A 63-year-old woman with a previous episode of Streptococcus agalactiae endocarditis requiring a ... more A 63-year-old woman with a previous episode of Streptococcus agalactiae endocarditis requiring a bioprosthetic aortic valve replacement presented with a short history of malaise, a right panopthalmitis with a Roth spot on funduscopy of the left eye and Streptococcus pneumoniae grown from vitreous and aqueous taps as well as blood cultures. She developed first degree heart block and her ECG was suggestive of an aortic root abscess. This gradually resolved over 6 weeks, during which she was treated with intravenous antibiotics. After careful consideration, it is likely that what was thought to be an aortic root abscess was instead an area of perivalvular inflammation.
With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascu... more With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascular disease and risk. An understanding of this is particularly important in the elderly patient, where likely triggers to atrial fibrillation and the influence of other pathologies on the safety and efficacy of proposed treatments will all contribute to optimal care of these patients. It is not yet clear whether rate control or cardioversion to sinus rhythm is the best strategy for the generality of patients with atrial fibrillation, and still less so for individuals. Age and comorbidity add complexities to this decision, which should inform the choice of drugs to be used. Further uncertainties arise from a literature that has often excluded elderly patients and derived its conclusions about mode of drug action from studies undertaken during sinus rhythm rather than atrial fibrillation. Despite these difficulties the careful evaluation of elderly patients with atrial fibrillation and the...
Several aggregate data meta-analyses suggest that treatment guided by the serum concentration of ... more Several aggregate data meta-analyses suggest that treatment guided by the serum concentration of natriuretic peptides (B-type natriuretic peptide (BNP) or its derivative N-terminal pro-B-type natriuretic peptide (NT-BNP)) reduces all-cause mortality compared with usual care in patients with heart failure (HF). We propose to conduct a meta-analysis using individual participant data (IPD) to estimate the effect of BNP-guided therapy on clinical outcomes, and estimate the extent of effect modification for clinically important subgroups. We will use standard systematic review methods to identify relevant trials and assess study quality. We will include all randomized controlled trials (RCTs) of BNP-guided treatment for HF that report a clinical outcome. The primary outcome will be time to all-cause mortality. We will collate anonymized, individual patient data into a single database, and carry out appropriate data checks. We will use fixed-effects and random-effects meta-analysis method...
We present the case of a 55-year-old lady presenting 5 months after a liver transplant with acute... more We present the case of a 55-year-old lady presenting 5 months after a liver transplant with acute coronary syndrome. She was on maintenance-dose tacrolimus. An angiogram diagnosed a spontaneous coronary artery dissection, which was successfully stented. This is the third case in the literature associating a calcineurin inhibitor with a spontaneous coronary arterial dissection. The detrimental effect of calcineurin inhibitors on vasculature is well recognised. This report highlights their potentially serious side-effects. It should be appreciated that calcineurin inhibitors have the potential to cause or contribute to this rare vascular phenomenon and the diagnosis should therefore be considered in those taking such drugs.
A previously fit and well 40-year-old man presented to the emergency department with palpitations... more A previously fit and well 40-year-old man presented to the emergency department with palpitations after suffering an 11 000 volt electrical shock from overhead power cables through a mobile crane which he was operating. His ECG demonstrated the presence of new atrial fibrillation at a rate of 80 beats per min. He was haemodynamically stable, and had otherwise only sustained a small exit burn to his left great toe. Routine blood tests including creatine kinase and troponin T were normal. A bolus of intravenous flecainide failed to restore sinus rhythm, but an amiodarone infusion was successful. An electrical shock is a rare cause of atrial fibrillation. There is no consensus over optimal medical management. Numerous treatment plans have been previously employed with varying degrees of success.
The American Journal of Geriatric Cardiology, 2002
... Mary's Wing, Highgate Hill, London N19 5NF, United Kingdom E-mail: suzanna.hardman@ whit... more ... Mary's Wing, Highgate Hill, London N19 5NF, United Kingdom E-mail: suzanna.hardman@ whittington.thenhs.com. Publication History. Issue published online: 6 JUN 2007; Article first published online: 6 JUN 2007. SEARCH. ... 54 Volgman AS, Carberry PA, Stambler BS, et al. ...
Oral viridians group streptococci (OVGS) have been implicated in infective endocarditis (IE) resu... more Oral viridians group streptococci (OVGS) have been implicated in infective endocarditis (IE) resulting in antibiotic prophylaxis (AP) prior to invasive dental procedures becoming the standard of care for preventing IE worldwide. However, in a review the UK National Institute for Health and Clinical Excellence (NICE) found a lack of scientific evidence for efficacy of AP and recommended it's cessation in March 2008. Objectives: The aim of this study was to assess compliance with the NICE guidelines and to identify any resulting increase in IE cases or deaths. Methods: National inpatient hospital activity data for patients discharged from hospitals in England with a diagnosis of IE were obtained and analysed along with AP prescribing data for England from January 2000 to October 2009. Results: Dentists were responsible for 92% of AP prescriptions using 3g amoxicillin or 600mg clindamycin. After the NICE guidelines, AP prescribing dropped 78% (p<0.0001) from 10,9001006 (meanSD) ...
The Journal of antimicrobial chemotherapy, Jan 29, 2015
Antibiotic prophylaxis (AP) administration prior to invasive dental procedures has been a leading... more Antibiotic prophylaxis (AP) administration prior to invasive dental procedures has been a leading focus of infective endocarditis prevention. However, there have been long-standing concerns about the risk of adverse drug reactions as a result of this practice. The objective of this study was to identify the incidence and nature of adverse reactions to amoxicillin and clindamycin prophylaxis to prevent infective endocarditis. We obtained AP prescribing data for England from January 2004 to March 2014 from the NHS Business Services Authority, and adverse drug reaction data from the Medicines and Healthcare Products Regulatory Agency's Yellow Card reporting scheme for prescriptions of the standard AP protocol of a single 3 g oral dose of amoxicillin or a single 600 mg oral dose of clindamycin for those allergic to penicillin. The reported adverse drug reaction rate for amoxicillin AP was 0 fatal reactions/million prescriptions (in fact 0 fatal reactions for nearly 3 million prescri...
A 63-year-old woman with a previous episode of Streptococcus agalactiae endocarditis requiring a ... more A 63-year-old woman with a previous episode of Streptococcus agalactiae endocarditis requiring a bioprosthetic aortic valve replacement presented with a short history of malaise, a right panopthalmitis with a Roth spot on funduscopy of the left eye and Streptococcus pneumoniae grown from vitreous and aqueous taps as well as blood cultures. She developed first degree heart block and her ECG was suggestive of an aortic root abscess. This gradually resolved over 6 weeks, during which she was treated with intravenous antibiotics. After careful consideration, it is likely that what was thought to be an aortic root abscess was instead an area of perivalvular inflammation.
With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascu... more With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascular disease and risk. An understanding of this is particularly important in the elderly patient, where likely triggers to atrial fibrillation and the influence of other pathologies on the safety and efficacy of proposed treatments will all contribute to optimal care of these patients. It is not yet clear whether rate control or cardioversion to sinus rhythm is the best strategy for the generality of patients with atrial fibrillation, and still less so for individuals. Age and comorbidity add complexities to this decision, which should inform the choice of drugs to be used. Further uncertainties arise from a literature that has often excluded elderly patients and derived its conclusions about mode of drug action from studies undertaken during sinus rhythm rather than atrial fibrillation. Despite these difficulties the careful evaluation of elderly patients with atrial fibrillation and the...
Several aggregate data meta-analyses suggest that treatment guided by the serum concentration of ... more Several aggregate data meta-analyses suggest that treatment guided by the serum concentration of natriuretic peptides (B-type natriuretic peptide (BNP) or its derivative N-terminal pro-B-type natriuretic peptide (NT-BNP)) reduces all-cause mortality compared with usual care in patients with heart failure (HF). We propose to conduct a meta-analysis using individual participant data (IPD) to estimate the effect of BNP-guided therapy on clinical outcomes, and estimate the extent of effect modification for clinically important subgroups. We will use standard systematic review methods to identify relevant trials and assess study quality. We will include all randomized controlled trials (RCTs) of BNP-guided treatment for HF that report a clinical outcome. The primary outcome will be time to all-cause mortality. We will collate anonymized, individual patient data into a single database, and carry out appropriate data checks. We will use fixed-effects and random-effects meta-analysis method...
We present the case of a 55-year-old lady presenting 5 months after a liver transplant with acute... more We present the case of a 55-year-old lady presenting 5 months after a liver transplant with acute coronary syndrome. She was on maintenance-dose tacrolimus. An angiogram diagnosed a spontaneous coronary artery dissection, which was successfully stented. This is the third case in the literature associating a calcineurin inhibitor with a spontaneous coronary arterial dissection. The detrimental effect of calcineurin inhibitors on vasculature is well recognised. This report highlights their potentially serious side-effects. It should be appreciated that calcineurin inhibitors have the potential to cause or contribute to this rare vascular phenomenon and the diagnosis should therefore be considered in those taking such drugs.
A previously fit and well 40-year-old man presented to the emergency department with palpitations... more A previously fit and well 40-year-old man presented to the emergency department with palpitations after suffering an 11 000 volt electrical shock from overhead power cables through a mobile crane which he was operating. His ECG demonstrated the presence of new atrial fibrillation at a rate of 80 beats per min. He was haemodynamically stable, and had otherwise only sustained a small exit burn to his left great toe. Routine blood tests including creatine kinase and troponin T were normal. A bolus of intravenous flecainide failed to restore sinus rhythm, but an amiodarone infusion was successful. An electrical shock is a rare cause of atrial fibrillation. There is no consensus over optimal medical management. Numerous treatment plans have been previously employed with varying degrees of success.
The American Journal of Geriatric Cardiology, 2002
... Mary's Wing, Highgate Hill, London N19 5NF, United Kingdom E-mail: suzanna.hardman@ whit... more ... Mary's Wing, Highgate Hill, London N19 5NF, United Kingdom E-mail: suzanna.hardman@ whittington.thenhs.com. Publication History. Issue published online: 6 JUN 2007; Article first published online: 6 JUN 2007. SEARCH. ... 54 Volgman AS, Carberry PA, Stambler BS, et al. ...
Oral viridians group streptococci (OVGS) have been implicated in infective endocarditis (IE) resu... more Oral viridians group streptococci (OVGS) have been implicated in infective endocarditis (IE) resulting in antibiotic prophylaxis (AP) prior to invasive dental procedures becoming the standard of care for preventing IE worldwide. However, in a review the UK National Institute for Health and Clinical Excellence (NICE) found a lack of scientific evidence for efficacy of AP and recommended it's cessation in March 2008. Objectives: The aim of this study was to assess compliance with the NICE guidelines and to identify any resulting increase in IE cases or deaths. Methods: National inpatient hospital activity data for patients discharged from hospitals in England with a diagnosis of IE were obtained and analysed along with AP prescribing data for England from January 2000 to October 2009. Results: Dentists were responsible for 92% of AP prescriptions using 3g amoxicillin or 600mg clindamycin. After the NICE guidelines, AP prescribing dropped 78% (p<0.0001) from 10,9001006 (meanSD) ...
The Journal of antimicrobial chemotherapy, Jan 29, 2015
Antibiotic prophylaxis (AP) administration prior to invasive dental procedures has been a leading... more Antibiotic prophylaxis (AP) administration prior to invasive dental procedures has been a leading focus of infective endocarditis prevention. However, there have been long-standing concerns about the risk of adverse drug reactions as a result of this practice. The objective of this study was to identify the incidence and nature of adverse reactions to amoxicillin and clindamycin prophylaxis to prevent infective endocarditis. We obtained AP prescribing data for England from January 2004 to March 2014 from the NHS Business Services Authority, and adverse drug reaction data from the Medicines and Healthcare Products Regulatory Agency's Yellow Card reporting scheme for prescriptions of the standard AP protocol of a single 3 g oral dose of amoxicillin or a single 600 mg oral dose of clindamycin for those allergic to penicillin. The reported adverse drug reaction rate for amoxicillin AP was 0 fatal reactions/million prescriptions (in fact 0 fatal reactions for nearly 3 million prescri...
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