Acebutolol in cardiac arrhythmiaa

Acebutolol (Sectral), a new beta-adrenoceptor antagonist, was used in 44 patients with cardiac arrhythmias (53 episodes). It was used intravenously (12,5 and 25 mg), orally (100 mg every 8 hours) or in combination with quinidine. Acebutolol was most effective in supraventricular tachyarrhythmias, to control the ventricular response when digital's was ineffective, as a synergist with quinidine to convert patients to sinus rhythm, or prophylactically to prevent relapse to atrial fibrillation. It also terminated ventricular tachycardia in two patients. Side-effects occurred in three ill patients.S. Afr. Med. J., 48, 821 (1974

Follow-up of patients with arrhythmogenic right ventricular cardiomyopathy dysplasia

Objective. The enlargement of data on the natural course and management of patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D).Design. Retrospective and partly prospective observational study.Setting. Cardiac Unit, Wentworth Hospital, Durban - the only unit in KwaZulu-Natal providing an arrhythmia and electrophysiology service.Study population. Those included were: (i) patients referred for palpitations, unexplained syncope, or ventricular tachycardia and in whom ARVC/D was diagnosed according to multiple criteria; and (ii) family members of patients with ARVC/D in whom the disease was documented using the same criteria. Main outcome and measurements. Diagnosis, management, morbidity and mortality were analysed.Results. Twelve patients were diagnosed with ARVC/D over a period or 6 years. At the end of follow-up for 3.4 ± 3.2 years, 7 of them were well and alive on anti-arrhythmic medication, 2 were asymptomatic, and 3 had died. One death was sudden, 1 patient died due to left ventricular failure, and 1 patient died due to a low cardiac output syndrome 3 months after right ventricular isolation, i.e. the mortality rate was 25%. ARVC/D was found in all racial groups and was familial in 5 patients (42%). In all but one patient the correct diagnosis was not suspected by the referring institution, physician or cardiologist.Conclusions. ARVC/D needs to be included into a differential diagnosis of unexplained syncope, palpitations, or ventricular tachycardia by an health service providers. Its management remains a complex challenge with varying results

Neonatal imaging diagnosis

No abstract available

Neonatal imaging

No abstract available

Large Scale Agent-Based Modeling of the Humoral and Cellular Immune Response

The Immune System is, together with Central Nervous System, one of the most important and complex unit of our organism. Despite great advances in recent years that shed light on its understanding and in the unraveling of key mechanisms behind its functions, there are still many areas of the Immune System that remain object of active research. The development of in-silico models, bridged with proper biological considerations, have recently improved the understanding of important complex systems [1,2]. In this paper, after introducing major role players and principal functions of the mammalian Immune System, we present two computational approaches to its modeling; i.e., two in-silico Immune Systems. (i) A large-scale model, with a complexity of representation of 106 - 108 cells (e.g., APC, T, B and Plasma cells) and molecules (e.g., immunocomplexes), is here presented, and its evolution in time is shown to be mimicking an important region of a real immune response. (ii) Additionally, a viral infection model, stochastic and light-weight, is here presented as well: its seamless design from biological considerations, its modularity and its fast simulation times are strength points when compared to (i). Finally we report, with the intent of moving towards the virtual lymph note, a cost-benefits comparison among Immune System models presented in this paper. © 2011 Springer-Verlag

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease