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1.
Pan Afr Med J ; 36: 257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014253

RESUMO

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Dor Abdominal/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Lesões Encefálicas/complicações , Dor no Peito/complicações , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Achados Incidentais , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Tunísia/epidemiologia , Adulto Jovem
2.
BMC Infect Dis ; 20(1): 662, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907540

RESUMO

BACKGROUND: The outbreak of the novel coronavirus (COVID-19) that was firstly reported in Wuhan, China, with cases now confirmed in more than 100 countries. However, COVID-19 pneumonia with spontaneous pneumothorax is unknown. CASE PRESENTATION: We reported a case of 66-year-old man infected with COVID-19, presenting with fever, cough and myalgia; The patient received supportive and empirical treatment including antiviral treatment, anti-inflammatory treatment, oxygen supply and inhalation therapy; The symptoms, CT images, laboratory results got improved after the treatments, and a throat swab was negative for COVID-19 PCR test; However, on the hospital day 30, the patient presented with a sudden chest pain and dyspnea. CT showed a 30-40% left-sided pneumothorax. Immediate thoracic closed drainage was performed and his dyspnea was rapidly improved. With five more times negative PCR tests for SARS-CoV-2 virus, the patient was discharged and home quarantine. CONCLUSION: This case highlights the importance for clinicians to pay attention to the appearance of spontaneous pneumothorax, especially patients with severe pulmonary damage for a long course, as well as the need for early image diagnose CT and effective treatment once pneumothorax occurs.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pneumotórax/complicações , Idoso , Betacoronavirus/patogenicidade , Dor no Peito/complicações , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Tosse/complicações , Drenagem , Dispneia/complicações , Febre/complicações , Humanos , Masculino , Pandemias , Alta do Paciente , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Pneumotórax/terapia
3.
Dig Dis ; 38(5): 355-363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995802

RESUMO

BACKGROUND: Hypercontractile motility of the esophagus is occasionally noted on high-resolution manometry (HRM), but its clinical correlations are unclear. We compared symptom severity and clinical presentation of patients with hypercontractile motility of the esophagus. METHODS: This was a retrospective cohort study. We queried a prospectively maintained database for patients who underwent esophageal function testing from October 1, 2016, to October 30, 2018. We included patients with jackhammer esophagus (JE; ≥2 swallows with distal contractile integral [DCI] ≥8,000 mm Hg∙cm∙s), nutcracker esophagus (NE; mean DCI 5,000-8,000 mm Hg∙cm∙s without meeting JE criteria), or esophagogastric junction outflow obstruction ([EGJOO]: abnormal median integrated relaxation pressure (>15 mm Hg) without meeting achalasia criteria, with JE [EGJOO-h], or normal motility [EGJOO-n]). HRM, endoscopy, barium esophagram, ambulatory pH studies, and symptom questionnaires were reevaluated for further analysis. Clinical parameters were analyzed using Spearman Rho correlation. Categorical variables were assessed with Fisher exact or chi-square test. RESULTS: Altogether, 85 patients met inclusion criteria. They were divided into 4 subgroups: 28 with JE, 18 with NE, 15 with EGJOO-h, and 24 with EGJOO-n. Patients with EGJOO-h were the most symptomatic overall. No correlation was seen between symptoms and mean DCI (p ≥ 0.05 all groups) or number of hypercontractile swallows (≥8,000 mm Hg∙cm∙s, p ≥ 0.05). A significant correlation was noted between dysphagia and lower esophageal sphincter pressure (LESP) and LESP integral (p ≤ 0.05). CONCLUSION: The number of hypercontractile swallows and mean DCI were not associated with patient-reported symptoms. Elevated LESP may be a more relevant contributor to dysphagia.


Assuntos
Manometria , Contração Muscular/fisiologia , Peristaltismo/fisiologia , Idoso , Dor no Peito/complicações , Dor no Peito/fisiopatologia , Transtornos de Deglutição/complicações , Transtornos de Deglutição/fisiopatologia , Endoscopia , Transtornos da Motilidade Esofágica/complicações , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/fisiopatologia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Relaxamento Muscular , Pressão , Estudos Retrospectivos , Inquéritos e Questionários
4.
Intern Emerg Med ; 15(2): 319-326, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31729617

RESUMO

We studied whether previously developed cardiac risk scores-including history, ECG, age, risk factors, and troponin (HEART); Thrombolysis in Myocardial Infarction (TIMI); Global Registry of Acute Coronary Events (GRACE); and Emergency Department Assessment of Chest Pain (EDACS)-could be applied to predict major adverse cardiac events (MACE) in patients with possible coronary artery disease, including anginal equivalents. Patients with chest pain or anginal equivalents who underwent coronary computed tomographic angiography were included. The primary outcome was 30-day MACE. We compared the cardiac risk scores by the area under the receiver-operating characteristic curves (AUC). The primary outcome occurred in 200 patients (16.0%) of the 1247 patients included. For the prediction of MACE, the AUC of the HEART score (0.765) was superior to those of the TIMI (0.726), GRACE (0.612), and EDACS (0.631) scores. Among patients identified by each score as being at low risk, the MACE rate was the lowest for the HEART score (5.7%), followed by the TIMI (8.8%), EDACS (11.2%), and GRACE (12.2%) scores. At a sensitivity level of a < 2% rate of misses, the negative predictive value of the HEART score (1.0) outperformed those of the GRACE (0.932) and EDACS (0.964). The HEART score appeared to be more predictive of MACEs than the TIMI, GRACE, and EDACS in patients with chest pain or anginal equivalents. However, previously suggested cutoff could not safely identify low-risk patients for early discharge because of the unacceptably high rate of missed MACEs.


Assuntos
Dor no Peito/complicações , Medição de Risco/métodos , Idoso , Área Sob a Curva , Dor no Peito/mortalidade , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , República da Coreia , Estudos Retrospectivos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos , Fatores de Risco
5.
Drug Discov Ther ; 13(5): 297-298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31723102

RESUMO

Myocardial injury with systemic sclerosis (SSc) causes pericarditis and arrhythmia, and polymyositis-induced muscle inflammation causes myocarditis. We report a rare case of overlap syndrome (SSc and polymyositis) who presented with sudden chest pain secondary to myocardial fibrosis. Although the etiology of chest symptoms in collagen disease was difficult to identify, cardiac magnetic resonance imaging (MRI) revealed not myocarditis but myocardial fibrosis in our case. Synthetic judgement of serum brain natriuretic peptide/ troponin T levels and cardiac MRI is useful in the search for the cause of chest symptoms even in patients with collagen diseases.


Assuntos
Dor no Peito/diagnóstico , Fibrose/diagnóstico por imagem , Fibrose/patologia , Coração/diagnóstico por imagem , Miocárdio/patologia , Polimiosite/complicações , Esclerodermia Difusa/complicações , Dor no Peito/complicações , Fibrose/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Peptídeo Natriurético Encefálico/sangue , Polimiosite/sangue , Polimiosite/diagnóstico , Esclerodermia Difusa/sangue , Esclerodermia Difusa/diagnóstico , Síndrome , Troponina T/sangue , Adulto Jovem
6.
Medicine (Baltimore) ; 98(39): e17195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574826

RESUMO

The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared with concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD).A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into 4 groups: ECG-/Echo- (negative ECG and Echo), ECG+/Echo- (positive ECG and negative Echo), ECG-/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death.MACEs were similar between ECG-/Echo- and ECG+/Echo- groups. Compared with ECG+/Echo- group, ECG-/Echo+ group had more MACEs (adjusted hazard ratio [HR] adjusted by clinical risk factors [95% confidence interval {CI}], 3.57 [1.75-7.29], P < .001). Compared with ECG+/Echo+ group, ECG-/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs (HR, 0.49 [0.29-0.81], P = .006).Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared with exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes.


Assuntos
Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Infarto do Miocárdio/fisiopatologia , Adulto , Idoso , Dor no Peito/complicações , Angiografia Coronária , Doença da Artéria Coronariana/etiologia , Exercício Físico/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X
7.
Medicine (Baltimore) ; 98(26): e15884, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261496

RESUMO

Proton pump inhibitor (PPI)-refractory non-cardiac chest pain (NCCP) is often resolved when constipation was relieved. This study aimed to investigate the clinical features of patients with both NCCP and constipated functional bowel disorders (FBD).Among 692 consecutive patients diagnosed with functional constipation or irritable bowel syndrome with constipation and underwent anorectal manometry (ARM) in our hospital, PPI-refractory NCCP was present in 37. The clinical course of various torso symptoms including NCCP and ARM findings were retrospectively evaluated.The mean age was lower in the NCCP than in the non-NCCP group (57.4 vs 61.3 years, respectively, P = .042). Back pain (16.2% vs 2.0%, P < .001) and sharp abdominal pain (13.5% vs 0.9%, P < .001) were more common in the NCCP group. Increased resting pressure (16.2% vs 6.9%, P = .036) and squeezing pressure (62.2% vs 50.7%, P = .049) of the anal sphincter, increased urgency volume (40.5% vs 23.2%, P = .004), and maximal volume (25.7% vs 15.0%, P = .032) for rectal sensation were more frequently observed in the NCCP group. After taking laxatives for 1 to 3 months, 81.1% of patients with NCCP reported improvement.Subjects with NCCP showed decreased rectal sensation more frequently at anorectal manometry. Majority of patients with NCCP reported improvement of symptom upon relief of constipation. Constipation might be a therapeutic target in patients with NCCP related to constipated functional bowel disorders.


Assuntos
Dor no Peito/complicações , Dor no Peito/tratamento farmacológico , Constipação Intestinal/complicações , Constipação Intestinal/tratamento farmacológico , Laxantes/uso terapêutico , Fatores Etários , Canal Anal/fisiopatologia , Dor no Peito/fisiopatologia , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/tratamento farmacológico , Síndrome do Intestino Irritável/fisiopatologia , Estudos Longitudinais , Masculino , Manometria , Pessoa de Meia-Idade , Fenótipo , Reto/fisiopatologia , Estudos Retrospectivos , Sensação , Resultado do Tratamento
8.
Biomark Med ; 13(5): 379-392, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30920848

RESUMO

Aim: We evaluated the role of the tubular biomarkers N-acetyl-ß-D-glucosaminidase (NAG), kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with chest pain. Methods: Serum and urine samples were collected of 223 patients and 47 healthy controls. None of them was exposed to contrast media. Results: NAG showed among others significant correlation with N-terminal pro brain natriuretic peptide (NTproBNP), troponin I and creatinine. KIM-1 and NGAL showed weaker correlations. NAG was significantly elevated in all subgroups of acute coronary syndrome (ACS) compared with chest wall syndrome and controls. NAG was an independent predictor for the diagnosis of myocardial infarction. Conclusion: NAG may demonstrate the presence of acute tubular injury due to cardiac impairment already in the emergency department. NAG should be evaluated as marker of acute cardiorenal syndrome in patients with chest pain.


Assuntos
Acetilglucosaminidase/metabolismo , Dor no Peito/metabolismo , Meios de Contraste , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Túbulos Renais/metabolismo , Lipocalina-2/metabolismo , Acetilglucosaminidase/urina , Idoso , Estudos de Casos e Controles , Dor no Peito/complicações , Dor no Peito/diagnóstico por imagem , Dor no Peito/fisiopatologia , Estudos de Coortes , Angiografia Coronária , Feminino , Taxa de Filtração Glomerular , Humanos , Túbulos Renais/fisiopatologia , Lipocalina-2/urina , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Curva ROC
9.
Int J Cardiol ; 289: 6-11, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770262

RESUMO

BACKGROUND: Non-cardiac chest pain (NCCP) is a common reason for presenting to an emergency department (ED). Many patients re-present with similar symptoms despite reassurance. OBJECTIVE: To investigate the clinical value of a brief cognitive behavioural treatment (CBT) in reducing re-presentations of patients who present with NCCP. METHOD: A randomised controlled trial (RCT) comparing three or four sessions of NCCP directed CBT with treatment as usual (TAU). The primary outcome measure was reducing health service use measured as re-presentations to the ED and hospitalisations for NCCP over 12 months of follow-up. Secondary outcomes were chest pain, health anxiety, depression, anxiety, quality of life and social functioning. RESULTS: 214 patients received CBT and 210 TAU. There was no difference in ED visits or hospitalisation at three months or 12 months follow-up. Those with prior ED presentations for NCCP were significantly less likely to present with NCCP at three months follow-up but not at 12 months. Health anxiety was less at three months in those who received CBT but this effect was not present at 12 months. No other differences in secondary outcome measures were present. CONCLUSIONS: A brief CBT intervention for NCCP failed to reduce representations or improve psychological health over 12 months. We do not recommend such an intervention to unselected patients with NCCP. Patients presenting with prior episodes of NCCP obtain benefit for a three month period. Working with those patients to sustain their improvement might be worthwhile.


Assuntos
Ansiedade/prevenção & controle , Dor no Peito/terapia , Terapia Cognitivo-Comportamental/métodos , Saúde Mental , Qualidade de Vida , Adolescente , Adulto , Idoso , Ansiedade/etiologia , Dor no Peito/complicações , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
BMC Neurol ; 19(1): 348, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888520

RESUMO

BACKGROUND: Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date. CASE PRESENTATION: We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug. CONCLUSIONS: This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.


Assuntos
Dor no Peito/complicações , Dor no Peito/tratamento farmacológico , Epilepsia/complicações , Anticonvulsivantes/uso terapêutico , Eletroencefalografia , Epilepsia/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Monitorização Fisiológica
13.
BMC Infect Dis ; 19(1): 1090, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888522

RESUMO

BACKGROUND: In most developing countries, smear-negative pulmonary TB (SNPT) often gets missed from the diagnosis of consideration, though it accounts 30-65% of total PTB cases, due to deficient or inaccessible molecular diagnostic modalities. METHODS: The cross-sectional study enrolled 360 patients with clinical-radiological suspicion of SNPT in Tribhuvan University Teaching Hospital (TUTH). The patient selection was done as per the algorithm of Nepal's National Tuberculosis Program (NTP) for Xpert MTB/RIF testing. Participants' demographic and clinical information were collected using a pre-tested questionnaire. The specimens were collected, processed directly for Xpert MTB/RIF test according to the manufacturer's protocol. The same samples were stained using the Ziehl-Neelsen technique then observed microscopically. Both findings were interpreted; rifampicin-resistant, if obtained, on Xpert testing was confirmed with a Line Probe Assay. RESULT: Of 360 smear-negative sputum samples analyzed, 85(23.61%) found positive while 3(0.8%) of them were rifampicin resistance. The infection was higher in males, i.e. 60(25.3%) compared to female 25(20.3%). The age group, > 45(nearly 33%) with median age 42 ± 21.5, were prone to the infection. During the study period, 4.6% (515/11048) sputum samples were reported as smear-positive in TUTH. Consequently, with Xpert MTB/RIF assay, the additional case 16.5% (n = 85/515) from smear-negative presumptive TB cases were detected. Among the most occurring clinical presentations, cough and chest pain were positively associated with SNPT. While upper lobe infiltrates (36.4%) and pleural effusion (40.4%) were the most peculiar radiological impression noted in PTB patient. 94 multi-drug resistant(MDR) suspected cases were enrolled; of total suspects, 29(30.8%) samples were rifampicin sensitive, 1(1.06%) indeterminate, 3(3.19%) rifampicin-resistant while remaining of them were negative. 2(2.2%) MDR cases were recovered from the patient with a previous history of ATT, of total 89 previously treated cases enrolled However, a single rifampicin-resistant from the new suspects. CONCLUSION: With an application of the assay, the additional cases, missed with smear microscopy, could be sought and exact incidence of the diseases could be revealed.


Assuntos
Bioensaio/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Adolescente , Adulto , Algoritmos , Dor no Peito/complicações , Tosse/complicações , Estudos Transversais , DNA Bacteriano/efeitos dos fármacos , DNA Bacteriano/isolamento & purificação , Países em Desenvolvimento , Farmacorresistência Bacteriana Múltipla , Feminino , Hospitais Universitários , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Nepal , Derrame Pleural/complicações , Rifampina/efeitos adversos , Rifampina/uso terapêutico , Sensibilidade e Especificidade , Escarro/microbiologia , Adulto Jovem
14.
Acta Radiol ; 60(1): 45-53, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29742921

RESUMO

BACKGROUND: Coronary computed tomography angiography (CCTA) is increasingly used to detect coronary artery disease (CAD), but long-term follow-up studies are still scarce. PURPOSE: To evaluate the prognostic value of CCTA in patients with suspected CAD. MATERIAL AND METHODS: A total of 1205 consecutive CCTA patients with chest pain were classified as normal coronary arteries, non-obstructive CAD, or obstructive CAD. The primary outcome was major adverse cardiac event (MACE), defined as a composite outcome including cardiac death, myocardial infarction, unstable angina pectoris, or late revascularization (after >90 days). RESULTS: Over 7.5 years follow-up (median = 3.1 years), Kaplan-Meier estimates demonstrated a MACE in 1.0%, 4.6%, and 20.7% in normal coronary arteries, non-obstructive CAD, and obstructive CAD, respectively. Log rank test for pairwise comparisons showed significant differences between non-obstructive CAD and normal coronary arteries ( P = 0.023) and between obstructive CAD and normal coronary arteries ( P < 0.001). In a multivariable analysis, adjusting for classical risk factors, non-obstructive CAD and obstructive CAD were independent predictors of MACE, with hazard ratios (HR) of 3.22 ( P = 0.041) and 25.18 ( P < 0.001), respectively. CONCLUSION: Patients with normal coronary arteries have excellent long-term prognosis, but the risk for MACE increases with non-obstructive and obstructive CAD. Both non-obstructive and obstructive CAD are independently associated with future ischemic events.


Assuntos
Dor no Peito/complicações , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Adulto , Idoso , Dor no Peito/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Tempo
15.
J Clin Psychol Med Settings ; 26(2): 131-141, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29948646

RESUMO

The aim of this study was to investigate the role of disease conviction in the chest pain and life interference of patients with non-cardiac chest pain (NCCP), after controlling for anxiety sensitivity and body vigilance. While all three psychological constructs are theoretically implicated and empirically associated with the experience of NCCP, no research has examined the influence of disease conviction in the context of other relevant constructs. The sample included 229 participants with NCCP who were recruited after a medical evaluation failed to elicit an organic explanation for their chest pain. Hierarchical regression analyses revealed that while anxiety sensitivity significantly predicted chest pain severity and interference, only body vigilance contributed significant additional variance to chest pain severity, and only disease conviction contributed significant additional variance to chest pain interference. While anxiety sensitivity, body vigilance, and disease conviction all appear to affect those with NCCP, it seems that their impact is manifest in different domains (i.e., pain perception vs. psychosocial impairment).


Assuntos
Transtornos de Ansiedade/complicações , Atitude Frente a Saúde , Dor no Peito/complicações , Dor no Peito/psicologia , Hipocondríase/complicações , Modelos Psicológicos , Adulto , Idoso , Transtornos de Ansiedade/psicologia , Estudos de Coortes , Feminino , Humanos , Hipocondríase/psicologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
Med Princ Pract ; 28(1): 87-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30380556

RESUMO

OBJECTIVE: Acute thrombotic occlusion of > 1 major coronary arteries is very rare (2.5%). Herein, we report a patient with simultaneous anterior and inferior myocardial infarction without cardiogenic shock. CLINICAL PRESENTATION AND INTERVENTION: A 43-year-old woman was admitted with severe chest pain. Electrocardiography showed ST segment elevation in anterior and inferior derivations. There was no severe hypotension. Urgent coronary angiography showed that there were thrombotic occlusions in both left anterior descending artery and right coronary artery. Both lesions were successfully treated with coronary stenting. CONCLUSION: If there is multiple ST segment elevation on presentation electrocardiography, clinicians should be aware of possible simultaneous coronary occlusions.


Assuntos
Dor no Peito/complicações , Dor no Peito/diagnóstico por imagem , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico por imagem , Adulto , Angioplastia Coronária com Balão , Angiografia Coronária , Oclusão Coronária/cirurgia , Eletrocardiografia , Feminino , Humanos , Infarto do Miocárdio , Resultado do Tratamento
17.
J Clin Psychol Med Settings ; 26(2): 194-199, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30151664

RESUMO

This study was performed to check the hypothesis that low serum vitamin D and reduced calcium intake may contribute to the comorbidity of psychological symptoms (anxiety and depression) and non-cardiac chest pain (NCCP). The design was a case-control study that involved 40 subjects with NCCP and 40 age and gender-matched healthy controls. Serum vitamin D was assessed using electrochemiluminescence immunoassay; anxiety and depression symptoms were assessed using Hospital Anxiety and Depression Scale, and dietary calcium intake was assessed by self-reporting. Subjects with NCCP had higher anxiety and depression scores and lower vitamin D and dietary calcium intake compared to healthy controls (p < .05). NCCP was associated with anxiety score (odds ratio = 1.40, p < .01). Prevalence of abnormal anxiety score was much higher in subjects with NCCP (47.5%) compared to healthy controls (7.5%). Anxiety score was inversely correlated with vitamin D level and dietary calcium intake (p < .01). Anxiety score was inversely associated with vitamin D level (R2 = .32, p < .05). In conclusion, development of NCCP can be predicted from increased anxiety score which in turn can be predicted from low vitamin D levels. This suggests physicians to consider anxiety and vitamin D deficiency as possible causes for NCCP.


Assuntos
Transtornos de Ansiedade/sangue , Transtornos de Ansiedade/complicações , Cálcio na Dieta/sangue , Dor no Peito/complicações , Dor no Peito/psicologia , Vitamina D/sangue , Adulto , Transtornos de Ansiedade/psicologia , Cálcio na Dieta/administração & dosagem , Estudos de Casos e Controles , Dor no Peito/sangue , Feminino , Humanos , Masculino , Autorrelato
18.
Medicine (Baltimore) ; 97(49): e13498, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544446

RESUMO

INTRODUCTION: Coronary computed tomography angiography (CCTA) has emerged as a valuable noninvasive imaging tool for assessing atheromatous plaque morphology and composition, and several CCTA features have been validated as reliable indicators of the plaque-associated risk. However, the role of lesion geometry as a CCTA feature of plaque vulnerability has not been investigated so far. MATERIAL AND METHODS: Here we present the study protocol of the GEOMETRY trial, a prospective, single center, cohort study in which we aim to investigate the relationship between plaque geometry (as expressed by cross-sectional and longitudinal plaque eccentricity) and the risk for major adverse cardiac events (MACE) during 2 years of follow-up, in order to validate plaque eccentricity as a new CCTA marker of coronary plaque vulnerability. One thousand patients with suspected coronary artery disease (CAD) and pretest probability of CAD between 15% and 85%, who undergo CCTA and in whom CCTA identifies the presence of at least 1 significant coronary plaque (producing a luminal narrowing of at least 50%) will be enrolled in the study. Based on the results of complex image post-processing and plaque analysis, patients will be divided into 2 groups: group 1-patients in whom CCTA analysis identifies only non-eccentric coronary plaque; and group 2-patients in whom CCTA analysis reveals the presence of at least 1 eccentric significant coronary plaque producing a significant luminal narrowing. Study outcomes will consist in the rate of major cardiovascular events and the rate of plaque progression during follow-up.The study is funded by the Romanian Ministry of European Funds, the Romanian Government and the European Union, as part of the research grant number 103544/2016 - PlaqueIMAGE (contract number 26/01.09.2016). CONCLUSION: In conclusion, GEOMETRY will be the first CCTA-based study that will investigate the impact of geometric distribution of coronary atheromatous plaque on the future risk of cardiovascular events and on the rate of plaque progression, introducing and validating a new potential feature of plaque vulnerability represented by plaque geometry.


Assuntos
Dor no Peito/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Dor no Peito/complicações , Doença da Artéria Coronariana/complicações , Progressão da Doença , Humanos , Seleção de Pacientes , Medição de Risco
19.
Echocardiography ; 35(12): 2127-2129, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30328208

RESUMO

Coronary artery fistulae are congenital cardiac abnormalities characterized by an abnormal communication between a coronary artery and a cardiac chamber, systemic or pulmonary vessel. Most of the cases are asymptomatic and are discovered incidentally during an angiography. We describe a rare case of a right coronary artery fistula draining to the right atrium, manifesting in chest pain and pulmonary arterial hypertension (PAH). The fistula was detected on transesophageal echocardiography during the workup for PAH.


Assuntos
Dor no Peito/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Hipertensão Pulmonar/diagnóstico , Fístula Vascular/diagnóstico , Adulto , Dor no Peito/complicações , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Tomografia Computadorizada Multidetectores/métodos , Fístula Vascular/complicações , Fístula Vascular/congênito
20.
Rev. Soc. Bras. Clín. Méd ; 16(2): 77-79, 20180000. ilus
Artigo em Português | LILACS | ID: biblio-913361

RESUMO

OBJETIVO: Avaliar a adesão dos plantonistas da emergência na aplicação de um protocolo de dor torácica e o impacto no índice de mortalidade por infarto agudo do miocárdio. MÉ- TODOS: Estudo retrospectivo, realizado de maio de 2016 até maio de 2017. Os dados foram obtidos por relatórios do sistema TASY e mostram todas as admissões por queixa de dor torácica, segundo a CID10. Estas admissões foram tabuladas em planilha Excel. RESULTADOS: Dos 1.657 pacientes com entrada na emergência clínica por queixa de dor torácica, 471 apresentavam síndrome coronariana. Na amostra, 67,39% dos pacientes eram do sexo masculino, com média de idade de 59,72 anos. Destes, 92 (19,96%) foram diagnosticados com infarto agudo do miocárdio, 30 (28,26%) apresentavam supradesnivelamento do segmento ST e 62 (71,74%) foram diagnosticados como infarto agudo do miocárdio sem supradesnivelamento do segmento ST. Todos os casos que necessitaram de angioplastia tiveram o procedimento executado dentro do prazo estabelecido pelas diretrizes internacionais. Receberam aspirina profilática 469 (99,57%) pacientes. A mortalidade dos pacientes internados com infarto agudo do miocárdio foi de 2,17%. CONCLUSÃO: O gerenciamento deste protocolo permite mapear o processo, bem como verificar eficácia, pontos fortes e fracos, e os riscos.(AU)


OBJECTIVE: To evaluate the adherence of emergency doctors to the application of the chest pain protocol, and the impact on mortality rate from acute myocardial infarction. METHODS: This is a retrospective study performed from May 2016 to May 2017. Data were obtained from TASY reports and show all admissions for chest pain complaints (ICD-10). These admissions were tabulated in Excel spreadsheet. RESULTS: Of the 1.657 patients admitted to the clinical emergency due to a complaint of chest pain, 471 had a coronary syndrome. In the sample, 67.39% of patients were male, with a mean age of 59.72 years. Of these, 92 (19.96%) were diagnosed with acute myocardial infarction, 30 (28.26%) presented ST segment elevation, and 62 (71.74%) were diagnosed as acute myocardial infarction without ST segment elevation. All cases requiring angioplasty had the procedure performed within the period established by the international guidelines. Of the patients, 469 (99.57%) received prophylactic aspirin. The mortality of patients hospitalized with acute myocardial infarction was 2.17%. CONCLUSION: The management of this protocol allows mapping the process, checking efficacy, strengths, weaknesses, and risks.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Qualidade da Assistência à Saúde , Dor no Peito/complicações , Protocolos Clínicos , Síndrome Coronariana Aguda/mortalidade , Infarto do Miocárdio/mortalidade
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