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Natalia Stoeva, Galina Kirova, Milena Staneva, Diana Lekova, Anton Penev, Rumiana Bakalova
BACKGROUND: The assessment of the clinical symptoms is the weakest link of the pulmonary embolism (PE) diagnostic algorithm. Despite the presence of highly sensitive and specific imaging methods, verifying PE remains difficult due to nonspecific clinical symptoms and frequently its subclinical course. OBJECTIVE: The aim of this study is to improve the recognition of PE by investigating the clinical presentation and short-term prognosis of unprovoked PE in comparison to provoked PE...
February 2018: Respiratory Medicine
Joseph Bledsoe, Scott Woller, Scott Stevens, Valerie Aston, Rich Patten, Todd Allen, Benjamin Horne, Lydia Dong, James Lloyd, Greg Snow, Troy Madsen, Gregory Elliott
BACKGROUND: The efficacy and safety of managing patients with low-risk pulmonary embolism (PE) without hospitalization requires objective data from US medical centers. We sought to determine the 90-day composite rate of recurrent symptomatic venous thromboembolism (VTE), major bleeding events, and all-cause mortality among consecutive patients diagnosed with acute low-risk PE managed without inpatient hospitalization; and to measure patient satisfaction. METHODS: We performed a prospective cohort single-arm management study conducted from January 2013 to October 2016 in five emergency departments...
February 1, 2018: Chest
Kwok M Ho, Yusrah Harahsheh
Background: It is uncertain whether we can predict contrast-induced nephropathy (CIN) after CT pulmonary angiography (CTPA). This study compared the ability of a validated CIN prediction score with the Pulmonary Embolism Severity Index (PESI) in predicting CIN after CTPA. Methods: This cohort study involved critically ill adult patients who required a CTPA to exclude acute pulmonary embolism (PE). Patients with end-stage renal failure requiring dialysis were excluded...
2018: Journal of Intensive Care
Carlos Andrés Quezada, Celia Zamarro, Vicente Gómez, Ina Guerassimova, Rosa Nieto, Esther Barbero, Diana Chiluiza, Deisy Barrios, Raquel Morillo, David Jiménez
BACKGROUND AND OBJECTIVE: To determine the accuracy of clinical gestalt to identify patients with acute symptomatic pulmonary embolism (PE) at low-risk for short-term complications. PATIENTS AND METHODS: This study included a total of 154 consecutive patients diagnosed with acute symptomatic PE in a tertiary university hospital. We compared the prognostic accuracy of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI), and clinical gestalt of 1) 2senior physicians (one with and one without experience in the management of patients with PE), 2) a fourth-year resident of Pneumology, 3) a third-year resident of Pneumology, and 4) a second-year resident of Pneumology...
December 21, 2017: Medicina Clínica
Katherine Lee Chuy, Emad Uddin Hakemi, Tareq Alyousef, Geetanjali Dang, Rami Doukky
BACKGROUND: In patients with acute pulmonary embolism (PE), detectable levels of cardiac troponin I (cTnI) using a highly sensitive assay have been associated with increased in-hospital mortality. We sought to investigate the impact of detectable cTnI on long-term survival following acute PE. HYPOTHESIS: Detectable cTnI levels in patients presenting with acute PE predict increased long-term mortality following hospital discharge. METHODS: In a retrospective cohort study, we analyzed consecutive patients with confirmed acute PE and cTnI assay available from the index hospitalization...
December 15, 2017: Clinical Cardiology
Ekrem Şahan, Murat Karamanlıoğlu, Suzan Şahan, Murat Gül, Ahmet Korkmaz, Omaç Tüfekçioğlu
OBJECTIVE: Right ventricular (RV) functions are clinically important in acute pulmonary embolism (APE). Measurement of systolic function of the right ventricular outflow tract (RVOT) with echocardiography is a simple method to evaluate RV function. The aim of this study was to determine the relationship between RVOT systolic function and the Pulmonary Embolism Severity Index (PESI). METHODS: A total of 151 patients diagnosed with APE by pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were included...
December 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Erin R Weeda, Jonathan T Caranfa, Simon B Zeichner, Craig I Coleman, Elaine Nguyen, Christine G Kohn
Background: Numerous risk stratification tools exist to predict early post-pulmonary embolism (PE) mortality; however, few were specifically designed for use in patients with cancer. This study sought to evaluate the performance of 3 cancer-specific (RIETE, POMPE-C, and Font criteria) and 3 generic (Hestia, Pulmonary Embolism Severity Index [PESI], and Geneva prognostic score [GPS]) risk stratification tools for predicting 30-day post-PE mortality in patients with active cancer. Methods: We identified consecutive, adult, objectively confirmed patients with PE and active cancer presenting to our institution from November 2010 to January 2014...
December 2017: Journal of the National Comprehensive Cancer Network: JNCCN
N Faller, O Stalder, A Limacher, S Bassetti, J H Beer, D Genné, E Battegay, D Hayoz, J Leuppi, B Mueller, A Perrier, G Waeber, N Rodondi, D Aujesky
INTRODUCTION: Whether clinical prediction rules for pulmonary embolism are accepted and used among general internal medicine residents remains uncertain. We therefore evaluated the frequency of use and acceptability of the Revised Geneva Score (RGS) and the Pulmonary Embolism Severity Index (PESI), and explored which factors were associated with rule use. MATERIALS/METHODS: In an online survey among general internal medicine residents from 10 Swiss hospitals, we assessed rule acceptability using the Ottawa Acceptability of Decision Rules Instrument (OADRI) and explored the association between physician and training-related factors and rule use using mixed logistic regression models...
December 2017: Thrombosis Research
Yogeshwar Singh Rajaram, Thong Le, Maree Ross-Smith, Andrew Owen, Jason Chuen, Peter F Mount
AIMS: Acute thrombosis of hemodialysis (HD) arteriovenous access is an urgent problem for HD patients and is commonly managed by endovascular thrombolysis. Pulmonary embolism (PE) is a recognized complication of HD access thrombosis and thrombolysis but the risk and outcomes are unclear. This study aims to determine the incidence, predictors, and outcomes of PE after endovascular thrombolysis of HD arteriovenous access in patients presenting with acute thrombosis. MATERIALS AND METHODS: A single-center retrospective study was performed for all adult chronic kidney disease patients undergoing arteriovenous access thrombolysis between January 1, 2012, and December 31, 2014...
September 2017: Clinical Nephrology
Muthiah Subramanian, Sowmya Gopalan, Srinivasan Ramadurai, Preetam Arthur, Mukund A Prabhu, Rajesh Thachathodiyl, Kumaraswamy Natarajan
Accurate identification of low-risk patients with acute pulmonary embolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. This study analyzed data from 400 consecutive patients with acute PE. We derived and internally validated our prediction rule based on clinically significant variables that are routinely available at initial examination and that were categorized and weighted using coefficients in the multivariate logistic regression...
August 15, 2017: American Journal of Cardiology
Ana Maria Balahura, Andrada Guţă, Vlad Mihalcea, Emma Weiss, Maria Dorobanţu, Daniela Bartoş, Elisabeta Bădilă, Gheorghe Andrei Dan
INTRODUCTION: Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania. MATERIAL AND METHODS: We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 - December 2016)...
December 1, 2017: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
Stefan Walen, Bianca Katerberg, Martijn F Boomsma, Jan Willem K van den Berg
BACKGROUND: Despite growing evidence on safe and feasible outpatient treatment for acute pulmonary embolism (PE), the majority of patients is still treated in an inpatient setting. This is probably due to a lack of clear guidelines on this subject. OBJECTIVES: To evaluate safety and patient reported outcome measures (PROM) on outpatient treatment of acute PE. METHODS: We conducted a prospective cohort study. 250 patients presenting with acute PE and Pulmonary Embolism Severity Index (PESI) class I or II were enrolled...
June 23, 2017: Thrombosis Research
Marie Méan, Tobias Tritschler, Andreas Limacher, Stéphane Breault, Nicolas Rodondi, Drahomir Aujesky, Salah D Qanadli
INTRODUCTION: Computed tomography pulmonary angiography (CTPA) has not only become the method of choice for diagnosing acute pulmonary embolism (PE), it also allows for risk stratification of patients with PE. To date, no study has specifically examined the predictive value of CTPA findings to assess short-term prognosis in elderly patients with acute PE who are particularly vulnerable to adverse outcomes. METHODS: We studied 291 patients aged ≥65 years with acute symptomatic PE in a prospective multicenter cohort...
2017: PloS One
P-M Roy, T Moumneh, A Penaloza, O Sanchez
Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n=3036) or discharged early (n=535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i...
May 4, 2017: Thrombosis Research
Daisuke Shiomi, Hiroshi Kiyama, Masatsugu Shimizu, Muneaki Yamada, Naohiro Shimada, Aya Takahashi, Nobuaki Kaki
OBJECTIVES: Acute massive pulmonary embolism (AMPE) is a life-threatening condition that often induces rapid haemodynamic deterioration. The mortality of surgical embolectomy is still poor in patients with preoperative cardiopulmonary arrest (CPA). We analysed the outcome of surgical pulmonary embolectomy for haemodynamically unstable patients. METHODS: Thirty-one patients underwent surgical embolectomy for haemodynamically unstable AMPE. The indications for surgical embolectomy were (i) <7 days from onset, (ii) haemodynamically unstable, (iii) massive clots in bilateral pulmonary arteries or unilateral pulmonary artery occlusion with a floating clot in the main pulmonary artery or right atrium and (iv) right ventricular dilatation in transthoracic echocardiography...
August 1, 2017: Interactive Cardiovascular and Thoracic Surgery
A Vamsidhar, D Rajasekhar, V Vanajakshamma, A Y Lakshmi, K Latheef, C Siva Sankara, G Obul Reddy
OBJECTIVE: The aim of this study is to prospectively assess the diagnostic accuracy of pulmonary embolism severity index, echocardiogram, computed tomography pulmonary angiogram (CTPA), and N-terminal pro b-type natriuretic peptide (NT-proBNP) for predicting adverse events in acute pulmonary embolism patients. METHODS: Thirty consecutive acute pulmonary embolism patients were included in this study. Combined adverse events consisted of in-hospital death or use of escalation of care including cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, or secondary thrombolysis during hospital stay...
January 2017: Indian Heart Journal
Hyeyoung Park, Seung-Ick Cha, Jae-Kwang Lim, Kyung Nyeo Jeon, Seung-Soo Yoo, Jaehee Lee, Shin-Yup Lee, Chang-Ho Kim, Jae-Yong Park
OBJECTIVES: Data regarding coexisting pulmonary thromboembolism (PTE) in patients with tuberculosis are limited. The aim of this study was to investigate the clinical features of coexisting PTE in patients with respiratory tuberculosis. METHODS: Clinical parameters were retrospectively compared between the tuberculosis group (PTE and coexisting respiratory tuberculosis) and unprovoked or provoked group selected from a single institution in South Korea, a country that has an intermediate tuberculosis burden...
February 2017: American Journal of the Medical Sciences
P-M Roy, D J Corsi, M Carrier, A Theogene, C de Wit, C Dennie, G Le Gal, A Delluc, T Moumneh, M Rodger, P Wells, E Gandara
Essentials Clinical benefit of hospitalization vs. outpatient treatment in pulmonary embolism (PE) is unknown. We performed a propensity matched cohort study of hemodynamically stable PE patients. Regardless of the risk assessment, hospitalized patients had the highest rate of adverse event. If confirmed, ambulatory care of normotensive PE patients may be preferred whenever possible. SUMMARY: Background The decision to hospitalize or not patients with acute pulmonary embolism (PE) is controversial...
April 2017: Journal of Thrombosis and Haemostasis: JTH
Lu Guo, Aamer Rasheed Chughtai, Hongli Jiang, Lingyun Gao, Yan Yang, Yang Yang, Yuejian Liu, Zhenliang Xie, Weimin Li
BACKGROUNDS: Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. METHODS: We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III-V on the basis of the PESI score were excluded...
November 2016: Journal of Thoracic Disease
Alejandro Gonzalez Della Valle, Alvaro Blanes Perez, Yuo-Yu Lee, Gregory R Saboeiro, Gabrielle P Konin, Yoshimi Endo, Nigel E Sharrock, Eduardo A Salvati
BACKGROUND: In the event of a postoperative pulmonary embolism (PE), it is generally believed that patients with centrally located emboli will have worse clinical symptoms than those with segmental or subsegmental ones. We studied if a relationship exists between the clinical severity at the time of PE diagnosis and the location of the emboli within the pulmonary vasculature. METHODS: All 269 patients who developed an in-hospital, computed tomography pulmonary angiography-proved, PE following elective total hip arthroplasty or total knee arthroplasty in our institution were studied...
November 25, 2016: Journal of Arthroplasty
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