Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis

Background  

Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery.     

Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study

BACKGROUND: There are obvious advantages to increasing donor retention. However, for reasons of blood safety, certain donors may, in fact, be more desirable to retain than others. “Safe” donors are defined as those who provided a blood donation that was negative on all laboratory screening tests and who subsequently reported no behavioral risks in response to an anonymous survey. This study identifies the most important factors affecting the intention of “safe” donors to provide another donation. STUDY DESIGN AND METHODS: An anonymous survey asking about donation history, sexual history, injecting drug use, and recent donation experience was mailed to 50,162 randomly selected allogeneic donors (including directed donors) who gave blood from April through July or from October through December 1993 at one of the five United States blood centers participating in the Retrovirus Epidemiology Donor Study. Before mailing, questionnaires were coded to designate donors with nonreactive laboratory screening tests at their most recent donation. RESULTS: A total of 34,726 donors (69%) responded, with substantially higher response among repeat donors. According to reported intentions only, the vast majority of “safe” donors indicated a high likelihood of donating again within the next 12 months. Only 3.4 percent reported a low likelihood of donating again. A comparison of those likely to return and those unlikely to return reveals significant differences in demographics and in ratings of the donation experience. A higher proportion of those unlikely to return were first-time donors, minority-group donors, and donors with less education. The highest projected loss among “safe” donors was seen for those who gave a fair to poor assessment of their treatment by blood center staff or of their physical well-being during or after donating. CONCLUSION: These data suggest that efforts to improve donors' perceptions of their donation experience, as well as attention to the physical effects of blood donation, may aid in the retention of both repeat and first-time donors.     

Mutation spectrum and genotype-phenotype analyses in Cowden disease and Bannayan-Zonana syndrome, two hamartoma syndromes with germline PTEN mutation

The tumour suppressor gene PTEN , which maps to 10q23.3 and encodes a 403 amino acid dual specificity phosphatase (protein tyrosine phosphatase; PTPase), was shown recently to play a broad role in human malignancy. Somatic PTEN deletions and mutations were observed in sporadic breast, brain, prostate and kidney cancer cell lines and in several primary tumours such as endometrial carcinomas, malignant melanoma and thyroid tumours. In addition, PTEN was identified as the susceptibility gene for two hamartoma syndromes: Cowden disease (CD; MIM 158350) and Bannayan-Zonana (BZS) or Ruvalcaba-Riley-Smith syndrome (MIM 153480). Constitutive DNA from 37 CD families and seven BZS families was screened for germline PTEN mutations. PTEN mutations were identified in 30 of 37 (81%) CD families, including missense and nonsense point mutations, deletions, insertions, a deletion/insertion and splice site mutations. These mutations were scattered over the entire length of PTEN , with the exception of the first, fourth and last exons. A 'hot spot' for PTEN mutation in CD was identified in exon 5 that contains the PTPase core motif, with 13 of 30 (43%) CD mutations identified in this exon. Seven of 30 (23%) were within the core motif, the majority (five of seven) of which were missense mutations, possibly pointing to the functional significance of this region. Germline PTEN mutations were identified in four of seven (57%) BZS families studied. Interestingly, none of these mutations was observed in the PTPase core motif. It is also worthy of note that a single nonsense point mutation, R233X, was observed in the germline DNA from two unrelated CD families and one BZS family. Genotype-phenotype studies were not performed on this small group of BZS families. However, genotype-phenotype analysis inthe group of CD families revealed two possible associations worthy of follow-up in independent analyses. The first was an association noted in the group of CD families with breast disease. A correlation was observed between the presence/absence of a PTEN mutation and the type of breast involvement (unaffected versus benign versus malignant). Specifically and more directly, an association was also observed between the presence of a PTEN mutation and malignant breast disease. Secondly, there appeared to be an interdependent association between mutations upstream and within the PTPase core motif, the core motif containing the majority of missense mutations, and the involvement of all major organ systems (central nervous system, thyroid, breast, skin and gastrointestinal tract). However, these observations would need to be confirmed by studying a larger number of CD families.      

Testing for anosmia and ageusia in patients presenting to the emergency department with suspected coronavirus disease 2019 in Saudi Arabia

ObjectiveThis study investigated the role of objective olfactory dysfunction (OD) and gustatory dysfunction (GD) testing among patients with suspected coronavirus disease 2019 (COVID-19) who presented with respiratory symptoms.MethodsA prospective, blinded, observational study was conducted in the emergency units of two tertiary hospitals. Participants were asked to identify scents in the pocket smell test (PST) and flavors in four different solutions in the gustatory dysfunction test (GDT). We assessed the level of agreement between objective findings and self-reported symptoms. We evaluated the diagnostic accuracy of chemosensory dysfunction for diagnosing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.ResultsOf 250 participants, 74 (29.6%) were SARS-CoV-2-positive. There was slight agreement between self-reported symptoms and objective findings (kappa = 0.13 and 0.10 for OD and GD, respectively). OD assessed by the PST was independently associated with COVID-19 (adjusted odds ratio = 1.89, 95% confidence interval, 1.04–3.46). This association was stronger when OD was combined with objective GD, cough, and fever (adjusted odds ratio = 7.33, 95% confidence interval, 1.17–45.84).ConclusionsNeither the PST nor GDT alone are useful screening tools for COVID-19. However, a diagnostic scale based on objective OD, GD, fever, and cough may help triage patients with suspected COVID-19.     

Lichen sclerosus mistaken for child sexual abuse

A 3-year-old girl presented to the primary care clinic at King Abdulaziz Medical City (KAMC) with asymptomatic white discoloration of the vulva of 3 months’ duration. Dysuria, genital itching, and vaginal discharge followed 2 months later. The discharge was yellowish-greenish in color and occasionally associated with blood-tinged staining of the underwear. The mother had noted that the genital skin changes had worsened in the last 2 weeks and that the genital itching and dysuria had become more frequent. There was no history of trauma, behavioral problems, abnormal sexual behaviour, encopresis, or any underlying disease. On questioning the mother, the possibility of sexual abuse could not be ruled out as she reported that the father was drug and alcohol dependent and behaved inappropriately when under the influence of these factors. Because of this possibility, the girl and her parents were referred to the suspected child abuse and neglect (SCAN) team at KAMC for further evaluation. The physician, social worker, and child psychiatrist interviewed the girl, her three older brothers, and the parents separately. The girl and her siblings denied any abnormal touching by an adult. The mother reported that she and the father had been separated for 1 year; however, the couple had been reunited for the last month and were currently living together. The mother linked the appearance of the genital changes to the time the father returned; however, no definite history of sexual abuse was obtained. The father denied any sexual or other abnormal encounter with the child. On examination, the child was well developed and well nourished, cooperative, and showed no abnormal fear of genital or anal examination. Genital examination revealed sharply demarcated, hypopigmented, atrophic plaques symmetrically surrounding the labia majora ( Fig. 1 ). Three sharply demarcated, 0.5 cm, nonpalpable, reddish purpuric macules on the medial aspect of both the labia majora and the base of the clitoris were noted ( Fig. 2 ). Two sharply defined healing erosions were noted on the left side distal to the introitus. The hymenal ring could not be seen, but the hymenal orifice was not dilated. The introitus and the anus appeared normal. Because of the genital findings and the mother's concerns, the possibility of sexual abuse was contemplated. Extensive laboratory testing for sexually transmitted diseases, including syphilis, chlamydia, human immunodeficiency virus, and gonorrhea, were negative. Urine analysis and culture were negative. Routine vaginal culture grew group B β-hemolytic streptococcus, and the patient was treated with amoxicillin-clavulanate orally for 10 days. Due to a lack of evidence of sexual abuse, the SCAN team decided to follow up the child and to investigate further before reporting to the protective agency.

Figure 1 Open in figure viewer PowerPoint Photograph of the vulva showing atrophic, hypopigmented, sharply defined plaques