29 research outputs found
Glycoprotein IIb/IIIa inhibitor associated severe thrombocytopenia in patients with coronary artery disease: Clinical course and outcomes
No full textThrombocytopenia, both at baseline and acquired throughout admission is associated with poor clinical outcomes in patients with coronary artery disease. It is not known whether severe thrombocytopenia in patients receiving glycoprotein IIb/IIIa inhibitors (GPI) carries the same risk as thrombocytopenia from other aetiologies. We identified 50 consecutive patients referred for percutaneous coronary intervention (PCI) who developed severe thrombocytopenia (<50 × 10(9) cells/l) and followed their clinical course to 30 days. Two groups were compared: (1) severe thrombocytopenia following GPI usage and (2) severe thrombocytopenia without exposure to GPI. Baseline platelet counts were higher in GPI group (201 ± 62 vs. 112 ± 83 × 10(9) cells/l, p < 0.05). Patients in GPI group had more profound thrombocytopenia yet quicker recovery of platelet counts. The GPI group received fewer blood product transfusions (red cells: 0.1 ± 0.4 vs. 1.3 ± 2.0, p < 0.05, platelets: 0.22 ± 0.6 vs. 1.1 ± 1.7, p < 0.05) and had lower event rates for the primary end point of 30-day mortality (3.7% vs. 42.1%, p < 0.05), and for major bleeding (0% vs. 15.8%, p < 0.05). In conclusion, GPI associated severe thrombocytopenia follows a distinct clinical course when compared to severe thrombocytopenia due to other aetiologies. Our results suggest that patients who develop severe thrombocytopenia following GPI therapy may be managed conservatively with careful monitoring.Girish Viswanathan, Ananth Kidambi, Adam Nelson, Gnanamoorthy Mayurathan, John Hardy, Patrick Kesteven, & Azfar Zama
Lower limb ischemia and multiple organ dysfunction syndrome following wasp Sting
No full textWasp stings are commonly encountered in tropical countries. Various manifestations after wasp sting have been described. We report 66-years old healthy female developed lower limb ischemia, myocardial infarction, renal, liver and hematological involvement following multiple wasp stings. She was fully recovered after two weeks of treatmen
Prevalence and association of underweight, overweight, obesity, neck circumference, hypertension and diabetes mellitus among school staff in Jaffna district
No full textThe aim of the study was to determine the prevalence and associations of underweight/overweight/obesity, neck circumference (NC), hypertension (HT) and diabetes mellitus (DM) among school staff in Jaffna district. It was a descriptive study on 6335 (31% were males and 69% were females) school staff. Overweight and obesity were defined according to the cut-off values for Asian population. Results showed, among males 3% were underweight, 26% were normal weight, 48% were overweight and 23% were obese. Among females 6% were underweight, 28% were normal weight, 41% were overweight and 25% were obese. Seventeen and 6% of the total population had HT and DM respectively. Average NC for males was 32.85cm for underweight, 35.48cm for normal weight, 38.27cm for overweight and 40.59cm for obese. Average NC for females was 29.13cm for underweight, 30.95cm for normal weight, 32.81cm for overweight and 34.53cm for obese. In conclusion the body mass index (BMI) distribution of the population sample shows that more people in both gender categories were predominantly overweight. About 44% of the total population is overweight. Furthermore, approximately 25% of both genders were obese. Altogether at least 2/3 of the population sample was above the healthy weight. More men were overweight/obese than women. Diabetes was less common than hypertension among the target population. However like hypertension, the prevalence of DM also increased with BMI increment. Interestingly the size of the NC increased parallels with BMI increment
Atypical lichen myxedematosus: a rare case with complete resolution of skin
No full textLichen myxedematosus (LM) is a rare disorder classified into three categories based on the type and distribution of skin lesions: generalised (scleromyxoedema), localised, and atypical variants. Scleromyxoedema, often associated with monoclonal gammopathy, exhibits multi-organ involvement and necessitates specific treatments such as intravenous immunoglobulin. Localised LM has benign characteristics and typically does not progress to scleromyxodema. The atypical variant does not meet the criteria of the previous two categories and may resolve spontaneously. We present a case of a 45-year-old woman who manifested an erythematous papular lesion on both shins over three months, which spontaneously resolved over one month. A skin biopsy confirmed the diagnosis of Lichen myxedematosus. However, clinical features were not suggestive of either Scleromyxodema or localised LM. The Patient was diagnosed to have an atypical variant of LM because the lesion, which was confined to bilateral shins, completely resolved within a month and was not associated with paraproteinemia. This report highlights the challenges in diagnosing and managing such atypical cases
Health Related Quality of Life After Percutaneous Coronary Revascularisation in Patients with Previous Coronary Artery Bypass Grafts: A Two-Year Follow Up Study
No full textPercutaneous coronary revascularisation [PCR] improves angina and health related quality of life [HRQOL] compared to standard medical therapy. It is unknown whether PCR has the same benefits for patients with a history of CABG. Over a period of 5 years, we assessed HRQOL of patients undergoing PCR using Part 1 of the Nottingham Health Profile [NHP] at baseline 3, 12 and 24 months. We compared HRQOL after PCR in 255 patients with CABG to 2680 without. There were more males [81.1% v 69.6% p = 0.002] and older patients [mean age 60.1 years v. 58.0 p = 0.03] in CABG group. Perceived HRQOL improved at 24 months for pain, energy and emotional reaction but the improvement was less in the CABG group. However, mean NHP scores at 24 months for those with CABG had returned to baseline levels for sleep [34.9] and for physical function was worse than at baseline [22.0 vs 30.7]. This relationship persisted after adjustment for male sex, history of previous MI and coronary stent usage. Patients with previous CABG had less improvement in HRQOL after PCR. Further work is needed to assess the benefits and cost effectiveness of PCR in these patients. \ua9 2010 Springer Science+Business Media B.V./The International Society for Quality-of-Life Studies (ISQOLS)
Unfractionated Heparin during Elective PCI: Fixed Dose or Weight Adjusted?
No full textIntroduction: To assess two different dosing strategies of unfractionated heparin (UFH) during elective percutaneous coronary intervention (PCI). Aims: The optimal dose of heparin during elective PCI in patients with stable angina is unknown. Existing guidelines are based on limited data. We interrogated data from the PCI database. Patients with stable angina undergoing planned transradial PCI for uncomplicated single lesions were included. The main endpoint was troponin I release. We compared a fixed heparin dose (3000 U) UFH to a weight-adjusted dose. Results: Of 698 patients 244 (35.0%) received fixed dose (3000 U) and 454 (65.0%) 70 U/kg weight-adjusted UFH. There was no significant difference in median troponin between the fixed dose and the weight-adjusted groups; 0.17 ng/mL versus 0.14; P= 0.21. The proportion of troponin positive patients was similar in both groups (61.9% in the fixed dose group vs. 58.1%; P= 0.37). There were no deaths or major ischemic events during hospitalization. There was no bleeding requiring transfusion or delaying hospital discharge. Conclusion: In conclusion, this retrospective observational study of elective transradial PCI demonstrated that a reduced, fixed dose of periprocedural heparin was associated with similar postprocedural troponin levels when compared to a standard weight-adjusted regime. Our study further questions the optimal dose of heparin required during elective PCI and suggests a need for further trials
The first case of prosthetic valve endocarditis due to Salmonella enterica Serovar Enteritidis infection in Sri Lanka
No full textProsthetic valve replacement is one of the predisposing factors for the development of infective endocarditis. Prosthetic valve infective endocarditis caused by non typhoidal Salmonellae is an uncommon manifestation. We report a case of a female patient with a history of bioprosthetic aortic valve replacement admitted due to prolonged fever with diarrhoea. The echocardiogram revealed a prosthetic valve vegetation with the etiological diagnosis of infective endocarditis by Salmonella enterica Serovar Enteritidis. She had a fulminant clinical course and died after 6 months despite prolonged antibiotic treatment.</p
Health related quality of life after percutaneous coronary revascularisation in patients with previous coronary artery bypass grafts: A two-year follow up study
No full textPercutaneous coronary revascularisation [PCR] improves angina and health related quality of life [HRQOL] compared to standard medical therapy. It is unknown whether PCR has the same benefits for patients with a history of CABG. Over a period of 5 years, we assessed HRQOL of patients undergoing PCR using Part 1 of the Nottingham Health Profile [NHP] at baseline 3, 12 and 24 months. We compared HRQOL after PCR in 255 patients with CABG to 2680 without. There were more males [81.1% v 69.6% p = 0.002] and older patients [mean age 60.1 years v. 58.0 p = 0.03] in CABG group. Perceived HRQOL improved at 24 months for pain, energy and emotional reaction but the improvement was less in the CABG group. However, mean NHP scores at 24 months for those with CABG had returned to baseline levels for sleep [34.9] and for physical function was worse than at baseline [22.0 vs 30.7]. This relationship persisted after adjustment for male sex, history of previous MI and coronary stent usage. Patients with previous CABG had less improvement in HRQOL after PCR. Further work is needed to assess the benefits and cost effectiveness of PCR in these patients
