Broad Spectrum Of Complications Research Articles

Abstract 4140198: Impact of Non-ST-segment elevation Myocardial Infarction on outcomes of Diabetic Ketoacidosis in Hospitalized Patients: A National Inpatient Sample Analysis

Introduction: Diabetes Mellitus (DM) has a broad spectrum of complications and is one of the leading 5 causes of hospital admissions in the US. Decompensated DM is associated with high mortality in hospitalized patients. Cardiac ischemia and related events are proposed to be increasingly prevalent in hospitalized patients with decompensated diabetes. Numerous studies and reports have suggested that elevation in troponin levels is associated with high mortality in such patients. Notably, there have only been a few studies that assessed the prevalence of NSTEMI (Non-ST segment elevation myocardial infarction) and its effect on outcomes in patients hospitalized with Diabetes ketoacidosis (DKA). Methods: We aimed to compare the outcomes of DKA in hospitalized adults (age >18 years) with NSTMI with those without NSTEMI using the National Inpatient Sample (NIS) database from 2018 to 2020. NIS is the largest publicly available all-payer inpatient care database in the United States, containing data on more than seven million hospital stays. Results: There were a total of 1113295 hospitalizations identified with a diagnosis of DKA. Of these, 9860 (0.88%) patients had NSTEMI. The mean age of this subpopulation was 38.71 years. Among these patients, 48.59% were female, and 58.40% were male. We attempted to assess the impact of NSTEMI on the occurrence of complications such as cardiac arrest, acute renal failure (ARF), Acute liver failure (ALF), Acute heart failure (Acute HF), and acute respiratory failure in patients admitted with DKA. The results of this analysis are depicted in the table below. The cost of hospitalization for DKA with NSTEMI was $35878 higher and the length of stay was 50% longer compared to the patients with DKA without NSTEMI. The Odds ratio for mortality was 2.84 for patients with NSTEMI. Conclusions: Our analysis suggests that the occurrence of NSTEMI negatively impacts outcomes in DKA patients. The occurrence of primary outcomes assessed in this study (Cardiac arrest, ARF, ALF, Acute HF, and Acute respiratory failure) was significantly higher in DKA patients with concomitant diagnosis of NSTEMI. NSTEMI also increased the cost burden on hospitalizations for DKA.

Current Patient Management for Bacterial Meningitis Simultaneously Affected by Stroke.

Bacterial meningitis (BM) is a critical central nervous system infection characterized by increased risks of complications and potentially fatal outcomes. The chances of full recovery are significantly reduced in the presence of concomitant neurovascular complications such as ischemic and hemorrhagic strokes, intracerebral hemorrhage, and cerebral sinus thrombosis. Effective treatment of BM requires a targeted approach that simultaneously addresses the causative pathogen and manages the neurologically related complications. However, clinicians continue to face challenges in determining optimal pharmacotherapy for these patients.The presence of neurological complications is pivotal in determining patient outcomes, contributing to high disability and mortality rates. Early medical management is crucial and begins with essential stabilization followed by rapid diagnostic testing and the administration of empirical broad-spectrum antimicrobial therapy. The use of targeted antibiotics based on culture results is standard, with adjunct therapies such as dexamethasone and, in some cases, anticoagulants playing supportive roles. Despite the deployment of such comprehensive therapeutic strategies, the variability in treatment response and the high incidence of adverse outcomes necessitate ongoing research. This includes exploring novel therapeutic approaches and enhancing current clinical practices through retrospective studies and clinical trials to mitigate the high morbidity and mortality rates associated with BM and its complications. Strategic management is crucial for patient recovery, considering the substantial risk, a broad spectrum of complications, and fatal outcomes from this meningeal infection and stroke. The use of antimicrobial therapy with intravenous adjunct dexamethasone isthe current standard of care for patients with cerebrovascular complications and acute BM. In addition, other options that can provide benefits in complicated cases include anticoagulants and neurosurgery. Further investigation into treatment algorithms for patients with meningeal infection complicated by stroke and/or increased intracranial pressure is still needed.

Nephrological Detrimental Impacts Resulting From Novel Immunotherapy Drugs Used in the Treatment of Cancer: A Systematic Review.

The most recent advancements in cancer therapycenter on efficiently and conveniently enhancing a patient's natural immune system. Immune checkpoint inhibitors (ICIs) are antibodies that target cytotoxic thymus (T) lymphocyte antigen-4 (CTLA-4) and its receptor. They function by stimulating T-cell activity against malignancies. Immune-related adverse events (irAEs) are a distinct class of inflammatory side effects that are specific to a given organ. Antineoplastic medications can impact any part of the kidney, leading to the development of proteinuria, hypertension, electrolyte abnormalities, glomerulonephritis, and both acute and chronic interstitial nephritis. We reviewed the scientific literature regarding kidney problems that can arise from chemotherapy and immunotherapy for neoplasms, such as various cancers, melanoma, non-small cell lung cancer, and colorectal cancer. We discussed the pathophysiology, associated risk factors, management, and safety measures for patients experiencing acute renal injury after a new immunotherapy medication treatment. Antineoplastic drugs have the potential to damage the renal tubules, glomeruli, parenchyma, and blood vessels, among other kidney tissues. This can result in a broad spectrum of complications, spanning from a rise in serum creatinine levels without symptoms to the development of acute kidney injury (AKI). The research examined a range of risk factors associated with acute kidney injury (AKI). These factors encompassed age, gender, preexisting medical conditions (such as diabetes, hypertension, and chronic kidney disease), and the medications that patients were taking at the beginning of the study, which included non-steroidal anti-inflammatory drugs,renin-angiotensin system inhibitors, allopurinol, diuretics, corticosteroids, and proton pump inhibitors. The data suggests that patients who were receiving baseline treatment with proton pump inhibitors (PPIs) or corticosteroids had a higher risk of mortality. This study serves as an illustration of the effective management of acute kidney injury and proteinuria linked to novel immunotherapy drugs like pembrolizumab. The approach involved the use of corticosteroids tailored to the patient's condition. Furthermore, it references the recommendations outlined in the Common Terminology Criteria for Adverse Events (CTCAE). Prompt recognition and effective management of these side effects are essential to optimizingoutcomes for patients undergoing immunotherapy. Our results were refined and focused by utilizing Medical Subject Headings (MeSH) keywords in our search strategy. The MeSH keywords used were "renal side effects" OR "immunotherapy" OR "cancer treatment." The studies reviewed encompassed a total of 48,529 participants among the 21 studies examined.

Spectrum of Complications and Complication Rates After Diagnostic Catheter Angiography in Neuroradiology

PurposeTo retrospectively evaluate the total complication rates and type of complications after diagnostic cerebral and spinal catheter angiography.MethodsData from 2340 patients undergoing diagnostic angiography over a period of 10 years in a neuroradiologic center were retrospectively evaluated. Local, systemic, neurological, and technical complications were analyzed.ResultsA total of 75 clinically noted complications occurred. The risk for clinical complications was increased when the angiography was performed under emergency conditions (p = 0.009). The most common complication was groin hematoma (1.32%). Neurological complications occurred in 0.68% of patients, of which 0.13% were stroke with permanent disability. Technical complications without noticeable clinical symptoms of the patients occurred in 2.35% of the angiographic procedures. Deaths caused by angiography did not occur.ConclusionThere is a definite risk for complications after diagnostic angiography. Although a very broad spectrum of complications was considered, complications in the individual subgroups showed a low incidence.

Neurobrucellosis: report of 54 cases

BackgroundBrucellosis is among the most widespread zoonotic diseases worldwide. Although rare, nervous system involvement due to Brucella infection is a major diagnostic challenge in endemic regions.Patients and methodsThis study was a cross-sectional investigation of hospitalized adults with neurobrucellosis from March 2007 to February 2017. We described the clinical characteristics, radiographical and laboratory features, and clinical outcomes of patients with neurobrucellosis.ResultsFifty-four patients with neurobrucellosis were included. The median age was 35 (interquartile range, 25–50) years, and 32 (59%) cases were male. Thirty-four (63%) patients were stockmen or shepherds. The most common clinical manifestations were fever in 49 (91%) cases, headache in 47 (87%), decreased consciousness in 12 (22%), and seizures in 6 (11%). Meningeal signs were detected in 36 (67%) cases. Brucella species were isolated in five cases from blood or cerebrospinal fluid (CSF). The median of CSF leukocytes was 75 per µL, CSF protein 83 mg/dL, and CSF glucose 39 mg/dL. Only two cases had severe hypoglycorrhachia and one CSF protein ≥ 500 mg/dL. No patient died during hospitalization.ConclusionsThe symptoms of neurobrucellosis could be mild and nonspecific and the classic triad of meningitis is uncommon. Mild CSF pleocytosis of fewer than 50 leukocytes per microliter of CSF was common but severe hyperproteinorrhachia and severe hypoglycorrhachia were rare in neurobrucellosis. Differentiation between neurobrucellosis and systemic brucellosis is important, because more prolonged treatment is indicated for neurobrucellosis, and it could be associated with a broad spectrum of complications that require close follow-up.

Liver transplant biopsy interpretation: Diagnostic considerations and conundrums.

Liver transplantation is now a well-established therapeutic strategy for irreversible acute and chronic liver diseases. There is a broad spectrum of complications encountered in early and late period after transplantation and these contribute to significant morbidity and mortality. Distinguishing among these complications often requires interpretation of allograft biopsies. Histology is the gold standard for the diagnosis of rejection. However, interpretation of these biopsies is quite challenging due to the atypical and complex histomorphology. Multiple simultaneous insults, effects of immunosuppression (IMS), de novo complications, and presentations distinct from non-transplant setting are a few cardinal concerns. Awareness of the time period of occurrence of various complications, the most characteristic histological features or patterns, and distinguishing features between various complications are crucial. The management can be completely divergent; hence, recognition of dominant problem and interpretation in appropriate clinical context is much needed. This review focuses on histopathology of major complications accountable for early and late graft dysfunction. Tabulation of clinico-pathological features to distinguish various complications helps to solve the conundrums and arrive at the correct diagnosis.

How I treat cardiovascular complications in patients with lymphoid malignancies

AbstractThe prognosis of several lymphoid malignancies has improved through development of novel therapies, combination with traditional chemotherapies, and delineation of appropriate therapeutic sequencing. Toxicities that are arising because of prolonged or multiple sequential therapeutic interventions are becoming increasingly impactful. Among the broad spectrum of complications that patients with lymphoid malignancies may experience, cardiovascular toxicities are significant in terms of morbidity and mortality. The entire cardiovascular system can be affected, but cardiomyopathy, heart failure, and arrhythmias remain of greatest concerns with the use of anthracyclines, hematopoietic stem cell transplantation, and radiation therapy in patients with lymphoid malignancies. These aspects will be covered in this article within the framework of case-based discussions. Key to the management of cardiovascular complications in patients with lymphoid malignancies is awareness and preparedness across the cancer continuum. Baseline risk stratification helps to direct surveillance and early intervention efforts before, during, and after cancer therapy, which are paramount for the best possible outcomes. Along these lines, the overall goal is to enable the best possible therapies for lymphoid malignancies without the complications of clinically significant cardiovascular events.

Complications following T-tube & C-tube Drainage of the Common Bile Duct

The aim of this study is to assess the complications of T-tube (Kehr) and C- tube (Cystic) drainage used for biliary drainage, following biliary surgery. 
 We evaluate all possible complications, related to the tube in situ, during cholangiography and following t- tube removal retrospectively, during a 4- year period 2016-2019.
 T-tubes were inserted in 48 patients, with 11 (22.8%) patients experiencing complications related to T-tube. A broad spectrum of complications was found, ranging from biliary-specific complications such as a biliary leak, biliary peritonitis, and retained stones, to systemic general complications as wound infection, pulmonary thromboembolism, and internal hemorrhage.
 Although this retrospective study has underestimated the incidence of T-tube complications, it has demonstrated significant morbidity related to T-tube use, which poses the need for replacement by minimally invasive surgical techniques.

Complications of RFA for Thyroid Nodules: Prevention and Management

This review will summarize the various complications of RFA for thyroid nodules as well as preventative and management strategies that can be used when faced with these adverse events. Although widely perceived to be less invasive and a potentially safer option than surgery, a broad spectrum of complications have been reported in recent years, including nerve damage, nodule rupture, permanent hypothyroidism, and needle tracking seeding. Complications occur at a rate ranging from 0.0–16.7%. Understanding the complications that arise during treatment is essential in conducting safe and effective ablation therapy. Radiofrequency ablation (RFA) has become an increasingly popular alternative to surgery for thyroid nodules. RFA has been consistently shown to be safe and effective for treatment. While complications can occur, they are seldom life-threatening. Understanding the minor and major complications that arise during treatment is essential in conducting safe and effective ablation therapy.

P1301 Opposite outcomes of two equally destructive forms of infective endocarditis

Abstract Introduction Infective Endocarditis is a complex entity with great variability of clinical manifestations and a broad spectrum of complications. The prognosis depends not only on the baseline characteristics of the patient, but also on the agent and the complications, both local and systemic, with clinical repercussion. Two clinical cases are presented. A 67-year-old woman with history of uncharacterized aortic valve disease, presented in the emergency department with a 3-month evolution of asthenia and anorexia, and ocasional fever. She presented pallor, with a systolic murmur II/VI audible throughout the precordium and no other abnormalities in physical examination. Blood tests showed Hb 9g/dL with normal MCV and MCH, no leucocytosis, CRP 132mg/L, mild elevation of troponin I (0.32ng/ml; N <0.04ng / ml) and erythrocyturia. Transthoracic and transesophageal echocardiograms (TTE and TEE) showed a mass on the aortic valve suggestive of vegetation, conditioning a moderate aortic regurgitation (AoR) and mitroaortic pseudoaneurysm. Another 49-year-old female patient, submitted during childhood to a subaortic aneurysm, intraventricular comunication, AoR and aortic coarctation repair, presented with deterioration of functional and neurological status, associated with fever and lower limb edema. At examination she had tachypnea, tachycardia, pallor, aortic systolic murmur and signs of pulmonary congestion. Blood tests had leukocytosis and neutrophilia, CRP 174mg/L, Hb 9.6g/dL, elevation of liver enzymes, spontaneous INR 1.4 and no renal damage. TTE and TEE showed a mobile vegetation attached to the ventricular face of the aortic valve with major AoR and perivalvular abscess fistulized to the left ventricle. Both patients were treated with empirical therapy with gentamicin, ampicillin, and flucloxacillin. The first case evolved with hemodynamic stability, without heart failure or distant embolization. It was isolated a multisensitive Strept. gordonii and antibiotic therapy was de-escalated to ampicillin alone. In the second case, the patient showed rapidly progressive clinical deterioration with hypoxemic respiratory failure and cardiogenic shock requiring vasopressor support, and was urgently presented to a surgical center. No microorganism was isolated and broad-spectrum antibiotic therapy was maintained. She eventually died before she underwent valve surgery. On the other hand, in the first case, 6 weeks of antibiotic therapy were completed and aortic valve replacement surgery was performed without complications. She was discharged without cardiovascular symptoms and has an unremarkable follow-up of 6 months. With these cases it was possible to demonstrate the variability of presentations and prognosis of the same entity, even if ab initio with equally severe local complications. The initial stratification of the prognosis, the initiation of early treatment and the adequacy of the surgical time for intervention are of importance. Abstract P1301 Figure. Imaging study of endocarditis

Matricaria Chamomilla Extract Improves Diabetic Wound Healing in Rat Models

Background: Diabetes mellitus (DM) has a broad spectrum of complications and comorbidities. Delayed wound healing is a major reason for infections and further life-threatening complications; the process of vascularization and tissue regeneration as well as anti-inflammatory and anti-oxidant reactions of the body are impaired in DM. Matricaria Chamomilla (MC) is a herbal medicine which has antimicrobial, antioxidant and wound healing potentials.Objectives: In this study, these potentials are evaluated on full thickness diabetic excisional skin wounds by using stereological methods.Methods: In this experimental study, 48 male Wistar rats with streptozotocin (STZ)-induced diabetes (50 mg/kg intraperitoneally) were divided into 4 groups (n = 12) randomly: MC 5% gel treated, MC 10% gel treated, gel-base treated group, and the control group receiving no treatment. After creating 1 cm2 wounds, rats were treated every 24 hours for 15 days. Volume densities of collagens, wound closure rate, volume density, length density, and mean diameter of vessels, and fibroblast proliferation, were examined and analyzed. P ≤ 0.05 was mentioned as statistically significant.Results: MC gels receiving groups showed hastened wound area reduction in contrast with gel-base and control groups (P < 0.05). Numerical density of fibroblasts, mean diameter and length densities of the vessels in MC groups were significantly higher than the control and the base groups (P < 0.05).Conclusions: It is demonstrated that MC has the ability to improve wound healing by enhancing fibroblast proliferation and revascularization in diabetic skin injuries and has the potential to be considered as an alternative treatment.

Risk factors for perioperative morbidity in spine surgeries of different complexities: a multivariate analysis of 1,009 consecutive patients

Background ContextThere is a broad spectrum of complications during or after surgical procedures, with differing incidences reported in the published literature. Heterogeneity can be explained by the lack of an established evidence-based classification system for documentation and classification of complications in a standardized manner. PurposeThe objective of this study was to identify predictive risk factors for perioperative and early postoperative morbidities in spine surgeries of different complexities in a large cohort of consecutive patients. Study DesignThis study is a retrospective case series. Outcome MeasuresThe outcome measures are the occurrence of perioperative and early postoperative morbidities. MethodsA classification of surgical complexity (Grades I–III) was created and applied to 1,009 patients who consecutively underwent spine surgery at a single university hospital. The incidence and the type of perioperative and early postoperative morbidities were documented. Multivariate binary logistic regression analyzed risk factors for (1) hospital stay of ≥10 days, (2) intermediate care unit (IMC) stay of ≥24 hours, (3) blood loss of >500 mL, and occurrence of a (4) surgical or (5) medical morbidity. ResultsA deviation from the regular postoperative course (defined as “morbidity”) included surgical reasons, such as relapse of symptoms of any kind (3.3%), wound healing problems (2.4%), implant-associated complications (1.6%), postoperative neurologic deficits (1.5%), infection (1.5%), fracture (0.8%), and dural tear in need of revision (0.6%). Medical reasons included anemia (1.8%), symptomatic electrolyte derailment (1.0%), and cardiac complications (0.7%), among others. An independent risk factor associated with a surgical reason for an irregular postoperative course was male gender. Risk factors associated with a medical reason for an irregular postoperative course were identified as preoperatively high creatinine levels, higher blood loss, and systemic steroid use. Independent risk factors for a prolonged hospitalization were preoperatively high C-reactive protein level, prolonged postoperative IMC stay, and revision surgery. Spinal stabilization or fusion surgery, particularly if involving the lumbosacral spine, age, and length of surgery were associated with blood loss of >500 mL. Higher surgical complexity, involvement of the pelvis in instrumentation, American Society of Anesthesiologists Grade ≥III, and preoperatively higher creatinine levels were associated with a postoperative IMC stay of >24 hours. ConclusionsThe present study confirms several modifiable and non-modifiable risk factors for perioperative and early postoperative morbidities in spine surgery, among which surgical factors (such as complexity, revision surgery, and instrumentation, including the pelvis) play a crucial role. A classification of surgical complexity is proposed and validated.

O3.03 * THE SPECTRUM OF LATE PAROXYSMAL NEUROLOGICAL SYNDROMES AFTER BRAIN IRRADIATION

INTRODUCTION: Late delayed multifocal paroxysmal neurological syndromes, known as stroke-like migraine attacks after radiation therapy (SMART), peri-ictal pseudoprogression (PIPG) and acute late-onset encephalopathy after radiotherapy (ALERT), have been recently reported after brain irradiation (RT). These syndromes share clinical and neuro-radiological features and might result from a common radiation-induced damage. Their diagnosis is challenging even for expert neurologists, as they have to be differentiated from a broad spectrum of complications, such as tumor progression, seizures, and toxic/metabolic encephalopathies. METHODS: We conducted a retrospective study in five institutions. Patients' inclusion criteria were 1) a remote history of brain irradiation; 2) the appearance of acute/subacute neurological signs and symptoms not related to tumor progression or epilepsy; 3) the presence of MRI abnormalities. Patients with stroke and transient “stroke-like” focal neurological signs in absence of ischemic/hemorrhagic lesions were included in the study. In all cases a thorough diagnostic workup was performed to exclude all other possible aetiologies. We identified 16 patients matching these criteria, and their clinical records were reviewed. RESULTS: Five patients presented a typical SMART pattern. Clinical presentation was characterized by hemianopia (3/5), confusion (2/5), headache (2/5), aphasia (2/5). Recovery was complete in 3 out of 5 patients after median interval of 8 days after symptom onset. Five patients presented ALERT syndrome. Clinical presentation was characterized by stupor/coma (5/5), headache (3/5), aphasia (3/5) and hemiparesis (3/5). All patients were treated with high dose steroids. Recovery was complete in 3 out of 5 patients after median interval of 9 days. Two patients presented an ischemic lesion within the radiation field, and were put on antiplatelet drugs. Four patients presented transient “stroke-like” events. Clinical presentation was characterized by aphasia (2/4), motor/sensory hemisyndrome (3/4). Two patients received antiplatelet drugs. Recovery was complete within hours or days in 3 out of 4 patients. We did not observe cases of PIPG in this series. In none of the patients tumor relapse occurred within the follow-up period. Three patients died due to pulmonary conditions. CONCLUSIONS: Long-term survivors after brain irradiation may present late paroxysmal neurological syndromes, that can be confused with tumor progression. Clinical presentation may be dramatic and recovery incomplete, resulting in residual severe morbidity. The aim of this report is to strengthen the observation of late delayed paroxysmal neurological syndromes after brain irradiation and to raise the neuro-oncologists' attention to the importance of developing adequate algorithms for the diagnosis and treatment of these conditions.

Incidence and predictive factors for complications after uterine leiomyoma embolization.

What is the risk of complications after uterine leiomyoma embolization and what are the factors associated with complications? The cumulative risk of complications after embolization is relatively low even in the long term, but submucosal leiomyoma location may increase the risk. A broad spectrum of complications after leiomyoma embolization have been described with widely varying rates. There is uncertainty over the actual risk of complications and the factors associated with this risk. This was a prospective cohort study of 288 consecutive women undergoing leiomyoma embolization in the general gynaecology clinic of a university teaching hospital between January 2001 and December 2010. Complications occurring after embolization were categorized as major or minor according to the severity of their impact on health, the level of care required and the outcome. Cumulative complication rates were estimated by survival analysis and log-rank tests according to baseline variables. Multivariable Cox proportional hazards analysis was performed to adjust for confounders. There were 48 patients who experienced a complication at a median of 5 months (95% confidence interval, 4.1-11.4) after embolization. Complications were minor in 38 patients and major in 10 patients. The cumulative overall complication rate was 13% (95% CI, 9.0-17.0) at 6 months, 16% (95% CI, 11.0-20.0) at 1 year, 17% (95% CI, 12.0-22.0) at 3 years and 18% (95% CI, 12.9-22.8) at 5 years. The most frequent complication (19/48, 39.6%) was leiomyoma expulsion, which occurred spontaneously in 13 (68.4%) of these cases and required assistance in 6 (31.6%) cases. Eight (2.8%) patients underwent re-intervention, including six hysteroscopic myomectomies, one laparoscopic myomectomy and one hysteroscopic adhesiolysis, as a result of a complication. Submucosal leiomyoma location was the only baseline variable associated with an increased risk for complications [Hazard ratio (HR), 2.28, 95% CI, 1.24-4.18, P = 0.008]. Our population did not include women of African descent, who have been reported to be at higher risk of post-procedural complications compared with Causcasian women. If such women were involved in the study, higher morbidity rates might have been observed. Women with submucosal leiomyomas at the time of embolization are more likely to have post-procedural complications. This is important new information for counselling patients contemplating this therapeutic approach. The authors have no competing interests to declare. The study was not supported by any external grant.

EComment. Surgical complications of permanent cardiac pacemaker insertion

We read with interest the manuscript by Wu and Chen and we would like to comment on the surgical complications of intracardiac pacemaker implantation [1]. The use of permanent pacemakers (PPM) and implantable cardioverter-defibrillators (ICD) is increasing due to the expansion of indications and aging of the population. As a consequence, cardiologists and cardiothoracic surgeons have to deal with a broad spectrum of complications, which are sometimes under-estimated and life-threatening. The surgical complications of PPM and ICD may occur during the immediate or early post-operative period and can be related to venous access process (pneumothorax, hemothorax, air embolism, haematoma, arterial puncture, wound healing problems, infection, pain), to the pacemaker lead (cardiac perforation, tamponade, malposition or dislodgement of the lead), or to the generator device. In addition, other complicationed that may occur during the late post-operative period are related to infections, thrombosis, endocarditis, pulmonary embolism, superior vena cava (SVC) syndrome (due to thrombus formation and/or fibrosis of the pacing wires within the SVC) and pericarditis [2-5]. Ostovan and Aslani have reported on the successful treatment of massive pulmonary air embolism during a PPM implantation with air suctioning by the guide catheter inserted into main pulmonary artery via the left femoral vein. Treatment for air embolisms includes oxygen treatment, haemodynamic support and prevention of further air entry in the systemic circulation. The left lateral decubitus position can prevent the air obstruction of the pulmonary outflow tract (air can be moved toward the right ventricular apex) [2]. Aggarwal et al. found no difference in the incidence of intraoperative and early postoperative complications (up to two months after implantation) between single and dual chamber pacing systems [3]. Sohail et al., in their retrospective review of 189 patients with pacemaker related infections, found out that the most common clinical presentations were generator pocket infection (69%) and device-related endocarditis (23%). The leading pathogens were Coagulase-negative Staphylococci and Staphylococcus aureus, in 42% and 29% of cases, respectively. There was a broad spectrum of related complications such us septic arthritis, sternal or vetebral or femoral osteomyelitis, and abscesses in lung, spleen, liver, brain and perinephric area. Twenty-two (11.6%) patients had thrombosis of the subclavian vein or superior vena cava and 6 of them developed clinical manifestations of pulmonary embolism. Ninety-eight percent of patients underwent complete device removal combined with antibiotic treatment and 96% of patients were treated successfully [4]. Nineteen patients had lead extraction via a median sternotomy and the rest underwent percutaneous lead extraction. Interventional complications were more common in patients with a history of multiple device-related procedures and were related to tricuspid valve failure, laceration of subclavian vein, hemothorax, haematoma, fracture of lead tip, ventriculotomy and bleeding [4]. Right atrial thrombosis and pulmonary embolism are infrequent complications (0.6%-3.5%) and its therapeutic modalities include anticoagulation, thrombolysis and or surgery [5]. In conclusion, the knowledge of all potential complications of the PPM/ICD and its multidisciplinary approach is very important for its prevention and definitive treatment. Conflict of interest: none declared

Unmet Needs in Hispanic/Latino Patients with Type 2 Diabetes Mellitus

In the United States, the prevalence of adults who are overweight or obese is higher in Hispanics/Latinos compared with non-Hispanic whites. In addition, data from the National Health and Nutrition Examination Survey (NHANES) indicate that the prevalence of type 2 diabetes mellitus is consistently greater in racial/ethnic minority groups, such as Hispanics/Latinos, compared with non-Hispanic whites. In fact, data from the Centers for Disease Control and Prevention (CDC) from 2007 to 2009 suggest that the prevalence of type 2 diabetes is almost twice as high in Hispanics/Latinos compared with non-Hispanic whites (11.8% vs. 7.1%, respectively). Although genetics plays a role in the increased prevalence of type 2 diabetes in Hispanics/Latinos, cultural and environmental factors also contribute. In addition to the increased prevalence of type 2 diabetes in Hispanics/Latinos, evidence suggests that the patients in this population are often undertreated and, therefore, less likely to achieve control of their glucose, blood pressure, and lipid levels. Because individuals with type 2 diabetes have a 2- to 4-fold increased risk of cardiovascular disease compared with individuals with normal glucose levels, there is consensus that targeting environmental factors, particularly the development of obesity at an early age, is the most cost-effective approach to prevent the development of type 2 diabetes and its broad spectrum of complications, including cardiovascular disease. Cultural and socioeconomic barriers, such as language, cost, and access to goods and services, must be overcome to improve management of type 2 diabetes in this high-risk population. By increasing healthcare provider awareness and the availability of programs tailored to Hispanic/Latino individuals, the current treatment gap among ethnic minorities in the United States will progressively narrow, and eventually, disappear.

In vitro activity and chemical characterization of an apolar fraction of Morus alba leaf hot water extract

White mulberry (Morus alba L.) leaf is a well known traditional medicine of type II. diabetes, a progressive disease with a broad spectrum of complications which has increasing incidency worldwide. Most typically it is taken as tea, often in combination with other phytotherapeutics. Many constituents were found to contribute to the antidiabetic activity of mulberry leaf, including iminosugars, flavonoids and related compounds, glycoproteins and ecdysteroids. Moreover, the role of phenylpropanes and megastigmane glycosides was also hypothesized by our group [1,2].

Management of cosmetic eyelid surgery complications.

There is a broad spectrum of complications that can occur following cosmetic eyelid surgery. The experienced eyelid surgeon should be able to avoid most serious complications through proper patient selection, a comprehensive preoperative assessment and surgical plan, meticulous surgical technique, and appropriate postoperative care. The aesthetic eyelid surgeon must counsel a patient contemplating blepharoplasty surgery regarding typical expectations including edema, eyelid numbness, dry eyes, and mild blurred vision. Patients must also be aware of the risks and the signs of serious complications such as infection, hematoma, or severe vision loss. Oculofacial surgeons must be capable of managing these adverse outcomes. The management of these urgent complications as well as other significant postoperative problems including diplopia, lagophthalmos, eyelid malposition, severe chemosis and edema, crease abnormalities, and wound dehiscence is outlined in this review.

Aneurysm of the Popliteal Artery in Neurofibromatosis

The neurofibromatoses are a heterogeneous set of genetic disorders having clinical manifestations that involve the skin, the nervous system, or both. In addition, the disease can be confounded by a broad spectrum of complications, such as various kinds of osseous lesion, vascular lesions, aqueduct stenosis, optic glioma, and learning disabilities. Neurofibromatosis results in vascular involvement in approximately 10% of cases. Stenotic lesions predominate, but aneurysms have been documented as well. Rarely noted, however, have been peripheral aneurysms. In this report, we discuss the case of a 66-year-old woman with type 1 neurofibromatosis and a popliteal artery aneurysm who was operated upon because of threatened limb ischemia. Histological findings confirmed neurofibromatous invasion of the vessel wall.

Bronchobiliary Fistula after Radiofrequency Thermal Ablation of Hepatic Tumor

A broad spectrum of complications can occur after radiofrequency (RF) ablation of hepatic tumors, even though it has been accepted as a safe and effective technique for unresectable hepatic tumors. Recently, the rare complication of brochobiliary fistula was encountered after RF ablation in a patient with a metastatic tumor from stomach cancer. It was assumed to have developed from collateral damage to the adjacent diaphragm and lung base as well as biloma formation at the ablation zone. Symptomatic improvement was achieved by conservative management with an external drainage catheter, but the fistula was still persistent on a 2-month follow-up image.