Nonfatal Complications Research Articles

Modelling rheumatic heart disease progression in australia using disease register data linked to administrative records

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Australian Government National Health and Medical Research Council OnBehalf ERASE project Background Rheumatic Heart Disease (RHD) is a major contributor to morbidity and mortality globally, and is endemic among Indigenous Australians. The RHD Endgame strategy was recently launched, outlining comprehensive methods for eliminating RHD in Australia by 2031. However, there is currently limited information on national rates of RHD and progression to severe or complicated RHD. Purpose This study provides current estimates of RHD progression prior to RHD Endgame Strategy implementation. We estimate the probability and predictors of progressing from RHD diagnosis to cardiovascular complications, death, or need for surgical intervention in the Australian population from expanded data sources, addressing methodological shortcomings in existing evidence by using cross-jurisdictional administrative datasets and a competing risks approach. Methods This retrospective cohort study used linked RHD register, hospital and death data from five Australian jurisdictions (>70% Australians). Progression from RHD diagnosis to all-cause mortality, non-fatal cardiovascular complications (heart failure, stroke, endocarditis, atrial fibrillation), or need for surgical intervention were estimated for people aged <35years diagnosed with first-ever RHD between 2010 and 2018. A minimum 8.5-year look-back excluded prevalent cases; maximum follow-up was 8 years. Proportional cause-specific hazard regression modelling investigated independent predictors of outcomes, with death treated as a competing risk. Sensitivity analyses compared results between all-sources and register-only cohorts. Results We identified 1714 first-ever RHD cases aged <35years in the all-sources cohort (84% Indigenous, 11% migrant, 63% women, 40% age 5-14years, 85% non-metropolitan). Six months after diagnosis, 8.1% (95%CI:6.9-9.5%) had experienced heart failure, other cardiovascular complications or surgical intervention and 23.6% (95%CI:20.2-27.5%) progressed to these outcomes within 8 years. The register-only cohort experienced less disease progression with estimated composite event rates of 5.6% (95%CI:4.7-6.6%) and 18.4% (95%CI:16.6-20.5%) at 6 month and 8 years respectively. Death rate in the all-sources cohort was 0.5% at 6 months and 3.2% at 8 years. Older age, Metropolitan residence, and history of acute rheumatic fever, but not sex or Indigenous status, were independent predictors of major cardiovascular outcomes. Conclusions This study provides the most definitive and contemporary estimates of RHD disease progression in young Australians. Despite Australia"s excellent healthcare system infrastructure, RHD complication rates remain high. Improvements in healthcare systems for diagnosis, monitoring, and management of RHD cases will need to be implemented in both Metropolitan and remote settings as Australia implements its Endgame strategy against RHD. However, primordial and primary prevention provides the best potential to reduce the burden of RHD in Australia and beyond.

Immediate outcomes of simultaneous and step-by-step reconstruction of aortic dissection: a single-center study

The aim. To evaluate the immediate outcomes after complete single-stage or step-by-step reconstruction of the primary and secondary distal aortic dissection using implantation of bare metal stents in the thoracoabdominal aorta.Materials and methods. A prospective study was performed involving 21 patients (19 male) with aortic dissection: 8 had secondary distal dissection (group 1) and 13 had primary distal dissection (group 2). In all patients, indications for intervention were signs of malperfusion in one or more vascular regions. The following factors were evaluated: 30-day survival after surgery, causes of fatal outcomes, frequency and characteristics of non-fatal complications.Results. The average age in group 1 was 43.0 ± 3.1 years, in group 2: 56.0 ± 3.9 years (p < 0.05). The most common cause of dissection in group 1 was connective tissue dysplasia, in group 2 – atherosclerosis in combination with arterial hypertension (p < 0.05). In group 1, 1 (13%) lethal outcome was registered, in group 2 – 4 (31%), the difference between the groups was not significant. Lethal complications were: multiple organ failure, stent implantation in the false aortic canal, aortic rupture, and thrombosis of the superior mesenteric artery. Non-fatal complications developed in group 1 in 3 (38%), in group 2 – in 3 (23%) patients, the difference between the groups is not significant. Among the non-lethal complications, malperfusion of the upper and lower extremities was diagnosed, requiring stent placement, prosthetics or bypass surgery; cerebrospinal circulation disorder, acute cerebrovascular accident, multiple organ failure, conservatively treated.Conclusion. The survival rate for 30 days after a complete single-stage or step-by-step reconstruction of the primary and secondary distal aortic dissection using implantation of bare metal stents in the thoracoabdominal aorta is 76%, the frequency of non – fatal complications is 28%.

Percutaneous mitral valve repair with MitraClip device in hemodynamically unstable patients: A systematic review.

Very few data exist on percutaneous mitral valve repair (PMVr) in unstable patients with concomitant moderate-severe mitral regurgitation (MR). The purpose of this systematic review was to evaluate baseline characteristics, management and clinical outcomes of critically ill patients undergoing PMVr with MitraClip. We conducted a systematic review of the published data on MitraClip from its first use in 2003 to December 2020. Studies referring to critically ill patients in cardiogenic shock or acute refractory pulmonary edema were included. A total of 40 publications including 254 patients with significant MR (Grade 4 in 91%) were included. Mean age was 70 ± 12 years with mean Euroscore II and STS of 21 ± 13 and 20.5 ± 16, respectively. Clinical presentation was with cardiogenic shock and acute myocardial infarction in 72.8 and 60.0% of patients, respectively. Device success was achieved in 238 (93.7%) patients with a significant reduction in MR (Grade ≤ 2 in 91.8%, p < .001). The median weaning time from the procedure, to discontinuation of mechanical circulatory or respiratory support, was 2 days (IQR 1-4), with an in-hospital mortality and non-fatal complication rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an overall mortality rate of 39.1% at 12-month follow-up, with persistent reduction in MR severity for survivors (Grade ≤ 2 in 81.3%) and one case of mitral valve reintervention. Percutaneous mitral valve repair with MitraClip device is a technically feasible and potentially viable management option in high-risk patients with cardiogenic shock or refractory pulmonary edema and concomitant moderate-severe MR. Prospective trials are required to confirm these findings, and definitively determine the value of MitraClip in hemodynamically unstable patients.

ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France

BackgroundSystems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown.AimTo compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019.MethodsIn this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction.ResultsA total of 6306 patients were included. During the pandemic peak, a 13.9 ± 6.6% (P = 0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150−705] vs 245 [140−646] min; P = 0.013), driven by the increase in time from symptom onset to first medical contact (121 [60−360] vs 150 [62−420] min; P = 0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P = 0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P = 0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock.ConclusionsDuring the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.

Catheter ablation in adults with congenital heart disease: A 15-year perspective from a tertiary centre

With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in patients with ACHD, over a significant period of time, remain scarce. We aimed to describe temporal trends in volume and outcomes of catheter ablation in patients with ACHD. This was a retrospective observational study including all consecutive patients with ACHD undergoing attempted catheter ablation in a large tertiary referral centre over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 and 24 months were analysed. From November 2004 to November 2019, 302 catheter ablations were performed in 221 patients with ACHD (mean age 43.6±15.0 years; 58.9% male sex). The annual number of catheter ablations increased progressively from four to 60 cases per year (P<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% (P<0.001). Use of irrigated catheters (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.86-8.55), a three-dimensional mapping system (OR 3.70, 95% CI 1.72-7.74), contact force catheters (OR 3.60, 95% CI 1.81-7.38) and high-density mapping (OR 3.69, 95% CI 1.82-8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (P=0.001). Seven (2.3%) non-fatal complications occurred. The number of catheter ablation procedures in patients with ACHD has increased considerably over the past 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and mid-term outcomes.

Systematic review of endovascular stent grafting versus open surgical repair for the elective treatment of arch/descending thoracic aortic aneurysms

ObjectiveTo review comparisons of the effectiveness of endovascular stent grafting (ESG) against open surgical repair (OSR) for treatment of chronic arch or descending thoracic aortic aneurysms (TAA).DesignSystematic review and meta-analysisData...

The indications and safety of prolonged temporary pacing using active-fixation leads and externalized pulse generator.

Temporary cardiac pacing, conventionally achieved using a passive transvenous pacing wire, can be life-saving for unstable arrhythmias. However, they run the risk of complications, the longer they remain in-situ. Externalized prolonged temporary pacing (EPTP), using active-fixation lead and an externalized pulse generator; may be an alternative for transient pacing indications, concurrent illness or sepsis that precludes permanent pacing. Sixty-seven patients (mean age 69 ± 14 years; 82% male) underwent EPTP between November 2011 and April 2019. EPTP was performed in a sterile facility, under fluoroscopy, using active-fixation leads anchored to the right ventricle septum. Externalized lead was connected to a re-sterilized pulse generator and secured to anterior chest wall with transparent dressings. EPTP indications and patient outcomes were evaluated. Pacing indications were high-grade atrio-ventricular (AV) block (73.2%), sinus arrest (14.9%), overdrive suppression of VT (5.9%) and pause-dependent VT (4.5%). Reasons for ETPT rather than permanent pacing included: sepsis (38.8%), CIED-related infection (8.9%), transient pacing indication (25%), to allow further investigations prior to decision on CIED type (22%), and over-drive arrhythmia suppression (6%). Sixty three percent patients were severely ill in an ICU. Mean duration of pacing was 16 ± 12 days. Sixty seven percent patients subsequently received a CIED and had no evidence of device-related infection at 1-year post-implant. There were three non-fatal complications during EPTP while no deaths were attributed to EPTP. EPTP is a safe and useful method of prolonged temporary pacing for patients who require chronotropic support, but in whom immediate permanent pacemaker implantation is contraindicated.

Predicting risk factors for postoperative coronary artery bypass grafting using logistic regression and CHAID

Non-fatal postoperative complications are postoperative morbidity that can affect the patient’s functional status and quality of life. Evaluation of postoperative morbidity is the step needed to assess and improve the quality of patient care. Therefore, a method is required in order to predict risk factors in evaluating a patient’s postoperative morbidity. After this the results will be used to determine the insurance premiums. In this research, the Logistic Regression are used to know the risk factors that would occur in patients who had undergone Coronary Artery Bypass Grafting (CABG) surgery. Then we use the CHAID method to classify readmission based on patient characteristics. Based on the two analyzes, it can be concluded that the CHAID analysis supports the Logistics analysis, there are two risk factors significantly influence the complications of patients after Coronary Artery Bypass Graft (CABG), namely Sex and Ejection Fraction.

Catheter ablation in adults with congenital heart disease: A 15-year perspective form a tertiary center

With the growing adult congenital heart disease (ACHD) population, the number of catheter ablation procedures is expected to dramatically increase. Data reporting experience and evolution of catheter ablation in ACHD patients, over a significant period of time, remain scarce. We aimed to describe temporal trends in volume and outcomes of catheter ablation in ACHD patients. Retrospective observational study including all consecutive ACHD patients undergoing attempted catheter ablation in a large tertiary referral center over a 15-year period. Acute procedural success rate and freedom from recurrence at 12 months were analyzed. From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6 ± 15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 cases per year ( P < 0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common arrhythmia ( n = 217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.4% ( P < 0.001). Use of irrigated catheters (OR = 4.03, 95% CI: 1.86–8.55), 3D-mapping system (OR = 3.70, 95% CI: 1.72–7.74), contact force catheters (OR = 3.60, 95% CI: 1.81–7.38), and high-density mapping (OR = 3.69, 95% CI: 1.82–8.14) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% ( P = 0.001). Seven (2.3%) non-fatal complications occurred ( Fig. 1 ). The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Growing experience and advances in ablative technologies appear to be associated with a significant improvement in acute and midterm outcomes.

Radiofrequency Ablation of Ventricular Arrhythmias on Bioprosthetic Valve, a Never Found Case Before

INTRODUCTION Although the catheter ablation of frequent premature ventricular complexes (PVCs) from outflow tracts is reported as a highly successful procedure especially in patients with structurally normal hearts, but some cases create a great challenge. Patients with prosthetic valves often are not considered for radiofrequency ablation (RFA) due to risk of possible fatal and nonfatal complications. CASE SUMMARY We describe a rare experience of performing RFA in this high risk, challenging patient. A 76-years-old man with history of coronary artery bypass graft (CABG) due to previous myocardial infarct (MI) and aortic valve replacement with bioprosthetic valve for his aortic insufficiency was referred to our department due to feeling of suffocation and irregularity of pulse during a flight. RF ablation was scheduled for him due to high PVC burden. PVCs showed LBBB morphology, inferior axis with transition in (V3-V4) leads. After failed attempt of RFA through the right outflow tract (RVOT), PVC was terminated from the left coronary cusp. DISCUSSION This case highlights the fact that efficacy of the radiofrequency ablation in patients with bioprosthetic valves is feasible. It has to be emphasized that in such a challenging case, risk of severe complications should be weighted against its benefit.

Effect of head and tail rope‐assisted recovery of horses after elective and emergency surgery under general anaesthesia

SummaryThe recovery phase is a critical period during equine anaesthesia. In an attempt to reduce the risk of recovery, several recovery systems, including head and tail ropes, have been developed over time. However, the clinical safety and efficacy of these systems have not been compared to a nonassisted group in a larger study. The objective of this comparative, retrospective, nonrandomised single‐centre study was to determine whether the risk of developing fatal and nonfatal complications after general anaesthesia is reduced in horses assisted with head and tail ropes during recovery compared with horses recovering unassisted. Included were all horses undergoing general anaesthesia at the Large Animal Hospital, University of Copenhagen, Denmark, from 2010 to 2019. Analysed data included age, body mass, American Society of Anesthesiologists grade of physical status (ASA score), type of surgery and anaesthetic duration. Complications were divided into none, fatal and nonfatal. Logistic regression was performed to analyse the risk and predictors of fatal and nonfatal complications using the built‐in R function ‘step’. Tukey’s honest significance difference test was applied to determine significance, set at P&lt;0.05, within the categorical variables of the reduced models. The study included 1252 horses: 662 recovered with assistance (group A) and 590 without (group NA). Overall recovery‐associated mortality was 1.4%: 0.6% in group A and 2.2% in group NA. Both emergency abdominal surgery (P = 0.004) and duration of surgery (P = 0.0001) affected the risk of fatal complications negatively. Assisted recovery (P = 0.02) significantly reduced the risk of fatal complications after emergency abdominal surgery. The limitation of the study was a lack of randomisation and potentially a larger proportion of sedation among assisted horses. It was concluded that emergency abdominal surgery and duration of anaesthesia are significant risk factors for fatal complications during recovery. Head and tail rope‐assisted recovery is a significant factor of reducing fatal complications during recovery after emergency abdominal surgery.

Paroxysmal nocturnal hemoglobinuria: patient journey and burden of disease.

Patients with paroxysmal nocturnal hemoglobinuria (PNH) often experience a lengthy path to diagnosis. Fewer than 40% of patients with PNH receive a diagnosis within 12 months of symptom onset, and 24% of all PNH diagnoses can take 5 years or longer. Diagnostic delay is a source of distress and can affect emotional well-being for patients with PNH. In PNH disease management, patients and care providers focus on risk of organ failure and mortality related to disease progression; nonetheless, patients' health-related quality of life (HRQOL) is largely affected by extensive treatment requirements and nonfatal complications of disease, such as fatigue. In particular, thrombosis is associated with significant impairments in physical and social functioning and global health status and significant fatigue. Among patients with anemia who are transfusion dependent, the burden of transfusion is considerable. Transfusion dependence has a negative effect on HRQOL; is associated with risks and complications, including iron overload; and results in lost productivity due to travel times to and time spent at infusion centers. DISCLOSURES: This research was developed under a research contract between RTI Health Solutions and Apellis Pharmaceuticals and was funded by Apellis Pharmaceuticals. Bektas, Copley-Merriman, and Khan are employees of RTI Health Solutions. Sarda is an employee of Apellis Pharmaceuticals. Shammo consults for Apellis Pharmaceuticals.

Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross-Sectional Study.

Background Despite the advancement in the healthcare system, the impact of surgical interventions on public health systems will continue to grow. But predicting the outcome is challenging. Concerns related to unexpected outcomes and delays in the diagnosis of postoperative complications are the major issue. Intestinal obstruction is a common life-threatening surgical condition followed by fatal and nonfatal postoperative complications. This study was aimed at assessing results after surgery for intestinal obstruction in a hospital of Ethiopia. Methodology. An institutional-based cross-sectional study was conducted among 254 postoperative patients admitted with intestinal obstruction from January 1, 2014, to December 31, 2017. Data were coded and entered into EpiData 4.2.0.0 software and exported to the Statistical Package for the Social Sciences version 22 for analysis. A binary logistic regression model was used for analysis. All variables with a p value < 0.25 during bivariable analysis were considered for multivariable logistic regression analysis. Results The magnitude of poor surgical outcome of intestinal obstruction was 21.3% for patients enrolled into this investigation. The age group of ≥55 years (adjusted odds ratio (AOR) = 2.9, 95% CI: 1.03, 8.4), duration of illness of ≥24 hrs (AOR = 3.1, 95% CI: 1.03, 9.4), preoperative diagnosis of a gangrenous large bowel (AOR = 3.6, 95% CI: 1.3, 9.8), and a gangrenous small bowel (AOR = 4.2, 95% CI: 1.3, 13.7) were significantly associated with poor surgical outcome. Conclusions The magnitude of poor surgical outcome was high. Age, late presentation of illness, and gangrenous bowel obstructions were significantly associated with poor outcomes. So, concern should be given in early detection and follow-up of patients who came late and older patients.

Balloon Pulmonary Angioplasty in Patients with Chronic Thromboembolic Pulmonary Hypertension: Impact on Clinical and Hemodynamic Parameters, Quality of Life and Risk Profile.

Balloon pulmonary angioplasty (BPA) is a novel treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are not eligible for pulmonary endarterectomy (PEA) or suffer from persistent pulmonary hypertension after PEA. The aim of this study was to evaluate the real-life efficacy and safety of BPA in a consecutive group of patients who were diagnosed and treated in the national referral center for CTEPH in the Czech Republic. Here we report data from 160 BPA procedures performed in 64 patients. Efficacy analysis was performed in the subgroup of 25 patients who completed BPA series. Significant improvements were observed in New York Heart Association functional class (4% to 79% in I/II, p < 0.001), 6 min walking test distance (+54.3 m, p < 0.001), risk profile (15.8% to 68.5% with presence of 2/3 low risk criteria, p < 0.001), pulmonary artery mean pressure (−18%, p < 0.001), pulmonary vascular resistance (−32%, p < 0.001), stroke volume (+17%, p = 0.011) and quality of life (+37% in assessment of overall health status by a patient, p < 0.001). We observed 1 fatal periprocedural complication (1.6% of all 64 patients) and 19 BPA-related non-fatal complications (11.9% of all 160 interventions) that predominantly included hemoptysis (10.0% of all sessions). Overall survival at 12 months was 94.6%.

Catheter ablation in adults with congenital heart disease: a 15-year perspective from a tertiary center

Abstract Background With the growing population of adults with congenital heart disease (ACHD), the number of catheter ablation procedures is expected to increase over time. Purpose We aimed to describe temporal trends in volume and outcomes of catheter ablation procedures in ACHD patients in a large tertiary center. Methods Retrospective observational study including all consecutive ACHD patients undergoing catheter ablation in a tertiary reference center over a 15-year period. Acute procedural success rate (including complete success in case of non-inducibility of any arrhythmia at the end of the procedure) as well as freedom from recurrence at 12 months were analyzed. Results From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6±15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 by year (p&amp;lt;0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common targeted arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.3% (p&amp;lt;0.001), including complete acute procedural success from 45.0% to 88.1% (p&amp;lt;0.001) (Figure 1). The use of irrigated catheters (30.0% to 94.8%, p&amp;lt;0.001), 3D-mapping systems (60.0% to 96.3%, p&amp;lt;0.001), contact force catheters (0.0% to 91.9%, &amp;lt;0.001), and high-density mapping (0.0% to 71.9%, p&amp;lt;0.01) increased significantly. Use of irrigated catheters (OR=3.96, 95% CI: 1.79–8.55), 3D-mapping system (OR=3.55, 95% CI: 1.62–7.55), contact force catheters (OR=3.46, 95% CI: 1.71–7.25), and high-density mapping (OR=3.85, 95% CI: 1.60–7.26) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (p=0.001). Seven (2.3%) non-fatal complications occurred. Conclusions The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Advances in ablative technologies appear to be associated with a low rate of complications and a significant improvement in acute and midterm outcomes. Evolution of acute procedural success Funding Acknowledgement Type of funding source: None

Resection of primary tumor in stage 4S neuroblastoma: a second study by the Italian Neuroblastoma Group.

To clarify the role of primary tumor resection in stage 4S neuroblastoma. We investigated a cohort of 172 infants diagnosed with stage 4S neuroblastoma between 1994 and 2013. Of 160 evaluable patients, 62 underwent upfront resection of the primary tumor and 98 did not. Five-year progression-free and overall survival were significantly better in those who had undergone upfront surgery (83.6% vs 64.2% and 96.8% vs 85.7%, respectively). One post-operative death and four non-fatal complications occurred in the resection group. Three patients who had not undergone resection died of chemotherapy-related toxicity. Thirteen patients underwent late surgery to remove a residual tumor, without complications: all but one alive. Outcomes were better in patients diagnosed from 2000 onwards. Infants diagnosed with stage 4S neuroblastoma who underwent upfront tumor resection had a better outcome. However, this result cannot be definitely attributed to surgery, since these patients were selected on the basis of their favorable presenting features. Although the question of whether to operate or not at disease onset is still unsolved, this study confirms the importance of obtaining enough adequate tumor tissue to enable histological and biological studies to properly address treatment, to achieve the best possible outcome.

Hypoglossal Nerve Palsy after Carotid Endarterectomy: Case Report

Carotid artery stenosis is the important causes of ischemic stroke, and it may result in death. Many complications can occur during carotid endarterectomy (CEA), which is the standard revascularization procedure for treating severe carotid artery stenosis. CEA is applied for prevention of stroke occurred by atherosclerotic plaque which is located at the common carotid artery bifurcation and, commonly, internal carotid artery. In addition to serious complications, such as stroke, infection, myocardial infarction, postoperative bleeding and death, non-fatal complications, such as cranial nerve palsy, can also occur rarely. Cranial nerve injury is a well-recognized complication' of carotid endarterectomy. Although major injuries are rare, in several series where thorough pre and postoperative neurologic examinations were performed, the incidence of cranial nerve dysfunction after carotid surgery ranged from 9.7% to 39% Here we present the an 80-year-old male patient with hypoglossal nerve palsy after carotid endarterectomy as it is a rare complication.

Primary PCI in the management of STEMI in sub-Saharan Africa: insights from Abidjan Heart Institute catheterisation laboratory.

Implementation of primary percutaneous coronary intervention (PCI) in sub-Saharan Africa remains a challenging issue. The aim of this study was to report the results of primary PCI and outcomes in the catheterisation laboratory of the Abidjan Heart Institute. Between April 2010 and March 2019, all patients aged 18 years presenting to the Abidjan Heart Institute for ST-segment elevation myocardial infarction (STEMI) over the study period and who underwent primary PCI were included. We considered primary PCI when it was performed within 48 hours of the onset of symptoms. Baseline data, PCI characteristics and outcomes were analysed. Among a total of 780 patients hospitalised for STEMI, 471 were admitted within 48 hours of the onset of symptoms. One-hundred and sixty six patients underwent primary PCI, with a ratio of primary PCI/STEMI of up to 21.3%. One hundred and six patients (63.9%) were admitted within 12 hours of the onset of symptoms. The femoral approach was the most commonly used (78.3%). Primary PCI was performed with stent implantation in 84.3% of patients. Drug-eluting stents (DES) were used in 42.1% of patients. In most cases, angiographic success was observed (157/166, 94.6%). Non-fatal complications were mainly haematomas (3.6%). Peri-procedural mortality rate was 1.2%. Primary PCI can be performed safely in some small-volume centres in sub-Saharan Africa. Healthcare policies and regional networks must be encouraged in order to improve management of STEMI patients.

Social vulnerability and heat on emergency medical services in San Antonio, Texas, 2015-2018

Abstract Background A burgeoning body of research indicates that excessive heat is a leading weather-related cause of fatalities in the United States. The average annual heat-related deaths in the U.S. are about 1,500, which are more than deaths resulting from all natural disasters combined. Extreme heat conditions are also associated with non-fatal medical complications. More importantly, socially and economically disadvantaged or vulnerable populations can face greater exposure to health risks during extreme heat events. The purpose of this study is to investigate the effects of excessive heat and community-level social vulnerability on morbidity in San Antonio, Texas, from 2015 to 2018. Methods Heat Index data were collected from the San Antonio International Airport weather station, including the dates from May 1, 2015 to September 30, 2018. Social vulnerability was measured by the Centers for Disease Control and Prevention's Social Vulnerability Index at the zip-code level. Morbidity was gauged by the number of Emergency Medical Service incidents. Sixty-two zip codes in the San Antonio area were analyzed for the 612 constrained calendar days from May 1 to September 30, 2015-2018. Three time-stratified case-crossover negative binomial regression models were estimated to examine the independent effects of Heat Index and Social Vulnerability Index as well as the interaction effects of Heat Index and Social Vulnerability Index on the rate of Emergency Medical Services incidents. Results Both Heat Index and Social Vulnerability Index are significantly and positively associated with the rate of Emergency Medical Services incidents. Additionally, while Heat Index increases the rate of EMS incidents, the rate is even higher as social venerability becomes more pronounced. Conclusions As the number of excessive heat days increases and San Antonio continues to have extreme disparities by location, there will be an effect on health systems, including emergency medical services. Key messages Excessive heat and community-level social vulnerability are significantly and positively associated with emergency medical service incidents. There is a significant and positive interaction effect of heat and social vulnerability on emergency medical service incidents.

Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

BackgroundReliable estimates of the absolute and relative risks of postoperative complications in kidney transplant recipients undergoing elective surgery are needed to inform clinical practice. This systematic review and meta-analysis aimed to estimate the odds of both fatal and non-fatal postoperative outcomes in kidney transplant recipients following elective surgery compared to non-transplanted patients.MethodsSystematic searches were performed through Embase and MEDLINE databases to identify relevant studies from inception to January 2020. Risk of bias was assessed by the Newcastle Ottawa Scale and quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Random effects meta-analysis was performed to derive summary risk estimates of outcomes. Meta-regression and sensitivity analyses were performed to explore heterogeneity.ResultsFourteen studies involving 14,427 kidney transplant patients were eligible for inclusion. Kidney transplant recipients had increased odds of postoperative mortality; cardiac surgery (OR 2.2, 95%CI 1.9–2.5), general surgery (OR 2.2, 95% CI 1.3–4.0) compared to non-transplanted patients. The magnitude of the mortality odds was increased in the presence of diabetes mellitus. Acute kidney injury was the most frequently reported non-fatal complication whereby kidney transplant recipients had increased odds compared to their non-transplanted counterparts. The odds for acute kidney injury was highest following orthopaedic surgery (OR 15.3, 95% CI 3.9–59.4). However, there was no difference in the odds of stroke and pneumonia.ConclusionKidney transplant recipients are at increased odds for postoperative mortality and acute kidney injury following elective surgery. This review also highlights the urgent need for further studies to better inform perioperative risk assessment to assist in planning perioperative care.