Articles: outcome.
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The use of automated external defibrillators (AEDs) following a cardiac arrest in the out-of-hospital setting has demonstrated increased survival rates, likely because up to 71% of out-of-hospital cardiac arrests are associated with rhythm disturbances that are able to be treated with defibrillation. It is less clear whether the use of AEDs in the hospital setting would be effective because fewer patients (approximately 25%) have initial cardiac rhythms that respond to defibrillation and because survival may be compromised if the use of AEDs contributes to interruptions in the delivery of chest compressions. ⋯ Of the 11,695 patients with cardiac arrests, the majority (82.2%; n=9616) were in a nonshockable rhythm, such as asystole or pulseless electrical activity (PEA). Only 17.8% (n=2079) of patients in the study were in a shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used on 4515 patients (38.6%). An overall survival to discharge rate of 18.1% (n=2117) was reported. The use of an AED was associated with lower survival rates (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI], 0.78-0.92; P<0.001). AED use in those patients with asystole or PEA (unshockable rhythms) was associated with lower survival (10.4% vs 15.4%; adjusted RR, 0.74; 95% CI, 0.65-0.83; P<0.001). Where shockable rhythms, such as ventricular tachycardia or ventricular fibrillation, were present, AED use did not increase survival (38.4% vs 39.8%; adjusted RR, 1.00; 95% CI, 0.88-1.13; P=0.99). These trends were consistent for AED use in both monitored and nonmonitored hospital units (p>.10). For cardiac arrest due to asystole or PEA the use (or not) of an AED did not influence the rates of ROSC. For cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia the rates of ROSC and survival at 24 h did not differ by AED use. AED use did not shorten the time to defibrillation and for those patients with ROSC, and was not associated with shorter CPR times or fewer administered defibrillations. Overall the authors concluded that the use of AEDs in hospitalised patients following cardiac arrest was not associated with improved survival.
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To determine the long-term prognostic value of stress imaging and clinical risk scoring for cardiovascular mortality in chest pain patients after ruling out acute coronary syndrome (ACS). ⋯ TIMI and GRACE score but not DSE and MPS are accurate predictors of long-term cardiovascular mortality, even in chest pain patients with a normal or non-diagnostic electrocardiogram undergoing a rule-out protocol.
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Plasma gelsolin depletion has been associated with poor outcome of critically ill patients. However, there is a paucity of data available on circulating plasma gelsolin concentration in traumatic brain injury (TBI). Thus, we sought to investigate change in plasma gelsolin level after TBI and to evaluate its relation with disease outcome. ⋯ Decreased plasma gelsolin level is associated with GCS scores and an independent prognostic marker of mortality after TBI. Reversing plasma gelsolin deficiency may be an effective treatment for TBI.
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Kashmir, a snow bound and mountain locked valley, is populated by about 7 million ethnic and non-migratory Kashmiris who have specific dietary and social habits than rest of the world. The neurological disorders are common in Kashmiri population. ⋯ Spontaneous intracranial subarachnoid hemorrhage, due to aneurysmal rupture, is common in Kashmir, with worst outcome. Food habits like "salt-tea twice a day", group-smoking of wet tobacco like "Jejeer", winter season, female gender, hypertension, and inhalation of "Kangri" smoke are special risk factorsof SAH, in Kashmiris. The plain CT brain and CT angiography are best diagnostic tools. The preventive measures for aneurysmal formation and rupture seems most promising management of future. The detachable endovascular aneurysmal occupying video assisted micro-camera capsules or plugs may be future treatment.