Coronary slow flow and its correlation with reduced left ventricle global longitudinal strain: a case-control study.

BACKGROUND: Coronary slow flow (CSF) often links to inflammation and endothelial function disturbance. While conventional ejection fraction measurements fall short in identifying myocardial dysfunction, left ventricular global longitudinal strain (LV GLS) has shown superior efficacy in this regard. Our study aimed to explore subclinical left ventricular systolic dysfunction by assessing LV GLS in patients diagnosed with coronary slow flow (CSF). METHODS: The study included sixty patients with CSF and sixty control individuals without CSF. Coronary angiography employed the Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) to identify CSF. LV GLS values were evaluated and compared between the two groups. RESULTS: Significantly reduced LV GLS was evident in the CSF group compared to the control group (- 16.18 ± 1.25 vs. - 19.34 ± 1.33, p < 0.001). A notable correlation (r = 0.492, p < 0.001) between LV GLS and TFC was observed in the CSF group. Multivariate logistic regression analysis highlighted reduced LV-GLS (OR 2.2, 95% CI 1.57-3.09, p < 0.001) and smoking (OR 11.55, 95% CI 3.24-41.2, p < 0.001) as significant predictors for CSF presence. The receiver operating characteristic curve established that an LV GLS value of ≥ - 17.8% accurately predicted the presence of CSF (AUC: 0.958, 95% CI: 0.924-0.991, p < 0.001) with 90% specificity and 91.7% sensitivity. CONCLUSION: Our study indicates that reduced LV GLS is associated with CSF presence, offering a valuable means to early detect subclinical left ventricular systolic dysfunction in high-risk patients susceptible to heart failure. TRIAL REGISTRATION: ZU-IRB#7038/12-7-2021 Registered 12 July 2021, email: IRB_123@medicine.zu.edu.eg.

In vivo dose measurements for tangential field-in-field ultra-hypofractionated breast radiotherapy.

INTRODUCTION: Ultra-hypofractionated radiotherapy (UHF-RT) mandates more accuracy in each part of the treatment cycle to maximize cure rates and minimize toxicities. In vivo dosimetry is a direct method for verifying overall treatment accuracy. This study evaluated uncertainties in the delivered dose of Hypofractionated (HF) and UHF Whole Breast Irradiation (WBI) and to analyze the accuracy of the workflow to pave the way for a wide-scale use of UHF-RT. METHODS: Thirty-three breast cancer cases, including 16 HF-WBI and 17 UHF-WBI were treated with 3D conformal Radiotherapy (3D-CRT), where 79 fields were analyzed for dose verification. The measurement point was set at the beam entrance (1.5 cm depth). The expected dose at Dmax was calculated via TPS. Before in vivo measurements, diode detectors were tested and calibrated. We developed initial validation measurements for UHF-RT on an anthropomorphic breast phantom for the first time. RESULTS: For RANDO phantom, the percentage difference between measured and calculated doses showed an average of -0.52 ± 5.4%, in addition to an excellent dose reproducibility within 0.6%. The overall in vivo measurements for studied cases showed that 83.5% of the measured doses were within ±5% and only 1.8% of the measured doses were greater than ±10% of the calculated doses. The percentage accuracy was slightly larger for UHF cohort (84.2%) compared to HF cohort (83.2%). The maximum percentage difference between them was less than 1%. CONCLUSION: Breast in vivo dosimetry is an adequate tool for treatment verification that improves the accuracy of the treatment cycle. UHF-RT may contribute in reducing the long waiting lists, increasing patient convenience, and saving the available resources for breast cancer patients.

Insight into potassium's role in childhood mortality due to severe acute malnutrition.

Hypokalaemia is associated with an increase in mortality in children with severe acute malnutrition (SAM) and diarrhoea. This is a descriptive cross-sectional retrospective study conducted in the Nutritional Ward at Mohamed Alamin Hamid Pediatrics Hospital in Omdurman, Sudan. It aimed to assess the frequency of hypokalaemia among children with SAM to understand the influence of hypokalaemia and potassium supplementations contributed on the children survival rates (January-December 2015). It included 215 patients with SAM and acute diarrhoea. The potassium levels of all the patients were assessed upon hospital admission and this correlated with the mortality according to the degree of hypokalaemia and treatment initiated. Hypokalaemia was evident in 70.2% of the patients. Mortality was 3.1% in normokalaemic and 13.9% in hypokalaemic patients. The patients' survival was significantly associated with their serum potassium levels and the treatment received. The survival rates have been assessed via the Multinomial Logistic Model, which reveals that normokalaemic children had a chance of 157.349 (95% confidence interval 18.479-1,339.811) times higher than that compared to the baseline children with advanced hypokalaemia with serum levels <2 mEq/l (p-value < 0.001). Children with mild hypokalaemia within the serum levels of 3.0-3.4 mEq/ml showed an increased survival chance of 549.970 (95% CI 19.293-3,238.716) times compared to the baseline children (p-value = 0.000). In patients with SAM, who presented with acute diarrhoea, there was an increase in mortality in patients with hypokalaemia compared with patients who presented with normal potassium levels. Corresponding mortality rates increased significantly with the severity of hypokalaemia. In severe hypokalaemia, there is a significant difference in mortality between patients treated with oral rehydration solutions for malnutrition in relation to patients treated with oral potassium supplements or with intravenous potassium.