Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This revi...Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This review delves into the epidemiological connections between IBD and ASCVD,elucidating potential underlying mechanisms.Furthermore,it discusses the impact of current IBD treatments on cardiovascular risk.Additionally,the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated,drawing parallels with observations in patients with rheumatoid arthritis.This article aims to comprehensively evaluate the existing evidence supporting these associations.To achieve this,we conducted a meticulous search of PubMed,spanning from inception to August 2023,using a carefully selected set of keywords.The search encompassed topics related to IBD,such as Crohn’s disease and ulcerative colitis,as well as ASCVD,including coronary artery disease,cardiovascular disease,atrial fibrillation,heart failure,conduction abnormalities,heart blocks,and premature coronary artery disease.This review encompasses various types of literature,including retrospective and prospective cohort studies,clinical trials,meta-analyses,and relevant guidelines,with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.展开更多
AIM: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely. METHODS: Eight of 70 patients presenting in tertia...AIM: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely. METHODS: Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5-F multipurpose catheter to reestablish flow, followed by intralesional infusion of urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h). RESULTS: Eight patients, mean age 47.77±12.20 years presented with subacute pulmonary embolism (mean duration of symptoms 2.4 wk). At presentation, mean heart rate, shock index, miller score and mean pulmonary pressures were 101.5±15.2/min, 0.995±0.156, 23.87±3.76 and 37.62±6.67 mmHg which reduced to 91.5±12.2/min (P=0.0325), 0.789±0.139 (P=0.0019), 5.87±1.73 (P=0.0000004) and 27.75±8.66 mmHg (P=0.0003) post procedurally. Mean BP improved from 80.00±3.09 mmHg to 90.58±9.13 mmHg (P=0.0100) post procedurally. Minor complications in the form of local hematoma-minor hematoma in 1 (12.5%), and pseudoaneurysm (due to femoral artery puncture) in 1 (12.5 %) patient were seen. At 30 d and 6 mo follow up survival rate was 100% and all the patients were asymptomatic and in New York Heart Association class 1. CONCLUSION: Combined modality of mechanical fragmentation and intralesional thrombolysis appears to be a promising alternative to high risk surgical procedures in patients with subacute massive pulmonary embolism.展开更多
文摘Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This review delves into the epidemiological connections between IBD and ASCVD,elucidating potential underlying mechanisms.Furthermore,it discusses the impact of current IBD treatments on cardiovascular risk.Additionally,the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated,drawing parallels with observations in patients with rheumatoid arthritis.This article aims to comprehensively evaluate the existing evidence supporting these associations.To achieve this,we conducted a meticulous search of PubMed,spanning from inception to August 2023,using a carefully selected set of keywords.The search encompassed topics related to IBD,such as Crohn’s disease and ulcerative colitis,as well as ASCVD,including coronary artery disease,cardiovascular disease,atrial fibrillation,heart failure,conduction abnormalities,heart blocks,and premature coronary artery disease.This review encompasses various types of literature,including retrospective and prospective cohort studies,clinical trials,meta-analyses,and relevant guidelines,with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.
文摘AIM: To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely. METHODS: Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5-F multipurpose catheter to reestablish flow, followed by intralesional infusion of urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h). RESULTS: Eight patients, mean age 47.77±12.20 years presented with subacute pulmonary embolism (mean duration of symptoms 2.4 wk). At presentation, mean heart rate, shock index, miller score and mean pulmonary pressures were 101.5±15.2/min, 0.995±0.156, 23.87±3.76 and 37.62±6.67 mmHg which reduced to 91.5±12.2/min (P=0.0325), 0.789±0.139 (P=0.0019), 5.87±1.73 (P=0.0000004) and 27.75±8.66 mmHg (P=0.0003) post procedurally. Mean BP improved from 80.00±3.09 mmHg to 90.58±9.13 mmHg (P=0.0100) post procedurally. Minor complications in the form of local hematoma-minor hematoma in 1 (12.5%), and pseudoaneurysm (due to femoral artery puncture) in 1 (12.5 %) patient were seen. At 30 d and 6 mo follow up survival rate was 100% and all the patients were asymptomatic and in New York Heart Association class 1. CONCLUSION: Combined modality of mechanical fragmentation and intralesional thrombolysis appears to be a promising alternative to high risk surgical procedures in patients with subacute massive pulmonary embolism.
