Objectives
Differential diagnosis of COVID-19 includes a broad range of conditions. Prioritizing containment efforts, protective personal equipment and testing can be challenging. Our aim was to develop a tool to identify patients with higher probability of COVID-19 diagnosis at admission.
Methods
This cross-sectional study analyzed data from 100 patients admitted with suspected COVID-19. Predictive models of COVID-19 diagnosis were performed based on radiology, clinical and laboratory findings; bootstrapping was performed in order to account for overfitting.
Results
A total of 29% of patients tested positive for SARS-CoV-2. Variables associated with COVID-19 diagnosis in multivariate analysis were leukocyte count ≤7.7 × 10
3
mm
–3
, LDH >273 U/L, and chest radiographic abnormality. A predictive score was built for COVID-19 diagnosis, with an area under ROC curve of 0.847 (95% CI 0.77–0.92), 96% sensitivity and 73.5% specificity. After bootstrapping, the corrected AUC for this model was 0.827 (95% CI 0.75–0.90).
Conclusions
Considering unavailability of RT-PCR at some centers, as well as its questionable early sensitivity, other tools might be used in order to identify patients who should be prioritized for testing, re-testing and admission to isolated wards. We propose a predictive score that can be easily applied in clinical practice. This score is yet to be validated in larger populations.
ObjectiveTo evaluate our experience following the introduction of a percutaneous
program for endovascular treatment of aortic diseases using Perclose
Proglide® assessing efficacy, complications and identification of
potential risk factors that could predict failure or major access site
complications.MethodsA retrospective cohort study during a two-year period was performed. All the
patients submitted to totally percutaneous endovascular repair (PEVAR) of
aortic diseases and transcatheter aortic valve implantation since we started
the total percutaneous approach with the preclosure technique from November
2013 to December 2015 were included in the study. The primary endpoint was
major ipsilateral access complication, defined according to PEVAR trial.
ResultsIn a cohort of 123 patients, immediate technical success was obtained in 121
(98.37%) patients, with only two (0.82%) cases in 242 vascular access sites
that required intervention immediately after the procedure. Pairwise
comparisons revealed increased major access complication among patients with
>50% common femoral artery (CFA) calcification vs. none
(P=0.004) and > 50% CFA calcification
vs. < 50% CFA calcification
(P=0.002). Small artery diameter (<6.5 mm) also
increased major access complication compared to bigger diameters (> 6.5
mm) (P=0.027).ConclusionThe preclosure technique with two Perclose Proglide® for PEVAR is safe
and effective. Complications occur more often in patients with unfavorable
access site anatomy and the success rate can be improved with proper patient
selection.
Objective: Rhythm abnormalities following transcatheter aortic valve implantation
(TAVI) and indications for permanent pacemaker implantation (PPI) were reviewed,
which aren't well established in the current guidelines. New left bundle branch
block and atrioventricular block are the most common electrocardiographic
changes after TAVI. PPI incidence ranges from 9-42% for self-expandable and
2.5-11.5% for balloon expandable devices. Not only anatomical variations in
conduction system have an important role in conduction disorders, but different
valve characteristics and their relationship with cardiac structures as well.
Previous right bundle branch block has been confirmed as one of the most
significant predictors for PPI.
Symptomatic occlusion of the superior mesenteric artery can be treated by open repair, hybrid procedure, or endovascular revascularization. In most cases, endovascular procedures are done by the antegrade approach. We report a case of a 67-year-old woman who presented with acute-on-chronic mesenteric ischemia successfully treated by retrograde endovascular recanalization of an occluded common hepatomesenteric trunk through the inferior mesenteric artery and arc of Riolan.
previous thoracic surgery or chest radiation, comorbidities or overall frailty [2] .In this scenario, transcatheter aortic valve implantation (TAVI) has assumed an important role. It was initially designed for high risk patients, but now it can be used even in moderate risk ones [Society of Thoracic Surgeons (STS) score from 4% to 8%] [3] . Nevertheless, not all patients are candidates for TAVI, some due aortic root or valve abnormalities, others because additional cardiac procedures are needed (other valve replacement, coronary artery bypass grafting or repair of the aortic root).As alternatives to these difficulties, modern sutureless aortic prostheses have emerged. Since now, the Perceval prosthesis (LivaNova Biomedica Cardio Srl, Sallugia, Italy) has been considered the device that surgeons have more expertise. Its surgical implant allows complete and safe annulus decalcification and can be performed through minimally invasive procedures.A special subgroup of patients who could benefit from this device is that with a very small annulus, that could require aortic annular enlargement during aortic valve replacement or the elderly patients with comorbidities and calcified aorta.Considering that the Perceval sutureless aortic prosthesis is the most worldwide studied and implanted valve, this report
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