Early Outcome of On-pump Versus Off-pump Elective Surgical Revascularization in Patients with Prior ST-Segment Elevation Myocardial Infarction.

Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. History of a ST-elevation myocardial infarction (STEMI) is considered an independent risk factor for CABG irrespective of timing for an emergency or elective surgery. Patients with STEMI are candidates for both On-pump and Off-pump CABG procedures. This paper discusses the possible best option for elective surgical revascularization in patients with prior STEMI. This prospective clinical trial of 60 eligible patients with prior STEMI was conducted in a Tertiary Care Hospital from April 2018 to March 2019. Among them, 30 patients underwent off-pump (Group A) and 30 patients underwent on-pump (Group B) CABG procedures. Outcomes between both groups were observed from surgery to 1 month postoperatively. Data was analysed by the software statistical program for social science (SPSS 25.0 Inc). The surgery was successful in both groups of patients. Differences were observed by mean number of grafts per patient (2.77±0.43 vs. 3.10±0.71) and duration of operation (4.41±0.35 hours vs. 5.71±0.48 hours). An improvement in Left Ventricular Ejection Fraction (LVEF %) was observed in both groups postoperatively (17.98% vs. 10.98%) and the postoperative LVEF% at different time points were found statistically significant (p<0.05) over preoperative LVEF%. Multivariable stepwise logistic regression analysis correlated on-pump CABG with prolonged need for ionotropic support, need for blood transfusion, longer hospital stay and less improvement in LVEF%. The study supports the Off-pump CABG as a better surgical option over on-pump CABG in patients with prior STEMI.

Safety and Feasibility of Trans Radial Percutaneous Coronary Intervention Approach in Elderly Patients with Acute Coronary Syndrome.

Coronary catheterization is usually performed using the transfemoral approach but trans-radial has been increasingly used as an alternative to transfemoral approach due to less vascular complications, earlier ambulation time and improved patient comfort. The aim of the study was to compare the safety and feasibility of trans-radial and transfemoral PCI in the elderly ACS patients. This prospective observational study was conducted in the NICVD, Dhaka from October 2017 to September 2018. Total 80 patients were categorized into two groups according to the approach of PCI. Group I consists 40 patients who underwent trans-radial PCI and Group II consists 40 patients who underwent transfemoral PCI. Patients with abnormal Allen's test, history of CABG, CKD were excluded. Patient's demographics were same in both groups. The mean procedural time in min (37.44±5.13 vs. 34.42±4.42, p=0.004) and fluoroscopy time in min (21.6±4.11 vs. 17.55±2.78, p=0.02) were more in Group I but the mean hemostasis time in min (7.58±1.11 vs. 15.59±3.33, p=0.005) and the ambulation time in hour (0.00±0.00 vs. 15.59±3.33, p=0.001) were more in Group II. Significant arterial spasm following puncture (10.0% vs. 0.0%, p=0.01) were more in Group I. Post procedural major bleeding (0.0% vs. 10.0%, p=0.004), minor bleeding (10.0% vs. 20.0%, p=0.004) were significant in Group II but vessel occlusion (5.0% vs. 0.0%, p=0.02) were significant in Group I. Transradial PCI is safe in respect of procedural and post procedural vascular complications. Transradial procedure leads to improved quality of life after the procedure and thus gives much comfort to the patient. It also shortened mean duration of hospital stay. So transradial approach is an attractive alternative to conventional transfemoral approach in the elderly.

Association of Stress Hyper-Glycaemia on Outcomes of Hospitalized Non Diabetic Patients with First Attack of Acute ST Elevated Myocardial Infarction Underwent Thrombolysis.

Coronary heart disease (CHD) is the most common cause of heart disease and serious cause of early death in developed countries around the world. Stress hyper-glycaemia has a bad prognostic implication in hospital outcomes in acute ST elevated myocardial infarction patients. It serves as a marker of myocardial damage, provides information about complications of acute MI and bad prognosis. The aim of this cross-sectional descriptive study was to find out prognostic implications of Stress hyper-glycaemia in non diabetic patients with first attack of acute ST elevated myocardial infarction underwent thrombolysis and conducted in the department of Cardiology in Mymensingh Medical College Hospital, Mymensingh, Bangladesh from June 2017 to May 2018. Total 249 first attack of Acute STEMI patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group I: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic stress hyper-glycaemia (Blood sugar >7.8mmol/L and HbA1c <6.5), Group II: Patients with first attack of acute STEMI underwent thrombolysis with non diabetic normo-glycaemia (Blood sugar <7.8mmol/L and HbA1c <6.5). In this study, in non diabetic Stress hyperglycemic patients' death was 5.7% and in non diabetic normo-glycemic patients death was 0.6%. It was statistically significant (p<0.05). In non diabetic stress hyperglycemic patients, heart failure was 78.31% patients and in non diabetic normo-glycemic patients, it was 21.6%. It was statistically significant (p<0.01). Echocardiography showed that patients with non diabetic Stress hyper-glycaemia had mean ejection fraction (LVEF) was 44.01±4.93 and patients with non diabetic normo-glycaemia had mean ejection fraction (LVEF) was 47.70±5.71. It was statistically significant (p<0.01). In this study, in non diabetic Stress hyperglycaemic patients, cardiogenic shock was 16.1% and in non diabetic normo-glycemic patients, it was 3.7%. It was statistically significant (p<0.05). Mean duration of hospital stay, in non diabetic Stress hyperglycaemic patients was 5.07±0.566 and in non diabetic normo-glycemic patients, it was 3.52±0.850. It was statistically significant (p<0.001). In conclusion, the incidence of death, heart failure, cardiogenic shock and hospital stay were higher in non diabetic Stress hyperglycaemic patients than non diabetic normo-glycemic patients who admitted with first attack of acute ST elevated myocardial infarction.

RBE-LET relationships for cell inactivation and mutation induced by low energy protons in V79 cells: further results at the LNL facility.

PURPOSE: RBE-LET relationships for cell inactivation and hprt mutation in V79 cells have been studied with mono-energetic low-energy proton beams at the radiobiological facility of the INFN-Laboratori Nazionali di Legnaro (LNL), Padova, Italy. MATERIALS AND METHODS: V79 cells were irradiated in mono-layer on mylar coated stainless steel petri dishes, in air. Inactivation data were obtained at 7.7, 34.6 and 37.8 keV/microm and hprt mutation was studied at 7 7 and 37.8 keV/microm. Additional data were also collected for both the end points with the proton LET already considered in our previous publications, namely 11.0, 20.0 and 30.5 keV/microm. RESULTS: A maximum in the RBE-LET relationship for cell inactivation was found at around 31 keV/microm, while the RBE for mutation induction increased continuously with LET. CONCLUSIONS: The proton RBE-LET relationship for cell inactivation is shifted to lower LET values compared with that for heavier ions. For mutation induction, protons of LET equal to 7.7keV/microm gave an RBE value comparable with that obtained by helium ions of about 20 keV/microm. Mutagenicity and lethality caused by protons at low doses in the LET range 7.7-31 keV/microm were proportional, while the data at 37.8 keV/microm suggest that this may not hold at higher LET values.

PIGE-PIXE analysis of medicinal plants and vegetables of pharmacological importance.

PIGE and PIXE techniques were employed to the study of elemental constituents of some traditional medicinal plants generally used in curing many diseases and ailments in southwestern Nigeria. Analyses were also carried out on commonly edible vegetables of medicinal and pharmacological importance. PIGE measurements were carried out using 3.5-MeV collimated protons from the 7 mV CN Van-de-Graaff accelerator of INFN, LNL, Legnaro (Padova), Italy, whereas the PIXE measurements were carried out using 1.8 MeV from the 2.5 MV AN 2000 Van-de-Graaff accelerator of the same laboratory. The results show that many of the medicinal plants contain elements of cardinal importance in human metabolism. The results from the vegetables also show the presence of vital elements that are needed for growth and development. In addition, some of the toxic elements, which include As, Cd, Hg, and so forth, were not detected. However, some of the recipes contain trace amounts of Pb at very low concentrations. This calls for proper control of dose rates in some samples to prevent the attendant negative cumulative effects.

DNA double strand break production and rejoining in V79 cells irradiated with light ions.

Low energy protons and other densely ionizing light ions are known to have RBE>1 for cellular end points relevant for stochastic and deterministic effects. The occurrence of a close relationship between them and induction of DNA dsb is still a matter of debate. We studied the production of DNA dsb in V79 cells irradiated with low energy protons having LET values ranging from 11 to 31 keV/micrometer, i.e. in the energy range characteristic of the Bragg peak, using the sedimentation technique. We found that the initial yield of dsb is quite insensitive to proton LET and not significantly higher than that observed with X-rays, in agreement with recent data on V79 cells irradiated with alpha particles of various LET up to 120 keV/micrometer. By contrast, RBE for cell inactivation and for mutation induction rises with the proton LET. In experiments aimed at evaluating the rejoining of dsb after proton irradiation we found that the amount of dsb left unrepaired after 120 min incubation is higher for protons than for sparsely ionizing radiation. These results indicate that dsb are not homogeneous with respect to repair and give support to the hypothesis that increasing LET leads to an increase in the complexity of DNA lesions with a consequent decrease in their repairability.

Inactivation and mutation induction in V79 cells by low energy protons: re-evaluation of the results at the LNL facility.

During the upgrading of the radiobiological facility at the Laboratori Nazionali di Legnaro (LNL) we found that uncorrected values of the proton energy were used in the past. This circumstance prompted us to perform the re-evaluation of the physical parameters for all the proton beams used in our previous radiobiological investigations (Belli et al. 1987) and, subsequently, the re-evaluation of all our previous dose-response curves for inactivation and mutation induction (Belli et al. 1989, 1991). This re-evaluation leads to significant changes in the dose-response curves and in the RBE-LET relationships only at the two lowest energies (highest LET) used. These two points are not reliable for the identification of a peak in RBE-LET relationship for cell inactivation. In spite of that, the extent of the changes is not such as to modify the general conclusion previously drawn, pointing out that there is a LET range where protons are more effective than alpha-particles.