Alcohol septal ablation versus surgical septal myectomy: comparison of effects on atrioventricular conduction tissue

OBJECTIVES: This study was designed to evaluate the effect of septal reduction therapies on the conduction system for patients with hypertrophic cardiomyopathy (HCM). BACKGROUND: Heart block is a potential complication of both catheter-based and surgical procedures to relieve left ventricular outflow tract obstruction in HCM, but it is important to understand the different effects of these treatments on the conduction system. METHODS: The electrocardiograms and postoperative course of patients who underwent percutaneous alcohol septal ablation or surgical myectomy at Mayo Clinic between 1999 and 2003 were reviewed. RESULTS: For the 58 patients who underwent alcohol septal ablation, 21 (36%) developed right bundle branch block. Six patients (12%) developed complete heart block requiring permanent pacing, three of whom had left bundle branch block before the procedure. Among the 117 patients who underwent surgical septal myectomy, 47 (40%) developed left bundle branch block. Four patients (3%) developed heart block requiring permanent pacing after the procedure, three of whom had right bundle branch block preoperatively. CONCLUSIONS: Percutaneous septal ablation selectively produces transmural infarction of the basal mid-septum and adjacent right bundle tissue, whereas surgical myectomy affects the endocardial portion of the basal anterior septum and adjacent left bundle tissue. These observations may help identify patients at risk for complete heart block after septal reduction procedures for HCM.     

Aromatase inhibitors associated osteonecrosis of jaw: signal refining to identify pseudo safety signals

International Journal of Clinical Pharmacy - Background Signal generation through data mining algorithms is an innovative and emerging field in pharmacovigilance. Early detection of safety signals...     

Novel CD3Z and CD3E Deficiency in Two Unrelated Females

Journal of Clinical Immunology -     

Quantum dot-sensitized O-linked heptazine polymer photocatalyst for the metal-free visible light hydrogen generation

Metal-free organic polymer photocatalysts have attracted dramatic attention in the field of visible light-induced hydrogen evolution reaction (HER). Herein, we showed a polymeric O-linked heptazine polymer (OLHP) decorated with S, N co-doped graphene quantum dots (S,N-GQDs) as a photosensitizer to generate hydrogen upon quantum dot sensitization. Both of these heptazine-based systems show effective photosensitization with strong π–π interactions and enhanced photocatalytic H₂ generation (24 times) as metal-free systems. Electrochemical impedance and optical measurements show effective charge transfer kinetics with decreased charge recombination, which is responsible for the enhanced photocatalytic activity. As a result, a significant high apparent quantum yield (AQY) with highest value of 10.2% was obtained for our photocatalyst OLHP/S,N-GQD10.

A polymeric O-linked heptazine polymer (OLHP) decorated with S, N co-doped graphene quantum dots (S,N-GQDs) as a photosensitizer to utilize visible light (λ > 420 nm) for hydrogen generation.     

Text Messaging Real-Time COVID-19 Clinical Guidance to Hospital Employees

Background  During the initial days of the coronavirus disease 2019 (COVID-19) pandemic, hospital-wide practices rapidly evolved, and hospital employees became a critical population for receiving consistent and timely communication about these changes. Objectives  We aimed to rapidly implement enterprise text messaging as a crisis communication intervention to deliver key COVID-related safety and practice information directly to hospital employees. Methods  Utilizing a secure text-messaging platform already routinely used in direct patient care, we sent 140-character messages containing targeted pandemic-related updates to on-duty hospital employees three times per week for 13 weeks. This innovation was evaluated through the analysis of aggregate “read” receipts from each message. Effectiveness was assessed by rates of occupational exposures to COVID-19 and by two cross-sectional attitudinal surveys administered to all text-message recipients. Results  On average, each enterprise text message was sent to 1,997 on-duty employees. Analysis of “read” receipts revealed that on average, 60% of messages were consistently read within 24 hours of delivery, 34% were read in 2 hours, and 16% were read in 10 minutes. Readership peaked and fell in the first week of messaging but remained consistent throughout the remainder of the intervention. A survey administered after 2 weeks revealed that 163 (79%) users found enterprise texts “valuable,” 152 (73%) users would recommend these texts to their colleagues, and 114 (55%) users preferred texts to email. A second survey at 9 weeks revealed that 109 (80%) users continued to find texts “valuable.” Enterprise messaging, in conjunction with the system''s larger communication strategy, was associated with a decrease in median daily occupational exposure events (nine events per day premessaging versus one event per day during messaging). Conclusion  Enterprise text messages sent to hospital-employee smartphones are an efficient and effective strategy for urgent communications. Hospitals may wish to leverage this technology during times of routine operations and crisis management.     

A simple technique to reinforce kinked South Pole RAE tracheal tube

Journal of Clinical Monitoring and Computing -     

Convalescent plasma therapy for severe Covid-19 in patients with hematological malignancies

BackgroundData on convalescent plasma therapy (CPT) in patients of hematological malignancies with severe Covid-19 is scarce.ObjectiveTo study 14-day mortality in patients who received CPT.Patients & methodsRetrospective multicentre observational study conducted in 4 centres treating haematological malignancies across Delhi-national capital region. Total 33 haematological malignancies patients with severe Covid-19 who received CPT were analysed.ResultsThe median age of the study cohort was 62 years (18–80 years). Twenty one percent patients had 1 comorbidity, 18 % had 2 comorbidities and 6% patients had 3 and 5 comorbidities each. Twenty four patients were on active therapy. Sixty nine percent of patients required ICU stay. Twenty five patients received plasma therapy within 7 days (early) of diagnosis of Covid-19 infection. Median day of plasma infusion from date of diagnosis of Covid-19 infection was 4 days (range: 2–25 days). Patient who had early initiation of plasma therapy had shorter duration of hospitalisation (12.7 vs 24.3 days, p = 0.000). Overall mortality in the cohort was 45.5%. There was no effect of disease status, active therapy, presence of comorbidity on mortality. There was no difference in the mortality in patients receiving early vs late initiation of plasma therapy or in patients receiving one versus two plasma therapy.ConclusionsWe provide a large series of patients with hematological malignancies and role of CPT in this group.     

Assessment of Mediastinal Lymph Node Size in Pneumococcal Pneumonia with Bacteremia

Introduction

The significance of mediastinal lymphadenopathy in bacterial pneumonia is unclear.

Methods

We performed a retrospective analysis of mediastinal lymph node size determined by chest CT in patients with bacteremic pneumococcal pneumonia. All patients who had positive blood cultures for streptococcus pneumonia over an 11-year period and had a chest CT scan (index CT) within 2 weeks of the positive blood culture were included in the study. Two thoracic radiologists and one pulmonologist independently examined the index CT plus any chest CT scans performed prior (pre-CT) or after (post-CT) the bacteremic episode.

Results

The study cohort of 49 patients was 57% male, 65% White, with mean age of 53 (SD = 20) years. Mediastinal lymphadenopathy was detected in 25/49 (51%) of the cases. The mean size of the largest mediastinal lymph node in short axis was 0.99 (SD = 0.71), ranging from 0.0 to 2.05 cm. There was no correlation noted between the number of lobes involved with pneumonia, and the size of the largest mediastinal lymph node (p = 0.33) or the number of pathologically enlarged mediastinal lymph nodes (p = 0.08). There was a statistically significant increase in the mean size of the largest lymph node between the pre-CT and index-CT group (p = 0.02), and decrease between the index-CT group and the post-CT (p = 0.03).

Conclusion

Pneumococcal pneumonia with bacteremia is associated with mild mediastinal lymph node enlargement. The presence of marked mediastinal lymphadenopathy (short axis LN size > 2 cm) should not be assumed from pneumococcal pneumonia.