Management of Residual Left Atrial Appendage Stump with a Second Epicardial Clip.

Epicardial exclusion of LAA has gained increasing popularity since its introduction in 2009. While the clip has demonstrated a success rate ranging from 93.9-100% in excluding the LAA, one significant complication is incomplete exclusion due to residual stump (> 1 cm) as a result of the clip being deployed too distally. We describe here the first reported case of implanting a second clip underneath the first clip to obliterate the residual stump for a 71-year-old male with AF evaluated for intervention for stroke risk reduction.

The Impact of Bacterial Biofilms on End-Organ Disease and Mortality in Patients with Hematologic Malignancies Developing a Bloodstream Infection

Bacterial bloodstream infection (BSI) is a significant complication in hematologic patients and is associated with high mortality rates. Despite improvements in BSI management, factors leading to sepsis are understood only partially.

Comprehensive Use of Routine Clinical Parameters to Identify Patients at Risk of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

(1) Background: New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI). Our study aimed to investigate whether routinely checked clinical parameters aid in NOAF identification in modernly treated AMI patients. (2) Patients and methods: Patients admitted consecutively within 2017 and 2018 to the University Clinical Centre in Gdańsk (Poland) with AMI diagnosis (necrosis evidence in a clinical setting consistent with acute myocardial ischemia) were enrolled. Medical history and clinical parameters were checked during NOAF prediction. (3) Results: NOAF was diagnosed in 106 (11%) of 954 patients and was significantly associated with in-hospital mortality (OR 4.54, 95% CI 2.50–8.33, p < 0.001). Age, B-type natriuretic peptide (BNP), C-reactive protein (CRP), high-sensitivity troponin I, total cholesterol, low-density lipoprotein cholesterol, potassium, hemoglobin, leucocytes, neutrophil/lymphocyte ratio, left atrium size, and left ventricular ejection fraction (LVEF) were associated with NOAF in the univariate logistic analysis, whereas age ≥ 66 yo, BNP ≥ 340 pg/mL, CRP ≥ 7.7 mg/L, and LVEF ≤ 44% were associated with NOAF in the multivariate analysis. (4) Conclusions: NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Simple, routinely checked clinical parameters could be helpful indices of this arrhythmia in current invasively treated patients with AMI.

Surgical treatment of rectal bleeding in comorbid patients with chronic radiation proctitis

Radiation proctitis is a rare and significant complication of the combined therapy in patients with pelvic cancer. The choice of treatment of chronic radiation proctitis depends on the stage of disease and recurrent rectal bleeding. Comorbidity is cause to complicated proctitis. These clinical cases describe the choice and sequence of surgical interventions in order to achieve successful results in patients with chronic radiation proctitis.

Six steps for a successful phacoemulsification in hard cataracts

Phacoemulsification in rock-hard cataracts is always challenging for the phaco surgeon. Patient presenting with hard cataract is common in rural and suburban areas. In such situations phaco surgeons face higher incidence of significant complication like endothelial cell loss, posterior capsular rupture, zonular dialysis. By judicious use of the appropriate technology like perfect power modulations, enhanced fluidics, adequate OVDs usage better results can be achieved in these cases. In this short communication we have put together six salient steps that would help the surgeon in achieving successful phacoemulsification in hard cataracts.

Preseptal cellulitis and infraorbital abscess as a complication of a routine COVID-19 swab

This case report describes a significant complication of a routine COVID-19 swab in a previously fit and well young patient who developed preseptal cellulitis and an infraorbital abscess as a consequence of the mentioned nasal swabbing. Other authors have previously reported various complications in connection with the use of nasal swabs, including retained swab fragments, epistaxis and cerebrospinal fluid leakage. To our knowledge, to date, this is the first reported case of an abscess as a consequence of COVID-19 swabbing. There has been a clear growth in the use of nasal swabbing worldwide over the last 9 months and many healthcare workers involved in COVID-19 prevention may not be aware of the potential risks of nasopharyngeal swabbing. The presented case highlights the need for better awareness of the complications of these routine tests and we hope that it will also lead to their safer implementation.

Simple clinical parameters could help to identify the patients with a high probability of new-onset atrial fibrillation in acute myocardial infarction

Funding Acknowledgements Type of funding sources: None. Background New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI) associated with a poor prognosis. The knowledge and understanding of risk factors of this arrhythmia are still the subjects of interest. Purpose: We aimed to investigate which clinical, routinely checked parameters could have the most predictive power on NOAF occurrence in AMI patients. Patients and methods This single-center, retrospective study was conducted on 954 consecutive patients admitted to our university clinical center with AMI diagnosis from January 2017 to December 2018. Patients underwent routine clinical assessment and laboratory investigations. AF detected at the time of admission or during a hospital stay, without a prior history of persistent or paroxysmal AF, was diagnosed as NOAF. Detailed medical history, routinely checked laboratory and echocardiography parameters, invasive and pharmacological treatment, as well as complications and in-hospital mortality, were taken into consideration. Results NOAF was documented in 106 (11%) AMI patients at median age 74 (66 - 84) years old, and was significantly associated with in-hospital mortality [OR 4.53, p &lt; 0.001). There were some clinical factors significantly predicted NOAF in univariate logistic regression analysis: age ≥ 66 years old (odds ratio [OR] 3.09, p &lt; 0.001), B-type natriuretic peptide (BNP) ≥ 340 pg/ml (OR 5.28, p &lt; 0.001), C- reactive protein (CRP) ≥ 7.7 mg/l (OR 3.53, p &lt; 0.001), high-sensitivity troponin ≥ 1.85 ng/ml (OR 2.4, p &lt; 0.001), total cholesterol ≤ 195 mg/dl (OR 2.17, p &lt; 0.002), low-density lipoprotein ≤ 128.5 mg/dl (OR 2.03, p &lt; 0.007), potassium level ≤ 4.2 mmol/l (OR 1.92, p &lt; 0.002), hemoglobin ≤ 14 g/dl (OR 1.71, p &lt; 0.020), leucocytes ≥ 10.2 x10^9/l (OR 1.76, p &lt; 0.009), neutrophil to lymphocyte ratio ≥ 4.6 (OR 1.85, p &lt; 0.004), left atrium size ≥ 41 mm (OR 2.14, p &lt; 0.001), and left ventricular ejection fraction (LVEF) ≤ 44% (OR 2.99, p &lt; 0.001). Age, BNP, CRP, and LVEF at mentioned above pre-specified cut-off values turned out to be the most important independent predictors of NOAF development in multivariate analysis. Conclusions NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Older age, higher BNP and CRP level, and lower LVEF are independently associated with the probability of NOAF.

Extraperitoneal laparoscopic repair of huge inguinoscrotal bladder hernia: a case report and literature review

Inguinal herniation of urinary bladder is a rare condition which might associated with significant complication. Exact pre-operative diagnosis is extremely important. We reported a case of huge inguinoscrotal bladder hernia, associated with bilateral hydronephrosis and kidney injuries, managed by laparoscopy technique.