-
Journal of the American Heart... Jun 2024The study aimed to describe the patterns and trends of initiation, discontinuation, and adherence of oral anticoagulation (OAC) in patients with new-onset postoperative...
BACKGROUND
The study aimed to describe the patterns and trends of initiation, discontinuation, and adherence of oral anticoagulation (OAC) in patients with new-onset postoperative atrial fibrillation (POAF), and compare with patients newly diagnosed with non-POAF.
METHODS AND RESULTS
This retrospective cohort study identified patients newly diagnosed with atrial fibrillation or flutter between 2012 and 2021 using administrative claims data from OptumLabs Data Warehouse. The POAF cohort included 118 366 patients newly diagnosed with atrial fibrillation or flutter within 30 days after surgery. The non-POAF cohort included the remaining 315 832 patients who were newly diagnosed with atrial fibrillation or flutter but not within 30 days after a surgery. OAC initiation increased from 28.9% to 44.0% from 2012 to 2021 in POAF, and 37.8% to 59.9% in non-POAF; 12-month medication adherence increased from 47.0% to 61.8% in POAF, and 59.7% to 70.4% in non-POAF. The median time to OAC discontinuation was 177 days for POAF, and 242 days for non-POAF. Patients who saw a cardiologist within 90 days of the first atrial fibrillation or flutter diagnosis, regardless of POAF or non-POAF, were more likely to initiate OAC (odds ratio, 2.92 [95% CI, 2.87-2.98]; <0.0001), adhere to OAC (odds ratio, 1.08 [95% CI, 1.04-1.13]; <0.0001), and less likely to discontinue (odds ratio, 0.83 [95% CI, 0.82-0.85]; <0.0001) than patients who saw a surgeon or other specialties.
CONCLUSIONS
The use of and adherence to OAC were higher in non-POAF patients than in POAF patients, but they increased over time in both groups. Patients managed by cardiologists were more likely to use and adhere to OAC, regardless of POAF or non-POAF.
PubMed: 38934887
DOI: 10.1161/JAHA.124.035708 -
Journal of the American Heart... Jun 2024Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare...
Abbreviated Versus Standard Dual Antiplatelet Therapy Times After Percutaneous Coronary Intervention in Patients With High Bleeding Risk With Acute Coronary Syndrome: Insights From the SWEDEHEART Registry.
BACKGROUND
Dual antiplatelet therapy (DAPT) reduces ischemic events but increases bleeding risk, especially in patients with high bleeding risk (HBR). This study aimed to compare outcomes of abbreviated versus standard DAPT strategies in patients with HBR with acute coronary syndrome undergoing percutaneous coronary intervention.
METHODS AND RESULTS
Patients from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-Based Bare in Heart Disease Evaluated According to Recommended Therapies) registry with at least 1 HBR criterion who underwent percutaneous coronary intervention for acute coronary syndrome were identified and included. Patients were divided into 2 groups based on their planned DAPT time at discharge: 12-month DAPT or an abbreviated DAPT strategy and matched according to their prescribed P2Y12 inhibitor at discharge. The primary outcome assessed was time to net adverse clinical events at 1 year, which encompassed cardiac death, myocardial infarction, ischemic stroke, or clinically significant bleeding. Time to major adverse cardiovascular events and the individual components of net adverse clinical events were considered secondary end points. A total of 4583 patients were included in each group. The most frequently met HBR criteria was age older than 75 years (65.6%) and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy score ≥25 (44.6%) in the standard DAPT group and oral anticoagulant therapy (79.6%) and age 75 years and older (55.2%) in the abbreviated DAPT group. There was no statistically significant difference in net adverse clinical events (12.9% versus 13.1%; hazard ratio [HR], 0.99 [95% CI, 0.88-1.11], =0.83), major adverse cardiovascular events (8.6% versus 7.9%; HR, 1.08 [95% CI, 0.94-1.25]), or their components between groups. The results were consistent among all of the investigated subgroups.
CONCLUSIONS
In patients with HBR undergoing percutaneous coronary intervention due to acute coronary syndrome, abbreviated DAPT was associated with comparable rates of net adverse clinical events and major adverse cardiovascular events to a DAPT duration of 12 months.
PubMed: 38934886
DOI: 10.1161/JAHA.124.034709 -
Journal of the American Heart... Jun 2024The long-term impact of weight gain (WG) on cardiovascular outcomes among patients with atrial fibrillation (AF) is unclear.
BACKGROUND
The long-term impact of weight gain (WG) on cardiovascular outcomes among patients with atrial fibrillation (AF) is unclear.
METHODS AND RESULTS
We studied 62 871 (mean age, 72±12, 43% women) adult patients with AF evaluated at the University of Pittsburgh Medical Center between January 1, 2010, and May 13, 2021. Serial body mass index, risk factors, comorbidities, and subsequent death and hospitalization were ascertained and stratified according to percentage WG (≥0% to <5%, ≥5% to <10%, and ≥10%). Over 4.9±3.19 years of follow-up, 27 114 (43%) patients gained weight (61%, ≥0% to <5%; 23%, ≥5% to <10%; 16%, ≥10%). Patients with progressive WG were incrementally younger (<0.001) women (40%, 42%, and 47%) with lower median household income (=0.002) and active smoking (8%, 13% and 13%), and they were less likely to be on a non-vitamin K oral anticoagulant (39%, 37%, and 32%). WG was incrementally associated with a significant increase in risk of hospitalization for AF (≥10% WG; hazard ratio [HR], 1.2 [95% CI, 1.2-1.3]; <0.0001), heart failure (≥10% WG; HR, 1.44 [95% CI, 1.3-1.6]; <0.001; ≥5% to <10% WG; HR, 1.17 [95% CI, 1.1-1.2]; <0.001), myocardial infarction (≥10% WG; HR, 1.2 [95% CI, 1.3-1.6]; <0.001) and all-cause stroke (4.2%, 4.3%, and 5.6%) despite significantly lower mean CHADSVasc score (2.9±1.7, 2.7±1.6, and 2.7±1.7). Patients with more WG were significantly more likely to receive cardiac and electrophysiologic interventions.
CONCLUSIONS
Among patients with AF, WG is incrementally associated with increased hospitalization for cardiovascular causes, particularly heart failure, stroke, myocardial infarction, and AF.
PubMed: 38934853
DOI: 10.1161/JAHA.123.032550 -
Indian Journal of Public Health Oct 2023Good glycemic control is the aim of managing type 2 diabetes mellitus (T2DM) which is crucial for the prevention of long-term complications in individuals with T2DM. The...
Good glycemic control is the aim of managing type 2 diabetes mellitus (T2DM) which is crucial for the prevention of long-term complications in individuals with T2DM. The aim of this study was to identify the factors associated with good glycemic control in individuals with T2DM following up at a rural health-care facility (HCF) in Goa. A cross-sectional study was conducted among 120 individuals with T2DM who regularly followed up at a rural HCF in Goa. Participants were selected using simple random sampling. It was found that the participants belonging to the 60-89 years of age group and those on mono/dual oral therapy were more likely to have good glycemic control. Participants' glycated hemoglobin A1c decreased by 0.083% for every year of increase in age and increased by 0.044% for every centimeter increase in abdominal girth.
Topics: Humans; Diabetes Mellitus, Type 2; Cross-Sectional Studies; Middle Aged; Male; Female; Aged; Glycated Hemoglobin; Aged, 80 and over; Glycemic Control; India; Age Factors; Rural Health Services; Adult; Hypoglycemic Agents; Rural Population
PubMed: 38934817
DOI: 10.4103/ijph.ijph_1654_22 -
Indian Journal of Public Health Oct 2023A prospective observational study was conducted in a rural tertiary health-care hospital in the Maval region to analyze sociodemographic contributors, clinical profile,... (Observational Study)
Observational Study
A prospective observational study was conducted in a rural tertiary health-care hospital in the Maval region to analyze sociodemographic contributors, clinical profile, and outcomes in snake envenomation. Fifty-eight patients with confirmed snakebites admitted to the hospital from November 2019 to August 2021 were studied. Snakebite was found to be the most common in middle-aged adult male agricultural population while working outdoors in the daytime. Bleeding from the bite site and other areas such as the oral cavity, swelling, and bluish discoloration of the affected limb were the clinical features observed. Complications such as cellulitis and acute kidney injury were detected in 81% of patients. Despite this, there was no mortality or permanent disability in any of the patients. The knowledge of risk factors can help the vulnerable agrarian population to protect themselves from snakebites. Good medical facilities such as intensive care units, laboratory support, and availability of antisnake venom and blood products are important determinants in final patient outcome.
Topics: Snake Bites; Humans; Male; India; Adult; Middle Aged; Prospective Studies; Female; Tertiary Care Centers; Young Adult; Adolescent; Risk Factors; Antivenins; Aged
PubMed: 38934808
DOI: 10.4103/ijph.ijph_1337_22 -
Indian Journal of Dental Research :... Jan 2024This case report presents a rare combination of congenital anomalies in an otherwise healthy male infant born at 36 weeks. The infant was diagnosed with congenital...
RATIONALE
This case report presents a rare combination of congenital anomalies in an otherwise healthy male infant born at 36 weeks. The infant was diagnosed with congenital maxillomandibular synechia, ectrodactyly, and ankyloglossia superior syndrome (ASS).
PATIENT CONCERNS
Inability to open the mouth completely, feeding challenges, and a cleft palate. The infant was stabilized through successful positive pressure ventilation via a face mask at birth and enteral feeding was initiated via a feeding gastrostomy.
EXAMINATION
Diagnostic tests revealed a midline palatal cleft, hypoplastic jaws, persistent metopic suture, and a bony fusion at the midline.
TREATMENT
Sectioning of the bony spur along the midline and achieving a mouth opening of 2 cm post-manipulation. The patient is under follow-up, with future treatment plans including cleft palate correction at 12 months and potential frontomandibular and lower jaw advancement depending on growth trajectories.
TAKEAWAY LESSONS
This case underscores the complexity of managing multiple congenital anomalies and the need for individualized treatment plans.
Topics: Humans; Male; Cleft Palate; Tongue; Palate, Hard; Infant, Newborn; Abnormalities, Multiple; Maxilla; Ankyloglossia; Jaw Abnormalities; Mandible
PubMed: 38934763
DOI: 10.4103/ijdr.ijdr_961_23 -
Indian Journal of Dental Research :... Jan 2024Gout is a metabolic disorder that leads to elevated serum uric acid levels and deposition of urate crystals in the joints. The disease is usually confined to the joint... (Review)
Review
Gout is a metabolic disorder that leads to elevated serum uric acid levels and deposition of urate crystals in the joints. The disease is usually confined to the joint space and leads to pain and limitation of jaw opening. The case describes a 45-year-old female patient with a chief complaint of 'occasional pain in the left temporal muscle region'. The case disclosed a gout manifestation in the temporomandibular joint (TMJ) after physical and radiographic findings. Gout manifestation in the TMJ is an unusual presentation and a few reports in the English literature address the subject. Gout in the TMJ should be included as a differential diagnosis for joint disorders because of its rarity. A clinician may overlook gout involving the TMJ in the differential diagnosis of facial pain even when the patient has received a diagnosis of gout in other joints.
Topics: Humans; Female; Middle Aged; Temporomandibular Joint Disorders; Arthritis, Gouty; Diagnosis, Differential
PubMed: 38934761
DOI: 10.4103/ijdr.ijdr_15_22 -
Indian Journal of Dental Research :... Jan 2024Melanoma is the ninth most prevalent and the second most lethal tumour. The aetiology and pathogenesis remain uncertain. It occurs in elderly people, over the fifth...
Melanoma is the ninth most prevalent and the second most lethal tumour. The aetiology and pathogenesis remain uncertain. It occurs in elderly people, over the fifth decade, and is predominant in males. Clinically, they present as an asymptomatic macular or nodular growth. The prognosis is impacted by the size of the tumour and distant metastases. Patients with distant metastases have a 5-year survival rate of less than 30%, constituting metastasis as the major cause of melanoma-related fatality. Currently, the mainstay of treatment for metastatic melanoma is immunotherapy due to the inoperable state, radioresistant nature of the tumour and high chances of cytotoxicity in chemotherapy. A senile male patient, who was diagnosed with oral malignant melanoma of the maxillary buccopalatal gingiva with distant metastasis to the liver and the prostate, is reported here. Although metastasis to the liver is common among malignant melanomas, in this case metastasis to the prostate gland highlights the rarity.
Topics: Humans; Male; Melanoma; Prostatic Neoplasms; Mouth Neoplasms; Liver Neoplasms; Gingival Neoplasms; Aged
PubMed: 38934760
DOI: 10.4103/ijdr.ijdr_376_23 -
Indian Journal of Dental Research :... Jan 2024Pregnancy is accompanied by several physiological changes such as altered salivary flow rate, mucosal immunity and altered microbial flora. This may predispose pregnant...
Pregnancy is accompanied by several physiological changes such as altered salivary flow rate, mucosal immunity and altered microbial flora. This may predispose pregnant women to oral health problems. This could be accentuated by oral health neglect, polypharmacy and a host of other factors, including dietary modification. However, a very significant percentage of women are not counselled on oral health during pregnancy. Lack of proper oral healthcare and awareness predispose pregnant women to oral and odontogenic infections, which can lead to severe complications. The manuscript aims to present a rare case of Ludwig's angina (LA) in a full-term pregnant woman requiring immediate attention.
Topics: Humans; Ludwig's Angina; Female; Pregnancy; Adult; Pregnancy Complications
PubMed: 38934759
DOI: 10.4103/ijdr.ijdr_839_23 -
Indian Journal of Dental Research :... Jan 2024During orthodontic treatment, temporary anchoring devices (TADs) are used to restrain tooth movement. They are a relatively recent addition to the dental toolkit.
INTRODUCTION
During orthodontic treatment, temporary anchoring devices (TADs) are used to restrain tooth movement. They are a relatively recent addition to the dental toolkit.
AIM
As TADs have limitations, Dr. Eric Lieu of Taiwan developed Infra Zygomatic Crest (IZC) screws which are placed between the maxillary second premolar at the bony crest.
TREATMENT PLANNING
The goal of this case study is to emphasize the value of anatomy, site selection, and IZC retrieval in the event of an accident. Cone beam computed tomography was used as a diagnostic tool for the precise location of the displaced IZC and immediate surgical retrieval was done under local anesthesia from the infratemporal space to prevent further complications.
TAKEAWAY LESSONS
Orthodontists knowledge of soft tissue and hard tissue anatomy and precise positioning is crucial for successful TAD implantation.
Topics: Humans; Orthodontic Anchorage Procedures; Cone-Beam Computed Tomography; Zygoma; Bone Screws; Male; Female; Bicuspid; Maxilla; Tooth Movement Techniques
PubMed: 38934757
DOI: 10.4103/ijdr.ijdr_143_23