Genetic risk factors for drug-induced long QT syndrome: findings from a large real-world case-control study.

Aim: Drug-induced long QT syndrome (diLQTS), an adverse effect of many drugs, can lead to sudden cardiac death. Candidate genetic variants in cardiac ion channels have been associated with diLQTS, but several limitations of previous studies hamper clinical utility. Materials & methods: Thus, the purpose of this study was to assess the associations of KCNE1-D85N, KCNE2-I57T and SCN5A-G615E with diLQTS in a large observational case-control study (6,083 self-reported white patients treated with 27 different high-risk QT-prolonging medications; 12.0% with diLQTS). Results: KCNE1-D85N significantly associated with diLQTS (adjusted odds ratio: 2.24 [95% CI: 1.35-3.58]; p = 0.001). Given low minor allele frequencies, the study had insufficient power to analyze KCNE2-I57T and SCN5A-G615E. Conclusion: KCNE1-D85N is a risk factor for diLQTS that should be considered in future clinical practice guidelines.

Some medications can lead to a condition called drug-induced long QT syndrome (diLQTS), which can be a serious abnormal heart rhythm in some patients. In our research, we explored three specific changes in DNA related to the electrical function of the heart (KCNE1-D85N, KCNE2-I57T, SCN5A-G615E) and their link to diLQTS. Our study revealed a connection between KCNE1-D85N and diLQTS. This study emphasized the importance of including KCNE1-D85N in the medical guidelines to help identify patients at risk of diLQTS. We were unable to identify the connection of KCNE2-I57T and SCN5A-G615E with diLQTS, due to a low number of carriers in the study.

Eyes and the heart: what a clinician should know.

The eye is prone to various forms of afflictions, either as a manifestation of primary ocular disease or part of systemic disease, including the cardiovascular system. A thorough cardiovascular examination should include a brief ocular assessment. Hypertension and diabetes, for example, would present with retinopathy and dyslipidaemia would present with corneal arcus. Multisystem autoimmune diseases, such as Graves' disease, rheumatoid arthritis and sarcoidosis, would present with proptosis, episcleritis and scleritis, respectively. Myasthenia gravis, while primarily a neuromuscular disease, presents with fatigable ptosis and is associated with Takotsubo cardiomyopathy and giant cell myocarditis. Connective tissue diseases such as Marfan syndrome, which commonly presents with aortic root dilatation, would be associated with ectopia lentis and myopia. Wilson's disease, which is associated with arrhythmias and cardiomyopathies, would present usually with the characteristic Kayser-Fleischer rings. Rarer diseases, such as Fabry disease, would be accompanied by ocular signs such as cornea verticillata and such cardiac manifestations include cardiac hypertrophy as well as arrhythmias. This review examines the interplay between the eye and the cardiovascular system and emphasises the use of conventional and emerging tools to improve diagnosis, management and prognostication of patients.

The genetics of drug-induced QT prolongation: evaluating the evidence for pharmacodynamic variants.

Drug-induced long QT syndrome (diLQTS) is an adverse effect of many commonly prescribed drugs, and it can increase the risk for lethal ventricular arrhythmias. Genetic variants in pharmacodynamic genes have been associated with diLQTS, but the strength of the evidence for each of those variants has not yet been evaluated. Therefore, the purpose of this review was to evaluate the strength of the evidence for pharmacodynamic genetic variants associated with diLQTS using a novel, semiquantitative scoring system modified from the approach used for congenital LQTS. KCNE1-D85N and KCNE2-T8A had definitive and strong evidence for diLQTS, respectively. The high level of evidence for these variants supports current consideration as risk factors for patients that will be prescribed a QT-prolonging drug.

Covered Stenting as Bail-Out Technique for Central Venous Catheter Malposition Within the Brachiocephalic Trunk.

Central venous catheter (CVC) insertion with ultrasound guidance is routine clinical practice in the critically ill patient. Arterial malposition is serious and may lead to severe complications such as hemorrhage, stroke, or death. We describe a bail-out technique for removal of right-sided CVC that was mispositioned into the brachiocephalic trunk (BCT) at the origin of the right common carotid artery (CCA). Covered stenting of the BCT extending into the CCA in combination with plug embolization of the right subclavian artery was utilized.

Comparing sterile bag rubbing and paint on technique in skin preparation of the hands.

BACKGROUND: The aim of this study was to compare two techniques for surgical site skin preparation in hand surgery. METHODS: We compared the standard sponge paint technique versus a plastic bag immersion technique using a 10% povidone-iodine with alcohol solution (Betadine, ORION Laboratories Pty Ltd, Balcatta,WA,Australia) to prepare surgical site skin for hand surgery. This sterile bag rubbing technique involves using a sterile plastic bag filled with 60 mL of Betadine solution to immerse the subjects' hand. Samples were taken from 10 subjects for bacteria colony-forming unit (CFU) counts before and 3 min after surgical site preparation in each group. Outcome measures were preparation time and CFU reduction with a plate impression test using commercially available agar slides. RESULTS: The sterile bag rubbing technique significantly reduced (P < 0.0001) the time required for surgical site skin preparation (28 s) compared with the standard technique (86 s). Both techniques were found to have similar efficacy in the reduction of CFU. CONCLUSIONS: The sterile bag rubbing technique is a quicker alternative method for surgical site preparation in hand surgery and has comparable efficacy to the widely practised standard paint-on technique.

Surgical management of extracranial carotid artery aneurysms.

Extracranial carotid artery aneurysms are uncommon and not much is known about them. The purpose of this study is to report the authors' surgical experience and present a review of this entity. This single institution experience shows that resection of these aneurysms and restoration of flow can be accomplished using a number of surgical techniques with relatively low morbidity and mortality. Endovascular techniques are also increasingly being considered in the repair of these aneurysms, although long-term data from such techniques are not currently available.

Can beta agonists cause dilated cardiomyopathy?

We report a case of dilated cardiomyopathy that we believe is secondary to excessive use of inhaled beta agonists. Clinicians should be mindful of this possibility when using beta agonists to treat patients with obstructive airways disease; particularly if there is already recognised left ventricular dysfunction.

Endoluminal repair of abdominal aortic aneurysm: the Middlemore Hospital experience.

INTRODUCTION: With endoluminal stent graft (ESG) repair of abdominal aortic aneurysms (AAA) becoming more common, the morphological boundaries are constantly being pushed in deciding which patients to offer this mode of surgical management. In our tertiary hospital we have a relatively strict morphological selection as well as a multidisciplinary team that provides a good platform for performing endoluminal AAA repair. METHOD: A retrospective audit of patients undergoing elective endoluminal AAA repair at Middlemore Hospital (Otahuhu, Auckland, New Zealand) between 1999 and 2005 was performed; 40 patients were identified during this period and all records were reviewed. Prior to surgery, all patients had CT aortography with 3D-reconstruction, and each case was discussed at a multidisciplinary team meeting (vascular surgeons and interventional radiologists present). Patients less than 65 years of age were excluded from this endoluminal assessment. A strict morphological selection criteria was applied and adhered to. RESULTS: Forty patients underwent elective endoluminal AAA repair between 1999 and 2005--5:1 male:female ratio and mean age 73.4 years. Fifty percent of patients had a history of ischaemic heart disease, 48% had known hypertension, 33% had known pulmonary disease, 12% had known diabetes mellitus, while a previous stroke, chronic renal failure, and current smokers respectively accounted for 18%. The American Society of Anaesthesiology (ASA) classification was used to assess patient fitness for surgery. Eighty percent of patients in this study had an ASA of III, 15% had an ASA of II, and the remaining patients had an ASA of IV. These figures are similar to Australian audit data (audit undertaken by ASERNIP-S). Morphology AAA showed mean diameter AAA of 5.2 cm (4.3?6.7 cm). Most AAA were fusiform (fusiform 90% vs saccular 10%). All grafts were of Zenith Cook type bifurcated grafts. There were 2 endoleaks (5%)--type II endoleaks that were sealed with endovascular therapy; 2 patients returned to theatre for embolic complications with good postoperative result; and 1 patient died due to myocardial infarction (MI) postprocedure (mortality 2.5%). Primary technical success was 95% and secondary technical success 100%. There were no conversions to open surgery and no procedural-related deaths. CONCLUSION: This audit from Middlemore Hospital shows good results can be achieved using strict morphological selection criteria and a multidisciplinary approach to treatment for ESG of AAA.

Streptococcus gallinaceus bacteraemia in an abattoir worker presenting with a febrile illness.

Streptococcus gallinaceus is a newly described species of viridans streptococci, previously only identified as causing disease in broiler chickens. This organism was recovered in pure culture from blood taken from a New Zealand abattoir worker presenting with a febrile illness. This first report of bacteraemia caused by S. gallinaceus in a human may help the understanding of the ecology of this recently described organism.