Stroke is the fifth leading cause of death and disability in the United States. According to World Heart Federation, every year, 15 million people suffer from stroke worldwide out of which nearly 6 million people die ...Stroke is the fifth leading cause of death and disability in the United States. According to World Heart Federation, every year, 15 million people suffer from stroke worldwide out of which nearly 6 million people die and another 5 million people are disabled. Out of many organs affected after stroke, one of them is eye. Majority of the stroke victims suffer vision loss due to stroke-induced retinal damage. However, stroke-induced retinal damage and microvascular changes have not been given paramount importance in understanding stroke pathophysiology and predicting its occurrence. Retinal imaging can be a very powerful tool to understand and predict stroke. This review will highlight the importance of retinal changes in predicting occurrence of stroke, major retinal changes, the relationship between retinal diseases and stroke and moreover, molecular mechanisms delineating the stroke induced-retinal changes and therapeutics associated with it.展开更多
Objective:To validate a better scoring system between CURB-65 and the pneumonia severity index(PSI)to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.Methods...Objective:To validate a better scoring system between CURB-65 and the pneumonia severity index(PSI)to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.Methods:A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota,Rajasthan.Relevant data about history,and general and systemic examination with laboratory investigations was collected.Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI.Sensitivity,specificity,positive predictive value,negative predictive value,and area under the curve were calculated.Continuous variables,means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data.Results:100 patients who tested positive for SARS-CoV-2 by RT-PCR were included;67 were male and 33 were female.58 patients had severe disease(SpO2≤90%)and 30 patients died.CURB-65 had an area under the curve(AUC)of 0.81 for predicting ICU admission,with a sensitivity of 92%and a specificity of 54%for high risk patients.Meanwhile,PSI had an AUC of 0.88,with a sensitivity of 83%and a specificity of 73%in high risk patients.In addition,CURB-65 had an AUC of 0.79 for predicting 30-day mortality,with a sensitivity of 60%and a specificity of 89%in high risk patients.PSI had an AUC of 0.71 for predicting 30-day mortality,with a sensitivity of 90%and a specificity of 46%in high risk patients.Conclusions:This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality.However,PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.展开更多
Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous clos...Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002–2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. Results 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79–0.87,P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62–0.89,P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27–0.42,P < 0.001) were lower as compared to the 1st tertile of hospital volume. Conclusion Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.展开更多
文摘Stroke is the fifth leading cause of death and disability in the United States. According to World Heart Federation, every year, 15 million people suffer from stroke worldwide out of which nearly 6 million people die and another 5 million people are disabled. Out of many organs affected after stroke, one of them is eye. Majority of the stroke victims suffer vision loss due to stroke-induced retinal damage. However, stroke-induced retinal damage and microvascular changes have not been given paramount importance in understanding stroke pathophysiology and predicting its occurrence. Retinal imaging can be a very powerful tool to understand and predict stroke. This review will highlight the importance of retinal changes in predicting occurrence of stroke, major retinal changes, the relationship between retinal diseases and stroke and moreover, molecular mechanisms delineating the stroke induced-retinal changes and therapeutics associated with it.
文摘Objective:To validate a better scoring system between CURB-65 and the pneumonia severity index(PSI)to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.Methods:A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota,Rajasthan.Relevant data about history,and general and systemic examination with laboratory investigations was collected.Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI.Sensitivity,specificity,positive predictive value,negative predictive value,and area under the curve were calculated.Continuous variables,means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data.Results:100 patients who tested positive for SARS-CoV-2 by RT-PCR were included;67 were male and 33 were female.58 patients had severe disease(SpO2≤90%)and 30 patients died.CURB-65 had an area under the curve(AUC)of 0.81 for predicting ICU admission,with a sensitivity of 92%and a specificity of 54%for high risk patients.Meanwhile,PSI had an AUC of 0.88,with a sensitivity of 83%and a specificity of 73%in high risk patients.In addition,CURB-65 had an AUC of 0.79 for predicting 30-day mortality,with a sensitivity of 60%and a specificity of 89%in high risk patients.PSI had an AUC of 0.71 for predicting 30-day mortality,with a sensitivity of 90%and a specificity of 46%in high risk patients.Conclusions:This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality.However,PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.
文摘Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002–2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. Results 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79–0.87,P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62–0.89,P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27–0.42,P < 0.001) were lower as compared to the 1st tertile of hospital volume. Conclusion Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.
