European Journal of Cardiovascular Medicine

Background: Legionella pneumophila is a common cause of Community Acquired Pneumonia (CAP) which is often associated with a severe clinical course and a mortality rate of 5% to 25% among immunocompetent patients. Complications of Legionella infection include acute renal and respiratory failures, disseminated intravascular coagulation and septic shock which often require intensive level of medical care. Reported cases of myocardial dysfunction and acute systolic heart failure from legionella disease are rare. This case describes an atypical presentation of legionella pneumonia in a previously healthy patient complicated by multi-organ failure. Case Presentation: A 63 year old female with medical history of hypertension was admitted to the intensive care unit for acute onset of altered mental status, decreased oral intake, subjective fevers, dizziness and diarrhea. Physical exam was remarkable for temperature of 101.2 F, pulse rate 112 beats/minute, respiratory rate 22 cycles/minute and blood pressure 88/60 mmHg. Laboratory studies showed leukocytosis, markedly elevated serum Creatinine Kinase (CPK), and creatinine and lactic acid levels. Troponin was elevated; however no evidence of cardiac ischemia on electrocardiogram. Chest X-ray revealed right mid-lung opacities consistent with pneumonia. A Transthoracic Echo (TTE) showed reduced ejection fraction of 35% and urine legionella antigen test was positive for Legionella pneumophilia group 1 antigen. She was admitted to the medical Intensive Care Unit (ICU) and initiated on Intravenous (IV) fluids and empiric antibiotics for CAP (IV Ceftriaxone 2 g daily and Azithromycin 500 mg daily) and by day 5 of hospitalization, her fever had completely resolved and neurological status returned to normal. Her serum CPK and creatinine levels significantly improved and troponin levels normalized. She was discharged home to follow up with infectious disease and cardiology team outpatient. A repeat TTE six weeks later showed normal ejection fraction of 60% to 65% and a normal cardiac stress test.

Introduction: Most epidemiological data concerning low back pain (LBP) are related to developed and industrialized countries but little information about LBP in the general population in developing and low-income countries. Back pain affects 60-80% of people at some time in their lives. Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare case of serious underlying pathology. Aim of the study: The aim of the study is to evaluate the different causes of low back pain, occupational and risk factors, association with age and sex of the patient and their life styles. Materials and Methods: The present study is a retrospective study of 300 patients of low back pain between the age group of 31-70 years of both sexes who were admitted and treated at Dept. of Forensic Medicine, Kushtia Medical College Hospital, Kushtia, Bangladesh from January 2020 to December 2020. The information was collected from the patients regarding their occupation, education, obesity, smoking, tuberculosis, diabetes, alcohol consumption, osteoporosis, Osteoarthritis and history of trauma. The provisional diagnosis of cases was done and confirmed radiologically. A proforma was prepared and the patient’s age, sex, duration of symptoms, place of living and the cause for low back pain was noted. A neurological examination of the lower limbs was performed. Results: The author tabulated 300 patients of low back pain into four categories according to age and noted the number of cases in each group. The highest number of cases (124) is observed in the age group of 31-40 years (41%) and the lowest number of cases (45) is observed in the age group of 51-60 years (15%). All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus, smoking, alcohol and medication history), subjected to a rigorous clinical examination and a battery of investigations. In 300 cases of LBP studied, the most common cause for back pain was disc prolapse (44%). The next common causes were lumbar spondylosis, spondylolisthesis and lumbar spinal stenosis (17%, 10% & 10% respectively).The study found association between low back pain and various factors. Prevention is the best strategy for avoiding low back pain but is realistically hard to practice because the problem of low back pain has many environmental and intrinsic risk factors. Conclusion: Low back pain affects a large proportion of the population and is difficult to diagnose. Physicians must accept the diagnostic ambiguity that often accompanies the condition. Identification of etiological and risk factors, cause for back pain and type of occupation and instituting preventive measures, as well as rehabilitation of patients can lead to a meaningful reduction in the incidence of debilitating back pain.

Since the first reports of a novel Coronavirus Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged from the province of Wuhan, China in December 2019 [1], it has brought the entire worldwide to a standstill and impacted every single individual on the planet. In this age of globalization, as expected, the eyes of the world have been vehemently focused on the medical fraternity in hopes of a so far elusive cure. In spite of hundreds of clinical trials, anecdotal reports and off-label attempts, no therapy has proven to be effective in improving outcomes nor provide effective prophylaxis. Intense social, political and media scrutiny, along with the sheer scale of the pandemic, have presented a unique challenge to the medical and scientific fraternity to be able to develop effective remedies in an extremely limited amount of time, and at times, with limited resources as well. Unfortunately, the discovery and licensing of a nascent molecule as an effective drug involves a prolonged gestational period, creating an unacceptable lag between therapeutic need and availability. Drug repurposing, a novel approach which involves identification of new indications for pre-existing drugs, is an economic and time saving endeavor [2], allowing a drug to directly enter phase III or IV clinical trials, thereby saving billions of dollars in production cost [3]. Much like the Middle East Respiratory Syndrome virus (MERS), the SARS-CoV-2 spreads through the respiratory route; however, unlike the former which utilizes Dipeptidyl Peptidase 4 (DPP4), it utilizes Angiotensin Converting Enzyme 2 (ACE 2) as a receptor to enter cells [4,5]. Fusion, is followed by endocytosis of the virion, which is facilitated by an acidic environment, wherein comes in to play diprotic bases such as hydroxychloroquine and chloroquine [6]. Activation of the main RNA Dependent RNA Polymerase (RDRP) enzyme requires proteolysis by a viral protease. Inhibition of the latter by anti-retroviral agents such as lopinavir, ritonavir and darunavir hold therapeutic promise [6]. Agents targeting RDRP such as remdesivir, favipiravir and arbidol have demonstrated some degree of in vitro and in vivo activity against SARS-CoV-2.

Background: Diabetes is one of the most common chronic diseases. The development of albuminuria in Type 2 Diabetes (T2DM) increases the risk for renal disease. Methods: The study was retrospective conducted at the Primary Health Care Clinics at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. A total of 1583 Saudi with T2DM were randomly selected. Results: Total of 1583 patients with T2DM included in this study; 636 (40.2%) male and 8947 (59.8%) female with mean age 56.0

Acute Respiratory Distress Syndrome (ARDS) is a major medical emergency requesting acute therapeutic intervention. Here we report that Nitric Oxide (NO) gas attenuates ARDS in mice. Using a novel portable NO generator we found that NO at 20 ppm attenuates endotoxin (LPS) induced neutrophil recruitment lung alveolar epithelial damage reduced inflammatory cytokines, neutrophil. Therefore, the data suggest that the use of a portable NO generator may be considered as an interesting therapeutic possibility for patients with severe ARDS.

Background: In recent years, there has been a greater emphasis on the epidemiological of mistakes and adverse outcomes rather than on procedures that decrease such incidents. aim of study is to: Assess nurses Knowledge regarding preoperative nursing safety practices for cardiac catheterization patients. Methodology: The descriptive research design was utilized for this study. and the sitting of the study was at AL Hussein teaching hospital in Al muthanna governorate. The subjects of the study consisted of all nurses (30 nurses) working at the above mentioned. The toll of the study included the safety practices in the postoperative phase cardiac catheterization. These were categorized a checklist related to the availability of the equipment and safety items provided for patients at the catheterization unit. This checklist items was checked as being either available (2) ,or (1) not available (0). As regard safety it is a three Likert scale ranged from done completely (2), done incompletely (1), to not done (0). Result: the main results of study reveal that, there was no a highly significant relation between socio-demographic characteristics and nursing safety practices for cardiac catheterization patients at preoperative phase. Conclusion: the studied nurses had no significance in practicing safety practices in cardiac catheterization centers. Educational levels and years of experience had no statistical significant effects on nurses' safety practices. Recommendation: Pre- services on the job training programs are advocated for all nurses about patients' safety in nursing work requirement and utilize the results of the current study to ameliorate& update cardiac catheterization patient’s safety practices with continuing evaluation.