ABSTRACT
OBJECTIVE: The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. METHODS: A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. RESULTS: Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159-5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259-0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. CONCLUSIONS: A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.
Subject(s)
Endocarditis/epidemiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Cohort Studies , Endocarditis/microbiology , Endocarditis/mortality , Endocarditis/virology , Greece/epidemiology , Humans , Male , Middle Aged , Prospective StudiesSubject(s)
Carcinoid Heart Disease/diagnostic imaging , Carcinoid Tumor/pathology , Echocardiography/methods , Neuroendocrine Tumors/complications , Aftercare , Aged , Ascites/drug therapy , Ascites/surgery , Carcinoid Heart Disease/complications , Carcinoid Heart Disease/drug therapy , Carcinoid Heart Disease/pathology , Carcinoid Tumor/complications , Female , Humans , Liver/diagnostic imaging , Liver/pathology , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/secondary , Paracentesis/methods , Somatostatin/analogs & derivatives , Somatostatin/metabolism , Treatment OutcomeABSTRACT
A 87-year-old woman was hospitalised because of a third-degree atrioventricular block. After the insertion of a temporary pacemaker lead through the left subclavian vein, she developed an ipsilateral pneumothorax. Although there were clinical and echocardiographic signs of cardiac tamponade after chest tube placement for pneumothorax, a second echocardiogram performed after transportation for surgical drainage failed to demonstrate the presence of any pericardial fluid, while the patient showed an unexpected clinical improvement. A new X-ray showed a collection of left pleural fluid. Over the following days a limited amount of blood was drained through the tube with disappearance of the pleural effusion and no further signs of major bleeding. A permanent DDD pacemaker was subsequently implanted and the patient was discharged in a good condition.
