Impacto da avaliação nutricional precoce e intervenção em pacientes com cirrose hepática / Evaluating the impact of early nutritional assessment and intervention in hospitalized liver cirrhosis patients

ABSTRACT Background Malnutrition is common in liver cirrhosis patients that is correlated with early complications, morbidity and mortality. Objective The purpose of the study was to assess nutritional status, impact of nutritional screening and intervention in liver cirrhosis patients by evaluating their actual energy and protein intake during hospital stay. Methods A cross sectional study was conducted wherein all patients' nutritional status was defined by Subjective Global Assessment tool. Adequate energy and protein supply were planned and executed by using individualized nutritional plan for patients with dietitian's collaboration. Anthropometric measurements included height, weight, body mass index, mid upper arm circumference, hand grip strength and triceps skin-fold thickness. Biochemical tests included haemoglobin, mean corpuscular haemoglobin, volume and concentration, albumin and liver function tests. To record the daily food intake, a 24-hour dietary recall was used. Results Overall 83 patients (mean age 55) were included, among them 46% of patients were moderately malnourished, 12% were normal, while 42% of cirrhotic patients were severely depleted according to Subjective Global Assessment. The mean intake of calories and protein was improved during stay in hospital after nutritional intervention and critical monitoring (P<0.05). Anthropometric measurements at baseline and discharge showed significant differences (P <0.05) in weight, body mass index, triceps skin fold thickness and mid upper arm circumference values, but not in hand grip strength that was associated with malnourishment among patients. Conclusion Providing individualized nutritional intervention and its monitoring by qualified dietitians during hospital stay helps to improve intake in patients that prevent further risk of malnutrition and related complications.

RESUMO Contexto A desnutrição é comum em pacientes com cirrose hepática e está correlacionada com complicações precoces, morbidade e mortalidade. Objetivo O objetivo do estudo foi avaliar o estado nutricional, o impacto da triagem nutricional e a intervenção em pacientes com cirrose hepática, avaliando sua ingestão real de energia e proteína durante a internação hospitalar. Métodos Foi realizado um estudo transversal em que o estado nutricional de todos os pacientes foi definido pela ferramenta de Avaliação Global Subjetiva. O fornecimento adequado de energia e proteína foi planejado e executado por meio de plano nutricional individualizado para pacientes com colaboração de nutricionista. As medidas antropométricas incluíram: altura, peso, índice de massa corporal, circunferência do braço médio, força de aderência da mão e espessura da dobra da pele tríceps. Os testes bioquímicos incluíram: hemoglobina, volume e concentração da hemoglobina corpuscular média, albumina e testes de função hepática. Para registrar a ingestão diária de alimentos, foi utilizado um recall dietético de 24 horas. Resultados Ao todo foram incluídos 83 pacientes (média de 55 anos), entre eles 46% dos pacientes estavam moderadamente desnutridos, 12% estavam normais, enquanto 42% dos pacientes cirróticos estavam severamente depletados de acordo com a Avaliação Global Subjetiva. A ingestão média de calorias e proteínas foi melhorada durante a internação hospitalar após intervenção nutricional e monitoramento crítico (P<0,05). As medidas antropométricas na linha de base e descarga apresentaram diferenças significativas (P< 0,05) em peso, índice de massa corporal, espessura da dobra da pele do tríceps e valores médios de circunferência do braço, mas não na força de aderência da mão que estava associada à desnutrição entre os pacientes. Conclusão Proporcionar intervenção nutricional individualizada e seu acompanhamento por nutricionistas qualificados durante a internação hospitalar ajuda a melhorar a ingestão em pacientes que previnem maior risco de desnutrição e complicações relacionadas.

Antibiotic resistance pattern shown by various pathogens, causing infections in neonates

This study was schemed to comprehend the latest kaleidoscopic trends of bacterial resistance in neonatal pathogens against all those antibiotics commonly employed as empirical therapy in neonates. The methodological approach included; isolation and subsequent identification of those pathogens having caused bacterial infections in neonates, application of antibiotic sensitivity testing and finally construing the conclusion depicting patterns of antibiotic resistance by various pathogens, isolated from neonatal biological samples. Antibiotic resistance patterns was evident in gram-positive as well as in gram-negative bacteria in all the eight species identified in this study. Even antibiotic drugs which are being commonly relied upon for treating multi-resistant bacterial infections, found to be in effective against many newly emerged resistant bacteria, when used alone. Resistance Antibiotics drugs against which most prominent resistance pattern emerged include; Amikacin sulphate, Linezolid, Piperacillin / Tazobactam, Amoxicillin / Clavulanic acid, Vencomycin, Cefoperazone / Sulbactam, Ceftriaxone sodium, Ciprofloxacin, Cefixime trihydrate and Imipenem. The inferred upshot suggests that antibiotic resistance is emerging fast and ever-changing phenomenon of antibiotic resistance has significantly reduced the therapeutic space to maneuver, particularly, in treating neonatal infections

Allgrove syndrome: adrenal insufficiency with hypertensive encephalopathy

Allgrove syndrome or triple-A syndrome is a rare familial multisystem autosomal recessive disorder. It is characterised by triad of alacrima, achalasia and adrenal insufficiency due to adrenocorticotropin hormone [ACTH] resistance. If it is associated with autonomic dysfunction, it is termed as 4-A syndrome. This syndrome is caused by a mutation in the Achalasia - Addisonism - Alacrima [AAAS] gene on chromosome 12q13 encoding the nuclear pore protein ALADIN. A 5-year boy presented with history of fits and altered sensorium for one day. He also had increased pigmentation of body and persistent vomiting since six months of age. Laboratory investigations and imaging revealed alacrimia, achalasia and adrenal insufficiency due to ACTH resistance. He had episodes of hypertensive crises, for which he was thoroughly investigated and it was found to be due to autonomic instability. Based on clinical findings and investigations he was diagnosed as case of Allgrove syndrome or 4-A syndrome with autonomic dysfunction

Therapeutic intervention and molecular characterizations of bacteriocin producing Lysinibacillus sp., nov., isolated from food sample

Many bacteriocins from Lactobacilli have been reported as immunostimulatory, preservatives, anticancerous and biocontroling. However, antimicrobial potential of Lysinibacillus is not much reported. In this study, an attempt was made to isolate and anticipate therapeutic potential of Lysinibacillus from spoiled food sample. We screened 125 Lactobacilli for their antagonistic nature against food borne and disease causing bacterial and fungal pathogens. Among them, one Bacillus was phenotypically, and 16S rRNA based, molecularly identified as Lysinibacillus species given with accession numbers JX416855 in NCBI. The type strain JX416855 has shown the 99% identity with the Lysinibacillus fusiformis, Lysinibacillus sphaericus and Lysinibacillus xylanilyticus. It was amylase, protease, gelatinase, nitrate reductase and urease negative and catalase positive. The growth conditions and bacteriocin activity were found optimum with MRS media at pH 7-10, Temp-35-40[degree]C and salt tolerance at 1-3% which was optimized with MRS broth at pH 7.4, 37[degree] C, 1.5% NaCl for 48 h in shaking conditions at 100 rpm. The isolate showed broad-spectrum antibacterial activity against gram positive [10-13mm] and gram-negative [20mm] bacteria. It also strongly inhibited to fungus Aspergillus, Fusarium and Trichoderma. Bacteriocin from 60% ammonium sulphate fraction strongly inhibited to gram-negative R. planticola and Pseudomonas aeruginosa, which showed three protein bands of high molecular weight [nearly 40-70kD] by SDS-PAGE analysis

Comparative study of chromium toxicity with hypertension and end stage renal failure cases

Objective: To assess the association between hypertension and chronic renal failure with lethal effects of chromium on the beginning of the Chronic Kidney disease

Study Design: A prospective cross sectional study

Place and Duration of Study: Jinnah post graduate medical centre and Kidney centre Karachi during December 2012 to December 2013

Materials and Methods: The present study was conducted on a total of 150 patients [age > 40 years] divided into three groups. Patients in Group I included 50 patients with hypertension whereas Group II included 50 patients with hypertension associated with chronic renal failure [CRF] and Group III consisted of 50 healthy controls

Results: Results showed that levels of fasting blood sugar and HbA1c in both group I and group II weresignificantly higher as compared to controls. The levels of serum urea [132.0 +/- 28.2] and creatinine [7.8 +/- 1.38] in group II patients were significantly high as compared to group I and group III patients. The Creatinine clearance [55.1 +/- 9.61] in group II patients were significantly less as compared to group I and group III patients. Serum chromium levels were significantly high in group II patients[59.6 +/- 6.73]as compared togroup I andcontrols

Conclusion: Serum chromium level has significant correlation with glycemic index in both group I and group II patients compared to controls, while correlation with renal failure was significant only in group II patients

Anti diabetic effects of cinnamon extract in albino rats with effects on the serum insulin levels

To determine the changes in the serum insulin levels in alloxan induced diabetic albino rats in comparison with oral hypoglycemic drugs. An experimental study. This study was conducted at Al Tibri Medical College Karachi during December 2012 to December 2013. The present study was conducted on 60 Albino rats which were group from A to F consisting of 10 rats in each group. These groups were further divided into two sub groups which were treated with low dose and high dose of the cinnamon and oral hypoglycemic drugs. The results showed that there is significant reduction in serum insulin level in the alloxan treated group animals which was improved in group C animals treated with low dose of cinnamon extract in alloxan induced diabetic rats. Also animals in group D and group E treated with tolbutamide and acarbose respectively showed higher increase in serum insulin level as compared with cinnamon extract treated groups, however when cinnamon extract was used in combination with tolbutamide or acarbose it showed synergetic effects. Tolbutamide and Acarbose treated groups showed better anti diabetic effect by increasing the serum insulin level in comparison with cinnamon extract treated groups when used individually. This effect was enhanced when cinnamon extract was used in combination with either tolbutamide or acarbose

Study to determine the antimicrobial sensitivity and resistance pattern of various strains against commonly prescribed antibiotics

The main objective of this study was to determine the sensitivity and resistance of various bacterial strains both gram negative and gram positive against commonly used antibiotics. Experimental / Retrospective study. This study was conducted in Hayatabad Medical Complex at Microbiology Laboratory for a period of six month studies from 6.8.2013 to 10.02.2014. The study was conducted in which both in-door and out-door patients were randomly selected for this specified period of time. Bacterial strains used were Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa and Proteus Mirabilis against commonly prescribed antibiotics i.e; Ceftraixone, Amoxicillin, Amikacin and Cefepime and to find out the sensitivity and resistance pattern. Among the selected antibiotics Ceftraixone was found to be sensitive in 84.6% of out-door patients and 75% of in-patient against Pseudomonas Aeruginosa, 71.4% of out-door patients and 68.4% of in-patients against Escherichia Coli, 52% of out-door patients and 60% in-patient against Staphylococcus Aureus and least sensitive against Proteus Mirabilis 25% out-patients and 16.7% in-patients. Amoxicillin was 40%, 6.6% and 0% sensitive in in-patients and 16%, 17.1%, 0.7% and 0% in out-patients against Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa and Proteus Mirabilis respectively. Amikacin was 44%, 35%, 33.3% and 0% sensitive in in-patients and 36%, 37.2%, 32% and 0% in out-patients against Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa and Proteus Mirabilis respectively. Cefepime was most sensitive against Proteus Mirabilis 25% in out-door patients and 16.7% in in-door patients while least sensitive against Pseudomonas Aeruginosa both in out-door and in-door patients. It is concluded from the results obtained that Ceftraixone, Amoxicillin and Amikacin were more than 60% sensitive against the selected strains of bacteria except Proteus Mirabilis while Cefepime is least sensitive i.e; less than 25% against all these antibacterial strains. These results should be considered in future prescribing of antibiotics against these bacterial strains to avoid resistance and to prescribe appropriate treatment for the patients

Clinical outcome of double valve repalcement with or without small aortic prosthesis

To determine the effect of aortic prosthesis size on clinical outcome of patients undergoing double cardiac valve replacement [DVR]. A quasi-experimental study. Cardiac Surgery Department, Punjab Institute of Cardiology, Lahore, Pakistan, from February 1996 to December 2008. One hundred and forty patients undergoing double cardiac valve replacement were divided into 2 groups. Group I, 75 [53.6%] receiving aortic prosthesis size of /= 21 mm size. All patients were prospectively followed-up for 12 years in order to study mortality and valve related complications. There were 94 males [67.1%] and 46 females [32.9%] with a mean age of 25.5 +/- 10 years. In Group I, 21 patients [28%] had aortic valve replacement [AVR] with 19 mm valve size and 54 patients [72%] had 21 mm size valves implanted. In Group II, 39 patients [60%] had AVR with 23 mm size valves implanted followed by 16 [24.6%] who received 25 mm size valves. Posterior mitral leaflet was preserved in 15 patients [20%] in Group I and 14 [21.5%] in Group II. Mortality was seen in 13 patients [9.3%]; of these 5 [3.6%] were in Group I and 8 [5.7%] were in Group II. Nine patients [6.4%] had incomplete follow-up [In Group I, 2 patients died in ICU, 2 died within 30 days of admission and one was a late death. In Group II, 1 patient died in ICU, 1 within 30 days of admission and 6 within 1 year of operation]. Double valve replacement with implantation of small aortic prosthesis has similar overall mortality as compared to patients having larger sized aortic valves

Outcome of double vs. single valve replacement for rheumatic heart disease

To compare the follow-up results of double valve replacement [DVR] i.e. mitral valve replacement [MVR] and aortic valve replacement [AVR] vs. isolated MVR or AVR for rheumatic heart disease. An interventional qausi-experimental study. Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, from September 1994 till December 2007. Prospective follow-up of 493 patients with mechanical heart valves was carried out using clinical assessment, international normalized ratio and echocardiography. Patients were divided into three groups: group I having MVR, group II having AVR and group III having DVR. Survival, time and causes of mortality, and frequency of valve thrombosis, haemorrhage and cerebrovascular haemorrhage was noted in the three groups and described as proportions. Actuarial survival was analyzed by Kaplan-Meier method. There were 493 with 287 [58.3%] in group I, 87 [17.6%] in group II and 119 [24.1%] in group III. Total follow-up was 2429.2 patient [pt]-years. Of 77 [15.6%] deaths, 19 [3.8%] were in-hospital and 58 [11.8%] were late. In-hospital mortality was highest 4 [4.6%] in group II followed by 5 [4.2%] group III and 10 [3.5%] group I. Late deaths were 39 [13.4%] in group I, 9 [10.2%] in group II and 10 [8.3%] in group III. The total actuarial survival was 84.4% with survival of 83%, 85.1%, 87.4% in groups I, II and III respectively. On follow-up valve thrombosis occurred in 12 [0.49%/pt-years] patients; 9 [0.67%/pt-years] group I, 1 [0.22%/pt-years] in group II and 2 [0.31%/pt-years] in group III. Severe haemorrhage occurred in 19 [0.78%/pt-years]; 14 in [1.04%/pt-years] in group I, 3 [0.66%/pt-years] group II and 2 [0.31%/pt-years] in group III. Cerebrovascular accidents occurred in 34 [1.3%/pt-years]; 26 [1.95%/pt-years] in group I and 4 in groups II [0.89%/pt-years] and III [0.62%/pt-years] each. In patients with rheumatic heart disease having combined mitral and aortic valve disease DVR should be performed whenever indicated as it has similar in-hospital mortality and better late survival as compared to isolated aortic or mitral valve replacement

Biatrial myxoma and atrial septal defect

Myxomas are rarely associated with congenital cardiac anomalies. We report a case of a young female presenting with symptoms of atrial myxoma but having co-existing ASD visualized on 64 slice multidetector computed tomography [MDCT] prior to cardiac surgery. Patient had a successful resection of biatrial myxoma and ASD repair. This case is unique as the myxoma originated from the inferior margin of the ASD straddling the inferior limbus. Over the years due to the left to right shunt at the ASD, the myxoma was initially prolapsing and oscillating between the two atria. As it grew larger it obliterated the ASD and got stuck in the right atrium [RA] and continued to grow giving false impression of a right atrial mass. Multi detector computed tomography is an alternative diagnostic modality to the gold standard transesophageal echo-cardiograph for detection of an ASD in the presence of atrial myxoma. Biatrial myxoma with associated atrial septal defect has optimal postoperative results

In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG

Due to advancement of non-surgical methods of coronary revascularization the patients referred for surgery have extensive and complex coronary anatomy. Patients with diffuse atheromatous coronary artery disease required coronary artery reconstruction or coronary endarterectomy [CE]. Coronary endarterectomy on beating heart needs skill and better surgical technique. Coronary endarterectomy along with coronary artery bypass grafting [CABG] done on beating heart is compared with coronary endarterectomy done by using conventional CABG technique. Seven hundred and ninety five consecutive patients underwent CABG from January 2006 to March 2007 in a prospective randomized trial at cardiac surgery department, Punjab Institute of Cardiology, Lahore; out of these 115 patients underwent coronary endarterectomy [CE] and were included in this study. Coronary artery bypass grafting was performed in 115 patients. Seventy two [62.6%] were in group A on-pump and 43 [37.39%] were in group B off-pump. Mean age in group A was 55.68 +/- 1.06 and 52.63 +/- 1.40 in group B. Sixty six male and 6 female were included in group A, 40 male and 3 female patients were in group B. In-hospital mortality among patients undergoing CABG was 5.6% in on-pump group and 2.3% in offpump group [p=0.649], the duration of post-operative mechanical ventilation in on-pump was 6.78 +/- 9.34 hours and 5 +/- 4.0 hours in off-pump group [p=0.060], 66.7% patients in on-pump and 58.1% patients in off-pump group required blood transfusions, Intra-aortic balloon pump [IABP] was required in 5.6% of the patients in on-pump group. Other factors included, smoking 26.4% in on-pump and 41.9% in offpump group [p=0.01], Intensive care unit [ICU] stay was statistically significant 4 +/- 3 in on-pump group and 4 +/- 2 in off-pump group [p=0.02], and drain in on-pump group was 455 +/- 208 ml and 540 +/- 370 ml in off-pump group [p=0.01]. Coronary endarterectomy [CE] has higher post-operative morbidity and mortality but the post-operative outcome after the procedure on either technique is comparable and CE is feasible on off-pump technique as well

Early vascular complications of intraaortic balloon counterpulsation in patients undergoing open heart surgery

The use of IABP is helpful for haemodynamic stability of patients with low cardiac output and compromised left ventricular function in patients who undergo coronary artery bypass grafting. This procedure is also associated with some vascular complications due to the insertion of IABP. The objective of this research was to study the vascular complications in patients with IABP counterpulsation. We observed the clinical outcome of these patients with special reference to post IABP complications in our research. One hundred and six consecutive patients were included in this study from August 2005 to February 2007. Mean age of patients was 58.08 +/- 1.814 years. Seventy nine patients [74.5%] were male and 29 [25.5%] were females. Out of these 106 patients, 101 were operated for CABG, one for angina due to aortic stenosis, two patients had ischemic mitral regurgitation and one patient had post infarct VSD. In 102 [96.2%] patients IABP was inserted percutaneously, one patient received transthoracic and in three patients IABP was inserted with open technique. Thirteen [12.3%] patients received IABP with sheath and 93 [87.7%] received IABP without sheath. Ten patients [9.4%] out of 106 developed vascular complications due to insertion of IABP. Seven patients [6.6%] had the major complications and 3 [2.8%] patients developed minor vascular complications. Mortality due to vascular complications in 106 patients was 8.49% with p<0.005. IABP has remarkable beneficial effects in patients with haemodynamic instability due to myocardial ischemia and low cardiac output syndrome. At the same time IABP is related to significant morbidity and mortality related to vascular complications due to its insertion which include limb ischemia, limb loss and even mortality

Mid-term results of endarterectomy in advanced coronary artery disease

To compare the angiographic results of patency of endarterectomized vessels vs non endarterectomized vessels and their associated grafts after one year of coronary artery bypass grafting. Study was conducted at the Cardiology Department, Punjab Institute of Cardiology, Jail Road, Lahore from 1st October 2004 till 30th July 2006. Consecutive patients were included in the study after undergoing coronary artery bypass grafting and coronary endarterectomy in the hospital. All the patients included in the study were followed up prospectively after 1, 3, 6, 9 and 12 months of coronary artery bypass grafting and angiographic studies were performed at the end of 1 year of follow-up. The mean age of the study population was 55.8 +/- 10.1 years. There were 64 [85.3%] males and 11 [14.7%] females. Hypertension and family history of ischemic heart disease both were present in 40 [53.3%] patients. Diabetes mellitus was present in 23 [30.7%] patients while 38 [50.6%] patients were smokers. A total of 266 grafts were applied to these 75 patients. Of these 181 grafts wee applied to non-endarterectomized vessels and 85 to endarterectomized vessels. Follow-up angiography revealed 6 [3.3%] blocked grafts in a total of 181 non endarterectomized vessels. Of the 85 endarterectomized vessels, 4 [4.7%] grafts with their parent vessels were blocked. Graft patency was not significantly different between endarterectomized and non-endarterectomized grafts [95.3% vs 96.6%] p<0.11. All patients receiving LIMA to LAD had patent grafts at the end of one year. The blocked grafts were all SVGs

Early left ventricular remodeling after aortic valve replacement

Aortic valve disease is associated with eccentric or concentric left ventricular [LV] hypertrophy and changes in the LV mass. The relationship between LV mass and function and the effect of LV remodeling after aortic valve replacement [AVR], in patients with aortic valve disease needs evaluation, that is largely unknown in our population. The aim of this study was to evaluate the effect of AVR on LV remodeling, in patients with aortic valve disease. Fifty patients with aortic valve disease were studied using transthoracic echocardiography to assess LV mass before AVR and compared with early postoperative changes in the LV dimensions and function. LV mass was studied preoperatively and before discharge in 50 consecutive patients undergoing isolated aortic valve replacement. Out of fifty patients, 47[94%] were male and 03[6%] were female. Mean age of the patients was 40.42 years. 22 [44%] had isolated aortic stenosis [AS], 16 [32%] patients had isolated aortic regurgitation [AR] and 12 [24%] patients had mixed aortic valve disease [MAVD]. 02 [4%] patients died. LV mass regression was studied in all the patients. In group A, with aortic stenosis, LV regressed to 69.88 gm [mean] with maximum of 156.88 gms and minimum of 0.00 gms [SD 43.67 gms, p value=0.001]. In group B, with aortic regurgitation, LV mass regressed to 203.96 gms [mean] with maximum 453.79 gms and minimum of 45.65 gms [SD 95.33, p value=<0.001]. In group C, with mixed aortic valve disease, postoperatively LV mass regressed to 122.94 gms [mean] with minimum 9.57 and maximum of 224.75 gms [SD 69.53, p value=0.524]. There was significant early LV mass regression after aortic valve replacement in patients with pre existing aortic valve disease. However, it was noticed that LV mass regressed in all patients except no significant changes in LV wall thickness [hypertrophy]

Informatics in medicine: Building companion website

Patients and their families are adapting to collect information from internet rather than by physically visiting the place of interest. As the demand is increasing gradually, the information availability in the form of website is becoming inevitable for all healthcare industry. This article introduces the building of a medical website in three simple steps. Medical website can focus on health professionals and patients or it can be used as e-publishing tool for advertisement of medical institutions, academics or for e-learning by telemedicine. Creating a presence on the web can be achieved in three simple steps. First, identify a website hosting-service and register your website name; second, assemble your contents and third step is to upload contents, advertise and get certified

Trans-myocardial revascularization by laser [TMRL] - mechanism of action and five-year follow-up

We report 5 years' follow up of Transmyocardial Revascularization by Laser [TMRL] in patients with Ischemic heart disease and propose a possible mechanism of action of TMRL. Many studies of TMRL on 'no-option' patients have been published reporting symptom relief and improvement in exercise duration, reduction in drugs required and hospitalization for up to one year duration. A Norwegian clinical trial has reported 43 months follow up. Mechanism of action of TMRL is still debatable. We studied 50 patients of Ischemic heart disease NYHA angina class III, IV who were symptomatic on maximum medical treatment, not suited for CABG, PTCA, i.e. 'no-option' patients and were offered TMRL. Their symptoms, exercise tolerance, medications and symptom-free survival were studied for 5 years. A left ventriculogram was performed after 5 years on consenting patients to identify any channels in the myocardium. We offered TMRL to50 patients of angina NYHA class III, IV [mean 3.44 +/- 0.50]. Their angina class improved to mean 1.88 +/- .74 at 6 months [p=0.00585], to 0.96 +/- 0.77 at 2 years [p = .150], and stayed at 2.06 +/- 0.80 at 5 years [p=0.019]. Their ETT mean value before operation was 5.036 +/- 1.54 minutes, at 2 years 6.56 +/- 1.79 minutes [p=7.83 E-18] and at 5 years 5.26 +/- 1.56 minutes [p=0.0002]. Kaplan Meier symptoms free survival rate was 83.1 percent at 6 months 77.3 percent at 2 years and 66.5 percent at 5 years. Left ventriculogram patients showed a meshwork of channels in the lased myocardium. Transmyocardial Revascularization by Laser provides improvement of 1-2 angina classes, quality of life perception as well as in effort tolerance in 'no-option' patients of Ischemic heart disease. The improvement is maintained beyond five years. Lased myocardium develops a network of new vascular channels which originate from left ventricular cavity

Trans-myocardial revascularization by laser, two-year follow-up

The objective of this study was to investigate the effects of Transmyocardial Revascularization by Laser [TMRL] in patients of ischemic heart disease. 50 patients of ischemic heart disease NYHA class III, IV who were not suitable for other methods of revascularization like CABG, PTCA ['No Option' patients] were offered TMRL. These patients were symptomatic on maximum medical treatment. 50 patients of angina NYHA class III, IV [mean 3.44 +/- 0.50] were offered TMRL. Their angina class improved to mean 1.88 +/- 0.74 at 6 month [p=0.00585] and persisted at mean 0.96 +/- 0.77 at 2 years [p =0 0.0150]. Their ETT mean value before operation was 5.036 +/- 1.54 minutes and at 2 years mean was 6.56 +/- 1.79 minutes [p=0.8318]. Kaplan Meier symptoms free survival rate was 83.1% at 6 months [14 censored] and 77.3 at 2 years [24 censored]