How accurate can electrocardiogram predict left ventricular diastolic dysfunction?

Heart failure continues to be a major challenge to healthcare; several resting and exercise electrocardiographic parameters have been investigated to predict the left ventricular diastolic dysfunction [LVDD]. One hundred and forty patients, classified into 2 groups according to LVDD, were assessed by measurement of normal and corrected QT interval, T wave peak to T wave End and P wave dispersion in resting ECG. Exercise stress test looking for Hump sign [upward deflection of the ST-segment] was done. The relationships between these ECG parameters and LVDD were investigated. The study revealed significant occurrence of hump sign in patients with LVDD, there was a significant difference between both groups regarding QTc and P wave dispersion. P wave dispersion was significantly higher in patients with LVDD. Sensitivity and specificity of the ST hump sign in prediction of LVDD were 86% and 78% respectively. The study also concluded that P wave dispersion at cut off value of about 0.045 msec had the highest sensitivity [sensitivity 98%; specificity 64%] while QTc at cut off value of 0.395 msec had the highest specificity [sensitivity 81%, specificity 79%]. P wave dispersion and hump sign had higher sensitivity while corrected QT interval had higher specificity in prediction of LVDD

Evaluation of hip fracture risk factors in older adults in the Lebanese population

Hip fractures are serious fall injuries that often result in long-term functional impairment and increased mortality. As the population ages, the number of hip fractures is likely to increase worldwide. The main objective of this pilot study was to evaluate the risk factors of hip fracture among the older adults in the Lebanese population. This pilot epidemiological, prospective, and case-control study was performed in 6 hospitals in Great Beirut and South Lebanon. Subjects who met the inclusion criteria filled out a questionnaire consisting on the socio- demographic characteristics, health status, drugs intake and cigarette smoking. Overall, 195 subjects were recruited, with 65 cases of hip fracture and 130 controls all aged over 50 yr. Females represented around two third of the studied population. The logistic regression, using adjusted odds ratio [OR[a]], showed a significant relationship between hip fracture and chronic diseases [OR[a]=3.02; 95% CI: 1.63, 6.66], antihypertensive drugs intake [OR[a]=2.72; 95% CI: 1.56, 6.42], fall [OR[a]=2.79; 95% CI: 1.82, 7.06] previous fracture [OR[a]=3.80; 95% CI: 1.57, 9.23] and family history of fracture [OR[a]=4.82; 95% CI: [2.29, 10.86]. Besides, smoking increased the risk of hip fracture [OR[a]=2.55; 95% CI: [1.96, 5.80]. Having a bow was associated with the highest risk for hip fracture [OR[a]=5.18; 95% CI: 2.30, 12.24]. Elderly people in Lebanon are exposed to many risk factors contributing to hip fracture. Our finding has implication in geriatric health improvement by preventing hip fracture in the Lebanese population

Gemcitabine, cisplatin and dexamethasone in patients with recurrent or refractory B-cell lymphoma not candidates for high-dose therapy

High dose therapy [HDT] with autologous stem-cell transplantation is the treatment of choice for patients with relapsed lymphoma, but is not appropriate for all patients. Effective and less toxic alternatives to conventional salvage regimens are needed. To determine efficacy and safety of gemcitabine, cisplatin and dexamethasone in patients with relapsed or refractory B-cell lymphoma who are not candidates for high dose therapy. Thirty patients with relapsed or refractory B-cell lymphoma were treated with gemcitabine 1000mg/m[2] intravenously [iv] on days 1 and 8, cisplatin 75mg/m[2] iv on day 1, and dexamethasone 40mg/m[2] orally on days 1-4, every 21 days on an outpatient, for a maximum of 6 cycles. The majority [66.7%] had diffuse large B-cell lymphoma. All 30 patients were evaluable for response and toxicity, Five patients [16.7%] achieved complete remission and 12 patients [40%] had partial remission of their disease with an overall response rate of 56.7%. The 2-year progression-free and overall survival rates were 20% and 33.3% respectively. Myelosuppression was the main toxicity. Grade 3 and 4 neutropenia occurred in 40% and 26.7% respectively. Grade 3 and 4 thrombocytopenia occurred in 30% and 23.3% respectively. Only one patient had neutropenic sepsis. Grade 3 non hematological toxicity was minimal with no patients suffered from grade 4 toxicity. Gemcitabine in combination with cisplatin and dexamethasone is an effective and well tolerated salvage regimen in patients with relapsed or refractory B-cell lymphoma who are not eligible for HDT

quality of care for patients with advanced ovarian carcinoma

To assess the quality of care for patients with advanced ovarian carcinoma at Mansoura University Teaching Hospital. Case notes of 96 patients with advanced ovarian carcinoma [stages III-IV] were reviewed. Operative intervention was carried out by Gynecologists in 50 patients and optimal debulking was achieved in 19 [38%]. A combined team of Gynecologists and Surgeons achieved optimal debulking in 17/21 [81%], while general surgeons achieved optimal debulking in 5/25 [20%] of patients. 78% of patients completed 6 cycles of platinum based chemotherapy. The median progression-free and overall survival was 16 and 22.9 months respectively. Optimal cytoreduction was the single favorable prognostic factor. Patients were managed on individual basis with no specialization or multi-disciplinary team management. Multidisciplinary surgical management achieved the best survival for patients with advanced ovarian carcinoma. Centralization of care and surgical sub-specialization are still suboptimal in Mansoura

Concurrent chemoradiotherapy plus consolidation chemotherapy compared with concurrent chemoradiotherapy alone in unresectable stage III non-mall-cell lung cancer

To evaluate the addition of consolidation chemotherapy to concurrent Chemoradiotherapy in patients with locally advanced unresectable stage III non-small-cell lung cancer as regard efficacy and safety. Forty one patients were randomly assigned to either concomitant Chemoradiotherapy alone [arm 1, n = 19] or concomitant Chemoradiotherapy followed by consolidation chemotherapy [arm 2, n = 22]. In the concurrent arm, patients received weekly paclitaxel [45 mg/m[2]], carboplatin [100 mg/m[2]] and concomitant thoracic radiotherapy at a dose of 63 Gy in 34 fractions over 7 weeks. In the concurrent/consolidation arm, the same regimen was administered followed by two additional courses of paclitaxel [200 mg/m[2]] and carboplatin [300 mg/m[2]] every 3 weeks. Pre-treatment characteristics were well balanced between the two arms. Median survival was 13 months in the concurrent arm and 16.5 months in the concurrent/consolidation arm [p = 0.59]. One-, 2-, and 3- year survival rates were better in the concurrent/consolidation arm [63.6%, 36.4%, and 13.6% respectively] than in the concurrent arm [52.6%, 26.3%, and 10.5% respectively], p = 0.48. Grade 3/4 granulocytopenia occurred in 16% and 27% of patients on the concurrent and concurrent/consolidation arms respectively [p = 0.38]. The most common grade 3/4 non-hematological toxicity was esophagitis. It was more frequent in the consolidation arm than in the concurrent arm [32% v 21%], p = 0.43. Concurrent Chemoradiotherapy followed by consolidation chemotherapy represent the preferred regimen for the treatment of unresected stage III NSCLC. However, toxicity, particularly, non-hematological toxicity, remains a major obstacle

Concomitant boost radiotherapy plus concurrent cisplatin for muscle invasive bladder cancer

To determine the efficacy and toxicity of accelerated concomitant boost radiotherapy [RT] plus concurrent cisplatin in patients with muscle invasive bladder cancer. Sixty four patients with muscle invading transitional cell bladder cancer were entered into a protocol of transurethral resection of the bladder tumor [TURBT] followed by concurrent cisplatin [10mg/m[2] thrice weekly] and accelerated concomitant boost radiotherapy. The whole pelvis was treated by l.8Gy conventional daily fractions up to a total dose of 45Gy. A concomitant boost limited to the bladder was delivered as a second daily fraction [1.4Gy] during the last 3 weeks up to a total dose of 66Gy. The patients were evaluated for local control, toxicity and survival. All but two patients completed the radiotherapy protocol. Fifty eight patients received the full doses of cisplatin. Grade 3 acute urinary toxicity was observed in 10 patients [15.6%]. Also, 6 patients [9.4%] presented with acute grade 3 bowel toxicity. Eight patients [12.6%] experienced late grade 3 toxicity [4 with bladder and 4 with bowel toxicity]. The 3-year actuarial local control, distant disease control and overall survival rates were 60% [95% CI, 50.1-69.3], 65.6% [95% CI, 53.7%-74.3%], and 37.5% [95% CI, 26.1%-45.9%] respectively. The results of our protocol of acclerated concomitant boost radiotherapy with concurrent cisplatin, as regard locoregional control and overall survival, did not appear to be improved in comparison with other studies combining cisplatin and standard conventional fractionation, moreover the observed toxicity was higher

Prognostic value of interleukin-6 [IL-6] and tumor necrosis factor-alpha [TNF-alpha] in Egyptian patients with breast cancer

The study was conducted on 41 females selected from National Cancer Institute, Cairo University, Surgery Department. The patients were divided into two groups. Group I included 21 clinically established breast cancer patients in early stage [I or II] and Group II included 20 clinically established breast cancer patients in late stage [III or IV]. Beside 20 healthy females were included as control group. The aim of the present work is to assess the prognostic value of pre and postoperative IL-6, TNF-alpha and to investigate the relationship between these parameters and the serum inflammatory parameter [ESR]. The results showed that non-significant changes were found in the serum levels of IL-6 and TNF-alpha in early cases before and after surgery when compared to control group, while ESR value was significantly increased before and after surgery [p<0.01] and [p<0.05] respectively. Both IL-6 and TNF-alpha showed non-significant changes on comparing early cases group before and after surgery, while ESR values showed a significant decrease after surgery [p<0.01]. In late cases, levels of IL-6, TNF-alpha and ESR were highly significantly increased before surgery, [,p<0.001] for all parameters when compared to the control group. After surgery, this increase was still highly significant for IL-6, TNF-alpha and ESR [p<0.001, <0.01, <0.01] respectively when compared to controls. Comparing, TNF-alpha and ESR before and after surgery in group II, our results showed significant decrease [p < 0.05] for both parameters. While IL-6 showed highly significant decrease [p<0.001]. In conclusion, the preoperative serum levels of IL-6, TNF-alpha, and ESR significantly increased with advanced stages of breast cancer. So, IL-6 and TNF-alpha may be considered as promising additive prognostic parameter for breast cancer

Anatomical study of auriculotherapy

Fifteen rabbits were utilized in this study. Surgically induced lesions were done in the stomach, lung, kidney, suprarenal and pancreas. The electrical resistance of the corresponding acupuncture points of the left auricle were measured and recorded before and after the operation. After the operation these points showed marked decrease in theft resistance. This effect can not be demonstrated after injection of local anaesthesia in the auricle. This study confirmed the viewpoint that the body being represented on the auricle and suggested that the effect of auriculotherapy may be due to a nervous mechanism