Diagnosing left ventricular dysfunction after myocardial infarction: the Dundee algorithm

Large-scale trials of angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI) suggest that the benefits are greatest in patients with left ventricular (LV) dysfunction. However, early evaluation of LV function in all patients after AMI by current methods can be difficult due to a lack of resources and skilled personnel. Thus a clinical algorithm that could be used at the bedside to reliably identify patients with a left ventricular ejection fraction (LVEF) < or = 40% would be helpful as an occasional alternative to echocardiography. We have devised such an algorithm based on the presence of one of: (i) clinical signs of heart failure; (ii) an index Q-wave anterior myocardial infarction; (iii) lack of thrombolytic therapy when there is a history of two or more previous myocardial infarctions and a CK rise > 1000 U/l. We tested this new algorithm prospectively in the coronary care units of two hospitals (one UK and one USA). In the UK centre, the sensitivity and specificity of the algorithm at identifying patients with a LVEF < or = 40% were 82% and 72%, respectively. In the US centre, the sensitivity of the algorithm was 91% and the specificity 78% at identifying patients with LV dysfunction. We have validated a simple clinical algorithm which can be used at the bedside for identifying patients who would benefit from an ACE inhibitor after AMI.      

Hepatitis B e Antigen Negative Chronic Hepatitis in Indian Patients : A Reality

Background

Hepatitis B e antigen negative chronic hepatitis (e⁻ CHB) with detectable levels of hepatitis B virus DNA (HBV DNA) in serum has been reported in cases from Asia. This study was undertaken to find out prevalence e⁻CHB and to correlate its presence with the clinical status and severity of the illness in cases of chronic liver disease in India.

Methods

All patients of infective hepatitis, who were hepatitis B surface antigen (HBsAg) positive by enzyme-linked immunosorbent assay (ELISA), were evaluated with liver function tests and HBeAg and antiHBe antibody studies. Polymerase chain reaction (PCR) test was carried out to detect HBV DNA qualitatively.

Result

Out of 2064 samples tested by ELISA, 429 (20.78 %) were HBsAg positive. HBV DNA (qualitative) was performed on all 429 patients and 74 (17.2%) were HBV DNA positive. Of these only 42 (56.75 %) tested positive for HBeAg. Overall, 8.3 % of HBeAg negative patients (32/384) were viraemic with evidence of chronic liver disease/clinical cirrhosis and alteration of transaminase levels, while three cases (0.84 %) HBeAg positive cases did not show presence of HBV DNA.

Conclusion

This study shows e⁻CHB prevalence rate of 8.3% in patients with HBV infection in India. Since HBeAg negative patients had detectable levels of HBV DNA as seen in HBeAg positive patients, benefit of antiviral therapy should be given to them. Population studies on e⁻ CHB cases are needed to determine its true prevalence, natural course and response to therapy.Key Words: Chronic hepatitis, Hepatitis B virus, Hepatitis B e antigen negative     

DUAL-ENERGY X-RAY ABSORPTIOMETRY IN RHEUMATOID ARTHRITIS: COMPARISON BETWEEN AXIAL AND APPENDICULAR SKELETON FINDINGS

SUMMARY Bone mineral density was measured by dual-energy x-ray absorptiometry (DXA) at the lumbar spine, both hips and distal radius in 10 postmenopausal patients with rheumatoid arthritis (RA). DXA values at the lumbar spine and distal radius were compatible with osteoporosis in all but 1 patient. Only 4 patients had osteoporosis of the hip, and 3 of these were over 65. Preliminary results over this small population suggest that in RA a correlation may be expected between DXA values in lumbar spine and distal radius, but not between either of these and the hip.     

The recurrence risk of severe de novo pre-eclampsia in singleton pregnancies: a population-based cohort

Objective  Previous studies have found recurrence risks of severe pre-eclampsia as high as 40%. Our objective was to determine both the recurrence risk of severe de novo pre-eclampsia and risk factors associated with it in a contemporaneous population.
Study design  Population-based retrospective cohort study.
Population  Women who had two or more singleton liveborn or stillborn hospital deliveries in Ontario, Canada between April 1994 and March 2002 and without a history of chronic hypertension
Methods  International Classification of Disease codes were used to identify patients in the Canadian Institute for Health Information Discharge Abstract Database.
Main outcome measures  The absolute and adjusted risks of recurrent severe de novo pre-eclampsia were determined.
Results  Between 1 April 1994 and 30 March 2002, there were 185 098 women with two or more singleton deliveries >20 weeks in the province of Ontario, Canada. There were 1954 women who had severe de novo pre-eclampsia in the index pregnancy, 133 of whom had recurrent severe pre-eclampsia, for a risk of recurrent severe pre-eclampsia of 6.8% (95% CI 5.7–7.9%). The risk of recurrent severe de novo pre-eclampsia was increased in women with pre-existing renal disease (adjusted OR 17.98, 95% CI 3.50–92.52) and those >35 years of age (adjusted OR 3.79, 95% CI 2.04–7.04, reference 20–25 years).
Conclusions  The recurrence risk of severe de novo pre-eclampsia in our population-based cohort study (6.8%) is lower than previously published reports in selected populations.     

Herbal care for reproductive health: ethno medicobotany from Uttara Kannada district in Karnataka, India

Traditional herbal medicine is predominantly practiced by the rural people of India, especially remote areas such as the Uttara Kannada District in Western Ghats of Karnataka. Local traditional healers play an important role in the management of reproductive health problems of the native population due to socio-economical and geographical factors. In the present study, 92 traditional medicine practitioners/healers from various regions of Uttara Kannada district were interviewed to collect information on the use of herbal treatments for a range of female and male reproductive disorders. Information was also collected on the method of preparation, dose and duration along with the botanical names, family and local names of the medicinal plants. The plants were then collected and identified. A total of 18 formulations from 25 plant species belonging to 17 families were identified, which are commonly used to treat 12 different reproductive ailments. This study identifies herbal remedies not previously documented, that are used by indigenous people in the treatment of reproductive disorders. Additionally, the paper highlights the need to retain and explore the rich biodiversity associated with Indian rain forests that may result in the discovery of new medical treatments. Finally, this paper notes the continuing reliance on herbal medicines and healing traditions by local people in remote areas. Understanding and working with local healers and tribes provides a unique opportunity to learn about the use of potentially new herbal and plant medications.     

The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure

BACKGROUND: The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurements of downstream renal artery resistance. PI and RI have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. The aim of the present study was to evaluate the potential relationship between these indices and the rate of decline in renal function, as reflected by changes in different parameters of renal function in patients with chronic renal failure. METHODS: Twenty- one patients (8 females; 13 males, mean age 58 years (36-75)) with chronic renal failure were enrolled in the study. Doppler examinations were performed in the segmental arteries by an Acuson 128XP. The PI and the RI was calculated from the blood flow velocities. Parameters of renal function were measured every 3 1/2 months, and all patients were followed for 18-21 months. Progression of renal dysfunction was estimated by linear regression of parameters of renal function versus time. RESULTS: In a multiple regression analysis both PI and RI correlated significantly to the rate of decline in reciprocal serum creatinine (PI: r = -0.48, P = 0.03; RI: r = -0.52, P = 0.02). Furthermore, when separating the patients in two groups by the median RI value, there was a significant difference between the groups in rate of decline in reciprocal serum creatinine (P = 0.02). For PI this distinction was also present (P = 0.04). CONCLUSION: PI and RI correlated to the severity of the renal disease, as reflected by the rate of decline in reciprocal serum creatinine during antihypertensive treatment. The median RI or PI value could separate the patients into groups one of slow and another of fast progression.      

Hair as a Biopsy Material

Lead was measured by atomic absorption spectrometry in the hair of a random sample of the population of the Republic of Panama. Age, sex, and place of residence were found to influence the lead concentration of hair. Lead concentration increased in a rural-urban gradient, with females having higher concentrations than males. Awareness of these factors will increase the utility of hair as 2 biopsy material in the assessment of environmental exposure.     

5-Lipoxygenase inhibitors induce potent anti-proliferative and cytotoxic effects in human tumour cells independently of suppression of 5-lipoxygenase activity

BACKGROUND AND PURPOSE

Certain 5-lipoxygenase (5-LO) inhibitors exhibit anti-carcinogenic activities against 5-LO overexpressing tumour types and cultured tumour cells. It has been proposed therefore that 5-LO products significantly contribute to tumour cell proliferation. To date, the relationship between the inhibitory mechanisms of 5-LO inhibitors, which vary widely, and tumour cell viability has not been evaluated. This study addresses the anti-proliferative and cytotoxic potency of a number of 5-LO inhibitors with different inhibitory mechanisms in 5-LO-positive and 5-LO-negative tumour cells.

EXPERIMENTAL APPROACH

Cell viability was measured by the WST-1 assay; cell proliferation was assessed using the bromodeoxyuridine (BrdU) incorporation assay. Cell death was analysed by annexin V staining, Western blot analysis of PARP (poly ADP-ribose polymerase) cleavage and a cytotoxicity assay. 5-LO product formation was quantified by a 5-LO activity assay.

KEY RESULTS

The common 5-LO inhibitors AA-861, Rev-5901 and MK-886 induced cytotoxic and anti-proliferative effects in 5-LO-positive Capan-2 pancreatic cancer cells; BWA4C and CJ-13,610 only caused anti-proliferative effects, while zileuton failed to impair cell viability. Moreover, the concentrations of the 5-LO inhibitors required to induce anti-proliferation and cytotoxicity highly exceeded those for suppression of 5-LO. Supplementation with mitogenic 5-LO products failed to protect Capan-2 cells from the effects of 5-LO inhibitors. Finally, the cytotoxic and anti-proliferative 5-LO inhibitors also potently reduced the viability of 5-LO-deficient tumour cell lines (HeLa, Panc-1 and U937).

CONCLUSIONS AND IMPLICATIONS

Certain 5-LO inhibitors cause cytotoxic and anti-proliferative effects independently of suppression of 5-LO activity. Thus, the role of 5-LO overexpression in tumour cell viability remains unclear and requires further elucidation.