SPONTANEOUS RETROPERITONEAL HEMATOMA ASSOCIATED WITH ANTITHROMBOTIC TREATMENT FOR ACUTE MYOCARDIAL INFARCTION

Retroperitoneal spontaneous hematoma is a serious condition, sometimes fatal. It occurs in association with anticoagulant therapy, unrelated to any trauma, surgery, invasive procedures or aortic aneurysm.A 68-year-old male patient is admitted for a non ST elevation myocardial infarction. He has a history of ischemic dilated cardiomyopathy with severe systolic dysfunction and atrial fibrillation. He is started on double antiplatelet therapy, anticoagulation, statin, beta blocker, ACE, and iv diuretic. Eight days later he suffers a syncope and the clinical examination reveals a large tender abdominal mass. The computed tomography examination shows a massive retroperitoneal hematoma. Although the antiplatelet and anticoagulant therapy is discontinued, the volume resuscitation (with crystalloids and packed red blood cells) is initiated and vasoconstrictor drugs are used, his condition continues to deteriorate. He is taken to the operation room for emergency laparotomy and the hematoma is evacuated. Although his clinical status improved and he remained hemodinamically stable, he suffers a cardiac arrest 27 days later and the resuscitation maneuvers are unsuccessful.</jats:p

Acute Myocardial Infarction Mortality Rates and Trends in Romania between 1994 and 2017

Introduction: The current study aimed to assess recent acute myocardial infarction (AMI) mortality rates and trends in Romania between 1994 and 2017. This dataset is a necessity in the context of the current improvement of emergency protocols, medical addressability, and modernization of hospital infrastructure. Materials and Methods: The study is a retrospective analysis of an anonymized mortality database containing all deaths registered in Romania during 1994–2017. AMI crude mortality rates (CMR) and age-standardized mortality rates (ASMR) were calculated using the European Standard Population. Poisson regression was used for calculating the annual percentage change (APC) in mortality, subsequently used to make mortality predictions through the year 2030. Results: There were 197,152 AMI deaths in women (39.3% of total AMI), and 304,644 (60.7%) in men. Mortality rates were higher in men as compared with women for the entire time covered by the study. Based on the 1994–2017 ASMR dynamics, predictions for the year 2030 showed an overall AMI ASMR of 70.9 (95% CI 69.9–71.9), with gender analysis showing 46.8 (95% CI 45.8–47.9) in women and 104.1 (95% CI 102.3–105.8) in men. Conclusion: Acute myocardial infarction age-standardized mortality rates decreased significantly in Romania between 1994 and 2017 in close correlation to the implementation of national healthcare programs.</jats:p

Dysfunctional high-density lipoproteins have distinct composition, diminished anti-inflammatory potential and discriminate acute coronary syndrome from stable coronary artery disease patients

AbstractThere is a stringent need to find means for risk stratification of coronary artery diseases (CAD) patients. We aimed at identifying alterations of plasma high-density lipoproteins (HDL) components and their validation as dysfunctional HDL that could discriminate between acute coronary syndrome (ACS) and stable angina (SA) patients. HDL2 and HDL3 were isolated from CAD patients’ plasma and healthy subjects. ApolipoproteinAI (apoAI), apoAII, apoCIII, malondialdehyde (MDA), myeloperoxidase (MPO), ceruloplasmin and paraoxonase1 (PON1) were assessed. The anti-inflammatory potential of HDL subfractions was tested by evaluating the secreted inflammatory molecules of tumor necrosis factor α-activated endothelial cells (EC) upon co-incubation with HDL2 or HDL3. We found in ACS versus SA patients: 40% increased MPO, MDA, apoCIII in HDL2 and HDL3, 35% augmented apoAII in HDL2, and in HDL3 increased ceruloplasmin, decreased apoAII (40%) and PON1 protein and activity (15% and 25%). Co-incubation of activated EC with HDL2 or HDL3 from CAD patients induced significantly increased levels of secreted inflammatory molecules, 15–20% more for ACS versus SA. In conclusion, the assessed panel of markers correlates with the reduced anti-inflammatory potential of HDL subfractions isolated from ACS and SA patients (mostly for HDL3 from ACS) and can discriminate between these two groups of CAD patients.</jats:p