59 research outputs found
Expressive aphasia in a patient with recent dual-chamber cardioverter-defibrillator implantation: A preventable complication
Transvenous pacemaker and/or defibrillator lead placement into the left heart chambers is
rarely done. Approximately a third of such cases reported in the literature presented with signs
of thromboembolism, mostly neurological deficits. We describe a patient who presented with
a cerebrovascular accident three months after inadvertent and unrecognized lead placement
into the left atrium and ventricle through a sinus venosus atrial septal defect. Implant techniques
to avoid this complication are discussed. (Cardiol J 2011; 18, 2: 197-199
Catheter ablation of atrial fibrillation in the elderly: Where do we stand?
Catheter ablation has emerged as an important therapy for the management of drug refractory
symptomatic paroxysmal and persistent atrial fibrillation (AF). Although the elderly account
for the majority of patients with AF, limited data exists regarding the use of catheter ablation
for elderly patients with AF. As AF ablation has become more widespread, ablation techniques
have improved and the complication rate has decreased. As a result, referrals of elderly patients
for catheter ablation of AF are on the rise. Two retrospective analyses have recently demonstrated
that catheter ablation of AF in the elderly can safely be performed and results are
comparable to a younger population with up to 80% or more of patients maintaining sinus
rhythm at 12 months follow-up. We compared the results of 15 consecutive patients ≥ 70 years
old with symptomatic paroxysmal atrial fibrillation who underwent catheter ablation of AF at
our institution to 45 randomly sampled younger patients. The primary endpoint of our study,
presence of sinus rhythm in the absence of symptoms at 12 months follow-up, was present in
60% of elderly patients and 80% of younger patients (p = 0.17). There was no statistically
significant difference in complication rate between the younger and elderly patients. In this
article we present the results of our study and review the published literature to date regarding
the clinical efficacy and safety of catheter ablation for AF in elderly patients with paroxysmal
and persistent atrial fibrillation
The Field of Cardiac Electrophysiology
Cardiac electrophysiology is a unique and growing field that has made numerous advances in the past 15Â years. Specifically, the field is advancing in terms of types of procedures as well as scope of practice. Pacemakers, implantable cardioverter-defibrillators (ICDs), and ablations have been the cornerstone of the field and continue to treat more and more conditions. This chapter will convey a birds-eye view of the types of the procedures in electrophysiology, the indications/contraindications, and the advances in the past 15Â years. Additionally, local vs. general anesthesia in these procedures as well as the indication for the type of anesthesia will be discussed. The overall aim of this chapter is to present a unique viewpoint of cardiac electrophysiology as well as elaborate on the various types of anesthesia in this field
Water, Sanitation, and Hygiene (WASH): a critical component for sustainable soil-transmitted helminth and schistosomiasis control
Soil-transmitted helminths (STH) and
schistosomes are parasites that affect the
world’s poorest people, causing losses of
up to 39 million and 70 million disability
adjusted life years (DALYs) respectively. The World Health Organization
(WHO) is at the forefront of developing
policy for the control of STH and
schistosomiasis, advocating for chemotherapy
as the cornerstone of control, with the
objective of reducing infection-associated
morbidity. Global uptake of chemotherapy
with albendazole or mebendazole
for STH and praziquantel for schistosomiasis
has significantly increased and
remains the principal control strategy. It is
cost-effective and reduces STH and
schistosome infections in human hosts.SJC is funded by an Australian Postgraduate Award and a University of Queensland Advantage
Scholarship, ACAC is an Australian National Health and Medical Research Council (NHMRC) Career
Development Fellow (631619), RJSM is funded by a Post-doctoral Research Fellowship from the University
of Queensland (41795457), JSM is an Australian National Health and Medical Research Council Practitioner
Fellow, and DJG is an Australian Research Council (DECRA) Fellow. This work is funded by an NHMRC
Partnership project in collaboration with WaterAid Australia
Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste
Background: Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. Methods: Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. Results: Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. Conclusions: According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although the international reference standards need to be critically evaluated for their applicability in Timor-Leste. Strategies to improve child development and morbidity outcomes, for example via nutrition and iron supplementation programmes, are recommended for these communities. Despite the apparent lack of an association from STH in driving anaemia, stunting, wasting and underweight, high endemicity suggests a need for STH control strategies.ACAC is an Australian National Health and Medical Research Council (NHMRC)
Senior Research Fellow (1058878), JSM is an Australian NHMRC Practitioner Fellow,
and DJG is an Australian NHMRC Career Development Fellow. This work is funded
by an NHMRC Partnership project in collaboration with WaterAid Australia
Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR
Background: No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste. Methods: A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection. Results: 2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9–19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1–14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0–4.3; heavy-intensity ARR 2.7; 95% CI 1.6–4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09–0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01–0.25). Few WASH risk factors were significant. Conclusion: In this high-prevalence setting, strong risk associations with environmental factors indicate that anthelmintic treatment alone will be insufficient to interrupt STH transmission, as conditions are favourable for ongoing environmental transmission. Integrated STH control strategies should be explored as a priorityACAC is an Australian National Health and
Medical Research Council (NHMRC) Senior
Research Fellow (1058878), JSM is an Australian
NHMRC Practitioner Fellow, and DJG is an
Australian NHMRC Career Development Fellow.
This work is funded by an NHMRC Partnership
project in collaboration with WaterAid Australia.
The funders had no role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript
Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste
BACKGROUND: Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification. RESULTS: A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10-14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9-95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3-100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4-64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0-97.0%). CONCLUSIONS: The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way
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