Analyzing the Content Found on Fellowship Websites for Adult Congenital Heart Disease.

The Adult Congenital Heart Disease (ACHD) fellowship is a two-year fellowship that can be done by physicians who have finished their internal medicine residency and cardiology fellowship. This study evaluated the accessibility and provided information on the websites of the ACHD fellowship programs to identify potential areas of improvement for future fellowship applicants. Analysis of 25 ACHD fellowship program websites was conducted based on 34 criteria under three main categories: recruitment information, education and research information, and incentive information. This study found that many evaluated ACHD program websites lacked information regarding recruitment. Specifically, information regarding mentorship opportunities, hospital statistics/number of beds, selection process, and interview dates, leaving out crucial details on what to expect during the matching process. Additionally, more information on education and research is beneficial for applicants to sufficiently compare ACHD fellowship programs and make more informed decisions about which programs they would like to apply to. Information on academic stipends, evaluation criteria, expected caseload, moonlighting opportunities, elective opportunities, rotation schedules, call requirements, and types of procedures were all limited across multiple websites. Lastly, incentive information was found to be insufficient across most ACHD fellowship websites. Incentive information included fellow wellness, harassment policies, parental leave, salary, benefits, and vacation/sick leave. This study shows that ACHD fellowship programs need to supply more information on their websites to provide applicants with details to help them choose the fellowship program that corresponds best with their career goals. Expanding upon information regarding recruitment, education, research, and incentives will provide applicants with a strong understanding of ACHD fellowship programs and what they can expect throughout their education. In return, this will help ACHD fellowship programs attract stronger applicants, ultimately improving the quality of their respective programs.

The elusive cause of syncope: Left atrial myxoma with mitral valve obstruction.

Key Clinical Message: Syncopal patients should be evaluated for cardiac causes, including myxoma, as highlighted in this case. Transthoracic echocardiography and coronary angiography are valuable diagnostic tools. Interventional cardiology plays a crucial role in the successful treatment of myxoma. Abstract: This case video describes the presentation and successful treatment of a 58-year-old woman who experienced recurrent episodes of syncope. After ruling out other health concerns, a pulmonary embolism was suspected and further investigations revealed a mass in the left atrium causing significant obstruction of the mitral valve. The mass, identified as a neovascularized myxoma, was successfully resected, emphasizing the significance of considering myxoma as a potential cause of syncope and highlighting the role of interventional cardiology in its management.

Becker muscular dystrophy and successful intervention with mechanical thrombectomy of right atrial clot-in-transit with pulmonary embolism.

This case report discusses the effectiveness of the Inari FlowTriever system in treating a right atrial (RA) clot in-transit in a 55-year-old male patient with Becker's muscular dystrophy (BMD). BMD is an X-linked recessive muscle disease caused by mutations in the gene that code for the protein dystrophin, which is associated with partially functional dystrophin in variable amounts. Right heart thrombi (RHT) are thrombi that can be visualized in the right atrium, right ventricle, or proximal surrounding vasculature. The Inari FlowTriever system was used to treat RA clot in-transit and removed acute, subacute, and chronic clot in a single session without the use of thrombolytics and subsequent ICU stay. The estimated blood loss with the FlowSaver system was approximately 150 mL. This report complements the FLARE study by highlighting the effectiveness of the FlowTriever system for mechanical thrombectomy of RA clot-in-transit in a patient with BMD.

Peripheral Arterial Diseases and Diabetes Mellitus: Associations With Quality of Health Measures in Patients Undergoing Percutaneous Vascular Interventions.

BACKGROUND: Peripheral arterial disease (PAD) is more prevalent and severe in patients with diabetes mellitus (DM) compared with those without DM. Peripheral vascular intervention (PVI) is often used in patients failing conservative management. The association of PVI with health status in diabetic patients has yet to be determined. METHODS: We analyzed the clinical response to PVI in DM (n = 203, 52 %) compared with non-DM patients (n = 183, 48 %), using the Peripheral Arterial Questionnaire (PAQ) for patients during baseline and a maximum 6 months after PVI. We used the PAQ summary score, which summarized the patients' level of physical and social function, patient symptoms, and overall quality of life. This represented the PAD-related Quality of Health (QOH). Our score range is between 0 (lowest health quality) and 100 (highest health quality). RESULTS: Compared with non-DM patients, those with DM were more likely to have a history of prior PVI, an increased prevalence of PAD risk factors, and significantly lower QOH scores at baseline (32.7 ± 20 vs 37.5 ± 20.6, p = 0.02). After adjustment for baseline confounding, neither the baseline, the change, nor the final summary scores were significantly different between groups, suggesting similar symptomatic and functional improvement in non-DM and DM patients post-PVI. CONCLUSIONS: Following PVI, PAD-specific health status showed a similar improvement in patients with and without DM, illustrating that use of this strategy among patients with multiple comorbidities or diffuse PAD as useful.

Mechanisms of in-vitro-selected daptomycin-non-susceptibility in Staphylococcus aureus.

Daptomycin is highly active against Staphylococcus aureus, including multidrug-resistant strains and those with reduced susceptibility to vancomycin. However, daptomycin-non-susceptible (Dap(NS)) strains [minimum inhibitory concentration (MIC) >1mg/L] have been derived clinically and in vitro. The mechanism(s) by which this occurs is incompletely understood, but existing data indicate that it is multifactorial. Dap(NS) derivatives of one laboratory and three clinical strains of S. aureus produced using gradient plates were evaluated. The Dap(NS) phenotype included increases in glycopeptide and nisin MICs and in some instances defective autolysis and reduced susceptibility to lysostaphin lysis. Amino acid substitutions in MprF, YycG (WalK), or both, were identified in all Dap(NS) strains. Reduced cytochrome c binding and ability of daptomycin to depolarise whole cells correlated with the Dap(NS) phenotype, consistent with an increase in cell surface positivity. Gene expression data revealed increased expression of vraS, one member of a two-component system involved in the regulation of cell wall biosynthesis, in three of five Dap(NS) strains. The pathway to the Dap(NS) phenotype is not linear, as variable genetic and phenotypic changes may result in identical increases in MICs.