Miracle-dz/UniFAR-FTUs huggingface dataset:
Low incidence of permanent complications during catheter ablation for atrial fibrillation using open-irrigated catheters: a multicentre registry.

AIMS Despite catheter ablation (CA) has become an accepted treatment option for symptomatic, drug-resistant atrial fibrillation (AF), the safety of this procedure continues to be cause for concern. The aim of the present study was to assess the incidence of complications with permanent sequelae of CA for AF using open-irrigated catheters in a contemporary, unselected population of consecutive patients. METHODS AND RESULTS From 1 January 2011 to 31 December 2011, data from 2167 consecutive patients who underwent CA for AF using an open-irrigated catheter in 29 Italian centres were collected. All the complications occurring to the patient from admission to the 30th post-procedural day were recorded. No procedure-related death was observed. Complications occurred in 81 patients (3.7%): 46 patients (2.1%) suffered vascular access complications; 13 patients (0.6%) cardiac tamponade, successfully drained in all the cases; six patients (0.3%) arterial thromboembolism (four transient ischaemic attack and two ischaemic strokes); five (0.2%) patients conservatively treated pericardial effusion; three patients (0.1%) phrenic nerve paralysis; three patients (0.1%) pericarditis; three patients (0.1%) haemothorax, and two patients (0.1%) other isolated adverse events. At multivariate analysis, only female sex [odds ratio (OR) 2.5, confidence interval (CI): 1.5-3.7, P < 001] and the operator experience (OR 0.5, CI: 0.4-0.7, P < 001) related to the complications. Only five (0.2%) patients developed permanent sequelae from their complications. CONCLUSION Catheter ablation for AF with the use of open-irrigated catheters is currently affected by a very low rate of complications leading to permanent sequelae.
Burden of Clostridium difficile infection in the United States.

for the CHIPS Study Group Since publication of their article, the authors report no further potential conflict of interest. 1. Lewis G, ed. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer — 2003-2005: the seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: The Confidential Enquiry into Maternal and Child Health (CEMACH), December 2007 (http://www.hqip.org.uk/ assets/NCAPOP-Library/CMACE-Reports/18.-December-2007 -Saving-Mothers-Lives-reviewing-maternal-deaths-to-make -motherhood-safer-2003-2005-Executive-Summary.pdf).
Condutas em neurologia infantil

Nesta edicao, as coordenadoras, Professora Maria Va-leria Leme de Moura-Ribeiro e Dra. Lisiane Seguti Fer-reira, revisaram e atualizaram o livro que traz uma am-pla abordagem dos assuntos mais relevantes em Neuro-logia Infantil de acordo com a visao pratica e atualizada de diversos autores.Este livro expoe, de maneira didatica, temas que vao desde o periodo neonatal e ao longo da primeira deca-da ate a adolescencia, incluindo aspectos emergenciais e tambem de carater predominantemente ambulatorial, assim oferecendo ao leitor uma revisao relativamente ra-pida, porem profunda, dos diferentes topicos relativos a Neurologia Infantil.A leitura e agradavel, e os avancos bem como a atua-lizacao dos temas essenciais aqueles que atendem crian-cas com disturbios neurologicos sao de facil compreen-sao, o que reflete a enorme experiencia das coordenado-ras e autores. E um livro de excelente conteudo e, em nossa opiniao, a sua leitura e fundamental para neurologistas e pediatras.
Efficacy of catheter ablation of atrial fibrillation in patients with obstructive sleep apnoea with and without continuous positive airway pressure treatment: a meta-analysis of observational studies.

AIMS An association between obstructive sleep apnoea (OSA) and atrial fibrillation (AF) has been established. However, studies on the role of OSA in AF recurrence after catheter ablation have yielded conflicting results, and the effect of OSA treatment by continuous positive airway pressure (CPAP) on the success rate of AF catheter ablation is indeterminate. The aim of this meta-analysis was to investigate the rate of AF recurrence after catheter ablation in patients with AF with or without OSA and to evaluate the relationship between CPAP therapy and AF recurrence. METHODS AND RESULTS We performed an online search and identified five studies involving 3743 patients with AF. Patients with OSA had a 31% greater risk of AF recurrence after catheter ablation than did patients without OSA [relative ratio (RR) = 1.31, P = 0.00], and this risk increased by 57% in patients with OSA not undergoing CPAP therapy (RR = 1.57, P = 0.00). However, CPAP users had a risk of AF recurrence similar to that of patients without OSA (RR = 1.25, P = 0.37), and this similarity was maintained even after the removal of study heterogeneity (RR = 0.99, P = 0.39). CONCLUSION Obstructive sleep apnoea was associated with AF recurrence after catheter ablation. The efficacy of catheter ablation for AF was similar between patients without OSA and patients with OSA undergoing CPAP treatment.
Pulmonary vein isolation using a circular, open irrigated mapping and ablation catheter (nMARQ): a report on feasibility and efficacy.

AIMS Pulmonary vein isolation (PVI) is the mainstay of interventional treatment of paroxysmal atrial fibrillation (PAF). We report on the feasibility and efficacy of a novel, open-irrigated mapping and radiofrequency (RF) ablation catheter. METHODS AND RESULTS Thirty-nine consecutive patients (pts; age 60 ± 10 years, 8 females) suffering from drug-refractory PAF referred for PVI were included in this prospective study. Pulmonary vein isolation was performed with the use of a novel 10-pole circular, open-irrigated mapping and ablation catheter (nMARQ, Biosense Webster). Outcome parameters were the acute success rate in establishing complete PVI and the rate of sustained sinus rhythm (SR) during follow-up (FU). Ten patients underwent a repeat procedure for recurrent AF. Ninety-eight percent of the PVs could be acutely isolated using solely the nMARQ catheter by applying a mean total of 10.0 ± 4.6 min of RF energy. The mean total procedure duration was 86 ± 29 min, and the mean fluoroscopy time was 22.2 ± 6.5 min, respectively. Transient reconnection provoked by adenosine was observed in 10 of 24 patients, most frequently in the right superior PV. Cardiac tamponade related to transseptal puncture occurred in one patient. Reconnected PVs could be identified as a source of recurrent AF in 9 of 10 patients undergoing a repeat procedure. Single and multiple procedure success rates during a mean FU of 140 ± 75 days were 66 and 77%, respectively. CONCLUSION Irrigated multi-electrode RF ablation is fast and effective, providing a high rate of isolated PVs without the need of touch-up lesions. Success rates were comparable with other techniques with a low complication rate. Recurrences of AF were mainly due to recovered pulmonary vein/left atrium conduction.
Risk factors for stillbirths at universty of Maiduguri teaching hospital, Maiduguri, Nigeria: A cross-sectional retrospective analysis

Background:Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. Data on birth outcomes are important for planning maternal and child health care services in developing countries. There is little or no literature on the stillbirth rate in north-eastern Nigeria. This may be the first study to serve as the baseline data in Maiduguri. Objective: This study aimed at determining the prevalence and identifying the risk factors contributing to foetal demise. Study design: A cross-sectional retrospective analysis of stillbirth among women delivering in UMTH over a-4 year period, from January 2001 to December 2004. Method: The Case records of 7996 women that delivered in UMTH over the study period were retrieved and the trend of the stillbirth experiences followed up retrospectively, and relevant information with special reference to socio-demographic characteristics, clinical risk factors for stillbirth and type of stillbirth obtained and analyzed. Results: There was a total of 179 stillbirths among the 7996 deliveries giving the institutional prevalence of 22/1000 deliveries. Macerated stillbirths with no obvious congenital malformation predominated (OR: 10.89; CI: 6.51-31.80), accounting for 52.5%, while fresh stillbirths (OR: 5.81; CI: 3.77– 11.87), accounted for 47.5%. Most of the risk factors (63.7%) for stillbirths were present ante partum such as multiparity (OR: 2.88; CI: 1.47-6.09), lack of antenatal care (OR: 1.91; CI: 0.92- 2.05), maternal literacy level (OR: 2.82; CI: 1.44-5.41), hypertension, pre-eclampsia and eclampsia disease complex (c2=15.12; P-value =0.006); while intra partum risk factors contributed 36.3% with SVD as a mode of delivery, the leading risk factor (c2= 23.79; & P-value 0.000). Conclusion: The prevalence of stillbirth is high and is predominantly associated with ante partum risk factors. In our setting, antenatal care should be considered as the cornerstone in the prevention of stillbirth. With adequate antenatal care and good understanding of the determinants of stillbirth, women with clinical risk factors to stillbirth could be identified and measures to avoid or substantially decrease the occurrence of stillbirth instituted. Key words: stillbirth, prevalence, aetiologic determinants
Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naïve atrial fibrillation patients: Danish nationwide descriptive data 2011-2013.

AIMS Non-vitamin K antagonist oral anticoagulation (NOAC) agents have been approved for stroke prophylaxis in atrial fibrillation (AF). We investigated 'real-world' information on how these drugs are being adopted. METHODS AND RESULTS Using Danish nationwide administrative registers, we identified all oral anticoagulation-naïve AF patients initiating oral anticoagulation from 22 August 2011 through 31 October 2013. Using logistic regression analysis, baseline characteristics and temporal utilization trends were compared between initiators of warfarin vs. one of the N OACs: dabigatran, rivaroxaban, or apixaban. We identified 18 611 oral anticoagulation-naïve AF patients of which 9902 (53%) initiated warfarin treatment, 7128 (38%) dabigatran, 1303 (7%) rivaroxaban, and 278 (1%) apixaban. Overall, 40% of newly initiated patients were started on dabigatran within the first 4 months of when the drug came on market. By October, 2013, 40% were being started on warfarin and dabigatran, respectively, and another 20% were started on either rivaroxaban or apixaban. Rivaroxaban and apixaban users generally had a higher predicted risk of stroke and bleeding compared with warfarin and dabigatran users. Older age, female gender, and prior stroke were some of the factors associated with NOAC use vs. warfarin, whereas chronic kidney disease, myocardial infarction, and heart failure showed the opposite association. CONCLUSION Among oral anticoagulation-naïve AF patients initiated on oral anticoagulation in Denmark, warfarin initiation has declined since the introduction of dabigatran in August 2011. Dabigatran is the most frequently used alternative option to warfarin; however, use of rivaroxaban and apixaban is increasing. Patients initiated with rivaroxaban or apixaban in general have a higher predicted stroke and bleeding risks compared with warfarin or dabigatran initiators.
Aspectos clínicos, morfológicos e imuno-histoquímicos da pitiose gastrintestinal canina

Four suspect and two confirmed cases of gastrointestinal pythiosis were found in a retrospective study of biopsy and necropsy cases of dogs received in the Laboratorio de Patologia Veterinaria at the Universidade Federal de Santa Maria. The two diagnosed and published cases have had the etiology confirmed by culture and zoosporogenesis induction or by nested-PCR. On this study, the etiologic diagnosis of four suspect cases was confirmed by immunohistochemistry using anti-Pythium insidiosum policlonal antibody. Epidemiology, clinical signs, gross and microscopic lesions, histochemistry, immunohistochemistry, and differential diagnoses are reported and discussed.
Syncope recurrence and mortality: a systematic review.

AIMS Data on adverse events and death rates following syncope are heterogeneous among studies, and knowledge of syncope prognosis could help to better define the correct management of patients. METHODS AND RESULTS We performed a systematic review of literature by searching for prospective observational studies enrolling consecutive patients presenting to the Emergency Department because of syncope. The outcomes considered were syncope recurrence and short- and long-term mortality. Morbidity and a composite of morbidity and mortality were also assessed. Pooled event rates and 95% confidence intervals (CI) were calculated for each outcome using the random effects model. Twenty-five studies (11 158 patients) were included. The incidence of syncope relapse linearly increased from 0.3% at 30 days to 22% at 2 years follow-up. One-year mortality rate varied between 5.7 and 15.5%; the pooled estimate was 8.4% (95% CI: 6.7-10.2%). The incidence of adverse events (morbidity) varied between 6.1 and 25.2% at 10 days and 2 years, respectively. The short-term (10 days) pooled incidence of the composite of morbidity and mortality was 9.1% (95% CI: 6.6-12.5%). We found a high statistical heterogeneity between studies. CONCLUSION This meta-analysis of prospective observational studies shows that the chance of being asymptomatic linearly progressively decreased over time after the first syncope. Short-term (10-30 days) mortality after syncope was <2% and that the overall 10-day rate of the composite endpoint of death and major events was ∼9%. The knowledge of syncope prognosis could help clinicians to understand syncope patients' prognosis and researchers to design future studies.
Pharmacological treatment of Parkinson disease: a review.

IMPORTANCE Parkinson disease is the second most common neurodegenerative disease worldwide. Although no available therapies alter the underlying neurodegenerative process, symptomatic therapies can improve patient quality of life. OBJECTIVE To provide an evidence-based review of the initial pharmacological management of the classic motor symptoms of Parkinson disease; describe management of medication-related motor complications (such as motor fluctuations and dyskinesia), and other medication adverse effects (nausea, psychosis, and impulse control disorders and related behaviors); and discuss the management of selected nonmotor symptoms of Parkinson disease, including rapid eye movement sleep behavior disorder, cognitive impairment, depression, orthostatic hypotension, and sialorrhea. EVIDENCE REVIEW References were identified using searches of PubMed between January 1985 and February 2014 for English-language human studies and the full database of the Cochrane Library. The classification of studies by quality (classes I-IV) was assessed using the levels of evidence guidelines from the American Academy of Neurology and the highest-quality data for each topic. RESULTS Although levodopa is the most effective medication available for treating the motor symptoms of Parkinson disease, in certain instances (eg, mild symptoms, tremor as the only or most prominent symptom, aged <60 years) other medications (eg, monoamine oxidase type B inhibitors [MAOBIs], amantadine, anticholinergics, β-blockers, or dopamine agonists) may be initiated first to avoid levodopa-related motor complications. Motor fluctuations may be managed by modifying the levodopa dosing regimen or by adding several other medications, such as MAOBIs, catechol-O-methyltransferase inhibitors, or dopamine agonists. Impulse control disorders are typically managed by reducing or withdrawing dopaminergic medication, particularly dopamine agonists. Evidence-based management of some nonmotor symptoms is limited by a paucity of high-quality positive studies. CONCLUSIONS AND RELEVANCE Strong evidence supports using levodopa and dopamine agonists for motor symptoms at all stages of Parkinson disease. Dopamine agonists and drugs that block dopamine metabolism are effective for motor fluctuations and clozapine is effective for hallucinations. Cholinesterase inhibitors may improve symptoms of dementia and antidepressants and pramipexole may improve depression. Evidence supporting other therapies for motor and nonmotor features is less well established.
Catheter ablation restores decreased plasma miR-409-3p and miR-432 in atrial fibrillation patients.

AIMS Despite numerous studies identifying specific microRNA (miRNA) expression profiles associated with atrial fibrillation (AF), changes in plasma miRNA expression in pre- and post-operative AF patients who have received catheter ablation, remain poorly characterized. This study aimed to reveal disease-related biomarkers by detecting plasma miRNA expression in AF patients, and examining the levels of AF-specific miRNAs in patients after catheter ablation, in order to help gauge therapeutic effects and assess prognosis. METHODS AND RESULTS A total of 100 Han Chinese patients with AF who had received catheter ablation, and 100 healthy individuals, were sequentially recruited to the study. Atrial fibrillation-specific plasma miRNAs were detected by Solexa sequencing and quantitative reverse transcription polymerase chain reaction. The expression levels of AF-specific miRNAs were also investigated in 40 post-operative patients (24-48 h) and 20 patients followed up (58.52 ± 36.00 days) after catheter ablation, to explore changes in miRNA expression. The expressions of miR-409-3p and miR-432 in the plasma of AF patients were lower than healthy individuals. In binary logistic regression analyses, reduced miR-409-3p and miR-432 levels were independently associated with AF (95% confidence interval: 1.02-2.22 and 1.09-2.43, P = 0.040 and 0.018, respectively). The levels of miR-409-3p and miR-432 showed no significant difference between post-operative patients and healthy individuals (P = 0.411 and 0.681, respectively), or between followed-up patients and healthy individuals (P = 0.720 and 0.073, respectively). CONCLUSION We suggest that plasma miR-409-3p and miR-432 are potential markers of AF, and catheter ablation restores their decreased levels in AF patients.
Differentiation of Tuberculous and Pyogenic Spondylitis Using Double Phase F-18 FDG PET

To assess the usefulness of double phase F-18 FDG PET in pyogenic spondylitis (PS) and tuberculous spondylitis (TS). Also, to investigate whether double phase F-18 FDG PET could improve the diagnostic accuracy for discrimination of PS from TS. Methods: Double phase F-18 FDG PET/CT was performed in a consecutive 23 patients (9 men, 14 women; mean age, 58.5±17.9 years, range, 19~81 years) suspected having spondylitis. PET/CT imaging was performed 60 and 120 minutes after injection of F-18 FDG. Results: The SUVmax1 of TS and PS showed no statistical differences (TS, 4.53 1.77; PS, 4.5 1.9, p=0.9515). The SUVmax2 also showed no statistical differences between two groups (TS, 5.17 1.95; PS, 5.3 2.21, p=0.9321). The mean SUV of early and delayed F-18 FDG PET images revealed no statistical differences between TS and PS. The % SUVmax and % SUVmean have no statistical differences between TS and PS (% SUVmax, TS, 15.07 6.57%, PS, 18.79 10.48%, p=0.5109; % SUVmean, TS, 16.49 9.1%, PS, 16.88 6.72%, p=0.6524). Also, none of these quantitative indices could differentiate the TS from PS. Furthermore, none of these quantitative indices could predict the presence of TS. Conclusion: Based on the presented data, the quantitative indices of double phase F-18 FDG PET could not differentiate TS from PS despite of high sensitivity for the detection of spondylitis of F-18 FDG PET.
Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads.

BACKGROUND Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). METHODS AND RESULTS We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001). CONCLUSIONS Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
An evaluation of counselling and rehabilitation courses for Chronic Fatigue Syndrome

The aim of the current study was to evaluate the services offered by Action for ME to sufferers of Chronic Fatigue Syndrome using measures developed and validated in previous research. Preliminary studies had suggested that clients attending rehabilitation residential courses were benefiting from the service. A further, more in-depth evaluation process with a greater number of health-related outcome measures was warranted. In addition, assessment was widened to include other services offered to sufferers of the illness. Data relating to the usefulness and success of the services (rated by the clients) were also collected. Data from client volunteers were collected at baseline (that is, before intervention) and approximately six months later. Quantitative comparative analyses were conducted using within-group comparisons to assess any improvements in scores at six-month follow-up from baseline. Fifty-six participants completed wide-ranging questionnaires assessing illness history, psychopathology, psychosocial factors and health and well-being. Data relating to improvements in illness status and acceptability of treatment were also collected by means of global outcome measures. Both the counselling and residential groups showed improvements in many areas assessed at follow-up. Most importantly, improvements were indicated in areas such as fatigue and the levels of disability suffered by patients. In addition, there were significant improvements in ratings of mood, anxiety, depression and physical symptoms. Overall, clients reported satisfaction with the care received and most found the services useful. All of the participants who completed the evaluation stated that they would recommend Action for ME services to fellow sufferers. The outcome of the current study is encouraging. The data presented provides evidence of the high level of support and advice Action for ME offers to sufferers of this illness. Furthermore, measurable improvements in scores relating to illness status were accompanied by improvements in mental health and psychosocial variables in the patient group.