["Ictal" Bradyarrhythmias in Patients with Drug-Resistant Epilepsy: Results of Long-Term Heart Rhythm Monitoring].

Aim      To determine the type and incidence of ictal bradyarrhythmias in patients with drug-resistant types of epilepsy by long-term electrocardiogram (ECG) monitoring.Material and methods  Subcutaneous ECG monitors programed for recording pauses >3 sec and episodes of bradycardia ≤45 bpm were implanted in 193 patients with persistent epileptic seizures without organic pathology of the myocardium. Recording was activated by the patient/family at the onset of epileptic seizure. The follow-up period was 36 months with visits to the clinic every three months.Results For 36 months of monitoring, 6494 ECG fragments were recorded. Ictal bradycardia was observed in 6.7 % of patients, including ictal asystole in 2.6 % of patients. Episodes of bradycardia and asystole during epileptic seizures were transient and developed significantly more frequently in men, patients with long duration of the disease, bilateral tonic-clonic or focal seizures with disorder of consciousness, during sleep, on the background of treatment with several antiepileptic agents, mostly from the group of potassium channel blockers.Conclusion      Bradyarrhythmias accompanying epileptic seizures are transient and reproducible from seizure to seizure. They reflect functional changes in the myocardium and do not determine the life prediction for patients with epilepsy without organic pathology of the heart.

Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis.

BACKGROUND AND PURPOSE: Patients with multiple sclerosis routinely have MR imaging with contrast every 6-12 months to assess response to medication. Multiple recent studies provide evidence of tissue deposition of MR imaging contrast agents, questioning the long-term safety of these agents. The goal of this retrospective image-analysis study was to determine whether contrast could be reserved for only those patients who show new MS lesions on follow-up examinations. MATERIALS AND METHODS: We retrospectively reviewed brain MRIs of 138 patients. To increase our sensitivity, we used a previously described computerized image-comparison software to evaluate the stability or progression of multiple sclerosis white matter lesions in noncontrast FLAIR sequences. We correlated these findings with evidence of contrast-enhancing lesions on the enhanced T1 sequence from the same scan. RESULTS: Thirty-three scans showed an increase in white matter lesion burden. Among those 33 patients, 14 examinations also demonstrated enhancing new lesions. While we found a single example of enhancement of a pre-existing white matter lesion that appeared unchanged in size, that same examination showed an overall increase in lesion burden with enhancement of other, new lesions. Thus, we found that all patients with enhancing lesions had evidence of progression on their noncontrast imaging. CONCLUSIONS: Because all enhancing lesions were associated with new lesions on unenhanced imaging and progression was only evident in 24% of patients, in patients with relapsing-remitting MS, it is reasonable to consider reserving contrast for only those patients with evidence of progression on noncontrast MR images.

[Algorithm for choosing parameters for relex smile surgery]. / Algoritm vybora parametrov pri operatsii ReLEx SMILE.

Presently ReLEx Smile as a method of vision correction in refractive surgery is becoming increasingly popular in Russia and abroad. PURPOSE: to develop an algorithm for planning the surgery and choosing its parameters, and to assess the efficacy, safety and predictability of the results in the 6-month follow-up period. MATERIAL AND METHODS: The study involved 80 patients (159 eyes) with myopia of various degrees with a mean age of 33±6 years (25 to 44 years old). Preoperative BCVA was 0.99±0.04 (0.8 to 1.0), spherical equivalent (SE) was -5.14±1.9 (-10.0 to -1.5). All surgeries were planned and performed according to the developed algorithm. RESULTS: Results were analyzed 6 months postop. The average SE after the surgery was -0.08 D (-0.75 to +0.5). 79.5% of patients (126 eyes) were within ±0.5 D from target refraction, 6% of patients (10 eyes) received 1-2 lines of BCVA, in 87% (138 eyes) BCVA remained unchanged, 6% of patients (10 eyes) lost 1-2 lines of BCVA. 95% of patients (151 eyes) had UCVA of 0.8 and higher 6 month after the surgery, and 79% (125 eyes) achieved 1.0 vision. No significant intraoperative and postoperative complications had occurred. CONCLUSION: ReLEx Smile is an effective, safe and predictable method of myopia correction. The newly developed algorithm reduces the risks of complications. It may be recommended for practical use by surgeons performing ReLEx Smile.

Cardiogenic anorexia and underweighting in a child: case report.

INTRODUCTION: In this case, we present a child with a diagnosis of anorexia and no known cardiac disease, who was referred to our clinic for a routine cardiac monitoring. 'Asymptomatic' high degree of atrioventricular block (AVB) was revealed. She underwent successful pacemaker (PM) implantation and losing of the weight stopped. CASE PRESENTATION: In this case, the abrupt AVB with more than 6 s ventricular pauses without escape rhythm during the day-time most possible is a type of neurally mediated AVB which was presented by anorexia, underweighting, and refusing to eat in a 12-year-old girl. All symptoms disappeared after PM implantation, and weight gain was recorded during 6 months of follow-up. DISCUSSION: The causal link between AVB and anorexia is discussed. In this case, patient's eating disorder was related to her AV conduction abnormality. The main reason of this case report is to emphasize, that in children with unexplained anorexia and underweighting cardiogenic origin must be excluded.

Tuberculosis among migrants in Bishkek, the capital of the Kyrgyz Republic.

Setting: Twenty-two first-line, two second-line and one tertiary health facility in Bishkek, the capital of Kyrgyzstan. Objectives: Among migrants, a marginalised population at risk for acquiring and transmitting tuberculosis (TB), we determined the proportion with TB among all registered TB cases. For those registered at primary-level facilities, we then reported on their demographic and clinical profiles and TB treatment outcomes. Design: This was a retrospective cohort analysis of 2012-2013 programme data. Results: Of 2153 TB patients registered in all health facilities, 969 (45%) were migrants, of whom 454 were registered in first-line facilities. Of these, 27% were cross-border migrants, 50% had infectious TB and 12% had drug-resistant TB. Treatment success was 74% for new cases and 44% for retreatment TB (the World Health Organization target is ⩾85%). Failure in new and retreatment TB patients was respectively 8% and 25%. Twenty-six individuals started on a first-line anti-tuberculosis regimen failed due to multidrug-resistant TB. Eight (25%) of 32 individuals on a retreatment TB regimen also failed. Loss to follow-up was 10% for new and 19% for retreatment TB. Conclusion: Migrants constituted almost half of all TB patients, drug resistance is prevalent and treatment outcomes unsatisfactory. Fostering inter-country collaboration and prioritising rapid TB diagnostics (Xpert® MTB/RIF) and innovative ways forward for improving treatment outcomes is urgent.

Contexte : Vingt-deux structures de santé de premier niveau, deux de second niveau et une de troisième niveau à Bichkek, la capitale du Kirghizstan.Objectifs : Parmi les migrants qui sont une population marginalisée à risque d'acquérir et de transmettre la tuberculose (TB), nous avons déterminé la proportion de migrants atteints de TB parmi tous les cas de TB enregistrés. Pour ceux enregistrés dans des structures de premier niveau, nous exposons leur profil démographique et clinique et les résultats du traitement de la TB.Schéma : Une analyse rétrospective de cohorte des données du programme de 2012 à 2013.Résultats : Sur 2153 patients TB enregistrés dans toutes les structures de santé, 969 (45%) ont été des migrants ; 454 ont été enregistrés dans des structures de premier niveau. Parmi ces derniers, 27% étaient des migrants transfrontaliers, 50% avaient une TB contagieuse et 12% avaient une TB pharmacorésistante. Le taux de succès a été de 74% pour les cas nouveaux et de 44% pour les TB en retraitement (cible de l'Organisation Mondiale de la Santé ⩾85%). Les échecs dans les cas nouveaux et les cas en retraitement ont été respectivement de 8% et de 25%. Vingt-six individus mis sous protocole de traitement de TB de première ligne ont eu un échec dû à une TB multirésistante. Huit (25%) des 32 individus en protocole de retraitement de TB ont également eu un échec. Les taux de perdus de vue ont été de 10% pour les cas nouveaux et de 19% pour les TB en retraitement.Conclusion : Les migrants ont constitué près de la moitié de tous les patients TB, la pharmacorésistance a été prévalent et les résultats du traitement ne sont pas satisfaisants. Il est urgent d'encourager la collaboration entre les pays, de prioriser les diagnostics rapides de TB (Xpert® MTB/RIF) et les manières innovantes d'améliorer les résultats du traitement.

Marco de referencia: Veintidós establecimientos de salud de atención primaria, dos establecimientos de atención secundaria y uno de atención terciaria en Bishkek, la capital de Kirguistán.Objetivos: En los migrantes, una población marginada con riesgo de contraer la tuberculosis (TB) y transmitirla, se determinó la proporción que padecía TB a partir de todos los casos de TB registrados. En los casos notificados por los establecimientos de atención primaria, se analizaron luego sus características demográficas, el aspecto clínico y los desenlaces del tratamiento antituberculoso.Método: Fue este un análisis retrospectivo de cohortes de datos del programa del 2012 y el 2013.Resultados: De los 2153 pacientes registrados con diagnóstico de TB en todos los establecimientos de salud, 969 eran migrantes (45%); 454 se registraron en centros de atención primaria. De estos últimos, el 27% correspondió a migrantes transfronterizos, el 50% presentaba TB contagiosa y el 12% padecía TB farmacorresistente. La tasa de éxito terapéutico en los casos nuevos de tuberculosis fue 74% y en los casos de retratamiento fue 44% (meta de la Organización Mundial de la Salud ⩾85%). El índice de fracaso terapéutico de los casos nuevos fue 8% y el de los casos en retratamiento fue 25%. En 26 personas que iniciaron el tratamiento antituberculoso de primera línea el tratamiento fracasó debido a la TB multirresistente. También fracasó el régimen de retratamiento en ocho de las 32 personas que lo habían recibido (25%). Las pérdidas durante el seguimiento fueron 10% en los casos nuevos y 19% en los casos de retratamiento.Conclusión: Los migrantes representan cerca de la mitad de todos los casos de TB, la farmacorresistencia es frecuente y alcanzan desenlaces terapéuticos desfavorables. Es urgente promover la colaboración entre los países, dar prioridad a los medios diagnósticos rápidos de la TB (Xpert® MTB/RIF) y encontrar formas innovadoras de progreso que favorezcan mejores desenlaces terapéuticos.

[The Use of Rivaroxaban in Perioperative Period of Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation].

Results of an observational study. devoted to prevention of thromboembolic complications in patients with atrial fibrillation undergoing catheter pulmonary vein atrium isolation are discussed. Patients (n= 199) were divided into two comparable groups depending on the anticoagulant (rivaroxaban or warfarin) used. Clinical thromboembolic and/or hemorrhagic complications as well as rate of development of asymptomatic cerebral thromboembolisms in various periods after procedure were assessed. Main conclusion: rivaroxaban was not inferior to warfarin for thromboprophylaxis in patients with atrial fibrillation undergoing catheter pulmonary vein antrum isolation.

Performance of decentralised facilities in tuberculosis case notification and treatment success in Armenia.

We assessed the performance of decentralised tuberculosis (TB) out-patient centres in tuberculosis (TB) case notification and treatment success in Armenia. An average threshold case notification of ⩾37/100 000 was seen in centres that had higher numbers of presumptive TB patients, where more TB was diagnosed by in-patient facilities and where TB contacts were examined. The number of doctors and/or TB specialists at centres did not influence case notification. Onsite smear microscopy was significantly associated with a treatment success rate of ⩾85% for new TB patients. Addressing specific characteristics of TB centres associated with lower case notification and treatment success and optimising their location may improve performance.