It's a long way to the top! Congenital venous anomalies and left isomerism limiting atrial fibrillation transcatheter ablation

BACKGROUND

Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Catheter ablation is increasingly used to improve symptoms and prognosis in selected patients. Lower limb venous access with subsequent transseptal approach to the left atrium is the standard procedure for atrial fibrillation catheter ablation.

CASE PRESENTATION

We report an unusual case of complex venous anomaly with a left-sided inferior vena cava with hemiazygos continuation to a persistent left superior vena cava draining in an enlarged coronary sinus in a patient with persistent atrial fibrillation scheduled for transcatheter ablation.

DISCUSSION

Lower limb venous anomalies may limit a standard transseptal approach to the left atrium thus precluding an effective catheter ablation procedure for atrial fibrillation. Alternative interventions, such as unconventional percutaneous access, thoracoscopic approach and "ablate and pace" procedures, may be necessary in patients with symptomatic atrial fibrillation and complex venous anomalies.

Edoxaban for the treatment of pulmonary embolism in hospitalized COVID-19 patients

PURPOSE

We aimed to investigate the clinical performance of edoxaban for the treatment of pulmonary embolism (PE) in hospitalized COVID-19 patients.

METHODS

We conducted a retrospective analysis selecting hospitalized patients with COVID-19 admitted to our Institution from 20 May 2020 to 20 November 2020 with computer tomography (CT) detected PE at admission, treated with edoxaban after initial parenteral therapy. Clinical outcomes were compared between patients with and without ARDS at admission and between those with and without CT confirmed PE resolution.

RESULTS

50 patients were included. Mean follow-up was 42.5 ± 10 days. No baseline differences were found between patients with ARDS (30%) and those without ARDS at admission. Patients with PE resolution (84%) were younger (P = 0.03), had a shorter duration of fondaparinux therapy (9.9 ± 3.8 vs 15.8 ± 7.5 days; P = 0.0015) and length of hospitalization (36 ± 8 vs 46 ± 9 days: P = 0.0023) compared with those without PE resolution. 2 patients experienced major bleedings. At multivariate analysis the time to edoxaban switch was the only predictor of the PE resolution (HR: 0.92; 95% C.I. 0.86 to 0.99).

CONCLUSION

Edoxaban was an effective and safe treatment for acute PE in COVID-19 setting.

Antibacterial properties of grapefruit seed extract against Paenibacillus larvae subsp. larvae

Twenty-one samples of grapefruit seed extract (GSE) either from marketed products or provided by an apiculturist were analysed to verify their inhibition activity, in particular against Paenibacillus larvae subsp. larvae, responsible for American foulbrood. The bactericide capacity of GSE has been measured in Bacillus subtilis BGA, Bacillus cereus 11778, Bacillus cereus K250 and Micrococcus luteus 9341a; these bacteria are normally used in the laboratory to study inhibitors. The results showed that not all GSE have the same inhibitory activity and two of those analysed do not inhibit the five bacteria used. Considering that 19 samples inhibited American foulbrood bacillus, the authors conclude that the use of a natural product (such as GSE) to control this important disease of bees, can be used as a substitute for chemotherapeutic products, after appropriate expedients.

Determination of rotenone in honey by high performance liquid chromatography and ultraviolet detection

A method to determine residues of the insecticide rotenone in honey using high-performance liquid chromatography (HPLC) is described. The sample was extracted with an acetone/water mixture, followed by a liquid/liquid partition with diethyl ether. A solid-phase extraction (SPE) clean-up step on alumina neutral cartridge was then performed. The chromatographic analysis was conducted on a C18 column (250 x 4 mm, 5 microm) using acetonitrile-water (65:35, v/v) as mobile phase. Rotenone was detected in the ultraviolet range at a wavelength of 295 nm. The specificity of the method was demonstrated through analyses of raw and commercial honey samples. The limit of detection was equal to 40 microg kg(-1). The precision and accuracy of the method were evaluated trueness honey samples spiked at three concentration levels (100-250-500 microg kg(-1)). The intra-laboratory coefficient of variation (from 9.2 to 10.6%) and mean recovery values (from 81.4 to 86.6%) were satisfactory. The calibration curve was linear in the range 0.125-2 microg ml(-1), with a determination coefficient R2 of 0.9999. Rotenone levels in honey samples from bees treated with this miticide were in the range 120-430 microg kg(-1).