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1.
Clin Imaging ; 81: 143-146, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34717236

RESUMO

A pyogenic hepatic abscess is an uncommon complication after laparoscopic sleeve gastrectomy (LSG) that can develop secondary to an infected hematoma or a staple line leak due to bacterial seeding. Appropriate screening for and management of a pyogenic hepatic abscess are essential in patients with clinical suspicion for complications after LSG. Early diagnosis is essential as pyogenic hepatic abscess can be fatal if not treated early. Only five cases have been reported in the literature so far. We present a case of pyogenic hepatic abscess that occurred two weeks after LSG in a 46-year-old female without immunosuppressive conditions or early postoperative leak. The abscess was diagnosed by computed tomography (CT) and was successfully treated with antibiotics and CT-guided drainage.


Assuntos
Laparoscopia , Abscesso Hepático Piogênico , Obesidade Mórbida , Fístula Anastomótica , Drenagem , Feminino , Gastrectomia/efeitos adversos , Humanos , Abscesso Hepático Piogênico/diagnóstico por imagem , Abscesso Hepático Piogênico/etiologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
2.
J Intensive Care Med ; 37(1): 120-127, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33412988

RESUMO

INTRODUCTION: In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response. METHODS: We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children's hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student's t test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation. RESULTS: Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], p < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], p = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both p < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response. CONCLUSION: In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.


Assuntos
Bronquiolite , Ventilação não Invasiva , Insuficiência Respiratória , Bronquiolite/terapia , Cânula , Humanos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
3.
Heart Fail Clin ; 18(1): 101-113, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776072

RESUMO

In the wide phenotypic spectrum of cardiomyopathies, sudden cardiac death (SCD) has always been the most visible and devastating disease complication. The introduction of implantable cardioverter-defibrillators for SCD prevention by the late 1980s has moved the question from how to whom we should protect from SCD, leaving clinicians with a measure of uncertainty regarding the most reliable option to guide identification of the highest-risk patients. In this review, we will go through all the available evidence in the field of arrhythmic expression and arrhythmic risk stratification in the different phenotypes of cardiomyopathies to provide practical suggestions in daily clinical management.


Assuntos
Cardiomiopatias , Desfibriladores Implantáveis , Cardiomiopatias/genética , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Fenótipo
4.
Heart Fail Clin ; 18(1): 115-123, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776073

RESUMO

"Sudden unexplained death (SUD) is a tragic event for both the family and community, particularly when it occurs in young individuals. Sudden cardiac death (SCD) represents the leading form of SUD and is defined as an unexpected event without an obvious extracardiac cause, occurring within 1 hour after the onset of symptoms. In children, the main causes of SCD are inherited cardiac disorders, whereas coronary artery diseases (congenital or acquired), congenital heart diseases, and myocarditis are rare. The present review examines the current state of knowledge regarding SCD in children, discussing the epidemiology, clinical causes, and prevention strategies."


Assuntos
Morte Súbita Cardíaca , Cardiopatias , Criança , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos
5.
Heart Fail Clin ; 18(1): 125-137, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776074

RESUMO

Takotsubo syndrome is an acute reversible heart failure syndrome, most frequently seen in postmenopausal women and precipitated generally by significant emotional stress or physical illness. A sudden sympathetic activation seems to play a key role in the pathophysiology, but growing evidence is emerging about the role of inflammation in the subacute and chronic phases. An incidence of life-threatening complications occurring in the acute phase and at long-term follow-up has been demonstrated, comparable with the acute coronary syndrome. Multimodality imaging could be useful to stratify in-hospital and long-term prognosis. The efficacy of specific medical treatments in long-term follow-up should be investigated.


Assuntos
Cardiomiopatia de Takotsubo , Feminino , Humanos , Prognóstico , Síndrome , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/etiologia
6.
Heart Fail Clin ; 18(1): 51-60, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776083

RESUMO

Mitochondrial diseases (MD) include an heterogenous group of systemic disorders caused by sporadic or inherited mutations in nuclear or mitochondrial DNA (mtDNA), causing impairment of oxidative phosphorylation system. Hypertrophic cardiomyopathy is the dominant pattern of cardiomyopathy in all forms of mtDNA disease, being observed in almost 40% of the patients. Dilated cardiomyopathy, left ventricular noncompaction, and conduction system disturbances have been also reported. In this article, the authors discuss the current clinical knowledge on MD, focusing on diagnosis and management of mitochondrial diseases caused by mtDNA mutations.


Assuntos
Cardiomiopatias , Cardiomiopatia Dilatada , Cardiomiopatia Hipertrófica , Doenças Mitocondriais , Cardiomiopatias/etiologia , Cardiomiopatias/genética , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/terapia , DNA Mitocondrial/genética , Humanos , Doenças Mitocondriais/diagnóstico , Doenças Mitocondriais/genética , Doenças Mitocondriais/terapia
7.
Heart Fail Clin ; 18(1): 9-18, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34776087

RESUMO

Sudden cardiac death (SCD) is the most common cause of death in childhood hypertrophic cardiomyopathy (HCM) and occurs more frequently than in adult patients. Risk stratification strategies have traditionally been extrapolated from adult practice, but newer evidence has highlighted important differences between childhood and adult cohorts, with the implication that pediatric-specific risk stratification strategies are required. Current guidelines use cumulative risk factor thresholds to recommend implantable cardioverter defibrillator (ICD) implantation but have been shown to have limited discriminatory ability. Newer pediatric models that allow clinicians to calculate individualized estimates of 5-year risk allowing, for the first time, personalization of ICD implantation decision-making have been developed. This article describes the pathophysiology, risk factors, and approach to risk stratification for SCD in childhood HCM and highlights unanswered questions.


Assuntos
Cardiomiopatia Hipertrófica , Desfibriladores Implantáveis , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/terapia , Criança , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Medição de Risco , Fatores de Risco
8.
Clin Podiatr Med Surg ; 39(1): 143-156, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809792

RESUMO

Pediatric equinus is broadly defined as generalized limited dorsiflexion at the ankle joint. It may result from either congenital or acquired causes and exhibit varying characteristics such as flexible, rigid, or spastic types. It has been extensively studied in literature and is known to be associated with the pathological condition of the bone, soft tissue, or combined deformity. In children, rigid plantarflexed cases can be debilitating and prevent them from ambulating without pain, if at all. As this volume in Clinics has chapters on comprehensive pediatric examination and neuromuscular disorders, this article will focus on (non-neurologic equinus) and its treatment via conservative and surgical methods with an emphasis on gradual correction.


Assuntos
Pé Equino , Articulação do Tornozelo , Criança , Pé Equino/etiologia , Pé Equino/cirurgia , Humanos
9.
Clin Podiatr Med Surg ; 39(1): 73-87, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809796

RESUMO

This article explores different pediatric forefoot deformities including syndactyly, polydactyly, macrodactyly, curly toe, and congenital hallux varus. The epidemiology and genetic background are reviewed for each condition. Preferred treatment options and recommended surgical techniques are discussed with review of the current literature.


Assuntos
Deformidades do Pé , Hallux , Polidactilia , Criança , Deformidades do Pé/diagnóstico , Deformidades do Pé/epidemiologia , Deformidades do Pé/etiologia , Humanos
10.
Facial Plast Surg Clin North Am ; 30(1): 15-22, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809883

RESUMO

Facial trauma accounts of 7% to 10% of emergency department visits in the United States every year. The management of facial soft tissue trauma is an essential skill for the facial plastic surgeon. Understanding preoperative evaluation, repair/management of concomitant injuries, postoperative care, and scar treatment help the facial plastic surgeon obtain the best functional and aesthetic results for the patient. Treating the face by subunit and avoiding common pitfalls is the key to achieving optimal results. This article can serve as a basis for surgical pearls and considerations when evaluating and repairing facial soft tissue trauma.


Assuntos
Traumatismos Faciais , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Cicatriz/cirurgia , Traumatismos Faciais/cirurgia , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Lesões dos Tecidos Moles/cirurgia
11.
Facial Plast Surg Clin North Am ; 30(1): 63-70, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809887

RESUMO

Le Fort fractures occur at uniform weak areas in the midface often due to blunt impact to the face. Sporting injuries are a common cause of facial trauma; however, use of protective equipment has reduced the number of sports-related injuries. All patients with traumatic injuries should be evaluated using Advanced Trauma Life Support protocol. Le Fort fractures can contribute to airway obstruction, and urgent intubation may be indicated. Surgery is indicated for most displaced Le Fort fractures to restore function and facial harmony. To facilitate reduction, the original occlusive relationship should be restored by placing the patient in MMF.


Assuntos
Traumatismos Faciais , Fraturas Maxilares , Fraturas Cranianas , Face , Ossos Faciais/cirurgia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Humanos , Osteotomia de Le Fort
12.
Cardiol Clin ; 40(1): 29-43, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809915

RESUMO

Pulmonary hypertension (PH), a syndrome characterized by elevated pulmonary pressures, commonly complicates connective tissue disease (CTD) and is associated with increased morbidity and mortality. The incidence of PH varies widely between CTDs; patients with systemic sclerosis are most likely to develop PH. Several different types of PH can present in CTD, including PH related to left heart disease and respiratory disease. Importantly, CTD patients are at risk for developing pulmonary arterial hypertension, a rare form of PH that is associated with high morbidity and mortality. Future therapies targeting pulmonary vascular remodeling may improve outcomes for patients with this devastating disease.


Assuntos
Doenças do Tecido Conjuntivo , Hipertensão Pulmonar , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/epidemiologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia
13.
Cardiol Clin ; 40(1): 45-54, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809916

RESUMO

It is important to recognize and treat human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) because of the associated morbidity and mortality. With the introduction of antiretroviral therapies (ART), improved survival has changed the focus of treatment management from immunodeficiency-related opportunistic infections to chronic cardiovascular complications, including HIV-PAH. The 2018 6th World Symposium of Pulmonary Hypertension recommended a revised definition of PAH that might result in a greater number of patients with HIV-PAH; however, the implication of this change is not yet clear. Here, we review the current literature on the diagnosis, management, and outcomes of patients with HIV-PAH.


Assuntos
Infecções por HIV , Hipertensão Pulmonar , Hipertensão Arterial Pulmonar , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia
14.
Cardiol Clin ; 40(1): 55-67, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809917

RESUMO

Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients with PAH-CHD is medical therapy, although defect closure is considered in select cases.


Assuntos
Complexo de Eisenmenger , Cardiopatias Congênitas , Hipertensão Pulmonar , Adulto , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/diagnóstico , Complexo de Eisenmenger/terapia , Coração , Cardiopatias Congênitas/complicações , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia
15.
Cardiol Clin ; 40(1): 69-76, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809918

RESUMO

Pulmonary hypertension (PH) due to left heart disease (LHD; group 2 PH) is a common complication of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction and is often related to disease severity and duration of these diseases. PH due to LHD is associated with negative impact on outcomes in addition to worse symptoms and exercise capacity. Risk factors for group 2 PH are older age, hypertension, atrial fibrillation, and features of metabolic syndrome. The main mechanisms for group 2 PH are believed to be vascular remodeling secondary to sustained elevated intravascular pressure.


Assuntos
Cardiopatias , Insuficiência Cardíaca , Hipertensão Pulmonar , Disfunção Ventricular Esquerda , Idoso , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Fatores de Risco , Volume Sistólico
16.
Cardiol Clin ; 40(1): 77-88, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809919

RESUMO

Patients with advanced lung disease can develop pulmonary hypertension and succumb to right ventricular failure/cor pulmonale. Patients with pulmonary hypertension owing to chronic lung disease, or World Health Organization group 3 pulmonary hypertension, are more limited and carry a high risk of mortality. Adjunctive therapies remain the cornerstones of treatment. Recent evidence suggests that inhaled pulmonary vasodilator therapy can be helpful in patients with pulmonary hypertension owing to interstitial lung disease. Lung transplantation may be the only life-saving option in select patients, whereas palliative care and hospice should be sought for those who are not candidates as the disease progresses.


Assuntos
Insuficiência Cardíaca , Hipertensão Pulmonar , Pneumopatias , Doença Cardiopulmonar , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/etiologia , Artéria Pulmonar
17.
Cardiol Clin ; 40(1): 89-101, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809920

RESUMO

Chronic thromboembolic pulmonary hypertension is a progressive disease, which may lead to severe right ventricular dysfunction and debilitating symptoms. Pulmonary thromboendarterectomy (PTE) provides the best opportunity for complete resolution of obstructing thromboembolic disease and functional improvement in appropriately selected patients. In this article, the authors review preoperative workup, patient selection, operative technique, postoperative care, and outcomes after PTE.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Disfunção Ventricular Direita , Doença Crônica , Endarterectomia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia
18.
J Intensive Care Med ; 37(1): 100-106, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33307945

RESUMO

BACKGROUND: Despite the importance of transfusion in treating sickle cell disease acute chest syndrome, the target hemoglobin and optimal modality for transfusion remain unknown. OBJECTIVES: To compare hospital length of stay (LOS) in intensive care unit (ICU) patients with acute chest syndrome transfused to hemoglobin ≥ 8 g/dL versus patients transfused to hemoglobin < 8 g/dL; and to compare hospital LOS in acute chest syndrome patients treated with and without exchange transfusion. METHODS: We performed a retrospective cohort study of all acute chest syndrome patients treated in the medical ICU at 2 tertiary care hospitals between January 2011 and August 2016 (n = 82). We compared median hospital LOS in patients transfused to hemoglobin ≥ 8 g/dL by the time of ICU transfer to the medical floor versus patients transfused to hemoglobin < 8 g/dL as well as patients who received exchange transfusion versus no exchange transfusion using Wilcoxon rank-sum tests. We modeled the association between hospital LOS and hemoglobin at ICU transfer to the medical floor using multivariable log-linear regression. RESULTS: Median hospital LOS was about half as long for patients transfused to hemoglobin ≥ 8 g/dL versus hemoglobin < 8 g/dL (8.0 versus 16.5 days, P = 0.008). There was no difference in LOS for patients treated with and without exchange transfusion. On average, a 1 g/dL increase in hemoglobin was associated with a 19.5% decrease (95% CI 10.8-28.2%) in LOS, controlling for possible confounding factors. CONCLUSIONS: Transfusion to a hemoglobin target ≥ 8 g/dL is associated with decreased hospital LOS in patients with acute chest syndrome. There was no difference in LOS between patients who received exchange transfusion and those who did not.


Assuntos
Síndrome Torácica Aguda , Anemia Falciforme , Síndrome Torácica Aguda/etiologia , Síndrome Torácica Aguda/terapia , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Transfusão de Sangue , Hemoglobinas/análise , Humanos , Estudos Retrospectivos
19.
Food Chem ; 367: 130735, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34365247

RESUMO

Green and black teas are regarded to possess therapeutic potential for the treatment of obesity, however it is not clear which tea performs better in body weight control. In this study, aiming to eliminate cultivar variation, green tea phenolics (GTP) were oxidized by tyrosinase to obtain oxidized tea phenolics (OTP). Thereafter, their anti-obesity effect on high-fat diet induced obese mice were compared. The results showed that despite their distinctive phenolic profiles, GTP and OTP exerted similar anti-obesity properties after 12 weeks of dietary intervention. Furthermore, cecal microbiota profiling exhibited comparable modulatory effects of GTP and OTP on multiple bacterial taxa, including Parabacteroides distasonis, Bifidobacterium, Prevotella, and Akkermansia muciniphila, which were strongly associated with obesity related indexes. Putative bacterial function profiling implicated that both GTP and OTP might regulate the lipid metabolism similarly. Collectively, the oxidation of GTP did not influence the anti-obesity and gut microbiota modulatory effects to any large extent.


Assuntos
Microbioma Gastrointestinal , Chá , Animais , Bacteroidetes , Camundongos , Camundongos Obesos , Obesidade/tratamento farmacológico , Obesidade/etiologia
20.
Appl Ergon ; 98: 103588, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34562781

RESUMO

Through a randomized controlled trial, we evaluated the effects of an electro-magnetic active seat suspension that reduces exposure of a long-haul truck driver to whole body vibration (WBV) on low back pain (LBP) and disability. Among 276 drivers recruited from six trucking terminals of a major US trucking company, 135 eligible drivers were assigned to either having an Active Seat (Intervention: n = 70) - the BoseRide® electro-magnetic active seat - or Passive Seat (reference: n = 65) - a new version of their current seat (passive air suspension seat) - installed in their truck via block (terminal) randomization. Low back pain (LBP) severity, on a 0-10 scale and the Oswestry LBP Disability Index were collected before and 3-, 6-, 12-, 18-, and 24-months post seat installation. LBP severity and LBP disability scores were significantly lower post seat installation in both groups. At 3 months, LBP severity decreased -1.4 [95% CI: -2.1 to -0.7: n = 46] for drivers in the Active Seat arm, and -1.5 [95% CI: -2.3 to -0.8: n = 41] for drivers in the Passive Seat arm. In a subset of drivers, WBV exposures were collected before and after the seat installation. WBV exposures significantly decreased post seat installation for Active Seat (p < 0.01) but not for Passive Seat (p = 0.15). While the new seat-suspension technology reduced WBV exposures, LBP appeared to be improved by multiple factors. These results were limited by the secondary prevention approach and the longer-term loss to follow up due to large rates of driver turnover typical for the industry.


Assuntos
Condução de Veículo , Dor Lombar , Doenças Profissionais , Exposição Ocupacional , Desenho de Equipamento , Humanos , Dor Lombar/etiologia , Dor Lombar/prevenção & controle , Veículos Automotores , Exposição Ocupacional/efeitos adversos , Vibração/efeitos adversos
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