A retrospective analysis of cardiovascular outcomes of clozapine treated individuals within Hunter New England.

Background: Clozapine has demonstrated superiority in improving both positive and negative symptoms of treatment-resistant schizophrenia; however, there are associated treatment-limiting side effects, including myocarditis, cardiomyopathy and agranulocytosis.

Aim: This retrospective cohort study describes the prevalence of myocarditis, left ventricular (LV) dysfunction, cardiovascular risk factors and outcomes in a cohort of patients maintained on clozapine therapy.

Methods: Data were retrospectively collated from patients who had a diagnosis of schizophrenia, had been managed with clozapine at any stage during their care and undergone at least one echocardiogram.

Assessing quality of life in pulmonary arterial hypertension: An independent prognostic marker.

Pulmonary arterial hypertension (PAH, or PH Group 1), a disease of aberrant pulmonary vascular remodeling, causing progressive right heart failure (RHF) due to elevation of pulmonary vascular resistance (PVR). Patient mortality risk stratification guides choice and intensity of pharmacological intervention and is assessed by haemodynamics (especially PVR) as well as noninvasive tools including WHO functional class (FC), 6-min walk distance (6MWD), and NT-proBNP levels. Quality of life (QOL) assessment is acknowledged as a central aspect of patient-centered care, but our study sought to extend QOL's role as an additional noninvasive risk marker that could further refine risk stratification and hence therapeutic choices within a "treatment to target" paradigm (aiming to achieve low-risk status).

Adaptive Clinical Trials in Pediatric Critical Care: A Systematic Review.

Objectives: This systematic review investigates the use of adaptive designs in randomized controlled trials (RCTs) in pediatric critical care.

Data Sources: PICU RCTs, published between 1986 and 2020, stored in the www.PICUtrials.

Agreement of Clinician-Administered and Modified Parent-Administered House-Brackmann Scales in Children with Bell's Palsy.

Objective: Currently there is no parent administered scale for facial nerve function in children. We set out to assess the agreement between a newly developed parent-administered modified version of the House-Brackmann (HB) scale and the standard clinician-administered HB scale in children with Bell's palsy.

Study Design: Secondary analysis of a triple-blind, randomized, placebo-controlled trial of corticosteroids to treat idiopathic facial paralysis (Bell's palsy) in children (6 months to <18 years).

Prevalence and survival associated with pulmonary hypertension after mitral valve replacement: National echocardiography database of Australia study.

The specific prevalence and outcome of pulmonary hypertension after mitral valve replacement (MVR) is not well documented. The aim of the study was to determine the prevalence and prognostic impact of pulmonary hypertension after MVR. In addition, we sought to determine the threshold of mortality risk according to echocardiography derived pulmonary pressures and those echocardiographic characteristics that are associated with increased mortality.

Platypnea-Orthodeoxia Syndrome in the Setting of Patent Foramen Ovale Without Pulmonary Hypertension or Major Lung Disease.

Background Patent foramen ovale (PFO)-associated platypnea-orthodeoxia syndrome is characterized by dyspnea and hypoxemia when upright. The pathogenesis is thought to involve an increase in right atrial pressure or change in degree of right to left shunting with upright posture. Methods and Results We sought to characterize patients with platypnea-orthodeoxia syndrome related to PFO without pulmonary hypertension.

Does the introduction of pre-operative cardiopulmonary exercise testing in radical cystectomy delay or alter surgical care?

Objectives: To assess if the introduction of routine pre-operative cardiopulmonary exercise testing (CPET) in radical cystectomy has delayed surgical intervention.

Materials And Methods: A prospective database of patients undergoing radical cystectomy in our local health network was maintained. A retrospective analysis of two years (2018-2020) included 38 patients.

Neonatal nevus lipomatosus cutaneous superficialis managed by surgical resection alone.

Naevus Lipomatosus Cutaneous Superficialis(NLCS) is very rare in neonates and presents as part of broad spectrum of skin lesions. Clinical appearance alone can be deceptive. Prompt radiologic evaluation and surgical excision with visible clear margins should be first line of management followed by pathological confirmation to rule out any other sinister pathology.

Cord blood group 2 innate lymphoid cells are associated with lung function at 6 weeks of age.

Objective: Offspring born to mothers with asthma in pregnancy are known to have lower lung function which tracks with age. Human group 2 innate lymphoid cells (ILC2) accumulate in foetal lungs, at 10-fold higher levels compared to adult lungs. However, there are no data on foetal ILC2 numbers and the association with respiratory health outcomes such as lung function in early life.

Mepolizumab asthma treatment failure due to refractory airway eosinophilia, which responded to benralizumab.

Monoclonal antibodies directed against interleukin (IL)-5, such as mepolizumab and benralizumab, are an effective and established treatment for severe eosinophilic asthma. Here, we present a patient with eosinophilic asthma with a partial clinical response to mepolizumab initially, as measured by these biomarkers, who when investigated was found to have refractory airway eosinophilia. Escalation of the mepolizumab dose led to further but still only partial response.

Severe Nocardia pneumonia in an immunocompromised patient with alpha-1 antitrypsin deficiency.

Pulmonary nocardiosis is an uncommon pulmonary infection that is more likely found in immunocompromised patients with underlying chronic lung disease. The presentation of pulmonary nocardiosis is widely variable and shares features with other types of pulmonary infections. Nocardia is also not as easily isolated on standard culture mediums and hence more difficult to identify.

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury.

The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH).

Conservative Management of Abnormally Invasive Placenta Previa after Midtrimester Foetal Demise.

We present the case of a midtrimester intrauterine foetal demise (IUFD) in the context of abnormally invasive placentation. This was a grade 4 placenta previa with placenta increta in a patient requesting fertility conservation and was managed conservatively without immediate surgical intervention. The patient spontaneously delivered the fetus after 33 days, followed by a large obstetric haemorrhage requiring immediate laparotomy and hysterotomy.

Clarion call for histopathological clot analysis in "cryptogenic" ischemic stroke: implications for diagnosis and treatment.

Diagnosis, treatment, and secondary management of cryptogenic stroke patients pose a formidable challenge. The scenario is further complicated in patients with native and prosthetic valvular heart disease. We present a case study of a 36-year-old man who received intravenous thrombolysis (IV-tPA) and endovascular thrombectomy (EVT) for presumed "cryptogenic" complete middle cerebral artery infarction who made a surprisingly excellent clinical recovery despite poor baseline and postintervention neuroimaging.

Hypertrichosis cubiti, a case report and literature review.

Hypertrichosis cubiti is an uncommon congenital hypertrichosis with links to genetic syndromes, both autosomal dominant and recessive, with variable penetrance and expressivity. It may also present in sporadic cases with no phenotypic abnormalities or family history.

Predictors of disability worsening in clinically isolated syndrome.

Objective: To assess demographic, clinical, magnetic resonance imaging, and treatment exposure predictors of time to 3 or 12-month confirmed disability worsening in clinically isolated syndrome (CIS) and early multiple sclerosis (MS).

Methods: We utilized the MSBase Incident Study (MSBasis), a prospective cohort study of outcome after CIS. Predictors of time to first 3 and 12-month confirmed expanded disability status scale worsening were analyzed using Cox proportional hazards regression.

Comparative efficacy of switching to natalizumab in active multiple sclerosis.

Objective: To compare treatment efficacy and persistence in patients who switched to natalizumab versus those who switched between glatiramer acetate (GA) and interferon-beta (IFNβ) after an on-treatment relapse on IFNβ or GA using propensity score matched real-world datasets.

Methods: Patients included were registered in MSBase or the TYSABRI Observational Program (TOP), had relapsed on IFNβ or GA within 12 months prior to switching to another therapy, and had initiated natalizumab or IFNβ/GA treatment ≤6 months after discontinuing prior therapy. Covariates were balanced across post switch treatment groups by propensity score matching at treatment initiation.

Trans-radial versus trans-femoral access in patients with end-stage liver disease undergoing cardiac catheterization.

Cardiac catheterization has been increasingly utilized to evaluate coronary artery disease in patients with end stage liver disease (ESLD). It is known in other populations that radial access reduces access site complications;however, there is a paucity of data in ESLD patients. We investigated vascular and bleeding complications rates between trans-femoral and trans-radial cardiac catheterizations in this high risk population.

Quantitative (99m)Tc DTPA renal transplant scintigraphic parameters: assessment of interobserver agreement and correlation with graft pathologies.

Various (99m)Tc DTPA scintigraphic quantitative parameters for renal graft function assessment have been recommended, but none is universally accepted. In this study, 439 dynamic renal transplant scintigraphies (DRTS) were retrospectively analysed. In the first set of studies, four observers analysed the 47 random DRTS and interobserver agreement of eleven derived parameters was assessed.

Obesity in asthma: approaches to treatment.

There is mounting evidence that obesity is associated with asthma, both of which are seeing a dramatic increase in prevalence. Not only is obesity a risk factor for the development of asthma but it is also associated with poor asthma control. Asthma phenotypes associated with obesity include early-onset allergic asthma and late-onset non-allergic asthma.

Predictors of a favorable response to transforaminal injection of steroids in patients with lumbar radicular pain due to disc herniation.

Background: Transforaminal injection of steroids (TFIS) is effective for some patients with lumbar radicular pain caused by disc herniation. Factors associated with better outcomes are unknown.

Objective: To identify clinical and radiological features predictive of a favorable response to TFIS.