Histological evidence for reversible cardiomyocyte changes and serum cardiac troponin T elevation after exercise in rats.

This study characterized cardiac troponin T (cTnT) appearance and associated histological evidence of reversible or irreversible changes in myocardial ultrastructure, determined via electron microscopy, in rats undertaking isoproterenol (ISO) infusion or an endurance exercise challenge. Male rats were randomized into ISO and exercise groups. In ISO trials rats were killed 5 h (ISO-5H) and 24 h (ISO-REC19H) after a single ISO or saline injection (SAL-5H; SAL-REC19H). In the exercise trials rats were killed before, as a control (EXE-CON), immediately after (EXE-END5H) and 19 h after (EXE-REC19H) a 5-h bout of swimming with 5% body weight attached to their tail. Serum cTnT was quantified by electrochemiluminescence, and myocardial samples in ISO-REC19H, EXE-REC19H and SAL-REC19H were harvested for assessment of specific mitochondrial injury scores using electron-microscopy. cTnT was undetectable in all control animals (SAL-5H/SAL-REC19H and EXE-CON). cTnT increased in all animals after ISO and exercise but the response was significantly higher (P < 0.05) at ISO-5H (median [range]: 2.60 [1.76-6.18] μg · L(-1)) than at EXE-END5H (median [range]: 0.05 [0.02-0.14] μg · L(-1)). cTnT returned to baseline at EXE-REC19H, but had not completely recovered at ISO-REC19H (median [range]: 0.17 [0.09-1.22] μg · L(-1)). Mitochondrial "injury scores" were significantly higher (P < 0.05) in ISO-REC19H compared to EXE-REC19H and SAL-REC19H, with no difference between EXE-REC19H and SAL-REC19H. Mitochondria from EXE-REC19H appeared aggregated in nonlinear clusters in a small number of scans. These findings suggest that acute exercise-induced appearance of cTnT in this animal model is only associated with reversible changes in cardiomyocyte structure

Costs &amp; outcomes of hospitalized scrub typhus infection in a tertiary hospital in south India

Background &amp; objectives: Scrub typhus is a rickettsial infection seen along the Asian-Pacific rim and imposes a considerable burden on affected people in low- and middle-income countries. The present study was aimed to determine the direct cost of hospitalization of scrub typhus and its trend over six years. Methods: This was a retrospective, observational, hospital based study of individuals admitted to the hospital, diagnosed with scrub typhus over six years, from January 2013 to December 2018. The potential out of pocket expenditure was evaluated. Results: A total of 198 patients were included in the study. The median cost of admission (adjusted to INR 2020) for the six years (2013 to 2018) was found to be ₹ 37,026 (US $490) [interquartile range (IQR) 22,996-64,992]. The median cost for patients admitted to the intensive care unit (ICU) was ₹ 128,046 (US$ 1695) (IQR 71,575-201,171), while the cost for patients admitted to the ward-alone was ₹ 33,232 (US $ 440) (IQR 19,609-45,373). The multivariable analysis showed that ARDS and SOFA score were the independent predictors of ICU admission. Interpretation &amp; conclusions: Hospitalisation for scrub typhus is associated with a substantial healthcare expense. The predictors of increased cost were the presence of acute respiratory distress syndrome (ARDS), shock, increasing sequential organ failure assessment (SOFA) score and duration of hospital stay

Long-term myocardial recovery after mitral valve replacement in noncompaction cardiomyopathy

Isolated noncompaction of the left ventricle is a congenital cardiomyopathy, which has been described recently, with literature limited to case reports and case series. Even though various complications have been reported with noncompaction cardiomyopathy, among them severe mitral regurgitation has been reported recently in a few cases. There is no great evidence in the literature about its management, apart from some cases of mitral valve repair and replacement in young patients. We are reporting a case of an elderly lady with isolated left ventricular noncompaction cardiomyopathy associated with severe mitral regurgitation treated with mitral valve replacement with one and half year of follow up demonstrating significant myocardial recovery

Paid work is associated with improved health-related quality of life in patients with rheumatoid arthritis

Numerous patients with rheumatoid arthritis (RA) end their working career due to consequences of the disease. No publication has reported whether there is an independent association between patients' health-related quality of life (HRQOL) and employment status. The objective of the study was to investigate the association of paid work and HRQOL in patients with RA whilst controlling for demographics and disease severity. This was a cross-sectional study. Three hundred and ten patients were consecutively recruited from two Norwegians hospitals when commencing disease modifying anti-rheumatic drug treatment. Data on demographics, employment status, disease activity (DAS28-3), physical functioning, pain, tiredness, and HRQOL (SF-36) were collected. HRQOL were compared between 123 patients working full- or part-time and 187 patients not working due to disability pension, retirement, being students or “home workers”. The regression analyses showed an independent positive association between paid work and the physical (p = 001) and the mental component (p = 012) of the SF-36 when controlling for demographics and disease severity. Paid work was statistically significantly associated with better HRQOL in patients with RA. The positive association of performing paid work and HRQOL imply that health care providers should thoroughly evaluate the possibilities for the patients to continue with paid work

Minimally invasive treatment of patients with bronchobiliary fistula: a case series

<p>Abstract</p> <p>Introduction</p> <p>Bronchobiliary fistula is an uncommon complication secondary to hepatobiliary surgery. Bilioptysis is a pathognomic finding for bronchobiliary fistulas. Diagnosis may be easily established in the light of clinical history, which can be aided by imaging studies to pinpoint the exact location. Some diagnostic procedures such as endoscopic retrograde cholangiopancreatectomy are also useful for treatment.</p> <p>Case presentation</p> <p>We present three Turkish patients with bronchobiliary fistula secondary to previous hepatic surgery due to hydatid cyst in two, a 19-year-old and a 47-year-old man, and iatrogenic trauma of the common bile duct by endoscopy in a 35-year-old man. All of the patients were successfully treated by minimally invasive methods including percutaneous drainage and endoscopic retrograde cholangiopancreatography.</p> <p>Conclusion</p> <p>We suggest that bronchobiliary fistula could be managed through conservative treatment methods which do not require in-hospital follow-up, particularly in uncomplicated cases. Otherwise, surgical management can be unavoidable.</p

Sex differences in release of cardiac troponin T after endurance exercise.

CONTEXT: Post-exercise cardiac troponin release has been extensively described in athletic groups but little attention has been given to any role of sex in mediating this phenomenon. OBJECTIVE: We compared the release of cardiac troponin T (cTnT) after endurance running in training-experience, biological-age and maturity-matched young male and female runners. MATERIALS AND METHODS: Nineteen male (training history: 2.3 ± 1.0 years; mean age: 16.1 ± 1.2 years; Tanner stage: 3.7 ± 0.6) and 19 female (training history: 2.2 ± 1.0 years; mean age: 15.9 ± 1.4 years; Tanner stage: 4.0 ± 0.4) runners performed a 21 km run with "all-out" effort. Serum cTnT levels were assessed at pre-exercise (Pre-ex) and at 4 h post-exercise (Post-ex). RESULTS: At Pre-ex, cTnT concentrations were below the 99th percentile value (10 ng.l(-1)) in 32/38 runners. Post-ex cTnT increased in all subjects but the response was substantially higher (p < 0.05) in males [median (range): 210 (20-1360) ng.l(-1)] than females [median (range): 80 (10-550) ng.l(-1)]. At Post-ex, 95% (95% confidence interval: 75-99%) of males and 63% (95% confidence interval: 41-81%) of females (p < 0.05) had cTnT concentrations above the cut-off for acute myocardial infarction. CONCLUSIONS: The present data suggest that post-exercise cTnT elevation occurs in all runners but is augmented in young male compared to female athletes

Impact of high-intensity interval training and moderate-intensity continuous training on resting and post-exercise cardiac troponin T concentration.

We evaluated the influence of 12 weeks high-intensity interval training (HIIT, repeated 4-min cycling at 90% V̇O2max interspersed with 3-min rest, 200-300 KJ/session, 3-4 days wk-1 ) and work-equivalent moderate-intensity continuous training (MICT, continuous cycling at 60% V̇O2max ) on resting cardiac troponin T (cTnT) as well as exercise-induced cTnT appearance. Forty-eight sedentary obese young women were randomly assigned to HIIT, MICT, or a control group. V̇O2max and body composition were measured before and after training. At baseline, cTnT was assessed using a high-sensitivity assay at rest and immediately, 2 h and 4 h after 45-min cycling at 60% V̇O2max . After a 12-wk training period, cTnT was assessed before and after 45-min cycling at the same relative and absolute intensities as before training. Training led to higher V̇O2max and lower fat mass in both HIIT and MICT (all P < 0.05). Before training, cTnT was significantly elevated in all three groups (35 to 118%, all P < 0.05) with acute exercise. After training both resting and post-exercise cTnT levels (same relative intensity) were similar to pre-training values. In contrast, post-exercise cTnT (same absolute intensity, which represented a smaller exercise stimulus) was not elevated from rest in both HIIT and MICT groups. In conclusion, 12 weeks of either HIIT or MICT largely abolished the elevation of post-exercise cTnT concentration when exercise was performed at the same absolute intensity. There was, however, no impact of training on resting cTnT or post-exercise cTnT appearance for exercise performed at the same relative intensity. This article is protected by copyright. All rights reserved

Incidence of rotavirus infection in children with gastroenteritis attending Jos university teaching hospital, Nigeria

This study was conducted to determine the incidence of rotavirus infection in children with gastroenteritis attending Jos university teaching hospital, Plateau State. A total of 160 children with acute diarrhea were selected by random sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay technique using standard diagnostic BIOLINE Rotavirus kit. Demographic data of parents were also recorded. Rotavirus were detected in faeces of 22(13.8%) children with acute diarrhea, 90.9% of positive cases of rotavirus gastroenteritis were under 2 years of age with highest prevalence in children 7-12 months of age. Males excreted rotavirus at a significant higher rate than females (P < 0.05). Rotavirus excretion was highest when all three symptoms (diarrhea, fever and vomiting) occurred in the same child (7.5%) and lower when 2 symptoms occurred together (diarrhea and vomiting) with 3.8%, diarrhea and fever with 1.3% and lowest when diarrhea occurred alone with 1.3%. Playing with toys, attending day care, distance of source of water from toilet, eating of food not requiring cooking and playing with other children may serve as predisposing factors of rotavirus disease in these children

Predictive factors for severe toxicity of sunitinib in unselected patients with advanced renal cell cancer

Sunitinib has been registered for the treatment of advanced renal cell cancer (RCC). As patient inclusion was highly selective in previous studies, experience with sunitinib in general oncological practice remains to be reported. We determined the efficacy and safety of sunitinib in patients with advanced RCC included in an expanded access programme. ECOG performance status >1, histology other than clear cell and presence of brain metastases were no exclusion criteria. Eighty-two patients were treated: 23% reached a partial response, 50% had stable disease, 20% progressed and six patients were not evaluable. Median progression-free survival (PFS) was 9 months and median overall survival (OS) was 15 months. Importantly, 47 patients (57%) needed a dose reduction, 35 (43%) because of treatment-related adverse events, 10 (12%) because of continuous dosing, and two because of both. Stomatitis, fatigue, hand–foot syndrome and a combination of grade 1–2 adverse events were the most frequent reasons for dose reduction. In 40 patients (49%), there was severe toxicity, defined as dose reduction or permanent discontinuation, which was highly correlated with low body surface area, high age and female gender. On the basis of age and gender, a model was developed that could predict the probability of severe toxicity