Cholesterol embolization syndrome following thrombolytic therapy

Cholesterol embolization syndrome [CES] is a rare and serious complication of thrombolytic therapy. Awareness of this complication would lead to earlier diagnosis and better management. We report a case of a 70-year-old man who presented with acute myocardial infarction and was thrombolysed with tenecteplase. His hospital stay was complicated by acute renal failure, blue toe syndrome and livedo reticularis. Skin biopsy revealed cholesterol crystals. He eventually became dialysis dependent

effect of dietary supplementation of nigella sativa seeds on some biochemical parameters in hypercholesterolemic rats

Nigella Sativa [N. sativa] has been extensively studied for its biological activities and therapeutic potential, the seeds of N. sativa are widely used in treatment of various diseases. Hyperlipidemia is associated with profound alterations in the plasma lipid and lipoprotein profile and with an increased risk of coronary heart disease. Therefore, this study was carried out to evaluate the effect of dietary supplementation of nigella sativa seeds on lipid profile, liver function and CBCs in hypercholesterolemic Rats. The study carried out on 40 female albino rats divided to two groups [-ve] control fed on basal diet and hypercholesterolemic rats in 4 subgroups fed on hypercholosterolemic diet containing 5%, 10% and 15% of N. sativa seeds diets for 28 days, at the end of feeding trial feed intake, body weight gain, serum lipid profile, liver function, CBCs determined. The present study has identified, body weight gain decreased significantly [P<0.01] by 36%, 39%, 40.8%, and 42.6% in both [-fve] control, 5%, 10%, 15% N. sativa groups respectively as compared with [-ve] control group . Dietary supplementation of 10% and 15% N. sativa for hypercholesterolemic rats decreased significantly [P<0.001] and 5% N. sativa decreased significantly [P<0.05] the values of T. Lipids, total cholesterol, and VLDL-c as compared with [+ve] control group. The results revealed that the means values of AST in 5%, 10%, and 15% N. sativa groups decreased [by 3.8% at P<0.005, 4.1% at P<0.001, and 5.9% at P<0.001 respectively] as compared to [+ve] control group. RBCs increased significantly [by 19.2% at P<0.001] after the supplementation of 15% N. sativa when compared with [+ve] control group

Conclusion: The findings of this study indicate the administration of different doses of N. sativa were effective in improving lipid profile, AST, RBCs and thrombocytes in hypercholesterolemic rats

outcome of pharmacist counseling at the time of hospital discharge: an observational nonrandomized study

Adverse drug events [ADEs] may occur after discharge from acute care hospitalization because of limited instruction on medications at discharge. The right instructions given to patients may reduce the risk of ADEs. The objective of our study was to assess a program involving comprehensive medication counseling provided by pharmacists at the time of discharge from a tertiary hospital in Riyadh, Saudi Arabia. A prospective, nonrandomized observational study over a period of 3 months in a 1000-bed tertiary hospital. patients discharged from the internal medicine wards with more than three medications received comprehensive pharmacist counseling. The intervention pharmacist counseled patients about their discharge medications and provided written materials as needed. Topics discussed with the patients included the importance of following prescribed medication regimens and the indications, directions, and any potential side effects of discharge medications. The control group included similar patients who received routine discharge counseling by nurses. Two weeks after discharge, the same pharmacist called the patients and assessed the frequency of ADEs. Two independent clinicians reviewed each ADEs and judged its severity and preventability. Out of 200 patients included in the study [100 patients from the intervention group and 100 patients from the control group], 175 patients [87.5%] were successfully contacted two weeks after discharge [88 patients from the intervention group and 87 patients from the control group]. ADEs occurred in 2 patients [2.3%] in the intervention group and in 21 patients [24%; 23 incidents in 21 patients] in the control group [P<.001]. In the control group, 14 ADEs [61%] were judged as preventable, and 9 [39%] were judged as serious. A comprehensive medication counseling program at hospital discharge reduced the incidence of ADEs two weeks after discharge from a tertiary hospital in Riyadh, Saudi Arabia. Further studies assessing the long-term outcomes of such a program are needed

Effect of rosemary on lung functions and immunoglobulin E [igE] in adult asthmatic patients

Asthma is a clinical syndrome characterized by chronic airway inflammation, airway responsiveness] and expiratory airflow limitation. Nocturnal symptoms and decreases in lung .functions are common aspects of the asthma clinical syndrome. The objective of the present study was to determine the effect of rosemary supplementation on lung function in adult asthmatic patients. A sample of twenty patients with asthma [10 Men and 10 Women] aged 43.7+/- 1.0 years were chosen from outpatient clinics of Tanta University Hospital, Egypt. All patients were diagnosed according to lung functions, blood variables, and clinical signs. The patients were · randomly divided into two equal groups; control group [CG] who received medical treatment only; Rosemary group [RG] who received medical treatment plus two cups of rosemary tea daily. The supplementation continued for three consecutive months. Lung functions [forced vital capacity [FVC], FEVI, maximum voluntary ventilation [MVV], and peak expiratory flow rate [FEFR], were measured and CBC was also determined at baseline and after three months of supplementation. The results revealed that the majority of subjects were of intermediate socio-economic status [70%], the percentage of forced expiratory volume 1 second [FEV 1 %] improved significantly among RG [by 3.4% at P<0.001], [MVV] increased significantly [P<0.001] for RG more than CG. RBCs improved significantly [P<0.01] for both groups. Leucocytes values decreased significantly [by 11.7% at P<0.001] after the supplementation for RG. Finally, the [IgE] decreased significantly [by 9% at P < 0.05] in CG and also decreased significantly [by 36% at P < 0.001] in RG. In conclusion: Data suggests that administration of rosemary at a safe dose [2 cups rosemary tea daily] was effective in improving the health and lung functions of adult asthmatic patients

Influence of diabetes on the outcome of acute coronary syndrome in Kuwait

To describe the baseline characteristics and management of patients with and without diabetes mellitus [DM] hospitalized with acute myocardial infarction [AMI] and to assess the influence of DM on hospital outcomes and hospital mortality. We analyzed data from a 6-month observational study [Kuwait Acute Coronary Syndrome Registry] of unselected patients admitted with a diagnosis of AMI over a period of 6 months, from December 2003 through May 2004. Of 1,295 patients enrolled, 609 [47%] were diabetics and 686 [53%] were non-diabetics. Diabetics were more likely to have a past history of coronary artery disease, hypertension and left ventricular systolic dysfunction than non-diabetics. There was less use of beta-blockers and aspirin in diabetics as compared to non-diabetics [62 vs. 71% and 95.5 vs. 97.9%, p<0.03, for beta-blockers and aspirin, respectively]. Left ventricular failure and cardiogenic shock occurred more often in diabetics compared to non-diabetics [16 vs. 7% and 5 vs. 3%, p<0.001, for left ventricular failure and shock, respectively]. The mortality rate was 6% for diabetics and 2% for non-diabetics [p<0.001]. DM is a major health problem among the adult population in Kuwait and almost half the AMI population suffer from diabetes. Diabetic patients had higher rates of complications, especially left ventricular failure and cardiogenic

Kuwait acute coronary syndromes registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

To identify the characteristics of patients with acute coronary syndromes [ACS], their hospital management and in-hospital outcomes, through a prospective registry system in Kuwait. A registry involving all 7 general hospitals in Kuwait was set up. Consecutive patients diagnosed as having ACS over a period of 6 months were enrolled. Of 2,129 patients enrolled, 718 [34%] had ST segment elevation myocardial infarction [STEMI], 576 [27%] non-ST segment elevation myocardial infarction [NSTEMI] and 835 [39%] unstable angina [UA]. Thrombolytic therapy was used in 556 [77%] patients with STEMI. The median time from diagnostic electrocardiogram to administration of thrombolytic therapy was 38 min. Almost all patients with ACS [2,050, 96%] received aspirin during hospitalization. Only a minority received clopidogrel, 18 [3%] STEMI, 36 [6%] NSTEMI and 96 [12%] UA patients. The use of glycoprotein llb/llla antagonists was minimal [38 patients, 2%]. beta-blockers were used in 1,473 [69%] patients, while 982 [46%] received angiotensin-converting enzyme inhibitors. Coronary angiography during hospitalization was performed in 119 [17%], 120 [21%] and 126 [15%] patients with STEMI, NSTEMI and UA, respectively. In-hospital mortality occurred in 31 [4%] myocardial infarction patients and 4 [0.5%] UA patients [p < 0.0001]. This registry has enabled us to determine the incidence and characteristics of ACS patients in Kuwait. It has also enabled us to identify some barriers that we need to overcome for the full implementation of published guidelines for the management of patients with ACS

Comparison of intravenous Lornoxicam and fentanyl combined with midazolam on analgesia during extracorporeal shock wave lithotripsy

Various sedative and analgesic medications have been used for shockwave lithotripsy [SWL]. This study compare the analgesic and side effects of intravenous lornoxicam with that of intravenous fentanyl, in combination with midazolam in ESWL. One hundred patients were randomly divided into two groups; group A [n = 50] received 16 mg lornoxicam i.v. 30 min before ESWL and group B [n = 50] received 2 microg/kg fentanyl i.v. 3 min before ESWL. All patients received 2 mg midazolam i.v. 3 min before ESWL for intraoperative sedation. Pain intensity was evaluated on a visual analog scale [VAS]. A supplemental analgesia with intravenous fentanyl 25 micro g was given when complained of pain, changed position, or grimaced in response to the shockwaves. The level of sedation was determined using the Observer's Assessment of Alertness/Sedation [OAS/S]. Oxygen supplement through a face mask was given when the SpO[2] fell below 94%. Side effects [nausea, vomiting, dizziness] and the time of discharge from post-anesthesia room [PAR] were recorded. There were no differences between two groups in the demographic data, number of shock waves, duration of ESWL procedure, and fentanyl supplement. The incidence of oxygen supplement was lower in lornoxicam group [5/50] compared with that of fentanyl group [20/50], P < 0.01. The frequency of dizziness was lower in lornoxicam group [3/50] than that in fentanyl group [15/50], P < 0.01. Five patients in fentanyl group complained of nausea, but two did in lornoxicam group. The discharge time from PAR was significantly shorter in lornoxicam group [24.4 +/- 3.23 min] than that in fentanyl group [37.14 +/- 5.82 min], P < 0.01. Intravenous lornoxicam plus midazolam could provide an adequate analgesia as good as fentanyl plus midazolam but with a lower incidence of desaturation, nausea/vomiting and dizziness and could be discharged from PAR earlier. Therefore, we suggest that a single-dose intravenous lornoxicam combined with midazolam is a safe and effective regimen for pain relief in ESWL

Immediate surgical repair of penile fracture:report of eight cases and review of the literature

Purpose: to evaluate prospectively the outcome of immediate surgical repair of penile fracture in eight cases. Patients and methods: Eight patients with penile fractures were evaluated by history taking and clinical examination to assess the extent of penile hematoma, the site of tear in the tunica albuginea and bleeding at urethral meatus. Their ages ranged between 22 and 46 years [mean 33.3 years]. All of them underwent immediate surgical exploration after fixation of urethral catheter using subcoronal circumferential incision with degloving of the penile skin. Penile hematoma was evacuated and tunical tear was repaired using absorbable interrupted suture [vicryl 3/0]. The degloved skin was returned back and sutured using chromic catgut 3/0. No drain was fixed and pressure bandage dressing was applied. Pen-operative broad spectrum antibiotics were given. Follow up period ranged from 6 to 8 months after repair. Penile fractures occurred due to vigorous sexual intercourse in 4 cases, rolling over in bed in 3 cases, and during masturbation in one patient. All patients had acute penile pain and swelling. The typical presentation of hearing snap sound was found in only one patient during masturbation. No urologic symptoms or urethral bleeding reported. The time elapsed between the occurrence of the fracture and presentation ranged from four to thirty six hours [mean 14.3 hours]. The site of tunical tear was palpated in 4 [50%] out of the eight cases. Tunical tear was in the right side in six cases [75%] and left side in two cases [25%]. Midshaft was injured in five cases and distal shaft was affected in three cases. All tears were unilateral and transverse and varied in length between 1.5 and 4 centimeters. Hospital stay after surgical repair ranged from 48 to 96 hours and patients were discharged from the hospital after removal of urethral catheter and bandages. Postoperative wound infection occurred in only one patient. However normal erectile function was regained in seven out of the eight cases. One patient developed erectile dysfunction. Diagnosis of penile fracture can be reached only by history taking and clinical examination. Early surgical interference with repair of tunical defect with absorbable sutures is advantageous with minimal morbidity

Diagnostic value of endothelin - 1 [ET - 1] in perinatal asphyxia

Asphyxia denotes progressive hypoxia, accumulation of carbon dioxide, and acidosis. It may result in permanent brain injury or death. Perinatal asphyxia is one of the leading causes of perinatal morbidity and mortality. Hypoxic ischaemic encephalopathy [HIE] is the effect of perinatal asphyxia on the brain. Research works are in a continuous challenge for construction of new methods whether radiological or laboratory for diagnosis and assessment of perinatal asphyxia. It is the leading cause of perinatal morbidity and mortality and disability later on among survivors. Endothelin-1 [ET-1] is a novel potent vasoconstrictor endothelium derived peptide. It is formed of 21 aminoacids. It is encoded by a single gene localized on chromosome[6]. ET-1 immunoreactivity has been detected in the kidney, spleen, skeletal muscle, lung as well as in plasma. Recent clinical observations have been shown that circulating [ET-1] is increased in certain diseases such as acute renal failure, surgical stress, acute myocardial infarction and intracranial hemorrhage. The present study was intended to assess plasma [ET-1] level in newborns with HIE in the first day of life to uncover the role of [ET-1] during perinatal asphyxia. This study was performed on 70 newborns [50 cases with perinatal asphyxia and 20 healthy control newborns. The 50 cases were 27 males and 23 females with gestational age between [32 to 40] wks. They were grouped into stage 1 [n=15], stage II [n=22] and stage III [n=13] according to Sarnat and Sarnat classification. Inclusion criteria included. Low Apgar scores at 1st and 5th min and needed active resuscitation. Low pH [<7.2] of cord blood and presence of neurological manifestation infants were excluded if they had early neonatal sepsis. All newborns [cases and controls] were subjected to: thorough maternal and neonatal history taking and meticulous clinical examination of the newborn. The results revealed that, most asphyxiated cases were complicated by respiratory distress, maternal hypertension, advanced maternal age and difficult labor, C.S and ventouse delivery. There was marked decrease in Apgar score in 1, 5, 10 and 20 min. There were hyponatraemia, hyperkalaemia, and hypocalcemia. These electrolyte changes were also more evident in stage [III-HIE]. Hypoxia, hypcrcarpia and acidosis were more evident in stage III. Plasma ET-1 was significantly increased in asphyxiated infants. It was negatively correlated with PaO2, HCO3 and Apgar score which reveal the strong relation between plasma ET-1 level and degree of asphyxia. Elevated plasma ET-1 was more evident in stage III asphyxia and patients with ventilatory support. Conclusion, ET-1 can be considered as a marker for HIE diagnosis. It can be considered also an indicator for degree of HIE. So, it has a diagnostic and prognostic value for evaluation of perinatal asphyxia. However, we recommend further studies to emphasize these results