Prognostic value of blood pressure in ambulatory heart failure: a meta-analysis and systematic review. Ambulatory blood pressure predicts heart failure prognosis

Heart Failure Reviews - Previous primary studies have explored the association between blood pressure (BP) and mortality in ambulatory heart failure (HF) patients reporting varying and contrasting...     

Utility of the INTERMACS profile at the time of assessment for heart transplant

The Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) profiles are associated with mortality in heart failure patients undergoing ventricular assist device (VAD) implantation and heart transplantation (HTx). We assessed the prognostic value of the INTERMACS profile at the time of assessment for HTx or durable VAD implantation as bridge to candidacy (BTC). A total of 503 consecutive patients considered for HTx or VAD between 2006 and 2016 were included. The associations between INTERMACS profile and (a) waitlist mortality or delisting, (b) probability of HTx, and (c) overall mortality or delisting were evaluated using multivariable analysis. Median follow-up time was 2.9 years (IQR: 0.9-5.5) during which 184 received VAD, 347 received HTx, and 73 died (27 waitlist, 46 post-transplant). INTERMACS I-II profile was associated with higher waitlist mortality or delisting (HR: 3.83, 95% CI: 1.22-12.03), and this risk was reversed by VAD implantation (HR: 0.12, 95% CI: 0.03-0.50). INTERMACS III-IV profile was associated with a higher probability of HTx (HR: 1.82, 95% CI: 1.37-2.40). INTERMACS profile was not associated with the composite outcome of overall mortality or delisting. These results emphasize the prognostic utility of INTERMACS at time of decision for advanced therapies and its potential value in selecting patients for different interventions.     

Gastroesophageal reflux as cause of chronic respiratory symptoms

Objective : Gastroesophageal reflux (GER) is a relatively common disorder in infants and children. It maybe associated with severe complications. The coexistence of GER and a wide range of respiratory symptoms has been reported. The purpose of our study was to investigate the relationship between chronic respiratory symptoms and GERD as an underlying cause. To our knowledge, there is not a method known study for identifying this relationship and prevalence in our area.Methods : The study group consists of fifty-two (4 months-10 years) children who were referred to pediatric surgery ward for evaluation of GERD as a cause of chronic respiratory symptoms by 24 hours PH monitoring. Additionally, 10 patients with only one episode of pneumonia were evaluated as the control group. Chronic respiratory presentations include the following: chronic cough, recurrent pneumonia, asthma, and respiratory distress.Results : 24 hour esophageal PH monitoring revealed GER in 22 (42.2%) patients as a cause of their chronic respiratory symptoms, while (30 (57.7%) children did not show any evidence of GER. GER was detected in 11 of 24 (45.7%) patients with chronic cough. Thirty-three patients presented with recurrent pneumonia, 13(39.9%) of whom had GER. In 8 patients with asthma, GER was found in 4 cases. None of the 6 patients with respiratory distress had GERD.Conclusion : The possibility of GERD was significantly higher in study group (children with chronic respiratory symptoms) compared to control group (p-value<0.01). All patients with chronic cough, recurrent pneumonia and asthma should be aggressively investigated for the possibility of GER. Documenting abnormal gastroesophageal reflux helps direct appropriate therapy before occurrence of major complications.     

Rapid determination of metformin in human plasma using ion-pair HPLC

A rapid, simple and sensitive ion-pair HPLC method has been developed for quantification of metformin in plasma. The assay enables the measurement of metformin for therapeutic drug monitoring with a minimum detectable limit of 20 ng/ml. The method involves simple, one-step extraction procedure and analytical recovery was complete. The separation was performed on an analytical 150 x 4.6 mm i.d. mubondapak C(18) column. The wavelength was set at 235 nm. The mobile phase was 40% acetonitrile, 0.01 M sodium dodecyl sulphate, 0.01 M sodium dihydrogen phosphate, and distilled water to 100%, adjusted to pH 5.1 at a flow rate of 1.5 ml/min. The calibration curve was linear over the concentration range 0.2-2.5 microg/ml. The coefficients of variation for inter-day and intra-day assay were within the range of clinical usefulness.     

Impact of pretransplant recipient body mass index on post heart transplant mortality: A systematic review and meta‐analysis

The ISHLT's 2016 Guidelines on the selection of heart transplant (HT) candidates recommends weight loss prior to listing for persons with body mass (BMI) index greater than 35 kg/m². We conducted a systematic review to assess the impact of BMI on all‐cause mortality. We searched to identify eligible observational studies that followed HT recipients. We used the GRADE system to quantify absolute effects and quality of evidence, and meta‐analyzed survival curves to assess post‐transplant mortality across BMI categories. We found a significantly increased risk of mortality in patients with BMI > 30 kg/m² across all age categories, independently of transplant era and study source (BMI 30‐34.9: HR 1.10, 95% CI 1.04‐1.17; BMI ≥ 35: HR 1.24, 95% CI 1.12‐1.38). We also found an increased risk of death in underweight (BMI < 18.5 kg/m²) candidates over 39 years of age (Age 40‐65: HR 1.24, 95% CI 1.02‐1.53; Age > 65: HR 1.70, 95% 1.13‐2.57). We found obesity and underweight BMI to be associated with mortality post‐HT. The similar and overlapping increased risk of mortality in patients with BMI 30‐34.9 and BMI ≥ 35 does not support the recently updated ISHLT guidelines. Future evidence in the form of randomized controlled trials is required to assess effectiveness of interventions targeting obesity‐related comorbidities and weight management.     

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369μm, ±0.233, 0.133± 0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm ±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P<0.01) and total spherical aberration (P<0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P=0.05). Mesopic pupil size in the myopic group was larger (P≤0.05). CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.     

Application of monolithic column in quantification of gliclazide in human plasma by liquid chromatography

A simple, rapid and sensitive isocratic reversed phase HPLC method with UV detection using a monolithic column has been developed and validated for the determination of gliclazide in human plasma. The assay enables the measurement of gliclazide for therapeutic drug monitoring with a minimum quantification limit of 10ngml(-1). The method involves simple, one-step extraction procedure and analytical recovery was complete. The separation was carried out in reversed-phase conditions using a Chromolith Performance (RP-18e, 100mmx4.6mm) column with an isocratic mobile phase consisting of 0.01M disodium hydrogen phosphate buffer-acetonitrile (52:48, v/v) adjusted to pH 4.0. The wavelength was set at 230nm. The calibration curve was linear over the concentration range 10-5000ngml(-1). The coefficients of variation for inter-day and intra-day assay were found to be less than 6.0%.     

Development of a rapid HPLC method for determination of famotidine in human plasma using a monolithic column

A rapid and sensitive HPLC method using a monolithic column has been developed for quantification of famotidine in plasma. The assay enables the measurement of famotidine for therapeutic drug monitoring with a minimum detectable limit of 5 ngml(-1). The method involves simple, one-step extraction procedure and analytical recovery was complete. The separation was carried out in reversed-phase conditions using a Chromolith Performance (RP-18e, 100 mm x 4.6 mm) column with an isocratic mobile phase consisting of 0.03 M disodium hydrogen phosphate buffer-acetonitrile (93:7, v/v) adjusted to pH 6.5. The wavelength was set at 267 nm. The calibration curve was linear over the concentration range 20-400 ngml(-1). The coefficients of variation for inter-day and intra-day assay were found to be less than 8%.