Does electrocardiography at admission predict outcome in Crimean-Congo hemorrhagic fever

Background & objectives: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever withconsiderable mortality. Despite increasing knowledge about hemorrhagic fever viruses, the pathogenesis ofCrimean-Congo hemorrhagic fever and causes of death were not well described. We aimed to evaluate whetherthere were electrocardiographic parameters designating mortality among these patients.Study design: This retrospective study was performed among confirmed Crimean-Congo hemorrhagic fevercases in Turkey. Electrocardiography was available in 49 patients within 24 h of hospitalization. Allelectrocardiograms were evaluated by two expert cardiologists according to Minnesota coding system.Results: Among patients with available electrocardiograms, there were 31 patients who survived, and 18patients who died of Crimean-Congo hemorrhagic fever. Both groups were similar in terms of age, sex, bodytemperature, heart rate, and blood parameters. T-wave changes and bundle branch block were more frequentlyencountered among those who died. Presence of T-wave negativity or bundle branch block in this cohort ofpatients with Crimean-Congo hemorrhagic fever predicted death with a sensitivity of 72.7%, specificity of92.6%, positive predictive value of 88.9%, negative predictive value of 80.6%.Conclusions: We think within the light of our findings that simple electrocardiography at admission may helprisk stratification among Crimean-Congo hemorrhagic fever cases

Plasma osmolality predicts mortality in patients with heart failure with reduced ejection fraction

Background: Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. Aim: This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. Methods: A total of 509 patients (383 males, 126 females) with HF with reduced ejection fraction in three HF centres were retrospectively analysed between January 2007 and December 2013. Follow-up data were completed for 496 patients. Plasma osmolality was calculated as (2 × Na) + (BUN/2.8) + (Glucose/18). Quartiles of plasma osmolality were produced, and the possible relationship between plasma osmolality and cardiovascular mortality was investigated. Results: The mean follow-up was 25 ± 22 months. The mean age was 56.5 ± 17.3 years with a mean EF of 26 ± 8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280 ± 6, 2nd % = 288 ± 1, 3rd % = 293 ± 2 (95% confidence interval [CI] 292.72–293.3), and 4th % = 301 ± 5 mOsm/kg. The EF and B-type natriuretic peptide levels were similar in the four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypo-osmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Conclusions: Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292–293 mOsm/kg) seems to be the optimal plasma osmolality level in terms of cardiovascular prognosis in patients with HF.Background: Heart failure (HF) is a fatal disease. Plasma osmolality with individual impacts of sodium, blood urea nitrogen (BUN), and glucose has not been studied prognostically in patients with HF. This study aims to investigate the impact of serum osmolality on clinical endpoints in HF patients. Methods: A total of 509 patients (383 males, 126 females) with heart failure with reduced ejection fraction (HFrEF) in three HF centers were retrospectively analyzed between January 2007 and December 2013. Follow up data were completed for 496 patients. Plasma osmolality was calculated as (2*Na)+(BUN/2.8)+(Glucose/18). Quartiles of plasma osmolality were produced and the possible relationship between plasma osmolality and cardiovascular mortality (CV) was investigated.  Results: The mean follow-up was 25±22 months The mean age was 56.5±17.3 years with a mean ejection fraction (EF) of 26±8%. The mean levels of plasma osmolality were as follows in the quartiles: 1st % = 280±6, 2nd % = 288±1, 3rd % = 293±2 (95% confidence interval [CI] 292.72-293.3), 4th % = 301±5 mOsm/kg. The EF and BNP levels were similar in four quartiles. Univariate and multivariate analyses in the Cox proportional hazard model revealed a significantly higher rate of mortality in the patients with hypoosmolality. The Kaplan-Meier plot showed graded mortality curves with the 1st quartile having the worst prognosis, followed by the 4th quartile and the 2nd quartile, while the 3rd quartile was shown to have the best prognosis. Conclusions: Our study results suggest that normal plasma osmolality is between 275 and 295 mOsm/kg. However, being close to the upper limit of normal range (292 to 293 mOsm/kg) seems as the optimal plasma osmolality level in terms of CV prognosis in patients with HF

Alveolar Hemorrhage Following Tirofiban Treatment. A Misleading Diagnosis

An n=8 worldsheet superfield action is proposed for describing chiralfermions in the twistor-like formulation of an N=1, D=10 heterotic superstring