Rodriguezmedeiros8813

INTRODUCTION The purpose of this study was to investigate the prevalence of illicit drug use among patients admitted with traumatic orthopaedic injuries and to determine its effect on hospital length of stay (LOS). We hypothesized that patients with pre-injury drug use would have a longer hospital LOS compared to those who do not use drugs. METHODS We conducted a retrospective cohort study at our level 1 urban trauma center of patients admitted with traumatic orthopaedic injuries between 2013 and 2015 with urine toxicology screening. We collected demographic and hospital LOS data from chart review. RESULTS Of 611 patients, over half (55%) had a positive drug screen marijuana (41%), amphetamine (19%), cocaine (7%), and/or PCP (2%). The highest incidence of drug use was in males under 19 years of age (81%). Patients with any drug use had a longer hospital LOS compared to those who did not use drugs (8.3 vs. 6.3 days; p = 0.03). Patients who used amphetamines had a longer hospital LOS than those patients who did not (9.5 vs. 6.9 days; p = 0.01). CONCLUSION Compared to the orthopaedic trauma population two decades ago, the current population using illicit drugs is younger ( less then 30 years) with an increased preference for amphetamine and marijuana and a decreased preference for cocaine. Pre-injury drug use was associated with a longer hospital LOS in patients with a traumatic orthopaedic injury. Knowledge of the current trends in illicit drug use amongst orthopaedic trauma patients could facilitate medical decision-making regarding clinical care and optimizing resource utilization in this complex population of individuals. The recently reported ISCHEMIA trial will reignite the debate regarding the optimal first diagnostic test when evaluating chest pain in patients suspected to have coronary artery disease. This article considers whether the debate should be refocused even before selecting any diagnostic test. The case is made to prioritize risk factor management and empiric angina pectoris control as part of optimal secondary prevention followed by expeditious clinical reassessment to determine adequacy of therapeutic responses, including quality of life, before embarking on diagnostic testing. Once anatomical coronary artery disease is known in diagnostic algorithms that incorporate cardiac computed tomographic angiography, there is the potential to forego an adequate trial of conservative management, thereby failing to translate the key finding of ISCHEMIA to practice. Embedded in this "Symptom-driven Path" is the principle that definitive diagnostic testing must be expeditious if symptoms persist or deteriorate and impair quality of life during conservative management. This strategy would ensure appropriate utilization of contemporary conservative management which is replete with numerous effective pharmacotherapies that modify atherosclerosis and dramatically reduce cardiovascular risk. In conclusion, diagnostic testing and invasive therapy would be minimized and dictated primarily by adequacy of patient symptoms and quality of life. Described herein is a 42-year-old woman who suddenly developed a spontaneous isolated coronary arterial dissection which led to massive acute myocardial infarction with shock, unsuccessful coronary artery bypass grafting, transiently successful extracorporeal life support, and finally successful heart transplant. Such a sequence of events is exceedingly rare for patients with coronary dissection and prompted this report. see more Patients with cirrhosis often have concomitant coronary artery disease and require percutaneous coronary intervention (PCI). PCI in cirrhotics can be associated with significant risks due to thrombocytopenia, possible coagulopathies, bleeding, and renal failure. Longer term risks of PCI in cirrhotics have not been well studied. Our study seeks to evaluate the 90-day outcomes of PCI in patients with cirrhosis. Patients receiving PCI were identified from the Nationwide Readmissions Database from 2010 to 2014 and stratified by the presence of co-morbid cirrhosis. The total mortality during index admission and 90-day readmissions as well as the readmissions rate were examined. Adverse events including bleeding, stroke, kidney injury, and vascular complications were also compared. Patients with cirrhosis had a significantly higher number of co-morbidities. The cirrhosis group had a higher overall 90-day mortality (10.3% vs 2.5%, p less then 0.01), including during the index hospitalization (7.0% vs 1.8%, p less then 0.01), as well as a higher 90-day readmission rate (38.2% vs 20.2%, p less then 0.01). Patients with cirrhosis also had higher frequencies of overall 90-day adverse events (44.7% vs 17.7%, p less then 0.01), including gastrointestinal bleeding (15.3% vs 2.7%, p less then 0.01) and acute kidney injury (28.4% vs 10.1%, p less then 0.01). In conclusion, patients with cirrhosis face a significantly higher risk of adverse outcomes including mortality, readmissions, and adverse events in the 90 days after hospitalization for PCI compared with the general population. The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities.