Patent foramen ovale in liver transplant recipients does not negatively impact short-term outcomes.

AIM: Patent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of a PFO in patients undergoing liver transplantation (LT) is unknown. OBJECTIVE: Assess the impact of PFO and physiologic intrapulmonary shunt (IPS) on the perioperative outcomes of patients who underwent LT. METHODS: We performed a retrospective, intention-to-treat analysis of patients with PFO and controls without PFO who underwent LT at Mayo Clinic in Florida between 2008 and 2013. Patients with physiologic IPS were also analyzed. The cohorts were compared for baseline characteristics, length of stay in the intensive care unit (ICU), postoperative oxygen requirements, 30-d cerebrovascular accidents, and mortality. RESULTS: Of the 935 patients who underwent LT, 10.4% had proven PFO by pre-LT echocardiogram. Control patients (n = 101) were statistically older than PFO and IPS (n = 56) patients, but similar in sex, BMI, Model for End-stage Liver Disease score, American Society of Anesthesiologist score, and left ventricular ejection fraction. PFO and IPS patients had similar length of stay in the ICU, mechanical ventilation times, post-LT oxygen requirements, and 30-d mortality compared to controls. Subgroup analysis showed similar outcomes for large PFO and IPS patients to controls. CONCLUSIONS: The presence of PFO did not have a negative impact on perioperative LT outcomes.

Chemical analysis of Hg0-containing Hindu religious objects.

Parad items used in Hindu practices and Ayurvedic medicines contain elemental mercury (Hg0) and have traditionally been used in prayer and to treat a variety of diseases including diabetes, heart conditions, and sexual dysfunction. These items are often referred to as amalgams of silver, and take the form of shivlings, statues of gods, necklaces, and other jewelry. Fourteen parad items were purchased from online vendors in India and the United States and analyzed. All items produced copious amounts of Hg0 vapor, with Hg0 concentrations exceeding 1,000,000 ng/m3 as measured using a Mercury Instruments Mercury Tracker 3000 IP atomic absorption spectrometer. Measured concentrations were highly variable, so a simple qualitative experiment employing a UV-C light source and a thin-layer chromatography plate impregnated with a fluorescent dye that glows green when irradiated at 254 nm allowed for the indirect visualization of the Hg0 being evolved. In addition, all items were screened using a hand-held X-ray fluorescence analyzer to estimate the concentration of Hg, Sn, Pb, As, and Cd on the surface of the item. Select samples were then digested in aqua regia and analyzed for Hg content using a direct mercury analyzer. All samples were found to exceed 20% by mass Hg. The digestates were analyzed using inductively-coupled plasma-optical emission spectrometry and were determined to be between 10-55% by mass Pb and contain up to 0.3% by mass As. While Article 4 of the Minamata Convention on Mercury specifically requires parties to stop importing, exporting, and manufacturing Hg-added products, products used in traditional and religious practices are excluded.

Incidence of Sustained Ventricular Tachycardia in Patients with Prolonged QTc After the Administration of Azithromycin: A Retrospective Study.

BACKGROUND: Azithromycin has been associated with abnormalities of cardiac repolarization and development of torsades de pointes. Observational data suggest that the risk of death from cardiovascular causes is increased in patients taking azithromycin. Little is known regarding the risk of ventricular arrhythmia in patients with prolongation of the corrected QT interval who receive azithromycin. OBJECTIVE: The purpose of this study was to determine the incidence of sustained ventricular tachycardia in patients with prolonged corrected QT (QTc) who subsequently received azithromycin. METHODS: We performed a retrospective cohort analysis of the incidence of sustained ventricular tachycardia in patients with prolonged QTc (greater than 450 ms) who successively received intravenous (IV) and/or oral azithromycin. Patients hospitalized in a tertiary care teaching hospital between November 2009 and June 2012 were included in the study. The primary outcome was sustained ventricular tachycardia documented in patients on telemetry. RESULTS: Of the 103 patients enrolled in the study, only one patient experienced the primary outcome (0.97 %). The event occurred 1 day after the administration of a single dose of 500 mg IV azithromycin. CONCLUSION: The risk of sustained ventricular tachycardia was 0.97 % in our cohort of patients with prolonged QTc who subsequently received azithromycin. Given the small size of this study, additional research is needed to determine the true incidence of arrhythmia in the population.