RESUMEN
Rickettsia tsutsugamushi causes an acute febrile illness known as scrub thypus. Humans get infected when they accidentally encroach the mite infested areas (mite islands) mainly in rural and sub-urban areas1. Scrub typhus is being increasingly reported in India. It should be considered in the differential diagnosis of patients with acute febrile illness, including those with thrombocytopenia, abnormalities in liver function tests, altered sensorium, atypical pneumonia, acute respiratory distress syndrome. We report a case Multi Organ Dysfunction due to scrub typhus infection. A thorough knowledge of scrub typhus including varied presentations and its complications is important for providing life saving treatment for patients.
RESUMEN
Rickettsia tsutsugamushi causes an acute febrile illness known as scrub thypus. Humans get infected when they accidentally encroach the mite infested areas (mite islands) mainly in rural and sub-urban areas1. Scrub typhus is being increasingly reported in India. It should be considered in the differential diagnosis of patients with acute febrile illness, including those with thrombocytopenia, abnormalities in liver function tests, altered sensorium, atypical pneumonia, acute respiratory distress syndrome. We report a case Multi Organ Dysfunction due to scrub typhus infection. A thorough knowledge of scrub typhus including varied presentations and its complications is important for providing life saving treatment for patients.
RESUMEN
AIM: To investigate the efficacy of Nicorandil in preventing no-flow/slow reflow phenomenon in patients with acute myocardial infarction undergoing primary PCI. MATERIALS AND METHODS: From September 2004 to October 2005, 29 patients underwent a primary percutaneous coronary intervention and stenting with nicor-andil as a protocol drug at a dose of 1 mg/hour - this drug was titrated upwards to maximum tolerated dose, with a 2 mg intracoronary bolus given after balloon inflation during PCI. LAD was the infarct related artery in 62% of cases. 72.4% of them had a TIMI thrombus grade of 5. The corrected TIMI frame count following primary percutaneous intervention in the Nicorandil arm was 19.54 + 8.7. None of the patients had a no flow or slow reflow phenomenon with this protocol. One patient developed a subacute stent thrombosis necessitating a revascularization. At a mean follow up of 251 +/- 96.7% days, MACE was not reported in the other patients. Thirty four patients underwent a primary percutaneous coronary intervention and stenting without nicorandil as an adjuvant drug. Some of these patients were retrospectively assessed. They have been followed up for 285.4 +/- 264.6 days. LAD was the infarct related artery in 61.8% of cases while 79.5% of them had a TIMI thrombus grade of 5. The corrected TIMI frame count in this group was 23.9 +/- 17.5 (p <0.56). MACE was reported in 5 of these patients. The mean TIMI frame count for these 5 patients was 40.5 +/- 29.2. Glycoprotein IIb/IIIa receptor inhibitors were given to all patients in both groups. The choice of the agent used was left to the discretion of the operator. CONCLUSION: Nicorandil prevents no-flow/slow reflow phenomenon in patients undergoing primary PCI for acute myocardial infarction. This is shown by a lower corrected TIMI frame count in the nicorandil arm (p < 0.56). Reduction in the incidence of no-flow/slow reflow phenomenon translates into a lower MACE. The drug is safe and does not require intensive monitoring. It must be started early and electively in patients undergoing a primary PCI as a strategy to prevent no-flow rather than to treat this phenomenon.