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[PMID]: 28457798 [Au] Autor: Tabit CE; Coplan MJ; Spencer KT; Alcain CF; Spiegel T; Vohra AS; Adelman D; Liao JK; Sanghani RM [Ad] Endereço: Section of Cardiology, Department of Medicine, The University of Chicago Medical Center, Ill. [Ti] Título: Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure. [So] Source: Am J Med;130(9):1112.e17-1112.e31, 2017 Sep. [Is] ISSN: 1555-7162 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. RESULTS: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. CONCLUSION: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure. [Mh] Termos MeSH primário: Cardiologia/normas Serviço Hospitalar de Emergência/utilização Insuficiência Cardíaca/terapia Educação de Pacientes como Assunto/organização & administração Readmissão do Paciente/estatística & dados numéricos [Mh] Termos MeSH secundário: Doença Aguda Idoso Cardiologia/economia Cardiologia/métodos Estudos de Casos e Controles Chicago Controle de Custos/métodos Controle de Custos/normas Serviço Hospitalar de Emergência/economia Serviço Hospitalar de Emergência/organização & administração Feminino Insuficiência Cardíaca/economia Seres Humanos Masculino Meia-Idade Estudos de Casos Organizacionais Alta do Paciente/economia Alta do Paciente/normas Alta do Paciente/estatística & dados numéricos Educação de Pacientes como Assunto/economia Educação de Pacientes como Assunto/métodos Readmissão do Paciente/economia Guias de Prática Clínica como Assunto Pontuação de Propensão Encaminhamento e Consulta/economia Encaminhamento e Consulta/normas Estudos Retrospectivos Fatores Socioeconômicos Centros de Atenção Terciária/economia Centros de Atenção Terciária/organização & administração Saúde da População Urbana/economia Saúde da População Urbana/estatística & dados numéricos [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 180311 [Lr] Data última revisão: 180311 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE

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[PMID]: 29288428 [Au] Autor: Scappaticci GB; Marini BL; Nachar VR; Uebel JR; Vulaj V; Crouch A; Bixby DL; Talpaz M; Perissinotti AJ [Ad] Endereço: Department of Pharmacy Services and Clinical Sciences, Michigan Medicine and University of Michigan College of Pharmacy, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA. [Ti] Título: Outcomes of previously untreated elderly patients with AML: a propensity score-matched comparison of clofarabine vs. FLAG. [So] Source: Ann Hematol;97(4):573-584, 2018 Apr. [Is] ISSN: 1432-0584 [Cp] País de publicação: Germany [La] Idioma: eng [Ab] Resumo: The 5-year overall survival (OS) in patients ≥ 60 years old with acute myeloid leukemia (AML) remains < 10%. Clofarabine-based induction (CLO) provides an alternative to low-intensity therapy (LIT) and palliative care for this population, but supporting data are conflicted. Recently, our institution adopted the FLAG regimen (fludarabine, cytarabine, and granulocyte colony-stimulating factor) based on data reporting similar outcomes to CLO in elderly patients with AML unable to tolerate anthracycline-based induction. We retrospectively analyzed the efficacy and safety of patients ≥ 60 years old with AML treated with FLAG or CLO over the past 10 years. We performed a propensity score match that provided 32 patients in each group. Patients treated with FLAG had a higher CR/CRi rate (65.6 vs. 37.5%, P = 0.045) and OS (7.9 vs. 2.8 months, P = 0.085) compared to CLO. Furthermore, FLAG was better tolerated with significantly less grade 3/4 toxicities and a shorter duration of neutropenia (18.5 vs. 30 days, P = 0.002). Finally, we performed a cost analysis that estimated savings to be $30,000-45,000 per induction with FLAG. Our study supports the use of FLAG both financially and as an effective, well-tolerated high-dose treatment regimen for elderly patients with AML. No cases of cerebellar neurotoxicity occurred. [Mh] Termos MeSH primário: Nucleotídeos de Adenina/uso terapêutico Envelhecimento Antimetabólitos Antineoplásicos/uso terapêutico Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico Arabinonucleosídeos/uso terapêutico Quimioterapia de Indução Leucemia Mieloide Aguda/tratamento farmacológico Vidarabina/análogos & derivados [Mh] Termos MeSH secundário: Nucleotídeos de Adenina/efeitos adversos Nucleotídeos de Adenina/economia Idoso Idoso de 80 Anos ou mais Antimetabólitos Antineoplásicos/efeitos adversos Antimetabólitos Antineoplásicos/economia Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos Protocolos de Quimioterapia Combinada Antineoplásica/economia Arabinonucleosídeos/efeitos adversos Arabinonucleosídeos/economia Estudos de Casos e Controles Doença Hepática Induzida por Substâncias e Drogas/economia Doença Hepática Induzida por Substâncias e Drogas/epidemiologia Doença Hepática Induzida por Substâncias e Drogas/mortalidade Doença Hepática Induzida por Substâncias e Drogas/terapia Estudos de Coortes Terapia Combinada/economia Redução de Custos Custos e Análise de Custo Citarabina/efeitos adversos Citarabina/economia Citarabina/uso terapêutico Fator Estimulador de Colônias de Granulócitos/efeitos adversos Fator Estimulador de Colônias de Granulócitos/economia Fator Estimulador de Colônias de Granulócitos/uso terapêutico Custos Hospitalares Seres Humanos Incidência Quimioterapia de Indução/efeitos adversos Quimioterapia de Indução/economia Tempo de Internação Leucemia Mieloide Aguda/economia Leucemia Mieloide Aguda/mortalidade Michigan/epidemiologia Meia-Idade Neutropenia/induzido quimicamente Neutropenia/economia Neutropenia/mortalidade Neutropenia/terapia Pontuação de Propensão Estudos Retrospectivos Análise de Sobrevida Centros de Atenção Terciária Vidarabina/efeitos adversos Vidarabina/economia Vidarabina/uso terapêutico [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Nm] Nome de substância: 0 (Adenine Nucleotides); 0 (Antimetabolites, Antineoplastic); 0 (Arabinonucleosides); 04079A1RDZ (Cytarabine); 143011-72-7 (Granulocyte Colony-Stimulating Factor); 762RDY0Y2H (clofarabine); FA2DM6879K (Vidarabine) [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180309 [Lr] Data última revisão: 180309 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171231 [St] Status: MEDLINE [do] DOI: 10.1007/s00277-017-3217-1

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[PMID]: 29287885 [Au] Autor: Sheehan CC; Lopez J; Elmaraghy CA [Ad] Endereço: The Ohio State University College of Medicine, Columbus, OH, United States. [Ti] Título: Low rate of positive bronchoscopy for suspected foreign body aspiration in infants. [So] Source: Int J Pediatr Otorhinolaryngol;104:72-75, 2018 Jan. [Is] ISSN: 1872-8464 [Cp] País de publicação: Ireland [La] Idioma: eng [Ab] Resumo: OBJECTIVES: To describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body. STUDY DESIGN: Retrospective chart review. METHODS: A retrospective review was performed of patients at a tertiary children's hospital with suspected inhalation of a foreign body. Charts were reviewed for demographic information, radiologic findings, operative reports, and respiratory viral panels were reviewed. RESULTS: Sixteen pediatric patients under 12 months of age were identified from 2008 to 2016 with a diagnosis of possible airway foreign body inhalation who underwent emergent bronchoscopy. Of these patients, only one was positive for a foreign body present in the airway. The remaining 15 children were found to have a negative direct laryngoscopy and bronchoscopy evaluation for a foreign body. Of these fifteen patients, 14 were found to have structural airway abnormalities and 7 tested positive for a respiratory viral infection. CONCLUSIONS: Our institution has a low rate of positive bronchoscopy for highly suspected foreign body inhalation in a group of patients less than 12 months of age. Patients presenting with respiratory distress, stridor, or other airway symptoms were often found to have an underlying airway abnormality or viral infection, which coupled with an unclear history, would increase the suspicion for an airway foreign body and subsequent decision to perform bronchoscopy. In stable patients, diagnostic evaluation for an underlying respiratory infection should be performed in these cases. LEVEL OF EVIDENCE: Case Series. [Mh] Termos MeSH primário: Broncoscopia/estatística & dados numéricos Corpos Estranhos/diagnóstico Sistema Respiratório/lesões [Mh] Termos MeSH secundário: Feminino Corpos Estranhos/epidemiologia Hospitais Pediátricos Seres Humanos Lactente Recém-Nascido Laringoscopia/estatística & dados numéricos Masculino Estudos Retrospectivos Centros de Atenção Terciária [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180309 [Lr] Data última revisão: 180309 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171231 [St] Status: MEDLINE

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[PMID]: 29178197 [Au] Autor: MacKenzie RK; van Lettow M; Gondwe C; Nyirongo J; Singano V; Banda V; Thaulo E; Beyene T; Agarwal M; McKenney A; Hrapcak S; Garone D; Sodhi SK; Chan AK [Ad] Endereço: Dignitas International, Zomba, Malawi. [Ti] Título: Greater retention in care among adolescents on antiretroviral treatment accessing "Teen Club" an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi. [So] Source: J Int AIDS Soc;20(3), 2017 Nov. [Is] ISSN: 1758-2652 [Cp] País de publicação: Switzerland [La] Idioma: eng [Ab] Resumo: INTRODUCTION: There are numerous barriers to the care and support of adolescents living with HIV (ALHIV) that makes this population particularly vulnerable to attrition from care, poor adherence and virological failure. In 2010, a Teen Club was established in Zomba Central Hospital (ZCH), Malawi, a tertiary referral HIV clinic. Teen Club provides ALHIV on antiretroviral treatment (ART) with dedicated clinic time, sexual and reproductive health education, peer mentorship, ART refill and support for positive living and treatment adherence. The purpose of this study was to evaluate whether attending Teen Club improves retention in ART care. METHODS: We conducted a nested case-control study with stratified selection, using programmatic data from 2004 to 2015. Cases (ALHIV not retained in care) and controls (ALHIV retained in care) were matched by ART initiation age group. Patient records were reviewed retrospectively and subjects were followed starting in March 2010, the month in which Teen Club was opened. Follow-up ended at the time patients were no longer considered retained in care or on 31 December 2015. Cases and controls were drawn from a study population of 617 ALHIV. Of those, 302 (48.9%) participated in at least two Teen Club sessions. From the study population, 135 (non-retained) cases and 405 (retained) controls were selected. RESULTS: In multivariable analyses, Teen Club exposure, age at the time of selection and year of ART initiation were independently associated with attrition. ALHIV with no Teen Club exposure were less likely to be retained than those with Teen Club exposure (adjusted odds ratio (aOR) 0.27; 95% CI 0.16, 0.45) when adjusted for sex, ART initiation age, current age, reason for ART initiation and year of ART initiation. ALHIV in the age group 15 to 19 were more likely to have attrition from care than ALHIV in the age group 10 to 14 years of age (aOR 2.14; 95% CI 1.12, 4.11). CONCLUSIONS: This study contributes to the limited evidence evaluating the effectiveness of service delivery interventions to support ALHIV within healthcare settings. Prospective evaluation of the Teen Club package with higher methodological quality is required for programmes and governments in low- and middle-income settings to prioritize interventions for ALHIV and determine their cost-effectiveness. [Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico Infecções por HIV/tratamento farmacológico Aceitação pelo Paciente de Cuidados de Saúde Padrão de Cuidado [Mh] Termos MeSH secundário: Adolescente Instituições de Assistência Ambulatorial Estudos de Casos e Controles Feminino Seres Humanos Malaui Masculino Estudos Prospectivos Estudos Retrospectivos Grupos de Autoajuda Centros de Atenção Terciária Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-HIV Agents) [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180307 [Lr] Data última revisão: 180307 [Sb] Subgrupo de revista: IM; X [Da] Data de entrada para processamento: 171128 [St] Status: MEDLINE [do] DOI: 10.1002/jia2.25028

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[PMID]: 27779562 [Au] Autor: Dumon T; Wegner I; Sperling N; Grolman W [Ad] Endereço: *Jean Causse Ear Clinic, Colombiers, France †Department of Otorhinolaryngology-Head and Neck Surgery ‡Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands §Department of Clinical Otolaryngology, Weill Cornell Medical College, New York, New York. [Ti] Título: Implantation of Bone-Anchored Hearing Devices Through a Minimal Skin Punch Incision Versus the Epidermal Flap Technique. [So] Source: Otol Neurotol;38(1):89-96, 2017 01. [Is] ISSN: 1537-4505 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To compare the minimal skin punch incision without additional skin incision or soft tissue reduction with the epidermal flap technique and soft tissue reduction, for the implantation of percutaneous bone-anchored hearing devices. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care referral center. SUBJECTS AND METHODS: Two hundred seventeen patients underwent 220 implantations. Sixty five cases underwent implantation by means of a skin punch resection without soft tissue reduction (punch group) and 155 cases underwent epidermal flap and soft tissue reduction (dermatome group). Main outcome measures were duration of surgery, perioperative adverse events, skin tolerance, and revision surgery. RESULTS: The duration of surgery was shorter in the punch group (p < 0.001). The percentage of normal to moderate skin reactions, by Holgers classification, was higher in the punch group (90%) than in the dermatome group (84%). No severe reactions occurred in the punch group, but did occur in 7% in the dermatome group. These differences, although clinically important, did not reach statistical significance (p = 0.071). The rate of revision surgeries was not significantly different between the two groups. The indication for revision was different: mainly for skin issues in the dermatome group, against implant dislocation in the punch group. CONCLUSION: The implantation of the currently available percutaneous bone-anchored hearing implants with a minimal skin punch resection shortened duration of surgery and improved postoperative appearance, while preserving a good skin tolerance. In the punch group, there were less skin issues leading to revision surgery, however we did observe more implant dislocations needing revision surgery. [Mh] Termos MeSH primário: Auxiliares de Audição Procedimentos Cirúrgicos Otológicos/métodos [Mh] Termos MeSH secundário: Adulto Idoso Estudos de Coortes Feminino Seres Humanos Masculino Meia-Idade Período Pós-Operatório Estudos Prospectivos Reoperação Retalhos Cirúrgicos Âncoras de Sutura Centros de Atenção Terciária [Pt] Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 180307 [Lr] Data última revisão: 180307 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161026 [St] Status: MEDLINE

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[PMID]: 28450653 [Au] Autor: Soewondo P; Suyono S; Sastrosuwignyo MK; Harahap AR; Sutrisna B; Makmun LH [Ad] Endereço: Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. soewondops@yahoo.com. [Ti] Título: Prediction of Wound Healing in Diabetic Foot Ulcers: an Observational Study in Tertiary Hospital in Indonesia. [So] Source: Acta Med Indones;49(1):41-51, 2017 Jan. [Is] ISSN: 0125-9326 [Cp] País de publicação: Indonesia [La] Idioma: eng [Ab] Resumo: AIM: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. METHODS: a cohort study (February - October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). RESULTS: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. CONCLUSION: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing. [Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/complicações Pé Diabético/sangue Osteoprotegerina/sangue Calcificação Vascular/sangue Cicatrização [Mh] Termos MeSH secundário: Idoso Biomarcadores/sangue Estudos de Coortes Endotelina-1/sangue Feminino Seres Humanos Indonésia Estimativa de Kaplan-Meier Modelos Lineares Masculino Meia-Idade Análise Multivariada Centros de Atenção Terciária [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Nm] Nome de substância: 0 (Biomarkers); 0 (Endothelin-1); 0 (Osteoprotegerin); 0 (TNFRSF11B protein, human) [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170429 [St] Status: MEDLINE

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[PMID]: 27775983 [Au] Autor: Strassle PD; Williams FN; Napravnik S; van Duin D; Weber DJ; Charles A; Cairns BA; Jones SW [Ad] Endereço: From the *Department of Epidemiology, University of North Carolina at Chapel Hill; †Department of Surgery, University of North Carolina at Chapel Hill, ‡North Carolina Jaycee Burn Center, Chapel Hill; and §Division of Infectious Diseases, University of North Carolina, Chapel Hill. [Ti] Título: Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013. [So] Source: J Burn Care Res;38(3):187-193, 2017 May/Jun. [Is] ISSN: 1559-0488 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved. [Mh] Termos MeSH primário: Unidades de Queimados Queimaduras/mortalidade Queimaduras/terapia Centros de Atenção Terciária [Mh] Termos MeSH secundário: Adulto Feminino Mortalidade Hospitalar Seres Humanos Tempo de Internação/estatística & dados numéricos Masculino Meia-Idade North Carolina Sistema de Registros Fatores de Risco Taxa de Sobrevida [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161025 [St] Status: MEDLINE [do] DOI: 10.1097/BCR.0000000000000456

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[PMID]: 27774615 [Au] Autor: Kinnunen EM; De Feo M; Reichart D; Tauriainen T; Gatti G; Onorati F; Maschietto L; Bancone C; Fiorentino F; Chocron S; Bounader K; Dalén M; Svenarud P; Faggian G; Franzese I; Santarpino G; Fischlein T; Maselli D; Dominici C; Nardella S; Gherli R; Musumeci F; Rubino AS; Mignosa C; Mariscalco G; Serraino FG; Santini F; Salsano A; Nicolini F; Gherli T; Zanobini M; Saccocci M; Ruggieri VG; Philippe Verhoye J; Perrotti A; Biancari F [Ad] Endereço: Department of Surgery, Oulu University Hospital, Oulu, Finland. [Ti] Título: Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low-risk patients. [So] Source: Transfusion;57(1):178-186, 2017 01. [Is] ISSN: 1537-2995 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Excessive bleeding and blood transfusion are associated with adverse outcome after cardiac surgery, but their mechanistic effects are difficult to disentangle in patients with increased operative risk. This study aimed to evaluate the incidence and prognostic impact of bleeding and transfusion of blood products in low-risk patients undergoing coronary artery bypass grafting (CABG). STUDY DESIGN AND METHODS: Sixteen tertiary European centers of cardiac surgery contributed to the prospective European registry of CABG (E-CABG). The severity of bleeding was defined by the E-CABG bleeding severity classification and universal definition of perioperative bleeding (UDPB) classification. RESULTS: Of 1213 patients with EuroSCORE II of less than 2% (mean, 1.1 ± 0.4%), 18.5% suffered from mild bleeding (E-CABG bleeding Grade 1) and 3.4% experienced severe bleeding (E-CABG bleeding Grade 2-3). Similarly, 19.7% had UDPB Class 2 and 5.9% had UDPB Classes 3 and 4. Mild and severe bleeding defined by the E-CABG and UDPB classifications were associated with an increased risk of several adverse events as adjusted by multiple covariates. The risk of death, stroke, and acute kidney injury was particularly increased in patients with severe bleeding. CONCLUSION: Severe bleeding is rather uncommon in low-risk patients undergoing CABG, but it is associated with an increased risk of major adverse events. Prevention of excessive perioperative bleeding and patient blood management may improve the outcome of cardiac surgery also in low-risk patients. [Mh] Termos MeSH primário: Transfusão de Sangue Ponte de Artéria Coronária/efeitos adversos Hemorragia Pós-Operatória/epidemiologia Hemorragia Pós-Operatória/terapia Sistema de Registros [Mh] Termos MeSH secundário: Idoso Europa (Continente)/epidemiologia Feminino Seres Humanos Incidência Masculino Meia-Idade Hemorragia Pós-Operatória/diagnóstico Prognóstico Estudos Prospectivos Fatores de Risco Centros de Atenção Terciária [Pt] Tipo de publicação: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 180302 [Lr] Data última revisão: 180302 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161025 [St] Status: MEDLINE [do] DOI: 10.1111/trf.13885

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[PMID]: 29237359 [Au] Autor: Cragg J; Lowry D; Hopkins J; Parker D; Kay M; Duddy M; Tiwari A [Ad] Endereço: 1 Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom. [Ti] Título: Safety and Outcomes of Ipsilateral Antegrade Angioplasty for Femoropopliteal Disease. [So] Source: Vasc Endovascular Surg;52(2):93-97, 2018 Feb. [Is] ISSN: 1938-9116 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE: Previous reports have suggested higher periprocedural complications after ipsilateral antegrade femoral arterial access (AA). We looked at a contemporary series comparing complication rates between AA and contralateral retrograde femoral arterial access (RA) for femoropopliteal angioplasty. METHOD: A prospective review of all cases between 2010 and 2015 in a United Kingdom tertiary vascular center. Demographical and procedural data were obtained for those undergoing percutaneous femoropopliteal angioplasty. The primary outcome looked at periprocedural complications including retroperitoneal hematoma, pseudoaneurysm, hematoma requiring transfusion, arteriovenous fistulation, and surgical intervention. Secondary outcomes included contrast and radiation doses in addition to procedural failure leading to major amputation. RESULTS: A total of 556 (66% male) patients underwent femoropopliteal angioplasty, 461 (82%) via AA. Groups were of comparable age, sex, comorbidity, and symptomatology. AA patients had a lower body mass index, 26 versus 29 ( P = .005). No significant difference was seen in periprocedural (15.8% AA vs 11.6% RA; P = 0.292) or access site complications (3.7% AA vs 1.1% RA; P = 0.186). There was less need for a closure device, 40.3% AA vs 73% RA ( P < .01), less contrast, 94 mL AA: 114 mL RA ( P < .001), and less radiation, 3487 cGy cm AA: 9697 cGy cm RA ( P < .001). Arterial access was also associated with greater technical success of 83.8%: 73.3% RA ( P = .002). CONCLUSIONS: Arterial access is associated with higher technical success and reduced contrast/radiation doses with no significant difference in complications compared to RA contrary to previous reports. [Mh] Termos MeSH primário: Angioplastia/métodos Artéria Femoral Doença Arterial Periférica/terapia Artéria Poplítea/fisiopatologia [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Angiografia Angioplastia/efeitos adversos Bases de Dados Factuais Inglaterra Feminino Artéria Femoral/diagnóstico por imagem Artéria Femoral/fisiopatologia Seres Humanos Masculino Meia-Idade Doença Arterial Periférica/diagnóstico por imagem Doença Arterial Periférica/fisiopatologia Artéria Poplítea/diagnóstico por imagem Dose de Radiação Exposição à Radiação/efeitos adversos Exposição à Radiação/prevenção & controle Estudos Retrospectivos Fatores de Risco Centros de Atenção Terciária Fatores de Tempo Resultado do Tratamento [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180228 [Lr] Data última revisão: 180228 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171215 [St] Status: MEDLINE [do] DOI: 10.1177/1538574417739762

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[PMID]: 28458485 [Au] Autor: Ibrahim Y; Sani Y; Saleh Q; Saleh A; Hakeem G [Ad] Endereço: Department of Microbiology, Faculty of Science, Bayero University, Kano, Nigeria. [Ti] Título: Phenotypic Detection of Extended Spectrum Beta lactamase and Carbapenemase Co-producing Clinical Isolates from Two Tertiary Hospitals in Kano, North West Nigeria. [So] Source: Ethiop J Health Sci;27(1):3-10, 2017 Jan. [Is] ISSN: 2413-7170 [Cp] País de publicação: Ethiopia [La] Idioma: eng [Ab] Resumo: BACKGROUND: Continue rise in unprofessional use of antibiotics in our hospitals and communities is worrisome. A research study was therefore conducted to detect extended spectrum beta-lactamase (ESBL), carbapenemase, metallobeta lactamase and their co-production phenotypically from isolates obtained from patients admitted to or attending two tertiary hospitals in Kano, Nigeria. METHOD: A total of 248 isolates of Escherichia coli and Klebsiella pneumoniaewere screened phenotypically for ESBL production and carbapenemase production according to CLS1 2012 breakpoints using double disk synergy test and modified Hodge test (MHT) respectively. Antibiotic susceptibility of the organisms was tested against colistin, tigecycline and 3 flouroquinolones. RESULTS: The result shows that 58.0% of the isolates were ESBL producers with higher percentage in K. pneumoniae (62.9%). Further, about 40.3% and 36.6% of the isolates were resistant to meropenem and imipenem respectively. However, E. coli showed higher resistance to meropenem (47.1%) while K. pneumoniae showed higher resistance to imipenem (44.4%). Co-productions of carbapenemase and ESBL were observed in both E. coli and K. pneumoniae. Carbapenemase producing isolates were more obtained from uro-pathogens and wound isolates, with almost all the cases of co-production of the ß lactamases occurring in urine and cathertips isolates. Overall susceptibilities of the isolates to colistin and tigecycline were 64.6and70.0% respectively, but isolates were less susceptible to flouroquinolones. CONCLUSION: The finding of the study therefore indicates that carbapenem resistance is mediated by carbapenemase production and or overproduction of ESBL coupled with reduced porins. Co-production of carbapenemase, MBLs and ESBLs by some of the isolates is worrisome. Susceptibility to colistin and tigecycline was still promising, but increasing resistance to flouroquinolones has been observed. [Mh] Termos MeSH primário: Proteínas de Bactérias/biossíntese Escherichia coli/isolamento & purificação Klebsiella pneumoniae/isolamento & purificação beta-Lactamases/biossíntese [Mh] Termos MeSH secundário: Antibacterianos/farmacologia Seres Humanos Testes de Sensibilidade Microbiana Nigéria Fenótipo Centros de Atenção Terciária [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents); 0 (Bacterial Proteins); EC 3.5.2.6 (beta-Lactamases); EC 3.5.2.6 (carbapenemase) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180228 [Lr] Data última revisão: 180228 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE

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