Background: To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction(AMI)complicated by heart failure. Methods: The EPHESUS ...Background: To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction(AMI)complicated by heart failure. Methods: The EPHESUS trial enrolled patients with AMI complicated by heart failure. Patients from Canada, the UK, and the United States completed a Medical Outcomes Study-Depression questionnaire at baseline in addition to a comprehensive clinical examination. Cox proportional hazards regression was used to determine the relationship between depressive symptoms and outcomes, including 2-year all-cause mortality and cardiovascular death or hospitalization, adjusting for baseline clinical variables. Results: Overall, 143 of 634 patients(22.6% )had significant depressive symptoms at baseline(Medical Outcomes Study-Depression score ≥ 0.06). Depressed patients had higher 2-year mortality(29% vs 18% ; P=.004)and cardiovascular death or hospitalization(42% vs 33% ; P=.016). After risk adjustment, depressive symptoms remained significantly associated with mortality(hazard ratio 1.75, 95% CI 1.15- 2.68, P=.01)and cardiovascular death or hospitalization(hazard ratio 1.41, 95% CI 1.03- 1.93, P=.03). Results were consistent across demographic and clinical subgroups. Conclusions: Depression is an independent predictor of all-cause mortality and cardiovascular death or hospitalization after AMI complicated by heart failure. Although many factors may mediate outcomes in patients with AMI, studies are warranted to evaluate whether a depression intervention can improve survival and/or reduce hospitalizations.展开更多
Background: Pusher syndrome is a disorder of postural control observed in patients with right or left brain damage associated with hemiparesis. Those patients show a peculiar behavior of actively pushing away from the...Background: Pusher syndrome is a disorder of postural control observed in patients with right or left brain damage associated with hemiparesis. Those patients show a peculiar behavior of actively pushing away from the nonhemiparetic side and resisting against passive correction, with a tendency to fall toward the paralyzed side. Thus far this phenomenon has been exclusively associated with stroke patients. Abstract:Objective: We investigate the occurrence, imaging features and clinical evolution of pusher behavior in patients with acute encephalic lesions at a tertiary emergency hospital. Methods: Pusher patients were identified from 530 inpatients during a 1 year period. Patients were evaluated using a standardized Scale for Contraversive Pushing (SCP), neurological examination, assessment of neuropsychological symptoms, activities of daily living function and neuroimaging studies. Results: We found eight patients (1.5% ) with severe contraversive pushing, three female and five male. Age at symptoms onset ranged from 48 to 80 years (mean 65.4). All patients had scores equal or above 1.5 in each tested parameter of the SCP. Six patients (75% ) had right- hemisphere brain damage. A stroke etiology was found in four patients. The other four patients had non- stroke etiology (three traumatic, one metastatic tumor). Stroke patients showed complete recovery of pusher behavior at a mean duration of 15.3 weeks. In patients with brain trauma, pushing behavior was completely resolved in a mean time of 5 weeks. Conclusions: The results demonstrate that contraversive pushing may also occur in patients with non- stroke neurological lesions and suggest that resolution of symptoms may vary according to the underlying etiology.展开更多
文摘Background: To evaluate whether depressive symptoms are independently predictive of mortality and hospitalization among patients with acute myocardial infarction(AMI)complicated by heart failure. Methods: The EPHESUS trial enrolled patients with AMI complicated by heart failure. Patients from Canada, the UK, and the United States completed a Medical Outcomes Study-Depression questionnaire at baseline in addition to a comprehensive clinical examination. Cox proportional hazards regression was used to determine the relationship between depressive symptoms and outcomes, including 2-year all-cause mortality and cardiovascular death or hospitalization, adjusting for baseline clinical variables. Results: Overall, 143 of 634 patients(22.6% )had significant depressive symptoms at baseline(Medical Outcomes Study-Depression score ≥ 0.06). Depressed patients had higher 2-year mortality(29% vs 18% ; P=.004)and cardiovascular death or hospitalization(42% vs 33% ; P=.016). After risk adjustment, depressive symptoms remained significantly associated with mortality(hazard ratio 1.75, 95% CI 1.15- 2.68, P=.01)and cardiovascular death or hospitalization(hazard ratio 1.41, 95% CI 1.03- 1.93, P=.03). Results were consistent across demographic and clinical subgroups. Conclusions: Depression is an independent predictor of all-cause mortality and cardiovascular death or hospitalization after AMI complicated by heart failure. Although many factors may mediate outcomes in patients with AMI, studies are warranted to evaluate whether a depression intervention can improve survival and/or reduce hospitalizations.
文摘Background: Pusher syndrome is a disorder of postural control observed in patients with right or left brain damage associated with hemiparesis. Those patients show a peculiar behavior of actively pushing away from the nonhemiparetic side and resisting against passive correction, with a tendency to fall toward the paralyzed side. Thus far this phenomenon has been exclusively associated with stroke patients. Abstract:Objective: We investigate the occurrence, imaging features and clinical evolution of pusher behavior in patients with acute encephalic lesions at a tertiary emergency hospital. Methods: Pusher patients were identified from 530 inpatients during a 1 year period. Patients were evaluated using a standardized Scale for Contraversive Pushing (SCP), neurological examination, assessment of neuropsychological symptoms, activities of daily living function and neuroimaging studies. Results: We found eight patients (1.5% ) with severe contraversive pushing, three female and five male. Age at symptoms onset ranged from 48 to 80 years (mean 65.4). All patients had scores equal or above 1.5 in each tested parameter of the SCP. Six patients (75% ) had right- hemisphere brain damage. A stroke etiology was found in four patients. The other four patients had non- stroke etiology (three traumatic, one metastatic tumor). Stroke patients showed complete recovery of pusher behavior at a mean duration of 15.3 weeks. In patients with brain trauma, pushing behavior was completely resolved in a mean time of 5 weeks. Conclusions: The results demonstrate that contraversive pushing may also occur in patients with non- stroke neurological lesions and suggest that resolution of symptoms may vary according to the underlying etiology.
