Letteratura scientifica selezionata sul tema "Clinical School of Medicine (Woodstock, Vt.)"

Introduction: Ventricular Tachycardia (VT) ablation is indicated in patients with recurrent episodes of VT or ICD shocks despite the use of AAD. Hypothesis: to evaluate the clinical characteristics and follow-up of patients that underwent scar related VT ablation in a school hospital in south america. Methods: We collected and analyzed data of all VT ablation performed in our institution between 2013 and 2014. Results: During the 2-year period we performed 107 scar related VT ablation procedures in 86 patients with an age of 56.7±14 years-old, most were male (70,9%). Sixty (56%) presented Chagas disease, 17 (16%) ischemic, 13 (12%) dilated, 12 (11%) RVAD and 5 (5%) other cardiomyopathies and the mean LV EF was 36.9±12.4%. The ablation was performed with CARTO in 60 (56,1%), Ensite 3 (2,8%) and EP only mapping in 44 (41,1%) procedures. Epicardial mapping was performed in 65 procedures (60,7%), most frequent in Chagas patients (81,7%;P<0.001). There was complications in 6 (5,6%) procedures: one hemopericardium that open-chest surgery was necessary; two iliac artery dissection, both with conservative treatment; one complete AV block; one patient with refractory hypotension with the need of IABP and procedure interruption and one patient with late cardiac tamponade with the need of surgical drainage. In a median follow-up of 261 (Q1: 93 Q3: 479) days, 42 (40%) procedures presented recurrence in a median time of 40 (Q1: 7.5 Q3: 125) days. After the VT recurrence the ablation was repeated, and one patient underwent 4 ablation, 2 three ablations and 13 underwent two ablations. Following the last ablation, 61 (72.6%) patients remained free of VT recurrence (figure). Sixteen (19%) patients died in a median time of 34 (Q1: 14.75 Q3: 93) days following last ablation. Conclusion: Chagas disease was the most common cardiopathy in this population, where epicardial approach was frequently performed. After the last procedure, the majority of patients remained free of VT recurrence

Abstract Introduction Despite the fact not all women experience bleeding at first vaginal intercourse (BFVI), in some cultures failure to prove virginity on the wedding night (sheets/garments covered with blood) may have serious consequences for a woman (bullying, domestic violence, shame and even honor killings). Low awareness of the true frequency of BFVI and of individual variation of the anatomy of the hymen may lead to inaccurate conclusions in cases of sexual assault or “virginity testing” (VT) at schools and/or in clinical settings, which can have a drastic impact on the mental health of young women. In cultures where defloration is sacralized, young women tend to choose anal sex instead of vaginal, which bears further risks including higher hazard of HIV; women also tend to seek hymenoplasty often performed in secrecy (in many cases it cannot guarantee bleeding at following intercourse, as intended). Objective To evaluate the frequency of stereotypes surrounding BFVI among Russian-speaking women Methods An anonymous survey was completed by 6370 Russian-speaking women across different countries who have had at least one vaginal intercourse. We aimed to reach women from varying religious, socioeconomic and educational backgrounds. The survey included questions on whether women experienced BFVI and if not, whether it had any negative consequences; and list of questions regarding their feelings about virginity, hymen reconstruction and sex in general. The questionnaire was distributed by the authors and biomedical bloggers, via social media (Instagram, Facebook, and Telegram). Preliminary results are presented. Results Median age was 31 (15–70); 59% were married; 73.6% reported being raised in secular families. 21.2% - in religious families, and 2.1% - in strictly religious. 43,2% respondents denied having any BFVI; 42,3% confirmed BFVI; while 5,3% reported bleeding on following sexual encounters but not on first intercourse. A minority (3,6%) did not remember whether any bleeding was present. Among those who didn’t have BFVI, 75 (2,2%) reported long-lasting conflicts with partners, 166 (5%) reported withdrawal of their partners, 115 (3,5%)– mistrust, 88 (2,7%)– constant blaming, 37 (1,1 %) – emotional abuse, 2 (0,1%) – physical violence. Two hundred twenty-three (3.5%) women experienced VT at school, 76 (1.2%) referred themselves for VT, and 25 (0.4%) did so at the demand of their own family. Conclusions Traditions demonstrating BFVI associate with negative emotions and affect marital relationships as well as sexual health of women. Medical professionals should be aware of the frequency of BFVI; anatomy and gynecology books should reflect corresponding scientific findings. Myths about virginity should be addressed via media and opinion leaders to prevent gender based violence. Disclosure No.

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme Background The optimal method of risk stratification of hyp­ertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM. Methods This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization. Results The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness &gt;30mm, significant left ventricular outflow tract (LVOT) gradient of &gt; 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p&lt;0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively]. Conclusion LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.

Abstract Funding Acknowledgements Type of funding sources: None. Background/objectives: Recent studies have suggested that patients with premature ventricular complexes (PVCs) may have a higher risk of ischemic stroke. However, the data are limited and inconclusive. We conducted a systematic review and meta-analysis to investigate the association between PVCs and the risk of ischemic stroke. Methods A comprehensive literature review was conducted by searching for published articles indexed in MEDLINE and EMBASE databases from inception through September 25, 2020, to identify studies that compared the risk of ischemic stroke between patients with PVCs and individuals without PVCs. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of Dersimonian and Laird. Results A total of four observational studies (2 prospective and 2 retrospective cohort studies) with 42,677 participants met the eligibility criteria and were included in the meta-analysis. We found that patients with PVCs have a significantly higher risk of ischemic stroke than individuals without PVCs with the pooled RR of 1.31 (95% CI, 1.07-1.60, I2 = 43%). Conclusions: From our systematic review and meta-analysis, we found that PVCs are associated with a higher risk of ischemic stroke. Whether this association is causal and how it should be addressed in clinical practice require further investigations. Table 1Ofoma et al.Agarwal et al.Lin et al.Im et al.Year of publication2012201520152018Country of originUnited StatesUnited StatesTaiwanKoreaStudy designProspective cohort studyProspective cohort studyRetrospective cohort studyRetrospective cohort studyStudy subjectsCases: Cases were patients with PVCs who were diagnosed based on 2-minute ECG. Cases were identified from the 1987 to 1989 ARIC study. Comparators: Comparators were the rest of the patients in the study who did not carry a diagnosis of PVCs. The average follow-up time was 13 years. Patients with a history of stroke, CAD, SAH, and ICH were excluded from the analysis.Cases: Cases were patients with PVCs who were diagnosed based on routine ECG. Cases were identified from the 2003 to 2007 REGARDS study. Comparators: Comparators were the rest of the patients in the study who did not carry a diagnosis of PVCs. An average (SD) follow-up time was 6 (2) years. Patients with a history of stroke or TIA and hemorrhagic stroke were excluded from the analysis.Cases: Cases were patients with PVCs (&lt;720 beats/day) who were diagnosed based on 24-hour ECG monitoring. Cases were identified from the 2002 to 2004 Taipei Veterans General Hospital database. Comparators: Comparators were the rest of the patients in the database who did not carry a diagnosis of PVCs. The average follow-up time was 10 ± 1 years. Patients with a history of sustained or non-sustained VT, PPM, HF, MI, ablation, VHD, and PVCs &gt; 720 beats/day were excluded from the analysis.Cases: Cases were patients with PVCs (&gt;10%) who were diagnosed based on standard ECG or 24-hour ECG monitoring. Cases were identified from the 2013 to 2015 Kosin University database. Comparators: Comparators were the rest of the patients in the database who did not carry a diagnosis of PVCs. The average follow-up time was 4 years. Patients with a history of cardiomyopathy, VHD, CHD, hepatic or renal disease, and acute cardiovascular or cerebrovascular event within 3 months, any trauma or surgery within 3 months, hyperthyroidism, uncontrolled HT, malignancy, CTD, IHD, and any acute or chronic inflammatory disease were excluded from the analysis.Number of subjectsCases: 793Comparators: 13,700Cases: 1,415Comparators: 23,045Cases: 1,074 (Uniform PVCs), 1,166 (Multiform PVCs)Comparators: 1,111Cases: 203Comparators: 170Baseline characteristics of subjectsMean age, year: Cases: 55.97Comparators: 53.85 Mean BMI, kg/m2:Cases: 28.47Comparators: 27.61 Mean TC, mg/dL: Cases: 211.85Comparators: 214.69 Female: Case: 50.82%Comparators: 57.06% White: Case: 68.1%Comparators: 73.38% HT:Cases: 44.54 %Comparators: 32.80 % Diabetes:Cases: 13.98%Comparators: 10.76% Smoking:Cases: 25.73%Comparators: 25.83% Mean age, year: Cases: 68.3 ± 9.2 Comparators: 64.3 ± 9.3 Mean BMI, kg/m2:Cases: 29.2 ± 6.1Comparators: 29.3 ± 6.2 Mean SBP, mmHg:Cases: 130.1 ± 16.9 Comparators: 126.9 ± 16.4 Female:Cases: 45.4%Comparators: 59% Black: Cases: 41.9%Comparators: 39.9% EducationNo high school:Cases: 15.5%Comparators: 11.1% High school/no college:Cases: 26.3%Comparators: 25.6% College or professional: Cases: 58.2%Comparators: 63.3% Geographic regionNon-Belt:Cases: 47.2%Comparators: 43.9% Belt:Cases: 33.9%Comparators: 34.8% Buckle:Cases: 19.0%Comparators: 21.3% Previous heart disease: Cases: 25.4%Comparators: 12.2% HT:Cases: 64.7%Comparators: 56.2% DM: Cases: 21.8%Comparators: 19.1% AF: Cases: 9.7%Comparators: 7.8% LVH: Cases: 11.2%Comparators: 9.4% Current smoking:Cases: 13.0%Comparators: 14.0% Use of warfarin: Case: 3.5%Comparators: 2.7% Use of aspirin: Case: 48.1%Comparators: 40.9%Mean age, year: Cases: 58.7 ± 19.3 (Uniform PVCs), 65.7 ± 16.9 (Multiform PVCs)Comparators: 50.7 ± 20.1 Female:Cases: 44.9% (Uniform PVCs), 31.4% (Multiform PVCs)Comparators: 53.4% DM: Cases: 7.4% (Uniform PVCs), 9.4% (Multiform PVCs)Comparators: 5.6% HT: Cases: 31.2% (Uniform PVCs), 38.0% (Multiform PVCs)Comparators: 21.6% Hyperlipidemia: Cases: 7.4% (Uniform PVCs), 5.8% (Multiform PVCs)Comparators: 5.5% CKD: Cases: 1.4% (Uniform PVCs), 1.4% (Multiform PVCs)Comparators: 0.3% Cirrhosis: Cases: 0.8% (Uniform PVCs),0.8% (Multiform PVCs)Comparators: 0.5% AF: Cases: 6.7 % (Uniform PVCs), 6.8 % (Multiform PVCs)Comparators: 6.7% CLD: Cases: 2.6% (Uniform PVCs), 2.8% (Multiform PVCs)Comparators: 2.0% Use of AAD: Cases: 0.2% (Uniform PVCs), 0.5% (Multiform PVCs)Comparators: 0.5% Use of anti-HT: Cases: 16.4% (Uniform PVCs), 20.8 % (Multiform PVCs)Comparators: 12.2% Use of statin: Cases: 7.2 % (Uniform PVCs), 5.7% (Multiform PVCs)Comparators: 5.1% Mean age, year:Cases: 61.0 ± 15.2Comparators: 57.6 ± 16.4 Female: Cases: 56.7 %Comparators: 52.7% DM:Cases: 17.5 %Comparators: 20.0% HT:Cases: 28.4%Comparators: 30.6% CAD: Cases: 11.3%Comparators: 12.4% MedicationAmiodarone: Cases: 7.7%Comparators: 0% Propafenone: Cases: 1.0%Comparators: 0% Digoxin: Cases: 5.2%Comparators: 4.8% Beta-blocker:Cases: 53.6%Comparators: 8.2% CCB: Cases: 21.6%Comparators: 20% ARB & ACEI: Cases: 17.0%Comparators: 16.4% Statin: Cases: 39.4%Comparators: 37.6% Aspirin: Cases: 24.6%Comparators: 25.3% Clopidogrel: Cases: 13.4%Comparators: 12.0% VKA: Cases: 9.8%Comparators: 11.2%Diagnosis of PVCsPVCs were detected by 2-minute ECG.PVCs were detected by routine ECG. PVCs were detected by 24-hour Holter monitoring.PVCs were detected by standard ECG or 24-hour Holter monitoring.Diagnosis of strokeThe diagnosis of ischemic stroke was supported by annual telephone follow-up and a community surveillance system. Stroke was diagnosed by agreement of computer and reviewer classification. Disagreements were adjudicated by a second physician-reviewer.The diagnosis of ischemic stroke was supported by telephone follow-up every 6 months. Stroke events were defined following the WHO definition. The stroke was diagnosed and confirmed by an adjudication committee.Ischemic stroke was diagnosed by physicians and also confirmed by brain imaging.Ischemic stroke was determined by a neurologist if the patient felt painless, weakness, sudden numbness or dead feeling on one side of the body, sudden painless loss of vision, and sudden loss of ability to understand what people were saying and also confirmed by brain MRI in all patients.Confounder adjusted in the multivariate analysisAge, race, gender, BMI, HT, diabetes, smoking, TC levelsAge, sex, race, geographic region, education level, previous heart disease, SBP, use of antihypertensive medication, LVH, AF, DM, current smoking, use of warfarin and aspirinAge, sex, HT, DM, CKD, use of hypertensive medicationAge, AF, HT, LVH, E/E’, MR grade, NT-proBNPNewcastle-Ottawa scoreSelection: 4 stars Comparability: 2 stars Outcome: 3 starsSelection: 4 stars Comparability: 2 stars Outcome: 3 starsSelection: 3 stars Comparability: 1 star Outcome: 3 starsSelection: 4 stars Comparability: 2 stars Outcome: 3 starsBaseline characteristics of studies included in the meta-analysisAbstract Figure. Forest plot of the meta-analysis