Neurobrucellosis: report of 54 cases.

BACKGROUND: Brucellosis is among the most widespread zoonotic diseases worldwide. Although rare, nervous system involvement due to Brucella infection is a major diagnostic challenge in endemic regions. PATIENTS AND METHODS: This study was a cross-sectional investigation of hospitalized adults with neurobrucellosis from March 2007 to February 2017. We described the clinical characteristics, radiographical and laboratory features, and clinical outcomes of patients with neurobrucellosis. RESULTS: Fifty-four patients with neurobrucellosis were included. The median age was 35 (interquartile range, 25-50) years, and 32 (59%) cases were male. Thirty-four (63%) patients were stockmen or shepherds. The most common clinical manifestations were fever in 49 (91%) cases, headache in 47 (87%), decreased consciousness in 12 (22%), and seizures in 6 (11%). Meningeal signs were detected in 36 (67%) cases. Brucella species were isolated in five cases from blood or cerebrospinal fluid (CSF). The median of CSF leukocytes was 75 per µL, CSF protein 83 mg/dL, and CSF glucose 39 mg/dL. Only two cases had severe hypoglycorrhachia and one CSF protein ≥ 500 mg/dL. No patient died during hospitalization. CONCLUSIONS: The symptoms of neurobrucellosis could be mild and nonspecific and the classic triad of meningitis is uncommon. Mild CSF pleocytosis of fewer than 50 leukocytes per microliter of CSF was common but severe hyperproteinorrhachia and severe hypoglycorrhachia were rare in neurobrucellosis. Differentiation between neurobrucellosis and systemic brucellosis is important, because more prolonged treatment is indicated for neurobrucellosis, and it could be associated with a broad spectrum of complications that require close follow-up.

Arrhythmia Monitoring for Risk Stratification in Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy, presenting significant clinical heterogeneity. Arrhythmia risk stratification and detection are critical components in the evaluation and management of all cases of HCM. The 2020 American Heart Association/American College of Cardiology HCM guidelines provide new recommendations for periodic 24-48-hour ambulatory electrocardiogram monitoring to screen for atrial and ventricular arrhythmias. A strategy of more frequent or prolonged monitoring would lead to earlier arrhythmia recognition and the potential for appropriate treatment. However, whether such a strategy in patients with HCM results in improved outcomes is not yet established. The available evidence, knowledge gaps, and potential merits of such an approach are reviewed. Cardiac implantable electronic devices provide an opportunity for early arrhythmia detection, with the potential to enable early management strategies in order to improve outcomes.

La cardiomyopathie hypertrophique (CMH) qui est la cardiomyopathie héréditaire la plus fréquente présente une hétérogénéité clinique importante. La stratification du risque d'arythmies et leur détection sont des composantes essentielles de l'évaluation et de la prise en charge de tous les cas de CMH. Les lignes directrices 2020 de l'American Heart Association et de l'American College of Cardiology en matière de CMH fournissent les nouvelles recommandations sur la surveillance périodique de l'électrocardiogramme ambulatoire de 24-48 heures pour dépister les arythmies auriculaires et ventriculaires. Une stratégie de surveillance plus fréquente et prolongée permettrait de dépister plus précocement l'arythmie et pourrait mener au traitement approprié. Toutefois, il n'a pas encore été établi qu'une telle stratégie chez les patients atteints de CMH entraînait de meilleurs résultats cliniques. Les données probantes actuelles, les lacunes en matière de connaissances et les mérites potentiels d'une telle approche sont passés en revue. Les dispositifs cardiaques électroniques implantables offrent la possibilité de détecter précocement l'arythmie et le potentiel de favoriser des stratégies de prise en charge précoce pour améliorer les résultats cliniques.

In-hospital and long-term outcomes among patients with spontaneous coronary artery dissection presenting with ventricular tachycardia/fibrillation.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction (MI) in young to middle-age women. Ventricular tachycardia/ventricular fibrillation (VT/VF) may complicate acute SCAD presentations, and the long-term outcomes are unknown. OBJECTIVE: The purpose of this study was to report the outcomes of SCAD patients presenting with VT/VF. METHODS: We analyzed our prospective Canadian SCAD registries for patients presenting with VT/VF during index hospitalization. Long-term outcomes including VT/VF and cardiac arrest were collected. Univariate and multivariable analyses were performed to identify predictors of VT/VF at follow-up. RESULTS: Among 1056 consecutive SCAD patients, 84 (8.0%) presented with VT/VF, and 8 underwent implantable cardioverter-defibrillator (ICD) insertion. Patients with VT/VF during index hospitalization were younger (49.3 vs 52.0 years; P = .019) and were more likely to have ST-elevation MI, lower left ventricular ejection fraction (LVEF), and left main dissection (all P <.001). Initial VT/VF was associated with in-hospital events, including recurrent MI, unplanned revascularization, heart failure, ICD insertion, and in-hospital death (all P <.05). At mean follow-up of 4.8 ± 3.3 years, 8 patients suffered VT/VF (time to event 5.2 ± 6.2 years); 5 of 8 patients had VT/VF on initial SCAD presentation, and 1 of 8 had undergone ICD insertion. Predictors of VT/VF during follow-up included LVEF <50%, LVEF <35%, peripartum SCAD, unplanned revascularization, repeat MI, heart failure, and initial VT/VF. Multivariable analysis showed initial VT/VF (odds ratio [OR] 9.5; 95% confidence interval [CI] 2.0-44; P = .004) and LVEF <50% (OR 12.9; 95% CI 1.5-111; P = .019) were independent predictors of VT/VF at follow-up. CONCLUSION: SCAD patients presenting with VT/VF were at greater risk for in-hospital events and recurrent VF/VT at follow-up. Both VT/VF and LVEF <50% were independent predictors of subsequent VT/VF.

Safety and Feasibility of Same-Day Discharge After Left Atrial Appendage Closure.

Subacute or late complications > 24 hours after left atrial appendage closure (LAAC) are infrequent. We therefore created a clinical pathway to enable safe same-day discharge (SDD) after LAAC. Patients were assessed for overall physical conditioning, lack of significant frailty and comorbidities limiting physical abilities, good home support, and patient preference. Of 78 LAACs performed, 24 patients (30.8%) were discharged the same day: 21 were transesophageal echocardiography guided and 3 intracardiac echocardiography guided. SDD clinical pathway patients were discharged 395.4 ± 56.6 minutes after leaving the procedural room. There were no clinical complications at 1 month or in long-term follow-up. SDD is safe and feasible after LAAC, following a dedicated clinical pathway and surveillance in carefully selected patients.