45 Webster Commons Blvd Ste 200
Webster NY 14580
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Procalcitonin level for prediction of postoperative infection in cardiac surgery. - Asian cardiovascular & thoracic annals
Diagnosing infection after cardiac surgery remains difficult due to the systemic inflammatory response induced by cardiopulmonary bypass. We compared procalcitonin levels with white blood cell counts as predictors of infection after cardiac surgery.We prospectively enrolled 100 consecutive adult cardiac patients. Postoperative white blood cell counts, serum procalcitonin levels, and blood cultures were examined.The sensitivity and specificity of white blood cell count and procalcitoninâ€‰>â€‰2â€‰ngâ€‰mL(-1) were 60% and 100%, 58.8% and 42.5%, respectively. Procalcitoninâ€‰>â€‰7â€‰ngâ€‰mL(-1) had 95% sensitivity and 80% specificity. Receiver-operating characteristic analysis showed a greater area under the curve for procalcitonin level (pâ€‰<â€‰0.0001) compared to white blood cell count (pâ€‰=â€‰0.31). Patients with positive blood cultures had significantly higher procalcitonin levels (51.97â€‰Â±â€‰39.62 vs. 6.67â€‰Â±â€‰10.73â€‰ngâ€‰mL(-1)), Acute Physiology and Chronic Health Evaluation-II scores (16.95â€‰Â±â€‰3.24 vs. 13.60â€‰Â±â€‰2.98), and intensive care unit stay (6.35â€‰Â±â€‰3.42 vs. 4.6â€‰Â±â€‰2.2 days). Non-survivors had significantly higher Acute Physiology and Chronic Health Evaluation-II scores (19.09â€‰Â±â€‰1.30 vs. 13.67â€‰Â±â€‰2.97) and procalcitonin levels (43.83â€‰Â±â€‰52.15 vs. 12.26â€‰Â±â€‰19.89â€‰ngâ€‰mL(-1)) but on logistic regression analysis, only Acute Physiology and Chronic Health Evaluation-II score was an independent risk factor for mortality.The diagnostic accuracy of procalcitonin for bacterial infection is fairly high. Acute Physiology and Chronic Health Evaluation-II score is a better predictor of mortality and morbidity than absolute procalcitonin level. Procalcitoninâ€‰>â€‰7â€‰ngâ€‰mL(-1) can prognosticate and identify the high-risk group.Â© The Author(s) 2016.
Right Coronary Artery to Pulmonary Arterial Fistula Associated With Tetralogy of Fallot: A Case Report and Review of Literature. - World journal for pediatric & congenital heart surgery
A 16-year-old boy with tetralogy of Fallot (TOF), pulmonary stenosis, and coronary artery to pulmonary arterial fistulous communication arising from the proximal right coronary artery is reported for its rarity. The surgical importance of this anomaly is highlighted. The diagnosis should be borne in cases of TOF, with echocardiographic demonstration of severe right ventricular outflow tract obstruction without a corresponding degree of systemic arterial desaturation.Â© The Author(s) 2015.
Congenital Erythropoietic Porphyria With Calcific Constrictive Pericarditis: A Case Report and Brief Review of Literature. - World journal for pediatric & congenital heart surgery
An 18-year-old boy with congenital erythropoietic porphyria and calcific constrictive pericarditis underwent total pericardiectomy. The cause of pericardial calcification could be deposition of porphyrins in the pericardium. Surgical importance of this rare condition is highlighted.Â© The Author(s) 2015.
Surgical removal of failed ruptured Sinus of Valsalva Aneurysm device. - Asian cardiovascular & thoracic annals
A Sinus of Valsalva Aneurysm can cause aortic insufficiency, coronary artery flow compromise, cardiac arrhythmia, or aneurysm rupture. There are different management plans available, ranging from open surgery to percutaneous device closure, but sometimes, device closure may be life-threatening. We report a case of ruptured Sinus of Valsalva Aneurysm in a 42-year-old woman, which was managed by percutaneous device closure that failed and required surgical removal of the device.Â© The Author(s) 2015.
Early postoperative arrhythmias after pediatric cardiac surgery. - Asian cardiovascular & thoracic annals
This prospective study proposed to determine the incidence, risk factors, and management protocols for early postoperative arrhythmias after pediatric cardiac surgery, with focus on outcomes, using a uniform protocol, and also to see if children operated on at a later age have different issues from those operated on earlier.Of 224 consecutive pediatric patients undergoing cardiac surgery from September 2013 to July 2014, 24 were excluded because their procedures were performed without cardiopulmonary bypass.The median age was 24 months (mean 50.1â€‰Â±â€‰62.4 months, range 0.5-216 months). Fifteen (7.5%) patients developed arrhythmia, the most common was junctional ectopic tachycardia (nâ€‰=â€‰7, 46.6%) followed by supraventricular tachycardia (nâ€‰=â€‰5, 33.3%). All junctional ectopic tachycardias occurred within 24â€‰h of intensive care unit admission. Of the 7 patients with junctional ectopic tachycardia, 5 responded to conventional measures and 2 required amiodarone infusion. There was a significant longer cardiopulmonary bypass time in patients with arrhythmias compared to those without arrhythmias.We observed a very low incidence of arrhythmias, particularly junctional ectopic tachycardia, after open heart surgery in children. Other than a longer cardiopulmonary bypass time, no specific predictors were identified. It appears that the cause of arrhythmias following pediatric cardiac surgery is multifactorial and needs further study with a greater number of patients.Â© The Author(s) 2015.
Left atrial ball thrombus with acute mesenteric ischemia: anesthetic management and role of transesophageal echocardiography. - Annals of cardiac anaesthesia
A 62 year old female with severe mitral stenosis, large left atrial ball thrombus and acute mesenteric ischemia emergently underwent mitral valve replacement, left atrial clot removal and emergency laparotomy for mesenteric ischemia. Peri-operative management issues, particularly, the anesthetic challenges and the role of transesophageal echocardiography are discussed.
Co-agonist of glucagon and GLP-1 reduces cholesterol and improves insulin sensitivity independent of its effect on appetite and body weight in diet-induced obese C57 mice. - Canadian journal of physiology and pharmacology
Dual agonism of glucagon and glucagon-like peptide-1 (GLP-1) receptors reduce body weight without inducing hyperglycemia in rodents. However, the effect of a co-agonist on insulin sensitivity and lipid metabolism has not been thoroughly assessed. Diet-induced obese (DIO) mice received 0.5 mgÂ·kg(-1) of co-agonist or 2.5 mgÂ·kg(-1) of glucagon or 8 Î¼gÂ·kg(-1) of exendin-4 by subcutaneous route, twice daily, for 28 days. A separate group of mice was pair-fed to the co-agonist-treated group for 28 days. Co-agonist treatment reduced food intake and reduced body weight up to 28 days. In addition, it reduced leptin levels and increased fibroblast growth factor 21 (FGF21) levels in plasma, when compared with control and pair-fed groups. Co-agonist treatment decreased triglyceride levels in serum and liver and reduced serum cholesterol, mainly due to reduction in low-density lipoprotein (LDL) cholesterol. These changes were not seen with pair-fed controls. Co-agonist treatment improved glucose tolerance and increased insulin sensitivity, as observed during glucose and insulin-tolerance test, hyperinsulinemic clamp, and reduced gluconeogenesis, as observed in pyruvate-tolerance test. The effects on insulin sensitivity and lipid levels are mostly independent of the food intake or body weight lowering effect of the co-agonist.
Treatment with exendin-4 improves the antidiabetic efficacy and reverses hepatic steatosis in glucokinase activator treated db/db mice. - European journal of pharmacology
The glucokinase activators improve the fasting as well as postprandial glucose control and are important investigational drugs for the treatment of diabetes. However, recent studies have implicated that continuous activation of glucokinase with a small molecule activator can increase hepatic triglycerides and the long term glucose control is not achieved. In this study, we investigated the effect of combination of glucokinase activator (GKA, Piragliatin) with GLP-1 receptor agonist exendin-4 (Ex-4) in male db/db mice. Twelve weeks combination treatment in the db/db mice resulted in a significant decrease in body weight gain, food consumption, random glucose and %HbA1c. The decrease in serum glucose and %HbA1c in combination group was more profound and significantly different than that of individual treatment (GKA or Ex-4) group. GKA treatment increased hepatic triglycerides, whereas combination of Ex-4 with GKA attenuated hepatic steatosis. The combination of GKA with Ex-4 reduced the hepatic lipid accumulation, improved the insulin sensitivity, and reduced hepatic glucose production in db/db mice. Overall, our data indicate that combination of GKA and GLP-1 receptor agonist Ex-4 improves glucose homeostasis, shows antiobesity activity, without causing harmful side effects like fatty liver.Copyright Â© 2013 Elsevier B.V. All rights reserved.
The effect of brushing time and dentifrice on dental plaque removal in vivo. - Journal of dental hygiene : JDH / American Dental Hygienists' Association
Routine toothbrushing is the principal method by which individuals remove plaque and control plaque-related diseases, such as periodontitis and caries. Oral health care professionals generally recommend at least 2 minutes brushing with an appropriate technique, and yet the average brushing time in the general population is closer to 45 seconds. Our understanding of the relationship between brushing time and plaque removal, in an untutored general population using a conventional manual toothbrush and dentifrice, is limited. The role of dentifrice in plaque removal is also unclear.This study was undertaken to measure plaque removal during untutored brushing over timed periods between 30 and 180 seconds with 1.5 g dentifrice, using an Aquafresh Flex brush and Aquafresh Advanced dentifrice. Plaque removal after brushing without dentifrice was also determined (at the 60 second time point only). Forty-seven subjects participated in the study, in which plaque level was assessed using the Quigley-Hein (Turesky-modification) Index.Plaque removal increased with brushing time across the range studied, tending towards a maximum at longer brushing times. At the extremes, brushing for 180 seconds removed 55% more plaque than brushing for 30 seconds. Brushing for 120 seconds removed 26% more plaque than brushing for 45 seconds. The use of dentifrice did not increase plaque removal during 60 seconds of brushing.Oral health care professionals should reinforce efforts to persuade patients to brush for longer periods of time, as increasing brushing time to the consensus minimum of 2 minutes from a more typical 45 seconds increases plaque removal to an extent likely to provide clinically significant oral health benefits.
Reactive Lyme serology in optic neuritis. - Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
Establishing a causal relationship between optic neuritis and Lyme disease (LD) has been hampered by technical limitations in serologic diagnosis of LD. Even so, there is a general impression that optic neuritis is a common manifestation of LD.Retrospective case analysis of Lyme serology in 440 patients with optic neuritis examined between 1993 and 2003 in a single neuro-ophthalmic practice at Stony Brook University Medical Center, Suffolk County, New York, a region hyper-endemic for LD.Lyme enzyme-linked immunosorbent assay (ELISA) was positive in 28 (6.4%) patients with optic neuritis, three of whom had syphilis with cross-reactive antibodies. Among the remaining 25 ELISA-positive patients, optic neuritis could be confidently attributed to LD in only one case, a patient with papillitis. The other 24 cases had reactive Lyme serologies related to a history of LD years earlier, asymptomatic exposure, false-positive results, or non-specific humoral expansion. The ELISA in these 24 cases were weakly positive and the Western blots were negative by Centers for Disease Control criteria. There were no significant clinical differences between the 25 seropositive optic neuritis cases and 50 seronegative optic neuritis cases.Based on these cases and a review of the literature, there is insufficient evidence for a causal link between LD and retrobulbar optic neuritis or neuroretinitis. There is sufficient evidence to establish a causal link between LD and papillitis and posterior uveitis.
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45 Webster Commons Blvd Ste 200 Webster, NY 14580
1015 Ridge Rd