RocScholar (Rochester Regional Health)
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Demographic, risk factors, and management practices of patients with acute coronary syndrome: an observational study in a tertiary care hospital in Central India
No full textBackground: Acute coronary syndrome (ACS) remains a major cause of mortality worldwide, with India reporting approximately three million cases annually. This study aims to assess the demographics, risk factors, and treatment patterns of ACS patients in Central India while exploring challenges related to pre-hospital delays and financial constraints.
Materials and Methods: A cross-sectional, questionnaire-based study was conducted at a tertiary care hospital. Data from patients with ACS were collected through face-to-face interviews using a self-designed, semi-structured, open-ended questionnaire.
Results: Among the 90 participants, 86.6% were diagnosed with an acute ST-segment elevation myocardial infarction (STEMI), with a male predominance (81.1%). Common risk factors included smoking, diabetes, hypertension, and a history of cardiovascular events. The primary reasons for delays in seeking medical care were a lack of recognition of symptom severity (37%), prolonged travel times (21%), and unavailability of suitable transportation (21%). Chest pain was the most frequently reported initial symptom (73.3%), with symptom onset occurring most often in the morning (43.3%). Males were more likely to experience anterior wall MI, while females predominantly presented with inferior or posterior wall MI. Emergency medical service (EMS) utilization was low, with most patients relying on personal vehicles for transportation. Additionally, rural patients required at least one additional hospital visit before reaching the tertiary care center compared to their urban counterparts. Thrombolysis was the primary treatment modality, administered to 76.67% of participants, with an average door-to-needle time of 78 ± 63 min.
Conclusion: Multiple hospital referrals and inadequate EMS utilization hinder optimal ACS management. This study underscores the need for a streamlined referral process, enhanced EMS infrastructure, reduced door-to-needle time, and targeted interventions to mitigate financial barriers to ACS care in India
Inpatient Electronic-Consults for Asthma Hospitalization Improve Outpatient Outcomes
No full textObjective: Asthma exacerbations frequently lead to systemic corticosteroid use, emergency department (ED) visits, and hospitalizations. While specialist care can improve asthma outcomes, a critical gap often exists between inpatient hospitalization and outpatient follow-up. This study measured the clinical impact of an allergy/immunology (A/I) electronic consult (e-consult) for patients hospitalized for asthma exacerbation.
Methods: In this quality improvement project, all patients admitted for asthma received an A/I e-consult addressing asthma controller therapy and outpatient follow-up. Clinical outcomes were tracked for the subsequent year. Results are reported with descriptive statistics, and a paired T-test was used to compare groups.
Results: 133 patients were enrolled; mean age 28.9 ± 23.3 years, 76 (57%) females, 64 (48%) Black, and 36 (27%) Hispanic. 73 (55%) patients were on asthma maintenance therapy, whereas 60 (45%) were on monotherapy with a short-acting beta agonist (SABA). In the year prior to hospital admission, 43 (32%) had been seen in the ED/UC and 73 (55%) had been previously hospitalized. The mean courses of SCS was 2.5 ± 2.2. Following the inpatient e-consult, 77 (58%) followed up as scheduled, and there was a decrease in hospitalization (mean 1.38 ± 0.11 to 0.42 ± 0.10, p\u3c .0001), ED/UC visits (mean 1.35 ± 0.23 to 0.70 ± 0.15, p=.0025), and SCS courses (mean 2.74 ± 0.25 to 1.43 ± 0.25, p\u3c .0001). An inpatient e-consult improved outcomes regardless of follow-up status for both pediatric and adult patients.
Conclusion: Inpatient A/I e-consults for asthma exacerbations decreased SCS use and healthcare utilization, including inpatient hospitalization, in both pediatric and adult patients
TCT-1270 Impact of Frailty on Patients Undergoing TEER MitraClip With Underlying Hypertrophic Cardiomyopathy
No full textOver Two Years of Sustained Remission With Olaparib Monotherapy in Stage IV Non-Small Cell Lung Cancer With ATM Mutation: A Case Report
No full textBackground: Ataxia telangiectasia mutated (ATM) mutations represent the most common homologous recombination deficiency (HRD) mutation in non-small cell lung cancer (NSCLC). However, their therapeutic role in NSCLC has not been established.
Case: Here, we present a case of a 91-year-old male with metastatic NSCLC who progressed on multiple lines of treatment. Next-generation sequencing revealed ATM mutations, leading to the initiation of olaparib, which successfully achieved remission over a two-year period.
Conclusion: This case underscores the promising role of olaparib in treating NSCLC with HRD, particularly ATM mutations, highlighting the importance of molecular testing and targeted therapies
Critical Care Wrapped/Rewind 2024: Taylor\u27s Version
No full textCritical Care Wrapped/Rewind 2024: Taylor\u27s Version. Jason Lyons, MD, Critical Care Medicine
Objectives: Update on recent data and studies in critical care medicin
Successful Multimodal Interventional Management of Extensive Portal Venous System Thrombosis in a Patient with a Hypercoagulable State
Get PDFWe present a case of extensive mesenteric and portal vein thrombosis in a 59-year-old male with a history of multiple thrombotic events and hypercoagulable conditions. The patient presented with abdominal pain, nausea, vomiting, and black stools, leading to the discovery of thrombosis in the portal vein, splenic vein, and superior mesenteric vein (SMV) with associated bowel ischemia. The goal of treatment was to prevent mesenteric ischemia, maintain portal vein patency, and preserve options for potential liver transplantation. The case was managed through a combination of ultrasound-guided paracentesis, portal and SMV venography, mechanical thrombectomy using the AngioJet device, and continuous thrombolytic therapy. Initial intervention reduced thrombus burden; however, residual thrombus necessitated ongoing thrombolysis. Follow-up venograms showed improved patency in the portal vein and SMV with significant resolution of the thrombus
Impact of Frailty on Inpatient Outcomes of COVID-19 Patients: Evidence From a US National Inpatient Sample
No full textIntroduction: The global impact of Coronavirus Disease 2019 (COVID-19), caused by severe-acute-respiratory-syndrome coronavirus 2 (SARS-CoV-2), has been profound, claiming the lives of more than 3 million individuals within a year and a half. Among the affected population, heightened vulnerability is observed among older and frailer individuals, leading to more severe symptoms and adverse outcomes compared to their younger, non-frail counterparts. This study to analyze the impact of frailty on the outcomes of adult patients admitted with COVID-19.
Methods: Using the National Inpatient Sample (NIS) database 2020, we identified adult patients admitted with a principal diagnosis of COVID-19. The patients were then divided into two groups, i.e., frail and non-frail, based on the Hospital Frailty Risk Score (HFRS) cut-off of 5. Using a multivariate regression model, we compared COVID-19 hospitalizations, with frailty status serving as the exposure variable. Statistical analysis was performed using STATA version 14.2.
Results: Out of 1,050,045 adult patients hospitalized with COVID-19, 509,915 (48.56%) met the criteria for frailty. Among these frail patients, the majority were white, older females with a high comorbidity burden. Compared to their non-frail counterparts, these frail patients experienced greater odds of mortality (adjusted odds ratio [aOR] 4.00, 95% confidence interval [CI] 3.78–4.23;P.
Conclusion: In conclusion, our findings highlight a complex interplay between COVID-19 and frailty, revealing that frailty is associated with increased odds of mortality as well as associated complications. These findings contribute to a deeper understanding of the clinical complexities surrounding COVID-19 in frail patients, necessitating tailored management strategies
