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Hodges Gregory posted an update 6 months, 1 week ago
The benefit of
cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinical response and outcome are less well documented as compared to
implantation.
To investigate the efficacy and outcome of CRT upgrade procedures in patients with existing cardiac implantable electronic devices (CIEDs).
Baseline characteristics, change in New York Heart Association (NYHA) functional class, echocardiographic parameters, life-threatening ventricular tachyarrhythmias, all-cause mortality and mode of death were evaluated in CRT patients with the comparison between
and upgrade CRT procedures.
About 410 patients (CRT upgrade/
CRT,
= 97/313) were followed for 63.5 ± 38.1 months. Upgrade patients were older (75.5 ± 8.1 vs 69.9 ± 10.7 years;
< 0.001), had more often an ischaemic cause of heart failure (58.8% vs 45.4%;
= 0.021), a higher NYHA functional class (
= 0.004) and a higher comorbidity burden. Improvement in left ventricular ejection fraction (LVEF) was higher in the
CRT group (8.4 ± 9.9 vs 11.0 ± 10.3%;
= 0.035). Clinical response was similar between both groups (60.5 vs 62.5%;
= 0.793), as was mortality at 1 year (8.2 vs 5.8%;
= 0.351) and at last follow-up (33.0 vs 28.8%;
= 0.447). The proportion of cardiovascular related deaths was similar between both groups (46.9% vs 38.9%;
= 0.531).
Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with
CRT implantation.
Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with de novo CRT implantation.This case report describes a 17-year-old high school student serious suicide attempt using an injectable composite of veterinary medications (vitamins, vaccines, antibiotics, and antihelminthics) typically used to treat chickens. The use of this particular substance and the route of administration was novel as a method for suicide lethality and there have been no previous cases of this kind. However, this youth also developed chronic self-harming behaviors where she would repeatedly self-inject the veterinarian medication composite which included substances that were largely inert but did have a potential neuropsychiatric side effect profile that complicated her psychiatric presentation. In this context of chronically injecting a substance with unclear psychoactive properties, an interesting set of symptoms and behaviors emerged that required diagnostic clarification and interpretation. Diagnostic considerations for this youth included major depressive disorder with psychotic features, a possible emerging borderline personality disorder, post-traumatic stress disorder (PTSD), as well a possibility of an unknown substance use disorder using the veterinary medication composite. The purpose of this case study is to highlight the clinical course and explore sociocultural factors, including family and interpersonal relationships as contextually important variables.
The prognosis of patients with advanced heart failure is unfavourable. However, little is known about the survival of patients referred for heart transplantation but finally disqualified from transplantation due to contraindications. This study aimed to evaluate the prognosis of patients’ disqualified from heart transplantation.
It was a retrospective study based on medical records of patients disqualified from heart transplantation.
One hundred and fifty-one patients were included and 94 deaths were recorded during long-term follow-up (range 0.02-10.1 years). UC2288 The survival rate at 5 years was 25%. The mean age of the studied population was 57.7 years and the majority of patients were males, 87.4%. The ischaemic aetiology (66.2%) was the most dominant aetiology of heart failure. In the Cox regression model, supervision by the specialist cardiology centre (HR 0.61;
= 0.04) and pharmacotherapy with beta-blockers (HR = 0.47;
= 0.02) positively influenced the prognosis. On the contrary, well-known heart failure risk factors like a renal failure (HR 1.59;
= 0.049), pulmonary hypertension (HR 1.55;
= 0.046), liver failure (HR 2.65;
= 0.02) were negative predictors of outcome. By Kaplan-Meier analysis, patients with other than pulmonary hypertension causes of disqualification from heart transplantation had a better survival rate,
= 0.047.
The prognosis of patients disqualified from heart transplantation is unfavourable. However, some of the patients experience relatively long survival. Therefore, careful clinical assessment and identification of factors influencing prognosis may improve adequate patients’ qualifications for heart transplantation.
The prognosis of patients disqualified from heart transplantation is unfavourable. However, some of the patients experience relatively long survival. Therefore, careful clinical assessment and identification of factors influencing prognosis may improve adequate patients’ qualifications for heart transplantation.The frequency and severity of respiratory disorders among workers exposed to hard metal dust is not well known.The objective of this cross-sectional study is to report the prevalence of respiratory symptoms, functional status, and radiological findings in hard metal-exposed workers in Türkiye.Among 139 workers, 96 were machining workers, and 43 were industrial tool sharpening workers. Radiographic abnormalities compatible with pneumoconiosis were found 39% of the workers and were more in machining workers statistically significant.Also, in machining workers group, percentage of expected values of FVC was lower than industrial tool sharpening workers group. The prevalence of respiratory symptoms was 14.3%, and there was not a statistically significant difference in working groups. The study reveals that pulmonary symptoms, functional abnormalities, and radiological findings are mild. Assuming that reversibility may develop with avoidance from exposure when detected at this stage, early diagnosis of lung damage is essential.