BackgroundEarly diagnosis and risk-stratification among infective endocarditis (IE) patients are limited by poor microbiological yield and inadequate characterization of vegetations. A simple tool that can predict adverse outcomes in the early phase of management is required.AimTo study the prognostic value of C-reactive protein (CRP) levels at admission and its role in predicting various clinical outcomes.MethodsIn a prospective study of consecutive IE patients diagnosed by modified Duke’s criteria, we measured the peak levels of CRP and erythrocyte sedimentation rate (ESR) in the first 3 days of admission and correlated it with in-hospital mortality, six-month mortality, embolic phenomena and the need for urgent surgery. Predefined laboratory-microbiological sampling protocols and antibiotic-initiation protocols were followed. Receiver-operating-characteristics curves were generated to identify a reliable cut-off for CRP in predicting various outcomes.ResultsOut of 101 patients who were treated, 85 patients had ‘definite’ IE. Blood cultures were positive in 55% (n = 39); and Staphylococcus species was the most common organism. Major complications occurred in 74.1% (n = 63) and in-hospital mortality was 32.9% (n = 28). Mean ESR and CRP levels were 102 ± 31 mm/h and 51 ± 20 mg/l, respectively. In multivariable analysis, high CRP levels were independently predictive of mortality, major complications, embolic events and need for urgent surgery. A CRP >40 mg/l predicted adverse outcomes with a sensitivity of 73% and specificity of 99%.ConclusionThe study shows that baseline CRP level in the first 3 days of admission is a strong predictor of short term adverse outcomes in IE patients, and a useful marker for early risk stratification.
Objectives
To evaluate the safety and performance of the Hydra transcatheter aortic valve (THV) in the treatment of symptomatic severe aortic stenosis in patients at high or extreme surgical risk.
Background
The Hydra THV (Vascular Innovations Co. Ltd., Nonthaburi, Thailand) is a novel flexible repositionable self‐expanding system with supra‐annular bovine pericardial leaflets, available in three sizes, covering aortic annuli between 17 and 27 mm.
Methods
The GENESIS trial was a prospective, multi‐center, single‐arm, 6 month follow‐up study conducted in India. The primary performance endpoint was device success defined as per VARC‐II criteria at 30 days. The primary safety endpoint was all‐cause mortality at 30 days. All endpoints were adjudicated by an independent clinical events committee.
Results
Forty high‐risk patients (74.5 ± 6.7 years, 60% men; STS Score:5.6 ± 4.2%) were enrolled in 11 centres. Device success was achieved in 92.5%. The effective orifice area improved from 0.7 ± 0.2 to 2.3 ± 0.6 cm2 at 30 days and to 2.2 ± 0.7 cm2 at 6 months (p < .0001). Mean aortic valve gradient decreased from 53.5 ± 18.1 to 8.9 ± 4.9 mmHg at 30 days and to 7.6 ± 2.7 mmHg at 6 months (p < .0001). The rate of new permanent pacemaker implantation was 7.5% at 30 days, and no patient had more than mild paravalvular leak at 6 months. The 30 days and 6 month all‐cause mortality was 10.0 and 17.5%, cardiovascular mortality 7.5 and 7.5%, device‐related mortality 5.0 and 5.0%, respectively. No patients had stroke up to 6 months.
Conclusions
The GENESIS trial demonstrated high efficacy of the self‐expanding Hydra THV. The cardiovascular mortality rate of 7.5% may partly be explained by the inclusion of some centres with no or limited previous experience in transcatheter aortic valve implantation.
This article reports the accidental public radiation exposure in a scrap market in Delhi, India, on March 2010. The source, a gamma unit containing Cobalt-60 pencils, was improperly disposed of by a research institution in violation of national regulations for radiation protection and safety of radioactive sources. The unit was sold off to unsuspecting scrap dealers who dismantled the equipment. This event subsequently caused the most severe radiation accident reported in India to date, resulting in seven radiation injuries and one death. The clinical course of five of the patients treated at the All India Institute of Medical Sciences hospital, New Delhi, is summarised in this report. All five patients suffered from the haematological form of the acute radiation syndrome and local cutaneous radiation injury as well. While four patients exposed to doses between 0.6 and 2.8 Gy survived with intensive or supportive treatment, the patient with the highest exposure of 3.1 Gy died due to acute respiratory distress syndrome and multi-organ failure on Day 16 after hospitalisation. The incident highlights the current gaps in the knowledge, infrastructure and legislation in handling radioactive materials. Medical institutions need to formulate individualised triage and management guidelines to immediately respond to future public radiological accidents.
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