Transvenous Lead Extraction of Cardiac Implantable Electronic Devices Indications, Complications and Outcome: An Egyptian Two Years' Experience

BACKGROUND: The growing needs to extract cardiovascular implantable electronic devices warrants the need to improve the outcome and prevent complications. AIM: This study aims to analyse the findings and identify factors associated with complications of Percutaneous Transvenous Lead Extraction in the Critical Care Department, Cairo University. METHODS: We studied 52 candidates for Percutaneous Transvenous Lead extraction of a Permanent Pace Maker (PPM) regarding extraction indications, comorbidities, device type, complications and outcome. Extraction was first attempted by simple manual traction using regular non-locking stylet and if failed, locking stylet, and evolution dilator sheath were used. RESULTS: We extracted 110 leads with a mean lead age of 4.67 ± 3.6 years. The most common extraction indication was an infection (71.15%). Indications correlated significantly with comorbidities (p = 0.024), the most common being Diabetes Mellitus (40.38%). Simple traction was successful in 31 % of the leads, while 69% were extracted using locking stylet and evolution dilator sheath. The method of lead extraction correlated significantly with lead age (P ≤ 0.001). Complications were significantly higher with extraction by evolution dilator sheaths than by simple traction (P = 0.003) and in older patients (P = 0.008). Complications also correlated significantly with extractions indications (p = 0.012), type of PPM (P = 0.037), number of extracted leads (P = 0.041), and lead age (p= 0.011). CONCLUSION: Among the studied variables, extraction indications particularly infection, was the only preventable factor significantly associated with complications. While focusing on preventable factors, improving, implantation and extraction techniques should also be addressed

Application of recommended therapies among patients with heart failure during the Syrian conflict : reality and barriers

Aims Lower socio-economic status may delay and even prevent the application of guideline-directed heart failure (HF) therapy for most patients. This study aims to evaluate the feasibility and possible difficulties facing the application of this treatment during the current Syrian conflict. Methods and results A questionnaire on HF management and feasibility of recommended HF therapy was addressed to physicians practising cardiology in Syria. The questionnaire consisted of 30 questions and focused on the quality of HF management and awareness of recommended drug and device therapy for HF among physicians practising cardiology in Syria. A total of 228 physicians participated in the survey. Awareness of recommended medical and device therapy of HF was very high among participants (98% and 95%, respectively). The majority of participants (>75%) believe that more than half of HF patients do not receive optimal medical HF therapy. Ninety per cent of participants believe that <10% of patients with an appropriate indication for device therapy receive it. More than 75% of participants believe that the cost of medications, alone or in combination with other medical causes, represents the major problem facing the application of optimal HF medical therapy. More than 95% of participants reported that cost alone, or in combination with unavailability, is the primary reason why patients with appropriate indications are not offered device therapy. Conclusions Despite the high level of awareness of recommended HF therapies among Syrian cardiologists, the majority of HF patients are still undertreated. Financial difficulties and lack of resources are the main causes of this problem

Estimation of key potentially toxic elements in arid agricultural soils using Vis-NIR spectroscopy with variable selection and PLSR algorithms

Potentially toxic elements (PTEs) pose a significant threat to soil and the environment. Therefore, the fast quantification of PTEs is crucial for better management of contaminated sites. Versatile technique such as Visible near-infrared spectroscopy (Vis–NIRS) (350–2,500 nm) has attracted tremendous attention for assessing PTEs and has achieved promising results combined with successful multivariate analysis. This research investigated the potential of Vis–NIRS combined with partial least squares regression (PLSR) and variable selection methods to assess key PTEs (Cd, Co, Cu, Cr, Pb, and Zn) in agricultural soils under arid conditions. The soil samples (80) were collected from a polluted area around Al-Moheet drainage, Minya Governorate–upper Egypt. The samples were scanned using an ASD FieldSpec-4 spectroradiometer. Simulated annealing (SA) and uninformative variable elimination (UVE) were used to select the effective wavelengths in predicting PTEs. PLSR was used to develop the spectral models using the full range (FR-PLS) and feature-selected spectra techniques SA (SA-PLS) and UVE (UVE-PLS). The results indicated that UVE-PLS models performed better than FR-PLS and SA-PLS models in predicting the key PTEs. The obtained coefficient of determination (R2) and the ratio of performance to deviation (RPD) were 0.74 and 2.48 (Cr), 0.72 and 2.03 (Pb), 0.62 and 1.86 (Cd), 0.59 and 1.78 (Cu), 0.52 and 1.68 (Co), and 0.46 and 1.41 (Zn), respectively. The results suggested that the UVE-PLS spectral model is promising for predicting Cr, Pb, and Cd, and can be improved for predicting Cu, Co, and Zn elements in agricultural soils

Usefulness of plasma B type natriuretic peptide as a predictor to identify responders following CRT

It has been shown that patients with heart failure have high levels of brain or type B natriuretic peptide (BNP), and that there is a correlation between these and the severity of their condition. Many studies report that monitoring BNP levels could be a sensitive method for diagnosing heart failure and performing risk stratification, and that they could act as an independent predictor of adverse events helping clinicians arrive at a prognosis. To achieve this purpose we studied 30 patients with CHF (27 males, mean age 57 years) undergoing CRT implantation. The main finding of our study was that CRT exerted a substantial reduction in plasma BNP levels among responders, but no significant change in nonresponders after 3 months follow-up, only responders showed a significant decrease in plasma BNP levels (229.64 pg/ml ± 111) as compared to non-responders (468 pg/ml ± 96) P value <0.01. Response could be predicted with a cut-off value of 360 pg/ml, with a sensitivity and specificity of 90.9% and 87.5%, respectively. In conclusion, BNP monitoring is potentially a good prognostic indicator of LV functional recovery and reverse remodeling after CRT can accurately identify echocardiographic responders after CRT. Percentage change in plasma BNP levels from baseline to 3 months was the strongest predictor of long-term response to CRT and may have potential to predict outcome

V–V delay interval optimization in CRT using echocardiography compared to QRS width in surface ECG

Introduction: CRT had become a standard of treatment for patients with drug refractory heart failure. The presence of many cases of non-responders raises the need for device optimization echocardiography that is an established tool used to optimize CRT programming, but it is time-consuming. It was not yet defined whether a QRS width-based strategy may be a helpful tool for device programming. Aim of study: The aim of this study is to compare the optimal interventricular delay interval (V–V interval) obtained by echo with that obtained by a simpler method using QRS width in surface ECG. Methods and results: Twenty patients with implanted CRT were enrolled. All patients underwent echocardiographic optimization of the (A–V interval) after which five different V–V intervals (LV + 30, LV + 60, RV + 30, RV + 60, L + R0) were compared measuring Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) as a surrogate for ejection fraction. A 12-lead ECG was recorded and QRS duration was measured in the lead with the greatest QRS width. The ECG optimized V–V interval was defined according to the narrowest achievable QRS interval among the 5 V–V intervals. The echocardiographic-optimized V–V interval was defined according to the highest LVOT VTI among the 5 V–V intervals. The echocardiographic-optimized V–V interval was left ventricle + 30 ms in 2 patients (10%), left ventricle + 60 ms in 8 pts (40%), simultaneous pacing in 8 pts (40%) and right ventricle + 30 ms in 2 pts (10%). ECG method (using QRS width), had 85% coincidence with the echocardiographic method (using LVOT VTI) (κ = 0.906), (r = 0.81 P < 0.001). Conclusion: Significant correlation appeared to exist during optimization of CRT between VV programming based on the shortest QRS interval at 12-lead ECG pacing and that based on highest LVOT VTI by echocardiography. A combined ECG and echocardiographic approach could be a more convenient solution in performing V–V optimization

Microbiome diversity in African American, European American, and Egyptian colorectal cancer patients

Purpose: Although there is an established role for microbiome dysbiosis in the pathobiology of colorectal cancer (CRC), CRC patients of various race/ethnicities demonstrate distinct clinical behaviors. Thus, we investigated microbiome dysbiosis in Egyptian, African American (AA), and European American (EA) CRC patients. Patients and methods: CRCs and their corresponding normal tissues from Egyptian (n = 17) patients of the Alexandria University Hospital, Egypt, and tissues from AA (n = 18) and EA (n = 19) patients at the University of Alabama at Birmingham were collected. DNA was isolated from frozen tissues, and the microbiome composition was analyzed by 16S rRNA sequencing. Differential microbial abundance, diversity, and metabolic pathways were identified using linear discriminant analysis (LDA) effect size analyses. Additionally, we compared these profiles with our previously published microbiome data derived from Kenyan CRC patients. Results: Differential microbiome analysis of CRCs across all racial/ethnic groups showed dysbiosis. There were high abundances of Herbaspirillum and Staphylococcus in CRCs of Egyptians, Leptotrichia in CRCs of AAs, Flexspiria and Streptococcus in CRCs of EAs, and Akkermansia muciniphila and Prevotella nigrescens in CRCs of Kenyans (LDA score >4, adj. p-value <0.05). Functional analyses showed distinct microbial metabolic pathways in CRCs compared to normal tissues within the racial/ethnic groups. Egyptian CRCs, compared to normal tissues, showed lower l-methionine biosynthesis and higher galactose degradation pathways. Conclusions: Our findings showed altered mucosa-associated microbiome profiles of CRCs and their metabolic pathways across racial/ethnic groups. These findings provide a basis for future studies to link racial/ethnic microbiome differences with distinct clinical behaviors in CRC

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population