bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the long‐term efficacy of implantable defibrillators and sotalol for documented spontaneous sustained ventricular tachyarrhythmias secondary to coronary artery disease
Authors: Kovoor P. , Yung A. , Byth K. , Eipper V. E. , Uther J. B. , Cooper M. J. , Ross D. L. 
Published: March 2008

Abstract Background: The relative efficacy of antitachycardia pacing implantable cardioverter defibrillators (ATPICD) and sotalol in the treatment of ventricular tachyarrhythmias is controversial. Aim: To compare the mortality in patients treated with ATPICD and sotalol for documented spontaneous sustained ventricular tachyarrhythmias occurring late after previous myocardial infarction. Methods: In this non‐randomised retrospective study of 139 consecutive patients all patients had inducible ventricular tachycardia at baseline electrophysiological studies. Before the availability of ATPICD, 22 patients were treated with sotalol as part of a randomised study comparing the efficacy of sotalol to amiodarone. After ATPICD became available sotalol was used in 49 patients in whom intravenous testing predicted sotalol to be effective and ATPICD were implanted in 68 patients in whom sotalol was predicted to be ineffective at electrophysiological testing. Thus, 68 patients were treated with an ATPICD and 71 with sotalol. Results: The two groups were well‐matched for age, type of presenting arrhythmia, severity of coronary artery disease and ventricular function. At 36 months Kaplan‐Meier estimates of mortality from ventricular tachyarrhythmia were 0% with ATPICD and 15% with sotalol (p=0.03). Kaplan‐Meier estimates of total mortality at 36 months were 12% with ATPICD and 25% with sotalol (p=0.09). Multivariate analysis showed hazard ratio of 7.9 (p=0.06) for death from ventricular tachyarrhythmia in patients treated with sotalol compared to ATPICD. Conclusions: While no difference in total mortality was demonstrated, treatment with ATPICD is probably superior to sotalol for preventing deaths due to ventricular tachyarrhythmia. (Aust NZ J Med 1999; 29: 331–341.)
Mechanical circulatory support devices in the treatment of heart failure
Authors: Knight J. L. 
Published: March 2008

AbstractWith an increasingly aging population, heart failure is a major health issue, affecting more than 10% of the population over 65 years of age, and costing hundreds of millions of dollars per year for ongoing care. Even with maximal medical therapy, annual mortality rates of in excess of 25% are commonly reported. Over the last three decades, various surgical approaches have been examined in the hope of improving the outcome of congestive cardiac failure. These procedures range from simple coronary revascularisation to left ventricular reduction surgery and cardiac transplantation. Although of value in selected situations, no surgical approach, beyond transplantation, has had significant impact on the outcome of heart failure.In the last decade, development in the area of mechanical support for the failing heart has continued to expand at a rapid rate. Strong evidence now exists to show that in many patients with advanced heart failure, prolonged mechanical support results in significant myocardial recovery. There are currently several mechanical support devices available for clinical use, although most are considered experimental in this country. These devices are expensive and are not without significant complications, but early results of their use as either a bridge to transplantation or as a stand alone treatment, have been very encouraging. Currently available mechanical assist devices are described, with discussion of indications for implantation, complications and results of their use.
The role of diastolic ventricular interaction in abnormal cardiac baroreflex function in chronic heart failure
Authors: Atherton J. J. , Frenneaux M. P. , Thomson H. L. 
Published: March 2008

AbstractBaroreflex abnormalities have been well documented in both patients with chronic heart failure and experimental animal models of heart failure. These abnormalities are associated with increased mortality and probably contribute to neurohumoral activation. While it is likely that several mechanisms contribute to reduced baroreflex sensitivity, it has been difficult to explain why baroreflex control mechanisms during acute volume unloading in patients with severe chronic heart failure should be directionally opposite to those in normal subjects. Volume unloading normally causes a reduction in baroreceptor activity, and hence an increase in sympathetic outflow; however, patients with chronic heart failure develop attenuated increases or paradoxical reductions in forearm vascular resistance, muscle sympathetic nerve activity, and noradrenaline spillover. It has been suggested that this probably represents paradoxical activation of left ventricular (LV) mechanoreceptors, but why LV receptors should behave in such a fashion has not been determined.In the setting of diastolic ventricular interaction, the filling of the left ventricle is constrained by the surrounding pericardium and right ventricle. In these patients, the reduction in right ventricular (RV) volume that normally occurs during acute volume unloading allows for an increase in LV end‐diastolic volume (as opposed to the reduction in LV volume that normally occurs). We have demonstrated this to be important in some patients with chronic heart failure, and observed that baroreflex control of forearn vascular resistance was markedly impaired in these patients. We propose that the increase in LV volume that occurred during volume unloading would increase LV mechanoreceptor activity, and could therefore explain the paradoxical reductions in sympathetic outflow. As discussed, this has important therapeutic implications.
Monoclonal gammopathy of undetermined significance (MGUS) ‐ 31 year follow up of a community study
Authors: Colls B. M. 
Published: March 2008

Abstract Background: When unselected healthy adults in the community have their serum screened by cellulose acetate or paper electrophoresis, monoclonal gammopathy of undetermined significance (MGUS) may be found in 0.5‐1%. Aim: To report upon a 31 year follow up of MGUS in a New Zealand community. Methods: Serum from 2192 subjects (82% of the adult population) of a New Zealand town was collected in 1967 and subsequently screened by cellulose acetate electrophoresis. Eleven of the 2192 (0.5%) were found to have MGUS. Clinical correlation was sought in 1970 and subsequently to elucidate the underlying cause. Results: Seven of the 11 patients have developed a haematological malignancy. Two have been diagnosed as having Waldenstrom's macroglobulinaemia, one malignant lymphoma and acute myelomonocytic leukaemia and four developed myeloma. Myeloma developed at one, nine, 23 and 25 years after the original screening. One myeloma patient and one patient with MGUS are currently alive and well, 31 years after discovery of their gammopathy. Conclusions: The incidence of MGUS in this community is only half that detected in a comparable study. The association with haematological malignancy in this study (64%) is considerably higher than that found in the Swedish study (6%), possibly because of the longer follow up in New Zealand. MGUS should not only be studied in depth at the time of its discovery, but needs very long term follow up as the underlying disease may not surface until the third decade.
A cost‐analysis of two approaches to infection control in a lung function laboratory
Authors: Side E. A. , Harrington G. , Thien F. , Walters E. H. , Johns D. P. 
Published: March 2008

Abstract Background: The Thoracic Society of Australia and New Zealand (TSANZ) guidelines for infection control in respiratory laboratories are based on a ‘Universal Precautions’ approach to patient care. This requires that one‐way breathing valves, flow sensors, and other items, be cleaned and disinfected between patient use. However, this is impractical in a busy laboratory. The recent introduction of disposable barrier filters may provide a practical solution to this problem, although most consider this approach to be an expensive option. Aim: To compare the cost of implementing the TSANZ infection control guidelines with the cost of using disposable barrier filters. Methods: Costs were based on the standard tests and equipment currently used in the lung function laboratory at The Alfred Hospital. We have assumed that a barrier filter offers the same degree of protection against cross‐infection between patients as the TSANZ infection control guidelines. Time and motion studies were performed on the dismantling, cleaning, disinfecting, reassembling and re‐calibrating of equipment. Conservative estimates were made as to the frequency of replacing pneumotachographs and rubber mouthpieces based on previous equipment turnover. Labour costs for a scientist to reprocess the equipment was based on $20.86/hour. The cost of employing a casual cleaner at an hourly rate of $14.07 to assist in reprocessing equipment was also investigated. The new high efficiency HyperFilterTM disposable barrier filter, costing $2.95 was used in this cost‐analysis. Results: The cost of reprocessing equipment required for spirometry alone was $17.58 per test if a scientist reprocesses the equipment, and $15.56 per test if a casual cleaner is employed to assist the scientist in performing these duties. In contrast, using a disposable filter would cost only $2.95 per test. Using a filter was considerably less expensive than following the TSANZ guidelines for all tests and equipment used in this cost‐analysis. Conclusions: The TSANZ infection control guidelines are expensive and impractical to implement. However, disposable barrier filters provide a practical and inexpensive method of infection control.
The clinical associations of mitotic spindle autoantibodies in a South Australian cohort
Authors: Limaye V. , Roberts‐Thomson P. , Gillis D. , Pile K. 
Published: March 2008

Abstract Background: The mitotic spindle apparatus (MSA) is a unique structure of microtubules and associated proteins involved in the segregation and reorganisation of chromosomes during cell division. Autoantibodies to the MSA (anti‐MSA) are reported to occur rarely, but are easily identified during the immunofluorescent detection of anti‐nuclear antibodies (ANA), and are generally reported as part of that investigation. Aims: As the clinical significance of these antibodies is unknown, our aim was to identify the clinical features of subjects identified with anti‐MSA, and in a subset investigate the co‐association with organ specific anti‐thyroid antibodies. Methods: All ANA results from the three major immunology laboratories serving South Australia between January 1993 and June 1998 were retrospectively reviewed to identify anti‐MSA subjects. Clinical details were extracted from hospital or general practice records using a standard proforma. Thyroid autoantibodies were measured using standard technique. A control group of consecutive ANA positive, anti‐MSA negative individuals had anti‐thyroid antibodies measured. Statistical comparison used χ2 test. Results: Fifty‐five subjects (43F) were identified with mean age 59.8 (range 17–91); 39 had specific diagnoses, with 16 identified as part of non‐specific investigations. ‘Arthritis’ broadly accounted for the largest group, transient inflammatory arthritis n=7, degenerative joint disease n=6, rheumatoid arthritis n=5. Adenocarcinoma and mesothelioma accounted for one case each. Thirty‐two subjects had anti‐thyroid antibodies tested, with ten of 21 and two of 11 positive among the groups with anti‐MSA titre >1:80 and <1:40 respectively, χ2=2.7, p=0.1. Anti‐thyroid antibodies were detected more frequently among the high titre anti‐MSA group (ten of 21) compared with high titre positive ANA, negative anti‐MSA group (two of 11), RRisk 4.4, χ2=5.34, p=0.02. Conclusion: This study confirmed the relative rarity of anti‐MSA and that its association is primarily with rheumatic diseases. The coincidence of mesothelioma is novel with only two previous reports of malignancy and anti‐MSA. The co‐association of high titre anti‐MSA and thyroid autoantibodies suggest that the latter should be a follow up investigation if the former is identified as part of an investigative screen.
Treatment of de novo acute myeloid leukaemia in Hong Kong: a twenty‐year experience (1975 to 1996)
Authors: Chim C. S. , Liang R. , Kwong Y. L. , Lie A. K. W. , Todd D. , Chan T. K. 
Published: March 2008

Abstract Background: Small patient numbers and short follow‐up are common in some acute myeloid leukaemia (AML) studies and data on secondary malignancies after treatment of AML are rare. Aims: To determine the prognostic factors and long‐term treatment results. Methods: A retrospective study of patients with de novo AML under the age of 60 over a 20‐year period in which two induction therapy regimens: 7:3 (1975–1983) and 7:3:7 (1984–1996) and three consolidation chemotherapy regimens: 5:2 (1975–1983), 5:2:5 (1984–1990) and Ara‐C/mitoxantrone (1991–1996) were used. Disease‐free (DFS), overall survivals (OS) and prognostic factors were analysed. Results: Two‐hundred and two of 276 (73%) patients attained complete remission (CR). The CR rates of 7:3 and 7:3:7 regimens were 70.5% and 74.5% respectively (p=0.92). The median DFS was 12 months and the projected DFS at 10‐ and 20‐years were 23% and 21% respectively. For patients consolidated with 5:2, 5:2:5 and Ara‐C/ mitoxantrone, the median DFS was 15 m, 12 m and 11 m respectively and the projected ten‐year DFS were 27%, 21% and 18% respectively (p=0.2). Ninety per cent of relapses occurred within two years from remission but there were two late relapses at 109 m and 120 m respectively. Young age and FAB M3 subtype were favourable prognostic factors to OS (p=0.04) and DFS (p=0.006) respectively. There was no secondary solid tumour in the long‐term survivors. Conclusion: Our experience confirmed the efficacy of standard‐dose Ara‐C/daunorubicin and the prognostic value of age and FAB subtype. Median and projected DFS were similar to western studies.
Helicobacter pylori eradication with lansoprazole, amoxycillin and clarithromycin: testing an ideal regimen in a multicultural south east Asian population and examining factors potentially influencing eradication
Authors: Kaushik S. P. , Vu C. 
Published: March 2008

Abstract Background: From European and North American data, it is recommended in the Asia Pacific consensus statement, that one week therapy with a proton pump inhibitor, amoxycillin and clarithromycin be used for Helicobacter pylori eradication, in areas of high metronidazole resistance. The efficacy of this regimen is unknown in Singapore. Aim: To assess the efficacy, safety and compliance of an H. pylori eradication regimen and examine clinical factors that potentially determine eradication. Methods: Consecutive outpatients from a multicultural, south east Asian, population with H. pylori infection, with or without peptic ulcer, were treated with lansoprazole 30 mg, amoxycillin 1 gm, clarithromycin 500 mg, twice a day for seven days. Eradication was assessed by either rapid urease, histology or urea breath test. Compliance and side effects were recorded. The eradication rate and effect of ethnicity, age, sex, usage of alcohol, smoking and non‐steroidal anti‐inflammatory drugs, history of ulcer and endoscopic diagnosis on eradication were examined by univariate and multivariate analysis. Results: Of 113 patients, the eradication rate by intention to treat was 98/113 (87%) (95% confidence interval [CI] 80–93%) and per protocol was 98/106 (92%) (95% CI 87–97%). Using Fisher's exact test, eradication was more successful in Chinese (intention to treat and per protocol respectively p=0.02 and p<0.001) compared to non‐Chinese. By logistic regression analysis ethnicity was an independent factor associated with eradication success (p=0.0025). Side effects occurred in five (4.4%), resulting in cessation of treatment. Conclusions: This one week eradication regimen is safe and effective in south east Asians. Chinese ethnicity may be associated with a higher likelihood of eradication success.
The potential impact of global environmental change on population health
Authors: Tong S. 
Published: March 2008

AbstractDue to rapid industrial changes and increased pressure of people on fragile ecosystems, large‐scale environmental perturbations have been occurring on Earth. Major current environmental problems that can be expected to have a substantial effect on human health include human‐induced climate change and stratosphere ozone depletion, because they threaten the ecological support systems on which human life depends. The most serious potential consequence of global environmental change is the erosion of Earth's life‐support systems. The public health assessments of the present and future anthropogenic damage to the biosphere have important implications for human health and wellbeing. Medical practitioners have an important role to play in this field.
A comparison of two dosing regimens of zidovudine in Thai adults with early symptomatic HIV infection. Conducting clinical HIV trials in South‐East Asia
Authors: Phanuphak P. , Grayson M. L. , Sirivichayakul S. , Suwanagool S. , Ruxrungtham K. , Hanvanich M. , Ratanasuwan W. , Ubolyam S. , Hughes M. D. , Wanke C. A. , Hammer S. M. 
Published: March 2008

Abstract Aim: To compare the clinical and immunological efficacy, and tolerance of two dosage regimens of zidovudine (ZDV) in an adult Thai population with early symptomatic human immunodeficiency virus (HIV) disease and to identify important clinical issues associated with conducting HIV trials in South‐East Asia. Methods: HIV‐infected Thai adults, with early symptomatic HIV disease and CD4 lymphocyte counts less than 400/mm3, who were managed in the infectious diseases clinics at two university teaching hospitals in Bangkok, Thailand, were enrolled in a randomised, open‐label, dose‐regimen comparison trial of ZDV. Two oral ZDV dosing regimens: regimen A, 100 mg tid+200 mg nocte (ZDV‐A) vs regimen B, 250 mg bid (ZDV‐B) were compared. The main outcome measures were:1. Clinical efficacy: rate of progression to acquired immunodeficiency syndrome (AIDS) or death.2. Immunologic efficacy: changes in CD4 lymphocyte numbers compared to baseline; rate of decline of CD4 lymphocyte numbers to less than 100/mm3.3. Toxicity, as defined by clinical symptomatology and laboratory parameters. Results: Two hundred and four patients were enrolled (103 ZDV‐A; 101 ZDV‐B) of whom 195 were followed beyond baseline. Patients were typical of those encountered with HIV in Thailand: mean age 33 years; 89% male; 88% heterosexual HIV acquisition; mean baseline CD4 lymphocyte count 241/mm3. Follow‐up while on therapy was comparable for the two groups (mean +SD): 533+236 days (ZDV‐A) vs 5925210 days (ZDV‐B). One hundred and eleven patients (57%; 51 ZDV‐A, 60 ZDV‐B) were treated for at least 22 months (669530 days). Clinical and immunological outcomes for ZDV‐A and ZDV‐B, including rate of progression to AIDS or death, development of non‐AIDS‐defining opportunistic infections, mean changes in CD4 lymphocyte numbers/mm3, difference in area under the CD4:time distribution curve and difference in the rate of decline of CD4 lymphocyte numbers to less than 100/mm3, were not significantly different. The presence of oral hairy leukoplakia or unintential weight loss of 10–20% at enrolment were significantly associated with the later development of AIDS (p=0.03 and 0.04, respectively). ZDV‐associated toxicity was similar for both regimens. Maintaining protocol adherence and appropriate clinical follow‐up emerged as important practical issues. Conclusion: In Thai adults, ZDV 100 mg tid+200 mg nocte and ZDV 250 mg bid have similar clinical and immunological efficacy. Rates of ZDV toxicity are comparable to those reported in non‐Asian populations. Despite limitations in medical care access and maintaining long‐term follow‐up, successful trials of antiretroviral agents are feasible in South‐East Asia and multi‐drug treatment trials should be pursued in appropriate institutions.
Teaching asthma management: an evidence‐based educational approach
Authors: Yates D. H. , Shah S. , Veitch E. , Thomas P. S. 
Published: March 2008

Abstract Background: Asthma management plans and asthma education have been incorporated into recent guidelines, and implementation of these reduces asthma morbidity. Junior doctors are frequently involved in asthma management, but teaching about asthma in medical school is seldom assessed. We studied asthma knowledge, confidence in practical asthma management, and the effectiveness of an interactive asthma education workshop in final year medical students. Thirty‐five students attended the workshop, with 26 returning questionnaires on both of the two sessions. Methods: Students attended a two hour asthma workshop comprising interactive teaching sessions on management of acute and stable asthma, and a practical session using asthma devices. Theoretical knowledge was assessed by a 20 item questionnaire, completed immediately prior to the workshop and after two weeks, at a feedback session. Practical knowledge was assessed by confidence scores in use of asthma devices on a five point scale (not at all confident to very confident), before, immediately after the workshop, and after two weeks. Results: Students scored poorly in questions on: predictors of asthma mortality, nebuliser and Turbuhaler® use, asthma management plans, and physical signs in acute asthma. Mean (SE) knowledge score increased significantly from 64.4% (6.1) to 74.2% (5.6) (p<0.05; paired t‐test) at two weeks. Confidence scores rose significantly for all practical aspects of asthma management (p<0.01; Wilcoxon matched pairs test), and declined at two weeks, but still remained significantly higher than at baseline (p<0.05). Conclusions: Medical students had poor knowledge about several important features of asthma care. The asthma workshop was effective in increasing knowledge and confidence in management of asthma in the short term, and could be useful in optimising implementation of asthma guidelines in clinical practice and potentially later in training of junior medical officers.