Abhishek Sawant

Neutrophil to lymphocyte ratio predicts short and long term mortality following revascularization therapy for ST elevation myocardial infarction

BACKGROUNDnSeveral inflammation biomarkers have been implicated in the pathogenesis and prognosis of acute coronary syndromes. However, the prognostic role of the neutrophil-lymphocyte white cell interactive response to myocardial injury in predicting short- and long-term mortality after ST elevation myocardial infarction (STEMI) remains poorly defined.nnnMETHODSnWe evaluated 250 consecutive STEMI patients presenting acutely for revascularization to our tertiary care center over 1 year. Patients with acute sepsis, trauma, recent surgery, autoimmune diseases, or underlying malignancy were excluded. Data gathered included demographics, clinical presentation, leukocyte markers, electrocardiograms, evaluations, therapy,major adverse cardiac events, and all-cause mortality.nnnRESULTSnMean age was 62 ± 15 years, 70.4% of subjects were males while majority (49.4%) were Caucasians. Mean duration of follow-up was 571 ± 291 days (median 730 days). Univariate analysis of several inflammatory biomarkers including C-reactive protein, revealed white cell count (OR = 1.09, p < 0.001) and neutrophil to lymphocyte ratio (NLR) (OR = 1.05, p = 0.011) as predictors of short- and long-term mortality; but not mean neutrophil count (OR = 1.04, p = 0.055) or lymphocyte count alone (OR = 0.96, p = 0.551). Multivariate analysis using backward stepwise regression revealed NLR (OR = 2.64, p = 0.026), female gender (OR = 5.35, p < 0.001), cerebrovascular accident history (OR = 3.36, p = 0.023), low glomerular filtration rate (OR = 0.98, p = 0.012) and cardiac arrest on admission (OR = 17.43, p < 0.001) as robust independent predictors of long-term mortality. NLR was divided into two sub-groups based on an optimal cut off value of 7.4. This provided the best discriminatory cut off point for predicting adverse mortality outcome. Both short-term (≤ 30 days) and long-term (≤ 2 years) mortality were predicted with Kaplan-Meier survival curve separation best stratified by a NLR cut off value of 7.4.nnnCONCLUSIONSnNLR based on an optimal cut off value of 7.4, was an excellent predictor of short- and long-term survival in patients with revascularized STEMI and warrants larger scale multi-center prospective evaluation, as a prognostic indicator. NLR offers improved prognostic capacity when combined with conventional clinical scoring systems, such as the Thrombolysis In Myocardial Infarction risk score.

Increased Length of Stay and Costs Associated with Inpatient Management of Vascular Access Failures

The creation and maintenance of vascular access for hemodialysis patients is responsible for a significant amount of morbidity and hospital expenses which continue to escalate with increasing population of ESRD patients. A retrospective review of patient charts were performed from 2008 to May 2011 at an academic tertiary care center who had a diagnosis of vascular access failure based on ICD 9 coding. Data regarding demographic information, length of stay (LOS), source of insurance, hospital expenses, and discharge status were obtained. Based on strict inclusion criteria we identified 172 total patients. The mean age among all patients was 60.53u2003±u200315.35u2003years and the majority of patients were Hispanic (nu2003=u200381). The Mean LOS was 5.30u2003±u20034.64u2003days. Mean hospital costs were 41,896u2003± 20,318u2003US

Intrapulmonary cystic teratoma mimicking malignant pulmonary neoplasm.

. Patients admitted for tunneled dialysis placement had greater length of stay (p‐valueu2003=u20030.011) as did patients with hypertension (p‐valueu2003=u20030.030). Hospital expenses were significantly higher for patients admitted for arterio‐venous fistula complications (55,456u2003±u200323,779u2003US

Right heart failure caused by metastatic renal cell carcinoma masquerading as an obstructive cardiac tumour

) compared with admissions for catheter or dialysis graft related complications (p‐valueu2003=u20030.004). Patients on Medicare had significantly lower length of stay (3.98u2003±u20033.32 days) compared with patients with Medicare/Medical (6.59u2003±u20035.69u2003days), p‐valueu2003=u20030.047. Inpatient management of vascular access failure is associated with increased length of stay, and significant hospital expenses. Timely referral to vascular access centers can prevent unnecessary hospitalizations and provide cost‐saving benefits.

Hemodynamic durability of transcatheter aortic valves using the updated Valve Academic Research Consortium-2 criteria

Benign cystic teratoma of lung is an extremely rare tumour, which was first described in literature by Mohr in 1839. Intrapulmonary teratoma is thought to be a derivative of the third endo-dermal pharyngeal pouch, which is an anlage of the thymus. The authors present a rare case of mature cystic teratoma in a young male involving the right upper lobe of the lung. Diagnosis is often missed and patients are treated for various infectious conditions. Treatment is complete resection for both benign and malignant teratomas and carries excellent prognosis. Benign cystic teratoma, if not excised may cause grave complications like life-threatening haemoptysis or malignant transformation with metastatic disease.

Alcaligenes xylosoxidans endocarditis of a prosthetic valve and pacemaker in a 62-year-old woman.

We present a rare case of renal cell carcinoma (RCC) in a 58-year-old Hispanic woman presenting with progressive shortness of breath of 2u2005months duration. Physical examination was remarkable for jugular venous distension, pedal oedema and left flank fullness. An initial transthoracic echocardiogram revealed a large, greater than 4×3u2005cm solid mass extending from the inferior vena cava (IVC) into the right atrium (figure 1). Subsequently, a 64-slice contrast-enhanced axial helical CT scan of the chest, abdomen and pelvis revealed a very large lobulated heterogeneously enhancing mass …

PROGNOSTIC VALUE OF FRONTAL QRS-T ANGLE IN PREDICTING SURVIVAL AFTER PRIMARY PERCUTANEOUS CORONARY REVASCULARISATION/CORONARY ARTERY BYPASS GRAFTING FOR STEMI

We investigated the hemodynamic durability of the transcatheter aortic valves (TAVs) using the updated Valve Academic Research Consortium‐2 (VARC‐2) criteria.