Clinical and echocardiographic characteristics of patients with significant pericardial effusion requiring pericardiocentesis

Objective: Clinical and echocardiographic features of significant pericardial effusion (PE) have been reported from the west. Currently there is lack of published data from this part of the world, we reviewed all consecutive cases of significant PE requiring echocardiographic assisted pericardiocentesis to analyze the clinical and echocardiographic features of these patients.Methods: Forty four consecutive patients who underwent echocardiography assisted pericardiocentesis at the Aga Khan University Hospital (AKUH) between January 1988 and May 2001 re included in this review.Results: Most common presenting symptoms were dyspnea (89%) and fever (36%). Elevated JVP and pulsus paradoxus were documented in 59% and 41% of patients respectively. Sinus tachycardia (75%) and low voltage (34%) were the most common ECG findings. Malignancy (45-51%) and tuberculosis (27%) were among the most frequent causes of PE. One patient died during echocardiography-assisted pericardiocentesis.CONCLUSION: The symptoms and physical findings of haemodynamically significant PE are frequently nonspecific. Transthoracic echocardiography is the gold standard for rapid and confirmatory diagnosis of PE and cardiac tamponade. The most common cause of PE was malignancy followed by tuberculosis. Pericardiocentesis under echocardiographic guidance is a safe and effective treatment for significant PE

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Spontaneous multivessel coronary artery dissection associated with elevated homocysteine levels

A case of spontaneous multi-vessel coronary artery dissection in a young man, with markedly elevated serum homocysteine levels, is reported. The effects of elevated homocysteine levels on arterial endothelial function and possible plaque rupture leading to coronary dissection and acute coronary syndrome and / or sudden cardiac death are also discussed

Myocardial infarction during factor IX infusion in hemophilia B: case report and review of the literature

There are very few reports in the literature of acute myocardial infarction (MI) occurring during infusion of factor concentrates, particularly cryosupernatant in patients with hemophilia B. We describe a case of a 61-year-old man with hemophilia B who suffered an acute MI while receiving cryosupernatant infusion as factor replacement therapy. Cryosupernatant is rich in coagulation factor IX and contains low levels of fibrinogen and von Willebrand\u27s factor. Factor IX and other factors present in cryosupernatant can possibly become activated during the manufacturing process causing thrombus formation in patients who are prone to it

Improved remediation of amoxicillin-contaminated water by floating treatment wetlands intensified with biochar, nutrients, aeration, and antibiotic-degrading bacteria

ABSTRACTResidual antibiotics have become emerging contaminants of concern for their adverse impact on the ecosystem. Additionally, their accumulation in the environment is increasing antibiotic resistance among pathogens. This study assessed the impact of intensification of biochar, nutrients, aeration, and bacteria (BNAB) on the remediation potential of floating treatment wetlands (FTWs) to treat amoxicillin (AMX)-contaminated water. The FTWs were developed with saplings of Vetiveria zizanioides and intensified with biochar (1.5%), nutrients (25 mgL−1 N, 25 mgL−1 P, 20 mg L1 K), aeration (7 mg L−1), and AMX-degrading bacteria. The results showed that all the amendments enhanced the AMX degradation, while the maximum reduction in COD (89%), BOD (88%), TOC (87%), and AMX (97%) was shown by the combined application of all the amendments. The combined application also enhanced plant growth and persistence of the inoculated bacteria in the water, roots, and shoots. This approach can be employed for the low-cost, environment-friendly treatment, and recycling of antibiotic-contaminated wastewater, where BNAB intensification can further improve the bioremediation efficiency of FTWs in the case of heavily polluted waters

Enhanced Degradation of Ciprofloxacin in Floating Treatment Wetlands Augmented with Bacterial Cells Immobilized on Iron Oxide Nanoparticles

Antibiotic contamination of water is an emerging global issue with severe implications for both public health and the environment. Ciprofloxacin (CIP) is a synthetic fluoroquinolone antibiotic, which is broadly used in human and veterinary medicines around the world to treat various bacterial infections. The presence of CIP in the aquatic environment poses serious health problems to human beings and other living entities. Floating treatment wetland (FTW) is a low-cost and eco-friendly wastewater remediation technology. In the current study, the Canna indica. (Indian shot) was vegetated in a floatable mat to develop FTWs. A consortium of three bacterial strains, Acinetobacter lwoffii ACRH76, Bacillus pumulis C2A1, and Acinetobacter sp. HN3, was immobilized on iron oxide nanoparticles (Fe3O4-NPs) and augmented in the FTWs for the remediation of CIP-contaminated (100 mg/L) water. The augmentation of bacteria (immobilized or free) in the FTWs significantly enhanced the removal of CIP from water. The maximum reduction in CIP (98%), chemical oxygen demand (COD; 90%), biochemical oxygen demand (BOD; 93%) and total organic carbon (TOC; 95%) was observed in FTWs that had Fe3O4-NP supported bacteria. This study reveals that FTWs have a great potential to remove the CIP from contaminated water, albeit its CIP removal efficiency was substantially enhanced by augmentation with Fe3O4-NPs supported bacteria

Enhanced Degradation of Ciprofloxacin in Floating Treatment Wetlands Augmented with Bacterial Cells Immobilized on Iron Oxide Nanoparticles

Antibiotic contamination of water is an emerging global issue with severe implications for both public health and the environment. Ciprofloxacin (CIP) is a synthetic fluoroquinolone antibiotic, which is broadly used in human and veterinary medicines around the world to treat various bacterial infections. The presence of CIP in the aquatic environment poses serious health problems to human beings and other living entities. Floating treatment wetland (FTW) is a low-cost and eco-friendly wastewater remediation technology. In the current study, the Canna indica. (Indian shot) was vegetated in a floatable mat to develop FTWs. A consortium of three bacterial strains, Acinetobacter lwoffii ACRH76, Bacillus pumulis C2A1, and Acinetobacter sp. HN3, was immobilized on iron oxide nanoparticles (Fe3O4-NPs) and augmented in the FTWs for the remediation of CIP-contaminated (100 mg/L) water. The augmentation of bacteria (immobilized or free) in the FTWs significantly enhanced the removal of CIP from water. The maximum reduction in CIP (98%), chemical oxygen demand (COD; 90%), biochemical oxygen demand (BOD; 93%) and total organic carbon (TOC; 95%) was observed in FTWs that had Fe3O4-NP supported bacteria. This study reveals that FTWs have a great potential to remove the CIP from contaminated water, albeit its CIP removal efficiency was substantially enhanced by augmentation with Fe3O4-NPs supported bacteria