Coronary calcium scores (CCS) are a semi-automated test that has been used to estimate risk of myocardial infarction for patients at intermediate risk for coronary disease. The ability for CCS to predict coronary disease of haemodynamic significance is unclear. We conducted a retrospective cohort study to establish any association between vessel-specific CCS and invasive fractional flow reserve (FFR). We identified patients who had an invasive FFR between 2019 and 2022 at Royal North Shore Hospital and North Shore Private Hospital, and examined medical records to determine if a CCS was performed within a three-month period before the FFR was performed. Data were collected on baseline characteristics, CCS results, angiographic characteristics, and invasive FFR results. Associations between CCS and FFR were analysed using a linear regression analysis. 240 vessels with a CCS and invasive FFR were identified, including LAD (n=208), Cx (n=31) and RCA (n=28). Mean patient age was 67.9 year (±9.9), 29% were female, 62.8% with hypertension, 48.2% smoking history, 39% with dyslipidaemia and 16.5% diagnosed with diabetes-mellitus. 95% of studies were due to either stable angina or cardiovascular risk assessment. There was a linear relationship between CCS and age (R2=0.07, p<0.0001). There was an inverse relationship between CCS and FFR (R=-0.15, p=0.03). There is a clear association between vessel-specific CCS and haemodynamic burden of coronary disease as assessed using invasive FFR.

Myocardial perfusion scan (MPS) is an established non-invasive diagnostic tool for assessing reversible ischaemia in low-to- intermediate-risk chest pain patients. The diagnostic utility of Coronary Artery Calcium Score {CACS} in isolation is less established in this cohort at excluding obstructive coronary artery disease. In comparison to MPS; CACS is less costly; more time efficient and utilizes smaller doses of ionizing radiation.

Myocardial perfusion studies (MPS) and coronary artery calcium scores (CACS) are widely utilised non-invasive modalities in the assessment of patients with low- to intermediate-risk chest pain. CACS correlates to burden to atherosclerotic disease whereas MPS is beneficial in assessing myocardial function and ischaemia. The combination of both modalities can be valuable in risk stratifying patients in the low to intermediate-risk in order to consider appropriate further invasive coronary investigation.

Fractional Flow Reserve (FFR) is a lesion-specific pressure index tool used to assess haemodynamic significance of intermediate coronary lesions on coronary angiography. An FFR of 0.8 is considered the cut off for haemodynamic significance. Few studies have looked at outcomes in patients with a negative FFR at values approaching haemodynamic significance. The purpose of this study is to evaluate hospital re-admission, repeat coronary angiography and intervention rates in patients with negative FFR results. A retrospective analysis was performed on 109 FFR cases performed in a tertiary hospital between 2015 and 2017. FFR data was stratified into four groups; positive (≤0.80), high-moderate risk (0.81-0.85), low-moderate (0.86-0.90) and low risk (>0.90).Tabled 16465.221.74.34.36766.716.74.24.26855.627.88.35.67661.619.27.77.7 Open table in a new tab Low-risk FFR cases were associated with higher age and higher rates of repeat coronary angiography and percutaneous intervention compared to moderate risk patients. The variance in the population data and repeat angiography rates between low and intermediate risk patients suggests that a graded rather than a binary assessment of FFR may be beneficial. Furthermore, the increase in age observed with lower FFR readings suggests a bias towards performing FFR in elderly patients with non-haemodynamically significant lesions. However, a more comprehensive multi-centre trial would provide further insight.

Background: Trans-radial access is the current gold standard approach for coronary angiography, with reduced access-site complications, early patient ambulation, and reduced all-cause mortality and major adverse cardiac events (MACE). Radial artery anomalies are common and may be associated with access related failure or complications. Methods: Between the years 2011 and 2012, angiographic assessment of radial arteries was commonly performed by trans-radial operators at Wollongong Hospital. For patients who had angiography of the access site, data were collected on baseline characteristics, procedural details, radial anatomical anomalies, and procedural complications. Results: A total of 313 forearm angiographic images were taken during this period. Access was attained used a 6Fr Radial sheath on 265 occasions, and 5Fr Radial sheath on 48 occasions. The TIG was the most common catheter used, being the diagnostic catheter of choice on 285 occasions (90.4%). Diagnostic angiography alone was performed 265 times (81.2%). 8 cases of radial artery loops were identified (2.5%). Radial artery tortuosity was described in 70 cases (22.3%). There were 12 cases of access crossover to the femoral artery, which were mostly associated with radial anatomical abnormalities (66.7%), including 5 cases associated with radial artery loops and 3 associated with radial artery tortuosity. Conclusion: Radial artery anomalies were common and were associated with a higher risk of access site crossover.

Myocardial perfusion scan (MPS) is an established tool for assessing reversible ischaemia in intermediate-risk chest pain patients. The Global Registry of Acute Coronary Events (GRACE) score is a validated tool to assess 6-month mortality post ACS, guiding management and follow up.Tabled 1Low riskHigh riskMPS-(136)MPS+(17)MPS-(176)MPS+(67)Male53.364.756.864.2Age60.159.776.876.4CVA0.70.01.13.0AMI0.75.91.79.0Death0.70.01.73.0MACE2.25.94.514.9PCI4.429.41.122.4 Open table in a new tab In this retrospective analysis we assessed the utility of using the GRACE risk assessment tool to improve prediction of major adverse cardiac events (MACE) in patients undertaking MPS. Scores were retrospectively calculated for all inpatient MPS studies performed in a tertiary hospital between January and December 2018. Outcomes assessed included progression to coronary angiography, percutaneous coronary intervention and MACE (composite of myocardial infarction, stroke and death). 396 patients were included in the study, with a mean age 70.3 ± 13.6 years and 57.3% male proportion. The retrospective application of the GRACE risk stratification tool increased the specificity of MPS in the prediction of MACE and PCI. Prospective randomised controlled studies would be beneficial to confirm the utility of cardiac risk assessment tools prior to myocardial perfusion scanning.

The Ultimaster stent is bioresorbable polymer sirolimus-eluting stent currently being investigated for abbreviated duration dual antiplatelet therapy in high risk bleeding patients [[1]Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen (MASTER DAPT), Cardialysis et.al. European Cardiovascular Research Center. ClinicalTrials.gov Identifier: NCT03023020.Google Scholar]. We aim to review the real-world safety and performance data from Wollongong Hospital, the highest utiliser of Ultimaster stents in Australia. A retrospective analysis of 317 patients receiving a total of 536 stents from August 2017 to January 2019 was performed. Target lesion failure (TLF), a outcome of unsuccessful intervention, target vessel related myocardial infarction and cardiac death), was measured and patient specific endpoints of MACE (composite of all-cause death, myocardial infarction and stroke) and major bleeding were also measured. Outcomes were recorded until the time of writing. Of the 317 patients (mean age 67.6 ± 11.4 years and 70% male) 65.9%, 56.8% and 30.0% had hypertension, hyperlipidaemia and diabetes respectively and 59.9% were smokers. 89.3% of patients were initiated on aspirin/clopidogrel post-PCI with ticagrelor and prasugrel replacing clopidogrel in 4.7% and 5.4% respectively. 76% of stents were inserted via radial access. Average stent diameter and length was 2.95 ± 0.48mm and 21.89 ± 8.55 mm, respectively. Analysis revealed an incidence of 4.4% TLF and 8.2% MACE while the incidence of major bleeding was 3.4%. This is the first real-world study in Australia on the Ultimaster stent and results are comparable with pre-marketing randomised controlled trials [[2]Wohrle J. Markovic S. Rottbauer W. Muramatsu T. Kadota K. Vazquez-Gonzalez N. Odenstedt J. Serra A. Antoniucci D. Varenne O. Saito S. Wijns W. Bioresorbable polymer sirolimus-eluting coronary stent compared with permanent polymer everolimus-eluting coronary stent implantation for treatment of small vessel coronary artery disease: CENTURY II trial.EuroIntervention [Internet]. 2016; 12 (In: Ovid MEDLINE(R) [Internet].): e167-e174Google Scholar] proving translation of safety and efficacy into clinical application.

Background: Direct stenting and stenting after pre-dilation are strategies used in the setting of Primary PCI for ST-elevation Myocardial Infarction (STEMI). There is a paucity of evidence to guide one treatment strategy over the other. Methods: We performed a retrospective review of a registry of Primary PCI for STEMIs between April 2013 and November 2018. Procedures were performed at Wollongong Hospital, a large tertiary centre in NSW, Australia. We collected data on baseline characteristics, procedural characteristics, procedural complications, and follow up data on Major Adverse Cardiovascular Events (MACE). Results: Data were collected on a total of 310 patients who were treated with Primary PCI for STEMI. Of these, 260 (83.9%) were treated with stenting after pre-dilatation, 38 (12.3%) were treated with a direct stenting strategy (including 11 with aspiration thrombectomy, 28 without), and 12 (3.9%) of patients were treated with “Plain Old Balloon Angioplasty” (POBA). Mean follow up duration was 29 months. There was a complication rate of 7.9% in the direct stenting arm (including a 5.3% risk of slow flow or no-reflow). This was higher than the rate for stenting with pre-dilatation, with a 6.9% rate of procedural complication (including a 1.9% risk of slow flow/no-reflow), though this did not reach statistical significance (p = 0.83). Incidence of MACE on follow up was 15.8% for the direct stenting arm vs 17% for the stenting with pre-dilatation (p = 0.86). Conclusion: In our cohort, there was no statistically significant difference in incidence of peri-procedural complications and MACE between direct stenting and stenting after pre-dilation.

Objectives: Our aim was to compare the incidence of left atrial appendage (LAA) thrombus in patients on warfarin versus NOACs prior to transoesophageal echocardiogram (TOE) guided cardioversion in patients with Atrial Fibrillation. Background: Prior to cardioversion in patients with atrial fibrillation, careful transoesophageal echocardiographic assessment of the LAA is paramount. Warfarin has traditionally been used for anticoagulation prior to TOE guided cardioversion. More recently advantages of NOAC administration compared to warfarin have been demonstrated. However, evidence for use in cardioversion for patients with atrial fibrillation is limited. Methods: This is a retrospective study undertaken at a single regional centre between January 2014 – Dec 2015. Consecutive patients undergoing TOE guided cardioversion for atrial fibrillation were included. Patients not administered anticoagulation or anticoagulation for < 3 weeks were excluded. Primary end point was incidence of LAA thrombus. Secondary end point was bleeding. Patients were grouped according to pre-procedure warfarin (group 1) or NOAC (group 2) administration. Results: 151 patients underwent cardioversion; 73 patients were excluded. 31 patients were in group 1 and 47 in group 2. Gender and comorbidities between groups were similar. LAA thrombus was found in three patients (4%), (Group 1 N=0, group 2 N=3) (p=0.15). Secondary there were no significant complications of anticoagulation administration between groups. Conclusion: There was no significant difference in the incidence of LAA thrombus in patients administered NOACs compared to warfarin prior to transoesophageal guided cardioversion.

Hercules is a dwarf spheroidal satellite of the Milky Way, found at a distance of about 138 kpc, and showing evidence of tidal disruption. It is very elongated and exhibits a velocity gradient of 16 +/- 3 km/s/kpc. Using this data a possible orbit of Hercules has previously been deduced in the literature. In this study we make use of a novel approach to find a best fit model that follows the published orbit. Instead of using trial and error, we use a systematic approach in order to find a model that fits multiple observables simultaneously. As such, we investigate a much wider parameter range of initial conditions and ensure we have found the best match possible. Using a dark matter free progenitor that undergoes tidal disruption, our best-fit model can simultaneously match the observed luminosity, central surface brightness, effective radius, velocity dispersion, and velocity gradient of Hercules. However, we find it is impossible to reproduce the observed elongation and the position angle of Hercules at the same time in our models. This failure persists even when we vary the duration of the simulation significantly, and consider a more cuspy density distribution for the progenitor. We discuss how this suggests that the published orbit of Hercules is very likely to be incorrect.

The interest of antiobiotic treatment of Shigella infections: to reduce the carriage and contamination, duration of the symptoms and the risk of complications.The evolution of the treatment Over the past years, strains of Shigella sonnei have become resistant to aminopenicillin and cotrimoxazole (treatment recommended till now) and now predominate.Inter-human transmission The Shigella reservoir is human. The bacteria are easily transmitted in fecal-oral mode. The populations most at risk are those in situations of great promiscuity.Regarding diagnosis Shigella sonnei infections are commonly characterised by intermediate diarrhoea and fever, following a short period of incubation. Only culture of the faeces permits the diagnosis.The decision to treat Confronted with an isolated case, treatment can only be initiated after bacteriological diagnosis. Confronted with symptomatic cases with at least one confirmed bacteriologically, treatment can be initiated without waiting for the results of the faecal culture.In children Azithromycine has become the treatment of choice. Ceftriaxone, administered via the parenteral route, can hardly be considered as the first-line treatment. Quinolones can only be considered in last intention; only ciprofloxacine can be recommended.In adults Ciprofloxacine and of loxacine can be recommended firstline over a period of 3 days.Guidelines A summary; including good faecal culture practices, can be found on the Website of the French Agency for the saitary of health products (Afssaps) (www.afssaps.sante.fr).

Although rheumatic fever virtually no longer occurs in France, pharyngitis due to group A beta-hemolytic streptococci (ABHS) remains a common pediatric problem. American studies have underscored the high rate of bacteriologic treatment failures and recurrences of ABHS pharyngitis. Furthermore, several comparative studies have demonstrated that cephalosporins provide better results on these two parameters. This prospective randomized study compared the effectiveness of penicillin V (50 000 to 100 000 IU/kg/day in three divided doses) and Cefaclor (20 to 40 mg/kg/day in three divided doses), each given for ten consecutive days. From September 1989 through October 1990, 117 children (mean age 5.7 years) were entered into the study. All study subjects were seen as outpatients and found to have ABHS pharyngitis on the basis of a rapid screening test and confirmatory bacteriologic studies. Cefaclor was given to 56 patients and penicillin V to 61. Reevaluation with a repeat bacteriologic study was performed in all patients at the end of the treatment period, or earlier in the event of new clinical manifestations, and towards D40. Among patients given penicillin V, bacteriologic failure rate at completion of therapy was 19.6 %, clinical failure rate on D10 was 8 %, and recurrence rate on D40 was 16.5 %. Cefaclor exhibited greater bacteriologic and clinical effectiveness, with 3.4 % bacteriologic failures on D10 (p < 0.01), 1.7 % clinical failures on D10, 8.9 % clinical recurrences between D10 and D40, and an overall 10.6 % rate of failure or recurrence (p = 0.05).

The combination of erythromycin ethylsuccinate and acetyl sulfafuroxazole (Pediazole(R) = ES) is effective against Hemophilus influenzae, including beta-lactamase-producing strains, and against Streptococcus pneumoniae, including macrolide-resistant strains. In this study, mean daily dosage was 40-50 mg/kg for cefaclor and 50 mg/kg ES + 150 mg/kg sulfamide for Pediazole(R). Both products were given in three divided doses per day for ten days. Tolerance was evaluable in 106 children and effectiveness in 103 children including 52 in the ES group and 51 in the cefaclor group. Mean age was 23.5 months and both groups were comparable as concerns age, weight, previous ENT disease, and severity of the otitis media. Tolerance was satisfactory in both groups. Clinical results were as follows: failures before or at completion of the course, 5/52 in the ES group versus 13/51 in the cefaclor for the treatment of children with acute otitis media.