High-Sensitive Troponin T and N-Terminal Pro B-Type Natriuretic Peptide for Early Detection of Stress-Induced Cardiomyopathy in Patients with Subarachnoid Hemorrhage.

BACKGROUND: Patients developing stress-induced cardiomyopathy (SIC) after subarachnoid hemorrhage (SAH) have increased risk of vasospasm, delayed cerebral ischemia and death. We evaluated whether high-sensitive troponin T (hsTnT) and N-terminal pro B-type natriuretic peptide (NTproBNP) are useful biomarkers for early detection of SIC after SAH. METHODS: Medical records of all patients admitted to our NICU with suspected or verified SAH from January 2010 to August 2014 were reviewed. Patients in whom echocardiography was performed and blood samples for measurements of hsTnT and/or NTproBNP were obtained, within 72 and 48 h, respectively, after onset of symptoms, were included. SIC was defined as reversible left ventricular segmental hypokinesia diagnosed by echocardiography. RESULTS: A total of 502 SAH patients were admitted during the study period, 112 patients fulfilled inclusion criteria and 25 patients fulfilled SIC criteria. Peak levels of hsTnT and NTproBNP were higher in patients with SIC (p < 0.001). hsTnT had its peak on admission, while NTproBNP peaked at days 2-4 after onset of symptoms. A hsTnT > 89 ng/l or a NTproBNP > 2,615 ng/l obtained within 48 h after onset of symptoms had a sensitivity of 100% and a specificity of 79% in detecting SIC. CONCLUSIONS: The cardiac biomarkers, hsTnT and NTproBNP, are increased early after SAH and levels are considerably higher in patients with SIC. These biomarkers are useful for screening of SIC, which could make earlier diagnosis and treatment of SIC in SAH patients possible.

Storage of extemporaneously prepared ophthalmic antimicrobial solutions.

The feasibility of long-term storage of commonly used ophthalmic antimicrobial solutions was studied. Solutions of tobramycin 15 mg/mL (as the sulfate salt), cefazolin 33 mg/mL (as the sodium salt), and vancomycin 50 mg/mL (as the hydrochloride salt), each in artificial tears, were prepared with aseptic technique. Ten 15-mL portions of each solution were prepared; five of each were stored at 4 degrees C and the other five at 25 degrees C. Samples of each portion were tested before storage and 7, 14, 21, and 28 days after preparation for osmolality, pH, and antimicrobial activity. For the tobramycin solution there were no differences in osmolality or the zone of inhibition associated with temperature or time. The pH dropped between days 0 and 7 at both temperatures. For the cefazolin solution there were no differences in osmolality associated with temperature or time. The pH was higher in portions stored at 25 degrees C than at 4 degrees C and increased over time in portions stored at either temperature. The zone of inhibition was larger for portions stored at 4 degrees C than at 25 degrees C but did not change over time. For the vancomycin solution there were no differences in osmolality associated with temperature or time. The pH did not differ between portions stored at 4 and 25 degrees C but dropped sharply at both temperatures between days 0 and 7. The zone of inhibition did not differ with temperature or time. The tobramycin solution could be stored for 28 days at room temperature and the cefazolin solution for 28 days under refrigeration. The pH of the vancomycin solution changed too quickly for storage to be recommended.

alpha-Interferon in myelofibrosis: a case report.

A patient with advanced myeloid metaplasia was treated with alpha-interferon (29 months) with a remarkable response. He had anaemia, thrombocytopenia and hepatosplenomegaly with infarction. The initial bone marrow showed replacement with fibrosis with no evident haemopoietic cells. Post-therapy, the patient became asymptomatic, transfusion independent and had normal blood counts. The repeat bone marrow was 30% cellular with 1 + reticulin and no fibrosis. Treatment was well tolerated without appreciable side-effects. These results indicate that prolonged therapy with alpha-interferon can improve haemopoiesis and reverse marrow fibrosis.