Search

BackgroundWe investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals.Methods and resultsOne hundred and sixty-eight patients were evaluated 28–60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); pIn adjusted multivariate logistic regression analysis, healthcare worker status associated with a binary classification (probable/very likely vs not present/unlikely) of adjudicated myocarditis (OR: 2.99; 95% CI (1.01 to 8.89) by 28–60 days postdischarge).After a mean (SD, range) duration of follow-up after hospital discharge of 450 (88) days (range 290, 627 days), fewer healthcare workers died or were rehospitalised (1 (3%) vs 22 (17%); p=0.038) and secondary care referrals for post-COVID-19 syndrome were common (42%) and similar to non-healthcare workers (38%; p=0.934).ConclusionHealthcare worker status was independently associated with the likelihood of adjudicated myocarditis, despite better antecedent health. Two in five healthcare workers had a secondary care referral for post-COVID-19 syndrome.Trial registration numberNCT04403607.

Approximately 40% of patients undergoing invasive coronary angiography for investigation of angina are found to have no obstructive coronary artery disease (ANOCA). Abnormal coronary function underlies coronary vasomotion syndromes including coronary endothelial dysfunction, microvascular angina, vasospastic angina, post-PCI angina and myocardial infarction with no obstructive coronary arteries (MINOCA). Each of these endotypes are distinct subgroups, characterized by specific disease mechanisms. Diagnostic criteria and linked therapy for these conditions are now established by expert consensus and clinical guidelines. Coronary function tests are performed as an adjunctive interventional diagnostic procedure (IDP) in appropriately selected patients during coronary angiography. This aids differentiation of patients according to endotype. The IDP includes two distinct components: a diagnostic guidewire test and a pharmacological coronary reactivity test. The tests last approximately 5 minutes for the former and 10-15 minutes for the latter. Patient safety and staff education are key. The diagnostic guidewire test measures parameters of coronary flow limitation (fractional flow reserve [FFR], coronary flow reserve [CFR], microvascular resistance [index of microvascular resistance (IMR)], basal resistance index, and vasodilator function [CFR, resistive reserve ratio (RRR)]). The pharmacological coronary reactivity test measures the vasodilator potential and propensity to vasospasm of both the main coronary arteries and the micro-vessels. It involves intra-coronary infusion of acetylcholine and glyceryl trinitrate (GTN). Acetylcholine is not licensed for parenteral use and is therefore prescribed on a named-patient basis. Vasodilatation is the normal, expected response to infusion of physiological concentrations of acetylcholine. Vascular spasm represents an abnormal response, which supports the diagnosis of vasospastic angina. The purpose of this practical guide is to provide information on the preparation and administration of the IDP in clinical practice. It discusses some key preparation and safety considerations, as well as tips for procedural success. The IDP supports stratified medicine for a personalized approach to health and wellbeing.

Purpose The purpose of this study was to answer the following clinical question: among patients who have their third molars (M3s) removed, do those who receive only postoperative antibiotics compared with those who receive no perioperative antibiotics have a lower frequency of postoperative inflammatory complications? Materials and Methods The authors designed and implemented a prospective cohort study and enrolled a sample of patients who had at least 1 M3 removed in an ambulatory private practice setting from June 2011 through May 2012 by oral and maxillofacial surgeons participating in a practice-based research collaborative. The predictor variable was postoperative antibiotic use categorized as postoperative antibiotics alone or no antibiotics. The primary outcome variable was the presence or absence of an inflammatory complication (ie, alveolar osteitis or surgical site infection) after M3 removal. Descriptive, bivariate, and multiple logistic regression statistics (adjusted for clustering within surgical practices) were computed to measure the association between postoperative antibiotic use alone and inflammatory complications after M3 removal, with statistical significance set at a P value less than or equal to .05. Results The study sample was composed of 1,877 patients having 5,631 M3s removed, of which 61% received postoperative antibiotics only. The overall inflammatory complication frequencies in the groups receiving postoperative antibiotic only and no antibiotic were 4.3 and 7.5%, respectively (P = .003). After adjusting for differences between the 2 study groups and clustering of patients within surgical practices, postoperative antibiotic use was associated with a 40% decreased risk of developing postoperative inflammatory complications (P = .04) with marginal statistical significance. Conclusions The results of this study suggest that postoperative antibiotic therapy is associated with a statistically meaningful decreased risk of inflammatory complications after M3 removal compared with no antibiotic therapy.

optimal PAEDP for this patient was 18 to 22 mm Hg and the cardiac output 4.5-5.0 liters/min. The patient survived and underwent resection of an akinetic area 4 months later. These studies indicate that hemodynamic monitoring in acute myocardial infarction is beneficial in the management of heart failure and shock. intubated. From the beginning of each experiment high speed, high frequency electrocardiographic leads II, Vi-V, and 3 intracardiac leads were recorded on magnetic tape. The intracardiac leads were recordings from the bundle of His and right bundle branch. Arterial blood gases and respiration were monitored. The dogs were allowed to breathe 1 of 3 aerosols, 2 of which used halogenated hydrocarbons as their propellants. Significant hypoxia or acidosis was not allowed to ocMicroscopy of Myocardium from the Left Ventricular Outflow Tract of Patients with Hypertrophic Obstructive Cardiomyopathy VICTOR J. FERRANS, MD, PhD; ANDREW J. MORROW, MD, FACC; WlLLlAM C. ROBERT’S, MD, FACC, Bethesda, Maryland Electron microscopic studies of surgically resected myocardium from the left ventricular outflow tract in 11 patients with hypertrophic obstructive cardiomyopathy (idiopathic hypertrophic subaortic stenosis) disclosed severe hypertrophy and focal interstitial fibrosis in each patient. The nuclei of the muscle cells were enlarged, with marginated chromatin, prominent nucleoli and bizarre infoldings of the nuclear membranes. The sarcoplasmic reticulum was normal in many areas, slightly dilated in others. Increased numbers of ribosomes, both free and attached to membranes of sarcoplasmic reticulum, were present in perinuclear zones. The amount of glycogen in muscle cells varied greatly. Many muscle cells showed abnormal orientation of myofibrils, some of which followed irregularly oblique courses through the cells. In all patients the Z bands of myofibrils frequently showed abnormalities characterized by increased width and by the formation of extensions of Z band material into adjacent regions of the sarcomeres. These Z band abnormalities were similar to, but less advanced than, those observed by Bishop in right ventricular myocardium after constriction of the pulmonary trunk. Basophilic degeneration of muscle cells was found by light microscopy in 2 patients ; in 1, electron microscopy showed that the basophilic deposits consisted of fibrils, 50 A in diameter, associated with granules 200 A in diameter. No evidence was observed to support Pearse’s concept that muscle cells in the hypertrophied outflow tract resemble those of atria1 myocardium or sinoatrial node. Cardiac Arrhythmias and Sudden Sniffing Deaths NANCY C. FLOWERS, MD, FACC; LEO G. HORAN, MD, FACC