ABSTRACT
SUMMARY Objective: Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients. Material and Methods: In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1- and 6-month follow-ups. Results: According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53±38.51 g vs. 212.69±40.82 g; 99.05 g/m2 (90.00-116.5) vs. 106.0 g/m2 (96.0∼123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22±40.07 g vs. 207.52±41.61 g; 101.0 g/m2 (92.25-111.75.0) vs. 104.50 g/m2 (95.0∼116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05). Conclusion: Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post-myocardial infarction cardiac remodeling.
ABSTRACT
In Pakistan, we have 4.9% prevalence of HCV in general population, with 79% genotype 3. Recently Sofosbuvir has been made available at compassionate price in Pakistan. Management of chronic hepatitis C includes counseling of HCV patients, their proper assessment to select those who need antiviral therapy, initiation of appropriate antiviral agents and duration of therapy, along-with careful monitoring for safety and efficacy. Hepatic status as well as previous history of HCV therapy needs to be taken in the consideration before starting antiviral therapy. Other factors include co-morbid conditions like obesity, DM, NASH, etc. Treatment of special populations like liver transplant patients, patients with HBV co-infection, chronic kidney disease and hemoglobinopathies need special considerations when initiating HCV therapy
Subject(s)
Humans , Antiviral Agents , Hepatitis C, Chronic/therapy , Disease Management , CoinfectionABSTRACT
Acute bacterial meningitis [ABM] is one of the most potentially serious infections occurring in infants and older children. Indications for PICU admission are shock, markedly elevated intracranial pressure [ICP], coma, and refractory seizures. [1] This cross sectional study enrolled children 2 months-12 years of age presented with [ABM] who were admitted to Children Welfare Teaching Hospital [CWTH] -Medical City- Baghdad, including those who needed Pediatric Intensive Care Units [PICUs] admission in CWTH Unit and Surgical Specialty Hospital [SSH] Unit in the period from the 1[st] of Feb 2004 to the 1[st] of Feb 2006. The diagnostic inclusion criteria of [ABM] were clinical symptoms and signs of meningitis plus a CSF neutrophilic pleocytosis with a CSF cells count of more than 5 cells/mm[3]. [1] Data included history, clinical examination, investigations, complications, PICU management, and outcome. Statistical analysis was done by using SPSS version 13.0 computer facility, Chi-square test and T test were used when needed and a P.value < 0.05 was considered significant. In the present study [ABM] in children 2 months -12 years constituted 7% of cases admitted to PICUs. The majority of cases [77.2%] were below 2 years of age. The mean age of children with [ABM] was 18.3 +/- 6.80 months. The PICU cases of [ABM] differed from the neurological ward cases in their more acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium and longer duration of stay and all these characteristics showed highly significant differences The case fatality rate of children with [ABM] is 13.3%. The study concluded the need for PICU admission in children with [ABM] with acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium, and recommended laboratory and PICU service expansion