Prevalence of Left Ventricular Diastolic Dysfunction in Patients with Essential Hypertension.

BACKGROUND: Left Ventricular Diastolic Dysfunction is considered a critical link between hypertension and heart failure, particularly in individuals with heart failure and preserved ejection fraction. The aim of this study is to assess the prevalence and factors associated with clinical parameters of left ventricular diastolic dysfunction in patients with essential hypertension. METHODS: A hospital-based cross-sectional study was done among 68 newly diagnosed and known hypertensive patients visiting out patientdepartmentat Bir hospital. Patients who meet the inclusion criteria were chosen alternatively by referring OPD register. Patients with hypertension had undergone echocardiography to see whether left ventricular diastolic dysfunction was present and was compared to other clinical parameters like age, sex, body mass index, and dyslipidemia using the student t-test/chi-square test. RESULTS: The prevalence of left ventricular diastolic dysfunction in essential hypertensive patients was 33.8%. About 25% patients had grade 1; 7.4% and 1.5% of patients had grade 2 and grade 3 diastolic dysfunction respectively. Patients who had a duration of hypertension of more than five years were more than nine times (OR 9.14; 2.89-28.87) more likely to have Left ventricular diastolic dysfunction. Age and Body Mass Index were found statistically significant with diastolic dysfunction (P<0.05). CONCLUSIONS: Left ventricular diastolic dysfunction was found prevalent in hypertensive patients.  Age, Body mass index, Dyslipidemia and Duration of hypertension were found to be statistically significant with diastolic dysfunction  Keywords: Diastolic dysfunction; hypertension; Nepal; prevalence.

Acute coronary syndrome in an intensive care unit of a tertiary care centre: the spectrum and coronary risk factors.

INTRODUCTION: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction. Its spectrum and incidence is crucial as a part of need assessment of cardiac catheterization laboratories. METHODS: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit of College of Medical Sciences Teaching Hospital, Bharatpur, Nepal from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed. RESULTS: A total of 57 subjects were included in the study. The majority 36 (63.16%) were males. The mean age was 64.54±13.8 years. Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. The major coronary heart disease risk factors were smoking 29 (50.88%), diabetes 25 (43.85%), hypertension 21 (36.87%), and previous history of coronary heart disease 18 (31.58%). ST elevation myocardial infarction was the major category 24 (42.11%) followed by non-ST elevation myocardial infarction and unstable angina 18 (31.58%) and 15 (26.32%), respectively. Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%). CONCLUSIONS: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifi able risk factors such as the management of hypertension, dyslipidemia, diabetes and obesity. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might improve the mortality and morbidity in such cases.

Coexistence of cardiomyopathy and chronic liver disease in non-moderate drinkers.

INTRODUCTION: The dose-response relationship suggests a toxic effect of alcohol on heart and liver and the possibility of a correlation between alcohol-induced liver and heart disease. The present study was aimed to look into the relationship between chronic liver and heart muscle disease among the non-moderate drinkers in our context. METHODS: An observational study on non-moderate chronic drinkers was carried out. Clinical evaluation along with detail sonographic study of heart and liver was conducted. RESULTS: Fifty-eight percent had echocardiographic features consistent with heart muscle disease, either as a dilated cardiomyopathy, categorized by the presence of echo features of impaired LV systolic function and dilated left ventricle or as a possible cardiomyopathy categorized by the presence of any of these two echo features. Similarly, 56 of the total recruits showed ultrasonographic evidence of chronic liver disease as cirrhosis or early cirrhosis. Approximately, 86% of these 56 non-moderate drinkers with chronic liver disease also had echocardiographic features of heart muscle disease and 83% of the 58 non-moderate drinkers showing echo features of heart muscle disease had ultrasonographic features of chronic liver disease. CONCLUSIONS: Our study showed a strongly positive relationship on the coexistence of chronic liver disease and cardiomyopathy among the non-moderate drinkers. Non-moderate drinkers with chronic liver disease have a high likelihood of having a concurrent clinical or sub-clinical heart muscle disease and vice versa.

Unruptured left ventricular pseudoaneurysm following inferior wall myocardial infarction.

Left ventricular (LV) pseudoaneurysm is a rare but potentially lethal complication of acute myocardial infarction (MI). We report a very rare case of a 60 year-old woman with a ruptured myocardial wall, and a non-ruptured LV pseudoaneurysm. The patient presented with acutely worsening shortness of breath and exertional dyspnea of one month's duration, and palpitation. She had an inferior wall MI nine months previously. Coronary angiography showed severe stenosis at right coronary artery. Echocardiography, LV angiography, and computed tomography angiography revealed a large pseudoaneurysm postero-inferior to the LV. Surgical resection of the pseudoaneurysm was performed and repair of the ruptured LV wall done, with good results.

Constrictive pericarditis with a calcified pericardial band at the level of left ventricle causing mid-ventricular obstruction.

An adolescent presented with insidious onset and gradually progressive distension of abdomen associated with bilateral ankle swelling of few months duration. He had one episode of prolonged low-grade self-limiting febrile illness during childhood but had not consulted to doctor and never had been diagnosed as case of tuberculosis or acute pericarditis. A detail clinical evaluation showed raised central venous pressure, ascites and ankle oedema. Systemic examination was not much informative except ejection systolic murmur in third left intercostal space. Echocardiography and CT scan heart showed localised thickened pericardium with calcific band around the left ventricle at mid ventricle level. The band around the heart caused the heart to have a 'dumbbell' appearance with ballooning in apical area and a rare mid-ventricular obstruction in the left. A diagnosis of chronic constrictive pericarditis with calcific band was made and the patient was referred to another centre for cardiac surgery.

Cardiogenic shock complicating acute myocardial infarction--a review.

Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction and is the leading cause of death in patients hospitalized with acute myocardial infarction. Mortality from cardiogenic shock still remains high. The development of cardiogenic shock is rarely unexpected; most patients who develop cardiogenic shock do so within 48 hrs of admission, with only 10% shocked on arrival. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Early revascularization is the cornerstone treatment of acute myocardial infarction complicated by cardiogenic shock. According to the guidelines, revascularization is effective up to 36 hours after the onset of cardiogenic shock and performed within 18 hours after the diagnosis of cardiogenic shock. Primary percutaneous coronary intervention is the most efficient therapy to restore coronary flow in the infarct-related artery. However, invasive strategy in a developing country like ours is not only costly but also technically demanding. We present a case of acute myocardial infarction complicated with cardiogenic shock that underwent primary percutaneous coronary intervention and also review the incidence, pathophysiology, management and outcome of cardiogenic shock complicating acute myocardial infarction.

Poly(2-N-carbazolylethyl acrylate)-modified silica as a new polymeric stationary phase for reversed-phase high-performance liquid chromatography.

Poly(2-N-carbazolylethyl acrylate) having terminal trimethoxysilyl groups was newly synthesized by radical polymerization and immobilized onto the silica surface (Sil-CEA). The chromatographic property of Sil-CEA was examined by applying polycyclic aromatic hydrocarbons as solutes. Poly(4-vinylpyridine)-modified silica (Sil-VP) and monomeric octadecylated silica (ODS) columns were used as the reference columns. Less sensitivity to molecular hydrophobicity and enhanced molecular planarity selectivity were obtained with Sil-CEA compared to ODS. On the other hand, high retention factors for the analyzed solutes and an opposite elution order for linear and disc-shaped solutes were obtained with Sil-CEA compared with Sil-VP. In this paper, the application for separation of tocopherols was also described.

Thermodynamic investigations on shape selective separation behaviors of poly(4-vinylpyridine)-grafted silica for polycyclic aromatic hydrocarbons in both normal-phase and reversed-phase high-performance liquid chromatography.

With the successful implementation of poly(4-vinylpyridine)-grafted silica prepared by grafting-from approach (GF-VP(n)) as a stationary phase for the separation of polycyclic aromatic hydrocarbons (PAHs) in normal-phase HPLC, this paper describes the chromatographic retention behaviors of PAHs with GF-VP(n) in reversed-phase HPLC. Significantly higher retention factor along with enhanced shape selectivity were observed with GF-VP(n). Thermodynamic study on the retention behaviors of PAHs with GF-VP(n) in normal-phase and reversed-phase HPLC revealed that retention of PAHs was exothermic in both phases. Furthermore, higher entropic contribution was observed in reversed-phase HPLC compared to normal-phase HPLC.

Enhancement of retentivity and selectivity for PAHs in NP-HPLC by high-density immobilization of poly(4-vinylpyridine) as an organic phase on silica.

Poly(4-vinylpyridine)-modified silica with high grafting density have been prepared by a grafting-from (g-from) approach through radical chain-transfer reactions. The widely used silane coupling agent 3-mercaptopropyltrimethoxysilane was used to prepare thiol-terminated silica. Chain-transfer reaction and polymerization of 4-vinylpyridine was carried out using alpha,alpha'-azobisisobutyronitrile as an initiator. Thiol-terminated silica and polymer-modified silica were both characterized qualitatively and quantitatively. The quantification of the organic phase has been done by thermogravimetric analysis and elemental analysis. Thus, the modified silica was used as a packing material and the retention behavior of polycyclic aromatic hydrocarbons (PAHs) was studied in normal-phase high-performance liquid chromatography. Results were compared with those of poly(4-vinylpyridine)-modified silica prepared by a grafting-to (g-to) approach. Commercially available aminopropyl-bonded silica and bare silica columns were also used as reference columns. The column of poly(4-vinylpyridine)-grafted silica prepared by the g-from method, having higher grafting density, provided the better retentivity and selectivity for PAHs compared to the other reference columns.

High retentivity and selectivity for polycyclic aromatic hydrocarbons with poly(4-vinylpyridine)-grafted silica in normal-phase high-performance liquid chromatography.

In this study, we introduce an attractive stationary phase, poly(4-vinylpyridine)-grafted silica (VP(n)) for normal-phase high-performance liquid chromatography. The retention behavior of polycyclic aromatic hydrocarbons (PAHs) was investigated with VP(n) column under n-hexane/2-propanol mixture as mobile phase. Conventional octadecylated silica, aminopropyl-bonded silica, bare silica and poly(styrene)-grafted silica columns were used as reference columns. Extremely high retention factors were observed for PAHs but not for alkylbenzenes and distinct higher selectivity towards PAHs was observed for the detailed molecular shape such as planarity and aspect ratio. The reason for these results seems to be a multiple interaction effect including an inductive interaction between the pyridyl and aromatic rings.

Acute peritoneal dialysis in eastern Nepal.

OBJECTIVE: B.P. Koirala Institute of Health Sciences is the only dialysis center outside the capital city of Nepal. Although the burden of renal failure in Nepal is high, limited resources and dialysis facilities are the major constraint on management of acute renal failure (ARF) and acute dialysis in chronic renal failure (CRF). In the present study, carried out from January 2000 to June 2002, we looked into the prospect of introducing peritoneal dialysis (PD) to the district hospitals for treatment of ARF and acute dialysis in CRF. PATIENTS AND METHODS: We designed a form to evaluate the causes of renal failure and the indications for, complications of, and outcomes of dialysis. During this study, junior doctors in our hospitals completed the forms. Resident doctors were trained to do intermittent peritoneal dialysis (IPD) and were responsible for the carrying out the procedure under supervision, together with a staff nurse. RESULTS: A total of 120 patients underwent IPD during the study period, including 66 men and 54 women. The most common indications for acute dialysis in CRF were metabolic acidosis (56%), uremic encephalopathy (45%), and fluid overload (44%). The most common causes of ARF were acute gastroenteritis (20%), sepsis (20%), and septic abortion (16%). Fifteen patients died of sepsis and multi-organ failure. CONCLUSIONS: Lack of dialysis facilities in the geographic periphery means that most patients present late in the course of their disease, as evidenced by severe metabolic acidosis and uremic encephalopathy. Peritoneal dialysis is a simple procedure, easily tolerated by the patient and requiring less expertise than hemodialysis does. Moreover, nursing staff, technicians, and doctors can be easily trained in the technique. Despite certain limitations, PD still has much potential and can be successfully accomplished in district hospitals and less accessible areas.