Device updates successfully reduce T­wave oversensing and inappropriate shocks in subcutaneous ICD patients.

AIMS: To analyse the impact of device and software updates on the prevention of T­wave oversensing (TWOS) and inappropriate shocks (IS) in subcutaneous ICD (S-ICD) patients. BACKGROUND: TWOS is a feared complication after implantation. It may lead to harmful IS. To date, specific strategies to reduce these events are lacking. METHODS: In this retrospective single-centre trial we analysed 146 S­ICD patients who were implanted between 2010 and 2016. In all eligible consecutive patients (n = 139), follow-up of at least 6 weeks was studied. The incidence of TWOS/IS was analysed in patients receiving a 2nd generation S­ICD (Emblem-S-ICD) between 2014 and 2016 (Emblem). Their outcome was compared with a control group (SQ) treated with the SQ1010 device between 2010 and 2014, who were followed up for a maximum of 2 years. Furthermore, to test if the software update SMR8 reduces inappropriate shocks in the SQ1010-S-ICD population, the incidence of TWOS/IS was evaluated before and after update installation. RESULTS: Basic characteristics and indications for S­ICD implantation were similar in both groups. However, the cumulative incidence of TWOS/IS was significantly decreased in Emblem vs. SQ (SQ: 15.4%, n = 14/91 vs. Emblem 4.2%, n = 2/48; p = 0.049). Furthermore, with regards to the SQ population we also observed a trend towards a significant reduction of TWOS/IS after installation of the software update SMR8 in 2014 (before update: 13.4%, n = 11/82 vs. after update: 4.6%, 3/65, p = 0.07). CONCLUSION: 2nd generation devices but probably also the SMR8 software update reduce the incidence of TWOS/IS in S­ICD patients.

Refinement of detecting atrial fibrillation in stroke patients: results from the TRACK-AF Study.

BACKGROUND AND PURPOSE: Detection of occult atrial fibrillation (AF) is crucial for optimal secondary prevention in stroke patients. The AF detection rate was determined by implantable cardiac monitor (ICM) and compared to the prediction rate of the probability of incident AF by software based analysis of a continuously monitored electrocardiogram at follow-up (stroke risk analysis, SRA); an optimized AF detection algorithm is proposed by combining both tools. METHODS: In a monocentric prospective study 105 out of 389 patients with cryptogenic stroke despite extensive diagnostic workup were investigated with two additional cardiac monitoring tools: (a) 20 months' monitoring by ICM and (b) SRA during hospitalization at the stroke unit. RESULTS: The detection rate of occult AF was 18% by ICM (n = 19) (range 6-575 days) and 62% (n = 65) had an increased risk for AF predicted by SRA. When comparing the predictive accuracy of SRA to ICM, the sensitivity was 95%, specificity 35%, positive predictive value 27% and negative predictive value 96%. In 18 patients with AF detected by ICM, SRA also showed a medium risk for AF. Only one patient with a very low risk predicted by SRA developed AF revealed by ICM after 417 days. CONCLUSIONS: A combination of SRA and ICM is a promising strategy to detect occult AF. SRA is reliable in predicting incident AF with a high negative predictive value. Thus, SRA may serve as a cost-effective pre-selection tool identifying patients at risk for AF who may benefit from further cardiac monitoring by ICM.

Caracterización microbiológica y molecular de Staphylococcus aureus en productos cárnicos comercializados en Cartagena Colombia / Microbiology and Molecular Characterization of Staphylococcus aureus in meat products marketed in Cartagena, Colombia

ResumenStaphylococcus aureus en la actualidad no solamente hace parte de los microorganismos nosocomiales sino también de enfermedades transmisibles por alimentos-ETAs.Objetivo:Cuantificar y caracterizar por metodología microbiológica convencional y análisis molecular Staphylococcus aureus presente en carne de res y cerdo.Método:Fueron utilizadas 160 muestras de carne molida de res y chuleta de cerdo, en 40 expendios de tres localidades de la ciudad de Cartagena: 1. Histórica y del caribe Norte (LH); 2. Industrial de la Bahía (LI); 3. De la Virgen y Turística (LV). Para la identificación microbiológica fue utilizada la técnica de recuento en placa y la técnica de Reacción en Cadena de Polimerasa (PCR).Resultados:La metodología microbiológica convencional identificó Staphylococcus aureus en el 100 % de las muestras. La técnica PCR confirmó la presencia de Staphylococcus aureus en el 88 %. El 72 % de los expendios presento recuentos > 100 UFC/g, 27 % presentaron recuentos < 100 UFC/g. La localidad industrial de la Bahía presento (48,2 %), seguido de la localidad Histórica y del Caribe Norte con 34,4 %.Discusión:El 32,5 % de los expendios analizados comercializan carne molida y chuleta de cerdo no apta para el consumo humano, por presentar recuentos que sobrepasan los parámetros de referencia para Staphylococcus aureus en carnes crudas picadas y molidas (100 - 1000 UFC/g). Fue determinada la presencia del gen MecA que codifica las cepas de Staphylococcus aureus resistente a Meticilina (SARM) en dos muestras que por metodología molecular no corresponde a Staphylococcus aureus.

AbstractStaphylococcus aureus at present not only is part of nosocomial microorganisms but also of food - borne diseases.Objetive:quantify and characterize by conventional microbiological and molecular analysis methodology to Staphylococcus in beef and pork meat.Method:They were used 160 samples of ground beef and pork chop, 40 outlets in three locations in the city of Cartagena: 1. Historic North and Caribbean (LH) 2. Bay Industrial (LI) 3. Virgin and Tourism (LV). For microbiological identification was used the plate count technique and the technique of Polymerase Chain Reaction (PCR).Results:The conventional microbiological methods Staphylococcus aureus was identified in 100 % of samples, while the PCR confirmed the presence of Staphylococcus aureus in 88 %. In 72 % of outlets were found counts > 100 CFU/g, 27 % had counts < 100 CFU/g. The highest percentage was found in the industrial town of Bay (48,2 %), followed by the Historical town and North Caribbean with 34,4 %. 32,5 % of analyzed are marketing outlets and ground pork chop unfit for human consumption meat, to present counts that exceed benchmarks for Staphylococcus aureus in raw meat chopped and ground (100-1000 CFU/g). It was determined the presence of the MecA gene encoding strains of methicillin-resistant Staphylococcus aureus (MRSA) in two samples by molecular methods is not for Staphylococcus aureus.

IFRD1 gene polymorphisms are associated with nasal polyposis in cystic fibrosis patients.

BACKGROUND: Nasal polyposis (NP) is an inflammatory disease of the upper nasal airways frequently present in CF patients. Interferon-Related Developmental Regulator 1 (IFRD1) gene was reported as a possible modifier of CF lung disease severity. Three IFRD1 SNPs were analyzed to investigate a possible effect on the development of NP in CF patients. METHODS AND PATIENTS: The DNA of 143 patients with CF (40 with and 103 without NP) was purified from peripheral blood samples. IFRD1 SNPs (rs7817, rs3807213, rs6968084) were genotyped by restriction enzyme analysis. RESULTS: The T allele of the common polymorphisms rs7817 and the rs7817-rs3807213 haplotype were associated with NP (p = 0.002 and 0.004, respectively). CONCLUSIONS: These results showed the association of the IFRD1-rs7817 polymorphism with NP in CF patients.

The Gene-Environment Interactions in Respiratory Diseases (GEIRD) Project.

The role of genetic and environmental factors, as well as their interaction, in the natural history of asthma, allergic rhinitis and chronic obstructive pulmonary disease (COPD) is largely unknown. This is mainly due to the lack of large-scale analytical epidemiological/genetic studies aimed at investigating these 3 respiratory conditions simultaneously. The GEIRD project is a collaborative initiative designed to collect information on biomarkers of inflammation and oxidative stress, individual and ecological exposures, diet, early-life factors, smoking habits, genetic traits and medication use in large and accurately defined series of asthma, allergic rhinitis and COPD phenotypes. It is a population-based multicase-control design, where cases and controls are identified through a 2-stage screening process (postal questionnaire and clinical examination) in pre-existing cohorts or new samples of subjects. It is aimed at elucidating the role that modifiable and genetic factors play in the occurrence, persistence, severity and control of inflammatory airway diseases, by way of the establishment of a historical multicentre standardized databank of phenotypes, contributed by and openly available to international epidemiologists. Researchers conducting population-based surveys with standardized methods may contribute to the public-domain case-control database, and use the resulting increased power to answer their own scientific questions.

Epidemiology and a novel procedure for large scale analysis of CFTR rearrangements in classic and atypical CF patients: a multicentric Italian study.

BACKGROUND: Mutation epidemiology in each ethnic group is a crucial step of strategies for cystic fibrosis (CF) diagnosis and counselling. To date, the scanning of the whole coding region of the cystic fibrosis transmembrane conductance regulator (CFTR) gene permits to identify about 90% of alleles from patients bearing CF and a lower percentage in patients bearing atypical CF. CFTR rearrangements in heterozygosis elude current techniques for molecular analysis, and some of them have been reported with a frequency up to 6% in various ethnic groups. METHODS: Using quantitative PCR analysis of all coding regions, we assessed the occurrence of CFTR rearrangements in 130 alleles from classic CF patients and in 198 alleles from atypical CF patients (all unrelated and from Italian descent) bearing unidentified mutations after the scanning of CFTR. RESULTS: Seven rearrangements (i.e., dele1, dele2, dele2_3, dele 14b_17b, dele17a_18, dele22_23, and dele22_24) were identified in 34/131 (26.0%) CF alleles bearing undetected mutations (which means about 2.5% of all CF alleles) and in none of the 198 alleles from atypical CF. The CFTR haplotype and the sequence analysis of the breakpoints confirmed the common origin of all the rearrangements. Thus, we set up a novel duplex PCR assay for the large-scale analysis of the seven rearrangements. The procedure was rapid (all PCR amplifications were obtained under the same conditions), costless and repeatable. CONCLUSIONS: It is useful to select the CFTR rearrangements more frequent in specific ethnic groups and to set up procedures for large-scale analysis. Their study can be performed in cases in which a high detection rate is required (i.e., partners of CF carriers/patients). On the contrary, the analysis of rearrangement is useless in atypical CF patients.

Unnecessary arterial Doppler examination of the legs. Clinical decision rules may help?

Health resources consumption depends mainly on physicians prescription habits. We identified reduction of unnecessary prescribed lower limbs arterial Doppler examinations as an area of potential cost control and quality improvement. We designed therefore a screening method based on clinical decision rules derived from epidemiological considerations: study of our records showed that patients with normal clinical examination and low risk factors score could be considered free from arterial disease by clinical grounds only, and that patients with normal clinical examination and very high risk score needed an extensive noninvasive evaluation. By offering a screening clinical examination (needing a working time shorter than a Doppler examination) with short waiting lists, we were able to safely exclude many normal patients from extensive Doppler examination, improving effectiveness by reducing total examination time by 22% and service quality by a Doppler examinations scheduling based on clinical severity judgement.

The effects of naloxone on body rotation-induced analgesia and anorexia in male mice.

The effects of body rotation in a horizontal plane and the opiate antagonist, naloxone, on the nociceptive responses and the feeding behavior of male mice were examined. In the first experiment the mice were rotated (70 rpm, schedule of 15 sec on; 5 sec off) for 60 minutes or exposed to sham rotation for the same duration. Midway through the rotation or sham procedure the mice were either injected with naloxone (1 mg/kg) or isotonic saline. At the end of the 60-minute treatment period the animals were placed on a warm surface (47.5 degrees C) and their latency to show a foot-licking response was measured. The rotation procedure produced a significant (p less than 0.01) increase in response latency in the saline-injected mice and the naloxone injections blocked this analgesic effect. This finding provides evidence for opioid involvement in the rotation-induced analgesia. In Experiment 2 mice on a food restriction schedule were rotated (70 rpm, 15 sec on; 5 sec off) or sham exposed for 60 minutes. Midway through this treatment period the mice were either injected with naloxone (1 mg/kg) or isotonic saline. Following the treatment period the mice were given access to food for 2 hours. The rotation procedure produced a significant (p less than 0.01) reduction in feeding (anorexia) in the first 30 minutes of food access for the saline-injected mice. Injections of naloxone significantly (p less than 0.05) enhanced the rotation-induced anorexia. These experiments demonstrate that rotation-induced analgesia in mice is blocked by the opiate antagonist, naloxone, whereas rotation-induced anorexia is not.(ABSTRACT TRUNCATED AT 250 WORDS)

[Liver cirrhosis. Survival of a homogeneous population]. / Cirrosi epatica. Sopravvivenza di una popolazione omogenea.

The aim of the study was the evaluation of survival of 140 cirrhotic patients who had a liver biopsy between 1970 and 1987. It is interesting to point out that all the patients with cirrhosis were included in the study and that they were all coming from a limited geographic area. This justifies the limited drop-out (7/147 patients). The high survival rate could be due to the fact that only patients suitable to receive a liver biopsy were elected for the study. We found that factors critical for prognosis in the short term (6-12 months) are biochemical values such as prothrombin index, serum albumin, serum bilirubin, alkaline phosphatase, while the factors affecting long-term prognosis are age, sex, etiology of cirrhosis, high alcohol intake after biopsy, ascites and untreated portal hypertension.

Body-rotation induced analgesia in male mice: effects of duration and type of rotation procedure.

The effects of body-rotation in a horizontal plane on the nociceptive responses of male mice were examined. In the first experiment the mice were rotated (70 rpm, schedule of 15 sec on; 5 sec off) for 30 minutes or exposed to sham rotation. The animals were then placed on a warm surface (47.5 degrees C) and their latency to show a foot-licking response was measured. Immediately after the preceding rotation procedure a trend toward a significant increase in response latencies, indicative of analgesia, was observed (p = 0.057). However, if tested 30 minutes after the end of the rotation period, no analgesia could be demonstrated (p greater than 0.50). In Experiment 2 mice were rotated (15 sec on; 5 sec off) or sham rotated for durations of 60 or 90 minutes. Response latencies were significantly elevated (p less than 0.01) after both rotation durations, but not differentially so (p greater than 0.20). In the last experiment the effects of 60 minutes of the intermittent rotation procedure (15 sec on; 5 sec off) were compared to those of 60 minutes of continuous rotation. Both types of rotation resulted in the induction of analgesia and the intermittent procedure produced a significantly greater degree of analgesia than the continuous rotation (p less than 0.05). These experiments demonstrate that 60 to 90 minutes of body-rotation can produce a significant "stress-induced" analgesia in mice and that an intermittent schedule of rotation is more effective than a continuous rotation exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute rickettsial myocarditis. Description of a clinical case and review of the literature]. / Miocardite acuta da rickettsie. Descrizione di un caso clinico e revisione della letteratura.

A case of acute rickettsial myocarditis in a young patient is described. The Authors analyze the clinical features, discuss epidemiologic features and the necessity of treatment with tetracycline.