NEJM Group’s Post

Based on the results of this clinical trial, how should we address the question asked in the title? As always, the answer is more complex than a simple Yes or No. Clinicians should take an individualized approach, combining the best available evidence with clinical context and patient preference. Similar to non-COVID ARDS, in C-ARDS, without additional evidence, the use of iNO should be primarily reserved for patients with refractory hypoxemia, severe pulmonary hypertension, and right ventricular failure. Future clinical trials could concentrate on preventing intubation or rescuing more severely affected patients with higher predicted morbidity and mortality. The direct effects of high-dose iNO on viral replication and inflammation require further study.

🩺Case Study: Multiple Renal Infarctions in a Cat 🔍 Clinical Presentation A middle-aged cat presented with lethargy, dehydration, and decreased appetite. Physical examination revealed abdominal discomfort, and blood tests indicated azotemia. 📊 Diagnostics Ultrasound showed hypoechoic areas in both kidneys, suggestive of infarcts. Further diagnostic workup included blood pressure monitoring (hypertension confirmed) and a coagulation panel, ruling out coagulopathies. Doppler ultrasound confirmed reduced blood flow to affected renal areas. 🧪 Underlying Causes Common causes of renal infarctions include: Thromboembolism (often secondary to cardiac disease, hyperthyroidism, or neoplasia) Septic emboli Vasculitis (autoimmune or infectious) In this case, underlying heart disease (HCM) was diagnosed as the primary cause. 💊 Treatment Fluid therapy to support hydration and renal perfusion Antithrombotic therapy (clopidogrel) to prevent further embolic events Antihypertensive medications Close monitoring of renal function

This study examines the association between complications arising from Extracorporeal Membrane Oxygenation (ECMO) treatment and in-hospital mortality among adult patients. It involves a retrospective analysis of 856 ECMO interventions, revealing that vascular and cerebrovascular complications occurred in 20.2% and 13.6% of cases, respectively. The overall in-hospital mortality rate was 48.7%. #CerebrovascularComplications #ECMO #InHospitalMortality #VascularComplications

Acute Aortic Dissection (AAD) is a life-threatening condition characterized by the rapid development of an intimal flap. Dissection can spread in an antegrade or retrograde fashion, involving side branches, and cause complications such as malperfusion syndrome due to the dynamic or static obstruction (from coronary to iliac arteries), tamponade, or aortic insufficiency. The incidence of MI among Stanford Type A AAD patients is 1-2% due to the compromise of the coronary ostium by the hematoma or intimal flap Type A aortic dissection involving coronary ostia has a high mortality rate of 1-2% per hour after symptom onset Carefully illustrated history and clinical examination may also miss the diagnosis of AAD; hence, the point of contact diagnostic non-invasive test should be implied with utmost sensitivity to screen this lethal disease, which often mimics acute MI, leading to significant misdiagnosis and potentially hazardous management with thrombolysis. The use of more than two screening imaging tests is immensely helpful in improving the predictive power.

Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers

VIDAS® High sensitive Troponin I Delivering a diagnosis in only 2 hours VIDAS® High sensitive Troponin I is a useful aid to optimize the management of Acute Coronary Syndromes (ACS). 👇Did you know? Every year, 16 million people worldwide die of cardiovascular diseases, specifically heart attacks or stroke (1). Chest pain is among the top 10 reasons to visit an emergency department (ED), accounting for about 5% of all ED visits (2). Expected prevalence of acute myocardial infarction (MI) in chest pain patients in the ED is between 5 and 10% for ST-segment elevation MI (STEMI) and 15 and 20% for non-ST segment elevation MI (NSTEMI)(3). ✅️Our VIDAS® High sensitive Troponin I assay helps deliver accurate diagnosis of MI in only 2 hours for improved patient outcomes and optimized patient management in the ED. BIOMERIEUX | PIONEERING DIAGNOSTICS. RJTC | QUALITY IS OUR PRIORITY.

Kidney function–specific cut-off values of high-sensitivity cardiac troponin T for the diagnosis of acute myocardial infarction Clinical Kidney Journal, Volume 17, Issue 9, September 2024, sfae247, https://lnkd.in/dZqTiNhh Published: 23 August 2024 In patients with kidney dysfunction, using the traditional cut-off value of high-sensitivity cardiac troponin T (hs-cTnT) reduced the specificity for diagnosing AMI. This study adds the kidney function –specific cut-off values of hs-cTnT determined in patients with varying level of an estimated glomerular filtration rate by a principle without sacrificing sensitivity, were developed, and validated the improved specificity in the validation cohort. The kidney function–specific cut-off values were determined as: 14, ng/L for GFR > 60 mL/min/1.73 m2, 18 ng/L for GFR 30 - 60 mL/min/1.73 m2, 48 ng/L for patients with eGFR <30 mL/min/1.73 m2

📃Scientific paper: Effects of resistance training on patients with End-Stage Renal Disease: an umbrella review with meta-analysis of the pooled findings Abstract: Objectives This umbrella review aimed to review the effects of resistance training on patients with end-stage renal disease and assess the methodological quality of the available literature. Methods An umbrella review and meta-meta-analysis was performed. A systematic search was conducted until May 2022. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The meta-meta-analyses were performed with a random-effects model and the summary statistics were presented in the form of a forest plot with a weighted compilation of all standardized mean differences and corresponding 95% confidence interval. Twenty-four reviews were eventually included. The protocol was registered in the international registry PROSPERO (CRD42022321702). Results Resistance training showed positive effects on functional capacity ( g  = 0.614), aerobic capacity ( g  = 0.587), health-related quality of life ( g  = 0.429), and peak force ( g  = 0.621). Fifteen of the included studies (63%) presented low risk of bias, and the remaining studies (37%) showed unclear risk of bias. Conclusion Resistance training in patients undergoing hemodialysis is an intervention that shows positive results regarding physical and functional outcomes. The quality level of the literature is inconclusive, but the included studies present low risk of bias. Graphical abstract Continued on ES/IODE ➡️ https://etcse.fr/fsH2I ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

The literature notes the scarcity of surgical revascularization in LVD patients in randomized studies, with observational data supporting coronary revascularization's benefits. ONCABG is recommended for multivessel disease in LVD with LVEF < 35%, while OPCAB is proposed for older, high-risk patients. Strategies like internal thoracic artery skeletonization harvesting and postoperative glycemic control mitigate risks with BITA in uncontrolled diabetes. Total arterial revascularization maximizes long-term survival, and hybrid revascularization offers advantages like shorter hospital stays and reduced costs for significant LAD lesions.

Our latest study focuses on acute myocardial infarction-related cardiogenic shock treated with VA ECMO, specifically highlighting bleeding, ischemic complications and the management of antiplatelet and anticoagulation therapies: - 39% of patients experienced severe bleeding (BARC >3a) - 31% of patients developed thrombocytopenia with levels lower than 50 g/L - 19% had hypofibrinogenemia (less than 1.5 g/L) during the ECMO course -32% discontinuation rate of dual antiplatelet therapy - 6% incidence of stent thrombosis in ICU Factors associated with severe bleeding included: - female sex - duration on ECMO (in days) - troponin levels - Impella use Managing these patients are particularly challenging due to the accumulation of multiple bleeding risk factors.