Does impaired glucose tolerance imply a risk in pregnancy?

Summary. Of 218 pregnant women with abnormal glucose tolerance by the criteria of the World Health Organization (1985) 81·2% had impaired glucose tolerance and 18·8% gestational diabetes. Gestational diabetic women were of higher parity, more obese, required insulin therapy more often, had more babies weighing >4 kg and had higher fasting plasma glucose than women with impaired glucose tolerance. Women with gestational impaired glucose tolerance were older, of higher parity, more obese and had heavier babies than pregnant women with a normal screening plasma glucose. Compared with women with impaired glucose tolerance, gestational diabetic women were more likely to have abnormality, and more severe impairment of their glucose tolerance test in the puerperium.     

Regional Disparities of Endocardial Atrial Activation in Paroxysmal Atrial Fibrillation

Previous experimental data suggest that atrial activity is homogeneously distributed during paroxysmal atrial fibrillation (AFib). Little is known about this in human paroxysmal AFib. Methods : Twenty-five men and two women (mean age 49 ± 11 years; five with structural heart disease) with paroxysmal AFib for a mean 5 ± 6.2 years despite the use of a mean of 3.6 ± 1.7 antiarrhythmic drugs underwent atrial mapping. The right atrium was divided into four regions: posterior (intercaval), lateral, anterior, and septal. A 14-pole catheter was positioned to assess complex electrical activity defined as the duration of continuous electrical activity or electrograms with FF intervals < 100 ms for 60 seconds (expressed as percentage of time). In addition, the left atrium (divided into three regions: posterior, anterior, and septal) was explored in 12 patients with a multipolar catheter. Results : The complex electrical activity time between all the regions explored was significantly different. In the right atrium, the septa] (74%± 32%; P = 0.02) and the posterior (63%± 32%; P = 0.04) areas were significantly more disorganized than the lateral (22%± 23%) and anterior (21 %± 26%) regions. In the left atrium, complex electrical activity was predominant and widely distributed (posterior: 87%± 11%; septal: 65%± 27%) except in the appendage area (anterior region: 18%± 14%). Conclusions : Quantitative assessment of complex electrical activity in both atria in humans shows heterogeneous temporal and spatial distribution. This may have implications for guiding catheter ablation of AFib.     

Syphilitic Hepatitis

Liver involvement in syphilis varies with the stage of the disease. The presence of fibrosis. gumma and hepar lobatum are well described in patients with late and congenital syphilis.¹ On the other hand since Hahn's review of 1943,² only eight cases with secondary syphilis have been described in the literature.^3–11 With the new acceptance of aberrant sexual practice there has been an increase in the prevalence of venereal diseases and emergence of new syndromes related to homosexuality.¹²
This case report illustrates one of the manifestations of syphilis that may be easily confused with other causes of jaundice.     

CHRONIC CUTANEOUS LEISHMANIASIS: LEISHMANIA PARASITES IN BLOOD

Two patients with chronic cutaneous leishmaniasis had positive blood cultures. The diagnosis was established by the clinical picture, skin biopsy, and culture for Leishmania major and tropica.     

Effectiveness of Veadent as a plaque-inhibiting mouthwash

The aim of this study was to compare the effect of the commercially available Veadent mouthwash and chlorhexidine on plaque formation. Plaque accumulating during two 5-day periods was recorded in a group of 10 students. During the experimental periods, the test subjects abstained from mechanical cleaning of the teeth, and chewed sucrose-containing chewing gum every 4th h in order to enhance plaque formation. They also rinsed with either chlorhexidine or Veadent twice a day according to the manufacturer's recommendations. Chlorhexidine mouthrinses resulted in significantly lower plaque scores than did Veadent in the present short-term model study.     

Nitrate-induced Biochemical and Histopathological Changes in the Liver of Rats:Ameliorative Effect of Hyparrhenia hirta

Objective The present study investigated the protective role of Hyparrhenia hirta （H. hirta） against sodium nitrate （NaNO3）-induced hepatoxicity. Methods Male Wistar rats were randomly divided into three groups： a control group and two treated groups during 50 d with NaNO3 administered either alone in drinking water or co-administered with H. hit＇to. Results NaNO3 treatment induced a significant increase in serum levels of glucose, total cholesterol and triglyceride while serum total protein level decreased significantly. Transaminases and lactate deshydrogenase activities in serum were elevated indicating hepatic cells＇ damage after treatment with NaNO3. The hyperbilirubinemia and the increased serum gamma glutamyl transferase activities suggested the presence of cholestasis in NaNO3 exposed rats. In parallel, a significant increase in malondialdehyde level along with a concomitant decrease in total glutathione content and superoxide dismutase, catalase and glutathione peroxidase activities were observed in the liver after NaNO3 treatment. Furthermore, nitrate caused a significant induction of DNA fragmentation. These modifications in NaNO3-treated rats corresponded histologically with hepatoceltular necrosis and mononuclear cells infiltration. H. hirta supplementation showed a remarkable amelioration of the abnormalities cited above. Conclusion The results concluded that the treatment with H. hirta had a significant role in protecting the animals from nitrate-induced liver dysfunction.     

BRUCELLA ARTHRITIS AMONG IRAQI PATIENTS

The clinical features of acute Brucella arthritis were reportedin a prospective study of 58 patients (29 male, 29 female).Polyarthritis occurred in 33, was migratory in ten, additivein 23 and symmetrical in ten. Monoarthritis of knee or hip jointsoccurred in ten patients, whilst the spine alone was involvedin 15. Hip and spinal involvement was more destructive thanperipheral joint involvement. Hotness, redness and joint effusionswere not prominent features. Tissue-typing did not show anyassociation with Brucella arthritis. Treatment with various antimicrobials was followed by recovery,but the relapse rate was lowest with combined tetracycline andstreptomycin. Brucella arthritis is frequently seen in Iraq, and dairy productsprepared locally from unpasteurised milk should be controlledby local health authorities. KEY WORDS: Brucella, Peripheral arthritis, Spine, Tissue type, Treatment     

Outcome of Early Revascularization Surgery in Patients with ST‐Elevation Myocardial Infarction

Objectives

To compare morbidity and mortality of patients with ST‐elevation myocardial infarction (MI) undergoing coronary artery bypass graft (CABG) surgery within 24 hours with those who had surgery delayed >24 hours.

Background

Patients with ST‐elevation MI are currently managed by emergency percutaneous coronary intervention (PCI). If PCI is unsuccessful, or if there is severe coronary artery disease not amenable to PCI, CABG is considered. If the patient is clinically stable, surgeons wait several days before performing surgery, as very early surgery carries a prohibitive risk.

Methods

One hundred and eighty‐four patients with acute ST elevation MI (STEMI) who had undergone CABG were divided into two groups based on their surgery timing (<24 hours vs. >24 hours). Mortality and complication rates were studied between the two groups by Fischer test. Time‐to‐event analyses were performed for five primary variables: all‐cause mortality, cardiac events, congestive heart failure, stroke, and renal failure.

Results

At one month post‐CABC, all‐cause mortality was noted in 10.6% of patients who had CABG within 24 hours of STEMI diagnosis, compared with 8.9% in patients who had CABG after 24 hours (P = 0.3). Cardiac events including re‐exploration, atrial fibrillation, graft occlusion, and arrhythmias requiring shock occurred in 17.1% versus 13.9% between the two groups, respectively (P = 0.68). One year post‐coronary artery bypass surgery, there was no difference in individual or combined events between the two groups.

Conclusions

In patients with ST‐elevation myocardial infarction who required emergency coronary artery bypass surgery, there was no difference in procedure complications or mortality between early (within 24 hours) or later (more than 24 hours). That was noted at one month and one year after the index myocardial infarction. (J Interven Cardiol 2015;28:14–23)