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1.
Rev Med Suisse ; 17(728): 418-423, 2021 Mar 03.
Artigo em Francês | MEDLINE | ID: mdl-33656293

RESUMO

SARS-CoV-2 affects the cardiovascular system triggering a proinflammatory response which results in direct and indirect myocardial injury. The objective of this article is to describe the underlying mechanisms and clinical implications.


Le système cardiovasculaire est largement affecté par le coronavirus SARS-CoV-2. La maladie à coronavirus 2019 (Covid-19) peut déclencher une réaction inflammatoire intense, responsable de lésions myocardiques directes et indirectes chez environ un quart des patients hospitalisés. L'objectif de cet article est de décrire les mécanismes sous-jacents aux atteintes cardiovasculaires et de discuter les potentielles implications cliniques.


Assuntos
COVID-19 , Doenças Cardiovasculares , Humanos , SARS-CoV-2
2.
J Clin Med ; 12(17)2023 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-37685579

RESUMO

BACKGROUND: The appropriate selection of patients for the intensive care unit (ICU) is a concern in acute care settings. However, the description of patients deemed too well for the ICU has been rarely reported. METHODS: We conducted a single-centre retrospective observational study of all patients either deemed "too well" for or admitted to the ICU during one year. Refused patients were screened for unexpected events within 7 days, defined as either ICU admission without another indication, or death without treatment limitations. Patients' characteristics and organisational factors were analysed according to refusal status, outcome and delay in ICU admission. RESULTS: Among 2219 enrolled patients, the refusal rate was 10.4%. Refusal was associated with diagnostic groups, treatment limitations, patients' location on a ward, night time and ICU occupancy. Unexpected events occurred in 16 (6.9%) refused patients. A worse outcome was associated with time spent in hospital before refusal, patients' location on a ward, SOFA score and physician's expertise. Delayed ICU admissions were associated with ICU and hospital length of stay. CONCLUSIONS: ICU triage selected safely most patients who would have probably not benefited from the ICU. We identified individual and organisational factors associated with ICU refusal, subsequent ICU admission or death.

3.
Catheter Cardiovasc Interv ; 77(1): 154-7, 2011 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-20602473

RESUMO

Central venous catheter (CVC) placement, even if performed under duplex scan control, may be associated with incidental arterial injury leading to increased morbidity, mortality, and prolonged hospital stay. Erroneous CVC placement in the carotid or subclavian arteries has been usually treated surgically because those puncture sites may not be efficaciously compressed manually. However, surgery in this setting may be challenging because of difficulty of access for the catheters positioned in the subclavian artery and of the risk of cerebrovascular complications for carotid catheters. Recently, several cases have been published, describing the successful endovascular management of iatrogenic arterial injury using different types of vascular closure devices (VCD). However, in this setting, it remains difficult to be completely sure that the VCD has achieved complete hemostasis and that the patient does not subsequently incur in a clinically silent intrathoracic bleeding. We report the case of an erroneous CVC placement in the right subclavian artery successfully retrieved using an Angioseal VCD. The immediate and complete hemostasis at the puncture site was confirmed at angiography.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Erros Médicos , Artéria Subclávia , Idoso , Cateterismo Venoso Central/instrumentação , Remoção de Dispositivo/efeitos adversos , Desenho de Equipamento , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Punções , Radiografia , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento
5.
BMJ Case Rep ; 20132013 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-23376677

RESUMO

We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day 4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results.


Assuntos
Estenose Coronária/diagnóstico , Doença da Descompressão/diagnóstico , Mergulho/efeitos adversos , Dor no Peito/etiologia , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Doença da Descompressão/complicações , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Stents , Trombectomia
6.
Am J Drug Alcohol Abuse ; 33(5): 665-74, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17891659

RESUMO

We studied profile of patients (n=1782) treated in specialized centers and general practice (GP) enrolled in methadone maintenance treatment (MMT) programs during 2001 in the Swiss Canton of Vaud. We found that GPs treated the majority of patients (76%). Specialized centers treated a higher proportion of patients with uncontrolled intravenous use of cocaine and heroin, and prescribed neuroleptics as concomitant medication three times more frequently than GPs. Patients treated in specialized centers were more likely to undergo screening for HIV, HBV, HCV, and receive complete HBV immunization. In conclusion, specialized centers are more likely to treat severely addicted patients and patients with a poor global assessment (physical, psychiatric, and social).


Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Sorodiagnóstico da AIDS , Adulto , Antipsicóticos/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/reabilitação , Estudos Transversais , Quimioterapia Combinada , Medicina de Família e Comunidade/métodos , Feminino , Seguimentos , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Dependência de Heroína/tratamento farmacológico , Dependência de Heroína/reabilitação , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pacientes Desistentes do Tratamento , Centros de Tratamento de Abuso de Substâncias/métodos , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/reabilitação , Inquéritos e Questionários , Suíça
7.
Eur Addict Res ; 11(2): 99-106, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15785071

RESUMO

Using data from the Public Health Service, we studied the demographic and clinical characteristics of 1,782 patients enrolled in methadone maintenance treatment (MMT) during 2001 in the Swiss Canton of Vaud, comparing our findings with the results of a previous study from 1976 to 1986. In 2001, most patients (76.9%) were treated in general practice. Mortality is low in this MMT population (1%/year). While patient age and sex profiles were similar to those found in the earlier study, we did observe a substantial increase in the number of patients and the number of practitioners treating MMT patients, probably reflecting the low-threshold governmental policies and the creation of specialized centers. In conclusion, easier access to MMT enhances the number of patients, but new concerns about the quality of management emerge: benzodiazepine as a concomitant prescription; low rates of screening for hepatitis B, C and HIV, and social and psychiatric preoccupations.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Metadona/uso terapêutico , Entorpecentes/uso terapêutico , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Área Programática de Saúde , Demografia , Feminino , Soropositividade para HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite B/terapia , Vacinas contra Hepatite B/administração & dosagem , Humanos , Masculino , Administração em Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários , Suíça/epidemiologia
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