Hospital Chronicles (E-Journal)
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Pyogenic Granuloma on Facial Skin Associated With Long-Term Topical Application of Tacrolimus: Pyogenic granuloma ans tacrolimus
Full text linkPyogenic granuloma (PG) is a benign vascular neoplasm of the skin and mucous membranes, the exact cause and pathogenesis of which still remain unknown. PG typically occurs in the form of solitary and rarely multiple, rapidly developing, glistering, hemorrhagic and ulceration-prone, pink or purple, angiomatous papule or nodule. Proposed stimuli for the occurrence of PG include minor trauma and chronic irritation, infections, viral oncogenes, pregnancy, microscopic arteriovenous anastomoses and diverse drugs. Tacrolimus is a macrolide, produced by the Streptomyces Ttsukubaensis, which exerts potent immunosuppressive action through inhibition of calcineurin. Topically applied tacrolimus has been approved for the treatment of patients with moderate to severe atopic dermatitis unresponsive or intolerant to conventional regimens, but it has also been used as an off-label treatment for various cutaneous diseases. We report a 35-year-old man who developed PG on his face after a long-term topical application of tacrolimus ointment for the treatment of seborrheic dermatitis. The patient didn’t recall any trauma or other chronic irritation at the site of his recently emerging solitary lesion, whereas other predisposing factors for PG were excluded. To the best of our knowledge the case presented here is the first report of this adverse reaction. PG should be considered as a possible side-effect of topical application of tacrolimus and dermatologists should be able to diagnose and properly treat it
Combined Transaortic Valve Implantation and off-pump Coronary Artery Bypass Graft surgery in a patient with aortic stenosis, left main disease and «porcelain» aorta: Transaortic Valve Implantation and CABG in a patient with severe aortic stenosis
Full text linkConventional aortic valve replacement in patients with porcelain aorta can be technically challenging and is even sometimes seen as contraindication. Trans-aortic valve implantation has been proposed as an alternative to other trancutaneous routes of implantation and is feasible when there is a small healthy area in the right anterolateral aspect of the ascending aorta. Herein we report an interesting case of combined transaortic valve implantation and off-pump coronary artery bypass grafting in a patient with severe aortic stenosis, severe ostial left main coronary artery disease and porcelain aorta
Red Blood Cell Unit Utilization in the ICU: Evidence and Confidence
Full text linkAnemia is an almost universal phenomenon (ninety five percent) among critically ill patients, especially if they stay in the ICU more than 3 days. Forty to fifty percent of such patients receive red blood cell transfusions. Blood loss (due to blood sampling), iron reduced availability and utilization and cytokine mediated bone marrow suppression account for this loss of red blood cell mass. Anemia is itself associated with worse outcomes, independently of the nature of underlying disease. Transfusion therapy nevertheless, probably is not the ideal solution as it is related to increased mortality and hospital infections. Both the degree of anemia and transfusion intensity could represent either causative influences or merely surrogate markers of severe illness, posing significant difficulties on the interpretation of investigational results. Currently, restriction of red blood cell transfusion threshold to 7g/l has become the standard practice. Following the famous TRICC trial which introduced the low threshold concept, the few predicted exceptions regarding sepsis, hemorrhage or cardiac disease were addressed with new studies. The results of these studies force towards the implementation of the restrictive strategy throughout the whole transfusion indications spectrum in the ICU, with the exception of the symptomatic coronary patients. In order to minimize transfusion intensity however, acute context care must be optimum, multidisciplinary treatment approaches and support being timely provided. 
Physiotherapy in a Burn Patient Admitted in Intensive Care Unit
Full text linkBackgroundEarly physiotherapy in critical ill patients is a key component to their functional recovery. Burn patients are presented with severe complications that lead to reduced functional ability.ObjectiveThe aim of this paper is to present the case of a 22 year old male patient with a 45% burn of total body surface area, who was admitted in the Intensive Care Unit.MethodsEarly physiotherapy commenced from the early stages of acute illness and involved respiratory and musculoskeletal interventions in order to prevent and address complications from prolonged immobilization and mechanical ventilation. ResultsPatient through his stay in the ICU presented significant clinical improvements. He was successfully liberated from mechanical ventilation and decannulated from tracheostomy tube. Improvements in muscle strength and functional ability was noted once discharged from the ICU to a High Dependence Unit.ConclusionIn the current case study physiotherapy was a vital and effective component of the therapeutic plan of severe burn patient being admitted in a acute care facility and positioning of the upper and lower limbs is of huge importance, in order to minimize and avoid contractures
Diabetes News / Recent Literature Review / Forth Quarter 2019
Full text linkAssociation of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity
In this observational retrospective study, 2287 patients with obesity (BMI≥30 ) and type 2 diabetes who underwent metabolic surgery within the Cleveland Clinic Health System, were matched 1:5 to nonsurgical patients with diabetes and obesity.
The primary end point was the incident of extended major adverse cardiovascular events (MACE, composite of 6 outcomes), defined a first all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy and atrial fibrillation. Secondary outcome included 3-component MACE (myocardial infarction, ischemic stroke and mortality). The median follow-up duration was 3.9 years. At the end of the study period, 385 (30.8%) patients in the surgical group and 3243 (44.7%) patients in the nonsurgical group experienced a primary end point (hazard ratio, HR 0.61, 95% CI, 0.55 – 0.69). All secondary putcomes showed significantly differences in favor of metabolic surgery. All-cause mortality occurred in 112 patients in the metabolic surgery group and 1111 patients in the nonsurgical group (HR = 0.59, 95%CI, 0.48- 0.72). Metabolic surgery was also associated with a significant reduction of HbA1c (mean difference between groups1.1%), and use of noninsulin diabetes medication, insulin antihypertensive medications and lipid0lower therapies. In the 90 days after metabolic surgery, complications included bleeding requiring transfusion (n=68, 3.0 %), pulmonary adverse events (n=58, 2.5%), venous thromboembolism (n=4, 0.2%), cardiac events (n=17, 0.7%), and renal failure requiring dialysis (n=4, 0.2%) (Aminlan A et al, JAMA 2019;322:1271-1282)
Human disease on stage
Full text linkTheater, being in most cases a representation of real life, can refer to anyone of its aspects, including disease. Human disease is a specific condition associated with several effects in the behavior of both, the patient and his environment, as well as their interrelationship. Several play writers, even from the ancient years, have tried to present these effects. Furthermore, another topic for the theater can be the way Medicine is practiced, usually with a critical approach.
Of course play writers have not in general studied Medicine and so their references to disease may not be always absolutely right, especially if they represent aspects of past time. Furthermore, if we refer to poetic or symbolic drama it may express unrealistic situations only to serve the main idea of the author