Cardiogenic Shock

Cardiogenic shock is the second most common cause of circulatory shock, occurs secondary to myocardial infarction, which accounts for 80% of the cases, and remains one of the leading causes of death in patients with acute myocardial infarction. Cardiogenic shock carries a high morbidity and mortality despite recent advances in medical and mechanical therapies. Cardiogenic shock also occurs in non-acute coronary syndrome conditions, such as Takotsubo cardiomyopathy, fulminant myocarditis, end stage heart failure, and others. In this chapter, we provide a brief review on the pathophysiology, diagnosis, and acute management of cardiogenic shock patients. We will focus more on the management of acute coronary syndrome related cardiogenic shock, given that it is the most common etiology

Styloid Process: What Length Is Abnormal?

The length of the styloid process varies greatly in different populations and depends on ethnicity and geographical background. The elongated styloid process may be associated with Eagle’s syndrome. Therefore, the mean normal length of the styloid process in different population groups needs to be calculated and the upper cutoff limit for elongated styloid process should be found. The objective of the research was to evaluate the styloid process length in the Kashmiri population using multidetector computed tomography. Materials and Methods. We retrospectively evaluated 304 patients who underwent computed tomography of the head and paranasal sinuses, and the mean styloid process length was calculated on both sides. The mean of three measurements of styloid process length was taken. The study population was grouped as follows: Group I included patients at the age of 21-30 years; Group II comprised patients at the age of 31-40 years; Group III included 68 patients at the age of 41-50 years; Group IV comprised patients > 50 years old. Results. The mean length of the styloid process in the studied population varied from 20 to 51 mm (mean 31.3 ± 4.5 mm). There was no significant difference in the length on both sides (p=0.835). The mean length of the styloid process was 30.1 ± 4.2 mm in females and 32.3 ± 4.8 mm in males (p< 0.034). The lengths of the styloid process in different age groups were as follows: in Group I - 30.9 ± 4.4 mm; in Group II - 31.2 ± 4.8 mm; in Group III - 31.6 ± 4.3 mm; in Group IV - 31.5 ± 4.5 mm. Conclusions. The mean length of the styloid process in our population was higher as compared to many other ethnic groups. The styloid process in males was longer. The elongated styloid process on computed tomography scan should not be labeled as Eagle’s syndrome unless clinical symptoms are present

Brain abscesses in a patient with a patent foramen ovale: a case report

<p>Abstract</p> <p>Introduction</p> <p>Brain abscesses arising from right-to-left cardiac shunting are very rare in adults.</p> <p>Case presentation</p> <p>We describe the case of a 47-year-old non-hispanic white male with periodontal disease who developed several brain abscesses caused by <it>Streptococcus intermedius</it>. A comprehensive workup revealed a patent foramen ovale with oral flora as the only plausible explanation for the brain abscesses.</p> <p>Conclusion</p> <p>Based on this case and the relevant literature, we suggest an association between a silent patent foramen ovale, paradoxical microbial dissemination to the brain, and the development of brain abscesses.</p

Computed Tomography Severity Grading of Chronic Obstructive Pulmonary Disease based on Volumetric Assessment of Inspiratory and Expiratory Scans

Background & Aims:  To determine attenuation threshold for detection and quantification of air trapping in obstructive airway disease. Quantify airway dysfunction in patients of obstructive airway disease & its correlation with pulmonary function tests. Materials & Methods: Paired HRCT scans of 48 patients were done and correlated with Pulmonary Function Tests taken within 2 weeks of the study. Threshold attenuation value on expiratory scan that signifies air trapping was obtained by correlating relative volumes with PFT parameters (PEF 25-75% & RV/TLC). The lung volumes at this threshold were then correlated with PFT values signifying airway dysfunction (FEV1, FEV1/FVC and PEF 25-75%) and airway dysfunction was then quantified based on these volumes. Results: Maximum correlation of PFT parameters signifying air trapping is with relative volume of limited lung at -850HU (l850) (p -10%). Conclusion: l850 can be used as a CT parameter to quantify airway dysfunction irrespective of presence or absence of emphysema. Severity classification of obstructive airway disease was formulated based on l850

Check list of Anthocerophyta and Marchantiophyta of Pakistan and Kashmir

In the present study, a review of previously published literature regarding Anthocerophyta and Marchantiophyta of Pakistan and Kashmir has been done in order to know the diversity of these groups. Previous contributions collectively reveal 122 taxa distributed in 36 genera and 24 families. Of these 118 taxa (97.52%) are belonging to the Marchantiophyta, while the rest of 4 species (3.30%) members to Anthocerophyta. Aytoniaceae is the largest family with 16 species. Genera-wise, Riccia is the largest genus with 12 species. An average number of species/genera is c. 3.36. A major portion of Pakistan is still un-explored especially Sindh and Balochistan province of Pakistan, and on the basis of this study it can be said that many more taxa will be added to the list

Advances in the meta-analysis of heterogeneous clinical trials I: the inverse variance heterogeneity model

This article examines an improved alternative to the random effects (RE) model for meta-analysis of heterogeneous studies. It is shown that the known issues of underestimation of the statistical error and spuriously overconfident estimates with the RE model can be resolved by the use of an estimator under the fixed effect model assumption with a quasi-likelihood based variance structure — the IVhet model. Extensive simulations confirm that this estimator retains a correct coverage probability and a lower observed variance than the RE model estimator, regardless of heterogeneity. When the proposed IVhet method is applied to the controversial meta-analysis of intravenous magnesium for the prevention of mortality after myocardial infarction, the pooled OR is 1.01 (95% CI 0.71–1.46) which not only favors the larger studies but also indicates more uncertainty around the point estimate. In comparison, under the RE model the pooled OR is 0.71 (95% CI 0.57–0.89) which, given the simulation results, reflects underestimation of the statistical error. Given the compelling evidence generated, we recommend that the IVhet model replace both the FE and RE models. To facilitate this, it has been implemented into free meta-analysis software called MetaXL which can be downloaded from www.epigear.com