Soluble MICA versus Troponin as Early snd Specific Predictor for Acute Myocardial Infarction in Patients with Chronic Kidney Disease

Abstract Background Accurate early detection & early management of MI as a life threatening condition in patients with CKD , who are more likely than those without it to have elevated troponin levels still challenging. Recently, MICA could be activated in the normal tissues by a variety of stimuli, such as ischemia/reperfusion-induced tissue injury. Aim of the Work To compare sensitivity and specificity of serum sMICA to that of Troponin for early and accurate diagnosis of AMI in patients with CKD. Patients and Methods Total 30 patients was enrolled in the study and divided into 2 groups A & B (15 for each one) in NHI , cTnI and sMICA was assayed in both groups; in the group A,cTnI & sMICA was assayed serially according to time from arrival of the patient to ED (0 hour , 3 hours, 6 hours, 12 hours, and 24 hours ) and recording the pattern of rising, peaking & falling of both biomarkers.. ‘ Results At zero hour both markers were positive serum level in both groups but lower in sMICA then pattern of rising and peaking of sMICA was early than TnI in AMI group which peaks later. Conclusion sMICA could be considered as a novel predictor that more sensitive and specific than cTnI.

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Necrotizing fasciitis with group A Streptococci and Eggerthella lenta as a complication of Varicella in a child – case presentation –

ARS Medica Tomitana ◽

10.2478/arsm-2014-0007 ◽

2014 ◽

Vol 20 (1) ◽

pp. 35-39

Author(s):

Cambrea Simona Claudia ◽

Ilie Maria Margareta ◽

Carp Dalia Sorina ◽

Ionescu C.

Keyword(s):

Necrotizing Fasciitis ◽

Severe Disease ◽

The Body ◽

Group A Streptococci ◽

Threatening Condition ◽

Life Threatening ◽

Group A ◽

The Right ◽

Surgery Department ◽

Short Time

ABSTRACT Necrotizing fasciitis is a life threatening condition that can be quickly spread through the flesh surrounding the muscle. The disease can be polymicrobial, or caused by group A beta hemolytic Streptococci, or by Clostridium spp. We present a case of a 7 years old girl, which was hospitalized in Children Infectious Diseases Department in a 7th day of chickenpox (hematic crusts all over the body), high fever, asthenia, vomiting, oligoanuria, and tumefaction, pain and functio lessa in the right thigh. In a very short time in the right thigh swelling, edema and congestion have increased gradually, and in the third highest middle thigh the ecchymotic areas appeared evolving towards bubbles and blisters which included the right thigh and calf. After excluding the diagnosis of thrombophlebitis was raised suspicion of necrotizing fasciitis. CT pelvic scan evidenced pelvic asymmetry by maximus and medium right gluteal muscles swelling with important inflammatory infiltrate extended laterally in the subcutaneous adipose tissue. In blood culture was isolated Eggerthella lenta, and from throat swab was isolated group A Streptococci. Treatment consists of a combination of antibiotics associated with intravenous immunoglobulin administration. Despite medical treatment evolution worsened and required transfer in a pediatric surgery department where emergent surgical debridement associated with intensive antibiotic therapy was done. After this intervention evolution was slowly favorable without major limb dysfunction. Polymicrobial necrotizing fasciitis is a severe disease, which if recognized early can have a favorable outcome.

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Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111534 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11534

Author(s):

Stefano Sartini ◽

Laura Massobrio ◽

Ombretta Cutuli ◽

Paola Campodonico ◽

Cristina Bernini ◽

...

Keyword(s):

Respiratory Failure ◽

Adverse Outcome ◽

University Hospital ◽

Rt Pcr ◽

Threatening Condition ◽

Life Threatening ◽

Group A ◽

Group B ◽

The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

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The ischemic preconditioning and postconditioning effect on the intestinal mucosa of rats undergoing mesenteric ischemia/reperfusion procedure

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502008000100005 ◽

2008 ◽

Vol 23 (1) ◽

pp. 22-28 ◽

Cited By ~ 31

Author(s):

Carlos Henrique Marques dos Santos ◽

Otoni Moreira Gomes ◽

José Carlos Dorsa Vieira Pontes ◽

Luciana Nakao Odashiro Miiji ◽

Marco Aurélio Feltrin Bispo

Keyword(s):

Intestinal Mucosa ◽

Ischemic Preconditioning ◽

Mesenteric Ischemia ◽

Tissue Injury ◽

Ischemia Reperfusion ◽

Ischemic Postconditioning ◽

Ischemia And Reperfusion ◽

Mean Values ◽

Group A ◽

Group B

PURPOSE: To evaluate the effect of the ischemic preconditioning and the ischemic postconditioning over the tissue injury in the intestinal mucosa of rats undergoing the procedure of mesenteric ischemia and reperfusion. METHODS: Thirty Wistar rats were studied, divided in three groups: group A, undergoing mesenteric ischemia (30 minutes) and reperfusion (60 minutes); group B, mesenteric ischemia and reperfusion preceded by ischemic preconditioning; group C, mesenteric ischemia and reperfusion and, before the beginning of reperfusion, the ischemic postconditioning was performed. At the end, a segment of the small intestine was dissected for histological analysis. The results were evaluated using the CHIU et al.6 classification followed by the statistic treatment. RESULTS: The mean values of the tissue injury levels were: group A, 3.5; group B, 1.2; and group C, 1. The difference between the result of group A with the results of groups B and C was considered statistically significant (p < 0,05). CONCLUSION: The ischemic preconditioning and postconditioning are able to minimize the tissue injury in the intestines of rats that underwent the procedure of mesenteric ischemia and reperfusion.

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Life-threatening necrotizing myometritis, due to Group A streptococcus - still a life-threatening condition

Clinical Case Reports ◽

10.1002/ccr3.217 ◽

2015 ◽

Vol 3 (5) ◽

pp. 291-293

Author(s):

Sidsel Boie ◽

Jan Krog ◽

Sofus Tørring ◽

Isil Pinar Bor

Keyword(s):

Group A Streptococcus ◽

Threatening Condition ◽

Life Threatening ◽

Group A

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Necrotizing Fasciitis Resulting from Human Bites: A Report of Two Cases of Disease Caused by Group A Streptococci

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2005/706238 ◽

2005 ◽

Vol 16 (4) ◽

pp. 221-224 ◽

Cited By ~ 7

Author(s):

Christopher A Sikora ◽

Jack Spielman ◽

Kerry MacDonald ◽

Gregory J Tyrrell ◽

John M Embil

Keyword(s):

Necrotizing Fasciitis ◽

Present Article ◽

Group A Streptococcus ◽

Group A Streptococci ◽

Human Bites ◽

Threatening Condition ◽

Life Threatening ◽

Group A ◽

Bite Wounds

Necrotizing fasciitis is a serious and potentially life-threatening condition. Although bite wounds are common, they are not frequently reported as a cause of necrotizing fasciitis. In the present article, two cases of bite-associated necrotizing fasciitis caused by group A streptococcus are reported. Previously published cases are also reviewed.

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Pitfalls in the Diagnosis of Posterior Circulation Stroke in the Emergency Setting

Frontiers in Neurology ◽

10.3389/fneur.2021.682827 ◽

2021 ◽

Vol 12 ◽

Author(s):

Carolin Hoyer ◽

Kristina Szabo

Keyword(s):

Signs And Symptoms ◽

Diagnostic Error ◽

Posterior Circulation ◽

Arterial System ◽

Emergency Setting ◽

Early Management ◽

Posterior Circulation Stroke ◽

Wide Range ◽

Threatening Condition ◽

Life Threatening

Posterior circulation stroke (PCS), caused by infarction within the vertebrobasilar arterial system, is a potentially life-threatening condition and accounts for about 20–25% of all ischemic strokes. Diagnosing PCS can be challenging due to the vast area of brain tissue supplied by the posterior circulation and, as a consequence, the wide range of—frequently non-specific—symptoms. Commonly used prehospital stroke scales and triage systems do not adequately represent signs and symptoms of PCS, which may also escape detection by cerebral imaging. All these factors may contribute to causing delay in recognition and diagnosis of PCS in the emergency context. This narrative review approaches the issue of diagnostic error in PCS from different perspectives, including anatomical and demographic considerations as well as pitfalls and problems associated with various stages of prehospital and emergency department assessment. Strategies and approaches to improve speed and accuracy of recognition and early management of PCS are outlined.

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Automatic Prediction of Ischemia-Reperfusion Injury of Small Intestine Using Convolutional Neural Networks: A Pilot Study

Sensors ◽

10.3390/s21196691 ◽

2021 ◽

Vol 21 (19) ◽

pp. 6691

Author(s):

Jie Hou ◽

Runar Strand-Amundsen ◽

Christian Tronstad ◽

Jan Olav Høgetveit ◽

Ørjan Grøttem Martinsen ◽

...

Keyword(s):

Small Intestine ◽

Deep Learning ◽

Reperfusion Injury ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Learning Models ◽

Confidence Measure ◽

Digital Microscope ◽

Threatening Condition ◽

Life Threatening

Acute intestinal ischemia is a life-threatening condition. The current gold standard, with evaluation based on visual and tactile sensation, has low specificity. In this study, we explore the feasibility of using machine learning models on images of the intestine, to assess small intestinal viability. A digital microscope was used to acquire images of the jejunum in 10 pigs. Ischemic segments were created by local clamping (approximately 30 cm in width) of small arteries and veins in the mesentery and reperfusion was initiated by releasing the clamps. A series of images were acquired once an hour on the surface of each of the segments. The convolutional neural network (CNN) has previously been used to classify medical images, while knowledge is lacking whether CNNs have potential to classify ischemia-reperfusion injury on the small intestine. We compared how different deep learning models perform for this task. Moreover, the Shapley additive explanations (SHAP) method within explainable artificial intelligence (AI) was used to identify features that the model utilizes as important in classification of different ischemic injury degrees. To be able to assess to what extent we can trust our deep learning model decisions is critical in a clinical setting. A probabilistic model Bayesian CNN was implemented to estimate the model uncertainty which provides a confidence measure of our model decisions.

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May-Thurner syndrome – Are we aware enough?

VASA ◽

10.1024/0301-1526/a000775 ◽

2019 ◽

Vol 48 (5) ◽

pp. 381-388 ◽

Cited By ~ 6

Author(s):

Katalin Mako ◽

Attila Puskas

Keyword(s):

Contraceptive Use ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.254.cut ◽

2016 ◽

Vol 25 (4) ◽

pp. 555-558

Author(s):

Alina Popp

Keyword(s):

Celiac Disease ◽

International Normalized Ratio ◽

Gluten Free Diet ◽

Alveolar Hemorrhage ◽

Severe Anemia ◽

Gluten Free ◽

Pulmonary Infiltrates ◽

Pulmonary Hemosiderosis ◽

Threatening Condition ◽

Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

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LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

10.36106/ijsr/7502922 ◽

2019 ◽

Author(s):

Madan Goyal ◽

R K Goel

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Open Cholecystectomy ◽

Critical View Of Safety ◽

Recent Onset ◽

Conversion To Open Cholecystectomy ◽

Threatening Condition ◽

Life Threatening ◽

Fluid Collections ◽

A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

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