Prehospital Diagnosis of ST-segment Elevation Myocardial Infarction Using an “All-Posterior” 12-Lead Electrocardiogram

The ECC Guidelines 2000 considered interesting new evidence about a pre-defibrillation period of prescribed CPR to increase the probability that the postshock rhythm would be perfusing rather than asystole. If victims of out-of-hospital cardiac arrest have not received bystander CPR before the arrival of the defibrillator, a period of preshock CPR could enhance the value of the shocks. At the end of the year 2000 there was insufficient evidence to recommend any other approach than shock as soon as possible and perform CPR at all other times.     

Acute Respiratory Compromise in the Emergency Department: A Description and Analysis of 3571 Events from the Get With the Guidelines–Resuscitation® Registry

Background

Respiratory events requiring the use of assisted ventilation are relatively common in the emergency department (ED), and can be associated with substantial morbidity and mortality.

Responsiveness and Predictive Validity of the Participation Measure–3 Domains, 4 Dimensions in Survivors of Stroke

ObjectivesTo examine the responsiveness and predictive validity of the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D) in people receiving outpatient rehabilitation following stroke.DesignProspective cohort observational study.SettingOutpatient rehabilitation settings.ParticipantsVolunteer patients (N=269) with stroke (mean age ± SD [y], 55.36±12.46; 70.26% male).InterventionsNot applicable.Main Outcome MeasuresThe PM-3D4D was designed to measure 3 domains (Productivity, Social, and Community) and 4 dimensions (Diversity, Frequency, Desire for change, and Difficulty) of participation in individuals with rehabilitation needs. All participants completed the PM-3D4D, the Participation Assessment with Recombined Tools-Objective (PART-O), the Participation Measure for Post-Acute Care (PM-PAC), and the EuroQol-5-Dimension (EQ-5D) at the baseline assessment and again following 3 months of outpatient rehabilitation.ResultsSignificant mean changes in scores were observed for most of the PM-3D4D subscales, with the largest score change observed in the Difficulty subscale (standardized response mean=0.57～0.88). The minimal detectable change and meaningful clinically important differences were calculated for each subscale. The Frequency and Difficulty dimensions of the PM-3D4D demonstrated significantly greater responsiveness than the PART-O and PM-PAC, respectively. The baseline PM-3D4D scores, except for Desire for change subscales, were significantly correlated with the PART-O, PM-PAC, and EQ-5D scores after 3 months of rehabilitation.ConclusionsThis study provides evidence supporting the responsiveness and predictive validity of the PM-3D4D in survivors of stroke. Among all subscales of the PM-3D4D, the Difficulty dimensional scale demonstrated the greatest responsiveness. The Desire for change dimension of the PM-3D4D showed less responsiveness, and we recommend that it be used as a goal-setting tool rather than an outcome measure. The PM-3D4D can potentially be used to predict participation outcomes and the health-related quality of life following rehabilitation interventions.     

How Many Planes Are Required to Get an Accurate and Timesaving Measurement of Left Ventricular Volume and Function by Real-Time Three-Dimensional Echocardiography in Acute Myocardial Infarction?

To derive the optimal cutting planes of real-time 3-D echocardiography (RT-3DE) for measuring left ventricular volume and ejection fraction (EF) in the presence of left ventricular regional wall motion abnormalities, 14 open-chest dogs were studied with RT-3DE full volume imaging and 2-D echocardiography (2DE) after left anterior descending coronary arteries were occluded for 90 min. Left ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and EF were measured off-line with 2DE and RT-3DE (2-, 4- and 8-plane) methods. The autopsy EDV was estimated by the volume of saline solution injected into the excised heart and served as the reference volume (RefV) for comparison with EDV measured by 2DE and RT-3DE. Agreement analysis was performed according to the method of Bland and Altman. There were excellent correlations between 2DE, RT-3DE (2-plane) and RT-3DE (4-plane) methods on one hand, and RT-3DE (8-plane) method on the other in the measurements of EDV, ESV and SV (r = 0.84-0.99). However, 2DE and RT-3DE (2-plane) measurements significantly underestimated RT-3DE (8-plane) (p < 0.01), whereas no significant differences between RT-3DE (4-plane) and RT-3DE (8-plane) were found in terms of EDV, ESV and SV measurements. The values of EF determined by 2DE, RT-3DE (2-plane) and RT-3DE (4-plane) methods correlated highly with that by RT-3DE (8-plane) (r = 0.82-0.98) and there was no significant difference between the two measurements. EDV values determined by 2DE, RT-3DE (2-plane), RT-3DE (4-plane) and RT-3DE (8-plane) correlated highly with RefV (r = 0.84, r = 0.92, r = 0.94 and r = 0.97, respectively) and there was no significant difference between RefV and EDV by RT-3DE (4-plane) and RT-3DE (8-plane). In contrast, EDV measured by 2DE and RT-3DE (2-plane) methods underestimated RefV significantly (p < 0.01). In conclusion, RT-3DE allows reliable and reproducible measurement of left ventricular volume and EF, even in the presence of left ventricular regional wall motion abnormalities. RT-3DE (4-plane) is the method of choice for an accurate and timesaving quantification of left ventricular volume and function.     

A Higher Dose of Dasatinib May Increase the Possibility of Crossing the Blood–brain Barrier in the Treatment of Patients With Philadelphia Chromosome–positive Acute Lymphoblastic Leukemia

PurposeDasatinib is a second-generation tyrosine kinase inhibitor with higher central nervous system (CNS) penetration compared with imatinib and nilotinib in in vitro studies. However, limited clinical data are available regarding the dosage and CNS penetration of dasatinib. The purpose of this study was to investigate the actual ability of dasatinib to cross the blood–brain barrier in patients with Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph⁺ ALL).MethodsPlasma and cerebrospinal fluid (CSF) samples collected from Ph⁺ ALL patients treated with dasatinib were analyzed by using an LC-MS/MS assay.FindingsOrally administered dasatinib 100 mg once daily was well absorbed by the patient but penetrated poorly into the CSF. The use of a higher drug dosage (140 mg/d) may increase systemic drug exposure and enhance the penetration of dasatinib into the CSF.ImplicationsBased on this study, the use of a higher dosage of dasatinib (140 mg/d) is recommended in patients at high risk of CNS relapse or patients who need treatment for CNS leukemia. ClinicalTrials.gov identifier: NCT02523976.     

Evaluation of the Comparative Efficacy and Safety of Artemether-Lumefantrine,Artesunate-Amodiaquine and Artesunate-Amodiaquine-Chlorpheniramine (Artemoclo?) for the Treatment of Acute Uncomplicated Malaria in Nigerian Children

Objective

To evaluate the comparative efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and artesunate-amodiaquine-chlorpheniramine (AQC) for the treatment of acute uncomplicated malaria among Southwest Nigerian children.

Subjects and Methods

One hundred and sixty children aged 6 months to 14 years with acute uncomplicated malaria were randomized to AL (n = 53), ASAQ (n = 53), or AQC (n = 54). Enrollees were seen daily on days 0-3 and then on days 7, 14, 21, 28 and 42 for clinical and parasitological evaluations. Paired samples of genomic DNA at enrolment and at the time of recurrent parasitaemia were genotyped using nested PCR to distinguish between reinfection and recrudescence. Detailed haematological and biochemical evaluations were carried out in a subset of enrollees on days 0, 7 and 28 as part of a safety evaluation.

Results

Of the 160 children, 144 (90%) completed the study. The mean fever clearance times and parasite clearance times for AL, ASAQ and AQC were comparable (p = 0.94 and p = 0.122, respectively). On day 14, the adequate clinical and parasitological response (ACPR) for AL and AQC was 100% and for ASAQ it was 90% (p = 0.39). The PCR-uncorrected results on days 28 and 42 and the ACPR-corrected results on day 42 were similar for all drugs (p = 0.62 and p = 0.56, respectively). AQC resulted in the best parasite clearance and haematological recovery on day 2 (p = 0.022 and p = 0.018, respectively). Biochemical parameters were not adversely affected by the three artemisinin-based combination therapies (ACTs) and these were well tolerated.

Conclusion

The three ACTs were efficacious and safe, but AQC resulted in a better haematological recovery on day 2 and higher cure rates throughout the study period.Key Words: Childhood malaria, Artesunate, Amodiaquine, Artemether, Lumefantrine, Chlorpheniramine     

Can simple tests performed in the primary care setting provide accurate and efficient diagnosis of benign prostatic hyperplasia? Rationale and design of the Diagnosis Improvement in Primary Care Trial

Effective treatment of benign prostatic hyperplasia (BPH) improves lower urinary tract symptoms (LUTS) and patient quality of life, and reduces the risk of complications arising from disease progression. However, treatment can only be initiated when men with BPH are identified by accurate diagnostic tests. Current evidence suggests that diagnostic procedures employed by primary care physicians vary widely across Europe. The expected increases in BPH prevalence accompanying the gradual aging of the population, coupled with greater use of medical therapy, mean that general practitioners (GPs) are likely to have an increasingly important role in managing the condition. The GP/primary care clinic is therefore an attractive target location for strategies designed to improve the accuracy of BPH diagnosis. The Diagnosis Improvement in Primary Care Trial (D‐IMPACT) is a prospective, multicentre, epidemiological study that aims to identify the optimal subset of simple tests applied by GPs in the primary care setting to diagnose BPH in men who spontaneously report obstructive (voiding) and/or irritative (storage) LUTS. These tests comprise medical history, symptom assessment with the International Prostate Symptom Score questionnaire, urinalysis, measurement of serum levels of prostate‐specific antigen and subjective GP diagnosis after completing all tests including digital rectal examination. GP diagnoses and all other tests will be compared with gold‐standard diagnoses provided by specialist urologists following completion of additional diagnostic tests. D‐IMPACT will establish the diagnostic performance using a non‐subjective and reproducible algorithm. An adjusted and multivariate analysis of the results of D‐IMPACT will allow identification of the most efficient combination of tests that facilitate accurate BPH diagnosis in the primary care setting. In addition, D‐IMPACT will estimate the prevalence of BPH in patients who present spontaneously to GPs with LUTS.