Internal and emergency medicine
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Pacemaker implantation can be complicated by ventricular perforation. We present a case of diaphragmatic stimulation induced by right ventricular pacemaker lead perforation.
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Observational Study
New indices of arterial stiffness correlate with disease severity and mid-term prognosis in acute decompensated heart failure.
Arterial stiffness has been implicated in pathophysiology of heart failure (HF) since it is involved in the ventricular-vascular coupling. Recently, new indices obtained by a cuff oscillometric technique, the arterial velocity pulse index (AVI) for the stiffness of central arteries and the arterial pressure volume index (API) for the stiffness of peripheral arteries have been developed and validated. However, the AVI and API measurement has not been attempted in HF population. ⋯ Apart from the level of NT-proBNP, the AVI at discharge of ≥ 26 showed a trend of being associated with the composite outcome (HR 2.747, 95% CI 1.411-5.349, P < 0.001 for univariate analysis; HR 1.864, 95% CI 0.892-3.893, P = 0.09761 for multivariate analysis). New noninvasive arterial stiffness indices as the AVI and API reflected severity of illness and midterm prognosis in admitted HF patients. Further studies are warranted for understanding its mechanisms and developing clinical applications.
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Intracranial bruits (ICB) are faint, high-pitched, and mostly heard on the orbit in the systolic phase of the cardiovascular cycle. This report discusses a case of Listeria monocytogenes meningitis in a 17-month-old male patient in whom ICB were auscultated. ICB is thought to be caused by compression of blood vessels due to increased intracranial pressure and may serve as an additional sign supporting the diagnosis of meningitis. The present report contains video data on the ICB.
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The diffusion of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) worldwide prompted the World Health Organization to declare the status of pandemic. The molecular diagnosis of SARS-CoV-2 infection is based on the detection of viral RNA on different biological specimens. Unfortunately, the test may require several hours to be performed. ⋯ We observed a prevalence of SARS-CoV-2 infection of 74.7%. In this setting, the positive and negative predicted values were 88.6% (95% CI 84.4-92.0) and 73.3% (95% CI 62.6-82.2%), respectively. Lung POCUS is a sensitive first-line screening tool for ED patients presenting with symptoms suggestive of SARS-CoV-2 infection.