Surgery for Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is an inherited disorder with variable expressivity, resulting in asymmetric septal hypertrophy and left ventricular outflow tract obstruction (LVOTO). Symptoms are similar to those of aortic stenosis and are due to LV diastolic dysfunction and myocardial ischemia in the absence of epicardial coronary narrowing. Goals of treatment include symptomatic control, resolution of hemodynamic abnormalities and their sequelae, reduction of sudden cardiac death risk and screening of family members. Left ventricular outflow tract obstruction at rest is a predictor of severe symptoms, heart failure, and death. The majority of patients are managed medically, predominantly with b-blockers and calcium channel blockade.Disopyramide, a negative inotrope, can be used in cases with persistently high resting gradients. To prevent sudden cardiac death, implantable cardioverterdefibrillators are used aggressively

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Effect of clopidogrel in bone healing-experimental study in rabbits

BACKGROUND Clopidogrel is a widely prescribed drug for prevention of myocardial infarction and stroke in patients at risk. It inhibits thrombus formation via inhibition of the P2Y12 purinergic receptor on platelets, which is important in their activation by ADP. However, the P2Y12 receptor has also been found to be expressed in both osteoblasts and osteoclasts. Accumulated evidence suggests that purinergic receptors regulate important functions of bone turnover. Previous studies on the effect of clopidogrel on bone metabolism indicated potential harmful effects, but their results remain conflicting. Thus, clopidogrel treatment may affect bone healing, but it has not yet been studied. AIM To evaluate if continuous perioperative clopidogrel treatment has any negative effect on bone healing in the rabbit calvarial defect model. METHODS Sixteen male white New Zealand rabbits were randomly assigned in two groups: One group received daily 3 mg/kg of clopidogrel per os and the other group received the vehicle alone for a week prior to the surgical procedures; the treatments were continued for another 6 wk postoperatively. The surgical procedures included generation of two circular calvarial defects 11 mm in diameter in every animal. After the 6-wk period of healing, postmortem radiographic and histomorphometric evaluation of the defects was performed. RESULTS Both the surgical procedures and the postoperative period were uneventful and well tolerated by all the animals, without any surgical wound dehiscence, signs of infection or other complication. New bone was formed either inwards from the defect margins or in the central portion of the defect as separated bony islets. While defect healing was still incomplete in both groups, the clopidogrel group had significantly improved radiographic healing scores. Moreover, the histomorphometric analysis showed that bone regeneration (%) was 28.07 ± 7.7 for the clopidogrel group and 19.47 ± 4.9 for the control group, showing a statistically significant difference between them (P = 0.018). Statistically significant difference was also found in the defect bridging (%), i.e. 72.17 ± 21.2 for the clopidogrel group and 41.17 ± 8.5 for the control group, respectively (P = 0.004), whereas there was no statistical difference in bone tissue density between the groups. CONCLUSION Our results indicate that maintenance of perioperative clopidogrel treatment does not negatively affect bone healing but rather promotes it. Further research is needed in order to find useful applications of this finding. © The Author(s) 2019

Ethnopharmacological approach to the herbal medicines of the "antidotes" in Nikolaos Myrepsos' Dynameron

Ethnopharmacological relevance:This paper focuses on the plants quoted in the recipes of the first chapter entitled "About the Antidotes" belonging to the first and largest section "Element Alpha" of Nikolaos Myrepsos' Dynameron, a medieval medical manuscript. Nikolaos Myrepsos was a Byzantine physician at the court of John III Doukas Vatatzes at Nicaea (13th century). He wrote in Greek a rich collection of 2667 recipes, the richest number known in late Byzantine era, conventionally known as Dynameron and divided into 24 sections, the "Elements". The only existing translation of this work is in Latin, released in 1549 in Basel by Leonhart Fuchs. Since no other translation has ever been made in any language, this work still remains poorly known. Materials and Methods:Our primary source material was the codex written in 1339 and kept in the National Library of France (in Paris) under the number grec. 2243. For comparison, all the other codices, which contain the entire manuscript, have also been studied, namely the codices EBE 1478 (National Library of Greece, Athens), grec. 2237 and grec. 2238 (both in Paris), Lavra Ε 192 (Mont Athos, Monastery of Megisti Lavra), Barocci 171 (Oxford) and Revilla 83 (Escorial). Results: The exhaustive study of the "About the Antidotes" led us to the interpretation of 293 plant names among which we recognized 39 medicinal plants listed by the European Medicines Agency, (Herbal Medicines, www.ema.eu); the therapeutic indications of some of them provided by Myrepsos were similar or related to their current ones, as given in their monographs. The plants belong to various families of which the most frequent are: Apiaceae 10.6%; Lamiaceae 9.2%; Asteraceae 8.9%; Fabaceae 6.8% and Rosaceae 5.1%. The most frequently mentioned plants even under several different names are the following: Apium graveolens L., Crocus sativus L., Nardostachys jatamansi (D. Don) DC., Zingiber officinale Roscoe, Rosa centifolia L., Syzygium aromaticum (L.) Merr. & L.M. Perry, Papaver somniferum L., Costus sp., Petroselinum crispum (Mill.) Fuss, Anethum graveolens L., Foeniculum vulgare Mill., Daucus carota L. Conclusions: This research led us to the conclusion that the content of "About the Antidotes" is a valuable source for the study of recipes based mainly on medicinal plants, most of them inherited from classic ancient Greek and Hellenistic periods. © 2015 Elsevier Ireland Ltd.All rights reserved