Worldwide Survey of COVID-19-Associated Arrhythmias

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Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic.

Percutaneous VDD leadless pacer implant post recent bioprosthetic tricuspid valve replacement for infective endocarditis

In January 2020, the first Medtronic VDD leadless pacemaker Micra AV was approved by FDA to treat patients with advanced AV block, based on the encouraging results from the Micra Atrial tRacking using a Ventricular accELerometer 2 (MARVEL 2). There is reassuring data about safety and short-term outcomes of traditional leadless pacemaker implant after recent surgical tricuspid valve replacement, but only few cases are reported in literature. No data was found regarding AV Micra implant safety and outcomes in patients following bioprosthetic tricuspid valve replacement as of today. Our patient is a 44-year-old gentleman with history of IV drug use who recently underwent tricuspid replacement with bioprosthesis for infective endocarditis complicated by postsurgical heart block, acute kidney insufficiency requiring hemodialysis, persistent bacteremia and candidemia, and progressive failure of the epicardial pacing wires. Given the elevated infective risk, the decision of attempting leadless pacer implant through the bioprosthetic valve was taken and our patient underwent successful Micra AV implant on postoperative day 30. To our knowledge, this is the first AV Micra placement following bioprosthetic tricuspid valve replacement. The uneventful procedure and the encouraging short-term device follow-up results seem to confirm the relative safety of this device in treating advanced atrioventricular conduction disorders in patients at elevated infective risk.

Managing arrhythmias in the intensive care unit

Patients admitted to the intensive care unit (ICU) are at increased risk for cardiac arrhythmias, the most common of which can be subdivided into tachyarrhythmias and bradyarrhythmias. These arrhythmias may be the primary reason for ICU admission or may occur in the critically ill patient. This article addresses the occurrence of arrhythmias in the critically ill patient, and discusses their pathophysiology, implications, recognition, and management.

Integration of nanowire devices in out-of-plane geometry

We report the fabrication of arrays of single and multiple out-of-plane nanowire devices on a single substrate, an important step for the fabrication of novel three-dimensional devices and the integration of individually addressable nanowires onto current Si planar technology platforms. Vertical nanowire device fabrication can greatly increase device densities; however integrating such devices into arrays with registry to the substrate requires precise control over the number and position of the nanowires. Here we report the directed assembly of gold nanoparticle seeds into patterned arrays for the growth of nanowires using chemical recognition and electrophoretic methods. Chemical recognition provides highly reproducible control of the position and number of nanoparticles per pattern element and is shown to be in good agreement with a simple electrostatic model. Individually addressed out-of-plane, vapor-liquid-solid grown Ge nanowires with single and multiple nanowires per element are fabricated and electrically characterized.

SEM characterization of silicon nanostructures: can we meet the challenge?

The current semiconductor technology road map for device scaling champions a 4.5 nm gate length in production by 2022. The scanning electron microscope (SEM) as applied to critical dimensions (CD) metrology and associated characterization modes such as electron beam-induced current and cathodoluminescence (CL) has proved to be a workhorse for the semiconductor industry during the microelectronics era. We review some of the challenges facing these techniques in light of the silicon nanotechnology road map. We present some new results using voltage contrast imaging and CL spectroscopy of top-down fabricated silicon nanopillar/nanowires (<100 nm diameter), which highlight the visualization challenge. However, both techniques offer the promise of providing process characterization on the 10-20 nm scale with existing technology. Visualization at the 1 nm scale with these techniques may have to wait for aberration-corrected SEM to become more widely available. Basic secondary electron imaging and CD applications may be separately addressed by the He-ion microscope.

Types of urethral catheters for management of short-term voiding problems in hospitalised adults

BACKGROUND

Urinary tract infection is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialised urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and the cost.

OBJECTIVES

The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterisation.

SEARCH STRATEGY

We searched the specialised trials registers of the Cochrane Incontinence Group (November 2003) and the Cochrane Renal Group (February 2003). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials.

SELECTION CRITERIA

All randomised and quasi randomised trials comparing types of indwelling urinary catheters for short-term catheterisation in hospitalised adults. Short-term catheterisation was defined as up to and including fourteen days, or other temporary short-term use as defined by the trialists.

DATA COLLECTION AND ANALYSIS

Data were extracted by one reviewer and independently verified by a second reviewer. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. Where data in trials were not fully reported, clarification was sought directly from the trialists (secondary sources were used to confirm results of one trial).

MAIN RESULTS

Eighteen trials met the inclusion criteria involving 4237 hospitalised adults in 17 parallel group trials and 27,878 adults in one large cluster-randomised cross-over trial. Only three of the possible six comparisons were addressed in these trials: antiseptic impregnated catheters versus standard catheters (n=11 trials), antibiotic impregnated catheters versus standard catheters (n=1 trial) and comparison of different standard catheters (n=6 trials). The results of the antiseptic versus standard catheter trials differed according to the antiseptic used to impregnate the catheter. The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterised hospitalised adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68 to 1.15). Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.36, 95% CI 0.24 to 0.52) in hospitalised adults catheterised for less than one week. At greater than one week catheterisation the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.67, 95% CI 0.50 to 0.90). The risk of symptomatic urinary tract infection was also found to be reduced with the use of silver alloy catheters (RR 0.60, 95% CI 0.50 to 0.73). The randomised cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3 per cent and 35.5 per cent. One small trial investigated men post radical prostatectomy catheterised with antibiotic impregnated catheter versus standard catheters and found a lower rate of asymptomatic bacteriuria in the antibiotic group at less than one week of catheterisation (RR 0.36, 95% CI 0.18 to 0.73). The trial at less than one week found that the risk of bacteriuria was also less in the antibiotic impregnated catheter group (RR 0.36, 95% CI 0.18 to 0.73); however, at greater than one week the result was not significant (RR 0.94, 95% CI 0.86 to 1.03). One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 9h 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03 to 1.63). Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection but the results were not pooled because of the clinical and statistical heterogeneity between trials. Individual findings of the trials did not show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. Another three trials compared different types of standard catheters to investigate for adverse urethral effects in catheterised men. Once again the trials were not pooled due to significant heterogeneity; however, the results of the individual trials indicate a trend toward silicone catheters being less likely to result in adverse urethral effects in men.

REVIEWER'S CONCLUSIONS

The results suggest that the use of silver alloy indwelling catheters for catheterising hospitalised adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters.Catheters coated with a combination of minocycline and rifampin may also be beneficial in reducing bacteriuria in hospitalised men catheterised less than one week but this requires further testing. There was not enough evidence to suggest whether or not any standard catheter was better than another in terms of reducing the risk of urinary tract infection in hospitalised adults catheterised short-term. Siliconised catheters may be less likely to cause urethral side effects in men: however, this result should be interpreted with some caution as the trials were small and the outcome definitions and specific catheters compared varied.

Comparison of catheter-securing devices

Care of urethral urinary catheters is a major part of urologic nursing. Basic procedures, such as securing of urinary catheters, are poorly researched or reported in the literature. The question of how to secure a urinary catheter and with what device often relies on knowledge, availability of equipment, and on information supplied by manufacturers of commercial devices. Manufacturers claim that their devices are easier to apply, have longer "wear-times," add to patient comfort, prevent infection, and are thus more cost effective than the traditional adhesive tape and pin device. However, it was discovered in this study that sometimes the cheaper, more easily accessible option can still be the best for patients.

Improved patient outcomes at a urology nurse clinic

A urology nurse clinic was developed to improve cost and quality of care outcomes for patients with benign prostatic hypertrophy amid cost constraints and the need for improved service delivery. Cost and quality of care outcomes were achieved through earlier discharge and improved assessment, education, and discharge planning for patients. The professional development of urology nurses also improved through increased practice of advanced assessment skills and broadened scope of practice.

Voluntary and electromyostimulation forces in trained and untrained men

Electromyostimulation (EMS) evoked responses of lower extremity muscles of sedentary or disabled subjects have been extensively studied to improve muscular strength and delay atrophy. However, it is not apparent whether EMS can serve a similar function in upper extremity muscles and in athletes. We compared the forces of maximal voluntary isometric contraction (MVC), percutaneous EMS-evoked tetanus, and EMS superimposed on MVC of the elbow flexors in six strength-trained and six untrained healthy men. Stimulation consisted of a 2.5-kHz alternating current sine wave modulated at 50 bursts.s-1 with a 50% duty cycle. Reliability of the criterion measures was assessed over 4 d and ranged from R = 0.746 to R = 0.948. Strength-trained men had 29% higher MVC than untrained controls (P less than 0.001). Untrained men tolerated 21.9 mA and trained men 31.3 mA of EMS current (P less than 0.021), yet tetanic forces were similar: 92.5 N vs 96.0 N (P greater than 0.196). These tetanic forces corresponded to 32% (untrained) and 24% (trained) of MVC (P less than 0.047). When EMS was superimposed on MVC, compared with MVC alone, force was significantly (P less than 0.048) lower by 10% (31 N, untrained) and 13% (55 N, trained). These data suggest that, independent of training status, percutaneous EMS reduces maximal voluntary elbow flexion forces and that tetanic forces may not be sufficiently high for purposes of muscular strength development or prevention of atrophy.

Liposomal amphotericin B for treatment of pulmonary aspergillosis in a heart transplant patient

Pulmonary aspergillosis developed in a 52-year-old man 2 months after heart transplantation for ischemic cardiomyopathy. Conventional amphotericin B therapy caused marked deterioration of his already compromised kidney function after only 10% of the projected total dose. Conversion to liposomal encapsulated amphotericin B was associated with reversal of the kidney dysfunction and clearing of the pulmonary infiltrate. It is now 16 months since completion of therapy, and there is no evidence of recurrent infection.

In vivo and in vitro effects of beta-carotene and algae extracts in murine tumor models

Phycotene, an algae extract with known antineoplastic activity, was demonstrated to prolong, but not sustain, an increased survival rate in a murine fibrosarcoma model when it was combined with immunotherapy. It was further shown that splenocytes from phycotene and beta-carotene-treated survivors could not confer protection to a fresh tumor cell challenge in virgin mice after adoptive transfer. In a series of cytotoxicity assays, phycotene combined with immunization was demonstrated to enhance cell-mediated and complement-dependent cytotoxicity in the first 14-21 days. However, after 21 days, the phycotene and immunization groups exhibited a decreased ability to mediate immune cytotoxicity compared with immunization-only controls. This may serve to explain the in vivo findings that while survival was increased early on in active immunization and phycotene-treated mice, it eventually dropped to the level of the active immunization controls.

Power spectral analysis of the EEG following protein malnutrition

In these studies, power spectral analysis techniques were utilized to quantify the EEG obtained from rats reared on either an 8% or 25% casein diet during various vigilance states at two stages of development: (1) adulthood-90 to 120 days old; and (2) immediately after weaning-22 to 23 days old. It was found that the cortical EEG contained relatively more power in the low frequencies (ie., 0.5 to 10 Hz) for the 22-23 day old animals than for the 90-120 day old rats, especially during the slow wave sleep states-SWS1 and SWS2. Theta activity (5-8 Hz) in the hippocampus was shown to have greater power for the 22-23 day old group than for the older animals during both REM sleep and waking. Analyses of power spectral data and other indices of the frequency distribution of the hippocampal EEG indicated that those animals subjected to protein malnutrition have significantly more power in the theta band during REM sleep than the normal adult group. Since it was also noted that the hippocampal EEG obtained from the 22-23 day old group contained relatively more power in the theta band than the 90-120 day old group, the dietary treatment effect might be intrepreted as an instance of retarded development associated with protein malnutrition. Thus, a significant effect of the dietary manipulation used in the study may be largely on the system responsible for regulating theta activity.

Effects of maternal dietary protein restriction on growth of the brain and body in the rat

We studied the growth of the brain and body in rats born of dams fed a low-protein (8% casein) diet ad lib beginning 5 weeks prior to mating and continuing throughout gestation and lactation. Control dams were fed an isocaloric 25% casein diet. Litters were culled at birth to 8 pups. At birth, brain weights and body weights of pups of protein restricted dams were similar to those of control pups. During the period of lactation, pups of restricted exhibited severely retarded body growth but only mildly retarded brain growth resulting in an elevated brain/body weight ratio. This relative macrocephaly was maximal at 10-20 days of age, declining completely by 35 days of age. The relative macrocephaly could not be accounted for by increased retention of water in the brain of the malnourished rats. Following weaning, pups were maintained ad lib on the diets fed their mothers. At adulthood brain/body weight ratios were normal in the protein restricted group.