Clinical characteristics and outcomes of bone marrow transplantation patients presenting to the ED of a tertiary care center.

BACKGROUND: Bone marrow transplantation is a breakthrough in the world of hematology and oncology. In our region, there is scarce literature studying emergency department visits among BMT patients, as well as their predictors of mortality. OBJECTIVES: This study aimed to assess the frequency, reasons, clinical characteristics and outcomes of patients presenting to the ED after a BMT, and to study the predictors of mortality in those patients. This study also compares those variables among the different types of BMT. METHODS: This was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and visited the ED. RESULTS: Our study included 115 BMT patients, of whom 17.4% died. Those who died had a higher median number of ED visits than those who did not die. Around 36.5% presented with fever/chills with 29.6% diagnosed with pneumonia on discharge. We found that the odds of mortality were significantly higher among those who presented with dyspnea (p < .0005) and AMS (p = .023), among septic patients (p = .001), those who have undergone allogeneic BMT (p = .037), and those who were admitted to the ICU (p = .002). Moreover, the odds of mortality were significantly higher among hypotensive (p ≤0005) and tachycardic patients (p = .015). CONCLUSION: In our study, we have shown that BMT patients visit the ED very frequently and have high risk of in-hospital mortality. Moreover, our study showed a significant association between mortality and patients with dyspnea, AMS, sepsis, allogeneic BMT type, ICU admission, hypotension and tachycardia.

Comparison of outcomes in ST-elevation myocardial infarction according to age.

BACKGROUND: Myocardial infarction constitutes a significant cause of morbidity and mortality. Its pathophysiology varies according to age; atherosclerosis is the most common cause in older patients while thrombosis or plaque rupture is behind premature MI. OBJECTIVE: To compare the outcome differences between young (age ≤ 45 years) and older adults (age > 45 years) presenting with STEMI. METHOD: This was a retrospective cohort study of patients presenting with STEMI to the Emergency Department of a tertiary care center, between 2008 and 2018.Cases were patients age ≤ 45 and controls were the older population. Descriptive and bivariate analyses were conducted followed by Logistic regression to identify the outcomes. RESULTS: 107 cases were matched with 214 controls. Majority of patients were males (93% of cases and controls). Younger patients were more likely to be smokers (80% vs. 57%, p < 0.001) and with a family history of MI (56% vs. 37%, p = 0.002). Diabetes, hypertension, dyslipidemia and a previous history of MI were more common among controls, 37%, 60%, 43% and 42% respectively versus 10%, 24%, 36% and 25% in the younger population. Younger patients had a higher prevalence of single-vessel disease compared to older patients (73% vs. 50%, p = 0.001). LAD was the most commonly blocked vessel in both groups (71% vs. 64% respectively). Ejection fraction was within normal range in the majority of controls and cases (63% vs. 56% respectively and 57% vs. 60% respectively). CONCLUSION: Premature MI predominantly affects males and the associated risk factors are smoking and family history of MI. It's characterized by single-vessel disease as compared to older patients.