Recurrent Torsade de Pointes type ventricular tachycardia in intracranial hemorrhage

Two out of 72 cases of intracranial hemorrhage-induced polymorphous ventricular tachycardia with typical Torsade de Pointes morphology are presented. Bot patients had marked QT_c prolongation more than 550 ms. In one patient (QT_c: 669 ms) Torsade de Pointes degenerated into fatal ventricular fibrillation. Even though polymorphous Torsade de Pointes type ventricular tachycardia is rare during the clinical course of intracranial hemorrhage, attention should be given to the QT interval. QT_c prolongation more than 550 ms may carry a high risk of Torsade de Pointes type ventricular tachycardia and ventricular fibrillation.     

Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis

ObjectiveThe current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care.Material and methodsWe performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3.ResultsThe search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD = ?3.71 [?4.46, ?2.96]; p < 0.00001; I² = 88%). Placenta previa (OR = 9.54 [7.23, 12.59]; p < 0.00001; I² = 88%), placental abruption (OR = 6.77 [5.25, 8.73]; p < 0.00001; I² = 72%), emergency C-section (OR = 1.92 [1.42, 2.60]; p < 0.0001; I² = 75%), general anesthesia (OR = 8.43 [7.90, 9.00]; p < 0.00001; I² = 72%), multiple gestations (OR = 1.60 [1.24, 2.06]; p = 0.0003; I² = 85%), preterm labor (OR = 3.34 [2.75, 4.06]; p < 0.00001; I² = 85%), prolonged labor (OR = 1.68 [1.44, 1.96]; p < 0.00001; I² = 78%), unbooked cases (OR = 2.42 [1.22, 4.80]; p = 0.01; I² = 80%), hypertensive disorders of pregnancy (OR = 1.81 [1.72, 1.90]; p < 0.00001; I² = 71%), and fibroids (OR = 2.32 [1.55, 3.47]; p < 0.0001; I² = 72%) were significantly higher in the transfused group compared to the non-transfused group. Chronic hypertension (OR = 0.67 [0.29, 1.55]; p = 0.36; I² = 90%), maternal age (MD = 0.09 [?0.27, 0.45]; p = 0.62; I² = 50%), maternal body mass index (MD = ?0.14 [?0.81, 0.53]; p = 0.67, I² = 86%), diabetes (OR = 0.93 [0.75, 1.15]; p = 0.51; I² = 52%), and malpresentation (OR = 0.65 [0.38, 1.11]; p = 0.13; I² = 64%) were not significantly associated with an increased risk of blood transfusion in C-section in the two groups.ConclusionPlacenta previa, placental abruption, emergency C-section, booking status, multiple gestations, and preoperative hematocrit were the risk factors most significantly associated with blood transfusion, while a prior C-section did not increase the risk of transfusion.     

Propafenone-Induced Torsade de Pointes: Cross-Reactivity with Quinidine

A 77-year-oid/emale with new onset atrial fibrillation occurring in the absence of structural heart disease developed torsade de pointes during therapy with quinidine bisulfate 500 mg orally every 8 hours. Ten days after quinidine therapy had been discontinued she developed torsade de pointes while receiving propafenone 300 mg orally every 8 hours. This case demonstrates that propafenone may be associated with torsade de pointes and suggests a cross-reactivity between this effect and prior occurrence of torsade de pointes on Class IA antiarrhythmic drug therapy.     

Methylation status of interleukin-6 gene promoter in patients with Behçet's disease

BackgroundIL-6 mRNA expression is significantly high in many autoimmune diseases such as Behçet's disease; this is often related with more aggressive phenotypes. Nevertheless, the essential molecular process for its high expression has not been completely realized. The aim of this study was undertaken to estimate the gene copy number variation and promoter methylation to IL-6's high expression.MethodsThis study was performed on 51 patients and 61 healthy controls. Initially, DNA and RNA were extracted from all specimens. Promoter methylation levels of IL-6 were evaluated by MeDIP-qPCR technique. Also, IL-6 gene expression was measured by Real-time PCR. After that, we evaluated the relationship between gene expression and methylation, as well as their relationship with clinical specification.ResultsAs we expected, the expression level of IL-6 gene increased significantly in the patient group compared to the healthy subjects. Also, the relative promoter methylation level of the IL-6 mRNA was significantly lower in patient group compared to healthy group (p < 0.001).DiscussionWe disclosed that the promoter hypomethylation may be considered as one of the main defects for IL-6 mRNA high expression in patients with Behçet's disease.     

Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: Relation with disease activity and lupus nephritis

ObjectivesTo investigate the role of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as activity markers in systemic lupus erythematosus (SLE) without nephritis and lupus nephritis (LN) patients.Patients and methodsThis study included 60 SLE patients with LN, 60 SLE patients without renal involvement and 30 healthy controls. We analyzed correlations between NLR and PLR and both disease activity and renal affection.ResultsThe NLR of SLE patients was much higher than those of the controls. Both ratios showed significantly increased values in SLE patients with active disease. NLR and PLR were positively correlated with SLEDAI, ESR, and CRP and negatively correlated with C4. SLE patients with LN had higher levels of NLR than those without nephritis. NLR showed positive correlations with BUN, serum urea, serum creatinine and 24 h urinary protein. We found NLR to be related to anti-ds-DNA level and renal biopsy classes. While PLR was related only to anti ds-DNA. The best NLR to predict SLE active disease was 2.2 and the best PLR cut-off value was 132.9.ConclusionNLR and PLR are useful inflammatory markers to evaluate disease activity in SLE patients. Also, NLR could reflect renal involvement in SLE patients and is associated with the different classes of its histological staging.