Inflammatory biomarkers at hospital discharge are associated with readmission and death in patients hospitalized for COVID-19

European Journal of Clinical Microbiology & Infectious Diseases -     

Ventricular activity cancellation in electrograms during atrial fibrillation with constraints on residuals’ power

During atrial fibrillation (AF), cancellation of ventricular activity from atrial electrograms (AEG) is commonly performed by template matching and subtraction (TMS): a running template, built in correspondence of QRSs, is subtracted from the AEG to uncover atrial activity (AA). However, TMS can produce poor cancellation, leaving high-power residues. In this study, we propose to modulate the templates before subtraction, in order to make the residuals as similar as possible to the nearby atrial activity, avoiding high-power ones. The coefficients used to modulate the template are estimated by maximizing, via Multi-swarm Particle Swarm Optimization, a fitness function. The modulated TMS method (mTMS) was tested on synthetic and real AEGs. Cancellation performances were assessed using: normalized mean squared error (NMSE, computed on simulated data only), reduction of ventricular activity (VDR), and percentage of segments (PP) whose power was outside the standard range of the atrial power. All testings suggested that mTMS is an improvement over TMS alone, being, on simulated data, NMSE and PP significantly decreased while VDR significantly increased. Similar results were obtained on real electrograms (median values of CS1 recordings PP: 2.44 vs. 0.38 p < 0.001; VDR: 6.71 vs. 8.15 p < 0.001).     

Diagnosis and management of amiodarone-induced thyrotoxicosis: similarities and differences between North American and European thyroidologists

Objective To investigate how North American thyroidologists assess and treat amiodarone‐induced thyrotoxicosis (AIT) and to compare the results with those of the same questionnaire‐based survey previously carried out among European thyroidologists. Design Members of the American Thyroid Association (ATA) with clinical interests were sent by e‐mail a questionnaire on the diagnosis and management of AIT, 115 responses were received from the United States and Canada, representing about one‐third of ATA members with clinical interests. Results The majority of respondents (91%vs. 68% in Europe, P < 0·05) see < 10 new cases of AIT per year, and AIT seems less frequent than amiodarone‐induced hypothyroidism (AIH) in North America (34% and 66% of amiodarone‐induced thyroid dysfunction, respectively, vs. 75% and 25%, respectively, in Europe, P < 0·001). When AIT is suspected, in North America hormonal assessment is mostly based on serum free T4 (FT4) and TSH measurements, while serum free T3 (FT3) determination is requested less frequently than in Europe; thyroid autoimmunity is included in the initial assessment less than in Europe. Most commonly used additional diagnostic procedures include, as in Europe, thyroid colour‐flow Doppler sonography, and to a lesser extent, thyroid radioactive iodine uptake and scan, but Europeans tend to request multiple tests more than North Americans. Withdrawal of amiodarone is more often considered unnecessary by North American thyroidologists (21%vs. 10% in Europe in type 1 AIT, P < 0·05, 34%vs. 20% in type 2 AIT, P < 0·05). In type 1 AIT thionamides represent the treatment of choice for North Americans as well as for Europeans, but the former use them as monotherapy in 65%vs. 51% of Europeans (P < 0·05) who more often consider potassium perchlorate as an useful addition (31%vs. 15% of North Americans, P < 0·01). Glucocorticoids are the selected treatment for type 2 AIT, alone (62%vs. 46% in Europe, P < 0·05) or in association with thionamides (16%vs. 25% in Europe, P = NS). After restoration of euthyroidism, thyroid ablation in the absence of recurrent thyrotoxicosis is recommended in type 1 AIT less frequently by North Americans. If amiodarone therapy needs to be reinstituted, prophylactic thyroid ablation is advised by 76% in type 1 AIT, while a ‘wait‐and‐see’ strategy is adopted by 61% in type 2 AIT, similar to behaviour of European thyroidologists. Conclusion Similarities and differences exist between expert North American and European thyroidologists concerning the diagnosis and management of AIT. While differences reflect the frequent uncertainty of the underlying mechanism leading to AIT, similarities may represent the basis to refine the diagnostic criteria and to improve the therapeutic outcomes of this challenging clinical situation.     

Protected iliofemoral venous thrombectomy in a pregnant woman with pulmonary embolism and ischemic venous thrombosis

Although thromboembolism is uncommon during pregnancy and the postpartum period, physicians should be alert to the possibility because the complications, such as pulmonary embolism, are often life threatening. Pregnant women who present with thromboembolic occlusion are particularly difficult to treat because thrombolysis is hazardous to the fetus and surgical intervention by any of several approaches is controversial. A 22-year-old woman, in her 11th week of gestation, experienced an episode of pulmonary embolism and severe ischemic venous thrombosis of the left lower extremity The cause was determined to be a severe protein S deficiency in combination with compression of the left iliac vein by the enlarged uterus. The patient underwent emergency insertion of a retrievable vena cava filter and surgical iliofemoral venous thrombectomy with concomitant creation of a temporary femoral arteriovenous fistula. The inferior vena cava filter was inserted before the venous thrombectomy to prevent pulmonary embolism from clots dislodged during thrombectomy When the filter was removed, medium-sized clots were found trapped in its coils, indicating the effectiveness of this approach. The operation resolved the severe ischemic venous thrombosis of the left leg, and the patency of the iliac vein was maintained throughout the pregnancy without embolic recurrence. At full term, the woman spontaneously delivered an 8-lb, 6-oz, healthy male infant.     

Métastase musculaire striée unique au niveau de l’avant-bras révélant une linite gastrique

Prerequisite

Stomach carcinoma gives essentially lymph node, hepatic and pulmonary metastases. Skeletal muscle is not a known location of gastric metastases.

Purpose of work

Report of an original observation of solitary gastric metastasis in a skeletal muscle of the forearm and revealing the primary lesion.

Methods

Patient supported for a tumor lesion of the forearm. The excision and pathologic examination had revealed an adenocarcinoma.

Results

The survey of the primary site of metastasis revealed a gastric linitis.

Conclusions

This method of revelation of a gastric tumor is exceptional and this observation is even more original than this metastasis is unique.     

Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil

When looking at developing countries, the prolonged intensive medical and nursing care required by many patients places extra demands on an already stretched healthcare budget. The purpose of this study was to verify the effectiveness of a systematic rehabilitative program for swallowing and oral-motor movements in intensive care unit patients with the diagnosis of tetanus. Forty-five patients who were clinically diagnosed with tetanus were included in the study. Participants were divided in two groups: GI - consisted of 18 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2002 to December 2005, prior to the existence of a systematic swallowing and oral-motor intervention; GII - consisted of 27 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2006 to December 2009 and were submitted to a specific rehabilitative management of swallowing and of the oral-motor movements. Results indicate that the proposed rehabilitative program reduced by approximately 50% the time patients remained in the ICU. The significant improvement observed in patients with tetanus who were submitted to the rehabilitative program for swallowing and oral-motor movements occurred in conjunction with a reduction in the amount of time necessary to reintroduce oral feeding, to decannulate and to remove the feeding tubes. In conclusion, swallowing/muscle exercise, in patients with severe/very severe tetanus, seem to promote the remission of muscle tension and seem to maximize functional swallowing.     

Safety in the Use of Dexmedetomidine (Precedex) for Deep Brain Stimulation Surgery: Our Experience in 23 Randomized Patients

Objective: Evaluation of safety and efficacy of dexmedetomidine in deep brain stimulation (DBS) surgery. Materials and Methods: A cohort of 23 patients, candidates for DBS for Parkinson's disease, Tourette syndrome, or obsessive‐compulsive disorder, was randomized in two groups: dexmedetomidine group and control group. Standard anesthesiologic parameters were recorded and analyzed, together with the need for other medications. A ten‐degree scale (visual analog scale) assessing patient discomfort during DBS also was recorded at the end of surgery. Results: The results demonstrated good stability of intraoperative monitoring: no respiratory depression and good overall cooperation with the neurologist, while no side‐effects were recorded. Conclusions: Our conclusion is that dexmedetomidine should be considered as a valuable option for sedation in poorly collaborating patients undergoing DBS surgery.     

Description of response to aspirin and clopidogrel in outpatients with coronary artery disease using multiple electrode impedance aggregometry

Identification of outpatients with high platelet reactivity (HPR) on antiplatelet treatment is an unmet need. The present study was conducted in healthy individuals (n = 50) and in outpatients with coronary artery disease (CAD) at a distance from the acute ischemic episode (aspirin group, n = 71; aspirin/clopidogrel group, n = 106). We studied the feasibility and the precision of whole blood multiple electrode aggregometry (MEA) after triggering platelet aggregation by arachidonic acid or adenosine diphospate (ADP). The MEA can be performed on whole blood within 2 hours after sample venipuncture. The threshold for the diagnosis of HPR is situated at 55 and 50 U for the arachidonic acid and ADP test, respectively. Frequency of HPR was 7% and 20% in aspirin and aspirin/clopidogrel groups, respectively. In 3.8% of patients in aspirin/clopidogrel group, combined HPR on aspirin and clopidogrel was found. In outpatients with CAD, use of MEA is feasible for the diagnosis of HPR.