Leptospirosis is a life-threatening zoonotic disease of global distribution. It has variable presentation ranging from mild febrile illness to life-threatening complications like acute renal failure, acute hepatic fai...Leptospirosis is a life-threatening zoonotic disease of global distribution. It has variable presentation ranging from mild febrile illness to life-threatening complications like acute renal failure, acute hepatic failure, pulmonary hemorrhages and cardiac arrhythmias. Cardiac manifestations of leptospirosis are not uncommon but are underdiagnosed. Cardiac manifestations may vary from minor rhythm abnormalities to fatal ventricular arrhythmias. We report an unusual presentation of leptospirosis in a patient who presented to the Emergency Department with epigastric pain and congestive cardiac failure with rhythm disturbances and selective myocardial involvement mimicking as Non ST elevation Inferior wall myocardial infarction (NSTEMI). The Cardiac manifestations of Leptospirosis need meticulous intensive care management as the mortality rate is very high in this subset of patients. Index suspicion and early treatment remains the mainstay of this life threatening zoonotic disease.展开更多
Treatment of acute ischaemic stroke(AIS)focuses on rapid recanalisation of the occluded artery.In recent years,advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retr...Treatment of acute ischaemic stroke(AIS)focuses on rapid recanalisation of the occluded artery.In recent years,advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure.Despite ongoing developments and progress in AIS imaging techniques,it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment.Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients.In this review,what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined.This review also discusses the evidence that AIS thrombus composition varies with aetiology,questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment.Furthermore,this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition.Further use of new emerging technologies based on bioimpedance,as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced.Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.展开更多
文摘Leptospirosis is a life-threatening zoonotic disease of global distribution. It has variable presentation ranging from mild febrile illness to life-threatening complications like acute renal failure, acute hepatic failure, pulmonary hemorrhages and cardiac arrhythmias. Cardiac manifestations of leptospirosis are not uncommon but are underdiagnosed. Cardiac manifestations may vary from minor rhythm abnormalities to fatal ventricular arrhythmias. We report an unusual presentation of leptospirosis in a patient who presented to the Emergency Department with epigastric pain and congestive cardiac failure with rhythm disturbances and selective myocardial involvement mimicking as Non ST elevation Inferior wall myocardial infarction (NSTEMI). The Cardiac manifestations of Leptospirosis need meticulous intensive care management as the mortality rate is very high in this subset of patients. Index suspicion and early treatment remains the mainstay of this life threatening zoonotic disease.
基金funded by European Regional Development Fund(13/RC/2073_2)Sensome(No grant number),Science Foundation Ireland(13/RC/2073_2).
文摘Treatment of acute ischaemic stroke(AIS)focuses on rapid recanalisation of the occluded artery.In recent years,advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure.Despite ongoing developments and progress in AIS imaging techniques,it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment.Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients.In this review,what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined.This review also discusses the evidence that AIS thrombus composition varies with aetiology,questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment.Furthermore,this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition.Further use of new emerging technologies based on bioimpedance,as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced.Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.
