1
|
Roshanravan N, Seyed Ghiasi N, Ghaffari S, Ghasemnezhad Saadatlou S, Seifimansour S, Hamzezadeh S, Naseri A, Ghanivash A, Mosharkesh E, Nasiri E, Javanshir E, Banisefid E. Lipid profile and mortality in patients with pulmonary thromboembolism; a systematic review and meta-analysis. J Basic Clin Physiol Pharmacol 2024; 0:jbcpp-2024-0085. [PMID: 39091249 DOI: 10.1515/jbcpp-2024-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Considering the availability and accessibility of assessing the serum lipids, this study aims to define the predictive value of lipid profile, as well as the history of lipid disorders, for the mortality of PTE patients. CONTENT Clinical studies, in which the relation of lipid profile, including triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol, as well as history of imbalance of lipids, with mortality of PTE patients was reported, were included. Non-English articles, reviews, letters, editorials, and non-English papers were excluded. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science databases. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools and CMA 4 was utilized for the quantitative synthesis. Out of 3,724 records, six studies were included in this systematic review. Lipid profile is suggested as a prognostic marker for survival in patients with PTE so higher initial serum HDL, LDL, and total cholesterol levels were associated with lower mortality rates in PTE patients. In addition, dyslipidemia was found to be associated with mortality of PTE patients. Based on the quantitative synthesis, there was a greater serum level of HDL in the survival group (standardized mean difference: -0.98; 95 % CI: -1.22 to -0.75; p-value<0.01). SUMMARY AND OUTLOOK Mortality is lower in PTE patients with greater serum lipid levels; therefore, the early prognosis of PTE may be ascertained by measuring serum lipids within the first 24 h of admission.
Collapse
Affiliation(s)
- Neda Roshanravan
- Cardiovascular Research Center, 48432 Tabriz University of Medical Sciences , Tabriz, Iran
| | - Nikan Seyed Ghiasi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, 48432 Tabriz University of Medical Sciences , Tabriz, Iran
| | | | - Sina Seifimansour
- Student Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sina Hamzezadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence Based-Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Ghanivash
- Cardiovascular Research Center, 48432 Tabriz University of Medical Sciences , Tabriz, Iran
| | - Erfan Mosharkesh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Nasiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, 48432 Tabriz University of Medical Sciences , Tabriz, Iran
| | - Erfan Banisefid
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
2
|
Sakellakis M, Reet J, Kladas M, Hoge G, Chalkias A, Radulovic M. Cancer-Induced Resting Sinus Tachycardia: An Overlooked Clinical Diagnosis. Oncol Rev 2024; 18:1439415. [PMID: 39156014 PMCID: PMC11327047 DOI: 10.3389/or.2024.1439415] [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] [Received: 05/27/2024] [Accepted: 07/23/2024] [Indexed: 08/20/2024] Open
Abstract
Elevated resting heart rate is frequently observed in cancer patients, and is associated with increased mortality. Although specific chemotherapeutic agents can induce cardiotoxicity, the presence of sinus tachycardia in chemotherapy-naive patients suggests other factors likely contribute to this clinical presentation. Despite its prevalence, cancer-associated resting sinus tachycardia has not been fully recognized and comprehensively described as a separate clinical entity. Secondary effects of cancer, especially structural cardiac changes, secretory factors (inflammatory cytokines), and thromboembolic disease can cause resting tachycardia. Alternatively, rapid heart rate may reflect compensatory mechanisms responding to increased metabolic demands, raised cardiac output states, and even pain. Hence, cancer-associated tachycardia presents a clinical dilemma; acute life-threatening conditions (such as sepsis, pulmonary embolism, etc.) must be ruled out, but cancer itself can explain resting sinus tachycardia and more conservative management can avoid unnecessary testing, cost and patient stress. Furthermore, identification and management of cardiac conditions associated with cancer may improve survival and the quality of life of cancer patients.
Collapse
Affiliation(s)
- Minas Sakellakis
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jashan Reet
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Michail Kladas
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Gregory Hoge
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Outcomes Research Consortium, Cleveland, OH, United States
| | - Miroslav Radulovic
- Department of Medicine, Jacobi Medical Center/North Central Bronx Hospital, Albert Einstein College of Medicine, Bronx, NY, United States
| |
Collapse
|
3
|
Ben Yehuda O, Itelman E, Vaisman A, Segal G, Lerner B. Early Detection of Pulmonary Embolism in a General Patient Population Immediately Upon Hospital Admission Using Machine Learning to Identify New, Unidentified Risk Factors: Model Development Study. J Med Internet Res 2024; 26:e48595. [PMID: 39079116 PMCID: PMC11322683 DOI: 10.2196/48595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 12/02/2023] [Accepted: 04/30/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Under- or late identification of pulmonary embolism (PE)-a thrombosis of 1 or more pulmonary arteries that seriously threatens patients' lives-is a major challenge confronting modern medicine. OBJECTIVE We aimed to establish accurate and informative machine learning (ML) models to identify patients at high risk for PE as they are admitted to the hospital, before their initial clinical checkup, by using only the information in their medical records. METHODS We collected demographics, comorbidities, and medications data for 2568 patients with PE and 52,598 control patients. We focused on data available prior to emergency department admission, as these are the most universally accessible data. We trained an ML random forest algorithm to detect PE at the earliest possible time during a patient's hospitalization-at the time of his or her admission. We developed and applied 2 ML-based methods specifically to address the data imbalance between PE and non-PE patients, which causes misdiagnosis of PE. RESULTS The resulting models predicted PE based on age, sex, BMI, past clinical PE events, chronic lung disease, past thrombotic events, and usage of anticoagulants, obtaining an 80% geometric mean value for the PE and non-PE classification accuracies. Although on hospital admission only 4% (1942/46,639) of the patients had a diagnosis of PE, we identified 2 clustering schemes comprising subgroups with more than 61% (705/1120 in clustering scheme 1; 427/701 and 340/549 in clustering scheme 2) positive patients for PE. One subgroup in the first clustering scheme included 36% (705/1942) of all patients with PE who were characterized by a definite past PE diagnosis, a 6-fold higher prevalence of deep vein thrombosis, and a 3-fold higher prevalence of pneumonia, compared with patients of the other subgroups in this scheme. In the second clustering scheme, 2 subgroups (1 of only men and 1 of only women) included patients who all had a past PE diagnosis and a relatively high prevalence of pneumonia, and a third subgroup included only those patients with a past diagnosis of pneumonia. CONCLUSIONS This study established an ML tool for early diagnosis of PE almost immediately upon hospital admission. Despite the highly imbalanced scenario undermining accurate PE prediction and using information available only from the patient's medical history, our models were both accurate and informative, enabling the identification of patients already at high risk for PE upon hospital admission, even before the initial clinical checkup was performed. The fact that we did not restrict our patients to those at high risk for PE according to previously published scales (eg, Wells or revised Genova scores) enabled us to accurately assess the application of ML on raw medical data and identify new, previously unidentified risk factors for PE, such as previous pulmonary disease, in general populations.
Collapse
Affiliation(s)
- Ori Ben Yehuda
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Edward Itelman
- Education Authority, Chaim Sheba Medical Center, Faculty of Health Science and Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Cardiology Division, Rabin Medical Center, Petach-Tikva, Israel
| | - Adva Vaisman
- Education Authority, Chaim Sheba Medical Center, Faculty of Health Science and Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Segal
- Education Authority, Chaim Sheba Medical Center, Faculty of Health Science and Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boaz Lerner
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
4
|
Altorbak NA, Daghistani RA, Al-Omaish HR, Alsaab TA, Alhomaiani SK. Pulmonary artery air embolism with consequent primary respiratory alkalosis and secondary metabolic alkalosis following ventilation therapy: A case report. Medicine (Baltimore) 2024; 103:e39078. [PMID: 39058848 PMCID: PMC11272342 DOI: 10.1097/md.0000000000039078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND An air embolism is a rare complication that occurs after air enters blood vessels, causing almost no to mild symptoms in patients. Although uncommon, air embolism can be deadly. Critical care professionals should know the warning signs of air embolism and be prepared to carry out the necessary therapeutic interventions. To reduce morbidity and death, this clinical condition must be identified early. Here we are presenting a case of pulmonary artery air embolism as a consequence of contrast agent injection in a chest computed tomography study. CASE PRESENTATION A 70-year-old male patient were presented with pulmonary artery air embolism as a consequence of contrast agent injection in a chest computed tomography study. The patient experienced worsening respiratory symptoms that necessitated oxygen therapy, which resulted in respiratory alkalosis with secondary metabolic alkalosis. Following removal of the BiLevel positive airway pressure, the patient was switched to a 2-L nasal cannula, and his breathing rate increased to 34 breaths/min. After 8.5 hours of monitoring the patient's vital signs, the nasal cannula was removed, and the patient began breathing room air on his own. His vital signs then stabilized and arterial blood gas parameters returned to normal. The patient's condition improved, and he was discharged from the hospital after 9 days. Due to a high level of cytomegalovirus, the discharge prescriptions included valganciclovir film-coated tablets (900 mg, oral BID every 12 hours for 30 days) and apixaban (5 mg BID). The patient was then monitored at the outpatient clinic. CONCLUSION Although rare, an air embolism can cause minor symptoms if it is small in volume or can be fatal if large. After contrast-enhanced radiological studies, physicians should be aware of any signs of respiratory distress or worsening of symptoms in their patients. Additionally, patients should be mindful of the potential complications associated with ventilation therapy.
Collapse
Affiliation(s)
- Nora A. Altorbak
- Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Suadi Arabia
| | - Rayyan A. Daghistani
- Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Suadi Arabia
| | - Hassan R. Al-Omaish
- Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Suadi Arabia
| | - Thamer A. Alsaab
- Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Suadi Arabia
| | - Shahad K. Alhomaiani
- Medical Imaging Department, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| |
Collapse
|
5
|
Shetty SM, Vora A, George R, M V. Challenges, Recommendations, and Epidemiology of Pulmonary Embolism in India: A Narrative Review. Cureus 2024; 16:e64195. [PMID: 39130902 PMCID: PMC11310498 DOI: 10.7759/cureus.64195] [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: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
An embolized clot that travels to the lungs from the legs or, less commonly, other parts of the body (known as deep vein thrombosis or DVT) causes pulmonary embolism (PE), which is characterized by obstruction of blood flow to the pulmonary artery. As PE has the propensity to masquerade as various illnesses affecting both the cardiovascular (CV) and the respiratory system, it is crucial to identify PE at the earliest. Appropriate diagnosis of PE may lead to earlier treatment and improved patient outcomes. While pulmonary angiography remains the established gold standard for diagnosing PE, the contemporary standard of care for this condition is the computed tomography pulmonary angiogram (CTPA). Anticoagulation therapy is the fundamental strategy for managing PE, with the forefront of treatment being the use of novel and upcoming oral anticoagulants known as non-vitamin K antagonist oral anticoagulants (NOACs). The NOACs provide a practical single-drug treatment strategy, which does not hinder the patient's lifestyle and domestic responsibilities. Although PE may be fatal, early detection may lead to effective management. Despite that, mortality and morbidity associated with PE are very high in India. The awareness among Indian healthcare professionals about PE should be improved, and unified pan-country diagnostic and management guidelines should be formulated to tackle the country's PE burden.
Collapse
Affiliation(s)
- Sadanand M Shetty
- Cardiology, Karamshibhai Jethabhai Somaiya Super Specialty Institute, Mumbai, IND
| | - Agam Vora
- Pulmonology, Vora Clinic, Mumbai, IND
| | - Robbie George
- Department of Vascular and Endovascular Surgery, Narayana Institute of Vascular Sciences, Bangalore, IND
| | - Vidita M
- Internal Medicine, Pfizer Ltd, Mumbai, IND
| |
Collapse
|
6
|
Thomas SE, Weinberg I, Schainfeld RM, Rosenfield K, Parmar GM. Diagnosis of Pulmonary Embolism: A Review of Evidence-Based Approaches. J Clin Med 2024; 13:3722. [PMID: 38999289 PMCID: PMC11242034 DOI: 10.3390/jcm13133722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Venous thromboembolism, commonly presented as pulmonary embolism and deep-vein thrombosis, is a paramount and potentially fatal condition with variable clinical presentation. Diagnosis is key to providing appropriate treatment in a safe and timely fashion. Clinical judgment and assessment using clinical scoring systems should guide diagnostic testing, including laboratory and imaging modalities, for optimal results and to avoid unnecessary testing.
Collapse
Affiliation(s)
- Sneha E Thomas
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ido Weinberg
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Robert M Schainfeld
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kenneth Rosenfield
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gaurav M Parmar
- Vascular Medicine Section, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
7
|
Mohyeldin M, Ezukuse V, Bhattarai R, Nasr R. Pulmonary Embolism in a Young African American Male: A Diagnostic Challenge. Cureus 2024; 16:e62348. [PMID: 39006732 PMCID: PMC11246543 DOI: 10.7759/cureus.62348] [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: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
This case report highlights the diagnostic challenges posed by pulmonary embolism (PE) in a young, otherwise healthy 33-year-old African American male with no apparent risk factors. The patient presented with penile pain, swelling, hematuria, flank pain, and rash, and was admitted for balanoposthitis and acute urinary retention. Despite prophylactic heparin, he suffered two cardiac arrests secondary to PE on the fifth day of hospitalization. Prompt thrombolytic therapy and heparin infusion were initiated, but his course was complicated by anuric acute kidney injury requiring hemodialysis, shock liver, and gastrointestinal bleeding. Imaging revealed a substantial thrombus burden in the pulmonary arteries. Notably, a hypercoagulable workup was negative. The absence of typical risk factors, negative hypercoagulable workup, and occurrence of PE despite prophylaxis underscore the importance of vigilance in recognizing atypical presentations. This case emphasizes the need for a high index of suspicion and comprehensive evaluation to diagnose PE in young patients without clear predisposing factors.
Collapse
Affiliation(s)
| | - Vanisa Ezukuse
- Internal Medicine, BronxCare Health System, Bronx, USA
- Department of Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | | | - Rabih Nasr
- Nephrology, BronxCare Health System, Bronx, USA
| |
Collapse
|
8
|
Dina AJ, Hicks S. Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Report of Two Cases. Cureus 2024; 16:e61838. [PMID: 38975399 PMCID: PMC11227445 DOI: 10.7759/cureus.61838] [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: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Pulmonary embolism (PE) is often underrecognized due to its ability to mimic other conditions; however, ultrasound can provide diagnostic clues to aid in the diagnosis of PE. We describe two patients who presented with symptoms suggestive of cardiac ischemia and had electrocardiograms (EKGs) indicative of anteroseptal myocardial infarction. In both cases, cardiac point-of-care ultrasonography showed signs of large pulmonary emboli, which were then confirmed on computed tomography angiography of the chest. Both patients underwent successful aspiration thrombectomy with rapid resolution of cardiac dysfunction. Point-of-care ultrasonography should be used as an adjunct in patients presenting with anterior ischemia on EKG to evaluate for signs of PE.
Collapse
Affiliation(s)
- Anthony J Dina
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Sherell Hicks
- Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| |
Collapse
|
9
|
Suwadi A, Tandarto K, Laksono S. Systemic Immune-Inflammation Index as a Potential Biomarker for Predicting Acute Pulmonary Embolism: A Systematic Review. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 0:rjim-2024-0016. [PMID: 38595041 DOI: 10.2478/rjim-2024-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Acute pulmonary embolism (APE) is a life-threatening condition with a high mortality rate. The pathophysiology involves various complex processes. The systemic immune-inflammatory index (SII) is a well-known biomarker that reflects the intricate balance between pro-inflammatory and anti-inflammatory immune components. In this systematic review, we aim to determine the significance of SII as a potential biomarker for APE. METHOD We utilized PubMed, ProQuest, EBSCOHost, and Google Scholar to search for articles. We assessed bias risk using the Newcastle Ottawa Scale (NOS). The outcomes we examined included in-hospital and long-term mortality, the severity of APE, and the sensitivity and specificity of the SII in predicting APE. RESULTS Four studies, involving 2,038 patients, were included for analysis. These studies discuss the use of SII in predicting APE severity, APE mortality, high-risk APE, and the occurrence of APE. SII demonstrates significant results in predicting each of these variables. Furthermore, each study establishes different SII cut-off values. Specifically, a cut-off of 1161 predicts massive APE events with a sensitivity of 91% and a specificity of 90%. A cut-off of >1235.35 differentiates high-risk APE with a sensitivity of 87.32% and a specificity of 68.85%. A cut-off of >1111x109 predicts overall mortality with a sensitivity of 72% and a specificity of 51%. Finally, a cut-off at 1839.91 predicts APE events with a sensitivity of 75.8% and a specificity of 61.9%. CONCLUSION The SII can be employed as a potential new biomarker to predict outcomes in APE patients, particularly the occurrence, severity, and mortality of APE.
Collapse
Affiliation(s)
- Andrew Suwadi
- 1Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Kevin Tandarto
- 1Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Sidhi Laksono
- 2Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Muhammadiyah Prof. Dr. Hamka, Tangerang, Indonesia
- 3Department of Cardiology and Vascular Medicine, Pusat Pertamina Hospital, South Jakarta, Indonesia
| |
Collapse
|
10
|
Tajeri T, Langroudi TF, Zadeh AH, Taherkhani M, Arjmand G, Abrishami A. The correlation between the CT angiographic pulmonary artery obstructive index and clinical data in patients with acute pulmonary thromboembolism. Emerg Radiol 2024; 31:45-51. [PMID: 38102455 DOI: 10.1007/s10140-023-02187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The potentially fatal consequences of pulmonary embolism emphasize the need for more effective diagnostic methods. The Qanadli obstruction index has been described as a convenient tool for risk stratification to determine and quantify the degree of obstruction. This study aimed to assess the correlations between the Qanadli index with clinical and paraclinical findings (D-dimer, troponin, and echocardiographic findings) in patients with pulmonary embolism. MATERIALS AND METHODS A total of 102 patients with pulmonary embolism underwent echocardiography and CT pulmonary angiography at a single tertiary referral center between 2019 and 2020. The clinical and paraclinical findings, pulmonary arterial obstruction index, atrial measurements, right and left ventricle size and function, tricuspid annular plane systolic excursion, pulmonary artery pressure, and pulmonary hypertension (PH) were analyzed. Vital signs were recorded and assessed. The Qanadli index score was measured, and graded risk stratification was measured based on the quantified index score. RESULTS The total mean Qanadli index was 28.75 ± 23.75, and there was no significant relationship between the Qanadli index and gender. Patients' most common clinical findings were exertional dyspnea (84.3%; n = 86) and chest pain (71.7%; n = 73). There were significant correlations between the Qanadli index and pulse rate (PR), troponin, D-dimer levels, and PH. Four patients died during the study, including one from a cardiac condition and three with non-cardiac conditions. CONCLUSIONS It is possible to determine the severity, prognosis, and appropriate treatment by the Qanadli index based on strong correlations with PR, troponin, D-dimer levels, and PH.
Collapse
Affiliation(s)
- Taraneh Tajeri
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Faghihi Langroudi
- Radiology Department, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezou Hashem Zadeh
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Taherkhani
- Cardiovascular Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, 9Th Boostan St, Tehran, 1419733141, Iran.
| | - Ghazal Arjmand
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
Haile AT, Haile RG, Gebrehiwot EH, Abeje EW. Venous Thromboembolism and Associated Factors in Hospitalized Patients with COVID-19 at Addis Ababa COVID-19 Field Hospital, Ethiopia. Infect Drug Resist 2024; 17:305-317. [PMID: 38293313 PMCID: PMC10826547 DOI: 10.2147/idr.s449401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
Background The association of COVID-19 with venous thromboembolism is of particular interest as there are reports that have associated thrombotic events with the pandemic. COVID-19 may predispose to venous thromboembolism. There is initial evidence suggesting that individuals with COVID-19 may be more prone to developing venous thromboembolism (VTE). This study aims to assess venous thromboembolism and associated factors in 19 patients admitted to Addis Ababa's field hospital for COVID-19. Objective To identify associated factors that affect the development of thromboembolism in patients admitted with the diagnosis of COVID-19. Methods To determine the risks of VTE patients, an institution-based case control research was conducted using SPSS version 26, multivariable binary logistic regression analysis was used. Results Significant factors associated with the development of VTE in COVID-19 patients included having a severe case (AOR = 0.38, 95% CI = 0.149-0.961), risk factors for VTE (AOR = 2.57, 95% CI = 1.18-5.33), diabetes (AOR = 3.745, 95% CI = 1.715-8.176), chest pain (AOR = 4.13, 95% CI = 1.89-9), stage 1 hypertension levels (AOR = 3.67, 95% CI = 1.37-9.836), and hospital anticoagulation (AOR = 11.78, 95% CI = 5.25-26.4). Conclusion The results of VTE in individuals with COVID-19 imply a direct association between severe COVID-19 and diabetes, having risk factors, hypertension, and hospital anticoagulation.
Collapse
Affiliation(s)
- Abel Teklit Haile
- Research Department, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
- Department of Internal Medicine, Wollo University, Dessie, Ethiopia
| | - Robel Gemechu Haile
- Research Department, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
- Department of Internal Medicine, Wollo University, Dessie, Ethiopia
- School of Public Health, Gamby Medical and Business College, Addis Ababa, Ethiopia
| | - Esrom Hagos Gebrehiwot
- Research Department, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
- Department of Internal Medicine, Wollo University, Dessie, Ethiopia
- School of Public Health, Gamby Medical and Business College, Addis Ababa, Ethiopia
| | - Eden Workalemahu Abeje
- Research Department, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
- Department of Internal Medicine, Wollo University, Dessie, Ethiopia
- School of Public Health, Gamby Medical and Business College, Addis Ababa, Ethiopia
| |
Collapse
|
12
|
Zyśko D, Kluwak K, Furdal M, Skoczyński P, Gogolewski G, Chourasia G, Banasiak W, Jagielski D, Klempous R, Rozenblit J. Capnography derived breath variability analysis feasibility and its importance for pulmonary embolism prediction. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
13
|
de Bock E, Filipe MD, Herman ES, Pronk A, Boerma D, Heikens JT, Verheijen PM, Vriens MR, Richir MC. Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2023; 55:100620. [PMID: 37163195 PMCID: PMC10159662 DOI: 10.1016/j.ijso.2023.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
Background During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic. Methods This multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals. Results One hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06-9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32-0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02-1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02-1.08; p = 0.001), surgical urgency and surgical discipline. Conclusion A confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.
Collapse
Affiliation(s)
- Ellen de Bock
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Mando D Filipe
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Eline S Herman
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joost T Heikens
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, the Netherlands
| | - Paul M Verheijen
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - Menno R Vriens
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| | - Milan C Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, the Netherlands
| |
Collapse
|
14
|
Fanni SC, Greco G, Rossi S, Aghakhanyan G, Masala S, Scaglione M, Tonerini M, Neri E. Role of artificial intelligence in oncologic emergencies: a narrative review. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:344-354. [PMID: 37205309 PMCID: PMC10185441 DOI: 10.37349/etat.2023.00138] [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] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 05/21/2023] Open
Abstract
Oncologic emergencies are a wide spectrum of oncologic conditions caused directly by malignancies or their treatment. Oncologic emergencies may be classified according to the underlying physiopathology in metabolic, hematologic, and structural conditions. In the latter, radiologists have a pivotal role, through an accurate diagnosis useful to provide optimal patient care. Structural conditions may involve the central nervous system, thorax, or abdomen, and emergency radiologists have to know the characteristics imaging findings of each one of them. The number of oncologic emergencies is growing due to the increased incidence of malignancies in the general population and also to the improved survival of these patients thanks to the advances in cancer treatment. Artificial intelligence (AI) could be a solution to assist emergency radiologists with this rapidly increasing workload. To our knowledge, AI applications in the setting of the oncologic emergency are mostly underexplored, probably due to the relatively low number of oncologic emergencies and the difficulty in training algorithms. However, cancer emergencies are defined by the cause and not by a specific pattern of radiological symptoms and signs. Therefore, it can be expected that AI algorithms developed for the detection of these emergencies in the non-oncological field can be transferred to the clinical setting of oncologic emergency. In this review, a craniocaudal approach was followed and central nervous system, thoracic, and abdominal oncologic emergencies have been addressed regarding the AI applications reported in literature. Among the central nervous system emergencies, AI applications have been reported for brain herniation and spinal cord compression. In the thoracic district the addressed emergencies were pulmonary embolism, cardiac tamponade and pneumothorax. Pneumothorax was the most frequently described application for AI, to improve sensibility and to reduce the time-to-diagnosis. Finally, regarding abdominal emergencies, AI applications for abdominal hemorrhage, intestinal obstruction, intestinal perforation, and intestinal intussusception have been described.
Collapse
Affiliation(s)
- Salvatore Claudio Fanni
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Giuseppe Greco
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Sara Rossi
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Gayane Aghakhanyan
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Michele Tonerini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, 56126 Pisa, Italy
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
15
|
Borna N, Niksolat M, Shariati B, Saeedi V, Kamalzadeh L. Pulmonary embolism or COVID-19 pneumonia? A case report. Respirol Case Rep 2023; 11:e01121. [PMID: 36935898 PMCID: PMC10018382 DOI: 10.1002/rcr2.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023] Open
Abstract
Pulmonary embolism (PE) is the most severe clinical presentation of venous thromboembolism (VTE), which can be challenging to diagnose due to its non-specific symptoms. The overlapping clinical symptoms of Coronavirus disease 2019 (COVID-19) and PE may make distinguishing between the two difficult. Thus, the diagnosis of PE may be delayed or missed, with grave consequences for the patient's outcome and safety. We herein present the case of a 63-year-old Iranian female admitted to our hospital showing symptoms of delirium superimposed on dementia. Soon after her admission, she developed a fever and respiratory symptoms. However, overestimating the likelihood of COVID-19 pneumonia and attributing the patient's symptoms to this disease led to a delayed diagnosis and treatment of pulmonary embolism, resulting in the patient's death. During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of PE, especially in patients with identifiable risk factors. This is specifically true for older patients who cannot express their symptoms due to neurocognitive disorders.
Collapse
Affiliation(s)
- Nahid Borna
- Geriatric mental health research center, Department of Psychiatry, School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Maryam Niksolat
- Department of Geriatric Medicine, School of Medicine, Firoozabadi Clinical and Research Development UnitIran University of medical scienceTehranIran
| | - Behnam Shariati
- Geriatric mental health research center, Department of Psychiatry, School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Vahid Saeedi
- Pediatric Endocrinology and Metabolism Department, School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Leila Kamalzadeh
- Geriatric mental health research center, Department of Psychiatry, School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| |
Collapse
|
16
|
Ochani RK, Aibani R, Jatoi HN, Anwar M, Khan SA, Ratnani I, Surani S. Evolving paradigm of thrombolysis in pulmonary embolism: Comprehensive review of clinical manifestations, indications, recent advances and guideline. World J Clin Cases 2023; 11:1702-1711. [PMID: 36970000 PMCID: PMC10037295 DOI: 10.12998/wjcc.v11.i8.1702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
Thrombolytic therapy has been the mainstay for patients with pulmonary embolism (PE). Despite being linked to a higher risk of significant bleeding, clinical trials demonstrate that thrombolytic therapy should be used in patients with moderate to high-risk PE, in addition to hemodynamic instability symptoms. This prevents the progression of right heart failure and impending hemodynamic collapse. Diagnosing PE can be challenging due to the variety of presentations; therefore, guidelines and scoring systems have been established to guide physicians to correctly identify and manage the condition. Traditionally, systemic thrombolysis has been utilized to lyse the emboli in PE. However, newer techniques for thrombolysis have been developed, such as endovascular ultrasound-assisted catheter-directed thrombolysis for massive and intermediate-high submassive risk groups. Additional newer techniques explored are the use of extracorporeal membrane oxygenation, direct aspiration, or fragmentation with aspiration. Because of the constantly changing therapeutic options and the scarcity of randomized controlled trials, choosing the best course of treatment for a given patient may be difficult. To help, the Pulmonary Embolism Reaction Team is a multidisciplinary, rapid response team that has been developed and is used at many institutions. Hence to bridge the knowledge gap, our review highlights various indications of thrombolysis in addition to the recent advances and management guidelines
Collapse
Affiliation(s)
- Rohan Kumar Ochani
- Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Sindh, Pakistan
| | - Rafi Aibani
- Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Sindh, Pakistan
| | - Hafsa Nazir Jatoi
- Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Sindh, Pakistan
| | - Masroor Anwar
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar 00000, Pakistan
| | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Iqbal Ratnani
- Department of Anesthesiology & Critical Care, Houston Methodist Hospital, Houston, TX 77030, United States
| | - Salim Surani
- Department of Medicine, Texas A&M University, College Station, TX 77843, United States
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
17
|
Diagnostic test accuracy of imaging modalities for adults with acute pulmonary embolism: A systematic review and meta-analysis. J Med Imaging Radiat Sci 2023; 54:178-194. [PMID: 36456459 DOI: 10.1016/j.jmir.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to evaluate the current literature on diagnostic test accuracy (DTA) of imaging modalities for adults with acute pulmonary embolism (APE). BACKGROUND Medical imaging plays an integral role in evaluating and managing those with APE. Guidance for imaging modality use for APE diagnosis varies due to a lack of clinical standardisation. Despite this, CTPA remains the first-line imaging modality used by clinicians. METHODS A literature search of PubMed, EMBASE, Trove and Mednar databases (2012-2020; English language) was performed. Studies assessing the DTA of imaging modalities for APE diagnosis were included. DTA studies methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2 tool). Results of eligible studies were pooled using random or fixed effects modelling the calculate the pooled DTA of explored imaging modalities for APE. The Higgins I2 test were performed to assess between study heterogeneity. RESULTS 10 Studies, involving 998 participants, were enrolled and pooled using the random effects model. Of the explored modalities, magnetic resonance imaging (MRI), specifically pulmonary MRI and magnetic resonance pulmonary angiography (MRPA) exhibited the highest pooled DTA. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio for MRPA were 0.952 (95% CI, 0.881 to 0.987), 0.857 (95% CI, 0.637 to 0.97), 5.631 (95% CI, 2.163 to 14.659), 0.06 (95% CI, 0.007 to 0.537) and 80.310 (95% CI, 15.607 to 413.25) respectively. Based on the QUADAS-2 criteria, most studies presented low to moderate risk of bias and concern regarding applicability. CONCLUSION The explored ultrasound and MRI protocols which exhibit a lower radiation burden when compared to the current gold standard computed tomography pulmonary angiography (CTPA), have acceptable diagnostic accuracy for APE and can be useful in certain situations.
Collapse
|
18
|
Neurological Consequences of Pulmonary Emboli in COVID-19 Patients: A Study of Incidence and Outcomes in the Kingdom of Saudi Arabia. Brain Sci 2023; 13:brainsci13020343. [PMID: 36831886 PMCID: PMC9954757 DOI: 10.3390/brainsci13020343] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Pulmonary embolism (PE) is a significant consequence that is becoming more common in COVID-19 patients. The current study sought to determine the prevalence and risk factors for PE in a study population of COVID-19 patients, as well as the relationship between PE and neurological sequelae. The research also sought to analyze the consistency of neurological examination and imaging techniques in detecting neurological problems. The research comprised a total of 63 individuals with COVID-19. The incidence of PE in the study group was 9.5% for smokers, 23.8% for obese patients, 33.3% for hypertensive patients, and 19% for diabetic patients, according to the findings. After adjusting for possible confounders such as age, gender, BMI, smoking, hypertension, and diabetes, a logistic regression analysis indicated that the probabilities of having neurological complications were 3.5 times greater in individuals who had PE. In conclusion, the present study highlights the high incidence of PE among patients with COVID-19 and the association between PE and neurological complications. The study also emphasizes the importance of a thorough neurological examination and imaging studies in the detection of neurological complications in patients with PE.
Collapse
|
19
|
Ahaneku CA, Akpu BB, Njoku CH, Elem DE, Ekeng BE. Pulmonary embolism presenting as delirium: an acute confusional state in an elderly patient-a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:8. [PMID: 36777903 PMCID: PMC9899661 DOI: 10.1186/s43162-023-00193-5] [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] [Received: 12/27/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023] Open
Abstract
Background Large numbers of elderly patients are admitted to hospitals in acute confusional states. In many, the underlying causes are easily found; in some, correct diagnosis is difficult. Pulmonary embolism (PE), the most serious clinical presentation of venous thromboembolism, is often misdiagnosed because of its non-specific features including delirium. Case presentation A 73-year-old woman was admitted to our hospital in a confused state with no obvious risk factors of PE. D-dimer levels were elevated and contrast-enhanced high-resolution computed tomography (HRCT) of the chest confirmed the diagnosis of PE. She was treated with enoxaparin and discharged on dabigatran. Her symptoms had resolved at the time of discharge, and she has been stable for over three month's follow-up visit. Conclusion PE should be regarded as a differential in elderly patients with an acute confusional state despite the absence of obvious risk factors. Investigating for and treating when confirmed may save a life.
Collapse
Affiliation(s)
- Chidimma A. Ahaneku
- grid.413097.80000 0001 0291 6387Department of Internal Medicine, Respiratory Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria
| | - Benard B. Akpu
- grid.413097.80000 0001 0291 6387Department of Internal Medicine, Cardiology, Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria
| | - Chibueze H. Njoku
- grid.413097.80000 0001 0291 6387Department of Internal Medicine, Respiratory Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria
| | - David E. Elem
- grid.413097.80000 0001 0291 6387Department of Internal Medicine, Infectious Disease Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria
| | - Bassey E. Ekeng
- grid.413097.80000 0001 0291 6387Department of Internal Medicine, Infectious Disease Unit, University of Calabar, Teaching Hospital, Calabar, Nigeria
| |
Collapse
|
20
|
Oyarzun A, Parsons S, Bassed R. Myocarditis in the forensic setting. Cardiovasc Pathol 2023; 62:107476. [PMID: 36122893 DOI: 10.1016/j.carpath.2022.107476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/16/2022] [Accepted: 09/11/2022] [Indexed: 12/24/2022] Open
Abstract
Diagnosis of myocarditis as the cause of death in the forensic setting at post-mortem is currently determined by a forensic pathologist. There is no systematic method for diagnosis and thus the determination is subject to inter-observer variability and is often non-reproducible. The primary aim of this study was to investigate the differences in the amount of inflammation between cases where myocarditis was deemed the cause of death, compared to cases where myocardial inflammation was incidentally present at autopsy, but not determined to be the cause of death. Participants were sourced from the Victorian Institute of Forensic Medicine (VIFM) database, from full autopsies conducted on reportable death in Victoria, Australia between the years 2011 and 2021. Cases of fatal myocarditis were significantly more likely to experience infection-like symptoms prior to death, and to be in hospital at the time of death. Histopathological examination revealed fatal cases had a significantly higher inflammatory index compared to the incidental group. Lethal cases were also significantly more likely to have myocyte necrosis, and a diffuse pattern of inflammation. There are significant differences between cases where myocardial inflammation has been determined to be the cause of death and cases where inflammation in the myocardium was an incidental finding. These results could be used in the forensic autopsy to help pathologists determine if inflammation should be considered fatal or incidental.
Collapse
Affiliation(s)
- Adele Oyarzun
- Adjunct Associate Professor Sarah Parsons, Prof Richard Bassed, Melbourbe, VIC, Australia.
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourbe, VIC, Australia
| | - Richard Bassed
- Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, Melbourbe, VIC, Australia
| |
Collapse
|
21
|
Asadi Anar M, Ansari A, Erabi G, Rahmanian M, Movahedi M, Chichagi F, Deravi N, Taghavi F, Kazemi B, Javanshir E, Amouei E, Ghaffari S. Prognostic value of fragmented QRS in acute pulmonary embolism: a cross-sectional-analytic study of the Iranian population. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:21-28. [PMID: 36938519 PMCID: PMC10017924 DOI: pmid/36938519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/09/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Acute Pulmonary embolism (APE) is considered one of the deadliest cardiovascular diseases. Electrocardiographic (ECG) abnormalities in pulmonary embolism (PE) are increasingly reported. A growing number of studies have recommended that ECG plays a crucial role in the prognostic assessment of PE patients. However, there is scarce data on the prognostic importance of fragmented QRS (fQRS) on outcomes in patients with APE. This study aims to investigate the prognostic value of fQRS in APE patients. MATERIALS AND METHODS This is a cross-sectional-analytic study. This study included 280 patients diagnosed with APE admitted to Shahid Madani hospital, Tabriz, Iran. Computed tomography pulmonary angiography (CTPA) was used to diagnose APE. A checklist was prepared for all patients, demographic, clinical characteristics, and Major Adverse Cardiopulmonary events (MACPE), including in-hospital mortality, need for thrombolysis, mechanical ventilation, and surgical embolectomy, were recorded. Patients were divided into two groups: patients who manifested fQRS on their ECG and patients who did not; Then, demographic, clinical characteristics, and MACPE were compared in the two groups, as mentioned earlier. Furthermore, all statistical analyses were carried out using SPSS software. RESULTS 48 patients (17.14%) had fQRS(+) on their ECG, and 232 patients (82.86%) did not have it on their ECG. In data analysis, 22 patients (8.7%) had in-hospital mortality, 35 patients (13.9%) needed thrombolysis, nine patients (3.9%) required mechanical ventilation, and 13 patients (5.1%) needed surgical embolectomy. fQRS was not significantly associated with in-hospital mortality (P = 0.225), need for thrombolysis (P = 0.684), mechanical ventilation (P = 1.000), and surgical embolectomy (P = 1.000). Demographic and clinical characteristics were also similar in both groups. CONCLUSIONS This study does not support the idea that fQRS on ECG is a valuable predictor of in-hospital mortality, the need for thrombolysis, mechanical ventilation, and surgical embolectomy.
Collapse
Affiliation(s)
- Mahsa Asadi Anar
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical SciencesTehran, Iran
| | - Akram Ansari
- Medical Student, Shantou University Medical CollegeShantou, Guangdong, China
| | - Gisou Erabi
- Student Research Committee, Urmia University of Medical SciencesUrmia, Iran
| | - Mohammad Rahmanian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical SciencesTehran, Iran
| | | | - Fatemeh Chichagi
- Students’ Scientific Research Center (SSRC), Tehran University of Medical SciencesTehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical SciencesTehran, Iran
| | - Farid Taghavi
- Cardiovascular Research Center, Tabriz University of Medical SciencesTabriz, Iran
| | - Babak Kazemi
- Cardiovascular Research Center, Tabriz University of Medical SciencesTabriz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical SciencesTabriz, Iran
| | - Erfan Amouei
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical ScienceTehran, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical SciencesTabriz, Iran
| |
Collapse
|
22
|
Medson K, Yu J, Liwenborg L, Lindholm P, Westerlund E. Comparing ‘clinical hunch’ against clinical decision support systems (PERC rule, wells score, revised Geneva score and YEARS criteria) in the diagnosis of acute pulmonary embolism. BMC Pulm Med 2022; 22:432. [DOI: 10.1186/s12890-022-02242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
Pulmonary embolism (PE) is a common and potentially life-threatening condition. Since it is considered a ‘do not miss’ diagnosis, PE tends to be over-investigated beyond the evidence-based clinical decision support systems (CDSS), which in turn subjects patients to unnecessary radiation and contrast agent exposure with no apparent benefits in terms of outcome.
The purpose of this study was to evaluate the yield of ‘clinical hunch’ (gestalt) and four CDSS: the PERC Rule, Wells score, revised Geneva score, and Years criteria.
Methods
A review was conducted on the Electronic Medical Records (EMR) of 1566 patients from the Emergency Department at a tertiary teaching hospital who underwent CTPA from the 1st of January 2018 to the 31st of December 2019. The scores for the four CDSS were calculated retrospectively from the EMR data. We considered that a CTPA had been ordered on a clinical hunch when there was no mention of CDSS in the EMR, and no D-dimer test. A bypass of CDSS was confirmed when any step of the diagnostic algorithms was not followed.
Results
Of the total 1566 patients who underwent CTPA, 265 (17%) were positive for PE. The diagnosis yield from the five decision groups (clinical hunch and four CDSS) was as follows—clinical hunch, 15%; PERC rule, 18% (6% when bypassed); Wells score, 19% (11% when bypassed); revised Geneva score, 26% (13% when bypassed); and YEARS criteria, 18% (6% when bypassed).
Conclusion
Clinicians should trust the evidence-based clinical decision support systems in line with the international guidelines to diagnose PE.
Collapse
|
23
|
Jung HJ, Choo KS. Pilot study on the effect of grape seed proanthocyanidin extract on inferior vene cava blood flow in patients with chronic venous insufficiency using 4D flow MRI. Medicine (Baltimore) 2022; 101:e31792. [PMID: 36401399 PMCID: PMC9678586 DOI: 10.1097/md.0000000000031792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Four-dimensional (4D) flow magnetic resonance imaging (MRI) was used to objectively assess changes in blood flow velocity in patients with chronic venous insufficiency (CVI) who underwent stocking treatment alone and stocking combined with Grape seed proanthocyanidin extract (GSPE) treatment. METHODS Patients diagnosed with CVI were recruited from August 31, 2018 to December 31, 2020. A total of 23 participants were selected, with 10 and 13 patients in the stocking treatment and stocking + GSPE treatment groups, respectively. The blood flow velocity (Th-plane peak and average velocities) was calculated using 4D flow MRI. A paired t test was used to evaluate the differences in blood flow velocity before and after treatment. RESULTS In the stocking treatment group, The Th-Plane peak velocity increased by 2.48 ± 5.05 cm/s after treatment (P = .16). In the stocking + GSPE treatment group, the Th-Plane peak velocity increased by 4.85 ± 5.57 cm/s after treatment (P < .001). CONCLUSION The blood flow velocity on 4D flow MRI was significantly increased in participants who underwent GSPE, highlighting the potential of GSPE for CVI treatment.
Collapse
Affiliation(s)
- Hyuk Jae Jung
- Endovascular and Vascular and Transplantation Division, Department of Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine and Medical Research Institute, Busan National University Yangsan Hospital, Busan, Korea
| |
Collapse
|
24
|
Perioperative Prevention of Venous Thromboembolism in Abdominal Surgery Patients Based on the Caprini or the Padua Risk Score-A Single Centre Prospective Observational Study. Life (Basel) 2022; 12:life12111843. [PMID: 36430978 PMCID: PMC9694484 DOI: 10.3390/life12111843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022] Open
Abstract
Surgical patients should receive perioperative thromboprophylaxis based on risk assessment, and the Caprini score is validated for this purpose. Whether the Padua score, originally devised for medical patients, can be useful in surgical patients remains to be fully clarified. This study aimed to evaluate perioperative thromboprophylaxis based on the Caprini or the Padua score in elective abdominal surgery. A total of 223 patients undergoing elective abdominal surgery for malignant or benign disease were prospectively evaluated. The patients were divided into two groups in which thromboprophylaxis was prescribed according to either the Caprini score (n = 122) or the Padua score (n = 101). Patients with high-risk scores in both groups received nadroparin. The alternate risk score in each group was calculated for evaluation purposes only. During a 3-month follow-up, we assessed patients for symptomatic venous thromboembolism (VTE), bleeding, or mortality. In the Caprini score group, 87 patients (71%) had a high risk for VTE (≥5 points), while 38 patients (38%) had a high risk for VTE (≥4 points) in the Padua score group; p < 0.00001. The overall correlation between the Caprini and Padua scores was moderate (r= 0.619), with 85 patients having high Caprini and discordant Padua scores. Ten patients died during follow-up (4.5%), and five developed non-fatal symptomatic VTE (2.2%). Among the five major bleeding incidents recorded (1.8%), two cases were possibly associated with pharmacological thromboprophylaxis. The incidence of adverse outcomes did not differ between the two groups. The odds ratio for adverse outcomes was significantly higher with a high Caprini or Padua risk score, malignant disease, age ≥65 years, and active smoking. We found no significant differences in adverse outcomes between abdominal surgical patients who received perioperative thromboprophylaxis based on either the Caprini or the Padua risk score. However, a discordant Padua score was noted in almost 40% of patients who had a high Caprini score, suggesting that the latter may be more sensitive than the Padua score in surgical patients.
Collapse
|
25
|
Xu X, Yuan J, Pan X, Du G, Zhang J. The Diagnostic Value of Bedside Echocardiography and Lower Extremity Blood Vessels in Acute Pulmonary Embolism. Stem Cells Int 2022; 2022:5012613. [PMID: 36213685 PMCID: PMC9534721 DOI: 10.1155/2022/5012613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to evaluate the value of bedside echocardiography (TTE) and lower extremity blood vessels in diagnosis and prognosis of acute pulmonary embolism (APE). Methods A retrospective study was performed on 53 patients with APE diagnosed by CT pulmonary angiography (CTPA) (systemic systolic blood pressure was >90 mmHg at time of consultation, and systemic systolic blood pressure decreased by <40 mmHg compared with basic value in those with hypertension). All patients underwent TTE examination before treatment. The high-risk factors, clinical manifestations, laboratory tests, and prognosis were retrospectively analyzed. Results The rate of PE-related deterioration (cardiopulmonary resuscitation, tracheal intubation, cardiogenic shock, and death) within 14 days of hospitalization in RVD was 28%, and mortality rate (sudden death) was 20%, compared with non-RVD (both 0%). TTE examination showed that RVD as a predictor of pulmonary embolism-related death had a sensitivity of 100%, a specificity of 58%, a positive predictive value of 20%, and a negative predictive value of 100%. Conclusions (1) TTE has increasingly shown obvious advantages in diagnosis of APE. It can detect direct or indirect signs of pulmonary embolism, confirm diagnosis or suspected diagnosis, and noninvasively and dynamically observe hemodynamic changes of heart in patients with acute PTE before and after treatment.. (2) The PE-related exacerbation rate (28%) or mortality (20%) of APE patients in normotensive with RVD was higher without RVD (0%). RVD is an independent predictor of poor prognosis in normotensive acute PTE. TTE tests allow people to identify people at risk of early death. The short-term prognosis of patients without RVD was better (14 days).
Collapse
Affiliation(s)
- Xinxin Xu
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Jing Yuan
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Xiaojie Pan
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Guibin Du
- Department of Ultrasound, Hebei Petrochina Central Hospital, Langfang, Hebei 065000, China
| | - Jiahui Zhang
- Department of Mammary Gland, Guangyang Maternal and Child Health Hospital, Langfang, Hebei, China
| |
Collapse
|
26
|
Outcomes in Emergency Department Patients with Dyspnea versus Chest Pain: A Retrospective Consecutive Cohort Study. Emerg Med Int 2022; 2022:4031684. [PMID: 36158766 PMCID: PMC9507768 DOI: 10.1155/2022/4031684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022] Open
Abstract
Dyspnea and chest pain are major and important causes of contact at the emergency department (ED). Dyspnea is associated with high morbidity and mortality, but data on characteristics and outcomes compared with chest pain in the ED are limited. This was a retrospective cohort study of consecutive patients with contact causes of dyspnea or chest pain at two Swedish EDs from 2010 to 2014. Hospital admittance, ED revisits, and mortality were analyzed using multivariable regression models, adjusted for ED and markers of disease severity (age, sex, centre, Charlson comorbidity index, c-reactive protein, troponin T, and arrival by ambulance). 29,291 patients (mean age 58.3 years; 48.9% women) with dyspnea (n = 8,812) or chest pain (n = 20,479) were included. Dyspnea patients were older than patients with chest pain (64 vs. 56 years, p < 0.001) and had more comorbidity and higher average blood troponin T and c-reactive protein levels. Dyspnea patients also had higher hospitalization rates (48% vs. 30%; adjOR (95% CI) 2.1–2.3), including the intensive care unit (1.4% vs. 0.1%; adjOR 6.9–15.9), and more ED revisits (11% vs. 7%; adjOR 1.2–1.7) in 30 days. Dyspnea patients had five-fold increased mortality compared to those with chest pain; hazard ratio (HR) 5.1 (4.8–5.4), adjusted for markers of disease severity, the mortality was two-fold higher, HR 2.2 (2.0–2.4). Compared with chest pain patients, ED dyspnea patients are older, have more comorbidity, and have worse outcomes in terms of hospitalization, morbidity, and mortality.
Collapse
|
27
|
Lasica R, Asanin M, Djukanovic L, Radovanovic N, Savic L, Polovina M, Stankovic S, Ristic A, Zdravkovic M, Lasica A, Kravic J, Perunicic J. Dilemmas in the Choice of Adequate Therapeutic Treatment in Patients with Acute Pulmonary Embolism—From Modern Recommendations to Clinical Application. Pharmaceuticals (Basel) 2022; 15:ph15091146. [PMID: 36145366 PMCID: PMC9501350 DOI: 10.3390/ph15091146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary thromboembolism is a very common cardiovascular disease, with a high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. The heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decisions surrounding this therapeutic regimen also represent a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate–high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except for certain categories of patients (patients with antiphospholipid syndrome, mechanical valves, pregnancy). When using oral anticoagulant therapy, special attention should be paid to drug–drug interactions, which can lead to many complications, even to the death of the patient. Special population groups such as pregnant women, obese patients, patients with antiphospholipid syndrome and the incidence of cancer represent a great therapeutic challenge in the application of anticoagulant therapy. In these patients, not only must the effectiveness of the drugs be taken into account, but great attention must be paid to their safety and possible side effects, which is why a multidisciplinary approach is emphasized in order to provide the best therapeutic option.
Collapse
Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Correspondence:
| | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nebojsa Radovanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Lidija Savic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marija Polovina
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Arsen Ristic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | | | | | - Jelena Kravic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jovan Perunicic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| |
Collapse
|
28
|
Posa A, Barbieri P, Mazza G, Tanzilli A, Iezzi R, Manfredi R, Colosimo C. Progress in interventional radiology treatment of pulmonary embolism: A brief review. World J Radiol 2022; 14:286-292. [PMID: 36160834 PMCID: PMC9453319 DOI: 10.4329/wjr.v14.i8.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/14/2022] [Accepted: 08/05/2022] [Indexed: 02/08/2023] Open
Abstract
Pulmonary embolism represents a common life-threatening condition. Prompt identification and treatment of this pathological condition are mandatory. In cases of massive pulmonary embolism and hemodynamic instability or right heart failure, interventional radiology treatment for pulmonary embolism is emerging as an alternative to medical treatment (systemic thrombolysis) and surgical treatment. Interventional radiology techniques include percutaneous endovascular catheter directed therapies as selective thrombolysis and thrombus aspiration, which can prove useful in cases of failure or infeasibility of medical and surgical approaches.
Collapse
Affiliation(s)
- Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Pierluigi Barbieri
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giulia Mazza
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Alessandro Tanzilli
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Riccardo Manfredi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| |
Collapse
|
29
|
Trott T, Bowman J. Diagnosis and Management of Pulmonary Embolism. Emerg Med Clin North Am 2022; 40:565-581. [DOI: 10.1016/j.emc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Krishnan AM, Gadela NV, Ramanathan R, Jha A, Perkins ME, Metersky ML. A Comparative Analysis of Catheter Directed Thrombolysis with Anticoagulation Alone or Systemic tPA in Acute Pulmonary Embolism with Cor Pulmonale. J Intensive Care Med 2022; 37:1336-1343. [DOI: 10.1177/08850666221083241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pulmonary embolism (PE) with cor pulmonale causes considerable mortality and morbidity. Randomized trials have failed to show a mortality difference between treatment modalities including anticoagulation (AC), Catheter directed thrombolysis (CDT) and systemic tPA (tissue plasminogen activator). Methods This is a cross-sectional retrospective case-control study utilizing the 2017 National Inpatient Sample (NIS). Patients admitted with acute PE with cor pulmonale were divided into groups based on whether they received anticoagulation, CDT or systemic tPA based on appropriate ICD-10 PCS codes. The AC group and CDT group were compared using univariate and multivariate analyses after adjusting for age, gender, race, comorbidities, insurance status and Charlson comorbidity index (CCI). Secondary outcomes included factors influencing length of stay (LOS) and total charges incurred. Similar analyses were done to compare the CDT group with the tPA group. Results In 2017, 13240 patients were admitted with acute PE and cor pulmonale, of whom 18% underwent CDT, 10% underwent systemic tPA and 72% underwent AC alone. Patients who received CDT over AC alone were significantly younger (61.5 vs. 65.5, p = 0.00). Mortality rate overall was 4.8% with tPA group, CDT group and AC alone group having a 11.2%, 3.0% and 4.4% mortality rate respectively. On multivariate analyses, there was no significant mortality difference between the CDT and AC groups (aOR 0.61, 0.34-1.1 95%CI, p = 0.103). Patients with liver disease had significantly higher mortality while obese patients had a significantly lower mortality after adjusting for treatment strategy and confounders. Length of stay (LOS) was not significantly different between the groups however, compared to AC alone, patients who underwent CDT or tPA incurred significantly higher total hospital charges. Conclusions CDT offers an attractive alternative to tPA therapy; however, our study does not show an in-hospital mortality benefit. More studies are required to guide patient selection prior to establishing treatment protocols.
Collapse
Affiliation(s)
- Anand Muthu Krishnan
- Department of Cardiovascular Disease, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Naga Vaishnavi Gadela
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Rudra Ramanathan
- Department of Pulmonology and Critical Care Disease, NYU Langone, NY
| | - Anil Jha
- Department of Internal Medicine, Lawrence General Hospital, Boston, Massachusetts, USA
| | - Michael E. Perkins
- Department of Pulmonology and Critical Care, Hartford Hospital, Hartford, Connecticut, USA
| | - Mark L. Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington
| |
Collapse
|
31
|
Eid M, Boghdady AM, Ahmed MM, Dahab LHA. Echocardiographic findings in patients with acute pulmonary embolism at Sohag University Hospitals. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:21. [PMID: 35221662 PMCID: PMC8857893 DOI: 10.1186/s43162-022-00114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Acute pulmonary thromboembolism (PTE) is one of the serious medical issues with higher prevalence and mortality rates. As mentioned in several medical reports, most of the chest pain patients, visiting the emergency departments, are usually diagnosed with either acute PTE, acute coronary syndromes, or acute aortic syndromes. The current study aimed to study the risk factors and explore the echocardiographic findings in patients with PTE. Results Forty patients with acute pulmonary embolism were enrolled in the study. Echocardiography and computed tomography pulmonary angiography (CTPA) were evaluated for all participants. The echocardiography showed that 29 patients (72.5%) had echocardiographic findings suggestive of acute PTE. Twenty-four patients (60%) had tricuspid regurge. Twenty-one patients (52.5%) had dilated right ventricle (RV). Also, 13 patients (32.5%) had an echocardiographic finding of pulmonary hypertension. Furthermore, ten patients (25%) had McConnell’s sign, and 21 patients (52.5%) had RV systolic dysfunction where only two (5%) showed RV thrombosis. Echocardiographic data of the eight high-risk patients showed that 6 patients (75%) had TR, 8 patients (100%) had dilated RV, 5 patients (62.5%) had pulmonary hypertension, 8 patients (100%) had McConnell’s sign, one patient (12.5%) had RV thrombus, and 8 patients (100%) had RV systolic dysfunction. Conclusion The results revealed that thrombus in the main pulmonary trunk was a high-risk factor for patients with acute pulmonary embolism. The current study suggested that echocardiography is an important bedside imaging tool for the diagnosis of PTE. Echocardiography could detect the tricuspid regurge, pulmonary hypertension, McConnell’s sign, RV dilatation, thrombosis, and dysfunction. Furthermore, echocardiography was considered a non-invasive test for rapid diagnosis of PTE and determining the degree of the risk category (high- or low-risk patients) specially with the presence of McConnell’s sign, dilated RV, and RV systolic dysfunction.
Collapse
|
32
|
Brgdar A, Ojo AS, Rougui L, Anee K, Sumon M, Mehari A. Pulmonary Embolism and Chronic Superior Vena Cava Occlusion Complicating Central Line-Associated Venous Thromboembolism in a Sickle Cell Disease Patient. Cureus 2022; 14:e22113. [PMID: 35308691 PMCID: PMC8918275 DOI: 10.7759/cureus.22113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/05/2022] Open
Abstract
Sickle cell disease (SCD), the most common genetic disorder globally, is often associated with an increased risk of venous thromboembolic events (VTE). Many of these patients have central lines placed for the purposes of repeated medication administration, blood transfusions, and blood draw, further increasing the risk of VTE. Given the non-specific presentation of VTE and pulmonary embolism, as well as the risk of mortality if interventions are delayed, a high index of suspicion is required for early diagnosis of the condition. We report the case of a 35-year-old woman with SCD and a port-a-cath in place who presented with extensive upper extremity and intrathoracic VTE with associated pulmonary embolism and chronic superior vena cava (SVC) occlusion. We also discuss the peculiarities of the clinical manifestations and management of VTE and pulmonary embolism in the setting of SCD based on the evidence from existing literature.
Collapse
|
33
|
Ibrahim WH, Ata F, Choudry H, Javed H, Shunnar KM, Shams A, Arshad A, Bosom A, Elkahlout MH, Sawaf B, Ahmed SM, Olajide T. Prevalence, Outcome, and Optimal Management of Free-Floating Right Heart Thrombi in the Context of Pulmonary Embolism, a Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221140114. [PMID: 36384306 PMCID: PMC9677292 DOI: 10.1177/10760296221140114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope ( p: 0.027), chest pain ( p: 0.006), and obstructive shock ( p: 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival ( p: 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p: 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p: 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p: 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p: 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed.
Collapse
Affiliation(s)
- Wanis H. Ibrahim
- Department of Pulmonology and Internal Medicine, Weill-Cornell Medicine & Hamad General Hospital, Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Hassan Choudry
- Department of Respiratory Medicine, University Hospital of Leicester, Leicester, UK
| | - Huzaifa Javed
- Department of Medicine, Cavan General Hospital, Cavan, Ireland
| | - Khaled M Shunnar
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdullah Shams
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Abdullah Arshad
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Adel Bosom
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Bisher Sawaf
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Shahda M.A. Ahmed
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Tinuola Olajide
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| |
Collapse
|
34
|
Clinical and radiological characteristics of acute pulmonary embolus in relation to 28-day and 6-month mortality. PLoS One 2021; 16:e0258843. [PMID: 34962922 PMCID: PMC8714121 DOI: 10.1371/journal.pone.0258843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Patients with acute pulmonary embolism (PE) exhibit a wide spectrum of clinical and laboratory features when presenting to hospital and pathophysiologic mechanisms differentiating low-risk and high-risk PE are poorly understood. Objectives To investigate the prognostic value of clinical, laboratory and radiological information that is available within routine tests undertaken for patients with acute PE. Methods Electronic patient records (EPR) of patients who underwent Computed Tomography Pulmonary Angiogram (CTPA) scan for the investigation of acute PE during 6-month period (01.01.2016–30.06.2016) were examined. Data was gathered from EPR for patients that met inclusion criteria and all CTPA scans were re-evaluated. Biochemical thresholds of low-grade and high-grade inflammation, serum CRP >10mg/L and >150mg/L and serum albumin concentrations <35g/L and <25 g/L, were combined in the Glasgow Prognostic Score (GPS) and peri-operative Glasgow Prognostic Score (poGPS) respectively. Neutrophil Lymphocyte ratio (NLR) was also calculated. Pulmonary Embolus Severity Index score was calculated. Results Of the total CTPA reports (n = 2129) examined, 245 patients were eligible for inclusion. Of these, 20 (8%) patients had died at 28-days and 43 (18%) at 6-months. Of the 197 non-cancer related presentations, 28-day and 6-month mortality were 3% and 8% respectively. Of the 48 cancer related presentations, 28-day and 6-month mortality were 29% and 58% respectively. On univariate analysis, age ≥65 years (p<0.01), PESI score ≥100(p = <0.001), NLR ≥3(p<0.001) and Coronary Artery Calcification (CAC) score ≥ 6 (p<0.001) were associated with higher 28-day and 6-month mortality. PESI score ≥100 (OR 5.2, 95% CI: 1.1, 24.2, P <0.05), poGPS ≥1 (OR 2.5, 95% CI: 1.2–5.0, P = 0.01) and NLR ≥3 (OR 3.7, 95% CI: 1.0–3.4, P <0.05) remained independently associated with 28-day mortality. On multivariate binary logistic regression analysis of factors associated with 6-month mortality, PESI score ≥100 (OR 6.2, 95% CI: 2.3–17.0, p<0.001) and coronary artery calcification score ≥6 (OR 2.3, 95% CI: 1.1–4.8, p = 0.030) remained independently associated with death at 6-months. When patients who had an underlying cancer diagnosis were excluded from the analysis only GPS≥1 remained independently associated with 6-month mortality (OR 5.0, 95% CI 1.2–22.0, p<0.05). Conclusion PESI score >100, poGPS≥1, NLR ≥3 and CAC score ≥6 were associated with 28-day and 6-month mortality. PESI score ≥100, poGPS≥1 and NLR ≥3 remained independently associated with 28-day mortality. PESI score ≥100 and CAC score ≥6 remained independently associated with 6-month mortality. When patients with underlying cancer were excluded from the analysis, GPS≥1 remained independently associated with 6-month mortality. The role of the systemic inflammatory response (SIR) in determining treatment and prognosis requires further study. Routine reporting of CAC scores in CTPA scans for acute PE may have a role in aiding clinical decision-making regarding treatment and prognosis.
Collapse
|
35
|
Green M, Saha P. Case study: Acute iliofemoral DVT in a young female with factor V Leiden. JOURNAL OF VASCULAR NURSING 2021; 39:104-107. [PMID: 34865719 DOI: 10.1016/j.jvn.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/05/2020] [Accepted: 07/28/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Meryl Green
- Vascular Clinical Nurse Specialist, Undertaking MSc in Advanced Practice, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Prakash Saha
- Consultant Vascular Surgeon, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
36
|
Wang J, Wang L, Jin L, Rong X, Tang X, Guo H, Liu X, Shi L, Tao G. Predictive Value of MPV and Plasma NT-ProBNP Combined with the Simplified Geneva Scale for the Prognosis of Acute Pulmonary Embolism. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1292921. [PMID: 34712339 PMCID: PMC8548102 DOI: 10.1155/2021/1292921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the predictive value of mean platelet volume (MPV) and plasma N-terminal probrain natriuretic peptide (NT-ProBNP) combined with a simplified Geneva scale for the prognosis of acute pulmonary embolism (APE). METHODS The clinical data of 68 patients with APE admitted to our hospital from October 2017 to October 2019 were collected. According to the prognosis, the patients were divided into a good prognosis group (n = 45) and a poor prognosis group (n = 23). The clinical data, laboratory clinical indexes, and simplified Geneva scale scores were recorded for the two groups. The risk factors of poor prognosis were analyzed by binary multivariate logistic regression analysis; the predictive ability of each index on the prognosis of patients with APE was analyzed by the ROC curve. RESULTS The incidences of deep vein thrombosis, diabetes, and hyperlipidemia in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). PLT, platelet distribution width (PDW), MPV, and plasma NT-ProBNP in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). The simplified Geneva scale score of the poor prognosis group was higher than that of the good prognosis group (P < 0.05). PDW, MPV, plasma NT-ProBNP, and simplified Geneva scale were all independent risk factors for the poor prognosis of APE patients (P < 0.05). The AUC of MPV in predicting the prognosis of APE patients was 0.818 (95% CI: 0.712-0.925). When the optimal cutoff value was 0.571, the sensitivity was 77.1%, and the specificity was 80.0%. The AUC of plasma NT-ProBNP in predicting the prognosis of APE patients was 0.762 (95% CI: 0.634-0.891). When the optimal cutoff value was 0.475, the sensitivity was 71.5%, and the specificity was 76.0%. The AUC of the simplified Geneva scale in predicting the prognosis of APE patients was 0.749 (95% CI: 0.618-0.879). When the optimal cutoff value was 0.469, the sensitivity was 82.9%, and the specificity was 64.0%. The AUC of MPV and plasma NT-ProBNP combined with the simplified Geneva scale in predicting the prognosis of APE patients was 0.907 (95% CI: 0.826-0.988). When the optimal cutoff value was 0.726, the sensitivity was 88.6%, and the specificity was 84.0%. CONCLUSION MPV, plasma NT-ProBNP, and simplified Geneva scale have a certain predictive value for the prognosis of APE. Compared with a single index, the combination of the three indexes has a significant improvement in predicting the prognosis of APE and has better clinical value.
Collapse
Affiliation(s)
- Jing Wang
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Lu Wang
- Department of Internal Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Ling Jin
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xiaolei Rong
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xueshuang Tang
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Haina Guo
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xiaochuan Liu
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Lei Shi
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Guilu Tao
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| |
Collapse
|
37
|
Abstract
Pulmonary CTA is a ubiquitous study interpreted by radiologists with different levels of experience in a variety of practice settings. Pulmonary embolism (PE) can range from an incidental and clinically insignificant finding to a clinically significant thrombus that can be managed on an outpatient basis to a potentially fatal condition requiring immediate medical or invasive management. Accordingly, a clear and concise pulmonary CTA report should effectively communicate the most pertinent findings to help the treating medical team diagnose or exclude the diagnosis of PE and provide information to guide appropriate management. In this expert panel narrative review, we discuss the purpose of the radiology report for pulmonary CTA, the optimal report format, the relevant findings that need to be addressed and their clinical significance.
Collapse
|
38
|
Deng D, Wu H, Wei H, Song Z, Yu Y, Zhang C, Yang L. Syncope as the initial presentation of pulmonary embolism in two patients with hepatocellular carcinoma: Two case reports and literature review. Medicine (Baltimore) 2021; 100:e27211. [PMID: 34559110 PMCID: PMC8462621 DOI: 10.1097/md.0000000000027211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/27/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pulmonary embolism (PE) has diverse clinical manifestations and syncope might be the first or only symptom of PE. Tumor disease usually presents with symptoms associated with the primary site, however, PE may be the first manifestation of occult tumors. PATIENT CONCERNS Here, we report 2 patients admitted to our hospital because of syncope. One patient had a chronic hepatitis B history of more than 20 years and the other patient had chronic heavy drinking for many years. Neither patient had been diagnosed with neoplastic disease before admission. DIAGNOSES Clinical examinations, including laboratory tests and imaging tests upon admission demonstrated PE resulting in syncope. Furthermore, malignant hepatocellular carcinoma (HCC), inferior vena cava, and right atrium tumor thrombus were diagnosed. INTERVENTIONS Thrombolysis and anti-coagulation therapy were performed immediately after the diagnosis of PE. Twenty-seven HCC patients with PE in 27 articles from 1962 to 2020 in the PubMed database were reviewed. OUTCOMES The improvement was achieved that no syncope recurred after treatment of PE. The oxygen partial pressure increased and the D-dimer level decreased. The clinical characteristics of 27 HCC patients with PE were summarized and analyzed. LESSONS It is important for clinicians to be aware that occult carcinoma might be a reason for patients with PE presenting with syncope. If PE cannot be explained by common causes, such as our patient, and HCC should be highly suspected when inferior vena cava and right atrial mass are found on imaging tests.
Collapse
Affiliation(s)
- Dayong Deng
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Haidi Wu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Huafang Wei
- Department of Internal Medicine-1, Jilin Provincial Cancer Hospital, Changchun, China
| | - Zikai Song
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Yang Yu
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Chongyin Zhang
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Lei Yang
- Department of Radiology, Jilin Provincial Cancer Hospital, Changchun, China
| |
Collapse
|
39
|
Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel) 2021; 9:870. [PMID: 34356248 PMCID: PMC8307931 DOI: 10.3390/healthcare9070870] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.
Collapse
Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Campus “S. Venuta”, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| |
Collapse
|
40
|
Giri A, Srinivasan A, Sundar IK. COVID-19: Sleep, Circadian Rhythms and Immunity - Repurposing Drugs and Chronotherapeutics for SARS-CoV-2. Front Neurosci 2021; 15:674204. [PMID: 34220430 PMCID: PMC8249936 DOI: 10.3389/fnins.2021.674204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected nearly 28 million people in the United States and has caused more than five hundred thousand deaths as of February 21, 2021. As the novel coronavirus continues to take its toll in the United States and all across the globe, particularly among the elderly (>65 years), clinicians and translational researchers are taking a closer look at the nexus of sleep, circadian rhythms and immunity that may contribute toward a more severe coronavirus disease-19 (COVID-19). SARS-CoV-2-induced multi-organ failure affects both central and peripheral organs, causing increased mortality in the elderly. However, whether differences in sleep, circadian rhythms, and immunity between older and younger individuals contribute to the age-related differences in systemic dysregulation of target organs observed in SARS-CoV-2 infection remain largely unknown. Current literature demonstrates the emerging role of sleep, circadian rhythms, and immunity in the development of chronic pulmonary diseases and respiratory infections in human and mouse models. The exact mechanism underlying acute respiratory distress syndrome (ARDS) and other cardiopulmonary complications in elderly patients in combination with associated comorbidities remain unclear. Nevertheless, understanding the critical role of sleep, circadian clock dysfunction in target organs, and immune status of patients with SARS-CoV-2 may provide novel insights into possible therapies. Chronotherapy is an emerging concept that is gaining attention in sleep medicine. Accumulating evidence suggests that nearly half of all physiological functions follow a strict daily rhythm. However, healthcare professionals rarely take implementing timed-administration of drugs into consideration. In this review, we summarize recent findings directly relating to the contributing roles of sleep, circadian rhythms and immune response in modulating infectious disease processes, and integrate chronotherapy in the discussion of the potential drugs that can be repurposed to improve the treatment and management of COVID-19.
Collapse
Affiliation(s)
| | | | - Isaac Kirubakaran Sundar
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| |
Collapse
|
41
|
Alshumrani G, Al bshabshe A, Mousa WF. Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients. Medicine (Baltimore) 2021; 100:e26213. [PMID: 34087898 PMCID: PMC8183708 DOI: 10.1097/md.0000000000026213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia.Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE.Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement.CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.
Collapse
Affiliation(s)
| | - Ali Al bshabshe
- Department of Medicine (Adult Critical Care Division), College of Medicine, King Khalid University, Abha
| | - Wesam Faried Mousa
- Department of Critical Care, Khamis General Hospital, Khamis Mushyet, Saudi Arabia
| |
Collapse
|
42
|
Tran D, Hays N, Shah A, Pasrija C, Cires-Drouet RS, Toursavadkohi SA, Mazzeffi MA, Herr DL, Madathil RJ, Gammie JS, Griffith BP, Deatrick KB, Kaczorowski DJ. Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation. J Card Surg 2021; 36:2685-2691. [PMID: 33982349 DOI: 10.1111/jocs.15622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound-assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA-ECMO for PE. METHODS A review of all VA-ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in-hospital death, 90-day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO. RESULTS Median age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA-ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in-hospital death, and were alive at 90-day follow-up. CONCLUSION Ekosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA-ECMO for PE, and allow for survival with RV recovery with minimal complications.
Collapse
Affiliation(s)
- Douglas Tran
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nicole Hays
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Aakash Shah
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rafael S Cires-Drouet
- Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shahab A Toursavadkohi
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael A Mazzeffi
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Daniel L Herr
- Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Ronson J Madathil
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Kristopher B Deatrick
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - David J Kaczorowski
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| |
Collapse
|
43
|
Acute pulmonary embolism mimicking COVID-19 pneumonia. Radiol Case Rep 2021; 16:2072-2076. [PMID: 33995743 PMCID: PMC8106876 DOI: 10.1016/j.radcr.2021.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/04/2022] Open
Abstract
The case of 21-year-old man with an asthma history from childhood presenting severe respiratory distress associated with a right lower thoracic pain has been studied. The non-contrast Computed Tomography (CT)-chest scan showed a basal ground-glass opacity (GGO) of the right lung leading to suspicion of COVID-19 pneumonia. However, the molecular Reverse transcription polymerase chain reaction test and blood serology were negative while laboratory analyses revealed high levels of D-dimers (D-D). In addition, 2 repeated COVID-19 tests were negative. A thoracic CT angiography was disclosed due to the persistence of pain at the lower right thoracic side and hemoptysis that shows a bilateral distal pulmonary embolism with a right-sided basal subsegmental ischemia. We discuss a fortuitous discovery of pulmonary embolism associated with peripheral basal ground-glass opacities similar to radiological manifestations of SARS-CoV-2 pneumonia.
Collapse
|
44
|
Rezapour A, Souresrafil A, Arabloo J. Economic Evaluation of New Oral Anticoagulants in Prevention of Venous Thrombosis Following Joint Replacement Surgery: A Systematic Review. Clin Ther 2021; 43:e139-e156. [PMID: 33875243 DOI: 10.1016/j.clinthera.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The main purpose of prescribing oral anticoagulants in patients undergoing total knee and total hip replacement surgery is to prevent venous thromboembolism (VTE). The present study aimed to summarize evidence from economic evaluations regarding new oral anticoagulants (NOACs) used in VTE prophylaxis after joint replacement surgery. METHODS To obtain relevant literature on economic evaluations of NOACs used in the prevention of VTE following joint replacement surgery, we searched the Cochrane Library, PubMed, Web of Science, Embase, and Scopus, as well as specialized economic evaluation databases, for articles published from January 2008 to December 2019. Next, 2 reviewers screened the titles and abstracts of studies, extracted data from the full-text articles, and assessed the quality of the methodologies using the Quality of Health Economic Studies checklist. FINDINGS Twenty-eight studies of economic evaluations met the inclusion criteria of the research. The quality assessment showed that 20 articles had scores within the range of 75 to 100 (high quality), and 9 studies had scores within the range of 50 to 74 (moderate quality). All of the identified studies had been carried out based on modelling, and 23 studies used decision trees to model acute events after surgery. In addition, 20 studies utilized a Markov model to capture long-term complications of VTE. The results showed that rivaroxaban was more cost-effective than apixaban and dabigatran from a perspective of the health care system in the prevention of VTE after total knee and total hip replacement surgery. In addition, apixaban was associated with a lower risk for bleeding events than other NOACs, making it the most cost-effective NOAC from the perspective of the payer. IMPLICATIONS The results suggest that NOACs are cost-effective alternatives to low-molecular-weight heparins. Rivaroxaban and dabigatran were assessed as the most and least cost-effective prophylaxis options, respectively, after joint replacement surgery for the prevention of VTE. It is recommended that future research be conducted on economic evaluations of edoxaban.
Collapse
Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Aghdas Souresrafil
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Jalal Arabloo
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
45
|
Celik AI, Bezgin T, Biteker M. Predictive role of the modified Glasgow prognostic score for in-hospital mortality in stable acute pulmonary embolism. Med Clin (Barc) 2021; 158:99-104. [PMID: 33781570 DOI: 10.1016/j.medcli.2020.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND IMPORTANCE The modified Glasgow prognostic score (mGPS) has been reported to have a prognostic value in various patient populations. However, the prognostic significance of mGPS has not been studied inacute pulmonary embolism (APE). OBJECTIVE This study aimed to investigate the predictive value of mGPS on in-hospital mortality in patients with hemodynamically stableAPE. METHODS We retrospectively included 258 hemodynamically stableAPE patients. Clinical, echocardiographic, and laboratory data recorded on admission. The mGPS scored as 0, 1, or 2 based on the C-reactive protein (CRP) and albumin levels. RESULTS A total of 258hemodynamically stableAPE patients were included, and 28 (10.9%) died during the hospital stay. Compared with survivors, non-survivors were older, had higher N-terminal pro-B-type natriuretic peptide, CRP, creatinine, high-sensitive cardiac troponin T (hs-cTnT), and mGPS levels, and had higher pulmonary embolism severity index (PESI) at study entry. In the multivariate logistic regression analysis, NT-proBNP>2350pg/mL (OR: 2.180, 95% CI 1.102-5.213, p<0.001), hs-cTnT>21pg/mL (OR: 1.426, 95% CI 0.951-3.751, p=0.001), CRP>3.1mg/dL (OR: 1.567, 95% CI 1.072-4.429, p=0.001), PESI>139 (OR: 2.745, 95% CI 0.869-6.369, p=0.001), systolic blood pressure<100mmHg (OR: 3.465, 95% CI 0.867-8.934, p<0.001), mGPS=1 (OR: 2.120, 95% CI 1.089-3.754, p=0.011), and mGPS=2 (OR: 3.350, 95% CI 1.457-5.367, p<0.001) were independently associated with in-hospital mortality. CONCLUSION This study demonstrates the mGPS, which is a new and easily measurable marker, is a useful predictor in-hospital mortality in hemodynamically stableAPE.
Collapse
Affiliation(s)
- Aziz Inan Celik
- Department of Cardiology, Gebze Fatih State Hospital, Kocaeli, Turkey.
| | - Tahir Bezgin
- Department of Cardiology, Gebze Fatih State Hospital, Kocaeli, Turkey
| | - Murat Biteker
- Department of Cardiology, Mugla Sıtkı Kocman University, Faculty of Medicine, Mugla, Turkey
| |
Collapse
|
46
|
Jusmanova K, Rice C, Bourke R, Lavan A, McMahon G, Cunningham C, Kenny RA, Briggs R. Response: Impact of a specialist service in the emergency department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness. QJM 2021; 114:78-79. [PMID: 33237312 DOI: 10.1093/qjmed/hcaa315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Jusmanova
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - C Rice
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - R Bourke
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - A Lavan
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - G McMahon
- Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - C Cunningham
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - R A Kenny
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - R Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
47
|
Dickerson KL, Brown DFM, Wittels K, Wilcox SR. Case Presentations of the Harvard Affiliated Emergency Medicine Residencies: Shortness of Breath and Cyanosis. J Emerg Med 2021; 60:684-687. [PMID: 33546920 DOI: 10.1016/j.jemermed.2020.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Katherine L Dickerson
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David F M Brown
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen Wittels
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
48
|
Tural K, Kara F, Avcı S, Erdoğdu Hİ. CAN COMPLETE BLOOD CELL COUNT PARAMETERS PREDICT DEEP VEIN THROMBOSIS? Acta Clin Croat 2020; 59:661-666. [PMID: 34285436 PMCID: PMC8253064 DOI: 10.20471/acc.2020.59.04.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/19/2018] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to evaluate complete blood cell count parameters including red blood cell indices, white blood cell subtypes, and platelet indices for predicting deep vein thrombosis (DVT). A total of 71 (44 male and 27 female) patients with acute femoral and popliteal DVT diagnosed by doppler ultrasonography during a period of seven years (2011-2017) were included in the study. By matching age and gender, 142 (88 male and 54 female) subjects diagnosed with venous insufficiency in the same time interval were assigned as control group. Data were obtained by reviewing hospital records of the study participants, including clinical and demographic characteristics and complete blood cell parameters. Frequencies of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure, and coronary arterial disease were higher in DVT group as compared to non-DVT group (p<0.05). Hemoglobin and lymphocyte values were lower, and red blood cell distribution width, neutrophil, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio higher in DVT group as compared with non-DVT group (p<0.05). There was no significant between-group difference in terms of mean corpuscular volume, platelet, mean platelet volume, mean platelet volume to platelet ratio, and platelet distribution width (p>0.05). Hypertension, hemoglobin, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. We found that hypertension, anemia, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. In particular, neutrophil to lymphocyte ratio and hemoglobin may be used as novel, inexpensive, and reliable diagnostic tools for DVT.
Collapse
Affiliation(s)
| | - Fatih Kara
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| | - Sema Avcı
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| | - Halil İbrahim Erdoğdu
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| |
Collapse
|
49
|
Mir T, Attique HB, Sattar Y, Regmi N, Khan MS, Youns H, Qayoom B, Jerger MT, Alraies MC. Does pulmonary embolism in critically ill COVID-19 patients worsen the in-hospital mortality: A meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:34-40. [PMID: 33257254 PMCID: PMC7687401 DOI: 10.1016/j.carrev.2020.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mortality in critically ill COVID (coronavirus disease) patients secondary to pulmonary embolism (PE) has conflicting data. We aim to evaluate the mortality outcomes of critically ill patients with and without PE (WPE). METHODS Three studies were identified after a digital database search on PE in ICU (intensive care unit) patients until September 2020. The primary outcome was mortality. Outcomes were compared using a random method odds ratio and confidence interval of 95%. RESULTS A total of 439 patients were included in the study. Diabetes, hypertension, and renal replacement requirement had no statistically significant association between PE and WPE, p = 0.39, p = 0.23, and p = 0.29 respectively. The study revealed that males have higher odds of PE, OR-1.98, 95%CI-1.01-3.89; p = 0.05. In-hospital mortality results were comparable between PE and WPE after subgroup analysis and correction of heterogeneity, p = 0.25. CONCLUSION PE in critically ill COVID patients had similar in-hospital mortality outcomes as WPE patients. The findings are only hypotheses generated from observational studies and need future randomized, prospective clinical trials for a definitive conclusion.
Collapse
Affiliation(s)
- Tanveer Mir
- Internal Medicine Detroit Medical Center, Wayne State University, Detroit, USA.
| | | | - Yasar Sattar
- Icahn School of Medicine at Mount Sinai Elmhurst Hospital, New York, USA
| | - Neelambuj Regmi
- Department of Pulmonary and Critical Care, Detroit Medical Center/Wayne State University, USA
| | | | - Haris Youns
- Internal Medicine Detroit Medical Center, Wayne State University, Detroit, USA
| | | | - Michael T Jerger
- Department of Pulmonary and Critical Care, Detroit Medical Center/Wayne State University, USA
| | | |
Collapse
|
50
|
Peng L, Han L, Li XN, Miao YF, Xue F, Zhou C. The Predictive Value of microRNA-134 and microRNA-1233 for the Early Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Pulmonary Embolism. Int J Chron Obstruct Pulmon Dis 2020; 15:2495-2503. [PMID: 33116466 PMCID: PMC7575827 DOI: 10.2147/copd.s266021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background The differential diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with acute pulmonary embolism (APE) complications are difficult because of the variability of clinical presentations and the shortage of an unfailing screening biomarkers or instruments. Objective Aimed to detect and compare the expression of serum microRNAs (miR-1233, miR-134) in AECOPD patients complicated with APE. Patients/Methods Blood samples were collected from 52 AECOPD patients (13 patients with APE complications, 39 patients without APE) and 10 patients with stable COPD. Serum miRNAs expression was detected with real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). The levels of plasma D-dimers were determined by detection with an enzyme-linked immunosorbent assay (ELISA). The receiver-operator characteristic (ROC) curve was used for evaluating the diagnostic accuracy of the studied miRNAs. Results According to the Wells score, 42 of the 52 AECOPD patients were unlikely to have APE (≤4 points), whereas the remaining 10 (>4 points) were likely to have APE. There were 4 cases (4/13 30.8%) in the AECOPD combined with APE group with a Wells score of >4 points. The expression levels of miR-1233 and miR-134 in the serum were considerably upregulated in the AECOPD+APE group compared with the AECOPD group and the stable COPD group (P<0.05). The areas under the curve (AUCs) for miR-134 and miR-1233 were, respectively, 0.931 (95% CI 0.863-0.999) (P<0.05) and 0.884 (95% CI 0.79-0.978) (P<0.05) and were higher compared with the AUC for D-dimer of 0.628 (95% CI 0.447-0.809), the AUC for age-adjusted D-dimer of 0.705 (95% CI 0.525-0.885) and the AUC for Wells score of 0.577 (95% CI 0.389-0.765). Conclusion Our study indicated that serum miR-1233 and miR-134 have high clinical value in the early diagnosis of AECOPD patients combined with APE, or could be used as potential biomarkers for clinical identification of AECOPD with or without APE complication.
Collapse
Affiliation(s)
- Ling Peng
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- Department of Respiratory Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Li Han
- Department of Respiratory Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Xiao-Ning Li
- Department of Respiratory Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Ya-Fang Miao
- Department of Respiratory Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Fei Xue
- Department of Respiratory Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China
| | - Chao Zhou
- School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- Department of Respiratory Medicine, Guangming Traditional Chinese Medicine Hospital of Pudong New Area, Shanghai, People’s Republic of China
| |
Collapse
|