Implantation of a novel insertable cardiac monitor: preliminary multicenter experience in Europe.

BACKGROUND: The LUX-Dx™ is a novel insertable cardiac monitor (ICM) introduced into the European market since October 2022. PURPOSE: The aim of this investigation was to provide a comprehensive description of the ICM implantation experience in Europe during its initial year of commercial use. METHODS: The system comprises an incision tool and a single-piece insertion tool pre-loaded with the small ICM. The implantation procedure involves incision, creation of a device pocket, insertion of the ICM, verification of sensing, and incision closure. Patients receive a mobile device with a preloaded App, connecting to their ICM and transmitting data to the management system. Data collected at European centers were analyzed at the time of implantation and before patient discharge. RESULTS: A total of 368 implantation procedures were conducted across 23 centers. Syncope (235, 64%) and cryptogenic stroke (34, 9%) were the most frequent indications for ICM. Most procedures (338, 92%) were performed in electrophysiology laboratories. All ICMs were successfully implanted in the left parasternal region, oriented at 45° in 323 (88%) patients. Repositioning was necessary after sensing verification in 9 (2%) patients. No procedural complications were reported, with a median time from skin incision to suture of 4 min (25th-75th percentiles 2-7). At implantation, the mean R-wave amplitude was 0.39 ± 0.30 mV and the P-wave visibility was 91 ± 20%. Sensing parameters remained stable until pre-discharge and were not influenced by patient characteristics or indications. Procedural times were fast, exhibited consistency across patient groups, and improved after an initial experience with the system. Operator Operator feedback on the system was positive. Patients reported very good ease of use of the App and low levels of discomfort after implantation. CONCLUSIONS: LUX-Dx™ implantation appears efficient and straightforward, with favorable post-implantation sensing values and associated with positive feedback from operators and patients.

Surgical management of bilateral, upper and lower eyelid entropion in 27 Shar Pei dogs, using the Stades forced granulation procedure of the upper eyelid only.

Aims: To evaluate the outcome of surgical management of entropion of the upper and lower eyelids in Shar Pei dogs which had previously undergone temporary palpebral tacking, using the Stades forced granulation procedure of the upper eyelid only.Methods: Medical records were retrospectively searched to identify Shar Pei dogs referred for bilateral entropion of both the lower and upper eyelids, and that were treated with the forced granulation procedure of the upper eyelid only. Dogs were included if they had previously undergone unsuccessful temporary palpebral tacking and had at least three follow-up examinations in the 30 days following surgery.Results: Twenty-seven Shar Pei dogs with a median age of 7.9 (min 4, max 24) months were included in the study. Before surgery, all dogs showed signs of severe ocular discomfort with bilateral keratitis and visual deficit due to blepharospasm, enophthalmos and protrusion of the third eyelid. In 13/54 eyes, keratitis was associated with a corneal ulcer. When re-examined 4 weeks after surgery, correction of the upper eyelid entropion and associated trichiasis resolved ocular signs in 50/54 eyes. Mild bilateral lower entropion remained in two dogs postoperatively, which underwent revision surgery with the Hotz-Celsus technique. There were no cases of long-term recurrence of entropion or ocular irritation in the 38 eyes (19 dogs) which were re-examined 1 year after surgery.Conclusion and clinical relevance: The forced granulation procedure performed on the upper eyelid only was effective for correction of entropion in the Shar Pei dogs included in this study. In our experience, it is preferable to operate on the upper eyelid alone, rather than attempting to correct upper and lower entropion during the same surgical operation. The dog can then be reassessed a few weeks later to determine whether the lower entropion is anatomical or secondary to the severe blepharospasm resulting from the painful ocular irritation.

The invasion of abandoned fields by a major alien tree filters understory plant traits in novel forest ecosystems.

The abandonment of agricultural use is a common driver of spontaneous reforestation by alien trees. The N-fixing black locust (Robinia pseudoacacia L.) is a major alien invader of old fields in Europe. Here we show that canopy dominance by this tree may filter the frequency distribution of plant functional traits in the understory of secondary woodlands. Higher soil C/N ratio and available P are associated with black locust stands, while higher soil phenols associate with native tree stands. These environmental effects result in differences in understory flowering periods, reproduction types and life forms. Our findings emphasize the effect of a major alien tree on functional plant trait composition in the early stages of spontaneous reforestation of abandoned lands, implying the development of a novel forest ecosystem on a large geographical scale.

Carpal tunnel syndrome in HIV-positive patients coinfected with HCV.

A wide range of rheumatic and peripheral nervous system disorders may develop in patients with HIV infection, leading to pain, sensory symptoms, and muscle weakness. Over the past three decades, the progress in management of HIV disease with anti-retroviral therapy (ART) has resulted in increased life expectancy for people living with HIV disease. With this new chronicity of the disease has a constellation of chronic musculoskeletal, orthopaedic and rheumatic manifestations has emerged, as potential complications of the disease itself and/or the results of ART treatment regimen and/or because of expected age-related symptoms/manifestations. The incidence of CTS in the general population is around 3.8% with clinical examination and, when electroneuromyography is used, it is 2.7%. In the HIV-positive population, the incidence is very close to that of the general population. The aim of this study was to evaluate the incidence of CTS and to identify factors influencing the development of CTS in HIV-infected patients attending our clinic. This syndrome has been associated with advanced HIV disease and the use of ART possibly due to an increased inflammatory state and the presence of concurrent HCV infection.

Functioning and Disability in Leprosy.

This study has been carried out to investigate the frequency of musculoskeletal symptoms in people affected by leprosy and correlate this to their functional capacity to perform daily living and working activities and to their degree of disability. This cross-sectional study was performed on 100 clients who answered a questionnaire on personal and clinical data, the Nordic Musculoskeletal (QNSO), and the shoulder, arm and hand dysfunction (DASH) questionnaires. The mean age was 53.63 years and there was a predominance of men (67%), low education (53%), and multibacillary disease (84%). Physical impairment affected 95% of respondents and 92% indicated pain and/or paresthesia in the arms that interfered in functional capacity.Respondents with musculoskeletal symptoms have more difficulty to perform daily living and working activities compared to those without musculoskeletal symptoms (p-value<0.05). The presence of physical disabilities was not associated with difficulties to perform daily living (p-value=0.29) and labor activities (p-value=0.87). The majority of patients experienced pain and/or paresthesia of the arms, and this was associated with difficulties to perform daily living and working activities. However, the presence of physical disability does not seem to cause major impediments or limitations to perform these activities.

Embalagem de alimentos: educação para o consumo sustentável visando a preservação do meio ambiente

O consumismo desenfreado faz com que a degradação do meio ambiente e preservação dos recursos naturais tornem-se questões cada vez mais discutidas em agendas mundiais. Novas embalagens estão sendo propostas, porém, para que atitudes saudáveis e ecologicamente corretas sejam tomadas pela população, é preciso que haja conscientização sobre saúde.

Elaboração de uma história em quadrinhos para ensino e prevenção das doenças transmitidas por alimentos

Doenças transmitidas por alimentos (DTA) representam um problema de saúde pública, contudo, são passíveis de prevenção. Os surtos alimentares ocorrem em grande parte nas residências, devido manipulação ou armazenagem inadequada dos alimentos; assim, estratégias de educação em saúde voltadas à população podem colaborar na diminuição dos riscos relacionados. Considera-se que a criação de um material impresso voltado para o público infanto-juvenil pode colaborar para o interesse e fácil disseminação do conhecimento.

Circuito itinerante de palestras do Instituto Adolfo Lutz promove o conhecimento e estimula a prevenção das doenças transmitidas por alimentos para alunos do ensino fundamental

As Doenças Transmitidas por Alimentos (DTA) são uma importante causa de morbidade e mortalidade em todo o mundo, emergindo como um crescente problema econômico e de saúde pública. A falta de dados sobre os casos de DTA devido à subnotificação, escassez de conhecimento da população sobre o assunto, falhas de controle sanitário ao longo da cadeia alimentar e a dificuldade de elucidação dos surtos pelas vigilâncias são alguns dos fatores contribuintes para o agravo desse problema.

Efeitos adversos da poliquimioterapia para hanseníase

Quando há efeitos adversos da poliquimioterapia para a hanseníase utilizam-se drogas alternativas preconizadas pela OMS. Objetivos: Identificar o número de portadores de hanseníase e avaliar as condições clínicas dermatológicas dos que fizeram uso de tratamento alternativo (a retirada da drogas Rifampicina RMP ou Dapsona DDS).

Identificação da necessidade de reabilitação física para membros superiores na hanseníase

A hanseníase é uma doença causada pelo bacilo Mycobacterium leprae que se instala em terminações nervosas e nervos periféricos, principalmente dos olhos, nariz, mãos e pés. O diagnóstico muitas vezes é realizado tardiamente, fomentando lesões neurais e consequentemente deficiências físicas, prejudicando assim a qualidade de vida dos indivíduos afetados. Apesar de ser curável, essa doença pode causar diferentes graus e tipos de seqüelas físicas. O indivíduo pode ainda apresentar graves conseqüências psicológicas, econômicas e, muito freqüentemente, exclusão social.

Avaliação do conhecimento dos profissionais de saúde para o atendimento da hanseníase pós capacitação

A hanseníase é um sério problema da saúde pública a ser equacionado no Brasil, inclusive no estado de São Paulo onde existem regiões com alta taxa de detecção. A nova concepção de universalização do diagnóstico e tratamento da hanseníase da OMS recomenda a descentralização do atendimento à população.

Estudo dos polimorfismos dos genes gstt1, gstm1 e ninjurin1 em indivíduos com hanseníase

Hanseníase, doença infecciosa crônica causada pelo Mycobacterium leprae (M. leprae), patógeno intracelular obrigatório, que afeta a pele e o sistema nervoso periférico. A expressão dessa doença resulta da interação entre o bacilo e o sistema imunológico; a maioria das pessoas infectadas desenvolve resposta imune eficaz contra M. leprae, sem sintomas da doença; outras exibem diferentes manifestações clínicas ligadas ao padrão da resposta imunológica do hospedeiro ao patógeno. Entre os mecanismos de defesa do hospedeiro estão as espécies reativas de oxigênio (ROS), que são elementos fundamentais para destruição bacilar intramacrofágica. Os Glutatião S-transferase (GSTT1 e GSTM1) são enzimas que eliminam as ROS. O NINJURIN1 (NINJ1 asp110ala) é uma molécula de adesão celular que fornece substratos apropriados para reparação das células de Schwann após lesão no nervo periférico.

Observatório de hanseníase: proposta inovadora para municípios que estão na fase de pós-eliminação da doença

Com a hanseníase em fase de pós-eliminação no município de São José do Rio Preto-SP, objetivou-se corrigir as inconsistências do banco SINAN no período de 1998 a 2010, conhecer o número real de pacientes tratados e criar um Banco de Dados próprio para estudo contínuo das variáveis clínico-epidemiológicas.

Sintomas depressivos, trabalho e grau de incapacidade em pessoas com deficiências na hanseníase

A depressão é o transtorno psiquiátrico mais comum na hanseníase. Objetivo: verificar a frequência dos sintomas depressivos e sua relação com o grau de incapacidade (GI) e com as variáveis sociodemográficas.

Characterization of the profession/occupation of individuals affected by leprosy and the relationship with limitations in professional activities.

People who had leprosy stay away from work and have difficulty of employability and to perform their functions or retire early. This study aimed at determining whether there is a relationship between profession/occupation and limitations in activities. This was a cross-sectional study that used the SALSA scale (Screening of Activity Limitation and Safety Awareness) to assess limitations and to classify professions/occupations as low, medium or high risk. Of the 277 people surveyed, 50.2% were men, the mean age was 53.8 years (SD = 16.3), 62.7% had multibacillary, 59.7% had family incomes of 3 minimum wages or less, 58.5% had up to 6 years schooling and 57% did not have paid jobs. As for occupations, 45.8% were considered low, 39.7% medium and 12.3% high risk. Of thetotal, 49.1% had mild/moderate, 8.7% severe/very severe and 42.2% did not have any limitations. The relationship between limitations in activities and occupational risk indicated that people with severe limitations tend to have low risk occupations (p value < 0.05). The limitations associated with employability showed that most active individuals have no limitations (p value < 0.05). Hence, most people who had leprosy have low risk professions/occupations; the limitations favor a shift from high-risk activities and interfere with employability.

[The Cri du Chat syndrome: a study on the quality of care]. / Sindrome del Cri du Chat: indagine sulla qualità dell' assistenza.

AIM: The Cri du Chat syndrome (SCdC / [OMIM #123450]) is a rare disease characterized by the deletion of the short arm of chromosome 5. The typical clinical features are the cat-like cry, microcephaly, a distinct facial phenotype and a severe psychomotor and mental retardation. The aim of this study was to provide an analysis on the data concerning the life quality and families assistance to whom have a child affected by Cri du Chat syndrome such as: the life's change of parents after the child's birth, the frequency of treatments, the collaboration between family and center of reference. METHODS: We have also analyzed the improvement obtained, the type of school attended, the aide and the time spent at home in postprimary education. Through a questionnaire sent to 100 families, we have been picked up information on 76 patients. RESULTS: These families have to adapt to the reality of a child with a rare genetic disorder for which there are no pharmacological or surgical therapies. CONCLUSION: Therefore, it seems important to give information and tips for dealing with the disease and the early start of rehabilitation and educational therapy.

Development and structural validation of a shortened version of the Participation Scale.

PURPOSE: To validate a shortened version of the Participation Scale (P-scale) that will be quicker to use and to describe the factor structure found in the P-scale data in various study samples. METHODS: A large multi-country and multi-cultural database was compiled consisting of 5125 respondents. Item analysis, explanatory factor analysis and confirmatory factor analysis were applied to identify items for deletion and investigate the factor structure of the P-scale. RESULTS: The multi-country database included 11 databases from six different countries. Respondents were affected by a range of health conditions, including leprosy, HIV/AIDS, dermatological conditions and various disabilities. Of the respondents included 57% were male. The P-scale Short (PSS) contains 13 items. A two-factor structure, with factors named "work-related participation" (three items) and "general participation" (10 items), showed the best model fit (Comparative Fit Index = 0.983, Tucker Lewis Index = 0.979, Rooted Mean Square Error of Approximation = 0.061). The Cronbach's alphas were very good for both the whole scale and the subscales, 0.91, 0.83 and 0.90, respectively. Correlation between the two factors was high (r = 0.75) indicating that interpreting the P-scale as measuring an overall factor "participation" is still valid. A very high correlation (r = 0.99) was found between the full P-scale and the PSS. CONCLUSIONS: The findings suggest good validity of the P-scale across a range of languages and cultures. However, field testing needs to confirm the validity of the PSS to measure the level of social participation restrictions across cultures and health conditions.

Humic substances induce lateral root formation and expression of the early auxin-responsive IAA19 gene and DR5 synthetic element in Arabidopsis.

Humic substances (HS) have positive effects on plant physiology, but the molecular mechanisms underlying these events are only partially understood. HS exert auxin-like activity, but data supporting this hypothesis are under debate. To investigate the auxin-like activity of HS, we studied their biological effect on lateral root initiation in Arabidopsis thaliana. To this aim we characterised HS by means of DRIFT and (13)C CP/MAS NMR spectroscopy, and measured their endogenous content of IAA. We then utilised a combination of genetic and molecular approaches to unravel HS auxin activity in the initiation of lateral roots. The data obtained using specific inhibitors of auxin transport or action showed that HS induce lateral root formation mostly through their 'auxin activity'. These findings were further supported by the fact that HS used in this study activated the auxin synthetic reporter DR5::GUS and enhanced transcription of the early auxin responsive gene IAA19.

Endometrial carcinoma: intraoperative evaluation of myometrial invasion. A prospective study.

AIM: The authors investigated the diagnostic value of intraoperative assessment of myometrial invasion in endometrial cancer patients. Following hysterectomy, the uterus was sectioned and macroscopically examined in order to assess the depth of myoinvasion, which was classified as <50% and >50%. In patients with macroscopic depth of invasion>30% and <50%, a frozen section of this area was carried out. The results of intraoperative evaluation were compared with the results of postoperative pathological examination. The agreement between methods was developed as generalized Kappa type statistic. Sensitivity, specificity, positive and negative predictive values for intraoperative only macro and macro/micro evaluation were calculated. METHODS: Seventy eight consecutive patients (median age 64 years, range 43-92; median Body Mass Index [BMI] 30.5, range 21.9-46.7) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (THBSO) were included in the study. Following intraoperative macroscopic evaluation, frozen section was carried out in 15 (19%) patients. The median time to obtain the results was 16 min for macroscopic evaluation, and 29 min for the macro/micro assessment. RESULTS: Macroscopic only assessment correctly identified depth of myoinvasion in 91% of patients, while, when the frozen section was carried out, myoinvasion was correctly identified in 95% of patients. For macroscopic only and macro-micro assessment sensitivity and specificity were 76% and 98%, 86% and 98%, respectively. CONCLUSION: These data suggest that the frozen section may improve, the diagnostic value of macroscopic only intraoperative assessment of myometrial invasion in selected patients.

First Report of Stemphylium vesicarium as Causal Agent of Wilting and Root Rotting of Radish Sprouts in Italy.

A consistent contamination from a Stemphylium sp. was detected on radish (Raphanus sativus) seeds by a seed blotter test. Twenty-five percent of seed lots were contaminated. Stemphylium vesicarium (teleomorph Pleospora allii) was identified on the basis of morphological characters of conidia and conidiophores (4). Conidia were golden brown to dark drown, oblong to oval with one to four transverse and one to three longitudinal septa, constricted at one to three of the major transverse septa. Conidia dimensions ranged from 12 to 22 × 30 to 40 µm. Conidiophores were straight or occasionally one-branched with a swollen apex and one to four septate. Pseudothecia with asci and ascopores were observed on radish seeds. Asci were cylindrical to clavate with eight ascospores with up to six transverse septa and numerous longitudinal septa. Species identification was also confirmed after comparing the sequences of the internal transcribed spacer (ITS) region of rDNA and gpd (glyceraldehyde-3-phosphate dehydrogenase) (3) of four isolates with those of Stemphylium species already present in the NCBI database. Accessions Nos. AM 746020 to AM746023 and AM883174 to AM883177 were deposited for ITS and gpd, respectively. Artificial inoculations were carried out on radish seeds previously disinfected with 1% sodium hypochlorite for 10 min and then plated on S. vesicarium sporulating colonies grown on potato dextrose agar (PDA). The four sequenced isolates were tested for pathogenicity. Disinfected seeds were plated onto PDA only and used as a control. After 48 h of incubation, seeds were sown in sterilized soil in plastic plates. The emerging and the eventually dead plants were counted. Stem necrosis and root rotting developed on sprouts within the first week after sowing. On the surviving infected plantlets, wilting and death occurred on more than 70% of the plants within 4 weeks after sowing. Control plantlets obtained from disinfected seeds remained healthy. The fungus reisolated from wilted and dead plants was morphologically identical to the original isolates, thus confirming S. vesicarium as the causal agent. In Italy, this pathogen is common on asparagus (1), but it has also been reported on Allium spp., tomato, and pear. On European pear it is the causal agent of brown spot (2), a destructive disease in the Mediterranean area but also in the Netherlands and other continental European countries. On the basis of these results, seed contamination with S. vesicarium can represent a threat for the production of radish for sprout consumption. To our knowledge, this is the first report of S. vesicarium on radish plantlets in Italy. References: (1) F. Del Zan et al. L'informatore Agrario 11:95, 1989. (2) I. Llorente and E. Montesinos. Plant Dis. 90:1368, 2006. (3) B. M. Pryor and D. M. Bigelow. Mycologia 95:1141, 2003. (4) E. G. Simmons. Sydowia 38:284, 1985.