Horizontal transmission of hepatitis B virus infection in household contacts, Pune, India

The study was undertaken to detect the risk of infection, if any, among 193 household contacts of 40 hospitalised hepatitis patients (group I) with hepatitis B surface antigen (HBsAg) in their blood. As a control group, 103 household contacts of 27 hospitalised hepatitis patients who were negative for HBsAg (group II) were investigated. The family contacts of the former group had a significantly higher prevalence of HBV infection than those of the latter group (P less than .001). Significant differences were observed both in the prevalence of HBsAg (P less than .05) and antibody to HBsAg (anti-HBs) (P less than .025) between the two groups. IgM antibody to hepatitis B core antigen (anti-Hbc-IgM) was detected in 32 out of the 39 (82%) sera tested from the patients of group I with HBsAg. A statistically significant difference (P less than .005) of HBV prevalence was also found in the contacts of these 32 patients suffering from acute hepatitis B as compared to the contacts of the patients of group II. Overall, the children of the first group showed a significantly higher prevalence of HBsAg as compared to the second group. All the children with HBsAg were positive for HBeAg also, but were negative for anti-HBc-IgM. Anti-HBs was detected in a significantly larger number of adult females. Spouses were found to be affected more than other relatives. A significant difference (P less than .025) was noted in the number of families having HBV markers in group I (80.0%) as compared to those in group II (48.1%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Isolated hepatic tuberculosis: An uncommon presentation of a common culprit

Hepatic tuberculosis (HTB) is commonly encountered in patients with widespread miliary disease. Isolated affection of the liver is extremely rare. We present a case of a young woman who presented with a subacute afebrile hepatic failure. Investigations including a liver biopsy proved that the presentation was due to granulomatous hepatitis secondary to mycobacterial infection of the liver. It is important that tuberculosis (TB) be kept in mind especially in endemic areas even in atypical clinical scenarios by clinicians, radiologists, and pathologists. Use of anti-tuberculous drugs in such cases is usually successful and must be instituted early.     

Electromagnetic interference between implantable cardiac devices and continuous-flow left ventricular assist devices: a review

Journal of Interventional Cardiac Electrophysiology - Many patients with continuous-flow left ventricular assist devices (CF-LVAD) have other, co-existing implantable cardiac devices. While such...     

Sustained Bundle Branch Reentry in a Patient with Hypertrophic Cardiomyopathy and Nondilated Left Ventricle

Ventricular tachycardia is a well-known complication in patients withhypertrophic cardiomyopathy. We report the case of a patient withhypertrophic cardiomyo<->pathy with easily inducible monomorphic ventriculartachycardia. Electrophysiology study demonstrated that bundle branch reentrywas the mechanism of the tachycardia. The tachycardia was renderednon-inducible by radiofrequency ablation of the right bundle branch.     

Prevalence and prognostic significance of atrial arrhythmias after orthotopic cardiac transplantation

Objectives. We studied the duration and prognostic significance of atrial arrhythmias in the denervated transplanted heart, specifically the occurrence of atrial fibrillation in the absence of vagal modulation.

Background. Substantial animal data indicate that vagally induced dispersion of atrial refractoriness plays a central role in the induction and maintenance of atrial fibrillation.

Methods. We studied the occurrence of atrial arrhythmias in the denervated hearts of 88 consecutive orthotopic transplantations in 85 patients by means of continuous telemetry and all available electrocardiographic tracings.

Results. Fifty percent of recipients (44 of 88) developed at least one atrial arrhythmia. Atrial fibrillation occurred 23 times (21 recipients), atrial flutter 39 times (26 recipients), ectopic atrial tachycardia 3 times (3 recipients) and supraventricular tachycardia 18 times (11 recipients). The number of atrial fibrillation and atrial flutter episodes did not differ (23 vs. 39, p = 0.072), but the fibrillation (37.0 ± 10 vs. 6.6 ± 3.6 h, p = 0.014). Atrial fibrillation was associated with an increased risk of subsequent death (10 of 21 recipients with vs. 15 of 67 without atrial fibrillation, risk ratio 3.15 ± 0.18, p = 0.005 by Cox proportional hazards model). All 5 recipients who developed “late” atrial fibrillation (>2 weeks after transplantation) died versus 5 of 16 who developed atrial fibrillation within the first 2 weeks (p = 0.007). Causes of death included rejection (three recipients), allograft failure (two recipients), infection (three recipients) and multiorgan failure (two recipients). Atrial fibrillation was not associated with age, gender, ischemic time, reason for transplantation, echocardiographic variables, invasive hemodynamic variables or biopsy grade. Mean time from atrial arrhythmia to echocardiography was 2.7 ± 3.3 days; that to biopsy was 4.8 ± 6.3 days. Atrial flutter was not associated with subsequent death. Only 7 (15.9%) of 44 recipients demonstrated moderate or severe allograft rejection at the time of the arrhythmia.

Conclusions. Atrial arrhythmias occur frequently in the denervated transplanted heart, often in the absence of significant rejection. Late atrial fibrillation may be associated with an increased all-cause mortality.