Assessment of sex-related differences and outcome in patients who underwent cryoballoon pulmonary vein isolation for atrial fibrillation:an observational cohort study

OBJECTIVES: Pulmonary vein isolation (PVI) is widely accepted as an effective and safe treatment for symptomatic atrial fibrillation (AF). However, data on sex-related differences and associations with clinical outcome and safety of PVI with cryoballoon ablation are limited. We sought to compare sexrelated efficacy and safety of cryoballoon ablation and identify sex-related associations with clinical outcomes. METHODS AND RESULTS: We included 650 consecutive patients with AF undergoing PVI with cryoballoon ablation at our institution between 2013 and 2017. The efficacy outcome was the first documented recurrence (>30 s) of AF, atrial flutter or atrial tachycardia (AF/AT) or repeat ablation during follow-up, after a 90-day blanking period. The safety outcome was the incidence of periprocedural complications. Mean age of the population was 58±10, and 210 (32.3%) patients were women. Women were older, had a higher body mass index, had more renal dysfunction and less coronary artery disease as compared with men. The rate of AF/AT recurrence was similar between women and men at 12-month follow-up (27.6% vs 24.8%, p=0.445). The incidence of periprocedural complications was higher in women (12.9% vs 4.6%; p<0.001), specifically groin haematomas and phrenic nerve palsy. On multivariate analysis, left atrial volume index (adjusted OR 1.05, 95% CI 1.00 to 1.10; p=0.032) was associated with the incidence of procedural complications in women. For men, no relation with complications could be found. CONCLUSION: The efficacy of cryoballoon ablation was similar between women and men; however, women had a higher risk of procedural complications

Generalizability of nociception level as a measure of intraoperative nociceptive stimulation: a retrospective analysis

BackgroundNociception-guided intraoperative opioid administration might help reduce postoperative pain. A commonly used and validated nociception monitor system is nociception level (NOL), which provides the nociception index, ranging from 0 to 100, with 0 representing no nociception and 100 representing extreme nociception. We tested the hypothesis that NOL responses are similar in men and women given remifentanil and fentanyl, across various types of anesthesia, as a function of American Society of Anesthesiologists physical status designations, and over a range of ages and body morphologies.MethodsWe conducted a retrospective cohort analysis of trial data from eight prospective NOL validation studies. Among 522 noncardiac surgical patients enrolled in these studies, 447 were included in our analysis. We assessed NOL responses to various noxious and non-noxious stimuli.ResultsThe average NOL in response to 315 noxious stimuli was 47 ± 15 (95% CI = 45–49). The average NOL in response to 361 non-noxious stimuli was 10 ± 12 (95% CI = 9–11). NOL responses were similar in men and women, in patients given remifentanil and fentanyl, across various types of anesthesia, as a function of American Society of Anesthesiologists physical status designations, and over a range of ages and body morphologies.ConclusionNociception level appears to provide accurate estimates of intraoperative nociception over a broad range of patients and anesthetic conditions.Perioperative Medicine: Efficacy, Safety and Outcome (Anesthesiology/Intensive Care

Women have less progression of paroxysmal atrial fibrillation:data from the RACE V study

BACKGROUND: Sex differences in atrial fibrillation (AF) are observed in terms of comorbidities, symptoms, therapies received, AF progression and cardiovascular complications.METHODS: We assessed the differences in prevalence and the determinants of AF progression, as well as the clinical characteristics and quality of life (QoL), between women and men with paroxysmal AF included in the RACE V (Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilisation in the Progression of AF) study. At baseline, extensive phenotyping was done. To assess AF progression, implantable loop recorder (ILR) monitoring was used throughout follow-up. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of paroxysmal AF (&gt;3% burden increase).RESULTS: 417 patients were included, 179 (43%) of whom were women. Women were older (median 67 years vs 63 years, p&lt;0.001), less often had coronary artery disease (n=11 (6%) vs n=36 (16%), p=0.003), had more obesity (n=57 (32%) vs n=50 (21%), p=0.013), had less epicardial and pericardial fat (median 144 (interquartile range [IQR] 94-191) mL vs 199 (IQR 146-248) mL, p&lt;0.001; and median 89 (ICQ 61-121) mL vs 105 (IQR 83-133) mL, p&lt;0.001, respectively) and had more impaired left atrial function. The median follow-up was 2.2 (1.6-2.8) years. 51 of 417 patients (5.5% per year) showed AF progression (15/179 (8.4%) women and 36/238 (15.1%) men, p=0.032). Multivariable analysis showed tissue factor pathway inhibitor, N-terminal prohormone brain natriuretic peptide (NT-proBNP) and PR interval being associated with AF progression in women and factor XIIa:C1 esterase, NT-proBNP and proprotein convertase subtilisin/kexin type 9 in men. QoL was not different between sexes.CONCLUSION: Despite older age, the incidence of AF progression was lower in women. Parameters associated with AF progression varied in part between sexes, suggesting different underlying pathophysiological mechanisms.</p

Pathogenic Bacteria and their Susceptibility to Antimicrobial Agents at Abouzar Children Hospital, Ahvaz, Iran

Background: Antibiotic-resistant Gram negative bacteria are increasingly emerging as serious causes of infections than ever before. Materials and Methods: This retrospective study examined the pattern of pathogenic bacterial isolates and their susceptibilities to antimicrobial agents at Abouzar Children Hospital, Ahavz-Iran, between Jan and July 2005. Results: Of the 216 bacterial isolates from 193 patients, 156 (72.3%) were from urine, 25 (11.6%) from blood, 10 (4.7%) from stool, 14 (6.4%) from cerebrospinal fluid, 5 (2.3%) from wound and 6 (2.7%) from sputum. The organisms included E. coli 121 (56%), Klebsiella pneumoniae 30 (13.9%), Pseudomonas aeruginosa 20 (9.3%), S. aureus 16 (7.4%), Shigella spp 7 (3.3%), S. typhi 7 (3.2%), Enterobacter spp 4 (1.8%), Heamophillus influenza 6 (2.8%), Pneumococcus 3 (1.4%), Citrobacter spp 1 (0.5%), Neisseria spp 1 (0.5%). Of the 121 E. coli isolated, 73.8 % and 73.6 % were resistant to Nalidixic acid and Nitroforantoin, respectively; another 69.6% these isolates were resistant to Co-trimaxazole. Similarly, 66 % and 44 % of Klebsiella pneumoniae and Pseudomonas aeruginosa were resistant to Co-trimaxazole. Conclusion: There is a high prevalence of urinary tract infections and high incidence of multi-drug resistant bacteria, particularly gram negative bacteria, at Abouzar children hospital. Keywords: Bacteria, resistance, children > African Journal of Paediatric Surgery Vol. 3 (2) 2006: pp. 54-5

Isolation and antimicrobial susceptibility of bacteria from external ear canal of cancer patients at shafa cancer hospital -Ahwaz

A bacteriological study of external ear canal was performed in 52 hospitalized cancer patients and 42 non hospitalized cancer patients at Shafa hospital, Ahwaz. Study was under taken to find out the normal flora changes in the external ear canals and to observe the prevalence of external otitis among these cancer patients. The control group consisted of 40 non-cancer patients. We observed the following bacteria among hospitalized cancer patients. Staphylococcus Coagulase negative (51.9 %), Staphylococcus aureus (15.7%) and Streptococcus pneumomiae (11.9 %). Similarly, among non hospitalized cancer patients, Staphylococcus Coagulase negative (45.2 %), S. aureus (9.5%) and Streptococcus pneumomiae (4.7 %). Incidence of Staphylococcus Coagulase negative and Streptococci pneumoniae is higher in control group than that in cancer patients [Table 1]. We have concluded that cancer patients probably suffer from external otitis more frequently because of enhanced colonization by S. aureus ( P &gt; 0.05). The antimicrobial susceptibility of these organisms to various antibiotics was determined by disk diffusion method using Muller Hinton agar. In hospitalized cancer patients Staphylococcus Coagulase negative was 25% and 85% resistant to Vancomycin and Penicillin G and in non hospitalized cancer patients, Staphylococcus Coagulase negative were 45% and 80% resistant to Vancomycin and Penicillin G. S. aureus of both the groups (hospitalized and non hospitalized) were sensitive Penicillin G. Similarly, both the groups were 55% and 50 % resistance to Vancomycin

Isolation and antimicrobial susceptibility of bacteria from external ear canal of cancer patients at Shafa Cancer Hospital -Ahwaz

A bacteriological study of external ear canal was performed in 52 hospitalized cancer patients and 42 non hospitalized cancer patients at Shafa hospital, Ahwaz. Study was under taken to find out the normal flora changes in the external ear canals and to observe the prevalence of external otitis among these cancer patients. The control group consisted of 40 non-cancer patients. We observed the following bacteria among hospitalized cancer patients. Staphylococcus Coagulase negative (51.9 %), Staphylococcus aureus (15.7%) and Streptococcus pneumomiae (11.9 %). Similarly, among non hospitalized cancer patients, Staphylococcus Coagulase negative (45.2 %), S. aureus (9.5%) and Streptococcus pneumomiae (4.7 %). Incidence of Staphylococcus Coagulase negative and Streptococci pneumoniae is higher in control group than that in cancer patients [Table 1]. We have concluded that cancer patients probably suffer from external otitis more frequently because of enhanced colonization by S. aureus ( P > 0.05). The antimicrobial susceptibility of these organisms to various antibiotics was determined by disk diffusion method using Muller Hinton agar. In hospitalized cancer patients Staphylococcus Coagulase negative was 25% and 85% resistant to Vancomycin and Penicillin G and in non hospitalized cancer patients, Staphylococcus Coagulase negative were 45% and 80% resistant to Vancomycin and Penicillin G. S. aureus of both the groups (hospitalized and non hospitalized) were sensitive Penicillin G. Similarly, both the groups were 55% and 50 % resistance to Vancomycin