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  • MDPI AG  (4)
  • Freund, Ophir  (4)
  • 1
    Online-Ressource
    Online-Ressource
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 21 ( 2022-11-05), p. 6565-
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 21 ( 2022-11-05), p. 6565-
    Kurzfassung: Patients undergoing percutaneous coronary interventions (PCIs) are prone to a wide range of complications; one complication that is constantly correlated with a worse prognosis is acute kidney injury (AKI). Gender as an independent risk factor for said complications has raised some interest; however, studies have shown conflicting results so far. We aimed to investigate the possible relation of gender to the occurrence of AKI in STEMI patients undergoing PCI. This retrospective observational study cohort included 2967 consecutive patients admitted with STEMI between the years 2008 and 2019. Their renal outcomes were assessed according to KDIGO criteria (AKI serum creatinine ≥ 0.3 mg/dL from baseline within 48 h from admission), and in-hospital complications and mortality were reviewed. Our main results show that female patients were older (69 vs. 60, p 〈 0.001) and had higher rates of diabetes (29.2% vs. 23%, p 〈 0.001), hypertension (62.9% vs. 41.3%, p 〈 0.001), and chronic kidney disease (26.7% vs. 19.3%, p 〈 0.001). Females also had a higher rate of AKI (12.7% vs. 7.8%, p 〈 0.001), and among patients with AKI, severe AKI was also more prevalent in females (26.1% vs. 14.5%, p = 0.03). However, in multivariate analyses, after adjusting for the baseline characteristics above, the female gender was a non-significant predictor for AKI (adjusted OR 1.01, 95% CI 0.73–1.4, p = 0.94) or severe AKI (adjusted OR 1.65, 95% CI 0.80–1.65, p = 0.18). In conclusion, while females had higher rates of AKI and severe AKI, gender was not independently associated with AKI after adjusting for other confounding variables. Other comorbidities that are more prevalent in females can account for the difference in AKI between genders.
    Materialart: Online-Ressource
    ISSN: 2077-0383
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2022
    ZDB Id: 2662592-1
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 2
    In: Diagnostics, MDPI AG, Vol. 13, No. 14 ( 2023-07-11), p. 2335-
    Kurzfassung: Hypersensitivity pneumonitis (HP) is a heterogeneous interstitial lung disease (ILD) that may be difficult to confidently diagnose. Recently, the 2020 ATS/JRS/ALAT HP diagnostic guidelines were published, yet data validating their performance in real-life settings are scarce. We aimed to assess the diagnostic performance of the HP guidelines compared to the gold-standard multidisciplinary discussion (MDD). For this purpose, we included consecutive ILD patients that underwent diagnostic bronchoscopy between 2017 and 2020 in three large medical centers. Four diagnostic factors (antigen exposure history, chest computed tomography pattern, bronchoalveolar lavage lymphocyte count, and histology results) were used to assign guidelines-based HP diagnostic confidence levels for each patient. A sensitivity analysis was performed, with MDD diagnosis as the reference standard. Overall, 213 ILD patients were included, 45 (21%) with an MDD diagnosis of HP. The guidelines’ moderate (≥70%) confidence threshold produced optimal performance with 73% sensitivity for HP, 89% specificity, and a J-index of 0.62. The area under the receiver operating characteristic curve (AUC) for a correct guidelines-based diagnosis was 0.86. The guidelines had better performance for non-fibrotic than fibrotic HP (AUC 0.92 vs. 0.82). All diagnostic factors, except bronchoalveolar lavage lymphocyte count, were independent predictors for MDD diagnosis of HP in a multivariate analysis. In conclusion, the HP guidelines exhibited a good diagnostic performance compared to MDD diagnosis in real-life setting.
    Materialart: Online-Ressource
    ISSN: 2075-4418
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2023
    ZDB Id: 2662336-5
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 3
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 17 ( 2022-08-24), p. 4962-
    Kurzfassung: Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for patients with severe AS. Since the TAVR population and patients’ outcomes have dramatically changed over the last decade, updated data regarding contemporary practice and trends are pertinent to clinical use. We performed a retrospective observational analysis of consecutive patient who underwent TAVR for symptomatic severe AS between the years 2009 and 2021 in a single high-volume center. Patients were divided into four equal time groups based on the procedure date (2009–2012, 2013–2015, 2016–2018 and 2019–2021). A total of 1988 patients were included in this study and divided into four groups, with 321, 482, 565 and 620 patients in groups 1–4, respectively. Significant trends were seen in baseline characteristics of a few parameters, including lower age, lower procedural risk and reduced rates of comorbidity (p for trend 〈 0.0001 for all factors mentioned above). A shift was seen in the procedural technique with lower balloon pre-dilatation and higher device success rates (p for trend 〈 0.0001). The post-procedural period changed over the years with fewer pacemaker placements (p 〈 0.0001) and reduced rates of AKI and post-procedural bleed (p value 0.02 and 〈 0.0001, respectively). Furthermore, overall hospital stay was shortened from 7 ± 7.1 days to 2.3 ± 1.7 (p 〈 0.0001). Finally, patient follow up revealed reduced mortality rates at 30 days (p 〈 0.0001) and 1 year (p = 0.013). Multivariate regression revealed that a late implantation date was an independent protector from mortality (HR 0.84, p = 0.002). In conclusion, our study demonstrated that TAVR has become a safer practice over the years with reduced rates of morbidity and mortality.
    Materialart: Online-Ressource
    ISSN: 2077-0383
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2022
    ZDB Id: 2662592-1
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 4
    Online-Ressource
    Online-Ressource
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 16 ( 2022-08-16), p. 4781-
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 16 ( 2022-08-16), p. 4781-
    Kurzfassung: Physicians use Holter electrocardiography (ECG) monitoring to evaluate some patients with syncope in the internal medicine department. We questioned whether Holter ECG should be used in the presented setting. Included were all consecutive patients admitted with syncope to one of our nine internal medicine departments who had completed a 24 h Holter ECG between 2018 and 2021. A diagnostic Holter was defined as one which altered the patient’s treatment and met ESC/ACC/AHA diagnostic criteria. A total of 478 Holter tests were performed for syncope evaluation during admission to an internal medicine department in the study period. Of them, 25 patients (5.2%) had a diagnostic Holter finding. Sinus node dysfunction was the most frequent diagnostic recording (13 patients, 52%). In multivariant analysis, predictors for diagnostic Holter were older age (OR 1.35, 95% CI 1.08–1.68), heart failure with preserved ejection fraction (OR 4.1, 95% CI 1.43–11.72), and shorter duration to Holter initiation (OR 0.73, 95% CI 0.56–0.96). There was a positive correlation between time from admission to Holter and hospital stay, r(479) = 0.342, p 〈 0.001. Our results suggest that completing a 24 h Holter monitoring during admission to the internal medicine department should be restricted to patients with a high pre-test probability to avoid overuse and possible harm.
    Materialart: Online-Ressource
    ISSN: 2077-0383
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2022
    ZDB Id: 2662592-1
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
    BibTip Andere fanden auch interessant ...
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