Effects of pericardial tamponade on the hemodynamics of aortic stenosis.

Compressive pericardial physiology (i.e., cardiac tamponade) reduces ventricular chamber volume/filling and cardiac output, which exacerbates coexisting hemodynamic derangements. In this hemodynamic rounds, we demonstrate the interaction of two hemodynamic conditions in one patient with acute pericardial tamponade in the setting of aortic stenosis (AS). Simultaneous pressures across the aortic valve before and after relief of cardiac tamponade demonstrate an acute and uncommon improvement in the hemodynamics of AS.

Calciphylaxis.

Calciphylaxis is a disease in which metastatic calcification affects small- and medium-sized vessels resulting in significant dermatologic manifestations. Lesions typically occur over areas of high fat content and progress to black leathery eschars. Calciphylaxis is associated with intense pain and markedly increased risk of infection, often leading to sepsis requiring hospitalization. Diagnosis is made by clinical history and skin biopsy. Management of calciphylaxis is interdisciplinary, emphasizing factors such as primary prevention, proper wound care, pain control, and hormone and mineral balance. Although calciphylaxis carries a high mortality rate, symptomatic treatment has shown promise as a method for controlling disease progression.

Maternal and fetal outcomes in pregnant women with heart failure.

OBJECTIVES: The goal of this study is to report the prevalence, aetiology and clinical outcome of pregnant women with heart failure. METHODS: This is a retrospective community-based cohort study that included pregnant women in the Kaiser Permanente Health System between 2003 and 2014. Women with heart failure were identified using International Classification of Disease, Ninth Revision codes. Medical records were manually reviewed to confirm diagnosis and adjudicate outcomes. RESULTS: In a cohort of 385 935 pregnancies, 488 (0.13%) had a diagnosis of heart failure, corresponding to 126 cases per 100 000 pregnancies. Peripartum cardiomyopathy was the most common cause of heart failure, accounting for 333 (68.2%) cases. Preterm birth and caesarean delivery were more common in patients with heart failure. Neonatal death rate was higher in the heart failure group (1.0% vs 0.4%, p=0.03). Infants delivered to women with heart failure had lower birth weights (3112.0±774.0 g vs 3331.9±575.5 g, p<0.001) and lower Apgar score at 1 min (7.9±1.5 vs 8.3±1.1, p<0.001). Median follow-up was 6.2 years (IQR 3.2-9.2). During follow-up, 7 (1.4%) in the heart failure group and 423 (0.11%) in the control group died. Heart failure was associated with a 7.7-fold increase risk of death (adjusted HR 7.7, 95% CI 3.6 to 16.4, p<0.001). CONCLUSION: Heart failure during pregnancy is associated with unfavourable fetal outcomes including prematurity and low birth weight. While the overall mortality rate was low, pregnant women with heart failure carried an excess risk of death compared with controls.

A simple intervention to reinforce awareness of tanning bed use and skin cancer in non-medical skin care professionals in Southern California.

BACKGROUND: (i) To assess the baseline knowledge of non-medical skin care professionals (estheticians, cosmetologists, massage therapists) on tanning bed use and its association with melanoma; and (ii) to provide preliminary evidence of the potential impact of a fast and simple educational intervention on tanning beds and melanoma on the awareness of non-medical skin care professionals towards skin cancer prevention. METHODS: A pre-intervention survey was administered to non-medical skin care professional at salons or spas in Southern California to assess baseline knowledge on tanning and skin cancer. This was followed immediately by a 10-minute oral presentation on tanning bed use and its association with melanoma. One month later, a post-intervention survey was distributed to individuals who attended the initial oral presentation. RESULTS: Significant changes pre- and post-intervention were found in non-medical skin care professionals' answer responses to the following: (i) increased speaking to clients about cancer risk with tanning bed use 42-66% (OR 2.44; 95% CI 1.39, 4.30)]; (ii) decreased personal tanning bed use (23-15% [OR 0.61; 95% CI 0.37, 1.00]); and (iii) decreased belief that tanning beds are an excellent cosmetic tool (29-20% [OR 0.60; 95% CI 0.38, 0.96]). CONCLUSION: This study provides preliminary evidence that non-medical skin care professionals could be an important source of primary prevention information for reducing the burden of melanoma.