RESUMO
BACKGROUND: Atrial fibrillation (Afib) is one of the most common and significant risk factors for stroke, with the CHADsVAsc score used as the tool for stroke risk assessment. Pulmonary hypertension (PH) has not been studied as an independent risk factor for stroke in individuals with Afib. METHODS: In this retrospective case-control study, National Inpatient Sample Database was used to sample individuals with atrial fibrillation, and baseline demographics and comorbidities were collected using ICD-10 codes. Patients with missing data, age under 18, history of thromboembolic diseases, or stroke were excluded. Greedy propensity matching using R was performed to match patients with and without PH on age, race, gender, and 19 other comorbidities, including anticoagulation use. Binary logistic regression was performed after matching to assess whether PH was an independent risk factor for stroke. A p-value of <0.05 was considered statistically significant. RESULTS: Of the 2,421,545 patients included in the study, 158,545 (6.5%) had PH. PH patients were more likely to be elderly, females, and smokers. Comorbidities were more common in the PH group. Patients with PH were more likely to have an ischemic stroke (3.6% vs. 2.9%, p<0.001), hemorrhagic stroke (2.2% vs. 0.7%, p<0.001), and transient ischemic attack (TIA) (2.3% vs. 0.7%, p<0.001). After matching, the presence of PH was associated with increased ischemic stroke (OR: 1.2 [1.1-1.2]; p<0.001), hemorrhagic stroke (OR: 2.4 [2.1-2.6]; p<0.001) and TIA (OR: 2.2 [2.0-2.4]; p<0.001). PH patients also had increased length of stay (ß = 0.8; p<0.001) mortality (OR: 1.1 [1.0-1.2]; p<0.001). CONCLUSION: Apart from demonstrating the deleterious effect of PH on mortality and length of hospital stay, this study is the first to report on such a large scale that PH independently increases the incidence of all types of strokes in patients with Afib.
Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral Hemorrágico , Hipertensão Pulmonar , Ataque Isquêmico Transitório , AVC Isquêmico , Acidente Vascular Cerebral , Feminino , Humanos , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/complicações , Ataque Isquêmico Transitório/etiologia , Estudos Retrospectivos , Estudos de Casos e Controles , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Acidente Vascular Cerebral Hemorrágico/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Fatores de Risco , AVC Isquêmico/complicaçõesAssuntos
Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Recidiva Local de Neoplasia/epidemiologia , Nefrectomia/estatística & dados numéricos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/estatística & dados numéricos , Progressão da Doença , Intervalo Livre de Doença , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Nivolumabe/uso terapêutico , Intervalo Livre de Progressão , Inibidores de Proteínas Quinases/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptores de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Sunitinibe/uso terapêuticoAssuntos
Adenocarcinoma/etiologia , Adenocarcinoma/terapia , Biomarcadores Tumorais , Terapia de Alvo Molecular , Oncologistas , Receptor ErbB-2/metabolismo , Neoplasias Gástricas/etiologia , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico , Tomada de Decisão Clínica , Gerenciamento Clínico , Suscetibilidade a Doenças , Humanos , Estadiamento de Neoplasias , Receptor ErbB-2/genética , Neoplasias Gástricas/diagnósticoRESUMO
COVID-19 is still around, and in the most severe cases can rapidly progress to acute respiratory distress syndrome. When mechanical ventilation fails to improve oxygenation, we desperately shift our management to venovenous extracorporeal membrane oxygenation (vv-ECMO). In this opinion article, we discuss which patients are the most suitable to select for this technique, reiterate previous observations in acute respiratory distress syndrome, and the options for the patients judged not fitting for ECMO.
Assuntos
COVID-19 , Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório , Humanos , Oxigenação por Membrana Extracorpórea/métodos , COVID-19/terapia , Síndrome do Desconforto Respiratório/terapia , Pulmão , Respiração Artificial/métodosRESUMO
CDK 4/6 inhibitors have been yielding propitious results when with hormone therapy in the management of Her2-negative and hormone-receptor (HR)-positive metastatic breast cancer, palbociclib being one of the first molecules investigated in this setting. However, the response to CDK4/6 inhibitors is variable. To identify predictive and prognostic factors of response to this therapeutic regimen. Eligible patients were females with HR+ and Her2- advanced breast cancer, receiving Palbociclib in combination with Letrozole. PFS was the primary endpoint in the evaluation of response to treatment. This survival was then further segregated according to various characteristics: histological (type, grade, hormone receptors), metastatic site, line of treatment, response type at initial assessment, and best response achieved. The data was then processed by two statistical analysis models: Kaplan-Meier and univariate preceding multivariate Cox proportional risks. Sixty patients were included and followed for a median follow-up duration of 15.98 months. PFS recorded a median of 19.07 months (95% CI=15.43-22.71). PFS had a median of 12.99 months in the absence of progesterone receptors (vs 20.05 months in the case of positive estrogen and progesterone receptors; P = 0.046), a median of 13.02 months in the presence of liver metastases (vs 22.98 months in the absence of liver metastases; P = 0.007), and 15.94 months in the case of second-line and beyond (vs 22.98 months in the case of first-line; P = 0.033). Regarding the Hazard Ratio of progression, we note age (HR 0.941; P = 0.019), liver metastases (HR 2.751; P = 0.051), response at initial evaluation (HR<1; P < 0.001) and best response (HR<1; P = 0.003). PFS reached similar figures to those of international studies. The absence of progesterone receptors, presence of liver metastases, and use as second-line or beyond are associated with a reduced median PFS. One year age increase (protective factor), liver metastases (risk factor), response at initial evaluation, and best response achieved are identified as the most predictive factors of the response to this treatment regimen and of the progression risk.