Oral antioxidant supplementation does not prevent acute mountain sickness: double blind, randomized placebo-controlled trial.

BACKGROUND: Acute mountain sickness may be caused by cerebrovascular fluid leakage due to oxidative damage to the endothelium. This may be reduced by oral antioxidant supplementation. AIM: To assess the effectiveness of antioxidant supplementation for the prevention of acute mountain sickness (AMS). DESIGN: A parallel-group double blind, randomized placebo-controlled trial. METHODS: The study was conducted in a university clinical research facility and a high altitude research laboratory. Eighty-three healthy lowland volunteers ascended to 5200 m on the Apex 2 high altitude research expedition. The treatment group received a daily dose of 1 g l-ascorbic acid, 400 IU of alpha-tocopherol acetate and 600 mg of alpha-lipoic acid (Cultech Ltd., Wales, UK) in four divided doses. Prevalence of AMS was measured using the Lake Louise Consensus score sheet (LLS). Secondary outcomes were AMS severity measured using a novel visual analogue scale, arterial oxygen saturation and pulmonary artery systolic pressure (PASP). RESULTS: Forty-one subjects were allocated to the antioxidant group, and 42 to the placebo group. There was no difference in AMS incidence or severity between the antioxidant and placebo groups using the LLS at any time at high altitude. At the pre-determined comparison point at Day 2 at 5200 m, 69% of the antioxidant group (25/36) and 66% of the placebo group (23/35) had AMS using the LLS criteria (P = 0.74). No differences were observed between the groups for PASP, oxygen saturation, presence of a pericardial effusion or AMS assessed by VAS. CONCLUSION: This trial found no evidence of benefit from antioxidant supplementation at high altitude. TRIAL REGISTRATION NUMBER: NCT00664001.

Managing heart failure in the community; role of the nurse specialist.

OBJECTIVE: To assess the effectiveness of a nurse specialist in managing patients with heart failure in the community. DESIGN: Out patient attendances and re-admissions to hospital for the two years (April 1995-97) before the service started were compared with the two years afterwards (April 1997-99). SETTING: Integrated Community and Acute Trust in West Lothian. PATIENT POPULATION: Sixty one patients with severe heart failure (New York Heart Association class IV). RESULTS: Twenty eight patients died within the study period. Of those surviving, total re-admissions (bed days used) were reduced from 605 to 270 days, outpatient clinic attendances fell from 168 to 60. Among those who died the rates corrected for survival period were not changed for re-admission but reduced from a mean of 6.6 to 2.3 attendances per patient. CONCLUSION: A nurse lead service for patients with heart failure significantly reduces clinic attendances and hospital re-admission.

Atrial fibrillation in general practice: how useful is echocardiography in selection of suitable patients for anticoagulation?

All patients identified from records in two practices in West Lothian (n = 103) as having atrial fibrillation (AF) were offered a clinical examination, electrocardiogram (ECG), and echocardiography. Sixty-five patients attended the examinations. Of these, 26 (40%) were found to be in sinus rhythm. Many of those in AF were already on warfarin. Only eight who were found to have AF, who were not already on warfarin and who had no contraindications to it, had additional risk factors that suggested they be treated with warfarin. In no case did echocardiography alter management decisions.

Ten year follow up of patients referred for coronary artery bypass grafting from a single district general hospital.

OBJECTIVE: To determine the status of patients 10 years after referral for coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective analysis of case notes from all patients referred between 1 April 1981 and 31 March 1985. Full information gathered from hospital notes, GP records, and Registrar General for Scotland. SETTING: District General Hospital, West Lothian, Scotland. PATIENTS: 102 patients referred for CABG during study period. Cardiac surgery was undertaken in Brompton Hospital, London, Royal Infirmary, Edinburgh, and Western Infirmary, Glasgow. RESULTS: At 10 years after operation 32 patients had died (27 cardiac, five non-cardiac causes). Full data were not available for five patients. Of the 65 remaining patients 24 had no angina, 13 had had a repeat procedure (CABG or angioplasty), and 28 had angina. CONCLUSIONS: Long term benefits of CABG surgery is disappointing. Further steps are required to reduce progression of disease in this population.

A survey of exercise testing practice in Scottish hospitals.

A 1989 survey (unpublished) of exercise testing practice in Scotland suggested that there were important differences in the practice of exercise testing between hospitals. A postal questionnaire was sent to 30 teaching and district general hospitals in 1991 and followed up by telephone questioning of consultants. The numbers of exercise tests performed had increased to 22,012 in 1990, and a greater proportion were performed in district general hospitals. General practitioners had very limited access to the service but hospital doctors of any grade had almost free access. Rationing of early post myocardial infarction testing led to attempts to define "high risk" post infarction patients and this included inappropriate patients in many hospitals. A variety of different protocols was used. Eighteen out of 30 hospitals surveyed discontinued beta blockers but only four hospitals took account of antianginal, antihypertensive or other medication, and all but one exercised patients while on digoxin. In the majority of hospitals decisions regarding drug therapy were taken by individual physicians. A variety of personnel reported tests, many without specialist training in cardiology. Even among consultants there was no concerns on the degree of ST depression which was significant. Exercise tests performed in different hospitals in Scotland are not comparable due to the wide variation in patient selection, test conditions, and interpretation of tests. This problem is likely to be exacerbated by the multiple personnel involved in all aspects of testing. It seems probable that there is a problem throughout the United Kingdom, and that there is a need for guidelines.

Serum myoglobin and creatine kinase enzymes in acute myocardial infarction treated with Anistreplase.

AIMS: To compare plasma myoglobin concentration and cardiac enzyme activity with electrocardiographic (ECG) changes in two groups of patients (reperfused and non-reperfused) participating in a placebo-controlled randomised double blind trial of treatment of myocardial infarction (MI) with intravenous thrombolytic therapy (Anistreplase). METHODS: Twenty two patients with confirmed MI obeying strict inclusion and exclusion criteria were studied. Plasma myoglobin was measured by radioimmunoassay and creatine kinase enzyme (CK and CKMB) by NAC activated and NAC activated/immunoinhibition methods respectively in all patients before and at frequent intervals after injection of Anistreplase or placebo. Patients were divided into reperfused (R) and non-reperfused (NR) groups on the basis of ECG criteria. Reperfusion was diagnosed if the measured ST segment elevation fell by greater than or equal to 50% at 2 hours post dosing. RESULTS: The time to peak (TTP) myoglobin was significantly less in the R group compared with the NR group but there was considerable overlap in the range of values. The area under the enzyme time curves (AUCs) and summed ST segment epsilon ST elevations were significantly smaller in the R compared with the NR group. CONCLUSIONS: Although TTP myoglobin results were significantly lower in the R group, TTP myoglobin will probably not be useful as an non-invasive indicator of reperfusion because of the overlap in values between the two groups. The significant reduction in the AUC and epsilon ST only in the R group suggests decreased infarct size. However, in this small preliminary study reperfusion did not occur more frequently with Anistreplase than without.

Effects of self-help post-myocardial-infarction rehabilitation on psychological adjustment and use of health services.

A home-based exercise programme has been found to be as useful as a hospital-based one in improving cardiovascular fitness after an acute myocardial infarction. To find out whether a comprehensive home-based programme would reduce psychological distress, 176 patients with an acute myocardial infarction were randomly allocated to a self-help rehabilitation programme based on a heart manual or to receive standard care plus a placebo package of information and informal counselling. Psychological adjustment, as assessed by the Hospital Anxiety and Depression Scale, was better in the rehabilitation group at 1 year. They also had significantly less contact with their general practitioners during the following year and significantly fewer were readmitted to hospital in the first 6 months. The improvement was greatest among patients who were clinically anxious or depressed at discharge from hospital. The cost-effectiveness of the home-based programme has yet to be compared with that of a hospital-based programme, but the findings of this study indicate that it might be worth offering such a package to all patients with acute myocardial infarction.

The natural history of dilated cardiomyopathy--a community study.

The incidence, clinical features and natural history of dilated cardiomyopathy within a clearly defined population of Scotland was studied retrospectively. From 1982 to 1986, 57 cases were recorded in a population of 145,00, representing an annual incidence of 7.9 per 100,000 per year. This incidence rate is higher than that reported from other centres, and the overall survival rates were poorer.

Platelet monoamine oxidase activity and life stress as predictors of psychopathology and coping in a community sample.

The present study, using a diathesis-stress model, attempted to confirm prior findings with platelet monoamine oxidase (MAO) activity and stress in a middle-aged, non-clinic population. One hundred and seventy-eight adult males from a statewide community club were tested for platelet MAO activity and stressful life events and were also given a variety of psychological measures of both psychopathology and psychosocial coping. The data were examined both for correlations across the total sample and for a comparison of high-risk groups (top and bottom 15% of MAO activity) with a middle MAO group. Low platelet MAO activity was related to a higher incidence of contact with mental health professionals, and more frequent use of alcohol and cigarette smoking. High MAO activity was related to higher levels of anxiety and somatization. High levels of stress were related to increased psychosocial problems reported for female and family members, higher scores on two schizophrenia-related MMPI scales (schizophrenia and paranoia subscales), but fewer idiosyncratic associations, elevated hypomanic, depression, and anxiety scores, increased alcohol use, and increased use of prescribed antianxiety and sedative medication. Neither MAO nor stress were related to current levels of psychosocial coping. Moreover, no interaction effects were uncovered for MAO activity and stress combined.

Management of patients with prolonged ischemic chest pain without acute myocardial infarction.

Consecutive patients admitted to a Coronary Care Unit during 1981-1982 were studied. One hundred twenty-eight patients had prolonged ischemic chest pain without developing myocardial infarction. Follow-up information was available in 121 at an average period of 38 months. Thirty-eight patients (32.8%) sustained significant cardiovascular events, including 14 cardiac deaths. Only 15 patients were symptom-free off treatment. Prognosis was best determined from the resting ECG. Transient ST-T wave shifts predicted patients at high risk of further cardiovascular events and allowed selection of a group meriting more intensive treatment.

A myelodysplastic syndrome with eosinophilia associated with a break in the short arm of chromosome 16.

A case is reported of a young man with cardiomyopathy and myelodysplasia with bone marrow and peripheral blood eosinophilia. Cytogenetic investigation revealed a (5;16) (q33;p13) translocation. This is the first report of myelodysplasia with eosinophilia associated with a break in 16p13 alone, with no abnormality of 16q22.

Longitudinal variations in maximal oxygen consumption in healthy men.

Maximal oxygen consumption [(VO2)max] was measured on three separate occasions over 8 years in 12 healthy men. The decline in (VO2)max with age was less than noted in previous studies and was smallest in men taking regular physical exercise. The presence of ST depression during or after exercise did not influence the decline in (VO2)max.