Internal and emergency medicine
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It has been proposed that vaccines may exert an unspecific protective effect against infectious agents, different than expected. Coronavirus disease 2019 (COVID-19) is a pandemic infection with high mortality in older patients due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The high number of vaccinations may be one of the reasons why children show a lower susceptibility to SARS-CoV-2 infection and milder severity when compared to adults. ⋯ After correction for gender, age, and comorbidities, we found a lower risk of death at 60 days in patients with flu vaccination than in not vaccinated patients (p = 0.001). Our study shows that flu vaccination could reduce the mortality of COVID-19. Prospective studies are needed to confirm this result.
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Observational Study
The natural history of idiopathic pulmonary fibrosis in a large European population: the role of age, sex and comorbidities.
Placebo arms of clinical trials provide an opportunity to investigate the natural history of idiopathic pulmonary fibrosis (IPF) but these patients are not representative of the real life IPF population. Objective of this article is to evaluate patients' characteristics of incident IPF cases and their impact on mortality and hospitalizations risk. We conducted a retrospective cohort study using data from administrative databases from 2000 to 2010. ⋯ Using different algorithms proposed and validated in literature, we observed that mortality and hospitalization rate are high in patients with IPF and age, sex and comorbidities significantly affect clinical outcomes. Females show a significant survival advantage over males, even after adjusting for age and comorbidities. Patients with pre-existing diseases, especially those with pulmonary and cardiovascular diseases are at higher risk.
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The recovery of gastrointestinal functions is an important determinant of course of acute pancreatitis and the timing of hospital discharge. Here, we evaluated association between fluid resuscitation volume and opioid use with clinically significant ileus development in patients with acute pancreatitis. Consecutive adults admitted with acute pancreatitis between January 2014 and December 2019 to our academic and two community hospital were included. ⋯ On univariate analysis, the presence of SIRS syndrome (< 0.001), a > 3 BISAP score (p < 0.001), and severity of pancreatitis (p < 0.001) were associated with ileus, mean fluid resuscitation volume (5.6L vs 5.5L, p = 0.888) and cumulative median morphine-equivalent units (12 vs 12, p = 0.232) on day 1 and day 2 were not. However, ileus development was associated with increased hospital length of stay and admission to intensive care unit. On observations, clinically significant ileus development is associated with severity of acute pancreatitis, not with fluid resuscitation volume or opioid analgesia dose used in current standard of care.
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Observational Study
Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes.
Pericardial effusion can dangerously precipitate patient's hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010-2019). ⋯ Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65-20.01, and OR 5.81, 95% CI 2.11-15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45-11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.
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The purpose of this study is to report our experiences over 12 years with bronchoscopic interventions in patients with benign central airway stenosis using three types of working channels (rigid bronchoscope, laryngeal mask, and endotracheal intubation), with a focus on their related advantages, disadvantages, and postoperative complications. We analyzed the clinical data from 273 patients with benign central airway stenosis who underwent a bronchoscopic intervention. The Wilcoxon rank-sum test was used to analyze the immediate results after the first bronchoscopic intervention, and the Chi-square test was used to analyze the correlation between glottic edema and operation time. ⋯ And the incidence rate was significantly correlated with the operation time (P < 0.01). Therefore, for patients with benign central airway stenosis, the best choice of working channel during an operation should be made by the operation procedure, lesion location, and pathology of the patients. Shortening the operation time was an important factor in preventing glottic edema.