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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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Effects of a percutaneous coronary intervention or conservative treatment strategy on treatment outcomes in elderly female patients with acute coronary syndrome


Aim. To determine the difference in hospital outcomes between percutaneous coronary intervention (PCI) and conservative treatment of elderly female patients hospitalized for acute coronary syndrome (ACS).

Material and Methods. This controlled study included 123 female patients admitted to the Clinic for heart and cardiovascular diseases University Hospital of Split with a diagnosis of ACS and multiple cardiovascular risk factors. We recorded their habits, history, demographics, presenting symptoms, electrocardiograms, ultrasound results, laboratory tests, diagnostic tests and treatment. We compared these data between the two groups, i.e., those treated with conservative therapy and those treated with PCI.

Results. There were fewer arrhythmias (P<0.001) and episodes of heart failure (P<0.001) during hospitalization in the PCI group than in the conservative therapy group. There was no significant difference in complications between the groups (P=0.887).

Conclusion. Elderly female patients with ACS treated with PCI had less arrhythmias and heart failure during hospitalization than those treated with conservative therapy and there was no difference in complications. These results suggest that even high risk patients have better outcomes after treatment with PCI, and therefore PCI is suggested as first-line treatment in these patients, regardless of risk factors.

Key words: percutaneous coronary intervention, acute coronary syndrome, women

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Unreported deaths in pediatric surgery and anesthesia: a national, twenty year report


Introduction. Pediatric perioperative mortality is extremely low but it is underreported in peer-reviewed journals, making it difficult to understand the magnitude of the problem. The aim of this study was to identify pediatric deaths reported by the mass media over a 20- year period in pediatric and non-pediatric hospitals.

Materials and methods. The international search engines Google, Yahoo, Bing, and the online archives of major newspapers were searched independently by 3 trained investigators (1st January 1995 to 1st January 2015) looking for children (<18 years old) who died in the perioperative period in Italy, excluding obstetrical or neonatal deaths.

Results. A total of 51 fatal events were identified with 41 cases (80%) being elective procedures. Most fatal events (31 cases, 61%) occurred in non-specialized hospitals, 12 cases (23%) occurred in high-volume non-pediatric hospitals, and 8 cases (16%) in pediatric hospitals. The most frequently represented operations were head/neck 21 cases (41%), abdominal 11 cases (21%), and orthopedic surgery 9 cases (18%). The reported causes of death were equally distributed between surgical (25 cases, 49%) and anesthesiological complications. The most common causes of death were hemorrhage (n=11), difficult airway management (n=10), infections (n=6), and allergic reactions (n=4). In 25% of cases (13 cases), the complication resulted in intraoperative death.

Conclusion. Our findings suggest that most pediatric deaths reported by mass media occurred in non-pediatric centers during elective surgical procedures (e.g. adenotonsillectomy and appendicectomy), suggesting that referral to large-volume or pediatric hospitals should be preferred. Moreover, one of the most commonly reported complications was difficult airway management, confirming that this aspect should have a central role in physician training and practice.

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Stray bullet injuries in a tertiary care center


Background. A stray bullet injury is defined as an accidental firearm injury occurring outdoors by an anonymous attacker. Stray bullet injuries are rare, but not uncommon in certain parts of the world. In Pakistan, 165 patients with stray bullet injuries were recorded between 2006 and 2010.

Objectives. In Lebanon, gunshots may occur during politicians’ speeches, funerals and after exam results are published. No studies to date have looked at the details and consequences of these gunshot injuries.

Methods. A retrospective chart review of patients presenting to an emergency department (ED) in Beirut, Lebanon, from 2010 to 2015, with clear stray bullet injuries was conducted. Variables included: demographics, injured body part, admission to hospital, number of days in hospital, length of stay in the ED, mortality, past medical history, emergency severity index, and consequences of injury including surgery.

Results. Out of 154 bullet injuries, 12 stray bullet injuries were recorded. Injuries of the lower extremity were most common, followed by the head, shoulder/thorax, abdomen/pelvis and upper extremity. Surgery was needed in 7 patients (58.3%). The median length of stay was 3.08 hours in the ED and 4.78 days in hospital. There were no recorded deaths. Consequences of each stray bullet injury are presented.

Conclusion. Stray bullet injuries are commonly reported on in news and media outlets. This is the first study in Lebanon and the region to document cases of stray bullet injuries presenting to the ED. Better laws and educational policies need to be implemented to help discourage this practice.

Key words: stray bullets, emergency department, injured body part, consequences of stray bullets, hospital admissions, severity of injury, surgical intervention, Lebanon

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Acute respiratory infection: first clinical manifestation of active infection with cytomegalovirus in HIV patients presenting to the emergency department


Introduction. Traditionally, digestive and ophthalmic symptoms have been described as predominant in the clinical presentation of active infection with cytomegalovirus (AICMV). Nevertheless, it seems that this has changed following the introduction of antiretroviral therapy (ART). Nowadays, respiratory infection (RI) in HIV-infected patients is the first reason for consulting an Emergency Department (ED). Among these patients, the mortality is important.

Aim. To determine if RI in HIV-infected patients is a common manifestation of AICMV and to describe the changes in clinical presentation of AICMV in relation to what was previously described.

Methods. A single-center, retrospective study was conducted over the duration of nine years (2005-2015). All HIV patients who consulted our emergency department with respiratory symptoms and were diagnosed with AICMV were included. Isolation of other co-infecting microorganisms and mortality in the series are also described.

Results. 56 HIV-infected patients with AICMV were identified. RI was diagnosed in 34 (61%), 31(91%) patients had pneumonia and 3(9%) pulmonary tuberculosis. The most frequently isolated microorganism was P. jirovecii, in 21 (68%) patients. Bacteria were isolated in five patients (15%). Five patients died from RI (9%). No patient had acute retinitis or any other ophthalmic involvement.

Conclusion. Clinical manifestation of AICMV in HIV patients has changed, and RI is the most common manifestation, caused by opportunistic microorganisms with 9% mortality.

Key words: HIV, infection respiratory, pneumonia, CMV

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Clonidine for neonatal abstinence syndrome: a single neonatology department’s experience


Clonidine has been shown effective in reducing sympathetic hyperactivity in neonatal abstinence syndrome (NAS). The aim of this study was to analyze clinical and laboratory characteristics of a group of newborns treated with clonidine for NAS due to maternal drug addiction and due to withdrawal from opioid analgesic therapy. Only one full–term newborn presented with metabolic acidosis and hyperkalemia; in others no clinical or laboratory adverse effects were detected. This report emphasizes the importance of alertness to potential adverse effects of clonidine therapy, and discusses possible pathophysiological aspects of hyperkalemia and metabolic acidosis during treatment for NAS.

Key words: newborn, sympathetic hyperactivity, metabolic acidosis, hyperkalemia

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