IntroductionCOVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity.Methods and analysesWe will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo). All eligible subjects will be consecutively invited to undergo a 1–2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6–9 months and 12–15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics.Ethics and disseminationAll components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.Trial registration numberRBR-8z7v5wc; Pre-results.
There was no evidence of impaired QoL in patients with an ICD. However, ICD patients must be educated of all possible risks and benefits, including transitory declines in QoL after ICD shocks.
BackgroundVenous obstructions are common in patients with transvenous cardiac
implantable electronic devices, but they rarely cause immediate clinical
problems. The main consequence of these lesions is the difficulty in
obtaining venous access for additional leads implantation.ObjectivesWe aimed to assess the prevalence and predictor factors of venous lesions in
patients referred to lead reoperations, and to define the role of
preoperative venography in the planning of these procedures.MethodsFrom April 2013 to July 2016, contrast venography was performed in 100
patients referred to device upgrade, revision and lead extraction. Venous
lesions were classified as non-significant (< 50%), moderate stenosis
(51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral
circulation was classified as absent, discrete, moderate or accentuated. The
surgical strategy was defined according to the result of the preoperative
venography. Univariate analysis was used to investigate predictor factors
related to the occurrence of these lesions, with 5% of significance
level.ResultsModerate venous stenosis was observed in 23%, severe in 13% and occlusions in
11%. There were no significant differences in relation to the device side or
the venous segment. The usefulness of the preoperative venography to define
the operative tactic was proven, and in 99% of the cases, the established
surgical strategy could be performed according to plan.ConclusionsThe prevalence of venous obstruction is high in CIED recipients referred to
reoperations. Venography is highly indicated as a preoperative examination
for allowing the adequate surgical planning of procedures involving previous
transvenous leads.
Background:Complications after surgical procedures in patients with cardiac implantable
electronic devices (CIED) are an emerging problem due to an increasing
number of such procedures and aging of the population, which consequently
increases the frequency of comorbidities.Objective:To identify the rates of postoperative complications, mortality, and hospital
readmissions, and evaluate the risk factors for the occurrence of these
events.Methods: Prospective and unicentric study that included all individuals undergoing
CIED surgical procedures from February to August 2011. The patients were
distributed by type of procedure into the following groups: initial
implantations (cohort 1), generator exchange (cohort 2), and lead-related
procedures (cohort 3). The outcomes were evaluated by an independent
committee. Univariate and multivariate analyses assessed the risk factors,
and the Kaplan-Meier method was used for survival analysis.Results: A total of 713 patients were included in the study and distributed as
follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative
complications were detected in 7.5%, 1.6%, and 11.8% of the patients in
cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up,
there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors
of hospital readmission included the use of implantable
cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class
III-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of
mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR
= 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR
= 2.3).Conclusions: Postoperative complications, hospital readmissions, and deaths occurred
frequently and were strongly related to the type of procedure performed,
type of CIED, and severity of the patient's underlying heart disease.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.