Low voltage electric shock resulting in myocarditis induced delayed death is a rarity and has not been reported so far, to the best of our knowledge. The definitive diagnosis is autopsy based as it has variable clinical presentations. We report such a case where in the histopathologic findings of myocarditis came as a surprise during microscopic evaluation of the autopsy sections in a case with an apparently normal heart on gross examination. The present case mandates a careful microscopic examination of autopsy sections in cases of electrocution.
Aims: The aim of this study is to show how the coagulation laboratory and clinical findings worked together in the management of a patient with hereditary thrombophilia and pulmonary embolism (PE) in terms of diagnosis, the choice of anticoagulation treatment and the duration of secondary thromboprophylaxis.
Study Design: A case report with the presentation of clinical and laboratory findings, treatment and long-term follow up of the patient.
Place and Duration of Study: Institute of Transfusion Medicine and University Clinics of Cardiology, St Cyril and Methodius University, Skopje, Macedonia in the period from February 2015 and December 2017.
Case Presentation: Computer tomography confirmed the diagnosis of PE in a 32-year-old man who was admitted to the cardiology emergency department with D-dimer level of 5980 ng/mL after an episode of syncope. After the initial anticoagulation with unfractionated heparin 30.000i.e./24 h, enoxaparin 80 mg/12 h and acenocoumarol were introduced. The therapeutic INR rang could not be achieved so the acenocoumarol was switched to rivaroxaban 2x15 mg/day. One year later the anticoagulation with rivaroxaban 20 mg/day was discontinued. Thrombophilia testing included: prothrombin (PTB), Factor V Leiden and methylene tetrahydrofolate reductase (MTHFR) C677T gene mutation, as well as antiphospholipid antibodies, antithrombin, protein C and S.
Results: The patient was homozygous for the PTB. His parents were heterozygous for the same mutation; his mother also being heterozygous for MTHFR C677T. His brother was compound heterozygote for PTB and MTHFR C677T and his sister was heterozygous for the PTB. Coagulation status monitoring showed hypercoagulability (APTT was 24-26 seconds) and increment of D-dimer (2100-2400 ng/ml) when rivaroxaban was discontinued and normal APTT (28-38 seconds) and D-dimer (< 500 ng/mL) when it was reintroduced.
Conclusion: According to the laboratory findings and also having in mind that this was a second episode of a thrombotic event, we decided for an extended secondary thromboprophylaxis. Although it sometimes implies that it will be continued life-long we consider worthwhile to apply the patient-oriented approach to the decision when and whether to terminate anticoagulation.
Introduction: This study aimed to know the incidence and factors associated with aneurysmal sac reduction (ASR) after endovascular aneurysm repair (EVAR) at 3 years of follow up in the Spanish population.
Material and Methods: This is a retrospective observational study. We analyzed all patients with abdominal aortic and aortoiliac aneurysms who underwent elective EVAR in our hospital between January 2007 and September 2015. We studied ASR incidence at 3 years of follow-up. ASR was defined as a reduction in sac diameter ≥ 5 mm. Multiple preoperative and postoperative variables were analyzed. We used chi2 and T student tests for statistical analysis. Kaplan-Meier survival analysis and actuarial analysis were performed.
Results: Three hundred one patients underwent EVAR. The majority was men (97.3%) with a mean age of 74 ± 8 years, and 77.4% were at high surgical risk according to the American Society of Anesthesiologists classification (ASA). There was an incidence of 51.6% ASR at 3 years of follow up. Patients under chronic anticoagulation had 60% ASR vs 50.5%, p = 0.489. An aortic neck> 20 mm in length was associated with 55.3% ASR vs 45.7%, p = 0.303. Patients with ASR were younger 71 ± 8 years vs 76 ± 6 years, (P = 0.001, 95% CI, -7-1.9). Type II endoleak was associated with lower ASR, 32.4% vs 60, 8%, p = 0.006. Overall survival at 6, 12, 24 and 36 months was 90%, 82%, 71% and 61%, respectively. Survival in patients with ASR was better than patients without ASR, p = 0.008.
Conclusions: ASR incidence after EVAR was high in our series and was associated with increased survival rate. The overall survival at medium term was good despite the high surgical risk of our series.
Background: Dyslipidemia is a major cardiovascular disease (CVD) risk factor with an increasing occurrence in sub-Saharan Africa.
Aim: To determine the distribution of elevated serum cholesterol and triglyceride levels, and assess the level of awareness of dyslipidemias in the general adult population of Ngaoundere, Cameroon.
Methodology: This was a community-based cross-sectional study conducted from February to December 2015 in Ngaoundere town. Following a three-stage sampling method, a total 932 participants of at least 20 years old were enrolled. Demographic data were collected, and body mass index (BMI), waist circumference, blood pressure, fasting blood glucose (FBG), serum total cholesterol (TC) and triglycerides (TG) were measured.
Results: The overall prevalence of raised cholesterol and triglyceride levels were 25.97% (n=242) and 5.26% (n=49) respectively. The overall mean concentrations of TC and TG were 207.30± 54.18 mg/dL and 105.49 ± 51.22 mg/dL respectively. The population’s level of awareness of dyslipidemias was recorded at 0.77% (n=2), and no participant was on lipid-lowering drugs. The 40-64 years (OR:2.21, P<0.001) and ≥ 60 years (OR:2.19, P=0.006) age ranges, abdominal obesity (OR:1.76, P=0.026) and hypertriglyceridemia (OR:4.53, P<0.001) were independently associated with hypercholesterolemia, while the age range 40-64 years (OR:2.11, P=0.027), hypertension (OR:2.38, P=0.011) and hypercholesterolemia (OR:4.63,P<0.001) were independently associated with hypertriglyceridemia.
Conclusion: The present study portrayed a high prevalence of elevated serum cholesterol level, a very low level of awareness and poor treatment coverage of dyslipidemias in the Ngaoundere population while reaffirming the relationships between advance age, abdominal obesity, hypertension and dyslipidemias.