RESUMO
INTRODUCTION: Recommendations on non-invasive imaging to assess pre-operative cardiac risk among liver transplant candidates vary amongst societal guidelines and individual institutional practices. In 2018, a standardized pre-transplant coronary evaluation protocol was established at Beth Israel Deaconess Medical Center, Boston MA, to ensure appropriate and consistent pre-operative testing was performed. METHODS: All patients who underwent liver transplant evaluation between January 1st, 2016 and December 31st, 2019, were retrospectively analyzed and divided into three cohorts; before the introduction of the protocol (prior to 2018), initial protocol favoring invasive coronary angiography (ICA) (2018), and amended protocol favoring coronary computed tomography angiography (CCTA) (post-2018). We described clinical characteristics, candidacy for transplant, and cardiovascular complications during follow-up. As an unadjusted exploratory analysis, the Cochran-Armitage Exact Trend Test was used to examine univariate differences across time. RESULTS: A total of 462 patients underwent liver transplant evaluation during the study period. Among these, 218 (47.2%) patients underwent stress test, 50 (10.8%) underwent CCTA, and 68 (14.8%) underwent ICA. Across the three time periods, there was an increase in the proportion of CCTAs performed (3%, 6.3%, and 26.3% respectively; p <0.001) and proportion of patients diagnosed with obstructive CAD using CCTA (0%, 30%, and 51.4% respectively; p = 0.04). There was no significant difference in post-transplant cardiac complications among patients evaluated before 2018, during 2018, and after 2018 (5.9% vs. 5.6 vs. 6.0%; p=1.0). CONCLUSION: Our findings suggest it is reasonable to shift practice to a less invasive approach utilizing CCTA or nuclear stress testing when assessing liver transplant candidates at increased cardiovascular risk.
Assuntos
Doença da Artéria Coronariana , Transplante de Fígado , Estudos de Coortes , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Transplante de Fígado/efeitos adversos , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de RiscoRESUMO
Introducción: Los niños también son susceptibles a la infección por SARS-CoV-2, pero sus manifestaciones clínicas son leves y la evolución en la mayoría de los casos es satisfactoria. Objetivo: Caracterizar clínica-epidemiológicamente a pacientes pediátricos infectados con el nuevo coronavirus SARS-CoV‐2. Métodos: Estudio descriptivo, transversal y retrospectivo en los primeros 77 pacientes menores de 18 años confirmados con COVID 19 e ingresados en las salas de pediatría del hospital "Dr. Luis Díaz Soto" en el período comprendido entre el 13 de marzo al 30 junio 2020. De las historias clínicas se tomaron los datos de las variables edad y sexo, comorbilidades, fuente de infección y lugar de exposición, presencia de síntomas y tiempo de aparición después del contacto y periodo en que se inició la mejoría. Resultados: Hubo discreto predominio del sexo femenino (54,5 por ciento) y los adolescentes (51,8 por ciento) más vulnerables a la infección. Se refirieron comorbilidades en 23 casos (22,8 por ciento) y el asma fue la más frecuente (10-13 por ciento). Se precisó la fuente de infección en 74 (96,1 por ciento) y 58 (75,3 por ciento) estaban asintomáticos al diagnóstico. Los síntomas más frecuentes fueron los respiratorios (tos 7-36,8 por ciento, rinorrea 5-26,3 por ciento y estornudos 4- 21,0 por ciento), le siguió la cefalea con 4 (21.0 por ciento); solo 3 presentaron fiebre (15,8 por ciento) y otros 3 anosmia-disgeusia (15,8 por ciento). La evolución fue favorable en 100,0 % de los pacientes y la mayoría estaba asintomática al 7mo. día. Conclusiones: La infección por SARS-CoV-2 se presentó sin distinción significativa de sexo, preferentemente en adolescentes, con manifestaciones leves de la enfermedad y evolución satisfactoria. No hubo fallecidos(AU)
Introduction: Children are also vulnerable to Sars-CoV-2 infections, but their clinical manifestations are slight and the evolution in most of the cases is satisfactory. Objective: Characterize in a clinical-epidemiological way pediatric patients infected with the new SARS-CoV-2 coronavirus. Methods: Descriptive, cross-sectional and retrospective study in the first 77 patients under 18 years confirmed with COVID-19 and admitted in the pediatric service of "Dr. Luis Díaz Soto" Hospital, in the period from March 13th to June 30th, 2020. From the clinical records were taken data of variables like age and sex, comorbidities, source of infection and place of exposure, presence of symptoms and time of onset after the contact, and period in which started an improvement of the disease. Results: There was a discreet predominance of female sex (54.5 percent) and the adolescents (51.8 percent) being more vulnerable to the infection. Comorbidities were noticed in 23 cases (22.8 percent) and asthma was the most frequent (10-13 percent). It was specified the source of infection in 74 patients (96.1 percent) and 58 patients (75.3 percent) were asymptomatic during the diagnosis. The most frequent symptoms were: respiratory ones (cough: 7-36.8 percent; rhinorrhoea: 5-26.3 percent; and sneezing: 4-21,0 percent); followed by cephalalgia with 4 (21,0 percent); just 3 patients presented fever (15.8 percent) and other 3 presented anosmia-dysgeusia (15.8 percent).The evolution was favorable in 100.0 percent of the patients and most of them were asymptomatic at the seventh day. Conclusions: The infection by SARS-CoV-2 was present with significative distinction of sex, more commonly in adolescents with slight manifestations of the disease and satisfactory evolution. There were no deaths(AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Pediatria , Prontuários Médicos , Estudos Retrospectivos , Diagnóstico , Betacoronavirus , InfecçõesRESUMO
We report the use of topic negative pressure for seromas resulting from mobilization of tensor fascia lata miocutaneous flap in the trochanteric areas for pressure sores. In 5 consecutive patients we successfully treated seroma with the use of external and internal topic subatmospheric pressure.
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Tratamento de Ferimentos com Pressão Negativa/métodos , Úlcera por Pressão/cirurgia , Seroma/cirurgia , Humanos , Retalhos CirúrgicosRESUMO
Pyoderma Gangrenosum is a rare disease whose etiology is probably autoimmune. We report two males aged 48 and 49 years and one female aged 54 years, with lesions in the right thigh, right leg and in the borders of a surgical incision in the chest. This article gives a brief description of the lesions, tips for diagnosis and help for the initial management and treatment.