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Journal of Infection in Developing... May 2024The coronavirus disease 2019 (COVID-19) spread rapidly in Shanghai in February 2022. Patients with asymptomatic and mild symptoms were admitted to Fangcang shelter...
INTRODUCTION
The coronavirus disease 2019 (COVID-19) spread rapidly in Shanghai in February 2022. Patients with asymptomatic and mild symptoms were admitted to Fangcang shelter hospitals for centralized quarantine.
METHODOLOGY
A total of 5,217 non-severe patients hospitalized in the Longyao Fangcang and Shilong Fangcang hospitals were included in the study. Demographic and clinical characteristics, comorbidity, exposure history, treatment and disease duration were analyzed. Univariate analysis and binomial logistic regression analysis were performed to identify the factors influencing nucleic acid change from positive to negative over 14 days.
RESULTS
Consecutive positive nucleic acid test results (days) were significantly associated with advanced age (OR = 1.343, 95% CI 1.143 to 1.578, p < 0.001), smoking (OR = 0.510, 95% CI 0.327 to 0.796, p = 0.003) and vaccination (OR = 0.728, 95% CI 0.641 to 0.827, p < 0.001). However, there was no significant difference between asymptomatic and mild symptomatic patients (p = 0.187). In univariate analysis, comorbidities including diabetes, hypertension, cardiovascular system, malignant tumors, autoimmune diseases and cerebral apoplexy were associated with consecutive positive nucleic acid test results, but there was no significant difference in binomial logistics regression analysis.
CONCLUSIONS
Aging and comorbid conditions lead to the prolongation of positive nucleic acid test results for several days. Improving vaccination coverage is beneficial for prevention and control of the epidemic. The management and treatment methods of Shanghai Fangcang shelter hospitals had important referential significance, which can provide valuable guidance for the prevention and control of the COVID-19 epidemic in the future.
Topics: Humans; COVID-19; China; Male; Middle Aged; Female; Retrospective Studies; Adult; Aged; SARS-CoV-2; COVID-19 Nucleic Acid Testing; Comorbidity; Young Adult; Aged, 80 and over; Adolescent; Hospitals
PubMed: 38865397
DOI: 10.3855/jidc.17729 -
Cureus Jun 2024Unilateral exudative pleural effusions have been described as a rare complication of polycystic liver disease. Surgical debridement of the main cyst reduces recurrence...
Unilateral exudative pleural effusions have been described as a rare complication of polycystic liver disease. Surgical debridement of the main cyst reduces recurrence of the pleural effusion. We describe the case of an elderly Asian woman with recurrent large right-sided pleural effusion and also a large hepatic cyst under her right hemidiaphragm. She was deemed a poor surgical candidate and was treated with an indwelling pleural catheter (IPC). She was discharged from Sengkang General Hospital with improvement in symptoms. An 88-year-old Asian woman presented twice to Sengkang General Hospital with recurrent right-sided exudative pleural effusion. She had a past medical history of hypertension, type 2 diabetes, hyperlipidemia, ischemic heart disease (left ventricle ejection fraction 55%), atrial fibrillation, and chronic kidney disease stage 3 (estimated glomerular filtration rate 53). She denied any family history of polycystic kidney or liver disease. Computer tomography of her chest, abdomen, and pelvis revealed a large right pleural effusion and also a large hepatic cyst. A pleural catheter was inserted and the fluid analysis was consistent with an exudative effusion. The pleural fluid was sterile to culture for bacteria and mycobacterium. The cytology was negative for malignant cells. The pleural effusion recurred quickly despite repeated large-volume drainage from the pleural catheter. Our patient was not suitable for surgical debridement of the hepatic cyst and eventually received an IPC and was discharged. With the advent of IPC, there has been increasing interest in using IPC in the management of non-malignant pleural effusions. While surgical debridement of hepatic cysts is the preferred treatment option in recurrent pleural effusion associated with polycystic liver disease, IPCs now provide another viable and minimally invasive option for clinicians and patients.
PubMed: 38859945
DOI: 10.7759/cureus.62058 -
Zhonghua Jie He He Hu Xi Za Zhi =... Jun 2024Obstructive sleep apnea (OSA) shows sex differences in the pathophysiology, epidemiology, and clinical presentation. Women have different characteristics of OSA at...
Obstructive sleep apnea (OSA) shows sex differences in the pathophysiology, epidemiology, and clinical presentation. Women have different characteristics of OSA at different life stages. Based on 26 guidelines and consensus, 121 English literatures, and 24 Chinese literatures, the Sleep Disorder Group of Chinese Thoracic Society has drafted a consensus with multidisciplinary experts to summarize the epidemiology, clinical characteristics, diagnosis, treatment, and follow-up of OSA in women at different life stages, particularly issues related to OSA during pregnancy. The consensus is divided into four parts: epidemiology, diagnosis, treatment, and issues for pregnant women with OSA, with 34 recommendations covering 13 clinical issues. The aim was to improve the understanding and managements of OSA in women. What is the prevalence of OSA in women at different life stages?The prevalence of OSA varies among women at different life stages. Sex differences are not significant in childhood and adolescence. The prevalence of OSA in women of childbearing age is significantly lower than that in men. The prevalence of OSA increases during pregnancy due to changes in hormone levels and the influence of pregnancy physiology, as well as with gestational weeks. In postmenopausal women, the prevalence of OSA increases significantly, and the sex differences are no longer significant. What are the risk factors for OSA in women at different life stages?The risk factors for OSA in women at different life stages are not identical. (1) Childhood and adolescence: Tonsillar and adenoid hypertrophy, obesity, and craniofacial structural anomalies increase the risk of OSA; (2) Childbearing age: The prevalence of OSA in women is lower than in men. However, obesity, hypothyroidism, acromegaly, and polycystic ovary syndrome increase the risk of OSA, and these patients should be screened for OSA; (3) Pregnancy: hormonal effects, uterine enlargement, and weight changes increase the risk of OSA, especially in those with a history of snoring or OSA before pregnancy; (4) Perimenopausal and post-menopausal periods: Decreased levels of estrogen/progesterone reduce the protective effects on the upper airways, and increase the risk of OSA. Menopause is an important risk factor for OSA in women. What are the harms of OSA in women?OSA is an independent risk factor for diseases such as hypertension, cardiovascular and cerebrovascular diseases, metabolic disorders, emotional and cognitive impairments, and malignant tumors in women. OSA during pregnancy has several adverse effects on maternal and infant health, and is associated with increased risks of preeclampsia, hypertensive disorders complicating pregnancy (HDP), gestational diabetes mellitus (HDM), premature birth, neonatal asphyxia, fetal growth restriction, . What are the clinical symptoms and physical signs of OSA in women?The symptoms of OSA in women are different from those in men. Attention should be paid to whether women snore and the frequency of snoring, especially among postmenopausal and obese women. The atypical symptoms of OSA, including insomnia, daytime fatigue, morning headache, anxiety and nightmares, should not be ignored, especially in postmenopausal, obese, and pregnant women. When should women be screened for OSA?(1) Postmenopausal and pregnant women, as well as women with a first-degree relative with OSA. It should be noted that the clinical symptoms of OSA in women are not typical; (2) Women with polycystic ovary syndrome, hypothyroidism, and acromegaly; (3) Women engaged in various occupations, including driving and working at heights. How to screen OSA in women?Many screening tools and questionnaires can be used to screen for OSA, but should not be used to diagnose OSA in the absence of objective sleep tests. (1) Questionnaires and screening tools: The STOP-Bang questionnaire targeting the general population has higher sensitivity than Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS), and others. STOP Bang≥3 points combined with ESS can further improve its specificity and can be used for OSA screening in women. However, the questionnaire has poor sensitivity for female OSA. Type Ⅳ monitoring devices can be used for OSA screening in women with a weak recommendation; (2) PSG is the gold standard for diagnosis. Type Ⅱ or Ⅲ portable monitoring (PM) devices are recommended for the diagnosis of OSA in women in the following conditions: 1) Diagnosis of high-risk OSA patients without complex comorbidities; 2) OSA patients who are immobile or critically ill and unable to undergo PSG monitoring in a sleep center; 3) Diagnosis of perioperative OSA patients; 4) Pregnant women with high suspicion of OSA. How to diagnose OSA in women?The diagnostic and grading criteria for adult non-pregnant women with OSA are the same as the diagnostic criteria for adult OSA; for diagnosis and grading of OSA in pregnant women, see "Section 4: OSA in Pregnancy". How to treat OSA in women?For all the OSA patients with varying degrees of severity in women, the general treatment can be applied: weight loss, dietary control, exercise, position therapy, reduction of alcohol intake, and cautious use of sedative and hypnotic drugs. Medical costs and the risk of comorbidities with OSA in women are higher than those in men. Therefore, OSA patients in women should be promptly evaluated and treated. How to optimize non-invasive positive pressure ventilation (NPPV) treatment and improve compliance for OSA patients in women?(1) NPPV is the first-line treatment for moderate to severe OSA in women. It can relieve upper airway obstruction, eliminate sleep hypoxia, improve sleep quality and quality of life, and reduce the incidence of related complications and mortality; (2) To improve compliance with NPPV treatment, behavioral interventions and patient education are recommended. Selecting an appropriate human-machine interface, improving the humidification effect, promptly handling adverse reactions, and applying remote medical models may improve the compliance. What are the other options for OSA treatment in women?Other treatment methods include oral appliances, upper airway surgery, and sublingual nerve stimulation therapy, which have moderate therapeutic effects in women. Postmenopausal hormone therapy (MHT) in women has a certain therapeutic effect on OSA, but its safety needs further evaluation. What is follow-up evaluation for OSA in women?(1) Follow-up every 6 months or 1 year after receiving NPPV treatment; (2) PSG should be rechecked at the 3rd and 6th months after surgical treatment to evaluate the therapeutic effects. For patients with poor therapeutic effects after surgery, it is recommended to use treatments such as NPPV; (3) PSG should be rechecked at the 3rd and 6th months after oral appliance treatment. Oral appliances should be adjusted as needed to consolidate long-term efficacy, or switched to a treatment such as NPPV; (4) During follow-up, attention should be paid to the improvement of apnea hypopnea index(AHI), symptoms, and side effects; (5) It is recommended that NPPV treatment be remotely managed via the internet, which can provide high-quality and comprehensive sleep care; (6) Follow-up of OSA during pregnancy can be found in "Section 4: OSA in Pregnancy ". How to diagnose and evaluate OSA during pregnancy?OSA during pregnancy has adverse effects on maternal and infant outcomes. It is recommended that high-risk pregnant women be screened and diagnosed for OSA during pregnancy management and healthcare.(1) Screening of the high-risk population: Individuals who meet any of the following criteria are considered at high risk for OSA during pregnancy. 1) Symptoms: snoring during sleep, arousal, headache in the morning, insomnia, depression, excessive daytime sleepiness, and fatigue; 2) Pregnant women over 35 years old; 3) Physical signs: weight exceeding standard body weight by 20% or more, BMI≥28 kg/m, and neck circumference>40 cm; anatomical abnormalities of the upper airways, such as nasal obstruction, tonsil hypertrophy, and mandibular retrognathia, .; 4) Combined internal medicine diseases, such as refractory hypertension, unknown arrhythmia, chronic congestive heart failure, refractory diabetes and insulin resistance, refractory asthma, hypothyroidism, primary aldosteronism; 5) Those with obstetric related diseases, such as preeclampsia, HDP, GDM, and intrauterine growth restriction of the fetus, and with symptoms of chest tightness and apnea that cannot be explained by other factors, and with previous history of gestational OSA or family history.(2) Screening time: There is currently no strong evidence to support the recommendation for optimal screening time. Given the adverse effects of OSA on mothers and infants, it is recommended that high-risk individuals of OSA be screened for OSA between12 and 18 weeks of pregnancy.(3) Screening tools: The main manifestations of OSA in pregnant women are insomnia and poor sleep quality, whereas daytime drowsiness is often not severe. Various sleep questionnaires and models for OSA in pregnancy have poor sensitivity and specificity. Type Ⅳ and consumer-level monitoring devices are lack of sufficient clinical validation. It is recommended that the results of the above screening tools should only have an indicative role in the diagnosis of OSA during pregnancy.(4) Diagnostic tools: PSG is the gold standard for the diagnosis of OSA in pregnancy. PM may be the first choice diagnostic technique for OSA in pregnancy, and Type Ⅲ monitoring devices are the most commonly used devices.(5) Diagnostic criteria: Diagnosis of OSA during pregnancy should be based on symptoms, signs, and PSG or PM monitoring results. Diagnostic criteria for OSA during pregnancy are as follows: 1) PSG or PM monitoring shows AHI≥5 times/h with symptoms or signs of OSA in women, or with related complications (such as diagnosed hypertension, emotional disorders, unexplained arrhythmias, chronic congestive heart failure, HDP, HDM, intrauterine growth restriction that cannot be explained by other factors, chest tightness and apnea excluding other reasons), or with previous history of OSA or family history of OSA; 2) PSG or PM monitoring shows AHI≥10 times/h in those with less daytime drowsiness (ESS≤9 points). How to manage OSA during pregnancy?(1) Once OSA is diagnosed during pregnancy, personalized treatment plans from pregnancy to birth should be developed through collaborative discussions between sleep center professionals, obstetricians, pregnant women, and their families. Multidisciplinary collaboration among anaesthesia, neonatology, and critical care medicine may be required in some cases. A comprehensive management approach should be adopted based on the patient's condition, which includes strengthening weight management, positioning treatment, NPPV treatment, oral appliances, and management of maternal and infant complications; (2) Considering the Regarding continuous weight gain during pregnancy, APAP treatment is more appropriate mode for pregnant women with OSA; (3) Oral appliances are suitable for patients with snoring or mild to moderate OSA, especially those with combined mandibular retraction or NPPV intolerance. However, oral appliances are not recommended as the first-line treatment; (4) It is not recommended to use surgical methods to treat OSA during pregnancy; (5) Follow-up and evaluation: Patients' conditions should be re-evaluated and treatment plans should be adjusted at around 24 weeks of pregnancy. Postpartum PSG or PM monitoring should be repeated to assess the need for continued treatment after delivery.
Topics: Humans; Sleep Apnea, Obstructive; Female; Pregnancy; Pregnancy Complications; Consensus
PubMed: 38858201
DOI: 10.3760/cma.j.cn112147-20240206-00072 -
Journal of Wound Care Jun 2024Cutaneous malignant melanoma (cMM) can develop at any site, but one-third of cases primarily affect the lower extremities, with ankle and foot lesions representing 3-15%...
Cutaneous malignant melanoma (cMM) can develop at any site, but one-third of cases primarily affect the lower extremities, with ankle and foot lesions representing 3-15% of all cases. However, cMM may become a clinical conundrum when it presents as chronic ulceration that is clinically indiscernible from other lower extremity ulcers in patients with diabetes. We present the case of a 71-year-old female patient with a longstanding history of diabetes, hypertension, obesity, chronic kidney disease and heart failure who presented to our hospital with a fungating heel ulcer. The lesion was initially managed in another hospital as a neuropathic diabetic foot ulcer (DFU), treated by multiple local wound debridement. However, the ulcer progressed into a fungating heel lesion that interfered with the patient's mobility and quality of life. Consequently, the patient was referred to our specialist diabetic foot service for further management. Excisional biopsy of the lesion disclosed a cMM. Positron emission tomography/computed-tomography scanning revealed hypermetabolic ipsilateral inguinal lymphadenopathy, and a right cerebral metastasis for which palliative chemotherapy was initiated. Immunotherapy was considered, but the patient died before it was started. Atypical foot ulcers in patients with diabetes warrant a careful diagnostic approach, especially for recalcitrant cutaneous lesions not responding to standard therapies. Conscientious management, without undue delay in obtaining a histopathological diagnosis, might lead to early diagnosis of melanoma and potentially more favourable outcomes. This case highlights the importance of consideration of atypical foot lesions, in general practice in addition to referral centres, to try to identify alarming features and act accordingly.
Topics: Humans; Female; Aged; Skin Neoplasms; Heel; Melanoma; Diabetic Foot; Diagnosis, Differential; Fatal Outcome; Melanoma, Cutaneous Malignant; Foot Ulcer
PubMed: 38843045
DOI: 10.12968/jowc.2022.0281 -
Kardiologiia May 2024Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and...
AIM
Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis.
MATERIAL AND METHODS
The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively.
CONCLUSION
Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.
Topics: Humans; Cause of Death; Male; Female; Retrospective Studies; Aged; COVID-19; Middle Aged; Moscow; Myocardial Ischemia; Ambulatory Care; Registries; SARS-CoV-2; Patient Acceptance of Health Care
PubMed: 38841784
DOI: 10.18087/cardio.2024.5.n2341 -
BMC Psychiatry Jun 2024Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of succinylcholine...
BACKGROUND
Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of succinylcholine (Suxamethonium). Despite the frequent use of succinylcholine with electroconvulsive therapy (ECT), there has been no reported case of potentially lethal malignant hyperthermia following ECT. In addition, the time interval between the administration of succinylcholine and the onset of malignant hyperthermia has not been outlined in the context of ECT.
CASE PRESENTATION
We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to succinylcholine administration during an ECT session. She presented with a high fever of 40.2 °C, tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT, which occurred in a psychiatric ward rather than an operating room, and reached their peak in less than 24 h. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2 °C and completely eased her muscle rigidity within two days after ECT.
CONCLUSIONS
This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthermia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient's vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.
Topics: Humans; Succinylcholine; Electroconvulsive Therapy; Aged; Malignant Hyperthermia; Female; Neuromuscular Depolarizing Agents; Dantrolene; Psychiatrists
PubMed: 38834964
DOI: 10.1186/s12888-024-05846-5 -
Cureus May 2024A 47-year-old male, a known case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath....
Iatrogenically Acquired Mycobacterium abscessus Infection in an Indwelling Intercostal Drainage In Situ in a Patient With Alcoholic Liver Disease and Bilateral Hepatic Hydrothorax: A Report of a Rare Case.
A 47-year-old male, a known case of alcoholic chronic liver disease with portal hypertension, presented with complaints of abdominal distension and shortness of breath. A provisional diagnosis of ethanol-related compensated chronic liver disease (CLD) with portal hypertension and splenomegaly, gross ascites with bilateral hepatic hydrothorax was made. The left-sided pleural effusion subsided after three pleural taps, but the right-sided effusion kept refilling even after four to five days of repeated therapeutic taps, so a pigtail catheter was left in situ. The pleural fluid was sent for culture which did not grow any pathogenic organisms. Cartridge-based nucleic acid amplification tests where complex (MTBC) was not detected, Ziehl-Neelsen staining was done in which acid-fast bacilli were not seen, and cytology was done where no malignant cells were seen. The patient was discharged with the pigtail in situ on the right side and, after 20 days, the patient again presented with shortness of breath, and imaging revealed moderate right-side pleural effusion. Draining of pleural fluid was done and sent for investigation which again revealed no infective etiology. The patient was admitted to the hospital for one month as the right-sided effusion did not resolve. Suddenly, the patient developed shortness of breath, and a chest X-ray was done, which showed pigtail blockage; pigtail flushing was done, and the bag was drained. The patient was empirically started on IV meropenem 500 mg TID, IV teicoplanin 400 mg BD, and inj polymyxin B 500,000 IU IV BD. The pleural fluid was sent continuously for investigation for the first two months which again did not reveal any infective etiology. After two months of pigtail in situ, the pleural fluid was sent for CBNAAT where MTBC was not detected, and ZN stain showed smooth acid-fast bacilli. The sample was cultured, and it grew acid-fast bacilli in 72 hours on blood agar, MacConkey agar, and Lowenstein-Jensen media. A line probe assay done from the isolate revealed it to be subsp. abscessus which was resistant to macrolides and sensitive to aminoglycosides. subsp. abscessus was isolated from repeated cultures of pleural fluid, and the patient was advised on a combination treatment of amikacin, tigecycline, and imipenem. The patient was discharged with the indwelling pigtail with the advised treatment; unfortunately, we lost patient follow-up as the patient never returned to us.
PubMed: 38832176
DOI: 10.7759/cureus.59626 -
World Journal of Hepatology May 2024Non-cirrhotic non-malignant portal vein thrombosis (NCPVT) is an uncommon condition characterised by thrombosis of the portal vein, with or without extension into other... (Review)
Review
Non-cirrhotic non-malignant portal vein thrombosis (NCPVT) is an uncommon condition characterised by thrombosis of the portal vein, with or without extension into other mesenteric veins, in the absence of cirrhosis or intra-abdominal malignancy. Complications can include intestinal infarction, variceal bleeding and portal biliopathy. In this article, we address current concepts in the management of NCPVT including identification of risk factors, classification and treatment, and review the latest evidence on medical and interventional management options.
PubMed: 38818283
DOI: 10.4254/wjh.v16.i5.751 -
Alternative Therapies in Health and... May 2024To investigate the effects of sacubitril valsartan sodium combined with levosimendan on improving cardiac and renal functions in patients with CRS.
OBJECTIVE
To investigate the effects of sacubitril valsartan sodium combined with levosimendan on improving cardiac and renal functions in patients with CRS.
METHODS
90 patients with the cardiorenal syndrome who were hospitalized in our hospital from February 2020 to February 2022 were selected and divided into two groups, the control group, and the joint group, according to both single and double number methods, with 45 cases in each group. Patients who met the diagnostic criteria for CRS, were older than 18 years of age, had NYHA class II to IV, and had stage 1 or 2 chronic kidney disease were included in the study. Patients with severe hypersensitivity to the drugs used in this test, haemodynamic instability, combined hyperthyroidism, malignancy, severe pulmonary hypertension, cardiogenic shock, malignant arrhythmias and pregnant women were excluded. Among them, the control group was treated with sacubitril valsartan sodium alone, and the joint group was treated with levosimendan supplemented with the treatment method of the control group. The treatment effect, the improvement of cardiac and renal function, and the incidence of adverse reactions were compared between the two groups of CRS patients, and the prognostic effect was followed up 6 months after treatment.
RESULTS
The total effective rate of treatment in the joint group was 95.56%, which was significantly higher than that in the control group of 80.00%, and the difference was statistically significant by using χ2 test (P < .05). After treatment, LVEF, LVEDD, and NT-proBNP levels in both groups were significantly improved compared with those before treatment (P < .05), and the improvement effect of each index in the joint group was more significant than that in the control group (P < .05). After treatment, the levels of SCr, BUN, and UA in both groups were significantly lower than those before treatment (P < .05), and the levels of each index in the joint group were significantly lower than those in the control group, statistical analyses showed significant differences (P < .05) using t test. The incidence of adverse effects such as tachycardia, premature ventricular contractions, heart failure, and myocardial ischaemia was 22.22% in the combined group, which was significantly lower than 42.22% in the control group, and the difference in the total incidence between the two groups was statistically significant by χ2 test (P < .05). One case of malignant arrhythmia and five cases of recurrence of heart failure occurred 6 months after surgery in the combined group, which were significantly lower than the eight and twelve cases in the control group.
CONCLUSION
Sacubitril valsartan sodium combined with levosimendan can significantly improve the therapeutic effect of CRS, with significant improvement in cardiac and renal function of CRS patients, and its incidence of adverse effects and long-term prognostic effects are lower than those of sacubitril valsartan sodium alone. This combination therapy offers a promising new direction for CRS management, warranting further investigation in larger, multicenter trials.
PubMed: 38814606
DOI: No ID Found -
JAMA Network Open May 2024People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the...
IMPORTANCE
People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population.
OBJECTIVE
To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024.
MAIN OUTCOMES AND MEASURES
Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease-specific ambulatory care-sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use.
RESULTS
The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P < .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P < .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73).
CONCLUSIONS AND RELEVANCE
In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.
Topics: Humans; Male; Female; Emergency Service, Hospital; Middle Aged; Renal Dialysis; Aged; Alberta; Adult; Cohort Studies; Kidney Failure, Chronic
PubMed: 38809552
DOI: 10.1001/jamanetworkopen.2024.13754