Objective: Chronic kidney disease (CKD) is characterized by decreased renal autoregulatory capacity, increased proteinuria, and direct transmission of systemic blood pressure to the glomeruli. Thereby, an increase in central (aortic) blood pressure (cBP) accelerates the progression of CKD. Antares is a pulse wave analysis algorithm designed to allow a non-invasive estimation of cBP using automated oscillometric blood pressure devices. We aimed to compare the invasively measured cBP with the estimated cBP using the Antares algorithm in patients with CKD. Design and method: 26 patients with stages 3-5 CKD (eGFR <60 ml/min/1.73m 2 , 88% stage 3 CKD, age 78±9 years, BMI 29±5 kg/m 2 , 65% male) were included and cBP was measured invasively during elective coronary angiography and simultaneously non-invasively using the custo screen 400 device (custo med GmbH, Ottobrunn, Germany) with the integrated Antares algorithm (Redwave Medical GmbH, Jena, Germany). Results: The mean difference for cBP was -0.7 ± 6.3 mmHg for central systolic BP (cSBP), -2.0 ± 5.1 mmHg for central mean arterial pressure (cMAP) and -4.2 ± 7.2 mmHg for central diastolic BP (cDBP). High correlations were found between estimated and invasively measured cBP (cSBP, r = 0.96; cMAP, r = 0.92; cDBP, r = 0.77; all p<0.001). Conclusions: The present study demonstrates that the Antares algorithm can estimate cBP with high accuracy in patients with CKD. Measurement of cBP and subsequent therapeutic interventions could improve renal and cardiovascular prognosis in these patients.
Im Juni 2013 ist die neue Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) zur Herzschrittmacher- (HSM) und kardialen Resynchronisationstherapie (CRT) erschienen. Die Empfehlungen zu den bradykarden Rhythmusstörungen wurden mit dem Ziel einer einfacheren klinischen Umsetzbarkeit neu strukturiert.
Author(s): Richter, Stefan Eisen | Advisor(s): Needleman, Jack | Abstract: Infections due to antibiotic-resistant Gram-negative rods (GNRs) result in high associated mortality and frequently have poor treatment options. To determine risk factors for recovery on culture of antibiotic resistant GNRs, cases were retrospectively analyzed at a major academic hospital system from 2011-2016. Three separate classes of antibiotics were studied - colistin (analyzed separately for GNRs and for Klebsiella Pneumoniae), carbapenems (analyzed separately for ertapenem and anti-Pseudomonal carbapenems), and aminoglycosides (analyzed separately for gentamicin/tobramycin and amikacin). In each case, bivariate associations were determined and used to develop multivariate models predicting the presence of resistance to the chosen antibiotic. Models had c-statistics ranging from 0.63 to 0.89. Common predictors included male gender, medical comorbidities, transfer from another healthcare facility, indicators of mechanical ventilation or tracheostomy, and recent antibiotic exposure. We then compared two strategies of treating empirically with either meropenem or colistin and performed sensitivity analyses to determine which strategy was preferable in terms of cost (low acuity) and avoidance of mortality (high acuity strategy) under several willingness-to-pay thresholds. Under base case assumptions, the meropenem-first strategy dominated in low acuity patients at a meropenem resistance rate of up to 10.9%. In high acuity patients, the colistin strategy was preferable with a willingness-to- pay per avoided death as low as $46,231; at $468,750 per avoided death, the colistin- first strategy was preferable with meropenem resistance rates as low as 5.5%. The model predicting likelihood of resistance to anti-Pseudomonal carbapenems can provide critical information in determining the optimal initial empiric antibiotic strategy.
Alveolar rhabdomyosarcoma is an aggressive tumour in adulthood, in which cardiac troponin T seems to be a tumour marker and course parameter. We present the clinical course of a young man suffering from this rare disease and the development of troponin T during therapy. Noninvasive cardiac imaging was used to exclude cardiac involvement, myocardial infarction or inflammation processes.
Abstract Background Daily bathing of ICU patients with chlorhexidine gluconate (CHG) is an important method for healthcare-associated infection prevention. We set out to understand the relationship between CHG concentrations and MDRO colonization Methods In our trauma/surgical ICU at a large urban medical center, we performed CHG concentrations 2 days/week at 4 times points relative to CHG bathing (Medline, Northfiled, IL) application: 30 min. prior, and 30 min., 6 hrs., and 12 hrs. after application. CHG testing was done at 4 body sites: lateral neck, anterior chest, arm, and inguinal fold. On the contralateral side we tested the presence of the following 4 MDROs: methicillin resistant S. aureus (MRSA), and 3 enteric bacteria--extended spectrum beta-lactamase (ESBL)+ gram-negative rods, vancomycin resistant enterococcus (VRE), and carbapenem resistant enterobacteriaceae (CRE). Results We performed testing for 256 patient-days total, of which 42 were swabbed 1 time, 38 swabbed twice, 79 swabbed 3 times, and 97 swabbed 4 times (patient movement for tests, ICU transfer were limitations). Mean CHG skin concentrations were above the MICs of pathogens at all post-CHG application time points at all body sites at all times points (Figure) and decreased during the time points after bathing. In a logistic regression model controlling for patient characteristics, MRSA detection was inversely associated with CHG concentration with an 18% increase in odds of recovery for each 2-fold decrease in CHG concentration, as well as presence of a GI device and lack of ability to sit and roll. In a logistic regression model controlling for patient characteristics, resistant enteric bacteria detection was inversely associated with CHG concentration with an 11% increase in odds of recovery for each 2-fold decrease in CHG concentration, as well as mechanical ventilation, GI device, central line, and ICU duration. Conclusion In our large study of CHG use and its association with MDRO detection, CHG concentrations decreased during the 24 hours after application, but were typically above concentrations considered adequate to kill MDROs. CHG concentration were inversely associated with the presence of MRSA and resistant enterics, suggesting that CHG application quality is a key component of the CHG bathing process. Disclosures Loren G. Miller, MD, MPH, Medline (Grant/Research Support, Other Financial or Material Support, Contributed product) Stryker (Other Financial or Material Support, Contributed product) Xttrium (Other Financial or Material Support, Contributed product) James A. McKinnell, MD, Medline (Grant/Research Support)
Background: Drug-coated balloons (DCB) are a novel therapeutic strategy for small native coronary artery disease. However, their safety and efficacy as compared to drug-eluting stents (DES) is poorly defined.
