A Case Report: Surgical Removal of Missing Guide Wire, Is it the Best Intervention?

Nowadays, the use of central venous catheter insertion (CVC), has abundantly increased. It is a common technique in critically ill patients who are admitted to intensive care and emergency departments in order to hemodynamic monitoring and fluid and medication administration. In this report, we express a 28-year-old man who has multiple trauma with decreased level of consciousness during a car accident three months ago and needs intensive care and monitoring by central venous catheter placing. A missed guide wire remaining inside the venous system after peripherally inserted in femoral vein that was incidentally diagnosed by taking a chest X-ray after three months. Although, guide wires are often retrieved by snaring catheter under fluoroscopic guidance and an interventional cardiologist, we have successfully extracted the lost wire through vascular surgery. Eventually, this report is supposed to increase awareness of this rare and preventable complication and to provide a solution to prevent this complication. Finally, the purpose of this report is to emphasize that surgical extracting is the best intervention to remove the missed guide wire (after 3 months) and this option could be developed, introduced and standardized in appropriate and controlled conditions.

Factors associated with mortality in hospitalized cardiovascular disease patients infected with COVID-19.

INTRODUCTION: To reduce mortality in hospitalized patients with COVID-19 and cardiovascular disease (CVD), it is necessary to understand the relationship between patient's symptoms, risk factors, and comorbidities with their mortality rate. To the best of our knowledge, this paper is the first which take into account the determinants like risk factors, symptoms, and comorbidities leading to mortality in CVD patients who are hospitalized with COVID-19. METHODS: This study was conducted on 660 hospitalized patients with CVD and COVID-19 recruited between January 2020 and January 2021 in Iran. All patients were diagnosed with the previous history of CVD like angina, myocardial infarction, heart failure, cardiomyopathy, abnormal heart rhythms, and congenital heart disease before they were hospitalized for COVID-19. We collected data on patient's signs and symptoms, clinical and paraclinical examinations, and any underlying comorbidities. t test was used to determine the significant difference between the two deceased and alive groups. In addition, the relation between pairs of symptoms and pairs of comorbidities has been determined via correlation computation. RESULTS: Our findings suggest that signs and symptoms such as fever, cough, myalgia, chest pain, chills, abdominal pain, nausea, vomiting, diarrhea, and anorexia had no impact on patients' mortality. There was a significant correlation between COVID-19 cardiovascular patients' mortality rate and symptoms such as headache, loss of consciousness (LOC), oxygen saturation less than 93%, and need for mechanical ventilation. CONCLUSIONS: Our results might help physicians identify early symptoms, comorbidities, and risk factors related to mortality in CVD patients hospitalized for COVID-19.

Prevalence of aspirin resistance in patients with type II diabetes: a descriptive-analytical study
.

BACKGROUND: Aspirin resistance is one of the most important factors for arterial thrombotic events in diabetic patients. This study aimed to evaluate aspirin resistance in diabetic patients. METHODS: In this cross-sectional study, 180 patients who received 80 mg of aspirin daily for at least 10 days were studied, and their urinary 11-DH-TXB2 was measured. Those with 11-dehydro-thromboxane B2 above 1,500 pg/mg creatinine were considered aspirin resistant. Data with significance level of 5% were analyzed in SPSS-16. RESULTS: The mean ± SD of patient age was 60.22 ± 9.59 years and 50% (n = 90) were male. BMI was normal in 29.4% of the patients (n = 53), the others were overweight or obese. Aspirin resistance was observed in 33 (18%) patients. The relationship between aspirin resistance and gender, age, and BMI was not significant (p > 0.05). CONCLUSIONS: There is a high prevalence of aspirin resistance in diabetic patients and given that such patients are at risk of arterial thrombotic events, evaluation of aspirin resistance is suggested for those at a high risk of cardiovascular events or recurring events despite the use of aspirin.
.

An Extremely Rare Complication of Ureteral Pigtail Stent Placement: A Case Report.

Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.

Acetyl salicylic acid resistance in patients with chronic stable angina and the correlation with coronary risk factors.

OBJECTIVE: To evaluate acetyl salicylic acid (ASA) resistance in patients with cardiovascular diseases and evaluate correlation with coronary risk factors. METHODS: One hundred and twenty-four patients with stable coronary artery diseases (CAD) were enrolled in this cross sectional study from the outpatient clinic of the Department of Cardiology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran, between May 2008 and August 2008. All patients had prior history of cardiovascular disease and were under treatment of 80 mg daily ASA for at least 7 days. Aspirin resistance was measured by urinary 11-dehydro-thromboxane beta-concentrations with an enzyme immunoassay kit. RESULTS: Approximately 49.2% patients were resistant to ASA, 15.3% borderline response, and 35.5% were sensitive to ASA. Acetyl salicylic acid-resistant patients were more likely to be smokers and older ages (63% versus 45.4%) (37.7% less than 60 years, 53.7% between 60-69 years, and 63.3% aged ≥ 70 years). Other variables such as gender, diabetes mellitus, hypertension, cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and hemoglobin levels were not significantly associated with aspirin resistance. CONCLUSION: Acetyl salicylic acid resistance was present in a high number of patients with chronic stable angina. Moreover, advanced age and smoking had a direct influence on the aspirin resistance.