Lost and found: Coronary stent retrieval and review of literature

A 61‐year‐old man with a history of percutaneous coronary intervention (PCI) of the mid right coronary artery (RCA) with a drug eluting stent (DES), presented with non‐ST segment elevation myocardial infarction. Coronary angiography demonstrated complex disease of the distal RCA as well as in‐stent stenosis of the previously placed mid RCA stent. The patient underwent bifurcation PCI of the distal RCA followed by attempted intervention with a DES on the mid RCA lesion. The stent could not cross the lesion and eventually became dissociated from its delivery system. The lost stent was successfully retrieved using two different snaring systems. The procedure was terminated without further attempts for stent delivery. The patient had an uneventful recovery and underwent successful PCI of the mid RCA lesion one month later.     

Dose and duration of nerve growth factor (NGF) administration determine the extent of behavioral recovery following peripheral nerve injury in the rat

Nerve growth factor (NGF) has been previously shown to support neuron survival and direct neurite outgrowth in vitro, and to enhance axonal regeneration in vivo. However, a systematic analysis of NGF dose and dose duration on behavioral recovery following peripheral nerve injury in rodents has not been previously investigated. Here, we show that NGF promotes a bell shaped dose–response, with an optimal threshold effect occurring at 800 pg/μl. High dose NGF inhibited regeneration. However, this effect could be reversed through functional blockade of p75 receptors, thus implicating these receptors as mediators of the inhibitory response. Longer term evaluation showed that animals administered NGF at 80 ng/day for 3 weeks had greater sensorimotor recovery compared to all other treatment groups. These animals made significantly fewer errors during skilled locomotion, and displayed both increased vertical and fore-aft ground reaction forces during flat surface locomotion. Furthermore, terminal electrophysiological and myological assessments (EMG, wet gastrocnemius muscle weights) corroborated the behavioral data. Overall, these data support the hypothesis that both appropriate dose and duration of NGF are important determinants of behavioral recovery following nerve injury in the rat.     

Desmopressin for haemostasis in cardiac surgery: when to use?

Bleeding after cardiac surgery increases morbidity and exposes patients to the risks associated with blood transfusion. Desmopressin acetate, a synthetic vasopressin analogue, has been used in patients undergoing cardiac operations to reduce postoperative blood loss and transfusion requirements, although a benefit has not been demonstrated in large randomized controlled trials. Therefore, the routine use of desmopressin in uncomplicated cardiac operations is not recommended. This review article discusses the pharmacology of desmopressin as a haemostatic agent and evaluates available clinical evidence to determine current indications for desmopressin as a haemostatic agent in cardiac surgery.     

Reduced Relative Lymphocyte Count in African-Americans With Decompensated Heart Failure

BackgroundA reduction in relative lymphocyte count (%L) has been reported in whites with heart failure that inversely correlated with jugular venous pressure thereby implicating systemic venous hypertension with splanchnic congestion.ObjectivesTo study whether a reduced %L (<20%) occurs in African-Americans (AA) with heart failure and to address pathophysiologic mechanisms having the potential to influence lymphocyte biology and survival, we monitored patients with or without systemic venous hypertension, hypoalbuminemia, hypovitaminosis D, and secondary hyperparathyroidism.MethodsIn 131 AA (90 men; 53 ± 12 years): 113 were hospitalized, 50 with decompensated biventricular failure (DecompHF), 24 with acute left heart failure, and 39 with heart disease, but no heart failure (HDNHF); and 18 were outpatients with compensated heart failure. At the time of admission or outpatient visit, we monitored: white blood cell count and %L; and serum albumin, 25(OH)D, and parathyroid hormone (PTH).ResultsWhite blood cell count did not differ among the groups, whereas %L was reduced only in those with DecompHF (15 ± 1%; P < 0.05) versus 25 ± 2% with left heart failure, 29 ± 1% in HDNHF, and 28 ± 3% in compensated heart failure. Serum albumin was reduced in DecompHF (2.8 ± 0.1; P < 0.05), but not in any of the other groups. Reduced 25(OH)D (<30 ng/mL), in keeping with hypovitaminosis D, was found in all AA, whereas elevated serum PTH (>65 pg/mL) was found only in those with DecompHF (123 ± 22 pg/mL).ConclusionsA relative lymphocytopenia, together with hypoalbuminemia and elevated PTH, were found only in hospitalized AA with DecompHF. These findings implicate splanchnic congestion and the enteric loss of lymphocytes and albumin with an associated secondary hyperparathyroidism.     

A pilot study to modify the SF-36V physical functioning scale for use with veterans with spinal cord injury

OBJECTIVE: To develop a valid and reliable spinal cord injury (SCI) specific physical functioning (PF) scale for the Veterans Health Administration (VHA) version of the 36-Item Short-Form Health Survey. DESIGN: A mixed qualitative and quantitative research design was used. In phase 1, a pool of SCI-specific PF items was generated based on focus groups with patients and health care providers. In phase 2, the psychometric properties of the SCI-specific PF scale were established. SETTING: A VHA SCI center. PARTICIPANTS: The sample consisted of valid responses from 359 veterans with traumatic SCI who were seen at a VHA SCI center during the prior year (2002). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Physical functioning in people with SCI. RESULTS: Exploratory factor analysis was conducted separately on respondents with lower neurologic-level injuries (paraplegia, 53% [n=190]) and those with higher neurologic-level injuries (tetraplegia, 45% [n=163]) and identified 9 items loading on 1 factor in both groups. These 9 items were included in separate item response theory (IRT) model analyses for each subgroup. Based on the IRT analysis, 1 item was eliminated, resulting in an 8-item, SCI-specific PF scale. CONCLUSIONS: Although several of the items in the SCI-specific PF scale showed floor effects, particularly in people with tetraplegia, we found excellent reliability and strong support of convergent and divergent validity of the scale.     

Influence of single‐nucleotide polymorphisms in the IFNG towards susceptibility to tuberculosis in a Pakistani population

Tuberculosis (TB) is a global issue as one‐third of the population worldwide is considered to be infected. TB has become a critical public health problem as a result of increasing drug resistance, which poses a challenge to current control strategies. Similar to environmental factors, genetic makeup of the host equally contributes to disease onset. We performed genotypic analysis to examine the relationship between IFNG and TB onset and drug resistance in a Pakistani population comprising 689 subjects. Notable differences were observed in the IFNG polymorphism (+874T/A) between the case and control groups. The frequency of the wild‐type genotype (TT) in the controls (43.2%) was significantly higher than in the cases (25.3%) (odds ratio [OR] = 0.77, p < 0.0001), while the mutant genotype frequency (AA) (38.57%) in the cases was significantly higher than in the controls (22.6%) (OR = 1.46, p < 0.0001). The heterozygous genotype frequency (TA) did not significantly differ between the control and case groups. Compared with the controls, the variant allele (A) was approximately twice as frequent in the cases. Females and older people have a higher chance of disease development. Finally, the IFNG (+874T/A) polymorphism was not associated with drug sensitivity or resistance. However, a genotypic polymorphism of IFNG (+874T/A) was significantly associated with susceptibility to TB, and the T allele conferred protection against TB. Additional studies involving larger cohorts are needed to further explore this relationship between genetics and disease vulnerability.     

Injuries among Afghan refugees: review of evidence

BACKGROUND: Injuries are a public health problem in developing countries resulting in major financial and productivity losses. Injuries in vulnerable populations, such as refugees, make an even greater impact on loss of life. Afghan refugees in Pakistan continue to form one of the world's largest refugee populations. This study systemically reviews the literature to estimate the magnitude and prevalence of intentional and unintentional injuries in Afghan refugees, and explores the implications of the findings for refugee healthcare policy and development of potential interventions specifically for Afghan refugees. METHODS: Electronic databases of MEDLINE, POPLINE, Refworld, and Winspirs were searched. In addition, a web search was conducted and specific organizational websites were reviewed. The search in developing countries was limited to studies in English or with an English abstract for the years 1966-2001. RESULTS: The literature review identified patients with reported war injuries who presented to hospitals. Injuries to extremities (45%) were more frequent than injuries to the head or neck (36%, p < 0.001), and thorax/abdomen (14%, p < 0.001) regions. A majority of the injuries were caused by explosives, which included landmines (32.5%), fragmentations, such as shrapnel (33%), and firearms (27%). The mean incidence of mortality in these studies was 11%. CONCLUSIONS: Despite such an extensive search, limited information was found pertinent to injuries in Afghan refugees residing in refugee camps. This dearth of literature on the prevalence of injuries, risk factors, and outcomes among this vulnerable group is a research and policy gap for public health. Specific quantitive and qualitative studies in this field are required to shape refugee healthcare policies and develop intervention programs.     

Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review and GRADE assessments

Infantile haemangiomas are a type of birthmark. They are soft, raised swellings on the skin, often with a bright-red surface caused by a non-cancerous overgrowth of blood vessels in the skin. The majority of these lesions are uncomplicated and will shrink on their own by age seven; however, some require treatment if they occur in high-risk areas or cause psychological distress. This article summarises the major findings of a Cochrane Review, which aimed to assess the benefits and harms of treatments for haemangiomas of the skin in infants and children, collecting evidence up to February 2017. The review included 28 studies (1728 children), which assessed lasers, beta-blockers, steroids and radiation therapy, among other treatments. When compared with placebo treatment, propranolol taken by mouth at a dose of 3 mg/kg/day is probably more beneficial in terms of complete or almost-complete clearance of swelling and reduction in volume of the haemangioma (moderate-quality evidence). In addition, timolol maleate 0.5%-gel applied topically (to the skin) twice daily may reduce redness when assessed against placebo (low-quality evidence). Short- or long-term serious cardiovascular events were not reported in either group. Likewise, there was no evidence of a difference between propranolol taken by mouth (via a tablet once per day, at a 1.0 mg/kg/dose) and topical timolol maleate (0.5% eye drops applied twice daily) in terms of their effect on reducing haemangioma size by 50% or more (low-quality evidence). Oral propranolol is currently the standard treatment for this condition, and we did not find evidence to contest this treatment in terms of efficacy and safety. High-quality future research should assess the effects of propranolol and timolol maleate, as well as other alternative medications, on outcomes that are important to patients, including adverse-related events (unwanted side effects), parents’/children's opinions of improvement, and cosmetic appearance.