Background Coronavirus disease 2019 (COVID-19) had spread into a pandemic affecting healthcare providers worldwide. Heart failure patients with implanted cardiac devices require close follow-up in-spite of pandemic related healthcare restrictions. Methods Patients were retrospectively registered and clinical outcomes were compared of 61 remote monitored (RMG) versus 71 conventionally (in-office only) followed (CFG) cardiac device implanted, heart failure patients. Follow-up length was 12 months, during the COVID-19 pandemic related intermittent insitutional restrictions. We used a specified heart failure detection algorithm in RMG. This investigation compared worsening heart failure-, arrhythmia- and device related adverse events as primary outcome and heart failure hospitalization rates as secondary outcome in the two patient groups. Results No significant difference was observed in the primary composite end-point during the first 12 months of COVID-19 pandemic (p = 0.672). In RMG, patients who had worsening heart failure event had relative modest deterioration in heart failure functional class (p = 0.026), relative lower elevation of N terminal-pro BNP levels (p < 0.01) at in-office evaluation and were less hospitalized for worsening heart failure in the first 6 months of pandemic (p = 0.012) compared to CFG patients. Conclusions Specified remote monitoring alert-based detection algorithm and workflow in device implanted heart failure patients may potentially indicate early worsening in heart failure status. Preemptive adequate intervention may prevent further progression of deteriorating heart failure and thus prevent heart failure hospitalizations.
IntroductionThe impact of remote monitoring (RM) on clinical outcomes in heart failure (HF) patients with cardiac resynchronization therapy-defibrillator (CRT-D) is controversial. This study sought to evaluate the performance of an RM follow-up protocol using modified criteria of PARTNERS HF trial in comparison with a conventional follow-up scheme.Material and methodsWe compared cardiovascular (CV) mortality (primary endpoint), and hospitalization events for decompensated HF, and the number of ambulatory in-office visits (secondary endpoint) in CRT-D implanted patients with automatic RM utilizing daily transmissions (RM group, n=45) and conventional follow-up (CFU group, n=43) in a single-center, observational study.ResultsAfter a median follow-up of 25 months, a significant advantage was seen in the RM group in terms of CV mortality (1 vs. 6 death event, p=0.04), although RM follow-up was not an independent predictor for CV mortality (HR: 0.882; 95% CI 0.25-3.09; p=0.845). Patient CV mortality was independently influenced by hospitalization events for decompensated HF (HR: 3.24; 95% CI 8-84; p=0.022) during follow-up. We observed significantly fewer hospitalization events for decompensated HF (8 vs. 29 events, p=0.046) in the RM group. Furthermore a decreased number of total (161 vs. 263, p<0.01) and unnecessary ambulatory in-office visits (6 vs.19, p=0.012) were seen in RM group as compared to CFU group.ConclusionsFollow-up of CRT-D patients using automatic RM with daily transmissions based on modified PARTNERS HF criteria enabled more effective ambulatory interventions leading indirectly to improved CV survival. Moreover, RM directly decreased the number of HF hospitalizations and ambulatory follow-up burden compared to CRT-D patients with conventional follow-up.
A chloroquint napjainkban szisztémás autoimmun kórképek kezelésére használják, autoimmun szöveti károsodást gátló és immunomoduláns hatása miatt. Ritka, ám súlyos mellékhatása a szernek, hogy restriktív cardiomyopathia-szerű képet okozhat, ami fenotípus és hisztológiai kép tekintetében egyaránt a Fabry-kór kardiális manifesztációjára emlékeztet. Munkánkban egy 73 éves nőbeteg esetét mutatjuk be, akinek fulmináns lefolyású szívelégtelensége hátterében chloroquin-cardiomyopathia állt. A beteg anamnézisében tartós chloroquinszedés szerepelt, rheumatoid arthritise miatt. 71 éves, korában harmadfokú atrioventricularis blokk miatt igényelt végleges pacemaker-implantációt. 2 évvel később kardiális dekompenzáció miatt került intézeti felvételre. Ekkor transthoracalis echokardiográfia során masszív koncentrikus bal kamrai hipertrófia, közepes fokban csökkent szisztolés balkamra-funkció és restriktív típusú mitrális beáramlási görbe volt észlelhető. A beteg a kéthetes hospitalizáció során kompenzálható volt, azonban 1 hónapon belül súlyos állapotban rehospitalizációra került sor, ami fatális kimenetelű volt. A klinikai kép és az autopsziás lelet alapján felmerült Fabry-betegség gyanúja. Tekintettel azonban a beteg tartós chloroquin szedésére, chloroquin indukálta cardiomyopathiát valószínűsítettünk. A chloroquin kardiális jellegű mellékhatásai – bár az alkalmazási előírásban említésre kerülnek – kevésbé ismertek. Ajánlásokra lenne szükség azzal kapcsolatban, hogy milyen gyakran, milyen módszerrel javasolt a tartósan chloroquint szedő betegek kardiológiai szűrése.
Background: Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not be inferior to the standard modality in any aspect. Some complications specific to the technique, however, are severe and complication rate seem to be higher than in standard open surgery. Methods: In this paper the authors report their guiding principles in applying LC and methods of treatment, and describe the bile duct injuries of 2500 LCs accomplished during the past 4.5 years. Results: Seventeen ductal injuries occurred in the whole series, which means an overall incidence rate of 0.68%. Data obtained in the last period, however, show a decrease down to 0.14%. Following ductal injuries six ductal strictures became clinically apparent. The various complications of these injuries caused the death of two patients. Conclusions: The great number of intraoperatively undetected injuries, many of them arising not due to technical difficulties, suggest the possibility of an injury caused by electric current. Depending on the type of injury direct suture, T-tube drainage or biliodigestive anastomosis can equally be effective. Long established practice and experience can help reduce the occurrence of complications to the level in standard open surgery.
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