Prevalence of Orbscan II corneal abnormalities in relatives of patients with keratoconus

Background: To determine the prevalence of Orbscan II‐derived keratoconus traits in relations of individuals with keratoconus and a control group and to apply these to a pedigree analysis. Methods: In a controlled, prospective, observational case series, four Orbscan II‐derived corneal parameters were examined in relations of individuals with keratoconus and a control group of low myopes (<2.5 D). The four parameters and thresholds for abnormality (derived from a literature review) were as follows: average keratometry (≥47.2 D), I‐S value (≥1.2 D), posterior float apex (≥42 µm) and thinnest pachymetry (≤463 µm). Results: Forty‐four unrelated controls (88 eyes) and eight families with 90 members without known (178 eyes) and 11 members with keratoconus (19 eyes) were analysed. One of 88 (1.14%) control eyes had a single keratoconus trait, and none had more than one trait. Of 178 eyes from relatives of patients with keratoconus, 45 (25.3%) had one or more keratoconus traits. Relatives of patients with keratoconus had an elevated risk of possessing a keratoconus trait (relative risk 14.67, CI 2.07–104.07, P < 0.001) compared with controls. Approximately 53.3% of relatives with a keratoconus trait were evident on either pachymetric or posterior elevation indices alone. Six of eight families suggested dominant inheritance. Conclusions: Keratoconus traits are common in relatives of patients with keratoconus. There prevalence may have been previously underestimated by using placido image‐based topography alone where corneal pachymetry and posterior elevation are not assessed. This study suggests an autosomal dominant pattern of inheritance with variable expressivity in some families.     

An assessment of tissue harmonic versus fundamental imaging modes for echocardiographic measurements

The study aimed to evaluate whether a significant difference exists between tissue harmonic imaging (THI) and fundamental imaging (FI) in routine quantitative echocardiographic assessment. We also examined the effects of THI on endocardial definition (ED). Fifty-eight unselected patients (29 men, 29 women; mean age 53 years) referred for transthoracic echocardiography were studied with use of both FI and THI modes. Two independent observers made M-mode measurements of the following: left atrium, aortic root, and left ventricular internal dimensions and wall thickness; they also measured left ventricular outflow tract diameter and left atrial area from 2-dimensional images. Endocardial definition was assessed with use of an arbitrary scoring system (0 = endocardium not visualized, 1 = endocardium visualized but suboptimally, 2 = endocardium well defined) and the American Society of Echocardiography 16-segment model. No significant difference existed between cardiac measurements derived from FI and THI. However, a highly significant improvement in ED occurred with THI (ED index 1.83 versus 1.70, P <.0001). This study suggests that no systematic differences exist in standard echocardiographic measurements between THI and FI, even in the setting of improved ED.     

Drug-related admissions to an Australian hospital

This study was conducted to determine the prevalence of drug-related hospital admissions in southern Tasmania, Australia. The causes of consecutive admissions to medical wards of the Royal Hobart Hospital were reviewed. Comprehensive data were collected over a 10-week period on 691 admissions (median age: 67 years and range: 11–97 years; 50.8% males). Sixty-eight (9-8%) of the admissions were classified as being either probably or definitely drug-related. Most of these admissions were attributable to intentional overdose (38.2%) or an adverse drug reaction (30.9%). The overdoses often involved benzodiazepines or antipsychotics. Gastrointestinal bleeding related to the use of nonsteroidal anti-inflammatory drugs was the most common adverse drug reaction (38.1% of all reactions). Other drug-related admission categories were poor compliance (14.7%), dosage decrease or therapy cessation by a doctor producing an exacerbation of symptoms (7.4%), substance abuse (4.4%) and drug interaction (4.4%). Patients with a drug-related admission were, on average, younger than the other medical admissions, with no significant difference in gender. Patients admitted due to an overdose or substance abuse were younger than other drug-related admissions and non-drug related admissions. In conclusion, this study has determined that almost 10% of medical admissions to the hospital are drug-related and it is estimated that 40 to 50 elderly people are admitted each year suffering from gastrointestinal bleeding related to nonsteroidal anti-inflammatory drugs.     

Digoxin–quinidine and digoxin–amiodarone interactions: frequency of occurrence and monitoring in Australian repatriation hospitals

An extensive scrutiny of 19,460 patients' charts was carried out by clinical pharmacists in six Australian Repatriation Hospitals. The incidence of the prescribing of digoxin–quinidine and digoxin–amiodarone combinations was 018% and 022% of patients, respectively, giving an overall level of 04% (4/1000). For both combinations, digoxin was prescribed long term in 81% of the cases and quinidine or amiodarone recently added to digoxin therapy in 44% of patients identified. Therapeutic drug monitoring of digoxin therapy was initiated by clinical pharmacists in 41% of patients and resulted in modifications to digoxin therapy in 63% of this sub–group of patients. Quinidine and amiodarone therapies were also changed in nine patients. Of particular note was the number (15 or 58%) of dosage changes or therapy cessations made to digoxin therapy for patients also receiving amiodarone which occurred as a result of clinical pharmacist intervention.     

Epicardial Brugada syndrome ablation unmasking inferior J waves

Patients with Brugada syndrome are at risk of life‐threatening ventricular arrhythmias. Epicardial substrate ablation for Brugada syndrome has been described as a means of controlling these arrhythmias and recent reports describe elimination of the Brugada phenotype with ablation. We describe a unique case in which a patient developed inferior J waves with an early repolarization‐type electrocardiogram following successful epicardial infundibular substrate ablation (which eliminated the Brugada syndrome electrocardiogram on ajmaline challenge). We discuss the likely underlying pathophysiology responsible for this phenomenon, its relationship to the anatomic obstacles encountered during epicardial ablation, and the implications for long‐term arrhythmic risk.