Prognostic value of right ventricular diastolic dysfunction in patients with inferior ST elevated myocardial infarction

Background

Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricle dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not evaluate RV diastolic dysfunction.

Purpose

In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI.

Methods

Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Presence of a pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (e', a' and E/e' ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period.

Results

The average age of the study population was 51.58±10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary oedema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 hours. Patients who developed MACE had high filling pressures, as all of them had E/e' >6. E' velocity ≤6 cm/s was associated with increased MACE as 25% of patients with e' velocity ≤6 cm/s had MACE compared with 2.3% of patients with e' velocity >6 cm/s with a P value of 0.015.

Conclusions

Because tricuspid inflow velocities by PW doppler varies with respiration, volume status and other conditions, tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/e' and e' has a prognostic value in patients with Inferior STEMI and RV infarction.

Funding Acknowledgement

Type of funding sources: None.

Antibacterial and UV Protection Properties of Modified Cotton Fabric Using a Curcumin/TiO2 Nanocomposite for Medical Textile Applications

Medical textiles are one of the most rapidly growing parts of the technical textiles sector in the textile industry. This work aims to investigate the medical applications of a curcumin/TiO2 nanocomposite fabricated on the surface of cotton fabric. The cotton fabric was pretreated with three crosslinking agents, namely citric acid, 3-Chloro-2-hydroxypropyl trimethyl ammonium chloride (Quat 188) and 3-glycidyloxypropyltrimethoxysilane (GPTMS), by applying the nanocomposite to the modified cotton fabric using the pad-dry-cure method. The chemistry and morphology of the modified fabrics were examined by Fourier transform infrared spectroscopy, energy-dispersive X-ray spectroscopy, and scanning electron microscopy. In addition, the chemical mechanism for the nanocomposite-modified fabric was reported. UV protection (UPF) and antibacterial properties against Gram-positive S. aureus and Gram-negative E. coli bacterial strains were investigated. The durability of the fabrics to 20 washing cycles was also examined. Results demonstrated that the nanocomposite-modified cotton fabric exhibited superior antibacterial activity against Gram-negative bacteria than Gram-positive bacteria and excellent UV protection properties. Moreover, a good durability was obtained, which was possibly due to the effect of the crosslinker used. Among the three pre-modifications of the cotton fabric, Quat 188 modified fabric revealed the highest antibacterial activity compared with citric acid or GPTMS modified fabrics. This outcome suggested that the curcumin/TiO2 nanocomposite Quat 188-modified cotton fabric could be used as a biomedical textile due to its antibacterial properties.

Antibacterial And UV Protection Properties Modified Cotton Fabric Using Curcumin/ TiO2 Nanocomposite For Medical Textile Applications.. [DOI: 10.21203/rs.3.rs-555492/v1]

Medical textiles are one of the most rapidly growing parts of the technical textiles sector of the textile industry. This work was developed for biocompatible materials of curcumin / TiO2 nanocomposite fabricated on the surface of cotton fabric for medical applications. Cotton fabric was pretreated with three crosslinking agents namely, citric acid, Quat-188, and GPTMS. Applying nanocomposite on modified cotton fabric using pad-dry cure method. The chemistry and morphology of modified fabrics are examined by Fourier-transformed infrared spectroscopy, energy-dispersive X-ray spectroscopy, and scanning electron microscopy. In addition, the chemical mechanism for nanocomposite modified fabric was reported. UV protection (UPF) and antibacterial properties against Gram - positive S. aureus and Gram - negative E. coli bacterial strains were investigated. The durability of fabrics to 20 washing cycles was also examined. Results demonstrated that nanocomposite modified cotton fabric exhibited superior antibacterial activity against Gram - negative bacteria that Gram - positive bacteria and excellent UV protection properties. Moreover, good durability was obtained, possibly due to the effect of the crosslinker used. Among the three pre-modification of cotton fabric, Quat-188 modified fabric reveals the highest antibacterial activity comparing with citric acid or GPTMS modified fabrics. This outcome suggested that curcumin / TiO2 nanocomposite Quatt-188 modified cotton fabric could be used in biomedical textile as antibacterial properties.

Low adherence of Kuwaiti adults to fruit and vegetable dietary guidelines

The study aimed to assess the adherence of Kuwaiti adults to dietary guidelines for daily fruit and vegetable intake. Data were compiled from national cross-sectional studies from 2006 to 2008 including 9350 adults. Demographic data, frequency of fruit and vegetable consumption and anthropometric and lifestyle indicators were collected. Approximately 11% of people reported consuming 5 or more fruits and vegetables daily with a mean consumption of 3.04 times per day. Consumption increased with age and body mass index but decreased with smoking and non-exercising. Minimal change in compliance with 5-per-day fruit and vegetable consumption was observed between 2006 and 2008. However, the average daily consumption of total vegetables and green salads decreased and of total fruits, fruit juices and cooked and fried potatoes increased. The low frequency of fruit and vegetable consumption among Kuwaiti adults indicates the need to adopt more healthy eating patterns to control chronic diseases.

The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States

This paper reviews studies on the prevalence of overweight, obesity and related nutrition-related non-communicable diseases in Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and the UAE. Obesity is common among women; while men have an equal or higher overweight prevalence. Among adults, overweight plus obesity rates are especially high in Kuwait, Qatar and Saudi Arabia, and especially among 30-60 year olds (70-85% among men; 75-88% among women), with lower levels among younger and elderly adults. The rate of increase in obesity was pronounced in Saudi Arabia and Kuwait. Prevalence of obesity is high among Kuwaiti and Saudi pre-schoolers (8-9%), while adolescent overweight and obesity are among the highest in the world, with Kuwait having the worst estimates (40-46%); however, comparison of child data is difficult because of differing standards. Among nutrition-related non-communicable diseases, hypertension and diabetes levels are very high and increase with age, with the UAE performing the worst because of a rapid rate of increase between 1995 and 2000. Additional monitoring of the prevalence of metabolic syndrome and cancers is necessary. Nationally representative longitudinal surveys with individual, household and community-level information are needed to determine the importance of various factors that contribute to these troubling trends.

Histologic study of the tunica albuginea of the penis and mode of cavernosus muscles' insertion in it

The tunica albuginea (TA) is the outer covering of the corpora cavernosa (CCs) and corpus spongiosum (CS) of the penile shaft. The different histoanatomical patterns of the TA, as well as the mode of attachment of the ischio-/bulbo-cavernosus muscles (ICM, BCM) to the TA, were studied, aiming at elucidating their role in the mechanism of erection. Twenty-eight cadaveric specimens (18 adults, 10 neonatal deaths) were studied morphologically and histologically after staining with hematoxylin and eosin and Verhoeff-van Gieson stains. The TA consisted in 20 specimens of 2 layers: inner circular and outer longitudinal, in 6 specimens of 3 layers: inner circular, longitudinal and outer circular, and in 2 of only one longitudinal layer. The CS TA was formed of one layer of longitudinal fibers. The mode of cavernosus muscles insertion into the TA revealed 3 patterns. The conjoint BCM and ICM formed a fibrous belt over the CCs in 18 specimens, a muscular belt in 6 and no belt in 4. The functional role of the variations in the TA morphological structure is not exactly known. We hypothesize that the 3-layered TA gives more penile rigidity than the double and single layers. Considering the type of cavernosus muscles insertion into the TA, it appears that the fibrous belt exerts more CC compression than the other 2 types of insertion.

Bulboprostatic anastomotic urethroplasty with preservation of potency: anatomical study, operative approach and clinical results

OBJECTIVE. To identify the precise anatomy of the membranous and bulbous urethrae and their relation to the neurovascular bundles (cavernous nerves and vessels). Based on the findings, a modified surgical technique was developed to preserve potency by avoiding injury to the neurovascular bundles during surgery on the posterior urethra.

MATERIAL AND METHODS

The material for this study consisted of 10 male cadavers. We injected eight cadavers with a mixture of red latex and lead oxide. By means of meticulous dissection we removed the bladder, prostate, urethra, penis, surrounding vessels and nerves. We also identified the anatomical relations between various urogenital structures and the vessels and nerves. We examined the specimens radiologically. In the other two cadavers, we removed the membranous urethrae and subjected them to histological examination. We used haematoxylin-eosin and Verhoeff von Gieson stains to study the elastic tissues.

RESULTS

The membranous urethra measured 2.5-3 cm in length. It originated from the lower third of the anterior surface of the prostate (and not from the apex) as a continuation of the prostatic urethra. The wall of the membranous urethra contained abundant elastic fibres. The neurovascular bundles were located posterolateral to the mid-portion of the prostate and prostatic apex. Near the apex the neurovascular bundle divided into two parts: a larger anterior part and a smaller posterior part. The anterior part crossed the membranous urethra, then the bulb of the penis at the 1 and 11 o'clock positions and finally entered the corpus cavernosum. The posterior part crossed the membranous urethra more posteriorly to enter the bulb of the penis. Between 1992 and 2003 we managed 22 patients (age range 16-50 years) with posterior urethral obstruction secondary to pelvic fracture by means of bulboprostatic anastomosis. We managed 17 patients via the perineal route and five via a combined perineoabdominal-transpubic route. All of these patients were potent before the operation, which proved the integrity of the neurovascular bundles. We could spare the anterior divisions of the neurovascular bundles (greater cavernous nerves and vessels) during their crossing of the bulb of the penis by cutting and dissecting within the bulb (not outside it) before dismembering it from the urogenital diaphragm. We also refrained from any dissection of the apex and the posterolateral surfaces of the prostate to avoid injury to the neurovascular bundles. At 6-year follow-up (range 1-10 years) 21/22 patients preserved their potency, giving a success rate of 95.45%. Of the 22 patients, two became temporarily impotent after the operation but regained potency within a period of 4-6 months.

CONCLUSION

Our technique of neurovascular bundle preservation during bulboprostatic anastomotic urethroplasty may solve the problem of postoperative impotence.

Perceptions of community nutrition and health needs in the Lower Mississippi Delta: a key informant approach

OBJECTIVE

Key informants' perceptions of nutrition and health needs in their southern rural communities were assessed prior to nutrition intervention planning.

DESIGN

This cross-sectional survey used in-person interviews.

SUBJECTS/SETTINGS

A sample of 490 individuals from 12 professional and lay roles in 8 community sectors in 36 counties in Arkansas, Louisiana, and Mississippi was chosen.

STATISTICAL ANALYSES PERFORMED

Factor analysis was carried out on reported food, nutrition, and health problems and contributing factors. The General Linear Models procedure identified within- and between-subject effects for factors. Tukey's post hoc tests identified differences between sectors and states. Frequencies and weighted rankings were computed for health problems.

RESULTS

Key informants rated individual-level factors (food choices, education, willingness to change, health behavior) as more important than community-level factors (food and health care access, resources) with regard to nutrition and health problems and contributors to problems. The number one health problem was hypertension.

IMPLICATIONS

Key informants are knowledgeable about nutrition and health problems, contributing factors, and available resources. Individual factors were perceived as more important contributors to nutrition and health problems providing valuable information for planning nutrition interventions.

Validity of a telephone-administered 24-hour dietary recall in telephone and non-telephone households in the rural Lower Mississippi Delta region

OBJECTIVE

To determine if 24-hour dietary recall data are influenced by whether data are collected by telephone or face-to-face interviews in telephone and non-telephone households.

DESIGN

Dual sampling frame of telephone and non-telephone households. In telephone households, participants completed a 24-hour dietary recall either by face-to-face interview or telephone interview. In non-telephone households, participants completed a 24-hour dietary recall either by face-to-face interview or by using a cellular telephone provided by a field interviewer.

SUBJECTS/SETTING

Four hundred nine participants from the rural Delta region of Arkansas, Louisiana, and Mississippi.

MAIN OUTCOME MEASURES

Mean energy and protein intakes.

STATISTICAL ANALYSES PERFORMED

Comparison of telephone and non-telephone households, controlling for type of interview, and comparison of telephone and face-to-face interviews in each household type using unpaired t tests and linear regression, adjusting for gender, age, and body mass index.

RESULTS

Mean differences between telephone and face-to-face interviews for telephone households were -171 kcal (P = 0.1) and -6.9 g protein (P = 0.2), and for non-telephone households -143 kcal (P = 0.6) and 0.4 g protein (P = 1.0). Mean differences between telephone and non-telephone households for telephone interviews were 0 kcal (P = 1.0) and -0.9 g protein (P = 0.9), and for face-to-face interviews 28 kcal (P = 0.9) and 6.4 g protein (P = 0.5). Findings persisted when adjusted for gender, age, and body mass index. No statistically significant differences were detected for mean energy or protein intake between telephone and face-to-face interviews or between telephone and non-telephone households.

APPLICATIONS/CONCLUSIONS

These data provide support that telephone surveys adequately describe energy and protein intakes for a rural, low-income population.

Outcomes of a cardiovascular nutrition counseling program in African-Americans with elevated blood pressure or cholesterol level

OBJECTIVE

To evaluate a cardiovascular nutrition education package designed for African-American adults with a wide range of literacy skills.

DESIGN

Comparison of a self-help group and a full-instruction group; each group received nutrition counseling and clinical monitoring every 4 months.

SUBJECTS

Three hundred thirty African-American adults, aged 40 to 70 years, with elevated cholesterol level or high blood pressure were randomly assigned to the self-help or full-instruction group; 255 completed the 12-month follow-up.

INTERVENTIONS

Counseling to reduce intake of dietary fat, cholesterol, and sodium was based on Cardiovascular Dietary Education System (CARDES) materials, which included food-picture cards, a nutrition guide (self-help and full-instruction group), a video and audiotape series, and 4 classes (full-instruction group only).

MAIN OUTCOME MEASURES

Changes in lipid levels and blood pressure after 12 months.

STATISTICAL ANALYSES PERFORMED

Primary analyses consisted of repeated-measures analysis of variance to examine effects of time and randomization group on outcomes.

RESULTS

Total cholesterol and low-density lipoprotein cholesterol level decreased by 7% to 8% in the self-help and full-instruction groups of men and women (P < .01). The ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C) decreased in both groups of women and in the men in the full-instruction group (P < .01). In full-instruction and self-help participants with elevated blood pressure at baseline, systolic blood pressure decreased by 7 to 11 mm Hg and diastolic blood pressure decreased by 4 to 7 mm Hg (P < .01). Outcomes did not differ by literacy scores but were positively related to the reported initial frequency of using CARDES materials.

APPLICATIONS/CONCLUSIONS

These results suggest that periodic nutrition counseling based on CARDES materials used for home study can enhance management of lipid levels and blood pressure in African-American outpatients.

Prevalence of self-reported nutrition-related health problems in the Lower Mississippi Delta

OBJECTIVES

The purpose of this study was to assess demographic and geographic differences in prevalence of self-reported nutrition-related health problems in Arkansas, Louisiana, and Mississippi.

METHODS

The authors analyzed 1991 and 1993 Behavioral Risk Factor Surveillance System data for adults 18 years or older.

RESULTS

Less educated African American women and women of other minority groups who were aged 35 to 64 years reported the highest prevalence of health problems. Geographic differences involved prevalence of hypertension, health status, and insurance status.

CONCLUSIONS

Specific demographic subgroups and geographic areas with a high risk of health problems are in particular need of targeted interventions.