ABSTRACT
INTRODUCTION AND AIMS: Transcatheter aortic valve implantation (TAVI) is an alternative procedure for patients with symptomatic aortic stenosis unfit for open heart surgery. Notwithstanding the safer profile, TAVI can still result in serious complications including acute kidney injury (AKI). MATERIALS AND METHODS: We conducted a single-center retrospective study to investigate the incidence of AKI following TAVI, identify any predictors, and assess the impact on patient survival. RESULTS: A total of 104 patients underwent TAVI at a mean age of 76.7 ± 7.2 years. AKI occurred in 35.9% of patients; 26.2% stage 1, 5.8% stage 2, and 3.9% stage 3. These patients had higher incidence of chronic kidney disease (CKD) (37.8 vs. 18.2%; p = 0.035), higher median EuroSCORE-II (4.2, IQR: 5.7 vs. 2.7, IQR: 3.6; p = 0.019), longer hospital stay (6 days, IQR: 7 vs. 5 days, IQR: 3; p = 0.016), and higher all-cause mortality (35.1 vs. 12.1%, p = 0.01) compared to patients without AKI. None of the patient mortality was directly related to the TAVI-AKI event. EuroSCORE-II (OR: 1.19, CI: 1.05 - 1.37, p = 0.009) and CKD (OR: 2.74, CI: 1.10 - 6.82, p = 0.03) were established as independent predictors for AKI. Cumulative survival was lower in patients with AKI (log-rank; χ2 = 6.43, p = 0.011). AKI was established as a hazard for mortality (HR: 2.97, CI: 1.23 - 7.19, p = 0.016). CONCLUSION: More than a third of patients undergoing TAVI developed AKI. These had significantly higher incidence of CKD, higher EuroSCORE-II, higher all-cause mortality, and longer hospital stay. Finally, EuroSCORE-II and CKD were established as independent predictors for AKI and can therefore be used for risk stratification.â©.
Subject(s)
Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Aortic Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Female , Humans , Incidence , Length of Stay , Male , Prognosis , Renal Insufficiency, Chronic/complications , Retrospective Studies , Risk Assessment , Risk Factors , Survival RateABSTRACT
PURPOSE: To evaluate the perception and 5-year application of anatomic side markers (ASMs) by radiographers in Malta. METHODS AND MATERIALS: Phase 1 involved a longitudinal, retrospective observation of a stratified sample of radiographs over 5 years, using a self-designed data record sheet to record features of the placement of ASMs. Phase 2 consisted of a cross-sectional, prospective self-designed questionnaire evaluating the radiographers' perception on the use of ASMs in professional practice. RESULTS: In phase 1, radiographs (n = 500) were selected from 234,105 taken over the 5-year period (error: ±4.38%; 95% confidence level). Four hundred thirty radiographs (86%) had evidence of markers, of which 110 (25.6%) had a pre-exposure marker and 320 (74.4%) had a postprocessed marker. The remaining 14% had no evidence of any markers. Two hundred eighty two (56.4%) of the radiographs had ASMs placed according to recommended guidelines by Ballinger, Frank, and Merrill. In phase 2, most radiographers (84.6%) preferred using postprocessing markers, with 15.4% preferring pre-exposure markers (76.6% of radiographers found applying pre-exposure markers time consuming). Sixty percent (60.5%) of radiographers gave correct answers on use of markers as recommended in the guidelines. CONCLUSIONS: Radiographer preference in using postprocessing markers was evident, while the use of pre-exposure markers was seen to be influenced by time of examination, projection executed, and patient positioning. Radiographer awareness and continuous training are recommended.
ABSTRACT
CONTEXT: The effect of seasons and meteorology on the incidence of nephrolithiasis has been studied in various regions around the globe, but seldom in the Mediterranean. AIMS: This retrospective analysis aims at investigating these putative effects in the Maltese Islands, whose climate is typically Mediterranean, followed by a systematic review of the literature. MATERIALS AND METHODS: Submission rate and chemical composition of all kidney stones after spontaneous passage or surgical removal between January 2009 and December 2011 were analyzed according to seasons and corresponding meteorology. RESULTS: A total of 389 stones were analyzed. A higher stone submission rate was observed in summer compared to winter (31.6% vs. 20.8%, P = 0.0008) and in the warm period compared to the cold period (57.1% vs. 42.9%, P = 0.0001). Significant correlation was established between the monthly number of stones and mean monthly maximum temperature (r = 0.50, P = 0.002), mean monthly temperature (r = 0.49, P = 0.003) and mean monthly Humidex (r = 0.49, P = 0.007). Humidex was found to be an independent predictor for stone submission (ß = 0.49, P = 0.007). The majority of stones contained calcium (83.3%), combined with oxalate (77.6%), phosphate (14.7%), and carbonate (2.8%). Some stones (11.8%) contained a mixture of >1 negatively charged molecules. Urate (11.6%), cysteine (4.6%), and ammonium-magnesium-phosphate (0.5%) constituted the rest. There was no association between chemical composition and seasons. Literature review included 25 articles. Higher ambient temperature and warm seasons were the most commonly encountered risk factors for both presentation and etiology of nephrolithiasis. CONCLUSIONS: A significant positive correlation was noted between ambient temperature and stone submission rate, which was significantly higher during the warm months in Malta.
