Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease

<p>Abstract</p> <p>Rationale</p> <p>There is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea.</p> <p>Objectives</p> <p>To determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention.</p> <p>Methods</p> <p>78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea – Index < 10/h (group I) and 35 pt. with obstructive sleep apnea and an AHI > 10/h (group II). Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 ± 3.1 months.</p> <p>Main results</p> <p>Angiographic restenosis (>50% luminal diameter), was present in 6 (14%) of group I and in 9 (25%) of group II (p = 0.11). Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 ± 0.69 mm vs. 0.38 ± 0.37 mm, p = 0.01). Among these 35 patients, 21(60%) used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 ± 0.47 mm vs. 0.99 ± 0.86 mm, p = 0.08). There was no difference in late lumen loss between treated patients and the group I (p = 0.206).</p> <p>Conclusion</p> <p>In summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.</p

No evidence of enhanced oxidant production in blood obtained from patients with obstructive sleep apnea

<p>Abstract</p> <p>Background</p> <p>Obstructive sleep apnea syndrome (OSAS) is a recognized risk factor for cardiovascular morbidity and mortality, perhaps due to causative exacerbations of systemic oxidative stress. Putative oxidative stress related to numerous episodes of intermittent hypoxia, may be an oxidants chief driving force in OSAS patients.</p> <p>Methods</p> <p>We assessed the resting and n-formyl-methionyl-leucyl-phenylalanine (fMLP)- induced whole blood chemiluminescence (as a measure of oxidant production by polymorphonuclear leukocytes and monocytes), ferric reducing ability of plasma (FRAP) and H₂O₂generation in the whole blood of 27 untreated OSAS patients, 22 subjects after a night of CPAP therapy and 11 controls without OSAS. All of them were matched to age, BMI (body mass index) and smoking habits. All parameters were measured before and after polysomnography-controlled sleep, individual results were obtained as a mean from duplicated experiments.</p> <p>Results</p> <p>No significant differences were distinguished between evening and morning blood chemiluminescence, H₂O₂activity and FRAP within and between all three study groups.</p> <p>For instance patients with untreated OSAS had similar morning and evening resting whole blood chemiluminescence (2.3 +/- 2.2 vs. 2.4 +/- 2.2 [aU·10^-4phagocytes]), total light emission after stimulation with fMLP (1790 +/- 1371 vs. 1939 +/- 1532 [aU·s·10^-4phagocytes]), as well as FRAP after 3 min. plasma incubation (602 +/- 202 vs. 671 +/- 221 [uM]). Although, in the subgroup of 11 patients with severe OSAS (apnea/hypopnea index 58 +/- 18/h and oxygen desaturation index 55 +/- 19/h), the morning vs. evening resting chemiluminescence and total light emission after stimulation with fMLP observed a propensity to elevate 2.5 +/- 2.7 vs. 1.9 +/- 1.8 [aU·10^-4phagocytes] and 1778 +/- 1442 vs. 1503 +/- 1391 [aU·s·10^-4phagocytes], respectively, these did not attain statistical significance (p > 0.05).</p> <p>Conclusion</p> <p>Our investigation exposed no evidence in the overproduction of oxidants via circulating phagocytes, once considered a culprit in the oxidative stress of OSAS patients.</p

Effects of body position on autonomic regulation of cardiovascular function in young, healthy adults

Background: Analysis of rhythmic patterns embedded within beat-to-beat variations in heart rate (heart rate variability) is a tool used to assess the balance of cardiac autonomic nervous activity and may be predictive for prognosis of some medical conditions, such as myocardial infarction. It has also been used to evaluate the impact of manipulative therapeutics and body position on autonomic regulation of the cardiovascular system. However, few have compared cardiac autonomic activity in supine and prone positions, postures commonly assumed by patients in manual therapy. We intend to redress this deficiency. Methods: Heart rate, heart rate variability, and beat-to-beat blood pressure were measured in young, healthy non-smokers, during prone, supine, and sitting postures and with breathing paced at 0.25 Hz. Data were recorded for 5 minutes in each posture: Day 1 - prone and supine; Day 2 - prone and sitting. Paired t-tests or Wilcoxon signed-rank tests were used to evaluate posture-related differences in blood pressure, heart rate, and heart rate variability. Results: Prone versus supine: blood pressure and heart rate were significantly higher in the prone posture (p &lt; 0.001). Prone versus sitting: blood pressure was higher and heart rate was lower in the prone posture (p &lt; 0.05) and significant differences were found in some components of heart rate variability. Conclusion: Cardiac autonomic activity was not measurably different in prone and supine postures, but heart rate and blood pressure were. Although heart rate variability parameters indicated sympathetic dominance during sitting (supporting work of others), blood pressure was higher in the prone posture. These differences should be considered when autonomic regulation of cardiovascular function is studied in different postures

Safety and efficacy of simplified antibiotic regimens for outpatient treatment of serious infection in neonates and young infants 0-59 days of age in Bangladesh: design of a randomized controlled trial.

BACKGROUND: Because access to care is limited in settings with high mortality, exclusive reliance on the current recommendation of 7-10 days of parenteral antibiotic treatment is a barrier to provision of adequate treatment of newborn infections. METHODS: We are conducting a trial to determine if simplified antibiotic regimens with fewer injections are as efficacious as the standard course of parenteral antibiotics for empiric treatment of young infants with clinical signs suggestive of severe infection in 4 urban hospitals and in a rural surveillance site in Bangladesh. The reference regimen of intramuscular procaine-benzyl penicillin and gentamicin given once daily for 7 days is being compared with (1) intramuscular gentamicin once daily and oral amoxicillin twice daily for 7 days and (2) intramuscular penicillin and gentamicin once daily for 2 days followed by oral amoxicillin twice daily for additional 5 days. All regimens are provided in the infant's home. The primary outcome is treatment failure (death or lack of clinical improvement) within 7 days of enrolment. The sample size is 750 evaluable infants enrolled per treatment group, and results will be reported at the end of 2013. DISCUSSION: The trial builds upon previous studies of community case management of clinical severe infections in young infants conducted by our research team in Bangladesh. The approach although effective was not widely accepted in part because of feasibility concerns about the large number of injections. The proposed research that includes fewer doses of parenteral antibiotics if shown efficacious will address this concern

Assessment of calibration coefficient ND, W in terms of absorbed dose-to-water of some ionization chambers

The absorbed dose-to-water calibration coefficients ND,W of some ionization chambers were determined in terms of the secondary standard chambers in 60Co gamma-ray beam based on the TRS-398 protocol. The reference absorbed dose-to-water Dw were measured using secondary standard ionization chambers of model NE 2781#0537 (0.60 cm3 volume) and NE 2771#1205 (0.69 cm3 volume) which are traceable to the dosimetry laboratory of the International Atomic Energy Agency (IAEA). This study mainly focuses on the comparative assessment of the determined ND,W coefficients of twenty cylindrical ionization chambers from various user groups. The determined ND,W coefficients were compared with the manufacturer provided ND,W coefficients. The observed percentage of deviation between the measured and the manufacturer’s ND,W coefficients among all the chambers were found to be in the range of 0.019% and -2.263% as the least and highest, respectively. The observed percentage of deviations for studied chambers were found within the IAEA’s acceptance limit of 1.5% with an exception for three chambers. This observed discrepancy with the IAEA’s acceptance limit for the three chambers out of the twenty chambers, indicates the calibration necessity before using chambers in routine reference dosimetry. In ND,W measurement, the uncertainty Uc is reported with the coverage factor k=1 that providing a level of confidence of approximately 68%.</jats:p

Disorders of Sex Development: Can You Be Sure This Baby Is A Boy or Girl? We Must See Beyond The Diagnosis

Throughout the pregnancy, the parents have anticipated whether their child will be a boy or a girl. No part of a newborn baby’s anatomy arouses as much interest initially as the external genitalia. Most newborn children have the typical features of a boy or girl, but in some cases the baby’s sex can’t be clearly identified. Infants born with ambiguous or abnormal genitalia may have indeterminate phenotypic sex.1 Disorders of sex development (DSDs), formerly termed intersex conditions, are congenital conditions in which development of the chromosomal, gonadal, or anatomic sex is atypical and may affect up to 1:1000 individuals in the population.2&#x0D; J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 103-110</jats:p

Syndromic survey de-identified data in SPSS

De-identified syndromic survey data made available in SPSS format. This supports the PLOS ONE paper, "An epidemic of chikungunya in northwestern Bangladesh in 2011" and is hosted on Figshare