The efficacy and safety of Batroxobin in combination with anticoagulation on cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke with highly variable clinical presentation. Although anticoagulation with heparin and/or warfarin remains the standard treatment for CVST, treatment failure is still common. This study aims to evaluate the safety and efficacy of Batroxobin in combination with anticoagulation on CVST control. In this retrospective study, a total of 61 CVST patients were enrolled and divided into Batroxobin (n?=?23) and control (n?=?38) groups. In addition to the same standard anticoagulation in control, patients in the treatment group received Batroxobin 5 BU intravenous infusion (10 BU for the first time) every other day, for a total of three infusions. A higher recanalization rate was found in Batroxobin group (adjusted OR [95% CI] of 2.5 [1.1–5.0], p?=?0.028) compared to the control group, especially in patients with high levels of fibrinogen (adjusted OR [95% CI] of 4.7 [1.4–16.7], p?=?0.015). Statistically significant differences between the two groups were seen regarding the levels of thrombin time, fibrinogen and d-dimer at each cut-off time point (all p?<?0.01). Compared with baseline, NIHSS scores at discharge showed significant improvement in the Batroxobin group [0(0, 4.25)–5(2, 11), p?=?0.036]. No significant difference in mRS scores was found between the two groups at discharge or at 6-month outpatient follow-up (all p?>?0.05). Additionally, Batroxobin did not increase the risk of intracranial hemorrhage. We conclude that Batroxobin is a potentially safe and effective adjunct therapeutic agent promoting CVST recanalization especially in patients with high level of fibrinogen.     

Influence of surgery on the natural history of rheumatic mitral and aortic valve disease

The rate of survival, the evolution of functional cardiac status and the incidence of major complications during a 5 year period were studied in 410 patients with rheumatic mitral or aortic valve disease, of whom 200 were treated medically and 210 by surgery. The 5 year survival rates in patients with various types of rheumatic mitral valve disease were similar (45 percent for those with mitral stenosis and 46 percent for those with mitral insufficiency or mixed mitral insufficiency and stenosis). The survival rate in patients with aortic valve disease was somewhat more favorable (64 percent).Mitral valvulotomy had the most positive influence on mortality. The 85 percent 5 year survival rate of patients who underwent this procedure was significantly higher than that of patients with medically treated mitral stenosis. In patients submitted to mitral and aortic valve replacement, the survival rate was also improved in comparison with data in the corresponding medically treated groups, but to a lesser degree (70 percent for aortic valve replacement and 60 percent for mitral valve replacement). In all surgically treated groups, initial operative mortality was the primary determinant of the rate of survival at the end of 5 years.Survivors of all surgical groups had appreciable improvement in cardiac functional classification and a remarkable reduction in the incidence of heart failure and atrial fibrillation. The incidence of infectious endocarditis was significantly reduced after mitral valvulotomy, as compared with the incidence in patients with medically treated mitral stenosis. Mitral and aortic valve replacement did not reduce the incidence of infectious endocarditis. The incidence of thromboembolic phenomena was favorably influenced by mitral valvulotomy and aortic valve replacement, but not by mitral valve replacement.     

Influenza vaccine in chronic lymphoproliferative disorders and multiple myeloma

OBJECTIVE: Vaccination against influenza in patients with chronic lymphoproliferative disorders (CLPD) and multiple myeloma (MM) is still a matter of clinical uncertainty. The aim of this study was to determine the safety, immunogenicity and clinical response to a commercially available vaccine against influenza in a group of such patients. METHODS: Thirty-four patients with CLPD and MM and 34 immunologically normal subjects were vaccinated with the same vaccine against influenza. Patients were observed during the epidemic season from October 1999 to April 2000, and monitored for side-effects of the vaccine, seroprotection and seroconversion after vaccination. The prevaccination level of immunoglobulins was also determined. Occurrence of influenza episodes was demonstrated with the positive isolation of a viral strain from a pharyngeal swab. RESULTS: No patient had untoward reactions to the vaccine used. Seroconversion and seroprotection were up to the standard established by the European Agency for the Evaluation of Medicinal Products. Only one patient developed influenza during follow-up. CONCLUSIONS: Influenza vaccine is effective and well tolerated in patients with CLPD and MM. No contraindications exist for its use, and it should become a routine practice, in order to prevent serious complications during the influenza epidemic season.     

Cardiac computed tomography in the contemporary evaluation of infective endocarditis

Increasing data have accumulated on the role of Cardiac Computed Tomography (CCT) in infective endocarditis (IE) with high accuracy for large vegetations, perivalvular complications and for exclusion of coronary artery disease to avoid invasive angiography. CCT can further help to clarify the etiology of infective prosthetic valve dysfunction (e.g. malposition, abscess, leak, vegetation or mass). Structural interventions have increased the relevance of CCT in valvular heart disease and have amplified its use. CCT may be ideally integrated into a multimodality approach that incorporates a central role of transesophageal echocardiography (TEE) with 18-FDG PET and/or cardiac magnetic resonance in individually selected cases, guided by the Heart Team. The coronavirus-19 (COVID-19) pandemic has resulted in renewed attention to CCT as a safe alternative or adjunct to TEE in selected patients. This review article provides a comprehensive, contemporary review on CCT in IE to include scan optimization, characteristics of common IE findings on CCT, published data on the diagnostic accuracy of CCT, multimodality imaging comparison, limitations and future technical advancements.     

Vertigo without cochlear symptoms: vestibular migraine or Menière disease?

Neurological Sciences - Menière’s disease (MD) is an inner ear disorder due to raised endolymphatic pressure (hydrops), characterized by cochlear symptoms associated with episodic...     

The description and histopathology of Leptorhynchoides polycristatus n. sp. (Acanthocephala: Rhadinorhynchidae) from sturgeons, Acipenser spp. (Actinopterygii: Acipenseridae) in the Caspian Sea, Iran, with emendation of the generic diagnosis

Of the three known species of Leptorhynchoides Kostylew 1924, two are reported from North American fishes: Leptorhynchoides aphredoderi Buckner and Buckner 1976 and Leptorhynchoides thecatus (Linton 1891) Kostylew 1924. The third species, Leptorhynchoides plagicephalus (Westrumb 1821) Kostylew 1924, is commonly found in the Caspian and Black Sea from at least four species of sturgeons including Acipenser stellatus Pallas 1771 and the Acipenser nudiventris Lovetzsky 1828 from which Leptorhynchoides polycristatus n. sp. was found. No taxonomic work has been reported for L. plagicephalus for the last 90 years. L. polycristatus n. sp. can be readily confused with L. plagicephalus because of many superficial similarities. Such similarities include the general shape of the trunk, proboscis, and organ systems. However, L. polycristatus is clearly distinguished from the other three species primarily by having (1) 19–20 proboscis hooks per row; (2) the shortest hooks are anterior and the longest at the middle; the opposite is true in L. plagicephalus; (3) with a cuticular collar enveloping the base of the proboscis hooks; (4) the surface of its proboscis hooks is ribbed; (5) with a broad collar of multiple rectangular cuticular crests encircling the anterior end of the trunk; this is the only member of Leptorhynchoides with such a structure; (6) with many large ovoid uninucleated cells in the subcuticular layer of the trunk; (7) with paired glandular clusters near the male reproductive opening and of suction cup-like sensory structures on the bursa; (8) with dorsoventral ligament across the vagina; (9) cement glands are in a cluster of eight arranged in two horizontal tiers of four glands each; (10) with female gonopore near terminal; (11) with structures interpreted as possible microtriches on the surface of the trunk; (12) and with thinner eggs. L. polycristatus caused extensive histopathological damage to host intestinal layers. The armed proboscis invades and attaches to the host mucosa causing villi compression and necrosis of the epithelial lining with subsequent hemorrhaging and granulocyte migration. No encapsulation of the acanthocephalan is visible, and the worm can migrate deep into the smooth muscle layers of the muscularis extrema. The presence of L. polycristatus in the lumen of the host intestine obstructs and damages the absorbing surface of the host affecting the nutritional potential. Dead, necrotic host epithelial tissue and remnants of villi and crypts are visible.     

Solitary rectal ulcer syndrome in children and adolescents: a descriptive clinicopathologic study

Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of the rectum. While benign, it can cause concern for patients and affect quality of life. Reported studies on SRUS worldwide are scarce. The aim of this study is to describe the clinicopathologic characteristics of SRUS in a cohort of children based in Saudi Arabia. In this study, children with a confirmed diagnosis of SRUS at King Abdulaziz University Hospital (KAUH) were included, during the period November 2003 to November 2017. Data were collected from hospital medical records. The study comprised twenty-one patients: 17 males (81%) and 4 females (19%); the median age was 11.4 years (range, 5.43-17.9 years). The most common presenting symptoms were rectal bleeding in 21 patients (100%), passage of mucus in 16 (76.1%), abdominal pain in 14 (66.6%), constipation in 13 (61.9%), straining in 9 (42.9%), and rectal prolapse in 5 (23.8%). The most common finding at initial colonoscopy was a single ulcer in 7 patients (33.3%), multiple ulcers in 6 (28.5%), polypoid lesions in 5 (23.8%), and hyperemic mucosa in 3 (14.2%). All patients received medical treatment and 14 (81%) continued to manifest one or more of the symptoms following treatment, which required subsequent modification of the treatment course. None of the patients required surgery. In conclusion, the study found rectal bleeding to be the most common presentation, with a single ulcer being the most prevalent lesion in endoscopy. Treatment response was variable, but almost half of patients reported relief of symptoms following treatment.     

Chest radiography requirements for patients with asymptomatic COVID-19 undergoing coronary artery bypass surgery: Three case reports

BACKGROUNDThe coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, represents a major challenge to health care systems both globally and regionally, with many opting by cancelling elective surgeries. Cardiac operations in patients diagnosed with COVID-19 have been imperative due to their emergency nature, critical condition of patients awaiting cardiac surgery, and accumulated number of cardiac surgical interventions throughout the last months.CASE SUMMARYHere we describe three COVID-19 positive cases who underwent coronary surgery, on an urgent basis. We did not experience worsening of the patients’ clinical condition due to COVID-19 and therefore a routine post-operative chest X-ray (CXR) was not required. None of the health care providers attending the patients endured cross infection. Further trials would be needed in order to confirm these results.CONCLUSIONWhile the pandemic has adversely hit the health systems worldwide, cardiac surgical patients who concomitantly contracted COVID-19 may undergo a smooth post-operative course as a routine post-operative CXR may not be required.