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1.  Cryofibrinogenaemia: not just skin deep 
BMJ Case Reports  2013;2013:bcr2012008102.
A Caucasian woman in her 60s with a history of rheumatoid arthritis presented to our institution complaining of skin ulceration. Her initial course was complicated by superinfection and sepsis until a diagnosis of cryofibrinogenaemia was finally established. Cryofibrinogenaemia remains as an under-recognised entity in part, because it can mimic other causes of skin ulcerations. In addition, its diagnosis can be challenging because of the particular handling techniques required of lab specimens. This case exemplifies some of the diagnostic and treatment challenges encountered while managing the patient with cryofibrinogenaemia.
PMCID: PMC3604005  PMID: 23429017
2.  Long Term Mortality Risk in Individuals with Atrial or Ventricular Premature Complexes– Results From The Third National Health And Nutrition Examination Survey (NHANES III) 
Premature ectopic beats are frequently detected on routine 12-lead screening-electrocardiogram (ECG). However, their prognostic importance in individuals without known cardiovascular disease (CVD) is not well established. We evaluated prognostic value of atrial premature complexes (APC’s) and ventricular premature complexes (VPC’s) detected by a single 12-lead-ECG. A prospective cohort of 7504 participants selected from nationally-representative, community-dwelling individuals living in United States, enrolled in the Third Health and Nutrition Examination Survey (NHANES-III) from 1988 – 94 with follow up through December 2006 without known CVD. The main outcomes were all – cause mortality, CVD related mortality and IHD related mortality. Out of 7504 participants (mean age 60 ± 14 years, 47% women, 49% whites), 89 (1.2%) had APC’s and 110 (1.5%) had VPC’s on 12 – lead ECG. During a follow up of up to 18 years, 2386 deaths occurred, of which 963 were due to CVD and 511 were due to IHD. In a multivariable adjusted for demographics, clinical variables and ECG measures, APC’s were significantly associated with all-cause mortality [HR, 1.41 (95% CI, 1.08–1.80)], CVD death [HR, 1.78 (95% CI, 1.26–2.44)] and IHD death [HR, 2.40 (95% CI, 1.59–3.47)]. For VPCs, however, there were no significant associations with all – cause mortality [HR, 1.05 (95% CI, 0.80–1.36)], CVD death [HR, 0.96 (95% CI, 0.62–1.43)] and IHD death [HR, 0.89 (95% CI, 0.47–1.52)]. In conclusion, APC’s, but not VPC’s, on routine screening ECG are predictive of adverse events in community-dwelling individuals without known CVD.
PMCID: PMC4334655  PMID: 24819898
Ventricular premature complex; atrial premature complex; mortality; cardiovascular disease mortality; ischemic heart disease mortality
3.  Aortic arch variant presenting as an acute ST elevation myocardial infarction 
BMJ Case Reports  2013;2013:bcr2012007962.
A woman in her 40s presented to our institution with a first episode of sudden-onset right-sided chest pain. Initially, her ECG revealed ST segment elevation in leads V1–V3 and cardiac biomarkers were elevated with a troponin I (TnI) 5 µg/l. Her cardiac risk factors included type II diabetes mellitus and a history of hypertension. Intravenous heparin was initiated and emergent cardiac catheterisation revealed non-obstructive coronary artery disease. A two-dimensional echocardiogram confirmed hypokinesis of the anterior wall. A CT thorax demonstrated a rare anatomical variant of the aortic arch with an aberrant right subclavian artery. This is a rare case of an aortic arch anomaly presenting as a myocardial infarction.
PMCID: PMC3604285  PMID: 23314453
4.  Disseminated Intravascular Coagulation as a Possible Cause of Acute Coronary Stent Thrombosis: A Case Report and Literature Review 
Case Reports in Critical Care  2012;2012:178260.
Disseminated intravascular coagulation (DIC), as a cause of acute coronary stent thrombosis, has not yet been reported to our knowledge. We report a case of 64-year-old male, who presented with non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography revealed right coronary artery (RCA) stenosis and a drug eluting stent was deployed. Fifteen hours following the intervention, the patient developed an inferior wall ST elevation myocardial infarction. Repeat cardiac catheterization showed an acute in-stent thrombosis. Following thrombectomy, another stent was placed. The patient noted to have an acute drop in platelet count following the second intervention. Two hours following repeat intervention, the patient again developed chest pain and EKG showed recurrent ST-segment elevations in leads II, III, and aVF. Prior to repeat cardiac catheterization, the patient became unresponsive and developed cardiogenic shock. The patient was resuscitated and intubated, and repeat catheterization showed complete stent thrombosis. Intracoronary tissue plasminogen activator (tPA) was given. The platelet count further dropped. Additional studies confirmed the diagnosis of DIC. No further cardiac catheterization was done at this point. The patient then later had a cardiac arrest and unfortunately cardiopulmonary resuscitation could not revive him. Amongst the etiologies of acute stent thrombosis, DIC was deemed a possible cause.
PMCID: PMC4010063  PMID: 24826332
5.  Erythromelalgia: An Uncommon Presentation Precipitated by Aspirin Withdrawal 
Case Reports in Medicine  2012;2012:616125.
Erythromelalgia is a rare disorder frequently associated with myeloproliferative disorders. We describe a case of elderly patient diagnosed with myeloproliferative disorder in remission. The patient was on aspirin for secondary prevention of stroke and was taken off aspirin and developed erythromelalgia within two weeks of withdrawal of aspirin. After restarting aspirin, patient's symptoms improved within 2 weeks.
PMCID: PMC3403327  PMID: 22844295
6.  Public Availability of Published Research Data in High-Impact Journals 
PLoS ONE  2011;6(9):e24357.
There is increasing interest to make primary data from published research publicly available. We aimed to assess the current status of making research data available in highly-cited journals across the scientific literature.
Methods and Results
We reviewed the first 10 original research papers of 2009 published in the 50 original research journals with the highest impact factor. For each journal we documented the policies related to public availability and sharing of data. Of the 50 journals, 44 (88%) had a statement in their instructions to authors related to public availability and sharing of data. However, there was wide variation in journal requirements, ranging from requiring the sharing of all primary data related to the research to just including a statement in the published manuscript that data can be available on request. Of the 500 assessed papers, 149 (30%) were not subject to any data availability policy. Of the remaining 351 papers that were covered by some data availability policy, 208 papers (59%) did not fully adhere to the data availability instructions of the journals they were published in, most commonly (73%) by not publicly depositing microarray data. The other 143 papers that adhered to the data availability instructions did so by publicly depositing only the specific data type as required, making a statement of willingness to share, or actually sharing all the primary data. Overall, only 47 papers (9%) deposited full primary raw data online. None of the 149 papers not subject to data availability policies made their full primary data publicly available.
A substantial proportion of original research papers published in high-impact journals are either not subject to any data availability policies, or do not adhere to the data availability instructions in their respective journals. This empiric evaluation highlights opportunities for improvement.
PMCID: PMC3168487  PMID: 21915316

Results 1-6 (6)