Cirurgia de Endocardite Infecciosa. Análise de 328 Pacientes Operados em um Hospital Universitário Terciário / Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital

Resumo Fundamento A endocardite infecciosa (EI) refere-se à infecção da superfície endocárdica do coração e geralmente ocorre em valvas nativas ou protéticas. Objetivo Este estudo teve como objetivo levantar dados de EI refletindo a terapêutica cirúrgica, em um Hospital Universitário do interior do estado de São Paulo - Brasil. Método Abordagem retrospectiva e observacional de 328 pacientes com EI operados entre 1982 e 2020 Resultados Os principais dados (n=121/37%), insuficiência cardíaca congestiva (n=114/35%), valvopatia (n=92/28%), diabetes mellitus (n=85/26%), doença renal crônica (n=59/18%) e febre reumática (49/15%). A insuficiência renal é um dos principais e mais relevantes fatores de risco pré-cirúrgicos para um mau prognóstico. Conclusão Para um melhor resultado clínico e cirúrgico é necessário o diagnóstico sindrômico e etiológico precoce da EI, principalmente em pacientes com múltiplas comorbidades.

Abstract Background Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. Objective This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. Method Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020 Results The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. Conclusion For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

“Comparative Study on Complications of Early Enteral Feeding and Nil Per Oral in Mild and Moderate Acute Pancreatitis”

Introduction: Acute pancreatitis is a potentially lethal disease with wide variation in severity ranging from mild and self-limiting to a rapidly progressive illness leading to multiorgan failure. In accordance with this wide variation in clinical presentation, the treatment of acute pancreatitis requires a multidisciplinary approach. Mild acute pancreatitis causes disturbance in the homeostatic mechanism of the body is minimal; the treatment is aimed at supporting the native reparative processes of the body. One of the main supportive mechanisms is adequate and safe nutritional supplementation. Objectives: To assess the occurrence of infective and non-infective complications in cases of acute pancreatitis on early enteral nutrition. Materials & Methods: This is a prospective study conducted on patients who were admitted to SSIMS AND RC Davangere with symptoms suggestive of acute pancreatitis from July 2019 to July 2021. Patients with a clinical picture consistent with the diagnosis of acute pancreatitis, along with more than a 3-fold elevation of serum amylase and elevated serum lipase were considered to have acute pancreatitis. After initial diagnosis and assessment, patients were duly informed regarding the study and consent was obtained. A 16-gauge nasogastric Ryle’s tube was inserted for all patients included in the study. The feeding patterns were initiated depending upon the severity of acute pancreatitis. Feeding was started after calculating the nutrition requirement. In the early feeding group, patients were given a protein powder to achieve a target nutrition in a stepwise manner. The tolerance to feeds, infective and non-infective complications and the time taken to start on an oral diet were noted and analysed. Results: The incidence of infective complications in our study was found to be 2% with none of the infections involving the pancreas itself. The incidence of non-infective complications in our study was found to be 30% with 13% involving the pancreas proper. Conclusions: The use of early enteral feeding does not influence the incidence of infective and non-infective complications in mild and moderate acute pancreatitis. Early enteral feeding delivers nutrition, in a simpler and more cost-effective. Nasogastric and oral feeding reduces the morbidity of the patient by accelerating the return to normal activities.

Non-infectious thrombotic endocarditis associated with chronic rheumatic heart disease and disseminated tuberculosis

Rheumatic heart disease is still common in developing countries and requires prompt intervention to prevent chronic complications. Vegetations in rheumatic heart disease might be due to acute episodes of rheumatic fever itself or due to either infective endocarditis (IE) or Non-infectious thrombotic endocarditis (NITE). Each form of vegetations has specific pathological characteristics on gross and microscopic examination. However, clinically IE and NITE may have overlapping signs and symptoms. A chance of misdiagnosis of NITE as culture-negative infective endocarditis is higher if the former present with infective symptoms like fever. NITE of valves can be due to underlying associated malignant neoplasm, particularly mucinous adenocarcinoma, pneumonia, cirrhosis, autoimmune disorders, and hypercoagulable state. The coexistence of tuberculosis, non-infectious thrombotic endocarditis and rheumatic valvular heart disease was rarely documented in medical literature. We describe a case of chronic rheumatic heart disease with vegetations in the posterior mitral valve leaflet, treated as culture-negative infective endocarditis, which, at autopsy, reveals the presence of Nonbacterial thrombotic endocarditis vegetation over calcified, fibrosed mitral valve leaflets and associated disseminated tuberculosis along with classic pathological sequela findings of chronic rheumatic mitral valvular heart disease in lungs and liver.

Endocarditis marántica como presentación de cáncer de páncreas: caso clínico / Non-bacterial thrombotic endocarditis: report of one case

Marantic or nonbacterial thrombotic endocarditis is characterized for the presence of vegetations formed by a meshwork of fibrin and other cellular material similar a blood clot, without the presence of microorganisms. It is often related with tumors and chronic inflammatory states. We report a 49 years old female with a history of weight loss and asthenia, presenting with multiple cerebrovascular attacks and fever. Blood cultures were negative and the fever did not subside with antibiotic treatment. Trans esophageal echocardiogram showed a mitral valve vegetation and thickening of the free edge of both leaflets. In search of the etiology of such a case, a primary pancreatic cancer with distant metastases was found. We cannot rule out the differential diagnosis with bacterial endocarditis with negative blood cultures, although the clinical context supports a non-infectious etiology.

Role of Procalcitonin and C-reactive protein in differentiating culture negative bacterial sepsis and systemic inflammatory response

Background: It is very important to distinguish between non-infectious systemic inflammatory response (SIRS) and culture negative sepsis as the management of the two conditions is different this often creates diagnostic challenge in day to day practice. The aim of present study is to investigate the diagnostic accuracy of serum PCT and CRP to differentiate between culture negative bacterial sepsis and non-infective SIRS. We have also studied their diagnostic efficacy in culture-positive sepsis. Materials and methods: 178 cases who were admitted in acute medical care unit in tertiary care centre, were included in the study. The cases were divided into three groups. Group I (culture positive sepsis) patients with positive microbial culture and 2 or more signs of sepsis. Group II (culture negative sepsis) includes patients with 2 or more sign of SIRs and clinical suspicion of infection with negative culture result. Group III (non-infective SIRs) includes patient with 2 or more sign of SIRS without evidence of any infection. Samples were collected for blood culture, differential count, PCT and CRP along with other routine investigation. The diagnostic performance of PCT and CRP was demonstrated with ROC curve analysis. Results: The median Procalcitonin was approximately 9 fold higher in culture negative group compared to non-infective SIRS and it was statistically significant (P<0.01) whereas CRP showed Siraj Ahmed Khan, Iyyapu Krishna Mohan, Bhavya Sirivelu, Rachel Jacob. Role of Procalcitonin and C-reactive protein in differentiating culture negative bacterial sepsis and systemic inflammatory response. IAIM, 2017; 4(3): 24-29. Page 25 only 2-3 fold increase between these groups. ROC curve analysis for PCT and CRP between culture negative and SIRS groups for prediction of systemic infection were performed. The area under the curve for PCT and CRP were 0.986 and 0.785 respectively. Conclusion: Biomarkers such as PCT and CRP are strongly associated with infection likelihood and sepsis and they can serve as useful adjuncts to routine clinical information. These markers were also able to distinguish between patients with non-infective SIRS and sepsis.

Causes of Aseptic Persistent Pain after Total Knee Arthroplasty

BACKGROUND: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. METHODS: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees). RESULTS: In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive. CONCLUSIONS: Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking.

Non-Bacterial Thrombotic Endocarditis in a Patient with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is frequently associated with various extra-joint complications. Although rare, thromboembolic complications are associated with high morbidity and mortality. We experienced a very rare case of nonbacterial thrombotic endocarditis (NBTE) and subsequent embolic stroke in a patient with RA. A 72-year-old male with a 15-year history of RA suddenly developed neurologic symptoms of vomiting and dizziness. Brain magnetic resonance imaging revealed recently developed multiple cerebellar and cerebral lacunar infarctions. Echocardiography showed a pulsating mitral valve vegetation involving the posterior cusp of the mitral valve leaflet, which was confirmed as NBTE. Immediate anti-coagulation therapy was started. The NBTE lesion disappeared in follow-up echocardiography after 4 weeks of anti-coagulation treatment.

Non-Infective Endocarditis in a Patient with Rheumatoid Arthritis / 대한내과학회지

Pericarditis and atherosclerotic events are generally regarded as relatively common cardiac manifestations of rheumatoid arthritis (RA). However, RA-associated endocarditis is rarely reported, and can be confused (by clinicians) with an infective vegetation. Herein, we report a case of sterile endocarditis involving the mitral valve in a 36 year-old patient with longstanding RA; the problem was accidentally detected during performance of a valve operation.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer / 결핵및호흡기질환

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

Multiple Hypercoagulability Disorders at Presentation of Non-Small-Cell Lung Cancer / 결핵및호흡기질환

Hypercoagulability disorders are commonly encountered in clinical situations in patients with a variety of cancers. However, several hypercoagulability disorders presenting as first symptoms or signs in cancer patients have rarely been reported. We herein described a case of a woman with adenocarcinoma of the lung presenting with deep vein thrombosis, nonbacterial thrombotic endocarditis, recurrent cerebral embolic infarction, and heart failure.

Nonbacterial Thrombotic Endocarditis in a Patient with Bowel Infarction due to Mesenteric Vein Thrombosis

Ante mortem cases of venous thrombosis in patients with nonbacterial thrombotic endocarditis (NBTE) have not yet been reported. We describe a rare case of NBTE in a patient with mesenteric vein thrombosis. A healthy 37-year-old man with abdominal pain and fever underwent emergency small bowel resection due to bowel ischemia resulting from mesenteric vein thrombosis. Transthoracic echocardiography revealed multiple mobile masses attached to the anterior leaflet of the mitral valves and their chordae tendineae. On suspicion of infective endocarditis, the cardiac masses were excised through open-heart surgery. However, pathologic reviews were compatible with NBTE. The patient was stable after the cardiac surgery and was treated with warfarin. Laboratory and imaging findings regarding his hypercoagulable condition were all negative.

Accidente cerebrovascular embólico por endocarditis de Libman-Sacks como manifestación inicial de síndrome antifosfolípidos primario en una paciente de 17 años: Report of one case / Libman-Sacks endocarditis associated with antiphospholipid syndrome

Libman-Sacks endocarditis is a non-infectious valvular damage associated with autoimmune disorders such as Systemic Lupus Erythematosus and Antiphospholipid Syndrome. We report a 17-year-old female consulting in the emergency room due to a right hemiparesis and aphasia. A magnetic resonance imaging showed multiple infarctions in the territory of the left middle cerebral artery, presumably of embolic origin. A trans-esophageal echocardiogram showed a vegetation in the mitral valve. Blood cultures were negative. Antinuclear antibodies and serological tests for antiphospholipid syndrome were positive. Oral anticoagulation was started and the patient was discharged. After six months of follow up, antiphospholipid antibodies are still positive.

Observation of Buzhong Yiqi Granule in treatment of gynecological postoperative non-infective fever / 中草药

Objective: To observe BuzhongYiqi Granule for the treatment of gynecological postoperative non-infective fever. Methods: From February 2012 to May 2013, 100 patients who still run a fever without any postoperative infection two days after gynecological surgery in Tianjin Central Hospital of Gynecology Obstetrics were randomly divided into two groups, 50 cases each. Basic treatment for the fever after gynecological surgery in the control group was carried out by the conventional treatment process, and the treatment in the treatment group was as same as the control group. On this basis, BuzhongYiqi Granule was taken at the same time. Neither of the two groups did take the measures of the treatment on body temperature directly to compare the clinic observation. Results: The total effective rates were 92.0% and 66.0% in the treatment and control groups, respectively. There was a significant difference (P < 0.05), the treatment group was better than the control group. Conclusion: Buzhong Yiqi Granule has a good curative effect in the treatment of gynecological postoperative non-infective fever.

Pattern Of Skin Diseases In Patients Attending OPD Of Dermatology Department At Faridpur Medical College Hospital, Bangladesh.

It is generally agreed that the pattern of skin diseases differs in different countries, and within various regions of a country depending on social, economic, racial and environmental factors. Many workers have reported various patterns of skin diseases in different countries. So far, no such report is available in our country for Faridpur region. To fill the lacunae we decided to undertake a retrospective study of the skin disease pattern in this tertiary hospital of Faridpur, Bangladesh. All the newly diagnosed cases attending the OPD of Dermatology and Venereology, Faridpur Medical College Hospital, during the period of one year starting from 1st July 2007 to 30th June, 2008 were included in the study. Diagnosi s was done on clinical grounds and laboratory investigations were done whenever required. Eczema (19.2%), fungal infections (17.26%), scabies (15.16%) and pyodermas (7.59%) were the major skin diseases. STD's accounted for (0.73%) of the cases. Genodermatoses (0.01%) formed the minimal number of cases. Eczema was the commonest group of disorders. Out of the infective skin disorders fungal infections were the commonest group. Genodermatoses formed the least number of cases.

Changes of C-Reactive Protein and Von Willebrand Factor in Children with Systemic Inflammatory Response Syndrome Caused by Non-Infective Diseases / 实用儿科临床杂志

Objective To explore the changes of C-reactive protein(CRP) and von willebrand(VW) factor levels on pathogenesis of systemic inflammatory response syndrome(SIRS)caused by non-infective diseases in children.Methods Thirty-two children who attained to SIRS criterias caused by non-infective diseases were selected as study group,who were further divided into multiple organ(fai)-lure(MOF)group and non-MOF group according to whether the patients had MOF.Blood samples were taken to measure VW factor and CRP by ELISA and immune turbidimetry respectively.Twenty health children were as control group.Results Concentrations of blood VW factor(37 mg/L) and CRP[(185.50?27.71)%] were significantly higher in children with SIRS than those in control group(all(P