Renal Function of Patients with a Failing Fontan Circuit Undergoing Total Cavopulmonary Revision Surgery

This report characterizes renal dysfunction after total cavopulmonary (TCPC) revision surgery for atriopulmonary Fontan (APF) circulations, a known risk factor for a poor outcome. The perioperative data for 23 consecutively identified patients were reviewed. The preoperative mean glomerular filtration rate (GFR) was 101 ± 30 ml/min/1.73 m², decreasing to 65 ± 41 ml/min/1.73 m² early in the postoperative period. The preoperative GFR was highly correlated with age at APF (r = −0.5; p = 0.024), age at TCPC (r = −0.5; p = 0.01), and mixed venous saturation (r = 0.6; p = 0.01). Three of four patients requiring renal replacement therapy (RRT) died at a median age of 3 months (range, 18 days to 9 months). Determinants of early GFR and RRT were preoperative GFR (p = 0.016) and creatinine (p = 0.035). Younger age at primary Fontan (p = 0.008), higher preoperative mixed venous saturation (p = 0.019), and higher preoperative blood pressure (p = 0.006) independently predicted better GFRs at the latest follow-up evaluation. Renal function declines acutely after TCPC revision, often necessitating RRT. A requirement for RRT marks greater mortality. Higher preoperative creatinine levels identify those at greatest risk.     

Numerical taxonomy of some Old World Leishmania species

Iraqi Leishmania stocks originating from human cutaneous and visceral infections, others from the sandfly Sergentomyia baghdadis, and one visceral stock from a dog, were compared among themselves and with Old World reference stocks, by electrophoresis of 11 enzymes. 79 unit characters emerged. Paired comparison technique and complete-linkage cluster analysis revealed heterogeneity within the L. donovani complex. The Iraqi L. donovani stocks appear to be more closely related to an Ethiopian reference L. donovani than to an L. donovani infantum. Two Indian visceral stocks were linked to the L. donovani complex and the L. tropica complex by similarity indices of the same range. The results show a marginally closer association between L. tropica and L. donovani complexes than between L. tropica and L. major.     

Harmful Drinking, Depression, and Conduct Disorder among Females Involved in Alcohol-Related Motor Vehicle Crashes: A Secondary Analysis

Alcohol is involved in 40% of the deaths that occur from traffic injury in the US. Little is known, however, about factors that are associated with alcohol-related traffic injury in women. The purpose of this study was to analyze the relationships among alcohol consumption and two psychological variables (depression and conduct disorder) in a sample of women with harmful drinking patterns and who were involved in an alcohol-related motor vehicle crash (ARMVC). Wilsnack's theoretical model of causes and consequences of problem drinking among women was used to guide the study. The sample included 43 participants, 18 to 45 years old, with a mean age of 28.84 years (SD = 7.10). Regression analyses were performed to find the best fit regression model. Results indicated that the best-fit regression model that significantly explained approximately 25% of the variance in the average number of drinks per drinking day included depression over a life time, conduct disorder after age 15, and age. Although more work is needed to understand the relationships among the variables, when young women are injured in alcohol-related vehicular crashes, they should also be screened for depression and may have conduct disorder in their past history.     

A survey of folk remedies for gastrointestinal tract diseases from Thailand's three southern border provinces

Ethnopharmacological relevance: Gastrointestinal tract diseases commonly occur in Thailand. However, surveying for finding out traditional drugs has never been done.     

Synthesis,Antiproliferative and Antioxidant Activity of 3-Mercapto-1,2,4-Triazole Derivatives as Combretastatin A-4 Analogues

Pharmaceutical Chemistry Journal - Two series of 3-mercapto-1,2,4-triazole derivatives containing alkoxy substituents different in size and position were synthesized and their structures were...     

Prognostic value of absence or presence of coronary artery disease determined by 64-slice computed tomography coronary angiography A systematic review and meta-analysis

To determine via a meta-analysis the prognostic value of 64-slice computed tomography angiography (CTA) by quantifying risk of major adverse cardiac events (MACE) in different patient groups classified according to CT angiographic findings. A systematic literature search and meta-analyses was conducted on 10 studies examining stable, symptomatic and intermediate risk patients by 64-slice CTA. Patients were followed up for a mean of 21 month. Patient groups with CT-angiographic non-obstructive (stenosis <50% of luminal narrowing) or obstructive (stenosis ≥50% of luminal narrowing) CAD were compared to those having normal angiography without CAD. MACE (cardiac death, non-fatal myocardial infarction and revascularization) numbers were used to calculate odds ratios (OR) with 95% confidence interval (CI) in each group. Ten studies including 5,675 patients were eligible for meta-analysis. The cumulative MACE rate over 21 months were 0.5% in patients with normal CTA, 3.5% in non-obstructive CAD and 16% in obstructive CAD. Compared to normal CTA, non-obstructive CAD was associated with significant increased risk of MACE with OR = 6.68 (3.01–14.82 CI 95%), P = 0.0001. Obstructive CAD was associated with further significant increased risk of MACE with OR = 41.19 (22.56–75.18, CI 95%), P = 0.0001. The studies were homogenous, P-value >0.05 for heterogeneity. 64-slice CTA is able to differentiate low-risk from high-risk patients with suspected or known CAD. Absence of CAD predicts excellent prognosis, while obstructive CAD is associated with markedly increased risk of MACE.     

Reduction of painful vaso-occlusive crisis of sickle cell anaemia by tinzaparin in a double-blind randomized trial

A randomized double-blind clinical trial was performed to test the safety and efficacy of a low-molecular-weight heparin, tinzaparin (Innohep), for the management of acute painful vasoocclusive crisis characteristic of sickle cell anemia (SCA). We studied 253 patients with acute painful crisis but with no other complications of SCA, randomized to treatment or control groups. In the treatment group, 127 patients received tinzaparin at 175 IU/kg, subcutaneous once daily, along with supportive care including morphine analgesia; in the control group, 126 patients received placebo and the same supportive care. The maximal experimental treatment period was seven days. Analysis revealed a statistically significant reduction in number of days with the severest pain score, overall duration of painful crisis, and duration of hospitalization (p < 0.05 for each comparison of tinzaparin vs. placebo). The decline in pain intensity was sharper for tinzaparin-treated patients, and complications consisted of two minor bleeding events that were reported and treated by cessation of tinzaparin. This investigation demonstrated that tinzaparin, administered at its approved treatment regimen, reduced the severity and duration of acute crisis of SCA.     

Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis

To determine via meta-analysis the diagnostic accuracy of 64-slice computed tomography coronary angiography (CTA) for assessment of significant obstructive coronary artery stenosis at different coronary artery calcium score (CACS) levels. Data of 12,053 versus 5,890 segments, 906 versus 758 arteries and 1,120 versus 514 patients in low versus high CACS subgroups from 19 eligible studies were compared. The per-patient prevalence of coronary artery disease was 48% versus 68%, respectively. Subgroups were stratified by different CACS thresholds ranging from 100 to 400. Meta-analyses of per-patient data comparing overall low versus high CACS subgroups resulted in a sensitivity of 97.5 (95.5–99)% versus 97 (94.5–98.5)%, specificity of 85 (82–88)% versus 66.5 (58–74.5)%, diagnostic odds ratio of 153 (81–290) versus 40 (20–83), positive predictive value of 85 (82–87)% versus 86 (84–88)%, negative predictive value of 97.5 (95–99)% versus 91 (88–94)% and overall accuracy of 91% versus 89% with 95% confidence interval, respectively. The drop in specificity was significant (P = 0.035), while the sensitivity and overall accuracy were insignificantly changed (P > 0.05). Meta-analyses of independent subgroups at CACS levels ≤10 and ≤100 demonstrated high specificities of 90 (94–100)% and 88.5 (81–91.5)%, whereas at CACS levels ≥400 the specificity declined significantly to 42 (28–56)% but with consistently retained high sensitivity of 97.5 (94–99)%. The specificity of CTA decreases with increasing CACS, while the sensitivity remains high independent of that. The suggested CACS thresholds are arbitrary and do not necessarily warrant cancelling angiography. Diagnostic studies are needed to explore whether a specific CACS threshold may serve as a pre-angiographic gatekeeper to prevent likely equivocal angiographies.