Does Reception of Appropriate Shocks from the Implantable Cardioverter Defibrillator Affect Survival?

The impluntable Cardioverter defibrillafor has become an important therapeutic modality for treatment of life-threatening ventricular tachyarrhythmias. Recent reports have suggested that patients who receive appropriate shocks from this device have an inordinately high overall mortality, and questioned the extent of benefit these patients derive from the implant. This report analyzed the survival among 184 patients who received the implantable Cardioverter defibrillator to assess survival differences between patients who received appropriate shocks versus those who did not. At a mean follow-up of 24 ± 18.7 months, 68 patients received an appropriate shock from their device while 116 did not receive an appropriate shock. Overall survival of the entire population was quite similar (o those published by others. There was no significant difference between overall survival of patients who received an appropriate shock versus those who did not. However, there was a statistically significant difference in sudden death mortality. The group of patients that received appropriate shocks included all five sudden deaths. This observation suggested that sudden death in this population was likely due to ventricular tachyarrhythmias rather than strictly bradycardia or asystole. The "benefit" of the device to the entire population was also assessed by estimating survival after receipt of the first appropriate shock. Using this approach, an estimated 10% of patients died without receiving an appropriate shock. In other words, ultimately, 90% of patients were expected to benefit from the device. This survival curve, which initiated only after receipt of the first appropriate shock was fairly similar to those estimated from conventional methods. Therefore, survival after receipt of an appropriate shock was comparable to overall survival and there was no significant difference between survival of patients who received appropriate shocks and those who did not.     

An evaluation of Type A and B alcoholics

Evaluations of 1539 alcohol-dependent subjects (including 5/2 women) were carried out in an attempt to replicate the Type AJB dichotomy suggested by Babor et al. (1992). The subjects are participants in the Collaborative Study on the Genetics of Alcoholism (COGA), and each was evaluated using a face-to-face structured interview. Following the procedure of Babor et al. (1992), data were used to create 17 domains, and a k-means clustering method was invoked to generate a two-cluster solution. Thirty-one per cent of the mates and 25% of the females fell into the Type B group, with overall R² of 0.22 and 0.24 for males and females, respectively. The scores in each of the 17 domains and the analyses of the clinical characteristics for Type A and B subjects were, in general, consistent with the earlier onset and more severe course for Type B men and women. The ability of the domains to identify subgroups of alcoholics remained robust even after the exclusion of alcohol dependent subjects with antisocial personality disorder (ASPD) and those with an onset of alcohol dependence before age 25 years. The present analyses suggest that five of the 17 domains might be especially useful in identifying Type A and B groups.     

Evaluation of a Teen Parent Program Designed to Reduce Child Abuse and Neglect and to Strengthen Families

The purpose of this study was to evaluate a teen parent program designed to increase parents' self-esteem, improve parenting skills, and increase parental knowledge about child development. Subjects ( n = 30) in the program were referred from public health services. Control subjects ( n = 30) were served by a local health department. Subjects were tested before and on completion of the program (or 6-9 months later for controls) using the Coopersmith Self-Esteem Inventory (SEI), the Inventory of Parents' Experiences (IPE), and the Denver Developmental Screening Test (DDST). Findings included (a) intervention subjects scored lower than control subjects on the pretesting in self-esteem ( p < 0.05), parental role satisfaction ( p < 0.05), and community support ( p < 0.0001); (b) control subjects scored lower on satisfaction with intimate relationships ( p < 0.0001); (c) at post-test, there were no statistically significant differences, and intervention subjects recorded self-esteem scores had increased to control levels; and (d) no developmental delays were detected in newborns at either pre- or post-testing. Implications of this study include (a) data support effectiveness of the program in enhancing self-esteem, maintaining satisfaction in parental role, and increasing community support for teen parents; and (b) evaluation of teen parent programs' effects should be done every 3-6 months to reduce subject attrition.     

Factors associated with employment among a cohort of injection drug users

Introduction and Aims. One of the most substantial costs of drug use is lost productivity and social functioning, including holding of a regular job. However, little is known about employment patterns of injection drug users (IDU). We sought to identify factors that were associated with legal employment among IDU. Design and Methods. We describe the employment patterns of participants of a longitudinal cohort study of IDU in Vancouver, Canada. We then use generalised estimating equations (GEE) to determine statistical associations between legal employment and various intrinsic, acquired, behavioural and circumstantial factors. Results. From 1 June 1999 to 30 November 2003, 330 (27.7%) of 1190 participants reported having a job at some point during follow up. Employment rates remain somewhat stable throughout the study period (9–12.4%). Factors positively and significantly associated with legal employment in multivariate analysis were male gender (adjusted odds ratio [AOR] = 2.78) and living outside the Downtown Eastside (AOR = 1.85). Factors negatively and significantly associated with legal employment included older age (AOR = 0.97); Aboriginal ethnicity (AOR = 0.72); HIV‐positive serostatus (AOR = 0.32); HCV‐positive serostatus (AOR = 0.46); daily heroin injection (AOR = 0.73); daily crack use (AOR = 0.77); public injecting (AOR = 0.50); sex trade involvement (AOR = 0.49); recent incarceration (AOR = 0.56); and unstable housing (AOR = 0.57). Discussion and Conclusions. Our results suggest a stabilising effect of employment for IDU and socio‐demographic, drug use and risk‐related barriers to employment. There is a strong case to address these barriers and to develop innovative employment programming for high‐risk drug users.[Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev 2010]     

Quinine May Trigger Torsades de Pointes During Astemizole Therapy

Because of serious cardiovascular events, warnings against concomitant use of certain medications with the use of antihistamine (Hismanal^R have been published and added to product labeling. Quinine, the optical isomer to quinidine, is included in these warnings. We present the case of a patient with only mild electrolyte disturbances who experienced an episode of torsades de pointes after a single dose of quinine while taking astemizole.     

Lymphocyte Cyclic AMP Levels Antepartum and Postpartum as an Indirect Assessment of the Immune System During Pregnancy

ABSTRACT: The literature dealing with the immunological state of the pregnant woman has been conflicting. The concentrations and activity of a number of hormones and proteins which modify lymphocytic activity have been measured both in vivo and in vitro during pregnancy. Most of the differences between reported studies can be reconciled to technical or experimental variations. In some instances, the purported suppressive effects of embryonic proteins such as HCG have actually been caused by the impurity of the preparation studied. We have attempted to approach the question of whether or not the pregnant woman is immunosuppressed by studying a regulatory material in the lymphocytes. It is known that cAMP is a mirror of lymphocytic activity and that low levels of cAMP may indicate a high degree of reactivity, while high levels are present when lymphocyte reactivity is low. In an initial study, ten women volunteered to have blood drawn in the last trimester and two months postpartum. Cyclic AMP was extracted from lymphocyte-enriched leukocytes and stored until all samples were available from all patients so that the analysis could be made simultaneously. Five samples were obtained from healthy nonpregnant women in the same age range. Postpartum and nonpregnant women were found to have significantly elevated levels of cAMP as compared to the lymphocytes obtained in the third trimester of pregnancy. The experiments were then repeated using seven more patients. The same significant increase in postpartum lymphocyte cAMP concentrations were found. The precise reason(s) for this is not known, but may be due to increased suppressor cell activity.     

Molecular and serological characteristics of the glutathione S-transferases of Schistosoma japonicum and Schistosoma mansoni

When aqueous extracts of Schistosoma japonicum and S. mansoni adult worms are passed over columns of glutathione-conjugated agarose, two molecular species of Mr 26,000 and Mr 28,000 are detected in eluates as analysed by SDS-PAGE, these eluates having glutathione S-transferase (GST) activity. The molecules, termed Sj26 and Sj28 from S. japonicum and Sm26 and Sm28 from S. mansoni, can be immunogenic in rabbits or mice and appear not to be linked together as subunits of GST heterodimers. The elution profile of SjGST (Sj26+Sj28) from glutathione columns resembles that of SmGST (Sm26+Sm28) and, by peptide mapping, radioiodinated Sj26 and Sm26 are related as are the two Mr 28,000 molecules. Similarities between radioiodinated Sj28 and Sm28 are also obvious on two-dimensional gel electrophoresis with some differences being observed between Sj26 and Sm26. The Mr 28,000 molecules are more prominent than the Mr 26,000 molecules and, although Sj28 and Sm28 is a poor immunogen in mice, immunological cross-reactivity between Sj28 and Sm28 is generally more readily detected than that between Sj26 and Sm26. Whether experimental vaccination against schistosomiasis japonica and schistosomiasis mansoni reported with cloned GSTs can be improved by incorporation of both Mr 28,000 and Mr 26,000 species into the vaccine remains to be determined. On this point, the present data suggest that vaccination of mice with Sj26 plus Sm28 should be a useful means of increasing antibody responses to the GSTs of S. japonicum.     

First Experience with an Automatic Sensing Algorithm in Single-Lead VDD Stimulation

An "Autosensing" algorithm available in SSI(B) and DDD(R) pacemakers automatically adapts the device's sensitivity to changing intracardiac signals. The atrial sensing function of this algorithm was tested for the first time with a VDD pacing system in which large variations of the atrial signal may occur because the atrial electrodes float in the atrial blood pool. Methods: 15 patients with a VDD pacing system were studied (Unity 292–07, lead 425; Sulzer Intermedics). The atrial sensing threshold was measured, and the atrial sensitivity was programmed with a 2:1 safety margin. The autosensing algorithm and sensitivity profile were temporarily activated, and an ambulatory ECG with continuous marker annotation was recorded. All patients underwent a 30-minute daily life activities protocol. A beat-to-beat analysis of the ambulatory ECG was correlated with the changes in atrial sensitivity. Results: The algorithm changed the baseline sensitivity from 0.57 ± 0.23 mV during the test to 0.39 ± 0.20 mV after the final rest period (P < 0.05). During the test 12.6 ± 10.2 adaptations of the sensitivity occurred (range 0–33). In eight patients atrial undersensing occurred in 4.4%± 7.5% of the cycles (4–458 unsensed P waves]. In these patients, the algorithm continuously adjusted the sensitivity towards more sensitive values, operating 19.1 ± 18.3 changes compared with 5.4 ± 7.3 changes in patients without undersensing (P = 0.009). Oversensing did not occur. Conclusion: The autosensing algorithm effectively optimized atrial sensitivity in VDD pacing. In patients with atrial undersensing the algorithm continuously remained near the most sensitive settings, thus reacting as intended. A faster sensitivity adjustment of the system would be desirable.