Electrocardiogram as prognostic and diagnostic parameter in follow up of patients with heart failure

Most patients with HF due to systolic dysfunction have a significant abnormality on ECG. It is a widely available tool relatively inexpensive, simple to perform, and yields an instant result. To determine whether heart failure [ECG] conveys prognostic and diagnostic information in patients with HF. The study was carried out on 100 heart failure patients. All patients were subjected to history taking, clinical examination, standard 12 lead ECG [at admission, discharge, and 3 month follow up] for assessment of the following: [QRS voltage amplitude: in limb leads and in chest leads, total QRS voltage and transthoracic echocardiography were done for all patients [at discharge and at 3 month follow up [FU]. There were 75males and 25 females, aged between 21 and 86 years [mean=59.14 +/- 13.41 -years]. Total QRS voltage, limb leads voltage and chest leads voltage; all significantly increased from admission values [98.54 +/- 20.64, 37.87 +/- 11.06, and 60.67 +/- 15.26 mm] to [110.72 +/- 21.28, 43.01 +/- 11.92, and 67.71 +/- 15.22] at discharge [p<0.001 for all]. Also there was a significant increase in voltage at FU [111.72 +/- 21.28, 43.30 +/- 11.96, and 68.61 +/- 16.61 mm] [p<0.001 for all]. There was a negative correlation found between left ventricular end diastolic and systolic dimensions [LVEDD and LVESD] with total QRS voltage, chest leads voltage and limb leads voltage, both at discharge and at FU. The total QRS Voltage was significantly higher in patients having no lower limb [LL] edema than those with edema on admission, at discharge and on FU [p<0.001]. Voltages of ECG are considered one of the most important parameters in diagnosis and FU of patients with heart failure. Voltage of chest leads well correlated with LVEDD and LVESD. Voltage of limb leads has important inverse correlation with LL edema

Albumin to creatinine ratio as a predictor to the severity of coronary artery disease

Microalbuminuria [MA] is a well-known risk factor for coronary artery disease [CAD]. It is associated with higher cardiovascular mortality, especially in diabetics. However, there are few data linking angiographic severity of CAD to MA. The aim of the present study was to assess the albumin to creatinine ratio as a new predictor for CAD and to correlate with its severity apart from other traditional CAD risk factors. Our study included 100 patients with documented CAD by coronary angiography in Alexandria main university hospital. The severity of CAD was scored on the basis of the number and the extent of lesions within the coronary arteries by using Syntax score. Urine albumin excretion was measured for all patients in morning spot urine samples by immune precipitation technique. We correlate between MA and severity of CAD. In a total of 100 patients [74 males and 26 females], [mean age 55.71 +/- 8.99 y] MA was present in 34 patients only. Patients were divided into two groups; group I included those without MA and group II with MA. CAD occurred more frequently in males than in females and in smokers than in non-smokers. There were no significant differences in the prevalence of hypertension and hypercholesterolemia between the two groups. A direct relationship between MA and extension of atherosclerotic coronary lesions was noticed [P = 0.009]. Patients with MA having more severe angiographic CAD were compared to those without MA. This relation is independent of other risk factors. MA could be utilized as an independent risk factor for CAD

Prevalence of chlamydophila pneumoniae in patients with pneumonia in the Main University Hospital in Alexandria

Pneumonia is a common illness in all parts of the world. It is a major cause of death among all age groups and is the leading cause of death in children in low income countries. This prospective study was done at Department of chest diseases and microbiology from January 2011 to July 2011. A total of 60 patients, with pneumonia were included in the study. The present study was conducted on 60 patients with pneumonia who have been admitted to the Chest Department in the Main University Hospital in Alexandria [55 patients] and El Maamoura Chest Hospital [5 patients] in the period from January 2011 to April 2011. The patients were subdivided into 2 groups: group I includes 30 patients with CAP and group II includes 30 patients with HAP; 16 patients with COPD, 7 patients with bronchial asthma, 4 patients with bronchogenic carcinoma and 3 patients with ILF. We can conclude that, Chlamydophila pneumoniae cannot be ignored as a cause of pneumonia. ELISA is an excellent screening test because of its high sensitivity for detection of C. pneumoniae while PCR is more accurate because of its high sensitivity and high specificity in diagnosis of C. pneumoniae infection.DM is a risk factor for C. pneumoniae infection

Impact of drug-eluting stents on treatment of long lesions in diabetic patients

The study was designed to evaluate in-hospital and mid-term clinical outcomes of drug-eluting stents in treatment of long lesions in diabetic versus non-diabetic patients. We studied 100 diabetic and 200 non-diabetic patients with long lesions >/= 20 mm treated with either Cypher or Taxus stents. The majority of the patients were males with a mean age over sixty years in both groups. Both groups were almost matched as regards demographic and clinical characteristics. The majority of patients in both groups presented with unstable angina [49% diabetics and 46.5% non-diabetics]. The incidence of multivessel disease was higher within the diabetic population The mean lesion length in diabetic group was 34.24 +/- 13.48 mm versus 36.68 +/- 16.32 mm in non-diabetic [p=0.11]. The mean percentage of multiple stents per lesion was 40.5% in diabetic patients versus 46.6% in non-diabetic patients [p=0.16]. The in-hospital Major Adverse Cardiac Events [MACE] rate was 10% in diabetic patients versus 7.5% in non-diabetic patients [p=0.25]. Only 2 patients [0.66%] had subacute stent thrombosis while there was no late stent thrombosis. After a mean clinical follow-up period of 328 +/- 127 days, there was no statistical difference between the two groups, in terms of survival [96.88%for diabetic vs. 98.96%for non-diabetic group at 15 months, p=0.29], While the midterm clinical outcome showed higher rate of MACE in uncontrolled diabetics [23.07%] than controlled diabetics [11.36%][p=0.016]. In selected group of patients, the stenting of long lesion with DES may be a good alternative to surgery with excellent mid-term outcome. Also, diabetes mellitus in the era of Drug-Eluting Stents [DES] has limited impact on outcome after PCI in long lesions when the glycemic state is well controlled