Pericardial Disease in Cardiac Amyloidosis: A Comprehensive Review.

In patients with cardiac amyloidosis, pericardial involvement is common, with up to half of patients presenting with pericardial effusions. The pathophysiological mechanisms of pericardial pathology in cardiac amyloidosis include chronic elevations in right-sided filling pressures, myocardial and pericardial inflammation due to cytotoxic effects of amyloid deposits, and renal involvement with subsequent uremia and hypoalbuminemia. The pericardial effusions are typically small; however, several cases of life-threatening cardiac tamponade with hemorrhagic effusions have been described as a presenting clinical scenario. Constrictive pericarditis can also occur due to amyloidosis and its identification presents a clinical challenge in patients with cardiac amyloidosis who concurrently manifest signs of restrictive cardiomyopathy. Multimodality imaging, including echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is useful in the evaluation and management of this patient population. The recognition of pericardial effusion is important in the risk stratification of patients with cardiac amyloidosis as its presence confers a poor prognosis. However, specific treatment aimed at the effusions themselves is seldom indicated. Cardiac tamponade and constrictive pericarditis may necessitate pericardiocentesis and pericardiectomy, respectively.

Racial and Ethnic Disparities in Peripheral Vascular Disease Admissions Using a Nationally Representative Sample.

Our study aimed to identify clinical outcomes and resource utilization associated with race and ethnicity in patients admitted with peripheral vascular disease (PVD) across the United States. We queried the National Inpatient Sample database from 2015 to 2019 and identified 622,820 patients admitted with PVD. Patients across 3 major race and ethnic categories were compared in terms of baseline characteristics, inpatient outcomes, and resource utilization. Black and Hispanic patients were more likely to be younger and of the lowest median income but incur higher total hospital costs. Black race predicted higher rates of acute kidney injury, need for blood transfusion, and need for vasopressor but lower rates of circulatory shock, and mortality. Black and Hispanic patients were less likely to undergo limb-salvaging procedures and more likely to undergo amputation than White patients. In conclusion, our findings indicate that Black and Hispanic patients experience health disparities in resource utilization and inpatient outcomes for PVD admissions.

Long-term compliance of patients with osteoporosis treatment and its effect to fracture occurrence.

OBJECTIVES: The objective of this study was to evaluate the effect of long-term treatment of patients with osteoporosis being actively managed by medical staff and following the therapeutic methods and principles of treatment of osteoporosis. METHODS: The medical records of patients which were examined in an osteological outpatient office first time in the year 2009 were reviewed. The results of densitometry examinations were compared with the results from the year 2019. Patients regularly absolved densitometry, properly and regularly took prescribed medicaments for either anti-osteoporotic treatment or for supplementation of vitamin D and calcium. The cohort consisted of 100 patients. Next, we split the group into 3 categories - less than 65 years of age, 65-75 years of age and lastly over 75 years of age. By default, we assessed and compared the T-scores (deviation from the average value of bone density of 30 years old healthy person) in the area of the proximal femur and in the area of the lumbar spine. The bone mineral density (BMD) values in g/cm2 and their relation to corresponding T-score from set area were also reviewed. RESULTS: Based on the results of densitometry, osteoporosis was diagnosed in 41 patients, manifest osteoporosis in 14 and osteopenia in 36, nine patients had their bone density value within the normal range. The average T-score values of "total hip" were -1.42, "neck" -2.08, BMD values of "total hip" were 0.802 g/cm2, "L1-L4" -2.05, "L total" -1.45, and BMD of "L total" was 0.886 g/cm2. In the time of the last examination, the T-score (disregarding the type of treatment) raised from the initial value by 40.16% in the area of lumbar spine, by 56.69% in the area of "total hip", and by 40.16% in the area of "neck". While sorting the cohort based on age, we detected a similar effect of active management of treatment in each of the 3 categories. CONCLUSION: Cooperation of the patients during the treatment of a chronic disease requiring long-term usage of medicaments is often problematic and it is necessary to devote adequate attention to it. The solution to improve the treatment can be active management of the patient by the medical facility or by the medical staff.

Evaluation of Safety and Efficacy of Traction, Closed Reduction, and Subsequent Hip Fixation in Hilgenreiner Brace in Patients with Severe Forms of Hip Developmental Dysplasia.

Background: Hilgenreiner brace (Hb) was developed to improve hip reduction rate and reduce the incidence of femoral head avascular necrosis (AVN). In children under the age of 18 months with unstable hip joints or a dislocated hip joint, the treatment method involves nonsurgical treatment in most cases. Objectives: To evaluate the effectiveness and safety of traction, closed reduction, and hip fixation in Hb in patients with severe forms of hip developmental dysplasia (DDH) in follow-up. Materials and Methods: Prospective, clinical, cohort observation and retrospective matched-pair analysis. Analysis of medical records was conducted to evaluate the effectiveness of using Hb for treatment of dislocated hip joints in <18-month-old children. The investigated cases were of the dislocated hip joint since DDH was confirmed through clinical and imaging diagnosis and treated by the application of the close reduction method together with Hb, in a nonhuman position (hip joint in 90 degrees of flexion and 80 degrees of abduction). Analysis was carried out using the modified Berkeley's Mckay criteria and hip joint centralization, and evaluation was done using X-ray images according to the basic modified Severin classification system. Results: The use of Hb applied after overhead traction to (mean 22.8 days, confidence level (95%)) 68 hip joints showed a significant improvement (92%) in the treated hips. In summary, only one brace replacement was performed due to swelling of the thigh and fixation pressure, three cases suffered from hip joint redislocation after removing the Hb (5%), and one patient had bilateral avascular necrosis (2.8%). Conclusions: The use of Hb reduced avascular necrosis of the femur head, maintained higher hygiene conditions, and lowered both the risk of cast breakage and skin complications over the use of hip spica as compared to Hb. Hb is more cost-effective, and radiolucency is an additional advantage for this technique. Closed reduction and application of Hb after oral administration of a bolus dose of chlorpromazine chloride or phenobarbital resulted in complication avoidance of total anaesthesia.

A multimodal opioid-sparing pain management following total knee replacement.

OBJECTIVE: The purpose of this study is to compare the pain scores, opioid consumption, and range of motion of the operated knee after total knee replacement (TKR) in the 10-day follow-up period between a traditional opioid-containing pain management protocol and a multimodal opioid-sparing treatment protocol. METHODS: This prospective, randomized, single-center study included 90 patients (24 men and 66 women; mean age 69.7±7.2 years) undergoing TKR for osteoarthritis between October 2019 and October 2020. Patients were randomized into 3 cohorts for comparison: traditional opioid-containing pain management protocol (n=30), multimodal opioid-sparing pain management protocol (n=30), and traditional opioid-containing pain management protocol with additional local infiltration analgesia (LIA). Changes in visual analog scale for pain (VAS), range of motion (ROM), and opioid consumption were compared between groups. RESULTS: A lower mean postoperative VAS score was observed in the opioid-sparing cohort, which was statistically significant at all time points compared with the traditional cohorts. Mean total morphine consumption was significantly lower in the opioid-sparing cohort (2.7±5.8 MMEs) compared to the traditional (14.0±14.8 MMEs) and traditional with LIA cohorts (8.3±9.5 MMEs; p<0.05). The mean degree of flexion of the operated knee of patients was significantly greater in patients in the opioid-sparing group than in the other groups on the postoperative day 3 (opioid-sparing: 87.0±11.2°; traditional: 74.1±11.6°; traditional with LIA: 84.7±8.9°; p<0.05), as well as on day 10 (opioid-sparing: 99.3±10.8°; traditional: 87.3±12.4°; traditional with LIA: 92.5±9.7°; p<0.05). The rate of adverse events after TKR did not differ between the groups. CONCLUSION: The results of this study suggest that a multimodal opioid-sparing pain protocol after TKR, which includes oral non-opioid medications and periarticular injection with bupivacaine, provides better pain relief and early functional gains with fewer rescue opioids compared to traditional opioid-based protocols (Tab. 4, Fig. 2, Ref. 22).

Isolated Persistent Left Superior Vena Cava Associated With Autosomal Dominant Polycystic Kidney Disease (ADPKD): Challenges and Clinical Significance.

Persistent left superior vena cava (PLSVC) is the most common venous anomaly of the thorax that usually coexists with the right superior vena cava. However, in a minority of cases, there is only a PLSVC without a right superior vena cava which is called an isolated PLSVC. There are some reported anomalies that can co-occur with PLSVC; yet, none have reported an association with autosomal dominant polycystic kidney disease (ADPKD). In this case report, we describe a 41-year-old man with end-stage renal disease from ADPKD who underwent central venous catheterization (permacath) to initiate hemodialysis. Upon catheterization, a complete right internal jugular vein septum (bicuspid valve) was found, along with an isolated PLSVC that drained directly in the coronary sinus. We demonstrate the multiple challenges encountered during the catheterization procedure and we illustrate the anomaly with detailed images and supplementary videos. Furthermore, we discuss the coexistence of PLSVC with renal anomalies in the context of previous literature. To conclude, interventional radiologists should keep the possibility of PLSVC in mind, especially when difficulties are encountered during catheterization where proper characterization of the PLSVC type and associated anomalies is crucial for tailoring the best management approach. Moreover, an association between venous anomalies including left superior vena cava and renal anomalies may co-exist, and further studies are needed to explore this possible association.

COVID-19 Vaccine and Hyperosmolar Hyperglycemic State.

Coronavirus disease 2019 (COVID-19) is a multi-system disease that causes multiple complications. It is linked to the development of new-onset diabetes or unmasking of underlying diabetes. Despite the uncertain exact mechanism, pancreatic angiotensin-converting enzyme 2 (ACE2) receptor, the main enzyme related to COVID-19 pathophysiology has been implied. COVID-19 vaccine was authorized to help control the rapid spread of COVID-19 disease. We report a case of new-onset diabetes type 2 presenting as hyperosmolar hyperglycemic state (HHS) in a patient after receiving COVID-19 vaccine with some literature review of the potential mechanisms by which COVID-19 may cause new-onset diabetes type 2.

Tranexamic acid decreases the risk of revision for acute and delayed periprosthetic joint infection after total knee replacement.

OBJECTIVES: This study aims to analyze the effect of intravenous administration of tranexamic acid (TA) on reducing the risk of revision for acute and delayed periprosthetic joint infection (PJI) after primary total knee replacement (TKR). PATIENTS AND METHODS: This prospective observational cohort study included 1,529 TKRs (396 males, 1,133 females; mean age 67.8 years; range, 44 to 85.1 years) performed between January 2003 and October 2017. We analyzed the revision rate for acute and delayed PJI in a group of 787 TKRs with preoperatively intravenously administered TA (TA group) in comparison with a group of 742 TKRs without administration of TA (non-TA group). Multiple logistic regression analysis was used to evaluate significant predictors of TKR revision for acute and delayed PJI. RESULTS: Revision surgery due to PJI was recorded in one patient in the TA group and eight patients in the non-TA group. Cumulative revision rate of TKR was significantly lower in the TA group (0.13% vs. 1.08%, hazard ratio 0.113; 95% confidence interval [CI] 0.0147-0.937; p=0.043). Multivariate logistic regression analysis confirmed two predictors of revision: being aged over 75 years at the time of primary surgery (odds ratio [OR] 8.464; 95% CI: 2.016-35.54; p=0.004) and male gender (OR: 7.9; 95% CI: 1.879-33.26; p=0.005). The use of TA was shown as the significant protective factor (OR: 0.109; 95% CI: 0.0128-0.929; p=0.043). CONCLUSION: We have found a lower cumulative revision rate of TKR for acute and delayed PJI when TA was used. We think that the preoperative intravenous use of TA may be an effective, safe and inexpensive method for the prevention of PJI.

Liquid chromatography-mass spectroscopy and liquid chromatography-ultraviolet/visible photodiode array analysis of selected colchicum species.

An in-house strategy to dereplicate colchicinoid alkaloids was recently developed by our team. It aimed at quickly identifying Colchicum constituents using LC-MS (liquid chromatography-mass spectroscopy) and LC-UV/Vis PDA (liquid chromatography-ultraviolet/ visible photodiode array) techniques. In this project, our goal was to validate the developed method through analysing the alkaloid-rich fractions of three Colchicum species that had been previously studied phytochemically using the traditional bioactivity-guided fractionation methodology. The analysed species were Colchicum tauri Siehe ex Stefanoff, Colchicum stevenii Kunth, and Colchicum tunicatum Feinbr., all belonging to the family Colchicaceae. In addition to identifying the compounds previously isolated and characterized by the traditional methodology, the new strategy succeeded in tentatively identifying a set of known compounds, but new to the species.

Colchicinoids from Colchicum crocifolium Boiss. (Colchicaceae).

A new colchicinoid from Colchicum crocifolium Boiss. (Colchicaceae) was isolated and identified as N,N-dimethyl-N-deacetyl-(-)-cornigerine (5), along with four known compounds, but new to the species: (-)-colchicine (1), (-)-demecolcine (2), (-)-N-methyl-(-)-demecolcine (3) and 3-demethyl-N-methyl-(-)-demecolcine (4). All isolated compounds showed potent cytotoxicity against a human cancer cell panel.

Trace minerals status and antioxidant enzymes activities in calves with dermatophytosis.

The aim of this study was to determine the levels of trace minerals Zn, Cu, and Se, the effect of dermatophytosis on the level of thiobarbituric acid reactive substances (TBARS) as an indicator of lipid peroxidation, the status of enzymatic and nonenzymatic antioxidants, and the relationship between the mentioned trace minerals and antioxidant defense system in calves with dermatophytosis. A total of 21 Holstein calves with clinically established diagnosis of dermatophytosis and an equal number of healthy ones were included in this study. Results showed that 81% of mycotic isolates were Trichophyton verrucosum, while 19% were Trichophyton mentagrophytes. The level of Zn, Cu, Se, and glutathione (GSH) and the activity of the antioxidant enzymes, glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) were significantly (P

Determination of selected heavy metals in air samples from the northern part of Jordan.

In this work, the atmospheric concentrations of selected heavy metals including lead (Pb), iron (Fe), cadmium (Cd), copper (Cu), nickel (Ni), manganese (Mn), and zinc (Zn) were measured for two different sampling sites (urban and rural) in the northern part of Jordan (Irbid city). Samples were collected according to a certain schedule for 1 year. High volume air samplers and glass fiber filters were used to collect the samples. Collected samples were digested using a mixture of analytical grade nitric acid and analytical grade hydrochloric acid, and analyzed to evaluate the levels of heavy metals by atomic absorption spectrophotometry. Six heavy metals (Pb, Fe, Cu, Ni, Mn, and Zn) were measured in all samples; the concentrations of Cd and Co were not detected in Irbid atmosphere by atomic absorption spectroscopy. The results were used to determine the levels of heavy metal pollutants in air, possible sources, and to compare the levels of selected heavy metals in the two studied sites. Aerosols from the rural site have lower concentrations for all the metals compared to those from the urban site. The daily and monthly variations of the elements were investigated. All heavy metals in urban and rural sites reached maximum concentrations in June, July, and August. This is consistent with the increased activities leading to particulate matter emission during the summer period. The enrichment factors with respect to earth crust and correlation coefficients of heavy metals were investigated to predict the possible sources of heavy metals in air.

A single-step extraction method for the determination of nicotine and cotinine in Jordanian smokers' blood and urine samples by RP-HPLC and GC-MS.

A simple, rapid, reliable, and low cost one-step extraction method is developed and validated for the determination of nicotine and cotinine in human plasma and urine in smokers using reversed-phase high-performance liquid chromatography (RP-HPLC) and gas chromatography-mass spectrometry (GC-MS). The run times are 16 and 10 min for HPLC and GC-MS, respectively. The method is validated over a wide linear range of 1-5000 ng/mL with correlation coefficients being consistently greater than 0.9985. The criteria considered for validation are: limit of quantitation, linearity, accuracy, precision, recovery, specificity, and selectivity. This study is aimed to estimate the nicotine and cotinine in Jordanian smokers' blood and urine samples; to study the relationship between the concentration of nicotine in urine and plasma samples; and to investigate the effect of pH on the extraction of nicotine and cotinine in urine samples. In the presented study, one hundred blood and urine samples are collected from eighty smokers and twenty nonsmokers. Samples are taken from the same volunteer at the same time after each volunteer fills in a questionnaire. Results of nicotine concentrations in smokers' plasma are in the range of 181-3702 ng/mL with an average of 1263.1 ng/mL, whereas nicotine in urine samples is in the range of 1364-1972 ng/mL, with an average of 1618 ng/mL. Cotinine concentrations in smokers' plasma are in the range of 21-4420 ng/mL with an average of 379.4 ng/mL, whereas cotinine in urine is in the range of 6-3946 ng/mL with an average of 865 ng/mL. Statistical analysis indicates highly significant differences in nicotine and cotinine concentrations in smoker samples compared with nonsmoker samples (p<0.05).

Colchicinoids from Colchicum crocifolium Boiss.: a case study in dereplication strategies for (-)-colchicine and related analogues using LC-MS and LC-PDA techniques.

As a part of a project designed to investigate Colchicum species in Jordan, the chemical constituents of Colchicum crocifolium Boiss. (Colchicaceae) were investigated using LC-MS and LC-UV/Vis PDA. A decision tree for working with colchicinods has been developed by incorporating data from LC-UV/PDA and LC-MS. This dereplication strategy draws upon the UV/PDA spectra to classify compounds into one of four structural groups and combines this with retention time and mass spectra/molecular weight to identify the compounds. This strategy was applied on a small amount of extract (2 mg) of Colchicum crocifolium to dereplicate 10 known compounds from four different structural groups, namely (-)-demecolcine, 2-demethyl-(-)-colchicine or 3-demethyl-(-)-colchicine, N-deacetyl-(-)-colchicine, (-)-colchiciline, (-)-colchicine, beta-lumidemecolcine, 2-demethyl-beta-lumicolchicine or 3-demethyl-beta-lumicolchicine, N,N-dimethyl-N-deacetyl-beta-lumicornigerine, (-)-isoandrocymbine and (-)-autumnaline. Furthermore, a new compound was identi?ed as N,N-dimethyl-N-deacetyl-(-)-cornigerine. Three compounds, which had molecular ions at m/z 325, 340 and 374, could not be dereplicated into any obvious structural classes that have been isolated in our laboratories previously or reported in the literature.