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Mixed-Type Carotid Sinus Syndrome in a Patient With Advanced Laryngeal Cancer: A Case Report
No full textHead and neck tumors can rarely cause carotid sinus syndrome (CSS), a condition characterized by bradycardia, hypotension, and syncope. A 68-year-old male with advanced laryngeal cancer presented with syncope. Examination revealed a fixed 5 cm submandibular mass. Computed tomography angiography (CTA) neck showed a large mass encasing the carotid arteries. During the hospital stay, the patient experienced recurrent bradycardia and hypotension, which were resolved when his neck was turned to the left. Diagnosis of mixed-subtype CSS secondary to tumor compression was assumed. Blood tests, EKG, and CT imaging ruled out other causes. The tumor\u27s encasement of the carotid arteries likely triggered the carotid sinus reflex during head movement. Both cardioinhibitory and vasodepressor components were present, suggesting a mixed subtype of CSS. CSS should be considered in patients with head and neck cancer, presenting with unexplained bradycardia or hypotension. Multidisciplinary management is the key to accurate diagnosis and treatment.
Keywords: bradycardia; cancer; treatment
Transcatheter Versus Surgical Aortic Valve Replacement in Patients Aged 50 to 64 Years in the United States
No full textBackground: Outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients aged 50-64 years have not been evaluated in randomized clinical trials. Despite the lack of randomized data, these patients are often treated with TAVR.
Methods: We queried the Nationwide Readmissions Database (2016-2021) to identify patients aged 50-64 years hospitalized for isolated aortic valve replacement (AVR). The contemporary use of TAVR and SAVR in patients aged 50-64 years was evaluated. In-hospital outcomes of TAVR vs SAVR were compared using propensity score matching. Readmissions were compared using the Cox proportional hazards regression model.
Results: Of 75,413 weighted hospitalizations for isolated AVR in patients aged 50-64 years, 22,695 (30.1%) included TAVR, and 52,718 (69.9%) included SAVR. From 2016Q1 to 2021Q4, the proportion of AVR performed using TAVR increased from 12.6% to 41.4% in patients aged 50-64 years (ptrend \u3c .001). TAVR, compared with SAVR, was associated with lower in-hospital mortality (1.0% vs 2.0%; P \u3c .001), stroke (1.4% vs 2.8%; P \u3c .001), acute kidney injury (9.8% vs 17.4%; P \u3c .001), and major bleeding (1.0% vs 1.4%, P = .04) and with higher permanent pacemaker placement (4.7% vs 3.4%; P \u3c .001), vascular complications (3.5% vs 1.6%; P \u3c .001), and 180-day all-cause readmissions (14.4% vs 9.0%; P \u3c .001). Length of stay was shorter (2 vs 6 days; P \u3c .001) and nonhome discharges were lower (17.1% vs 54.6%; P \u3c .001) with TAVR than those with SAVR.
Conclusions: This nationwide observational analysis found that TAVR is increasingly performed among patients aged 50-64 years with lower in-hospital mortality and resource utilization but higher readmissions than SAVR.
Keywords: aortic stenosis; outcomes; readmissions; surgical aortic valve replacement; transcatheter aortic valve replacement
Effects of Supersaturated Oxygen Therapy on Infarct Size and Microvascular Obstruction Following Myocardial Infarction: A Systematic Review and Meta-Analysis
No full textBackground: Supersaturated oxygen (SSO₂) therapy is an emerging intervention to minimize myocardial damage and improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI). This meta-analysis evaluated the efficacy of SSO₂ therapy to reduce infarct size and microvascular obstruction (MVO).
Methods: PubMed, Embase, and Cochrane databases were systematically searched for studies comparing percutaneous coronary intervention (PCI) plus SSO2 to PCI alone for STEMI. Outcomes of interest included infarct size, MVO, and subsequent major adverse cardiovascular events (MACE), all-cause mortality, re-infarction, and target vessel revascularization (TVR). Mean differences (MD) with 95% confidence intervals (CIs) were calculated using random-effects models.
Results: Six studies (n=1660) were included with 548 patients (33%) receiving SSO₂ therapy. Pooled analysis showed that PCI plus SSO₂ significantly reduced infarct size (MD -4.31; 95% CI -6.70 to -1.92; p\u3c 0.01) and MVO (SMD -0.72; 95% CI -1.11 to -0.34; p\u3c 0.01) compared with PCI alone. MACE, all-cause mortality, re-infarction, and TVR were comparable between the groups.
Conclusion: SSO₂ therapy significantly reduced infarct size and MVO in patients undergoing PCI for STEMI.
Keywords: Acute myocardial infarction; Meta-analysis; Percutaneous coronary intervention; Supersaturated oxygen therapy
Play, Learn, Move: The Impact of Games, Exercise and Education on Fall Prevention
No full texthttps://scholarlycommons.libraryinfo.bhs.org/nursing_artof_questioning_innovation2025/1018/thumbnail.jp
Inpatient Tobacco Cessation Counseling and Treatment: A Survey of U.S.-Based Cardiologists
No full textBackground: Hospitalization is an ideal time to provide tobacco cessation counseling, but little is known about current practices of inpatient tobacco treatment in the United States.
Objectives: The objective of the study was to describe the prevailing practices and perceptions regarding inpatient tobacco cessation treatment and counseling among U.S. Cardiologists.
Methods: A 27-question survey was developed, pretested, and administered to 498 cardiologists through the American College of Cardiology CardioSurve program.
Results: In total, 122 (24%) participants responded, of which 100 were eligible and completed the survey, achieving our expected response rate. The sample was generally representative of U.S. cardiologists. Cardiologists reported routinely screening for cigarette use (92%) but only a minority (20%) reported routinely referring patients for additional tobacco cessation support. Most cardiologists (74%) reported using the nicotine patch on occasion, but few ever used varenicline (31%) or bupropion (28%). A minority (12%) reported working at a hospital with an inpatient smoking cessation team, but many (41%) expressed interest in championing such a program. Administrative, financial, and time constraints were commonly reported barriers to successful deployment of an inpatient smoking cessation program.
Conclusions: Although tobacco cessation is critical posthospitalization, most hospitals do not have tobacco cessation teams, and most cardiologists do not assist their patients in quit attempts. Although improving knowledge among cardiologists is important, policy changes to incentivize hospital-wide adoption of such programs is crucial to increase availability.
Keywords: cardiologists; cardiovascular disease; nicotine replacement; tobacco cessation; tobacco treatment teams
Longitudinal Associations Between Peritraumatic Oestradiol and Fear Responding in Women and Men
No full textPTSD is more prevalent in women than men and associated with autonomic dysfunction. Higher oestradiol levels have been associated with decreased PTSD severity, however, the impact of oestradiol on autonomic function is not well characterised. We examined associations among peritraumatic oestradiol levels and autonomic function in the multi-site AURORA study. Participants (n = 283, 69.6% female) were recruited from the emergency department (ED) following trauma exposure. Skin conductance (SC) was measured during trauma recall at the ED. Oestradiol was assayed from blood collected at ED, 2-week and 6-month. Fear conditioning, including fear potentiated startle (FPS), was completed at 2-week and 6-month. In women, ED oestradiol was significantly positively associated with ED SC and FPS at 6-month. In men, significant negative correlations between ED oestradiol and SC were found. Among women in the study, peritraumatic oestradiol was positively associated with fear responding 6-month. Findings suggest that the protective effects of oestradiol on PTSD may depend on other factors, such as time since trauma. Additional research is needed to elucidate how peritraumatic oestradiol and autonomic function may interact to confer risk for PTSD.
Keywords: PTSD; autonomic function; fear conditioning; gender; trauma
Definitions of Cardiogenic Shock and Indications for Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society
No full textBackground: The management of patients with cardiogenic shock (CS) is complex and resource-intensive, particularly given the recent surge in temporary mechanical circulatory support (tMCS) devices. This document was created to establish an approach to the assessment of CS to provide early and targeted therapies, including tMCS.
Methods: An interdisciplinary, international panel of experts, utilizing a structured appraisal of the literature and a modified Delphi method, derived consensus regarding the assessment of CS based on pathophysiologic severity, etiology, and phenotypic clustering to guide escalation of care as well as identify those patients who might benefit from tMCS.
Results: Key principles included early and continuous assessment for the evolution of shock severity to guide the escalation of care as well as establishment of the cause of CS to facilitate triage and assignment of initial therapies. Phenotypic clustering is complementary and aids in prognosis. tMCS provides the greatest benefit in CS for relief of congestion refractory to medical therapy, ideally when initiated before the development of organ injury. The use of tMCS should be preceded by an interdisciplinary discussion as part of the informed consent process to establish therapeutic goals, including exit strategies.
Conclusions: Based on the available literature and expert consensus, there is an opportunity to further standardize the approach to CS, including characterization based on the severity of the shock state, etiology, and further enhancement by phenotyping. Monitoring, early triage and timely escalation of care, including the targeted initiation of tMCS, can minimize organ injury and in-hospital mortality
Vaccine Effectiveness Against Influenza A(H1N1), A(H3N2), and B-Associated Hospitalizations-United States, September 1, 2023-May 31, 2024
No full textBackground: The 2023-2024 influenza season included sustained elevated activity from December 2023-February 2024 and continued activity through May 2024. Influenza A(H1N1), A(H3N2), and B viruses circulated during the season.
Methods: During September 1, 2023-May 31, 2024, a multistate sentinel surveillance network of 24 medical centers in 20 U.S. states enrolled adults aged ≥18 years hospitalized with acute respiratory illness (ARI). Consistent with a test-negative design, cases tested positive for influenza viruses by molecular or antigen test, and controls tested negative for influenza viruses and SARS-CoV-2. Vaccine effectiveness (VE) against influenza-associated hospitalization was calculated as (1 - adjusted odds ratio for vaccination) × 100%.
Results: Among 7690 patients, including 1170 influenza cases (33% vaccinated) and 6520 controls, VE was 40% (95% CI: 31%-48%) with varying estimates by age (18-49 years: 53% [34%-67%]; 50-64 years: 47% [31%-60%]; ≥65 years: 31% [16%-43%]). Protection was similar among immunocompetent patients (40% [30%-49%]) and immunocompromised patients (32% [7-50%]). VE was statistically significant against influenza B (67% [35%-84%]) and A(H1N1) (36% [21%-48%]) and crossed the null against A(H3N2) (19% [-8%-39%]). VE was higher for patients 14-60 days from vaccination (54% [40%-65%]) than \u3e120 days (18% [-1%-33%]).
Conclusions: During 2023-2024, influenza vaccination reduced the risk of influenza A(H1N1)- and influenza B-associated hospitalizations among adults; effectiveness was lower in patients vaccinated \u3e120 days prior to illness onset compared with those vaccinated 14-60 days prior.
Keywords: hospitalization; seasonal influenza; severe influenza; vaccine effectiveness; waning
Blood Product Utilization in Thromboelastography-Aided Transfusion in Gastrointestinal Bleeding: A Single-Center Experience
No full textBackground: Gastrointestinal bleeding (GIB) is a common cause for intensive care unit (ICU) admissions and is associated with high mortality rates. Effective resuscitation is essential prior to definitive procedural intervention. Thromboelastography (TEG) assesses patients\u27 dynamic coagulation profiles and has been shown to reduce blood product usage and mortality in specific patient populations; however, its role in the management of GIB remains controversial.
Methods: We performed a retrospective study of patients who had TEG performed during resuscitation of GIB in the ICU between January 1, 2017 and December 31, 2020 at a single center. Patients were identified through ICD-10 codes and blood bank\u27s database.
Results: A cohort of 244 patients was identified, of which 18 were excluded. The cohort was mainly represented by White (72%, n = 162) males (65%, n = 147) with a mean age of 61 (standard deviation (SD) 14) years. Alcoholic liver disease (31%, n = 69) and esophageal varices (30%, n = 65) were the most common comorbidities. Mean nadir systolic blood pressure was 75 (SD 18) mm Hg. Mean nadir hemoglobin concentration was 6.5 (SD 1.7) g/dL. Patients received a median of 5 packed red blood cells (pRBC) (interquartile range (IQR) 5.8), 1 fresh frozen plasma (FFP) (IQR 2), and 0 platelets and cryoprecipitate units (IQR 1 and 0, respectively). The median ICU length of stay was 3 (IQR 3) days. The observed mortality rate was 39% (n = 88).
Conclusion: Although TEG may help reduce unnecessary blood product transfusions, its overall clinical benefit remains uncertain given the high mortality observed among patients with hemorrhagic shock secondary to GIB. Further studies are warranted to better evaluate the efficacy and clinical utility of TEG-guided transfusion strategies in this patient population.
Keywords: Gastrointestinal bleeding; Hemorrhagic shock; Mortality; Restrictive resuscitation; Thromboelastography
Mechanical outcomes of coronary stenting guided by intravascular ultrasound versus optical coherence tomography: A systematic review and meta-analysis with trial sequential analysis of randomized trials
No full textBackground: Intravascular imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may guide stent sizing and placement during percutaneous coronary intervention (PCI). We compared IVUS- vs. OCT-guided PCI in terms of mechanical outcomes.
Methods: PubMed, Embase and Cochrane databases were systematically searched until December 2024 for randomized controlled trials (RCTs) comparing IVUS- vs. OCT-guided PCI. Random-effects models were used to estimate mean differences (MDs) and standard mean differences (SMDs) with 95 % confidence intervals (CIs).
Results: Six RCTs with 2696 patients were included; 1396 (49.6 %) underwent IVUS-guided PCI. The mean age was 65.1 ± 10.2 years. In the pooled analysis, the post-PCI minimum stent area (MSA) was significantly higher with IVUS-guided PCI than with OCT-guided PCI (MD 0.64 mm2; 95 % CI 0.17-1.10; p \u3c 0.01), and post-PCI mean diameter stenosis was significantly lower with IVUS (MD -1.05 %; 95 % CI -1.90 to -0.21; p = 0.01). There were no significant differences between groups in acute lumen gain, stent expansion index, malapposition, tissue protrusion, or edge dissection. In a subgroup analysis, IVUS-guided PCI yielded a greater MSA in studies that did not size vessels by measurement of the external elastic membrane. However, trial sequential analysis suggested that the RCTs to date have not reached the required quantity of information to support definitive conclusions about MSA and mean diameter stenosis.
Conclusion: This meta-analysis demonstrated that IVUS-guided PCI was associated with greater MSA and reduced diameter stenosis compared to OCT-guided PCI, with no difference in stent expansion index, more trials are required to confirm this hypothesis