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Porter L, Sultan O, Mitchell BG, Jenney A, Kiernan M, Brewster DJ, Russo PL. How long do nosocomial pathogens persist on inanimate surfaces? A scoping review. J Hosp Infect 2024; 147:25-31. [PMID: 38447803 DOI: 10.1016/j.jhin.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Healthcare hygiene plays a crucial role in the prevention of healthcare-associated infections. Patients admitted to a room where the previous occupant had a multi-drug-resistant bacterial infection are at an increased risk of colonization and infection with the same organism. A 2006 systematic review by Kramer et al. found that certain pathogens can survive for months on dry surfaces. The aim of this review is to update Kramer et al.'s previous review and provide contemporary data on the survival of pathogens relevant to the healthcare environment. We systematically searched Ovid MEDLINE, CINAHL and Scopus databases for studies that described the survival time of common nosocomial pathogens in the environment. Pathogens included in the review were bacterial, viral, and fungal. Studies were independently screened against predetermined inclusion/exclusion criteria by two researchers. Conflicts were resolved by one of two senior researchers. A spreadsheet was developed for the data extraction. The search identified 1736 studies. Following removal of duplicates and application of the search criteria, the synthesis of results from 62 included studies were included. 117 organisms were reported. The longest surviving organism reported was Klebsiella pneumoniae which was found to have persisted for 600 days. Common pathogens of concern to infection prevention and control, can survive or persist on inanimate surfaces for months. This data supports the need for a risk-based approach to cleaning and disinfection practices, accompanied by appropriate training, audit and feedback which are proven to be effective when adopted in a 'bundle' approach.
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Affiliation(s)
- L Porter
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - O Sultan
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia
| | - B G Mitchell
- School of Nursing, Avondale University, Wahroonga, Australia; School of Nursing and Midwifery, Monash University, Clayton, Australia; School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - A Jenney
- Microbiology Unit, Alfred Health, Prahran, Australia
| | - M Kiernan
- Richard Wells Research Centre, University of West London, London, UK
| | - D J Brewster
- Central Clinical School, Monash University, Clayton, Australia; Intensive Care Unit, Cabrini Health, Malvern, Australia
| | - P L Russo
- Department of Nursing Research, Cabrini Health, Malvern, Australia; School of Medicine, Monash University, Clayton, Australia; School of Nursing, Avondale University, Wahroonga, Australia.
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Abbasi A, Siddiqui SA, Ram B, Khan JUA, Sheikh K, Ali A, Raja Memon W, Rehan M, Zia Ul Haq M, Kumar Seetlani N, Akhter TS, Khoso M, Javed A, Hussain Khokhar R, Hussain Memon Z, Akbar W, Naeem M, Shaikh S, Khan Khattak A, Memon AQ, Bhatty S, Sultan O, Shani I, Maheshwary N. Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population. Cureus 2023; 15:e48994. [PMID: 38111444 PMCID: PMC10726382 DOI: 10.7759/cureus.48994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND AIM While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population. METHODS This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA. RESULTS Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the second week of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients. CONCLUSIONS The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.
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Affiliation(s)
| | | | - Bikha Ram
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | | | - Khalid Sheikh
- Internal Medicine, People's University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Asif Ali
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
- Medicine, Dow General Hospital/Dow University of Health Sciences, Karachi, PAK
| | - Waseem Raja Memon
- Medicine, People's University of Medical and Health Sciences for Women, Nawabshah, PAK
| | | | | | | | | | - Masood Khoso
- Gastroenterology, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Asif Javed
- Internal Medicine, Social Security New Born & Children Hospital (MNCH), Faisalabad, PAK
| | - Riaz Hussain Khokhar
- Internal Medicine, People's University of Medical and Health Sciences for Women, Nawabshah, PAK
| | | | - Wajid Akbar
- Internal Medicine, Bacha Khan Medical College, Peshawar, PAK
| | - M Naeem
- Gastroenterology, Mardan Medical Complex, Peshawar, PAK
| | | | | | | | - Shaheen Bhatty
- Internal Medicine, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | - Omar Sultan
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Idress Shani
- Internal Medicine, District Head Quarters (DHQ) Hospital, Faisalabad, PAK
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Han HC, Wang J, Birnie DH, Alings M, Philippon F, Parkash R, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Healey JS, Redfearn D, Toal S, Becker G, DeGrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Gervais P, Rioux L, Hemels MEW, Bouwels LHR, Exner DV, Dorian P, Connolly SJ, Longtin Y, Krahn AD. Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality. JAMA Cardiol 2023; 8:484-491. [PMID: 37017943 PMCID: PMC10077129 DOI: 10.1001/jamacardio.2023.0467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/06/2023] [Indexed: 04/06/2023]
Abstract
Importance Cardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established. Objective To evaluate the association of the extent and timing of CIED infection with all-cause mortality. Design, Setting, and Participants This prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023. Exposures Prospectively identified CIED infections. Main Outcomes and Measures Time-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections. Results Of 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001). Conclusions and Relevance Findings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.
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Affiliation(s)
- Hui-Chen Han
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David H. Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marco Alings
- Division of Cardiology, Amphia Ziekenhuis & Working Group on Cardiovascular Research the Netherlands (WCN), Breda, the Netherlands
| | - François Philippon
- Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Division of Cardiology, Department of Medicine, University of Toronto, St Michael Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- Division of Cardiology, St Mary’s General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Division of Cardiology, Centre hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R. Aaron Low
- Division of Cardiology, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Carlos Morillo
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey S. Healey
- Division of Cardiology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Satish Toal
- Division of Cardiology, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel DeGrâce
- Division of Cardiology, Hôtel-Dieu de Lévis, Levis, Montreal, Quebec, Canada
| | - Bernard Thibault
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eugene Crystal
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- Division of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Montreal, Quebec, Canada
| | - Philippe Gervais
- Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Leon Rioux
- Division of Cardiology, Centre Intégré de Sante et Service Sociaux du Bas-Laurent (CISSSBSL), Rimouski, Montreal, Quebec, Canada
| | - Martin E. W. Hemels
- Division of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
- Division of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Leon H. R. Bouwels
- Division of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Derek V. Exner
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Paul Dorian
- Division of Cardiology, Department of Medicine, University of Toronto, St Michael Hospital, Toronto, Ontario, Canada
| | - Stuart J. Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Sheldon R, Talajic M, Tang A, Becker G, Essebag V, Sultan O, Baranchuk A, Ritchie D, Morillo C, Krahn A, Brignole M, Manns B, Maxey C, Raj SR. Randomized Pragmatic Trial of Pacemaker Versus Implantable Cardiac Monitor in Syncope and Bifascicular Block. JACC Clin Electrophysiol 2022; 8:239-248. [PMID: 35210082 DOI: 10.1016/j.jacep.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In this study, the authors tested whether a strategy of empiric permanent pacing reduces major composite events more effectively than acting on the results of an implantable cardiac monitor (ICM). BACKGROUND Syncope may be caused by intermittent complete heart block in patients with bifascicular heart block, but competing diagnoses coexist. Whether empiric permanent pacing or acting on investigative results provides best care is unknown. METHODS This was a multinational, randomized, pragmatic clinical trial of patients ≥50 years of age with bifascicular block, preserved left ventricular function, and ≥1 syncope in the preceding year. The primary composite outcome measure comprised cardiovascular death, syncope, bradycardia resulting in pacemaker insertion, and device complications. RESULTS There were 57 and 58 subjects randomized to receive a pacemaker or ICM. A total of 41 patients had left bundle branch block and 74 had right bundle branch block and a left fascicular block. Patients were followed for a median 33 months. There were fewer composite primary outcomes in patients randomized to pacemaker compared with ICM, respectively (20 [35%] vs 44 [76%]; chi square P < 0.0001), with lower actuarial probabilities of a primary outcome (0.45 and 1.00; P < 0.001). Syncope was as likely in the groups randomized to receive a pacemaker or ICM (29% vs 26%, chi-square P = 0.95). CONCLUSIONS Empiric permanent pacing compared with ICM reduced major adverse events but not syncope in older patients with bifascicular block and recent syncope. There remains a substantial likelihood of syncope recurrence in patients who receive a permanent pacemaker likely caused by vasodepressor syncope. (Syncope: Pacing or Recording in the Later Years [SPRITELY]; NCT01423994).
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Affiliation(s)
- Robert Sheldon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | | | - Anthony Tang
- University of Western Ontario, London, Ontario, Canada
| | | | | | - Omar Sultan
- Regina General Hospital, Regina, Saskatchewan, Canada
| | | | - Debbie Ritchie
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Carlos Morillo
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Braden Manns
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Connor Maxey
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Longtin Y, Gervais P, Birnie DH, Wang J, Alings M, Philippon F, Parkash R, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Rioux L, Hemels MEW, Bouwels LHR, Exner DV, Dorian P, Connolly SJ, Krahn AD. Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT). Open Forum Infect Dis 2021; 8:ofab513. [PMID: 34859113 PMCID: PMC8632784 DOI: 10.1093/ofid/ofab513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT. Methods This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test. Results Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P = .10) or vancomycin (90.8% vs 90.2%; P = .90). Conclusions Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections. Trial registration NCT01002911.
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Affiliation(s)
- Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Philippe Gervais
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marco Alings
- Amphia Ziekenhuis & Working Group on Cardiovascular Research (WCN), Breda, the Netherlands
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Eugene Crystal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Leon Rioux
- Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Ziekenhuis Rijnstate, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
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Ho K, Yatham K, Seno R, Sultan O. A case report of primary cardiac intimal sarcoma presenting with atrial fibrillation and a left atrial mass. Eur Heart J Case Rep 2021; 5:ytab410. [PMID: 34859182 PMCID: PMC8633751 DOI: 10.1093/ehjcr/ytab410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/09/2021] [Accepted: 10/05/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Intimal sarcoma is an exceedingly rare type of primary cardiac tumour. It is characterized by poorly differentiated spindle-shaped cells that can mimic smooth muscle and is strongly associated with MDM2 genetic amplification. Owing to its rarity and non-distinctive histological features, diagnosis remains a significant challenge. CASE SUMMARY In this case report, we describe a case of primary cardiac intimal sarcoma in a 37-year-old woman who presented with atrial fibrillation (AF) and a left atrial mass. Despite having a histological sample from an excised left atrial mass, the diagnosis was not made until she presented with back pain secondary to metastatic disease to the spine. DISCUSSION Primary cardiac intimal sarcoma is an extremely rare diagnosis. The mainstay management of intimal cardiac sarcoma is aggressive surgical resection. Unfortunately, the prognosis of cardiac sarcomas remains very poor, with a mean survival between 3 months and 1 year. This case of cardiac intimal sarcoma highlights the difficulty in establishing a diagnosis, particularly given the unusual presentation of AF.
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Affiliation(s)
- Karen Ho
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Kavya Yatham
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
| | - Rommel Seno
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, 4101 Dewdney Avenue, Regina, SK, Canada S4T 1A5
| | - Omar Sultan
- Department of Medicine, University of Saskatchewan College of Medicine, 103 Hospital Drive, Saskatoon, SK, Canada S7N 0W8
- Department of Cardiology, Saskatchewan Health Authority, 1440 14th Avenue, Regina, SK, Canada S4P 0W5
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7
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Kaoutskaia A, Shurrab M, Amit G, Parkash R, Exner D, Toal S, Sterns L, Sarrazin JF, Chauhan V, Sultan O, Nair G, Deyell M, Macle L, Klassen S, Glover B, Crystal E. Canadian national electrophysiology ablation registry report 2011-2016. BMC Health Serv Res 2021; 21:435. [PMID: 33957918 PMCID: PMC8101210 DOI: 10.1186/s12913-021-06441-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/PURPOSE Interventional cardiac electrophysiology (EP) is a rapidly evolving field in Canada; a nationwide registry was established in 2011 to conduct a periodic review of resource allocation. METHODS The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, success rates, and wait times. Leading physicians from each EP lab were contacted electronically; participation was voluntary. RESULTS All Canadian EP centres were identified (n = 30); 50 and 45 % of active centres participated in the last 2 instalments of the registry. A mean of 508 ± 270 standard and complex catheter ablation procedures were reported annually for 2015-2016 by all responding centres. The most frequently performed ablation targets atrial fibrillation (PVI) arrhythmia accounting for 36 % of all procedures (mean = 164 ± 85). The number of full time physicians ranges between 1 and 7 per centre, (mean = 4). The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1-4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85 % centres; 38 % of the respondents use circular ablation techniques. CONCLUSIONS This initiative provides contemporary data on invasive electrophysiology lab practices. The EP registry provides activity benchmarks on national trends and practices.
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Affiliation(s)
- Anna Kaoutskaia
- Sunnybrook Health Sciences Centre, University of Toronto, 890 Sheppard Avenue West, Ontario, M4N 3M5, Toronto, Canada.
- St. Matthew's University School of Medicine, Grand Cayman, Cayman Islands.
| | | | - Guy Amit
- McMaster University, Hamilton, Ontario, Canada
| | | | - Derek Exner
- University of Calgary, Calgary, Alberta, Canada
| | - Satish Toal
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | | | | | | | - Omar Sultan
- Regina General Hospital, Regina, Saskatchewan, Canada
| | - Girish Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc Deyell
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Benedict Glover
- Sunnybrook Health Sciences Centre, University of Toronto, 890 Sheppard Avenue West, Ontario, M4N 3M5, Toronto, Canada
| | - Eugene Crystal
- Sunnybrook Health Sciences Centre, University of Toronto, 890 Sheppard Avenue West, Ontario, M4N 3M5, Toronto, Canada
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Sultan O, Nuhmani S, Muaidi QI. Comparison of plantar loading patterns on natural grass and artificial turf during various athletic activities. J Sports Med Phys Fitness 2021; 61:680-686. [PMID: 33472347 DOI: 10.23736/s0022-4707.21.11342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to investigate the differences in plantar pressure during various athletic activities on natural grass and artificial turf. METHODS Twenty-one athletes were fitted with properly sized soccer shoes and corresponding F-Scan system insoles and performed walking, running, vertical jumping and cutting activities to the right and left sides on both natural and artificial turf. RESULTS There were no statistically significant differences between natural grass and artificial turf in peak pressure, maximum force and force-time integral during all the athletic activities (P˃0.05). On both turfs, the highest peak pressure and maximum force values occurred during running and cutting to the right, and the highest force-time integral value occurred during cutting to the right. There were no statistically significant differences between the two turfs in peak pressure in the various anatomical regions during any of the athletic activities (P˃0.05). The peak pressure was the highest on the first metatarsal and the hallux during all five activities. A clinically meaningful difference between the surfaces in peak pressure on the second to fifth metatarsals was found during walking, indicating more loading on artificial turf than on natural grass. There was more loading on artificial turf than on natural grass during cutting left and at hallux and third toe on natural grass during cutting right. However, these differences were not statistically significant (P˃0.05). CONCLUSIONS The results of this study suggest that it is important to limit or prevent athletes from undertaking certain activities that increase the risk of re-injury during rehabilitation.
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Affiliation(s)
- Omar Sultan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia -
| | - Qassim I Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Kaoutskaia A, Shurrab M, Amit G, Parkash R, Exner D, Toal S, Sterns L, Sarrazin JF, Glover B, Chauhan V, Sultan O, Nair G, Deyell MW, Macle L, Crystal E. P1872Canadian electrophysiology labs registry report update 2011–2018. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Interventional cardiac electrophysiology (EP) is rapidly evolving; a nationwide registry was established and re-administered since 2011 to conduct a periodic review of resource allocation across Canada.
Methods
The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, and wait times. Leading physicians from each EP lab were contacted electronically.
Results
All Canadian EP centres were identified (n=30); 50% and 45% of active centres participated in the last 2 instalments of the registry. Since 2011, data has been consistently obtained from 11 university-affiliated centres. Table 1 reports trends in procedural volumes and operators. Figure 1 depicts the ablations done per operator. The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, 15.9 weeks for VT ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1–4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85% and cryoballoon in 77% of the centres; 38% of the respondents use circular ablation techniques.
Trends in procedural volumes + operators 2015–2016 2013–2014 2011–2012 Procedures per operator 117±70 120±68 113±42 Procedures per centre 498±299 477±245 446±237 Ratio of staff to trainees 2.0:1 1.6:1 1.5:1 Full time physicians per centre 4.1 (0–7) 4.1 (1–7) 3.5 (0–7) Nurses trained specifically for EP 4.6 (0–10) 4.4 (0–10) n/a Ablation procedures volume: AV Reciprocal Tachycardia 12% 10% 11% AV Nodal Re-entry Tachycardia 18% 19% 23% Atrial Fibrillation/Atypical Flutter 33% 35% 30% Typical Flutter 20% 14% 19% Ventricular Tachycardia 8% 8% 10% Total annual ablations in all respondent centres 5478 5243 4908 Mean ± standard deviation. Staff (full-time + part-time prorated to 0.5).
Annual ablation volumes per operator
Conclusion
This initiative provides contemporary data on invasive EP practices. The results show feasibility in data collection which will serve as a reference for decisions regarding resource planning.
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Affiliation(s)
- A Kaoutskaia
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Shurrab
- Health Sciences North, Sudbury, Canada
| | - G Amit
- McMaster University, Hamilton, Canada
| | - R Parkash
- Dalhousie University, Halifax, Canada
| | - D Exner
- University of Calgary, Calgary, Canada
| | - S Toal
- Saint John Regional Hospital, Saint John, Canada
| | - L Sterns
- Royal Jubilee Hospital, Victoria, Canada
| | | | - B Glover
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - V Chauhan
- Toronto General Hospital, Toronto, Canada
| | - O Sultan
- Regina General Hospital, Regina, Canada
| | - G Nair
- University of Ottawa Heart Institute, Ottawa, Canada
| | - M W Deyell
- University of British Columbia, Vancouver, Canada
| | - L Macle
- Montreal Heart Institute, Montreal, Canada
| | - E Crystal
- Sunnybrook Health Sciences Centre, Toronto, Canada
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Krahn AD, Longtin Y, Philippon F, Birnie DH, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Gervais P, Rioux L, Hemels MEW, Bouwels LHR, van Vlies B, Wang J, Exner DV, Dorian P, Parkash R, Alings M, Connolly SJ. Prevention of Arrhythmia Device Infection Trial: The PADIT Trial. J Am Coll Cardiol 2019; 72:3098-3109. [PMID: 30545448 DOI: 10.1016/j.jacc.2018.09.068] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/09/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infection of implanted medical devices has catastrophic consequences. For cardiac rhythm devices, pre-procedural cefazolin is standard prophylaxis but does not protect against methicillin-resistant gram-positive organisms, which are common pathogens in device infections. OBJECTIVE This study tested the clinical effectiveness of incremental perioperative antibiotics to reduce device infection. METHODS The authors performed a cluster randomized crossover trial with 4 randomly assigned 6-month periods, during which centers used either conventional or incremental periprocedural antibiotics for all cardiac implantable electronic device procedures as standard procedure. Conventional treatment was pre-procedural cefazolin infusion. Incremental treatment was pre-procedural cefazolin plus vancomycin, intraprocedural bacitracin pocket wash, and 2-day post-procedural oral cephalexin. The primary outcome was 1-year hospitalization for device infection in the high-risk group, analyzed by hierarchical logistic regression modeling, adjusting for random cluster and cluster-period effects. RESULTS Device procedures were performed in 28 centers in 19,603 patients, of whom 12,842 were high risk. Infection occurred in 99 patients (1.03%) receiving conventional treatment, and in 78 (0.78%) receiving incremental treatment (odds ratio: 0.77; 95% confidence interval: 0.56 to 1.05; p = 0.10). In high-risk patients, hospitalization for infection occurred in 77 patients (1.23%) receiving conventional antibiotics and in 66 (1.01%) receiving incremental antibiotics (odds ratio: 0.82; 95% confidence interval: 0.59 to 1.15; p = 0.26). Subgroup analysis did not identify relevant patient or site characteristics with significant benefit from incremental therapy. CONCLUSIONS The cluster crossover design efficiently tested clinical effectiveness of incremental antibiotics to reduce device infection. Device infection rates were low. The observed difference in infection rates was not statistically significant. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot] [PADIT]; NCT01002911).
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Affiliation(s)
- Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Canada
| | - François Philippon
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Division of Cardiology, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- Division of Cardiology, St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Division of Cardiology, Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Division of Cardiology, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel Degrâce
- Division of Cardiology, Hôtel-Dieu de Lévis, Levis, Quebec, Canada
| | - Bernard Thibault
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eugene Crystal
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Philippe Gervais
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Leon Rioux
- Division of Cardiology, Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Division of Cardiology, Rijnstate Hospital, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Leon H R Bouwels
- Division of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Bob van Vlies
- Division of Cardiology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Derek V Exner
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Division of Cardiology, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Marco Alings
- Division of Cardiology, Amphia Ziekenhuis & Working Group on Cardiovascular Research The Netherlands (WCN), Breda, the Netherlands
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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11
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Malhi N, Cheung CC, Deif B, Roberts JD, Gula LJ, Green MS, Pang B, Sultan O, Konieczny KM, Angaran P, Dorian P, Lashevsky I, Healey JS, Alak A, Tadros R, Andorin A, Steinberg C, Ayala-Paredes F, Simpson CS, Atallah J, Krahn AD. Challenge and Impact of Quinidine Access in Sudden Death Syndromes. JACC Clin Electrophysiol 2019; 5:376-382. [DOI: 10.1016/j.jacep.2018.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022]
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12
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Mahfud R, Latief NAEL, Sultan O. Biosorption of Methylene Blue from Aqueous Solution Using Seagrass: Batch Study. Advances in Science, Technology & Innovation 2018:231-233. [DOI: 10.1007/978-3-319-70548-4_74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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13
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Sheldon R, Talajic M, Becker G, Essebag V, Sultan O, Ritchie D, Rose S, Morillo C, Krahn A, Brignole M, Maxey C. SYNCOPE: PACING VERSUS RECORDING IN THE LATER YEARS. A RANDOMIZED PRAGMATIC CLINICAL TRIAL OF STRATEGIES OF PERMANENT PACEMAKER VERSUS IMPLANTABLE CARDIAC MONITOR IN OLDER PATIENTS WITH SYNCOPE. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Sultan O, Rana Z. P1395Role of PVAC therapy in the setting of recurrent atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux158.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Shurrab M, Fishman E, Kaoutskaia A, Birnie D, Ayala-Paredes F, Sultan O, Chauhan V, Skanes A, Parkash R, Morillo C, Janmohamed A, Toal S, Essebag V, Sterns L, Veenhuyzen G, Mangat I, Redfearn D, Philippon F, Connors S, Healey J, Verma A, Crystal E. Snapshot of adult invasive cardiac electrophysiology in Canada: results of the web-based registry. J Interv Card Electrophysiol 2014; 40:93-8. [PMID: 24752794 DOI: 10.1007/s10840-014-9899-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Interventional cardiac electrophysiology (EP) has experienced a significant growth in Canada. Our aim is to establish a periodic registry as a nationwide initiative. METHODS The registry is designed to collect information regarding EP laboratory infrastructure, human resources, and the spectrum and volumes of EP procedures. Respective administrative staff were contacted electronically. RESULTS Out of 25 identified Canadian EP centers, 19 centers (76%) have participated in the registry. Responding centers have access on average to 5.3 lab days per week to perform EP studies/ablations; average lab time per full- and part-time (prorated to 0.5) EP physician is 0.8 day per week. Diagnostic EP studies and radio-frequency ablations are performed in all (19) centers; cryoablation is available in 83% of centers. Two centers have remote magnetic navigation systems. EnSite NavX is the most widely available 3D mapping system utilized in 15 (83%) centers, followed by CARTO and intracardiac echo which are each available in 14 (78%) centers; LocaLisa is actively used in one center. The number of full-time physicians ranges between 0 and 7, with a mean of 3.5 full-time physicians per center. The ratio of staff to trainees is 1.6:1. A total of 8,041 EP procedures are performed in the 19 centers per annum. On an annual average, 104 procedures per one operator and 159 procedures per trainee are performed. CONCLUSIONS This registry provides contemporary information on invasive EP lab resources and procedures in Canada. It also demonstrates that Canadian EP procedural intensities of practice and training are comparable to international standards.
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16
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Shurrab M, Fishman E, Kaoutskaia A, Birnie D, Ayala-Paredes F, Sultan O, Chauhan V, Skanes A, Parkash R, Morillo C, Janmohamed A, Toal S, Essebag V, Sterns L, Veenhuyzen G, Mangat I, Redfearn D, Verma A, Crystal E. Snapshot of Invasive Electrophysiology in Canada in 2012: Results From the National Survey. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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17
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Fagerquist CK, Sultan O, Carter MQ. Possible evidence of amide bond formation between sinapinic acid and lysine-containing bacterial proteins by matrix-assisted laser desorption/ionization (MALDI) at 355 nm. J Am Soc Mass Spectrom 2012; 23:2102-2114. [PMID: 23055076 DOI: 10.1007/s13361-012-0490-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/29/2012] [Accepted: 09/03/2012] [Indexed: 06/01/2023]
Abstract
We previously reported the apparent formation of matrix adducts of 3,5-dimethoxy-4-hydroxy-cinnamic acid (sinapinic acid or SA) via covalent attachment to disulfide bond-containing proteins (HdeA, Hde, and YbgS) from bacterial cell lysates ionized by matrix-assisted laser desorption/ionization (MALDI) time-of-flight-time-of-flight tandem mass spectrometry (TOF-TOF-MS/MS) and post-source decay (PSD). We also reported the absence of adduct formation when using α-cyano-4-hydroxycinnamic acid (CHCA) matrix. Further mass spectrometric analysis of disulfide-intact and disulfide-reduced over-expressed HdeA and HdeB proteins from lysates of gene-inserted E. coli plasmids suggests covalent attachment of SA occurs not at cysteine residues but at lysine residues. In this revised hypothesis, the attachment of SA is preceded by formation of a solid phase ammonium carboxylate salt between SA and accessible lysine residues of the protein during sample preparation under acidic conditions. Laser irradiation at 355 nm of the dried sample spot results in equilibrium retrogradation followed by nucleophilic attack by the amine group of lysine at the carbonyl group of SA and subsequent amide bond formation and loss of water. The absence of CHCA adducts suggests that the electron-withdrawing effect of the α-cyano group of this matrix may inhibit salt formation and/or amide bond formation. This revised hypothesis is supported by dissociative loss of SA (-224 Da) and the amide-bound SA (-206 Da) from SA-adducted HdeA and HdeB ions by MS/MS (PSD). It is proposed that cleavage of the amide-bound SA from the lysine side-chain occurs via rearrangement involving a pentacyclic transition state followed by hydrogen abstraction/migration and loss of 3-(4-hydroxy-3,5-dimethoxyphenyl)prop-2-ynal (-206 Da).
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Affiliation(s)
- Clifton K Fagerquist
- Agricultural Research Service, US Department of Agriculture, Western Regional Research Center, 800 Buchanan Street, Albany, CA 94710, USA.
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Fagerquist CK, Sultan O. A new calibrant for matrix-assisted laser desorption/ionization time-of-flight-time-of-flight post-source decay tandem mass spectrometry of non-digested proteins for top-down proteomic analysis. Rapid Commun Mass Spectrom 2012; 26:1241-1248. [PMID: 22499200 DOI: 10.1002/rcm.6220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
RATIONALE Matrix-assisted laser desorption/ionization (MALDI) time-of-flight-time-of-flight (TOF-TOF) post-source decay (PSD) tandem mass spectrometry (MS/MS) has seen increasing use for analysis of non-digested protein ions for top-down proteomic identification. However, there is no commonly accepted calibrant for this purpose beyond the use of peptide calibrants whose fragment ions span a lower mass-to-charge (m/z) range. METHODS We have used the PSD-generated fragment ions of disulfide-reduced/alkylated thioredoxin (AlkTrx) for TOF-TOF calibration in reflectron mode for the purpose of PSD-MS/MS analysis. The average m/z values of AlkTrx fragment ions were used for calibration. The quality of the calibration was assessed from the observed fragment ion mass error of MS/MS of the YahO protein from an unfractionated bacterial cell lysate of Escherichia coli O157:H7 as well as from MS/MS of bovine ubiquitin. The fragment ion mass errors of these two analytes were also used to assess instrument calibration using the monoisotopic fragment ions of [Glu(1)]-fibrinopeptide B (GluFib). RESULTS A general improvement in fragment ion mass accuracy was observed using the AlkTrx calibration compared to the GluFib calibration which resulted in a more significant top-down proteomic identification of these analyte proteins. CONCLUSIONS Our results suggest that AlkTrx may be useful as a calibrant for MALDI-TOF-TOF-PSD-MS/MS of small and modest-sized protein ions. The uniform fragmentation efficiency of YahO across its sequence suggests that it may be useful as a post-calibration standard to assess PSD-MS/MS instrument performance as well as establishing appropriate top-down proteomic fragment ion tolerances.
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Affiliation(s)
- Clifton K Fagerquist
- Western Regional Research Center, Agricultural Research Service, US Department of Agriculture, Albany, CA 94710, USA.
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Hiraoka M, Urschitz J, Sultan O, Ward K. A polymorphism in the retinol binding protein 4 gene is not associated with gestational diabetes mellitus in several different ethnic groups. Hawaii Med J 2011; 70:164-167. [PMID: 21886308 PMCID: PMC3158378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Various Asian and Pacifific Islander groups have higher prevalence rates of type 2 diabetes and gestational diabetes. This increased incidence is likely to include genetic factors. Single nucleotide polymorphisms in the retinol binding protein 4 gene have been linked to the occurrence of type 2 diabetes. Hypothesizing a link between retinol binding protein 4 and gestational diabetes, we performed a candidate gene study to look for an association between an important retinol binding protein gene polymorphism (rs3758539) and gestational diabetes. STUDY DESIGN Blood was collected from Caucasian, Asian, and Pacific Islander women diagnosed with gestational diabetes and from ethnically matched non-diabetic controls. DNA was extracted and real time PCR technology (TaqMan, Applied Biosystems) used to screen for the rs3758539 single nucleotide polymorphism located 5' of exon 1 of the retinol binding protein 4 gene. RESULTS Genotype and allele frequencies in the controls and gestational diabetes cases were tested using chi-square contingency tests. Genotype frequencies were in Hardy-Weinberg equilibrium. There was no association between the rs3758539 retinol binding protein 4 single nucleotide polymorphism and gestational diabetes in the Caucasian, Filipino, or Pacific Islander groups. CONCLUSION Interestingly, the rs3758539 retinol binding protein 4 single nucleotide polymorphism was not found to be associated with gestational diabetes. The absence of association suggests that gestational and type 2 diabetes may have more divergent molecular pathophysiology than previously suspected.
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Affiliation(s)
- Mark Hiraoka
- University of Hawai'i, Department of Obstetrics, Gynecology and Women's Health, Honolulu, USA.
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Lin A, Sultan O, Lau HK, Wong E, Hartman G, Lauzon CR. O serogroup specific real time PCR assays for the detection and identification of nine clinically relevant non-O157 STECs. Food Microbiol 2011; 28:478-83. [DOI: 10.1016/j.fm.2010.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 10/14/2010] [Accepted: 10/19/2010] [Indexed: 11/29/2022]
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21
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Fagerquist CK, Sultan O. Induction and identification of disulfide-intact and disulfide-reduced β-subunit of Shiga toxin 2 from Escherichia coli O157:H7 using MALDI-TOF-TOF-MS/MS and top-down proteomics. Analyst 2011; 136:1739-46. [PMID: 21336382 DOI: 10.1039/c0an00909a] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The disulfide-intact and disulfide-reduced β-subunit of Shiga toxin 2 (β-Stx2) from Escherichia coli O157:H7 (strain EDL933) has been identified by matrix-assisted laser desorption/ionization time-of-flight-time-of-flight tandem mass spectrometry (MALDI-TOF-TOF-MS/MS) and top-down proteomic analysis using software developed in-house. E. coli O157:H7 was induced to express Stx2 by culturing on solid agar media supplemented with 10-50 ng mL(-1) of ciprofloxacin (CP). Bacterial cell lysates at each CP concentration were analyzed by MALDI-TOF-MS. A prominent ion at mass-to-charge (m/z) ~7820 was observed for the CP concentration range: 10-50 ng mL(-1), reaching a maximum signal intensity at 20 ng mL(-1). Complex MS/MS data were obtained of the ion at m/z ~7820 by post-source decay resulting in top-down proteomic identification as the mature, signal peptide-removed, disulfide-intact β-Stx2. Eight fragment ion triplets (each spaced Δm/z ~33 apart) were also observed resulting from backbone cleavage between the two cysteine residues (that form the intra-molecular disulfide bond) and symmetric and asymmetric cleavage of the disulfide bond. The middle fragment ion of each triplet, from symmetric disulfide bond cleavage, was matched to an in silico fragment ion formed from cleavage of the backbone at a site adjacent to an aspartic acid or glutamic acid residue. The flanking fragment ions of each triplet, from asymmetric disulfide bond cleavage, were not matched because their corresponding in silico fragment ions are not represented in the database. Easier to interpret MS/MS data were obtained for the disulfide-reduced β-Stx2 which resulted in an improved top-down identification.
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Affiliation(s)
- Clifton K Fagerquist
- Western Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, 800 Buchanan Street, Albany, CA 94710, USA.
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Sadat-Ali M, Al-Elq AH, Sultan O, Al-Turki H, Bukhari R, Al-Mulhim E. Low bone mass due to sickle cell anemia: is it becoming a real issue? West Afr J Med 2008; 27:218-223. [PMID: 19469399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The prevalence of sickle cell anemia in Saudi population was reported to be between 0-5.27%. OBJECTIVE This cross-sectional study was conducted to assess the prevalence of osteoporosis and osteopenia in patients with sickle cell anemia and to correlate its severity with the hematological parameters. METHODS A cross-sectional study which included consecutive adult patients with sickle cell anemia attending the outpatient clinics or were admitted with uncomplicated vaso-occlusive crisis to King Fahd University Hospital, Al Khobar, Saudi Arabia, between August 2006 and March 2007 was undertaken. After informed verbal consent to participate, patient's age and sex were documented and body mass index (BMI) calculated. Blood was drawn for heamatological and biochemical parameters. Bone mineral density (BMD) measurement was done using dual energy X-ray absorbtiometry (DEXA) at upper femur and lumbar spine. Osteopenia and osteoporosis were diagnosed as per the WHO criteria. RESULTS A total of 87 patients were studied. There were 41 male and 46 female patients. The mean age of males was 29.59+/-6.1 years, and females was 32.1+/-7.6 years. Over 65% of the males and 65.2% of the females were either osteopenic or osteoporotic. The prevalence of osteoporosis in both groups was highest at lumbar spine. Other variables like BMI, percentage of sickle hemoglobin and degree of anemia did not affect the bone mass. CONCLUSIONS This study supports the view that prevalence of osteopenia and osteoporosis among sickle cell anemia patients is high. Sickle cell anemia is becoming the most common cause of secondary osteoporosis and physician's awareness about this issue is essential for early diagnosis and appropriate management.
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Affiliation(s)
- M Sadat-Ali
- Department of Orthopaedic Surgery, King Fahd University Hospital, Saudi Arabia.
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Sultan A, Killeen J, Sultan O, Carney ME. Endometriosis may be the pre-malignant lesion for certain histologic subtypes of ovarian cancers. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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