Do barrier dressings reduce cardiac implantable device infection: Protocol for a randomized controlled trial (BARRIER-PROTECT).

Background: Cardiac implantable electronic device (CIED) procedures can be associated with serious complications, including infection with significant mortality and morbidity, necessitating removal of the device and prolonged hospitalization. One potential pathophysiological mechanism is pocket contamination at the time of device implantation. Therefore, steps taken to prevent contamination at this stage can potentially reduce CIED infections.The barrier dressing, an adhesive material applied to the skin, has the potential to reduce the colonization of the surgical site with host flora that can predispose to infection. There are a limited number of randomized prospective studies on barrier dressing use during various surgeries, but it has never been systematically studied in CIED implantation. Objectives: Do Barrier Dressings Reduce Cardiac Implantable Device Infection? (BARRIER-PROTECT trial; NCT04591366) is a single-centre, prospective, double-armed, single-blinded, randomized controlled trial designed to evaluate the use of an intra-operative adhesive barrier dressing to reduce the risk of end-of-procedure pocket swab positivity. We hypothesize that adhesive draping during implant procedures will reduce the risk of contamination from the skin flora. Also, we aim to investigate if the end-of-procedure pocket swab culture positivity can be used as a potential surrogate marker of CIED infection. Methods and Design: Patients undergoing a second or later procedure on the same device pocket (pulse generator change, lead/pocket revision or upgrade) will be enrolled. Eligible and consenting patients will be equally randomized to the use of barrier dressing or not using an automated web-based system. Patients, but not the operator, will be blinded to the arm. The person performing the pocket swabs will also be blinded. The primary endpoint is the end-of-procedure pocket swab culture positivity. The main secondary endpoint is the CIED infection rate. Discussion: This is the first randomized controlled trial to assess the effectiveness of using a barrier adhesive draping on reducing the end-of-procedure pocket swab culture positivity. In this study, we are exploring a low-cost intervention that may significantly reduce CIED infection. Also, having a valid surrogate marker for CIED infection at the time of implant will facilitate design of future clinical trials.

Impact of atrial fibrillation on the risk of major adverse cardiac events following coronary revascularisation.

OBJECTIVE: Atrial fibrillation (AF) remains a highly prevalent arrhythmia with significant burden on morbidity and mortality. The impact of AF in the revascularised population remains incompletely described. Given the high prevalence of AF in the revascularised population, we sought to evaluate the incidence and prognosis in patients with pre-existing and new-onset AF following revascularisation. METHODS: We used the University of Ottawa Heart Institute Revascularisation Registry to identify patients who underwent revascularisation between August 2015 and March 2020, who were prospectively followed for an average of one year. We conducted a retrospective cohort study analysing the association between AF and clinical outcomes. The primary outcome of interest was 1-year major adverse cardiac events (MACE) defined as a composite of death, myocardial infarction, unplanned revascularisation and cerebrovascular accidents. Moreover, secondary outcomes include the individual components of MACE and bleeding. RESULTS: A total of 6704 patients underwent revascularisation and completed 1-year clinical follow-up. Median time to follow-up was 12.8 (IQR 11.2-15.9) months. One-year MACE occurred in 166 (21.8%) and 683 (11.5%) patients in AF and non-AF groups, respectively (adjusted HR, 1.61; 95% CI 1.29 to 2.01; p<0.0001). AF was independently predictive of 1-year mortality, myocardial infarction, unplanned revascularisation, cerebrovascular accident and bleeding. Within 1 year, 299 (4.5%) episodes of new-onset AF was observed. New-onset AF following revascularisation was also associated with 1-year MACE, mortality, myocardial infarction, cerebrovascular accident and unplanned revascularisation. CONCLUSIONS: Preprocedural and new-onset AF following revascularisation remains highly predictive 1-year MACE. AF should be considered in addition to traditional risk factors for adverse outcomes following revascularisation.

Adamantinoma de la tibia con componente de quiste óseo aneurismático secundario / Adamantinoma of the tibia component of secondary aneurysmal bone cyst

El adamantinoma de los huesos largos es uno de los tumores malignos menos frecuentes, representando únicamente el 1%. Su localización en la tibia es la más común, y el tratamiento indicado es la resección en bloque y salvamento de extremidad. En algunos reportes de la literatura se describe con poca frecuencia un componente óseo aneurismático. En este artículo reportamos el caso de un paciente masculino quien presentó un adamantinoma de la tibia proximal con un gran componente de quiste óseo aneurismático que enmascaró su patología de base, y retrasó el diagnóstico y su tratamiento. Presentamos el tratamiento realizado, su evolución y las complicaciones presentadas.

Quiste óseo aneurismático grado 3 del tercio proximal de fémur manejo con arcos costales alogénicos: reporte de un caso / Grade 3 aneurysmal bone cyst of the proximal femur with costal arches allogeneic management: a case report

El Quiste Óseo Aneurismático (QOA) representa el 1% a 2% de todos los tumores óseos primarios, presentándose en el 80% de las veces en las primeras dos décadas de la vida, con cierta predilección por la metáfisis de los huesos largos tubulares; con una prevalencia discretamente mayor en el género femenino. La mayoría de los pacientes son tratados con curetaje asociado o no con injertos óseos y otros coadyuvantes locales. Se hace la presentación del caso una de niña de cinco años, que sufrió una fractura patológica pertrocantérica del fémur derecho secundaria a un QOA agresivo, cuyo tratamiento consistió en resección intralesional con injerto de matriz ósea desmineralizada y dos aloinjertos de arcos costales a manera de clavos cefalomedulares para reconstrucción. Después de 19 meses de seguimiento, observamos adecuada incorporación de los injertos con preservación de la articulación y buen resultado funcional.