Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality.

PURPOSE: Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. MATERIALS AND METHODS: This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. RESULTS: Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. CONCLUSIONS: Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs.

In-stent restenosis nine years after initial placement of a drug-eluting stent.

In-stent restenosis after drug-eluting stent implantation is a rare event and the time frame of restenosis occurrence is less well understood for drug-eluting stent. We describe the case of a patient who presented with an acute coronary syndrome and was found to have severe focal in-stent restenosis in a drug-eluting stent that was placed 9 years earlier.

Administration of Rotaglide™ solution for treating refractory severe radial artery spasm: A case report.

Severe radial artery spasm is a complication of transradial cardiac catheterization. We describe a case of severe radial artery spasm causing catheter entrapment. The spasm was refractory and resistant to intra-arterial vasodilators, systemic vasodilators, and moderate sedation. Rotaglide™ (Boston Scientific, Marlborough, MA) solution via continuous infusion was delivered through the catheter and then the sheath, resolving the spasm and allowing the removal of the catheter and sheath without injury to the radial artery.

Race, contrast-induced nephropathy and long-term outcomes after coronary and peripheral angiography and intervention.

BACKGROUND: Contrast-induced nephropathy (CIN) is a complication of diagnostic angiography and percutaneous coronary and endovascular intervention. We investigated the effect of race on the development of CIN. METHODS: We studied 4070 predominantly male patients undergoing peripheral and coronary angiography and percutaneous coronary and endovascular intervention. We analyzed the incidence of CIN at 72 h, of renal dysfunction at 3 months as well as the long-term incidence of hemodialysis and of death. RESULTS: The mean age was 67.2 years. CIN occurred in 92 (7.1%) Caucasian patients and in 42 (6.6%) non-Caucasians at 72 h after the procedure (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.74-1.57; P = 0.69). At 3 months, renal dysfunction was seen in 231 (11.24%) Caucasian patients versus 121 (11.52%) of the non-Caucasian group (OR 0.97, CI 0.77-1.23; P = 0.81). After a follow-up of 5 years, of the 4070 patients, 17 patients (0.64%) of the Caucasian group were placed on dialysis versus 27 (1.88%) of the non-Caucasian group (OR 0.34, 0.18-0.62; P = 0.0004) and 535 (20.28%) of the Caucasian patients had died compared to 293 (20.44%) of the non-Caucasian group (OR = 0.99, 95% CI 0.85-1.17; P = 0.94). CONCLUSIONS: In this cohort of patients, race was not associated with the development of CIN at 72 h, or the development of renal dysfunction at 3 months post angiography or intervention. In the long-term, the rate of initiation of dialysis was significantly lower in the Caucasian patients but mortality was not.

IL2 Inducible T-cell Kinase, a Novel Therapeutic Target in Melanoma.

PURPOSE: IL2 inducible T-cell kinase (ITK) promoter CpG sites are hypomethylated in melanomas compared with nevi. The expression of ITK in melanomas, however, has not been established and requires elucidation. EXPERIMENTAL DESIGN: An ITK-specific monoclonal antibody was used to probe sections from deidentified, formalin-fixed paraffin-embedded tumor blocks or cell line arrays and ITK was visualized by IHC. Levels of ITK protein differed among melanoma cell lines and representative lines were transduced with four different lentiviral constructs that each contained an shRNA designed to knockdown ITK mRNA levels. The effects of the selective ITK inhibitor BI 10N on cell lines and mouse models were also determined. RESULTS: ITK protein expression increased with nevus to metastatic melanoma progression. In melanoma cell lines, genetic or pharmacologic inhibition of ITK decreased proliferation and migration and increased the percentage of cells in the G0-G1 phase. Treatment of melanoma-bearing mice with BI 10N reduced growth of ITK-expressing xenografts or established autochthonous (Tyr-Cre/Pten(null)/Braf(V600E)) melanomas. CONCLUSIONS: We conclude that ITK, formerly considered an immune cell-specific protein, is aberrantly expressed in melanoma and promotes tumor development and progression. Our finding that ITK is aberrantly expressed in most metastatic melanomas suggests that inhibitors of ITK may be efficacious for melanoma treatment. The efficacy of a small-molecule ITK inhibitor in the Tyr-Cre/Pten(null)/Braf(V600E) mouse melanoma model supports this possibility.