Assessment of Matrix Metalloproteinases-1 in Septic Acute

The extracellular matrix (ECM) does not simply maintain the form of tissues; it is a dynamic factor that plays a major role in cell function. Matrix metalloproteinases (MMPs) are the most important enzymes in ECM degradation, and their activity is controlled strictly by specific inhibitors, that is tissue inhibitors of metalloproteinase (TIMPs). We assessed the clinical course of changes in ECM-degrading enzymes TNF-a, IL-6, IL-8, and nitrite/nitrate (NOx) in the blood of two septic acute respiratory distress syndrome (ARDS) patients. Negative correlation was found between the PaO2/FIO2 ratio (P/F ratio) and MMP-1, but positive correlation was found between the P/F ratio and both the TIMP-1/MMP-1 ratio and MMP-1 • TIMP-1 complex level. TIMP-1 was consistently maintained at high levels. These results suggest that both MMP-1 and TIMP-1 may be involved in septic ARDS, and that the balance between MMP-1 and TIMP-1 is important.


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Thyroid Storm: A Forgotten Cause of Arrhythmias with Septic Feature

Hyperthyroidism is the condition resulting from the effect of excessive amounts of thyroid hormones on body tissues. A dramatic extreme expression of thyrotoxicosis known as thyroid strom occurs rarely but requires prompt recognition and intervention to avoid the 90 percent mortality of untreated disease. Characteristically the patient present with fever, rapid tachyarrhythmias and atrial fibrillation. High output congestive heart failure can result from the tachycardia and severe hypermetabolic state. Frequently the clinical picture is clouded by a secondary infection such as pneumonia, a viral infection, or infection of the upper respiratory tract. Because of its variable presentation and because thyroid storm is rare condition, the correct diagnosis may be missed. We report two interesting cases of thyroid storm. The first was a lady who presented with a supraventricular tachycardia and atrial fibrillation initially misdiagnosed as septicemia with arrhythmias. The second case was a man with longstanding undiagnosed hyperthyroidism who presented with threatening thyroid storm and atrial fibrillation associated with cardiomyopathy. Both patients were subsequently managed successfully at our hospital. We hope misdiagnosis and late treatment of the similar cases will be avoided in the future.


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Respiratory Distress in An Infant Induced By Respiratory Syncytial Virus Bronchiolitis Complicated By Bronchogenic Cyst

A 3-month-old infant developed respiratory distress as a result of respiratory syncytial virus bronchiolitis. The patient was first treated for initial symptoms which were gradually improving, but mechanical ventilation was required for seven days. Upon extubation, rapid respiratory distress ensued, requiring reintubation. Chest computed tomograph examination revealed a mediastinal mass, which was surgically removed and the patient was successfully weaned from mechanical ventilation. Histological diagnosis was bronchogenic cyst.


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Interleukin 11 and Stem Cell Factor Levels in Patients with Disseminated Intravascular Coagulation: A Report of Four Cases

Interleukin 11 (IL-11) and stem cell factor (SCF) stimulate platelet production. In this study, we examined serum IL-11 and SCF levels in 4 patients with disseminated intravascular coagulation (DIC) complicating massive trauma and infections. The serum concentrations of both IL-11 and SCF showed a marked increase coinciding with the development of DIC in these patients, regardless of the presence or absence of infections. Further studies are required to confirm whether the increase in levels of these two platelet- inducing cytokines with the onset of DIC reflects an enhancement of platelet production in order to maintain the biological system in balance, or simply an inflammatory biological response.


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Significantly Raised Brain Natriuretic Peptide in a Young Patient with Dengue Fever without Heart and Renal Failure

Objective: This is the fi rst case report of association of raised brain natriuretic peptide (BNP) in patients with dengue fever (DF). BNP is raised in patients with heart failure. It can also be elevated in renal failure and subarachnoid haemorrhage in the absence of heart failure. Raised BNP has never been described in patients with DF. Clinical features: We describe a young patient with DF who complained of sudden onset breathlessness on day 3 of admission. She was found to have right sided crepitations. Myocardial screen was done which was negative but BNP was 3555 pg/ml. Her SpO2 and arterial blood gas while breathing room air was normal. There was no elevated jugular venous pressure, pedal edema or laboratory evidence of heart failure. There was no renal impairment or systemic infl ammatory response syndrome. A transthoracic 2-dimensional echocardiography was normal. Treatment: Patient was treated with intravenous fl uids and oral clarithromycin for 5 days. Outcome: Patient was discharged on day 8 of admission. She was well but follow-up BNP was high but on downward trend. She refused any further invasive investigations for heart. Conclusions: BNP may be raised in patient with DF without heart failure. The exact pathogenesis of raised BNP in DF is unclear.


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Unilateral Diaphragmatic Pacing: An Innovative Solution for Unilateral Diaphragmatic Paralysis

Mechanical ventilation has always been a cornerstone of respiratory support for patients with respiratory muscle paralysis. In selected patients, diaphragm pacing (DP) through electrical stimulation of the phrenic nerves provides an alternative to mechanical ventilation with signifi cant advantages in life quality. We report an interesting case of unilateral diaphragmatic paralysis in which unilateral diaphragmatic pacing produced signifi cant improvement in quality of life.


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