Rare cause of arterial hypertension

Description

We report the case of a man aged 55 years who was referred to our department for investigation of arterial hypertension. He had only a previous diagnosis of situs inversus. At presentation, his blood pressure was 190/100 mm Hg in both arms, but significantly lower in lower limbs. The pulses were equal over both upper extremities, but lower limbs pulses were also weakly palpable. On cardiac auscultation, a grade II/VI systolic murmur was heard on the right scapular region.

Chest radiography showed dextrocardia and bilateral rib notching (figure 1).

Figure 1

Chest radiogram showing bilateral rib notching (arrow).

The transthoracic echocardiography showed mild concentric hypertrophy and mild dilation of the ascending thoracic aorta; due to a poor suprasternal view, the aortic arch could not be adequately assessed.

Multislice CT angiography revealed a complete interruption of the aortic arch distal to the origin of...

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Partial segmental thrombosis of the corpus cavernosum presenting with perineal pain

We describe the case of a man aged 43 years who presented with a 2-week history of a palpable lump in the right proximal penile shaft. This was preceded by a 6-month history of perineal pain, accompanied by erectile dysfunction. An urgent MRI scan of his penis identified a thrombus within the right crus and corpus of the penis. His thrombophilia screen was normal. The patient was started on oral anticoagulation and a phosphodiesterase inhibitor (PDE-5i) to prevent thrombus progression and maintain erectile function. At 5 months, the patients' symptoms had resolved and an MRI showed a reduction in the thrombus size. MRI is a useful imaging modality to diagnose a thrombus within the corpus cavernosum in patients presenting with a history of penile and perineal pain together with a palpable lump. The non-enhancement of the lesion helps to differentiate this from alternative rare lesions within the penis and perineum.

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Large thymoma mass invading cardiac structures

Description

We report a retired, Afro-Caribbean man aged 69 years who presented to his local hospital with several weeks of dyspnoea and cough. Physical examination was unremarkable apart from an elevated jugular venous pressure and a bilateral pedal oedema. His medical history included asthma and controlled hypertension. Urgent transthoracic echocardiography showed a large soft tissue mass in the pericardial space compressing the right ventricle (RV), and the right atrium (RA).

A CT of the thorax showed a mass measuring 16 cm in width by 8 cm in depth with infiltration and compression of RV and RA with distortion of atrioventricular groove anatomy between RV and RA (figure 1).

Figure 1

Contrast CT scan of the chest (left) showing thymoma mass invading the right ventricle (RV) (arrow A), invading the right coronary artery origin (arrow B) and invading the right atrium (arrow C). Three-dimensional reconstruction of thymic mass...

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Symmetrical digital gangrene after a high dose intravenous infusion of epinephrine and dopamine following resuscitation from cardiac arrest

Description

Symmetrical digital gangrene (SDG) is mostly due to low cardiac output and disseminated intravascular coagulation (DIC) (table 1).1 We describe a 36-year-old right-handed man with SDG requiring amputation of 14 digits. He had received continuous intravenous infusion of epinephrine and dopamine given for a cardiac arrest that developed 1 hour after resection of a meningioma (table 2). In cardiogenic shock, he had decreased responsiveness, sinus tachycardia (135 bpm) and arterial hypotension (50/45 mm Hg). Advanced cardiac life support with mechanical ventilatory support was instituted. The administration of inotropic agents stabilised blood pressure to around 110/65, heart rate at 98 and mean arterial pressure (MAP) at 70 mm Hg. The patient's responsiveness improved gradually, but cardiovascular instability made him inotropic dependant.

Table 1

Causes of symmetrical digital gangrene

Hypercoagulable statePrimary: Antithrombin III deficiency, protein C and protein S deficiency, abnormalities of the...

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Distortion-Product Otoacoustic Emission Measured Below 300 Hz in Normal-Hearing Human Subjects

Abstract

Physiological noise levels in the human ear canal often exceed naturally low levels of otoacoustic emissions (OAEs) near the threshold of hearing. Low-frequency noise, and electronic filtering to cope with it, has effectively limited the study of OAE to frequencies above about 500 Hz. Presently, a custom-built low-frequency acoustic probe was put to use in 21 normal-hearing human subjects (of 34 recruited). Distortion-product otoacoustic emission (DPOAE) was measured in the enclosed ear canal volume as the response to two simultaneously presented tones with frequencies f ₁ and f ₂. The stimulus–frequency ratio f ₂/f ₁ was varied systematically to find the "optimal" ratio evoking the largest level at 2 f ₁−f ₂ frequencies 87.9, 176, and 264 Hz. No reference data exist in this frequency region. Results show that DPOAE exists down to at least 87.9 Hz, maintaining the bell-shaped dependence on the f ₂/f ₁ ratio known from higher frequencies. Toward low frequencies, however, the bell broadens and the optimal ratio increases proportionally to the bandwidth of an auditory filter as defined by the equivalent rectangular bandwidth. The DPOAE phase rotates monotonously as a function of the stimulus ratio, and its slope trend supports the notion of a lack of scaling symmetry in the apex of the cochlea.

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Ph1b Study of Oraxol in Comb. w. Ramucirumab in Patients w. Gastric, Gastro-esophageal, or Esophageal Cancers

Conditions:   Gastric Cancer;   Esophageal Cancer;   Gastro-esophageal Cancer
Interventions:   Drug: Oraxol;   Drug: Ramucirumab
Sponsor:   Kinex Pharmaceuticals Inc
Not yet recruiting - verified November 2016

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Nineteen reasons why physiatrists should do musculoskeletal ultrasound: EURO-MUSCULUS/USPRM recommendations

This article is an eventual consensus of experts from the European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) pertaining to the use of musculoskeletal ultrasound in physical and rehabilitation medicine. Nineteen important reasons (as regards general advantages, specific conditions in physical and rehabilitation medicine, as well as comparisons with other imaging tools) have been highlighted to consolidate the scenario of how/why the probe of ultrasound needs to become the stethoscope, the extended hand, and the pen of physiatrists.

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Possible pathogenic mechanism of propofol infusion syndrome involves coenzyme Q

BACKGROUND: Propofol is a short-acting intravenous anesthetic agent. In rare conditions, a life-threatening complication known as propofol infusion syndrome can occur. The pathophysiologic mechanism is still unknown. Some studies suggested that propofol acts as uncoupling agent, others suggested that it inhibits complex I or complex IV, or causes increased oxidation of cytochrome c and cytochrome aa3, or inhibits mitochondrial fatty acid metabolism. Although the exact site of interaction is not known, most hypotheses point to the direction of the mitochondria. METHODS: Eight rats were ventilated and sedated with propofol up to 20 h. Sequential biopsy specimens were taken from liver and skeletal muscle and used for determination of respiratory chain activities and propofol concentration. Activities were also measured in skeletal muscle from a patient who died of propofol infusion syndrome. RESULTS: In rats, authors detected a decrease in complex II+III activity starting at low tissue concentration of propofol (20 to 25 µM), further declining at higher concentrations. Before starting anesthesia, the complex II+III/citrate synthase activity ratio in liver was 0.46 (0.25) and in skeletal muscle 0.23 (0.05) (mean [SD]). After 20 h of anesthesia, the ratios declined to 0.17 (0.03) and 0.12 (0.02), respectively. When measured individually, the activities of complexes II and III remained normal. Skeletal muscle from one patient taken in the acute phase of propofol infusion syndrome also shows a selective decrease in complex II+III activity (z-score: -2.96). CONCLUSION: Propofol impedes the electron flow through the respiratory chain and coenzyme Q is the main site of interaction with propofol.

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Congenital Hypothyroidism: An Unusual Combination of Biochemical Abnormalities

A forty-five-day-old female infant presented with prolonged jaundice with clinical features suggestive of congenital hypothyroidism (CHT). On investigations, the infant was noted to have indirect hyperbilirubinemia (13.8 mg/dl) with increased levels of AST (298 IU/dl) and ALT (174 IU/dl) in the serum. The child had low levels of free T3 (500 microIU/ml) in the serum. The combination of indirect hyperbilirubinemia and raised levels of hepatic transaminases has not been reported in babies with CHT. Following institution of oral thyroxin therapy, the serum bilirubin levels ameliorated (2.9 mg/dl) considerably by 15 days of therapy and the serum levels of AST (40 IU/dl) and ALT (20 IU/dl) got normalized. The case demonstrates that raised levels of hepatic transaminases can occur in infants with CHT and these can resolve just with thyroxin therapy, obviating the need for extensive investigative laboratory work-up.

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Dilated Cardiomyopathy Induced by Chronic Starvation and Selenium Deficiency

Protein energy malnutrition (PEM) has been rarely documented as a cause of cardiovascular abnormalities, including dilated cardiomyopathy. Selenium is responsible for antioxidant defense mechanisms in cardiomyocytes, and its deficiency in the setting of PEM and disease related malnutrition (DRM) may lead to exacerbation of the dilated cardiomyopathy. We report a rare case of a fourteen-year-old boy who presented with symptoms of congestive heart failure due to DRM and PEM (secondary to chronic starvation) along with severe selenium deficiency. An initial echocardiogram showed severely depressed systolic function consistent with dilated cardiomyopathy. Aggressive nutritional support and replacement of selenium and congestive heart failure medications that included diuretics and ACE inhibitors with the addition of carvedilol led to normalization of the cardiac function within four weeks. He continues to have significant weight gain and is currently completely asymptomatic from a cardiovascular standpoint.

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Computational Methods for Annotation Transfers from Sequence

Cozzetto, D; Jones, DT; (2016) Computational Methods for Annotation Transfers from Sequence. In: Dessimoz, C and Škunca, N, (eds.) The Gene Ontology Handbook: Part II. (pp. 55-67). Springer New York: New York, USA. Green open access

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Overlap Between the General Factor of Personality and Emotional Intelligence: A Meta-Analysis

Van der Linden, D; Pekaar, KA; Bakker, AB; Schermer, JA; Vernon, PA; Dunkel, CS; Petrides, KV; (2016) Overlap Between the General Factor of Personality and Emotional Intelligence: A Meta-Analysis. Psychological Bulletin 10.1037/bul0000078 . Green open access

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Internet-of-things data aggregation using compressed sensing with side information

De Castro Mota, JF; Zimos, E; Rodrigues, M; Deligiannis, N; (2016) Internet-of-things data aggregation using compressed sensing with side information. In: 2016 23rd International Conference on Telecommunications (ICT). IEEE: Thessaloniki. Green open access

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Francis Bacon's "Speech on a Case of Deer-Stealing"

Williams, IS; (2017) Francis Bacon's "Speech on a Case of Deer-Stealing". Notes and Queries (In press).

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X-Ray Image Separation via Coupled Dictionary Learning

De Castro Mota, JF; Deligiannis, N; Cornelis, B; Rodrigues, M; Daubechies, I; (2016) X-Ray Image Separation via Coupled Dictionary Learning. In: 2016 IEEE International Conference on Image Processing. (pp. pp. 3533-3537). IEEE: Phoenix, AZ, USA. Green open access

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Fertility and pregnancy in systemic lupus erythematosus

Jones, A; Giles, IP; (2016) Fertility and pregnancy in systemic lupus erythematosus. Indian Journal of Rheumatology , 11 (6) pp. 128-134. 10.4103/0973-3698.194546 . Green open access

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The influence of socioeconomic status on changes in young people's expectations of applying to university

Anders, JD; (2017) The influence of socioeconomic status on changes in young people's expectations of applying to university. Oxford Review of Education (In press).

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Inhibitory effect of estrogen receptor beta on P2X3 receptors during inflammation in rats

Jiang, Q; Li, WX; Sun, JR; Zhu, TT; Fan, J; Yu, LH; Burnstock, G; Jiang, Q; Li, WX; Sun, JR; Zhu, TT; Fan, J; Yu, LH; Burnstock, G; Yang, H; Ma, B; - view fewer (2016) Inhibitory effect of estrogen receptor beta on P2X3 receptors during inflammation in rats. Purinergic Signalling 10.1007/s11302-016-9540-5 . (In press).

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Four Thoughts on Trait Emotional Intelligence

Petrides, KV; (2016) Four Thoughts on Trait Emotional Intelligence. Emotion Review , 8 (4) p. 345. 10.1177/1754073916650504 . Green open access

http://ift.tt/2f2PnN8

eFORGE: A Tool for Identifying Cell Type-Specific Signal in Epigenomic Data

Breeze, CE; Paul, DS; van Dongen, J; Butcher, LM; Ambrose, JC; Barrett, JE; Lowe, R; Breeze, CE; Paul, DS; van Dongen, J; Butcher, LM; Ambrose, JC; Barrett, JE; Lowe, R; Rakyan, VK; Iotchkova, V; Frontini, M; Downes, K; Ouwehand, WH; Laperle, J; Jacques, PÉ; Bourque, G; Bergmann, AK; Siebert, R; Vellenga, E; Saeed, S; Matarese, F; Martens, JH; Stunnenberg, HG; Teschendorff, AE; Herrero, J; Birney, E; Dunham, I; Beck, S; - view fewer (2016) eFORGE: A Tool for Identifying Cell Type-Specific Signal in Epigenomic Data. Cell Reports , 17 (8) pp. 2137-2150. 10.1016/j.celrep.2016.10.059 . Green open access

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Testing a speculative bubble in the dry bulk shipping market: a multi-factor approach

Cocconcelli, L; Medda, F; (2016) Testing a speculative bubble in the dry bulk shipping market: a multi-factor approach. International Journal of Decision Sciences, Risk and Management , 6 (3) p. 281. 10.1504/IJDSRM.2016.079795 .

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The political economy of Jamaican taxation, 1754-1839

Graham, AB; (2017) The political economy of Jamaican taxation, 1754-1839. The Journal of Imperial and Commonwealth History (In press).

http://ift.tt/2flEj9a

Bayesian compressed sensing with heterogeneous side information

De Castro Mota, JF; Zimos, E; Deligiannis, N; Rodrigues, M; (2016) Bayesian compressed sensing with heterogeneous side information. In: Data Compression Conference Proceedings 2016. (pp. pp. 191-200). IEEE (In press). Green open access

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Dyspnoea perception and susceptibility to exacerbation in COPD

Ridsdale, HA; Hurst, JR; (2016) Dyspnoea perception and susceptibility to exacerbation in COPD. Thorax 10.1136/thoraxjnl-2016-209318 . (In press). Green open access

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Cystinosis: a new perspective

Cystinosis is a rare, autosomal recessive inherited lysosomal storage disease. It is the most frequent and potentially treatable cause of the inherited renal Fanconi syndrome. If left untreated, renal function rapidly deteriorates towards end-stage renal disease by the end of the first decade of life. Due to its rarity and nonspecific presentation, the entity is often not promptly recognized resulting in delayed diagnosis. Two major milestones in cystinosis management, cystine-depleting therapy with cysteamine and renal allograft transplantation, have had a considerable impact on the natural history and prognosis of cystinosis patients. However, due to its significant side effects and a strict 6-hourly dosing regimen, non-adherence to the immediate release of cysteamine bitartrate formulation (Cystagon((R))) is a major issue that might affect long-term outcome. Recently, a new twice-daily administered delayed-release enteric-coated formula of cysteamine bitartrate (Procysbi((TM))) has been approved by the European Medical Agency for the treatment of cystinosis, and has been shown to be safe and effective. This delayed-release cysteamine has the potential to improve compliance and hence prognosis, through its better dosing regimen, positive impact on quality of life and possibly less side-effects, and is now tested in an ongoing long-term clinical trial. Longer survival of patients with cystinosis makes transition from pediatric to adult-oriented care another challenge in cystinosis management and requires an extended multidisciplinary approach.

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Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis: a survey from the European Paediatric Dialysis Working Group

Pleural or pericardial effusions secondary to pleuro-peritoneal fistula (PPF) and pericardio-peritoneal fistula (PcPF) are rare but serious complications of peritoneal dialysis (PD). We conducted a 10-year survey across all participating centres in the European Paediatric Dialysis Working Group to review the incidence, diagnostic techniques, therapeutic options and outcome of children on chronic PD with PPF and/or PcPF. Of 1506 children on PD there were ten cases (8 of PPF, 1 each of PcPF and PPF + PcPF), with a prevalence of 0.66 %. The median age at presentation was 1.5 [inter-quartile range (IQR) 0.4-2.4] years, and nine children were < 3 years. The time on PD before onset of symptoms was 4.3 (IQR 1.3-19.8) months. Eight children had herniae and seven had abdominal surgery in the preceding 4 weeks. Symptoms at presentation were respiratory distress, reduced ultrafiltration and tachycardia. PD was stopped in all children; three were managed conservatively and thoracocentesis was performed in seven (with pleurodesis in 3). PD was restarted in only three children, in two of them with success. In conclusion, PPF and PcPF are rare in children on chronic PD, but are associated with significant morbidity, requiring a change of dialysis modality in all cases. Risk factors for PPF development include age of < 3 years, herniae and recent abdominal surgery.

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Management of hypertension in children and adolescents

Hypertension has been recognized as an important health issue in the pediatric population over the past years. This emphasizes the need for an organized and effective plan for diagnosis and management. This review provides information to guide physicians through a structured approach to (1) screen children for hypertension during routine visits; (2) use normative blood pressure tables for diagnosis and classification; (3) perform a clinical evaluation to identify the presence of risk factors, comorbidities and/or target organ damage; and (4) initiate an individualized plan of care that includes follow-up blood pressure measurement, therapeutic lifestyle changes and - if necessary - pharmacological therapies.

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A case of chronic recurrent multifocal osteomyelitis associated with Crohn's disease

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory bone disease of unknown etiology, most commonly affecting the metaphysis of long bones, especially the tibia, femur and clavicle. The clinical spectrum varies from self-limited uni-or multi-focal lesions to chronic recurrent courses. Diagnosis is based on clinical, radiologic and pathological findings, is probably under-diagnosed due to poor recognition of the disease. A dysregulated innate immunity causes immune cell infiltration of the bones with subsequent osteoclast activation leading to sterile bone lesions. The molecular pathophyiology is still incompletely understood but association with other auto-inflammatory diseases such as inflammatory bowel disease (IBD), psoriasis, Wegener's disease, arthritis and synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is interesting. CRMO can precede the symptoms of the associated disease by several years. The bone remodeling caused by CRMO can cause permanent disability. We report the case of a 10-year-old boy with CRMO in association with Crohn's disease.

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EURAMOS-1, an international randomised study for osteosarcoma: results from pre-randomisation treatment

Background: Four international study groups undertook a large study in resectable osteosarcoma, which included two randomised controlled trials, to determine the effect on survival of changing post-operative chemotherapy based on histological response. Patients and methods: Patients with resectable osteosarcoma aged <= 40 years were treated with the MAP regimen, comprising pre-operatively of two 5-week cycles of cisplatin 120 mg/m(2), doxorubicin 75mg/m(2), methotrexate 12 g/m(2) x 2 (MAP) and post-operatively two further cycles of MAP and two cycles of just MA. Patients were randomised after surgery. Those with >= 10% viable tumour in the resected specimen received MAP or MAP with ifosfamide and etoposide. Those with < 10% viable tumour were allocated to MAP or MAP followed by pegylated interferon. Longitudinal evaluation of quality of life was undertaken. Results: Recruitment was completed to the largest osteosarcoma study to date in 75 months. Commencing March 2005, 2260 patients were registered from 326 centres across 17 countries. About 1334 of 2260 registered patients (59%) were randomised. Pre-operative chemotherapy was completed according to protocol in 94%. Grade 3-4 neutropenia affected 83% of cycles and 59% were complicated by infection. There were three (0.13%) deaths related to pre-operative chemotherapy. At definitive surgery, 50% of patients had at least 90% necrosis in the resected specimen. Conclusions: New models of collaboration are required to successfully conduct trials to improve outcomes of patients with rare cancers; EURAMOS-1 demonstrates achievability. Considerable regulatory, financial and operational challenges must be overcome to develop similar studies in the future. The trial is registered as NCT00134030 and ISRCTN 67613327.

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Prevalence of gender nonconformity in Flanders, Belgium

Gender nonconformity refers to the extent to which a person's gender identity, gender role and/or gender expression differs from the cultural norms prescribed for people of a particular sex, within a certain society and era. Most data on gender nonconformity focus on the prevalence of gender dysphoria (which also includes a distress factor) or on the number of legal sex changes. However, not every gender nonconforming individual experiences distress or applies for treatment. Population-based research on the broad spectrum of gender nonconformity is scarce and more information on the variance outside the gender binary is needed. This study aimed to examine the prevalence of gender incongruence (identifying stronger with the other sex than with the sex assigned at birth) and gender ambivalence (identifying equally with the other sex as with the sex assigned at birth) based on two population-based surveys, one of 1,832 Flemish persons and one of 2,472 sexual minority individuals in Flanders. In the general population, gender ambivalence was present in 2.2% of male and 1.9% of female participants, whereas gender incongruence was found in 0.7% of men and 0.6% of women. In sexual minority individuals, the prevalence of gender ambivalence and gender incongruence was 1.8% and 0.9% in men and 4.1% and 2.1% in women, respectively. With a current Flemish population of about 6 million, our results indicate a total of between 17,150 and 17,665 gender incongruent men and between 14,473 and 15,221 gender incongruent women in Flanders.

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Recent advances in multidisciplinary critical care

The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters.

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Automated testing combined with automated retraining to improve CPR skill level in emergency nurses

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Neurological involvement in Erdheim–Chester disease

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Bipolar electrograms characteristics at the left atrial-pulmonary vein junction: toward a new algorithm for automated verification of pulmonary vein isolation

BACKGROUND: Verification of pulmonary vein isolation (PVI) is challenging because of the coexistence of PV and far-field potentials in bipolar electrograms recorded at the Left atrial-pulmonary vein (LA-PV) junction. OBJECTIVE: The purpose of this study was to characterize algorithmically LA-PV potentials before and after PVI and to develop an algorithm to differentiate nonisolated from isolated PVs. METHODS: In 61 patients, we characterized by type (morphology) and parameters-1440 electrograms recorded during sinus rhythm before and after PVI. Based on vein-dependent prevalence of a given type before and after PVI (first step) and based on vein- and type-dependent cutoff values in parameters specific for recordings before and after PVI (second step), we developed a 2-step algorithm to differentiate nonisolated from isolated PVs. We prospectively validated this algorithm in another dataset of 20 patients. RESULTS: Characteristics before and after PVI were as follows: low voltage (10% +/- 7% vs 36% +/- 15%), monophasic (13% +/- 4% vs 27% +/- 9%), biphasic (18% +/- 4% vs 21% +/- 7 9%), triphasic (22% +/- 5% vs 11% +/- 13%), multiphasic (26% +/- 7% vs 3% +/- 3%), double potentials (11% +/- 5% vs 2% +/- 1%), peak-to-peak amplitude (0.97 +/- 0.21 mV vs 0.35 +/- 0.23 mV), maximal slope (0.179 +/- 0.033 mV/ms vs 0.071 +/- 0.029 mV/ms), minimal slope (0.030 +/- 0.003 mV/ms vs 0.024 +/- 0.002 mV/ms), and sharpest peak (1.82 degrees +/- 0.26 degrees vs 3.45 degrees +/- 0.85 degrees, P < .01 for all except biphasic). Overall sensitivity and specificity of the 2-step algorithm was 100% and 87%, respectively. CONCLUSION: We algorithmically characterized LA-PV potentials before and after PVI in a Large dataset (library of types and parameters). This library enabled us to develop an accurate 2-step algorithm to automatically differentiate nonisolated from isolated PVs. The 2-step algorithm is objective and reliable for assessing PV isolation without the need for pacing maneuvers.

http://ift.tt/2f2IBqK

The impact of chronic benzodiazepine use on cognitive evolution in nursing home residents

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IgM interference in the Abbott iVanco immunoassay: a case report

Vancomycin; Interference; IgM paraprotein; Immunoassay; SERUM

http://ift.tt/2f2BKO1

Ultrafast quantification of β-lactam antibiotics in human plasma using UPLC-MS/MS

http://ift.tt/2fllnYo

Role of angiogenic factors/cell adhesion markers in serum of cirrhotic patients with hepatopulmonary syndrome

Background & Aims: Hepatopulmonary syndrome is a complication of chronic liver disease resulting in increased morbidity and mortality. It is caused by intrapulmonary vascular dilations and arteriovenous connections with devastating influence on gas exchange. The pathogenesis is not completely understood but evidence mounts for angiogenesis. Aims of this study were to identify angiogenic factors in serum of patients with hepatopulmonary syndrome and to study the possibility to predict its presence by these factors. Methods: Multiplex assays were used to measure the concentration of angiogenic factors in patients with (n=30) and without hepatopulmonary syndrome (n=30). Diagnosis was based on the presence of gas exchange abnormality and intrapulmonary vasodilations according to published guidelines. Results: Patients with and without hepatopulmonary syndrome had similar MELD scores (median: 11.2 vs. 11.6; P=0.7), Child-Pugh score (P=0.7) and PaCO2 values (median: 35 vs. 37; P=0.06). PaO2 and P(A-a) O-2 gradient were significantly different (respectively median of 80 vs. 86, P=0.02; and 24 vs. 16, P=0.004). Based on area under the curve (AUC) data and P-values, the best predictors were vascular cell adhesion molecule 1 (VCAM1) (AUC=0.932; P<0.001) and intercellular adhesion molecule 3 (ICAM3) (AUC=0.741; P=0.003). Combining these factors results in an AUC of 0.99 (after cross-validation still 0.99). Conclusions: VCAM1 and ICAM3 might be promising biomarkers for predicting hepatopulmonary syndrome. Combining these factors results in an AUC of 0.99 and a negative predictive value of 100%. Determining the concentration of these biomarkers might be a screening method to detect hepatopulmonary syndrome. The use of these biomarkers should be validated in larger groups of patients.

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Bronchial Foreign Body Alerting of a Bronchial Tumor: The Need of a Follow-Up Radiography

Lung tumors are extremely rare in the pediatric population, comprising only 0.2% of all malignancies in children. Among them, mucoepidermoid carcinoma (MEC) is even rarer with a reported frequency of 0.1% to 0.2%. MEC is defined by the World Health Organization as a tumor characterized by a combination of mucus-secreting, squamous, and intermediate cell types. We describe the case of a 4-year-old girl who presented with a history of intermittent fever and nonproductive cough of 1-month duration after foreign body aspiration. The chest X-ray showed complete collapse of the left lung. After removal of the foreign body, the lung expanded well after. However, the control chest X-ray done after 5 days showed again complete collapse of the left lung. The biopsy specimen taken during bronchoscopy confirmed the diagnosis of low-grade MEC. Fluorescence in situ hybridization (FISH) confirmed the presence of MAML2 rearrangement. Complete surgical resection with preservation of lung parenchyma was performed. No adjuvant therapy was needed. Repeat bronchoscopy was performed 2 months after surgery and showed no recurrence of the tumor. In conclusion, a remote chest X-ray after removal of a foreign body is necessary to avoid missing a rare serious underlying disease such as MEC. According to the size and the location of the tumor, complete surgical removal is sufficient without additional treatment in case of low-grade tumor. The presence of MAML2 rearrangement confers a favorable outcome and may have long-term implications for the clinical management.

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Verzekering voor een pop-up store

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Gender dysphoria: social factors

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De non-profit sector, booming business? Hybridisering van middenveldorganisaties richting de markt: een begrippenkader

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Prevalence, determinants, and prognostic significance of pulmonary hypertension in elderly patients admitted with acute decompensated heart failure: a report from the BIO-HF Registry

Purpose: Pulmonary hypertension (PHT) is a predictor of mortality and morbidity in patients with chronic heart failure (HF). However, the prevalence, determinants, and prognostic significance of PHT in elderly patients admitted with acute decompensated HF are unclear. Methods: We prospectively evaluated 401 patients aged 75years (mean age 835years, 50% women) with acute HF, who were discharged alive, and whose tricuspid regurgitation (TR) gradient was measured by echocardiography during hospitalization. PHT was defined as a TR gradient 30mmHg. The endpoint was all-cause mortality. Results: PHT was found in 280/401 patients (69%), including in 67% of patients with HF with reduced ejection fraction (HFrEF) and 73% of patients with HF with preserved ejection fraction (HFpEF) (P=0.19). Clinical characteristics and comorbidities were similar between patients with and without PHT. The prevalence of PHT increased with increasing severity of mitral regurgitation (MR) (mild: 65%; moderate: 67%; severe: 85%; P<0.01). After a mean follow-up of 405 +/- 399days, 118 patients (30%) had died. In a multivariate Cox regression analysis, that included age, sex, serum creatinine, TR gradient, comorbidities, and medications at discharge, age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.11, P<0.001), serum creatinine (HR 1.41, 95% CI 1.15-1.73, P<0.01), and PHT (HR 1.60, 95% CI 1.03-2.49, P<0.01) were independent predictors of all-cause mortality. Conclusion: In elderly patients admitted with acute HF, PHT is common, mainly associated with the severity of MR and associated with a worse outcome after discharge.

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Ischaemic necrosis of the tongue as a rare complication of cardiogenic shock

Ischaemic necrosis of the tongue is an unusual clinical finding. In most cases it is associated with vasculitis, particularly giant cell arteritis (GCA). Other causes include profound cardiogenic shock. We report a case of tongue necrosis in an 81-year-old Caucasian woman. The patient was admitted to the intensive care unit (ICU) for cardiogenic shock. Swelling of the tongue was reported before intubation and evolved into tongue ischaemia and necrosis of the tip of the tongue. After surgical debridement the patient recovered. To our knowledge, this is the second report of a patient surviving tongue necrosis resulting from cardiogenic shock.

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Gezinnen in transitie

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The Asklepios project in perspective: the population on its way to ageing

The Asklepios project was developed by a consortium of researchers from the Ghent University in close collaboration with a group of exceptionally motivated primary care physicians (GPs) of the twin cities Erpe-Mere and Nieuwerkerken. These communities are situated on both sides of the busy motorway from Brussels to Ghent. The GP's were highly committed to show that they were able to actively collaborate and to provide the necessary men and women for a top scientific project'. Serendipitously, a number of key necessary strengths were present at that moment and time at Ghent University. In the departments of cardiology and public health, there was an extensive expertise in cardiovascular epidemiology, hypertension, non-invasive haemodynamic, and cardiovascular function testing. Furthermore, the planned project provided an ideal population-based testing ground for a number of physiological questions that grew out of a long-standing collaboration with civil engineers, who had built up a leading expertise in biomedical and biomechanical modelling of the cardiovascular system. Furthermore, the inherent interest in ageing was the link to a new partnership with experts in telomere biology and epigenetics...

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The use of cardiovascular imaging in prognostic stratification

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Orthostatic hypotension and associated conditions in geriatric inpatients

Screening of orthostatic hypotension (OH) was performed in 285 patients aged 75 years. Current drugs, reasons for admission, geriatric syndromes, and confounding medical conditions were collected. Patients with OH (n=116, 41%) as compared to those without OH (n=169) more frequently (P<0.01) presented falls in the last 6 months (62 vs. 40%, P<0.001), a fall as the reason for the current admission (49 vs. 26%, P<0.001), feeling of fainting (20 vs. 6%, P=0.002), syncope (29 vs. 4%, P<0.001) or functional decline (71 vs. 47%, P=0.012). No difference was observed between the two groups in terms of age (85 +/- 5 vs. 84 +/- 4 years), gender (59 vs. 50% female), common geriatric conditions (e.g. malnutrition 46 vs. 58%, dementia 22 vs. 26%), comorbidity or confounding conditions (dehydration 28 vs. 30%, sepsis 2 vs. 6%). No difference was detected in the use of drugs with psychotropic cardiovascular or diuretic effect, or in their associations. Orthostatic hypotension is frequent upon hospital admission and should be screened, particularly in geriatric fallers. This absence of relation between OH and drugs use suggests that non-pharmacological interventions should be first attempted in older inpatients with OH before deciding to reduce or withdraw useful drugs.

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Archiefbank Vlaanderen: Blauwdruk voor een geautomatiseerd register van het Vlaams privaat archivalisch erfgoed

http://ift.tt/2fYFCN4

Assessment of cubosomal alpha lipoic acid gel efficacy for the aging face: a single-blinded, placebo-controlled, right-left comparative clinical study

Summary

Background

A poloxamer solution acting as a vehicle for the lipid base particulate system (cubosome dispersions) containing alpha lipoic acid (ALA) has achieved encouraging results in skin aging.

Objective

Evaluate the efficacy of 5% Cubosomal ALA as an anti-aging formulation.

Methods

This single-blinded, placebo-controlled, comparative study was conducted on 20 females. Patients were instructed to apply a gel formulation containing the active ingredient over the right half of their face and a placebo gel on the left half twice daily for 6 months. Global aesthetic improvement scale (GAIS) was utilized as a measure of clinical progress. The thicknesses of the epidermis and dermis were assessed before and after treatment using an ultrasound biomicroscope.

Results

The GAIS score assessment at 3 and 6 months showed a significantly greater improvement on the right sides in comparison with the left sides. At the end of the treatment period, the mean epidermal thickness significantly increased on the right side in comparison with the left side and the mean dermal thickness increased more on the right side in comparison with the left side; however, this difference was not significant.

Conclusion

5% Cubosomal ALA is an effective and safe modality for improving aging face.

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