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Left Ventricular Global Function Index: A Potential Predictor of Mortality and Major Adverse Cardiovascular Events in NSTEMI Patients.
No full textBackground and Objectives: The prognostic value of Left Ventricular Global Function Index (LVGFI) in chronic cardiovascular diseases is well-documented; however, limited evidence exists for its utility in non-ST elevation myocardial infarction (NSTEMI). This study aims to evaluate LVGFI as a predictor of three-year mortality and major adverse cardiovascular events (MACE) in NSTEMI patients. Materials and Methods: This retrospective cohort study included 432 NSTEMI patients divided into tertiles based on LVGFI values: T1 (low), T2 (intermediate), and T3 (high). LVGFI values were derived from echocardiographic imaging. Kaplan-Meier survival analysis was used to assess outcomes, and the Cox proportional hazards models, adjusted for demographics and clinical covariates, determined the association between LVGFI tertiles and three-year outcomes. Results: The average age and sex distribution were similar across tertiles with no significant differences in cardiovascular risk factors or most laboratory parameters. However, significant differences were noted in body surface area (higher in T3), platelet counts (higher in T1), and triglyceride levels (lower in T3). The ROC analysis identified an optimal LVGFI cut-off of 23.22 for predicting three-year mortality, with a sensitivity of 72% and specificity of 75% (AUC: 0.81; 95% CI: 0.74-0.87, p \u3c 0.001). Patients in the T1 exhibited a three-year mortality rate of 25%, compared to 2.1% in the T3. After adjustment, the hazard ratio (HR) for mortality was significantly higher in T1 (HR 11.86; 95% CI: 3.60-39.10) compared to T3. Similarly, MACE rates were highest in T1 (27.1%) and lowest in T3 (7.6%). Conclusions: LVGFI is a significant independent predictor of three-year mortality and MACE in NSTEMI patients
Non-operative Management of a Diaphragmatic Hematoma: A Case Report.
No full textDiaphragmatic hematomas are a rare complication of blunt trauma that are often overlooked due to the presence of high-acuity injuries. However, this injury can result in significant long-term complications if not managed appropriately. We present a 59-year-old female who developed a diaphragmatic crural hematoma following a motor vehicle accident. The patient arrived at the trauma bay unresponsive, hypertensive, requiring bag-valve mask ventilation, and with a Glasgow Coma Scale score of 3/15. On physical examination, the patient was found to have bilateral diminished breath sounds and was promptly intubated. Initial CT imaging of the patient demonstrated active contrast extravasation that was thought to be an adrenal hemorrhage but was actually a diaphragmatic hematoma upon re-examination. Although surgical intervention is a common approach for managing diaphragmatic injuries, non-operative management was chosen in this case due to the patient\u27s stable condition and minimal evidence of active bleeding. This case highlights the possibility of non-operative management of diaphragmatic hematomas when used with accurate radiologic and clinical findings. When appropriate, non-operative management can reduce morbidity and mortality but requires careful radiologic follow-up to detect potential complications
The Role of Donor Blood and ECMO (Extracorporeal Membrane Oxygenation) Circuit Interaction in ECMO-SIRS
Get PDF9 year old female presenting with L lower leg pain diagnosed with Erdheim-Chester Disease (ECD)
Get PDFThe Weekly Assessment of Child Behavior: Psychometric Properties of a Behavior Problem Screening Tool
Get PDFPerceptions of Family-Caregivers of Children/Youth with Special Health Care Needs About Their Child’s Diagnosis of Greatest Concern in an Emergency Scenario
Get PDFClinician Perspectives on Acceptability, Feasibility, and Safety of Maternal Postpartum Hypertension Screening in Newborn Visit
Get PDFCannabis Use During Pregnancy Correlates With Adverse Maternal Mental Health Outcomes: A Retrospective Study.
No full textIntroduction The prevalence of cannabis use during pregnancy has risen alongside its legalization and perceived safety, often being used to alleviate pregnancy-related discomforts. However, cannabis use during pregnancy may have adverse implications for maternal mental health, including increased rates of depression, panic disorder, suicidal ideation, and alcohol abuse. This study aims to evaluate the association between cannabis use during pregnancy and these mental health outcomes. Methods This retrospective cohort study utilized the TriNetX database, including over 2 million pregnant patients from 69 U.S. healthcare organizations (HCOs). A cohort of 51,087 cannabis users during pregnancy was compared to 1,936,508 non-users. Outcomes analyzed included depression, panic disorder, suicidal ideation, and alcohol abuse, identified using the International Classification of Diseases, 10th Revision (ICD-10) codes. Risk ratios, hazard ratios, and Kaplan-Meier survival probabilities were calculated, with statistical significance set at p \u3c 0.05. Results Cannabis use during pregnancy was associated with higher incidences of all four mental health outcomes. Alcohol abuse showed the greatest relative risk (risk ratio = 13.57; hazard ratio = 12.44), followed by suicidal ideation (risk ratio = 10.67; hazard ratio = 9.81), panic disorder (risk ratio = 5.47; hazard ratio = 5.01), and depression (risk ratio = 2.66; hazard ratio = 3.50). Depression affected 29.7% of cannabis users, compared to 11.2% of non-users, with significant differences in survival probabilities (p \u3c 0.001). Conclusion Cannabis use during pregnancy is significantly associated with increased risks of adverse mental health outcomes. These findings emphasize the importance of screening for cannabis use and mental health conditions during pregnancy and underscore the need for public health initiatives addressing the risks of prenatal cannabis use. Further research is needed to explore causal relationships and dosing effects
Evaluating the impact of different message strategies about OSA employed in the American Academy of Sleep Medicine Count on Sleep campaign.
No full textHealth campaigns hold promise for promoting general awareness about obstructive sleep apnea. In 2023, the American Academy of Sleep Medicine developed a series of messages as part of their Count on Sleep campaign. Three distinct messaging strategies were employed in posts disseminated on Facebook: (1) positive outcome (benefits of obstructive sleep apnea treatment); (2) negative outcome (consequences of untreated obstructive sleep apnea); and (3) partner-focused. We evaluated Facebook analytics to explore which of the 3 strategies was most impactful. The impressions were highest for the positive outcome message (n = 120,062), followed by the negative outcome (n = 12,286) and partner-focused (n = 10,259) messages. Female users were more likely to engage with positive (39% vs 28%) and negative (34% vs 25%) message than males, but sexes were quite balanced in engagement with the partner-focused message (36% vs 36%). There was more engagement from older adults (65 years and older) than from younger adults across all message types.
CITATION: Robbins R, Morkous SSW, Honaker S, Darby CV, DelRosso LM. Evaluating the impact of different message strategies about OSA employed in the American Academy of Sleep Medicine Count on Sleep campaign
Bilateral Patellar Tendon Rupture: Obesity as a Risk Factor
Get PDFIntroductionBilateral patellar tendon rupture is an uncommon presentation in the Emergency Department but can occur in the setting of certain risk factors. Obesity is an independent predisposing condition in which early identification can expedite diagnosis and treatment.
Case DescriptionWe report a case of bilateral patellar tendon rupture in a young male with obesity as the sole risk factor following a low-energy trauma. The patient ruptured his bilateral patellar tendons while jumping up during a basketball game. The diagnosis was made on exam and confirmed with plain radiographs and Magnetic Resonance Imaging. Because of the bilateral involvement and inability to bear weight, he underwent urgent primary repair and subsequent physical therapy.
DiscussionBilateral tendon rupture is a rare event. Prior case reports have noted risk factors such as medications including corticosteroids and fluoroquinolones. Certain medical conditions can also increase risk of bilateral rupture including diabetes, chronic kidney disease and collagen disorders. Our case is unique in that the patient did not have any of the previously noted risk factors. He did have morbid obesity which may have impacted his tendon integrity