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Henderickx M, Hendriks N, Baard J, Bouma-Houwert C, Kamphuis G. Which stone-treatment approach is the most urologist-friendly? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Figaroa O, Bins A, Baard J. DNA mismatch repair testing in upper tract urothelial carcinoma patients - Is Universal Lynch Syndrome screening necessary? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Henderickx M, Stoots S, De Bruin D, Wijkstra H, Freund J, Ploumidis A, Skolarikos A, Somani B, Şener T, Emiliani E, Dragos L, Wiseman O, Villa L, Talso M, Daudon M, Traxer O, Doizi S, Kronenberg P, Tailly T, Tefik T, Beerlage H, Baard J, Kamphuis G. Endoscopic stone recognition: Is the diagnostic accuracy rock-solid or rock-bottom? EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Henderickx M, Stoots S, De Bruin D, Wijkstra H, Freund J, Ploumidis A, Skolarikos A, Somani B, Şener T, Emiliani E, Dragos L, Wiseman O, Villa L, Talso M, Daudon M, Traxer O, Doizi S, Kronenberg P, Tailly T, Tefik T, Beerlage H, Baard J, Kamphuis G. Video quality as perceived by the endourologist does not influence endoscopic stone recognition. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Henderickx M, Zabegalina N, Brits T, Baard J, Ballout M, Beerlage H, De Wachter S, Kamphuis G. Does operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy? Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Viljoen CA, Sliwa K, Azibani F, Johnson MR, Baard J, Osman A, Briton O, Ntsekhe M, Anthony J, Chin A. P2533Prospective randomized study on implanted cardiac rhythm recorders in pregnant women with symptomatic arrhythmia and/or structural heart disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac arrhythmia is an important cause of maternal morbidity and mortality in pregnancy, but is difficult to diagnose.
Purpose
The aim of this single-centre, prospective, randomized pilot study was to compare the implantable loop recorder (ILR) with standard assessment of arrhythmia (12-lead ECG; 24-hour Holter ECG) in terms of acceptability, detection of arrhythmias and impact on outcome in pregnant women with symptomatic arrhythmias and/or structural heart disease (SHD).
Methods
The study recruited 40 consecutive patients from a weekly, dedicated cardiac obstetric clinic. Inclusion criteria: symptoms of arrhythmia and/or having SHD at risk of arrhythmia. Patients were randomized to either standard care (SC) or standard care plus ILR (SC-ILR). ILR recordings were read at the monthly visits and/or when presenting with symptoms.
Results
There were no demographic differences between the study groups. Seventeen patients consented to ILR insertion, all of whom found the procedure acceptable. No arrhythmias were recorded by the 12-lead ECGs. Holter monitoring detected arrhythmias in 10 of 23 patients (43%) from the SC group. In the SC-ILR group, 8 of 17 patients (47%) had arrhythmias detected by Holter, whereas 13 of 17 patients (76%) patients had arrhythmias detected by ILR (p=0.157). One of 4 patients with supraventricular tachycardia, 2 of 3 patients with premature ventricular complexes and 2 patients with paroxysmal atrial fibrillation (AF) recorded by ILR did not have the arrhythmias detected by Holter monitoring (Figure 1A shows a scatter plot of the variable R-R intervals seen in AF and 1B a rhythm strip of AF with irregular RR intervals and the absence of P waves, both downloaded from the ILR). Four of these 5 patients (80%) had a change in management as a direct result of their ILR recordings. There were no maternal deaths up to 42 days postpartum in either of the study groups. Nine babies were born with a low birthweight (<2500g), 5 stillbirth/neonatal deaths and 1 pregnancy termination occurred (5 in the Holter group and 1 in ILR group, p=0.37).
Figure 1
Conclusion(s)
This study suggests that an ILR is an acceptable diagnostic modality in pregnant women with a suspected or at risk of arrhythmia. The ILR increased the diagnostic yield to detect arrhythmias that were not detected by routine ECG and Holter monitoring which led to a change in management in the SC-ILR group and was associated with better maternal and neonatal outcomes. The impact of ILR monitoring should be further assessed in larger studies with longer follow up.
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Affiliation(s)
- C A Viljoen
- University of Cape Town, Division of Cardiology, Cape Town, South Africa
| | - K Sliwa
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - F Azibani
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - M R Johnson
- Imperial College London, London, United Kingdom
| | - J Baard
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - A Osman
- University of Cape Town, Division of Obstetrics and Gynaecology, Cape Town, South Africa
| | - O Briton
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - M Ntsekhe
- University of Cape Town, Division of Cardiology, Cape Town, South Africa
| | - J Anthony
- University of Cape Town, Division of Obstetrics and Gynaecology, Cape Town, South Africa
| | - A Chin
- University of Cape Town, Division of Cardiology, Cape Town, South Africa
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Freund JE, Liem EIML, Savci-Heijink CD, Baard J, Kamphuis GM, de la Rosette JJMCH, de Bruin DM. Confocal laser endomicroscopy for upper tract urothelial carcinoma: validation of the proposed criteria and proposal of a scoring system for real-time tumor grading. World J Urol 2019; 37:2155-2164. [PMID: 30684035 PMCID: PMC6763512 DOI: 10.1007/s00345-019-02646-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/16/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Confocal laser endomicroscopy (CLE) is a fluorescence-based fiber-optic imaging technique with the potential for intraoperative grading of upper tract urothelial carcinoma (UTUC). This study aims to (1) investigate the prevalence of the previously proposed CLE criteria for bladder cancer in papillary UTUC, (2) estimate the diagnostic value of CLE for UTUC grading and (3) propose a scoring system for a more quantifiable approach of CLE-based grading of UTUC. Materials and methods Ureteroscopic CLE was performed in patients with UTUC. Following CLE imaging, co-localized biopsies were taken for histopathologic comparison. Postoperatively, two blinded raters assessed the CLE images. Results Fifty-three papillary UTUCs (34 low grade and 19 high grade) were imaged with CLE in 36 patients. All the previously described CLE criteria were identifiable in varying proportions. After excluding 10 non-diagnostic recordings (5 low grade and 5 high grade) due to insufficient image quality, the histopathologic grade was correctly identified with CLE in 26 low-grade UTUCs (90%) and in 12 high-grade UTUCs (86%). The most prevalent CLE criteria with the highest diagnostic potential were cellular organization, morphology and cohesiveness of cells. A scoring system was proposed with these criteria, which yielded similar diagnostic accuracies. Conclusions Based on the previously proposed criteria, CLE enables accurate grading of papillary UTUC at a non-diagnostic rate of 19%. The most prevalent CLE criteria with the highest diagnostic potential for grading of papillary UTUC are cellular organization, morphology and cohesiveness of cells. The proposed scoring system may simplify the assessment of CLE images for UTUC grading but external validation is required.
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Affiliation(s)
- J E Freund
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - E I M L Liem
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C D Savci-Heijink
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - G M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J M C H de la Rosette
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey.,Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - D M de Bruin
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Hoevelmann J, Viljoen C, Manning K, Baard J, Bauersachs J, Sliwa K. PO308 A Prolonged Corrected QT Interval Predicts Poor Outcome in Peripartum Cardiomyopathy. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Hoevelmann J, Viljoen CA, Manning K, Baard J, Hahnle L, Ntsekhe M, Bauersachs J, Sliwa K. The prognostic significance of the 12-lead ECG in peripartum cardiomyopathy. Int J Cardiol 2018; 276:177-184. [PMID: 30497895 DOI: 10.1016/j.ijcard.2018.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure, which appears in previously healthy women towards the end of pregnancy or within five months following delivery. Although the ECG is widely used in clinical practice, its prognostic value has not been established in PPCM. METHODS We analysed 12-lead ECGs of patients with PPCM, taken at index presentation and follow-up visits at 6 and 12 months. Poor outcome was determined by the composite endpoint of death, readmission, NYHA functional class III/IV or left ventricular ejection fraction (LVEF) of ≤35% at follow-up. RESULTS This cohort of 66 patients had a median age of 28.59 (IQR 25.43-32.19). The median LVEF at presentation (33%, IQR 25-40) improved significantly at follow-up (LVEF 49%, IQR 38-55, P < 0.001 at 6 months; 52% IQR 38-57, P = 0.001 at 12 months). Poor outcome occurred in 27.91% at 6 months and 41.18% at 1 year. Whereas sinus tachycardia at baseline was an independent predictor of poor outcome at 12 months (OR 6.56, 95% CI 1.17-20.41, P = 0.030), sinus arrhythmia was associated with event free survival (log rank P = 0.013). T wave inversion was associated with an LVEF ≤35% at presentation (P = 0.038), but did not predict poor outcome. A prolonged QTc interval at presentation (found in almost half of the cohort) was an independent predictor of poor outcome at 6 months (OR 6.34, 95% CI 1.06-37.80, P = 0.043). CONCLUSION(S) A prolonged QTc and sinus tachycardia at baseline were independent predictors of poor outcome in PPCM at 6 months and 1 year respectively.
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Affiliation(s)
- J Hoevelmann
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa; Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - C A Viljoen
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa; University of Cape Town, Division of Cardiology, Cape Town, South Africa
| | - K Manning
- University of Cape Town, Department of Medicine, Cape Town, South Africa
| | - J Baard
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - L Hahnle
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa; University of Cape Town, Division of Cardiology, Cape Town, South Africa
| | - M Ntsekhe
- University of Cape Town, Division of Cardiology, Cape Town, South Africa
| | - J Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - K Sliwa
- University of Cape Town, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa.
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Azibani F, Libhaber E, Baard J, Osman A, Zuhlke L, Lachmann A, Chin A, Ntsekhe M, Soma-Pillay P, Johnson MR, Roos-Hesselink J, Anthony J, Sliwa K. P1563Reducing late maternal death due to cardiovascular disease by targeted interventions. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Azibani
- University of Cape Town, Medicine, Cape Town, South Africa
| | - E Libhaber
- University of the Witwatersrand, Soweto Cardiovascular Research Unit, Johannesburg, South Africa
| | - J Baard
- University of Cape Town, Medicine, Cape Town, South Africa
| | - A Osman
- University of Cape Town, Obstetrics & Gynaecology, Cape Town, South Africa
| | - L Zuhlke
- University of Cape Town, Department of Paediatrics, Cape Town, South Africa
| | - A Lachmann
- University of Cape Town, Obstetrics & Gynaecology, Cape Town, South Africa
| | - A Chin
- University of Cape Town, Cardiology, Cape Town, South Africa
| | - M Ntsekhe
- University of Cape Town, Cardiology, Cape Town, South Africa
| | - P Soma-Pillay
- University of Pretoria, 6 Department of Obstetrics and Gynecology, Maternal and Foetal Medicine, Pretoria, South Africa
| | - M R Johnson
- Imperial College London, London, United Kingdom
| | - J Roos-Hesselink
- Erasmus Medical Center, Department of Cardiology, Rotterdam, Netherlands
| | - J Anthony
- University of Cape Town, Obstetrics & Gynaecology, Cape Town, South Africa
| | - K Sliwa
- University of Cape Town, Medicine, Cape Town, South Africa
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Kariv S, Azibani F, Baard J, Osman A, Soma-Pillay P, Anthony J, Sliwa K. Haemorrhage and other complications in pregnant women on anticoagulation for mechanical heart valves: a prospective observational cohort study. Cardiovasc J Afr 2018; 29:289-295. [PMID: 30059130 DOI: 10.5830/cvja-2018-029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/22/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To document maternal and foetal morbidity and mortality in anticoagulated, pregnant patients with mechanical heart valves until 42 days postpartum. METHODS In a tertiary single-centre, prospective cohort, 178 consecutive patients at the cardiac-obstetric clinic were screened for warfarin use between 1 July 2010 and 31 December 2015. Of 33 pregnancies identified, 29 were included. Patients received intravenous unfractionated heparin from six to 12 weeks' gestation and peripartum, and warfarin from 12 to 36 weeks. Maternal outcomes including death, major haemorrhage and thrombosis, and foetal outcomes were documented. RESULTS There were two maternal deaths, five returns to theatre post-delivery, eight patients transfused, six major haemorrhages, one case of infective endocarditis and three ischaemic strokes. Ten pregnancies had poor foetal outcomes (six miscarriages, three terminations, one early neonatal death). Twenty patients required more than 30 days' hospitalisation, and 15 required three or more admissions. HIV positivity was associated with surgical delivery (p = 0.0017). CONCLUSION Complication rates were high despite centralised care.
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Affiliation(s)
- S Kariv
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
| | - F Azibani
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town; Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences and IDM, University of Cape Town, Cape Town, South Africa
| | - J Baard
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town; Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences and IDM, University of Cape Town, Cape Town, South Africa
| | - A Osman
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - P Soma-Pillay
- Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - J Anthony
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - K Sliwa
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town; Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences and IDM, University of Cape Town, Cape Town, South Africa
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Baard J, Osman A, Dowling W, Azibani F, Anthony J, Sliwa K. P1498The effect of beta-blockers on fetal birth weight in pregnancies complicated with structural heart disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J. Baard
- Hatter Institute of Cardiovascular Research in Africa, Medicine, Cape Town, South Africa
| | - A. Osman
- University of Cape Town, Department of Obstetrics and Gynaecology, Cape Town, South Africa
| | - W. Dowling
- Hatter Institute of Cardiovascular Research in Africa, Medicine, Cape Town, South Africa
| | - F. Azibani
- Hatter Institute of Cardiovascular Research in Africa, Medicine, Cape Town, South Africa
| | - J. Anthony
- University of Cape Town, Department of Obstetrics and Gynaecology, Cape Town, South Africa
| | - K. Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Medicine, Cape Town, South Africa
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Abstract
The last confirmed case of poliomyelitis in Namibia had been reported in 1988. However, between Nov 8, 1993, and Jan 7, 1994, 27 cases of paralytic poliomyelitis were confirmed in the country. The outbreak was limited to the south health region; at least 80% of infants in this region have received four doses of oral poliovaccine (OPV) by the age of 1 year. Acute flaccid paralysis (AFP) was the predominant clinical presentation during the outbreak. The patients' ages ranged from 13 months to 12 years; 24 were younger than 5 years. Of the 26 patients whose vaccine status was known, 14 had received four doses of OPV, 6 had one or two doses, and 6 no vaccine. Genotypic analysis showed 86% homology of outbreak isolates with a 1982 Namibian isolate and west African isolates. Factors that may have had a role in the outbreak include establishment of a pool of susceptible people, rapid urbanisation, inadequate sanitation, poor water supply, and possible endemicity of poliovirus in neighbouring areas. Epidemics can occur in areas of high vaccine coverage. Our findings emphasise the need to improve AFP surveillance activities and the estimation of vaccine coverage to identify areas of potential susceptibility for outbreaks.
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