Hospital Chronicles (E-Journal)
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Cutaneous Manifestations of Inflammatory Bowel Disease
Get PDFCutaneous lesions are among the most frequent extraintestinal manifestations of inflammatory bowel disease (IBD). They may precede, occur with or postdate the onset of the intestinal disease and can significantly contribute to the morbidity and impairment of the overall quality of life of the affected patients. In this article, the cutaneous manifestations of IBD are reviewed with particular emphasis on their clinicopathological and therapeutic aspects
Generalised Pustular Psoriasis (von Zumbusch type) following renal Transplantation. Report of a case and review of the literature
Get PDFGeneralized pustular psoriasis appears as an uncommon variant form of psoriasis consisting of widespread pustules on an erythematous background (von Zumbusch). A 39-year old male patient with a history of plaque psoriasis since the age of 9 who had an acute onset of generalized pustular psoriasis 12 days after he underwent renal transplantation is presented. Despite administered immunosuppression for transplantation the addition of cyclosporine A and methotrexate did not reverse the ongoing process of disease and the patient died on the 57th post-transplant day due to multiorgan failure following severe bone marrow suppression
New Biochemical Markers of Ischemia:The Diagnostic and Prognostic Role of Brain Natriuretic Peptide, C-Reactive Protein, Ischemia Modified Albumin & Myeloperoxidase
Get PDFThe traditional biomarkers, CK-MB and troponins, used for the diagnosis of myocardial ischemia and the risk stratification of patients with acute coronary syndromes (ACS) are of limited use mainly because they require some degree of necrosis in order to become detectable. Based on the knowledge gained into the pathophysiology of ACS, several new biomarkers have been developed. Brain natriuretic peptides (BNP and NT-proBNP) as markers of hemodynamic stress have shown in several studies a good diagnostic and prognostic performance. C-reactive protein (CRP) reflecting systemic inflammation, has mainly a role as risk stratifier. Ischemia modified albumin (IMA) a pure ischemia marker may offer a substantial aid in diagnosing an acute coronary event in patients with negative troponin. Finally, myeloperoxidase (MPO), a marker of oxidative stress, may also contribute to the diagnosis of ischemia although this is not yet supported by a fair amount of data. Nevertheless, although highly sensitive, these new biomarkers are not specific enough and a multi-marker approach seems the most appropriate strategy for diagnosis of myocardial ischemia and for assessing the risk of an adverse outcome in patients with an acute coronary syndrome
Right External Iliac Vein Thrombosis After Percutaneous Transluminal Coronary Angioplasty
Get PDFWe present a 43-year-old patient with an acute anterior myocardial infarction,who sought medical advice 24 hours after the initial episode of chest pain. Chest pain lasted for about 4 hours and then subsided. The patient was admitted to the coronary care unit of our hospital 24 hours after the initial insult. He was clinically stable without chest pain, dyspnea, or palpitations. He was a rather thin young gentleman (body mass index-BMI of 21), current heavy smoker, and was receiving non-steroidal anti-inflammatory drugs for recent back pain. He was started on tirofiban, aspirin, clopidogrel (300 mg loading dose), ??-blocker and an angiotensin converting enzyme (ACE) inhibitor. At 52 hours later since the initial episode he was subjected to coronary angiography
Atrial Fibrillation Ablation: Guidance by Newer Imaging Techniques
Get PDFNowadays, image integration in electrophysiology comprises X-ray, angiography, intracardiac signals, impedance level and stability, 3D-mapping systems (e.g. Carto, NavX-Ensite), magnetic navigation, ???off-line?? systems (magnetic resonance imaging- MRI, computed tomography-CT) and ???on-line?? systems (transesophageal echo-TEE, intracardiac echo-ICE)
Cardiac Arrest: Automatic External Defibrillators in Public Places Can Save Lives
No full text???±???·????????½?¬ ?????·?½ ??????????±?????? ??½?????· ?????????????????????? ?±???? 1 ?????±?????????????? ?¬?½??????????? ???¬?½?????½ ???· ?????? ???????? ?±???? ???±???½?????? ?±?½?±???????? ???±??????¬??. ???????????????? ?? ????±?³???????? ?±???????? ?±??????????? ?±?????¬?½?????±?? ?????½???????? ?»???³?? ?????? ???????????????? ??????????? ?????????? (???±?????????????? ??????, ???¬???½???????±, ?????±?????????, ??.?±.). ???? ?±?????????±?????? ??????????????????? ?±?????½??????????? ???? ???·?????????????? ??????????? ???????????½ ?½?± ???????????½ ??????? ?±?½??????????½ ?????? ????????½ ?????????????? ???±??????±???? ?±?½?±????????. ???????? ?±?????½??????????? ???? ???·?????????????? ??????????? ???????????½ ?½?± ???????? ??????????????½???±?? ???????»???½????? ?????? ????????½ ???????±?????????????? ?³???± ???? ?????????? ?±??????. ???? ???????????±?????? ??????????????????? ???????½??????????? ??? Automated External Difibrilator ( AED ) ?????½?±?? ?????»??????????????½????, ?±?????????±???????????·????½???? ???±?? ?±?????????????????? ???????????????, ???? ???????????? ????·??????????????????½ ?±???»??? ?????½?·????????? ???½?????»??? ?????·?½ ???»?»?·?½?????? ?³?»???????± ???±?? ????????????? ?????·?³?????? ?³???± ?½?± ?±?½?±?³?½????????????½, ?½?± ???±??±?????»??????????½ ???????????¬ ???? ?·?»????????????±????????³??¬???·???± (??????), ???±?? ?±?½?±?»??????½ ????????????½?± (???½?????·). ?£?????????? ?????½?±?? ?½?± ???±???????·?³????½ ???????? ?±?½?????????????????????? ?????±???????????? ???±?? ?????±?³?³???»???±???????? ???³?????±?? ???? ?????????? ???·?½ ??????????¬???????± ?±?????±?»????? ?±?????½?????????·?? ???? ??????±???± ???? ???±??????±???? ?±?½?±????????. ?????????»????½ ?????½ ?±???±???????? ?³?½?????????? ?????¬?³?½?????·?? ?????? ?????? ???±?? ?? ????????????????? ?????? ????±?³???±?????????????????±?? ???? ?»???³????????· ???????±???????????· (excerpt)More than a million people sustain a cardiac arrest annually in the European Union. Unfortunately this tragic number keeps rising because of the "Western life style" (lack of exercise and physical activity, smoking, eating habits, etc). The automatic external defibrillators when available in public places could save the lives of people who sustain a cardiac arrest. These devices can be employed by specifically trained volunteers at first until this training is expanded to the lay public (English excerpt
Non-classical Indications for Cardiac Resynchronization Therapy
Get PDFBased on randomized controlled studies, cardiac resynchronization therapy (CRT) is currently indicated in patients with systolic heart failure of New York Heart Association (NYHA) functional class III and IV, left ventricular ejection fraction? 120 ms). Most of the enrolled patients were in sinus rhythm, were not previously paced and had mainly LBBB. Thus, there are uncertainties regarding several other populations, not included or underrepresented in the main studies.These populations include patients with atrial fibrillation (AF), previous pacemakers considered for upgrade to CRT, RBBB, narrow QRS < 120 ms, NYHA functional class? < III, or right heart failure. These non-classical indications are herein reviewed.Although CRT seems to benefit patients with AF and patients with preexisting pacemakers, in patients with NYHA functional class II-III, or with narrow QRS, or with RBBB, or in those with predominant right heart failure, the role of CRT is not established yet and further relevant clinical trials are needed
Access to Catheterization Facilities in Patients Admitted With ST-elevation Myocardial Infarction
Get PDFThe primary goal of therapy for acute ST-elevation myocardial infarction (STEMI) is rapid, complete and sustained restoration of the infarct related coronary artery blood flow and myocardial perfusion, with a consequent positive impact on the patient???s outcome. Timely reperfusion of the infarct-related artery is the cornerstone of therapy for this goal.Thrombolytic therapy and percutaneous coronary intervention (PCI) are effective means to achieve reperfusion, but current trends reflect an increasing preference for PCI. Even though the development of reperfusion strategies and ancillary therapies over the last decades resulted in significant improvement in the prognosis of STEMI, the implementation of such therapies in the ???real world??? is often inefficient. Despite the increasing use of primary PCI, the proportion of eligible patients undergoing early reperfusion remained constant at about 70%, from 1994 through 1999, with roughly 30% of patients receiving neither reperfusion therapy. Findings from the GRACE study showed that nearly one ???third of patients who presented with STEMI within 12 hours and who were eligible for reperfusion therapy did not receive it. Thus, a considerable proportion of patients with STEMI do not receive reperfusion therapy for a variety of reasons. These include age, gender, concomitant comorbid conditions, delays in seeking medical attention, disparities in health system organization, ???triaging??? problems, disparities in patients??? transfer, awareness of the public, and other reasons
Coronary Artery Disease Prevention, Diagnosis, Prognosis and Treatment: What's Different for Women?
Get PDFCardiovascular disease (CVD) is the leading cause of morbidity and mortality. Coronary heart disease (CHD) occurs in women a decade later compared with men and the gap between men and women narrows with advancing age. In addition, cardiovascular mortality declines in men but not in women. Coronary heart disease (CHD) accounts for the majority of CVD deaths in women.The spectrum of CVD risk in women (10-year absolute CHD risk) varies from high ( > 20%) for women with established CHD, cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm, diabetes and chronic kidney disease to intermediate risk (10-20%) for women with multiple risk factors, markedly elevated levels of a single risk factor, metabolic syndrome, first degree relatives with early onset of CVD and subclinical CVD (e.g. coronary calcification) and low risk (< 10%), mainly for women with 1 or no risk factors. Hypertriglygeridemia, low HDL cholesterol, diabetes and the metabolic syndrome are more potent risk factors for CHD in women compared with men. High-sensitivity C-reactive protein (CRP) and anemia are other novel risk factors for women and hypoestrogenemia of hypothalamic origin may be a risk factor for pre-menopausal women and one possible cause for the increased mortality in young women versus age-matched men in acute myocardial infarction (MI) as well as post bypass surgery. For prevention aspirin, ??-blockers, angiotensin converting enzyme (ACE) inhibitors and statins are indicated for higher risk women, whereas for lower risk healthy life style changes are recommended
Metabolic Syndrome and Cardiovascular Risk: The Nurse's Role
Get PDFMetabolic Syndrome (MS) is characterized by dysglycemia, arterial hypertension, atherogenic dyslipidemia and central obesity. Its presence has been associated with increased risk for the development of diabetes mellitus and cardiovascular disease.The main treatment goal is to lower the incidence of both MS and its cardiovascular sequelae and includes diet, exercise, weight loss, control of blood glucose and pharmacological therapy of hypertension and dyslipidemia. Nursing care focuses in the development of a concise treatment plan based upon patient???s education, psychosocial support and close follow-up. Nurses should have a wide knowledge of MS pathophysiology which will facilitate their active participation in both diagnosis and treatment processes. The final goal is to assure the long-term compliance of patients with both the proposed lifestyle changes and the medical treatment in order to achieve a significant reduction in their cardiovascular morbidity and mortality