Background: The lack of evidence with respect to complications with mitral valve approaches leaves the choice of exposure to the surgeon’s preference, basing it on individual experience, speed, ease, and quality of exposure. Methods: Analysis of patients undergoing mitral valve surgery by either a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first time elective mitral valve procedures, isolated or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. Primary endpoint was to determine the association between the superior transeptal approach and clinically significant adverse outcomes including arrhythmias, need for permanent pacemaker, cerebrovascular events, and mortalityResults: 652 patients met the inclusion criteria, 391 received the left atrial approach and 261 superior transseptal. After matching, 96 patients were compared with 69, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias and the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, however the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period, and in the long-term follow-up.Conclusion: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome, therefore we consider that the superior transeptal approach is useful and safe for mitral valve exposure.
Objetivo: este estudio busca describir los individuos evaluados por sobredosis de acetaminofén entre 2019 y 2020 en un centro de referencia de trasplante hepático en Colombia. Metodología: estudio derivado del análisis secundario de historias clínicas entre el 1.º de enero de 2019 y el 31 de diciembre de 2020. Los criterios de inclusión abarcan individuos con ingestión aguda y voluntaria de dosis tóxicas de acetaminofén (>4 g/día). Resultados: sesenta y tres casos, 68% mujeres, 67% menores de 18 años y 54% estudiantes. Reportó historia personal de enfermedad psiquiátrica el 60% y el 35% al menos un intento de suicidio previo. La mediana de dosis de acetaminofén fue 15g, 46% refirieron co-ingesta de otras sustancias y 13% estaba bajo efecto de sustancias psicoactivas. El 57% tenía la intención clara de suicidarse, así como 81% vomitó antes de acudir al servicio de urgencias, 22% recibió medidas de descontaminación y 10% no recibió N - acetilcisteína. Quince individuos desarrollaron lesión hepática aguda, nueve con criterios de severidad. Conclusiones: la población era predominantemente joven, la historia de enfermedad psiquiátrica fue muy prevalente y la mayoría refirieron un evento vital que explicara el comportamiento impulsivo de consumo. Ninguno desarrolló criterios para trasplante hepático, lo cual podría explicarse por la edad de los individuos, los episodios de vómito temprano, y la ausencia de enfermedad hepática crónica o de consumo de sustancias hepatotóxicas.
Background: Patients with coronavirus disease 2019 present an increase in oxidative stress, characterized by the production of reactive oxygen species and a concomitant deficiency of antioxidants. There are multiple defense mechanisms including enzymatic scavengers and non-enzymatic molecules (glutathione and vitamins A, C, D, E, and zinc). Methods: In this observational, cross-sectional, retrospective study, we aimed to describe the clinical behavior of patients hospitalized due to COVID-19 (those treated with a standardized nutritional intervention versus those who received the COVID-19 standard treatment available at the time). A total of 214 medical records of patients hospitalized due to COVID-19 who required nutritional intervention were analyzed. Descriptive analyses of continuous and categorical variables were performed, and an ANOVA test was performed for numerical variables. A logistic regression model and a propensity score matching determined the differences between the matched groups. Findings: 33•6% of the patients were admitted to the Intensive Care Unit (ICU), 28•5% required invasive mechanical ventilation, and the overall mortality was 19•6%. 44•8% of the patients received the standardized nutritional intervention. There were no statistically significant differences between intervention groups, except for the intervention time, in which the standardized nutritional intervention (days) was identified as a protective factor OR=0•550 (p <0•05; CI=0•324-0•936). Conclusions: This is the first study in Colombia to consider a standardized nutritional intervention in patients hospitalized due to COVID-19. Despite not being able to meet the primary objectives, controlled experiments must be carried out to determine the role and possible therapeutic effects of micro and macronutrients in patients with COVID-19.
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