Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage.

BACKGROUND: First described in 2005, inverted takotsubo is one of the four stress-induced cardiomyopathy patterns. It is rarely associated with subarachnoid hemorrhage but was not previously reported after intraparenchymal bleeding. PURPOSE: We reported a symptomatic case of inverted takotsubo pattern following a cerebellar hemorrhage. CASE REPORT: A 26-year-old woman presented to the emergency department with sudden headache and hemorrhage of the posterior fossa was diagnosed, probably caused by a vascular malformation. Several hours later, she developed acute pulmonary edema due to acute heart failure. Echocardiography showed left ventricular dysfunction with hypokinetic basal segments and hyperkinetic apex corresponding to inverted takotsubo. Outcome was spontaneously favorable within a few days. CONCLUSION: Inverted takotsubo pattern is a stress-induced cardiomyopathy that could be encountered in patients with subarachnoid hemorrhage and is generally of good prognosis. We described the first case following a cerebellar hematoma

Low-dose hydroxychloroquine therapy and lower mortality in hospitalized patients with COVID-19: association does not mean causality.

We read with interest the article recently published by Catteau et al from the Belgian Collaborative group on COVID-19 Hospital surveillance reporting on a retrospective observational study of 8075 COVID-19 patients treated in 109 Belgian hospitals between March and May 2020. [...

Neurally Adjusted Ventilatory Assist During Weaning From Respiratory Support in a Case of Guillain-Barre Syndrome

We report a case of Guillain-Barré syndrome complicated by respiratory failure requiring mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) allowed proper patient-ventilator synchronization by pressure support proportional to the electrical activity of the diaphragm (Edi). Prolonged ventilation with NAVA seems feasible in patients with neuromuscular impairment, but the weaning process conducted by a continuous monitoring of Edi for pressure support titration needed to be assessed in a Guillain-Barré syndrome patient. Beginning on day 12 after hospital admission, the patient was ventilated with NAVA for 8 d. The NAVA level (pressure support per unit of Edi) was decreased from 1.2 cm H2O/μV to zero over the 8-d period. A simultaneous decrease in the tidal volume/Edi ratio was interpreted as a sign of recovery. A spontaneous breathing trial was successfully performed on day 20, followed by decannulation 4 d later. In conclusion, NAVA should be further investigated in patients with Guillain-Barré syndrome, particularly during the weaning period

Severe acute cardiomyopathy associated with venlafaxine overdose and possible role of CYP2D6 and CYP2C19 polymorphisms.

Venlafaxine (VEN) is a serotonin-norepinephrine-dopamine reuptake inhibitor that causes usually a mild cardiotoxicity when ingested in overdose. We report a patient who developed acute heart failure following overdose. As the toxicokinetic data suggested a prolonged metabolism, genetic polymorphisms for cytochrome P450 isoenzymes CYP2D6 and CYP2C19 were also investigated

Functional Threshold Power Field Test Exceeds Laboratory Performance in Junior Road Cyclists

The functional threshold power (FTP) field test is appealing for junior cyclists, but it was never investigated in this age category, and even in adults, there are few data on FTP collected in field conditions. Nine male junior road cyclists (16.9 ± 0.8 years) performed laboratory determination of maximal aerobic power (MAP), 4-mM lactate threshold (P4mM), critical power (CP), and the curvature constant (W′), plus a field determination of FTP as 95% of the average power output during a 20-minute time trial in an uphill road. The level of significance was set at p < 0.05. Outdoor FTP (269 ± 34 W) was significantly higher than CP (236 ± 24 W) and P4mM (233 ± 23 W). The VO2peak of the field FTP test (66.9 ± 4.4 ml·kg−1·min−1) was significantly higher than the VO2peak assessed in the laboratory (62.7 ± 3.7 ml·kg−1·min−1). Functional threshold power was correlated, in descending order, with MAP (r = 0.95), P4mM (r = 0.94), outdoor and indoor VO2 peak (r = 0.93 and 0.93, respectively), CP (r = 0.84), and W′ (r = 0.66). It follows that in junior road cyclists, the FTP field test was feasible and related primarily to aerobic endurance parameters and secondarily, but notably, to W′. However, the FTP field test significantly exceeded all laboratory performance tests. When translating laboratory results to outdoor uphill conditions, coaches and sport scientists should consider this discrepancy, which may be particularly enhanced in this cycling age category