Intermediate-Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set.

BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long-term risk following limited higher-risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions. METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age-adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic valve replacement and coronary artery bypass graft versus percutaneous coronary intervention. Procedures and diagnoses were identified by International Classification of Disease, Ninth Revision, Clinical Modification codes. After cardiac procedures, 90-day ischemic stroke readmission rate was highest after transcatheter aortic valve replacement (2.05%); 90-day hemorrhagic stroke rate was highest after left ventricular assist device placement (0.09%). The hazard ratio for ischemic stroke after transcatheter aortic valve replacement, compared with surgical aortic valve replacement, in fully adjusted Cox models was 1.86 (95% confidence interval, 1.12-3.08; P=0.016) and 6.17 (95% confidence interval, 1.97-19.33; P=0.0018) for hemorrhagic stroke. There was no difference between coronary artery bypass graft and percutaneous coronary intervention. CONCLUSIONS: We demonstrated elevated readmission rates for ischemic and hemorrhagic stroke in the intermediate 30-, 60-, and 90-day risk periods following common cardiac procedures. Furthermore, we found an elevated risk of stroke after transcatheter aortic valve replacement compared with surgical aortic valve replacement up to 1 year

Original Article

It has been the general practice to employ culture methods in discerning whether Ascaris eggs are alive or dead. Although culture methods are most reliable, they are not without shortcomings- -the time required in going through the procedures is very long. The discovery of some reliable and simple methods, therefore, has eagerly been awaited. However little research has been done on this subject and no better methods have ever been developed. Sudan III staining method is one of the methods developed so far, but its reliability is doubted by many researchers. In an effort to devise a new staining method, the author carried out a series of experiments; sudan III staining method was first checked on the attempts were made to enhance the ability of eggs to stain by pre-treating them with acid and alkali, and finally a number of dyes, especially fatty dyes, were experimented on. As a result of these experiments, the author has developed anew staining method using Lugol\u27s solution and has proved that it is superior to sudan III staing method. Further experiments were carried out in order to investigate into the mechanism of staining. A comparative study of this method with the staining method using fluoroscopic dye, which had recently been developed, was also performed. The results of the experiments are summarized as follows: 1. The eggs killed by heating stained well by sudan III staining method, but the eggs killed by other means did not stain well. Attemts were made to enhance the ability to stain by applying various pre-treatment but without success. 2. The live eggs stained with Lugol\u27s solution are not decolorized by alcohol, but the dead eggs stained with Lugol\u27s solution are decolorized by alcohol. It would thus be possible to discern by this method whether eggs are dead or alive. Although it has no absolute value, this method is superior to sudan III staining method and is availabe for experimental purposes.3. It seems that the permeability of the egg-shell plays an important part in Lugol\u27s solution staining method. Although results vary with the change in the methods used for killing eggs, it seems that the permeability of shells of eggs are enhanced when they are dead, thereby promoting decolorization. 4. It is assumed that it is the .third layer that plays a significant role in the permeability of the eggshell. 5. It seems that the staining method using fluoroscopic dyes, which has more or less similar value as sudan III staining method, is inferior to Lugol\u27s .solution staining method in discerning whther Ascaris eggs are dead or alive

Sepsis: The evolution in definition, pathophysiology, and management

There has been a significant evolution in the definition and management of sepsis over the last three decades. This is driven in part due to the advances made in our understanding of its pathophysiology. There is evidence to show that the manifestations of sepsis can no longer be attributed only to the infectious agent and the immune response it engenders, but also to significant alterations in coagulation, immunosuppression, and organ dysfunction. A revolutionary change in the way we manage sepsis has been the adoption of early goal-directed therapy. This involves the early identification of at-risk patients and prompt treatment with antibiotics, hemodynamic optimization, and appropriate supportive care. This has contributed significantly to the overall improved outcomes with sepsis. Investigation into clinically relevant biomarkers of sepsis are ongoing and have yet to yield effective results. Scoring systems such as the sequential organ failure assessment and Acute Physiology and Chronic Health Evaluation help risk-stratify patients with sepsis. Advances in precision medicine techniques and the development of targeted therapy directed at limiting the excesses of the inflammatory and coagulatory cascades offer potentially viable avenues for future research. This review summarizes the progress made in the diagnosis and management of sepsis over the past two decades and examines promising avenues for future research

Manganese Neurotoxicity as a Complication of Chronic Total Parenteral Nutrition

Manganese accumulation in the central nervous system creates clinical symptoms of cognitive dysfunction, behavioral changes, and movement disorders resembling Parkinson’s disease. Radiographic features of this rare clinical entity include symmetric T1 hyperintensities in the bilateral globus pallidi, with corresponding hypointensities on T2-weighted images. Total parenteral nutrition (TPN) is an increasingly used potentially lifesaving therapy for patients who cannot tolerate enteral nutrition. However, when used over a period of several weeks to months, its associated risks and complications carry significant morbidity and mortality. One of the more rare complications of TPN use is manganese toxicity. We provided care for a 38-year-old female on chronic TPN who presented to the hospital with Parkinsonian features, confusion, falls, and lethargy. MRI brain showed T1 hyperintensities in the bilateral globus pallidi, which were attributed to manganese toxicity from chronic TPN use. Supporting evidence for this rare entity included decreased signal intensity in the bilateral globus pallidi on T2-weighted images and T1 hyperintensities in the substantia nigra. With antifungal treatment and permanent cessation of TPN, her mentation and neurological symptoms began to improve within a week. Repeat MRI brain performed one month after discontinuation of TPN revealed improvement of the T1 hyperintensities in the bilateral globus pallidi. Our objective in presenting this case is to highlight manganese neurotoxicity as a rare complication of TPN in a patient without known hepatic dysfunction and to emphasize the importance of routinely monitoring patients for the possible adverse effects of chronic TPN. Our case is among the handful of published cases in which a patient without known liver dysfunction, which is the primary organ responsible for manganese elimination from the body, developed manganese neurotoxicity

Reply to the Comment on: Subrat Khanal et al. The Repertoire of Adenovirus in Human Disease: The Innocuous to the Deadly. <i>Biomedicines</i> 2018, <i>6</i>, 30

We would like to thank Dr [...

The Repertoire of Adenovirus in Human Disease: The Innocuous to the Deadly

Adenoviridae is a family of double-stranded DNA viruses that are a significant cause of upper respiratory tract infections in children and adults. Less commonly, the adenovirus family can cause a variety of gastrointestinal, ophthalmologic, genitourinary, and neurologic diseases. Most adenovirus infections are self-limited in the immunocompetent host and are treated with supportive measures. Fatal infections can occur in immunocompromised patients and less frequently in the healthy. Adenoviral vectors are being studied for novel biomedical applications including gene therapy and immunization. In this review we will focus on the spectrum of adenoviral infections in humans

Comparison of positive anxiety screens between study population (years 2013–2014) and NHANES population (years 1999–2004).

<p>Comparison of positive anxiety screens between study population (years 2013–2014) and NHANES population (years 1999–2004).</p

Distribution of GAD-7 scores in study population.

<p>Distribution of GAD-7 scores in study population.</p

Dealing with stress, anxiety, emotions, depression.

<p>Dealing with stress, anxiety, emotions, depression.</p