ST-recovery loop of exercise-induced ST deviation in the identification of coronary artery disease: which parameters should we measure?

This study aimed to characterize the ST-recovery loop and assess which range of heart rates (HRs) best discriminates between patients with and without significant coronary artery stenosis. Bicycle exercise tests were undertaken in 44 men and 18 women with coronary artery disease (CAD) and in 59 controls (26 men, 33 women) in the same age range with no signs of CAD. The ST level and the ST-segment slope were continuously monitored, and changes from rest to peak exercise and to 4 min after exercise, respectively, were calculated. Plotting the ST level against HR gives the STHR loop, characterized by the normalized area (NA(alpha)) circumscribed by the ST level during and after exercise from alpha% to 100% of the HR range. Eight values of alpha between 20% and 90% were investigated, and chest and extremity leads were investigated separately. Optimal alpha was found to be < or =70% in men and < or =30% in women. Change in ST-segment slope was the only parameter that gave significant additional discriminating power in both men and women once the area had been taken into account. We conclude that NA(alpha) for extremity and chest leads have similar weights, and that a substantial part of the STHR loop should be taken into consideration, especially in women. NA(30) was superior to end-exercise ST-depression and STHR loop orientation (as defined by the sign of NA(90)) in both men and women, and to ST/HR index in men, in identifying CAD.     

关于儿童药物不良反应及相关因素

目的：分析儿童药物不良反应的相关因素,探讨为减少或避免儿童药物不良反应药师所应采取的措施。方法回顾性分析了自2008年1月—2014年12月该院所收治的425例儿童药物不良反应病例,分析相关因素。结果425例儿童药物不良反应中,共涉及到了21种药物,累及到16个系统器官,24例儿童自愈,305例儿童为治愈,85例儿童出现好转,10例儿童留有后遗症,1例儿童死亡。结论为保证儿童用药安全有效,药师应采取相应措施,减少或避免儿童药物不良反应。     

正交试验法优选金银花总有机酸的提取工艺条件

目的：优选并确立金银花中总有机酸的最佳提取工艺。方法以总有机酸提取率为指标,采用正交设计实验法对提取过程中的影响因素进行优选研究。结果金银花中总有机酸最佳提取工艺为：提取时间1.5 h,提取次数为3次,加水量16倍量。在此条件下,总有机酸提取率达66 mg/g。结论采用此提取方法不仅能够充分提取金银花中总有机酸,而且方法简便,适用于工业化生产。     

Pre-conference workshop on drug resistant TB – NATCON 2020

Pre-conference workshop on Drug Resistant Tuberculosis was conducted under the banner of NATCON-2020 on 18th December 2020. The workshop covered various aspects of diagnosis including newer rapid genotypic methods, and gene sequencing. The workshop deliberated on the latest recommendations of the global and national guidelines about the management of DR-TB patients. Case scenarios focusing on the management of MDR TB and XDR TB patients were presented and the principles of making the regimen for DR-TB patients were discussed. Various aspects of shorter MDR TB regimen including bedaquiline containing shorter regimen and all oral longer regimen for DR-TB patients were also presented to the participants. The participants were also informed regarding what is in store in the near future at global and national level regarding the management of DR-TB patients.The participants included students, teaching faculty and the practicing physicians. The workshop informed the delegates on the latest recommendations of the global and national guidelines about the management of DR-TB. The detailed deliberations were very useful for the participants in their day-to-day clinical practice. The main highlights of the workshop have been mentioned below.     

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report

Introduction

The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.

Case Report

This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg.

Discussion

Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.     

Genital footprints of extragenital tuberculosis in infertile women: Comparison of various diagnostic modalities

BackgroundGenital tuberculosis (TB) continues to remain an important cause of infertility in women, especially in developing countries. It is mostly consequent to a primary infection elsewhere in the body. The diagnosis is challenging, considering its paucibacillary nature. Although there are many studies on association of genital tuberculosis with infertility, there is paucity of literature on impact of extragenital tuberculosis on fertility of women through involvement of female reproductive organs. The various diagnostic modalities available have limitations and quest is ongoing for the best diagnostic test.MethodThis was a prospective observational study conducted at the infertility clinic of a tertiary care health facility where 60 infertile women with either tubal factor or unexplained infertility with or without past history of extragenital tuberculosis were enrolled as study subjects or controls respectively. Mantoux test was performed in all women and diagnostic laparo-hysteroscopy was performed in all women to look for any evidence of uterine and/or tubal damage. The peritoneal fluid was sent for GeneXpert and Liquid culture for mycobacterium tuberculosis. Results of Mantoux test, GeneXpert and liquid culture were compared with the laparohysteroscopic findings.ResultOf the thirty infertile women in the study group, 27/30 (90%) had a history of pulmonary tuberculosis and 3/30 (10%) had history of tubercular cervical lymphadenopathy. It was observed that Mantoux test was positive (induration >10 mm) in 27/30 (90%) of women in the study group as compared to only 4/30 (13.3%) controls. Abnormal hysteroscopic findings were documented in 26.6% (8/30) study group women as compared to 6.6% (2/30) women in the control group. Similarly, 60% (18/30) of women in the study group had abnormal laparoscopic findings compared to 33% (10/30) in the control group. Seven out of thirty (23.3%) women were positive for GeneXpert in the study group compared to only 1/30 (3.3%) in the control group. Similarly, liquid culture was positive in 6/30 (20%) of women in the study group as compared to 1/30 (3.3%) in the control group. All the above differences were statistically significant. We observed that the sensitivity of Mantoux test (75.8%) stand alone was higher than the other tests combined (50%). However, specificity and positive predictive value (PPV) increases markedly (up to 100%) to when all the three tests are combined.ConclusionThe authors conclude that all women presenting with infertility should be screened for a past history of tuberculosis and actively worked up for genital tuberculosis in case the history is positive. The various available tests (Mantoux test, GeneXpert and liquid culture) have their limitations for the diagnosis of genital tuberculosis. Thus an approach of early resort to laparohysteroscopy in suspected patients is desirable so that definitive management may be instituted timely and promptly.