Internal and emergency medicine
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Poor outcome among patients undergoing myocardial perfusion imaging with intermediate-zone troponin.
Intermediate zone troponin elevation is defined as one to five times the upper limit of normal. Approximately half the patients presenting with chest pain to the emergency department have initial intermediate zone troponin. ⋯ Intermediate zone troponin elevation is an independent risk factor associated with adverse outcomes and therefore patients with an initial value in this range should be closely monitored and aggressively managed.
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Comparative Study
Comparison of characteristics and outcomes of patients admitted to hospital with COVID-19 during wave 1 and wave 2 of the current pandemic.
In this study of patients admitted with COVID-19, we examined differences between the two waves in patient characteristics and outcomes. Data were collected from the first COVID-19 admission to the end of study (01/03/2020-31/03/2021). Data were adjusted for age and sex and presented as odds ratios (OR) with 95% confidence intervals (CI). ⋯ Survivors of COVID-19 in wave 1 stayed longer in hospital (median = 6.5 days; interquartile range = 2.9-12.0) as compared to survivors from wave 2 (4.5 days; interquartile range = 1.9-8.7). Patient characteristics differed significantly between the two waves of COVID-19 pandemic. There was an improvement in outcomes in wave 2, including shorter length of stay in hospital and reduction of mortality.
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Tofacitinib has only been available in China for 2 years to treat rheumatoid arthritis (RA). Our purpose was to compare real-world effectiveness of tofacitinib with that of disease-modifying anti-rheumatic drugs (DMARDs) in Chinese patients with RA. The records of patients with RA treated at Guangdong Provincial People's Hospital between July 2017 and September 2019 were retrospectively reviewed. ⋯ All disease indices in the three groups decreased with time, indicating improvement of symptoms, with no differences among the groups at 12 months. Tofacitinib appeared to improve symptoms more rapidly than other treatments; however, differences in disease indices were not significant. This real-world study suggests that tofacitinib is rapidly effective and that the effects are sustained after 12 months in Chinese patients with RA.
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Military studies have identified significant trends in combat related preventable death, particularly with respect to limb hemorrhage. Little is known, however regarding preventable death due to firearms in the civilian patient population, or the anatomic distribution of these injuries. An understanding of this information and the applicability of military studies to the civilian patient population is critical to developing strategies for treating these injuries. ⋯ These four anatomic locations were the most likely to be classified as Critical-Red by prehospital providers: 62.66% of chest injuries, 54.22% of abdomen injuries, 48.42% of neck injuries, and 42.31% of back injuries. The NEMESIS data on patient acuity indicates that the number of firearm related preventable deaths due to torso injury may be significantly greater than those due to limb exsanguination. In addition to the focus on tourniquet use, research focused on improved prehospital care of firearm injuries to the torso may provide additional strategies for reducing preventable death.
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Eosinophilic granulomatosis with polyangiitis (EGPA) is defined the disease as having two subgroups, ANCA (+) and ANCA (-). We aimed to compare EGPA subgroups in terms of clinical features, outcomes, and treatments. A multidisciplinary team was established under our vasculitis centre since October 2014. ⋯ Consequently, both clinical features, disease activity, and treatments appear to be significantly different between EGPA subgroups. The relapse risk was similar although clinical features and treatment strategies were different. Also, elevated Ig E levels may be a precursor for the relapse.