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- 저자 : ( Jaime Aherrera ) (검색결과 2 건)
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( Jaime Aherrera ),( Lowe Chiong ),( Paul Reganit ),( Felix Punzalan ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Patients with documented acute coronary syndromes (ACS) exhibit a wide spectrum of early risk of death. An elevated neutrophil count predicts a worse outcome in ACS. In contrast, a low lymphocyte count is related to high risks of adverse outcomes. The neutrophil-lymphocyte ratio (NLR), therefore, integrates for two WBC subtypes with opposite actions in terms of vascular infl ammation. Objectives: Among patients diagnosed with ACS, we aim to determine if an elevated NLR taken within 24 hours of admission is associated with higher rates of adverse outcomes. Methods: A prospective cohort of adult patients admitted with a diagnosis of ACS was conducted. The participants were stratifi ed into two: low to intermediate NLR (NLR < 6.5) and high NLR (NLR > 6.50). Primary outcome was in-hospital mortality. Secondary outcomes include development or worsening of congestive heart failure (CHF) and the development of cardiogenic shock, re-infarction, renal failure, pneumonia, and arrhythmias. Results: 117 patients with a mean age of 60 +/- 13 were included. Diagnosis on admission was unstable angina (28%), NSTEMI (40%), and STEMI (37%). Analysis of data showed that the odds of in-hospital deaths among those with a high NLR is 5.71 times higher compared to those with low-intermediate NLR [OR 5.71 (1.53-21.23, p 0.009)]. Using linear regression, the NLR of patients who were non-survivors was computed at 9.91, while the NLR of those who survived was 5.47. A high NLR was also predictive of the development or worsening of CHF, shock, re-infarction, arrhythmias, and development of any adverse outcome. Conclusion: Among patients with ACS, an elevated NLR (>6.5) taken within 24 hours of presentation is a useful marker to predict in-hospital mortality, development or worsening or CHF, and development of shock, re-infarction, and arrhythmias.
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( Manalo Jaime Aherrera ),( Lauro Abrahan ),( Anastacio Degayo ),( Michael Agbayani ),( Michael Reyes ),( Wilfred Dee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Synopsis: The Wolff Parkinson White syndrome and mitral stenosis (MS) is a unfortunate combination, with less than 15 patients reported in literature. They are individually associated with supraventricular arrhythmias and their combination may have profound hemodynamic consequences. Our case is a young male presenting with neurologic deficits who was newly diagnosed with the WPW syndrome and mitral stenosis. Case: A 25 year old male sought consult syncope, palpitations, and dizziness. On the day of admission, he experienced persistent palpitations then subsequently lost consciousness. He had a diastolic rumble, right sided hemiparesis, and dysarthria. A cranial CT scan revealed a left basal ganglia infarction. Electrocardiogram showed sinus rhythm and left atrial enlargement, a short PR interval, wide QRS complexes, and delta waves. Holter monitoring showed episodes of atrial fl utter with rapid ventricular rates. QRS complexes were narrow during other episodes of tachycardia. Echocardiogram revealed moderate mitral stenosis and a dilated LA with no thrombus. Diagnosis was WPW syndrome and rheumatic MS manifesting as a stroke in the young. Percutaneous transvenous mitral commissurotomy (PTMC) was done. He is now on regular follow up on chronic anticoagulation and medical therapy for the WPW syndrome. Conclusion: To our knowledge, this is the fi rst case of a WPW syndrome with rheumatic MS presenting as a stroke in the young who was successfully managed with PTMC for MS and anti-arhrythmics for the WPW syndrome. This unfortunate combination may have potentiated the risk for cardioembolic events which emphasizes that detection of these entities is of paramount importance. Though either of the two entities may have caused the stroke, treatment is warranted for both entities as to avoid future episodes of cardioembolic phenomena.
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