Association between prosthesis geometry and leaflet thrombosis following transcatheter aortic valve replacement

Introduction

Leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is a recognised condition. The association between prosthesis geometry [expansion, implant depth and commissural alignment (CA)] and LT is unclear.

Methods

Patients that received intra-annular TAVR prosthesis and post-procedure computed tomography (CT) with a 320-slice scanner were included. LT, defined as at least 50% restricted leaflet motion, was assessed with a dedicated 3Mensio workstation by two experienced CT readers. Prosthesis expansion was defined as actual divided by expected prosthesis area as a percentage of expected area whilst eccentricity was [(maximum diameter − minimum diameter) / maximum diameter) × 100%], both measured at prosthesis inflow, annulus and outflow. Implant depth was the average distance between prosthesis inflow and nadir of each cusp. CA was the average angle between each native and prosthesis leaflet coaptations. Significant commissural misalignment (CMA) was defined as CA greater than 30 degrees. To exclude anticoagulation bias, similar analysis was also performed in the cohort of non-anticoagulated patients.

Results

117 patients were included; the prevalence of LT was 13.7% [13/93 cases (14.0%) of Lotus valves and 3/24 cases (12.5%) of Sapien 3 valves]. Baseline demographics (age, STS score, cardiac risk factors) and procedural characteristics (access site, post-dilation, repositioning) were similar in both groups. None of the patients with LT were discharged on anticoagulation therapy (0.0% vs 22.8%, p<0.01). There were no differences in actual prosthesis area, perimeter or eccentricity at the three prosthesis levels. Patients with LT had reduced annulus expansion (89.3±9.8% vs 94.6±8.3%, p=0.02), lower implant depth (6.9±1.5mm vs 4.9±1.5mm, p<0.01) and more significant CMA (81.3% vs 48.5%, p=0.02). These findings were similar in patients that were not anticoagulated (94/117 patients).

Conclusion

Patients with LT had reduced annulus expansion, lower implant depth and greater CMA. These findings were not affected by presence or absence of anticoagulation. These factors may be important considerations during procedural planning for TAVR.

Graphical abstract

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council (NHMRC). National Heart Foundation (NHF) Australia.

Melatonin Ameliorates BPA Induced Oxidative Stress in Human Red Blood Cells: An In vitro Study

BACKGROUND

Bisphenol A (BPA) is a xenobiotic that causes oxidative stress in various organs in living organisms. Blood cells are also an endpoint where BPA is known to cause oxidative stress. Blood cells, especially red blood cells (RBCs), are crucial for maintaining homeostasis and overall wellbeing of the organism. They are highly susceptible to oxidative stress induced by xenobiotics. However, there is limited data about the oxidative stress induced by BPA in blood, especially in red blood cells. This study was carried out to evaluate BPA induced oxidative stress in human RBCs in vitro and its amelioration by melatonin.

OBJECTIVE

To find if melatonin exerts a protective effect on the oxidative stress induced by the BPA in human red blood cells in vitro.

METHODS

The erythrocyte suspensions (2 ml) were divided into six groups and treated with 0, 50, 100, 150, 200, and 250 μg/ml of BPA. Another set of erythrocyte suspension with similar BPA treatment and 50 μM Melatonin per group was also set. Incubations lasted for 12 hrs in the dark. Lipid peroxidation, glutathione, glutathione reductase, catalase, and superoxide dismutase were measured as indicators of oxidative stress.

RESULTS

BPA caused a significant increase in lipid peroxidation. A decrease in GSH levels was also observed. The activities of all the studied antioxidants also decreased with BPA treatment. Melatonin was seen to mitigate the oxidative stress induced by BPA.

CONCLUSION

Treatment of red blood cells with BPA caused an increase in oxidative stress, while melatonin decreased the induced oxidative stress.

251Revacept, an inhibitor of platelet adhesion in symptomatic carotid stenosis: Results from a phase II study

Acknowledgement/Funding

None

Pemphigoid variants affecting the skin

Pemphigoid diseases are autoimmune subepidermal blistering diseases affecting the skin and mucous membranes, which are caused by autoantibodies targeting structural hemidesmosomal proteins or hemidesmosome-associated proteins. Variants of pemphigoid can be differentiated based on targeted antigens and clinical aspects. In this review, we will discuss pemphigoid variants that predominantly affect the skin, and provide clinicians with clues to diagnosis.

Evaluation of Immunization Coverage in the Rural Area of Peshawar, Khyber Pakhtunkhwa

BACKGROUND

In children, the leading cause of morbidity and mortality is infectious disease. Immunization is one of the most cost-effective methods for child survival. The purpose of the survey is to assess access and coverage of immunizations in the rural areas of the District Peshawar, Khyber Pakhtunkhwa.

METHODS

A cross‑sectional study was conducted in a rural population area of District Peshawar from February 2016 to April 2016 using the WHO's 30 cluster sampling method for evaluation of immunization coverage.

RESULTS

A total of 390 children aged 12-23 months were included in the study. It was found that 67.94% of the children were fully immunized against vaccine-preventable diseases. Thirty percent of the children were partially immunized; the percentage of unimmunized children was 2.06%. Immunization cards were issued to and available with 58.8% of the subjects. The most common cause of partial immunization was a lack of information regarding vaccinations (27%). Immunization against measles was found to be low (67%). Those using private facilities were more likely to be completely immunized as compared to government facilities.

CONCLUSIONS

Immunization coverage in our survey was 68%. Sustained efforts are required to achieve universal coverage of immunization. Significant interventions are required, especially in areas that are more rural and less educated.

Bisphenol A-Induced Endocrine Toxicity and Male Reprotoxicopathy are Modulated by the Dietary Iron Deficiency

INTRODUCTION

Bisphenol A (BPA) is suspected to cause hormonal imbalance in humans. Dietary factors are known to bring changes in hormonal profile. In order to study chemico-biological interaction of iron deficiency on toxicity outcome of BPA exposure, we studied the modulatory effects of iron deficiency on the hormone levels in rats chronically-exposed to BPA.

METHODS

Weanling rats maintained on normal and iron-deficient diets were exposed to low level of BPA at 0, 1, 5 and 10 ppm for six months through drinking water. The serum levels of thyroidstimulating hormone (TSH), testosterone, progesterone and estradiol were measured in the animals by enzyme-linked immunosorbent assay kit. Histopathology was performed to check the pathological changes in gonads.

RESULTS

No significant change was observed in TSH, progesterone and estradiol levels at 1 and 5 ppm BPA. However, at 10 ppm BPA a significant increase in TSH level was observed in the animals maintained on an iron-deficient diet of either sex. BPA caused a significant change in testosterone level even at 5 and 10 ppm doses in animals of either sex. However, in male rats 1 ppm dose also showed a significant effect in the animals maintained on iron deficient diet. Changes in the histoarchitecture of the testes at high dose of BPA (10 ppm) were more remarkable in anemic rats.

CONCLUSION

These results suggest that iron deficiency has no generalized effect on hormonal levels in BPA-treated animals and trends indicate a more remarkable effect in male animals at hormonal and tissue levels.

Ankle Arthrodesis using Ilizarov Ring Fixator: A Primary or Salvage Procedure? An Analysis of Twenty Cases

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients.

Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle.

Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Post-procedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months.

Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.

Strategies to improve hand hygiene compliance among healthcare workers in adult intensive care units: a mini systematic review

BACKGROUND

Hand hygiene compliance among healthcare workers (HCWs) in intensive care units (ICUs) is disconcertingly low.

AIM

To identify the effective intervention(s) for increasing HH compliance among HCWs in adult ICUs.

METHODS

Two major electronic databases, OVID Medline and CINAHL, were searched by using a combination of MeSH terms and text words (e.g. hand hygiene, hand washing, compliance, adher*, improve*, develop* and intensive care unit) for relevant articles. This was supplemented by Google Scholar and hand searching of included bibliographies. Data from identified articles were then abstracted, quality-assessed, and combined into a summary effect.

FINDINGS

Of 89 titles and abstracts that were identified, 14 articles were finally included. Overall study quality was good. However, variations in design, setting, sample size, and intervention(s) tested precluded a meta-analysis; hence a narrative synthesis was conducted. The interventions included education, observation, provision of supplies, improving access and directive support; tested singly or in combination; resulted in positive outcomes in all but one study. A combination of administrative support, 'supplies', education and training, reminders, surveillance, and performance feedback raised the compliance from a baseline of 51.5% to a record 80.1%; but no set of intervention(s) could improve the compliance to the desired near-100% level.

CONCLUSION

Available data suggest that multi-modal interventions are effective in raising the compliance to a 'plateau' level but not up to the desired standard. Methodologically appropriate trials of combined interventions could enhance the evidence about interventions to improve hand hygiene compliance among ICU staff.

Temperature changes alter the acute toxicity responses of cypermethrin in Zebrafish

The study was carried out to determine the effect of temperature changes on acute toxicity of pyrethroid pesticide cypermethrin in zebrafish. A two-day renewal bioassay system for 96h was conducted to find out LC50 value of cypermethrin at two temperature regimes i.e. 25°C and 30°C considering as T1 and T2, respectively. During the determination of LC50 in both temperatures, blood glucose (mg/dL) levels were measured at lower concentration (0.25 µg/L) of cypermethrin. The results of acute toxicity test at 96h LC50 values were calculated through probit analysis. It was found that 96h LC50 for T1 and T2 groups were about 2.1 and 1.4 µg/L, respectively. Significantly lower LC50 of cypermethrin at T2 compared to T1 showed that higher temperature increased the toxicity of cypermethrin. There was a significant increase (P<0.05) in blood glucose level (mg/dL) in 0.25 µg/L compared to 0 µg/L concentration of cypermethrin at both treatments. Dissolved oxygen decreased and free CO2 increased significantly (P<0.05) with increasing temperature, while the pH of the water was almost unchanged throughout the study period. The present study indicated the impact of increased temperature on pesticide toxicity in the aquatic ecosystem.Progressive Agriculture 29 (1): 64-70, 2018 

Can Bangladesh produce enough cereals to meet future demand?

Bangladesh faces huge challenges in achieving food security due to its high population, diet changes, and limited room for expanding cropland and cropping intensity. The objective of this study is to assess the degree to which Bangladesh can be self-sufficient in terms of domestic maize, rice and wheat production by the years 2030 and 2050 by closing the existing gap (Yg) between yield potential (Yp) and actual farm yield (Ya), accounting for possible changes in cropland area. Yield potential and yield gaps were calculated for the three crops using well-validated crop models and site-specific weather, management and soil data, and upscaled to the whole country. We assessed potential grain production in the years 2030 and 2050 for six land use change scenarios (general decrease in arable land; declining ground water tables in the north; cropping of fallow areas in the south; effect of sea level rise; increased cropping intensity; and larger share of cash crops) and three levels of Yg closure (1: no yield increase; 2: Yg closure at a level equivalent to 50% (50% Yg closure); 3: Yg closure to a level of 85% of Yp (irrigated crops) and 80% of water-limited yield potential or Yw (rainfed crops) (full Yg closure)). In addition, changes in demand with low and high population growth rates, and substitution of rice by maize in future diets were also examined. Total aggregated demand of the three cereals (in milled rice equivalents) in 2030 and 2050, based on the UN median population variant, is projected to be 21 and 24% higher than in 2010. Current Yg represent 50% (irrigated rice), 48-63% (rainfed rice), 49% (irrigated wheat), 40% (rainfed wheat), 46% (irrigated maize), and 44% (rainfed maize) of their Yp or Yw. With 50% Yg closure and for various land use changes, self-sufficiency ratio will be > 1 for rice in 2030 and about one in 2050 but well below one for maize and wheat in both 2030 and 2050. With full Yg closure, self-sufficiency ratios will be well above one for rice and all three cereals jointly but below one for maize and wheat for all scenarios, except for the scenario with drastic decrease in boro rice area to allow for area expansion for cash crops. Full Yg closure of all cereals is needed to compensate for area decreases and demand increases, and then even some maize and large amounts of wheat imports will be required to satisfy demand in future. The results of this analysis have important implications for Bangladesh and other countries with high population growth rate, shrinking arable land due to rapid urbanization, and highly vulnerable to climate change.

Measure Of Frequency Of Alveolar Osteitis Using Two Different Methods Of Osteotomy In Mandibular Third Molar Impactions: A Double-Blind Randomized Clinical Trial

BACKGROUND

Dento-alveolar surgical procedures involving third molar teeth are the most common surgical procedure in the field of surgery. The objective of this research was to analyse the impact of surgery on the incidence of alveolar osteitis after surgical removal of mandibular third molar and to compare two different bone cutting methods following impacted mandibular third molar surgery..

METHODS

This double blinded randomized clinical trial was executed at the OPD of Department of Oral and Maxillofacial Surgery, Dow University of Health Sciences, Karachi. The study duration was four months. It was conducted on 60 patients needing unilateral mandibular third molar impaction removal. Patients were randomized to two groups (i.e., physio dispenser group and slow speed handpiece group) before surgery. The surgical procedure was performed under local anaesthesia by using standardized cross infection protocol. The frequency of alveolar osteitis was evaluated on thirdday postoperatively. Alveolar osteitis was diagnosed and confirmed by patient's history and clinical evaluation. Post-operative sequelae were observed and recorded objectively.

RESULTS

Out of 60 patients', five patients experienced alveolar osteitis, and the incidence rate was 8.3%. A significant pvalue of 0.000 was calculated using binomial test for comparison of alveolar osteitis among both groups. Inter-examiner reliability was assessed by kappa and good (62%) agreement, which was found among the examiners, who diagnosed alveolar osteitis clinically. Post-operative sequelae were insignificant in slow speed hand piece group.

CONCLUSIONS

It was observed that alveolar osteitis was reported in physio-dispenser group; similarly, post-operative complications were also more in this group as compared with slow speed-hand piece group. No surgical complications were observed in slow speed-hand piece group suggesting slow speed hand piece mode of osteotomy to be safer for third molar extraction as compared with physio-dispenser.