Prevalence of Non-Alcoholic Fatty Liver Disease in Women with Polycystic Ovary Syndrome and its Correlation with Metabolic Syndrome: A Single Centre Study

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women. Women with PCOS have androgen excess as a defining feature. They also have increased insulin resistance and obesity, which are also risk factors for non-alcoholic fatty liver disease (NAFLD). However, published data regarding PCOS as independent risk factor for NAFLD remain controversial. To determine the prevalence of NAFLD and metabolic syndrome in patients with PCOS, and to verify if there is a correlation between NAFLD and metabolic syndrome in this population.Material & Methods:The prospective study was developed to determine the prevalence of NAFLD and MS in adult women with PCOS. Patients were admitted to the Bangladesh Institute of Research and Rehabilitation in Diabetes (BIRDEM), Dhaka, Bangladesh which treats patients with Diabetes Mellitus from all over the country Bangladesh. The study sessions were conducted from January 2020 to December 2020.Results:A total 213 patients were included and analyzed into two groups. Of these, 153 were diagnosed with PCOS, and 60 had other diagnoses. In the PCOS group, 36 (23.53%) patients had NAFLD, and 117 (76.47%) patients did not have NAFLD. From the control group, only two patients had NAFLD, and NAFLD was absent in 58 (96.67%) patients. In the control group, we found 16 (26.67%) patients with metabolic syndrome (NCEP/ATP III criteria) and 44 (73.33%) patients without metabolic syndrome (NCEP/ATP III criteria). From another perspective, describes the PCOS group, there are 68(44.44%) patients with metabolic syndrome (IDF criteria) and 85 (55.56%) patients without metabolic syndrome (IDF criteria). In the control group, we found 22 (36.67%) patients with metabolic syndrome (IDF criteria) and 38 (63.33%) patients without metabolic syndrome (IDF criteria).Conclusions:The mechanism of development of NAFLD in PCOS women is not fully known. Besides the progress in the diagnosis of NAFLD in PCOS, there is a lack of knowledge about mechanisms that lead to the development of NAFLD in PCOS. Future studies which would integrate epidemiological, clinical, and molecular investigations about NAFLD in PCOS will have a key role in the development of new diagnostic and therapeutic approaches of NAFLD in PCOS.

Prevalence of Hypomagnesaemia Among Type 2 Diabetic Patients Admitted to a Tertiary Care Hospital

Background: Magnesium (Mg) is one of the dominant intracellular cations. It catalyzes more than 300 intracellular reactions and has multiple functions in areas of energy production, intracellular calcium regulation, protein synthesis and degradation, and neurotransmitter release. To estimate the prevalence of hypomagnesaemia among patients with type 2 diabetes attending a tertiary care Hospital.Material & Methods:A cross-sectional study was carried out at the Bangladesh Institute of Research and Rehabilitation in Diabetes (BIRDEM), which treats patients with Diabetes Mellitus from all over the country. A total of 754 patients were included and analyzed in this study. All patients with type 2 diabetes who were referred to the BIRDEM during the period from the first of July 2020 to the end of June 2021 and had their serum Mg assessed were included in the study.Results:Out of 754 patients with type 2 diabetes, 150 patients (19.89%) (95% CI, 16.8%-21.4%) were hypomagnesaemic. Female gender, hypertension, statin therapy, HbA1c between 7-7.9% or ? 9% and patients with diabetes duration more than five years were independent risk factors for hypomagnesaemia. No association between hypomagnesaemia and age distribution, smoking history, neuropathy and retinopathy was found. In comparison with individuals enrolled in the National Vitamin D study, diabetic patients in this study had a much higher prevalence of hypomagnesaemia (19% vs. 0.7%) with odd’s ratio of 32 (95% CI, 21-48.2).Conclusions:The present study has shown that an apparently-healthy elderly population may have a magnesium deficiency that may need to be identified and treated for optimizing clinical care. Further multicentric studies with a greater sample size should be done in this field, which will benefit the elderly population.

Prevalence of Depression Among Newly Detected Hypothyroid Patients Attending a Tertiary Care Hospital in Bangladesh

Background: Hypothyroidism is the most prevalent endocrine disorder worldwide. In patients with endocrine diseases, a high prevalence of mood disorders in general and particularly major depression (MD) has been commonly found, especially in thyroid diseases. Aim of the study: A descriptive, cross-sectional study was conducted from January 2021 to December to estimate the prevalence of depression among hypothyroid patients in Satkhira Medical College hospital a tertiary care hospital in Satkhira, Bangladesh. A total of 115 patients were included and analyzed in this study.Material & Methods:A cross-sectional study was conducted to estimate the prevalence of depression among hypothyroid patients in a tertiary care hospital in Bangladesh. Patients were screened for depression using the Patient Health Questionnaire-9 screening tool, obtaining their sociodemographic data, details of their thyroid function status, and other risk factors for depression. Also, used patient medical files were to get the laboratory results. Data were analyzed using the Statistical Package for the Social Science (SPSS) version 23. Continuous data were displayed using mean and standard deviation; categorical data were expressed in numbers and percentages. The Chi-square test was used to assess the relationship between the variables. A P value of less than 0.05 was considered statistically significant.Results:This is a descriptive cross-sectional study; 115 patients were enrolled and analyzed in this study. The mean age was 42.05 ± 11.49 years, ranging from a minimum of 23 years to a maximum of 72 years. The majority of patients were females (94.78% of patients were female and 83.9% of patients were male, respectively). Two-thirds of patients were married, 76(66.09%) and 64(55.65%) carried bachelor’s or diploma degrees, and only 8(6.96) % were illiterate. More than three quarters, 81(70.43%), were non-working [Table1]. Met a higher percentage of depressed patients among those who experienced stressful life events, with no statistically significant association [Table5].Conclusion: Depression was prevalent among hypothyroid patients, and screening for depression among hypothyroid patients is recommended.

Outcome of open reduction and internal fixation in lateral condyle humeral fractures in pediatrics

Background: Lateral condyle fractures of the distal humerus are the second most common fractures at the elbow in the paediatric population usually between the ages of 6-10 years old making up 5-20% of fractures in children. The aim of the present study was to assess the early results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation. Methods: Our clinical trial was conducted involving 12 patients treated with open reduction and internal fixation (ORIF). Preoperative stage included clinical evaluation, routine investigations and radiological evaluation. Fractures were classified using the Milch. Patients were followed up weekly until radiological union of the fracture was evident. Results: 83.3% of our patients were males, while 16.7% were females. According to mechanism of injury, falling down continues to play a major role in causing disability. At (3-5) weeks all cases were with soft callus remove K wire; at 8 weeks, all cases were with union fracture; but at 12 weeks, one case (8.3%) was with mild stiffness and the rest was with full range of motion. As regards the carrying angle in our study, only 16.7% were with abnormal carrying angle. 33.3% were complicated; one case with mild limitation of motion and valgus; one case with varus and two cases with superficial infection. Conclusions: The open reduction and internal fixation of lateral humeral condyle fracture is the ideal treatment and it has a rate of complications

Burden of Aeromonas Hydrophila Associated Diarrhea among Children Younger than 2 Years in Rural Egyptian Community

Introduction: Between 2004 and 2007; a birth cohort of Egyptian children was analysed to evaluate the epidemiology of enteric diseases. Methodology: A stool sample was collected from the study children every two weeks as well as whenever they experienced diarrhea. Samples were tested for routine bacterial pathogens as well as enteropathogenic viruses and parasites. A secondary goal of the study was to evaluate the burden of less commonly reported pathogens including Aeromonas hydrophila. Results: Of the 348 study subjects; 79 had A. hydrophila isolated from their stool at some point during the study. Thirty-six children had exclusively symptomatic (S) infections while 33 had exclusively asymptomatic (AS) infections. However; 10 children had both S and AS infections. Among symptomatic cases; A. hydrophila was the sole pathogen isolated 36of the time. An important aspect of A. hydrophila associated diarrhea was the high level of resistance to cephalosporins. Conclusion: Although relatively uncommon; A. hydrophila was found to be associated with diarrhea among children living in Egypt and was frequently multi-drug resistant

Pulmonary veins potential recording in paroxysmal, persistent atrial fibrillation: prevalence and technical aspects

The focal theory of atrial fibrillation [AF] has tempted the electrophysiologists to try radically curing AF via radiofrequency [RF] ablation. Interventional ablation depended on localizing and precisely recording pulmonary vein potentials [PVPs] from the origins of the 4 pulmonary veins [PVs] and less commonly from the ostia of the superior vena cava [SVC], and coronary sinus [CS]. The present study is intended to assess the prevalence and feasibility of recording PVPs in patients [pts] with paroxysmal and persistent AF. The study included 27 pts, [14M, 13F] of variable age groups [27-62 yrs], mean age 39.3 +/- 10 and highlysymptomatic paroxysmal and/or persistent AF. refractory to more than two antianhythmic drugs. all had normal thyroid functions. All pts were subjected to left atrial mapping after a trans-septal puncture and introduction of 2 catheters, one via an 8F femoral sheeth [the Lasso catheter] a special circumferential pulmonary vein catheter for recording, and the other was the ablation catheter. Pulmonary venography preceded the PV-mapping to localize the site and to delineate the size of PV and hence the diameter of the lasso catheter that will be used. A coronary sinus hexapolar catheter was placed distally in the coronary sinus. PV potentials were mapped in both sinus rhythm [for Rt. PVs] and with distal coronary sinus or left atrial appendicular [LAA] pacing [for left PVs]. An arrhythmogenic PV was defined on the basis of documented ectopy [single or multiple] with or without conduction to the LA. PV potentials can be described as sharp electrical activity superimposed on atrial activity, that can be separated by LAA pacing in the Left sided veins. or recorded without pacing from Rt sided veins. One hundred and four out of 108 PVs were mapped. Pulmonary venous potentials could be recorded in 25 out of 27 left superior PVs [92.6%], 21 out of 26 left inferior PV [80.8%], 20 out of 25-" right superior PVs [80%] and in 19 out of 26 right inferior PVs [73%]. Pts were arbitrarily divided according to age into 2 age groups; 14 below 40 and 13 above the age 40y. Compared to the younger age oup, those above 40 yrs. exhibited significant lower prevalence of PVP [3.6 +/- 0.6 Vs 2.6 +/- 1.3 respectively]. proximal CS and the former was superceded by pacing from LAA. PVPs cou1dnt be recorded in 2 out of 27 LSPVs, 5 out of 26 LIPVs, 5 out of 25 RSPVs. 7 out of 26 RIPVs, Four PVs were not mapped due to technical problems. Three cases were complicated with cardiac tamponade the first due to puncture of the LA appendage with the transieptal needle, the case due to extensive ablation and the 3 due to over anticoagulation. Two ps [7.4%] developed mild pericardial effusion that was asymptomatic and disappeared during follow-up and one developed TIA. No mortality was recorded. Pulmonary vein potential recording is an essential prerequiste for successful RE ablation of focal AF using Lasso technique. Our data point to the feasibility anti safety of recording in non rheumatic cases and stress the importance of the learning curve. Left superior, Left inferior, Rt superior, Rt inferior pulmonary veins in that order of frequency are arrhytbmogenic foci generating PV potentials. Left sided and superior PVs are more frequently a source of PVPs representing triggers that initiate AF than right sided and inferior PVs. The prevalence of PVPs recording progressively declines with aging possibly pointing to the increasing role of micro reentry in the genesis of AF and the diminishing of PV triggers. Identification of PVPs is highly important and could be easily detected without pacing in case of Rt sided PVs and with CS or LAA pacing for left sided PVs. Pacing from distal CS was noted to promote better separation of PVPs from the atrial activity than pacing from proximal CS and the former was superceded by pacing from LAA

Facilitated percutaneous coronary interventrion: a new treatment strategy for acute myocardial infarction

Restoring patency of infarct related artery [IRA] is the ultimate goal which can be achieved either pharmacologically [using thrombolytic therapy] or mechanically [through percutaneous coronary intervention [PCI]. The latter needs a sophisticated setup, an equipped Cath. Lab. and a skilled team. Such a system might not be always available, and a full dose thrombolytic therapy is the next best alternative. Recently there is a trend towards "facilitated PCI" whereby low dose thrombolytic and/or antiplatelet therapies are used prior to primary PCI, aiming at an early, complete, and sustained epicardial flow and myocardial perfusion. To compare the efficacy and safety of facilitated PCI with standard primary PCI, we studied 40 pts with acute myocardial infarction [AMI] divided into 2 groups. A study group consisted of 20 pts [18M, 2F, mean age 46.3 +/- 11.5y], all received 750.000 u of streptokinase combined with GP IIb/IIIa receptor inhibitor "tirofiban" 0.4ug/kg/min over 30min followed by 0.1ug/kg/min over 48 hours. Twenty pts [15M, 5F, mean age 54 +/- 8.6y] served as control group [no thrombolytic nor antiplatelet therapy]. Both groups underwent PCI within [73 +/- 18min] from randomization. Angiographic patency was expressed in terms of TIMI flow grading system, ECG criteria comprised extent and rapidity of ST segment resolution and laboratory criteria involved early peaking of CK-MB within 12 hours from randomization. Besides clinical evaluation in terms of major adverse cardiac events [MACE], echocardiographic parameters [LVEDD and LVEF] were used to assess LV function before and after PCI and monthly thereafter for 6 months. Compared to the group subjected to PCI alone, those who had preceding adjunctive pharmacological therapy "facilitated PCI" exhibited significantly greater TIMI 3 flow [84%: vs 60%, p<0.05], smaller LVEDD [5.0 vs 5.5, p<0.05], significantly higher LVEF [55.4% vs 50.7%, p<0.05] and lower rate of MACE [0% vs 20%]. Patients with facilitated PCI also exhibited significantly higher ST segment resolution, [58% vs 45%, p<0.05] and earlier peaking of CK-MB [85% vs 35%] compared to control group. Facilitated PCI offers an excellent way of circumventing the time delay preceding PCI that is frequently encountered on hospital admission of pts with acute MI. Through combining interventional, fibrinolytic and GP IIb/IIIa inhibitor therapy, facilitated PCI provides a more rapid, complete and sustained patency of IRA than primary PCI alone without the adverse effects of full dose thrombolylic therapy and a with better outcome in terms of lesser MACE and preserved LV function

ACE gene polymorphism: a predictor of instent restenosis

Restenosis is the maladaptive response of the coronary artery to Restenosis occurs in 20-50% of patients [Pts] after balloon angioplasty and in 10-30% of patients receiving a stent. Neointimal proliferation is one distinct processes involved and the rennin-angiotensin system has been implicated in its pathogenesis. The level of plasma has been implicated in its pathogenesis. The level of plasma ACE is party under genetic control and the plasma and cellular levels pf ACE are associated with the insertion/deletion [I/D] polymorphism in the ACE gene where DD genotype bearers have higher levels of ACE than either ID or II genotype bearers. Aim: To assess the possible role of ACE gene polymorphism in the pathogenesis of instent restenosis [ISR]. We studies 136 patients having elective or emergency successful angioplasty and of a previously untreated native single coronary artery, including 117 males and 19 females, with a mean age of 52.5 +/- 9.8 years. Besides clinical evaluation, all pts were subjected to routine laboratory measurements, followed by DNA extraction for a peripheral venous sample using the QUIAmp Blood Kit. ACE gene was amplified by PCR-technique [30cycles], then were electrophoresed in agars gel and visualized directly with ethidium bromide staining under an ultraviolet light source to determine the ACE I/D genotypes. Clinical follow-up was performed on monthly basis up to six months for the occurrence of major adverse cardiac events. Angiographic follow-up was done in 93 patients at a mean of 6.17 +/- 2.3 months after PCI using edge detection and segment analysis by the Xcelera catch Philips Intruris QCA program to detect the minimal lumen diameter, reference vessel diameter and segment length before and after PCI and after 6 months follow up in the same views at baseline, to detect acute gain, late lumen loss and binary restenosis rate. ISR was expressed as >/= 50% diameter loss. Out of 136 pts, 93 were available for angiographic follow- up. Those were divided into two groups: 41 pts with angiographic evidence of restenosis [ISR], and 52pts without angiographic evidence of restenosis [NO-ISR]. The homozygous DD genotype was significantly more frequent in the ISR group compared to the NO-ISR group [51.2% vs 11.5%, p=0.005]. The heterozygous ID genotype was significantly more frequent in the NO-ISR group compared to the ISR group [76.9% vs 39%, p=0.005]. The homozygous II genotype was equal in both group [11.5% in ISR vs 9.8% in No ISR, p=0.79]. Compared to the heterozygous ID and the homozygous II, genotypes the homozygous DD genotype, of the ACE gene was more significantly associated with in-stent restenosis. This knowledge may help in the selection of subgroups of patients who will benefit form alternative therapeutic strategies such as CABG surgery or intensive preventive treatment or drug-eluting stent

Primary versus delayed PCI after acute MI: effect on ventricular remodeling and function

It has been well established that early restoration of patency of IRA by percutaneous coronary intervention [PCI] with recent myocardial infarction [MI] may preserve left ventricular [LV] global function and also prevent LV remodeling. There were controversies however concerning the possible benefits of delayed [within 30 days] restoration of patency of infarct-related artery of patients. To evaluate and compare the results of primary versus delayed PCI in patients with acute MI. Forty patients [35 males, 5 females mean age 50.9] were included in the study with first anterior MI, and were divided into 2 groups. Group A[20 pst] who had the chance of undergoing primary PCI within a mean 5.4 hrs from the onset of chest pain with a door to balloon time 1.6 hrs and group B[20pts] with delayed hospitization [i.e>12 hours] who nether received thrombolytic nor primary PCI, but were scheduled for routine PCI with a mean of 20.7 days. The LV function and dimensions were assessed by serial echocardiographic readings measuring LV end diastolic volume [LVEDV], LV end systolic volume [LVESV], ejection fraction [EF], regional wall motion scoring index [RWMI] at 24hrs of admission and after 3 and six months. At 3 months compared to delayed PCI group, group showed significant improvement in RWMI [from 1.9 +/- 0.3 to 1.27 +/- 0.13 in group A vs 1.6 +/- 0.2 to 1.38 0.18 in group B, p value 0.032]. There was a non significant increase in LVEDV values in the two groups, [from 101 +/- 17.6 to 109 +/- 20.1 in group A vs 98.3 +/- 22.3 to 106.3 +/- 22.1 in group B, p 0.062]. The change in EF values was nearly the same in both groups; [59.6% +/- 3.9 at base line to 58.5% +/- .5 in group A vs 57.1%9.3 to 55.2% +/- 6.4 in group B]. At six month, there was no more improvement in the RWMI in both groups but the group B showed marked increase in LVEDV [from 98.3 +/- 22.3 at base line to 138 +/- 32.96, i.e. 28.9% increase versus 15% increase in the group A [from 101 +/- 17.6 at base line to 115 +/- 32.14, p=0.041]. Where the EF% value was nearly preserved in group A [59.6% +/- 3.9 at base line to 59.9% +/- 6.81], there was remarkable deterioration in the EF% in the delayed group [from 57.1 +/- 9.3 at base line to 51.8 +/- 10.8, p 0.008] after six month. Despite the enthusiasm to the concept of restoring patency of infarct related artery irrespective of time, our data showed that early and immediate revascularization [primary PCI] is superior to delayed intervention. Therefore prompt restoration of patency is highly recommended for myocardial salvage and preserving LV function

effects of different levels of auto-PEEP on hemodynamics in mechanically ventilated patients, correlation with lung mechanics and gas exchange in different ventilator settings

The goal of this study was to detect auto-PEEP in mechanically ventilated patients and monitor how its different levels may affect the patients hemodynamics, lung mechanics and gas exchange and trial of estimating an optimal PEEP level. Another goal was to monitor how the addition of external PEEP may affect the patient hemodynamics, lung mechanics and gas exchange and trial of estimating an optimal PEEP level. This study included 18 mechanically ventilated patients who were classified into three groups: COPD group [10 patients], restrictive group [4 patients] and normal group [4 patients]. Besides the routine clinical examination, ECG, chest X-ray, laboratory investigation and ABG, each individual patient was subjected to serial monitoring of hemodynamic parameters [SV, PCWP, LVSW, RVSW, PVR], lung mechanics parameters [auto-PEEP, external PEEP, total PEEP, P pressure, P mean, P total, Raw, C stat]. This is done for base line readings and after every change in ventilatory settings according to the study on different levels of auto-PEEP and on different levels of external PEEP. The results showed that auto-PEEP was detected in 13 out of 18 patients included in the study [72%] with mean of 6.8 cm H2O SD 5. On application of external PEEP, auto-PEEP had a significantly negative correlation with external PEEP in all groups

Paclitaxel-carboplation in advanced ovarian cancer

This study included 85 female patients with advanced ovarian epithelial cancer. Fifty patients were subjected to primary optimal debulking surgery, followed by adjuvant combination chemotherapy either cisplatin-cyclophosphamide or paclitaxel-carboplatin with comparable treatment outcome. The other 35 cases were not amenable to optimal surgery. They received primary chemotherapy, either cisplatin-cyclophosphamide or paclitaxel-carboplatin. The overall median duration of response and survival in this subgroup was 12 and 28 months, respectively, which was significantly lower than in those subjected to primary optimal debulking surgery [22 and 35 months, respectively]. However, in the subgroup of patients who received primary chemotherapy [paclitaxel-carboplatin], the median duration of response and survival was significantly higher than those received cisplatin-cyclophosphamide and comparable with those patients subjected to primary debulking surgery and adjuvant chemotherapy. Also, the treatment related toxicity was significantly higher among the patients receiving cisplatin-cyclophosphamide

Activity of single agent oxaliplatin in recurrent ovarian cancer, previously treated with cisplatin or carboplatin

This study included 28 females with recurrent ovarian cancer previously treated with combination chemotherapy including cisplatin or carboplatin. The platinum free interval was >6 - <12 months in 11 patients and >12 months in 17 patients. Oxaliplatin was prescribed in a dose of 130 mg/m2 administered over 2 hours every 21 days with an average of 5 cycles/patient. An overall response was achieved in ten patients with a median time to tumor progression and overall survival of 11 and 17 months, respectively. A favorable response was observed in the platinum sensitive group [platinum free interval of >12 months] as well as those cases with non-bulky recurrent disease. Oxaliplatin administration was associated with an accepted level of drug related toxicity

Effect of noninvasive ventilation in chronic obstructive pulmonary disease: hospital outcome

In patients with acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation may he used in an attempt to avoid endotracheal intubation and complications associated with mechanical ventilation. We conducted a prospective, randomized study comparing noninvasive ventilation delivered through a facemask with standard treatment in patients admitted to ICU. A total of 23 patients were recruited from a large group of 63 patients with chronic obstructive pulmonary disease admitted to critical care department. A total of 12 patients were randomly assigned to noninvasive ventilation [group I] and II to standard treatment [group II]. The two groups had similar demographic characteristics with mean age 51.8 +/- 10 vs. 58.7 +/- 8.4, p=0.082 and weight 74.8 +/- 13.8 vs. 74.9 +/- 89, p=0.97 and clinical characteristics on admission to the hospital. The use of noninvasive ventilation reduced the need of endotracheal intubation [which was dictated by objective criteria]: 5 of 12 [41.7%] in noninvasive ventilation group were intubated, as compared with 9 of 11[81.8%] [p=0.0487] in standard treatment group. The mean [ +/- SD] treatment duration and hospital stay for patients receiving noninvasive ventilation was significantly shorter than that for patients receiving standard treatment [2.2 +/- 1.2 and 8.8 +/- 9.9 vs. 7.9 +/- 5.2 and 16.2 +/- 5.9, p=0.001 and p=0.004 respectively]. The in-hospital mortality rate was also reduced with noninvasive ventilation I of 12 [8.3%] vs 3 of 11[27.3%], however, did not reach statistical significance [p=0.23 13]. In selected cases with acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, the length of the hospital stay and the in-hospital mortality rate

Effect of noninvasive ventilation on pulmonary gas exchange in chronic obstructive pulmonary disease

In patients with acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation may be used in an attempt to avoid endotracheal intubation and complications, associated with mechanical ventilation. We conducted a prospective, randomized study comparing noninvasive ventilation delivered through a face mask with standard treatment in patients admitted to ICU. A total of 23 patients were recruited from a large group of 63 patients with chronic obstructive pulmonary disease admitted to Critical Care Department. A total of 12 patients were randomly assigned to noninvasive ventilation [group I] and 11 to standard treatment [group 11]. The two groups had similar demographic characteristics with [mean age 51, 8 +/- 10 vs. 58.7 +/- 8.4, p=0.082 and weight 74.8 +/- 13.8 vs. 74.9 +/- 8.9, p 0.97] and clinical characteristics on admission to the hospital. The use of noninvasive ventilation significantly improved some of the final arterial blood gases and oxygenation parameters in successful cases. In selected cases with acute exacerbation of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation and can improve the hypoventilation associated with the disease

Prognostic markers after exacerbated chronic obstructive pulmonary disease. A new computerized multivariate algorithm

This study aimed to verify whether baseline clinical and laboratory parameters could predict the outcome for patients hospitalized due to acutely exacerbated COPD. To define the clinical and laboratory variables predictive of early mortality in patients with COPD, 50 consecutive admissions were studied, including 34 males and 16 female, with a mean age of 56 + 11 years. In all patients, demographic data, admission hemodynamics and arterial blood gases, mechanical ventilation, worst expressed as P02 <50 mun Hg PC02 /<30 or >/55 mum Hg and evident shunt P02/F102 /<200 were measured. The system for prognostication in patients with exacerbated COPD was based on a multivariate approach with staged trials using demographic data, admission hemodynamics and arterial blood gases. The study concluded that to allow prognostication in patients with COPD, a reasonable objective system was suggested for assessment, with a predictive accuracy reaching 96%. This system is characterized by being user-friendly, comprehensive and highly predictive

Myocardial infarction. correlation with ventricular arrhythmia and left ventricular function

Great effort has been expended on attempts to predict ventricular arrhythmia and left ventricular function; a two major source of mortality in AMI. QT dispersion have been demonstrated to reflect regional inhomogenicity of ventricular repolarization, which is considered a fundamental factor for initiation of ventricular arrhythmia. Prospective study of 27 consecutive patients admitted to CCU with AMI indicated for streptokinase [SK] [21 M/ 6 F, mean age: 50ys] compared with control group of 15 consecutive patient contraindicated for SK [11 M/ 4F, mean age 50 ys] treated by nitroglycerin [NG]. Both groups were matched for age, and site of MI. For both study and control group 12 lead ECG was done on admission, post thrombolytic and at discharge. SAECG, Heart Rate Variability [HRV], 24 hour Holter monitoring and Doppler echocardiography were done only at discharge. QTc calculated as QT int [sec] square root [RR [sec]] QT dispersion [QTd] calculated from 12 lead ECG as difference between maximum QT interval minus minimum QT interval. QTc was not different in both groups on admission and on discharge [0.41 +/- 0.08 vs 0.39 +/- 0.04 in gpI; 0.47 +/- 0.05 vs 0.45 +/- 0.05 in gp. II]. QTd was high in all AMI patient on admission. However, only the thrombolytic therapy caused significant reduction of QTd which was maintained until discharge. SK: Admission: 103 +/- 26.7- Post therapy: 46.6 +/- 18.3- Before discharge 40 +/- 11- P value: 0.0001. NG Admission: 118 + 27.7- Post therapy: 0- Before discharge: 121 +/- 31.5- P value: 0.334. [There is significant difference in both groups as regard EDD in echocardiography where group II had more dilated end diastole than group I.] In 24 hour Holter monitoring, there was significant higher incidence of ischemic ST depression in NG gp than SK gp. [92.3% vs 3.7%, P value: 0.0001]. But there was no significant difference between the two group in SAECG and HRV indices. The SK group with improved QT dispersion showed significantly lower incidence of tachyarrhymia [none vs 66%] lower mortality [non vs 13%] and less LV dilatation [3.7% vs 33.3%]. QTd not QTc serve as a good discrimenant between complicated and non complicated MI. Persistent high QTd could predict more arrhythmia and left ventricular failure. SK therapy not NG is the treatment of choice in AMI for correction of QTd

Metabolic profile of critically ill patients

The study was conducted on 31 mechanically ventilated critically ill patients: 11 patients with congestive heart failure [CHF], ten patients with acute respiratory failure, ten patients with sepsis or septic shock, ten volunteers taken as controls. Within one hour of admission, the sedated individuals were subjected to gas mixing chamber indirect calorimetry and the average of 60 readings over one hour was determined. Metabolic profile did not have a consistent pattern in critically ill patients compared with the healthy subjects. However, when divided into various subsets, oxygen consumption was significantly higher in patients with congestive heart failure class III and IV according to NYHA compared with the healthy subjects

use of "vinorelbine" in the Treatment of advanced non-small Cell lung cancer

This study included 19 patients suffering from advanced non-small cell lung cancer [NSCLC]. They were treated either with Vinorelbine-Cisplatinum; or Vinorelbine as a single agent for elderly patients, or those with poor performance status, or with renal impairment [9 cases]. Objective partial response was achieved in 5 cases [26%] with median duration of response for 25 weeks for the whole study group. The response was comparable in both treatment arms; with better tolerance in patients receiving Vinorelbine alone. This study demonstrates the efficiency of Vinorelbine in the treatment of advanced NSCLC either in combination with Cisplatinum, or as a single agent in elderly frail patients

Efficacy of IV propafenone in the management of atrial fibrillation after open heart surgery

The aim of this study was to evaluate the efficacy and safety of propafenone in patients with AF after OHS. Twenty patients who underwent OHS [CABG two patients and valve replacement 18 patients] and had AF in the first 48 hours of the study [heart rate >110 b/min., FS >/25%, with fair liver, renal and respiratory functions] received i.v. Propafenone 2 mg/kg. Another group of the patients received placebo as a control. Patients had continuous electrocardiographic, BP and CVP monitoring 0, 15, 30 and 60 minutes from beginning of the infusion. Ten patients reverted to sinus rhythm [all were in sinus rhythm preoperatively] with a mean time of 24 +/- 11 minutes. These patients had significant decrease in CVP. Ten patients did not revert but showed significant decrease in HR [146 +/- 17 b/min. To 104 +/- 17 b/min.] and CVP did not change. No side effects of propafenone were recorded. Control group showed no reversion in sinus rhythm with no change in HR or CVP. It is concluded that i.v. Propafenone is a valuable drug for treatment of AF post OHS. It reverts patients to sinus rhythm and even when ineffective it significantly slowed the heart rate with no detrimental hemodynamic effects