Reuse of explanted permanent pacemakers donated by funeral homes.

Poor patients in developing countries may not receive permanent pacemakers (PPMs) even as lifesaving measures because of their high cost. In this report we examined whether PPMs that were explanted and donated by funeral homes in the United States could be safely and effectively reused in indigent patients in India. With permission from the deceased patients' families, 121 PPMs were explanted and donated by funeral homes for reuse. These PPMs were sterilized and sent for implantation in needy and indigent patients at a charity hospital in Mumbai, India. From the pool of donated 121 PPMs, 53 (88%, 11 single-chamber PPMs, 21%, and 42 dual-chamber PPMs, 79%) were acceptable for reuse and implanted (37 new implants, 70%, and 16 for battery/generator replacement, 30%) in 53 patients (mean ± SD 64 ± 10 years old, 28 women, 53%). Indications for PPM implantation were complete heart block (n = 27, 51%) and sick sinus syndrome (n = 26, 49%). All patients were alive and well postoperatively. No significant complications including infections or device failures occurred over 19 to 1,827 days (mean 661) of follow-up. Of 40 patients (75%) who were followed locally, 4 (10%) died because of nonpacemaker-related causes; time to death was 121 to 750 days (mean 430) after PPM implantation. All except 2 patients (5%) reported marked improvement in their symptoms. There were only 4 patients (8%) who were previously employed, and all were able to resume their manual labor work. Also, of the women, 27 patients (96%) reported improvement in symptoms enabling them to resume regular household chores as housewives after PPM implantation. In conclusion, with proper device sterilization and handling protocols, reuse of explanted PPMs in poor patients in developing countries is safe and effective. Implantation of donated PPMs can not only save lives but also improve quality of life of needy poor patients.

Beta3-adrenoreceptor stimulation ameliorates myocardial ischemia-reperfusion injury via endothelial nitric oxide synthase and neuronal nitric oxide synthase activation.

OBJECTIVES: This paper examined whether nebivolol protects the heart via nitric oxide (NO) synthase and NO-dependent signaling in an in vivo model of acute myocardial infarction. BACKGROUND: Beta(3)-adrenergic receptor (AR) activation promotes endothelial nitric oxide synthase (eNOS) activity and NO bioavailability. We hypothesized that specific beta(3)-AR agonists would attenuate myocardial ischemia-reperfusion (MI/R) injury via eNOS activation and increased NO bioavailability. METHODS: Mice were subjected to 45 min of myocardial ischemia in vivo followed by 24 h of reperfusion (R). Nebivolol (500 ng/kg), CL 316243 (1 µg/kg), BRL-37344 (1 µg/kg), or vehicle (VEH) was administered at the time of R. Myocardial area-at-risk (AAR) and infarct size (INF)/AAR was measured at 24 h of R. Cardiac tissue and plasma were collected to evaluate eNOS phosphorylation, neuronal nitric oxide synthase (nNOS), inducible nitric oxide synthase expression, and nitrite and nitrosothiol levels. RESULTS: Nebivolol (500 ng/kg) reduced INF/AAR by 37% (p < 0.001 vs. VEH) and serum troponin-I levels from 41 ± 4 ng/ml to 25 ± 4 ng/ml (p < 0.05 vs. VEH). CL 316243 and BRL-37344 reduced INF by 39% and 42%, respectively (p < 0.001 vs. VEH). Nebivolol and CL 316243 increased eNOS phosphorylation at Ser-1177 (p < 0.05 vs. VEH) and increased nitrite and total nitrosylated protein levels. Nebivolol and CL 316243 significantly increased myocardial nNOS expression. Nebivolol failed to reduce INF after MI/R in beta(3)-AR (-/-), eNOS(-/-), and in nNOS(-/-) mice. CONCLUSIONS: Our results indicate that beta(3)-AR agonists protect against MI/R injury. Furthermore, the cardioprotective effects of beta(3)-AR agonists are mediated by rapid eNOS and nNOS activation and increased NO bioavailability.

The use of pathological and histopathological techniques in the diagnosis of peste des petits ruminants in India.

The authors report on an outbreak of peste des petits ruminants (PPR) among sheep and goats in the Province of Gujarat, India. Clinical signs observed during outbreaks were typical of PPR. Predominant signs were severe diarrhoea, dyspnoea, mucopurulent discharge from the eyes and nose, erosive rhinitis, necrotic ulcers in the mouth, on the dental pad, tongue, upper and lower lips, fever and depression. Common post-mortem findings included congestion, red hepatisation, raised patches of emphysema in the lungs, haemorrhages and froth exudates in the trachea, severe enteritis and streaks of haemorrhages in the intestine, enlargement and petechial haemorrhages in the spleen and oedema and inflammatory lesions in the mesenteric lymph nodes. Spectacular histopathological changes were observed in the lungs, intestine, spleen, mesenteric lymph nodes, liver and kidneys. Clinical, gross and histopathological lesions and haematological changes were suggestive of PPR, which was further confirmed by detection of PPR viral antigen in clinical samples, as well as post-mortem tissues using the sandwich enzyme-linked immunosorbent assay (s-ELISA).

Prevalence of a Brugada pattern electrocardiogram in an urban population in the United States.

OBJECTIVE: To determine the prevalence of a Brugada-type pattern on routine electrocardiogram (ECG) in an urban population served by a tertiary medical center in the United States. METHODS: The investigators reviewed the ECG database at the Montefiore Medical Center, a tertiary teaching center in the Bronx, New York, over a 10-year period. During this time, 653,006 ECG records in 162,590 patients were identified. The database was queried by applying standard diagnostic criteria in an attempt to identify records with apparent conduction delay and ST abnormality in leads V1-V3. Additional diagnostic criteria were then applied to identify records in an attempt to mimic Brugada-like changes. A cardiac electrophysiologist reviewed records meeting these criteria to confirm the presence of a Brugada-type pattern. RESULTS: In total, 16,067 patients (9.8%) were identified as having ECGs with right bundle branch block, incomplete right bundle branch block, or RSR' in leads V1 and V2. After applying additional diagnostic criteria evaluating ST segment shift, 456 patients were identified as having a pattern potentially consistent with a Brugada-type ECG. The presence of a Brugada-type pattern was confirmed by physician overread in 20 patients (0.012%). CONCLUSION: The Brugada-type ECG pattern is infrequently seen in a large ethnically diverse urban US population. Further evaluation should be considered when this pattern is seen on routine ECG.

Intracoronary abciximab use in patients undergoing PCI at a community hospital: a single operator experience.

OBJECTIVE: To evaluate the safety of intracoronary (IC) abciximab during percutaneous coronary intervention (PCI). BACKGROUND: Adjunctive treatment with glycoprotein IIb/IIIa inhibitors, especially abciximab, during PCI has been shown to improve clinical and procedural outcomes in numerous studies. However, significant bleeding complications exist with its use and this has limited its standard use. Interest has grown in local (IC) use with studies showing safety and long-term effectiveness, especially in patients with high thrombus loads. METHODS: A retrospective review of records in a database of patients who had PCI by a single operator at the Easton Hospital. RESULTS: 611 patients received IC abciximab, and there were no complications in 610 (98.3%) patients; only 1 had an allergic reaction. CONCLUSIONS: IC abciximab is safe and has a unique role in the catheterization lab and in patients at high risk of bleeding complications who would benefit from its limited use.