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Case Report: Unusual and Rare Presentation of Rheumatoid Arthritis as Multiple Large Synovial Cysts in Uncommon Locations
No full textRheumatoid arthritis (RA) is a chronic autoimmune disorder primarily characterized by persistent synovitis, leading to joint destruction, deformities, and systemic involvement. Synovial cysts are rare extra-articular manifestations of RA, usually arising from inflamed synovial tissues. While most synovial cysts occur in typical locations like the knees and wrists, we present a unique case of RA manifesting as multiple large synovial cysts in uncommon locations. A 67-year-old female patient with a history of well-controlled RA presented with complaints of progressive swelling and discomfort in her upper arms and thighs, unresponsive to conventional RA management. Physical examination revealed large, fluctuant masses, which were non-tender but limited the range of motion in the affected limbs. Diagnostic imaging, including ultrasound and magnetic resonance imaging (MRI), confirmed the presence of multiple synovial cysts, each measuring over 5 cm in diameter, situated in atypical areas around the elbow, hip, and shoulder joints. Given the patient’s history, these findings were initially unexpected, prompting further investigation to exclude differential diagnoses, such as lipomas, abscesses, and malignancies. Aspiration of the cysts revealed a synovial fluid consistent with RA pathology, confirming the diagnosis. This case highlights an unusual and rare presentation of RA. While synovial cysts are a known manifestation, their appearance in less typical locations emphasizes the importance of a comprehensive diagnostic approach. This case underscores the need for clinicians to consider atypical presentations when evaluating RA patients, particularly those with unusual swelling or masses that do not respond to standard treatments. Proper imaging and aspiration can facilitate accurate diagnosis, ensuring timely and appropriate management. Further research is needed to understand the mechanisms driving such atypical cyst formations and to optimize treatment strategies for similar cases
Comparison of Psychiatric Outcome Between Patients Experiencing Psychosis With and Without Traumatic Brain Injury
No full textPercutaneous pigtail catheter versus chest tube for the treatment of pediatric traumatic hemothorax: An Eastern Association for the Surgery of Trauma multicenter study.
No full textBACKGROUND: Small percutaneously placed pigtail catheters (PCs) for traumatic hemothorax (HTX) are safe and effective in adults but have not been evaluated in children. We hypothesized that PC would have similar efficacy and complication rates compared with chest tubes (CTs).
METHODS: A retrospective study of hemodynamically stable pediatric trauma patients (younger than 18 years) with HTX or hemopneumothorax was conducted at 41 trauma centers (January 2010 to December 2022). Catheter failure was defined as a requirement for surgery, additional tube placement, or thrombolytics. Multivariable logistic regression analysis adjusting for age, sex, mechanism of injury, and Injury Severity Score (ISS) was used to evaluate the associated risk of failure.
RESULTS: Of 548 patients, 477 had CT and 71 PC. The median age (CT: 15.7 vs. PC: 15.6, p = 0.49) and ISS (CT: 17 vs. PC: 16, p = 0.17) were similar between cohorts. Penetrating trauma patients more often received CTs (62.6% vs. 35.2%, p \u3c 0.0001). Failure rate was similar between CT versus PC (17.6% vs. 12.6%, p = 0.38). While the overall complication rate (respiratory distress, effusion, empyema, pneumonia, infection, deep venous thrombosis) was higher in the PC group on univariate analysis (19.7% vs. 11.9% in CT, p = 0.02), the risk of complications was not increased on multivariable analysis (odds ratio, 1.05; 95% confidence interval, 0.95-1.15; p = 0.3). Length of stay and intensive care unit length of stay were similar between cohorts (all p \u3e 0.05). Logistic regression analysis revealed that PC was not associated with the risk of failure (odds ratio, 0.95; 95% confidence interval, 0.87-1.04; p = 0.31). There was an increased risk of complications with ISS of \u3e15 (odds ratio, 1.17; 95% confidence interval, 1.10-1.26; p \u3c 0.0001) and lower risk with penetrating injury (odds ratio, 0.86; 95%confidence interval, 0.80-0.92; p = 0.0001).
CONCLUSION: There was no difference in risk of failure between PC and CT for pediatric HTX/hemopneumothorax and no difference in risk of complications after adjustment for confounders. Pigtail catheters had similar safety and efficacy compared with larger-bore CTs in this large multi-institutional study.
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III
Targeted Temperature Management Strategies in Pediatric Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Grading of Recommendations, Assessment, Development, and Evaluation-Assessed Systematic Review and Meta-Analysis.
No full textOut-of-hospital cardiac arrest (OHCA) in children is a rare but catastrophic event, often resulting in significant neurological injury. Targeted temperature management (TTM), including therapeutic hypothermia (TH), has been proposed as a neuroprotective strategy. This systematic review and meta-analysis aims to evaluate the effects of different TTM strategies on survival and neurological outcomes in pediatric patients after OHCA. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Pooled outcomes were synthesized using odds ratios (OR) with 95% confidence intervals (CI), and the certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of nine studies encompassing 2107 pediatric patients were included. TH was associated with significantly higher odds of survival (OR: 1.72; 95% CI: 1.36-2.18
TCT-14 Improved Survival but Higher Complication Rates in Women Undergoing TAVR: A Long-Term Sex-Based Outcome Analysis
No full textBackground: Sex-related differences in outcomes following transcatheter aortic valve replacement (TAVR) have been reported, but long-term comparative data remain limited. This study aims to compare long-term clinical outcomes between women and men undergoing TAVR. Methods: A total of 8,762 patients (4,139 women and 4,623 men) who underwent TAVR for severe symptomatic aortic stenosis were followed over a median of 3.8 years. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, stroke, major bleeding, vascular complications, and rehospitalization. Adjusted hazard ratios (HR) and p-values were calculated using Cox proportional hazards models. Results: At long-term follow-up, women demonstrated a lower risk of all-cause mortality compared to men (HR 0.88, 95% CI 0.82–0.95, p = 0.002). Women had a significantly higher risk of major vascular complications (HR 1.34, 95% CI 1.19–1.51, p \u3c 0.001) and major bleeding events (HR 1.21, 95% CI 1.10–1.33, p \u3c 0.001). Stroke rates were similar between the sexes (p = 0.28). Women had significantly lower rates of cardiovascular mortality and rehospitalization. Conclusion: Despite a higher incidence of vascular and bleeding complications, women undergoing TAVR experienced significantly better long-term survival and lower cardiovascular mortality compared to men. These findings underscore the importance of sex-specific risk stratification and procedural planning in TAVR candidates. Categories: STRUCTURAL: Womens Health Issues: Structura
TCT-24 Transcatheter Mitral Valve Repair With MitraClip Versus Surgical Repair for Acute Severe Mitral Regurgitation With Cardiogenic Shock: A Comparative Analysis of Patient Demographics and Clinical Outcomes
No full textBackground: Acute severe mitral regurgitation (MR) in the setting of cardiogenic shock presents a high-risk clinical scenario with limited time for intervention. This study compares outcomes between transcatheter edge-to-edge mitral valve repair (TEER) using the MitraClip device versus surgical mitral valve repair or replacement (SMVR) in patients presenting with acute severe MR and cardiogenic shock. Methods: A retrospective cohort analysis of 310 patients presenting with acute severe MR and cardiogenic shock across multiple centers from 2017–2023. Patients were treated either with MitraClip (n=158) or surgical repair/replacement (n=152). Baseline characteristics, procedural details, and in-hospital and 30-day outcomes were analyzed. Results: A total of 310 patients with acute severe MR complicated by cardiogenic shock were included in the analysis. Of these, 158 patients underwent transcatheter mitral TEER, and 152 underwent SMVR. Procedural success was achieved in 92.4% of patients in the M-TEER group compared with 97.3% in the SMVR group (p = 0.04). In-hospital mortality was significantly lower among patients treated with M-TEER (19.6%) compared to those who underwent SMVR (28.9%, p = 0.04). M-TEER also experienced shorter intensive care unit (ICU) stays (5.2 ± 2.8 days vs. 7.9 ± 3.6 days, p \u3c 0.001) and were less likely to require mechanical ventilation for more than 48 hours (16.4% vs. 34.8%, p \u3c 0.001). The incidence of acute kidney injury was also significantly lower in the M-TEER group (14.6% vs. 26.3%, p = 0.01). At 30 days, mortality remained significantly lower in the MitraClip group (24.1%) compared to the surgical repair group (33.6%, p = 0.03). Among survivors, successful MR reduction to ≤2+ at discharge was observed in 88.0% of patients treated with MitraClip versus 91.4% of those who underwent surgery (p = 0.32). Conclusion: In high-risk patients presenting with acute severe MR and cardiogenic shock, MitraClip offers a less invasive alternative to surgery with comparable procedural success and improved short-term outcomes. Patient selection remains paramount, and multidisciplinary Heart Team evaluation is essential. Categories: STRUCTURAL: Valvular Disease and Intervention: Mitra
TCT-470 Comparative Outcomes of Serum LDL Levels \u3c55 mg/dL Versus 55–100 mg/dL for Primary Prevention of Undiagnosed Coronary Artery Disease: A Retrospective Cohort Study
No full textBackground: Lowering low-density lipoprotein (LDL) cholesterol is a cornerstone of atherosclerotic cardiovascular disease prevention. However, the optimal target for primary prevention in asymptomatic individuals with undiagnosed coronary artery disease (CAD) remains debated. Our study objective was to compare clinical outcomes in individuals with serum LDL levels \u3c 55 mg/dL versus 55–100 mg/dL for primary prevention of undiagnosed CAD. Methods: In this retrospective cohort study involving 6,200 asymptomatic adults aged 40–75 without known CAD, we analyzed baseline LDL levels and tracked major adverse cardiovascular events (MACE) over a median 5-year follow-up. Patients were stratified into two groups: LDL \u3c 55 mg/dL (n = 2,150) and LDL 55–100 mg/dL (n = 4,050). Primary outcomes included incidence of non-fatal myocardial infarction (MI), all-cause mortality, cardiovascular mortality, and need for coronary revascularization. Multivariate Cox regression was used to adjust for age, sex, smoking, hypertension, diabetes, and statin use. Results: individuals with serum LDL levels \u3c 55 mg/dL had significantly lower rates of adverse cardiovascular outcomes compared to those with LDL levels between 55–100 mg/dL over a median follow-up of 5 years. Specifically, the \u3c 55 mg/dL group showed reduced incidence of non-fatal myocardial infarction (1.4% vs. 3.1%, HR 0.46, 95% CI 0.31–0.68, p\u3c 0.001), cardiovascular mortality (0.9% vs. 2.1%, HR 0.42, 95% CI 0.25–0.72, p=0.001), all-cause mortality (2.9% vs. 4.2%, HR 0.67, 95% CI 0.50–0.89, p=0.005), and need for coronary revascularization (1.7% vs. 3.6%, HR 0.48, 95% CI 0.33–0.69, p\u3c 0.001). The composite major adverse cardiovascular event (MACE) rate was also significantly lower in the \u3c 55 mg/dL group (4.4% vs. 8.2%, HR 0.53, 95% CI 0.42–0.66, p\u3c 0.001), underscoring the potential benefit of more intensive LDL reduction in the primary prevention setting. Conclusion: Serum LDL-C \u3c 55 mg/dL is associated with significantly reduced risk of MACE in asymptomatic individuals with potential undiagnosed CAD. These results may warrant revisiting current LDL-C targets in primary prevention, especially in individuals with risk-enhancing factors or silent coronary atherosclerosis. Categories: CORONARY: Pharmacology/Pharmacotherap
