Hospital Chronicles (E-Journal)
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Patient operated for an intraparenchymal brain tumor with serious lower limb weakness. The role of in-hospital physiotherapy
Full text linkThe aim of this case study is to present the role of hospital physiotherapy in a patient who was operated for an intraparenchymal brain tumor, from admission to intensive care unit until his discharge from hospital. Following acute surgical management, physiotherapy commenced and was devided in four phases:  1) Patient in ICU under mechanical support, 2) Patient in ICU without mechanical support, 3) Patient in step down unit, 4) Patient on the neurosurgical ward. During all phases of patient management, physiotherapy focused on daily assessment of respiratory and musculoskeletal function as well as the prevention and management of acute complications in intensive care unit and acquired physical impairments. Interventions included state of the art chest physiotherapy techniques as well as an early rehabilitation regimen from ICU to the step down unit and the ward. Significant improvements were noted before the patient was discharged, in respiratory function, muscle power and mobility. Planning and application of all physiotherapy techniques was in accordance to the most recent research evidence and clinical guidelines and contributed significantly to the patient’s overall clinical outcome
Could Immunophenotype Guide Molecular Analysis in Patients with Myeloid Malignancies?
Full text linkObjective: Immunophenotype has been correlated with molecular aberrations in several studies. The aim of this study was the discovery of immunophenotypic features related to mutations in AML and MDS patients connected to prognostic factors. Moreover, an effort to evaluate a method for the detection of the most common NPM1 mutations of exon12 and Internal Tandem Duplications (ITD) mutations of FLT3 gene by flow cytometry was performed. Method: Patients with de novo myeloid neoplasms [ AML and MDS (AML-M3 patients were excluded)] were included. FLT3/ITD/TKD and NPM1 mutations were detected by PCR and fragment analysis. The immunophenotypic analysis was performed by multi-dimensional flow cytometry (FC) with a standardized panel of monoclonal antibodies on peripheral blood or bone marrow samples. Nucleophosmin Antibody and CD135 were used for the mutations immunophenotypic detection. Results: NPM1 and/or FLT3 mutations correlated with low or no expression of more immature cells markers such as CD34, CD117, HLADR, as well as higher expression of more mature markers such as CD11b. The higher expression of CD33 should be mentioned as well. The presence of NPM1mut and FLT3/ITD does not seem to be detectable by FC at least using these two monoclonal antibodies. The presence of CD7 aberrant lymphoid marker’s expression was associated with FLT3mut, NPM1wt genotype. CD56 or CD2 positivity was found only in patients’ samples negative for NPM1 and/or FLT3 mutations. Conclusions: Certain immunophenotype findings including the presence of aberrant lymphoid markers may be indicative of the presence of mutations in NPM1 and FLT3 linked to prognosis
Artificial Intelligence: Are we creating a new Frankenstein?
Full text linkMary Shelley (1797-1851) is an English novelist best known for her Gothic novel[1] Frankenstein or The Modern Prometheus, written in 1818. In this novel, Victor Frankenstein, an excellent young scientist specialized in chemistry but also connoisseur of other sciences, develops a genius technique to impart life in a huge humanoid that he constructed using parts of dead human bodies. However, when he sees his creature come into life he abandons it terrified. As the creature wanders without an aim or help, it faces human enmity and that transforms it to a maniac for vengeance, extremely directed against its creator. It does not hesitate to murder the persons who are most precious to Victor, including his younger brother and even his bride at the night of their wedding. Victor starts a desperate chase of his creature that leads him to the North Pole, where he dies of exhaustion. The Creature, seeing him dead, mourns for him and, having decided to die too, drifts away on an ice raft and is soon "lost in darkness and distance", never to be seen again.1 Although the “Creature†remains nameless in the novel, it is usually referred in every-day practice with the name of its creator. That’s why the name “Frankenstein†is often used metaphorically to describe an evil existence that causes death and destruction (fig. 1)
Galectins 7 and 9 in Dermatology : Current knowledge and future perspectives
Full text linkGalectins constitute a family of β-galactoside-binding proteins lectins that are widely distributed in nature occurring in mammals, sponges, fungi, nematodes, insects and viruses. Galectins are involved in fundamental cellular processes in human skin and other tissues and exert biological effects of paramount importance through interactions with cytoplasmic and nuclear proteins and with components of cell surface and extracellular matrix, as well.In this paper we summarize current knowledge on the expression of galectins 7 and 9 in normal and diseased human skin and present the future perspectives of the use of these galectins or their antagonists/inhibitors in the diagnosis, prognosis and treatment of cutaneous disorders
Procalcitonin in acute heart failure
Full text linkAcute heart failure (AHF) isa time critical disease and it is of outmost importance to identify the underlyingprecipitating factors as soon as possible as this can improve patient outcomes. Infection is such a significant factor. Procalcitonin (PCT), as a biomarker of bacterial infection, can be used in AHF patients to establish the diagnosis of concomitant bacterial infection. PCT can guide the early initiation of antibiotic therapy and provide prognostic information regarding AHF patients. This short review summarizes the current evidence on PCT use in AHF including the preliminary results of the IMPACT-BIC-18 trial. 
The adverse reactions to contrast media during percutaneous coronary interventions; keep in mind the non-idiosyncratic reactions.
Full text linkBackground: Iodinated contrast media (ICM) have been among the most commonly used agents in the modern era of medicine and have become of paramount importance in the field of interventional cardiology. Although ICM have an overall good safety profile, severe or life-threatening reactions can occur as well.
Description of case: Herein, we report the case of a 74-year-old female patient who presented with a non-ST elevation myocardial infarction and underwent a successful percutaneous coronary intervention (PCI). At completion of the procedure, the patient complained of dizziness and a metallic taste. She became severely hypotensive with simultaneous bradycardia, simulating a vasovagal reaction. The persistence, however, of the reaction despite initial appropriate measures, guided our thought to a non-idiosyncratic reaction to the contrast media. The patient was hemodynamically stabilized with administration and up-titration of vasopressors and transferred to the coronary care unit, where she developed the full-blown clinical picture of an ICM adverse reaction. She was discharged 8 days later with no further complications.
Conclusion: Non-idiosyncratic reactions to contrast media during a PCI can be misinterpreted as a complication of the procedure per se or as a vasovagal reaction. A high level of clinical suspicion is warranted to ensure prompt recognition and appropriate management
Diabetes News/Recent Literature Review/ First Quarter 2018
Full text linkMetformin Treatment in Patients with Type 2 Diabetes and Chronic Kidney Disease Stages 3A, 3B, or 4
The safety of metformin was examined in moderate and severe chronic kidney disease (CKD)( stages 3A/3B and 4, eGFR 59-45, 44-30, and <15 mL/min/1.72 m2 , respectively). Three metformin doses were examined: 1,500mg (0.5 g in the morning [qam]+ 1g in the evening [qpm]) in CKD3A, 1,000 mg (0.5g qam + o.5 g qpm ) in CKD3B, and 500 mg (qam) in CKD 4. After 4 months on these regimens, patients displayed stable metformin concentrations that never exceeded the safe upper limit of 5.0 mg/L. Hyperlactatemia was absent, and HbA1c levels did not change. The study provided solid basis for the continuing metformin treatment in patients with moderate or severe CKD, supporting the recent guidelines on metformin treatment, providing that the dose is adjusted to the eGFR (Lalau JD et al, Diabetes Care 2018;43:547-553)