Evaluation of conventional troponin I testing for the detection of myocardial dysfunction in children

2020 ◽  
Author(s):  
Eimear McGovern ◽  
Christine Voss ◽  
Nicole M Hemphill ◽  
Shubhayan Sanatani ◽  
Vilte Barakauskas ◽  
...  
Keyword(s):  
Predictive Value ◽  
Myocardial Injury ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Healthy Children ◽  
Clinical Predictors ◽  
Tertiary Care Centre

Abstract Objectives Troponin is a marker of myocardial injury but is not well studied in children. Our primary objective was to ascertain the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional troponin I for the detection of acute myocardial dysfunction in previously healthy children. Our secondary objective was to identify clinical predictors of myocardial dysfunction in the setting of elevated troponin. Study Design This was a retrospective chart review in a single, paediatric, tertiary care centre of troponin tests performed in all admitted children over a 4-year period. Demographics, symptoms, signs, chest x-ray, ECG, and echocardiogram abnormalities were documented. Myocardial dysfunction was presumed to be absent when the patient had a normal cardiac assessment, with or without echocardiography, and did not re-present. Results From January 2014 through December 2017, 566 patients had troponin tested as a screen for myocardial injury. Troponin was positive in 38 of 566 cases (6.7%). Myocardial dysfunction was detected in 9 of 566 cases (1.6%). Troponin was elevated in six of nine cases of myocardial dysfunction. The sensitivity of conventional troponin I for detecting acute myocardial dysfunction was 66% (95% confidence interval [CI] 30 to 93%). The specificity was 94% (95% CI 92 to 96%). PPV was 16% (95% CI 6 to 31%) and NPV 99% (95% CI 98 to 100%). An abnormal ECG was more prevalent in patients with a true positive versus a false-positive troponin result (P=0.03). Conclusion Troponin testing identified few cases of myocardial dysfunction. We found the test to have only 66% sensitivity. Troponin testing as a screen for myocardial injury in children has limited utility.

scholarly journals COVID-19 Study of biochemical haematological parameters in patients dying from COVID-19 in a tertiary care centre

2021 ◽  
Vol 6 (2) ◽  
pp. 94-97
Author(s):  
Ramakrishna Rachakonda ◽  
Kiranmayi Abburi ◽  
Sai Ramya Gonuguntla ◽  
Bhavanarayana Jannela ◽  
Chakradhar Bolleddu ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Troponin I ◽  
Hematological Parameters ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Normal Platelet Count ◽  
Normal Platelet ◽  
Inflammatory Parameters ◽  
D Dimer

COVID-19 pandemic resulted in a death of 419 patients among total admissions of 10682 with a death rate of 3.92% in the tertiary care COVID-19 hospital. We studied the biochemical and hematological parameters among 241 patients who died of the disease. CRP values were raised above 12mg/L in 58% of patients. 83% of patients had elevated LDH levels of >250 IU/L. Procalcitonin levels were above 0.5 microgram/L in nearly 66% of patients. Serum ferritin was more than 500 micrograms/L in 51% of patients. Elevated IL-6 were found in 83% of patients making it a significant inflammatory parameters. D-dimer levels were more than 500ng/ml in 74% of patients. HS Troponin I was raised in 83% of patients. Leukocytosis of more than 11000/Cu mm was seen in 38%. Leukopenia was seen in 35%. Thrombocytopenia was seen in 27% and normal platelet count was seen in 62%. Biochemical parameters help in assessing the severity of inflammation in COVID-19 disease. They aid in the process of treatment particularly anticoagulants and corticosteroid. Specific parameters like IL-6 can help in decision making by treating physician regarding the use of anti IL-6 drugs like Tocilizumab. Elevated HS troponin I in our study showed myocardial injury played a significant role in mortality of COVID 19 patients at our centre.

scholarly journals Characteristics of infective endocarditis in a cancer population

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001664
Author(s):  
Cullen Grable ◽  
Syed Yusuf ◽  
Juhee Song ◽  
George M Viola ◽  
Owais Ulhaq ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Mortality Data ◽  
Limited Information ◽  
Tertiary Care Centre ◽  
Indwelling Catheters ◽  
Patients With Cancer ◽  
Duke Criteria ◽  
Immunocompromised State

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

scholarly journals Correlation of clinical and ultrasonographic features with histopathology in post-menopausal bleeding

2020 ◽  
Vol 9 (7) ◽  
pp. 2817
Author(s):  
Meenakshi Vempalli ◽  
Lopamudra B. John ◽  
G. Chandana
Keyword(s):  
Predictive Value ◽  
Histopathological Examination ◽  
Endometrial Thickness ◽  
Tertiary Care ◽  
Statistical Correlation ◽  
Clinical Findings ◽  
Postmenopausal Bleeding ◽  
Tertiary Care Centre ◽  
Post Menopausal ◽  
Sensitivity Specificity

Background: Postmenopausal bleeding is generally regarded as an ominous alarm of genital pathologies which requires a thorough evaluation clinically and pathologically to exclude carcinoma as the cause and ensure a benign pathology. This study aims at finding out whether clinical diagnosis and ultrasonographic features can be reliable parameters for the diagnosis of causes and whether the findings correspond with histopathology reports.Methods: This observational study was conducted in a tertiary care centre in Pondicherry between January 2018 to August 2019. 114 women were enrolled for whom detailed history taking and clinical examination was done. All the patients were subjected to transvaginal ultrasonography. Patients with clinically visible lesions on cervix and vulva were subjected to biopsy and the rest underwent fractional curettage and the sample was sent for histopathological examination. Finally, histopathology report was compared with clinical and ultrasonographic findings.Results: With endometrial thickness cut off of 4 mm, the sensitivity, specificity, positive predictive value and negative predictive value in predicting malignancy by ultrasonography were 100%, 12.3%, 4.5% and 100%. Histopathology showed atrophic endometrium (43.8%), endometrial hyperplasia (8%), endometrial polyp (7.9%) and endometrial carcinoma (3%). Clinical and ultrasonographic findings did not show any statistical correlation with histopathology.Conclusions: Authors conclude that clinical findings and ultrasonographic features do not correlate with histopathology in cases of postmenopausal bleeding for which atrophic endometrium was the commonest etiology. However, ultrasound should be done routinely before endometrial sampling as the sensitivity for predicting malignancy was 100% for endometrial thickness cut off of 4 mm.

scholarly journals A STUDY OF HISTOCYTOLOGICAL FINDINGS OF LUNG LESIONS IN IMAGE GUIDED FNAC AND BIOPSY IN TERTIARY CARE CENTRE

2020 ◽  
pp. 1-3
Author(s):  
Renuka Gahine ◽  
Shashikala Kosam ◽  
Vivek Patre ◽  
Kiranlata Bhagat
Keyword(s):  
Cell Carcinoma ◽  
Predictive Value ◽  
Tertiary Care ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Lung Lesion ◽  
Tertiary Care Centre ◽  
Predisposing Factor ◽  
Lung Lesions ◽  
Tertiary Referral Center

Aims and Objectives: To study the cytological and histological findings of lung masses and correlate findings with clinical and radiological findings. Material and methods: The study was an observational study, comprised of two years of prospective from December 2017 to September 2019 and five years of retrospective study between October 2012 to November 2017, conducted in Histopathology & Cytology laboratory, Department of Pathology, Pt. J.N.M. Medical College & Dr. B.R.A.M. Hospital, Raipur, (C.G.), a tertiary referral center. Result: Total 104 cases were studied . Out of 104 lung lesions 74 (71.2%) were males and 30 (28.8%) were females with M:F of 2.46:1. Majority of lung lesions were seen in the age group of 61-70 years i.e. 35 (33.66%) and 51-60 years i.e. 30 (28.85%) followed by 41-50 years 17 (16.35%). Mean age of the patients in our study was 56.4 years. Smoking was the most common predisposing factor for lung carcinoma observed in 58 (55.77%) cases followed by tobacco chewing. Clinically the most common complaint was cough in 65 (62.5%) cases, followed by weight loss. 10 cases were diagnosed as benign and 94 cases as malignant. Among benign lesions most common lung lesions were non-specific inflammatory lesions reported in 6 (5.77%) cases followed by granulomatous lesion in 3 (2.89%), hydatid cyst in 2 (1.93%) and aspergilloma in 1 (0.97%) case. Adenocarcinoma was the most common malignant lung lesion found in 52 (50%) cases followed by Squamous cell carcinoma 20 (24%), Small cell carcinoma 12 (13.04%) and Poorly differentiated carcinoma 6 (5.77%) cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of our study was 97.83%, 66.67%, 95.74%, 80.0% and 94.23% respectively. Conclusion: Guided FNAC and biopsy are safe, simple, less invasive, cost effective, well accepted and accurate diagnostic procedures with minimal complications and low morbidity rates.

scholarly journals Prevalence of surgical site infection in general surgery in a tertiary care centre in India

2017 ◽  
Vol 4 (9) ◽  
pp. 3101 ◽  
Author(s):  
Ansul Kumar ◽  
Arpita Rai
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Surgical Procedure ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Exploratory Laparotomy ◽  
Site Infection ◽  
Tertiary Care Centre ◽  
One Year

Background: Surgical site infection (SSI) can be defined as an infection that is present up to 30 days after a surgical procedure if no implants are placed and up to one year if an implantable device was placed in the patient. SSI is a significant problem associated with major surgeries and is the 3rd most frequently reported nosocomial infection. This study aims to study the prevalence of SSI in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi.Methods: A retrospective study was undertaken at the Department of General Surgery for a period of one year. Retrospective chart review was conducted from the hospital database. The rate of SSI was studied in relation to its type, the type of surgical procedure and elective vs emergency surgeries.Results: The present study revealed 12.5% prevalence of SSI in Department of General Surgery, RIMS. Among the 3 types, superficial incision SSI was most prevalent followed by deep incisional SSI and finally by organ/space SSI. The surgical procedure most commonly associated with SSI was exploratory laparotomy. An alarming 17.7% of SSI was associated with emergency surgeries as compared to 12.5% of elective surgeries.Conclusions: The consequences of SSIs greatly impact patients and the healthcare systems. Prevention of SSI requires a multifaceted approach targeting pre-, intra-, and postoperative factors. It is imperative that facilities have open-minded management teams, regulatory agencies and medical associations that want to provide the foundation required to generate a culture of patient safety in our health care systems.

Early Troponin I Levels in Newborns Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Residual Encephalopathy at Discharge

2020 ◽  
Author(s):  
Upender K. Munshi ◽  
Meredith Monaco Brown ◽  
Kate A. Tauber ◽  
Michael J. Horgan
Keyword(s):  
Therapeutic Hypothermia ◽  
Predictive Value ◽  
Troponin I ◽  
Retrospective Chart Review ◽  
Hypoxic Ischemic Encephalopathy ◽  
Mri Findings ◽  
Group 3 ◽  
Group 2 ◽  
Ischemic Encephalopathy ◽  
Group 1

Objective Elevation of serum troponin I has been reported in newborns with hypoxic ischemic encephalopathy (HIE), but it is diagnostic and prognostic utility for newborn under 6 hours is not clear. Study the predictive value of early serum troponin I levels in newborns with HIE undergoing therapeutic hypothermia (TH) for persistent residual encephalopathy (RE) at discharge. Study Design Retrospective chart review of newborns admitted with diagnosis of HIE to neonatal intensive care unit (NICU) for TH over a period of 3 years. Troponin levels were drawn with the initial set of admission laboratories while initiating TH. Newborns were followed up during hospital course and stratified into three groups based on predischarge examination and their electrical encephalography and cranial MRI findings: Group 1: no RE, Group 2: mild-to-moderate RE, and Group 3: severe RE or needing assisted medical technology or death. Demographic and clinical characteristics including troponin I levels were compared in each group. Results Out of 104 newborns who underwent TH, 65 infants were in Group 1, 26 infants in Group 2, and 13 newborns in Group 3. All groups were comparable in demographic characteristics. There was a significant elevation of serum troponin in group 2 (mild-to-moderate RE) and group 3 (severe RE) as compared with group 1 (no RE). Receiver operator curve analysis for any RE (groups 2 and 3) compared with group 1 (no RE as control) had 0.88 (0.81–0.95) area under curve, p < 0.001. A cut-off level of troponin I ≥0.12 µg/L had a sensitivity of 77% and specificity of 78% for diagnosis of any RE, positive predictive value of 68%, and a negative predictive value of 84%. Conclusion In newborns undergoing TH for HIE, the elevation of troponin within 6 hours of age predicts high risk of having RE at discharge. Key Points

Utility of the Edmonton Frail Scale (EFS) in identifying frail elderly patients during treatment of colorectal cancer (CRC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14001-e14001
Author(s):  
Brandon M Meyers ◽  
Radhika Yelamanchili ◽  
Sara Rask ◽  
Humaid Obaid Al-Shamsi ◽  
Callista Maria Phillips ◽  
...  
Keyword(s):  
Pilot Study ◽  
Odds Ratio ◽  
Performance Status ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Primary Objective ◽  
Stage Ii ◽  
Care Utilization ◽  
Study Phase ◽  
Tertiary Care Centre

e14001 Background: CRC is the second leading cause of cancer-related death, and 40-50% of patients are older than 70 years. Frailty is a concept that has been proposed by geriatricians as an indicator of functional age. The EFS is a 15 point incremental scale; it is quick (<5 min), and simple to administer. We conducted a pilot study to establish if the EFS would add utility beyond clinician’s expertise. The primary objective was to determine if there was an association between the EFS and receipt of chemotherapy. Methods: The EFS was administered to stage II-IV CRC patients ≥70 years, referred to a Medical Oncologist at a tertiary care centre. The EFS was completed by one of the investigators, with the treating oncology team blinded to results and a follow up 14 month chart review. Results: Forty-six patients were enrolled with the following characteristics: average age 76, 48% male, 78% performance status (PS) 0-1, and 21 (46%) started chemotherapy. The EFS was reproducible between visits (r = 0.81 [CI 0.64-0.9, p<0.0001]). There was no correlation between the EFS and receipt of chemotherapy for the study population as a whole. As none of the 16 stage II patients had high-risk features requiring chemotherapy, the analysis was repeated excluding these patients. There was a reduced likelihood of receiving chemotherapy for stage III/IV patients with higher EFS scores (Odds ratio 0.56 [CI 0.37-0.85, p<0.01] per unit increment). A similar effect was observed after multivariable analysis (adjusting for PS, age, stage and gender, Odds ratio 0.41 [CI 0.18-0.96, p<0.05] per unit increment). No correlation existed between EFS and upfront dose reductions, choice of less toxic regimens, or hospitalization secondary to grade 3/4 toxicities. Conclusions: This pilot study suggests the EFS can identify patients that Oncologists may have thought were too frail for chemotherapy, independent of PS. Therefore, the EFS has the potential to add a reproducible, and quantifiable measure of frailty to the clinician’s decision making armamentarium. The next study phase will employ the EFS real-time, and determine if using the EFS can minimize complications and unplanned health care utilization in elderly cancer patients.

Limiting sarcolemmal Na+entry during resuscitation from ventricular fibrillation prevents excess mitochondrial Ca2+accumulation and attenuates myocardial injury

2007 ◽  
Vol 103 (1) ◽  
pp. 55-65 ◽  
Author(s):  
Sufen Wang ◽  
Jeejabai Radhakrishnan ◽  
Iyad M. Ayoub ◽  
Julieta D. Kolarova ◽  
Domenico M. Taglieri ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Chest Compression ◽  
Myocardial Injury ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Ischemia And Reperfusion ◽  
Reverse Mode ◽  
Ventricular Compliance

Background: intracellular Na+accumulation during ischemia and reperfusion leads to cytosolic Ca2+overload through reverse-mode operation of the sarcolemmal Na+-Ca2+exchanger. Cytosolic Ca2+accumulation promotes mitochondrial Ca2+(Ca2+m) overload, leading to mitochondrial injury. We investigated whether limiting sarcolemmal Na+entry during resuscitation from ventricular fibrillation (VF) attenuates Ca2+moverload and lessens myocardial dysfunction in a rat model of VF and closed-chest resuscitation. Methods: hearts were harvested from 10 groups of 6 rats each representing baseline, 15 min of untreated VF, 15 min of VF with chest compression given for the last 5 min (VF/CC), and 60 min postresuscitation (PR). VF/CC and PR included four groups each randomized to receive before starting chest compression the new NHE-1 inhibitor AVE4454B (1.0 mg/kg), the Na+channel blocker lidocaine (5.0 mg/kg), their combination, or vehicle control. The left ventricle was processed for intracellular Na+and Ca2+mmeasurements. Results: limiting sarcolemmal Na+entry attenuated cytosolic Na+increase during VF/CC and the PR phase and prevented Ca2+moverload yielding levels that corresponded to 77% and 71% of control hearts at VF/CC and PR, without differences among specific Na+-limiting interventions. Limiting sarcolemmal Na+entry attenuated reductions in left ventricular compliance during VF and prompted higher mean aortic pressure (110 ± 7 vs. 95 ± 11 mmHg, P < 0.001) and higher cardiac work index (159 ± 34 vs. 126 ± 29 g·m·min−1·kg−1, P < 0.05) with lesser increases in circulating cardiac troponin I at 60 min PR. Conclusions: Na+-limiting interventions prevented excess Ca2+maccumulation induced by ischemia and reperfusion and ameliorated myocardial injury and dysfunction.

scholarly journals Comparing WHO C-Model generated C-Section probabilities to actual delivery outcomes in a tertiary care centre

2017 ◽  
Vol 7 (1) ◽  
pp. 229
Author(s):  
Amita Ray ◽  
Arun Gopi ◽  
Sujoy Ray
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Vaginal Delivery ◽  
Predictive Value ◽  
Model Comparison ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Tertiary Care Centre ◽  
High Positive Predictive Value ◽  
Sensitivity Specificity

Background: A model which takes into account several relevant factors and gives the probability of C-Section in a woman would have the advantage of preparing for such an event. The identification of women at high risk of C-Section (>50% risk) would provide the opportunity for understanding risks involved in pursuing a vaginal delivery whereas if the risk of C-Section was less (<50%) it would prove useful in counselling for a vaginal delivery. We used the WHO C-Model with the aim to find the predictability of this model in our facility and the overuse of C-section in the 10 Robson’s Groups.Methods: A retrospective observational study in which all women who gave birth at our hospital from June 2016 to May 2017 were included and C-Section probability was calculated using the C-Model. Comparison with the actual mode of delivery was done to find the sensitivity, specificity, positive and negative predictive value of the model and the overuse of C-Section in the Robson’s Groups.Results: Out of the 314 C-Sections done only 45 women had a >50% probability, giving the model a sensitivity of 14.33%, specificity of 98.8%, positive predictive value of 90% and negative predictive value of 60.56%. Robson’s Groups 5 and 3 demonstrated the greatest overuse of C-Sections.Conclusions: The WHO Model when applied to this centre showed a high positive predictive value for C-Sections but the negative predictive value or the ability to correctly predict a vaginal delivery was much less.

Sign in / Sign up

Export Citation Format

Share Document