Echocardiographic comparison of regional wall motion abnormality between patients with acute anteroseptal and acute extensive anteior ST segment elevation myocardial infarction.

Post myocardial infarction (MI) short and long-term clinical outcome is largely determined by the size of the infarcted area. It is generally assumed that as the lead involvement in electrocardiography (ECG) is less in anteroseptal ST segment elevation myocardial infarction (AS-STEMI), where ST segment elevation (STE) is limited to leads V1 to V3, myocardial damage is likely to be less; and in extensive anterior STEMI (EA-STEMI), as the STE extends further upto V6, the myocardial damage is likely to be more. This study was intended to compare regional wall motion abnormality (RWMA) between acute anteroseptal STEMI and acute extensive anterior STEMI patients. 90 patients with AS-STEMI and 106 patients with EA-STEMI, admitted in between October 2012 and September 2013, were included. For each patient, a transthoracic echocardiogram (TTE) was performed within 24-48 hours of MI and was interpreted by an independent investigator blinded to the patient's ECG data. No differences were observed between the two groups in baseline characteristics; except AS-STEMI group had more patients with diabetes and EA-STEMI group had more patients with family history of coronary artery disease. Distribution, extent of wall motion abnormalities and mean number of total involved segments were similar between patients with AS-STEMI and those with EA-STEMI (p > 0.05). Regarding regional dysfunction, the apical septal (99.1% vs. 92.2%, p < 0.05) and apical (76.4% vs. 60.0%, p < 0.05) segments were the only two segments that were affected significantly more in patients with EA-STEMI than in patients with AS-STEMI. So, the term AS-STEMI may be a misnomer, as it implies that only the anteroseptal segments of the left ventricle are involved. This study shows that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region. So, any patients with anterior wall involvement, either anteroseptal or extensive anterior STEMI, should be treated with equal importance.

A family history of knee joint replacement increases the progression of knee radiographic osteoarthritis and medial tibial cartilage volume loss over 10 years.

OBJECTIVES: Osteoarthritis (OA) has a genetic component but it is uncertain if the offspring of those with knee OA are at a greater risk. The aim of this study was to describe radiographic OA (ROA) progression and cartilage loss over 10 years in a midlife cohort with some having a family history of OA and some community based controls. METHODS: 220 participants [mean-age 45 (26-61); 57% female] were studied at baseline and 10 years. Half were adult offspring of subjects who underwent knee replacement for OA and the remainder were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed on radiographs and cartilage volume (tibial, femoral and patellar), cartilage defects, bone marrow lesions (BMLs) and meniscal tears were assessed on Magnetic resonance imaging (MRI). RESULTS: For ROA, there was a significant difference between offspring and controls in unadjusted analysis for change in total ROA, medial JSN, total medial, total lateral and total osteophyte scores. This difference persisted for medial JSN (difference in ratios = +1.93 (+1.04, +3.51)) only, after adjustment for confounders and baseline differences. In unadjusted analysis for cartilage loss, offspring lost more cartilage at the medial tibial (difference in means = -79.13 (-161.92, +3.71)) site only. This difference became of borderline significance after adjustment for baseline differences (P = 0.055). CONCLUSION: The offspring of subjects having a total knee replacement have a greater worsening of ROA (both JSN and osteophytes) and higher medial tibial cartilage volume loss over 10 years. Most of these changes are mediated by differences in baseline characteristics of offspring and controls except for increase in medial JSN.

Flower synchrony, growth and yield enhancement of small type bitter gourd (Momordica charantia L.) through plant growth regulators and NPK fertilization.

Assessment of growth regulator and NPK fertilization effects are important tools for flower stimulation and yield improvement in cucurbits. This investigation demonstrates the comparative male-female flower induction and fruit yield of small sized bitter gourd treated with NPK fertilizers and plant growth regulators. Namely, two experiments having three replicates were conducted in a Randomized Complete Block Design (RCBD) with NPK fertilization and plant growth regulators-GA3, NAA and Ethophon application on small sized bitter gourd-genotype BG5 at the research field of the Bangabandhu Sheikh Mujibur Rahman Agricultural University (BSMRAU). In experiment 1, different doses of NPK fertilizers comprised of 10 treatments and in that of experiment 2, different levels of plant growth regulators indicated 10 treatments. The results indicated that application of different doses of NPK fertilizer and plant growth regulators significantly (< or = 0.05) influenced over the flower initiation and fruit setting. The application of N90-P45-K60 fertilizer along with Ethophon spraying resulted in the better yield of small sized bitter gourd.

Body mass index and waist/height ratio for prediction of severity of coronary artery disease.

BACKGROUND: To determine whether waist-to-height ratio correlates with coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by coronary angiography in Bangladeshi population. METHODS: This cross sectional study was done on patients in Department of Cardiology in DMCH and those referred in the cath-lab of the Department of Cardiology for CAG during November 2009 to October 2010 involving 120 patients. They were divided into group-A (with coronary score ≥7) and group-B (coronary score <7) depending on Gensisni score. RESULT: There were no statistically significant difference regarding the distribution of age, sex and clinical diagnosis and parameters between the two groups. The mean age of patients was 51.7 ± 8.2 years and 48.8 ± 9.1 years in Group A and Group B respectively with a male predominance in both the groups. Patients in group A had higher BMI ≥25 and waist to height ratio (≥0.55) than Group B which showed a statistically significant association (p < 0.001). Though a significant positive correlation (r = 0.296, p = 0.006) was observed between BMI and Coronary artery disease score in group A patients, scenario was reverse fro group B (r = 0.076, p = 0.659). The statement was also true for Waist-to-height ratio and Waist-to-height ratio with BMI. Multivariate analysis also yeilded that a patient with BMI ≥25 kg/m2 and waist-to height ratio of ≥0.55 are 3.06 times and 6.77 times, more likely to develop significant coronary artery disease respectively. CONCLUSION: The waist-to-height ratio showed better correlation with the severity of coronary artery disease than the BMI.

Elevated serum homocysteine level has a positive correlation with serum cardiac troponin I in patients with acute myocardial infarction.

The objective of the present study is to find out whether the increased serum homocysteine level is associated with the increased serum troponin I as a surrogate marker of extent of myocardial injury in acute myocardial infarction patients. Elevated homocysteine levels are associated with increased thrombosis. In patients presenting with Acute Coronary Syndrome (ACS), it is not known whether this association is reflected in the degree of myocardial injury. This was a cross sectional study conducted among the patients with acute myocardial infarction in the Department of Cardiology, Dhaka Medical College Hospital during the period of October 2009 to September 2010 and which included 194 consecutive patients with acute myocardial infarction. The mean (+/- SD) serum homocysteine level was 20.2 +/- 14.3 micromol/L with range from 7.4 to 129.1 micromol/L. Mean serum troponin-I level was classified according to normal (<15 micromol/L) and high (> or = 15 micromol/L) levels of serum homocysteine values. The mean serum troponin-I level was 8.9 +/- 8.6 ng/ml in the patients having normal serum homocysteine level and 18.4 +/- 6.5 ng/ml in the patients having high serum homocysteine level. A significant positive correlation (r=0.273; p<0.001) was found between serum troponin-I level with homocysteine level. Patients with moderate hyperhomocysteinemia (> or = 15 micromol/L) was found to be 7.09 times more likely to have increased serum troponin-I (a surrogate marker of extent of myocardial injury). The main observation of the present study was that elevated serum homocysteine level has a positive correlation with serum cardiac troponin-I in patients with acute myocardial infarction. So serum homocysteine is associated with increased extent of myocardial injury as measured by serum cardiac troponin-I level, a surrogate marker in patients with acute myocardial infarction.

Improvement in pulsed wave Doppler echocardiographic assessment of pulmonary artery pressure.

Non invasive estimation of pulmonary artery pressure (PAP) is of paramount importance in various form of cardiac, respiratory and intensive care medicine practice. Using pressure gradient between different chambers enables a reliable estimation of PAP and are being largely practiced. In absence of these pressure gradient, various time interval or the ratios of pulmonary blood flow velocity curve (PBFVC) in pulsed wave doppler echocardiography (PWDE) can predict the PAP. But there is lack of general agreement as which parameter should be used. We hypothesized that using separate time interval or their ratios of PBFVC for different group of patient may improve the PWDE prediction of PAP. Forty-six consecutive patients with different cardiac diseases and 20 consecutive control persons underwent PWD echocardiographic examination. Pulmonary blood flow velocity curve derived time intervals--the time intervals--time to peak velocity (TPV), Pre-ejection period (PEP) and right ventricular ejection time (RVET) and their ratios were measured. The Doppler derived measurements were compared with cardiac catheterization (CC) measured PAP in 46 patients in whom CC were done. PBFVC derived time interval TPV and the ratio PEP/TPV correlated well with CC measured systolic PAP (r=-0.78 and r=0.77 respectively). For congenital left to right shunt disease the ratio PEP/TPV improved the prediction (r=-0.87) while the same measure showed weak correlation in patients with left sided heart disease. Only TPV could predict mean PAP in patients with left sided heart disease (r=-0.60). We concluded that the use of separate PBFVC derived time interval or their ratio from PWDE may improve the prediction of PAP with different pathological group of disease.

Detection of antibodies to hepatitis C virus in dried blood spot samples from mothers and their offspring in Lahore, Pakistan.

Dried blood spot samples from mothers and their offspring attending the obstetric and pediatric departments of two hospitals in Lahore, Pakistan, were tested for antibodies to hepatitis C virus (HCV). The seroprevalence of HCV in the women was 6.7% (95% confidence interval [CI], 4.3 to 9.1), and that in the children was 1.3% (95% CI, 0.34 to 2.26). Four anti-HCV immunoglobulin G (IgG)-positive children had mothers that were anti-HCV IgG negative, which suggested that their infection was community acquired.

Knowledge, attitude and behaviour towards AIDS among educated youth in Lahore, Pakistan.

OBJECTIVE: To assess the knowledge, attitude and behaviour regarding AIDS among educated young people in Lahore, Pakistan. METHODS: An anonymous survey of 733 males and 355 females was carried out using structured questionnaire among educated youth, selected randomly from non-medical educational institutions and work places. RESULTS: Knowledge on exsistance of AIDS in Pakistan was expressed by 698 (95.2%) males and 273 (76.9%) females, in, while only 189 (25.7%) males and 76 (21.4%) females knew its cause. Knowledge of the different modes of transmission was good, however 59%, 48%, 68% and 43% males; 28%, 45%, 59% and 35% females believed that it could be transmitted through sharing of utensils, mouth kissing, casual contact and mosquito bite, respectively. Ninety one percent males and 86% females believed that AIDS sufferers should be isolated. Extra marital sex was experienced by 6% subjects and only 5% used condoms. Generally, males had better knowledge than females except in attitudes towards monogamy and having sex with someone known. CONCLUSIONS: The study revealed gaps in the knowledge of females regarding AIDS and its transmission. The results indicates an urgent need to include health education syllabi emphasising AIDS and other Sexually Transmitted Diseases in the Curriculum of schools/colleges to convey the message adequately to the youth.