A Comprehensive Systemic Literature Review of Pericardial Decompression Syndrome: Often Unrecognized and Potentially Fatal Syndrome.

BACKGROUND: Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as an entity, has discrete literature; this review is to understand its epidemiology, presentation, and management. METHODOLOGY: Medline, Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and after removal of duplicates, 49 manuscripts were included in this review. For statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. t-test was conducted for continuous variable and chi-square test was conducted for categorical data used for analysis. RESULTS: A total of 42 full-length case reports, 2 poster abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection fraction, which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post-procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories, namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. The use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275. CONCLUSION: Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.

Recurrent Pleural Effusion as a Result of Bilateral Renal Artery Stenosis. Does Renal Revascularization Help?

Renal artery stenosis (RAS) is the leading cause of secondary hypertension. Renal artery stenosis can result in various cardiopulmonary complications mostly through activation of neurohormonal pathways that result in fluid overload and systemic hypertension. We herein describe a 72-year-old man with recurrent rapidly accumulating transudative pleural effusion in a patient with severe bilateral RAS. Patient pleural effusion resolved following stent placement with revascularization of the left renal artery despite absence of improvement of renal function. Patient renal function continued to decline and ultimately treated with fixed hemodialysis.

Apical Hypertrophic Cardiomyopathy: A Case Report.

Apical hypertrophic cardiomyopathy (ApHCM) is a rare variant of hypertrophic cardiomyopathy, characterized by a spade-like left ventricular cavity. A 58-year-old African-American female with past medical history of hypertension presented for evaluation of recurrent exertional chest tightness, palpitations and headache. Prior workup including multiple stress tests and angiogram was non-conclusive. Electrocardiogram (EKG) showed characteristic marked T-waves inversions in inferior leads and left ventriculography revealed left ventricle apical hypertrophy with spade like left ventricular cavity that was typical of Yamaguchi syndrome. This case highlights the rare incidence of the disease among African American as well as the challenging diagnostic and presentation features of the disease.

A History of Kawasaki Disease From Childhood and Coronary Artery Ectasia With Recurrent ST Elevation Myocardial Infarction: A Therapeutic Challenge.

Coronary artery ectasia (CAE) is an uncommon anomaly, usually found in 1.2-2% of patients undergoing coronary angiography, defined as a segment of the coronary artery that has a diameter of more than 1.5 times the normal adjacent segments. Atherosclerosis is considered as the cause of half of the CAE cases. We herein present a 65-year-old Asian male with past medical history of Kawasaki disease (KD) who developed recurrent episodes of inferior wall ST-elevation myocardial infarction (STEMI) despite treatment with dual antiplatelet therapy (DAPT). Repeat coronary angiogram showed severely ectatic and tortuous coronary arteries more predominant on the right coronary artery (RCA) with diffuse thrombus in its mid segment. Given his unfavorable vascular anatomy, the condition was managed medically with the addition of warfarin to his DAPT with target international normalized ratio (INR) 2 - 3. This case highlights the association of CAE with a prior history of KD and its therapeutic challenge.

Relación de la inteligencia emocional y la calidad de vida profesional con la consecución de objetivos laborales en el distrito de atención primaria Costa del Sol / Relationship between perceived emotional intelligence and professional quality of life with the achievement of occupational objectives in the costa del sol primary health care district

OBJETIVO: Explorar la relación existente entre «calidad de vida profesional» e «inteligencia emocional percibida», y la relación de ambas con el grado de consecución de objetivos laborales en el Distrito de Atención Primaria Costa del Sol. DISEÑO: Estudio observacional descriptivo transversal multicéntrico. Emplazamiento: Distrito Sanitario Costa del Sol en la Provincia de Málaga. PARTICIPANTES: Muestra de profesionales de todas las categorías, fijos y contratados, de las Unidades de Gestión del Distrito Costa del Sol (n = 303). Respondieron 247 (81,5%). MEDICIONES PRINCIPALES: Se recogieron los datos de porcentaje de consecución de objetivos del año 2010 y los datos sociodemográficos de los participantes; para ello se utilizaron cuestionarios autoadministrados diseñados ad hoc. Para medir la «inteligencia emocional percibida» y «calidad de vida profesional percibida», se utilizaron los cuestionarios TMMS-24 que mide las dimensiones: percepción, comprensión y regulación emocional y CVP-35 que mide las dimensiones: apoyo directivo, demanda de trabajo y motivación intrínseca. RESULTADOS: Se observaron correlaciones significativas entre calidad de vida profesional e inteligencia emocional en las categorías de regulación (p < 0,01) y comprensión (p < 0,05). También existían correlaciones significativas entre la profesión y tipo de contrato con la consecución de objetivos, (p < 0,005) y entre calidad de vida profesional y tipo de contrato (p < 0,05). CONCLUSIONES: La calidad de vida profesional percibida se relaciona con la percepción y la regulación como dimensiones de la inteligencia emocional. Desde los órganos de gestión se debe promover el conocimiento de métodos del manejo de las emociones en todos sus profesional

OBJECTIVE: To examine the relationship between "Quality of Professional Life" and "Perceived Emotional Intelligence" and the relationship of both of these with the level of achievement of occupational objectives in the Costa del Sol Primary Health Care District. DESIGN: Multicentre descriptive cross-sectional observational study. LOCATION: The Costa del Sol Primary Health Care District in the province of Málaga. PARTICIPANTS: Sample of Employees of all categories in fixed and contracted employment in the Management Units of the Costa del Sol District. (N = 303). Respondents 247 (81.5%). Principal Measurements: The data collected was that of the percentage of achievement of objectives in 2010 and the socio-demographic data of the participants, using ad hoc designed self-report questionnaires. The TMMS -24 questionnaire was used to measure the "Perceived Emotional Intelligence", with the following dimensions: Perception, comprehension, and emotional control, and the CVP-35 measuring: management support, work demands, and intrinsic motivation. RESULTS: Significant correlationas were observed between Quality of Professional Life and Emotional Intelligence in the Regulation (p< .01) and Comprehension categories (p < 0.05). There were also significant correlations between the profession and the type of contract in the achievement of objectives (p< .005), and quality of professional life and type of contract (p< .05). CONCLUSIONS: The perceived quality of professional life is related to perception and regulation dimensions of Emotional Intelligence. Knowledge of emotion management methods should be promoted by management organisations for all employees

[Relationship between perceived emotional intelligence and professional quality of life with the achievement of occupational objectives in the costa del sol primary health care district]. / Relación de la inteligencia emocional y la calidad de vida profesional con la consecución de objetivos laborales en el distrito de atención primaria Costa del Sol.

OBJECTIVE: To examine the relationship between "Quality of Professional Life" and "Perceived Emotional Intelligence" and the relationship of both of these with the level of achievement of occupational objectives in the Costa del Sol Primary Health Care District. DESIGN: Multicentre descriptive cross-sectional observational study. LOCATION: The Costa del Sol Primary Health Care District in the province of Málaga. PARTICIPANTS: Sample of Employees of all categories in fixed and contracted employment in the Management Units of the Costa del Sol District. (N=303). Respondents 247 (81.5%) PRINCIPAL MEASUREMENTS: The data collected was that of the percentage of achievement of objectives in 2010 and the socio-demographic data of the participants, using ad hoc designed self-report questionnaires. The TMMS -24 questionnaire was used to measure the "Perceived Emotional Intelligence", with the following dimensions: Perception, comprehension, and emotional control, and the CVP-35 measuring: management support, work demands, and intrinsic motivation. RESULTS: Significant correlationas were observed between Quality of Professional Life and Emotional Intelligence in the Regulation (p<.01) and Comprehension categories (p<0.05). There were also significant correlations between the profession and the type of contract in the achievement of objectives (p<.005), and quality of professional life and type of contract (p<.05). CONCLUSIONS: The perceived quality of professional life is related to perception and regulation dimensions of Emotional Intelligence. Knowledge of emotion management methods should be promoted by management organisations for all employees.

Myoclonic encephalopathy after exposure to trichloroethylene.

Trichloroethylene is a widely-used industrial solvent that is absorbed through the digestive or respiratory tracts or cutaneously. It has a selective tropism for the cardiovascular and central nervous systems and may cause death due to cardiac arrest or neurological sequelae. We present the case of a 25-yr-old women who was exposed to trichloroethylene in the workplace for 18 months and who developed a disabling myoclonic encephalopathy. Non-toxicological causes were excluded. Although the exposure ceased, the disease progressed with thalamic and cerebellar involvement. The patient, who had only a partial response to symptomatic treatment, suffered severe limitations in the activities of daily living and was registered as permanently disabled due to a work-related disability.