The effects of past SARS experience and proximity on declines in numbers of travelers to the Republic of Korea during the 2015 MERS outbreak: A retrospective study.

BACKGROUND: The experience of previous sizable outbreaks may affect travelers' decisions to travel to an area with an ongoing outbreak. METHODS: We estimated changes in monthly numbers of visitors to the Republic of Korea (ROK) in 2015 compared to projected values by selected areas. We tested whether areas' experience of a previous SARS outbreak of ≥100 cases or distance to the ROK had a significant effect on travel to the ROK during the MERS outbreak using t-tests and regression models. RESULTS: The percentage changes in visitors from areas with a previous SARS outbreak of ≥100 cases decreased more than the percentage changes in visitors from their counterparts in June (52.4% vs. 23.3%) and July (60.0% vs. 31.4%) during the 2015 MERS outbreak. The percentage changes in visitors from the close and intermediate categories decreased more than the far category. The results from regression models and sensitivity analyses demonstrated that areas with ≥100 SARS cases and closer proximity to the ROK had significantly larger percentage decreases in traveler volumes during the outbreak. CONCLUSIONS: During the 2015 MERS outbreak, areas with a previous sizable SARS outbreak and areas near the ROK showed greater decreases in percentage changes in visitors to the ROK.

Axillary, Chest Wall and Abdominal Hematoma as a Rare Complication of Radial Artery Catheterization.

BACKGROUND Radial artery access during coronary angiography has gained popularity as there are fewer associated complications when compared with femoral artery access. However sporadic complications can occur following radial artery catheterization. A rare case of axillary, chest wall and abdominal hematoma is presented following radial artery catheterization. CASE REPORT A 58-year-old man with hypertension, type 2 diabetes, with a history of smoking, underwent elective coronary artery angiography via the right radial artery route. He was discharged from care without event, before returning 24 hours later with a large hematoma of the right axilla, extending to the anterior chest wall and abdomen. One year previously, he underwent coronary artery angiography with catheterization of the femoral artery, which was without complications. On this occasion, after resolution of the hematoma, he underwent coronary artery bypass graft (CABG) surgery. CONCLUSIONS This case has reported a rare complication of radial artery catheterization that involved extensive hematoma involving the chest, abdominal wall, and axilla. Although such complications may be rare, a high level of vigilance should be maintained for rare complications in patients undergoing radial artery catheterization.

Systolic left ventricular dysfunction detected by echocardiography: demographics and aetiology - abstract

The aim of this retrospective study was to determine the demographic features and causes of heart failure in patients presenting a tertiary care institution: 65 patients aged >16 years with an ejection fraction (EF) < 40 percent, undergoing echocardiography during a two-year period, 1992-94, were included in the study. The mean age was 60 ñ 12 years, 68 percent were male, 50 percent and 42 percent were African and East Indian, respectively. The prevalence of diabetes and hypertension was 40 percent and 45.3 percent respectively. The majority of patients were in NYHA class II or III. The mean left ventricular ejection fraction (LVEF) was 29.7 ñ 8.6 percent. There was no correlation between NYHA class and LVEF at initial presentation. The underlying causes of heart failure were coronary artery disease (CAD) (42 percent), idiopathic dilated cardiomyopathy (10.9 percent), hypertensive heart disease (9.4 percent), alcohol related dilated cardiomyopathy (7.8 percent), valvular heart disease (7.8 percent), myocarditis (1.6 percent) and hypertrophic cardiomyopathy (1.6 percent). The dominant primary cause could not be determined in 18.8 percent. LVEF was similarly depressed in the two major ethnic groups and in the ischaemic and non-ischemic cardiomyopathy groups. We concluded that CAD was the most common cause of LV systolic dsyfunction and that LVEF was not related to ethnicity, aetiology or severity of symptoms. (AU)

Intracardiac extension of a Wilms' tumour

A case report is presented of a Wilms' tumour in a three-year-old child. Direct intravascular extension into the heart led to a fatal outcome. Though a rare complication, clinical suspicion, combined with appropriated investigation and management, should lead to salvage of such a patient (AU)

Coronary artery bypass surgery at the Eric Williams Medical Sciences Complex: clinical profile and outcome - abstract

Coronary artery bypass grafting surgery (CABG) has been recently performed at the Eric Williams Medical Sciences Complex, for the management of patients with coronary artery disease (CAD). This is a review of the joint experience of the Eric WIlliams Medical Sciences Complex/Caribbean Heart Care Venture. Forty-one patients had CABG between November, 1993 and October, 1994. Their ages ranged from 39 to 73 years with mean age 56 years; 28 patients (83 per cent) were male and 7 (17 per cent) were female. Twenty patients (49 per cent) were hypertensive, 16 (39 per cent) were diabetic, 5 had mild pre-operative impairment of renal function, 1 had had previous bypass surgery in 1984 and pre-operatively most patients were using maximal oral therapy for angina control. The indications for surgery were: left main coronary disease (7 per cent), 3-vessel coronary disease with ejection fraction < 50 per cent (12 per cent), unstable or refractory stable angina due to 2-vessel, 3-vessel or proximal left anterior descending coronary disease with good LV function (80 per cent). Left internal mammary artery grafts were used in 68 per cent of patients and saphenous vein grafts in the rest. The mean stay in hospital post-operatively was 9.6 days. Two patients died, both in the early post-operative period. In two patients, in whom complete revascularization was not possible, mild angina occurred during the post-discharge mobilization period. All other patients have been free of angina since discharge. Complications included early re-operation (day 1) for excessive bleeding from the chest drains (1 patient), aortic dissection requiring repair (1 patient), lobar atelectasis requiring prolonged physiotherapy (4 patients), pneumonia (1 patient), severe transient post-pericardiotomy syndrome (1 patient) and peroneal nerve palsy (1 patient) (AU)

Coronary angiography and myocardial perfusion scintigraphy: a correlative analysis - abstract

The assessment of myocardial perfusion has for many years been performed with thallous chloride (T1-201). This imaging agent suffers, however, from a number of well-recognized limitations, which has prompted a global search for better radiopharmaceuticals. Within the last two years, Technetium labelled myocardial perfusion imaging agents, namely, Sestamibi (Du Pont Pharma) and Tetrofosmin (Amersham) became available, and prompted us to evaluate the efficacy with respect to coronary angiography (CA) recently introduced at our institution. The data for both imaging agents were analyzed in fifty consecutive patients (ages 30 to 70 years), referred over the past eighteen months for myocardial perfusion scintigraphy (MPS). Twenty-five patients had combined MPS and CA studies. Comparative analysis for individual coronary artery territories yielded a sensitivity of 97 percent, specificity of 80 percent and an overall accuracy of 80 percent for MPS. Angiographic review of initially ascribed false positive MPS in eight patients revealed pathophysiological abnormalities other than coronary artery stenosis which accounted for the observed perfusion deficits. These included differential blood flow in two patients and myocardial bridging in one. The remaining false positives were attributed to diaphragmatic or breast attenuation (AU)

Sudden cardiac death caused by coronary ostial compression by an aneurysm of the sinus of valsalva

A 22-year-old man was asymptomatic until he died suddenly after being startled. Post-mortem examination was normal except for aneurysmal dilation of the left Sinus of Valsalva, the upper margin of which formed a flap-like ridge, partially occluding the ostium of the left main coronary artery which arose immediately above it. Further compression of this "slit-like" orifice by aneurysmal distention was the proposed cause of myocardial ischaemia and arrhythmic death (AU)

A hospital based study of patient and physician response to acute myocardial ischaemia - abstract

A prospective study was undertaken to investigate whether current patient and physician response to acute myocardial ischaemia was suffiently expedient to allow for thrombolysis within the first 6 hours of evolving acute myocardial infarction. During the 1-month study period, 70 patients with chest pain syndrome presented to the Accident and Emergency Department, General Hospital, Port-of-Spain (A&E, POSGH). Data were available on 67 patients, of whom 38 (57 percent) were found to have definite myocardial ischaemia by E.C.G. criteria. The modal time of arrival was 1-3 hours after the onset of chest pain. Sixty-four per cent of all patients arrived within 6 hours of the onset of chest pain. The corresponding figure for the subgroup with confirmed ischaemia was 68 percent. The mean time for evaluation and disposition of patients with confirmed ischaemia in the A&E, POSGH was 47.5 minutes (range 20-112 minutes). Furthermore, the longer time taken for triage of patients who did not have an eventual diagnosis of myocardial ischaemia (57.6 vs 47.5 min) is consistent with the urgency of physician management and the likelihood of ischaemia. The result of this study suggest that the majority of patients presenting to the A&E, POSGH for the treatment of acute myocardial ischaemic s

Acute myocardial infraction following blunt chest trauma due to the kick of a cow

A previously healthy 29-year-old man developed electrocardiographic evidence of an anterolateral myocardial infarction following the kick of a cow to the left precordial area. This was complicated by three episodes of ventricular fibrillation and cardiogenic shock. After five months, electrocardiographic and echocardiographic evidence of ventricular aneurysm persists (AU)

Clinical exercise testing: its application to Trinidad and Tobago

Exercise treadmill testing has gone far beyond its initial application to the diagnosis of chest pain. Consequently test results can no longer be interpreted by the unqualified designation of "positive" or "negative". If utilized in a thoughtful manner it can provide useful answers to specific questions concerning most ambulatory patients and so provide information which may be used to customize individual management plans. (AU)