Aim
In a prior study of seven North American cities Pittsburgh had the highest crude rate of cardiac arrest deaths in patients 18 to 64 years of age, particularly in neighborhoods with lower socioeconomic status (SES). We hypothesized that lower SES, associated poor health behaviors (e.g., illicit drug use) and pre-existing comorbid conditions (grouped as socioeconomic factors [SE factors]) could affect the type and severity of cardiac arrest, thus outcomes.
Methods
We retrospectively identified patients aged 18 to 64 years treated for in-hospital (IHCA) and out-of hospital arrest (OHCA) at two Pittsburgh hospitals between January 2010 and July 2012. We abstracted data on baseline demographics and arrest characteristics like place of residence, insurance and employment status. Favorable cerebral performance category [CPC] (1 or 2) was our primary outcome. We examined the associations between SE factors, cardiac arrest variables and outcome as well as post-resuscitation care.
Results
Among 415 subjects who met inclusion criteria, unfavorable CPC were more common in patients who were unemployed, had a history of drug abuse or hypertension. In OHCA, favorable CPC was more often associated with presentation with ventricular fibrillation/tachycardia (OR 3.53, 95% CI 1.43-8.74, p=0.006) and less often associated with non-cardiovascular arrest etiology (OR 0.22, 95% CI 0.08-0.62, p=0.004). We found strong associations between specific SE factors and arrest factors associated with outcome in OHCA patients only. Significant differences in post-resuscitation care existed based on injury severity, not on SES.
Conclusions
SE factors strongly influence type and severity of OHCA but not IHCA resulting in an association with outcomes.
Use of POCUS by EMS physicians to detect cardiac activity in OHCA is feasible and correlates with expert interpretation. Several avoidable barriers were identified and should be considered in the future implementation of prehospital POCUS. Larger studies are needed to determine what role POCUS may play in prehospital cardiac arrest management.
We investigated the prevalence of human papillomavirus (HPV) and its pathologic correlation in an adolescent clinic population (13-20 years, mean 16 years) over a 2-year period. 413 cervical specimens were obtained and analyzed cytologically and by a Southern Blot (SB) method for HPV DNA. 277 specimens from 210 patients could be fully analyzed. 23 patients (10.9%) were positive for HPV DNA by SB. Cytologic findings in these 23 patients demonstrated changes compatible with low-grade squamous intraepithelial lesions (LGSIL) and HPV-associated changes in 4 cases (17%). Cervical biopsies obtained in 3 cases with abnormal cytology demonstrated LGSIL in all cases. 6 patients were retested for HPV 2 to 6 months after the initial positive, two showed persistence of the initial virus, one was positive for a different HPV type and three were negative for HPV DNA.
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