Use of a novel needle wire in patients undergoing transseptal puncture associated with severe septal tenting

Abstract Introduction An increasing number of patients undergo left atrial ablation procedures, since several approaches have proven efficacy in the treatment of atrial fibrillation. Although transseptal catheterization was generally shown be a safe technique, it harbors the principal risk of cardiac injury. Therefore, there is a need for a safe and effective tool to enable transseptal puncture in difficult cases as well. Methods and Results In 158 consecutive patients, a transseptal puncture was intended for mapping and ablation of left atrial tachycardias. In seven patients of this series transseptal puncture using different sheaths and needle designs, the operators failed to cross the interatrial septum as a result of severe tenting. Three patients were known to have a septal aneurysm; a redo procedure was performed in two patients. In the remaining patients, there was no obvious explanation for the difficulty in crossing the interatrial septum conventionally. In all seven patients, a 120-cm-long nitinol guidewire ("needle wire") with a 0.014-inch diameter was used to cross the atrial septum with the following idea: after tenting the fossa ovalis with the transseptal dilator and the Brockenbrough needle positioned just inside the tip, effortless advancement of the needle wire perforates the membranous fossa. Unsupported by the needle and dilator, the tip of the wire immediately assumes a "J" shape, rendering it incapable of further tissue penetration after its entry into the left atrium. In all seven patients, the needle wire could be placed into a left pulmonary vein. In five patients, a single attempt was sufficient to reach the left atrium with the wire, two patients needed two and three attempts, respectively. No complications occurred. Conclusions Additional use of a needle wire to perform transseptal puncture in a subset of patients at higher risk for complications appears safe and effective

Die Begleittherapie mit Glykoprotein IIb/IIIa-Rezeptorantagonisten bei Patienten mit akutem Koronarsyndrom ohne ST-Strecken-Hebungen (UAP und NSTEMI), die einer perkutanen Koronarintervention (PCI) unterzogen wurden

Die Auswirkung einer Begleittherapie mit intravenösen GPA wurde in einem unselektionierten Patientenkollektiv hinsichtlich der hospitalen Mortalität und MACCE sowie der nichttödlichen Komplikationen analysiert. Die Daten von insgesamt 7104 Patienten aus 38 Krankenhäusern des ALKK-Registers, die im Jahr 2005 wegen eines NSTE-ACS einer PCI unterzogen wurden, sind hinsichtlich des Einsatzes einer Begleittherapie mit einem GPA untersucht worden. Die Auswertung der Daten zeigt hauptsächlich, dass Patienten mit NSTE-ACS, die einer PCI unterzogen wurden und eine Begleittherapie mit einem GPA erhielten, ein signifikant erhöhtes Risiko für intraprozedurale bzw. nicht-prozedurbedingte Komplikationen und die kombinierten Hauptendpunkte haben. Für eine Begleittherapie mit einem GPA bei Patienten mit NSTE-ACS, die einer PCI unterzogen werden, muss eine sorgfältige individuelle Risikostratifizierung erfolgen, die sowohl die bestehenden Blutungsrisiken als auch den zu erwartenden Nutzen berücksichtigt

Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm.

BACKGROUND AND OBJECTIVE The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician. METHODS We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint. RESULTS Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases. CONCLUSION The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future

Breakthrough pain associated with a reduction in serum buprenorphine concentration during dialysis

PURPOSE: To describe a case of breakthrough pain associated with a reduction in serum buprenorphine concentration during dialysis. METHODS: Pharmacokinetic sampling of total and free buprenorphine and norbuprenorphine in an 80 year old male undergoing haemodialysis three times per week who received 5760 µg oral and transdermal buprenorphine daily was performed. The patient's serum albumin concentration was 23g/l (reference range: 35-52 g/l). FINDINGS: Pharmacokinetic sampling revealed a free buprenorphine fraction of 32% (consistent with the hypoalbuminaemia), which was markedly reduced at the end of dialysis (free buprenorphine concentration 2.4 µg/l before vs. <0.1 µg/l after dialysis). IMPLICATIONS: Clinicians should be aware that some patients may require extra buprenorphine doses during dialysis to prevent significant falls in the concentration of active drug

Comparison between Management and Pharmacotherapy of COVID-19 in Iran and Switzerland: Management and Pharmacotherapy of COVID-19 in Iran and Switzerland

Background: On 30 January 2020, the WHO declared the outbreak of SARS-CoV-2 as a public healthemergency. In the present study, we compared the preventative and therapeutic strategies and the success rates of Iran and Switzerland during the COVID-19 outbreak.Materials and Methods: This study was conducted using electronic databases such as PubMed, Scopus, andWeb of Science. In addition, the official documents of developed countries and WHO from 1st February until 15th May 2020 were studied. Relevant documents were reviewed in detail, and vital data were extracted.Results: Both countries have restriction policies to reduce the infection rate in the prevention setting. Thesepolicies, such as the recommendation to all citizens to stay home unless necessary, army participation, andnon-face-to-face counseling, were surveyed by similar techniques in both countries. Some policies wereimplemented in both countries with different protocols. These policies, including social distancing practices,smart distancing methods, business activities, border closures, border controls, and restrictions, travelrestrictions, testing and screening for infection and fever, and decreased working hours, were performed inboth countries. In the treatment setting, the therapeutic strategy used in Iran consisted of hydroxychloroquineor chloroquine phosphate and anti-viral drugs. Switzerland followed the guidelines of the European countries.The infection rate, recovery rate, and death rate were 0.139%, 78.73%, and 5.91% in Iran, while these rateswere 0.352%, 88.81%, and 6.15% in Switzerland, respectively.Conclusion: Due to the lack of special treatment for the disease, prevention must be considered the mostimportant factor in policymaking. Importantly, observing social distance is the most effective method amongthe preventative strategies. The capacity of the health care systems to provide optimal services and facilities isan important factor for patients recovery