This study evaluated predictors of gastrointestinal bleeding in 51 patients with acute intracerebral hemorrhage. The researchers found that 30% of patients experienced GI bleeding. Multivariate analysis identified three key predictors: larger hematoma size, presence of sepsis, and lower Glasgow Coma Scale scores. Patients with these factors were more likely to experience GI bleeding. The study highlights sepsis as an important and modifiable risk factor for GI bleeding in ICH patients.
Role of Left Ventricular Mass Index Versus Left Ventricular Relative Wall Thi...Premier Publishers
This study examined left ventricular geometry in 100 patients with non-cardioembolic ischemic stroke using echocardiography. The study found that concentric remodeling was the most common left ventricular pattern at 43%, followed by normal geometry at 27%, concentric hypertrophy at 22%, and eccentric hypertrophy at 8%. Abnormal left ventricular relative wall thickness was more common than abnormal left ventricular mass index, occurring in 61.4% versus 38.6% of patients. The results suggest that assessing relative wall thickness in addition to mass index can help identify more patients with left ventricular remodeling who may be at increased risk of stroke.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
Transcatheter intraarterial infusion of rt pa forHans Garcia
This study evaluated the success and complication rates of using intraarterial recombinant tissue-type plasminogen activator (rt-PA) infusion to treat acute lower extremity artery and bypass graft occlusions in 74 limbs of 70 patients. Thrombolytic success, defined as 95% thrombolysis and return of blood flow, was achieved in 86% of cases. Major bleeding complications occurred in 47% of patients, including bleeding at vascular access sites in 22 patients and remote bleeding in 7 patients. Despite the significant bleeding complications, 30-day mortality was 1% and amputation rate was 6%, resulting in a favorable 30-day amputation-free survival rate of 93%.
Postoperative chylothorax after cardiothoracicgisa_legal
This study examines the incidence, risk factors, and outcomes of postoperative chylothorax in children undergoing cardiothoracic surgery. The researchers found that the incidence of chylothorax was 3.8% and was significantly higher after heart transplantation, Fontan procedures, and tetralogy of Fallot repairs. Patients with chylothorax had significantly longer hospital stays compared to those without chylothorax. Nutritional management including low fat diets and octreotide were used to treat chylothorax, but surgical interventions provided limited benefit when reserved for severe or prolonged cases. Early diagnosis may reduce the duration of chylothorax.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
This case report describes a 76-year-old male patient diagnosed with Marine-Lenhart syndrome. The patient had a history of Graves' disease treated with antithyroid drugs. Tests showed suppressed TSH levels and the patient was referred to an endocrinology department. Exams including ultrasound and scintigraphy revealed the patient had Graves' disease along with a hyperactive nodule in the thyroid, consistent with Marine-Lenhart syndrome. The patient was treated with antithyroid drugs followed by radioactive iodine therapy. Follow up showed improvement of hyperthyroidism symptoms. Marine-Lenhart syndrome is a rare cause of hyperthyroidism where a patient has Graves' disease concurrently with a hyperfunctional thyroid nodule.
1) Primary percutaneous coronary interventions (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease can be performed via culprit-only PCI, multivessel (MV) PCI during the same procedure, or staged PCI.
2) Studies have found that MV PCI during STEMI is associated with higher mortality and stent thrombosis compared to culprit-only or staged PCI.
3) The HORIZONS-AMI trial of patients with STEMI and multivessel disease found higher mortality with single/one-time MV PCI compared to staged PCI.
Role of Left Ventricular Mass Index Versus Left Ventricular Relative Wall Thi...Premier Publishers
This study examined left ventricular geometry in 100 patients with non-cardioembolic ischemic stroke using echocardiography. The study found that concentric remodeling was the most common left ventricular pattern at 43%, followed by normal geometry at 27%, concentric hypertrophy at 22%, and eccentric hypertrophy at 8%. Abnormal left ventricular relative wall thickness was more common than abnormal left ventricular mass index, occurring in 61.4% versus 38.6% of patients. The results suggest that assessing relative wall thickness in addition to mass index can help identify more patients with left ventricular remodeling who may be at increased risk of stroke.
This document summarizes two studies on percutaneous left ventricular assist devices (LVADs) and coronary artery fistulas.
The first study investigated the ability of a percutaneous LVAD to deliver blood to the systemic circulation during cardiac arrest in pigs. The LVAD maintained blood flow and preferentially perfused vital organs like the brain. Intensified fluid loading further improved LVAD performance.
The second study evaluated the microvascular effects of ultrasound contrast (Definity) in hamsters with conditions like ischemia-reperfusion, diabetes, and sepsis. Inflammatory responses were higher in diabetes with ischemia and sepsis groups, independent of contrast use. Contrast did not alter hemodynamics or reology.
Transcatheter intraarterial infusion of rt pa forHans Garcia
This study evaluated the success and complication rates of using intraarterial recombinant tissue-type plasminogen activator (rt-PA) infusion to treat acute lower extremity artery and bypass graft occlusions in 74 limbs of 70 patients. Thrombolytic success, defined as 95% thrombolysis and return of blood flow, was achieved in 86% of cases. Major bleeding complications occurred in 47% of patients, including bleeding at vascular access sites in 22 patients and remote bleeding in 7 patients. Despite the significant bleeding complications, 30-day mortality was 1% and amputation rate was 6%, resulting in a favorable 30-day amputation-free survival rate of 93%.
Postoperative chylothorax after cardiothoracicgisa_legal
This study examines the incidence, risk factors, and outcomes of postoperative chylothorax in children undergoing cardiothoracic surgery. The researchers found that the incidence of chylothorax was 3.8% and was significantly higher after heart transplantation, Fontan procedures, and tetralogy of Fallot repairs. Patients with chylothorax had significantly longer hospital stays compared to those without chylothorax. Nutritional management including low fat diets and octreotide were used to treat chylothorax, but surgical interventions provided limited benefit when reserved for severe or prolonged cases. Early diagnosis may reduce the duration of chylothorax.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
This case report describes a 76-year-old male patient diagnosed with Marine-Lenhart syndrome. The patient had a history of Graves' disease treated with antithyroid drugs. Tests showed suppressed TSH levels and the patient was referred to an endocrinology department. Exams including ultrasound and scintigraphy revealed the patient had Graves' disease along with a hyperactive nodule in the thyroid, consistent with Marine-Lenhart syndrome. The patient was treated with antithyroid drugs followed by radioactive iodine therapy. Follow up showed improvement of hyperthyroidism symptoms. Marine-Lenhart syndrome is a rare cause of hyperthyroidism where a patient has Graves' disease concurrently with a hyperfunctional thyroid nodule.
1) Primary percutaneous coronary interventions (PCI) in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease can be performed via culprit-only PCI, multivessel (MV) PCI during the same procedure, or staged PCI.
2) Studies have found that MV PCI during STEMI is associated with higher mortality and stent thrombosis compared to culprit-only or staged PCI.
3) The HORIZONS-AMI trial of patients with STEMI and multivessel disease found higher mortality with single/one-time MV PCI compared to staged PCI.
This study examined the relationship between a peripheral blood gene expression score (GES) and measurements of coronary plaque by intravascular ultrasound with radiofrequency backscatter analysis (IVUS/VH) in 18 patients. The main findings were:
1) Higher GES was associated with greater total plaque volume and volumes of necrotic core, dense calcium, and non-calcified plaque as measured by IVUS/VH.
2) This preliminary study suggests that increased GES is linked to a more vulnerable plaque phenotype with a larger necrotic core and dense calcium.
3) The GES was not only related to obstructive coronary disease but also predicted higher plaque burden and a phenotype seen as more vulnerable to rupture.
The central venous access is one of the most common procedures in interventional nephrology [1-3]. One of the known complications of this procedure is the right branch lesion of the His bundle that leads to temporary or permanent blockage.
Complete revascularization in patients with multivessel disease undergoing primary PCI was associated with a small increase in additional infarction in non-IRA territories compared to IRA-only revascularization. However, total infarct size and measures of cardiac function were similar between the two groups both before discharge and at 9 month follow up. While complete revascularization led to more type 4a MIs, the increased risk did not negatively impact clinical outcomes.
This journal club discusses a study comparing outcomes for patients receiving drug-eluting stents (DES) versus bare-metal stents (BMS) for percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). The study analyzed data from the British Cardiovascular Intervention Society on over 15,000 patients undergoing SVG PCI from 2006-2013. It found lower rates of in-hospital major adverse cardiac events, 30-day mortality, and 1-year mortality for patients receiving DES, particularly newer generation DES, compared to BMS. The results provide reassurance on the safety and effectiveness of newer DES for treating SVG disease based on a large real-world dataset.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
The PRAMI trial was a randomized controlled trial that compared preventive percutaneous coronary intervention (PCI) to PCI limited to the infarct artery in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel coronary artery disease. The trial found that preventive PCI of non-infarct arteries with major stenoses significantly reduced the risk of adverse cardiovascular events compared to PCI limited to the infarct artery alone. However, the trial had a small sample size. Guidelines recommend PCI of a non-infarct artery be performed separately from primary PCI, but the optimal timing remains unclear due to varying results from observational studies.
Probing into arrhythmias in type 2 diabetics ijar feb 2015Sachin Adukia
This study examined arrhythmias in 50 patients with type 2 diabetes. The most common arrhythmia was sinus tachycardia (38%), followed by complete heart block (12%). Over half of patients (54%) had a prolonged QTc interval, with the majority (16 patients) also showing signs of cardiac autonomic neuropathy. Poor glycemic control correlated with a higher incidence of arrhythmias like sinus tachycardia, ventricular premature complexes, atrial fibrillation, and complete heart block. The presence of comorbidities like hypertension and ischemic heart disease also increased the risk of arrhythmias. All patients responded well to standard treatment for their arrhythmias.
This document summarizes guidelines for preventing deep vein thrombosis and pulmonary embolism in surgical patients. It discusses the causes of VTE including stasis, intimal injury, and hypercoagulability due to surgery. It also describes methods for assessing patient risk and different prophylaxis options including unfractionated heparin, low molecular weight heparin, and pentasaccharide. The summary provides an overview of dosing and administration for various prophylaxis modalities.
This document summarizes a study exploring the roles of intrinsic myocardial systolic dysfunction and cardiac chamber dilatation in left ventricular pump dysfunction following chronic beta-adrenergic receptor activation in rats. The study found that chronic isoproterenol administration resulted in left ventricular pump dysfunction, as evidenced by reduced fractional shortening and decreased slope of the pressure-volume relation, despite normal intrinsic myocardial contractility. Pump failure was attributed to left ventricular dilatation rather than intrinsic systolic failure, as midwall fractional shortening and stress-strain relations were unchanged.
Thrombus aspiration during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is said to reduce PCI-induced distal occlusion.
In an attempt to enhance its effectiveness, thrombus aspiration is often coupled with glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors, although conflicting results with this strategy have been reported.
GP IIb/IIIa antagonists inhibit the final common pathway that leads to platelet aggregation and leukocyte plugging, which are the main components of fresh thrombi.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
Characteristics of coronary artery ectasia and its association with carotid i...Premier Publishers
This study was conducted to uncover the relation between coronary artery ectasia (CAE) and markers of atherosclerosis. A total of 1611 coronary angiograms were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with stenotic coronary artery disease (CAD) “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements. Out of examined angiograms, 35 subjects showed mixed CAE “group 1” and 26 showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of DM and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, P < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, P < 0.001 for both). We concluded that atherosclerosis may not be the only plausible explanation for CAE.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Percutaneous Coronary Intervention [PCI] has been a revolutionary advance in cardiology, and many lives have been saved as a result of the widespread application of primary PCI. However, elective PCI has not yet been proven to save lives or reduce the risk of myocardial infarction. Despite this lack of
evidence, elective PCI has been misused and in some cases, abused for nonmedical reasons. The considerable cost of elective PCI can be reduced, and the resources could potentially be utilized for better public health outcomes. The following.article intends to highlight the lack of evidence supporting the use of elective PCI, which is a problem not only in North America and Europe but also throughout the world.
Better regulation of the elective PCI procedure could reduce health care expenditures and divert resources to cardiovascular disease prevention.
Frequency of cirrhotic cardiomyopathy in patientsSamiullah Shaikh
This study aimed to determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis. The study included 74 patients with liver cirrhosis. Various tests were performed including ECG, echocardiogram, and proBNP levels. Cirrhotic cardiomyopathy was diagnosed if abnormalities were found on tests. The results found cirrhotic cardiomyopathy present in 44.6% of patients. A strong relationship was seen between cardiomyopathy and severity of cirrhosis, prolonged QT interval, reduced ejection fraction, and elevated proBNP levels. The study concluded that cirrhotic cardiomyopathy was present in a sizable proportion of patients, and increased with later stages of cirrhosis.
Stich ii trial for supratentorial intra cerebral bleedgarry07
This document summarizes the STICH II trial which compared early surgery versus initial conservative treatment for spontaneous supratentorial lobar intracerebral haemorrhages between 10-100mL. The trial involved 601 patients randomized to either early surgery within 12 hours or initial conservative treatment with delayed surgery if needed. The primary outcome of death or severe disability at 6 months showed no significant difference between the groups. Secondary outcomes of mortality, functional scales also showed no significant differences, indicating that early surgery did not improve outcomes over initial conservative treatment for these types of hemorrhages.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
The document discusses issues related to end stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the population. While total Medicare spending and spending per patient on dialysis has stabilized in recent years, the total number of dialysis patients has continued to increase and now exceeds 500,000. The document discusses challenges with the current conventional dialysis treatment approach, including its inability to adequately manage issues like fluid overload, hypertension, and cardiovascular disease - which are the major drivers of mortality in ESRD patients. It suggests alternative home dialysis modalities may help address these issues but barriers need to be addressed to increase their utilization
A baby named Charlotte Weatherall was born. As an infant, she enjoyed being held and cuddled. She grew into a curious toddler who was learning to walk and talk.
Mastervoorlichting educatieve master voor het schoolvak maatschappijleer (MA)...Felix van Vugt
In deze presentatie vindt u alle relevante informatie over de educatieve master voor het schoolvak maatschappijleer (MA) en maatschappijwetenschappen (MAW) van de Universiteit Utrecht.
This study examined the relationship between a peripheral blood gene expression score (GES) and measurements of coronary plaque by intravascular ultrasound with radiofrequency backscatter analysis (IVUS/VH) in 18 patients. The main findings were:
1) Higher GES was associated with greater total plaque volume and volumes of necrotic core, dense calcium, and non-calcified plaque as measured by IVUS/VH.
2) This preliminary study suggests that increased GES is linked to a more vulnerable plaque phenotype with a larger necrotic core and dense calcium.
3) The GES was not only related to obstructive coronary disease but also predicted higher plaque burden and a phenotype seen as more vulnerable to rupture.
The central venous access is one of the most common procedures in interventional nephrology [1-3]. One of the known complications of this procedure is the right branch lesion of the His bundle that leads to temporary or permanent blockage.
Complete revascularization in patients with multivessel disease undergoing primary PCI was associated with a small increase in additional infarction in non-IRA territories compared to IRA-only revascularization. However, total infarct size and measures of cardiac function were similar between the two groups both before discharge and at 9 month follow up. While complete revascularization led to more type 4a MIs, the increased risk did not negatively impact clinical outcomes.
This journal club discusses a study comparing outcomes for patients receiving drug-eluting stents (DES) versus bare-metal stents (BMS) for percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). The study analyzed data from the British Cardiovascular Intervention Society on over 15,000 patients undergoing SVG PCI from 2006-2013. It found lower rates of in-hospital major adverse cardiac events, 30-day mortality, and 1-year mortality for patients receiving DES, particularly newer generation DES, compared to BMS. The results provide reassurance on the safety and effectiveness of newer DES for treating SVG disease based on a large real-world dataset.
Clinical Profile of Patients with Coronary Tortuosity and its Relation with C...Premier Publishers
Coronary tortuosity is a common angiographic finding. This study was done to observe the clinical profile of patients with coronary tortuosity (CT) and its relation with coronary artery disease (CAD). Method: A total 224 patients undergoing angiography for suspected CAD were included in the study. Coronary tortuosity was defined by the presence of ≥3 consecutive bends of > 45 degree, measured at end-diastole in an epicardial artery ≥2 mm in diameter. Coronary tortuosity was present in 45(20.1%) patients (CT group) in the study and another 45 patients without coronary tortuosity was randomly selected as control (NCT group). Clinical profile of CT and NCT group was compared. Results: Incidence of coronary tortuosity was significantly higher in females (p=0.000) and hypertensives (p=0.001) patients. Coronary tortuosity was most commonly seen in Left circumflex coronary artery. Incidence of CAD was significantly lower in CT group as compare to NCT group (0.02). Risk factors for CAD was associated with reduced incidence of Coronary tortuosity. Majority (88.5%) patient with CT without CAD presented with chronic stable angina out of which (65.2%) had an objective evidence of myocardial ischemia. Conclusion: Coronary tortuosity is more commonly seen females and hypertensive patients. It has negative correlation with CAD but can lead to myocardial ischemia. Risk factors of CAD do not predict CT.
The PRAMI trial was a randomized controlled trial that compared preventive percutaneous coronary intervention (PCI) to PCI limited to the infarct artery in patients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel coronary artery disease. The trial found that preventive PCI of non-infarct arteries with major stenoses significantly reduced the risk of adverse cardiovascular events compared to PCI limited to the infarct artery alone. However, the trial had a small sample size. Guidelines recommend PCI of a non-infarct artery be performed separately from primary PCI, but the optimal timing remains unclear due to varying results from observational studies.
Probing into arrhythmias in type 2 diabetics ijar feb 2015Sachin Adukia
This study examined arrhythmias in 50 patients with type 2 diabetes. The most common arrhythmia was sinus tachycardia (38%), followed by complete heart block (12%). Over half of patients (54%) had a prolonged QTc interval, with the majority (16 patients) also showing signs of cardiac autonomic neuropathy. Poor glycemic control correlated with a higher incidence of arrhythmias like sinus tachycardia, ventricular premature complexes, atrial fibrillation, and complete heart block. The presence of comorbidities like hypertension and ischemic heart disease also increased the risk of arrhythmias. All patients responded well to standard treatment for their arrhythmias.
This document summarizes guidelines for preventing deep vein thrombosis and pulmonary embolism in surgical patients. It discusses the causes of VTE including stasis, intimal injury, and hypercoagulability due to surgery. It also describes methods for assessing patient risk and different prophylaxis options including unfractionated heparin, low molecular weight heparin, and pentasaccharide. The summary provides an overview of dosing and administration for various prophylaxis modalities.
This document summarizes a study exploring the roles of intrinsic myocardial systolic dysfunction and cardiac chamber dilatation in left ventricular pump dysfunction following chronic beta-adrenergic receptor activation in rats. The study found that chronic isoproterenol administration resulted in left ventricular pump dysfunction, as evidenced by reduced fractional shortening and decreased slope of the pressure-volume relation, despite normal intrinsic myocardial contractility. Pump failure was attributed to left ventricular dilatation rather than intrinsic systolic failure, as midwall fractional shortening and stress-strain relations were unchanged.
Thrombus aspiration during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is said to reduce PCI-induced distal occlusion.
In an attempt to enhance its effectiveness, thrombus aspiration is often coupled with glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors, although conflicting results with this strategy have been reported.
GP IIb/IIIa antagonists inhibit the final common pathway that leads to platelet aggregation and leukocyte plugging, which are the main components of fresh thrombi.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
This study reviewed 86 patients who underwent pericardiectomy for chronic constrictive pericarditis (CCP) at a single center from 2010-2014. Preoperatively, most patients were in NYHA class II or III. Tuberculosis was the cause of CCP in 32.6% of patients. The overall mortality rate was 2.3%. Postoperatively, 90.6% of surviving patients were in NYHA class I or II. The results showed pericardiectomy to be an effective treatment for CCP, with tuberculosis remaining a common cause in India.
Characteristics of coronary artery ectasia and its association with carotid i...Premier Publishers
This study was conducted to uncover the relation between coronary artery ectasia (CAE) and markers of atherosclerosis. A total of 1611 coronary angiograms were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with stenotic coronary artery disease (CAD) “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements. Out of examined angiograms, 35 subjects showed mixed CAE “group 1” and 26 showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of DM and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, P < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, P < 0.001 for both). We concluded that atherosclerosis may not be the only plausible explanation for CAE.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Percutaneous Coronary Intervention [PCI] has been a revolutionary advance in cardiology, and many lives have been saved as a result of the widespread application of primary PCI. However, elective PCI has not yet been proven to save lives or reduce the risk of myocardial infarction. Despite this lack of
evidence, elective PCI has been misused and in some cases, abused for nonmedical reasons. The considerable cost of elective PCI can be reduced, and the resources could potentially be utilized for better public health outcomes. The following.article intends to highlight the lack of evidence supporting the use of elective PCI, which is a problem not only in North America and Europe but also throughout the world.
Better regulation of the elective PCI procedure could reduce health care expenditures and divert resources to cardiovascular disease prevention.
Frequency of cirrhotic cardiomyopathy in patientsSamiullah Shaikh
This study aimed to determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis. The study included 74 patients with liver cirrhosis. Various tests were performed including ECG, echocardiogram, and proBNP levels. Cirrhotic cardiomyopathy was diagnosed if abnormalities were found on tests. The results found cirrhotic cardiomyopathy present in 44.6% of patients. A strong relationship was seen between cardiomyopathy and severity of cirrhosis, prolonged QT interval, reduced ejection fraction, and elevated proBNP levels. The study concluded that cirrhotic cardiomyopathy was present in a sizable proportion of patients, and increased with later stages of cirrhosis.
Stich ii trial for supratentorial intra cerebral bleedgarry07
This document summarizes the STICH II trial which compared early surgery versus initial conservative treatment for spontaneous supratentorial lobar intracerebral haemorrhages between 10-100mL. The trial involved 601 patients randomized to either early surgery within 12 hours or initial conservative treatment with delayed surgery if needed. The primary outcome of death or severe disability at 6 months showed no significant difference between the groups. Secondary outcomes of mortality, functional scales also showed no significant differences, indicating that early surgery did not improve outcomes over initial conservative treatment for these types of hemorrhages.
Advancing dialysis: Recasting kidney failure as cardiovascular diseaseAdvancingDialysis.org
The document discusses issues related to end stage renal disease (ESRD) and dialysis treatment in the United States. It notes that ESRD represents 7% of the Medicare budget while only treating 1% of the population. While total Medicare spending and spending per patient on dialysis has stabilized in recent years, the total number of dialysis patients has continued to increase and now exceeds 500,000. The document discusses challenges with the current conventional dialysis treatment approach, including its inability to adequately manage issues like fluid overload, hypertension, and cardiovascular disease - which are the major drivers of mortality in ESRD patients. It suggests alternative home dialysis modalities may help address these issues but barriers need to be addressed to increase their utilization
A baby named Charlotte Weatherall was born. As an infant, she enjoyed being held and cuddled. She grew into a curious toddler who was learning to walk and talk.
Mastervoorlichting educatieve master voor het schoolvak maatschappijleer (MA)...Felix van Vugt
In deze presentatie vindt u alle relevante informatie over de educatieve master voor het schoolvak maatschappijleer (MA) en maatschappijwetenschappen (MAW) van de Universiteit Utrecht.
Powerpoint GST masteravond 8okt 2014 - maatschappijleer en maatschappijwetens...Felix van Vugt
PPT voor de mastervoorlichting over de eenjarige master leraar voorbereidend hoger onderwijs voor het schoolvak: maatschappijleer en maatschappijwetenschappen
The music video uses dull colors and sad, reflective movements and attire to convey a sad, lonely tone that matches the song. Still images from the video showing the main character walking alone in a forest or sitting alone by a river were used in ancillary products to depict isolation. Font, still images, and themes of isolation are consistent across the main video and ancillary products like a magazine ad and digipak, making their combination effective at promoting the mood of the video.
Mastervoorlichting Docent maatschappijleer en maatschappijwetenschappen (VHO)Felix van Vugt
Voorlichting over de 1- en 2-jarige educatieve masters voor het schoolvak MAATSCHAPPIJLEER en MAATSCHAPPIJWETENSCHAPPEN van de Universiteit Utrecht (Centrum voor Leren en Onderwijs)
The document describes a school visit to the City to Sea Museum where students learned Maori legends, including the story of how Maui fished up the North Island of New Zealand using his grandfather's jawbone as a fishing hook. At the museum, students listened to this story of Maui and saw a carving depicting this legend. They also read how Maui slowed the sun and made puppets, then used puppets at the library to act out the story of how Maui beat the sun to make it go more slowly. The students enjoyed their visit to the museum.
El documento define y clasifica diferentes tipos de ángulos, incluyendo agudos, rectos y obtusos. También describe ángulos suplementarios y complementarios, ángulos opuestos por el vértice, y ángulos correspondientes formados por una recta transversal que intersecta líneas paralelas. Además, explica los polígonos como figuras geométricas cerradas con tres o más lados, y define triángulos equiláteros, isósceles y escalenos.
This document provides specifications for different types of steel sheets, including their common qualities, chemical compositions, mechanical properties, most frequent applications, and technical dimensions and weights. It includes data on cold rolled, hot rolled, galvanized, and non-slip steel sheets. Dimension tables are provided for various thicknesses and sizes.
This document summarizes the qualifications to teach in secondary education under the K-12 program in the Philippines. Graduates of science, math, and technical-vocational courses can teach in their specialized subjects without a LET or bachelor's degree as long as they have the necessary TESDA certification. Faculty of higher education institutions and experts/practitioners can also teach part-time without a LET as long as they have the appropriate degree or expertise. The transition period to implement these changes runs until the end of the 2021-2022 school year.
This document outlines 8 methods for characterizing characters in literature: 1) Physical Description, 2) Attitude/Appearance, 3) Dialogue, 4) Thoughts, 5) Reactions of Others, 6) Action or Incident, 7) Background Information, and 8) Objects and Possessions. It provides examples for each method from passages of novels. The examples demonstrate how each method can reveal aspects of a character's personality, relationships, values, and development over the course of a story. The document encourages analyzing characters using all 8 methods to develop a well-rounded characterization rather than a superficial description.
Year 1 and 2 students have been working with clay as part of their art program, making taniwha out of clay. Nicki Dench from the Clay Penguin showed the students how to create the taniwha out of clay.
The document discusses the process of developing and validating test items which includes a try-out phase, item analysis phase, and item revision phase. Key aspects of item analysis are calculating the item difficulty index and discrimination index to evaluate how well each item measures the intended construct and distinguishes between students with high and low ability levels. Formulas and interpretation guidelines are provided to help determine whether items should be retained, revised, or discarded based on these analysis results.
This document discusses various methods of family planning, including natural and artificial methods. Natural family planning relies on abstaining from sex during the most fertile times in a woman's cycle, which can be determined through basal body temperature tracking, cervical mucus monitoring, or calendar-based methods. Artificial methods aim to prevent fertilization through barriers like condoms, diaphragms containing spermicide, or IUDs. Other options include hormonal contraceptives like birth control pills, injections, implants or sterilization procedures for both men and women.
There are several conceptual models of learning that can be effectively supported through educational technology, including meaningful learning, constructivism, and generative learning. Meaningful learning connects new experiences to existing knowledge through hands-on activities and relating classroom lessons to real-world examples. Discovery learning allows students to uncover new ideas through engaging personally with open-ended tasks. Different models are suited to different instructional goals and subject matters.
Google Plus et la visibilité: Pourquoi vous devez être sur Google Plus !Guinel CADIGNAN
Saviez-vous que Google devient peu à peu Google Plus?
Si Google Plus a longtemps été qualifié de "réseau social désert", il réunit aujourd'hui plus de 300 millions d'utilisateurs actifs le propulsant ainsi au rang de second réseau social le plus peuplé.
Plus qu'un réseau social, Google Plus modifie peu à peu le paysage du web et devient indispensable à la visibilité des entreprises sur Internet.
- Comment Google a imposé son réseau social
- Quelles fonctionnalités propose Google Plus
- Comment utiliser Google Plus pour améliorer son référencement
- Comment développer une bonne stratégie de communication sur Google Plus
- Pourquoi G+ est devenu indispensable à la visibilité de votre entreprise
C'est pourquoi demain, la visibilité sur le web passera par une présence active sur Google+.
This study aimed to compare global volume-related hemodynamic variables to regional variables as predictors of outcome in critically ill septic patients after initial resuscitation. Twenty-eight septic patients underwent standardized resuscitation targeting global pressures. Regional variables like gastric mucosal pH and indocyanine green clearance were superior predictors of mortality compared to global pressures. While global pressures guide initial resuscitation, monitoring regional perfusion may better detect occult shock and predict outcomes in stabilized septic patients.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this
important cardiovascular risk factor should reduce the health burden of ICH.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, and the RENAMEVASC investigators
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.
1) The study examined predictors of ischemia and outcomes in 169 Egyptian patients with diabetes referred for nuclear perfusion imaging over 2 years of follow up.
2) Significant relationships were found between higher summed stress scores and outcomes of sudden cardiac death, myocardial infarction, and heart failure. Higher summed rest scores also significantly predicted several adverse outcomes.
3) Degree of typical chest pain, transient left ventricular dilation, lung uptake on imaging, and extent of ischemia (summed difference score) were independent predictors of myocardial infarction. Transient left ventricular dilation was the strongest predictor of sudden cardiac death.
1. Recurrent myocardial infarction (MI) after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) occurs in about 21% of patients and is associated with worse clinical outcomes.
2. Recurrent MI significantly increases the risks of subsequent cardiac mortality, noncardiac mortality, stroke, and bleeding.
3. Early recurrent MIs within 1 day of the initial PPCI are associated with higher unadjusted cardiac mortality compared to later recurrent MIs, but after adjustment, recurrent MIs occurring more than 1 year after PPCI carry the highest risk of cardiac death.
1) The 30-day mortality from spontaneous intracerebral hemorrhage (ICH) ranges from 35-52% with half of deaths occurring within two days. Only 12% of patients have mild or no disability at 30 days.
2) Larger initial ICH volume, lower level of consciousness, hematoma growth, intraventricular extension, early neurologic deterioration, preceding use of oral anticoagulants or antiplatelets, and not limiting care are associated with worse prognosis.
3) Patients on oral anticoagulants have mortality rates over 50% and those with hematoma growth are more likely to die or have worse functional outcomes compared to spontaneous ICH.
Poor short-term outcome in patients with ischaemic stroke.pdfarianiputridevanti
1) Patients with active cancer (AC) who experienced an ischemic stroke were younger, had more severe strokes, and had a higher rate of in-hospital mortality compared to patients with non-active cancer (NAC).
2) AC patients were more likely to have cryptogenic strokes and infarcts in multiple areas of the brain, while NAC patients more often had cardioembolic strokes and small vessel disease.
3) Having AC, a higher NIH Stroke Scale score, and higher C-reactive protein levels were independently associated with in-hospital mortality after experiencing an ischemic stroke.
Increased Cardiac Troponin T in Patients without Myocardial InfarctionYogeshIJTSRD
According to the World Health Organization, the diagnosis of acute myocardial infarction AMI is based on two of the three main criteria changes in the ECG up to 25 of myocardial infarctions are not reflected in the ECG , anginous pain, and increased markers of myocardial necrosis. In 2000, the European Scientific Society and the American College of Cardiology made a correction to the definition of AMI, according to which the determining factor in the diagnosis of AMI is the detection of an increased level of specific markers of myocardial necrosis — cardiac troponins in the blood. Troponin is a protein that is part of myofibrils. Cardiac troponin contains three subunits T, I, and C. Troponin C is non specific for the myocardium, in contrast to the T and I subunits, whose structure in the contractile fibers of cardiomyocytes differs from similar proteins of other muscle cells. The widespread use of the determination of cardiac troponins in the blood significantly increased the detection of AMI by 30 200 . Until recently, it was believed that troponins enter the blood only as a result of the death of cardiomyocytes. However, in recent years, it has been shown that troponins can penetrate into the interstitial space, and then into the blood, when cardiomyocytes are damaged with an increase in the permeability of their cell membranes, which can be caused not only by AMI, but also by conditions accompanied by hyper production of pro inflammatory cytokines tumor necrosis factor a, interleukin 1, etc. . The aim of this study was to analyze the final diagnoses in patients with increased cardiac troponin T levels without a clinical picture and characteristic ECG changes in AMI. Khusainova Munira Alisherovna "Increased Cardiac Troponin-T in Patients without Myocardial Infarction" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Special Issue | Innovative Development of Modern Research , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd40034.pdf Paper URL : https://www.ijtsrd.com/medicine/other/40034/increased-cardiac-troponint-in-patients-without-myocardial-infarction/khusainova-munira-alisherovna
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
Association between Galectin-3 and oxidative stress parameters with coronary ...komalicarol
Galectin-3 (Gal-3), as a mediator of inflammation and fibrosis, has been reported to be a biomarker of severity in
coronary artery disease (CAD). The study aimed to assess the relationships between coronary artery disease (CAD) and risk factors,
including parameters of oxidative stress in Tunisian patients CAD.
Association Between Galectin-3 and Oxidative Stress Parameters with Coronary ...semualkaira
Galectin-3 (Gal-3), as a mediator of inflammation and fibrosis, has been reported to be a biomarker of severity in
coronary artery disease (CAD). The study aimed to assess the relationships between coronary artery disease (CAD) and risk factors,
including parameters of oxidative stress in Tunisian patients CAD
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
cardiorenal syndrome and its characteristics and complications and causes.pptxArunDeva8
This study analyzed the risk factors and outcomes of acute cardiorenal syndrome (CRS-1) in 460 patients admitted with acute coronary syndrome or acute decompensated heart failure at a tertiary care center in South India. 34% of patients developed CRS-1, defined as acute kidney injury resulting from acute worsening of cardiac function. Risk factors for CRS-1 included diabetes, chronic kidney disease, lower ejection fraction, and higher levels of cardiac biomarkers. Patients with CRS-1 required more intensive care interventions and had higher in-hospital mortality of 20.2% compared to 7.8% in patients without CRS-1. Early detection and multidisciplinary management can help provide better outcomes for patients with
HIGH SENSITIVE C-REACTIVE PROTEIN (hs-CRP) AND ITS CORRELATION WITH ANGIOGRAP...M A Hasnat
Association between the plasma hs-CRP levels and the severity of coronary
stenosis in subjects remains controversial. This cross sectional study was performed in the
Department of Cardiology, Dhaka Medical College during July 2008 to December 2009, to determine whether the concentrations of hs-CRP correlate with the coronary atherosclerotic disease assessed by coronary angiography.
This study aimed to determine if levels of high-sensitivity C-reactive protein (hs-CRP) correlate with the severity of coronary artery disease as assessed by coronary angiography. 90 patients undergoing coronary angiography were divided into three groups based on their hs-CRP levels. Significant positive correlations were found between hs-CRP levels and vessel score, stenosis score, and extent score, suggesting higher hs-CRP levels are associated with more extensive coronary artery disease. The results indicate hs-CRP levels may be predictive of the severity of coronary atherosclerosis.
Thermal Imaging for the Diagnosis of Early Vascular Dysfunctions: A Case Reportasclepiuspdfs
Diseases of blood vessels (referred in this article as vascular dysfunction) cause more morbidity and mortality, than combined impact of any other major non-communicable disease including cancer. We strongly feel that the development of a therapy system based on the management of disease of the vessel than management of the risk factors will yield better results and provide greater opportunity for individualized therapy. Detection of early vascular changes before clinical manifestations of endothelial dysfunction, hardening of the arteries, increased intima-media thickness, is of great importance for early identification of individuals with increased risk of accelerated atherosclerosis.
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Background: Myocarditis is a relatively common inflammatory disease that affects the myocardium. Infectious disease accounts for most of the cases either because of a direct viral infection or post-viral immune-mediated reaction. Cardiovascular magnetic resonance (CMR) has become an established non-invasive diagnosis tool for acute myocarditis. A recent large single centre study with patients with biopsy-proven viral myocarditis undergoing CMR scans found a high rate of mortality. The aim of this study was to assess the rate of clinical events in our population of patients with diagnosed myocarditis by CMR scan.
Methods: Patients who consulted to the emergency department with diagnosis of myocarditis by CMR were retrospectively included in the study from January 2008 to May 2012. A CMR protocol was used in all patients, and were followed up to assess the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or implantable cardiac defibrillator (ICD). A descriptive statistical analysis was performed.
Results: Thirty-two patients with myocarditis were included in the study. The mean age was 42.6±21.2 years and 81.2% were male. In a mean follow up of 30.4±17.8 months, the rate of the composite endpoint of all-cause death, congestive heart failure, sudden cardiac death, hospitalization for cardiac cause, recurrent myocarditis or need of radiofrequency ablation or ICD was 15.6% (n=5). Two patients had heart failure (one of them underwent heart transplant), one patient needed ICD because of ventricular tachycardia and two other patients were re-hospitalized, for recurrent chest pain and for recurrent myocarditis respectively.
Conclusions: In our series of acute myocarditis diagnosed by CMR we found a low rate of cardiovascular events without mortality. These findings might oppose data from recently published myocarditis trials.
Bosche, Molcanyi et al. - Occurence and recurrence of spont. cSDH ... FXIII d...Dr. Bert Bosche
This document summarizes a study investigating the role of coagulation factor XIII (FXIII) in spontaneous chronic subdural haematoma (cSDH). The study found that among 117 cSDH patients, 18 had spontaneous cSDH. These patients had significantly lower FXIII activity than controls. Within these 18 patients, 6 developed re-bleeding events after haematoma evacuation, and these patients had significantly lower FXIII activity than the other 12 patients. A FXIII cutoff of 68.5% accurately predicted re-bleeding events, with 100% sensitivity and 75% specificity. The study suggests that FXIII deficiency may play a pathophysiological role in spontaneous cSDH and FXIII activity could help
This study analyzed clinical outcomes in 2002 STEMI patients undergoing primary PCI. Patients were divided into 3 age groups: <60, 60-79, and ≥80 years old. The study found that rates of adverse events like mortality, recurrent MI, stroke, and major bleeding increased with age. Specifically, patients ≥80 years old had higher rates of comorbidities and experienced the highest rates of ischaemic and bleeding complications compared to younger patients, even after adjusting for confounding factors. The study concluded that elderly STEMI patients, especially those ≥80 years old, are a high-risk group that requires individualized therapy to optimize clinical outcomes.
Similar to Predictors of gastrointestinal bleeding in acute intracerebral haemorrhage (20)
Predictors of gastrointestinal bleeding in acute intracerebral haemorrhage
1. Journal of the Neurological Sciences 208 (2003) 25 – 29
www.elsevier.com/locate/jns
Predictors of gastrointestinal bleeding in acute intracerebral haemorrhage
U.K. Misra a,*, J. Kalita a, S. Pandey a, S.K. Mandal b
a
Department of Neurology, Sanjay Gandhi PGIMS, Rae Bareily Road, Lucknow 226014, India
b
Department of Biostatistics, Central Drug Research Institute, Lucknow, India
Received 3 June 2002; received in revised form 23 September 2002; accepted 22 October 2002
Abstract
Background: Gastrointestinal (GI) haemorrhage is an important and sometimes serious complication in critically ill neurological patients
who suffered from stroke and head injury and those in intensive care. There is no study evaluating frequency, severity and risk factors of GI
haemorrhage in patients with primary intracerebral haemorrhage (ICH). Aims: To evaluate the frequency, severity and predictors of GI
haemorrhage in patients with ICH. Methods: In a prospective hospital-based study, consecutive CT-proven ICH patients within 10 days of
the ictus were included. The patients with history of peptic ulcer, GI haemorrhage, liver and kidney disease, bleeding diathesis and those on
antiplatelet, anticoagulant or nonsteroidal antiinflammatory drugs (NSAIDS) were excluded. A detailed neurological evaluation was carried
out. Glasgow coma scale (GCS) was used for assessment of consciousness level and Canadian neurological scale (CNS) for severity of
stroke. The haematomas were classified into small ( < 20 ml), medium (20 – 40 ml) and large ( > 40 ml). The occurrence of GI haemorrhage
during 14 days of ictus was considered due to ICH. To evaluate the predictors of GI haemorrhage, various clinical and CT scan findings
were evaluated by univariate followed by multivariate logistic regression analysis. Results: Fifty-one patients with ICH were included
whose age ranged between 30 and 80 years and 14 were female. The mean GCS score was 8.9 (3 – 15) and CNS score was 2.2 (2 – 4).
Haematoma was small ( < 20 ml) in 11 patients and medium (20 – 40 ml) and large (>40 ml) in 20 patients each. Evidences of septicemia
were present in 20 patients. Gastric haemorrhage (GH) was noted in 15 patients which was more than 40 ml in 4 patients and one of these
patients needed blood transfusion. On univariate analysis, the size of haematoma, septicemia, motor signs on the nonhemiplegic side and
pupillary asymmetry were significantly related to GI haemorrhage. On multivariate analysis, the best set of predictors of gastric
haemorrhage included size of haematoma, septicemia and GCS score. Conclusion: GI haemorrhage is more likely present in patients with
larger haematoma having septicemia. Our study highlights the importance of septicemia, which is an important and modifiable risk factor
for GI bleeding in ICH patients.
D 2002 Elsevier Science B.V. All rights reserved.
Keywords: Gastric haemorrhage; Intracerebral haemorrhage; Septicemia; CT scan
1. Introduction reported to be low and usually does not contribute to
increased morbidity and mortality [5 – 7]. In a study, GI
Cushing [1] reported 11 patients with either gastrointes- haemorrhage was noted in 0.1% of patients with stroke; 14
tinal (GI) ulceration, perforation or haemorrhagic erosion in of these patients had ischaemic stroke, 2 patients had
his postoperative brain tumour patients. Subsequently, all GI subdural haematoma and 1 patient had haemorrhagic stroke
lesions associated with intracranial disease are known as [5]. In another study, patients with severe stroke, especially
Cushing’s ulcer. Gastrointestinal bleeding occurs frequently those with Glasgow coma scale (GCS) score below 10 had
in intensive care unit patients who have intracranial dis- higher frequency of GI haemorrhage [6]. In this study, we
eases. Following head injury, endoscopic evidence of have evaluated the frequency, severity and factors respon-
mucosal lesion can appear within 24 h and 17% of patients sible for GI haemorrhage in patients with primary intra-
with GI haemorrhage may present clinically with significant cerebral haemorrhage (ICH).
bleeding [2]. Mortality in patients with GI haemorrhage may
be as high as 50% [3,4]. GI haemorrhage in stroke has been
2. Subjects and methods
* Corresponding author. Fax: +91-522-440017, +91-522-440973.
E-mail addresses: ukmisra@sgpgi.ac.in, ukmisra@indiatimes.com This study was conducted in a tertiary care teaching
(U.K. Misra). institute in India. Fifty-one patients with CT-proven
0022-510X/02/$ - see front matter D 2002 Elsevier Science B.V. All rights reserved.
doi:10.1016/S0022-510X(02)00415-X
2. 26 U.K. Misra et al. / Journal of the Neurological Sciences 208 (2003) 25–29
intracerebral haemorrhage within 10 days of ictus who 2.1. Statistical analysis
were managed by us during 2000 –2001 were included in
the present study. Patient’s consciousness was evaluated To study the variables contributing to the occurrence of
by Glasgow coma scale (GCS) and severity of stroke by GI haemorrhage, a number of clinical (age, sex, CNS score,
Canadian neurological scale (CNS) score [8]. Presence of GCS score, diabetes, NSAIDS, pupillary asymmetry, decere-
hyperventilation, pupillary asymmetry and motor signs on bration, motor signs on nonhemiplegic side and presence of
the nonhemiplegic side were recorded. The diagnosis of septicemia) and radiological (site, size, intraventricular
septicemia was considered if at least two of the follow- extension of haematoma) details were analysed by employ-
ing features were present: (1) temperature>38 jC or ing univariate logistic regression, followed by multiple
below 36 jC, (2) heart rate>90/min, (3) respiratory logistic regression analysis. The independent variables were
rate>20/min or pa CO 2 < 32 Torr, and (4) leucocyte categorised as sex (male = 1, female = 2), diabetes, septice-
counts>12 000/mm3 or < 4000/mm3 or more than 10% mia, NSAIDS use, hyperventilation, pupillary asymmetry,
band forms [9]. Presence of Fibrin degradation product motor signs on nonhemiplegic side and decerebration
(FDP) was also noted. History of peptic ulcer, diabetes, (present = 1, absent = 2), size of haematoma (large = 1,
alcoholism, smoking and use of nonsteroidal antiinflam- medium = 2, small = 3), and intraventricular extension
matory drugs (NSAIDS) during hospital stay were (present = 1, absent = 2). The raw score of age, GCS score
recorded. Hemoglobin, full blood count, hematocrit, and CNS score were analysed. The dichotomous-dependent
serum chemistry, prothombin time and activated pro- variable (GI haemorrhage = y) was assigned the value 1 when
thrombin time, radiograph of chest and electrocardiogram GI haemorrhage was absent and 0 when it was present. If x1,
were carried out in all the patients. Noncontrast cranial x2, x3. . ., xp were the characteristics relating to the occurrence
CT scan was carried out on a third generation CT of GI haemorrhage, then the logistic regression model
scanner and 10-mm axial section was obtained parallel specified the conditional probability of GI haemorrhage as
to orbitomeatal line. On CT scan, the location of hae- follows:
matoma, its size, ventricular extension and midline shift
were noted. The size of haematoma was calculated by
ABC/2, where A = largest diameter of haematoma in Pðy ¼ 1=x1 ; x2 ; x3 ; . . . xp Þ
" !#
centimeter, B = diameter in centimeter in 90j to A and X
P
C = number of parenchymal haemorrhage seen in 1 – 0.5 ¼ 1=1 þ exp À A þ ÀBj Xj ð1Þ
J ¼1
cm slice. The haematomas were classified into small ( < 20
ml), medium (20 – 40 ml) and large (>40 ml). Patients
were managed conservatively. Mannitol was given to the The multivariate logistic risk factors were formulated
patients with clinical signs of raised intracranial pressure as Eq. (1), where Bj was the logistic coefficient and A
(i.e. pupillary asymmetry, hyperventilation, decrebration or was constant. The parameters of the model were obtained
decorticaltion and pyramidal signs on nonhemiplegic side). by maximum likelihood ration [10]. Initially, all the
Corticosteroids were not given in any patient. Antihyper- variables were included for the analysis but later, the
tensive was prescribed if blood pressure was more than best model was obtained using stepwise logistic regres-
180/110 mm Hg in acute stage. None of the patients sion in which the parameters with the lowest weight
underwent surgical evacuations of haematoma. Occurrence (Coefficient) was removed sequentially till the best model
of GI haemorrhage during first 14 days of ictus was was arrived at.
considered due to ICH. Gastric haemorrhage was defined
as gross blood or coffee ground substance in nasogastric
aspirate or hematochesia, hematemesis or malena. Gastro- 3. Result
intestinal endoscopic study was not possible in any as
patients were in altered sensorium and noncooperative for Fifty-one consecutive patients with ICH were included
this study. The GI haemorrhage was considered severe if whose age ranged between 30 and 80 (mean 56.76) years
there was hypotension and/or need for blood transfusion. and 14 were females. The location of haematoma was
The exclusion criteria included: (1) use of anticoagulants putaminal in 38 patients, thalamic in 11 patients, and
or antiplatelet drugs in preceeding 7 days; (2) history of caudate and pontine in 1 patient each. Twenty patients
coagulation disorder, purpura, chronic liver or kidney had septicemia, of whom fibrin degradation product was
disease or acid peptic disease or history of hematemesis, present in four patients. Gastrointestinal haemorrhage was
malena or oesopharyngeal varices. All the patients present in 15 patients which exceeded 50 ml in 4 patients
received sucralfate suspension 1 g every 6 h for 3 weeks and blood transfusion was needed in 1 patient. The clinical
and H2-receptor blockers or proton pump inhibitiors in details of the patients are given in Table 1.
standard dose except one patient. The patients were fol- On univariate logistic regression analysis, the significant
lowed at the end of 1 month. The end point was 1-month parameters related to GI haemorrhage included size of
mortality. haematoma (Z = 2.74), septicemia (Z = 3.8), nonhemiplegic
3. U.K. Misra et al. / Journal of the Neurological Sciences 208 (2003) 25–29 27
Table 1 Table 3
Clinical features of patients with intracerebral haemorrhage Best predictors of gastric haemorrhage in patients with intracerebral
No. of patients haemorrhage in multivariate logistic regression analysis
Parameters Coefficient Odd’s ratio Z
History of hypertension 16
Diabetes mellitus 4 Lower Upper
Smoking 6 Size of À 2.2177 0.0135 0.876 2.08*
Alcohol 4 haematoma
GCS score Septicemia À 3.6374 0.0031 0.223 3.34*
<6 9
GCS score 0.2048 0.8810 1.841 0.99
6 – 12 33 Constant 6.2313 3.28
>12 9
CNS score Likelihood ratio statistics, 27.868; df = 3.
< 3.5 43 * P < 0.05.
z 3.5 8
Signs of raised ICP 33
Haematoma size nificantly related to the 1-month mortality of ICH patients
Small 11 (X2 = 4.34, df = 1, P < 0.05).
Medium 20
Large 20
Mortality at 1 month 14
4. Discussion
In our study, 30% of patients with ICH had GI haemor-
motor signs (Z = 2.68) and pupillary asymmetry (Z = 2.92). rhage and the best predictors of GI bleeding by multivariate
The variables which were not found to be significantly logistic regression analysis included septicemia, size of
related to GI haemorrhage included age (Z = 0.32), sex haematoma and GCS score. In the available literature, we
(Z = 1.9), decerebration (Z = 1.99), hyperventilation have not come across any study evaluating the predictors of
(Z = 2.51), GCS score (Z = 2.24), CNS score (Z = 1.76), GI haemorrhage in ICH patients. In a retrospective analysis
NSAIDS (Z = 0.12), diabetes (Z = 2.55), site of haematoma of 16,672 stroke patients, 17 had GI haemorrhage, high-
(Z = 1.51) and intraventricular extension of haematoma lighting the rarity of GI bleeding in stroke. Interestingly, the
(Z = 2.06). The clinical and radiological features of the majority of these patients had ischaemic stroke and the
patients with ICH having GI haemorrhage as well as those strokes were mild enough for these patients to undergo GI
without it are summarised in Table 2. endoscopy that needs patient’s cooperation. Only one
On multivariate logistic regression analysis, the best set patient in this study had ICH and two had subdural
of predictors for occurrence of GI haemorrhage included haematoma. In this study, history of NSAIDS, aspirin and
size of haematoma, presence of septicemia and GCS score. corticosteroid therapy and H. pylori infection were found to
The statistical findings are presented in Table 3. At the end be contributing to GI haemorrhage [7]. The higher fre-
of 1 month, 14 patients died and 8 patients of whom had GI quency of GI haemorrhage in our patient may be due to
haemorrhage. The occurrence of GI haemorrhage was sig- more severe stroke and presence of septicemia. All our
patients had intracerebral haemorrhage, 78% of them had
medium- or large-size haematoma resulting in raised intra-
Table 2 cranial pressure, herniation and altered sensorium. Upper
Important predictors of gastric haemorrhage (GH) in patients with gastrointestinal endoscopy was not possible in our patients
intracerebral haemorrhage (ICH) in univariate logistic regression analysis
because of more severe stroke, resulting in variable extent of
Variables Level (no.) ICH Z altered sensorium. We have excluded the patients on long-
With Without term use of NSAIDS, aspirin, anticoagulant and cortico-
GH GH steroid therapy.
Size Small (11) 1 10 2.74* In an unconscious patient, septicemia may occur follow-
Medium (20) 3 17 ing catheterisation, IV cannulation, endotracheal intubation
Large (20) 11 9
Septicemia Present (20) 13 7 3.80*
and pneumonia. In our study, 65% of patients with septice-
Absent (31) 2 29 mia had GI haemorrhage. Septicemia may result in reduc-
NHM signs Present (22) 11 11 2.68* tion of gastric blood flow leading to mucosal ischaemia. The
Absent (29) 4 25 mucous layer can be disrupted by ischaemic insults to the
Pupillary Present (15) 9 6 2.92* underlying mucosa leading to change in mucosal permi-
asymmetry Absent (36) 6 30
GCS score < 6 (9) 5 4 2.24
ability. Subsequently, an unrestricted influx of hydrogen
6 – 12 (33) 9 24 ions can damage gastric mucosa [11,12]. In critically ill
>12 (9) 1 8 patients in intensive care unit, several studies have high-
NMH = nonhemiplegic motor, GCS = Glasgow coma scale. lighted the importance of septicemia in producing GI
* P < 0.05. haemorrhage [13 – 15]. Although we have excluded the
4. 28 U.K. Misra et al. / Journal of the Neurological Sciences 208 (2003) 25–29
patients on anticoagulant and antiplatelet therapy, septice- From this multivariate logistic regression analysis, it can
mia itself can result in coagulation abnormality, which may be concluded that the size of haematoma, septicemia and
also contribute to GI haemorrhage. In a metaanalysis of GCS score are the best predictors of GI haemorrhage in ICH
critically ill intensive care unit patients, prophylaxis against patients. Our study highlights the importance of septicemia
stress-related upper GI haemorrhage was recommended in in ICH, which is not only an important but also a modifiable
patients with coagulopathy and respiratory failure [14]. In risk factor for GI haemorrhage in ICH patients.
our study, of 13 patients having septicemia and GI haemor-
rhage, 7 patients had abnormal coagulation profile and 4
patients were positive for fibrin degradation product. Acknowledgements
Size of haematoma determines the clinical picture and
outcome of ICH patients [16]. A large haematoma may We gratefully acknowledge Mr. Rakesh Kumar Nigam
result in uncal or transtentorial herniation, which may be for secretarial help.
associated with excessive autonomic discharge due to hypo-
thalamic or brainstem insult. In stroke, excessive sympa-
thetic discharge has been reported to result in various References
cardiac arrhythmia, myocardial ischaemia and sudden death
[17]. Increased intracranial pressure has also been reported [1] Cushing H. Peptic ulcers and the interbrain. Surg Gynecol Obstet
1932;55:1 – 34.
to result in transient renal impairment in ICH patients,
[2] Kamada T, Fusamoto H, Kawano S, et al. Gastrointestinal bleeding
which was postulated to be due to excessive catecholamine following head injury. A clinical study of 433 cases. J Trauma 1977;
release [18,19]. An overproduction of luminal acid, which is 17:44 – 7.
essential for production of stress ulcer, is more likely in [3] Peura DA, Johnson LF. Cimetidine for prevention and treatment of
stroke patients. Acid and pepsin hypersecretion has been gastrointestinal mucosal lesions in an intensive care unit. Ann Iut Med
reported following central nervous system injury [20]. 1985;103:173 – 7.
[4] Pimila JC, Olamuk FH, Reed D, et al. Does antacid prophylaxis
When normal inhibitory affect on vagal nuclei is abolished prevent upper gastrointestinal bleeding in critically ill patients. Crit
due to various supratentorial or infratentorial lesions, there Care Med 1985;13:646 – 50.
is unopposed parasympathetic stimulations resulting in [5] Davenport RJ, Dennis MJ, Warlow CP. Gastrointestinal haemorrhage
excessive acid pepsin secretion, leading to gastrointestinal after acute stroke. Stroke 1996;27:421 – 4.
ulceration [21,22]. Autopsy review of patients dying of [6] Machfoed MH, Herainy, Eko T. Cimetidine parenteral for prevention
of acute upper gastrointestinal bleeding in acute stroke patients. Can J
central nervous system diseases revealed an incidence of Neurol Sci 1993;20:S247.
haemorrhagic ulcers in 12.5% which was twice that found in [7] Wijdick SEFM, Fulgham JR, Batts KF. Gastrointestinal bleeding in
patients succumbing to non-neurological diseases [23]. stroke. Stroke 1994;25:2146 – 8.
Stress ulcer bleeding in patients with head injury correlates [8] Cotes R, Battista RM, Wolfson C, et al. The Canadian neurological
with the severity of injury regardless of the presence of other scale: validation and reliability assessment. Neurology 1989;39:
638 – 43.
risk factors [2]. Acute intracerebral haemorrhage may have [9] Braderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of
some pathophysiological similarity with head injury patients intracerebral hemorrhage. A powerful and easy to use predictor of 30
because of its catastrophic occurrence. In our study, other day mortality. Stroke 1993;24:987 – 93.
significant predictors of GI haemorrhage in univariate [10] McGee DL. A programme logistic regression on IBM PC. Am J
analysis included upper motor signs on nonhemiplegic side Epidemiol 1986;124:702 – 5.
[11] Cheung LY, Chang M. The role of gastric mucosal blood flow and
and pupillary asymmetry. These signs may be an indicator hydrogen ion diffusion in the pathogenesis of acute gastric erosions. J
of transtentorial herniation, which may be related to the size Surg Res 1977;22:357 – 61.
of haematoma and raised intracranial pressure. Transtento- [12] Lu WY, Rhoneuy DH, Boling WB, Johnson JD, Smith TC. A review
rial herniation results in compression of third nerve and crus of stress ulcer prophylaxis in the neurological intensive care unit.
Neurosurgery 1997;41:416 – 26.
cerebri which manifest with pupillary asymmetry and upper
[13] Pimentel M, Roberts DE, Bernstein CN, Hoppensack M, Duerksen
motor signs on nonhemiplegic side as well. The importance DR. Clinical significant gastrointestinal bleeding is critically ill pa-
of letter in outcome of ICH patients has been highlighted in tients in an era of prophylaxis. Am J Gastroenterol 2000;95:2801 – 6.
an earlier study [24]. [14] Saint S, Matthay MA. Risk reduction in the intensive care unit. Am J
Gastric haemorrhage in our patients was mild to moder- Med 1998;105:515 – 23.
ate except in one patient who needed blood transfusion. [15] Fahrlander H, Fettes F, Seiler W, Zach A. Stress ulcer: clinical as-
pects, pathogenesis, diagnosis and therapy. Z Gastroenterol 1996;14:
Occurrence of GI haemorrhage in our study was signifi- 168 – 78.
cantly related to 1-month mortality. This mortality may not [16] Garde A, Bohmer G, Selden B, Neiman J. 100 cases of spontaneous
be due to GI haemorrhage per se but as well be due to intracerebral haematoma. Eur Neurol 1983;22:161 – 72.
associated other risk factors, such as more severe stroke and [17] Dimant J, Grob D. Electrocardiographic changes and myocardial
septicemia. Our patients were receiving sucralfate and/or damage in patients with acute cerebrovascular accidents. Stroke 1977;
8:448 – 55.
H2-receptor blocker or proton pumb inhibitors. The role of [18] Misra UK, Kalita J, Srivastava M, Mandal SK. Transient renal im-
these agents in ICH is debatable and awaits randomised pairment in acute intracerebral haemorrhage. Neurology 1996;243:
control trials. 417 – 20.
5. U.K. Misra et al. / Journal of the Neurological Sciences 208 (2003) 25–29 29
[19] Meyer JS, Stoica E, Pasur I, Shimazu K, Hartman A. Catecholamine [22] Lewis E. Gastroduodenal ulceration and haemorrhage of neurogenic
concentrations in CSF and plasma of patients with cerebral infarction origin. Br J Surg 1973;60:279 – 83.
and haemorrhage. Brain 1973;96:277 – 88. [23] Karch S. Upper gastrointestinal bleeding as a complication of intra-
[20] Idjadi F, Robbins R, Stahi W, Essiet G. Prospective study of gastric cranial disease. J Neurosurg 1972;37:27 – 9.
secretionin stressed patients with intracranial injury. J Trauma 1971; [24] Misra UK, Kalita J. Prognostic significance of central motor conduc-
11:681 – 6. tion on the non hemiplegic side in supratentorial hematoma. Electro-
[21] French JD, Porter RW, Von Amerongen FK, Raney RB. Gastrointes- encephalogr Clin Neurophysiol 1995;97:255 – 8.
tinal haemorrhage and ulceration associated with intracranial lesions:
a clinical and experimental study. Surgery 1952;32:395 – 407.