Morbidity In Adult Patients Research Articles

The severity of hyponatremia worsens the outcome in pediatric intensive care patients

Objectives: Hyponatremia is known to increase mortality and morbidity in adult patients. However, the significance of hyponatremia in critically ill pediatric patients is unknown, unlike in adults. We tried to determine the prevalance of hyponatremia in critically ill children and whether the severity of hyponatremia contributes to hospital stay and mortality. Methods: The results of 190 patients who met the inclusion criteria and were admitted to the pediatric intensive care unit between April 2014 and April 2017 were analyzed. Results: Eighty-six (45.3%) patients developed hyponatremia at the time of hospitalization, and Hospital‑Acquired Hyponatremia (HAH) developed in 46 (24.2%) patients during the hospitalization. Fifty-eight (30.5%) patients were normonatremic. The patients in the HAH group were significantly more septic (p = 0.015). The duration of intensive care hospitalization was significantly longer in the HAH group (p < 0.001) and significantly less in the normonatremic group (p = 0.008). Total mortality was 41% (n = 78). There was no difference between the groups regarding mortality (p = 0.4). However, the degree of hyponatremia was associated with mortality. Mortality was 24.1% in mildly hyponatremic patients, 45.6% in moderate patients, and 58.8% in severe patients (OR: 2.636, 95% CI: 1.189-5.842; OR: 4.490, 95% CI:1.439-14.008, p = 0.01). We discovered that as hyponatremia severity increased, so did the length of stay in the intensive care unit, the need for invasive ventilation, and the need for vasoactive drugs (p = 0.009, p = 0.018, and p = 0.006, respectively). Conclusions: Unlike adults, the prognostic value of hyponatremia in terms of mortality has not been determined in critically ill children. However, as the severity of hyponatremia increased, it was seen that the length of stay in the intensive care unit and mortality increased.

Effect of Influenza Vaccination in Patients with Cardiovascular Disease: An Updated Meta-Analysis of Randomized Controlled Trials

Background: Influenza is a major cause of morbidity and mortality in patients with cardiovascular disease (CVD). The aim of this updated systematic review and meta-analysis was to evaluate the effect of influenza vaccination (IV) on morbidity and morbidity in adult patients with CVD. Methods: We conducted a systematic review and meta-analysis (PubMed, Cochrane Library, International Clinical Trials Registry Platform, and manual search of conference presentations) of randomized clinical trials published up to April 2022 analyzing whether IV reduced all-cause mortality in adult patients with CVD, including heart failure (HF) and coronary artery disease (CAD), compared with patients who were not vaccinated. Results: A total of six clinical trials comprising 9316 patients were analyzed. Five trials included CAD patients, and one trial included HF patients. Mean follow-up was 16 ± 9.7 months. Influenza vaccine was associated with a reduction of mortality compared to controls: relative risk (RR) 0.67, 95% confidence interval (95% CI), 0.47-0.95; p = 0.03; I2 = 53%, and with reduction of cardiovascular death compared to controls: RR 0.64; 95% CI 0.44-0.94; p = 0.02; I2 = 54%. There was a non-statistically significant reduction in myocardial infarction compared to control: RR 0.82, 95% CI 0.60-1.12; p = 0.57; I2 = 0%. Conclusion: In this meta-analysis of six randomized controlled clinical trials, IV was associated with a 33% and 36% relative risk reduction of all-cause mortality and cardiovascular death, respectively, in patients with CVD. We sought to promote consensus about the persistent benefits of influenza vaccination in patients with CVD by including two new clinical trials in CAD and HF, confirming the association of vaccination with risk reduction in subjects with CVD.

Analysis of the effects of ha-330 hemo adsorption column application on mortality and morbidity of adult patients with sepsis in general intensive care unit

Analysis of the effects of ha-330 hemo adsorption column application on mortality and morbidity of adult patients with sepsis in general intensive care unit

Developing the Aesthetic Postoperative Complication Score for Detecting Major Morbidity in Facial Aesthetic Surgery

INTRODUCTION: Facial aesthetic surgery encompasses a wide variety of procedures with a complication rate that is difficult to estimate. To explore this further, we sought to estimate major complication rates in patients undergoing facial aesthetic procedures and to develop a risk assessment tool to stratify risk. METHODS: We utilized the Tracking Operation and Outcomes for Plastic Surgeons database from 2003 to 2018. The database was evaluated to include major facial aesthetic procedures selected based on CPT codes. All infra-cervical procedures were excluded. Procedures included were blepharoplasty (upper and lower), rhytidectomy (forehead, neck with platysma tightening, glabellar, SMAS flap, cheek, chin, and neck), repair or brow ptosis, repair of blepharoptosis, canthopexy (lateral and medial), genioplasty, augmentation of mandibular body, primary rhinoplasty (minor and major), revision rhinoplasty (minor and major), subcutaneous injection/fat transfer, cervicoplasty, and otoplasty. Demographics, comorbidities, and procedures were analyzed with univariate analysis for initial selection. Clinically relevant cutoff points were used to dichotomize significant continuous variables for the model. A backward stepwise multivariate regression model was developed to determine the risk factors for prediction. Goodness-of-fit was assessed with Hosmer-Lemeshow test. Regression coefficients were multiplied by two and rounded up to the nearest integer, and then summed to create the total score. Area under receiver operating characteristic curves were used to measure performance and choose optimal predictive models. Lastly, sensitivity analysis was performed with a complete case analysis to evaluate robustness of the model. RESULTS: A total of 38,569 patients were identified to have had a facial aesthetic procedure. The major complication rate for this adult population undergoing at least one facial aesthetic procedure was 1.44% (460). From the available demographics and perioperative variables, those statistically significant in univariate analysis included current/former smoker, diabetes mellitus, body mass index, ASA classification, canthoplasty, blepharoptosis repair, rhytidectomy in forehead, rhytidectomy with platysma thickening, rhytidectomy with SMAS flap, rhytidectomy with check/chin/neck, cervicoplasty, subcutaneous injection of filler/fat graft, primary rhinoplasty, lower blepharoplasty, and over three procedures were performed at the same time. In the final stepwise backward regression model undergoing rhytidectomy with platysmal tightening, rhytidectomy of cheek/chin/neck, cervicoplasty, over three surgeries at the same time, BMI ≥ 25, and ASA class ≥ 2 were the variables fit for calculating the risk prediction score [n = 13,349; AUC: 0.70, SE: 0.02, (0.66–0.74)]. The sum of the calculated integers gives a total score of 7 with cervicoplasty counting for two points and the rest of the covariates each given one point. Sensitivity analysis from each level of our score (0–7) showed the cutoff point of ≥2 to best balance sensitivity and specificity, with 58% and 70%, respectively. At this cutoff point, 70% of cases were correctly classified as a major complication (n = 12,764). CONCLUSIONS: Despite low morbidity rates, we were able to develop an acceptable risk prediction score with a cutoff value of ≥2 correctly classifying approximately 70% of major morbidity in adult patients undergoing face and neck aesthetic surgery.

Male-female differences in acute thoracic aortic dissection: a systematic review and meta-analysis.

OBJECTIVESThis study aims to systematically review published literature on male–female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).METHODSA systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan–Meier curves.RESULTSNine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P < 0.001) and AD-B (P < 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46–0.70; P < 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17–0.41; P < 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58–0.72; P < 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84–1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83–1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male–female difference, whereas male patients had more reinterventions during follow-up.CONCLUSIONSThis systematic review shows male–female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male–female characteristics and outcomes are clearly warranted. Improved knowledge of male–female differences in AD will help shape optimal individualized care for both males and females.Clinical registration numberPROSPERO, ID number: CRD42020155926.

NCMP-18. NEUROTOXICITY AS A POTENTIAL SURROGATE MARKER FOR THERAPEUTIC RESPONSE WITH COMMERCIAL ANTI-CD19 CAR T-CELL THERAPY

Abstract Neurotoxicity is a common occurrence and a major form of morbidity in adult patients with relapsed or refractory (R/R) diffuse large B cell lymphoma (DLBCL) patients treated with anti-CD19 directed chimeric antigen receptor (CAR) T-cell therapy. Variables related to the incidence and severity of neurotoxicity have been relatively well delineated, but the association between neurotoxicity and the efficacy of CAR T-cell therapy has not been well studied. We performed a retrospective analysis of the outcomes of DLBCL patients who developed neurotoxicity following anti-CD19 CAR T-cell treatment. The analysis included 26 patients with R/R DLBCL who received commercial anti-CD19 CAR T-cell therapy. All patients received a lymphodepleting chemotherapy regimen consisting of fludarabine and cyclophosphamide. Twenty-five patients received axicabtagene ciloleucel, and 1 received tisagenlecleucel. The overall incidence of neurotoxicity was 88%; 31% developed severe neurotoxicity (Grade III-IV by CTCAE). Higher neurotoxicity was associated with better PFS by both CTCAE (CR 2.4 ± 1.1 vs. PD 1.4 ± 1.3, p = 0.051) and CARTOX-10 (CR 3.78 ± 4.6 vs. PD 7.7 ± 3.8, p = 0.044) grading systems. Higher neurotoxicity continued to show a trend at 6, 9, and 12 months by the CTCAE grading system (CR 2.4 ± 1.0 vs. PD 1.7 ± 1.3, p = 0.085), and no patients had disease recurrence after 6 months. In this limited cohort, neurotoxicity severity was paradoxically positively correlated with progression-free survival with commercial CAR T-cell therapy and may therefore indicate an effective therapeutic response.

End Stage Liver Disease Models and Outcomes in Pediatric Patients Supported with Short-Term Continuous Flow Ventricular Assist Devices

Purpose Short-term continuous flow VADs (STCF-VAD) are increasingly being utilized for mechanical support (MS) in the pediatric population. End-stage liver disease (ELD) models have been associated with mortality and morbidity in adult patients on MS. We sought to determine the relationship between outcomes in pediatric patients on STCF-VADs and 4 ELD models: MELD-XI, MELD-XI for those >1 year, PELD, and Pediatric MELD-XI (PMELD). Methods All pediatric patients supported with STCF-VADs, between June 2009 and December 2016 were included. Adverse outcomes, including major bleeding and neurological dysfunction were defined by PEDIMACs criteria. The MELD-XI, PELD, and PMELD score were calculated and their association with adverse events and a composite measure of death, major bleeding and neurological dysfunction was analyzed. Results Of 33 patients included, median age was 0.58 years (IQR 0.11-4.31), median weight was 8.0 kg (IQR 3.8-15.9), 52% had congenital heart disease, and 52% were male. For device strategy, 55% were on LVADs, 18% RVADs, and 24% BiVADs. In total, 76% patients experienced one of the 3 adverse events, with 76% experiencing a major bleed, 24% with neurological dysfunction, and 15% dying while on a STCF-VAD. The median MELD-XI score was 11.2 (IQR 9.4-29.9), MELD-XI (>1yr) 9.4 (IQR 9.4-22.9), PELD 6.0 (IQR 4.0-13.7) and PMELD -14.7 (IQR -18.8 - -12.2). A higher MELD-XI for all ages was significantly associated with death on device (31.52 vs. 10.24, p=.049) while a trend was seen for increased MELD-XI being associated with a major bleeding event (13.80, p=.054) and having any composite endpoint for all ages (13.80, p=.054). In addition, there was a trend towards a higher PMELD being associated with death (-12.87, p=.053). Lastly, there was no association with the models and any neurological events. Conclusion None of the ELD models were associated with neurological events. MELD-XI was significantly associated with death in patients of all ages and a trend can be seen with having a major bleeding event or any of the composite endpoints. These results suggest that ELD models may be limited in their ability to predict outcomes in this patient population. However, given the small patient numbers further work in a larger population are required to determine if the findings in this study hold true.

Impact of Resident Involvement on Morbidity in Adult Patients Undergoing Fusion for Spinal Deformity.

A retrospective study of prospectively collected data. The aim of this study was to determine whether patients undergoing spinal deformity surgery with resident involvement are at an increased risk of morbidity. Resident involvement has been investigated in other orthopedic procedures but has not been studied in adult spinal deformity surgery. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a large multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current procedural terminology (CPT) codes were used to query the database for adults who underwent fusion for spinal deformity between 2005 and 2012. Patients were separated into propensity score matched groups of those with and without resident involvement. Univariate analysis and multivariate logistic regression were used to analyze the effect of resident involvement on the incidence of postoperative morbidity and other surgical outcomes. Resident involvement was an independent predictor of overall morbidity [odds ratio (OR) 2.2, P < 0.0001], wound complication (OR 2.5, P = 0.0252), intra-/postoperative transfusion (OR 2.3, P < 0.0001), and length of stay > 5 days (OR 2.0, P < 0.0001). However, resident involvement was not an independent predictor for other complications, such as mortality. Resident participation was associated with significantly longer operative times. As a result, higher rate of certain morbidity, but not mortality, was found, specifically for complications that have been previously associated with long operative duration. 3.

Cardiovascular and metabolic morbidity in adult patients with classic congenital adrenal hyperplasia

Cardiovascular and metabolic morbidity in adult patients with classic congenital adrenal hyperplasia

Interictal Psychiatric Morbidity in Adult Patients with Epilepsy in South East Nigeria

Interictal Psychiatric Morbidity in Adult Patients with Epilepsy in South East Nigeria

Albumin in Burn Shock Resuscitation: A Meta-Analysis of Controlled Clinical Studies.

Critical appraisal of outcomes after burn shock resuscitation with albumin has previously been restricted to small relatively old randomized trials, some with high risk of bias. Extensive recent data from nonrandomized studies assessing the use of albumin can potentially reduce bias and add precision. The objective of this meta-analysis was to determine the effect of burn shock resuscitation with albumin on mortality and morbidity in adult patients. Randomized and nonrandomized controlled clinical studies evaluating mortality and morbidity in adult patients receiving albumin for burn shock resuscitation were identified by multiple methods, including computer database searches and examination of journal contents and reference lists. Extracted data were quantitatively combined by random-effects meta-analysis. Four randomized and four nonrandomized studies with 688 total adult patients were included. Treatment effects did not differ significantly between the included randomized and nonrandomized studies. Albumin infusion during the first 24 hours showed no significant overall effect on mortality. However, significant statistical heterogeneity was present, which could be abolished by excluding two studies at high risk of bias. After those exclusions, albumin infusion was associated with reduced mortality. The pooled odds ratio was 0.34 with a 95% confidence interval of 0.19 to 0.58 (P < .001). Albumin administration was also accompanied by decreased occurrence of compartment syndrome (pooled odds ratio, 0.19; 95% confidence interval, 0.07–0.50; P < .001). This meta-analysis suggests that albumin can improve outcomes of burn shock resuscitation. However, the scope and quality of current evidence are limited, and additional trials are needed.

Higher Serum Ferritin Levels Correlate with an Increased Risk of Cutaneous Morbidity in Adult Patients with β-Thalassemia: A Single-Center Retrospective Study

Disturbed iron homeostasis characterizes β-thalassemia and increases its morbidity. Our aim was to retrospectively associate β-thalassemia disease characteristics with treatment-requiring skin conditions. The files of adult β-thalassemia (including sickle β-thalassemia) patients were screened over a 10-year period for treatment-requiring skin disease episodes and their correlation with hematologic diagnoses and epidemiological and serological characteristics. Seventy-eight patients were identified, and 7 (9%) developed at least one relevant episode including cutaneous small-vessel vasculitis (CSVV), urticaria, and leg ulcers. Average ferritin serum level correlated significantly with development of a dermatosis (2,034 ± 799 μg/l in cases vs. 920 ± 907 μg/l in the overall population; p = 0.001, ANOVA). This difference relied exclusively on the high ferritin levels observed in patients with ‘generalized' dermatoses (urticaria and CSVV: 3,860 ± 1,220 μg/l) as opposed to values within the normal range in the case of ‘localized' ones (leg ulcers: 662 ± 167 μg/l). The employed iron chelation treatment influenced ferritin levels (p = 0.002, Kruskal-Wallis test) since chelation with a single agent seems to increase the risk of a skin disease (p = 0.013, likelihood ratio method). Conclusively, serum ferritin can be evaluated as risk factor for generalized dermatoses, but not for leg ulcers, in patients with the β-thalassemia genotype. This risk can be efficiently controlled with adequate chelation.

Is elevated Red cell distribution width a prognostic predictor in adult patients with community acquired Pneumonia?

BackgroundCommunity acquired pneumonia (CAP) is a major cause of morbidity and mortality. We recently demonstrated that among young patients (<60 years old) with CAP, elevated red blood cell distribution width (RDW) level on admission was associated with significant higher rates of mortality and severe morbidity. We aimed to investigate the prognostic predictive value of RDW among CAP patients in general population of internal wards.MethodsThe cohort included patients of 18 years old or older who were diagnosed with CAP (defined as pneumonia identified 48 hours or less from hospitalization) between January 1, 2005 and December 31, 2010. Patients were retrospectively analyzed for risk factors for a primary endpoint of 90-day mortality. Secondary endpoint was defined as complicated hospitalization (defined as at least one of the following: In- hospital mortality, length of stay of at least 10 days or ICU admission). Binary logistic regression analysis was used for the calculation of the odds ratios (OR) and p values in univariate and multivariate analysis to identify association between patient characteristic, 90-day mortality and complicated hospitalization.ResultsThe cohort included 3815 patients. In univariate analysis, patients with co-morbid conditions tended to have a complicated course of CAP. In multivariate regression analysis, variables associated with an increased risk of 90-day mortality included age > 70 years, high Charlson comorbidity index (>2), Hb < 10 mg/dl, Na <130 meq/l, blood urea nitrogen (BUN) >30 mg/dl, systolic blood pressure < 90 mmHg and elevated RDW >15%. Variables associated with complicated hospitalization included high Charlson comorbidity index, BUN > 30 mg/dl, hemoglobin < 10 g/dl, heart rate >124 bpm, systolic blood pressure < 90 mmHg and elevated RDW. Mortality rate and complicated hospitalization were significantly higher among patients with increased RDW regardless of the white blood cell count or hemoglobin levels.ConclusionsElevated RDW levels on admission are associated with significant higher rates of mortality and severe morbidity in adult patients with CAP. RDW as a prognostic marker was unrelated with hemoglobin levels, WBC count, age or Charlson score.

Coexisting chronic conditions associated with mortality and morbidity in adult patients with asthma

Objective: Many asthma patients suffer from chronic conditions other than asthma. We investigated the specific contribution of common comorbidities on mortality and morbidity in adult asthma. Methods: In an observational study of adults with incident asthma identified between 1999 and 2003 using National Veterans Affairs and Centers for Medicare and Medicaid Services encounter databases (n = 25 975, follow-up 3.0 ± 1.7 years), association between 13 most prevalent comorbidities (hypertension, ischemic heart disease (IHD), osteoarthritis, rheumatoid arthritis, diabetes, mental disorders, substance/drug abuse, enlarged prostate, depression, cancer, alcoholism, HIV and heart failure) and four conditions previously associated with asthma (sleep apnea, gastroesophageal reflux disease (GERD), rhinitis and sinusitis) and mortality, hospitalizations and asthma exacerbations were assessed using multivariate regression analyses adjusted for other clinically important covariates. Results: HIV followed by alcoholism and mental disorders among 18–45-years old, and heart failure, diabetes, IHD and cancer among those ≥65 years old were associated with an increased risk of all-cause mortality. Many conditions were associated with increased risk for all-cause hospitalizations, but the increased risk was consistent across all ages for mental disorders. For asthma exacerbations, mental disorder followed by substance abuse and IHD were associated with increased risk among those 18–45 years old, and chronic sinusitis, mental disorder and IHD among those ≥65-years old. GERD was associated with decreased risk for asthma exacerbation in all ages. Conclusions: Many comorbidities are associated with poor outcome in adult asthmatics and their effect differs by age. Mental disorders are associated with increased risk of mortality and morbidity across ages.

Growth hormone replacement normalizes impaired fibrinolysis: New insights into endothelial dysfunction in patients with hypopituitarism and growth hormone deficiency

BackgroundCardiovascular morbidity in adult patients with growth hormone deficiency (GHD) and hypopituitarism is increased. Clustering of cardiovascular risk factors leading to endothelial dysfunction and impaired fibrinolysis has also been reported and may account for progression to overt vascular changes in these patients. However, effect of long lasting GH replacement therapy on fibrinolytic capacity in GH deficient patients has not been investigated so far. ObjectiveTo investigate fibrinolysis before and after challenge with venous occlusion in GHD patients with hypopituitarism before and during one year of growth hormone replacement. DesignHospital based, interventional, prospective study. Investigated subjectsTwenty one patient with GHD and fourteen healthy control subjects matched for age, sex and body mass index (BMI). MethodsAnthropometric, metabolic and fibrinolytic parameters were measured at the start and after three, six and twelve months of treatment with human recombinant GH. ResultsAt baseline GHD patients had significantly impaired fibrinolysis compared to healthy persons. During treatment with GH, significant changes were observed in insulin like growth factor 1(IGF-1) [from baseline 6.9(2.4–13.5) to 22.0(9.0–33.0) nmol/l after one month of treatment; p<0.01] and fibrinolysis. Improvement in fibrinolysis was mostly attributed to improvement of stimulated endothelial tissue plasminogen activator (t-PA) release in response to venous occlusion [from baseline 1.1(0.4–2.6) to 1.9(0.5–8.8) after one year of treatment; p<0.01]. ConclusionGrowth hormone replacement therapy has favorable effects on t-PA release from endothelium and net fibrinolytic capacity in GHD adults, which may contribute to decrease their risk of vascular complications.

Eplerenone: A Review of Its Use in Patients with Chronic Systolic Heart Failure and Mild Symptoms

Eplerenone (Inspra®) is a selective mineralocorticoid receptor antagonist (MRA). In the EU, it is approved for use (in addition to standard optimal therapy) to reduce the risk of cardiovascular (CV) mortality and morbidity in adult patients with chronic systolic heart failure (HF) and mild symptoms. This article reviews the efficacy and tolerability of eplerenone in this indication and briefly summarizes its pharmacology. In the EMPHASIS-HF study, relative to placebo, the addition of eplerenone to optimal background therapy significantly reduced the risk of death from CV causes or hospitalization for HF in patients with chronic systolic HF and mild symptoms. Benefits of eplerenone therapy over placebo were also observed in several secondary outcomes, including: death from any cause or hospitalization for HF; death from any cause; hospitalization for any reason; or hospitalization for HF. Eplerenone was generally well tolerated in this study, with the most frequent adverse event being hyperkalaemia, which is a known adverse event of the drug class. Sexual adverse events (e.g. gynecomastia) occurred in <1 % of eplerenone recipients, reflecting the selectivity of eplerenone for mineralocorticoid receptors. Based on these results, European guidelines have been updated and recommend the use of an MRA to reduce the risk of HF hospitalization and premature death in all patients with persisting symptoms (New York Heart Association class II-IV) and a left-ventricular ejection fraction of ≤35 %, despite treatment with ACE inhibitor (or an angiotensin receptor blocker if an ACE inhibitor is not tolerated) and a β-blocker.

Mortality in a cardiac intensive care unit

There are no reliable data on mortality and morbidity of adult patients in modern university-based cardiac intensive care units. Therefore, the present study was aimed to provide complete data in respect to mortality and morbidity of all patients admitted between 1 January 2008 and 31 December 2009 to the newly opened cardiac intensive care unit of the Heart Centre of the Cologne University Hospital. All patients admitted to the 6-bed intensive care unit of the Heart Centre of the University of Cologne between January 1 2008 and December 31 2009 were included in this study. A total of 684 patients were investigated. The majority of patients (71.1%) were male. The overall in-hospital mortality was 32.5%. The most frequent diagnosis was acute coronary syndrome (43.6%). Coronary angiography was performed in 45.5% of all patients. Cardiopulmonary resuscitation was the reason for admission in 30.8%, the in-hospital mortality of those patients (46.0%) was much higher compared to the overall mortality. Our data demonstrate that despite state-of-the-art university-based intensive care medicine with modern equipment the mortality remains high. These findings will help in calculating the resources required to meet the increasing demand for intensive care medicine.

Clinical features of adult patients with Eisenmenger's syndrome in Japan and Korea

BackgroundThere are few articles on mortality and morbidity of adult patients with Eisenmenger's syndrome (ES) in the current era when disease targeting therapy (DTT) has been available. Methods and results198 patients (a median age 35years, 64% female) with ES who visited the 16 participating institutes in Japan and Korea from 1998 to 2009 were enrolled. Clinical data during adulthood were collected from each institutional chart and analyzed centrally. During a median follow-up of 8years, 30 patients died including 14 sudden deaths. 89 patients took oral medication of DTT and clinical improvement was observed in 54 of them. However, survival rate in patients taking DTT was not different from those without (87% vs 84%, p=0.55). When the clinical data in between first and last clinic visits were compared in 85 patients, the patients with NYHA ≧ III increased from 24% to 48% (p<0.001), SpO2 decreased from 89% to 85% (p=0.008) and hematocrit increased from 51.4% to 52.9% (p=0.04). Non-survivors had poorer NYHA function class, lower body weight (BW), lower body mass index (BMI), and higher serum level of Cr at the first visits than survivors. ConclusionsLong term survival and clinical status of adult patients with ES remains unsatisfactory even in the current era of DTT. Poor NYHA functional class, low BW, low BMI and high serum level of Cr were related to mortality. DTT therapy improved clinical status in many patients with Eisenmenger's syndrome, but no significant impact on survival could be shown.

Anabolic therapy in b-thalassaemia major induced osteoporosis: case report and literature review

Transfusion program and chelating therapy treatment has extended the life expectancy of thalassaemic patient; osteoporosis is considered an important cause of morbidity in adult patients who display increased fracture risk. This is a case report is about a thalassaemic young female with multiple spine fractures (D11, D12 e L2) and lumbar spine DEXA - T score = -3,1 and femoral = -3,4. This was in spite of therapy with alendronate 70 mg/week from January 2006 to September 2007. The patient was subsequentently treated for 18 months with 1-34 recombinant human parathyroid hormone and colecalciferol (100.000 U/monthly). After 4 months of therapy, the patient showed a decrease in spinal pain (Roland and Morris Disability Questionnaire) and an improvement of quality of life (Qualeffo) with normalization of osteocalcin and 25-OHcolecalciferol haematic levels after 6 months. Lumbar spine and femoral DEXA - Tscore, at 18 months, rose respectively to -2,5 and -2,4. Thalassaemia-induced osteoporosis is multifactorial and its management is very difficult. Bone marrow expansion, endocrine dysfunction, iron overload and genetic factors all seem to play important roles in the development of low bone mass in these patients. Bisphosfonates have been used in the management of thalassemia induced osteoporosis but there is no data about fracture risk. Anabolic therapy for thalassemic patients requests additional study on a large scale.

An Atypical Degenerative Osteoarthropathy in Hyp Mice is Characterized by a Loss in the Mineralized Zone of Articular Cartilage

Patients with X-linked hypophosphatemia (XLH) develop enthesophytes and osteophytes secondary to articular cartilage degeneration and together are the primary cause of morbidity in adult patients so afflicted. We have previously characterized the enthesopathy in Hyp mice, a murine model of XLH. We now extend these studies to the synovial joint in order to characterize potential cellular changes in articular cartilage that may predispose patients to the osteoarthropathy of XLH. We report that, despite highly elevated levels of alkaline phosphatase activity throughout articular cartilage, there is a complete loss in the mineralized zone of articular cartilage as assessed by von Kossa staining of mineral and as quantified by EPIC-microCT analysis and evidence of vascular invasion. We also identify the downregulation of extracellular matrix (ECM) factors identified as regulators of terminally differentiated mineralizing articular chondrocytes. There is also a striking increase in the histochemical staining of sulfated proteoglycans, a change that may reflect the loss of a transitional tissue that reduces mechanical stress at the interface between cartilage and subchondral bone. The failure of mineralizing articular chondrocytes to develop in the hypophosphatemic state suggests that phosphate may be a key regulator of chondrocyte mineralization. Accordingly, we find that the appropriate zonal arrangement and phenotypic markers of articular cartilage are significantly reestablished by phosphate-replacement therapy. Given the turnover and maintenance of articular cartilage ECM, the identification of early and abnormal cellular changes unique to XLH will undoubtedly aid in a more effective management of this disease to minimize the onset of degenerative osteoarthropathy.