ABSTRACT
Background: Marfan syndrome (MS) is inherited autosomal dominant connective tissue disorder caused by mutations in the FBN1 gene encoding fibrillin-1. Aortic dilatation is present in about 80% patients with MS and is the major cause of premature mortality. The objective of our study was to determine the effect of beta-blockers on aortic root growth rate in patients with MS. Methods: We performed a systematic review of all randomized controlled trials and prospective cohort studies that evaluated the efficacy of beta-blockers in patients with MS. The primary outcome of the study was aortic root growth rate. Secondary outcome was composite of death, aortic regurgitation, congestive heart failure, aortic dissection or cardiovascular surgery. Results: Five prospective trials were identified with similar comparable groups, with a total of 243 patients. In our study mean patient age was 12 years with a mean follow-up 86.5 months. There was a significant reduction in aortic root growth rate (SMD -0.86, 95% CI -1.23 to -0.48, p <0.001) with the use of beta-blockers. No significant difference was observed in secondary outcomes in the beta-blocker group as compared to placebo (OR = 1.80, 95% CI 0.21-15.53). Conclusion: Beta-blockers were associated with a significant reduction in aortic root growth rate with reduction in morbidity and mortality.
ABSTRACT
Background: Role of immunosuppression treatment in patients with inflammatory dilated cardiomyopathy is controversial. The aim of this review is to summarize current evidence for immunosuppressive therapy in inflammatory cardiomyopathy. Methods: A systematic literature search was performed using PubMed, Embase and MELDINE to identify trials comparing immunosuppressive therapy with either placebo or conventional medical therapy in adult patients with inflammatory cardiomyopathy. Combined primary outcome in our study was all cause mortality and heart transplantation. Secondary outcomes included improvement in left ventricular ejection fraction (LVEF) and left ventricular end diastolic dimension (LVEDD). Results: Five randomized controlled trials (RCTs) were identified and four trials with similar comparable groups, with a total of 359 adult patients were included for analysis. Pooled data demonstrated no reduction in all-cause mortality and heart transplantation amongst the immunosuppression or the placebo arm (OR 0.98, 95% CI 0.48-1.98). There was a significant improvement in LVEF (1.34%, 95% CI 0.37-2.30) in patients treated with immunosuppressive medications, however no difference was observed in LVEDD [-0.11mm (95% CI -1.92 – 1.71)] in the treatment arm. Conclusion: There was no survival benefit or reduction in heart transplantation events with a significant improvement in LVEF in inflammatory cardiomyopathy patients treated with immunosuppression therapy.
ABSTRACT
Background & Objective: Urinary tract infection is one of the common infections in the Indian community. Distribution and susceptibility of UTI-causing pathogens change according to time and place. This study aims to analysis present trend of locally prevalent uropathogens and their antibiotic susceptibility for prudent use of antibiotics to combat antimicrobial resistance. Methodology: Total 135 urine samples from suspected UTI was collected from both outdoor and indoor patients during the study period of August 2014 to Jun 2015.Culture and antibiotic sensitivity testing of the isolates were done. At the last, analysis of uropathogen and antibiotic susceptibility pattern was done. Results: Total 54(40%) samples were found to be positive for uropathogen in culture, in which gram negative organisms & gram positive organisms were isolated from 45 (83%) & 9(17%) samples, respectively. The E coli was most common organism isolated. Conclusion: Females are predominantly affected by UTI, with most common uropathogen E coli. Antimicrobial susceptibility pattern shows high sensitivity for Amikacin and levofloxacin compared to other routinely used antibiotics.
ABSTRACT
Tuberculosis of the thyroid gland is very rare disease and isolated involvement of thyroid is even more rare. There are about 200 cases of thyroid gland tuberculosis had been reported worldwide .In India das et al repotred 21 cases thyroid tuberculosis . Almost all cases were secondary to some primary foci elsewhere in the body.The diagnosis is usually very difficult as the clinical presentation has no distinct characterstics. Clinically it may resemble thyroditis or goiter or some malignant etiology. On histo pathological evaluation, presence of necrotizing epitheloid cell granuloma along with langhan giant cells are diagnostic of thyroid tuberculosis. Further demonstration of acid fast bacilli in Z N staining confirms diagnosis.