Fox et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The feasibility and safety of same-day discharge after transvenous implantable cardioverter-defibrillator implantation is well-established. However, subcutaneous ICDs (S-ICDs) are now increasingly being implanted, and the feasibility, safety, and potential cost savings associated with same-day discharge after S-ICD placement has not been widely investigated. In a small cohort of patients (n = 24) who underwent S-ICD implantation at our institution, 54% were successfully discharged on the same day as their implant procedure. Procedure-related complications were not apparent in this sampling and the reduction in health care costs was high, suggesting this protocol has immense benefit in today's health care environment. As such, same-day discharge of S-ICD patients is appropriate to consider and should receive further attention.
BackgroundAtypical hemolytic uremic syndrome (aHUS), a rare thrombotic microangiopathy, is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure. Caused by genetic mutations in the alternative complement cascade, aHUS often will culminate in end-stage renal disease and occasionally death. Renal transplantation in aHUS patients has been contraindicated in the past due to the recurrence risk, with certain immunosuppressive regimens being commonly attributed. In this study, we analyzed the association between aHUS and immunosuppressive agents so as to offer evidence for the use of certain immunosuppressive regimens in renal transplant recipients.Material/MethodsOur study is a retrospective analysis using data from the United States Renal Data System from 2004 to 2012. A cohort of renal transplantation patients diagnosed with aHUS were identified to include in the study. The primary endpoint was the determination of aHUS incidence in renal transplant recipients due to various immunosuppressive agents. The secondary endpoints were to check the relationship between the drug type as well as the demographic variables that increase the risk for aHUS.ResultsIt was found that there was a higher usage of sirolimus (P=0.015) and corticosteroids (P=0.030) in the aHUS patients compared to patients in other diagnoses group.ConclusionsThere was a higher usage of sirolimus and corticosteroids in renal transplantation patients diagnosed with aHUS. Unfortunately, due to the rarity of this disease, the sample size was small (n=14). Despite the small sample size, this data analysis throws light on the relationship between aHUS and immunosuppressive agents in renal transplant recipients, although we still have much to learn.
Summary: Sudden cardiac death in the community can be reduced by early resuscitation. The commonest arrhythmia encountered in this setting is ventricular fibrillation. A portable external automatic defibrillatorpacing machine for use by emergency services and laymen after basic training, has recently been introduced. This device has a tongue-abdominal pathway for sensing the electrocardiogram and respiration, as well as delivery of current. In its automatic mode, the machine cannot defibrillate unless the patient's breathing and gag reflex are virtually absent. The decision-making characteristics of the machine were defined in isolation from the patient using simulated ECG signals and recordings of arrhythmias obtained during cardiac surgery and during electrophysiological studies. The pathway was evaluated separately by attaching it to a conventional defibrillator and using it in the elective cardioversion of 15 patients. Electrode sites were examined and creatine phosphokinase (CPK) and creatinine phosphokinase isoenzyme (CPKMB) release determined following conversion. recordings showed that decisions were consistent 95% of the time. Automatic pacing always occurred with asystole. ECG signals less than 0.35 mV in amplitude were not recognized, but a manual override switch could be operated in those circumstances where there was failure to act upon fine ventricular fibrillation. Defibrillation of 50% of the recordings of supraventricular and ventricular tachycardia did occur, but this could not have happened in practice unless the patient was unconscious, and in addition, the operator failed to countermand this decision. The tongue-abdominal pathway yielded good recordings of the ECG. There was no significant damage to the tongue and the defibrillator charges employed were comparable to those that would be used with conventional chest paddles. In conclusion, the tongue-abdominal pathway was safe and the machine, although its ECG logic made some inappropriate decisions, had sufficient safeguards to recommend its use in the emergency setting of the victim collapsing out of hospital.
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