Internal and emergency medicine
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This study on the Lombardia Cardiac Arrest Registry (Lombardia CARe,) the most complete nationwide out-of-hospital cardiac arrest (OHCA) registry in Italy, aims at evaluating post-OHCA intra-hospital mortality risk according to patient's characteristics and emergency health service management (EMS), including level of care of first-admission hospital. Out of 12,581 patients included from 2015 to 2022, we considered 1382 OHCA patients admitted alive to hospital and survived more than 24 h. We estimated risk ratios (RRs) of intra-hospital mortality through log-binomial regression models adjusted by patients' and EMS characteristics. ⋯ Intra-hospital mortality is associated with non-shockable presenting rhythm (RR 1.27, 95% CI 1.19-1.35) and longer CPR time (RR 1.39, 95% CI 1.28-1.52 for 45 min or more). Patients who accessed to a secondary vs tertiary care hospital were more frequently older, with a non-shockable presenting rhythm and longer EMS intervention time. Non-shockable presenting rhythm accounts for 27% increased risk of intra-hospital death in OHCA patients, independently of first-access hospital level, thus demonstrating that patients' outcomes depend only by intrinsic OHCA characteristics and Health System's resources are utilised as efficiently as possible.
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Acute intoxications and poisonings are a relevant cause for ICU admission of critically ill patients. This study aimed to determine the characteristics of intoxicated patients in a tertiary center medical ICU in Austria over time and to investigate parameters associated with ICU mortality. This study was a retrospective data analysis including adult ICU patients from the years 2007 to 2021. ⋯ Psychiatric illness predisposes patients to severe intoxications necessitating ICU care, thus increasing prevention measures seems warranted. Females did present with a different spectrum of intoxications compared to males. ICU mortality remained low over time and most deceased patients had a grim prognosis already on ICU arrival.
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Coronary artery disease (CAD), particularly three-vessel coronary disease (3VD), is the main cause of death in industrialized countries. Chronic kidney disease is an independent risk factor for CAD. The CHA2DS2-VASc score shows a good ability to predict CV events in high-risk population independently from atrial fibrillation. ⋯ The prevalence of 3VD was higher among patients belonging to higher tertiles of R2CHA2DS2-VASc (17.2% vs 26.7% vs 33.6% for first, second, and third tertile respectively, p < 0.001) with a risk more than doubled for the third tertile compared to the first one (OR 2.45; 95% CI 1.71-3.49, p < 0.001). The R2CHA2DS2-VASc score is independently associated with 3VD in patients at high cardiovascular risk. The score could be considered a useful tool for clinicians to identify patients who are at high risk of 3VD.
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This study aimed to develop several new machine learning models based on hibernating myocardium to predict the major adverse cardiac events(MACE) of ischemic left ventricular systolic dysfunction(LVSD) patients receiving either percutaneous coronary intervention(PCI) or optimal medical therapy(OMT). This study included 329 LVSD patients, who were randomly assigned to the training or validation cohort. Least absolute shrinkage and selection operator(LASSO) regression was used to identify variables associated with MACE. ⋯ The RSF model (0.991 vs. 0.982 vs. 0.980) had the highest area under the ROC curve (AUC) compared with the other models. The BS (0.077 vs. 0.095vs. 0.077) of RSF model were less than 0.25 at 12, 18, and 24 months. This study developed a novel predictive model based on RSF to predict MACE in LVSD patients who underwent either PCI or OMT.
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Review Case Reports
Infections and gender: clues for diagnosis of adrenal insufficiency-a case report and a review of the literature.
The clinical presentation of adrenal insufficiency, a condition causing adrenal hormone deficiency, is characterised by non-specific symptoms and signs: consequently, an important diagnostic delay is often evident which correlates with an increased mortality. This case report shows how the clustering of some symptoms and signs may hamper the diagnostic suspicion for this condition: serum electrolyte alterations and weight loss, when associated to recurrent infections and, in female patients, an empty sella may further guide the clinician towards a diagnosis of adrenal insufficiency. Accordingly, a clinical approach taking into account gender medicine could improve the diagnostic workup.