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Harada T, Nakanishi T, Kutsuna S, Nakai M. Unexpected Sudden Deaths Following the Co-administration of Ceftriaxone and Lansoprazole: A Case Series. Cureus 2024; 16:e64143. [PMID: 39119376 PMCID: PMC11308275 DOI: 10.7759/cureus.64143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
Ceftriaxone and lansoprazole are commonly used in clinical settings, but recent analyses indicate a potential risk for QTc prolongation and cardiac events when used together. This case series examines three patients from a cohort of sudden death cases at a single institution over a decade, who received both medications within 24 hours before death. Three cases were identified, each with contributing factors for cardiac arrhythmias. The results underscore the importance of monitoring and possibly avoiding this drug combination in patients at risk of QT prolongation, pending further investigation into the underlying mechanisms.
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Affiliation(s)
- Taku Harada
- General Medicine, Nerima Hikarigaoka Hospital, Tokyo, JPN
- Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
| | | | | | - Mori Nakai
- General Medicine, Nerima Hikarigaoka Hospital, Tokyo, JPN
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Sugarbaker PH. After thirty years of experience with early postoperative intraperitoneal 5-fluorouracil now saying goodbye. Surg Oncol 2022; 42:101757. [DOI: 10.1016/j.suronc.2022.101757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 01/23/2023]
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Mirzaei M, Joodi G, Bogle B, Chen S, Simpson RJ. Years of Life and Productivity Loss Because of Adult Sudden Unexpected Death in the United States. Med Care 2019; 57:498-502. [PMID: 31107395 PMCID: PMC6565486 DOI: 10.1097/mlr.0000000000001129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have evaluated the years of life lost (YLL) and productivity loss due to sudden unexpected death (SUD). The burden of SUD on society is undetermined because of lack of population-based studies and comprehensive adjudication methods. OBJECTIVE We estimated YLL and productivity loss from SUD in working-age adults and compared it with the leading causes of death in the United States. METHODS We screened all out of hospital deaths among people aged 20-64 in Wake County, NC from 2013 to 2015 to adjudicate SUDs. We extrapolated Wake County incidence to estimate the age-standardized and sex-standardized rate of SUD in the United States. YLL was calculated based on the remaining life expectancy of the victims. Incorporating market and housekeeping value estimated the present value of lifetime productivity loss because of SUD. RESULTS SUD incidence rates in the US adults aged 20-64 were 49.3 (95% confidence interval, 41.2-58.3) and 21.7 (95% confidence interval, 16.5-27.8) per 100,000 among men and women, respectively. SUD resulted in the loss of 2 million years of life, accounting for 10.0% of YLL from all causes of death. Among natural causes of death, YLL from SUD was only lower than that from all cancers combined and heart disease. Lifetime productivity loss because of SUD was ~$51 billion, exceeding productivity loss from any individual cancer. CONCLUSION SUD is an important source of YLL and productivity loss among adults aged 20-64. Such a high burden on society justifies prioritizing health policies and interventions toward preventing SUD.
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Affiliation(s)
- Mojtaba Mirzaei
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
| | - Golsa Joodi
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
| | - Brittany Bogle
- Department of Epidemiology, Gillings School of Public
Health, University of North Carolina at Chapel Hill
| | - Sarah Chen
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
| | - Ross J Simpson
- Department of Medicine, Division of Cardiology, University
of North Carolina at Chapel Hill
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Marongiu F, Barcellona D. Has time come for the use of direct oral anticoagulants in the extended prophylaxis of venous thromboembolism in acutely ill medical patients? No. Intern Emerg Med 2018; 13:1015-1018. [PMID: 29594815 DOI: 10.1007/s11739-018-1843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
Acutely ill hospitalized medical patients are at high risk of venous thromboembolism (VTE). Although thromboprophylaxis in these patients is recommended since 2004 by the American College of Chest Physicians, it is widely underused. The doubt as to whether or not to treat patients at high VTE risk after hospital discharge came from the knowledge that this risk may persist after the hospital admission period. Two meta-analyses comparing extended- versus short-duration prophylaxis are published. The results demonstrate an unfavorable balance between VTE prevention and incidence of major bleeding in patients assigned to extended-duration thromboprophylaxis. Only in the APEX study, betrixaban, a direct inhibitor of factor Xa, shows similar efficacy and safety compared to enoxaparin. However, while it is very promising, oral anticoagulant phase III studies and post-marketing registers are lacking. Moreover, betrixaban has a long half-life, an excretion in the gut by means of P-glycoprotein, and the lack of an antidote. These characteristics and the meta-analysis results prompt us to answer no to the extended thromboprophylaxis in hospitalized medical patients, at least now.
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Affiliation(s)
- Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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Ishikawa M, Tanino MA, Miyazaki M, Kimura T, Ishida Y, Wang L, Tsuda M, Nishihara H, Nagashima K, Tanaka S. A Clinicopathological Analysis of Six Autopsy Cases of Sudden Unexpected Death due to Infectious Aortitis in Patients with Aortic Tears. Intern Med 2018; 57:1375-1380. [PMID: 29321404 PMCID: PMC5995715 DOI: 10.2169/internalmedicine.8976-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Cardiovascular disease is a leading cause of sudden unexpected death even in hospitalized patients. Infectious aortitis is a rare disease that has the potential to cause aortic tears and hemorrhage followed by sudden death. The aim of this study was to reveal the clinicopathological features of infectious aortitis that are related to sudden unexpected death. Methods We retrospectively reviewed 1,310 autopsy cases over 15 years and selected the cases involving patients who died suddenly due to aortic tears. We analyzed the clinical information and pathological findings. Results One hundred thirty-three of 1,310 cases (10.2%) were autopsied under the clinical diagnosis of unexpected sudden death. Aortic tears were identified in 33 cases (2.5%) and infectious aortitis was diagnosed in 6 (18.2%) of these cases. All cases involved male patients (middle-aged to elderly) with risk factors for atherosclerosis (i.e., hypertension). The laboratory data showed continuous leukocytosis and C-reactive protein elevation, even during the improvement phase, in patients with pre-existing infectious disease. The autopsy findings revealed three types of aortic tears (aneurysms, dissections and penetrating atherosclerotic ulcers with moderate to severe atherosclerosis), and the infiltration of numerous neutrophils at the site of rupture. Gram-positive bacteria were detected in four cases and Gram-negative bacteria were detected in two cases. Discussion We demonstrated that sudden unexpected death caused by infectious aortitis rarely occurred in hospitalized patients, even in the recovery phase of the preceding infectious disease. We therefore recommend that clinicians pay attention to infectious aortitis in patients with infectious disease, particularly elderly patients with atherosclerotic disease, even those who are in the improvement phase. Conclusion Unexpected sudden death by infectious aortitis in the recovery phase of antecedent infection.
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Affiliation(s)
- Marin Ishikawa
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Mishie Ann Tanino
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Masaya Miyazaki
- Department of Renal and Genitourinary surgery, Hokkaido University Graduate School of Medicine, Japan
| | - Taichi Kimura
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Yusuke Ishida
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Lei Wang
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Masumi Tsuda
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Kazuo Nagashima
- Department of Diagnostic Pathology, Sapporo Higashi Tokushukai Hospital, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Japan
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Hickey C, Schwartz A, Sattler S. Acute pulmonary embolism and ischemic foot in the setting of supratherapeutic INR. Am J Emerg Med 2017; 35:666.e3-666.e4. [DOI: 10.1016/j.ajem.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022] Open
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Ifteni P, Correll CU, Burtea V, Kane JM, Manu P. Sudden unexpected death in schizophrenia: autopsy findings in psychiatric inpatients. Schizophr Res 2014; 155:72-6. [PMID: 24704220 DOI: 10.1016/j.schres.2014.03.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/07/2014] [Accepted: 03/12/2014] [Indexed: 12/16/2022]
Abstract
Schizophrenia is associated with premature mortality and a high rate of sudden, unexpected deaths. Autopsy data are scant, and in studies using death certificates or root cause assessments, a majority of sudden deaths remained unexplained. In the community, post-mortem data indicate that the most common cause of sudden "natural" death is coronary artery disease. In this study, we used autopsy findings to determine the cause of sudden death in a consecutive cohort of 7189 schizophrenia patients admitted to a free-standing, psychiatric teaching hospital from 1989 to 2013. Medical record review identified 57 patients (0.79%) who died suddenly and unexpectedly during hospitalization. Autopsies were performed in 51 (89.5%) patients (55.9±9.4years, male=56.9%). Autopsy-based causes of sudden death were most commonly cardiovascular disorders (62.8%). Specific causes included myocardial infarction (52.9%), pneumonia (11.8%), airway obstruction (7.8%), myocarditis (5.9%), and dilated cardiomyopathy, hemopericardium, pulmonary embolus, hemorrhagic stroke and brain tumor (2.0% each). The sudden death remained unexplained in 6 (11.8%) patients, 3 of whom had evidence of coronary arteriosclerosis on autopsy. Patients with and without myocardial infarction were similar regarding age, gender, smoking, body mass index and psychotropic treatment (p values≥0.10). In conclusion, sudden cardiac death occurs at a 0.8% rate in a psychiatric hospital, well above general population rates. Autopsy findings indicate that sudden death in schizophrenia is caused by structural cardiovascular, respiratory and neurological abnormalities, with most cases due to acute myocardial infarction. Early recognition and treatment of coronary artery disease must become a clinical priority for all adults with schizophrenia.
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Affiliation(s)
- Petru Ifteni
- Faculty of Medicine, Transilvania University, Brasov, Romania
| | - Christoph U Correll
- Zucker Hillside Hospital, Glen Oaks, NY, United States; Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States
| | - Victoria Burtea
- Faculty of Medicine, Transilvania University, Brasov, Romania
| | - John M Kane
- Zucker Hillside Hospital, Glen Oaks, NY, United States; Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States
| | - Peter Manu
- Zucker Hillside Hospital, Glen Oaks, NY, United States; Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States.
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Discrete event simulation model of sudden cardiac death predicts high impact of preventive interventions. Sci Rep 2014; 3:1771. [PMID: 23648451 PMCID: PMC3646271 DOI: 10.1038/srep01771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/12/2013] [Indexed: 11/08/2022] Open
Abstract
Sudden Cardiac Death (SCD) is responsible for at least 180,000 deaths a year and incurs an average cost of $286 billion annually in the United States alone. Herein, we present a novel discrete event simulation model of SCD, which quantifies the chains of events associated with the formation, growth, and rupture of atheroma plaques, and the subsequent formation of clots, thrombosis and on-set of arrhythmias within a population. The predictions generated by the model are in good agreement both with results obtained from pathological examinations on the frequencies of three major types of atheroma, and with epidemiological data on the prevalence and risk of SCD. These model predictions allow for identification of interventions and importantly for the optimal time of intervention leading to high potential impact on SCD risk reduction (up to 8-fold reduction in the number of SCDs in the population) as well as the increase in life expectancy.
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Ruppert ADP, Soeiro ADM, de Almeida MCF, de Oliveira MT, Serrano CV, Capelozzi VL. Clinical manifestations and pulmonary histopathological analysis related to different diseases in patients with fatal pulmonary thromboembolism: an autopsy study. Open Access Emerg Med 2014; 6:15-21. [PMID: 27147874 PMCID: PMC4753983 DOI: 10.2147/oaem.s52891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To correlate underlying diseases, in autopsies of patients with pulmonary thromboembolism (PTE) to histological findings and manifestations reviewed in the medical records. Methods The autopsy records between 2001 and 2008 of 291 patients whose cause of death was PTE were reviewed. The following data were obtained: age, sex, clinical “in vivo” manifestations, postmortem pathological patterns, and main associated underlying diseases, cancers, and surgeries performed in the last hospitalization. The pulmonary histopathological changes were categorized as diffuse alveolar damage, pulmonary edema, alveolar hemorrhage, and lymphoid interstitial pneumonia. Odds ratios of positive relations were obtained by logistic regression and were considered significant when P<0.05. Results The median age was 64 years old. About 64% of patients presented cardiovascular illness associated with PTE. The most prevalent pulmonary finding was pulmonary edema. Only 13% of cases had clinical suspicion of PTE. Acute respiratory failure was positively related to pulmonary edema, alveolar hemorrhage, and diffuse alveolar damage as well as hemodynamic instability to alveolar hemorrhage and diffuse alveolar damage. Conclusion We found important relations between clinical data and histological findings of patients with fatal PTE. A greater understanding of the pulmonary physiopathological mechanisms involved with each disease associated to PTE could improve its diagnosis and treatment.
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Affiliation(s)
| | | | | | | | - Carlos V Serrano
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Vera Luiza Capelozzi
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
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