Spontaneous omental bleeding in the setting of dual anti-platelet therapy with ticagrelor.

A 68 year-old man, initially managed with primary percutaneous coronary intervention (PCI) to the right coronary artery (RCA) for an inferior ST elevation myocardial infarction (STEMI) with residual disease requiring coronary artery bypass graft surgery (CABG), re-presented with chest pain. There were no acute ischaemic changes on ECG and his pain settled with nitrates. A day later, he developed left sided abdominal pain and hypovolaemic shock after straining in the toilet. A subsequent computed tomography (CT) scan of his abdomen revealed an omental bleed. He proceeded to emergency laparotomy, recovered well, and was discharged on aspirin and clopidogrel. Apart from dual antiplatelet therapy with aspirin and ticagrelor, and presumed raised intra-abdominal pressure, there were no other identified risk factors for increased bleeding.

The big parade: emerging percutaneous mitral and tricuspid valve devices.

Over the last decade, percutaneous intervention for the treatment of aortic stenosis has become commonplace with >300,000 implantations performed worldwide. With this now being an established therapy, focus has shifted to the more intricate challenge of mitral and tricuspid valve disease, where there remains a large population of patients with unmet clinical needs. These complex anatomical structures demand unique approaches to treat a wide range of pathologies involving the valve leaflets, annulus and chordae. A large armamentarium of devices is under evaluation in preclinical animal studies or preliminary clinical trials. Herein, we review the technical characteristics of mitral and tricuspid devices in current clinical application and summarise the available data concerning their use in humans.

Sputum Conversion and Treatment Success among Tuberculosis Patients with Diabetes Treated under the Tuberculosis Control Programme in an Urban Setting in South India.

BACKGROUND: Studies from India on sputum conversion and tuberculosis (TB) treatment outcomes among TB patients with diabetes are limited. OBJECTIVE: The objective of this study is to estimate the proportion of sputum smear conversion and successful treatment outcomes among diabetic-TB patients treated under Revised National TB Control Programme (RNTCP). METHODOLOGY: Information on TB disease, diabetes, sputum conversion, and treatment outcomes were collected from treatment cards of adult TB patients (age >18 years) treated in the District TB Centre TB Unit, Tiruchirapalli, Tamil Nadu from July 1, 2014, to October 31, 2015. RESULTS: Diabetes was documented in 163 (14%) of 1131 TB patients. Sputum conversion was in 107 (94%) of 114 smear positive-TB patients. Successful TB treatment outcome was in 116 (85%) of 136 patients and 107 (86%) of 124 new TB patients. CONCLUSION: Sputum conversion was as per RNTCP target while treatment success rate among the new TB patients with diabetes was suboptimal.

Antecedents to cardiac arrests in a hospital equipped with a medical emergency team.

BACKGROUND: Studies conducted before the conception of medical emergency teams (METs) revealed that cardiac arrests were often preceded by deranged vital signs. METs have been implemented in hospitals to review ward patients whose conditions are deteriorating in order to prevent adverse events, including cardiac arrest. Antecedents to cardiac arrests in a MET-equipped hospital have not been assessed. OBJECTIVES: To determine what proportion of patients who had cardiac arrests had documented MET criteria before the arrest, and what proportion had a premorbid status suggesting they were unsuitable resuscitation candidates. DESIGN AND SETTING: Prospective observational study of cardiac arrests at the Austin Hospital, Melbourne, Australia, 1 April - 30 September 2010. Data were obtained from the patients' records and electronic "respond blue" database. MAIN OUTCOME MEASURES: Patients' premorbid medical condition and functional status; prior "not-for-resuscitation" (NFR) order; presence or absence of a MET call before cardiac arrest; time and rhythm of cardiac arrest; and in hospital mortality. RESULTS: 27 patients had a cardiac arrest during the study period, 22 of whom had no prior documented NFR order. Among these 22 patients, 18 (82%) had an initial rhythm of asystole or pulseless electrical activity, and 16 (73%) died in hospital. Fifty per cent of arrests were detected between midnight and 08:00. All six patients classified as unsuitable resuscitation candidates died in hospital, and there were trends for increased age and poorer functional status when compared with suitable candidates. A further six patients had documented MET criteria in the 6 hours before the arrest, but did not receive MET review. CONCLUSIONS: In this 6-month audit, about half the patients with cardiac arrest may have been unsuitable for resuscitation, or had objective warning signs that were not acted on. Further improvements in advanced care planning and optimisation of MET activation may further reduce cardiac arrest calls at our hospital.