Internal and emergency medicine
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Reverse dipping blood pressure, generally regarded as a pathological condition, is frequently observed in patients with acute stroke. We aimed to assess the association of reverse dipping blood pressure with in-hospital mortality among critically ill patients with ischemic stroke. This is a retrospective study of patients in the Medical Information Mart for Intensive Care IV database with ischemic stroke requiring intensive care unit admission. ⋯ After adjusting for potential confounders, reverse dipping was associated with a higher likelihood of in-hospital mortality (adjusted OR, 1.59; 95% CI 1.21-2.11; p = 0.001). Reverse dipping blood pressure was associated with a higher mortality rate among critically ill patients with ischemic stroke. The circadian rhythm of blood pressure should warrant more attention in cerebrovascular neurocritical care.
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The accuracy of using HEART (history, electrocardiogram, age, risk factors, and troponin) scores with high-sensitivity cardiac troponin (hs-cTn) to risk stratify emergency department (ED) chest pain patients remains uncertain. We aim to compare the performance accuracy of determining major adverse cardiac event (MACE) among three modified HEART (mHEART) scores with the use of hs-cTn to risk stratify ED chest pain patients. This retrospective single-center observational study included ED patients with suspected acute coronary syndrome who had HEAR scores calculated and at least one hs-cTnI result. ⋯ The 30-day MACE rates were 0.53%, 1.37%, and 2.00% for patients whose hs-cTnI was beyond the cutoffs of LoD, LoQ, and URL, respectively. However, when low risk was defined as an mHEART score of 0-3, the 30-day MACE rates ranged from 0.33 to 0.62% across different mHEART scores. The mHEART score for risk stratification of low-risk chest pain patients shows acceptable accuracy in predicting MACE outcomes.
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The aim was to identify predictors for early identification of HFNC failure risk in patients with severe community-acquired (CAP) pneumonia or COVID-19. Data from adult critically ill patients admitted with CAP or COVID-19 and the need for ventilatory support were retrospectively analysed. HFNC failure was defined as the need for invasive ventilation or death before intubation. 60 patients with CAP and 185 with COVID-19 were included. 27 (45%) patients with CAP and 69 (37.3%) patients with COVID-19 showed HFNC failure. ⋯ ROC-analysis identified a respiratory rate of 27/min as the optimal cut-off for predicting HFNC failure, with a specificity of 59% and a sensitivity of 75%, and an oxygenation index after HFNC initiation of 99.6 (specificity 81%, sensitivity 74%). In COVID-19, an elevated CRB65-score at hospital admission and at HFNC-initiation was significantly associated with HFNC failure. In CAP and COVID patients an oxygenation index < 99.6, a respiratory rate > 27/min and a ROX index < 4.88 were predictors for HFNC failure whereas a CRB65 score > 3 at hospital admission and > 2 at HFNC start was predictive for HFNC failure in COVID-19.
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Eosinophilic oesophagitis (EoE) is a chronic and progressive immune-mediated condition, typically affecting young atopic male adults and potentially leads to organ dysfunction and fibrosis. The clinical spectrum widely varies -from non-troublesome dysphagia to food impaction- and hence the rate of misdiagnosis and diagnostic delay are high, especially when presenting with minor symptoms, such as heartburn and acid regurgitation. There have been several major therapeutic breakthroughs for the management of EoE in recent years. ⋯ Therefore, the early diagnosis of this disorder and specialist referral is if of great importance. The evaluation of alarm signs and typical presentation patterns should allow a more straightforward recognition. The emergency and internal medicine doctors should actively be involved in this process and take part to the multidisciplinary care of patients with EoE, to allow better patient care and clinical outcomes.