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Background The effect of early hypertension on midlife cardiovascular (CV) mortality remains controversial. We assessed the association of established hypertension in late adolescence with subsequent CV mortality. Methods Of 2,298,130 Israeli adolescents (60 % males; age 17.4 ± 0.3 years) who underwent a compulsory medical examination prior to military service between 1967 and 2010, 8720 teenagers (0.4 %) were formally diagnosed with persistent hypertension. Using Cox proportional hazards modeling, we compared the hypertensive group to the large normotensive group with regard to time to event analysis of midlife mortality due to cerebrovascular accidents (CVA), coronary heart disease (CHD), sudden death (SD) and their summation as cardiovascular disease (CVD). Results During 45,729,521 person-years of follow-up, we identified 2918 CV deaths-2879 and 39 among the 2,289,410 normotensive and 8720 hypertensive adolescents, respectively. Hypertension at a young age was associated with a threefold elevation of stroke mortality compared to normotension when adjusted for sex, age at examination, birth year, country of origin, socioeconomic status, education, body mass index (BMI) and height [hazard ratio (HR) 3.12; 95 % confidence interval (CI) 1.76-5.54; p < 0.001]. There was no significant association of hypertension with CHD mortality or SD. An increased risk for overall CVD mortality among hypertensive youngsters (HR 1.51; 95 % CI 1.10-2.07) was attenuated after adjusting for BMI and other covariates (HR 1.24; 95 % CI 0.90-1.72). Conclusions Established hypertension at a young age was independently associated with elevated stroke mortality in midlife. This finding warrants confirmatory large-scale long-term follow-up studies to address the distant effects of adolescent hypertension., Author(s): Adi Leiba[sup.1] [sup.2] [sup.3] , Gilad Twig[sup.1] [sup.2] [sup.4] , Hagai Levine[sup.5] , Nehama Goldberger[sup.6] , Arnon Afek[sup.1] [sup.6] , Ari Shamiss[sup.1] , Estela Derazne[sup.2] , Dorit Tzur[sup.2] , [...]

Yaariv Khaykin1,2, Yana Shamiss11Heart Rhythm Program, Southlake Regional Health Center, Newmarket, Ontario, Canada; 2Faculty of Medicine, University of Toronto, Ontario, CanadaAbstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is associated with significant morbidity and mortality. At the societal level, AF carries an enormous cost. Strategies aimed at reducing AF morbidity and mortality and containing the associated fiscal burden are of paramount importance. This review will discuss AF treatment strategies and economics, focusing on the impact of dronedarone, a novel antiarrhythmic agent.Keywords: antiarrhythmic, rhythm control, heart failure, ablation, costs

The presence of pan-resistant bacteria worldwide possesses a threat to global health. It is difficult to evaluate the extent of carriage of resistant bacteria in the population. Sewage sampling is a possible way to monitor populations. We evaluated the presence of pan-resistant bacteria in Israeli sewage collected from all over Israel, by modifying the pour plate method for heterotrophic plate count technique using commercial selective agar plates. This method enables convenient and fast sewage sampling and detection. We found that sewage in Israel contains multiple pan-resistant bacteria including carbapenemase resistant Enterobacteriacae carrying blaKPC and blaNDM-1, MRSA and VRE. blaKPC carrying Klebsiella pneumonia and Enterobacter cloacae were the most common Enterobacteriacae drug resistant bacteria found in the sewage locations we sampled. Klebsiella pneumonia, Enterobacter spp., Escherichia coli and Citrobacter spp. were the 4 main CRE isolated from Israeli sewage and also from clinical samples in our clinical microbiology laboratory. Hospitals and Community sewage had similar percentage of positive samplings for blaKPC and blaNDM-1. VRE was found to be more abundant in sewage in Israel than MRSA but there were more locations positive for MRSA and VRE bacteria in Hospital sewage than in the Community. Therefore, our upgrade of the pour plate method for heterotrophic plate count technique using commercial selective agar plates can be a useful tool for routine screening and monitoring of the population for pan-resistant bacteria using sewage.

AIMS:The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. METHODS AND RESULTS:Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p

The association between white blood cell (WBC) count and coronary artery disease (CAD) is unknown in young adults. Our objective was to assess the association between WBC count and its changes over time with CAD incidence in the Metabolic, Life-style and Nutrition Assessment in Young adults (MELANY) study, a cohort of Israeli army personnel.29,120 apparently healthy young men (mean age; 31.2±5.5 years) with a normal baseline WBC count (3,000-12,000 cells/mm(3)) were followed during a mean follow up of 7.5±3.8 years for incidence of CAD. Participants were screened every 3-5 years using a stress test, and CAD was confirmed by coronary angiography. In a multivariate model adjusted for age, body mass index (BMI), LDL- and HDL-cholesterol, blood pressure, family history of CAD, physical activity, diabetes, triglycerides and smoking status, WBC levels (divided to quintiles) above 6,900 cells/mm(3) (quintile 4) were associated with a 2.17-fold increase (95%CI = 1.18-3.97) in the risk for CAD as compared with men in quintile 1 (WBC≤5,400 cells/mm(3)). When modeled as a continuous variable, a WBC increment of 1000 cells/mm(3) was associated with a 17.4% increase in CAD risk (HR 1.174; 95%CI = 1.067-1.290, p = 0.001). A decrease in the WBC level (within the normal range) during the follow-up period was associated with increased physical activity and decreased triglyceride levels as well as with reduced incidence of CAD.WBC count is an independent risk factor for CAD in young adults at values well within the normal range. WBC count may assist in detecting subgroups of young men at either low or high risk for progression to CAD.

Atrial fibrillation (AF) is a common and frequently disabling chronic condition associated with significant patient morbidity and affecting an increasing stratum of our ageing society. Direct costs related to atrial fibrillation are comprised from direct cost of medical therapy, catheter ablation, and related hospitalizations and imaging procedures, with indirect costs related to complications of the primary therapeutic strategy, management of related conditions, as well as disability and loss in quality of life related to AF. Over the last decade, catheter ablation became a promising alternative to rate and rhythm control among symptomatic AF patients. The purpose of this paper is to describe the evidence on the financial implications related to ablation based on published data and authors' experience.