Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding ten...Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding tendencies of these patients. This case report illustrates a patient with an unusual presentation of a patient with type Ⅳ EDS, platelet δ-storage pool disease and factor Ⅴ Leiden mutation. Young woman having previous bilateral deep vein thrombosis and pulmonary emboli coexisting with ruptured splenic aneurysm and multiple other aneurysms now presented with myocardial infarction. Presence of factor Ⅴ Leiden mutation raises the possibility that the infarct was due to acute coronary thrombosis, although coronary artery aneurysm and dissection with myocardial infarction is known to occur in vascular type EDS. This is the first report in the medical literature of factor Ⅴ Leiden mutation in an EDS patient which made the management of our patient challenging with propensity to both bleeding and clotting.展开更多
BACKGROUND In-hospital cardiac arrest(IHCA)constitutes a significant cause of morbidity and mortality.As data is scarce in the Middle East and Lebanon,we devised this study to shed some light on it to better inform bo...BACKGROUND In-hospital cardiac arrest(IHCA)constitutes a significant cause of morbidity and mortality.As data is scarce in the Middle East and Lebanon,we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1,2016 and May 2,2019.Sociodemographic variables included age and sex,in addition to the comorbidities listed in the Charlson comorbidity index.IHCA event variables were day,event location,time from activation to arrival,initial cardiac rhythm,and the total number of IHCA events.We also looked at the months and years.We considered the return of spontaneous circulation(ROSC)and survival to discharge(StD)to be our outcomes of interest.RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions(95%CI:6.09−7.08).Non-shockable rhythms were 90.7%of IHCAs.Most IHCA cases occurred in the closed units(87.9%)(intensive care unit,respiratory care unit,neurology care unit,and cardiology care unit)and on weekdays(76.5%).ROSC followed more than half the IHCA events(56%).However,only 5.4%of IHCA events achieved StD.Both ROSC and StD were higher in cases with a shockable rhythm.Survival outcomes were not significantly different between day,evening,and nightshifts.ROSC was not significantly different between weekdays and weekends;however,StD was higher in events that happened during weekdays than weekends(6.7%vs.1.9%,P=0.002).CONCLUSIONS The incidence of IHCA was high,and its outcomes were lower compared to other developed countries.Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week.These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.展开更多
文摘Ehlers-Danlos syndrome(EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding tendencies of these patients. This case report illustrates a patient with an unusual presentation of a patient with type Ⅳ EDS, platelet δ-storage pool disease and factor Ⅴ Leiden mutation. Young woman having previous bilateral deep vein thrombosis and pulmonary emboli coexisting with ruptured splenic aneurysm and multiple other aneurysms now presented with myocardial infarction. Presence of factor Ⅴ Leiden mutation raises the possibility that the infarct was due to acute coronary thrombosis, although coronary artery aneurysm and dissection with myocardial infarction is known to occur in vascular type EDS. This is the first report in the medical literature of factor Ⅴ Leiden mutation in an EDS patient which made the management of our patient challenging with propensity to both bleeding and clotting.
文摘BACKGROUND In-hospital cardiac arrest(IHCA)constitutes a significant cause of morbidity and mortality.As data is scarce in the Middle East and Lebanon,we devised this study to shed some light on it to better inform both hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.METHODS We analyzed retrospective data from 680 IHCA events at the American University of Beirut Medical Center between July 1,2016 and May 2,2019.Sociodemographic variables included age and sex,in addition to the comorbidities listed in the Charlson comorbidity index.IHCA event variables were day,event location,time from activation to arrival,initial cardiac rhythm,and the total number of IHCA events.We also looked at the months and years.We considered the return of spontaneous circulation(ROSC)and survival to discharge(StD)to be our outcomes of interest.RESULTS The incidence of IHCA was 6.58 per 1,000 hospital admissions(95%CI:6.09−7.08).Non-shockable rhythms were 90.7%of IHCAs.Most IHCA cases occurred in the closed units(87.9%)(intensive care unit,respiratory care unit,neurology care unit,and cardiology care unit)and on weekdays(76.5%).ROSC followed more than half the IHCA events(56%).However,only 5.4%of IHCA events achieved StD.Both ROSC and StD were higher in cases with a shockable rhythm.Survival outcomes were not significantly different between day,evening,and nightshifts.ROSC was not significantly different between weekdays and weekends;however,StD was higher in events that happened during weekdays than weekends(6.7%vs.1.9%,P=0.002).CONCLUSIONS The incidence of IHCA was high,and its outcomes were lower compared to other developed countries.Survival outcomes were better for patients who had a shockable rhythm and were similar between the time of day and days of the week.These findings may help inform hospitals and policymakers about the magnitude and quality of IHCA care in Lebanon.
