In case of metachronous presentation, it is obvious that immediate care will be directed without delay toward the initial event, according to standard practice guidelines (eg, percutaneous coronary ...intervention in a patient with an initial presentation of STEMI). Of the various thrombolytic therapies available, alteplase (tissue plasminogen activator) is the best option in these instances owing to its favorable adverse effect profile; besides, it is the only thrombolytic that can be administered in patients with ischemic stroke.
Research on human stem cells and embryos creates ethical issues. Here I discuss ten frequently used arguments against research and point out their weaknesses. These arguments include the possessed ...potentiality of the embryo per se and, in contrast to other cell systems, the “slippery slope” argument, the right of disposal of parents, totipotency versus pluripotency, the burden of proof for research, natural versus artificial, and three arguments based on the precaution principle (the open biological questions, uncertainty regarding clinically applicable therapies, and the problem solving rule). I finally suggest a different answer to the ethical questions concerning research on human embryos and embryonic stem cells, which takes into consideration their biological context.
The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this ...catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature.
We reviewed all PubMed/Medline indexed articles published between 1993-2013, reporting the development of PA pseudoaneurysm after Swan-Ganz catheter use. Cases were analyzed with specific reference to patient demographics, indication for Swan-Ganz insertion, initial presenting symptom, duration between insertion and first evidence of PA injury, inciting event, site of pseudoaneurysm, treatment and outcome.
Forty-one patients were identified from 27 papers. In the reviewed population, 87.8% were older than 60 years of age and 82.9% were females. Fifty-one percent of the patients had an episode of hemoptysis on the day of Swan-Ganz catheter insertion. Ninety-seven percent of the patients had PA pseudoaneurysm in the right pulmonary circulation. The admission-to-discharge mortality rate in the reviewed cohort was 15%. Cause of death in 22% of the cases was hemoptysis, while non-catheter related complications were responsible for the remaining deaths.
PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter based or surgical interventions.
Background and aims
Mutations in
FDXR
gene, involved in mitochondrial pathway, cause a rare recessive neurological disorder with variable severity of phenotypes. The most common presentation includes ...optic and/or auditory neuropathy, variably associated to developmental delay or regression, global hypotonia, pyramidal, cerebellar signs, and seizures. The review of clinical findings in previously described cases from literature reveals also a significant incidence of sensorimotor peripheral polyneuropathy (22.72%) and ataxia (43.18%). To date, 44 patients with
FDXR
mutations have been reported. We describe here on two new patients, siblings, who presented with a quite different phenotype compared to previously described patients.
Methods
Clinical, neurophysiological, and genetic features of two siblings and a systematic literature review focused on the clinical spectrum of the disease are described.
Results
Both patients presented with an acute–sub-acute onset of peripheral neuropathy and only in later stages of the disease developed the typical features of
FDXR
-associated disease.
Interpretation
The peculiar clinical presentation at onset and the evolution of the disease in our patients and in some cases revised from the literature shed lights on a new possible phenotype of
FDXR
-associated disease: a peripheral neuropathy which can mimic an acute inflammatory disease.
Carbon Monoxide (CO) intoxication is still a leading cause of mortality and morbidity in many countries. Due to the problematic detection in the environment and subtle symptoms, CO intoxication ...usually goes unrecognized, and both normobaric and hyperbaric oxygen (HBO) treatments are frequently administered with delay. Current knowledge is mainly focused on acute intoxication, while Delayed Neurological Sequelae (DNS) are neglected, especially their treatment. This work details the cases of two patients presenting a few weeks after CO intoxication with severe neurological impairment and a characteristic diffused demyelination at the brain magnetic resonance imaging, posing the diagnosis of DNS. After prolonged treatment with hyperbaric oxygen, combined with intravenous corticosteroids and rehabilitation, the clinical and radiological features of DNS disappeared, and the patients' neurological status returned to normal. Such rare cases should reinforce a thorough clinical follow-up for CO intoxication victims and promote high-quality studies.
Torsade de pointes is a form of polymorphic ventricular tachycardia that differs from other forms of ventricular tachycardia in its morphology, precipitating factors, and therapeutic approach. Its ...recognition is of utmost importance, as the standard anti-arrythmic drugs not only might be ineffective in its termination but also may aggravate it. Herein, we report a case of antipsychotic-induced torsade de pointes and describe the use of magnesium sulfate, isoproterenol, and phenytoin and their proposed mechanism of action.
Pediatric anesthesia nowadays requires specific knowledge and expertise. The Anesthesia PRactice In Children Observational Trial (APRICOT) was a European multicenter study designed for the ...identification of perioperative severe critical events and management. We aimed at analyzing the Italian database in an attempt to determine the practice of anesthesia and the incidence of severe critical events in Italy.
Secondary analyses of the database consisted in extracting the raw data from the 25 Italian centers that participated to APRICOT. Descriptive statistics and comparison with the reference data were made for all the variables collected.
The study analyzed 2087 children. The Italian cohort represents 6.7% of the overall study population. Most of the children were ASA 1-2 (90.6%) and underwent a surgical procedure (62.8%). In more than 84% of the cases, anesthesia management was performed by an expert with main or frequent activity in pediatric anesthesia with on an average 15 years of experience. The overall incidence of severe critical events was 3% (95% CI: 2.2-3.8). The most frequently reported severe critical incidents were of respiratory (2%; CI: 1.4-2.6) and cardiovascular origin (0.7%; CI. 0.3-1), while drug error, anaphylaxis and bronchial aspiration were very rare. There were no reports of perioperative cardiac arrest or patients with neurological damage.
This secondary analysis demonstrates that the incidence of severe critical incidence was lower in Italy in comparison to that reported for Europe. This low rate of critical events may be related to the high expertise and experience of the anesthesiologists in charge of the children in the Italian centres that participated to APRICOT.
Multisystem Inflammatory Syndrome in Children (MIS-C) treatment is still under debate and involves Intravenous Immunoglobulins (IVIG) and/or steroids. We retrospectively analysed data from the ...patients admitted to Our Institution during the year 2020 to investigate whether prompt IVIG treatment conditions cardiac dysfunction and need for support and if addition of steroids in different doses correlates with outcomes. Days of fever, time between fever appearance and IVIG treatment, left ventricular ejection fraction (LVEF%) at admission and Cardiac Function Recovery Time (time between worst LVEF and resume of LVEF >55%) were used as outcomes. 38 patients were admitted with MIS-C. All except one received IVIG; 24 received also different Methylprednisolone dosages. Time to IVIG treatment, adjusted for age and sex, correlated with global duration of fever (Coefficient: 1.2; 95% CI:0.73-1.68) and with Vasoactive Inotropic Score (VIS) (Coefficient: 0.09; 95% CI 0.02-0.15), with pericardial effusion (Coefficient: 2.37; 95% CI: 0.45-4.2). Global duration of fever was associated with time to IVIG (Coefficient: 0.8; 95% CI :0.49-1.13) and positive Covid-19 swab (Coefficient: 1.71; 95% CI 0.21-3.22). Cardiac Function Recovery Time did not show differences with different steroid dose regimens. High-dose steroids did not show any benefit in our cohort.
In this article, we discuss the experimental application of iterative co-design, community-based and place-centred approaches in the creation of 3D immersive experiences of places that have been ...badly damaged or destroyed after natural catastrophic events. We take as our case study the community of Senerchia, hit and partially destroyed by the 1980 Irpinia earthquake in Italy. The main purpose of this paper is to analyse and discuss the co-creation process we undertook with residents of the town for the making of an immersive documentary Italia Terremotata which explores life before, during and after the earthquake. Our approach is based on design-thinking and aims to define an ethical framework for the creation of reflexive and multi-vocal 3D immersive storytelling systems that consider 'vulnerability' and 'empathy' as central design values of the iterative prototyping and co-creation cycle.
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