Hospital Chronicles (E-Journal)
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Functional Assessment Scales in a General Intensive Care Unit
Get PDFThe aims of this study were to describe the functional assessment scales for intensive care unit patients, to examine the psychometric evidence for reliability and validity and to summarize the strengths and the weaknesses of them. Several instruments have been used so far for the assessment of functional ability, impairment and/or disability in ICU patients, but all of them have specific limitations. These measurement tools include: Barthel Index, Functional Independence Measure, Functional Status Score for the ICU, Physical Function ICU Test Modified Rankin Scale, Karnofsky Scale Index, 4P questionnaire, Glasgow Outcome Scale, and Disability Rating Scale. The choice of the most appropriate assessment tool will depend on the specific patient population, its diagnosis and rehabilitation phase and the psychological properties of the available measurement. Future studies should examine additional types of reliability and validity with more sophisticated statistical analyses and to assess whether the tool is used for research and/or for clinical purposes
Invasive Aspergillosis as the Presenting Manifestation of Small-Cell Carcinoma
Get PDFInvasive aspergillosisusually occurs in immunocompromised patients, particularly in patients with hematological malignancies because of severe and prolonged neutropenia and/orcytotoxic therapy. Therapy requires antifungal chemotherapy, with lipid-formulations of Amphotericin B or with azoles together with wide surgical excision of the fungal lesion. We report a case of invasive sino-orbital aspergillosis due to Aspergillus fumigatus in a patient with uncontrolled diabetes mellitus and small cell carcinoma. We support the notion that dual immunosuppression due to diabetes and small cell carcinoma with liver metastases was responsible for the invasive form of aspergillosis in this patient
Acute Aortic Syndromes: Surgical, Endovascular or Medical Treatment
Get PDFThe term acute aortic syndrome (AAS) refers to a heterogeneous group of conditions that cause a common set of signs and symptoms, the foremost of which is aortic pain. Various pathological entities may give rise to this syndrome, but the topic has come to focus on penetrating aortic ulcer and intramural hematoma and their relation to aortic dissection. Penetrating aortic ulcer is a focal atherosclerotic plaque that corrodes a variable depth through the intima into the media. Intramural hematoma is a blood collection within the aortic wall not freely communicating with the aortic lumen, with restricted flow. It may represent a subcategory of aortic dissection that manifests different behavior by virtue of limited flow in the false lumen. The initial management of all patients with AAS involves pain relief and aggressive blood pressure control. Subsequent surgical, endovascular or medical treatment depends on the type of AAS and associated procedural risk. An overview of AAS conditions, their pathophysiology and management is herein attempted
Transcatheter Aortic Valve Implantation in Severe Left Ventricular Dysfunction: A Viable Option in a Patient With Low-Flow, Low-Gradient Critical Aortic Stenosis
Get PDFImages are provided from a successful procedure of transcatheter aortic valve implantation (TAVI) in an elderly patient with symptomatic low-flow, low-gradient critical aortic stenosis, and associated severe left ventricular dysfunction, who had a very high-risk for surgery
Transesophageal Overdrive Pacing: A Simple and Versatile Tool
Get PDFIn the present case, a patient with atrial flutter failed drug conversion with use of intravenous amiodarone and before resorting to electrical cardioversion, transesophageal atrial overdrive pacing was proposed and performed as a bedside procedure with successful conversion of atrial flutter into sinus rhyth
Contact and Noncontact Mapping Systems in the Electrophysiology Laboratory
Get PDFThe most important step for the operator to perform a successful radiofrequency ablation procedure for the treatment of cardiac tachyarrhythmias is to accurately identify the origin of and localize the arrhythmia focus and to determine the sequence of electrical activity. Intracardiac mapping techniques came a long distance from single catheter recordings to three dimensional voltage and morphology reconstructing systems. The aim of this review is to summarize the benefits and disadvantages of the existing cardiac mapping systems
Dyslipidemia: Treatment in Statin – Intolerant Patients
Get PDFStatins are the mainstay of lipid-lowering therapy because of their well-established efficacy for reducing cardiovascular disease mortality and morbidity in various high risk populations. However, certain patients cannot avail themselves of these beneficial effects due to intolerance in these agents. Statin-induced myopathy is by far the most common side-effect. A less common side-effect of statin therapy is hepatic toxicity. Intolerance to statins is frequently encountered in clinical practice, mostly due to muscular symptoms and/or elevation of hepatic aminotransferases, which overall constitutes approximately two-thirds of reported adverse events during statin therapy. The first step in handling intolerant patients is to rule out any secondary causes of myopathy or liver toxicity. The second step is to determine whether the adverse effects are indeed related to statin therapy by statin dechallenge and rechallenge. Another option is to restart with the same statin at a lower dosage or to switch to another statin with defferent pathways of metabolism. If the symptoms are recurrent, different approaches should be considered, such as unconventional dosing (every other-day or weekly administration) of statins with longer half-life. Another option in patients who cannot tolerate statins is the use of non-lipid lowering drugs, such as ezetimibe, bile acids sequestrants (colesevelam) and fibrates, alone or in combination. Concerning low-risk individuals the use of herbal supplements effective in reducing LDL cholesterol may be considered
Secondary Antiphospholipid Syndrome with Recurring Acute Coronary Events
Get PDFA 41-year-old gentleman with a recent history of Hodgkin’s lymphoma sustained an acute inferior wall myocardial infarction, managed with percutaneous coronary intervention, thromboaspiration and stenting in a totally occluded right coronary artery. He was placed on triple antithrombotic treatment with dual antiplatelet therapy and oral anticoagulation because of a large thrombotic load in the right coronary artery. Three months later and 5 days after discontinuation of prescribed oral anticoagulant, he had a new acute coronary event due to acute reocclusion in the right coronary artery. Thrombus aspiration and repeat angioplasty restored vessel patency. The patient was put back on triple antithrombotic therapy and was investigated for uncommon causes of blood hypercoagulability. Blood assays revealed elevated anti-β2 glycoprotein I (anti-β2GPI) (IgM) and anticardiolipin antibodies (IgM), consistent with a diagnosis of secondary antiphospholipid syndrome
Coronary “Collateralization†or “De-collateralization†by Percutaneous Coronary Intervention in the Collateral Flow Supplying or Receiving Vessel
Get PDFImages of coronary angiography are being presented of two patients undergoing percutaneous coronary intervention (PCI). In the first patient with chronic total vessel occlusion, who also had a significant stenosis of the contralateral artery, there were no visible collaterals, which became fully functional and visible right after the successful PCI of the contralateral lesion (collateralization by PCI). In the second patient with acute myocardial infarction undergoing primary PCI of a total vessel occlusion, there was good collateral supply (provided by the contralateral vessel), which vanished upon restoration of anterograde flow to the totally occluded artery (de-collateralization by PCI)
Effectiveness of Early Mobilization in Hospitalized Patients with Deep Venous Thrombosis
Get PDFDeep venous thrombosis (DVT) is a common problem among hospitalized patients. It places the patient at risk for pulmonary embolism (PE), recurrent thrombosis, and post-thrombotic syndrome (PTS). In particular, up to 50% of patients with proximal DVT of the lower extremity develop PE. Because of the high mortality rate, there is a great concern from physiotherapists and physicians regarding patient’s treatment in the hospital setting. Thus, the purpose of the present review is to examine the effectiveness of early mobilization on acute leg DVT of lower extremity in hospitalized patients. Current evidence showed that early mobilization, i.e., walking and/or exercising, with anticoagulation and leg compression may be encouraged in patients with acute DVT. Recent studies reported the benefits of reduction in pain and edema, with improvement in quality of life when using the therapeutic strategy of early mobilization in patients with DVT. Early mobilization does not appear to increase the risk of developing PE, progression of an existing DVT, or developing a new DVT. Further research with larger hospitalized patient samples is required to determine the appropriate time in which ambulation should initiate after DVT, and whether exercise (regular or vigorous) or not exercise is more effective for DVT, PE, and PTS