Ochsner Medical Center

About: Ochsner Medical Center is a healthcare organization based out in New Orleans, Louisiana, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

Thoracic endovascular repair versus medical management for acute uncomplicated type B aortic dissection.

Abstract: Background Current treatment options and outcomes for acute uncomplicated thoracic Type-B aortic dissection (TBAD) remain unclear between medical management (MED) and thoracic endovascular aortic repair (TEVAR). In this study we aim to compare both strategies in terms of all-cause mortality, aortic dilation, and aortic rupture. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through March 2017. Only studies comparing TEVAR to MED for acute uncomplicated TBAD were included. Random-effects meta-analysis was used to pool outcomes across studies. Study outcomes included short (1 month), intermediate (1 year), and mid-term (2-5 year) all-cause mortality. Additional outcomes included aortic dilation and rupture at 1 year. Results A total of 1,960 patients (64.3 years; 75.8% male) were included from six studies (one prospective and five retrospective). No difference was observed in short-term (odd ratio [OR] 0.73 with 95% confidence interval [CI] 0.47 to 1.12, P = 0.15), intermediate (OR 0.99 with 95% CI 0.56 to 1.73, P = 0.96), or mid-term all-cause mortality (OR 1.12 with 95% CI 0.54 to 2.32, P = 0.75). No difference in aortic dilation with either modality was noted at 1-year (OR 1.11 with 95% CI 0.76 to 1.64, P = 0.59). TEVAR was associated with a significantly lower 1-year risk of aortic rupture (OR 2.49 with 95% CI 1.23 to 5.06, P = 0.01). Conclusion There were no short, intermediate, or mid-term differences in mortality between TEVAR or MED in patients with acute uncomplicated TBAD. Although the dilation rate was similar between both groups, TEVAR was associated with lower likelihood of aortic rupture at 1 year.

Class 1C antiarrhythmic drugs in atrial fibrillation and coronary artery disease.

Abstract: Class 1C antiarrhythmic drugs (AAD) are effective first-line agents for atrial fibrillation (AF) treatment. However, these agents commonly are avoided in patients with known coronary artery disease (CAD), due to known increased risk in the post-myocardial infarction population. Whether 1C AADs are safe in patients with CAD but without clinical ischemia or infarct is unknown. Reduced coronary flow capacity (CFC) on positron emission tomography (PET) reliably identifies myocardial regions supplied by vessels with CAD causing flow limitation. To assess whether treatment with 1C AADs increases mortality in patients without known CAD but with CFC indicating significantly reduced coronary blood flow. In this pilot study, we compared patients with AF and LVEF ≥50% who were treated with 1C AADs, to age-matched AF patients without 1C AAD treatment. No patient had clinically evident CAD (i.e., reversible perfusion defect, known ≥70% epicardial lesion, PCI, CABG, or myocardial infarction). All patients had PET-based quantification of stress myocardial blood flow (sMBF) and CFC. Death was assessed by clinical follow-up and SSDI search. 78 patients with 1C AAD exposure were matched to 78 controls. Over a mean follow-up of 2.0 years, the groups had similar survival (p=0.54). Among patients with CFC indicating the presence of occult CAD (i.e., reduced CFC involving ≥50% of myocardium), 1C-treated patients had survival similar to (p=0.44) those not treated with 1C agents. In a limited population of AF patients with preserved LV function and PET CFC indicating occult CAD, treatment with 1C AADs appears not to increase mortality. A larger study would be required to confidently assess safety of these drugs in this context. This article is protected by copyright. All rights reserved.

Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis

Abstract: Very-low-carbohydrate diets or ketogenic diets are frequently used for weight loss in adults and as a therapy for epilepsy in children The incidence and characteristics of kidney stones in patients on ketogenic diets are not well studied Methods: A systematic literature search was performed, using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases' inception through April 2020 Observational studies or clinical trials that provide data on the incidence and/or types of kidney stones in patients on ketogenic diets were included We applied a random-effects model to estimate the incidence of kidney stones Results: A total of 36 studies with 2795 patients on ketogenic diets were enrolled The estimated pooled incidence of kidney stones was 59% (95% CI, 46-76%, I2 = 47%) in patients on ketogenic diets at a mean follow-up time of 37 +/- 29 years Subgroup analyses demonstrated the estimated pooled incidence of kidney stones of 58% (95% CI, 44-75%, I2 = 49%) in children and 79% (95% CI, 28-201%, I2 = 29%) in adults, respectively Within reported studies, 487% (95% CI, 332-646%) of kidney stones were uric stones, 365% (95% CI, 106-736%) were calcium-based (CaOx/CaP) stones, and 278% (95% CI, 121-519%) were mixed uric acid and calcium-based stones, respectively Conclusions: The estimated incidence of kidney stones in patients on ketogenic diets is 59% Its incidence is approximately 58% in children and 79% in adults Uric acid stones are the most prevalent kidney stones in patients on ketogenic diets followed by calcium-based stones These findings may impact the prevention and clinical management of kidney stones in patients on ketogenic diets