Demographics, treatment and outcomes of atrial fibrillation in a developing country: the population-based TuRkish Atrial Fibrillation (TRAF) cohort.

AIMS: Although atrial fibrillation (AF) is increasingly common in developed countries, there is limited information regarding its demographics, co-morbidities, treatments and outcomes in the developing countries. We present the profile of the TuRkish Atrial Fibrillation (TRAF) cohort which provides real-life data about prevalence, incidence, co-morbidities, treatment, healthcare utilization and outcomes associated with AF. METHODS AND RESULTS: The TRAF cohort was extracted from MEDULA, a health insurance database linking hospitals, general practitioners, pharmacies and outpatient clinics for almost 100% of the inhabitants of the country. The cohort includes 507 136 individuals with AF between 2008 and 2012 aged >18 years who survived the first 30 days following diagnosis. Of 507 136 subjects, there were 423 109 (83.4%) with non-valvular AF and 84 027 (16.6%) with valvular AF. The prevalence was 0.80% in non-valvular AF and 0.28% in valvular AF; in 2012 the incidence of non-valvular AF (0.17%) was higher than valvular AF (0.04%). All-cause mortality was 19.19% (97 368) and 11.47% (58 161) at 1-year after diagnosis of AF. There were 35 707 (7.04%) ischaemic stroke/TIA/thromboembolism at baseline and 34 871 (6.87%) during follow-up; 11 472 (2.26%) major haemorrhages at baseline and 10 183 (2.01%) during follow-up, and 44 116 (8.69%) hospitalizations during the follow-up. CONCLUSION: The TRAF cohort is the first population-based, whole-country cohort of AF epidemiology, quality of care and outcomes. It provides a unique opportunity to study the patterns, causes and impact of treatments on the incidence and outcomes of AF in a developing country.

Memorandum on the use of information technology to improve medication safety.

BACKGROUND: Information technology in health care has a clear potential to improve the quality and efficiency of health care, especially in the area of medication processes. On the other hand, existing studies show possible adverse effects on patient safety when IT for medication-related processes is developed, introduced or used inappropriately. OBJECTIVES: To summarize definitions and observations on IT usage in pharmacotherapy and to derive recommendations and future research priorities for decision makers and domain experts. METHODS: This memorandum was developed in a consensus-based iterative process that included workshops and e-mail discussions among 21 experts coordinated by the Drug Information Systems Working Group of the German Society for Medical Informatics, Biometry and Epidemiology (GMDS). RESULTS: The recommendations address, among other things, a stepwise and comprehensive strategy for IT usage in medication processes, the integration of contextual information for alert generation, the involvement of patients, the semantic integration of information resources, usability and adaptability of IT solutions, and the need for their continuous evaluation. CONCLUSION: Information technology can help to improve medication safety. However, challenges remain regarding access to information, quality of information, and measurable benefits.

High detection sensitivity achieved with cryogenic detectors in combination with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry.

Cryogenic detectors directly measure the impact energy of any impinging particle independent of its velocity. Thus a very high, mass-independent, detection efficiency is expected from their application in TOF-MS. The cryogenic detector applied here is based on a superconducting phase-transition thermometer and was implemented in a dual reflector time-of-flight mass spectrometer (N-geometry). A dilution series using standard sample preparation procedures shows that the detection limit for insulin (Mr: 5,734) can be decreased by several orders of magnitude, down to 0.5 amol on the MALDI target. Detection limits for rhM-CSF beta (Mr: 49,032) and for polyclonal IgG (Mr: ca 150,000) in the high femtomole and low picomole range, respectively, were established.

Posture and central compensation after acoustic neurinoma surgery.

After acoustic neurinoma surgery via the enlarged middle cranial fossa approach the patients usually benefit from a good prognosis of the vestibular compensation, almost independent of the size of the tumour and of the patient's age, if the central vestibular pathways were not injured. Only 8% of the patients showed a reduced vestibular compensation. The success and gradation of the vestibular compensation in diseases with a permanent labyrinthine loss, even though after acoustic neurinoma surgery, can easily be classified by the so-called vestibular-index.

"Telemetric" electronystagmography: a new method for examination of nystagmus outside the clinic.

The diagnosis of the vestibular system is expanded by an newly developed system. It offers mainly two additional ways for the examination of eye movements: 1) Time and place independent, telemetric ENG recording by the patient himself. 2) Simultaneous visual examination of the nystagmus and ENG recording in clinic and surgery. The device contains of special, handy ENG recorder with digitalized storing of ENG curves. For easy application, special goggles with pre-installed electrodes have been combined with modified Frenzel's glasses. The recorded curves can be evaluated with the aid of a regular personal computer.

Simultaneous palsy of facial and vestibular nerve in a child with Lyme borreliosis.

We describe a boy with borreliosis characterized by lymphocytic meningitis and simultaneous palsy of facial and vestibular nerves on the left side. A mild sensoneural affection was also confirmed by brainstem evoked response audiometry. While symptoms of vestibular dysfunction quickly decreased during antibiotic treatment, facial palsy improved only slowly.

[Blindness caused by central artery occlusion following nasal septum correction]. / Erblindung durch Zentralarterienverschluss nach Septumkorrektur.

Visual loss following intranasal injections is extremely rare. A case report of blindness in the only seeing eye after infiltration of the septal mucosa with local anaesthetics and vasopressin is presented. The pathological mechanism and the relationship between different surgical procedures and visual loss are analysed and discussed. Some rules are given to prevent this complication.

[Diagnostic and treatment of lesions of the facial nerve after fractures of the temporal bone]. / Diagnostic et traitment des lésions du nerf facial après fractures du rocher.

The authors review functional late results of 47 cases of facial palsies due to otobasal fracture by considering the clinical and electrophysiological test results, seen between 1983 and 1988. There were 36 longitudinal, 5 transversal and 6 combined temporal bone fractures. 5 patients suffered from a bilateral facial paralysis. In all cases, an electrodiagnostic examination was carried out in order to determine the pronosis and to indicate a surgical exploration. The electrodiagnostic consisted in electromyographie (EMG) and electroneuromyographie (ENoG). 36 patients got a medical treatment and 6 patients were treated by surgery. All facial nerve paralyses (n = 28), that were incomplete according to the clinical examination as well as the electrophysiological tests, received a medical treatment which lead to good functional late results without exception. 19 facial nerve paralyses seemed to be complete in clinical examination, but in 11 cases electrodiagnostic tests revealed a residual volontary electrical activity. This indicated a conservative therapy with 7 good (66%) and 4 (33%) fair results. So, no poor result had been found in this group. In the other 8 cases, 4 of which had a delayed onset of the paralysis, no electrocal activity could be proved. 4 patients were treated by surgery, and in 2 cases a complete facial nerve transection was found. The reconstruction of the facial nerve led to 1 good and to 1 satisfactory result. In the other 2 cases, the decompression lead to 1 good and to 1 poor late result. In these 4 cases the facial nerve had been completely decompressed, in a combined transmastoidal and enlarged transtemporal middle fossa approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypertension in dialysis patients: does CAPD provide an advantage?

We considered the hypothesis that CAPD is a superior treatment to HD in patients with dialysis-refractory hypertension. We compared 12 HD patients to 22 CAPD patients entered to our program over a one year period. All had been treated for hypertension before dialysis. We found that systolic blood pressure decreased in CAPD patients compared to HD patients, even though medications were more commonly reduced in CAPD patients compared to HD patients. Ten CAPD patients required no medications after one year's treatment. These preliminary data in this small pilot study support the notion that CAPD is superior to HD in blood pressure management of hypertensive patients. A large, multicenter study may be warranted to determine if CAPD favorably influences the risk of cardiovascular complications in dialysis patients compared to HD.

Suprarenal occurrence of an adenomatoid tumor.

Adenomatoid tumors are rare, benign mesotheliomas that usually are associated with genito-urinary tract. The suprarenal occurrence of this tumor is uncommon. We present such a case and review the origin of the adenomatoid tumor.

Elevated level of serum creatine kinase MB fraction associated with a noninflammatory myopathy. Report of a case.

A 50-year-old man had progressive, noninflammatory myopathy associated with a persistently elevated serum creatine kinase (CK) level and CK MB fraction. Possible sources of this serum CK MB include cardiac muscle, skeletal muscle, other organ sites, or occult malignant neoplasm. In our patient, lack of significant cardiovascular disease and absence of CK MB in skeletal muscle homogenate suggest another, undetermined source for serum CK MB.