Aortic valve calcification in hemodialyzed patients at the iraqi dialysis center

Background: Aortic valve calcification in End Stage Renal Disease [ESRD] patients occurs ten to twenty years earlier than general population. It is associated with myocardial, coronary arteries and conduction system calcification and it is associated with rapid development of aortic valve stenosis

Objective: To study the incidence of aortic valve calcification in hemodialysis patients and to look for risk factors associated with this calcification

Patients and Methods: Forty six patients with End Stage Renal Disease [ESRD] on regular haemodialysis in Baghdad Teaching Hospital / Dialysis Unit and forty six patients with no renal disease as control group were studied between February 2005 - January 2006. Duration of dialysis, blood flow rate during dialysis, serum Calcium, serum Phosphorous and their products were included in this study. Echocardiography was done for all patients

Results: The incidence of Aortic Valve Calcification [AVC] in ESRD patients on haemodiaysis was 30% and it was higher than that of general population [p value 0.0085] . It occurs 10-15 year earlier than in patients with no renal disease. End Stage Renal Disease patients with AVC were older than those with non calcified valves. Only 7.4% of those ESRD patients with AVC have hemodynamic AV stenosis [p value 0.5]. The mean duration of haemodialysis in ESRD patients with AVC was longer than that of ESRD patients without AVC which was statistically significant. Also there was statistically significant association between blood flow rate during haemodialysis and AVC. There was statistically significant association between Calcium phosphate products and AVC in ESRD patients

Conclusion: There is ahigher incidence of aortic valve calcification in ESRD patients on haemodialysis . This calcification occurs earlier than that in patients with no renal disease .The duration of haemodialysis is a risk factors for AVC

Cardiovascular manifestations of primary hypothyroidism

Primary hypothyroidism accounts for 90 to 95% of all cases of hypothyroidism. Thyroid hormone deficiency increases systemic vascular resistance, decreases contractility and slow the heart rate. To investigate cardiac changes in primary hypothyroidism. In this prospective study 36 patients with untreated primary hypothyroidism were compared with 30 healthy persons. Cardiovascular evaluation of all subjects had been made both clinically and by the following studies :Chest X-Ray, electrocardiography, serum lipid and Echocardiography.The main cardiac manifestations of hypothyroidism were: Easy fatigability [88.9%], exertional dyspnea [75%]obesity or gaming weight [66.7%], sinus bradycardia [47.2%] and peripheral edema [l 1.1%] Electrocardiography showed sinus bradycardia in [47%] low QRS voltage in [33.3%], flat or inverted T wave [27.8%], prolonged QT interval [19.5%], first degree heart block in [19.5%] .Echocardiography showed the following :a decrease in global systolic function, asymmetric sepal hypertrophy in [91.6%] Pericardial effusion in [38.8%].Low QRS voltage was found to be related to thyroxin level and age of the patient .No correlation was found between heart rate and thyroxin level. Primary hypothyroidism accompanied by significant changes in cardiovascular system which may explain the development of premature coronary artery disease in these patients

Chronic phase chronic myeloid leukemia: response of imatinib mesylate and significance of Sokal score, age and disease duration in predicting the hematological and cytogenetic response.

OBJECTIVE: To evaluate the response of imatinib mesylate in chronic phase of chronic myeloid leukemia and to observe the significance of Sokal score and various factors which predict the response. METHODS : This was a descriptive, prospective study conducted from May 2001 to September 2006. One hundred and thirty six patients with diagnosis of chronic myeloid leukemia in chronic phase were analyzed. Hematologic and cytogenetic responses were assessed according to defined criteria. RESULTS: The median age at time of diagnosis was 33 years (range, 12-65 years). Among them 86 were males, 50 were females. At the end of study response was analyzed overall and according to Sokal score. At median follow-up of 18 months, 122 patients were evaluable for cytogenetic response. Complete hematologic response was seen 86% while complete and major cytogenetic response was observed in 34.4% and 49.2% cases respectively. Analysis of variables like younger age, disease duration at time of starting imatinib failed to show any significant influence on response to imatinib mesylate, however, response was found to be higher in patients who had low Sokal score at the time of presentation. CONCLUSION: Imatinib mesylate has substantial activity in chronic phase of CML. Low Sokal score at time of presentation predict the higher hematologic as well as cytogenetic response in patients with chronic phase.

Factors affecting radiographers' participation in continuing professional development in Oman

Continuing Professional Development [CPD] became an ongoing, lifelong activity for health care professionals. Radiographers must participate in CPD to sustain and improve their knowledge and professional competence. This study aimed at assessing different factors affecting radiographers' participation in CPD in Oman. A cross sectional study was carried out on 93 radiographers working in primary and secondary health care facilities of 3 regions in Oman. Data were collected using a pre-tested, self-administered and anonymous questionnaire sheet including: personal data, inquiring about current participation in any CPD activities, CPD activities mostly attended, compulsory or voluntary CPD preferred, radiographer 's perception, thought and agreement on importance, benefits and barriers of CPD. The results revealed that 66.7% of radiographers reported current participation in CPD activities, 51.6% reported monthly attendance, while 17.2% never attended. Lectures had the highest percentage of attendance [38.7%] among CPD activities. Two thirds of participants [66.7%] preferred voluntary CPD activities than compulsory ones with significant difference in relation to regions and institutions. Respondents who preferred compulsory CPD activities reported significantly higher scores than those who agreed with voluntary ones regarding their perception of being encouraged by their departments to carry out CPD activities [78.2% vs 69.4%]. Those working in secondary care facilities recorded significantly higher scores than those working in primary ones regarding their perception that their departments offer enough courses at their clinical area. Finance was perceived by radiographers to be a greater barrier to participate in CPD [mean score=76.9%]. Participants who believed that they are responsible for introducing and developing CPD activities reported significantly higher scores than those who mentioned superintendents regarding most perceptions and attitudes. Significant positive correlation was reported regarding radiographers' agreement of importance of CPD to the radiography profession and its benefit in improving the clinical practice [means scores=90.9% and 8 1.2% respectively]. Most radiographers showed a positive attitude in participating in CPD activities. Departmental managers should take active role in encouraging staff to participate in CPD activities. The responsibility to introduce and develop CPD activities should be shared between employers, managers, and radiographers. Follow-up studies are recommended to determine if the aims of CPD activity have been achieved

Left ventricular hypertrophy in hypertensive patients electrocardiographic and echocardiographic correlations and geometrical patterns

Left ventricular hypertrophy is considered to be an important risk factor for cardiovascular morbidity and mortality. To study the frequency of occurrence of left ventricular hypertrophy in hypertensive patients using the standard ECG and echocardiographic methods, risk factors for its developments and different LVH geometrical echocardiographic patterns. Two hundred and three hypertensive patients [203] and fifty [50] normotensive healthy subjects underwent standard ECG and echocardiographic examinations using internationally accepted formula for the detection of left ventricular hypertrophy. Electrocardiographic detection of LVH was found in 10.3% of hypertensive patients, compared to 50.2% detected by echocardiography with sensitivity of 18.4% and specificity of 91.3%. Concentric hypertrophy was the most common geometrical echocardiographic pattern [23.7%] followed by eccentric hypertrophy [17.3%] and concentric remodeling [15.3%]. Independent predictors of getting LVH were Age, obesity, uremia. Echocardiography is a more sensitive tool than ECG for the detection of left ventricular hypertrophy; concentric geometry is the most prevalent echocardiographic LVH pattern. Age, obesity and chronic renal failure were independent predictors of getting L VH in hypertensive patients

Prevalence of hepatitis G virus in Pakistani children with transfusion dependent beta- thalassemia major.

We ought to obtain data on the prevalence of the newly discovered tranfusion transmittable hepatitis G virus in polytransfused b- thalassemia major children. Each individual had received multiple blood transfusions, from 12 to 36 per year. No documentation of prior hepatic infection was available. Serum samples were collected prospectively from the randomly selected subjects and were analyzed for HGV RNA by polymerase chain reaction using primer specific for two different regions of the HGV genome. Among the 100 individuals examined 21 were positive for HGV RNA. Four patients had evidence of dual infection, both HGV RNA and HCV RNA were isolated from their sera. While in one sample presence of both HGV RNA and HBV DNA was established. Only one child was positive for hepatitis E antibodies. The sera of 10 children were reactive for hepatitis B surface antigen whereas 35 individuals were positive for hepatitis C virus antibody. The ALT levels were variable in HGV infected children. Four out of 16 (25%) showed peak ALT levels of 218 IU/I, 8/16 (50%) children demonstrated slightly elevated ALT levels whereas 25% individuals showed normal ALT levels. Alkaline Phosphatase levels were elevated in 90% of the children and 20% patients of this series also had higher GGT levels. The observed AP levels were not statistically different among HGV, HGV/HCV or HGV/HBV groups. Even though the ALT levels were deranged in the children with HGV alone but none of the children had demonstrated symptoms of liver disease, their direct and total bilirubin levels were normal and no complain of jaundice was recorded. In conclusion, our findings suggested that like other blood borne hepatic viruses, HGV is also prevalent in the high risk group of multiple transfused patients in Pakistan but our results support the absence of any causal relationship between HGV and hepatitis.

Lipid profile study in subjects and patients with ischemic heart disease

This study was conducted to obtain knowledge on the status of the plasma lipid fractions in normal subjects and in patients with ischemic heart disease [IHD]. Thirty one normal volunteers and 104 consecutive patients with ischemic heart disease were included in the study. The values in normal subjects were: Total serum cholesterol [T.Ch] 215 +/- 44 mg/ 100 ml, low density lipoprotein cholesterol [LDL-C] 139 +/- 40 mg/100 ml and triglyceride [TG] 130 +/- 56 mg/100 ml. These data were significantly lower than the values in patients with IHD: T. ch 236 +/- 43 mg/ 100 ml, LDL-C 155 +/- 45 mg/ 100 ml and TG 189 +/- 86 mg/ 100 ml. The high density lipoprotein cholesterol [HDL-C] in normal subjects was significantly higher [49 +/- 11 mg/100 ml] than patients with IHD [44 +/- 10 mg/ 100 ml]. The T.ch/HDL-C and the LDL-C/HDL-C were significantly lower in normal subjects than in patients with IHD. The values of the lipid fractions in normal subjects which included the T.Ch, LDL-C and HDL-C were similar to the values reported from Iraq, the United State of America, North and South Europe. However, the serum TG level was significantly higher in the American population

Lipid profile study in patients with ischemic heart diseases

To study the prevalence of hyperlipidemia in patients with IHD, 68 consecutive patients with angina pectoris and / or myocardial infarction were included. The results revealed that 50% had elevated cholesterol and / or Triglycerides, with a mean of 247.9 mg% [ +/- 56.7SD] and 177.7 mg% [ +/- 85.5 SD] respectively Hypercholesterolemia was present in 38%, hypertriglyceridemia in 28%.and 16%. had both hypercholesterolemia and hypertriglyceridemia. Low HDL - C was present in 19%, high LDL - C in 22% and low HDL - C + high HDL - C in 6% of the patients. However, elevated LDL - C / HDL - C was present in 62%. In 14 asymptomatic "Normal" persons the total serum cholestrol and serum Triglycerides were 215.4 mg% [ +/- 42.4] and 127.7 mg% [ +/- 50: 7] respectively. Thirty six% appeared to have hypercholestrolemia, 7% hypertriglyceridemia and 7% had both while 29% had elevated- LDL - C / HDL - C. We conclude that our patients have higher prevalence of hyperilipidemia than what.was reported elsewhere and that the calculation of LDL - C / HDL - C is the most beneficial in showing high incidence in patients with ischemic heart disease