QT Prolongation and Clinical Outcomes in Patients with Takotsubo Cardiomyopathy.

BACKGROUND: Takotsubo cardiomyopathy (TCM) has been associated with repolarization abnormalities including QT prolongation and acquired long QT syndrome. However, the association between QT prolongation and clinical outcomes in patients with TCM remains unclear. The aim of this study is to examine the association between QT prolongation and ventricular arrhythmias, cardiogenic shock, and death in patients with TCM. METHODS: Forty-six patients with TCM met our inclusion criteria in an ongoing prospective cohort database from 2010 to May 2015. We assigned the patients to a long QT group or a normal QT group, and created a composite outcome consisting of ventricular arrhythmias, cardiogenic shock, or death. RESULTS: The mean age of the participants was 59.7 ± 16 years, 67% were women, and 63% had hypertension. Median follow-up time was 3.1 years (interquartile range: 2.0-3.8), with a total of 133.8 person-years. The mean left ventricular ejection fraction at diagnosis was 27.2% ± 1.4%. The mean QTc on diagnosis was 484 ms ± 10.2 ms for men, and 488 ms ± 8.6 ms for women. The long QT group had a 4.1-times higher odds of having the composite clinical outcome as compared to the normal QT group (95% confidence interval: 1.1, 16.1, P = 0.04) after adjusting for age and race in logistic regression. CONCLUSION: Patients with TCM who have a long QT interval or develop acquired long QT syndrome due to TCM may be more likely to be intubated; require vasopressors; and develop shock, ventricular arrhythmias, and death than those with a normal QT interval.

Mycobacterium chelonae vertebral osteomyelitis.

Mycobacterium chelonae is a rapidly growing mycobacterium (RGM) in Runyon group IV. This group includes all other nontuberculous mycobacterium (NTM) except the mycobacterium tuberculosis complex. The most commonly infected organ by RGM is the lung, usually in immunosuppressed patients or those with underlying lung disease. Vertebral infection is very rare. Osteomyelitis is rarely caused by M. chelonae, and only one other case of M. chelonae vertebral osteomyelitis has been reported. A case of M. chelonae vertebral osteomyelitis in a man with intravenous drug abuse is reported, and NTM osteomyelitis is reviewed with a focus on M. chelonae and appropriate treatment options for M. chelonae vertebral osteomyelitis.

Uremic cardiomyopathy: an underdiagnosed disease.

Uremic cardiomyopathy is responsible for high morbidity and mortality rates among patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD); however, the early implementation of hemodialysis may halt its progression. Nonconventional hemodialysis, such as frequent hemodialysis, appears to have an advantage over conventional hemodialysis. Kidney transplantation has been shown to reverse uremic cardiomyopathy and to confer a significant survival advantage over hemodialysis. Targeting future therapies at the underlying cellular mechanisms of uremic cardiomyopathy may finally start to reduce the burden of uremic cardiomyopathy in the CKD and ESRD population.

Gasoline ingestion: a rare cause of pancytopenia.

The majority of reported cases of gasoline intoxication involves inhalation or percutaneous absorption. Data are scarce on complications and outcomes after gasoline poisoning by oral ingestion. The major cause of mortality and morbidity associated with the ingestion of gasoline is related to pulmonary aspiration. Despite the high frequency of the ingestions, there is little documentation of nonpulmonary toxic effects of gasoline. After ingestion, the principal toxicity is aspiration pneumonia, but any documented extra pulmonary manifestations of this condition may be important in the overall management of these patients. We are reporting a rare case of pancytopenia along with aspiration pneumonia and multisystem organ failure in a 58-year-old male after prolonged intentional ingestion of gasoline. To our knowledge, this is the only reported case of gasoline toxicity causing pancytopenia.