One-year evaluation of the treatment of hydrocephalus associated with Galen’s vein aneurysm: about 3 cases in a country with limited health resources

Background Aneurysm of vein of Galen is a rare congenital arteriovenous malformation. Clinical manifestations depend on the age of discovery. Endovascular embolization is currently the treatment of choice. This technique is not always available in developing countries. We report 3 cases treated symptomatically by endoscopic third ventriculostomy and ventriculoperitoneal shunt. Cases presentation Three patients, 7 months, 15 years, and 26 years old, received in a table of acute intracranial hypertension, associated for the first one with convulsions and for the second one with moderate heart failure. Bain CT scan revealed triventricular hydrocephalus secondary to sacciform dilatation of the Galen’s vein in all three patients, requiring symptomatic treatment by endoscopic third ventriculostomy for the first patient and ventriculoperitoneal shunt for the other two in the absence of an adequate clinical platform for endovascular embolization. The evolution was favorable at 1 year’s follow-up. Conclusion Galen’s vein aneurysm is a rare vascular malformation. It mainly affects newborns and small children but can be discovered in adulthood. Endovascular embolization is its treatment of choice. This technique is not always available in some countries, which makes it necessary to resort to symptomatic treatment by ventricular shunt.

Assessment of Pharmacist Intervention Among Post Hospital Discharge Patients with Moderate and Severe Acute Heart Failure

Background: Acute heart failure is the most common cause for hospitalization and the third highest cause of hospital readmission with nearly quarter of patients being re hospitalized within 30 days after discharge. Implementation of Clinical pharmacists in coordinated inpatient care, discharge planning and outpatient care result in significant improvements in adverse drug events reduction, medication adherence, quality of life and patient knowledge. Objective: Evaluating pharmacist- based program for patients with moderate and sever acute heart failure via improving summary discharge in reduction hospital readmission, enhancing medications adherence and improve quality of life. Patients and Methods: This prospective study was carried out under interventional pharmacist- based program carried out on 50 patients whom completed this study, they were randomly allocated to two groups, program group who are receiving program for assessment and review starting from 30 minutes pre hospital discharge till 12 weeks. The control group on usual care which include physician-based discharge summary, routine laboratory test without pharmacist intervention (25 patients for each group). Result: After 12 weeks of follow up among program patients in comparison with control group, study findings revealed significant improvement in self-care heart failure index domains (maintenance, management, confidence and total SCHFI score (P=0.001) in both moderate heart failure (NYHAIII) and severe heart failure (NYHAIV) groups, also increase in domains of belief medication questionnaire whether specific necessity and specific concern domains (P=0.001) or decreased in general harm and general overuse (P=0.001) in both moderate and severe heart failure. Moreover, increase in all domains of WHO quality of life questionnaire (WHOQOL) (P=0.001) in both moderate and sever heart failure with predominant improvement in moderate heart failure. Both serum brain natriuretic peptide (P=0.001) and cardiac troponin I (P<0.01) level were decreased in patients with moderate and severe HF and ejection fraction was improved (P=0.03) only among patients with severe HF of program group. Conclusion: Implementing pharmacist- based management program for patients with moderate and severe acute heart failure via summary discharge markedly improve disease awareness, medication adherence, reduced hospital readmission and total mortality at the end-line of study among intervention patients compared to the usual care.

Recent Progress in the Analysis of Captopril Using Electrochemical Methods: A Review

Background: Captopril is the synthetic dipeptide used as an angiotensin converting enzyme inhibitor. Captopril is used to treat hypertension as well as for the treatment of moderate heart failure. Analytical instrumentation and methodology plays an important role in pharmaceutical analysis. Methods: This review presents some important applications of electrochemical modes used for the analysis of captopril. So far captopril has been analyzed by using different bare and modified working electrodes with a variety of modifiers from organic and inorganic materials to various types of nano particles/materials. Results: This paper presents some of the methods which have been published in the last few years i.e. from 2003 to 2016. This review highlights the role of the analytical instrumentation, particularly electrochemical methods in assessing captopril using various working electrodes. Conclusion: A large number of studies on voltammetry noted by means of various bare and modified electrodes. Among all of the published voltammetric methods, DPV, SWV, CV and miscellaneous modes were trendy techniques used to analyze captopril in pharmaceutical formulations as well as biological samples. Electrodes modified with nanomaterials are promising sensing tools as this showed high sensitivity, good accuracy with precision as well as selectivity. In comparison to chromatographic methods, the main advantages of electrochemical methods are its cheaper instrumentation, lower detection limit and minimal or no sample preparation.

A REVIEW OF ICD ANTITACHYCARDIA THERAPY PROGRAMMING WITH OUR RECOMMENDED GENERIC PROGRAMMING TEMPLATE FOR PRIMARY AND SECONDARY PREVENTION

<p>Implantable cardioverter-defibrillator (ICD) remains the main therapeutic option in reducing sudden cardiac death . Several randomized trials and registries have shown that ICDs extend survival in patients with severely impaired left ventricular function and mild to moderate heart failure . The delivery of ICD shocks remain an important source of mortality and morbidity. They are potentially proarrhythmic if delivered inappropriately and can worsen heart failure. Shocks are also painful, cause significant anxiety and can also lead to a post-traumatic stress disorder . Inappropriate ICD shocks remain also contribute a significant burden to ICD therapies. We provide an overview of important ICD trials and evolution of anti-tachycardia therapy and identify the principles on which the programming recommendations can be based to safely minimise anti-tachycardia therapies. </p>

Abstract 17911: Acute Cardiac Dysfunction by Adult-onset Cardiac Myosin Light Chain Kinase Ablation

Introduction: Under sustained pressure overload, myocytes that initially remodel to become short and thick, eventually become elongated and maladaptive with little force for contraction. Mechanisms underlying this transition are largely unknown. We previously demonstrated that 1 week of transverse aortic constriction in wild-type mice reduced cardiac myosin light chain kinase (cMLCK) levels by ~85%. In cultured cardiomyocytes, cMLCK knockdown led to sarcomere disorganization. Germline Mylk3 (encoding cMLCK) knockout mice demonstrated moderate heart failure. Hypothesis: Acute cMLCK reduction is causative for reduced contractility and remodeling of cardiomyocytes during the transition from compensated to decompensated hypertrophy. Methods: To mimic acute cMLCK reduction, adult inducible Mylk3 gene knockout mice, Mylk3flox/flox/merCremer, were generated and compared to 2 control mice (Mylk3flox/flox and Mylk3+/+/merCremer) following tamoxifen injection (50 mg/kg/day, 2 consecutive days). We assessed cardiac function (MRI, echocardiogram) in addition to histopathologic (tissue sectioning, immunostaining, and EM), cellular (cell size and cell shortening and intracellular free Ca2+) and molecular analyses. Results: Reduction of cMLCK proteins was evident at day 4 following tamoxifen-injection in inducible Mylk3 knockout mice. At day 7, inducible Mylk3 knockout but not control mice demonstrated heart failure [%FS, 28.0% in flox/flox (n=6), 27.7% in +/+/merCremer (n=6), 19.8% in flox/flox/merCremer (n=8)]. Analysis of inducible Mylk3 knockout mice revealed unique, severely convoluted cell morphology; isolated cardiomyocytes were elongated and thinner with disorganized sarcomere and reduced contractility (%FS in sarcomere length, control 5.1% vs. inducible knockout 2.4%). Adenovirus encoding cMLCK enhanced organized sarcomere structures; this was not prevented by co-infection of adenovirus unphosphorylatable MLC2v(Ser14/15Ala) mutants incorporated into sarcomere. Conclusion: Results of acute cMLCK reduction in a novel mouse model suggest that cMLCK plays a pivotal role in transition from compensated to decompensated hypertrophy via sarcomere disorganization likely independent of MLC2 phosphorylation.