ABSTRACT
Background: It has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina. Methods: A total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n ¼ 108, CAS; n ¼ 1878). For adjustment, propensity score matching (PSM) was done (C-statistics ¼ 0.766, DESCAS; n ¼ 102, CAS; n ¼ 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data. Results: Baseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p ¼ 0.012) and ST-T change (10.7% vs. 1.9%, p ¼ 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p ¼ 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p ¼ 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005). Conclusion: In this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.
ABSTRACT
Objective: In this study our main goal is to evaluate thefrequency of candida infection in post chemotherapy febrileneutropenia patient with acute leukemia.Method: This prospective type of observation study carried outat Department of Haematology of Bangabandhu Sheikh MujibMedical University (BSMMU) from September 2016 to August2017. A total 63 patients of acute leukaemia (AML and ALL)were admitted in the Department of Haematology in BSMMU.Patients were selected by purposive sampling. A typedquestionnaire was supplied to all patients and those who gavethe written consent were selected as cases.Results: In the study, it was found that 19 (30.2%) patientsbelonged to age ≤20 years followed by 19 (30.2%) of 21-30years, 13 (20.6%) 31-40 years, 6 (9.5%) 41-50 years and 6(9.5%) >50 years of age. Immunophenotypically AML wasfound in 35 patients which was 55.6% of study population, BALL in 9 (14.3%), T ALL in 5 (7.9%) and APL in 2 (3.2%)patients. Majority of the patients 28 (44.4%) were found inconsolidation phase of chemotherapy followed by 26 (41.3%)in induction phase, 5 (7.9%) in relapse, 3 (4.8%) in re-inductionand 1 (1.6%) in palliative phase. 6 (9.5%) patients were foundpositive for throat swab for Candida in this study and bloodculture were negative for candida. Among the AML patients 4(66.7%) patients were found positive for candida in throat swaband 36 (64.3%) were found negative.Conclusion: In the study, it was found that among candida inthroat swab were more common in AML than ALL. Cause wasunknown but might be due to Reduce duration of neutropeniaby applying G-CSF and empirical local and systemic antifungaltherapy.