A 10-year review of presentation, management and outcomes of STEMI in a high-volume regional tertiary Australian centre.

OBJECTIVE: To assess the trends and impact of changes in management of ST Elevation Myocardial Infarction (STEMI) from 2010 to 2019. DESIGN: Retrospective analysis of data from STEMI hospitalisations including demographic, comorbidity, angiographic and outcome data. SETTING/PARTICIPANTS: High-volume non-surgical regional Australian tertiary referral centre. MAIN OUTCOME MEASUREMENTS: Index & 12-month mortality (all-cause & cardiovascular), door-to-balloon time, target-vessel failure, target-vessel revascularisation & procedure-related bleeding. RESULTS: From 2010 to 2019, 1299 patients presented with STEMI. The cardiovascular risk factor profile did not significantly change over the 10-year study period, p = 0.23. There was a significant trend toward culprit vessel percutaneous coronary intervention with stenting, rather than balloon angioplasty followed by surgical revascularisation, p = 0.029. The mean door-to-balloon time was 88 +/- 5.7 min and demonstrated a statistically significant improvement across the decade, p = 0.035. Radial access became the preferred angiographic approach (2010 92% femoral, 2019 91% radial). Drug-eluting stents (DES) replaced bare metal stent use. There was a statistically significant reduction in 12-month cardiovascular mortality across the decade (p = 0.042). However index hospitalisation (cardiovascular and all-cause) and 12-month all-cause mortality did not reduce. Young patients and women are important sub-groups of STEMI presentations with different risk factor profile. CONCLUSIONS: Advances in management of STEMI such as radial access, use of DES and a significant reduction in door-to-balloon time across the decade resulted in a reduction of 12-month cardiovascular mortality over the decade however there was no significant reduction in 12-month all-cause mortality, or index hospitalisation cardiovascular or index hospitalisation all-cause mortality. Further research is needed to ensure non-mortality outcomes, such as heart failure hospitalisation and quality of life, also demonstrate temporal improvement with STEMI management advances. Earlier cardiovascular risk assessment should be considered in smokers than is currently recommended in Australian guidelines (≥45yo for most individuals).

Characterization of microbes associated with cervico-vaginal adhesion in the reproductive system of camels (Camelus dromedaries).

Vaginal and cervical adhesions are severe long-standing reproductive disorder in dromedaries and consequently result in a high culling rate. This study was designed to compare the microbial communities of the vaginae, cervices, and uteri of normal (n = 10) camels versus camels suffering from cervico-vaginal adhesion (n = 23). Vaginal, cervical, and uterine swab samples were collected from control and affected animals. Furthermore, serum samples were obtained for serological testing of Chlamydiosis and Coxiellosis. For bacteriological and fungal examination, swab samples were plated on Columbia and Saboraud's dextrose agar, respectively. Polymerase chain reaction (PCR) assay was applied to samples expressed seropositive for Chlamydiosis. Vaginal swab bacterial cultures showed that the affected animals were significantly infected with Staphylococcus aureus (P = 0.0322, CI: 0.25-0.95) than the control, while mycological cultures showed that both control and affected animals were infected with Cryptococcus and Candida albicans. Corynebacterium spp. (22.7%), Pseudomonas spp. (4.5%), Klebsiella spp. (9.1%), T. pyogenes (18.2%), and anaerobic bacteria (Fusobacterium necrophorum and Clostridium spp.; 34.78%) were also identified in affected animals. Cervical samples from affected animals were distinguished by the existence of S. aureus (27.8%), Klebsiella spp. (5.6%), Corynebacterium spp. (22.2%), Cryptococcus (16.7%), Proteus spp. (11.1% (, T. pyogenes (11.1%), Pseudomonas spp. (5.6%), and Fusobacterium necrophorum (17.4%). Uterine samples from affected animals were characterized by the presence of S. aureus (22.2%), Streptococcus (22.2%), Corynebacterium spp. (11.1%), E. coli (11.1%), and Pseudomonas spp. (11.1%). Anaerobic bacteria were not isolated from control nor affected animals. Enzyme immunoassays revealed that 50% and 34.8% of the control and affected animals were positive for Coxiella burnetii, respectively, Chlamydia was detected in 43.5% of samples from affected animals, only 60% of which were confirmed positive. These results show that microbial communities linked with cervico-vaginal adhesion in dromedary camels are likely to be polymicrobial. The findings of this study are helpful in designing antimicrobial therapies toward reducing the incidence for cervico-vaginal adhesion.