Gram-negative infective endocarditis: a retrospective analysis of 10 years data on clinical spectrum, risk factor and outcome.

Infective endocarditis (IE) is a significant cause of morbidity and mortality. Underlying congenital heart disease and acquired valvular disease significantly increases the IE risk, which is still prevalent in developing countries. Gram-negative organism related IE prevalence appears to be rising with limited data on their presentation and outcomes. This study hopes to shed further light on this subject. This retrospective cross-sectional study occurred in a tertiary care center in South India. A retrospective cross-sectional study performed in a single tertiary care center in South India. All patients with IE from 2006 to 2016 were included in this study. The details of clinical presentation, laboratory investigations, clinical course, microbiology, and outcomes were obtained. Patients fulfilling the modified Duke's criteria and a culture-proven diagnosis of gram-negative IE were eligible for inclusion. A total of 27 patients were enrolled from Jan 2006 to Dec 2016, among whom 78% were male. Prior structural heart disease was common in our cohort (41%) with renal (55%) and embolic (51%) complications being the most common systemic complications. A comparison of mortality with survivors found that congenital and acquired structural heart disease had a higher risk of mortality. Non-fermenting GNB accounted for 52% of the cohort, with Pseudomonas accounting for 19%. E. coli was the most common bacilli isolated, constituting 37% of the cohort. Assessment of risk factors for adverse outcomes found that renal dysfunction and intravascular device were significant with multivariate-logarithmic analysis showing renal dysfunction as an independent risk factor. In-hospital mortality in this series was 30%. In conclusion, gram-negative IE was more prevalent among males. Underlying structural heart disease was the most common risk factor associated with the disease. Renal dysfunction and embolic complications were the most common complications in this cohort. E. coli and NFGNB accounted for 70% of the offending organisms. In-hospital mortality was similar to patients with IE secondary to common organisms. The presence of renal dysfunction was an independent risk factor for an adverse outcome.

Association between a prolonged corrected QT interval and outcomes in patients in a medical Intensive Care Unit.

INTRODUCTION: Patients admitted into a medical Intensive Care Unit (ICU) have varying illnesses and risk factors. An electrocardiogram (ECG) is a useful tool to assess the cardiac status. The aim of the study was to determine the prevalence of QT prolongation of the ECG in patients admitted to a medical ICU in a tertiary hospital, to assess outcomes in terms of mortality, cardiovascular events, and duration of ICU stay. MATERIALS AND METHODS: Prospective observational study, 6 months duration, assessing the prevalence of prolonged corrected QT interval (QTc) at admission into a medical ICU. A QTc calculated by Bazett's formula, of >440 ms for males and >460 ms for females was considered prolonged. Details of illness, clinical and lab parameters were monitored. RESULTS: The total number of patients screened was 182. There was a high prevalence of prolonged QTc (30%) on admission to the ICU. This reduced to 19% on day 3 (P = 0.011). In patients with a prolonged QTc the odds ratio of adverse outcome from ICU was 3.17 (confidence interval [CI]: 1.52-6.63) (P = 0.001) and of adverse outcome for hospital stay was 2.27 (CI: 1.11-4.66) (P = 0.014). In the study, 35% of all patients received drugs with QT prolonging action. Of patients with a prolonged QTc at admission 18 (35%) received a QT prolonging drug. CONCLUSIONS: We found that prolonged QTc is common (30%) in our medical ICU at admission and a large proportion (35%) received drugs capable of prolonging QT interval. These patients with QTc prolongation have a higher odds ratio for adverse outcomes.

Plasma Von Willebrand Factor Levels Predict Survival in COVID-19 Patients Across the Entire Spectrum of Disease Severity.

BACKGROUND: Characterization of reticulo-endothelial activation in COVID-19 may guide treatment. OBJECTIVES: To assess reticulo-endothelial activation and its correlation with disease severity and death in patients across the entire spectrum of COVID-19 severity. METHODS: Consecutive hospitalized COVID-19 patients were studied, with similar number of patients in each disease severity category. Baseline serum ferritin, sCD163 (macrophage activation markers) and plasma von Willebrand factor (VWF) antigen (endothelial activation marker) levels were studied. Clinical parameters and plasma D-dimer levels were also studied. The study parameters were correlated with COVID-19 severity and survival. RESULTS: The 143 patients (104 males [80%], age 54 [42 - 65] years, median [inter-quartile range]) presented 4 (3-7) days after symptom onset. Thirty-four patients had mild disease, 36 had moderate disease, 36 had severe disease and 37 had critical disease at baseline. With increasing COVID-19 severity, ferritin, sCD163, VWF and D-dimer levels significantly increased at baseline, however, 139 patients had normal sCD163 levels. Of the reticulo-endothelial markers, VWF level independently correlated with COVID-19 severity and with survival. VWF level > 332.6 units/dl correlated with COVID-19 severity (odds ratio [OR]: 2.77 [95% confidence interval (C.I): 1.1 - 6.99], p value: 0.031) and in-hospital death (OR [95% CI]: 29.28 [5.2 - 165], p value < 0.001). CONCLUSIONS: Reticulo-endothelial activation markers increased incrementally with worsening COVID-19 severity. Baseline endothelial activation marker (VWF), and not macrophage activation markers, independently correlated with COVID-19 severity and death.

Lateral medullary syndrome after a scorpion sting.

Scorpion bites are a common problem in Southern parts of India. The sting of Mesobuthus tamulus belonging to the Buthidae family is known for being fatal. The toxidrome of scorpion sting is known for its effect on the cardiovascular system, and there have been rare reports of cerebrovascular accidents as well. We describe a case of lateral medullary syndrome secondary to scorpion sting. As per the knowledge of the authors, this is the first case report of the same.