Clinical and economic outcomes of a systematic same-day discharge programme after pulmonary vein isolation: comparison between cryoballoon vs. radiofrequency ablation

AIMS

Same-day discharge (SDD) is feasible after pulmonary vein isolation (PVI). We aim to compare prospectively cryoballoon (CRYO) vs. radiofrequency (RF) ablation in a systematic SDD programme.

METHODS AND RESULTS

We prospectively analysed the 617 scheduled PVI performed consecutively at our institution (n = 377 CRYO, n = 240 RF) from 1 April 2019 to 31 December 2022 within a systematic programme of SDD. The feasibility of SDD, the 10-day incidence of urgent/unplanned medical care after discharge (UUC-10), and the cost per procedure due to hospital resource use were studied. The 100 procedures performed during the previous year, in which patients were systematically hospitalized, were used as a control group. Same-day discharge was achieved in 585/617 (95%) procedures, with a significant trend towards a higher monthly SDD rate from 2019 to 2022 (P = 0.03). The frequency of SDD was similar in CRYO (356/377; 94%) vs. RF (229/240; 95%). After SDD, the UUC-10 was 66/585 (11.3%), being similar for CRYO (41/356; 11.5%) and RF (25/229; 10.9%); P = 0.8 (log-rank test). Of these, 10 patients were re-hospitalized, with an identical rate in CRYO-treated (6/356; 1.7%) and RF-treated (4/229; 1.7%) patients and owing to similar causes (4 haematomas, 4 pericarditis, and 2 symptomatic sinus node dysfunction). Same-day discharge was associated with an average savings per procedure of 63% (P < 0.001), but no differences were found between the CRYO and RF (P = 0.8).

CONCLUSION

In a systematic SDD programme, feasibility (95%, increasing over time), safety (11% UUC-10, 1.7% re-hospitalizations), and savings (63% per procedure) were similar for CRYO and RF ablation procedures.

Track Analysis of the North, Central, and South American Species of the Epicauta maculata Group (Coleoptera: Meloidae)

We undertook a panbiogeographic analysis of 23 species of the Epicauta maculata group of America-Epicauta abeona Pinto, Epicauta adspersa (Klug), Epicauta andersoni Werner, Epicauta atomaria (Germar), Epicauta apache Pinto, Epicauta cavernosa (Courbon), Epicauta dilatipennis Pic, Epicauta fulvicornis (Burmeister), Epicauta horni Champion, Epicauta jeffersi Pinto, Epicauta koheleri Denier, Epicauta lizeri Denier, E. maculata (Say), Epicauta magnomaculata Martin, Epicauta minutepunctata Borchmann, Epicauta nigropunctata (Blanchard), Epicauta normalis Werner, Epicauta ocellata (Dugès), Epicauta pardalis LeConte, picauta phoenix Werner, Epicauta pluvialis Borchmann, Epicauta proscripta Werner, Epicauta rubella Denier, and Epicauta ventralis Werner-with the purpose of analyzing the distributional data for taxa, to establish patterns of distribution of an ancestral biota and areas where these groups have interacted. Based on the overlap of 20 individual tracks, four generalized tracks constituted by different numbers of species were identified; two of them are located in the Nearctic region and the Mexican transition zone (tracks "A" and "B"), and the other two are distributed in the Neotropical region and the South America transition zone ("C", "D"). Six nodes were recognized: Two of them are included in the Nearctic Region, node 'I' located in northern USA and node 'II' located in southwestern USA, both at the intersection of the tracks "A" and "B". The other four are included in the Neotropical Region at the intersection of the tracks "C" and "D": Node 'III' is located in Chaco province; node 'IV' is located in Parana Forest province; node 'V' is located in the northwest of Argentina in Puna province, and node 'VI' is located in Monte province.

Determination of zinc (II) in pharmaceuticals based on a flow-through bulk optode

A method based on flow injection (FI), was applied for the determination of Zn (II) using a flow-through bulk optode membrane that incorporates 1-(2-pyridylazo)-2-naphthol in a plasticized poly (vinyl chloride) membrane entrapped in a cellulose support. The calibration graph plotting the reflectance at 562 nm versus [Zn (II)] was linear in the range 0.16-3.27 mgl(-1) (2.5 x 10(-6)-5 x 10(-5) M) with a detection limit of 0.10 mgl(-1). The variation coefficients of the sensor response for 0.33 mgl(-1) of Zn (II) were +/-0.11% for consecutive measurements (n=10), +/-0.19% between days (n=5) and +/-0.22% between different membranes (n=6). The sensor can be readily regenerated with the same acetic/acetate carrier of pH 3.9. The FI method proposed was applied to the determination of zinc (II) in pharmaceuticals.

Development of a new flow-through bulk optode for the determination of manganese(II)

A flow-through bulk optode based on the use of 1-(2-pyridylazo)-2-naphthol (PAN) immobilized in a plasticized poly(vinyl chloride) membrane entrapped in a cellulose support, in conjuntion with the flow injection analysis technique, is proposed for the determination of manganese(II). The calibration graph obtained at 570 nm was linear in the range 0.27-27.5 mg L(-1) (5 x 10(-6)-5 x 10(-4) M) Mn(II) with a detection limit of 0.18 mg L(-1). The coefficients of variation of the sensor response for 5.5 mg L(-1) of Mn(II) were +/-0.22% for consecutive measurements (n = 10), +/-0.48% between days (n = 5) and +/-0.38% between different membranes (n = 6). The sensor was readily regenerated with the carrier acetic acid/acetate buffer of pH 4.5. The method was applied to the determination of manganese in steels, waters and lemon tree leaves.

Spectrophotometric methods for determining meloxicam in pharmaceuticals using batch and flow-injection procedures

Two sensitive and fast spectrophotometric methods using batch and flow-injection procedures for the determination of meloxicam (MX) are proposed. The methods are based on the formation of a green complex between this drug and Fe(III) [2MX/Fe(III)] in a methanolic medium. The calibration graphs resulting from measuring the absorbance at 570 nm are linear over the ranges 2.0-200 and 5.00-250 mg l(-1) with detection limits of 0.47 and 0.72 mg l(-1), respectively. Furthermore, a flow-injection spectrophotometric method involving measurement of the absorbance of the drug at 362 nm in 0.1 M NaOH is presented. The calibration graph is linear over the range 0.5-20 mg l(-1) with a detection limit of 0.04 mg l(-1). The methods are applied to the routine analysis of MX in pharmaceuticals.

Flow-injection spectrophotometric methods for the determination of tenoxicam

Two sensitive and rapid flow-injection spectrophotometric methods are proposed for the determination of tenoxicam (TX). In the first method, a Fe(III)-tenoxicam complex is formed in a methanolic medium and the absorbance is measured at 540 nm, while the second method involves measurement of the absorbance at 355 nm of a solution containing the drug in hydrochloric acid medium. In both methods, the peak heights were proportional to tenoxicam concentration over the ranges 7.0-320 and 0.5-8.5 mg/l(-1), respectively. The methods have been applied to the routine determination of the drug in dosage forms.

[Electro-clinical and neuroimaging studies in epilepsy in elderly patients]

INTRODUCTION

Due to the aging population in developed countries, epidemiological studies show an increasing tendency to the prevalence of epilepsy in the elderly.

PATIENTS AND METHODS

During 54 months, we have studied the electroclinical and neuroimaging features in outpatients older than 60, with active epilepsy. Every patient was interviewed by one of the authors. Then, we have reviewed the medical records about the clinical features, EEG and neuroimaging (NI) studies and seizures frequency (SF) outcome. Differences in crude proportions were assessed by chi 2 test for independence by 2 x 2 tables.

RESULTS

The study was been performed in 78 patients with 70.3 +/- 7.3 years of mean age at review. Partial seizures were significantly related with an higher SF at onset and, in the series of complex partial seizures was more frequent a temporal EEG topography. There was predominance of men, NI abnormal, symptomatic etiology and SF at onset > or = 1 by day in that patients who started their epilepsy after 60 years. A 51.3% was seizures-free in the last year and in 80% the SF was improved a 50% or more from the beginning.

CONCLUSION

A significantly greater percentage of patients remained with seizures in four cases: in those with a SF at onset greater than 1 every day, in those suffering complex partial seizures, in women and in patients with temporal EEG topography.

Simultaneous determination of piroxicam and its major metabolite 5'-hydroxypiroxicam in human plasma by derivative spectrophotometry

A first-derivative spectrophotometric method for the simultaneous determination of piroxicam (PX) and its major metabolite 5'-hydroxypiroxicam (OH PX) in human plasma is described. The method consists of direct extraction of the two drugs from the plasma samples with hydrochloric and trichloroacetic acid prior to their determination by measuring the first-derivative signals at 337.0 nm for PX and at 327.0 nm for OHPX (zero-crossing wavelength). The calibration graphs were linear up to 10.0 and 8.0 mg l-1 of PX and OH PX, respectively, and the limits of quantification were 0.27 and 0.56 mg l-1. The possible interfering effects of other substances were studied.

Flow-injection spectrophotometric determination of diclofenac sodium in pharmaceuticals and urine samples

A sensitive and fast flow-injection spectrophotometric method for the determination of diclofenac sodium based on the formation of coloured compound with Ce(IV)-3-methyl-2-benzothiazolinone hydrazone hydrochloride (MBTH) in H2SO4 3 x 10(-2) M medium is proposed. Using the peak height as a quantitative parameter diclofenac was determined at 580 nm over the range 0.20-8.0 micrograms ml-1. The proposed method was successfully applied to the determination of diclofenac in pharmaceuticals and urine samples.

Spectrophotometric methods for the determination of cephradine or ceftazidine in human urine using batch and flow-injection procedures

Sensitive and fast spectrophotometric methods for the determination of cephradine or ceftazidine in human urine, based on the formation of compounds between these drugs and Pd(II), are described. In the batch procedures the calibration graphs resulting from the measurement of the absorbance at 330 nm is linear over the range 5.0-60.0 micrograms. ml-1 for cephradine and 3.0-60.0 micrograms ml-1 for ceftazidine. The methods were successfully adapted to FI-systems, the peak heights being proportional to cephalosporin concentration over the range 5.0-60.0 micrograms ml-1 for cephradine and 3.0-60.0 micrograms ml-1 for ceftazidine. The sampling frequency was 60 h-1 with a sample injection of 72 microliters.

Flow-injection spectrophotometric determination of frusemide or sulphathiazole in pharmaceuticals

Two sensitive and fast flow-injection spectrophotometric methods are proposed for the determination of frusemide or sulphathiazole based on the formation of coloured complexes between these compounds and Pd(II) at pH 5.0 and 55 degrees C. Using the peak height as a quantitative parameter, frusemide or sulphathiazole was determined at 410 nm over the range 2.0 x 10(-5)-4.0 x 10(-4) M or 5.0 x 10(-5)-3 x 10(-4) M, respectively. The methods were applied to the determination of these sulphonamides in pharmaceuticals.

Myocardial infarction and cardiovascular risk factors in Mexico City and San Antonio, Texas

Because the epidemiology of cardiovascular disease in Mexico is largely unknown, we examined the prevalence of cardiovascular risk factors and myocardial infarction (MI) in adults from low-income colonias in Mexico City. Data were collected as part of the Mexico City Diabetes Study, a population-based survey of diabetes and cardiovascular disease conducted between 1987 and 1992. Results were compared with those obtained from a comparable survey conducted previously among low-income Mexican Americans in San Antonio, Tex. A total of 2271 individuals between the ages of 35 and 64 years from Mexico City and 1143 adults of the same age range from San Antonio were studied. Despite being leaner and having lower levels of total cholesterol, Mexicans in Mexico City had markedly higher levels of triglycerides (P < .001) and lower levels of HDL cholesterol (P < .001) than Mexican Americans in San Antonio. MI was assessed by Minnesota-coded electrocardiograms and by a self-reported history of physician-diagnosed heart attack. In men, the prevalence of self-reported heart attack was significantly higher in San Antonio than in Mexico City (odds ratio, 5.85; P < .001), and in women, the prevalence of electrocardiogram-documented MI was significantly higher in San Antonio than Mexico City (odds ratio, 2.51; P < .001). The apparent excess of MI in San Antonio relative to Mexico City could be due to higher case-fatality in Mexico City or to a higher incidence in San Antonio.

Determination of captopril in pharmaceutical samples by flow injection analysis

A flow injection spectrophotometric method for the determination of captopril involving measurement of the absorbance of the captopril complex with palladium(II) in a 0.12 M HCl medium at 400 nm is presented. The calibration graph was linear over the range 2 x 10(-5)-6 x 10(-4) M. The sampling frequency was 90 h-1 with sample injections of 70 microliters. The proposed method was applied to the determination of captopril in pharmaceutical samples.

Circulating immune complexes in breast and lung cancer, before and after chemotherapy

Circulating immune complexes (CIC) levels were evaluated in two groups of cancerous patients to try to correlate CIC levels, tumor stage and chemotherapy received. There were 40 patients with Lung Cancer (LC) clinical stages III and IV; 60 patients with Breast Cancer (BC) stages II, III and IV and 38 normal controls. LC patients showed significant increase in CIC values before, during and after treatment as compared to controls, without any difference among groups under different treatment combinations and tumor stage. Stage II BC patients showed decreased CIC levels during treatment (p less than 0.01 vs initial value). This decrease was maintained after treatment (p less than 0.02). Stage III BC patients showed different behaviour according to treatment: those who only received chemotherapy (ADM + CTX) showed no significant differences during treatment, and those treated with ADM + CTX and megestol acetate (MA) displayed decreased CIC levels after treatment (p less than 0.05) reaching similar control values. Stage IV patients treated with ADM + CTX + MA returned to normal CIC values during treatment. These results proved that combined treatment of chemotherapy and hormone therapy diminished CIC levels in BC patients, while therapy given to LC patients did not present any modifications.

[Effect of BCG on the growth rate of Sarcoma in normal and splenectomized mice]

A study was carried out on the growth of Sarcoma 180 alone or mixed with BCG in normal and splenectomized BALB/c mice, with or without previous immunization with BCG intradermally (id), 40 days before tumor challenge. No survival was observed in non splenectomized mice inoculated with Sarcoma 180, both in normal mice and in those previously treated with BCG, whereas the inoculation of Sarcoma 180 mixed with BCG produced a 37 % increase in the survival rate in normal animals and an 83 % increase in the group previously treated with BCG. In splenectomized mice the survival rate was 56 % in those inoculated with Sarcoma 180 alone, rising to 100 % in the group inoculated with Sarcoma 180 mixed with BCG. Previous immunization with BCG in splenectomized animals did not affect tumor incidence significantly. These results suggest the participation of the spleen in the mechanism of tumoral rejection favoured by BCG inoculation.