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2.
PLoS One ; 16(8): e0252612, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34428208

RESUMO

BACKGROUND: Chest pain is amongst the most common reason for presentation to the emergency department (ED). There are many causes of chest pain, and it is important for the emergency physician to quickly and accurately diagnose life threatening causes such as acute myocardial infarction (AMI). Multiple clinical decision tools have been developed to assist clinicians in risk stratifying patients with chest. There is growing recognition that machine learning (ML) will have a significant impact on the practice of medicine in the near future and may assist with diagnosis and risk stratification. This systematic review aims to evaluate how ML has been applied to adults presenting to the ED with undifferentiated chest pain and assess if ML models show improved performance when compared to physicians or current risk stratification techniques. METHODS AND FINDINGS: We conducted a systematic review of journal articles that applied a ML technique to an adult patient presenting to an emergency department with undifferentiated chest pain. Multiple databases were searched from inception through to November 2020. In total, 3361 articles were screened, and 23 articles were included. We did not conduct a metanalysis due to a high level of heterogeneity between studies in both their methods, and reporting. The most common primary outcomes assessed were diagnosis of acute myocardial infarction (AMI) (12 studies), and prognosis of major adverse cardiovascular event (MACE) (6 studies). There were 14 retrospective studies and 5 prospective studies. Four studies reported the development of a machine learning model retrospectively then tested it prospectively. The most common machine learning methods used were artificial neural networks (14 studies), random forest (6 studies), support vector machine (5 studies), and gradient boosting (2 studies). Multiple studies achieved high accuracy in both the diagnosis of AMI in the ED setting, and in predicting mortality and composite outcomes over various timeframes. ML outperformed existing risk stratification scores in all cases, and physicians in three out of four cases. The majority of studies were single centre, retrospective, and without prospective or external validation. There were only 3 studies that were considered low risk of bias and had low applicability concerns. Two studies reported integrating the ML model into clinical practice. CONCLUSIONS: Research on applications of ML for undifferentiated chest pain in the ED has been ongoing for decades. ML has been reported to outperform emergency physicians and current risk stratification tools to diagnose AMI and predict MACE but has rarely been integrated into practice. Many studies assessing the use of ML in undifferentiated chest pain in the ED have a high risk of bias. It is important that future studies make use of recently developed standardised ML reporting guidelines, register their protocols, and share their datasets and code. Future work is required to assess the impact of ML model implementation on clinical decision making, patient orientated outcomes, and patient and physician acceptability. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews registration number: CRD42020184977.


Assuntos
Dor no Peito/diagnóstico , Diagnóstico por Computador , Serviço Hospitalar de Emergência , Aprendizado de Máquina , Infarto do Miocárdio/diagnóstico , Dor no Peito/fisiopatologia , Humanos , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco
3.
Am Heart J ; 241: 83-86, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34302751

RESUMO

SARS-CoV-2 infection has been associated with cardiovascular disease in children, but which children need cardiac evaluation is unclear. We describe our experience evaluating 206 children for cardiac disease following SARS-CoV-2 infection (one of whom had ventricular ectopy) and propose a new guideline for management of these children. Routine cardiac screening after SARS-CoV-2 infection in children without any cardiac signs or symptoms does not appear to be high yield.


Assuntos
Assistência ao Convalescente , COVID-19/fisiopatologia , Cardiopatias/diagnóstico , Encaminhamento e Consulta , Adolescente , Assistência Ambulatorial , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bradicardia/diagnóstico , Bradicardia/etiologia , Bradicardia/fisiopatologia , COVID-19/complicações , Cardiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Dispneia/fisiopatologia , Ecocardiografia , Eletrocardiografia , Fadiga/fisiopatologia , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/diagnóstico , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Ciência da Implementação , Masculino , Pediatria , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Índice de Gravidade de Doença , Síncope/fisiopatologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Complexos Ventriculares Prematuros/fisiopatologia , Adulto Jovem
4.
Sci Rep ; 11(1): 10513, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34006974

RESUMO

Identification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81-2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66-0.71) to 0.76 (95% CI 0.74-0.78) in the CAD2 and from 0.64 (95% CI 0.62-0.67) to 0.74 (95% CI 0.72-0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.


Assuntos
Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Adulto , Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/diagnóstico por imagem , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade
5.
Am J Emerg Med ; 48: 165-169, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33957340

RESUMO

BACKGROUND: Coronary risk scores (CRS) including History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score and Emergency Department Assessment of Chest pain Score (EDACS) can help identify patients at low risk of major adverse cardiac events. In the emergency department (ED), there are wide variations in hospital admission rates among patients with chest pain. OBJECTIVE: This study aimed to evaluate the impact of CRS on the disposition of patients with symptoms suggestive of acute coronary syndrome in the ED. METHODS: This retrospective cohort study included 3660 adult patients who presented to the ED with chest pain between January and July in 2019. Study inclusion criteria were age > 18 years and a primary position International Statistical Classification of Diseases and Related Health Problems-10th revision coded diagnosis of angina pectoris (I20.0-I20.9) or chronic ischemic heart disease (I25.0-I25.9) by the treating ED physician. If the treating ED physician completed the electronic structured variables for CRS calculation to assist disposition planning, then the patient would be classified as the CRS group; otherwise, the patient was included in the control group. RESULTS: Among the 2676 patients, 746 were classified into the CRS group, whereas the other 1930 were classified into the control group. There was no significant difference in sex, age, initial vital signs, and ED length of stay between the two groups. The coronary risk factors were similar between the two groups, except for a higher incidence of smokers in the CRS group (19.6% vs. 16.1%, p = 0.031). Compared with the control group, significantly more patients were discharged (70.1% vs. 64.6%) directly from the ED, while fewer patients who were hospitalized (25.9% vs. 29.7%) or against-advise discharge (AAD) (2.6% vs. 4.0%) in the CRS group. Major adverse cardiac events and mortality at 60 days between the two groups were not significantly different. CONCLUSIONS: A higher ED discharge rate of the group using CRS may indicate that ED physicians have more confidence in discharging low-risk patients based on CRS.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angina Pectoris/diagnóstico , Dor no Peito/fisiopatologia , Tomada de Decisão Clínica , Serviço Hospitalar de Emergência , Hospitalização/estatística & dados numéricos , Isquemia Miocárdica/diagnóstico , Alta do Paciente/estatística & dados numéricos , Síndrome Coronariana Aguda/complicações , Fatores Etários , Idoso , Angina Pectoris/complicações , Dor no Peito/sangue , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Estudos de Coortes , Doença da Artéria Coronariana/epidemiologia , Eletrocardiografia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Transferência de Pacientes , Estudos Retrospectivos , Sudorese , Troponina/sangue
6.
Curr Pain Headache Rep ; 25(5): 32, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33760994

RESUMO

PURPOSE OF REVIEW: Chest pain is a very common presenting complaint among patients in the hospital, a large proportion of whom have non-cardiac chest pain (NCCP). Neurological causes of NCCP have not been previously reviewed although several causes have been identified. RECENT FINDINGS: Chest pain has been reported as a symptom of multiple neurological conditions such as migraine, epilepsy, and multiple sclerosis, with varying clinical presentations. The affected patients are often not formally diagnosed for long periods of time due to difficulties in recognizing the symptoms as part of neurological disease processes. This paper will briefly summarize well-known etiologies of chest pain and, then, review neurological causes of NCCP, providing an overview of current literature and possible pathophysiologic mechanisms.


Assuntos
Dor no Peito/etiologia , Doenças do Sistema Nervoso/complicações , Sensibilização do Sistema Nervoso Central , Dor no Peito/fisiopatologia , Síndromes da Dor Regional Complexa/complicações , Síndromes da Dor Regional Complexa/fisiopatologia , Epilepsia/complicações , Epilepsia/fisiopatologia , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/fisiopatologia , Herpes Zoster/complicações , Herpes Zoster/fisiopatologia , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Neuralgia Pós-Herpética/complicações , Neuralgia Pós-Herpética/fisiopatologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/fisiopatologia , Radiculopatia/complicações , Radiculopatia/fisiopatologia , Raízes Nervosas Espinhais , Rigidez Muscular Espasmódica/complicações , Rigidez Muscular Espasmódica/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
7.
Am J Cardiol ; 149: 16-20, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33757786

RESUMO

Despite the increasing use of Coronary Artery Calcium (CAC) scoring for cardiovascular risk stratification in asymptomatic patients, the gender differences in CAC among symptomatic patients have not been well evaluated. We analyzed patients presenting to the emergency department (ED) with chest pain suggesting possible coronary artery disease (CAD) who received coronary computed tomography angiography (CCTA). Ordinal logistic regression was used to determine the odds ratio for the association of traditional cardiovascular risk factors and CAC. Patients with a CAC score ≥ 100 were followed for cardiovascular events or changes in medical management. Our cohort included 542 individuals (263 male, 279 female). Ordinal logistic regression model showed that among traditional cardiovascular risk factors, male sex had the highest odds ratio (OR) of 3.04 (p < 0.001, 95% CI [2.01, 4.59]) for the presence of CAC. Also, males had more diffuse distribution of coronary atherosclerosis (p=0.01). Subgroup analysis revealed that obesity was a bigger risk factor in male patients (OR 2.16), while smoking showed the greatest effect (OR 4.27) on CAC in women. Of patients who had CAC > 100 with an average follow-up of 346 days, there was an increase in both aspirin and statin use, yet significant sex differences were observed especially in patients with non-obstructive lesions on CCTA. Among male patients with non-obstructive lesions, 68.2% were on aspirin and 86.4% were on statin therapy after the CCTA compared to 27.3% and 45.5% respectively in their female counterparts. In conclusion, sex not only is the most powerful predictor for higher CAC among traditional cardiovascular risk factors in symptomatic patients but also influences the contribution of various traditional risk factors to elevated CAC. Furthermore, the discovery of CAD led to the initiation of medical therapy in male patients more frequently than in female patients, even after adjusting for the degree of luminal stenosis detected on coronary CT angiography.


Assuntos
Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/epidemiologia , Estenose Coronária/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , Calcificação Vascular/epidemiologia , Adulto , Aspirina/uso terapêutico , Estudos de Coortes , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos Retrospectivos , Fatores Sexuais , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia
8.
JAMA Netw Open ; 4(3): e211085, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33688964

RESUMO

Importance: Solid estimates of the risk of developing symptoms and of progressing to critical disease in individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are key to interpreting coronavirus disease 2019 (COVID-19) dynamics, identifying the settings and the segments of the population where transmission is more likely to remain undetected, and defining effective control strategies. Objective: To estimate the association of age with the likelihood of developing symptoms and the association of age with the likelihood of progressing to critical illness after SARS-CoV-2 infection. Design, Setting, and Participants: This cohort study analyzed quarantined case contacts, identified between February 20 and April 16, 2020, in the Lombardy region of Italy. Contacts were monitored daily for symptoms and tested for SARS-CoV-2 infection, by either real-time reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs or retrospectively via IgG serological assays. Close contacts of individuals with laboratory-confirmed COVID-19 were selected as those belonging to clusters (ie, groups of contacts associated with an index case) where all individuals were followed up for symptoms and tested for SARS-CoV-2 infection. Data were analyzed from February to June 2020. Exposure: Close contact with individuals with confirmed COVID-19 cases as identified by contact tracing operations. Main Outcomes and Measures: Age-specific estimates of the risk of developing respiratory symptoms or fever greater than or equal to 37.5 °C and of experiencing critical disease (defined as requiring intensive care or resulting in death) in SARS-CoV-2-infected case contacts. Results: In total, 5484 case contacts (median [interquartile range] age, 50 [30-61] years; 3086 female contacts [56.3%]) were analyzed, 2824 of whom (51.5%) tested positive for SARS-CoV-2 (median [interquartile range] age, 53 [34-64] years; 1604 female contacts [56.8%]). The proportion of infected persons who developed symptoms ranged from 18.1% (95% CI, 13.9%-22.9%) among participants younger than 20 years to 64.6% (95% CI, 56.6%-72.0%) for those aged 80 years or older. Most infected contacts (1948 of 2824 individuals [69.0%]) did not develop respiratory symptoms or fever greater than or equal to 37.5 °C. Only 26.1% (95% CI, 24.1%-28.2%) of infected individuals younger than 60 years developed respiratory symptoms or fever greater than or equal to 37.5 °C; among infected participants older than 60 years, 6.6% (95% CI, 5.1%-8.3%) developed critical disease. Female patients were 52.7% (95% CI, 24.4%-70.7%) less likely than male patients to develop critical disease after SARS-CoV-2 infection. Conclusions and Relevance: In this Italian cohort study of close contacts of patients with confirmed SARS-CoV-2 infection, more than one-half of individuals tested positive for the virus. However, most infected individuals did not develop respiratory symptoms or fever. The low proportion of children and young adults who developed symptoms highlights the possible challenges in readily identifying SARS-CoV-2 infections.


Assuntos
COVID-19/fisiopatologia , Portador Sadio/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Febre/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/epidemiologia , Teste de Ácido Nucleico para COVID-19 , Teste Sorológico para COVID-19 , Dor no Peito/epidemiologia , Dor no Peito/fisiopatologia , Criança , Pré-Escolar , Busca de Comunicante , Tosse/fisiopatologia , Estado Terminal , Progressão da Doença , Dispneia/fisiopatologia , Feminino , Febre/fisiopatologia , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Faringite/epidemiologia , Faringite/fisiopatologia , Quarentena , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Taquipneia/epidemiologia , Taquipneia/fisiopatologia , Adulto Jovem
9.
Chron Respir Dis ; 18: 14799731211002240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729021

RESUMO

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I 2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I 2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I 2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I 2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Dor no Peito/epidemiologia , Tosse/epidemiologia , Dispneia/epidemiologia , Fadiga/epidemiologia , COVID-19/epidemiologia , Dor no Peito/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Humanos , Prevalência , SARS-CoV-2 , Sobreviventes
11.
Neurogastroenterol Motil ; 33(5): e14092, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33550640

RESUMO

BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.


Assuntos
Ansiedade/psicologia , COVID-19 , Dispepsia/fisiopatologia , Gastroenteropatias/fisiopatologia , Azia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Estresse Psicológico/psicologia , Dor Abdominal/fisiopatologia , Dor Abdominal/psicologia , Adulto , Dor no Peito/fisiopatologia , Dor no Peito/psicologia , Controle de Doenças Transmissíveis , Dispepsia/psicologia , Feminino , Gastroenteropatias/psicologia , Azia/psicologia , Humanos , Síndrome do Intestino Irritável/psicologia , Itália , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Política Pública , SARS-CoV-2 , Inquéritos e Questionários
12.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431524

RESUMO

A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.


Assuntos
COVID-19/diagnóstico , Dor no Peito/fisiopatologia , Dispneia/fisiopatologia , Comunicação Interatrial/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Síndrome de Cimitarra/diagnóstico por imagem , Adulto , Cateterismo Cardíaco , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Diagnóstico Diferencial , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Dispneia/etiologia , Ecocardiografia , Eletrocardiografia , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/fisiopatologia , Imageamento por Ressonância Magnética , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/fisiopatologia , SARS-CoV-2 , Síndrome de Cimitarra/complicações , Síndrome de Cimitarra/fisiopatologia , Tomografia Computadorizada por Raios X , Pressão Ventricular
13.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462033

RESUMO

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.


Assuntos
COVID-19/complicações , Convalescença , Pneumotórax/etiologia , Adulto , COVID-19/fisiopatologia , Teste Sorológico para COVID-19 , Dor no Peito/fisiopatologia , Tubos Torácicos , Tosse/fisiopatologia , Dispneia/fisiopatologia , Febre/fisiopatologia , Humanos , Masculino , Mialgia/fisiopatologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/fisiopatologia , Pneumotórax/terapia , Radiografia Torácica , SARS-CoV-2 , Índice de Gravidade de Doença , Toracostomia , Tomografia Computadorizada por Raios X
14.
Am J Cardiol ; 145: 64-68, 2021 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-33497655

RESUMO

Atrial fibrillation (AF) comes to attention clinically during an evaluation of symptoms, an evaluation of its adverse outcomes, or because of incidental detection during a routine examination or electrocardiogram. However, a notable number of additional individuals have AF that has not yet been clinically apparent or suspect-subclinical AF (SCAF). SCAF has been recognized during interrogation of pacemakers and defibrillators. More recently, SCAF has been demonstrated in prospective studies with long-term monitors-both external and implanted. The REVEAL AF trial enrolled a demographically "enriched" population that underwent monitoring for up to 3 years with an insertable cardiac monitor. SCAF was noted in 40% by 30 months. None of these patients had AF known before the study; however, some had nonspecific symptoms common to patients with known AF. The current study assessed whether patients with versus without such symptoms were more likely to have SCAF detected. We found that only palpitations had an association with AF detection when controlling for other baseline symptoms (hazard ratio 1.61 (95% confidence interval 1.12 to 2.32; p = 0.011). No other prescreening symptoms evaluated were associated with an increased likelihood of SCAF detection although patients without detected SCAF had an even higher frequency of symptoms than those with detected SCAF. Thus, REVEAL AF demonstrated that the presence of palpitations is associated with an increased likelihood of SCAF whereas other common symptoms are not; and, symptoms, per se, may more likely be consequent to associated disorders than they are a direct consequence of SCAF.


Assuntos
Fibrilação Atrial/fisiopatologia , Doenças não Diagnosticadas/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Dor no Peito/fisiopatologia , Desfibriladores Implantáveis , Tontura/fisiopatologia , Dispneia/fisiopatologia , Tolerância ao Exercício , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial , Marca-Passo Artificial , Modelos de Riscos Proporcionais , Síncope/fisiopatologia , Doenças não Diagnosticadas/diagnóstico , Doenças não Diagnosticadas/epidemiologia
16.
Sci Rep ; 11(1): 2615, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33510371

RESUMO

Chronic post-thoracotomy pain is a debilitating condition after traumatic multiple rib fractures and surgery. We aimed to estimate the prevalence of chronic post-thoracotomy pain after traumatic multiple rib fractures in South Korea and explore factors associated with it. From October 2017 to June 2019, a cross-sectional survey of 100 adults, who had undergone thoracotomy due to traumatic fractures of two or more ribs 2 years to 3 months prior to the survey, was conducted in the regional trauma center in South Korea. In total, 80% and 65% patients reported any level and above moderate chronic pain, respectively. Quality of life was mostly below the normative value of the US general population. Forty-six percent patients had restrictive respiratory dysfunction, and 47% and 59% patients were classified as being at risk of above mild-level anxiety and depression, respectively. More than 70% of patients had a current opioid prescription. Multivariable logistic regression analysis showed weak evidence of association between acute, severe postoperative pain and chronic postsurgical pain (adjusted odds ratio 2.4, 95% confidence intervals 0.9 to 6.4). Collectively, chronic post-thoracotomy pain and associated incomplete recovery regarding respiratory, functional, and psychological outcomes were prevalent in patients with traumatic multiple rib fractures in South Korea.


Assuntos
Dor no Peito/epidemiologia , Dor Crônica/epidemiologia , Dor Pós-Operatória/epidemiologia , Fraturas das Costelas/cirurgia , Toracotomia/efeitos adversos , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Ansiedade/epidemiologia , Ansiedade/etiologia , Dor no Peito/etiologia , Dor no Peito/fisiopatologia , Dor no Peito/psicologia , Dor Crônica/etiologia , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/psicologia , Prevalência , República da Coreia/epidemiologia , Fraturas das Costelas/fisiopatologia , Fraturas das Costelas/psicologia
18.
Eur J Clin Invest ; 51(3): e13392, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32857868

RESUMO

BACKGROUND: Acute pericarditis has a wide spectrum of clinical presentations largely depending on underlying aetiologies. We assessed the role of age and sex in the clinical features and outcome of acute pericarditis. MATERIALS AND METHODS: A total of 240 consecutive patients hospitalized with a first episode of acute pericarditis were included. At baseline demographics, clinical features, laboratory and imaging findings and medical therapy were recorded. Patients were followed up for at least 18 months for complications. Data comparisons were performed according to sex and age (≤60 or >60 years). RESULTS: The male/female ratio was 1.42, and 56% of patients were >60 years. Younger patients depicted more often chest pain (P = .001), fever and rubs (P < .001 for both), ST elevation and PR depression (P = .032 and .009, respectively), higher CRP values (P = .009) and less often dyspnoea (P = .046) and pericardial effusion (P = .036). Moreover, they received less often glucocorticoids (P < .001) and depicted less atrial fibrillation (P = .003) and a higher rate of recurrent pericarditis (P = .013). After multivariate adjustment for confounders, age >60 years remained an independent predictor for a lower risk of recurrent pericarditis (hazard ratio 0.60, 95% CI: 0.39-0.96, P = .033). Regarding sex, females were older (P = .007), showed less often ST elevation and PR depression (P < .001 and .002, respectively) and had a higher baseline heart rate (P = .02). Sex was not associated with recurrent pericarditis risk. CONCLUSIONS: Patients with acute pericarditis have distinct presenting clinical, biochemical and prognostic features according to age and sex. Awareness of such differences is important for clinical decision-making.


Assuntos
Dor no Peito/fisiopatologia , Dispneia/fisiopatologia , Derrame Pericárdico/fisiopatologia , Pericardite/fisiopatologia , Doença Aguda , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Fibrilação Atrial/epidemiologia , Colchicina/uso terapêutico , Eletrocardiografia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Ibuprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pericardiocentese , Pericardite/epidemiologia , Pericardite/terapia , Recidiva , Distribuição por Sexo , Fatores Sexuais
19.
Am J Gastroenterol ; 116(2): 407-410, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33136569

RESUMO

INTRODUCTION: Per-oral endoscopic myotomy (POEM) is an effective modality for the management of achalasia. Tension pneumoperitoneum is a significant complication that causes hemodynamic instability, generally within the periprocedural period. METHODS: Here, we report 2 cases of delayed tension pneumoperitoneum that was recognized and treated several hours after uncomplicated POEM. RESULTS: These cases illustrate the importance of continued vigilance for this complication outside of the immediate periprocedural period as well as the utility of computed tomography-guided aspiration in managing it. DISCUSSION: When discharging patients after POEM, caregivers should be aware of this rare complication and alert patients to return for immediate care when it happens.


Assuntos
Acalasia Esofágica/cirurgia , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural , Pneumoperitônio/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Dor Abdominal/fisiopatologia , Dor no Peito/fisiopatologia , Descompressão Cirúrgica , Dispneia/fisiopatologia , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/fisiopatologia , Pessoa de Meia-Idade , Boca , Agulhas , Pneumoperitônio/fisiopatologia , Pneumoperitônio/cirurgia , Pneumotórax/diagnóstico por imagem , Pneumotórax/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Punções , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/fisiopatologia
20.
Neurogastroenterol Motil ; 33(1): e13965, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32779296

RESUMO

BACKGROUND: Pseudoachalasia manifests high-resolution manometry (HRM) findings of achalasia but results from a secondary process. We analyzed clinical and HRM characteristics of pseudoachalasia, including malignant and non-malignant subtypes. METHODS: High-resolution manometry was retrospectively reviewed in patients with confirmed pseudoachalasia, and corroborated with endoscopic and radiographic studies. A control cohort of idiopathic achalasia patients was identified. Clinical characteristics, Eckardt score, and HRM metrics were extracted from institutional records. Grouped data and medians (interquartile range) were compared between pseudoachalasia and idiopathic achalasia, and between malignant and non-malignant pseudoachalasia, using parametric and non-parametric statistical tests. KEY RESULTS: Of 28 pseudoachalasia patients (62.2 ± 2.5 years, 60.7% female), 18 (64.3%) had malignancy, and 10 (35.7%) had non-malignant obstruction. Although Eckardt score did not differentiate pseudoachalasia from 58 achalasia patients (55.9 ± 2.5 years, 53.4% female), weight loss was greater (median 9.1 [5.0-18.5] vs 3.6 [0-9.1] kg, P < .02) with shorter duration of symptoms (median 12.9 [8.0-38.6] vs 36.0 [25.7-45.0] weeks, P < .001] in pseudoachalasia. Esophagogastric junction (EGJ) metrics demonstrated lower mean IRP values and lower EGJ contractile integral in pseudoachalasia (P < .04 for each comparison with idiopathic achalasia). Type 1 pattern was more frequent in pseudoachalasia (39.3% vs 13.8%, P < .008). Pseudoachalasia demonstrated incomplete HRM patterns, with lower rates of lack of peristalsis (79.6%, vs 93.1% in achalasia, P < .05). Despite higher Eckardt scores in malignant vs non-malignant pseudoachalasia (median 8.0 [7.0-9.0] vs 6.0 [3.5-7.8], P < .03], no significant HRM differences were noted. CONCLUSIONS AND INFERENCES: Pseudoachalasia manifests with a shorter history, greater weight loss, and incomplete HRM achalasia patterns compared to achalasia.


Assuntos
Dor no Peito/fisiopatologia , Transtornos de Deglutição/fisiopatologia , Acalasia Esofágica/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Esôfago/fisiopatologia , Refluxo Laringofaríngeo/fisiopatologia , Manometria , Idoso , Estudos de Casos e Controles , Acalasia Esofágica/etiologia , Neoplasias Esofágicas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peristaltismo/fisiologia , Estudos Retrospectivos , Fatores de Tempo , Perda de Peso
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