Clinical Impact of High-Sensitivity Cardiac Troponin T Implementation in the Community

BackgroundLimited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation.ObjectivesThis study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation.MethodsObservational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation March 12, 2018, to September 11, 2018) to 5th generation (Gen) cTnT (post-implementation September 12, 2018, to March 11, 2019). Diagnoses were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay, hospitalizations, and cardiac testing.ResultsIn this study, 3,536 unique patients were evaluated, including 2,069 and 2,491 ED encounters pre- and post-implementation. Compared with 4th Gen cTnT, encounters with ≥1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%; p < 0.0001). Acute MI (3.3% vs. 8.1%; p < 0.0001) and myocardial injury (11% vs. 38%; p < 0.0001) increased. Although type 1 MIs increased (1.7% vs. 2.9%; p = 0.0097), the overall MI increase was largely due to more type 2 MIs (1.6% vs. 5.2%; p < 0.0001). Women were less likely than men to have MI using 4th Gen cTnT (2.3% vs. 4.4%; p = 0.008) but not 5th Gen cTnT (7.7% vs. 8.5%; p = 0.46). Overall length of stay and stress testing were reduced, and angiography was increased (all p < 0.05). Among those without cTnT increases, there were more ED discharges and a reduction in length of stay, echocardiography, and stress tests (all p < 0.05).ConclusionsHigh-sensitivity cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.     

Melatonin and serotonin profiles in beans of Coffea species

A high-performance liquid chromatography (HPLC) and an electrospray ionization mass spectrometry (LC/ESI-MS) methods were applied to quantify the profiles of melatonin and serotonin (5-HT) in green and roasted beans of Coffea canephora (robusta) and Coffea arabica (arabica). Both melatonin and 5-HT were detected in green coffee beans (5.8±0.8μg/g dry weight (DW), 10.5±0.6μg/g DW) and also in roasted beans of C. canephora (8.0±0.9μg/g DW, 7.3±0.5μg/g DW). Melatonin (3.0±0.6μg/50mL) and 5-HT (4.0±0.7μg/50mL) were detected in coffee brew. In C. arabica, 5-HT was high in green beans (12.5±0.8μg/g DW) compared with roasted beans (8.7±0.4). The levels of melatonin were higher (9.6±0.8μg/g DW) in roasted beans compared with green beans (6.8±0.4μg/g DW). Both melatonin (3.9±0.2μg/50mL) and 5-HT (7.3±0.6μg/50mL) were detected in coffee brew. Because of the relevance of indoleamines as bioactive molecules with implications for food, nutritional sciences and human health, it was of interest to explore their levels in coffee, an important universal beverage.     

CHOLECYSTECTOMY : FUNDUS TO PORTA APPROACH

Cholecystectomy is a commonly performed operation but there is still controversy whether dissection of the gall bladder should proceed from the fundus to the cystic duct or in the opposite direction. In usual practice the fundus-first method is adopted whenever difficulty is encountered in visualizing the anatomy of the cystic duct and Calot''s triangle. Although haemorrhage is a little greater than with the duct-first method the risk of damage to the common bile duct or right hepatic artery is minimized. This article describes a brief experience with thirty randomized patients in whom cholecystectomies were performed with planned fundus-first approach.KEY WORDS: Cholecystectomy, Surgical technique, Bile duct obstruction     

Stab wounds to the neck: role of angiography

Angiographic findings in 61 stab wounds to the neck were correlated with specific clinical findings. Eighteen of the stab wounds were associated with one or more major physical findings that included (a) pulse deficit, (b) active bleeding or expanding hematoma, (c) bruit or murmur, (d) neurologic deficit, or (e) hypotension. Of these 18 wounds, only two involved significant vascular injuries. The other 43 stab wounds were associated with minor physical findings, with the only indications for angiography being nonexpanding hematoma or proximity of trauma to major vessels. None of these 43 wounds involved significant vascular injury.