Necklace‐embedded electrocardiogram for the detection and diagnosis of atrial fibrillation

BackgroundAtrial fibrillation (AF) is the major cause of stroke since approximately 25% of all strokes are of cardioembolic‐origin. The detection and diagnosis of AF are often challenging due to the asymptomatic and intermittent nature of AF.HypothesisA wearable electrocardiogram (ECG)‐device could increase the likelihood of AF detection. The aim of this study was to evaluate the feasibility and reliability of a novel, consumer‐grade, single‐lead ECG recording device (Necklace‐ECG) for screening, identifying and diagnosing of AF both by a cardiologist and automated AF‐detection algorithms.MethodsA thirty‐second ECG was recorded with the Necklace‐ECG device from two positions; between the palms (palm) and between the palm and the chest (chest). Simultaneously registered 3‐lead ECGs (Holter) served as a golden standard for the final rhythm diagnosis. Two cardiologists interpreted independently in a blinded fashion the Necklace‐ECG recordings from 145 patients (66 AF and 79 sinus rhythm, SR). In addition, the Necklace‐ECG recordings were analyzed with an automatic AF detection algorithm.ResultsTwo cardiologists diagnosed the correct rhythm of the interpretable Necklace‐ECG with a mean sensitivity of 97.2% and 99.1% (palm and chest, respectively) and specificity of 100% and 98.5%. The automatic arrhythmia algorithm detected the correct rhythm with a sensitivity of 94.7% and 98.3% (palm and chest) and specificity of 100% of the interpretable measurements.ConclusionsThe novel Necklace‐ECG device is able to detect AF with high sensitivity and specificity as evaluated both by cardiologists and an automated AF‐detection algorithm. Thus, the wearable Necklace‐ECG is a new, promising method for AF screening. Clinical trial registration: Study was registered in the ClinicalTrials.gov database ({"type":"clinical-trial","attrs":{"text":"NCT03753139","term_id":"NCT03753139"}}NCT03753139).     

Effects of gentamycin and chloramphenicol on the transparency of cultured rat lenses

The effect of the antibiotics gentamycin and chloramphenicol on lens opacity was studied in an organ culture system. Opacity was monitored by split laser beam. Both antibiotics enhanced the onset of opacity in the cultured lenses under a variety of conditions. For instance, treatment with 5.0 mg/ml gentamycin for 60 min caused initial opacity after 4.8 +/- 1.3 days as opposed to untreated lenses at which initial opacity appeared after 18.1 +/- 2.99 days. Exposure to 20 mg/ml chloramphenicol for 60 min caused initial opacity after 4.6 +/- 1.51 days. Continuous exposure to penicillin and streptomycin (0.1 mg/ml each) did not enhance the onset of opacity.     

Endoscopic sclerosis of the cardia affects gastroesophageal reflux

Summary Gastroesophageal reflux disease remains a disorder of unknown etiology associated with abnormal function of the lower esophageal sphincter (LES) and other physiological co-factors of the pathologic reflux. Effective operations for reflux are designed to reinforce the anti-reflux barrier and alter the tendency towards abnormal reflux. We have postulated that the most important component of these procedures is the prevention of distraction of the lowermost components of the LES at the onset of a potential reflux episode. Distraction of the LES causes shortening of the effective sphincter mechanism and can initiate experimental reflux events. In this study we used endoscopic sclerosis of the submucosal space at the cardia as a means of reducing distraction of the cardia in the hope that this would reduce abnormal reflux events. Canine gastroesophageal reflux was induced by intravenous atropine and monitored by continuous esophageal pH monitoring. Sclerosis of the cardia prevented gastroesophageal reflux, without measurable effect on the LES pressure or length. Endoscopic sclerosis of the cardia may be a useful technique in the control of human gastroesophageal reflux.Presented at the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin 1988     

Recurrent corneal oedema following late migration of intraocular glass.

This is a report of very late complications following intraocular penetration of numerous fragments of glass as a result of a test tube explosion. Fifteen years after the initial injury glass splinters began to migrate from the vitreous into the anterior chamber, causing acute episodes of corneal oedema. Four such episodes occurred over the past nine years, the corneal oedema each time disappearing within a few days following surgical extraction of the glass splinters. The literature on intraocular glass and its movement within the eye is reviewed.     

Die systemische Sklerose – Eine rheumatologische Herausforderung

The connective tissue disease systemic sclerosis (SSc) is still a challenge to every rheumatologist. SSc is characterized by progressing fibrosis of the skin and internal organs, abnormal activation of the immune system and distinct changes in microcirculation. Although it is a rare disease with a prevalence of about 20:100,000, one may come across it in daily practice. SSc is classified into limited and diffuse forms. Both entities usually involve internal organs. Life expectancy is limited and depends predominantly on the extent of the organs involved. Therefore, it is essential to diagnose SSc early and to identify and closely monitor the organs involved.     

Experimentelle Untersuchungen über die Ausscheidung des Alkohols im Schlaf

Zusammenfassung An Hand einer Reihe von Untersuchungen wurde nachgewiesen, daß es im Schlaf zu einer Verzögerung der Alkoholausscheidung kommen kann, die recht beträchtliche Grade anzunehmen vermag.Ob der Schlaf allein für diese Vorgänge verantwortlich ist, oder ob Überlagerungen durch Alkoholwirkung dabei eine Rolle spielen, läßt sich auf Grund des Ausfalls der Untersuchungen nicht eindeutig entscheiden. Beides kann für möglich gehalten weiden.     

Die „Pulmonalsklerose“ als Ursache des plötzlichen natürlichen Todes

Zusammenfassung Es wurden zwei plötzliche Todesfälle bei Thrombenarteriitis obliterans bzw. primärer Pulmonalsklerose beschrieben und dabei auf die Möglichkeit des plötzlichen Todes bei den vasculär bedingten Störungen des Pulmonalkreislaufes der sog. Pulmonalsklerose eingegangen.Es wurde kurz zu der Frage Unfall und Entschädigungspflicht bei Pulmonalsklerose Stellung genommen.     

“We are part of a family”. Benefits and limitations of community ART groups (CAGs) in Thyolo,Malawi: a qualitative study

Introduction : In 2012 Community ART Groups (CAGs), a community‐based model of antiretroviral therapy (ART) delivery were piloted in Thyolo District, Malawi as a way to overcome patient barriers to accessing treatment, and to decrease healthcare workers’ workload. CAGs are self‐formed groups of patients on ART taking turns to collect ART refills for all group members from the health facility. We conducted a qualitative study to assess the benefits and challenges of CAGs from patients’ and healthcare workers’ (HCWs) perspectives. Methods : Data were collected by means of 15 focus group discussions, 15 individual in‐depth interviews, and participant observation in 2 health centres. The 94 study participants included CAG members, ART patients eligible for CAGs who remained in conventional care, former CAG members who returned to conventional care and HCWs responsible for providing HIV care. Patient participants were purposively selected from ART registers, taking into account age and gender. Narratives were audio‐recorded, transcribed, and translated from Chichewa to English. Data were analyzed through a thematic analysis. Results : Patients and HCWs spoke favourably about the practical benefits of CAGs. Patient benefits included a reduced frequency of clinic visits, resulting in reduced transportation costs and time savings. HCW benefits included a reduced workload. Additionally peer support was perceived as an added value of the groups allowing not only sharing of the logistical constraints of drugs refills, but also enhanced emotional support. Identified barriers to joining a CAG included a lack of information on CAGs, unwillingness to disclose one's HIV status, change of residence and conflicts among CAG members. Participants reported that HIV‐related stigma persists and CAGs were seen as an effective strategy to reduce exposure to discriminatory labelling by community members. Conclusions : In this setting, patients and HCWs perceived CAGs to be an acceptable model of ART delivery. Despite addressing important practical barriers to accessing ART, and providing peer support, CAGs were not well known by patients and had a limited impact on reducing HIV‐related stigma. The CAG model of ART delivery should be considered in similar settings. Further measures need to be devised and implemented to address HIV‐related stigma.