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  1. Article: Limitation of life sustaining measures in neurocritical care: sex, timing, and advance directive.

    Bögli, Stefan Yu / Stretti, Federica / Utebay, Didar / Hitz, Ladina / Hertler, Caroline / Brandi, Giovanna

    Journal of intensive care

    2024  Volume 12, Issue 1, Page(s) 3

    Abstract: Background: The limitation of life sustaining treatments (LLST) causes ethical dilemmas even in patients faced with poor prognosis, which applies to many patients admitted to a Neurocritical Care Unit (NCCU). The effects of social and cultural aspects ... ...

    Abstract Background: The limitation of life sustaining treatments (LLST) causes ethical dilemmas even in patients faced with poor prognosis, which applies to many patients admitted to a Neurocritical Care Unit (NCCU). The effects of social and cultural aspects on LLST in an NCCU population remain poorly studied.
    Methods: All NCCU patients between 01.2018 and 08.2021 were included. Medical records were reviewed for: demographics, diagnosis, severity of disease, and outcome. Advance directives (AD) and LLST discussions were reviewed evaluating timing, degree, and reason for LLST. Social/cultural factors (nationality, language spoken, religion, marital status, relationship to/sex of legal representative) were noted. Associations between these factors and the patients' sex, LLST timing, and presence of AD were evaluated.
    Results: Out of 2975 patients, 12% of men and 10.5% of women underwent LLST (p = 0.30). Women, compared to men, more commonly received withdrawal instead of withholding of life sustaining treatments (57.5 vs. 45.1%, p = 0.028) despite comparable disease severity. Women receiving LLST were older (73 ± 11.7 vs. 69 ± 14.9 years, p = 0.005) and often without a partner (43.8 vs. 25.8%, p = 0.001) compared to men. AD were associated with female sex and early LLST, but not with an increased in-hospital mortality (57.1 vs. 75.2% of patients with and without AD respectively).
    Conclusions: In patients receiving LLST, the presence of an AD was associated with an increase of early LLST, but not with an increased in-hospital mortality. This supports the notion that the presence of an AD is primarily an expression of the patients' will but does not per se predestine the patient for an unfavorable outcome.
    Language English
    Publishing date 2024-01-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 2739853-5
    ISSN 2052-0492
    ISSN 2052-0492
    DOI 10.1186/s40560-023-00714-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Complement inhibition for the treatment of COVID-19 triggered thrombotic microangiopathy with cardiac failure: a case report.

    Utebay, Didar / Seeger, Harald / Müller, Antonia M S / David, Sascha

    European heart journal. Case reports

    2021  Volume 5, Issue 10, Page(s) ytab386

    Abstract: ... of confirmed SARS-CoV-2 infection was admitted to our intensive care unit. Coronary angiography did not reveal ...

    Abstract Background: Severe coronavirus disease 2019 (COVID-19) has been increasingly recognized as a multisystem disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect literally any cell type that expresses its target receptor angiotensin-converting enzyme 2. However, COVID-19-associated organ dysfunction is not only mediated by direct viral effects but also by the interaction between the host's immune response, endotheliopathy, and microvascular coagulopathy. It has been proposed that the activation of the complement system plays a central role in the pathophysiology of severe COVID-19 and the associated endotheliopathy.
    Case summary: A 76-year-old male patient with indeterminate cardiogenic shock in the setting of confirmed SARS-CoV-2 infection was admitted to our intensive care unit. Coronary angiography did not reveal a plausible explanation for his symptoms. The patient developed renal failure, neurological symptoms, severe thrombocytopenia, and a Coombs-negative haemolytic anaemia with schistocytes. All together the clinical picture was highly suggestive of a thrombotic microangiopathy (TMA) with microvascular cardiac involvement. Conventional therapeutic strategies including high-dose steroids and seven sessions of therapeutic plasma exchange were all unsuccessful. Interestingly, complement inhibition with Eculizumab as rescue approach led to a rapid clinical and laboratory improvement and the patients were discharged with normalized organ functions at Day 36.
    Conclusion: The aetiology of cardiogenic shock observed in this patient cannot simply be explained by his focal and chronic coronary findings. Although viral myocarditis was not formally excluded, both the clinical features of TMA and the rapid resolution of all clinical signs and symptoms after pharmacological complement inhibition suggest a SARS-CoV-2-driven microangiopathic origin of heart failure.
    Language English
    Publishing date 2021-09-28
    Publishing country England
    Document type Case Reports
    ISSN 2514-2119
    ISSN (online) 2514-2119
    DOI 10.1093/ehjcr/ytab386
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Sans-papiers mais pas sans droit à la santé.

    Dabboubi, Najia / Diakhate, Julie Meyrat / Piergiovanni, Sophia / Solari, Daria / Utebay, Didar

    Revue medicale suisse

    2011  Volume 7, Issue 288, Page(s) 717–718

    Title translation Undocumented but not without the right to health.
    MeSH term(s) Emigrants and Immigrants ; Health Services Accessibility ; Humans ; Switzerland
    Language French
    Publishing date 2011-03-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2177010-4
    ISSN 1660-9379
    ISSN 1660-9379
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5998: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Sex-related differences of invasive therapy in patients with aneurysmal subarachnoid hemorrhage.

    Bögli, S Y / Utebay, D / Smits, N / Westphal, L P / Hirsbrunner, L / Unseld, S / Keller, E / Brandi, G

    Acta neurochirurgica

    2022  Volume 164, Issue 11, Page(s) 2899–2908

    Abstract: ... However, after excluding death as a possible outcome, sex did not remain a predictor of unfavorable outcome ...

    Abstract Background: Sex-related differences in patients with aneurysmal subarachnoid hemorrhage (aSAH) exist. More females than males are affected. Aneurysm location is associated to sex. The relationship between sex and outcome, however, is unclear. Possible differences in management might influence the occurrence of primary and secondary brain injury and thus outcome. The study compares demographics, intensity of treatment, complications, and outcome among females and males with aSAH.
    Methods: All consecutive patients with aSAH admitted to the neurocritical care unit, University Hospital Zurich over a 5-year period were eligible in this retrospective study. Patients' characteristics, comorbidities, aSAH severity, frequency of vasospasm/delayed cerebral ischemia, frequency of invasive interventions, and 3-month outcome were compared by sex. Univariate analysis was performed with the data dichotomized by sex, and outcome. Multivariate analysis for prediction of outcomes was performed.
    Results: Three hundred forty-eight patients were enrolled (64% females). Women were older than men. Comorbidities, scores at admission, and treatment modality were comparable among males and females. Vasospasm and DCI occurred similarly among females and males. Interventions and frequency of intraarterial spasmolysis were comparable between sexes. In the multivariate analysis, increasing age, female sex, increasing comorbidities, WFNS and Fisher grade, and presence of delayed cerebral ischemia were predictors of unfavorable outcome when considering all patients. However, after excluding death as a possible outcome, sex did not remain a predictor of unfavorable outcome.
    Conclusions: In the study population, women with aSAH might have present a worse outcome at 3 months. However, no differences by sex that might explain this difference were found in intensity of treatment and management.
    MeSH term(s) Male ; Humans ; Female ; Subarachnoid Hemorrhage/epidemiology ; Subarachnoid Hemorrhage/therapy ; Subarachnoid Hemorrhage/complications ; Retrospective Studies ; Brain Ischemia/epidemiology ; Brain Ischemia/therapy ; Cerebral Infarction ; Vasospasm, Intracranial/epidemiology ; Vasospasm, Intracranial/therapy
    Language English
    Publishing date 2022-08-19
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-022-05345-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.180: Show issues Location:
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