Search

Background: The long-term efficacy and safety of bioresorbable vascular scaffolds (BVS) in real world clinical practice including Magmaris need to be elucidated to better understand performance of this new and evolutive technology. The aim of this study was to evaluate long-term performance of Magmaris, drug-eluting bioresorbable metallic scaffold, in all-comers patients’ population. Methods: We included in this prospective registry first 54 patients (54 ± 11 years; male 46) treated with Magmaris, with at least 30 months of follow-up. Diabetes mellitus and acute coronary syndrome were present in 33 (61%) and 30 (56%) of the patients, respectively. Patients were followed for device- and patient-oriented cardiac events during a median follow-up of 47 months (DOCE–cardiac death, target vessel myocardial infarction, and target lesion revascularization; POCE–all cause death, any myocardial infarction, any revascularization). Results: Event-free survivals for DOCE and POCE were 86.8% and 79.2%, respectively. The rate of DOCE was 7/54 (13%), including in total target vessel myocardial infarction in two patients (4%), target lesion revascularization in six patients (11%), and no cardiac deaths. The rate of POCE was 11/54 (21%), including in total any myocardial infarctions in 3 patients (6%), any revascularization in 11 patients (20%), and no deaths. Definite Magmaris thrombosis occurred in two patients (3.7%), and in-scaffold restenosis developed in five patients (9.3%). Variables associated with DOCE were implantation of ≥2 Magmaris BVS (HR: 5.4; 95%CI: 1.21–24.456; p = 0.027) and total length of Magmaris BVS ≥ 40 mm (HR: 6.4; 95%CI: 1.419–28.855; p = 0.016), whereas previous PCI was the only independent predictor of POCE (HR: 7.4; 95%CI: 2.216–24.613; p = 0.001). Conclusions: The results of the long-term clinical outcome following Magmaris implantation in patients with complex clinical and angiographic features were acceptable and promising. Patients with multi-BVS and longer multi-BVS in lesion implantation were associated with worse clinical outcome.

The Constitutional Court, by Decision No. 110/Law-X/2012, repealed Articles 96, 100, and 101 of Law No. 11 of 2012 on the Child Criminal Justice System, which establishes penalties for judges, prosecutors, and investigators who do not seek discrimination against children who face the law. These provisions have no more binding legal force for judges, police, and prosecutors who do not perform their duties. The study focuses on the implementation of diversity and the impact of child protection before and after the Constitutional Court rulings. The interview data is obtained from the Banda Aceh State Court, supported by library data, and analyzed using a juridico-empirical approach. Based on the analysis of the data, it was found that the execution of diversion in the Banda Aceh State Court before the birth of the decision of the Constitutional Court Number 110/PUU-X/2012 was in accordance with the regulations of the laws in force and was accompanied by the threat of criminal offenses. After the birth of the judgment of the Constitutional Court, the execution of differences is an obligation that must be carried out by the judge but is not accompanied by the threat of a criminal offense for a judge who does not perform it. The impact of the ruling of the Constitutional Court is that there is no criminal threat to the judge, JPU, and investigator because the Constitutional Court ruling has declared Articles 96, 100, and 101 to have no binding legal force. Nevertheless, the duty of diversification remains a duty that must be enforced by law enforcement.

With the increasing availability and clinical use of exome and whole-genome sequencing, reverse phenotyping is now becoming common practice in clinical genetics. Here, we report a patient identified through the Wellcome Trust Deciphering Developmental Disorders study who has homozygous pathogenic variants in CC2D2A and a de-novo heterozygous pathogenic variant in KIDINS220. He presents with developmental delay, intellectual disability, and oculomotor apraxia. Reverse phenotyping has demonstrated that he likely has a composite phenotype with contributions from both variants. The patient is much more mildly affected than those with Joubert Syndrome or Spastic paraplegia, intellectual disability, nystagmus, and obesity, the conditions associated with CC2D2A and KIDINS220 respectively, and therefore, contributes to the phenotypic variability associated with the two conditions.

Myopericarditis is a rare but well-documented clinical presentation of primary Toxoplasma gondii infection in immunocompetent patients. Here, early detection of Toxoplasma DNA in the peripheral blood by PCR allowed the diagnosis of acute toxoplasmosis while serological tests were negative. Additional serological evaluations 2 weeks later confirmed the diagnosis and showed that cardiac manifestations occurred before seroconversion. This highlights the importance of a second serological control in the case of a suspected active infection. Overall, we show here that PCR testing for Toxoplasma is a sensitive and straightforward alternative to serological examinations. Keywords: Acute toxoplasmosis, Myopericarditis, Immunocompetent, Toxoplasma gondii, PCR, Second serological control, Molecular diagnosis

Objectives To evaluate long-term clinical outcomes of the Absorb bioresorbable vascular scaffold (BVS) system (Abbott Vascular) in an all-comers Middle East population. Methods This prospective registry study included an initial set of patients with coronary lesions treated using Absorb BVS. Patients were followed for target vessel failure (TVF) including cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization. Results A total of 217 patients (age, 55 ± 11 years; male, 169) with 300 treated lesions were included (median follow-up, 36 months [range, 26–41 months]; complete follow-up, 201 patients). Diabetes mellitus and acute coronary syndrome were present in 50% and 57% of patients, respectively. TVF rate was 32/201 (15.9%), including cardiac death in 10 (5%), target vessel MI in 13 (6.5%), and target lesion revascularization in 22 patients (10.9%). Definite or probable device thrombosis occurred in 11/201 patients (5.5%). TVF was associated with heart failure, worse ejection fraction, multi-vessel BVS, multi BVS in lesion, and total BVS length >50 mm. Conclusions Long-term outcome following Absorb BVS implantation in a population with high prevalence of high-risk and complex patients is acceptable, but heart failure, worse ejection fraction, and multi-vessel or long BVS implantation were associated with worse outcomes.

BACKGROUND & OBJECTIVE: The purpose of the study was to understand the dependency on smokeless tobacco. METHODS: The major aspect of the interview was to study the type of chewing tobacco used, frequency of purchase of chewing tobacco, change in attitude and behavior after the use of chewing tobacco. This study was done in 2005 in London. Of the 110 respondents interviewed 88 were used for the data analysis. STUDY DESIGN: An exploratory study was conducted in East London, United Kingdom. The selected sample was interviewed through a questionnaire, based on the Severson Smokeless Tobacco Dependence Scale. RESULTS: Cross tabulations report that in a sample of 88 South Asian UK resident men 46.6% used leaf (paan), 43.2% used processed form of chewing tobacco and 10.2% used gutka. Older age (67%) respondents were more likely than the younger age (30%) respondents to chew tobacco. The frequency of purchase of chewing tobacco is reported high (67.2%) in the older age group than the younger age group (50%). CONCLUSION: This current study used an amended form of the Severson Smokeless Tobacco Scale questionnaire to study the dependency on smokeless tobacco. The study could be developed in the selection of the sample, which would include both males and females to study the dependency on smokeless tobacco.

Introduction This study was performed to evaluate the clinical efficacy of using the Perio-Flow device (Electro Medical Systems, Nyon, Switzerland) adjunctively with mechanical instrumentation on periodontal parameters and halitosis. Materials and Methods Sixty patients who presented with a 4- to 6-mm probing pocket depth were recruited for the study. Patients were randomly assigned to scaling and root planing (SRP) or SRP + glycine powder air-polishing (GPAP). For both groups, the plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level scores were recorded at baseline and 1 month. Volatile sulphur compounds (VSCs) were measured by a Halimeter (Interscan Corp., Chatsworth, CA, USA) at baseline, immediately after treatment, and at 7, 14, and 30 days. Results Both groups showed significantly lower plaque index, gingival index, pocket depth, bleeding on probing, and clinical attachment level gain scores at 1 month than at baseline. No significant differences were found between the groups at any time point. The VSCs were significantly different at 1 month compared with baseline in both groups. However, the intergroup comparisons of VSCs were not statistically significant at any time point. Conclusion Within the limits of this study, SRP is effective for treatment of periodontitis and halitosis. However, using GPAP adjunctively with mechanical instrumentation has no beneficial effects on halitosis or periodontal parameters.

To determine whether an Elders Risk Assessment (ERA) index can predict incident hip fractures without the need for physician-patient encounter or bone mineral density testing.A retrospective cohort study was conducted in a community-based cohort of 12,650 patients aged 60 years and older. An ERA score was computed for each subject at index time (January 1, 2005). Incidents of hip fracture from January 1, 2005, through December 31, 2006, were obtained from electronic medical records. We divided the cohort into 5 groups, with the lowest ERA scores forming group A (15%); 15% to 49%, group B; 50% to 74%, group C; 75% to 89%, group D; and the top 11%, group E. With group A as a reference group, we used logistic regression to compute odds ratios of sustaining hip fracture during a 2-year period (January 1, 2005, through December 31, 2006) for groups B, C, D, and E. Sensitivity and specificity of each possible ERA score were calculated, and a receiver operating characteristic curve was created.Two hundred sixty-five patients (2.1%) sustained at least 1 hip fracture from January 1, 2005, through December 31, 2006. Odds ratios (95% confidence intervals) for groups B, C, D, and E were 1.6 (0.7-3.4), 4.5 (2.2-9.4), 6.9 (3.3-14.3), and 18.4 (8.9-37.9), respectively. The area under the receiver operating characteristic curve was 74.5%.An electronic medical record-based, easily derived ERA index might be useful in hip fracture risk stratification.

© 2009 Mayo Foundation for Medical Education and Research An 83-year-old woman with Alzheimer dementia presented to the emergency department with abdominal distention. Her husband provided the history. After having constipation for 1 week, she developed a progressively distended abdomen in the course of 2 days, with anorexia but no vomiting, melena, or hematochezia. She had no history of fever, rigors, dyspnea, or weight loss. Her medical history was remarkable for hypertension, coronary artery disease, and impaired fasting blood glucose levels. Despite the recent symptoms, she had no history of gastroenterologic symptoms, cancer, abdominal surgeries, or colon screening studies. She lived with her husband in the community and was dependent on him for her activities of daily living except for ambulation with a walker and feeding herself. She was a nonsmoker and nondrinker. Her medications were 60 mg/d of isosorbide mononitrate, 325 mg/d of aspirin, 2.5 mg/d of amlodipine, 20 mg/d of atorvastatin, and a combination of 37.5 mg/d of triamterene and 25 mg/d of hydrochlorothiazide. On examination, the patient appeared to be in mild distress with abdominal distention. Her vital signs were as follows: temperature, 36.6oC; blood pressure, 154/89 mm Hg; regular pulse, 84 beats/min; respiration rate, 20 breaths/ min; and oxygen saturation, 94% while breathing room air. Abdominal examination revealed marked distention with diminished bowel sounds and moderate discomfort with deep palpation of the left lower quadrant, but no peritoneal irritation signs, Murphy sign, McBurney point tenderness, abdominal bruit, ascites, hepatosplenomegaly, or palpable mass. Rectal examination revealed no stool in the vault and no obvious mass. The patient had normal levels of hemoglobin, white blood cells, platelets, chloride, bicarbonate, creatinine, blood urea nitrogen, troponin, and lipase, as well as a prothrombin time within the normal range. She had a serum sodium of 126 mEq/L (reference ranges provided parenthetically) (135-145 mEq/L), a potassium level of 2.5 mmol/L (3.6-4.8 mmol/L), and a blood glucose level of 198 mg/ dL (70-100 mg/dL). Urinalysis was positive for trace occult blood and 1+ protein. Abdominal plain radiography showed prominent gaseous dilatation of the transverse colon and redundant sigmoid colon without distinct signs of obstruction or free air.

Toxoplasmosis acquired during pregnancy exposes the fetus to congenital toxoplasmosis. Avidity tests are commonly used to date time of infection to evaluate the fetal risk and to offer prenatal diagnosis. This study evaluated and compared 2 commercial avidity tests: Platelia™ Toxo IgG Avidity (Bio-Rad, Marnes la Coquette, France) and Liaison® Toxo IgG Avidity II (Diasorin, Saluggia, Italy) kits. In complement, a study of specific IgG and IgM in the 2 systems was carried out. Sensitivity and specificity of the avidity tests were 94.4% and 87.8% for the Liaison® and 91.3% and 98.5% for the Platelia™ methods, respectively. Percentages of complete discrepancies, partial discrepancies, and agreement between both tests were 1.1%, 23.6%, and 75.3%, respectively. Moreover, the combination of both avidity tests may be useful in some cases. Indeed, that strategy permitted to confirm without delay a chronic toxoplasmosis in 23 cases and avoid treatment in these pregnant women.