The role of an antibiotic envelope in the prevention of major cardiac implantable electronic device infections: A systematic review and meta-analysis.

BACKGROUND: Over the past decade, rates of cardiac implantable electronic device (CIED) related infections have increased and been associated with increased morbidity, mortality and financial burden on healthcare systems. METHODS: To examine the effect of an antibacterial envelope in reducing major CIED related infections, we performed a systematic review and meta-analysis by searching PubMed/MEDLINE, CENTRAL, Google scholar and Clinicaltrials.gov for studies that examined the effect of an antibiotic envelope in reducing major related CIED infections, comprising of device-related endocarditis, systemic infection requiring systemic antibiotics and or device extraction, compared to control up till February 15th, 2020. A random-effects meta-analysis was conducted by calculating risk ratios (RR) and respective 95% confidence intervals (CI). RESULTS: We include 6 studies that comprise of 11,897 patients, of which 5844 received an antibiotic envelope and 6053 did not. Compared with control, utilization of an antibiotic envelope at the time of procedure was associated with a significant 74% relative risk reduction in major CIED related infections among patients at high risk for infection (RR: 0.26 [95% CI, 0.08-0.85]; P = .03), while no significant reduction was observed among patients enrolled from studies with any risk for infection (RR: 0.53 [95% CI, 0.06-4.52]; P = .56). Additionally, no reduction in mortality among patients that received an envelope compared to control was observed (RR: 1.15 [95% CI, 0.53-2.50]; P = .72). CONCLUSION: The utilization of an antibiotic envelope at the time of device implantation or upgrade reduces major CIED infections, especially if used in patients perceived to be at higher risk for infection.

Transrectal ultrasound guided biopsy for detecting prostate cancer: can random biopsies be reduced using the 4-dimensional technique?

We present our experience with a new technique of real time 3-dimensional sonography -- "4-dimensional Transrectal ultrasound (TRUS)" guided prostate biopsy. A total of 64 patients suspected of having prostate cancer based on an elevated prostate-specific antigen (greater than 4 ng/ml) formed the study group. A voluson (General Electric Vivid 3) ultrasound machine equipped with a transrectal 5-8 MHz curvilinear transducer was used. Sonography-guided prostate biopsy was performed following prostate imaging and volume calculation using 3D and 4D imaging. Biopsies of tumor suspicious areas, if present, as well as random biopsies were done. Histopathology showed prostate cancer in 15 (23.4%) and benign prostatic conditions in 49 (76.6%). TRUS examination in the 15 detected prostatic cancers showed that 6(40%) were hypoechoic, 4 (26.7%) were of mixed hypo and hyper echogenicity, 1 (6.7%) was hyperechoic, and 4 (26.7%) were isoechoic. TRUS finding of a hypoechoic lesion was significantly associated with malignancy. Other TRUS findings such as texture, calcification, and cysts did not show any association with malignancy. Mortality was zero after ultrasound-guided prostate biopsy. TRUS is the diagnostic test of choice in detection of prostate cancer. With advances in the technique of TRUS, effort is being made to identify more subtle lesions in order to reduce random biopsies. 4-Dimensional TRUS does improve the diagnostic accuracy but there is still a group of patients with "invisible" cancers. Therefore, the policy of random biopsies has to be continued till this incidence can be eliminated.

In vivo and in vitro assessment of human saphenous vein wall changes.

PURPOSE: To investigate if noradrenaline (NA) and 5-hydroxyptamine (5-HT) drugs induce responses of isolated control and varicose veins are altered by removal of the endothelium. SUBJECTS #ENTITYSTARTX00026; METHODS: Specimens of the great saphenous vein (GSV) were obtained from 12 subjects with primary varicose veins and 12 subjects from donor vessels at cardiac surgery. A total of 10 normal healthy volunteers were selected for comparison. The diameter changes of GSV during the resting phase, at the end of 5 minutes occlusion, and then every 30 seconds post deflation for five minutes were measured using B-mode ultrasound. Post-surgery the vein sample was collected in a tube of Krebs-Henseleit solution. RESULTS: The repeated measure ANOVA test for the diameter, percent, and difference changes of GSV diameter from maximum diameter at different time intervals showed significance difference within and between all groups. NA and 5-HT produced concentration-dependent contractions of control and varicose saphenous vein segments. There was no significant difference in the potency of NA and for 5-HT, but the maximum response, normalized for tissue weight, was less in varicose vein segments. Removal of the endothelium had no effect on the potency of NA or 5-HT but significantly (p<0.05) reduced the maximum response to NA and 5-HT in varicose vein segments but not to 5-HT in control veins. CONCLUSION: The venous endothelial damage may cause vascular smooth muscle contractions dysfunction that favours dilatation and secondary valvular insufficiency.