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Safety of Contrast Agents in the Critically Ill

Safety of Contrast Agents in the Critically Ill

Ultrasound contrast agent safety in critically ill patients undergoing echocardiography has been questioned by the FDA. This controversy was the result of rare reports showing that deaths or life-threatening adverse reactions occurred in close proximity to the administration of ultrasound contrast agents. “Since these reports surfaced around 2007, many studies have been conducted to better define the safety profile of these agents,” says Michael L. Main, MD. An Observational Analysis In a large observational study published in JACC: Cardiovascular Imaging, Dr. Main and colleagues compared 48-hour all-cause mortalities and hospital stay mortalities among critically ill patients who underwent echocardiography either with or without an ultrasound contrast agent. Data were collected on more than a million participants through discharge information from a database that included information on primary and secondary diagnoses, procedure billing codes, and demographic and baseline patient information in addition to hospital characteristics. At discharge, more than 990,000 patients underwent echocardiography without a contrast agent, whereas 16,222 received a contrast agent for their exam. According to the results, ultrasound contrast agent use was associated with a 28% lower mortality rate at 48 hours among critically ill patients undergoing echocardiography when compared with no ultrasound contrast agent use. Recipients of ultrasound contrast agents also had significantly lower mortality rates over their entire hospital stay when compared with those who did not receive one (14.85% vs 15.66%). “Importantly, our findings were consistent across a wide variety of major comorbidities and important demographic subgroups, such as age and gender,” says Dr. Main. Overall, there were no groups with significantly greater odds for mortality after receiving a contrast agent. Impactful Findings Data...
Treatment-Resistant Hypertension: Assessing Predictors & Outcomes

Treatment-Resistant Hypertension: Assessing Predictors & Outcomes

Treatment-resistant hypertension (HTN) has been defined in various ways in clinical research. Some definitions go so far as to say which medications should be used before classifying patients as having resistant HTN. Regardless of the definition, the overriding theme of treatment-resistant HTN is that it occurs when several anti-hypertensive drugs are needed to control blood pressure (BP). Studies suggest that treatment-resistant HTN is present in 20% to 30% of patients with HTN. Its prevalence has more than doubled over the past 25 years, and research has linked it to an increased risk of cardiovascular events when compared with patients without treatment-resistant HTN. “The topic of treatment-resistant HTN has gained attention in recent years,” says Rhonda M. Cooper-DeHoff, PharmD, MS, FAHA, FACC. “The condition increases long-term risk for poor outcomes, regardless of whether or not HTN is controlled or uncontrolled. Unfortunately, we’re lacking important data on the long-term effects of treatment-resistant HTN.” Coronary artery disease (CAD) is among the leading causes of mortality, and treatment-resistant HTN is more common in patients with CAD than without CAD. Little is known, however, about the impact that treatment-resistant HTN has on cardiovascular outcomes in patients with CAD. Such data may inform clinicians on strategies to aggressively manage risk factors. Identifying Predictors & Impact In the Journal of Hypertension, Dr. Cooper-DeHoff and colleagues published a study that described the prevalence, predictors, and impact on adverse cardiovascular outcomes of resistant HTN among patients with CAD and HTN. More than 17,000 study participants were divided into three groups according to achieved BP: 1) controlled (BP<140/90 mm Hg on three or fewer drugs); 2) uncontrolled (BP≥140/90 mm Hg on...

Shady History Hasn’t Hurt Cosmetic Surgeon’s Online Ratings

There seems to be no shortage of bad doctor stories going around these days. Just when you thought you’d heard the worst, along comes another. Dr. Ehab Mohamed, a “cosmetic surgeon” in California, has lost his license to practice medicine and has been charged with involuntary manslaughter in the 2010 death of a 61-year-old woman during a 10-hour liposuction procedure performed in his office. She apparently died from an overdose of lidocaine, fentanyl, and oxycodone. This physician may have trained at renowned institutions. One website says the doctor had been a resident at both Columbia and Johns Hopkins. However, this cannot be verified. His training was in obstetrics and gynecology, and he was not board-certified. He called himself a cosmetic surgeon but apparently had no formal training in cosmetic or plastic surgery. In addition to the manslaughter charge, he was charged with elder abuse of a 77-year-old woman who also had complications during liposuction. He charged patients exorbitant fees for procedures, allegedly as high as $650,000, but routinely in the range of $50,00 to $100,000. He once anesthetized a patient for surgery, and while she was sedated, apparently had her sign for more surgery at an increased fee. He supposedly offered discounts to patients if they would enroll in a Harvard University study, which was later proven to be fake by Charles Feldman, a persistent investigative reporter for a Los Angeles radio station. The California Medical Board was warned by other surgeons about him 2 years before the death of the liposuction patient. He has also apparently been living illegally in the United States since his visa expired in...
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