D-dimer may aid in the diagnosis of pediatric musculoskeletal infections: a prospective study.

Musculoskeletal infections, including septic arthritis, osteomyelitis, and soft tissue infections, are critical morbidity factors for children and adolescents. This study investigated the role of D-dimer levels for diagnosing childhood musculoskeletal infections. This single-center prospective study was initiated in April 2020 following approval from the local ethics committee. The study included 54 children, divided into the infection group ( n = 21), comprising patients who underwent surgical treatment for childhood musculoskeletal infections and had macroscopically visible purulent discharge during surgery, and the control group ( n = 33), comprising healthy children. In the infection group, the mean values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasma D-dimer, and white blood cell (WBC) were 39.42 ± 27.00 mm/h, 101.50 ± 76.90 mg/l, 2.34 ± 2.59 mg/l, and 15.55 ± 6.86 × 10 9 /l, respectively. On comparison, the infection group showed higher levels of WBC, CRP, ESR, D-dimer, and neutrophil-to-lymphocyte ratio than the control group. When the D-dimer cutoff value of 0.43 mg/l was taken, it was observed that it had 95.2% sensitivity and 81.8% specificity. The area under curve (AUC) of the above-mentioned parameters calculated via receiver operating characteristic curves showed CRP levels as the optimum predictor of childhood musculoskeletal infections, followed by the ESR, plasma D-dimer, and WBC levels in descending order (AUC: 0.999, 0.997, 0.986, and 0.935, respectively). D-dimer is another test, which in combination with other conventional established tests (CRP and ESR) can be helpful in diagnosis of pediatric infection. We recommend the addition of D-Dimer to ESR, CRP, and WBC as a first-line investigation in cases with suspected pediatric musculoskeletal infections.

Decreased coronary blood flow velocity in patients with aortic insufficiency but normal coronary arteries: the use of TIMI frame count in aortic insufficiency cases.

Patients with aortic insufficiency (AI) may suffer from anginapector is in the absence of obstructive coronaryartery disease. In this study, we aimed to investigate coronary blood flow using the thrombolysis in myocardialinfarction (TIMI) frame count (TFC) method in patients with AI and normal coronaryarteries. The study included 64 patients (Group 1; meanage 62.4 ± 13.2 years) with moderate to severe AI who had under gonecoronaryangio graphy that resulted in angiographically normal coronaries, and 42 patients with a typical chest pain and angiographically normal coronaryarteriogram (Group 2; meanage 58.8 ± 9.8 years). All patients under went coronaryangiography either to exclude coronaryartery disease or to evaluate their coronaryanatomy before aorticvalve replacement. TFC was calculated and compared for each artery, including the left anterior descending (LAD), circumflex (LCX), and right coronaryartery (RCA) in both groups. The base line characteristics of the study groups were similar. In both groups, TIMI-3 flow was present in eachartery at the time of arteriography, and the coronaryarteries were entirely normal. LCx and RCA frame counts and corrected LAD frame counts were significantly higher in Group 1 than in Group 2 (26.4 ± 2.1 vs. 24.3 ± 3.6, P < 0.05; 22.1 ± 2.3 vs. 20.5 ± 2.9, P < 0.05; and 22.5 ± 1.8 vs. 20.5 ± 2.4, P < 0.05, respectively). The TFC method may be used as a marker forcoronary flowvelocity in patients with aortic insuffiency and angiographically normal coronaryarteries toestimate decreased coronary blood flowve locity.

Prothrombin complex concentrates utility for warfarin-associated hemorrhage.

INTRODUCTION: Prothrombin Complex Concentrate (PCC) for reversal of warfarin is the main therapeutic option in cases of life-threatening bleeding. Aim of the study was to investigate for using 4-factor PCC brought to the therapeutic levels of International Normalized Ratio (INR) values in cases of life-threatening bleeding in Emergency Department. METHODS: This retrospective cohort study was performed in a tertiary care university emergency department. Patients with active bleeding who were taking warfarin with INR levels of ≥1.5, and had received 4-factor prothrombin complex concentrate for treatment were included in to study. RESULTS: A total of 75 patients were included in the study. The median age of the study participants was 68 (minimum 23 to maximum 87) years and 45.3% (n = 34) of them were male. INR levels was normalized all patients who were received 4-factor PCC. Red blood cell (RBC) was transfused in 16 patients (21%) because of the low hemoglobin levels. Mean unite of the RBC packet was 2,75. The lengths of hospital stay of receiving 4-factor PCC rate were determined 4.9 ± 8.7 days. No thrombotic complications or adverse drug reactions were observed after 4-factor PCC administration in any of the patients. CONCLUSIONS: In our study 4-factor PCC was found to be effective and safe in rapidly reversing the effects of warfarin.

A rare case of Epstein-Barr virus-induced dilated cardiomyopathy.

Although half of dilated cardiomyopathy (DCM) cases have unknown causes, the remaining causes of DCM are extensive. In some cases, DCM starts with myocarditis, which is basically an inflammation of the heart muscle. Myocarditis can present in a variety of ways, from asymptomatic to cardiogenic shock. Myocarditis is associated with a wide range of infections, most commonly viral, bacterial, and parasitic. The main mechanism seems to be immune-mediated damage to the myocardium, which leads to a global or local ventricular dysfunction and DCM. Epstein-Barr virus is a rare cause of myocarditis. We could locate only 15 cases (9 adults and 6 children) reported in the medical literature in English. We report an adult patient who presented with signs and symptoms of heart failure most likely secondary to myocarditis caused by Epstein-Barr virus infection. The diagnosis was made by viral serology and a multidisciplinary approach.

Long-term exposure to biomass fuel and its relation to systolic and diastolic biventricular performance in addition to obstructive and restrictive lung diseases.

BACKGROUND: Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. METHODS: Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). RESULTS: BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). CONCLUSIONS: BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events.

BNP levels in patients with long-term exposure to biomass fuel and its relation to right ventricular function.

UNLABELLED: Previous studies have demonstrated a consistent increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However right ventricular (RV) function have not been investigated yet in these patients. In this study, pulmonary function, right ventricular function and their relations with Brain Natriuretic Peptide (BNP) were investigated in non-smoking female patients with BFE. METHODS: Our study population consisted of 39 female patients with BFE (group 1) and, 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular volumes, diameters and tissue velocities were obtained by tissue Doppler echocardiography. BNP levels were measured and correlated to right ventricular measurements and pulmonary artery pressure. RESULTS: In BFE group, obstructive and restrictive spirometric findings were found. RV diameters, volumes and pulmonary artery pressure were higher in group 1 than group 2. BNP levels were well correlated with right ventricular end diastolic diameter and pulmonary artery pressure. A suspicion is also arised that toxic chemicals in biomass fuel may play a role in RV dysfunction. CONCLUSION: Biomass fuel exposure not only cause obstructive and/or restrictive lung disease but also leads to systolic and diastolic right ventricular dysfunction. BNP levels may be used to monitor pulmonary artery pressure and right ventricular enlargement in these patients.

Pulmonary artery dissection mimicking mediastinal mass.

Pulmonary artery dissection (PAD) is a rare diagnosis that is often made postmortem in patients with pulmonary hypertension. It can be visualized by echocardiography, computed tomography, or magnetic resonance imaging. We present a patient with emphysematous chronic obstructive pulmonary disease and secondary pulmonary hypertension in whom a PAD appeared like a mediastinal mass on computed tomography. The diagnosis was made at autopsy. We think that physicians should consider the possibility of a PAD in patients with chronic pulmonary hypertension who present with dyspnea and chest pain.

Gender-based evaluation of the XIENCE V everolimus-eluting coronary stent system: clinical and angiographic results from the SPIRIT III randomized trial.

OBJECTIVES: We evaluated the role of gender on clinical and angiographic results of the everolimus-eluting stent in the SPIRIT III trial. BACKGROUND: The SPIRIT III trial demonstrated superior efficacy of the XIENCE V everolimus-eluting stent compared with the TAXUS paclitaxel-eluting stent. Whether these results are applicable to women is unknown. METHODS: A total of 1,002 patients with coronary artery lesions of 28 mm or less long in 2.5-3.75 mm diameter vessels were prospectively randomized to receive percutaneous coronary intervention with either XIENCE V stent or TAXUS stent placement. Post hoc gender subset analysis was performed. RESULTS: A total of 669 patients (200 women) received the XIENCE V stent, and 332 patients (114 women) were assigned to the TAXUS stent. Women were older and had more hypertension and diabetes than men. At 1 year, rates of MACE (11.1% vs. 5.7%, P = 0.004), TVF (13.7% vs. 7.5%, P = 0.003), TVR (10.8% vs. 4.6%, P = 0.0007), and TLR (7.2% vs. 2.7%, P = 0.002) were higher in women compared with men. The difference in 1 year MACE and TVF rates between men and women remained after adjusting for baseline covariates. Although the angiographic characteristics at baseline were similar among the female cohort, women assigned to XIENCE V had lower in-stent late loss (0.19 vs. 0.42 mm, P = 0.01) compared with women treated with the TAXUS stent. Although 30-day clinical outcomes were similar for women treated with XIENCE V and TAXUS stents, at 1 year, women with XIENCE V stents had significantly lower MACE (8.2% vs. 16.1 %, P = 0.04) and TVR (3.1% vs. 8.9%, P = 0.03) compared with those treated with TAXUS stents. Stent thrombosis rates were similar between women receiving either XIENCE V or TAXUS stents. CONCLUSIONS: Women in the SPIRIT III trial had inherently higher MACE and TVF rates than men. However, the angiographic and clinical benefits of using XIENCE V stents are generalizable to women.

Extensive Salmonella enteritidis endocarditis involving mitral, tricuspid valves, aortic root and right ventricular wall.

After conducting a PubMed search, 11 articles describing a total of 12 cases of native valve Salmonella enteritidis (S. enteritidis) endocarditis were identified in the English literature. Only 13 cases of prosthetic valve endocarditis attributed to S. enteritidis have been published in the English literature. Only 1 case involving the myocardium and other valves concomitantly could be located. Transthoracic echocardiography proved inadequate to demonstrate valvular vegetations. Transesophageal echocardiography was instrumental in establishing the diagnosis of endocarditis by documenting vegetations. S. enteritidis endocarditis can cause devastating endovascular infections in immunocompromised patients. Patients who present with multiple vague symptoms with medical histories that include diabetes mellitus, immunocompromise, and prosthetic heart valves should alert clinicians to strongly consider S. enteritidis endocarditis in their differential diagnoses. Despite considerable effort, S. enteritidis endocarditis poses very high risk for morbidity and mortality.

Nonsurgical management of a left ventricular pedunculated papillary fibroelastoma: a case report.

Papillary fibroelastoma (PFE) is a benign cardiac tumor that has the potential to cause life-threatening embolic events. Surgical excision of the tumor is recommended for all patients who develop symptoms, but the treatment of asymptomatic patients with an echocardiographically identified PFE is still controversial. Our case report describes a 63-year-old patient with the incidental finding of a probable left ventricular PFE. The patient was not a candidate for surgical excision of this tumor because of comorbidities and refusal to undergo surgery. The patient was followed up during a period of 4 years and was kept on anticoagulation with warfarin. During this follow-up period, the patient developed no symptoms or complications attributable to the cardiac tumor. This is the first case reported in the literature with left ventricular mobile PFE conservatively managed for a duration of more than 4 years. Randomized controlled trials regarding the best management for such incidental PFEs may be needed.

Failure of guideline-based anticoagulation in a patient with mitral prosthetic valve and recurrent thromboembolism.

Prosthetic valve (PV)-related thromboembolism is a rare but serious complication of implanted mechanical valves. There is not a design that has yet achieved mechanical perfection; therefore, using these mechanical valves is not free of mortality and morbidity. Some of the complications of using such valves include PV thrombosis, systemic embolization, bleeding, endocarditis, perivalvular leak, and structural valve failure. These valves are thrombogenic, and their use requires anticoagulation postoperatively to prevent systemic embolization and PV thrombosis. This intervention also carries the risk of bleeding, which can be detrimental for a subset of patients, especially elderly, pregnant, and those with other systemic comorbidities. In this case we present a patient with recurrent thromboembolic events and a nonobstructing St. Jude mitral PV thrombosis despite vigorous anticoagulation with Coumadin (Bristol-Myers Squibb Co., Princeton, NJ) and aspirin.