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The complexation reaction of cephalosporins namely cefotaxime (CTX), cefuroxime (CRX), and cefazolin (CEFAZ) with palladium (II) ions have been studied in water and DMF in 25 °C by the spectrophotometric methods. The method is based on the formation of yellow to yellowish brown complex between palladium (II) chloride and the investigated cephalosporins in the presence of sodium lauryl sulfate (SLS) as surfactant. The complexation process was optimized in terms of pH, temperature and contact time. The stoichiometry of all the complexes was found to be 2:1 (metal ion/ligand) for CTX, CRX, and 1:2 for CEFAZ. The stoichiometry of palladium (II)–cephalosporins was estimated by mole ratio and continuous variation methods and emphasized by the KINFIT program. These drugs could be determined by measuring the absorbance of each complex at its specific λ max . The results obtained are in good agreement with those obtained using the official methods. The proposed method was successfully applied for the determination of these compounds in their dosage forms.

Background An adverse event (AE) is defined as an unintended injury or complication caused by healthcare management rather than the disease process that may prolong admission and lead to disability or death. This study retrospectively assessed all reported general surgery-related AEs in a district general hospital in the south-east of England. Methods All general surgical AEs arising from adult inpatient admissions between 2002 and 2007, that had been reported to the risk management team, following completion of the standard ‘Adverse Incident Report Form', were retrospectively reviewed. Results There were 24,185 general surgical admissions over the period of the study; 461 AEs were reported (1.9% mean annual incident rate; 95% CI, 1.3%–2.5%). The majority (85%) were near miss or no injury events (category I and II) while serious/serious near-miss incidents accounted for just 2% of events. Communicative or administrative problems were implicated in 54% of cases while 12% arose from theatre/surgery-related failure. Of 58 medico-legal claims (0.24% of admissions) that were made, 16 (27.5%) progressed to the law courts for formal settlement. Conclusion The reported annual AE incident rate of approximately 2% is well below the national average: this may be due to pre-selection of general surgery-related AEs or represent under-reporting of incidents. The vast majority of AEs were related to administrative and communicative error. These areas must be addressed if patient safety and outcome is to be significantly improved.

Introduction Adjunct anti-thrombotic therapies (ATT) such as Glycoprotein 2b3a inhibitors (GPI) and bivalirudin are shown to improve clinical outcome in primary percutaneous coronary intervention (PPCI). However, most of the studies related to this were done prior to high dose loading of clopidogrel (600 mg) and without the routine use of thrombectomy device. We aimed to compare the outcome between patients who had thrombectomy and parenteral ATT with those who had thrombectomy with no ATT during PPCI in our unit. Methods We included all patients undergoing PPCI in our unit from September 2009 to November 2011. All patients during the study period were loaded with Aspirin 300 mg and Clopidogrel 600 mg prior to angiography. Unfractionated Heparin (UFH) is used routinely for all PPCI in our unit immediately after angiography, irrespective of whether GPI or bivalirudin is used as ATT. This is in response to the HORIZONS AMI study analysis, which showed use of UFH reduced the risk of stent thrombosis in both arms of the study. Operators used ATT at their own discretion. We defined non-CABG bleeding as anyone requiring at least one unit of red cell transfusion. Results Of the 1471 patients who underwent PPCI during the study period, we excluded 408 (27.7%) patients who did not have thrombus aspiration (TA) during their procedure. The remaining patients (n=1063) were divided into two groups according to whether they had ATT or not (ATT grp: TA+UFH+ATT and UFH grp: TA+UFH). In the ATT group 397 (48.6%), 395 (48.4%) and 25 (3.4%) patients had abciximab, bivalirudin and combination therapy of both respectively. There were more elderly patients and women in the UFH group when compared to ATT group, but all other baseline and procedural characteristics were similar in both groups (table 1). In-hospital mortality, 30-day mortality, non-CABG major bleeding and stent thrombosis rates were similar in both groups (UFH vs ATT) (table 2). On logistic regression analysis of all 1063 patients, there was no effect of ATT on 30-day mortality (OR 0.8, 95% CI 0.4 to 1.6, p 0.5). The positive predictors of 30-day mortality were age >75 years (OR 4.8, 95% CI 2.6 to 8.8, p Conclusions This single centre study shows no significant mortality difference in patients receiving ATT when compared to UFH alone, despite the fact that patients receiving UFH alone were of higher risk. This suggests that the operators9 decision to avoid ATT was justified in some patients who had TA. Bleeding risk between the groups was also similar, but this could be related to the definition used in our study. Further studies are needed to clarify the benefit of ATT in PPCI at the present time, with the routine use of more potent or high dose anti-platelet agents and TA.

Introduction Tako-tsubo cardiomyopathy (TCM) is increasingly being recognised in patients admitted with suspected acute coronary syndrome, as access to angiography and echocardiography are much quicker than before. Typically, patients with TCM present to the primary PCI service (PPCI) with chest pain and ST elevation on their electrocardiogram mimicking ST elevation myocardial infarction (STEMI). However, there is no ‘real-world’ data about the prevalence of this condition in PPCI admissions for suspected STEMI. Therefore we aimed to analyse the prevalence of TCM in a high volume regional PPCI service in UK. Methods All patients admitted with suspected STEMI between Sept 2009 and Nov 2011 to our centre were included. After excluding those who underwent PPCI, We analysed the echocardiogram and/or left ventriculogram of those patients who did not undergo PPCI to identify patients with typical TCM features of apical akinesia with basal hyperkinesia. Their coronary angiograms were reviewed and the inclusion criteria to identify TCM was the absence of significant coronary disease with no artery having >50% stenosis. Results Of the 1875 patients admitted, 17 (0.9%) patients (0 m, 17 f) with the mean age of 70±10.7 years (range 56–94 years) were identified to have typical TCM features. The prevalence of TCM in female PPCI admission was 3.1% (17/560) (figure 1). The admission ECG showed ST elevation in 14 patients (82%) and three had LBBB (18%). In those who had positive hsTroponin (n=16, 94.1%), the mean level was 921±668 (median 778, range 110–2550). Two patients had cardiac arrest prior to hospital admission with successful resuscitation. Left ventricular function was severely impaired (EF≤30%) in 2 patients whilst all others had moderately impaired LV function (EF 31–50%) (table 1). Aspirin, β-blocker, Angiotensin converter enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) was given to 13 (76.5%), 13 (76.5%) and 15 (88.2%) patients respectively on their discharge. All the 15 patients who had repeat echocardiogram within 3 months of their index admission showed complete recovery of their LV function. During a mean follow up period of 22±7 months (median 21, range 8–36 months), there was no mortality. Conclusions This first ‘real-world’ observational study of TCM in STEMI patients admitted for PPCI to a single centre showed an overall prevalence of 0.9% with 3% prevalence in female population. Although TCM is not benign during the acute episode, there is an excellent survival outcome if managed appropriately during the acute phase.