Search Results (267)

Background: Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is an acute but reversible form of left ventricular dysfunction, most commonly triggered by physical or emotional stress. Although well documented in cardiology practice, its occurrence following hepatobiliary surgery is rarely reported. Case presentation: We describe the case of a 67-year-old woman with a history of arterial hypertension and prior cholecystectomy who was admitted for elective hepatobiliary surgery due to choledocholithiasis complicated by a liver abscess. She underwent laparotomy with choledocholithotomy, hepaticojejunostomy, and abdominal drainage. The postoperative course was complicated by intra-abdominal bleeding, requiring reoperation, and subsequent intestinal leakage, necessitating a second re-laparotomy. On the tenth postoperative day after the second surgery, she developed chest discomfort and dyspnea upon minimal exertion. Electrocardiography revealed T-wave inversions in leads V3–V6, while echocardiography demonstrated a reduced ejection fraction of 45% with apical akinesis. Plasma levels of N-terminal pro-B-type natriuretic peptide (NT–proBNP) were elevated, whereas troponin remained within normal limits. Coronary angiography excluded obstructive coronary artery disease, and ventriculography confirmed apical ballooning consistent with Takotsubo cardiomyopathy. Conclusions: This case highlights Takotsubo cardiomyopathy as a rare but important postoperative complication of major hepatobiliary surgery. Awareness of this condition in surgical patients presenting with acute chest symptoms is essential, as timely recognition and differentiation from acute coronary syndrome directly influence management and prognosis. Full article

Background/Objectives: Acute respiratory distress syndrome (ARDS) represents a critical complication in polytrauma patients, characterized by diffuse lung inflammation and bilateral pulmonary infiltrates with mortality rates reaching 45% in intensive care units (ICU). The heterogeneous nature of ARDS and complex clinical presentation in severely injured patients poses substantial diagnostic challenges, necessitating early prediction tools to guide timely interventions. Machine learning (ML) algorithms have emerged as promising approaches for clinical decision support, demonstrating superior performance compared to traditional scoring systems in capturing complex patterns within high-dimensional medical data. Based on the identified research gaps in early ARDS prediction for polytrauma populations, our study aimed to: (i) develop a balanced random forest (BRF) ML model for early ARDS prediction in critically ill polytrauma patients, (ii) identify the most predictive clinical features using ANOVA-based feature selection, and (iii) evaluate model performance using comprehensive metrics addressing class imbalance challenges. Methods: This retrospective cohort study analyzed 407 polytrauma patients admitted to the ICU of the Center of Traumatology and Major Burns of Ben Arous, Tunisia, between 2017 and 2021. We implemented a comprehensive ML pipeline that incorporates Tomek Links undersampling, ANOVA F-test feature selection for the top 10 predictive variables, and SMOTE oversampling with a conservative sampling rate of 0.3. The BRF classifier was trained with class weighting and evaluated using stratified 5-fold cross-validation. Performance metrics included AUROC, PR-AUC, sensitivity, specificity, F1-score, and Matthews correlation coefficient. Results: Among 407 patients, 43 developed ARDS according to the Berlin definition, representing a 10.57% incidence. The BRF model demonstrated exceptional predictive performance with an AUROC of 0.98, a sensitivity of 0.91, a specificity of 0.80, an F1-score of 0.84, and an MCC of 0.70. Precision–recall AUC reached 0.86, demonstrating robust performance despite class imbalance. During stratified cross-validation, AUROC values ranged from 0.93 to 0.99 across folds, indicating consistent model stability. The top 10 selected features included procalcitonin, PaO₂ at ICU admission, 24-h pH, massive transfusion, total fluid resuscitation, presence of pneumothorax, alveolar hemorrhage, pulmonary contusion, hemothorax, and flail chest injury. Conclusions: Our BRF model provides a robust, clinically applicable tool for early prediction of ARDS in polytrauma patients using readily available clinical parameters. The comprehensive two-step resampling approach, combined with ANOVA-based feature selection, successfully addressed class imbalance while maintaining high predictive accuracy. These findings support integrating ML approaches into critical care decision-making to improve patient outcomes and resource allocation. External validation in diverse populations remains essential for confirming generalizability and clinical implementation. Full article

Background: Coronary computed tomography angiography (CCTA) is a non-invasive imaging tool used predominantly in suspected chronic coronary artery disease (CAD) patients, due to its high negative predictive value. However, increasing focus has been placed on CCTA to manage and risk stratify acute chest pain patients in emergency departments (ED). Objective: This scoping review summarizes the available evidence on the role of CCTA to exclude acute coronary syndrome (ACS) in low-risk acute chest pain patients, focusing on its diagnostic accuracy, safety, and application in the context of high sensitivity cardiac troponin assays (hs-cTn). Methods: Articles published between January 2015 and March 2025 investigating CCTA use in low-risk acute chest pain patients were retrieved from Medline, Embase, Emcare, and Web of Science databases. Results: 22 articles (13,617 patients) were retrieved. CCTA had strong diagnostic performance, with an excellent negative predictive value (99.8–100%) and sensitivity (94–100%) for ACS diagnosis and prediction of major adverse cardiovascular events. Specificity and positive predictive values were lower and less consistent. When combined with hs-cTn, the diagnostic accuracy of CCTA for ACS was improved significantly. CCTA was associated with low rates of ACS at follow-up (0–3.5%), which were lower than or comparable to the safety outcomes of standard care and stress testing. Full article

Background: Acute coronary syndrome (ACS) is a major cardiovascular emergency influenced by environmental and genetic factors. Thrombophilic variants such as prothrombin G20210A (rs1799963) and factor V Leiden G1691A (rs6025) may influence thrombin generation and has been reported to show associations with coronary events. Methods: This case–control study included 100 ACS patients and 131 age and sex-matched healthy controls. Genotyping of rs1799963 and rs6025 was performed using polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) analysis. Results: The GG genotype was markedly more common among ACS patients for both variants. For rs1799963, carriers of the A allele (GA + AA) were less common in ACS (2.0%) than controls (9.2%; p = 0.039), corresponding to an 8.6-fold higher odds of ACS in GG carriers (OR = 8.624; 95% CI: 1.757–42.345; p = 0.008). For rs6025, A allele carriers (9.0%) were also reduced in ACS versus controls (18.3%; p = 0.049), and GG homozygotes exhibited a 2.6-fold higher risk (OR = 2.635; 95% CI: 1.104–6.290; p = 0.029). Age was independently associated with higher ACS risk (OR = 1.047; 95% CI: 1.029–1.066; p < 0.001). Conclusions: Our findings indicate that the rs1799963 and rs6025 variants were independently associated with ACS, together with advancing age. Both the GG genotype and older age were associated with higher odds of ACS, whereas A-allele carriers appeared less common among ACS cases. Full article

Background: Down syndrome (DS) is commonly associated with complex respiratory phenotypes due to anatomical, immunological, and vascular factors. Pulmonary sequestration (PS) is a rare congenital malformation of non-functioning lung tissue with anomalous systemic arterial supply, occasionally reported in syndromic individuals. Case presentation: We report the case of a female infant with DS who developed acute respiratory distress secondary to respiratory syncytial virus infection. Chest imaging revealed an intralobar pulmonary pseudosequestration in the right lower lobe, supplied by the celiac trunk and draining into the pulmonary veins, with a communication to the bronchial tree. The patient required pediatric intensive care support and nutritional rehabilitation. Surgical resection was deferred until adequate weight optimization could be achieved. Discussion: This is, to our knowledge, the first description of intralobar pulmonary pseudosequestration in a patient with DS. The association suggests possible overlapping developmental mechanisms involving abnormal angiogenesis and emphasizes the importance of considering congenital pulmonary malformations in DS patients presenting with recurrent or severe respiratory symptoms. Conclusions: Early recognition and tailored management may improve clinical outcomes in this vulnerable population. Full article

Sickle cell disease (SCD) is the most common monogenic disorder worldwide and remains a major cause of morbidity and mortality. Sickle cell anemia (SCA), the homozygous HbSS genotype, represents the most severe and frequent form within the spectrum of SCD. Hydroxyurea (HU), a ribonucleotide reductase inhibitor, represents the first and most widely used disease-modifying therapy for SCA. This review summarizes current evidence on the mechanisms of action, clinical efficacy, systemic effects, and long-term safety of chronic HU therapy in patients with SCA. A comprehensive literature search was conducted in PubMed up to 2025 using the terms “sickle cell disease,” “sickle cell anemia”, “hydroxyurea,” and “children” or “paediatric.” Eligible studies included randomized controlled trials, cohort studies, and systematic reviews evaluating HU therapy in SCA. Literature analysis showed that HU exerts pleiotropic effects by inducing fetal hemoglobin (HbF) synthesis, improving red blood cell deformability, reducing leukocyte and platelet counts, and enhancing nitric oxide bioavailability. These mechanisms lead to decreased vaso-occlusive crises, acute chest syndrome, transfusion requirements, and overall mortality. Beyond hematologic improvement, HU confers neuroprotective benefits, modulates inflammatory and immune pathways, and supports normal growth and endocrine development in children. Adverse events, primarily mild bone marrow suppression, are dose-dependent and reversible with appropriate monitoring. No evidence supports an increased risk of malignancy with long-term use. In conclusion, chronic HU therapy is a safe, effective, and multifaceted treatment that substantially improves survival and quality of life in patients with SCA. Early initiation and individualized dosing maximize its therapeutic benefits and help prevent irreversible organ damage. Full article

Background and Clinical Significance: Fever of undetermined origin (FUO is a diagnostic challenge. It is essential to exclude infections, paraneoplastic syndromes, and large-vessel vasculitis (LVV). Case presentation: We describe a 59-year-old female with FUO and no apparent signs of infection. Laboratory results were consistent with inflammation (ESR 83, CRP 203 (ref. value (RV) < 5 mg/dl), ferritin 311 (RV < 120 µg/L), microcytic anemia, thrombocytosis. With administration of both ceftriaxone and levofloxacin, a decrease in CRP was monitored (51 mg/L). HRCT of the chest, abdomen, and pelvis revealed a saccular aneurysm of the descending thoracic aorta and an ectatic right common iliac artery. Due to suspicion of LVV, CT angiography was performed to exclude inflammatory changes in the blood vessels. Diffuse atherosclerosis with a 30 mm penetrating thoracic aortic ulcer (PAU) was found. PET-CT and leukocyte scintigraphy were used to rule out vasculitis and infection. The patient was successfully treated with Thoracic Endovascular Aortic Repair (TEVAR). Conclusions: As sophisticated imaging techniques become more widely used, more PAUs are being detected as incidental abnormalities in individuals without acute aortic syndrome. With adequate management, many people with PAU can live a stable and healthy life without experiencing significant consequences. Full article

Lung involvement in patients with leptospirosis is associated with a more complicated disease course. However, the demographic and clinical associations of lung involvement are incompletely defined, and its optimal management is uncertain. This retrospective study examined consecutive patients admitted to a referral hospital in tropical Australia, with laboratory-confirmed leptospirosis between January 2015, and June 2024. Lung involvement was defined as new lung parenchymal changes on chest imaging at any point during the patients’ hospitalisation. The demographics, clinical findings and clinical course of the patients with and without lung involvement were compared. The median (interquartile range (IQR)) age of the 109 patients was 39 (24–56) years; 93/109 (85%) were male. Lung involvement was present in 62/109 (57%), 55 (89%) of whom had no documented comorbidities. Patients with lung involvement received antibiotics later in their disease course than those without lung involvement (after a median (IQR) of 5 (4–6) versus 3 (2–5) days of symptoms, p = 0.001). Lung involvement was frequently associated with multi-organ failure: patients with lung involvement were more likely to require intensive care unit admission than patients without lung involvement (41/62 (66%) versus 15/47 (32%), p < 0.001). Overall, 30/109 (28%) satisfied criteria for acute respiratory distress syndrome (ARDS) and 26/109 (24%) developed pulmonary haemorrhage. Patients with lung involvement received cautious fluid resuscitation, vasopressor support and prompt initiation of additional supportive care—including mechanical ventilation, renal replacement therapy and extracorporeal membranous oxygenation—guided by the patients’ physiological parameters and clinical trajectory. All 109 patients in the cohort were alive 90 days after discharge. Life-threatening lung involvement was identified in the majority of individuals in this cohort and occurred in young and otherwise well individuals. However, in Australia’s well-resourced health system excellent outcomes can be achieved using a standard contemporary approach to the management of a patient with undifferentiated infection while a confirmed diagnosis of leptospirosis is awaited. Full article

Objectives: The field of view on abdominal CT includes the lower portion of the heart and thoracic aorta. Notably, triple rule-out (TRO) abnormalities [acute myocardial infarction (AMI), acute aortic syndrome (AAS), and pulmonary thromboembolism (PE)] may be overlooked on abdominal CT. The purpose of this paper is to evaluate the frequency of overlooked TRO abnormalities on abdominal CT in patients presenting with nonspecific abdominal pain. Methods: We retrospectively identified 913 patients from January 2017 to June 2018 in whom enhanced abdominal CT was performed due to nonspecific abdominal pain. Two chest radiologists retrospectively assessed the abdominal CT, focusing on whether TRO abnormalities were overlooked. Results: Upon retrospective review, there were 0.5% TRO abnormalities (four AMI and one AAS) not described on abdominal CT. A majority (71.4%) of the TRO abnormalities were overlooked on the initial CT report. Conclusions: Radiologists should routinely assess the lower chest on abdominal CT to avoid overlooked TRO abnormalities. Full article

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD) with complex infectious and non-infectious etiologies. Bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and atypical organisms such as Mycoplasma pneumoniae, play crucial roles in ACS pathogenesis, particularly in immunocompromised SCD patients with functional asplenia. Despite the importance of infectious triggers, regional data on pathogen identification rates and antimicrobial management strategies in ACS remain limited, especially from high-prevalence SCD regions. This study aimed to investigate the infectious etiologies, pathogen identification patterns, and antimicrobial management outcomes of ACS in adult SCD patients in Eastern Saudi Arabia. A five-year retrospective analysis was conducted on patients aged ≥14 years with SCD who were admitted with ACS to Dammam Medical Complex between 2018 and 2022. Comprehensive microbiological evaluation included blood cultures, sputum cultures, and atypical pathogen testing (Mycoplasma pneumoniae, Chlamydia pneumoniae). Data on antimicrobial regimens, pathogen identification rates, vaccination status against encapsulated bacteria, and clinical outcomes were systematically analyzed. Empirical antibiotic strategies and their effectiveness in this immunocompromised population were evaluated. A total of 60 adult SCD patients experiencing 80 episodes of ACS were included. Despite comprehensive microbiological workup, specific infectious pathogens were identified in only 8 (10.0%) episodes, highlighting the complex multifactorial etiology of ACS. Blood cultures yielded pathogens in 5 (6.3%) cases, sputum cultures in 4 (5.0%) cases, and Mycoplasma pneumoniae was identified in 3 (3.8%) episodes. All patients received empirical broad-spectrum antimicrobial therapy, with ceftriaxone and azithromycin combination being the most frequent regimen (76 cases, 95.0%), providing coverage for both typical and atypical bacterial pathogens. Antibiotic escalation was required in 16 (20.0%) episodes. Vaccination rates against Streptococcus pneumoniae were suboptimal at 30 (50.0%), representing a significant risk factor for invasive bacterial infections in this functionally asplenic population. The intensive care unit (ICU) admission rate was 15 (18.8%), and in-hospital mortality was 3 (3.8%), with infectious complications contributing to severe outcomes. In this cohort of SCD patients, ACS demonstrated low rates of specific pathogen identification despite systematic microbiological investigation, supporting the multifactorial infectious and non-infectious etiology of this syndrome. The predominant use of broad-spectrum antimicrobial therapy targeting both typical and atypical bacterial pathogens proved effective in this immunocompromised population. However, suboptimal vaccination rates against encapsulated bacteria represent a critical gap in infection prevention strategies. These findings emphasize the importance of empirical antimicrobial coverage for suspected bacterial pathogens in ACS management and highlight the urgent need for enhanced vaccination programs to prevent infectious complications in functionally asplenic SCD patients. Full article

Background: Acute chest pain is a common emergency with only 10–20% of cases attributable to acute coronary syndrome (ACS). Rapid and accurate pre-hospital diagnosis remains challenging, particularly for non-ST elevation ACS, where ECG findings may be inconclusive. AI-guided focused cardiac ultrasound (FoCUS) using handheld devices offers a potential solution by enabling immediate functional cardiac assessment. The aim was to investigate the feasibility and diagnostic performance of pre-hospital AI-guided FoCUS for detecting ACS in patients with acute chest pain. Methods: In this single-center, prospective pilot study, 75 patients with acute chest pain were enrolled. FoCUS examinations were performed by experienced sonographers (72%) and EMS paramedics (28%) using AI-guidance for obtaining the apical 4-chamber (AP4CH), apical 2-chamber (AP2CH), and apical 3-chamber (AP3CH) views. The quality of the obtained images was assessed, and quantitative measurements—including left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS)—were analyzed. Diagnostic performance was subsequently evaluated using ROC curve analysis. Results: At least one apical view was acquired in 91% of patients, with sonographer achieving higher acquisition rates than paramedics (96% vs. 67% for the AP4CH view). Complete acquisition of all apical views was achieved in 67% of cases (83% vs. 24%), and image quality was high across views, with median scores ranging from 83% to 100%. GLS yielded an AUC of 0.76 (89% sensitivity, 56% specificity) and LVEF yielded an AUC of 0.65 (75% sensitivity, 73% specificity). In patients with intermediate to high HEAR-scores (>3), lower LS-AP4CH values were associated with ACS. Conclusion: Pre-hospital AI-guided FoCUS is feasible and shows promise for ACS detection, although quantitative parameters do not yet outperform established clinical scores. Enhanced training and further refinement of AI algorithms are needed before widespread implementation. Full article

Background/Objectives: Cardiovascular diseases (CVDs), including valvular heart disease (VHD), remain the leading cause of morbidity and mortality in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Case Presentation: We report a rare case of a woman in her fifth decade of life diagnosed with overlap syndrome (RA and SLE), in whom transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) revealed a degenerative altered bicuspid aortic valve with moderate aortic regurgitation (AR) and preserved left ventricular systolic function. The patient presented with a recent history of continuous, moderate chest discomfort and progressive exertional dyspnea, along with a mild elevation in highly cardioselective enzymes. AR was confirmed as the cause of her symptoms, rather than acute coronary syndrome or heart failure. Conclusions: This case highlights the potential contribution of chronic systemic inflammation in RA/SLE to the pathogenesis of AR, an extra-articular manifestation associated with adverse clinical outcomes. These findings support the routine use of echocadiography in rheumatologic patients as a key strategy for early detection and prevention of life-threatening CV complications. Full article

Background: Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with life-threatening complications such as acute chest syndrome (ACS), which may necessitate extracorporeal membrane oxygenation (ECMO) in refractory cases. Despite growing use, ECMO in SCD remains challenging due to risks of hemolysis, thrombosis, and anticoagulation complications. This systematic review consolidates existing evidence on ECMO outcomes in SCD, focusing on indications, complications, and survival. Methods: A systematic search of MEDLINE, Cochrane CENTRAL, and Google Scholar was conducted up to January 2025, identifying case reports/series on ECMO use in SCD. Studies reporting venovenous (VV) or venoarterial (VA) ECMO for acute cardiopulmonary failure were included. Data on demographics, laboratory findings, management, and outcomes were extracted. Quality assessment was performed using the Joanna Briggs Institute checklist. Results: Sixteen case reports (23 patients) were included. Most patients were female (65.2%), with ACS (47.8%) and pulmonary embolism (13.0%) as common ECMO indications. VV-ECMO (69.6% of cases) was primarily used for respiratory failure, with a 69% survival rate, while VA-ECMO (30.4%) had a 29% survival rate, often due to cardiogenic shock or cardiac arrest. Complications included hemorrhage (26.1%), neurological injury (21.7%), and thrombosis (13.0%). Exchange transfusion was frequently employed (43.5%), with post-ECMO echocardiography showing improved right ventricular function in survivors. Conclusions: VV-ECMO demonstrates favorable outcomes in SCD-related respiratory failure, whereas VA-ECMO carries higher mortality risks. Careful patient selection, anticoagulation management, and multidisciplinary coordination are essential. Larger prospective studies are needed to refine ECMO utilization in this high-risk population. Full article

Introduction: Chest pain is one of the most common and high-risk presentations in the emergency department (ED), necessitating timely and accurate evaluation to prevent adverse cardiovascular outcomes. Coronary Computed Tomography Angiography (CCTA) has emerged as a promising non-invasive modality with high sensitivity (90–100%) and a negative predictive value (98–100%) for ruling out significant coronary artery disease (CAD), as evidenced by trials such as ROMICAT II and ACRIN-PA. Despite its expanding role in ED triage, further evaluation of its impact on patient-centered outcomes is essential. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between January 2010 and June 2025 were identified from PubMed, Embase, and the Cochrane Library. Eligible studies included randomized controlled trials and prospective cohort studies assessing CCTA in ED patients with suspected acute coronary syndrome (ACS), compared with alternative diagnostic strategies, and reporting outcomes, including diagnostic accuracy, time to diagnosis, ED discharge rates, hospital admissions, and cost-effectiveness. Results: Twenty-three studies comprising over 60,000 patients were included. CCTA in low- to intermediate-risk patients significantly reduced diagnostic time (up to 54%), increased early ED discharges, and lowered unnecessary admissions. It consistently demonstrated excellent diagnostic performance, with pooled sensitivity ≥90% and near-perfect negative predictive value. Economic evaluations showed reduced costs due to shorter ED stays and less downstream testing. Challenges included radiation exposure, contrast use, and incidental findings. Conclusions: CCTA enhances ED efficiency and safety in ACS evaluation, offering accurate CAD exclusion and resource optimization. Future studies should explore its long-term cost-effectiveness and integration into high-sensitivity troponin protocols. Full article

Background: Patients with sickle cell disease (SCD) experience severe and life-threatening complications over their lifespans. However, research on SCD age-related complications is limited. Objective: This study examined differences in the number and type of SCD-related complications by age group among Texas Medicaid pediatric patients, and the factors associated with salient complications. Methods: This retrospective study used Texas Medicaid prescription and medical claims (2012–2021). Subjects aged 2 to 18 years, with ≥3 SCD hospitalizations or outpatient visits, and continuously enrolled for ≥12 months after the first SCD diagnosis claim were included. Complications were characterized by number and type of organ systems affected. Sociodemographic and clinical factors were used as potential factors associated with the most salient complications. Descriptive and inferential (ANOVA, Chi-square, and multivariable logistic regression) analyses were employed. Results: The included 1555 patients (mean age = 9.5 ± 5.1) were categorized into four age groups: 2–4 (23.4%), 5–9 (26.9%), 10–14 (27.4%), and 15–18 (22.3%) years. Documented number and type of complications differed significantly (all p < 0.0001) by age group, with the 2–14 years group having more documented complications compared to the 15–18 years group. Neurological complications were most common (~65%), followed by infections (~42%), and cardio-pulmonary complications (~30%). Young age group, hydroxyurea use, and having mental health comorbidities were associated with greater likelihood of experiencing vaso-occlusive crises, respiratory infections, and acute chest syndrome. Conclusions: Patterns of SCD-related complications (e.g., VOCs, respiratory infections, and acute chest syndrome) differ significantly by age group, leading to increased morbidity and acute care utilization. Despite its reported association with better outcomes, hydroxyurea utilization was found to be poor, with only 16% of patients receiving it for at least 180 days annually. Access to appropriate healthcare and improved utilization of hydroxyurea are needed to improve health outcomes of this population over their lifespan. Full article