Efficacy of first-line sodium thiosulphate administration in a case of potassium cyanide poisoning

Cyanide poisoning may occur following accidental fire-smoke inhalation or deliberate ingestion of salts. Hydroxocobalamin represents a first-line life-saving antidote. Although hydroxocobalamin represents a first-line lifesaving antidote, it is still not promptly available in the emergency department. Sodium thiosulfate can be administered in association with hydroxocobalamin whereas the delayed onset of clinical response makes sodium thiosulfate less suitable for emergency use. We describe a case of cyanide intoxication of a 43-year-old man who ingested an unknown amount of potassium cyanide, purchased via the Internet, in an attempted suicide. At admission to the emergency department, the patient presented GCS 3 with severe lactic acidosis. Orotracheal intubation, gastric lavage and oral activated charcoal were applied. Sodium thiosulfate was available in the emergency department and 10 grams were infused over a 30 minute period. Hydroxocobalamin was prescribed by the poison control centre and 5 grams were infused 2 hours after admission. Following sodium thiosulfate administration the patient was arousable and lactate concentration improved. No adverse effects were noted. Metabolic acidosis completely resolved 12 hours later. Cyanide concentration performed on blood samples collected at admission confirmed high cyanide blood levels (15 mg/L). This report highlights as the first-line administration of sodium thiosulfate, in rapid infusion, resulted effective and safe for cyanide poisoning. Our report suggests that sodium thiosulfate should be considered when hydroxocobalamin is not promptly available in an emergency settin

Leg Ulceration in Sickle Cell Disease: An Early and Visible Sign of End‐Organ Disease

Introduction: Leg ulcers are a frequent and debilitating complication of sickle cell disease (SCD), particularly of the SS genotype. The prevalence of leg ulcers in patients with sickle cell disease (SCD) varies geographically ranging widely from 75% in Jamaica to as low as 1% in Saudi Arabia. The prevalence of leg ulcers in the Cooperative Study of Sickle Cell Disease (CSSCD) in the United States was 5% in SS genotype with the incidence increasing with age. As patients with SCD have increasingly improved survival, the prevalence of leg ulcers is likely to be higher. These ulcers are slow to heal, have a high rate of recurrence, and are associated with severe unremitting pain and depression, thus leading to high healthcare costs. Despite being a well‐recognized complication of SCD, there are no specifically designed evidence‐based guidelines to help clinicians manage these patients

Mechanical Properties of Growing Melanocytic Nevi and the Progression to Melanoma

Melanocytic nevi are benign proliferations that sometimes turn into malignant melanoma in a way that is still unclear from the biochemical and genetic point of view. Diagnostic and prognostic tools are then mostly based on dermoscopic examination and morphological analysis of histological tissues. To investigate the role of mechanics and geometry in the morpholgical dynamics of melanocytic nevi, we study a computation model for cell proliferation in a layered non-linear elastic tissue. Numerical simulations suggest that the morphology of the nevus is correlated to the initial location of the proliferating cell starting the growth process and to the mechanical properties of the tissue. Our results also support that melanocytes are subject to compressive stresses that fluctuate widely in the nevus and depend on the growth stage. Numerical simulations of cells in the epidermis releasing matrix metalloproteinases display an accelerated invasion of the dermis by destroying the basal membrane. Moreover, we suggest experimentally that osmotic stress and collagen inhibit growth in primary melanoma cells while the effect is much weaker in metastatic cells. Knowing that morphological features of nevi might also reflect geometry and mechanics rather than malignancy could be relevant for diagnostic purpose

Occurrence of Paraleucilla magna Klautau et al., 2004 (porifera : Calcarea) in Malta

The calcareous sponge Paraleucilla magna, first recorded from the Mediterranean in 2001 (southern Tyrrhenian, southern Adriatic and northwest Ionian coasts of Italy), is recorded from Malta (Central Mediterranean) where it was found forming part of the fouling community on small, surface marker-buoys around a fish-farm in Marsaxlokk Bay.peer-reviewe

Non-Vitamin K antagonist oral anticoagulants for mechanical heart valves is the door still open?

The estimated prevalence of mitral or aortic valvular heart disease is ≈2.5% in the general population of Western countries, and is expected to rise with population aging. A substantial proportion of patients with valvular heart disease undergoes surgical valve replacement. Mechanical heart valves are much more durable than bioprostheses, and are thus preferentially implanted in patients with a longer life expectancy, but have the major drawback of requiring lifelong anticoagulation to prevent valve thrombosis because of their higher thrombogenicity. The non-vitamin K antagonist oral anticoagulants (NOACs) are replacing vitamin K antagonists in many settings, including bioprostheses, because of their favorable safety and efficacy profiles. However, mechanical heart valves currently pose an absolute contraindication to NOACs based on the results of a single phase II study comparing dabigatran and warfarin (RE-ALIGN [Randomized, Phase II Study to Evaluate the Safety and Pharmacokinetics of Oral Dabigatran Etexilate in Patients after Heart Valve Replacement]). That trial was stopped prematurely because of an excess of both stroke and bleeding with the dabigatran doses tested. Because of such negative findings, research in this area has been halted. We believe that several aspects of both the preclinical studies and the RE-ALIGN trial should be critically reevaluated. In our opinion, 1 single trial with a single NOAC does not represent sufficient evidence for dismissing a therapeutic strategy, anticoagulation with NOACs, that has shown better safety and at least similar efficacy as warfarin in the setting of atrial fibrillation and venous thromboembolism,. Herein, we reevaluate this topic to identify the patient profile that has the greatest likelihood of benefit from some of the NOACs, with a focus on factor Xa inhibitors, thus providing some perspectives for basic and translational research

Aspirin Therapy for Primary Prevention: The Case for Continuing Prescribing to Patients at High Cardiovascular Risk-A Review

Current evidence supports the use of low-dose aspirin for secondary cardiovascular prevention. By contrast, the benefit-to-risk ratio of aspirin use in primary prevention is debated: Three contemporary randomized control trials have been conflicting, and meta-analyses have concluded for an unclear clinical benefit, based on the consideration that the reduction in thromboembolic events is counterbalanced by increased bleeding. The primary prevention setting is, however, a heterogeneous mix of subjects at highly variable cardiovascular risk. One possible explanation for the uncertainty of data interpretation is the progressive reduction in risk of major adverse cardiovascular events (MACEs) in primary prevention that has accompanied global education programs, leading patients to smoke less, exercise more, and increasingly take lipid-lowering therapies. Based on a meta-regression of the benefits and harm of aspirin therapy in primary prevention as a function of the 10-year risk of MACE, we favor a nuanced approach still, however, based on the evaluation of cardiovascular risk, acknowledging differences between patients and emphasizing an individualized assessment of both benefits and harm. After optimal control of cardiovascular risk factors, and when patients are less than 70 years of age, clinicians should assess the risk of MACE and base decision on such stratification, considering the risk of bleeding and patient preferences. Clinicians would then advise the use of aspirin in primary prevention patients at the highest risk of MACE who do not have a prohibitive risk of bleeding, and in the majority of cases after initiation of properly titrated statin therapy

A novel approach to the analysis of human growth

OBJECTIVES: Several formulations have been proposed in order to model human growth from birth to maturity. They are usually based on “ad hoc” heuristic assumptions. In the present contribution we adopt, as an alternative, a completely general (interdisciplinary) approach, based on the formalism of the Phenomenological Universalities (PUN). METHODS: The main PUN class investigated to date, i.e. UN, can only account for the overall growth pattern. For a realistic description it is necessary to add to it one or more “spurts”, as expected on biological grounds, due to the stimulation of growth and sex hormones. RESULTS: A new PUN class (UN + FM) is generated and shown to be able to provide excellent agreement with standard auxological datasets. The accuracy of the fitting and reliability of the model suggest applications both at the diagnostic and therapeutic level. CONCLUSIONS: The developed formalism can be suitably related to the biological description of bone plate growth under selective hormonal stimulation on the bone epiphysis; i.e., the additional increase of stature is the “macroscopic” response to a well defined biological signal

Is there equivalence between PCI and CABG surgery in long-term survival of patients with diabetes? Importance of interpretation biases and biological plausibility.

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Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease

Abstract Background Valvular heart disease (VHD) and atrial fibrillation (AF) often coexist. Phase III trials comparing non–vitamin K antagonist oral anticoagulants (NOACs) with warfarin excluded patients with moderate/severe mitral stenosis or mechanical heart valves, but variably included patients with other VHD and valve surgeries. Objectives This study aimed to determine relative safety and efficacy of NOACs in patients with VHD. Methods We performed a meta-analysis of the 4 phase III AF trials of the currently available NOACs versus warfarin in patients with coexisting VHD to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for stroke/systemic embolic events (SSEE), major bleeding, intracranial hemorrhage (ICH), and all-cause death. Results Compared with warfarin, the rate of SSEE in patients treated with higher-dose NOACs was lower and consistent among 13,585 patients with (RR: 0.70; 95% CI: 0.58 to 0.86) or 58,098 without VHD (RR: 0.84; 95% CI: 0.75 to 0.95; interaction p = 0.13). Major bleeding in patients on higher-dose NOACs versus warfarin was similar and consistent among patients with (RR: 0.93; 95% CI: 0.68 to 1.27) or without VHD (RR: 0.85; 95% CI: 0.70 to 1.02; interaction p = 0.63 for VHD/no-VHD difference). Intracranial hemorrhage was lower with higher-dose NOACs than with warfarin irrespective of VHD (RR: 0.47; 95% CI: 0.24 to 0.93, and 0.49; 95% CI: 0.41 to 059, respectively; interaction p = 0.91). No protective effect of higher-dose NOACs in preventing all-cause death seemed to be present in patients with VHD versus without VHD (RR:1.01; 95% CI: 0.90 to 1.14 vs. RR: 0.88; 95% CI: 0.82 to 0.94, respectively; interaction p = 0.03). Conclusions High-dose NOACs provide overall efficacy and safety similar in AF patients with or without VHD