The effect of displacement of the esophagus by transoesophageal echocardiography probe in cryoablation of atiral fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Sun ◽  
X.M Yin ◽  
L.J Gao ◽  
X.J Xiao ◽  
X.H Yu ◽  
...  
Keyword(s):  
Lower Risk ◽  
Transoesophageal Echocardiography ◽  
The Other ◽  
Esophageal Injury ◽  
Funding Source ◽  
Success Rates ◽  
Procedure Time ◽  
Mechanical Displacement ◽  
Significant Difference

Abstract Background Esophageal injury caused by cryoballoon-based PVI is common. Cryoablation guided by transoesophageal echocardiography (TEE) for occlusion of the pulmonary vein (PV) is safe and effective. Objective To investigate the protective effect of mechanical displacement of the esophagus by TEE probe in cryoablation of atiral fibrillation. Methods Fifty patients with paroxysmal AF (PAF) were enrolled in the present study. 25 patients underwent cryoablation without TEE (non-TEE group) and the other 25 underwent with TEE (TEE group) for PV occlusion guidance and displacement of the esophagus. In the TEE group during the procedure, TEE was used to guide the movement of the balloon to achieve PV occlusion. And before freezing, the probe of the TEE was moved to displace the esophagus away from the PV being freezed in order to reduce the risk of cryoinjury. All patients underwent esophagogastroscopy within 2 days of the procedure. The patients were followed up in our center at regularly scheduled visits every 2 months. Results There was no significant difference between the TEE group and non-TEE group in regard to the procedure time. The fluoroscopy time in the TEE group was less compared to the non-TEE group (4.1±3.3 min vs. 16.6±6.9 min, P<0.05), and the amount of contrast agent in the TEE group was less than the non-TEE group (4.7±5.7ml vs. 17.9±3.4 ml, P<0.05). The incidence of esophageal injury was significantly lower in TEE group compared with non-TEE group (0 vs. 20%, P<0.05). At a mean of 14.0 months follow-up, success rates were similar between the TEE group and non-TEE group (80.0% vs. 84.0%, P=0.80). Conclusion Cryoablation of AF with TEE for protecting the esophagus from cryoinjury is safe and effective. Lower risk of esophageal injury can be achieved with the help of TEE probe movement for mechanical displacement of the esophagus during freezing. Funding Acknowledgement Type of funding source: None

scholarly journals Diabetes and female gender are found to increase the hazard of deterioration? Results from the MEETinCY trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Lambrinou ◽  
A Protopapas ◽  
N Christoforou ◽  
N Vouri ◽  
A Malaktou ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Cox Regression ◽  
Hospital Readmissions ◽  
The Other ◽  
Rank Test ◽  
Control Group ◽  
Funding Source ◽  
Log Rank Test ◽  
Significant Difference

Abstract Background Despite advances in the treatment of heart failure (HF), HF deteriorations are characterized by high hospital readmissions and linked with increased morbidity and mortality. Aim The aim of this study was to determine the effectiveness of a nurse-led management program on the reduction of the number of visits to ER, unplanned readmissions and mortality of patients with HF due to acute events of decompensation at 12 and 24-weeks post discharge. Secondary aim was to identify possible association between demographic or clinical characteristics and the hazard for acute events. Methods This study was designed as a multicenter single-blinded randomized clinical trial (RCT), The MEETinCY, with three different intervention groups (IGs) and one control group (CG) that received the usual care which did not include a structured educational programme. The first IG received only education (EE) before discharge, the second IG received only telephone follow-up (TT) for three months after discharge, the third IG included combination of education before discharge and telephone follow-up (ET) for three months after discharge. The efficacy of interventions on mortality and rehospitalization rates were estimated using a Kaplan Meier analysis and were compared with log rank test. The association of demographic and clinical characteristics to the hazard for acute events was explored using a multivariate Cox regression. Results Two hundred and forty-two (242) patients completed the study [CG n=68, EE n=57, ET n=59, TT n=58]. During the 90 and 180 days study periods, the intervention groups, although appearing to have a “better survival experience” than the CG, no statistically significant difference was found for the periods 90 (log-rank test, x2 = 3.7 p=0.28) and 180 (log rang x2=2.87, p=0.41) days. Regarding the incidence risk of acute events (Readmission, ER visit, HF death) at 3 months seems to be higher in the CG (N=28–41.2%) than the other groups [EE n:16 28.1%, ET n:20 33.9%, TT n:16 27.6%], but not statistically significant (p=0.32). Results at 6 months showed the frequency of acute events in the CG (N=34, 50%), to be lower compared to the other groups [EE N:23 40.4%, ET n:24 39%, TT n:25, 43.1%], but not statistically significant (p=0.59). The hazard of deterioration was found to be significantly higher in patients with diabetes and in females, where the acute event hazard increased by 72% [HR: 1.72 (95% CI: 1.047–2.844), p=0.033)], and 88% [HR: 1.88 (95% CI: 1.172–3.013), p=0.009)] respectively. In addition, NYHA status was found to be associated with increased hazard of acute events; NYHA IV patients had 2.6 times higher risk [HR: 2,637, (95% CI: 1,007 - 6,902)] than NYHA I patients. Conclusions This highlights the need for further investigation of educational and supportive programs to reduce the risk of incidence of acute events in HF. It is also important to identify possible associated factors that may be reversible or preventable. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Cyprus University of Technology State Funding

HIV may indirectly accelerate coronary artery disease through enhancing the effects of conventional and non-conventional cardiovascular risk factors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kolossvary ◽  
E.K Fishman ◽  
G Gerstenblith ◽  
D.A Bluemke ◽  
R.N Mandler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Hiv Infection ◽  
Cardiovascular Risk Factors ◽  
Agatston Score ◽  
Funding Source ◽  
Significant Difference ◽  
Ascvd Risk ◽  
Artery Disease

Abstract Background/Introduction Cross-sectional studies are inconsistent on the potential independent adverse effects of human immunodeficiency virus (HIV)-infection on coronary artery disease (CAD). Furthermore, there is no information on the potential effects of HIV-infection on plaque volumes. Also, only the independent effects of HIV-infection on CAD have been investigated. Purpose In a prospective longitudinal observational cohort, we wished to assess whether HIV-infection accelerates CAD independently, or by acting in synergistic fashion with conventional and nonconventional cardiovascular risk factors to accelerate disease progression as assessed by clinical and volumetric parameters of CAD on coronary CT angiography (CCTA). Methods Overall, 300 asymptomatic individuals without cardiovascular symptoms but with CCTA-confirmed coronary plaques (210 males, age: 48.0±7.2 years) with or without HIV (226 HIV-infected) prospectively underwent CCTA at two time points (mean follow-up: 4.0±2.3 years). Agatston-score, number of coronary plaques, segment stenosis score were calculated, and we also segmented the coronary plaques to enumerate total, noncalcified (−100–350HU) and calcified (≥351HU) plaque volumes. Linear mixed models were used to assess the effects of HIV-infection, atherosclerotic cardiovascular disease (ASCVD) risk, years of cocaine use and high-sensitivity C-reactive protein on CCTA markers of CAD. Results In univariate analysis, there was no significant difference in CAD characteristics between HIV-infected and -uninfected, neither at baseline nor at follow-up (p>0.05 for all). Furthermore, there was no significant difference in annual progression rates between the two groups (p>0.05 for all). By multivariate analysis, HIV was not associated with any CAD parameter (p>0.05 for all). However, among HIV-infected individuals, each year of cocaine use significantly increased all CAD parameters (p<0.05 for all), while ASCVD risk score was significantly associated with CAD parameters except for Agatston-score (p<0.05). These associations were only present among HIV-infected individuals. Conclusion(s) Instead of directly worsening CAD, HIV may promote CAD through increased susceptibility to conventional and nonconventional cardiovascular risk factors. Therefore, aggressive management of both conventional and nonconventional cardiovascular risk factors is needed to reduce cardiovascular burden of HIV-infection. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Drug Abuse

Effectiveness of Virtual Resilience Training on Assertiveness in Student Girls Aged 9–10 Years: A 1-Month Follow-Up

2021 ◽  
pp. 105984052110135
Author(s):  
Shima Gadari ◽  
Jamile Farokhzadian ◽  
Parvin Mangolian Shahrbabaki
Keyword(s):  
Experimental Study ◽  
Internal Stress ◽  
Intervention Group ◽  
The Other ◽  
Hormonal Changes ◽  
Emotional Instability ◽  
Other Hand ◽  
Significant Difference ◽  
Resilience Training

Girls between the ages of 9 and 10 begin to experience physical, physiological, and hormonal changes that may lead to internal stress. At this age, children are struggling for autonomy; on the other hand, they may experience emotional instability, and for these reasons, they may be vulnerable in many ways. This experimental study aimed to investigate the effect of resilience training on assertiveness in student girls aged 9–10. Data were collected before, immediately after, and 1 month after the intervention in the control ( n = 40) and intervention ( n = 37) groups. There was a significant difference between the assertiveness of the intervention immediately (26.80 ± 3.73) and 1 month after the intervention (27.05 ± 3.73), and assertiveness significantly increased in the intervention group ( p = .0001). Resilience training leads to improvements in assertiveness in student girls aged 9–10.

Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Redfern ◽  
K Hyun ◽  
D Brieger ◽  
D Chew ◽  
J French ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Rehabilitation ◽  
Data Linkage ◽  
Research Network ◽  
Funding Source ◽  
Cardiovascular Research ◽  
Coronary Syndrome ◽  
Follow Up Study ◽  
Significant Difference

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

A two different chemoprophylaxis approaches after phacoemulsification surgery in one thousand patients in Iraq

2020 ◽  
Vol 1 (3) ◽  
pp. 154-159
Author(s):  
Suzan Amana Rattan ◽  
◽  
Mahir Kadhim Mutashar ◽  
Keyword(s):  
Treated Group ◽  
The Other ◽  
Eye Drops ◽  
Topical Medication ◽  
Group Methods ◽  
Significant Difference ◽  
Infection And Inflammation ◽  
Group 2 ◽  
Age Range

AIM: To evaluate the effectivity of the combination of intracameral moxifloxacin 0.1% with subconjunctival triamcinolone acetonide 4 mg as prophylaxis of infection and inflammation after phacoemulsification in comparison with topical medication treated group. METHODS: A total one thousand patients with age range from 38 to 70 years old who scheduled for phacoemulsification were divided into 2 groups of no statistically significant differences in age, preoperative intraocular pressure (IOP) and central macular thickness (CMT), P=0.6, 0.9 and 0.8 respectively. The surgeries were done by 2 surgeons each one planned to use one method of prophylaxis at Eye Speciality Private hospital, Baghdad, Iraq. For the 1st group of patients (500) a topical moxifloxacin hydrochloride 0.5% and dexamethasone 0.1% eye drops were prescribed four times a day for 1mo postoperatively. For the 2nd group intracameral (IC) diluted moxifloxacin at 0.1% with subconjunctival (SC) triamcinolone 4mg in 0.4 cc were administered at the conclusion of the surgery. Follow up visits were on the first postoperative day, 1wk, 1mo, and 3mo postoperatively. Anterior chamber (AC) reaction was examined during the 4 visits while IOP was measured during the last 3 and CMT was measured only in the last one. RESULTS: The current clinical trial study compared 2 samples with 2 different prophylaxis methods. No endophthalmitis case reported in both group. By a 2-Sample t-test, the IC-treated group (group 2) had statistically significant lower AC cells at the 1st day postoperative visit than the other group while there were no statistically significant differences at 1wk, 1 mo and 3mo visits between the 2 groups. There was no statistically significant difference at 3mo visits in IOP and CMT between the two groups. A breakthrough inflammation rate with the topical medication was (9.6%) while in the other group (IC treated ) was 4.0%. A significant IOP elevation ≥10 mm Hg at 1mo in 2.4% within the topical medication group which was higher than the rate in the other group (0.8%). CONCLUSION: In addition to the safety and effectivity of the combination of intracameral moxifloxacin and subconjunctival triamcinolone in preventing infection and inflammation after cataract surgery. The majority (480) of our included patients didn’t require any topical postoperative medication that is cost saving for the patient, helped patients who were unable to administer topical medication, and decreased chance of complication related to patient poor adherence to postoperative medication.

scholarly journals A mitralis elégtelenség sebészi kezelésének új megközelítése: transapicalis ínhúrpótlás dobogó szíven

2016 ◽  
Vol 157 (18) ◽  
pp. 700-705
Author(s):  
Tamás Ruttkay ◽  
Gábor Jancsó ◽  
Károly Gombocz ◽  
Balázs Gasz
Keyword(s):  
Mitral Regurgitation ◽  
Surgical Intervention ◽  
Transoesophageal Echocardiography ◽  
Invasive Technique ◽  
Success Rates ◽  
Special Instrument ◽  
Improved Outcomes ◽  
Procedural Success ◽  
Early Surgical Intervention

Severe mitral regurgitation due to prolapse of the valve demands early surgical intervention. Recently artificial chord implantation is the prefered solution, which requires cardioplegia and application of cardiopulmonary bypass using the left atrial approach. Transoesophageal echocardiography guided transapical neochord implantation is an emerging new technique for the treatment of mitral regurgitation. It enables the operation through left minithoracotomy on beating heart using a special instrument introduced into the left ventricle. Acute procedural success rates in different centres vary between 86 and 100%. According to reports, 92% of the patients do not require additional intervention at the 3-month follow-up. Continuous integration of data resulting improved outcomes supports the hope that this novel, less-invasive technique will be applied widely for the treatment of mitral regurgitation. Orv. Hetil., 2016, 157(18), 700–705.

scholarly journals A Clinical and Radiographic Assessment of Sodium Hypochlorite Versus Formocresol Pulpotomy in Primary Molar Teeth: 12-month Follow-up.

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Zahra Bahrololoomi ◽  
Fatemeh Zarebidoki ◽  
Atefeh Shakib
Keyword(s):  
Root Resorption ◽  
Clinical Success ◽  
Primary Molars ◽  
Pathologic Finding ◽  
Success Rates ◽  
Primary Molar ◽  
Exact Test ◽  
Significant Difference ◽  
Molar Teeth

Objective: The aim of this study was to compare the clinical and radiographic success rates of pulpotomy in primary molars using formocresol versus sodium hypochlorite.Methods:  Twenty-three children aged 4-9 years with at least two primary molars requiring pulpotomy were randomly allocated into two groups. All teeth received stainless steel crown after conventional pulpotomy procedure with either NaOCl or formocresol. Clinical and radiographic signs/symptoms were recorded at six and 12 months. Outcomes were statistically analyzed using Fisher’s exact test and Chi-squaretest.Results: Clinical success rates at 6 and 12-month follow-up in both groups was 100%. At 6-month follow-up, radiographic success rate for NaOCl and formocresol groups was 100%. At 12-month recalls, in NaOCl group, 20 teeth (87%) and in formocresol group, 21 teeth (91.3%) had radiographic success. No significant difference was found in the radiographic success rates at 12 months (P=1.00). Internal root resorption was the most common radiographic pathologic finding in both groups.Conclusion:Clinical and radiographic success rates in NaOCl group was comparable with formocresol group, so NaOCL can be suggested as an alternative for primary teeth pulpotomies. However further clinical studies with long-term follow-ups are needed. 

scholarly journals MO377HOW THE ITALIAN COVID-19 LOCKDOWN AFFECTED NEFROLOGICAL ACTIVITY IN A LOMBARD CENTER

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Paolo Albrizio ◽  
Silvano Costa ◽  
Annalisa Foschi ◽  
Ivo Angelo Antonio Milani ◽  
Stefano Rindi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
First Aid ◽  
The Other ◽  
Renal Diseases ◽  
Significant Difference

Abstract Background and Aims Italy and Lombard hospitals particularly, were hard affected by Covid-19 pandemic, mostly during spring and autumn, seasons characterized by two lockdown periods which were however, partly different as rules. During first lockdown in fact, by hospital decision, all ambulatorial activity was closed, including nephrological one. This did not happen during second lockdown period. How the different choices about hospital activity affected nephrological patients is the aim of this study. Method we evaluated all nephrological advices requested by first aid units of our 3 hospitals, all located in Lombardy, to our Nephrology Unit, splitting out data in 3 periods (I lockdown, summer and II lockdown) and comparing with 2019. Data collected were: number of advices requested by day, age, sex, previous regular nephrological follow-up, Covid-19 diagnosis, nephrological diagnosis after nephrological advice and outcome. Results as shown in table 1, during I lockdown period, with hospital decision of suspending our nephrological ambulatorial activity, we suffered an incremented rate of patients approaching local first aid units compared to 2019 same period with an increased rate of acute kidney injury, mostly for dehydration, and with a higher rate of patients requiring hospitalization. All these differences resulted statistically significant vs 2019 same period (figure 1). On the other side, no statically significant difference was found during the other two examined periods, including the II lockdown, while all our ambulatories were fully operating. Conclusion Covid-19 pandemic affected also the nephrological population with an increased rate of first aid units’ accesses, acute kidney injury events and hospitalization comparing to 2019. However, these differences were detectable only during the I lockdown period characterized by the suspension of all ambulatorial activity, including our Unit. The absence of statistically significant differences during summer and primarily during II lockdown period demonstrates the importance of nephrological ambulatorial activity in management of renal diseases and in prevention of acute events.

scholarly journals Comparison between Ormeloxifene and Norethisterone in reducing menorrhagia in dysfunctional uterine bleeding

2018 ◽  
Vol 7 (12) ◽  
pp. 4966
Author(s):  
Swati Gett ◽  
Shruti Singh
Keyword(s):  
Endometrial Thickness ◽  
Mean Value ◽  
Uterine Bleeding ◽  
The Other ◽  
P Value ◽  
Loss Assessment ◽  
Dysfunctional Uterine Bleeding ◽  
Significant Difference ◽  
Before And After

Background: Dysfunctional Uterine Bleeding (DUB) is a condition that affects nearly every woman at some point in her life. This study aims to compare the efficacy of Ormeloxifene and Norethisterone in reducing menorrhagia in such patients.Methods: This prospective study was done on 100 women presenting with dysfunctional uterine bleeding, of 20-50 years of age, who were ready for follow-up and were allocated into two equal groups, one was given Ormeloxifene and the other was given Norethisterone for a period of 3 months. Haemoglobin levels, endometrial thickness on ultrasound and Pictorial Blood loss Assessment Chart (PBAC) scores were assessed before and after the treatment.Results: It was found that both Ormeloxifene and Norethisterone reduced menorrhagia, with a significant difference in PBAC scores (p value <0.05). There was a notable reduction in PBAC scores in Ormeloxifene group (66.53% change from pretreatment mean value) as compared to Norethisterone group (31.38% change from pretreatment mean value); and same holds true for the change in haemoglobin levels as well as endometrial thickness. Ormeloxifene was found to have a greater effect on heavy menstrual bleeding in comparison to Norethisterone.Conclusions: Ormeloxifene is a new modality and is found to be a better option in reducing menorrhagia in DUB in respect to a greater success rate, better compliance and cost effectiveness.

scholarly journals Release of the Tibialis Posterior Muscle Osseofascial Sheath Improves Results of Deep Exertional Compartment Syndrome Surgery: A Comparative Analysis and Long-term Results

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094275
Author(s):  
J. Taylor Bellamy ◽  
Adam R. Boissonneault ◽  
Morgan E. Melquist ◽  
Sameh A. Labib
Keyword(s):  
Patient Satisfaction ◽  
Compartment Syndrome ◽  
Tibialis Posterior ◽  
Success Rates ◽  
Posterior Compartment ◽  
Posterior Tibial ◽  
Significant Difference ◽  
Exertional Compartment Syndrome

Background: Success rates for surgical management of chronic exertional compartment syndrome (CECS) are historically lower with release of the deep posterior compartment compared with isolated anterolateral releases. At our institution, when a deep posterior compartment release is performed, we routinely examine for a separate posterior tibial muscle osseofascial sheath and release it if present. Purpose: Within the context of this surgical approach, the aim of the current study was to compare long-term patient satisfaction and activity levels in patients who underwent 2-compartment fasciotomy versus a modified 4-compartment fasciotomy for CECS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients treated with fasciotomy for lower extremity CECS from 2007 to 2017 were retrospectively identified. In all patients in whom a 4-compartment fasciotomy was indicated, the tibialis posterior muscle was examined for a separate osseofascial sheath, which was released when present. Patients completed a series of validated patient-reported outcome (PRO) surveys, including the Marx activity score, Tegner activity score, 12-Item Short Form Health Survey, and Likert score for patient satisfaction. Results: Of the 48 patients who were included in this study, 34 (71%) patients with a total of 52 operative limbs responded and completed PRO surveys. The mean follow-up for the entire cohort was 5.5 ± 2.6 years. Of the 34 patients, 23 (68%) underwent 2-compartment fasciotomy and 11 (32%) underwent 4-compartment fasciotomy. Among the patients in the 4-compartment fasciotomy group, 7 (64%) were found to have a fifth compartment. No significant difference was found in any of the validated PRO measures between patients who had a 2- versus 4-compartment fasciotomy or those who underwent 4-compartment fasciotomy with or without a present fifth compartment. At a mean 5.5-year follow-up, 74% of patients who underwent a 2-compartment release reported good or excellent outcomes compared with 82% of patients who underwent our modified 4-compartment release. Conclusion: The current study, which included the longest follow-up on CECS patients in the literature, demonstrated that the addition of a release of the posterior tibial muscle fascia led to no significant difference in PRO measures between patients who underwent a 2- versus 4-compartment fasciotomy, when historically the 2-compartment fasciotomy group has had higher success rates.

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