scholarly journals Management of Young Athletes with Asymptomatic Preexcitation—A Review of the Literature

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 824
Author(s):  
Tomasz M. Książczyk ◽  
Radosław Pietrzak ◽  
Bożena Werner
Keyword(s):  
Literature Review ◽  
Sudden Death ◽  
Systematic Reviews ◽  
English Language ◽  
Accessory Pathway ◽  
Young Athletes ◽  
Manual Search ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Life Threatening

Introduction: The management of young athletes with asymptomatic preexcitation remains a challenge, regardless of the progress we have made in understanding the basis of condition and developing catheter ablation procedures. The risk of sudden death, however small, yet definite, being the first symptom is determining our approach. The aim of the study was to establish the current state of knowledge regarding the management of young athletes diagnosed with asymptomatic preexcitation, by conducting a literature review. Material and methods: A comprehensive literature review was completed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was limited to English language publications using the following search terms: “asymptomatic” or “incidental” and “pre-excitation” or “Wolff–Parkinson–White” or “delta wave” and “athlete” or “sport”. The search was supplemented by hand review of the bibliographies of previous relevant systematic reviews. Results: The search resulted in 85 of abstracts, and the manual search of the bibliographies resulted in 24 additional papers. After careful analysis 10 publications were included in the review. In all but one of the presented papers, the authors used non-invasive methods and then either trans-esophageal or invasive EPS as a way to risk stratify asymptomatic patients. Evidence of rapid conduction through the accessory pathway was considered high risk and prompted sport disqualification. In the analysed reports there were combined: 142 episodes of the life-threatening events (LTE)/sudden death (SCD), of which 56 were reported to occur at rest, 61 during activity and no data were available for 25. Conclusions: athletic activity may impose an increased risk of life-threatening arrhythmias in patients with asymptomatic preexcitation; hence, a separate approach could be considered, especially in patients willing to engage in high-intensity, endurance and competitive sports.

scholarly journals AB0747 MATERNAL AND FETAL OUTCOMES IN PREGNANT WOMEN WITH JUVENILE IDIOPATHIC ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1402.1-1402
Author(s):  
R. Pinheiro Torres ◽  
M. H. Fernandes Lourenco ◽  
A. Neto ◽  
F. Pimentel Dos Santos ◽  
I. Silva ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Literature Review ◽  
Pregnant Women ◽  
Systematic Literature Review ◽  
English Language ◽  
Placenta Previa ◽  
Bibliographic Databases ◽  
Fetal Outcomes ◽  
Term Birth ◽  
Increased Risk

Background:Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA instead the small patient samples analysed.Objectives:In this review, our aim is to describe the current available knowledge on JIA adverse, maternal and fetal, outcomes.Methods:A systematic literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases. The search was limited to articles in English language, presenting a comparator group (healthy individuals or patients without known auto-immune rheumatic diseases) and at least one clinical outcome of interest. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility.Results:Ten observational studies out of 1560 references, fulfilled the inclusion criteria, of which, 9 were retrospective and 1 prospective. A total of 6.214 women with JIA (with 6.811 pregnancies) and 18.659.513 healthy controls (with 21.339.194 pregnancies) were included in this review.Concerning maternal outcomes, delivery by caesarian section (CS) was more frequent among JIA women (in 4 out of 6 studies). Pre-eclampsia was referred in 3 out of 6 studies and a higher risk of vaginal bleeding and placenta previa in one additional study. No study found an increased risk for gestational diabetes or hypertension in pregnant women with JIA.Regarding fetal outcomes, 8 studies revealed significantly increased of pre-term birth (only in first births in one study) but one study didn’t show any increased risk. Two studies showed a higher risk of small gestational age (SGA) and in another 2, increased risk for low birth weight (LBW). No evidence of increased risk of major congenital malformations.Conclusion:This systematic review suggests an increased risk for pre-eclampsia, preterm birth, delivery by CS, SGA and LBW, among pregnant women with JIA. Conclusions should be carefully interpreted, giving the heterogeneity of studied populations regarding demography, disease type, disease activity, and prescribed medication.Disclosure of Interests:None declared

Wolff–Parkinson–White syndrome: lessons learnt and lessons remaining

2017 ◽  
Vol 27 (S1) ◽  
pp. S62-S67 ◽  
Author(s):  
D. Woodrow Benson ◽  
Mitchell I. Cohen
Keyword(s):  
Atrial Fibrillation ◽  
Sudden Death ◽  
Accessory Pathway ◽  
Minimal Risk ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
High Negative Predictive Value ◽  
Patients At Risk ◽  
Accessory Atrioventricular Pathway

AbstractThe Wolff–Parkinson–White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope – the “delta wave”. It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff–Parkinson–White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.

Asymptomatic pre-excitation

ESC CardioMed ◽  
2018 ◽  
pp. 2100-2105
Author(s):  
Jonathan Chrispin ◽  
Hugh Calkins
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Symptoms ◽  
Accessory Pathway ◽  
Clinical Signs ◽  
Epidemiological Data ◽  
Population Based ◽  
Increased Risk ◽  
Pr Interval ◽  
Life Threatening ◽  
Electrocardiogram Ecg

Manifest pre-excitation on the surface electrocardiogram (ECG) with a short PR interval and delta wave occurs in a very small percentage of the population based on epidemiological data. For the vast majority, this ECG finding will have no clinical manifestation and over time the ECG manifestation of pre-excitation may even go away. A small minority of individuals, however, develop clinical signs related to ventricular pre-excitation, most notably atrioventricular reentrant (reciprocating) tachycardia. This non-life-threatening arrhythmia is associated with clinical symptoms of palpitations, dyspnoea, and presyncope. Those with ventricular pre-excitation are at increased risk for atrial fibrillation. Multiple invasive electrophysiological and longitudinal studies have shown that those with atrial fibrillation and robust conduction down the atrioventricular accessory pathway are at an increased risk of sudden cardiac death from ventricular fibrillation. This chapter reviews the available and recommended strategies for assessing the patient with asymptomatic pre-excitation.

scholarly journals Giant Fibroelastoma of the Aortic Valve

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Michele di Summa ◽  
Federica Iezzi
Keyword(s):  
Ventricular Fibrillation ◽  
Aortic Valve ◽  
Sudden Death ◽  
Long Term Results ◽  
Surgical Experience ◽  
Cardiac Tumours ◽  
Asymptomatic Patients ◽  
Life Threatening ◽  
Valve Sparing

Fibroelastomas account for less than 10% of all cardiac tumours, representing the most common valvular and the second most common cardiac benign tumour, following myxomas. Fibroelastomas are histologically benign; they can result in life-threatening complications such as stroke, acute valvular dysfunction, embolism, ventricular fibrillation, and sudden death. Surgical resection should be offered to all patients who have symptoms and to asymptomatic patients who have pedunculated lesions or tumors larger than 1 cm in diameter. Valve-sparing excision produces good long-term results in most instances. We report our surgical experience of a giant fibroelastoma in the aortic valve.

scholarly journals Giant Squamous Cell Carcinoma on Chronic Lichen Planus on the Ankle - A Case Report and Short Literature Review

2019 ◽  
Vol 7 (18) ◽  
pp. 3061-3063 ◽  
Author(s):  
Uwe Wollina ◽  
Claudia Krönert ◽  
Jacqueline Schönlebe ◽  
Aleksandra Vojvodic ◽  
Torello Lotti
Keyword(s):  
Squamous Cell Carcinoma ◽  
Case Report ◽  
Literature Review ◽  
Cell Carcinoma ◽  
Lichen Planus ◽  
Squamous Cell ◽  
Caucasian Woman ◽  
Increased Risk ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND: Cutaneous squamous cell carcinoma (SCC) is the second most common malignancy of skin. Although a major risk factor is a chronic exposure to ultraviolet radiation, preexistent chronic inflammatory disorders may also possess an increased risk for SCC. That is not the case for cutaneous lichen planus in contrast to oral lichen planus and oral SCC.  CASE REPORT: We report the case of an 87-year-old Caucasian woman presenting with a giant verrucous tumour on the left ankle. She suffered from long-standing disseminated lichen planus. Histology confirmed the diagnosis of SCC on partly verrucous lichen planus. The course was complicated due to sepsis. An emergency transfemoral amputation became necessary. The patients survived and could be released into her nursery. A literature review underlined the rarity of SCC on lichen planus of the skin. Most of these rare cases were in patients in their second half of life on the lower legs. Hypertrophic lichen plnaus was overrepresented.   CONCLUSIONS: Although very rare by number, SCC can complicate lichen planus and lead to the life-threatening situation. Atypical verrucous lesions on lichen planus warrant a histologic analysis. Surgery is the treatment of choice for cutaneous SCC.

scholarly journals Promotion of Physical Activity in Older People Using mHealth and eHealth Technologies: Rapid Review of Reviews

10.2196/22201 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e22201
Author(s):  
Lisa McGarrigle ◽  
Chris Todd
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Systematic Reviews ◽  
English Language ◽  
Rapid Review ◽  
Activity Levels ◽  
Increased Risk ◽  
Reduced Physical Activity ◽  
Promotion Of Physical Activity ◽  
Review Of Reviews

Background Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. Objective The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. Methods We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. Results Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. Conclusions There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support.

Use of electrophysiologic testing to assess risk in children with Wolff-Parkinson-White syndrome

2002 ◽  
Vol 12 (3) ◽  
pp. 248-252 ◽  
Author(s):  
Anne M. Dubin ◽  
Kathryn K. Collins ◽  
Nancy Chiesa ◽  
Debra Hanisch ◽  
George F. Van Hare
Keyword(s):  
Radiofrequency Ablation ◽  
Sudden Death ◽  
Risk Stratification ◽  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
White Syndrome ◽  
Asymptomatic Children ◽  
Asymptomatic Patients ◽  
Electrophysiologic Studies ◽  
Wolff Parkinson White Syndrome

In adults with Wolff-Parkinson-White syndrome, the likelihood of sudden death can be estimated based upon the presence or absence of symptoms. Comparable data in children do not exist. To date, therefore, invasive risk stratification has been used to guide management regarding radiofrequency ablation in symptomatic children. As the safety of electrophysiology study and radiofrequency ablation in children has improved, asymptomatic patients have been referred more commonly for invasive risk stratification. We sought to compare the findings from electrophysiologic studies in symptomatic children with Wolff-Parkinson-White syndrome to the findings in asymptomatic children with Wolff-Parkinson-White pattern on their electrocardiogram. Thus, we compared the findings from electrophysiologic studies carried out in patients seen at Stanford University and University of California, San Francisco, from April 1999 to February 2001 with a preexcitation pattern on their electrocardiogram. The patients were divided into three groups: 23 asymptomatic patients studied for risk stratification, 19 patients who presented with syncope, and 77 patients presenting with documented supraventricular tachycardia. Data were collected for commonly accepted invasive criterions for stratification of risk: an effective refractory period of the accessory pathway less than 270 ms, multiple pathways, septal location of pathway, and inducibility of supraventricular tachycardia. Groups were compared by chisquare. No differences were found between the groups for any of the variables. These data suggest that risk factors for sudden death, developed in studies of adult patients, are not clearly applicable to children. Further studies are needed better to define the indications for study and ablation in children.

scholarly journals Barriers and facilitators to implementing Clinical Imaging Referral Guidelines among medical professionals: Protocol for a systematic mixed studies review

2020 ◽  
Author(s):  
Harriet Nalubega Kisembo ◽  
Alison Annet Kinengyere ◽  
Abdirahaman Omar Sahal ◽  
Richard Malumba ◽  
Dina Husseiny Salaama ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
English Language ◽  
Barriers And Facilitators ◽  
Systematic Review Protocol ◽  
Increased Risk ◽  
Review Protocol ◽  
Medical Professions ◽  
Meta Analyses

Abstract Background The past two decades have seen increasingly rapid advances in the field of diagnostic imaging technology. This has significantly contributed to the quality of medical care outcomes. However, a number of studies have found that 20%-50% of imaging requisitions are inappropriate and unjustified. This wastes the already meager resources and exposes patients to unnecessary radiation with increased risk of radiation induced cancers.Clinical Imaging Guidelines (CIGs) are evidence-based tools developed to support the imaging referrer’s decision-making process by choosing the most appropriate imaging investigation for a particular patient with a specific set of symptoms and signs. However, implementing CIGs has not been effective in several settings. Identifying factors that influence CIGs implementation could give an insight into the type of strategies to put in place before implementing CIGs This systematic review protocol is aimed at understanding barriers and facilitators that influence implementation of CIGs among medical professions. Review Methods The development of the systematic review protocol will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P) (additional file 1) Key databases Pubmed (Medline) and Embase will be searched using relevant terms. The, experts in the field will be contacted for their opinion and references from included studies will also be searched Only literature written in the English language will be reviewed. All study designs will be included, and there will be no limit set by the year of publication. The criteria for inclusion will be those studies which document and discuss barriers and facilitators to implementing CIGs among medical professions. All identified studies will be screened by a single reviewer but Quality of the studies to be included and extraction of data will be independently performed by two reviewers. Any discrepancies will be resolved by consensus through discussion, with a 3rd reviewer as a tie breaker Pre-established categories of barriers and facilitators to implementing CIGs in practice from literature, will be used to assess content analysis Discussion The findings from this review will provide an insight and direction to the “champions” implementing adoption or adaption of CIGs, especially in Africa of what is ahead of them for proper planning The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020136372.

scholarly journals Physical illnesses associated with childhood homelessness - a literature review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Strashun ◽  
S D'Sa ◽  
D Foley ◽  
J Hannon ◽  
A M Murphy ◽  
...  
Keyword(s):  
Literature Review ◽  
Access To Health Care ◽  
English Language ◽  
Vulnerable Population ◽  
Deficiency Anemia ◽  
Upper Respiratory Tract ◽  
Homeless Children ◽  
Contributing Factors ◽  
Increased Risk ◽  
Tract Infections

Abstract Background and aims Childhood homelessness is a growing concern in Ireland creating a Pediatric subpopulation at increased risk of physical illnesses, many with life-long consequences. Our aim was to identify and categorize the physical morbidities prevalent in homeless children. Methods A review of the English-language literature on physical morbidities affecting homeless children (defined as &lt; 18 years of age), published from 1999-2019 was conducted. A total of 1194 articles were identified, 33 articles of which met our inclusion criteria. Results Respiratory issues were the most commonly cited illnesses affecting homeless children; including asthma, upper respiratory tract infections, and chronic cough. Homeless children were described as being at increased risk of contracting infectious diseases, many studies placing emphasis on STI and HIV/AIDS transmission. Dermatologic concerns comprised of scabies and head lice infestation, dermatitis, and abrasions. Malnutrition manifested as a range of physical morbidities; including childhood obesity, iron deficiency anemia, and stunted growth. Studies found a higher prevalence of poor dental and ocular health in this population as well. Many articles also commented on the risk factors predisposing homeless children to these physical health concerns, which can broadly be categorized as limited access to health care, poor living conditions, and lack of education. Conclusions This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified, and included a dearth of studies focusing on younger children compared to adolescents. We believe that the current issue of child homelessness is socially and medically unacceptable and that homelessness occurring today will be one of the scandals of the next generation. Further research into prevention and intervention programs for this vulnerable population is urgently needed. Key messages This literature review shows that homeless children are at an increased risk of several physical morbidities and identified the common themes among them. Based on this literature review, it is recommended that more research be done into developing appropriate intervention and prevention strategies to help this vulnerable population.

scholarly journals Promotion of Physical Activity in Older People Using mHealth and eHealth Technologies: Rapid Review of Reviews (Preprint)

2020 ◽  
Author(s):  
Lisa McGarrigle ◽  
Chris Todd
Keyword(s):  
Physical Activity ◽  
Older People ◽  
Systematic Reviews ◽  
English Language ◽  
Rapid Review ◽  
Activity Levels ◽  
Increased Risk ◽  
Reduced Physical Activity ◽  
Promotion Of Physical Activity ◽  
Review Of Reviews

BACKGROUND Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. OBJECTIVE The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. METHODS We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. RESULTS Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. CONCLUSIONS There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support.

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