52426 research outputs found
Sort by
Stratifying Traumatic Brain Injury Mortality and Readmission Risk: An Unsupervised Machine Learning Approach
No full textPrevalence and Impact of Chronic Kidney Disease on Outcomes and Recurrence of Takotsubo Syndrome - A Comprehensive Review.
No full textTakotsubo Syndrome (TTS) is a condition that usually affects the left ventricle (LV), primarily in the apical region characterized by transient left ventricular dysfunction triggered by a variety of stresses. Patients with TTS often present clinically as acute coronary syndrome (ACS) making the diagnosis challenging. TTS can lead to serious adverse events, such as cardiac arrhythmias, cardiogenic shock, and thromboembolic events, which can worsen an already poor prognosis. Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular disease, and TTS prognosis is worsened when kidney function is compromised. With a prevalence of 6.7% among TTS patients, CKD increases the morbidity and mortality risks in TTS patients. Moreover, CKD exacerbates TTS recurrence, with risk factors including female sex, advanced age, and diabetes mellitus. Clinical management of TTS in CKD patients requires comprehensive evaluation and tailored interventions. While ACE inhibitors and angiotensin receptor blockers may mitigate recurrence risk, optimization of dialysis treatments and management of comorbidities are paramount.This review synthesizes current literature to elucidate the prevalence, recurrence, pathophysiological mechanisms, clinical implications, and management strategies of CKD in TTS patients
Electrographic Seizure Characteristics and Electrographic Status Epilepticus Prediction.
No full textPURPOSE: We aimed to characterize electrographic seizures (ES) and electrographic status epilepticus (ESE) and determine whether a model predicting ESE exclusively could effectively guide continuous EEG monitoring (CEEG) utilization in critically ill children.
METHODS: This was a prospective observational study of consecutive critically ill children with encephalopathy who underwent CEEG. We used descriptive statistics to characterize ES and ESE, and we developed a model for ESE prediction.
RESULTS: ES occurred in 25% of 1,399 subjects. Among subjects with ES, 23% had ESE, including 37% with continuous seizures lasting \u3e30 minutes and 63% with recurrent seizures totaling 30 minutes within a 1-hour epoch. The median onset of ES and ESE occurred 1.8 and 0.18 hours after CEEG initiation, respectively. The optimal model for ESE prediction yielded an area under the receiver operating characteristic curves of 0.81. A cutoff selected to emphasize sensitivity (91%) yielded specificity of 56%. Given the 6% ESE incidence, positive predictive value was 11% and negative predictive value was 99%. If the model were applied to our cohort, then 53% of patients would not undergo CEEG and 8% of patients experiencing ESE would not be identified.
CONCLUSIONS: ESE was common, but most patients with ESE had recurrent brief seizures rather than long individual seizures. A model predicting ESE might only slightly improve CEEG utilization over models aiming to identify patients at risk for ES but would fail to identify some patients with ESE. Models identifying ES might be more advantageous for preventing ES from evolving into ESE
Medical & Socioeconomic Risk Factors Associated with Lack of Neurodevelopmental Evaluation Following Neonatal Cardiac Surgery.
No full textNeonates with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB) are at high-risk for unfavorable neurodevelopmental (ND) outcomes and are recommended for ND evaluation (NDE); however, poor rates have been reported. We aimed to identify risk factors associated with lack of NDE. This single-center retrospective observational study included neonates \u3c 30 days old who underwent CPB and survived to discharge between 2012 and 2018. Primary outcome (NDE) was ≥ 1 appointment at our center\u27s dedicated cardiac, neonatal, or general ND clinics before the 3rd birthday. Predictor variables included demographic, medical, and social factors. Social disorganization index (SDI) was obtained with geocoding based on address at time of discharge. Logistic regression identified risk factors associated with lack of NDE. The cohort included 594 patients, predominantly male (59%) and white (59%). A majority (63%) had NDE. Lack of NDE was more common in patients with postnatal CHD diagnosis, CHD without arch obstruction, absence of postoperative seizures, living below 100% poverty level, lack of insurance, younger parental age, and overall higher SDI (p \u3c 0.03). In multivariable analysis, lack of NDE was associated with single-ventricle CHD without arch obstruction (OR 2.17; 95% CI 1.08-4.55), two ventricle CHD without arch obstruction (OR 2.56; 95% CI 1.59-4.17), and higher SDI (OR 1.25; 95% CI 1.05-1.49); all p \u3c 0.05. This study identifies medical and neighborhood-level socioeconomic factors that may help address care gaps in this high-risk population. Patients with socioeconomic disparities may benefit from increased care coordination upon discharge
Late-Onset Findings During Extended EEG Monitoring Are Rare in Critically Ill Children.
No full textPURPOSE: Electrographic seizures (ES) are common in critically ill children undergoing continuous EEG (CEEG) monitoring, and previous studies have aimed to target limited CEEG resources to children at highest risk of ES. However, previous studies have relied on observational data in which the duration of CEEG was clinically determined. Thus, the incidence of late occurring ES is unknown. The authors aimed to assess the incidence of ES for 24 hours after discontinuation of clinically indicated CEEG.
METHODS: This was a single-center prospective study of nonconsecutive children with acute encephalopathy in the pediatric intensive care unit who underwent 24 hours of extended research EEG after the end of clinical CEEG. The authors assessed whether there were new findings that affected clinical management during the extended research EEG, including new-onset ES.
RESULTS: Sixty-three subjects underwent extended research EEG. The median duration of the extended research EEG was 24.3 hours (interquartile range 24.0-25.3). Three subjects (5%) had an EEG change during the extended research EEG that resulted in a change in clinical management, including an increase in ES frequency, differential diagnosis of an event, and new interictal epileptiform discharges. No subjects had new-onset ES during the extended research EEG.
CONCLUSIONS: No subjects experienced new-onset ES during the 24-hour extended research EEG period. This finding supports observational data that patients with late-onset ES are rare and suggests that ES prediction models derived from observational data are likely not substantially underrepresenting the incidence of late-onset ES after discontinuation of clinically indicated CEEG
IMPACT OF HIGH INTENSITY STATIN THERAPY ON SHORT-TERM AND LONG-TERM OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING: A SYSTEMATIC REVIEW AND META-ANALYSIS
No full text
Posterior Reversible Encephalopathy Syndrome Induced Demyelination (P3-2.011).
No full textOBJECTIVE: N/A.
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) typically manifests as vasogenic edema in the subcortical white matter, predominantly in the posterior cerebral hemispheres. These changes are generally reversible once the underlying cause is addressed. We present a case of PRES resulting in demyelination, as confirmed by subsequent tissue examination.
DESIGN/METHODS: A 68-year-old right-handed female with a history of hypertension, renal mass, and coronary artery disease presented with altered mental status. The patient reported feeling unwell, and the next day developed nonsensical speech, vision loss, and headaches. Upon arrival at the emergency department, her systolic blood pressure was recorded in the 240-250 range. An CT of the head showed no acute hemorrhage or infarct but revealed hypoattenuation in the bilateral occipital lobes, suggestive of PRES. A CTA of the head and neck revealed stable but severe stenosis of the right carotid bifurcation and moderate stenosis of the left carotid bifurcation. No large vessel occlusion was noted. A follow-up MRI of the brain showed FLAIR signal hyperintensities in the posterior parietal and occipital lobes, without hemorrhage or infarction. The patient was started on Keppra 500 mg twice daily and initiated on nicardipine. Over the next few days, she became more oriented and reported improved vision. She admitted to noncompliance with her blood pressure medications, though no other clear risk factors for PRES were identified. The patient was readmitted two weeks later for sepsis and passed away shortly after. Brain examination, as part of a requested autopsy, revealed several areas of demyelination that were not observed on prior MRI imaging.
RESULTS: N/a.
CONCLUSIONS: PRES typically results in permanent changes only when associated with secondary cerebral infarcts or hemorrhage. This case highlights possible irreversible demyelination, a finding not commonly reported in the literature, suggesting the need for further research into the long-term sequelae of PRES