Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.308
Filtrar
1.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 643-652, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747157

RESUMO

The article deals with methods of treating patients with bradyarrhythmias, life-threatening tachyarrhythmias and chronic heart failure with the use of implantable antiarrhythmic devices permanent pacemakers, cardioverter defibrillators, and cardio-resynchronizing systems. Methods of instrumental and electrocardiographic diagnosis acceptable for such patients are described. The work defines management approaches to these patients in the postoperative and subsequent periods of life.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca , Marca-Passo Artificial , Taquicardia , Cardioversão Elétrica , Eletrocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos , Taquicardia/diagnóstico , Taquicardia/terapia
2.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31519793

RESUMO

OBJECTIVES: We assessed racial differences in sepsis recognition in a pediatric emergency department (ED) with an established electronic sepsis alert system. METHODS: Quality-improvement data from June 1, 2016 to May 31, 2017 was used in this retrospective cohort study. All ED visits were included for non-Hispanic black (NHB) and non-Hispanic white (NHW) patients. The sepsis pathway was activated through the alert, 2 stages and a huddle, or outside of the alert using clinician judgment alone. We evaluated racial differences in the frequency of alerts and sepsis pathway activation within and outside of the alert. Multivariable regression adjusted for high-risk condition, sex, age, and insurance. RESULTS: There were 97 338 ED visits: 56 863 (58.4%) and 23 008 (23.6%) from NHBs and NHWs, respectively. NHWs were more likely than NHBs to have a positive second alert (adjusted odds ratio [aOR] 2.4; 95% confidence interval [CI] 2.1-2.8). NHWs were more likely than NHBs to have the sepsis pathway activated (aOR 1.4; 95% CI 1.02-2.1). Of those treated within the alert, there was no difference in pathway activation (aOR 0.93; 95% CI 0.62-1.4). Of those recognized by clinicians when the alert did not fire, NHWs were more likely than NHBs to be treated (aOR 3.4; 95% CI 1.8-6.4). CONCLUSIONS: NHWs were more likely than NHBs to be treated for sepsis, although this difference was specifically identified in the subset of patients treated for sepsis outside of the alert. This suggests that an electronic alert reduces racial differences compared with clinician judgment alone.


Assuntos
Afro-Americanos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hipotensão/diagnóstico , Sepse/diagnóstico , Taquicardia/diagnóstico , Adolescente , Criança , Pré-Escolar , Intervalos de Confiança , Diagnóstico Precoce , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Razão de Chances , Philadelphia , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Análise de Regressão , Estudos Retrospectivos , Sepse/etnologia , Sepse/terapia
3.
Lakartidningen ; 1162019 Aug 13.
Artigo em Sueco | MEDLINE | ID: mdl-31408188

RESUMO

Atrial high rate episodes (AHRE) are frequently detected in patients with pacemakers or implantable cardioverter defibrillators. AHRE episodes ≥5 minutes are associated with increased risk of ischemic stroke. There is no clear temporal relationship between AHRE and ischemic stroke, therefore atrial arrhythmia could be suspected to at least in part be a risk marker and not solely a direct cause of stroke. No results have been published on the effect of anticoagulation in patients with AHRE, but several studies are in progress. The European Heart Rhythm Association (EHRA) recommends anticoagulation for patients with AHRE ≥5.5 hours per day and a CHA2DS2-VASc score of ≥2 (≥3 in females). Anticoagulation may be considered for CHA2DS2-VASc scores of 1 (2 in females). In patients with several risk factors anticoagulation should be considered also in cases with shorter duration of AHRE.


Assuntos
Fibrilação Atrial/complicações , Desfibriladores Implantáveis , Marca-Passo Artificial , Acidente Vascular Cerebral/etiologia , Taquicardia/complicações , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico
5.
J Obstet Gynaecol Res ; 45(8): 1619-1625, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172617

RESUMO

Fetal seizure is rarely observed. Investigation of both video-recording of seizures and cardiotocography is crucial for a precise diagnosis. Here, we report a case of fetal seizure, and also show a video-ultrasound recording. A 40-year-old woman was admitted to us due to loss of variability in cardiotocography. Ultrasound repeatedly revealed opisthotonus-like and clonic-seizure-like movements. After the abnormal movement, tachycardia up to 210 bpm (postictal tachycardia) was noted. Ultrasound revealed a nuchal cord. A careful investigation of video-ultrasound recording by an epilepsy specialist led to the confirmation of epileptic seizures. At 364/7 , she vaginally gave birth to an infant with an umbilical artery pH of 7.22. The infant died 30 min after birth. No clear video-recordings associated with fetal seizure were available for cases reported so far in the literature. The video provided in this case may be of use for further analyses.


Assuntos
Doenças Fetais/diagnóstico , Convulsões/diagnóstico , Taquicardia/diagnóstico , Adulto , Eletrocardiografia , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Recém-Nascido , Morte Perinatal , Gravidez , Convulsões/diagnóstico por imagem , Taquicardia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Monitorização Uterina
6.
Pediatr Cardiol ; 40(6): 1144-1150, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152184

RESUMO

Congenital right atrial appendage aneurysm (RAAA) is an extremely rare malformation that can coexist with atrial tachyarrhythmia. There is no consensus on treatment for this condition. This research aimed to investigate the clinical characteristics and efficacy of surgical resection to treat atrial tachyarrhythmia originating from RAAA in children. Four RAAA children diagnosed with atrial tachyarrhythmia at the age of 1-5.25 years weighing 8.3-17.1 kg were discussed in this retrospective study. Patients underwent various treatments, included electrocardiogram (ECG) and echocardiography, antiarrhythmic medication therapy, radiofrequency catheter ablation (RFCA), surgical resection of RAAA and pathological examinations. The results from these treatments along with clinical features of patients were analyzed. The incidence of RAAA in patients with atrial tachycardia originating from the right or left atrial appendages (RAA or LAA) was 7.3% (4/55). The prevalence of RAAA in the RAA was 12.5% (4/32). Atrial tachyarrhythmia was identified both prenatally (26 and 36 weeks of gestational age) and postnatally (1 and 4 months after birth), with two patients per group, respectively. The RAAAs condition in two patients with atrial tachycardia (AT), concomitant atrial flutter (AF) and atrial fibrillation (Af) was identified using echocardiogram. Although, RAAA in two patients with mono AT was unidentified in echocardiogram and failed to be identified in the procedure of RFCA, RAAA was confirmed during surgical resection of the RAA. Multiple pre-surgical antiarrhythmic medications combined therapy used to treat all four patients showed either no effect at all or was only partially effective. The original atrial tachyarrhythmia was successfully abolished after RAAA surgical resection in four patients. AT originating from new foci was established in two patients post-surgically. The conditions of these two patients were successfully reverted and normal sinus rhythm maintained in the application of antiarrhythmic medications. These results confirmed the efficacy of RAAA surgical resection. The pathology study showed cystic dilation in parts of the atrial cavity, fibrosis of the cyst wall, generalized fibrosis of atrial myocardium with myocardium atrophy and cystic dilation. RAAA is prone to misdiagnosis by echocardiogram. Atrial tachyarrhythmia in patients with RAAA is usually resistant to antiarrhythmic medication therapy and RFCA. Surgical resection of RAAA is a safe and effective option that is minimally invasive.


Assuntos
Apêndice Atrial/cirurgia , Aneurisma Cardíaco/cirurgia , Taquicardia/cirurgia , Antiarrítmicos/uso terapêutico , Apêndice Atrial/anormalidades , Ablação por Cateter/métodos , Pré-Escolar , Ecocardiografia , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/epidemiologia , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Taquicardia/complicações , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Resultado do Tratamento
7.
Med. infant ; 26(2): 123-129, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1015231

RESUMO

Introducción: Las taquiarritmias en pediatría son uno de las principales motivos cardiológicos de consulta a la guardia. Durante el primer año de vida presentan una significativa morbi-mortalidad, por lo que el tratamiento farmacológico inmediato es fundamental para reducir la misma. Hasta los 3 años existe la posibilidad de curación espontánea en un porcentaje de éstos pacientes. La indicación de procedimientos de ablación durante los primero 4 años de vida se limita a casos refractarios al tratamiento antiarrítmico, dado que cuanto menor peso presenta el paciente, más pequeño es el corazón y más riesgoso es el mismo. Las taquicardias en pacientes con cardiopatía empeora el pronóstico de la misma. A pesar que el tratamiento farmacológico ha permitido el control de la gran mayoría de ellas, en muchos casos se requieren más de una droga antiarrítmica, con mayor exposición a efectos adversos, y en muchos otros se vuelven refractarias. En las últimas 3 décadas se ha desarrollado en forma exponencial el tratamiento de las taquiarritmias por medio de la ablación por radiofrecuencia o por frío (crioablación). Estos procedimientos han permitido obtener la curación de la mayor parte de las taquiarritmias en pediatría. En nuestro trabajo se evaluaron las indicaciones de dichos procedimientos en una población pediátrica, como así también la tasa de éxito, recurrencia, y la morbimortalidad tanto globalmente, como en cada arritmia (AU)


In children, tachyarrhythmias are one of the main reasons for cardiological consultation at the Department of Emergency. In the first year of life, they are associated with significant morbiditymortality and therefore, immediate drug treatment is essential up to 3 years of age. The indication of ablation procedures during the first 4 years of life is limited to patients refractory to antiarrhythmic treatment, since the lower weight of the patient, the smaller the heart and the riskier the intervention. In patients with heart disease, tachycardia worsens the prognosis. Although pharmacological treatment controls the vast majority of tachyarrhythmias, more than one antiarrhythmic drug is often required, leading to greater exposure to adverse effects, and many become refractory. Over the past three decades, treatment of tachyarrhythmias has developed exponentially with the advent of radiofrequency or cold ablation (cryoablation). These procedures have led to the cure of most tachyarrhythmias in children. Our study assessed the indications for these procedures in a pediatric population, as well as the success and recurrence rates, and morbidity both overall and of each arrhythmia episode (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Arritmias Cardíacas/epidemiologia , Taquicardia/epidemiologia , Registros , Criocirurgia , /métodos , Arritmias Cardíacas/cirurgia , Arritmias Cardíacas/diagnóstico , Taquicardia/cirurgia , Taquicardia/diagnóstico , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
8.
Card Electrophysiol Clin ; 11(2): 203-217, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31084847

RESUMO

Implantable loop recorders allow prolonged and continuous single-lead electrocardiogram recording, with the pivotal addition of remote monitoring. They have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias/tachyarrhythmias and proved helpful in arrhythmia burden definition, offering invaluable information in the diagnostic workup for syncope and atrial fibrillation. Advanced cardiac signal recording is also possible by transesophageal catheters. They have been used to orient diagnosis during wide and narrow QRS complex tachycardias and also to perform minimally invasive pacing. Intracardiac electrophysiologic study remains, however, essential for diagnosis of several arrhythmias in the perspective of curative catheter ablation.


Assuntos
Técnicas Eletrofisiológicas Cardíacas , Processamento de Sinais Assistido por Computador , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Humanos , Taquicardia/diagnóstico , Taquicardia/fisiopatologia
9.
Card Electrophysiol Clin ; 11(2): 283-299, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31084851

RESUMO

Several arrhythmogenic substrates may generate narrow QRS complex tachycardia, frequently encountered in clinical practice. Some narrow QRS complex tachycardias, however, are sustained by an uncommon arrhythmogenic mechanism. Although rare, these forms should be taken into account in the differential diagnosis to avoid misdiagnosis and improper patient management. Dual atrioventricular node physiology can be responsible for different uncommon forms of narrow QRS complex tachycardia, also nonreentrant in mechanism. A ventricular origin also is possible, if the tachycardia site is located in the upper ventricular septum with fast ventricular propagation to the specific conduction system and narrowing of the QRS complex.


Assuntos
Eletrocardiografia , Taquicardia , Nó Atrioventricular , Humanos , Taquicardia/diagnóstico , Taquicardia/fisiopatologia
10.
Ter Arkh ; 91(4): 83-89, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094481

RESUMO

AIM: To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. MATERIALS AND METHODS: Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). RESULTS: ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). CONCLUSION: The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.


Assuntos
Bloqueio de Ramo/diagnóstico , Eletrocardiografia/métodos , Taquicardia/diagnóstico , Adulto , Idoso , Bloqueio de Ramo/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Taquicardia/fisiopatologia
12.
Am J Emerg Med ; 37(7): 1340-1345, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31027937

RESUMO

The evaluation and treatment of wide QRS-complex tachycardia remains a challenge, and mismanagement is quite common. Diagnostic aids such as wide-complex tachycardia algorithms perform poorly in the real-life setting. The purpose of this review is to offer a simple clinical-electrocardiographic approach for the initial evaluation and management of the adult patient with stable wide-complex tachycardia that does not require recollection of complex guidelines or algorithms.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/diagnóstico , Administração Intravenosa , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/complicações , Diagnóstico Diferencial , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Taquicardia/complicações , Síndrome de Wolff-Parkinson-White/complicações
13.
J Anal Toxicol ; 43(5): e1-e7, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30843073

RESUMO

4-Fluoromethylphenidate (4F-MPH) is an halogenated derivative of methylphenidate (MPH), a re-uptake inhibitor for dopamine and norepinephrine used for the treatment of attention deficit hyperactivity disorders. In the last few years, several compounds structurally related to MPH have been marked as new psychoactive substances (NPS) with stimulating and euphoric effects similar to the parent drug, but with more dopaminergic activity. This report represents the first case of an analytically confirmed non-fatal intoxication by 4F-MPH. A 26-year-old female was admitted to the emergency department with neuropsychiatric and cardiologic symptoms that lasted for a week, during which she sniffed a powder named 4F-MPH acquired as entactogen on the Internet. The patient required sedation with intravenous diazepam and was discharged two days later with a prescription of promazine and quetiapine. The seized product was analytically characterized by gas chromatography-mass spectrometry, liquid chromatography high-resolution mass spectrometry and nuclear magnetic resonance. These analyses confirmed the composition of the product as a 4F-MPH diastereomeric (±)-threo and (±)-erythro mixture, with a large preponderance of the active (±)-threo isomer. A minimal validation, intended for rare analytes, was performed for the quantification of 4F-MPH in the biological samples by liquid chromatography-tandem mass spectrometry. Accuracy (bias) and precision were within ±15% for both blood and urine. The blood and urine concentration of (±)-threo 4F-MPH were 32 ng/mL and 827 ng/mL, respectively. Analyses for classic drugs (opiates, methadone, cocaine, cannabis metabolites, amphetamines, ecstasy and LSD), ethanol, qualitative full screen by gas chromatography-mass spectrometry and targeted analysis for 50 NPS by liquid chromatography-tandem mass spectrometry tested negative; comorbidities were excluded, too. Based on these data, it can be assumed that the clinical manifestations were due to 4F-MPH only.


Assuntos
Acatisia Induzida por Medicamentos/diagnóstico , Estimulantes do Sistema Nervoso Central/toxicidade , Metilfenidato/análogos & derivados , Metilfenidato/toxicidade , Taquicardia/diagnóstico , Adulto , Acatisia Induzida por Medicamentos/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/sangue , Estimulantes do Sistema Nervoso Central/urina , Diazepam/uso terapêutico , Feminino , Humanos , Metilfenidato/sangue , Metilfenidato/urina , Taquicardia/induzido quimicamente , Taquicardia/tratamento farmacológico , Resultado do Tratamento
14.
Kardiol Pol ; 77(5): 541-552, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-30882181

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia resulting in hospitalization. The assessment of symptoms and health­related quality of life (HRQoL) can provide valuable information before, during, and after health care interventions for AF. AIMS: We aimed to perform a translation and cultural adaptation of the Arrhythmia­Specific Questionnaire in Tachycardia and Arrhythmia (ASTA), and to evaluate the reliability and validity of its Polish version. METHODS: The standard forward­backward translation procedure to translate the ASTA questionnaire into Polish was used. A total of 244 patients with AF at a mean (SD) age of 70.7 (10.7) years completed the questionnaire and were included in the study. Reliability was tested using internal consistency (Cronbach α) and validity with an item­total correlation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS: The ASTA symptom scale had satisfactory psychometric properties (α = 0.718), and the corrected item­total correlation was sufficient for most items (0.361-0.506), except for cold sweats (0.156). The ASTA HRQoL scale showed good psychometric properties (α = 0.855). Initial CFA analyses showed that the 1- and 2­factor models had similar properties, with strong factor loadings and satisfactory goodness­of­fit values according to the comparative fit index (0.947 for the 1­factor model vs 0.988 for the 2­factor model). A comparison of the 1­and 2­factor models showed that the close fit for the root­mean­square error of approximation was better for the 2­factor model (0.387 vs 0.193). A 2­factor EFA model was produced, and for factor 1 (physical scale), the varimax low ranged between 0.470 and 0.804, and for factor 2 (the mental scale), it ranged between 0.597 and 0.873. CONCLUSIONS: The psychometric properties of the Polish version of the ASTA questionnaire were overall found to be satisfactory.


Assuntos
Arritmias Cardíacas/diagnóstico , Psicometria , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/psicologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Qualidade de Vida , Reprodutibilidade dos Testes , Taquicardia/diagnóstico , Taquicardia/psicologia
17.
Dermatol Online J ; 25(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710907

RESUMO

Cellulitis, a bacterial infection of the skin and subcutaneous tissue, is often misdiagnosed. Cellulitis accounts for a large number of all infectious disease-related hospitalizations in the U.S. Cellulitis can be challenging to diagnose since it lacks pathognomonic findings. We reviewed all articles on cellulitis within the last 20 years that included a statistical analysis, with odds ratios (OR), of specific clinical features of cellulitis. We then constructed a mnemonic encompassing the features with the highest odds ratios. Our mnemonic is CELLULITIS for cellulitis history, edema, local warmth, lymphangitis, unilateral, leukocytosis, injury, tender, instant onset, and systemic signs. The first characteristic has the highest OR and may be the easiest to recall: past episode(s) of cellulitis.


Assuntos
Celulite (Flegmão)/diagnóstico , Febre/diagnóstico , Leucocitose/diagnóstico , Linfangite/diagnóstico , Pele/lesões , Taquicardia/diagnóstico , Celulite (Flegmão)/complicações , Edema/etiologia , Febre/etiologia , Temperatura Alta , Humanos , Leucocitose/etiologia , Linfangite/etiologia , Anamnese , Memória , Exame Físico , Taquicardia/etiologia , Fatores de Tempo
18.
Am J Trop Med Hyg ; 100(2): 411-419, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30652671

RESUMO

According to the World Health Organization, 98% of fatal dengue cases can be prevented; however, endemic countries such as Colombia have recorded higher case fatality rates during recent epidemics. We aimed to identify the predictors of mortality that allow risk stratification and timely intervention in patients with dengue. We conducted a hospital-based, case-control (1:2) study in two endemic areas of Colombia (2009-2015). Fatal cases were defined as having either 1) positive serological test (IgM or NS1), 2) positive virological test (RT-PCR or viral isolation), or 3) autopsy findings compatible with death from dengue. Controls (matched by state and year) were hospitalized nonfatal patients and had a positive serological or virological dengue test. Exposure data were extracted from medical records by trained staff. We used conditional logistic regression (adjusting for age, gender, disease's duration, and health-care provider) in the context of multiple imputation to estimate exposure to case-control associations. We evaluated 110 cases and 217 controls (mean age: 35.0 versus 18.9; disease's duration pre-admission: 4.9 versus 5.0 days). In multivariable analysis, retro-ocular pain (odds ratios [OR] = 0.23), nausea (OR = 0.29), and diarrhea (OR = 0.19) were less prevalent among fatal than nonfatal cases, whereas increased age (OR = 2.46 per 10 years), respiratory distress (OR = 16.3), impaired consciousness (OR = 15.9), jaundice (OR = 32.2), and increased heart rate (OR = 2.01 per 10 beats per minute) increased the likelihood of death (AUC: 0.97, 95% confidence interval: 0.96, 0.99). These results provide evidence that features of severe dengue are associated with higher mortality, which strengthens the recommendations related to triaging patients in dengue-endemic areas.


Assuntos
Diarreia/diagnóstico , Icterícia/diagnóstico , Náusea/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Dengue Grave/diagnóstico , Taquicardia/diagnóstico , Adolescente , Adulto , Anticorpos Antivirais/sangue , Estudos de Casos e Controles , Colômbia , Vírus da Dengue/imunologia , Vírus da Dengue/isolamento & purificação , Diarreia/mortalidade , Diarreia/fisiopatologia , Diarreia/virologia , Doenças Endêmicas , Feminino , Cefaleia , Humanos , Imunoglobulina M/sangue , Icterícia/mortalidade , Icterícia/fisiopatologia , Icterícia/virologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Náusea/mortalidade , Náusea/fisiopatologia , Náusea/virologia , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Síndrome do Desconforto Respiratório do Adulto/virologia , Medição de Risco , Dengue Grave/mortalidade , Dengue Grave/fisiopatologia , Dengue Grave/virologia , Análise de Sobrevida , Taquicardia/mortalidade , Taquicardia/fisiopatologia , Taquicardia/virologia
20.
Eur J Anaesthesiol ; 36(2): 105-113, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30507620

RESUMO

BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is a major contributor to peri-operative morbidity and mortality with a reported incidence of about 8%. Tachycardia increases myocardial oxygen demand, and decreases oxygen supply, and is therefore a potential cause of MINS. OBJECTIVE: We tested the hypothesis that there is an association between intra-operative area above a heart rate (HR) of 90 bpm and a composite of MINS and in-hospital all-cause mortality. DESIGN: Retrospective analyses. SETTING: Major tertiary care hospital, Cleveland, USA. PATIENTS: Adults having elective or nonelective noncardiac surgery and scheduled troponin monitoring during the first 3 postoperative days between 2010 and 2015. MAIN OUTCOME MEASURES: All-or-none composite of myocardial injury (MINS), defined by a peak postoperative generation 4 troponin T concentration at least 0.03 ng ml, and in-hospital all-cause mortality. RESULTS: Among 2652 eligible patients, 123 (4.6%) experienced MINS within 7 days after surgery and 6 (0.2%) died before discharge. Intra-operative area above HR more than 90 bpm was not associated with the all-or-none composite of MINS and in-hospital mortality, with an estimated odds ratio (95% confidence interval) of 0.99 (0.97 to 1.01) per 1 h bpm increase in area above HR more than 90 bpm. Secondary outcomes were also unrelated to the composite, with estimated odds ratios (98.3% confidence interval) of 0.99 (0.98 to 1.00) for area above HR more than 80, 0.98 (0.92 to 1.04) for area above HR more than 100 bpm, and 0.96 (0.88 to 1.05) for maximum HR. CONCLUSION: There was no apparent association between various measures of tachycardia and a composite of MINS and death, a result that contradicts previously reported associations between other measures of intra-operative tachycardia and MINS/mortality.


Assuntos
Infarto do Miocárdio/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Taquicardia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Frequência Cardíaca , Mortalidade Hospitalar , Humanos , Incidência , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquicardia/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA