1194 research outputs found
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Prevalence of conventional cardiovascular risk factors in patients with acute coronary syndrome
Get PDFBackground: Primary prevention studies have shown that early detection and aggressive treatment of cardiovascular risk factors (CRF) prevent cardiovascular events. It is not well described the prevalence of CRF in patients, at the moment of admission due to acute coronary syndrome (ACS).
Aim: To determine the prevalence of CRF among patients admitted with ACS.
Methods: We analysed 4871 patients admitted consecutively in our coronary care unit with a diagnosis of ACS and included in a prospective registry, from January 2002 to October 2013. We studied the prevalence of conventional risk factors (diabetes, hypertension, smoking, dyslipidaemia) and compared findings according to gender and type of ACS: ACS with ST elevation (STEMI), ACS without ST elevation (NSTEMI).
Results: Men represented 75% (n=3658) of the total population, were younger than women (61.6±12,9 vs 70.9 ±11.8 years; p<0.001) and had more frequently body mass index ≥ 25 kg/m2 (70.9% vs 62.3%; p<0.001). The most frequent CRF was hypertension (62.4%; n=3038), followed by dyslipidaemia (50.6%, n=2467), smoking (43.2%; n=2106) and diabetes (27.2%; n=1324). In women, the more common CRF were hypertension (75%) and dyslipidaemia (51.2%), whereas in men were smoking (54.4%) and dyslipidaemia (50.5%). We identify, at least, one CRF in 92,4% of all patients and two or three risk factors in 58.1%. Women had more frequently 2 CRF than men (40.1% vs 36.3%; p=0.011), although mean had, more often, 4 CRF (8.9% vs 4.1%; p<0.001). Previous history of cerebrovascular disease was more observed in women (8.6% vs 6.1%; p=0.002), but men had more often history of previous revascularization (9.8% vs 6.8%; p<0.001). On admission men presented more frequently STEMI (50.8% vs 43.5%; p<0,001) and less frequently renal dysfunction (17.2% vs 39.6%; p<0.001) and anaemia (18.8% vs 33.3%; p<0.001). Hypertension was the most prevalent CFR as in patients STEMI (56.6%) as in NSTEMI patients (67.9%), followed by smoking (47.5%) in STEMI patients and by dyslipidaemia (55.7%) in NSTEMI patients.
Conclusion: We found at least one CRF in 92.8% of patients and two or three in more than half. Hypertension emerged as the major CRF in both forms of presentation of ACS
Extensive Subcutaneous Emphysema as a Presentation of Ischemic Colitis
Get PDFIntroduction. Subcutaneous emphysema is usually benign and self-limited; however, it may be associated with a life-threating situation. Case Report. An elderly woman with progressive malaise with extensive subcutaneous emphysema (cervical to abdominal wall) was observed at the emergency department. Colonic perforation was diagnosed and the patient underwent surgery. Intraoperatively, necrosis and perforation of the sigmoid colon into the retroperitoneum were found and a Hartmann procedure was performed. Conclusion. Cervical and thoracic subcutaneous emphysema may be the first sign of intra-abdominal lesion
Effector memory CD4(+) T cells are associated with cognitive performance in a senior population
Get PDFOBJECTIVE:
Immunosenescence and cognitive decline are common markers of the aging process. Taking into consideration the heterogeneity observed in aging processes and the recently described link between lymphocytes and cognition, we herein explored the possibility of an association between alterations in lymphocytic populations and cognitive performance.
METHODS:
In a cohort of cognitively healthy adults (n = 114), previously characterized by diverse neurocognitive/psychological performance patterns, detailed peripheral blood immunophenotyping of both the innate and adaptive immune systems was performed by flow cytometry.
RESULTS:
Better cognitive performance was associated with lower numbers of effector memory CD4(+) T cells and higher numbers of naive CD8(+) T cells and B cells. Furthermore, effector memory CD4(+) T cells were found to be predictors of general and executive function and memory, even when factors known to influence cognitive performance in older individuals (e.g., age, sex, education, and mood) were taken into account.
CONCLUSIONS:
This is the first study in humans associating specific phenotypes of the immune system with distinct cognitive performance in healthy aging
Giant congenital melanocytic nevi and neurocutaneous melanosis
Get PDFIntroduction. The major medical concern with giant congenital melanocytic nevi CMN is high risk of developing cutaneous melanoma, leptomeningeal melanoma, and neurocutaneous melanocytosis. Case Report. A 30-year-old woman with a giant congenital melanocytic nevus covering nearly the entire right thoracodorsal region and multiple disseminated melanocytic nevi presented with neurological symptoms. Cerebral magnetic resonance imaging revealed a large expansive lesion in the left frontal region. Postsurgically pathological diagnosis revealed characteristics of melanoma. Immunohistochemical examination showed S100(+), HMB45(+), MelanA(+), and MiTF(+). She received radiotherapy with temozolomide followed by two more chemotherapy cycles with temozolomide. She followed a rapidly progressive course, reflecting widespread leptomeningeal infiltration, and she died of multiorgan failure seven months after diagnosis of cerebral melanoma. Discussion. This patient was diagnosed as having a neurocutaneous melanosis with malignant widespread leptomeningeal infiltration. Diffuse spinal involvement is unusual and is described in only another patient
Primary malignant mixed Müllerian tumour of the fallopian tube: a rare and difficult but possible diagnosis.
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Biventricular Takotsubo vs Myocarditis – a diagnostic challenge
Get PDFBackground: Takotsubo cardiomyopathy (TCM) is an important differential diagnosis of acute coronary syndrome and myocarditis. It is characterized by normal or near-normal coronary arteries and regional wall motion abnormalities that extend beyond a single coronary vascular bed. Variants of the classical left ventricular (LV) apical ballooning are increasing in recognition as cardiac magnetic resonance (CMR) is more extensively used.
Case report: We present a case of 69-year-old woman with a previous history of hypertension, diabetes and dyslipidaemia, transferred to our emergency department due to suspected acute coronary syndrome. She had a history of two episodes of an oppressive chest pain longer than 1 hour, orthopnoea and paroxysmal nocturnal dyspnoea 36 hours before. Two weeks before she had had a lower tract respiratory infection, that was not totally resolved. On admission, she only had dyspnoea. On examination, she had wheezing, arrhythmic pulse and hypertension. Breath sounds were absent in lower chest and rales were also noted. Electrocardiogram showed rapid atrial fibrillation, poor R wave progression in anteroseptal leads and inverted T waves in I, aVL and V2-V6 leads. Modest elevation in cardiac troponin (4.55 ng/mL) was observed. Chest x-ray showed bilateral pleural effusion. A transthoracic echocardiography (TTE) was immediately performed and revealed akinesis/dyskinesis of mid to apical segments (apical ballooning) of both ventricles, extended beyond a single epicardial coronary distribution, compatible with biventricular TCM. Cardiac catheterization showed absence of obstructive coronary disease. A CMR, performed two days later, showed moderate biventricular systolic dysfunction, hypokinesis in mid to apical segments of LV and hypokinesis in apical right ventricle. It also showed non-ischemic late gadolinium enhancement in antero-apical and lateral apical segments. After several days of medical management, the patient was discharged from the hospital in stable condition. TTE performed 6-month after evidenced complete biventricular function recovery and no segmental contractility changes. CMR supported the functional recovery and the resolution of contractility abnormalities, but noticed the intramyocardial late gadolinium enhancement in the segments previously reported.
Conclusion: There are fewer reports of this unusual presentation of TCM, described by ETT. This case represents a good example of the diagnostic challenge between myocarditis and takotsubo cardiomyopathy. Taking in account the exuberance of the case, the mild elevation of troponin, the full recovery of biventricular function and resolution of contractility abnormalities, it seems more probably to be a TCM, in a patient who, probably had a previous scar of myocarditis. Although, the hypothesis of acute myocarditis as the primary diagnosis cannot be excluded
