A systematic review of current trends in pharmacologic management after stent placement in nonthrombotic iliac vein lesions

Objective Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). Methods The MEDLINE database was searched using the term “iliac vein stent.” Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. Results 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. Conclusion Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL.

Anaesthesia management in Chronic Kidney Disease (CKD) patient undergo repair pseudoaneurysms surgery: a case report

Introduction: Chronic kidney disease (CKD) is marked by the presence of kidney damage (usually defined as estimated GFR < 60 mL/ min/1.73 m2) for 3 or more months, and it may be caused by a multitude of disease processes. Management of patients with CKD includes aggressive treatment of the underlying cause, pharmacologic therapy to delay disease progression and prevent complications, and preparation for hemodialysis as ESRD ensues. Case presentation: In this case report, a 48-year-old man with a pseudoaneurysms due to the insertion of a vascular access for hemodialysis, undergo repair pseudoaneurysms surgery under general anesthesia, at the Sanglah General Hospital, October 2020. The patient came with fully awareness, blood pressure 145/95 mmHg, heart rate 85 times per minute regular and oxygen saturation 97% with room air. Conclusion: General anesthesia in patients with CKD requires an understanding of the pathologic changes that accompany renal disease, co-existing medical conditions, and the impact of reduced renal function on drug pharmacokinetics.

Assessment of the Low Referral Rate of Cardiologists to Dietitians/Nutritionists

Background: Dietary factors are a leading contributor to cardiovascular disease. Cardiologists are ideally positioned to initiate dietary discussions with patients and to make appropriate referrals to dietitians/nutritionists, yet the frequency of such referrals is unknown. Methods: A national survey was distributed to cardiologists to assess the frequency of their referrals to dietitians/nutritionists, their assessment of the efficacy of such referrals, and the perceived barriers to patient implementation of dietary changes following referral to dietitians/nutritionists. Results: A total of 123 cardiologists responded to the survey. The majority of respondents (71%) reported that they referred 10% or fewer of their patients to dietitians/nutritionists. Cardiologists who participated in a nutrition-focused continuing medical education activity were nearly twice as likely to refer patients to a dietitian/nutritionist as those who did not. Thirty-two percent of cardiologists believed that 25% or more of their referred patients made significant gains in achieving dietary goals. Most cardiologists (63%) attributed the primary challenge to achieving dietary goals to “the patient’s lack of interest and motivation in making dietary changes” while 6% believed the lack of desired results were related to the quality of the counseling provided. Overall, 59% of cardiologists endorsed the belief that dietary interventions can improve outcomes to an equal or greater degree than pharmacologic therapy Conclusion: Cardiologists reported making few referrals to dietitians/nutritionists; however, those who received continuing education in nutrition were significantly more likely to make a referral than those who did not receive nutrition education. The efficacy of referrals to dietitians/nutritionists was considered to be limited, which the majority of cardiologists attributed to a lack of patient interest and motivation—a belief that is not aligned with prior surveys of patient preferences.

Terapi Akupresure Terhadap Kadar Asam Urat Pada Penderita Asam Urat di Dusun Muara Jaya Kecamatan Kebun Tebu Lampung Barat

ABSTRAK Gout merupakan penyakit metabolik yang disebabkan oleh kelebihan kadar senyawa urat didalam tubuh, baik karena produksi berlebih, eliminasi yang kurang, atau peningkatan asupan purin. Salah satu terapi nonfarmakologik yang telah terbukti mampu mengatasi berbagai permasalahan kesehatan adalah akupresur. Akupresur yaitu tindakan pemberian tekanan ke titik khusus pada tubuh untuk mengurangi peningkatan kadar asam urat, menghasilkan relaksasi, dan mencegah atau mengurangi rasa mual. Tujuan pelaksanaan pengabdian kepada masyarakat ini untuk mendapatkan pengalaman dan kompetensi lebih dalam pemberian asuhan keperawatan komprehensif pemberian terapi Akupresure terhadap penurunan kadar asam urat. Adapun kegiatan yang dilakukan berupa penyuluhan menggunakan leaflet dan demonstrasi terapi akupresure. Terdapat penurunan kadar asam urat setelah dilakukan terapi akupresure pada penderita asam urat. Terapi akupresure sangat efektif dalam menurunkan kadar asam urat. Kata Kunci: Akupresure, Asam urat, Kadar asam urat ABSTRACT Gout is a metabolic disease caused by excess levels of urate compounds in the body, either due to overproduction, lack of elimination, or increased intake of purines. One non-pharmacologic therapy that has been proven able to overcome various health problems is acupressure. Acupressure is the act of applying pressure to a special point on the body to reduce the increase in uric acid levels, produce relaxation, and prevent or reduce nausea. The purpose of the study was to gain more experience and competence in the provision of comprehensive nursing care in the provision of acupressure therapy for decreasing uric acid levels. The activities carried out in the form of counseling using leaflets and demonstrations of acupressure therapy. There was a decrease in uric acid levels after doing acupressure therapy in gout sufferers. Thus, acupressure therapy was very effective in reduces uric acid levels. Keywords: Acupressure, Gout, Uric Acid Levels

Identifying Atrial Fibrillation Mechanisms for Personalized Medicine

Atrial fibrillation (AF) is a major cause of heart failure and stroke. The early maintenance of sinus rhythm has been shown to reduce major cardiovascular endpoints, yet is difficult to achieve. For instance, it is unclear how discoveries at the genetic and cellular level can be used to tailor pharmacotherapy. For non-pharmacologic therapy, pulmonary vein isolation (PVI) remains the cornerstone of rhythm control, yet has suboptimal success. Improving these therapies will likely require a multifaceted approach that personalizes therapy based on mechanisms measured in individuals across biological scales. We review AF mechanisms from cell-to-organ-to-patient from this perspective of personalized medicine, linking them to potential clinical indices and biomarkers, and discuss how these data could influence therapy. We conclude by describing approaches to improve ablation, including the emergence of several mapping systems that are in use today.

330. Evaluating the Relationship Between Comorbidity Treatment Status and In-hospital Mortality Among COVID-19 Patients

Background Chronic comorbidities increase the risk of poor outcomes in patients with COVID-19. However, there are insufficient data to determine whether control of chronic comorbidities influences outcomes. The purpose of this study was to determine whether pharmacologic treatment for common comorbidities influences in-hospital mortality. Methods This multicenter, retrospective study included adult patients with diabetes, hypertension, and/or dyslipidemia who were hospitalized with COVID-19 in Southwest GA, U.S. Patients were divided into two groups based on treatment status, where treated was defined as documentation in the electronic medical record of outpatient pharmacologic therapy indicated for that specific comorbidity while untreated was defined as no record of pharmacologic therapy for one or more comorbidity. The primary outcome was to compare in-hospital mortality between treated and untreated COVID-19 patients. Secondary outcomes included comparing length of hospital stay, development of thrombotic events, requirement for vasopressors, mechanical ventilation, and transfer to the ICU between groups. Results A total of 360 patients were included with a median age of 66 years (IQR 56-75). The majority were African American (83%) and female (61%) with a median Charlson Comorbidity Index of 4 (IQR 2-6). Hypertension, diabetes, and dyslipidemia were present in 91%, 55%, and 45% of patients, respectively, of which 76% (n=274) were treated. Mortality was similar between treated and untreated patients (25% vs 20%, p=0.304). Average length of stay was 9.5 days (SD 8.7) in treated patients compared to 10.6 days (SD 9.1) in untreated patients (p=0.302). No differences were observed in the rates of thrombosis (3% vs 4%, p=0.765), receipt of vasopressors (23% vs 21%, p=0.741), mechanical ventilation (31% vs 27%, p=0.450), or transfer to the ICU (27% vs 14%, p=0.112). Conclusion Hospitalized COVID-19 patients being treated for hypertension, diabetes, and/or dyslipidemia have similar rates of complications and mortality compared to untreated patients. Further research is needed to determine whether degree of control of chronic comorbidities impacts COVID-19 outcomes. Disclosures All Authors: No reported disclosures

Positive Expiratory Pressure: A Potential Therapy to Mitigate Acute Bronchoconstriction in the Asthma of Obesity

Late-onset non-allergic (LONA) asthma in obesity is characterized by increased peripheral airway closure secondary to abnormally collapsible airways. We hypothesized that positive expiratory pressure (PEP) would mitigate the tendency to airway closure during bronchoconstriction, potentially serving as rescue therapy for LONA asthma of obesity. The PC20 dose of methacholine was determined in 18 obese participants with LONA asthma. At each of 4 subsequent visits, we used oscillometry to measure input respiratory impedance (Zrs) over 8 minutes; participants received their PC20 concentration of methacholine aerosol during the first 4.5 minutes. PEP combinations of either 0 or 10 cmH2O either during and/or after the methacholine delivery were applied, randomized between visits. Parameters characterizing respiratory system mechanics were extracted from the Zrs spectra. In 18 LONA asthma patients (14 females, BMI: 39.6±3.4 kg/m2), 10 cmH2O PEP during methacholine reduced elevations in the central airway resistance, peripheral airway resistance and elastance, and breathing frequency was also reduced. During the 3.5 min following methacholine delivery, PEP of 10 cmH2O reduced Ax and peripheral elastance compared to no PEP. PEP mitigates the onset of airway narrowing brought on by methacholine challenge, and airway closure once it is established. PEP thus might serve as a non-pharmacologic therapy to manage acute airway narrowing for obese LONA asthma.