Association between HV interval and electrocardiographic findings in individuals with syncope and left bundle branch block

INTRODUCTION The occurrence of syncope is associated with increased mortality in patients with left bundle branch block (LBBB). Among syncope risk scores, it is consensual that electrocardiographic (ECG) abnormalities and the presence of underlying cardiac disease are prominent factors. However, there is no further investigation directed towards this population and there is few that could add to clinical judgement in such cases, until electrophysiological study (EPS) is performed. The method's modest sensitivity limits its practical usage in spite of current literature recommendation. Therefore, identifying those patients more prone to serious events is of clinical significance. OBJECTIVES AND METHODS This was a cross-sectional study of patients with syncope and LBBB undergoing EP study in a tertiary hospital, which aimed to assess the relation between ECG parameters and prolonged HV interval on EPS. RESULTS Ninety-four consecutive patients were eligible for the final analysis. Mean age was 63.1 ± 11.9 years (68.1% male). As for main comorbidities, the prevalence of smoking was 39.3%, hypertension 84%, diabetes mellitus 29.7%, coronary artery disease 28.7% and reduced left ventricle ejection fraction (LVEF) (≤ 40%) 48.9%. In the univariable analysis, LVEF ≤ 40% appeared to be somewhat important but this was not confirmed upon logistic regression. QRS duration ≥ 165 ms (OR 7.79; p = 0.0005) and PR interval ≥ 220 ms (OR 7.10; p = 0.003) were independent predictors for HV interval ≥ 70 ms. For each 10 ms increase in QRS and PR duration, the odds of HV interval ≥ 70 ms enhanced by 39.8% and 27.1%, respectively. For the subgroup presented with such outcome, mean QRS was 170.88 ± 26.81 ms, significantly larger than the patients with HV interval < 70 ms. When combined, QRS ≥ 165 ms and PR interval ≥ 220 ms had an accuracy of 80% to predict an HV interval ≥ 70 ms in the EPS. Other analyzed data were not systematically associated with the evaluated outcome. CONCLUSION In patients with syncope and LBBB, prolonged QRS and PR interval were independent predictors of increased HV interval on EP study. Larger studies are needed to confirm these findings.

A web-based incident reporting system: a two years' experience in an Italian research and teaching hospital.

BACKGROUND: A web-based incident reporting system (IRS) is a tool allowing healthcare workers to voluntary and anonymously report adverse events/near misses. In 2010, this system was introduced in a research and teaching hospital in metropolitan area in the North part of Italy, in order to detect errors and to learn from failures in care delivery. The aim of this paper is to assess whether and how IRS has proved to be a valuable tool to manage clinical risk and improve healthcare quality. MATERIALS AND METHODS: Adverse events are reported anonymously by staff members with the use of an online template form available in the hospital intranet. We retrospectively reviewed the recorded data for each incident/near miss reported between January 2011 and December 2012. RESULTS: The number of reported incidents/near misses was 521 in 2011 and 442 in 2012. In the two years the admissions were 36.974 and 36.107 respectively. We noticed that nursing staff made more use of IRS and that reported errors were basically related to prescription and administration of medications. CONCLUSIONS: Much international literature reports that adverse events and near misses are 10% of admissions. Our data are far from that number, thus meaning that a failure in reporting adverse events exists. This consideration, together with the high number of near misses in comparison with occurred errors, leads us to speculate that adverse events with serious consequences for patients are marginally reported. Probably the lack of a strong leadership considering IRS as an instrument for improving quality and operators' reluctance to overcome the culture of blame may negatively affect IRS.

Determination of pH and calcium ion release provided by pure and calcium hydroxide-containing AHPlus.

AIM: To compare in vitro the pH and calcium ion release provided by pure and calcium hydroxide-containing AHPlus. METHOD: Pure and modified AHPlus, the latter containing 5 and 10% (w/w) calcium hydroxide added during spatulation, were used. The material was spatulated and stored in 10 tubes that were 1 cm long and 1.5 mm in diameter, and then immersed in 20 mL deionized water before the materials had set. Ten tubes with zinc oxide and eugenol were used as controls. Four millilitres of water was removed from the flasks after 24 and 48 h, and after 7, 14 and 30 days, and pH and calcium release were measured with a pH meter and by atomic absorption spectrophotometry, respectively. The results obtained at each time point were compared statistically. RESULTS: A more alkaline pH for AHPlus supplemented with 5 and 10% calcium hydroxide was recorded when compared to pure AHPlus; there were significant differences at 14 and 30 days (P<0.05). The results of calcium ion release showed no significant difference between pure AHPlus and zinc oxide plus eugenol (P>0.05). The comparisons between the AHPlus containing 10% calcium hydroxide with AHPlus containing 5% calcium hydroxide, pure AHPlus, zinc oxide plus eugenol demonstrated significant differences (P<0.05) at all periods. The comparisons between AHPlus containing 5% calcium hydroxide with pure AHPlus and zinc oxide plus eugenol demonstrated significant differences (P<0.05) at all periods of evaluation. CONCLUSIONS: The addition of 5 and 10% calcium hydroxide to AHPlus cement favoured a more alkaline pH and greater calcium ion release.

[Aggressive digital papillary adenocarcinoma: a case report]. / Adenocarcinoma digitale papillare aggressivo: descrizione di un caso.

AIM: We describe a case of Aggressive Digital Papillary Adenocarcinoma, a rare skin neoplasm with acral location. RESULTS: The patient, a 66 year old man, presented with an ulcerated mass of the fifth toe of the left foot, 4.4 cm in size. Histologically the tumour was characterized by a solid-cystic structure, with extensive papillary component, comedo necrosis and focal eccrine differentiation. Immunohistochemistry showed diffuse positivity for cytokeratins AE1/AE3 and 7, and, focal staining for Muscle Specific Actin, Vimentin and EMA. Chest CT scan showed the presence of a single pulmonary node, whose cytological features were consistent with a metastatic disease. CONCLUSIONS: The clinico-pathological features of the present are similar to those previously reported in the literature and confirms the aggressive nature of this neoplasm.

[Comparative analysis of various biochemical and immunohistochemical methods for evaluating hormone receptors in breast carcinoma]. / Analisi comparativa di diverse metodiche immunoistochimiche e biochimiche per la valutazione dei recettori ormonali nel carcinoma della mammella.

The aim of this study was to compare the grade of concordance between three methods to evaluate and to quantify the expression of estrogen and progesterone receptors in 180 cases of breast cancer. The methods compared were dextran-coated charcoal (DCC) method, immunochemical analysis (ICA), and immunohistochemistry (IHC). The grades of concordance are so summarized: (1) 77.8% for estrogen receptors (ER) and progesterone receptors (PgR) with DCC and ICA methods (r = 0.53 and r = 0.64, respectively); (2) 83.3% for ER (r = 0.53) and 75.6% for PgR (r = 0.64) with DCC and IHC methods; (3) 87.8% for ER (r = 0.98) and 86.7% for PgR (r = 0.99) with ICA and IHC methods. Nowadays, the technique carried out on tissue sections provides the most reliable information. The IHC method performed on formalin-fixed and paraffin-embedded tissue is preferred in laboratories with a high work load because it is easy and inexpensive and can be automated.

Evaluation of pH and calcium ion release of three root canal sealers.

The pH and calcium ion release of three root canal sealers--Sealapex, Sealer 26, and Apexit--were assessed at 24 and 48 hr, and at 7 and 30 days after spatulation. After manipulation, the sealers were placed in 1-cm-long tubes measuring 4 mm in diameter and immersed in a glass flask containing 10 ml of deionized water, which was hermetically sealed and stored at 37 degrees C. The tubes were removed at the scheduled times and the water in which they were immersed was tested for pH with a pHmeter and for released calcium by atomic absorption spectrophotometry. Starting 48 hr after immersion, Selapex produced an alklaine pH and released significantly higher calcium amounts compared with the other two sealers, with even more pronounced results after 30 days. On the basis of the results obtained, we conclude that Sealapex presented the highest calcium and hydroxyl release, especially after longer time intervals, whereas Sealer 26 showed highest release during the initial periods (i.e. during its setting time). Apexit presented the least satisfactory results.

[Human recombinant erythropoietin in the treatment of anemia in obstetric-gynecologic patients. Evaluation of such treatment as an alternative to blood transfusion]. / Impiego dell'eritropoietina umana ricombinante in stati anemici di interesse ostetrico-ginecologico. Valutazione dell'utilità di tale trattamento in alternativa all'emotrasfusione.

The authors introduce the subject with physiological comments regarding the ability of r-HuEP to stimulate erythropoietic bone marrow, underlining the need for other molecules to backup the therapy (vitamin B12, folic acid and iron). Subsequently, and in the light of this introduction, they outline the indications for r-HuEPO treatment in specialist fields and the relative contraindications. They then report the results obtained in a group of 24 patients with the relevant indications receiving subcutaneous treatment on alterate days with r-HuEPO in fials of 4000 IU/ml. Basal hemoglobin levels were 6-8 g and treatment was continued until levels of around 10-11 g were reached; tolerance was good in both gynecological and obstetric patients.

[Variations in the pulsatile index of the uterine arteries in postmenopausal women receiving hormone replacement therapy]. / La variazione dell'indice di pulsatilità delle arterie uterine in donne in post-menopausa in trattamento ormonale sostitutivo.

The authors studied variations in the pulsatility index of the uterine arteries in postmenopausal women who had received hormone replacement treatment (HRT) for at least one year and compared them to those in a control group not receiving HRT. The results showed a significant variation in this index with the tendency to assume lower values compared to the control group, thus resulting in increased uterine vascularization, almost resembling that observed during the child-bearing period. This drop in the pulsatility index should probably be considered the anatomo-functional in patients not receiving HRT.

[Tubal carcinoma. Clinical and anatomo-pathologic considerations on an unusual lesion]. / Il carcinoma tubarico. Considerazioni cliniche ed anatomo-patologiche su di una lesione rara.

Tubal carcinoma is the rarest neoplasia of the gynecological tract; it is found during the course of abdomino-gynecological surgery with an incidence of 1:1000. The authors report a case of papilliferous tubal carcinoma which was brought to their attention having not been recognised earlier. In fact, diagnosis was made at an advanced stage during the course of emergency surgery 2 days after hospitalisation. Intraoperative histological tests resulted in bilateral adnexectomy (without apparent damage to the tubes) as well as colostomy on the transverse colon due to stenosis of the sigmoid caused by serofibrinous peritonitis. The final histological analysis of the part removed confirmed the intraoperative diagnosis.

Controle da infecçäo intra-hospitalar na clínica pediátrica do HSPM / Control of hospital infection in the Pediatric Clinic of HSPM

Este trabalho tem como objetivo principal, mostrar o desenvolvimento da infecçäo intra-hospitalar, no que se refere à enteroinfecçäo, analisando a ocorrência da mesma num período de 12 meses. Na metade deste período foram implantadas medidas de controle de infecçäo intra-hospitalar, que väo desde alteraçöes na estrutura física das enfermarias, criaçäo de folha própria de controle de infecçäo, reestruturaçäo na internaçäo dos pacientes e criaçäo de enfermarias de triagem. Houve ainda treinamento e conscientizaçäo do pessoal médico e paramédico do serviço. Os resultados säo analisados através de um gráfico de dispersäo, aplicando-se nele os métodos de regressäo linear, mostrando duas linhas de tendência distintas: uma anterior às medidas adotadas, que mostra aumento da infecçäo intra-hospitalar, e outra após as medidas adotadas mostrando inversäo da tendência para decrescente