In this report, Ebola virus was cultured from aqueous humor 14 weeks after disease onset and 9 weeks after resolution of viremia, a finding that indicates the potential for delayed clearance of the ...virus from immune-privileged sites.
The current outbreak of EVD is believed to have begun in December 2013.
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As of April 26, 2015, a total of 26,312 cases of EVD (including 10,899 deaths) had been reported in six countries in West Africa (i.e., Sierra Leone, Liberia, Guinea, Mali, Nigeria, and Senegal), the United States, the United Kingdom, and Spain.
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The outbreak has also resulted in the largest number of EVD survivors in history.
Among survivors of EVD, late complications that include ocular disease can develop during convalescence.
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However, few systematic studies have been conducted on post-EVD sequelae, so the incidence and clinical manifestations of . . .
BACKGROUND—The most frequent complications associated with implantable cardioverter-defibrillators (ICDs) involve the transvenous leads. A subcutaneous implantable cardioverter-defibrillator (S-ICD) ...has been developed as an alternative system. This study evaluated the safety and effectiveness of the S-ICD System (Cameron Health/Boston Scientific) for the treatment of life-threatening ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation).
METHODS AND RESULTS—This prospective, nonrandomized, multicenter trial included adult patients with a standard indication for an ICD, who neither required pacing nor had documented pace-terminable ventricular tachycardia. The primary safety end point was the 180-day S-ICD System complication-free rate compared with a prespecified performance goal of 79%. The primary effectiveness end point was the induced ventricular fibrillation conversion rate compared with a prespecified performance goal of 88%, with success defined as 2 consecutive ventricular fibrillation conversions of 4 attempts. Detection and conversion of spontaneous episodes were also evaluated. Device implantation was attempted in 321 of 330 enrolled patients, and 314 patients underwent successful implantation. The cohort was followed for a mean duration of 11 months. The study population was 74% male with a mean age of 52±16 years and mean left ventricular ejection fraction of 36±16%. A previous transvenous ICD had been implanted in 13%. Both primary end points were metThe 180-day system complication-free rate was 99%, and sensitivity analysis of the acute ventricular fibrillation conversion rate was >90% in the entire cohort. There were 38 discrete spontaneous episodes of ventricular tachycardia/ventricular fibrillation recorded in 21 patients (6.7%), all of which successfully converted. Forty-one patients (13.1%) received an inappropriate shock.
CONCLUSIONS—The findings support the efficacy and safety of the S-ICD System for the treatment of life-threatening ventricular arrhythmias.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01064076.
To describe the ocular findings, visual impairment, and association of structural complications of uveitis with visual impairment in a cohort of survivors of Ebola virus disease (EVD) in Monrovia, ...Liberia.
Retrospective, uncontrolled, cross-sectional study.
Survivors of EVD who were evaluated in an ophthalmology clinic at Eternal Love Winning Africa (ELWA) Hospital in Monrovia, Liberia.
A cohort of EVD survivors who underwent baseline ophthalmic evaluation at ELWA Hospital were retrospectively reviewed for demographic information, length of Ebola treatment unit (ETU) stay, visual acuity (VA), and ophthalmic examination findings. For patients with uveitis, disease activity (active vs. inactive) and grade of inflammation were recorded according to Standardization of Uveitis Nomenclature criteria. The level of VA impairment was categorized according to World Health Organization classification for VA impairment as follows: normal/mild, VA 20/70 or better; moderate, VA 20/70-20/200; severe, VA 20/200-20/400; blindness, VA <20/400. Visual acuity, length of ETU stay, and structural complications were compared between EVD survivors with and without uveitis. Structural complications associated with moderate VA impairment or poorer were analyzed.
Frequency of ocular complications including uveitis and optic neuropathy in EVD survivors, level of VA impairment in EVD survivors with uveitis, and structural complications associated with VA impairment in EVD survivors.
A total of 96 survivors of EVD were examined. A total of 21 patients developed an EVD-associated uveitis, and 3 patients developed an EVD-associated optic neuropathy. Visual acuity was blind (VA >20/400) in 38.5% of eyes with uveitis. Anatomic subtypes of uveitis included anterior, posterior, and panuveitis in 2, 13, and 6 patients, respectively. Examination findings associated with at least moderate visual impairment by World Health Organization criteria (VA <20/70) included keratic precipitates (P < 0.002), posterior synechiae (P < 0.002), vitritis (P < 0.005), and chorioretinal scars (P < 0.02).
Survivors of EVD are at risk for uveitis, which may lead to secondary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa because of the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.
An increase in coronavirus disease (COVID‐19) infections prompted Level 4 lockdown throughout New Zealand from 25 March 2020. We have investigated trends in coronary and electrophysiology (EP) ...procedures before and during this lockdown. The number of acute procedures for ST elevation myocardial infarction remained stable. In contrast, the number of in‐patient angiograms and percutaneous intervention procedures fell by 53% compared with the previous 4 weeks in 2020 and by 56% compared with the corresponding period in 2019. Further study is required to determine the reasons for these trends.
Christchurch, New Zealand, experienced two major earthquakes on 4th September 2010 and 22nd February 2011. Previous studies have demonstrated that earthquakes are associated with sudden cardiac ...deaths. Whilst myocardial ischemia would contribute to this, ventricular arrhythmia triggered by stress has also been suggested. We aim to study the impact of the two earthquakes on ventricular arrhythmia events.
We conducted a retrospective review of all patients resident in the earthquake zone with implantable defibrillators. Ventricular arrhythmia requiring therapy and non-sustained events were recorded from the period of 30 days before thru 30 days after the two earthquakes. Weekly event rates were calculated and compared using log rank analysis. Results are expressed as mean (range), significance was determined at the <0.05 level.
For the 211 patients who were exposed to the 2010 earthquake, there was no difference in the proportion of patients free of therapy, either Shock or ATP (0.943 before and 0.933 after the earthquake, p = 0.85, ns). Similarly, there was no significant increase in events requiring therapy in the 236 patients exposed to the 2011 earthquake (0.957 before and 0.961 after the earthquake, p = 0.80, ns). We identified one patient who required multiple therapy for ventricular tachycardia immediately following both earthquakes.
The two Christchurch earthquakes were not associated with an increase in the event rate of either sustained or non-sustained ventricular arrhythmias in our patients. We identified only a single patient who had arrhythmic storms immediately following the earthquakes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In a prospective global study, extravascular implantable cardioverter–defibrillators with a substernal lead were implanted safely and were able to detect and terminate induced ventricular arrhythmias ...at the time of implantation.
In this report from the Democratic Republic of Congo, Ebola virus disease (EVD) developed in a young man, and he recovered after treatment with a monoclonal antibody. Six months later, EVD ...recrudesced, and he transmitted the virus to others and died from EVD.
An entirely subcutaneous implantable cardioverter–defibrillator without transvenous or epicardial leads was evaluated in two short-term trials to identify a suitable device configuration and assess ...energy requirements. In a 6-patient, long-term pilot study and a 55-patient, single-group trial, the cardioverter–defibrillator consistently detected and converted induced ventricular fibrillation and detected and treated all 12 episodes of spontaneous ventricular tachyarrhythmia.
In a 6-patient, long-term pilot study and a 55-patient, single-group trial, an entirely subcutaneous implantable cardioverter–defibrillator consistently detected and converted induced ventricular fibrillation and detected and treated all 12 episodes of spontaneous ventricular tachyarrhythmia.
The use of implantable cardioverter–defibrillators (ICDs) is an established therapy for the prevention of death from ventricular arrhythmia.
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However, conventional ICDs rely on transvenous leads for cardiac sensing and defibrillation. Complications of defibrillator implantation have been associated mainly with transvenous lead insertion and have included pneumothorax, hemothorax, and cardiac tamponade.
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Difficulties in achieving venous access can prolong the procedure and occasionally result in failed ICD implantation.
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In the long term, lead failure remains a major limitation in the use of ICDs, despite decades of innovations in lead design.
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Lead failure either generates inappropriate shocks or impedes . . .
BACKGROUND:Catheter ablation for atrial fibrillation has potential to cause esophageal thermal injury. Esophageal temperature monitoring during ablation is commonly used; however, it has not ...eliminated thermal injuries, possibly because conventional sensors have poor spatial sampling and response characteristics. To enhance understanding of temperature dynamics that may underlie esophageal injury, we tested a high-resolution, intrabody, infrared thermography catheter to continuously image esophageal temperatures during ablation.
METHODS AND RESULTS:Atrial fibrillation ablation patients were instrumented with a flexible, 9F infrared temperature catheter inserted nasally (n=8) or orally (n=8) into the esophagus adjacent to the left atrium. Ablation was performed while the infrared catheter continuously recorded surface temperatures from 7680 points per second circumferentially over a 6-cm length of esophagus. Physicians were blinded to temperature data. Endoscopy was performed within 24 hours to document esophageal injury. Thermal imaging showed that most patients (10/16) experienced ≥1 events where peak esophageal temperature was >40°C. Three patients experienced temperatures >50°C; and 1 experienced >60°C. Analysis of temperature data for each subject’s maximum thermal event revealed high gradients (2.3±1.4°C/mm) and rates of change (1.5±1.3°C/s) with an average length of esophageal involvement of 11.0±5.4 mm. Endoscopy identified 3 distinct thermal lesions, all in patients with temperatures >50°C; all resolved within 2 weeks.
CONCLUSIONS:Infrared thermography provided dynamic, high-resolution mapping of esophageal temperatures during cardiac ablation. Esophageal thermal injury occurred with temperatures >50°C and was associated with large spatiotemporal gradients. Additional studies are warranted to determine the relationships between thermal parameters and esophageal injury.
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