Atrial High-Rate Episodes in Patients with Devices Without a History of Atrial Fibrillation: a Systematic Review and Meta-analysis

Cardiovascular Drugs and Therapy - Atrial high-rate episodes (AHREs) recorded with cardiac implantable electronic devices (CIEDs) have been associated with the development of clinical atrial...     

Polymyositis in a patient with recurring ovarian cancer and history of unrelated breast cancer

Background Polymyositis (PM) is an idiopathic inflammatory myopathy. Occasionally, it may present as a paraneoplastic syndrome and it is strongly associated with ovarian and weakly with breast cancer. We present here a case of a 60-year-old patient with sequential breast and ovarian (second primary) carcinomas followed by PM as a paraneoplastic disorder. Case report The patient had been diagnosed with stage I breast carcinoma 3 years ago and had been treated with conservative surgery followed by radiotherapy and six cycles of chemotherapy (CMF). One and a half year later an ovarian carcinoma was diagnosed for which the patient underwent abdominal hysterectomy oophorectomy and omentectomy. The pathological report characterized it as second primary. Adjuvant chemotherapy with carboplatin and taxol was administered. Fourteen months after the initial laparotomy, the patient was re-operated due to ovarian carcinoma recurrence which was involving all lesser pelvis organs. After a successful radical removal of the recurrence the patient developed a fully expressed PM. This case serves to remind that this disease can occur as a paraneoplastic disorder.     

An assessment of the physiological significance of cimetidine interactions with copper and zinc in biofluids as based on the computer-simulated distribution of the involved complexes at therapeutic levels of the drug

The hypothesis was formerly put forward that the main therapeutic action of cimetidine (the histamine H₂-receptor antagonist marketed as Tagamet^®) as well as some of its side effects might be mediated by its interactions with essential metal ions.The present paper reports the potentiometric study of the coordination of the drug with copper(II) and zinc(II) in NaCl 0.15 mol dm^–3 at 37°C. Special attention was paid to copper complexes, due to (i) the involvement of cimetidine in rheumatoid arthritis evolution which could be related to the well-established role of copper against this disease, (ii) the anti-ulcer and anti-inflammatory properties of copper. In particular, the copper-cimetidine-histamine and copper-cimetidine-histidine ternary systems were investigated.Computer simulations of the distribution of cimetidine, zinc and copper in blood plasma were performed at therapeutic levels of the drug. No influence can be expected from cimetidine on the bioavailability of these metal ions, the opposite being also true. The mediation of copper in the action of cimetidine on rheumatoid arthritis should thus be ruled out, the influence of the drug being rather interpretable in terms of reduction of histamine release. Similarly, the sexual dysfunctions due to cimetidine administration are unlikely to arise from the interactions of drug with zinc in blood plasma.The possible involvement of copper and zinc in cimetidine gastrointestinal absorption is also discussed.     

Isosexual Pseudoprecocious Puberty in a 2½-Year-Old Girl Presenting with Intense Skin Pigmentation

BackgroundOvarian follicular cyst producing estradiol is a rare cause of isosexual pseudoprecocious puberty. Intense pigmentation of breast papillae, areolae, and labia minora is also rarely reported in the literature.CaseWe describe a 2½ year old girl presenting with signs of precocious puberty and advanced bone age due to a large follicular cyst. Estradiol and Dehydro-epiandrosterone sulfate (DHEAS) levels were remarkably elevated. Hyperpigmentation was also noted. Salpingoophorectomy resulted in regression of precocity and depigmentation, but DHEAS serum levels remained elevated.Summary and ConclusionHigh levels of circulating estradiol due to an ovarian follicle can induce precocious puberty and pigmentation of the skin which regresses after surgical removal of the cyst. Elevated DHEAS levels may be the initiating event causing the formation of the large follicular cyst.     

Changes in glycemic control are associated with changes in cognition in non-diabetic elderly

The aim of the present study was to examine the relationship of changes in long term glucose levels as measured by Hemoglobin A1c (HbA1c) with simultaneous changes in cognition. The sample included in the present analysis consisted of 101 community dwelling non-diabetic elderly subjects participating in ongoing longitudinal studies of cognition. Subjects were included in this study if they were cognitively normal at baseline, had at least one co-temporaneous follow-up assessment of HbA1c and the Mini Mental State Exam (MMSE), and complete data on age, gender, race, and years of education. MMSE decline over time was the main outcome measure. In TOBIT mixed regression models, MMSE was the dependent variable and HbA1c the time-varying covariate. Sociodemographic (age, gender, and education), cardiovascular (hypertension and APOE4 status), and lifestyle (smoking and physical activity) covariates were included in the statistical model. After adjusting for age at follow-up, there was a decrease of 1.37 points in the MMSE (p = 0.0002) per unit increase in HbA1c. This result remained essentially unchanged after adjusting also for gender and education (p = 0.0005), cardiovascular factors (p = 0.0003), and lifestyle (p = 0.0006). Additionally, results remained very similar after excluding subjects with potentially incipient diabetes with HbA1c between 6 and 7. These findings suggest that in non-diabetic non-demented elderly subjects, an increase in HbA1c over time is associated with cognitive decline. Such results may have broad clinical applicability since manipulation of glucose control, even in non-diabetics, may affect cognitive performance, perhaps enabling preventive measures against dementia.     

Non-vitamin K oral anticoagulants in nonvalvular atrial fibrillation: a network meta-analysis

Objectives. We conducted a systematic review and network meta-analysis of randomized controlled trials (RCTs) including the comparison of non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin for patients with atrial fibrillation (AF). Design. Network meta-analysis. Two authors independently extracted data. All authors evaluated overall confidence in the evidence. Results. Eighteen RCTs included in our review, a total of 78,796 patients with AF, with sample sizes from 90 to 21,105 patients. Apixaban 5?mg (OR: 0.79, 95% CI: 0.66 to 0.95), dabigatran 110?mg (0.91, 0.74–1.12), dabigatran 150?mg (0.66, 0.53–0.82), edoxaban 60?mg (0.87, 0.74–1.02), and rivaroxaban 20?mg (0.88, 0.74–1.03) reduced the risk of stroke or systemic embolism compared with warfarin. Dabigatran 150?mg had the highest P-score for reducing stroke or systemic embolic events. The risk of haemorhagic stroke and all-cause mortality was lower with all NOACs than with warfarin. Apixaban 5?mg (0.69, 0.60–0.80), dabigatran 110?mg (0.80, 0.69–0.93), dabigatran 150?mg (0.93, 0.80–1.08), edoxaban 30?mg (0.46, 0.40–0.54), and edoxaban 60?mg (0.78, 0.69–0.90) reduced the risk of major bleeding compared with warfarin. Edoxaban 30?mg had the highest P-score for reducing major bleeding. The plots of P-scores rank showed that apixaban offered the most favorable balance of efficacy and safety. Conclusions. This study adds an attempt for treatment ranking of both efficacy and safety outcomes. Future trials comparing directly NOACs are needed in order to provide conclusive proofs for these results and not only circumstantial evidence offered by a network meta-analysis.     

Ultrasound-assisted intraoperative localization and laparoscopic management of a previously missed unruptured retroperitoneal ectopic pregnancy

Primary retroperitoneal ectopic pregnancy represents an extremely unusual entity with a rather obscure pathogenesis. Implantation in the retroperitoneal space has been reported to occur both spontaneously and with use of assisted reproduction techniques. The pelvic and the upper retroperitoneum have both been involved, and implantation in the most unusual anatomic sites has been reported. The majority of retroperitoneal gestations are located close to large blood vessels, and laparotomy is performed because of the high risk of massive hemorrhage. Few cases have been treated with laparoscopy so far. We report the case of an early first-trimester retroperitoneal broad ligament live pregnancy occurring after spontaneous conception in a patient who had a history of an ipsilateral tubal ectopic pregnancy, previously treated with laparoscopic right salpingectomy. Current gestation had been missed during initial laparoscopy, and was located and removed during a repeat laparoscopic procedure under intraoperative ultrasonographic guidance.     

Ifosfamide and paclitaxel salvage chemotherapy for advanced epithelial ovarian cancer

Objective: To evaluate the efficacy and toxicity of the combinationof ifosfamide (1.5 g/m² i.v. on days 1, 2, 3) and paclitaxel(135 mg/m² i.v. over 3 hours on day 3) with G-CSF (5µg/kg/d subcutaneously, days 7–11) administered every 3 weeks onan outpatient basis in patients with advanced epithelial ovarian cancerpreviously treated with platinum-based chemotherapy.Patients and methods: Thirty-five consecutive patients were treated,12 of whom had previously received two regimens. Twelve of the 35 were definedas platinum-resistant and 23 as potentially platinum-sensitive.Results: Fifteen patients (43%; 95% CI:26%–61%) achieved objective responses, five of themcomplete and ten partial. Objective responses occurred in 17% of theplatinum-resistant patients and in 57% of those with potentiallyplatinum-sensitive disease. The median duration of response was seven monthsand the median overall survival 11 months. The treatment was well toleratedand only 15% of the patients developed grade 3 or 4 neutropenia. Withthe exception of alopecia there were no other grade 3 or 4 toxicities.Conclusions: The combination of ifosfamide and paclitaxel was welltolerated and showed activity in patients with ovarian cancer who hadpreviously undergone platinum-based chemotherapy.