Prognostic significance of NT-proBNP, 3D LA volume and LV dyssynchrony in patients with acute STEMI undergoing primary percutaneous intervention

Objectives

The aim of the present study was to assess the short term prognostic significance of N-terminal pro BNP (NT-proBNP), 3D left atrial volume (LAV) and left ventricular (LV) dyssynchrony in patients of acute ST-elevation myocardial infarction (STEMI) who underwent primary Percutaneous intervention (PCI).

Background

NT-proBNP, LV dyssynchrony and LAV in patients with acute coronary syndrome have been associated with PCI outcomes and predict the short and long-term prognosis.

Methods

This study consisted of 142 patients with a first STEMI who underwent primary PCI. Baseline echocardiographic data was collected at admission and at 6 months follow up. Left ventricular dyssynchrony was measured by tissue Doppler imaging and LAV by real time 3D-echocardiography, plasma NT-proBNP levels were estimated between 72 and 96 h of admission.

Results

During study period 3 patients expired and 4 developed congestive heart failure (CHF). Baseline NT-proBNP and LV dyssynchrony correlated with LV size and LV ejection fraction (LVEF) at baseline and during follow up. Patients with higher NT-proBNP levels and higher LV dyssynchrony showed significant increase in LV size with decrease in LVEF during follow-up. Baseline Left atrial volume index (LAVI) showed significant correlation with LV size but no association with LVEF at baseline and during follow-up.

Conclusions

Higher levels of NT-proBNP and higher LV dyssynchrony can predict patients with increase in LV size, worsening of LV systolic and diastolic function during follow-up. Patients with higher NT-proBNP levels at baseline developed CHF during follow-up.     

Post-stroke Fatigue is an Independent Predictor of Post-stroke Disability and Burden of Care: A Path analysis Study

Post-stroke fatigue (PSF) is a common and one of the most distressing symptoms in stroke survivors. However, little is known about the relationship between severity of fatigue and the overall impact it has on post-stroke disability and burden of care. We aimed to examine the role of PSF in post-stroke disability and burden of care among stroke survivors after their first-ever stroke.

Methods: We prospectively recruited 163 subjects (35 females) from patients examined consecutively in a tertiary stroke care center in India, after their first-ever ischemic or hemorrhagic stroke (>3 months after event). In addition to demographic and clinical characteristics, the following assessments were done – SF-36 vitality domain (fatigue), Modified Rankin Scale (functional recovery), Hospital anxiety and depression scale (depression), Functional independence measure (disability and burden of care). We used path analysis to identify a model that will capture the interactions of fatigue, depression, and degree of functional recovery in stroke survivors.

Results: The severity of PSF positively correlated with the severity of disability and PSF had significant contribution to disability over and above functional recovery and depression, with all three factors accounting for 43% of the variance. Among the four models that were proposed to explore these relationships, the best fitting model showed that the effect of PSF is mediated through both the direct effect of fatigue on disability and through its interaction with depression, which remained a separate contributor to post-stroke disability and burden of care.

Conclusions: PSF, therefore, is an important determinant of post-stroke disability and should be evaluated for successful post-stroke rehabilitation.     

Hydrogen Peroxide Improves the Visibility of Ulcer Bases in Acute Non-variceal Upper Gastrointestinal Bleeding: A Single-Center Prospective Study

Background  

Acute non-variceal upper gastrointestinal bleeding (ANVB) or hemorrhage (used interchangeably) is an emergency. Endoscopically applied hydrogen peroxide (H₂O₂) has been shown to improve visualization of the ulcer base.     

Access to pocket money and low educational performance predict tobacco use among adolescent boys in Kerala, India

BACKGROUND: Tobacco use is increasing among adolescents. We conducted this study to find prevalence and correlates of tobacco use among adolescent boys in Trivandrum city, Kerala. METHODS: Using a two-stage cluster sampling technique, 1323 boys (12-19 years) were selected from 14 schools. Information on tobacco use, academic performance, pocket money, and other variables was collected using a questionnaire. Multivariate analyses were done to find associations between current use of tobacco and other variables. RESULTS: Prevalence of current tobacco use was 11.3% (95% CI 9.6-13.0). Current tobacco use was 2.9 times higher among older boys compared to younger boys (OR 2.9, CI 1.6-5.3), 2 times higher among boys whose fathers used tobacco (OR 2.0, CI 1.3-3.1), 2.9 times higher among boys whose friends used tobacco (OR 2.9, CI 1.6-5.1) compared to their counterparts, 3 times higher among boys securing poor (<40% marks) grade compared to those securing excellent (>80% marks) grade (OR 3.0, CI 1.4-6.6), and 4 times higher among those who received pocket money compared to those who did not (OR 4.0, CI 2.2-7.4). CONCLUSIONS: Health programs to quit tobacco are suggested in schools with special emphasis on poor performers, those receiving pocket money, and those whose fathers and friends use tobacco.     

Effect of pH on tumor cell uptake of radiogallium in vitro and in vivo

When injected at tracer levels into the blood, radiogallium as ⁶⁷Ga-citrate binds to, and is transported to the site of the tumor by, transferrin. The process by which transferrin-bound Ga is converted to tumor-bound Ga is not fully understood, but may involve the differential physiology of neoplasms compared with normal tissues. Based on the slight acidity known to be exhibited by the extracellular fluid of many animal and human tumors, we have studied the effect of pH on stability and dissociation of the Ga-transferrin complex and on the uptake of Ga by tumor cells in vitro and animal tumors in vivo. When plasma from rabbits injected with ⁶⁷Ga-citrate was dialyzed at pH 6.5–7.5, dissociation of Ga from transferrin showed an inverse pH-dependence. A similar inverse dependence on pH was observed for the uptake of Ga by L1210 leukemia cells and Ehrlich ascites cells incubated with Ga-transferrin complex. Tumor uptake of Ga in rats bearing Walker-256 carcinosarcoma or Murphystum lymphosarcoma whose tumor pH had been further lowered by administration of glucose showed a statistically significant increase over control rats receiving no glucose. These results demonstrate that the stability of the Ga-transferrin complex is pH-dependent and suggest that dissociation of this complex due to decreased pH at the tumor site may be one factor involved in tumor localization and binding of Ga.Supported, in part, by NCI Grant 5 PO1 CA 19438, NHLBI Grant 5 RO1 21273, and Biomedical Research Grant 5 SO7 RR 05466 13 to the Professional Staff Association, LAC/USC Medical Center     

The Influence of Socioeconomic and Demographic Variables on Willingness to Donate Cadaveric Human Organs in Malaysia

The growing shortage in human organs has raised serious concerns. To address this problem, we examine in this article the association between demographic and socioeconomic factors, and respondents’ willingness to donate cadaveric organs using a large survey of Malaysian adults aged 18 years and above.A convenience sampling method was used to extract information from a total of 10,350 participants from Metropolitan Kuala Lumpur over the period of April 2, 2013 to February 29, 2014. In addition to analyzing the data using incidence of willingness to donate by demographic and socioeconomic factors, we carried out logistic regression analysis to estimate the odds ratio of respondents’ willingness to become cadaveric organ donors controlling for age.About less than a third of the participants pledged to donate their organs upon death with women (35.6%) showing a higher incidence compared with men (33.2%). The Chinese (35.7%) and Malays (35.0%) pledged to contribute more than the Indians (31.6%) and the logistic regressions show that Malays (adjusted odds ration [OR] = 1.18) and Chinese (adjusted OR = 1.21) are more likely to donate than Indians (reference group). The results by religion were significant among Muslims and Hindus but not Buddhists. The likelihood of Muslims donating was the lowest (adjusted OR = 0.26). Income was also highly significant but the relationship with willingness to donate was negative. Against tertiary education, all other occupations were significant. However, the respondents with primary education enjoyed the highest adjusted OR (5.46) whereas that of secondary (0.48) and higher secondary (0.83) education was low. Among occupations (against supervisory, clerical, and direct workers), it was significant only among the unemployed and managers with adjusted OR of 1.50 and 1.58, respectively.Sex, education, ethnicity, religion, and income are important demographic and socioeconomic influences on the likelihood of Malaysians willing to become cadaveric organ donors. The Malaysian evidence suggests that awareness programs should be targeted at men, Muslims, Hindus, Malays, and the rich more than the others.     

Synthesis and anticancer activity of 4β-alkylamidochalcone and 4β-cinnamido linked podophyllotoxins as apoptotic inducing agents

A series of 4β-alkylamidochalcone and 4β-cinnamido linked podophyllotoxin congeners have been synthesized. All the twenty nine compounds were evaluated for anticancer activity against five human cancer cell lines (A-549, A375, MCF-7, HT-29 and ACHN). Some of the synthesized compounds showed good anticancer activity that is comparable to etoposide. The IC(50) of compounds 17a and 17f is 2.7 and 2.1?μM respectively against A-549 cancer cell line. Flow cytometric analysis showed that these two compounds arrested the cell cycle in the G2/M phase leading to caspase-3 dependent apoptotic cell death. Further, Hoechst 33258 staining and DNA fragmentation assay also suggested that 17a and 17f induced cell death by apoptosis.     

Long-term seizure outcome and its predictors in patients with recurrent seizures during the first year aftertemporal lobe resective epilepsy surgery

Purpose: The existing data on the implications of the characteristics of seizures that recur during the first year following epilepsy surgery on subsequent seizure outcome are conflicting. We investigated the impact of recurrent seizures in the first postoperative year and their attributes on long‐term seizure outcome. Methods: We studied the postoperative courses of 492 patients who had completed two or more years of follow‐up after temporal lobe resective epilepsy surgery. We used Kaplan‐Meier survival curves to define long‐term seizure outcome and assessed the predictive value of recurrent seizure characteristics on the outcome by univariate and multivariate proportional hazards regression models. Key Findings: In our patients, seizure recurrences during the first postoperative year, irrespective of the attributes of recurrent seizures (such as provoked vs. unprovoked, and timing and number of recurrences), imparted fourfold to sevenfold increased hazards for continued seizures beyond the first postoperative year. Although patients with complex partial seizures with or without secondary generalized tonic–clonic seizures (CPS/GTCS) had a sixfold increased risk, those with auras alone had only a borderline risk for seizures beyond the first postoperative year. In the multivariate model, CPS/GTCS as the predominant seizure type and three or more seizure recurrences during the first postoperative year independently predicted unfavorable long‐term seizure outcome. Significance: Our study provides valuable information that is helpful in prognosticating and counseling patients, and in making rational decisions on the withdrawal of antiepileptic drugs following surgery. Our findings enhance the general understanding of the etiopathogenesis of surgical failure.