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Left main stenting induced flow disturbances on ascending aorta and aortic arch

Abstract

Background and Objective

Ostial LM stenting potentially induces turbulence in the aortic wall near the LM ostium, which might be correlated with aorta dilation and dissection. We investigated through a computational fluid dynamic analysis (CFD), the presence and potential consequences of flow turbulences both in the ascending aorta and arch after a stenting left main (LM) mid shaft or distal disease.

Methods

The model of the ascending aorta and left coronary artery was reconstructed reviewing both angiographic and echocardiographic measurements of 80 consecutive patients (43 males, mean age 75.1 ± 6.2 years) with significant LM mid shaft or distal disease treated in our institution. For stent simulation, a third-generation everolimus-eluting stent was reconstructed. Two stenting procedures (lesion 1:1 or ostial coverage) were investigated.

Results

The net area averaged WSS of the model resulted higher when the stent covered the lesion 1:1 compared to the ostial coverage (3.68 vs. 2.06 Pa, P=0.01 and 3.97 vs. 1.98 Pa, P < 0.001, respectively). LM ostial coverage generates more turbulences in the LM itself, in the aortic wall at ostium level, and at the sino-tubular junction compared with the stenting of the lesion 1:1. Conversely, in the ascending aorta, the WSS appears lower when stenting the lesion 1:1.

Conclusion

Extending the stent coverage up to the ostium, when the ostial region is not diseased, might induce unfavorable alterations of flow; not only both at the level of the LM lesion and ostium sites, but also in the ascending aorta and aortic arch, potentially predisposing the aortic wall to long-term damage.

Open access
LncRNA: An all-rounder in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease and is supposed to have both genetic and environmental backgrounds. Plenty of studies have demonstrated the roles of long non-coding RNAs (lncRNAs) in the initiation and development of RA. Numerous lncRNAs have been found to be dysregulated in RA and to be correlated with disease activity of RA, which indicates potential diagnostic roles of lncRNAs. In addition to working as biomarkers for RA, lncRNAs participate in many specific pathological processes including inflammation, aberrant proliferation, migration, invasion and apoptosis. Further screenings and researches are required to validate the clinical potentials of lncRNAs as diagnostic and therapeutic targets in RA.

Open access
Management of patients with liver cirrhosis and invasive bladder cancer: A case-series

Abstract

Liver cirrhosis is a major risk factor for increased mortality and morbidity in patients undergoing non-hepatic surgery with overall mortality rates as high as 45–50%. However, cirrhotic patients are often in need of surgical procedures including urological surgeries like cystectomies for muscle invasive bladder cancer. Data on the prognosis of these patients undergoing cystectomy for bladder cancer are scarce in the literature. In the present case-study, we describe the outcomes of 3 patients with liver cirrhosis who underwent radical cystectomy for muscle invasive bladder cancer. To the best of our knowledge, this is the first study reporting on this kind of urological surgery in patients with liver cirrhosis. Accordingly, we provide a review in the literature on prognosis and factors influencing the survival of cirrhotic patients who undergo surgical procedures.

Open access
Short course of high-dose steroids for anaphylaxis caused flare up of tuberculosis: A case report

Abstract

A 25-year-old male patient received high-dose intravenous steroids for life-threatening anaphylaxis because of bee sting only for 4 days resulted in reactivation of latent tuberculosis infection (LTBI). Clinical presentation is acute form of progressive pulmonary tuberculosis with pleural efusion that can be misdiagnosed as a community-acquired pneumonia. High index of suspicion with adequate evaluation is must in all cases to have satisfactory treatment outcome. Bronchoscopy is crucial in evaluation with histopathology expertise is must while managing such cases.

Open access
Agglomeration effect of medical education: Based on the web of science database

Abstract

By retrieving the 1900–2016 medical education-related essays from the web of science database, UCINET software was used to build the national cooperation network and its nested visualization software, and NetDraw was used to visualize the country cooperation networks in different time windows. We found that international medical education papers began to show exponential growth until 1945 and international cooperation did not begin to become dense until 1961. With the increasing number of participating countries in international medical education, the cooperation factions formed more complicated. The intensity of international cooperation between the United States, Britain and other major international medical education powers has been declining from 1991 to 2016. Between Brazil and China, during 1996–2016, the center of cooperation network has been on the rise for a long time, and the intensity of Canada's cooperation in medical education research has been on the rise for nearly 25 years. The center of international medical education is gradually being transferred from the United States to Canada.

Open access
Clinical Significance of Serum Bilirubin in Behçet's Disease

Abstract

Background and Objective

Bilirubin (Bb) is the product of the intravascular compartment of catabolic pathway. In a small number of clinical trials, it has been shown that Bb molecules are associated with cardiovascular diseases, diabetes, cancer, autoimmune (lupus, rheumatoid arthritis) diseases and schizophrenia. Behçet's disease is a chronic, multisystemic, inflammatory vasculitis that was first described by Hulusi Behçet in 1937, which affects almost all organs and systems without any known aetiology. Here, we investigated the clinical significance of serum Bb as a biomarker in the patients with Behçet's disease.

Methods

Seventy-one (N = 71) patients with Behcet's diagnosis within the last 1 year were included retrospectively. Control group consisted of 75 subjects with similar age and sex distribution. Serum Bb, indirect Bb, total Bb, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) data were recorded from the hospital records.

Results

In the Behçet group, direct Bb was significantly lower (P = 0.011), ESR and CRP were significantly higher (P = 0.00). No significant differences were observed in other parameters. In the whole group, total Bb and indirect Bb were negatively correlated with ESR (P = 0.025, P = 0.01). Direct Bb was negatively correlated with CRP (P = 0.002). For the diagnosis of Behçet, direct Bb with a threshold of < 0.14 can be used as a diagnostic test (P = 0.000) with 70% sensitivity, 68% specificity (area under the curve = 0.69; 95% confidence interval 0.59–0.80) in ROC curve analysis.

Conclusion

According to our study, we found that inflammatory markers were high and direct Bb values were low in patients with Behcet's disease. In addition, Bb parameters were negatively associated with acute phase reactants. As a practical biomarker with anti-oxidative properties, the direct Bb can be used to diagnose and clinical follow-up in cases with Behçet's disease.

Open access
Complementing EMR-based Interventions to Improve Hepatitis C Screening
Open access
Correlation between MELD and UNa/K ratio in predicting renal dysfunction in cirrhotic patients

Abstract

Background

Renal dysfunction is one of the dreaded complications of cirrhosis. MELD is a validated chronic liver disease (CLD) severity scoring system. Urinary (U) Na/K ratio closely correlates with renal dysfunction in terms of low GFR in cirrhotic patients.

Patients and Methods

All consecutive patients with decompensated cirrhosis between the age of 18 to 70 years, of either gender, presenting in the outpatients’ department of Sindh Institute of Urology and Transplantation, Karachi, from June 2015 to June 2017 were included. The MELD score was calculated and the UNa/K ratio less than 1 was taken as surrogate marker of renal dysfunction. Statistical analysis was performed by SPSS (version 20.0).

Results

A total of 71 patients were enrolled. The mean age was 43.79 years and majority were male (67.6%). The most common cause of liver cirrhosis was HCV, found in 42 (59.2%) patients. The mean CTP score was 10.48 ± 2.069 (range: 6–14) with majority of the patients following in class C, that is, 48 (67.6%). Mean MELD score was 21.75 ± 8.96 (range: 8–43). In 57 patients (80.3%), MELD score was > 15.The mean serum creatinine and mean serum sodium were 1.5 ± 1.1 mg/dl (range: 0.37–5.3) and 133.79 ± 6.9 mmol/L (range: 112–152), respectively. Mean urinary sodium and urinary potassium were 38.60 ± 46.64 mmol/L (range: 5–181) and 38.15 ± 23.9 mmol/L (range: 4.3–112), respectively. In majority of study population, UNa/K ratio was below 1, that is, in 52 patients (73.2%). Statistically significant correlation was documented between MELD score and UNa/K ratio (ɤ = 0.34, P = 0.004).

Conclusion

The inverse correlation between MELD scores and UNa/K ratio indicates that patients with CLD and higher MELD scores might have renal dysfunction. This finding however should be corroborated by large scale studies.

Open access
A double catheter approach for extracorporeal CO2 removal integrated within a continuous renal replacement circuit
Open access
Electroencephalographic abnormalities in sepsis patients in correlation to the calculated prognostic scores: A case series

Abstract

Objective

To evaluate the electroencephalographic (EEG) findings and correlate EEG findings with inflammatory biomarkers and the sepsis prognostic scores SOFA, SAPS II and APACHE II in patients who present in the Emergency Department with sepsis without clinical central nervous system involvement.

Methods

The study included seventeen patients (< 70 years old) with sepsis without central nervous system involvement presenting in the Emergency Department of the University Hospital of Patras, Greece. All patients underwent neurologic examination and EEG analysis on admission to the hospital and were treated according to the international guideline protocols for sepsis.

Results

Six of seventeen sepsis patients had mild or moderate EEG abnormalities. We did not find any significant correlation between EEG abnormalities and inflammatory biomarkers (CRP, WBC) or commonly used prognostic sepsis scores.

Conclusions

EEG could serve as a useful tool to identify brain alterations at an early stage in sepsis, before clinical sings of encephalopathy can be detected. However, the presence of EEG abnormalities does not correlate with sepsis severity as measured by the commonly used prognostic sepsis scores SOFA, APACHE II or SAPS II. Because this was a small single center observational study, large multi-center studies are warranted to confirm these findings.

Open access