Plasma interleukin-6 levels correlate with survival in patients with bacterial sepsis and septic shock

In this study, IL-6 levels were assessed as inflammatory biomarker of bacterial sepsis in patients hospitalized at the ICU of the hospital of Colombia.Materials and methodsProspective study on 62 patients diagnosed with sepsis and septic shock. An ELISA assay was used to test serum levels of IL-6 at admission and 48 h after admission. Variables were analyzed by χ2 test (alfa <0.05). Multivariable Cox regression was used to determine the survival with the statistical program SPSS v23.00.ResultsPatient's median age was 53 years old and 59.7% were male. Lung was the most common primary site of infection (43.5%), and hypertension comorbidity with higher prevalence (40%). Infection by Gram negative bacteria were significantly more frequent among patients than Gram positive (P = 0.037). Overall, survival analysis showed that 10 (16.1%) patients died with a survival median of 7.00 +4.874 (2–3) days. In patients with sepsis we detected a significant decline in the average of IL-6 serum levels after 48 h of admission [7.50 (SD: 7.00–68.00) pg/mL vs. 68.00 [SD: 7.00–300.00] pg/mL (P = 0.000). Only 25% of patients with septic shock who presented high levels of IL-6 at the time of admission and at 48 h had a survival up to 15 days (P = 0.005).ConclusionWe found significant differences between the plasma levels of IL-6 during the first 48 h after admission to the ICU among patients with sepsis and septic shock. Patients with sepsis had a significant decline in IL-6 levels, whereas in patients who developed septic shock, levels of this cytokine remained high and have a lower survival compared to those who maintained low levels of IL-6.

Pulsation of catheter during coronary angiography: Is it a sign of severe aortic regurgitation?

A 48-year-old male patient was admitted to our outpatient clinic with complaints of shortness of breath. He also had a holo-diastolic murmur at the right sternal border and an apical impulse being displaced laterally and inferiorly. Transthoracic echocardiography showed a severe aortic regurgitation without aortic valve stenosis and a mildly dilated left ventricle accompanied by an ejection fraction of 55%. The aortic regurgitation jet was eccentric and there were significant holodiastolic flow reversals in the descending thoracic aorta. Surgical management was advised for this patient because of symptomatic severe aortic regurgitation. Then, the patient underwent preoperative coronary angiography through the right femoral artery route. The left coronary ostium could be engaged with a 6 Fr Judkins left diagnostic catheter; however, the catheter jumped through the ascending aorta. Afterwards, the catheter was engaged and again jumped through the ascending aorta. Engagement and jumping cycles observed between successive systole to diastole. In our opinion, this catheter movement is explained by wide pulse pressure, like the severe characteristic physical findings of severe aortic regurgitation. Further studies are needed to understand whether this catheter movement is angiographically evidence of severe aortic regurgitation.

Efficacy, safety and tolerability of bosentan as an adjuvant to sildenafil and sildenafil alone in persistant pulmonary hypertension of newborn (PPHN)

BackgroundPulmonary Arterial Hypertension (PAH) carries a poor prognosis in both adult and pediatric patients. It is a life-threatening condition in newborns. Current recommendations advocate the use of targeted monotherapy as a first-line approach for the treatment of Persistent Pulmonary Hypertension of the Newborn (PPHN). In case of an inadequate clinical response to treatment, an addition of a second or third agent is considered. PAH is usually managed with a phosphodiesterase 5 inhibitor or an endothelin receptor blocker. There are limited pediatric studies that address questions like which class of therapy should be initiated first or if a combination should be initiated together. With this background, the present study was initiated to compare the efficacy, safety, and tolerability of bosentan as an adjuvant to sildenafil and sildenafil alone in PPHN.ResultsA total of 40 patients were enrolled in the study. Out of them, 26 were males (65%) and 14 were females (35%). PPHN was most commonly seen in the 29 (72.5%) of participants with a history of first order birth. Mean duration of symptoms was 14.05 ± 2.06 days. The participants were randomized to two groups. Group A consisted of total 25 participants that received both bosentan and sildenafil and group B had 15 participants that received sildenafil alone. Both groups were comparable in terms of birth weight and present weight, consanguinity, and mode of delivery. Efficacy was determined by the reduction in mean baseline Pulmonary Artery Systolic Pressure (PASP). PASP in group A was 75.56 ± 10.62 mm Hg and in group B was 64.86 ± 12.25 mm Hg which was not statistically significant (P > 0.05). PASP on the third and seventh day in group A were 43.72 ± 8.63 and 24.47 ± 3.52 mm Hg compared to 42.28 ± 9.43 and 27.276 ± 8.38 respectively in group B which was statistically significant (P < 0.05).There were two deaths each in both groups. Two participants in Group A developed liver function abnormalities. None of the participants in Group B had adverse effects.ConclusionMost common clinical manifestations were nonspecific. Cardiovocal syndrome was common in PPHN. We conclude that oral sildenafil treatment is a safe, simple and effective treatment for persistent pulmonary hypertension in newborn. Combination of bosentan with sildenafil is more effective and safe in reducing pulmonary artery (PA) pressures in high-risk patients with PPHN.

Peculiarities of vascular endothelial growth factor of oral cavity in atopic condition VEGF of oral cavity in atopic condition

Background and aimsVascular endothelial growth factor (VEGF) is regarded as a potent stimulating factor for angiogenesis and vascular permeability and probably is connected with an inflammatory reaction. Our study aimed to determine the effect of VEGF in the inflammatory process in the oral mucosa of experimental animals in the modulation of atopic disease.Materials and methodsAtopic condition was simulated by the ovalbumin model. Obtained specimens of oral mucosa were examined histologically; immunohistochemistry was performed with detection VEGF, CD23, CD20.ResultsMost pronounced changes with twice increased expression activity of VEGF has been detected in the affected areas of the lamina propria and were associated with perivascular inflammatory microinfiltration, but unexpected expression in the epithelial layer has been revealed surround of intraepithelial inflammatory cells mainly. Pronounced correlations have been detected as VEGF and CD23 (r = 0.91), VEGF and CD20 (r = 0.87), CD23 and CD20 (r = 0.89).Discussiondescribed the changes in the tissues of the oral mucosa could be served as a basis for the development of preventive measures in patients with atopic diseases.discussionConclusionsActivation of VEGF is connected with accumulation of inflammatory infiltrate represented by B-lymphocytes, activated macrophages, eosinophils with a correlation in atopic process.

Assessment of relationship between the use of cell phone and social networks and sleep quality in students of medical sciences: A cross-sectional study

Introduction Sleep quality is an essential aspect in human health and function. Considering high prevalence of using smartphones and social networks among students and their impact on sleep quality, this study was conducted to determine the relationship between the overuse of cell phone and addiction to social networks and students’ sleep quality. Materials and methods This cross-sectional study was conducted in Kermanshah University of Medical Sciences, Kermanshah, Iran in 2018. Using cluster sampling, 321 students from different disciplines were selected. Data gathering tools consisted of the questionnaire of Pittsburgh Sleep Quality Index (PSQI). Cell phone use and addiction to social networks were assessed using Cell Phone Overuse Scale and a researcher-made questionnaire, respectively. Data were analyzed using SPSS software (version 19) and Pearson’s correlation test. Results The mean total score of sleep quality in students was 6.58 ± 1.05. There was a positive and significant correlation between sleep quality and social networks addiction score (p < 0.05, r = 0.5) and cell phone overuse (p < 0.05, r = 0.44); this is an inverse correlation, because higher scores of the total PSQI denote a lower sleep quality and, in Cell Phone Overuse Scale, higher scores shows overuse. Conclusions According to the findings of this study, there was a significant statistical relationship between the overuse of cell phone and social networks and students’ sleep quality. In other words, students who have had overuse of cell phones had poorer sleep quality. Therefore, providing effective educational programs to improve the sleep quality in this group is essential.

A different technique for sutureless coronary bypass grafting

Introduction Many coronary anastomotic devices have been designed to replace manual stitching in coronary surgery; however, interestingly, none of them became widespread. Our aim was to work out an easy and fast endoluminal vessel-to-vessel stent bridge distal anastomotic technique. Materials and methods Ten coronary arteries of eight fresh human hearts were used in this study. The anastomosis was performed with the implantation of a graft vessel into the lumen of the coronary artery by performing stent fixation. The technique is described and photo documented in detail. The durability and the conductibility of the anastomosis were examined with intraluminal endoscopy, functional streaming test, and a coloring of the vessels. Results The anastomosis had great results in all cases. Obstruction, dissection, or dislocation of the vessels was not observable. Conclusions This study confirmed the ex-vivo feasibility of the described technique. This method can be an easy, fast, and reliable method applied in the endoscopic distal coronary artery anastomosis surgery. The development of stents adapted to this method and the in-vivo testing of this technique are necessary for the future.

Association of XRCC3 18067 C>T (Thr241Met) polymorphism with risk of cervical and ovarian cancers: A systematic review and meta-analysis

The 18067 C>T polymorphism of XRCC3 gene has been considered to be implicated in the development of cervical and ovarian cancers, but the results are inconsistent. Thus, we conducted a meta-analysis to assess the association of XRCC3 18067 C>T polymorphism with risk of cervical and ovarian cancers. All studies on the association of XRCC3 18067 C>T polymorphism with cervical and ovarian cancers risk were retrieved. Finally, a total of 17 studies including 10 studies with 5,637 cases and 10,057 controls on ovarian cancer and 7 studies with 1,112 cases and 1,233 controls on cervical cancer were selected. Overall, pooled results showed that the XRCC3 18067 C>T polymorphism was significantly associated with increased risk of ovarian cancer (TC vs. CC: OR = 0.904, 95% CI = 0.841–0.972, p = 0.006; TT + TC vs. CC: OR = 0.914, 95% CI = 0.853–0.979, p = 0.010) and cervical cancer (TC vs. CC: OR = 1.00, 95% CI = 1.066–1.585, p = 0.009). Further subgroup analysis by ethnicity revealed an increased risk of cervical and ovarian cancer in Asians and Caucasians, respectively. The present meta-analysis inconsistent with the previous meta-analysis suggests that the XRCC3 18067 C>T polymorphism might be implicated in the pathogenesis of cervical and ovarian cancers.

Eosinophil percentage as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background In addition to proinflammatory properties, eosinophils can stimulate platelet activation and enhance prothrombotic pathways. In this study, we aimed to investigate the association between the eosinophil percentage (EOS%) and major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled a total of 1,909 patients who were diagnosed with STEMI. Ventricular arrhythmia, reinfarction, the need for cardiopulmonary resuscitation, target vessel revascularization, congestive heart failure, and cardiovascular mortality during index hospitalization were defined as MACE. Results Three hundred and eighty patients (19.7%) reached the combined endpoint with MACE. The rates of inhospital mortality and MACE were significantly higher in low EOS% group as compared to high EOS% group (4% vs. 1.1%, p < 0.01 and 32.8% vs. 11.3%, p < 0.01, respectively). On multivariate logistic regression analyses, EOS% (OR = 0.44, p < 0.01) was found to be one of the independent predictors of MACE. The EOS% lower than 0.60 on admission predicted inhospital MACE with a sensitivity of 68% and a specificity of 72% (AUC: 0.684, p < 0.01). Conclusions Low EOS% on admission may be associated with high inhospital MACE in STEMI patients. EOS% may be used as a novel biomarker for risk stratification of these patients.

Success and reliability of extrafemoral Exoseal vascular closure device: “Off-label” usage

Aim The aim of this study is to present the reliability and efficacy of Exoseal vascular closure device (EVCD) for closure of extrafemoral punctures. Materials and methods All patients who were treated with EVCD following arterial endovascular treatment involving an extrafemoral puncture between April 2013 and January 2014 were examined retrospectively. This study included 11 patients (4 women and 7 men between the ages of 48 and 87 years; average age = 65 years). A total of 13 procedures were performed in 11 patients involving the following access routes: brachial artery (n = 5), popliteal artery (n = 4), and polytetrafluoroethylene graft (n = 4). Results Twelve out of 13 EVCD procedures achieved technical success and procedural success. One minor and one major complications occurred. Both complications were revealed to be pseudoaneurysms, both in the brachial artery. Pseudoaneurysm of the minor complication was treated by Fibrin Sealant (Tisseel) injection guided by ultrasonography and the other pseudoaneurysm was treated by covered stent placement. Conclusions The femoral artery is an essential access route of arterial endovascular procedures; however, in some cases, the extrafemoral arterial route is necessary. In this study, EVCD was found to be useful for closing extrafemoral arterial routes. This study had a limited number of cases and more large-scale studies are needed.

Randomized controlled trial of aquatic exercise for treatment of knee osteoarthritis in elderly people

Aim The aim of this study is to assess the efficacy of aquatic exercise on pain, gait, and balance among elderly patients with knee osteoarthritis. Methods We performed a randomized controlled trial at a university hospital. Overall, 32 men with knee osteoarthritis, aged ≥ 60 years, were included. Pain, balance, and gait were evaluated before and 2 months after interventions. The group control used acetaminophen and followed lifestyle recommendations. The intervention group performed the aquatic exercise three sessions per week for 8 weeks. Results At the end of the study, mean pain scores were significantly different between the groups (p = 0.010). Within-group analyses showed that group intervention experienced significant pain relief (p = 0.019), whereas group control did not show the significant change (p = 0.493). There was significant improvement in favor of aquatic exercise with regard to static (p = 0.001) and dynamic (p = 0.001) balance, step length (p = 0.038), stride length (p < 0.001), and cadence (p < 0.001). However, we did not find a significant difference in step time and width between the two groups. Conclusions Aquatic exercise would be beneficial in decreasing subjective pain of osteoarthritis. There are some recognizable improvements in patients’ gait and balance as well.