ABSTRACT
Purpose@#Cardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone. @*Materials and Methods@#We included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO× MAP)/[451×body surface area (BSA)] (W/m2). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR. @*Results@#The mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62–0.72], 0.65 (95% CI, 0.60–0.70), 0.66 (95% CI, 0.61–0.71), and 0.63 (95% CI 0.58–0.68), respectively. @*Conclusion@#GCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.
ABSTRACT
Background: Several epidemiological studies have shown that the prevalence of tobacco smoking in the Spanish healthcare centres is relatively high
Objective: to assess the current situation of tobacco smoking among medical specialists of Reina Sofia University Hospital [Cordoba, Spain]. As a secondary objective we intended to calculate the indirect costs of smoking among medical specialists during the working hours
Materials and Methods: Descriptive cross-sectional study of the medical specialists of Reina Sofia University Hospital. Our survey was conducted using an interview questionnaire that included the following variables: age, sex, medical specialty, smoking habits, tobacco smoking during work hours, time spent on each cigarette, intention to quit smoking and the possibility to participate in a smoking cessation program
Results: A total of 143 medical specialists; 64 women and 79 men were interviewed. About 14% of participants were former smokers and 10.5% were current smokers, of whom 67% wanted to quit smoking. About 73% of smokers consumed tobacco during the working hours. Most of smokers consumed 2 cigarettes during the working hours. About 60% of smokers would use a permanent aid program to quit smoking. The hours lost by the smoking habits of medical specialists cause an annual loss of 143.512,96 euros
Conclusions: The study results show that currently there is an increasing awareness of health professionals about the harmful effects of smoking: former smokers have increased, and most of smokers want to quit. Also, they would use a permanent aid program to quit smoking
ABSTRACT
Background: Although the beneficial effects of breastfeeding are well-known, the prevalence of breastfeeding in many developed countries is quite low
Objective: The objective of this study was to estimate the prevalence of breastfeeding in the catchment area of Reina Sofia University Hospital of Cordoba [Spain]
Materials and Methods: A cross sectional study was conducted for mothers attending the outpatient clinic of Reina Sofia University Hospital of Cordoba, for follow-up after 6 weeks of delivery. All mothers attending the outpatient clinic over 3 months accepted to participate in the study. Finally, we had a sample of 91 mothers. Study variables were age, educational level, gestational weeks, type of delivery, gender and weight of the new born, type of feeding for the baby over the first 6 weeks of his/her life, motives for abandoning breastfeeding, and motives for selecting the artificial formula. The information was collected through a previously validated interview questionnaire
Results: The mean age of the mothers was 31.8 [SD 3.13] years old. About 67% of mothers selected exclusive breastfeeding and 4.39% selected the combination of breastfeeding with the artificial formula. More than 28% of mothers selected the artificial formula. The reasons for selecting the artificial formula were own decision [46.15%], medical recommendation [11.53%], lack of breast milk [3.84%]. The remaining 23.1% of mothers who selected the artificial formula refused to answer this question
Conclusions: Our results show that only two-third of mothers adopted breastfeeding in the first 6 weeks after delivery. Health education and promotion programmes for breastfeeding are urgently needed
ABSTRACT
Background: Systemic lupus erythematosus [SLE] is a chronic inflammatory autoimmune disease with features of multisystem involvement, relapsing and remitting course. Gastrointestinal system affection is common in Lupus patients but coexistence of the inflammatory bowel disease [IBD] and SLE is rare. The coexistence of signs and symptoms of both diseases in the same patient represents a diagnostic challenge. Diagnoses of both diseases is difficult as both may share the same gastrointestinal features. Some of the therapies used in IBD may induce lupus. Aim of the study: To detect the presence of IBD in SLE patients
Methods: Only19 studies investigating the coexistence of IBD in SLE patients were published from January 2000 to March 2017 searching the Medline, PubMed, Ovid, Trip and Cochrane database. We excluded 16 studies [case reports] as they lacked the inclusion criteria for the meta-analysis. Only three studies were included in this systematic review. The prevalence/frequency and its 95% CI are included or estimated whenever possible
Results: Most of the studies that detected a statistical association between both diseases were case series and case control study that revealed the presence of IBD in some lupus patients. Criteria for the diagnosis of SLE cases and IBD cases were clearly explained in these studies, and same stratified results according to gender. The pooled results of all cases with SLE were [total 6665] showed that, there were IBD cases [total 79] associated with lupus with a frequency [95% CI] is 1.19% [0.96-1.48]
Conclusion: The prevalence of IBD in SLE patients is rare however, the coexistence of both diseases in the same patient could occur
ABSTRACT
Background and aim: Variable techniques could be used to raise the success rate and reduce complications of endoscopic retrograde cholangiopancreatography [ERCP]
Patients and methods: From 73 patients subjected to ERCP in our endoscopy unit, during the period between January 2016 to December 2017, 47 patients were managed with standard free direct cannulation maneuver [group- I], 21 patients managed with indirect maneuvers [DGT and\\or TPS as group-II] and ERCP was failed in 5 cases; in 3 of them temporary pancreatic stent was placed but with no value
Results: From 73 patients, standard free direct cannulation was done in 47 patients with success rate 64.4%, the remaining 26 patients managed with indirect maneuvers with successful cannulation of CBD in 21 cases with success rate 80.7% and total success rate of 94.4%. Procedure duration was longer in patients of indirect maneuvers than patients of standard free direct cannulation maneuver, with high significant difference [P value of 0.0036]. The post-ERCP complications were noticed in 21 patients with complications rate of 28.8 %. Complications were significantly higher in patients of indirect maneuvers than patients of standard direct maneuver [47.6% vs. 23.4%]. Post-ERCP pancreatitis recorded in 7 patients [9.6%] with significant higher rate in patients of indirect maneuvers than patients of direct maneuver [23.8% vs. 4.3%]
Conclusion: Indirect biliary cannulation [DGT and/or TPS] solved the problem of failed cannulation but had a higher rate of complications and took longer time