive statistics were used for categorical and continuous variables [meanâ±âstandard deviation or median (interquartile range)]. As an exploratory analysis, differences between patients with acute pericarditis and myopericarditis were compared. RESULTS: A total of 33 studies (32 case reports and 1 case series) involving 34 patients were included. The mean age was 51.6â±â19.5âyears and 62% of patients were men. Sixty-two percentage of patients were diagnosed with myopericarditis. The most frequent electrocardiographic pattern (56%) was diffuse ST-elevation and PR depression. Pericardial effusion and cardiac tamponade were reported in 76 and 35% of cases, respectively. The median values of C-reactive protein [77âmg/dl (12-177)] and white blood cells [12â335âcells/µl (5625-16â500)] were above the normal range. Thirty-eight percent and 53% of patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine, respectively. These drugs were more frequently used in patients with acute pericarditis compared with myopericarditis. The in-hospital mortality was 6% without a significant difference between both groups. CONCLUSION: Our review shows that COVID-19 patients with pericarditis had similar clinical features to other viral cardiotropic infections. However, NSAIDs and colchicine were used in half or less of the cases. Overall, the short-term prognosis was good across groups.
Assuntos
COVID-19 , Administração dos Cuidados ao Paciente , Pericardite , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/fisiopatologia , COVID-19/terapia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/estatística & dados numéricos , Pericardite/diagnóstico , Pericardite/tratamento farmacológico , Pericardite/etiologia , Pericardite/fisiopatologia , Prognóstico , SARS-CoV-2/isolamento & purificaçãoRESUMO
Coronavirus disease 2019 (COVID-19) can cause a wide range of cardiovascular diseases, including ST-segment elevation myocardial infarction (STEMI) and STEMI-mimickers (such as myocarditis, Takotsubo cardiomyopathy, among others). We performed a systematic review to summarize the clinical features, management, and outcomes of patients with COVID-19 who had ST-segment elevation. We searched electronic databases from inception to September 30, 2020 for studies that reported clinical data about COVID-19 patients with ST-segment elevation. Differences between patients with and without obstructive coronary artery disease (CAD) on coronary angiography were evaluated. Forty-two studies (35 case reports and seven case series) involving 161 patients were included. The mean age was 62.7 ± 13.6 years and 75% were men. The most frequent symptom was chest pain (78%). Eighty-three percent of patients had obstructive CAD. Patients with non-obstructive CAD had more diffuse ST-segment elevation (13% versus 1%, p = 0.03) and diffuse left ventricular wall-motion abnormality (23% versus 3%, p = 0.02) compared to obstructive CAD. In patients with previous coronary stent (n = 17), the 76% presented with stent thrombosis. In the majority of cases, the main reperfusion strategy was primary percutaneous coronary intervention instead of fibrinolysis. The in-hospital mortality was 30% without difference between patients with (30%) or without (31%) obstructive CAD. Our data suggest that a relatively high proportion of COVID-19 patients with ST-segment elevation had non-obstructive CAD. The prognosis was poor across groups. However, our findings are based on case reports and case series that should be confirmed in future studies.
Assuntos
COVID-19/complicações , Doença da Artéria Coronariana/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Idoso , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/terapia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Stents , Terapia Trombolítica , Fatores de Tempo , Resultado do TratamentoRESUMO
Objetivos: Conocer el perfil y la situación laboral del médico joven egresado de la Facultad de Medicina Humana de la Universidad Nacional Pedro Ruiz Gallo en Lambayeque y Lima en el 2013. Materiales y métodos: Estudio descriptivo transversal, se evaluó una muestra de 230 egresados en el periodo 2002 a 2011. Se indago a través de un cuestionario validado por juicio de expertos sobre aspectos sociodemográficos, formación profesional, inserción laboral y oportunidades de trabajo. Resultados: La edad media de los egresados fue de 32,5; la mayoría varones (67,4%) y solteros (48,3%). Su principal motivación para la selección de la carrera fue la vocación (83,0%), contando con estudios de especialización el 52,6%. Su empleo actual lo realiza principalmente en instituciones públicas (82,6%) y realizando una labor asistencial (65,9%). La satisfacción en el empleo actual fue alta en un 60,8%. Conclusiones: La mayoría de egresados fueron varones, con edades entre 30 y 34 años, solteros, nacidos en el departamento de Lambayeque. Sus motivaciones para la selección de la carrera fueron generalmente vocacionales, más de la mitad es especialista o se encuentra realizando la residencia médica. El primer empleo se consiguió a través de contactos personales y el empleo actual a través de concurso público, en ambos casos en instituciones públicas y realizando labor asistencial. La satisfacción con el empleo actual es alta.
Objective: To describe the perception of newly graduated physicians of faculties of Human Medicine of Lima (Peru) on his internship. Methods: An observational, descriptive and cross-sectional study was conducted. We surveyed physicians during a course, collecting data related to biosafety boarding, medical insurance, aggression, teaching, workload and administrative burden. Results: In a population of 268 physicians, 42.5% said it has been delivered biosafety materials whenever necessary, 35.8% who did not have health insurance, 42.5% have not had rest after a night shift, 63.1% have ever suffered during his internship verbal aggression, 21.6% sexual harassment , and 6.3% physical aggression. Conclusion: as perceived by respondents, problem situations are described during internship with respect to the supply of materials biosafety, health insurance, the rest after a night shift, and violence.
RESUMO
Objetivo: Comparar los promedios de las puntuaciones de empatía en estudiantes de Medicina Humana de la Universidad Nacional Pedro Ruiz Gallo, según sexo, edad, año de estudios y especialidad médica a seguir. Material y Métodos: Estudio descriptivo transversal realizado en 183 estudiantes de medicina de la Universidad Nacional Pedro Ruiz Gallo. Se utilizó la Escala de Empatía Médica de Jefferson para medir la empatía; se realizó el análisis de datos con SPSS 19.0. Resultados: Se obtuvieron mayores puntuaciones de empatía en los hombres que en las mujeres. Al comparar los grupos de edad, estudiantes <25 años obtuvieron mayores puntuaciones que aquellos ≥25 años. Según el año de estudio, se encontraron mayores puntuaciones de empatía en los estudiantes de tercer año con relación a los de cuarto año y de sexto año. Especialidades "vinculadas al paciente" obtuvieron mayores puntuaciones que aquellas "no vinculadas al paciente". Además, 60 hombres (75%) y 66 estudiantes (82,5%) del grupo de edad <25 años alcanzaron niveles adecuados de empatía. Así mismo, 32 estudiantes (50,8%) de 3º año y 43 (53,8%) de especialidades "vinculadas al paciente" obtuvieron niveles adecuados de empatía. Conclusiones: Existen mayores puntuaciones de empatía en estudiantes varones, del grupo de edad <25 años, que cursan el 3º año y que eligieron especialidad "vinculadas al paciente", no hallándose significación estadística. Además, ser hombre, tener <25 años, cursar el 3º año y elegir especialidades "vinculadas al paciente", podría ser factor protector para desarrollar niveles adecuados de empatía, no hallándose intervalos de confianza significativos(AU)
Objective: To compare the mean scores of empathy in medicine students from the Universidad Nacional Pedro Ruiz Gallo, according to sex, age, year of study and medical especialty to follow. Methods: Cross- sectional descriptive study done in 183 medicine students from the Universidad Nacional Pedro Ruiz Gallo. The Jefferson Medical Empathy Scale was used to measure empathy, and data analysis was done using SPSS 19.0. Results: Greater empathy scores were obtained in men than in women. When comparing age groups, students <25 years obtained greater scores than those ≥25years. According to the year of study, we found greater empathy scores in third year students compared to fourth and sixth year students. Specialties linked to the patient obtained greater scores than those who weren't linked to the patient. Besides, 60 men (75 %) and 66 students (82.5 %) of the age group < 25 years reached adequate levels of empathy. Likewise, 32 students (50.8 %) of third year and 43 (53.8 %) of specialties linked to the patient obtained adequate levels of empathy. Conclusions: There are greater empathy scores in male students, of the age group <25 years, that are currently in third year and who chose a specialty linked to the patient, with no statistical significance found. Besides, being a man, having <25 years, being in third year and choosing specialties linked to the patient, may be a protective factor for developing adequate levels of empathy, with no confidence intervals found. (AU)
RESUMO
Antecedentes. La inteligencia emocional de manera práctica establece las diferencias en el grado en que los individuos usan la información afectiva y la integran en su pensamiento; esto puede tener importantes efectos en el rendimiento en la escuela médica, aunque se han realizado pocos estudios hasta ahora. Objetivos. Conocer el nivel de inteligencia emocional en estudiantes de pregrado de Medicina Humana de la Universidad Nacional Pedro Ruiz Gallo (UNPRG). Método. Todos los estudiantes de medicina de la UNPRG fueron invitados a desarrollar la TMMS-24, un indicador de los niveles de inteligencia emocional. Resultados. Se obtuvieron resultados de 242 estudiantes; de los que el 46,3% presentó niveles adecuados de percepción, el 52,5% de comprensión y el 60,3% de regulación. Se encontraron diferencias según edad, sexo y año de estudios. Conclusiones. Este estudio proporciona información que indica que existen niveles adecuados de IE en la mayoría de estudiantes de medicina; además establece diferencias según variables como la edad, el sexo y el año de estudios. (AU)
Background. Emotional intelligence provides a practical way the differences in the degree to which individuals use emotional information and integrate it into their thinking, which may have important effects on performance in medical school, although few studies have been conducted so far. Objectives. To know the level of emotional intelligence to undergraduate students of Human Medicine of the Pedro Ruiz Gallo National University. Results. There were scores of 242 students, of which 46,3% had adequate levels of attention, 52,5% of comprehension and 60,3% of regulation. There were differences by age, sex and year of study. Conclusions. This study provides information which indicates that there are adequate levels of IE in most medical students, also establishes differences variables such as age, sex and year of study.(AU)