ABSTRACT
BACKGROUND: The kinetics of high sensitivity cardiac troponin T (hs-cTnT) levels after elective, biphasic, direct-current cardioversion for persistent atrial fibrillation/flutter remains unknown. METHODS: We examined hs-cTnT kinetics in 24 patients at baseline and at 2, 6 and 24 hours post-cardioversion, and again at 7 and 30 days. We also examined levels of creatine kinase, aspartate aminotransferase, lactate dehydrogenase, brain natriuretic peptide (BNP), and high sensitivity C-reactive protein (hs-CRP). RESULTS: Median (25th, 75th interquartiles) baseline hs-cTnT concentration was 19.8 (10.4, 35.2) ng/L with 14 patients presenting with levels above the 99th percentile (13 ng/L). Hs-cTnT levels did not change significantly over time although they tended to decrease by 30 days, 18.8 ng/L (12.5, 23.3). There was no significant rise in other markers of myocardial injury. Similarly, BNP and hs-CRP levels were elevated at baseline and tended to decrease over time. CONCLUSIONS: Patients with persistent atrial fibrillation/flutter have elevated hs-cTnT levels, as part of a general rise in biomarkers such as BNP and hs-CRP, without a further rise after cardioversion. After cardioversion, there is a gradual non-significant decrease in biomarker levels over time, and thus a rise in hs-cTnT levels should not be attributed to cardioversion.
Subject(s)
Atrial Fibrillation/therapy , Atrial Flutter/therapy , Electric Countershock/methods , Troponin T/metabolism , Aged , Biomarkers/metabolism , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Time FactorsABSTRACT
Stem cell therapy has developed extensively in recent years, leading to several new clinical fields. The use of mesenchymal stromal cells sparks special interest, as it reveals the importance of the paracrine and immunomodulatory effects of these supporting cells, in disease and in cure. This review discusses our current understanding of the basic clinical principles of stem cell therapy and demonstrates the broad range of this treatment modality by examining two relatively new therapeutic niches--autoimmune and cardiac diseases.
Subject(s)
Autoimmune Diseases/therapy , Heart Diseases/therapy , Mesenchymal Stem Cell Transplantation , Humans , Myocardial Infarction/therapyABSTRACT
The features of infective endocarditis include both cardiac and non-cardiac manifestations. Neurologic complications are seen in up to 40% of patients with infective endocarditis and are the presenting symptom in a substantial percentage. We describe in detail the clinical scenarios of three patients admitted to our hospital, compare their characteristics and review the recent literature describing neurologic manifestations of infective endocarditis. Our patients demonstrate that infective endocarditis can develop without comorbidity or a valvular defect. Moreover, our patients were young and lacked the most common symptom of endocarditis: fever. The most common neurologic manifestations were focal neurologic deficits and confusion. We conclude that infective endocarditis should always be considered in patients presenting with new-onset neurologic complaints, especially in those without comorbidities or other risk factors. A prompt diagnosis should be reached and antibiotic treatment initiated as soon as possible.
Subject(s)
Endocarditis, Bacterial/complications , Nervous System Diseases/etiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Brain/diagnostic imaging , Brain/pathology , Brain Infarction/diagnosis , Brain Infarction/etiology , Brain Ischemia/diagnosis , Brain Ischemia/etiology , Confusion/etiology , Diagnosis, Differential , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Female , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Headache/diagnosis , Headache/etiology , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/etiology , Heart Valve Diseases/surgery , Humans , Magnetic Resonance Imaging , Male , Nervous System Diseases/diagnosis , Tomography, X-Ray Computed , UltrasonographyABSTRACT
OBJECTIVE: To assess the reported increased rate of cesarean sections in women carrying male fetuses. STUDY DESIGN: A retrospective analysis of all deliveries in 2001 was performed. All singleton deliveries were enrolled. We compared fetal sex distribution in cesarean ased risk of cesarean sections performed for various indications. The study had 80% power to detect a explained by different parturient difference in the cesarean section rate in women carrying male and female fetuses. RESULTS: The overall cesarean section rate was similar in women with male or female fetuses, 19.7% and 19.1%, respectively. This lack of association was also found in specific subgroups of cesarean indications: non-reassuring fetal heart rate pattern, fetal distress, nonprogressive labor, elective cesarean, suspected macrosomia, abnormal lie and severe preeclampsia. CONCLUSION: In contrast with previous investigators, we did not find an increased risk of cesarean section in women carrying male fetuses.
