Effect of Race on Left Ventricular Ejection Fraction Decline After Initial Improvement with Beta Blockers in Patients with Non-Ischemic Cardiomyopathy: A Retrospective Analysis

Background

Although beta blockers (BBs) are established therapy in heart failure, some patients whose left ventricular ejection fraction (LVEF) initially increases on BB therapy experience a subsequent LVEF decline. This study aimed to evaluate the proportion of patients with non-ischemic cardiomyopathy (NICM) whose LVEF declines while on BB therapy and determine important predictors of LVEF decline.

Methods

A retrospective analysis of 238 patients receiving a BB (carvedilol, metoprolol succinate, or tartrate), with an ejection fraction of ≤40 % and NICM, whose LVEF initially rose ≥5 % after 1 year of BB therapy, was conducted. Post-response LVEF decline ≥5 % to a final LVEF of ≤35 % was evaluated within 4 years of BB initiation.

Results

In our study, we had 52 Caucasians (22 %), 78 Hispanics (33 %), and 108 African Americans (45 %). Overall, 32 patients (13.44 %) had post-response LVEF decline. The nadir LVEF of patients with post-response LVEF decline was 25 % (interquartile range 20–27). Compared with others, Hispanics had lower nadir LVEF (22 %, p < 0.001). Important predictors of LVEF decline were Hispanic race (odds ratio (OR) 6.094, p < 0.001), New York Heart Association (NYHA) class (OR 2.287, p < 0.05), baseline LVEF (OR 1.075, p < 0.05), and age (OR 0.933, p < 0.001).

Conclusion

A significant proportion (13.44 %) of NICM patients with LVEF increase over 1 year of BB therapy experienced subsequent LVEF decline. Race, NYHA class, baseline LVEF, and age are important predictors of this decline.     

The roots of evil: the amazing history of trichinellosis and <Emphasis Type="Italic">Trichinella</Emphasis> parasites

This review aims to investigate, from a historical point of view, the roots of the Trichinella pathogens and the disease they produce, beginning from the times first recorded in the Bible and continuing until the scientific mysteries of the pathogen were finally unveiled. Our journey sheds light on “strange” epidemics developing before the discovery of the parasite and bearing a clinical similitude to trichinellosis; it follows the controversies that erupted after the nineteenth century discovery of the parasite and the subsequent official outbreaks, and then examines the pioneering methods used for its visualization. Finally, it tries to reveal the possible relationship of trichinellosis with the arts. Furthermore, it seems that the saga of the helminth, “destined to remain with us, both in nature and in the laboratory,” will continue to haunt and fascinate scientists from both developing and developed countries, as they try to answer new questions about the parasite's “evil” nature.     

Reviews on trichinellosis (II): neurological involvement

Neurological involvement may occur in 0.2%-52% of cases with trichinellosis, generally in the most severely affected patients. This review focuses on neurotrichinellosis and includes a brief overview of selected cases reported in the literature. Our primary goal was to increase the awareness of infectious diseases specialists, neurologists, and general practitioners about these major complications with possible fatal outcome. Seventy seven of the cases, for which enough details were available, have been pooled for statistical analysis. The mean age of the investigated group was 34.6?±?16.8 years. Patients with both focal and diffuse manifestations predominated (55.8%), and they were significantly older (40?±?15.5 years old) than those who presented solely focal (28.9?±?17.8 years old; p?=?0.03) or diffuse lesions (27.9?±?15.3 years old; p?=?0.007). In most of the cases (59.7%), complete recovery was reported, whereas 23.4% of cases had sequelae and 16.9% of the patients died. Patients who died had significantly lower eosinophil counts (13.8%?±?14%) when compared with those who made complete recovery (28.7%?±?18%; p?=?0.015) and the cases with sequelae (35%?±?17.9%; p?=?0.006). To sum up, trichinellosis must be considered in the differential diagnosis of any patient with encephalitis or other central nervous system malady of ambiguous etiology.     

Reviews on trichinellosis (I): renal involvement

Besides cardiac and neurological complications of trichinellosis, renal involvement is the most important as regards the cases published and discussed in literature and is generally characteristic of the severe forms of the disease. This article focuses exclusively on the renal disturbances that may occur in this parasitic illness and includes a synopsis of published cases. Our primary goal was to increase the awareness of infectious diseases specialists, nephrologists, and general practitioners about these complications with possible fatal outcome. To our knowledge, this is the first international review dedicated to this topic. Cases for which enough details were available have been analyzed, and the results indicated that the mean age of the affected patients was 31.6 years, with a slightly male predominance (56.2%). The fatality rate was 26.1%. Proteinuria was detected in 84.8% of cases, hematuria in 30.4%, and casts were observed in urine specimens from 23.9% of patients. Renal failure was evidenced in 8.7% of patients, whereas renal lesions were found by biopsy or necropsy in 43.5% of cases. Of the routine laboratory parameters that are relevant for trichinellosis, mean eosinophil count was 32.2% and mean leukocyte count was 17,312 cells/μL. Finally, we emphasize on the necessity of establishing an early and correct diagnosis of trichinellosis to avoid later and severe complications. Additionally, implementation of public health and food safety prophylactic measures against the disease must represent an immediate priority for the affected regions.     

High dose rate brachytherapy as monotherapy for localised prostate cancer

Background and purpose

To evaluate the oncological outcome of a three-implant high dose rate (HDR) brachytherapy (BRT) protocol as monotherapy for clinically localised prostate cancer.

Kabuki make-up (Niikawa-Kuroki) syndrome in the Byelorussian register of congenital malformations: Ten new observations

We describe clinical manifestations and historical data on ten patients with Kabuki make-up syndrome. All patients are of European ancestry and all have the characteristics of the syndrome, including typical face, retarded physical development, and mild to moderate mental retardation. Two of the probands have low-normal intelligence. Prominent and broad philtrum was described as an important component manifestation of the syndrome. In three families some clinical manifestations of Kabuki make-up syndrome were observed in parents and some other relatives of the probands in three generations. Some phenotypic differences between Asian and non-Asian patients were noted. The possible cause of the syndrome is discussed. The present observations and a literature review suggest autosomal dominant inheritance with different expressivity of the Kabuki make-up syndrome. © 1995 Wiley-Liss, Inc.     

Pharmacological properties of inhibitions in the cerebellar cortex

Summary Stimulation of the parallel fibres, or the mossy fibres, in the cerebellar cortex depresses the potential generated in the granular layer by anti-dromic invasion of the Purkinje cells (N₁), and that generated by the axon discharge of granule cells (P₂). The reduction of these potentials indicate inhibitions mediated respectively by basket and Golgi cells. The depressions of both N₁ and P₂ potentials are unaffected by strychnine at doses of up to 1 mg/kg. Picrotoxin and bicuculline reduce or suppress both inhibitions at doses of 2 to 5 mg/kg and 0.2 to 0.4 mg/kg respectively. The action of the picrotoxin is long lasting or even possibly irreversible, whereas that of bicuculline lasts only a few minutes. The ratio by weight between the dose of picrotoxin and that of bicuculline necessary to reduce the N₁ and P₂ depression exceeds 10.These results indicate that gamma-aminobutyric acid may be the chemical inhibitory transmitter at basket cell — Purkinje cell and Golgi cell — granule cell synapses.Postgraduate student of the Scuola Normale Superiore of Pisa.From the Clinica delle Malattie Nervose e Mentali della Università di Perugia, Italy.     

Import of malaria in a Romanian Western County

BACKGROUND: Malaria is not a serious concern in Romania nowadays although 30-60 imported cases are diagnosed yearly, especially in travellers from Africa. Timis, the most extensive of the Romanian counties, is the western gate of the country from where a lot of people travel abroad. The aim of this study is to overview all the imported cases of malaria diagnosed in our county and to describe two recent severe cases. METHODS: We retrospectively analyzed both the medical records of 28 malaria patients treated between 1974 and 2007 at Victor Babes Hospital of Infectious Disease from Timisoara, Romania, and the results of 6 blood examinations performed in the last decade in the parasitological laboratory of Victor Babes University of Medicine and Pharmacy from Timisoara. A comparison between the two recent severe cases was made, emphasizing on the clinical aspects, complications and the laboratory test results. RESULTS: Most of the patients (55.38%) were in the age group of 20-29 years; 85.71% of the patients were males; Plasmodium falciparum was found in 75% of the cases. CONCLUSIONS: Findings of our study have shown that P. falciparum is the main malaria species in Timis County, outlining the difficulties in the diagnosis and management of the imported cases.