Mohamed Ayan

Hand ischemia after transradial coronary angiography: resulting in right ring finger amputation.

Critical hand ischemia is an extremely rare and serious complication of transradial coronary angiography. It is almost always associated with radial artery occlusion. Early recognition and involvement of vascular surgery is imperative for optimal management. Up to our knowledge, there have been only 5 cases reported in the medical literature. Herein, we describe a case of an 81-year-old male who had undergone transradial coronary intervention complicated by critical hand ischemia requiring amputation of the right 4th finger.

Acute Amiodarone Pulmonary Toxicity after Drug Holiday: A Case Report and Review of the Literature

Amiodarone is reported to cause a wide continuum of serious clinical effects. It is often challenging to detect Amiodarone-induced pulmonary toxicity (AIPT). Typically, the diagnosis is made based on the clinical settings and may be supported by histopathology results, if available. We describe a 57-year-old patient who developed severe rapidly progressive respiratory failure secondary to AIPT with acute bilateral infiltrates and nodular opacities on chest imaging. Interestingly, Amiodarone was discontinued 3 weeks prior to his presentation. He had normal cardiac filling pressures confirmed by echocardiography. To our knowledge, this is the first case of isolated acute lung injury induced by Amiodarone, three weeks after therapy cessation, with adequate clinical improvement after supportive management and high dose steroid therapy.

Meta-analysis of Randomized Controlled Trials on Patent Foramen Ovale Closure Versus Medical Therapy for Secondary Prevention of Cryptogenic Stroke

The optimal management of patients with cryptogenic stroke (CS) and patent foramen ovale (PFO) remains controversial. We conducted a meta-analysis to assess the effect of PFO closure for secondary prevention of stroke on patients with CS. We searched the literature for randomized control trials assessing the recurrence of stroke after PFO closure compared with medical therapy (antiplatelet and/or anticoagulation). Five randomized control trials with a total of 3,440 patients were included. The mean age was 45.2 ± 9.7 years and follow-up duration ranged from 2.0 to 5.9 years. PFO closure significantly reduced the risk of stroke compared with the medical therapy (2.8% vs 5.8%; relative risk [RR] 0.48, confidence interval [CI] 0.27 to 0.87, p = 0.01, I2 = 56%). The number needed to treat for stroke prevention was 10.5. PFO closure was associated with an increased risk of atrial fibrillation compared with medical therapy (4.2% vs 0.7%; RR 4.55, CI 2.16 to 9.6, p = 0.0001, I2 = 25%). There was no significant difference in all-cause mortality (RR 1.33, CI 0.56 to 3.16, p = 0.52, I2 = 0%), as well as no difference in bleeding risk between the 2 groups (RR 0.94, CI 0.49 to 1.83, p = 0.86, I2 = 29%). In conclusion, our meta-analysis demonstrates that PFO closure is associated with significantly lower risk of recurrent stroke in patients with PFO and CS compared with medical therapy. However, atrial fibrillation was more common among closure patients.

Infective endocarditis caused by Klebsiella oxytoca in an intravenous drug user with cancer

Infective endocarditis caused by Klebsiella species is rare, with most isolates being K. pneumoniae. We report the case of a 24-year-old intravenous drug user with newly diagnosed seminoma who developed K. oxytoca endocarditis. In addition to having K. oxytoca isolated from blood culture, cultures of that species were obtained from a retroperitoneal metastasis found on original presentation.

Meta‐analysis of Randomized Controlled Trials on Atrial Fibrillation Ablation in Patients with Heart Failure with Reduced Ejection Fraction

The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF).

Multiple admissions to the coronary care unit due to falsely elevated cardiac troponin

ABSTRACT The measurement of cardiac troponin, released from injured cardiomyocytes, is of paramount importance in the diagnosis of acute myocardial infarction. Elevated troponin can be encountered, however, in patients with cardiomyopathy, significant cardiac arrhythmias, vasculitis, right-sided heart strain, critical systemic illnesses, stroke, drug toxicity (such as Adriamycin), poisons (such as snake venoms), renal failure, seizure, and rhabdomyolysis. If the clinical picture is not consistent with any of these causes, a false-positive result should be considered. We herein describe a 94-year-old man with a prior history of coronary artery disease who presented with altered mental status and was found to have a persistently high troponin level resulting in three admissions to the coronary care unit for various noncardiac complaints. Because of discordance between clinical and laboratory data, immunological interference due to heterophile antibodies in the locally used assay (AccuTnI+3, Beckman Coulter) was suspected. The same serum sample tested on a different assay (Elecsys Troponin I Assay, Roche) resulted in an undetectable cardiac troponin I level, thus confirming the diagnosis.

EFFICACY OF ANTICOAGULATION IN PREVENTING THROMBOEMBOLISM AFTER BIO PROSTHETIC AORTIC VALVE REPLACEMENT: A META-ANALYSIS

The efficacy of oral anticoagulation (AC) after bio prosthetic aortic valve replacement (BPAVR) remains unclear. Current guidelines recommend AC for first three months after BPAVR, but there is significant variation in clinical practice. We performed a meta-analysis of studies comparing AC to

Early Versus Conventional Atropine use in Dobutamine Stress Testing: A Meta Analysis

Atropine is widely used in dobutamine stress testing (DST) to increase heart rate and improve diagnostic yield. Several studies have compared conventional (after achieving dobutamine dose of 30 mcg/kg/min) versus early use of atropine during DST, the results are mixed. A systematic review of the

Case of acquired or pseudo-Pelger-Huët anomaly

Pelger-Huët anomaly (PHA) is a rare benign autosomal-dominant anomaly with an incidence of ∼1 in 6000. It does not cause neutrophilia, but it can cause a false increase in band forms. It should be differentiated from acquired or pseudo-Pelger-Huët anomaly (PPHA), which has similar morphology, however; it is associated with different pathological states like Myelodysplastic syndrome, as well as with certain infections and drugs. We report a case of a 67-year-old Caucasian gentleman with past medical history of rheumatoid arthritis, type II diabetes mellitus and hypothyroidism, who presented with 1 day history of fever (101°F) and night sweats. Medications include ibuprofen, methotrexate, hydroxychloroquine and levothyroxine. Patient denied any other symptoms. His work-up showed normal WBC count (8.6) and increase in bands (24%). The patient was admitted for further evaluation. During the next 2 days, the patient did not have any fever or any new symptoms. Peripheral blood smear was done as part of his work-up for bandemia, showed findings suggestive of PHA. Ibuprofen was discontinued. Follow-up few weeks later showed normal blood smear. Diagnosis of PPHA was made. The presented case showed that we should think of PHA\PPHA in any case with normal total WBC count and significant shift to the lift with no apparent explanation. Looking at smears directly under the microscopes is crucial to make diagnosis.

HEAVY HEART WITH LIGHT PROTEINS: AN INSIGHT

case: A 74-year-old male presented with 8 months of progressive exercise intolerance and bilateral leg swelling. Medical history included old anterior MI with previous stenting, hypertension, and dyslipidemia. A stress echocardiography was negative a year ago. No prior history of valvular dysfunction, heart failure or significant arrhythmias. His medications included: Aspirin, Atorvastatin, Captopril and Metoprolol. Physical examination showed controlled blood pressure with signs of heart failure: basal lung crackles, elevated jugular venous pressure, bilateral leg edema and S4 gallop.