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2.
Praxis (Bern 1994) ; 107(20): 1097-1106, 2018.
Artigo em Alemão | MEDLINE | ID: mdl-30278847

RESUMO

CME: Ethylene Glycol Intoxication Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.


Assuntos
Acidose/induzido quimicamente , Injúria Renal Aguda/induzido quimicamente , Etilenoglicol/intoxicação , Equilíbrio Ácido-Base , Acidose/mortalidade , Acidose/terapia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Adulto , Terapia Combinada , Cuidados Críticos/métodos , Diagnóstico Diferencial , Diagnóstico Precoce , Intervenção Médica Precoce , Serviço Hospitalar de Emergência , Etilenoglicol/farmacocinética , Humanos , Necrose do Córtex Renal/induzido quimicamente , Necrose do Córtex Renal/mortalidade , Necrose do Córtex Renal/terapia , Masculino , Diálise Renal , Tentativa de Suicídio
5.
PLoS One ; 13(1): e0191752, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29381721

RESUMO

BACKGROUND: Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. METHODS: In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. RESULTS: 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women). 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI) did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients. CONCLUSION: This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Medicina Geral , Hospitais de Ensino/organização & administração , Padrões de Prática Médica , Estudos Transversais , Humanos , Medicina Interna , Suíça
9.
Eur J Prev Cardiol ; 24(12): 1287-1293, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28464700

RESUMO

Background Smartphone manufacturers offer mobile health monitoring technology to their customers, including apps using the built-in camera for heart rate assessment. This study aimed to test the diagnostic accuracy of such heart rate measuring apps in clinical practice. Methods The feasibility and accuracy of measuring heart rate was tested on four commercially available apps using both iPhone 4 and iPhone 5. 'Instant Heart Rate' (IHR) and 'Heart Fitness' (HF) work with contact photoplethysmography (contact of fingertip to built-in camera), while 'Whats My Heart Rate' (WMH) and 'Cardiio Version' (CAR) work with non-contact photoplethysmography. The measurements were compared to electrocardiogram and pulse oximetry-derived heart rate. Results Heart rate measurement using app-based photoplethysmography was performed on 108 randomly selected patients. The electrocardiogram-derived heart rate correlated well with pulse oximetry ( r = 0.92), IHR ( r = 0.83) and HF ( r = 0.96), but somewhat less with WMH ( r = 0.62) and CAR ( r = 0.60). The accuracy of app-measured heart rate as compared to electrocardiogram, reported as mean absolute error (in bpm ± standard error) was 2 ± 0.35 (pulse oximetry), 4.5 ± 1.1 (IHR), 2 ± 0.5 (HF), 7.1 ± 1.4 (WMH) and 8.1 ± 1.4 (CAR). Conclusions We found substantial performance differences between the four studied heart rate measuring apps. The two contact photoplethysmography-based apps had higher feasibility and better accuracy for heart rate measurement than the two non-contact photoplethysmography-based apps.


Assuntos
Fibrilação Atrial/diagnóstico , Telefone Celular/instrumentação , Eletrocardiografia , Frequência Cardíaca/fisiologia , Aplicativos Móveis/normas , Fotopletismografia/métodos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/fisiopatologia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Adulto Jovem
11.
Praxis (Bern 1994) ; 105(25): 1469-1470, 2016.
Artigo em Alemão | MEDLINE | ID: mdl-27976963
12.
Echocardiography ; 32(7): 1140-6, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25327820

RESUMO

BACKGROUND: Echocardiographic quantification of mitral regurgitation (MR) can be challenging if the valve geometry is significantly altered. Our aim was to compare the quantification of MR by the recently developed real time three-dimensional (3D) volume color flow Doppler (RT-VCFD) method to the conventional two-dimensional (2D) echocardiographic methods during the MitraClip procedure. METHODS: Twenty-seven patients (mean age 76 ± 8 years, 56% male) were prospectively enrolled and severity of MR was assessed before and after the MitraClip procedure in the operating room by 3 different methods: (1) by integrative visual approach by transesophageal echocardiography, (2) by transthoracic 2D pulsed-wave Doppler-based calculation of aortic stroke volumes (SV) and mitral inflow allowing calculation of regurgitant volume, and (3) by transthoracic 3D RT-VCFD-based calculation of regurgitant volume. RESULTS: We found moderate agreement between the integrative visual approach and the 3D RT-VCFD method for assessment of MR severity before (κ = 0.4, P < 0.05) and after MitraClip (κ = 0.5, P < 0.05). Relevant MR (3+ and 4+) was detected by visual approach in 27/27 and by 3D-VCFD method in 24/27 patients before and in 1 patient by both methods after the MitraClip procedure. In contrast, MR quantification by 2D SV method did not agree with the integrative visual approach or with the 3D RT-VCFD method. CONCLUSIONS: Quantification of MR before and after percutaneous MV repair by 3D RT-VCFD is comparable to the integrative visual assessment and more reliable than the 2D SV method in this small study population. Further automation of 3D RT-VCFD is needed to improve the accuracy of peri-interventional MR quantification.


Assuntos
Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Volume Sistólico
15.
Praxis (Bern 1994) ; 102(15): 933-6, 2013 Jul 24.
Artigo em Alemão | MEDLINE | ID: mdl-23876691

RESUMO

We report the case of a 58 year old man with unspecific lower abdominal pain, respiratory failure and shock. An acute aortic syndrome and a massive pulmonary embolism were excluded, and a coronary angiography for suspected acute myocardial infarction was performed, with detection of a high-grade stenosis of the left main coronary artery. A percutaneous coronary intervention was needed. We discuss the difficulty to distinguish an acute aortic syndrome, an acute coronary syndrome, and a massive pulmonary embolism in the emergency situation. In addition we discuss the difficulty of detecting a left main coronary artery stenosis in the ECG.


Assuntos
Dor Abdominal/etiologia , Dispneia/etiologia , Infarto do Miocárdio/diagnóstico , Insuficiência Respiratória/etiologia , Choque Cardiogênico/diagnóstico , Angioplastia Coronária com Balão , Angiografia Coronária , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Choque Cardiogênico/terapia , Stents
16.
Praxis (Bern 1994) ; 102(7): 415-9, 2013 Mar 27.
Artigo em Alemão | MEDLINE | ID: mdl-23531910

RESUMO

We admitted a 42 year old woman with clinical signs of shock, coma, and ecg changes consistent with a ST elevation myocardial infarction to percutaneous coronary intervention. Normal coronary arteries were found. Due to the comatose state a cranial computed tomography scan was performed, where a subarachnoid hemorrhage was detected. We discuss the difficulty of diagnosing a subarachnoid hemorrhage, the pathophysiological cause of cardiac damage and ecg changes in acute neurological disease, and the differential diagnosis of ST elevation in the ecg.


Assuntos
Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Encéfalo/fisiopatologia , Dispneia/etiologia , Dispneia/fisiopatologia , Eletrocardiografia , Coração/inervação , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/fisiopatologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/fisiopatologia , Processamento de Sinais Assistido por Computador , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Adulto , Aneurisma Roto/terapia , Baixo Débito Cardíaco/diagnóstico , Baixo Débito Cardíaco/fisiopatologia , Angiografia Cerebral , Angiografia Coronária , Erros de Diagnóstico , Embolização Terapêutica , Feminino , Humanos , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/terapia , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
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