Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 7 Articles
Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses\nrapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse\nthe patientâ??s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the\nmost effective, supportive and adjunct strategy. In this paper we analyzed our experience in\nmanaging AFM with ECMO support. Methods: During October 2003 and February 2017, a total\nof 35 patients (â?¦â?¦18 years) were enrolled in the study. Twenty patients survived, and another 15\npatients expired. General demographics, the hemodynamic condition, timing of ECMO intervention,\nand laboratory data were compared for the survival and non-survival groups. Univariate and\nmultivariate Cox regression analyses were performed to identify the associations with in-hospital\nmortality following ECMO use in this situation. Results: The survival rate was 57.1% during the\nin-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac\nrhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial\nand 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need\nfor hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak\ntroponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used\nfor AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I\nlevels and 24-h serum lactic acid levels following ECMO use were independently associated with\nin-hospital mortality....
Heart trauma caused by a firearm projectile is the most fatal of cardiac injuries\ndue to the great potential for death. The increase in the number of cases\nin recent years is observed, due to the greater urban violence. We report the\ncase of a patient, a victim of firearm perforation, who suffered a cardiac\ntransfixing lesion, with clinical presentation and with an unusual cardiac injury,\noperated at our service with success....
Background: Patients on hemodialysis are at high risk of adverse cardiac\nevents after coronary artery bypass grafting (CABG). The aim of this study is\nto know whether CABG with complete revascularization and similar graft selection\ncan provide equivalent long-term benefits for patients on and not on\nhemodialysis. Methods: Between 2004 and 2018, 746 patients underwent isolated\nCABG, of which 106 were on hemodialysis. Propensity matching on\nbaseline characteristics, graft types and on/off-pump CABG was performed to\ncompare clinical outcomes between patients on (n = 102) and not on (n =\n102) hemodialysis. Results:.................
Background: Infection is a major complication in aplastic anemia (AA) patients. Primary objectives of this study\nwere to determine the prevalence of infections and to determine types of pathogens associated with infections in\npatients with AA. Secondary objectives were to evaluate overall survival after infections as well as risk factors of\ninfections in patients with AA.\nMethods: The authors retrospectively evaluated the infectious episodes (IEs), type of infections, associated pathogens,\nand outcomes of infections in patients with AA who were diagnosed and treated at Chiang Mai University between\nJanuary 2010 and December 2015.\nResults: Sixty-seven patients with a median age of 51 years (range, 15â??87 years) were enrolled. Forty two patients\n(62.6%) were severe AA. Median absolute neutrophil count (ANC) was 984 /mm3 (range, 120â??5500/mm3). Twenty\nfive patients (37.3%) received antithymocyte globulin plus cyclosporine A, 41 patients (61.1%) received anabolic\nhormone, and 2 patients (2.9%) underwent allogeneic hematopoietic stem cell transplantation. Overall, 31 IEs\nwere documented in 22 patients (32.8%). The most common microbiologically documented site of infection was\nbloodstream infection (23.4%) followed by pulmonary infection (14.9%). Culture-negative febrile neutropenia\noccurred in 12.7%. Common pathogens identified were bacteria (73.9%), mainly gram-negative (52.9%) including\nAcinetobacter baumannii (23.5%) and Pseudomonas aeruginosa (17.6%). Fungal infections were diagnosed in 21.7%\nand all were Aspergillus spp. Six patients (9%) died during the study period. All of them died from infection which\ngram-negative bacteria were most common pathogens (66.7%). Patients with infections had 5-year overall\nsurvival of 72% that is significantly less than patients without infection (100%) (p = 0.0002). Only risk factor that\ncorrelates with high probability of infection was ANC < 500/mm3. (HR 2.29, 95%CI 1.03â??7.72, p = 0.043).\nConclusions: Prevalence of infections in AA patients in Chiang Mai University was 32.8% Bacterial infections especially\ngram-negative bacteria were the major pathogens. Patients with ANC < 500/mm3 had higher risk of infections. Infection\nwas the most important cause of death in AA....
Individuals with SickleCell Trait (SCT), generally considered a benign carrier state of hemoglobin S (HbAS), are thought to be at risk\nfor exertional rhabdomyolysis and hematuria, conditions that can also be caused by various other acquired and inherited factors.We\nreport an SCT positive service member with an exertional rhabdomyolysis event, recurrent hematuria with transient proteinuria,\nand episodic burning pain in the lower extremities. Clinical and genetic studies revealed the multifactorial nature of his complex\nphenotype. The service member was taking prescription medications known to be associated with exertional rhabdomyolysis. He\ncarried a pathogenicmutation, NPHS2 p.V260E, reported in nephropathy and a new variant p.R838Q in SCN11A, a gene involved in\nfamilial episodic pain syndrome. Results suggest that drug-to-drug interactions coupled with the stress of exercise, coinheritance\nof HbAS and NPHS2 p.V260E, and p. R838Q in SCN11A contributed to exertional rhabdomyolysis, recurrent hematuria with\nproteinuria, and episodic pain, respectively. This case underscores the importance of comprehensive clinical and genetic evaluations\nto identify underlying causes of health complications reported in SCT individuals....
Objective.This systematic reviewaimed to measure the association between neutrophil lymphocyte ratio (NLR) and cardiovascular\ndisease (CVD) risk. Methods. Relevant studies were identified from Medline and Scopus databases. Observational studies with\nNLR as a study factor were eligible for review.The outcomes of interest were any type of CVD including acute coronary syndrome,\ncoronary artery disease, stroke, or a composite of these cardiovascular events. Mean differences in NLR between CVD and non-\nCVDpatients were pooled using unstandardized mean difference (USMD). Odds ratios of CVDbetween high and low NLR groups\nwere pooled using a random effects model. Results. Thirty-eight studies (n=76,002) were included. High NLR was significantly\nassociated with the risks of CAD, ACS, stroke, and composite cardiovascular events with pooled ORs of 1.62 (95% CI: 1.38-1.91),\n1.64 (95% CI: 1.30, 2.05), 2.36 (95% CI: 1.44, 2.89), and 3.86 (95% CI: 1.73, 8.64), respectively. In addition, mean NLRs inCAD,ACS,\nand stroke patients were significantly higher than in control groups. Conclusion. High NLR was associated with CAD, ACS, stroke,\nand composite cardiovascular events.Therefore, NLR may be a useful CVD biomarker....
We have investigated the frequencies of regulatoryT cells and the level of FOXP3 isoforms expression in peripheral blood of patients\nwith myelodysplastic syndromes and found the significant reduction of regulatory T cells at all stages of the disease. At the same\ntime in untreated patients,we observed the shift in the FOXP3 isoforms expression profile towards the full-length molecule possibly\ndue to inflammation. Based on the already known information about the potentially higher functional activity of FOXP3molecule\nlacking exon 2, we have also hypothesized that our finding may explain the high risk of autoimmune disorders in this disease....
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