I. Kaplanis, G. Michas, Sofia Arapi, George Karvelas, A. Trikas
Iodinated contrast media are of paramount importance in the field of modern interventional cardiology. Although iodinated contrast media have an overall good safety profile, severe or life-threatening reactions can also occur. Herein, we report the case of a 74-year-old female patient who presented with non-ST elevation myocardial infarction and underwent a successful percutaneous coronary intervention. Shortly after the procedure the patient developed the full-blown clinical picture of an iodinated contrast media adverse reaction that was timely recognized and treated. The two types of adverse reactions to iodinated contrast media during a percutaneous coronary intervention are being discussed. A high level of clinical suspicion is warranted to ensure prompt recognition and appropriate management. I n T R o d u C T I o n Organic radiographic iodinated contrast media (ICM) have been among the most commonly used agents in the modern era of medicine and have become of paramount importance in the field of interventional cardiology. Although ICM have a good safety record, with usually mild and self-limited adverse effects, severe or life-threatening reactions can also occur. Therefore, physicians should be able to immediately recognize and treat the severe reactions of ICM.
{"title":"The adverse reactions to contrast media during percutaneous coronary interventions; keep in mind the non-idiosyncratic reactions.","authors":"I. Kaplanis, G. Michas, Sofia Arapi, George Karvelas, A. Trikas","doi":"10.2015/HC.V14I1.848","DOIUrl":"https://doi.org/10.2015/HC.V14I1.848","url":null,"abstract":"Iodinated contrast media are of paramount importance in the field of modern interventional cardiology. Although iodinated contrast media have an overall good safety profile, severe or life-threatening reactions can also occur. Herein, we report the case of a 74-year-old female patient who presented with non-ST elevation myocardial infarction and underwent a successful percutaneous coronary intervention. Shortly after the procedure the patient developed the full-blown clinical picture of an iodinated contrast media adverse reaction that was timely recognized and treated. The two types of adverse reactions to iodinated contrast media during a percutaneous coronary intervention are being discussed. A high level of clinical suspicion is warranted to ensure prompt recognition and appropriate management. I n T R o d u C T I o n Organic radiographic iodinated contrast media (ICM) have been among the most commonly used agents in the modern era of medicine and have become of paramount importance in the field of interventional cardiology. Although ICM have a good safety record, with usually mild and self-limited adverse effects, severe or life-threatening reactions can also occur. Therefore, physicians should be able to immediately recognize and treat the severe reactions of ICM.","PeriodicalId":91266,"journal":{"name":"Hospital chronicles = Nosokomeiaka chronika","volume":"14 1","pages":"24-26"},"PeriodicalIF":0.0,"publicationDate":"2019-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43623519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndrome”), use of pentoxifylline is recommended.
{"title":"Alcoholic Liver Disease from the Clinical Point of View","authors":"V. Sevastianos, S. Dourakis","doi":"10.2015/hc.v11i4.756","DOIUrl":"https://doi.org/10.2015/hc.v11i4.756","url":null,"abstract":"Liver disease is responsible for more than 55% of deaths resulting from alcohol abuse, while the prevalence of alcoholic liver disease (ALD) is closely correlated with per capita alcohol consumption. ALD represents a wide range of histological changes ranging from simple steatosis to heavier forms of liver injury including alcoholic hepatitis, cirrhosis and/or concurrent development of hepatocellular carcinoma. These alterations of the hepatic parenchyma do not necessarily reflect distinct stages of liver disease progression, but rather a continuum relating to histological changes that may be observed simultaneously in the same patient. The fact that only 35% of patients with heavy alcohol abuse develop advanced stages of liver disease, suggests that in the pathogenesis of ALD a number of other factors are involved that include gender, obesity, drinking patterns, dietary factors, non-sex-linked genetic factors and smoking. Also, long-term drinking can affect synergistically with hepatitis B or C and/or the human immunodeficiency virus, the non-alcoholic fatty liver disease and hepatic disorders such as hemochromatosis. The diagnosis of ALD is based on a combination of findings, including the history of significant alcohol consumption, the clinical evidence of the concomitant liver injury supported by the resultant histological, imaging and laboratory findings. A beneficial effect of alcoholic hepatitis treatment with corticosteroids is observed in patients with encephalopathy or with poor prognosis based on the various grading and prognostic systems of gravity, while the harmful effect is prominent in patients with milder disease, as they manifest an increased risk of infections compared with those not receiving corticosteroids. In patients with alcoholic hepatitis that cannot take corticosteroids for various reasons and in those with the onset of functional renal failure (“hepatorenal syndrome”), use of pentoxifylline is recommended.","PeriodicalId":91266,"journal":{"name":"Hospital chronicles = Nosokomeiaka chronika","volume":"11 1","pages":"200-210"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49517670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alzheimer’s disease (AD) is a chronic progressive disease, which accounts for 60% of all dementias. Sometimes 10-30% of AD cases have a more fulminant course, but this AD subtype is not the only cause of rapidly progressive dementia (RPD). There exists a variety of entities presenting as RPDs, a number of which are reversible or treatable. It is imperative that accurate and prompt diagnosis be made, since it is crucial for neuronal survival. Some of these rapidly progressive manifestations concern vascular, infectious, toxic-metabolic, autoimmune, metastatic-neoplastic, iatrogenic, neurodegenerative or systemic diseases, which can be arranged in a list using the mnemonic "VITAMINS". This review summarizes the major etiologies of RPDs. Differential diagnostic algorithms are also presented.
{"title":"Rapidly Progressive Dementia: Is it Alzheimer’s or not?","authors":"A. Mouzak","doi":"10.2015/HC.V11I4.706","DOIUrl":"https://doi.org/10.2015/HC.V11I4.706","url":null,"abstract":"Alzheimer’s disease (AD) is a chronic progressive disease, which accounts for 60% of all dementias. Sometimes 10-30% of AD cases have a more fulminant course, but this AD subtype is not the only cause of rapidly progressive dementia (RPD). There exists a variety of entities presenting as RPDs, a number of which are reversible or treatable. It is imperative that accurate and prompt diagnosis be made, since it is crucial for neuronal survival. Some of these rapidly progressive manifestations concern vascular, infectious, toxic-metabolic, autoimmune, metastatic-neoplastic, iatrogenic, neurodegenerative or systemic diseases, which can be arranged in a list using the mnemonic \"VITAMINS\". This review summarizes the major etiologies of RPDs. Differential diagnostic algorithms are also presented.","PeriodicalId":91266,"journal":{"name":"Hospital chronicles = Nosokomeiaka chronika","volume":"11 1","pages":"188-199"},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44598483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Sodium Nitroprusside has successfully been an excellent choice when considering a decrease in systemic vascular resistance in the critical care setting. However, reflex tachycardia and ventilation-perfusion mismatch are possible side effects of this agent. To maintaining cardiac output, cerebral perfusion pressure, and concurrently drop SVR, low-dose epinephrine or dopamine are viable options. The aim of this paper is to conduct dose-response simulations to identify the equivalent dopamine, epinephrine, and nitroprusside infusion doses to decrease the systemic vascular resistance by 20% and by 40% from baseline resting values. METHODS Three studies were identified in the literature with reported epinephrine, dopamine, and sodium nitroprusside infusion doses with corresponding systemic vascular resistance responses. Infusion doses were normalized to mcg/kg/min and SVR values were normalized and scaled to the percent decrease (%SVR) in SVR from baseline resting values. The original published studies were mathematically modeled and the Hill equation parameters used for further dose-response simulations of a virtual population. One-hundred patients were simulated various doses resulting in corresponding %SVR responses for each of the three drugs. RESULTS Equivalent infusion doses achieving in an approximate 20-25% decrease in SVR, from baseline, were identified for epinephrine, dopamine, and sodium nitroprusside. Moreover, equivalent infusion doses were identified for epinephrine and nitroprusside to decrease the SVR by 40% from baseline. CONCLUSION Even though sodium nitroprusside is traditionally used in decreasing SVR, low doses of dopamine or epinephrine are viable alternatives to patients with contraindications to nitroprusside infusions or who will require prolonged infusions to avoid toxicity. The multiple comparisons procedure-modeling approach is an excellent methodology for dose-finding exercises and has enabled identification of equivalent pharmacodynamic responses for epinephrine, dopamine, and sodium nitroprusside through mathematic simulations.
{"title":"The influences of nitric oxide, epinephrine, and dopamine on vascular tone: dose-response modeling and simulations.","authors":"A. Eugene","doi":"10.2015/HC.V11I1.736","DOIUrl":"https://doi.org/10.2015/HC.V11I1.736","url":null,"abstract":"INTRODUCTION\u0000Sodium Nitroprusside has successfully been an excellent choice when considering a decrease in systemic vascular resistance in the critical care setting. However, reflex tachycardia and ventilation-perfusion mismatch are possible side effects of this agent. To maintaining cardiac output, cerebral perfusion pressure, and concurrently drop SVR, low-dose epinephrine or dopamine are viable options. The aim of this paper is to conduct dose-response simulations to identify the equivalent dopamine, epinephrine, and nitroprusside infusion doses to decrease the systemic vascular resistance by 20% and by 40% from baseline resting values.\u0000\u0000\u0000METHODS\u0000Three studies were identified in the literature with reported epinephrine, dopamine, and sodium nitroprusside infusion doses with corresponding systemic vascular resistance responses. Infusion doses were normalized to mcg/kg/min and SVR values were normalized and scaled to the percent decrease (%SVR) in SVR from baseline resting values. The original published studies were mathematically modeled and the Hill equation parameters used for further dose-response simulations of a virtual population. One-hundred patients were simulated various doses resulting in corresponding %SVR responses for each of the three drugs.\u0000\u0000\u0000RESULTS\u0000Equivalent infusion doses achieving in an approximate 20-25% decrease in SVR, from baseline, were identified for epinephrine, dopamine, and sodium nitroprusside. Moreover, equivalent infusion doses were identified for epinephrine and nitroprusside to decrease the SVR by 40% from baseline.\u0000\u0000\u0000CONCLUSION\u0000Even though sodium nitroprusside is traditionally used in decreasing SVR, low doses of dopamine or epinephrine are viable alternatives to patients with contraindications to nitroprusside infusions or who will require prolonged infusions to avoid toxicity. The multiple comparisons procedure-modeling approach is an excellent methodology for dose-finding exercises and has enabled identification of equivalent pharmacodynamic responses for epinephrine, dopamine, and sodium nitroprusside through mathematic simulations.","PeriodicalId":91266,"journal":{"name":"Hospital chronicles = Nosokomeiaka chronika","volume":"35 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2016-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85511227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Eugene, J. Masiak, J. Kapica, M. Masiak, R. Weinshilboum
INTRODUCTION The purpose of this electrophysiological neuroimaging study was to provide a deeper mechanistic understanding of both olanzapine and risperidone pharmacodynamics relative to gender. In doing so, we age-matched 22 men and women and evaluated their resting-state EEG recordings and later used standard low resolution brain Electrotomography to visualize the differences in brain activity amongst the two patient groups. METHODS In this investigation, electroencephalogram (EEG) data were analyzed from male and female schizophrenia patients treated with either olanzapine or risperidone, both atypical antipsychotics, during their in-patient stay at the Department of Psychiatry. Twenty-two males and females were age-matched and EEG recordings were analyzed from 19 Ag/AgCl electrodes. Thirty-seconds of resting EEG were spectrally transformed in standardized low resolution electromagnetic tomography (sLORETA). 3D statistical non-paramentric maps for the sLORETA Global Field Power within each band were finally computed. RESULTS The results indicated that, relative to males patients, females schizophrenia patients had increased neuronal synchronization in delta frequency, slow-wave, EEG band located in the dorsolateral prefrontal cortex, within the middle frontal gyrus (t= -2.881, p < 0.03580). These findings suggest that females experience greater dopamine (D2) receptor and serotonin (5-HT2) receptor neuronal blockade relative to age-matched males. Further, our finding provided insight to the pharmacodynamics of second-generation antipsychotics olanzapine and risperidone. CONCLUSION When compared to male patients, female patients, suffering from schizophrenia, have D2 and 5-HT2 receptors that are blocked more readily than age-matched male schizophrenia patients. Clinically, this may translate into a quicker time to treatment-response in females as compared to male patients.
本电生理神经成像研究的目的是对奥氮平和利培酮的药效学与性别的关系提供更深层次的机制理解。在此过程中，我们对22名男性和女性进行了年龄匹配，并评估了他们的静息状态脑电图记录，随后使用标准的低分辨率脑电断层扫描来观察两组患者大脑活动的差异。方法分析精神分裂症患者在精神科接受非典型抗精神病药物奥氮平或利培酮治疗期间的脑电图数据。22名男性和女性年龄匹配，分析19个Ag/AgCl电极的脑电图记录。采用标准低分辨率电磁断层扫描(sLORETA)对30秒静息脑电图进行频谱转换。最后计算了sLORETA全球场强在各波段的三维统计非参数图。结果与男性相比，女性精神分裂症患者位于额叶中回背外侧前额皮质慢波δ频的神经元同步性明显增加(t= -2.881, p < 0.03580)。这些发现表明，与同龄男性相比，女性经历了更多的多巴胺(D2)受体和血清素(5-HT2)受体神经元阻断。此外，我们的发现为第二代抗精神病药物奥氮平和利培酮的药效学提供了见解。结论与男性相比，女性精神分裂症患者D2和5-HT2受体比同龄男性精神分裂症患者更容易被阻断。在临床上，这可能意味着与男性患者相比，女性患者的治疗反应时间更快。
{"title":"Electrophysiological Neuroimaging using sLORETA Comparing 22 Age Matched Male and Female Schizophrenia Patients.","authors":"A. Eugene, J. Masiak, J. Kapica, M. Masiak, R. Weinshilboum","doi":"10.2015/HC.V10I2.696","DOIUrl":"https://doi.org/10.2015/HC.V10I2.696","url":null,"abstract":"INTRODUCTION\u0000The purpose of this electrophysiological neuroimaging study was to provide a deeper mechanistic understanding of both olanzapine and risperidone pharmacodynamics relative to gender. In doing so, we age-matched 22 men and women and evaluated their resting-state EEG recordings and later used standard low resolution brain Electrotomography to visualize the differences in brain activity amongst the two patient groups.\u0000\u0000\u0000METHODS\u0000In this investigation, electroencephalogram (EEG) data were analyzed from male and female schizophrenia patients treated with either olanzapine or risperidone, both atypical antipsychotics, during their in-patient stay at the Department of Psychiatry. Twenty-two males and females were age-matched and EEG recordings were analyzed from 19 Ag/AgCl electrodes. Thirty-seconds of resting EEG were spectrally transformed in standardized low resolution electromagnetic tomography (sLORETA). 3D statistical non-paramentric maps for the sLORETA Global Field Power within each band were finally computed.\u0000\u0000\u0000RESULTS\u0000The results indicated that, relative to males patients, females schizophrenia patients had increased neuronal synchronization in delta frequency, slow-wave, EEG band located in the dorsolateral prefrontal cortex, within the middle frontal gyrus (t= -2.881, p < 0.03580). These findings suggest that females experience greater dopamine (D2) receptor and serotonin (5-HT2) receptor neuronal blockade relative to age-matched males. Further, our finding provided insight to the pharmacodynamics of second-generation antipsychotics olanzapine and risperidone.\u0000\u0000\u0000CONCLUSION\u0000When compared to male patients, female patients, suffering from schizophrenia, have D2 and 5-HT2 receptors that are blocked more readily than age-matched male schizophrenia patients. Clinically, this may translate into a quicker time to treatment-response in females as compared to male patients.","PeriodicalId":91266,"journal":{"name":"Hospital chronicles = Nosokomeiaka chronika","volume":"22 1","pages":"91-98"},"PeriodicalIF":0.0,"publicationDate":"2015-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87931038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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