Assessment of the role of speckle tracking echocardiography in targeting the left ventricular lead position in patients undergoing cardiac resynchronization therapy

Background: Cardiac Resynchronization Therapy [CRT] is now a well-established treatment for patients with advanced heart failure through biventricular pacing. Optimizing the left ventricular [LV] lead position via echocardiographic speckle tracking guidance could reduce the rate of non-responders to CRT

Objectives: to assess the role of speckle tracking echocardiography in determining the proper position of the left ventricular lead in patients undergoing CRT

Methods: the study population comprised 50 patients who were indicated for CRT according to the ESC 2012 guidelines. Speckle tracking echocardiography was done to all patients before CRT implantation or shortly after implantation while switching off pacing to determine the latest activated myocardial wall of the LV. The patients were classified after CRT implantation into two groups; the first group [group A] included 20 patients and represented those with concordance between the most mechanically delayed myocardial wall derived from speckle tracking echocardiography and the coronary sinus lead position, and the second group [group B] included 30 patients that showed discordance between them. Both groups were recruited for follow-up after a period of 6 months to assess clinical response, echocardiographic response and mortality

Results: Significant correlation was observed between echocardiographic response and the LV lead concordance [p value=0.041], and between combined clinical and echocardiographic response and LV lead concordance. There was a nearly significant difference between clinical response and the LV lead concordance [p value=0.057], and there was a trend towards less mortality in the group with concordant LV lead [10.5% in the concordant group versus 24.1% in the discordant group] with no statistical significance [p value=0.286]

Conclusions: we demonstrated an increased benefit with an echocardiographically optimized LV lead position targeting the most delayed myocardial wall by 2D speckle tracking echocardiography

Association of ano-rectal inflammatory bowel diseases with cases of fistula-in-ano-[a cross sectional hospital based study] at Al Thora Hospital, Al Beida

Incidence of Inflammatory bowel diseases at Libya is 0.9 to 3.6 / 100 000 population as per 2006 study. And extrapolated prevalence of Inflammatory bowel diseases at Libya is 11, 263 / 5.631.585 [1] Inflammatory bowel disease mainly constitute Crohn's disease, Ulcerative colitis, Intermediate colitis, and pouchitis. Perianal pathological problems are fairly frequent manifestation of Inflammatory bowel diseases. A study has been carried out at Al Thora Hospital, Al Beida, in last 5 years, from Jan 2005 to Dec 2009; about the association of ano-rectal Inflammatory bowel diseases with cases of fistula-in-ano

Bronchial asthma in females and its relation to the menstrual period

To confirm the relationship between bronchial asthma and the menstrual period, 20 asthmatic and 10 healthy females were included in this study. Measurment of serum progesterone levels was made two times for each subject one week before [Luteal phase] and one week after [follicular phase] a regular menstrual period, respiratory function tests [EEV[1], FEV[1] / FVC% and PEFR] were measured two times for each subject one week after [follicular phase] and on the first day [late luteal] of the menstrual period. Results obtained showed that serum progesterone levels were significantly lower in asthmatic than that in normal females in both the follicular and luteal phases. Values for respiratory function tests [EEV[1], FEV[1] / FVC% and PEFR] all showed a significant reduction on the first day than that obtained 7 days after the menstrual period, and the reduction was significantly higher in asthmatic than in normal females