Medical Ctr Blvd
Winston Salem NC 27157
Medical School: Other - Unknown
Accepts Medicare: No
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License #: 2014-01433
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Meta-Analysis of Continuous Positive Airway Pressure as a Therapy of Atrial Fibrillation in Obstructive Sleep Apnea. - The American journal of cardiology
Atrial fibrillation (AF) is a significant health care problem for patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) as a therapy for OSA is underused, and it is unknown if CPAP might reduce rates of AF. We systematically reviewed the published reports on CPAP use and risk of AF. MEDLINE, EMBASE, CINAHL, Web of Science, meeting abstracts, and Cochrane databases were searched from inception to June 2015. Studies needed to report the rates of AF in participants who were and were not on CPAP. Data were extracted by 2 authors. A total of 8 studies on OSA were identified (1 randomized controlled trial) with 698 CPAP users and 549 non-CPAP users. In a random effects model, patients treated with CPAP had a 42% decreased risk of AF (pooled risk ratio, 0.58; 95% confidence interval, 0.47 to 0.70; p <0.001). There was low heterogeneity in the results (I(2)Â = 30%). In metaregression analysis, benefits of CPAP were stronger for younger, obese, and male patients (p <0.05). An inverse relationship between CPAP therapy and AF recurrence was observed. Results suggest that more patients with AF also should be tested for OSA.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Osmotic demyelination syndrome. - WMJ : official publication of the State Medical Society of Wisconsin
Formerly known as central pontine myelinolysis, osmotic demyelination syndrome (ODS) is defined by a symmetrical destruction of myelin sheaths involving mainly the central portion of the basis pontis without evidence of vascular involvement. We report the case of a 60-year-old man who presented to the emergency department with a 2-week history of progressive confusion, memory loss, and lower extremity weakness with limited ambulation. A computed tomography scan of the head revealed areas of low attenuation within the pons, and brain magnetic resonance imaging (MRI) confirmed the changes as compatible with ODS.
Outcome of early revascularization surgery in patients with ST-elevation myocardial infarction. - Journal of interventional cardiology
To compare morbidity and mortality of patients with ST-elevation myocardial infarction (MI) undergoing coronary artery bypass graft (CABG) surgery within 24â€‰hours with those who had surgery delayed >24â€‰hours.Patients with ST-elevation MI are currently managed by emergency percutaneous coronary intervention (PCI). If PCI is unsuccessful, or if there is severe coronary artery disease not amenable to PCI, CABG is considered. If the patient is clinically stable, surgeons wait several days before performing surgery, as very early surgery carries a prohibitive risk.One hundred and eighty-four patients with acute ST elevation MI (STEMI) who had undergone CABG were divided into two groups based on their surgery timing (<24â€‰hours vs. >24â€‰hours). Mortality and complication rates were studied between the two groups by Fischer test. Time-to-event analyses were performed for five primary variables: all-cause mortality, cardiac events, congestive heart failure, stroke, and renal failure.At one month post-CABC, all-cause mortality was noted in 10.6% of patients who had CABG within 24â€‰hours of STEMI diagnosis, compared with 8.9% in patients who had CABG after 24â€‰hours (Pâ€‰=â€‰0.3). Cardiac events including re-exploration, atrial fibrillation, graft occlusion, and arrhythmias requiring shock occurred in 17.1% versus 13.9% between the two groups, respectively (Pâ€‰=â€‰0.68). One year post-coronary artery bypass surgery, there was no difference in individual or combined events between the two groups.In patients with ST-elevation myocardial infarction who required emergency coronary artery bypass surgery, there was no difference in procedure complications or mortality between early (within 24â€‰hours) or later (more than 24â€‰hours). That was noted at one month and one year after the index myocardial infarction.Â© 2014, Wiley Periodicals, Inc.
Remote ischemic preconditioning for coronary artery bypass graft operations. - The Annals of thoracic surgery
Ischemia-reperfusion injury occurs during coronary artery bypass graft operations. Strategies are needed to lower the extent of damage. Attempts to find these strategies have been occurring for more than 40 years, with remote ischemic preconditioning being one method. This review provides a look at potential mechanisms involved in remote ischemic preconditioning, experimental evidence supporting it, clinical studies that support and negate it, and potential reasons for differences between clinical studies. With remote ischemic preconditioning having the potential to better clinical outcomes in patients undergoing coronary artery bypass graft operations, a large clinical trial needs to be undertaken to better assess its practical clinical application.Copyright Â© 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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