Background We evaluated the effect of an intercurrent noncoronary illness on the management and outcome of patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods Consecutive hospitalized patients with a primary diagnosis of NSTEMI between August 2008 and December 2019 at Sheba Medical Center. All patients’ records were reviewed for the presence of a noncoronary precipitating event (NCPE): a major intercurrent acute noncoronary illness or condition, either cardiac or non-cardiac. The primary outcome was all-cause mortality. Cox regression with interaction analysis was applied. Results Final study population comprised 6,491 patients, of whom 2,621 (40%) had NCPEs. Patients with NCPEs were older (77 vs. 69 years) and more likely to have comorbidities. The most prevalent event was infection (35%, n = 922). During a median follow-up of 30 months, 2,529 patients died. Patients with NCPEs were 43% more likely to die during follow-up in a multivariable model (95% CI 1.31-1.55). Invasive strategy was associated with a 55% lower mortality among patients without NCPE and only 44% among patients with NCPE (P for interaction < .001). Dual antiplatelet therapy (DAPT) was associated with a 20% lower mortality in patients without NCEP and a nonsignificant mortality difference among patients with NCPE (P for interaction = 0.014). Sub-analysis by the specific NCPE showed the highest mortality risk among patients with infectious precipitant. The lower mortality associated with invasive strategy was not observed in this subgroup. Conclusion Among NSTEMI patients, the presence of an NCPE is associated with poor survival and modifies the effect of management strategies.
Purpose We reviewed the experience with adrenal ganglioneuroma (AGN) pathologically confirmed following adrenalectomy in medium- to high-volume medical centers. Methods The medical records of all adrenalectomy cases in 4 medical centers between 2006 and 2020 were retrospectively reviewed for demographics, clinical, radiological and laboratory findings, surgical treatment, pathology results, and outcomes. Results Twenty-five out of 875 adrenalectomy cases (2.9%) were pathologically confirmed as AGN. Those patients' average age was 40.5 years (range, 4–76 years), 13 (52.0%) were males, and 18 lesions (72.0%) were right-sided. One patient had a family history of neurofibromatosis, and another had a succinate dehydrogenase gene mutation. Abdominal/back pain attributed to mass effect was the most common symptom. All 25 patients underwent abdominal computerized tomography scanning in which the average maximal tumor diameter was 6.61 cm. The mean pre- and postcontrast Hounsfield units (HU) values were 35.2 and 59, respectively; and the mean late-phase HU value was 71.1. Twenty-two patients (88.0%) underwent minimally invasive surgery. The average tumor diameter recorded in the final pathology report was 7 cm. Isolated AGN was diagnosed in 21 cases (84.0%), and the additional components reported for the remaining 4 cases included pheochromocytoma (2), ganglioneuroblastoma (1), and neurofibroma (1). The average follow-up length was 16.8 months (range, 1–136 months), during which there was no recurrence or death. Conclusion AGN is a rare, slow-growing, large benign tumor with radiological characteristics similar to those seen in malignant tumor. Final diagnosis is established by pathology after surgical resection, preferably minimally invasive, with an overall excellent prognosis.
Objective:Adolescence elevated blood pressure is an emerging public health issue with growing evidence of its future deleterious cardiovascular and renal effects. Most data regarding systolic (SBP) and diastolic blood pressure (DBP) trajectories are based on surveys of selected adolescent populations within short periods of time. Our objective was to describe the secular trends of blood pressure and body mass index (BMI) throughout the years 1977-2020.Design and method:This nationwide population-based study comprised of 2,785,515 Israeli male and female (41.6%) adolescents (mean age 17.4 years) whose weight, height and blood pressure were routinely measured as part of comprehensive medical assessment prior to compulsory military service. Linear regression models were applied to calculate the P for trend along the study period separately for males and females. Predicted SBP and DBP adjusted for BMI, were calculated using the Analysis of Covariance.Results:Throughout study period, the mean BMI increased in males by 2.1 and 1.6 kg/m2 in females (P for trend < 0.001 in both sexes). The mean DBP decreased by 3.6 and 2.9 mmHg among males and females, respectively. (P < 0.001 in both sexes). While the mean SBP blood increased by 1.6 mmHg among males and decreased by 1.9 mmHg among females. These trends were consistent in models assessing BMI adjusted SBP and DBP. The trend were consistent in sub analyses stratifying the population by immigration status and by health status (existence of additional significant comorbidities).Conclusions:DBP among adolescents decreased over the the last 44 years, despite the significant increase in BMI and obesity prevalence in both sexes. Meanwhile, SBP increased slightly in males and decreased in females.
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