Accuracy of dobutamine echocardiography for detection of myocardial viability in patients with an occluded left anterior descending coronary artery

Objectives.We studied the accuracy of dobutamine echocardiography for the detection of myocardial viability in patients with an occluded left anterior descending coronary artery and regional ventricular dysfunction.Background.Contractile reserve during dobutamine echocardiography is an accurate marker of myocardial viability in patients with coronary stenoses and ventricular dysfunction. However, its accuracy in patients with an occluded vessel has not been evaluated.Methods.We studied 41 patients with >50% stenosis of the left anterior descending coronary artery and regional ventricular dysfunction who underwent dobutamine echocardiography for detection of viable myocardium. Contractile reserve was defined as improvement in wall motion score of two or more contiguous septal or anterior segments during dobutamine echocardiography. Recovery of function was defined as improvement in rest wall motion score of two or more contiguous segments after revascularization.Results.Patients were classified into two groups according to the presence (n = 20) or absence (n = 21) of left anterior descending coronary artery occlusion. Contractile reserve was detected in 40% of patients with an occluded and 43% with a nonoccluded artery (p = 0.8). Of 41 patients, 27 underwent revascularization, 12 with and 15 without an occluded vessel. Recovery of function occurred in 6 (50%) of 12 patients in the occluded artery group and in 5 (33%) of 15 in the nonoccluded artery group (p = 0.4). Among patients with an occluded artery, the positive and negative predictive values of dobutamine echocardiography for recovery of function were 100% (95% confidence interval [CI] 48% to 100%) and 86% (95% CI 42% to 100%), respectively.Conclusions.Our results indicate that contractile reserve during dobutamine echocardiography can be detected in patients with an occluded vessel and may be useful for predicting recovery of function after revascularization

The Role of Magnetic Resonance Venography in Headache Due to Suspected Cerebral Venous Sinus Thrombosis in the Presence of Normal T1 and T2 Dural Sinus Signal

OBJECTIVES Cerebral venous sinus thrombosis (CVST) is an important but uncommon aetiology of stroke.  The presentation of CVST is extremely variable clinically, moreover its onset can be either acute or subacute, and less frequently, chronic. Headache is the most common symptom of CVST.  The headache is typically diffuse and progressing in severity over days to weeks.  MRI and MRV have very high sensitivity and specificity and have become the modality of choice to confirm the diagnosis of CVST.  The aim of this study was to weigh the benefits of added MRV in patients with headache, after a negative MRI for CVST.  METHODOLOGY The total number of patients included was 207, with chief complaints of headache and suspicion of CVST. The MRV sequence used was dynamic coronal by using the time-of-flight technique. The diagnosis of CVST was made by the loss of normal signal void both on T1WI and T2WI as well as on non-visualization on MRV.RESULTSOut of these 207 patients, CVST was present in 52 patients.  Superior sagittal sinus was involved in 8 cases, right transverse sinus in 2 cases, left transverse sinus in 7 cases, left sigmoid sinus in 3 cases, and multiple sinuses in 32 cases. 34 cases out of 52 had infarction which was mostly haemorrhagic i.e. 27.  A total of 97 cases (46%) had aplastic/hypoplastic transverse segments which were mostly the left one (87, 42%) and 10 cases (4.8 %) on the right side. In none of the patients, CVST was picked by MRV alone after a negative T1 and T2 MRI. CONCLUSION In patients presenting with headache and suspected CVST additional MRV is only required if the routine MR sequences are not able to pick up the thrombus and the suspicion of CVST is very high

Evaluation of essential trace and toxic elements in scalp hair samples of smokers and alcohol user hypertensive patients

The incidence of hypertension has been associated to cigarette smoking and consumption of alcohol. In the present study, trace and toxic elements were determined in scalp hair of patients diagnosed with hypertension who are smokers and habitual alcohol drinkers living in Dublin, Ireland. These results were compared with age- and sex-matched healthy, nonsmokers, nondrinking controls. The concentrations of trace and toxic elements were measured by inductively coupled plasma atomic emission spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked using certified reference material (NCS ZC 81002b) and by the conventional wet acid digestion method on the same certified reference material and on real samples. The recovery of all the studied elements was found to be in the range of 97.5%–99.7% in certified reference material. The results of this study showed that the mean values of cadmium, copper, iron, nickel and lead were significantly higher in scalp hair samples of both smoker and nonsmoker hypertensive patients than referents (P < 0.001); whereas, the concentration of zinc was lower in the scalp hair samples of hypertensive patients of both genders. The deficiency of zinc and the high exposure of trace and toxic metals as a result of cigarette smoking and alcohol consumption may be synergistic with risk factors associated with hypertension

Interaction between zinc, cadmium, and lead in scalp hair samples of Pakistani and Irish smokers rheumatoid arthritis subjects in relation to controls

The incidence of rheumatoid arthritis (RA) has been associated with cigarette smoking. The aim of our study was to assess the trace essential and toxic metals, cadmium (Cd), lead (Pb), and zinc (Zn), in scalp hair samples of 32 Irish and 46 Pakistani smokers and non-smokers RA male patients with age range 42-56 years. For comparison purpose, the scalp hair samples of 27 Irish and 55 Pakistani non-RA male subjects of the same age group were collected. The concentrations of trace and toxic elements were measured by inductive coupled plasma atomic emission spectrophotometer and atomic absorption spectrophotometer prior to microwave-assisted acid digestion. The validity and accuracy of the methodology was checked using certified reference materials and using conventional wet acid digestion method on the same certified reference materials (CRMs). The recovery of all studied elements was found to be in the range of 97.5-99.7% of certified reference values of CRMs. The results of this study showed that the mean values of Cd and Pb were significantly higher in scalp hair samples of both smoker and non-smoker RA patients than in referents (P < 0.001), whereas the concentration of Zn was lower in the scalp hair samples of smokers and non-smokers rheumatoid arthritis patients. The deficiency of Zn and the high exposure of Cd and Pb as a result of cigarette smoking may be synergistic risk factors associated with rheumatoid arthritis

Interaction between essential trace and toxic elements in the scalp hair samples of smokers and alcohol user diabetics

In the present study, trace and toxic elements were determined in the Scalp Hair (SH) samples of patients diagnosed with diabetes mellitus (DM) who were smokers and habitual alcohol drinkers living in Dublin, Ireland. The concentrations of elements were measured by inductively coupled plasma atomic emission spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology was checked using Certified Reference Material (CRM) (NCS ZC 81002b) and by the conventional wet acid digestion method on the same CRM. The results of this study showed that the mean values of cadmium, copper, iron, nickel and lead were significantly higher (P<0.001), in scalp hair samples of diabetic patients as compared to referents of both gender. While the smokers and alcohol drinker referents and DM patients have two to three time higher values of these elements than those subjects who were not smokers and teetotallers. The concentrations of zinc, chromium and manganese were lower in the scalp hair samples of diabetic patients as compared to referents. The deficiency of zinc, chromium and manganese, while the high exposure of cadmium, lead and nickel, as a result of cigarette smoking and alcohol consumption, may be synergistic with risk factors associated with diabetes

Comparative metal distribution in scalp hair of Pakistani and Irish referents and diabetes mellitus patients

Background: The essential metals, chromium (Cr), magnesium (Mg), manganese (Mn) and zinc (Zn), are necessary for many metabolic processes and their homeostasis is crucial for life. The toxic metals, cadmium (Cd) and lead (Pb), have no beneficial role in human metabolism. The aim of this study was to investigate the levels of Cd, Cr, Mg, Mn, Pb, and Zn in scalp hair samples of type 2 diabetes mellitus patients of both genders, ages ranging from 30 to 50 y, and belong to urban areas of Ireland and Pakistan. For comparison purposes, age matched non-diabetic subjects of both countries were selected as referents. Methods: The concentrations of metals in scalp hair samples were measured by inductively coupled plasma atomic emission spectrophotometer and atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by conventional wet-acid-digestion method and using certified reference materials. Results: The mean values of Cd and Pb were significantly higher in scalp hair samples of both Pakistani and Irish diabetic patients as compared to referents of both countries (P<0.001). In contrast, lower Cr, Mg, Mn, and Zn (P<0.01) concentrations were detected in scalp hair derived from patients with type 2 diabetes versus healthy subjects of both countries. Conclusion: This study showed that, increased toxic elements and decreased essential elements are associated with diabetes mellitus. Therefore, these elements may play a role in the development and pathogenesis of diabetes mellitus

Estimation of toxic elements in the samples of different cigarettes and their effect on the essential elemental status in the biological samples of Irish smoker rheumatoid arthritis consumers

Cigarette smoking interferes with the metal homeostasis of the human body, which plays a crucial role for maintaining the health. A significant flux of heavy metals, among other toxins, reaches the lungs through smoking. In the present study, the relationship between toxic element (TE) exposure via cigarette smoking and rheumatoid arthritis incidence in population living in Dublin, Ireland, is investigated. The trace {zinc (Zn), copper (Cu), manganese (Mn), and selenium (Se)} and toxic elements arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) were determined in biological (scalp hair and blood) samples of patients diagnosed with rheumatoid arthritis, who are smokers living in Dublin, Ireland. These results were compared with age and sex-matched healthy, nonsmoker controls. The different brands of cigarette (filler tobacco, filter, and ash) consumed by the studied population were also analyzed for As, Cd, Hg, and Pb. The concentrations of trace and TEs in biological samples and different components of cigarette were measured by inductively coupled plasma mass spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked using certified reference materials. The recovery of all the studied elements was found to be in the range of 96.4–99.8 % in certified reference materials. The filler tobacco of different branded cigarettes contains Hg, As, Cd, and Pb concentrations in the ranges of 9.55–12.4 ng, 0.432– 0.727 μg, 1.70–2.12 μg, and 0.378– 1.16 μg/cigarette, respectively. The results of this study showed that the mean values of As, Cd, Hg, and Pb were significantly higher in scalp hair and blood samples of rheumatoid arthritis patients as compare to healthy controls, while Zn, Cu, Mn, and Se concentrations were found to be lowerin rheumatoid arthritis patients, the difference was significant in the case of smoker patients (p<0.001). The levels of four toxic elements were 2–3-folds higher in scalp hair and blood samples of nonrheumatoid arthritis smoker subjects as compared to nonsmoker controls. The high exposure of toxic metals as a result of cigarette smoking may be synergistic with risk factors associated with rheumatoid arthritis

Evaluation of Essential Metals and Arsenic in Poultry Feeds and Litters of Different Poultry Farms

The current study was aim to evaluate the speciation of arsenic (total arsenic “TAs”, arsenite “AsIII” and arsenate “AsV”) and total contents of essential metals in the feeds and litters of branded poultry feed using farms (BPF) and non-branded poultry feed utilizing farms (NBPF) at Hyderabad Sindh, Pakistan. The TAs and essential metals determined by graphite furnace and flame atomic absorption spectrometry (GF and FAAS), respectively. Whereas, the AsIII and AsV separated by solvent extraction followed by GF-AAS. The high levels of sodium, potassium, and zinc were observed in branded poultry feeds whilst calcium and iron contents were higher in non-branded poultry feed. The contents of total arsenic in poultry feed samples of both branded and non-branded poultry feed utilizing farms were within the NRC permissible limits (30.0 mg/kg) except NBPF-1 and NBPF-4. Total As in all poultry litter samples were found under the permitted monthly average dose of As (41.0 mg/kg) for agronomical application expert poultry litter samples of BPF-1, NPBF-2, and NPBF-3. The daily accumulation of total As from feed to boilers were also studied

Pattern of Presentation of Spinal Dysraphism: A Study of 72 Patients in Hayatabad Medical Complex Peshawar, Pakistan

Objective:&nbsp;&nbsp;To review the pattern of presentation and current understanding of patients with spinal dysraphism in our local population. Material and Methods:&nbsp;&nbsp;Cases of spinal dysraphism of any gender and age were admitted via OPD, emergency or referred from another department were included in the study. Information on demographics, developmental history, presenting symptoms , presence/absence of back swelling, hairy patches, a nevus, dimple, an appendage/ skin tag, lower limb function, sensory/ motor deficit, bowel and bladder dysfunction were recorded. MRI spine was done in all patients to know the exact diagnosis. Results:&nbsp;&nbsp;Out of 72 cases, 52 (72.2%) presented with spina bifida Aperta (spina bifida cystica) while 20 (27.7%) with spina bifida occulta. Total 53 (73.6%) patients presented at the age of 0 – 1 years. 41 (56.9%) of the patient presented with visible sac, 35 (48.6%) swelling over the back, in 5 (6.9%) of patient have hairy patch and dermal sinus each, while 28 (38.8%) patients have neurological deficit. Most common type of spinal dysraphism was myelomeningocele 45 (62.5%). Postoperative course of patients with spinal dysraphism was found to be uneventful in 56 (77.7%), wound infection was seen in 11 (15.2%), deterioration of neurological status in 3 (4.16%) of cases. Conclusion:&nbsp;&nbsp;Spinal dysraphism is not an uncommon condition in our local population its clinical presentation and features are in line with internationally reported literature. Our population is least aware of the adverse neurological outcomes of the condition and face difficulties to access the adequate healthcare for spinal dysraphism

Effect of trace and toxic elements of different brands of cigarettes on the essential elemental status of Irish referent and diabetic mellitus consumers

Cigarette smoking interferes with the metal homeostasis of the human body, which plays a crucial role for maintaining the health. A significant flux of heavy metals, among other toxins, reaches the lungs through smoking. In the present study, the relationship between toxic element (TE) exposure via cigarette smoking and diabetic mellitus incidence in population living in Dublin, Ireland is investigated. The trace [zinc (Zn) and selenium (Se)] and toxic elements arsenic (As), aluminum (Al), cadmium (Cd), nickel (Ni), mercury (Hg), and lead (Pb) were determined in biological (scalp hair and blood) samples of patients diagnosed with diabetic mellitus, who are smokers living in Dublin, Ireland. These results were compared with age and sex matched healthy, nonsmokers controls. The different brands of cigarette (filler tobacco, filter, and ash) consumed by the studied population were also analyzed for As, Al, Cd, Ni, Hg, and Pb. The concentrations of TEs in biological samples and different components of cigarette were measured by inductively coupled plasma atomic emission spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked using certified reference materials (CRM). The recovery of all the studied elements wasfound to be in the range of 96.4–99.7 % in certified reference materials. The filler tobacco of different branded cigarettes contains Hg, As, Al, Cd, Ni, and Pb concentrations in the ranges of 9.55–12.4 ng/cigarette, 0.432– 0.727 μg/cigarette, 360–496 μg/cigarette, 1.70–2.12 μg/cigarette, 0.715–1.52 μg/cigarette, and 0.378–1.16 μg/cigarette, respectively. The results of this study showed that the mean values of Al, As, Cd, Hg, Ni, and Pb were significantly higher in scalp hair and blood samples of diabetic mellitus patients in relation to healthy controls, while the difference was significant in the case of smoker patients (p<0.001). The levels of all six toxic elements were twofolds to threefolds higher in scalp hair and blood samples of nondiabetic mellitus smoker subjects as compared to nonsmoker controls. The high exposure of toxic metals as a result of cigarette smoking may be synergistic with risk factors associated with diabetic mellitu