Browsing by Subject "Medical management"

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    Giant Actinomyces brain abscess in an immunocompetent child: A management strategy
    (Scientific Scholar, 2021-07-06) Chicoine, Nicole H.; Griffith-Linsley, Jackson; Goh, Joling; Manaloor, John J.; Raskin, Jeffrey S.; Neurological Surgery, School of Medicine
    Background: Intraparenchymal brain abscess is a collection of microbes caused by inoculation through direct extension or hematogenous spread. Although rare, intraparenchymal abscesses are potentially fatal and can be detected when patients are symptomatic due to local mass effect on adjacent neural tissue. Brain abscess treatment includes medical management with appropriate antibiotics alone or medical management in combination with surgical debridement. Treatment strategies depend on the size and location of disease, as well as the virulence of the microorganism. Similar to medical management strategies, surgical strategies among providers are not uniform, with variation in approaches from complete extirpation of the abscess, including the abscess wall, to minimally invasive stereotactic needle aspiration. In particular, for children, there are no guidelines for therapy. Case description: We report a case of giant Actinomycosis right frontal brain abscess in an immunocompetent child without risk factors. A review of the literature for the treatment of brain abscess caused very rarely by Actinomyces in children is performed. Conclusion: Successful treatment of brain access depends on organism and location. The even more uncommon giant intraparenchymal abscesses can be managed with minimal access and prolonged antibiosis, especially when slow-growing organisms are identified. Long-term follow-up should be employed to mitigate missed late failures.
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    Invasive Versus Medical Management in Patients With Chronic Kidney Disease and Non-ST-Segment-Elevation Myocardial Infarction
    (American Heart Association, 2022) Majmundar, Monil; Ibarra, Gabriel; Kumar, Ashish; Doshi, Rajkumar; Shah, Palak; Mehran, Roxana; Reed, Grant W.; Puri, Rishi; Kapadia, Samir R.; Bangalore, Sripal; Kalra, Ankur; Medicine, School of Medicine
    Background: The role of invasive management compared with medical management in patients with non–ST‐segment–elevation myocardial infarction (NSTEMI) and advanced chronic kidney disease (CKD) is uncertain, given the increased risk of procedural complications in patients with CKD. We aimed to compare clinical outcomes of invasive management with medical management in patients with NSTEMI‐CKD. Methods and Results: We identified NSTEMI and CKD stages 3, 4, 5, and end‐stage renal disease admissions using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes from the Nationwide Readmission Database 2016 to 2018. Patients were stratified into invasive and medical management. Primary outcome was mortality (in‐hospital and 6 months after discharge). Secondary outcomes were in‐hospital postprocedural complications (acute kidney injury requiring dialysis, major bleeding) and postdischarge 6‐month safety and major adverse cardiovascular events. Out of 141 052 patients with NSTEMI‐CKD, 85 875 (60.9%) were treated with invasive management, whereas 55 177 (39.1%) patients were managed medically. In propensity‐score matched cohorts, invasive strategy was associated with lower in‐hospital (CKD 3: odds ratio [OR], 0.47 [95% CI, 0.43–0.51]; P<0.001; CKD 4: OR, 0.79 [95% CI, 0.69–0.89]; P<0.001; CKD 5: OR, 0.72 [95% CI, 0.49–1.06]; P=0.096; end‐stage renal disease: OR, 0.51 [95% CI, 0.46–0.56]; P<0.001) and 6‐month mortality. Invasive management was associated with higher in‐hospital postprocedural complications but no difference in postdischarge safety outcomes. Invasive management was associated with a lower hazard of major adverse cardiovascular events at 6 months in all CKD groups compared with medical management. Conclusions: Invasive management was associated with lower mortality and major adverse cardiovascular events but minimal increased in‐hospital complications in patients with NSTEMI‐CKD compared with medical management, suggesting patients with NSTEMI‐CKD should be offered invasive management.