Ahmed N. Ghanem
Hypothesis: The transurethral resection of the prostate (TURP) syndrome is defined as severe vascular hypotension reaction that complicates endoscopic surgery as a result of massive irrigating fluid absorption causing severe acute dilution hyponatraemia (HN) of <120 mmol/l. The vascular shock is usually mistaken for one of the recognized shocks and Volumetric Overload Shock (VOS) type 1 (VOS1) is overlooked.
Objective: To report VOS and its successful treatment of hyper-tonic sodium therapy (HST) that is lifesaving. To report that Starling's law is wrong and the correct replacement is the hydrodynamic of the porous orifice (G) tube.
Methods: We conducted the following studies:
1. Prospective study on 100 consecutive TURP patients among whom 10 developed the TURP syndrome with acute dilution HN and vascular shock.
2. A case series of 23 TURP syndrome cases.
3. A physics study on the hydrodynamic of the G tube.
Results: The TURP syndrome is defined as severe vascular hypotension reaction that complicates endoscopic surgery as a result of massive irrigating fluid absorption causing severe acute dilution HN of <120 mmol/l. The vascular shock is usually mistaken for one of the recognized shocks and Volumetric Overload Shock type 1 (VOS1) is overlooked making Volumetric Overload Shock Type 2 (VOS2) unrecognizable. In adults VOS1 is induced by the infusion of 3.5-5 liters (Figure 1) of sodium-free fluids and is known as TURP syndrome or HN shock. VOS2 is induced by 12-14 liters of sodium-based fluids and is known as the adult respiratory distress syndrome. The most effective treatment for VOS1 and VOS2 is HST of 5%NaCl and/or 8.4%NaCo3. The literature on TURP syndrome is reviewed and the underlying patho-etiology is discussed. Starling's law proved wrong and the correct replacement is the hydrodynamic of the G tube.
Conclusion: Volumetric overload causes shock of two types, VOS1 and VOS2. VOS 1 is characterized with acute dilution HN and is known as the TURP syndrome. Mistaking VOS1 for a recognized shock and treating it with vascular expansion is lethal while HST is life-saving. Starling's law which dictates the faulty rules on fluid therapy proved wrong and the correct replacement is the hydrodynamic of the G tube.
1. Ghanem AN, Ward JP. Osmotic and metabolic sequelae of volumetric overload in relation to the TURP syndrome. Br J Uro 1990; 66: 71-78
2. Harrison III RH, Boren JS, Robinson JR. Dilutional hyponatraemic shock: another concept of the transurethral prostatic reaction. J Uro. 1956; 75 (1): 95-110.
3. Arieff AI. Hyponatraemia, convulsion, respiratory arrest and permanent brain damage after elective surgery in healthy women. N Engl J Med 1986; 314 (24): 1529-34.
4. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967; ii: 319-23.
5. Danowski TS, Winkler AW, Elkington JR. The treatment of shock due to salt depression; comparison of isotonic, of hypertonic saline and of isotonic glucose solutions. J. Clin. Invest. 1946; 25: 130
COVID-19 may contribute to delayed presentations of acute myocardial infarction. Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes. Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19. Also, standardized personal protective equipment (PPE) precautions are established for all members of the team, regardless of pending COVID-19 testing which might further add to delays.
We compared performance measures and outcomes of all patients who presented to our facility with ST elevation myocardial infarction (STEMI) during the COVID-19 pandemic to same time cohort from 2018 and 2018. There was a trend towards longer time interval from symptom onset to first medical contact (FMC) and time to first electrocardiogram (ECG) in the COVID-19 group. Peak troponin levels were significantly higher in the COVID-19 group (p 0.04). The likelihood of an in-hospital MACE was significantly higher among the COVID-19 group with 20% (3 of 16) patients experiencing an in-hospital MACE, while none occurred among the matched group (x2 = 5.82, df = 1, p = 0.02).
This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which is translating into worse clinical outcomes.
Heart failure (HF) is the leading cause of hospitalization and readmission among older adults. Chronic heart failure (CHF) is the most common cause of readmission for patients in the Pakistan and worldwide. . Despite this recent attention to HF readmission, we know relatively little about its actual causes.[2 ]despite the fact that patients are in many ways best positioned to identify the underlying factors that contribute to their readmissions. National Institute Of Cardiovascular Diseases, NICVD is a tertiary care hospital, which is one of the biggest cardiac care unit, with all the cardiac modalities under one roof. Therefor this is the most appropriate institute to study the reason of readmission of heart failure patient, and its impact resource used in term of hospital stay. The purpose of our study was to systematically investigate patient perspectives about the reasons for their readmission following a hospital discharge for HF. And to study than what could be done to improve the system to decrease the number of readmission in cost effective way.
Patients were recruited for this study were admitted to national institute of cardiovascular diseases, through emergency. Patients discharged with a primary discharge diagnosis for HF who were then readmitted for any cause in the subsequent 6 month were eligible for the study. Eligible patients were approached, consented, and interviewed within the next 24 hours while they were still in hospital. . Interview was conducted by heath care professional, fellow cardiology in training who have in depth knowledge of heart failure management and its care. . Detail was taken for medication included beta blocker, ACEI dose at the time of discharge, whether it was maximize to optimum tolerated dose or not compliance to medication. Proper counseling of patient disease and care was given or not.
We recruit patients over the period of 3 month form June 2019 till august 2019, all patients were admitted to hospital from emergency room. For the readmission, median length of stay was 6 days. Total 500 patient included, out of which 375 (75%) were male and most important cause of heart failure is ischemic cardiomyopathy 400 (80%). No death recorded. Common reason for readmission , lack of counseling 200(40%), under dose 75(15%), non-compliance 60(12%), volume over load 50(10%), hypertension 50(10%), secondary infection 35(7%).
Heart failure readmission is increasing now days which are financial burden on hospital and patient, and also the extra use of resources which can be easily control taking certain measure by physician and patient. For patient compliance of medication, appropriate fluid intake, self-care and life style modification are the important elements to care off according to this study which can be improve with psychotherapies and proper counseling session. For physician side proper information and detail discussion should be done with patient at the time of diagnosis. With each follow up visit symptom assessment and according to which dose adjust is very necessary to reduce the readmission.
Small steps can really make a big difference in the quality of life of patient we should take it
Shradha Satish Runwal
A six year female was referred to us in view of dyspnea, fatigue and central cyanosis with a provisional diagnosis of congenital cyanotic heart disease. Patient had an oxygen saturation of 78% at room air. On auscultation, she had a single first heart sound, wide and fixed split second heart sound and grade II/IV pansystolic flow murmur heard at apex. Echocardiography revealed situs ambiguous with atrioventricular canal defect seen as large ostium primum atrial septal defect with common atrium morphology and small inlet ventricular septal defect (as shown in figure 1) with moderate atrioventricular regurgitation (as shown in figure 2), a large patent ductus arteriosus (as shown in figure 3), left sided aortic arch, hepatic veins draining directly into right atrium (as shown in figure4), inferior vena cava on the left of abdominal aorta, persistent left superior vena cava (as shown in figure5).
Figure 1 showing large ostium primum ASD.
Figure 2 showing large PDA.
Figure 3 showing hepatic veins directly draining into RA.
Figure 4 showing persistent left SVC.
CT scan of thorax and abdomen with contrast venography showed findings of situs ambiguous with left isomerism including trachea bifurcating into bilateral morphologically similar bronchi (as shown in figure 6) and bilateral bilobed lungs, liver in the left hypochondrium with hemangioma in segments II and IVa, polysplenia, non rotated gut, persistent left superior vena cava (as shown in figure 7), hemiazygos vein continuous with left sided inferior vena cava (as shown in figure 8).
Figure 6: CT thorax showing trachea bifurcating into bilateral morphologically similar bronchi.
Figure 7: CT thorax showing persistent left superior vena cava.
Figure 8: CT Venography showing hemiazygos vein continuous with left inferior vena cava.
The left superior vena cava was continuous with infradiaphragmatic part of inferior vena cava (as shown in figure 9) which is a very rare finding in reported cases of situs ambiguous.
Figure 9: CT venography showing left sided inferior vena cava continuous with persistent left superior vena cava.
The patient was advised surgical correction but refused for any surgical intervention.
Shradha Satish Runwal
Reperfusion therapy has become the mainstay for the treatment of acute myocardial infarction with the goal of restoring flow in the occluded infarct-related artery and thus potentially salvaging ischemic myocardium.1 However, reperfusion has been referred as a double edged sword because reperfusion itself may lead to accelerated and additional myocardial injury beyond that generated by ischemia alone. This results in a spectrum of reperfusion associated pathologies, collectively called as reperfusion injury.2 Reperfusion arrhythmias are an important noninvasive marker of successful recanalization of infarction related coronary artery. However they are also a sign of reperfusion injury and a finding which may limit the favourable effect of reperfusion.3
To study the course of ECG rhythm changes during and within six hours of thrombolysis in patients of acute myocardial infarction.
OBJECTIVE: To analyse the prevalence of various arrhythmias within six hours of thrombolysis in patients of STEMI.
All patients presenting to intensive cardiac care unit of our tertiary care centre with acute STEMI within 2 years of study.
Patients with previous history of myocardial infarction, pericarditis, valvular heart disease, pacemaker device.
MATERIAL AND METHODS :
Every 4th patient of acute onset STEMI presenting to our tertiary care centre thrombolysed with Inj. Streptokinase (15 lac U IV over 1 hour) was monitored for arrhythmias using Holter monitor during and within 6 hours of thrombolysis. A total of 200 patients were studied. It was a cross sectional study. Statistical analysis was done using Chi Square test .P value <0.005 was considered statistically significant.
In this study of 200 cases, the prevalence of arrhythmias was 84%.
The mean age of patients with ST elevation myocardial infarction was 57.01±12.37 years. Occurrence of idioventricular rhythm and monomorphic couplets was significantly more between 41-70 years of age group (p<0.0001).
The prevalence of arrhythmias was 83.09% in males and 85.94% in females. No significant relationship was observed between gender and type of arrhythmia except ventricular tachycardia which was significantly more common in females.
Ventricular premature complexes (VPCs) were observed in 84% cases. Most common arrhythmia in both genders was idioventricular rhythm, followed by nonsustained ventricular tachycardia.
Diabetes, hypertension, tobacco, and alcohol consumption did not increase the risk of arrhythmias in a statistically significant way. Ventricular tachycardia (75%) and sinus tachycardia (58.3%) were more common in anterior wall infarction, but the difference was not statistically significant. Complete heart block (87.5%) and sinus bradycardia (64.7%) were more common in inferior wall infarction, but the difference was not statistically significant. Most common arrhythmia in patients of both anterior and inferior wall MI was idioventricular rhythm followed by nonsustained ventricular tachycardia.
The occurrence of idioventricular rhythm and non sustained ventricular tachycardia was significantly higher between 5-6 hours and first three hours after start of thrombolysis. The occurrence of monomorphic couplets and polymorphic couplets, ventricular bigeminy was significantly higher in first two hours after onset of thrombolysis and decreased thereafter(p<0.0001).
Idioventricular rhythm is the most common arrhythmia after thrombolysis in acute MI. The occurrence of monomorphic couplets and polymorphic couplets, ventricular bigeminy was significantly higher in first two hours after onset of thrombolysis and decreased thereafter.
Rheumatic heart disease is one of the most common heart diseases in developing country. One of the most common complications of Rheumatic Heart Disease is Mitral Stenosis which ultimately lead to pulmonary hypertension and heart failure and death. So, PTMC (Percutaneous Transluminal Mitral Commissurotomy) is a well-established simple, effective, and safe therapeutic intervention for mitral stenosis.
While many literatures reviewed till date have shown that it takes 3-6 months’ time period for the reduction of pulmonary artery pressure after PTMC, this study is designed to see the result in pulmonary artery pressure immediately after procedure.
Friederike S. Seggewies Background: MADD results in deficient electron transfer from FAD-dependent dehydrogenases to the mitochondrial respiratory chain. The riboflavin non-responsive phenotype presents as a potential neonatal life-threatening disorder complicated by severe acidosis, hyperammonemia, hypoglycemia and seizures. Early severe cardiomyopathy is frequent and only very few patients are known to have reached adulthood as the treatment of this disorder is very difficult. Orally supplemented OHB is an additional treatment option to be considered in severe cases. Case study: We report on 2 cousins (now 18 and 19 years old) with enzymatically and genetically confirmed riboflavin non-responsive MADD. There is a strong family history of severe MADD: 4 siblings died in neonatal period. Both cousins developed a neonatal life-threatening cardiomyopathy unresponsive to conventional treatment. After commencing OHB, the cardiac contractility showed progressive and sustained improvement. The elder cousin presented with a prolonged out-of-hospital cardiac arrest presumed secondary to ventricular arrhythmias in association with cardiomyopathy at the age of 12 years. He was successfully resuscitated. As a preventive measure, both children underwent an implantable cardioverter-defibrillator (ICD) insertion. The younger cousin needed MitraClip placement at the age of 18 years, because of severe mitral valve regurgitation on a background of a longstanding history of left atrial enlargement. Discussion: Early and long-term treatment with OHB is a promising lifesaving therapeutic add-on option for patients with severe MADD. It has ameliorated the potentially lethal outcome in our patients. However the risk of long term complications, particularly cardiac life-threatening events including arrhythmias and cardiomyopathy necessitate careful monitoring and management.
Riboflavin non-responsive multiple acyl-CoA dehydrogenase deficiency (MADD) with early severe cardiomyopathy: Favorable long-term outcome on D,L-3-hydroxybutyrate (OHB) supplementation
Friederike S. Seggewies
MADD results in deficient electron transfer from FAD-dependent dehydrogenases to the mitochondrial respiratory chain. The riboflavin non-responsive phenotype presents as a potential neonatal life-threatening disorder complicated by severe acidosis, hyperammonemia, hypoglycemia and seizures. Early severe cardiomyopathy is frequent and only very few patients are known to have reached adulthood as the treatment of this disorder is very difficult. Orally supplemented OHB is an additional treatment option to be considered in severe cases.
We report on 2 cousins (now 18 and 19 years old) with enzymatically and genetically confirmed riboflavin non-responsive MADD. There is a strong family history of severe MADD: 4 siblings died in neonatal period. Both cousins developed a neonatal life-threatening cardiomyopathy unresponsive to conventional treatment. After commencing OHB, the cardiac contractility showed progressive and sustained improvement. The elder cousin presented with a prolonged out-of-hospital cardiac arrest presumed secondary to ventricular arrhythmias in association with cardiomyopathy at the age of 12 years. He was successfully resuscitated. As a preventive measure, both children underwent an implantable cardioverter-defibrillator (ICD) insertion. The younger cousin needed MitraClip placement at the age of 18 years, because of severe mitral valve regurgitation on a background of a longstanding history of left atrial enlargement.
Early and long-term treatment with OHB is a promising lifesaving therapeutic add-on option for patients with severe MADD. It has ameliorated the potentially lethal outcome in our patients. However the risk of long term complications, particularly cardiac life-threatening events including arrhythmias and cardiomyopathy necessitate careful monitoring and management.
Maja Karaman IliÄ?
Prevention of post-operative cardio-respiratory deterioration in cardiac and non-cardiac patients who have undergone non cardiac surgical procedure due to perioperative fluid overload.
Induction in general anesthesia (GA) drives patients in hypotension.
Vasodilation, particularly veno-dilatation, is the primary cause of relative hypovolemia produced by anesthetic drugs. Relative hypovolemia is a consequence of increased venous compliance, decreased venous return and reduced response to vasoactive substances. Maintenance of adequate cardiac output (CO) and arterial blood pressure are vital for preserving tissue perfusion and oxygen delivery (DO2).To preserve CO and adequate organ perfusion, anesthesiologists may chose between liberal perioperative fluid approach and a restrictive one with small dose of vasoactive drugs. Each choice carries its own risks. In general, a liberal perioperative volume replacement strategy is more common choice. As a consequence of selected therapy, fluid overload is often seen. The clinically most significant complication of excessive volume is ”Lung -Swelling” respectively - pulmonary edema.
Standard monitoring that includes clinical exam, chest X ray, oxygen saturation of peripheral blood (SpO2) and blood lactate level lacks sensitivity and specificity for pulmonary edema diagnose. Additionally, those are late indicators of tissue and organ hypo-perfusion.
Lung ultrasound provides high diagnostic sensitivities and specificities in detecting various lung pathologies: interstitial syndrome (interstitial sy), pneumothorax and alveolar consolidation. Interstitial sy represents a variety of clinical situations, including pulmonary edema, respiratory distress syndrome,pneumonia and interstitial diseases. Due to the development of pulmonary edema, transition of A-profile (normal lung ultrasound finding) to B-profile (that is specific for interstitial sy) occurs.This findings enable us to act therapeutically even before the late indicators of cardio-respiratory deterioration appear.
Lung ultrasonography is a helpful, non-invasive method for early detection and treatment of perioperative fluid overload.
Anthony Mclean,Stephen Huang.Lung and pleural ultrasound. In: Critical Care Ultrasound Manual.Chatswood,NSW:Elsevier Australia, 2012;126-134.
Echocardiography is a key diagnostic investigation used for many cardiac conditions. Significant delays in the availability of echocardiogram findings and a backlog of echocardiograms requests, were identified as having an impact on clinical decision making in a focused questionnaire delivered to doctors and echocardiographers on a cardiac ward in a district general hospital in London, UK.
Aim. This quality improvement project aimed to expedite delivery of key echocardiogram information to doctors by applying two strategies; 1) introduce a provisional report, and 2) reduce the number of referral requests by implementing a new echocardiogram triage system.
Methods: Baseline data were gathered during a 9-week period aimed at understanding and calculating the median time needed to order, perform and report an echocardiogram, as well as monitoring the total number of echocardiogram requests made. The first intervention (strategy 1), lasting 6 weeks, involved a provisional report (PR) containing key clinical information such as left ventricular function and, if present, any valvular, wall motion or any other relevant abnormalities. This was then given by echocardiographers to doctors soon after an echocardiogram was completed. The number of requests, rate of PR uptake and the time from echocardiogram completion to PR availability were monitored during this period.
A second intervention (strategy 2), aimed at reducing unnecessary requests, was implemented 4 weeks after the conclusion of the first intervention and it involved a consultant cardiologist triaging the echocardiogram requests daily, for a 6-week period. The number of requests, procedures and the time from referral to full report availability were again monitored. Semi-structured questionnaires were proposed to doctors (FY2 to consultant level) in cardiac wards at the beginning and end of both cycles to explore participants’ subjective opinion.
We enhanced staff motivation and adherence through visual aids on wards and stakeholder involvement through regular weekly meetings and constant feedback.
The provisional report (PR) reduced the median time for key information to be available to clinicians from 227 to 48.5 minutes, without negatively affecting the time needed to obtain a full report. However, uptake of the PR varied widely across the intervention window being at best, 40% of the total number of echocardiograms performed.
Triaging resulted in a decrease in the median number of referrals per week, from 47 to 27.5, and a reduction from 2.73 days to 1.87 days in the median time from referral to full report availability. The results were stable across the observation window.
62% of interviewed doctors reported they noticed improvements in speed of echocardiogram information delivery after strategy 1 which increased to 71% after the application of strategy 2. 87% of participants felt strategy 1 and 71% felt strategy 2 improved patient outcomes and timely discharge.
Discussion & Conclusion:
Substantial improvements in reporting times for a key diagnostic procedure can be achieved as shown by the application of strategy 1, while strategy 2 demonstrated how eliminating inappropriate referrals can streamline the process of obtaining investigation results. Furthermore, qualitatively, staff acknowledged significant improvements in the availability of echocardiogram results leading to better support in
clinical decision making and patients’ outcomes. However, sustainability and staff engagement were variable, especially when additional duties, like the formation of a provisional report, are introduced as in the first intervention (strategy 1). Pilot experiences such as this reported experiment and subsequent positive feedback, could become key elements to achieving higher rates of adherence and sustained positive changes.
Declaration of interest: nothing to declare.
This project was exempt from ethical approval as the work was deemed an improvement study; local policy meant that ethical approval was not required
Zebrafish is widely becoming more and more useful model to study heart regeneration due to fast re-growing of both myocardial and epicardial cells. Therefore, the regenerative capacity and such genetic tractability in zebrafish encouraged scientists to use this model for their stud-ies. The cheap supply of zebrafish for laboratories also add another reason to use zebrafish rather other animal models.
A new transgenic zebrafish line model added a new approach to understand the underlying signalling pathways requiring for cardiac regeneration. Therefore, this model also provided an extensive genetic fate map for cardiac cell arrangement during cardiac regeneration.
Here in this review, the attempt has been made to elucidate three major injury models in zebrafish and analysing how zebrafish model can potentially become a permanent solution for establishing a new platform for cardiac regenerative medicine
Increased ratio of Triglyceride (TG)/ High-density Lipoprotein (HDL) has been known as an accompanying finding in conditions like obesity and metabolic syndrome. Therefore, the aim of this study was to assess the utility of TG/HDL ratio as a diagnostic tool for the assessment of coronary artery disease (CAD).
This study was conducted at a semi-private hospital Karachi; patients above 15 years of age and undergone angiography or PCI were included. Patients with Congenital Heart Disease and familial hyperlipidmeia were excluded. TG/HDL ratio was obtained for all patients, severity of the disease was classified as normal, mild to moderate, moderate to severe, and very severe based on coronary angiography. Analysis of variance was applied to assess significant differences in mean TG/HDL ratio among severity of disease. P-value<0.05 was considered significant.
A total of 2,212 CAD patients were reviewed out of which 1613 (72.9%) were male and 599 (27.1%) were female. Average age of the patients was 55.12 years (±SD=9.93). Of these 2212 patients, 533 (24.1%) had very severe disease, 1213 (54.8%) had moderate to severe disease, 258 (11.7%) had mild to moderate disease, and 208 (9.4%) were normal. A Significant and an increasing trend was observed in TG/HDL ratio with the severity of disease (p=0.0001) Statistically significant difference was observed in the TG/HDL ratio of patients with mild to moderate, moderate to severe and very severe disease from normal patients. However, no statistically significant difference was seen in the TG/HDL ratio between the patients with moderate to severe and very severe disease.
A positive relationship between Triglyceride to HDL Ratio and severity of coronary artery disease was observed. Therefore, TG/HDL ratio can be used as an indicator of severity of coronary artery disease in addition to other parameters of lipid profile
ThapaKeywords: Tenecteplase, Coronary Angiography, Percutaneous Coronary intervention, Thrombolysis
Corresponding Author: Dr. Shivaji Bikram Silwal, Consultant Cardiologist,
Head, Department of Cardiology , Scheer Memorial Hospital, Banepa, Kavre
BACKGROUND: In the absence of contraindications, fibrinolytic therapy is administered to ST-elevation MI (STEMI) patients with symptom onset within 12 hours after diagnosis of STEMI in partly limited availability of primary percutaneous coronary intervention (PCI) hospital. Reperfusion treatment in acute STEMI represents the main indication for thrombolytic therapy in a community hospital set up.
OBJECTIVE: To study newer fibrin specific thrombolytic agent for the management of acute STEMI.
RESULT: In our study, we had 38 patients presented to the emergency department of Scheer Memorial Hospital and were diagnosed as STEMI presented within the window period. Among 38 patients, 18 were male (37-80 years) and 11 were female (45-82 years). All patients were in killips class I-II. They did not have any contraindications for thrombolysis. Informed consent was obtained. They were thrombolysed with tenecteplase (TNKase) according to body weight. Successful thrombolysis was observed with post TNKase (after 90 minutes). Electrocardiograms were recorded to those patient treated. Successful thrombolysis was observed in both genders. Nine patients underwent coronary angiography (CAG) soon after thrombolysis. Out of nine CAG, three patients had single vessel disease, two normal CAG and four unknown. Three patients with complete heart block were sent to cardiac centre following TNKase. Three died in the hospital ICU. Four patients (> 75 years) had COPD, Pneumonia. Twenty-one patients are still living comfortably with LVEF: > 45%. Two died after two years follow up. Six patients are living with LVEF: <30%. Details of five patients could not be obtained. None of the patients had intracranial bleeding.
CONCLUSION: TNKase appears to be effective and well tolerated in the management of STEMI. TNKase is associated with reduced risk of major bleeding in patient treated for STEMI and has higher thrombolytic potency. TNKase is easy to administer and can be used in community hospital. The entire bolus dose is delivered over five seconds; no second dose is required, and gives very competitive result that can be expected for majority of patients present in first three hours of ACS at community hospital. TNkase offers timely reperfusion in community hospital to prevent the catastrophe in STEMI.
Idiopathic chylopericardium is a rare clinical condition that consist of pericardial effusion composed of high concentrations of triglycerides known as chyle. It may occur as a result of chest trauma, mediastinal neoplasms, mediastinal tuberculosis, mediastinal radiotherapy, and thrombosis of the subclavian vein or can be idiopathic. We hereby present a case that illustrates a healthy female fitness trainer in her 50s who presented with dyspnea that progressively worsened to the point where she was referred to a Cardiologist. Subsequently, chylopericardium was diagnosed with pericardiocentesis. She successfully responded to two and a half weeks of continuous drainage and low fat diet. It has only been a month since discharge. In conclusion, this case demonstrates an rare condition to help elucidate medical literature.
Segundo Mesa Castillo
There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.
A new systems approach to diseased states and wellness result in a new branch in the healthcare services, namely, personalized and precision medicine (PPM). To achieve the implementation of PPM concept, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of biomarkers of hidden abnormalities long before the disease clinically manifests itself.
Each decision-maker values the impact of their decision to use PPM on their own budget and well-being, which may not necessarily be optimal for society as a whole. It would be extremely useful to integrate data harvesting from different databanks for applications such as prediction and personalization of further treatment to thus provide more tailored measures for the patients resulting in improved patient outcomes, reduced adverse events, and more cost effective use of the latest health care resources including diagnostic (companion ones), preventive and therapeutic (targeted molecular and cellular) etc. A lack of medical guidelines has been identified by responders as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PPM! Implementation of PPM requires a lot before the current model “physician-patient” could be gradually displaced by a new model “medical advisor-healthy person-at-risk”. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PPM to elicit the content of the new branch.