Favorable Waitlist and Posttransplant Outcomes in Children and Adolescent Patients Supported With Durable Continuous-Flow Ventricular Assist Devices.

Pediatric centers are implanting durable adult continuous-flow ventricular assist devices (CFVADs) in children who are smaller than the industry-recommended size. Waitlist and posttransplant outcomes data in pediatric patients supported with CFVADs as a bridge to transplant are limited. We analyzed the United Network of Organ Sharing and Organ Procurement and Transplantation Network registry to identify patients aged ≤18 years with a CFVAD at the time of listing or transplantation. Patients were stratified by body surface area (BSA; >1.5 vs. ≤1.5 m(2) ) at time of listing. We identified 138 patients with a durable CFVAD during the listing period (100 with BSA >1.5 m(2) , 38 with BSA ≤1.5 m(2) ). Patients with BSA ≤1.5 m(2) were more likely to have a noncardiomyopathy diagnosis (18% vs. 4%, p = 0.007) and to be implanted with a centrifugal-flow rather than an axial-flow device (74% vs. 30%, p = 0.001). There was no difference in failure-free waitlist survival between BSA groups (p = 0.99) among patients with a CFVAD at listing. Posttransplantation survival was 100% and 88% at 1 and 5 years, respectively, for the entire cohort and did not differ by BSA group (p = 0.99). Consequently, waitlist and posttransplant outcomes are favorable for pediatric CFVAD recipients. Small patients (≤1.5 m(2) ) had pre- and posttransplant outcomes similar to those of larger patients that met the industry-recommended size for implantation.

Systemic ventricular assist device support in Fontan patients: A report by ACTION.

BACKGROUND: The size of the Fontan population with end-stage heart failure is growing. In this population, heart transplantation has been the only option. This study sought to investigate the efficacy of ventricular assist device (VAD) support in Fontan patients. METHODS: We conducted a retrospective study of Fontan patients in the Advanced Cardiac Therapies Improving Outcomes Network. We evaluated patient characteristics, and the clinical and physiologic outcomes after VAD implantation. RESULTS: We identified 45 Fontan patients implanted with VAD. The average age of patients was 10 years (interquartile range: 4.5-18) and 30% were female. The majority had a morphologic right ventricle (69%), moderate or greater ventricular dysfunction (83%), and moderate or greater atrioventricular valve regurgitation (65%). The majority of implants were as a bridge to transplantation (76%), and the majority of patients were Interagency Registry for Mechanically Assisted Circulatory Support Profile 2 (56%). The most commonly employed device was the Medtronic HeartWare HVAD (56%). A total of 13 patients were discharged on device support, and 67% of patients experienced adverse events, the most common of which were neurologic (25%). At 1 year after device implantation, the rate of transplantation was 69.5%, 9.2% of patients continued to be VAD supported, and 21.3% of patients had died. Hemodynamically, VAD was effective in decreasing both Fontan and ventricular end-diastolic pressures in some individuals. CONCLUSIONS: VAD is effective in supporting patients with end-stage Fontan failure awaiting heart transplantation. Future research should focus on identifying clinical and physiologic characteristics predictive of a favorable response to VAD support.

Oropharyngeal gonorrhoea: rate of co-infection with sexually transmitted infection, antibiotic susceptibility and treatment outcome.

The aim of the present study is to investigate the rate of co-infections with other sexually transmitted infections (STIs), antibiotic susceptibility and management of oropharyngeal gonorrhoea diagnosed in a busy genitourinary medicine clinic. The method involved a retrospective study on consecutive patients diagnosed with oropharyngeal gonorrhoea. A total of 131 patients were diagnosed with oropharyngeal gonorrhoea over the study period. The median age of the infected patients was 28 (interquartile range: 22 to 35) years. Forty-one (31%) of patients were younger than 24 years. High rates of co-infection with urethral gonorrhoea (37%), rectal gonorrhoea (37%) or chlamydial infection (16%) were identified. Thirty patients (23%) had only oropharyngeal infection. Twenty-two (17%) patients' isolates showed resistance to at least one antibiotic. Antibiotic resistance among oropharyngeal gonococcal isolates was above 5% between 2000 and 2009. Test-of-cure (TOC) was carried out for only 63 (48%) of patients; none had positive culture. Among 46 isolates treated with cefixime 400 mg/stat, 27 (59%) had TOC; all were negative. Repeat TOC was not carried out for any of the patients. In conclusion, successful management of oropharyngeal gonorrhoea should comprise of counselling, partner notification and TOC after treatment with appropriate antibiotic regimen.

Value of laparoscopy in the management of calculi complicating renal malformations.

A minimally invasive approach for urolithiasis patients with complex anatomic abnormalities occasionally necessitates the use of laparoscopic techniques, either alone or in combination with endourologic techniques. The management of these patients is best accomplished in centers with the facilities to provide a spectrum of endourologic and laparoscopic techniques. Two illustrative cases are described.

Alterations in predicted growth rates of pediatric kidneys treated with extracorporeal shockwave lithotripsy.

The long-term effects of extracorporeal shockwave lithotripsy (SWL) on the kidneys of children treated for renal calculi are unclear. In order to determine if SWL has any negative effects on renal growth rates, we reviewed long-term (mean 9-year) follow-up data on 29 pediatric patients treated between 1984 and 1988 with an unmodified Dornier HM3 lithotripter. Changes in renal length, serum creatinine, and blood pressure were analyzed. Predicted renal growth was calculated using a formula for age-adjusted renal length. Treated kidneys were stratified into normal and abnormal groups based on a history of renal surgery, evidence of recurrent infection, and obvious anatomic abnormalities. Fifty-six upper urinary tract calculi were treated in 34 renal units. Twenty-two renal units (68%) were rendered stone free, and 65% of the patients continue to be stone free. At follow-up, one patient was classified as having new-onset hypertension, and the mean serum creatinine was 0.93 +/- 0.08 mg/dL. Both at treatment and at follow-up, no significant differences were found in the sizes of the treated and untreated kidneys. However, at treatment, the abnormal group of kidneys seemed to be smaller than expected (mean Z -1.30 +/- 1.10), whereas the group of normal kidneys was very close (mean Z 0.18 +/- 0.54) to the predicted length. At follow-up, the deviations between actual and predicted renal length were significantly more negative. Treated kidneys were an additional 1.26 +/- 0.49 SD units below their expected length (p = 0.02). Untreated kidneys were further below normal as well but possibly to a lesser degree (-0.82 +/- 0.36; p <0.04). Although there was a trend for the abnormal group to have smaller kidneys than the normal group, both groups showed the same trend toward an age-adjusted reduction in renal growth at follow-up. The alterations in renal growth patterns observed in this population are unsettling and could be secondary to either treatment effect (SWL) or, more likely, to some underlying pathology intrinsic to pediatric kidneys with urolithiasis. Until further data are available, SWL in the pediatric population should be applied with caution and at the lowest dosage sufficient to achieve stone comminution.

Correlation between toxic natures of pyrethroid and behavioral response of desert locusts.

Optomotor normal visual response of the locust Schistocerca gregaria was compared when injected (between 1st and 2nd thoracic segments) with 10, 5, 2.5 and 1.25 microg/g body weight doses of Permethrin after different intervals of time (just after injection, 10 and 20 minutes). LD50 value for Permethrin was calculated to be 3.0 microg/g. Results are analyzed statistically by t. test and ANOVA technique. It was noticed that there was a significant decrease of vision (P<0.005, Table II) in treated locusts and at the same time Permethrine effect is significantly time related (P<0.05, ANOVA, table III). Correlation between increasing age, weight and increasing toxicity has also been established. The inhibition of neural enzyme Cholinesterase with Permethrin and as a result more accumulation of acetylcholine at nerve junctions and less passage of the transmission of impulses thus less response from the locusts has also been explored and discussed.

A study on the analysis of ochratoxin-A in different poultry feed ingredients.

A study to assess ochratoxin content in different feed ingredients was conducted. Out of 156 samples of feed ingredients analyzed 36 were found contaminated with ochratoxin. The highest content was detected in maize (*84.4 microg/kg) while millet contained the minimum content (5 microg/kg). 120 samples i.e. 77% were found to be free of ochratoxin and 23% were contaminated. In the light of these results it is suggested that proper harvesting, storage of feed be done and unhygienic method of processing and production be avoided.

Infection control education: impact on ventilator-associated pneumonia rates in a public sector intensive care unit in Pakistan.

We describe efforts towards introducing infection control (IC) practices and establishment of antimicrobial resistance (AMR) surveillance in a public sector hospital in Pakistan. The study was conducted in an eight-bed intensive care unit. IC principles, introduced through interactive sessions, were used as an intervention and their impact was observed by conducting surveillance for ventilator-associated pneumonia (VAP) before and after the intervention. Respiratory isolates of VAP patients in the period after intervention were screened for AMR, and empiric antibiotic at the time of admission was compared with the antimicrobial sensitivity pattern reported. VAP rates were high in general and declined in the period after intervention, although the difference was not significant. Of 37 VAP patients in the period after intervention, 68% had more than one clinically significant organism isolated from the respiratory specimen. Acinetobacter spp. were isolated from 76% of patients and Pseudomonas aeruginosa from 43%. All Acinetobacter spp. and 72% P. aeruginosa were multidrug resistant. The mean stay of the nosocomially infected patients was significantly higher than for the uninfected group (6.5 vs. 2.1 days, P<0.001). Our study suggests IC education needs to be supplemented by a hospital system that facilitates IC practices and development of surveillance programmes.

Experience with the second generation UroLume prostatic stent.

OBJECTIVE: To assess the efficacy of the new, second generation UroLume (American Medical Systems) prostatic stent. PATIENTS AND METHODS: Forty-seven men with symptomatic and objective evidence of bladder outflow obstruction who were fit for a transurethral resection accepted, as an alternative, the insertion of a new prostatic stent which shortens less than its predecessor. RESULTS: It was possible to insert the stent into 44 of the 47 men. All patients voided spontaneously following stent insertion. Thirty-three patients had their stent inserted either as a day case or with an overnight stay. Six patients were lost to follow-up and two died. Of the remaining 36 patients 22 have now been followed for 2 years, with a mean obstructive score of 1.6 (range 0-12), a mean irritative score of 2.5 (range 0-10) and a mean peak flow of 16.8 mL/s (range 3-31). Fourteen stents had to be removed; in the majority of cases this was because of stent migration or the development of epithelial hyperplasia within the lumen of the stent. CONCLUSION: Because of the development of epithelial hyperplasia and stent migration in approximately one-third of men in this study, a third generation stent has now been developed. Before permanently implanted stents can be recommended for widespread use, the efficacy of new stents should be assessed in specialist units with large numbers of patients and adequate facilities for follow-up.

Novel cycloartane saponins from Corchorus depressus L.

Two novel bidesmosidic cycloartane-type glycosides, depressosides C and D were isolated from Corchorus depressus L. Their structures were elucidated as (22R)-16beta,22-epoxy-3beta,26-dihydroxy-9,19-cyclolanost-++ +24E-ene 3, 26-di-O-beta-D-glucopyranoside and (22R,24S)-22,25-epoxy-3beta,16beta,24-trihydroxy-9,19-cyclolano stane 3, 24-di-O-beta-glucopyranoside, respectively on the basis of chemical evidence and detailed spectroscopic studies.