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1.
Anne Keats Dane Moran Siobhan Rothwell Timothy Woodcock Tammy Williams Nishi Rawat 《Journal of the Saudi Heart Association》2018,30(3):180-187
Objective
To improve compliance with a target door-to-electrocardiogram (EKG) time of 10?minutes or less in patients presenting with symptoms concerning for acute coronary syndrome.Methods
A pre-post study was performed between January 2014 and May 2016 at five emergency departments (EDs) in Saudi Arabia. Patients who presented to ED with symptoms concerning for acute coronary syndrome were included in the study. The primary outcome of interest was whether EKG was completed within 10?minutes after the patient arrival to ED. Quality improvement interventions consisted of human resources adjustments, education, technological improvements, and improved interdepartmental collaboration. Multivariate analysis was used to model the percentage of EKGs that were completed within the targeted time.Results
During the study period, 11,518 patients received EKGs. Prior to the intervention, compliance with a door-to-EKG time of 10?minutes or less was found to be 62.6%. Post intervention, compliance improved to 87.7%. On multivariate analysis, male patients were significantly more likely to receive EKG within 10?minutes than female patients (odds ratio?=?1.231, 95% confidence interval?=?1.113–1.361; p?<?0.001).Conclusion
A quality improvement project can successfully increase the percentage of patients receiving EKG within 10?minutes of presentation to ED. Further research is required to demonstrate the clinical significance of improved door-to-EKG times. 相似文献2.
Saud M. Elsaughier Ramadan Ghaleb Amr Salah Amin Khaled Sayed elmaghraby Khaled Abdelghany Baraka 《The Egyptian Heart Journal》2018,70(4)
Background
Patent ductus arteriosus is generally associated with hyperdynamic status. Given the vascular shunt between the aorta and pulmonary artery, intrinsic aortic changes occur (aortic stiffness). In the present study, we attempted to assess the impact of PDA on aortic stiffness and its connection with cardiovascular function before and after transcatheter closure of PDA.Patient and methods
Our study consisted of 60 children who were preparing for transcatheter closure of PDA and 60 healthy controls. All patients had clinical and echocardiographic proof of hemodynamically significant PDA.Results
Patients with PDA exhibited significantly higher ASI than controls before closure (p-value?<?0.05). After closure, ASI was significantly reduced (p-value?<?0.05), but still higher than that of controls (p-value?<?0.05) at the six-month follow-up assessment. Patients with PDA had significantly lower LVEF than controls before closure (p-value?<?0.05). After closure, LVEF was significantly enhanced (p-value?<?0.05), and no significant difference was noted amongst patients and controls (p-value?<?0.05) at the six-month follow-up assessment.Conclusion
Aortic stiffness is significantly increased in patients with PDA regardless of PDA size. Aortic stiffness is related to reduced heart function. ASI may be valuable for observing the course of patients with PDA before and after intervention. 相似文献3.
Background
The beneficial effects of atrial septal defect (ASD) device closure on electrical cardiac remodeling are well established. The timing at which these effects starts to take place has yet to be determined.Objectives
To determine the immediate and short term effects of ASD device closure on cardiac electric remodeling in children.Methods
30 pediatric patients were subjected to 12 lead Electrocardiogram immediately before ASD device closure, 24 h post procedure, 1 and 6?months after. The maximum and minimum P wave and QT durations in any of the 12 leads were recorded and P wave and QT dispersions were calculated and compared using paired T test.Results
The immediate 24?h follow up electrocardiogram showed significant decrease in P maximum (140.2?±?6 versus 130.67?±?5.4?ms), P dispersion (49.73?±?9.01 versus 41.43?±?7.65?ms), PR interval (188.7?±?6.06?ms versus 182.73?±?5.8?ms), QRS duration (134.4?±?4.97?ms versus 127.87?±?4.44), QT maximum (619.07?±?15.73?ms versus 613.43?±?11.87), and QT dispersion (67.6?±?5.31 versus 62.6?±?4.68?ms) (P?=?0.001). After 1?month all the parameters measured showed further significant decrease with P dispersion reaching 32.13?±?6 (P?=?0.001) and QT dispersion reaching 55.0?±?4.76 (P?=?0.001). These effects were maintained 6?months post device closure.Conclusion
Percutaneous ASD device closure can reverse electrical changes in atrial and ventricular myocardium as early as the first 24 h post device closure. 相似文献4.
Sonia Rekik Imen Abdelkefi Soumaya Boussaid Ilhem Cheour Hela Sahli Mohamed Elleuch 《The Egyptian Rheumatologist》2018,40(4):255-260
Aim of the work
The aim of the present study was to evaluate effectiveness of anti-tumor necrosis factor-α (anti-TNFα) in the treatment of spondyloarthritis (SpA) and to assess their safety and drug survival.Patients and methods
Forty-two SpA patients (33 men, 9 women) were retrospectively studied. The disease was progressive in all patients. Response was assessed after 6 months using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Functional Index (BASFI) scores and other clinical parameters. A major clinical response was defined as 50% improvement of the initial BASDAI. Patients were grouped into those with ankylosing spondylitis (AS) (24 patients) or psoriatic arthritis (PsA) and enteropathic arthritis (EA) (18 patients) and the response to anti-TNF was compared.Results
The mean age of the patients was 41.3?±?9.7?years and disease duration 14.6?±?8.2?years. After 6?months, 74% of patients were BASDAI 50 responders. The mean BASDAI and BASFI scores varied from 56?±?20 and 61.8?±?26 to 19?±?19 and 24?±?25 respectively (p?<?.001). The two SpA groups had the same effectiveness profile. The comparison between them showed a greater reduction of morning stiffness duration and erythrocyte sedimentation rate in patients with PsA or EA (p?=?.04). At least, one adverse event developed by 48% of patients and it was severe in 12%. Bronchopulmonary infections were the most frequent (8 patients). Drug survival rate was estimated at 86% after 1?year of treatment.Conclusion
Anti-TNFα therapy has a good response rate in SpA patients and an acceptable safety profile which explains the high drug survival rates. 相似文献5.
Sanjay de Mel Yunxin Chen Adeline Lin Teck Guan Soh Melissa Ooi Eng Soo Yap Lara Kristina Sioco Donato Nurul Aidah Abdul Halim Joanna Mah Karen Lim Li Mei Poon Belinda Tan Hui Li Lim Liang Piu Koh Bee Choo Tai Zhaojin Chen Wee Joo Chng Lip Kun Tan 《Hematology/oncology and stem cell therapy》2018,11(4):225-232
Background
High dose Cyclophosphamide (Cy) and Vinorelbine Cyclophosphamide (Vino-Cy) are stem cell (SC) mobilisation options for patients with multiple myeloma (MM). We present a comparison of mobilisation outcomes using these regimens.Patients and methods
Vino-Cy patients received Vinorelbine 25?mg/m2 on day 1, cyclophosphamide 1500?mg/m2 on day 2, and pegylated GCSF on day 4 or GCSF 10?mcg/kg/day from day 4 onwards. Cy patients were given cyclophosphamide 4000?mg/m2 on day 1 and GCSF10?mcg/kg/day from day 5 onwards. The target CD34?+?SC collection was 5?×?106?per kg/BW.Results
149 patients were included. SC collection was lower in the Vino-Cy group (8.20?×?106/Kg BW) compared to the Cy group (11.43?×?106/Kg BW), with adjusted geometric mean ratio of 0.59 (95% CI 0.41 to 0.86, p?=?0.006). Time taken to achieve an adequate PB SC count was shorter for Vino-Cy (9?±?1?day compared to 12?±?2?days for Cy, adjusted absolute mean difference ?3.95, 95% CI ?4.85 to ?3.06, P?<?.001). Mobilisation related toxicities (in particular, neutropaenic fever) were greater for Cy.Conclusion
Vino-Cy is a potential alternative to Cy given the need for effective mobilisation protocols with acceptable toxicity. 相似文献6.
7.
Ahmed Shawky Elserafy Ahmed Nabil Ali Ali Ramzy Mohamed Abdelmenem 《The Egyptian Heart Journal》2018,70(3):149-153
Background
Right ventricular involvement in ST segment elevation myocardial infarction (STEMI) entails an increased morbidity and mortality. However, very scarce data is present on its affection in the setting of non-ST segment elevation myocardial infarction (NSTEMI).Aim
To assess the affection of right ventricular function in patients presenting with NSTEMI undergoing an invasive procedure.Subjects and methods
One hundred and fifty patients admitted with a first NSTEMI and eligible for reperfusion therapy via invasive percutaneous coronary intervention. These patients were divided in two groups; group A including patients with normal RV function, and group B including patients with impaired RV function as diagnosed by tricuspid annular plane systolic excursion (TAPSE) cutoff value?<?17?mm. All patients underwent angioplasty and were followed up in-hospital and for 3?months.Results
RV dysfunction occurred in ninety-five (61.3%) patients of the study population. Significant improvement occurred to TAPSE after 3?months in comparison to TAPSE at baseline (15.45?±?3.21 versus 17.09?±?4.17?mm). Those with impaired RV function showed improvement of TAPSE after three months as compared to baseline (13.62?±?2.58 vs 17.16?±?3.64 p?=?0.008). Multivariate analysis determined the independent predictors of RV dysfunction as RVEDD?>?26?mm, RVFAC?<?35%, RAA?>?20?cm2, and TAPSE?<?17?mm.Conclusion
RV dysfunction is not uncommon in NSTEMI when using the definition of TAPSE?<?17?mm. Following up RV function by TAPSE, showed significant improvement after 3?months with successful PCI as compared to baseline. We recommend assessing and following up RV function in all patients admitted with a NSTEMI. 相似文献8.
Manal Abd El Baky Mahmoud Menat Allah Ali Shaaban Ali Ali Ramzy 《The Egyptian Heart Journal》2018,70(3):155-159
Objective
To assess the role of Copeptin in diagnosis of acute myocardial infarction in troponin-blind period.Subjects and methods
This study was conducted on 40 patients who presented to emergency department complaining of chest pain and were highly suspicious to have acute cardiac ischemia, in addition to 10 subjects serving as a healthy control group. Blood samples were collected for determination of CK-MB, cTnI and Copeptin. These were measured twice (in patients’ group); at 3 h and then at 6–9 h from admission time.Results
The first sample revealed a non-significant difference between UA group and AMI group as regards CKMB and troponin, however, high significant difference was found as regards Copeptin (Z?=?5.29, P?<?0.001). Moreover, ROC curve analysis of serum Copeptin for discriminating AMI group from UA group in the first sample showed diagnostic sensitivity and specificity of 100%.In conclusion
Determination of copeptin in early diagnosis of AMI has diagnostic value being superior to a conventional cTn-I within the first three hours after acute chest pain. 相似文献9.
Osama A. Smettei Sawsan Sayed Abdullah M Al Habib Fahad Alharbi Rami M. Abazid 《Journal of the Saudi Heart Association》2018,30(3):165-171
Background
Coronary computed tomography angiography (CCTA) is increasingly being used for the evaluation of coronary artery disease; however, radiation exposure remains a major limitation of its use.Objective
To compare image quality and radiation exposure in two groups of patients undergoing CCTA using a 256-slice dual-source helical computed tomography scanner with high-pitch (FLASH) or prospective [step-and-shoot (SAS)] gating protocols.Methods
A prospective, single-center study was performed in our cardiac center. In total, 162 patients underwent CCTA with either FLASH or SAS scanning protocols. Subjective image quality was graded on the basis of a four-point grading system (1, non-diagnostic; 2, adequate; 3, good; 4, excellent). Objective image quality was assessed using image signal, noise, and signal-to-noise ratio (SNR). The effective radiation dose was also estimated.Results
The clinical and demographic characteristics of the patients in both groups were similar. The median age of the patients in both groups was 48.43?years, and males accounted for 63% and 68.7% of the FLASH and SAS groups, respectively. We found that the subjective image quality obtained with the FLASH protocol was superior to that obtained with the SAS protocol (3.35?±?0.6?mSv vs. 2.82?±?0.61?mSv; p?<?0.001). Image noise was higher in the FLASH group but was not statistically significant (25.0?±?6.13 vs. 24.0?±?6.8; p?=?0.10), whereas the signal and SNR was significantly higher with the FLASH protocol than with the SAS protocol [(469?±?116 vs. 397?±?106; p?>?0.001) and (21.6?±?8.7?mSv vs. 16.6?±?7.7?mSv; p?<?0.001), respectively]. Radiation exposure was 62% lower in the FLASH protocol than in the SAS protocol, (1.9?±?0.4?mSv vs. 5.12?±?1.8?mSv; p?<?0.001).Conclusion
The use of 256-slice CCTA performed with the FLASH protocol has a better objective and subjective image quality as well as lower radiation exposure when compared with the use of prospective electrocardiography gating. 相似文献10.
Khaled Mohamed Said Ahmed Ibrahim Nassar Ahmed Fouad Ali A. Ramzy Mustafa Fayed Fadle Abd Allah 《The Egyptian Heart Journal》2018,70(4):353-359
Background
Two-dimensional (2D) speckle-tracking strain imaging is a novel method for assessment of regional myocardial deformation that uses tracking of acoustic speckles or kernels rather than Doppler myocardial velocities. It has been suggested that Left atrial (LA) strain as measured by 2D speckle tracking can be used to evaluate dynamic LA function.Objective
To study the relation between left atrial deformation and the severity of coronary artery stenosis in patients with stable coronary artery disease (CAD).Study design
30 patients with stable coronary artery disease (SCAD) with coronary artery stenosis (>50%) who were admitted for elective coronary angiography at Ain Shams University hospitals and AlAzhar University hospitals were included in the study. Measurements of conventional echocardiographic parameters as well as LA strain and strain rate parameters were obtained, Syntax (SX) score was calculated for all patients.Results
Patients were categorized into 3 groups: low Syntax score of <23 (Group I), moderate syntax score 23–32 (Group II) and high syntax score of ≥33 (Group III). Peak atrial longitudinal strain (PALS) (Group I: 29.80?±?4.48, Group II: 22.44?±?1.42, Group III: 19.53?±?4.46; p?<?0.001) and Peak atrial contraction strain (PACS) (Group I: 13.43?±?4.05, Group II: 10.84?±?2.47, Group III: 7.19?±?0.71; p?<?0.022) were significantly lower in high syntax group. Significant negative correlation was found between SX score level and LA strain parameters (PALS and PACS) (r?=?0.861; p?<?0.001).Conclusion
Left atrial deformation analysis by 2D Speckle tracking Doppler Echocardiography can predict the severity of coronary affection in patients with stable CAD. 相似文献11.
Ghada Youssef Zakarya Saad Waleed Ammar Yasser Sharaf 《The Egyptian Heart Journal》2018,70(3):189-194
Background
Three-dimensional echocardiography provides a volumetric measurement of global and regional left ventricular (LV) function. It avoids the subjectivity of 2D echocardiography in the assessment of regional wall motion abnormalities (RWMA).Purpose
Evaluate the feasibility and practicality of 3D echocardiography in the evaluation of ischemic patients with abnormal regional LV contractility.Methods
The study included 40 patients with ischemic heart disease and RWMA as well as 30 control subjects. They underwent routine clinical examination and conventional 2D echocardiographic assessment. Segments were categorized as; normal, hypokinetic; akinetic or dyskinetic. Three-dimensional echocardiographic images were acquired and later on analyzed offline. Global LV function was semi-automatically calculated by the machine using volumetric measurements. Regional LV function was calculated manually for the 17 LV segments by detecting the end-diastolic (EDD) and end-systolic (ESD) points on the specific segment volume curve and the regional ejection fraction (EF) was calculated by the following formula {(EDDx-ESDx)/EDDx}, where x represents the specific segment. Regional EF was compared between patients and control subjects.Results
The mean age was 55.0?±?8.0 and 32.6?±?8.5?years (P?<?0.001) in patients and control groups, respectively. No statistically significant difference in EF between 2D and 3D images (47.3?±?10.5 vs 48.0?±?8.0, p?=?0.6). There was a good correlation between the 2D-RWMA and 3D-regional EF, and this correlation was consistent in the whole 17 segments.Conclusion
Three-dimensional echocardiography is an easy, non-invasive and objective tool to detect regional wall motion abnormalities in ischemic patients. It shows comparable results with conventional 2D images with the advantage of quantitative assessment of regional myocardial function. 相似文献12.
Objectives
To evaluate the safety of using the stiff end of a coronary wire to perforate an atretic pulmonary valve (PV) in patients with pulmonary atresia with intact ventricular septum (PAIVS).Background
Radiofrequency perforation is an accepted modality to perforate the PV in patients PAIVS. However, the high cost precludes its widespread use.Patients and methods
This is a single-center experience that spanned from March 2013 to January 2016 and involved 13 neonates who were severely cyanotic with PAIVS and with ductal-dependent pulmonary circulation. The stiff end of a coronary wire was used to perforate the atretic PV anterogradely, followed by balloon pulmonary valvuloplasty.Results
The mean age of patients was 3.9?±?2.7?days and their mean weight was 2.8?±?0.19?kg. The mean oxygen saturation was 77.1?±?3.2%. All had membranous pulmonary atresia, with patent infundibulum and tripartite right ventricle. The valve was successfully perforated in 11 out of 13 patients. Death occurred in two patients (15.4%) owing to heart failure and sepsis. Patent ductus arteriosus stenting was performed 2?days after the procedure in one patient because of cyanosis followed by one and half ventricle repair at of age 5?months. Two patients (15.4%) had one and a half ventricle repair at age of 5?months and 6?months owing to insufficient anterograde pulmonary flow. Two patients (15.4%) underwent second intervention with balloon dilatation of the valve. The remaining seven patients (53.8%) had no further intervention. Two cases (15.4%) had femoral artery thrombosis treated with streptokinase. The mean duration of follow-up was 13.17?±?7?months. There was significant improvement in the degree of tricuspid incompetence. There was a significant growth in the tricuspid valve annulus during the follow-up (the mean Z score increased from ?0.8?±?0.9 to 0.1?±?0.9) (p?=?0.003). There was also a significant increase in the tricuspid valve annulus/mitral valve annulus ratio as its mean increased from 0.73?±?0.10 to 0.86?±?0.11 during follow-up (p?<?0.001).Conclusion
Perforation of the atretic PV in selected cases with membranous atresia and patent infundibulum using the stiff end of a coronary wire is an effective alternative to using radiofrequency perforation. 相似文献13.
Zeinab O. Nawito Ghada S. El-Azkalany Marwa El-Sayad 《The Egyptian Rheumatologist》2018,40(4):265-268
Aim of the work
To evaluate the Nottingham Health Profile (NHP) assessment of health-related quality of life (HRQoL) in primary knee osteoarthritis (KOA) patients and to determine its relationships with clinical and radiological measures.Patients and methods
This study included 50 primary KOA patients and 25 matched healthy controls. All were assessed by NHP-HRQoL, visual analog scale (VAS) for pain in rest and activity, 15-m walk test for physical performance and knee joint range of motion (ROM). Radiographic grading of KOA was scored using Kellgren–Lawrence (K-L) score.Results
The 50 KOA patients were 33 (66%) females and 17 (34%) males with mean age of 43.3?±?8.6?years and BMI of 32.2?±?3.7. The VAS at rest was 2.6?±?2.1, during motion was 6.2?±?2.1, the 15-m test 22.6?±?3.6?s, ROM active flexion 122.9?±?10.8 and in passive flexion 132.1?±?11.1. All NPH subscales (physical mobility, pain, energy level, sleep and emotional reaction) except social isolation showed significantly higher scores in KOA patients compared to controls and tended to be higher in females. There were significant correlations between NHP subscales with age, VAS-rest, VAS-activity, knee flexion and degree of incomplete extension, walk test, also with K-L score.Conclusion
The NPH-HRQoL is affected in Egyptian patients with primary KOA and may be used as a measure to reflect pain, physical performance and radiographic severity. Physical mobility, pain, sleep, energy, and emotional reactions items were obviously reported except social isolation domain attributed to different cultures and morals of eastern communities. 相似文献14.
Hania S. Zayed Amr Amin Samy Alsirafy Nahla D. Elsayed Soheir Abo Elfadl Mohamed Nasreldin Dalia Enaba Zeinab Nawito 《Arab Journal Of Gastroenterology》2018,19(2):71-75
Background and study aims
Central nervous system (CNS) involvement in hepatitis C virus (HCV) infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis.Patients and methods
Nineteen patients (15 females and 4 males) with chronic HCV infection (mean age 46.5?±?7 and mean duration since diagnosis of HCV infection 4.7?±?4?years, including 6 (32%) Child-Pugh class A cirrhotic patients) and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale (WMS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Brain HMPAO Single Photon Emission Computed Tomography (SPECT) was performed for HCV patients.Results
Patients with HCV had lower scores on the block design test compared to control subjects (8.37?±?1.89 versus 10.37?±?1.47, p?<?0.001), lower total WMS scores (43.15?±?10.49 versus 60.27?±?8.08, p?<?0.001) and higher anxiety and depression scores (16.94?±?10.46 and 37.17?±?10.38 versus 10.3?±?4.67 and 28.9?±?5.99, p?=?0.004 and 0.001, respectively). Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis (39.14?±?9.3 versus 51.17?±?8.3, p?=?0.019) while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores (35.87?±?10.8 versus 46.79?±?8.6 in those with normal SPECT, p?=?0.049).Conclusions
Vasculitis may contribute to the development of neuropsychiatric involvement in HCV patients. 相似文献15.
Samia Salah-El-Din Mahmoud Doaa Ghaith Yomna Farag Bishoy Ibrahim 《The Egyptian Rheumatologist》2018,40(4):273-276
Introduction
Ferritin is an acute-phase reactant that is elevated in several autoimmune disorders. Serum ferritin levels have been correlated with disease activity scores of juvenile systemic lupus erythematosus (JSLE). Furthermore, enhanced levels of ferritin have also been described in lupus nephritis (LN).Aim of the work
To evaluate serum ferritin as a cheap and available marker of disease activity and renal involvement in Egyptian children with JSLE.Patients and methods
Forty-eight JSLE cases recruited from the Pediatric Rheumatology Clinic in Cairo University Specialized Children’s Hospital and 43 matched healthy children were enrolled in the study. SLE disease activity score-2000 (SLEDAI-2K) and renal activity score were assessed. Serum levels of ferritin, was quantified by enzyme-linked immunosorbent assay.Results
The mean age of the patients was 12.6?±?3.02?years and disease duration 3.4?±?2.5?years. Serum ferritin significantly higher in patients (416.1?±?1022.9?ng/ml) compared with control (36.1?±?18.2?ng/ml) (p?<?0.001). Serum ferritin was significantly higher in active (n?=?20) (890.4?±?1474.8?ng/ml) compared to inactive (n?=?28) (77.4?±?74.1?ng/ml) patients (p?<?0.001). A significant correlation was found between serum ferritin with SLEDAI-2K (r?=?0.35, p?=?0.014), renal-SLEDAI-2K (r?=?0.49, p?<?0.001) and with renal activity score (r?=?0.38, p?=?0.008). A significant correlation was found between serum ferritin and anti-double stranded-DNA (r?=?0.44, p?=?0.002) and complement 3 (r?=??0.42, p?=?0.003).Conclusion
Serum ferritin level can be considered a reliable biomarker for monitoring disease and renal activity in children with JSLE and LN. This may lead to improvement of management and consequently prognosis of JSLE patients as serum ferritin is an available and relatively cheap marker. 相似文献16.
Mohamed A. Mekky Ahmad R. Riad Marwa A. Gaber Mohamed O. Abdel-Malek Yosef M. Swifee 《Arab Journal Of Gastroenterology》2018,19(2):76-79
Background and study aims
Many regimens are tried in managing overt hepatic encephalopathy (HE). We investigated the efficacy of rifaximin versus metronidazole in management of an acute episode of HE on top of cirrhosis.Patients and methods
An open label prospective controlled trial was conducted on patients with an acute episode of HE on top of cirrhosis who were randomly divided into metronidazole-group (M-group) and rifaximin-group (R-group) with 60 patients in each.The main outcome measure was the clinical improvement of HE, duration of hospital stay and the changes in the level of serum ammonia after 3?days of starting therapy.Results
Both M-group and R-group were comparable as regards age and sex (mean age 51?±?11?years and 49?±?12; male/female ratio 45:15 and 50:10, respectively). Forty-six patients (76.7%) in M-group compared with forty-five (75%) in R-group showed clinical improvement (p?=?0.412). Hospital stays were comparable between both group; 4.2?±?2.1 and 3.9?±?1.7 for M-group and R-group; respectively (p?=?0.435). There was no significant difference of venous ammonia levels (Mean of delta 160.77?±?185.34?µg/dL and 207.95?±?218.43?µg/dL with p 0.664 and 0.974 in M-group and R-group, respectively). No adverse events were reported throughout the whole study.Conclusion
Rifaximin and metronidazole are equally effective in management of acute episode of overt HE, therefore, re-auditing of treatment protocols of HE are warranted especially in limited resource settings. 相似文献17.
Siva Subramaniyan Neeraj Pandit Ranjit Kumar Nath Ajay Raj Athar Kamal Deepankar Vatsa 《The Egyptian Heart Journal》2018,70(4)
Background
It is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required.Methods
61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24?h of PPCI and then on day 15, 3?months and 6?months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6?months along with effect of duration of chest pain on diastolic function.Results
54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6?months (p value?<?0.001). Diastolic function indices like deceleration time, isovolumic relaxation time, E wave, A wave, E/A ratio, left atrial volume and index improved statistically from baseline to 6?months except mitral E/e′ ratio. As time required to achieve reperfusion increases (chest pain duration and D to B time) the incidence of residual diastolic dysfunction also increases (p value?<?0.001). Patients with TIMI flow?<?III had more diastolic dysfunction (p value?<?0.001).Conclusions
Primary PCI improves diastolic dysfunction in patients with anterior wall STEMI over a period of 6?months. Time to achieve reperfusion and effectiveness of reperfusion have significant effect on diastolic dysfunction. 相似文献18.
Hayder Saeed Swati Yalamanchi Meng Liu Emily Van Meter Zartash Gul Gregory Monohan Dianna Howard Gerhard C. Hildebrandt Roger Herzig 《Hematology/oncology and stem cell therapy》2018,11(2):90-95
Objectives
Allogeneic hematopoietic stem cell transplant (HCT) continues to evolve with the treatment in higher risk patient population. This practice mandates stringent update and validation of risk stratification prior to undergoing such a complex and potentially fatal procedure. We examined the adoption of the new comorbidity index (HCT-CI/Age) proposed by the Seattle group after the addition of age variable and compared it to the pre-transplant assessment of mortality (PAM) that already incorporates age as part of its evaluation criteria.Methods
A retrospective analysis of adult patients who underwent HCT at our institution from January 2010 through August 2014 was performed. Kaplan-Meier’s curve, log-rank tests, Cox model and Pearson correlation was used in the analysis.Results
Of the 114 patients that underwent allogeneic transplant in our institution, 75.4% were ≥40?years old. More than 58% had a DLCO ≤80%. Although scores were positively correlated (correlation coefficient 0.43, p?<?0.001), HCT-CI/Age more accurately predicted 2-year overall survival (OS) and non-relapse mortality (NRM) in patients with lower (0–4) and higher (5–7) scores (52% and 36% versus 24% and 76%, p?=?0.004, 0.003 respectively). PAM score did not reach statistical significance for difference in OS nor NRM between the low (<24) and high-risk (≥24) groups (p?=?0.19 for both).Conclusions
Despite our small sample population, HCT-CI/Age was more discriminative to identify patients with poor outcome that might benefit from intensified management strategies or other therapeutic approaches rather than allogeneic HCT. 相似文献19.
Heba M. Tawfik 《The Egyptian Heart Journal》2018,70(3):213-216
Background
Hypertension is a public health problem and obesity is becoming an epidemic, increasing the risk of hypertension. Both are risk factors for cardiovascular diseases (CVD).Methods
A case control study recruiting 102 patients aged?≥60?years, divided into 55 cases with hypertension and 47 controls without. Body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR) were measured as well as lipid profile then Framingham risk score (FRS) was calculated.Results
Odds ratio (OR) for hypertension and medium to high risk cardiovascular events was the same in female patients using WC and WHtR. In male patients, only WHtR increased the risk for hypertension and for cardiovascular events, OR significantly increased with higher WHtR compared to WC.Conclusion
WHtR and WC are strong risk factors for hypertension and cardiovascular events in Egyptian elderly female patients. WHtR is the best anthropometric predictor for hypertension and cardiovascular events in male patients. 相似文献20.
Ebru Şahan Meliha Zengin Eroğlu Mehmet Baran Karataş Başak Mutluer Can Uğurpala Tonguç Demir Berkol 《The Egyptian Heart Journal》2018,70(3):143-147