Outpatient Treatment of Pulmonary Embolism: sPESI Score and Highly Sensitive Troponin may Prove Helpful

Introduction

Despite advances in therapeutic and diagnostic options, acute pulmonary embolism (PE) is associated with high morbidity and mortality. Risk classification is important in deciding how and where to treat patients This study aimed to investigate simplified pulmonary embolism severity index (sPESI) scores and highly sensitive troponin levels to predict 30-day clinical outcomes.

Methods

Patients with the symptoms of dyspnoea, chest pain, and haemoptysis were included in the study. Multiple detector computed tomography (CT) examinations were performed. If the patients' glomerular filtration rate levels were less than 60 ml/min/1.73 m2, then the ventilation/perfusion (V/Q) scan was the preferred imaging modality. Venous blood samples were collected to test for highly sensitive troponin T levels (Elecsys troponin T high sensitive, Roche diagnostics). All patients were examined by two-dimensional bedside echocardiography for detection of right ventricular dilatation. Patients' baseline characteristics (sex, ages, etc.) were recorded along with co-morbidities, symptoms, haemodynamic conditions, all-cause mortality rates during hospitalisation, the duration of hospital stay, radiographic test results, and laboratory findings, and electrocardiography were also obtained during emergency department admission. Primary outcome measure was defined as death in a month. Logistic regression model was created to reveal the associated parameters related to mortality within a month of the emergency department visit.

Results

One hundred and seventy patients suspected of PE underwent either a CT angiogram or pulmonary V/Q scan. In total 70 patients were diagnosed with PE and included in the study. The logistic regression model was created in order to assess poor prognosis markers. In addition to the troponin levels and sPESI scores commonly used for pulmonary embolism prognosis, right ventricular dilatation, heart rate, systolic blood pressure and oxygen saturation using logistic regression models were created. Positive troponin level (odds ratio: 5.23 and 95% confidence interval [CI] 1.03 to 26.51) and negative sPESI score (odds ratio 2.14 and 95% CI 1.00 to 4.60) were found to be significant.

Conclusions

Some scoring systems, including PESI and sPESI score, can be used for predicting mortality in patients with pulmonary embolism. If sPESI score is zero, and troponin levels are negative, the patient can be discharged safely.

Sporadic hyperekplexia due to self-limiting brainstem encephalopathy

Hyperekplexia is a rare movement disorder characterized by pathologically exaggerated response to unexpected stimuli. It is differentiated from the normal startle reflex by its lower threshold, higher intensity, and resistance to habituation. Many of the acquired hyperekplexias result from brainstem involvement such as encephalitis, infarct, hemorrhage, pontocerebellar hypoplasia and medullary compression. This case report depicts a rare manifestation of hyperekplexia. The unusual aspect of this case was the vocalization that was reproduced in response to startling stimuli. Startle induced vocalization is not a part of the classical hyperekplexia description. When faced with a patient with pathologically exaggerated response to unexpected stimuli, the physician should consider this rare condition in the differential diagnosis, and also keep in mind that the disease may present with features different from those listed in the textbooks.

Unusual location of median raphe cyst presenting as perianal polyp: a case report

Median raphe cysts (MRC) are uncommon, benign congenital lesions that may present anywhere in the midline between the urinary meatus and the anus, with the shaft of the penis and the glans penis being the most common sites. We report a 52-year-old man with median raphe cyst unusually located in perianal region and treated by surgical excision.

Anti-genotoxic effect of naringin against bleomycin-induced genomic damage in human lymphocytes in vitro

Naringin is a flavonoid found in grapefruit and other citrus fruits that shows antioxidant activity. The aim of the present study was to determine the anti-genotoxic and protective effects of naringin on the chemotherapeutic/radiomimetic agent bleomycin (BLM) in human blood lymphocyte cultures in vitro using micronucleus test and chromosomal aberrations (CA) assay. We tested the three doses of naringin (1, 2, 3 µg/mL) and a single dose of BLM (20 µg/mL). BLM significantly increased the total CAs and micronucleus frequency at a concentration of 20 µg/mL. Naringin did not show any toxicity in doses of 1, 2, and 3 µg/mL. Combined treatments of BLM and naringin (2 and 3 µg/mL) significantly reduced micronucleus formation. Naringin dose-dependently decreased the total chromosome aberrations frequency induced by BLM. These results indicate that naringin could prevent BLM (20 µg/mL)-induced genotoxicity.

Investigation of genotoxicity in acromegaly from peripheral blood lymphocyte cultures using a micronucleus assay

CONTEXT

Although patients with acromegaly may have an increased risk of developing several types of cancers, the degree of risk for malignancy in these patients is unresolved.

OBJECTIVE

The present study aimed to investigate the potential genotoxic effects of acromegaly on the cell cycle in peripheral blood lymphocyte cultures.

DESIGN

This was a single center, crossover, case-control study conducted on the acromegalic patients in Turkey.

SETTING

The study was conducted in the outpatient clinic of a university hospital.

PATIENTS

Seventy-one consecutively screened acromegalic patients and 56 controls participated in the study.

INTERVENTION

Patients were included, regardless of the disease activity status and their treatment duration before the study.

MAIN OUTCOME MEASURES

The primary end point was the frequency of micronucleus (MN) in the peripheral blood lymphocyte cultures, and the secondary end point was its clinical correlations.

RESULTS

The MN level was 3.82 ± 1.49 in the control group and 18.00 ± 6.13 in the acromegalic group (P < .01), whereas the nuclear division index (NDI) was 1.79 ± 0.12 in the control group and 1.68 ± 0.07 in the acromegalic group (P < .01). Neither MN nor NDI was correlated with age, GH, IGF-I, initial GH, initial IGF-I, duration of the remission period, and initial tumor size. Only the MN level was positively correlated with the duration of disease (r = 0.323, P = .014).

CONCLUSION

Our results indicated that acromegalic patients had genotoxic damage at a substantial level, and there was a positive correlation between the duration of disease and genotoxicity level.

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced diabetes mellitis

PURPOSE

In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats.

MATERIALS AND METHODS

Twenty- eight Wistar Albino rats were included in the study after streptozocin (60 mg/kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg-1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon® 1000 mg/5 mL - Roche) were applied one hour before administrating 150 mg.kg-1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer.

RESULTS

Erythrocyte deformability was significantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model.

CONCLUSIONS

Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2, Ref. 57).