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Cureus Apr 2024Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually...
Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.
PubMed: 38770477
DOI: 10.7759/cureus.58627 -
Transplantation Direct Jun 2024Four-factor prothrombin complex concentrate (PCC) is a plasma product that contains factors II, VII, IX, X, protein C, and protein S. PCC can be used off-label to treat...
BACKGROUND
Four-factor prothrombin complex concentrate (PCC) is a plasma product that contains factors II, VII, IX, X, protein C, and protein S. PCC can be used off-label to treat coagulopathy during orthotopic liver transplantation (OLT). However, its use comes with safety concerns regarding thrombosis. The purpose of our study is to determine the safety of PCC in OLT.
METHODS
We conducted a retrospective cohort study of patients who received 4-factor PCC during OLT at our institution from January 1, 2018, to May 1, 2022, with a 1:1 match of 83 patients who received PCC and 83 patients who did not. We evaluated 30-d mortality, 1-y mortality, prevalence of thrombotic complications (portal vein thrombosis, deep venous thrombosis, myocardial infarction, and pulmonary embolus), and postoperative intensive care (ICU) length of stay (LOS).
RESULTS
There was no significant difference in 30-d mortality (odds ratio [OR] 5; 95% confidence interval [CI], 0.58-42.8; = 0.14), 1-y mortality (OR 3; 95% CI, 0.61-14.86; = 0.18), or ICU LOS (OR -13.8; 95% CI, -39.2 to 11.6; = 0.29). There was no increased incidence of thrombotic complications among patients receiving PCC 90 d after surgery, including portal vein thrombosis (OR 1.5; 95% CI, 0.42-5.32; = 0.53), pulmonary embolus (OR 1; 95% CI, 0.14-7.1; = 0.99), deep venous thrombosis (OR 0.67; 95% CI, 0.11-3.99; = 0.66), and myocardial infarction (OR 1.67; 95% CI, 0.4-6.97; = 0.48).
CONCLUSIONS
Although there was a statistically insignificant increase in mortality after PCC administration during OLT, we did not see a significant increase in perioperative complications, including thrombotic events and increased ICU LOS.
PubMed: 38769975
DOI: 10.1097/TXD.0000000000001637 -
Microbiology Spectrum Jul 2024Tuberculous meningitis (TBM) is a prevalent global intracranial infection and the most lethal and disabling form of tuberculosis. TBM with mixed intracranial infections...
UNLABELLED
Tuberculous meningitis (TBM) is a prevalent global intracranial infection and the most lethal and disabling form of tuberculosis. TBM with mixed intracranial infections is clinically rare but has a higher mortality rate. To investigate the clinical characteristics of TBM with mixed intracranial infections, demographic and clinical data of TBM and pulmonary tuberculosis (PTB) patients admitted to Shenzhen Third People's Hospital between January 2015 and October 2022 were collected anonymously. A total of 207 cases of TBM were diagnosed, of which 16 cases (7.73%) were TBM with mixed intracranial infections. The overall mortality rate of TBM cases was 16.4%, while the mortality rate of TBM cases with mixed intracranial infections was as high as 35.7%. Compared to simple TBM cases, TBM cases with mixed intracranial infections had severer clinical symptoms. The percentage of human immune deficiency virus (HIV)-positive TBM cases with mixed intracranial infections reached up to 68.8%. HIV co-infection, CD4/CD8 T-cell counts less than 1, cranial nerve impairment, paralysis, cerebral infarction, PRO less than 450 mg/L, WBC less than 10 × 10 /L, and CL more than 120 mmol/L were risk factors for TBM cases with mixed intracranial infections. Compared to PTB, HIV co-infection, CD4 T cell less than 550 /uL, and age less than 45 years were risk factors for TBM, and TBM was associated with higher mortality rates. Our study provides additional data to better understand single TBM and TBM with mixed intracranial infections. More than two-thirds of TBM cases with mixed intracranial infections were HIV-positive. Clinicians should consider the possibility of multiple infections in people with TBM/HIV co-infection.
IMPORTANCE
TBM can cause severe neurological damage and death, and TBM with mixed intracranial infections can exacerbate the damage and poor prognosis of the disease. TBM with mixed intracranial infections is a rare disease, which has led to an incomplete understanding of its clinical features. This study investigated the clinical features of TBM and its associated factors by comparing the characteristics of TBM with mixed intracranial infections, single TBM and pulmonary tuberculosis. This information will help to improve the understanding of TBM, diagnostic accuracy and treatment outcomes.
Topics: Humans; Tuberculosis, Meningeal; China; Male; Female; Adult; Retrospective Studies; Middle Aged; HIV Infections; Coinfection; Mycobacterium tuberculosis; Risk Factors; Young Adult; Tuberculosis, Pulmonary; Aged; Adolescent
PubMed: 38767391
DOI: 10.1128/spectrum.03747-23 -
Journal of Atherosclerosis and... May 2024In patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), a low serum albumin-to-creatinine ratio (sACR)...
Serum Albumin-to-Creatinine Ratio: A Novel Predictor of Pulmonary Infection in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.
AIM
In patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), a low serum albumin-to-creatinine ratio (sACR) is associated with elevated risk of poor short- and long-term outcomes. However, the relationship between sACR and pulmonary infection during hospitalization in patients with STEMI undergoing PCI remains unclear.
METHODS
A total of 4,507 patients with STEMI undergoing PCI were enrolled and divided into three groups according to sACR tertile. The primary outcome was pulmonary infection during hospitalization, and the secondary outcome was in-hospital major adverse cardiovascular events (MACE) including stroke, in-hospital mortality, target vessel revascularization, recurrent myocardial infarction, and all-cause mortality during follow-up.
RESULTS
Overall, 522 (11.6%) patients developed pulmonary infections, and 223 (4.9%) patients developed in-hospital MACE. Cubic spline models indicated a non-linear, L-shaped relationship between sACR and pulmonary infection (P=0.039). Receiver operating characteristic curve analysis indicated that sACR had good predictive value for both pulmonary infection (area under the ROC curve [AUC]=0.73, 95% CI=0.70-0.75, P<0.001) and in-hospital MACE (AUC=0.72, 95% CI=0.69-0.76, P<0.001). Kaplan-Meier survival analysis indicated that higher sACR tertiles were associated with a greater cumulative survival rate (P<0.001). Cox regression analysis identified lower sACR as an independent predictor of long-term all-cause mortality (hazard ratio [HR]=0.96, 95% CI=0.95-0.98, P<0.001).
CONCLUSIONS
A low sACR was significantly associated with elevated risk of pulmonary infection and MACE during hospitalization, as well as all-cause mortality during follow-up among patients with STEMI undergoing PCI. These findings highlighted sACR as an important prognostic marker in this patient population.
PubMed: 38763733
DOI: 10.5551/jat.64717 -
NPJ Digital Medicine May 2024Artificial intelligence-enabled electrocardiogram (ECG) algorithms are gaining prominence for the early detection of cardiovascular (CV) conditions, including those not...
Artificial intelligence-enabled electrocardiogram (ECG) algorithms are gaining prominence for the early detection of cardiovascular (CV) conditions, including those not traditionally associated with conventional ECG measures or expert interpretation. This study develops and validates such models for simultaneous prediction of 15 different common CV diagnoses at the population level. We conducted a retrospective study that included 1,605,268 ECGs of 244,077 adult patients presenting to 84 emergency departments or hospitals, who underwent at least one 12-lead ECG from February 2007 to April 2020 in Alberta, Canada, and considered 15 CV diagnoses, as identified by International Classification of Diseases, 10th revision (ICD-10) codes: atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT), cardiac arrest (CA), atrioventricular block (AVB), unstable angina (UA), ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), pulmonary embolism (PE), hypertrophic cardiomyopathy (HCM), aortic stenosis (AS), mitral valve prolapse (MVP), mitral valve stenosis (MS), pulmonary hypertension (PHTN), and heart failure (HF). We employed ResNet-based deep learning (DL) using ECG tracings and extreme gradient boosting (XGB) using ECG measurements. When evaluated on the first ECGs per episode of 97,631 holdout patients, the DL models had an area under the receiver operating characteristic curve (AUROC) of <80% for 3 CV conditions (PTE, SVT, UA), 80-90% for 8 CV conditions (CA, NSTEMI, VT, MVP, PHTN, AS, AF, HF) and an AUROC > 90% for 4 diagnoses (AVB, HCM, MS, STEMI). DL models outperformed XGB models with about 5% higher AUROC on average. Overall, ECG-based prediction models demonstrated good-to-excellent prediction performance in diagnosing common CV conditions.
PubMed: 38762623
DOI: 10.1038/s41746-024-01130-8 -
Mediterranean Journal of Rheumatology Mar 2024The aim of this study was to compare the risk of major cardiovascular events (MACE) and venous thromboembolic events (VTE) between tumour necrosis factor (TNF) and Janus...
Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism with JAK Inhibitors versus TNF Inhibitors in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.
OBJECTIVE
The aim of this study was to compare the risk of major cardiovascular events (MACE) and venous thromboembolic events (VTE) between tumour necrosis factor (TNF) and Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA).
METHODS
We researched PubMed, Scopus, Cochrane Library, and clinicaltrials.gov until December of 2023 for randomised controlled trials (RCTs) and observational studies. The outcomes studied were MACE (stroke, heart attack, myocardial infarction, sudden cardiac death) and VTE (deep vein thrombosis, pulmonary embolism). We pooled data using random effects model. Risk for the reported outcomes was expressed as odds ratio (OR) with a 95% confidential interval (CI). We performed a subgroup analysis based on study design.
RESULTS
We identified 23 studies, 20 of which compared the odds for MACE and 14 the odds for VTE between JAK and TNF inhibitors in RA patients. Ten studies were RCTs and the rest were observational. Regarding MACE risk we pooled data from a total of 215,278 patients (52,243 were treated with JAK inhibitors, while the rest 163,035 were under TNF inhibitors). Compared with TNF inhibitors, the OR for JAK inhibitors in regards with MACE risk was 0.87 (0.64-1.17, p<0.01). Regarding VTE, a total of 176,951 patients were analysed (41,375 JAK inhibitors users and 135,576 TNF inhibitors users). The OR for VTE for JAK inhibitors compared with TNF inhibitors was 1.28 (0.89-1.84, p<0.01).
CONCLUSION
According to our results, there is no statistically significant difference for MACE or VTE in RA patients who receive either JAK or TNF inhibitors.
PubMed: 38756933
DOI: 10.31138/mjr.171023.rof -
Cureus Apr 2024Pulmonary embolism (PE) constitutes a substantial health burden among individuals in the United States. It ranks as the third most common cause of cardiovascular death...
Pulmonary embolism (PE) constitutes a substantial health burden among individuals in the United States. It ranks as the third most common cause of cardiovascular death aside from stroke and myocardial infarction. Diagnostic errors are common with PE as patients can present with non-specific symptoms or could be completely asymptomatic with PE being an incidental finding. Diagnostic errors can result in missed or late diagnosis of PE, which, in turn, increases health care costs, morbidity, and mortality rates. Hence, early diagnosis is crucial. Computed tomography pulmonary angiography (CTPA) remains the gold standard in PE diagnosis, despite exposure to high doses of radiation. Point-of-care ultrasound (POCUS) is an underutilized, non-invasive technique that aids in the early diagnosis of PE and can safely reduce the radiation from CTPA in cases where contraindication exists. POCUS has been shown to have a high sensitivity and specificity for early diagnosis of PE.
PubMed: 38752077
DOI: 10.7759/cureus.58272 -
BioRxiv : the Preprint Server For... Apr 2024All approved RNA therapeutics require parenteral delivery. Here we demonstrate an orally bioavailable formulation wherein synthetic noncoding (nc) RNA, packaged into...
All approved RNA therapeutics require parenteral delivery. Here we demonstrate an orally bioavailable formulation wherein synthetic noncoding (nc) RNA, packaged into lipid nanoparticles, is loaded into casein-chitosan (C2) micelles. We used the C2 formulation to deliver TY1, a 24-nucleotide synthetic ncRNA which targets the DNA damage response pathway in macrophages. C2-formulated TY1 (TY1) efficiently packages and protects TY1 against degradative enzymes. In healthy mice, oral TY1 was well-tolerated and nontoxic. Oral TY1 exhibited disease-modifying bioactivity in 2 models of tissue injury: 1) rat myocardial infarction, where a single oral dose of TY1 was cardioprotective, on par with intravenously-delivered TY1; and 2) mouse acute lung injury, where a single dose of TY1 attenuated pulmonary inflammation. Mechanistic dissection revealed that TY1 is not absorbed into the systemic circulation but is, instead, taken up by intestinal macrophages, namely those of the lamina propria and Peyer's patches. This route of absorption may rationalize why an antisense oligonucleotide against Factor VII, which acts on hepatocytes, is not effective when administered in the C2 formulation. Thus, some (but not all) ncRNA drugs are bioavailable when delivered by mouth. Oral RNA delivery and uptake, relying on uptake via the gastrointestinal immune system, has broad-ranging therapeutic implications.
PubMed: 38746093
DOI: 10.1101/2024.04.27.591474 -
Global Cardiology Science & Practice Mar 2024Right ventricular thrombus is a rare finding found in 4% of people diagnosed with pulmonary embolism. Although right ventricular thrombi are usually associated with...
Right ventricular thrombus is a rare finding found in 4% of people diagnosed with pulmonary embolism. Although right ventricular thrombi are usually associated with atrial fibrillation, deep venous vein thrombi, or intracardiac procedures, isolated right ventricular thrombi are rare. Right ventricular thrombus has also been reported in patients with right ventricular infarction, as hypokinesis of the right ventricle causes blood stasis and promotes thrombosis as per Virchow's triad. However, we present a case of isolated RV thrombus in a patient without evidence of deep vein thrombosis or right ventricular hypokinesis who presented with dyspnea on exertion.
PubMed: 38746065
DOI: 10.21542/gcsp.2024.13 -
Alternative Therapies in Health and... May 2024This study aimed to investigate the changes in angiopoietin-2 and tumor necrosis factor α levels in patients with acute myocardial infarction complicated with pulmonary...
OBJECTIVE
This study aimed to investigate the changes in angiopoietin-2 and tumor necrosis factor α levels in patients with acute myocardial infarction complicated with pulmonary infection.
METHODS
Retrospective selection was conducted on 61 patients with acute myocardial infarction complicated with pulmonary infection and 122 patients with simple acute myocardial infarction. A comparison was made between the two groups regarding general information and serum myocs. The distribution and drug resistance of pathogenic bacteria were also explored.
RESULTS
The study showed significant differences in the duration of alcohol consumption, the proportion of diabetes mellitus, and levels of certain markers (serum cardiac troponin T, creatine kinase isoenzyme, myoglobin, angiopoietin-2, tumor necrosis factor α) between the two groups (P < .05). Logistic regression analysis identified elevated levels of serum angiopoietin-2 and tumor necrosis factor α, along with diabetes mellitus, as independent risk factors for acute myocardial infarction complicated with pulmonary infection (P < .05). Pearson correlation analysis demonstrated a positive correlation between serum angiopoietin-2 and tumor necrosis factor α levels and CPI scores in patients (P < .05). ROC curve analysis indicated that combined diagnosis of serum angiopoietin-2 and tumor necrosis factor α had an AUC of 0.867, with a sensitivity of 85.25% and specificity of 77.87% for detecting acute myocardial infarction complicated with pulmonary infection. Among the sputum culture specimens, gram-negative bacteria accounted for 55.34%, gram-positive bacteria for 39.81%, and fungi for 4.85%. Gram-negative bacteria like Klebsiella pneumoniae and Escherichia coli showed high resistance to various antibiotics, while gram-positive bacteria like Streptococcus pneumoniae and Staphylococcus aureus had relatively low resistance to specific antibiotics.
CONCLUSION
Gram-negative bacteria were the main pathogens and exhibited resistance to several antibiotics. Increased levels of angiopoietin-2 and tumor necrosis factor α were observed. Early detection of these markers can assist in the clinical diagnosis and guide the appropriate use of antibiotics.
PubMed: 38743883
DOI: No ID Found