Impact of type of thrombolytic agent on in-hospital outcomes in ST-segment elevation myocardial infarction patients in the Middle East

Little is known about the impact of thrombolytic agents on in-hospital outcomes in the Middle East. The objective of this study was to evaluate the impact of thrombolytic agents on in-hospital outcomes in ST-segment elevation myocardial infarction (STEMI) patients in six Middle Eastern countries. Gulf Registry of Acute Coronary Events was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients admitted to 65 hospitals in 2006 and 2007. Out of 1,765 STEMI patients admitted to hospitals within 12 h of symptoms onset, 25, 43, and 30% were treated with streptokinase, reteplase, and tenecteplase, respectively. Median age of the study cohort was 50 (45–59) years and majority were males (89%). The overall median symptom onset-to-presentation and median door-to-needle times were 130 min (65–240) and 45 min (30–75), respectively. Streptokinase patients had worse GRACE risk scores compared to patients who received fibrin specific thrombolytics. Academic hospitals and cardiologists as admitting physicians were associated with the use of fibrin specific thrombolytics. After significant covariate adjustment, both reteplase [odds ratio (OR), 0.38; 95% CI: 0.18–0.79; P = 0.009] and tenecteplase (OR, 0.30; 95% CI: 0.12–0.77; P = 0.012) were associated with lower all-cause in-hospital mortality compared with streptokinase. No significant differences in other in-hospital outcomes were noted between the thrombolytic agents. In conclusion, in light of the study’s limitations, fibrin specific agents, reteplase and tenecteplase, were associated with lower all-cause in-hospital mortality compared to the non-specific fibrin agent, streptokinase. However, the type of thrombolytic agent used did not influence other in-hospital outcomes.     

A retrospective analysis of early experience with modified complete primary repair of exstrophy bladder (CPRE) in neonates and children

Objective:

To study the problems faced during the surgery and follow-up of modified complete primary repair of exstrophy (CPRE) technique. Initial experience with CPRE and its short- and long-term outcomes with respect to continence status and psychosocial impact are reported.

Materials and Methods:

A retrospective review of the hospital case records from March 2008 to September 2012 was performed. Data of patients with bladder exstrophy managed by a single paediatric surgeon using modified CPRE technique were analysed. Quality of life and psychosocial impact of the surgery were assessed using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers.

Results:

Eight children (age 4 days-12 years) underwent CPRE using modified Mitchell''s technique. Two patients (25%) experienced early postoperative complications, with infection and fistula developing in one each. All the patients were doing well on follow-up, with variable continence rates and good cosmesis. Mean duration of follow-up was 18.5 months (range 6 months-4 years). Five out of seven (71%) children were continent or partially continent. One case was lost to follow-up. PedsQL scores were comparable with those of age-matched peers in all domains except the social functioning domain in 8-12 years age group (83.53 ± 9.70 vs. 77.86 ± 10.22, P < 0.05).

Conclusion:

Our preliminary results with modified CPRE in neonates and children have been encouraging. No major complications were observed. Continence rate was satisfactory and cosmetic results were good. Though the technique is being practiced at several Indian centres, there is a paucity of comprehensive Indian data on CPRE.KEY WORDS: Bladder exstrophy, complete primary repair, urinary continence     

Gastrointestinal dysfunction in Parkinson’s disease: molecular pathology and implications of gut microbiome,probiotics, and fecal microbiota transplantation

Journal of Neurology - Gastrointestinal symptoms and gut dysbiosis may occur before the onset of motor symptoms in Parkinson's disease (PD). Prediagnostic and prodromal features, such as...     

Intraoperative retrograde TEVAR to control endoleak after emergent total arch replacement and frozen elephant trunk repair for ruptured Kommerell's diverticulum

We report an emergent complex hybrid repair of a type A intramural hematoma with a tear of the aortic arch at the site of Kommerell's diverticulum and an aberrant right subclavian artery. We identified a type IA endoleak intraoperatively, which was managed immediately with proximal extension. Performing this operation in the hybrid operating room facilitated optimal surgical management.     

Effect of Substrate Plate Heating on the Microstructure and Properties of Selective Laser Melted Al-20Si-5Fe-3Cu-1Mg Alloy

The Al-20Si-5Fe-3Cu-1Mg alloy was fabricated using selective laser melting (SLM). The microstructure and properties of the as-prepared SLM, post-treated SLM, and SLM with substrate plate heating are studied. The as-prepared SLM sample shows a non-uniform microstructure with four different phases: fcc-αAl, eutectic Al-Si, Al₂MgSi, and δ-Al₄FeSi₂. With thermal treatment, the phases become coarser and the δ-Al₄FeSi₂ phase transforms partially to β-Al₅FeSi. The sample produced with SLM substrate plate heating shows a relatively uniform microstructure without a distinct difference between hatch overlaps and track cores. Room temperature compression test results show that an as-prepared SLM sample reaches a maximum strength (862 MPa) compared to the heat-treated (524 MPa) and substrate plate heated samples (474 MPa) due to the presence of fine microstructure and the internal stresses. The reduction in strength of the sample produced with substrate plate heating is due to the coarsening of the microstructure, but the plastic deformation shows an improvement (20%). The present observations suggest that substrate plate heating can be effectively employed not only to minimize the internal stresses (by impacting the cooling rate of the process) but can also be used to modulate the mechanical properties in a controlled fashion.