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Heart stroke sepsis

Adrian D Wood, Gurdeep S Mannu, Allan B Clark, Somsak Tiamkao, Kannikar Kongbunkiat, Joao H Bettencourt-Silva, Kittisak Sawanyawisuth, Narongrit Kasemsap, Raphae S Barlas, Mamas Mamas, Phyo Kyaw Myint
BACKGROUND AND PURPOSE: Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. METHODS: We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored...
October 4, 2016: Stroke; a Journal of Cerebral Circulation
Saad Ullah, Omar Elbita, Mahmoud Abdelghany, Hassan Tahir, Puneet Tuli, Waseem Zaid Alkilani, Joshan Suri
Gram-negative bacterial endocarditis causes 5% of all bacterial endocarditis. Among gram-negative bacteria, Klebsiella species are rare causes of native valve endocarditis. Klebsiella oxytoca is an extremely rare subspecies that can infrequently cause endocarditis and is associated with poor outcome. We report a case of Klebsiella oxytoca endocarditis in an elderly man who initially presented with stroke but later developed sepsis and heart block secondary to endocarditis.
July 2016: Journal of Investigative Medicine High Impact Case Reports
Daniel Zimpfer, Martin Strueber, Philipp Aigner, Jan D Schmitto, Arnt E Fiane, Robert Larbalestier, Steven Tsui, Paul Jansz, Andre Simon, Stephan Schueler, Francesco Moscato, Heinrich Schima
OBJECTIVES: Ventricular blood stasis is a concern for continuous flow mechanical support devices and might contribute to the formation of thromboembolic events. The HeartWare® Ventricular Assist System (HVAD®) is equipped with the Lavare™ cycle that is a periodic speed modulation feature designed to alter flow patterns within the left ventricle and reduce areas of potential blood stasis. Here, we report in vitro and clinical findings on the effects of the Lavare cycle. METHODS: The effect of pump speed changes on the intraventricular flow field was examined with an in vitro particle image velocimetry model...
September 7, 2016: European Journal of Cardio-thoracic Surgery
Yaoming Wang, Zhen Zhao, Sanket V Rege, Min Wang, Gabriel Si, Yi Zhou, Su Wang, John H Griffin, Steven A Goldman, Berislav V Zlokovic
Activated protein C (APC) is a blood protease with anticoagulant activity and cell-signaling activities mediated by the activation of protease-activated receptor 1 (F2R, also known as PAR1) and F2RL1 (also known as PAR3) via noncanonical cleavage. Recombinant variants of APC, such as the 3K3A-APC (Lys191-193Ala) mutant in which three Lys residues (KKK191-193) were replaced with alanine, and/or its other mutants with reduced (>90%) anticoagulant activity, engineered to reduce APC-associated bleeding risk while retaining normal cell-signaling activity, have shown benefits in preclinical models of ischemic stroke, brain trauma, multiple sclerosis, amyotrophic lateral sclerosis, sepsis, ischemic and reperfusion injury of heart, kidney and liver, pulmonary, kidney and gastrointestinal inflammation, diabetes and lethal body radiation...
September 2016: Nature Medicine
Miriam Kalbitz, Fatemeh Fattahi, Todd J Herron, Jamison J Grailer, Lawrence Jajou, Hope Lu, Markus Huber-Lang, Firas S Zetoune, J Vidya Sarma, Sharlene M Day, Mark W Russell, José Jalife, Peter A Ward
There is accumulating evidence during sepsis that cardiomyocyte (CM) homeostasis is compromised, resulting in cardiac dysfunction. An important role for complement in these outcomes is now demonstrated. Addition of C5a to electrically paced CMs caused prolonged elevations of intracellular Ca(2+) concentrations during diastole, together with the appearance of spontaneous Ca(2+) transients. In polymicrobial sepsis in mice, we found that three key homeostasis-regulating proteins in CMs were reduced: Na(+)/K(+)-ATPase, which is vital for effective action potentials in CMs, and two intracellular Ca(2+) concentration regulatory proteins, that is, sarcoplasmic/endoplasmic reticulum calcium ATPase 2 and the Na(+)/Ca(2+) exchanger...
September 15, 2016: Journal of Immunology: Official Journal of the American Association of Immunologists
Allan J Walkey, Emily K Quinn, Michael R Winter, David D McManus, Emelia J Benjamin
IMPORTANCE: Atrial fibrillation (AF) during sepsis is associated with an increased risk of ischemic stroke during hospitalization, but risks and benefits associated with anticoagulation for AF during sepsis are unclear. OBJECTIVE: To determine clinician practice patterns and patient risk of stroke and bleeding associated with use of anticoagulation for AF during sepsis. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study using enhanced administrative claims data from approximately 20% of patients hospitalized in the United States July 1, 2010, to June 30, 2013, examined patients with AF during sepsis who did not have additional indications for therapeutic anticoagulation...
September 1, 2016: JAMA Cardiology
Mei Gao, Jianzhong Sun, Nilas Young, Douglas Boyd, Zane Atkins, Zhongmin Li, Qian Ding, James Diehl, Hong Liu
OBJECTIVES: Body mass index (BMI) commonly is used in obesity classification as a surrogate measure, and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate the impact of BMI on short-term outcomes after cardiac surgery. DESIGN: A retrospective cohort study. SETTING: University teaching hospital, 2 centers. PARTICIPANTS: The study comprised 4,740 patients who underwent cardiac surgery at 2 hospitals-from July 1, 2001, to June 30, 2013, in 1 hospital and from September 1, 2003, to August 31, 2014, in a second hospital...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Hao Cheng, Zhongmin Li, Nilas Young, Douglas Boyd, Zane Atkins, Fuhai Ji, Hong Liu
OBJECTIVE: The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery. DESIGN: Retrospective investigation. SETTING: Patients from a single tertiary medical center. PARTICIPANTS: A total of 505 patients (≥65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery. CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not (Non-Dex group)...
March 3, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Weihua Zhu, Linjun Wan, Xiaohong Wan, Gang Wang, Meixian Su, Gengjin Liao, Qingqing Huang
OBJECTIVE: To investigate the accuracy and feasibility of brachial artery peak velocity variation (ΔVpeakbrach) and inferior vena cava variability (VIVC) as indicators of fluid responsiveness in critically ill patients. METHODS: A single-center prospective observation was conducted. The patients on mechanical ventilation with spontaneously breathing admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from June 2013 to August 2015 were enrolled...
August 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Saskia Skonetzki, Florian Lüders, Christiane Engelbertz, Nasser M Malyar, Eva Freisinger, Matthias Meyborg, Holger Reinecke
BACKGROUND, OBJECTIVES, DESIGN: Aging of the population is one of the major challenges facing public health systems. The impact of aging on acute and long-term outcome of patients with peripheral artery disease (PAD) and critical limb ischemia (CLI) is currently not sufficiently clarified. This analysis consists of comprehensive, anonymized data obtained from the largest public health insurance in Germany. RESULTS: A total of 41,740 PAD patients with an index hospitalization between January 1, 2009, and December 31, 2011, and a follow-up time up to 4 years were included (40-49 years: n = 1179; 50-59 years: n = 5415; 60-69 years: n = 10,565; 70-79 years: n = 13,313; 80-89 years: n = 9714; and 90-100 years: n = 1554)...
October 1, 2016: Journal of the American Medical Directors Association
Cheung-Ter Ong, Yi-Sin Wong, Chi-Shun Wu, Yu-Hsiang Su
BACKGROUND/PURPOSE: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients. MATERIALS AND METHODS: Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed...
2016: Therapeutics and Clinical Risk Management
Wei Du, Xiao-Ting Wang, Yun Long, Da-Wei Liu
BACKGROUND: Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. METHODS: Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate (HR) ≥100 beats/min...
July 20, 2016: Chinese Medical Journal
Hesham R Omar, Maya Guglin
INTRODUCTION: Admission hypothermia is associated with increased mortality in patients hospitalized with sepsis, trauma or stroke. We hypothesized that hypothermia on admission in patients with acute systolic heart failure (HF) would be associated with worse survival. METHODS: Using ESCAPE trial data, we compared patients hospitalized with acute systolic HF with admission temperature ≤35.5°C or >35.5°C. The study endpoints were 30-day and 6-month all-cause mortality...
October 1, 2016: International Journal of Cardiology
Jean-Pierre Bassand, Gabriele Accetta, Alan John Camm, Frank Cools, David A Fitzmaurice, Keith A A Fox, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Werner Hacke, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Hugo Ten Cate, Alexander G G Turpie, Freek W A Verheugt, Ajay K Kakkar
AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy...
June 29, 2016: European Heart Journal
David J Cote, Aditya V Karhade, William T Burke, Alexandra M G Larsen, Timothy R Smith
INTRODUCTION: Post-operative respiratory failure can occur after neurosurgical operations. Identification of risk factors for respiratory failure after neurosurgery may help guide clinical decision-making, decrease length of stay, improve patient outcomes, and lower costs. METHODS: We performed a search of the ACS-NSQIP database for all patients undergoing operations with a neurosurgeon from 2006 to 2013. We analyzed demographics, past medical history, and post-operative respiratory failure, defined as unplanned intubation and/or ventilator dependence for more than 48 h post-operatively...
September 2016: Acta Neurochirurgica
Serkan Ertugay, Cagatay Engin, Ahmet Daylan, Erman Pektok, Pelin Ozturk, Sanem Nalbantgil, Mehdi Zoghi, Tahir Yagdi, Mustafa Ozbaran
Pump thrombosis is associated with high morbidity and mortality in patients with a continuous-flow left ventricular assist device. Although it has been defined clearly, the diagnosis and treatment of this complication still remain controversial. Between 2010 and 2014, 163 consecutive patients (mean age: 50.7 ± 13 years, 84% males, median duration of support: 277 (2-1077) days) were implanted a continuous-flow left ventricular assist device. Prospectively collected data of all patients who had at least one pump thrombosis event have been analyzed, retrospectively...
September 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Joao Miguel Carvas, Cátia Canelas, Gustavo Montanha, Carlos Silva, Francisco Esteves
INTRODUCTION: Severe sepsis and septic shock are common conditions with high levels of morbi-mortality surpassing those of coronary heart disease or stroke. The reality of hospital treated sepsis is largely unknown outside of the intensive care unit. We therefore aimed to evaluate the level of compliance with the Surviving Sepsis Campaign 6-hour bundle in a Portuguese emergency department and to relate it to the patient clinical outcomes. MATERIAL AND METHODS: We conducted a retrospective, observational cohort study with 178 severe sepsis/septic shock patients admitted to the intensive and intermediate care unit between January 1st 2012 and December 31st 2012...
February 2016: Acta Médica Portuguesa
Brit J Long, Luis A Serrano, Jose G Cabanas, M Fernanda Bellolio
UNLABELLED: Introduction Emergency Medical Service (EMS) systems are vital in the identification, assessment, and treatment of trauma, stroke, myocardial infarction, and sepsis patients, improving early recognition, resuscitation, and transport. Emergency Medical Service personnel provide similar care for patients with syncope. The role of EMS in the management of patients with syncope has not been reported. Hypothesis/Objective The objective of this study was to describe the management of out-of-hospital syncope by prehospital providers in an urban EMS system...
August 2016: Prehospital and Disaster Medicine
Abdallah Fayssoil, Adam Ogna, Cendrine Chaffaut, Sylvie Chevret, Raquel Guimarães-Costa, France Leturcq, Karim Wahbi, Helene Prigent, Frederic Lofaso, Olivier Nardi, Bernard Clair, Anthony Behin, Tanya Stojkovic, Pascal Laforet, David Orlikowski, Djillali Annane
BACKGROUND: Type 2C and 2D limb girdle muscular dystrophies (LGMD) are a group of autosomal recessive limb girdle muscular dystrophies manifested by proximal myopathy, impaired respiratory muscle function and cardiomyopathy. The correlation and the prognostic impact of respiratory and heart impairment are poorly described. We aimed to describe the long-term cardiac and respiratory follow-up of these patients and to determine predictive factors of cardio-respiratory events and mortality in LGMD 2C and 2D...
2016: PloS One
Patrick Nierlich, Alina Hold, Robin Ristl
OBJECTIVES: Pulmonary endarterectomy (PEA) is the only curative treatment for patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH). In patients with a pulmonary vascular resistance (PVR) higher than 1000 dynes s cm(-5), this procedure is linked with an increased perioperative risk. We compare the outcomes of patients with moderate to severe versus extremely elevated PVR. METHODS: Between 1992 and 2013, 214 patients underwent PEA for CTEPH at our institution...
April 12, 2016: European Journal of Cardio-thoracic Surgery
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