1,720,963 research outputs found
The correct early diagnosis established by the multidisciplinary team is the key to success in the treatment of the post-myocardial infarction patient, complicated with renal infarction and pneumonia-infarction
Get PDFUniversitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroduction. According to the ESC guideline for the management of Acute Coronary Syndrome (ACS) it meets a spectrum of conditions, from symptoms and signs, with or without 12-lead ECG changes and with or without positive troponins. ACS is the cause of death in 1.9 million male patients and 2.2 million female patients annually. Case statement. In the given article I present the clinical case of a 66-year-old male patient, diagnosed in an outpatient setting with arrhythmia and aggravated pectoral angina. The given case was studied through the lens of the ACS guideline of the ESC (2023), articles on the subject of ACS, AMI, renal infarction and infarction-pneumonia. Discussions. From the patient's laboratory analyses: complete blood count – thrombocytopenia (142-167 x 10^9/l), blood biochemistry – no changes, Troponins – negative (0.07 ng/ml). On ECG: tachysystolic atrial fibrillation-flutter and signs of left bundle branch block of His fascicle. On echocardiography: mild dilatation of the left atrium, right atrium, hypertrophy of the left ventricular myocardium, multiple regions with akinesia and dyskinesia and apical parietal thrombus with dimensions of 28x18 mm, fixed, ejection fraction – 45%. The patient's clinic is complicated by discomfort and dull pain in the right meso-hypogastrium. Computed tomography of the internal organs shows signs of renal infarction, thrombosis of the hepatic veins and inferior vena cava, infarction-pneumonia on the right. At coronary angiography, subocclusive LAD stenosis was detected, at renal arteriography - no pathological changes. Conclusion. Due to early established multidisciplinary diagnosis, high-performance investigative methods and effective targeted therapy, the patient was treated and discharged with improvement and curative ambulatory measures. (ACS) it meets a spectrum of conditions, from symptoms an d signs, with or without 12-lead ECG changes and with or without positive troponins. ACS is th e cause of death in 1.9 million male patients and 2.2 million female patients annually. Case statement. In the given article I present the clinical case of a 66-year-old male patient, diagnosed in an outpatient setting with arrhythmia and aggrava ted pectoral angina. The given case was studied through the lens of the ACS guideline of the ESC (2023), articles on the subject of ACS, AMI, renal infarction and infarction-pneumonia. Discussions. From the patient's laboratory analyses: complete blood c ount – thrombocytopenia (142-167 x 10^9/l), blood biochemistry – no changes, Troponins – ne gative (0.07 ng/ml). On ECG: tachysystolic atrial fibrillation-flutter and signs of left bundle branch block of His fascicle. On echocardiography: mild dilatation of the left atrium, righ t atrium, hypertrophy of the left ventricular myocardium, multiple regions with akines ia and dyskinesia and apical parietal thrombus with dimensions of 28x18 mm, fixed, ejection fract ion – 45%. The patient's clinic is complicated by discomfort and dull pain in the right meso-hy pogastrium. Computed tomography of the internal organs shows signs of renal infarctio n, thrombosis of the hepatic veins and inferior vena cava, infarction-pneumonia on the right. At coron ary angiography, subocclusive LAD stenosis was detected, at renal arteriography - no patholog ical changes. Conclusion. Due to early established multidisciplinary diagnosis, high- performance investigative methods and effective targeted therapy, the patient was t reated and discharged with improvement and curative ambulatory measures
Cardiac resynchronization therapy – a modern heart failure solution. Challenging clinical case
Get PDFIntroduction. Heart failure is known as the impossibility of the heart to execute its contractile function, in
the way to supply the vital systems with oxygenated blood. Nowadays, there are 64.3 million people living
with heart failure (ESC 2020). The patients with left bundle branch block have class I level A indication
for Cardiac Resynchronization Therapy (CRT). CRT implantation is a challenging procedure, most difficult
part being left ventricle (LV) lead implantation.
Case presentation. We present a case of a 55 years-old male patient with a dilative cardiomyopathy with
ejection fraction 30%, LBBB, class III NYHA heart failure, C stage AHA/ACC. The patient has the right
upper limb amputated and he asked to implant the CRT-D device on that side. After informed consent, the
procedure was fitted to the patient but created some difficulties. The patient had an unsuccessful LV lead
implantation during the first procedure due to the dissection and perforation of coronary sinus. The second
and third unsuccessful attempts were performed after one month and two months. The Heart Team decision
was to implant epicardial LV lead but just before cardiac surgery to perform a fourth attempt to implant the
LV lead via transvenous approach.
Discussion. The 4th attempt was also difficult. After several attempts to cannulate the CS using both
contrast agent and deflectable ablation catheter, we performed coronary angiography in venous phase to
locate the CS ostium. Using the images as reference, we finally cannulated the CS ostium with a deflectable
ablation catheter and implanted the LV lead without any complications in the postero-lateral branch. The
patient was discharged the next day with satisfying state of health. Along with the multiple sources
recommendation degrees, an individual approach to the patient and a well-trained multidisciplinary team
are the key to a less-traumatic therapy and a high rate of intervention’s success. Brignole et al. (2013) affirm
that the CRT improves the ventricular ejection fraction, left ventricular contractility, on the other hand
reduces the ventricular remodelling. Most of the studies have shown that the implantation of CRT-D or
CRT-P essentially reduces the mortality and the hospitalisation rate in patients with NYHA III-IV class.
Conclusion. The CRT remains one of the golden choices in HF treatment, based on the studied literature.
The clinical case provided the tough way to achieve the goal and treat a patient in a special physical state
Tratament inovativ al fibrilației atriale în Republica Moldova. Pacient tratat prin crioablație
Get PDFUSMF „Nicolae Testemițanu”, Disciplina de Cardiologie, Spitalul Internațional MedparkIntroducere. FA se caracterizează
prin descărcarea haotică a
miocardului atrial, împotriva
fenomenului fiziologic. Este cel mai
întâlnit tip de aritmie. În ultimii 20
ani prevalența și incidența au crescut
substanțial. Patologia se mai poate
dezvolta și asimptomatic. Datorită
acestui moment fiziopatologic adesea
pacienții se adresează, când unica
soluție este terapia de anticoagulare,
pentru a reduce maxim posibil
complicațiile cauzate de FA.
Caz clinic. Pacient M., 63 ani. Bolnav
din 2010. Subiectiv prezintă palpitații
periodice. În urma investigațiilor de
laborator și electrofiziologice
pacientul a fost diangosticat cu FA
paroxistică, tahisistolie. Risc
tromboembolic scăzut
(CHA₂DS₂-VASc - 0 p.).
Echo-cord: AS - medio-lateral - 40
mm., supero-inferior - 48 mm.,
AD - medio-lateral - 43 mm.,
supero-inferior - 47 mm., FE- 60%.
Info. Într-un studiu autohton
(Darciuc R., Boiciuc I., et al.) asupra
ablației cu criobalon, s-a observat
recurența paroxismelor la doar 2
persoane din 8 admise pentru
intervenție, ceea ce constituie 25%.
Recurența a fost depistată în primele
3 luni post-intervențional. În termeni
mai mari ablația prin criobalon este o
metodă eficientă de a izola focarele
ectopice de descărcare a cordului și
este veriga intermediară între
diagnostic și tratamentul chirurgical.
Ce este crioablația?
Este o procedură minim invazivă de
tratament al FA. Aceasta constă în
izolarea focarelor ectopice cu
automatism discordant. Dese ori, așa
capacitate o dobândesc venele
pulmonare, țesutul cărora se poate
atrializa, fenomen de achiziționare a
trăsăturii comune cu atriile -
susținerea impulsului electric.
Fiziopatologic aceasta reprezintă
substratul pentru crearea focarelor
aberante.
Materiale și metode. A fost studiată
fișa pacientului tratat prin
crioablație a FA, internat în Spitalul
Internațional Medpark. Toate
finalitățile și ideile emise izvorăsc
din rezultatele investigațiilor
efectuate de către pacient, precum:
Ecografia cordului, Eco-Doppler a
cordului, investigații de laborator.
Scopul. Scopul acestui studiu de caz
este informarea despre procedura de
crioablație, utilitatea și actualitatea
acesteia.
Rezultate. Pacientul a fost admis
pentru tratamentul FA prin
crioablație. Ca rezultat au fost izolate
focarele ectopice de descărcare
electrică a cordului. În urma
intervenției pacientul a fost externat
în stare satisfăcătoare și cu un
pronostic favorabil în ceea ce ține de
recurența fibrilației atriale.
Ca rezultat pacientul se cunoaște cu
un istoric al bolii mai modest
deoarece scade simptomatica și
accesele de palpitații, se prelungește
timpul până când pacientul revine la
medicația anticoagulantă. Datorită
acestei proceduri scade frecvența
Accidentelor Vasculare Ischemice,
rata evenimentelor trombolice în FA
valvulară fiind de 17.5%, iar cea
non-valvulară de 5% anual.
Concomitent se îmbunătățește
calitatea vieții și starea
psiho-emoțională a pacientului
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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