Is Colchicine a New Game-Changer in Patients With Acute Coronary Syndrome?

Colchicine, an anti-inflammatory drug, was declared as a potently cheap and effective drug in treating atherosclerosis. This report is a detailed understanding and an in-depth interpretation of the colchicine cardiovascular outcomes trial (COLCOT) that has taken place in recent years. It is a secondary quantitative study that has reviewed studies discussing the role of colchicine in myocardial infarction, inflammation, ST-elevation myocardial infarction, and in general, acute coronary syndrome (ACS). Different trials statistically proved colchicine's role in ACS by lowering the levels of high c-reactive protein, decreasing low attenuation plaque volume, and stabilizing plaque. Hence, in other words, it has been revealed that this drug has potential in the management of ACS. Colchicine reported promising results in reducing the risk of recurrent myocardial infarction, stroke, and sudden cardiac arrest, playing a massive role in lowering inflammation and the mortality caused by cardiovascular diseases.

Molecular Epidemiological Surveillance of CTX-M-15-producing Klebsiella pneumoniae from the patients of a teaching hospital in Sindh, Pakistan.

Background  The presence of Extended-spectrum ß-lactamase (ESBL) positive bacteria in hospital setting is an aggravating influential factor for hospitalized patients, and its consequences may be hazardous. Therefore, there is a need for rapid detection methods for newly emerging drug-resistant bacteria. This study was aimed at the molecular characterization of ESBL-positive  Klebsiella pneumoniae isolates recovered from clinical samples.   Methods  A total of 513  K. pneumoniae isolates were obtained from various clinical samples during June 2019 to May 2020. The collected isolates were investigated for antimicrobial susceptibility (antibiogram), and PCR and DNA sequencing were performed to analyse the ESBL genes.   Results  Among the 513 isolates, as many as 359 (69.9%) were ESBL producers and 87.5% were multi-drug resistant, while none had resistance to imipenem. PCR scored 3% blaTEM, 3% blaSHV, and 60% blaCTX-M-15 genes for the tested isolates.   Conclusion  The study showed that CTX-M-15 was the major prevalent ESBL type among the isolates. Additionally, all the isolates were susceptible to carbapenems. Screening and detection of ESBL tests are necessary among all isolates from the enterobacteriaceae family in routine microbiology laboratory to prevent associated nosocomial infections. A larger study is essential to understand molecular epidemiology of ESBL producing organisms to minimize morbidities due to these multidrug resistant organisms.

Displaced intracapsular fracture complicating transient osteopoenia of the hip in pregnancy: timing of surgery.

A patient who presented with a displaced subcapital fracture of the proximal femur in her third trimester of pregnancy is reported. Following delivery of the baby with an emergency caesarean section, the fracture was immediately reduced and fixed using cannulated screws. The outcome of her fracture management for this rare condition is discussed. Only seven cases have been reported in the literature and we review the possibility that this condition may be a systemic rather than a purely localised problem as previously believed.

Two Year Outcomes, Cognitive and Behavioral Markers of Decline in Healthy, Cognitively Normal Older Persons with Global Deterioration Scale Stage 2 (Subjective Cognitive Decline with Impairment).

BACKGROUND: Little is known with respect to behavioral markers of subjective cognitive decline (SCD), a condition initially described in association with Global Deterioration Scale (GDS) stage 2. OBJECTIVE: Two-year interval behavioral markers were investigated herein. METHODS: Subjects from a published 7-year outcome study of GDS stage 2 subjects were selected. This study had demonstrated a hazard ratio of 4.5 for progression of GDS stage 2, in comparison with GDS stage 1 (no subjective or objective cognitive decline) subjects, after controlling for demographic and temporal variables. Because GDS 2 subjects have previously demonstrated impairment in comparison with healthy persons free of complaints, we herein suggest the terminology "SCD(I)" for these persons. 98 SCD(I) persons, 63 women and 35 men, mean baseline age, 67.12±8.75 years, with a mean educational background of 15.55±2.60 years, and mean baseline MMSE scores of 28.9±1.24 were followed for 2.13±0.30 years. RESULTS: Observed annual decline on the GDS was 6.701% per annum, very close to a 1986 published estimate. At follow up, the MMSE, and 7 of 8 psychometric tests did not decline significantly. Of 21 Hamilton Depression Scale items, 2 improved and the remainder were unchanged. Anxieties declined from multiple perspectives. The Brief Cognitive Rating Scale (BCRS) declined significantly (p < 0.001), with component declines in Remote memory (p < 0.01), and Functioning/self-care (p = 0.01). CONCLUSION: SCD(I) persons decline at an annual rate of approximately 6.7% /year from several recent studies. The BCRS assessments and the Digit Symbol Substitution Test can be sensitive measures for future studies of progression mitigation.

A Review of the Mechanism of Antagonism of N-methyl-D-aspartate Receptor by Ketamine in Treatment-resistant Depression.

The biochemical processes involved in depression go beyond serotonin, norepinephrine, and dopamine. The N-methyl-D-aspartate (NMDA) receptor has a major role in the neurophysiology of depression. Ketamine, one of the prototypical NMDA antagonists, works rapidly in controlling depressive symptoms, including acutely suicidal behavior, by just a single injection. Ketamine may rapidly increase the glutamate levels and lead to structural neuronal changes. Increased neuronal dendritic growth may contribute to synaptogenesis and an increase in brain-derived neurotrophic factor (BDNF). Activation of the mechanistic target of rapamycin (mTOR), as well as increased levels of BDNF, may increase long-term potentiation and result in an improvement in the symptoms of depression. The mechanisms of ketamine's proposed effect as an off-label treatment for resistant depression are outlined in this paper.

An unusual complication of knee arthroscopy: portal site synovial cyst.

We describe a previously un-reported case of a large synovial cyst developing in the portal site 10 years post knee arthroscopy. The pathology, indications and method of treatment are discussed.

Presentation of compartment syndrome without an obvious cause can delay treatment. A case report.

Compartment syndrome is a serious condition which leads to chronic morbidity unless an urgent decompression of the affected area is performed. An increased intra compartmental pressure commonly occurs after a physical insult though rarer causes have been identified. We report an atypical presentation of compartment syndrome and subsequent delayed intervention where there was no identifiable aetiological factor. Frontline medical staff must rule out compartment syndrome early so that complications secondary to compartment syndrome can be avoided.