Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
N Z Med J ; 137(1590): 93-99, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38386858

RESUMO

Heart failure affects 1-3% of the population and remains a major public health problem, with high rates of hospitalisation and mortality. Health inequities in the incidence of heart failure have widened over the last 13 years in Aotearoa New Zealand. Urgent action is required to address the inequitable burden of heart failure among Maori and Pasifika. Regional and international heart failure guidelines now provide clear and consistent guidance on the contemporary approach to management for patients with heart failure. The purpose of this position statement is to ensure that all people in Aotearoa New Zealand have access to optimal healthcare delivery and pharmacotherapy for contemporary management of heart failure. Three main areas are addressed, including: 1) access to evidence-based pharmacotherapy for patients with heart failure, 2) the importance of early initiation and titration of pharmacotherapy, and 3) the workforce required to ensure timely delivery of heart failure therapies. Implementation of evidence-based healthcare will ensure all patients with heart failure in Aotearoa New Zealand have opportunity for substantial improvement in health.


Assuntos
Insuficiência Cardíaca , Povo Maori , Humanos , Nova Zelândia/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Pacientes , Hospitalização
2.
N Z Med J ; 135(1551): 13-24, 2022 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-35728167

RESUMO

AIM: To explore the epidemiology, presentation, management and healthcare impact of infective endocarditis (IE) in Northland, to guide strategies for prevention and quality improvement. METHOD: Health records of patients treated for IE in Northland between 2010 and 2019 were analysed retrospectively. Cases were classified using Modified Duke Diagnostic Criteria. RESULTS: One hundred and forty cases of IE (97 definite, 43 possible) were identified. The incidence of IE in Northland was 8.5 per 100,000-person-years. The highest-risk group were elderly Maori. There was a 44% rate of prosthetic valve endocarditis (PVE) with 27% of these patients having a history of rheumatic heart disease. Organisms causing IE included streptococcal species (43%), Staphylococcus aureus (23%) and enterococci (16%). Complications included stroke (24%), systemic embolism (38%), congestive heart failure (30%) and paravalvular abscess (14%). Median length of hospitalisation was 22 days (IQR 14-34) and 32% required valve surgery. The mortality rate at six weeks after diagnosis was 18%. An estimated total of NZ$6,560,470 was spent on direct patient care. CONCLUSION: IE is causing substantial morbidity and mortality in Northland and consuming considerable healthcare resources. A high index of suspicion for IE is recommended. A high proportion of cases were caused by odontogenic organisms. Preventative investment in oral health promotion and dental care has the potential to be cost-effective.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Idoso , Endocardite/epidemiologia , Endocardite/terapia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/terapia , Humanos , Nova Zelândia/epidemiologia , Estudos Retrospectivos
3.
HLA ; 95(6): 516-531, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31970929

RESUMO

A catalog of common, intermediate and well-documented (CIWD) HLA-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5, -DQB1 and -DPB1 alleles has been compiled from over 8 million individuals using data from 20 unrelated hematopoietic stem cell volunteer donor registries. Individuals are divided into seven geographic/ancestral/ethnic groups and data are summarized for each group and for the total population. P (two-field) and G group assignments are divided into one of four frequency categories: common (≥1 in 10 000), intermediate (≥1 in 100 000), well-documented (≥5 occurrences) or not-CIWD. Overall 26% of alleles in IPD-IMGT/HLA version 3.31.0 at P group resolution fall into the three CIWD categories. The two-field catalog includes 18% (n = 545) common, 17% (n = 513) intermediate, and 65% (n = 1997) well-documented alleles. Full-field allele frequency data are provided but are limited in value by the variations in resolution used by the registries. A recommended CIWD list is based on the most frequent category in the total or any of the seven geographic/ancestral/ethnic groups. Data are also provided so users can compile a catalog specific to the population groups that they serve. Comparisons are made to three previous CWD reports representing more limited population groups. This catalog, CIWD version 3.0.0, is a step closer to the collection of global HLA frequencies and to a clearer view of HLA diversity in the human population as a whole.


Assuntos
Alelos , Genética Populacional , Antígenos de Histocompatibilidade Classe II/genética , Antígenos de Histocompatibilidade Classe I/genética , Frequência do Gene , Haplótipos , Humanos
5.
N Z Med J ; 125(1354): 51-9, 2012 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-22595924

RESUMO

BACKGROUND: Staphylococcus lugdunensis, a species of coagulase-negative staphylococci is associated with a wide variety of infections ranging from mild skin and soft tissue infections to serious infections which include brain abscess, chronic osteomyelitis and infective endocarditis. The aim of this study was to review cases of S. lugdunensis bacteraemia isolated from a New Zealand tertiary institution and describe the clinical presentation, diagnosis and treatment of the patients. METHODS: All blood cultures reported positive for S. lugdunensis from the Microbiology Laboratory, Waikato Hospital, New Zealand between March 2006 to April 2011 were reviewed. RESULTS: A total of 11 cases of S. lugdunensis bacteraemia were identified during the 5-year period. Three (27%) cases were due to infective endocarditis with one delayed diagnosis due to the failure of recognize the coagulase-negative Staphylococcus. Transthoracic or transoesophageal echocardiography was performed in 6 (55%) of the patients. One patient with endocarditis required early surgery and the other two were managed successfully with intravenous antibiotics. There was no in hospital mortality in the patients with endocarditis. The remaining 8 cases included 1 (9%) necrotizing fasciitis, 1 (9%) immunocompromised nosocomial multiple organism sepsis, 1 (9%) deep tissue infection requiring 6 weeks of intravenous antibiotics, 2 (18.5%) superficial skin infection, 1 (9%) nosocomial post-pacemaker insertion infection and 2 (18.5%) had fever of unknown origin. All isolates were sensitive to Flucloxacillin and Vancomycin. Overall the survival rate of the acute presentation and treatment was 91% (10/11). CONCLUSION: Three of our 11 patients (27%) with S. lugdunensis bacteraemia were diagnosed with infective endocarditis. Evaluation for endocarditis is therefore advised in patients who have positive blood culture for this organism.


Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus lugdunensis/patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Coagulase , Endocardite/tratamento farmacológico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus lugdunensis/isolamento & purificação , Virulência
7.
Heart Lung Circ ; 19(10): 611-4, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20573545

RESUMO

The first percutaneous transcatheter aortic valve implantation (TAVI) was performed in 2002 by Alain Cribier with over 10,000 valve implants since. Despite this, as with all new technologies we remain on a learning curve and continue to encounter new challenges and complications. We report a case of acute structural valve failure treated successfully with a second valve in valve implantation of transcatheter aortic valve in a patient who had severe aortic stenosis (AS) complicated by a severely unfolded aorta.


Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica/patologia , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/instrumentação , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Fatores de Tempo , Ultrassonografia
8.
BMJ Case Rep ; 20092009.
Artigo em Inglês | MEDLINE | ID: mdl-21687005

RESUMO

A 70-year-old male presented to hospital with both anterior ST elevation myocardial infarction and spontaneous oesophageal rupture (Boerhaave's syndrome). He underwent primary angioplasty and stenting for a lesion of the left anterior descending in addition to cardiothoracic surgery for the oesophageal rupture. This combination of pathologies is a rare entity and often difficult to diagnose. To date, only a few cases have been reported.

10.
Heart Lung Circ ; 13(3): 252-5, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16352203

RESUMO

BACKGROUND: Ischaemic stroke is reduced by anticoagulant therapy in high-risk patients with atrial fibrillation. Evidence however, suggests patients are under treated. AIM: To assess anticoagulant use in patients with ischaemic stroke and atrial fibrillation in Waikato Hospital. METHODS: A retrospective review of all patients admitted with stroke over a one-year period. RESULTS: Ischaemic stroke occurred in 189 patients with atrial fibrillation noted in 21% (39/189) of this group. The majority were female, 59% (23/39) with a mean age of 79.8 years. A total of 84% (33/39) were considered high risk for thromboembolic complications but only 18% (6/33) were anticoagulated prior to the stroke. Following the cerebrovascular accident all patients were considered to be at high risk but only a further 25% (10/39), were anticoagulated. In the remaining 55% (21/39) anticoagulant therapy was not commenced with age alone cited as a contraindication in 8% (3/39). At a mean follow-up of 10 months no complications of anticoagulant therapy were reported. CONCLUSIONS: A significant proportion of patients with atrial fibrillation and high-risk characteristics are not anticoagulated prior to ischaemic stroke. These findings reflect overseas experience. Reasons are unknown but may in part relate to physician reluctance to anticoagulate elderly patients.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...