The predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients.

OBJECTIVE: Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients. METHODS: This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission. RESULTS: One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores. CONCLUSION: Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.

The predictive value of left ventricular global longitudinal strain in normotensive critically ill septic patients / Valor preditivo do strain longitudinal global do ventrículo esquerdo em pacientes críticos normotensos com sepse

ABSTRACT Objective: Evaluation of left ventricular systolic function using speckle tracking echocardiography is more sensitive than conventional echocardiographic measurement in detecting subtle left ventricular dysfunction in septic patients. Our purpose was to investigate the predictive significance of left ventricular global longitudinal strain in normotensive septic intensive care patients. Methods: This observational, prospective cohort study included septic normotensive adults admitted to the intensive care unit between June 1, 2021, and August 31, 2021. Left ventricular systolic function was measured using speckle-tracking echocardiography within 24 hours of admission. Results: One hundred fifty-two patients were enrolled. The intensive care unit mortality rate was 27%. Left ventricular global longitudinal strain was less negative, which indicated worse left ventricular function in non-survivors than survivors (median [interquartile range], -15.2 [-17.2 - -12.5] versus -17.3 [-18.8 - -15.5]; p < 0.001). The optimal cutoff value for left ventricular global longitudinal strain was -17% in predicting intensive care unit mortality (area under the curve, 0.728). Patients with left ventricular global longitudinal strain > -17% (less negative than -17%, which indicated worse left ventricular function) showed a significantly higher mortality rate (39.2% versus 13.7%; p < 0.001). According to multivariate analysis, left ventricular global longitudinal strain was an independent predictor of intensive care unit mortality [OR (95%CI), 1.326 (1.038 - 1.693); p = 0.024], along with invasive mechanical ventilation and Glasgow coma scale, APACHE II, and SOFA risk scores. Conclusion: Impaired left ventricular global longitudinal strain is associated with mortality and provided predictive data in normotensive septic intensive care patients.

RESUMO Objetivo: A avaliação da função sistólica do ventrículo esquerdo utilizando ecocardiografia com speckle tracking é mais sensível do que a medição ecocardiográfica convencional na detecção de disfunções sutis do ventrículo esquerdo em pacientes sépticos. Nosso objetivo foi investigar a significância preditora do strain longitudinal global do ventrículo esquerdo em pacientes sépticos normotensos internados em unidades de terapia intensiva. Métodos: Este estudo de coorte observacional e prospectivo incluiu adultos sépticos normotensos internados em uma unidade de terapia intensiva entre 1° de junho de 2021 e 31 de agosto de 2021. A função sistólica do ventrículo esquerdo foi mensurada utilizando a ecocardiografia com speckle tracking nas primeiras 24 horas após a internação. Resultados: Foram recrutados 152 pacientes. A taxa de mortalidade na unidade de terapia intensiva foi de 27%. O strain longitudinal global do ventrículo esquerdo foi menos negativo, o que indicou pior função do ventrículo esquerdo em não sobreviventes do que em sobreviventes (mediana [intervalo interquartil] -15,2 [-17,2 - -12,5] versus -17,3 [-18,8 - -15,5]; p < 0,001). O valor de corte ótimo para o strain longitudinal global do ventrículo esquerdo foi -17% para prever a mortalidade na unidade de terapia intensiva (área sob a curva de 0,728). Pacientes com strain longitudinal global do ventrículo esquerdo > -17% (menos negativo do que -17%, o que indicou pior função do ventrículo esquerdo) apresentaram taxa de mortalidade significativamente maior (39,2% versus 13,7%; p < 0,001). De acordo com a análise multivariada, o strain longitudinal global do ventrículo esquerdo foi um preditor independente de mortalidade na unidade de terapia intensiva [RC (IC95%), 1,326 (1,038 - 1,693); p = 0,024], com ventilação mecânica invasiva e os escores de risco da escala de coma de Glasgow, APACHE II e SOFA. Conclusão: Alterações do strain longitudinal global do ventrículo esquerdo estão associadas a mortalidade e podem fornecer dados preditivos em pacientes sépticos normotensos internados em unidades de terapia intensiva.

A rare presentation of a patient with COVID-19: Cardiac tamponade.

The clinical presentation of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2, can range from only mild, flu-like symptoms to severe progressive pneumonia. Cardiac involvement may be observed during the course of the infection and may include myocarditis, acute myocardial infarction, heart failure, and cardiac rhythm disturbances, but cases describing cardiac tamponade in patients previously diagnosed with COVID-19 are very rare. A 58-year-old female had been hospitalized in another hospital 2 weeks prior to the currently described presentation due to atypical pneumonia. A nasopharyngeal swab specimen was positive for COVID-19. The hospitalization was uncomplicated and she was discharged after a week. She presented at our emergency department with symptoms of shortness of breath and swelling in both legs. A bedside transthoracic echocardiography showed globally depressed left ventricular contraction with an ejection fraction of 30% and there was significant pericardial effusion, which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit with the diagnosis of pericardial tamponade. Bedside pericardiocentesis was performed and serohemorrhagic fluid was drained. Pericardial effusion and pericardial tamponade should be considered in the differential diagnosis of patients with COVID-19 exhibiting dyspnea or worsening of dyspnea. A 58-year-old female has been hospitalized in another hospital two weeks ago due to atypical pneumonia. Her nasopharyngeal swab specimen was positive for COVID-19. She had an uncomplicated course during the hospitalization and was discharged a week ago. She presented to our emergency department (ED) with symptoms of shortness of breath and swelling in both legs. We performed bedside transthoracic echocardiography (TTE) which showed globally depressed left ventricular contraction with ejection fraction (EF) of 30% and there was significant pericardial effusion which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit (CICU) with the diagnosis of pericardial tamponade. Bedside pericardiosentesis was performed and serohemorrhagic fluid was drained. Patients with COVID-19 infection who develops or have worsening dyspnea, pericardial effusion and pericardial tamponade should be considered in differential diagnosis.

Prospective comparison of two suturing techniques of amniotic membrane transplantation for symptomatic bullous keratopathy.

PURPOSE: To determine the outcomes of a modified amniotic membrane transplantation (AMT) suturing technique for pain and discomfort relief in patients with symptomatic bullous keratopathy (BK). DESIGN: Randomized, double-blind controlled clinical trial. METHODS: setting: Ankara Research and Training Hospital 1st and 2nd Eye Clinics, Ankara, Turkey. study population: This prospective study included 39 eyes (39 patients) with BK presenting with intractable pain or discomfort and poor visual potential. intervention: Patients were randomly assigned into two groups: in group 1 (21 patients), patients underwent a modified AMT suturing technique; a groove was prepared by vacuum trephine on the recipient cornea and the edges of the punch-shaped amniotic membrane (AM) were sutured to this groove with the basement membrane side up. In group 2 (18 patients), patients underwent the standard AMT suturing to the cornea. main outcome measure: During a mean follow-up of 27.3 +/- 8.5 months (standard deviation) (range, 12 to 36 months), epithelial healing, persistence of AM, pain relief, and visual changes were analyzed and were compared between groups. RESULTS: The mean age (P = .15), the mean follow-up (P = .73), and the mean preoperative visual acuity (P = .53) were similar in both groups. With the modified suturing technique, the postoperative visual acuity was better (P = .03), epithelialization time was shorter (P < .001), and the AM remained longer (P < .001). Successful epithelialization was achieved in 20 eyes (95.3%) in group 1, and in 16 eyes (88.9%) in group 2 (P = .586). The pain scores of patients in group 1 remained stable (P = .223) over time, however increased from the first week to the third month postoperatively in group 2 (P = .046). CONCLUSIONS: The modified AMT suturing technique has a similar epithelialization rate to standard AMT suturing to cornea. Though technically more demanding, shorter epithelialization time, longer persistence of AM, and stable pain scores in the postoperative period makes this a promising method for the treatment of symptomatic BK.

Ocular complications in 2 cases with porphyria.

PURPOSE: We aimed to report our observation regarding the long-term follow-up results of 2 cases with similar ophthalmic manifestations of 2 different porphyrias, congenital erythropoietic porphyria (CEP), and porphyria cutanea tarda (PCT). METHODS: Both patients presented with ocular pain and photophobia in both eyes. The patient with CEP had a scleral necrosis of 3 mm in diameter at the lateral limbus of the right eye and medial limbus of the left eye, accompanied with cicatricial ectropion and lid swelling OU. The patient with PCT had scleral necrosis in the interpalpebral area nasally, OU. RESULTS: Both patients were followed-up for 4 years. The patients received intensive topical lubrication and topical and oral immune-suppressive medication. They underwent amniotic membrane grafting, when required, and were advised to wear UV glasses. The case with PCT followed a more salient course and remained symptom free until the end of the follow-up period. In contrast, the patient with CEP developed further scleral necrosis, despite the treatment and evisceration surgery were inevitable owing to endophthalmitis unresponsive to the treatment. CONCLUSIONS: Ocular complications are rarely reported in porphyrias, and the studies on the long-term follow-up results are fewer. Despite careful follow-up and intensive treatment, scleral necrosis can be progressive and results in the loss of vision or even the loss of eye. Further studies regarding the care of patients with porphyrias are required to more effectively treat these rare ophthalmic conditions.

Lens concentration of ofloxacin and lomefloxacin in an experimental endophthalmitis model.

UNLABELLED: Abstract. BACKGROUND: Bacterial endophthalmitis is a serious complication of ocular surgery and penetrating trauma. The primary causative organisms are strains of Staphylococcus aureus and Staphylococcus epidermidis. Fluoroquinolones are widely used to treat endophthalmitis. There are a few studies on the penetration of fluoroquinolones into the lens in inflamed eyes. A literature search did not identify any data regarding penetration of topical ofloxacin into the lens in normal and inflamed eyes. OBJECTIVE: The aim of this study was to determine the penetration of topical ofloxacin and lomefloxacin into the lens in a rabbit endophthalmitis model. METHODS: New Zealand white rabbits were randomly divided into 2 groups. The left eyes were infected with an intravitreal inoculation of S aureus. The right eyes were used as a noninoculated control. Groups 1 and 2 received topical ofloxacin and lomefloxacin treatment, respectively, 24 hours after the inoculation. Two drops of the study drugs were instilled in the eyes every 30 minutes for 3 hours and then every 60 minutes for 3 hours. Lens samples were obtained 30 minutes after the last ofloxacin or lomefloxacin drops were administered. High-performance liquid chromatography was used to determine the fluoroquinolone concentration. RESULTS: Ten rabbits were equally divided into the 2 treatment groups. There was no significant difference in mean (SD) lens concentrations between the control and inoculated eyes in either treatment group-ofloxacin (0.26 [0.32] µg/mL vs 0.11 [0.05] µg/mL, respectively) and lomefloxacin (0.50 [0.87] µg/mL vs 0.12 [0.08] µg/mL, respectively). CONCLUSION: The results of this small experimental study found that topical ofloxacin and lomefloxacin can accumulate in the crystalline lens after installation. Inflammation did not affect the penetration of ofloxacin or lomefloxacin into the lens.