Age shock index as an early predictor of cardiovascular death in acute coronary syndrome patients.

BACKGROUND: The shock index (SI), reflecting heart rate (HR) to SBP ratio, is established for predicting adverse outcomes in acute coronary syndrome (ACS) patients. Exploring the age shock index (ASI), obtained by multiplying SI with age, could offer further insights into ACS prognosis. OBJECTIVES: Assess ASI's effectiveness in predicting in-hospital death in individuals with ACS. METHODS: This study encompassed patients with acute myocardial infarction, drawn from a national registry spanning October 2010 to January 2022. The optimal ASI threshold was established using receiver operating characteristic (ROC) curve analysis. The primary outcome was in-hospital mortality. RESULTS: A total of 27 312 patients were enrolled, exhibiting a mean age of 66 ±â€…13 years, with 72.3% being male and 47.5% having ST-elevation myocardial infarction. ROC analysis yielded an area under the curve (AUC) of 0.80, identifying the optimal ASI cutoff as 44. Multivariate regression analysis, adjusting for potential confounders, established ASI ≥ 44 as an independent predictor of in-hospital death [hazard ratio: 3.09, 95% confidence interval: 2.56-3.71, P  < 0.001]. Furthermore, ASI emerged as a notably superior predictor of in-hospital death compared to the SI (AUC ASI  = 0.80 vs. AUC SI  = 0.72, P  < 0.0001), though it did not outperform the Global Registry of Acute Coronary Events (GRACE) score (AUC ASI  = 0.80 vs. AUC GRACE  = 0.85, P  < 0.001) or thrombolysis in myocardial infarction (TIMI) risk index (AUC ASI  = 0.80 vs. AUC TIMI  = 0.84, P  < 0.001). CONCLUSION: The ASI offers an expedient mean to promptly identify ACS patients at elevated risk of in-hospital death. Its simplicity and effectiveness could render it a valuable tool for early risk stratification in this population.

A Giant Mass Filling the Left Atrium: A Case Report.

BACKGROUND: Cardiac tumors have heterogeneous and unspecific clinical presentations which is why their diagnosis is difficult. CASE REPORT: A middle-aged woman presented to the emergency department with unspecific symptoms developing over 2 weeks. Multimodality imaging revealed a large mass filling the left atrium with a large base adherent to the fossa ovalis and flow obstruction. After surgical extraction, the anatomopathological analysis was compatible with a primary benign cardiac tumor. CONCLUSION: Clinical presentation of cardiac tumors is usually unspecific and multimodality imaging is crucial in the diagnostic workflow. Surgical excision should be performed as quickly as possible.

Impact of coronary angioplasty in elderly patients with non-ST-segment elevation myocardial infarction.

BACKGROUND: As treatment of coronary artery disease improved over the last years, management of elder patients remained a matter of debate since this age group has been underrepresented in most trials. The study aimed to evaluate a population of patients with ≥ 85 years old with non-ST-segment elevation myocardial infarction (NSTEMI) and compare the prognosis according to coronary revascularization execution. METHODS: We retrospectively studied 324 patients included in a national multicenter registry between October 2010 and October 2018, who underwent coronary angiography and had at least one stenosis ≥ 50%. RESULTS: In this population, 73.1% of the patients underwent percutaneous coronary intervention (PCI) and 26.9% of the patients underwent optimized medical treatment (OMT). The OMT group had more past history of diabetes, stroke and dementia. On coronary angiography, the PCI group used more often the femoral artery access and single-vessel lesions were also more common. Three-vessel disease was more common in the OMT group. During hospitalization, there were more major bleeding events and death in the PCI group. During the one-year follow-up, there were no significant differences in all-cause mortality rate. CONCLUSIONS: Very old patients with NSTEMI submitted to OMT had more comorbidities and more three-vessel disease, factors that could have influenced the therapeutic decision. Patients undergoing PCI had more in-hospital major bleeding events and mortality, with no significant differences after one year.

Psicoterapia em grupo com mães de desnutridos crônicos / Group psychotherapy with mothers of malnutrition children

Neste estudo, observamos que a psicoterapia em grupo permite que as mães percebam seus sentimentos de desesperança, apatia e impotência para exercer o papel materno. À medida que compartilham essas dificuldades, confrontando-as com as situações vividas por outras mães, passam a ter acesso a novas significações. Essa concepção/interpretação permite que as mães se re-situem em função do papel que estão ocupando, restabelecendo sua condição de sujeito e podendo intervir ativamente no seu ambiente e no relacionamento com seu filho.

Aplicacao de protocolo para diagnóstico de demência, segundo os critérios do DSM-III-R: resultados preliminares / Application of a workup for the diagnosis of dementia, according to DSM-III-R criteria: preliminary results

O protocolo para diagnóstico de demência do Serviço de Geriatria do HSPE foi desenvolvido para: investigar sistematicamente os que procuravam seu ambulatório com queixa de prejuízo cognitivo e estudar detalhadamente os pacientes com diagnóstico clínico de demência. Neste trabalho apresentamos os resultados preliminares da aplicaçäo desse protocolo a 26 pacientes, destacando as características clínicas da populaçäo estudada e discutindo os resultados encontrados no teste mental (Mini Mental State Examination, MMSE) e nos exames complementares (exames laboratoriais, radiografia de tórax, ECG e TC de crânio) aplicados aos pacientes. Os resultados iniciais indicam que a aplicaçäo sistem tica de protocolo de investigaçäo, especialmente em casos iniciais de demência possibilita: 1) a detecçäo eventual de casos potencialmente reversíveis; 2) a identificaçäo de fatores agravantes dessa síndrome, facilitando o tratamento de condiçöes associadas à demência; 3) a obtençäo de diagnósticos etiológicos mais precoces e precisos

Aplicacao de protocolo para o diagnostico de demencia, segundo os criterios do DSM-III-R: resultados preliminares

O protocolo para o diagnostico de demencia do Servico de Geriatria do HSPE foi desenvolvido para: investigar sistematicamente os que procuravam seu ambulatorio com queixa de prejuizo cognitivo e estudar detalhadamente os pacientes com diagnostico clinico de demencia. Neste trabalho apresentamos os resultados preliminares da aplicacao desse protocolo a 26 pacientes, destacando as caracteristicas clinicas da populacao estudada e discutindo os resultados encontrados no teste mental (Mini Mental State Examination, MMSE) e nos exames complementares (exames laboratoriais, radiografia de torax, ECG e TC de cranio) aplicados aos pacientes. Os resultados iniciais indicam que a aplicacao sistematica de protocolo de investigacao, especialmente em casos iniciais de demencia, possibilita: 1) a deteccao eventual de casos potencialmente reversiveis; 2) a identificacao de fatores agravantes dessa sindrome, facilitando o tratamento de condicoes associadas a demencia; e 3) a obtencao de diagnosticos etiologicos mais precoces e precisos.