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1.
Kyobu Geka ; 73(10): 731-737, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130757

RESUMO

Surgery for active infective endocarditis( IE) carries the greatest risk of any valve surgery, especially when complicated by cerebral infarction or bleeding. Surgical candidates with IE associated with neurologic symptoms should have a neurologic evaluation and brain imaging either by computed tomography (CT) or magnetic resonance imaging (MRI). Even among patients without neurologic symptoms, routine preoperative screening can be justified, especially those with high-risk vegetation. Current recommendations indicate that surgery should be delayed for 1 to 2 weeks in patients with non-hemorrhagic strokes and 3 to 4 weeks in patients with hemorrhagic strokes. If patients have suffered from stroke, any anticoagulation increases the risk of hemorrhagic conversion, and if bleeding has already occurred, this risk further increases. Accordingly, the treatment team has to make a difficult decision whether anticoagulation should be withheld or decreased. Transesophageal echocardiography (TEE) and/or transthoracic echocardiography (TTE) play a major role in determining the size of vegetation, abscess and fistula formation, and severity of regurgitation during the pre- and intra-operative periods. Cerebral MRI/CT are also important to diagnose the severity of cerebral infarction or bleeding before and after surgery. The risk of IE patients with cerebral complication may change by the hour, so a solid heart team approach is mandatory to make a prompt diagnosis and determine the optimal timing for surgery.


Assuntos
Endocardite Bacteriana , Endocardite , Infarto Cerebral , Ecocardiografia , Ecocardiografia Transesofagiana , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos
3.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1074-1079, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081893

RESUMO

OBJECTIVE: To analyze the risk factors of acute kidney injury (AKI) in hospitalized patients with infective endocarditis (IE), construct prediction model, and discuss its predictive value. METHODS: The clinical data of 402 adult inpatients diagnosed with IE admitted to the Affiliated Hospital of Qingdao University from January 2010 to January 2020 were retrospectively analyzed. The patients were divided into the AKI group and the non-AKI group. The clinical data, such as gender, age, presence of diabetes, basic estimated glomerular filtration rate (eGFR), laboratory indexes at admission, involvement of valves, presence of sepsis, medication during hospitalization, surgery and outcome of the two groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of AKI in IE inpatients. A predictive model was constructed, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model. RESULTS: A total of 290 patients with IE were enrolled, including 198 non-AKI patients and 92 AKI patients. The incidence of AKI was 31.7%. Among the 92 AKI patients, 46 patients were at AKI stage 1 (50.0%), while 46 patients were at AKI stage 2 and stage 3 (50.0%). Compared with the non-AKI group, patients in the AKI group were older [years old: 64 (55, 71) vs. 55 (46, 63)], and had lower basic eGFR (mL×min-1×1.73 m-2: 64.6±13.6 vs. 82.9±19.5), higher proportion of diabetic and incidence of sepsis (16.3% vs. 8.6%, 38.0% vs. 13.1%), more frequent use of angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists (ACEI/ARB), diuretics and non-steroidal anti-inflammatory drugs (NSAIDs; 25.0% vs. 15.2%, 82.6% vs. 63.1%, 58.7% vs. 24.2%), more abnormal urine test results (hematuria or proteinuria, 35.9% vs. 22.7%), higher pathogen culture negative rate (73.9% vs. 51.5%), lower Gram positive (G+) cocci infection rate and surgery rate (22.8% vs. 40.4%, 60.9% vs. 81.8 %), with significant differences (all P < 0.05). There were no significant differences in the gender, number and location of involved valves, and laboratory indexes at admission between the two groups. Compared with the non-AKI group, the inpatient mortality rate of the AKI group was higher (30.4% vs. 8.6%, P < 0.01), and the inpatient mortality rate of patients with AKI stage 2 and stage 3 was significantly higher than that of patients with AKI stage 1 (43.5% vs. 17.4%, P < 0.01). In multivariate Logistic regression analysis, the lower basic eGFR [hazard ratio (HR) = 0.136, 95% confidence interval (95%CI) was 0.066-0.280], sepsis (HR = 6.100, 95%CI was 2.394-15.543), demand for NSAIDs (HR = 2.990, 95%CI was 1.184-7.546) and radiocontrast agent (HR = 3.153, 95%CI was 1.207-8.238) were independent risk factors for AKI in hospitalized patients with IE (all P < 0.05). A prediction model was constructed based on the above risk factors, and ROC curve analysis showed that the area under the ROC curve (AUC) of prediction model for AKI was 0.888 (95%CI was 0.833-0.943, P < 0.01) with sensitivity of 86.4% and specificity of 80.9%. CONCLUSIONS: In the IE-susceptible population, low basic eGFR, sepsis, the need for NSAIDs and contrast agent are independent risk factors to AKI. The predictive model constructed by the above risk factors has certain predictive value for the occurrence of AKI in the IE inpatients.


Assuntos
Lesão Renal Aguda , Endocardite , Lesão Renal Aguda/etiologia , Endocardite/complicações , Hospitalização , Humanos , Estudos Retrospectivos , Fatores de Risco , Sepse
4.
Am J Cardiol ; 137: 127-129, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-32991857

RESUMO

Described herein is a 49-year-old black man with advanced polycystic renal disease, on hemodialysis for 6 years, who during his last 12 days of life had his vegetations on the aortic valve extend to the mitral and tricuspid valves, through the aortic wall to produce diffuse pericarditis, to the atrioventricular node to produce complete heart block, and embolize to cerebral arteries producing multiple brain infarcts, to a branch on the left circumflex coronary artery producing acute myocardial infarction, and to mesenteric arteries producing bowel infarction.


Assuntos
Infarto Cerebral/etiologia , Endocardite/complicações , Bloqueio Cardíaco/etiologia , Doenças das Valvas Cardíacas/etiologia , Infarto do Miocárdio/etiologia , Valva Aórtica , Infarto Cerebral/diagnóstico , Ecocardiografia , Eletrocardiografia , Endocardite/diagnóstico , Evolução Fatal , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Infarto do Miocárdio/diagnóstico , Valva Tricúspide
5.
Am J Case Rep ; 21: e925931, 2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-32980852

RESUMO

BACKGROUND The worldwide spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has created unprecedented situations for healthcare professionals and healthcare systems. Although infection with this virus is considered the main health problem currently, other diseases are still prevalent. CASE REPORT This report describes a 59-year-old man who presented with symptoms of dyspnea and fever that were attributed to Covid-19 infection. His clinical condition deteriorated and further examinations revealed a subjacent severe aortic regurgitation due to acute infective endocarditis. Surgical treatment was successful. CONCLUSIONS The results of diagnostic tests for Covid-19 should be re-evaluated whenever there are clinical mismatches or doubts, as false-positive Covid-19 test results can occur. Clinical interpretation should not be determined exclusively by the Covid-19 pandemic. This case report highlights the importance of using validated and approved serological and molecular testing to detect infection with SARS-CoV-2, and to repeat tests when there is doubt about presenting symptoms.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Diagnóstico Tardio , Endocardite/complicações , Endocardite/diagnóstico , Pneumonia Viral/diagnóstico , Anticorpos Antivirais/análise , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Estado Terminal , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Endocardite/virologia , Reações Falso-Positivas , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Resultado do Tratamento
6.
JAMA Netw Open ; 3(8): e2012974, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32785635

RESUMO

Importance: People who inject drugs (PWID) who are being treated for infective endocarditis remain at risk of new bloodstream infections (BSIs) due to ongoing intravenous drug use (IVDU). Objectives: To characterize new BSIs in PWID receiving treatment for infective endocarditis, to determine the clinical factors associated with their development, and to determine whether new BSIs and treatment setting are associated with mortality. Design, Setting, and Participants: This retrospective cohort study was performed at 3 tertiary care hospitals in London, Ontario, Canada, from April 1, 2007, to March 31, 2018. Participants included a consecutive sample of all PWID 18 years or older admitted with infective endocarditis. Data were analyzed from April 1, 2007, to June 29, 2018. Main Outcomes and Measures: New BSIs and factors associated with their development, treatment setting of infective endocarditis episodes (ie, inpatient vs outpatient), and 90-day mortality. Results: The analysis identified 420 unique episodes of infective endocarditis in 309 PWID (mean [SD] patient age, 35.7 [9.7] years; 213 episodes [50.7%] involving male patients), with 82 (19.5%) complicated by new BSIs. There were 138 independent new BSIs, of which 68 (49.3%) were polymicrobial and 266 were unique isolates. Aerobic gram-negative bacilli (143 of 266 [53.8%]) and Candida species (75 of 266 [28.2%]) were the most common microorganisms. Ongoing inpatient IVDU was documented by a physician in 194 infective endocarditis episodes (46.2%), and 127 of these (65.5%) were confirmed by urine toxicology results. Multivariable time-dependent Cox regression demonstrated that previous infective endocarditis (hazard ratio [HR], 1.89; 95% CI, 1.20-2.98), inpatient treatment (HR, 4.49; 95% CI, 2.30-8.76), and physician-documented inpatient IVDU (HR, 5.07; 95% CI, 2.68-9.60) were associated with a significantly higher rate of new BSIs, whereas inpatient addiction treatment was associated with a significantly lower rate (HR, 0.53; 95% CI, 0.32-0.88). New BSIs were not significantly associated with 90-day mortality (HR, 1.76; 95% CI, 0.78-4.02); significant factors associated with mortality included inpatient infective endocarditis treatment (HR, 3.39; 95% CI, 1.53-7.53), intensive care unit admission (HR, 9.51; 95% CI, 4.91-18.42), and methicillin-resistant Staphylococcus aureus infective endocarditis (HR, 1.77; 95% CI, 1.03-3.03), whereas right-sided infective endocarditis was associated with a significantly lower mortality rate (HR, 0.41; 95% CI, 0.25-0.67). Conclusions and Relevance: In this study, new BSIs were common in PWID receiving parenteral treatment for infective endocarditis. Discharging patients to outpatient treatment was not associated with an increase in new BSI incidence or mortality; carefully selected PWID may therefore be considered for such treatment.


Assuntos
Endocardite , Sepse , Abuso de Substâncias por Via Intravenosa , Adulto , Endocardite/complicações , Endocardite/epidemiologia , Endocardite/mortalidade , Endocardite/terapia , Feminino , Hospitalização , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Sepse/complicações , Sepse/epidemiologia , Sepse/mortalidade , Infecções Estafilocócicas , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/mortalidade , Adulto Jovem
7.
World J Pediatr Congenit Heart Surg ; 11(5): 654-657, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32853075

RESUMO

Although infective endocarditis rarely appears during infancy, fungal infections remain a concern in the preterm neonatal population as the result of compromised immunity, prolonged hospitalization, and invasive procedures. The increased awareness of fungal colonization and improvements in medical therapy have not reduced the high mortality rate of mycotic infections in premature newborns, especially in developing countries, and there is no consensus on the surgical timing to treat neonatal fungal endocarditis. We present the case of a two-month-old boy with a history of three weeks of hospitalization for prematurity. After being discharged, the patient developed symptomatic candidemia resulting from a large right atrial abscess obstructing the tricuspid valve; despite antifungal therapy, urgent surgical resection was required.


Assuntos
Abscesso/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/complicações , Átrios do Coração/diagnóstico por imagem , Micoses/complicações , Abscesso/diagnóstico , Abscesso/cirurgia , Países em Desenvolvimento , Ecocardiografia , Endocardite/diagnóstico , Átrios do Coração/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Micoses/diagnóstico
9.
Expert Rev Cardiovasc Ther ; 18(6): 331-342, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32476525

RESUMO

INTRODUCTION: Infective endocarditis (IE) is a life-threatening adverse event for patients with congenital heart disease (CHD). Its incidence has changed little over time despite progress in techniques for diagnosis and treatment, and guidelines for prophylaxis. AREAS COVERED: The review sought for key-words: 'congenital heart disease,' 'infective endocarditis,' 'microbial diagnosis,' 'imaging diagnosis,' 'surgical techniques,' 'prognosis,' 'prophylaxis.' Objectives were to investigate epidemiology, novel techniques for imaging and microbial diagnosis, therapeutic management and prognosis, and guidelines for prophylaxis in patients with CHD. The incidence of IE is increasing in adults with CHD. Morbidity caused by a broad clinical spectrum of cardiac and extracardiac episode-related complications is high. Surgical management is increasingly required in the early phase of the disease. Despite new techniques for diagnosis and microbiological therapy, mortality rate is still up to 10-20%. EXPERT OPINION: IE has increased in the growing cohort of adults with complex heart disease, living with residual cardiac lesions and prosthetic materials. Diagnosis is challenging for complex heart defects. Pet-scan technique can provide beneficial information to locate intracardiac lesions and embolic foci. Identification of the microbiological agents is improving. Innovative surgical techniques aim to avoid prosthetic material. Guidelines for prophylaxis currently emphasize oral and skin daily hygiene.


Assuntos
Endocardite/cirurgia , Cardiopatias Congênitas/cirurgia , Adulto , Criança , Endocardite/complicações , Endocardite/diagnóstico por imagem , Endocardite/microbiologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Prognóstico
10.
Intern Med ; 59(12): 1497-1507, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32536676

RESUMO

Objective No research on infective endocarditis (IE) concerning populations of more than 40 patients from all departments of the hospitals they may have visited in Japan has been conducted since 2000. The present study clarified the status quo of IE in a university hospital in Japan. Methods Data of inpatients of Saga University Hospital with definite IE from September 2007 to August 2017 were retrospectively analyzed. Patients Records of inpatients with diagnosed IE admitted to any department were scrutinized; those with "definite IE" according to the modified Duke's criteria comprised the study cohort. Results The study cohort was 74 patients with a median age 66.5 years old. Symptoms within 2 months before the first visit to our hospital included a fever (73.0%), general malaise (33.8%), disturbance of consciousness (24.3%), and dyspnea (24.3%). High-frequency causative microorganisms were Staphylococcus aureus (28.4%), followed by Streptococcus viridans (18.9%) and Enterococcus spp. (6.8%). The most frequently involved valves were the mitral valve (48.6%), followed by the aortic valve (25.7%) and multiple valves (14.9%). Patients without cardiac murmurs accounted for 37.8%, and those without or with only mild valvular disease accounted for 32.4%. The incidence of complications was 93.2%, and high-frequency complications were central nervous system disorder (60.8%), followed by glomerulonephritis (45.9%) and extracranial embolism (36.5%). Conclusion The incidences of IE without cardiac murmurs and IE without or with only minor valvular disease were higher than those values previously reported in 2000 in Japan. When IE is suspected clinically, clinicians must check thoroughly for common complications, even in patients without cardiac murmurs or valvular disease.


Assuntos
Endocardite/diagnóstico , Endocardite/epidemiologia , Adulto , Idoso , Valva Aórtica , Endocardite/complicações , Feminino , Hospitais Universitários , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Valva Mitral , Estudos Retrospectivos , Taxa de Sobrevida , Avaliação de Sintomas
11.
J Card Surg ; 35(7): 1725-1728, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32579761

RESUMO

Infective endocarditis (IE) is a serious condition leading to heart failure, persistent sepsis. The management of IE involving valve is mainly excision of the infected valve and replacement with a heart valve; which are also at the risk of prosthetic valve endocarditis. Hence repair of the valve with autologous pericardium is much more physiological. We had a 20-year-old male presented with features of heart failure and high-grade fever not responding to optimum medical management. Two-dimensional echocardiogram revealed vegetation on pulmonary valve cusps with the erosion of the left and right cusps. Neo cusps with autologous pericardium offered good hemodynamics with trivial regurgitation. The patient is doing well with normal pulmonary valve function 3 months after surgery. This technique is reliable, economic, and easily reproducible.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Endocardite/cirurgia , Glutaral/uso terapêutico , Pericárdio/transplante , Valva Pulmonar/cirurgia , Ecocardiografia , Endocardite/complicações , Endocardite/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Valva Pulmonar/diagnóstico por imagem , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
12.
J Card Surg ; 35(7): 1714-1716, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557775

RESUMO

OBJECTIVE: This study highlights the management strategy in simultaneous bicuspid aortic valve infective endocarditis and mycotic pseudoaneurysm of an aortic coarctation. METHODS: A staged repair of mycotic pseudoaneurysm of aortic coarctation and infective bicuspid aortic valve endocarditis. RESULTS: We present a 19-year old gentleman who was admitted with aching pain in his bilateral lower extremities with associated purpuric rash and fevers. Work-up was significant for severe aortic valve regurgitation and a pseudoaneurysm in the distal aortic arch. He underwent operative repair through a left posterior-lateral thoracotomy with femoral-femoral partial cardiopulmonary bypass. Intraoperative findings were significant for a juxta-ductal coarctation and pseudoaneurysm. The mycotic pseudoaneurysm and remnant ligamentum arteriosum were completely resected and were replaced with a 18 mm Gelweave graft (Terumo Cardiovascular Group, Ann Arbor, MI) from the distal arch to the descending thoracic aorta. The patient underwent a planned secondary washout and omental flap for biologic coverage of the graft. Subsequently, a staged aortic valve replacement was completed 1 week later. The patient's postoperative course was uncomplicated, and he was discharged with intact motor and sensory function. CONCLUSIONS: A staged approach is a prudent strategy to manage a patient with simultaneous endocarditis and aortic mycotic pseudoaneurysm, with precedence toward the most critical lesion.


Assuntos
Falso Aneurisma/cirurgia , Coartação Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Falso Aneurisma/complicações , Coartação Aórtica/complicações , Ponte Cardiopulmonar , Endocardite/complicações , Humanos , Masculino , Reoperação , Retalhos Cirúrgicos , Toracotomia , Resultado do Tratamento , Adulto Jovem
13.
Medicine (Baltimore) ; 99(19): e20120, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384490

RESUMO

INTRODUCTION: Aortic regurgitation (AR) was recognized as a major, but rare complication after device closure for perimembranous ventricular septal defects (PmVSD). Most of them are temporary and non-significant. Infectious endocarditis (IE) is another extremely rare post-procedure complication of PmVSD. Theoretically, AR could increase risk for post-interventional IE. However, no cases have been documented thus far. We firstly described a case of very late-onset IE associated with non-significant AR after transcatheter closure of PmVSD with modified symmetrical double-disk device, underscoring the need for reassessing long-term prognostic implications of non-significant post-procedure AR after PmVSD occlusion and the most appropriate treatment strategy. PATIENT CONCERNS: A 15-year old male received transcatheter closure of a 6.4 mm sized PmVSD with a 9-mm modified symmetric double-disk occluder (SHAMA) 11 years ago in our hospital. A new-onset mild eccentric AR was noted on transthoracic echocardiography (TTE) examination 1-year post procedure, without progression and heart enlargement. At this time, the child was admitted with a complaint of persistent fever for 16 days and nonresponse to 2-weeks course of amoxicillin and cefoxitin. DIAGNOSIS: The diagnosis of post-procedure IE was established since a vegetation (14 × 4 mm) was found to be attached to the tricuspid valve, an anechoic area (8 × 7 mm) on left upper side of ventricular septum and below right aortic sinus, and severe eccentric AR as well as the isolation of Staphylococcus aureus from all three-blood cultures. INTERVENTIONS: Treatment with vancomycin was initially adopted. However, surgical interventions including removal of vegetation, abscess and occluder, closure of VSD with a pericardial patch, tricuspid valvuloplasty, and aortic valvuloplasty were ultimately performed because of recurrent fever and a new-onset complete atrioventricular block 12-days later. The child continued with antibiotic therapy up to six weeks post operation. OUTCOMES: The child's temperature gradually returned to normal with alleviation of AR (mild) and heart block (first degree). The following course was uneventful. CONCLUSION: Late-onset IE could occur following device closure of PmVSD and be associated with post-procedure AR. For non-significant AR after device closure of PmVSD, early surgical intervention could be an alternative for reducing the aggravation of aortic valve damage and the risk of associated IE.


Assuntos
Insuficiência da Valva Aórtica/complicações , Endocardite/complicações , Infecções Estafilocócicas/complicações , Adolescente , Cateterismo Cardíaco/métodos , Endocardite/tratamento farmacológico , Endocardite/cirurgia , Comunicação Interventricular/cirurgia , Humanos , Masculino , Dispositivo para Oclusão Septal , Valva Tricúspide/patologia
16.
Am J Med ; 133(11): 1343-1349, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32445720

RESUMO

BACKGROUND: Patients who present to the hospital for infectious complications of intravenous opioid use are at high risk for against-medical-advice discharge and readmissions. The role of medication-assisted treatment for inpatients is not clear. We aimed to assess outcomes prior to and after rollout of an inpatient buprenorphine-based opioid use disorder protocol, as well as to assess outcomes in general for medication-assisted therapy. METHODS: This was a retrospective observational cohort study at our community hospital in New Hampshire. The medical record was searched for inpatients with a complication of intravenous opioid use. We searched for admissions 11 months prior to and after the November 2018 buprenorphine protocol rollout. RESULTS: Rates of medication-assisted therapy usage and buprenorphine linkage increased significantly after protocol rollout. Rates of against-medical-advice discharge did not decrease after protocol rollout, nor did readmissions. However, when evaluating the entire group of patients regardless of date of presentation or protocol use, against-medical-advice discharge rates were substantially lower for patients receiving medication-assisted therapy compared with those receiving supportive care only (30.0% vs 59.6%). Readmissions rates were lower for patients who were discharged with any form of ongoing medication-assisted therapy compared with those who were not (30-day all-cause readmissions 18.8% vs 35.1%; 30-day opioid-related readmissions 10.1% vs 29.9%; 90-day all-cause readmissions 27.3% vs 42.7%; 90-day opioid-related readmissions 15.1% vs 33.3%). CONCLUSIONS: There is a strong association between medication-assisted therapy and reduced against-medical-advice discharge rates. Additionally, maintenance medication-assisted therapy at time of discharge is strongly associated with reduced readmissions rates.


Assuntos
Combinação Buprenorfina e Naloxona/uso terapêutico , Hospitalização , Infecções/terapia , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Readmissão do Paciente/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Abscesso/complicações , Abscesso/terapia , Doença Aguda , Adulto , Artrite Infecciosa/complicações , Artrite Infecciosa/terapia , Bacteriemia/complicações , Bacteriemia/terapia , Celulite (Flegmão)/complicações , Celulite (Flegmão)/terapia , Estudos de Coortes , Discite/complicações , Discite/terapia , Endocardite/complicações , Endocardite/terapia , Feminino , Infecções por HIV/complicações , Infecções por HIV/terapia , Hepatite C/complicações , Hepatite C/terapia , Humanos , Infecções/complicações , Masculino , Miosite/complicações , Miosite/terapia , Transtornos Relacionados ao Uso de Opioides/complicações , Osteomielite/complicações , Osteomielite/terapia , Alta do Paciente/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico
17.
Int Heart J ; 61(2): 404-408, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173704

RESUMO

A man in his 40s with a history of congenitally corrected transposition of the great arteries (CCTGA) and closure of ventricular septal defect was referred to our hospital with purpura and hematuria. Presence of purpura, renal damage, and pathological findings on skin biopsy led to the diagnosis of IgA vasculitis (IgAV). Oral prednisolone (PSL) was initiated. However, Streptococcus pseudoporcinus was isolated from blood cultures, and transthoracic echocardiogram revealed vegetation on the pulmonary valve. From these findings, the diagnosis of infective endocarditis (IE) was made. Although the patient's condition improved after PSL interruption and antibiotic administration, his purpura relapsed. PSL readministration improved symptoms, with no further relapse even after gradual PSL dose reduction. The present case raises awareness of the importance of recognizing the occurrence of IE in IgAV patients, especially in those with congenital heart disease. CCTGA should be acknowledged as a risk factor for IE in the right-sided heart.


Assuntos
Transposição Congênita Corrigida de Grandes Artérias , Endocardite/complicações , Vasculite/imunologia , Adulto , Humanos , Imunoglobulina A , Masculino , Artéria Pulmonar
18.
J Stroke Cerebrovasc Dis ; 29(4): 104598, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32024600

RESUMO

BACKGROUND: Ischemic stroke is a frequent neurologic complication of infective endocarditis. This systematic review aims to evaluate the efficacy and safety of thrombectomy in comparison to thrombolysis and to combined treatment in patients with infective endocarditis associated acute ischemic stroke. METHODS: A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review included case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials, which reported the treatment of endocarditis-related acute ischemic stroke with mechanical thrombectomy, intravenous or intra-arterial thrombolysis in adult patients. DATA SOURCES: Scielo, b-on, Pubmed and Cochrane, from inception to April 2019. Reference lists were also checked. We compared the efficacy (independence, neurological improvement) and safety (intracranial bleeding, death) of acute ischemic stroke treatment with thrombolysis, thrombectomy and combined therapy. RESULTS: Through systematic review 37 articles describing 52 patients met criteria. The risk of intracranial hemorrhage was 4.14 times higher in patients treated with intravenous thrombolysis (P = .001) and 4.67 times higher in patients treated with combined treatment (P = .01). There was trend for independence (P = .09) and neurological improvement (P = .07) in favor of thrombectomy, when comparing this group to the group treated with intravenous thrombolysis. CONCLUSIONS: With the limitation of the low quality of the available evidence, thrombectomy in infective endocarditis associated stroke appears to be safer than thrombolysis, or combined treatment. These results may be useful to guide clinical decisions, in selected patients.


Assuntos
Endocardite/complicações , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Adulto , Idoso , Terapia Combinada , Endocardite/diagnóstico , Endocardite/mortalidade , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Resultado do Tratamento
19.
World Neurosurg ; 137: 173, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32001410

RESUMO

This case Video 1 demonstrates a microsurgical technique for trapping and excision of 2 ruptured mycotic aneurysms. The patient was a 64-year-old man with severe mitral regurgitation and valvular vegetations suggestive of endocarditis. On examination, the patient presented with speech difficulty. Preoperative imaging showed a large left temporoparietal intracerebral hemorrhage and associated sulcal subarachnoid hemorrhage from 2 distal aneurysms of the left middle cerebral artery. In the presence of ruptured aneurysms in a patient who requires anticoagulation for valve replacement, endovascular options are limited. For aneurysms located in an eloquent area in the left hemisphere, microsurgical treatment with small corridors can facilitate excision and minimize damage to the surrounding tissue. As such, the patient was treated with microsurgical trapping and excision of the aneurysms followed by evacuation of intraparenchymal hemorrhage using stereotactic navigation. Intraoperative neurophysiologic monitoring was used to prepare for a potential bypass in the event of inadequate collaterals or changes in neurophysiologic potentials. Postoperatively, the patient remained symmetric in his motor strength and had improved speech deficits, indicative of an uneventful recovery. The patient was cleared for full anticoagulation and valve replacement on postoperative day 10. The patient underwent intravenous antibiotic therapy with ceftriaxone before undergoing mitral valve replacement by cardiac surgery.


Assuntos
Aneurisma Roto/cirurgia , Hemorragia Cerebral/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Artéria Cerebral Média/cirurgia , Procedimentos Neurocirúrgicos/métodos , Aneurisma Roto/etiologia , Anticoagulantes/uso terapêutico , Hemorragia Cerebral/etiologia , Endocardite/complicações , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Aneurisma Intracraniano/etiologia , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Técnicas Estereotáxicas
20.
BMJ Case Rep ; 13(2)2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32086329

RESUMO

We present the case of a patient admitted to hospital in septic shock. He had a history of tricuspid valve infective endocarditis (IE) 6 months prior and regularly injected intravenous drugs. A bedside echo on arrival confirmed vegetations on his tricuspid valve, torrential tricuspid regurgitation and signs of significantly raised right-sided pressures. The admission chest radiograph showed consolidative changes in the lungs, suggestive of septic pulmonary emboli. He was commenced on antibiotics and treated in the high-dependency unit. He subsequently developed an acutely ischaemic right foot and nasal tip. Suspicions were raised of a paradoxical septic embolus through a right-to-left shunt, subsequently confirmed on bubble echo which showed passage of agitated saline between the atria. This was not apparent clinically or on echocardiogram during his previous episode of tricuspid valve IE, raising the possibility of the development of an acquired inter-atrial communication since his previous episode.


Assuntos
Endocardite/complicações , Átrios do Coração/fisiopatologia , Embolia Pulmonar/etiologia , Sepse/etiologia , Insuficiência da Valva Tricúspide/complicações , Valva Tricúspide/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Evolução Fatal , Forame Oval Patente/fisiopatologia , Humanos , Masculino
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