Clinical trials evaluating angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the setting of acute myocardial infarction

There is strong evidence from controlled clinical trials that in the setting of acute myocardial infarction complicated by heart failure or isolated left ventricular dysfunction, angiotensin-converting enzyme inhibitors started late during hospitalisation and continued in the long term, significantly reduced mortality and improved the prognosis. On the other hand, administration of angiotensin-converting enzyme inhibitors during the first 24 h in unselected patients with acute myocardial infarction provided only a slight benefit in terms of mortality. Angiotensin-II receptor blockers have and are being examined in the setting of acute myocardial infarction with left ventricular dysfunction and can provide an alternative for patients who cannot tolerate angiotensin-converting enzyme inhibitors. In this article, an evidence-based review of these major trials and suggestions for clinical application are presented.     

Anatomical study of the temporalis tendon. Value in temporalis lengthening myoplasty

The lengthening temporalis myoplasty is indicated in long standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. The knowledge of the anatomy of this strong and wide tendon is necessary to use successfully their anatomical advantages. A study of ten cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedure: the strong tendon, when liberated from the coronoid process, is from 4 to 6 cm long.     

Reoperation by anterior perineal approach for missed puborectalis

Poor postoperative continence in patients operated for high imperforate anus may result from an inadequate bowel pull-through behind the puborectal muscle. Between 1979 and 1983, we used the anterior perineal approach for reoperations in five such cases (3 males, 2 females). In all of them, preoperative continence was socially unacceptable. Each time it was possible to identify a partially or totally missed puborectal muscle. Although some complications occurred postoperatively, all patients acquired a socially acceptable level of continence with a mean follow-up of 4.5 years. Preoperative and postoperative rectal manometries are presented. The anterior perineal approach not only provides adequate exposure of the urethra and puborectal muscle, but also has the advantage of operating through an area that has not been previously dissected.     

Immune response of Bangladeshi children with acute diarrhea who subsequently have persistent diarrhea

BACKGROUND: Because altered immune responses may be a risk factor for persistent diarrhea, various aspects of the immune response were examined to elucidate the underlying immune mechanisms that may be involved in the development of persistent diarrhea. METHODS: Children (7-12 months of age) with watery diarrhea for 6 to 8 days from the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), were enrolled. Children were classified as having acute diarrhea (AD) or persistent diarrhea (PD) if diarrhea resolved within 14 days or persisted for more than 14 days, respectively. Uninfected control children (n = 13), from the Nutrition Follow-Up Unit of ICDDR,B were also enrolled. Of the 123 children with diarrhea who were enrolled, 85 had AD and 38 had PD. Comparisons were performed for clinical features, nutritional status (weight for age, plasma transferrin, and serum albumin levels), and immune responses: neutrophil function; peripheral blood mononuclear cell function, delayed-type hypersensitivity (DTH) responses, plasma levels of immunoglobulins, tumor necrosis factor-alpha, and interferon-gamma. Univariate analyses were conducted to assess differences among the three groups of children and between children with AD and PD. Logistic regression was performed to determine risk factors for PD. RESULTS: There were no differences in clinical features and nutritional status among the groups of children studied. More children in whom PD developed had a negative DTH response to tuberculin than those with AD (P = 0.021). Also, a negative DTH response to tuberculin was a significant risk factor for PD (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.5-9.9). CONCLUSIONS: Children with acute diarrhea with a negative DTH response to tuberculin are more likely to have development of persistent diarrhea.     

Particulate black carbon and gaseous emission from brick kilns in Greater Dhaka region,Bangladesh

Eighteen brick kilns of three brick-making technologies (Fixed Chimney Kiln (FCK), Zigzag, and Hoffmann) were selected to measure the concentrations of particulate matter (PM_2.5) with Aerocet 531S (USA) sampler, black carbon (BC) with Magee Scientific, OT-21 Soot scan Transmissometer (USA), and gaseous pollutants (CO₂, CO, SO₂, NO_x, and volatile organic carbon (VOC)) with Aeroqual 500 gas sampler (New Zealand) to understand the emission scenario from brick sector in Greater Dhaka region, Bangladesh. Emission factor (EF) of each pollutant was computed from their respective concentration for three brick kiln technologies. Ambient PM_2.5 and PM₁₀ were measured in brick kiln premises and 1 km far from the respective kilns to see the effect on the surrounding areas. The PM_2.5 concentration was found on an average of 141?±?86, 128?±?72, and 110?±?53 mg/m³ in FCK, Zigzag, and Hoffmann kilns, respectively. The average BC concentration was found 16.6?±?7.1 (FCK), 11.8?±?4.2 (Zigzag), and 8.9?±?4.4 (Hoffmann) mg/m³. FCK has a greater emission of CO, whereas Zigzag has a higher CO₂ emission. A comparatively higher value of CO₂ and lower value of CO indicates effective combustion of coal, and this is found to be more efficient for Zigzag and Hoffmann compared to traditional FCK. SO₂ and VOC emissions were depending not only on the kiln types but also on the fuel qualities. From EF calculation, approximately 4526 t of PM_2.5, 340 t of BC, 209,776 t of CO₂, 8700 t of CO, 19,441 t of SO₂, and 835,450 t of VOC per year found to emit from 1000 brick kilns. The conversion of traditional FCK to improved one, i.e., Zigzag and/or Hoffman is not a straight forward solution, as CO₂ emission was higher in Zigzag whereas BC and PM_2.5 emissions were higher in FCK. Therefore, considering EF of various pollutants from these three types of kilns, conversion of FCK to Zigzag or Hoffmann could be a better choice.     

Coronary artery disease prevalence and outcome in patients hospitalized with acute heart failure: an observational report from seven Middle Eastern countries

Objectives: The purpose of this study was to report prevalence, clinical characteristics, precipitating factors, management and outcome of patients with coronary artery disease (CAD) among patients hospitalized with heart failure (HF) in seven Middle Eastern countries and compare them to non-CAD patients.

Methods: Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute HF during February-November 2012 in 7 Middle Eastern countries.

Results: The prevalence of CAD among Acute Heart Failure (AHF) patients was 60.2% and varied significantly among the 7 countries (Qatar 65.7%, UAE 66.6%, Kuwait 68.0%, Oman 65.9%, Saudi Arabia 62.5%, Bahrain 52.7% and Yemen 49.1%) with lower values in the lower income countries. CAD patients were older and more likely to have diabetes, hypertension, dyslipidemia and chronic kidney disease. Moreover, CAD patients were more likely to have history of cerebrovascular and peripheral vascular disease when compared to non-CAD patients. In-hospital mortality rates were comparable although CAD patients had more frequent re-hospitalization and worse long-term outcome. However, CAD was not an independent predictor of poor outcome.

Conclusion: The prevalence of CAD amongst patients with HF in the Middle East is variable and may be related to healthcare sources. Regional and national studies are needed for assessing further the impact of various etiologies of HF and for developing appropriate strategies to combat this global concern.     

Extended-release niacin with laropiprant : a review on efficacy, clinical effectiveness and safety

INTRODUCTION: Although treatment with statins reduces cardiovascular (CV) events in patients with dyslipidemia, a residual 60 - 70% CV risk remains. This CV risk may be inversely related to high-density lipoprotein-cholesterol (HDL-C). Interest in niacin has re-emerged because of its HDL-C raising effects. The flushing associated with niacin which has previously affected patient compliance can now be significantly blocked with laropiprant (LRPT). AREAS COVERED: This review aims to assess the efficacy, clinical effectiveness and safety of extended-release niacin (ERN) with LRPT. The authors searched PubMed and MEDLINE for literature published between January 2006 and November 2011, for efficacy, clinical effectiveness and safety reports of ERN with LRPT. EXPERT OPINION: Niacin has been shown to prevent CV events, reduce mortality and has beneficial effects on vascular endothelial function. Evidence suggests that this is due to its broad-spectrum lipid altering properties, including lowering lipoprotein (a) (Lp(a)), and its pleiotropic actions. While side effects associated with niacin have limited its use in the past, the extended-release formulations and co-administration of LRPT have increased its tolerability, particularly by reducing flushing. The authors advise that ERN should be used in patients with a high risk of cardiovascular disease, who have failed to reach conventional targets.     

A quasi-static discomfort measure in whole-body vibration

A new methodology for objective evaluation of discomfort in whole-body vibration (WBV) is introduced in this work. The proposed objective discomfort characterizes discomfort based on the relative motion between adjacent segments of the human body from neutral positions. It peaks when the joints reach their limits. The objective discomfort has been tested on five subjects in the fore-aft direction using discrete sinusoidal frequencies of 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8, 9, 10, 12, 14, and 16 Hz. Each frequency file runs for 15 s with a 3 s resting period as a reference for discomfort comparison. All files run at a constant acceleration of 0.7 m/s(2). The subjects were tested with back support and without back support, and their subjective discomfort was reported based on the Borg CR-10 scale. The proposed objective discomfort has shown significant correlation with the subjective discomfort. The objective discomfort has also been tested on five subjects under multiple-axis random WBV with three common industrial seating configurations (seat-mounted control, floor-mounted control, and steering wheel), and has shown promising results.