- Publikační typ
- kazuistiky MeSH
There are several differences between younger and older adults with acute coronary syndrome (ACS). However, few studies have evaluated these differences. We analysed the pre-hospital time interval [symptom onset to first medical contact (FMC)], clinical characteristics, angiographic findings, and in-hospital mortality in patients aged ≤50 (group A) and 51-65 (group B) years hospitalised for ACS. We retrospectively collected data from 2010 consecutive patients hospitalised with ACS between 1 October 2018 and 31 October 2021 from a single-centre ACS registry. Groups A and B included 182 and 498 patients, respectively. ST-segment elevation myocardial infarction (STEMI) was more common in group A than group B (62.6 and 45.6%, respectively; P < 0.001). The median time from symptom onset to FMC in STEMI patients did not significantly differ between groups A and B [74 (40-198) and 96 (40-249) min, respectively; P = 0.369]. There was no difference in the rate of sub-acute STEMI (symptom onset to FMC > 24 h) between groups A and B (10.4% and 9.0%, respectively; P = 0.579). Among patients with non-ST elevation acute coronary syndrome (NSTE-ACS), 41.8 and 50.2% of those in groups A and B, respectively, presented to the hospital within 24 h of symptom onset (P = 0.219). The prevalence of previous myocardial infarction was 19.2% in group A and 19.5% in group B (P = 1.00). Hypertension, diabetes, and peripheral arterial disease were more common in group B than group A. Active smoking was more common in group A than group B (67 and 54.2%, respectively; P = 0.021). Single-vessel disease was present in 52.2 and 37.1% of participants in groups A and B, respectively (P = 0.002). Proximal left anterior descending artery was more commonly the culprit lesion in group A compared with group B, irrespective of the ACS type (STEMI, 37.7 and 24.2%, respectively; P = 0.009; NSTE-ACS, 29.4 and 21%, respectively; P = 0.140). The hospital mortality rate for STEMI patients was 1.8 and 4.4% in groups A and B, respectively (P = 0.210), while for NSTE-ACS patients it was 2.9 and 2.6% in groups A and B, respectively (P = 0.873). No significant differences in pre-hospital delay were found between young (≤50 years) and middle-aged (51-65 years) patients with ACS. Although clinical characteristics and angiographic findings differ between young and middle-aged patients with ACS, the in-hospital mortality rate did not differ between the groups and was low for both of them.
- Publikační typ
- časopisecké články MeSH
Many scoring systems for predicting the outcomes of patients with acute coronary syndrome (ACS) have been proposed. In some populations, a significant reduction in length of hospital stay may be achieved without compromising patient prognoses. However, the use of such scoring systems in clinical practice is limited. The aim of this study was to propose a universal list of predictors that can identify low-risk ACS patients who may be eligible for an earlier hospital discharge without increased short-term risk for major adverse cardiac events. A cohort of 1420 patients diagnosed with ACS were enrolled into a single-centre registry between October 2018 and December 2020. Clinical, laboratory, echocardiographic, and angiographic measurements were taken for each patient and entered into the study database. Using retrospective univariant analyses of patients treated with percutaneous coronary intervention (PCI) (n = 932), we compared each predictor to 30-day mortality rate using the Czech national registry of dead people. Eleven predictors correlate significantly with 30-day survival: age <80 years, ejection fraction >50%, no cardiopulmonary resuscitation, no mechanical ventilation needed, Killip class I at admission, haemoglobin levels >110 g/L while hospitalized, successful PCI procedure(s), no residual stenosis over 90%, Thrombolysis in Myocardial Infarction 3 flow after PCI, no left main stem disease, and no triple-vessel coronary artery disease. In all, presence of all predictors applies to 328 patients (35.2% of the cohort), who maintained a 100% survival rate at 30 days. A combination of clinical, echocardiographic, and angiographic findings provides valuable information for predicting the outcomes of patients with all types of ACS. We created a simple, useful tool for selecting low-risk patients eligible for early discharge.
- Publikační typ
- časopisecké články MeSH
Defining the risk factors affecting the prognosis of patients with acute coronary syndrome (ACS) has been a challenge. Many individual biomarkers and risk scores that predict outcomes during different periods following ACS have been proposed. This review evaluates known outcome predictors supported by clinical data in light of the development of new treatment strategies for ACS patients during the last three decades.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Příčiny novorozenecké hyperbilirubinémie se v asijské a kavkazské populaci liší. V asijské populaci je popisován zvýšený výskyt asijské formy Gilbertova syndromu (GS), jihovýchodoasijské ovalocytózy, deficitu 6-glukózafosfátdehydrogenázy, talasemie a srpkovité anémie. Popisujeme případ vietnamského donošeného eutrofického chlapce z druhé gravidity, který byl přijatý k hospitalizaci pro výrazný ikterus a únavu s nekonjugovanou hyperbilirubinémií 455 µmol/l. Laboratorní vyšetření nepodporovala podezření na aloimunizaci (krevní skupina dítěte 0+, matky B+, přímý Coombsův test negativní), ani na zvýšenou hemolýzu (retikulocyty 5,8 ‰), jaterní testy byly v normě. Hladina bilirubinu na fototerapii rychle klesla, chlapec byl propuštěn do sledování PLDD, kde byly hladiny stabilní. Ve třech týdnech věku se vrací s hladinou 389 µmol/l. Přímo indikované molekulárně genetické vyšetření dokumentovalo bodovou mutaci c.211G>A (p.Gly71Arg) v prvním exonu genu UGT1A1 v homozygotním stavu. Jedná se o gen kódující enzym bilirubin uridindifosfoglukuronyltransferázu, který je zásadní pro konjugaci bilirubinu v hepatocytech. Důležité je zdůraznit, že prevalentní mutace GS v kavkazské populaci se nachází v promotoru uvedeného genu a vyšetření cílené na prevalentní mutaci v kavkazské populaci by tuto formu GS nezachytilo.
The causes of neonatal hyperbilirubinemia in Asian and Caucasian population differ. There is a higher incidence of Asian forms of Gilbert's syndrome (GS), Southeast Asian Ovalocytosis, 6-glucose phosphatedehydrogenase deficiency, thalassemia and sickle cell anemia in the Asian population. We describe a case of a eutrophic Vietnamese boy from the second pregnancy, who was admitted to the hospital for marked icterus and fatigue with unconjugated hyperbilirubinemia of 455 µmol/l. Laboratory examinations did not support suspicion of alloimmunization (blood type of the child 0+, mother B+, direct Coombs test negative), or increased haemolysis (reticulocytes 5.8 ‰), liver function tests were normal. Levels of bilirubin dropped rapidly after phototherapy, the boy was discharged and followed-up by general practitioner. At three weeks of age, the boy returns with total bilirubin level of 389 µmol/l. The directly indicated molecular genetic examination documented the mutation c.211G>A (p.Gly71Arg) in the first exon of the UGT1A1 gene in a homozygous form. The gene encodes the enzyme bilirubin UDP-glucuronyltransferase, which is essential for the conjugation of bilirubin in hepatocytes. It is important to emphasize that the prevalent mutation in GS in the Caucasian population is located in the promoter of the gene and that genetic testing for these mutation in the Caucasian population would miss this form of GS.
- Klíčová slova
- bilirubin uridindifosfoglukuronyltransferáza,
- MeSH
- Asijci MeSH
- Gilbertova nemoc diagnóza genetika terapie MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká hyperbilirubinemie * diagnóza genetika terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
