Anticoagulation in patients with atrial fibrillation,thrombocytopenia and hematological malignancy

Journal of Thrombosis and Thrombolysis - Managing anticoagulation in hematological malignancy patients with atrial fibrillation and thrombocytopenia is a clinical challenge with limited data. We...     

Pre-Menopausal Breast Fat Density Might Predict MACE During 10 Years of Follow-Up: The BRECARD Study

ObjectivesThis study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women.BackgroundTo our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women.MethodsProspective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition.ResultsThe propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation.ConclusionsAmong pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217)     

<Emphasis Type="Italic">Acinetobacter</Emphasis> Infections in Neonates

Purpose of Review

MDR-Gram-negative bacteria are a great concern in the neonatal population, with a worldwide rise in the reported incidence and with very limited therapeutic options. Acinetobacter baumannii is responsible for many infections in neonates and outbreaks in neonatal intensive care unit (NICU); also, outbreaks caused by other Acinetobacter species have been reported. The aim of this review is to document the epidemiology of Acinetobacter spp. infections in neonates and risk factors for acquisition of Acinetobacter spp. in the NICU using data from published studies.

Recent Findings

Acinetobacter spp. infections are increasing in neonates in NICU. Outbreak caused by multidrug resistant (MDR) or extensively drug resistant (XDR) A. baumannii but also outbreak caused by susceptible A. soli and A. septicus sp. nov., were reported in neonates. Acinetobacter spp. were responsible for bloodstream infections and respiratory tract infections in neonates. Risk factors for A. baumannii acquisition in neonates were low birthweight, length of NICU stay, umbilical catheterization, central-venous catheterization, assisted ventilation, and prior antibiotic use.

Summary

This review highlights the importance of surveillance of risk factors for healthcare-associated infections in NICU to control MDR and XDR A. baumannii infections in neonates.

     

Seventeen-year experience with the St. Jude medical biocor porcine bioprosthesis

BACKGROUND AND AIM OF THE STUDY: Bioprostheses in heart surgery have been investigated in recent years to reduce the long-term anticoagulant administration associated with mechanical devices. Positive results have been achieved, particularly in elderly patients who have a supposed delayed fibrocalcification and reduced life expectancy. Herein are reported 17-year data on the ongoing long-term study of the Biocor porcine prosthetic heart valve, an improved bioprosthesis with reduced stiffness and improved flexibility of the valve cusps designed to resolve issues of reduced lifespan of previous biological valves. METHODS: Data were presented for 1,455 patients who underwent aortic valve replacement (AVR) or mitral valve replacement (MVR) in Sweden with glutaraldehyde-preserved Biocor bioprostheses between 1983 and 2000. Follow up after surgery was evaluated on alternate years using hospital records, interviews, questionnaires and the Cox regression model of multivariate analysis. RESULTS: At 17 years, the cumulative follow up was 6,540 and 989 patient-years (pt-yr) for AVR and MVR, respectively. Late mortality accounted for 357 (28%) and 65 (38%) patients, respectively, and actuarial survival was 28.2% and 35.4%, respectively. Thromboembolic events occurred in 82 AVR (1.25%/pt-yr) and 18 MVR (1.82%/pt-yr) patients, respectively, with freedom from thromboembolism decreasing with age; 181 AVR and 44 MVR patients received anticoagulants. Reoperations due to structural valve deterioration (SVD) were required in 63 AVR and nine MVR patients. Freedom from reoperation due to SVD increased with age in both groups; actuarial freedom from reoperation was 73.9% and 81.3%, respectively. CONCLUSION: Seventeen-year data confirm the low incidence of valve-related complications and improved valve durability reported at the 15-year follow up after both AVR and MVR using Biocor porcine bioprostheses.