D-dimer level predicts in-hospital mortality in patients with infective endocarditis: A prospective single-centre study

Background

Increased circulating D-dimer levels have been correlated with adverse outcomes in various clinical conditions. To our knowledge, the association of on-admission D-dimer and in-hospital mortality in infective endocarditis (IE) has not been investigated. We hypothesized that increased on-admission D-dimer levels would correlate with adverse outcomes when prospectively studied in patients with IE.

Methods

In this prospective study, a total of 157 consecutive patients with the definite IE diagnosis met the inclusion criteria and underwent testing for on-admission D-dimer and CRP assays. The outcome measure was in-hospital death from any cause.

Results

In-hospital mortality occurred in 40 (26%) patients. Increased levels of plasma D-dimer (5.1 ± 1.7 vs 1.9 ± 0.8, p < 0.001), CRP [45(13-98) vs 12(5–28), p < 0.001] were found in dead patients compared with those survived. In addition to S. aureus infection, increased leukocyte count, end-stage renal disease, LVEF < 50%, vegetation size of > 10 mm, perivalvular abscess, on-admission D-dimer (HR: 1.32; 95% CI: 1.24-1.40; p < 0.001) and CRP (HR: 1.18; 95% CI: 1.09-1.36; p = 0.001) levels were significantly associated with in-hospital mortality. Furthermore, the sensitivity and specificity of D-dimer ≥ 4.2 mg/L in predicting in-hospital death in IE were 86% and 85%, respectively. Moreover, the sensitivity and specificity of CRP levels ≥ 13.6 mg/L were 72% and 69%, respectively.

Conclusion

Our findings suggest that on-admission D-dimer level may be a simple, available and valuable biomarker that allows us to identify high-risk IE patients for in-hospital mortality. D-dimer ≥ 4.2 mg/L, CRP ≥ 13.6 mg/L were independently associated with IE related in-hospital death.     

Adverse effects of a hybrid nanofluid in a wavy non-uniform annulus with convective boundary conditions

The presented investigation theoretically studies the physical characteristics of a two-dimensional incompressible hybrid nanofluid in a non-uniform annulus where the boundaries are flexible. A mixed convective peristaltic mechanism is implemented to model blood-based nanofluids using two different nanoparticles (Ag + Al₂O₃). Convective boundary conditions are employed and different forms of nanoparticles are discussed (bricks, cylinders and platelets). The problem is shortened by engaging a lubrication method. Exact expressions for the temperature of cumulative heat source/sink standards, hemodynamic velocity, pressure gradient and streamlines of different shapes of nanoparticles are obtained. Special cases of pure blood and the Al₂O₃ nanofluid of our model are derived. A comparison is set between nanofluids and hybrid nanofluids from which we observed variations in heat transfer rate in different regions due to the oscillatory nature of the waves. The current model has the potential to be useful for applications related to the metabolic structures that play a vital role in heat sources inside the human body.

The presented investigation theoretically studies the physical characteristics of a two-dimensional incompressible hybrid nanofluid in a non-uniform annulus where the boundaries are flexible.     

The horror of unsafe abortion: case report of a life threatening complication in a 29-year old woman

Background

Every year 42 million women with unintended pregnancies choose abortion, and fifty percent of these procedures, 20 million are unsafe. An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both.Pakistan is the one of the six countries where more than 50% of the world’s all maternal deaths occur. It is estimated that 890,000 induced abortions are performed annually in Pakistan, and estimate an annual abortion rate of 29 per 1000 women aged 15-49.

Case presentation

Here we present a case report of a 29-year old woman who underwent an unsafe abortion for unintended pregnancy resulting in uterine perforation. The unskilled provider pulled out her bowel through vagina after perforating the uterus, as a result she lost major portion of her small intestine resulting in short bowel syndrome.

Conclusion

The law of Pakistan only allows abortion during early stages of pregnancy for purpose of saving the life of a mother but does not cater for cases of rape, incest and fetal abnormalities or social reasons.Only legalization of abortion is not sufficient, preventing unintended pregnancy should be the priority of all the nations and for this reason contraception should be widely accessible.Practitioners need to become better trained in safer abortion methods and be to able transfer the patient to health facility when complications occur.

     

Pediatric chondrodermatitis nodularis helicis

Chondrodermatitis nodularis helicis (CNH) is a rare condition of the pinna affecting mainly adults. A pediatric case of this condition is presented in the current report, and the literature of pediatric CNH is reviewed.     

Coronary artery thromboembolism: Unexpected presentation of left atrial myxoma covered with thrombus

Cardiac myxomas are benign primer cardiac tumors of the heart. They can be fatal with a thromboembolic presentation. Myocardial infarction is one of these unusual thromboembolic presentations. We report a patient who presented with cardiac arrest due to ventricular fibrillation related to myocardial infarction. After successful resuscitation, coronary angiography and transthoracic echocardiography were performed. A left atrial mass was observed and interpreted as a possible cause of coronary embolism leading to myocardial infarction. After surgical excision, the pathological examination confirmed myxoma, which was the essential cause of the tendency to arterial embolism.     

Is the burden of oral diseases higher in urban disadvantaged community compared to the national prevalence?

Background

The urban low income has often been assumed to have the greatest dental treatment needs compared to the general population. However, no studies have been carried out to verify these assumptions. This study was conducted to assess whether there was any difference between the treatment needs of an urban poor population as compared to the general population in order to design an intervention programme for this community.

Methods

A random sampling of living quarters (households) in the selected areas was done. 586 adults over 19 years old living in these households were clinically examined using World Health Organization (WHO) Oral Health Survey criteria 4th edition (1997).

Results

The overall prevalence of dental caries, periodontal disease, denture wearers and temporomandibular joint problems were 70.5%, 97.1%, 16.7% and 26%, respectively. The majority (80.5%) needed some form of dental treatment. The highest treatment needs were found in the oldest age group while the lowest were in the youngest group (19-29 years) (p = 0.000). The most prevalent periodontal problem was calculus; regardless of gender, ethnicity and age. Significantly more females (20.5%) wore prosthesis than males (11.1%) (p = 0.003). Prosthetic status and need significantly increased with age (p = 0.000). About one in four adults had Temporo-Mandibular Joint (TMJ) problems. Overall, it was surprising to note that the oral disease burden related to caries, prosthetic status and treatment need were lower in this population as compared to the national average (NOHSA, 2010). However, their periodontal disease status and treatment needs were higher compared to the national average indicating a poor oral hygiene standard.

Conclusions

The evidence does not show that the overall oral disease burden and treatment needs in this urban disadvantaged adult population as higher than the national average, except for periodontal disease. The older age groups and elderly were identified as the most in need for oral health intervention and promotion. An integrated health intervention programme through a multisectoral common risk factor approach in collaboration with the Faculties of Medicine, Dentistry and other agencies is needed for the identified target group.

     

Extraction of Retinal Layers Through Convolution Neural Network (CNN) in an OCT Image for Glaucoma Diagnosis

Glaucoma is a progressive and deteriorating optic neuropathy that leads to visual field defects. The damage occurs as glaucoma is irreversible, so early and timely diagnosis is of significant importance. The proposed system employs the convolution neural network (CNN) for automatic segmentation of the retinal layers. The inner limiting membrane (ILM) and retinal pigmented epithelium (RPE) are used to calculate cup-to-disc ratio (CDR) for glaucoma diagnosis. The proposed system uses structure tensors to extract candidate layer pixels, and a patch across each candidate layer pixel is extracted, which is classified using CNN. The proposed framework is based upon VGG-16 architecture for feature extraction and classification of retinal layer pixels. The output feature map is merged into SoftMax layer for classification and produces probability map for central pixel of each patch and decides whether it is ILM, RPE, or background pixels. Graph search theory refines the extracted layers by interpolating the missing points, and these extracted ILM and RPE are finally used to compute CDR value and diagnose glaucoma. The proposed system is validated using a local dataset of optical coherence tomography images from 196 patients, including normal and glaucoma subjects. The dataset contains manually annotated ILM and RPE layers; manually extracted patches for ILM, RPE, and background pixels; CDR values; and eventually final finding related to glaucoma. The proposed system is able to extract ILM and RPE with a small absolute mean error of 6.03 and 5.56, respectively, and it finds CDR value within average range of ± 0.09 as compared with glaucoma expert. The proposed system achieves average sensitivity, specificity, and accuracies of 94.6, 94.07, and 94.68, respectively.