Impact in total ischemic time and ST-segment elevation myocardial infarction admissions during COVID-19.

BACKGROUND: Despite the COVID-19 pandemic, cardiovascular disease is still the main cause of death in developed countries. Of these deaths, acute coronary syndromes (ACS) account for a substantial percentage of deaths. Improvement in ACS outcomes, are achieved by reducing the time from symptom onset until reperfusion or total ischemic time (TIT). Nevertheless, due to the overwhelming reality at the beginning of the pandemic, acute coronary syndrome (ACS) care may have been compromised. OBJECTIVES: We evaluated delays in TIT based on the date and timing of admissions in patients with STEMI, by a timeline follow-up form, before and during the current COVID-19 pandemic. METHODS: Between July 2018 and June 2020, two hundred and twelve patients diagnosed with ST-segment elevation myocardial infarction (STEMI) were admitted to our medical center. Upon presentation, cases were assigned a timeline report sheet and each time interval, from onset of symptoms to the catheterization lab, was documented. The information was later evaluated to study potential excessive delays throughout ACS management. RESULTS: Our data evidenced that during the COVID-19 pandemic ACS admissions were reduced by 34.54%, in addition to several in-hospital delays in patient's ACS management including delays in door-to-ECG time (9.43 ± 18.21 vs. 18.41 ± 28.34, p = 0.029), ECG-to-balloon (58.25 ± 22.59 vs. 74.39 ± 50.30, p = 0.004) and door-to-balloon time (57.41 ± 27.52 vs. 69.31 ± 54.14, p = 0.04). CONCLUSIONS: During the pandemic a reduction in ACS admissions occurred in our hospital that accompanied with longer in-hospital TIT due to additional tests, triage, protocols to protect and prevent infection within hospital staff, and maintenance of adequate standards of care. However, door-to-balloon time was maintained under 90 min.

[Pulmonary embolism in athletes--a surprising diagnosis].

Pulmonary embolus is considered a rare and surprising event in the athletic population. Failure to diagnose this condition may lead to serious morbidity and even death. We report a case series of athletes diagnosed at the Acute Diagnostic Unit over the last two years, and discuss the special diagnostic, mechanistic and treatment principles in this population. We hope that this article will increase awareness of this condition amongst the medical teams dealing with this super fit population.

Civilian doctors in military clinics--outsourcing for better medicine.

OBJECTIVES: To determine whether outsourcing of medical consulting services could improve the quality of medical treatment in military primary care clinics. METHODS: Data were collected prospectively over 2 months in two regular army clinics manned by ordinary army doctors and in two intervention clinics also staffed with senior civilian doctors. The causes for doctor visits, diagnoses, and other patient data were collected. RESULTS: Information was recorded from 4970 soldier visits in the four clinics. Although a prescription of rest days was similar in both types of clinics, the level of tertiary referrals was lower by one-third in the intervention clinics compared to the regular clinics. Surrogate markers for quality of care, such as increased use of planned follow-up and reduced antibiotic use, were significantly better in the intervention clinics, and so was overall patient satisfaction. CONCLUSIONS: Integration of specialist civilian physicians in the military primary care system is highly beneficial and provides better care and saves costs.

Acute pulmonary edema in the emergency department: clinical and echocardiographic survey in an aged population.

BACKGROUND: This study is aimed at better defining the prevalence of left ventricular dysfunction, atrial fibrillation, and mitral regurgitation in aged patients with cardiogenic acute pulmonary edema. METHODS: One hundred and twenty-three consecutive patients with acute pulmonary edema (APE) arriving at the emergency department of a peripheral hospital who underwent Doppler echocardiography within 36 hours of admission were reviewed retrospectively. RESULTS: Left ventricular ejection fraction (LVEF) was normal or near normal (ie, LVEF > or = 40%) in 41.4% (n = 51 patients), and depressed in 58.5% (n = 72). Significant valvular dysfunction was present in 37.4%; mitral regurgitation was the most frequent (22.8%; n = 28). We found a significant positive correlation between systolic blood pressure (SBP) and LVEF (P = 0.003). Within the group of patients presenting with lower SBP (< or = 140 mm Hg), as blood pressure diminished, LVEF also diminished significantly (P = 0.008). In a logistic regression analysis, male sex and SBP of less than 120 mm Hg were found to be the strongest predictors for LVEF < or = 40%, conferring a 2.68- and 2.73-fold risk, respectively (95%CI, 1.19 to -6.00; P = 0.016 and 95%CI, 0.956-7.80; P = 0.061, respectively) compared with female sex and higher SBP groups. CONCLUSIONS: This study emphasizes that emergency departments should have clear-cut policies for diagnosing and treating acute coronary syndromes and tachyarrhythmias, as being potential treatable causes of APE. Once stabilized, patients should be examined for treatable valvular causes. A further study, of acute echocardiography done upon arrival to the emergency department in patients with APE is warranted.