Kounis Syndrome: Allergic Vasospastic Cardiac Event.

Kounis syndrome (KS) is an acute coronary event secondary to an allergic reaction. It is provoked by environmental agents, food, and medications. KS is caused by the release of allergic mediators. We are reporting a case of a 39-year-old man who had a syncopal episode after he took cephalexin and ibuprofen for toothache. He developed chest pain and erythematous rash later. His electrocardiography did not show any ST-segment elevation changes and cardiac troponins were elevated. He was started on the acute coronary syndrome treatment protocol. Coronary angiography revealed no significant obstructive or culprit lesions. The patient was discharged home in stable condition. He is advised to adhere to lifestyle modification and outpatient follow-up with cardiology and allergy/immunology. KS is infrequently reported in the medical literature. Physicians should pay attention to any allergic reaction preceding the acute cardiac event and consider KS in the differential diagnosis.

Effect of oxygenation modalities among patients with postoperative respiratory failure: a pairwise and network meta-analysis of randomized controlled trials.

BACKGROUND: Postoperative respiratory failure is associated with increased perioperative complications. Our aim is to compare outcomes between non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen in patients at high-risk for or with established postoperative respiratory failure. METHODS: Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to September 2019. We included only randomized controlled trials (RCTs) that compared NIV, HFNC, and standard oxygen in patients at high risk for or with established postoperative respiratory failure. We performed a Bayesian network meta-analysis to calculate the odds ratio (OR) and Bayesian 95% credible intervals (CrIs). RESULTS: Nine RCTs representing 1865 patients were included (the mean age was 61.6 ± 10.2 and 64.4% were males). In comparison with standard oxygen, NIV was associated with a significant reduction in intubation rate (OR 0.23; 95% Cr.I. 0.10-0.46), mortality (OR 0.45; 95% Cr.I. 0.27-0.71), and intensive care unit (ICU)-acquired infections (OR 0.43, 95% Cr.I. 0.25-0.70). Compared to standard oxygen, HFNC was associated with a significant reduction in intubation rate (OR 0.28, 95% Cr.I. 0.08-0.76) and ICU-acquired infections (OR 0.41; 95% Cr.I. 0.20-0.80), but not mortality (OR 0.58; 95% Cr.I. 0.26-1.22). There were no significant differences between HFNC and NIV regarding different outcomes. In a subgroup analysis, we observed a mortality benefit with NIV over standard oxygen in patients undergoing cardiothoracic surgeries but not in abdominal surgeries. Furthermore, in comparison with standard oxygen, NIV and HFNC were associated with lower intubation rates following cardiothoracic surgeries while only NIV reduced the intubation rates following abdominal surgeries. CONCLUSIONS: Among patients with post-operative respiratory failure, HFNC and NIV were associated with significantly reduced rates of intubation and ICU-acquired infections compared with standard oxygen. Moreover, NIV was associated with reduced mortality in comparison with standard oxygen.

ST-elevation Myocardial Infarction and Complete Heart Block in a Nitrate-free Patient using a New Emerging Substance called Rhino.

The pervasive use of counterfeit sexual enhancement supplements is increasing worldwide. There are thousands of vendors on the internet while local gas stations and convenience stores are selling it across the United States (US). We report a case of right coronary artery ST-segment elevation and complete heart block in a nitrate-free patient shortly after consuming three 950 mg pills of a sexual enhancer known as rhino and completing sexual intercourse. Coronary angiography revealed 100% occlusion of the right coronary artery and a drug-eluting stent was inserted with a transvenous pacer that he tolerated well, and recovered without complications. The counterfeit drug has gained traction for its high user satisfaction and low cost among recreational customers. The Food and Drug Administration (FDA), through its MedWatch program, has frequently released citations to consumers warning them against rhino since 2015, while their labs have recognized two prime ingredients: sildenafil and tadalafil. Although adverse cardiac risk with this therapeutic class is low, we aim to parse out its temporal relationship with rhino, an enhancer containing 14-200 times the prescription limits of sildenafil and tadalafil.

Cross-Sectional Survey of Healthcare Provisions for Female Tuberculosis Patients in Specialized Pulmonary Division from Low Socioeconomic Class in Lahore, Pakistan.

OBJECTIVES: This study aimed to investigate various healthcare provisions for women affected with tuberculosis (TB) from low socioeconomic status and their health seeking behaviors, also whether or not patients feel stigmatized about their disease. INTRODUCTION: Pulmonary tuberculosis has more prevalence in Pakistan as compared to western countries where it occurs predominantly in the immunocompromised individuals and immigrants of certain countries. It is a contagious disease and Pakistan stands at the fifth position with maximum reported cases each year. METHODS: A cross-sectional study was carried at Gulab Devi Hospital, a public sector hospital located in Lahore, through a questionnaire-based survey followed by interviewing all participants. Two hundred seventy-seven female patients, who were already diagnosed with pulmonary tuberculosis, were included in the study. The sample was drawn by non-probability, convenience sampling. Literacy, a major contributor to socioeconomic status, was taken primary criteria to select the sample for the study. RESULTS: The study shows that literacy of patients has no impact on whether they feel stigmatized due to their disease as 42% (45 out of 108) of the literate women felt stigmatized while 39% (65 out of 169) of illiterate women also presented with similar feelings. Furthermore, the research also showed that these patients have no effect on requiring permission for going to the health facility as the study revealed that 62% (67 out of 108) in the literate women required permission while 67% (113 out of 169) illiterate women required permission. CONCLUSION: Pakistani population must be educated about TB and factors associated with the progression and consequences of the disease. It was noted that even educated people feel embarrassed when they develop symptoms of TB, thereby causing the unprecedented delay in effective disease management. To conclude, TB clinic should be opened in each community so that people have easy access to treatment of the disease.

Think Before Chopping a Diabetic Foot: Insight to Vascular Intervention.

Diabetes mellitus is a most commonly occurring chronic disease around the world, resulting in damage to multiple organs. One of the consequences of poorly controlled diabetes is vascular damage resulting in peripheral artery disease, leading to inadequate perfusion of the foot and eventually gangrene and amputation. Research over the past decade or so has provided us with the statistics that vascular intervention has better clinical outcomes including patient mortality, morbidity, quality of life, and patient satisfaction. This editorial advocates the importance of pursuing a vascular plan prior to a limb salvaging procedure. We highlight some important aspects of saving a diabetic foot and encourage the importance of giving a vascular trial.