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Pubblicazioni recenti - pediatric cardiac
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Circulating humanin is lower in coronary artery disease and is a prognostic biomarker for major cardiac events in humans.
Biochim Biophys Acta Gen Subj2021 Sep;():130010. doi: S0304-4165(21)00169-0.
Cai He, Cao Pengyu, Sun Wanqing, Shao Wangshu, Li Rongyu, Wang Lin, Zou Lin, Forno Erick, Muzumdar Radhika, Gong Zhenwei, Zheng Yang,
Abstract
BACKGROUND:
Humanin is an endogenous mitochondria-derived peptide that plays critical roles in oxidative stress, inflammation and CAD. In this study, we measured the levels of circulating humanin, markers of oxidative stress and inflammation in patients with unstable angina and MI and studied the relationship between these parameters and major adverse cardiac events (MACE).
METHODS:
A total of 327 subjects were recruited from the inpatient department at First Hospital of Jilin University and divided into 3 groups [control, angina and myocardial infarction (MI)] based on the clinical data and the results of the angiography. Serum humanin and thiobarbituric acid reactive substances (TBARS) were measured at the time of initial admission. The hospitalization data and MACE of all patients were collected.
RESULTS:
Circulating humanin levels were lower in the angina group compared to controls [124.22?±?63.02 vs. 157.77?±?99.93?pg/ml, p?0.05] and even lower in MI patients [67.17?±?24.35?pg/ml, p?0.05 vs controls] and oxidative stress marker were higher in MI patients compared to the control and angina groups [12.94?±?4.55 vs. 8.26?±?1.66 vs. 9.06?±?2.47 umol/ml, p?0.05]. Lower circulating humanin levels was an independent risk factor of MI patients. Circulating humanin levels could be used to predict MACE in angina group.
CONCLUSIONS:
Lower circulating humanin levels was an independent risk factor for CAD, and a potential prognostic marker for mild CAD.
GENERAL SIGNIFICANCE:
Humanin may become a new index for the diagnosis and treatment of CAD.
Copyright © 2021. Published by Elsevier B.V.
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Reply to Schmitz et al.
Am J Physiol Heart Circ Physiol2021 Oct;321(4):H665-H666. doi: 10.1152/ajpheart.00481.2021.
Van Guilder Gary P, Preston Claudia C, Munce Thayne A, Faustino Randolph S,
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Dosing Regimen Prediction and Confirmation with Rivaroxaban for Thromboprophylaxis in Children after the Fontan Procedure: Insights from the Phase III UNIVERSE Study.
J Clin Pharmacol2021 Sep;():. doi: 10.1002/jcph.1966.
Zhu Peijuan, Willmann Stefan, Zhou Wangda, Yang Haitao, Michelson Alan D, McCrindle Brian W, Li Jennifer S, Harris Kevin C, Pina Liza Miriam, Weber Traci, Nessel Kimberly, Lesko Lawrence J, Kubitza Dagmar, Zannikos Peter,
Abstract
Thrombosis remains an important complication for children with single ventricle physiology post-Fontan procedure and effective thromboprophylaxis is an important unmet medical need. To obviate conventional dose-finding studies and expedite clinical development, a rivaroxaban dose regimen for this indication was determined utilizing a model-informed drug development approach. A physiologically based pharmacokinetic (PBPK) rivaroxaban model was used to predict a pediatric dosing regimen that would produce drug exposures similar to that of 10 mg once daily in adults. This regimen was used in an open-label, multicenter Phase 3 study, which investigated the use of rivaroxaban for thromboprophylaxis in post-Fontan patients 2 to 8 years of age. The pharmacokinetics (PK) of rivaroxaban was assessed in Part A (n = 12) and in Part B (n = 64) of UNIVERSE. The safety and efficacy in the rivaroxaban group were compared to those in the acetylsalicylic acid group for 12 months. Pharmacodynamic endpoints were assessed in both parts of the study. Rivaroxaban exposures achieved in Part A and B were similar to the adult reference exposures. Prothrombin time also showed similarity to the adult reference. Exposure-response analysis did not identify a quantitative relationship between rivaroxaban exposures and efficacy/safety outcomes within the observed exposure ranges. A body-weight based dose regimen selected by PBPK modeling was shown in the UNIVERSE study to be appropriate for thromboprophylaxis in the post-Fontan pediatric population. Model-based dose selection can support pediatric drug development and bridge adult dose data to pediatrics, thereby obviating the need for dose-finding studies in pediatric programs. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Intracranial Pressure and Cerebral Hemodynamic Monitoring After Cardiac Arrest in Pediatric Pigs Using Contrast Ultrasound-Derived Parameters.
J Ultrasound Med2021 Sep;():. doi: 10.1002/jum.15825.
Shin Samuel S, Sridharan Anush, Khaw Kristina, Hallowell Thomas, Morgan Ryan W, Kilbaugh Todd J, Hwang Misun,
Abstract
OBJECTIVES:
We explore the correlation of contrast-enhanced ultrasound (CEUS) parameters to intracranial pressure (ICP) in a porcine experimental model of pediatric cardiac arrest.
METHODS:
Eleven pediatric pigs underwent electrically induced cardiac arrest followed by cardiopulmonary resuscitation. ICP was measured using intracranial bolt monitor and CEUS was monitored through a cranial window. Various CEUS parameters were monitored at baseline, immediately post return of spontaneous circulation (ROSC), 1?hour-post ROSC, and 3?hours post-ROSC.
RESULTS:
There was significant ICP correlation with wash-out slope assessed by CEUS time intensity curve analysis at immediate post-ROSC. At 3?hours post-ROSC there was also significant negative correlation between ICP and peak enhancement which may be due to the evolution of anoxic injury.
CONCLUSION:
The use of CEUS in assessing disruption of cerebral hemodynamics and ICP post cardiac arrest will need future validation and comparison to other imaging modalities. The correlation between CEUS parameters and ICP may be due to the alterations in cerebral autoregulation that result from anoxic brain injury.
© 2021 American Institute of Ultrasound in Medicine.
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Evaluation of Clinical Course and Maintenance Drug Treatment of Supraventricular Tachycardia in Children During the First Years of Life. A Cohort Study from Eastern Germany.
Pediatr Cardiol2021 Sep;():. doi: 10.1007/s00246-021-02724-9.
Bücking Claudio, Michaelis Anna, Markel Franziska, Weidenbach Michael, Dähnert Ingo, Gebauer Roman Antonin, Paech Christian,
Abstract
Supraventricular tachycardia (SVT) is considered the most common cause of arrhythmia in children and infants. Regarding the likelihood of a spontaneous resolution of SVTs during the first years of life, drug treatment aims to bridge the time until children 'grow out' out of the arrhythmia. The choice of antiarrhythmic agents and the planning of maintenance therapy are mainly based on clinical experience and retrospective single- and multi-institutional analyses and databases from all over the world approaching differently to this topic. The current study aimed to evaluate the clinical course, pharmacological treatment strategies, and constellations of risk for recurrences in the management of SVTs in children aged 3?
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Comparison of Patent Ductus Arteriosus Stent and Blalock-Taussig Shunt as Palliation for Neonates with Sole Source Ductal-Dependent Pulmonary Blood Flow: Results from the Congenital Catheterization Research Collaborative.
Pediatr Cardiol2021 Sep;():. doi: 10.1007/s00246-021-02699-7.
Bauser-Heaton Holly, Qureshi Athar M, Goldstein Bryan H, Glatz Andrew C, Ligon R Allen, Gartenberg Ari, Aggarwal Varun, Shashidharan Subhadra, McCracken Courtney E, Kelleman Michael S, Petit Christopher J,
Abstract
Patent ductus arteriosus (PDA) stenting is an accepted method for securing pulmonary blood flow in cyanotic neonates. In neonates with pulmonary atresia and single source ductal-dependent pulmonary blood flow (SSPBF), PDA stenting remains controversial. We sought to evaluate outcomes in neonates with SSPBF, comparing PDA stenting and surgical Blalock-Taussig shunt (BTS). Neonates with SSPBF who underwent PDA stenting or BTS at the four centers of the Congenital Catheterization Research Collaborative from January 2008 to December 2015 were retrospectively reviewed. Reintervention on the BTS or PDA stent prior to planned surgical repair served as the primary endpoint. Additional analyses of peri-procedural complications, interventions, and pulmonary artery growth were performed. A propensity score was utilized to adjust for differences in factors. Thirty-five patients with PDA stents and 156 patients with BTS were included. The cohorts had similar baseline characteristics, procedural complications, and mortality. Interstage reintervention rates were higher in the PDA stent cohort (48.6% vs. 15.4%, p?0.001).
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Extracorporeal Life Support for Respiratory Failure in Patients With Electronic Cigarette or Vaping Product Use-Associated Lung Injury.
Crit Care Med2021 Sep;():. doi: 10.1097/CCM.0000000000005299.
Gupta Vikas S, Hayes Don, Hsu Stephanie C, Tonna Joseph E, Rycus Peter T, Bridges Brian C, Diaban Fatima, Bosma Karen J, Bhatt Jayesh M, Sakla Nicole M, Han Jason J, Bermudez Christian A, Manetta Frank, Garcia Elisa I, Harting Matthew T,
Abstract
OBJECTIVES:
Electronic cigarette or vaping product use-associated lung injury is a clinical entity that can lead to respiratory failure and death. Despite the severity of electronic cigarette or vaping product use-associated lung injury, the role of extracorporeal life support in its management remains unclear. Our objective was to describe the clinical characteristics and outcomes of patients with electronic cigarette or vaping product use-associated lung injury who received extracorporeal life support.
DESIGN:
We performed a retrospective review of records of electronic cigarette or vaping product use-associated lung injury patients who received extracorporeal life support. Standardized data were collected via direct contact with extracorporeal life support centers. Data regarding presentation, ventilatory management, extracorporeal life support details, and outcome were analyzed.
SETTING:
This was a multi-institutional, international case series with patients from 10 different institutions in three different countries.
PATIENTS:
Patients who met criteria for confirmed electronic cigarette or vaping product use-associated lung injury (based on previously reported diagnostic criteria) and were placed on extracorporeal life support were included. Patients were identified via literature review and by direct contact with extracorporeal life support centers.
MEASUREMENTS AND MAIN RESULTS:
Data were collected for 14 patients ranging from 16 to 45 years old. All had confirmed vape use within 3 months of presentation. Nicotine was the most commonly used vaping product. All patients had respiratory symptoms and radiographic evidence of bilateral pulmonary opacities. IV antibiotics and corticosteroids were universally initiated. Patients were intubated for 1.9 days (range, 0-6) prior to extracorporeal life support initiation. Poor oxygenation and ventilation were the most common indications for extracorporeal life support. Five patients showed evidence of ventricular dysfunction on echocardiography. Thirteen patients (93%) were placed on venovenous extracorporeal life support, and one patient required multiple rounds of extracorporeal life support. Total extracorporeal life support duration ranged from 2 to 37 days. Thirteen patients survived to hospital discharge; one patient died of septic shock.
CONCLUSIONS:
Electronic cigarette or vaping product use-associated lung injury can cause refractory respiratory failure and hypoxemia. These data suggest that venovenous extracorporeal life support can be an effective treatment option for profound, refractory respiratory failure secondary to electronic cigarette or vaping product use-associated lung injury.
Copyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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Exercise intervention decreases acute and late doxorubicin-induced cardiotoxicity.
Cancer Med2021 Sep;():. doi: 10.1002/cam4.4283.
Wang Fei, Chandra Joya, Kleinerman Eugenie S,
Abstract
BACKGROUND:
Doxorubicin (Dox) is one of the most effective chemotherapy agents used to treat adolescent and young adult sarcoma patients. Unfortunately, Dox causes cardiotoxicities that compromise long-term survival. We investigated whether exercise prevented cardiotoxicity and increased survival following myocardial infarction.
METHODS:
Juvenile mice received Dox, Dox + exercise (Exer), Dox then exercise or were exercised during and after Dox. Mice were evaluated by echocardiography and histology immediately after therapy and 12 weeks later. Mice subjected to permanent ligation of the left anterior descending artery 90 days after therapy were assessed for survival at 45 and 100 days.
RESULTS:
Mice treated with Dox, but not Dox + Exer, had decreased ejection fraction (EF) and fractional shortening (FS) immediately after Dox therapy, which continued to deteriorate over 12 weeks with the development of diastolic failure and fibrosis. Acute Dox-induced cardiotoxicity was documented by induction of autophagy and abnormal mitochondria and vascular architecture with decreased pericytes. These abnormalities persisted 12 weeks after therapy. These acute and late changes were not seen in the Dox + Exer group. Initiating exercise after Dox therapy promoted recovery of EF and FS with no functional or histologic evidence of Dox-induced damage 12 weeks after therapy. Survival rates at 100 days after MI were 67% for control mice, 22% for mice that received Dox alone, and 56% for mice that received Dox + Exer.
CONCLUSIONS:
Exercise inhibited both early and late Dox-induced cardiotoxicity and increased recovery from an ischemic event. Exercise interventions have the potential to decrease Dox-induced cardiac morbidity.
© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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An "occlusive thrombosis-on-a-chip" microfluidic device for investigating the effect of anti-thrombotic drugs.
Lab Chip2021 Sep;():. doi: 10.1039/d1lc00347j.
Berry Jess, Peaudecerf François J, Masters Nicole A, Neeves Keith B, Goldstein Raymond E, Harper Matthew T,
Abstract
Cardiovascular disease remains one of the world's leading causes of death. Myocardial infarction (heart attack) is triggered by occlusion of coronary arteries by platelet-rich thrombi (clots). The development of new anti-platelet drugs to prevent myocardial infarction continues to be an active area of research and is dependent on accurately modelling the process of clot formation. Occlusive thrombi can be generated in a range of species, but these models are limited by variability and lack of relevance to human disease. Although models using human blood can overcome species-specific differences and improve translatability, many models do not generate occlusive thrombi. In those models that do achieve occlusion, time to occlusion is difficult to measure in an unbiased and objective manner. In this study we developed a simple and robust approach to determine occlusion time of a novel microfluidic assay. This highlighted the potential for occlusion to occur in thrombosis microfluidic devices through off-site coagulation, obscuring the effect of anti-platelet drugs. We therefore designed a novel occlusive thrombosis-on-a-chip microfluidic device that reliably generates occlusive thrombi at arterial shear rates by quenching downstream coagulation. We further validated our device and methods by using the approved anti-platelet drug, eptifibatide, recording a significant difference in the "time to occlude" in treated devices compared to control conditions. These results demonstrate that this device can be used to monitor the effect of antithrombotic drugs on time to occlude, and, for the first time, delivers this essential data in an unbiased and objective manner.
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miR-145 transgenic mice develop cardiopulmonary complications leading to postnatal death.
Physiol Rep2021 Sep;9(17):e15013. doi: 10.14814/phy2.15013.
Thomas Shelby, Manivannan Sathiyanarayanan, Sawant Dwitiya, Kodigepalli Karthik M, Garg Vidu, Conway Simon J, Lilly Brenda,
Abstract
BACKGROUND:
Both downregulation and elevation of microRNA miR-145 has been linked to an array of cardiopulmonary phenotypes, and a host of studies suggest that it is an important contributor in governing the differentiation of cardiac and vascular smooth muscle cell types.
METHODS AND RESULTS:
To better understand the role of elevated miR-145 in utero within the cardiopulmonary system, we utilized a transgene to overexpress miR-145 embryonically in mice and examined the consequences of this lineage-restricted enhanced expression. Overexpression of miR-145 has detrimental effects that manifest after birth as overexpressor mice are unable to survive beyond postnatal day 18. The miR-145 expressing mice exhibit respiratory distress and fail to thrive. Gross analysis revealed an enlarged right ventricle, and pulmonary dysplasia with vascular hypertrophy. Single cell sequencing of RNA derived from lungs of control and miR-145 transgenic mice demonstrated that miR-145 overexpression had global effects on the lung with an increase in immune cells and evidence of leukocyte extravasation associated with vascular inflammation.
CONCLUSIONS:
These data provide novel findings that demonstrate a pathological role for miR-145 in the cardiopulmonary system that extends beyond its normal function in governing smooth muscle differentiation.
© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.
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Calcium Chloride Infusions are Not Associated with Improved Outcomes in Neonates Undergoing Cardiac Operations.
Pediatr Cardiol2021 Sep;():. doi: 10.1007/s00246-021-02730-x.
Murray Laura E, Burchett Holly, Chowdhury Shahryar M, Haney A Lauren, Hassid Marc, Strelow Jacob R, Graham Eric M, Kavarana Minoo N, Buckley Jason R,
Abstract
Neonatal cardiac performance is dependent on calcium delivery to the myocardium. Little is known about the use and impact of calcium chloride infusions in neonates who undergo cardiac surgery. We hypothesized that the use of calcium chloride infusions would decrease the doses required of traditional inotropic and vasoactive medications by supporting cardiac output in this patient population. We performed a single-institution, retrospective, cohort study. All neonates (??30 days old) undergoing cardiac surgery from 06/01/2015 through 12/31/2018 were included. Patients were divided into two groups: those who received postoperative calcium chloride infusions (calcium group) and those who did not (control group). The primary outcome was the occurrence of a maximum Vasoactive Inotropic Score (VIS)?>?15 in the first 24 h following surgery. One hundred and thirty-five patients met inclusion criteria. Sixty-six patients received postoperative calcium infusions and 69 patients did not. Gestational age, weight at surgery, age at surgery, surgical complexity and cardiopulmonary bypass times were similar between groups. Forty-two (70%) patients receiving calcium had a postoperative maximum VIS?>?15 compared with 38 (55%) patients not on a calcium infusion (p?=?0.08). There were no differences in postoperative length of ventilation, time to enteral feeding, hospital LOS, or operative mortality between groups. Calcium chloride infusions in neonates who underwent cardiac surgery did not decrease exposure to other inotropic and vasoactive agents in the first 24 post-operative hours or improve patient outcomes.
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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The Heart of the Problem in Multisystem Inflammatory Syndrome in Children.
Med (N Y)2021 Sep;2(9):993-995. doi: 10.1016/j.medj.2021.08.008.
Boribong Brittany P, Arya Puneeta, Yonker Lael M,
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe, life-threatening, post-COVID-19 hyperinflammatory illness that is not yet fully understood. In this issue of , de Cevins et al. used a multi-parametric approach to define COVID-19-related disease, specifically identifying a molecular signature of the most severe form of COVID-19-related illness: MIS-C with myocarditis..
© 2021 Elsevier Inc.
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Inhibition of ADAM10 ameliorates doxorubicin-induced cardiac remodeling by suppressing N-cadherin cleavage.
Open Life Sci2021 ;16(1):856-866. doi: 10.1515/biol-2021-0081.
Li Xiaoou, Pan Feng, He Bing, Fang Chengzhi,
Abstract
The present research was designed to examine the effects of disintegrin metalloproteinases 10 (ADAM10) on the doxorubicin (DOX)-induced dilated cardiomyopathy (DCM) and the mechanisms involved, with a focus on ADAM10-dependent cleavage of N-cadherin. The present study constructed recombinant lentiviral vectors expressing short hairpin RNA (shRNA) targeting the ADAM10 gene. H9C2 cells were treated with the recombinant lentivirus or GI254023 (an ADAM10 inhibitor). The expression level of N-cadherin and its C-terminal fragment1 (CTF1) was tested by western blotting and flow cytometry. The adhesion ability was analyzed using a plate adhesion model. Cardiac function and morphology were assessed in control and lentivirus-transfected rats with or without DOX treatment. The inhibition of ADAM10 activity significantly increased the expression of full-length N-cadherin on the cellular surface and reduced CTF1 generation and . The adhesion ability was also increased in ADAM10-knockdown H9C2 cells. Furthermore, DOX-induced myocardial dysfunction was ameliorated in rats transfected with ADAM10-shRNA lentivirus. These findings demonstrated that ADAM10 specifically cleaves N-cadherin in cardiomyocytes. ADAM10-induced N-cadherin cleavage results in changes in the adhesive behavior of cells. Therefore, ADAM10 may serve as a therapeutic target to reverse cardiac remodeling in DCM.
© 2021 Xiaoou Li et al., published by De Gruyter.
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PGC-1? promotes mitochondrial respiration and biogenesis during the differentiation of hiPSCs into cardiomyocytes.
Genes Dis2021 Nov;8(6):891-906. doi: 10.1016/j.gendis.2020.12.006.
Zhou Qin, Xu Hao, Yan Liang, Ye Liang, Zhang Xinyuan, Tan Bin, Yi Qin, Tian Jie, Zhu Jing,
Abstract
Although it is widely accepted that human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are readily available, robustly reproducible, and physiologically appropriate human cells for clinical applications and research in the cardiovascular field, hiPSC-CMs cultured retain an immature metabolic phenotype that limits their application, and little is known about the underlying molecular mechanism controlling mitochondrial metabolic maturation during human induced pluripotent stem cells (hiPSCs ) differentiation into cardiomyocytes. In this study, we found that peroxisome proliferator-activated receptor ? coactivator-1? (PGC-1?) played an important role in inducing mitochondrial biogenesis and establishing oxidative phosphorylation (OXPHOS) during the cardiac differentiation of hiPSCs. Knocking down PGC-1? by siRNA impaired mitochondrial respiration, while upregulating PGC-1? by ZLN005 promoted mitochondrial biosynthesis and function by regulating the expression of downstream genes involved in mitochondrial dynamics and oxidative metabolism in hiPSC-CMs. Furthermore, we found that estrogen-related receptor ? (ERR?) was required for the induction of PGC-1? stimulatory effects in hiPSC-CMs. These findings provide key insights into the molecular control of mitochondrial metabolism during cardiac differentiation and may be used to generate more metabolically mature cardiomyocytes for application.
© 2020 Chongqing Medical University. Production and hosting by Elsevier B.V.
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Correlation of elevated lamotrigine and levetiracetam serum/plasma levels with toxicity: A long-term retrospective review at an academic medical center.
Toxicol Rep2021 ;8():1592-1598. doi: 10.1016/j.toxrep.2021.08.005.
Wood Kelly E, Palmer Kendra L, Krasowski Matthew D,
Abstract
Lamotrigine and levetiracetam are widely used second-generation anti-epileptic drugs. Existing literature indicates that overdose of either drug is typically benign, but neurologic and cardiac toxicity can occur in some cases. In this retrospective study, we analyzed a large dataset of serum/plasma drug levels for lamotrigine and levetiracetam. The data covered 1,930 unique patients (5,046 levels) for lamotrigine and 2,451 patients (4,359 levels) for levetiracetam. We performed detailed chart review on all patients with one or more lamotrigine levels greater than 14.0 mg/L (293 unique patients) and all patients with one or more levetiracetam levels of 80 mg/L or higher (106 unique patients). No deaths directly attributable to lamotrigine or levetiracetam toxicity were reported. For cases with lamotrigine levels greater than 14.0 mg/L, the majority of patients were asymptomatic (55.3 %, n = 162). The most common presenting symptoms were ataxia (14.3 %, n = 42), seizures (14.0 %, n = 41), dizziness (11.9 %, n = 35), and altered mental status (11.6 %, n = 34). There were 12 overdoses (11 intentional) involving lamotrigine, all of which presented with either altered mental status (n = 8) or seizures (n = 4). The highest estimated dose reportedly ingested was 20 g. Cardiac toxicity was observed in two cases involving intentional overdose of lamotrigine. For patients with levetiracetam serum/plasma levels of 80 mg/L or higher, 48 patients (45.3 %) were asymptomatic. Symptomatic patients most commonly presented with seizures (31.1 %, n = 33) and altered mental status (15.1 %, n = 16), and none showed cardiac symptoms. There were only two cases involving intentional levetiracetam overdose, one of which presented with altered mental status after ingestion of 45 g and the other asymptomatic after ingestion of 6 g. Overall, our data is consistent with previous investigations that lamotrigine and levetiracetam toxicity most typically presents with neurologic symptoms and rarely cardiac arrhythmias. Approximately half of the patients with elevated lamotrigine or levetiracetam drug levels are asymptomatic.
© 2021 The Author(s).
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Calcinosis Cutis as an Unsuspecting Complication of Hyperkalemia Treatment.
Cureus2021 Aug;13(8):e17018. doi: 10.7759/cureus.17018.
Gresham Lauren N, Alallaf Jwan, Shah Jignesh,
Abstract
Calcinosis cutis is a known but rare complication from the extravasation of intravenous calcium preparations. Calcium gluconate is a commonly used medication to prevent cardiac arrhythmias in the setting of hyperkalemia and cardiac arrest during resuscitation and life support. Extravasation of calcium gluconate may result in skin necrosis and a bullous reaction in its most severe form, which should be promptly recognized so that treatment can be provided. Pediatric patients are more susceptible to this caustic effect while cases in adults are rare. We report the case of a patient who developed bullous skin lesions with skin necrosis and eschar formation after receiving intravenous calcium gluconate for the treatment of hyperkalemia. The patient required an extensive hospital stay and multiple surgical interventions. This case demonstrates that common medications such as calcium gluconate can lead to significant adverse effects that can be mitigated with proper administration and appropriate education about adverse events.
Copyright © 2021, Gresham et al.
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Intractable Vomiting in an 11-Month-Old Boy With Trisomy 21: A Case Report on Abnormal Calcium/Calcinosis/Creatinine in Down Syndrome.
Cureus2021 Aug;13(8):e16827. doi: 10.7759/cureus.16827.
Nguyen Minh, Litra Florentina, Kamil Ammar, Ergun-Longmire Berrin,
Abstract
Abnormal calcium/calcinosis/creatinine in Down syndrome (ABCD syndrome) is a very rare condition with no clear etiology. In this paper, we describe our clinical encounter with this disease. We report the case of an 11-month-old male infant with Down syndrome (DS) who presented to the hospital with intractable vomiting and decreased oral intake and urine output. The evaluation revealed an acute kidney injury (AKI) and hypercalcemia. Although his AKI improved with intravenous hydration, his hypercalcemia persisted. Extensive studies were notable for an elevated urinary excretion of calcium and bilateral medullary nephrocalcinosis seen on renal ultrasound (US). As a result, he was diagnosed with ABCD syndrome. Dietary calcium restriction was implemented. During his follow-up visit with a pediatric endocrinologist, his serum calcium was found to be normalized. To our knowledge, this is only the seventh case report on ABCD syndrome in the literature.
Copyright © 2021, Nguyen et al.
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Outcomes of Infants Undergoing Modified Blalock-Taussig Shunt Procedures in Oman: A retrospective study.
Sultan Qaboos Univ Med J2021 Aug;21(3):457-464. doi: 10.18295/squmj.8.2021.125.
Shaikh Samiuddin, Al-Mukhaini Khaloud S, Al-Rawahi Abdul Hakeem, Al-Dafie Omer,
Abstract
Objectives:
A modified Blalock-Taussig (mBT) shunt procedure is a common palliative surgery used to treat infants and children with cyanotic congenital heart disease (CCHD). This study aimed to report the outcomes of infants and children undergoing mBT shunt procedures in Oman. In addition, risk factors associated with early mortality, inter-stage mortality and reintervention were assessed.
Methods:
This retrospective cohort study was conducted from January 2016 to December 2018 at the National Heart Centre, Muscat, Oman. All paediatric patients with CCHD undergoing mBT shunt procedures as a primary palliative procedure during this period were included. Data were retrieved from electronic hospital records. Kaplan-Meier survival curves were used to describe overall survival.
Results:
A total of 50 infants and children were included in this study. The in-hospital mortality and interstage mortality rates were 10% and 6.7%, respectively. Preoperative mechanical ventilation (odds ratio [OR] = 3.00, 95% confidence interval [CI]: 1.98-4.76; = 0.007) and cardiopulmonary bypass (OR = 4.09, 95% CI: 2.44-6.85; = 0.002) were significant risk factors for early mortality. In-hospital and interval surgical reintervention rates were 12% and 13.3%, respectively. Following the primary shunt procedure, the median time to second-stage surgery was 15.5 months (range: 5.0-34.0 months).
Conclusion:
The findings of this study support those reported in international research regarding the risks associated with mBT shunt surgeries. In particular, preoperative mechanical ventilation and cardiopulmonary bypass were significant risk factors for early mortality.
© Copyright 2021, Sultan Qaboos University Medical Journal, All Rights Reserved.
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Plasma Metabolomic Profiles in Recovered COVID-19 Patients without Previous Underlying Diseases 3 Months After Discharge.
J Inflamm Res2021 ;14():4485-4501. doi: 10.2147/JIR.S325853.
Zhang Shujing, Luo Ping, Xu Juanjuan, Yang Lian, Ma Pei, Tan Xueyun, Chen Qing, Zhou Mei, Song Siwei, Xia Hui, Wang Sufei, Ma Yanling, Yang Fan, Liu Yu, Li Yumei, Ma Guanzhou, Wang Zhihui, Duan Yanran, Jin Yang,
Abstract
Background:
It remains unclear whether discharged COVID-19 patients have fully recovered from severe complications, including the differences in the post-infection metabolomic profiles of patients with different disease severities.
Methods:
COVID-19-recovered patients, who had no previous underlying diseases and were discharged from Wuhan Union Hospital for 3 months, and matched healthy controls (HCs) were recruited in this prospective cohort study. We examined the blood biochemical indicators, cytokines, lung computed tomography scans, including 39 HCs, 18 recovered asymptomatic (RAs), 34 recovered moderate (RMs), and 44 recovered severe/ critical patients (RCs). A liquid chromatography-mass spectrometry-based metabolomics approach was employed to profile the global metabolites of fasting plasma of these participants.
Results:
Clinical data and metabolomic profiles suggested that RAs recovered well, but some clinical indicators and plasma metabolites in RMs and RCs were still abnormal as compared with HCs, such as decreased taurine, succinic acid, hippuric acid, some indoles, and lipid species. The disturbed metabolic pathway mainly involved the tricarboxylic cycle, purine, and glycerophospholipid metabolism. Moreover, metabolite alterations differ between RMs and RCs when compared with HCs. Correlation analysis revealed that many differential metabolites were closely associated with inflammation and the renal, pulmonary, heart, hepatic, and coagulation system functions.
Conclusion:
We uncovered metabolite clusters pathologically relevant to the recovery state in discharged COVID-19 patients which may provide new insights into the pathogenesis of potential organ damage in recovered patients.
© 2021 Zhang et al.
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Correction to: Rare variants in KDR, encoding VEGF Receptor 2, are associated with tetralogy of Fallot.
Genet Med2021 Sep;():. doi: 10.1038/s41436-021-01279-7.
?kori?-Milosavljevi? Doris, Lahrouchi Najim, Bosada Fernanda M, Dombrowsky Gregor, Williams Simon G, Lesurf Robert, Tjong Fleur V Y, Walsh Roddy, El Bouchikhi Ihssane, Breckpot Jeroen, Audain Enrique, Ilgun Aho, Beekman Leander, Ratbi Ilham, Strong Alanna, Muenke Maximilian, Heide Solveig, Muir Alison M, Hababa Mariam, Cross Laura, Zhou Dihong, Pastinen Tomi, , Zackai Elaine, Atmani Samir, Ouldim Karim, Adadi Najlae, Steindl Katharina, Rauch Anita, Brook David, Wilsdon Anna, Kuipers Irene, Blom Nico A, Mulder Barbara J, Mefford Heather C, Keren Boris, Joset Pascal, Kruszka Paul, Thiffault Isabelle, Sheppard Sarah E, Roberts Amy, Lodder Elisabeth M, Keavney Bernard D, Clur Sally-Ann B, Mital Seema, Hitz Marc-Philip, Christoffels Vincent M, Postma Alex V, Bezzina Connie R,
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