RESUMEN
Takotsubo cardiomyopathy is characterised by reversible systolic dysfunction resulting from catecholamine-induced vasospasm, mainly triggered by intense emotional or physical stress. Adding adrenaline to arthroscopic irrigation solution enhances visibility by minimising bleeding. However, there is a risk of complications due to systemic absorption. Several severe cardiac consequences have been described. Here, we present a case of a patient who underwent elective shoulder arthroscopy involving an adrenaline-containing irrigation solution. Forty-five minutes after surgery began, he developed ventricular arrhythmias with hemodynamic instability, necessitating vasopressor support. Bedside transthoracic echocardiography revealed severe left ventricular dysfunction with basal ballooning, and emergent coronary angiography revealed normal coronary arteries. These findings correspond to a reverse variant of takotsubo cardiomyopathy. The patient was transferred to the intensive cardiac care unit sedated, ventilated and hemodynamically supported. Three days following the procedure, he was successfully weaned from vasopressors and mechanical ventilation. Transthoracic echocardiography 3 months after surgery demonstrated complete left ventricular function recovery. Although complications due to adrenaline-containing irrigation solutions are rare, a growing body of case reports should prompt consideration of the safety of this practice.
RESUMEN
Herein we present a microfluidic-multiplexed platform that integrates electrochemical sensors based on carbon nanotubes associated with ferrocene as redox marker (carbon nanotube (CNT)/ferrocene) for direct detection of pathogenic viral DNA from Hepatitis C and genomic DNA from Mycobacterium tuberculosis in clinical isolates. By operating the fluidic device under high flow (150 µl/min), the formation of a very thin depletion layer at the sensor surface (δS = 230 nm) enhances the capture rate up to one DNA strand per second. By comparison, this capture rate is only 0.02 molecule/s in a static regime without flow. This fluidic protocol allows thus enhancing the limit of detection of the electrochemical biosensor from picomolar in bulk solution to femtomolar with a large dynamic range from 0.1 fM to 1 pM. Kinetics analysis also demonstrates an enhancement of the rate constant of electron transfer (kS) of the electrochemical process from 1 s(-1) up to 6 s(-1) thanks to the geometry of the miniaturized fluidic electrochemical cell. This microfluidic device working under high flow allows selective direct detection of a Mycobacterium tuberculosis (H37Rv) rpoB allele from clinical isolate extracted DNA. We envision that a microfluidic approach under high flow associated with a multiwall CNT/ferrocene sensor could find useful applications as the point-of-care for multi-target diagnostics of biomarkers in real samples.