¿Existe correlación metabólica hipoglucémica y el síndrome de Percheron? Reporte de caso

Introducción: El síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: Presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatologia inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: Los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome.

Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

Does TGFBR3 Polymorphism Increase the Risk of Silent Cerebral Infarction in Egyptian Children with Sickle Cell Disease?

Objectives To evaluate the relationship between TGFBR3 rs284875 single nucleotide polymorphism (SNP) state and silent cerebral infarction (SCI) in asymptomatic patients with sickle cell disease (SCD). Methods A cross-sectional study was conducted on 50 children with SCD above 2 y of age followed up at the hematology outpatient clinic of Alexandria University Children's Hospital in Egypt. Twenty-four healthy children were included as a control group. All patients included in the study were subjected to complete history and clinical examination. Real-time polymerase chain reaction was performed on patients and controls for identifcation of SNP rs284875 of the TGFBR3 gene. A magnetic resonance imaging (MRI) of the brain were performed only on patients for detection of SCI. Results Fifty SCD patients were enrolled (26 males and 24 females), with a median age of 10.9 y (2.3–17.8 y), and 24 children as healthy control for the studied SNP. Thirty-fve (70%) patients had homozygous SCD, while 30% had sickle ?-thalassemia. The brain MRI was normal in all the patients except for 2 patients who had features of SCI. The TGFBR3 rs284875 SNP was detected in 15 (30%) patients in the homozygous state (GG) versus only 1 (4.2%) child from the control group (p=0.003). The prevalence of SCI was low in the study population and there was no statistically signifcant relationship between the TGFBR3 rs284875 SNP status and the presence of SCI in the brain MRI (p=0.621). Conclusions This study confrmed a low prevalence of SCI in the SCD patient included in the study. The TGFBR3 rs284875 SNP did not signifcantly increase SCI among those patients.

A Case Report of Ischemic Stroke in an Adult Patient of Dengue Fever with Thrombocytopenia

Neurological complications in Dengue patients are extremely rare with 0.5-6% incidence including encephalopathy, Guillain Barre Syndrome, Brachial neuritis, Myelitis, Encephalomyelitis. Stroke as a neurological complication is extremely rare with very few cases reported previously. We present the case of a 69-year-old male with Dengue fever where the patient presented with persistent hiccups was found to have pontine infarct.

Application of magnetic resonance imaging in nerve fiber tract analysis in a mouse model of stroke / 中华行为医学与脑科学杂志

Objective:To evaluate the cerebral infarct volume and the nerve fiber connectivity between cortical and neurogenesis-related regions in the mouse model of reperfusion after middle cerebral artery occlusion (MCAO) by 11.7 Tesla(11.7 T) magnetic resonance imaging (MRI).Methods:MCAO models were established in SPF grade adult male C57BL/6 mice using the suture-occluded method.MRI scans were performed at 3 days before and 1 day after modeling.Infarct volumes were calculated, and nerve fiber tracking was performed on specific brain regions to analyze the nerve fiber number and the parameters of fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity (AD)and radial diffusivity(RD). SPSS 26.0 was used for statistical analysis, and paired t test was used to compare the data before and after modeling. Results:(1) After MCAO-induced ischemia, the infarct volume was up to (35.11±17.57)mm 3, and the FA value of the infarct area was significantly reduced compared with that of before modeling( t=4.73, P<0.01). (2) At the anterior-posterior(AP): + 1.2 mm section, the results of fiber tracking showed that compared with before modeling, the number of fiber bundles originating from the dorsal horn of the lateral sub-ventricle zone(SVZ)to the cortex reduced ((92 584.20±14 751.00) vs (59 815.60±6 752.46), t=4.87, P<0.01), and the number of fiber bundles projected to the infarcted area reduced ((107 671.40±10 497.57) vs (61 658.60±10 178.21), t=6.43, P<0.01). FA, AD, MD, and RD values were all decreased in different degrees( t=3.38-6.43, all P<0.05). (3) At the AP: -3.8 mm section, the number of fiber bundles originating from the dorsal horn of the SVZ to the cortex decreased (after modeling(96 944.00±18 331.09), before modeling(58 767.80±16 445.25), t=2.99, P<0.05), and the values of FA, AD, MD and RD decreased after ischemia ( t=7.30, 5.05, 6.74, 4.13, all P<0.05). Conclusion:The ultra-high field strength of 11.7 T MRI can accurately detect the following results that the number of nerve fiber bundles from the SVZ to the cortex or infarct area are both significantly reduced, and diffusion tensor parameters are consistently changed in mice after 1 day of ischemia-reperfusion.

The history, current situation and prospect of lacunar infarct / 中华神经科杂志

The modern concept of lacunar infarct is largely based on the meticulous postmortem work of Fisher from the 1950s to 1970s, which forms the basis of the"lacunar hypothesis". Along with the application of CT or MRI techniques and classification of ischemic stroke subtypes, the lacunar infarct was endowed with the profile of imaging diagnosis and stroke subtypes. Thus, the concept of lacunar infarct has far expanded the initial pathological meanings and the terminology and definitions for lacunar infarct vary widely. In this review, the historical pathological findings and the term evolution of lacunar infarct were systemically reviewed, with a focus toward future directions in the complex entity of lacunar infarct.

Glutamate-releasing BEST1 channel is a new target for neuroprotection against ischemic stroke with wide time window

Many efforts have been made to understand excitotoxicity and develop neuroprotectants for the therapy of ischemic stroke. The narrow treatment time window is still to be solved. Given that the ischemic core expanded over days, treatment with an extended time window is anticipated. Bestrophin 1 (BEST1) belongs to a bestrophin family of calcium-activated chloride channels. We revealed an increase in neuronal BEST1 expression and function within the peri-infarct from 8 to 48 h after ischemic stroke in mice. Interfering the protein expression or inhibiting the channel function of BEST1 by genetic manipulation displayed neuroprotective effects and improved motor functional deficits. Using electrophysiological recordings, we demonstrated that extrasynaptic glutamate release through BEST1 channel resulted in delayed excitotoxicity. Finally, we confirmed the therapeutic efficacy of pharmacological inhibition of BEST1 during 6-72 h post-ischemia in rodents. This delayed treatment prevented the expansion of infarct volume and the exacerbation of neurological functions. Our study identifies the glutamate-releasing BEST1 channel as a potential therapeutic target against ischemic stroke with a wide time window.

Disección Aórtica Tipo A como diagnóstico diferencial potencialmente letal de dolor torácico: revisión de casos / Type A Aortic Dissection as a potentially lethal differential diagnosis of chest pain: case Review

Chest pain (CP) is a frequent reason for consultation in emergency departments (ED). It responds to a broad spectrum of pathologies, ranging from banal causes to severe conditions with high mortality. The clinician must be able to distinguish prompt when CP is due to severe pathology and thus make a timely intervention for the patient's benefit. Acute Aortic Syndrome (AAS) is one of the potentially fatal causes of CP. Within this syndrome, we find aortic dissection (AD), intramural hematoma and atherosclerotic penetrating ulcer. AD is the most frequent presentation of AAS. Although it is not a common condition, its high lethality and low suspicion make it of particular interest as a differential diagnosis of CP. The following are two clinical cases of AD of the ascending aortic treated at the Hospital Regional de Talca (HRT) to analyse the clinical characteristics that help to differentiate this condition, the main electrocardiographic and imaging findings, as well as some of its complications and management.

A rare case of cortical blindness following vaccination against SARS-CoV-2

A 61-year-old male presented with sudden loss of vision in both the eyes about 8 days after the first shot of coronavirus disease 2019 (COVID-19) vaccine (Covishield). On examination, the visual acuity was no perception of light in both the eyes. Contrast-enhanced magnetic resonance imaging (MRI) with diffusion-weighted imaging showed acute cerebral infarcts involving bilateral parieto-occipital region. Considering the temporal correlation with the vaccine shot and absence of any other precipitating factor, we hypothesized that this was probably an immunologic response to the vaccine.

Ischemic Stroke in Dengue Fever: Unusual Complication of a Common Disease

Dengue fever is an arboviral infection, which is highly prevalent in tropical and subtropical climates. It is frequently associated with neurological complications but its association with ischemic stroke is ill defined. We present a case of an apparently healthy young male admitted with dengue fever complicated by ischemic infarct in corpus callosum. Our patient was managed conservatively, improved clinically and discharged in satisfactory condition.

Xylometazoline Induced Isolated Left Medial Cerebellar Peduncle Infarct: A Rare Case Report

Xylometazoline, a sympathomimetic available as over the counter drug, acts as a nasal decongestant and has been reported as an independent risk factor for hemorrhagic and ischemic stroke. The chronic use of xylometazoline leads to either increased release of more potent vasoconstrictor norepinephrine in the presynaptic region, or acts directly on central adrenoreceptors which leads to dysfunction resulting in chronic progressive vasculopathy that manifests as an ischemic stroke. Sympathomimetics also activate 12-lipoxygenase pathways which induce proliferation and migration of vascular smooth muscle cells. 12-lipoxgenase also plays a significant role in regulating the degree and stability of platelet activation, as its activation significantly strengthens platelet activation and uncontrolled platelet activation, which may lead to myocardial infraction and stroke. The present case reports a rare case of young adult suffering from isolated left medial cerebellar peduncle infarct related to the chronic use of xylometazoline. Acute cerebellar stroke is rare, especially in young adults and represent only 3% of total ischemic and hemorrhagic strokes. Clinical symptoms, patient age at the onset of stroke, and lesion size had no significant effect on the clinical outcome. Symptoms are frequently underestimated and misdiagnosed which further lead to serious complications and poor functional outcomes.

Síndrome coronario agudo en el servicio de emergencias del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas

RESUMEN Introducción: el infarto agudo de miocardio con elevación del segmento ST como parte del síndrome coronario agudo, es una afección frecuente que cursa con una elevada mortalidad. En los últimos años, las enfermedades cardiovasculares han constituido la primera causa de muerte en Cuba, y en 2018 lo fueron en la provincia de Matanzas. Objetivo: caracterizar la morbimortalidad de los pacientes atendidos con síndrome coronario agudo. Materiales y métodos: se realizó un estudio transversal, descriptivo de 106 pacientes ingresados con diagnóstico de síndrome coronario agudo en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, en 2019. Resultados: 83 % de los pacientes llegaron en trasporte sanitario a la Unidad de Emergencia. El grupo de edad más afectado fue el de 70 a 79 años (28,30 %). Predominó el sexo masculino, con 51,89 %. El síndrome coronario agudo con elevación del segmento ST prevaleció sobre el síndrome coronario agudo sin elevación del segmento ST, en un total de 58 pacientes. El mayor número de casos se diagnosticó en los meses de invierno y en horas de la mañana. Prevaleció el tratamiento trombolítico en las primeras seis horas de iniciados los síntomas. Se demostró la desaparición del dolor y la regresión de los cambios electrocardiográficos como resultados de la reperfusión. Las arritmias malignas constituyeron la principal causa de muerte en los pacientes no trombolizados. Conclusiones: el uso de la trombólisis en servicios de emergencias disminuyó la mortalidad en las primeras horas, por enfermedades cardiovasculares, en la provincia de Matanzas en 2019.

ABSTRACT Introduction: Acute myocardium infarct with elevation of the ST segment as a part of the acute coronary syndrome, is a frequent disease that causes a high mortality. In the last years, cardiovascular diseases have constituted the first cause of death in Cuba, and in 2018 they were in the province of Matanzas. Objective: to characterize morbidity and mortality in patients attended with acute coronary syndrome. Materials and methods: a cross-sectional, descriptive study was carried out in 106 patients admitted with diagnosis of acute coronary syndrome in the Unit of Emergent Intensive Care of the Teaching Clinical-surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas, in 2019. Results: 83 % of patients arrived in sanitary transportation to the Emergency Unit. The most affected age group was the one aged 70-79 years (28.30 %). Male sex predominated, with 51.89 %. Acute coronary syndrome with elevation of ST segment prevailed over the acute coronary syndrome without elevation of the ST segment, in a total of 58 patients. The biggest number of cases was diagnosed in the winter months and in the morning. Thrombolytic treatment prevailed in the first six hours after the beginning of the symptoms. There it was demonstrated the disappearance of the pain and the regression of the electrocardiographic changes as a result of the reperfusion. Malignant arrhythmias were the main causes of death in non thrombolyzed patients. Conclusions: the use of thrombolysis in emergency services diminished mortality caused by cardiovascular diseases in the first hours in the province of Matanzas in 1919.

Effects of pre-treatment with metoprolol and diltiazem on cerebral ischemia/reperfusion-induced injuries

Abstract Stroke is one of the most important health concerns worldwide. Calcium ions accumulation in the nerve cells and increase in the catecholamines level of the brain following cerebral ischemia/reperfusion (I/R) are accompanied by damaging effects. Therefore, the present study aimed to evaluate the effects of diltiazem, as a calcium channel blocker, and metoprolol, as a β-adrenoceptors antagonist, on I/R injury. In this study, 30 male Wistar rats were divided into control, I/R, metoprolol, diltiazem, and metoprolol plus diltiazem groups (n=6 in each). Metoprolol (1 mg/kg/day) and diltiazem (5 mg/kg/day) were injected intraperitoneally (i.p.) for 7 days before I/R induction. On day 8, the animals underwent ischemia by bilateral common carotid arteries occlusion for 20 min. Histopathological analysis showed a significant reduction in leukocyte infiltration in diltiazem, metoprolol, and diltiazem plus metoprolol treated rats compared with the I/R group (P<0.05, P<0.01, P<0.01, respectively). In addition, in all treated groups, myeloperoxidase activity and malondialdehyde levels in the brain tissue significantly declined compared with the I/R group (P<0.001). Furthermore, pre-treatment with diltiazem and metoprolol alone or in co-administration remarkably reduced infarct size following I/R (P<0.001). Overall, the results indicate the considerable neuroprotective effects of metoprolol and diltiazem in cerebral I/R.

Lingbao Huxin Pill Alleviates Apoptosis and Inflammation at Infarct Border Zone through SIRT1-Mediated FOXO1 and NF- κ B Pathways in Rat Model of Acute Myocardial Infarction / 中国结合医学杂志

OBJECTIVE@#To investigate whether Lingbao Huxin Pill (LBHX) protects against acute myocardial infarction (AMI) at the infarct border zone (IBZ) of myocardial tissue by regulating apoptosis and inflammation through the sirtuin 1 (SIRT1)-mediated forkhead box protein O1 (FOXO1) and nuclear factor-κ B (NF-κ B) signaling pathways.@*METHODS@#Six-week-old Wistar rats with normal diet were randomized into the sham, the model, Betaloc (0.9 mg/kg daily), LBHX-L (0.45 mg/kg daily), LBHX-M (0.9 mg/kg daily), LBHX-H (1.8 mg/kg daily), and LBHX+EX527 (0.9 mg/kg daily) groups according to the method of random number table, 13 in each group. In this study, left anterior descending coronary artery (LADCA) ligation was performed to induce an AMI model in rats. The myocardial infarction area was examined using a 2,3,5-triphenyltetrazolium chloride solution staining assay. A TdT-mediated dUTP nick-end labeling (TUNEL) assay was conducted to assess cardiomyocyte apoptosis in the IBZ. The histopathology of myocardial tissue at the IBZ was assessed with Heidenhain, Masson and hematoxylineosin (HE) staining assays. The expression levels of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-1 β, and intercellular adhesion molecule-1 were measured using enzyme-linked immunosorbent assays (ELISAs). The mRNA expressions of SIRT1 and FOXO1 were detected by real-time qPCR (RT-qPCR). The protein expressions of SIRT1, FOXO1, SOD2, BAX and NF- κ B p65 were detected by Western blot analysis.@*RESULTS@#The ligation of the LADCA successfully induced an AMI model. The LBHX pretreatment reduced the infarct size in the AMI rats (P<0.01). The TUNEL assay revealed that LBHX inhibited cardiomyocyte apoptosis at the IBZ. Further, the histological examination showed that the LBHX pretreatment decreased the ischemic area of myocardial tissue (P<0.05), myocardial interstitial collagen deposition (P<0.05) and inflammation at the IBZ. The ELISA results indicated that LBHX decreased the serum levels of inflammatory cytokines in the AMI rats (P<0.05 or P<0.01). Furthermore, Western blot analysis revealed that the LBHX pretreatment upregulated the protein levels of SIRT1, FOXO1 and SOD2 (P<0.05) and downregulated NF- κ B p65 and BAX expressions (P<0.05). The RT-qPCR results showed that LBHX increased the SIRT1 mRNA and FOXO1 mRNA levels (P<0.05). These protective effects, including inhibiting apoptosis and alleviating inflammation in the IBZ, were partially abolished by EX527, an inhibitor of SIRT1.@*CONCLUSION@#LBHX could protect against AMI by suppressing apoptosis and inflammation in AMI rats and the SIRT1-mediated FOXO1 and NF- κ B signaling pathways were involved in the cardioprotection effect of LBHX.

Clinical value of common laboratory indexes in evaluating infarct size of ischemic stroke / 中国医师杂志

Objective:To explore the level changes of common laboratory indexes in patients with ischemic stroke (IS) with different infarct sizes and their clinical application value.Methods:The baseline data of 237 patients hospitalized in Lanzhou University Second Hospital from June 2019 to December 2020 and their laboratory indicators within 24 hours of admission were collected. The patients were divided into lacunar group ( n=80) and infarct group ( n=157) according to the infarct area. The experimental indexes and clinical data of the two groups were compared. Binary logistic regression was used to screen the independent influencing factors of infarct size and establish a joint diagnostic model. The receiver operating characteristic (ROC) curve and model calibration chart were used to verify the clinical application value of each index. Results:The levels of cholesterol (CHO)/high density lipoprotein (HDL), low density lipoprotein (LDL)/HDL, neutrophil count, Cystatin C (Cys C), phosphorus (PHOS), indirect bilirubin (IBIL), LDL, apolipoprotein (ApoB), homocysteine (HCY), D-dimer, smoking, drinking, overweight and arterial stenosis in the infarct group were higher than those in the lacunar group (all P<0.05), and the levels of apolipoprotein A Ⅰ (ApoAⅠ)/ApoB, ApoAⅠ and carbon dioxide (CO 2) in the infarct group were lower than those in the lacunar group (all P<0.05). ApoA Ⅰ/ApoB and CO 2 were independent protective factors of infarct size (all P<0.05); Cys C, PHOS and IBIL were independent risk factors of infarct size (all P<0.05). The combined prediction model of CO 2, PHOS, IBIL, ApoA Ⅰ/ApoB and Cys C has good prediction efficiency for infarct area, and the area under the curve (AUC) of combined diagnosis was 0.739. Conclusions:Laboratory indicators are closely related to the infarct size of IS. The model developed in this study have good clinical value, which provides a new basis for IS evaluation and early warning.

Stroke syndrome: A case of a Nine syndrome with a DWI-negative imaging

@#The brainstem contains important structures that give an array of clinical manifestations in pathologic processes. Here, we report a case of “Nine Syndrome” who was admitted in our institution with no acute findings on DWI sequence. The exact prevalence of Nine Syndrome has been accounted to only four cases reported in the literature and this is due to a pontine tegmentum lesion. Our patient is a 65 year-old male who presented with five-hour history of sudden onset of symptoms presented as ipsilateral gaze palsy, internuclear ophthalmoplegia, a lower motor neuron type of facial palsy, and a contralateral hemiparesis. Using a 1.5T MR cranial scanner and Philips scanner of the time-of-flight of the intracranial vessels, no evidence of acute territorial infarct but an old lacunar infarct was seen in the right pontine area. Both the anterior and posterior circulations are within normal course and caliber with no narrowing seen. Patient was started on dual anti-platelet, high dose statin, and anti-hypertensives on the fourth hospital day. Nine syndrome is a rare case, and its diagnosis rely on its clinical manifestations, neuroanatomy, and diagnostic imaging. An acute posterior ischemic infarct such as this may yield a negative DWI finding but should not impede the clinician in its early recognition and management.

Pituitary Apoplexy, Meningitis and Cerebral Infarction - A Perplexing Trifecta

Pituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together. We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.

Complexus cordis / Complexus cordis

Resumen El estudio científico del corazón nos ha permitido conocer su estructura y función profundamente, mediante la fragmentación y el análisis de sus partes, atendiendo a las pautas del método que tantos logros nos ha dado. Sin embargo, al momento de volver a ensamblar esos fragmentos analizados nos percatamos de que algo falta; simplemente la suma de las partes no hace al todo. Es así que, desde hace décadas, numerosos científicos han estudiado estrategias novedosas que permitan entender los fenómenos naturales desde modelos más incluyentes, abiertos e integradores, que atiendan con cercanía a las interacciones más que a los componentes. De esta manera, observamos que muchas variables suelen transgredir el plano convencional y parten hacia la no linealidad y la fractalidad, formando un tejido complejo que mantendrá su estructura mientras termodinámicamente sea viable. Así, en este documento se muestra la manera en que el estudio no lineal de la dinámica compleja cardiovascular comienza a darnos luz en muchas de las preguntas que a diario se plantea el cardiólogo clínico.

Abstract The science-based study of the heart has allowed us to know its structure and function deeply, through the fragmentation and analysis of its parts, following the guidelines that so many achievements have given to us. However, at the time of reassembling those analyzed fragments, we realize that something is missing; the simply sum of the parts is not equal to everything. Thus, for decades, numerous scientists have studied novel strategies that allow us understanding, every natural phenomena from a more inclusive, open and integrative models, which closely address to interactions rather than components. In this way, we can observe how, the behavior of many variables usually transgress the conventional plane and moves towards non-linearity and fractality, making a complex tissue that will maintain its structure while thermodynamically viable. Thus, this document shows the way how, the non-linear study of complex cardiovascular dynamics, begins to give us answers to many questions that the clinical cardiologist poses every day.

Insuficiencia renal aguda transitoria después de trombólisis coronaria con estreptoquinasa / Transient acute renal failure after coronary thrombolysis with streptokinase

Introducción: En la actualidad existen más de 150 medicamentos relacionados con la aparición de rabdomiólisis e insuficiencia renal aguda transitoria. La estreptoquinasa puede ser uno de ellos. Objetivo: Presentar un caso en el cual la administración de trombólisis con estreptoquinasa pudiera estar relacionado con una insuficiencia renal aguda transitoria. Caso clínico: Paciente de 38 años, con antecedentes de salud anterior y creatinina de 81 mg/L días antes del ingreso, sufrió infarto miocárdico agudo y después de la trombólisis con estreptoquinasa presentó dolores musculares intensos, náuseas, vómitos y lumbalgia intensa. La creatinina ascendió progresivamente; tuvo oligoanuria progresiva que evolucionó hasta las dos semanas y luego se recuperó. A los 21 días, la creatinina estaba en 116 mg/L. En la coronariografía, las coronarias son normales. Comentarios: Las causas de insuficiencia renal aguda transitoria pudieran ser, rabdomiólisis asociada con alteraciones del metabolismo del ATP y trastornos inmunológicos provocados por la administración de estreptoquinasa. La coronariografía resultó normal(AU)

Introduction: There are currently more than 150 medications related to the appearance of rhabdomyolysis and transient acute renal failure. Streptokinase can be one of them. Objective: Presenting a case the administration of streptokinase as a possible cause of acute, transient renal failure. Case report: A 38-year-old patient with a previous health history and 81 mg creatinine per liter days before admission, suffers acute myocardial infarction and after streptokinase thrombolysis he suffers severe muscle pain, nausea, vomiting, severe low back pain, creatinine ascends progressively and progressive oligoanuria that evolves until two weeks when it begins to return. At 21 days with 116 mg creatinine per liter, coronary angiography was performed with normal coronaries. Comments: The causes of transient acute renal failure may be rhabdomyolysis associated with abnormalities of the metabolism of ATP and immune disorders, caused by the administration of streptokinase. His coronary angiography was completely normal(AU)

Acute Myocardial Infarction in Chinese Medicine Hospitals in China from 2006 to 2013: An Analysis of 2311 Patients from Hospital Data / 中国结合医学杂志

OBJECTIVE@#To assess the trends in characteristics, treatments, and outcomes of acute myocardial infarction (AMI) patients in tertiary Chinese medicine (CM) hospitals in China between 2006 and 2013.@*METHODS@#This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years (2006 and 2013). Patients admitted to the hospital for AMI were enrolled. Hospital records were used as the data source. Case data were derived regarding baseline characteristics, treatments, and outcomes of patients to assess changes from 2006 to 2013. Logistic regression was used to analyze the relationship between prognosis, general influencing factors of disease, and various treatment measures.@*RESULTS@#Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013 (18 were repetitive) were surveyed. A total of 2,311 patients with AMI were enrolled (1,094 cases in 2006 and 1,217 cases in 2013). From 2006 to 2013, the mean age did not significantly change, but the proportion of patients younger than 65 years increased. The prevalence of risk factors such as hypertension, diabetes, and hyperlipidemia also increased. Significant increases were observed in primary percutaneous coronary intervention [20.48% (2006) vs. 24.90% (2013)] and revascularization [36.11% (2006) vs. 52.42% (2013)]. In-hospital mortality decreased from 11.15% in 2006 to 10.60% in 2013. A mortality logistic regression analysis identified reperfusion therapy [odds ratio (OR), 0.222; 95% confidence interval (CI), 0.106-0.464], Chinese patent medicines (OR, 0.394; 95% CI, 0.213-0.727), and CM decoctions (OR, 0.196; 95% CI, 0.109-0.353) as protective factors.@*CONCLUSION@#Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly, but in-hospital mortality has not significantly decreased. Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.