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1.
Cardiovasc Revasc Med ; 20(11): 1014-1019, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30553818

RESUMO

Left main coronary artery (LMCA) disease affect 5-7% of patient undergoing coronary angiography and is associated with multivessel CAD in 70% of the cases. Untreated significant LMCA disease is associated with significant mortality and morbidity. CABG is the traditional therapy for revascularization in LMCA disease. PCI is a reasonable alternative mainly in patients with high surgical risk or other specific factors. Drug-eluting stents, improved antiplatelet therapeutic options, atherectomy techniques, IVUS-guidance and improved operator experience have all contributed to the observed improvement in clinical outcomes. Given the large number of variables involved in deciding between PCI and CABG, a heart team should make decisions regarding revascularization of LMCA disease.


Assuntos
Aterectomia Coronária , Ponte de Artéria Coronária , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/mortalidade , Tomada de Decisão Clínica , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Stents Farmacológicos , Reserva Fracionada de Fluxo Miocárdico , Humanos , Seleção de Pacientes , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/mortalidade , Inibidores da Agregação Plaquetária/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
2.
Disaster Med Public Health Prep ; 13(2): 217-222, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29644946

RESUMO

OBJECTIVE: The purpose of this study was to investigate the 10-year impact of Hurricane Katrina on the incidence of acute myocardial infarction (AMI) along with contributing risk factors and any alteration in chronobiology of AMI. METHODS: A single-center, retrospective, comparison study of AMI incidence was performed at Tulane University Health Sciences Center from 2 years before Hurricane Katrina to 10 years after Hurricane Katrina. A 6-year, pre-Katrina and 10-year, post-Katrina cohort were also compared according to pre-specified demographic, clinical, and chronobiological data. RESULTS: AMI incidence increased from 0.7% (150/21,079) to 2.8% (2,341/84,751) post-Katrina (P<0.001). The post-Katrina cohort had higher rates of coronary artery disease (36.4% vs. 47.9%, P=0.01), diabetes mellitus (31.3% vs. 39.9%, P=0.04), hyperlipidemia (45.4% vs. 59.3%, P=0.005), smoking (34.4% vs. 53.8%, P<0.001), drug abuse (10.2% vs. 15.4%, P=0.02), psychiatric illness (6.7% vs. 14.9%, P<0.001), medication non-adherence (7.3% vs. 15.3%, P<0.001), and lack of employment (7.2% vs. 16.4%, P<0.001). The post-Katrina group had increased rates of AMI during nights (29.8% vs. 47.8%, P<0.001) and weekends (16.1% vs. 29.1%, P<0.001). CONCLUSIONS: Even 10 years after the storm, Hurricane Katrina continues to be associated with increased incidence of AMI, higher prevalence of traditional cardiovascular and psychosocial risk factors, and an altered chronobiology of AMI toward nights and weekends. (Disaster Med Public Health Preparedness. 2019;13:217-222).


Assuntos
Tempestades Ciclônicas/estatística & dados numéricos , Infarto do Miocárdio/etiologia , Adulto , Estudos de Coortes , Tempestades Ciclônicas/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Nova Orleans/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
Ann Transl Med ; 6(15): 299, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30211187

RESUMO

Coronary artery disease (CAD), including stable ischemic heart disease (SIHD) and acute coronary syndrome (ACS), remains the leading cause of death in the US and one of the primary modalities used in the treatment of CAD is percutaneous coronary intervention (PCI). Despite the potential benefits of PCI in high risk CAD patients, the risk of hemorrhage presents a dilemma in the treatment of patients with hemophilia A and B. In an attempt to provide guidance on the management of SIHD and ACS in patients with hemophilia, we present the case of a patient with moderate hemophilia B and ACS who subsequently underwent PCI followed by a review of the associated literature.

5.
J Drugs Dermatol ; 16(5): 489-494, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28628686

RESUMO

Injectable soft-tissue augmentation agents have become popular alternatives to surgical procedures for the aging face and body. In contrast to temporary, space-occupying replacement fillers such as collagen-based and hyaluronic acid products, poly-l-lactic acid (PLLA) has been demonstrated to gradually promotes deposition of collagen via a biostimulatory response, with therapeutic effects lasting approximately two years. In 2004, the FDA approved its use for rejuvenation of facial contours secondary to lipoatrophy associated with antiretroviral therapy for HIV infection. By 2009 PLLA was FDA-approved for the correction of nasolabial fold contour deficiencies and other lines and wrinkles. There have since been limited but promising results with off-label use of PLLA for nonfacial volumization as well, including the hands, neck/décolleté, abdomen, and gluteal area. The objective of this article is to review clinical evidence, current trends, and technical considerations for the use of PLLA for nonfacial, body rejuvenation.

J Drugs Dermatol. 2017;16(5):489-494.

.


Assuntos
Técnicas Cosméticas/tendências , Poliésteres/administração & dosagem , Rejuvenescimento , Envelhecimento da Pele/efeitos dos fármacos , Envelhecimento da Pele/patologia , Implantes Absorvíveis , Mãos/patologia , Mãos/fisiologia , Humanos , Pescoço/patologia , Pescoço/fisiologia , Rejuvenescimento/fisiologia , Envelhecimento da Pele/fisiologia , Tórax/efeitos dos fármacos , Tórax/patologia , Tórax/fisiologia
7.
J Invasive Cardiol ; 28(12): E185-E192, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27922810

RESUMO

OBJECTIVES: We examined a contemporary, unselected cohort of patients with coronary chronic total occlusions (CTOs) to determine the impact of CTO revascularization on long-term outcomes. METHODS: We retrospectively assessed the impact of CTO revascularization on clinical outcomes of consecutive patients found to have a CTO during coronary angiography performed at our institution during 2011 and 2012. The primary endpoint was the incidence of a major adverse cardiac event (MACE, defined as a composite of death, myocardial infarction, stroke, and target-vessel revascularization [TVR]). Survival analysis was performed in the overall and propensity-matched retrospective cohorts of patients stratified by prior coronary artery bypass graft (CABG) surgery. Propensity-adjusted hazard ratio (HR) and 95% confidence interval (95% CI) were calculated with Cox proportional hazards analysis. All analyses were by intention to treat. RESULTS: Of 624 patients (319 without prior CABG and 305 with prior CABG) included in the present analysis, CTO revascularization (surgical or percutaneous) was attempted in 60% and 16% of patients without and with prior CABG, respectively. During a median follow-up of 26 months (range, 18-40 months), the incidence of MACE was 20.6%. CTO revascularization (achieved or attempted) was associated with lower incidence of MACE among patients without prior CABG (propensity-adjusted HR, 0.51; 95% CI, 0.27-0.94; P=.03), but not among prior CABG patients (propensity-adjusted HR, 1.38; 95% CI, 0.64-2.96; P=.41). CONCLUSION: In a large, unselected patient population with coronary CTOs, a CTO revascularization attempt was associated with lower incidence of subsequent MACE among patients without prior CABG, but not among prior CABG patients.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Oclusão Coronária , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio , Complicações Pós-Operatórias , Idoso , Angiografia Coronária/métodos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/estatística & dados numéricos , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
8.
Case Rep Med ; 2015: 814269, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26421018

RESUMO

Introduction. A number of viruses have been implicated in viral myocarditis; however, there has been no previous report of human metapneumovirus (hMPV) causing this condition. Discovered in 2001, hMPV is typically associated with upper respiratory illness, mainly affecting children. Case Presentation. We report the case of a 25-year-old man with acute systolic heart failure from viral myocarditis secondary to the hMPV. The patient was initially admitted to the general medical ward but developed increasing oxygen requirements resulting in transfer to the cardiac intensive care unit. Cardiac magnetic resonance imaging was used to help confirm the diagnosis. He was treated with intravenous diuretics, and afterload and preload agents, and he was subsequently discharged home after seven days of hospitalization. Discussion. hMPV is typically a respiratory pathogen; however, it was associated with in myocarditis in our patient. Due to the recent ability to detect this virus, we may see more cases of this, particularly during peak months of infection. Conclusion. This is the first case description of myocarditis associated with hMPV infection.

9.
Dermatol Online J ; 19(8): 19269, 2013 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-24021447

RESUMO

Hidrocystomas are common, benign adnexal neoplasms most frequently found on the eyelids, canthi, or periocular areas. Herein, we report a case of multiple hidrocystomas distributed over less common facial areas: cheeks and cutaneous lips.


Assuntos
Bochecha/patologia , Neoplasias Faciais/patologia , Hidrocistoma/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Feminino , Humanos , Pessoa de Meia-Idade
10.
Dev Neurosci ; 32(2): 91-100, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20551645

RESUMO

Prenatal alcohol exposure can lead to a wide range of adverse effects on a developing fetus. As a whole, these teratogenic outcomes are generally known as fetal alcohol spectrum disorders, the most severe of which is fetal alcohol syndrome (FAS). Clinically, children diagnosed with FAS vary greatly in their presentation of symptoms, likely due to the amount of alcohol and timing of exposure, as well as maternal and genetic influences. All these factors play a role in determining the mechanisms through which alcohol damages a developing brain, the details of which are still largely unknown. However, continuing research and recent developments have provided promising results that may lead to screening mechanisms and treatment therapies for children with FAS. Here we review the teratogenic effects of alcohol, strategies for detecting maternal alcohol consumption, identification of fetal biological markers, and prevention methods for FAS.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Etanol/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/diagnóstico , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal , Biomarcadores/metabolismo , Criança , Família , Feminino , Transtornos do Espectro Alcoólico Fetal/patologia , Transtornos do Espectro Alcoólico Fetal/fisiopatologia , Humanos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Fatores de Risco , Teratogênicos
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