Clinical Relevance of Coronary Fractional Flow Reserve: Art-of-state

Objective:

The objective was to delineate the current knowledge of fractional flow reserve (FFR) in terms of definition, features, clinical applications, and pitfalls of measurement of FFR.

Data Sources:

We searched database for primary studies published in English. The database of National Library of Medicine (NLM), MEDLINE, and PubMed up to July 2014 was used to conduct a search using the keyword term “FFR”.

Study Selection:

The articles about the definition, features, clinical application, and pitfalls of measurement of FFR were identified, retrieved, and reviewed.

Results:

Coronary pressure-derived FFR rapidly assesses the hemodynamic significance of individual coronary artery lesions and can readily be performed in the catheterization laboratory. The use of FFR has been shown to effectively guide coronary revascularization procedures leading to improved patient outcomes.

Conclusions:

FFR is a valuable tool to determine the functional significance of coronary stenosis. It combines physiological and anatomical information, and can be followed immediately by percutaneous coronary intervention (PCI) if necessary. The technique of FFR measurement can be performed easily, rapidly, and safely in the catheterization laboratory. By systematic use of FFR in dubious stenosis and multi-vessel disease, PCI can be made an even more effective and better treatment than it is currently. The current clinical evidence for FFR should encourage cardiologists to use this tool in the catheterization laboratory.     

Role of tocilizumab for concomitant systemic fungal infection in severe COVID-19 patient: Case report

Rationale:Bacterial and fungal infections in Coronavirus Disease-19 (COVID-19) patients have been inadequately investigated and reported thus far. The safety profile of tocilizumab (TCZ) administration in candidemia patient still debatable.Patient concerns:A 54 year-old woman presenting with weakness on the left side of her body was diagnosed with COVID-19. After 7 days of admission, her condition worsened and developed respiratory distress and was having respiratory distress despite standard treatment.Diagnoses:Acute respiratory distress syndrome (ARDS) in COVID 19 was diagnoses based on real time-PCR swab, deterioration of PaO₂/FiO₂ and increased of acute phase reactants.Interventions:Anti Interleukin–6 (IL-6) was considered to tackle her inflammatory condition. Prior to TCZ administration, blood culture was performed and the result came with Candida tropicalis in the absence of bacterial growth.Outcomes:No major complications associated with intravenous antifungal or TCZ occurred. After 40 days of hospitalization, the patient''s clinical condition improved and was finally discharged.Lessons:This case underscores the safety profile of giving TCZ in candidemia as a secondary infection in severe COVID-19 patient.     

Dietary phosphatidylcholine alleviates fatty liver induced by orotic acid

OBJECTIVE: We compared the effect of dietary phosphatidylcholine (PC) with that of triacylglycerol (TG), both with the same fatty acid profiles, on fatty infiltration in orotic acid (OA)-induced fatty liver of Sprague-Dawley rats. METHODS: Rats were fed an OA-supplemented diets containing TG (TG+OA group) or PC (20% of dietary lipid, PC+OA group) for 10 d. Rats fed the TG diet without OA supplementation served as the basal group. RESULTS: Administering OA significantly increased the weights and TG accumulation in livers of the TG+OA group compared with the basal group. These changes were attributed to significant increases in the activities of fatty acid synthase, malic enzyme, and glucose-6-phosphate dehydrogenase, which are fatty acid synthetic enzymes, and phosphatidate phosphohydrolase, a rate-limiting enzyme of TG synthesis. However, the PC+OA group did not show TG accumulation and OA-induced increases of these enzyme activities. Further, a significant increase in the activity of carnitine palmitoyl transferase, a rate-limiting enzyme of fatty acid beta-oxidation, was found in the PC+OA group. CONCLUSIONS: Dietary PC appears to alleviate the OA-induced hepatic steatosis and hepatomegaly, mainly through the attenuation of hepatic TG synthesis and enhancement of fatty acid beta-oxidation in Sprague-Dawley rats.     

Indigenous round houses versus 'healthy houses': Health, place and identity among the Dawan of West Timor, Indonesia

Qualitative research was undertaken among Dawan people living in Fatumnasi, West Timor, to investigate the reasons for the Dawan's retention of traditional houses, ume kbubu, in the face of a national development campaign to introduce modern, "healthy" homes (rumah sehat). Indoor smoke pollution from internal fires and poor ventilation is believed to contribute to poor respiratory health among this population. The study explored Dawan cultural constructions of health to find that ume kbubu are fundamental to the Dawan's sense of psychosocial well-being and ethnic identity. While rumah sehat are associated with prosperity, public image and social status they do not provide the warmth, security and emotional nurturance that the Dawan perceive as necessary for optimum health and to protect them from disease.     

Determination of discretionary salt intake in an iodine deficient area of East Java-Indonesia using three different methods

As salt is a potential vehicle for delivering iodine to a population, study on salt intake is important. Many methods have been used to measure iodised-salt intake, but the methods were suspected to be inaccurate. A new method, called a lithium-marker technique, has been considered as suitable and safe; hence it has been proposed as a gold standard for measuring the actual salt intake of an individual. We conducted a study to determine discretionary salt intake using the lithium marker technique. The study shows that the total salt intake for children (N = 15) and mothers (N = 15) were 5.4+/-2.1 g/d and 5.8+/-1.7 g/d respectively in which 48.5+/-17.1% and 50.5?17.3% were discretionary salt. The discretionary salt intake measured using lithium marker (2.53 +/- 1.2 g/d for children and 2.99 +/- 1.5 g/d for mother) were significantly lower than using 24-hour salt recall (7.01+/-2.44 g/cap/d) and salt weighing (6.00+/-1.8 g/cap/d) (p<0.001). In conclusion, the discretionary salt intake by 24-hour salt recall and salt weighing were over estimated as compared to the lithium-labelled salt measurement. It is recommended that the level of iodine fortification in salt be increased up to 80-100 ppm of KIO3 to provide iodine intake of 150 microg/d.     

Pathophysiology of critical ill patients: focus on critical oxygen delivery

Critical ill patients experience acute physiological changes because the body cannot fulfill the oxygen demand to perform normal aerobic metabolism. Factors determining oxygen delivery include cardiac output, hemoglobin, and oxygen saturation. Incapability to fulfill adequate oxygen of the body to produce adenosine triphosphate (ATP) may occur due to decreased oxygen delivery and/or increased oxygen consumption. A condition in which oxygen consumption becomes very dependent on oxygen delivery is called critical oxygen delivery. Parameters to evaluate the adequate oxygen delivery to meet the oxygen consumption are central vein oxygen saturation (SvO2), serum lactate, oxygen extraction ratio (O2ER). A comprehension about oxygen delivery and consumption is very important to overcome tissue hypoxia and various factors in critical ill patients.     

The effect of 50% glycolic acid on the percutaneous absorption of eutectic mixture of local anesthetics (EMLA): a study of the electrofulguration-induced pain

Background EMLA has a slow onset due to its limited percutaneous absorption into an intact skin, while Glycolic acid (GA) has been known to have the capability of disrupting the skin barrier function. To the best of our knowledge, the effect of 50% GA on the percutaneous absorption of EMLA has not been studied previously. Methods The study used a two‐step randomized double blind controlled trial involving 20 healthy subjects each. The first step compared the pain intensity upon applying GA and placebo for 4 minutes prior to EMLA occlusive application over time. Based on findings made in the first step, second step observation focused on the effect of occlusion on EMLA percutaneous absorption after GA application in minute 30 and 45. A second of 20 mA electrofulguration induced the pain, while modified Verbal Rating Scale (VRS) measured the pain intensity. Results Significant VRS difference (P < 0.05) between GA and placebo group was found in minute 15, 20, 30 and 45. However, no significant VRS difference was found after minute 60 (P = 0.420). Adequate cutaneous analgesia was achieved in minute 30 in the treatment (GA) group and in minute 45 in the placebo. There was no significant VRS difference between the occlusive and non‐occlusive group in minute 30 (P = 0.214) and minute 45 (P = 0.309). Conclusion Administering 50% GA prior to EMLA application enhances percutaneous absorption of EMLA, which accelerates the onset of adequate cutaneous analgesia, even without using an occlusive dressing.     

Bacterial Profile and Antimicrobial Susceptibility Pattern of Isolates Among Burn Patients at Yekatit 12 Hospital Burn Center,Addis Ababa,Ethiopia

Background

Infection is a common cause of morbidity and mortality in burn patients. Clinical diagnosis of bacteremia and/or sepsis in burn patients is difficult for a number of reasons. It could be symptomatic and/or asymptomatic as a result of immune deficiency secondary to thermal injury.

Methods

A cross sectional study was conducted at Yekatit 12 Hospital Burn Center. Blood specimen and wound swab were collected from burn patients and were cultured by conventional method. Sensitivity/susceptibility pattern of the isolates was determined by disc diffusion method. Some of the risk factors of bacteremia like prior antibiotic use and total body surface area burn were also determined.

Results

Fifty patients were enrolled in the study of whom 21(42%) were found bacteremic. Five different bacteria were isolated from blood specimen. Coagulase negative Staphylococci, 9(42.8%), S. aureus, 8(38.2%), Bacillus spps, 2(9.52%), K. pneumoniae, 1(4.8%), and P. aeruginosa, 1(4.8%), were frequent isolates. From wound swab, S. aureus, (34.04%), and P. aeruginosa, (31.8%), were predominant. Antimicrobial resistance was observed for Ampicillin, (77.4%), Doxycycline, (74.0), Nalidixic acid, (70.5%), Penicillin G, (68.2%), and tetracycline, (67.5%). Total body surface area of burn ≥ 15% was found as a risk factor for bacteremia.

Conclusion

Bacteremia was detected at a rate of 42% among burn patients. Frequent isolates were S. aureus, (34.04%), and P. aeruginosa, (31.8%). About 82.16% of the isolates showed multiple resistances. In light of our findings, regular antibiotic resistance test has to be done for each patient in order to select an appropriate antimicrobial agent.