Controversies in the Management of ST Elevation Myocardial Infarction: Thrombin Inhibition.

Anticoagulation is essential in patients with ST elevation myocardial infarction (STEMI) to prevent further thrombosis and to maintain patency of the infarct-related artery after reperfusion. The various anticoagulant medications available for use in patients with STEMI include unfractionated heparin (UFH), low-molecular-weight heparin, fondaparinux, and bivalirudin, a direct thrombin inhibitor. The authors review the current anticoagulation strategies for patients with STEMI undergoing primary percutaneous coronary intervention (PCI), fibrinolysis, or no reperfusion. The authors present the latest evidence and controversies on this topic, with a focus on bivalirudin versus UFH in the setting of primary PCI for STEMI

PREVALENCE AND RISK FACTOR OF POLYCYSTIC OVARIAN SYNDROME

ABSTRACTPolycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. Its clinical manifestation varies from mild to severedisturbance of reproductive and metabolic functions. PCOS is clinical and public health importance because it is affecting up to one in five womenof reproductive age. It is an X-linked dominant condition and has diverse clinical implications such as psychological features (anxiety, depression),reproductive features (hirsutism and hyperandrogenism), and impaired glucose tolerance. It is widely dependent on environmental, genetic, ethnicityfactors including lifestyle and body weight. Weight loss improves the endocrine profile and increases chances of ovulation and pregnancy. It canbe treated with medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, and gonadotrophins. The last option for fertilization isin vitro fertilization when other treatment fails. Its prevalence is estimated at 4-8% from studies performed in Spain and USA. Lifestyle including diet,exercise, and behavior therapy improves fertility. PCOS has unique interactions with the ever increasing obesity prevalence worldwide as obesityinducedinsulin resistancesignificantlyaggravatesall thefeaturesof PCOS.EducationabouthowPCOSaffectslong-termhealth shouldbe providedtowomenwith this disordertofeelphysicaland psychologicalbenefits so that theycould engagethemselvesmorewith their health careproviders.Keywords: Polycystic ovarian syndrome, Hyperinsulinemia, Hormone disbalance, Hirsutism, Ovarian cyst, Obesity, Sleep disorders

Method and Compositions for Biofouling Deterrence

A method of deterring biofouling of a surface comprising attaching an adduct having formula (I) or noradrenalin to the surface. Formula (I) being defined as compounds that have the formula A-L-R wherein A is i) a C6 or C10 substituted aryl ring, or ii) a C1-C9 substituted or unsubstituted heteroaryl ring: L is a linking group, and R is a primary amino moiety comprising unit

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study

Background: Thrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital.Aim: To determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children.Methods: Children who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality.Results: Forty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV x PDW/Platelet count x PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/ Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69-10.99), 3.86 (95% CI, 1.53-9.75), 3.45 (95% CI, 1.38-8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45.Conclusion: The MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.Keywords: SICK Score, PRISM, severity of illness scores PIM, in-hospital mortality; platelet indice

Effect of prenap coffee on daytime sleepiness in university students

Background: Daytime sleepiness impairs academic performance in college students. Napping is a counter to daytime sleepiness, but often causes sleep inertia on waking up. Caffeine absorption from beverages peaks 30 minutes after their ingestion presenting a window of opportunity to have a short nap such that the time of waking up is in synchrony with onset of action of caffeine; thereby abolishing post-nap inertia and achieving synergistic mitigation of fatigue.Objective of this study to assess effect of nap, coffee, ‘coffee and nap’ and ‘wakeful break without coffee’ on daytime sleepiness using Psychomotor Vigilance Tests (PVTs) and Karolinska Sleepiness Scale (KSS) score.Methods: After Institutional Review Board clearance, 10 subjects (aged 19-21 years) were selected using their Epworth Sleepiness Scale score (ESS >5) and called to the study site 8 times on different days to be exposed to these four conditions twice - only coffee (standardized), only nap (30min), coffee immediately followed by 30min nap, wakeful break (30min) without coffee or nap. Pre and post scores were recorded for electronic PVT (Reaction Time and Motor Responsiveness) and KSS for each attempt.Results: Test outcome was associated with intervention used (p=0.00001). ‘Nap only’ group was associated with deterioration in outcomes (p=0.00001), accounting for highest percentage (41%) of all deteriorated test outcomes. ‘Coffee only’ group was associated with improvement in test scores (p=0.00001), responsible for highest share (38.8%) of all improved test outcomes. ‘Nap only’ and ‘Coffee-nap’ group showed improvement in 11.67% and 21.67% of outcomes respectively. Conclusions: Pre-nap coffee is a proactive counter-measure to post nap sleep inertia