Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic ...Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic stroke meeting the criteria for the diagnosis of SLE and findings consistent with an aortitis on imaging but mimicking the diagnosis of Takayasu’s pulseless arteritis. Blood and imaging investigations revealed the finding of SLE aortitis following an acute stroke presentation. Thus, it is imperative to note that even though it is infrequent, SLE can be associated with a large vessel vasculitis.展开更多
BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied a...BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.展开更多
Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of ...Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of presenting symptoms and features, it is a challenge to identify this condition, and patients are frequently misdiagnosed. The potentially critical course of aortic dissection can result in tragedy. We present the case of a 46-year-old woman who initially presented with a light headache and sensory loss in her right upper limb. She had a medical history of hypertension without regular medication, and her blood pressure (BP) was 110/67 mmHg on arrival. Four days later, she was sent to the emergency department again because she experienced transient loss of consciousness lasting for a few minutes. Her BP was 94/57 mmHg in the right arm and 89/54 in the left arm. She was admitted to the hospital, and the pulses in both upper limbs were impalpable on the following day. Chest magnetic resonance imaging (MRI) was arranged, and subsequently, aortic dissection was diagnosed. The case presented with unusual characteristics, which increased the difficulty in immediate correct diagnosis.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">First described in 1908, TAK has now been recognized as a non...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">First described in 1908, TAK has now been recognized as a non-specific inflammatory disease of unknown etiology, predominantly affecting young females. Sometimes, it progresses into relatively rare and potentially fatal scenarios such heart failure.</span><b><span style="font-family:Verdana;"> Case Presentation: </span></b><span style="font-family:Verdana;">Here, we present the case of a 50-year sub-saharan</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">female suffering from acute heart failure related to TAK.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Despite constitutional symptoms (fever, malaise, weight loss) and more characteristic features such claudication of lower extremities, carotydinia, and pulseless syndrome, diagnosis of TAK was delayed since main presentation was heart failure.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Immunosuppressive and anticoagulant therapies have induced improvement in cardiac manifestations.</span><b><span style="font-family:Verdana;"> Conclusion: </span></b><span style="font-family:Verdana;">Early diagnosis and proper treatment can protect the patient from dangerous complications such heart failure.</span></span>展开更多
目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注...目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注,再予电除颤,按初始剂量,胺碘酮组又分为300mg组(n=64)和150mg组(n=61);对照组(n=58):仅给予常规肾上腺素、CPR及电除颤;记录并比较各组患者的心律转复时间,入院、出院存活人数。结果两种剂量的胺碘酮均能明显缩短心律转复时间[(9.8±1.7)min,(10.5±2.3)min vs (15.6±2.2)min](P<0.05),提高入院存活率(35.9%,32.8% vs 20.7%)(P<0.05),300mg剂量的胺碘酮的效果略优于150mg剂量组,但差异无统计学意义(P>0.05),胺碘酮对于出院存活率无明显改善。结论300mg与150mg剂量的胺碘酮能有效缩短无脉性室速和心室纤颤患者的心律转复时间,但不能提高出院存活率。展开更多
2018年美国心脏病协会(The American Heart Association,AHA)和国际复苏联络委员会(International Liaison Committee on Resuscitation,ILCOR)更新了心肺复苏指南,推荐对胺碘酮和利多卡因治疗电除颤难复律性心室颤动(ventricular fibri...2018年美国心脏病协会(The American Heart Association,AHA)和国际复苏联络委员会(International Liaison Committee on Resuscitation,ILCOR)更新了心肺复苏指南,推荐对胺碘酮和利多卡因治疗电除颤难复律性心室颤动(ventricular fibrillation,VF)或无脉性室性心动过速(pulseless ventricular tachycardia,pVT)。本文总结胺碘酮、利多卡因在心肺复苏中的药理作用及推荐剂量,回顾两者在心肺复苏中的研究进展。展开更多
文摘Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic stroke meeting the criteria for the diagnosis of SLE and findings consistent with an aortitis on imaging but mimicking the diagnosis of Takayasu’s pulseless arteritis. Blood and imaging investigations revealed the finding of SLE aortitis following an acute stroke presentation. Thus, it is imperative to note that even though it is infrequent, SLE can be associated with a large vessel vasculitis.
文摘BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
文摘Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of presenting symptoms and features, it is a challenge to identify this condition, and patients are frequently misdiagnosed. The potentially critical course of aortic dissection can result in tragedy. We present the case of a 46-year-old woman who initially presented with a light headache and sensory loss in her right upper limb. She had a medical history of hypertension without regular medication, and her blood pressure (BP) was 110/67 mmHg on arrival. Four days later, she was sent to the emergency department again because she experienced transient loss of consciousness lasting for a few minutes. Her BP was 94/57 mmHg in the right arm and 89/54 in the left arm. She was admitted to the hospital, and the pulses in both upper limbs were impalpable on the following day. Chest magnetic resonance imaging (MRI) was arranged, and subsequently, aortic dissection was diagnosed. The case presented with unusual characteristics, which increased the difficulty in immediate correct diagnosis.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">First described in 1908, TAK has now been recognized as a non-specific inflammatory disease of unknown etiology, predominantly affecting young females. Sometimes, it progresses into relatively rare and potentially fatal scenarios such heart failure.</span><b><span style="font-family:Verdana;"> Case Presentation: </span></b><span style="font-family:Verdana;">Here, we present the case of a 50-year sub-saharan</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">female suffering from acute heart failure related to TAK.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Despite constitutional symptoms (fever, malaise, weight loss) and more characteristic features such claudication of lower extremities, carotydinia, and pulseless syndrome, diagnosis of TAK was delayed since main presentation was heart failure.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Immunosuppressive and anticoagulant therapies have induced improvement in cardiac manifestations.</span><b><span style="font-family:Verdana;"> Conclusion: </span></b><span style="font-family:Verdana;">Early diagnosis and proper treatment can protect the patient from dangerous complications such heart failure.</span></span>
文摘目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注,再予电除颤,按初始剂量,胺碘酮组又分为300mg组(n=64)和150mg组(n=61);对照组(n=58):仅给予常规肾上腺素、CPR及电除颤;记录并比较各组患者的心律转复时间,入院、出院存活人数。结果两种剂量的胺碘酮均能明显缩短心律转复时间[(9.8±1.7)min,(10.5±2.3)min vs (15.6±2.2)min](P<0.05),提高入院存活率(35.9%,32.8% vs 20.7%)(P<0.05),300mg剂量的胺碘酮的效果略优于150mg剂量组,但差异无统计学意义(P>0.05),胺碘酮对于出院存活率无明显改善。结论300mg与150mg剂量的胺碘酮能有效缩短无脉性室速和心室纤颤患者的心律转复时间,但不能提高出院存活率。
