Pulmonary embolism presenting as syncope: a case report

<p>Abstract</p> <p>Introduction</p> <p>Despite the high incidence of pulmonary embolism its diagnosis continues to be difficult, primarily because of the vagaries of symptoms and signs in presentation. Conversely, syncope is a relatively easy clinical symptom to detect, but has varied etiologies that lead to a documented cause in only 58% of syncopal events. Syncope as the presenting symptom of pulmonary embolism has proven to be a difficult clinical correlation to make.</p> <p>Case presentation</p> <p>We present the case of a 26-year-old Caucasian man with pulmonary embolism induced-syncope and review the pathophysiology and diagnostic considerations.</p> <p>Conclusions</p> <p>Pulmonary embolism should be considered in the differential diagnosis of every syncopal event that presents at an emergency department.</p

The Relationship of Markers With Carotid Artery Stenosis and Lesion Hardness: Superiority of C-Reactive Protein and Uric Acid

Background : Atherosclerosis is a disease that cholesterol plaque builds up inside arteries. The process of atherosclerosis starts when certain substances such as cholesterol, fats, and cellular waste products accumulate in the walls of arteries, and the immune system responds to these substances, triggering inflammation. Over time, this inflammation can cause the plaque to grow and harden, narrowing the artery and reducing blood flow. Carotid artery disease (CAD) is a conclusion of plaques in carotid artery. CAD can increase the risk of stroke, a potentially life-threatening condition that occurs when blood flow to the brain is interrupted. Objectives: The objectives of this study were to detect the association between carotid artery stenosis and inflammatory markers. Methods: This study was designed prospectively and included 109 and 100 patients having mild carotid stenosis and severe carotid stenosis, respectively. Further, 101 patients were included in the control group. The carotid ultrasonography was evaluated in all patients. After classifying the plaques into(severe stenosis) categories, they were also grouped into echogenicity plaques, namely, echolucent (soft) and echogenic (hard) plaques. Results: The uric acid (UA) values of the mild and severe stenosis groups were higher than that of the control group (P<0.01). The mean C-reactive protein (CRP) value was the highest in the severe stenosis group, and the lowest CRP value was found in the control group (P<0.01). A one-unit increase in UA could increase the risk by 2.203 times. The CRP value was higher in the soft lesion group without calcification than in the hard lesion group with calcification. Conclusion: Our findings demonstrated that age, UA, and CRP values were identified as predictors independent of each other in the development of carotid stenosis. Regarding plaque classification, our results identified CRP, mean platelet volume (MPV), white blood cell, and lymphocyte values as negative predictors. The findings of our study indicate that CRP and UA are valuable in predicting the severity of stenosis and the formation of soft plaque

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Long-term prognostic significance of terminal QRS distortion on patients with stemi and its correlation with the GRACE scoring system

WOS: 000458593300004PubMed ID: 30476633

Comparison of local infiltration anesthesia and peripheral nerve block: a randomized prospective study in hand lacerations

Background/aim: To compare local infiltration anesthesia (LIA) and peripheral nerve block (PNB) in repairing hand lacerations. Materials and methods: This prospective study was designed as a randomized, controlled, unblinded trial. Fifty four patients with hand lacerations were included in the study. While 23 of these patients had LIA, PNB was performed in the remaining 31 patients. Lidocaine hydrochloride 2\% and 27 gauge needles were used. Onset time of the anesthesia, response to the injection and suturing procedures, need for additional anesthetic, and patient satisfaction were compared. Results: No significant differences were noted between the groups in terms of response to injection pain and suture pain (Mann-Whitney U; P = 0.220/P = 0.316). There were also no significant differences between the groups when patient satisfaction (chi-square; P = 0.785) and need for additional local anesthetics (Fisher's exact; P = 0.628) were evaluated. The time to loss of pinprick sensation in the local infiltration group was 1.3 min, whereas in the nerve block group it was 2.2 min. The difference was statistically significant (Mann-Whitney U; P < 0.001). Conclusion: Despite the fact that performing PNB in emergency departments requires some experience, it still counts as a convenient method comparable to LIA