-
Heart Rhythm Apr 2023Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers,...
BACKGROUND
Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers, and attrition; studies relying on administrative codes, which lack specificity; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead.
OBJECTIVE
The purpose of this study was to determine whether adjudicated remote monitoring (RM) data can address these limitations and augment lead safety evaluation.
METHODS
Among 48,191 actively monitored patients with a cardiovascular implantable electronic device, we identified RM transmissions signifying incident lead abnormalities and, separately, identified all leads abandoned or extracted between April 1, 2019, and April 1, 2021. We queried electronic health record and Medicare fee-for-service claims data to determine whether patients had administrative codes for lead failure. We verified lead failure through manual electronic health record review.
RESULTS
Of the 48,191 patients, 1170 (2.4%) had incident lead abnormalities detected by RM. Of these, 409 patients had administrative codes for lead failure, and 233 of these 409 patients (57.0%) had structural lead failure verified through chart review. Of the 761 patients without administrative codes, 167 (21.9%) had structural lead failure verified through chart review. Thus, 400 patients with RM transmissions suggestive of lead abnormalities (34.2%) had structural lead failure. In addition, 200 patients without preceding abnormal RM transmissions had leads abandoned or extracted for structural failure, making the total lead failure cohort 600 patients (66.7% with RM abnormalities, 33.3% without). Patients with isolated right atrial or left ventricular lead failure were less likely to have lead replacement and administrative codes reflective of lead failure.
CONCLUSION
RM may strengthen real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.
Topics: Aged; Humans; United States; Defibrillators, Implantable; Medicare; Heart Failure; Monitoring, Physiologic
PubMed: 36586706
DOI: 10.1016/j.hrthm.2022.12.033 -
Scandinavian Journal of Trauma,... Feb 2020Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena... (Review)
Review
BACKGROUND
Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring.
MATERIALS AND METHODS
We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause; 2) CPR for any length of time; 3) A point was reached when it was felt that the patient had died; 4) Staff declared the patient dead and stood back. No further interventions took place; 5) Later, vital signs were observed. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care.
RESULTS
Sixty-five patients with ROSC after TOR were identified in 53 articles (1982-2018), 18 (28%) made a full recovery.
CONCLUSIONS
Almost a third made a full recovery after autoresuscitation. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min; 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation; 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided; 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm; 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min.
Topics: Cardiopulmonary Resuscitation; Heart Arrest; Humans; Respiration; Vital Signs
PubMed: 32102671
DOI: 10.1186/s13049-019-0685-4 -
Europace : European Pacing,... Mar 2021FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable... (Observational Study)
Observational Study
AIMS
FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups.
METHODS AND RESULTS
Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient's age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications.
CONCLUSION
In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient's age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
Topics: Aged; Attitude; Defibrillators, Implantable; Device Removal; Electric Countershock; Humans; Male; Middle Aged; Registries
PubMed: 33257986
DOI: 10.1093/europace/euaa290 -
Europace : European Pacing,... Jul 2020Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate...
AIMS
Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications.
METHODS AND RESULTS
All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction.
CONCLUSION
More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.
Topics: Cohort Studies; Defibrillators, Implantable; Device Removal; Follow-Up Studies; Humans; Pacemaker, Artificial; Retrospective Studies; Treatment Outcome
PubMed: 32447372
DOI: 10.1093/europace/euaa086 -
The Journal of Sexual Medicine Oct 2021Prostate cancer (PCa) treatments commonly lead to erectile difficulties. While the mainstay treatment is erectile aids (EAs) to promote erectile recovery, some men never...
BACKGROUND
Prostate cancer (PCa) treatments commonly lead to erectile difficulties. While the mainstay treatment is erectile aids (EAs) to promote erectile recovery, some men never use these treatments and those whose do use EAs often abandon them in the long-term.
AIM
The goal of this study was to examine PCa patients' experiences with EAs, to elucidate relationships between experiences with EAs on psychological and sexual well-being, and to explore benefits and drawbacks to EA use.
METHODS
A self-report survey including validated questionnaires was administered to examine PCa patients' use and perceptions of helpfulness of EAs, and to characterize associations between use, perceived helpfulness, and psychological and sexual well-being. The survey was followed by an open-ended prompt to explore participants' experiences with EAs.
OUTCOMES
We surveyed 260 North American men, up to 25 years after receiving treatment for PCa. Three groups of patients were observed, including those who used EAs and perceived them to be helpful, those who used EAs and perceived them to be unhelpful, as well as a smaller group of patients who never used EAs.
RESULTS
Around 80% of the sample were using or had used EAs. Despite the high frequency of use, not all men found EAs helpful. Men who used EAs and found them unhelpful reported poorer psychological and sexual well-being compared to men who didn't use aids or who used EAs but found them helpful. Results indicated both benefits and drawbacks to the use of EAs. Benefits related largely to the efficacy of the aid in promoting erections. A wide range of drawbacks were also reported.
CLINICAL IMPLICATIONS
Given the negative sexual and psychological impacts associated with using EAs and finding them unhelpful, we suggest that researchers and health care providers should take care to proactively address potential challenges that are common with EA use, and also to consider the risks of failed attempts with EAs.
STRENGTHS & LIMITATIONS
By using both scaled and open-ended questions, a more nuanced picture of the relative benefits and limitations of EA use within the PCa population is presented. As responses were not mandatory, a subset of participants provided comments about the use of EAs. Additionally, the sample was quite homogenous, with mostly white, American and well-educated participants, so it therefore lacks generalizability to other populations.
CONCLUSION
This paper illustrates several challenges to EA use, while providing insight into reasons for abandonment of use of EAs. Walker LM, Sears CS, Santos-Iglesias P, et al. Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids. J Sex Med 2021;18:1775-1787.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Prostatic Neoplasms; Self Report; Sexual Behavior; Surveys and Questionnaires
PubMed: 34526246
DOI: 10.1016/j.jsxm.2021.07.012 -
European Journal of Clinical... Aug 2019Colistin is an old antibiotic, which is abandoned decades ago because of high nephrotoxicity rates. However, it is reintroduced to clinical medicine due to lack of newly... (Review)
Review
Colistin is an old antibiotic, which is abandoned decades ago because of high nephrotoxicity rates. However, it is reintroduced to clinical medicine due to lack of newly discovered antibiotics and is still widely used for the treatment of resistant gram-negative infections. Discovering mechanisms to reduce nephrotoxicity risk is of significant importance since exposed patients may have many other factors that alter kidney functions. Several agents were evaluated in animal models of colistin nephrotoxicity as a means to prevent kidney injury. Considerable heterogeneity exists in terms of reporting colistin dosing and experimental designs. This issue leads clinicians to face difficulties in designing studies and sometimes may lead to report dosing strategies inadequately. Here, we present a review according to animal models of colistin nephrotoxicity using data gathered from previous experiments to draw attention on possible complexities that researchers may encounter.
Topics: Acute Kidney Injury; Animals; Anti-Bacterial Agents; Colistin; Disease Models, Animal; Dose-Response Relationship, Drug; Kidney; Rats; Rats, Sprague-Dawley; Rats, Wistar; Risk Factors; Toxicity Tests
PubMed: 30949899
DOI: 10.1007/s10096-019-03546-7 -
JPMA. the Journal of the Pakistan... Sep 2022Awake craniotomy (AC) is becoming increasingly popular for brain tumour surgery. The procedure allows better preservation of eloquent cortex and helps achieve greater...
Awake craniotomy (AC) is becoming increasingly popular for brain tumour surgery. The procedure allows better preservation of eloquent cortex and helps achieve greater tumour resection. However, a potential problem with the procedure is intraoperative seizures (IOS) that may affect the mapping and monitoring of awake patients and may even lead to abandoning of the awake procedure.
Topics: Humans; Wakefulness; Craniotomy; Brain Neoplasms; Seizures
PubMed: 36281000
DOI: 10.47391/JPMA.22-95 -
Journal of Religion and Health Apr 2023Extramarital pregnancy is a scarcely explored socio-ethical topic in Muslim countries. Extramarital sexual intercourse is legally prohibited and deemed shameful by...
Extramarital pregnancy is a scarcely explored socio-ethical topic in Muslim countries. Extramarital sexual intercourse is legally prohibited and deemed shameful by conservative Muslim societies. The legal and social implications of an extramarital pregnancy prevent access to care and lead to concealment and/or infant abandonment. This paper argues that the medical community must not become complicit in the criminalization and stigmatization of unmarried pregnant women, but must become a safe and reliable refuge instead. The paper also finds strong Islamic moral commitments that warrant the provision of confidential, non-judgmental care, and encourage compassion and forgiveness over reprimand and punishment.
Topics: Pregnancy; Humans; Female; Islam; Extramarital Relations; Morals; Religion and Medicine
PubMed: 36454333
DOI: 10.1007/s10943-022-01707-1 -
International Journal of Systematic and... Sep 2020Two novel strains, designated 92R-1 and 9PBR-1, were isolated from abandoned lead-zinc ore collected in Meizhou, Guangdong Province, PR China. Phylogenetic analyses...
Two novel strains, designated 92R-1 and 9PBR-1, were isolated from abandoned lead-zinc ore collected in Meizhou, Guangdong Province, PR China. Phylogenetic analyses based on 16S rRNA gene sequences showed that they fell into the genus of r and formed two distinct lineages. Strain 92R-1 was most closely related to JCM 19491 (98.7 %) and LMG 21873 (98.5 %), while strain 9PBR-1 was most closely related to LMG 21951 (99.0 %), JCM 17223 (98.7 %) and JCM 31653 (98.1 %). Strain 92R-1shared average nucleotide identity values of 80.0-83.7 % and digital DNA-DNA hybridization values of 23.1-27.1 % with its closely related type strains, respectively, while strain 9PBR-1 shared corresponding values of 80.3-83.2 % and 23.6-26.7 % with its closely related type strains, respectively. The two novel strains could be clearly distinguished from their closely related type strains by enzyme activities and substrates assimilation, respectively. Both of them took iso-C summed feature 3 (C 7 and/or C 6), summed feature 4 (iso-C I and/or anteiso-C B) and C 5 as major fatty acids, and showed clear differences from their closely relatives in the contents of several components. They contained menaquinone 7 as the major respiratory quinone and phosphatidylethanolamine as the dominant polar lipid. The G+C contents of strains 92R-1 and 9PBR-1 were 56.7 and 59.5 mol%, respectively. The results clearly supported that strains 92R-1 and 9PBR-1 represent two distinct novel species within the genus , for which the names sp. nov. (type strain 92R-1=GDMCC 1.1493=JCM 32697) and sp. nov. (type strain 9PBR-1=GDMCC 1.1491=JCM 32698) are proposed.
Topics: Bacterial Typing Techniques; Base Composition; China; Cytophagaceae; DNA, Bacterial; Fatty Acids; Lead; Mining; Nucleic Acid Hybridization; Phosphatidylethanolamines; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Vitamin K 2; Zinc
PubMed: 32749954
DOI: 10.1099/ijsem.0.004313 -
Translational Andrology and Urology Jun 2021Sclerosing lipogranuloma of the penis is a relatively rare disorder associated with injection of illicit foreign materials for penile augmentation. We aim to report the... (Review)
Review
OBJECTIVE
Sclerosing lipogranuloma of the penis is a relatively rare disorder associated with injection of illicit foreign materials for penile augmentation. We aim to report the clinical presentation, diagnosis, treatment, and outcomes of patients with this condition, and to review the most relevant literature currently available.
BACKGROUND
Injection of mineral oil into the subcutaneous tissues of the penis for augmentation has been practiced since ancient times. The potential for complications has long been known, and most doctors have abandoned the procedure. However, it is still practiced in some parts of the world. The complications may be devastating including death from embolism or sepsis. The affected area may not be restricted to the injection site, potentially involving the scrotal and suprapubic areas. Surgery with complete removal of the involved tissue followed by covering the denuded area with a graft or skin flap is the best therapeutic option.
METHODS
The literature search involved keywords such as penis, augmentation, enlargement, sclerosing, lipogranuloma, penile injection, paraffinoma, and was obtained from computerized search of databases such as PubMed, Google Search and Scopus. Personal experience of the lead author (BS) is also described. We tried arbitrarily to limit our search to articles including ≥5 patients pertaining to the subject of our review and, therefore, excluded single case reports. However, a single systematic search of PubMed and Scopus was also found and included.
CONCLUSIONS
The treatment of choice is radical excision of all the lesions followed by skin grafting. Bearing in mind that prospective, randomized, controlled studies are considered difficult to carry out, further work will continue apparently to be based on case series by individual surgeons. It is critical to advise patients to separate the myths from the facts and use preventive measures through awareness and education to best minimize the downsides of this problem.
PubMed: 34295755
DOI: 10.21037/tau-21-228