Prognostic impact of Atrial Fibrillation Pattern and other Clinical Biomarkers in patients with stroke admitted in a Tertiary Hospital in Cebu City from 2015-2022

Background@#The effect of atrial fibrillation (AF) patterns and clinical biomarkers among patients with AF-related stroke is still controversial. @*Objectives@#The objective of this study is to determine the association of the pattern of AF and markers on routine blood tests with the outcome of patients after an AF-related stroke. @*Methods@#This is a retrospective cohort study of patients with stroke and AF admitted in a tertiary hospital in Cebu City from 2015-2022. Patients’ baseline characteristics, laboratory tests, ECG, and radiologic data were collected. Descriptive statistics such as mean and frequency were computed. The Kaplan–Meier method and the log-rank test were used to calculate the incidence time. The Cox regression analysis was used to determine factors associated with survival. A stepwise regression technique was used in model building. @*Results@#The mortality rate of patients with AF-related stroke was 0.02. A Kaplan Meier survival estimate shows that patients with paroxysmal AF have better survival. Upon model building of variables, age, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet count, low density lipid cholesterol (LDL-C), and pattern of AF were predictive of mortality in patients with AF-related stroke. @*Conclusions@#Among AF-related stroke patients admitted at a tertiary hospital in Cebu City, pattern of AF, age, RDW, NLR, platelet count, and LDL-C were associated with mortality. The parameters associated with increased mortality could be easily assessed using an ECG, CBC, and lipid profile. These are all readily available and cost-efficient.

Predictors for hemorrhagic transformation among patients with Ischemic stroke admitted in a Tertiary Hospital in the Philippines from July 2018-July 2019

Background@#Among the multiple scoring systems for hemorrhagic transformation, only few of these address spontaneous hemorrhagic transformation after an ischemic stroke, with most done with Western population data. @*Objectives@#This study aims to identify the predictors for hemorrhagic transformation among patients with ischemic stroke admitted in a tertiary hospital in Cebu City, Philippines.@*Methods@#This is a retrospective cohort study of patients with ischemic stroke admitted in a tertiary hospital in Cebu City. Patients’ baseline characteristics, clinical, and radiologic data were collected. Chi square test and t-test were used to determine which variables were significantly different between patients with and without hemorrhagic transformation. Odds ratio (OR) and 95% confidence interval (CI) were determined to measure the association between the different variables and hemorrhagic transformation. @*Results@#A total of 500 ischemic stroke patients were included in the study. There were 28 (6%) ischemic stroke patients with Hemorrhagic Transformation. The mean age of these patients is 66.93 ± 12.42 years, 48.8% male, 10.8% had atrial fibrillation, and 2.4% had myocardial infarction. Controlling for the effect of confounders, white blood cell count (OR 1.11; 95% CI 1.03-1.19), myocardial infarction (OR 5.25; 95% CI 1.13-24.34), and presence of brain edema (OR 2.86; 95% CI 1.05-7.80) were significant predictors of hemorrhagic transformation.@*Conclusion@#White blood cell count, presence of brain edema, and myocardial infarction were significantly associated with hemorrhagic transformation among ischemic stroke patients.

"Proximal to distal" sequence of the release of the upper extremity post-burn contracture: Rule or case-based approach? / 中华创伤杂志(英文版)

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.

Electrocardiographic Manifestations in COVID-19 Patients — An Observational Study from a Tertiary Care Centre in North Eastern India

Introduction : The Coronavirus disease 2019 (COVID-19) primarily involves respiratory system but may also affect the Cardiovascular System leading to abnormal ECGs. Its early recognition is crucial as it may be associated with increased mortality. Hence we aimed to find out various Electrocardiographic (ECG) manifestations of COVID19 patients admitted in a Tertiary Care Hospital and its relation to disease severity. Methods : We performed a hospital-based retrospective observational study between April, 2021 to November 2021 and analyzed the ECG changes at admission by three Cardiologists according to standard definitions and diagnostic criteria. Results : Out of 579 patients, ECG of 473 was available for analysis. ECG was normal in 227 (48%) and abnormal in 246 (52%) patients. Most common abnormal ECG finding in COVID19 patients was Sinus Tachycardia(19.5%) and less common findings were Sinus Bradycardia (5.3%), Incomplete Right Bundle Branch Block (RBBB) (3.2%), atrial fibrillation (2.5%), complete RBBB (2.3%), atrial premature complexes (2.3%), S1Q1T3 pattern (2.1%), first degree AV block (1.5%), ST-T wave changes (1.3%), Atrial flutter (1.1%). In mechanically ventilated patients, incidence of acute Right Ventricular Pressure Overload (RVPO) related ECG findings were more frequent. Conclusion : There is a wide spectrum of ECG manifestations in COVID-19 patients which varies depending upon the severity of COVID as well as prior Cardiovascular status, associated comorbidities and need for ventilatory support. Knowledge of ECG changes might help in risk stratification and triaging of COVID-19 patients.

Association Between Metformin Use and Mortality Among Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Metformin has known mechanistic benefits on COVID-19 infection due to its anti-inflammatory effects and its action on the ACE2 receptor. However, some physicians are reluctant to use it in hypoxemic patients due to potential lactic acidosis. The primary purpose of the study was to determine whether metformin use is associated with survival. We also wanted to determine whether there is a difference in outcomes in subcategories of metformin use, whether at home, in-hospital, or mixed home/in-hospital use.@*Objectives@#This study aimed to determine an association between metformin use and mortality among patients with type 2 diabetes mellitus hospitalized for COVID-19 infection.@*Methodology@#This was a cross-sectional analysis of data acquired from the COVID-19 database of two tertiary hospitals in Cebu from March 1, 2020, to September 30, 2020. Hospitalized adult Filipino patients with type 2 diabetes mellitus who tested positive for COVID-19 via RT-PCR were included and categorized as either metformin users or metformin non-users.@*Results@#We included 355 patients with type 2 diabetes mellitus in the study, 186 (52.4%) were metformin users. They were further categorized into home metformin users (n=109, 30.7%), in-hospital metformin users (n=40, 11.3%), and mixed home/in-hospital metformin users (n=37, 10.4%). Metformin use was associated with a lower risk for mortality compared to non-users (p=0.001; OR=0.424). In-hospital and mixed home/in-hospital metformin users were associated with lower mortality odds than non-users (p=0.002; OR=0.103 and p=0.005; OR 0.173, respectively). The lower risk for mortality was noted in metformin, regardless of dosage, from 500 mg to 2 g daily (p=0.002). Daily dose between ≥1000 mg to <2000 mg was associated with the greatest benefit on mortality (p≤0.001; OR=0.252). The survival distributions between metformin users and non-users were statistically different, showing inequality in survival (χ2=5.67, p=0.017).@*Conclusion@#Metformin was associated with a lower risk for mortality in persons with type 2 diabetes mellitus hospitalized for COVID-19 disease compared to non-users. Use of metformin in-hospital, and mixed home/in-hospital metformin use, was also associated with decreased risk for mortality. The greatest benefit seen was in those taking a daily dose of ≥1000 mg to <2000 mg.

A study on patients with coronary artery disease with special reference to bone mineral density

Background: Osteoporosis and Coronary artery disease are known to share common risk factors, like inflammation, but a direct relationship between the two has not been established. Some of the previous studies showed low BMD (osteoporosis and/orosteopenia) as an independent predictive factor for coronary artery disease in ambulatory patients. However, some reports have failed to demonstrate a direct relationship between low bone mineral density (BMD) and CAD or cardiovascular risk factors. This study was carried out to estimate bone mineral density (BMD) in patients with coronary artery disease (CAD) and also to evaluate the association between bone mineral density and coronary artery disease.Methods: Hospital based prospective observational study, involving 96 consecutive patients who were referred for coronary angiography for the evaluation of established or suspected CAD and also patients who had acute coronary syndrome (ACS) are enrolled in this study. BMD was determined for the lumbar spine (L2-L4) and femoral neck using DXA scan.Results: The total number of subjects was 96. Out of 96, 24 (25%) patients were females and remaining 72 (75%) were males. Coronary angiography was carried out in all patients. 42 patients from the total had coronary angiography proven single vessel disease (SVD), 33 patients had double vessel disease (DVD) and 21 patients had triple vessel disease (TVD). DXA scan was carried out in all patients. T- score of neck of femur region and lumbar spine was calculated. Neither the presence of significant coronary stenoses ≥50% in two or more coronary vessels nor the prevalence of severe coronary stenoses ≥70% differed significantly between patients with normal bone density, osteopenia, or osteoporosis (p<0.05, respectively).Conclusions: The result of this study suggests that in patients undergoing coronary angiography for the evaluation of CAD, the prevalence of low BMD is high; however, there is no statistically significant relationship between osteoporosis, osteopenia and coronary artery disease state.

A five-year review of the clinicopathologic profile of patients with hydatidiform mole at the Philippine General Hospital / Philippine Journal of Obstetrics and Gynecology

Background@#The clinical presentation of patients with hydatidiform mole have changed in recent years due to earlier diagnosis as a result of widespread use of ultrasonography and availability of assays for human chorionic gonadotrophin.@*Objective@#To determine the clinicopathologic profile of patients diagnosed with hydatidiform mole at the Philippine General Hospital from January 2013 to August 2018.@*Methods@#This retrospective cross-sectional study included all patients with histologically confirmed diagnosis of hydatidiform mole managed at the Philippine General Hospital from January 2013 to August 2018. Medical records of patients were retrieved. All abstracted variables were analyzed retrospectively. The level of significance for all sets of analysis was set at p-value < 0.05 using two-tailed comparisons.@*Results@#From January 2013 to August 2018, a total of 435 patients diagnosed with hydatidiform mole were managed at the Philippine General Hospital with a prevalence rate of 15.7/1,000 pregnancies. Diagnosis was made in the first trimester in 52% of patients. A quarter of the patients had pre-evacuation B-hCG levels of more than 1 million mIU/mL. Vaginal bleeding was the most frequent presenting symptom but only 59% of the patients had anemia requiring blood transfusion. Majority (90.57%) had a histopathologic diagnosis of complete hydatidiform mole.@*Conclusion@#The prevalence and clinicopathologic profile of patients with hydatidiform mole in the Philippine General Hospital have remained largely unchanged.

Effectiveness of Parkland formula in the estimation of resuscitation fluid volume in adult thermal burns / 中华创伤杂志(英文版)

PURPOSE@#Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various formulae for fluid infusion are available but consensus is still lacking, resulting in under resuscitation or over resuscitation. Parkland formula is widely used but recently its adequacy is questioned in studies. This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula.@*METHODS@#All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study. Crystalloid solution for infusion was calculated as per Parkland formula; however, it was titrated according to the urine output. Data on fluid infusion were collected from patient's inpatient records and analyzed.@*RESULTS@#The study included a total of 90 patients, about 86.7% (n = 78) of the patients received fluid less than the calculated Parkland formula. Rate of fluid administered over 24 h in our study was 3.149 mL/kg/h. Mean hourly urine output was found to be 0.993 mL/kg/h. The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001).@*CONCLUSION@#The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula. This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.

Association between Clinical Malaria and Blood Lipids in North Eastern India.

Background: Changes in lipid profile are seen in many patients infected with malaria parasite. The malaria parasite causes hepatocellular damage and disturbs lipid handling by the liver. Inside hepatocytes and erythrocytes the parasite replicates rapidly scavenging cholesterol and lipids required for its growth and metabolism from the host. It also requires host lipids for detoxification of free heme to form the malarial pigment, haemozoin. The important question is whether these changes are characteristic for malaria infection or are they simply part of an acute phase reaction? This study analyzes the correlation between malaria infection and derangements in lipid profiles. Materials and Methods: This study comprised of 29 confirmed malaria cases, and 29 subjects in apparent good health, without the infection were included as control cases. Malaria cases were confirmed using rapid antibody-based diagnostic card tests that detect histidine-rich protein 2 (HRP2) or lactate dehydrogenase antigens in finger-prick blood samples followed by microscopic confirmation of malaria parasite. A 12 -hour fasting lipid profile was estimated by enzymatic method on day 2. Data obtained were statistically analyzed using Student’s t Test, assuming p<0.05 as significant. All issues related to ethics were taken care of during the whole course of study. Results: As compared with control subjects, patients with malaria showed low HDL (16.48±6.490 mg/dL versus 41.38±15.110 mg/dL), low LDL (70.45±22.720 mg/dL versus 104.46±27.353 mg/dL), low cholesterol (103.52±35.331 mg/dL versus 169.45±34.040 mg/dL) and elevated triglycerides (214.24±109.365 mg/dL versus 131.15±30.813 mg/dL). The observations show a statistically significant difference in HDL, LDL, cholesterol and triglycerides between malaria patients and control subjects (p<0.05). Conclusion: These results show a characteristic pattern of derangements of lipid profile in malaria. Further studies are required to understand the diagnostic, prognostic and therapeutic implications of these derangements.

Valproic acid induced pancreatitis: a case report.

Valproic acid is a commonly used antiepileptic drug. Apart from its common side effect there is definite association between valproic acid therapy and acute pancreatitis. Since 1979, many cases of acute pancreatitis induced by valproic acid have been published in medical literature. Here we are reporting a case of valproic acid induced acute pancreatitis in a 27 years old boy. The treatment is supportive, re-challenge is hazardous and should be avoided.

Cerebral infarction: an unusual manifestation of viper snake bite.

Snake envenomation causes significant mortality and morbidity. Viper bite usually present with local cellulites, renal failure and bleeding disorders. Thrombotic manifestation of snake bite is rarely reported and early administration of Anti-Snake Venom Serum (ASV) also reduces the risk of thrombotic complications. Cerebral infarction in case of viper bite may be due to hypotension, hypercoagulability or direct action of venom on vessel wall. We report a rare case of viper bite, presented with renal failure and cerebral infarction in spite of early ASV institution. The thrombotic manifestation in this case was possibly due to disseminated intravascular coagulation.

Acute Inflammatory Demyelinating Polyradiculoneuropathy following Plasmodium vivax malaria- a case report.

Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) is usually preceded by infection with certain bacteria and viruses. Parasitic infection has rarely been reported as a causal factor for AIDP. Neurological manifestations following malaria is commonly seen with P. falciparum. There are only few case reports of Guillain–Barré Syndrome or facial diplegia following P. vivax infection. Here we are reporting a patient who developed AIDP and facial diplegia within two weeks following successful treatment of P. vivax infection.

Eye of the tiger sign in neurodegeneration with brain iron accumulation: a case report.

Neurodegeneration with brain iron accumulation (NBIA) is a rare autosomal recessive disorder characterized by abnormal accumulation of ferritin in globus pallidus of brain. Magnetic resonance imaging (MRI) of brain demonstrates a characteristic ‘eye-of-the-tiger’ sign. We describe a case of NBIA in a child with classical clinical and MRI of brain features.

Lupus cystitis with hydroureteronephrosis in a young female with lupus nephritis.

Systemic lupus erythematosus is an autoimmune, multisystem disorder. Lupus nephritis is a common manifestation of SLE. Though rare, SLE may also involve lower urinary tract in the form of lupus cystitis with associated complications like hydroureteronephrosis. Lupus cystitis may present with gastro intestinal (GI) symptoms as the initial manifestation. The case reported herein is concerned with concomitant lupus nephritis and cystitis in a young female who also had associated GI symptoms and hydroureteronephrosis.

Filariasis presenting with pancytopenia diagnosed by Microfilaria in bone marrow aspirate – Report of a rare entity from India.

Filariasis is one of the major public health hazards among Indian population. The common features are asymptomatic microfilariaemia, acute adenolymphangitis, hydrocele and chronic lymphatic disease. There are very few reported cases of pancytopenia as a presenting feature of Filariasis. We describe a case of Filariasis who presented with features of pancytopenia and microfilariae were demonstrated in bone marrow aspirate.

Volvulus du colon pelvien au CHU de Lome (Togo)

Une etude retrospective des cas de volvulus pelvien operes dans le service de Chirugie Generale du CHU de Lome-Tokoin a ete entreprise dans le but d'en degager les caracteristiques epidemiologiques; etio-pathologiques; cliniques et pronostiques. Au nombre de 26; les volvulus du colon pelvien 30;95 pour cent des volvulus intestinaux ont represente 50 pour cent des causes d'occlusion colique mecanique. Ils ont ete marques par une nette predominance masculine (96;15 pour cent) avec un age moyen de 47; 65 ans. Sur le plan pathogenique; des facteurs constitutionnels affectant la morphologie du colon et une meso-sigmoidite retractile ont ete trouves a l'origine des volvulus. La radio de l'abdomen sans preparation; pratiquee dans tous les cas; a montre chez 22 patients une image typique de volvulus pelvien du colon pelvien. Le traitement a consiste en une detorsion simple (8 fois); une detorsion avec geste associe (7 fois); colectomie ideale (10 fois); et une hemicolectomie gauche (1 fois). Les auteurs ont deplore 4;76 pour cent de deces et 11;54 pour cent de redicives